European journal of cardiovascular nursing最新文献

Patient and public involvement (PPI) plays a pivotal role in enhancing the management and prevention of cardiovascular disease (CVD), at multiple levels. The partnership with patients and the public, those who are directly affected by CVD, is central to delivering personalized care, and may contribute to decreasing the burden of CVD and reducing health inequalities. This statement describes the concept of PPI and highlights the role of PPI across different settings including: clinical practice, research, regulatory processes, and policy and clinical guideline development. Recognition of the value of PPI and how to create environments and infrastructure to embed PPI into these areas requires further attention, specifically for under-represented communities. Therefore, considerations for good practice as well as future directions for improvement are provided. Whilst the content of this paper focusses on CVD, the insights provided can be applied to other conditions.

Aims: This study aimed to systematically synthesize the currently available body of literature on the impact of transitional care intervention on health outcomes in patients after percutaneous coronary intervention (PCI), focusing on clinical outcomes such as readmission rates, major adverse cardiovascular events (MACE), left ventricular ejection fraction (LVEF), and patient-reported outcomes such as 6 min walk test (6-MWT), quality of life (QoL), and symptoms of anxiety and depression. Furthermore, the study examined the relationship between intervention dosage (including duration, components, and intensity) and improvement in patient health outcomes.

Methods and results: A comprehensive search was conducted across multiple databases from their inception to November 2024, adhering to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. This search included randomized controlled trials (RCTs) aimed at assessing the effects of transitional care on postoperative outcomes in patients undergoing PCI. Softer R was used to perform meta-analysis. Twenty-seven studies involving 3345 participants were included. The meta-analysis results showed that transitional care interventions significantly reduced the readmission risk (RR = 0.56, 95% CI: [0.32, 0.98], I2 = 51.7%) and MACE (RR = 0.32, 95% CI: [0.19, 0.53], I2 = 0%). The QoL was significantly improved (SMD = 0.66, 95% CI: [0.31, 1.00], I2 = 89.5%). Furthermore, these interventions had a positive effect on LVEF (SMD = 0.62, 95% CI: [0.24, 1.00], I2 = 65.5%) and 6-MWT (SMD = 0.67, 95% CI: [0.26, 1.08], I2 = 83.0%). Also, they contributed to the reduction of anxiety (SMD = -0.59, 95% CI: [-0.97, -0.22], I2 = 85.6%) and depression (SMD = -0.82, 95% CI: [-1.53, -0.12], I2 = 95.4%) symptoms in patients.

Conclusion: Transitional care has been shown to have a positive impact on both clinical (e.g. readmissions, MACE, LVEF) and patient-reported (e.g. 6-MWT, QoL, anxiety, depression) outcomes post-PCI. It would be beneficial for future research to prioritize personalized plans based on patient and contextual factors to optimize effects.

Registration: PROSPERO: CRD42024606447.

Aims: Income influences individuals' engagement in health behaviours, which may mediate the relationship between income and cardiovascular event incidence. However, research on the association between cardiovascular event and cumulative low-income status remains limited, as most previous studies have assessed income at a single time point. This study aimed to investigate the association between cumulative low-income status and cardiovascular event incidence and to explore the mediating role of engagement in health behaviour.

Methods and results: In this retrospective cohort study, we analysed national representative data from the Korea Health Panel Survey (2008-2018), including 9284 Korean adults. Cumulative low-income status was defined based on total number of years classified as low-income status during the 3 year baseline. Cardiovascular event incidence was defined as the first diagnosis of myocardial infarction, stroke, or cardiovascular disease-related death. Engagement in health behaviour was measured through smoking, alcohol consumption, and physical activity. After adjusting for covariates, Cox proportional hazard models showed an association between increased risk of cardiovascular event incidence and prolonged cumulative low-income status [1 or 2 years: hazard ratio (HR) = 1.27, 95% confidence interval (CI) = 0.97-1.67; 3 years: HR = 1.33, 95% CI = 1.01-1.77; P for trend = 0.045]. A generalized structural equation model revealed that engagement in negative health behaviour mediated the longitudinal relationship between 1 and 2 years of cumulative low-income status and cardiovascular event incidence (indirect effect estimate = 0.179, P-value = 0.004).

Conclusion: These findings suggest that interventions targeting engagement in health behaviour among population with cumulative low-income status may help prevent cardiovascular events and promote cardiovascular health equity.

Aims: To determine feasibility, acceptability and test protocol integrity, for testing a mobile health (mHealth) intervention focused on enhancing self-management after adult cardiac surgery. Secondary aims were to assess the effect of the intervention on 30-day readmission, quality of life, and knowledge, skill and confidence for self-help.

Methods and results: A parallel-group, pilot randomized controlled trial was conducted in a major metropolitan publicly funded health service. Adult elective cardiac surgery patients discharged home within 30-days, able to understand spoken English, and use a smartphone, tablet or computer were eligible for inclusion. The mHealth intervention comprised patient narrative videos, and on-line resources focused on diagnosis, preparing for surgery, and immediate, and ongoing recovery. From August 2021 until the 23rd of December 2022, there were 341/516 elective cardiac surgery cases. Of 70 (20.5%) eligible patients, 61 (87.1%) participated. The mHealth intervention was accessed by 27 (84.4%) participants. When accessed, the intervention was feasible and acceptable for patients, there were no protocol violations. There was high viewing of content related to diagnosis, surgery and looking forward, compared with programmes related to rehabilitation. Readmission rates did not differ between groups. Participants taking action to manage their health in the intervention group incrementally increased from baseline to 90-day follow-up.

Conclusion: The effect of patient narratives on patient activation warrants testing in an adequately powered randomized controlled trial. While the uptake of the mHealth intervention was modest, trends in actions for self-help and rate of 30-day readmission imply the intervention is potentially effective in improving self-help management.

Registration: The Australian and New Zealand Clinical Trials Registry: ACTRN12621000082808.

Co-design is increasingly used in cardiovascular health research. Conducting co-design is an iterative process that involves collaboration with end-users, such as clinicians and people with lived experience. However, co-design is logistically, practically, and methodologically challenging. This methods paper aims to clarify what co-design is, why and when to use co-design, and how co-design research can be conducted. This paper, therefore, provides practical tools and examples to deal with the challenges and achieve a constructive co-design process in cardiovascular research.

Aims: This study aims to assess the association between the quadriceps rate of force development (RFD) and physical performance in older patients undergoing cardiovascular surgery.

Methods and results: A cross-sectional study was conducted with hospitalized patients aged ≥65 years who underwent cardiovascular surgery. Physical performance was evaluated using a Short Physical Performance Battery (SPPB). The 4 m gait speed and time for five repeated chair stands were analysed as secondary outcomes. Ninety-four participants were enrolled (mean age, 75 years; men, 58.5%; median SPPB, 10 points; ≤9 points, 42.6%). Quadriceps isometric strength was measured, and RFD values at two time points (RFD100, 0-100 ms; RFD200, 0-200 ms) were calculated from the slope of the force-time curve. Maximal voluntary contraction (MVC) was also calculated. In all participants, the SPPB was significantly associated with RFD100, RFD200, and MVC. The 4 m gait speed was correlated with RFD100, RFD200, and MVC, and the chair stand test time was negatively correlated with RFD100, RFD200, and MVC. Although these significant associations persisted after adjusting for age, sex, and body mass index or skeletal muscle mass, the association between RFD and physical performance was not significant after adjusting for MVC. Subgroup analysis revealed that the correlation coefficients between RFD and physical performance measures were greater in patients with low muscle mass than in those with preserved muscle mass. Similar results were observed for the secondary outcomes.

Conclusion: Rate of force development and physical performance were significantly correlated after cardiovascular surgery, especially in those with low muscle mass.

Aims: To explore the trends of self-care behaviours among Chinese older adults with chronic heart failure (CHF) during the vulnerable period (VP) and to analyze influencing factors.

Methods and results: This was a longitudinal study. From October 2022 to July 2023, 255 patients were recruited from a tertiary hospital in Shanghai, China. Data regarding self-care behaviours (self-care maintenance, symptom perception, and self-care management), self-care confidence, illness perception, self-efficacy, social support, HF knowledge, and demographic and clinical information were collected during hospitalization (T1) utilizing validated questionnaires and electronic health records. Follow-up behavioural data were collected at 2 weeks (T2), 4 weeks (T3), 2 months (T4), and 3 months (T5) post-discharge. Repeated measures ANOVA was used to identify the trends of self-care behaviours, and the generalized estimation equation was used to explore influencing factors. Self-care maintenance scores reached 70 at T2, T4, and T5, while self-care management scores exceeded 70 at time points from T2 to T5. Symptom perception scores never reached 70 any single time point. There were significant temporal variations across all 3 domains, characterized by a rapid improvement at 2 weeks post-discharge, followed by subsequent stabilization or decline (P < 0.05). Residential area, educational level, cardiac function, self-care confidence, and HF knowledge were key influencing factors (P < 0.05).

Conclusion: Self-care behaviours among patients improved within the first two weeks post-discharge but tended to stabilize or decline thereafter, indicating a critical window for targeted interventions. Health care professionals should tailor self-care promotion strategies to both the temporal patterns of behaviours and patient-specific characteristics.

Aims: Despite evidence supporting the inclusion of people with transient ischaemic attack (TIA) or mild stroke in cardiac rehabilitation, no process evaluations have investigated the implementation of integrated [TIA, mild stroke, coronary heart disease (CHD)] cardiovascular rehabilitation (CVR). We aimed to identify factors influencing CVR implementation success or failure, and evaluate CVR implementation outcomes, considering reach, effectiveness, adoption, implementation, and maintenance, from clinician perspectives.

Methods and results: This mixed-methods process evaluation was guided by the Reach, Effectiveness, Adoption, Implementation and Maintenance (RE-AIM) framework. Quantitative patient process-level data were collected throughout CVR implementation. Qualitative data (semi-structured interviews, field notes, observations) were collected and deductively coded to the Consolidated Framework for Implementation Research. Quantitative and qualitative data were mapped to the RE-AIM dimensions. Reach was 44% (140/315) of the eligible patient population, with referral adoption highest at site 1 (74%), influenced by larger referral teams and greater programme awareness. Clinicians viewed CVR as effective based on international recommendations, but more evidence is needed. Cardiovascular rehabilitation was delivered as intended, with fidelity linked to adequate staffing and clinician confidence in delivery. Sixty-six per cent (46/70) of patients completed ≥5 of 6 CVR sessions. Clear referral pathways and access to resources are necessary for CVR maintenance.

Conclusion: Cardiovascular rehabilitation was delivered as intended, and clinicians reported people with TIA, mild stroke, and CHD demonstrate similar needs. However, greater programme awareness and aligning referral pathways with existing services are indicated. Access to CVR programme resources and clinicians' confidence in CVR delivery enabled implementation and are essential for maintenance.

Registration: Australian New Zealand Clinical Trials Registry (ANZCTR), ACTRN 12621 00158 6808.

Aims: This randomized controlled trial examined the effectiveness of the 12-week NICE-Support programme-combining nutrition, nursing instruction, exercise, and support-on frailty and quality of life in patients with heart failure.

Methods and results: A total of 240 adults (≥20 years) with stable heart failure, cognitive and physical capacity for activity, and smartphone access were recruited from two Taiwanese medical centres and randomly allocated to either the intervention group or the control group. The 12-week intervention included nutritional counselling, three in-person nursing consultations (40-60 min each), a structured exercise regimen (three 30 min sessions per week), social media support, and biweekly follow-up calls. The control group received standard nursing care and routine discharge education. Frailty and quality of life were assessed at baseline and at 4, 12, and 24 weeks to evaluate short-term and sustained effects. Among the 240 participants, 192 (80%) completed the 24-week follow-up. An intention-to-treat analysis was conducted to evaluate the intervention effects. Both groups showed significant improvements over time. At 24 weeks, the control group demonstrated significant improvements in frailty scores (-8.11 points) and overall quality of life scores (-22.71 points). Compared with the control group, the intervention group exhibited significantly greater improvements in frailty (Cohen's d = 1.17) and overall quality of life (Cohen's d = 0.87) at Week 24.

Conclusion: The NICE-Support programme significantly reduces frailty and improves quality of life in patients with heart failure. Its integration into routine care is recommended.

Registration: ClinicalTrials.gov: NCT05366686.