European Journal of Cardiovascular Nursing

Background: Social status may impact health-related quality of life (HRQOL), hospitalization, and mortality in patients with heart failure (HF).

Purpose: To determine if social status was associated with HRQOL and event-free survival.

Hypotheses: Higher social status (quality of perceived support, emotional support, marital status, and economic status) is related to better HRQOL and event-free survival after controlling covariates (New York Heart Association [NYHA] functional class, comorbidity status, and age).

Methods: Patients (N = 147, 61 ± 11 years old, 70% male, 62% NYHA class III/IV) provided data on HRQOL (measured by the Minnesota Living with Heart Failure questionnaire) and social status. Event-free survival data were collected by medical record reviews and patient or family interviews. Hierarchical regression analysis and survival analysis were used to test the hypothesis.

Results: Better quality of perceived support, better economic status, better functional status, older age, and less comorbidity were related to better HRQOL (R2 = .365, p = <.001). Only economic status predicted event-free survival.

Conclusion: Attention should be given to those who have lower social support to improve HRQOL and those who have lower economic status to improve event-free survival.

The purpose was to investigate if women with high pre-procedural anxiety reported higher degree of relaxation and comfort if listening to music during coronary angiographic procedures. A prospective randomized controlled trial was used included 68 patients undergoing coronary angiography and/or PCI. The women were allocated to receive calming music and standard care or standard care only. Relaxation, environmental sound and discomfort associated with lying still were assessed. There was significantly more positive impression of the sound environment and less discomfort associated with lying still in women listening to music in comparison to women who received only standard care. No effect in relaxation was found.

Background: The incidence of acute myocardial infarction (AMI) is rapidly increasing among older adults in Korea. However, the factors associated with a delayed decision to visit a hospital and the reasons for this delay have not been explored adequately among older patients.

Aims: To determine factors predicting a prehospital delay time of > 6 h and to identify the cognitive barriers in the delayed decision of AMI patients aged ≥ 65 years.

Methods: This study adopted a mixed methodological approach using quantitative and qualitative analyses. The sample included 94 male and 71 female patients hospitalized for first-time AMI at a university hospital in Korea. Thematic content analysis was used to identify the themes from the qualitative interview data, and multiple logistic regression analysis was used to predict delayed hospital presentation by > 6 h.

Results: The median prehospital delay time was 12 h. Low education level, presence of preinfarction angina pain, and attribution of symptoms to a non-cardiac origin were found to be the predicting factors. From the qualitative data, four meaningful themes including 10 subthemes that influenced the delayed decision were identified. Some culturally peculiar themes were found in this Korean sample.

Conclusions: Educational strategies that focus on these cognitive decision-making barriers should be planned for elderly Korean at high risk for AMI.

Background: Patient delay in seeking treatment for acute coronary syndrome symptoms remains a problem. Thus, it is vital to test interventions to improve this behavior, but at the same time it is essential that interventions not increase anxiety. Purpose: To determine the impact on anxiety and perceived control of an individual face-to-face education and counseling intervention designed to decrease patient delay in seeking treatment for acute coronary syndrome symptoms. Methods: This was a multicenter randomized controlled trial of the intervention in which anxiety data were collected at baseline, 3-months and 12-months. A total of 3522 patients with confirmed coronary artery disease were enrolled; data from 2597 patients with anxiety data at all time points are included. The intervention was a 45 min education and counseling session, in which the social, cognitive and emotional responses to acute coronary syndrome symptoms were discussed as were barriers to early treatment seeking. Repeated measures analysis of covariance was used to compare anxiety and perceived control levels across time between the groups controlling for age, gender, ethnicity, education level, and comorbidities. Results: There were significant differences in anxiety by group (p = 0.03). Anxiety level was stable in patients in the control group, but decreased across time in the intervention group. Perceived control increased across time in the intervention group and remained unchanged in the control group (p = 0.01). Conclusion: Interventions in which cardiac patients directly confront the possibility of an acute cardiac event do not cause anxiety if they provide patients with appropriate strategies for managing symptoms.

Background: To provide patients with effective self-management education that takes their lifestyle into account, medical personnel need to provide education and evaluation of self-management behaviors which patients can apply to their daily life.

Aim: This study aimed to assess the reliability and validity of the evaluation scale for self-management behavior related to physical activity of patients with coronary heart disease (ES-SMBPA-CHD).

Methods and results: Outpatients with coronary heart disease (n = 76) completed a self-administered questionnaire supported by a previous study of ours. The ES-SMBPA-CHD was divided into two domains, the first dealing with self-management behavior to enhance physical activity in daily life and the second with behavior to maintain the level of physical activity. Factor analysis showed that the first part comprised four factors and the second five. The ES-SMBPA-CHD was associated with the International Physical Activity Questionnaire (IPAQ) subscales and activity energy expenditure (measured by Lifecorder EX). Cronbach’s α coefficient was between 0.71 and 0.90. The intraclass test–retest correlation coefficient of the subscale was between 0.75 and 0.93.

Conclusions: The ES-SMBPA-CHD is reasonably reliable and valid and is expected to prove useful for the assessment of patients’ self-management behavior and for individualized instruction.

Objective: The aim of this study was to describe the self-care behaviors and associated demographic factors affecting such behaviors in the heart failure population in Taiwan.

Methods: A descriptive, cross-sectional, correlational design was used in this study and 86 heart failure patients were sampled by convenience sampling. Demographic questionnaire and Self-Care of Heart Failure Index, V. 6 were used to collect these data. Descriptive statistic, correlation coefficient and multiple regression were used to analyze the data.

Results: The result indicated a low level of self-care maintenance and management although self-care confidence was adequate. Patients who were married had better self-care maintenance and self-care confidence than those who were single. Self-care confidence was a determinant of self-care maintenance.

Conclusion: This study provided detailed information on self-care behavior status in heart failure patients in Taiwan.

Background: Unexplained chest pain (UCP) affects everyday life, causing fear and anxiety. Patients often have difficulty understanding their symptoms.

Aim: To test a cognitive behavior group intervention program designed for women with UCP, and investigate its effects in terms of participants’ ideas and perceptions of the program as well as their pain experience.

Method: Nine women aged 44–69 participated in the pilot study, which included six group sessions. Three months after the intervention, interviews were conducted, followed by content analysis.

Results: Narrating and sharing experiences led to awareness and understanding of what may affect chest pain. Knowledge about how stress affects the body and an understanding of one’s own situation and what may affect the pain changed participants’ patterns of thinking. The treatment provided tools to take control over beginning reactions to stress and thus prevent chest pain. Fewer pain attacks were reported but there was no pronounced decrease in pain intensity.

Conclusion: This pilot study shows that it is possible, through a cognitive behavior group intervention program, to generate positive experiences of managing stress and inner pressure and to change thinking patterns. The possibility to use these strategies and techniques to improve sleeping problems and alleviate pain is also presented.

Heart Failure Nurse Specialists play a key role in facilitating the provision of palliative care for patients with advanced heart failure where supportive and palliative care needs are comparable to those with cancer. This article describes the attitudes of heart failure nurse specialists towards palliative care in the management of patients and their interface with specialist services in the context of changing policy drivers over this time period. Data is drawn from two national surveys, the first in 2005, and repeated in 2010 following national educational initiatives. This comparison provides encouraging results that over five years there has been a growing partnership between heart failure nurses and palliative care services and that heart failure nurses play a pivotal role in ensuring provision of both general and specialist palliative care for their patients. The importance of integrating cardiology and palliative care clinical services, and aspects of local, regional and national service provision in the setting of the Innovative Care for Chronic Conditions framework is highlighted.

Background: The Kansas City Cardiomyopathy Questionnaire (KCCQ) is a well-established instrument used to evaluate the health status of heart failure (HF) patients. There has been a lack of clarity about the best way to conceptualize the KCCQ. The purpose of this investigation of the KCCQ was to: (1) explore the factor structure with an exploratory factor analyses; (2) perform reliability and validity testing to determine the best factor solution for item groupings; and (3) determine the most meaningful components of health status captured by the KCCQ.

Methods and Results: A secondary analysis of data from 280 adults with stage-C HF enrolled from three US northeastern sites was conducted to test the KCCQ subscale structure. Criterion-related validity for the Self-efficacy subscale was tested with the Dutch Heart Failure Knowledge Scale and the Self-care of Heart Failure Index Self-care Confidence Scale. Overall, internal consistency reliability (Cronbach’s alpha) for the KCCQ and subscales was 0.92, social interference (seven items, 0.90), physical limitation (four items, 0.84), symptoms (eight items, 0.86), independent care (two items, 0.80), and self-efficacy (two items, 0.63). Two items failed to correspond to a previously identified factor so the independent care subscale was added. Items intending to measure quality of life were loaded in the social interference subscale.

Conclusions: We recommend eliminating the quality of life subscale and including those items in the social interference subscale, and eliminating the self-efficacy items and re-evaluating the items related to independent care.

Purpose: Evaluating rehabilitation programmes from the patient’s perspective is much needed, as the patients are the most important stakeholders in the health care system. A comprehensive rehabilitation programme, COPE-ICD programme, consists of exercise training and nursing consultations during a one year period post ICD implantation. The purpose of this paper is to describe the experience and meaning of participating in a comprehensive ICD-specific rehabilitation programme.

Methods: Qualitative interviews were conducted with 10 patients representing the participating population, and later transcribed. The analysis was inspired by Ricoeur’s theory of interpretation, which consists of three levels: naive reading, structured analysis and critical interpretation and discussion.

Results: The overall concept was that participating in the COPE-ICD programme meant feeling inspired and secure through individualized care. Four themes emerged: Knowledge: patients gained much needed understanding; Physical attention: patients interpreted body signals and adjusted their exercise behaviour; Trust: patients regained trust, felt secure and dared to live again; Strategies of living: patients’ coping was supported through reflection and professional dialogue, and they dealt with the risk of shock or death.

Conclusion: Participating in an ICD-specific rehabilitation programme can make patients feel inspired and secure through individualized care. They discover that they have to rethink some of their strategies of living and they gain support in the reflection and coping needed for that. Patients gain insight and they develop a special physical attention whereby they continue healthy activities through interpreting body signals and adjusting exercise behaviour. They learn to trust their body again.

Background: Communication with heart failure (HF) patients about their condition and wishes for end-of-life care is recommended in all HF guidelines.

Aims: The aims of this study were to: 1) identify whether hospitalized HF patients want to communicate regarding disease management, prognosis and resuscitation wishes, and 2) to identify the relationship of communication with clinical variables and quality of life (QOL).

Methods: Hospitalized HF patients (n = 47) were asked: 1) Did they want more information about their HF? 2) Did they want to discuss their prognosis? 3) Did they discuss their resuscitation wishes since being hospitalized?

Results: Patients’ mean age was 62.8 ± 17.0, mean QOL score was 29.4 (0–100) and approximately half (n = 22, 47%) were rehospitalized within 3 months. Twenty-eight (62%) wanted more information regarding disease self-management while 20 (44%) wanted more communication regarding their prognosis. Twenty-four (51%) did not recall a conversation about resuscitation during their hospitalization. Multivariate analysis showed patients who wanted more HF information were 4.4 times more likely to have better NYHA class (p = .02). Patients wanting more communication about their prognosis were more than 4 times more likely to experience future rehospitalizations (p=.03).

Conclusion: The majority of patients desired more information about HF. A minority had not discussed issues around prognosis, despite their desire to do so. Health care professionals are encouraged to communicate with HF patients about self-management when patients are less symptomatic. More research is needed to explain why patients who wanted more discussion about their prognosis were more likely to be rehospitalized.

Background: Cognitive impairment is a recognized consequence of heart failure; however, there are no neuropsychological batteries with documented psychometric data in the chronic heart failure population.

Aims: To document the psychometric properties of a brief neuropsychological battery in a chronic heart failure sample.

Methods: The Repeatable Battery for the Assessment of Neuropsychological Status, Trail Making Test Part A and Part B, and letter fluency was administered to a sample of individuals with chronic heart failure.

Results: Eighty individuals with stable heart failure participated in this study. Individuals with chronic heart failure scored significantly lower than expected age and education adjusted norms in the domains of attention (p < 0.001), memory (p < 0.001), language (p < 0.001), executive function (p < 0.001), and psychomotor speed (p = 0.02). Scores on the tests of memory and executive function correlated to functional status (r = 0.28, p = 0.02 and r = 0.29, p = 0.03, respectively). Acceptable convergent validity and test–retest reliability were documented for this battery.

Conclusion: The neuropsychological battery had adequate reliability and validity in individuals with chronic heart failure.

Background: Routine screening and assessment for depression occurs rarely in clinical practice for a variety of reasons, including the absence of systems to facilitate the process.

Aim: To identify nurses’ knowledge and practice regarding depression screening and referral for cardiac patients following the implementation of education workshops and a validated screening tool with referral actions.

Methods: Pre and post-test design using surveys and semi-structured interviews was conducted with a purposive sample of nurses in a large Australian metropolitan tertiary referral hospital. Prior to the introduction of the screening and referral tool, nurses engaged in an interactive one hour education workshop on the topic of depression and the tool; introduced to improve depression screening following an acute cardiac event.

Results: In the pre and post-survey 40 and 30 nurses, respectively, participated with 14 also engaging in semi-structured interviews. Eighty percent reported a ‘good’ understanding of depression post-program compared to 30% at baseline. Sixty percent reported routinely using the depression screening and referral tool. The interviews identified three main themes that supported the utility of the education and instrument: knowledge improvement; perceived self-efficacy and new knowledge into practice.

Conclusion: The vast majority of participants reported increased skill, knowledge and confidence to screen and refer for depression post an acute cardiac event. The substantial increase in the number of nurses who engaged in screening and referral actions further demonstrated the success of the program. These encouraging results provide evidence that screening for depression can be achieved through adopting formalised processes.

Approximately 5–10% of adolescent and adult patients with congenital heart disease (CHD) will develop pulmonary arterial hypertension (PAH). Patients with PAH associated with CHD (PAH–CHD) exhibit several similarities to those with idiopathic and other associated forms of PAH, especially with regards to their non-specific, cardinal symptoms. The development of PAH–CHD can lead to lifelong impairment although, paradoxically, survival may be better versus idiopathic PAH. Patients with PAH–CHD may experience social limitations, and emotional and psychological issues, arising from their disease burden. Nurses and other allied healthcare professionals are well placed to deliver the individually-tailored care that patients with PAH–CHD require. Activities known to be of particular benefit include patient engagement and education, patient empowerment, colleague training, and ensuring effective communication across the multidisciplinary team. Recent developments in the management of PAH–CHD have led to changes in the medical needs and optimal care of this patient population. This review aims to provide an overview of the natural course, diagnosis, symptoms and impact of PAH–CHD. We also aim to communicate the current standards in management of patients with PAH–CHD, and how their outlook can be improved in the future.

Research on the palliative care needs of heart failure patients is scant and requires development to provide a sound evidence base for improved care; but there are distinct practical and ethical challenges in conducting research with this population. This paper presents an integrative review of the literature that aims to describe these challenges and discuss potential strategies by which they may be addressed. It is recognised that heart failure is a volatile condition making identification of the end of the life phase difficult. This leads to an array of other issues; firstly clinical teams tend to use this as a rationale for their failure to discuss palliative care issues with patients and families, making identification of the population difficult and research related communication challenging. Symptom volatility also creates methodological problems for researchers in deciding patients’ eligibility, securing user involvement and contributes to sample attrition in research. There are also substantial ethical challenges for researchers in terms of gaining access and ensuring patient autonomy in this population. Acknowledgement of these issues and discussion of strategies by which they can be addressed has the potential to augment clinical research, develop practice and ultimately produce the much needed improvements in patient care required for those with advanced heart failure.