Pub Date : 2024-07-17DOI: 10.1093/eurjcn/zvae098.078
J Su, R Lin, L Batalik
Background Cardiac rehabilitation is a standard and multidisciplinary treatment of exercise promotion, patient education, risk factor management, and psychosocial counseling for people with coronary heart disease (CHD) that is underutilized due to disparities in access, referral, and participation. Empirical studies suggest that cardiac telerehabilitation (CTR) have safety and efficacy comparable to traditional in-person CR, however, older adults are under-reported with effectiveness, feasibility, and usability of CTR for this population remains unclear . Purpose This study investigates the effects, usability, and feasibility of 12-week CTR on health outcomes of older people with CHD. Design A pilot randomized controlled trial with qualitative process evaluation. Methods The study randomized 43 older adults with CHD to the 12-week CTR intervention or usual care. Guided by Social Cognitive Theory, intervention group participants received individualized in-person assessment and orientation session, followed by CTR usage at home. Participants were encouraged to visit the CR website for self-learning and data uploading, use the pedometer for daily step tracking, and chat with peers and CR nurse via social media for problem-solving and mutual support. Data were collected at baseline (T0), six-week (T1), and 12-week (T2). Results Participants in the CTR intervention group showed significant improvement in daily steps (T1: β=4126.58, p=0.001; T2: β=5285, p=0.01) and health-promoting lifestyle profile (T1: β= 23.26, p<.001; T2: β=12.18, p=0.008) across study endpoints. No significant difference was observed regarding self-efficacy, quality of life, psychological symptoms, and body weight and blood pressure. Twenty participants completed the intervention, with 100% used social media for tele-consultation, 90% used the pedometer for tele-monitoring, 40% (n=8) used the website. Improving awareness on rehabilitation and a clear action focus were considered as key enablers while physical discomforts and difficulties in using the technology were described as main barriers. Conclusions The CTR is effective in improving physical activity and healthy behaviors for older adults. Considering the variation in individual cardiovascular risk factors, full-scale RCT with larger sample is needed to determine the effect of CTR on psychological symptoms, body weight and blood pressure, and quality of life. Strategies to improve user intervention usage is needed.
{"title":"Feasibility and effectiveness of cardiac telerehabilitation for older adults with coronary heart disease patients: a pilot randomized controlled trial","authors":"J Su, R Lin, L Batalik","doi":"10.1093/eurjcn/zvae098.078","DOIUrl":"https://doi.org/10.1093/eurjcn/zvae098.078","url":null,"abstract":"Background Cardiac rehabilitation is a standard and multidisciplinary treatment of exercise promotion, patient education, risk factor management, and psychosocial counseling for people with coronary heart disease (CHD) that is underutilized due to disparities in access, referral, and participation. Empirical studies suggest that cardiac telerehabilitation (CTR) have safety and efficacy comparable to traditional in-person CR, however, older adults are under-reported with effectiveness, feasibility, and usability of CTR for this population remains unclear . Purpose This study investigates the effects, usability, and feasibility of 12-week CTR on health outcomes of older people with CHD. Design A pilot randomized controlled trial with qualitative process evaluation. Methods The study randomized 43 older adults with CHD to the 12-week CTR intervention or usual care. Guided by Social Cognitive Theory, intervention group participants received individualized in-person assessment and orientation session, followed by CTR usage at home. Participants were encouraged to visit the CR website for self-learning and data uploading, use the pedometer for daily step tracking, and chat with peers and CR nurse via social media for problem-solving and mutual support. Data were collected at baseline (T0), six-week (T1), and 12-week (T2). Results Participants in the CTR intervention group showed significant improvement in daily steps (T1: β=4126.58, p=0.001; T2: β=5285, p=0.01) and health-promoting lifestyle profile (T1: β= 23.26, p&lt;.001; T2: β=12.18, p=0.008) across study endpoints. No significant difference was observed regarding self-efficacy, quality of life, psychological symptoms, and body weight and blood pressure. Twenty participants completed the intervention, with 100% used social media for tele-consultation, 90% used the pedometer for tele-monitoring, 40% (n=8) used the website. Improving awareness on rehabilitation and a clear action focus were considered as key enablers while physical discomforts and difficulties in using the technology were described as main barriers. Conclusions The CTR is effective in improving physical activity and healthy behaviors for older adults. Considering the variation in individual cardiovascular risk factors, full-scale RCT with larger sample is needed to determine the effect of CTR on psychological symptoms, body weight and blood pressure, and quality of life. Strategies to improve user intervention usage is needed.","PeriodicalId":50493,"journal":{"name":"European Journal of Cardiovascular Nursing","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2024-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141745164","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-17DOI: 10.1093/eurjcn/zvae098.108
S Ingram
Background The Advanced Nurse Practitioner (ANP) led integrated community chest pain clinic provides an alternative avenue to which GPs can refer patients with non-acute chest pain providing emergency dept. avoidance. The role of the ANP is to differentiate between a non-anginal versus anginal cause. In addition to taking a clinical history, physical assessment and ECG the ANP utilises the 2019 ESC guidelines for chronic coronary syndromes pre-test-probability (PTP) score, to judge if invasive investigation is required. Purpose ANP assessment of chest pain in a community clinic is unique in the Irish healthcare setting. The aim was to assess if angina characteristics & allocated ESC PTP were predictive of coronary artery disease (CAD) diagnosis in a community chest pain cohort. Method A retrospective audit of 144 patients assessed by the ANP in the ICCPC and subsequently referred for coronary angiography was performed. Final diagnosis of was analysed by i. anginal characteristic, ii. ESC PTP, iii. age and sex. Approval was given by the department of quality, safety and risk management. Results The average combined age was 61 years in n=92 Male, and n=51 Female patients. Coronary Artery Disease was diagnosed in 92% (n= 132) of those referred for angiography; obstructive CAD in 38% (n=55) and non-obstructive CAD (NOCAD) in 54% (n=77). The ANP allocated the angina characteristic ‘typical’ in 31% (n=45) cases and 58% (n=26) were diagnosed with obstructive CAD, average PTP of 20%, and 38% (n=17) were diagnoses with NOCAD. In those with ‘typical’ symptoms only two cases resulted in normal coronary arteries. Conversely 34% (n=49) were allocated ‘non-anginal’ symptoms, in whom 28% (n=14) obstructive CAD was detected; 12 cases had an intermediate to high PTP due to age and clinical likelihood. The majority of referrals (57%) were ‘high’ PTP of CAD (≤16%-52%), average 22%. The average PTP was 27% (High) in those diagnosed with CAD versus a PTP of 11% (Intermediate) in those with normal coronaries (n=12). The new category of ‘dyspnoea’ was allocated to 14% (n=20) and resulted in diagnosis of NOCAD (n=12) and (n=5) CAD. Those with dyspnoea as a presenting symptom of CAD were all male with high PTP. Conclusion Pre-test-probability and age are highly correlated, rising with age and defined by sex. The main variable is the ‘angina’ characteristic allocated by the ANP. In this community-based cohort, ‘typical’ symptom allocation by the ANP resulted in a higher PTP and subsequent CAD diagnosis. Clinical suspicion in the ‘low-intermediate risk’ can be further adjusted using the clinical likelihood ratio. The value of the PTP score in predicting CAD is as useful as the ‘angina’ characteristic and clinical likelihood allocated, requiring expert health history taking. This retrospective analysis of coronary angiogram results in this community cohort evidences that the ANP is skilled in utilising the ESC PTP score to assist in the diagnosis of CAD.
{"title":"Does the ESC chronic coronary syndrome pre-test probability score assist coronary artery disease diagnosis in an advanced nurse practitioner led integrated community chest pain clinic?","authors":"S Ingram","doi":"10.1093/eurjcn/zvae098.108","DOIUrl":"https://doi.org/10.1093/eurjcn/zvae098.108","url":null,"abstract":"Background The Advanced Nurse Practitioner (ANP) led integrated community chest pain clinic provides an alternative avenue to which GPs can refer patients with non-acute chest pain providing emergency dept. avoidance. The role of the ANP is to differentiate between a non-anginal versus anginal cause. In addition to taking a clinical history, physical assessment and ECG the ANP utilises the 2019 ESC guidelines for chronic coronary syndromes pre-test-probability (PTP) score, to judge if invasive investigation is required. Purpose ANP assessment of chest pain in a community clinic is unique in the Irish healthcare setting. The aim was to assess if angina characteristics & allocated ESC PTP were predictive of coronary artery disease (CAD) diagnosis in a community chest pain cohort. Method A retrospective audit of 144 patients assessed by the ANP in the ICCPC and subsequently referred for coronary angiography was performed. Final diagnosis of was analysed by i. anginal characteristic, ii. ESC PTP, iii. age and sex. Approval was given by the department of quality, safety and risk management. Results The average combined age was 61 years in n=92 Male, and n=51 Female patients. Coronary Artery Disease was diagnosed in 92% (n= 132) of those referred for angiography; obstructive CAD in 38% (n=55) and non-obstructive CAD (NOCAD) in 54% (n=77). The ANP allocated the angina characteristic ‘typical’ in 31% (n=45) cases and 58% (n=26) were diagnosed with obstructive CAD, average PTP of 20%, and 38% (n=17) were diagnoses with NOCAD. In those with ‘typical’ symptoms only two cases resulted in normal coronary arteries. Conversely 34% (n=49) were allocated ‘non-anginal’ symptoms, in whom 28% (n=14) obstructive CAD was detected; 12 cases had an intermediate to high PTP due to age and clinical likelihood. The majority of referrals (57%) were ‘high’ PTP of CAD (≤16%-52%), average 22%. The average PTP was 27% (High) in those diagnosed with CAD versus a PTP of 11% (Intermediate) in those with normal coronaries (n=12). The new category of ‘dyspnoea’ was allocated to 14% (n=20) and resulted in diagnosis of NOCAD (n=12) and (n=5) CAD. Those with dyspnoea as a presenting symptom of CAD were all male with high PTP. Conclusion Pre-test-probability and age are highly correlated, rising with age and defined by sex. The main variable is the ‘angina’ characteristic allocated by the ANP. In this community-based cohort, ‘typical’ symptom allocation by the ANP resulted in a higher PTP and subsequent CAD diagnosis. Clinical suspicion in the ‘low-intermediate risk’ can be further adjusted using the clinical likelihood ratio. The value of the PTP score in predicting CAD is as useful as the ‘angina’ characteristic and clinical likelihood allocated, requiring expert health history taking. This retrospective analysis of coronary angiogram results in this community cohort evidences that the ANP is skilled in utilising the ESC PTP score to assist in the diagnosis of CAD.","PeriodicalId":50493,"journal":{"name":"European Journal of Cardiovascular Nursing","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2024-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141745169","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-17DOI: 10.1093/eurjcn/zvae098.081
B Arikan, F Demir Korkmaz
Background Frail patients are at increased risk for postoperative delirium, complications, delayed recovery, prolonged hospital and intensive care unit stay, morbidity and mortality. The number of studies examining frailty in cardiovascular surgery patients is limited (1,2). In this context, it is important to determine the prevalence of frailty in cardiac surgery patients (3,4). Purpose This research was conducted to examine the prevalence of frailty in coronary artery bypass graft surgery patients and associated factors with frailty. Methods The research was descriptive cross-sectional type. It was conducted between 18.02.2021 and 18.02.2022 at the cardiovascular surgery department of a training and research hospital in Turkey. A total of 96 patients who had undergone coronary artery bypass graft (CABG) were included. The "Sociodemographic and Clinical Data Form" which was prepared in accordance with the literature, the "Modified Fried Frailty Index", the "Mini Nutritional Assessment Test-Short Form", the "Barthel Daily Living Activities Index", the "Charlson Comorbidity Index", and the "Montreal Cognitive Assessment Scale" were used to collect data. The data were analyzed using the SPSS 23.0 package program. Descriptive statistics, Kolmogorov-Smirnov test, Chi-square test, One Way ANOVA, Kruskal Wallis test and multinomial logistic regression analysis were used in the evaluation of the data. Results As a result of the study, the mean age of the patients was 65.65±8.72 years (min:40-max:85), 62.5% consisted of males. The majority of patients (94.8%) had comorbid diseases, most of whom had hypertension (66.7%) and diabetes mellitus (63.5%). The mean ejection fraction of the patients was normal (54.59±8.70) according to the European Society of Cardiology and the majority (80.2%) were in the preserved LVEF group. The mean EuroSCORE was intermediate (4.79±2.40) and 49% of the patients were at intermediate risk for mortality. The majority of the patients (94.8%) were in the ASA III class according to the American Society of Anaesthesiologists. Of the patients. 14.6% were determined as ‘non-frail’, 45.8% as ‘pre-frail’ and 39.6% as ‘frail’. Age, educational status, income level, beta-blocker use, nutritional status, daily living activities, cognitive status, number of comorbidities, and level of potassium, procalcitonin and creatinine were found to be associated with frailty (p<0.05). Malnutrition, decreased daily living activity, cognitive impairment and creatinine elevation were found to be predictors of frailty (p<0.05). Sociodemographic and Clinical Characteristics by Frailty Status was presented in Table 1. Conclusions More than a third of CABG patients were frail. Malnutrition, decreased daily living activity, impaired cognitive status and high creatinine levels increased the risk. It is important to assesment frail cardiac surgery patients and provide them with appropriate nursing management.
{"title":"Prevalence of frailty and associated factors in coronary artery bypass graft surgery patients","authors":"B Arikan, F Demir Korkmaz","doi":"10.1093/eurjcn/zvae098.081","DOIUrl":"https://doi.org/10.1093/eurjcn/zvae098.081","url":null,"abstract":"Background Frail patients are at increased risk for postoperative delirium, complications, delayed recovery, prolonged hospital and intensive care unit stay, morbidity and mortality. The number of studies examining frailty in cardiovascular surgery patients is limited (1,2). In this context, it is important to determine the prevalence of frailty in cardiac surgery patients (3,4). Purpose This research was conducted to examine the prevalence of frailty in coronary artery bypass graft surgery patients and associated factors with frailty. Methods The research was descriptive cross-sectional type. It was conducted between 18.02.2021 and 18.02.2022 at the cardiovascular surgery department of a training and research hospital in Turkey. A total of 96 patients who had undergone coronary artery bypass graft (CABG) were included. The \"Sociodemographic and Clinical Data Form\" which was prepared in accordance with the literature, the \"Modified Fried Frailty Index\", the \"Mini Nutritional Assessment Test-Short Form\", the \"Barthel Daily Living Activities Index\", the \"Charlson Comorbidity Index\", and the \"Montreal Cognitive Assessment Scale\" were used to collect data. The data were analyzed using the SPSS 23.0 package program. Descriptive statistics, Kolmogorov-Smirnov test, Chi-square test, One Way ANOVA, Kruskal Wallis test and multinomial logistic regression analysis were used in the evaluation of the data. Results As a result of the study, the mean age of the patients was 65.65±8.72 years (min:40-max:85), 62.5% consisted of males. The majority of patients (94.8%) had comorbid diseases, most of whom had hypertension (66.7%) and diabetes mellitus (63.5%). The mean ejection fraction of the patients was normal (54.59±8.70) according to the European Society of Cardiology and the majority (80.2%) were in the preserved LVEF group. The mean EuroSCORE was intermediate (4.79±2.40) and 49% of the patients were at intermediate risk for mortality. The majority of the patients (94.8%) were in the ASA III class according to the American Society of Anaesthesiologists. Of the patients. 14.6% were determined as ‘non-frail’, 45.8% as ‘pre-frail’ and 39.6% as ‘frail’. Age, educational status, income level, beta-blocker use, nutritional status, daily living activities, cognitive status, number of comorbidities, and level of potassium, procalcitonin and creatinine were found to be associated with frailty (p&lt;0.05). Malnutrition, decreased daily living activity, cognitive impairment and creatinine elevation were found to be predictors of frailty (p&lt;0.05). Sociodemographic and Clinical Characteristics by Frailty Status was presented in Table 1. Conclusions More than a third of CABG patients were frail. Malnutrition, decreased daily living activity, impaired cognitive status and high creatinine levels increased the risk. It is important to assesment frail cardiac surgery patients and provide them with appropriate nursing management.","PeriodicalId":50493,"journal":{"name":"European Journal of Cardiovascular Nursing","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2024-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141744899","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-17DOI: 10.1093/eurjcn/zvae098.024
F Wefer, R Moehler, S Calo, S Koepke
Background Many patients with chronic heart failure (CHF) express thirst. Perceptions of thirst and strategies for reducing this symptom can differ between patients and nurses. Purpose As part of a study to develop and evaluate a nurse-based counselling intervention on thirst in patients with advanced CHF waiting for heart transplantation, we aimed to assess patients' and nurses' perceptions on thirst, possible strategies, as well as information needs and information transfer. Methods Mixed methods study consisting of semi-structured interviews with hospitalized patients waiting for a heart transplantation in Germany. Interviews focussed on experiences with thirst, needs and requirements, and experiences with the information provided by healthcare professionals. We also conducted focus groups and an online survey with German nurses with experiences in the care of cardiac patients. Topics of the focus groups were the perceptions and handling of the symptom in nursing practice as well as the provision of information and counselling. The survey was based on the results of the focus groups and current research findings. In addition to work-related data, we asked questions about the relevance of thirst, the causes of this symptom, recommended interventions and the need for counselling. We analysed quantitative data descriptively and qualitative data using content analysis. Results We conducted 10 interviews with patients (mean age: 43.5 years; 30% female; duration of CHF: 25 days to 21 years; length of stay: 7 to 116 days). All participants had a prescribed fluid restriction. Perceived thirst markedly differed between patients, with some reporting thirst to be very distressing. Most patients described that the feeling of thirst increased especially at mealtimes. Individual strategies for reducing thirst also differed between patients depended on disease durations and their therapeutic regiment. Some patients rated the information provision by healthcare professionals concerning thirst as insufficient. In addition, we conducted two focus groups with respectively 5 nurses from two university hospitals in Germany. 59 nurses participated in the survey. Nurses (81.4% working in a hospital; 54.2% already have at least 5 years of experience in care of cardiac patients) stated that the feeling of thirst in patients with CHF is of great importance in nursing practice, but only 44.1% specified to regularly assess thirst. The perceived most common cause of thirst was a prescribed fluid restriction (93.2%) and diuretics (79.7%). Among others, most nurses recommended ice cubes as intervention to reduce thirst and considered counselling interventions as important. Conclusion(s) The occurrence of thirst is an important issue for patients with advanced CHF. The perception of the symptom varies greatly. Individualised, evidence-based strategies for symptom management are required.
{"title":"Experiences of patients and nurses with thirst in advanced chronic heart failure: a mixed methods study","authors":"F Wefer, R Moehler, S Calo, S Koepke","doi":"10.1093/eurjcn/zvae098.024","DOIUrl":"https://doi.org/10.1093/eurjcn/zvae098.024","url":null,"abstract":"Background Many patients with chronic heart failure (CHF) express thirst. Perceptions of thirst and strategies for reducing this symptom can differ between patients and nurses. Purpose As part of a study to develop and evaluate a nurse-based counselling intervention on thirst in patients with advanced CHF waiting for heart transplantation, we aimed to assess patients' and nurses' perceptions on thirst, possible strategies, as well as information needs and information transfer. Methods Mixed methods study consisting of semi-structured interviews with hospitalized patients waiting for a heart transplantation in Germany. Interviews focussed on experiences with thirst, needs and requirements, and experiences with the information provided by healthcare professionals. We also conducted focus groups and an online survey with German nurses with experiences in the care of cardiac patients. Topics of the focus groups were the perceptions and handling of the symptom in nursing practice as well as the provision of information and counselling. The survey was based on the results of the focus groups and current research findings. In addition to work-related data, we asked questions about the relevance of thirst, the causes of this symptom, recommended interventions and the need for counselling. We analysed quantitative data descriptively and qualitative data using content analysis. Results We conducted 10 interviews with patients (mean age: 43.5 years; 30% female; duration of CHF: 25 days to 21 years; length of stay: 7 to 116 days). All participants had a prescribed fluid restriction. Perceived thirst markedly differed between patients, with some reporting thirst to be very distressing. Most patients described that the feeling of thirst increased especially at mealtimes. Individual strategies for reducing thirst also differed between patients depended on disease durations and their therapeutic regiment. Some patients rated the information provision by healthcare professionals concerning thirst as insufficient. In addition, we conducted two focus groups with respectively 5 nurses from two university hospitals in Germany. 59 nurses participated in the survey. Nurses (81.4% working in a hospital; 54.2% already have at least 5 years of experience in care of cardiac patients) stated that the feeling of thirst in patients with CHF is of great importance in nursing practice, but only 44.1% specified to regularly assess thirst. The perceived most common cause of thirst was a prescribed fluid restriction (93.2%) and diuretics (79.7%). Among others, most nurses recommended ice cubes as intervention to reduce thirst and considered counselling interventions as important. Conclusion(s) The occurrence of thirst is an important issue for patients with advanced CHF. The perception of the symptom varies greatly. Individualised, evidence-based strategies for symptom management are required.","PeriodicalId":50493,"journal":{"name":"European Journal of Cardiovascular Nursing","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2024-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141744975","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-17DOI: 10.1093/eurjcn/zvae098.016
I Uchmanowicz, M H Lisiak, M Wleklik, L Sawielajc, E Turgonyi, P Ponikowski, E A Jankowska
Introduction The STEP-ONE program was a significant initiative designed to enhance the skills and knowledge of nurses specializing in heart failure care in Central and Eastern Europe, and the Baltic countries (CEE-BA). Purpose Its importance lies in addressing the crucial role of nurses in heart failure management, an area often overlooked in these regions. By training nurses to provide optimal, integrated care, the program aims to improve patient outcomes and reduce hospitalizations. The number of nurses who participated in the program is not specified, but its impact is likely substantial in advancing heart failure care. Continuing the program as the STEP-TWO edition is planned to be updated of nurses and patients materials according to ESC HF 2023 guidelines6, taking into account the profile of the patient with HFrEF, HFmREF, HFimEF, HFpEF and taking into account the implementation of pilot projects: (1a) Assessment of HFpEF risk7 and recommendations for medical staff regarding further diagnostics; (1b) Analysis of recommended therapies according to guidelines; (2) Pilot training Program center Poland centers- CEE-BA; (3) Pilot research programs - 1a and 1/b in 2-3 centers (fig.1). All of the activities undertaken in the program are intended to improve care for heart failure patients and can be seen as a model solution for providing qualified personnel in the European countries. Conclusions The STEP ONE educational program was developed with the participation of the medical community, especially nurses caring for HF patients. Educational materials for nurses and patients, as well as an educational program, were prepared and implemented in Poland and the region of CEE-BA. During the second phase, an updated materials with the 2023 guidelines on HF will be prepared. A pilot study will evaluate the impact of educating HF nurses on patient risk assessment of HFPEF and on identifying patients who do not have optimal therapy according to GDMT. Optimization of the HF patient pathway at the pilotage centers of the program and collaboration between HF nurses and cardiologists will be sought. Moreover, the STEP-TWO program will include preparing educational materials focused and dedicated not only on patients but also on caregivers.
{"title":"The STEP-ONE program (Supportive Training and Essential Preparation for Optimal Nursing Education) - what have we done and what will we do in the STEP-TWO edition?","authors":"I Uchmanowicz, M H Lisiak, M Wleklik, L Sawielajc, E Turgonyi, P Ponikowski, E A Jankowska","doi":"10.1093/eurjcn/zvae098.016","DOIUrl":"https://doi.org/10.1093/eurjcn/zvae098.016","url":null,"abstract":"Introduction The STEP-ONE program was a significant initiative designed to enhance the skills and knowledge of nurses specializing in heart failure care in Central and Eastern Europe, and the Baltic countries (CEE-BA). Purpose Its importance lies in addressing the crucial role of nurses in heart failure management, an area often overlooked in these regions. By training nurses to provide optimal, integrated care, the program aims to improve patient outcomes and reduce hospitalizations. The number of nurses who participated in the program is not specified, but its impact is likely substantial in advancing heart failure care. Continuing the program as the STEP-TWO edition is planned to be updated of nurses and patients materials according to ESC HF 2023 guidelines6, taking into account the profile of the patient with HFrEF, HFmREF, HFimEF, HFpEF and taking into account the implementation of pilot projects: (1a) Assessment of HFpEF risk7 and recommendations for medical staff regarding further diagnostics; (1b) Analysis of recommended therapies according to guidelines; (2) Pilot training Program center Poland centers- CEE-BA; (3) Pilot research programs - 1a and 1/b in 2-3 centers (fig.1). All of the activities undertaken in the program are intended to improve care for heart failure patients and can be seen as a model solution for providing qualified personnel in the European countries. Conclusions The STEP ONE educational program was developed with the participation of the medical community, especially nurses caring for HF patients. Educational materials for nurses and patients, as well as an educational program, were prepared and implemented in Poland and the region of CEE-BA. During the second phase, an updated materials with the 2023 guidelines on HF will be prepared. A pilot study will evaluate the impact of educating HF nurses on patient risk assessment of HFPEF and on identifying patients who do not have optimal therapy according to GDMT. Optimization of the HF patient pathway at the pilotage centers of the program and collaboration between HF nurses and cardiologists will be sought. Moreover, the STEP-TWO program will include preparing educational materials focused and dedicated not only on patients but also on caregivers.","PeriodicalId":50493,"journal":{"name":"European Journal of Cardiovascular Nursing","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2024-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141745083","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-17DOI: 10.1093/eurjcn/zvae098.067
R Szczepanowski, D Krzyzanowski, J Kulinska, M Palej-Cieplinska, T Ferdinan, G Hernandez Ibarburu
Background Increased vulnerability to cardiovascular diseases (CVD) and stroke has been observed among people with mental disorders, such as bipolar disorder (BP). Yet, the evidence for the association between severe mental disorders and CVD and stroke events remains inconclusive. Purpose By running a cohort study based on large retrospective data, we aimed to establish the relative risk of CVD problems and stroke in patients admitted to the hospital and diagnosed with BP. Methods The study was conducted on electronic health records provided by 113 healthcare organizations worldwide from the TriNetX Global Collaborative Network, containing at least 690,946 patients with BP symptoms. The assessment was focused on the first incidence of ischemic heart diseases, nontraumatic brain hemorrhage, or cerebral infarction among patients after BP diagnosis. After propensity score matching age, gender, race and comorbidities, the rates were compared against a cohort of patients with no mental, behavioral, or neurodevelopmental disorders who also suffered from similar CVD and stroke events. In addition, Kaplan-Meier Analysis was performed to compare their survivability to CVD, taking into account patient censoring. Results Patient count after applying the score matching yielded 532,082 per cohort. The odds ratio (OR) of ischemic heart diseases, nontraumatic brain hemorrhage, or cerebral infarction on BP compared to people without any mental disorder was equal to 2.349, indicating a significantly elevated risk for such events. The Kaplan-Meier analysis showed that patients with BP diagnosis had 9.88% less survival probability to having CVD problems after 20 years since the diagnosis than patients without any mental disorder. With a hazard ratio of 1.970 (95%CI 1.935-2.005), the risk of developing a CVD problem on the former (patients with BP diagnosis) was almost twice greater than for patients suffering without mental health disorders. Conclusion There is an increased risk of developing cardiovascular problems and stroke among patients with bipolar disorder compared to patients affected by such symptoms without mental disorders. The robust results were ensured by limiting the potential confounders with the propensity score matching procedure, such as demographics, comorbidity, and medication. The study implies that monitoring and prevention approaches for cardiovascular and cerebral vascular diseases must be tailored to symptoms of mental disorders.
{"title":"Incidence of heart disease and stroke among patients with bipolar disorder","authors":"R Szczepanowski, D Krzyzanowski, J Kulinska, M Palej-Cieplinska, T Ferdinan, G Hernandez Ibarburu","doi":"10.1093/eurjcn/zvae098.067","DOIUrl":"https://doi.org/10.1093/eurjcn/zvae098.067","url":null,"abstract":"Background Increased vulnerability to cardiovascular diseases (CVD) and stroke has been observed among people with mental disorders, such as bipolar disorder (BP). Yet, the evidence for the association between severe mental disorders and CVD and stroke events remains inconclusive. Purpose By running a cohort study based on large retrospective data, we aimed to establish the relative risk of CVD problems and stroke in patients admitted to the hospital and diagnosed with BP. Methods The study was conducted on electronic health records provided by 113 healthcare organizations worldwide from the TriNetX Global Collaborative Network, containing at least 690,946 patients with BP symptoms. The assessment was focused on the first incidence of ischemic heart diseases, nontraumatic brain hemorrhage, or cerebral infarction among patients after BP diagnosis. After propensity score matching age, gender, race and comorbidities, the rates were compared against a cohort of patients with no mental, behavioral, or neurodevelopmental disorders who also suffered from similar CVD and stroke events. In addition, Kaplan-Meier Analysis was performed to compare their survivability to CVD, taking into account patient censoring. Results Patient count after applying the score matching yielded 532,082 per cohort. The odds ratio (OR) of ischemic heart diseases, nontraumatic brain hemorrhage, or cerebral infarction on BP compared to people without any mental disorder was equal to 2.349, indicating a significantly elevated risk for such events. The Kaplan-Meier analysis showed that patients with BP diagnosis had 9.88% less survival probability to having CVD problems after 20 years since the diagnosis than patients without any mental disorder. With a hazard ratio of 1.970 (95%CI 1.935-2.005), the risk of developing a CVD problem on the former (patients with BP diagnosis) was almost twice greater than for patients suffering without mental health disorders. Conclusion There is an increased risk of developing cardiovascular problems and stroke among patients with bipolar disorder compared to patients affected by such symptoms without mental disorders. The robust results were ensured by limiting the potential confounders with the propensity score matching procedure, such as demographics, comorbidity, and medication. The study implies that monitoring and prevention approaches for cardiovascular and cerebral vascular diseases must be tailored to symptoms of mental disorders.","PeriodicalId":50493,"journal":{"name":"European Journal of Cardiovascular Nursing","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2024-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141745166","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-17DOI: 10.1093/eurjcn/zvae098.114
J Popiolek-Kalisz, T Chrominski, M Szczasny, P Blaszczak
Background Nutritional risk is a recognized factor of mortality, complications, and length of stay at a hospital in various medical conditions. This relationship was already proven in surgery, oncology, and selected cardiovascular diseases. Purpose This study aimed to analyze, if the Nutritional Risk Screening 2002 (NRS 2002) score is a predictor of the hospitalization length and in-hospital convalescence period defined as the time from the procedure to discharge among patients undergoing cardiac ablations. Methods 265 patients who underwent cardiac ablation in 2023 were included in this retrospective study. The analyzed parameters included the overall length of stay and the time of the in-hospital convalescence after the ablation procedure. They were combined with the nutritional risk assessed with NRS 2002, body mass, and body mass index. The analysis was also performed in subgroups regarding the type of arrhythmia. Results The regression analysis revealed a significant impact of the NRS 2002 score on the overall length of stay (B=0.89, p=0.003) and the in-hospital convalescence time (B=0.57, p=0.02). Subgroup analysis revealed that this relationship was particularly strong in the atrial fibrillation patients (B=1.10, p=0.001 and (B=0.91, p=0.002 respectively), and in atrial arrhythmias for the overall length of stay (B=0.92, p=0.001), and ventricular arrhythmias for the convalescence time (B=0.76, p=0.002). Lower body mass index impacted the prolonged convalescence time (B= -0.05, p=0.03), mainly in the atrial fibrillation subgroup (B= -0.08, p=0.04) and atrial arrhythmias (B= -0.05, p=0.04). Conclusions Nutritional risk is a factor that impacts the length of stay and in-hospital convalescence in patients undergoing cardiac ablations, particularly in atrial fibrillation patients.
{"title":"Nutritional Risk Screening 2002 score is a predictor of prolonged hospitalizations after cardiac ablation procedures","authors":"J Popiolek-Kalisz, T Chrominski, M Szczasny, P Blaszczak","doi":"10.1093/eurjcn/zvae098.114","DOIUrl":"https://doi.org/10.1093/eurjcn/zvae098.114","url":null,"abstract":"Background Nutritional risk is a recognized factor of mortality, complications, and length of stay at a hospital in various medical conditions. This relationship was already proven in surgery, oncology, and selected cardiovascular diseases. Purpose This study aimed to analyze, if the Nutritional Risk Screening 2002 (NRS 2002) score is a predictor of the hospitalization length and in-hospital convalescence period defined as the time from the procedure to discharge among patients undergoing cardiac ablations. Methods 265 patients who underwent cardiac ablation in 2023 were included in this retrospective study. The analyzed parameters included the overall length of stay and the time of the in-hospital convalescence after the ablation procedure. They were combined with the nutritional risk assessed with NRS 2002, body mass, and body mass index. The analysis was also performed in subgroups regarding the type of arrhythmia. Results The regression analysis revealed a significant impact of the NRS 2002 score on the overall length of stay (B=0.89, p=0.003) and the in-hospital convalescence time (B=0.57, p=0.02). Subgroup analysis revealed that this relationship was particularly strong in the atrial fibrillation patients (B=1.10, p=0.001 and (B=0.91, p=0.002 respectively), and in atrial arrhythmias for the overall length of stay (B=0.92, p=0.001), and ventricular arrhythmias for the convalescence time (B=0.76, p=0.002). Lower body mass index impacted the prolonged convalescence time (B= -0.05, p=0.03), mainly in the atrial fibrillation subgroup (B= -0.08, p=0.04) and atrial arrhythmias (B= -0.05, p=0.04). Conclusions Nutritional risk is a factor that impacts the length of stay and in-hospital convalescence in patients undergoing cardiac ablations, particularly in atrial fibrillation patients.","PeriodicalId":50493,"journal":{"name":"European Journal of Cardiovascular Nursing","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2024-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141745141","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-17DOI: 10.1093/eurjcn/zvae098.055
A Trafalska, J Kulinska, D Krzyzanowski
Background Childhood and adolescent obesity and overweight is a major public health crisis nationally and internationally.. Obesity in childhood increases the risk of cardiovascular diseases, hypertension, lipid and carbohydrate metabolism disorders, including type 2 diabetes, abnormalities resulting from posture defects, and furthermore obesity in adulthood. Excessive body weight is also the cause of many emotional disorders related with lack of acceptance by oneself, family and peers. An analysis of the prevalence of obesity among children hospitalized in the Department of Rehabilitation was conducted in 2020-2023. Excessive body weight occurred in 23% of the examined patients. Purpose The aim of the study is to show the incidence of obesity and overweight among children hospitalized in the Department of Rehabilitation, to determine the cause of the disease based on the author's survey, which took into account the lifestyle of the examined patients, and to examine the relationship between body weight and elevated blood pressure values. The results were subjected to statistical analysis. Methods The clinical trial was conducted on 1,283 pediatric patients. The data were analyzed: weight, height, BMI, blood pressure and then the obtained values were placed on percentile charts. An original questionnaire was also conducted - took into account the age, gender, lifestyle, eating habits and physical activity of the respondents. Results 23% of hospitalized patients indicated excessive body weight. 10% of patients were obese and 13% were overweight. Back pain was the reason for hospitalization in 76% of overweight and obese children. Among children with excessive body weight, 25% indicated higher blood pressure values, while in the control group, this problem affected only 1% of respondents. A relationship has been shown between lack of physical activity, excessive body weight and problems with the locomotor system - 72% of overweight and obese children didn’t engage in any regular physical activity. After school, children spent their time mainly in a sitting or semi-reclining position. Moreover, 60% of parents reported that they don’t know what their child's diet looks like. Most teenagers admitted to eating meals irregularly, snacking between meals, and drinking sweetened drinks and leaving home without breakfast. Conclusions Obesity and overweight among children and adolescents is a significant public health problem in both medical and social dimensions. Counteracting obesity should start in early childhood and should be based on the lifestyle that includes proper nutrition and physical activity. Factors contributing to overweight and obesity include: lack of daily physical activity, avoiding exercise during physical education classes, spending many hours in a sitting position and inappropriate eating habits.
{"title":"Causes and effects of childhood obesity","authors":"A Trafalska, J Kulinska, D Krzyzanowski","doi":"10.1093/eurjcn/zvae098.055","DOIUrl":"https://doi.org/10.1093/eurjcn/zvae098.055","url":null,"abstract":"Background Childhood and adolescent obesity and overweight is a major public health crisis nationally and internationally.. Obesity in childhood increases the risk of cardiovascular diseases, hypertension, lipid and carbohydrate metabolism disorders, including type 2 diabetes, abnormalities resulting from posture defects, and furthermore obesity in adulthood. Excessive body weight is also the cause of many emotional disorders related with lack of acceptance by oneself, family and peers. An analysis of the prevalence of obesity among children hospitalized in the Department of Rehabilitation was conducted in 2020-2023. Excessive body weight occurred in 23% of the examined patients. Purpose The aim of the study is to show the incidence of obesity and overweight among children hospitalized in the Department of Rehabilitation, to determine the cause of the disease based on the author's survey, which took into account the lifestyle of the examined patients, and to examine the relationship between body weight and elevated blood pressure values. The results were subjected to statistical analysis. Methods The clinical trial was conducted on 1,283 pediatric patients. The data were analyzed: weight, height, BMI, blood pressure and then the obtained values were placed on percentile charts. An original questionnaire was also conducted - took into account the age, gender, lifestyle, eating habits and physical activity of the respondents. Results 23% of hospitalized patients indicated excessive body weight. 10% of patients were obese and 13% were overweight. Back pain was the reason for hospitalization in 76% of overweight and obese children. Among children with excessive body weight, 25% indicated higher blood pressure values, while in the control group, this problem affected only 1% of respondents. A relationship has been shown between lack of physical activity, excessive body weight and problems with the locomotor system - 72% of overweight and obese children didn’t engage in any regular physical activity. After school, children spent their time mainly in a sitting or semi-reclining position. Moreover, 60% of parents reported that they don’t know what their child's diet looks like. Most teenagers admitted to eating meals irregularly, snacking between meals, and drinking sweetened drinks and leaving home without breakfast. Conclusions Obesity and overweight among children and adolescents is a significant public health problem in both medical and social dimensions. Counteracting obesity should start in early childhood and should be based on the lifestyle that includes proper nutrition and physical activity. Factors contributing to overweight and obesity include: lack of daily physical activity, avoiding exercise during physical education classes, spending many hours in a sitting position and inappropriate eating habits.","PeriodicalId":50493,"journal":{"name":"European Journal of Cardiovascular Nursing","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2024-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141745285","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-17DOI: 10.1093/eurjcn/zvae098.008
A M Trenta, J Gemelli, M Luciani, D Ausili
Background The number of people with end-stage Heart Failure implanted with a Left Ventricular Assist Device (LVAD) is constantly increasing, demanding hospitals to develop new and specific treatment paths. No previous studies described services and treatments available for these patients at national level. Knowing how hospitals organize their resources in order to meet patients’ need would be useful to standardize and improve care offered to this population. Purpose To investigate how Italian hospitals that are reference centers for people with LVAD organize treatment paths and resources for these patients. Methods A cross-sectional observational study was conducted. A survey including questions about all the relevant aspects of treatment paths for people with LVAD was created and validated by 4 LVAD experts (2 nurses and 2 physicians) from 2 different hospitals. The survey was then administered to the 22 (> 95%) of the Italian hospitals that are reference centers for people with LVAD. Results Results show a picture of how treatment paths and resources for people with LVAD are organized in Italy nowadays. Nurses play a pivotal role in the multi-professional team that takes care of these patients, being often acknowledged as LVAD Coordinator (case-manager) and being involved in crucial activities such as health education, monitoring of health conditions before and after dismission, and improving patients’ empowerment. Health education is recognized as an essential activity, but many hospitals still struggle to organize it according to patients’ needs and not organizational ones. Palliative care, even if recognized by the most recent guidelines as a crucial element of treatment options in people with LVAD, is a need that remains often unmet. Conclusion The growing number of people with LVAD requires an effort for re-organizing resources and treatment paths for them. There is a great need for integrating palliative care in the several treatment options for these patients. Nurses play a pivotal role in all stages of the treatment paths, and should be provided with specific education, as the whole multi-professional team.
{"title":"Treatment paths and resources used for patients with a left ventricular assist device: an Italian survey","authors":"A M Trenta, J Gemelli, M Luciani, D Ausili","doi":"10.1093/eurjcn/zvae098.008","DOIUrl":"https://doi.org/10.1093/eurjcn/zvae098.008","url":null,"abstract":"Background The number of people with end-stage Heart Failure implanted with a Left Ventricular Assist Device (LVAD) is constantly increasing, demanding hospitals to develop new and specific treatment paths. No previous studies described services and treatments available for these patients at national level. Knowing how hospitals organize their resources in order to meet patients’ need would be useful to standardize and improve care offered to this population. Purpose To investigate how Italian hospitals that are reference centers for people with LVAD organize treatment paths and resources for these patients. Methods A cross-sectional observational study was conducted. A survey including questions about all the relevant aspects of treatment paths for people with LVAD was created and validated by 4 LVAD experts (2 nurses and 2 physicians) from 2 different hospitals. The survey was then administered to the 22 (&gt; 95%) of the Italian hospitals that are reference centers for people with LVAD. Results Results show a picture of how treatment paths and resources for people with LVAD are organized in Italy nowadays. Nurses play a pivotal role in the multi-professional team that takes care of these patients, being often acknowledged as LVAD Coordinator (case-manager) and being involved in crucial activities such as health education, monitoring of health conditions before and after dismission, and improving patients’ empowerment. Health education is recognized as an essential activity, but many hospitals still struggle to organize it according to patients’ needs and not organizational ones. Palliative care, even if recognized by the most recent guidelines as a crucial element of treatment options in people with LVAD, is a need that remains often unmet. Conclusion The growing number of people with LVAD requires an effort for re-organizing resources and treatment paths for them. There is a great need for integrating palliative care in the several treatment options for these patients. Nurses play a pivotal role in all stages of the treatment paths, and should be provided with specific education, as the whole multi-professional team.","PeriodicalId":50493,"journal":{"name":"European Journal of Cardiovascular Nursing","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2024-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141744978","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-17DOI: 10.1093/eurjcn/zvae098.058
K Pustelak
Introduction Patients with diabetes encounter a significantly higher risk of myocardial infarction, heart failure, and mortality following acute cardiac events. Examining pain intensity and analgesic needs in patients with diabetes can provide a comprehensive understanding of the pain experienced and individual analgesic needs in patients with diabetes. Aim of the study The aim was to assess pain intensity and analgesic requirements in patients with diabetes mellitus after STEMI. Material and Methods The study involved 104 participants (58 female and 46 male, with a mean age of approximately 72 years, M±SD= 11 yeas). The study was conducted at the Heart Institute, in the Intensive Cardiology Unit, and data were collected from patients following STEMI Participants were divided into two groups: 54 people with diabetes and 50 people without diabetes. The influence of factors such as gender, age, existing diseases, haemoglobin levels and the presence of diabetes on pain intensity was analysed. In the diabetes group, the effects of treatment method, duration of illness and diabetes compliance on pain intensity were also considered. A visual analogue scale (VAS) was used to assess pain, and analgesia requirement was assessed using an analgesic ladder. The level of significance wasp < 0.05. Results The analysis indicated the effect of diabetes on pain intensity in patients with myocardial infarction. Those with diabetes experienced significantly less pain, however glycated HbA1c levels above 7.0 mg/dl predisposed to experiencing more pain. The b standardized regression coefficient indicated for diabetes ,a strong negative correlation (β=-0.77 ,p = 0,008), and for HbA1c level ,a strong positive correlation (β=0.88 ,p =0,889). Comparative analysis of analgesics revealed lower usage in the diabetes group(p=0.002). Diabetes Patients, the most frequent use of first-line drugs while the group of patients without diabetes needed second-level analgesic treatment. Those with diabetes rated their pain level as low ,while the non-diabetic group was dominated by respondents with an intermediate pain level. Non-adherence to diabetic recommendations correlated with higher pain intensity , with a strong positive correlation (β coefficient=0.90, p = 0,010 ). No significant impact was observed based on gender, age, the presence of comorbidities, or the influence of diabetes treatment methods and duration on the intensity of perceived pain. Conclusions The analysis indicated the effect of diabetes on pain intensity in patients with myocardial infarction. Those with diabetes experienced significantly less pain than non-diabetes patients. Diabetes patients required a lower level of the analgesics ladder.
{"title":"Assessment of pain intensity and analgesic requirements in patients with diabetes mellitus after STEMI","authors":"K Pustelak","doi":"10.1093/eurjcn/zvae098.058","DOIUrl":"https://doi.org/10.1093/eurjcn/zvae098.058","url":null,"abstract":"Introduction Patients with diabetes encounter a significantly higher risk of myocardial infarction, heart failure, and mortality following acute cardiac events. Examining pain intensity and analgesic needs in patients with diabetes can provide a comprehensive understanding of the pain experienced and individual analgesic needs in patients with diabetes. Aim of the study The aim was to assess pain intensity and analgesic requirements in patients with diabetes mellitus after STEMI. Material and Methods The study involved 104 participants (58 female and 46 male, with a mean age of approximately 72 years, M±SD= 11 yeas). The study was conducted at the Heart Institute, in the Intensive Cardiology Unit, and data were collected from patients following STEMI Participants were divided into two groups: 54 people with diabetes and 50 people without diabetes. The influence of factors such as gender, age, existing diseases, haemoglobin levels and the presence of diabetes on pain intensity was analysed. In the diabetes group, the effects of treatment method, duration of illness and diabetes compliance on pain intensity were also considered. A visual analogue scale (VAS) was used to assess pain, and analgesia requirement was assessed using an analgesic ladder. The level of significance wasp &lt; 0.05. Results The analysis indicated the effect of diabetes on pain intensity in patients with myocardial infarction. Those with diabetes experienced significantly less pain, however glycated HbA1c levels above 7.0 mg/dl predisposed to experiencing more pain. The b standardized regression coefficient indicated for diabetes ,a strong negative correlation (β=-0.77 ,p = 0,008), and for HbA1c level ,a strong positive correlation (β=0.88 ,p =0,889). Comparative analysis of analgesics revealed lower usage in the diabetes group(p=0.002). Diabetes Patients, the most frequent use of first-line drugs while the group of patients without diabetes needed second-level analgesic treatment. Those with diabetes rated their pain level as low ,while the non-diabetic group was dominated by respondents with an intermediate pain level. Non-adherence to diabetic recommendations correlated with higher pain intensity , with a strong positive correlation (β coefficient=0.90, p = 0,010 ). No significant impact was observed based on gender, age, the presence of comorbidities, or the influence of diabetes treatment methods and duration on the intensity of perceived pain. Conclusions The analysis indicated the effect of diabetes on pain intensity in patients with myocardial infarction. Those with diabetes experienced significantly less pain than non-diabetes patients. Diabetes patients required a lower level of the analgesics ladder.","PeriodicalId":50493,"journal":{"name":"European Journal of Cardiovascular Nursing","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2024-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141745145","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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