Journal of Cardiovascular Nursing最新文献

Background: Ischemic heart disease is a major cause of premature death and disability worldwide. The chances for a recurrent coronary event and mortality increase significantly after the first event. Cardiac rehabilitation (CR) is an effective secondary prevention measure in reducing morbidity and mortality after a coronary event. Despite these benefits, fewer than 30% of eligible patients with coronary artery disease complete the recommended number of CR sessions.

Objective: In this integrative review, our aim was to synthesize research on the relationship between formal functional social support and CR participation and completion among adults with coronary artery disease.

Methods: We searched PubMed, Scopus, and CINAHL databases from inception to June 2023. Quantitative, qualitative, and mixed-methods studies were included. Two independent reviewers screened titles, abstracts, and full-text reviews. The study quality was appraised using the Critical Appraisal Skills Programme and Mixed Methods Appraisal Tool.

Results: An initial search yielded 629 studies; 9 were included, and 1 was added after a hand search. Of the 10 studies reviewed, 6 were quantitative (60%), whereas 20% were qualitative and 20% were mixed-methods studies. Two main types of formal support interventions emerged: (1) individual interventions delivered one-on-one; and (2) system-level interventions, which involved modifying the environment to better support participants. There were 7 studies in which support interventions were targeted at the individual level, while 3 were focused at the environmental/systemic level. Participants who received support interventions had increased enrollment and participation in CR programs.

Conclusions: Formal functional support was not objectively measured in the studies reviewed. However, participants expressed satisfaction with formal functional support programs, valued guidance from healthcare professionals, and the flexibility offered by support programs.

Background: Chronic heart failure (CHF) has emerged as a significant global public health challenge. Fear of progression (FoP) constitutes a critical psychosocial issue among patients with CHF, with dyadic coping (DC) and social support serving as key influencing factors; however, the intrinsic mechanisms linking these components remain ambiguous.

Objective: In this study, our aim was to elucidate the mediating role of social support within patient-spouse dyads as a bidirectional dependency in the relationship between DC and FoP, thereby providing a scientifically grounded foundation for clinical intervention strategies.

Methods: Between July 2024 and February 2025, a total of 221 CHF patient-spouse dyads were recruited via convenience sampling at a tertiary hospital in Tangshan City, Hebei Province. Data collection instruments included a demographic questionnaire, the Fear of Progression Questionnaire-Short Form, the Dyadic Coping Inventory, and the Perceived Social Support Scale. Data were analyzed using AMOS 24.0 for the actor-partner interdependence mediation model.

Results: Analysis of the actor-partner interdependence mediation model demonstrated significant actor effects across all pathways (β = -0.204 to 0.228, P <.01), with partial partner effects observed (β = -0.066 to 0.116, P <.05). Notably, significant mediating effects were identified (β = -0.043 to -0.017; 95% confidence interval: -0.071, -0.003; P <.05). Actor effects indicated that social support partially mediated the relationship between individual DC and FoP. Partner effects revealed that social support partially mediated the association between spouses' DC and patients' FoP.

Conclusion: The findings illuminate the interactive dynamics among DC capabilities, social support, and FoP within dyads of patients with CHF and their spouses. Clinical interventions should adopt a dyadic approach, simultaneously enhancing mutual coping skills and social support levels to effectively mitigate FoP in both patients and their spouses.

Background: Kinesiophobia is a significant barrier to exercise rehabilitation in patients with angina pectoris (AP). An understanding of the heterogeneity of kinesiophobia and the factors that influence it may help reduce fear of movement, increase rehabilitation adherence, and enhance quality of life of patients with AP.

Objective: To explore latent kinesiophobia in patients with AP and analyze any differences.

Methods: A cross-sectional survey was conducted on 210 patients with AP from 4 tertiary hospitals in Zhejiang, China, between February 2023 and August 2023. Kinesiophobia was assessed by the Tampa Scale for Kinesiophobia Heart, and latent class analysis was performed to identify the kinesiophobia profile. Multinomial logistic regression was used to determine predictive factors for classification.

Results: Three latent classes of kinesiophobia were identified: (1) high-fear type-motor avoidance; (2) intermediate-fear type-moderate fear characterized by motor fear; and (3) low-fear type-danger perception. Significant differences were observed in educational level, exercise frequency, pain severity, pain catastrophizing, angina stability, and anxiety between patient members of the 3 classes.

Conclusions: Kinesiophobia has 3 subtypes in patients with AP. Interventions should be adapted to take account of these classifications to reduce kinesiophobia, enhance adherence to rehabilitation, and improve patient outcomes.

Background: Cardiovascular diseases (CVDs) and chronic obstructive pulmonary disease (COPD) often occur comorbidly, sharing similar risk factors and symptom presentations. However, the influence of comorbid CVD on health-related quality of life (HRQoL) along the gradient of airflow limitation severity found within COPD is understudied.

Objective: The objective of this study was to identify if comorbid CVD demonstrates a significant moderating influence on HRQoL at each distinct stage of airflow limitation presenting among a sample of individuals living with COPD.

Methods: A cross-sectional secondary analysis of N = 1609 participants enrolled in the SubPopulations and InteRmediate Outcome Measures in COPD Study observational cohort study using a 4 × 2 factorial analysis of variance.

Results: There were significant differences in HRQoL among those with and without comorbid CVD at Global Initiative for Chronic Lung Diseases Stages I ( P  < .001) and II ( P  < .001); however, there were no significant differences at Stages III ( P  = .182) or IV ( P  = .138).

Conclusions: The moderating influence of comorbid CVD on HRQoL may be variable among the various stages of airflow limitation present within COPD. Future studies should further examine comorbid illness interactions within the context of their gradients of severity.

Background: The Self-Care Self-Efficacy Scale version 3.0 (SCSES-v3.0) measures self-efficacy in various chronic conditions. However, its psychometric properties in specific conditions and non-Western contexts are not well understood.

Objective: We evaluated the psychometric properties of the Thai version of the SCSES-v3.0 in patients with heart disease.

Methods: In this cross-sectional methodological study, we recruited patients with heart disease from 2 hospitals and 15 primary care settings. We evaluated structural validity using exploratory and confirmatory factor analysis, and hypothesis testing against the Self-Care of Chronic Illness Inventory version 4.c (SC-CII-v4.c). Reliability was assessed using McDonald's ω , Cronbach α , intraclass correlation coefficients, and measurement errors were calculated for score precision.

Results: Of 300 patients, 287 were included in the analysis after excluding outliers. Exploratory factor analysis conducted with the first split-half subsample revealed a 2-factor structure: one factor represented self-efficacy in maintenance and monitoring behaviors (items 1-5), and the other represented self-efficacy in management behaviors (items 6-10). Confirmatory factor analysis conducted with the second split-half subsample and the overall sample confirmed the scale's bidimensional model with high factor loadings. The dimensions and overall SCSES-v3.0 positively correlated with each scale and the overall SC-CII-v4.c. Reliability was excellent for internal consistency (range, 0.91-0.94) and test-retest reliability (range, 0.95-0.97). The measurement error results were satisfactory.

Conclusions: The SCSES-v3.0 demonstrated robust psychometric characteristics. Its validity and reliability make it a valuable instrument for clinical practice and research with the potential to enhance patient outcomes in heart disease management.

Background: Research on the care needs of patients with heart failure (HF) has predominantly relied on cross-sectional studies. Consequently, there is limited understanding of how care needs evolve over time within this population.

Objectives: The aims of this study were to explore the trajectories of care needs in patients with HF 1 year after discharge and analyze the potential factors that can predict these trajectories.

Methods: A total of 197 patients with HF were recruited and followed at 1, 3, 6, and 12 months postdischarge. Care needs were assessed using the care needs survey questionnaire, and potential factors were selected based on the Andersen Behavioral Model. A growth mixture model was used to identify the trajectories of care needs, whereas logistic regression analyses were used for statistical comparisons.

Results: Three trajectories in the care needs of patients with HF were identified: (1) a mild increase trajectory, (2) a decline trajectory, and (3) a persistently high trajectory. Need factors were the most significant determinants of care needs trajectories, with higher New York Heart Association functional classification, left ventricular ejection fraction less than 40%, and lower self-reported health serving as key predictors of persistently high trajectory. In contrast, only lower self-efficacy and the absence of a spouse as predisposing factors were associated with an increased risk of maintaining persistently high levels of care needs.

Conclusion: Care needs after discharge in patients with HF can be characterized by 3 trajectories. Need factors will help clinicians with early identification of patients with persistently high level of care needs.

Background: Frailty is common in patients with heart failure. Specific scales, including the Clinical Frailty Scale, exist but have not undergone thorough psychometric validation among patients with heart failure.

Objective: The aim of this study was to develop and validate the Frailty Assessment Scale for Heart Failure (FAS-HF) in patients with heart failure.

Methods: This study included 3 phases. In phase I, conceptualization and item generation, the FAS-HF was initially developed through the analysis of qualitative research data and a literature review. In phase II, item selection and content validity, the Delphi method was used to gather experts' opinions and suggestions regarding the FAS-HF. In phase III, field testing and psychometric evaluation, a cross-sectional study of 184 patients with heart failure in northern Taiwan was conducted to test the reliability and validity of the FAS-HF.

Results: The 15-item FAS-HF included the physical, psychological, and social frailty domains. The total score ranged from 0 to 45, with higher scores representing frailer individuals. Exploratory factor analysis revealed that the cumulative loading variance was 57.39%. In the confirmatory factor analysis, the goodness-of-fit index (0.91), adjusted goodness-of-fit index (0.87), and root mean square error of approximation (0.06) were acceptable for model fit. Acceptable reliability was found, with a Cronbach α coefficient of 0.87 and a test-retest reliability of 0.99. Compared with the Fried frailty phenotype, the area under the receiver operating characteristic curve was 0.94, and the optimal cutoff score for frailty was 20.

Conclusions: The FAS-HF has good reliability, validity, and discrimination and can be used as a frailty indicator for patients with heart failure.

Background: Home monitoring programs (HMPs) have been implemented for high-risk postoperative patients with congenital heart diseases.

Objective: We recently extended the indications for HMPs to preoperative patients with tetralogy of Fallot (ToF). Thus, our purpose was to evaluate the current practice of home monitoring for preoperative patients with ToF, emphasizing the early detection of hypoxic spell events and the prevention of preoperative attrition. Furthermore, we sought to identify the risk factors for unplanned urgent operations during the home monitoring period and to evaluate the effects of these unplanned operations on long-term outcomes after repair.

Methods: Among 126 consecutive patients born with ToF between January 2020 and December 2021, 100 (59 boys) were enrolled in the preoperative HMP group. The risk factors for unplanned urgent operations during HMP were assessed using Cox regression.

Results: The parents of 1 patient chose to undergo surgery at another hospital. Elective operations were performed in 79 patients (group 1, repair n = 74, systemic-to-pulmonary shunt n = 5) at a median age of 4 months (interquartile range [IQR], 3.5-4.9 months). In contrast, unplanned urgent operations were performed on 20 patients (group 2, repair n = 10, systemic-to-pulmonary shunt n = 10) at a median age of 1.2 months (IQR, 1.1-2.0 months). Risk factors for decreased time to unplanned urgent operations included a smaller pulmonary valve annulus (PVA) Z-score on follow-up echocardiography before surgery (P = .013; hazard ratio, 1.90 per 1 decrease) and lower daily minimum peripheral oxygen saturation (SpO2) (P < .001; hazard ratio, 1.16 per 1% decrease). There were no deaths. Complete repair was eventually performed on all patients (n = 99) at a median age of 4.1 months (IQR, 3.4-5.4 months), with PVA preservation in 95 patients (96%). Freedom from significant pulmonary stenosis or regurgitation at 24 months postrepair was similar between the 2 groups (P = .93).

Conclusions: Patients with preoperative ToF frequently require urgent unplanned operations, especially those with lower daily minimum SpO2 and insufficient postnatal PVA growth.

Background: Coronary angiography is an invasive procedure that can lead to changes in patients' pain levels, vital signs, and comfort levels.

Objective: The objective of this study is to investigate the effect of stress ball use on immobilization comfort, pain level, and vital signs in patients after coronary angiography.

Methods: This randomized controlled study was conducted between April and July 2024 in the cardiology clinic of a training and research hospital. The intervention group (n = 35) used a stress ball, whereas the control group (n = 35) was given standard care. Data collection was conducted using the "Patient Information Form," "Visual Analog Scale," "Immobilization Comfort Scale," and "Vital Signs Monitoring Form."

Results: The immobilization comfort level of the intervention group was significantly different from that of the control group ( P  = .042; η 2  = 0.023) ( P  < .05). Similarly, the pain intensity averages during and after the procedure in the intervention group were significantly different from the control group ( P  < .001, P  < .001; η 2  = 0.464, η 2  = 0.528) ( P  < .001). Respiratory rates of the intervention group were lower than those of the control group during and after the procedure, with a significant difference and effect between the 2 groups ( P  = .031, P  = .048; η 2  = 0.216, η 2  = 0.282) ( P  < .05).

Conclusions: Using a stress ball after coronary angiography was found to be an effective method for improving immobilization comfort, reducing pain, and lowering respiratory rates.