Kristen M. Tecson Ph.D.

Elsaid, O., V. Gulati, K. Tecson, M. Friedman and J. Kluger (2018). “Ventricular electrical delay as a predictor of arrhythmias in patients with cardiac resynchronization implantable cardioverter defibrillator.” Scand Cardiovasc J Dec 20: 1-16. [Epub ahead of print].

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BACKGROUND: Left ventricular (LV) remodeling and clinical response to cardiac resynchronization therapy (CRT) is inversely related to electrical dyssynchrony, measured as LV lead electrical delay (QLV). Presence of atrial or ventricular arrhythmia is correlated with worsening heart failure and LV remodeling. OBJECTIVE: We sought to assess the association of QLV with arrhythmic events in CRT recipients. METHODS: We identified patients implanted with a CRT device at our center. QLV interval was measured and corrected for baseline QRS (cQLV). We performed multivariable Logistic regression to assess the effect of cQLV on the occurrence of atrial/ventricular arrhythmic events. RESULTS: Sixty-nine patients were included in analyses. The cQLV was significantly shorter in patients with atria tachycardia/supraventricular tachycardia (AT/SVT) events compared to patients without AT/SVT events (43.4 +/- 22% vs. 60.3 +/- 26.7%, P = 0.006). In contrast, no significant difference in cQLV was observed between patients with and without ventricular tachycardia/fibrillation (VT/VF) events (46.2 +/- 25.4% vs. 56 +/- 25.7%, P = 0.13). cQLV was significantly shorter in patients with new onset AT/SVT events compared to those without (38.3 +/- 22.2% vs. 55.7 +/- 25.7%, P = 0.028). In contrast, no significant difference in cQLV was observed between patients with and without new onset VT/VF events (44.2 +/- 25.2% vs. 56.3 +/- 25.5%, P = 0.069). Following adjusted analyses, cQLV was a significant predictor of AT/SVT, but not for VT/VF. CONCLUSION: cQLV is a simple measure that can identify a vulnerable cohort of CRT patients at increased risk for atrial tachyarrhythmias, and hence can predict reverse remodeling and clinical response to CRT treatment.

Ko, J. M., K. S. White, A. H. Kovacs, K. M. Tecson, S. Apers, K. Luyckx, C. Thomet, W. Budts, J. Enomoto, M. A. Sluman, J. K. Wang, J. L. Jackson, P. Khairy, S. C. Cook, R. Subramanyan, L. Alday, K. Eriksen, M. Dellborg, M. Berghammer, B. Johansson, A. S. Mackie, S. Menahem, M. Caruana, G. Veldtman, A. Soufi, S. M. Fernandes, E. Callus, S. Kutty, A. Gandhi, P. Moons and A. M. Cedars (2018). “Physical Activity-Related Drivers of Perceived Health Status in Adults With Congenital Heart Disease.” Am J Cardiol 122(8): 1437-1442.

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Data on the differential impact of physical activity on perceived health status (PHS) in a large adult congenital heart disease (ACHD) patient population are lacking. We conducted a cross-sectional assessment of 4,028 ACHD patients recruited from 24 ACHD-specialized centers in 15 countries across 5 continents to examine the association between physical activity and PHS in a large international cohort of ACHD patients. A linear analog scale of the EuroQol-5D 3 level version and the 12-item Short Form Health Survey-version 2 were used to assess self-reported health status and the Health-Behavior Scale-Congenital Heart Disease was used as a subjective measurement of physical activity type, participation, and level. Correlation analyses and Wilcoxon Rank Sum tests examined bivariate relations between sample characteristics and PHS scores. Then, multivariable models were constructed to understand the impact of physical activity on PHS. Only 30% of our sample achieved recommended physical activity levels. Physically active patients reported better PHS than sedentary patients; however, the amount of physical activity was not associated with PHS. Further statistical analyses demonstrated that specifically sport participation regardless of physical activity level was a predictor of PHS. In conclusion, the majority of ACHD patients across the world are physically inactive. Sport participation appears to be the primary physical activity-related driver of PHS. By promoting sport-related exercise ACHD specialists thus may improve PHS in ACHD patients.

Lee, A. Y., K. M. Tecson, B. Lima, A. F. Shaikh, J. Collier, S. Still, R. Baxter, J. M. DiMaio, J. Felius, S. A. Carey, G. V. Gonzalez-Stawinski, R. Nauret, M. Wong, S. A. Hall and S. M. Joseph (2018). “Durable Left Ventricular Assist Device Implantation in Extremely Obese Heart Failure Patients.” Artif Organs Oct 25. [Epub ahead of print].

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BACKGROUND: Left ventricular assist devices (LVADs) have improved clinical outcomes and quality of life for those with end-stage heart failure. However, the costs and risks associated with these devices necessitate appropriate patient selection. LVAD candidates are becoming increasingly more obese and there are conflicting reports regarding obesity’s effect on outcomes. Hence, we sought to evaluate the impact of extreme obesity on clinical outcomes after LVAD placement. METHODS: Consecutive LVAD implantation patients at our center from June 2008- May 2016 were studied retrospectively. We compared patients with a body mass index (BMI) >/=40 kg/m(2) (extremely obese) to those with BMI <40 kg/m(2) with respect to patient characteristics and surgical outcomes, including survival. RESULTS: 252 patients were included in this analysis, 30 (11.9%) of whom met the definition of extreme obesity. We found that patients with extreme obesity were significantly younger (47[33, 57] v. 60[52, 67] years, p<0.001) with fewer prior sternotomies (16.7% v. 36.0%, p=0.04). They had higher rates of pump thrombosis (30% vs 9.0%, p=0.003) and stage 2/3 acute kidney injury (46.7% vs 27.0%, p=0.003), but there were no differences in 30-day or 1-year survival, even after adjusting for age and clinical factors. CONCLUSION: Extreme obesity does not appear to place LVAD implantation patients at a higher risk for mortality compared to those who are not extremely obese; however, extreme obesity was associated with an increased risk of pump thrombosis, suggesting that these patients may require additional care to reduce the need for urgent device exchange. This article is protected by copyright. All rights reserved.

Saef, J., S. Sodhi, K. M. Tecson, V. Al Rashida, J. Mi Ko, K. S. White, P. A. Ludbrook and A. M. Cedars (2018). “Contributors to disease-specific health knowledge in adults with congenital heart disease: A correlational study.” Congenit Heart Dis Sep 27. [Epub ahead of print].

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OBJECTIVE: Growth in the adults with congenital heart disease (ACHD) population represents a challenge to the health care infrastructure. As patients with chronic disease are increasingly held accountable for their own care, contributors to disease-specific health knowledge, which are known to correlate with patients’ participation in care, merit investigation to design patient-focused interventions. DESIGN: We conducted a single-site, cross-sectional study of ACHD patients. Investigators retrospectively gathered clinical data as well as psychometric and health status assessments completed at the time of enrollment. OUTCOME MEASURES: We investigated the impact of clinical and psychological variables on Leuven Knowledge Questionnaire for Congenital Heart Diseases health knowledge composite scores (HKCS). Variables with significant associations were considered in a stepwise multivariable regression model to determine which combination of variables jointly explained variability in HKCS. RESULTS: Overall HKCS was associated with the number of prior cardiac surgeries (r = 0.273; 95% CI: 0.050-0.467; P = .016), perceived stress (r = 0.260; 95% CI: 0.033-0.458; P = .024), SF-36 emotional well-being (r = -0.251; 95% CI: -0.451, -0.024; P = .030), history of noncardiac surgery (P = .037), cirrhosis (P = .048), and presence of implantable cardioverter-defibrillator (P = .028). On multivariable modeling, only the number of cardiac surgeries was found to correlate with HKCS. CONCLUSIONS: While univariate correlations were found between HCKS and several other clinical and psychological variables, only number of prior cardiac surgeries independently correlated with disease-specific health knowledge in ACHD patients. These results suggest that clinical and psychological variables are not impediments to disease-specific health knowledge.

Douglas Lawson, T., K. M. Tecson, C. N. Shaver, S. A. Barnes and S. Kavli (2018). “The impact of informal leader nurses on patient satisfaction.” J Nurs Manag Jul 11. [Epub ahead of print].

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BACKGROUND: The relationship between informal leaders, i.e., highly competent individuals who have influence over peers without holding formal leadership positions, and organisational outcomes has not been adequately assessed in health care. AIMS: We evaluated the relationships between informal leaders and experience, job satisfaction and patient satisfaction, among hospital nurses. METHODS: Floor nurses in non-leadership positions participated in an online survey and rated colleagues’ leadership behaviours. Nurses identified as informal leaders took an additional survey to determine their leadership styles via the Multifactor Leadership Questionnaire(TM) . Six months of patient satisfaction data were linked to the nursing units. RESULTS: A total of 3,456 (91%) nurses received peer ratings and 628 (18%) were identified as informal leaders. Informal leaders had more experience (13.2 +/- 10.9 vs. 8.4 +/- 9.7 years, p < 0.001) and higher job satisfaction than their counterparts (4.8 +/- 1.2 vs. 4.5 +/- 1.1, p = 0.007). Neither the proportion of informal leaders on a unit nor leadership style was associated with patient satisfaction (p = 0.53, 0.46, respectively). CONCLUSION: While significant relationships were not detected between patient satisfaction and styles/proportion of informal leaders, we found that informal leaders had more years of experience and higher job satisfaction. More work is needed to understand the informal leaders' roles in achieving organisational outcomes. IMPLICATIONS FOR NURSING MANAGEMENT: Nurse informal leaders are unique resources and health care organisations should utilise them for optimal outcomes.