European journal of cardiovascular nursing最新文献

Aims: Pregnancy-related cardiometabolic complications such as gestational diabetes mellitus, hypertensive disorders, and preterm birth significantly increase the risk of future cardiovascular diseases (CVD). Many postpartum women remain unaware of this risk, highlighting the need for targeted educational interventions. Validated tools to assess knowledge gaps in this population are lacking. Therefore, this study aimed to develop and preliminarily validate the Coronary Artery Disease Education Questionnaire for Postpartum Women (CADE-Q-PP) to ensure content validity and relevance.

Methods and results: The CADE-Q was systematically revised to identify items specific to postpartum women's knowledge concerning pregnancy-related cardiometabolic complications and CVD risk. A modified Delphi process was conducted with a panel of 28 international experts to refine the items, using a five-point Likert scale for consensus (mean score ≥4). Items were further simplified into plain language and a clarity assessment was completed with 20 postpartum women. A total of 61 items were drafted across four key knowledge areas: cardiovascular risk, physical activity, mental health, and nutrition. Through iterative discussion, consensus was achieved on 22 questionnaire items. Clarity assessment revealed a high degree of understanding among postpartum women (total mean 4.3 ± 0.9), with 20/22 items scoring above 4.0. Items that scored lower concerned long-term risks and specific interventions. Suggestions included sentence structure and providing context for terms like 'hidden sugar' and 'extra vitamins'.

Conclusion: The CADE-Q-PP was developed as an accessible tool for clinicians to assess knowledge gaps regarding cardiovascular risk and health promotion in postpartum women. Future work will include testing of psychometric properties to confirm validity.

Administrative health data provide valuable insights into healthcare, but missing data remains a major barrier to ensuring the veracity of findings. This paper presents a structured approach to addressing missingness in administrative datasets, focusing on data assessment and statistical methods. Using causal diagrams and understanding the types of missing data to guide appropriate analytical strategies aligned with the Treatment And Reporting of Missing data in Observational Studies (TARMOS) framework. A real-world example demonstrates multiple imputations in large-scale health research. By promoting transparent and rigorous methods, this methods paper enhances the reliability and policy relevance of administrative data-based healthcare research.

Aims: Despite its proven effectiveness, traditional exercise-based cardiac rehabilitation (exCR) suffers from low participation rates. However, telemedicine-based exCR can overcome access barriers to traditional rehabilitation while providing personalized, structured exercise training and remote monitoring. The aim of this review is to ascertain the efficacy of personalized, structured, telemedicine-based exCR in improving health outcomes in patients with coronary heart disease (CHD).

Methods and results: A systematic search was conducted in databases including Cochrane Library, PubMed, Web of Science, Embase, CINAHL, Scopus, Medline, China National Knowledge Infrastructure, Wanfang, VIP, and SINOMED from inception to March 2024 to identify randomized controlled trials (RCTs). The final analysis included 19 RCTs comprising 2219 participants. Among patients with CHD, telemedicine-based exCR demonstrated comparable effects to centre-based exCR across multiple outcomes, including exercise capacity, physical activity levels, cardiovascular risk factors, and quality of life (all P > 0.05). Notably, when compared with usual care, telemedicine-based exCR showed significant improvements in exercise capacity [standardized mean difference (SMD) = 0.23, 95% CI: (0.12, 0.35), I2 = 34%, P < 0.0001], physical activity level [SMD = 0.32, 95% CI: (0.09, 0.54), I2 = 53%, P = 0.006], diastolic blood pressure [mean difference (MD) = -1.54, 95% CI: (-2.89, -0.20), I2 =8%, P = 0.02], body mass index [MD = -0.54, 95% CI: (-1.94, -0.14), I2 = 4%, P  = 0.008], and depression [SMD = -0.27, 95% CI: (-0.42, -0.13), I2 = 33%, P = 0.0002].

Conclusion: Telemedicine-based exCR is equally effective as centre-based exCR in improving key health outcomes for patients with CHD, including exercise capacity, physical activity levels, cardiovascular risk factors, and quality of life. Furthermore, telemedicine-based exCR shows superior effectiveness to usual care, with statistically significant improvements in exercise capacity, physical activity, diastolic blood pressure, and depressive symptoms.

Registration: PROSPERO: CRD42024521465.

Cardiovascular disease (CVD) and stroke disproportionately affect people from culturally and linguistically diverse (CALD) backgrounds, with disparities driven by cultural, social, and systemic barriers. Despite these disparities, people of CALD backgrounds remain underrepresented throughout CVD research. The Transcultural Nursing theoretical framework provides a structure for culturally appropriate research by integrating patients' beliefs, values, and preferences. This discussion paper examines the Transcultural Nursing theoretical framework and its relevance in CVD and stroke research, and demonstrates its application through exemplars. Despite critiques concerning complexity and potential stereotyping, the Transcultural Nursing theoretical framework remains a valuable framework for culturally responsive research.

Aims: This study examined the associations between spirituality, caregiver burden, disability, and health-related quality of life (HRQoL) within stroke survivor-caregiver dyads using a dyadic structural equation modeling (SEM) approach. The aim was to explore spirituality as a shared dyadic resource in post-stroke adaptation.

Methods and results: A cross-sectional analysis was conducted with 217 stroke survivor-caregiver dyads recruited at discharge from rehabilitation hospitals. Spirituality, caregiver burden, disability, and HRQoL were assessed using validated instruments. Dyadic SEM estimated within-person and cross-dyadic associations. Missing data were minimal and not systematic. Survivors' spirituality showed significant within-person associations with better physical (β = 0.304, p < 0.001), cognitive (β = 0.449, p < 0.001), emotional (β = 0.455, p < 0.001), and social HRQoL (β = 0.343, p < 0.001). Cross-dyadic associations were observed: higher survivor spirituality was associated with lower caregiver time-dependent (β = -0.275, p < 0.001), developmental (β = -0.208, p < 0.001), and physical burden (β = -0.183, p = 0.030). Caregivers' spirituality showed a non-significant trend toward lower survivor cognitive disability (β = -0.117, p = 0.052). After adjustment for caregiver gender and survivors' activities of daily living, caregiver spirituality was associated with lower developmental burden (β = -0.227, p = 0.023).

Conclusion: Spirituality was associated with multiple dimensions of post-stroke adaptation through distinct within- and cross-dyadic pathways. These findings support the relevance of dyadic SEM in stroke rehabilitation and highlight spirituality as a relational psychosocial resource within survivor-caregiver dyads.

Aims: Health-related quality of life (HRQoL) is an important measure of disease status and represents a holistic approach to delivering patient-centered care. We conducted a scoping review of HRQoL patient reported outcome measures (PROMs) for cardiovascular diseases (CVDs) and evaluated their psychometric properties.

Methods and results: Randomized trials and observational studies that developed and validated HRQoL PROMs for adults with ischaemic heart disease (IHD), aortic stenosis (AS), atrial fibrillation (AF), heart failure (HF), or generic CVD were included, published from inception of databases to 8 February 2025 using PubMed, Web of Science, and Embase. Independent reviewers selected and extracted the psychometric properties of each PROM in accordance with the Consensus-based Standards for the selection of health Measurement Instruments (COSMIN) checklist: content validity, reliability, internal consistency, structural validity, criterion/convergent, cross-cultural validity, measurement error, hypothesis testing, and responsiveness. Each PROM was graded using the Grading of Recommendations Assessment, Development, and Evaluation approach. Of 9430 articles, 220 studies for 38 different PROMs were included (HF n = 17, 45%; AF n = 11, 29%; IHD n = 7, 18%; generic n = 2, 5%; AS n = 1, 3%). Eleven PROMs (29%) satisfied all nine COSMIN criteria; the majority (n = 19, 50%) required further validation and eight were deemed inadequate for clinical use (21%).

Conclusion: This scoping review of HRQoL PROMs in individuals with common CVDs found evidence that many PROMs do not fulfill all nine COSMIN criteria for methodological quality, and for some CVDs there is a limited choice of suitable PROMs for HRQoL measurement. There is an opportunity to improve HRQoL evaluation for use within routine care and research.

Aims: To describe management of life with a left ventricular assist device (LVAD) by patients and caregivers and to determine the fit of self- and family management as a guiding concept in LVAD research.

Methods and results: We applied dimensional analysis techniques to this concept analysis, beginning with a literature search (2010-25) of PubMed, CINAHL, Embase, PsycINFO, and Web of Science. Two reviewers screened and analysed 28 articles capturing perspectives on daily LVAD management among patients, caregivers, and healthcare professionals. Fourteen studies were qualitative, 12 were quantitative, and 2 were mixed methods. We identified five dimensions of patient and family management of LVAD therapy: patient facilitators and barriers; caregiver facilitators and barriers; processes of self- and family management; clinician facilitators and barriers/processes; and outcomes. These dimensions align with the concept of self- and family management and with core components of the Middle Range Theory of Self- and Family Management of Chronic Illness.

Conclusion: This dimensional concept analysis advances understanding of managing life with an LVAD by clarifying the collaborative roles of patients, caregivers, LVAD coordinators, and other healthcare professionals. Our analysis supports the use of self- and family management as a guiding concept and the application of the Middle Range Theory of Self- and Family Management of Chronic Illness in LVAD research. A new conceptual definition of LVAD self- and family management reflects this theoretical grounding. Our work offers direction for future research, clinical practice, and education aimed at improving outcomes for patients and caregivers managing life with an LVAD.

Aims: Although many studies have investigated the impact of telemedicine interventions on the outcomes of patients with heart failure (HF), the evidence on the impact of telemedicine interventions on self-care of patients with HF is still inconclusive. The objective was to explore the effect of non-invasive telemedicine on self-care ability of patients with HF.

Methods and results: We searched PubMed, Embase, Cochrane Library, Web of Science, and CINAHL databases for randomized controlled trials published in English from inception to 5 December 2024. The interventions considered included a variety of telemedicine approaches for monitoring patients with HF. The primary outcome was patient self-care; the European Heart Failure Self-Care Behaviuor Scale was used for evaluation. And the secondary outcome was patient satisfaction with quality of life. Meta-regression was subsequently performed to explore the relationship between telemedicine monitoring and its effectiveness. A total of seven studies involving 2853 patients were included. Meta-analysis showed that telemedicine significantly improved the self-care ability of HF patients (standardized mean difference [SMD] = -0.23, 95% CI -0.3 to -0.15, P < 0.01), but it did not significantly improve the quality of life of HF patients (MD = 0.05, 95% CI -3.78 to 3.89, P = 0.98). In addition, subgroup analysis showed that telemedicine intervention for 3 months (MD = -4.30, 95% CI -7.24 to -1.36, P = 0.004) and 6-12 months (SMD = -0.19, 95% CI -0.28 to -0.11, P < 0.01) had a significant impact on the self-care ability of the study subjects.

Conclusion: Studies have found that patients with HF can benefit from telemedicine monitoring, which can effectively improve the self-care ability of patients with HF, but the improvement of their quality of life is not obvious.

Registration: PROSPERO: CRD42024623404.

Aims: To ascertain the impact of varying exercise intensities and volumes on clinical outcomes of patients with coronary artery disease (CAD) via a systematic review and meta-analysis.

Methods and results: This study included randomized controlled trials to evaluate the effects of different intensity levels and volumes of exercise training and control interventions on clinical outcomes in patients with CAD. Data from eight databases were screened, extracted, and assessed for quality by two independent reviewers. Included studies were categorized into subgroups based on exercise intensity and volume. A random-effects model was used to conduct a meta-analysis of different outcomes. To further explore the combined effects, an exploratory network meta-analysis was performed, combining exercise intensity and exercise volume. Exercise training reduces the risk of cardiovascular mortality, overall hospitalization and cardiovascular hospitalization. In subgroup analyses, both moderate-intensity and continuous training significantly reduce the risk of overall hospitalization. Furthermore, the network meta-analysis shows that moderate-intensity continuous training (MICT) significantly lowers the risk of overall hospitalization [(risk ratio (RR) = 0.66, 95% confidence interval (CI): 0.47-0.95), surface under the cumulative ranking curve (SUCRA) = 70.6%] and cardiovascular hospitalization (RR = 0.66, 95% CI: 0.44-0.99, SUCRA = 80.1%) compared with usual care. In contrast to usual care, vigorous-intensity continuous training (VICT) lowers the risk of cardiovascular hospitalization (RR = 0.35, 95% CI: 0.14-0.92, SUCRA = 94.1%).

Conclusion: MICT significantly reduces the risk of overall hospitalization and cardiovascular hospitalization. Although the evidence is limited, VICT appears to reduce the risk of cardiovascular hospitalization. Consequently, it may become an effective exercise-based intervention for preventing such events.

Registration: PROSPERO: CRD42024519198.