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Dougherty CM, Liberato ACS, Streur MM, Burr RL, Kwan KY, Zheng T, Auld JP, Thompson EA. Physical function, psychological adjustment, and self-efficacy following sudden cardiac arrest and an initial implantable cardioverter defibrillator (ICD) in a social cognitive theory intervention: secondary analysis of a randomized control trial. BMC Cardiovasc Disord 2022; 22:369. [PMID: 35948889 PMCID: PMC9364545 DOI: 10.1186/s12872-022-02782-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 07/19/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Sudden cardiac arrest (SCA) survivorship results in unique issues in return to physical and psychological function. The purpose of the study was to compare recovery across the first year between SCA survivors and other arrhythmia patients who received a first-time implantable cardioverter defibrillator (ICD) for secondary prevention, participating in a social cognitive theory (SCT) intervention. METHODS 168 (129 males, 39 females) who received an ICD for secondary prevention (SCA N = 65; other arrhythmia N = 103) were randomized to one of two study conditions: SCT intervention (N = 85) or usual care (N = 83). Outcomes were measured at baseline hospital discharge, 1, 3, 6, & 12 months: (1) Physical Function: Patient Concerns Assessment (PCA), SF-36 (PCS); (2) Psychological Adjustment: State Trait Anxiety (STAI), CES-D depression, SF-36 (MCS); (3) Self-Efficacy: Self-Efficacy (SCA-SE), Self-management Behaviors (SMB), Outcome Expectations (OE). Outcomes were compared over 12 months for intervention condition x ICD indication using general estimating equations. RESULTS Participants were Caucasian (89%), mean age 63.95 ± 12.3 years, EF% 33.95 ± 13.9, BMI 28.19 ± 6.2, and Charlson Index 4.27 ± 2.3. Physical symptoms (PCA) were higher over time for SCA survivors compared to the other arrhythmia group (p = 0.04), ICD shocks were lower in SCA survivors in the SCT intervention (p = 0.01); psychological adjustment (MCS) was significantly lower in SCA survivors in the SCT intervention over 6 months, which improved at 12 months (p = 0.05); outcome expectations (OE) were significantly lower for SCA survivors in the SCT intervention (p = 0.008). CONCLUSIONS SCA survivors had greater number of physical symptoms, lower levels of mental health and outcome expectations over 12 months despite participation in a SCT intervention. Trial registration Clinicaltrials.gov: NCT04462887.
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Affiliation(s)
- Cynthia M. Dougherty
- School of Nursing, Biobehavioral Nursing and Health Informatics, University of Washington, 1959 NE Pacific Street, Box 357266, Seattle, WA 98195 USA
| | - Ana Carolina Sauer Liberato
- School of Nursing, Biobehavioral Nursing and Health Informatics, University of Washington, 1959 NE Pacific Street, Box 357266, Seattle, WA 98195 USA
- Evidera PPD, London, England, UK
| | - Megan M. Streur
- School of Nursing, Biobehavioral Nursing and Health Informatics, University of Washington, 1959 NE Pacific Street, Box 357266, Seattle, WA 98195 USA
| | - Robert L. Burr
- School of Nursing, Biobehavioral Nursing and Health Informatics, University of Washington, 1959 NE Pacific Street, Box 357266, Seattle, WA 98195 USA
| | - Ka Yee Kwan
- School of Nursing, Biobehavioral Nursing and Health Informatics, University of Washington, 1959 NE Pacific Street, Box 357266, Seattle, WA 98195 USA
| | - Tao Zheng
- School of Nursing, Biobehavioral Nursing and Health Informatics, University of Washington, 1959 NE Pacific Street, Box 357266, Seattle, WA 98195 USA
| | - Jon P. Auld
- School of Nursing, Biobehavioral Nursing and Health Informatics, University of Washington, 1959 NE Pacific Street, Box 357266, Seattle, WA 98195 USA
| | - Elaine A. Thompson
- School of Nursing, Biobehavioral Nursing and Health Informatics, University of Washington, 1959 NE Pacific Street, Box 357266, Seattle, WA 98195 USA
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Liberato ACS, Raitt MH, Zarraga IGE, MacMurdy KS, Dougherty CM. Health-Related Quality of Life in the Spironolactone to Reduce ICD Therapy (SPIRIT) Trial. Clin Nurs Res 2021; 31:588-597. [PMID: 34362264 DOI: 10.1177/10547738211036817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
To describe health related quality of life (HRQOL) and symptoms in the SPIRIT trial and determine effects of implantable cardioverter defibrillator (ICD) shocks on HRQOL over 24 months. Ninety participants aged 66 ± 10 years, 96% men, 75% with NYHA class II, with an ICD were randomized to spironolactone 25 mg (N = 44) or placebo (N = 46). HRQOL was measured every 6 months for 24 months using: Patient Concerns Assessment (PCA), Short Form Health Survey-Veterans Version (SF-36V), and Kansas City Cardiomyopathy Questionnaire (KCCQ). Linear mixed modeling compared changes in HRQOL over-time and ANCOVA compared HRQOL between those getting an ICD shock or not. Over 24-months, there were no differences in HRQOL between the spironolactone versus placebo groups. Those with at least one ICD shock reported significantly lower HRQOL and more symptoms at 6- and 24-months. Patients receiving one or more ICD shocks reported significant reductions in HRQOL and higher symptoms.
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Affiliation(s)
| | - Merritt H Raitt
- VA Portland Health Care System, OR, USA.,Oregon Health and Science University, Portland, USA
| | | | - Karen S MacMurdy
- VA Portland Health Care System, OR, USA.,Oregon Health and Science University, Portland, USA
| | - Cynthia M Dougherty
- University of Washington, Seattle, USA.,VA Puget Sound Health Care System, Seattle, WA, USA
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Liberato ACS, Thompson EA, Dougherty CM. Intervention mediating effects of self-efficacy on patient physical and psychological health following ICD implantation. J Behav Med 2021; 44:842-852. [PMID: 34302228 DOI: 10.1007/s10865-021-00244-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 07/09/2021] [Indexed: 11/28/2022]
Abstract
This study examined mechanisms by which social cognitive theory (SCT) interventions influence health outcomes and the importance of involving partners in recovery following the patients' receipt of an initial implantable cardioverter defibrillator (ICD). We compared direct and indirect intervention effects on patient health outcomes with data from a randomized clinical trial involving two telephone-based interventions delivered during the first 3 months post-ICD implant by experienced trained nurses: P-only conducted only with patients, and P + P conducted with patients and their intimate partners. Each intervention included the patient-focused component. P + P also included a partner-focused intervention component. ICD-specific SCT-derived mediators included self-efficacy expectations, outcome expectations, self-management behavior, and ICD knowledge. Outcomes were assessed at discharge, 3- and 12-months post ICD implant. Patients (N = 301) were primarily Caucasian, male, 64 (± 11.9) years of age with a mean ejection fraction of 34.08 (± 14.3). Intervention effects, mediated through ICD-specific self-efficacy and outcome expectations, were stronger for P + P compared to P-only for physical function (β = 0.04, p = 0.04; β = 0.02, p = 0.04, respectively) and for psychological adjustment (β = 0.06, p = 0.04; β = 0.03, p = 0.04, respectively). SCT interventions show promise for improving ICD patient physical and psychological health outcomes through self-efficacy and outcome expectations. Including partners in post-ICD interventions may potentiate positive outcomes for patients.Trial registration number (TRN): NCT01252615 (Registration date: 12/02/2010).
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Affiliation(s)
- Ana C S Liberato
- Evidera PPD Inc., Patient Centered Research, London, UK.,Department of Biobehavioral Nursing and Health Informatics, University of Washington School of Nursing, 1959 NE Pacific Street, 357266, Seattle, WA, 98195, USA
| | - Elaine A Thompson
- Department of Biobehavioral Nursing and Health Informatics, University of Washington School of Nursing, 1959 NE Pacific Street, 357266, Seattle, WA, 98195, USA
| | - Cynthia M Dougherty
- Department of Biobehavioral Nursing and Health Informatics, University of Washington School of Nursing, 1959 NE Pacific Street, 357266, Seattle, WA, 98195, USA.
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Auld JP, Thompson EA, Dougherty CM. Profiles of partner health linked to a partner-focused intervention following patient initial implantable cardioverter defibrillator (ICD). J Behav Med 2021; 44:630-640. [PMID: 33974172 DOI: 10.1007/s10865-021-00223-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 04/08/2021] [Indexed: 10/21/2022]
Abstract
This study examined differential responses among partners who participated in a RCT designed to compare two social cognitive theory interventions, one designed for patients only (P-only) and one for patients and their intimate partners (P + P). The interventions were delivered following the patient receiving an initial ICD implant. Partner health outcomes were examined longitudinally from baseline at hospital discharge to 3, 6, and 12 months. Outcomes included 6 measures: partner physical and mental health status (Short-Form-36 PCS and MCS), depression (Patient Health Questionnaire-9), anxiety (State-Trait Anxiety Inventory), caregiver burden (Oberst Caregiver Burden Scale), and self-efficacy in ICD management (Sudden Cardiac Arrest Self-efficacy scale). Growth mixture and mixed effect modeling were used to identify and compare trajectories of 6 health outcomes within the P-only and P + P arms of the study. Partners (n = 301) were on average 62 years old, female (74.1%) and Caucasian (83.4%), with few co-morbidities (mean Charlson Co-morbidity index, 0.72 ± 1.1). Two types of profiles were observed for P-only and P + P, one profile where patterns of health outcomes were generally better across 12 months and one with outcome patterns that were generally worse across time. For PCS, no significant partner differences were observed between P-only or P + P in either the better (p = 0.067) or the worse (p = 0.129) profile types. Compared to P-only, partners in the worse profile improved significantly over 12 months in MCS (p = 0.006), caregiver burden P + P (p = 0.004) and self-efficacy P + P (p = 0.041). Compared to P-only, P + P partners in the low anxiety profile improved significantly (p = 0.001) at 3 months. Partners with more psychosocial distress at hospital discharge benefited most from the P + P intervention. Among partners with generally low levels of anxiety, those in the P + P intervention compared to P-only showed greater improvement in anxiety over 12 months.
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Affiliation(s)
- Jonathan P Auld
- School of Nursing, Biobehavioral Nursing and Health Informatics, University of Washington, 1959 NE Pacific Street, HSB T602 Box 357266, Seattle, WA, 98195-7266, USA
| | - Elaine A Thompson
- School of Nursing, Biobehavioral Nursing and Health Informatics, University of Washington, 1959 NE Pacific Street, HSB T602 Box 357266, Seattle, WA, 98195-7266, USA
| | - Cynthia M Dougherty
- School of Nursing, Biobehavioral Nursing and Health Informatics, University of Washington, 1959 NE Pacific Street, HSB T602 Box 357266, Seattle, WA, 98195-7266, USA.
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Brumback LC, Andrews LIB, Jacobs DR, Duprez DA, Shah SJ, Dougherty CM, Denenberg JO, Allison MA. The association between indices of blood pressure waveforms (PTC1 and PTC2) and incident heart failure. J Hypertens 2021; 39:661-666. [PMID: 33239550 PMCID: PMC8177733 DOI: 10.1097/hjh.0000000000002707] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVES The radial artery pulse waveform is a continuous measure of pressure throughout the cardiac cycle, and thus can provide more information than just systolic and diastolic blood pressures. New indices based on a Windkessel model of the waveform, PTC1 and PTC2, are related to arterial compliance and add information for prediction of incident cardiovascular disease (coronary heart disease, stroke, myocardial infarction) but their association with heart failure is unknown. METHODS Among 6229 adults (mean age 62 years) from four race/ethnic groups who were initially free of clinical cardiovascular disease and heart failure in 2000-2002, we evaluated the associations of baseline PTC1 and PTC2 with incident heart failure. RESULTS Mean ± standard deviation PTC1 and PTC2 were 394 ± 334 and 94 ± 46 ms, respectively. During a median of 15.7 years follow-up, there were 357 heart failure events (148 with reduced, 150 with preserved, and 59 with unknown ejection fraction). After adjustment for traditional risk factors, the hazard ratio for heart failure per 1 standard deviation higher PTC2 was 0.73 (95% confidence interval: 0.63--0.85). Higher PTC2 was also significantly associated with lower risk of heart failure with reduced ejection fraction (hazard ratio = 0.67; 95% confidence interval: 0.56--0.80). There was no evidence of a significant association between PTC2 and heart failure with preserved ejection fraction or between PTC1 and heart failure. CONCLUSION The PTC2 measure of the radial artery pulse waveform may represent a novel phenotype related to heart failure, especially heart failure with reduced ejection fraction.
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Affiliation(s)
- Lyndia C Brumback
- Department of Biostatistics, School of Public Health, University of Washington, Seattle, Washington
| | - Leah I B Andrews
- Department of Biostatistics, School of Public Health, University of Washington, Seattle, Washington
| | - David R Jacobs
- Division of Epidemiology and Community Health, School of Public Health, and
| | - Daniel A Duprez
- Cardiovascular Division, Department of Medicine, School of Medicine, University of Minnesota, Minneapolis, Minnesota
| | - Sanjiv J Shah
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Cynthia M Dougherty
- Department of Biobehavioral Nursing and Health Informatics, University of Washington School of Nursing, Department of Medicine, Division of Cardiology, Seattle, Washington
| | - Julie O Denenberg
- Department of Family Medicine and Public Health, University of California San Diego, La Jolla, California
| | - Matthew A Allison
- Department of Family Medicine and Public Health, University of California San Diego, La Jolla, California
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Auld JP, Thompson EA, Dougherty CM. Social cognitive intervention following an initial implantable cardioverter defibrillator: Better treatment response for secondary versus primary prevention. Pacing Clin Electrophysiol 2020; 43:974-982. [PMID: 32364618 DOI: 10.1111/pace.13929] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Revised: 03/18/2020] [Accepted: 04/23/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND The patient + partner (P+P) is a patient/partner-focused social cognitive intervention with demonstrated efficacy to improve outcomes following an initial implantable cardioverter defibrillator (ICD). Little is known about how the patient response may differ by ICD implant indication. The aim of this study was to examine the response to intervention for patients with an initial ICD by reasons for primary versus secondary ICD indication. METHOD A longitudinal secondary analysis of data from a randomized clinical trial testing the P+P intervention examined patient health outcomes over 12 months, stratified by the indication for the ICD: primary prevention without cardiac resynchronization therapy (CRT) (1o No CRT, n = 100), primary prevention with CRT (1o CRT, n = 78), secondary prevention after cardiac arrest (2° Cardiac Arrest, n = 66), and secondary prevention for other arrhythmias (2o Other, n = 57). Outcomes included physical and mental health status (Short-Form-36 Physical Component Summary and Mental Component Summary), physical symptoms (Patient Concerns Assessment), depression (Patient-Health-Questionniare-9), and anxiety (State-Trait Anxiety Inventory). RESULTS Participants (n = 301) were on average 64 years old, primarily male (73.7%) and Caucasian (91%) with reduced ejection fraction (34%). There were no baseline differences between ICD groups for all outcomes (P > .05). Patients in the 2° Cardiac Arrest group showed greater improvement from baseline to 3 months in physical and mental health outcomes. The 2° Cardiac Arrest group had better physical (F = 11.48, P = .004) and mental health (F = 4.34, P = .038) and less severe physical (z = 2.24, P = 0.013) and depressive symptoms (z = 2.71, P = .003) at 12 months compared to the 1o No CRT group. CONCLUSION The P+P intervention was more effective for promoting physical and psychological health outcomes for individuals receiving an ICD for 2o prevention after cardiac arrest.
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Affiliation(s)
- Jonathan P Auld
- School of Nursing, Biobehavioral Nursing and Health Informatics, University of Washington, Seattle, Washington
| | - Elaine A Thompson
- School of Nursing, Psychosocial and Community Health, University of Washington, Seattle, Washington
| | - Cynthia M Dougherty
- School of Nursing, Biobehavioral Nursing and Health Informatics, University of Washington, Seattle, Washington
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Streur MM, Auld JP, Liberato ACS, Beckman JA, Mahr C, Thompson EA, Dougherty CM. Left Ventricular Assist Device Caregiver Experiences and Health Outcomes: A Systematic Review of Qualitative and Quantitative Studies. J Card Fail 2020; 26:713-726. [PMID: 32505816 DOI: 10.1016/j.cardfail.2020.05.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Revised: 05/22/2020] [Accepted: 05/27/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Knowledge synthesis is lacking regarding outcomes and experiences of caregivers of adult patients living with continuous flow left ventricular assist devices (CF-LVAD). The purpose of this systematic review was to summarize qualitative data related to the experience of caregivers of adult patients living with CF-LVAD as well as quantitative data related to health outcomes of caregivers. METHODS AND RESULTS Multiple databases were systematically queried for studies of qualitative experiences and quantitative health outcomes for caregivers of adult CF-LVAD recipients. Search dates were constrained to articles published between 2004 and August of 2018 because CF-LVADs were not routinely implanted before 2004. Two authors independently screened 683 articles; 15 met predetermined inclusion criteria. Eligible articles reported results from 13 studies. Of those, 8 used either qualitative or mixed methods and 5 used quantitative methods. Caregivers were primarily female (81%) and their mean age was 59 years. Qualitative studies revealed 3 overarching themes related to the caregiver role, coping strategies, and LVAD decisions. Quantitative studies revealed caregiver strain peaked between 1 and 3 months after implantation, anxiety and depression were relatively stable, mental health status improved, and physical health status was stable from before to after implantation. CONCLUSIONS CF-LVAD caregivers experience significant, sustained emotional strain for 3 months after implantation, reporting considerable stress in meeting their personal needs and those of their loved one.
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Affiliation(s)
- Megan M Streur
- School of Nursing, Biobehavioral Nursing and Health Informatics, University of Washington, Seattle, Washington.
| | - Jonathan P Auld
- School of Nursing, Biobehavioral Nursing and Health Informatics, University of Washington, Seattle, Washington
| | - Ana Carolina Sauer Liberato
- School of Nursing, Biobehavioral Nursing and Health Informatics, University of Washington, Seattle, Washington
| | - Jennifer A Beckman
- Department of Medicine, Division of Cardiology, University of Washington, Seattle, Washington
| | - Claudius Mahr
- Department of Medicine, Division of Cardiology, University of Washington, Seattle, Washington
| | - Elaine A Thompson
- School of Nursing, Biobehavioral Nursing and Health Informatics, University of Washington, Seattle, Washington
| | - Cynthia M Dougherty
- School of Nursing, Biobehavioral Nursing and Health Informatics, University of Washington, Seattle, Washington
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Affiliation(s)
- Megan M Streur
- 1Department of Biobehavioral Nursing and Health Informatics, School of Nursing, 2Division of Cardiology, Department of Medicine, University of Washington, Seattle, WA, USA
| | - Jennifer A Beckman
- 1Department of Biobehavioral Nursing and Health Informatics, School of Nursing, 2Division of Cardiology, Department of Medicine, University of Washington, Seattle, WA, USA
| | - Cynthia M Dougherty
- 1Department of Biobehavioral Nursing and Health Informatics, School of Nursing, 2Division of Cardiology, Department of Medicine, University of Washington, Seattle, WA, USA
| | - Song Li
- 1Department of Biobehavioral Nursing and Health Informatics, School of Nursing, 2Division of Cardiology, Department of Medicine, University of Washington, Seattle, WA, USA
| | - Claudius Mahr
- 1Department of Biobehavioral Nursing and Health Informatics, School of Nursing, 2Division of Cardiology, Department of Medicine, University of Washington, Seattle, WA, USA
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Sawyer KN, Camp-Rogers TR, Kotini-Shah P, Del Rios M, Gossip MR, Moitra VK, Haywood KL, Dougherty CM, Lubitz SA, Rabinstein AA, Rittenberger JC, Callaway CW, Abella BS, Geocadin RG, Kurz MC. Sudden Cardiac Arrest Survivorship: A Scientific Statement From the American Heart Association. Circulation 2020; 141:e654-e685. [DOI: 10.1161/cir.0000000000000747] [Citation(s) in RCA: 84] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Cardiac arrest systems of care are successfully coordinating community, emergency medical services, and hospital efforts to improve the process of care for patients who have had a cardiac arrest. As a result, the number of people surviving sudden cardiac arrest is increasing. However, physical, cognitive, and emotional effects of surviving cardiac arrest may linger for months or years. Systematic recommendations stop short of addressing partnerships needed to care for patients and caregivers after medical stabilization. This document expands the cardiac arrest resuscitation system of care to include patients, caregivers, and rehabilitative healthcare partnerships, which are central to cardiac arrest survivorship.
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Streur MM, Rosman LA, Sears SF, Steinke EE, Thompson EA, Dougherty CM. Patient and Partner Sexual Concerns During the First Year After an Implantable Cardioverter Defibrillator: A Secondary Analysis of the P+P Randomized Clinical Trial. J Sex Med 2020; 17:892-902. [PMID: 32198104 DOI: 10.1016/j.jsxm.2020.01.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Revised: 01/28/2020] [Accepted: 01/31/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Sexual concerns and changes in sexual activity are common among patients and their intimate partners after an implantable cardioverter defibrillator (ICD). AIMS Our aims were to (i) describe patient and partner sexual activity and related concerns from the time of an initial ICD implant through 12-month follow-up and (ii) identify factors predictive of return to sexual activity and fears associated with sexual activity. METHODS This secondary descriptive analysis was conducted with data from a randomized controlled trial (2009-2015) designed to compare 2 interventions for patients (Patient-Only) and for patients and their partners (Patient+Partner) after implant of an initial ICD. The sample included 105 patients and their intimate partners who reported sexual activity during the 24 months before ICD implant. OUTCOMES The Sexual Concerns Inventory was used to assess sexual activity and related concerns. RESULTS Study participants comprised 72% male and were of mean age 65.6 ± 10.6 years; partners comprised 64% female and were of mean age 63 ± 11.6 years. Sexual activity increased after ICD: 73% of patients reported no sexual intercourse during 2 months before study enrollment, whereas only 46% reported no sexual intercourse during the 2 months before 12-month follow-up. Reductions in sexual concerns were evident 1 month after implant, with continued reductions through 12 months (patient 6.48 ± 4.03 to 5.22 ± 3.38, P = .004; partner 6.93 ± 4.01 to 5.2 ± 3.56, P < .001). Patient physical health predicted sexual activity 3 months after implant placement (P = .04); general ICD concerns (P < .001) predicted patient ICD-related sexual fears at 3 months. At 12 months, baseline general ICD concerns (P < .02) predicted sexual fears. CLINICAL IMPLICATIONS ICD patients and partners report low levels of sexual activity at the time of initial ICD implant, with reported increases in sexual activity over the 12-month recovery period: Sexual concerns were highest immediately after ICD implant. STRENGTHS & LIMITATIONS Notably, the major strengths of this study were the repeated measures and longitudinal study design; the main limitation of the study was the lack of a "usual care" control group. CONCLUSION Sexual activity at the time of an initial ICD implant is low, and sexual concerns are most prominent for both patients and partners immediately after implant placement. Baseline physical health predicts subsequent sexual activity at 3 months, while general ICD-related worry predicts sexual fears at 3 and 12 months. Streur MM, Rosman LA, Sears SF, et al. Patient and Partner Sexual Concerns During the First Year After an Implantable Cardioverter Defibrillator: A Secondary Analysis of the P+P Randomized Clinical Trial. J Sex Med 2020;17:892-902.
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Affiliation(s)
- Megan M Streur
- Department of Biobehavioral Nursing and Health Informatics, School of Nursing, University of Washington, Seattle, WA, USA.
| | - Lindsey A Rosman
- Division of Cardiology, Department of Medicine, School of Medicine, University of North Carolina, Chapel Hill, NC, USA
| | - Samuel F Sears
- Department of Psychology, Department of Cardiovascular Sciences, East Carolina University, Greenville, NC, USA
| | - Elaine E Steinke
- School of Nursing, College of Health Professions, Wichita State University, Wichita, KS, USA
| | - Elaine A Thompson
- Department of Biobehavioral Nursing and Health Informatics, School of Nursing, University of Washington, Seattle, WA, USA
| | - Cynthia M Dougherty
- Department of Biobehavioral Nursing and Health Informatics, School of Nursing, University of Washington, Seattle, WA, USA.
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Streur MM, Thompson EA, Dougherty CM. Multisymptom Profile Predicts Increased Risk of Poor Outcomes After Initial Placement of Implantable Cardioverter Defibrillator. J Pain Symptom Manage 2020; 59:658-667. [PMID: 31707069 PMCID: PMC7024646 DOI: 10.1016/j.jpainsymman.2019.10.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Revised: 10/21/2019] [Accepted: 10/23/2019] [Indexed: 11/30/2022]
Abstract
CONTEXT Patients with implantable cardioverter defibrillators (ICDs) are at risk for multiple physical and psychological symptoms. Identification of specific symptom profiles associated with poor outcomes may elucidate novel strategies to enhance symptom management. OBJECTIVES The objectives were to determine common symptoms after initial ICD implantation, identify classes of individuals with similar symptom profiles, describe patient characteristics associated with different symptom profiles, and determine if symptom profiles at hospital discharge predicted outcomes three and 12 months after implantation. METHODS This was a secondary data analysis of a randomized controlled trial that compared patient + partner versus patient-only interventions designed to help patients manage symptoms, prepare for ICD shocks, and resume daily activities. Symptoms were measured with the Patient Concerns Assessment. Latent class regression analysis was used to identify symptom classes at baseline, three-month, and 12-month follow-up. Associations between patient characteristics, class membership, and outcomes were examined using chi-square, analysis of variance, and Poisson regression. RESULTS The study included 301 patients (74% male, mean age 64 ± 11.9 years). Three classes were identified: Multi-Symptom (N = 119, 40%), Tired-Rundown (N = 130, 43%), and Mostly Asymptomatic (N = 52, 17%). Patients in the Multi-Symptom class were younger (59.9 years, P < 0.001) and reported more anxiety (P < 0.001) and depression (P < 0.01) than the other classes. Membership in the Multi-Symptom class predicted lower quality of life and resulted in nearly double the rate of hospitalizations after 12 months (P = 0.02, IRR 1.9). CONCLUSION Evaluation of symptom profiles after ICD implantation offers a promising strategy for identifying patients at risk for poor health outcomes.
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Affiliation(s)
- Megan M Streur
- Biobehavioral Nursing and Health Informatics, School of Nursing, University of Washington, Seattle, Washington, USA
| | - Elaine A Thompson
- Biobehavioral Nursing and Health Informatics, School of Nursing, University of Washington, Seattle, Washington, USA
| | - Cynthia M Dougherty
- Biobehavioral Nursing and Health Informatics, School of Nursing, University of Washington, Seattle, Washington, USA.
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Dougherty CM, Thompson EA, Kudenchuk PJ. Patient plus partner trial: A randomized controlled trial of 2 interventions to improve outcomes after an initial implantable cardioverter-defibrillator. Heart Rhythm 2018; 16:453-459. [PMID: 30340060 DOI: 10.1016/j.hrthm.2018.10.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Indexed: 11/20/2022]
Abstract
BACKGROUND Interventions to improve physical and psychological outcomes in recipients with an initial implantable cardioverter-defibrillator (ICD) and their intimate partners are largely unstudied, though likely to have a major impact on adjustment to the ICD and general well-being. OBJECTIVE The purpose of this study was to report the primary outcomes of the patient plus partner randomized controlled trial. METHODS In a 2-group (N = 301) prospective randomized controlled trial, we compared 2 social-cognitive-based intervention programs-patient plus partner (P+P) and patient only (P only)-implemented after initial ICD implantation. The patient intervention, consisting of educational materials, nurse-delivered telephone coaching, videotape demonstrations, and access to a nurse via a 24/7 pager, was implemented in both groups. P+P also incorporated partner participation. The primary patient outcomes were symptoms and anxiety at 3 months. Other outcomes were physical function (SF-36 [Short Form 36] and ICD shocks-patient), psychological adjustment (PHQ-9 [Patient Health Questionaire-9]), relationship impact (Dyadic Adjustment Scale and Oberst Caregiving Burden Scale (DAS and OCBS) partner), self-efficacy and knowledge (Sudden Cardiac Arrest-Self Efficacy [SCA-SE], Sudden Cardiac Arrest-Outcomes Expectation [SCA-OE], and Knowledge Self-Assessment [KSA]), and health care utilization (outpatient visits and hospitalizations) at hospital discharge and 1, 3, 6, and 12 months post-ICD implantation. RESULTS For patients, P+P compared with P only was more effective in improving symptoms (P = .02), depression (P = .006), self-efficacy (P = .02), outcome expectations (P = .03), and knowledge (P = .07). For partners, P+P was more effective in improving partner caregiver burden (P = .002), self-efficacy (P = .001), and ICD knowledge (P = .04). CONCLUSION An intervention that integrated the partner into the patient's recovery after an ICD improved outcomes for both. Beyond survival benefits of the ICD, intervention programs designed to address both the patient and their partner living successfully with an ICD are needed and promising.
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Affiliation(s)
- Cynthia M Dougherty
- Department of Biobehavioral Nursing and Health Informatics, University of Washington School of Nursing, Seattle, Washington.
| | - Elaine A Thompson
- Psychosocial and Community Health, University of Washington School of Nursing, Seattle, Washington
| | - Peter J Kudenchuk
- Division of Cardiology, University of Washington School of Medicine, Seattle, Washington
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Kang Y, Steele BG, Burr RL, Dougherty CM. Mortality in Advanced Chronic Obstructive Pulmonary Disease and Heart Failure Following Cardiopulmonary Rehabilitation. Biol Res Nurs 2018; 20:429-439. [PMID: 29706089 PMCID: PMC6346312 DOI: 10.1177/1099800418772346] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Cardiopulmonary rehabilitation (CR) improves physical function and quality of life (QoL) in chronic obstructive pulmonary disease (COPD) and heart failure (HF), but it is unknown if CR improves outcomes in very severe disease. This study's purpose was to describe functional capacity (6-min walk distance [6MWD], steps/day), symptoms (dyspnea, depression), QoL (Short-Form Health Survey-Veterans [SF-36 V]) and cardiopulmonary function ( N-terminal pro-brain natriuretic peptide [NT-proBNP], forced expiratory volume in 1 s [FEV1]), and derive predictors of mortality among patients with severe COPD and HF who participated in CR. METHODS AND RESULTS In this secondary analysis of a randomized controlled trial comparing two CR methods in severe COPD and HF, 90 (COPD = 63, HF = 27) male veterans, mean age 66 ± 9.24 years, 79% Caucasian, and body mass index 31 kg/m2, were followed for 12 months after CR. The COPD group had greater functional decline than the HF group (6MWD, p = .006). Dyspnea was lower ( p = .001) and QoL higher ( p = .006) in the HF group. Mean NT-proBNP was higher in the HF group at all time points. FEV1 improved over 12 months in both groups ( p = .01). Mortality was 8.9%, 16.7%, and 37.8% at 12, 24, and 60 months, respectively. One-year predictors of mortality were baseline total steps (<3,000/day), 6MWD (<229 meters), and NT-proBNP level (>2,000 mg/pg). CONCLUSIONS In very severe COPD and HF, risks of mortality over 12 months can predict patients unlikely to benefit from CR and should be considered at initial referral.
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Affiliation(s)
- Youjeong Kang
- University of Utah School of Nursing, Salt Lake City, UT, USA
| | - Bonnie G. Steele
- Health Services Research and Development, VA Puget Sound Health Care System, Seattle, WA, USA
| | - Robert L. Burr
- Biobehavioral Nursing and Health Informatics, University of Washington School of Nursing, Seattle, WA, USA
| | - Cynthia M. Dougherty
- Health Services Research and Development, VA Puget Sound Health Care System, Seattle, WA, USA
- Biobehavioral Nursing and Health Informatics, University of Washington School of Nursing, Seattle, WA, USA
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Eiser AR, Kirkpatrick JN, Patton KK, McLain E, Dougherty CM, Beattie JM. Putting the “Informed” in the informed consent process for implantable cardioverter-defibrillators: Addressing the needs of the elderly patient. Pacing Clin Electrophysiol 2018; 41:312-320. [DOI: 10.1111/pace.13288] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/14/2017] [Revised: 11/14/2017] [Accepted: 01/15/2018] [Indexed: 12/26/2022]
Affiliation(s)
- Arnold R. Eiser
- Department of Medicine; Drexel University College of Medicine; Philadelphia PA USA
- Leonard Davis Institute; University of Pennsylvania; Philadelphia PA USA
| | - James N. Kirkpatrick
- Division of Cardiology; University of Washington School of Medicine; Seattle WA USA
| | - Kristen K. Patton
- Division of Cardiology; University of Washington School of Medicine; Seattle WA USA
| | - Emily McLain
- Summit Cardiology; Northwest Hospital; Seattle WA USA
| | - Cynthia M. Dougherty
- Research Biobehavioral and Health Systems; University of Washington School of Nursing; Seattle WA USA
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Corwin EJ, Moore SM, Plotsky A, Heitkemper MM, Dorsey SG, Waldrop-Valverde D, Bailey DE, Docherty SL, Whitney JD, Musil CM, Dougherty CM, McCloskey DJ, Austin JK, Grady PA. Feasibility of Combining Common Data Elements Across Studies to Test a Hypothesis. J Nurs Scholarsh 2017; 49:249-258. [PMID: 28231416 DOI: 10.1111/jnu.12287] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/23/2017] [Indexed: 11/28/2022]
Abstract
PURPOSE The purpose of this article is to describe the outcomes of a collaborative initiative to share data across five schools of nursing in order to evaluate the feasibility of collecting common data elements (CDEs) and developing a common data repository to test hypotheses of interest to nursing scientists. This initiative extended work already completed by the National Institute of Nursing Research CDE Working Group that successfully identified CDEs related to symptoms and self-management, with the goal of supporting more complex, reproducible, and patient-focused research. DESIGN Two exemplars describing the group's efforts are presented. The first highlights a pilot study wherein data sets from various studies by the represented schools were collected retrospectively, and merging of the CDEs was attempted. The second exemplar describes the methods and results of an initiative at one school that utilized a prospective design for the collection and merging of CDEs. METHODS Methods for identifying a common symptom to be studied across schools and for collecting the data dictionaries for the related data elements are presented for the first exemplar. The processes for defining and comparing the concepts and acceptable values, and for evaluating the potential to combine and compare the data elements are also described. Presented next are the steps undertaken in the second exemplar to prospectively identify CDEs and establish the data dictionaries. Methods for common measurement and analysis strategies are included. FINDINGS Findings from the first exemplar indicated that without plans in place a priori to ensure the ability to combine and compare data from disparate sources, doing so retrospectively may not be possible, and as a result hypothesis testing across studies may be prohibited. Findings from the second exemplar, however, indicated that a plan developed prospectively to combine and compare data sets is feasible and conducive to merged hypothesis testing. CONCLUSIONS Although challenges exist in combining CDEs across studies into a common data repository, a prospective, well-designed protocol for identifying, coding, and comparing CDEs is feasible and supports the development of a common data repository and the testing of important hypotheses to advance nursing science. CLINICAL RELEVANCE Incorporating CDEs across studies will increase sample size and improve data validity, reliability, transparency, and reproducibility, all of which will increase the scientific rigor of the study and the likelihood of impacting clinical practice and patient care.
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Affiliation(s)
- Elizabeth J Corwin
- Alpha Epsilon, Associate Dean for Research and Professor, Emory University Nell Hodgson Woodruff School of Nursing, Atlanta, GA, USA
| | - Shirley M Moore
- Alpha Mu, Professor, Case Western Reserve University, Bolton School of Nursing, Cleveland, OH, USA
| | - Andrea Plotsky
- Research Informatics Analyst, Emory University Nell Hodgson Woodruff School of Nursing, Atlanta, GA, USA
| | - Margaret M Heitkemper
- Psi-at-Large, Professor, University of Washington School of Nursing, Seattle, WA, USA
| | - Susan G Dorsey
- Pi, Professor, University of Maryland School of Nursing, Baltimore, MD, USA
| | - Drenna Waldrop-Valverde
- Associate Professor, Emory University Nell Hodgson Woodruff School of Nursing, Atlanta, GA, USA
| | - Donald E Bailey
- Beta Epsilon, Associate Professor, Duke University School of Nursing, Durham, NC, USA
| | - Sharron L Docherty
- Beta Epsilon, Associate Professor, Duke University School of Nursing, Durham, NC, USA
| | - Joanne D Whitney
- Psi-at-Large, Professor, University of Washington School of Nursing, Seattle, WA, USA
| | - Carol M Musil
- Alpha Mu, Professor, Case Western Reserve University, Bolton School of Nursing, Cleveland, OH, USA
| | - Cynthia M Dougherty
- Psi-at-Large, Professor, University of Washington School of Nursing, Seattle, WA, USA
| | - Donna J McCloskey
- Clinical Advisor/Contractor, National Institutes of Nursing Research, Washington, DC, USA
| | - Joan K Austin
- Alpha, Consultant, National Institutes of Nursing Research, Washington, DC, USA
| | - Patricia A Grady
- Tau, Director, National Institutes of Nursing Research, Washington, DC, USA
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Abstract
BACKGROUND Lifestyle choices have a significant impact on cardiovascular disease (CVD) risk. Interventions to promote a heart-healthy lifestyle in young adults at long-term high risk for CVD are needed to decrease the burden of CVD. However, few interventions with this purpose have been developed. OBJECTIVE The objective of this study was to examine the effect of a pilot intervention on young adults with a family history of CVD that used 3-generation pedigrees, risk factor information, and counseling on heart disease knowledge, perceived CVD risk, and intention to engage in a heart-healthy lifestyle. METHODS A pretest-posttest design, with within-group analysis, was used to examine the effect of the intervention. Paired t test and Wilcoxon signed rank tests were used to examine the changes in heart disease knowledge, perceived risk, and behavioral intention from baseline to postintervention. The Cohen d was calculated to examine the effect of the intervention on study measures. In addition, Spearman ρ was used to examine the associations between postintervention perceived risk, postintervention behavioral intention, and family history. RESULTS The sample for the pilot study included 15 mostly white and mostly female healthy young adults between the ages of 18 and 25 years. The intervention was effective at increasing CVD knowledge (P = .02) and had a medium effect on perceived risk and intention to engage in a heart-healthy lifestyle (Cohen d, 0.48-0.58). There were significant associations between postintervention perceived risk and postintervention intention to exercise and the participants' family history of coronary heart disease (r = 0.62, P = .014 and r = 0.55, P = .035, respectively). CONCLUSIONS Interventions are needed to increase individuals' awareness of their long-term CVD risk and to improve their ability to make lifestyle changes. Although this intervention was only tested in a small sample, it shows promise to improve heart disease knowledge and perceived lifetime CVD risk and may effect longer-term risk for CVD.
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Affiliation(s)
- Christopher C Imes
- Christopher C. Imes, PhD, RN Assistant Professor, School of Nursing, Department of Acute and Tertiary Care, University of Pittsburgh, Pennsylvania.Cynthia M. Dougherty, PhD, ARNP, FAHA, FAAN Professor, School of Nursing, Department of Biobehavioral Nursing and Health Systems, University of Washington, Seattle, Washington.Frances Marcus Lewis, PhD, FAAN Professor, School of Nursing, Department of Family and Child Nursing, University of Washington, Seattle, Washington.Melissa A. Austin, MS, PhD Professor Emeritus, School of Public Health, Department of Epidemiology, University of Washington, Seattle, Washington
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Doorenbos AZ, Levy WC, Curtis JR, Dougherty CM. An Intervention to Enhance Goals-of-Care Communication Between Heart Failure Patients and Heart Failure Providers. J Pain Symptom Manage 2016; 52:353-60. [PMID: 27401505 PMCID: PMC5545129 DOI: 10.1016/j.jpainsymman.2016.03.018] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2015] [Revised: 03/09/2016] [Accepted: 04/26/2016] [Indexed: 10/21/2022]
Abstract
CONTEXT Heart failure patients contend with a markedly impaired quality of life, experiencing emotional distress and severe physical discomfort that increases in frequency in the last months of life. Improving communication between patients and providers about goals of care has the potential to improve patient-provider communication and patient outcomes. OBJECTIVES To determine the effects of a goals-of-care (GoC) intervention compared to usual care on the number of GoC conversations, quality of communication between patients and providers, referrals to palliative care services and completion of advance care directives. METHODS A two-group randomized study (n = 40/group) compared a GoC intervention to usual care, conducted in an academic heart failure (HF) clinic. The GoC intervention was a previsit patient activation-education, telephone-based intervention delivered by a nurse. The primary outcome of the study was number of GoC conversations between HF patients and HF providers. Secondary outcomes were quality of communication, number of referrals to palliative care, and completion of advance directives. RESULTS Patients averaged 58.15 ± 11.26 years of age, with mean left ventricular ejection fraction = 30.31 ± 9.72% and Seattle Heart Failure Model scores = 95.1 ± 1.60. There was a significant increase in goals-of-care conversations (58% vs. 2.6%, P < 0.001) and quality of end-of-life communication (P = 0.03) in the GoC group compared to usual care after the intervention. There were no differences between groups on the other outcomes. CONCLUSION The GoC intervention resulted in more GoC conversations and higher quality communication between HF patients and providers without increased anxiety or depression. Further studies are needed to assess impact on longer term quality of care and patient outcomes.
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Affiliation(s)
- Ardith Z Doorenbos
- School of Nursing, University of Washington, Seattle, Washington, USA; School of Medicine, University of Washington, Seattle, Washington, USA.
| | - Wayne C Levy
- School of Medicine, University of Washington, Seattle, Washington, USA
| | - J Randall Curtis
- School of Medicine, University of Washington, Seattle, Washington, USA
| | - Cynthia M Dougherty
- School of Nursing, University of Washington, Seattle, Washington, USA; School of Medicine, University of Washington, Seattle, Washington, USA
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18
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Lau ET, Thompson EA, Burr RL, Dougherty CM. Safety and Efficacy of an Early Home-Based Walking Program After Receipt of an Initial Implantable Cardioverter-Defibrillator. Arch Phys Med Rehabil 2016; 97:1228-36. [DOI: 10.1016/j.apmr.2016.02.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2016] [Revised: 02/03/2016] [Accepted: 02/09/2016] [Indexed: 01/06/2023]
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Dougherty CM, Glenny RW, Burr RL, Flo GL, Kudenchuk PJ. Response to Letter Regarding Article, "Prospective Randomized Trial of Moderately Strenuous Aerobic Exercise After an Implantable Cardioverter Defibrillator". Circulation 2016; 132:e381. [PMID: 26667103 DOI: 10.1161/circulationaha.115.018778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Cynthia M Dougherty
- Biobehavioral Nursing and Health Systems University of Washington School of Nursing Seattle, WA Department of Medicine Division of Cardiology University of Washington School of Medicine Seattle, WA
| | - Robb W Glenny
- Departments of Medicine and Physiology and Biophysics Division of Pulmonary and Critical Care University of Washington School of Medicine Seattle, WA
| | - Robert L Burr
- Biobehavioral Nursing and Health Systems University of Washington School of Nursing Seattle, WA
| | - Gayle L Flo
- Mayo Clinic Division of Cardiovascular Diseases Rochester, MN
| | - Peter J Kudenchuk
- Department of Medicine Division of Cardiology University of Washington School of Medicine Seattle, WA
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Dougherty CM, Fairbanks AM, Eaton LH, Morrison ML, Kim MS, Thompson EA. Comparison of patient and partner quality of life and health outcomes in the first year after an implantable cardioverter defibrillator (ICD). J Behav Med 2015; 39:94-106. [PMID: 26345262 DOI: 10.1007/s10865-015-9671-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Accepted: 08/13/2015] [Indexed: 02/04/2023]
Abstract
Recovery following an implantable cardioverter defibrillator (ICD) impacts both the patient and partner, often in divergent ways. Patients may have had a cardiac arrest or cardiac arrhythmias, whereas partners may have to perform CPR and manage the ongoing challenges of heart disease therapy. Currently, support for post-ICD care focuses primarily on restoring patient functioning with few interventions available to partners who serve as primary support. This descriptive study examined and compared patterns of change for both patients and partners during the first year post-ICD implantation. For this longitudinal study, the sample included 42 of 55 (76.4 %) patient-partner dyads who participated in the 'usual care' group of a larger intervention RCT with patients following ICD implant for secondary prevention of cardiac arrest. Measures taken at across five time points (at hospital discharge and at 1, 3, 6 and 12 months follow up) tracked physical function (SF-12 PCS, symptoms); psychological adjustment (SF-12 MCS; State-Trait Anxiety Inventory; CES-D); relationship impact (Family Functioning, DOII; Mutuality and Interpersonal Sensitivity, MIS); and healthcare utilization (ED visits, outpatient visits, hospitalizations). Repeated measures analysis of variance was used to characterize and compare outcome trends for patients and partners across the first 12 months of recovery. Patients were 66.5 ± 11.3 (mean + SD) years old, predominately Caucasian male (91 %), with Charlson co-morbidities of 4.4 ± 2.4. Partners were 62.5 ± 11.1 years old, predominantly female (91 %) with Charlson co-morbidities of 2.9 ± 3.0. Patient versus partner differences were observed in the pattern of physical health (F = 10.8, p < 0.0001); patient physical health improved while partner health showed few changes. For partners compared to patients, anxiety, depression, and illness demands on family functioning tended to be higher. Patient mutuality was stable, while partner mutuality increased steadily (F = 2.5, p = 0.05). Patient sensitivity was highest at discharge and declined; partner sensitivity increased (F = 10.2, p < 0.0001) across the 12-month recovery. Outpatient visits for patients versus partners differed (F = 5.0, p = 0.008) due most likely to the number of required patient ICD visits. Total hospitalizations and ED visits were higher for patients versus partners, but not significantly. The findings highlight the potential reciprocal influences of patient and partner responses to the ICD experience on health outcomes. Warranted are new, sound and feasible strategies to counterbalance partner needs while simultaneously optimizing patient recovery outcomes.
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Affiliation(s)
- Cynthia M Dougherty
- Biobehavioral Nursing and Health Systems, University of Washington School of Nursing, 1959 NE Pacific Street, HSB T615A, Box 357266, Seattle, WA, 98195-7266, USA.
| | | | - Linda H Eaton
- University of Washington School of Nursing, Seattle, WA, USA
| | | | - Mi Sun Kim
- University of Washington School of Nursing, Seattle, WA, USA
| | - Elaine A Thompson
- Psychosocial and Community Health, University of Washington School of Nursing, Seattle, WA, USA
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Dougherty CM, Glenny RW, Burr RL, Flo GL, Kudenchuk PJ. Prospective randomized trial of moderately strenuous aerobic exercise after an implantable cardioverter defibrillator. Circulation 2015; 131:1835-42. [PMID: 25792557 PMCID: PMC4447571 DOI: 10.1161/circulationaha.114.014444] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2014] [Accepted: 03/12/2015] [Indexed: 02/01/2023]
Abstract
BACKGROUND Despite its salutary effects on health, aerobic exercise is often avoided after receipt of an implantable cardioverter defibrillator (ICD) because of fears that exercise may provoke acute arrhythmias. We prospectively evaluated the effects of a home aerobic exercise training and maintenance program (EX) on aerobic performance, ICD shocks, and hospitalizations exclusively in ICD recipients. METHODS AND RESULTS A total of 160 patients (124 men and 36 women) were randomly assigned who had an ICD for primary (43%) or secondary (57%) prevention to EX or usual care (UC). The primary outcome was peak oxygen consumption, measured with cardiopulmonary exercise testing at baseline and 8 and 24 weeks. EX consisted of 8 weeks of home walking for 1 h/d, 5 d/wk at 60% to 80% of heart rate reserve, followed by 16 weeks of maintenance home walking for 150 min/wk. Adherence to EX was determined from exercise logs, ambulatory heart rate recordings of exercise, and weekly telephone contacts. Patients assigned to UC received no exercise directives and were monitored by monthly telephone contact. Adverse events were identified by ICD interrogations, patient reports, and medical charts. ICD recipients averaged 55±12 years and mean ejection fraction of 40.6±15.7; all were taking β-blocker medications. EX significantly increased peak oxygen consumption (EX, 26.7±7.0 mL/kg per minute; UC, 23.9±6.6 mL/kg per minute; P=0.002) at 8 weeks, which persisted during maintenance exercise at 24 weeks (EX, 26.9±7.7 mL/kg per minute; UC, 23.4±6.0 mL/kg per minute; P<0.001). ICD shocks were infrequent (EX=4 versus UC=8), with no differences in hospitalizations or deaths between groups. CONCLUSIONS Prescribed home exercise is safe and significantly improves cardiovascular performance in ICD recipients without causing shocks or hospitalizations. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT00522340.
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Affiliation(s)
- Cynthia M Dougherty
- From Biobehavioral Nursing and Health Systems (C.M.D., R.L.B.), Division of Cardiology, Arrhythmia Services, Department of Medicine (C.M.D., P.J.K.), Division of Pulmonary and Critical Care, Departments of Medicine and Physiology and Biophysics (R.W.G.), University of Washington Seattle; and Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (G.L.F.).
| | - Robb W Glenny
- From Biobehavioral Nursing and Health Systems (C.M.D., R.L.B.), Division of Cardiology, Arrhythmia Services, Department of Medicine (C.M.D., P.J.K.), Division of Pulmonary and Critical Care, Departments of Medicine and Physiology and Biophysics (R.W.G.), University of Washington Seattle; and Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (G.L.F.)
| | - Robert L Burr
- From Biobehavioral Nursing and Health Systems (C.M.D., R.L.B.), Division of Cardiology, Arrhythmia Services, Department of Medicine (C.M.D., P.J.K.), Division of Pulmonary and Critical Care, Departments of Medicine and Physiology and Biophysics (R.W.G.), University of Washington Seattle; and Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (G.L.F.)
| | - Gayle L Flo
- From Biobehavioral Nursing and Health Systems (C.M.D., R.L.B.), Division of Cardiology, Arrhythmia Services, Department of Medicine (C.M.D., P.J.K.), Division of Pulmonary and Critical Care, Departments of Medicine and Physiology and Biophysics (R.W.G.), University of Washington Seattle; and Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (G.L.F.)
| | - Peter J Kudenchuk
- From Biobehavioral Nursing and Health Systems (C.M.D., R.L.B.), Division of Cardiology, Arrhythmia Services, Department of Medicine (C.M.D., P.J.K.), Division of Pulmonary and Critical Care, Departments of Medicine and Physiology and Biophysics (R.W.G.), University of Washington Seattle; and Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (G.L.F.)
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Imes CC, Lewis FM, Austin MA, Dougherty CM. My family medical history and me: feasibility results of a cardiovascular risk reduction intervention. Public Health Nurs 2014; 32:246-55. [PMID: 24840334 DOI: 10.1111/phn.12130] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Evaluate the feasibility and acceptability of a behaviorally focused intervention designed to increase perceived cardiovascular disease (CVD) and coronary heart disease (CHD) risk in young adults with a family history (FH) of CVD/CHD. DESIGN AND SAMPLE Single group, pre-post-test design. Fifteen, mostly female (n = 13, 86.7%), White, young adults (mean age 20.8 years) with a minimum of a high school education with a FH of CVD/CHD. MEASURES Feasibility examined the recruitment strategy, study procedures, appropriateness and quality of the study instruments, and problems that occurred during delivery of the intervention. Acceptability examined participants' engagement in the in person sessions and at home exercises and their feedback about the intervention. INTERVENTION Two, in person sessions provided personalized, tailored messages about 10-year and lifetime CHD risk based on risk factors, FH from a three-generation pedigree, lipid levels, blood pressure, and smoking status, and brief counseling about how to engage in a healthy lifestyle to decrease CVD/CHD risk. RESULTS The intervention was feasible and acceptable. Participants requested more information on healthy food choices, including which foods to avoid and which exercises most improve cardiovascular health. CONCLUSIONS Although requiring refinement, the intervention has potential public health implications and deserves further testing.
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Affiliation(s)
- Christopher C Imes
- Health Promotion and Development, University of Pittsburgh School of Nursing, Pittsburgh, Pennsylvania
| | - Frances M Lewis
- School of Nursing, Family and Child Nursing, University of Washington, Seattle, Washington
| | - Melissa A Austin
- School of Public Health, University of Washington, Seattle, Washington
| | - Cynthia M Dougherty
- School of Nursing, Biobehavioral Nursing and Health Systems, University of Washington, Seattle, Washington
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Steinke EE, Jaarsma T, Barnason SA, Byrne M, Doherty S, Dougherty CM, Fridlund B, Kautz DD, Mårtensson J, Mosack V, Moser DK. Sexual counselling for individuals with cardiovascular disease and their partners: a consensus document from the American Heart Association and the ESC Council on Cardiovascular Nursing and Allied Professions (CCNAP). Eur Heart J 2013; 34:3217-35. [PMID: 23900695 DOI: 10.1093/eurheartj/eht270] [Citation(s) in RCA: 73] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
After a cardiovascular event, patients and their families often cope with numerous changes in their lives, including dealing with consequences of the disease or its treatment on their daily lives and functioning. Coping poorly with both physical and psychological challenges may lead to impaired quality of life. Sexuality is one aspect of quality of life that is important for many patients and partners that may be adversely affected by a cardiac event. The World Health Organization defines sexual health as '… a state of physical, emotional, mental and social well-being in relation to sexuality; it is not merely the absence of disease, dysfunction or infirmity. Sexual health requires a positive and respectful approach to sexuality and sexual relationships, as well as the possibility of having pleasurable and safe sexual experiences ….'(1(p4)) The safety and timing of return to sexual activity after a cardiac event have been well addressed in an American Heart Association scientific statement, and decreased sexual activity among cardiac patients is frequently reported.(2) Rates of erectile dysfunction (ED) among men with cardiovascular disease (CVD) are twice as high as those in the general population, with similar rates of sexual dysfunction in females with CVD.(3) ED and vaginal dryness may also be presenting signs of heart disease and may appear 1-3 years before the onset of angina pectoris. Estimates reflect that only a small percentage of those with sexual dysfunction seek medical care;(4) therefore, routine assessment of sexual problems and sexual counselling may be of benefit as part of effective management by physicians, nurses, and other healthcare providers.
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Flo GL, Glenny RW, Kudenchuk PJ, Dougherty CM. Development and safety of an exercise testing protocol for patients with an implanted cardioverter defibrillator for primary or secondary indication. Cardiopulm Phys Ther J 2012; 23:16-22. [PMID: 22993498 PMCID: PMC3443465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
PURPOSE Performing exercise tests in patients with an implantable cardioverter defibrillator (ICD) presents specific challenges because of susceptibility to ventricular arrhythmias during maximal levels of exertion. The purpose of this paper is to outline the exercise testing protocol from the Anti-Arrhythmic Effects of Exercise after an ICD trial and to report baseline test results and safety outcomes using the protocol. METHODS AND RESULTS Maximal cardiopulmonary exercise testing was performed to assess levels of physical fitness as part of a randomized trial of walking exercise in patients with ICDs. Subjects were randomized after baseline testing to aerobic exercise plus usual care or usual care alone. A modified Balke treadmill exercise test was used and specific ICD programming procedures were implemented to avoid unnecessary shocks, which included programming off ventricular tachycardia (VT) therapies during testing. To date, 161 baseline tests have been performed. One ventricular fibrillation (VF) cardiac arrest occurred following completion of an exercise test and three tests were stopped by the investigators due to nonsustained ventricular tachycardia. Eleven subjects were not able to achieve maximum exercise, defined as reaching an anaerobic threshold (AT) at baseline testing. There have been no deaths as a result of exercise testing. CONCLUSIONS Symptom-limited maximal exercise testing can be performed safely and effectively in patients with ICDs for both primary and secondary prevention indications. Specific strategies for ICD programming and preparation for treating ventricular arrhythmias needs to be in place before exercise testing is performed.
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Affiliation(s)
- Gayle L. Flo
- Biobehavioral Nursing and Health Systems, University of Washington School of Nursing
| | - Robb W. Glenny
- Department of Medicine, Physiology & Biophysics, Division of Pulmonary and Critical Care University of Washington School of Medicine
| | - Peter J. Kudenchuk
- Department of Medicine, Division of Cardiology, Arrhythmia Services, University of Washington School of Medicine
| | - Cynthia M. Dougherty
- Biobehavioral Nursing and Health Systems, University of Washington School of Nursing
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Zarraga IGE, Dougherty CM, MacMurdy KS, Raitt MH. The Effect of Spironolactone on Ventricular Tachyarrhythmias in Patients With Implantable Cardioverter-Defibrillators. Circ Arrhythm Electrophysiol 2012; 5:739-47. [DOI: 10.1161/circep.112.970566] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Ignatius Gerardo E. Zarraga
- From the Division of Cardiology, Portland Veterans Affairs Medical Center and Oregon Health and Science University, Portland, OR (I.G.E.Z., K.S.M., M.H.R.); and Biobehavioral Nursing and Health Systems, University of Washington School of Nursing, Seattle, WA (C.M.D.)
| | - Cynthia M. Dougherty
- From the Division of Cardiology, Portland Veterans Affairs Medical Center and Oregon Health and Science University, Portland, OR (I.G.E.Z., K.S.M., M.H.R.); and Biobehavioral Nursing and Health Systems, University of Washington School of Nursing, Seattle, WA (C.M.D.)
| | - Karen S. MacMurdy
- From the Division of Cardiology, Portland Veterans Affairs Medical Center and Oregon Health and Science University, Portland, OR (I.G.E.Z., K.S.M., M.H.R.); and Biobehavioral Nursing and Health Systems, University of Washington School of Nursing, Seattle, WA (C.M.D.)
| | - Merritt H. Raitt
- From the Division of Cardiology, Portland Veterans Affairs Medical Center and Oregon Health and Science University, Portland, OR (I.G.E.Z., K.S.M., M.H.R.); and Biobehavioral Nursing and Health Systems, University of Washington School of Nursing, Seattle, WA (C.M.D.)
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Nguyen HQ, Steele BG, Dougherty CM, Burr RL. Physical activity patterns of patients with cardiopulmonary illnesses. Arch Phys Med Rehabil 2012; 93:2360-6. [PMID: 22772084 DOI: 10.1016/j.apmr.2012.06.022] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2012] [Revised: 05/29/2012] [Accepted: 06/24/2012] [Indexed: 10/28/2022]
Abstract
OBJECTIVES The aims of this paper were (1) to describe objectively confirmed physical activity patterns across 3 chronic cardiopulmonary conditions, and (2) to examine the relationship between selected physical activity dimensions with disease severity, self-reported physical and emotional functioning, and exercise performance. DESIGN Cross-sectional study. SETTING Participants' home environment. PARTICIPANTS Patients with cardiopulmonary illnesses: chronic obstructive pulmonary disease (COPD) (n=63), heart failure (n=60), and patients with implantable cardioverter defibrillator (n=60). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Seven ambulatory physical activity dimensions (total steps, percent time active, percent time ambulating at low, medium, and high intensity, maximum cadence for 30 continuous minutes, and peak performance) were measured with an accelerometer. RESULTS Subjects with COPD had the lowest amount of ambulatory physical activity compared with subjects with heart failure and cardiac dysrhythmias (all 7 activity dimensions, P<.05); total step counts were: 5319 versus 7464 versus 9570, respectively. Six-minute walk distance was correlated (r=.44-.65, P<.01) with all physical activity dimensions in the COPD sample, the strongest correlations being with total steps and peak performance. In subjects with cardiac impairment, maximal oxygen consumption had only small to moderate correlations with 5 of the physical activity dimensions (r=.22-.40, P<.05). In contrast, correlations between 6-minute walk test distance and physical activity were higher (r=.48-.61, P<.01) albeit in a smaller sample of only patients with heart failure. For all 3 samples, self-reported physical and mental health functioning, age, body mass index, airflow obstruction, and ejection fraction had either relatively small or nonsignificant correlations with physical activity. CONCLUSIONS All 7 dimensions of ambulatory physical activity discriminated between subjects with COPD, heart failure, and cardiac dysrhythmias. Depending on the research or clinical goal, use of 1 dimension, such as total steps, may be sufficient. Although physical activity had high correlations with performance on a 6-minute walk test relative to other variables, accelerometry-based physical activity monitoring provides unique, important information about real-world behavior in patients with cardiopulmonary illness not already captured with existing measures.
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Affiliation(s)
- Huong Q Nguyen
- Department of Biobehavioral Nursing and Health System, University of Washington, Seattle, WA 98195, USA.
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Imes CC, Dougherty CM, Pyper G, Sullivan MD. Descriptive study of partners' experiences of living with severe heart failure. Heart Lung 2011; 40:208-16. [PMID: 21411148 PMCID: PMC3089716 DOI: 10.1016/j.hrtlng.2010.12.007] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2010] [Revised: 12/17/2010] [Accepted: 12/21/2010] [Indexed: 02/07/2023]
Abstract
PURPOSE This qualitative study sought to describe the experiences of living with severe heart failure (HF) from the perspective of the partner. METHODS In-depth, semistructured interviews were conducted with 14 partners of individuals diagnosed with severe HF. Content analysis was performed to derive the main themes and subthemes of responses. RESULTS Three main themes were derived from the data: (1) My Experience of HF in My Loved One, (2) Experience With Healthcare Providers, and the (3) Patient's Experience of HF as Perceived by the Partner. CONCLUSION The severity of the patient's disease limited the partner's lifestyle, resulting in social isolation and difficulties in planning for the future for both the patient and the partner. The partners were unprepared to manage the disease burden at home without consistent information and assistance by healthcare providers. Moreover, end-of-life planning was neither encouraged by healthcare providers nor embraced by patients or partners.
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Affiliation(s)
- Christopher C Imes
- School of Nursing, University of Washington, Seattle, Washington 98195, USA
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Dougherty CM, Glenny RW, Kudenchuk PJ, Malinick TE, Flo GL. Testing an exercise intervention to improve aerobic conditioning and autonomic function after an implantable cardioverter defibrillator (ICD). Pacing Clin Electrophysiol 2010; 33:973-80. [PMID: 20230460 DOI: 10.1111/j.1540-8159.2010.02728.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Implantable cardioverter defibrillators (ICDs) are an increasingly common treatment for survivors of sudden cardiac arrest or others with life-threatening ventricular arrhythmias. Health-care providers are often reluctant to prescribe exercise for this group because of the belief that it will provoke ventricular arrhythmias and cardiac arrest; patients are often afraid to exercise because of concern over receiving an ICD shock. A social cognitive theory-driven exercise intervention aimed at stabilizing cardiac arrhythmias and reducing ICD shocks by increasing parasympathetic autonomic nervous system control is described. METHODS The exercise intervention has two phases that include an 8-week aerobic conditioning component followed by a 16-week exercise maintenance component. The aerobic exercise intervention is expected to have significant impact on cardiopulmonary function, ventricular arrhythmias, cardiac autonomic function, and self-efficacy in persons who have an ICD. The exercise intervention is currently being tested using a randomized clinical trial format, the results of which will be available in 2012. CONCLUSION The exercise after ICD trial is one of the first clinical trials to test the effects of aerobic exercise on cardiopulmonary outcomes after receiving an ICD for primary or secondary prevention of sudden cardiac arrest.
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Affiliation(s)
- Cynthia M Dougherty
- Biobehavioral Nursing and Health Systems, University of Washington School of Nursing, Seattle, Washington, USA.
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Nichol G, Aufderheide TP, Eigel B, Neumar RW, Lurie KG, Bufalino VJ, Callaway CW, Menon V, Bass RR, Abella BS, Sayre M, Dougherty CM, Racht EM, Kleinman ME, O'Connor RE, Reilly JP, Ossmann EW, Peterson E. Regional Systems of Care for Out-of-Hospital Cardiac Arrest. Circulation 2010; 121:709-29. [DOI: 10.1161/cir.0b013e3181cdb7db] [Citation(s) in RCA: 268] [Impact Index Per Article: 19.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Out-of-hospital cardiac arrest continues to be an important public health problem, with large and important regional variations in outcomes. Survival rates vary widely among patients treated with out-of-hospital cardiac arrest by emergency medical services and among patients transported to the hospital after return of spontaneous circulation. Most regions lack a well-coordinated approach to post–cardiac arrest care. Effective hospital-based interventions for out-of-hospital cardiac arrest exist but are used infrequently. Barriers to implementation of these interventions include lack of knowledge, experience, personnel, resources, and infrastructure. A well-defined relationship between an increased volume of patients or procedures and better outcomes among individual providers and hospitals has been observed for several other clinical disorders. Regional systems of care have improved provider experience and patient outcomes for those with ST-elevation myocardial infarction and life-threatening traumatic injury. This statement describes the rationale for regional systems of care for patients resuscitated from cardiac arrest and the preliminary recommended elements of such systems. Many more people could potentially survive out-of-hospital cardiac arrest if regional systems of cardiac resuscitation were established. A national process is necessary to develop and implement evidence-based guidelines for such systems that must include standards for the categorization, verification, and designation of components of such systems. The time to do so is now.
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Dougherty CM, Thompson EA. Intimate partner physical and mental health after sudden cardiac arrest and receipt of an implantable cardioverter defibrillator. Res Nurs Health 2009; 32:432-42. [PMID: 19434648 DOI: 10.1002/nur.20330] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The purpose of this study was to describe the physical and mental health of the intimate partners of persons receiving an implantable cardioverter defibrillator (ICD). A prospective longitudinal repeated measures design was used, with data collected at hospital discharge, and at 1, 3, 6, and 12 months after implantation. Intimate partners' physical health, symptoms, and depression significantly declined over the first year. Although anxiety was significantly reduced over time, it remained elevated in partners after 1 year. The impact of implantation of the ICD on the intimate relationship and care demands was most dramatic at hospital discharge. Health care use was low throughout the year. Intimate partners could benefit from an intervention that would assist in their psychological adjustment and provide strategies for dealing with caregiving demands at home.
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Affiliation(s)
- Cynthia M Dougherty
- Biobehavioral Nursing and Health Systems, School of Nursing, University of Washington, Box 357266, Seattle, WA, USA
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Dougherty CM, Johnston SK, Thompson EA. Reliability and validity of the self-efficacy expectations and outcome expectations after implantable cardioverter defibrillator implantation scales. Appl Nurs Res 2007; 20:116-24. [PMID: 17693214 PMCID: PMC2699595 DOI: 10.1016/j.apnr.2007.04.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
The purpose of this study was to assess the reliability and validity characteristics of two new scales that measure self-efficacy expectations (Self-Efficacy Expectations After Implantable Cardioverter Defibrillator Implantation Scale [SE-ICD]) and outcome expectations (Outcome Expectations After ICD Implantation Scale [OE-ICD]) in survivors (N = 168) of sudden cardiac arrest, all of whom received an ICD. Cronbach's alpha reliability demonstrated good internal consistency (SE-ICD alpha = .93 and OE-ICD alpha = .81). Correlations with other self-efficacy instruments (general self-efficacy and social self-efficacy) were consistently high. The instruments were responsive to change across time with effect sizes of .46 for SE-ICD and .26 for OE-ICD. These reliable, valid, and responsive instruments for measurement of self-efficacy expectations and outcome expectations after an ICD can be used in research and clinical settings.
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Affiliation(s)
- Cynthia M. Dougherty
- Biobehavioral Nursing and Health Systems, University of Washington School of Nursing, Box 357266, Room T608D, Seattle, WA 98195, USA, (206) 221-7927 Phone, (206) 543-4771 FAX, Nurse Practitioner, VA Puget Sound Health Care System, Seattle,
| | | | - Elaine Adams Thompson
- Psychosocial and Community Health, University of Washington School of Nursing, Seattle, WA, USA,
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Abstract
BACKGROUND The purpose of this study was to determine the long-term benefits of participating in a structured, 8-week educational telephone intervention delivered by expert cardiovascular nurses post-ICD. The intervention was aimed to (1) increase physical functioning, (2) increase psychological adjustment, (3) improve self-efficacy in managing the challenges of ICD recovery, and (4) lower levels of health care utilization over usual care in the first 12 months post-ICD. This article reports on the 6- and 12-month outcomes of the nursing intervention trial. METHODS AND RESULTS A two-group (N = 168) randomized control group design was used to evaluate intervention efficacy with persons receiving an ICD for the secondary prevention of sudden cardiac arrest. Measures were obtained at baseline, 6 and 12 months post hospitalization. Outcomes included (1) physical functioning (Patient Concerns Assessment [PCA], Short Form Health Survey [SF-12], ICD shocks), (2) psychological adjustment (State-Trait Anxiety Inventory [STAI], Centers for Epidemiologic Studies-Depression [CES-D], fear of dying), (3) self-efficacy (Sudden Cardiac Arrest-Self-Efficacy [SCA-SE], Sudden Cardiac Arrest-Behavior [SCA-B], Sudden Cardiac Arrest-Knowledge [SCA-K]), and (4) health care utilization (emergency room [ER] visits, outpatient visits, hospitalizations). Using repeated measures ANOVA, the 6- and 12-month benefits of the intervention over usual care were in reductions in physical concerns (P = 0.006), anxiety (P = 0.04), and fear of dying (P = 0.01), with enhanced self-confidence (P = 0.04) and knowledge (P = 0.001) to manage ICD recovery. There were no statistically significant differences between the groups on total outpatient visits, hospitalizations, or ER visits over 12 months. CONCLUSION A structured 8-week post-hospital telephone nursing intervention after an ICD had sustained 12-month improvements on patient concerns, anxiety, fear of dying, self-efficacy, and knowledge. Results may not apply to individuals with congestive heart failure who receive an ICD for primary prevention of sudden cardiac arrest.
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McFall M, Saxon AJ, Thompson CE, Yoshimoto D, Malte C, Straits-Troster K, Kanter E, Zhou XHA, Dougherty CM, Steele B. Improving the rates of quitting smoking for veterans with posttraumatic stress disorder. Am J Psychiatry 2005; 162:1311-9. [PMID: 15994714 DOI: 10.1176/appi.ajp.162.7.1311] [Citation(s) in RCA: 83] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Smoking is highly prevalent and refractory among people with posttraumatic stress disorder (PTSD). This study aimed to improve the rate of quitting smoking for veterans with PTSD by integrating treatment for nicotine dependence into mental health care. METHOD Smokers undergoing treatment for PTSD (N=66) were randomly assigned to 1) tobacco use treatment delivered by mental health providers and integrated with psychiatric care (integrated care) versus 2) cessation treatment delivered separately from PTSD care by smoking-cessation specialists (usual standard of care). Seven-day point prevalence abstinence was the primary outcome, measured at 2, 4, 6, and 9 months after random assignment. Data were analyzed by using a generalized estimating equations approach following the intent-to-treat principle. RESULTS Subjects assigned to integrated care were five times more likely than subjects undergoing the usual standard of care to abstain from smoking across follow-up assessment intervals (odds ratio=5.23). Subjects in the integrated care condition were significantly more likely than subjects in usual standard of care to receive transdermal nicotine and nicotine gum. They also received a greater number of smoking-cessation counseling sessions. Stopping smoking was not associated with worsening symptoms of PTSD or depression. CONCLUSIONS Smoking-cessation interventions can be safely incorporated into routine mental health care for PTSD and are more effective than treatment delivered separately by a specialized smoking-cessation clinic. Integrating cessation treatment into psychiatric care may have the potential for improving smoking quit rates in other populations of chronically mentally ill smokers.
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Affiliation(s)
- Miles McFall
- PTSD Programs (S-116 MHC), VA Puget Sound Health Care System, 1660 S. Columbian Way, Seattle, WA 98108, USA.
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Dougherty CM, Lewis FM, Thompson EA, Baer JD, Kim W. Short-Term Efficacy of a Telephone Intervention by Expert Nurses After An Implantable Cardioverter Defibrillator. Pacing and Clinical Electrophysiology 2004; 27:1594-602. [PMID: 15613121 DOI: 10.1111/j.1540-8159.2004.00691.x] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The ICD is a common therapy for treatment of ventricular arrhythmias and prevention of sudden cardiac death. After ICD therapy, 50% of survivors are known to have significantly elevated anxiety, depression, anger, and fear in getting back to normal physical activities. Despite these problems, few interventions to improve adjustment have been rigorously evaluated within a clinical trial format. This article reports the short-term efficacy of a structured weekly educational telephone intervention (8 weeks) delivered by expert cardiovascular nurses to recipients of an ICD. To test these effects, a two-group (n = 84/group) randomized clinical trial design was used with measures at baseline (hospital discharge), 1 month, and 3 months after ICD therapy. The study sample were first time ICD recipients for secondary prevention of sudden cardiac arrest. Primary outcomes included (1) physical functioning (Patient Concerns Assessment [PCA], Short-Form Health Survey [SF-12], ICD shocks), (2) psychological adjustment (State-Trait Anxiety Inventory [STAI]), Centers for Epidemiologic Studies-Depression (CES-D), (3) knowledge (Sudden Cardiac Arrest [SCA] knowledge assessment), and (4) health care use (emergency room visits, outpatient visits, hospitalizations). The intervention group, as compared to the control group, significantly reduced mean PCA symptoms at 1 month (11.3-8.8 vs 9.7-9.3, respectively, P < 0.02), and reduced state anxiety (36.1-31.9 vs 33.1-33.0, respectively, P < 0.08), and enhanced knowledge (21.8-22.4 vs 21.4-21.7, respectively, P < 0.02) at 3 months. The intervention did not significantly impact short-term health care use. A structured telephone intervention delivered during the first 8 weeks after ICD therapy by expert cardiovascular nurses decreased ICD related physical symptoms and anxiety, and increased SCA knowledge over 3 months.
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MESH Headings
- Adaptation, Psychological
- Aged
- Anxiety/nursing
- Anxiety/psychology
- Death, Sudden, Cardiac/prevention & control
- Defibrillators, Implantable/psychology
- Depression/nursing
- Depression/psychology
- Emergency Service, Hospital/statistics & numerical data
- Female
- Health Knowledge, Attitudes, Practice
- Heart Arrest/nursing
- Heart Arrest/psychology
- Hospitalization/statistics & numerical data
- Humans
- Longitudinal Studies
- Male
- Middle Aged
- Nurse Clinicians
- Outcome and Process Assessment, Health Care
- Patient Education as Topic/methods
- Primary Health Care/statistics & numerical data
- Self Care/psychology
- Sick Role
- Tachycardia, Ventricular/nursing
- Tachycardia, Ventricular/psychology
- Telephone
- Utilization Review
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Affiliation(s)
- Cynthia M Dougherty
- School of Nursing, University of Washington, Seattle, Washington 98195, USA.
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Abstract
BACKGROUND Although implantable cardioverter defibrillator (ICD) therapy has been found to be effective in preventing and treating life-threatening arrhythmias, adjusting to the ICD and resuming a normal lifestyle are often difficult. There are few intervention trials reported in the literature to aid in adjustment after receiving a primary ICD. OBJECTIVE This article describes the content and structure of a nursing intervention program designed to improve physical functioning and psychologic adjustment after ICD implantation. The nursing intervention program was based on social cognitive theory and the data from a previous investigation covering 7 areas of concern after ICD implantation. CONCLUSION Hospital-based education programs begin the process of recovery after ICD implantation, but they must be supplemented with further interventions to return the patient to baseline physical and psychologic functioning. This is a beginning effort in deriving and testing evidence-based intervention programs for patients with an ICD.
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Affiliation(s)
- Cynthia M Dougherty
- Biobehavioral Nursing and Health Systems, University of Washington, School of Nursing, Seattle 98195-7266, USA
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Abstract
PURPOSE There is limited research that describes the experiences of intimate partners of sudden cardiac arrest (SCA) survivors. The purposes of this article are to (1) describe the domains of concern of intimate partners of SCA survivors during the first year after internal cardioverter defibrillator (ICD) implantation and (2) outline strategies used by partners of SCA survivors in dealing with the concerns and demands of recovery in the first year after ICD implantation. METHODS This is a secondary analysis of interview data collected for the primary study "Family Experiences Following Sudden Cardiac Arrest." A grounded theory method was used to identify experiences of SCA survivors and their family members from hospitalization through the first year after ICD implantation. Data were collected from the SCA survivor and one intimate partner at 5 times: hospital discharge, and at 1, 3, 6, and 12 months postdischarge. RESULTS Eight Domains of Concern were identified for intimate partners following SCA and ICD implantation during the first year. These included (1) Care of the survivor, (2) My (partner) self-care, (3) Relationship, (4) ICD, (5) Money, (6) Uncertain future, (7) Health care providers, and (8) Family. Five categories of strategies to deal with the Domains of Concerns were identified (1) Care of the survivor, (2) My (partner) self-care, (3) Relationship, (4) Uncertain future, and (5) Controlling the environment. IMPLICATIONS Nursing intervention programs should include the intimate partner of SCA survivors and contain education and support in the following areas: (1) information on the function of the ICD, (2) normal progression of physical and emotional recovery experiences, (3) safety and maintenance of the ICD, (4) activities of daily living after an ICD, (5) strategies to assist with the survivors care, and (6) strategies to assist with partner self care.
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Affiliation(s)
- Cynthia M Dougherty
- University of Washington School of Nursing, Department of Biobehavioral Nursing & Health Systems, Seattle, Wash 98195, USA.
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Donta ST, Clauw DJ, Engel CC, Guarino P, Peduzzi P, Williams DA, Skinner JS, Barkhuizen A, Taylor T, Kazis LE, Sogg S, Hunt SC, Dougherty CM, Richardson RD, Kunkel C, Rodriguez W, Alicea E, Chiliade P, Ryan M, Gray GC, Lutwick L, Norwood D, Smith S, Everson M, Blackburn W, Martin W, Griffiss JM, Cooper R, Renner E, Schmitt J, McMurtry C, Thakore M, Mori D, Kerns R, Park M, Pullman-Mooar S, Bernstein J, Hershberger P, Salisbury DC, Feussner JR. Cognitive behavioral therapy and aerobic exercise for Gulf War veterans' illnesses: a randomized controlled trial. JAMA 2003; 289:1396-404. [PMID: 12636462 DOI: 10.1001/jama.289.11.1396] [Citation(s) in RCA: 135] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CONTEXT Gulf War veterans' illnesses (GWVI), multisymptom illnesses characterized by persistent pain, fatigue, and cognitive symptoms, have been reported by many Gulf War veterans. There are currently no effective therapies available to treat GWVI. OBJECTIVE To compare the effectiveness of cognitive behavioral therapy (CBT), exercise, and the combination of both for improving physical functioning and reducing the symptoms of GWVI. DESIGN, SETTING, AND PATIENTS Randomized controlled 2 x 2 factorial trial conducted from April 1999 to September 2001 among 1092 Gulf War veterans who reported at least 2 of 3 symptom types (fatigue, pain, and cognitive) for more than 6 months and at the time of screening. Treatment assignment was unmasked except for a masked assessor of study outcomes at each clinical site (18 Department of Veterans Affairs [VA] and 2 Department of Defense [DOD] medical centers). INTERVENTIONS Veterans were randomly assigned to receive usual care (n = 271), consisting of any and all care received from inside or outside the VA or DOD health care systems; CBT plus usual care (n = 286); exercise plus usual care (n = 269); or CBT plus exercise plus usual care (n = 266). Exercise sessions were 60 minutes and CBT sessions were 60 to 90 minutes; both met weekly for 12 weeks. MAIN OUTCOME MEASURES The primary end point was a 7-point or greater increase (improvement) on the Physical Component Summary scale of the Veterans Short Form 36-Item Health Survey at 12 months. Secondary outcomes were standardized measures of pain, fatigue, cognitive symptoms, distress, and mental health functioning. Participants were evaluated at baseline and at 3, 6, and 12 months. RESULTS The percentage of veterans with improvement in physical function at 1 year was 11.5% for usual care, 11.7% for exercise alone, 18.4% for CBT plus exercise, and 18.5% for CBT alone. The adjusted odds ratios (OR) for improvement in exercise, CBT, and exercise plus CBT vs usual care were 1.07 (95% confidence interval [CI], 0.63-1.82), 1.72 (95% CI, 0.91-3.23), and 1.84 (95% CI, 0.95-3.55), respectively. The OR for the overall (marginal) effect of receiving CBT (n = 552) vs no CBT (n = 535) was 1.71 (95% CI, 1.15-2.53) and for exercise (n = 531) vs no exercise (n = 556) was 1.07 (95% CI, 0.76-1.50). For secondary outcomes, exercise alone or in combination with CBT significantly improved fatigue, distress, cognitive symptoms, and mental health functioning, while CBT alone significantly improved cognitive symptoms and mental health functioning. Neither treatment had a significant impact on pain. CONCLUSION Our results suggest that CBT and/or exercise can provide modest relief for some of the symptoms of chronic multisymptom illnesses such as GWVI.
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Abstract
The purposes of this review are to 1) summarize current knowledge regarding the "natural history of recovery" (physical functioning, psychological adjustment, and neurologic impairments) following sudden cardiac arrest and internal cardioverter-defibrillator implantation over the first year; and 2) discuss the implications for the development of nursing intervention programs based on the natural history of recovery. The natural history serves as a basis for understanding the recovery experiences of sudden cardiac arrest survivors as well as determining how intervention programs might help the most.
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Affiliation(s)
- C M Dougherty
- Biobehavioral Nursing and Health Systems, University of Washington, School of Nursing, Seattle, WA 98195, USA
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Spertus JA, Dewhurst TA, Dougherty CM, Nichol P, McDonell M, Bliven B, Fihn SD. Benefits of an "angina clinic" for patients with coronary artery disease: a demonstration of health status measures as markers of health care quality. Am Heart J 2002; 143:145-50. [PMID: 11773925 DOI: 10.1067/mhj.2002.119894] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Our purpose was to determine the efficacy of health status measurement in quantifying improvements in quality of care provided by an "angina clinic." STUDY DESIGN In a pretest-posttest, nonequivalent control group design in the outpatient clinics of a Veterans Affairs Medical Center, 535 patients with coronary disease were followed up, without intervention, for 3 months and were defined as the "usual-care" group. Concurrently, a clinical trial that optimized the antianginal medications of 100 patients with chronic, stable coronary disease was conducted and defined as the "angina clinic" group. The 3-month change in scores for the Seattle Angina Questionnaire, a valid, reliable, and responsive disease-specific health status measure for patients with coronary disease, was used as the main outcome measure. RESULTS After baseline differences between groups were controlled, the "angina clinic" conferred substantial improvement on patient symptom control (3-month benefit in angina frequency +9.4, P <.001; in angina stability +14.7, P <.001), treatment satisfaction (+8.6, P <.001), quality of life (+6.8, P <.001), and physical limitations resulting from coronary disease (+3.6, P =.047). Only the changes in physical limitation were not clinically significant. CONCLUSION Disease-specific health status measures can provide valuable insights into the quality of care associated with innovations in health care delivery. These results suggest that patients in a clinical trial optimizing antianginal medications had greater improvements in symptom control, treatment satisfaction, and quality of life compared with similar patients receiving "usual care" in a general medicine clinic.
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Affiliation(s)
- John A Spertus
- Department of Medicine, Section of Cardiology, Mid America Heart Institute, University of Missouri, Kansas City, Mo 64111, USA.
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Dougherty CM, Johnson-Crowley NR, Lewis FM, Thompson EA. Theoretical development of nursing interventions for sudden cardiac arrest survivors using social cognitive theory. ANS Adv Nurs Sci 2001; 24:78-86. [PMID: 11554535 DOI: 10.1097/00012272-200109000-00009] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This article discusses the theoretical development of a nursing intervention program to enhance recovery over the first year following sudden cardiac arrest. Concepts from social cognitive theory and domains of concern following sudden cardiac arrest underpin a tailored and standardized nursing intervention. The nursing intervention program is designed for delivery by means of telephone and through the mail. Testing of the nursing intervention program is underway using a clinical trial design.
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Affiliation(s)
- C M Dougherty
- Biobehavioral Nursing and Health Systems, University of Washington, School of Nursing, Seattle, USA
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Spertus JA, Dewhurst T, Dougherty CM, Nichol P. Testing the effectiveness of converting patients to long-acting antianginal medications: The Quality of Life in Angina Research Trial (QUART). Am Heart J 2001; 141:550-8. [PMID: 11275919 DOI: 10.1067/mhj.2001.112781] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Our purpose was to test the hypothesis that converting patients with stable angina to long-acting antianginal medications would improve their functional status, symptom control, treatment satisfaction, and quality of life. METHODS AND RESULTS A single-blind randomized trial of 100 patients with stable coronary artery disease was performed in the outpatient clinic of a Veterans Affairs Health System. Outpatients with chronic stable angina taking at least 2 antianginal medications were studied. Patients were randomized to one of two treatments: optimal adjustment of their usual antianginal medications or conversion to solely long-acting medications (long-acting diltiazem +/- nitroglycerin patches +/- atenolol) with subsequent optimization. The primary outcome was the 3-month change in Seattle Angina Questionnaire scores. Although no differences in physical limitation scores were noted, patients randomized to receive long-acting medications had improved symptom control (3-month improvement in anginal stability [19.1 vs 5.6, P =.02] and anginal frequency [17.8 vs 5.5, P =.006]), more treatment satisfaction (3-month improvement of 8.2 vs 3.0, P =.057), and better quality of life (3-month improvement of 11.2 vs 5.6, P =.09) compared with patients whose pretrial medications were optimized. The improvement in symptom control was statistically significant. CONCLUSION Converting patients with chronic, stable angina to long-acting antianginal medications resulted in substantial improvements in symptom control with a trend toward better treatment satisfaction and quality of life.
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Affiliation(s)
- J A Spertus
- Department of Cardiology, University of Missouri-Kansas City School of Medicine, Kansas City, MO 64111, USA.
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Dougherty CM, Spertus JA, Dewhurst TA, Nichol WP. Outpatient nursing case management for cardiovascular disease. Nurs Clin North Am 2000; 35:993-1003. [PMID: 11072284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
Case management has been an effective treatment model for maintaining costs while preserving quality of care for vulnerable populations who are frequent care users. Nursing case management has been effective in improving health outcomes in chronically ill populations. Specifically, nurse practitioner care has been as effective, and in some areas, more effective in managing chronic health problems of patients than care provided by physicians. Cardiovascular disease is a chronic condition, often accompanied by long-term symptoms and disability, that is prevalent in the United States population. Outpatient nursing case management for chronic health problems associated with cardiovascular disease is posited as a model for a heavily used system that maintains quality of care in this group.
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Affiliation(s)
- C M Dougherty
- University of Washington School of Nursing, Seattle, Washington 98195, USA.
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Dougherty CM, Spertus JA, Dewhurst TA, Nichol WP. OUTPATIENT NURSING CASE MANAGEMENT FOR CARDIOVASCULAR DISEASE. Nurs Clin North Am 2000. [DOI: 10.1016/s0029-6465(22)02653-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Dougherty CM, Benoliel JQ, Bellin C. Domains of nursing intervention after sudden cardiac arrest and automatic internal cardioverter defibrillator implantation. Heart Lung 2000. [DOI: 10.1067/mhl.2000.105759] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Dougherty CM, Benoliel JQ, Bellin C. Domains of nursing intervention after sudden cardiac arrest and automatic internal cardioverter defibrillator implantation. Heart Lung 2000; 29:79-86. [PMID: 10739483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
PURPOSE The purpose of the study was to explore individual and family experiences after sudden cardiac arrest and automatic internal cardioverter defibrillator implantation during the first year of recovery. This report specifically addresses the domains of concern expressed and helpful strategies used by participants that are relevant to the development of future intervention programs. DESIGN A grounded theory approach was used to gain an understanding of areas of concern of sudden cardiac arrest survivors and families that could be used when designing future nursing interventions. Semistructured interviews were conducted with both sudden cardiac arrest survivors and 1 family member each at 5 points during the first year of recovery (hospitalization; 1, 3, 6, and 12 months after hospitalization). Participants were asked to identify those specific areas that most concerned them and that they would like assistance with during the first year. A total of 150 interviews were conducted with 176 hours of data generated. SETTING The study focused on 10 northwest urban community medical centers and participants' homes within a 50-mile driving distance from the medical centers. SAMPLE The sample included 15 first-time sudden cardiac arrest survivors (13 men and 2 women) and 1 family member each between the ages of 31 and 72 years. RESULTS Domains of concern identified by participants that can be used to design future nursing intervention programs included preventive care, dealing with automatic internal cardioverter defibrillator shocks, emotional challenges, physical changes, activities of daily living, partner relationships, and dealing with health care providers. Suggestions of helpful strategies used by participants during the first year are outlined. IMPLICATIONS Domains of concern and helpful strategies identified by participants provide a framework for the development and testing of nursing intervention programs to enhance recovery following sudden cardiac arrest for survivors and their families.
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Affiliation(s)
- C M Dougherty
- Veterans Affairs Puget Sound Health Care System, and University of Washington School of Nursing, Seattle, WA 98108-1597, USA
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Affiliation(s)
- C M Dougherty
- VA Puget Sound Health Care System, Seattle, WA 98108-1597, USA
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Dougherty CM, Dewhurst T, Nichol WP, Spertus J. Comparison of three quality of life instruments in stable angina pectoris: Seattle Angina Questionnaire, Short Form Health Survey (SF-36), and Quality of Life Index-Cardiac Version III. J Clin Epidemiol 1998; 51:569-75. [PMID: 9674663 DOI: 10.1016/s0895-4356(98)00028-6] [Citation(s) in RCA: 140] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Three instruments for the assessment of quality of life, the Seattle Angina Questionnaire (SAQ), the Short Form Health Survey (SF-36), and the Quality of Life Index-Cardiac Version III (QLI) were administered to 107 patients with stable angina pectoris in a longitudinal randomized trial comparing the use of alternative anginal medications in the management of chronic stable angina pectoris. This study demonstrated that differences in angina severity as measured by the Canadian Cardiovascular Society Classification (CCSC) were related to each of the SAQ subscales, to selected subscales of the SF-36, but not to the QLI. All quality of life (QOL) instruments demonstrated acceptable test-retest reliability when administered over a 2-week interval. Neither the SF-36 nor the QLI were discriminative of angina severity or sensitive to changes in CCSC angina classification. Both the SAQ and QLI detected changes in heart disease related QOL over time.
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Affiliation(s)
- C M Dougherty
- Puget Sound VA Health Care System, Seattle, Washington 98108-1597, USA
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Abstract
This paper 1) describes what is known about recovery for families of patients who survive sudden cardiac arrest (SCA) and undergo internal cardioverter defibrillator (ICD) implantation, 2) discusses empirical evidence for interventions aimed at affecting recovery following SCA and ICD implantation, 3) presents additional data that suggest interventions for cardiac arrest survivors and their families, and 4) makes recommendations for the development of future intervention programs for SCA survivors and their families. Research supporting the use of educational and support interventions designed for SCA survivors and families is reviewed. Recommendations are made for future design and testing of interventions in the population.
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Affiliation(s)
- C M Dougherty
- Puget Sound VA Medical Center, Seattle, Washington, USA
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Abstract
TOPIC The parameters of the diagnoses decreased cardiac output. PURPOSE To propose an alternative conceptual structure for cardiac output that links conceptual parameters with clinical and hemodynamic data. SOURCE Past discussions and research investigations. CONCLUSION Careful analysis illustrates several diagnoses are contained within cardiac output at differing levels of abstraction. Testing of the model, including linking diagnoses with nursing interventions and outcomes, is suggested.
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Affiliation(s)
- C M Dougherty
- Veterans Administration Puget Sound Medical Center, Seattle, WA, USA
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Abstract
A sample of 21 sudden cardiac arrest (SCA) survivors were interviewed every 48 hours during hospitalization to determine emotional, cognitive, and physiological parameters of recovery. On the average, SCA survivors were not excessively anxious, depressed, angry, or confused during hospitalization, but they did report high levels of denial and uncertainty. The two most predominant cognitive impairments at the time of hospital discharge were loss of short-term memory and construction ability. Both the number of cardiac arrhythmias and the types of interventions used to manage them decreased as hospital discharge approached.
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Affiliation(s)
- C M Dougherty
- Seattle Veterans Administration Medical Center, WA 98108, USA
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