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Cardiovascular disease (CVD) is the leading cause of mortality in patients undergoing chronic haemodialysis (HD). However, relatively few data exist regarding the influence of dialysis treatment on cardiac biomarkers such as high-sensitivity cardiac troponin I and T (hs-cTnI and hs-cTnT) and N-terminal pro-B-type natriuretic peptide (NT-proBNP), complicating their interpretation in the diagnosis of acute coronary syndrome and heart failure. This study aims to investigate the intradialytic kinetics of hs-cTnT, hs-cTnI and NT-proBNP, during HD and haemodiafiltration (HDF), in patients treated with chronic HD.
Single-centre, randomised, open-label, crossover study, comparing high-flux HD (FX 100 dialyser) and postdilution HDF (FX 1000 dialyser), regarding their potential clearance of hs-cTnI, hs-cTnT and NT-proBNP, in 24 stable patients treated with in-centre HD without acute CVD. The study will investigate changes in concentrations during and after high-flux HD and postdilution HDF and calculate reduction ratios, dialyser clearance and clearance by adsorption to the membrane of the selected cardiac biomarkers. Blood samples will be collected at baseline, after 10, 30, 60, 120, 180 and 240 min of dialysis and 30 min postdialysis. After 120 min of dialysis, dialysate will also be collected from the dialyser outlet line. The primary outcome is change from baseline in concentrations of hs-cTnI, hs-cTnT and NT-proBNP during high-flux HD and postdilution HDF.
The study has been approved by the North Denmark Region Committee on Health Research Ethics (N-20240016). Results will be published in an international peer-reviewed journal and disseminated at national and international research meetings.
We aimed to describe clinical and diagnostic characteristics of primary care patients with heart failure and physicians’ adherence to guideline-directed medical therapy (GDMT) for treating chronic heart failure.
Cross-sectional study based on baseline data from the prospective primary care-based study Heart failure in Southern Sweden (HISS).
Patients with heart failure were included from 20 primary healthcare centres in the southernmost region of Sweden (Skåne).
Between 2020 and 2023, patients were included in HISS, resulting in a total of 587 participants. Of these, 558 patients (95% of the HISS participants) had available data on left ventricular ejection fraction and were included in this study. Adult patients aged 18 years or older diagnosed with heart failure (International Classification of Diseases, 10th Revision codes I50, I11.0, I42, I43) were considered eligible for inclusion in HISS. Community-dwelling patients with assisted care were excluded.
The primary outcome measures were distribution of heart failure subtypes and prescribed medications. The secondary outcomes were temporal trends in GDMT and the association between physicians’ adherence to GDMT and clinical characteristics of patients, using logistic regression models.
Heart failure with preserved ejection fraction (HFpEF) was the most prevalent subtype (42%), followed by mildly reduced (30%) and reduced ejection fraction (HFrEF, 28%). Among patients with HFrEF, 20% were prescribed the recommended GDMT according to the European Society of Cardiology (ESC) 2021 guidelines, which consisted of a renin-angiotensin system inhibitor, a beta-blocker, a mineralocorticoid receptor antagonist and a sodium-glucose 2 inhibitor. We observed no significant change in the prescribing trends for the quadruple therapy in patients with HFrEF when comparing the 2 years before and after the publication of the ESC 2021 guidelines. Similarly, we observed no association between patient characteristics and the prescription of GDMT according to ESC 2021 for patients with HFrEF.
HFpEF was the most prevalent subtype, with conclusive and recent echocardiography data among two-thirds of the cohort. Temporal trends in prescription patterns showed no appreciable increase in the use of GDMT for HFrEF during the two years following guideline publication compared with the two preceding years. These findings indicate a need for inclusion of primary care patients as a basis for intensified medical recommendations and implementation strategies.
To investigate and compare the self-assessed professional competence of registered nurses, specialist nurses and midwives at a regional teaching hospital in Sweden. Moreover, to explore associations between potential predictive background factors and self-assessed professional competence.
A cross-sectional study.
Convenience sample of 615 nurses answered a questionnaire; sociodemographic data, 35-item Nurse Professional Competence Scale, Occupational Self-Efficacy Scale. Statistical analyses: Fisher's non-parametric permutation test, Kruskal–Wallis test, Mantel–Haenszel chi-square test, Spearman rank correlation test, calculating sum score. Multiple linear regressions and reliability testing with Cronbach's alpha.
Response rate, 58.7%; mean age, 44.7 years; work experience, 0.2 years to 45 years (mean 16.4 years); 83.4% women. 82.4% bachelor's degree; out of these, 34.3% with an additional master's degree. 17.6% nursing diploma without an academic degree. The highest mean scores for the NPC Scale were in Value-based nursing care, Medical and technical care. The lowest were in Care pedagogics and Development, leadership and organisation of nursing care. Total mean score 84.3, (79.3–90.0). Specialist nurses scored higher in all areas except Care pedagogics. Predictive factors indicated being a woman was positively associated with higher competence scores in all six areas, β coefficients 2.2–5.3 with p < 0.05. Longer nursing experience was positively associated with higher competence in Nursing care (β 0.17 per year, p = 0.01), Medical and technical care (β 0.14 per year, p = 0.01). The occupational self-efficacy scale was strongly positively associated with higher competence in all areas, β per scale step 0.42–0.63 with p < 0.0001. Nurses without academic degree had lower competence scores in several areas compared to bachelor's degree, β ranges from −3.47 to −2.31, p < 0.05.
Utilising competence data, the Swedish Enhanced Competence Development Model (vKUM) can effectively support the planning and management of ongoing professional competence development.
Study methods and results reported in adherence to STROBE checklist.
The nurses contributed their consent, time and data to this study.
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