European Journal of Cardiovascular Nursing

The aim of this study was to synthesise and evaluate the effectiveness of mobile phone-based self-management interventions for medication adherence and change in blood pressure in patients with coronary heart disease.

Relevant randomised controlled trials evaluating mobile phone-based self-management interventions for medication adherence and/or change in blood pressure in coronary heart disease patients were identified by searching six electronic databases (PubMed, Cochrane, CINAHL, ProQuest, Scopus and EMBASE) from January 2008 to January 2019. The trials were screened, data were extracted and quality was assessed by two independent reviewers. Meta-analyses were performed for different outcomes while narrative syntheses were conducted for studies that could not be pooled or when there was the presence of high heterogeneity.

Fifteen trials were included in this review, of which 11 of these trials were meta-analysed. Mobile phone-based self-management interventions were associated with a statistically significant reduction in diastolic blood pressure (combined mean difference of −1.99 (95% confidence interval (CI) –3.20 to −0.78; P=0.0001)). However, the combined effect on medication adherence (medium size effect of d=0.72 (95% CI −0.32 to 1.75; P=0.17)) and change in systolic blood pressure (combined mean difference of −1.08 (95% CI −5.51 to 3.35; P=0.63)) was not statistically significant. There was significant heterogeneity among the trials reviewed.

Mobile phone-based self-management interventions have the potential to improve self-management and adherence in patients with coronary heart disease but better designed, conducted and reported trials are needed to demonstrate this.

Secondary prevention of cardiovascular disease is a significant clinical challenge and despite European Society of Cardiology (ESC) Guidelines, evidence confirms sub-optimal patient care.

The aim of this study was to evaluate ESC members’ opinions on the current provision of cardiovascular prevention and rehabilitation services across Europe and explore barriers to guideline implementation.

Electronic surveys using a secure web link were sent to members of the ESC in eight purposively selected ESC affiliated countries.

A total of 479 professionals completed the survey, of whom 67% were cardiologists, 8.6% general physicians, 8.2% nurses and 16.2% other healthcare professionals. Respondents were predominantly (91%) practising clinicians, generally highly motivated regarding cardiovascular disease prevention, but most reported that secondary prevention in their country was sub-optimal. The main barriers to prevention were lack of available cardiac rehabilitation programmes and long-term follow-up, patients’ disease perception and professional attitudes towards prevention. While knowledge of the prevention guidelines was generally good, practices such as motivational counselling and better educational tools were called for to promote exercise, smoking cessation and for nutritional aspects.

The provision of services focusing on the secondary prevention of cardiovascular disease varies greatly across Europe. Furthermore, despite ESC Guidelines and a strong evidence base supporting the efficacy of secondary prevention, the infrastructure and co-ordination of such care is lacking. In addition patient motivation is considered poor and some professionals remain unconvinced about the merits of prevention. The disappointing results outlined in this survey emphasise that improved tools are urgently required to educate both patients and professionals and confirm the priority of cardiovascular prevention internationally.

Chronic heart failure (CHF) is one of the most common causes of hospital admissions and readmissions. Managing CHF requires a comprehensive treatment plan that consists of medication treatment and behavioural change. However, patients often feel unprepared for their self-management role in the community, especially during the period of transition after discharge from hospital. Therefore, an effective intervention to promote CHF self-management is needed.

This paper describes the development and pilot testing of a multicomponent nursing intervention (i.e. the HOM-HEMP) for a randomised controlled trial to assess its effectiveness in improving self-care behaviour among CHF patients in Singapore. A description of the study intervention is also delineated in detail.

The HOM-HEMP was developed based on the UK Medical Research Council framework for developing and evaluating complex interventions. After the development of the study intervention, a single group pre- and post-repeated measure pilot test was conducted to evaluate the study intervention package for its acceptability and the feasibility of the data collection procedure. Ten participants were recruited through consecutive sampling. All of the participants received the full intervention package with the supplementary mobile application. The data were collected at baseline and immediately after the study intervention (i.e. 6 weeks from baseline). The outcome measures included the Self-Care Heart Failure Index, Cardiac Self-Efficacy Scale, Minnesota Living with Heart Failure Questionnaire, Hospital Anxiety and Depression Scale and Short Form of the Social Support Questionnaire.

The results from the pilot testing showed that the programme was feasible and potentially effective in improving patient’s self-care management, psychological outcomes and health-related quality of life.

A self-management psychosocial education approach is the preferred choice for many patients with chronic diseases. The effectiveness of the HOM-HEMP will next be tested in a full scale randomised control trial.

Early detection of metabolic syndrome is highly desirable for the prevention and treatment of various diseases. Therefore, this study aimed to develop and validate an anthropometry-based nomogram for predicting metabolic syndrome in a working population.

The present study was a secondary analysis of a cross-sectional study. A total of 60,799 workers in Spain were enrolled between 2012 and 2016, of which 50% were randomly assigned to the derivation cohort and the remainder to the validation cohort. Participants’ demographics and anthropometric variables were entered into least absolute shrinkage and selection operator (LASSO) regression for the selection of variables. Subsequently, multivariable logistic regression was performed to develop the predictive model and a nomogram. The discrimination ability, calibration curve analysis and decision curve analysis of the nomogram was evaluated. Internal validation of the model was also performed.

There were 2725 (9.0%) participants diagnosed with metabolic syndrome in the derivation cohort and 2762 (9.1%) participants in the validation cohort. Six variables (age, smoking, body fat percentage, waist circumference, systolic blood pressure and diastolic blood pressure were included in the nomogram. The area under the curve was 0.901 (95% confidence interval (CI) 0.895–0.906) and 0.899 (95% CI 0.894–0.905) for the predictive and internal validation, respectively. Furthermore, decision curve analysis showed that if the threshold probability of metabolic syndrome is less than 72.0%, application of this nomogram can benefit more than either the treat-all or treat-none strategies.

An anthropometry-based nomogram for predicting metabolic syndrome in a working population was developed that incorporates reliable non-invasive anthropometric features to facilitate health counselling and self-risk assessment of developing metabolic syndrome.

Adherence to secondary prevention is an indispensable part of the management of patients with coronary artery disease. Finding patient factors affecting their adherence behaviours is important for improving the treatment effect and limiting further disease progression.

To examine the association between health literacy, self-efficacy, disease knowledge and adherence to secondary coronary artery disease prevention in patients in China.

In this cross-sectional study, 598 patients with coronary artery disease were enrolled in two tertiary hospitals in China during a hospitalisation for receiving percutaneous coronary intervention. Patient-reported data were collected on demographics, health literacy, self-efficacy, disease knowledge and adherence to secondary coronary artery disease prevention (medication-taking and heart-healthy lifestyle (exercise, reducing/eliminating alcohol intake and smoking, low salt and fat diet, stress reduction)). Chi-squared tests and regression analyses were performed.

The proportions of recalled self-report of adherence to medication-taking and a heart-healthy lifestyle immediately prior to the coronary artery disease hospitalisation were 84.7% and 53.2%, respectively. In logistic regression, health literacy, self-efficacy and disease knowledge was significantly associated with non-adherence to secondary coronary artery disease prevention. Limited health literacy demonstrated a 1.61-fold odds for non-adherence to a heart-healthy lifestyle. Each score increase of self-efficacy and disease knowledge had 0.98-fold odds and 1.05-fold odds of non-adherence to a heart-healthy lifestyle.

Adherence to medication-taking was relatively good in Chinese patients prior to coronary artery disease hospitalisation, but adherence to heart-healthy lifestyle behaviours should be improved. Health literacy, self-efficacy and disease knowledge should be taken into account when intervening to improve secondary coronary artery disease prevention.

Attending and maintaining a cardiac rehabilitation programme is a challenge.

The purpose of this study was to explore associations between non-adherence to early coronary artery bypass graft rehabilitation and sociodemographic and clinical baseline data.

Coronary artery bypass graft patients were randomised 1:1 to either four weeks of comprehensive early rehabilitation or usual care. Outcomes were assessed at three time-points points: baseline, discharge and four weeks post-coronary artery bypass graft. Differences in sociodemographic and clinical baseline data in adherent versus non-adherent patients were tested using the Pearson χ² test for categorical variables. To test associations between non-adherence to exercise training and sociodemographic and clinical baseline data, multivariate logistic regression was used to estimate the odds ratio for in-hospital training and post-discharge training adjusted for age, sex and left ventricular ejection fraction.

Non-adherence to in-hospital versus post-discharge exercise training was 31% (n=48) versus 53% (n=81). Female non-adherence was 20% versus 70%. Non-adherence to in-hospital versus post-discharge mindfulness was 87% versus 70%. Male non-adherence to mindfulness was 85% versus 70%. Non-adherence to psycho-educational consultations was 3%, most of whom were men. Patients with university level education were more adherent to in-hospital exercise training than patients with lower educational level (odds ratio=3.14 (95% confidence interval; 1.16–8.51), p=0.02). Diabetic patients were more non-adherent to exercise training after discharge (3.74 (1.54–9.08), p=0.004) as were overweight patients (0.37 (0.17–0.80), p=0.01).

This study demonstrated wide acceptance of psycho-educational consultations in post-coronary artery bypass graft patients. Adherence to physical rehabilitation was low especially after discharge from hospital and the opportunity to attend a mindfulness programme was not used.

Patient-reported outcomes are important predictors of mortality, cardiovascular events and hospitalisation in patients with cardiac diseases, but differences in patient-reported outcomes between groups of patients with arrhythmia have not yet been investigated.

To describe and compare patient-reported outcomes at discharge among patients with different types of cardiac arrhythmia and to examine the associations between demographic characteristics, inhospital factors and patient-reported outcomes.

Data were derived from the national DenHeart study including patient-reported outcomes from the following questionnaires: the hospital anxiety and depression scale (HADS), HeartQoL, short form 12 (SF-12), current health status (EQ-5D), brief illness perception questionnaire (B-IPQ) and the Edmonton symptom assessment scale (ESAS). Clinical and demographic data were obtained from national registers. Multiple linear and logistic regression models were used to investigate the associations between the potential risk factors and the patient-reported outcomes.

A total of 4251 patients diagnosed with arrhythmia completed the questionnaire. Across the arrhythmia subgroups, some differences were observed. In general, patient-reported outcome scores were worst among patients with ‘ventricular arrhythmia’ (e.g. highest depression scores and highest prevalence of feeling unsafe at discharge). Regression analysis revealed that longer hospital stay, female gender, being unmarried and having a short education were significantly associated with poor health for almost all arrhythmia subgroups.

Differences exist in self-reported health, quality of life and symptom burden across arrhythmia groups with patients with ventricular arrhythmia reporting poorer patient-reported outcomes. Longer hospital stay, female gender, being unmarried and having a low level of education were significantly associated with worse outcomes among the total population.

Percutaneous coronary intervention is a common revascularisation technique. Serious complications are uncommon, but death is one of them. Seeking informed consent in advance of percutaneous coronary intervention is mandatory. Research shows that percutaneous coronary intervention patients have inaccurate perceptions of risks, benefits and alternative treatments.

To assess cardiologists’ and patients’ views about the informed consent process and anticipated treatment benefits.

Two cross-sectional, anonymous surveys were distributed in England: an electronic version to a sample of cardiologists and a paper-based version to patients recruited from 10 centres.

A sample of 118 cardiologists and 326 patients completed the surveys. Cardiologists and patients shared similar views on the purpose of informed consent; however, over 40% of patients and over a third of cardiologists agreed with statements that patients do not understand, or remember, the information given to them. Patients placed less value than cardiologists on the consent process and over 60% agreed that patients depended on their doctor to make the decision for them. Patients’ and cardiologists’ views on the benefits of percutaneous coronary intervention were significantly different; notably, 60% of patients mistakenly believed that percutaneous coronary intervention was curative.

The percutaneous coronary intervention informed consent process requires improvement to ensure that patients are more involved and accurately understand treatment benefits to make an informed decision. Redesign of the patient pathway is recommended to allow protected time for health professionals to engage in discussions using evidence-based approaches such as ‘teach back’ and decision support which improve patient comprehension.