Journal of Cardiovascular Nursing最新文献

Background: Aortic valve stenosis in older adults presents a growing healthcare challenge, with transcatheter aortic valve replacement (TAVR) being widely used in patients aged ≥75 years owing to its minimally invasive approach. Despite its benefits, readmission remains common and is associated with adverse outcomes. However, evidence from rapidly aging countries such as South Korea is limited, highlighting the need for context-specific strategies.

Objective: To identify the key predictors associated with hospital readmission in older adults after TAVR.

Methods: This retrospective study analyzed the clinical data of 558 older adults who underwent TAVR between 2018 and 2023 at a tertiary hospital in Seoul. Statistical analyses included descriptive statistics, chi-square tests, and logistic regression using Statistical Package for Social Sciences 29.

Results: Of the 558 patients, 21.7% were readmitted. Significant predictors included male sex, hospital stay exceeding 10 days, high N-terminal pro B-type natriuretic peptide levels, and elevated age-adjusted Charlson comorbidity index scores.

Conclusions: This study emphasizes the role of patient severity in predicting readmission after TAVR in older adults. Key risk factors include elevated cardiac biomarkers, high comorbidity, prolonged hospitalization, and male sex. Integrating these into discharge planning may enhance nurse-led interventions and support safer care transition.

Background: Coronary heart disease (CHD) remains a major global health challenge that requires patients to sustain self-management efforts beyond acute clinical treatment. Within empowerment-oriented approaches to chronic disease care, perceived control and chronic illness resource utilization have been increasingly recognized as important psychosocial constructs that may influence patients' engagement in long-term health management. However, how these constructs interact-and the extent to which they contribute to health empowerment among individuals with CHD-has not been clearly established.

Objective: This study examined the levels of perceived control, chronic illness resource utilization, and health empowerment among patients with CHD, and further explored how perceived control influences health empowerment both directly and indirectly through chronic illness resource utilization.

Methods: From August 2022 to February 2023, 324 coronary heart disease patients were recruited from 2 tertiary hospitals in Chengdu, China. Data were collected using validated questionnaires: the revised Control Attitudes Scale, Chronic Illness Resource Survey, and Patient Perception Empowerment Scale. Pearson correlations and structural equation modeling were applied.

Results: Perceived control and health empowerment were moderately high, while resource utilization was moderately low. Both perceived control and resource utilization were positively associated with health empowerment. Resource utilization partially mediated the relationship between perceived control and empowerment.

Conclusions: Perceived control and chronic disease resource utilization are key positive predictors of health empowerment. Enhancing patients' control beliefs and promoting access to health resources may jointly support empowerment and better self-management outcomes.

Background: Silent myocardial ischemia (SMI) predicts adverse outcomes in coronary artery disease, yet the effects of cardiac rehabilitation (CR) in this group are limited. We evaluated the impact of CR on peak exercise capacity, ischemic threshold, training workload progression, medication adherence, depression, and exercise-related adverse events in patients with documented SMI Type I and II.

Methods: This retrospective cohort study includes 966 patients referred to CR. Twenty-nine patients who completed ≥1 session and had valid pre and post exercise tests were included in the final analysis. Main outcomes were changes in peak exercise capacity and ischemic threshold. Rate of adverse events, medication compliance, adverse drug reactions, and cardiac depression scores were also evaluated. Paired t tests were used (α=0.05).

Results: Exercise-based CR resulted in a clinically and statistically significant improvement in exercise capacity (METpeak: 8.43 ± 2.51 to 9.14 ± 2.81, P <.001). At ischemic threshold, heart rate increased (123.94 ± 16.08 to 127.82 ± 17.23, P <.001), systolic blood pressure reduced (167.41 ± 33.14 to 164.41 ± 22.59, P =.006), and rate-pressure product increased (21939.53 ± 5362.54 to 22013.88 ± 4203.48, P =.009). The rate of exercise-related adverse events was low (2.23 per 100 sessions), with no major adverse events. Compliance with medications remained above 85% pre-to-post CR, with only 1 reported adverse drug reaction.

Conclusions: Exercise-based CR is safe and effective for patients with SMI, improving exercise capacity and ischemic tolerance with few adverse events. These findings support integrating CR into the management of asymptomatic, high-risk coronary patients.

Background: Ischemic heart disease (IHD) remains a leading global cause of morbidity and mortality. Controlling modifiable risk factors can delay or prevent its onset, and greater knowledge is linked to better risk management. However, migration complicates the adoption of preventive behaviors. In this study, Indian migrants were the focus population, a group with a higher risk of early-onset IHD and poorer outcomes.

Objective: The aim of the study was to assess Indian migrants' knowledge of IHD risk factors and identify the factors influencing their knowledge of IHD risk.

Methods: An online survey using a modified Heart Disease Fact Questionnaire (in Hindi, Punjabi, Urdu, and English) was conducted. Data were analyzed using descriptive, univariate, and multivariate statistics. A Community Advisory Board provided cultural guidance and supported engagement.

Results: A total of 400 surveys were included in the analysis. The mean age of respondents was 38.8 years, with most being male and having resided in Australia for an average of 11.4 years. The majority held a university qualification. Overall, 76% demonstrated high levels of knowledge of IHD risk factors; however, notable gaps remained. Nearly half were unaware that IHD can be asymptomatic or of the protective role of high-density lipoproteins. Only 65% recognized the importance of blood sugar control in preventing IHD. No demographic factors were significantly associated with higher knowledge overall, though high levels of knowledge were more likely among those with a bachelor's degree, longer residency in Australia, and females.

Conclusions: Despite generally high knowledge scores, key gaps were identified in this study that have important implications for nurses working in primary and tertiary healthcare settings.

Background: Although palliative care is recommended for people with heart failure in various national and international guidelines, there remains no universally adopted standard on how and when to integrate it into heart failure care.

Objective: To map the palliative care services available for people with heart failure in 1 country within the United Kingdom and to determine how palliative care access for people with heart failure is implemented across the country.

Methods: An online survey was used to map palliative care services available for people with heart failure. Both quantitative and qualitative responses were gathered. Responses were gathered from heart failure experts, who represented heart failure service provision across the healthcare system within Northern Ireland.

Results: It was found that there are gaps in integration of palliative care services into heart failure services, evidenced by 5 key findings: assessment for palliative care needs was restricted to end-of-life; no agreed systematic tool/template implemented to guide holistic assessment of unmet supportive and palliative care needs; locally agreed eligibility criteria for specialist palliative care referral not universally known; advance care plans not completed routinely, and mainly by palliative care physicians; and inequity of palliative care provision for those with heart failure with preserved ejection fraction compared with those with heart failure with reduced ejection fraction. It was also evident that the integration of palliative care into heart failure services was determined by locality.

Conclusions: We identified gaps in palliative care provision for people impacted by heart failure. This enables recognition and response to these gaps to ensure delivery meets the needs of those individuals within our communities who have heart failure and palliative care needs.

Background: Managing heart failure (HF) is stressful for rural dyads who experience unique challenges to optimal HF self-care and a higher emotional burden. Tailored, dyadic problem-solving interventions that support teamwork in managing HF problems may enhance dyadic HF self-care and reduce depressive symptoms.

Objective: To examine the feasibility and preliminary effects of a telephone-based, tailored, dyadic problem-solving intervention on problem-solving, patient and care partner contributions to HF self-care, and depressive symptoms.

Methods: Using a dyadic single-group repeated-measures design, 41 rural HF dyads participated in 8 telephone sessions to address dyadic HF-related problems. Data on problem-solving, HF self-care, and depressive symptoms were collected at baseline and at 5, 9, and 13 weeks. Descriptive statistics were employed to analyze demographics and outcome variables. Changes in patient and care partner outcomes were analyzed using dyadic growth curve modeling.

Results: Patients were on average 66.54 years old, mostly White (69.2%), married (66.7%), and female (59%). Care partners were on average 60.83 years old, mostly White (70.7%), married (75.6%), females (58.5%), and spouses (68.3%). Patient scores significantly improved for problem-solving (b = 0.45, P <.001), self-care maintenance (b = 2.29, P <.001), and depressive symptoms (b = -1.81, P =.002). Self-care confidence significantly increased in both patients (b = 2.51, P <.001) and care partners (b = 2.26, P =.01).

Conclusions: Dyadic problem-solving interventions seem to be beneficial in improving problem-solving, HF self-care, and depressive symptoms, especially in rural patients. More research is needed to examine this intervention in a larger clinical trial.

Clinical trials registration: This study is registered at clinicaltrials.gov (#00001621).

Background: Optimizing self-care, particularly treatment adherence and health-promoting behaviors, is crucial for mitigating heart failure (HF) hospitalizations and mortality, while concurrently enhancing patients' quality of life. Currently, a dedicated Arabic-language self-care instrument is unavailable.

Objective: In his study, our aim was to examine the psychometric properties of the Self-Care of Heart Failure Index Arabic version 8.0.

Methods: In this multicenter, cross-sectional study involving 352 patients with HF, a comprehensive psychometric evaluation was undertaken. To establish robust structural validity and reliability, the methodology included forward-backward translation, exploratory and confirmatory factor analyses, network analysis, model-based internal consistency and test-retest reliability, and convergent validity with European HF Self-care Behavior (EHFScBS-9).

Results: The Self-Care of Heart Failure Index Arabic version 8.0 demonstrated robust psychometric properties. Construct validity was confirmed by a stable 3-factor structure with excellent model fit (χ2/df = 1.532, comparative fit index = 0.977, root mean square error of approximation < 0.039). Convergent validity was strong, evidenced by a significant positive correlation with the EHFScBS-9 (r = 0.39 - 0.78, P < .001). Internal consistency was exceptionally high across all subscales (α = 0.91 - 0.92), with an overall Cronbach's alpha of 0.96. Temporal stability was established via excellent test-retest reliability (0.96), supporting the scale's suitability for diverse clinical and research applications.

Conclusion: The Self-Care of Heart Failure Index Arabic version 8.0 demonstrates robust reliability and validity for self-care assessment in Arabic-speaking patients with HF, supporting its use in research and clinical practice.

Background: The New York Heart Association Functional Classification (NYHA-FC) is used in clinical practice to assess functional capacity.

Objective: This study examined the reliability and validity of the Consistently Assess Signs and Symptoms of Heart Failure (CLASS-HF) Guide in the assignment of NYHA-FC.

Methods: Providers assigned NYHA-FC using the CLASS-HF Guide and patients completed a 6-minute walk test.

Results: Interrater reliability revealed moderate agreement (κ = 0.462) among heart failure providers. A significant inverse correlation was found between assigned NYHA-FC and 6-minute meters walked (rs = -0.469, P < .001), with significant mean differences (analysis of variance F(3,99) = 10.72, P < .001) in distance walked.

Conclusions: The CLASS-HF Guide showed evidence of reliability and validity.

Background: Digital health technologies are transforming healthcare by enabling continuous monitoring of conditions such as atrial fibrillation (AF), a common cardiac arrhythmia. Atrial fibrillation's episodic nature makes it difficult to detect in clinical settings, and digital health devices offer a promising solution. However, Black and Latino individuals, who face a higher risk of cardiovascular disease, experience disparities in AF detection and treatment due to barriers like limited access to care and clinician bias. These challenges are compounded by a lack of trust in the healthcare system and low adoption of digital health tools in underserved communities.

Objectives: In this study the aim was to identify facilitators and barriers to adopting technology-based AF surveillance among Black and Latino adults with cardiovascular disease and key stakeholders. We further examined ethical considerations related to distributive justice and trust-building and proposed strategies to address these disparities.

Methods: Semistructured interviews were conducted between April and September 2023 with 25 stakeholders, including patients, caregivers, clinicians, and community health workers (CHWs). Interviews explored behavioral, environmental, and system-based factors influencing digital health adoption. Data were analyzed using directed content analysis guided by the socioecological framework.

Results: Barriers included low self-efficacy, financial constraints, language barriers, privacy concerns, and mistrust in healthcare systems. Facilitators included CHWs providing education and personalized support, family and community involvement, and health as a motivator. Participants emphasized the importance of addressing financial and logistical barriers, building trust through long-term community engagement, and tailoring interventions to underserved populations' needs.

Conclusion: Digital health devices hold potential for improving AF detection and management in underserved communities. However, a community-centered approach is necessary to bridge the digital divide, address ethical challenges, and build trust. Leveraging CHWs and trusted community settings can enhance access, engagement, and equity in digital health adoption for AF surveillance.

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.