Challenging experiences of the elderly with heart failure in the COVID-19 pandemic: a phenomenological study in Iran

BACKGROUND

Patients with heart failure (HF), especially the elderly, faced many challenges during the COVID-19 pandemic, which need to be explored. The present study aimed to analyse the challenging experiences facing the elderly with heart failure during the pandemic in Iran. To achieve this aim, a qualitative approach to research was employed.

METHODS

The present qualitative research employed a phenomenological approach to study 12 elderly with heart failure visiting Imam Ali Hospital during the COVID-19 pandemic in Kermanshah, Iran. The data collection occurred between August 5, 2022, and November 21, 2022. The participants were selected through a purposive sampling method and interviewed using a semi-structured interview. MAXQDA10 software was used for data organisation and the Colizzi analytical technique for data analysis. Guba and Lincoln's criteria were also used to evaluate the trustworthiness of the qualitative research.

RESULTS

A total of two categories, 8 subcategories, and 110 primary codes were extracted from the data. The two categories were challenges and coping strategies. The former included the sub-categories of economic issues, fear, anxiety, and fear of death; limited access to health care; quarantine issues; disruption of family life; and medication non-adherence. The subcategories of the latter were faith in God, social support, and self-care behaviors.

CONCLUSIONS

The present study revealed the challenges experienced and the coping strategies employed by elderly patients with heart failure during the pandemic in Iran. A knowledge of these challenges and experiences during the COVID-19 pandemic can raise healthcare workers' awareness of the elderly patients' strategies used to cope with the virus.

Assessing exposure to secondhand smoke among Iranian patients with cardiac diseases; a cross-sectional study

Introduction

Studies have linked secondhand smoke (SHS) exposure to adverse health effects. The high prevalence of heart disease necessitates the need for studies in this field. Therefore, the aim of the present study was to assess the exposure to SHS in cardiac patients.

Method

This study is a cross-sectional descriptive study. A total of 430 patients who were referred to Imam Ali Hospital in Kermanshah, Iran, in 2020 were included in the study based on predetermined inclusion and exclusion criteria. The researchers collected and recorded demographic information, disease history, and exposure to secondhand smoke (SHS) through a digital questionnaire. Bivariate analysis was conducted using a chi-square test and an independent T-test, depending on the variable scale.

Results

The results of the study showed that 237 patients were male (55.12 %) and 193 were female (44.8 %). The prevalence of exposure to secondhand smoke was 72.09 %. Notably, the highest rate of exposure to secondhand smoke was associated with 'exposure to tobacco smoke in public places' with a rate of 69.30 %. Additionally, it was observed that approximately 39.07 % of patients reported exposure to secondhand smoke in public places at least once a week.

Conclusion

The present study has found that cardiac patients frequently experience secondhand smoking exposure, with public settings being the primary location of exposure. Implementing intervention strategies and enacting laws that prohibit smoking can effectively mitigate the negative impact of SHS exposure.

Role of demographic variables in investigating occupational stress of disaster and emergency medical management center

BACKGROUND

Emergency medical services face stressful environments such as departments dealing with injuries and sick patients that pose challenging situations for the healthcare staff. This present study investigates the role of demographic variables in investigating occupational stress of disaster and emergency medical management center in 2021.

MATERIALS AND METHODS

This present descriptive study selected a sample size of 200 medical personnel associated with disaster and emergency medical management center in Iran, according to the inclusion chosen criteria. The study used a tool consisting of two parts, including demographic information and a job stress Health and Safety Executive (HSE) standard questionnaire. The study selected respondents through Cochran's sample size formula using stratified random sampling with a cross-sectional research design for data collection. This present study has analyzed received data using performed the descriptive and inferential information (t-test and one-way ANOVA) at a significance level P < 0.05. The participants of the survey were males only.

RESULTS

The study results specified that the mean age of respondents was 30.14 ± 5.96. The study results exhibited that the mean score of total occupational stress was 3.41 ± 0.26. The results showed the highest (4.34 ± 0.35) and the lowest (2.72 ± 0.86) stress levels were related to role dimensions.

CONCLUSIONS

The study findings revealed a significant relationship between stress level and participants' age, marital status, educational level, type of base, workplace, and the number of work hours per month. Emergency medical personnel experience a high level of occupational stress. Senior managers can use similar studies to implement measures to reduce the experience of employees' stress.

Investigation of the influencing factors with the uptake of the COVID-19 vaccine booster dose among the general population of Ardabil, Iran: A cross-sectional study

Background and Aims

Vaccination is one of the most efficient approaches to combating COVID-19 if it is adequately embraced by the general population. Numerous factors influence the uptake or refusal of the booster dose. The goal of this study was to look at the different factors that affect how the general population in Ardabil feels about getting vaccine boosters (annual boosters) for COVID-19 and to evaluate those feelings.

Methods and Materials

In the city of Ardabil, general population, perceptions towards the COVID-19 vaccine booster (annual boosters) dose were evaluated using a cross-sectional survey design between January 2 and March 25, 2022. A questionnaire was developed and filled out by 662 subjects via phone calls from healthcare providers. Descriptive statistics, the Chi-square test, the correlation coefficient, and regression analysis were run for the analysis of quantitative data.

Results

The findings of the research revealed that 238 participants, or 35.9%, had previously gotten the booster dose of the COVID-19 vaccination, while 198 participants, or 29.2%, expressed a desire to do so as soon as feasible. A total of 187 (28.2%) respondents reported not wanting to get a booster dose, and 39 (5.7%) could not decide. In the factors found to affect decisions not to accept regular doses, adverse effects (45.4%) and the presence of misinformation (30%) were the most important. Regression in educational achievement, and following the COVID-19 news showed to be the major predictors of the subjects' attitudes toward the regular COVID-19 vaccine.

Conclusion

The present findings revealed that low confidence in the efficiency of the booster shot and misinformation are two critical factors to consider in educational planning and interventions.

Does coping with pain help the elderly with cardiovascular disease? The association of sense of coherence, spiritual well-being and self-compassion with quality of life through the mediating role of pain self-efficacy

BACKGROUND

Population ageing is considered one of the biggest challenges facing the world, and the status of the elderly in society and their quality of life (QOL) have proved to be a concern in professional and scientific research circles. As a result, the current study sought to investigate the role of pain self-efficacy (PSE) as a moderator in the relationship between sense of coherence (SOC), spiritual well-being, and self-compassion with QOL in Iranian elderly with cardiovascular disease (CVD).

METHOD

This was a correlational study of the path analysis type. The statistical population included all elderly people with CVD who were at least 60 years of age in Kermanshah Province, Iran, in 2022, of whom 298 (181 men and 117 women) were selected using convenience sampling and according to the inclusion and exclusion criteria. The participants answered questionnaires from the World Health Organization on QOL, Paloutzian and Ellison's spiritual well-being, Nicholas's PSE, Antonovsky's SOC, and Raes et al.'s self-compassion.

RESULTS

The results of path analysis demonstrated that the hypothesized model of this study has a good fit in the studied sample. There were significant paths between SOC (β = 0.39), spiritual well-being (β = 0.13) and self-compassion (β = 0.44) with PSE. Although there were significant paths between SOC (β = 0.16) and self-compassion (β = 0.31) with QOL, there was no significant path between spiritual well-being and QOL (β = 0.06). Besides, there was a significant path between PSE and QOL (β = 0.35). Finally, PSE was found to mediate the relationship of SOC, spiritual well-being and self-compassion with QOL.

CONCLUSION

The results may provide psychotherapists and counselors working in this field of inquiry with advantageous information to choose or create a useful therapeutic method to work with the elderly with CVD. Meanwhile, other researchers are suggested to examine other variables which may serve a mediating role in the mentioned model.

Anxiety, coping style and hopelessness during COVID-19 pandemic: An Iranian population-based study

Background and Aims

The COVID-19 pandemic has caused new conditions such as nationwide quarantine, a dramatic decrease in-person interaction and an increase in death anxiety for governments and people. The pandemic of an unpredictable disease with no definite treatment can pose physical and psychological risks to individuals. The present study aimed to investigate the state of anxiety, coping styles, and hopelessness of people in the lockdown period and reopening in Iran.

Methods

In this national population-based cross-sectional study, a total of 1191 people who had access to social networks from all over Iran completed the anxiety, hopelessness, and coping style questionnaires online using the snowball sampling method. Analysis was conducted using Stata software version 12 (Stat Corp). The significance level was set at 0.05.

Results

The results of the study suggested that women experienced higher levels of anxiety than men, and, in stressful situations, women were more likely to use emotion-focused coping styles, while men frequently used problem-focused coping styles. The majority of participants reported moderate levels of anxiety and low levels of hopelessness (64.04%). The results of multiple linear regression show any level of anxiety mild (ß = 0.59, 95% confidence interval [CI]: 0.32-0.85), moderate (ß = 0.72, 95% CI: 1.36-1.08), and severe (ß = 2, 95% CI: 1.36-2.56) relative to the none anxiety significantly increase the hopelessness, Furthermore, showing a negative significant adjusted association with the problem-focused coping style (ß = -0.06, 95% CI: -0.07 to -0.04), and a significant positive association with the emotion-focused coping style (ß = 0.04, 95% CI: 0.02-0.06).

Conclusion

Our findings could be used to prevent psychological damage in societies and suggested addressing problem-focused coping style, especially during a crisis, and providing people with preprepared mental health protocols at this pandemic.

Clinical and epidemiological profile of ST-segment elevation myocardial infarction patients in a megacity of west of Iran

Background and Aims

Low- and middle-income nations account for at least three-quarters of cardiovascular disease deaths worldwide. This study aimed to obtain real knowledge about ST segment elevation myocardial infarction (STEMI) patients and provide the context for developing a principles for care quality improvement.

Method

This cross-sectional study was conducted from July 2018 through December 2019. The study sample consisted of1169 eligible patients based on inclusion criteria. The data were collected using the standard EROP and three specialized, trained questionnaires. The collected data were checked by the quality control officer and analyzed using Stata Version 14.

Results

Patient baseline characteristics showed that body mass index, low-density lipoprotein, high-density lipoprotein, total cholesterol, and triglyceride levels were higher in women. Also, females recorded a considerable history of diabetes mellitus, hypertension, and hypercholesterolemia compared to men. The results also showed that most men were smokers (46.80%). Aspirin (94.27%), statins (91.48%), and clopidogrel (90.68%) were the common medications used at hospital discharge for patients.

Conclusion

The present study suggests that identifying and managing modifiable risk factors can improve cardiovascular disease outcomes. Also, considering the early identification of STEMI patients with new therapies can effectively decrease the rate of cardiovascular disease and its attributed health outcomes.

Smoker pseudo-paradox in ST-segment elevation myocardial infarction patients

INTRODUCTION

Cigarette smoking is a preventable cause of cardiovascular morbidity and mortality. Despite the adverse effects of smoking, some studies have reported the term "smoker's paradox', meaning better outcomes in smokers following acute myocardial infarction.

AIM

The aim of the present study was to evaluate the relationship between smoking status and one-year mortality in patients with ST-segment elevation myocardial infarction (STEMI).

MATERIALS AND METHODS

This was a registry-based cohort study of STEMI patients from Imam-Ali hospital, Kermanshah, Iran. Consecutive STEMI patients (July 2016-October 2018) were stratified by smoking status and followed for one year. Cox proportional models were used to estimate crude, age-adjusted, and full-adjusted hazard ratios with 95% confidence intervals (HR, 95%CI).

RESULTS

Of 1975 patients (mean age 60.1 years, 76.6% male) included in the study, 48.1% (n=951) were smokers (mean age 57.7 years, 94.7% male). Crude and age-adjusted HR (95% CI) for the associations of smoking and mortality were 0.67 (0.50-0.92) and 0.89 (0.65-1.22), respectively. After adjusting for age, sex, hypertension, diabetes, body-mass index, anterior wall myocardial infarction, creatine kinase-MB, glomerular filtration rate, left ventricular ejection fraction, low-density lipoprotein cholesterol, and hemoglobin, smoking was associated with increased risk of mortality: HR (95% CI: 1.56 (1.04-2.35).

CONCLUSIONS

In our study, smoking was associated with an increased risk of mortality. Although the smokers had a better outcome, this would be reversed after controlling for age and the other STEMI associated factors.

Ethnic differences in the lifestyle behaviors and premature coronary artery disease: a multi-center study

BACKGROUND

Diverse ethnic groups that exist in Iran may differ regarding the risk factors such as hypertension, hyperlipidemia, dyslipidemia, diabetes mellitus, and family history of non-communicable disease. Premature Coronary Artery Disease (PCAD) is more endemic in Iran than before. This study sought to assess the association between ethnicity and lifestyle behaviors in eight major Iranian ethnic groups with PCAD.

METHODS

In this study, 2863 patients aged ≤ 70 for women and ≤ 60 for men who underwent coronary angiography were recruited in a multi-center framework. All the patients' demographic, laboratory, clinical, and risk factor data were retrieved. Eight large ethnicities in Iran, including the Farses, the Kurds, the Turks, the Gilaks, the Arabs, the Lors, the Qashqai, and the Bakhtiari were evaluated for PCAD. Different lifestyle components and having PCAD were compared among the ethnical groups using multivariable modeling.

RESULTS

The mean age of the 2863 patients participated was 55.66 ± 7.70 years. The Fars ethnicity with 1654 people, was the most subject in this study. Family history of more than three chronic diseases (1279 (44.7%) was the most common risk factor. The Turk ethnic group had the highest prevalence of ≥ 3 simultaneous lifestyle-related risk factors (24.3%), and the Bakhtiari ethnic group had the highest prevalence of no lifestyle-related risk factors (20.9%). Adjusted models showed that having all three abnormal lifestyle components increased the risk of PCAD (OR = 2.28, 95% CI: 1.04-1.06). The Arabs had the most chance of getting PCAD among other ethnicities (OR = 2.26, 95%CI: 1.40-3.65). While, the Kurds with a healthy lifestyle showed the lowest chance of getting PCAD (OR = 1.96, 95%CI: 1.05-3.67)).

CONCLUSIONS

This study found there was heterogeneity in having PACD and a diverse distribution in its well-known traditional lifestyle-related risk factors among major Iranian ethnic groups.

Psychometric properties of the mental health continuum-short form in Iranian adolescents

Introduction

Psychological tests are necessary to assess the mental state of individuals. Mental health is one of the important psychological indicators and is increasingly considered as having various aspects of well-being. The Mental Health Continuum-Short Form (MHC-SF) is a 14-item instrument that assesses mental health, focusing on emotional, psychological, and social well-being. The present study, the psychometric properties of the Persian version of the MHC-SF were examined in relation to its factor structure, internal consistency, construct validity, and gender measurement invariance among adolescents.

Methods

The population of this study was Iranian adolescents between 11-and 18-year-old who were enrolled in the seventh to twelfth grades. A convenience sample of 822 Adolescents from four large cities in the Iran (Tehran, Zanjan, Hamedan and Ghazvin) participated in the present study. Questionnaires were completed online. Statistical analyses to evaluate the factor structure, internal consistency, construct validity, gender and age factorial invariance were performed in SPSS and LISREL.

Results

According to the results of confirmatory factor analysis, the MHC-SF is composed of three factors: emotional, psychological, and social well-being. Reliability was confirmed by Cronbach's alpha method and composite reliability (>0.7). Measurement invariance were confirmed among girls and boys. Convergent and divergent validity were also evaluated and confirmed by correlating the test score with similar and different tests.

Conclusion

This study confirmed the psychometric properties of MHC-SF in the Iranian adolescent community. This instrument can be used in psychological research and diagnostic evaluations.

Determinants of Left Ventricular Systolic Function One Year after Primary Percutaneous Coronary Intervention for ST-elevation Myocardial Infarction in a Middle-Income Country

BACKGROUND

Little is known about the predictors of left ventricular ejection fraction (LVEF) -an important predictor of mortality- after primary percutaneous coronary intervention (PCI) in low- and middle-income countries.

METHODS

In a prospective cohort study at Imam Ali hospital, Kermanshah, Iran, we enrolled consecutive ST-elevation myocardial infarction (STEMI) patients treated with primary PCI (2016-2018) and followed them up to one year. LVEF levels were measured by echocardiography, at baseline and one-year follow-up. Determinants of preserved/improved LVEF were assessed using multi-variable logistic regression models.

RESULTS

Of 803 patients (mean age 58.53±11.7 years, 20.5% women), baseline LVEF levels of ≤35% were reported in 44%, 35- 50% in 40%, and ≥50% in 16% of patients. The mean ± SD of LVEF increased from 38.13%±9.2% at baseline to 41.49%±9.5% at follow-up. LVEF was preserved/improved in 629 (78.3%) patients. Adjusted ORs (95% CIs) for predictors of preserved/improved LVEF showed positive associations with creatinine clearance, 1.01 (1.00-1.02) and adherence to clopidogrel, 2.01 (1.33-3.02); and inverse associations with history of myocardial infarction (MI), 0.44 (0.25-0.78); creatine kinase MB (CK-MB), 0.997 (0.996- 0.999); door-balloon time (3rd vs. 1st tertile), 0.62 (0.39-0.98); number of diseased vessels (2 and 3 vs. 1: 0.63 (0.41-0.99) and 0.58 (0.36-0.93), respectively); and baseline LVEF (35-50% and ≥50% vs. ≤35%: 0.45 (0.28-0.71) and 0.19 (0.11-0.34), respectively).

CONCLUSION

Adherence to clopidogrel, short door-balloon time, high creatinine clearance, and lower baseline LVEF were associated with preserved/improved LVEF, while history of MI, high CK-MB, and multi-vessel disease were predictors of reduced LVEF. Long-term drug adherence should be considered for LVEF improvement in low- and middle-income countries.

Protective factors against suicide attempt in Iranian Kurdish women: a qualitative content analysis

BACKGROUND

A proper understanding of the protective factors against suicide attempt can provide the basis for planning preventive interventions. This study aimed to identify protective factors against suicide attempt among women.

METHODS

This qualitative study was conducted in Kermanshah, Iran between January and May 2021. Participants were 20 Kurdish women, survivors of suicide attempt, selected by purposive sampling method. The data collection method was face-to face and audio-recorded semi-structured interview. Qualitative data analysis was done according to Diekelmann 7-step approach.

FINDINGS

According to the results, the main topic was protective factors against suicide attempt in women, with two categories; "Individual factors" and "Social factors". "Individual factors" had five subcategories including coping strategies, reasons for living, resilience, religious beliefs, and fear of death, and "social factors" had two subcategories including social support and effective communication.

CONCLUSION

This study showed that women who intend to commit suicide may encounter some individual and social factors that play a protective role against suicide. It is recommended to identify and strengthen these protective factors for the effectiveness of suicide prevention interventions.

Creatinine clearance is key to solving the enigma of sex difference in in-hospital mortality after STEMI: Propensity score matching and mediation analysis

BACKGROUND

The precise impact of sex difference on in-hospital mortality in ST-elevation myocardial infarction (STEMI) patients are unclear, and the studies are no longer consistent. Therefore, we sought to evaluate the impact of sex differences in a cohort of STEMI patients.

METHODS

We analyzed the data of 2647 STEMI patients enrolled in the Kermanshah STEMI Cohort from July 2017 to May 2020. To accurately clarify the relationship between sex and hospital mortality, propensity score matching (PSM) and causal mediation analysis was applied to the selected confounder and identified intermediate variables, respectively.

RESULTS

Before matching, the two groups differed on almost every baseline variable and in-hospital death. After matching with 30 selected variables, 574 male and female matched pairs were significantly different only for five baseline variables and women were no longer at greater risk of in-hospital mortality (10.63% vs. 9.76%, p = 0.626). Among the suspected mediating variables, creatinine clearance (CLCR) alone accounts for 74% (0.665/0.895) of the total effect equal to 0.895(95% CI: 0.464-1.332). In this milieu, the relationship between sex and in-hospital death was no longer significant and reversed -0.233(95% CI: -0.623-0.068), which shows the full mediating role of CLCR.

CONCLUSION

Our research could help address sex disparities in STEMI mortality and provide a consequence. Moreover, CLCR alone can fully explain this relationship, which can highlight the importance of CLCR in predicting the short-term outcomes of STEMI patients and provide a useful indicator for clinicians.

Evaluating the access of slum residents to healthcare centers in Kermanshah Metropolis, Iran (1996-2016): A spatial justice analysis

Background

Proper access to health care centres and services is one of the key indicators of health justice, and it is more than ever important in slums.

Objective

This aim of this research is to evaluate the accessibility of health care centres to slum residents in the Kermanshah metropolis, Iran during the period 1996-2016.

Methods

In this cross-sectional study, data was obtained from the Census of Iran for the periods 1996, 2006 and 2016. Information on the number and location of health care centres was collected from the Kermanshah University of Medical Sciences. Network Analysis modelling method in Arc/GIS10.6 software was used to evaluate the accessibility of people to health centres.

Results

The results show that the spatial pattern of health centres in Kermanshah was random during 1996, 2006 and 2016, but the spatial pattern of poverty in the metropolis was clustered. In addition, the distribution of health centres was not consistent with the population densities. However, the overall population with inappropriate access to health centres in the slums of Kermanshah metropolis decreased over the study period (1996-54.02%, 2006-51.09%, and 2016-34.71%).

Conclusions

The findings of the study reveal that access to health care services by the slum population is not consistent with the increase of health care centres. This means that health policymakers were unsuccessful to provide the required health care services for the slums.

Predictors of 1-Year Major Cardiovascular Events after ST-Elevation Myocardial Infarction in a Specialized Cardiovascular Center in Western Iran

Background: Identifying the long-term predictors of recurrent cardiovascular events may help improve the quality of care and prevent subsequent events. We aimed to investigate the predictors of 1-year major cardiovascular events (MACE) in patients discharged after ST-elevation myocardial infarction (STEMI) in a tertiary hospital in Iran. Methods: This registry-based cohort study included consecutive STEMI patients between 2016 and 2019 in Imam-Ali Hospital, Kermanshah, Iran. All patients discharged alive from STEMI hospitalization were followed up for 1 year for MACE, consisting of all-cause mortality, nonfatal MI, and nonfatal stroke. We estimated the hazard ratio (HR) and the 95% confidence interval (95% CI) using Cox proportional-hazard models to evaluate potential predictors, including demographic characteristics, medical history, cardiovascular risk factors, laboratory tests, reperfusion therapy, and medications. Results: During 2187.2 person-years, 21 patients were lost to follow-up (success rate =99.1%). Of 2274 post-discharge STEMI patients (mean age =60.26 y; 21.9% female), 151 (6.6%) experienced MACE, including, all-cause mortality (n=115, 5.1%), nonfatal MI (n=20, 0.9%), and nonfatal stroke (n=16, 0.7%). Independent predictors of MACE were age (HR:1.02; 95% CI: 1.00-1.04), no education vs ≥12 years of formal schooling (HR: 2.07; 95% CI: 1.17-3.67), stroke history (HR: 2.37; 95% CI: 1.48-3.81), the glomerular filtration rate (HR: 0.98; 95% CI: 0.97-1.00), the body mass index (HR: 0.94; 95% CI:, 0.89-0.99), peak creatine kinase-MB (HR: 1.00; 95% CI: 1.00-1.002), thrombolysis vs primary percutaneous coronary intervention (HR: 1.85; 95% CI: 1.21-2.81), and left ventricular ejection fraction <35% vs ≥50% (HR: 2.82; 95% CI: 1.46-5.47). Conclusion: Age, education, stroke history, the glomerular filtration rate, the body mass index, peak creatine kinase-MB, reperfusion therapy, and left ventricular function can be independently associated with 1-year MACE.

Effect of cigarette smoking on coronary arteries and pattern and severity of coronary artery disease: a review

Objective

Smoking is a risk factor for coronary artery disease (CAD) and a known factor influencing the severity and pattern of CAD. We summarized evidence regarding the effect of smoking on the number of occluded coronary arteries and the severity and pattern of CAD.

Methods

We extracted data from observational studies reporting the pattern and severity of CAD in smokers. The quality of studies was assessed using the Strengthening the Reporting of Observational Studies in Epidemiology checklist, and results are reported in the Garrard table. The review process followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement.

Results

We screened 11 studies including 6037 samples. Six studies reported no relationship between smoking and the number of damaged arteries. One study reported that smoking was related to occlusion in the left anterior descending artery, but there was no relationship between smoking and the location of occlusion in the arteries. Smoking was related to CAD severity in five studies.

Conclusions

Smoking was found to be related to CAD severity and location of the damaged artery in the heart. However, there was no significant association of smoking with the number of damaged arteries and location of arterial occlusion.

Reperfusion Therapy and Predictors of 30-Day Mortality after ST-Segment Elevation Myocardial Infarction in a University Medical Center in Western Iran

BACKGROUND

Considerable variability in survival rate after ST-segment elevation myocardial infarction (STEMI) is present and outcomes remain suboptimal, especially in low- and middle-income contraries. This study aimed to investigate predictors of 30- day mortality after STEMI, including reperfusion therapy, in a tertiary hospital in western Iran.

METHODS

In this registry-based cohort study (2016-2019), we investigated reperfusion therapies - primary percutaneous coronary intervention (PPCI), pharmaco-invasive (thrombolysis followed by angiography/percutaneous coronary intervention), and thrombolysis alone - used in Imam-Ali hospital, the only hospital with a PPCI capability in the Kermanshah Province. We estimated hazard ratios (HRs) and 95% confidence intervals (CIs), using Cox proportional-hazard models, to investigate the potential predictors of 30-day mortality including reperfusion therapy, admission types (direct admission/referral from non-PPCI-capable hospitals), demographic variables, coronary risk factors, vital signs on admission, medical history, and laboratory tests.

RESULTS

Data of 2428 STEMI patients (mean age: 60.73; 22.9% female) were available. Reperfusion therapy was performed in 84% of patients (58% PPCI, 10% pharmaco-invasive, 16% thrombolysis alone). Only 17% of the referred patients had received thrombolysis at non-PPCI-capable hospitals. Among patients with thrombolysis, only 38.2% underwent coronary angiography/ percutaneous coronary intervention. The independent predictors of mortality were: no reperfusion therapy (HR: 2.01, 95% CI: 1.36-2.97), referral from non-PPCI-capable hospitals (1.73, 1.22-2.46), age (1.03, 1.01-1.04), glomerular filtration rate (0.97, 0.96-0.97), heart rate>100 bpm (1.94, 1.22-3.08), and systolic blood pressure<100 mm Hg (4.92, 3.43-7.04). Mortality was lower with the pharmaco-invasive approach, although statistically non-significant, than other reperfusion therapies.

CONCLUSION

Reperfusion therapy, admission types, age, glomerular filtration rate, heart rate, and blood pressure were independently associated with 30-day mortality. Using a comprehensive STEMI network to increase reperfusion therapy, especially pharmaco-invasive therapy, is recommended.

Acute myocardial infarction: Circadian, daily, monthly and seasonal patterns of occurrence in diabetics

BACKGROUND

Illustrating the temporal pattern of acute myocardial infarction (AMI), as a major cause of mortality, may help with disease prevention and better treatment. Therefore, the aim of our study was to investigate the circadian, daily, monthly and seasonal patterns of AMI occurrence in patients with diabetes mellitus, and other likely associated factors.

METHODS

This cross-sectional study was performed on 142 diabetic patients admitted to the Imam Ali cardiovascular hospital, Kermanshah, Iran with a diagnosis of ST-segment elevation myocardial infarction (STEMI) from March 2018 to February 2019. Data were collected using a checklist developed based on the study goals. One-way Analysis of Variance (ANOVA) and Chi-Square test (or Fishers҆ Exact test) were used to assess the differences between subgroups. Multiple logistic regression model was constructed to evaluate independent predictors of the AMI occurrence.

RESULT

Out of the 142 diabetic patients, 90 (63.4%) were male. The mean age of the patients was (mean ± SD) 62.81 ± 10.21 years. Occurrence of STEMI was the most common during winter (p = 0.001). Prior angina, prior congestive heart failure (CHF), prior stroke, High-density lipoprotein (HDL), and Creatine Phosphokinase (CPK) were significantly associated with seasonal pattern of STEMI (p-value < 0.05). Angiotensin receptor blockers (ARBs) use was associated with an increased odds of the AMI occurrence in winter (OR = 8.32; P = 0.027).

CONCLUSION

The present study of Iranian patients with diabetes revealed that AMI occurred more frequently during the winter compared to the other seasons. ARBs use was associated with an increased odd of the AMI occurrence in winter.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1007/s40200-021-00813-3.

Assessing the adherence to treatment among patients with cardiovascular diseases in Kermanshah, Iran

Background: The present study aimed to investigate the psychological determinants of adherence to treatment among patients with cardiovascular diseases (CVDs) referring to Imam Ali Hospital in Kermanshah, Iran.

Methods: This cross-sectional study was conducted on 227 patients (mean age=58.10, SD = 13.44) with CVDs, randomly selected amongst those admitted to Imam Ali cardiovascular center of Kermanshah in 2018. Data were collected through Meaning in Life Questionnaire (MLQ), the Jefferson Scale of Patient’s Perceptions of Physician Empathy (JSPPPE), the Illness Perception Questionnaire (IPQ), and Adherence to Treatment Questionnaire. The relationships between the criterion and predictor variables were assessed using Pearson correlation coefficient and linear regression (stepwise method) in IBM SPSS Statistics-23.

Results: The adherence to treatment was associated with meaning in life (r=0.367), patients’ perceptions of physician empathy (r=0.218), and illness perception (r=-0.238), at the 0.01 level. Meaning in life, patient’s perceptions of physician empathy, and illness perception explained 18.6% of the variance in adherence to treatment. Meaning in life (beta=0.367 and P≤0.001) was the most influential predictor of adherence to treatment. Additionally, there was a significant difference in the score of adherence to treatment by gender (23.46±4.42 for female vs. 24.77±3.53 for male, P = 0.030).

Conclusion: The patients’ perceptions of physician empathy, meaning in life, and illness perception were important factors to predict adherence to treatment in patients with CVDs. Gender was a significant predictor of the adherence to treatment.

Prevalence and predictors of slow coronary flow phenomenon in Kermanshah province

Introduction: This study was conducted to investigate prevalence and predictors of slow coronary flow phenomenon (SCF) phenomenon. Methods: This cross-sectional study was performed at Imam Ali Cardiovascular Hospital affiliated with the Kermanshah University of Medical Sciences (KUMS), Kermanshah province, Iran. From March 2017 to March 2019, all the patients who underwent coronary angiography were enrolled in this study. Data were obtained using a checklist developed based on the study's aims. Independent samples t tests and chi- square test (or Fisher exact test) were used to assess the differences between subgroups. Multiple logistic regression model was applied to evaluate independent predictors of SCF phenomenon. Results: In this study, 172 (1.43%) patients with SCF phenomenon were identified. Patients with SCF were more likely to be obese (27.58±3.28 vs. 24.12±3.26, P <0.001), hyperlipidemic (44.2 vs. 31.7, P <0.001), hypertensive (53.5 vs. 39.1, P <0.001), and smoker (37.2 vs. 27.2, P =0.006). Mean ejection fraction (EF) (51.91±6.33 vs. 55.15±9.64, P <0.001) was significantly lower in the patients with SCF compared to the healthy controls with normal epicardial coronary arteries. Mean level of serum triglycerides (162.26±45.94 vs. 145.29±35.62, P <0.001) was significantly higher in the patients with SCF. Left anterior descending artery was the most common involved coronary artery (n = 159, 92.4%), followed by left circumflex artery (n = 50, 29.1%) and right coronary artery (n = 47, 27.4%). Body mass index (BMI) (OR 1.78, 95% CI 1.04-2.15, P <0.001) and hypertension (OR 1.59, CI 1.30-5.67, P =0.003) were independent predictors of SCF phenomenon. Conclusion: The prevalence of SCF in our study was not different from the most other previous reports. BMI and hypertension independently predicted the presence of SCF phenomenon.

Investigation of anemia risk factors and its related outcomes in patients with ST-elevation myocardial infarction

Background: Anemia is one of the symptoms of hospital patients suffering from ST-elevation myocardial infarction (STEMI), which may have a predictive role in short- or long-term complications. This study aimed to identify anemia risk factors and related short- or long-term outcomes in STEMI patients.

Methods: This was a prospective study of patients older than 18 years diagnosed with STEMI who admitted to Imam Ali hospital from 2014 to 2015. To collect demographic and clinical information related to anemia, a questionnaire compiled by researchers was administered. The collected data were analyzed by SPSS (version 20); also, independent t test and multiple logistic regression analyses were applied to find related risk factors of anemia in STEMI patients. Significance level was set at p < 0.05 for all statistical tests.

Results: In total, 49 (11.7%) out of 423 patients suffered from anemia. STEMI patients with anemia were more likely to be female (OR = 2.92; CI 95% = 1.58-5. 38), diabetic (OR = 2.5; CI 95% = 1.32- 4.74), ≥ 60 years old (OR = 2.42; CI 95% = 1.24-4.73), nonsmokers (OR = 2.18; CI 95% = 1.07- 4.4), and susceptible to require in-hospital cardiopulmonary resuscitation (CPR), (OR = 3.12; CI 95% = 1.35- 7.1). In the final analysis, using the Forward Wald model in logistic regression, anemia remained significantly related to female gender (OR = 2.76; CI 95% = 1.42-5.36), diabetes mellitus (OR = 2.38; CI 95% = 1.2-4. 74), and a history of MI (OR = 2.5; CI 95% = 1.04-6.11).

Conclusion: STEMI patients with anemia are more susceptible to have in-hospital outcomes. Furthermore, female gender, hyperglycemia, and history of MI were factors related to anemia that might have major role in the complications of STEMI.

Comparison of Mean Platelet Volume in Acute Myocardial Infarction vs. Normal Coronary Angiography

<p>Considering the importance of cardiovascular disease and the role that platelets have in thrombosis formation in the coronary arteries, this study was done in order to assess platelet-related indices in patients who suffered acute myocardial infarction (MI) and compare them with those who had normal coronary angiography results.In this descriptive-analytical study, 200 patients who were admitted to our university hospital due to chest pain were included. The patients were divided into five groups including ST-segment elevation MI (STEMI), non-STEMI, unstable angina (UA), stable angina (SA), and healthy subjects (as control group). Platelet-related indices including platelet count as well asmean platelet volume (MPV) was determined. For this purpose, blood samples were taken from the patients upon admission and platelet count and volume were measured within three hours of admission.There was no statistically significant difference regarding MPV between the study groups (P&gt; 0.05).</p><p>MPV did not have any role in diagnosing various types of coronary artery disease (CAD).</p>

Emotion Risk-Factor in Patients with Cardiac Diseases: The Role of Cognitive Emotion Regulation Strategies, Positive Affect and Negative Affect (A Case-Control Study)

Application of psychological interventions is essential in classic treatments for patient with cardiac diseases. The present study compared cognitive emotion regulation strategies, positive affect, and negative affect for cardiac patients with healthy subjects. This study was a case-control study. Fifty subjects were selected using convenient sampling method from cardiac (coronary artery disease) patients presenting in Imam Ali medical center of Kermanshah, Iran in the spring 2013. Fifty subjects accompanied the patients to the medical center, selected as control group, did not have any history of cardiac diseases. For collecting data, the cognitive emotion regulation questionnaire and positive and negative affect scales were used. For data analysis, multivariate analysis of variance (MANOVA) was applied using the SPSS statistical software (ver. 19.0). In all cognitive emotion regulation strategies, there was a significant difference between the two groups. A significant difference was also detected regarding positive affect between the two groups, but no significant difference was found regarding negative affect. We found as a result that, having poor emotion regulation strategies is a risk factor for developing heart diseases.

Relationship between family functioning and mental health considering the mediating role of resiliency in type 2 diabetes mellitus patients

This study was aimed at describing the mediating role of resiliency in the relationship between family functioning and mental health in patients with type 2 diabetes mellitus. This descriptive research was a correlational study. A total of 225 individuals were chosen by simple random sampling technique from type 2 diabetic patients presented to diabetes care centers in Kermanshah in 2014 in Iran. The 12-item General Health Questionnaire (GHQ-12), the Family Assessment Device (FAD) and the Resilience Scale (CD-RISC) were used to collect the required data. The collected data were analyzed using the Pearson’s correlation test and to study the mediating role of resiliency in family functioning and mental health interaction, the path analysis method was applied. The results showed that there is a relationship between family functioning, resilience and mental health. Resilience plays a mediating role between family functioning and mental health. Therefore, paying attention to resilience in patients may lead to improving mental health in diabetic patients.