OBJECTIVES:Caregivers play a pivotal role in supporting patients with heart failure (HF). Caregiving may be associated with significant impact on the caregivers' health. This study aimed at exploring the impact of caregiving in relation to self-rated health, anxiety and depression compared with the general Danish population. METHODS:A cross-sectional exploratory study was conducted with caregivers of adult patients with HF New York Heart Association (NYHA) II, III and IV from the Department of Cardiology at the North Zealand Hospital in Denmark. Patients with HF were asked to indicate the caregiver ≥18 years to participate. Assessment of caregivers included the Zarit Burden Interview, Patient Health Questionnaire-4 and the 36-item Short-Form Health Survey. RESULTS:Of 127 included caregivers, 119 completed the questionnaire (96 women). The mean age was 67 years (range 28-87 years). Overall, 31% of caregivers found caregiving burdensome. The heaviest burden was found in caregivers of patients with the highest symptom burden and NYHA class (p=0.005). Caregivers had 1.63 (95% CI: 1.00 to 2.66) times higher odds of reporting signs of anxiety than individuals in the general population. However, caregivers had 1.88 (95% CI: 1.09 to 3.25) times higher odds of rating their health as good than the general Danish population. CONCLUSIONS:Our finding of a higher proportion of caregivers reporting good health compared with the general population is in keeping with other recent studies. However, educational and supportive interventions supporting caregivers in providing care while maintaining their own health should still be considered.

Malnutrition and nutrition impact symptoms are common during and after anticancer treatment. This systematic review aimed to identify nutrition screening and assessment tools validated in patients with cancer and/or survivors, and to provide an overview. Comprehensive searches were conducted. Covidence was used for reference screening, data extraction, and quality assessment by two reviewers independently. Studies were included if they tested concurrent validity of a tool reporting: sensitivity, specificity, area under the curve (AUC), Pearson's/Spearman's correlation coefficient, or kappa. Data were summarized in tables and described narratively. Of 6,332 screened records, 486 were full-text reviewed, and 98 articles covering 161 validation studies of 47 tools were included. Most articles included mixed cancer diagnoses, followed by head and neck and gastrointestinal cancer; few included survivors. The most frequently validated tools were Nutritional Risk Screening 2002 (NRS 2002), Malnutrition Screening Tool (MST), Malnutrition Universal Screening Tool (MUST), and the Scored Patient-Generated Subjective Global Assessment (PG-SGA). Several reference standards were used. Sensitivity ranged from 6% to 100%, specificity from 11% to 100%, and validity from 'Poor' to 'Good'. The absence of a universal gold standard complicates identification of a superior tool. Nonetheless, rather than ranking tools, this review provides an overview of their validity across different reference standards, offering guidance for clinicians. PROSPERO: CRD42018096678.

Cognitive deficits are prevalent among cardiac arrest survivors, yet there is no consensus on standardised screening methods. Hence, a novel screening tool is needed to assist healthcare professionals in determining the necessity of further assessment or rehabilitation. This paper reports on the development process of a pragmatic model for cognitive screening after cardiac arrest and makes recommendations for timing and how to communicate the results. Based on an iterative process that included clinical observations and roundtable discussions, we underwent a four-phase development process grounded in the GUIDED guidelines (1). During the first phase, we explored the cognitive after-effects of cardiac arrest, focusing on potentially affected cognitive functions, suitable tests, and cognitive rehabilitation needs. The second phase included developing a pen-and-paper neuropsychological screening battery, which proved too resource-intensive due to its reliance on neuropsychologists. Consequently, in the third phase, we transitioned to a tablet-based screening tool. The fourth phase involved proof of concept, assessing whether we had developed a feasible cognitive screening for cardiac arrest survivors that could be implemented in hospital departments and rehabilitation settings. For this procedure, we determined that the optimal time for screening is six to eight weeks after discharge from the hospital, with screening results categorised as: 'no concerns,' 'need for further assessment,' and 'need for specialised rehabilitation. A model of the screening, along with recommendations for timing and communication of results, is presented. We have successfully developed and reported an easy-to-use digital screening tool and procedure for cognitive deficits following cardiac arrest. This approach can potentially enable systematic screening for all cardiac arrest survivors.

AIMS:Women who have survived spontaneous coronary artery dissection (SCAD) struggle to resume their lives as before SCAD and lack knowledge on how to recover. Thus, this study aimed to explore the rehabilitation needs and challenges in resuming everyday life among women with SCAD. METHODS AND RESULTS:A qualitative approach using a phenomenological-hermeneutical methodology. We conducted six virtual focus groups involving 26 women with SCAD, recruited from a patient group. The focus groups were video-recorded, transcribed, and analysed using Ricoeur's theory of interpretation. The findings led to three themes: (i) Distrust of the normally well-functioning body, (ii) Being the expert on your condition, and (iii) Rehabilitation following SCAD: A matter of both the heart and the mind. The women strive to regain trust in their bodies and minds while reinforcing the distinction between the physical and mental self before and SCAD. The women felt a responsibility to educate themselves about SCAD, as professionals' lack of knowledge or misconceptions often left them managing their condition on their own. The one-sided focus on physical rehabilitation neglected the psychological impact, leaving women without strategies for managing the new everyday life with SCAD. CONCLUSION:The study highlights the complex physical and psychological rehabilitation needs and challenges faced by women following SCAD due to profound alterations in their lives, distrust in their bodies and the burden of becoming experts on their condition. Tailored rehabilitation programs that address these needs, in addition to improving healthcare professionals' knowledge about SCAD, are essential for enhancing recovery and quality of life.

Abstract Background The CopenHeart trials investigated the effects of cardiac rehabilitation in patients treated for atrial fibrillation with ablation (RFA), patients after infective endocarditis (IE), and after heart valve surgery (VR). Cardiorespiratory fitness (CRF) is a key measurement for evaluating cardiac patients, with higher CRF linked to lower mortality. Maximum oxygen uptake (VO2-peak), measured during exercise, is a prognostic parameter of CRF but has limitations. Therefore, biomarkers that offer quantitative and objective knowledge of CFR are warranted. Brain natriuretic peptide (BNP) is produced by the ventricles in response to damage, myocardial stretch, or ischemia. N-terminal pro-B-type natriuretic peptide (NT-pro-BNP) is the biologically inactive peptide that is cleaved off the pro-hormone, proBNP. Higher levels of both peptides have been associated with poorer cardiac outcomes in patients with cardiac conditions. The aim of this study was to investigate whether NT-pro-BNP and HS-CRP (high sensitive CRP) can be used as biomarkers of CFR (VO2-peak and 6 minutes walk distance (6MWD)) and their change over time in patients with RFA, VR or IE. Study Design and Methods We used data from 342 participants included in the CopenHeart trials with complete data on NT-pro-BNP, HS-CRP, 6MWD and VO2-peak at baseline. Results Of the 342 participant, 242 completed follow-up at 4 months and 222 at 12 months. Multivariate models, adjusting for age group, sex and cardiac complications showed that higher baseline NT-pro-BNP and HS-CRP was associated with lower VO2-peak (p=0.002 and p=0.006). Addition of NT-pro-BNP and HS-CRP in the same model showed similar results (see figure 1 and 2). VO2-peak was higher among individuals with RFA compared to IE, and VO2-peak decreased significantly by higher age group compared to age <50 years. However, higher baseline NT-pro-BNP and HS-CRP was not associated with poorer/shorter 6MWD. Compared to participants after IE, participants in the RFA and VR groups had better 6MWD, and 6MWD decreased significantly by higher age group compared to age <50 years. Neither NT-pro-BNP nor HS-CRP at baseline was associated with changes in VO2-peak or 6MWD from baseline until 4th months. Conclusion Higher baseline NT-pro-BNP and HS-CRP was associated with lower VO2-peak, but not 6MWT. Since VO2 peak is considered the most valid CRF test, the results could indicate that higher NT-pro-BNP and HS-CRP is associated with lower CRF in patients with RFA, IE and VR similarly to patients with other cardiovascular diseases.Figure 1 and 2

Aims Patients with heart failure (HF) often experience delayed identification of palliative care needs. While communication with HF patients and their caregivers is increasingly stressed, systematic conversations about end-of-life care wishes remain a gap. This study explores a dyad experience of Advance Care Planning (ACP) conversations in an HF outpatient clinic.Methods and results A qualitative interview study with 15 patients diagnosed with end-stage HF and 14 caregivers. Through qualitative content analysis and investigator triangulation, three subthemes emerged: 'ACP as a harsh reality', 'ACP as a catalyst for crucial conversations', and 'ACP conversations help appreciating life's small moments and adjusting hope'. Despite significant symptom burden, many patients lacked awareness of their end-stage HF prognosis. Following an initial 'reality shock', ACP conversations facilitated open discussions about end-of-life care wishes. Especially spousal caregivers experienced a significant caregiving load, generating complex emotions for both patients and their families. Notably, patients prioritized self-care, daily activities, and social interaction for maintaining quality of life.Conclusion This study highlights a gap between patients with end-stage HF disease status and their comprehension of disease severity. Early integration of ACP may address knowledge gaps, enable informed decision-making, and alleviate caregiver burden. The study also emphasizes the patient-and family-centred care to support self-care, daily life activities, and social connections for improved quality of life throughout the disease trajectory.Registration ClinicalTrials.gov: NCT05269875

Surviving an out-of-hospital cardiac arrest (OHCA) might can lead to long-term consequences, including fatigue, reduced quality of life, and mental health challenges. Although these factors impact daily activities, the influence of fatigue across specific age groups is currently unknown. The objective of this study was to describe the proportion and severity of fatigue, and to investigate the association between age groups (18-64 and +65 years) and fatigue, adjusted for socio-demographic-, clinical-, and self-reported outcomes. This study is based on data from a national cross-sectional survey, the DANish Cardiac Survivorship (DANCAS) survey. OHCA survivors aged ≥18 years and alive at 30 days post-OHCA were included. In the current study, the following self-reported outcome measures were included: Modified Fatigue Impact Scale, MFIS (measuring fatigue), Hospital Anxiety and Depression Scale, HADS (measuring symptoms of anxiety, HADS-A and depression HADS-D), WHO Disability Assessment Schedule, WHODAS 2.0 (measuring disability). Descriptive statistics were used to describe socio-demographic-, clinical- and self-reported outcomes across the two age groups. A simple (unadjusted) and two adjusted linear regression models (Model 1, adjusted for socio-demographic and clinical characteristics, Model 2 further adjusted for HADS-A, HADS-D and WHODAS) were used to investigate the association between age groups and fatigue, reported as regression coefficients β and 95% confidence intervals (CI). In total, n=1236 responding survivors were included in the study, with a median age of 67 years (interquartile range, IQR 57-74) divided into the two age groups: 18-64 years n=551, 65+ years n=685. Across the population, 81% were men. Younger survivors reported significantly higher (worse) levels of fatigue (median 19 IQR 6-38) compared to older survivors (median 13 IQR 5-28), in addition to worse scores on HADS-A, HADS-D and WHODAS 2.0. The regression analyses revealed that being in the younger age group was significantly associated with an increase in fatigue scores in both adjusted models (Model 1 β 4.80 95% CI 2.63;6.98, Model 2 β 1.57 95% CI 0.22;2.92), Table 1. Younger OHCA survivors reported statistically significantly worse levels of fatigue compared to older survivors, along with worse self-reported anxiety, depression and disability. Younger age was significantly associated with fatigue in adjusted models, although the inclusion of self-reported outcome measures reduced the strength of the association, highlighting their influence on fatigue. These findings demonstrate the importance of addressing age-specific challenges in rehabilitation- and support programs, in addition to emphasizing that fatigue following OHCA is a complexconcept influenced by multiple psychosocial and clinical factors.Table 1

AIM:This study aimed to establish general consensus on a systematic needs assessment model to determine eligibility for cardiac rehabilitation (CR) as part of secondary prevention in individuals with atrial fibrillation (AF). Specific objectives included identifying relevant needs assessment criteria and establishing consensus on referral criteria. METHODS:A Delphi study was conducted following the ACCORD guidelines (ACcurate COnsensus Reporting Document) with participation of an international, multi-disciplinary expert panel including physicians, nurses and other healthcare professionals, across primary and secondary care as well as academic research. The panel also included six people who had AF themselves. The Delphi process involved three iterative rounds of surveys and a video meeting to determine needs assessment criteria and facilitate consensus. Data collection included qualitative feedback and quantitative voting on proposed criteria. RESULTS:Sixty-nine experts participated. There was high agreement on the importance of the study, which identified 12 needs assessment criteria related to AF symptom burden, health-related quality of life, anxiety, medicine adherence, and various risk factors. Whilst there was agreement on the needs assessment model, experts noted that referral criteria should be flexible and tailored to local healthcare settings, emphasizing that each individual's situation is unique. CONCLUSION:This Delphi study established a needs assessment model that can be adapted to local contexts for individuals with AF. More research is needed to refine referral criteria and ensure effective implementation of individually tailored CR strategies.

OBJECTIVE:To undertake a contemporary review of the impact of exercise based cardiac rehabilitation (ExCR) for patients with atrial fibrillation (AF). DATA SOURCES:CENTRAL, MEDLINE, Embase, PsycINFO, CINAHL, WoS Core Collection, LILACS and trial registers were searched from inception up to 24 March 2024. ELIGIBILITY CRITERIA:Randomised clinical trials (RCTs) comparing ExCR with any non-exercise control. DESIGN:Random effect meta-analyses presented as effect estimates and 95% CIs. Meta-regression examined study level effect modification. Cochrane risk of bias, GRADE (Grading of Recommendations Assessment, Development and Evaluation) and trial sequential analysis (RTSA) were applied. RESULTS:20 RCTs (n=2039) with a mean follow-up of 11 months showed that ExCR did not impact all cause mortality (8.3% vs 6.0%, relative risk (RR) 1.06, 95% CI 0.76 to 1.48) or serious adverse events (2.9% vs 4.1%, RR 1.30, 95% CI 0.66 to 2.56) but did reduce AF symptom severity (mean difference (MD) -1.61, 95% CI -3.06 to -0.16), AF burden (MD -1.61, 95% CI -2.76 to -0.45), episode frequency (MD -0.57, 95% CI -1.07 to -0.07), episode duration (MD -0.58, 95% CI -1.14 to -0.03), AF recurrence (RR 0.68, 95% CI 0.53 to 0.89), and improved exercise capacity (maximal oxygen consumption (VO2 peak) MD 3.18, 95% CI 1.05 to 5.31 mL/kg/min). There was benefit for the mental component but not the physical component of a health related quality of life questionnaire. No differential effects across AF subtype, ExCR dose, or mode of delivery were seen. CONCLUSION:Meta-analyses of RCT evidence for ExCR in patients with AF demonstrated several clinical benefits without an increase in serious adverse events. GRADE and RTSA assessments indicated further high quality and adequately powered RCTs are needed.

BACKGROUND:Persistent cognitive deficits affect up to 50 % of out-of-hospital cardiac arrest (OHCA) survivors. Despite this prevalence, no consensus exists on the optimal tool for identifying deficits. This study assessed the predictive validity of the digital DANcSCA by comparing its classification of OHCA survivors into risk classes-green (low), yellow (moderate), and red (high)-against a neuropsychological test battery as the reference standard. METHODS:The prospective, multicentre DANcSCA validation study was conducted at Danish hospitals and the Knowledge Centre for Rehabilitation and Palliative Care. Adult OHCA survivors were included. The reference standard comprised four neuropsychological tests: Rey Auditory Verbal Learning Test, Symbol Digit Modalities Test, Trail Making Test, and Verbal Fluency. The DANcSCA index test used subtests from the Cambridge Neuropsychological Test Automated Battery. Cognitive assessments occurred six to eight weeks post-arrest or during rehabilitation three months to three years post-arrest. ROC curves were constructed for binary classifications of green versus non-green and red versus non-red. Thresholds were set by fixing sensitivity at 0.90 for the green/non-green ROC and specificity at 0.90 for the red/non-red ROC. RESULTS:Among 175 participants, the DANcSCA classified 23 % as green, 59 % as yellow, and 18 % as red, with 9 % false positives and 5 % false negatives. The ROC curve for distinguishing green from non-green had an AUC of 0.77, and for distinguishing red from non-red an AUC of 0.89. CONCLUSION:The digital DANcSCA appears suitable for cognitive screening following OHCA, although the modest AUC for green/non-green and potential overfitting warrant validation in new samples.

BACKGROUND:The evidence supporting beta-blocker therapy after myocardial infarction was established before the introduction of modern coronary reperfusion therapy and secondary prevention strategies. METHODS:In an open-label, randomized trial with blinded end-point evaluation, conducted in Denmark and Norway, we assigned patients who had had a myocardial infarction and who had a left ventricular ejection fraction of at least 40%, in a 1:1 ratio, to receive long-term beta-blocker therapy within 14 days after the event or no beta-blocker therapy. The primary end point was a composite of death from any cause or major adverse cardiovascular events (new myocardial infarction, unplanned coronary revascularization, ischemic stroke, heart failure, or malignant ventricular arrhythmias). RESULTS:A total of 5574 patients underwent randomization and were included in the main analyses - 2783 in the beta-blocker group and 2791 in the no-beta-blocker group. After a median follow-up of 3.5 years (interquartile range, 2.2 to 4.6), a primary end-point event had occurred in 394 patients (14.2%) in the beta-blocker group and in 454 patients (16.3%) in the no-beta-blocker group (hazard ratio, 0.85; 95% confidence interval [CI], 0.75 to 0.98; P = 0.03). Death from any cause occurred in 4.2% of the patients in the beta-blocker group and in 4.4% of those in the no-beta-blocker group; myocardial infarction occurred in 5.0% and 6.7%, respectively (hazard ratio, 0.73; 95% CI, 0.59 to 0.92), unplanned coronary revascularization in 3.9% and 3.9%, ischemic stroke in 1.6% and 1.3%, heart failure in 1.5% and 1.9%, and malignant ventricular arrhythmias in 0.5% and 0.6%. No apparent differences in safety outcomes were observed between the groups. CONCLUSIONS:Among patients with a myocardial infarction and a left ventricular ejection fraction of at least 40%, beta-blocker therapy led to a lower risk of death or major adverse cardiovascular events than no beta-blocker therapy. (Funded by the Health South-East research program in Norway and others; BETAMI-DANBLOCK ClinicalTrials.gov numbers, NCT03646357 and NCT03778554.).

BACKGROUND:The integration of Patient Reported Outcome Measures (PROM) in cardiac rehabilitation practice has potential to enhance patient involvement and management. User acceptance is crucial for successful implementation of healthcare interventions, but limited literature addresses PROM acceptability among cardiovascular patients. This study explored the acceptability of a new national PROM in cardiac rehabilitation clinical practice for patients with ischemic heart disease (IHD) in Denmark. METHODS:Patients who responded to the PROM were invited to complete two brief surveys evaluating perceived relevance, usefulness, and satisfaction. A purposefully selected subsample participated in semi structured interviews to gather in-depth experiences. A parallel convergent mixed-methods design was used with the Theoretical Framework of Acceptability applied to structure and interpret findings. RESULTS:105 and 119 patients respectively responded to the two evaluation surveys (response-rates 56.5% and 53.4% respectively) and 25 patients were interviewed. The study showed a strong willingness to engage with PROMs, indicating a high overall acceptability. Most patients perceived the PROM helpful for preparation and enhancing communication during consultations. A minority of patients reported emotional reactions and experienced issues with questionnaire comprehensiveness, structure, and relevance. CONCLUSION:The findings indicate that most IHD patients find PROM relevant and useful in cardiac rehabilitation. To enhance acceptability and, hence, future implementation, improvements are needed in clinical settings by providing adequate patient information, effectively using PRO results, and addressing patients' emotional reactions. Additionally, PROM development should focus on ensuring the questionnaire's relevance, comprehensiveness, and structure.

Cognitive deficits are prevalent among cardiac arrest survivors, yet there is no consensus on standardised screening methods. Hence, a novel screening tool is needed to assist healthcare professionals in determining the necessity of further assessment or rehabilitation. This paper reports on the development process of a cognitive screening for cardiac arrest survivors and makes recommendations for timing and how to communicate the results. Based on an iterative process that included clinical observations and roundtable discussions, we underwent a four-phase development process grounded in the GUIDED guidelines (Duncan E, BMJ Open 10:e033516, 2020). During the first phase, we explored the cognitive after-effects of cardiac arrest, focusing on potentially affected cognitive functions, suitable tests, and cognitive rehabilitation needs. The second phase included developing a pen-and-paper neuropsychological screening battery, which proved too resource-intensive due to its reliance on neuropsychologists. Consequently, in the third phase, we transitioned to a tablet-based screening tool. The fourth phase involved proof of concept, assessing whether we had developed a feasible cognitive screening for cardiac arrest survivors that could be implemented in hospital departments and rehabilitation settings. For this procedure, we determined that the appropriate time for screening is six to eight weeks after hospital discharge, with screening results categorised as: 'no concerns,' 'need for further assessment,' and 'need for specialised rehabilitation. The screening, appropriate timing for its administration, and communication of results are presented. We have successfully developed and reported a digital screening for cognitive deficits following cardiac arrest. This approach has the potential to enable systematic screening of all cardiac arrest survivors.

Ongoing monitoring and targeted treatment are important to ensure the best blood-pressure control and thus prevent cardiovascular risks. In this review, we evaluate the findings of four clinical studies investigating the effects of morning versus bedtime dosing of antihypertensives. In three out of four studies, overwhelming results were found favouring bedtime dosing. The same studies have been criticized for mechanistic implausible results and multiple study biases. No harmful effects were reported in relation to bedtime dosing. Thus, antihypertensives can be taken as it is most convenient for the patient.

Cardiac arrest (CA) survivorship is associated with risk of cognitive deficits, emotional and social consequences. Early recognition of these symptoms and referral to rehabilitation is considered to be the fifth link in the chain of survival. This review highlights the need for a national standardized care plan for CA survivors based on a multidisciplinary approach. A patient-tailored law-bound rehabilitation form is essential to proper services in Denmark and should be mandatory. Further research within different rehabilitation areas following CA is warranted to support clinical practice.

BACKGROUND AND AIMS:A heart-healthy diet is an important component of secondary prevention in ischemic heart disease. The Danish Health Authority recommends using the validated 19-item food frequency questionnaire HeartDiet in cardiac rehabilitation practice to assess patients' need for dietary interventions, and HeartDiet has been included in national electronic patient-reported outcome instruments for cardiac rehabilitation. This study aims to evaluate challenges and benefits of its use. The objectives are to: 1) describe HeartDiet responses of patients with ischemic heart disease and discuss HeartDiet's suitability as a screening tool, 2) discuss whether an abridged version should replace HeartDiet. METHODS AND RESULTS:A cross-sectional study using data from a national feasibility test. HeartDiet was sent electronically to 223 patients with ischemic heart disease prior to cardiac rehabilitation. Data were summarised with descriptive statistics, and Spearman's rank correlations, explorative factor analysis, and Cohen's kappa coefficient were used to derive and evaluate abridged versions. The response rate was 68 % (n = 151). Evaluated with HeartDiet, no respondents had a heart-healthy diet. There was substantial agreement between HeartDiet and an abridged 9-item version (kappa = 0.6926 for Fat Score, 0.6625 for FishFruitVegetable Score), but the abridged version omits information on milk products, wholegrain, nuts, and sugary snacks. CONCLUSION:With the predefined cut-offs, HeartDiet's suitability as a screening tool to assess needs for dietary interventions was limited, since no respondents were categorised as having a heart-healthy diet. An abridged version can replace HeartDiet, but the tool's educational potential will be compromised, since important items will be omitted.

Abstract Background The European Society of Cardiology (ESC) guidelines for the management of atrial fibrillation (AF) recommend integrated care in AF, combining medical treatment with lifestyle modifications and psychosocial management in a multi-disciplinary set-up. Research show that patients with AF can benefit from lifestyle interventions and psychosocial management, like patient education. According to World Health Organization recommendations, these health interventions are moving from hospitals to primary healthcare settings. Therefore, patients with AF should be systematically referred to these interventions. Yet, an evidence-based referral model that can support this transition is lacking. Purpose The purpose is to develop a systematic referral model for primary care health interventions for patients with AF. Methods We used the Delphi-technique with three rounds of questionnaires (figure 1). International and national clinical experts in AF across disciplines and health sectors were invited to participate. In the first round, the expert panel evaluated items that could be part of a referral model on relevance, improvability and self-reporting. In the second round, the expert panel evaluated each item as either an inclusion or exclusion criteria, important knowledge to have, or not relevant. In the third round, the expert panel evaluated the items according to data source and outcome status. A final model was drawn based on items reaching consensus. The study was reported according to the guidance on conducting and reporting Delphi studies (CREDES). Results In total, 69 of 139 invited experts accepted to participate (50%). These were mostly academics or clinicians (90%), stemming from primary sector (16%), secondary sector (35%) and research (32%). Most were medical doctors (36%) and nurses (35%). However physiotherapist, psychologists, dieticians, and other disciplines along with six patients with AF were also represented. The expert panel (60% females) had a mean age of 50 years, and 65% were from Denmark. For the final referral model (figure 2), AF symptom burden and impaired health-related quality of life, anxiety and poor medicine compliance combined with a risk factor profile were the main inclusion criteria. Furthermore, it was important to know about the patients’ mental well-being, self-management abilities and comorbidities. Conclusion Consensus was reached for a generic referral model, which can be further adjusted in the appropriate clinical context. The model includes inclusion criteria which closely correlate with guidelines for AF management focusing on reducing the patients’ symptom and risk factor burden. The referral model is expected to increase the number of patients with AF referred to primary care health interventions, which could lead to better quality of life, fewer hospital admissions and lowered health care costs in AF.

Introduction: Existing estimates of PD prevalence in Denmark are lower than those in the rest of Europe and are based on identification via single registries. Hence, are aim was to use a combined registry/self-report survey approach to identify people with PD and also investigate whether using different registry methods led to differences in the accuracy, completeness and characteristics of the identified cohorts. Methods: This study had a cross-sectional design using routinely collected health registry data to identify adults, >= 18 years of age and resident in Denmark, with PD from either the Danish National Patient (DNP) registry or Danish Prescription Medicines (DPM) registry. Those identified were asked to confirm their PD diagnosis using a national self -report survey. Results: 13,433 people were identified potentially as having PD via the DNP or DPM registry and sent a survey. Of these, 9094 responded (68 %) of which 85 % confirmed they had PD (n = 7763; 194/100,000; 95%CI:7650-7876). When adjusting for non -respondents, assuming an equal rate of confirmation in respondents and non -respondents, estimated Danish PD population was 11,467 (198.4/100,000; 95 % CI:197.2-199.6). Identification of people using those found in both registries led to 98 % confirming they had PD versus using one registry: DNP 93 % and DPM 88 %. No clear differences in sociodemographic characteristics were found between different registry identification methods. Conclusions: Estimated PD population in Denmark was significantly higher than previous Danish estimates and close to existing estimates in other European countries. The most accurate PD population was identified when including those found in both the DNP and DPM registries.

CONTEXT:Heart failure (HF) is considered a multifaceted and life-threatening syndrome characterized by high symptom-burden and significant mortality. OBJECTIVES:To describe the symptom-burden in patients with HF and identify their palliative care needs. In this respect, symptom burden related to sex, age and classification of HF using New York Heart Association Functional Classification (NYHA) were analyzed. METHODS:A cross-sectional questionnaire survey included adult HF patients according to NYHA II, III, and IV. Palliative care needs were assessed using validated patient reported outcomes measures; SF-36v1, HeartQoL, EORTC- QLQ-C15-PAL, MFI-20 and HADS. Patients were recruited from the Department of Cardiology, North Zealand Hospital, Denmark. RESULTS:In total, 314 patients (79%) completed the questionnaire (233 men). Mean age = 74 years (range 35-94 years). In all, 42% had NYHA III or IV and 53% self-rated their health to be fair or poor. In all, 19% NYHA II and 67% NYHA III/IV patients had ≥4 severe palliative symptoms according to EORTC-QLQ-C15-PAL. In addition, NYHA III/IV had a mean of 8.9 symptoms and a mean of 5.4 severe symptoms. Women, older patients, and those with NYHA III/IV had worse outcomes regarding health-related quality of life, functional capacity, and symptom burden. CONCLUSIONS:Patients with HF have a high prevalence of symptoms and, thus, potential palliative care needs. Predominantly, women, older patients, and those with higher severity of disease have the highest symptom burden. PROMs can help cardiologists address the palliative care needs and systematic assessment may be a prerequisite to integrate symptom-modifying and palliative care interventions.

Background : Knowledge about caregiver strain among relatives of out-of-hospital cardiac arrest (OHCA) survivors is limited. Thus, the objectives were to i) describe differences in self-reported mental well-being, mental health, and caregiver strain at different time points (1-5 years) post-OHCA and ii) investigate characteristics associated with caregiver strain. Methods : A national cross-sectional survey (DANCAS) from October 2020 to March 2021 with OHCA survivors and their closest relatives. The relative survey included the WHO-5 Well-being Index (WHO-5), the Hospital Anxiety and Depression Scale (HADS) and the Modified Caregiver Strain Index (M-CSI). Differences in scores between time groups were explored using descriptive statistics. Associations between characteristics and caregiver strain were investigated with multivariable logistic regression models, presented as odds ratios (OR) with 95% confidence intervals (CI), adjusted for gender, age, education status, relative affiliation, and time after OHCA. Results : Of 561 relatives, 24% (n = 137) experienced caregiver strain, with no significant differences in the relatives' mental well-being, mental health, or caregiver strain with time since OHCA. In the adjusted analyses, older age (OR 0.98 95% CI 0.96;0.99) and several self-reported outcomes, including reduced mental well-being (WHO-5 OR 7.27 95% CI 4.86;11.52), symptoms of anxiety (HADS-A OR 6.01 95% CI 3.89;9.29) and depression (HADS-D OR 15.03 95% CI 7.33;30.80) were significantly associated with worse caregiver strain. Conclusion : Nearly one-quarter of relatives of OHCA survivors experience caregiver strain, with this proportion remaining unchanged with time. Several outcomes were associated with caregiver strain, emphasising the need to identify relatives at greater risk of burden following OHCA.