Journal of Cardiovascular Nursing最新文献

Background: Congenital heart disease (CHD) can erode parental mental health and hamper adjustment in children with CHD; however, associations between family members are poorly understood.

Objective: The aim of this study was to test a model of associations of adjustment among family members of children with CHD.

Methods: Structural equation modeling was used to model 47 parent-sibling dyads. Parents completed measures of their mental health and patient adjustment (internalizing symptoms). Siblings self-reported symptoms of anxiety and depression.

Results: Parent mental health was associated with patient internalizing symptoms (P = .019) but not with depression (P = .793) or anxiety (P = .222) in siblings. Greater internalizing scores in patients were associated with more depression (P < .001) and anxiety (P = .042) in siblings.

Conclusions: Our sample did not reveal expected associations between parental and sibling adjustment in families of children with CHD but did reveal that patient adjustment may play an important role. Family-centered care should include all members of the family and provide support as needed.

Background: Fear of physical activity (FoPA) has been discussed as a barrier to physical activity in chronic heart failure. We describe associations of FoPA with accelerometer-assessed daily physical activity indicators and examine the contribution of the 2 coping dispositions cognitive avoidance and vigilance to this relationship.

Methods: In this multisite study, FoPA, using the "Fear of Activity in Situations 15-Heart Failure" questionnaire, and coping dispositions were assessed in 87 stable outpatients with chronic heart failure (61.0 ± 11.0 years, 26% women). Participants wore an accelerometer for 7 days. Step count and minutes of moderate to vigorous intensity activity (MVPA) per day were computed, both using 10-minute bouts and total MVPA. Multiple linear regression was applied to test associations of FoPA with physical activity. Direct and indirect (via FoPA) associations of coping dispositions with activity were examined.

Results: The 82 patients with valid accelerometer data had a median of 52 minutes of total MVPA per day (interquartile range 30.3-83.3) and 14.3 minutes of bouted MVPA per day (interquartile range 0-20.4). They walked a median of 5409 steps/d (interquartile range 3204-7944). Significant and independent associations of FoPA with reduced total MVPA per day (b = -10, SE = 2.85, P < .001) and step count per day (b = -811, SE = 258, P = .002) emerged. Cognitive avoidance contributed directly and independently to higher activity; vigilance had a small indirect effect on lower activity via increased FoPA.

Conclusions: In outpatients with chronic heart failure, FoPA constitutes a clinically relevant barrier to daily physical activity. Coping dispositions deserve further attention to deliver tailored fear-reducing interventions.

Background: The assessment of individual risk for cardiovascular disease is recommended in primary prevention; however, people may not have a correct perception of their personal cardiovascular risk.

Objective: The aim of this study was to compare cardiovascular risk perception with cardiovascular real risk among participants in Italian population screening events.

Methods: This is a cross-sectional multicenter study. Men and women without cardiovascular events aged 40 and 69 years were included. For each participant, sociodemographic and clinical data were collected, cardiovascular risk perception was measured by one 5-point Likert question, and cardiovascular real risk was calculated using the SCORE2 algorithm.

Results: A total sample of 286 participants was analyzed. The mean age was 53 years, and 69% were female; the larger part of participants demonstrated a low/moderate cardiovascular real risk (67.8%) and perceived the same level of cardiovascular risk perception (91.2%) as well. Most participants with a "high" or "very high" cardiovascular real risk (32.2% of the sample) reported an incorrect cardiovascular risk perception (91% and 94%, respectively). Incorrectness in cardiovascular risk perception was significantly (P < .001) associated with sociodemographic characteristics (sex, age, education, employment status) and clinical features of participants (smoking habit, arterial pressure, or lipid abnormalities).

Conclusions: In a sample of the Italian general population, an incorrect cardiovascular risk perception is associated with sociodemographic characteristics or clinical features that increase cardiovascular real risk. Community cardiovascular screening should comprise the evaluation of cardiovascular risk perception; future research might be directed to explore more in depth its determinants and consequences.

Background: Inflammation plays a significant role in the development of hypertension and obesity, and specific dietary patterns can influence systemic inflammation. However, the link between dietary inflammatory potential and obesity-related hypertension (ORH) remains unclear.

Objective: In this study, our aim was to evaluate the association between the Dietary Inflammatory Index (DII) and ORH using data from the National Health and Nutrition Examination Survey 1999 to 2020.

Methods: The DII, calculated from a 24-hour dietary recall questionnaire, was used to assess dietary inflammatory potential. Blood pressure was measured by trained examiners, and obesity was defined as a body mass index of 30 kg/m2 or higher. Weighted logistic regression analysis was used to explore the association between DII and ORH.

Results: Individuals with ORH exhibited a higher DII (1.58 ± 0.03) compared with hypertensive (1.41 ± 0.03) and nonhypertensive (1.34 ± 0.03) individuals. Weighted logistic regression indicated a significant positive correlation between DII and ORH. In the fully adjusted model, higher DII scores were associated with increased odds of ORH (Q2, 1.12 [0.99-1.27]; Q3, 1.34 [1.19-1.51]; Q4, 1.42 [1.26-1.61]). In addition, all-cause mortality risk significantly increased with higher DII levels in the population with ORH. Notably, the association between DII and ORH was more pronounced among non-Hispanic White individuals (p for interaction < .05).

Conclusions: Higher DII is associated with increased prevalence of ORH, as well as all-cause mortality, with non-Hispanic White individuals being more susceptible to the influence of proinflammatory diets.

Background: Congenital heart defects represent the most prominent cause of mortality in a child's first year of life. Management of cardiothoracic wounds in pediatric populations is complex, attributed to the fragility of soft tissue, with healing progressing differently in adults. Understanding the breadth of wound care management is essential in establishing its applicability to clinical practice, especially in the prevention of complications.

Objective: The aim of this study was to expansively explore preoperative, intraoperative, and postoperative cardiothoracic wound care in pediatrics.

Methods: In this scoping review, a systematic search of MEDLINE, EMBASE, and Cumulative Index to Nursing and Allied Health Literature was conducted to retrieve interventional studies on pediatric cardiothoracic surgical patients (younger than 21 years) with wounds requiring intervention published in the preceding 10 years.

Results: A total of 2379 studies were retrieved, with 23 studies included. This review predominantly consisted of observational studies (n = 13, 57%), with 2 randomized clinical trials (8.7%). Most studies focused on procedural interventions (n = 14, 41.2%), with an equal distribution of management-focused (n = 10, 29.4%) and bundle-focused (n = 10, 29.4%) interventions. Interventions were most used in the postoperative period (n = 68, 49.6%). Study authors typically assessed the association of pharmaceutical, dressing, mechanical, and decontamination interventions with the incidence of sternal wound infections, healing, other infections, nutrition, parental outcomes, and postoperative complications. Frequency of wound surveillance and dressing changes were heterogeneous and rarely reported among studies.

Conclusions: This review demonstrated the limited availability of high-level evidence evaluating the effectiveness of wound care interventions associated with pediatric cardiothoracic surgery. It is paramount that researchers leverage existing clinical networks to establish clinical trials.

Background: Cardiovascular complications are a major concern for hemodialysis patients with chronic kidney disease, especially post percutaneous coronary intervention (PCI). The authors of this study investigated the impact of a nurse-led cardiovascular risk assessment and management program on 1-year outcomes in these patients.

Methods: A retrospective secondary analysis was conducted on the data of 267 patients receiving hemodialysis due to chronic kidney disease who underwent PCI. The data of patients were divided into a nurse-led care group (n = 129) receiving nurse-led care and a usual care group (n = 138) receiving usual care. The nurse-led group received personalized treatment, health education, psychological support, skill training, and regular follow-ups over 1 year. Assessments of cardiovascular risk, laboratory characteristics, psychological status, quality of life (Short Form 36 Health Survey Questionnaire), and major adverse cardiovascular events were conducted at discharge and after 1 year.

Results: At 1 year, the nurse-led care group showed greater reductions in cardiovascular risk compared with the usual care group. The levels of serum creatinine, uric acid, and blood lipid in the nurse-led care group were significantly improved. Psychological assessments revealed reduced anxiety and depression scores in the nurse-led care group. Short Form 36 Health Survey Questionnaire quality of life scores were higher in the nurse-led care group in several domains. The incidence of major adverse cardiovascular events, particularly cardiogenic shock, was significantly reduced in the nurse-led care group.

Conclusion: Nurse-led cardiovascular risk management significantly improves cardiovascular risk profiles, psychological health, and quality of life, while reducing major adverse cardiovascular event incidence in patients receiving hemodialysis due to chronic kidney disease post PCI.

Background: Atrioventricular junction ablation can be used when maximal tolerable pharmacological therapy cannot relieve atrial tachyarrhythmia symptoms. However, this strategy requires lifelong pacemaker therapy.

Objective: The aims in this study were to evaluate the long-term effects of atrioventricular junction ablation and explore the differences by sex on symptom burden, functional capacity, and health-related quality of life in patients with implanted pacemaker and symptomatic atrial tachyarrhythmia.

Methods: In this prospective longitudinal study, 137 patients (mean age, 74 ± 8 years; 47 men) were included. Six-minute walk test, symptom-specific, and generic self-reported instruments for measuring symptom burden, functional status, and health-related quality of life were assessed at baseline, 6 and 12 months after ablation. Analysis was performed to explore the data in the total group and by sex.

Results: Baseline characteristics such as mean age, type of arrhythmia, ejection fraction, and cardiac resynchronization therapy differed statistically between the sexes (P < .05-.001). At the 12-month follow-up, the patients improved their mean walking distance by 56 m (P < .001). At the 12-month follow-up, both sexes showed significant improvement in symptom frequency and severity (P < .001), functional capacity (P < .05-.001), and health-related quality of life (P < .001).

Conclusions: Both sexes benefited from this treatment. Specifically, their symptoms and physical and functional capacities improved, resulting in increased engagement in daily activities. In addition, these patients improved their health-related quality of life. The women experienced greater psychosocial effects than the men. If medical therapy fails to achieve adequate rate and symptom control for symptomatic atrial tachyarrhythmia, atrioventricular junction ablation combined with pacemaker is a safe and well-tolerated option.

Background: It is essential to understand factors influencing young adult cardiovascular health (CVH) to reduce morbidity and mortality.

Objective: Evaluate longitudinal changes in CVH among young adults in a weight management intervention.

Methods: Life's Essential 8 (LE8) metrics were calculated for young adults with overweight and obesity enrolled in a randomized controlled trial (n = 459). Outcomes included LE8 total, LE8 behavior, LE8 health, and each LE8 metric. Linear mixed effects models evaluated associations between LE8 and intervention group and demographics and assessed longitudinal changes for 18 months.

Results: Although no composite LE8 scores changed over time, LE8 diet and blood glucose improved. Low socioeconomic status and non-White participants had lower scores for many LE8 metrics when controlling for time. A significant positive intervention effect on LE8 total was observed among those with baseline body mass index <27.5.

Conclusion: Identifying factors associated with LE8 in young adulthood can support CVH, prevent future disease, and minimize health disparities.

Background: Health-related quality of life (HRQoL) is poor in patients with heart failure. Psychological (ie, depressive symptoms [DS], anxiety, and perceived control) and physical (ie, functional status) factors are associated with HRQoL. The dynamic relationships among these variables and their impact on HRQoL remain unclear, limiting the ability to design effective interventions.

Purpose: Our aim was to evaluate a moderated mediation model, in which the association between perceived control and HRQoL was hypothesized to be mediated by DS and anxiety in the presence of a moderator, functional status.

Methods: Patients (N = 426) with heart failure completed the Control Attitudes Scale-Revised to measure perceived control, Duke Activity Status Index for functional status, Patient Health Questionnaire-9 for DS, Brief Symptom Inventory for anxiety, and Minnesota Living with Heart Failure Questionnaire for HRQoL. We performed a moderated parallel mediation analysis.

Results: Higher levels of perceived control were associated with better HRQoL through lower levels of anxiety and DS in the presence of functional status (index of moderated mediation for DS, b = 0.029; 95% confidence interval, 0.016-0.045; for anxiety: b = 0.009, 95% confidence interval, 0.002-0.018). The effect of perceived control on psychological symptoms was stronger at low and moderate functional statuses; however, this effect diminished with increasing functional status.

Conclusion: Functional status moderated the indirect effects of perceived control on HRQoL through DS and anxiety in patients with heart failure. Efforts to improve HRQoL by targeting perceived control may be more effective when considering DS and anxiety in patients with low to moderate levels of functional status.

Background: Adverse childhood experiences (ACEs) and suboptimal sleep both negatively associate with cardiovascular health. Although an association between ACEs and suboptimal sleep in youth has been reported, there has been no investigation for differential effects among ACE subdomains.

Objective: We examined associations between total and subdomain ACEs and sleep duration, and age as a moderator.

Methods: Using the 2020-2021 National Survey of Children's Health and the American Heart Association Life's Essential 8 scoring algorithm, we created 3 sleep subgroups: (1) optimal, (2) suboptimal (≥1 to <2 hours below or ≥1 hour above optimal), and (3) very suboptimal (≥2 hours below optimal). We assessed association between ACEs (total and subdomains) and sleep duration using multinomial logistic regression, controlling for sex, age, race/ethnicity, caregiver's education, household income, habitual bedtime, and physical activity. We tested the interactions between ACEs and child's age.

Results: In children aged 6 to 17 years (N = 58 964), mean sleep duration score was 77.2 (95% confidence interval, 76.6-77.9). The mean number of ACEs was 0.89 (95% confidence interval, 0.87-0.91). Adjusting for covariates, each additional ACE increased the likelihood of falling into the suboptimal subgroup by 8% and the very suboptimal subgroup by 26%. There was an association between each subdomain of ACE and suboptimal sleep duration, with no significant interaction with age.

Conclusions: Our findings show a dose-response relationship between ACEs and suboptimal sleep duration-a new cardiovascular health indicator in Life's Essential 8. Healthcare providers should screen for ACEs and suboptimal sleep in children to reduce future cardiovascular disease risk.