Investigating support needs for people living with heart disease

Key participant characteristics influencing completion of a phase II cardiac rehabilitation program: A cross-sectional analysis

Study objective

Cardiac rehabilitation (CR) programs are effective at reducing cardiovascular disease risk factors, yet programs in the United States (US) have poor participation and completion. The current study evaluates characteristics related to completion and drop-out for CR participants.

Design

A cross-sectional study design compared participants who completed the program (finishers) and those did not finish (non-finishers). Variables were compared to determine differences between the dichotomous groups included demographic data, initial six-minute walk test, Zung Depression Index, and Quality of Life Measure (QLM). Logistical regression using variables with differences between groups determined impact on program completion.

Setting

Phase two outpatient hospital based cardiac rehabilitation program.

Participants

Ninety-seven participants were part of the sample; 61 completed the program, and 36 dropped out.

Main outcome measure

Completion of CR.

Results

Ninety-seven participants are included; 61 (63 %) were finishers and 36 (37 %) were non-finishers. Finishers were older, had a higher proportion of females and Medicare insurance recipients, had lower depression scores, and reported higher quality of life. Results of the final logistic regression revealed finishers were more likely to have Medicare (odds ratio (OR) = 5.215, confidence interval (CI) 1.897-14.338), be female (OR = 4.597, 95 % CI 1.532-13.795) and have higher QLM Family Sub scores (OR = 1.129, 95 % CI 1.023-1.246). The model correctly classified 71.9 % of cases.

Conclusion

The analysis highlights Medicare insurance and family support are associated with program completion. Interventions to increase family and social support, and to provide financial assistance for those with financial burden through lack of insurance or high co-pays may increase cardiac rehabilitation completion rates.

Barriers and facilitators to return to work following cardiovascular disease: a systematic review and meta-synthesis of qualitative research

OBJECTIVES

Return to work is a key rehabilitation goal, however, people recovering from cardiovascular disease (CVD) often struggle with returning to work. The aim of this study was to conduct a systematic review and meta-synthesis of the existing qualitative evidence on barriers and facilitators to return to work experienced by people with CVD.

METHODS

A systematic literature search was conducted in PubMed, Embase, Web of Science, PsycINFO, Scopus and CINAHL in August 2022. The reference lists of the included articles were searched. The Critical Appraisal Skills Programme was used for quality appraisal and a meta-synthesis was employed.

FINDINGS

This review includes 15 studies of overall high methodological quality. Barriers covered four themes: physical limitations, psychological and relational factors, the working context and support within health and social care systems. Facilitators were related to five themes: return to normality, enhancing well-being, financial concerns, the working context and support within health and social care systems.

CONCLUSION

Our findings highlight that return to work following CVD is a complex process influenced by individual factors, as well as work-related factors, factors in the health and social care systems and social security policies and regulations. To improve return to work, this review illustrates a need for individualised, multidisciplinary and coordinated vocational rehabilitation programmes that accommodate potential barriers to re-employment. Similarly, this review highlights how vocational rehabilitation programmes should ensure individualised information and support early in the rehabilitation process, as well as the importance of engaging relevant stakeholders, such as employers, in making individualised return-to-work plans.

‘Making Ground’: An Ethnography of ‘Living With’ Harmful Methamphetamine Use and the Plurality of Recovery

The trajectories of people attempting to reduce harmful methamphetamine use are frequently understood within a binary framework of transitioning between states of health and disease. This framework can often be reinforced by service interactions informed by these dominant narratives of recovery and addiction. In this paper, we draw on a critical interactionist analysis of ethnographic fieldwork conducted with people who use methamphetamine, to examine how their experiences could undermine this binary, observing the ways participants experienced growth, change, and progress, without necessarily maintaining abstinence. These findings support a more diverse understanding of drug use trajectories, and we explore the concept of ‘living with drug use’, similar to how people live with other chronic conditions by finding ‘health in illness’. Participant experiences are also interpreted within the context of counter public health, arguing for the recognition and integration of values and goals which are divergent from the implicit aims of public health practice.

Who Cares? Perception of Loneliness in Patients Treated for Coronary Heart DiseaseHvem bekymrer sig? Oplevelsen af ensomhed hos patienter med iskæmisk hjertesygdom

Social support is known to be essential to cope with the physical and psychological aftermath following coronary heart disease treatment. Consequently, patients experiencing loneliness may be placed in a vulnerable situation. The aim of this study was to provide insight into the nuances and complexity of loneliness and its impact on health behaviour in the early rehabilitation period following treatment. The study used a hermeneutic philosophical approach. Patients classified as lonely were interviewed in either a focus group ( n = 7) or in an individual interview ( n = 10). We analysed the empirical material using inductive content analysis. The analysis illuminated various dimensions of patients’ perceived loneliness; ‘Loneliness as an emotional pain’, ‘A changed, but unmet need for social support’ and ‘Striving for symmetry in relationships’. Loneliness negatively influenced patients’ ability to adapt to the critical event and manage health behaviour changes. Insight into the mechanisms that aggravate loneliness may inform future social support interventions.

Social støtte er beskrevet som essentiel i forbindelse med håndteringen af de fysiske og psykiske følger af iskæmisk hjertesygdom. Derfor kan patienter som oplever ensomhed være i en særlig sårbar situation. Formålet med dette kvalitative studie var at opnå en nuanceret indsigt i patients oplevelse af ensomhed, samt hvordan ensomhed influerer på sundhedsadfærd i den tidlige rehabiliteringsperiode efter behandlingen for iskæmisk hjertesygdom. I studiet havde vi en hermeneutisk filosofisk tilgang. Patienter klassificeret som ensomme blev interviewet enten individuelt (n = 10) eller i fokusgruppe (n = 7). Vi analyserede det empiriske materiale med induktiv indholdsanalyse. Analysen tydeliggjorde forskellige dimensioner af patienternes oplevede ensomhed: ”Ensomhed som en emotionel smerte”, ”Et ændret, men ikke imødekommet behov for social støtte”, Stræben efter symmetri i relationer”. Ensomhed havde en negativ indflydelse på patienternes mulighed for at håndtere den kritiske hændelse og på sundhedsadfærd. En øget indsigt i de mekanismer som forværrer ensomhed, har relevans ved udarbejdelsen af fremtidige sociale støtteinterventioner.

One size does not fit all: A qualitative study exploring preferences and barriers towards the design of a loneliness reduction intervention in patients with coronary heart disease

Aim

To explore preferences and barriers towards the design of a loneliness reduction intervention in patients treated for coronary heart disease who experience loneliness.

Design

A qualitative study using patient involvement methodology.

Methods

Seventeen patients participated in either focus groups or individual interview sessions. The interview guide was based on patient involvement methodology. Interviews were analysed using deductive content analysis.

Results

Four overall findings emerged as follows: (a) An intervention involving a social network member must comply with patients perceived social norms; (b) An intervention involving a peer provides benefits from reciprocity and shared experiences, but also requires surplus mental energy; (c) The history of an existing relationship can act as both provider and barrier for confidentiality and (d) Start‐up, timeframe and structure of the intervention should be individually tailored to the patient's preferences. Findings illuminated preferences and barriers towards the design of a loneliness reduction intervention in patients with coronary heart disease.

Prognostic value of a brief loneliness questionnaire for patients with coronary heart disease: Proposal for a prediction model

BACKGROUND

In patients with coronary heart disease (CHD), loneliness is associated with increased risk of morbidity and mortality. No predictive tool is available to detect patients who are influenced by loneliness to a degree that impacts mortality.

AIM

To: (i) propose a prediction model that detects patients influenced by loneliness to a degree that increases one-year all-cause mortality, (ii) evaluate model classification performance of the prediction model, and (iii) investigate potential questionnaire response errors.

METHOD

A cohort of patients with CHD (n = 7169) responded to a national cross-sectional survey, including two questions on loneliness. Information on cohabitation and follow-up information on one-year all-cause mortality were obtained from national registers. Prediction model development was based on the prognostic values of item responses in the questionnaire on loneliness and of cohabitation, evaluated with Cox-proportional Hazards Ratio (HR). Item responses which significantly predicted one-year mortality were included in the high-risk loneliness (HiRL) prediction model. Sensitivity, specificity and likelihood ratio were calculated to evaluate model classification performance. Sources of response errors were evaluated using verbal probing technique in an additional cohort (n = 7). The TRIPOD checklist has been used to ensure transparent reporting.

RESULTS

Two item responses significantly predicted one-year mortality HR = 2.24 (95%CI = 1.24-4.03) and HR = 2.65 (95%CI = 1.32-5.32) and were thus included in the model. Model classification performance showed a likelihood ratio of 1.89. Response error was evaluated as low.

CONCLUSION

Based on the prognostic value in a loneliness questionnaire, a prediction model suitable to screen patients with CHD for high-risk loneliness was suggested.

RELEVANCE TO CLINICAL PRACTICE

The HiRL prediction model is a short and easy-to-use screening tool that offers clinical staff to identify patients with CHD who are influenced by loneliness to a degree that impacts mortality. However, further evaluation of model performance and questionnaire validation is recommended before integrating the model into clinical practice.

"Why would you not listen? It is like being given the winning lottery numbers and deciding not to take them": semi-structured interviews with post-acute myocardial infarction patients and their significant others exploring factors that influence participation in cardiac rehabilitation and long-term exercise training

PURPOSE

Despite the clinical benefits, coronary artery disease patient participation rates in cardiac rehabilitation (CR) and long-term exercise are poor. This study explored the factors related to participation in these interventions from the perspectives of post-acute myocardial infarction (AMI) patients and their significant others.

METHODS

Semi-structured interviews were performed with post-AMI patients (number (n) = 10) and their significant others (n = 10) following phase-III and phase-IV CR. Reflexive thematic analysis with an inductive orientation was utilised to identify themes within the dataset (ClinicalTrials.gov identifier: NCT03907293).

RESULTS

The overarching theme of the data was a perceived need to improve health, with the participants viewing health benefits as the principal motive for participating in CR and long-term exercise training. Three further themes were identified: motivation, extrinsic influences, and CR experience. These themes captured the underlying elements of the participants' decision to take part in CR and long-term exercise training for the purpose of health improvements.

CONCLUSION

An AMI collectively impacts the attitudes and beliefs of patients and their significant others in relation to CR participation, long-term exercise, and health. The factors identified in this study may inform strategies to promote patient enrollment in CR and adherence to long-term exercise.IMPLICATIONS FOR REHABILITATIONPost-AMI patients and their significant others reported that health benefits were the primary motive for participating in CR and long-term exercise, with aspects related to motivation, extrinsic influences, and CR experience underpinning the decision.Healthcare professionals should supply information about health benefits during the CR referral process, with insights into the experiences of CR graduates potentially improving the strength of recommendation.CR facilitators may promote long-term exercise adherence by assisting patients with the identification of an enjoyable exercise modality.Healthcare professionals should include significant others in the CR referral process, which may enable these individuals to support the patients' decisions.

Patients' Experiences of Cardiovascular Health Education and Risk Communication: A Qualitative Synthesis

Coronary heart disease (CHD) has no cure, and patients with myocardial infarction are at high risk for further cardiac events. Health education is a key driver for patients' understanding and motivation for lifestyle change, but little is known about patients' experience of such education. In this review, we aimed to explore how patients with CHD experience health education and in particular risk communication. A total of 2,221 articles were identified through a systematic search in five databases. 40 articles were included and synthesized using thematic analysis. Findings show that both "what" was communicated, and "the way" it was communicated, had the potential to influence patients' engagement with lifestyle changes. Communication about the potential of lifestyle change to reduce future risk was largely missing causing uncertainty, anxiety, and, for some, disengagement with lifestyle change. Recommendations for ways to improve health education and risk communication are discussed to inform international practice.

Application of relational tool to support acute cardiac patients' emotional recovery: analysis of effects during acute and follow-up care

After an acute cardiac event, many patients experience emotional disturbance. This is a normal response to the event and to hospitalization, but, if not treated with emotive and social support, the symptoms can evolve, resulting in emotional and behavioural disorders. The aim of the study was to evaluate the outcome of the use of a new nursing relational tool, designed to support patients’ emotional recovery. The data are the result of semi-structured narrative interviews, conducted in the intensive cardio care unit of the Mauriziano hospital of Turin and by telephone, during March and August of 2017. The research sample involved 26 patients, divided into control and intervention groups. Exclusion criteria were: under age of 18, cognitive impairment or dementia, difficulty with comprehension and expression in Italian, and previous acute cardiac events. The interviews have shown that an emotional management tool improves the patient’s recovery, the quality of information received, and the quality of the patient’s everyday life after the event. The use of a relational tool by nursing staff improves the patient’s emotional management and increases the knowledge required to ensure a good quality of life. Continuous use also improves the confidence of health professionals in managing these emotional conditions.

The role of public health nurses in risk factor modification within a high-risk cardiovascular disease population in Ireland – a qualitative analysis

Background/aims:

Health promotion for cardiovascular disease risk factors management is essential to secondary prevention of cardiovascular disease events. In Ireland, post-cardiac rehabilitation patients are discharged into the care of community public health nurses, who have a health promotion role. Little is known of the public health nurses’ perceptions or knowledge surrounding their role in cardiovascular disease risk factor management. Underpinned by a constructivist viewpoint, this study aims to generate empirical evidence on the phenomenon directly from public health nurses’ encounters within the context of the current health service.

Methods:

This qualitative cross-sectional analysis involved face-to-face, semi-structured interviews with a purposeful sample of 17 public health nurses. Interviews were audio-recorded, transcribed, subjected to thematic content analysis and subsequently reported incorporating verbatim quotes.

Results:

A significant gap exists between evidence-based guidelines for cardiovascular disease prevention and current practices. Variations in public health nurses’ training, experience and knowledge result in inconsistent practices, and public health nurses feel this is specialised area for which they are not equipped. The changing public health nurse role and increasing workloads result in prioritisation of other nursing duties over health promotion. Ineffective systems for care delivery and a lack of community-based rehabilitation programmes also negatively impact on secondary prevention practices.

Conclusions:

Findings support the need to develop a community cardiovascular disease specialist role to effectively support ongoing cardiovascular disease risk factor management. Evaluation of the mechanisms of current service delivery is required to ensure a quality-assured equitable service, in line with community needs and current evidence-based guidelines for practice. A quantitative triangulation study is recommended.

A Ricoeur-Inspired Approach to Interpret Participant Observations and Interviews

In-depth knowledge of what it means to patients to receive health care services is crucial to the development of adequate protocols for nursing. Qualitative research allows us to gain important insight into what is experienced by and meaningful to patients. The French philosopher Paul Ricoeur's thoughts have inspired qualitative researchers to conduct various forms of analysis and interpretation that increase our knowledge of ways of being-in-the-world. This article describes and discusses how a specific approach to derive in-depth knowledge of patients' lived experiences can be taken. A combination of participant observations and interviews was used to generate data. Field notes and transcribed interviews were gathered as one collective text and analyzed and interpreted with inspiration from Ricoeur's thoughts on narratives and interpretation. This approach is argued to be a significant way of developing in-depth knowledge of patients' lived experiences. Such knowledge is important within nursing science.

Family involvement in rehabilitation: Coronary artery disease-patients' perspectives

AIMS AND OBJECTIVES

To describe coronary artery disease patients' perceptions of family involvement in rehabilitation and the connection between background factors and family involvement.

BACKGROUND

Coronary artery disease patients' hospital stays can be very concise. Family members can support rehabilitation, but many challenges can emerge. There is a need to nurture patients and family members in an individual way and to recognise their concerns. More accurate patient education should be available for patients and their family members.

DESIGN

This study is a descriptive cross-sectional study.

METHODS

Data were collected from patients with coronary artery disease at least 6 weeks after discharge from hospital (n = 169) with a postal questionnaire. The Family Involvement in Rehabilitation (FIRE) scale measures family members' promotion of patients' rehabilitation and issues encumbering rehabilitation in family. The data have been analysed with statistical methods. Both parametric and nonparametric tests were used to evaluate group differences.

RESULTS

Patients with coronary artery disease perceived that family promotes their rehabilitation significantly. Respondents also perceived challenges at home. Family relations before hospitalisation were related to all subareas of family promoting rehabilitation and one subarea of issues encumbering rehabilitation in family. Patients with symptoms at rest also had more encumbrance on their rehabilitation. Patients who had undergone coronary artery bypass surgery perceived more challenges than percutaneous coronary intervention (PCI) patients in many subareas of issues encumbering rehabilitation in family.

CONCLUSIONS

Family relations prior to illness and the rigour of heart symptoms are significantly relevant to challenges that can occur between patient and their family members.

RELEVANCE TO CLINICAL PRACTICE

Healthcare staff need to pay attention to coronary artery disease patients' individual situation, and patient education should be more family-centred. In the future, it would be noteworthy to collect more data from family members of patients with coronary artery disease and to find out their perceptions of family involvement.

Women's experiences of how their recovery process is promoted after a first myocardial infarction: Implications for cardiac rehabilitation care

BACKGROUND

A rapid improvement in the care of myocardial infarction (MI) in the emergency services has been witnessed in recent years. There is, however, a lack of understanding of the factors involved in a successful recovery process, after the initial stages of emergency care among patients, and in particular those who are women. Both preventive and promotive perspectives should be taken into consideration for facilitating the recovery process of women after a MI.

AIM

To explore how women's recovery processes are promoted after a first MI.

METHODS

A qualitative content analysis was used.

FINDINGS

The women's recovery process is a multidirectional process with a desire to develop and approach a new perspective on life. The women's possibility to approach new perspectives on life incorporates how they handle the three dimensions: behaviour, that is, women's acting and engaging in various activities; social, that is, how women receive and give support in their social environment; and psychological, that is, their way of thinking, reflecting, and appreciating life.

CONCLUSIONS

The personal recovery of women is a multidirectional process with a desire to develop and approach a new perspective on life. It is important for cardiac rehabilitation nurses to not only focus on lifestyle changes and social support but also on working actively with the women's inner strength in order to promote the recovery of the women.

Empowered to gain a new foothold in life--A study of the meaning of participating in cardiac rehabilitation to patients afflicted by a minor heart attack

This study aimed to investigate what it means to patients afflicted by a minor heart attack to participate in cardiac rehabilitation (CR). CR is well-established internationally to support patients towards moving forward in satisfying, healthy, and well-functioning lives. Studies indicate that patients achieve improvement in quality of life when participating in CR. However, knowledge of how patients are supported during CR is sparse. Moreover, knowledge of what participating in CR means to patients afflicted by a minor heart attack is lacking. In-depth knowledge in this area is crucial in order to understand these patients' particular gains and needs. In a phenomenological-hermeneutic frame field observations, focus group interviews, and individual interviews were conducted among 11 patients during and after their participation in CR. Field notes and transcribed interviews underwent three-phased interpretation. It was found that patients were supported to gain renewed balance in their lives during CR. Three themes were identified: (1) receiving a helpful but limited caring hand, (2) being supported to find new values in life, and (3) developing responsibility for the remaining time. The patients were carefully guided through a difficult time and supported to continue in healthy everyday lives. They were given hope which enabled them to find themselves a new foothold in life with respect to their own sense of well-being. This guidance and a sense of hopefulness were provided by heart specialists and more seasoned heart patients. In conclusion, patients were empowered to achieve a healthier lifestyle and improve their personal well-being during CR. However, structural barriers in the programme prevented adequate support regarding the patients' total needs. Knowledge of the benefits of CR emphasizes the significance of the programme and highlights the importance of high inclusion. Efforts should be made to develop more flexible and longer lasting programmes and further involvement of relatives must be considered.