bluuebunny/crossref_metadata_2025 huggingface dataset:
Roses for nonsmokers' hearts
Authors: Johnson Kate
Published: May 2014

For the first two weeks of February shops and the media are full of references to Valentine's Day. Even the British Heart Foundation (BHF) have used the opportunity as part of their recent fundraising campaign for more BHF heart nurses. This year, however, Valentine's Day was marked by the vote in favour of a ban on smoking in public places, which is due to come into effect in England in the summer of 2007. The British Heart Foundation described this decision as ‘the best possible Valentine gift from MPs to bar workers in pubs, bars and private members’ clubs, across England’ (British Heart Foundation, 2006).
Hypertrophic cardiomyopathy: A care study
Authors: Cruickshank Stephanie
Published: May 2014

Hypertrophic cardiomyopathy is the highest cause of sudden cardiac death in young adults. However, it is a benign condition that affects 1 in 500 of the population. This case study focuses on the diagnosis and management of a 39-year-old male with familial cardiomyopathy. One of the challenges for health care professionals is Identifying those people who are at high risk of sudden death from this condition. The investigations that Damion under went to assess his risk and his subsequent management are presented along with the nursing and psychological care that he received.
Diagnosis and management in the rapid-access chest-pain clinic
Authors: Quinney Katie
Published: May 2014

Angina pectoris is a common condition and while presentation can vary, patients typically present with exertional chest pain that is relieved by rest. Rapid-access chest-pains clinics are an established ser vice that provide the specialized assessment of patients who present with new-onset chest pain. This care study focuses on the assessment, investigation and diagnosis of a 55-year-old man. He was seen and assessed by a nurse practitioner and this care study discusses further management and follow-up of this gentleman.
Heart disease does not just affect older people
Authors: Jolly Anne
Published: May 2014

Anne Jolly, founder of the Ashley Jolly Sudden Arrhythmic Death Syndrome Trust, discusses the crucial role it plays in influencing health-care policy and informing health professionals.
Glycaemic control in critically ill patients: Where are we now?
Authors: Naughton Corina
Published: May 2014

In many intensive care and coronary care units glyceamic control is part of the standard management of critically ill patients, regardless of whether or not they have diabetes. This change in clinical practice is based on an increased understanding of the metabolic changes associated with critical illness and large numbers of observational and interventional studies.

Interventional studies have demonstrated that controlling blood glucose can reduce mortality and morbidity in patients with a variety of critical illnesses. However, not all patients have demonstrated a survival benefit and more research is required to identify these subgroups.

Instigating a glycemic control regimen requires inter-disciplinary co-operation, education and additional resources but these can be offset by a reduction in hospital cost.

The ultimate success and safety of such a regimen relies on developing a positive attitude among nursing staff in particular, and encouraging both a practical and theoretical understanding of how glycaemic control works.
Managing chest pain and secondary prevention in a South Asian patient
Authors: Marshall Kathy
Published: May 2014

South Asians living in the United Kingdom (UK) have a higher incidence of coronary heart disease than the indigenous population. Their increased risk of developing coronary heart disease (CHD) is as high as 40% or more and they can die at a younger age. Although the death rate from CHD are falling in the UK, it does not appear to be falling as fast in South Asians living here. This care study focuses on the management of a 59-year-old South Asian man who attended at a rapid-access chest-pain clinic in southeast London. It highlights the challenges of managing his chest pain symptoms, supporting him with the self-managed Angina Plan programme to help him cope with his condition and change his lifestyle.
ECG of the month
Authors: Whitbread Mark
Published: May 2014

Mark Whitbread presents an ECG for you to analyse. The answer and management plan will be published next month
Tenecteplase: A fibrinolytic agent
Authors: Potts Katherine
Published: May 2014

Thrombolysis is an established therapy for acute myocardial infarction in the UK. ST-elevation myocardial infarction almost always occurs owing to coronary atherosclerosis and coronary thrombosis which develops because of plaque disruption. Fibrinolytic agents act to dissolve the clot.

Tenecteplase is a fibrinolytic agent that is given over ten seconds using the intravenous route. It is a fibrin-specific agent that has a prolonged plasma half-life and a high resistance to plasminogenactivator inhibitor type 1. These features mean that there is a potential decrease in the amount of time from the decision to thrombolyse and administration. In addition, because of the fibrin specificity and its resistance to plasminogen-activator inhibitor type 1, tenecteplase is more likely to restore a patent coronary artery.
Michael Noble's story: Living with primary pulmonary hypertension
Authors: Noble Michael
Published: May 2014

Michael Noble gives a personal account of his experience as someone diagnosed with pulmonary arterial hypertension. He discusses how he came to terms with it, the journey he faced and the future.
The importance of communication
Authors: Cosgrave Rebecca
Published: May 2014

September marks the third Arrhythmia Awareness Week (12–19 September), an annual health awareness campaign which, this year, ends with the launch of the first Heart Rhythm Congress (19–21 September). This congress is the first combined meeting of patient and professional groups involved in arrhythmia care, including Heart Rhythm UK, Heart Rhythm UK Nurses and the Arrhythmia Alliance. It promises to be very educational and I am looking forward to hearing debate on how Chapter 8: Arrhythmias and sudden cardiac death of the National Service Framework for Coronary Heart Disease (DH, London) has affected patient care.
Arrhythmia management in the 21st century
Authors: Sporton Simon
Published: May 2014

Simon Sporton discusses the progress that has been made in arrhythmia management but tells us that there is still some way to go.
Heat waves and heart failure: Dilemmas in advising patients
Authors: Jones Chris , Stephens Barbara , Bryden Clare
Published: May 2014

The incidence of extreme weather conditions is expected to rise over the next 50 years. The population of older and frail people is also expected to rise. Many of these older people will suffer from heart failure. Heat waves present special problems to patients in heart failure and the professionals who care for them. This article identifies lapses in the knowledge base relating to advice for patients in heart failure in the areas of lifestyle modification, medication and assessment. It also identifies the policy conclusions which have emerged from the analysis of heat waves which have occurred in the past and how these conclusions may be shaped to meet the needs of heart failure patients during conditions of extreme heat.
Not just sitting in an office and standing in a classroom: The role of a cardiac lecturer
Authors: Johnson Kate
Published: May 2014

Lecturing is an extremely diverse job and Kate Johnson tells us about all the different aspects of her role and how she ended up in higher education.
EUROACTION: A demonstration project in preventive cardiology
Authors: Jennings Catriona
Published: May 2014

EuroAction, the largest European demonstration project in preventive cardiology, has shown that the European cardiovascular disease prevention guidelines can be more effectively implemented in everyday clinical practice. This article describes the unique European Society of Cardiology EuroAction approach to preventive cardiology, which was formally evaluated in a randomized controlled trial across eight countries and 24 clusters of hospitals and general practices. In this nurse-led, multidisciplinary programme, patients with coronary artery disease and those at high risk of developing cardiovascular disease were identified in the same way in intervention and usual care hospitals and general practices. In intervention hospitals and practices, patients were invited to attend a preventive cardiology programme with their families. The programme helped patients and family members to meet the European lifestyle, risk factor and therapeutic targets for cardiovascular disease prevention. Patients managed in usual care were simply monitored for the care they received.
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 496
Atrial fibrillation and flutter: Is it better to be informed?
Authors: Dawes Jonathan
Published: May 2014

Jonathan Dawes asks whether nurses make the worst patients and gives a personal account of his experience of being diagnosed with paroxysmal atrial fibrillation and flutter
Health awareness and young people
Authors: Cosgrave Rebecca
Published: May 2014

Everyone working in health care will, at some time, have experienced how difficult it can be to raise awareness of a number of medical conditions. This can be even harder with younger people who, for obvious reasons, often don’t consider the possibility that they may not be invincible. I was delighted, therefore, to attend the Silent at Heart art exhibition last month which used art to raise awareness of sudden cardiac death in younger people.
Have you had your say yet?
Authors: Stuart-Jones Vicqui
Published: May 2014

This is my first opportunity to introduce myself to most of you since I took over from Rebecca as Editor. As I look ahead to future issues and make plans for the coming months, there are some much larger changes in the pipeline. The discussion about the future shape of the NHS made the news again at the beginning of October when Lord Darzi, the junior health minister, published his interim report on the Our NHS, Our Future review (DH, 2007a) reflecting on the comments received so far from those working in the NHS, patients and the public.
Calculating cardiac axis on a 12-lead ECG
Authors: Daviesis Alan
Published: May 2014

Determination of the cardiac axis on a 12-lead electrocardiogram (ECG) is considered a core element of basic ECG interpretation, but is also the area that many find the most complex when they are introduced to reading and interpreting ECGs. Alan Davies examines some of the methods of determining axis that can be used in the clinical environment.
The role of ezetimibe in cholesterol management
Authors: Pottle Alison
Published: May 2014

Raised cholesterol is a recognized risk factor for cardiovascular disease (CVD). If lifestyle changes do not result in cholesterol levels reaching the desired targets, then pharmacological agents may be required. Statins are the first-line treatment, but sometimes other classes of lipid-lowering drugs are required. Ezetimibe is a novel agent, which acts by inhibiting the intestinal absorption of cholesterol. Nurses caring for patients with CVD or at risk of developing CVD need to be aware of all the agents which may be used to control cholesterol levels.

This article will outline the process of cholesterol metabolism and examine the role of ezetimibe in the reduction of cholesterol levels. It will also discuss side effects and contraindications to this therapy so that nurses are able to safely care for patients taking ezetimibe.
A new model for nursing education?
Authors: Jones Ian
Published: May 2014

Ian Jones outlines a course in acute cardiac care being piloted in Greater Manchester in 2008 that will take a new approach to supporting students
Transoesophageal echo before cardioversion for AF: Reviewing the evidence
Authors: Wright Stuart
Published: May 2014

This article examines whether transoesophageal echocardiography (TOE) should be per formed on all patients before electrical cardioversion for atrial fibrillation (AF). The impact of AF within the healthcare setting is high and creates a considerable demand on the financial and clinical resources of the NHS as well as the health implications for patients. Cardioversion of AF to sinus rhythm is an established treatment for some patients, but the risk of emboli and subsequent embolic events needs to be ascertained. TOE is effective in establishing the risk of intracardiac emboli and its usage in the clinical setting is increasing. A review of the available literature supports the use of TOE as a prerequisite to cardioversion in some groups of patients but not all. Where facilities and expertise exist to deliver this service, it can offer better treatment to qualifying patients.
Nurses’ perception of their learning needs to deliver CVD prevention programmes
Authors: Kennedy Susan
Published: May 2014

Aims: To determine nurses’ perception of the knowledge and skills needed to deliver cardiovascular disease (CVD) prevention programmes and to describe their continuing professional development (CPD) needs.

Design: Two cross-sectional descriptive surveys using two postal questionnaires were conducted with first, past students (n=83) of the ‘Managing Cardiovascular Risk Factors’ course and second, practice nurses (PN) (n=690), taken from a purposeful sample of Scottish health boards.

Results: Past students rated knowledge and skills possibly needed to deliver CVD care. Those categorized as ‘advanced clinical’ were rated significantly higher than ‘management’ or ‘nurse development’ (P<0.001). Past students considered their future learning needs required more advanced-level courses (P=0.006, 95% CI 0.21, 0.45). PNs (9%) seeking a Masters-level course were more likely to perceive they had a high input into patient management (P<0.001) or have completed courses on CVD (P<0.001). PNs (19%) not attending any CVD CPD indicated this was due to lack of opportunity (P<0.001).

Conclusions: Nurses perceiving they had a high input into CVD care or who had completed courses on CVD were more likely to seek further higher-level education. This has implications for CVD CPD delivery.
Wolff-Parkinson-White: Assessing and treating asymptomatic patients
Authors: Mash Kelly Anne
Published: May 2014

Wolf-Parkinson-White is a condition which is associated with the presence of accessory pathways in the heart’s conduction system. The treatment of patients with Wolff-Parkinson-White syndrome tends to focus on those who have already suffered an arrhythmia because of the accessory pathway whereby the heart’s electrical conduction pathway bypasses the atrioventricular node. The risk of sudden cardiac death is recognized to be less in those without symptomatic arrhythmias. However, the risk of sudden cardiac death still exists. This paper will look at the evidence surrounding the risk stratifi cation and treatment of these asymptomatic patients.
Assisted dying in heart failure: The Joffe Bill
Authors: Jones Chris , Gladman Linda
Published: May 2014

The Joffe Bill on assisted dying was rejected in parliament. Chris Jones and Linda Gladman discuss whether there can ever be an assisted dying bill that will help people with heart failure.
Exploring patient adherence to cardiovascular medicines
Authors: Silcock Jonathan , Standage Claire
Published: May 2014

Medicines are the most common evidence-based healthcare intervention. However, low levels of patient adherence to medicines for chronic illnesses mean that some expenditure may be wasted. This article provides a guide for nurses who wish to explore the patient adherence literature and improve clinical practice. The related terms of compliance, adherence and concordance are defined, and differences in interpretation are explained. Broad roles are suggested for nurses who administer or prescribe medicines, and levels of patient adherence to various cardiovascular medicines are discussed. The risks and benefits associated with higher levels of adherence are summarized, and patient views about adherence are illustrated. Finally, some practical strategies for improving patient adherence and engagement in decision making are evaluated.
Nurse practitioners in cardiothoracic care: Practitioners’ perspectives
Authors: Swainston Katherine
Published: May 2014

Background: Redesigning the cardiothoracic workforce at one teaching hospital to meet government targets and changing patient needs has led to the introduction of several new healthcare roles including that of nurse practitioner.

Methodology: Nurse practitioners at one tertiary care centre were interviewed using a semi-structured process. The interviews were used to gain insight into the nurses’ roles.

Findings: This article reports the results of a qualitative evaluation into nurse practitioners’ perspectives on this new way of working. Thematic analysis of semi-structured interviews with eight nurse practitioners revealed five themes: professional development; making a difference; support; frustration of working in an evolving role; and uncertainty.

Implications: The findingsindicate that the nurse practitioner role can provide a rewarding career in which nurses can develop in a clinically oriented profession.

Conclusions: Contact with patients throughout their continuum of care can enhance job satisfaction and is likely to produce long-term benefits for cardiothoracic patients. As the boundaries of medicine and nursing, and the associated professional identities become less defined, the need for continual evaluation that does not neglect practitioner perspectives is apparent.
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 291
Learn all about cardiac pacing
Authors: Gibson Tracey
Published: May 2014

While there are a number of texts dedicated to cardiac pacing, most of these are aimed at cardiac physiologists or advanced practitioners, and assume a certain degree of previous knowledge on the subject. Tom Kenny has aimed to provide an ‘easy-to-navigate, user-friendly text that presents cardiac pacing in all of its aspects and complexity’.
Aldosterone antagonists in heart failure
Authors: Davies Siân
Published: May 2014

Previously aldosterone was only thought to exert damaging effects on the failing heart owing to adverse compensatory measures in fluid homeostasis. However, recent evidence has suggested that the mineralcorticoid receptor for aldosterone is also present in the vasculature and failing heart, and it is here that aldosterone’s role is of more significance in relation to worsening cardiac dysfunction. Aldosterone blockade with spironolactone has been strongly correlated with reduced mortality and morbidity rates in patients with chronic heart failure caused by systolic left ventricular dysfunction and, more recently, aldosterone blockade with eplerenone has also been indicated in cases of heart failure after acute myocardial infarction. The emerging evidence for the use of aldosterone blockade in the cardiac patient has also highlighted the need for careful patient selection and monitoring to prevent adverse effects, in particular from hyperkalaemia.
The first year of life as a newly-qualified staff nurse
Authors: Redman Polly
Published: May 2014

Having qualified last year Polly Redman is now completing the year-long cardiothoracic rotation which has enabled to develop both her confidence and her skills. She tells us all about it.
Skills in taking an accurate cardiac patient history
Authors: Tagney Jenny
Published: May 2014

People with cardiovascular disease will enter the healthcare system at varying stages of their disease progression (Lobert, 1996). An accurate assessment process is the cornerstone to ensuring that patients receive the care and treatment they need, at whatever stage they enter the healthcare system. Eliciting an accurate history from patients, in combination with appropriate, targeted clinical examination, is a critical step in the assessment process and will ensure that suitable management and treatment are commenced in an appropriate time frame. This article will give an overview of the skills and techniques required in obtaining an accurate patient history from a patient presenting with possible cardiac problems.
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 37
Please take a minute to…
Authors: Stuart-Jones Vicqui
Published: May 2014

we have two articles in this month’s issue that both relate directly to the issue of communication with patients—a pilot study on a course to help nurses deal with conveying difficult information to those with (end-stage) heart disease (Wilkinson et al, pp475-81) and the second of our articles on patient consent (Haxby and Shuldham, pp463-7). Both of these make the point that listening to what patients say is as important as what you tell them and how you say it.
Cognitive dissonance theory applied to CPR, DNAR, and the practice of slow codes
Authors: de Vriesis Jan MA
Published: May 2014

Cognitive dissonance theory holds that inconsistencies in our thinking or between beliefs and actions generate mental discomfort. This motivates efforts to reduce the inconsistencies by adapting behaviours or thoughts to make them more consistent with one another.

This article demonstrates how the theory can be applied as a framework to understand internal conflicts which health professionals may experience when they encounter inconsistencies between their principles and practice, in the implementation of cardiopulmonary resuscitation and ‘do-not-attempt-resuscitation’ orders.

The author suggests that the discomfort generated by these conflicts has been a motivating factor in the emergence of so called ‘slow codes’ (cardiopulmonary resuscitation efforts intentionally conducted too slowly or not long enough to be successful). Interventions are suggested that may help prevent the occurrence of slow codes.
Familial hypercholesterolaemia: A new focus on finding and managing increased CVD risk
Authors: Robertson Laura
Published: May 2014

Laura Robertson discusses the implications of the recently-released draft guidelines from NICE on screening for and management of familial hypercholesterolaemia
Research Roundup
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.
Confrontation and collaboration
Authors: Tagney Jenny
Published: May 2014

It is a pleasure to be able to introduce this month’s issue, which has a strong adult congenital heart disease theme. It is a testament to advances in both surgical and medical technologies that there are now more adults than children living with congenital cardiac disorders, yet our knowledge of the patient experience and the evidence base for nursing interventions in this group remains scant. It is helpful therefore that we have medical, nursing and patient contributions to help us to better understand some of the challenges and successes of current practice.
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 177
Impacting on improving patient care at every level
Authors: Currie Mary
Published: May 2014

Mary Currie reflects on the path that has taken her from traditional nursing roles to a focus on service improvement and business development Mary Crie reflects on the path that has taken her from traditional nursing roles to a focus on service improvement and business development
Key issues in heart failure
Authors: Riley Jillian
Published: May 2014

This useful handbook introduces the reader to key issues in enhancing the care of patients with heart failure. The book starts by presenting the context to how heart failure care is currently delivered in the UK health service and then introduces the reader to important issues in diagnosis. This is followed by a discussion of treatment options and the book concludes with a review of policy issues influencing practice development.
Reflections on a heart failure study
Authors: Shuldham Caroline
Published: May 2014

Caroline Shuldham shares her personal experiences of planning, conducting and disseminating primary research.
An audit of specialist nurse pharmacological intervention in chronic heart failure
Authors: Burke Katie , Penston Helen , Riley Jillian
Published: May 2014

Aim: Chronic heart failure (CHF) is a complex clinical syndrome associated with recurrent hospitalizations and high mortality. Evidence suggests that many patients are not receiving effective pharmacotherapy. The aim of this retrospective audit was to formally describe and evaluate the pharmacotherapy of an established heart failure nurse led clinic in North West London.

Methods: A retrospective audit was undertaken in January 2007 on all patients diagnosed with CHF attending the out-patient nursing clinic between October and December 2006. Descriptive statistics were used to summarise patient data.

Results: 77 patient letters were audited. Mean age 73 years (SD ± 13), with 32 patients (42%) female and 14 (18%) South Asian. ACE inhibitors were prescribed in 60 (78%) patients, with beta blockers and loop diuretics prescribed in 47 (61%) and 71 (92%) respectively. No statistically significant difference was found in prescription rates between male and female patients. A statistical significant difference (P=0.043) was observed in the age of patients prescribed aldosterone antagonists.

Conclusions: Demographic data is consistent with survey evidence from the EuroHeart failure surveys (EHFS) and ADHERE registries and is appropriate to the local population. Pharmacological prescription rates are comparable with national and international survey standards and adhere to the European Society of Cardiology (ESC) guidelines.
What are the experiences of patients waking from fast-track
Authors: Perkins Claire
Published: May 2014

Nationally, the majority of cardiac surgery centres practise some type of rapid recovery or fast-track (FT) system in which low-risk cardiac surgical patients are extubated quickly following surgery to relieve the pressure on scarce critical care resources and improve patient outcome. In order to facilitate early extubation, FT patients often receive less sedative and analgesic medication than their conventionally-recovered counterparts while in the intensive care environment.

Research was undertaken into the initial waking experiences of these patients as the intensive care unit (ICU) is well recognized to be a stressful place. This phenomenological study highlights that nurses play a vital role during the immediate post-operative period that goes beyond the more widely-recognized technical aspects of their role. The results of this study could be used by nurses to enhance patient experiences and potentially lead to improved physical and psychological outcomes for FT cardiac surgical patients in the future.
Research Roundup
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 over view, 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.
Chest X-ray case study 6
Authors: Ash-Miles Janice , Callaway Mark
Published: May 2014

Janice Ash-Miles and Mark Callaway present the final chest X-ray for you to analyse. The answers and discussion are given on page 546.
A beginner’s guide to appraising a qualitative research paper
Authors: Astin Felicity
Published: May 2014

Felicity Astin presents questions for the critical reader to bear in mind when assessing a piece of published qualitative research.
Mixed methods studies: A guide to critical appraisal
Authors: MacInnes Julie
Published: May 2014

Julie MacInnes discusses the reasoning behind mixed methods research—the use of both quantitative and qualitative data in the same study—and how to evaluate it
C-reactive protein and its role in coronary artery disease
Authors: Potts Katherine
Published: May 2014

C-reactive protein (CRP) is a marker of inflammation traditionally used to detect inflammation and infection. This is measured by taking a venous blood sample. There are two assays of CRP available with the most commonly-used assay used to detect a wide range of CRP levels in acute infection and inflammatory processes. A second assay is that of high-sensitivity CRP (hs-CRP) that has been studied in many diseases such as cardiovascular disease, peripheral vascular disease, hyper tension and diabetes to name a few. There has been extensive research into the role of CRP in the atherosclerotic process of cardiovascular disease. It is recognized that inflammation plays a role in the development of coronary artery disease and plays a par t in cardiovascular risk estimation. High sensitivity measurement of CRP adds to current tools for risk estimation and also as a prognostic tool to predict future events such as myocardial infarction, revascularization and death in patients with proven acute coronary syndromes (ACS).
Chest X-ray case study 2
Authors: Ash-Miles Janice , Callaway Mark
Published: May 2014

In the next in their series on chest X-ray interpretation, Janice Ash-Miles and Mark Callaway present a case for you to analyse. The answers and discussion are given on page 140.
Just the facts, ma’am?
Authors: Stuart-Jones Vicqui
Published: May 2014

A particular story caught my eye recently. That is to say, a headline caught my eye, and my initial reaction was not a very positive one. However, maybe:
Erectile dysfunction and CHD: Related risk factors and implications for nursing practice
Authors: O’Sullivan Brid , Savage Eileen
Published: May 2014

Erectile dysfunction needs further attention in nursing. The purpose of this article is to raise nurses’ awareness about the link between erectile dysfunction (ED) and coronary heart disease (CHD). This paper considers ED as a risk factor for CHD, discusses the pathophysiology and prevalence of ED and reviews the shared risk factors for ED and CHD.

Knowing that ED can occur before the onset of CHD may further encourage nurses to ask questions about sexual function. Understanding the link between ED and CHD may equip nurses in primary and secondary care settings to educate and empower patients to initiate lifestyle changes to improve both their sexual health and general wellbeing. This may potentially delay the onset or reduce the risk of other acute and chronic vascular conditions in their patients.
A field guide to cardiovascular organizations part 1: Government
Authors: Olson Kate
Published: May 2014

Kate Olson presents a guide to the main organizations that play a par t in the shaping of cardiovascular services across the UK. This first article in the series looks at government-led bodies in England, Scotland, Wales and Northern Ireland as well as other umbrella organizations that contribute to policy development.
Little hearts need loud voices
Authors: Brawn William
Published: May 2014

William Brawn argues that more needs to be done to ensure the best care for babies with challenging congenital heart conditions and their parents
Critical reading of meta-analyses
Authors: Linden Belinda , Priestley Jessia
Published: May 2014

Belinda Linden and Jessica Priestley provide guidance on how to read and critique a meta-analysis in order to be able to apply the information to evidence-based practice
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 383
Inferential analysis: Powerful storytelling
Authors: Delaney Laura
Published: May 2014

Laura Delaney provides an over view of the role and aims of inferential analysis: using information from a sample to draw conclusions about a larger population
Diagnosis and management of arrhythmogenic right ventricular cardiomyopathy
Authors: Waller Simon
Published: May 2014

Arrhythmogenic right ventricular cardiomyopathy (ARVC) is an inherited heart muscle disease that mainly affects the right ventricle. The main characteristic of the condition is replacement of the myocardium with fibro-fatty deposits. The condition and symptoms associated with ARVC are extremely variable in their presentation, which presents a diagnostic challenge. ARVC is a known cause of arrhythmia, and in some cases sudden death. ARVC is not a curable condition, and treatment modalities focus on the management of symptoms and the prevention of arrhythmias and sudden death. When a diagnosis is made, screening of first-degree relatives for ARVC is indicated due to the inherited nature of the condition. A diagnosis of ARVC can be a source of great anxiety, and appropriate psychological support should be offered to affected individuals and their families. Nurses are wellplaced to offer such support.
ECG of the month
Authors: Regan Claire
Published: May 2014

Claire Regan presents an ECG for you to analyse. The answer is given on page 45
RESEARCH ROUNDUP
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 over view, 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.
Remote monitoring of patients with cardiac devices
Authors: Fletcher Lisa
Published: May 2014

Remote monitoring offers a safe, practical and cost effective alternative to hospital follow up visits for patients with implantable cardioverter defibrillators (ICDs) or cardiac resynchronization therapy (CRT) devices. New options are also available for patients with pacemakers and implantable loop recorders using remote monitoring. It is an area in health behaviour that is emerging for patients with chronic disease.The ability to monitor patient status (heart rhythm, fluid overload) may expedite patient management. This may provide improvements in health-care pathways and clinical outcomes, especially in heart failure. Professional policy and ethical issues will need to be reviewed in order for this to be implemented, challenging the traditional health care systems. The follow up appointment is changing.
Clinical usefulness of B-type natriuretic peptide in cardiac rehabilitation and heart failure
Authors: Leslie Rosalind
Published: May 2014

Biomarker assays for B-type natriuretic peptide (BNP) and its precursor N-terminal pro-BNP(NT-proBNP) are recommended in heart failure clinical practice. Cowie et al (2010) have recently reported that there is firm evidence for natriuretic peptide (NP) testing as part of the heart failure diagnostic pathway and as a prognostic tool, and the recent 2010 update to the National Institute for Health and Clinical Excellence guidelines on heart failure refers to the use of NP testing to aid diagnosis and identify patients requiring further treatment. In addition, there is growing evidence for use in monitoring treatment.

This article summarizes the existing well-reported evidence for the diagnostic, prognostic and therapeutic uses of BNP. In addition, it discusses possible applications in a cardiac rehabilitation setting.
Research Roundup
Authors: Linden Belinda
Published: May 2014

With the increasing use of diagnostic scanning procedures such as computed tomography, and radiotherapy treatment, it is vital to explore any potential association between radiation exposure and cardiovascular disease. Several randomized controlled trials have found that treatment with radiotherapy for breast cancer can lead to an increased mortality risk from heart disease in later years (Darby et al, 2003).
A multi-professional approach to managing anaemia in heart failure
Authors: Whittingham Katharine , Dring Belinda , Quinn Miriam
Published: May 2014

The presence of anaemia in heart failure is a widely-recognized phenomenon. Anaemia is an independent predictor of mortality risk and is linked to a large increase in mortality. Evidence shows prevalence is higher in patients with severe, symptomatic heart failure. A systematic review and meta-analysis of interventions to treat anaemia in heart failure indicates that management with erythropoiesis–stimulating agents (erythropoetins) led to improvement in symptoms, lower classification in New York Heart Association (NYHA) scale; approximately 90% reduction in hospital admissions and an increased exercise tolerance.

This paper will use a case study to illustrate how a multi-professional approach was used to manage and monitor a heart failure patient with anaemia. The role and interventions provided by the heart failure nurse and renal nurse will be outlined. Reflections on the learning and recommendations for future clinical practice will be briefly discussed.
NICE guidance on unstable angina and NSTEMI
Authors: Linden Belinda
Published: May 2014

Belinda Linden presents an over view of recently-published guidance of relevance to cardiovascular nursing. This month we look at the NICE clinical guidance on early management of acute coronary syndromes besides ST-segment elevation myocardial infarction.
The ‘New Order’ requests our help
Authors: Tagney Jenny
Published: May 2014

It’s an interesting tactic isn’t it? We’ve all been asked to contribute our ideas ‘to make things better for less money’ via the Prime Minister’s specially-established website ‘The Spending Challenge’ (2010), following a letter sent by the Prime Minister David Cameron and Deputy Prime Minister Nick Clegg to all public sector workers (Cameron and Clegg, 2010). Apparently, public sector workers have responded well already—20 000 responses received when I access the site on June 28th. Who will review all the ideas? Who gets to say what will work and what will not? Does it give the government the power to say ‘well, these were your ideas—now you need to make them work’? Challenging it certainly will be, but how will success be judged: job losses or lack thereof? It does seem slightly perplexing that some jobs were created apparently specifi cally to meet the previous government’s targets (for example, NHS Direct appeared largely as part of attempts to prevent attendances to accident and emergency and GP surgeries) and may face large redundancies if not deemed part of ‘frontline’ delivery of care.
Screening for cardiovascular risk in patients with anorexia nervosa
Authors: Board Lisa , Ingle Lee
Published: May 2014

In young people, especially females, a high importance is placed on body image and physical appearance. Unfortunately, misperceptions of the ideal body shape can encourage a pre-occupation with weight loss strategies. Long-term, these strategies may lead to ill-health— anorexia nervosa (AN) is a condition where there is evidence of low body weight, a refusal to maintain body weight, a distorted body image, and menstrual dysfunction. This review focuses on screening techniques for identifying cardiovascular risk in patients with AN. Predictors of cardiac risk have not been robustly investigated in AN, consequently health professionals involved in cardiovascular risk screening may be reliant on screening methodologies that are based on anecdotal evidence. The current inability to accurately predict cardiac events and sudden cardiac death in chronically ill patients with enduring AN is a concern that requires greater national attention
Is ‘obese’ the new ‘big-boned’?
Authors: Stuart-Jones Vicqui
Published: May 2014

Language and obesity: two topics guaranteed to provoke heated discussion. These days, fat is not just a feminist issue (to misappropriate the title of Susie Orbach’s 1978 book). ‘Fat’ is either, depending on your point of view, a pejorative adjective, or the sort of plain speaking that health professionals should be using with patients.
Ethical aspects of health research
Authors: Wright Angie , Flynn Maria , Watmough Sarah , Fry Kathryn
Published: May 2014

In part 3 of a series on practical aspects of research, Angie Wright, Maria Flynn, Sarah Watmough and Kathryn Fry outline the key principles of research ethics and consider the implications for cardiac nurses in ensuring ethical practice in health research
Practical issues in improving medical management of heart failure in the elderly
Authors: Desai Tejal , Ali Khalid
Published: May 2014

Heart failure is a complex syndrome with an increasing prevalence in the elderly. The presence of multiple comorbidities and associated frailty make management of an already complex disease process more challenging. A practical and pragmatic approach is presented in this paper with regards to pharmacological interventions, the role of heart failure specialist nurses in the context of the multidisciplinary team (MDT) and end-of-life care issues.
Considerations in treating acute coronary syndromes with possible coexisting asthma
Authors: Haines Erica
Published: May 2014

When a patient presents with symptoms of an acute coronary syndrome (ACS) routine administration of antiplatelet and betablocking therapy is recommended according to the NICE guidance ( Cooper 2010 ). However certain comorbid conditions that may point to underlying asthma should be considered and the risk:benefit ratio assessed before administration of routine aspirin prophylaxis and betablockers on diagnosis of ACS. Bronchial hyperreactivity in response to betablockers and/or aspirin may result in rapid bronchospasm, severe dyspnoea and possible death in susceptible individuals. The presence of allergic rhinitis, nasal polyposis and chronic rhinosinusitis must be considered in the overall assessment and where a decision to treat is made, cardio-selective betablockers should be initiated at very low doses with close monitoring.
Living with the patient with heart failure—the partner's perspective
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.
Taking an effective clinical history in a patient presenting with new-onset atrial fibrillation
Authors: Holding Shona
Published: May 2014

Atrial fibrillation (AF) is a complex condition and if not treated promptly may precipitate heart failure and increase the risk of stroke. Detection, assessment and early diagnosis are essential to reduce the risk of complication. A comprehensive clinical history will help determine an individualized treatment plan for the management of AF. This article describes a practical approach to collating the relevant information which will be used to inform a treatment plan as illustrated in the case study.
Postoperative bleeding in the cardiac surgical patient
Authors: Laidler Sandra
Published: May 2014

As cardiac nurses we need to be aware of the signs, symptoms and potential outcomes of excessive bleeding and learn to recognise, prevent and treat it promptly to maintain quality care for our patients. The cardiac nurse requires specialist skills and knowledge in managing surgical patients both pre and postoperatively.

This article follows the patient journey and highlights the role and responsibilities of the cardiothoracic intensive care nurse and the cardiac ward nurse in assessing, preventing and managing bleeding following cardiac surgery. It covers preoperative assessment, risk factors for bleeding, tests and assessment at different levels of care.
Socio-demographics and health profile: Influence on self-care
Authors: Fredericks Suzanne , Sidani Souraya
Published: May 2014

Variability in the performance of self-care behaviours have been reported in the cardiovascular surgical population. Theoretical evidence suggest that demographic characteristics and health profile influence patients’ engagement in self-care behaviours. However, the influence of these variables on performance of self-care has not been examined. The purpose of this quantitative, non-experimental study was to determine how much variance in performance of self-care behaviours is accounted for by demographic characteristics, as well as the health profile of patients who underwent heart surgery. Data from a sample of 248 study participants, recruited from two cardiovascular surgical units, were collected. Descriptive statistics were used to characterize the sample on demographics and health profile, while multiple regression analysis was conducted to determine the relationship between variables. Findings suggest these factors have a minimal influence on self-care behaviour performance. Alternative factors influencing self-care behaviour performance were identified along with implications for future nursing practice.
The role of anticoagulants in AF and stroke risk
Authors: Nazarko Linda
Published: May 2014

Atrial fibrillation can lead to the formation of emboli and increases the risk of stroke. As well as warfarin, a new class of anticoagulants, factor Xa inhibitors, are now available that work by inhibiting factor Xa, a factor needed to form blood clots. Anticoagulation therapy can improve patient quality of life and reduce stroke risk.
Hypertension in pre- and postmenopausal women
Authors: Dubrey Simon
Published: May 2014

Post-menopausal women are reported as developing higher blood pressures than men of similar age, a feature that, in some way, explains why women develop similar cardiovascular risk to men. The management of hypertension in women is governed by two broad phases in their life: being either pre- or post-menopausal. In addition there are serious considerations regarding the choice of medication in women who are or might become pregnant, and in women using any form of hormonal manipulation or augmentation for contraceptive or replacement (HRT) therapy. This review offers an overview of the hypertensive status of women in these various phases of life. The influence of comorbidities, some of which are more applicable to women and their mechanisms, are reviewed. However, many of the mechanisms influencing blood pressure differences between the genders involve complex interrelationships, and in some instances remain incompletely understood.
Apolipoprotein B as a measure of lipoprotein apheresis efficacy
Authors: Neves Emma , Pottle Alison
Published: May 2014

An elevated level of low-density lipoprotein cholesterol in the bloodstream has been considered a risk factor in the development of coronary heart disease for many years. Cholesterol-lowering medication, while usually successful, may prove insufficient and lipoprotein apheresis may be the required method of treatment in order to achieve targets and reduce coronary heart disease risk. Efficacy of lipoprotein apheresis is measured by checking total cholesterol and low-density lipoprotein cholesterol levels before and after each treatment, with the aim of achieving a 50% reduction in each. This small study investigated whether apolipoprotein B is a more accurate measure of lipoprotein apheresis efficacy.