bluuebunny/crossref_metadata_2025 huggingface dataset:
Nurse-led versus physician-led post-myocardial infarction review clinics: A retrospective study
Authors: Leslie Stephen J , Katikreddi Vittal , Geddes Jane , Perkins Sarah , Hargreaves Allister D
Published: May 2014

Objectives: The study aimed to investigate differences between physician and nurse-led post myocardial infarction (MI) clinics in relation to quality of documentation and initiation of changes in treatment. In the hospital there was concern that patients were not seen in clinic quickly enough after their MI. Therefore the decision was made to undertake a study to help determine whether nurse-led clinics were an effective service development.

Methods: Clinic letters from 78 patients who attended both a physician-led and nurse-led clinic after a myocardial infarction were reviewed. The role of the clinic was to assess patients in relation to symptoms and drug treatment and to address any secondary prevention issues.

Results: Nurses letters contained more details of symptoms and clinical findings than those of doctors, and nurses invited more patients to attend rehabilitation, but they suggested fewer changes in drug treatment.

Conclusions: Nurses were better at the documenting symptoms and addressing secondary prevention but they were less confident about initiating treatment changes. Nurse-led clinics should continue to develop, but specialist physician support is needed to arrange invasive investigations or initiate complex therapy changes for more complex cases
Help us raise awareness about arrhythmias
Authors: Lobban Trudie
Published: May 2014

Trudie Lobban tells us what is in store at the third Arrhythmia Awareness Week and how you can help support the Arrhythmia Alliance in its aim to widen people’s knowledge.
Postoperative epicardial pacing: Indications and care
Authors: McNaughton Amanda
Published: May 2014

Coronary Heart disease remains one of the biggest killers in the UK today. To this end it is not surprising that the number of patients undergoing coronary artery bypass graft operations continues to increase with just under 30 000 operations being performed in the UK each year (British Heart Foundation (BHF), 2006).
Weaning intraaortic balloon counterpulsation: The evidence
Authors: Lewis Peter , Courtney Mary
Published: May 2014

The aim of this paper was to determine the most effective manner to wean intraaortic balloon counterpulsation (IABP) based on research evidence. An exhaustive search of the PubMed, Medline, CINAHL, Cochrane, Science Direct and Ovid databases was carried out to source relevant literature. The search revealed a paucity of literature related to the cessation of IABP. Evidence is unanimous in suggesting the minimization of pharmacological assistance before withdrawing any form of mechanical IABP. However, opinion related to the direct weaning of IABP by either volume reduction or frequency reduction is mixed. The assimilation of IABP studies would imply volume reduction weaning to be the most effective method of IABP support withdrawal. Volume reduction offers a more physiological approach in comparison to frequency reduction weaning, which fails to significantly differ from the complete cessation of IABP treatment. When initiating the withdrawal of any IABP support, volume reduction should be the method of choice.
Being that nightmare relative
Authors: Cosgrave Rebecca
Published: May 2014

I have to admit that, until recently, I have always felt apprehensive about caring for patients who are health professionals themselves or have relatives who are. I have always thought to myself ‘just because they are a nurse/doctor etc I am not going to give them preferential treatment. My best care is what I hope to give all my patients.’ I am sure most of us do, however, get that little flutter of anxiety when faced with a fellow health professional. ‘Are they watching what I’m doing? Oh no, I just touched the trolley with my sterile love. He/she must think I have dreadful aseptic technique. Does he/she think I am a bad nurse?’ It has come to my notice, however, that it must be very difficult for health professionals who are patients or relatives of patients to comment on what they perceive as a poor standard of care.
Obesity and cardiovascular disease: A population perspective
Authors: Lindfield Robert , Lemic Nada
Published: May 2014

Obesity is increasing rapidly throughout the world. As more people become obese there will be a significant rise in the prevalence of diseases associated with obesity. This has major implications for public health and health service provision.

Numerous studies have revealed the links between obesity and cardiovascular disease. In certain diseases such as hypertension, coronary heart disease, heart failure and stroke, there is clear evidence for an increased risk in adults with a body mass index greater than 30kg/m2. Childhood obesity probably increases the risk of cardiovascular disease in later life and intentional weight loss probably decreases the risk at any age but the evidence is less clear.

Prevention is key to avoiding the potential for epidemics in diseases associated with obesity. Prevention of obesity must include sustainable changes in lifestyle, including diet and exercise in an environment that supports healthy choices.
A considered approach to change
Authors: Jones Ian
Published: May 2014

Over the last twenty years cardiac nursing has been at the forefront of many of the changes in the NHS. It is imperative that we foresee change and ensure that service developments are evidence based and patient led as opposed to financially based and politically led.
Research Roundup
Authors: Linden Belinda
Published: May 2014

Physical activity is important for managing chronic diseases, such as diabetes and obesity. Yet over half of patients who adopt physical activity programs do not maintain them at 6 months. To encourage regular activity among their patients these researchers developed a one-day outpatient motivational workshop based on well-known theoretical frameworks. Their aim was to evaluate the effectiveness of the motivational workshop in terms of total and activity-specific energy expenditures and body mass index.
The cardiology nurse consultant in Scotland
Authors: McLean Scott
Published: May 2014

Scott McLean, Catherine Mondoa and Frances Divers describe their roles as nurse consultants working in cardiology in Scotland, against the background of the Scottish Executive’s targets for increasing the number of such posts
Reading a normal ECG
Authors: Whitbread Mark
Published: May 2014

This month we revisit Mark Whitbread’s tool for reading a 12-lead ECG, followed by this month’s ECG.
Patient support groups: How the people who know best can help
Authors: Smith Nancy
Published: May 2014

Nancy Smith was diagnosed with arrhythmogenic right ventricular cardiomyopathy after her younger sister died from the same condition. Since then she has learned to deal with the condition and is now a key figure supporting others.
ECG of the month
Authors: Whitbread Mark
Published: May 2014

Mark Whitbread presents an ECG for you to analyse. The answer and management plan are given on page 202
Addressing the taboos: Resuming sexual activity after myocardial infarction
Authors: O’Donovan Kate
Published: May 2014

Resuming sexual activity after a myocardial infarction (MI) is a common worry shared between patients and their partners. Common concerns that are expressed often involve the perceived risk of causing another acute coronary event and the impact that cardiovascular medication may have on sexual function. Patients and their partners need practical information that they can process and deal with. Such information comprises when to resume sexual activity and what to avoid. For example, avoiding sexual activity after a heavy meal or the consumption of alcohol. Patients also need to be informed that sexual dysfunction may develop as a result of the atherosclerotic process or the cardiovascular medications and other treatment options.

Providing information on resuming sexual activity after an MI is an essential aspect of patient education and the discharge process, but many nurses in the critical care setting are reluctant to initiate discussion on this sensitive subject. This reluctance may develop as a result of embarrassment or the nurse may be uncomfortable with his or her own sexuality. The nurse may also feel that bringing up this subject is an invasion of the patient’s privacy. Other influences include environmental factors. For example, the unit may be very busy or there is not a suitable place to conduct the conversation. In addition, the patient may be considered too ill. The literature has illustrated many strategies to overcome this reluctance to initiate a discussion about sexuality. These may include workshops or the use of open questions that may encourage discussion.
Research Round-Up
Authors: Riley jillian
Published: May 2014

This interesting article reports findings from a study evaluating a novel approach to patient education for the person with heart failure. Undertaken in five nurse-led centres in Sweden, 154 patients were randomized to one of two groups: standard education or standard education plus computer-based education. Standard education was provided through a 1-hour teaching session on heart failure which included physiology, heart failure symptoms, self-monitoring and lifestyle changes. For patients in the intervention arm this teaching session was followed by an interactive CD-ROM providing heart failure education, self-tests and animations. The programme used a touch screen for the interaction and took approximately 40 minutes to run. The study tested the effectiveness of this education package on quality of life and the patients’ knowledge and compliance with treatment.
Acute coronary syndromes and hospital care: Patients’ experiences
Authors: Dunckley Maria , Quinn Tom , McDonald Ruth , Dickson Rumona , Jayram Rav , Wright Christine
Published: May 2014

Background: Acute coronary syndromes (ACS) are a major health problem. However, there is little research into the determinants of patients’ experiences of their care when they are admitted to hospital with an ACS. Nurses across the NHS are being empowered to undertake a growing range of responsibilities but the literature on patients’ perceptions of these role changes is sparse. In this article we report findings from a patient focus group that was designed to inform the development of a patient survey. The aim of this survey was to evaluate the process of introducing ACS nurses into six hospitals in England and Scotland.

Method: Patients with a diagnosis of ACS were invited to take part in one focus group. Data were analysed using the method of constant comparison.

Results: Five men and five women (age range 51–85 years) participated. The following themes emerged from the analysis: expectations and satisfaction, competence of staff, nursing roles, communication and coordination, and discharge and transition.

Discussion: This study provides an insight into a number of potentially modifiable factors that may affect the experiences of patients who are being treated for an ACS in the NHS.
Returning to the front line
Authors: Cosgrave Rebecca
Published: May 2014

At the risk of repeating myself I would just like to emphasize the madness of the government’s knee-jerk reaction to balancing the National Health Service’s (NHS) books. It is almost incomprehensible that only 7 years ago we were desperate for nurses so NHS trusts responded by sponsoring thousands of nurses to come from abroad to help us out. It seems that over the last couple of years the NHS has ended up in financial dire straits and the government has reacted by forcing trusts to freeze or close posts, cut services and severely limit training budgets. How any of these can be seen not to affect the quality of patient care is beyond me.
Counting the cost of not using drug-eluting stents
Authors: Bishop Jill
Published: May 2014

Jill Bishop argues that the effectiveness of drug-eluting stents should not be measured by mortality comparisons with bypass graft surgery alone
Saving a service: the importance of communication
Authors: Marshall Kathy , Gramsma Kate , Marley Pat
Published: May 2014

Kathy Marshall, Kate Gramsma and Pat Marley share their experiences of a threat to funding for a cardiac rehabilitation service and the steps taken
ECG of the month
Authors: Bowbrick Steve
Published: May 2014

Steve Bowbrick presents an ECG for you to analyse. The answer and management plan are given on page 109.
Preparing a conference poster
Authors: Pontin David , Albarran John
Published: May 2014

David Pontin andJohn Albarran share their advice for planning, formatting and presenting an effective conference poster
Just about everything, for just about everyone
Authors: Jones Chris
Published: May 2014

This book of essays, which covers every aspect of cardiac nursing, is intellectually demanding without being obscure, well -illustrated and logical in development—in short, it is a tour de force. The usual subject areas such as acute coronary syndromes and clinical examination are covered in satisfying depth, as one would expect. Other, less familiar subjects are also given an airing. I was very impressed, for instance, by the treatment of Marfan’s syndrome as this is a condition which rarely hits the cardiac headlines.
Holistic care and the place of complementary therapies
Authors: Hatchett Richard , Thompson David
Published: May 2014

Many thanks to Chris Jones for his recent review of our new text, Cardiac nursing: a comprehensive guide (British Journal of Cardiac Nursing Volume 3, No. 3, p127) He raised two issues that are worth clarifying. It’s important for us to fly the flag for complementary therapies in cardiac care because many patients will experience their heart condition as a chronic disorder affecting their quality of life. We therefore asked Professor Suen to review the variety of approaches that can basically make the person feel better. In addition, there was the need to consider whether any of the therapies could affect risk factors such as cholesterol and hypertension, which may reduce further risk of coronary events.
The role of the ACHD nurse specialist
Authors: Kennedy Fiona
Published: May 2014

Fiona Kennedy discusses the development of the adult congenital heart disease specialist unit, and the role of the clinical nurse specialist within the team
Pushing for better provison of arrhythmia care
Authors: Woodings Simon
Published: May 2014

Simon Woodings outlines the aims of this year’s Arrhythmia Alliance Awareness week
New visions
Authors: Tagney Jenny
Published: May 2014

I am delighted to introduce July’s issue, which focuses on heart failure care. I would like to thank Jill Riley for her lead role in developing this issue and will leave her to discuss it in more depth in her guest editorial on p291.
ECG of the month
Authors: Bowbrick Steve
Published: May 2014

Steve Bowbrick presents an ECG for you to analyse. The answer and management plan are given on page 326
Assessing cardiovascular risk in the individual
Authors: Kennedy Susan
Published: May 2014

This article, the first of two on cardiovascular risk estimation, describes the rationale for assessing cardiovascular risk (risk of a cardiovascular event) in individuals and the risk assessment tools in common use. The difference between absolute and relative risk is explained. There is consideration of how clinicians could use and interpret the results of scoring systems. The older tools are criticized for leading to over-treatment of older people, under-treating younger people and being an example of the inverse care law. The newer risk scores ASSIGN and QRISK are described. This review provides practical guidance on using cardiovascular disease risk scoring in asymptomatic individuals. The difficulties of how best to communicate this risk will be explored in the second article in the series.
ECG of the month
Authors: Bowbrick Steve
Published: May 2014

Steve Bowbrick presents an ECG for you to analyse. The answer and management plan are given on page 434
Research Roundup
Authors: Linden Belinda
Published: May 2014

Waiting for coronary artery bypass graft surgery is oft en a stressful period for patients and their relatives, but many patients receive little medical or nursing care during this waiting period. For this reason, this research team from London introduced and evaluated the usefulness of a pre-operative support programme, as they saw this waiting period as an ideal time to tackle risk factors and provide information on surgery and recovery.
Disempowered, or disenchanted?
Authors: Stuart-Jones Vicqui
Published: May 2014

Reading the press coverage of the latest report from the National Audit of Cardiac Rehabilitation in late August, my eye wandered to the comments below the line on one of the reports. I tend to take them with a pinch of salt—the apparent anonymity of the medium can have a funny effect on some people. There are those who use it as a way to vent long-held grievances, and there are also those who invent spurious and inflammatory views just to get a rise out of fellow commentators.
Stored ICD electrograms: How do they aid diagnosis of arrhythmia episodes?
Authors: Elliott-Rotgans Donna
Published: May 2014

The development of specialist arrhythmia nurse roles caring for patients who have an implantable cardiac defibrillator (ICD) means nurses are increasingly expected to know more about the technical aspects of ICD therapy.

This article explains how the intracardiac electrogram (IEGM) data stored in an ICD is used by the device to adjust patient therapy. It also explains how the information is used in follow-up, including how it can guide device reprogramming by the specialized cardiac physiologist.
NACR report 2009: Implications for cardiac nurses
Authors: Jolly Kate , Wingham Jennifer
Published: May 2014

Kate Jolly and Jennifer Wingham discuss key findings of the latest national audit of cardiac rehabilitation, published in August 2009.
Electrical cardioversion to terminate cardiac arrhythmia
Authors: Sargent Andrew
Published: May 2014

Electrical cardioversion involves the passage of direct current (DC) electricity across the heart, synchronized to the ECG rhythm, to convert cardiac arrhythmias causing haemodynamic symptoms (where a cardiac output is still present).

This article describes the theory behind electrical cardioversion, indications and the procedure for elective cardioversion (for example, for atrial fibrillation). Nurse-led initiatives relating to this aspect of arrhythmia management are also considered.
How to present a successful oral abstract
Authors: Burke Katie
Published: May 2014

Katie Burke outlines the key points to consider when delivering a summary of a research project as an oral presentation at a scientific meeting or conference.
Pocket reference for end-of-life care
Authors: Whittingham Katharine , Whitworth Gill , Sharkey Christina
Published: May 2014

Katharine Whittingham, Gill Whitworth and Christina Sharkey discuss an initiative in Nottinghamshire to provide a resource on palliative care for heart failure clinicians
ECG of the month
Authors: Regan Claire
Published: May 2014

Claire Regan presents an ECG for you to analyse. The answer and management plan are given on page 141.
Arrhythmias: Running into problems?
Authors: Roome Paul
Published: May 2014

Paul Roome describes how his love of running was hampered by an irregular hear t rhythm. A version of this article first appeared in CMA News, published by the Cardiomyopathy Association.
ECG of the month
Authors: Regan Claire
Published: May 2014

Claire Regan presents an ECG for you to analyse. The answer and management plan are given on page 281
A field guide to cardiovascular organizations part 3: Charities
Authors: Olson Kate
Published: May 2014

Kate Olson concludes her guide to organizations shaping cardiac care in the UK with an over view of charitable bodies that have a specific focus on cardiovascular conditions.
Positive about pacemakers
Authors: Fletcher Monica
Published: May 2014

I read with interest Nicola Jenns’ article about living with a pacemaker in the June issue of BJCardN. I am Chief Executive of Education for Health: a medical education charity which educates health professionals in long-term conditions management including cardiovascular diseases, such as arrhythmias.
A multidisciplinary service for inherited cardiac disease in a regional clinical genetics service
Authors: Watts Sally , Bueser Tootie , Robert M L P
Published: May 2014

During the past decade there has been a rapid rise in genetic knowledge and huge technological advances. It is now possible to identify families at increased risk of inherited cardiac disorders such as cardiomyopathy and long QT syndrome. Such conditions can be associated with early onset sudden death and the National Service Framework (Chapter 8) recommends that families are offered appropriate support and treatment in specialized centres. In addition, delivery of efficient, effective and increasingly patient-focused services has become vital.

This article describes the development of a multidisciplinary cardiac genetics service in a regional genetics centre. It highlights the current challenges for health screening and genetic testing. The importance of the role of the health professionals caring for patients with inherited cardiac disease in establishing the accurate diagnosis and management of these families is also highlighted. A case study demonstrates the variability in presentation of cardiac disease that can occur in families and the necessity of providing a multidisciplinary service.
Evolution of a nurse-facilitated suspected arrhythmia clinic
Authors: Lapper Andrew , Smallwood Andrew
Published: May 2014

Objective: The purpose of this audit was to describe and compare the referred population to a nurse-facilitated suspected arrhythmia clinic for the period July 2007 to July 2008 with the previous year’s audit data as reported by Lapper and Smallwood (2008); assessing the impact on service provision and use of resources.

Method: Retrospective data were collected from all new referrals to a nurse-facilitated suspected arrhythmia clinic from July 2007 to July 2008.

Results: 302 patients were referred to the nurse-facilitated suspected arrhythmia clinic. Referrals were predominantly female, aged between 17–92 years and mostly Caucasian. The most common symptom prompting referral was palpitations (60%), with ‘stress’ being the most common self-reported precipitating factor (20%). Cardiac monitoring was instituted in 73% of patients. Following investigation atrial fibrillation was identified in 31% of referred patients, paroxysmal supra-ventricular tachycardia 9%, atrial ectopy 7%, ventricular ectopy 13%, sinus rhythm with pauses (1%), with no arrhythmias identified in 38% of the cohort. Findings were not recorded in 1% of patients.

Conclusions: The most striking feature of this review is the 57% increase in new patients referred suggesting that this clinic has become embedded in the cardiology appointments system and shows a willingness of referrers to use this avenue of referral. An impact on resources and practitioner role was noted. Despite the increase in referrals the number of arrhythmias detected was noted to be similar to the previous audit period. The need to evaluate clinic effectiveness is highlighted.
The shape of things to come?
Authors: Tagney Jenny
Published: May 2014

As I write this, there is a strange mix of developments within the health service. Obviously, we remain fairly dominated by swine flu and all the potential problems this will bring, including staff shortages. But there are many other significant issues that I fear have been overshadowed by the media frenzy this has attracted.
Heart attacks and circadian rhythms
Authors: Pierce-Hayes Ian
Published: May 2014

Aims: This study has two main aims. First, to confirm a peak incidence of heart attacks (acute myocardial infarction or AMI) occurring in the early hours of the morning and second, to explore the links between acute myocardial infarction and circadian rhythms.

Circadian rhythms control a host of biochemical, biological and behavioural patterns in humans. There is an internal mechanism for circadian rhythms known as the biological clock and external factors such as the light/dark cycle that ensures that our internal clock is synchronized with the environment.

Methods: This is a quantitative study collating data from patients attending a district general hospital with a diagnosis of ST-segment elevation MI as part of the Myocardial Ischaemia (formerly Infarction) National Audit Database (MINAP).

Results: The results of the study show that there is a significant peak in incidence of AMI in the morning hours between 6 am and 12 noon. This peak accounts for 34% of all patients presenting with AMI which is statistically significant (P<0.001). The review of the literature suggests a link between the peak in incidence of AMI and circadian rhythms.

Conclusions: An understanding of circadian rhythms is important to understand how patients with AMI and other acute coronary syndromes can be treated but also how to prevent their occurrence.
ECG texts for a variety of needs
Authors: Corrigan Philomena , Bowden Tracey
Published: May 2014

The focus of this American book is the interpretation of the ECG within the context of the patient’s clinical presentation. It assumes a basic knowledge and aims to develop advanced skills of ECG interpretation as part of clinical decision-making. Th e book would be of particular benefit to clinicians caring for both cardiac and non-cardiac patients in A&E, acute admissions units and critical care areas
How can we avoid a stroke crisis?
Authors: Mudd Jayne , Jerrome Jo
Published: May 2014

Jayne Mudd and Jo Jerrome explain why the Atrial Fibrillation Association (AFA) is highlighting the need for action on stroke prevention, and initiatives already under way.
Not just what but why
Authors: Stuart-Jones Vicqui
Published: May 2014

The 2009–2010 public report from the Myocardial Ischaemia National Audit Project (MINAP), covering England and Wales, was released just as this issue went to press. The headline figure from the report (covering the period from April 2009 to March 2010) is that more than 60% of eligible patients in England had their myocardial infarction treated with primary PCI, rather than thrombolytic drugs. Of those, three-quarters were admitted directly to a ‘heart attack centre’.
ECG of the month
Authors: Regan Claire
Published: May 2014

Clare Regan presents an ECG for you to analyse. The answer is given on page 506.
European Society for Cardiology Congress 2010
Authors: Fricker Janet
Published: May 2014

Janet Fricker presents highlights of the European Society of Cardiology (ESC) Congress, held in Stockholm, Sweden over 28 August–1 September 2010
Revolutionary road or road to nowhere?
Authors: Tagney Jenny
Published: May 2014

The latest consultation from the Department of Health, ‘Liberating the NHS: An Information Revolution’, was published on 18 October with a response deadline of 14 January 2011. The central themes of the proposals are for easily accessible, electronic patient records, better use of outcomes to improve care (and in particular to remove any reporting mechanisms that do not appear to improving care and outcomes), better clinician involvement in establishing appropriate standards and relevant systems to accurately record data. All sounds very sensible but in reality, haven’t we been trying to achieve this for some time and can we really afford such an overhaul at this time?
ECG of the month
Authors: Regan Claire
Published: May 2014

Clare Regan presents an ECG for you to analyse. The answer is given on page 557
On grief and bereavement
Authors: Walker Rachel
Published: May 2014

I was asked to review this book from the point of view of a nurse specialist working with people who have experienced the sudden death of a close family member.
ECG of the month
Authors: Regan Claire
Published: May 2014

Claire Regan presents an ECG for you to analyse. The answer and management plan are given on page 151
Recognizing anxiety and post-traumatic stress disorder in cardiac patients
Authors: Ayers Susan , Joekes Katherine , Copland Claire
Published: May 2014

Research has established that anxiety and post-traumatic stress disorder (PTSD) are risk factors for the development of heart disease in healthy populations. In addition, anxiety and PTSD are associated with further morbidity in people with existing heart disease. This article considers whether anxiety and PTSD influence onset and recovery from heart disease. Clinical implications for cardiac nursing are considered, including screening, treatment, and referral on to specialist services.
Myocardial perfusion scintigraphy
Authors: Keenan Jan
Published: May 2014

This article reviews the role of myocardial per fusion scintigraphy (MPS), a non-invasive cardiac imaging technique, in the diagnosis, assessment and management of coronary heart disease. An injection of a small amount of radioactive tracer and a gamma camera are used to produce images of blood flow to the myocardium after stress (exercise or pharmacological stress) and at rest. This allows reversible per fusion defects to be distinguished from fixed defects. As well as a tool in the diagnosis of coronary heart disease, it may also provide information to guide decisions on interventions, and to risk-stratify patients ahead of surgery.
Vascular risk factors and dementia
Authors: Ouldred Emma , Bryant Catherine
Published: May 2014

This article examines the evidence available regarding the association between vascular risk factors and dementia. Dementia is a distressing condition, which will affect 35 million people worldwide by 2010. Alzheimer’s disease (AD) is the most most common form of dementia and vascular causes are considered to be the second most common form. However, evidence is emerging that cerebrovascular disease and vascular risk factors are also important in the development and progression of AD. These emerging themes have prompted further consideration of the wider implications of vascular disease on cognitive function. Good practice in the management of patients with dementia is also highlighted in addition to information to direct carers to appropriate support organizations.
Braveheart: From research project to thriving community programme
Authors: Clyde Alison
Published: May 2014

Alison Clyde introduces the Braveheart Mentoring Programme, unique to Forth Valley, Scotland, designed and proven to help and support adults with coronary hear t disease.
Emotional impact on patients and families on the heart transplant waiting list
Authors: McDermott Anne , Hardy Jo , McCurry Mandy
Published: May 2014

Acceptance onto the heart transplant waiting list can lead to a period of uncertainty, as there are no guarantees as to when or if a suitable donor organ will be found. During this time, patients are seen to exhibit a wide variety of emotions, including fear, anxiety and depression and guilt, at the same time as experiencing a gradual decline in their physical health.

This is also a time of intense emotional stress for the family of the patient, who while fearing the death of their loved one, have to manage extended roles and responsibilities with limited time and resources.

All health professionals involved in the care of patients who are on the transplant waiting list should be aware of the physical and emotional demands placed upon the individual. This awareness must extend to the patients’ support network of family and friends.
ECG of the month
Authors: Regan Claire
Published: May 2014

Claire Regan presents an ECG for you to analyse. The answer and management plan are given on page 303
Exploring the impact of DNA testing for familial hypercholesterolaemia
Authors: Watson Melanie
Published: May 2014

Familial hypercholesterolaemia (FH) is a genetic disorder with a prevalence of 1 in 500, approximately 110 0000 people are estimated to be affected in the UK. The majority remain undiagnosed. Effective preventive treatment is available to reduce cholesterol. Untreated FH leads to premature CHD and death. The main aims of the study were to explore how patients and their families receive, make sense of and transmit genetic information and the impact that this dynamic process has on their perception of risk.

Semi-structured interviews were conducted with 7 patients with a clinical diagnosis of FH and a mutation positive result. A further 7 interviews were conducted with members of their families who had also undergone genetic testing. The interview transcripts were thematically analysed.

The findings suggest that genetic risk information help patients to make sense of their condition and acts as a stimulus to cascade testing. The process of family communication and the emotional responses to genetic risk information were complex.
Hypertension in primary and secondary prevention of CVD
Authors: Lambie James
Published: May 2014

Hypertension is a major risk factor in the development of coronary heart disease (CHD) and remains part of the longer-term management of those with established pathology. However, despite current UK primary prevention of cardiovascular disease (CVD) initiatives, optimal detection of hypertension and blood pressure (BP) management are a challenge. Mention of BP management in national guidelines for CHD care is brief. Evidence suggests though that improved outcomes follow optimal hypertension management in secondary prevention. This article outlines the role of BP in development of CHD and illustrate BP targets and current issues in BP management, while the question is asked whether there is a nursing role within primary and secondary prevention.
Research Roundup
Authors: Linden Belinda
Published: May 2014

Triglyceride is the major form of fat stored in the body, consisting of three molecules of fatty acids combined with one molecule of the alcohol glycerol. High levels of triglycerides in the blood have been linked with cardiovascular disease, but it remains uncertain whether triglycerides independently cause coronary disease and whether lowering triglyceride levels can reduce cardiovascular risk.
Atrioventricular blocks
Authors: Richley Dave , Cardiac Chief
Published: May 2014

I wish to comment on the ECG of the month in the June 2010 issue of British Journal of Cardiac Nursing. The answer states that the ECG shows ‘Mobitz type II 2:1 AV block.’ Mobitz type II block refers to the presence of non-conducted sinus P waves without preceding lengthening of the PR interval, in contrast to Mobitz type I (Wenckebach) block, in which there is lengthening of the PR interval before a nonconducted P wave. Th e Mobitz classification cannot apply to 2:1 block because in this particular condition there are not two consecutive conducted P waves. In other words, no statement can be made as to whether or not the PR interval lengthens before the dropped beat. 2:1 block is a separate category of second degree block. However, in the section of ECG published there is quite clearly a sequence of beats towards the end of the strip which deviates from the 2:1 block pattern and shows an increasing PR interval before a dropped beat. Th is, therefore, is a typical example of a Mobitz type I (Wenckebach) sequence. A more accurate summary of the ECG, then, might be that it shows sinus rhythm with 2:1 and Mobitz I (Wenckebach) AV block.
Creatine kinase testing: What and why?
Authors: Aziz Shahid
Published: May 2014

The enzyme creatine kinase (CK) is present in large concentrations in skeletal muscle, smooth muscle and cardiac muscle. Elevated levels of CK in the blood can occur in conditions where there is damage to cardiac or skeletal muscle. This article briefly discusses the underlying biology and clinical applications of serum CK testing.
Research Roundup
Authors: Linden Belinda
Published: May 2014

The first study linking short stature with coronary heart disease risk was in 1951, and since then, many further studies have also reported such an association, and others that have challenged these findings. However, there have been no systematic reviews which have pooled the research results.
NICE public health guidance on prevention of CVD
Authors: Linden Belinda
Published: May 2014

Belinda Linden presents an overview of recently-published guidance of relevance to cardiovascular nursing. This month we look at the NICE public health guidance on primary prevention of cardiovascular disease, which advocates taking steps at a national and local strategic level
Physical and psycho-social issues in treatment of elderly patients with valve disease
Authors: Parker Jessica , Saheecha Saad
Published: May 2014

The number of elderly patients with valvular heart disease is steadily rising. Modern medicine with advancing surgical research and intervention mean that there are multiple options for treating elderly ‘high-risk’ patients. Many of these patients are frail, have complex comorbidities and added difficulties such as visual or hearing loss.

Identifying the many physical and psychosocial issues that hinder interventional treatment and recovery of elderly patients with valve disease will help ensure they receive holistic unbiased treatment and maintain a good quality of life.

This article will explore the complex symptoms and diagnosis of valve disease in the elderly, treatments available to ‘high-risk’ patients and the difficulties that arise in care, treatment planning and recovery. Some key nursing roles are identified.
The impact of depression on the pathogenesis of heart failure
Authors: McGowan Doireann
Published: May 2014

Chronic heart failure is a widespread condition and its prevalence in the UK continues to grow. Living with chronic heart failure can severely impair longevity and quality of life. Despite the known severe impact this chronic disease has on patients’ lives, little research has explored the prevalence of depression among the UK heart failure population. Recent evidence suggests that depression may not only further worsen the already diminished quality of life for heart failure patients, but it may also significantly increase the mortality risk of the patient living with heart failure. This article reviews current evidence and guidelines to consider the prevalence of depression among UK heart failure patients and illustrates how the pathophysiology of depression negatively impacts on the pathogenesis of heart failure.
ECG of the month
Authors: Regan Claire
Published: May 2014

Clare Regan presents an ECG for you to analyse. The answer is given on page 47
SIGN guidance on management of obesity
Authors: Linden Belinda
Published: May 2014

Belinda Linden discusses the key points of interest for cardiovascular nurses in the clinical guideline from the Scottish Intercollegiate Guidleines Network on the management of obesity
Collaborative Working to Improve Care: Banking DNA in Unexpected Adult death
Authors: Bennett Michelle
Published: May 2014

Before the appointment of two arrhythmia nurse practitioners (ANPs) to a district general hospital it was identified that despite having a number of families with genetic disorders, no proper services existed for the assessment, management and support of patients and families. A process mapping event highlighted what services needed to be developed. One area that was identified was that samples of DNA were not being banked in the unexplained death of a person aged under 40 years. Through collaborative working an appropriate consent form was developed for these circumstances. This has resulted in the successful banking of DNA in new cases of sudden unexplained death in the young.
Over half of patients with NSTEMI delay going to hospital for over two hours
Authors: Linden Belinda
Published: May 2014

This section presents a synopsis of a selection of recently published articles of interest to those nurses working in the field of cardiovascular nursing. The aim of this round-up is to provide a brief overview, rather than a detailed critique, of the research papers selected. A full reference is provided for those who wish to look at the research in further detail.
Shorter hospital stay after myocardial infarction does not increase mortality risk
Authors: Linden Belinda
Published: May 2014

This section presents a synopsis of a selection of recently published articles of interest to those nurses working in the field of cardiovascular nursing. The aim of this round-up is to provide a brief overview, rather than a detailed critique, of the research papers selected. A full reference is provided for those who wish to look at the research in further detail.
Patient-reported outcomes underused in cardiovascular trials
Authors: Linden Belinda
Published: May 2014

This section presents a synopsis of a selection of recently published articles of interest to those nurses working in the field of cardiovascular nursing. The aim of this round-up is to provide a brief overview, rather than a detailed critique, of the research papers selected. A full reference is provided for those who wish to look at the research in further detail.
Median sternotomy scars: formation and impact on patient quality of life
Authors: Papaspyros SC , Patel RK , Polyzois K , Javagula KC , Jeffrey RR
Published: May 2014

More than 30 000 people undergo heart surgery in the UK each year. A significant source of long-term morbidity following sternotomy is the tendency to form abnormal scars. Living with scars can be challenging in a social environment that values physical attractiveness.

The physiology of wound healing is a complex, dynamic process that results in restoration of anatomical continuity and function. However, where the reparative processes are disrupted, wound healing can be impaired resulting in two pathological extremes: deficient healing leading to chronic wounds or excessive healing leading to hypertrophic or keloid scars.

Current post-sternotomy precautions are, at best, supported by indirect evidence and have several limitations.

Psychosocial distress is directly related to patient-perceived scar severity and unrelated to clinicians’ ‘objective’ rating. The potential impact of sternal scar formation should be discussed with patients pre-operatively and appropriate support (social skills training, cognitive behavioural therapy) should be offered during recovery.
Polypharmacy in heart failure: A growing challenge
Authors: Rushton Claire A , Kadam Umesh T
Published: May 2014

Current guidelines in heart failure recommend ‘add-on’ prescribing of evidence-based medicines aimed at improving symptoms and prognosis. Heart failure patients therefore commonly receive multiple drug therapies and this ‘polypharmacy’ is set to increase with the recognition of new potential drug targets. Drug regimes in heart failure are further complicated by increasing age and high levels of comorbidity inherent in this patient group. Nurses are central to the patient's care pathway and the commencement and titration of medicines are key component sof the patient's management plan. The development of nursing specialism in heart failure alongside independent prescribing have further extended nurse's responsibilities. Polypharmacy is an important consideration for nursing and this article provides an overview of the development of drug therapies in heart failure as well as the scope of polypharmacy for this group. The key implications of polypharmacy in heart failure will be explored, including side effects, drug interactions, prescription errors, optimal clinical prescribing and patient adherence.
Pulmonary arterial hypertension: An overview
Authors: Matura Lea Ann
Published: May 2014

Pulmonary arterial hypertension (PAH) is a devastating disease characterized by elevated mean pulmonary artery pressures (PAP) that ultimately leads to right heart failure and death. Approximately 100 000 patients are living with PAH worldwide. Life expectancy is 6–7 years with treatment. PAH affects mostly women (80%) with a mean age of diagnosis of 50 years. Common symptoms of PAH include dyspnea at rest, peripheral oedema, chest pain/discomfort, dizziness/lightheadedness, syncope, cough and abdominal distention. Pathobiological findings include vasoconstriction, remodelling and in situ thrombosis. Diagnosis is confirmed by elevated mean PAPs determined by right heart catheterization. Common treatments comprise oxygen, diuretics, and anticoagulation along with PAHspecific medications: calcium channel antagonists, prostanoids, endothelin antagonists, and phosphodiesterase inhibitors.
Prevention of ventilator-associated pneumonia
Authors: Standring Diane , Oddie Dawn
Published: May 2014

Ventilator-associated pneumonia is a common problem in intensive care, and is a complex issue where prevention is both vital and multifaceted. This article explores the extent of the problem, the current research and some of the key elements within a prevention strategy, the Department of Health ventilator bundle and National Institute for Health and Clinical Excellence/National Patient Safety Agency technical patient safety solutions.
Fewer patients undergoing CABG in the US
Authors: Linden Belinda
Published: May 2014

This section presents a synopsis of a selection of recently published articles of interest to those nurses working in the field of cardiovascular nursing. The aim of this round-up is to provide a brief overview, rather than a detailed critique, of the research papers selected. A full reference is provided for those who wish to look at the research in further detail.
Resuming sexual activity after myocardial infarction
Authors: O'Donovan Kate
Published: May 2014

Resuming sexual activity after a myocardial infarction (MI) is a common worry shared between patients and their partners. Common concerns that are expressed often involve the perceived risk of causing another acute coronary event and the impact that cardiovascular medication may have on sexual function. Patients and their partners need practical information that they can process and deal with. Such information comprises when to resume sexual activity and what to avoid. For example, avoiding sexual activity after a heavy meal or the consumption of alcohol. Patients also need to be informed that sexual dysfunction may develop as a result of the atherosclerotic process or the cardiovascular medications and other treatment options. Providing information on resuming sexual activity after an MI is an essential aspect of patient education and the discharge process, but many nurses in the critical care setting are reluctant to initiate discussion on this sensitive subject. This reluctance may develop as a result of embarrassment or the nurse may be uncomfortable with his or her own sexuality. The nurse may also feel that bringing up this subject is an invasion of the patient's privacy. Other influences include environmental factors. For example, the unit may be very busy or there is not a suitable place to conduct the conversation. In addition, the patient may be considered too ill. The literature has illustrated many strategies to overcome this reluctance to initiate a discussion about sexuality. These may include workshops or the use of open questions that may encourage discussion and the availability of patient educational resource materials.
An overview of risk prediction models and the implications for nursing practice
Authors: Betihavas Vasiliki , Newton Phillip J , Davidson Patricia M
Published: May 2014

Chronic heart failure is a common and costly condition and is one of the most common causes of hospitalisation and emergency department presentations in the elderly. This paper discusses risk prediction models in chronic heart failure, their utility in clinical practice and describes the implications for nursing practice. Based on a review of the literature, a description is presented of current risk models for chronic heart failure; the use of risk models in other conditions and the benefits of applying valid and reliable measurement tools in clinical practice. Consideration is given for clinical as well as non-clinical factors being incorporated into risk prediction models.