Centre for Cardiovascular Health

Launch of Digital Health for Heart Health Survey 2

The Digital Health for Heart Health – Priority Setting Partnership is identifying key questions about digital health in heart care. Join Survey 2 to help us prioritise them!

What is heart disease?

Heart disease is a collection of various conditions that impact heart function, such as coronary heart disease, irregular heart rhythms, heart failure, and valve problems. Digital health, which utilises technology to enhance healthcare, has the potential to transform heart disease care. However, there is still much to learn about its effectiveness in improving heart disease management.

What is the survey about?

To address this, patients, carers, family members, and healthcare professionals are collaborating to identify and prioritise crucial questions about digital health in heart care. This effort, supported by the James Lind Alliance, involves a UK-wide team working on the Digital Health for Heart Health Priority Setting Partnership (PSP) to determine the top 10 research priorities, ensuring that future advancements meet the needs of those most affected by heart disease.

In Survey 1, stakeholders shared what issues and questions were most important to them. We narrowed down these responses to create a list of priority research questions and are now asking you to rank your ‘Top 10.’ From here, we will seek funding to carry out research that will hopefully answer these questions.

If you are: a patient with a heart condition or heart disease, you care for someone who has a heart condition or heart disease, or a healthcare professional whose work involves those with heart conditions or heart disease, we would like to hear what current and future digital technology research priorities are most important to you. This is an opportunity to:

Influence heart research priorities
Have your voice heard, or be the voice of your patients

The survey is open until October 1st 2024. You can access here. Please take some time to fill it out and share it with those who may be interested. If you would like a paper copy, please contact the team at DigitalHeart@napier.ac.uk

Accessing National Safe Haven (NSH) Data as a PhD student

This blog post was written by PhD student Nicola Rea. Nicola’s PhD ‘Improving care transitions for critically ill patients’ requires access and use of National Safe Haven Data for data analysis. Nicola writes about her experience below.

Over the last two decades, National Safe Havens (NSH) have become ubiquitous in healthcare data research. The term “Safe Haven” covers two fundamental functions – a physical environment containing linked datasets and governance procedures to ensure sensitive data is managed in a secure manner. This study, carried out as part of my PhD sought the use of routinely collected data, which is pseudonymised at the point whereby researchers access the data and permitted the analyses of a national cohort of patients in Scotland.

This study aimed to understand the long-term outcomes for critical care survivors with pre-existing cardiovascular disease, an under-researched area whereby the answers remain unknown. The specific research questions are as follows:

Does pre-existing cardiovascular disease influence hospital readmission (within one year of index hospital discharge) rates?
What is the prevalence of pre-existing co-morbid disease in the Scottish ICU population?
What is the prevalence of pre-existing CVD in the Scottish ICU population?
Does pre-existing CVD influence whether patients are discharged home following an ICU admission?
Does pre-existing co-morbid disease influence whether patients are discharged home follow an ICU admission?

This study was carried out as part of a wider National Health Service (NHS) project which had previously sought and been granted both Public Benefit and Privacy Policy (PBPP) approval and generic NHS ethical approval. For me to gain access to the linked data held in the Safe Haven as part of this wider project, completion of Medical Research Council (MRC) Research, Confidentiality and GDPR training was required. On completion I was added as a “User”. Approvals were also sought and granted from Edinburgh Napier University (ENU) School of Health and Social Care (SHSC) Research Integrity Committee.

As a PhD student, I carried out extensive training in both statistical analysis and RStudio data analysis software. The analysis presents both descriptive and inferential statistics to answer the research questions outlined above. More specifically, binary logistic regression models have been developed to determine if CVD is a predictor of hospital readmission (within one year of index hospital discharge) or to determine discharge destination for patients with CVD or non-CVD co-morbidities. The findings from this study are required to undergo review by the electronic Data Research Innovation Service (eDRIS) for statistical disclosure prior to removal from the NSH. Until then, we are unable to share the results but hope to do so in the coming weeks.

If you would like to know more about this study, please contact myself, Nicola Rea (Nicola.Rea@napier.ac.uk).

The NSH accessed for use in this study is managed and maintained by eDRIS (part of Public Health Scotland).

ASMOSUS: Building student nurses’ skills in ASsessing cardiovascular risk, MOtivating change, and SUStaining a healthier lifestyle in themselves and others

The study described in this blog is funded by the Burdett Trust for Nursing.

Nurses are well placed to identify cardiovascular disease (CVD) risk and to support people in making healthier lifestyle choices to reduce the risk of developing CVD. Despite this, nurses often have high levels of overweight and obesity, smoking, alcohol consumption, and low levels of physical activity.

We worked with first year nursing students at Edinburgh Napier University and Queens’ University Belfast to develop an interactive online application (app). This educational app aimed to improve nursing students’ confidence and ability to assess cardiovascular risk, and to support patients and themselves to make healthier lifestyle choices. We wanted to understand whether the app helped students to become more confident to talk to patients about their lifestyle.

Interactive app content included the use of risk assessment tools, quizzes and decision making based on patient stories within the app.

The app has been included in a first-year undergraduate nursing module at both universities. So far, students have completed surveys before and after using the app to gain understanding of whether it made a difference to their confidence and ability to talk to patients about their lifestyle. The final part of the study will invite students to take part in focus groups to explore their experiences of using the app. We expect to present the results of this study later in 2024.

If you would like to read more about the project and study team, follow the link here.

Blog contributed by Dr Bruce Forrest, Lecturer in Nursing, School of Health and Social Care, Edinburgh Napier University.

Exploring what wheelchair users need to facilitate equity of access in exercise facilities

A guest post by MSc Nursing student Siobhan Smith. Siobhan has recently submitted her dissertation and shares some of her study findings below.

Wheelchair access is a topic often not thought about until it is required, which for some people is every day. The barriers to wheelchair access extends into places such as gyms, with the World Health Organisation (WHO) highlighting how this can leave out some disabled people in experiencing the health benefits that come through physical activity (WHO, 2022).

Fortunately, health inequalities as a result of access issues for disabled people are becoming more recognised nationally, with the National Health Service (NHS) declaring their focus on addressing the issue (NHS, 2019).

Scotland’s first ever gym for disabled people opened in 2022 which further brought the spotlight on the accessibility barriers of mainstream gyms (Robertson, 2022). Experiences from this specialised gym were used in a study I conducted to assess the impact of effective accessibility on wheelchair users. The aim of the study was to speak to wheelchair users directly about what they feel should be in place to allow for better wheelchair access to gyms.

The study used interviews to gather its data. These included speaking with two groups of people, 1) wheelchair users who use mainstream gyms, and 2) wheelchair users who use the specialist gym. The data was then looked at together to gain a greater perspective. It was found that wheelchair users felt the greatest negative impact came from the lack of understanding held by gym staff, other gym users, and the wider society. The effects of this lack of understanding were seen in a variety of settings within gyms, from the ability of wheelchair users to get inside to their ability to use the equipment safely.

Study Findings

Overall, the study showed that a lack of understanding about wheelchair users in gyms can, and does, result in gyms being designed in such a way that wheelchair users are unable to use them. In the specialist gym, where access barriers have been reduced as much as possible, wheelchair users had a more enjoyable experience. This came from an increase in confidence, safety, and ability to be effectively supported.

It was found that ultimately, if a gym doesn’t have wheelchair access, as well as sufficient training and understanding by staff, then it is simply not a place where wheelchair users are able to be. It was clear that steps need to be taken to increase the understanding of disabilities held by those within gyms, both professionally and personally, as well as an increase in representation of disabled people in gyms to wider society. Increasing staff training on how to support wheelchair users in gyms was found to be an effective way to begin to reduce barriers to access, as the perceptions stemming from a lack of understanding contribute to decisions made about gym layouts and staff training priorities. The figure below shows the continuous impact these issues can have:

Figure 1. Cycle of inaccessibility in exercise facilities.

Although the research brought about important conclusions, further research is required to find out what is the best way to develop and deliver the training required to achieve the changes that need to happen to better facilitate equity of access for wheelchair users in gyms.

References:

National Health Service. (2019). NHS Long Term Plan. Retrieved from: https://www.longtermplan.nhs.uk/wp-content/uploads/2019/08/nhs-long-term-plan-version-1.2.pdf [Accessed on 24/08/2023]

Robertson, D. (2022). DR Inclusive Fitness & Wellbeing. Retrieved from: https://drinclusivefitness.co.uk [Accessed on 24/02/2023]

World Health Organisation (WHO). (2022). Disability. Retrieved from: https://www.who.int/news-room/fact-sheets/detail/disability-and-health [Accessed on 24/02/2023]

Use Heart, Know Heart

World Heart Day is an annual event established by the World Heart Federation. The objective of the day is to promote heart health and raise awareness about cardiovascular diseases (CVD), as well as educate on the importance of a heart-healthy lifestyle.

This year’s theme is “Use Heart, Know Heart.” This emphasises the importance of heart care as a global issue and knowing what preventative measures can help keep our hearts healthy.

Most people will know or have heart what habits are good for heart health, such as regular exercise and healthy eating habits, stress management and adequate sleep. Some of the lesser-known facts and aspects of CVD that people may be less aware of (and what some of our research covers), include:

Women and Heart Disease: CVD is often seen as a predominantly male issue, but it’s the leading cause of death globally for women too. Symptoms vary from person to person, but women do not experience main symptoms (e.g. chest pain) more or less often than men.
Silent Heart Attacks: Not all heart attacks will have chest pain – sometimes symptoms are subtle, like fatigue, shortness of breath or mild discomfort.
Mental Health Impact: Certain mental health conditions, like depression, anxiety and chronic stress can increase the risk of CVD. Make sure to also take care of your mental wellbeing to take care of your heart.

Understanding these lesser-known aspects of CVD can help people take more proactive measures to protect their heart health and reduce their risk of heart-related problems. Regular check-ups, a healthy lifestyle, and awareness of risk factors are essential in the prevention and management of heart disease.

If you’d like to learn more about our research or about CVD more generally, you may wish to refer to any of the following resources:

Logo of heart and question mark

Exploring patient experiences of remote high blood pressure management in Scotland during COVID-19

This blog was written by Dr Sheona McHale, Research Fellow, School of Health and Social Care, Edinburgh Napier University

The study discussed in this blog is funded by the British Heart Foundation.

High Blood pressure can increase your risk of having a heart attack or stroke. If you can lower your blood pressure by 10mmHg, you can lower your risk of stroke by 25%. Find out about whether about whether you are at risk of stroke because of your blood pressure here.

The COVID-19 pandemic forced changes to healthcare delivery, which particularly affected the management of long-term conditions such as high blood pressure in GP surgeries. Telemonitoring is a way to monitor blood pressure without the need to visit your GP. It allows you to take your blood pressure at home and share your readings with your healthcare team via text or the internet. This is convenient and has been shown to improve blood pressure control.

In our study we wanted to understand how people diagnosed with high blood pressure experienced the delivery of a hypertension service during COVID-19. We were particularly interested in exploring people’s views and experiences of using remote home-based blood pressure monitoring technology and what they thought about going to hospital during the pandemic.

We wanted to learn how people diagnosed with high blood pressure accessed healthcare to manage their condition during a time when routine services were severely disrupted due to COVID-19. Also, we wanted to explore the experiences of patients within NHS Lothian primary care centres who used remote blood pressure telemonitoring to self-manage their high blood pressure during COVID-19 and to compare these to the experiences of patients who did not have access to blood pressure telemonitoring during the pandemic.

We designed a study to gain insight from asking people questions during a telephone interview. The telephone interview allowed us to gain personal views and experiences from high blood pressure patients managed in primary care within NHS Lothian, and who gave their consent to take part in the study.

We planned to identify and recruit 40 participants via the NHS Research Scotland (NRS) Primary Care Network (20 participants who had experience of telemonitoring technology and 20 without access to telemonitoring technology). Potential participants were identified from clinical records and provided with study information packs. At this point in time, we have not completed the recruitment stage of the study. Upon completion of study recruitment, we aim to analyse the personal views and experiences of participants to help us understand how those diagnosed with high blood pressure accessed healthcare to manage their chronic condition during the C0VID-19 pandemic.

This study is led by Dr Janet Hanley, Associate Professor, School of Health and Social Care at Edinburgh Napier University. If you would like further information, please contact

Sheona McHale, Research Fellow,

Centre for Cardiovascular Health, Edinburgh Napier University,

Tel: 0131455 3476

Email: s.mchale@napier.ac.uk

New World Health Organisation report of walking and cycling: Do we really need any more updates?

This blog was written by Dr Adrian L Davis, Professor of Transport & Health, Transport Research Institute at Edinburgh Napier University.

Since a few early studies, including the UK Whitehall Study (started 1967) which especially focused on cardiorespiratory disease prevalence, and a Birmingham male factory workers study (1986) of commuter cyclists, there began a trickle of evidence suggesting that walking and cycling provide significant health benefits. The headline was reduced all-cause mortality and for cycling higher fitness levels equivalent to being five to ten years younger. Then, from around 2000 there was a sharp increase in peer reviewed research, likely led by sport scientists getting more interested in population health. Then other scientists got interested.

So, why this new World Health Organisation (WHO) report? Well, the four main premises are:

These are good times for advancing walking and cycling
Walking and cycling are central to urban mobility – rather than an afterthought
Research provides a strong case to promote walking and cycling
Practice provides a rich portfolio of measures to promote walking and cycling

The target audience is firstly policy makers by providing support to make the case for more walking and cycling. Secondly, it’s for practitioners by providing an overview of effective measures. Thirdly, advocates can draw on this evidence to help develop a narrative of the most compelling arguments in favour of walking and cycling. Fourth, it’s also accessible for general readers as we take you through the breadth of research findings with further readings references.

Why now? There are quite a few good reasons, not least: COVID-19 and the lessons that travel patterns can change quickly and so can some infrastructure; more urgent Climate change challenges; electrification and E-bikes, other technological advances; and the need for equity in transport. Taking e-biking, the battery energy support and the expanded km range etc, has led to a broader demographic market, including those long-ago lapsed cyclists aged 60+. Across Europe we continue to witness substantial sales growth. That’s the up-side. On the downside we also see that e-biking is about twice as risky as cycling (based on Swiss data).

More generally, we must address perceived and actual harms which starts with road danger. Higher safety can be achieved through infrastructure and traffic regulation, a prerequisite for higher walking and cycling levels. In terms of air pollution, the evidence remains that physical activity benefits outweigh harms from pollution exposure although we must deal with this issue. In putting benefits and harms into perspective we highlight the increasing value of the Health Economic Assessment Tool. The HEAT is designed to enable users without expertise in impact assessment to conduct economic assessments of the health impacts of walking or cycling. Case studies are included. We hope they inspire. Just look at Seville (p 67), for example, to see what can be achieved with political will.

We conclude that a rich body of evidence finds that there are substantial benefits accruing from walking and cycling, for individual and population health. Moreover, their role in replacing existing car trips, helping move towards carbon-free mobility, is increasingly recognised. The challenge: current planning practice needs to realign prioritisation of travel modes regarding funds and space away from private cars and recognise active travel as central – not an afterthought – to meeting a broad set of policy goals including health and sustainability. Ending on a personal note, we largely know the infrastructural measures needed, we have to work hard to resolve the human behaviour challenges – embedded as they are in cultural norms – and re-enforced by spatial planning. In Scotland government policy is reflecting better the evidence-base although that does not alone guarantee success. We all need to take meaningful action, as advocates, and in how we choose to move around.

Read the full WHO report here: Walking and cycling: latest evidence to support policy-making and practice (who.int)

Meet Ali, the avatar nurse who wants to help people to manage their atrial fibrillation

By Dr Coral Hanson, Senior Research Fellow, Edinburgh Napier University

Atrial fibrillation is a common abnormal heart rhythm that affects more than 2 million people in the UK. People with atrial fibrillation are more likely to have a stroke and these strokes are more likely to be severely disabling than strokes of other causes. A medication that prevents blood clots from forming (an oral anticoagulant), reduces this risk by two-thirds. However, 75% of people with atrial fibrillation do not take their medication as recommended either because they do not understand or believe in their medications, or forget.

We wanted to develop a digital solution to help people to remember to take their medication. At the start of the project, we talked to people who had atrial fibrillation and asked them what they thought should be included in a mobile app. They told us that they wanted to know more about their medication, get reminders to take it, and be able to record what they had taken. They also wanted easy to understand information about their condition and know when to seek medical help for symptoms.

The team at the Centre for Cardiovascular Health, colleagues at Flinders University in Adelaide in Australia, and a technology company called Monkey Stack developed a mobile health app called My AF Nurse: available at Google Play: My AF Nurse or Apple: My AF Nurse.

Developing the app

First, we developed a storyboard that contained everything that would be in the app, and a script. We recruited one of our Scottish nurse colleagues to be the ‘voice’ of the app and students from the School of Arts and Creative Industries filmed her reading the script. The avatar’s facial expressions are based on the expressions of our ‘real Ali’.

Monkey Stack used the film and audio recorded by our students to create the finished app.

The My AF Nurse app

Ali, the avatar atrial fibrillation nurse is available 24 hours a day, seven days a week to help people to manage their atrial fibrillation. The app is jam packed full of information. We talked to cardiologists, doctors, other nurses, and patients to make sure we covered all the important stuff. Information is broken down into bite size chunks, so that users can listen in their own time, as many times as they want. There is a medication tracker to help users to remember to take their medication at the right time, every time.

Testing the My AF Nurse app

Now that we have created the app, we are testing whether we can recruit patients to use it via their GP surgery or cardiology clinic. We are exploring how they use the app and trying to understand the best way to measure whether users take their medication. More information about this study can be found at: https://doi.org/10.1186/ISRCTN10135302

Find out more about our research linked to Atrial Fibrulation