PUBLICATIONS

@article{Code2024c,

title = {At the heart of resilience: Empowering women’s agency in navigating cardiovascular disease},

author = {J Code},

doi = {https://doi.org/10.1016/j.cjco.2023.12.013},

year  = {2024},

date = {2024-02-01},

urldate = {2024-02-01},

journal = {CJCOpen},

volume = {6},

issue = {2},

pages = {473-484},

abstract = {Cardiovascular disease (CVD) is the leading cause of death among women globally, emphasizing the need for a healthcare approach that empowers women through agency. This review focuses on the critical role of women’s agency in navigating CVD, integrating insights from various fields, including medicine, education, psychology, and sociology. It highlights the shift towards patient-centred care, where women are recognized as key decision-makers, a crucial change given the historical underemphasis on women’s health issues in medical practice. The diagnosis of CVD in women often involves emotional and psychological challenges. Unexpected diagnoses significantly disrupt perceived well-being, and prolonged diagnostic processes lead to professional skepticism and neglect of symptoms, resulting in delayed or inaccurate diagnoses and strained healthcare relationships. Effective management of CVD necessitates continuous self-management and a holistic approach to care, particularly for those with trauma who are at increased risk of cardiac incidents. Empowerment for women with CVD involves promoting self-confidence, autonomy, and active patient participation in healthcare. Implementing comprehensive care models is crucial for improving chronic CVD management, highlighting the need for healthcare systems that prioritize patient agency and empowerment. From the perspective of a woman with lived experience, this article examines the impact of CVD on women’s agency throughout the diagnostic journey. By highlighting women’s agency rather than particular behavioural changes, this review offers a comprehensive analysis that can shape policy, stimulate new research, and foster a more equitable, efficient, and empathetic healthcare system for women with CVD.},

keywords = {heart disease, heart failure, Heart Transplant, literature review, patient agency, Patient Experience, women's health},

pubstate = {published},

tppubtype = {article}

}

@article{Mamataz2024,

title = {Factors affecting healthcare provider referral to heart function clinics: A mixed-method study},

author = {T Mamataz and D Lee and K Turk-Adawi and AM Hajaj and J Code and SL Grace},

doi = {https://doi.org/10.1097/jcn.0000000000001029},

year  = {2024},

date = {2024-01-01},

urldate = {2024-01-01},

journal = {The Journal of Cardiovascular Nursing},

volume = {39},

issue = {1},

pages = {18-30},

abstract = {Background 

Heart failure (HF) care providers are gatekeepers for patients to appropriately access lifesaving HF clinics. 

Objective 

The aim of this study was to investigate referring providers' perceptions regarding referral to HF clinics, including the impact of provider specialty and the coronavirus disease pandemic. 

Methods 

An exploratory, sequential design was used in this mixed-methods study. For the qualitative stage, semistructured interviews were performed with a purposive sample of HF providers eligible to refer (ie, nurse practitioners, cardiologists, internists, primary care and emergency medicine physicians) in Ontario. Interviews were conducted via Microsoft Teams. Transcripts were analyzed concurrently by 2 researchers independently using NVivo, using a deductive-thematic approach. Then, a cross-sectional survey of similar providers across Canada was undertaken via REDCap (Research Electronic Data Capture), using an adapted version of the Provider Attitudes toward Cardiac Rehabilitation and Referral scale. 

Results Saturation was achieved upon interviewing 7 providers. Four themes arose: knowledge about clinics and their characteristics, providers' clinical expertise, communication and relationship with their patients, and clinic referral process and care continuity. Seventy-three providers completed the survey. The major negative factors affecting referral were skepticism regarding clinic benefit (4.1 ± 0.9/5), a bad patient experience and believing they are better equipped to manage the patient (both 3.9). Cardiologists more strongly endorsed clarity of referral criteria, referral as normative and within-practice referral supports as supporting appropriate referral versus other professionals (Ps < .02), among other differences. One-third (n = 13) reported the pandemic impacted their referral practices (eg, limits to in-person care, patient concerns). 

Conclusion 

Although there are some legitimate barriers to appropriate clinic referral, greater provider education and support could facilitate optimal patient access.},

keywords = {heart disease, heart failure, Heart Transplant, mixed methods},

pubstate = {published},

tppubtype = {article}

}

@article{nokeyk,

title = {Challenges and opportunities for increasing patient involvement in heart failure self-care programs and self-care in the post-hospital discharge period},

author = {J Butler and M Petrie and M Bains and T Bawtinheimer and J Code and T Levitch and E Malvolti and P Monteleone and P Stevens and J Vafeiadou and C Lam},

doi = {https://doi.org/10.1186/s40900-023-00412-x},

year  = {2023},

date = {2023-04-01},

urldate = {2023-04-01},

journal = {Research Involvement and Engagement},

volume = {9},

issue = {23},

pages = {1-11},

abstract = {Background 

People living with heart failure (HF) are particularly vulnerable after hospital discharge. An alliance between patient authors, clinicians, industry, and co-developers of HF programs can represent an effective way to address the unique concerns and obstacles people living with HF face during this period. The aim of this narrative review article is to discuss challenges and opportunities of this approach, with the goal of improving participation and clinical outcomes of people living with HF. 

Methods 

This article was co-authored by people living with HF, heart transplant recipients, patient advocacy representatives, cardiologists with expertise in HF care, and industry representatives specializing in patient engagement and cardiovascular medicine, and reviews opportunities and challenges for people living with HF in the post–hospital discharge period to be more integrally involved in their care. A literature search was conducted, and the authors collaborated through two virtual roundtables and via email to develop the content for this review article. 

Results 

Numerous transitional-care programs exist to ease the transition from the hospital to the home and to provide needed education and support for people living with HF, to avoid rehospitalizations and other adverse outcomes. However, many programs have limitations and do not integrally involve patients in the design and co-development of the intervention. There are thus opportunities for improvement. This can enable patients to better care for themselves with less of the worry and fear that typically accompany the transition from the hospital. We discuss the importance of including people living with HF in the development of such programs and offer suggestions for strategies that can help achieve these goals. An underlying theme of the literature reviewed is that education and engagement of people living with HF after hospitalization are critical. However, while clinical trial evidence on existing approaches to transitions in HF care indicates numerous benefits, such approaches also have limitations. 

Conclusion 

Numerous challenges continue to affect people living with HF in the post–hospital discharge period. Strategies that involve patients are needed, and should be encouraged, to optimally address these challenges.},

keywords = {heart failure, self-care, self-efficacy, self-regulation},

pubstate = {published},

tppubtype = {article}

}

@article{nokeyl,

title = {Participating in the peer review process: The Journal of Cardiac Failure construct},

author = {E Joyce and CK Mcillvennan and JH Esquivel and AJ Sauer and ... and J Code and 181–192. 29(2) (2023). .},

doi = {https://doi.org/10.1016/j.cardfail.2022.11.007},

year  = {2023},

date = {2023-02-01},

urldate = {2023-02-01},

journal = {Journal of Cardiac Failure},

volume = {29},

issue = {2},

pages = {181-192},

abstract = {Cardiovascular medicine, and the field of heart failure (HF) in particular, abounds with rapid advances in diagnostics, therapeutics, and implementation, requiring a comprehensive yet efficient pathway to relay these findings to the HF community. To this effect, peer review serves as a cornerstone of academic publishing—to support meaningful scientific inquiry, rigor, and dissemination. The importance of peer review has been particularly highlighted by the coronavirus disease 2019 pandemic as the scientific community has witnessed more online publications including “pre-peer review” drafts and the retraction of high-profile articles owing to inaccurate data.},

keywords = {heart disease, heart failure, Heart Transplant, peer reivew, research methods},

pubstate = {published},

tppubtype = {article}

}

@article{Lannon2022,

title = {Patient and caregiver perspectives of the connection between home and the transplant journey},

author = {H Lannon and J Code and J Poole and C Simpson and V Bath},

doi = {https://doi.org/10.1016/j.hrtlng.2022.10.008},

year  = {2023},

date = {2023-01-01},

urldate = {2022-10-28},

journal = {Heart & Lunch},

volume = {57},

pages = {1-6},

abstract = {Background: For many heart failure patients, a heart transplant is required. Few hospitals in Canada perform heart transplants; thus, patients and caregivers must relocate to access transplant care. 

Objective: This study explores Canadian patients’ and caregivers’ experiences of to access transplant care and how patients and caregivers define home. The study's goal is to gain insights from the patient and caregiver experience and identify opportunities to improve the experience for those who relocate to access heart transplants. The research question was: How is the concept of home connected to the heart transplant journey? 

Methods: We conducted 18 interviews with advanced heart failure patients and caregivers, to explore patient and caregiver experiences of relocating to access transplant care. Patients and caregivers ranged in ages from 20′s to 60′s and had left their home of origin to move to a new location where medical care was available. 7 patients were male, 3 were female. All caregivers were female. 

Results: Patients and caregivers identified three supports during relocation: other patients and caregivers, medical team and family. Patients and caregivers defined home as friends, family, community, warmth, safety, belonging and comfort. 

Conclusion 

During relocation, patients and caregivers were supported by: other patients and caregivers, their medical team and family, and how these people made them feel: safe, warm, comfortable and that they belonged is how they defined home. The supports and definitions of home are connected; thus, a sense of home is inextricably linked to the transplant journey for patients and caregivers.},

keywords = {heart failure, Heart Transplant, Patient Experience},

pubstate = {published},

tppubtype = {article}

}

@article{Code2022e,

title = {Automated digital counselling with social network support as a novel intervention for patients with heart failure: protocol for a randomized controlled trial},

author = {R Peiris and H Ross and C Chan and S Poon and B Auguste and V Rac and M Farkouh and M McDonald and J Kaczorowski and J Code and Others},

url = {https://bmjopen.bmj.com/content/12/9/e059635},

doi = {10.1136/bmjopen-2021-059635},

year  = {2022},

date = {2022-10-07},

urldate = {2022-10-07},

journal = {BMJ Open},

volume = {12},

issue = {9},

pages = {e059635},

abstract = {Introduction. Heart failure (HF) symptoms improve through self-care, for which adherence remains low among patients despite the provision of education for these behaviours by clinical teams. Open Access Digital Community Promoting Self-Care, Peer Support and Health Literacy (ODYSSEE–vCHAT) combines automated digital counselling with social network support to improve mortality and morbidity, engagement with self–care materials, and health-related quality of life. Methods and analysis. Use of ODYSSEE-vCHAT via Internet-connected personal computer by 162 HF patients will be compared with a control condition over 22 months. The primary outcome is a composite index score of all-cause mortality, all-cause emergency department visits, and HF-related hospitalisation at trial completion. Secondary outcomes include individual components of the composite index, engagement with self-care materials, and patient-reported measures of physical and psychosocial well-being, disease management, health literacy, and substance use. Patients are recruited from tertiary care hospitals in Toronto, Canada and randomised on a 1:1 ratio to both arms of the trial. Online assessments occur at baseline (t=0), months 4, 8 and 12, and trial completion. Ordinal logistic regression analyses and generalised linear models will evaluate primary and secondary outcomes. 

Ethics and dissemination. The trial has been approved by the research ethics boards at the University Health Network (20-5960), Sunnybrook Hospital (5117), and Mount Sinai Hospital (21-022-E). Informed consent of eligible patients occurs in person or online. Findings will be shared with key stakeholders and the public. Results will allow for the preparation of a Canada-wide phase III trial to evaluate the efficacy of ODYSSEE-vCHAT in improving clinical outcomes and raising the standard of outpatient care.},

keywords = {heart failure, RCT},

pubstate = {published},

tppubtype = {article}

}

@article{Code2022c,

title = {From patient to agent},

author = {J Code},

doi = {https://doi.org/10.1016/j.cardfail.2022.04.007},

year  = {2022},

date = {2022-07-01},

urldate = {2022-06-17},

journal = {Journal of Cardiac Failure},

volume = {8},

number = {7},

pages = {1230-1234},

keywords = {advocacy, autoethnography, editorial, heart failure},

pubstate = {published},

tppubtype = {article}

}

@article{Ross2021,

title = {The use of text messaging to improve the hospital-to-community transition in acute coronary syndrome patients (Txt2Prevent): Results from a pilot randomized controlled trial},

author = {E Ross and B Sakakibara and M Mackay and D Whitehurst and J Singer and M Toma and K Corbett and K Rutherford and B Gheorghiu and J Code and S Lear},

doi = {https://doi.org/10.2196/24530},

year  = {2021},

date = {2021-05-01},

urldate = {2021-05-01},

journal = {Journal of Medical Internet Research (JMIR)},

volume = {9},

number = {5},

pages = {e24530},

abstract = {Background: 

Acute coronary syndrome (ACS) is a leading cause of hospital admission in North America. Many patients with ACS experience challenges after discharge that impact their clinical outcomes and psychosocial well-being. Text messaging has the potential to provide support to patients during this post-discharge period. 

Objective: 

This study pilot-tested a 60-day text-messaging intervention (Txt2Prevent) for patients with ACS. The primary objective was to compare self-management domains between usual care and usual care plus Txt2Prevent. The secondary objectives were to compare medication adherence, health-related quality of life, self-efficacy, and healthcare resource use between groups. The third objective was to assess the feasibility of the study protocol and the acceptability of the intervention. 

Methods: 

This was a randomized controlled trial with blinding of outcome assessors. We recruited 76 patients with ACS from St. Paul’s Hospital in Vancouver, Canada and randomized them to one of two groups within seven days of discharge. The Txt2Prevent program included automated one-way text messages about follow-up care, self-management and healthy living. Data was collected during the index admission and at 60-days after randomization. The primary outcome was measured with the Health Education Impact Questionnaire (heiQ). Other outcomes included the EQ-5D-5L, EQ visual analogue scale, Sullivan Cardiac Self-Efficacy Scale, Morisky Medication Adherence Scale and self-reported healthcare resource use. Analyses of covariance were used to test the effect of group assignment on follow-up scores (controlling for baseline) and were considered exploratory in nature. Feasibility was assessed with descriptive characteristics of the study protocol. Acceptability was assessed with two survey questions and semi-structured interviews. 

Results: 

There were no statistically significant differences between the groups for the heiQ domains (adjusted mean difference: health directed activity: –0.13 [95% confidence interval (CI): –0.39-0.13]; positive and active engagement in life: 0.03 [95% CI: –0.19-0.25]; emotional distress: 0.04 [95% CI: –0.22-0.29]; self-monitoring and insight: 0.14 [95% CI: –0.33-0.05]; constructive attitudes and approaches: –0.10 [95% CI: –0.36- 0.17]; skill technique and acquisition: 0.05 [95% CI: –0.18-0.27]; social integration and support: –0.12 [95% CI: –0.34-0.19]; health services navigation: –0.05 [95% CI: –0.29-0.19]). For the secondary outcomes, there were no statistically significant differences in adjusted analyses except in one self-efficacy domain (‘Total Plus’), where the Txt2Prevent group had lower scores (mean difference: –0.36 [95% CI: –0.66 to -0.50]). The study protocol was feasible although recruitment took longer than expected. Over 90% of participants reported they were satisfied with the program. 

Conclusions: 

The Txt2Prevent study was feasible to implement; however, although exploratory, there were no differences between the two groups in adjusted analyses except for one self-efficacy domain. As the intervention appeared acceptable, there is potential in using text messages in this context. The design of the intervention may need to be reconsidered to have more impact on outcome measures. Clinical Trial: ClinicalTrials.gov NCT02336919},

keywords = {ehealth, heart failure},

pubstate = {published},

tppubtype = {article}

}

@article{Ross2021b,

title = {User experiences with a pilot text messaging intervention aimed to support patients with acute coronary syndrome after discharge},

author = {E Ross and B Sakakibara and M Mackay and D Whitehurst and J Singer and M Toma and K Corbett and K Rutherford and B Gheorghiu and J Code and S Lea},

url = {https://res.cloudinary.com/ibtnetwork/image/upload/v1590348569/virtual%20posters%20ibtn%202020/Ross_IBTN_2020_Abstract_Qual_v3.pdf 

https://res.cloudinary.com/ibtnetwork/image/upload/v1590348569/virtual%20posters%20ibtn%202020/Ross_IBTN2020_Poster_v3.pdf},

year  = {2021},

date = {2021-05-01},

urldate = {2021-05-01},

journal = {Annals of Behavioral Medicine},

publisher = {Annals of Behavioral Medicine},

abstract = {Background: Acute coronary syndrome (ACS) is a leading cause of hospital admission. Many patients with ACS experience challenges after discharge. Text messaging (SMS) has the potential to reach these patients; however, there is limited knowledge about the effectiveness and acceptability of SMS programs during this period. 

Objectives: To assess the acceptability of and users’ experiences with a pilot SMS intervention that aims to support patients with ACS after discharge. 

Methods: Seventy-six participants were recruited as inpatients and were randomized at discharge to receive usual care or a 60-day SMS program that included automated one-way messages with information on follow-up care, self-management and healthy living. We 

conducted semi-structured interviews with 18 participants who received the messages. Using thematic analysis, we identified themes regarding the program’s design, user engagement, and the program’s impact. 

Results: Overall, participants liked the design and 90% indicated they were satisfied or very satisfied with the program. Many stated they looked forward to the messages and 95% read all the messages indicating high engagement. Perceived impacts of the program included making participants feel their recovery process was normal, feeling as if they were receiving social support, and reinforcing that they were on the right track. However, some participants did not feel they benefited much and as such did not change their behaviours. 

Conclusion: The SMS program was well received and acceptable to most participants; however, not all felt that it impacted their recovery.},

keywords = {ehealth, heart failure},

pubstate = {published},

tppubtype = {article}

}

@article{pellegrini2020social,

title = {Social media in heart failure: A mixed methods systematic review},

author = {D Pellegrini and Y Eliya and A B Gevaert and J Code and H G C Van Spall},

doi = {10.1016/S0735-1097(20)34163-2},

year  = {2020},

date = {2020-01-01},

journal = {Journal of the American College of Cardiology},

volume = {75},

number = {11 Supplement 1},

pages = {3536},

publisher = {Journal of the American College of Cardiology},

abstract = {Background 

Among social media (SoMe) platforms, Twitter and YouTube have gained popularity, facilitating communication between cardiovascular professionals and patients. This mixed methods systematic review aimed to assess the source profile and content of Twitter and YouTube posts about heart failure (HF). 

Methods 

We searched PubMed, Embase, and Medline using the terms “cardiology”, “social media”, and “heart failure”. We included full-text manuscripts published between January 1, 1999 and April 14, 2019. We searched Twitter and YouTube posts using the hashtags “#heartfailure”, “#HF”, or “#CHF” on May 15, 2019 and July 6, 2019. We performed a descriptive analysis of the data. 

Results 

Three publications met inclusion criteria, providing 677 tweets for source profile analysis; institutions (54.8%), health professionals (26.6%), and patients (19.4%) were the most common source profiles. The publications provided 1,194 tweets for content analysis: 83.3% were on education of professionals; 33.7% on patient empowerment; and 22.3% on research promotion. Our search of Twitter and YouTube generated 2,252 tweets and over 400 videos, of which we analyzed 260 tweets and 260 videos. Sources included institutions (53.5% Twitter, 64.2% YouTube), health professionals (42.3%, 28.5%), and patients (4.2%, 7.3%). Content included education of professionals (39.2% Twitter, 62.3% YouTube), patient empowerment (20.4%, 21.9%), research promotion (28.8%, 13.1%), advocacy of professionals (5.8%, 2.7%), and research collaboration (5.8%, 0%). 

Conclusion 

Twitter and YouTube are platforms for knowledge translation in HF, with contributions from institutions, health professionals, and less commonly, patients. Both focus largely on education of professionals and less commonly, on patient empowerment. Twitter includes more content on research promotion, research collaboration, and professional advocacy than YouTube. 

Footnotes 

Poster Contributions 

Posters Hall_Hall A 

Saturday, March 28, 2020, 12:30 p.m.-1:15 p.m. 

Session Title: Spotlight on Special Topics: Education and Training 2 

Abstract Category: 42. Spotlight on Special Topics: Education and Training 

Presentation Number: 1174-278},

keywords = {heart failure, mixed methods, social media, systematic review},

pubstate = {published},

tppubtype = {article}

}

@article{roston2020heart,

title = {Heart failure in the young: The patient perspective and lived-experience},

author = {T M Roston and M Bains and J Code and S A Virani},

doi = {10.22374/cjgim.v15iSP1.418},

year  = {2020},

date = {2020-01-01},

journal = {Canadian Journal of General Internal Medicine},

volume = {15},

number = {SP1},

pages = {36–39},

abstract = {Heart failure (HF) is an often-debilitating syndrome that carries a lifelong burden of increased morbidity and mortality. While most affected individuals are elderly with ischemic heart disease, there are subsets of younger individuals who will develop HF. In this group, non-ischemic causes of cardiomyopathy are more common, optimal therapies are less clear, and the personal and societal impact is often greater. The lived-experience of younger patients highlights several unmet needs not addressed by large HF trials that influence survival, personal and financial wellness and return to activities of daily living. In Canada, there is an increasing focus on the patient perspective, especially amongst young individuals, when devising guidelines, policies and promoting advocacy in HF. This article describes the lived-experience of HF through the case example of a young patient, summarizes the clinical challenges in this age-group, and discusses opportunities to elevate the patient experience of care as a performance indicator.},

keywords = {autoethnography, heart failure, lived experience},

pubstate = {published},

tppubtype = {article}

}

@article{Code2019,

title = {I am the clinical trial},

author = {J Code},

year  = {2019},

date = {2019-01-01},

journal = {JACC: Heart Failure},

volume = {7},

number = {5},

pages = {439-441},

keywords = {autoethnography, clinical trial, heart failure, qualitative},

pubstate = {published},

tppubtype = {article}

}