PROXIMITY TO COVID-19 ON MENTAL HEALTH SYMPTOMS AMONG HOSPITAL MEDICAL STAFF

Background: Exposure to patients with COVID-19 can have a significant impact on mental health of hospital medical staff. The aim of this study was to examine the influence of proximity to patients with COVID-19 considering occupational position and gender on the mental health of hospital staff. Subjects and methods: N=78 participants were included in the study, with n=40 of them with direct contact to patients with COVID-19 (51%); eight had contact with patients suspected of having COVID-19 (10%), and n=30 with no direct contact to people with COVID-19 (39%). Results: Multinomial regression analyses showed that proximity had a negative (inverse) influence on avoidance behaviour as part of PTSD, physical symptoms, somatization, compulsiveness and anger expression-in as tendency to suppress anger. In addition, there was a significant impact of the female gender on increased physical symptoms, while age, work experience and occupation had no further influence. Conclusions: These results that hospital medical staff is less psychologically stressed when closer to COVID-19 patients are inconsistent with previous studies. Self-efficacy and locus of control in these situations are relevant for processing the trauma. In summary, perception of personal risk is essential. Proximity is believed to be a proxy variable for personal risk perception. As a synopsis of these results, regular briefings of the hospital staff are recommended to prevent psychological impairment. They should contain specific information about conditions in the affected wards and the risk of infection, which could help reduce risk perception of medical personnel

PROXIMITY TO COVID-19 ON MENTAL HEALTH SYMPTOMS AMONG HOSPITAL MEDICAL STAFF

Background: Exposure to patients with COVID-19 can have a significant impact on mental health of hospital medical staff. The aim of this study was to examine the influence of proximity to patients with COVID-19 considering occupational position and gender on the mental health of hospital staff. Subjects and methods: N=78 participants were included in the study, with n=40 of them with direct contact to patients with COVID-19 (51%); eight had contact with patients suspected of having COVID-19 (10%), and n=30 with no direct contact to people with COVID-19 (39%). Results: Multinomial regression analyses showed that proximity had a negative (inverse) influence on avoidance behaviour as part of PTSD, physical symptoms, somatization, compulsiveness and anger expression-in as tendency to suppress anger. In addition, there was a significant impact of the female gender on increased physical symptoms, while age, work experience and occupation had no further influence. Conclusions: These results that hospital medical staff is less psychologically stressed when closer to COVID-19 patients are inconsistent with previous studies. Self-efficacy and locus of control in these situations are relevant for processing the trauma. In summary, perception of personal risk is essential. Proximity is believed to be a proxy variable for personal risk perception. As a synopsis of these results, regular briefings of the hospital staff are recommended to prevent psychological impairment. They should contain specific information about conditions in the affected wards and the risk of infection, which could help reduce risk perception of medical personnel

The INFluence of Remote monitoring on Anxiety/depRession, quality of lifE, and Device acceptance in ICD patients: a prospective, randomized, controlled, single-center trial.

Leppert F, Siebermair J, Wesemann U, et al. The INFluence of Remote monitoring on Anxiety/depRession, quality of lifE, and Device acceptance in ICD patients: a prospective, randomized, controlled, single-center trial. Clinical research in cardiology : official journal of the German Cardiac Society. 2020.BACKGROUND: Impact of telemedicine with remote patient monitoring (RPM) in implantable cardioverter-defibrillator (ICD) patients on clinical outcomes has been investigated in various clinical settings with divergent results. However, role of RPM on patient-reported-outcomes (PRO) is unclear. The INFRARED-ICD trial aimed to investigate the effect of RPM in addition to standard-of-care on PRO in a mixed ICD patient cohort.; METHODS AND RESULTS: Patients were randomized to RPM (n=92) or standard in-office-FU (n=88) serving as control group (CTL). At baseline and on a monthly basis over 1 year, study participants completed the EQ-5D questionnaire for the primary outcome Quality of Life (QoL), the Hospital Anxiety and Depression Scale, and the Florida Patient Acceptance Survey questionnaire for secondary outcomes. Demographic characteristics (82% men, mean age 62.3years) and PRO at baseline were not different between RPM and CTL. Primary outcome analysis showed that additional RPM was not superior to CTL with respect to QoL over 12months [+1.2 vs.+3.9 points in CTL and RPM group, respectively (p=0.24)]. Pre-specified analyses could not identify subgroups with improved QoL by the use of RPM. Neither levels of anxiety (-0.4 vs. -0.3, p=0.88), depression (+0.3 vs.±0.0, p=0.38), nor device acceptance (+1.1 vs.+1.6, p=0.20) were influenced by additional use of RPM.; CONCLUSION: The results of the present study show that PRO were not improved by RPM in addition to standard-of-care FU. Careful evaluation and planning of future trials in selected ICD patients are warranted before implementing RPM in routine practice

Health Related Quality of Life and Device-Acceptance in Patients with Implantable Cardioverter-Defibrillators and Telemonitoring

Leppert F, Siebermair J, Martens E, Kääb S, Greiner W. Health Related Quality of Life and Device-Acceptance in Patients with Implantable Cardioverter-Defibrillators and Telemonitoring. Value in Health. 2013;16(7):A535.HEALTH RELATED QUALITY OF LIFE AND DEVICE-ACCEPTANCE IN PATIENTS WITH IMPLANTABLE CARDIOVERTER-DEFIBRILLATORS AND TELEMONITORING Florian Leppert, Johannes Siebermair, Stefan Kääb, Wolfgang Greiner OBJECTIVES: Telemedical systems (TMS) and data management for implantable cardioverter-defibrillators (ICD) promise to reduce costs and optimize patient care. Depressive symptoms are common among patients with an ICD and the health related quality of life (HRQoL) is affected by the underlying disease and the implanted device, respectively. TMS might improve the HRQoL of patients and ICDs acceptance due to a closer monitoring and, thereby, an increased level of perceived safety. In this study, changes in the level of depression, HRQoL and device acceptance over a period of six months after ICD-implantation were investigated. METHODS: In this randomized controlled trial, 161 (80.7% male; age: 64,1 ± 14,6; 82% with coronary disease, 11% with dilated cardiomyopathy) patients with an ICD were randomized at the day of implantation into intervention (n=82) or control group (n=79). Patients in the intervention group were equipped with a telemonitoring system that transferred device data (e.g. critical events, status of battery, heart function) from the patients’ home to the medical practitioner via internet. The control group received regular care. Patients were asked to fill out three questionnaires (the generic EQ-5D, the depression specific Hospital Anxiety and Depression Scale (HADS) and the device specific Florida Patient Acceptance Survey (FPAS)); the follow-up period was six month, with postal surveys on a monthly basis (7 times in total). Collected data were analyzed in a pseudonymized manner. Datasets with missing values were filled by applying the Expectation-Maximization (EM) method. RESULTS: Nine patients dropped out before survey completion at month six for different reasons (e.g. draw back consent or death). Of the remaining 152 patients 140 patients filled out at least two sets of questionnaires and were included in the analyses. After six months the mean improvement in the health related quality of life (EQ-5D-Index) in the telemonitoring group was 10.7 points compared to baseline (p=.006) while the mean change in HRQoL in the control group was 5.5 points (p=.138). FPAS and HADS-D showed small but non-significant advantage for the telemonitoring group concerning acceptance and level of depression, respectively. CONCLUSIONS: Preliminary results suggest that telemonitoring systems have the ability to improve the health related quality of life of patients with implantable cardioverter-defibrillators. Results on effects towards the level of depression and anxiety and the enhancement of ICDs acceptance are also promising. Since ICDs are used in chronic heart diseases a longer follow-up period seems to be required to validate the effects

Health related quality of life and Device-Acceptance in patients with implantable cardioverter-defibrillators and telemonitoring

Siebermair J, Martens E, Leppert F, et al. Health related quality of life and Device-Acceptance in patients with implantable cardioverter-defibrillators and telemonitoring. Clinical Research in Cardiology. 2014;103(Suppl 1):V548

Visualization of thermal damage using 68 Ga-FAPI-PET/CT after pulmonary vein isolation

Purpose!#!68!##!Methods!#!Twelve PVI patients (5 RFA, 7 CBA) underwent !##!Results!#!Focal FAPI uptake around the PVs was observed in 10/12 (83.3%) PVI patients, no uptake was observed in 2 PVI patients and all controls. Patients after PVI had higher FAPI uptake in PVs compared to controls (SUV!##!Conclusion!#!We demonstrate in-vivo visualization o

Benefit of Contact Force Sensing Catheter Technology for Successful Left Atrial Anterior Line Formation: A Prospective Randomized Trial

Introduction. The value of contact force information for ablation of LA anterior line is unknown. In a prospective randomized clinical trial, we investigated if information on contact force during left atrial (LA) anterior line ablation reduces total radiofrequency time and results in higher rates of bidirectional line block in patients undergoing pulmonary vein isolation (PVI) plus substrate modification. Methods. We included patients with indication for pulmonary vein isolation (PVI) and additional substrate modification. For LA anterior line ablation, patients were randomized to contact force information visible (n=35) or blinded (n=37). Patients received contrast enhanced cardiac magnetic resonance imaging (cMRI) before and 3-6 months after ablation to visualize the LA anterior line. Primary endpoint was radiofrequency time to achieve bidirectional line block. Secondary endpoints were completeness of the LA anterior line on cMRI, distribution of contact force, procedural data, adverse events, and 12 months success rate. Results. In 72 patients (64±9 years, 68% male), bidirectional LA anterior line block was achieved in 70 (97%) patients. Radiofrequency time to bidirectional block did not differ significantly across groups (contact force information visible 23±18min versus contact force information blinded 21±15min, p=0.50). The LA anterior line was discernable on cMRI in 40 patients (82%) without significant differences across randomization groups (p=0.46). No difference in applied contact force was found depending on cMRI line visibility. Twelve-month success and adverse event rates were comparable across groups. Conclusion. Information on contact force does not significantly improve the ablation of LA anterior lines. Clinical Trial Registration. The trial was registered at http://www.clinicaltrials.gov by identifier: NCT02217657

Delayed 68Ga-FAPI-46 PET/MR imaging confirms ongoing fibroblast activation in patients after acute myocardial infarction

Purpose of the Report: Combined cardiac 68Ga-Fibroblast-Activation Protein-alpha inhibitor (FAPI) positron-emission tomography (PET) and cardiac magnetic resonance imaging (MRI) constitute a novel diagnostic tool in patients for the assessment of myocardial damage after an acute myocardial infarction (AMI). Purpose of this pilot study was to evaluate simultaneous Ga-68-FAPI-46-PET/MR imaging in the delayed phase after AMI. Material and Methods: Eleven patients underwent hybrid 68Ga-FAPI-46 PET/MRI post AMI. Standardized uptake values and fibroblast activation volume (FAV) were calculated and correlated with serum biomarkers and MRI parameters. Results: Significant 68Ga-FAPI-46 uptake could be demonstrated in 11 (100 %) patients after a mean period of 30.9 ± 22.0 days. FAV significantly exceeded the infarction size in MRI and showed a good correlation to MRI parameters as well as to serum biomarkers of myocardial damage. Conclusions: 68Ga-FAPI-46 PET/MRI offers molecular and morphological imaging of affected myocardium after AMI. This study demonstrates ongoing fibroblast activation in a delayed phase after AMI and generates hypotheses for future studies while aiming for a better understanding of myocardial remodeling following ischemic tissue damage