Journal of Cardiovascular Nursing最新文献

Background: Implantable cardioverter defibrillator (ICD) shocks are unexpected, painful, traumatic, and can lead to posttraumatic stress disorder (PTSD).

Objective: To describe the feasibility and efficacy of the Heart Rate Self-Monitoring (HRSM) intervention to reduce PTSD symptoms post-ICD shock.

Methods: A single-group, prepost design was used to assess study outcomes. In the HRSM intervention we used Polar HR monitoring and 4-weekly, nurse-led coaching sessions to review responses to tailored walking and deep breathing exercises. Outcomes included ICD shock anxiety, PTSD symptoms, depression, steps/day, self-efficacy, and salivary cortisol.

Results: Ten participants (100% male, 89% Caucasian, 58 years, and 55% prior ICD shock) completed the study. Intervention feasibility was established. Postintervention, ICD shock anxiety ( P = .03), PTSD symptoms ( P = .06), self-monitoring behaviors ( P = .02), and salivary cortisol ( P = .10) decreased. Steps/day and depression remained stable.

Conclusion: After ICD shock, participation in HRSM was associated with decreased anxiety, PTSD symptoms, and salivary cortisol.

Background: The Care Transitions Scale for Patients With Heart Failure (CTS-HF) is a scale that registered nurses working in the cardiovascular ward use to assess patients' readiness for hospital discharge; CTS-HF has shown sufficient reliability and validity for use.

Objective: In this study, our aim was to test the relationship between assessments using CTS-HF by nurses and patients' difficulties of symptom management and self-care 1 week after discharge.

Methods: In this longitudinal study we paired responses from nurses and patients with heart failure between 2022 and 2023. A nurse assessed a patient's readiness for hospital discharge using CTS-HF. One week after discharge, patients with heart failure completed a questionnaire about their daily difficulties at home. The relationship between the nurse-reported CTS-HF scores and patients' difficulties at home was analyzed.

Results: Twenty-three dyads of nurse-patient responses were included in the analysis. Nurse-assessed CTS-HF scores were significantly correlated with patients' symptom management difficulties at home ( r  = -0.471, P  = .012), degree of interference with daily life due to symptoms ( r  = -0.530, P  = .005), daily healthy ways to manage symptoms ( r  = 0.561, P  = .003), and emotional support at home ( r  = 0.435, P  = .019).

Conclusions: Nurse-reported CTS-HF scores showed a relationship with patients' difficulties after discharge. Because nurses' assessment before discharge may predict patients' difficulties managing symptoms after discharge, such discharge readiness assessment by nurses using CTS-HF may be useful in transitional care from hospital to home. Further studies on patients with complex care needs are warranted.

Background: Patients with heart failure (HF) experience several symptoms that can be alleviated by self-care, to which caregivers can contribute too. The degree of congruence between patients' and caregivers' perceptions of chronic illness should be explored to gain a holistic understanding of the dyadic illness management.

Objective: The aim of this study was to explore dyads in HF based on the congruence between patient self-care and caregiver contribution to patient self-care, and the levels of physical symptom burden in each dyad type.

Methods: This is a secondary analysis of data from the MOTIVATE-HF randomized controlled trial, which enrolled 510 dyads of patients with HF and their caregivers. Latent class mixture modeling was used to identify distinct patterns among empirical Bayes estimates of within-dyad congruence in self-care maintenance, management, and confidence, as well as symptom burden score. χ 2 Tests and analysis of variance were used to compare characteristics among the identified classes.

Results: We identified 3 classes of dyads. In class 1 (17%), caregivers contributed more to HF care than patients; patients in this class reported the highest symptom burden. In class 2 (7%), patients performed more self-care than caregivers contributed to HF care; patients in this class reported the lowest symptom burden. In class 3 (76%), patients and caregivers contributed similarly to HF care.

Conclusions: In HF, different dyad types exist based on the congruence between patient self-care and caregiver contribution to self-care, and the levels of patient symptom burden. This is pivotal to help generate an evidence base for symptom management interventions.

Background: Adherence to a heart-healthy lifestyle is essential for the prevention of cardiovascular disease. Although recent preventive strategies have shifted from targeting individual behaviors to addressing multiple behaviors simultaneously, empirical evidence on the determinants of such adherence remains limited.

Objective: The aims of this study were to assess adherence to a heart-healthy lifestyle encompassing multiple behaviors and to identify its determinants through path analysis guided by the information-motivation-behavioral skills model.

Methods: A cross-sectional design was used with 500 community-dwelling adults in South Korea who had no history of cardiovascular disease. Data were collected through an online survey. Behavioral determinants derived from the information-motivation-behavioral skills model-specifically, heart-healthy information, motivation, and self-efficacy for diet and exercise-were operationalized and measured as key predictors of adherence.

Results: The mean adherence was 2.5 on a 1-to-4 scale. Heart-healthy information exhibited no significant total effect on adherence. Heart-healthy intrinsic motivation exerted a significant total effect on adherence (β = 0.593, P  < .001), comprising both a significant direct effect and an indirect effect mediated by self-efficacy. Heart-healthy self-efficacy for both diet (β = 0.232, P  = .001) and exercise (β = 0.304, P  = .001) were found to have significant direct effects on adherence. The final path model demonstrated an excellent fit to the data, accounting for 50.0% of the variance in adherence.

Conclusions: These findings underscore heart-healthy intrinsic motivation as an initial intervention target for enhancing adherence to a heart-healthy lifestyle in the context of cardiovascular disease prevention.

Background: Cardiac surgery causes adverse physical and psychological responses. Listening to music could modulate these responses.

Objective: To measure physical/psychological responses pre and post 30 minutes of music (TX) compared with usual care (UC) in patients after cardiac surgery.

Methods: In this randomized, 2-group trial the impact of listening to music was examined in a sample of adults, ages 18-89 years who had undergone cardiac surgery. Cortisol, immunoglobulin A, vital signs, pain, and anxiety data were collected pre and post study period.

Results: There were 120 subjects, 61 in the TX group and 59 in the UC group. There were 84 males and 36 females, with mean age of 62.4 years. There were no differences between TX and UC groups on preintervention outcomes. Postintervention, the TX group had lower pain scores (3.8 vs. 4.5, P  < .04) and lower heart rate (beats per minute) (78 vs. 81, P  < .05) compared with the UC group.

Conclusion: Listening to music may be effective in reducing pain, and lowering heart rate, serving as a safe adjunct for pain management after cardiac surgery.

Background: Computerized cognitive training may reduce age-related cognitive impairment. Adherence is challenging, especially in older adults with cardiovascular disease.

Objective: To examine associations of sociodemographic, health, technology, and social isolation factors with cognitive training adherence among older women with cardiovascular disease.

Methods: Secondary analyses were conducted on data from a clinical trial (NCT04556305) with a 24-week cognitive training intervention and maintenance period. Baseline factors and adherence were assessed using Spearman's rho tests.

Results: Participants (mean age = 73.3, 56.4% non-Hispanic White, 80.9% college-educated) averaged 1.6 sessions/week for active intervention, decreasing to 0.7 (standard deviation = 1.0) during the maintenance period. Higher income ( rs = 0.22-0.25), partnered participants ( rs = 0.25), and higher education ( rs = 0.22) were associated with active period adherence but became nonsignificant in the maintenance period when adjusted for active period adherence.

Conclusions: Income and partner status were positively correlated with adherence. Further research should explore strategies to sustain adherence to cognitive training.

Background: Whether symptom clusters predict in-hospital death and subsequent rehospitalization or death is unknown in patients with heart failure (HF) in Taiwan. Our aims were to (1) identify symptom clusters in patients with HF hospitalized for an acute exacerbation of HF, (2) determine whether these symptom clusters predicted in-hospital death, and (3) determine whether these symptom clusters predicted HF rehospitalization and all-cause death during a 5-year follow-up period.

Methods: We used the electronic medical record database from Chang Gung Memorial Hospitals in Taiwan. We included 8161 patients admitted to hospitals for HF exacerbations between 2008 and 2013 and followed cardiac outcomes of each patient for 5 years. Cluster analysis was used to identify symptom clusters. Logistic regression was used to determine in-hospital death, and Cox regression was used to predict HF rehospitalization and all-cause mortality.

Results: We identified and named 4 distinct symptom clusters (cough, congestion, perfusion, and multiple symptoms) characterized by a high incidence of cough, edema, dyspnea, and many symptoms, respectively. The crude rates of in-hospital death in the cough, congestion, perfusion, and multiple symptoms clusters were 1%, 5.6%, 7.2%, and 33.6%, respectively. Membership in the multiple symptoms cluster significantly predicted higher risk of in-hospital death, rehospitalization for HF, all-cause death, and the composite outcomes of rehospitalization and all-cause death compared with those in the other 3 symptom clusters.

Conclusions: Symptom clusters predict in-hospital death and subsequent cardiac events. Monitoring and managing these clusters promptly could potentially decrease mortality rates and prevent unnecessary hospitalizations in patients with HF.

Background: Patients with atrial fibrillation (AF) benefit from long-term adherence to oral anticoagulants (OACs) for stroke prevention. Adherence to OACs undergoes continuous variation over time, therefore, exploring the trajectory and latent patterns of adherence to OACs among patients with AF in China is critical.

Objectives: To identify the trajectory and latent patterns of adherence to OACs among Chinese patients with AF, and determine predictors associated with trajectory patterns of adherence to OACs.

Methods: A cross-sectional study was conducted in Guangzhou, China, from July 2023 to January 2024. Data on medication adherence, beliefs about medicines, and anticoagulation knowledge were collected before hospital discharge and at 1 and 3 months after discharge. Sociodemographic and clinical data were also collected. Generalized estimation equation was used to investigate the overall trajectory of medication adherence. Latent growth mixture modeling was used to explore adherence trajectory patterns, and then binary logistic regression was used to explore predictors associated with each pattern.

Results: A total of 240 participants (age: 61.59 ± 10.91, 68.3% male) were included. Two adherence trajectory patterns were identified: "medium adherence-slight ascent followed by a downward trajectory" (72.9%) and "non-adherence-sharp ascent followed by a downward trajectory" (27.1%). Anticoagulation knowledge, beliefs about the necessity of medication, and anticoagulation knowledge were associated with different patterns (P < .05) of OACs medication adherence in patients with AF.

Conclusions: Identification of longitudinal patterns of nonadherence to OACs can alert clinicians to the need to monitor adherence longitudinally.