Background:Octogenarians with aortic stenosis are an increasing population of patients admitted for surgical aortic valve replacement (SAVR) or transcatheter aortic valve implantation (TAVI). Although adequate sleep is important after illness and surgery, it has scarcely been studied in the immediate postoperative phase.Aims:To determine and compare the nature of self-reported sleep and insomnia, and recorded sleep–wake patterns in octogenarians during the in-hospital postoperative phase after SAVR or TAVI.Methods:A prospective cohort design was used that included octogenarian patients undergoing SAVR or TAVI at a regional university hospital. Self-reports were used to document sleep and insomnia, and actigraphy was used to record sleep–wake patterns. Data were collected at baseline preoperatively, and then daily for the first five postoperative days.Results:SAVR patients experienced the most insomnia on postoperative nights later in recovery, while TAVI patients experienced the most insomnia on postoperative nights early in recovery. The median total sleep time, as measured by actigraphy, was 6.4 h, and the median sleep efficiency was 79% for the five postoperative nights, but no differences were found between SAVR and TAVI patients on this parameter. All patients slept more during daytime than at night, with SAVR patients having significantly more total sleep hours for all five days than TAVI patients (p < 0.01).Conclusion:Octogenarians with aortic stenosis had disturbed self-reported sleep, increased insomnia, and disturbed sleep–wake patterns postoperatively, resulting in more daytime sleep and inactivity. In patients undergoing SAVR or TAVI, sleep evolves differently during the in-hospital postoperative phase.

Background: Delirium affects nearly half of octogenarian patients after aortic valve replacement, resulting in impaired cognition, reduced awareness and hallucinations. Although healthcare professionals and relatives are often present during episodes, the nature of interactions with them is scarcely studied, and little is known about their long-term experiences. Purpose: The purpose of this study was to explore and describe how octogenarian patients with post-aortic valve replacement delirium experience interactions with healthcare professionals and relatives within the first year and four years later. Method: An explorative design with qualitative content analysis was used. Delirium was assessed for five consecutive days after aortic valve replacement using the Confusion Assessment Method. Delirious patients (n=10) were interviewed 6-12 months post-discharge and four years later (n=5). We used an inductive approach to identify themes in transcribed interviews. Findings: An overarching theme emerged: 'Healthcare professionals' and relatives' responses made a considerable impact on the delirium experience postoperatively and in a long-term'. Three sub-themes described the patients' experiences: 'the need for close supportive care', 'disrespectful behaviour created a barrier' and 'insensitive comments made lasting impressions'. Having healthcare professionals and relatives nearby made the patients feel secure, while lack of attention elevated patients' emotional distress. Four years later, patients clearly recalled negative comments and unsupportive actions in their delirious state. Conclusions: Healthcare professionals and relatives have an essential role in the aortic valve replacement recovery process. Inconsiderate behaviour directed at older patients in delirium elevates distress and has long-term implications. Supportive care focused on maintaining the patients' dignity and integrity is vital.

ObjectivesSleep disturbances and delirium are frequently observed complications after surgical aortic valve replacement (SAVR) and transcutaneous aortic valve implantation (TAVI), especially in octogenarian patients. However, a knowledge gap exists on patient experiences of sleep and delirium. In particular, patients’ long-term sleep and delirium experiences are unknown. This article explores and describes how octogenarian patients suffering from delirium after aortic valve replacement experience their sleep and delirium situation.DesignAn explorative and descriptive design with a longitudinal qualitative approach was applied. Qualitative content analysis following the recommended steps of Graneheim and Lundman was performed.SettingPatients were included at a tertiary university hospital with 1400 beds. Delirium and insomnia screening was performed at baseline and five postoperative days after aortic valve treatment. For qualitative data, 10 patients were interviewed 6–12 months after treatment with focus on delirium. Five of these patients were reinterviewed 4 years after treatment, with focus on their sleep situation.ParticipantsInclusion criteria; age 80+, treated with SAVR or TAVI and had experienced delirium after treatment.ResultsFor the initial interview, we included five men and five women, four following TAVI and six following SAVR, mean age 83. One overarching theme revealed from the content analyses; Hours in bed represented emotional chaos. Whereas three subthemes described the patients’ experiences with sleep and delirium, a cascade of distressful experiences disturbing sleep, the struggle between sleep and activity and elements influencing sleep. Four years after the treatment, sleep disturbances persisted, and patients still remembered strongly the delirium incidences.ConclusionsFor octogenarian patients, sleep disturbances and delirium are long-term burdens and need a greater attention in order to improve patient care.

Funding Acknowledgements Type of funding sources: Private company. Main funding source(s): Novo Nordic Foundation Background An estimated 35% of heart disease occurs in individuals between 35 to 54 years of age, which is the prime child-bearing and parenting years. Even though heart disease often has a good prognosis, its treatment and symptoms can cause changes in everyday life within the family. Existing research shows that adolescents who live with a parent having serious illness are to a higher degree at risk of psychosocial, behavioural, and emotional challenges than peers if they are not accommodated. To our knowledge, limited research exists about adolescents´ experiences of living with parental heart disease. Purpose To explore how adolescents experience having a parent with heart disease. Methods This qualitative study is performed with semi-structured individual interviews guided by relevant theory. Interviews of 33 adolescents from 13 to 19 years old, who either had a mother or father with one of the diagnoses: ischemic heart disease, arrhythmia, heart failure, or cardiac arrest were conducted. Their parent had been ill for at least six months and up to 5 years and the study was carried out in Denmark, Norway, and Sweden from 2019 until 2022. The analysis was inspired by Reflexive methodology. Results The findings of the present study highlighted three central themes: Response to parental heart disease, Strategies in a changed life situation, and Altered relationships. While the heart was experienced as the most vital organ for adolescent’s feelings of fear of losing their parent both physically and mentally appeared and led to a range of different reactions. Adolescents pursued normality as a strategy to overcome their new life situation with parental heart disease where they prioritized a safe space to seek away from the disruption. Adolescents took adult responsibility at home, and through the process, enhanced maturity and new practical skills were developed. Conclusion(s) This study has contributed to new knowledge in regard to how parental heart disease changes everyday life as experienced by their young relatives. In order to reconstruct the adolescent’s new lives and cope with parental heart disease the adolescent’s pursued normality, which is a significant coping strategy that must be taken into account in relation to supporting them. To expand our knowledge more research is needed to explore what adolescents’ needs from healthcare professionals are.

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