Trine Bernholdt Rasmussen

Purpose: The Myocardial Infarction Dimensional Assessment Scale (MIDAS) is a 35-item instrument developed for patients with myocardial infarction, but has not yet been evaluated in a Danish setting. The aim of this study was to translate and assess the psychometric properties of the Danish version of the MIDAS scale in patients with acute coronary syndromes or stable angina pectoris receiving percutaneous coronary intervention (PCI). Methods: This cross-sectional psychometric evaluation used two-month follow-up data from adult patients enrolled in the CONCARD ^PCI study. MIDAS was translated, culturally adapted, and pretested before use. Further questionnaires included assessment of angina (SAQ-7). symptoms of anxiety and depression (HADS) and physical and mental health status (RAND-12) linked with sociodemographic and clinical characteristics collected at baseline. Construct validity was evaluated through CFA and hypotheses testing, including known-groups analyses and correlations with SAQ-7, HADS, and RAND-12. Internal consistency was assessed using Cronbach’s alpha. Results: A total of 1447 patients were included: the median age was 67 years (IQR 57–74), and 22% were women. The CFA, based on 1051 participants with complete MIDAS data, did not adequately support the original seven-factor structure (χ²(539) = 4409, p < 0.001; RMSEA = 0.083; TLI = 0.833; CFI = 0.849). Standardized factor loadings ranged from 0.48 to 0.88. Three of six predefined known-groups hypotheses were supported (50%). Correlations for the expected convergent relationships were moderate to high, and domain-level Cronbach’s alpha values ranged from 0.67 to 0.93. Conclusion: The findings generally supported convergent validity and domain-level internal consistency, whereas the known-groups analyses provided limited support, and the original seven-factor structure was not adequately supported.

Aims: To explore the psychological effects of interventions aimed at supporting informal caregivers involved in the care and treatment of patients with cardiovascular disease. Methods and results: Databases (PubMed, CINAHL, Embase, Cochrane Library, and PsycInfo) were searched for studies in accordance with the Cochrane Handbook guidelines. Inclusion criteria were: caregivers of patients with one or more cardiovascular diseases, patient and caregiver >18 years, caregivers included in the intervention, and, reporting of psychological outcomes specific to caregivers. Study designs were randomized controlled trials with a follow-up periods of >2 months. The RoB 2.0 bias assessment tool was used to assess risk of bias. Fifteen studies from nine countries were identified. Most interventions consisted of multiple components including educational face-to-face sessions, telephone support, and/or written resources. The analysis showed inconsistent results on caregiver outcomes, but significant improvements were reported in eight studies in at least one caregiver outcome. Analysis indicated that the studies providing more frequent contact with caregivers and patients were more likely to report significant improvements in caregiver outcomes. Risk of bias was judged as low in three studies, some concerns in nine studies, and as high in three studies. Conclusion: Due to inconsistency in results, this review yield uncertainty about whether interventions targeting caregivers of patients with cardiovascular disease improve caregivers’ psychological outcomes. Therefore, further research is needed to develop effective interventions for caregivers, as they play a vital role in the daily care and treatment of patients with cardiovascular disease. Registration: PROSPERO: CRD420250654618.

Background: High blood pressure (BP) is a common condition that is estimated to soon affect one third of the worlds’ population. Poor subjective sleep quality is shown to be associated with an elevated risk of high BP, though it is a risk factor that can be modified. Yoga can be used as a complementary therapy to lower BP, but more knowledge on duration and intensity are needed. The overall aim is to test the effect of an online yoga intervention as a complementary therapy. The objectives are to: (1) Test whether online yoga can improve sleep quality, health related quality of life, and lower BP. (2) To explore and describe the implementation of online yoga and the participants’ experiences and perspectives on the intervention in a process evaluation. Methods: A pragmatic randomized controlled trial will be conducted. The study is described in accordance with the SPIRIT guidelines (Standard Protocol Items: Recommendations for Interventional Trials) and results will be reported following the CONSORT (CONsolidated Standards Of Reporting Trials) guidelines for pragmatic trials. The study is designed as a three arm, randomized superiority trial. Inclusion criteria: ≥65 years old, diagnosed with high BP, speaking and reading Danish, able to consent, no comorbidity that restricts them from participating in the intervention, and daily access to a smartphone or tablet. Participants will be randomly assigned to (i) control group which will be receiving treatment as usual (TAU), or to one of two intervention-groups (ii) performing yoga twice a week for 20 min (20 MIN) or (iii) 40 min (40 MIN) for a total of 10 weeks in addition to TAU. The primary outcome is sleep quality measured by the Pittsburg Sleep Quality Index and secondary outcomes include health related quality of life and BP. Analysis will present differences between groups and be carried out by a statistician blinded to group allocation. Discussion: The study is grounded in the urgent need to address high BP since pharmacological interventions remain the primary treatment modality, the exploration of non-pharmacological strategies, such as yoga, offers a promising avenue for enhancing patient outcomes in a holistic manner. Trial registration: ClinicalTrials.gov ID NCT06553820. Protocol version 1. 13th November 2024.

Aims: Following implantation of an implantable cardioverter defibrillator (ICD), patients are temporarily restricted from private motor vehicle driving and permanently prohibited from professional driving. We aimed to investigate the impact of driving restrictions following ICD implantation and in the case of ICD shock on employment, daily living activities, driving concerns, and driving behaviour. Methods and results: Data were retrieved from a nationwide survey on driving restrictions in Danish ICD patients, distributed in 2017 to all patients ≥18 years implanted with a first-time ICD from 2013 to 2016 (n = 3913). Responses were linked with data from nationwide registers. The response rate was 71% (final analysable population n = 2741, 83% male, median age 67 years, 316 had experienced an ICD shock, and 911 patients reported receipt of driving restrictions of minimum 1 month). Among active professional drivers (n = 175), 33% had lost their job as a direct consequence of the driving restrictions. Of those working prior to ICD implantation (n = 465), 47% reported being limited in maintaining employment due to private driving restrictions. Among those restricted from driving for a minimum of 1 month, 26% reported the restrictions overall had substantially impeded their daily living. Factors associated with substantial impediment were age <65 years [OR 1.84 (95% CI 1.35–2.52)], higher income [OR 1.47 (95% CI 1.05–2.05)], and driving ≥7 h/week pre-implantation [OR 1.66 (95% CI 1.23–2.24)]. Being nervous about driving or altering driving habits was reported by 3–7%. Conclusion: Both professional and private driving restrictions affect the ability to maintain employment and have a negative impact on ICD recipients’ daily living activities.

Sandra B Lauck, Markus Saarijävi, Trine Bernholdt Rasmussen; Moving evidence from publication to practice: Opportunities for accelerating knowledge translation

The objectives were to describe differences in self-reported health at discharge between women diagnosed with angina or unspecific chest pain and investigate the association between self-reported health and adverse outcomes within 3 years. Data from a national cohort study were used, including data from the DenHeart survey combined with 3 years of register-based follow-up. The population included two groups of women with symptoms of angina but no diagnosis of obstructive coronary artery disease at discharge (women with angina and women with unspecific chest pain). Self-reported health measured with validated instruments was combined with register-based follow-up on adverse outcomes (a composite of unplanned cardiac readmissions, revascularization, or all-cause mortality). Associations between self-reported health and time to first adverse outcomes were investigated with Cox proportional hazard models, reported as hazards ratios with 95% confidence intervals. In total, 1770 women completed the questionnaire (49%). Women with angina (n = 931) reported significantly worse self-reported health on several outcomes compared to women with unspecific chest pain (n = 839). Within the 3 years follow-up, women with angina were more often readmitted (29 vs. 23%, P = 0.011) and more underwent revascularization (10 vs. 1%, P < 0.001), whereas mortality rates were similar (4 vs. 4%, P = 0.750). Self-reported health (physical and mental) was associated with adverse outcomes between both groups (on most instruments). Women with angina reported significantly worse self-reported health on most instruments compared to women with unspecific chest pain. Adverse outcomes varied between groups, with women diagnosed with angina experiencing more events. ClinicalTrials.gov (NCT01926145).

Background: A paucity of resuscitation studies have examined sex differences in patient-reported outcomes upon hospital discharge. It remains unclear whether male and female patients differ in health outcomes in their immediate responses to trauma and treatment after resuscitation. Objectives: The aim of this study was to examine sex differences in patient-reported outcomes in the immediate recovery period after resuscitation. Methods: In a national cross-sectional survey, patient-reported outcomes were measured by 5 instruments: symptoms of anxiety and depression (Hospital Anxiety and Depression Scale), illness perception (Brief Illness Perception Questionnaire [B-IPQ]), symptom burden (Edmonton Symptom Assessment Scale [ESAS]), quality of life (Heart Quality of Life Questionnaire), and perceived health status (12-Item Short Form Survey). Results: Of 491 eligible survivors of cardiac arrest, 176 (80% male) participated. Compared with male, resuscitated female reported worse symptoms of anxiety (Hospital Anxiety and Depression Scale–Anxiety score ≥8) (43% vs 23%; P = .04), emotional responses (B-IPQ) (mean [SD], 4.9 [3.12] vs 3.7 [2.99]; P = .05), identity (B-IPQ) (mean [SD], 4.3 [3.10] vs 4.0 [2.85]; P = .04), fatigue (ESAS) (mean [SD], 5.26 [2.48] vs 3.92 [2.93]; P = .01), and depressive symptoms (ESAS) (mean [SD], 2.60 [2.68] vs 1.67 [2.19]; P = .05). Conclusions: Between sexes, female survivors of cardiac arrest reported worse psychological distress and illness perception and higher symptom burden in the immediate recovery period after resuscitation. Attention should focus on early symptom screening at hospital discharge to identify those in need of targeted psychological support and rehabilitation.

Aims: Women report worse health-related patient-reported outcomes (PROs) compared with men following acute myocardial infarction (AMI). However, this association is not well established when accounting for demographic and clinical patient characteristics at discharge. This knowledge is essential for clinicians when planning individualised care for patients following AMI. The aim of this study is to examine whether gender is associated with health-related PROs at discharge from a Danish heart centre, combining PROs with data from the national health and administrative registries. Methods and results: A cross-sectional study of 2131 patients with AMI discharged from a Danish heart centre responding to the following health-related PRO questionnaires: the Health-survey Short-Form-12 (SF-12), generating a physical component summary (PCS) and a mental component summary (MCS) score; the HeartQoL, providing a global, emotional, and physical score; the EuroQol five-dimensional questionnaire (EQ-5D-5L) and the EQ visual analogue scale (EQ VAS); the Hospital Anxiety and Depression Scale (HADS), generating an anxiety and depression score (HADS-A and HADS-D); the Edmonton Symptom Assessment Scale (ESAS); the Brief Illness Perception Questionnaire (B-IPQ). Patient-reported outcomes were linked to registry-based information adjusting for potential demographic and clinical confounding factors. In adjusted regression models, women reported worse health-related PROs compared with men in SF-12 PCS and SF-12 MCS, HeartQoL global, the HeartQoL emotional and HeartQoL physical score, EQ-5D-5L and EQ VAS, the HADS-A, ESAS, and in six out of eight B-IPQ items. Conclusions: Women reported worse health-related PROs compared with men. Health-related PROs have the potential to be further investigated to facilitate a more individualised healthcare follow-up after AMI.