Journal of Cardiovascular Nursing最新文献

Background: 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: 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.

Background: Previous investigators have shown that low levels of ML were associated with poor medication adherence, but few have explored this relationship in young patients with hypertension.

Objective: In this study, our objective was to analyze the current state of ML in young Chinese patients with hypertension and determine its relationship with medication adherence.

Methods: This was a prospective observational study using data from young patients with hypertension in Jiangsu Province, China. Sociodemographic data, ML, and medication adherence of participants were obtained. We used logistic regression and mediation effect analysis to explore the relationship between relevant dimensions of ML and medication adherence.

Results: A total of 171 participants were enrolled, aged 18 to 45 years, who had a median total ML score of 37.0 (score range: 20-51) and median scores of each subdimension of 10.0 for medication knowledge, 9.0 for medication attitude, 6.0 for medication skill, and 13.0 for medication behavior. After a 3-month follow-up, 46.8% of the participants still demonstrated poor medication adherence, with scores below 6 points. Medication attitude (odds ratio [OR], 1.196; 95% confidence interval, 1.041-1.373) and medication behavior (OR, 1.279; 95% confidence interval, 1.069-1.531) were associated with improved medication adherence. Medication behavior partially mediated the relationship between medication attitude and medication adherence with a mediating effect value of 10.9%.

Conclusions: Young patients with hypertension have poor ML and medication adherence. Medication literacy scores for medication attitude and medication behavior contributed to medication adherence, whereas medication behavior mediated the relationship between medication attitude and medication adherence. More detailed education on medication needs to be implemented to enhance ML.

Background: Comparatively less research has been done on caregiving for persons with cardiovascular disease (CVD) than in other chronic conditions, leaving gaps in guidance for clinical care and interventions.

Objective: We aimed to describe the care needs of older adults with CVD in the United States and identify determinants of stress and mental health in their care partners.

Methods: This was a cross-sectional analysis using the National Health and Aging Trends Study (n = 1011 persons with CVD) and the National Study of Caregiving (n = 510 CVD care partners). We compared differences in health and care needs of persons with and without CVD and described care partners' caregiving activities. Using multivariate regression, we examined determinants of care partner stress and anxiety/depression.

Results: Persons with CVD had higher comorbid burden, worse health, and more care needs than those without CVD. Most care partners helped with activities of daily living in addition to disease-related care. Worse stress was associated with worse care partner health ( β  = 0.357; 95% confidence interval [CI], 0.192-0.522), more care activities ( β  = 0.388; CI, 0.070-0.705), greater care coordination ( β  = 0.367; CI, 0.012-0.722), more medical/nursing tasks ( β  = 0.489; CI, 0.145-0.834), and poorer relationship quality with the care recipient ( β  = -0.269; CI, -0.365 to -0.173). Care partners were more likely to have anxiety/depression if their care recipient had poorer mental health (odds ratio [OR], 1.137; CI, 1.017-1.270), whereas better relationship quality and higher educational attainment appeared protective (OR, 0.837 [CI, 0.719-0.975], and OR, 0.170 [CI, 0.076-0.380], respectively).

Conclusions: Our findings suggest a need for broader examination of caregiving burden in CVD, well beyond CVD-specific aspects.

Background: Fatigue makes daily tasks difficult for patients with heart failure (HF); however, its impact on self-care has not been reported. In addition, self-efficacy, self-care confidence, and perceived control are psychological determinants of self-care in patients with HF. The mechanisms by which these cognitive aspects influence self-care have not been fully investigated.

Aim: The aim in this study was to determine whether perceived control mediates the relationship between fatigue and self-care in patients with HF.

Methods: We conducted a secondary analysis (n = 165) of a cross-sectional, observational study in which patients were enrolled between February and August 2018 in Japan. We used the Brief Fatigue Inventory to measure fatigue; the Self-care of Heart Failure Index for self-care maintenance, management, and confidence; and the Control Attitude Scale Revised for perceived control. The PROCESS macro was used to assess mediation.

Results: Fatigue had no direct effect on self-care maintenance, management, or confidence (effect coefficient [ c ] = 0.410; 95% confidence interval [CI], -1.039 to 1.858, c  = 1.594; 95% CI, -0.412 to 3.601, c  = 0.478; 95% CI, -1.041 to 1.997). There was, however, an indirect pathway between fatigue and self-care maintenance, management, and confidence through perceived control ( a * b  = -0.395; 95% CI, -0.936 to -0.040, a * b  = -0.749; 95% CI, -1.574 to -0.090, a * b  = -1.064; 95% CI, -2.086 to -0.181).

Conclusions: Perceived control mediates the association between fatigue and self-care, improving perceived control as a key component to reduce the impact of fatigue on self-care.

Background: Accurate assessment of caregivers' roles in self-care for heart failure (HF) is essential for effectively managing the condition. This evaluation helps identify areas needing additional support, allowing healthcare providers to create tailored and effective patient care strategies.

Objective: The objective of this study is to test the validity and reliability of the Arabic version of The Caregiver Contribution to Self-Care of Heart Failure Index Version 2 (CC-SCHFI v2) among the caregivers of patients with HF in Jordan.

Methods: A cross-sectional design was used to test the validity and reliability of the Arabic version of CC-SCHFI v2. A translation process and psychometric evaluation were performed. Three hundred caregivers and 300 patients with HF were statistically analyzed.

Results: Caregivers had a mean age of 42 years (females were dominant), whereas patients had a mean age of 66 years. Statistical analysis showed significant results: content validity showed high content validity index (0.92), construct validity showed that Bartlett test ( P  < .001) confirmed factorability, and the Kaiser-Meyer-Olkin index was 0.74. Confirmatory factor analysis indicated a good fit (χ 2  = 150.23, df  = 90, P  < .001; comparative fit index = 0.95, TLI = 0.94, root mean square error of approximation = 0.045), revealing a 3-factor solution that accounted for 75% of the total variance, 50% for self-care maintenance, 15% for symptom perception, and 10% for self-care management. Concurrent validity showed a strong correlation ( r  = 0.68, P  < .001) between the CC-SCHFI v2 and SCHFI scales. Reliability was good internal consistency, with Cronbach α between 0.78 and 0.84, and the test-retest showed intraclass correlation coefficients from 0.85 to 0.90.

Conclusion: This study provides valuable evidence supporting the reliability and validity of the Arabic version of the CC-SCHFI v2 among the caregivers of patients with HF in Jordan.

Background: Several audiovisual feedback (AVF) devices have been developed to monitor chest compression quality during cardiopulmonary resuscitation (CPR). However, most marketed stand-alone AVF devices are inflexible and rigid, causing discomfort and sometimes pain to the rescuers' hands.

Objective: The objective of this study was to evaluate the effectiveness and usability of a newly developed soft and flexible resuscitation glove designed to improve the quality of chest compressions during CPR.

Methods: We conducted a manikin-based randomized crossover study to compare the effectiveness of a newly developed AVF device (ResuGlove CPR Group) and standard CPR (Standard CPR Group) in improving the quality of chest compressions in simulated cardiac arrest cases. The usability of the newly developed ResuGlove was assessed using a System Usability Scale questionnaire.

Results: There were no significant differences in compression depth (mean, 53.69 vs 53.28; P  = .70) and compression rate (mean, 111.48 vs 113.38; P  = .23) between the ResuGlove CPR and Standard CPR groups. However, the group using ResuGlove had a higher percentage of complete chest releases between compressions ( P  = .008). Furthermore, the ResuGlove CPR Group had a significantly higher percentage of participants who performed chest compressions with adequate compression depth (82.8% vs 41.4%, P  = .001) and compression rate (96.6% vs 72.4%, P  = .012) compared with the Standard CPR Group. The ResuGlove usability score was calculated to be 70.4.

Conclusions: The newly developed ResuGlove significantly improved the quality of certain chest compression parameters, and the device's usability score was within the acceptable range.

Background: Identifying the initial factors predicting heart failure (HF) progression in patients with myocardial infarction (MI), a major cause of HF, is essential.

Objectives: We aimed to examine predictors of rehospitalization due to HF in patients with first-time MI from the Korea Acute Myocardial Infarction Registry-National Institutes of Health (KAMIR-NIH) prospective cohort between 2011 and 2015.

Methods: A secondary data analysis was conducted on a population of 8888 patients who completed 3 years of follow-up and had no history of MI, HF, or death. The HF group was defined as patients rehospitalized with an HF diagnosis due to worsening symptoms. A 1:4 propensity score matching analysis was performed on 11 baseline characteristics, and the clinical conditions and complications of the HF group (n = 252) were compared with the non-HF group (n = 991). Statistical analyses were performed using SAS version 9.4 and R version 4.2.3.

Results: A Cox proportional hazards model showed that the factors predicting rehospitalization due to HF were dyspnea (HR, 1.54; 95% CI, 1.16-2.04; P = .003), left ventricular ejection fraction <50% (HR, 2.71; 95% CI, 2.06-3.58; P < .001), and new-onset HF confirmed during hospitalization (HR, 1.77; 95% CI, 1.18-2.66; P = .006). Atypical chest pain (no chest pain) was significant only in univariate analysis.

Conclusions: This study highlights the importance of carefully monitoring symptoms and conditions during outpatient follow-up in post-MI patients, regardless of age, sex, or medical history. In particular, those who present with dyspnea at admission or develop new-onset HF during hospitalization should be considered high-risk for HF rehospitalization.

Background: Self-efficacy is a key determinant of adoption and maintainance of heart-healthy behaviors. Practicing multiple heart-healthy behaviors together significantly reduces cardiovascular disease risk. However, no validated tool currently exists to assess self-efficacy related to the integrated practice of these behaviors for cardiovascular disease prevention.

Objective: The aim of this study was to develop the Self-Efficacy for Heart-Healthy Lifestyle Behaviors (SE-HeartLife) scale and test its psychometric properties among community-dwelling adults without a history of cardiovascular disease.

Methods: A total of 1188 adults in South Korea were recruited. Scale development followed 3 phases: (1) conceptualization and item generation, (2) evaluation of content and face validity, and (3) refinement and psychometric testing. The sample was randomly split into subsample 1 (n = 594) for exploratory factor analysis (EFA) and subsample 2 (n = 594) for confirmatory factor analysis (CFA).

Results: The SE-HeartLife was conceptualized as an individual's perceived confidence in adopting and maintaining heart-healthy lifestyle behaviors in daily life. Of the initial 60 items derived from a comprehensive literature review, 52 were retained following evaluations of content and face validity. The EFA identified 5 underlying factors: SE-Physical-Activity, SE-Unhealthy-Eating-Control, SE-Healthy-Eating, SE-Substance-Use-Control, and SE-Heart-Health-Management. The CFA supported the 5-factor structure, yielding a final 35-item model with acceptable model fit (CMIN/DF = 2.99, standardized root mean squared residual = 0.05, root mean squared error of approximation = 0.06, comparative fit index = 0.93). The scale showed good concurrent and convergent validity, internal consistency, and test-retest reliability.

Conclusions: The 35-item SE-HeartLife scale is a psychometrically robust instrument for assessing self-efficacy in the integrated practice of multiple heart-healthy behaviors aimed at preventing cardiovascular disease.