Background and aimsDiet is important in prevention and management of non-communicable disease and in particular, cardiovascular disease. Recently, more hospitals gear towards healthier dietary... Show moreBackground and aimsDiet is important in prevention and management of non-communicable disease and in particular, cardiovascular disease. Recently, more hospitals gear towards healthier dietary policies, however, a tool to assess the effect of these interventions in patient populations is currently lacking. The Theory of Planned Behavior (TPB) is generally used to assess health-related behavior and offers a framework for development of questionnaires. In this study, we aim to evaluate the reliability, internal consistency and preliminary construct validity of the newly developed Dietary Intention Evaluation Tool for In-hospital patients (DIETI) which is based on the TPB.Methods and resultsAn expert panel constructed the item list of the DIETI. A total of 312 patients admitted to the cardiology ward filled out the DIETI. Explanatory- and confirmatory factor analysis showed that our tool adequately discerns five TPB-consistent factors regarding a healthy diet in hospitalized patients. (N = 312, for the CFA model χ2 = 313.072 (df = 160, p < 0.001, CFI = 0.939, RMSEA = 0.058). Subsequent analysis of reliability showed satisfactory to strong internal consistency of the questionnaire as a whole and all subscales (Cronbach's alpha for the subscales ranging between 0.65 and 0.88).ConclusionsWe conclude that the DIETI is an internally reliable tool to assess behavioral intentions regarding a healthy diet of in-hospital patients. Thus, this questionnaire can be used to evaluate the effect of dietary interventions aimed at hospitalized patients. Show less
Treskes, R.W.; Akker-van Marle, M.E. van den; Winden, L. van; Keulen, N. van; Velde, E.T. van der; Beeres, S.; ... ; Schalij, M.J. 2022
Background: Smartphone compatible wearables have been released on the consumers market, enabling remote monitoring. Remote monitoring is often named as a tool to reduce the cost of care.Objective:... Show moreBackground: Smartphone compatible wearables have been released on the consumers market, enabling remote monitoring. Remote monitoring is often named as a tool to reduce the cost of care.Objective: The primary purpose of this paper is to describe a cost-utility analysis of an eHealth intervention compared to regular follow-up in patients with acute myocardial infarction (AMI).Methods: In this trial, of which clinical results have been published previously, patients with an AMI were randomized in a 1:1 fashion between an eHealth intervention and regular follow-up. The remote monitoring intervention consisted of a blood pressure monitor, weight scale, electrocardiogram device, and step counter. Furthermore, two in-office outpatient clinic visits were replaced by e-visits. The control group received regular care. The differences in mean costs and quality of life per patient between both groups during one-year follow-up were calculated.Results: Mean costs per patient were euro 2417 +/- 2043 (US $2657 +/- 2246) for the intervention and euro 2888 +/- 2961 (US $3175 +/- 3255) for the control group. This yielded a cost reduction of euro 471 (US $518) per patient. This difference was not statistically significant (95% CI - euro 275 to euro 1217; P=.22, US $-302 to $1338). The average quality-adjusted life years in the first year of follow-up was 0.74 for the intervention group and 0.69 for the control (difference -0.05, 95% CI -0.09 to -0.01; P=.01).Conclusions: eHealth in the outpatient clinic setting for patients who suffered from AMI is likely to be cost-effective compared to regular follow-up. Further research should be done to corroborate these findings in other patient populations and different care settings. Show less
Rodrigo, S.F.; Exel, H.J. van; Keulen, N. van; Winden, L. van; Beeres, S.L.M.A.; Schalij, M.J. 2021
Purpose: Cardiac rehabilitation (CR) after hospitalization for acute coronary syndrome (ACS) has shown to reduce mortality, readmissions, and improve quality of life. CR is recommended by... Show morePurpose: Cardiac rehabilitation (CR) after hospitalization for acute coronary syndrome (ACS) has shown to reduce mortality, readmissions, and improve quality of life. CR is recommended by international guidelines but previous studies have shown low participation rates. Systematic CR referral might improve CR participation.Methods: The present study evaluates CR referral and CR participation of patients hospitalized for ACS in 2017 and treated according to local protocol, which includes systematic CR referral. Participation rate was divided into a group that finished the CR program and drop outs. In addition, factors associated with CR referral and participation rate were evaluated.Results: A total of 469 patients eligible for CR were included in the study, of which 377 (80%) were referred for CR and 353 (75%) participated in CR. Ninety percent of participants completed the CR pro-gram. Factors independently associated with CR referral included age (50-60 year vs. > 70 year: odds ratio [OR] 4.7, 95% confidence interval [CI] 1.98-11.2), diagnosis (ST-elevation myocardial infarction vs. unstable angina: OR 17.7, CI 7.59-41.7), previous cardiovascular disease (OR 0.4, CI 0.19-0.73) and left ventricular dysfunction vs. normal function (OR 2.2, CI 1.11-4.52). A larger distance to the CR center was associated with lower CR participation (<5km vs. > 20 km: OR 3.1, CI 1.20-7.72).Conclusions: Systematic CR referral in ACS patients results in high CR referral (80%) and participation (75%) rates. CR adherence might be further improved by increasing CR referral, especially in older patients and patients with NSTEMI or unstable angina. (c) 2021 The Authors. Published by Elsevier B.V. Show less
Treskes, R.W.; Winden, L.A.M. van; Keulen, N. van; Velde, E.T. van der; Beeres, S.L.M.A.; Atsma, D.E.; Schalij, M.J. 2020
Importance Smart technology via smartphone-compatible devices might improve blood pressure (BP) regulation in patients after myocardial infarction. Objectives To investigate whether smart... Show moreImportance Smart technology via smartphone-compatible devices might improve blood pressure (BP) regulation in patients after myocardial infarction. Objectives To investigate whether smart technology in clinical practice can improve BP regulation and to evaluate the feasibility of such an intervention. Design, Setting, and Participants This study was an investigator-initiated, single-center, nonblinded, feasibility, randomized clinical trial conducted at the Department of Cardiology of the Leiden University Medical Center between May 2016 and December 2018. Two hundred patients, who were admitted with either ST-segment elevation myocardial infarction or non-ST-segment acute coronary syndrome, were randomized in a 1:1 fashion between follow-up groups using smart technology and regular care. Statistical analysis was performed from January 2019 to March 2019. Interventions For patients randomized to regular care, 4 physical outpatient clinic visits were scheduled in the year following the initial event. In the intervention group, patients were given 4 smartphone-compatible devices (weight scale, BP monitor, rhythm monitor, and step counter). In addition, 2 in-person outpatient clinic visits were replaced by electronic visits. Main Outcomes and Measures The primary outcome was BP control. Secondary outcomes, as a parameter of feasibility, included patient satisfaction (general questionnaire and smart technology-specific questionnaire), measurement adherence, all-cause mortality, and hospitalizations for nonfatal adverse cardiac events. Results In total, 200 patients (median age, 59.7 years [interquartile range, 52.9-65.6 years]; 156 men [78%]) were included, of whom 100 were randomized to the intervention group and 100 to the control group. After 1 year, 79% of patients in the intervention group had controlled BP vs 76% of patients in the control group (P = .64). General satisfaction with care was the same between groups (mean [SD] scores, 82.6 [14.1] vs 82.0 [15.1]; P = .88). The all-cause mortality rate was 2% in both groups (P > .99). A total of 20 hospitalizations for nonfatal adverse cardiac events occurred (8 in the intervention group and 12 in the control group). Of all patients, 32% sent in measurements each week, with 63% sending data for more than 80% of the weeks they participated in the trial. In the intervention group only, 90.3% of patients were satisfied with the smart technology intervention. Conclusions and Relevance These findings suggest that smart technology yields similar percentages of patients with regulated BP compared with the standard of care. Such an intervention is feasible in clinical practice and is accepted by patients. More research is mandatory to improve patient selection of such an intervention. Show less
Treskes, R.W.; Winden, L.A. van; Keulen, N. van; Atsma, D.E.; Velde, E.T. van der; Akker-van Marle, E. van den; ... ; Schalij, M.J. 2017
