Journal of Cardiovascular Nursing最新文献

Background: Thirst is among the most unpleasant symptoms in patients with heart failure (HF). Intense thirst can lead to uncontrolled fluid intake, resulting in congestion and frequent readmissions. Many predictors of thirst were identified, but little research addressed its association with salt intake.

Objective: The aims were to describe the prevalence and characteristics of thirst in patients with HF, examine its association with salt intake, and identify its predictors.

Methods: Using a descriptive correlational design, 100 patients with New York Heart Association classes I, II, and III HF were interviewed about thirst, salt-related behaviors, and the Patient Health Questionnaire-2. Demographic and clinical information were extracted from medical records. Descriptive statistics as well as bivariate and multivariable regression analyses were used.

Results: Most participants were male and married, with university education and a mean age of 66.7 ± 13.2 years. The mean thirst intensity score was 3.81 ± 2.17 (out of 10), and its prevalence was 93%. The mean thirst distress score was 23.58 ± 7.66 (out of 40); 68% reported moderate or strong distress. Patients prescribed salt restriction had lower thirst intensity (3.60 vs 5.70, P = .003) than their counterparts and thirst distress (22.78 vs 27.50, P = .062) that approached significance. Salt restriction; use of statins, antidepressants, and any renin angiotensin aldosterone system (RAAS) blocker; and Patient Health Questionnaire-2 score predicted thirst intensity. Female sex as well as use of any RAAS blocker and antidepressants predicted thirst distress.

Conclusions: Thirst was prevalent, distressing, and predicted by salt restriction, use of any RAAS blocker, and depression. Assessing thirst and relieving it are recommended.

Background: Adherence to self-care behaviors can prevent or delay adverse outcomes associated with cardiovascular disease (CVD). Sex and socioculturally constructed gender might impact individuals' ability to adhere to healthy lifestyles.

Objective: The aim of this study was to systematically identify, evaluate, and synthesize the literature on the influence of sex and gender on adherence to self-care behaviors for CVD risk management in the global context.

Methods: We searched the MEDLINE, EMBASE, CINAHL, Scopus, Web of Science, and Global Health Databases for peer-reviewed original articles published between 2013 and 2023. We selected studies that investigated self-care behaviors, self-care maintenance, or self-care management as outcomes and reported sex- and gender-related factors (such as education level, employment status, and marital status). The data were synthesized in a narrative form.

Results: The search identified 3540 studies, 52 of which met the inclusion criteria for full-text review. Global North countries accounted for 55% of all the studies. Self-reported questionnaire scores were used in most of the studies (n = 47). Better self-care was associated with being a woman (n = 17), attaining a higher education level (n = 15), and having higher perceived social support (n = 10). The associations between adherence to self-care behaviors and employment status, socioeconomic status, marital status, and household size were inconsistent.

Conclusions: Adherence to self-care behaviors for CVD risk management varied widely, based on gender-related factors. Further research is needed to use a consistent measure of self-care adherence behavior and integrate a wider range of gender-related factors.

Background: Allostatic load (AL), a measure of cumulative stress-related physiological dysregulation, predicts the onset of chronic diseases. We investigated the relationship between AL and cardiovascular disease (CVD)-free survival in parents and offspring, including sex-specific differences.

Methods: The analysis consisted of 6145 offspring-mother-father trios derived from the Framingham Heart Study. Clinically defined cutoffs from 9 physiological biomarkers across biological systems were used to generate composite AL score. Assessments of the associations of AL with CVD-free survival were conducted using Kaplan-Meier plots, Irwin's restricted means, and Cox proportional hazards regression models.

Results: Over a 47-year period, parents and offspring experienced 1832 and 1060 incident CVD events, respectively. Parents exhibited a notably higher prevalence of high AL (29.5%) and CVD incidence rate (17.2 per 1000 person-years) compared with offspring (13.2% and 8.9, respectively, both P < .001). High parental AL was associated with 30% higher incident CVD risk in offspring, with maternal AL biomarkers being more predictive of offspring CVD risk than paternal. Parents and offspring with low AL lived 12.5 and 13.4 years longer without CVD, respectively, compared with those with high AL. The hazards of incident CVD were highest in daughters with high AL, up to 2.8 times (hazard ratio, 2.83; 95% confidence interval, 1.71-4.67), with similar risk observed in sons and parents.

Conclusion: Parental AL is associated with offspring CVD risk, with maternal AL biomarkers having a stronger association. This highlights the critical role of parental and, more importantly, maternal health in CVD risk management and broader public health strategies.

Hypertension disproportionately affects African Americans, and adequate blood pressure (BP) control remains a challenge. Self-management of hypertension is critical for improving BP control and reducing hypertension-related morbidities.

Objectives: The objective of this study is to describe hypertension self-management (HTN-SM) behaviors and the relationship between HTN-SM and self-reported BP in middle- to older-aged African American adults.

Methods: A cross-sectional correctional design was used, and African Americans 45 years and older were recruited through flyers. Data were collected using self-report surveys, including the Self-Care of Hypertension Inventory, administered via Qualtrics or by telephone interviews.

Results: Participants (N = 142) had a mean age of 63.04 years (SD = 12.0 years). One hundred sixteen (82%) were female and had lived with hypertension for 13.7 years (SD = 11.1 years). For those who could recall their most recent BP (n = 99, 70%), the average systolic BP was 133 (SD = 13.4) and diastolic BP was 80 (SD = 10.7). Thirty-six (36%) participants had BP readings considered stage 2 hypertension (ie, ≥140/90 mm Hg), and 37 (37%) had readings ≥130/80 mm Hg, considered stage 1 hypertension. The mean hypertension self-care maintenance score used to assess HTN-SM was 58.14 ± 16.67; 28% had adequate scores (≥70). Medication adherence, keeping healthcare provider appointments, and eating fruits and vegetables were the most frequent behaviors, whereas asking for low salt, low fat foods, and exercising were the least frequent. Higher hypertension self-care maintenance scores were significantly associated with lower BP readings.

Conclusions: A significant portion of participants had BP considered "uncontrolled" and low self-care maintenance scores. Facilitating HTN-SM is critical for lowering BP; therefore, assessment of HTN-SM is recommended for understanding potential barriers.

Background: Hypertension has become a major public problem. One of every 4 adults has hypertension. Medications are critical in controlling blood pressure, but patient medication adherence is low. Therefore, it is very crucial to promote medication adherence. However, the complexity and variety of interventions cause clinical decision-making difficulties for health managers and patients.

Objective: The aim of this study was to compare the effectiveness of different interventions to improve medication adherence in patients with hypertension.

Methods: We searched PubMed, Cochrane Library, Web of Science, EMBASE, Wan Fang, China National Knowledge Infrastructure, China Science and Technology Journal Database, and China Biology Medicine disc databases for eligible studies. Medication adherence rate and medication adherence difference were assessed as outcomes. Sensitivity analysis and inconsistency detection were performed to evaluate whether the exclusion of high-risk studies affected the validity. The risk of bias was assessed using the risk of bias table in Review Manager 5.4. The surface under the cumulative ranking curve was used to estimate the rankings among different interventions.

Results: Twenty-seven randomized controlled trials were included, and the interventions involved were categorized into 8 different categories. The network meta-analysis showed that the health intervention was the best to promote medication compliance in patients with hypertension.

Conclusions: Health intervention is recommended to improve medication adherence in patients with hypertension.

Clinical implications: Health managers are recommended to provide health intervention to patients with hypertension to improve their medication adherence. This approach reduces morbidity, mortality, and healthcare costs for patients with cardiovascular disease.

Background: There is evidence that heart failure with preserved ejection fraction (HFpEF)-related hospitalizations are increasing in the United States. However, there is a lack of knowledge about HFpEF-related hospitalizations among younger adults.

Objective: The aims of this study were to perform a retrospective analysis using the Nationwide Inpatient Sample and to examine age-stratified sex differences in the prevalence, correlates, and outcomes of HFpEF-related hospitalization across the adult life span.

Method: Using the Nationwide Inpatient Sample (2002-2014), patient and hospital characteristics were determined. Joinpoint regression was used to describe age-stratified sex differences in the annual average percent change of hospitalizations with HFpEF. Survey logistic regression was used to estimate adjusted odds ratios representing the association of sex with HFpEF-related hospitalization and in-hospital mortality.

Results: There were 8 599 717 HFpEF-related hospitalizations (2.43% of all hospitalizations). Women represented the majority (5 459 422 [63.48%]) of HFpEF-related adult hospitalizations, compared with men (3 140 295 [36.52%]). Compared with men younger than 50 years, women within the same age group were 6% to 28% less likely to experience HFpEF-related hospitalization. Comorbidities such as hypertensive heart disease, renal disease, hypertension, obstructive sleep apnea, atrial fibrillation, obesity, anemia, and pulmonary edema explained a greater proportion of the risk of HFpEF-related hospitalization in adults younger than 50 years than in adults 50 years or older.

Conclusion: Before the age of 50 years, women exhibit lower HFpEF-related hospitalization than men, a pattern that reverses with advancing age. Understanding and addressing the factors contributing to these sex-specific differences can have several potential implications for improving women's cardiovascular health.

Background: Risk factors for cardiovascular disease (CVD) among young and middle-aged women have increased, whereas CVD knowledge and awareness remain low.

Aims: The objective of this study was to describe the relationship between the stage of behavior change and awareness, knowledge, and perceptions of CVD among women 25-55 years and identify predictors of the stage of behavior change.

Methods: A cross-sectional online survey of women ages 25-55 years living in the United States was conducted. Awareness was measured with the question "What is the leading cause of death for women in the United States?" Knowledge, perceptions, and the stage of behavior change were measured with the Heart Disease Fact Questionnaire, Health Beliefs Related to CVD, and Precaution Adoption Process Model instruments, respectively. Chi-square and t tests were used to determine differences between awareness, knowledge, and perceptions based on the stage of behavior change. Multiple logistic regression was used to evaluate the relationship between the stage of behavior change and awareness, knowledge, and perceptions.

Results: A total of 149 primarily minority women (n = 105) were included (mean age = 37.15 ± 7.86 years). The perception of CVD susceptibility was associated with increased intention to change behavior (odds ratio, 1.247; 95% confidence interval, 1.101-1.414; P < .001). The perception of CVD severity was associated with reduced intention to change behavior (odds ratio, 0.809; P = .004).

Conclusion: Women who believed they were susceptible to CVD and did not perceive CVD as severe were more likely to report intent to change behavior, suggesting perception of CVD risk is more important than awareness or knowledge. Addressing misperceptions may be a strategy for primary risk reduction.

Background: There has not been a significant improvement in cardiovascular disease (CVD) statistics among women; 44.4% of women older than 20 years have a diagnoses of CVD. Only 24.3% of adults meet physical activity (PA) guidelines, women have significantly lower levels of PA significantly lower levels than men. There is a call to action from the American Heart Association to delineate reasons for related genderized, socially determined factors.

Objective: The purpose of this study was to use the individual and family self-management theory to explore and describe interacting sociodemographic, family, cultural, health/access-related, and personal factors contributing to PA engagement in women living in areas of reduced socioeconomic resources.

Methods: This study used a community-engaged, qualitative descriptive focus group design to explore PA engagement in women between 18 and 64 years old living in an area of reduced socioeconomic resources and high racial and ethnic diversity.

Results: Context-related factors included cost/access, transportation, safety, and setting and interacted with family structure and functioning. Process-level factors affecting PA engagement included outcome expectancy, goal incongruence, lack of self-efficacy, self-regulation, and provider support/collaboration. Facilitators included family/friend social support.

Conclusions: The current community-engaged study reveals socially constructed gender role elements related to family dynamics, self-perception, and self-regulation that potentially impact engagement in self-management behavior. Programs to increase awareness and self-management of CVD in women exist, but there is a lack of direct effects, speaking to unknown factors. Given perpetually high rates of CVD, low levels of PA, and declining knowledge levels among women, further investigation is imperative.