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Kirstine Laerum Sibilitz - One of the best experts on this subject based on the ideXlab platform.
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employment status before and after open Heart Valve Surgery a cohort study
PLOS ONE, 2020Co-Authors: Britt Borregaard, Kirstine Laerum Sibilitz, Jordi S Dahl, Lars Riber, Ola Ekholm, Emil L Fosbol, Sasja M Pedersen, Thomas P H Rothberg, Maiken H Nielsen, Selina Kikkenborg BergAbstract:OBJECTIVE Detachment from the workforce following open Heart Valve Surgery is a burden for the patient and society. The objectives were to examine patterns of employment status at different time points and to investigate factors associated with a lower likelihood of returning to the workforce within six months. METHODS A cohort study of patients aged 18-63 undergoing valvular Surgery at a Danish tertiary centre from 2013-2017. Return to the workforce was defined as being employed, unemployed (still capable of working) or receiving paid leave of absence. The association between demographic-, clinical characteristics (including a surgical risk evaluation, EuroScore), and return to the workforce were investigated with a multivariable logistic regression model. RESULTS In total, 1,395 consecutive patients underwent Surgery, 347 were between 18 and 63 years and eligible for inclusion. Of those, 282 were attached to the workforce before Surgery and included in the study. At the time of Surgery, 79% were on paid sick leave. After six months, 21% of the patients (being part of the workforce before Surgery), were still on sick leave. In the regression model, prolonged sick leave prior to Surgery (OR 0.43, 95% CI 0.23-0.79) and EuroScore ≥ 2.3 (OR 0.39, 95% CI 0.21-0.74) significantly reduced the likelihood of returning to the workforce. CONCLUSION One-fifth of patients in the working-age were on sick leave six months after Surgery. Prolonged sick leave prior to Surgery and a EuroScore ≥2.3 were associated with a lower likelihood of returning to the workforce.
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what to expect after open Heart Valve Surgery changes in health related quality of life
Quality of Life Research, 2020Co-Authors: Britt Borregaard, Selina Kikkenborg Berg, Jordi S Dahl, Susanne S Pedersen, Ola Ekholm, Kirstine Laerum SibilitzAbstract:To (i) describe changes in health-related quality of life (HRQoL) pre-operatively, at discharge, and 4 weeks after discharge following open Heart Surgery, (ii) compare the performance of the EuroQol Questionnaire (EQ-5D 5L) and the Kansas City Cardiomyopathy Questionnaire (KCCQ) against an anchor-based approach, and to (iii) investigate the association between HRQoL and 180-day readmission. A prospective, consecutive cohort (single-center study) of 291 patients completed the EQ-5D 5L and KCCQ pre-operatively, at discharge and 4 weeks post-discharge. Changes in HRQoL over time were evaluated, and the performance of the instruments was investigated. The association between HRQoL and readmission were investigated with Cox Proportional Hazard models. Scores of the EQ-5D Index and VAS decreased significantly from the pre-operative assessment to discharge and improved from discharge to 4 weeks after. The KCCQ scores significantly improved from baseline to 4 weeks after. Minimal clinically important improvements from before Surgery to 4 weeks after were seen among 24% (EQ-5D Index), 45% (EQ-5D VAS), and 57% (KCCQ). More than one-third experienced worse HRQoL 1 month after discharge. Area under the curve (AUC) (performance of the instruments) demonstrated the following: EQ-5D Index AUC 0.622 (95% CI 0.540–0.704), VAS AUC 0.674 (95% CI 0.598–0.750), and KCCQ AUC 0.722 (95% CI 0.65–0.792). None of the HRQoL measurements were associated with 180-day readmission. This study revealed that HRQoL measured with the EQ-5D is significantly worse at discharge compared to before Surgery, but scores increases within the first month measured with the EQ-5D and the KCCQ. The EQ-5D and KCCQ have a moderate correlation with an anchor-based approach but were not associated with readmission.
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early follow up after open Heart Valve Surgery reduces healthcare costs a propensity matched study
Open Heart, 2019Co-Authors: Britt Borregaard, Kirstine Laerum Sibilitz, Selina Kikkenborg Berg, Jordi S Dahl, Lars Riber, Ola Ekholm, Marc Weiss, Jacob E Moller, Emilie Karense Lykking, Jan SorensenAbstract:Objectives The objective was to assess differences in healthcare costs within 180 days after discharge from open Heart Valve Surgery in an intervention group receiving early, individualised and intensified follow-up compared with a historical control group. Methods A cost-minimisation analysis comparing costs from a consecutive prospective cohort compared with a propensity matched cohort. Costs related to the intervention, hospital (outpatient visits and readmissions) and general practitioners (all contacts) were included. Data were obtained from electronic patient records and registry data. A logistic propensity model was used to identify the historical control group. Main results are presented as mean differences and 95% CIs based on bootstrapping. Results After matching, the analysis included 300 patients from the intervention group and 580 controls. The mean intervention cost was €171 (SD 79) per patient. After 180 days, the mean healthcare costs were €1284 (SD 2567) for the intervention group and €2077 (SD 4773) for the controls. The cost of the intervention group was €793 (p Conclusions The intervention consisting of early, individualised and intensified follow-up after open Heart Valve Surgery significantly reduced the healthcare costs within 180 days after discharge.
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effect of early individualised and intensified follow up after open Heart Valve Surgery on unplanned cardiac hospital readmissions and all cause mortality
International Journal of Cardiology, 2019Co-Authors: Kirstine Laerum Sibilitz, Britt Borregaard, Jordi S Dahl, Lars Riber, Ola Ekholm, Marc WeissAbstract:Abstract Background Unplanned readmissions after Heart Valve Surgery are common, and constitute a significant burden for the patient and the health care system. The objective was to investigate the effect of individualised follow-up after open Heart Valve Surgery on a composite endpoint of first unplanned cardiac hospital readmission or all-cause mortality within 180 days of discharge. Methods The study is a prospective cohort study comparing the composite endpoint in patients undergoing early, individualised and intensified follow-up after Heart Valve Surgery with a propensity matched historical control group. A total of 308 consecutive patients were enrolled in the prospective cohort study, 980 consecutive patients comprised the control group. The propensity matched group consisted of n = 300 (intervention) and n = 580 (controls). Time to first event was analysed using uni- and multivariable Cox proportional hazard analysis. Kaplan-Meier survival curves were constructed to assess the probability of survival without readmission. Results After 180 days, the proportion of patients experiencing the composite endpoint was significantly lower in the intervention group compared with the controls for the overall, unmatched population (23% vs. 38%; HR 0.55; 95% CI, 0.42 to 0.73; P Conclusion An intervention consisting of early, individualised and intensified follow-up after open Heart Valve Surgery reduced the risk of a composite endpoint of first, unplanned cardiac hospital readmission or all-cause mortality within 180 days.
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measuring hrqol following Heart Valve Surgery the Heartqol questionnaire is a valid and reliable core Heart disease instrument
Quality of Life Research, 2019Co-Authors: Charlotte N Gronset, Kirstine Laerum Sibilitz, Selina Kikkenborg Berg, Lau Caspar Thygesen, Graziella Zangger, Marie Skov Kristensen, Susanne S Pedersen, Neil OldridgeAbstract:Patient-reported health-related quality of life is a complementary healthcare outcome and important when assessing treatment efficacy. Using COSMIN methodological recommendations, this study evaluates the validity and reliability of a core Heart disease-specific health-related quality of life questionnaire, the HeartQoL questionnaire (Danish version) in a sample of patients following Heart Valve Surgery. This project involved a cross-sectional validity study and a test–retest reliability study. Eligible patients completed the HeartQoL, the SF-36 health survey questionnaire, and the Hospital Anxiety and Depression Scale following Heart Valve Surgery. Construct validity was tested using a priori hypotheses. Internal consistency reliability was assessed with Cronbach’s alpha. An independent sample of patients participated in the test–retest study and reproducibility was determined with relative [intra-class correlation coefficient (ICC)] and absolute reliability [standard error of measurement (SEM) and smallest detectable change (SDC)]. Internal consistency was high with Cronbach’s alpha ≥ 0.87. ICC was 0.86–0.92. SEM ranged from 0.17 to 0.26 points and SDC ranged from 0.5 to 0.7 points. Construct validity was confirmed with 87% of all a priori hypotheses for predicted variables. The HeartQoL questionnaire demonstrates acceptable construct validity, internal consistency, and test–retest reproducibility in patients following Heart Valve Surgery. Future studies should focus on assessing the responsiveness of the HeartQoL questionnaire over time and following Heart Valve Surgery.
Selina Kikkenborg Berg - One of the best experts on this subject based on the ideXlab platform.
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association between frailty and self reported health following Heart Valve Surgery
IJC Heart & Vasculature, 2020Co-Authors: Selina Kikkenborg Berg, Britt Borregaard, Jordi S Dahl, Sandra Lauck, Jesper RygAbstract:Abstract Background Knowledge about the association between frailty and self-reported health among patients undergoing Heart Valve Surgery remains sparse. Thus, the objectives were to I) describe changes in self-reported health at different time points according to frailty status, and to II) investigate the association between frailty status at discharge and poor self-reported health four weeks after discharge among patients undergoing Heart Valve Surgery. Methods In a prospective cohort study, consecutive patients undergoing Heart Valve Surgery, including transapical/transaortic Valve procedures were included. Frailty was measured using the Fried score, and self-reported health using the Kansas City Cardiomyopathy Questionnaire (KCCQ) and the EuroQoL-5 Dimensions 5-Levels Health Status Questionnaire (EQ-5D-5L). To investigate the association between frailty and self-reported health, multivariable logistic regression models were used. Analyses were adjusted for sex, age, surgical risk evaluation (EuroScore) and procedure and presented as odds ratios (OR) with 95% confidence intervals (CI). Results Frailty was assessed at discharge in 288 patients (median age 71, 69% men); 51 patients (18%) were frail. In the multivariable analyses, frailty at discharge remained significantly associated with poor self-reported health at four weeks, OR (95% CI): EQ-5D-5L Index 3.38 (1.51–7.52), VAS 2.41 (1.13–5.14), and KCCQ 2.84 (1.35–5.97). Conclusion Frailty is present at discharge in 18% of patients undergoing Heart Valve Surgery, and being frail is associated with poor self-reported health at four weeks of follow-up. This supports a clinical need to address the unique risk of frail patients among Heart Valve teams broadly, and not only to measure frailty as a marker of operative risk.
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employment status before and after open Heart Valve Surgery a cohort study
PLOS ONE, 2020Co-Authors: Britt Borregaard, Kirstine Laerum Sibilitz, Jordi S Dahl, Lars Riber, Ola Ekholm, Emil L Fosbol, Sasja M Pedersen, Thomas P H Rothberg, Maiken H Nielsen, Selina Kikkenborg BergAbstract:OBJECTIVE Detachment from the workforce following open Heart Valve Surgery is a burden for the patient and society. The objectives were to examine patterns of employment status at different time points and to investigate factors associated with a lower likelihood of returning to the workforce within six months. METHODS A cohort study of patients aged 18-63 undergoing valvular Surgery at a Danish tertiary centre from 2013-2017. Return to the workforce was defined as being employed, unemployed (still capable of working) or receiving paid leave of absence. The association between demographic-, clinical characteristics (including a surgical risk evaluation, EuroScore), and return to the workforce were investigated with a multivariable logistic regression model. RESULTS In total, 1,395 consecutive patients underwent Surgery, 347 were between 18 and 63 years and eligible for inclusion. Of those, 282 were attached to the workforce before Surgery and included in the study. At the time of Surgery, 79% were on paid sick leave. After six months, 21% of the patients (being part of the workforce before Surgery), were still on sick leave. In the regression model, prolonged sick leave prior to Surgery (OR 0.43, 95% CI 0.23-0.79) and EuroScore ≥ 2.3 (OR 0.39, 95% CI 0.21-0.74) significantly reduced the likelihood of returning to the workforce. CONCLUSION One-fifth of patients in the working-age were on sick leave six months after Surgery. Prolonged sick leave prior to Surgery and a EuroScore ≥2.3 were associated with a lower likelihood of returning to the workforce.
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what to expect after open Heart Valve Surgery changes in health related quality of life
Quality of Life Research, 2020Co-Authors: Britt Borregaard, Selina Kikkenborg Berg, Jordi S Dahl, Susanne S Pedersen, Ola Ekholm, Kirstine Laerum SibilitzAbstract:To (i) describe changes in health-related quality of life (HRQoL) pre-operatively, at discharge, and 4 weeks after discharge following open Heart Surgery, (ii) compare the performance of the EuroQol Questionnaire (EQ-5D 5L) and the Kansas City Cardiomyopathy Questionnaire (KCCQ) against an anchor-based approach, and to (iii) investigate the association between HRQoL and 180-day readmission. A prospective, consecutive cohort (single-center study) of 291 patients completed the EQ-5D 5L and KCCQ pre-operatively, at discharge and 4 weeks post-discharge. Changes in HRQoL over time were evaluated, and the performance of the instruments was investigated. The association between HRQoL and readmission were investigated with Cox Proportional Hazard models. Scores of the EQ-5D Index and VAS decreased significantly from the pre-operative assessment to discharge and improved from discharge to 4 weeks after. The KCCQ scores significantly improved from baseline to 4 weeks after. Minimal clinically important improvements from before Surgery to 4 weeks after were seen among 24% (EQ-5D Index), 45% (EQ-5D VAS), and 57% (KCCQ). More than one-third experienced worse HRQoL 1 month after discharge. Area under the curve (AUC) (performance of the instruments) demonstrated the following: EQ-5D Index AUC 0.622 (95% CI 0.540–0.704), VAS AUC 0.674 (95% CI 0.598–0.750), and KCCQ AUC 0.722 (95% CI 0.65–0.792). None of the HRQoL measurements were associated with 180-day readmission. This study revealed that HRQoL measured with the EQ-5D is significantly worse at discharge compared to before Surgery, but scores increases within the first month measured with the EQ-5D and the KCCQ. The EQ-5D and KCCQ have a moderate correlation with an anchor-based approach but were not associated with readmission.
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early follow up after open Heart Valve Surgery reduces healthcare costs a propensity matched study
Open Heart, 2019Co-Authors: Britt Borregaard, Kirstine Laerum Sibilitz, Selina Kikkenborg Berg, Jordi S Dahl, Lars Riber, Ola Ekholm, Marc Weiss, Jacob E Moller, Emilie Karense Lykking, Jan SorensenAbstract:Objectives The objective was to assess differences in healthcare costs within 180 days after discharge from open Heart Valve Surgery in an intervention group receiving early, individualised and intensified follow-up compared with a historical control group. Methods A cost-minimisation analysis comparing costs from a consecutive prospective cohort compared with a propensity matched cohort. Costs related to the intervention, hospital (outpatient visits and readmissions) and general practitioners (all contacts) were included. Data were obtained from electronic patient records and registry data. A logistic propensity model was used to identify the historical control group. Main results are presented as mean differences and 95% CIs based on bootstrapping. Results After matching, the analysis included 300 patients from the intervention group and 580 controls. The mean intervention cost was €171 (SD 79) per patient. After 180 days, the mean healthcare costs were €1284 (SD 2567) for the intervention group and €2077 (SD 4773) for the controls. The cost of the intervention group was €793 (p Conclusions The intervention consisting of early, individualised and intensified follow-up after open Heart Valve Surgery significantly reduced the healthcare costs within 180 days after discharge.
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measuring hrqol following Heart Valve Surgery the Heartqol questionnaire is a valid and reliable core Heart disease instrument
Quality of Life Research, 2019Co-Authors: Charlotte N Gronset, Kirstine Laerum Sibilitz, Selina Kikkenborg Berg, Lau Caspar Thygesen, Graziella Zangger, Marie Skov Kristensen, Susanne S Pedersen, Neil OldridgeAbstract:Patient-reported health-related quality of life is a complementary healthcare outcome and important when assessing treatment efficacy. Using COSMIN methodological recommendations, this study evaluates the validity and reliability of a core Heart disease-specific health-related quality of life questionnaire, the HeartQoL questionnaire (Danish version) in a sample of patients following Heart Valve Surgery. This project involved a cross-sectional validity study and a test–retest reliability study. Eligible patients completed the HeartQoL, the SF-36 health survey questionnaire, and the Hospital Anxiety and Depression Scale following Heart Valve Surgery. Construct validity was tested using a priori hypotheses. Internal consistency reliability was assessed with Cronbach’s alpha. An independent sample of patients participated in the test–retest study and reproducibility was determined with relative [intra-class correlation coefficient (ICC)] and absolute reliability [standard error of measurement (SEM) and smallest detectable change (SDC)]. Internal consistency was high with Cronbach’s alpha ≥ 0.87. ICC was 0.86–0.92. SEM ranged from 0.17 to 0.26 points and SDC ranged from 0.5 to 0.7 points. Construct validity was confirmed with 87% of all a priori hypotheses for predicted variables. The HeartQoL questionnaire demonstrates acceptable construct validity, internal consistency, and test–retest reproducibility in patients following Heart Valve Surgery. Future studies should focus on assessing the responsiveness of the HeartQoL questionnaire over time and following Heart Valve Surgery.
Lars Hermann Tang - One of the best experts on this subject based on the ideXlab platform.
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cardiac rehabilitation increases physical capacity but not mental health after Heart Valve Surgery a randomised clinical trial
Heart, 2016Co-Authors: Kirstine Laerum Sibilitz, Lau Caspar Thygesen, Signe Stelling Risom, S K Berg, Trine Bernholdt Rasmussen, Lars Hermann TangAbstract:Objective The evidence for cardiac rehabilitation after Valve Surgery remains sparse. Current recommendations are therefore based on patients with ischaemic Heart disease. The aim of this randomised clinical trial was to assess the effects of cardiac rehabilitation versus usual care after Heart Valve Surgery. Methods The trial was an investigator-initiated, randomised superiority trial (The CopenHeart VR trial, VR; Valve replacement or repair). We randomised 147 patients after Heart Valve Surgery 1:1 to 12 weeks of cardiac rehabilitation consisting of physical exercise and monthly psycho-educational consultations (intervention) versus usual care without structured physical exercise or psycho-educational consultations (control). Primary outcome was physical capacity measured by VO 2 peak and secondary outcome was self-reported mental health measured by Short Form-36. Results 76% were men, mean age 62 years, with aortic (62%), mitral (36%) or tricuspid/pulmonary Valve Surgery (2%). Cardiac rehabilitation compared with control had a beneficial effect on VO 2 peak at 4 months (24.8 mL/kg/min vs 22.5 mL/kg/min, p=0.045) but did not affect Short Form-36 Mental Component Scale at 6 months (53.7 vs 55.2 points, p=0.40) or the exploratory physical and mental outcomes. Cardiac rehabilitation increased the occurrence of self-reported non-serious adverse events (11/72 vs 3/75, p=0.02). Conclusions Cardiac rehabilitation after Heart Valve Surgery significantly improves VO 2 peak at 4 months but has no effect on mental health and other measures of exercise capacity and self-reported outcomes. Further research is needed to justify cardiac rehabilitation in this patient group. Trial registration number NCT01558765, Results.
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exercise based cardiac rehabilitation for adults after Heart Valve Surgery
Cochrane Database of Systematic Reviews, 2016Co-Authors: Kristine Laerum Sibilitz, Lars Kober, Selina Kikkenborg Berg, Lars Hermann Tang, Signe Stelling Risom, Christian Gluud, Jane Lindschou, Christian HassagerAbstract:Exercise-based cardiac rehabilitation may benefit Heart Valve Surgery patients. We conducted a systematic review to assess the evidence for the use of exercise-based intervention programmes following Heart Valve Surgery.To assess the benefits and harms of exercise-based cardiac rehabilitation compared with no exercise training intervention, or treatment as usual, in adults following Heart Valve Surgery. We considered programmes including exercise training with or without another intervention (such as a psycho-educational component).We searched: the Cochrane Central Register of Controlled Trials (CENTRAL); the Database of Abstracts of Reviews of Effects (DARE); MEDLINE (Ovid); EMBASE (Ovid); CINAHL (EBSCO); PsycINFO (Ovid); LILACS (Bireme); and Conference Proceedings Citation Index-S (CPCI-S) on Web of Science (Thomson Reuters) on 23 March 2015. We handsearched Web of Science, bibliographies of systematic reviews and trial registers (ClinicalTrials.gov, Controlled-trials.com, and The World Health Organization International Clinical Trials Registry Platform).We included randomised clinical trials that investigated exercise-based interventions compared with no exercise intervention control. The trial participants comprised adults aged 18 years or older who had undergone Heart Valve Surgery for Heart Valve disease (from any cause) and received either Heart Valve replacement, or Heart Valve repair.Two authors independently extracted data. We assessed the risk of systematic errors ('bias') by evaluation of bias risk domains. Clinical and statistical heterogeneity were assessed. Meta-analyses were undertaken using both fixed-effect and random-effects models. We used the GRADE approach to assess the quality of evidence. We sought to assess the risk of random errors with trial sequential analysis.We included two trials from 1987 and 2004 with a total 148 participants who have had Heart Valve Surgery. Both trials had a high risk of bias.There was insufficient evidence at 3 to 6 months follow-up to judge the effect of exercise-based cardiac rehabilitation compared to no exercise on mortality (RR 4.46 (95% confidence interval (CI) 0.22 to 90.78); participants = 104; studies = 1; quality of evidence: very low) and on serious adverse events (RR 1.15 (95% CI 0.37 to 3.62); participants = 148; studies = 2; quality of evidence: very low). Included trials did not report on health-related quality of life (HRQoL), and the secondary outcomes of New York Heart Association class, left ventricular ejection fraction and cost. We did find that, compared with control (no exercise), exercise-based rehabilitation may increase exercise capacity (SMD -0.47, 95% CI -0.81 to -0.13; participants = 140; studies = 2, quality of evidence: moderate). There was insufficient evidence at 12 months follow-up for the return to work outcome (RR 0.55 (95% CI 0.19 to 1.56); participants = 44; studies = 1; quality of evidence: low). Due to limited information, trial sequential analysis could not be performed as planned.Our findings suggest that exercise-based rehabilitation for adults after Heart Valve Surgery, compared with no exercise, may improve exercise capacity. Due to a lack of evidence, we cannot evaluate the impact on other outcomes. Further high-quality randomised clinical trials are needed in order to assess the impact of exercise-based rehabilitation on patient-relevant outcomes, including mortality and quality of life.
Anndorthe Zwisler - One of the best experts on this subject based on the ideXlab platform.
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cost utility analysis of cardiac rehabilitation after conventional Heart Valve Surgery versus usual care
European Journal of Preventive Cardiology, 2017Co-Authors: Kirstine Laerum Sibilitz, Selina Kikkenborg Berg, Lau Caspar Thygesen, Anndorthe Zwisler, Tina Birgitte Hansen, Jakob Kjellberg, Patrick Doherty, Neil OldridgeAbstract:Background While cardiac rehabilitation in patients with ischaemic Heart disease and Heart failure is considered cost-effective, this evidence may not be transferable to Heart Valve Surgery patients. The aim of this study was to investigate the cost-effectiveness of cardiac rehabilitation following Heart Valve Surgery. Design We conducted a cost-utility analysis based on a randomised controlled trial of 147 patients who had undergone Heart Valve Surgery and were followed for 6 months. Methods Patients were randomised to cardiac rehabilitation consisting of 12 weeks of physical exercise training and monthly psycho-educational consultations or to usual care. Costs were measured from a societal perspective and quality-adjusted life years were based on the EuroQol five-dimensional questionnaire (EQ-5D). Estimates were presented as means and 95% confidence intervals (CIs) based on bootstrapping. Costs and effect differences were presented in a cost-effectiveness plane and were transformed into net benefit and presented in cost-effectiveness acceptability curves. Results No statistically significant differences were found in total societal costs (-1609 Euros; 95% CI: -6162 to 2942 Euros) or in quality-adjusted life years (-0.000; 95% CI -0.021 to 0.020) between groups. However, approximately 70% of the cost and effect differences were located below the x-axis in the cost-effectiveness plane, and the cost-effectiveness acceptability curves showed that the probability for cost- effectiveness of cardiac rehabilitation compared to usual care is at minimum 75%, driven by a tendency towards costs savings. Conclusions Cardiac rehabilitation after Heart Valve Surgery may not have improved health-related quality of life in this study, but is likely to be cost-effective for society, outweighing the extra costs of cardiac rehabilitation.
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cardiac rehabilitation patients perspectives on the recovery following Heart Valve Surgery a narrative analysis
Journal of Advanced Nursing, 2016Co-Authors: Tina Birgitte Hansen, Kirstine Laerum Sibilitz, Selina Kikkenborg Berg, Anndorthe Zwisler, Niels Buus, Anne LeeAbstract:Aims To explore the structure and content of narratives about the recovery process among patients undergoing Heart Valve Surgery participating in cardiac rehabilitation. Background Several studies with short-term follow-up have shown that recovering from cardiac Surgery can be challenging, but evidence on the long-term recovery process is very limited, especially following Heart Valve Surgery. Furthermore, few studies have explored the recovery process among cardiac rehabilitation participants. Design A qualitative study with serial interviews analysed using narrative methods. Methods We collected data over 18 months (April 2013–October 2014). We recruited nine patients undergoing Heart Valve Surgery from a randomized trial, CopenHeartVR and conducted 27 individual narrative interviews at 2-3 weeks, 3-4 months and 8-9 months after Surgery. Findings Following Heart Valve Surgery, the participants expected to return to normality. The analysis identified four courses of recovery, with three non-linear complex pathways deviating from the classic restitution narrative: the frustrated struggle to resume normality, the challenged expectation of normality – being in a limbo and becoming a Heart patient. These deviating pathways were characterized by physical, existential and mental challenges even up to 9 months after Surgery. Conclusion The recovery processes of participants' in cardiac rehabilitation were often more complicated than anticipated. Patients undergoing Heart Valve Surgery may benefit from more extensive medical follow-up immediately after discharge, individual psychological assessment and individualized, realistic information about the recovery trajectory.
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high readmission rate after Heart Valve Surgery a nationwide cohort study
International Journal of Cardiology, 2015Co-Authors: Kirstine Laerum Sibilitz, Lars Kober, Selina Kikkenborg Berg, Lau Caspar Thygesen, Tina Hansen, Christian Hassager, Anndorthe ZwislerAbstract:Abstract Background After Heart Valve Surgery, knowledge on long-term self-reported health status and readmission is lacking. Thus, the optimal strategy for out-patient management after Surgery remains unclear. Methods Using a nationwide survey with linkage to Danish registers with one year follow-up, we included all adults 6–12months after Heart Valve Surgery irrespective of Valve procedure, during Jan–June 2011 (n=867). Participants completed a questionnaire regarding health-status (n=742), and answers were compared with age- and sex-matched healthy controls. Readmission rates and mortality were investigated. Results After Valve Surgery, the self-reported health was lower (Short Form-36 (SF-36) Physical Component Scale (PCS): 44.5 vs. 50.6 and Mental Component Scale (MCS): 51.9 vs. 55.0, p Conclusions 6–12months after Heart Valve Surgery the readmission rate is high and the self-reported health status is low. Readmission is associated with low self-reported health. Therefore, targeted follow-up strategies post-Surgery are needed.
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availability of referral to and participation in exercise based cardiac rehabilitation after Heart Valve Surgery results from the national copenHeart survey
European Journal of Preventive Cardiology, 2015Co-Authors: Kirstine Laerum Sibilitz, Selina Kikkenborg Berg, Lau Caspar Thygesen, Anndorthe Zwisler, Tina Birgitte Hansen, Rikke Sogaard, Annemarie YazbeckAbstract:BackgroundAs with ischaemic Heart disease, cardiac rehabilitation (CR) is recommended for patients undergoing Heart Valve Surgery; recommendations are based on limited evidence. The organization of CR programmes and factors associated with uptake among patients undergoing Heart Valve Surgery have not been studied. This study investigated CR programmes for these patients and factors associated with referral and participation.Design and methodsWe distributed two nationwide surveys: one to 37 hospitals and 98 municipalities and one to 742 consecutive patients undergoing Heart Valve Surgery. Data were linked to nationwide registries. We analysed the provision and content of programmes using descriptive statistics, and factors associated with referral and participation using logistic regression analysis.ResultsCoverage of CR programmes for these patients was high, with national programme variation. The overall uptake rate was 52%. Simultaneous CABG was associated with a higher probability of referral to CR (OR...
Tina Birgitte Hansen - One of the best experts on this subject based on the ideXlab platform.
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cost utility analysis of cardiac rehabilitation after conventional Heart Valve Surgery versus usual care
European Journal of Preventive Cardiology, 2017Co-Authors: Kirstine Laerum Sibilitz, Selina Kikkenborg Berg, Lau Caspar Thygesen, Anndorthe Zwisler, Tina Birgitte Hansen, Jakob Kjellberg, Patrick Doherty, Neil OldridgeAbstract:Background While cardiac rehabilitation in patients with ischaemic Heart disease and Heart failure is considered cost-effective, this evidence may not be transferable to Heart Valve Surgery patients. The aim of this study was to investigate the cost-effectiveness of cardiac rehabilitation following Heart Valve Surgery. Design We conducted a cost-utility analysis based on a randomised controlled trial of 147 patients who had undergone Heart Valve Surgery and were followed for 6 months. Methods Patients were randomised to cardiac rehabilitation consisting of 12 weeks of physical exercise training and monthly psycho-educational consultations or to usual care. Costs were measured from a societal perspective and quality-adjusted life years were based on the EuroQol five-dimensional questionnaire (EQ-5D). Estimates were presented as means and 95% confidence intervals (CIs) based on bootstrapping. Costs and effect differences were presented in a cost-effectiveness plane and were transformed into net benefit and presented in cost-effectiveness acceptability curves. Results No statistically significant differences were found in total societal costs (-1609 Euros; 95% CI: -6162 to 2942 Euros) or in quality-adjusted life years (-0.000; 95% CI -0.021 to 0.020) between groups. However, approximately 70% of the cost and effect differences were located below the x-axis in the cost-effectiveness plane, and the cost-effectiveness acceptability curves showed that the probability for cost- effectiveness of cardiac rehabilitation compared to usual care is at minimum 75%, driven by a tendency towards costs savings. Conclusions Cardiac rehabilitation after Heart Valve Surgery may not have improved health-related quality of life in this study, but is likely to be cost-effective for society, outweighing the extra costs of cardiac rehabilitation.
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cardiac rehabilitation patients perspectives on the recovery following Heart Valve Surgery a narrative analysis
Journal of Advanced Nursing, 2016Co-Authors: Tina Birgitte Hansen, Kirstine Laerum Sibilitz, Selina Kikkenborg Berg, Anndorthe Zwisler, Niels Buus, Anne LeeAbstract:Aims To explore the structure and content of narratives about the recovery process among patients undergoing Heart Valve Surgery participating in cardiac rehabilitation. Background Several studies with short-term follow-up have shown that recovering from cardiac Surgery can be challenging, but evidence on the long-term recovery process is very limited, especially following Heart Valve Surgery. Furthermore, few studies have explored the recovery process among cardiac rehabilitation participants. Design A qualitative study with serial interviews analysed using narrative methods. Methods We collected data over 18 months (April 2013–October 2014). We recruited nine patients undergoing Heart Valve Surgery from a randomized trial, CopenHeartVR and conducted 27 individual narrative interviews at 2-3 weeks, 3-4 months and 8-9 months after Surgery. Findings Following Heart Valve Surgery, the participants expected to return to normality. The analysis identified four courses of recovery, with three non-linear complex pathways deviating from the classic restitution narrative: the frustrated struggle to resume normality, the challenged expectation of normality – being in a limbo and becoming a Heart patient. These deviating pathways were characterized by physical, existential and mental challenges even up to 9 months after Surgery. Conclusion The recovery processes of participants' in cardiac rehabilitation were often more complicated than anticipated. Patients undergoing Heart Valve Surgery may benefit from more extensive medical follow-up immediately after discharge, individual psychological assessment and individualized, realistic information about the recovery trajectory.
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availability of referral to and participation in exercise based cardiac rehabilitation after Heart Valve Surgery results from the national copenHeart survey
European Journal of Preventive Cardiology, 2015Co-Authors: Kirstine Laerum Sibilitz, Selina Kikkenborg Berg, Lau Caspar Thygesen, Anndorthe Zwisler, Tina Birgitte Hansen, Rikke Sogaard, Annemarie YazbeckAbstract:BackgroundAs with ischaemic Heart disease, cardiac rehabilitation (CR) is recommended for patients undergoing Heart Valve Surgery; recommendations are based on limited evidence. The organization of CR programmes and factors associated with uptake among patients undergoing Heart Valve Surgery have not been studied. This study investigated CR programmes for these patients and factors associated with referral and participation.Design and methodsWe distributed two nationwide surveys: one to 37 hospitals and 98 municipalities and one to 742 consecutive patients undergoing Heart Valve Surgery. Data were linked to nationwide registries. We analysed the provision and content of programmes using descriptive statistics, and factors associated with referral and participation using logistic regression analysis.ResultsCoverage of CR programmes for these patients was high, with national programme variation. The overall uptake rate was 52%. Simultaneous CABG was associated with a higher probability of referral to CR (OR...
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effect of comprehensive cardiac rehabilitation after Heart Valve Surgery copenHeartvr study protocol for a randomised clinical trial
Trials, 2013Co-Authors: Kirstine Laerum Sibilitz, Lars Kober, Selina Kikkenborg Berg, Christian Hassager, Tina Birgitte Hansen, Signe Stelling Risom, Trine Bernholdt Rasmussen, Daniel A SteinbruchelAbstract:Heart Valve diseases are common with an estimated prevalence of 2.5% in the Western world. The number is rising due to an ageing population. Once symptomatic, Heart Valve diseases are potentially lethal, and heavily influence daily living and quality of life. Surgical treatment, either Valve replacement or repair, remains the treatment of choice. However, post Surgery, the transition to daily living may become a physical, mental and social challenge. We hypothesise that a comprehensive cardiac rehabilitation programme can improve physical capacity and self-assessed mental health and reduce hospitalisation and healthcare costs after Heart Valve Surgery. A randomised clinical trial, CopenHeartVR, aims to investigate whether cardiac rehabilitation in addition to usual care is superior to treatment as usual after Heart Valve Surgery. The trial will randomly allocate 210 patients, 1:1 intervention to control group, using central randomisation, and blinded outcome assessment and statistical analyses. The intervention consists of 12 weeks of physical exercise, and a psycho-educational intervention comprising five consultations. Primary outcome is peak oxygen uptake (VO2 peak) measured by cardiopulmonary exercise testing with ventilatory gas analysis. Secondary outcome is self-assessed mental health measured by the standardised questionnaire Short Form 36. Also, long-term healthcare utilisation and mortality as well as biochemistry, echocardiography and cost-benefit will be assessed. A mixed-method design is used to evaluate qualitative and quantitative findings encompassing a survey-based study before the trial and a qualitative pre- and post-intervention study. The study is approved by the local regional Research Ethics Committee (H-1-2011-157), and the Danish Data Protection Agency (j.nr. 2007-58-0015). ClinicalTrials.gov ( http://NCT01558765 ).
