bluuebunny/crossref_metadata_2025_split huggingface dataset:
Psychological stress and its correlates in Chinese patients with acute coronary syndrome
Authors: Zou H , Chair SY , Cao X 
Published: July 2021

Abstract

Funding Acknowledgements
None.

Background
Psychological stress is associated with high incidence of coronary heart disease and increases the risk of mortality and poor health status. Although a few studies have investigated psychological stress in this population, this problem is usually unrecognized and untreated in most Chinese patients with acute coronary syndrome. There is insufficient information regarding the features of psychological stress and associated factors among this population.

Purpose
This study aimed to assess the level of psychological stress and to identify its correlates in Chinese patients with acute coronary syndrome.

Methods
Patients aged over 18 years and with acute coronary syndrome were invited to participate in a cross-sectional survey in two tertiary public hospitals in China, from June to July 2019. A total of 332 patients completed measures of sociodemographic and clinical characteristics, psychological stress (10-item Perceived Stress Scale), and illness perception (Brief Illness Perceptions Questionnaire). Independent sample t-tests, bivariate correlations, and multivariable linear regression were performed to analyze potential correlates, including age, gender, education level, employment status, income, episode of illness, revascularization procedure, comorbidities, body mass index, blood pressure, blood glucose, blood lipids, and illness perception.

Results
The average patient age was 62.2 years, 67.5% were male, and 54.2% had less than high school education. The mean score for psychological stress was 21.30 ± 3.99 and 66.9% of patients had high psychological stress (score ≥ 20). Multivariable regression analysis showed that being overweight/obesity versus normal weight (body mass index: ≥ 24 kg/m2 versus &lt; 24 kg/m2) was associated with lower psychological stress (β = -0.134, p = 0.007). Having a high level of fasting blood glucose (≥ 6.1 mmol/L) versus normal fasting blood glucose (&lt; 6.1 mmol/L) was associated with high psychological stress (β = 0.123, p = 0.017). Additionally, negative cognitive illness perception (β = 0.190, p = 0.01), negative emotional illness perception (β = 0.290, p &lt; 0.001), and poor illness understanding (β = 0.118, p = 0.032) were associated with high psychological stress.

Conclusions
Patients with acute coronary syndrome experience high psychological stress that is significantly correlated with body mass index, fasting blood glucose, and illness perception. Health professionals should recognize this issue and interventions looking to relive psychological stress may benefit from targeting these correlates.
Transitioning a cardiovascular health and rehabilitation programme to a virtual platform during covid 19
Authors: Mcgaffin S , Taggart M , Smyth D , O"doherty D , Brown J , Teague S , Slevin C , Montgomery L , Coll M , Lindsay C , Crumley B , Gibson L , Elliott H , Hughes S , Connolly S 
Published: July 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

OnBehalf
Our Hearts Our Minds

Purpose
Can a virtual cardiovascular prevention and rehabilitation programme be as effective as face-to-face programme.

Background
The Our Hearts Our Minds (OHOM) prevention and rehabilitation programme rapidly transitioned to a virtual platform in the covid era. Here we compare if a virtual programme potentially could offer the same standard of the nursing intervention (education, smoking cessation, medical risk factor management and psychosocial health) as the previous face to face programme

Methods
Both the initial assessment (IA) and end of programme (EOP) assessments were conducted via telephone/video as per patient preference. The following measures were recorded at both time points (home blood pressure (BP) monitors were provided)
Smoking (self report) BP/Heart rate, Lipids/HbA1c (facilitated by phlebotomy hub), cardio protective drugs (doses, adherence), Hospital Anxiety and Depression score, EuroQoL
Nursing Intervention Smoking cessation counselling and pharmacotherapy where appropriate
Weekly meeting with cardiologist to optimise BP and lipid management and up titration cardio protective drugs
Bimonthly virtual coaching consultation for monitoring/goal resetting
Bimonthly group video education sessions

Results
From April to November 2020, of the 432 referrals received 400 were eligible with 377 accepting the offer of an IA (94% response rate). 262 have had an IA with the remaining 115 awaiting an assessment date. Of the completed IA’s 257 were willing to attend the programme (98% uptake). 120 had been offered an end of programme assessment with 114 attending (96% of those offered). The results for the virtual programme were then compared to the same period one year previously when the programme was fully face to face and are outlined in the table below.
The comparison of results delivered via remote delivery are remarkably similar to those achieved in the previous year delivered via face to face.

Conclusion
Initial data has shown that virtual delivery of the nursing component of the OHOM prevention/rehabilitation programme was highly acceptable to patients and was as effective as that of the traditional face to face service.
Table 1 below exhibits the clinical and patient-reported outcomes.
Patophysiologic and gender differences regarding exercise responses in decompensated heart failure patients
Authors: Delgado BM , Froelicher ERIKA , Lopes IVO , Sousa LUIS , Novo ANDRÉ 
Published: July 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
Heart Failure patients often present impairment on their functional capacity. Exercise training is the key component of cardiac rehabilitation and must be early implemented. Knowing the characteristics that lead a patient to be a good responder to an exercise intervention would be useful to identify the ones that could benefit from this same intervention.

Purpose
Identify the characteristics of good responses to an aerobic exercise training in decompensated heart failure (HF) patients and understand if there are gender differences.

Methods
Cross sectional study with 76 inpatients who performed an aerobic exercise training program (AET). Functional capacity was evaluated at admission and discharge using three different tools: the London Chest of Activity of Daily Living (LCADL) scale, the Barthel Index (BI) and the 6-minute walking test (6MWT). Multivariate linear regression was performed by gender to understand which variables lead a patient to have better performance. Since it is known that men and women have different responses to exercise training, the results and analysis of the data collected were performed by gender.

Results
Seventy-six patients (52 men) were included. The mean age was 67 ± 10 years, 15.8% were New York Heart Association (NYHA) class IV and 76.3% had reduced ejection fraction. The major etiology of HF was ischemic disease (35.5%). Six predictive equations were obtained, one for each functional capacity (FC) tool divided by gender. NYHA class III patients do not differ from class IV in terms of FC at discharge. However, HFreduced ejection fraction patients presented higher 6MWT distance (309,6m vs 231m) and lower LCADL score (11 vs 15) compared to non-reduced. Gender analysis showed that women had an average of 4 days longer in-hospital stay and a considerable difference in the 6MWT. At admission women walked 15 meters less than man and at discharge 69 meters less, presenting also lower score at BI and higher at LCADL. However, only the discharge 6MWT distance presents a statistical significant difference (69 meters; p = 0.01). Traditionally women are more sedentary and present less fitness level than men. The linear regression model shows that gender is a independent variable that contributes to the change in the 6MWT - favouring men.

Conclusions
The AET program appears to be more effective in younger patients, with low FC at admission and who are less impaired. Those with left systolic ventricular function apparently interfered with progression during the program. Gender influences the performance of patients undergoing exercise training. Men present higher FC at discharge but the predictive models are stronger for women. These results are consistent with the idea that gender plays an important role in determine the performance of patients in exercise training programs.
Resilience among caregivers of patients with heart failure: a convergent mixed methods study
Authors: Durante A , Younas A , Cuoco A , Boyne J , Juarez-Vela R , Brawner B , Vellone E 
Published: July 2021

Abstract

Funding Acknowledgements
Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): HFA Nurse training Fellowship Award Center for Excellence for Culture and Nursing Research (CECRI)Nursing Scholarship OPI Rome Italy

Introduction
Resilience is a dynamic process of utilising abilities to harness personal, social, and spiritual resources and coping characteristics and developing regulatory flexibility to manage challenges and bounce back from emotional and physical distress. Caregivers of patients with heart failure are prone to increased stress and reduced resilience while assisting their family members in meeting self-care needs, activities of daily living, and complex medical and dietary regimens. To date, limited research exists on resilience and its predictors among caregivers of people with heart failure.

Purpose
To develop a comprehensive understanding of resilience and its predictors among caregivers of patients with heart failure.

Methods
A convergent mixed methods design was used. In total, 50 caregivers completed the Connor-Davidson Resilience Scale (CDRS) (score range: 0–100, with higher scores indicating higher resilience), the Caregiver Burden Inventory (CBI) (higher scores indicate greater caregiver burden; there are no cut-off points for classifying burden), and the Hospital Anxiety and Depression Scale (HADS) (two subscales, range score 0 and 21 per each subscale; higher scores mean worse anxiety and depression) and participated in semi-structured face-to-face interviews. Data were analysed using multiple regression, qualitative content analysis, and joint displays.

Results
The caregivers’ mean age was 62.8 ± 12.83 years. The CDRS mean score was 62.37 ± 24.2, and the mean HADS scores for anxiety and depression were 12.38 ± 2.74 and 8.54 ± 2.49, respectively. The mean CBI score was 16.82 ± 17.12. Regression analysis showed that the resilience score was only predicted by depression (B = -1.491, p = 0.031). Qualitative analysis generated three resilience-inhibiting factors (psychological outlook, physical weariness, and affective state) and two promoting factors (community interconnectedness and self-comforting activities). Mixed analysis confirmed that depression decreased caregivers’ resilience.

Conclusions
Caregivers of people with heart failure are likely to experience extreme stress and anxiety that affect their resilience to provide better care for their family members. This study identified that depression, hopelessness, pessimism, powerlessness, physical fatigue, and fluctuating emotional states affected negatively caregivers’ resilience. However, self-comforting activities and community interconnectedness improved caregivers’ resilience. Community care organizations and hospitals could establish alliances to develop programs for enhancing caregivers’ resilience.
Patient experiences of shared decision-making are associated with implantable cardioverter defibrillator recipients" openness to discuss device deactivation at end-of-life
Authors: Oh OJ , Lee KS , Miller J , Hammash M , Thompson DR , Ski CF , Cameron J , Moser DK 
Published: July 2021

Abstract

Funding Acknowledgements
Type of funding sources: Public Institution(s). Main funding source(s): In Australia, this study received funding from a faculty grand by Australian University Faculty of Health Sciences Research grant. In the United States, the study was funded by a research professor award from University of Kentucky.
Background. Shared decision-making is important for ICD recipients to fully contemplate and rationally decide about ICD deactivation at end-of-life. Although discussions about device deactivation at end-of-life are recommended to be held before ICD implantation and throughout the illness trajectory, such discussions rarely occur in clinical practice.
Purpose. To identify whether ICD recipients’ experiences of end-of-life discussions with clinicians are associated with openness to discussing ICD deactivation at end-of-life.
Methods. This cross-sectional study included 293 ICD recipients living in the United States, Australia, and South Korea (mean age 59, 22.5% female, mean ICD implantation 10 years). Hierarchical logistic regression was used to determine whether patients’ experiences of shared decision-making were associated with openness to discuss device deactivation at end-of-life after controlling for relevant covariates (i.e. age, gender, ICD implantation years, ICD shock experience, general ICD experience, ICD knowledge, and concerns related to the ICD).
Results. About half of the participants (57.7%) were open to discussing ICD deactivation at end-of-life with clinicians. Almost one-quarter (23.5%) had no prior experience of discussing any end-of-life issues with clinicians. Patients’ past experiences of end-of-life discussions with clinicians were significantly associated with openness to discuss device deactivation at end-of-life (OR: 1.30) after adjusting for covariates.
Conclusion. Our results highlight that clinicians’ willingness to discuss sensitive end-of-life issues such as battery replacement and deactivation of defibrillation therapy empowers patients to actively engage in end-of-life discussions.
A moderated moderation of living arrangements and social support on the relationship between depressive symptoms and medication adherence in patients with heart failure
Authors: Lindsay-Rahman R , Lennie TA , Moser DK , Chung ML 
Published: July 2021

Abstract

Funding Acknowledgements
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): National Institute of Nursing Research grant

Background
Medication adherence is essential to improve health outcomes in patients with heart failure (HF). Depressive symptoms contribute to decrease adherence behaviors. Although social support is helpful to improving medication adherence, perceived social support (PSS) may differ by living arrangement. How social support and living arrangement contribute to the relationship between depressive symptoms and medication adherence is not well understood in patients with heart failure.

Purpose
The purpose of this study was to determine whether perceived social support and living arrangement moderated the association between depressive symptoms and medication adherence.

Methods
This was a secondary analysis from outpatients with HF. Depressive symptoms were measured by the Patient Health Questionnaire-9. Perceived social support was assessed using Multidimensional Scale of Perceived Social Support, and patients were grouped into high and low PSS groups using a score of 79, the upper tertile value. Medication adherence was measured objectively by a medication event monitoring system for 3-months. Living arrangement was classified as (1) living with a spouse, (2) living with non-spouse family or friend, or (3) living alone. Moderated moderation analysis was conducted using PROCESS macro (Model 3) in SPSS with 5,000 bootstrap samples.

Results
Of the total of 208 patients (mean age = 61 ± 11.5 years, 64% male), 60% lived with spouse, 22% lived with non-spousal family or friend, and 26% lived alone. Three-way interaction (depressive symptoms*living arrangement*PSS) was significant (p = 0.0324, Figure 1). The effect of depressive symptoms on medication adherence was only significant for two groups (Figure 2): the living alone group with high PSS (effect = - 4.1855, p = 0.0021), and the living with a non-spousal family group with low PSS (effect = -1.0180, p = 0.0349). For these groups, their depressive symptoms were inversely associated with medication adherence. Conclusions: These results suggest that living arrangement and perceived social support are factors to be considered in medication adherence when planning care for patients with depressive symptoms. Future research is needed to explore whether the combined intervention of improving depressive symptoms and social support focusing on instrumental social support effectively increases medication adherence.
Who cares? Perception of loneliness in patients treated for coronary heart disease
Authors: Blakoe M , Berg SK , Hoejskov IE , Palm P , Bernild C 
Published: July 2021

Abstract

Funding Acknowledgements
Type of funding sources: Public hospital(s). Main funding source(s): University hospital of Copenhagen, Rigshospitalet research grant

Background
When patients are treated for Coronary heart disease (CHD), social support is known to be essential for them to adapt mentally and behaviourally to this critical event (1, 2). However, a substantial part of the CHD population experience loneliness in their everyday life, which places them in a vulnerable situation in the early rehabilitation period, as this period is characterized by an increased need for practical, informational and emotional support (3, 4) .

Aim
To provide insight into the nuances and complexity of loneliness, as well as the impact on health behaviour, in the early rehabilitation period following CHD treatment.

Method
This qualitative study has a philosophical hermeneutic approach. Patients classified as lonely during hospitalization in a social support questionnaire, were interviewed 8-12 weeks following discharge in either focus group (n = 7) or individual interview (n = 10) sessions. The empirical material was analysed using inductive content analysis.

Results
The analysis of the data produced three themes: i) A life in loneliness, ii) The changed, but unmet, need for social support, iii) Symmetry and asymmetry in relationships. Each theme contained of three sub-themes. A consistent finding was participants’ experience of shock related to the CHD event and the fundamental uncertainty to which it led, which increased the feeling of loneliness as an emotional pain. Participants experienced loneliness, not in relation to the lack of quantity of social network members, but in relation to the deficient quality of the relationships. In this regard, they described mutual and complimentary mechanisms that impacted how and from whom they could receive adequate social support. Participants described how dyadic relational mechanisms could either promote or limit who they could ask for social support as they experienced a need for reciprocity in the relationship, in order to receive practical and emotional support. Furthermore, a main finding was the participants experience on how loneliness affected their abilities to adapt to the critical event and manage health behavioural changes in the rehabilitation period.

Conclusion
In patients with coronary heart disease, loneliness is experienced as an emotional pain that negatively influenced the ability to adapt to the critical event and manage health behavioural changes. Participants assessed societal, dyadic and psychological mechanisms to impact their access to support from social network members.

Perspective
Insight into the patients’ experience of loneliness and the mechanisms mediating loneliness can enhance nursing care practice and inform future social support interventions.
Feasibility of the TARGET-EFT trial in frail and pre-frail cardiovascular inpatients
Authors: Ahmad F , Fountotos R , Munir H , Lantagne S , Hagerty K , Hedzazi MM , Volynsky F , Marsala J , Goldfarb M , Afilalo J 
Published: July 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Older adults are at risk for hospital-acquired disability and deconditioning, often leading to the "post-hospitalization syndrome" of accelerated functional decline. We hypothesized that this syndrome could be prevented by a pragmatic multi-faceted intervention, and now report the initial experience and feasibility of our ongoing randomized clinical trial.

Methods
Patients admitted to the cardiovascular ward at a single academic center are screened with the Essential Frailty Toolset (EFT). Those ≥65 years with frailty (EFT: 3-5) or pre-frailty (EFT: 1-2) are eligible for the TARGET-EFT trial, in which they are randomly allocated to usual care or intervention. The intervention is targeted such that patients with physical weakness receive supervised exercise sessions (in addition to clinically-indicated physiotherapy), those with cognitive impairment receive stimulation activities, those with iron deficiency anemia receive intravenous iron sucrose, and those with malnutrition-related hypoalbuminemia receive protein supplements. The outcome is a composite score representing mobility, disability, activity, discomfort, and mood (EQ-5D-5L) ascertained by a blinded observer on the day of discharge and at 30 days post-hospitalization.

Results
To date, 77 out of a planned 144 patients have been randomized. The most common reasons for exclusion are age &lt;65 years, expected discharge within &lt;3 days and patient refusal. The median age is 80 years and length of stay is 8 days. In each group, 1 patient withdrew and 1 died. There were no intervention-related adverse events. Of the 39 intervention patients, 36 qualified for exercise and received an average of 6 sessions (46% of sessions were deferred because patients were away for tests, were bedrest post-procedures, or refused), 18 received cognitive stimulation, 15 received intravenous iron sucrose, and 16 received protein supplements.

Conclusion
The TARGET-EFT intervention is feasible and appears safe for frail and pre-frail patients hospitalized with acute cardiovascular disease. Given that nursing staff, physiotherapists, nutritionists and clinicians already address basic cognitive orientation, mobilization and nutritional/iron supplementation needs, it appears that adding targeted interventions for patients’ specific frailty deficits is feasible when shared amongst allied health professionals.