European Journal of Cardiovascular Nursing - Articles in Press

Predictors for physical and mental health 6months after coronary artery bypass grafting: A cohort study - Corrected Proof

Irene Lie, Harald Arnesen, Leiv Sandvik, Glenys Hamilton, Eli H. Bunch — 2010-03-11

Abstract: Background: Knowledge of predictors for health related quality of life (HRQoL) after coronary artery bypass grafting is limited.Aim: To identify preoperative and postoperative factors related to physical and mental health status 6months after surgery.Methods: 185 patients completed the Short Form-36 survey preoperatively and 6months after surgery. Multiple linear regression was used to identify significant independent predictors for both physical and mental health component summary scores 6months after surgery.Results: Significant predictors for physical health were preoperative physical status (PCS), marital status, hospitalised with acute myocardial infarction and serum creatine kinase-MB (CK-MB) 1st postoperative day. Preoperative mental status (MCS and anxiety and/or depression symptoms) and postoperative pleural drainage were significant predictors of mental health 6months after surgery.Conclusion: This study identified predictors that have an impact on CABG patients' HRQoL 6months after surgery. These predictors could cause elevated risk for morbidity and mortality. Clinicians have the opportunity to improve the HRQoL of CABG patients by targeting counselling and/or interventions focusing on the identified predictors.

Nurse-led interventions in heart failure care: Patient and nurse perspectives - Corrected Proof

2010-03-08

Abstract: Background: Perspectives of nurses and patients on the intensity and content of disease management programmes (DMPs) in heart failure are seldom addressed but are important in optimizing these programmes.Aim: To describe the perspectives of patients and nurses on delivered care in two DMPs.Methods: In total 442 patients (62% male; age 68±12years; LVEF 33%±14), assigned to the intervention groups of the Coordinating Study Evaluating Outcomes of Advising and Counselling in HF (COACH), and 32 registered nurses, completed questionnaires on satisfaction with the intensity and components of the DMPs.Results: In spite of large differences in intensity and components, patients were satisfied with the content of both DMPs. In patients (NYHA III–IV), treatment and educational goals were more often achieved in those who received intensive support, compared to patients who received basic support (85% vs. 70%). Patients and nurses perceived that most home visits were adding significant value to the HF care, while 12% of the home visits were perceived as unnecessary by the nurses.Conclusion: Patients and nurses did not perceive the intense DMP as an emotional and physical burden for themselves. Patients with severe HF might be in need of more support to achieve optimal treatment and educational goals.

Equity of access to CVD risk management using electronic clinical decision support in the coronary care unit - Corrected Proof

Andy McLachlan, Susan Wells, Sue Furness, Rod Jackson, Andrew Kerr — 2010-02-19

Abstract: Background: Cardiovascular (CVD) risk management post myocardial infarction is inconsistently delivered with those who need the most receiving the least — the ‘inverse care law.’ The Acute PREDICT Initiative is a nurse led computerised decision support system (CDSS), to provide point-of-care guideline-based, patient-specific CVD risk management recommendations to all.Methods: All patients admitted to Middlemore Hospital CCU over 2years with acute CVD-related events potentially ‘eligible’ for PREDICT assessment were identified. Age, gender, ethnicity and a small area measure of socioeconomic status (NZDep01) were assessed.Results: 1813/2246 (81%) of people admitted were eligible for a PREDICT assessment. Of those, 973 (54%) received a complete assessment. There were no important differences by quintile of deprivation or ethnicity between the patients receiving PREDICT and the rest. PREDICT assessments were less likely for the elderly (35.7% of >75years compared with 57.7% of <75years), for women (47.1% of women and 56.5% of men), and for those who had 5 or more previous admissions.Conclusions: Patients potentially at higher risk because of their ethnic or socioeconomic background received equitable access to in-hospital CVD risk management post MI using PREDICT. However, some other high-risk groups under-utilised the system.

Improving nurses' ability to identify anatomic location and leads on 12-lead electrocardiograms with ST elevation myocardial infarction - Corrected Proof

Michele M. Pelter, Mary G. Carey, Kimberly E. Stephens, Holly Anderson, Wei Yang — 2010-02-15

Abstract: Background: ST segment elevation on the electrocardiogram (ECG) signifies complete occlusion of a coronary artery. Nurses play a significant role in obtaining, interpreting, and communicating 12-lead ECG findings.Aims: We evaluate a hand held paper tool to determine if it assists nurses; (1) identify the presence of ST elevation myocardial infarction (STEMI), (2) location, and (3) leads.Methods: A pre-test/post-test design was used. At pre-test, nurses from the emergency department (ED), coronary care unit (CCU), and the progressive care (PC) were given 6 patient scenarios (3 STEMI and 3 non-STEMI) and a corresponding 12-lead ECG. This was followed by a brief in-service on how to use the hand held tool. The nurse then interpret the same six ECGs (in a different order) using the hand held tool.Results: Seventy-five nurses participated. Identification of STEMI location improved when the tool was used. Lead identification improved in 2 of the 3 STEMI scenarios. Overall, nurses' ability to correctly identify the 3 non-ischemic ECGs was low, and in one ECG was lower when the tool was used.Conclusion: For ECGs with a STEMI pattern an easy-to-learn tool improves nurses' ability to identify STEMI location. Nurses require education for identifying ECG leads, and non-ischemic ECG patterns.

Psychometric properties of the Norwegian MacNew Heart Disease health-related quality of life inventory - Corrected Proof

Aud Hiller, Anne-Sofie Helvik, Stein Kaasa, Stig A. Slørdahl — 2010-02-05

Abstract: Background: MacNew is a health-related quality of life (HQOL) inventory for patients with ischaemic heart disease and includes three domains; emotional, physical and social. The MacNew gives new opportunities to compare directly patients with the three major ischaemic heart diagnoses, angina, myocardial infarction and heart failure. However, this inventory has not earlier been evaluated in Norwegian.Objective: The purpose of this study was to validate the Norwegian version of the disease-specific HQOL inventory MacNew by assessing the measurement model, internal consistent reliability and test–retest and convergent validity.Method: Patients with ischaemic heart disease (n=124; angina pectoris, n=53; myocardial infarction, n=35; and heart failure; n=36) participated in this cross-sectional study. Patients completed the self-administered MacNew and the generic HQOL-instrument SF-36. The MacNew and the SF-36 were repeated 2–3weeks later (test–retest) by 17 patients.Results: The psychometric properties were satisfactory to good. The construct validity assessed by factor analysis explained 61.5% of the variance. The internal consistent reliability was high (exceeded 0.90 in all domains). The test–retest analysis showed equivalent results demonstrating good reproducible properties. The convergent validity within each domain was evaluated with correlation analysis, demonstrating correlations of 0.74, 0.69 and 0.71 on the emotional, physical and social domains, respectively.Conclusion: The Norwegian version of the MacNew inventory demonstrated satisfactory to good psychometric properties and can be recommended for evaluating HQOL for patients with heart diseases in clinical studies.

Self management, symptom monitoring and associated factors in people with heart failure living in the community - Corrected Proof

Robyn Gallagher — 2010-01-21

Abstract: Background: Regular symptom monitoring enables early detection and treatment of heart failure exacerbations, reducing preventable hospital admissions.Aim: To determine the level of self management and frequency of symptom monitoring and factors associated in patients with moderate severity HF living in the community.Methods: A correlation study of a convenience sample of patients recently admitted or enrolled in treatment for heart failure were interviewed twice, one month apart, on self management and the frequency of monitoring five key heart failure symptoms.Results: Participants (n=63) had an age mean of 78.38years (SD 8.54years), and approximately half were male (57%) and married (56%). Daily monitoring occurred in 69.8% for peripheral oedema, 65% for weight and 41.3% for fatigue, 38.9% for dyspnea during normal activity and 28.6% for dyspnea at night or at rest. At baseline, better self management was predicted by more comorbid conditions (ß=−2.64) and stronger sense of coherence (ß=−0.24), and one month later, by the baseline self management score (ß=.65). The only predictor of symptom monitoring at one month was the frequency of monitoring at baseline (OR=9.18).Conclusions: Neither self management nor symptom monitoring is ideal in people with HF. As these behaviours did not change with time, interventions are needed early in the illness course.

The use of innovative methods designed to relieve social isolation in patients with chronic heart failure; volunteer befriending, forums and a newsletter - Corrected Proof

2010-01-18

Abstract: Introduction: Social isolation in patients with chronic heart failure (CHF) is an adverse prognostic factor. This paper reports the creation of a supportive patient/carer network (Heart Failure Support Service), led by a voluntary sector/National Health Service (NHS) partnership which involved volunteer befriending, regular patient and carer forum and a newsletter.The project: Over 3years, 37 volunteers were ‘befrienders’ to over 50 individuals with CHF. A thorough training and matching process ensured that the first befriending visit was a positive experience. 100% of patients found the visits from the volunteer worthwhile and said they would recommend the service to other patients. Prior to the first patient–carer forum, 200 questionnaires were sent out with a 56% response rate, 44% of respondents believed that a forum and a newsletter would be valued. Over a period of 3years, 12 quarterly meetings were held with an average attendance of 30–40 per meeting. The newsletter (current circulation >800 per quarter) contributed to self-management and encouraged communication between professionals and patients–carers.Conclusions: The Heart Failure Support Service (volunteers, forum and newsletter) created a supportive patient–carer network and represents a successful voluntary sector/NHS partnership.

Wound management and restrictive arm movement following cardiac device implantation — evidence for practice? - Corrected Proof

Katrine Bavnbek, Syed Y. Ahsan, Julie Sanders, Simon F. Lee, Anthony W. Chow — 2010-01-14

Abstract: Background: The rate of cardiac device implantation has risen significantly secondary to an increase in the number of indications. Wound infection and lead displacement are two common and potentially life-threatening complications. No national/international guidelines address postoperative care and controversy exists regarding wound management and arm movement following cardiac device implantation.Aims: We aimed to explore and review the evidence behind current practice but found that certain aspects of established practice.Methods: An electronic search of the databases EMBASE, British Nursing Index, CINAHL, Cochrane and PubMed to identify evidence regarding wound management and lead displacement.Findings: We found that certain aspects of established practice are based on tradition rather than evidence. Recent guidelines on wound management published by The National Institute for Health and Clinical Excellence in the UK recommend covering the wound postoperatively for 48h with a low-adherent transparent dressing and letting patients shower thereafter. Since specific guidelines for cardiac device patients are lacking, we suggest that further research address whether or not the NICE guidelines can be extrapolated to this area. Studies showed that early mobilisation and allowing a full range of arm movements following device implantation is safe. Further research must validate these findings.Conclusion: We discuss the reasons behind these gaps in the evidence base and support the idea that nursing education has not placed enough emphasis on how to critically appraise research. This accounts for the very small proportion of nurses that get involved in conducting research and generating guidelines. Additionally, we argue that nurses can play a key role in identifying and addressing research questions that lead to improved patient outcome. Thus, we support proposals to enhance nurses' opportunities to pursue academic careers to achieve adequate research skills.

Sedative treatment regimes in all Dutch centers carrying out percutaneous coronary interventions, a comprehensive nationwide survey - Corrected Proof

2010-01-14

Anxiety is a common emotion in patients undergoing a diagnostic coronary angiogram and/or percutaneous coronary intervention procedure. In many hospitals sedation is commonly administered assuming a beneficial effect on the well-being of these patients. However, data on the level and influence of anxiety are limited and show conflicting evidence . To our knowledge, only one small, single-center study has evaluated the level of anxiety in patients before, during and after a diagnostic coronary angiogram (DCA) and/or percutaneous coronary intervention (PCI). This small sized single center study interviewing 14 patients undergoing DCA and/or PCI hypothesized beneficial effects of peri-procedural sedation on the experienced well-being of the patients .

Disturbed sleep, fatigue, anxiety and depression in myocardial infarction patients - Corrected Proof

Ingvor Johansson, Björn W. Karlson, Gunne Grankvist, Eva Brink — 2010-01-14

Abstract: Background: Disturbed sleep has been linked to increased morbidity, mortality and depression and worsened health-related quality of life in patients with chronic illness. Few studies of readjustment after coronary artery disease have explicitly focused on sleep disturbance.Aim: To explore associations between disturbed sleep, fatigue, anxiety and depression, and to assess to what extent fatigue four months post-MI could be explained.Method: The sample included 204 consecutive patients, ≤80years of age who answered questionnaires about disturbed sleep, fatigue, anxiety and depression four months after MI.Results: The variables anxiety, depression and disturbed sleep were all associated with fatigue. The regression model accounted for 46% of the variance in fatigue with depression and disturbed sleep as predictors. Infarct size measured by conventional biochemical markers, left ventricle ejection fraction and history of previous MI were not correlated with disturbed sleep, fatigue, anxiety or depression.Conclusions: From knowledge about associations between disturbed sleep, fatigue, anxiety and depression after MI, cardiac nurses could be trained to observe such symptoms. Optimal care for sleep disturbance may include actions to reduce anxiety and depression as well as self-care advices about sleep hygiene in order to improve sleep quality and reduce fatigue.

Sleep disturbances — A significant problem for cardiovascular nurses in practice and/or research? - Corrected Proof

Peter Johansson, Anders Broström — 2010-01-14

Sleep, a state in which humans spend almost one third of their life, is a basic human need . All functions of sleep are not yet fully understood, but sleep appears to restore energy, promote learning and consolidation of memory and is important for the human immune function . Most of us have also experienced how it feels when our sleep has been bad; and as a consequence we feel excessive daytime sleepiness and/or fatigue; are less able to perform daily tasks as we are used to; become irritable and may feel of depressed. Hence, sleep is a central aspect for human physical and psychological well-being. During the last decade several studies using objective sleep recordings have found sleep disturbances to be common among patients with different cardiovascular diseases such as hypertension, angina, myocardial infarction, heart failure, stroke and atrial fibrillation . A recent study including 700 patients with heart failure reported a prevalence of 76% suffering from sleep disordered breathing . Looking at data based on self reports, around 50% of patients with heart failure, report that their sleep is bad . These patients may complain that they have problems to initiate sleep, maintain sleep, or do not feel fresh after a night's sleep. Patients who express that they have a poor sleep are probably very common in clinical practice. Reasons for sleep related problems are multiple and complex, but some probable causes are related to side effects of drugs; nocturia (diuretics?); nocturnal dyspnoea; worries and anxiousness because of the disease . Other causes of sleep related complaints are sleep related breathing disorders.

Evaluation of a Swedish version of the Watts Sexual Function Questionnaire (WSFQ) in persons with heart disease: A pilot study - Corrected Proof

2010-01-13

Abstract: Background: As part of preparation for a Swedish multicentre study, exploring sexual and married life in patients with myocardial infarction and their partners, a Swedish validated instrument was required.Aims: The aim of this pilot study was to evaluate the validity and reliability of a Swedish version of the Watts Sexual Function Questionnaire (WSFQ) among persons with a heart disease.Methods: A convenience sample of 79 persons (47 men and 32 women) living with a heart disease was recruited from the members of the National Association of Heart and Lung Patients. They completed a Swedish version of the WSFQ on two occasions.Results: Two separate factor analyses each revealed a two-factor structure on both occasions: “Sexual appetite” and “Sexual expectations” with gender-neutral questions and “Sexual sensitiveness” and “Sexual ability” with gender-specific questions. Cronbach's alpha coefficients ranged from 0.48 to 0.86 and test–retest values for all but one question exceeded 0.70.Conclusions: The Swedish version of the WSFQ showed good validity and stability and acceptable internal homogeneity. Extended evaluations of the questionnaire are recommended.

Spouses' experiences of a cardiac arrest at home: An interview study - Corrected Proof

Thorén Ann-Britt, Danielson Ella, Herlitz Johan, Axelsson B. Åsa — 2010-01-13

Abstract: Introduction: In case of out-of-hospital cardiac arrest (OHCA) influence of a bystander spouse is decisive for the chance of survival.Aim: To describe spouses' experiences of witnessing their partners' cardiac arrest at home, focusing on the time before the event and when it happened.Methods: Interviews with fifteen spouses were recorded and transcribed verbatim. Qualitative content analysis was conducted.Results: In the domain entitled “Time before cardiac arrest”, four themes emerged in the analysis process: “Lack of early warning signs”, “Difficulty interpreting early warning signs”, “Interpreting signs in the light of previous illness” and “Denial of serious illness”. In the domain entitled “The cardiac arrest event”, three themes emerged: “Perceiving the seriousness”, “Being unable to influence” and “Doing what is in one's power”. The emergency call services' (ECS) ability to instruct and help the spouses to do what they can becomes evident in these themes.Conclusion: Spouses who experienced OHCA demonstrated a lack of confidence in or ability to interpret early warning signs and symptoms. This lack of confidence also extended to the process of cardiopulmonary resuscitation (CPR). The support from the ECS and CPR training was acknowledged as helpful and important. Further research is required to determine which interventions can improve people's ability to intervene as early as possible.

Sleep disordered breathing, insomnia, and health related quality of life — A comparison between age and gender matched elderly with heart failure or without cardiovascular disease - Corrected Proof

2010-01-07

Abstract: Aims: The aims of this study are (I) to compare the prevalence of sleep disordered breathing (SDB) and insomnia between elderly with heart failure (HF) and age and gender matched elderly without cardiovascular disease (CVD), and (II) to examine the association between HF, SDB and insomnia, as well as their impact on health related quality of life (Hr-QoL).Methods: Three hundred and thirty-one elderly (71–87years) community-living individuals underwent sleep recordings and echocardiography. Questionnaires assessed insomnia and Hr-QoL. Comparisons were made between age and gender matched individuals with HF (n=36) and without CVD (n=36).Results: The HF group had higher mean apnoea–hypopnoea index (17.6 vs. 6.3, p<0.001). Moderate/severe SDB was found in 42% of those with HF vs. 8% in those without CVD (p=0.001). Those with HF had more difficulties maintaining sleep (DMS) (72% vs. 50%, p=0.05) and excessive daytime sleepiness (EDS) (25% vs. 8%, p=0.05) and scored worse Hr-QoL in five of eight SF-36 domains. In regression analysis SDB had no association to Hr-QoL. DMS associated to the physical-, and non restorative sleep to the mental domain of Hr-QoL. SDB had no correlations to insomnia or EDS.Conclusions: SDB, DMS and EDS are more common in elderly with HF. SDB is not an obvious cause for sleep complaints or poor Hr-QoL in elderly.

Precautions related to midline sternotomy in cardiac surgery: A review of mechanical stress factors leading to sternal complications - Corrected Proof

Barbara C. Brocki, Charlotte B. Thorup, Jan J. Andreasen — 2010-01-05

Abstract: Background: After midline sternotomy patients are instructed on activity precautions to avoid sternal wound complications. We questioned how restrictive these precautions must be, since they can lead to a postoperative decrease in quality of life.Aims: To identify mechanical stress factors causing sternal instability and infection in order to create evidence based guidelines for activity following sternotomy.Methods: Literature review.Results: No evidence was found to support weight limitation regarding activity, as long as the upper arms are kept close to the body and activity is within a pain-free range. Recommendations: Avoid stretching both arms backwards at the same time (10days); loaded activities should be done with the elbows close to the body (eight weeks); only move arms within a pain-free range; use leg rolling with counterweighing when getting in and out of bed; when coughing cross the arms in a “self-hugging” posture; supportive bra or vest is recommended when breast cup≥D, body mass index≥35 or frequent cough.Conclusion: This study provides insights into mechanical stress factors acting upon sternum and the overlying skin. Recommendations on activity precautions based on these finding have a patient supportive approach focusing on possibilities and not restrictions.

The effect of a self-management intervention to reduce vascular risk factors in patients with manifestations of vascular diseases - Corrected Proof

2009-12-31

Abstract: Background: Self-management can improve health behaviors and influence reduction of vascular risk. We developed a 1-year self-management intervention and investigated its effect on vascular risk factors and quality of life in patients with different vascular diseases.Design and methods: This observational cohort study involved 223 patients (self-management group, n=125; usual care group n=98) with at least two modifiable vascular risk factors.Results: Patients in the self-management group achieved treatment goals for LDL-cholesterol (difference 13%; 95%CI 1–26) and HDL-cholesterol (difference 9% 95%CI 0–19) significantly more often than did patients in the usual care group. Mean systolic blood pressure decreased significantly by 5mm Hg (95%CI −9 to 0) in the self-management group and mean BMI increased significantly by 0.4kg/m2 (95%CI −0.8 to −0.1) in the usual care group. No significant differences were seen in waist circumference, smoking, or triglycerides. General health (RAND36) improved more in the self-management group (by 8 points 95%CI 3–12) than in the usual care group.Conclusion: After 1year, the self-management intervention was more effective than usual care on several important vascular risk factors in patients with vascular diseases.Practice implications: This self-management intervention used in a hospital population may be applicable in different care settings.

Coping, sense of coherence and the dimensions of affect in patients with chronic heart failure - Corrected Proof

Catarina Nahlén, Fredrik Saboonchi — 2009-12-21

Abstract: Background: Living with chronic heart failure has an impact on several important dimensions of an individual's life. A patient's use of coping strategies may influence his or her health condition and emotional well-being.Aim: To investigate factors that may relate to the coping strategies used by individuals with chronic heart failure and how the coping strategies are associated with positive and negative affect.Methods: A cross-sectional research design was used. The participants provided demographic data and filled out three questionnaires: Sense of Coherence scale, Brief COPE and Positive Affect Negative Affect Schedule.Results: No differences in relation to coping strategies were found with regard to New York Heart Association class. Substance use was associated with gender and age. Sense of coherence was negatively associated with denial, behavioural disengagement, venting and self-blame, and positively associated with acceptance. It was found that avoidant coping positively and sense of coherence negatively, predicted negative affect. Problem focused coping positively predicted positive affect. Socially supported coping predicted both negative and positive affect.Conclusion: The present study found that the employment of different coping strategies and sense of coherence had an impact on affect and therefore also the emotional well-being among patients with chronic heart failure.

Patients perspective on endocarditis — an intermezzo in life - Corrected Proof

Selina Kikkenborg Berg, Pernille Preisler, Birthe D. Pedersen — 2009-12-17

Abstract: Background: Infective endocaditis (IE) is a life threatening disease with a mortality rate of 20–25%. There have been no previous reports, which describe the experience of health of patients suffering from IE.Aim: This study aimed to describe patients with IE's experience of health. This was done by having patients describe their experiences both before and during hospital admission, their experience of their physical symptoms, and their expectations for future health.Methods: Qualitative interviews were conducted with 10 patients with IE (age 27–75) and transcribed. The analysis consisted of three levels.Results: The overall concept that emerged was that IE is perceived as an intermezzo in life. The interviewees explain that a sudden unexpected physical change occurs that is difficult to understand and interpret. The concept “intermezzo in life” can be expounded as the following themes: Presage and appearance of IE, Reaction to IE, Living through IE, The little life with IE, Body change and Loved ones at a distance.Conclusion: IE is found to be a time of uncertainty and impenetrableness, where many things change, not least the perception of the body and self.

Improved cardiovascular risk profile in patients referred to a specialised vascular outpatient clinic: A cohort study - Corrected Proof

H.C.L. Verdouw-van Tol, H.G. Peltenburg, T. Koster — 2009-12-07

Abstract: We carried out a prospective cohort study in patients referred to our vascular outpatient clinic to see how their cardiovascular risk profile developed. The classical risk factors were compared at first visit and one year later. The adapted Framingham Heart Risk Score (FHRS) and the Heart SCORE (HS) were used to compare the cardiovascular risks.There was a decline of 9 and 5mmHg in mean systolic blood pressure in the hypertension group and in the group with atherosclerotic disease, respectively. On average 0.6 and 0.8 antihypertensive agents were added. In the hypertension group mean LDL-level decreased from 3.2 to 2.4mmol/l. For the secondary prevention group mean LDL-cholesterol decreased from 3.3 to 2.1mmol/l. In the hypertension group, the 10-year relative risk of myocardial infarction (FHRS) decreased by 28% (95% CI 25–30). The 10-year relative risk on a fatal cardiovascular event (HS) decreased by 33% (95% CI 31–36). The absolute risk decreased by 3.3% (95% CI 2.0–4.6) and 1.4% (95% CI 0.5–2.3) by using the HS.We conclude that the cardiovascular risk profile of our patients significantly improved as shown by the FHRS or the HS. These benefits were reached by a decreasing number of smokers, better blood pressure control and a lower LDL-cholesterol.