Impact of the Introduction of Accreditation Standards on the Satisfaction of Patients in Cardiology Departments

Background: It can be presumed that introducing accreditation standards and obtaining national accreditation by a hospital should translate into increased patient satisfaction. The aim was to analyze the impact of introducing accreditation standards on patient satisfaction in cardiology departments. Methods: 1080 patients, who were hospitalized in four cardiological wards (W1–W4) between 2009–2015, were asked to complete a 22-item questionnaire that assessed the level of their satisfaction with their medical care. 58 questionnaires were excluded because of incomplete data. The hospital was accredited in 2013. Results: In 3 of the 4 wards, a statistically higher total score (the patient was more satisfied) in the period after the accreditation (2013–2015) compared to the period before the accreditation (2009–2012) was as follows: W1 (80.37 ± 6.54 vs. 83.85 ± 5.9; p = 0.0004), W2 (79.95 ± 7.62 vs. 81.46 ± 8.2: p = 0.0376), W4: (78.84 ± 7.94 vs. 84.91 ± 5.57; p = 0.0376); in one ward, there was no statistical difference: W3 (80.11 ± 8.42 vs. 81.07 ± 8.15; p = 0.3284). A significant difference was found in the number of points for the total assessment that were collected for all of the analyzed departments throughout the entire period (2009–2015)–W1: p = 0.0032; W2: p = 0.0176; W3: p = 0.0313 and W4: p < 0.0001). The medium-term rate of the change of the total score decreased after the accreditation. Conclusion: Preparing a hospital for a national accreditation program brought significant benefits for patients in a long-term observation

New Method of Cardiac Lead Evaluation Using Chest Radiography

Background and Objectives: There is currently no method that can be used for a precise evaluation of pacemaker leads using X-ray images, which could be a valuable add-on in the follow-up of patients. The aim of this paper was to create a simple method to measure selected points and lines using the chest radiography of patients with cardiac pacemakers. Materials and Methods: The study included 99 patients after permanent pacemaker implantation (72.0 ± 12.9 y; 58 W). The newly created method was used to evaluate the course of the leads based on an X-ray of the chest in an AP (posterior–anterior) projection (standing up) with optimization. The chest X-ray was applied to the original measurement grid, which was determined by specific anatomical points. For the purpose of this paper, a number of measurable parameters have been proposed. Results: The technical quality of the images was very good (4.50 ± 0.72). There were no gender-specific differences: women 4.46 ± 0.75/men 4.56 ± 0.67; p = 0.5183. The quality of the imaging of the leads was also good (3.72 ± 0.83), and no statistical differences were found between the genders. After verifying the technical quality of the X-ray images, the tract of the leads was measured. The only significant difference was found in parameter E—this value describing the so-called “death bend”, which was significantly lower in women (3.98 ± 1.35) vs. men (4.58 ± 1.49): p = 0.039. Conclusions: The presented method permitted the leads of a cardiac pacemaker to be precisely described with good clinical validity using chest radiography

Can Frailty Be a Predictor of ICD Shock after the Implantation of a Cardioverter Defibrillator in Elderly Patients?

Introduction: The aim of the study was to assess the prevalence of frailty among elderly patients who had an implanted cardioverter defibrillator, as well as the influence of frailty on the main endpoints during the follow-up. Methods: The study included 103 patients > 60 years of age (85M, aged 71.56–8.17 years). All of the patients had an implanted single or dual-chamber cardioverter-defibrillator. In the research, there was a 12-month follow-up. The occurrence of frailty syndrome was assessed using the Tilburg Frailty Indicator scale (TFI). Results: Frailty syndrome was diagnosed in 75.73% of the patients that were included in the study. The mean values of the TFI were 6.55 ± 2.67, in the physical domain 4.06 ± 1.79, in the psychological domain 2.06 ± 1.10, and in the social domain 0.44 ± 0.55. During the follow-up period, 27.2% of patients had a defibrillator cardioverter electric shock, which occurred statistically more often in patients with diagnosed frailty syndrome (34.6%) compared to the robust patients (4%); p = 0.0062. In the logistic regression, frailty (OR: 1.203, 95% CI:1.0126–1.4298; p < 0.030) was an independent predictor of a defibrillator cardioverter electric shock. Similarly, in the logistic regression, frailty (OR: 1.3623, 95% CI:1.0290–1.8035; p = 0.019) was also an independent predictor for inadequate electric shocks. Conclusion: About three-quarters of the elderly patients that had qualified for ICD implantation were affected by frailty syndrome. In the frailty subgroup, adequate and inadequate shocks occurred more often compared to the robust patients

The Relationship between Frailty Syndrome and Concerns about an Implantable Cardioverter Defibrillator

Frailty syndrome may cause cognitive decline and increased sensitivity to stressors. This can result in an increased incidence of anxiety and depression, and thus, concerns about life with an implantable cardioverter defibrillator (ICD). The aim of the study was to assess the impact of frailty syndrome on the increase in the number of device-related concerns after the implantation of an ICD. Material and methods: The study sample was a group of 103 consecutive patients (85 M; aged 71.6 ± 8.2) with an implanted ICD. The ICD Concerns Questionnaire (ICDC) was used to analyze their concerns about life with an ICD, and the Tilburg Frailty Indicator scale (TFI) was used to diagnose frailty. Results: In the group of patients with an ICD implanted, 73% had recognized frailty (83.3% women, 74.1% men); the average point value was 6.55 ± 2.67. The total ICDC questionnaire score for the patients with an implanted cardioverter defibrillator was 34.06 ± 18.15. Patients with frailty syndrome had statistically (p = 0.039) higher scores (36.14 ± 17.08) compared to robust patients (27.56 ± 20.13). In the logistic regression analysis, the presence of frailty was strongly associated with the total questionnaire score (OR = 1.0265, p = 0.00426), the severity of the concerns (OR = 1.0417, p = 0.00451), and device-specific concerns (OR = 1.0982, p = 0.00424). Conclusion: Frailty syndrome occurs in about 80% of patients after ICD implantation. The presence of frailty syndrome was strongly associated with concerns about an implantable cardioverter defibrillator

Two-Point Left Ventricle Pacing and Cardiac Computed Tomography

Endocardial leads can potentially cause problems during coronary vessels visualization in multislice computed tomography (MSCT) due to a large number of artifacts. Based on presented case, we conclude that it is possible to perform MSCT of coronary arteries and leads visualization despite coexistence of four endocardial leads