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

High-density Mapping Guided Pulmonary Vein Isolation for Treatment of Atrial Fibrillation-Two-year clinical outcome of a single center experience

Pulmonary vein isolation (PVI) as interventional treatment for atrial fibrillation (AF) aims to eliminate arrhythmogenic triggers from the PVs. Improved signal detection facilitating a more robust electrical isolation might be associated with a better outcome. This retrospective cohort study compared PVI procedures using a novel high-density mapping system (HDM) with improved signal detection vs. age-and sex-matched PVIs using a conventional 3D mapping system (COM). Endpoints comprised freedom from AF and procedural parameters. In total, 108 patients (mean age 63.9 +/- 11.2 years, 56.5% male, 50.9% paroxysmal AF) were included (n = 54 patients/group). Our analysis revealed that HDM was not superior regarding freedom from AF (mean follow-up of 494.7 +/- 26.2 days), with one- and two-year AF recurrence rates of 38.9%/46.5% (HDM) and 38.9%/42.2% (COM), respectively. HDM was associated with reduction in fluoroscopy times (18.8 +/- 10.6 vs. 29.8 +/- 13.4 min;p < 0.01) and total radiation dose (866.0 +/- 1003.3 vs. 1731.2 +/- 1978.4 cGy;p < 0.01) compared to the COM group. HDM was equivalent but not superior to COM with respect to clinical outcome after PVI and resulted in reduced fluoroscopy time and radiation exposure. These results suggest that HDM-guided PVI is effective and safe for AF ablation. Potential benefits in comparison to conventional mapping systems, e.g. arrhythmia recurrence rates, have to be addressed in randomized trials

Rare truncating variants in the sarcomeric protein titin associate with familial and early-onset atrial fibrillation

Common genetic variants in structural proteins contribute to risk of atrial fibrillation (AF). Here, using whole-exome sequencing, the authors identify rare truncating variants in TTN that associate with familial and early-onset AF and show defects in cardiac sarcomere assembly in ttn.2-mutant zebrafish

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

Post-traumatic stress disorder among COVID-19-affected high-risk cardiac patients

Background During the first coronavirus disease 2019 (COVID-19) wave there was a high prevalence of mental health impairments and post-traumatic stress disorder (PTSD), particularly in patients with comorbid cardiac diseases. Methods During waves 2-5, all hospitalized patients with cardiac problems and suspected COVID-19 were eligible to participate in this study. Results The prevalence of PTSD was 31.4 (n=48) in 153 participants. No age- and gender-related differences for PTSD were found. Conclusions The prevalence is lower than during the first wave but higher than in patients reported in other studies who were isolated at home. Routine mental health assessments are strongly recommended for patients at risk

Post-traumatic stress disorder among COVID-19-affected high-risk cardiac patients

Background During the first coronavirus disease 2019 (COVID-19) wave there was a high prevalence of mental health impairments and post-traumatic stress disorder (PTSD), particularly in patients with comorbid cardiac diseases. Methods During waves 2-5, all hospitalized patients with cardiac problems and suspected COVID-19 were eligible to participate in this study. Results The prevalence of PTSD was 31.4 (n=48) in 153 participants. No age- and gender-related differences for PTSD were found. Conclusions The prevalence is lower than during the first wave but higher than in patients reported in other studies who were isolated at home. Routine mental health assessments are strongly recommended for patients at risk

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