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    Checking the moderating effect of perceived control on the relationship between anxiety and postoperative hospital length of stay among coronary artery bypass graft patients. AbuRuz Mohannad Eid,Al-Dweik Ghadeer,Al-Akash Hekmat Yousef International journal of general medicine BACKGROUND:Coronary artery disease (CAD) is the most common cardiovascular disease (CVD). Coronary artery bypass graft (CABG) surgery is the most common treatment used for CAD. Patients undergoing this surgery are always anxious, which might increase complications in the postoperative period, especially prolongation of postoperative length of stay (LOS). It has been shown that perceived control (PC) moderated the relationship between anxiety and complications in a cardiac population, but its effect has not been studied in post-CABG. AIM:The aim of this study was to check if there is a moderating effect for the PC on the relationship between anxiety and LOS post-CABG. PATIENTS AND METHODS:A non-experimental, prospective, observational study was conducted with a consecutive sample of 250 patients who underwent elective CABG from four hospitals in Amman, Jordan. PC was measured by the Arabic version of the Control Attitude Scale-Revised (CAS-R), and anxiety was measured by the Arabic version of the anxiety subscale of Hospital Anxiety and Depression Scale. LOS and other needed information were obtained from patients' medical records. RESULTS:Preoperative anxiety was significantly higher than postoperative anxiety (mean [SD]: 12.80 [6.70] vs 11.01 [6.74], <0.001). Female patients were more anxious and had longer LOS compared to male patients. In stepwise regression, anxiety and PC scores were independent predictors for LOS. Every unit increase in preoperative anxiety increased LOS by 0.381 days, and every unit increase in PC decreased the postoperative LOS by 0.210 days. Moderating effect was checked by simple slope analysis for high (+1 SD) and low (-1 SD) levels of PC. Patients with high anxiety and low PC had the longest LOS, and patients with low anxiety and high PC had the shortest LOS, indicating the moderating effect of PC on the relationship between anxiety and LOS. CONCLUSION:High levels of anxiety were associated with longer LOS after CABG. PC moderates this relationship. Enhancing PC in this population can improve outcomes and decrease LOS and morbidity. 10.2147/IJGM.S192333
    Linguistic and Psychometric Validation of the Chinese Version of the Control Attitudes Scale-Revised in Patients With Chronic Heart Failure. The Journal of cardiovascular nursing BACKGROUND:The concept of perceived control reflects the belief that one has resources needed to cope with negative events and the ability to positively influence consequences of those negative events. In patients with heart failure, perceived control is associated with a variety of health outcomes. Perceived control is commonly measured using the Control Attitudes Scale-Revised (CASR). There is no Chinese version of the CAS-R (CCAS-R). OBJECTIVE:The purpose of this article was to perform linguistic validation and psychometric evaluation of the CCAS-R. METHODS:The CAS-R was translated into Chinese according to Brislin's model. Then, a multicenter observational study was performed. Floor and ceiling effects, internal consistency, structural validity, and hypothesis testing were all assessed for psychometric validation of the CCAS-R. RESULTS:A total of 227 patients with chronic heart failure were included. There were no ceiling or floor effects detected. Cronbach α was 0.94, indicating a high reliability. The results of the confirmatory factor analysis showed that the 1-factor structure as proposed by the original CAS-R fits the data well. The results of the principal component analysis suggested that the 1-factor structure was optimal as well, accounting for 71.6% of the total variance. The a priori hypothesis was supported by a statistically significant correlation between the CCAS-R and 3 theoretically related variables. CONCLUSION:We developed a semantically equivalent version of the CAS-R in Chinese. The evaluation of the instruments' psychometric properties demonstrated that the CCAS-R has good reliability and validity for use in Chinese patients with chronic heart failure. 10.1097/JCN.0000000000000705
    Psychometric Validation of the Mandarin Version Control Attitudes Scale-Revised Questionnaire in Taiwanese Patients With Heart Failure. Huang Tsuey-Yuan,Hwang Shiow-Li The Journal of cardiovascular nursing BACKGROUND:Perceived control is an important construct in patients with heart failure (HF) and related to improved health outcomes. There is no reliable and valid instrument available for the measurement of perceived control in Taiwan, limiting the practical application of the construct in research and clinical practice. PURPOSE:The aim of this study was to translate, culturally adapt, and validate the Mandarin version of the Control Attitudes Scale-Revised (Mandarin CAS-R) in Taiwanese patients with HF. METHODS:The Mandarin CAS-R was developed using a translation/back-translation process and semantic equivalence; importantly, conceptual equivalence was also examined. Reliability was assessed using Cronbach's α to determine internal consistency, and item homogeneity was assessed using item-total and interitem correlations. Construct validity was examined using exploratory factor analysis and hypothesis testing for known associations. RESULTS:Three hundred forty-eight patients with HF were included, and 5-item Mandarin CAS-R was validated in the study. The model performance was acceptable with all factor loadings greater than 0.70, a variance explained of 55.2%, and a Cronbach's α of .79. The 5-item Mandarin CAS-R was associated with higher levels of self-care maintenance (β = 0.395, P < .001), management (β = 0.219, P < .01), and confidence (β = 0.524, P < .001); perceived social support (β = 0.246, P < .001); and depression (β = -0.125, P < .05). CONCLUSIONS:This study provided evidence of the reliability and validity of the 5-item Mandarin CAS-R as a measure of perceived control in Taiwanese patients with HF. 10.1097/JCN.0000000000000431
    Fatigue Is Associated With Diminished Cardiovascular Response to Anticipatory Stress in Patients With Coronary Artery Disease. Frontiers in physiology BACKGROUND:Fatigue and psychophysiological reactions to mental stress are known to be problematic in coronary artery disease (CAD) patients. Currently, studies exploring the relationship between fatigue and cardiovascular reactivity to stress are scarce and inconsistent. The current study aimed to investigate the links between cardiovascular response to mental stress and fatigue in CAD patients after acute coronary syndrome (ACS). METHODS:The cross-sectional study investigated 142 CAD patients (85% males, 52 ± 8 years) within 2-3 weeks after recent myocardial infarction or unstable angina pectoris. Fatigue symptoms were measured using Multidimensional Fatigue Inventory 20-items, while cardiovascular reactivity to stress [i.e., systolic (S) and diastolic (D) blood pressure (ΔBP), and heart rate (ΔHR)] was evaluated during Trier Social Stress Test (TSST). In addition, participants completed psychometric measures, including the Hospital Anxiety and Depression scale and the Type D Scale-14. Multivariable linear regression analyses were completed to evaluate associations between fatigue and cardiovascular response to TSST, while controlling for confounders. RESULTS:After controlling for baseline levels of cardiovascular measures, age, gender, education, heart failure severity, arterial hypertension, smoking history, use of nitrates, anxiety and depressive symptoms, Type D Personality, perceived task difficulty, and perceived task efforts, cardiovascular reactivity to anticipatory stress was inversely associated with both global fatigue (ΔHR: β = -0.238; = 0.04) and mental fatigue (ΔSBP: β = -0.244; = 0.04; ΔHR β = -0.303; = 0.01) as well as total fatigue (ΔSBP: β = -0.331; = 0.01; ΔHR: β = -0.324; = 0.01). CONCLUSION:In CAD patients after ACS, fatigue was linked with diminished cardiovascular function during anticipation of a mental stress challenge, even after inclusion of possible confounders. Further similar studies exploring other psychophysiological stress responses are warranted. 10.3389/fphys.2021.692098
    The Control Attitudes Scale-Revised: psychometric evaluation in three groups of patients with cardiac illness. Moser Debra K,Riegel Barbara,McKinley Sharon,Doering Lynn V,Meischke Hendrika,Heo Seongkum,Lennie Terry A,Dracup Kathleen Nursing research BACKGROUND:Perceived control is a construct with important theoretical and clinical implications for healthcare providers, yet practical application of the construct in research and clinical practice awaits development of an easily administered instrument to measure perceived control with evidence of reliability and validity. OBJECTIVE:To test the psychometric properties of the Control Attitudes Scale-Revised (CAS-R) using a sample of 3,396 individuals with coronary heart disease, 513 patients with acute myocardial infarction, and 146 patients with heart failure. METHODS:Analyses were done separately in each patient group. Reliability was assessed using Cronbach's alpha to determine internal consistency, and item homogeneity was assessed using item-total and interitem correlations. Validity was examined using principal component analysis and testing hypotheses about known associations. RESULTS:Cronbach's alpha values for the CAS-R in patients with coronary heart disease, acute myocardial infarction, and heart failure were all greater than .70. Item-total and interitem correlation coefficients for all items were acceptable in the groups. In factor analyses, the same single factor was extracted in all groups, and all items were loaded moderately or strongly to the factor in each group. As hypothesized in the final construct validity test, in all groups, patients with higher levels of perceived control had less depression and less anxiety compared with those of patients who had lower levels of perceived control. CONCLUSION:This study provides evidence of the reliability and validity of the 8-item CAS-R as a measure of perceived control in patients with cardiac illness and provides important insight into a key patient construct. 10.1097/NNR.0b013e3181900ca0
    Perceived control moderates the relationship between anxiety and in-hospital complications after ST segment elevation myocardial infarction. AbuRuz Mohannad Eid Journal of multidisciplinary healthcare PURPOSE:Anxiety is a common psychological response after acute myocardial infarction and might be associated with higher levels of in-hospital complications. Perceived control might moderate this relationship, but the effect of this method has not been checked in developing countries. Therefore, the objectives of this study were as follows: 1) to check if anxiety was an independent predictor of in-hospital complications after acute myocardial infarction; and 2) to check if perceived control moderates the relationship between anxiety and in-hospital complications after acute myocardial infarction. PATIENTS AND METHODS:This was a prospective observational study among 500 patients with a confirmed diagnosis of ST segment elevation myocardial infarction recruited from three private hospitals in Amman, Jordan. Anxiety was measured by the Anxiety subscale of Hospital Anxiety and Depression Scale, and perceived control was measured by the Arabic version of the Control Attitude Scale-Revised. RESULTS:One hundred and forty patients (28%) developed at least one complication during hospitalization. Two hundred and fifty-five patients had low anxiety scores (≤7), and 245 patients had high anxiety scores (≥8). Patients with high levels of perceived control had lower levels of anxiety (mean [SD]; 5.3 [3.6] vs 14.1 [6.3], <0.001) than those with low perceived control. In logistic regression, anxiety was an independent predictor of in-hospital complications after controlling for sociodemographic and clinical variables (odds ratio: 1.24, 95% CI, 1.08-1.41, <0.01). Moreover, the interaction of anxiety and perceived control was a significant predictor of complications. CONCLUSION:Anxiety was associated with increased risk of in-hospital complications after acute myocardial infarction independent of sociodemographic and clinical variables. Perceived control had a moderating effect for this association since the combination of low perceived control and high anxiety scores was associated with the greatest risk for complications. Supporting patients' levels of perceived control can decrease complications, morbidities, and mortality after acute myocardial infarction. 10.2147/JMDH.S170326
    Patients with ST segment elevation myocardial infarction: moderating effect of perceived control on the relationship between depression and in-hospital complications. AbuRuz Mohannad Eid BMC cardiovascular disorders BACKGROUND:Cardiovascular diseases remain the top global killer, with nearly 80% of related mortalities occurring in developing countries. Over half of cardiovascular diseases' mortality is due to coronary heart disease, which is commonly linked to acute myocardial infarction. Psychological factors (i.e., depression and anxiety) after acute myocardial infarction are associated with higher levels of complications and mortality. Perceived control moderated the effect of anxiety on complications in different cardiac populations, but impacts on depression and complications after acute myocardial infarction are not well studied. This study explores the moderating effect of perceived control on the relationship between depression and complications after ST segment elevation myocardial infarction. METHODS:Three hundred patients with a confirmed diagnosis of ST segment elevation myocardial infarction participated in this prospective observational study. Patients answered socio-demographic data, the depression subscale of the Hospital Anxiety and Depression Scale (HADS), and the Control Attitude Scale-Revised (CAS-R) questionnaires. In-hospital complications and all other necessary data were extracted from medical records after discharge. Data were analyzed using logistic regression. RESULTS:24% developed at least one complication. Patients with high depression scores (8-21) were more likely to develop complications (χ = 34.15, p < .001) than those with low depression scores (0-7). Patients with high levels of perceived control had lower levels of depression than those with low perceived control (mean [SD], 9.47 [6.43] vs. 12.31 [6.66], p < .001). The results of logistic regression showed that perceived control moderated the association between depression and complications, since depression scores, perceived control scores, and the interaction between depression and perceived control were significant predictors of complications. Participants with high depression and low perceived control had the highest rate of complications (31.5% vs. 15.4%, P < .001). CONCLUSIONS:Depression increased complications after ST segment elevation myocardial infarction. Perceived control moderated this relationship. Assessment of depression and enhancement of perceived control in patients with acute myocardial infarction can decrease complications and improve outcomes. 10.1186/s12872-019-1126-z
    Illness perceptions of Israeli hospitalized patients with acute coronary syndrome. Nursing in critical care BACKGROUND:Illness perceptions (IPs) can affect cardiac health behaviours and outcomes. AIMS AND OBJECTIVES:To investigate IPs among patients hospitalized with acute coronary syndrome (ACS). DESIGN:Longitudinal survey. METHODS:The ACS Israel Study is a national, biennial registry, enrolling all patients with ACS admitted to cardiac intensive care or cardiology wards in Israel within a 2-month period. Data includes demographics, medical history, and treatment for ACS using an electronic database. In 2018, a nursing component was added, including the Brief Illness Perception Questionnaire. Data were analysed using descriptive statistics and a two-stage cluster analysis. RESULTS:A total of 990 subjects were surveyed. Mean age was 62.8 (SD = 12.5) and most respondents were male and married. Mean IP scores ranged from 3.28 to 6.06. Three clusters were found; one only of women and two only of men (one cluster with lower IPs and little previous medical history and cardiac risk factors and the second with higher IPs, greater medical history, and cardiac risk factors. Those with higher education scored lower on several IPs. CONCLUSIONS:Subjects were moderately cognitively and emotionally impacted by their illness. Men tended to perceive their illness as having either a relatively strong or a relatively weak emotional and cognitive impact on their lives, where women were somewhere in-between. Participants with an academic education perceived less of an impact of the illness while those with a previous history of chronic disease reported the opposite. It is recommended that educational interventions and in-depth qualitative studies be designed that investigate the development of IPs during hospitalization to potentially improve cardiac health behaviours, especially among those without a previous medical history and cardiac risk factors. RELEVANCE TO CLINICAL PRACTICE:Those without a history of chronic disease or a lower level of education are less likely to absorb the full impact of a cardiac event while hospitalized and should, therefore, be monitored more closely and coached with greater intensity than other groups while still in-hospital. 10.1111/nicc.12616
    Factors associated with anxiety and depression in hospitalized patients with first episode of acute myocardial infarction. Alexandri Angeliki,Georgiadi Elpida,Mattheou Paschalia,Polikandrioti Maria Archives of medical sciences. Atherosclerotic diseases INTRODUCTION:Evaluation of anxiety and depression in cardiac patients is an area of nursing practice that is frequently neglected. The aim of the study was to explore anxiety and depression in hospitalized patients with their first episode of acute myocardial infarction. MATERIAL AND METHODS:The study sample included 148 hospitalized patients who had a first episode of acute myocardial infarction. Data collection was performed by the interview method using a specially designed questionnaire which included socio-demographic, clinical and other patients' characteristics as well as the Hospital Anxiety and Depression Scale (HADS) to assess patients' levels of anxiety and depression. RESULTS:Analysis of data showed that 52% and 38% of participants had high levels of anxiety and depression, respectively. Furthermore, anxiety levels revealed a statistically significant association with anxiolytics ( = 0.005) and antidepressant medication ( = 0.026) in hospital, the belief that they will face difficulties in relations with the social and family environment ( = 0.009 and = 0.002, respectively) and whether they considered themselves anxious ( = 0.003). Depression was statistically significantly associated with education level ( = 0.001), profession ( = 0.007), antidepressant medication in hospital ( ≤ 0.001), patients' relations with nursing staff ( = 0.019) and patients' belief that they will face difficulties in relations with the social and family environment ( ≤ 0.001 and ≤ 0.001, respectively). CONCLUSIONS:The results showed that socio-demographic and clinical characteristics should be taken into serious consideration when exploring anxiety and depression in patients with a first episode of acute myocardial infarction in order to implement appropriate interventions. 10.5114/amsad.2017.72532
    Effect of PCI Standardized Telephone Follow-Up Service Mode on Out-of-Hospital Complications, Rehospitalization Rate, and Quality of Life of Discharged Patients with Acute Coronary Syndrome after PCI. Computational and mathematical methods in medicine Objective:To explore the effect of percutaneous coronary intervention (PCI) standardized telephone follow-up service mode on out-of-hospital complications, rehospitalization rate, and life quality of discharged acute coronary syndrome (ACS) patients after PCI. Methods:From August 2020 to March 2022, 218 ACS patients who were discharged after PCI were included. The controls accepted routine nursing care, and the researches accepted PCI standardized telephone follow-up service mode. The nursing satisfaction, rehospitalization rate, out-of-hospital complication rate, blood lipid level, and life quality score were taken as the comparisons. Results:The nursing satisfaction of study group (100.00%) was significantly higher than that of control group (88.07%). The rehospitalization rate was dramatically lower in the study group (3/109; 2.75%) than in the control group (25/109; 22.94%) ( < 0.05). In addition, compared with the control group, the incidence of complications (acute myocardial infarction and angina pectoris) was significantly reduced in the study group outside the hospital ( < 0.05). The blood lipid levels of TCHO, TG, LDL-C, and HDL-C were lower in the study group than in the controls. Further, after nursing, the quality of life score of the two groups was both decreased with a higher quality of life score in the study group ( < 0.05). Conclusion:The application of PCI standardized telephone follow-up service mode in discharged patients with acute coronary syndrome after PCI can reduce out-of-hospital complications and rehospitalization rate and improve blood lipid level and life quality. 10.1155/2022/4319887
    Effect of the WeChat Platform Health Management and Refined Continuous Nursing Model on Life Quality of Patients with Acute Myocardial Infarction after PCI. Journal of healthcare engineering The purpose was to explore the effect of the WeChat platform health management and refined continuous nursing model on life quality of patients with acute myocardial infarction (AMI) after PCI. 100 AMI patients treated in the cardiovascular medicine of the First Affiliated Hospital of Soochow University from June 2018 to June 2019 were selected as the study subjects and randomly divided into research group and reference group, with 50 cases in each group. The reference group received routine nursing after PCI, while the research group received WeChat platform health management and continuous refined nursing. There were no significant differences in sex ratio, age, BMI, complications, education level, and residence between the two groups of patients ( > 0.05). The MPR values of patients in the two groups after intervention were significantly higher than those before intervention ( < 0.05), and the MPR value in the research group after intervention was significantly higher than that in the reference group ( < 0.05). The SF-36 scores of patients in the two groups after intervention were significantly higher than those before intervention ( < 0.001), and the SF-36 score in the research group after intervention was higher than that in the reference group ( < 0.001). The emotional, physical, and economic dimensions of patients in the research group after intervention were significantly lower than those in the reference group ( < 0.001). The HAMA and HAMD scores of patients in the research group after intervention were significantly lower than those in the reference group ( < 0.001). The nursing satisfaction score of patients in the research group was significantly higher than that in the reference group ( < 0.001). The total incidence of complications of patients in the research group after intervention was significantly lower than that in the reference group ( < 0.05). The WeChat platform health management and refined continuous nursing model can effectively improve the medication compliance of patients after PCI, improve the life quality, alleviate depression and anxiety, and reduce postoperative complications, with a definite effect, which is worthy of promotion and application. 10.1155/2021/5034269
    Incidence and predictors of delirium on the intensive care unit after acute myocardial infarction, insight from a retrospective registry. Jäckel Markus,Zotzmann Viviane,Wengenmayer Tobias,Duerschmied Daniel,Biever Paul M,Spieler Derek,von Zur Mühlen Constantin,Stachon Peter,Bode Christoph,Staudacher Dawid L Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions OBJECTIVES:This study aimed to identify the incidence and potential risk factors for delirium after myocardial infarction (MI). BACKGROUND:Delirium is a common complication on intensive care units. Data on incidence and especially on predictors of delirium in patients after acute MI are rare. METHODS:In this retrospective study, all patients hospitalized for MI treated with coronary angiography in an university hospital in 2018 were included and analyzed. Onset of delirium within the first 5 days after MI was attributed to the MI and was defined by a Nursing Delirium screening scale (NuDesc) ≥2. This score is taken as part of daily care in every patient on intensive care unit three times a day by especially trained nurses. RESULTS:A total of 624 patients with MI (age 68.5 ± 13.2 years, ST-elevation MI 41.6%, hospital mortality 3.2%) were included in the study. Delirium was detected in 10.9% of all patients. In the subgroup of patients with a stay on the intensive care unit (ICU) for more than 24 hr (n = 229), delirium was detected in 29.7%. Hospital and ICU stay were significantly longer in patients with delirium (p < .001). Delirium was an independent predictor of prolonged ICU-stay. Independent predictors of delirium were age, dementia, alcohol abuse, cardiac arrest, hypotension, and leucocytosis. Infarct size or presentation with ST-elevation were not associated with incidence of delirium. CONCLUSION:Development of delirium is frequent after acute MI and prolongs hospitalization. Incidence of delirium is associated with clinical instability, preexisting comorbidity, and age rather than MI type or size. 10.1002/ccd.29275
    The postcoronary patient. Evaluating feeding activities in a CCU. Merkel R,Brown C M The American journal of nursing
    Patients' perceptions in the CCU. Graham L E The American journal of nursing
    Individual and institutional factors affecting cardiac monitoring in coronary care units: a national survey of Chinese nurses. Zhou Lin,Tao Zhenhui,Wu Ying,Wang Naqing,Chen Tinghui,Song Yang,Deng Ying,Zhang Yarong International journal of nursing studies BACKGROUND:As cardiovascular diseases have become the leading cause of death in many countries including China, nurses are increasingly required to be abreast of technological advances and the skills necessary to manage this increasing health care problem. Chinese nurses are under pressure to provide skilled electrocardiography monitoring, and be sufficiently skilled to detect myocardial ischemia and infarction, in this large patient population. This presents a challenge for the nursing profession in China, particularly for nurses working in coronary care in a country where advancement has been so rapid, yet little research has been conducted or reported in the literature. OBJECTIVES:The two main objectives were: to explore the demographic and educational factors that affect the use of ST-segment monitoring and correct electrode placement by CCU/ICU nurses in China; and to explore the factors both individual and institutional that affect monitoring and lead placement. METHODS:A self-administered questionnaire was distributed to nurses in 126 randomly selected tertiary hospitals, which were stratified into three homogeneous regions across China. The instrument examined demographics, information about hospitals, electrocardiogram devices, current practice patterns and perceptions toward monitoring and lead placement. Data from 734 nurses and 59 nurse managers from 59 hospitals were analyzed using t-tests, ANOVA, Chi-square test and logistic regression. RESULTS:Electrocardiogram monitoring was used to detect myocardial ischemia by 43.7% of respondents, and 35.1% selected leads according to electrocardiogram or angiography findings. Most (70%) agreed that monitoring for acute coronary syndrome was important, while 39.2% did so, and 15.7% were able to identify correct placement. Logistic regression revealed a significant relationship between the uses of ST-segment monitoring and number of hospital beds, continuing education and a belief in its use and ease of use. Correct electrode placement was significantly correlated with respondents from university hospitals, hospitals with more acute coronary syndrome admissions and more independent thinking nurses. CONCLUSIONS:Despite best practice evidence, less than half of the sample used electrocardiogram monitoring to detect myocardial ischemia and the majority could not identify correct electrode placement, while ST-segment monitoring was not used routinely. This paper highlights the need for improvements in education both in universities and hospitals and discussion addresses conventions in units, which inhibit development of nurses' skills. 10.1016/j.ijnurstu.2011.10.004
    Comparison of risk factors of CHD in the men and women with MI. Ilali E,Taraghi Z Pakistan journal of biological sciences : PJBS The purpose of this study is comparison of risk factors of MI in hospitalized men and women patients in CCU. The CHD is the most important cause of mortality in the industry countries. Different environmental and race in each location can affect on frequency of risk factors of MI. In this cross sectional study, comparison was done between men and women who have involved in MI. The random sampling method was used Blood sugar, cholesterol and homocystein, LPa, BMI, family history, skin color, smoking and the amount of activity were assessed with variables such as age. The data was collected via questionnaire from September until March 2004-2005. Finally the data were analyzed with using t-test, Chi square and pearson correlation. In this research 169 patients who involved in MI (114 men and 55 women) have participated. The mean of age in the men was 55.4 and in the women was 61.02. All patients had risk factors. In the men, smoking (52.6%) and family history (41.1%) were the most common risk factors of MI. In the women, hyperlipidemia (66.4%), diabetes (62%) and hypertension (58.2%) were the most common risk factors of MI. The mean of BMI in the men was 25.9 +/- 4.25 and in the women was 27.6 +/- 4.71. The mean of LPa in the men was 59.2 +/- 4.21 and in the women was 50.9 +/- 4.25. the mean of homocystein in the men was 10.7 +/- 7.67 and in the women was 8.9 +/- 14.45. Diabetes, hyperlipidemia, hypertension and smoking had significant relationship with age and sex (p < 0.001) and skin color, homocystein, LPa, job, personality type and mobility didn't have significant relationship with age and sex. In this study the most common risk factors of MI in the men were smoking and positive family history and in the women were known hyperlipidemia and diabetes.
    Critical care unit transfer: reducing patient stress through nursing interventions. Schwartz L P,Brenner Z R Heart & lung : the journal of critical care Thirty patients hospitalized with acute myocardial infarction were studied by means of comparison of randomized groups to determine the effectiveness of two different nursing interventions on reducing the stress associated with CCU transfer. In order to promote continuity of patient care, one intervention implemented a family centered nursing approach while the other established a staff nurse-patient relationship prior to transfer to the general medical unit. Inferences as to the relationship between each of the nursing interventions and reduction of patient stress during the CCU transfer period were based on a comparison of the mean scores of psychosocial and physiological measures for the experimental and control groups. Six variables were measured. Overall, experimental patients in each group scored lower than control patients for (1-3) patient stress as reported by patient, family, and nurse, (4) cardiovascular complications within 24 hours of transfer, and (5) cardiovascular complications 24 to 72 hours after transfer; no difference was found in (6) physical complaints reported by the patient the evening of transfer.
    Assessing the information needs of post-myocardial infarction patients: a systematic review. Scott J Tim,Thompson David R Patient education and counseling We systematically reviewed studies examining information needs of post-myocardial infarction patients and their families. Electronic databases and bibliographies of relevant papers were searched and experts in the field contacted to find relevant studies. A standardised data form was used to extract data on study populations, instruments and results. Of 14 published studies, 6 used the same instrument. Information about risk factors ranked as the most important category overall, followed by information on cardiac anatomy and physiology, medications, and physical activity. Information about miscellaneous items, diet, psychological factors, and the CCU, although ranked lower, were still rated important. Some variation between settings was evident. Patients preferred physicians over nurses as information givers. Differences were found between patient and nurse ratings of information categories. Differences were found in the self-perceived information needs of patients responding to different instruments, indicating a priming effect. Changes in ranking of information categories between CCU, PCCU and PD are congruent with decreasing levels of patient dependency. The information needs of women and other post-MI subgroups, including the elderly, minority ethnic groups, patients with severe coronary disease, and deprived patients, have not been assessed. Patients have not been involved in the design of information needs assessment instruments.
    The Cardiovascular Intensive Care Unit-An Evolving Model for Health Care Delivery. Loughran John,Puthawala Tauqir,Sutton Brad S,Brown Lorrel E,Pronovost Peter J,DeFilippis Andrew P Journal of intensive care medicine Prior to the advent of the coronary care unit (CCU), patients having an acute myocardial infarction (AMI) were managed on the general medicine wards with reported mortality rates of greater than 30%. The first CCUs are believed to be responsible for reducing mortality attributed to AMI by as much as 40%. This drastic improvement can be attributed to both advances in medical technology and in the process of health care delivery. Evolving considerably since the 1960s, the CCU is now more appropriately labeled as a cardiac intensive care unit (CICU) and represents a comprehensive system designed for the care of patients with an array of advanced cardiovascular disease, an entity that reaches far beyond its early association with AMI. Grouping of patients by diagnosis to a common physical space, dedicated teams of health care providers, as well as the development and implementation of evidence-based treatment algorithms have resulted in the delivery of safer, more efficient care, and most importantly better patient outcomes. The CICU serves as a platform for an integrated, team-based patient care delivery system that addresses a broad spectrum of patient needs. Lessons learned from this model can be broadly applied to address the urgent need to improve outcomes and efficiency in a variety of health care settings. 10.1177/0885066615624664
    The effect of individualized education on the transfer anxiety of patients with myocardial infarction and their families. Tel Havva,Tel Hatice Heart & lung : the journal of critical care OBJECTIVE:The study determines the effect of individualized education on the anxiety level of patients with myocardial infarction and their families who are being transferred from the coronary care unit (CCU) to the general care unit. METHODS:The study consisted of experimental and comparison groups, and took place in a CCU of a teaching hospital. The study included 90 patients with myocardial infarction who were admitted to the CCU and 90 individuals who were the relatives of the patients. A personal characteristics information form was used that contained descriptive information about the patients and their relatives, a disease information form containing questions related to the disease and lifestyle habits, and Spielberger's State-Trait Anxiety Inventory. RESULTS:We found that the relatives and patients in the CCU experienced anxiety on the second day of admission and on the day of transfer. There was a statistically significant difference between the experimental and comparison groups with respect to the level of anxiety for the patients and their relatives on the second CCU day and on the day of transfer (P<.01). CONCLUSION:Patients in the CCU and their relatives experience anxiety. An individualized education program is effective in decreasing the anxiety of patients and their relatives when the patients are transferred from the CCU to the general care unit. 10.1016/j.hrtlng.2005.09.001
    The role of peer support education model on the quality of life and self-care behaviors of patients with myocardial infarction. Ebrahimi Hossein,Abbasi Ali,Bagheri Hossein,Basirinezhad Mohammad Hasan,Shakeri Sara,Mohammadpourhodki Reza Patient education and counseling OBJECTIVE:This study aimed to assess the effect of peer education on the quality of life and self-care behaviors of patients with myocardial infarction. METHODS:In this clinical trial, 70 patients with myocardial infarction meeting the inclusion criteria were assigned to experimental (n = 35) or control (n = 35) groups using block randomization. Patients in the intervention group received two one-hour training sessions on the third day after myocardial infarction during the CCU stay along with routine care. Education intervention was performed by peers. The control group will follow routine care. All patients selected were assessed using McNews' quality of life questionnaire and Miller self-care questionnaire, respectively before the intervention and also one month after discharge. Chi-square and t-test were used to analyze the data. RESULTS:After the intervention, the mean of quality of life and the mean score of self-care behaviors in the experimental group were significantly higher compared to the control group. CONCLUSIONS:According to the results, to improve the quality of life and promote the self-care behaviors in such patients, using peer education along with healthcare professionals is recommended. PRACTICE IMPLICATION:This patient education approach had a significant impact on quality of life and self-care behavior. 10.1016/j.pec.2020.08.002
    Stress reduction prolongs life in women with coronary disease: the Stockholm Women's Intervention Trial for Coronary Heart Disease (SWITCHD). Orth-Gomér Kristina,Schneiderman Neil,Wang Hui-Xin,Walldin Christina,Blom May,Jernberg Tomas Circulation. Cardiovascular quality and outcomes BACKGROUND:Psychosocial stress may increase risk and worsen prognosis of coronary heart disease in women. Interventions that counteract women's psychosocial stress have not previously been presented. This study implemented a stress reduction program for women and investigated its ability to improve survival in women coronary patients. METHODS AND RESULTS:Two hundred thirty-seven consecutive women patients, aged 75 years or younger, hospitalized for acute myocardial infarction, coronary artery bypass grafting, or percutaneous coronary intervention were randomized to a group-based psychosocial intervention program or usual care. Initiated 4 months after hospitalization, intervention groups of 4 to 8 women met for a total of 20 sessions that were spread over a year. We provided education about risk factors, relaxation training techniques, methods for self-monitoring and cognitive restructuring, with an emphasis on coping with stress exposure from family and work, and self-care and compliance with clinical advice. From randomization until end of follow-up (mean duration, 7.1 years), 25 women (20%) in the usual care and 8 women (7%) in the stress reduction died, yielding an almost 3-fold protective effect of the intervention (odds ratio, 0.33; 95% CI, 0.15 to 0.74; P=0.007). Introducing baseline measures of clinical prognostic factors, including use of aspirin, beta-blockers, angiotensin-converting enzyme inhibitors, calcium-channel blockers, and statins into multivariate models confirmed the unadjusted results (P=0.009). CONCLUSIONS:Although mechanisms remain unclear, a group-based psychosocial intervention program for women with coronary heart disease may prolong lives independent of other prognostic factors. 10.1161/CIRCOUTCOMES.108.812859
    The effects of exercise training programs on psychosocial improvement in uncomplicated postmyocardial infarction patients. Taylor C B,Houston-Miller N,Ahn D K,Haskell W,DeBusk R F Journal of psychosomatic research To determine the effects of exercise training programs on psychosocial improvement in uncomplicated postmyocardial infarction patients, 210 male patients hospitalized for an acute myocardial infarction (MI) were randomized to three week symptom limited treadmill (TM) plus home exercise training, TM plus medically supervised gym training, TM without formal exercise program or control, where patients were seen only at six months post MI. Patients in this sample were at low risk for psychosocial disturbance (13% were moderate to severely depressed, 23% reported marital disturbance and 3% were extremely anxious). Patients in the training groups improved from 3 to 26 weeks post MI on all depression and anxiety measures. The gym training group showed a significant reduction on one depression measure compared to no training and on one anxiety measure compared to controls.
    Enhanced depression care for patients with acute coronary syndrome and persistent depressive symptoms: coronary psychosocial evaluation studies randomized controlled trial. Davidson Karina W,Rieckmann Nina,Clemow Lynn,Schwartz Joseph E,Shimbo Daichi,Medina Vivian,Albanese Gabrielle,Kronish Ian,Hegel Mark,Burg Matthew M Archives of internal medicine BACKGROUND:Depressive symptoms are an established predictor of mortality and major adverse cardiac events (defined as nonfatal myocardial infarction or hospitalization for unstable angina or urgent/emergency revascularizations) in patients with acute coronary syndrome (ACS). This study was conducted to determine the acceptability and efficacy of enhanced depression treatment in patients with ACS. METHODS:A 3-month observation period to identify patients with ACS and persistent depressive symptoms was followed by a 6-month randomized controlled trial. From January 1, 2005, through February 29, 2008, 237 patients with ACS from 5 hospitals were enrolled, including 157 persistently depressed patients randomized to intervention (initial patient preference for problem-solving therapy and/or pharmacotherapy, then a stepped-care approach; 80 patients) or usual care (77 patients) and 80 nondepressed patients who underwent observational evaluation. The primary outcome was patient satisfaction with depression care. Secondary outcomes were depressive symptom changes (assessed with the Beck Depression Inventory), major adverse cardiac events, and death. RESULTS:At the end of the trial, the proportion of patients who were satisfied with their depression care was higher in the intervention group (54% of 80) than in the usual care group (19% of 77) (odds ratio, 5.4; 95% confidence interval [CI], 2.2-12.9 [P < .001]). The Beck Depression Inventory score decreased significantly more (t(155) = 2.85 [P = .005]) for intervention patients (change, -5.7; 95% CI, -7.6 to -3.8; df = 155) than for usual care patients (change, -1.9; 95% CI, -3.8 to -0.1; df = 155); the depression effect size was 0.59 of the standard deviation. At the end of the trial, 3 intervention patients and 10 usual care patients had experienced major adverse cardiac events (4% and 13%, respectively; log-rank test, chi(2)(1) = 3.93 [P = .047]), as well as 5 nondepressed patients (6%) (for the intervention vs nondepressed cohort, chi(2)(1) = 0.48 [P = .49]). CONCLUSION:Enhanced depression care for patients with ACS was associated with greater satisfaction, a greater reduction in depressive symptoms, and a promising improvement in prognosis. TRIAL REGISTRATION:clinicaltrials.gov Identifier: NCT00158054. 10.1001/archinternmed.2010.29
    Psychosocial adjustment in patients after a first acute myocardial infarction: the contribution of salutogenic and pathogenic variables. Israel Study Group on First Acute Myocardial Infarction. Drory Y,Kravetz S,Florian V Archives of physical medicine and rehabilitation OBJECTIVE:To ascertain the differential and independent impact of sociodemographic, medical, and psychologic variables assessed at patients' hospital discharge on these patients' psychosocial adjustment in several domains of life 3 to 6 months later. DESIGN:Two-hundred ninety Israeli male patients, aged 30 to 65 years, with a documented first acute myocardial infarction (AMI) were interviewed once before discharge and again 3 to 6 months postinfarct. Sociodemographic, medical, and psychologic data were elicited at the first interview and completed from medical information in the hospital files. Psychosocial adjustment in seven significant life domains was evaluated by the Psychosocial Adjustment to Illness Scale-Self-Report Version (PAIS-SR) at the second interview. Hierarchical regression analysis was used to examine the relation between the sociodemographic, medical, and psychologic variables at discharge to psychosocial adjustment in the different life domains 3 to 6 months later. RESULTS:Psychologic variables, such as depression, sense of coherence, and social support, and the sociodemographic variable of educational level at discharge predicted a relatively substantial amount of variance in psychosocial adjustment in most PAIS-SR-measured life domains. Low to moderate relations were found between such medical variables as Killip class, heart disease before AMI, other medical conditions, and perceived health before first AMI and psychosocial adjustment in specific life domains. The results also raised the possibility that part of the impact of the medical variables at discharge on psychosocial adjustment 3 to 6 months later may have been mediated by the psychologic variables. The centrality of the psychologic and domestic life domains to psychosocial adjustment in post-AMI patients was also suggested by the results. CONCLUSIONS:Both external and internal pathogenic (depression) and health proneness variables (sense of coherence and social support) at discharge predict psychosocial adjustment in most life domains 3 to 6 months after AMI.
    The first 12 weeks following discharge from hospital: the experience of Gujarati South Asian survivors of acute myocardial infarction and their families. Webster Rosemary A,Thompson David R,Davidson Patricia M Contemporary nurse The period following discharge from hospital after an acute myocardial infarction (MI) is associated with vulnerability and psychosocial and physical morbidity for many survivors and their families. It is reported that people experience interpersonal, family and financial problems, self-care obstacles, work and physical difficulties. Culture and ethnicity undeniably influence the illness experience and the process of recovery and adjustment. This study investigated the perceptions of Gujarati survivors of acute MI and their families in Leicester, United Kingdom in the first 12 weeks following discharge in order to develop a profile of their health seeking beliefs and needs. Thirty-one interviews with 19 Gujarati MI survivors and their families (representing approximately 31 hours of dialogue) were analysed using grounded theory. Qualitative data revealed a period of vulnerability not only for survivors but also their families as they processed recent events and faced the future. Data analysis revealed nine interrelated themes describing the post-discharge experience for Gujarati survivors and their families. Data revealed that normal life was often markedly changed by the MI experience. Reflection, contemplation and resignation characterize this period of vulnerability. Overwhelmingly, data analysis revealed that the Gujarati culture, beliefs and customs influenced the recovery experience. 10.5172/conu.15.3.288
    Effects of phase II cardiac rehabilitation on job stress and health-related quality of life after return to work in middle-aged patients with acute myocardial infarction. Yonezawa Ryusuke,Masuda Takashi,Matsunaga Atsuhiko,Takahashi Yumi,Saitoh Masakazu,Ishii Akira,Kutsuna Toshiki,Matsumoto Takuya,Yamamoto Kazuya,Aiba Naoko,Hara Miyako,Izumi Tohru International heart journal The aim of the present study was to clarify the effects of phase II cardiac rehabilitation (CR) on job stress and health-related quality of life (HRQOL) after return to work in middle-aged patients with acute myocardial infarction (AMI). A total of 109 middle-aged outpatients (57 +/- 7 years) who completed a phase I CR program after AMI were enrolled, 72 of whom participated in a phase II CR program for 5 months after hospital discharge (CR group) and 37 who discontinued the phase II CR program after the discharge (non-CR group). Job stress was assessed at 6 months after the AMI using a brief job stress questionnaire containing questions related to job stressors, worksite support, level of satisfaction with work or daily life, and psychological distress. HRQOL was assessed using the short-form 36-item health survey (SF-36) at hospital discharge and at 3 and 6 months after the AMI. There were no significant differences in clinical and occupational characteristics between the CR and non-CR groups. The CR group patients exhibited significantly better results for job stressors and psychological distress and higher SF-36 scores at 6 months after the AMI, as compared with those in the non-CR group. These findings suggest that discontinuing a phase II CR program induced chronic psychosocial stress after return to work in these middle-aged post-AMI patients. 10.1536/ihj.50.279
    Manageability, vulnerability and interaction: a qualitative analysis of acute myocardial infarction patients' conceptions of the event. European journal of cardiovascular nursing BACKGROUND:Delay in seeking care remains a problem for many patients with myocardial infarction. There is a great deal of knowledge available about clinical factors contributing to this delay, while studies focusing on the patients' own experiences are few. AIM:Describe variations in how individuals perceived suffering symptoms of an acute myocardial infarction. DESIGN:A qualitative method using phenomenographic design was applied. Interviews were conducted with 15 strategically selected patients with myocardial infarction. FINDINGS:Eight sub-categories in the pre-hospital phase were summarised into three categories: manageability, vulnerability, and interaction. To manage their situation, patients expressed a need to understand it and to have a similar situation to compare with. They also described coping with the arising threat to their lives by self-medication or denying their symptoms. Patients expressed vulnerability, with feelings of anxiety, both as triggers and barriers to seeking medical care. In interaction with others, psychosocial support and guidance from the environment, was fundamental in helping the patients to manage the situation. CONCLUSIONS:There were large variations in myocardial infarction patients' conceptions of the event. To improve disease management in the pre-hospital phase, the awareness of this large variation in conceptions about suffering symptoms of an myocardial infarction could be used in the dialogue between patients and health care professionals, in cardiac prevention programmes, as well as in health care education. 10.1016/J.EJCNURSE.2006.08.003
    Sense of coherence--a determinant of quality of life over time in older female acute myocardial infarction survivors. Norekvål Tone M,Fridlund Bengt,Moons Philip,Nordrehaug Jan E,Saevareid Hans I,Wentzel-Larsen Tore,Hanestad Berit R Journal of clinical nursing AIMS:To determine the relationships between different sense of coherence levels and quality of life, and in older female myocardial infarction survivors; to investigate how socio-demographic, clinical characteristics, sense of coherence self-reported symptoms and function affect quality of life; and to determine whether sense of coherence and quality of life are stable during a six-month follow-up. BACKGROUND:Myocardial infraction confers new physical and mental challenges. However, research on sense of coherence and other factors involved in maintaining physical, psychosocial and environmental aspects of quality of life in older female myocardial infraction survivors is scant. DESIGN:Survey. METHODS:A postal survey was conducted of 145 women, aged 62-80 years, three months to five years after myocardial infarction (T1), with a follow-up after six months (T2). Self-reported socio-demographic and clinical data and hospital medical records data were collected. The sense of coherence scale (SOC-29) and the World Health Organization Quality of Life Instrument Abbreviated (WHOQOL-BREF) were used. RESULTS:We found a significant difference in quality of life between weak, moderate, and strong sense of coherence groups (p<0.001). Sense of coherence contributed to the level of all quality of life domains (p<0.001). Several clinical characteristics contributed to quality of life: (1) physical domain: comorbidities (p<0.001), previous myocardial infarction (p = 0.013), ejection fraction (p<0.011), length of hospital stay (p = 0.005) symptoms and function (p<0.001); (2) psychological domain: previous myocardial infarction (p = 0.031) and symptoms and function (p<0.001); and (3) environmental domain: education (p = 0.033) and symptoms and function (p = 0.003). On group level, both sense of coherence and quality of life were stable. Experiencing specific health changes (p<0.001), not major life events, influenced quality of life during the six-month follow-up. CONCLUSION:Sense of coherence was an important stable determinant of quality of life domains in female myocardial infarction survivors. Although other factors were identified, further research is needed to elucidate additional determinants of quality of life. RELEVANCE TO CLINICAL PRACTICE:These specific factors could guide clinicians in making treatment decisions that optimize the quality of life of their patients. Applying a salutogenic perspective through patient education may be important. 10.1111/j.1365-2702.2009.02858.x
    Behavior in a stressful situation, personality factors, and disease severity in patients with acute myocardial infarction: baseline findings from the prospective cohort study SECAMI (the Secondary Prevention and Compliance following Acute Myocardial Infarction study). André-Petersson Lena,Schlyter Mona,Engström Gunnar,Tydén Patrik,Hedblad Bo BMC cardiovascular disorders BACKGROUND:Psychosocial stress has been identified as a risk factor in association with cardiovascular disease but less attention has been paid to heterogeneity in vulnerability to stress. The serial Color Word Test (CWT) measures adaptation to a stressful situation and it can be used to identify individuals that are vulnerable to stress. Prospective studies have shown that individuals with a maladaptive behavior in this test are exposed to an increased risk of future cardiovascular events. The aim of the present study was to investigate whether maladaptive behavior in the serial CWT alone or in combination with any specific personality dimension was associated with severity of myocardial infarction (MI). METHODS:MI-patients (n = 147) completed the test and filled in a personality questionnaire in close proximity to the acute event. The results were analyzed in association with four indicators of severity: maximum levels above median of the cardiac biomarkers troponin I and creatine kinase-MB (CKMB), Q-wave infarctions, and a left ventricular ejection fraction (LVEF) ≤ 50%. RESULTS:Maladaptive behavior in the serial CWT together with low scores on extraversion were associated with maximum levels above median of cardiac troponin I (OR 2.97, CI 1.08-8.20, p = 0.04) and CKMB (OR 3.33, CI 1.12-9.93, p = 0.03). No associations were found between the combination maladaptive behavior and low scores on extraversion and Q-wave infarctions or a decreased LVEF. CONCLUSIONS:Maladaptive behavior in combination with low scores on extraversion is associated with higher cardiac biomarker levels following an MI. The serial CWT and personality questionnaires could be used to identify individuals vulnerable to the hazardous effects of stress and thereby are exposed to an increased risk of a more severe infarction. 10.1186/1471-2261-11-45
    Smoking Cessation After Acute Myocardial Infarction in Relation to Depression and Personality Factors. Schlyter Mona,Leosdottir Margrét,Engström Gunnar,André-Petersson Lena,Tydén Patrik,Östman Margareta International journal of behavioral medicine BACKGROUND:Smoking is an important cardiovascular risk factor and smoking cessation should be a primary target in secondary prevention after a myocardial infarction (MI). PURPOSE:The purpose of this study was to examine whether personality, coping and depression were related to smoking cessation after an MI. METHOD:MI patients ≤70 years (n = 323, 73 % men, 58.7 ± 8.3 years), participating in the Secondary Prevention and Compliance following Acute Myocardial Infarction study in Malmö, Sweden, between 2002 and 2005, were interviewed by a psychologist to assess coping strategies and completed Beck Depression and NEO Personality Inventories, in close proximity to the acute event. Correlation between smoking status (current, former and never), personality factors, coping and depression was assessed at baseline and 24 months after the MI using logistic regression and in a multivariate analysis, adjusting for age and sex. RESULTS:Of the participating patients, 46 % were current smokers. Two years after the event, 44 % of these were still smoking. At baseline, current smokers scored higher on the depression and neuroticism scales and had lower agreeableness scores. Patients who continued to smoke after 2 years had higher scores on being confrontational (i.e. confrontative coping style) compared to those who had managed to quit. Patients who continued to smoke had significantly lower agreeableness and were more often living alone. CONCLUSION:Personality, coping strategies and psychosocial circumstances are associated with smoking cessation rates in patients with MI. Considering personality factors and coping strategies to better individualise smoking cessation programs in MI patients might be of importance. 10.1007/s12529-015-9514-y
    Quality of life, coping strategies, social support and self-efficacy in women after acute myocardial infarction: a mixed methods approach. Fuochi G,Foà C Scandinavian journal of caring sciences BACKGROUND:Quality of life, coping strategies, social support and self-efficacy are important psychosocial variables strongly affecting the experience of acute myocardial infarction (AMI) in women. AIMS:To gain a more in-depth understanding of how coping strategies, self-efficacy, quality of life and social support shape women's adjustment to AMI. DESIGN:Mixed methods study. Quantitative data were collected through a standardised questionnaire on coping strategies, self-efficacy, quality of life and social support. Qualitative data stemmed from 57 semistructured interviews conducted with post-AMI female patients on related topics. METHODS:Quantitative data were analysed with unpaired two-sample t-tests on the means, comparing women who experienced AMI (N = 77) with a control group of women who did not have AMI (N = 173), and pairwise correlations on the AMI sample. Qualitative data were grouped into coding families and analysed through thematic content analysis. Qualitative and quantitative results were then integrated, for different age groups. RESULTS:Quantitative results indicated statistically significant differences between women who experienced AMI and the control group: the former showed lower self-perceived health, perceived social support and social support coping, but greater self-efficacy, use of acceptance, avoidance and religious coping. Pairwise correlations showed that avoidance coping strategy was negatively correlated with quality of life, while the opposite was true for problem-oriented coping, perceived social support and self-efficacy. Qualitative results extended and confirmed quantitative results, except for coping strategies: avoidance coping seemed more present than reported in the standardised measures. CONCLUSION:Mixed methods provide understanding of the importance of social support, self-efficacy and less avoidant coping strategies to women's adjustment to AMI. RELEVANCE TO CLINICAL PRACTICE:Women need support from health professionals with knowledge of these topics, to facilitate their adaptation to AMI. 10.1111/scs.12435
    The impact of personality factors on delay in seeking treatment of acute myocardial infarction. Schlyter Mona,André-Petersson Lena,Engström Gunnar,Tydén Patrik,Östman Margareta BMC cardiovascular disorders BACKGROUND:Early hospital arrival and rapid intervention for acute myocardial infarction is essential for a successful outcome. Several studies have been unable to identify explanatory factors that slowed decision time. The present study examines whether personality, psychosocial factors, and coping strategies might explain differences in time delay from onset of symptoms of acute myocardial infarction to arrival at a hospital emergency room. METHODS:Questionnaires on coping strategies, personality dimensions, and depression were completed by 323 patients ages 26 to 70 who had suffered an acute myocardial infarction. Tests measuring stress adaptation were completed by 180 of them. The patients were then categorised into three groups, based on time from onset of symptoms until arrival at hospital, and compared using logistic regression analysis and general linear models. RESULTS:No correlation could be established between personality factors (i.e., extraversion, neuroticism, openness, agreeableness, conscientiousness) or depressive symptoms and time between onset of symptoms and arrival at hospital. Nor was there any significant relationship between self-reported patient coping strategies and time delay. CONCLUSIONS:We found no significant relationship between personality factors, coping strategies, or depression and time delays in seeking hospital after an acute myocardial infraction. 10.1186/1471-2261-11-21
    The prevalence of acute stress disorder after acute myocardial infarction and its psychosocial risk factors among young and middle-aged patients. Scientific reports Young and middle-aged people are vulnerable to developing acute stress disorder (ASD) following acute myocardial infarction (AMI). This study aims to explore the factors that contribute to ASD in young and middle-aged AMI patients. 190 AMI patients aged 18 to 60 years were enrolled in this study. We assessed the association between ASD and demographic data, adult attachment, and social support. This study examined a total of 190 young and middle-aged people. Among them, 65 participants were diagnosed with ASD, representing a 34.21% positive rate. Multivariate stepwise regression showed that adult attachment, infarct-related artery, social support, in-hospital complications are the main factors affecting ASD. Path analysis showed that social support had mediated the relationship between adult attachment and ASD. The incidence of ASD in young and middle-aged patients with AMI is high. Social support plays an important role in adult attachment and ASD relationships. Adult attachment and social support should be incorporated into post-traumatic cardiac rehabilitation to help patients cope with traumatic occurrences. 10.1038/s41598-022-11855-9
    Seasonal difference in onset of coronary heart disease in young Japanese patients: a comparison with older patients. Azegami Masako,Hongo Minoru,Yazaki Yoshikazu,Yanagisawa Setsuko,Yamazaki Akie,Imamura Hiroshi Circulation journal : official journal of the Japanese Circulation Society BACKGROUND:The aim of the present multicenter study was to investigate whether there is a seasonal difference in the onset of coronary heart disease (CHD) in young patients compared with older patients living in Nagano Prefecture, Japan. METHODS AND RESULTS:The study group comprised 101 young (aged < or = 40 years) and 94 older (aged > or =50 years) patients diagnosed with CHD from 1992 to 2002. In young patients, the prevalence of the onset of CHD events was significantly higher from June to September than from December to March (odds ratio =2.23, p=0.035). Obesity was found in 56%, hypertension in 29%, dyslipidemia in 54%, diabetes in 24%, smoking history in 82%, and habitual physical activity in 13% in young patients. There was a trend for an association between the presence of acute myocardial infarction (p=0.082) and history of smoking and the onset of CHD events during the summer months in young patients (p=0.077). CONCLUSIONS:There is a seasonal difference in the onset of CHD events, with an increase in the prevalence during the summer months in young patients. The data may provide insights into preventive approaches to CHD in the young population.
    The telephone lifestyle intervention 'Hartcoach' has modest impact on coronary risk factors: A randomised multicentre trial. Leemrijse Chantal J,Peters Ron Jg,von Birgelen Clemens,van Dijk Liset,van Hal John Mc,Kuijper Aaf Fm,Snaterse Marjolein,Veenhof Cindy European journal of preventive cardiology BACKGROUND:Unhealthy diets and inactivity are still common among patients with cardiovascular diseases. This study evaluates the effects of the telephonic lifestyle intervention 'Hartcoach' on risk factors and self-management in patients with recent coronary events. DESIGN:This was a randomised trial in five Dutch hospitals. METHODS:Patients (18-80 years), less than eight weeks after hospitalisation for acute myocardial infarction or (un)stable angina pectoris were randomised to the Hartcoach-group, who received telephonic coaching every four weeks for a period of six months (in addition to usual care), and a control group receiving usual care only. Simple random allocation was used (without relation to prior assignment). Measurements were taken by research nurses blinded for group allocation. Differences after six months of participation were compared using linear or logistic regression models with treatment-group and baseline score for the outcome under analysis as covariates, resulting in adjusted mean change (b). RESULTS:Altogether 374 patients were randomised (173 Hartcoach + usual care, 201 usual care only). Follow-up was obtained in 331 patients who still participated after six months. Hartcoach had significant favourable effects on body mass index (BMI) (b = -0.32; 95% CI:(-0.63- -0.003)), waist circumference (b = -1.71; 95% CI:(-2.73- -0.70)), physical activity (b = 15.08 (score); 95% CI:(0.13, 30.04)) daily intake of vegetables (b = 13.41; 95% CI:(1.10-25.71)), self-management (b = 0.11; 95% CI:(0.00-0.23)) and anxiety (b = -0.65; 95% CI:(-1.25- -0.06)). Hartcoach slightly increased the total number of risk scores on target (b = 0.45; 95% CI:(0.17-0.73)). CONCLUSIONS:Hartcoach has modest impact on BMI, waist circumference, physical activity, intake of vegetables, self-management and anxiety. Therefore, it may be a useful maintenance programme in addition to usual care, to support patients with recent coronary events to improve self-management and reduce risk factors. 10.1177/2047487316639681
    Sex differences in prodromal symptoms in acute coronary syndrome in patients aged 55 years or younger. Khan Nadia A,Daskalopoulou Stella S,Karp Igor,Eisenberg Mark J,Pelletier Roxanne,Tsadok Meytal Avgil,Dasgupta Kaberi,Norris Colleen M,Pilote Louise, Heart (British Cardiac Society) BACKGROUND:Studies suggest that young women are at highest risk for failing to recognise early symptoms of acute coronary syndrome (ACS). OBJECTIVES:To examine sex differences in prodromal symptoms occurring days and weeks prior to the acute presentation of ACS. We also examined health-seeking behaviours and prehospital management in young patients. METHODS:Prospective cross-sectional analysis of 1145 patients (368 women) hospitalised for ACS, aged ≤55 years, from the GENdEr and Sex DetermInantS of Cardiovascular Disease: From Bench to Beyond Premature Acute Coronary SYndrome cohort study (January 2009-April 2013). Prodromal symptoms were determined using the McSweeney Acute and Prodromal Myocardial Infarction Symptom questionnaire. Health-seeking behaviour and prehospital care were determined by questionnaires. RESULTS:The median age was 49 years. The prevalence of prodromal symptoms was high and more women reported symptoms than men (85% vs 72%, p<0.0001). Symptoms were similar between sexes and included unusual fatigue, sleep disturbances, anxiety and arm weakness/discomfort. Chest pain was less common in both sexes (24%). Women were more likely to seek care (49% vs 42%, p=0.04). Among those who sought care, women were more likely to use an ambulance for their ACS compared with men (52% vs 39%). Cardiovascular risk-reduction therapy use was low (≤40%) in all patients and less than half perceived their care provider suspected a cardiac source. CONCLUSIONS:Prior to ACS, women were more likely to experience prodromal symptoms and seek medical attention than men. Prehospital care was generally similar between sexes but demonstrated underutilisation of risk-reduction therapies in at-risk young adults. 10.1136/heartjnl-2016-309945
    Newly diagnosed diabetes and outcomes after acute myocardial infarction in young adults. Ding Qinglan,Spatz Erica S,Lipska Kasia J,Lin Haiqun,Spertus John A,Dreyer Rachel P,Whittemore Robin,Funk Marjorie,Bueno Hector,Krumholz Harlan M Heart (British Cardiac Society) OBJECTIVE:To examine prevalence and characteristics of newly diagnosed diabetes (NDD) in younger adults hospitalised with acute myocardial infarction (AMI) and investigate whether NDD is associated with health status and clinical outcomes over 12-month post-AMI. METHODS:In individuals (18-55 years) admitted with AMI, without established diabetes, we defined NDD as (1) baseline or 1-month HbA1c≥6.5%; (2) discharge diabetes diagnosis or (3) diabetes medication initiation within 1 month. We compared baseline characteristics of NDD, established diabetes and no diabetes, and their associations with baseline, 1-month and 12-month health status (angina-specific and non-disease specific), mortality and in-hospital complications. RESULTS:Among 3501 patients in Variation in Recovery: Role of Gender on Outcomes of Young AMI Patients study, 14.5% met NDD criteria. Among 508 patients with NDD, 35 (6.9%) received discharge diagnosis, 91 (17.9%) received discharge diabetes education and 14 (2.8%) initiated pharmacological treatment within 1 month. NDD was more common in non-White (OR 1.58, 95% CI 1.23 to 2.03), obese (OR 1.72, 95% CI 1.39 to 2.12), financially stressed patients (OR 1.27, 95% CI 1.02 to 1.58). Compared with established diabetes, NDD was independently associated with better disease-specific health status and quality of life (p≤0.04). No significant differences were found in unadjusted in-hospital mortality and complications between NDD and established or no diabetes. CONCLUSIONS:NDD was common among adults≤55 years admitted with AMI and was more frequent in non-White, obese, financially stressed individuals. Under 20% of patients with NDD received discharge diagnosis or initiated discharge diabetes education or pharmacological treatment within 1 month post-AMI. NDD was not associated with increased risk of worse short-term health status compared with risk noted for established diabetes. TRIAL REGISTRATION NUMBER:NCT00597922. 10.1136/heartjnl-2020-317101
    Development and Validation of a Risk Prediction Model for 1-Year Readmission Among Young Adults Hospitalized for Acute Myocardial Infarction. Dreyer Rachel P,Raparelli Valeria,Tsang Sui W,D'Onofrio Gail,Lorenze Nancy,Xie Catherine F,Geda Mary,Pilote Louise,Murphy Terrence E Journal of the American Heart Association Background Readmission over the first year following hospitalization for acute myocardial infarction (AMI) is common among younger adults (≤55 years). Our aim was to develop/validate a risk prediction model that considered a broad range of factors for readmission within 1 year. Methods and Results We used data from the VIRGO (Variation in Recovery: Role of Gender on Outcomes of Young AMI Patients) study, which enrolled young adults aged 18 to 55 years hospitalized with AMI across 103 US hospitals (N=2979). The primary outcome was ≥1 all-cause readmissions within 1 year of hospital discharge. Bayesian model averaging was used to select the risk model. The mean age of participants was 47.1 years, 67.4% were women, and 23.2% were Black. Within 1 year of discharge for AMI, 905 (30.4%) of participants were readmitted and were more likely to be female, Black, and nonmarried. The final risk model consisted of 10 predictors: depressive symptoms (odds ratio [OR], 1.03; 95% CI, 1.01-1.05), better physical health (OR, 0.98; 95% CI, 0.97-0.99), in-hospital complication of heart failure (OR, 1.44; 95% CI, 0.99-2.08), chronic obstructive pulmomary disease (OR, 1.29; 95% CI, 0.96-1.74), diabetes mellitus (OR, 1.23; 95% CI, 1.00-1.52), female sex (OR, 1.31; 95% CI, 1.05-1.65), low income (OR, 1.13; 95% CI, 0.89-1.42), prior AMI (OR, 1.47; 95% CI, 1.15-1.87), in-hospital length of stay (OR, 1.13; 95% CI, 1.04-1.23), and being employed (OR, 0.88; 95% CI, 0.69-1.12). The model had excellent calibration and modest discrimination (C statistic=0.67 in development/validation cohorts). Conclusions Women and those with a prior AMI, increased depressive symptoms, longer inpatient length of stay and diabetes may be more likely to be readmitted. Notably, several predictors of readmission were psychosocial characteristics rather than markers of AMI severity. This finding may inform the development of interventions to reduce readmissions in young patients with AMI. 10.1161/JAHA.121.021047
    A study protocol of a randomized controlled trial examining the efficacy of a symptom self-management programme for people with acute myocardial infarction. Klainin-Yobas Piyanee,Koh Karen Wei Ling,Ambhore Anand Adinath,Chai Ping,Chan Sally Wai-Chi,He Hong-Gu Journal of advanced nursing AIM:To report a study protocol of a randomized controlled trial examining if a symptom self-management programme helps patients with acute myocardial infarction self-manage their physical and psychological symptoms. BACKGROUND:In addition to physical conditions, people with acute myocardial infarction often experience psychological symptoms. However, there is limited empirical evidence on how to help individuals self-manage these psychological symptoms. DESIGN:A single-blinded, randomized controlled trial is proposed. METHODS:A convenience sample of 90 will be recruited. Eligible participants will be adult patients with acute myocardial infarction hospitalized at a tertiary hospital in Singapore. Participants will be randomly assigned to one of the three treatment groups: Intervention 1 and standard care (n = 30), Intervention 2 and standard care (n = 30) and standard care alone (n = 30). Data will be collected by self-reported questionnaires, physiological measures and open-ended questions. Quantitative data will be analysed by descriptive statistics, t-test, analysis of covariance and repeated measures analysis of variance. Open-ended questions will be analysed by content analysis. DISCUSSION:This study will identify a potentially efficacious symptom self-management programme for patients with acute myocardial infarction. If the efficacy of the programme is demonstrated, the programme can be integrated into hospital services to improve patient care. A new teaching method (virtual reality-based teaching) and new teaching materials (virtual reality videos and relaxation videos) derived from this study can be offered to patients. Future research with larger samples and multi-centre recruitment can be undertaken to further test the efficacy of the interventions. 10.1111/jan.12594
    Variations in Quality of Care by Sex and Social Determinants of Health Among Younger Adults With Acute Myocardial Infarction in the US and Canada. Raparelli Valeria,Pilote Louise,Dang Brian,Behlouli Hassan,Dziura James D,Bueno Hector,D'Onofrio Gail,Krumholz Harlan M,Dreyer Rachel P JAMA network open Importance:Quality of care of young adults with acute myocardial infarction (AMI) may depend on health care systems in addition to individual-level factors such as biological sex and social determinants of health (SDOH). Objective:To examine whether the quality of in-hospital and postacute care among young adults with AMI differs between the US and Canada and whether female sex and adverse SDOH are associated with a low quality of care. Design, Setting, and Participants:This retrospective cohort analysis used data from 2 large cohorts of young adults (aged ≤55 years) receiving in-hospital and outpatient care for AMI at 127 centers in the US and Canada. Data were collected from August 21, 2008, to April 30, 2013, and analyzed from July 12, 2019, to March 10, 2021. Exposures:Sex, SDOH, and health care system. Main Outcomes and Measures:Opportunity-based quality-of-care score (QCS), determined by dividing the total number of quality indicators of care received by the total number for which the patient was eligible, with low quality of care defined as the lowest tertile of the QCS. Results:A total of 4048 adults with AMI (2345 women [57.9%]; median age, 49 [interquartile range, 44-52] years; 3004 [74.2%] in the US) were included in the analysis. Of 3416 patients with in-hospital QCS available, 1061 (31.1%) received a low QCS, including more women compared with men (725 of 2007 [36.1%] vs 336 of 1409 [23.8%]; P < .001) and more patients treated in the US vs Canada (962 of 2646 [36.4%] vs 99 of 770 [12.9%]; P < .001). Conversely, low quality of post-AMI care (748 of 2938 [25.5%]) was similarly observed for both sexes, with a higher prevalence in the US (678 of 2346 [28.9%] vs 70 of 592 [11.8%]). In adjusted analyses, female sex was not associated with low QCS for in-hospital (odds ratio [OR], 1.05; 95% CI, 0.87-1.28) and post-AMI (OR, 1.07; 95% CI, 0.88-1.30) care. Conversely, being treated in the US was associated with low in-hospital (OR, 2.93; 95% CI, 2.16-3.99) and post-AMI (OR, 2.67; 95% CI, 1.97-3.63) QCS, regardless of sex. Of all SDOH, only employment was associated with higher quality of in-hospital care (OR, 0.72; 95% CI, 0.59-0.88). Finally, only in the US, low quality of in-hospital care was associated with a higher 1-year cardiac readmissions rate (234 of 962 [24.3%]). Conclusions and Relevance:These findings suggest that beyond sex, health care systems and SDOH that depict social vulnerability are associated with quality of AMI care. Taking into account SDOH among young adults with AMI may improve quality of care and reduce readmissions, especially in the US. 10.1001/jamanetworkopen.2021.28182
    Effect of a nurse-led individualized self-management program for Chinese patients with acute myocardial infarction undergoing percutaneous coronary intervention. European journal of cardiovascular nursing BACKGROUND:The study of the development and evaluation of self-management intervention among patients with acute myocardial infarction (AMI) undergoing percutaneous coronary intervention (PCI) is lacking, especially in China. AIM:To examine the effects of a nurse-led individualized self-management program (NISMP) on health behaviors, control of cardiac risk factors, and health-related quality of life (HRQoL) among patients with AMI undergoing PCI. METHODS:The quasi-experimental design included a convenience sample of 112 participants recruited from a tertiary hospital in China. The participants were assigned to the control group ( = 56) or the intervention group ( = 56). The intervention group underwent the NISMP, which includes six group-based education sessions, a face-to-face individual consultation, and 12-month telephone follow-ups. Data were collected at baseline and at the end of the 12-month program using the Health Promotion Lifestyle Profile, the Risk Factors Assessment Form, and the Short Form 36-item Health Survey. RESULTS:The baseline sociodemographic and clinical characteristics of the two groups were comparable ( > 0.05). After the 12-month intervention, the health behaviors and HRQoL of the participants in the intervention group had significantly improved ( < 0.05 for both) compared to those of the control group. Compared to the control group, the participants in the intervention group also reported significantly better control of cardiac risk factors including smoking (χ = 4.709, = 0.030), low-density lipoprotein (χ = 4.160, = 0.041), body mass index (χ = 3.886, = 0.049) and exercise (χ = 10.096, = 0.001). CONCLUSION:The NISMP demonstrated positive effects on health behaviors, control of cardiac risk factors, and HRQoL among Chinese patients with AMI undergoing PCI. 10.1177/1474515119889197