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Background: Cognitive impairment (CI) is common in patients with acute coronary syndrome (ACS) but is often undetected and may affect recovery and secondary prevention uptake. Nurses play a crucial role providing care for patients with ACS and promoting secondary prevention., Aim: This study aimed to explore current nursing practices and barriers regarding CI screening in patients with ACS., Methods: Cardiac nurses were recruited from three metropolitan teaching hospitals and two professional associations in Australia and undertook a 38-question purpose-built survey., Results: A total of 95 nurses participated (mean age 38±13 years; 78% [n=74] female): 69 were registered nurses, and 48% had received CI training. Only 16% of nurses in our sample reported that they regularly screen for CI, and 23% reported that they never screen; however, 59% believed screening should be part of everyday practice. Nurses mostly screened when ward policy required admission/daily cognitive screening (34%) or when they suspected cognitive problems or decline (39%). Nurses in acute settings (vs non-acute) were nine times more likely to screen when adjusting for confounders. The typically used screening instruments assessed delirium/confusion and dementia but not milder CI. Common barriers to screening included communication difficulties, patients too unstable/unwell, time constraints requiring clinical care prioritisation, and being unaware of patients' normal cognition status., Conclusions: Screening practices for CI in the context of ACS were found to be suboptimal, with only 16% of nurses in our sample reporting regularly screening. The most used methods focus on screening for delirium. Given current practice, many CI cases will be missed, especially mild CI, which will negatively affect secondary prevention efforts. Further research is required to identify appropriate methods to implement routine screening within the nursing clinical workflow and establish a suitable screening tool., Competing Interests: Conflicts of Interest There are no conflicts of interest to disclose., (Copyright © 2024 The Author(s). Published by Elsevier B.V. All rights reserved.)

Background: Non-adherence to medications is common in patients with atrial fibrillation (AF), increasing the risk of stroke, co-morbidities, and AF symptoms. Understanding factors influencing medication adherence is important in providing holistic care to patients with AF. This study aimed to explore medication adherence in patients with AF, and explore associations with health literacy, cognition, or AF knowledge., Methods: A single-centre pilot study, using survey questionnaires and open questions. Patients with a primary cardiac diagnosis, with AF as primary or secondary diagnosis, were eligible for recruitment. During hospitalisation, adherence to cardiac medications was assessed using the Basel Assessment of Adherence to Immunosuppressive Medication Scale (BAASIS). Health literacy, cognition, and AF knowledge were assessed through validated questionnaires. Facilitators and barriers for medication adherence were obtained through open-ended question and coded using a content analysis approach., Results: Fifty-four (54) patients were recruited (61% male, mean age 71±11). Twenty-two (22) participants (41%) were classified as non-adherent using the BAASIS; with a corresponding self-reported adherence of 87.7% in non-adherent participants compared to 97.8% in adherent participants. No associations were identified between medication adherence and cognition, health literacy, or AF knowledge. Facilitators for adherence included external assistance, routines, and medication knowledge, and these were reported by both adherent and non-adherent participants. Non-adherent participants reported more barriers including medication concerns, forgetfulness, and lifestyle factors., Conclusions: Large numbers of AF patients are likely to be non-adherent to medications. Medication adherence is influenced by multiple factors, individual to each patient. Diverse strategies are required to ensure adherence to cardiac medications., (Copyright © 2019 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier B.V. All rights reserved.)

Background: Globally, attendance at cardiac rehabilitation (CR) is between 15 and 30%. Alternative models of individualised care are recommended to promote participation in CR, however there has been no prospective testing of different durations of such models. We aimed to replicate the previously proven Choice of Health Options In prevention of Cardiovascular Events (CHOICE) intervention, and to determine if an extended version (CHOICEplus) would confer additional benefits., Methods: Acute coronary syndrome (ACS) survivors not accessing centre-based CR (n=203) were randomised to CHOICE for 3 months (n=100) or CHOICEplus for 24 months (n=103) at four urban hospitals. The program comprised telephone-based tailored risk-factor reduction., Results: CHOICE and CHOICEplus were equivalent demographically and in risk profile at baseline. At 24 months, lipid profiles improved significantly and fewer patients had ≥3 risk factors above target compared to baseline in both groups. There were no significant differences between groups., Conclusions: The 24-month CHOICEplus program did not confer additional benefit above the brief 3-month CHOICE intervention. However, participation in either CHOICE and CHOICEplus significantly improved cardiovascular risk profile in ACS survivors. Importantly, the study was feasible, and the intervention translated readily across four hospitals. Overall, this study adds to the existing evidence for brief individualised approaches to CR., (Copyright © 2017 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier B.V. All rights reserved.)

Atrial fibrillation (AF) is the most common cardiac arrhythmia, with a lifetime risk of one in four of developing AF over the age of 40 years. Around 40% of patients are asymptomatic, which is of concern as AF is a major risk factor for stroke. Early detection and appropriate management reduces stroke risk by two-thirds. Atrial fibrillation screening is now recommended in international guidelines, but there are some common arguments against screening. Overall, to be of value any screening program must fulfil the World Health Organization (WHO) Wilson and Jungner criteria for screening programs. In this paper we address the common arguments, and determine if AF screening fulfils the WHO criteria., (Copyright © 2017 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier B.V. All rights reserved.)

Aims and Objectives: To investigate whether using the 'think aloud' technique during standard quality of life surveys provides useful additional information about patients' experiences of living with atrial fibrillation (AF) and health related quality of life (HRQoL)., Background: Atrial fibrillation is the most common cardiac arrhythmia and has serious health consequences, particularly ischaemic stroke, high rates of morbidity and mortality and poor HRQoL. Standard quality-of-life questionnaires are often used but may not provide sufficient detail of patients' experiences living with AF., Design: A qualitative interpretative study based on semi-structured interviews., Methods: Patients with AF (n=12) were recruited from the Choice of Health Options in Prevention of Cardiovascular Events-in Atrial Fibrillation (CHOICE-AF), a risk factor management program. Participants were interviewed using a 'think aloud' technique with questions guided by the AF Effects on Quality Of Life Questionnaire (AFEQT) and the Short Form-12 (SF-12). Interviews were audio-recorded, transcribed and analysed thematically., Results: Participants had a median age of 71 years (interquartile range 52 to 77 years), and included four women and eight men. Four themes were identified related to experiences of living with AF and HRQoL including: (1) the adverse impact of atrial fibrillation symptoms, treatments, and related knowledge; (2) loss of function or independence; (3) the influence of age; and (4) approach to life., Conclusions: Atrial fibrillation, especially in older adults, creates an additional layer of requirements for self-management onto existing self-care needs. Even for patients with relatively high HRQoL, the 'think aloud' technique together with standard HRQoL questionnaires can help identify additional issues that can be addressed by health professionals to improve the HRQoL of these patients., (Copyright © 2016 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier B.V. All rights reserved.)