Journal of Cardiovascular Nursing最新文献

Background: Atrial fibrillation (AF) is associated with cognitive decline. Use of oral anticoagulant (OAC) medications offers a lower risk of dementia, but it is unclear whether differences exist between types of OAC agents.

Objective: This was a secondary analysis to explore whether the progression from normal cognition to mild cognitive impairment to dementia differs between adults with AF on warfarin versus non-vitamin K inhibitor medications (NOACs) using data extracted from the National Alzheimer's Coordinating Center clinical case series.

Methods: Subjects with AF on OACs, having normal cognition and no stroke at baseline, and at least 1 follow-up visit were included. OAC usage was calculated based on follow-up time and reported previous OAC use. Continuation ratio models (with subject-specific random intercepts) were used to examine the association between OAC type and cognitive diagnosis controlling for cognitive diagnosis from previous visit.

Results: Among 1475 eligible participants, 478 reported taking warfarin (n = 396) or NOACs (n = 82) at baseline (mean age of 79 years, 51% females, 84% non-Hispanic White). The median follow-up time was 4 years (interquartile range, 2-7). About 63% continued using either warfarin or NOACs, 44% switched from warfarin to NOACs, and 2% switched from NOACs to warfarin. After adjusting for age, sex, education, race, and cardiovascular clinical comorbidities, no significant association was found between OAC type and cognitive decline ( P = .14).

Conclusions: We found similar risks of cognitive decline between those on NOACs or warfarin. Future studies should consider effects of age, length of time from AF diagnosis, and OAC adherence on this risk.

Background: Research has shown that younger patients who have had a myocardial infarction (MI) experience more emotional distress than their older counterparts.

Objective: In this study, we aimed to compare emotional distress 2 months post-MI (follow-up 1) between younger (<55) vs older (≥55) patients in Sweden, and investigate its impact on working status and 4 secondary preventive goals 1 year after MI (follow-up 2).

Methods: Data (N = 50 213) from the SWEDEHEART National Quality Registers for Cardiac Care, which covers approximately 90% of all MIs in Sweden, were used.

Results: After adjusting for confounders, logistic regression analyses showed that younger patients who had experienced an MI had higher odds of experiencing emotional distress than older patients at follow-up 1 (adjusted odds ratio [AOR], 1.59; 95% confidence interval [CI], 1.52-1.67) and follow-up 2 (AOR, 1.47; 95% CI, 1.40-1.55). Emotional distress at follow-up 1 was associated with lower odds of working (AOR, 0.60; 95% CI, 0.53-0.67) and achieving smoking and physical activity goals (AOR, 0.76; 95% CI, 0.67-0.86; AOR, 0.83; 95% CI, 0.76-0.91) at follow-up 2. However, emotional distress was not associated with achieving goals for low-density lipoproteins or systolic blood pressure at follow-up 2.

Conclusions: Younger patients experienced emotional distress more often after a first-time MI than their older counterparts, and their distress predicted long-term lower levels of returning to work and achievement of smoking and physical activity goals. The results highlight the importance of identifying younger patients who have had an MI and are experiencing emotional distress, and offering them interventions targeting distress.

Background: Multidrug, guideline-directed medical therapy (GDMT) improves mortality and hospitalizations for heart failure (HF), but little is known about how optimization of multidrug GDMT influences patient-reported outcomes. Trials of single GDMT medications demonstrate improvements in patient-reported outcomes; however, the effect of the multidrug GDMT regimen on patient-reported outcomes is unclear.

Objective: The objective of this study is to determine how multidrug optimization during a multidisciplinary, advanced practice provider HF clinic impacted patient-reported symptoms and quality of life in adults with HF.

Methods: This retrospective cohort study examined patient-reported outcomes at baseline and 12 weeks during a multidrug GDMT optimization clinic for HF. Outcomes were compared across time and male and female sex. Quality of life was measured with the EQ5D. Symptoms were measured using the PROMIS-29 and PROMIS-Dyspnea Severity score. Descriptive statistics describe sample characteristics. Paired and independent t tests were used for comparisons.

Results: Of 301 adults with HF enrolled in a clinic, 101 completed patient-reported outcome measures at baseline and 12 weeks. Patients (predominantly White/Caucasian males; mean age, 59 years) reported significant improvement in the EQ5D domains of mobility and performance of usual activities, and PROMIS-29 subscales for physical function, fatigue, and ability to participate in social roles. Sex differences were noted for pain and depression, with females reporting improved pain and males reporting slightly less depression.

Conclusions: Multidisciplinary, advanced practice provider-led optimization clinics can promote optimization of multidrug GDMT that can improve patient-reported outcomes in adults with HF. Future studies are needed to comprehensively examine sex differences in patient-reported response to GDMT and patient-reported response to updated, "quadruple-therapy" GDMT recommendations.

Background: Poor self-management in adults with type 1 diabetes (T1DM) or type 2 diabetes (T2DM) leads to increased diabetes complications. Factors associated with self-management in T1DM and T2DM may differ due to the different methods for controlling blood glucose.

Purpose: The aim of this study was to examine the associations of modifiable physical, cognitive, and psychosocial factors and the nonmodifiable factor of age with overall self-management, diet, exercise, blood glucose testing (BGT), foot care, and smoking in adults with T1DM or T2DM.

Methods: In this cross-sectional, correlational study, data were collected from adults with T1DM (n = 64; mean age, 51.2 years) or T2DM (n = 84; mean age, 62.5 years) using REDCap in 2023 and were analyzed using multiple regression analyses.

Results: Older age, lower body mass index, and stronger knowledge in T1DM (F10,53 = 2.290, P = .026, R2 = 0.302), and lower body mass index and higher levels of self-efficacy in T2DM were associated with better overall self-management (F10,73 = 3.219, P = .002, R2 = 0.306). Different combinations of age, body mass index, knowledge, resilience, and self-esteem were associated with different components of self-management, including diet, BGT, and foot care, in T1DM, whereas different combinations of body mass index, knowledge, self-efficacy, and depressive symptoms were associated with different components of self-management, including diet, exercise, and BGT, in T2DM.

Conclusions: Factors associated with self-management differed based on types of diabetes and components of self-management. Clinicians need to consider the 2 types of diabetes and distinct factors associated with each component of self-management to improve it.

Abstract: During the past 3 decades, life course socio-ecological frameworks have received considerable attention from clinical and public health professionals; developmental, social, and behavioral scientists; and scholars. Substantial evidence underscores the importance of a life course approach to prevention of cardiovascular (CV) disease and the promotion of optimal CV health. This article provides an overview of evidence on early origins and progression of CV disease (CVD) processes across the life course of individuals from diverse populations. Emphasis is placed on the evidence-based guidelines designed to prevent CVD and promote CV health with recommendations for implementation by CV health professionals and directions for future research in global CVD prevention.

Background: Methamphetamine-associated heart failure (MethHF) carries devastating individual and societal consequences; however, our understanding of this condition is limited.

Objective: The objective of this study is to compare the sociodemographic and clinical characteristics of patients hospitalized with MethHF with patients hospitalized with heart failure (HF) not associated with methamphetamine (non-MethHF).

Methods: This was an analysis of screening data from MethHF patients who screened out of the Biological and Physiological Mechanisms of Symptom Clusters in Heart Failure study and a subset of non-MethHF patients enrolled in the study. Descriptive and comparative statistics were used.

Results: Patients hospitalized with MethHF (n = 99), compared with non-MethHF (n = 87), were significantly younger, more often male, more likely from urban areas, and had higher rates of prior emergency room usage. Patients with MethHF also had more nonischemic etiologies and reduced ejection fraction. Nearly a third of patients with MethHF also had a new diagnosis of HF.

Conclusions: There are a few notable differences in sociodemographic and clinical characteristics between patients hospitalized with MethHF versus non-MethHF.

Background: Several risk prediction models are used in intensive care units (ICUs) to detect delirium risk.

Objective: The aim of this study was to compare the sex-specific validity of the Prediction of Delirium in ICU patients (PRE-DELIRIC) and Early Prediction of Delirium in ICU patients (E-PRE-DELIRIC) models for predicting delirium in ICU patients after cardiac surgery.

Methods: Retrospective data from electronic medical records of ICU patients who underwent cardiac surgery between January 2019 and December 2022 were examined. Both models were evaluated using sensitivity, specificity, and positive and negative predictive values based on the highest Youden index for female and male patients. Receiver operating characteristic curve analysis was performed.

Results: Delirium incidence was 30.7% and 27.5% in female and male patients, respectively. In the PRE-DELIRIC model, the highest Youden index scores for female and male patients were 67.00 and 57.54, respectively, with sensitivities and specificities of 61% and 88%, and 72% and 79%, respectively. In the E-PRE-DELIRIC model, the highest scores for female and male patients were 14.25 and 14.05, with sensitivities and specificities of 78% and 50%, and 70% and 53%, respectively. The area under the curve of the PRE-DELIRIC model for female and male patients was 0.77 and 0.78, respectively, and that of the E-PRE-DELIRIC model was 0.67 and 0.63, respectively.

Conclusions: The PRE-DELIRIC model showed higher specificity and was more reliable for male patients, whereas the E-PRE-DELIRIC model demonstrated better sensitivity for female patients due to its inclusion of more female-sensitive factors. A combined approach is recommended for improved reliability and validity in delirium risk assessment in clinical settings.

Background: Existing literature indicates that benefit finding and social support play protective roles against depressive symptoms. However, there is a lack of understanding regarding the interplay between benefit finding, social support, and depressive symptoms within the dyadic context of stroke survivor-spousal caregiver relationships.

Objective: The objective of this study is to investigate the relationships among benefit finding, social support, and depressive symptoms in young and middle-aged stroke survivors and their spouse caregivers. In addition, the mediating role of social support in the association between benefit finding and depressive symptoms is explored.

Methods: A total of 203 pairs of stroke survivor-spouse caregiver were included in the study. Depressive symptoms, social support, and benefit finding were measured using the Patient Health Questionnaire-9, the Perceived Social Support Scale, the Benefit Finding Scale, and the Caregiver Benefit Finding Scale. The Actor-Partner Interdependence Mediation Model was used to assess direct and indirect effect.

Results: The findings revealed a significant negative association between higher levels of benefit finding and lower depressive symptoms in both stroke survivors (actor effect, -0.126) and spousal caregivers (partner effect, -0.044). Perceived social support emerged as a significant mediator in the relationship between benefit finding and depressive symptoms in spousal caregivers (indirect effect, -0.024). Furthermore, spousal caregivers' perceived social support served as a mediating variable between caregiver benefit finding and depressive symptoms in stroke survivors (indirect effect, -0.023).

Conclusion: The study underscores the interdependence between stroke survivors and spousal caregivers, highlighting the mutual influence they have on each other. Consequently, targeted interventions addressing both members of the dyad, with a focus on enhancing benefit finding and social support, could prove beneficial in ameliorating depressive symptoms in stroke survivor-spousal caregiver.

Background: Although cardiovascular disease is the leading cause of death among US adults of color, there is a limited understanding of cardiovascular health status, including health behaviors (sleep health, diet, physical activity, and nicotine exposure) and health factors (body mass index, blood lipids, blood glucose, and blood pressure).

Purpose/methods: The objective of this systematic review was to synthesize original research on racial and ethnic disparities in CVH among US adults aged 18 to 50 years using Life's Simple 7 and Life's Essential 8 metrics. Multiple electronic databases (PubMed, PsycINFO, and CINAHL) were searched for relevant original studies published in English until March 28, 2023.

Results: Fifteen original descriptive studies were selected (N = 364 426, mean age = 39.2 ± 8.4 years, 64.6% female, 65.4% non-Hispanic White [NHW], 10.7% non-Hispanic Black [NHB], 11.7% Hispanic, 6.2% multiracial 0.6% non-Hispanic Asian, and <1% American). There were race-, sex-, and age-based differences in CVH scores. People of color had lower CVH scores when compared with NHW, and NHB had the lowest CVH of all racial groups. Males had lower CVH and higher rates of low CVH across most racial groups. However, NHB women had lower CVH scores than NHB men on average compared with these other groups.

Conclusions/clinical implications: The findings of this review contribute to understanding CVH disparities among US adults of color. Ideal CVH is associated with a lower cardiovascular disease risk; therefore, further research is needed to estimate CVH among a racially and ethnically representative sample of US adults.

Background: Adequate energy intake is essential for good clinical outcomes. The association between energy intake and readmission burden of patients with heart failure (HF) still needs to be clarified.

Objective: In this study, our aim was to determine the association between energy intake and readmission in patients with HF.

Methods: A total of 311 inpatients with HF were recruited. Demographic and clinical information were collected during hospitalization; the daily diets of the participants were collected in the second week after discharge using the 3-day diet record, and the energy intake was calculated using a standardized nutrition calculator. The inadequate energy intake was defined as <70% × 25 kcal/kg of ideal body weight. The participants were followed up for 12 weeks after discharge. The number, reasons, and length of stay of unplanned readmissions were collected. Regression analyses were used to evaluate the associations between inadequate energy intake, and readmission rate and readmission days.

Results: The median of the energy intake of participants was 1032 (interquartile range, 809-1266) kcal/d. The prevalence of inadequate energy intake was 40%. Patients with inadequate energy intake had a higher risk of unplanned readmission (odds ratio, 5.616; 95% confidence interval, 3.015-10.462; P < .001) and more readmission days (incidence rate ratio, 5.226; 95% confidence interval, 3.829-7.134, P < .001) after adjusting for potential confounders.

Conclusions: Patients with HF had a high incidence of inadequate dietary energy intake, and it increases the burden of readmission.