European Journal of Cardiovascular Nursing

Mild cognitive impairment among patients with heart failure can be subtle. Heart failure-related variables such as ejection fraction, low systolic blood pressure and functional status are reportedly associated with cognitive impairment among heart failure patients. The purpose of this literature review was to examine the value of cardiac variables commonly assessed during heart failure-related hospitalizations for a phenotypic profile of the risk of cognitive impairment.

A literature review of primary research studies was conducted. Electronic databases (PubMed and CINAHL) were searched using the keywords heart failure, blood pressure, ejection fraction, functional status, and B-type natriuretic peptide (BNP) in combination with the terms cognition, cognitive function, cognitive dysfunction, and cognitive impairment.

Thirty-seven studies met the inclusion criteria. Evidence supports the potential utility of lower ejection fraction, lower blood pressure and functional status and elevated B-type natriuretic peptide as a phenotypic profile for an increased risk of cognitive impairment.

If the risk for cognitive impairment is suspected, specific evaluations of cognition can be performed. For community-dwelling heart failure patients with mild cognitive impairment, more intense interventions to support self-care, increased family involvement and more frequent follow up may be necessary.

Atrial fibrillation (AF) influences the lives of patients in the form of worsened well-being. Patients’ own experience of and how to handle AF is rarely investigated. These are important aspects for healthcare services to understand in order to support the well-being of patients with AF.

To explore and describe critical incidents in which patients experience how AF affects their well-being and what actions they take to prevent and handle it.

An explorative, descriptive design based on the critical incident technique (CIT) was used. Interviews were conducted with 25 patients (16 men and 9 women) with AF in a healthcare area in southern Sweden.

Patients experienced discomfort and limitations in daily life. The actions they took were self-care related actions and healthcare related actions.

AF affects well-being when it is uncomfortable and leads to pronounced limitations in daily life with the patients trying to maintain or restore well-being through adapting and developing strategies for self-care. Patients base the handling of AF on their personal experience.

Hypertension (HT) and obesity have both been linked to obstructive sleep apnoea (OSA). Difficulties have been described in identifying patients with OSA in primary care, causing low referral rates to sleep clinics. Increased knowledge about gender-specific characteristics and symptoms may help to identify patients.

The aim was to describe gender differences regarding undiagnosed OSA, self-rated sleep, insomnia and daytime sleepiness in middle-aged primary care patients with HT and different degrees of obesity.

A cross-sectional design was used and 394 patients (52.5% women), mean age 57.8 years (SD 6.7 years), with HT (BP >140/90 mmHg) were included. Clinical examinations, respiratory recordings and self-rated scales regarding OSA symptoms, sleep, insomnia and daytime sleepiness were used. Body mass index (BMI) was classified according to the criteria from the National Institutes of Health.

Pre-obesity and obesity classes I and II were seen among 53%, 26% and 8% of the men and 37%, 19% and 14% of the women, respectively. Occurrence of mild, moderate and severe OSA increased significantly across the BMI classes for both genders (p<0.01). Ninety percent of the men and 80% of the women in obesity class II had OSA. Insomnia was prevalent in obese patients. Other clinical variables did not differ between BMI classes or genders.

The occurrence of overweight/obesity and OSA was high among both genders. A high BMI might be a convenient clinical marker for healthcare personnel to identify hypertensive patients with possible OSA in need of further evaluation and treatment.

The promotion of self-care in patients with heart failure (HF) is a promising strategy for maintaining health and preventing exacerbation of HF and a continuous need for healthcare services. To assess patient self-care, valid and reliable instruments are needed, but there is no psychometrically tested instrument for use in a German HF population.

The aim of this study was to determine the validity and reliability of the German version of the 9-item European Heart Failure Self-care Behaviour Scale (G9-EHFScBS). Construct validity including factor analysis and discriminant validity, concurrent validity, test–retest reliability and internal consistency were analysed.

The G9-EHFScBS was translated into German, and its validity and reliability were tested with 109 patients. The item-total correlation ranged from 0.09 to 0.63. Internal consistency was fair, with a Cronbach’s alpha of 0.71 (95%CI: 0.63 to 0.77). Test–retest reliability using an intra-class correlation coefficient showed substantial agreement for the entire scale (ICC: 0.69; 95%CI: 0.56 to 0.79). The G9-EHFScBS was able to distinguish patients with and without extra HF education at a statistically significant level (t = 2.105; p = 0.04). A factor analysis did not show the theoretical assumed dimensions of the scale.

The G9-EHFScBS is deemed a valid and reliable instrument to assess HF-specific self-care in a German HF population.

The nurse’s role as educator has become very crucial in heart failure management; thus, nurses must be adequately prepared to undertake this task.

The main objective of the study was to estimate the level of Cypriot nurses’ knowledge on basic heart failure self-care principles.

A questionnaire measuring knowledge on heart failure self-care principles was administered among cardiology nurses working in five public urban hospitals of Cyprus. Data were analysed by using descriptive statistics, t-test and analysis of variance for categorical variables (such as gender and working setting) and correlation tests (Pearson’s) plus simple linear regression for continuous variables (such as working experience).

Participants were 143 nurses. The mean heart failure self-care knowledge score was 13.57/20 (SD 2.33). Gender, hospital and cardiac clinical experience do not significantly affect scoring. Significant difference in the knowledge score was observed among critical care, cardiology and medical unit nurses (f=4.1, p=0.018). Post hoc analysis showed that this significant difference originated from the comparison of critical care nurses with cardiology unit nurses (14.1, SD 2.3 vs. 13.0, SD 2.1 respectively). Correlation and linear regression analyses yielded only weak negative correlation between correct scoring and duration of nursing practice (r=−0.262, p=0.002), with 6% of the total variation in scoring being explained by this relationship.

Results are consistent with previous findings and it is thus under question whether cardiology nurses are properly educating their heart failure patients. Consequently, there is an urgent need for nurses to update their knowledge and enhance their educational skills.

Self-care behaviour in patients with heart failure (HF) represents a series of specific actions that patients should take, as an important treatment component.

The aim of this study was to identify potential determinants of HF self-care in ambulatory patients with stable systolic HF.

In a cross-sectional study of 318 patients with chronic systolic HF recruited in 48 German primary care practices, we evaluated the patient-reported European HF Self-care Behaviour scale (EHFScBs) assessments (range 12–60, where lower scores indicate better self-care). Potential determinants included socio-demographic (e.g. age, living status), clinical (e.g. NYHA class, LVEF, NT-proBNP levels, co-morbidities), behavioural (e.g. smoking and alcohol intake), psychosocial (SF-36 scales and KCCQ domains, e.g. quality of life and self-efficacy) and depression status (PHQ-D), plus previous health care utilisation. Mixed regression modelling was applied.

Patients had a mean (SD) age of 69.0 (10.4) years and were 71% male. They had a good overall EHFScBs score of 24.7 (7.8) (n=274). In the final regression model (n=271), six determinants were retained (β; descriptive p-value): self-efficacy (-0.24; <.001), age (-0.22; <.001), prosthetic heart valve (-0.14; .01), referrals to cardiologists (-0.14; .02), peripheral arterial disease (0.13; .03) and quality of life (0.16; .02).

In this exploratory cross-sectional study, the potential non-modifiable and modifiable risk factors and resources involved in patients’ HF self-care were at the individual and organisational level. Self-efficacy and quality of life are potentially modifiable, so these could be targeted for improvement by enhancing patient motivation, HF education and further supporting a collaborative care approach.

The most desirable outcome in heart failure (HF) management is to improve health-related quality of life (HRQoL) as a patient-centred health outcome. Nutrition is assumed to be important in HF management, whereas there is little evidence that nutritional risk affects HRQoL, except for sodium.

We aimed to determine whether nutritional risk is associated with worse HRQoL after controlling for daily sodium intake. Methods: A total of 134 consecutive patients with HF [age 63±11 years, 35% female, 45% New York Heart Association (NYHA) class III/IV, ejection fraction (EF) 33±13%] completed the Nutrition Screening Initiative (NSI) to assess nutritional risk and a 24-h urine sodium excretion assessment to estimate daily sodium intake at baseline. The Minnesota Living with HF Questionnaire was used to evaluate HRQoL at baseline and 6 months later. Hierarchical linear regressions were used to determine whether nutritional risk predicted HRQoL at baseline and 6 months later.

Seventy-eight (58.2%) patients had high nutritional risk as indicated by a total NSI score ≥6. Increased nutritional risk was independently associated with worse HRQoL at baseline and 6 months later (β=0.33, p<0.001; β=0.35, p<0.001, respectively), after controlling for age, gender, aetiology, body mass index, NYHA class, EF, total comorbidity score, prescribed medications, and daily sodium intake.

These findings show that higher nutritional risk beyond sodium intake affects worse HRQoL in patients with HF. Further work is required to provide specific dietary guidelines to improve health outcomes for patients with HF.

The accuracy of an indicator determines the direct relationship between a defining characteristic and the presence or absence of a specific nursing diagnosis.

To analyse the accuracy of the clinical indicators of ineffective airway clearance in patients during the postoperative period of cardiac surgery.

A total of 98 patients recruited from a postoperative unit were included in the study. An analysis of sensitivity, specificity, predictive value, likelihood ratio, diagnostic odds ratio, accuracy, and area under the ROC curve was used to determine the accuracy of these clinical indicators.

Four clinical indicators showed the highest levels of accuracy by statistical measure: dyspnoea, adventitious breath sounds, ineffective cough, and retained secretions. The indicators retained secretions and ineffective cough showed high diagnostic odds ratios (62.8 and 28.1, respectively).

The results suggest that there are differences between the ineffective airway clearance indicators as accuracy measures.

To reduce mortality and morbidity associated with acute coronary syndrome (ACS), individuals who experience ACS symptoms should seek treatment promptly. However, for this to be possible, they must adopt appropriate attitudes and beliefs about ACS symptoms and have the prerequisite knowledge to respond to those symptoms.

This paper details the results of a cross-sectional Irish study that measured knowledge, attitudes, and beliefs about ACS in patients diagnosed with ACS.

A total of 1947 patients were enrolled in the study. Recruitment took place across five academic teaching hospitals in Dublin, Ireland. Knowledge, attitudes, and beliefs about ACS were measured using the ACS Response Index questionnaire.

Almost half the patients (n=49.5%) demonstrated high knowledge levels (i.e. >70% of correct answers) about ACS symptoms. The majority recognized chest pain/pressure (98.9%) and left arm pain (90.2%) as symptoms. Many failed to associate jaw pain, heartburn and/or indigestion (44.7%), nausea and vomiting (47.6%), and neck pain (42.5%) with a heart attack. Higher knowledge levels were independently associated with higher levels of education (p=0.007), a history of angina (p=0.001), and attitudes (p=<0.001) and beliefs (p=<0.001) that are consistent with positively decisive responses to ACS symptoms.

Despite having experienced an ACS event, overall knowledge levels were poor. Higher knowledge levels were associated with better attitudes and beliefs, indicating the inextricable relationship between all three components. Educational programmes should incorporate all three components so that prompt behaviour can be initiated when symptoms arise.

Nurse researchers are exploring new ways of understanding heart failure (HF), spousal/partner dyad’s self care.

To assess the response to a new instrument developed to measure dyadic HF care type in HF patients and spousal/partner caregivers and explore relationships between type and other variables.

Dyads answered a written criterion referenced question related to dyadic HF care type. The relationships between the dyadic care type and sociodemographic and clinical variables were explored using χ 2, φ coefficient. Degree of agreement within the dyad on particular type was assessed by kappa statistic.

A total of 19 dyads were accrued. Patients were aged 71.7±9.7 years (mean±SD), male (n=15), and NYHA Class IIIB/IV (79%). Caregivers were aged 69.2±11.7 years, female (n=15), married for 45.2±14.1 years. HF patient and caregiver dyads were easily able to self select a dyadic type given specific criteria. Agreements ranged from 21% to 5%, by type, resulting in a kappa of 0.28 (p = 0.025) when patient self reported type was compared to their caregiver’s type.

Now that we are able to measure types of dyadic HF care, understanding how dyadic care type relates to self care outcomes is needed to advance the science.

Heart failure (HF) self-care is an important component of disease management and the focus of many interventions.

The aim of this study was to evaluate the validity and reliability of the nine-item European HF Self-care Behavior Scale (EHFScB-9) in a sample of 200 adults from the USA with symptomatic HF.

Psychometric tests included item and confirmatory factor analyses, convergent and discriminant validity, and internal consistency.

Item-total correlations ranged from 0.25 to 0.65. Many fit indices for the EHFScB-9 and the four-item consulting behaviors scale reached thresholds of acceptability. As expected, the EHFScB-9 was associated with other measures of HF self-care but not with quality-of-life. Coefficient α was 0.80 for the EHFScB-9 and 0.85 for the consulting behaviors subscale.

The EHFScB-9 was a valid and reliable measure of HF self-care among English-speaking US adults with symptomatic HF.