Tailored nurse-led cardiac rehabilitation after myocardial infarction results in better risk factor control at one year compared to traditional care: a retrospective observational study

A Systematic Review of the Completion of Cardiac Rehabilitation Programs for Adults Aged 18-50 Years

OBJECTIVE

To perform a systematic review of completion rates of cardiac rehabilitation (CR) in adults aged 18 to 50 yr and describe how core components were reported, measured, and tailored to those under 50 yr.

REVIEW METHODS

Database search of MEDLINE, Embase, Emcare, PsycINFO, CINAHL, Scopus, and the Cochrane Library based on keywords, including articles from January 1, 1990. The last search was performed on April 21, 2023. Following the Preferred Reporting Items for Systematic Review and Meta-Analyses protocol, eligible articles contained adults (aged between 18 and 50 yr) who had participated in a CR program.

SUMMARY

Out of the articles screened (n = 24,517), 33 reports across 31 independent studies were considered eligible (n = 1958 patients aged ≤50 yr). Cardiac rehabilitation completion rates ranged from 64% to 100%; however, only 5 studies presented a completion rate definition. The length of the program ranged from 7 d to 20 wk, with most (65%) ranging between 6 and 12 wk. While the studies included in this systematic review indicated relatively high rates of completing CR, these are likely to overrepresent the true completion rates as few definitions were provided that could be compared to completion rates used in clinical practice. This systematic review also found that all interventions prescribed exercise (eg, aerobic alone or combined with resistance training or yoga) but had very limited inclusion or description of other integral components of CR (eg, initial assessment and smoking cessation) or how they were assessed and individualized to meet the needs of younger attendees.

Rehabilitation nursing care in the acute phase of diseases with physical disabilities: A concept analysis study

BACKGROUND

Despite the importance of rehabilitation nursing care in improving patient outcomes, the provision of this care in the early stages of diseases and injuries is limited. In this situation, analyzing the concept of rehabilitation nursing care can increase nurses' understanding of this concept and improve the provision of rehabilitation nursing care in the acute phase. This study aimed to analyze the concept of rehabilitation nursing care in acute phase of diseases with physical disability.

METHOD

Walker and Avant's approach to concept analysis was performed in eight stages, including choosing a concept, determining the purpose of analysis, identifying all uses of the concept, defining attributes, identifying a model case, identifying borderline and contrary cases, identifying antecedents and consequences, and defining empirical referents.

RESULTS

The important characteristics of rehabilitation nursing are comprehensive, education-based, specialized, client and family centered, interprofessional, and need-based. The antecedents of rehabilitation nursing care are related to nurses, the care settings and the nursing profession. The most important consequence of rehabilitation nursing care is improving the quality of life of patients. Rehabilitation nursing care also has positive outcomes for nurses and the healthcare systems.

CONCLUSION

The findings indicate that rehabilitation nursing care has several attributes that require antecedents such as knowledge and specialized skills such as teamwork skills, effective communication skills, cultural sensitivity, holistic perspective, intuitive thinking, and reasoning. The most important consequence of rehabilitation nursing care is improving the quality of life of patients.

Thoracic Society of Australia and New Zealand Position Statement: Respiratory nursing

The Thoracic Society of Australia and New Zealand's (TSANZ) Position Statement recognizes the pivotal role respiratory nurses play in the lung health of Australians and New Zealanders. The national and international lung health strategies are evidence based to ensure optimal professional clinical support for patients. Respiratory nurses are essential to the success of these strategies as a professional workforce, irrespective of healthcare setting, as they are at the forefront of the delivery of world-class evidence-based respiratory care. Respiratory nursing, as an entity, does not have the status as a nursing specialist area despite its range of professional practice across the life span and diverse settings, including disease prevention, public health, occupational health, symptom management, health education, surgery, rehabilitation, non-invasive ventilation, support for a life-limiting illness and adjustments to living with a chronic disease. Recognition of the specialized nature of work and specialist nursing practice status has been conferred by nurse registration boards upon cancer, emergency, cardiac, critical care, midwifery, mental health and palliative care nurses. It is time to confer this speciality practice recognition upon respiratory nurses of Australia and New Zealand. Through this position statement, the TSANZ advocates for respiratory nursing as a speciality area of professional nursing practice, thus supporting registered nurses in respiratory practice as well as the development of future generations of respiratory nurses. Furthermore, this statement validates the strong partnerships between all professions within the society for the advancement of lung health.

Impact of nurse-led cardiac rehabilitation on patient's behavioral and physiological parameters after a coronary intervention: A pilot randomized controlled trial

BACKGROUND

Coronary artery disease, one of the leading causes of mortality and morbidity globally, is a major burden on healthcare resources. Cardiovascular rehabilitation is highly recommended for the early recovery of patients with Ischemic heart disease by improving the functional capacity and decreasing disease progression. A randomized controlled trial was conducted to assess the effect of nurse-led cardiac rehabilitation (CR) on behavioural parameters.

MATERIALS AND METHODS

Sixty-two adult patients who underwent percutaneous coronary intervention (PCI) were randomised to two groups to assess the effect of nurse-led cardiac rehabilitation (CR) on behavioural parameters, including adherence to drugs, cardiac diet, lifestyle changes, and selected physiological parameters. The intervention group had nurse-led individualized discharge counseling and clinical follow-up by telephone, whereas the control group received usual care. The comparisons between the control and intervention groups were made using independent Student's t-test or Mann-Whitney U test as appropriate. Pre-test and post-test scores were compared using paired t-test; all tests performed at 5% significance level.

RESULTS

Participants in the intervention group presented with moderate to good smoking cessation, improved adherence to drugs (P < 0.0001), physically active lifestyle in 90.3 versus 45.2% (P < 0.0001), adherence to dietary changes, and improved healthcare satisfaction (P < 0.0001). There was also a significant reduction in triglycerides level in the intervention group at 62.51 versus 20.12 mg/dl in the control arm with (P < 0.05), and better controlled physiological indices, including a reduction in systolic blood pressure of 1.54 vs-7.12 mmHg (P = 0.003), bodyweight reduction of 2.48 kg versus-0.09 kg (P < 0.0001) and body mass index of 0.9 versus-0.05 (P < 0.0001).

CONCLUSION

Personalised, nurse-led CR significantly improved the participants adherence to healthy lifestyle behaviors and decreased the cardiac risk factors in patients with coronary artery disease.

Effects of a structured team nursing model on the efficacy and quality of cardiopulmonary resuscitation in myocardial infarction patients undergoing PCI

OBJECTIVE

This study aimed to evaluate the effects of a structured team nursing model on the efficacy and quality of cardiopulmonary resuscitation (CPR) in acute myocardial infarction patients undergoing percutaneous coronary intervention (PCI).

METHODS

With the random number table, 130 myocardial infarction patients undergoing PCI were divided into two groups, including the control group (n=65) receiving routine emergency resuscitation and nursing care, and the study group (n=65) receiving a structured team care model. The efficacy of CPR, cardiac function, exercise tolerance, ability of daily living activities, quality of life, complication rate and nursing satisfaction were compared between the two groups.

RESULTS

The door-to-balloon time, length of stay at the emergency department, duration of balloon dilation, bedtime and hospital stay in the study group were shorter than those in the control group (P<0.05). The study group showed lower LVEDD and LVESD and higher LVEF than the control group after nursing (P<0.05). The extend of physical limitation, angina stability, level of disease awareness, number of angina attacks, and treatment satisfaction scores in the 6-MWT, MBI, and SAQ scales in the study group after nursing were higher than those in the control group (P<0.05). The complication rate in the study group (7.69%) was lower than that in the control group (20.00%) (P<0.05). The study group had higher satisfaction with operational skills, teamwork, clinical practice, rescue awareness, orderliness, and timeliness than the control group (P<0.05).

CONCLUSION

Structured team nursing model is helpful to improve the timeliness and quality of CRP, shorten the treatment time, improve patients' cardiac function and exercise tolerance, improve self-care ability and quality of life, reduce the occurrence of complications, and enhance the patient-nurse relationship.

Challenges in Managing Acute Cardiovascular Diseases and Follow Up Care in Rural Areas: A Narrative Review

This narrative review explores relevant literature that is related to the challenges in implementing evidence-based management for clinicians in rural and remote areas, while primarily focussing on management of acute coronary syndrome (ACS) and follow up care. A targeted literature search around rural/urban differences in the management of ACS, cardiovascular disease, and cardiac rehabilitation identified multiple issues that are related to access, including the ability to pay, transport and geographic distances, delays in patients seeking care, access to diagnostic testing, and timely treatment in an appropriate facility. Workforce shortages or lack of ready access to relevant expertise, cultural differences, and complexity that arises from comorbidities and from geographical isolation amplified diagnostic challenges. Given the urgency in management of ACS, rural clinicians must act quickly to achieve optimal patient outcomes. New technologies and quality improvement approaches enable better access to rapid diagnosis, as well as specialist input and care. Achieving an uptake of cardiac rehabilitation in rural and remote settings poses challenges that may reduce with the use of alternative models to centre-based rehabilitation and use of modern technologies. Expediting improvement in cardiovascular outcomes and reducing rural disparities requires system changes and that clinicians embrace attention to prevention, emergency management, and follow up care in rural contexts.