Journal of Cardiovascular Nursing最新文献

Background: Pain has detrimental consequences for individuals and is frequently reported in heart failure (HF). However, there is a lack of population studies investigating pain in HF.

Objective: In this study, our aim was to investigate the prevalence and intensity of pain, including chronic musculoskeletalpain (CMSP), in individuals with HF compared with the general population, and to determine whether patients with HF had different levels of pain than people in the general population.

Methods: In this cross-sectional population study we used data from the fourth wave of the Trøndelag Health Study in Norway (2017-2019), which included 56,041 individuals, of whom 1124 had HF. The HF diagnosis was ascertained by physicians. Outcomes in this study were overall pain, overall pain intensity, CMSP, and CMSP location. Prevalence of overall pain and overall pain intensity were assessed by an item in the Medical Outcomes Study Short Form health survey (SF-36), while prevalence and location of CMSP were evaluated by one item in the Standardised Nordic Questionnaire. We investigated whether individuals with HF reported more pain than individuals without HF, adjusted for potential confounders. Finally, we compared CMSP location among individuals with or without HF.

Results: Heart failure was associated with a high prevalence of overall pain (50.5%) and CMSP (62.1%). Pain intensity (range: 0-5) was higher among individuals with HF compared with controls (2.1 vs. 1.8, P ≤ .001). Chronic musculoskeletal pain locations were similar across groups. When adjusted for age, sex, comorbidities, body mass index, level of education, living status, and smoking, the association between HF and pain was not evident.

Conclusions: In this large population study, we found a high prevalence of overall pain and CMSP, and higher pain intensity in individuals with HF. The results suggest that healthcare personnel should incorporate pain assessment and tailored pain therapy during follow-up care of individuals with HF.

Background: Atrial fibrillation (AF), often accompanied by multimorbidity, places heavy demands on informal caregivers. Although caregiver burden is recognized in other chronic conditions, little is known about burden, health-related quality of life (HRQoL), and engagement among caregivers of patients with AF across Europe.

Objectives: The aim of the study was to examine caregiver burden, HRQoL, and engagement among informal caregivers of patients with AF and multimorbidity, and to explore interrelationships between these outcomes and caregiving characteristics.

Methods: A cross-sectional online survey was conducted between May 2022 and January 2023 with 179 informal caregivers from Italy, Romania, and Spain. Validated instruments assessed burden (Bakas Caregiving Outcomes Scale), HRQoL (EQ-5D-3L), and caregiver engagement (Caregiving Health Engagement Scale). Group differences were tested using nonparametric analyses, and associations were examined through partial Spearman correlations, adjusting for sociodemographic and caregiving variables.

Results: Participants reported moderate burden and preserved HRQoL in physical domains, but frequent pain/discomfort and anxiety/depression. Engagement was generally low, with most informal caregivers in early or intermediate stages of engagement. Burden was higher among women, younger caregivers, and those in Italy and Romania, while HRQoL was poorer in older caregivers, cohabitants, and those caring for patients with a higher number of comorbidities or reduced mobility. Highly engaged caregivers reported lower burden, better overall health, and less anxiety/depression than low-engaged peers.

Conclusions: Informal caregivers of patients with AF and multimorbidity face psychological strain despite preserved physical functioning. Engagement was a protective factor associated with a lower burden and improved well-being. Fostering engagement and collaboration with professionals may ease strain and support sustainability.

Background: Cardiovascular disease is increasingly comorbid with trauma and psychological stress, yet psychocardiologic models remain limited.

Objective: The aim of this study was to evaluate the feasibility and effects of a novel, trauma-informed, retreat-based intervention on mental and cardiovascular health among adults with a history of trauma.

Methods: We conducted a within-subjects pretest-and-posttest study involving 26 participants from an underresourced community. The 3-day retreat integrated trauma recovery sessions with cardiovascular wellness strategies, including guided movement, sound therapy, and peer support. Key outcomes included cardiovascular hemodynamics (central and peripheral blood pressure, augmentation index), posttraumatic stress disorder symptom severity, quality of life, and behavioral health indicators.

Results: At baseline, mean (SD) peripheral systolic blood pressure was 140.0 (19.5) mm Hg, and the mean (SD) posttraumatic stress disorder symptom score was 39.0 (12.5), indicating moderate symptom severity. Post retreat (day 3), participants experienced a significant 34.2% reduction in augmentation index (P < .001) and a 5.9-mm Hg drop in systolic blood pressure (P = .05). At the 4-week follow-up (n = 19), augmentation index reductions were sustained, and over half reported improved quality of life. Although average posttraumatic stress disorder scores remained stable, a shift toward lower symptom categories occurred. Participants also showed modest gains in physical activity, diet, and behaviors aligned with the American Heart Association's Life's Essential 8. Participants reported reduced stress, emotional relief, and stronger social connection.

Conclusions: Findings from this study underscore that a trauma-informed, retreat-based intervention may offer a feasible, practical, and scalable approach to addressing both cardiovascular and mental health in high-risk populations.

Background: Heart failure (HF) is a global chronic condition that contributes to high hospitalization rates, mortality, and healthcare costs. Effective self-care is crucial for improving quality of life, reducing hospitalizations, and lowering costs. Although much research has examined strategies that improve physical activity adherence and interventions that reduce rehospitalization, no umbrella reviews have explicitly addressed interventions to improve self-care in chronic HF.

Objective: The aim of this study was to systematically review existing evidence on interventions to improve self-care in adults with chronic HF.

Methods: A comprehensive search for systematic reviews or meta-analyses published between 2011 and 2024 was conducted across 5 electronic databases. Two independent reviewers appraised the studies using the Joanna Briggs Institute tool. Quantitative findings were summarized by intervention type, sample size, and main outcomes, and then synthesized in tabular and narrative formats.

Results: Forty-four systematic reviews met the inclusion criteria, encompassing 135 primary studies. The overlap across reviews was minimal (3.8%). The most prevalent categories of self-care intervention were face-to-face or telehealth education (63 studies), written educational materials (31 studies), and telemonitoring via phone calls or text messages (50 studies). The quality of the reviews ranged from moderate to high quality. The most effective interventions combined educational, psychological, and telehealth components.

Conclusions: All intervention categories showed statistically significant improvements in HF self-care. Although the importance of self-care in HF management is recognized, the optimal delivery modality remains uncertain and multifaceted. Future research should focus on developing multimodal interventions based on behavioral change theories and evaluating their long-term impact.

Background: Dietary Inflammatory Index (DII) has been widely investigated for its links to cardiovascular diseases. However, gaps remain in understanding the relationship between DII and biochemical markers, dietary intake, and clinical outcomes in individuals with heart failure (HF).

Objective: Our aim was to examine the relationship between DII and biochemical markers, dietary intake, and clinical outcomes in individuals with HF after a 36-month follow-up.

Methods: We studied 124 adults and older people of both sexes diagnosed with HF receiving outpatient care. Clinical outcomes, including hospitalization and mortality, were evaluated. Dietary intake was assessed using the 24-hour recall method, and relevant dietary components were used to calculate DII scores. Binomial Logistic Regression Models analyzed associations between DII tertiles and study variables. The associations between DII and clinical outcomes were assessed using Cox Regression.

Results: We found that 74.2% of individuals had a diet classified as anti-inflammatory. A significant association was observed between DII and hematocrit (P = .036). Participants in the highest DII tertile (tertile 3) had lower intake of total fiber, beta-carotene, vitamin A, B6, C, magnesium, potassium, garlic, and onion compared with participants in tertiles 1 and 2 (all P < .05). They also had higher intake of protein, vitamin B3, and phosphorus compared with tertile 2 (all P < .05), and higher saturated fat intake compared with tertile 1 (P = .012). No significant associations were observed between DII and mortality or hospitalizations (all P > .05).

Conclusions: An anti-inflammatory diet was observed by most HF outpatients; however, DII was not associated with hospitalization and mortality.

Background: Heart failure is a common chronic illness that often leads to anxiety, depression, and poor quality of life. These psychological issues can worsen health outcomes. A nurse practitioner-led collaborative healthcare model may help address both physical and mental health needs, improving overall patient well-being.

Objective: The aim of this study was to explore the effectiveness of a nurse practitioner-led collaborative healthcare model in reducing anxiety and depression and improving quality of life in patients with heart failure.

Methods: This randomized controlled trial was conducted in the cardiology department of a regional teaching hospital in southern Taiwan. A total of 100 patients with heart failure were recruited through random sampling and randomly assigned to 2 groups. The control group (n = 50) received standard care, whereas the experimental group (n = 50) received a 12-week intervention based on the collaborative healthcare model.

Results: Patients in the experimental group who received a 12-week nurse practitioner-led collaborative healthcare model intervention demonstrated significant reductions in anxiety and depressive symptoms, as well as notable improvements in quality of life. Compared with the control group, the experimental group exhibited a sustained trend of improvement at weeks 12, 16, and 20.

Conclusions: The nurse practitioner-led collaborative healthcare model effectively alleviates anxiety and depression in patients with heart failure while significantly improving quality of life. This multidisciplinary collaborative approach reduces disease burden, enhances physical and mental health, and demonstrates substantial clinical applicability. It is recommended to promote this model in clinical practice to optimize care outcomes.

Background: Mobility after cardiac surgery is facilitated using phase 1 cardiac rehabilitation. However, rehabilitation services may be limited, minimizing the full benefits of hospital-based early mobility.

Objective: To examine patient, surgical, and postoperative factors and clinical outcomes associated with maximal postoperative daily mobility.

Methods: A multisite, prospective, correlational design was used. Post intensive care unit stay, daily mobility was collected, patients completed psychological status surveys, and medical record data were retrieved. Maximum daily mobility level scores were recategorized into 4 groups; higher levels and groups represented greater mobility. Relationships between mobility category scores and patient factors were described using Spearman correlations (95% confidence intervals).

Results: Participants (N = 650) had a median (25th-75th percentile) of 4.0 (3.0-5.0) non-intensive care days of mobility data. Of patients, 62 (9.5%) had very low mobility (<20 ft/day) and 419 (64.5%) achieved the highest mobility (>200 ft/day). Higher maximum daily mobility was associated with younger age, commercial insurance, lower body mass index, no history of myocardial infarction, heart failure, cerebrovascular disease or diabetes, higher hemoglobin/hematocrit, lower serum creatinine, and lower rates of prolonged ventilation (all P < .05). Higher maximum daily mobility was associated with higher perceived general health (P = .003), shorter hospital length of stay (P = .009), and higher likelihood of discharge to home (P < .001). Day 4 mobility level was associated with lower 30-day rehospitalization, P = .014.

Conclusion: Maximal daily mobility after cardiac surgery varied by multiple factors-many that were not directly focused on the ability to ambulate. Attention to achieving higher post-intensive care unit daily mobility levels is warranted.

Background: Heart failure often leads to changes in body composition; however, conventional assessment methods struggle to differentiate body components. Bioelectrical impedance vector analysis (BIVA) offers a straightforward measurement, efficient in distinguishing fluid retention from lean mass loss.

Objective: We aimed to assess body composition and bioelectrical parameters, including BIVA, among individuals with heart failure categorized by New York Heart Association (NYHA) functional classification, and to analyze sex-related differences in BIVA's detection capacity.

Methods: This cross-sectional study included individuals with heart failure categorized according to NYHA functional class. We collected clinical data, anthropometry, bioelectrical impedance, incorporating BIVA. Statistical analysis included tests for normality and variance homogeneity, group comparisons using analysis of variance or Kruskal-Wallis with appropriate post hoc tests, Fisher's exact test for categorical data, and Hotelling'sT² test for vector analysis. Significance was set at P < .05.

Results: Participants with NYHA III/IV had significantly lower values in phase angle (P = .002) compared with the other groups. BIVA identified statistically significant vector differences between NYHA II and NYHA I groups (P = .002). Comparison between NYHA I and NYHA II versus NYHA III/IV group (P < .001 and P = .015, respectively) revealed greater fluid overload in those with more advanced classification. Males in all groups exhibited more pronounced fluid abnormalities, whereas females-especially those in the NYHA III/IV-exhibited with anasarca or obesity, and either reduced body cell mass or hyperhydration.

Conclusion: BIVA effectively identified body composition variations across NYHA functional classes and between sexes. These findings emphasize the need for a multidisciplinary approach to personalized nutritional management for heart failure.

Background: Sleep disturbances are common after cardiac surgery. Although nonpharmacological interventions such as cognitive behavioral therapy (CBT), relaxation, and sleep hygiene practices have shown effectiveness for improving sleep, their relative impact remains unclear.

Objective: We applied network meta-analysis (NMA) to compare multiple nonpharmacological interventions and identify the most effective approach for improving sleep quality in patients after cardiac surgery.

Methods: Following PRISMA-NMA guidelines, comprehensive searches across 6 databases were conducted in February 2025. Randomized controlled trials examining nonpharmacological interventions to improve sleep quality in postsurgical cardiac patients were included. All trials used the Pittsburgh Sleep Quality Index as the outcome measure. We performed NMA using STATA to determine the most effective intervention.

Results: Nineteen studies involving 1944 participants were examined. Interventions included education, relaxation, CBT, family-centered care, resistance exercise, aromatherapy, use of eye masks and earplugs, and combined therapies. Nonpharmacological interventions significantly improved sleep quality after cardiac surgery (standardized mean difference, 1.02; 95% confidence interval, -1.50 to -0.54). Among the interventions, CBT emerged as the most effective (surface under the cumulative ranking curve = 88.5%).

Conclusions: Our findings highlight the clinical value of CBT for postsurgical sleep management and support development of standardized guidelines for its implementation. Future research should explore a broader range of nonpharmacological interventions, assess their effectiveness across different types of cardiac surgeries, and investigate alternative CBT models such as online or shortened versions tailored to this population. Integrating CBT into routine postoperative care could enhance patient sleep, recovery, and well-being after cardiac surgery.