BACKGROUND:Cardiovascular disease (CVD) is the leading cause of death in the United States, disproportionately affecting populations affected by structural and social inequities. Million Hearts 2027 aims to advance CVD health equity through targeted policies, processes, and practices that promote equitable access to resources. The initiative prioritizes 5 populations at increased risk: racial and ethnic minority groups, individuals with lower incomes, people living in rural areas or healthcare access deserts, individuals with behavioral health conditions who use tobacco, and pregnant or postpartum persons with hypertension. PURPOSE:To provide registered nurses (RNs) and advanced practice registered nurses (APRNs) with tools, resources, and strategies to effectively partner with these 5 priority populations to reduce cardiovascular risks. CONCLUSIONS:Million Hearts has practical, adaptable change packages and action guides that translate evidence-based cardiovascular prevention strategies into clinical and community settings. It addresses both clinical risk factors and upstream social drivers of health among populations disproportionately affected by CVD. RNs and APRNs are uniquely positioned to implement these strategies through patient education, screening, chronic disease management, care coordination, and advocacy, to reduce cardiovascular morbidity, mortality, and health inequities. CLINICAL IMPLICATIONS:Registered Nurses and APRNs play a critical role in advancing equitable cardiovascular care. The use of the Million Hearts change packages and action guides focused on hypertension control, tobacco cessation, cholesterol management, cardiac rehabilitation, and hypertension in pregnancy can strengthen prevention efforts across diverse settings. Increased awareness and implementation of these tools support nurse-led interventions, interprofessional collaboration, and improved cardiovascular outcomes among vulnerable and underserved populations.
BACKGROUND:Cardiovascular disease (CVD) and CVD risk factors, including obesity and hypertension, are increasingly prevalent among children and youth, highlighting the need for early sustained prevention. Positioned at the intersection of health and education, school nurses are uniquely equipped to support cardiovascular health in everyday practice. PURPOSE:We propose a collaborative model linking school nurses with the cardiovascular nursing community, drawing on the American Heart Association's Life's Essential 8 for Kids framework, the National Association of School Nurses School Nursing Practice Framework, and principles of implementation science. This partnership, including researchers, clinicians, and professional organizations, is necessary to translate evidence on heart health prevention into school settings. CONCLUSIONS:Through coordinated care, leadership development, quality improvement, community engagement, and adherence to professional standards, this collaborative approach can support school nurses in promoting lifelong cardiovascular health for all children and youth. CLINICAL IMPLICATIONS:School nurses are a vital component of the cardiovascular healthcare team, with unique skills, knowledge, and access to students at risk for CVD in the community setting.
Background: Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia and is associated with substantial symptom burden and reduced quality of life. Catheter ablation is increasingly used; however, patients’ experiences across the treatment trajectory remain underexplored. Objective: To describe and explain patients’ experiences from referral to catheter ablation for AF to 4 months after the procedure. Methods: In this qualitative study, we used semistructured interviews with patients undergoing catheter ablation for AF. Interviews addressed experiences of referral, treatment, recovery, and follow-up. Data were analyzed using qualitative content analysis. Results: Our analysis revealed 6 categories describing patients’ experiences throughout the ablation trajectory: (1) Relational care is a pivotal cornerstone; (2) Communication creates a sense of security when individualized; (3) Recovery is a balance between caution and the desire for normality; (4) Ablation gives rise to concerns; (5) A well-planned and structured postablation pathway is needed; and (6) Waiting time creates unnecessary gaps. Two explanatory themes were revealed: "Navigating the emotional terrain of ablation through professional support and communication is needed, highlighting the need for organizational structures and professional support throughout the ablation pathway"; and "Living with uncertainty—Patient perspectives on recovery, expectations, and emotional responses, reflecting ongoing concerns before and after ablation". Conclusions: The findings underscore the importance of consistent involvement of healthcare professionals throughout the AF ablation trajectory. Coordinated, person-centered information, and a structured postablation follow-up pathway may address patient concerns, reduce uncertainty, and support recovery. Strengthening coordination and continuity of care appears essential to improving patient experiences.
BACKGROUND:Patients' expectations for recovery after cardiac intensive care unit (CICU) admission may influence their engagement in post-discharge care and overall recovery trajectory. While some evidence links expectations with clinical outcomes, few studies have examined how sociodemographic and clinical characteristics influence these expectations in CICU survivors. OBJECTIVE:To examine associations between sociodemographic and clinical characteristics and patients' expectations for recovery after a CICU stay. METHODS:This is a cross-sectional analysis of a longitudinal cohort of CICU survivors; the analysis was planned a priori. Participants (N = 98) were adults who completed the baseline survey within 45 days of CICU discharge. The outcome was expectations for recovery, measured on a 0 to 100 visual analog scale. Predictor variables included depressive symptoms, social support, income, intensive care unit (ICU) clinical context, length of stay, Sequential Organ Failure Assessment score, comorbidity burden, and sociodemographic characteristics. Multiple linear regression was used to assess associations. RESULTS:Participants had a mean age of 62.8 years (standard deviation = 13.0); 45.9% were female, 58.2% White, and 36.7% Black. Nearly half had an annual income <$49 000. Most (60.2%) had less than a college degree. The expectation for recovery score had a median of 80 (interquartile range: 64-95) and a mean of 76.4 (standard deviation = 22.9). Higher depressive symptoms (β = -1.08, P = .016) and lower income (β = -14.18, P = .014) were significantly associated with lower expectations. Other variables, including social support, ICU clinical context, the severity of acute illness, ICU length of stay, and comorbidities, were not significantly associated with expectations for recovery. CONCLUSIONS:Among CICU survivors, depressive symptoms and lower income were associated with lower expectations for recovery, whereas clinical characteristics were not. These findings suggest that psychosocial and socioeconomic contexts play a role in shaping recovery outlook. Future research is needed to better understand how expectations for recovery influence post-ICU recovery engagement and related outcomes.
BACKGROUND:Post-intensive care syndrome (PICS) is a significant challenge for cardiac surgery survivors. While early mobilization (EM) is recommended, there is a lack of evidence regarding the effectiveness and safety of nurse-led, algorithm-based protocols in cardiovascular intensive care units (ICUs). OBJECTIVE:To evaluate the effects of a nurse-led algorithm-based EM protocol on PICS scores, psychological distress (anxiety and depression), sleep quality, and nursing satisfaction in patients following cardiac surgery. METHODS:A randomized controlled pretest-posttest study was conducted with 38 adult patients at a Korean tertiary hospital. Participants were randomly assigned to a control (n = 19) or experimental (n = 19) group. The experimental group received the protocol from 12 hours post-intensive care admission until transfer. Outcomes were measured using the PICS Questionnaire, Hospital Anxiety and Depression Scale, Korean Modified Leeds Sleep Evaluation Questionnaire, and Nursing Service Satisfaction Tool. Data were analyzed using nonparametric tests. RESULTS:Significant improvements were observed in the experimental group compared with the control group in PICS scores (Z = -3.83, P < .001), anxiety and depression (Z = -3.52, P < .001), sleep quality (Z = -3.83, P < .001), and all subdomains of nursing satisfaction (Z = -3.58 to -3.83, P < .001). No mobilization-related adverse events occurred, indicating the safety of the protocol. CONCLUSIONS:The application of a nurse-led algorithm-based EM protocol is a safe and effective strategy to reduce PICS, alleviate psychological distress, and enhance sleep and nursing satisfaction after cardiac surgery. This standardized nurse-driven approach should be integrated into routine cardiovascular ICU clinical practice. TRIAL REGISTRATION:This study was registered with the Korean Clinical Research Information Service (CRIS) (identifier: KCT0010880, https://cris.nih.go.kr).
BACKGROUND:Over 900,000 percutaneous coronary interventions (PCI) are performed annually in the United States; however, gaps in discharge education persist. Inadequate teaching contributes to early readmissions, with up to 19% of readmissions occurring within 30 days. Video-based education has been associated with improved comprehension, but its role in PCI discharge teaching has not been established. OBJECTIVE:The investigators evaluated whether leveraging smartphone technology to deliver video-based discharge education alongside standard post-PCI instructions reduced hospital readmissions. Secondary outcomes were improved patient knowledge, satisfaction, medication adherence, lifestyle changes, and cardiac rehabilitation participation. METHODS:This study was conducted at a 705-bed academic medical center between May and August 2025 and included 81 patients who underwent PCI (40 standard education and 41 smartphone video group). The sample was 80.2% male (n = 65) and 19.8% female (n = 16), with a mean age of 69.2 years. All patients received written materials. The intervention group viewed 8 videos on their smartphones before discharge. Collected data included demographics, knowledge assessments, satisfaction surveys, 14-day follow-up adherence assessments, and 30-day readmission reviews. RESULTS:The smartphone video group demonstrated lower 14-day hospitalization rates (0% vs. 15.4%, P = .01), 30-day readmissions (5% vs. 20%, P = .04), higher medication adherence (97.5% vs. 74.4%, P = .03), better understanding of instructions (P = .04), and increased dietary modifications (P = .04). Patient knowledge scores, cardiac rehabilitation enrollment, and satisfaction rates were similar. CONCLUSIONS:Videos accessed via smartphone technology are a practical, patient-centered adjunct to PCI discharge teaching that improve self-management behaviors and reduce early readmissions.
BACKGROUND:Poor diabetes self-management is prevalent in individuals with diabetes and can result in macro- and micro-cardiovascular diabetes complications. Diabetes knowledge may impact diabetes self-management directly and indirectly via the impact on diabetes self-efficacy. However, these relationships have rarely been examined among individuals with diabetes, controlling for potential psychosocial, demographic, and clinical covariates. OBJECTIVE:To investigate whether diabetes knowledge was associated with diabetes self-management directly and indirectly via diabetes self-efficacy, controlling for depressive symptoms, diabetes distress, self-esteem, self-compassion, resilience, social support, body mass index, and age. METHODS:Baseline data from 2 studies were used in this cross-sectional, correlational study. Data on all study and demographic variables were collected from 228 adults with diabetes (mean age: 56.5 years) in 2023 and 2025. PROCESS Macro for the Statistical Package for Social Sciences (Model 4; 5000 bootstraps; 95% confidence intervals [CIs]) was used to examine the suggested relationships. RESULTS:The mean diabetes knowledge score was 10.7 out of 13 (standard deviation [SD] = 1.9); the mean diabetes self-efficacy score was 28.0 (SD = 6.1); and the mean diabetes self-management score was 18.0 (SD = 6.3). Stronger diabetes knowledge showed a direct relationship with better diabetes self-management (effect(B) = 0.779, 95% bootstrap CI = 0.401, 1.157) and an indirect relationship through higher levels of diabetes self-efficacy (effect(B) = 0.193, 95% bootstrap CI = 0.078, 0.333). CONCLUSIONS:Diabetes knowledge was associated with diabetes self-management directly and indirectly via diabetes self-efficacy. Clinicians and researchers may modify diabetes knowledge to improve diabetes self-efficacy, and, in turn, diabetes self-management.
BACKGROUND:The interactions of quality of life domains and their associated factors remain unclear among patients with heart failure. OBJECTIVE:Our aim was to identify the central domains of quality of life and their associated factors in patients with heart failure. METHODS:We enrolled 216 patients with heart failure from 3 university-affiliated hospitals in this cross-sectional study. Participants completed self-report questionnaires assessing physical symptoms, depressive and anxiety symptoms, social network, and quality of life. Network analysis was applied to examine the network structure. RESULTS:The mean total score for physical quality of life was 42.02 ± 7.99, and for mental quality of life was 47.35 ± 6.70. Physical role functioning (weight = 1.09), mental health (weight = 0.92), and vitality (weight = 0.84) played central domains among network structure of quality of life. Additionally, physical role functioning was most strongly negatively connected to physical symptoms (weight = -0.124), mental health was most strongly negatively connected to anxiety symptoms (weight = -0.328), and vitality was most strongly positively connected to social network (weight = 0.131), respectively. CONCLUSIONS:Physical role functioning, mental health, and vitality are the top 3 central quality of life domains in patients with heart failure. This finding underscores the need for healthcare providers to prioritize these central domains. Given that physical symptoms, anxiety symptoms, and social network are associated with central domains of quality of life, alleviating physical and anxiety symptoms, as well as fostering social network may provide an opportunity to improve quality of life in patients with heart failure.
BACKGROUND:Cardiovascular diseases remain the leading cause of death globally. Modifiable lifestyle factors such as diet, physical activity, and smoking play a critical role in disease development. However, the comparative effectiveness of lifestyle interventions versus pharmacologic therapy for cardiovascular prevention has not been clearly quantified. PURPOSE:This systematic review and meta-analysis compared the effects of lifestyle modification and pharmacologic therapy on major adverse cardiovascular events, all-cause mortality, cardiovascular mortality, and stroke incidence in middle-aged and older adults. METHODS:We searched PubMed, Embase, and Cochrane CENTRAL from inception to June 2025. We included 21 randomized controlled trials and 11 prospective cohort studies, totaling 312 645 participants. Pooled risk ratios were calculated using random-effects models. RESULTS:Lifestyle interventions significantly reduced major adverse cardiovascular events (risk ratio: 0.85), all-cause mortality (0.88), cardiovascular mortality (0.84), and stroke (0.82). Combined diet and exercise programs showed the greatest benefit (risk ratio: 0.80). Results were consistent across sensitivity analyses and showed no publication bias. CONCLUSIONS:Lifestyle modification provides cardiovascular protection comparable to or greater than pharmacologic therapy. Combined behavioral programs yield the strongest effects. CLINICAL IMPLICATIONS:Healthcare systems should integrate structured lifestyle programs as a first-line prevention strategy. Pharmacologic therapy remains valuable but should be viewed as complementary to behavioral interventions. Clinicians should prioritize diet and exercise counseling in routine practice.
BACKGROUND:Informal caregivers play a central role in supporting adults living with chronic illness, particularly in contexts where family caregiving is culturally expected and formal support is limited. However, the extent to which caregiver burnout is associated with caregiving appraisal, psychological symptoms, and dyad-informed relational characteristics remains insufficiently understood. OBJECTIVE:To examine caregiver burnout among informal caregivers of adults living with chronic illness and to identify associations between burnout and caregiving appraisal, psychological symptoms, caregiving characteristics, and dyad-informed variables. METHODS:A cross-sectional correlational study was conducted with 104 patient-caregiver dyads recruited from inpatient and outpatient settings of a tertiary medical center in Lebanon. Participants completed questionnaires assessing caregiver burnout, caregiving appraisal and support, caregiver preparedness, anxiety and depressive symptoms, relationship quality, care typology, and concordance or discordance in perceived care patterns. Caregiver burnout was examined across 3 dimensions: emotional exhaustion, depersonalization, and personal accomplishment. Bivariate analyses and multivariable linear regression models were used to identify factors associated with each burnout dimension. RESULTS:Caregivers reported moderate emotional exhaustion, low depersonalization, and high personal accomplishment. Higher perceived negative impact of caregiving and caregiver anxiety and depressive symptoms explained 68.1% of the variance in emotional exhaustion. Higher negative impact, depressive symptoms, and the presence of other caregivers explained 32.2% of the variance in depersonalization. Lower negative impact and higher positive appraisal of caregiving explained 21.5% of the variance in personal accomplishment. CONCLUSIONS:Caregiver burnout was most consistently associated with caregiving appraisal and psychological symptoms, while dyad-informed relational characteristics added important contextual insight. These findings highlight the need to integrate caregiver appraisal, mental health screening, and dyad-informed assessment into chronic illness care, particularly in settings where family caregiving is culturally expected and formal support is limited.
Background: H-type hypertension substantially increases cardiovascular and cerebrovascular risk in older adults, yet long-term medication adherence remains suboptimal. Beyond regimen complexity, age-related cognitive vulnerability and limited self-monitoring capacity may undermine adherence. However, few nurse-led interventions explicitly target memory-related mechanisms underlying medication-taking behavior. Objective: To evaluate the effectiveness of a nurse-led, metamemory-based intervention in improving medication adherence and related cognitive and psychosocial outcomes in older adults with H-type hypertension. Methods: In this 12-week, randomized controlled trial, 76 older adults with H-type hypertension were randomly assigned (1:1) to a nurse-led metamemory-based intervention or usual care. The intervention combined face-to-face sessions and remote follow-up to enhance memory strategy use, self-monitoring, and medication adherence. Primary outcomes were metamemory and medication adherence. Secondary outcomes included cognitive function, anxiety, depression, quality of life, and self-management. Results: Seventy-one participants completed the trial (intervention n = 35; control n = 36). Compared with usual care, the intervention group demonstrated significantly greater improvements in metamemory (mean change: 36.7 vs. 1.7; P < .001) and medication adherence (mean change: 2.1 vs. 0.5; P < .001). Significant between-group improvements were also observed in cognitive function, anxiety, quality of life, and self-management (all P < .05). Changes in depressive symptoms were modest and not statistically significant. Conclusions: A nurse-led metamemory-based intervention significantly improved medication adherence in older adults with H-type hypertension by strengthening memory self-monitoring and strategy use. These findings support metamemory as a clinically meaningful mechanism through which nursing interventions can enhance adherence in cognitively vulnerable cardiovascular populations.
BACKGROUND:Patients with coronary heart disease (CHD) and type 2 diabetes mellitus (T2DM) face significantly higher mortality and poorer health-related quality of life (HRQoL) than those with a single condition. However, evidence on HRQoL and its associated factors in these patients remains limited. OBJECTIVES:To evaluate HRQoL in patients with CHD and T2DM and identify associated factors. METHODS:A cross-sectional study was conducted among 207 patients with CHD and T2DM from a tertiary hospital in Shiyan. Sociodemographic questionnaire, Euro Quality-of-Life 5 Dimensions 5-Level Questionnaire, the Morisky Medication Adherence Scale-8, and the Center for Epidemiologic Studies-Depression scale were used to investigate the participants' HRQoL, medication adherence, and depression level. Data analysis was conducted using single-factor analysis and multiple linear regression to explore the factors influencing HRQoL. RESULTS:The mean Euro Quality-of-Life 5 Dimensions 5-Level Questionnaire score was 0.96 (standard deviation = 0.09), with pain/discomfort and anxiety/depression being the most frequently reported. Multiple regression analysis revealed that family history of disease, whether or not an individual knows something about the Chinese Food Guide Pagoda, sleep duration, regularity of work schedule, and severity of depression as potential factors associated with HRQoL in patients with CHD and T2DM. CONCLUSIONS:Patients with CHD and T2DM generally exhibited a relatively high HRQoL. However, family history of disease, unhealthy lifestyle behaviors, and depressive symptoms were significantly associated with lower HRQoL. Targeted interventions emphasizing health education, behavioral modification, and psychological support may effectively enhance both physical and mental health in this population, thereby contributing to improved long-term outcomes and overall quality of life.
BACKGROUND:Coronary heart disease (CHD) is the leading cause of death in the United States. While management guidelines recommend reducing dietary sodium/salt intake, salt taste can enhance food flavor and quality of life, making adherence to dietary recommendations challenging. OBJECTIVE:In this study, we aimed to explore differences in salt taste perception between adults with CHD and those without CHD and whether these differences interact with sex and body mass index (BMI). METHODS:We conducted a cross-sectional analysis to assess the associations of CHD with sodium intake and salt taste intensity using National Health and Nutrition Examination Survey 2013-2014 data. General linear model analyses were conducted by regressing sodium intake or salt tastant concentration on CHD, controlling for sex and BMI. RESULTS:Of the 4094 participants, 50.2% females with a mean age of 45.8 (standard deviation = 17.7). Individuals with CHD reported a higher intensity of dietary salt perception via the Tongue Tip Test: 1 M NaCl generalized Label Magnitude Scale (mean = 31.73, standard error = 2.71) compared with those without CHD (mean = 24.65; standard error = 0.51), P = .04. When stratifying by sex and BMI, there was a significant difference between individuals with and without CHD. CONCLUSIONS:These findings suggest that individuals with CHD exhibit distinct salt taste perception, with notable sex and BMI differences. Our study underscores the importance of incorporating sensory science into dietary counseling and developing tailored interventions to individual taste profiles to enhance dietary adherence and overall well-being.
BACKGROUND:Heart failure, characterized by its unpredictable trajectory and challenging symptom management, necessitates continual adaptation and the active involvement of patients and their families. OBJECTIVE:Heart failure is a growing health challenge in aging societies. Informal caregivers are often the first to observe and respond to symptoms, yet their voices remain underrepresented in the literature. In this study, our aim was to explore how caregivers recognize and manage symptoms in older adults with heart failure and to identify the support they require to sustain this vital role. METHODS:A sequential, explanatory, mixed methods study was performed. This mixed methods study was reported in accordance with the Good Reporting of A Mixed Methods Study (GRAMMS) checklist. Quantitative data were gathered from 205 caregivers through structured symptom assessments, while qualitative insights were obtained via in-depth interviews with 16 caregivers. RESULTS:The most frequently observed symptoms included fatigue, dyspnea, and edema. Caregivers described relying on visual cues rather than patient-reported symptoms, often due to limited clinical knowledge or support. Thematic analysis revealed significant emotional strain, physical fatigue, and informational gaps. Many caregivers highlighted the need for practical training, emotional support, and accessible guidance from healthcare professionals. CONCLUSIONS:Caregivers are not only essential partners in heart failure management-they are often the bridge between the home and healthcare system. Addressing their educational and psychosocial needs through structured training and remote nursing support is critical to improving care continuity and outcomes.
BACKGROUND:Cardiometabolic syndrome is a major global driver of poor outcomes. Behavioral and socioeconomic factors influence outcomes of cardiometabolic syndrome. Conventional risk models often neglect to capture the role of behavioral and socioeconomic characteristics in cardiometabolic syndrome mortality. OBJECTIVE:We aimed to identify behavioral-socioeconomic phenotypes among adults with cardiometabolic syndrome using a clustering approach and to examine their associations with cardiovascular and all-cause mortality. METHODS:We analyzed data from 7839 U.S. adults with cardiometabolic syndrome (2005-2018), followed for a median of 87 months. To explore behavioral-socioeconomic patterns, we used hierarchical clustering on factor analysis of mixed data. Survival analyses were performed using Kaplan-Meier curves with log-rank tests to evaluate mortality differences among clusters. Cluster profile differences were assessed to characterize the demographic, behavioral, socioeconomic, and clinical heterogeneity among the identified subgroups. RESULTS:Three distinct clusters were identified, differing significantly across demographic, socioeconomic, and behavioral characteristics (P < .001 for most comparisons). Cluster 1 comprised younger, socioeconomically deprived, physically active individuals with higher alcohol use and depression prevalence. Cluster 2 included predominantly older women with lower socioeconomic status, multiple comorbidities, and the poorest cardiometabolic profile, showing the highest cardiovascular and all-cause mortality rates (all log-rank P < .001). Cluster 3 represented socioeconomically advantaged, middle-aged men with the most favorable behavioral patterns and the lowest depression prevalence. CONCLUSION:Behavioral-socioeconomic clustering identified phenotypes with distinct prognoses in cardiometabolic syndrome. The high-risk cluster 2 reflects the cumulative physiological consequences of long-standing adverse behaviors, socioeconomic deprivation, and comorbid disease progression.
BACKGROUND:Congenital heart disease requires complex care, placing mothers at risk of high burden and low self-efficacy. Family-centered care (FCC), emphasizing collaboration with healthcare providers, may alleviate these challenges. However, its predictive role in the Turkish context remains underexplored. METHODS:This cross-sectional, descriptive correlational study included mothers of 131 children aged 0 to 2 years who were followed at a pediatric cardiac surgery unit. Data were collected using the FCC Scale, Zarit Caregiving Burden Scale, and Parental Self-Efficacy Scale. Analyses involved descriptive statistics, Pearson correlations, and multiple linear regression. RESULTS:Lower FCC perceptions were strongly associated with higher caregiving burden and lower parental self-efficacy. For caregiving burden, Model 1 explained 58.7% of the variance (adjusted R2 = 0.587; F(5, 82) = 25.718, P < .001). Significant predictors were extended family structure (β = 0.235, P = .002) and lower FCC perception (β = -0.744, P < .001). For parental self-efficacy, Model 2 explained 60.1% of the variance (adjusted R2 = 0.601; F(10, 78) = 14.231, P < .001). Significant predictors were urban residence (β = 0.189, P = .012), greater illness knowledge (β = 0.184, P = .019), and higher FCC perception (β = 0.643, P < .001). FCC emerged as the strongest predictor in both models. CONCLUSION:Mothers' perceptions of FCC emerged as a key determinant of caregiving outcomes, demonstrating a protective role by reducing burden and enhancing self-efficacy. IMPLICATION FOR PRACTICE:Integrating FCC into pediatric cardiology as a standard of care-through clear communication, tailored education, perioperative support, and telehealth for rural families-can promote maternal resilience, reduce caregiving stress, and improve child health outcomes.
Background: Sex- and gender-based differences significantly influence cardiovascular disease presentation, diagnosis, treatment response, and outcomes, contributing to persistent health disparities. Despite this, gender-focused education remains inconsistently integrated into cardiovascular nursing curricula. Purpose: Our aim, in this discussion paper was to examine the benefits and challenges of incorporating sex- and gender-focused care into cardiovascular nursing education and to highlight its role in improving clinical practice and promoting health equity. Conclusions: Integrating gender-focused education enhances nurses’ ability to recognize both sex- and gender-specific differences, improves clinical decision-making, and supports more equitable care delivery. However, implementation is limited by curriculum constraints, lack of faculty expertise, and the risk of reinforcing stereotypes. Structured, evidence-based approaches are needed to ensure effective integration. Clinical Implications: Embedding sex- and gender-focused care into nursing education can improve diagnostic accuracy, optimize treatment strategies, and foster patient-centered and culturally responsive care. This approach is essential to reduce disparities and enhance outcomes in cardiovascular health.
BACKGROUND:Cardiometabolic disease risk is disproportionately high in rural U.S. communities, where behavioral and metabolic determinants often intersect. However, relationships between sleep, psychological distress, and blood pressure variability remain understudied in rural communities. OBJECTIVE:In this study, we aimed to assess how sleep, depressive symptoms, and metabolic indicators influence blood pressure outcomes in rural adults. METHODS:In this exploratory descriptive cross-sectional study, survey and clinical measurement data were collected from n = 68 participants. Data were analyzed using descriptive statistics, bivariate correlations, and hierarchical regression. RESULTS:Age, gender, and sleep were positively associated with blood glucose. Depressive symptoms were inversely related to blood glucose and body mass index. Depressive symptoms and sleep dysfunction were positively associated with blood pressures, but in some models were attenuated by sleep, whereas sleep was related to elevated blood glucose. Age was inversely associated with blood pressure, and antihypertensive medication use did not account for this relationship. Among nonmedicated participants, mean blood pressures were significantly elevated. In subgroup analyses, the youngest nonmedicated adults (ages 29-33 years) had markedly higher mean arterial pressure. CONCLUSIONS:Sleep-related impairment and depressive symptoms were related to blood pressure and indicators of metabolic disruption and inflexibility in this rural community sample. The effect of depressive symptoms on blood pressure was consistent with autonomic and vascular tone mechanisms but was attenuated by sleep. The youngest participants (ages 29-33 years) exhibited disproportionately high untreated blood pressures compared to all other participants, highlighting the possibility that cardiometabolic vulnerability might manifest earlier in rural communities than typically recognized. Results support early detection initiatives and future biobehavioral-informed research targeting younger populations.
BACKGROUND:People hospitalized for heart failure (HF) often have coexisting diabetes mellitus (DM). However, the balance between HF- and DM-related inpatient care in specialized cardiovascular wards remains unclear. OBJECTIVE:In this study, our aim was to compare HF- and DM-related inpatient care processes in people hospitalized for HF with coexisting DM and identify nurse-led opportunities for integrated management. METHODS:This retrospective observational study was conducted in the specialized cardiovascular ward of a 400-bed Japanese hospital (April 2023-March 2024). Among 274 consecutive HF admissions, clinical characteristics were compared by DM status and, within the HF+DM subgroup (n = 79), HF versus DM care processes were assessed: specialist involvement, medication adjustments, and nursing documentation. Effect sizes (Cohen's d, risk difference, and risk ratio [RR]) were calculated. RESULTS:The prevalence of DM was 28.8%. Compared with people in the non-DM group, those in the HF+DM subgroup were younger (79.2 vs. 82.8 years; d = -0.31), had higher body mass index (23.5 vs. 20.9 kg/m2 at discharge; d = 0.52), and lower left ventricular ejection fraction (40.3% vs. 47.0%; d = -0.44). In the HF+DM subgroup, HF care practices were more frequently documented compared with DM care practices: specialist nurse involvement 45.6% versus 3.8% (RR = 12.00), medication adjustment 89.9% versus 22.8% (RR = 3.94), and nursing documentation 53.2% versus 5.1% (RR = 10.43). Some process gaps exceeded 10-fold differences. CONCLUSIONS:Diabetes mellitus care was markedly under-addressed during HF admission. This is the first Japanese study to quantify HF-DM care disparities using effect sizes and highlight targets for nurse-led integrated pathways and stronger collaboration with endocrinologists.
BACKGROUND:Prolonged intensive care unit (ICU) stay after heart valve surgery may delay recovery and increase complications; however, the risk factors remain underexplored. OBJECTIVE:In this study, we aimed to identify pre-, intra-, and postoperative clinical factors associated with prolonged ICU stay after heart valve surgery. METHODS:A retrospective case-control analysis was conducted on 498 patients admitted to the cardiovascular surgical ICU of a tertiary hospital in Seoul from January 1, 2021, to December 31, 2022. Patients were grouped based on ICU length of stay: ≤72 hours (nonprolonged, n = 332) and >72 hours (prolonged, n = 166), matched by age, sex, and surgery date. Data were obtained from the electronic medical records. Statistical analyses included t tests, Mann-Whitney U test, chi-square test, Fisher's exact test, and logistic regression. RESULTS:Significant predictors of prolonged ICU stay included New York Heart Association class (NYHA) II (odds ratio [ OR ] = 3.33, 95% confidence interval [CI] = 1.79-6.18), higher EuroSCORE II ( OR = 1.29, 95% CI = 1.10-1.53), fluid imbalance ( OR = 1.27, 95% CI = 1.01-1.59), and longer intubation duration ( OR = 1.01, 95% CI = 1.01-1.02). Additional factors included postoperative arrhythmia, red blood cell transfusion, neurological complications, hemodialysis, and fever. CONCLUSIONS:Multiple clinical and postoperative factors were associated with a prolonged ICU stay after valve surgery. These findings can inform nursing protocols and targeted interventions to enhance recovery and reduce ICU burden.
