In the area of cardiac rehabilitation, little attention has been given to phase III (maintenance phase), as compared to phase II (rehabilitation phase). Studies on the maintenance phase have highlighted the importance of maintaining the newly acquired healthy living habits in order to continue benefitting from them and prevent the recurrence of cardiovascular diseases and mortality. However, these studies have revealed disturbing dropout rates, from 25 to 50%. There is little research on the factors associated with the maintenance of the new healthy living habits after completing phase II of a cardiac rehabilitation program. This study innovates by measuring riskfactors and quality of life, as predictors of exercise maintenance. The goal of this project is to verify which variables are linked to the maintenance of physical activity during phase III. The sample of the study is composed of 529 patients who completed, between 2005 and 2012, phase II of the cardiac rehabilitation program, called Coeur en sant, offered by the Université de Moncton. The main results show that patients at risk of not maintaining their physical activity are younger, male, with only afew risk factors and a lower score on the quality of physical life scale, particularly with respect to the physical role and general health components.
BACKGROUND:Post-cardiac surgery surgical site infections (SSIs) pose devastating consequences in terms of morbidity and mortality to patients.OBJECTIVE:To examine current risk factors and best practice perioperative care for prevention of SSI following cardiac surgery through the lens of the demographic/clinical characteristics of patients who developed post-cardiac surgery SSIs at a major tertiary care institution, and to identify where documentation is lacking and could be improved to better serve clinical practice.METHODS:A literature review on post-cardiac surgery SSI prevention and risk factors was performed. These risk factors were examined through a retrospective chart review of the population of patients who developed SSIs during the study period.RESULTS:The study population was characterized by a high prevalence of riskfactors including age, diabetes, obesity, operative time, blood glucose control, surgical re-exploration, blood transfusions, and emergency context, as well as differences from best practice guidelines such as preoperative showering. Compared to other populations in the literature, several ofthese risk factors were more prevalent at the study site than in the other comparable populations.CONCLUSION:The patient population had a relatively high prevalence of riskfactors, and the care received by these patients varied in some ways from best practices. Using best practice guidelines, known risk factors, and the data specific to the institution can provide insightsfor analysis and practice improvement efforts in the form of identifying at-risk patients, improving adherence to best practice guidelines, targeting areas to focus care efforts, and improving clincal documentation.
RESULTS Participants expressed uncertainty about their future health and feared disease recurrence, which appeared to provide motivation for adopting a healthier lifestyle. Although two participants voiced the belief that the elective PCI cured their disease, this perception did not appear to influence their engagement in risk reduction behaviours. However, systemfactors such as a lack of information, direction, and/or support from health care providers appeared to play a limiting role in their ability to move forward with lifestyle change. BACKGROUND Elective ad-hoc percutaneous coronary interventions (PCIs) are increasingly used to manage the symptoms of coronary artery disease (CAD). However, we have limited understanding of the patients' experiences and health behaviours post-procedure. PURPOSE Explore the factors that influence the perceptions and health behaviours of patients after elective ad-hoc PCI. METHODS This interpretive descriptive study used purposive sampling to recruit participants (N = 10) aged 44 to 65 years following an elective ad-hoc PCI from a cardiac catheterization laboratory at a tertiary centre in Winnipeg, MB. Participants were interviewed 11 to 35 days following their procedure. Recruitment continued until no new substantive themes emerged. The Health Belief Model provided the frameworkfor developing, exploring, interpreting, and analyzing the data. PRACTICE IMPLICATIONS Nurses have a key role in the education of patients and in providingpatient-centred care that supports lifestyle change. Nurses need to develop strategies that decrease barriers to engaging in risk reduction behaviours following elective ad-hoc PCI if patients are to experience improved health and longevity.
This project aimed to co-develop and pilot an intervention plan to support shared decision-making (SDM) for patients considering a ventricular assist device (VAD), their caregivers and the health care team. The project involved a focus group with patients and caregivers to explore their decision-making needs along with regular participation in team meetings resulting in the creation of a decision aid. The decision aid answered needs expressed by patients and caregivers, as well as the team's initial needsfor informational support, optimization of information exchange and process standardization. A workshop on SDM was also conducted to increase competence toward this approach and the use of the decision aid. This project is timely and relevant given the increase in VAD implantation in Canada. The intervention could also be applicable to other decision-making situations in which active participation can improve the quality of the decision process.
UNLABELLED:Every 40 seconds a person dies of cardiovascular disease.Individuals do not recognize the warning signs--prodromalsymptoms--of an imminent myocardial ischemic event. TheProdromal Symptoms-Screening Scale (PS-SS) is a nine-itemmeasure designed to evaluate PS in individuals with coronaryartery disease.AIM:This article reports onfour studies (systematic review,focusgroup study, content validity testing and factor analysis) that contributed to the development and psychometric examination ofthe PS-SS.RESULTS:PS experienced included: unusual fatigue, sleep disturbance, chest pain, anxiety, gastrointestinal symptoms andshortness of breath. The CVI derived was 0.85. The PS-SS presented a two-factor structure pertaining to Specific ProdromalSymptoms and Non-Specific Prodromal Symptoms. Internal consistency reliability was 0.61.CONCLUSIONS:The PS-SS reflects current prodromal literature,clinical practice and ACS patients' experiences of PS. Furtheritem generation, clarity of symptom description and psychometricevaluation needs to occur prior to use in clinical practice.Keywords: prodromal symptoms, acute coronarysyndrome, psychometric testing, tool development
The present study was conducted to examine the concept of post-traumatic growth (PTG) and its relationship with social support in patients with myocardial infarction. The study included 166 patients with myocardial infarction admitted to heart clinics in Bonab, Iran. Data were collected using the Post Traumatic Growth Inventory and the Clinical Social Support Scale. A positive, moderate relationship between social support and PTG (p<0.001; r=0.361) was found. Talking to others, providing tangible goods, and giving information about the disease may facilitate cognitive processing and adaptation, which, in turn, can lead to more PTG. Given the positive relationship between social support and PTG, nurses, families, and other sources of social support can provide emotional, instrumental and informational supports to increase positive psychological behaviours in patients with myocardial infarction.
AIMS:The purpose of the study was to investigate the agreement between carotid-femoral pulse wave velocity (cfPWV) and augmentation index adjusted at heart rate 75 bpm (AI@75) and to examine the relationship of AI@75 and cfPVW to demographic factors and blood pressures (BPs) in Korean Americans.METHODS:This study was a secondary analysis of a previous data setfrom 102 Korean Americans. AI@75 and cfPWV were measured using the SphygmoCor equipment. Age, gender, height, body weight and brachial BPs were included in the analysis.RESULT AND CONCLUSION:cfPWV and AI@7S showed a good agreement. DBP was independently associated with both cfPWV (p=.022) and AI@75 (p<.001). Although PP is considered a surrogate measure of arterial stiffness, it was related to neither cfPWV nor AI@75 in our healthy middle-aged Korean Ameri- cans. Unlike cfPWV, AI@75 should be measured and analyzed carefully considering height since height was independently related to AI@75 (p<.001).
As the life expectancy of Canadians continues to increase, so does the economic burden of chronic conditions within the health care system. One chronic condition that has increased over the past decade is atrialfibrillation (AF). With health care costs forAF estimated at more than $800 million and rising, a new approach is needed to manage AF care to reduce hospitalizations and emergency room visits, while improving patients' quality of life. Multidisciplinary outpatient clinics for heart failure patients have been implemented across Canada over the past decade, and have shown a reduction in hospital admissions and emergency room visits. It is probable that the same benefit could be seen with the implementation of a structured, nurse-led outpatient AF clinic. The purpose of this article is to review the existing literature on AF outpatient management, and establish the best approachfor a clinical nurse specialist-led AF outpatient clinic within the Canadian health care system.
Mortality rates of women suffering from an acute myocardial infarction (AMI) are high, and in young women are on the rise. The goal of this review is to investigate what is known about women's experience of AMI symptoms. By exploring the complexity and intersections evident in the literature though an integrative literature review process, it becomes apparent that the problem involves deeper contextual influences arisingfrom women's situation in society. Keyfindings in this review suggest that not recognizing the risk or symptoms of an AMI can lead to delayed health care seeking behaviours, and warrants the need for further education. Awareness of these findings has implications for women's health outcomes and mortality rates. This review adds value to clinical practice by reifying the potential gaps in knowledge currently available to women and health care providers, and suggests filling these gaps with new more inclusive ways of knowing surrounding this phenomenon.
Out-of-hospital cardiac arrest (OOHCA) affects 20 to 140 people per 100,000 globally with survival rangingfrom 2% to 11% (Meaney et al., 2013). Patients who have survived, but have been left with cognitive impairments due to anoxic brain injury should be offered early identification and initiation of rehabilitation needs during their admission to mitigate the impact of these deficits (Moulaert et al., 2011). Unfortunately, most cardiac survivors do not receive specialized rehabilitation during their acute hospitalization and there are no clinical pathways that currently exist to guide acute care practitioners regarding the appropriate timing of cognitive screens and early rehabilitation interventions. This tertiary care institution designed and implemented a clinical pathway and patient and family education tools, which have systematically improved the identification and treatment ofpatients requiring cognitive rehabilitation. In this paper, the authors discuss the pathway/tool development and use a case study to highlight these interventions.
BACKGROUND:Globally, about 8.6 million women die each year due to cardiovascular disease with cerebral vascular disease being the third leading cause of death in women. The province of New-foundland and Labrador has one of the highest rates of vascular disease in comparison to the rest of Canada. Women in New-foundland and Labrador have higher rates of vascular disease than their female cohorts across Canada. A vascular risk reduction programfor women aged 35 to 65 years was developed and implemented in a rural and an urban setting.PURPOSE:An evaluation of the program was conducted to assess the impact of the program on participants' satisfaction and to assess how women were able to apply acquired knowledge into their everyday lives to improve their vascular health.PROCEDURE:A thematic analysis of qualitative data collected during tvo focus groups (N=19) was completed.FINDINGS:Three core themes were identified that captured the experiences of the women who participated in the program including Solidifying One's Risk, Translating Knowledge into Action, and Making a Change.IMPLICATIONS:Implementation of community-based vascular education programs must consider the context in which the program is delivered, the population's unique needs, and existing resources if they are to be successful in sustaining healthy lifestyle behaviours known to decrease one's riskfor vascular disease.
Pulmonary arterial hypertension is an uncommon and devastating chronic illness with no known cure. Little is known about the disease, and even less about the psychosocial burdens. While it is important to create awareness about the physical aspects of the disease, it is equally important to create awareness about the psychosocial burdens patients and their families face. We reviewed the literature to better understand these psychosocial burdens, which include impact from physical limitations, emotional strains, financial burdens, social isolation, lack of intimacy in relationships, and an overall lack of information. The findings can be used to assist health care providers to understand the psychosocial challenges that are being experienced by patients and families in order to better provide supportive care. The creation of a standardized tool to assess the psychosocial burdens at each clinic visit can benefit health care providers by addressing challenges faced and facilitate subsequent referral to appropriate specialists.
Abstract Symptom managementfor end-of-life heartfailure (HF) patients is a significant concern. Currently, Canadian practice does not support community milrinone therapy in end-of-life HF patients. Two patients had severe HF that was unresponsive to optimal medications. Further optimization and furosemide infusions were ineffective for symptom management. Both patients' symptoms were better controlled with optimal medication, furosemide, and milrinone infusions. A tailored discharge plan was developed to assist with community milrinone infusions. We discuss the challenges and successes of transitioning two patients to the community. By providing symptom management and meaningful patient and family experience, both patients were able to die in a setting of their choosing. Milrinone infusions as a bridge to end of life may improve symptoms and quality of life. Select patients may benefit from milrinone infusions with resources put in place; these end-of-life HF patients can be supported in the community.
BACKGROUND:Multiple studies have demonstrated a reduction of cardiovascular events in patients who receive the annual influenza vaccine. Despite recommendations from cardiovascular societies, influenza vaccination remains suboptimal in the implantable cardioverter defibrillator (ICD) population. Barriers to receiving the influenza vaccination have not been explored.PURPOSE:To evaluate the barriers to receiving the influenza vaccine in patients with ICDs.DESIGN:Exploratory descriptive design using a survey developed by the staff of the ICD clinic.PROCEDURE:A pilot study was conducted as part of a quality initiative of ICD patients at a regional cardiac centre. These patients were approached to participate in a one-page survey assessing barriers to receipt of the influenza vaccination. Predictors of vaccination were determined using multivariate logistic regression.FINDINGS:Of the 229 patients who completed the survey between September 1 and November 31, 2011, 78% of the patients received the influenza vaccine. The only factor independently associated with influenza vaccination was a positive patient attitude toward the safety of influenza vaccination. Easier access to the influenza vaccination was not associated with its receipt.CONCLUSION:A positive patient attitude toward the influenza vaccine is associated with its use. ICD clinic practitioners may have an opportunity to explore any misconceptions toward the influenza vaccine at each clinic visit in hope of increasing its receipt. Given the importance of this vaccination, future studies are recommended.
BACKGROUND:Sedentary behaviour and the level of daily physical activity are of particular concern in cardiac patients, as diminished activity may be a strong predictor of mortality in this population.PURPOSE:In this study we assessed sedentary behaviour and the quantity and quality of daily physical activity among older cardiac patients who were at different stages of recovery following a cardiac event.DESIGN:We used a cross-sectional design and a convenience sampling technique.METHOD:Participants were recruited into three groups: an Acute group (n = 32), a Rehab group (n = 32), and a Maintain group (n = 29). Continuous minute by minute physical activity was assessed using the SenseWear Mini Armband, which was worn throughout each day for four consecutive days and provided data on steps/day, as well as time spent sedentary (waking time ≤ 1.5 METs), or in light (1.6-2.9 METs) or moderate-vigorous (≥ 3.0 METs) physical activity.FINDINGS:While the Rehab group accumulated more daily activity than the other two groups, they remained sedentary for approximately 70% of waking time. The quantity and quality of the activity in the Maintain group was comparable to that observed in the Acute group.CONCLUSIONS:Our observation of consistently elevated sedentary time regardless of whether the participant was entering, completing or were long removed from a formal cardiac rehabilitation program reinforces the need for cardiac rehabilitation nurse educators to both monitor routine daily activity and encourage coronary artery disease patients to adapt a lifestyle that is focused on reducing sedentary behaviour by incorporating planned exercise training and unstructured physical activity throughout the day.
Many studies show that men make specific lifestyle choices. However, regarding high blood pressure (HBP), guidelines are without distinction for gender. The purpose of this project is to explore the men's experience with HBP. Using a phenomenological design, semi-structured interviews were conducted with ten men living with HBP to explore beliefs and perceptions of men living with HBP. The main framework used is the health belief model. Two themes emerged: the meaning given to HBP (an unavoidable disease, the trivialization of HBP et HBP as synonymous of stress) and the management of this illness (the notion of control, the paradox of knowing about what to do and implementation of healthy lifestyle, relationship with health professionals). These results bring a better understanding of the experience of men with hypertension.
BACKGROUND:There is evidence from large clinical trials that compliance with standardized best practice guidelines (BPGs) improves survival of acute coronary syndrome (ACS) patients. However, their application is often suboptimal.PURPOSE:In this study, the researchers evaluated whether the use of an interactive voice response (IVR) follow-up system improved ACS BPG compliance.METHOD:This was a single-centre randomized control trial (RCT) of 1,608 patients (IVR=803; usual care=805). The IVR group received five automated calls in 12 months. The primary composite outcome was increased medication compliance and decreased adverse events.RESULTS:A significant improvement of 60% in the IVR group for the primary composite outcome was found (RR 1.60, 95% CI: 1.29 to 2.00, p <0.001). There was significant improvement in medication compliance (p <0.001) and decrease in unplanned medical visits (p = 0.023). At one year, the majority of patients ( 85%) responded positively to using the system again. Follow-up by IVR produced positive outcomes in ACS patients.
