Journal of Cardiovascular Nursing最新文献

Background: Cardiovascular disease (CVD) is a leading cause of mortality among women in Spain, yet historically, research and clinical focus have primarily targeted men. To intensify prevention measures, it is crucial to investigate the main risk factors in women with CVD and the variables that are most relevant to disease outcomes. We investigate postmenopausal women with CVD, focusing on lifestyle habits, risk factors, and their impact on long-term outcomes.

Methods: Data from the 2011 Spanish National Health Survey and the national death register were utilized. These data include a complex 3-stage stratified sampling design to achieve a representative sample of all residents of Spain over the age of 15 years. Sociodemographic, lifestyle, health status, self-perceived health, health service utilization, and treatment data were analyzed.

Results: Among 974 eligible participants, a high prevalence of risk factors was observed. The 10-year cumulative incidence of cardiovascular death in this population is high (22.5%). Among the predictors of death, as well as age and diabetes, there are modifiable factors such as lack of leisure-time physical activity and low consumption of vegetables.

Conclusions: Findings underscore the significance of lifestyle interventions in secondary prevention among postmenopausal women with CVD. By addressing modifiable risk factors, considerable reductions in CVD mortality risk and improvements in life expectancy can be achieved. The creation of a specific risk scale for 10-year cardiovascular death in this population shows the considerable value of information that can be obtained through history-taking, without the need for diagnostic testing.

Background: Caregivers of patients hospitalized for coronary heart disease (CHD) are at risk of psychological distress, yet validated instruments for assessing anxiety and depression in this population during the acute phase are lacking.

Objective: In this study, we aimed to evaluate the psychometric properties of the Generalized Anxiety Disorder-7 (GAD-7) and Patient Health Questionnaire-9 (PHQ-9) in caregivers of hospitalized CHD patients.

Methods: This secondary analysis used data from 136 informal caregivers enrolled in the Self-Care in Coronary Heart Disease Patient and Caregiver Dyads study. Participants completed the GAD-7, PHQ-9, along with other self-report measures, during patient hospitalization. Item analysis, confirmatory factor analysis (CFA), internal consistency (McDonald's ω and Cronbach's α), convergent validity, and known-groups validity were examined.

Results: Mean scores indicated mild anxiety (GAD-7: 6.71, standard deviation [SD] = 6.58) and mild depressive symptoms (PHQ-9: 5.20, SD = 5.68). CFA supported a 2-factor structure (cognitive and somatic symptoms) for both scales, with good model fit and high factor loadings (>0.60). Internal consistency was satisfactory (GAD-7: ω = 0.93, α = 0.92; PHQ-9: ω = 0.89, α = 0.89). Convergent validity was supported by a strong correlation between GAD-7 and PHQ-9 scores (r = 0.72, large effect) and by associations between higher anxiety/depression and lower self-care self-efficacy scores. Known-groups validity was confirmed, with small-to-moderate correlations between female gender and both anxiety and depression.

Conclusions: The GAD-7 and PHQ-9 demonstrated robust psychometric properties in caregivers of hospitalized CHD patients. Both instruments appear suitable for identifying caregivers at risk of anxiety and depression during the acute phase, supporting timely interventions in clinical practice.

Background: Depressive symptoms are prevalent in patients with heart failure (HF) and an implantable cardioverter defibrillator (ICD), and are commonly undiagnosed and negatively affect patients' health. Therefore, finding a valid and reliable instrument to measure depressive symptoms in this population is crucial.

Objective: The aim of the study was to evaluate the psychometric properties of the Patient Health Questionnaire-9 (PHQ-9) in this population.

Methods: We conducted a secondary analysis of data from 258 patients with HF and an ICD. Internal consistency reliability was assessed using Cronbach's alpha and item analysis. Construct validity was assessed using hypothesis testing and convergent validity tests. The exploratory factor analysis was used to determine the dimensionality of the PHQ-9.

Results: The PHQ-9's internal consistency reliability was supported by a Cronbach's alpha of 0.85. The inter-item correlations ranged from 0.22 to 0.56. Our hypotheses that patients with moderate/severe HF symptoms would have higher PHQ-9 scores than those with no/mild symptoms (9.2 ± 6.2 vs. 5.0 ± 5.1; t = -5.9, P < .001), and that patients with higher anxiety would have higher depressive symptoms than those without anxiety (9.7 ± 6.0 vs. 4.3 ± 4.8; t = -8.0, P < .001) were supported. A significant correlation was found between the PHQ-9 and the Minnesota Living with Heart Failure (r = 0.73, P < .001), supporting convergent validity. The exploratory factor analysis results revealed that the PHQ-9, as expected, had 1 dimension explaining 47.29% of the variance of depressive symptoms.

Conclusions: Our findings provide evidence supporting the reliability and validity of the PHQ-9 as a measure of depressive symptoms in patients with HF and an ICD.

Background: Heart rate variability (HRV) is often reduced in individuals with high visceral adipose tissue (VAT), a major cardiovascular risk factor. Both high-intensity interval training (HIIT) and moderate-intensity continuous training (MICT) can improve HRV and reduce VAT, but the optimal approach remains unclear.

Objective: Our aim is to compare the effects of 8 weeks of HIIT and MICT on HRV, with body composition as a secondary outcome.

Methods: A two-stage randomized crossover trial was employed to include 31 community-dwelling adults aged 40 to 64 years with high VAT (≥100 cm2). The participants were randomly allocated to either HIIT (n = 16) or MICT (n = 15) groups; the intervention lasted 8 weeks. This was followed by an 8-week washout period (no exercise). Subsequently, they crossed over to the alternate modality and trained for 8 weeks. Heart rate variability and body composition were assessed both before and after each stage. Generalized estimating equations were used to compare outcomes between the 2 groups.

Results: The HIIT group exhibited a significantly lower low frequency/high frequency ratio than did the MICT group; therefore, HIIT outperformed MICT in improving autonomic balance (B = 0.77; P = .039). No significant between-group difference was observed in body composition changes. Both HRV and body composition improved during the exercise stages but declined during the washout period.

Conclusions: Eight weeks of HIIT, 3 times a week, was more effective than MICT in improving cardiac autonomic function in adults with high VAT. Health professionals should encourage sustained structured physical activity to maintain HRV benefits.

Background: The prevalence of coronary heart disease (CHD) in young and middle-aged populations continues to rise annually. Nevertheless, research regarding the factors influencing family resilience and potential enhancement pathways remains scarce among young and middle-aged patients with this condition.

Objective: In this study, we sought to examine the association between social support and family resilience in young and middle-aged patients with CHD, while investigating the mediating effects of sense of coherence and coping styles.

Methods: The investigation encompassed 251 young and middle-aged patients with CHD from a tertiary hospital in Hubei. Researchers utilized the shortened Chinese version of the Family Resilience Assessment Scale, Perceived Social Support Scale, Sense of Coherence Scale, and Simple Coping Style Questionnaire for data collection. Statistical analyses were performed using SPSS 25.0 and PROCESS plug-ins.

Results: Significant correlations emerged between social support, sense of coherence, adaptive coping, and family resilience. Social support demonstrated a direct positive influence on family resilience (direct effect, 0.247; 95% confidence interval, 0.119-0.374). Both sense of coherence and adaptive coping were found to independently mediate the relationship between social support and family resilience. Additionally, a statistically significant chain-mediating effect of sense of coherence and adaptive coping was observed (indirect effect, 0.010; 95% confidence interval, 0.002-0.022).

Conclusions: Among young and middle-aged patients with CHD, social support not only directly influences family resilience but also exerts indirect effects through both independent and chain-mediating pathways involving sense of coherence and adaptive coping. Hence, developing comprehensive interventions targeting social support enhancement, coherence strengthening, and adaptive coping promotion is crucial for bolstering family resilience.

Background: Clinical guidelines emphasize the administration of intravenous loop diuretics to manage acute decompensated heart failure (ADHF) effectively. Faster administration of diuretics, a concept called door-to-diuretic (D2D) time, may be associated with reduced hospital stay, lower readmission rates, and improved mortality and morbidity outcomes. Despite its significance, the factors contributing to prolonged D2D time remain unclear. Our aim was to identify predictors of prolonged D2D time among patients with ADHF.

Methods: In this retrospective analysis, we examined electronic medical records of 198 patients (275 hospitalizations) admitted with ADHF to the emergency department and who received intravenous diuretics at a major academic medical center. Predictor variables were standardized using z scores, and multicollinearity was assessed using the variance inflation factor. Feature selection was performed using recursive feature elimination and Least Absolute Shrinkage and Selection Operator regression, followed by backward elimination to refine the final model. Logistic regression models were fitted for different D2D time thresholds (<60 minutes, <90 minutes, median), and bootstrap resampling was conducted to validate model stability.

Results: The average D2D time was 328.56 minutes, with only n = 26 (12.6%) of patients receiving a diuretic within 90 minutes. The cohort was predominantly older (mean age, 71 years) and 57% male. Key predictors of prolonged D2D time included lower heart rate, respiratory rate, and diastolic blood pressure, as well as the absence of peripheral edema.

Conclusions: Identifying these predictors provides valuable insights into factors contributing to treatment delays in ADHF. Tailored interventions targeting these risk factors could improve clinical outcomes by ensuring timely diuretic administration.

Background: Although outpatient cardiac rehabilitation (OCR) is associated with improved outcomes post myocardial infarction (MI), authors of limited US studies report OCR travel distance/time estimates with fewer providing rural-urban comparisons.

Objective: We examined travel distance/time to the closest OCR facility for each Tennessee county.

Methods: We identified n = 61 Tennessee OCR facilities through a Tennessee Association of Cardiovascular and Pulmonary Rehabilitation list and a data scraping process using cardiac rehabilitation-related keywords. County-level mean travel distance/time to the closest OCR facility was determined using geospatial analysis. We conducted Kruskal-Wallis tests to examine whether mean travel distance/time varied by rural/urban county status and also by MI hospitalization rate status (low, 0 to <33.33 percentile; medium, 33.33 to <66.66 percentile; high, ≥66.66 percentile).

Results: Of Tennessee's 95 counties, 62.3% of facilities were in its 42 urban counties. Mean (SD) county-level travel distance to the closest OCR was 16.6 (10.0) miles, and mean (SD) county-level travel time was 27.9 (13.6) minutes. Travel distance/time did not significantly differ by rural/urban county status (rural: 15.4 miles, 28.9 minutes; urban: 12.9 miles, 23.2 minutes) or by MI hospitalization rate status (low: 10.4 miles, 19.6 minutes; medium: 14.5 miles, 24.1 minutes; high: 18.8 miles, 30.7 minutes).

Conclusions: Our findings indicate that overall mean travel distance was around half an hour, but lack of OCR facilities in rural Tennessee counties did not correspond with significantly greater travel distance/time to OCR in rural versus urban counties. Additional efforts are warranted to help patients post-MI with actual or perceived high travel burden navigate personal and structural factors precluding OCR receipt.

Background: Several risk prediction models are used in intensive care units (ICUs) to detect delirium risk.

Objective: The aim of this study was to compare the sex-specific validity of the Prediction of Delirium in ICU patients (PRE-DELIRIC) and Early Prediction of Delirium in ICU patients (E-PRE-DELIRIC) models for predicting delirium in ICU patients after cardiac surgery.

Methods: Retrospective data from electronic medical records of ICU patients who underwent cardiac surgery between January 2019 and December 2022 were examined. Both models were evaluated using sensitivity, specificity, and positive and negative predictive values based on the highest Youden index for female and male patients. Receiver operating characteristic curve analysis was performed.

Results: Delirium incidence was 30.7% and 27.5% in female and male patients, respectively. In the PRE-DELIRIC model, the highest Youden index scores for female and male patients were 67.00 and 57.54, respectively, with sensitivities and specificities of 61% and 88%, and 72% and 79%, respectively. In the E-PRE-DELIRIC model, the highest scores for female and male patients were 14.25 and 14.05, with sensitivities and specificities of 78% and 50%, and 70% and 53%, respectively. The area under the curve of the PRE-DELIRIC model for female and male patients was 0.77 and 0.78, respectively, and that of the E-PRE-DELIRIC model was 0.67 and 0.63, respectively.

Conclusions: The PRE-DELIRIC model showed higher specificity and was more reliable for male patients, whereas the E-PRE-DELIRIC model demonstrated better sensitivity for female patients due to its inclusion of more female-sensitive factors. A combined approach is recommended for improved reliability and validity in delirium risk assessment in clinical settings.