Journal of Cardiovascular Nursing最新文献

Introduction: The prevalence of hypertension (HTN) is rising at an accelerated rate, and it remains the primary factor contributing to cardiovascular illnesses. Sex can serve as an influencing factor, leading to variations in the factors affecting HTN.

Objective: This study aimed to investigate gender and sex differences in the prevalence of HTN and explore the associations between HTN and 4 categories of risk factors: demographics, habits or lifestyle, body measurement, and laboratory blood results among non-Hispanic Asians in the United States.

Methods: This secondary analysis included non-Hispanic Asian adults aged 18 years or older from the 2017 to 2018 National Health and Nutrition Examination Surveys.

Results: Among the 815 participants, 35% of men (140 of 399) and 37% (154 of 416) of women had HTN (P = .610). The mean age for men is 46.03 ± 16.9 years, whereas the mean age for women is 49.24 ± 16.8 years. After regression analysis, advancing age, increased body mass index, and increased serum uric acid were significant predictors of HTN in both sexes. However, men developed HTN earlier compared with women. Marital status and increased fasting glucose were only significant in men. Compared with their never-married counterparts, men who were currently married or living with a partner had lower odds of having HTN (odds ratio, 0.28; P = .034).

Conclusions: There was no significant difference in the prevalence of HTN between the sexes. Age, body mass index, and serum uric acid were significant risk factors in both men and women. Meanwhile, marital status and fasting glucose were only significant in men.

Background: Adherence to antihypertension medications has been explored in previous studies; however, these studies generally focus on individuals who reside in urban areas. Improved understanding is needed regarding rural older adults who are self-managing medications for hypertension and the motivational factors that may influence adherence.

Objectives: The purpose of this study was to examine medication adherence among rural older adults with hypertension and the association with motivational factors as defined in self-determination theory, including quality of motivation (autonomous vs controlled), perceived competence, perceived autonomy support, and basic psychological needs satisfaction. Rural nursing theory was also used to explore the concept of resilience.

Methods: This cross-sectional study involved 80 older adults (≥65 years old) self-managing at least 1 prescribed medication for managing their hypertension. Participants ranged in age from 65 to 89 (mean [SD], 74.04 [6.18]) years from rural areas in the northwest. Participants completed a demographic questionnaire, a measure of medication adherence, and questionnaires to assess perceived autonomy support, basic needs satisfaction, autonomous and controlled motivation, perceived competence, and resilience.

Results: Correlational analysis and multiple regression were used to examine associations and predict adherence. Perceived autonomy support, resilience, cost of medication, and medication regimen complexity were the only variables significantly associated with medication adherence and predicted adherence. Resilience mediated the relationship between perceived autonomy support and medication adherence.

Conclusions: Overall, findings indicate high levels of adherence. Interventions that enhance perceptions of autonomy support and resilience may be useful in managing hypertension.

Background: Heart failure (HF) is a complex problem characterized by frequent hospitalizations and high 30-day readmission rates. Researchers studying HF readmission report that patients and clinicians have different perspectives on readmission and preventability when unadjusted for disease severity.

Objective: The aim of this study was to gather patient, caregiver, nurse, and physician subjective reason(s) for 30-day HF readmission and perceptions of preventability with contextual factors to evaluate differences.

Methods: A convergent, parallel, mixed-methods design was used with interviews and chart reviews to evaluate contextual factors from the current and index hospital stay. Adults readmitted within 30 days of a previous inpatient stay with a coded HF diagnosis were enrolled and interviewed, followed by interviews with associated caregivers, attending physicians, and assigned nurses.

Results: Interviews were conducted with patients (n = 44), caregivers (n = 6), physicians (n = 24), and nurses (n = 44). Readmissions were emergent/urgent (95%) and occurred within 14.9 days (SD, 8.1; 2-28 days) on average after discharge. Index stay coding revealed that most patients (73%) had a high severity of illness (73%) and risk of mortality (68%). Heart failure stage was inconsistently documented. Patients reported acute symptomatic reasons, with only 32% describing readmission as preventable. Physicians reported diagnostic reasons, 38% of which were preventable. Nurses reported behavioral reasons, with 59% being preventable. Patient/clinician agreement on readmission reason was low (30%).

Conclusions: Patient/clinician perspectives on readmission varied among the patients with complex HF. Care planning based on HF stage and other contextual factors is needed to ensure a shared understanding of disease severity and a tailored symptom management approach to prevent readmission.

Background/objectives: Chronic sleep disturbance has been consistently associated with cardiovascular disease. We sought to determine whether behavioral interventions to improve sleep have been associated with improvements in 4 common cardiovascular disease risk factors: hypertension, diabetes mellitus (DM), obesity, and smoking.

Methods: Randomized controlled trials evaluating the prospective effect of behavioral sleep interventions on ( a ) blood pressure in participants with hypertension/prehypertension, ( b ) glycemic control in participants with DM/pre-DM, ( c ) anthropometrics in participants who were overweight/obese, and ( d ) smoking status in smokers were eligible. Where feasible, we undertook random-effects meta-analyses of standardized mean differences in cardiovascular disease risk factor change.

Results: Overall, 3 trials met the inclusion criteria for blood pressure, 4 for glycemic control, 9 for overweight/obesity, and 2 for smoking. On meta-analysis, interventions with sleep as the sole behavioral target were associated with a significant reduction in hemoglobin A 1c % (-0.84; 95% confidence interval [CI], -1.34 to -0.34), but not a significant reduction in systolic blood pressure (-0.18; 95% CI, -0.55 to 0.20) versus controls. In addition, any interventions with sleep as a behavioral target were associated with significant reductions in hemoglobin A 1c % (-0.71; 95% CI, -1.01 to -0.42) and weight (-0.78; 95% CI, -1.11 to -0.45), but not systolic blood pressure (-0.72; 95% CI, -1.82 to 0.37). Trials evaluating smoking status were not amenable to meta-analysis.

Conclusion: Behavioral interventions to improve sleep were associated with improved glycemic control in patients with DM. It is also possible that these interventions improve weight in individuals who were overweight/obese. A low number of trials and small sample sizes indicate that further large, well-designed randomized controlled trials of interventions are warranted.

Background: Prescribing of recommended medications for heart failure (HF) is suboptimal, leaving patients at a high risk of death or rehospitalization post discharge. Nurse-led titration (NLT) clinics are one strategy that could potentially improve the prescription of these medications.

Objective: The aim of this article was to determine the effect of NLT clinics on all-cause mortality, all-cause or HF rehospitalizations, and adverse effects in patients with HF.

Methods: We searched MEDLINE, EMBASE, Cochrane CENTRAL, International Clinical Trials Registry Platform, and ClinicalTrials.gov to identify randomized controlled trials comparing NLT of β-blocking agents, angiotensin receptor-neprilysin inhibitors, angiotensin-converting enzyme inhibitors, and/or angiotensin receptor blockers to optimization by another health professional in patients with HF. We used the fixed-effects Mantel-Haenszel method or meta-analyses. We assessed heterogeneity between studies using χ 2 and I2 .

Results: Eight studies with 2025 participants were included. Participants in the NLT group experienced a lower rate of all-cause rehospitalizations (relative risk, 0.76, 95% confidence interval, 0.68-0.85; moderate quality of evidence) and less HF-related rehospitalizations (relative risk, 0.47; 95% confidence interval, 0.33-0.66; high quality of evidence) compared with the usual care group. All-cause mortality was lower in the NLT group (relative risk, 0.67; 95% confidence interval, 0.48-0.92; moderate quality of evidence) compared with the usual care group. Authors of one study reported no adverse events, and another study found one adverse event.

Conclusion: This meta-analysis indicates that NLT clinics may improve optimization of guideline-recommended medications with the potential to reduce rehospitalization and improve survival in a cohort of patients known for their poor outcomes.

Background: Return to work (RTW) is a critical component of rehabilitation for most young and middle-aged patients after an acute myocardial infarction (AMI). Its success is related to the quality of life and social psychological function of patients, and their social economic growth. However, healthcare professionals often do not deeply understand the patients' experience and their difficulties and coping methods during this process, which limits their ability to institute effective management and support.

Objective: In this study, we aimed to explore the lived experiences and change processes of young and middle-aged patients with AMI at the different stages of RTW.

Methods: A descriptive qualitative approach was used. Patients aged 20 to 59 years with AMI were recruited from the Department of Cardiology of 3 general hospitals. Data were collected via semistructured interviews. Data analysis was performed by conventional content analysis methods.

Results: In total, 18 participants were included. Five main themes emerged: (1) "chaos," (2) "rebuilding," (3) "conflict," (4) "coping," and (5) "benefits." Patients may be more concerned about physical recovery during the initial clinical event. They then begin to plan and adjust for an RTW. Patients in the maintenance phase need strategies to prevent, identify, and respond to conflicts and challenges to maintain long-term stable work.

Conclusion: We identified several post-AMI stages spanning from the initial illness event to the maintenance of stable work. We described their perceived barriers, coping strategies, and support needs at these various stages. These data are crucial for healthcare professionals to develop improved vocational rehabilitation strategies for patients with AMI.