One in ten patients present to the emergency department (ED) with symptoms of acute coronary syndrome (ACS). The 13-item ACS Symptom Checklist is a validated tool for rapid ACS symptom assessment. We aimed to evaluate the effectiveness of the 13-item ACS Symptom Checklist in distinguishing NSTEMI patients with and without an occluded artery using natural language processing (NLP). We retrospectively extracted the 13 symptoms from the 13-item ACS Symptom Checklist for all patients admitted with NSTEMI. The outcome was an occluding coronary artery defined as one requiring revascularization. We applied Chi-square tests to assess the sensitivity and specificity of each symptom for an acutely occluded coronary artery. We used logistic regression models stratified by sex to measure the odds of an occluded artery after controlling for age, obesity, and diabetes. The majority of the 1905 patients were male (63.1%), older (66±12 years), and White (84%). Twenty-three percent of patients require revascularization. Common comorbidities included diabetes (17%) and obesity (42%). Symptoms differentiating patients with and without an occluded artery included palpitations (22.4% vs. 29.0%), arm pain (23.5% vs. 16.5%), unusual fatigue (19.1% vs. 3.3%), and lightheadedness (21.1% vs. 26.5%). Arm pain was associated with 1.532 (95% CI 1.155-2.033) increased odds of an occluded artery, with similar odds in men and women. Arm pain was the primary symptom predicting an occluded coronary artery in NSTEMI patients; of note, there were minimal sex differences. NLP was a useful tool for identifying arm pain and other symptoms from clinical notes.

To explore the experience and management of thirst in patients with heart failure and the cardiovascular nurses involved in their care. This qualitative exploratory study used purposive sampling to select patients with heart failure and cardiovascular nurses. One-on-one, semi-structured interviews were conducted, and data were analyzed using reflexive thematic analysis. Interviews were conducted with 12 patients with heart failure and 11 nurses. Three major themes with eleven sub-themes were identified: (1) The multidimensional burden of thirst (frequent and prolonged symptoms, physical discomfort, and emotional distress); (2) the interplay of innovative and traditional approaches (alleviation through drinking water, modifying behavioural habits, seeking help from Traditional Chinese Medicine (TCM), and utilizing various aids); and (3) barriers and needs in thirst management (thirst is perceived as minor compared to other symptoms, thirst is challenging to recognize, the need for standardized assessment, and the need for knowledge empowerment). This qualitative study highlights the significant burden of thirst in patients with heart failure and the critical need for improved thirst management. These findings have implications for healthcare providers in developing an environment that supports effective thirst management.

To develop and evaluate an autonomous artificial intelligence (AI) agent to support nurse-led delirium screening and guideline-concordant prevention and management. We constructed a delirium-specific knowledge graph from publicly available clinical guidelines and implemented an autonomous AI agent that integrates retrieval-augmented generation with validated delirium assessment tools to simulate decision-support in nursing workflows. In this proof-of-concept evaluation, the agent was benchmarked on 20 clinical patient cases to assess (i) tool selection accuracy, (ii) fidelity of clinical conclusions, and (iii) adherence to guideline-based delirium care recommendations. Human experts review rated coherence, relevance, and clinical interpretability of the outputs. The 20 cases were drawn from postoperative care (n=6), Cardiac Intensive Care Unit care (n=5), and cancer wards (n=9), including 6 males (30%) and 14 females (70%), with a mean age of 56.5 years (SD 17.9; range 21-82). Two experienced registered nurses independently validated the agent's outputs, benchmarked them against guideline-based recommendations. The agent achieved 100% accuracy in selecting appropriate tools, and 90% overall accuracy in generating conclusions and care recommendations, compared with 45% for other large language model baselines. Recommendations were presented in a structured, actionable format and aligned with guideline-based delirium care. This proof-of-concept study suggests that an autonomous AI agent can deliver clinically interpretable, guideline-aligned delirium decision support and may help reduce missed or delayed recognition while standardizing nursing actions. Given the high delirium burden in cardiovascular pathways (e.g., cardiac ICUs and postoperative care), prospective validation in cardiovascular settings is warranted to evaluate clinical impact, safety, and workflow integration.

Aerobic exercise (AE) is a cornerstone of management for patients with peripheral arterial disease (PAD) due to its benefits for functional capacity and quality of life. While the short-term effects of AE therapy are well documented, the long-term effects remain unclear. Therefore, this study aimed to investigate the long-term effects of aerobic exercise training in patients with PAD. A search of six electronic databases from inception to December 2024 was conducted, and studies were screened using the Rayyan AI tool. Randomized controlled trials involving AE interventions lasting more than 8 weeks with a follow-up period of any length were included. Risk of bias and methodological quality were assessed using the Cochrane Collaboration's risk of bias tool and the PEDro Scale, respectively. Six randomized controlled trials involving a total of 2,233 participants were included. Strong evidence indicates that improvements in physical activity levels achieved with lower extremity AE training are not maintained in the long term. However, there is conflicting evidence regarding the long-term maintenance of walking ability, functional status, mobility, and quality of life, as well as weak evidence for improvements in anxiety, depression, and self-efficacy. A meta-analysis could not be conducted due to substantial variation in outcome measures among the included studies. This systematic review indicates that the benefits of lower extremity AE training are not maintained at expected levels over the long term. Therefore, it is crucial to promote exercise as a lifelong habit and implement community-based exercise strategies for patients with PAD. PROSPERO CRD42024603996.

To identify the cardiac rehabilitation (CR) needs and preferences of women living in rural communities to inform the co-design of a women-focused web-based CR program. Using a person-centred care and co-design approach, six 2-hour focus groups were conducted in-person or online across six rural regions of South Australia. Women with cardiovascular diseases who had completed a CR program were included. Discussions were directed using a semi-structured guide on the needs and preferences of women for different aspects of CR delivery. Data were transcribed verbatim, and thematic analysis was performed using NVivo. Nineteen women (mean age 65.1 years, ±12.3) participated in one of six focus groups. Six key themes emerged: (1) Navigating financial barriers to care; (2) Early education and support matter; (3) Recognising women's heart health needs; (4) Empowering women through exercise and physical activity; (5) The power of connection: valuing professional and personal support; and (6) Integrating technology for accessible and flexible care. Women expressed openness to using a web-based program to access and facilitate early CR participation. Tailored educational and exercise components, delivered through a financially viable model and supported by CR nurses, were identified as essential to meet the needs and preferences of women in rural areas. These findings provide critical insights for developing inclusive and sustainable CR programs that address the unique needs of women in rural settings.

Systematic reviews of values and preferences are essential to ensure that healthcare decision-making and clinical practice guidelines reflect what truly matters to patients, caregivers, policymakers and other interest-holders. These reviews synthesise evidence on how people value different health outcomes and provide critical information about the trade-offs they are willing to make (e.g. the willingness to accept an intervention's side effects to gain a meaningful benefit for a more highly valued outcome). The importance of these reviews in developing trustworthy guidelines is evident, yet limited methodological guidance exists. The process of conducting these reviews presents unique methodological challenges. This paper addresses these challenges by providing a systematic, step-by-step guide for planning and conducting value and preference reviews. We detail key considerations for each stage, from formulating the review question to assessing the certainty of evidence and illustrate these methodological approaches with examples from published reviews to enhance practical understanding.

Adequate sedation and analgesia are essential for catheter ablation of atrial fibrillation (AF) to ensure patient comfort and procedural safety. However, the availability of cardiac anaesthesiology is limited. This study evaluated the efficacy and safety of an operator-directed, nurse-administered (ODNA) sedation protocol using propofol and remifentanil during AF ablation. In this prospective, single-centre observational cohort study, consecutive patients undergoing catheter ablation for AF from August 2023 to March 2024 were enrolled. Sedation-related adverse events and intra-procedural vital signs were recorded. Sedation depth was assessed using the Modified Observer's Alertness/Sedation (MOAA/S) scale, and patient satisfaction was evaluated using the Visual Analogue Scale (VAS). A total of 230 patients were included (mean age 61.9 years; 76.1% male). Of these, 7.4% had a body mass index of ≥30 kg/m2, and 4.3% had obstructive sleep apnoea. Paroxysmal AF accounted for 30.9%, and the mean procedure time was 174 min. The primary outcome-defined as unplanned sedation interruption, intubation, or continuous vasopressor requirement-occurred in 2.2% of patients. Intermittent hypotension (mean arterial pressure: <60 mmHg) occurred in 36.1% of patients, but no patient required continuous vasopressors. The mean MOAA/S score was 0.4 ± 0.4. Post-procedural surveys showed high satisfaction (mean VAS: 8.8) and low maximal pain (VAS: 0.9). An ODNA protocol using propofol and remifentanil provides effective and safe sedation for AF ablation, with high patient satisfaction and minimal serious adverse events.

We aimed to develop the Self-Care for a Heart-Healthy Lifestyle (SC-HeartLife) scale among community-dwelling adults without a history of cardiovascular disease and evaluate its psychometric properties. The 'SC-HeartLife' scale was developed in three phases-initial item pool generation, content and face validity, and psychometric testing-guided by the Middle-Range Theory of Self-Care of Chronic Illness. A total of 946 community-dwelling adults in South Korea were recruited through an online survey. From an initial 83 items, 43 were retained following content and face validity evaluations. Using two split random samples, exploratory factor analysis and the first confirmatory factor analysis (CFA) were performed with Subsample 1 (n = 473) to develop a seven-factor hierarchical model. The second CFA with Subsample 2 (n = 473) was then conducted for cross-validation. Structural validity was supported by a 38-item, seven-factor hierarchical model demonstrating good fit (CMIN/DF = 2.07, CFI = 0.91, TLI = 0.91, RMSEA = 0.05, SRMR = 0.06). The model comprises three scales: self-care maintenance (five factors), self-care monitoring (one factor), and self-care management (one factor). It was also evidenced by significant correlations of the 'SC-HeartLife' with health-promoting behaviours and health-related quality of life. Reliability was acceptable, with strong internal consistency (global reliability = 0.94) and test-retest stability (intraclass correlation coefficient = 0.89). The 38-item 'SC-HeartLife' scale, on a 5-point Likert scale, is a valid and reliable tool. It is applicable across both clinical and research settings, supporting the identification of individuals and communities vulnerable to inadequate 'SC-HeartLife' and the evaluation of tailored interventions designed to promote self-care in the context of cardiovascular disease prevention.