Background The new generation of implantable cardioverter-defibrillators (ICDs) supports wireless technology, which enables remote patient monitoring (RPM) of the device. In Sweden, it is mainly registered nurses with advanced education and training in ICD devices who handle the arrhythmias and technical issues of the remote transmissions. Previous studies have largely focused on the perceptions of physicians, and it has not been explored how the patients’ and nurses’ experiences of RPM correspond to each other. Objective Our objective is to describe, explore, and compare the experiences and perceptions, concerning RPM of ICD, of patients with heart failure (HF) and nurses performing ICD follow-up. Methods This study has a cross-sectional, descriptive, mixed methods design. All patients with HF and an ICD with RPM from one region in Sweden, who had transitioned from office-based visits to implementing RPM, and ICD nurses from all ICD clinics in Sweden were invited to complete a purpose-designed, 8-item questionnaire to assess experiences of RPM. The questionnaire started with a neutral question: “What are your experiences of RPM in general?” This was followed by one positive subscale with three questions (score range 3-12), with higher scores reflecting more positive experiences, and one negative subscale with three questions (score range 3-12), with lower scores reflecting more negative experiences. One open-ended question was analyzed with qualitative content analysis. Results The sample consisted of 175 patients (response rate 98.9%) and 30 ICD nurses (response rate 60%). The majority of patients (154/175, 88.0%) and nurses (23/30, 77%) experienced RPM as very good; however, the nurses noted more downsides than did the patients. The mean scores of the negative experiences subscale were 11.5 (SD 1.1) for the patients and 10.7 (SD 0.9) for the nurses (P=.08). The mean scores of the positive experiences subscale were 11.1 (SD 1.6) for the patients and 8.5 (SD 1.9) for the nurses (P=.04). A total of 11 out of 175 patients (6.3%) were worried or anxious about what the RPM entailed, while 15 out of 30 nurses (50%) felt distressed by the responsibility that accompanied their work with RPM (P=.04). Patients found that RPM increased their own (173/175, 98.9%) and their relatives’ (169/175, 96.6%) security, and all nurses (30/30, 100%) answered that they found RPM to be necessary from a safety perspective. Most patients found it to be an advantage with fewer office-based visits. Nurses found it difficult to handle different systems with different platforms, especially for smaller clinics with few patients. Another difficulty was to set the correct number of alarms for the individual patient. This caused a high number of transmissions and a risk to miss important information. Conclusions Both patients and nurses found that RPM increased assurance, reliance, and safety. Few patients were anxious about what the RPM entailed, while about half of the nurses felt distressed by the responsibility that accompanied their work with RPM. To increase nurses’ sense of security, it seems important to adjust organizational routines and reimbursement systems and to balance the workload.

Background: Despite its life saving benefits, Cardioverter Defibrillator (ICD) implantation is associated with increased risk of cognitive dysfunction. Studies examining the association between cognitive status and attitudes toward withdrawing ICD therapy [i.e., generator replacement at end-of-service and ICD deactivation at End-of-Life (EOL)] in the long term are scarce. Objective: The specific aims of this study were to: 1) describe patients’ attitudes toward withdrawal of ICD therapy at EOL; and 2) determine the association between cognitive dysfunction and recipients’ attitudes toward generator replacement and toward ICD deactivation at EOL, controlling for age, anxiety and depression. Methods: A total of 114 ICD recipients (35% female, age 67 ± 12 years) completed the Montreal Cognitive Assessment, Patient Health Questionnaire-9, and Brief Symptom Anxiety instruments. Data about participants’ attitudes toward withdrawal of therapy were collected by asking participants to answer “Yes/No” or “Not sure” for the following two statement, respectively: “I want to have the battery in my ICD replaced even if I am seriously ill suffering from another disease,” “I want to have the defibrillating shocks in my ICD even if dying of cancer or another serious disease.” The association between cognitive dysfunction and attitudes toward generator replacement and ICD deactivation were tested using logistic regression analysis. Results: The majority of participants (68%) would like to replace the generator at end-of-service even if they are seriously ill with another disease; 44% favored to keep shocks even if they are dying from cancer or other serious disease. Ten per cent and 16%, respectively, were indecisive about generator replacement and ICD deactivation at EOL. Cognitive dysfunction significantly predicted recipients’ attitude toward generator replacement (β = 4.12, p = .02), but not their attitudes toward ICD deactivation at EOL. Conclusion: Cognitive dysfunction predicted recipients’ attitude toward generator replacement at end of service. This suggests that considering patients’ cognitive function is essential to maximize ICD recipients’ ability to make treatment decisions at EOL.

BACKGROUND Heart failure (HF) affects not only the person diagnosed with the syndrome but also family members, who often have the role of informal carers. The needs of these carers are not always met, and information and communications technology (ICT) could have the potential to support them in their everyday life. However, knowledge is lacking about how family members perceive ICT and see opportunities for this technology to support them. OBJECTIVE The aim of this study was to explore the perceptions of ICT solutions as supportive aids among family members of persons with HF. METHODS A qualitative design was applied. A total of 8 focus groups, comprising 23 family members of persons affected by HF, were conducted between March 2015 and January 2017. Participants were recruited from 1 hospital in Sweden. A purposeful sampling strategy was used to find family members of persons with symptomatic HF from diverse backgrounds. Data were analyzed using qualitative content analysis. RESULTS The analysis revealed 4 categories and 9 subcategories. The first category, about how ICT could provide relevant support, included descriptions of how ICT could be used for communication with health care personnel, for information and communication retrieval, plus opportunities to interact with persons in similar life situations and to share support with peers and extended family. The second category, about how ICT could provide access, entailed how ICT could offer solutions not bound by time or place and how it could be both timely and adaptable to different life situations. ICT could also provide an arena for family members to which they might not otherwise have had access. The third category concerned how ICT could be too impersonal and how it could entail limited personal interaction and individualization, which could lead to concerns about usability. It was emphasized that ICT could not replace physical meetings. The fourth category considered how ICT could be out of scope, reflecting the fact that some family members were generally uninterested in ICT and had difficulties envisioning how it could be used for support. It was also discussed as more of a solution for the future. CONCLUSIONS Family members described multiple uses for ICT and agreed that ICT could provide access to relevant sources of information from which family members could potentially exchange support. ICT was also considered to have its limitations and was out of scope for some but with expected use in the future. Even though some family members seemed hesitant about ICT solutions in general, this might not mean they are unreceptive to suggestions about their usage in, for example, health care. Thus, a variety of factors should be considered to facilitate future implementations of ICT tools in clinical practice.

AimTo explore experiences of cardiac arrest in‐hospital and the impact on life for the patient who suffered the arrest and the family member who witnessed the resuscitation.BackgroundGuidelines advocate that the family should be offered the option to be present during resuscitation, but little is known about family‐witnessed cardiopulmonary resuscitation in hospital and the impact on the patient and their family.DesignA qualitative design consisting of joint in‐depth interviews with patients and family members.MethodsFamily interviews were conducted with seven patients and their eight corresponding family members (aged 19–85 years) 4–10 months after a family‐witnessed in‐hospital cardiac arrest. Data were analysed using interpretative phenomenological analysis. The study followed the guidelines outlined in the consolidated criteria for reporting qualitative research (COREQ) checklist.ResultsThe participants felt insignificant and abandoned following the in‐hospital cardiac arrest. Surviving patients and their close family members felt excluded, alone and abandoned throughout the care process; relationships, emotions and daily life were affected and gave rise to existential distress. Three themes and eight subordinate themes were identified: (1) the intrusion of death—powerless in the face of the fragility of life, highlights what it is like to suffer a cardiac arrest and to cope with an immediate threat to life; (2) being totally exposed—feeling vulnerable in the care relationship, describes how a lack of care from healthcare staff damaged trust; (3) learning to live again—making sense of an existential threat, pertaining to the family's reactions to a difficult event that impacts relationships but also leads to a greater appreciation of life and a positive view of the future.ConclusionSurviving and witnessing a cardiac arrest in‐hospital is a critical event for everyone involved. Patients and family members are vulnerable in this situation and need to be seen and heard, both in the hospital and after hospital discharge. Consequently, healthcare staff need to show compassion and attend to the needs of the family, which involves continually assessing how family members are coping during the process, and providing support and information during and after resuscitation.Relevance to clinical practiceIt is important to provide support to family members who witness the resuscitation of a loved one in‐hospital. Structured follow‐up care is crucial for cardiac arrest survivors and their families. To promote person‐centred care, nurses need interprofessional training on how to support family members during resuscitation, and follow‐up care focusing on providing resources for multiple challenges faced by survivors (emotional, cognitive, physical) and families (emotional) is needed.Patient or public contributionIn‐hospital cardiac arrest patients and family members were involved when designing the study.