Non-pharmacological strategies to decrease anxiety in cardiac catheterization: integrative review

Virtual reality to reduce periprocedural anxiety during invasive coronary angiography: rationale and design of the VR InCard trial

INTRODUCTION

Patients undergoing invasive coronary angiography (ICA) experience anxiety due to various reasons. Procedural anxiety can lead to physiological and psychological complications, compromising patient comfort and overall procedural outcomes. Benzodiazepines are commonly used to reduce periprocedural anxiety, although the effect is modest. Virtual reality (VR) is a promising non-pharmacological intervention to reduce anxiety in patients undergoing ICA.

METHODS AND ANALYSIS

A single-centre open-label randomised controlled trial is conducted assessing the effectiveness of add-on VR therapy on anxiety in 100 patients undergoing ICA and experiencing anxiety in a periprocedural setting. The primary outcome is the Numeric Rating Scale (NRS) anxiety score measured just before obtaining arterial access. Secondary outcomes include postarterial puncture and postprocedural anxiety, patient-reported outcome measures (PROMs) of anxiety and physiological measurements associated with anxiety. The NRS anxiety level and physiological measurements are assessed five times during the procedure. The PROM State-Trait Anxiety Inventory and Perceived Stress Scale are completed preprocedure, and the PROM STAI and the Igroup Presence Questionnaire are performed postprocedure.

ETHICS AND DISSEMINATION

The protocol of this study has been approved by the Research Ethics Committee of the Radboud University Medical Centre, the Netherlands (CMO Arnhem-Nijmegen, 2023-16586). Informed consent is obtained from all patients. The trial is conducted according to the principles of the Helsinki Declaration and in accordance with Dutch guidelines, regulations, and acts (Medical Research involving Human Subjects Act, WMO).

REGISTRATION DETAILS

Trial registration number: NCT06215456.

Impact of a PROgram of Cardiovascular nursE interventionS in a VALVular haEmodynamic Unit (PROCESS-VALVE) on Quality Indicators: A Quasi-Experimental Ambispective Study

Background

The percutaneous treatment of heart valve diseases carried out in the hemodynamic service is constantly growing. After analyzing the mortality, readmissions, success of the procedure, and complications, several studies support this type of percutaneous procedure. The increase in these procedures has required the creation of multidisciplinary teams and new diagnostic and care circuits, such as presurgical consultations and postsurgical follow-ups. Even so, there is little evidence regarding the effect of these consultations on quality indicators.

Purpose

The objective of this study is to evaluate the impact of a program of presurgical and postsurgical nurse interventions (PROCESS-VALVE) on quality indicators of the health of patients undergoing percutaneous valve procedures.

Patients and Methods

The influence of presurgical and postsurgical consultations on quality indicators will be evaluated through an ambispective quasi-experimental study. Patients will be recruited at a tertiary-level hospital in Barcelona, Spain. For the control group, data will be collected retrospectively from patients who underwent percutaneous valve procedures but did not receive pre- or postsurgical consultations. The intervention group comprises those patients agreeing to participate in the study and the hemodynamic nurse valve consultation program (PROCESS-VALVE). In addition, we will assess whether a face-to-face postsurgical consultation equally improves quality indicators compared to postsurgical telephone consultation; for this, a sub-study will be carried out comparing face-to-face or telephone postsurgical follow-up by means of a randomized controlled clinical trial with simple blinding in the intervention group.

Discussion

This study will generate scientific evidence regarding the impact on quality indicators of a nursing intervention via presurgical and postsurgical consultations. In addition, it will allow us to decide the most appropriate follow-up strategy for this type of patient.

Trial Registration

ClinicalTrials.gov NCT05179278, registration date 01/05/2022.

The effect of an information brochure on patients undergoing cardiac catheterization on their anxiety, knowledge and fear: A randomized controlled study

INTRODUCTION

Patients who undergo coronary angiography experience a rather stressful situation. They need information about this invasive procedure which most of the times find either from the internet, their referring physicians, acquaintances or friends with past experience of an invasive procedure.

AIM

The aim of the study was on the one hand to test the potential beneficial effects of an information brochure on undergoing a cardiac catheterization for the first time and on the other hand to highlight the importance of informing patients before coronary angiography and its beneficial effects on both reducing their fear and anxiety.

METHODS

Patients were randomly assigned to an experimental group receiving the brochure at least 1 day before the cardiac catheterization (N = 44), or to a control group not receiving the brochure (N = 44). The SFQ, ISQ and STAI tools were distributed to both groups.

RESULTS

All experimental subjects in the intervention group read the brochure. The intervention group had significantly lower scores on both short-term and overall fear compared to the control group. However, the fear of the long-term consequences of cardiac catheterization was similar in both groups. Women had higher fear of the short-term consequences of catheterization than men. The control group experienced a mean satisfaction score of 10.9 points (SD= 2.5 points) while the intervention group had a score of 11.1 points respectively (SD= 2.3 points). In addition, 95, 5% of the control group and 88, 6% of the intervention group patients considered that the provision of information could have been improved. In terms of stress, patients with co-morbidities scored 7.39 points higher, meaning they experienced more symptoms of permanent anxiety, compared to patients who did not have an underlying disease. In addition, the more the patients were satisfied with the information provided, the fewer the symptoms of transient anxiety they experienced.

CONCLUSIONS

Providing information in the form of a brochure regarding cardiac catheterization before the procedure, is of great importance and constitutes an efficient intervention.

Parental anxiety among children undergoing cardiac catheterisation

BACKGROUND

Parents may experience anxiety and stress when their children undergo cardiac catheterisation. The goal of this study was to assess the level of anxiety in parents of children undergoing cardiac catheterisation and to identify factors that were associated with level of anxiety.

METHODS

This was a cross-sectional survey of parents of children who underwent cardiac catheterisation. Anxiety levels were measured using a validated self-report questionnaire - State-Trait Anxiety Inventory, which generates state anxiety scores on the current state of anxiety and trait anxiety scores on the stable aspects of anxiety proneness. One sample t-test was used to compare the data with normative data. Multiple linear regression was used to assess the factors associated with the state score.

RESULTS

A total of 113 parents completed the survey. The mean age of parents was 34.0±7.7 years and the mean age of children undergoing catheterisation was 6.7±5.7 years. Compared with normative data, mean state score was significantly higher in our cohort (p<0.05) despite no difference in the trait score. Final multivariate model showed that the state score was significantly associated with child age group (<1 year [coefficient β 7.2] and 10-18 years [6.3], compared to 1 to <10 years of age [reference]) and history of previous catheterisation (-5.2) (p<0.05).

CONCLUSIONS

Concurrent state anxiety level was high among parents of children undergoing cardiac catheterisation, whereas trait anxiety level was not. Higher anxiety was experienced by parents of infants and adolescents without a history of previous catheterisation.

Elaboração e validação de um manual informativo sobre cateterismo cardíaco

Resumo Objetivo Elaborar e validar um manual informativo sobre o cateterismo cardíaco. Métodos Trata-se de um estudo metodológico. O manual foi elaborado de acordo com a experiência dos pesquisadores e em dados da literatura. Foi submetido à validação por oito enfermeiros, utilizando a Técnica de Delphi e para ser considerado válido deveria alcançar 100% de concordância. Posteriormente foi avaliado por 35 pacientes e deveria alcançar uma média de pontuação igual ou superior a 4. Resultados O manual contém os tópicos: definição, local e tempo de realização, como ele é realizado e os cuidados antes, durante e após o procedimento. Foram necessárias quatro rodadas para validar o manual com os enfermeiros. Na segunda etapa observou-se que todas as questões sobre o manual tiveram médias altas (4,83 a 4,91, p<0,001), tornando o manual válido pelos pacientes. Conclusão O manual foi elaborado e considerado válido pelos enfermeiros e pacientes e, poderá ser utilizado por diversas instituições.