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AbstractBackground:The present study focuses on assessing the physical activity level of children with Fontan circulation for Hypoplastic Left Heart Syndrome and identifying potential barriers and facilitators toward their participation in physical activity.Patients and methods:Seven children aged 5–16 years (mean (SD) 8.8 (3.7) years) with a Fontan procedure for hypoplastic left heart syndrome, their parents (n = 7), and siblings (n = 1) were recruited. Data were collected using a mixed-methods approach: (i) children wore an activity monitor for 7 days to record physical activity, with sedentary time and level of activity calculated from accelerometer data; (ii) children completed a bespoke questionnaire recording limitations in physical activity; (iii) parents completed a semi-structured interview discussing perceptions about their child’s physical activity participation. Qualitative data were analysed using thematic analysis.Results:Activity monitors data recorded highly active children with a mean (SD) of 153(36) minutes/day spent in moderate-to-vigorous physical activity. Time spent in sedentary behaviour was also high (57.5% of total accelerometer wearing-time). Four key themes relating to parental perceptions of physical activity were identified: (i) A new lease of life –post-Fontan; (ii) Setting limits – managing limitations; (iii) The wider world – how others set limits; and (iv) “I fear the future” – parental concerns.Conclusion:Following completion of the Fontan circulation, children engaged in higher levels of physical activity in comparison to the national average. However, more than half their time was spent in sedentary behaviour. Fears and anxiety from parents and teachers may act as a barrier toward physical activity participation.

AbstractIntroduction:Managing risk is central to clinical care, yet most research focuses on patient perception, as opposed to how risk is enacted within the clinical setting by healthcare professionals.Aim:To explore how surgical risk is perceived, encountered, and managed by congenital cardiac surgeons.Methods:Semi-structured interviews were conducted with 20 congenital cardiac surgeons representing every unit across England and Wales. All interviews were transcribed verbatim, with analysis based on the constant comparative approach.Findings:Three themes were identified, reflecting the interactions between personal, institutional, and political context in which risk is encountered and managed. First, “communicating risk”highlights the complexity and variability in methods employed by surgeons to balance legal/moral obligations with parental need and expectations. Universally, surgeons described the need for flexibility in their approach in order to meet the needs of individual patients. Second, “scrutiny and accountability”captures the spectrum of opinion arising from the binary nature of the outcomes collated and the way in which they are perceived to be interpreted. Third, “nature of the job”highlights the personal and professional implications of conveying and managing risk and the impact of recent policy changes on the way this is enacted.Conclusion:Variations in approaches to communicating risk demonstrate a lack of consensus, compounded by insufficient evidence to determine or monitor a “best-care” approach. With current surgical outcomes suggesting little room for increasing survival rates, future care needs should shift to the “soft skills” in order to continue to drive improvements in parental and patient experience.

Background/AimsIndividuals from South Asian backgrounds are at greater risk of developing coronary heart disease. Cardiac rehabilitation reduces the risk of future cardiac events, yet uptake is low among South Asian populations. This study explored South Asian patients' understanding and experiences of cardiac rehabilitation.MethodsThis qualitative, semi-structured study identified a purposeful sample of 36 eligible patients, of whom six participated in an interview that explored their experiences and perceptions of cardiac rehabilitation. Data were analysed using inductive analysis.ResultsThree themes were identified: starting the conversation; expectation vs reality; and meeting patient needs. Patients perceived cardiac rehabilitation as additional support rather than a fundamental part of care. Moreover, they considered the content of cardiac rehabilitation programmes to lack cultural sensitivity, which influenced both attendance and perceived relevance.Conclusions:Nurses must promote cardiac rehabilitation during the acute phase of recovery, while considering South Asian patients' beliefs, perceptions and cultural acceptance of cardiac rehabilitation. Invitations to attend and cardiac rehabilitation delivery must be personalised, accounting for cultural influences on lifestyle.

AbstractIntroduction:The way risk is interpreted by parents of children undergoing congenital cardiac surgery is poorly documented. Literature suggests clinicians have concerns that parents may not understand the complexity of procedures. Conversely, some parents perceive an unnecessary over-emphasis of risks.Aim:To explore how risk is encountered by parents of children who are undergoing cardiac surgery, in order to deliver effective and compassionate care.Methods:A qualitative approach was adopted. Interviews were undertaken with 18 parents (mothers n = 10; fathers n = 8). Recordings were transcribed verbatim and analysed using a constant comparative-based approach.Findings:Three themes emerged from the data: the nature of risk, reflecting the complexity of parental perception of risk and the influence of the doctor–parent relationship; presenting risk, highlighting the way in which risk is presented to and interpreted by parents; and risk and responsibility, examining the way in which parents engaged with risk and the impact of this on their relationship.Conclusions:The way in which risk is perceived by parents is complex and multi-factorial. The doctor–parent relationship is key to parental engagement. However, parents manage risk and uncertainty through a number of mechanisms, including those perceived as being not rational. This can cause tension, particularly when required to engage in informed decision-making.

Introduction:Initiating long-term oral anticoagulation (OAC) therapy in intracerebral haemorrhage (ICH) survivors who have atrial fibrillation (AF) has clinical equipoise for stroke physicians internationally, given the lack of clinical trial evidence. Understanding how physicians make decisions about stroke prevention in these patients will support and improve current decision-making practice and inform future guidelines.Aim:To explore physicians’ decision-making around prescription of long-term OAC for stroke prevention in patients with AF following an ICH.Methods:Qualitative sub-study of the PREvention of STroke in Intracerebral haemorrhaGE survivors with Atrial Fibrillation (PRESTIGE-AF) trial [NCT NCT03996772]. Semi-structured interviews with data analysed using Framework analysis.Results:Twenty stroke physicians (women n = 6 (30%), consultant in stroke medicine n =10, head of stroke department n = 6, geriatrician working in stroke n = 2, residents in neurology n = 2) across five European countries (Spain, France, Germany, Austria, UK) participated. The overarching theme ‘Managing Uncertainty’ highlights the difficulties faced by physicians. It draws together three sub-themes: ‘Computing the risks’, focusing on how physicians weigh-up the risks and benefits of long-term OAC; ‘The patient perspective’, which considers patients’ experiences and preferences; ‘Making the decision together’, which focuses on issues of communication between physicians and patients.Conclusion:The need to balance risks/benefits in the absence of data from randomised controlled trials and the uncertainty surrounding long-term outcomes of OAC were key challenges for physicians. Physicians rely on past personal clinical experience and collegiate advice to aid decision making. Physicians strive to ensure that patients understand the decision-making process. Future practice should support physicians in communicating clinical uncertainty to patients and encourage patients and physicians to work together to understand individual patients’ needs. Funding:This project has received funding from the European Union’s Horizon 2020 research and innovation programme under Grant Agreement No. 754517.