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      Cardiac rehabilitation patient perspectives during COVID-19 pandemic: quantitative and qualitative study

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          Abstract

          Background

          This study aimed to quantitatively assess stress, anxiety and obsessive thinking related to coronavirus disease-19 (COVID-19) and qualitatively appraise perceptions in patients after acute myocardial infarction (AMI) undergoing cardiac rehabilitation (CR) during the COVID-19 pandemic.

          Methods

          We used mixed-methods design in patients referred for CR in 2 centres which delivered uninterrupted service during COVID-19 pandemic. Coronavirus Anxiety Scale (CAS), Obsession with COVID-19 Scale (OCS), COVID-19 Stress Scale (CSS), Hospital Anxiety and Depression Scale (HADS), and in-person interviews (combination of a priori questions and probing) were used to evaluate patient experience and perceptions with COVID-19 and the healthcare services during pandemic.

          Results

          In total, 109 patients (mean age 59 ± 10, 20% women) were included in quantitative part and in 30 of them we conducted the in-person interviews. About a quarter of patients met HADS threshold for anxiety and depression while CAS and OCS results demonstrated extremely low possibility of coronavirus related dysfunctional thinking (3%) and anxiety (2%). The CSS indicated the most prevalent concerns were related to COVID-19 vaccines safety (60%) and fear of getting infected (60%). During interviews, patients perceived the CR as well as health care providers as safe, trustworthy and with enough support to avoid or manage COVID-19 related health risks.

          Conclusions

          Overall, patients reported AMI affected their lives more than the COVID-19 pandemic. The COVID-19 related stress and anxiety were relatively low and mostly related to general views of infectious disease. CR was perceived safe and trustworthy in terms of primary disease and COVID-19.

          Lay summary

          This mixed-method study included 109 patients with acute myocardial infarction who underwent cardiac rehabilitation during the COVID-19 and focused on their experience and perceptions with COVID-19 and the healthcare services during pandemic.

          • -

            Patients reported acute myocardial infarction affected their lives more than the COVID-19 pandemic.

          • -

            The COVID-19 related concerns were mostly related to general views of infectious disease (vaccine safety, fear of getting infected) whilst cardiac rehabilitation was perceived safe and trustworthy environment during COVID-19.

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          Most cited references42

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          Three approaches to qualitative content analysis.

          Content analysis is a widely used qualitative research technique. Rather than being a single method, current applications of content analysis show three distinct approaches: conventional, directed, or summative. All three approaches are used to interpret meaning from the content of text data and, hence, adhere to the naturalistic paradigm. The major differences among the approaches are coding schemes, origins of codes, and threats to trustworthiness. In conventional content analysis, coding categories are derived directly from the text data. With a directed approach, analysis starts with a theory or relevant research findings as guidance for initial codes. A summative content analysis involves counting and comparisons, usually of keywords or content, followed by the interpretation of the underlying context. The authors delineate analytic procedures specific to each approach and techniques addressing trustworthiness with hypothetical examples drawn from the area of end-of-life care.
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            The qualitative content analysis process.

            This paper is a description of inductive and deductive content analysis. Content analysis is a method that may be used with either qualitative or quantitative data and in an inductive or deductive way. Qualitative content analysis is commonly used in nursing studies but little has been published on the analysis process and many research books generally only provide a short description of this method. When using content analysis, the aim was to build a model to describe the phenomenon in a conceptual form. Both inductive and deductive analysis processes are represented as three main phases: preparation, organizing and reporting. The preparation phase is similar in both approaches. The concepts are derived from the data in inductive content analysis. Deductive content analysis is used when the structure of analysis is operationalized on the basis of previous knowledge. Inductive content analysis is used in cases where there are no previous studies dealing with the phenomenon or when it is fragmented. A deductive approach is useful if the general aim was to test a previous theory in a different situation or to compare categories at different time periods.
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              2021 ESC Guidelines on cardiovascular disease prevention in clinical practice

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                Author and article information

                Contributors
                URI : https://loop.frontiersin.org/people/734030/overviewRole: Role: Role: Role: Role: Role: Role:
                URI : https://loop.frontiersin.org/people/2748156/overviewRole: Role: Role: Role:
                Role: Role: Role: Role:
                URI : https://loop.frontiersin.org/people/126698/overviewRole: Role: Role: Role:
                Role: Role: Role: Role: Role: Role: URI : https://loop.frontiersin.org/people/2087250/overview
                Journal
                Front Cardiovasc Med
                Front Cardiovasc Med
                Front. Cardiovasc. Med.
                Frontiers in Cardiovascular Medicine
                Frontiers Media S.A.
                2297-055X
                30 July 2024
                2024
                : 11
                : 1373684
                Affiliations
                [ 1 ]University Medical Centre Ljubljana , Ljubljana, Slovenia
                [ 2 ]Faculty of Medicine, University of Ljubljana , Ljubljana, Slovenia
                [ 3 ]General Hospital Murska Sobota , Murska Sobota, Slovenia
                [ 4 ]National Institute of Public Health , Ljubljana, Slovenia
                Author notes

                Edited by: Otto Alexander Sanchez, Minneapolis Heart Institute Foundation (MHIF), United States

                Reviewed by: Tatjana Miljkovic, University of Novi Sad, Serbia

                Giovane Galdino, Federal University of Alfenas, Brazil

                [* ] Correspondence: Borut Jug borut.jug@ 123456kclj.si
                Article
                10.3389/fcvm.2024.1373684
                11319166
                39139755
                bb05bde4-8b5b-42df-a09d-0a49a5c26e31
                © 2024 Jug, Sedlar Kobe, Stojnic, Lainscak and Farkas.

                This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

                History
                : 20 January 2024
                : 11 July 2024
                Page count
                Figures: 5, Tables: 5, Equations: 0, References: 43, Pages: 13, Words: 0
                Funding
                Funded by: Slovenian Research and Innovation Agency and Republic of Slovenia Ministry of Health Grant
                Award ID: V3-2104
                The author(s) declare financial support was received for the research, authorship, and/or publication of this article.
                This study was supported by the Slovenian Research and Innovation Agency and Republic of Slovenia Ministry of Health Grant V3-2104 “Secondary prevention and quality of care of myocardial infarction in Slovenian hospitals, and the impact of the COVID-19 pandemic on the management of atherosclerotic vascular disease”.
                Categories
                Cardiovascular Medicine
                Original Research
                Custom metadata
                Cardiovascular Epidemiology and Prevention

                acute myocardial infarction,patients,cardiac rehabilitation,coronavirus disease,pandemic,psychological experience

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