Journal of Cardiovascular Nursing最新文献

Background: Thirst is among the most unpleasant symptoms in patients with heart failure (HF). Intense thirst can lead to uncontrolled fluid intake, resulting in congestion and frequent readmissions. Many predictors of thirst were identified, but little research addressed its association with salt intake.

Objective: The aims were to describe the prevalence and characteristics of thirst in patients with HF, examine its association with salt intake, and identify its predictors.

Methods: Using a descriptive correlational design, 100 patients with New York Heart Association classes I, II, and III HF were interviewed about thirst, salt-related behaviors, and the Patient Health Questionnaire-2. Demographic and clinical information were extracted from medical records. Descriptive statistics as well as bivariate and multivariable regression analyses were used.

Results: Most participants were male and married, with university education and a mean age of 66.7 ± 13.2 years. The mean thirst intensity score was 3.81 ± 2.17 (out of 10), and its prevalence was 93%. The mean thirst distress score was 23.58 ± 7.66 (out of 40); 68% reported moderate or strong distress. Patients prescribed salt restriction had lower thirst intensity (3.60 vs 5.70, P = .003) than their counterparts and thirst distress (22.78 vs 27.50, P = .062) that approached significance. Salt restriction; use of statins, antidepressants, and any renin angiotensin aldosterone system (RAAS) blocker; and Patient Health Questionnaire-2 score predicted thirst intensity. Female sex as well as use of any RAAS blocker and antidepressants predicted thirst distress.

Conclusions: Thirst was prevalent, distressing, and predicted by salt restriction, use of any RAAS blocker, and depression. Assessing thirst and relieving it are recommended.

Background: Hopelessness is present in up 52% of patients with ischemic heart disease (IHD) and is associated with increased morbidity and mortality. Lower perceived social support (PSS) has been associated with greater hopelessness in a pilot study of patients with IHD reporting moderate-severe hopelessness but has not been examined in a larger sample reporting none-severe levels of hopelessness and while controlling for covariates.

Objective: The aim of this study was to determine the relationship between PSS and hopelessness in patients with IHD.

Methods: Using a cross-sectional design, 178 participants were enrolled while hospitalized for an IHD event at 1 large hospital in the United States. Data collection occurred 2 weeks after hospital discharge using the State-Trait Hopelessness Scale, ENRICHD Social Support Inventory, Patient Health Questionnaire-9, a demographic form, and a medical record abstraction form. Linear models were used to assess the association between variables in unadjusted models and models adjusted for demographic and medical history.

Results: Most participants were male (67%), married (67%), and non-Hispanic White (92%) and underwent coronary artery bypass surgery (61%). There was a moderate inverse correlation between PSS and state ( r = -0.31, P < .001) and trait ( r = -0.28, P < .001) hopelessness in unadjusted models. The relationships remained significant in adjusted models and did not differ by sex, type of IHD event, or marital status.

Conclusions: Lower PSS was associated with greater hopelessness in patients with IHD. Assessing PSS and hopelessness during hospitalization for an IHD event may enable clinicians to provide targeted interventions to reduce risk of hopelessness and improve secondary prevention in patients with IHD.

Background: The positive effects of cardiac rehabilitation (CR) are well established; however, among older and vulnerable patients, nonattendance and dropout are prevalent problems.

Aim: The objective of this study is to explore if a 24-week peer-mentor intervention increases initial and long-term CR attendance. Secondary aims are whether peer-mentor intervention improves lifestyle (diet and physical activity) and psychological outcomes (self-efficacy, anxiety, depression, and quality of life) among older vulnerable patients with ischemic heart disease.

Methods: The study was designed as a 2-arm, single-center, parallel, 24-week, randomized controlled trial (RCT) with follow-up at 12 and 24 weeks. Patients were randomized at a ratio of 1:1 to receive either the peer-mentor intervention (in addition to standard CR) or standard CR along (control arm).

Results: Between August 2021 and March 2023, 117 older, vulnerable patients were enrolled and randomized (59 randomized to peer-mentor intervention and 58 to usual care). The peer-mentor intervention significantly increased CR attendance. This applies to both initial participation in 1 CR session of physical training or dietary advice (78.0% vs 58.6%; P = .03), and long-term attendance in ≥50% dietary advice sessions (50.8% vs 27.6%; P = .01) and completed ≥50% (64.4% vs 41.4% P = .01) or ≥75% of the physical training sessions (59.3% vs 37.9%; P = .02). The study found no statistically significant effect on secondary outcomes.

Conclusions: Low CR attendance is a well-known problem, especially among older, vulnerable patients; however, we tested a low-cost, peer-mentor intervention that significantly increased both initial CR participation and long-term attendance in CR sessions in this group of patients.

Background: Multiple behavior change interventions have gained traction in the behavioral health space. Yet, previous studies on health coaching (HC) focused on testing its effect on stages of change for individual health behaviors.

Objective: The purpose of this study was to examine the effects of HC on stages of change across multiple health behavior domains among patients at high risk of coronary heart disease and type 2 diabetes.

Methods: This secondary analysis of a randomized clinical trial included 200 primary care patients (mean age of 47.7 years, 49.0% women, 60.5% Whites) who completed transtheoretical model-based questionnaires related to weight reduction, exercise, healthier eating, and stress management. Multigroup latent transition analysis was used to compare the stage of change distributions and transitions over time between HC and controls at baseline, midpoint of the intervention (3 months), and postintervention (6 months).

Results: Three distinct categories of behavior change were identified ("Contemplation," "Preparation to Action," and "Action"), and membership in these categories changed over time as a function of intervention exposure. Both groups exhibited positive transitions through stages of change from baseline to 3 months. Pronounced intervention effects emerged from 3 to 6 months, revealing larger differences in transition probabilities between the groups. In particular, HC increased patients' likelihood of transitioning from "Contemplation" to both "Preparation for Action" and "Action," as well as from "Preparation for Action" to "Action." The control group remained stagnant during the same period.

Conclusions: Although HC produces changes across multiple behavioral domains, it was most effective for patients who were reluctant or ambivalent about changing their behaviors.

Background: Patients with heart failure (HF) are typically classified based on left ventricular ejection fraction (LVEF). However, this may not optimally reflect distinct groups or predict risk. Therefore, alternative classification methods are needed.

Objective: Our aim was to classify patients with HF based on sociodemographic and clinical data using latent class analysis, assess if latent classes pose varying risks of mortality and rehospitalization, and explore if these classes offer better risk stratification than LVEF or N-terminal prohormone of brain natriuretic peptide (NT-proBNP) alone.

Methods: Data from 1045 patients were analyzed using latent class analysis to identify classes and assess mortality and rehospitalization risks. Kaplan-Meier curves with log-rank tests were used to compare mortality across latent classes, LVEF-based groups, and NT-proBNP-based groups.

Results: Three latent classes were identified. Class 1 (48.8%) comprised middle-aged males with HF with reduced ejection fraction (HFrEF) and high NT-proBNP levels. Class 2 (26.1%) consisted of mainly older females with HF with preserved ejection fraction, high body mass index, hypertension, atrial fibrillation, and anemia. Class 3 (25.2%) included younger patients with HFrEF, high body mass index, and a high smoking rate. Class 1 and 2 had higher mortality risks ( P < .001) and longer rehospitalization durations ( P = .011) than class 3.

Conclusion: Latent class analysis categorized a heterogeneous group of patients with HF into homogeneous classes. These classes provide a close approximation of what could be observed in clinical practice and provide insight into patients at higher risk of mortality and rehospitalization.

Background: Frailty is common in adults with end-stage heart failure receiving a left ventricular assist device (LVAD). Short-term studies show frailty reversal post-LVAD. Little is known about long-term frailty and how frailty relates to key LVAD outcomes, including depression, quality of life (QoL), and cognition beyond 6 months.

Objective: The purpose of this study was to examine physical frailty, depression, QoL, and cognition from pre-LVAD implantation to 3, 6, and 12 months post-LVAD implantation.

Methods: Clinical data and measures of physical frailty, depression, QoL, and cognition pre- and post-LVAD were extracted from an existing institutional database. Descriptive statistics and tests for statistical significance were used to describe and compare changes over time. Frailty trajectories were identified to describe physical frailty from pre-LVAD to 12 months post-LVAD.

Results: The sample (n = 46) was predominantly male (76%), with a mean age of 64.7 ± 11 years, and over half (n = 25) were physically frail. Physical frailty was reduced by nearly half at 12 months. Frailty, depression, and QoL significantly improved at all time points ( P < .001). Improvements in cognition did not reach statistical significance. Recipients of LVAD without improvement in frailty exhibited worse depression, QoL, and cognition scores at 12 months compared with those not frail pre-LVAD or no longer frail post-LVAD implantation.

Conclusion: Some recipients of LVADs experienced physical frailty reversal with benefits sustained long-term. Those without improvement recorded worse long-term patient-reported outcomes. Identifying factors that predict physical frailty response to LVAD implantation is a key area of future research.

Background: Digital health technologies can promote healthy aging, diagnosis, treatment, self-care, and prevention to reduce inequities. However, limited data exist on the feasibility and efficacy of these technologies for healthy lifestyle behaviors and clinical outcomes for older adults at risk for cardiovascular disease.

Objectives: The purpose of this pilot study was to evaluate the feasibility of the study protocol for factors impacting process, resources, and safety and compared changes in eating patterns, physical activity, and clinical outcomes in participants randomized to Get FIT vs Get FIT + at baseline and 12 weeks.

Methods: Older adults (65.6 ± 5.8 years, 61% women, 61% married, 50% Asians, 6% Whites, 33% Hispanics, 11% Blacks) were randomized to Get FIT (n = 24) or Get Fit+ (n = 30) for 12 weeks. Get FIT included 1 in-person counseling session, a participant handbook, an activity tracker, and access to a nutrition app. Get Fit+ added weekly personalized motivational text messages.

Results: All feasibility measures were excellent, with 100% consent and retention at 12 weeks. Both groups gradually increased moderate to vigorous exercise and lowered calorie intake. The Get Fit+ and Get Fit participants reported 6% and 1% weight loss, respectively. Blood pressure, lipid profiles, and HgbAa1C improved for all participants. However, improvements in high-density lipoprotein cholesterol and triglycerides were more significant in the Get FIT + group.

Conclusion: Our findings suggest that Get Fit+ can promote healthy lifestyle behaviors in older adults while lowering cardiovascular disease risk factors. A large Randomized Control Trial is needed to determine the efficacy of this intervention's personalized text-messaging feature in this population.

Background: Despite the increasing recognition of heart failure (HF) as a critical public health issue for both rural populations and women, the intersection of rurality and female sex in HF remains underexplored.

Objective: The objective of this scoping review was to synthesize the evidence on the intersection of rurality with female sex and gender in HF, examining how individual, interpersonal, organizational, or community factors influence the experience, management, and outcomes of HF in women.

Methods: Using the PubMed, Embase, and Cumulative Index to Nursing and Allied Health Literature databases, a literature search was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews. Findings were organized by level of the social-ecological model (SEM).

Results: Among the 1119 articles reviewed, 11 original studies met inclusion criteria, and their results were synthesized. Rural women were found to be at higher risk of developing HF when compared with their male and urban counterparts and tended to have worse outcomes, including higher rates of hospitalizations and mortality. Rural women were also less likely to receive evidence-based care and used healthcare services less.

Conclusions: Findings underscore the intricate interplay between SEM factors that influence HF outcomes in rural women. While highlighting the disparities this demographic group faces, the findings also emphasize the urgency for targeted interventions to address these multifaceted disparities. Future research should further explore the interactions between individual, interpersonal, organizational, and community factors to improve the care and outcomes of rural women living with HF.