Understanding the lived experience of how individuals aged between 33 and 62 years of age diagnosed with coronary heart disease (CHD) feel they obtain emotional support post percutaneous coronary intervention (PCI)

BackgroundCoronary Heart Disease (CHD) is a major cause of ill health in Scotland and one of the main methods of symptom management for this disease is Percutaneous Coronary Intervention (PCI). This treatment relieves the symptoms of the disease but does not halt the disease process, therefore, there is a need for the individual post PCI to adhere to secondary prevention information. With the advances in treatment and reduced length of inpatient stay, access to health professionals for support and information is a challenge. Research confirms patients’ inability to access support increases the risk of them experiencing negative emotions which impair the individual’s ability to adhere to secondary prevention. This study sought to explore the lived experience of how CHD patients feel they obtain emotional support post PCI.MethodsA qualitative interpretative phenomenology approach was used and data were collected using individual semi-structured participant interviews. This method of data collection ensured the voice of the participant was shared. A purposive sample of 7 individuals diagnosed with CHD and treated with PCI within the past 12 months was recruited from a formalised phase IV gym-based exercise programme delivered in a community setting in one region of Scotland. The participants were mostly male with an average age of 47 years and 30% had comorbidities. Participants had undergone PCI between three and twelve months previously either as an intervention to control angina symptoms or to relieve the coronary artery obstruction caused by a myocardial infarction (heart attack). Data were analysed using an interpretive approach.FindingsThe methodological approach of analysis identified three overarching themes; PCI is not a fix, loss if identity and cardiac rehabilitation is a safety net. The use of Leventhal’s self-regulation model of illness perceptions contributed to understanding two main groups of emotions are experienced post PCI treatment. The emotions of fear, anxiety and disappointment are experienced in relation to the physical body and found to be due to the non-curative nature of the PCI. For the majority, this results in a fixation with diagnostic tests as a means of emotional support. The emotions of frustration, embarrassment and guilt are experienced in relation to a perceived loss of identity. For some a focus on lifestyle modification is a means of emotional support, for others, talking to others similar to themselves offers reassurance and for three male participants, risk-taking behaviour is exhibited as a means of taking back control. For the majority, cardiac rehabilitation provides an educational environment but fails to offer emotional support for individuals who do not trust the PCI treatment and have existing co-morbidities or experience complex social circumstances.ConclusionsThis is the first study to explore participant’s views of how age, gender, social circumstances and the presence of comorbidities affect emotions after the treatment of the PCI. Age and gender were associated with the experience of negative emotions related to the CHD diagnosis and non-curative treatment of the PCI. For some males, this resulted in risk-taking behaviour and for others, a fixation with diagnostic tests. For individuals who do not trust PCI as a treatment and have existing co-morbidities or females experiencing complex social circumstances, the information received within the current cardiac rehabilitation pathway is not sufficient to reduce negative emotions

The influence of perceived levels of physical activity on engagement with cardiac rehabilitation after acute coronary syndrome

Background: Cardiac rehabilitation (CR) is an effective therapy to reduce the risk of hospital readmission after an acute coronary syndrome (ACS) diagnosis. Despite this, half of eligible individuals do not engage. The reasons for this are complex and include patient-level barriers such as beliefs about being already active. Indeed, up to 40% of eligible individuals report meeting physical activity (PA) guidelines prior to attendance, yet little is known about how this influences CR engagement decisions. Therefore, the aim of this thesis was to provide evidence about how previous experience of PA influenced PA and CR engagement after an ACS diagnosis. Methods: Firstly, a systematic review of 12 studies, representing 388 participants from six countries, explored how previous PA experience influenced engagement with PA during CR was undertaken. Subsequently, a mixed methods explanatory sequential study included a cross-sectional element examining self-reported PA levels, illness perceptions and physical self-descriptions for 67 participants (mean age 64.2 (±10.53SD)), and a qualitative element involving telephone interviews with 26 previously active ACS survivors (aged 44-77 years). Results: Systematic review synthesis indicated that perceptions of physical ability, exercise self-reliance, severity of cardiac condition and fitness identity influenced perceived CR need. In the mixed-methods study, perceptions of previous PA levels influenced PA engagement decisions after an ACS diagnosis and during CR. Most participants (n=50, 74.6%) self-reported being at least moderately active and self-concept for being active predicted self-reported PA prior to CR. Participants understood ‘being active’ through the lens of previous PA and self-evaluation of health. CR communication and peer comparisons influenced engagement decisions and motivation for fitness goals. Individuals who self-reported being at least moderately active required CR support to increase PA intensity levels after an ACS diagnosis. Conclusions: ACS survivors conceptualise “being active” based on previous PA experience and these preconceptions influence future fitness goals

Green Health Partnerships in Scotland; Pathways for Social Prescribing and Physical Activity Referral

Increased exposure to green space has many health benefits. Scottish Green Health Partnerships (GHPs) have established green health referral pathways to enable community-based interventions to contribute to primary prevention and the maintenance of health for those with established disease. This qualitative study included focus groups and semi-structured telephone interviews with a range of professionals involved in strategic planning for and the development and provision of green health interventions (n = 55). We explored views about establishing GHPs. GHPs worked well, and green health was a good strategic fit with public health priorities. Interventions required embedding into core planning for health, local authority, social care and the third sector to ensure integration into non-medical prescribing models. There were concerns about sustainability and speed of change required for integration due to limited funding. Referral pathways were in the early development stages and intervention provision varied. Participants recognised challenges in addressing equity, developing green health messaging, volunteering capacity and providing evidence of success. Green health interventions have potential to integrate successfully with social prescribing and physical activity referral. Participants recommended GHPs engage political and health champions, embed green health in strategic planning, target mental health, develop simple, positively framed messaging, provide volunteer support and implement robust routine data collection to allow future examination of success

What do spontaneous coronary artery dissection survivors want to support their recovery? A qualitative study

Aims: Spontaneous Coronary Artery Dissection (SCAD) is increasingly recognised as an important cause of myocardial infarction predominantly affecting women aged under 50 years. There is limited research addressing female and male SCAD survivors’ experience of, or requirements for, support post-SCAD. This study explored what SCAD survivors wanted to support recovery. Methods and Results: A qualitative study using semi-structured video and telephone interviews. Data were analysed through thematic analysis using the framework approach. We interviewed 20 participants (19 females) with a mean age of 54.6 (+/-SD 8.5 years). Three overarching themes encapsulated participants’ views about support requirements. 1) Education and information. Participants thought healthcare professionals involved in diagnosis and supporting recovery required greater awareness of SCAD and the psychological effect of SCAD. They wanted accessible SCAD information immediately post-event and during the educational component of cardiac rehabilitation. 2) Physical Activity. Requirements were for advice tailored to individuals’ specific needs, physical capabilities, and physical activity preferences. Participants suggested that utilising wearable technology was helpful to encourage a safe return to activity. 3) Psychosocial Support. Participants wanted formal psychosocial support immediately post-event, during cardiac rehabilitation and in the longer term. Conclusion: Better healthcare professional training may improve diagnosis and increase support and awareness of SCAD. SCAD support programmes should provide early SCAD specific education utilising online sources, individually tailor physical activity prescription, offer wearable technology to support a return to being active, and provide short- and longer-term psychosocial support. As SCAD is predominately a female condition, programmes should consider female physical activity preferences

Spontaneous coronary artery dissection: a systematic review of physical and psychosocial recovery following discharge from hospital

IntroductionSpontaneous coronary artery dissection (SCAD) is increasingly recognised as an important cause of myocardial infarction, particularly among women. SCAD survivors may not know what physical activity is safe and effective and there may be a psychosocial burden of living with a SCAD diagnosis. This review aimed to determine the evidence regarding physical activity, cardiovascular risk factors, or associated factors, and the psychosocial impact of SCAD for SCAD survivors after hospital discharge.MethodsA systematic review completed in accordance with PRISMA guidelines (Prospero CRD42021254798).ResultsThe review included 28 studies. These used a range of methods. None were randomised controlled trials. There were 4167 SCAD participants although some were sourced from the same SCAD registries, so may not be unique. They were mainly female (n=3897 93.5%, range=57.7%-100%), with mean age 48.0±9.8 years at index event. Participants mostly came from the USA, Canada, or the Netherlands. We found very limited evidence for cardiorespiratory fitness improvements following cardiac rehabilitation (CR). Existing CR was not tailored to SCAD specific needs and SCAD survivors lacked guidance about appropriate physical activity. Some participants had high levels of psychosocial distress. SCAD survivors highlighted the need for tailored support that included family members. Many SCAD survivors have traditional risk factors including hypertension, hyperlipidaemia and overweight/obesity. Chest pain following SCAD is common.ConclusionsThere is an urgent need to develop physical and psychological recovery programmes for SCAD survivors, and test effectiveness via randomised controlled trials. Psychosocial support is particularly required, given the high burden of psychosocial issues

Exploring the patient experience of remote hypertension management in Scotland during COVID-19: a qualitative study

ObjectivesThe aim of this study was to understand how patients experienced hypertension management, with or without BP telemonitoring, during the COVID-19 pandemic. Design, Methods, participants, and settingThis qualitative study conducted between April and November 2022 consisted of 43 semi-structured telephone interviews (23 men and 20 women) from six primary care practices in one area of Scotland. Results From the views of 25 participants with experience of using the Connect Me telemonitoring service and 18 participants without such experience, five themes were developed. These were: (1) Navigating access to services. There were challenges to gaining timely and/or in-person access to services and a reluctance to attend clinical settings because participants were aware of their increased risk of contracting the COVID-19 virus. (2) Adapting NHS services. All six practices had adapted care provision in response to potential COVID-19 transmission, however, these adaptations disrupted routine management of in-person primary care hypertension, diabetes and/or asthma checks. (3) Telemonitoring feedback. Telemonitoring reduced the need to attend in-person primary care practices and supported access to remote healthcare monitoring and feedback. (4) Self-management. Many non-telemonitoring participants were motivated to use self-management strategies to track their blood pressure using home monitoring equipment. Also, participants were empowered to self-manage lifestyle and hypertension medication. (5) Experience of having COVID-19. Some participants contracting the COVID-19 virus experienced an immediate increase in their BP whilst a few experienced ongoing increased BP readings. ConclusionsThe COVID-19 pandemic disrupted routine in-person care for hypertension patients. Both telemonitoring and some non-telemonitoring patients were motivated to self-manage hypertension, including self-adjusting medication, however only those with access to telemonitoring had increased access to hypertension monitoring and feedback. Blood pressure telemonitoring permitted routine care to continue for participants in this study and may offer a service useful in pandemic proofing hypertension healthcare in the future

Gender differences in uptake, adherence and experiences: a longitudinal, mixed methods study of a physical activity referral scheme in Scotland, UK

Physical activity referral schemes (PARS) are implemented internationally to increase physical activity (PA) but evidence of effectiveness for population subgroups is equivocal. We examined gender differences for a Scottish PARS. This mixed-method, concurrent longitudinal study had equal status quantitative and qualitative components. We conducted 348 telephone interviews across three time points (pre-scheme, 12 and 52 weeks). These included validated self-reported PA and exercise self-efficacy measures, and open-ended questions about experiences. We recruited 136 participants, 120 completed 12-week and 92 completed 52-week interviews. PARS uptake was 83.8% (114/136) and 12-week adherence for those who started was 43.0% (49/114). Living in less deprived areas was associated with better uptake (p=0.021) and 12-week adherence (p=0.020), and with male uptake (p=0.024) in gender-stratified analysis. Female adherers significantly increased self-reported PA at 12 weeks (p=0.005) but not 52 weeks. Males significantly increased exercise self-efficacy between baseline and 52 weeks (p=0.009). Three qualitative themes and eight subthemes developed; gender perspectives, personal factors (health, social circumstances, transport and attendance benefits) and scheme factors (communication, social/staff support, individualisation and age appropriateness). Both genders valued the PARS. To increase uptake, adherence and PA, PARS should ensure timely, personalized communication, individualised, affordable PA and include mechanisms to re-engage those who disengage temporarily

Research priorities relating to the delivery of cardiovascular prevention and rehabilitation programmes: results of a modified Delphi process

Objective: The purpose of this British Association for Cardiovascular Prevention and Rehabilitation (BACPR) research priority setting project (PSP) was to identify a top 10 list of priority research questions for cardiovascular prevention and rehabilitation (CVPR). Methods: The PSP was facilitated by the BACPR clinical study group (CSG), which integrates as part of the British Heart Foundation Clinical Research Collaborative. Following a literature review to identify unanswered research questions, modified Delphi methods were used to engage CVPR-informed expert stakeholders, patients, partners and conference delegates in ranking the relevance of research questions during three rounds of an anonymous e-survey. In the first survey, unanswered questions from the literature review were ranked and respondents proposed additional questions. In the second survey, these new questions were ranked. Prioritised questions from surveys 1 and 2 were incorporated in a third/final e-survey used to identify the top 10 list. Results: From 459 responses across the global CVPR community, a final top 10 list of questions were distilled from an overall bank of 76 (61 from the current evidence base and a further 15 from respondents). These were grouped across five broad categories: access and remote delivery, exercise and physical activity, optimising programme outcomes, psychosocial health and impact of the pandemic. Conclusions: This PSP used a modified Delphi methodology to engage the international CVPR community to generate a top 10 list of research priorities within the field. These prioritised questions will directly inform future national and international CVPR research supported by the BACPR CSG