Effect of continuous nursing on angina attack and quality of life in patients with coronary artery disease: A protocol for systematic review and meta-analysis

BACKGROUND

Coronary Artery Disease is an ischemic or necrotic heart disease caused by myocardial hypoxia caused by coronary artery stenosis or occlusion. The main symptoms are heart failure and recurrent angina pectoris. Continuous nursing refers to the nursing mode from in-hospital nursing to out-of-hospital nursing, including guiding patients' follow-up treatment and lifestyle, which can effectively improve the quality of life in patients with Coronary Artery Disease and reduce the number of angina attacks. The study implemented in this program will systematically evaluate the efficacy and safety of continuous nursing intervention on an angina attack and quality of life in Coronary Artery Disease, and provide evidence-based basis for clinical application of continuous nursing intervention in Coronary Artery Disease.

METHOD

The 2 researchers search the databases of China Knowledge Network, VP Information Chinese Journal Service Platform, PubMed, Embase, the Cochrane Library and Web of Science. From the establishment of the database in December 2020, all the randomized controlled trials on continuous nursing intervention for Coronary Artery Disease are collected. The relevant data are extracted and the quality is evaluated. meta-analysis is performed on the included literature using Stata15.0 software.

RESULT

In this study, the efficacy and safety of continuous nursing intervention on Coronary Artery Disease are evaluated by Seattle angina questionnaire and other indicators.

CONCLUSION

This study will provide reliable evidence for the clinical application of nursing intervention in Coronary Artery Disease.

ETHICS AND DISSEMINATION

Private information from individuals will not be published. This systematic review also does not involve endangering participant rights. Ethical approval will not be required. The results may be published in a peer-reviewed journal or disseminated at relevant conferences.

OSF REGISTRATION NUMBER

DOI 10.17605/OSF.IO/7QRKV.

Family nursing with the assistance of network improves clinical outcome and life quality in patients underwent coronary artery bypass grafting: A consolidated standards of reporting trials-compliant randomized controlled trial

BACKGROUND

Family nursing with the assistance of network (FNAN) improves nurses' practice and provides family/community-oriented nursing care. This study aimed to explore the effects of FNAN on the clinical outcome and life quality of coronary atherosclerotic heart disease (CHD) patients underwent coronary artery bypass grafting (CABG).

TRIAL DESIGN

This study is a randomized, placebo-controlled and double-blind trial.

METHODS

One-hundred and twelve patients underwent CABG were randomly divided into control group (CG, routine family nursing care) and experimental group (EG, FNAN) and the allocation ratio was 1:1. The situation of anxiety and depression were analyzed using the Hamilton Anxiety Scale (HAMA) scale and Hamilton Depression Scale (HAMD). Sleep quality was measured by using Pittsburgh Sleep Quality Index (PSQI). Lung function parameters were measured, including minute ventilation (MVV), partial pressure of oxygen (PaO2), partial pressure of arterial carbon dioxide (PaCO2), oxygen saturation measurement by pulse oximetry (SpO2), forced expiratory volume in 1 second (FEV1) and forced vital capacity (FVC). Life quality was measured by using Chronic Obstructive Pulmonary Disease Assessment Test (CAT).

RESULTS

After a 3-month intervention, 10 and 6 patients were lost in the CG and EG groups, respectively. The scores of HAMA, HAMD, PSQI and CAT were reduced in the EG group when compared with the CG group (P < .05). The values of MVV, PaO2, SpO2, FEV1 and FVC in the EG group was higher than those in the CG group whereas the levels of PaCO2 in the EG group was lower than those in the CG group (P < .05). PSQI score had a strong relationship with the values of MVV, PaO2, PaCO2, SpO2, FEV1, and FVC.

CONCLUSION

FNAN improves the clinical outcome and life quality in the patients underwent CABG.

Eight-year post-trial follow-up of health care and long-term care costs of tele-based health coaching

OBJECTIVE

To evaluate the long-term effect of telephone health coaching on health care and long-term care (LTC) costs in type 2 diabetes (T2D) and coronary artery disease (CAD) patients.

DATA SOURCES/STUDY SETTING

Randomized controlled trial (RCT) data were linked to Finnish national health and social care registries and electronic health records (EHR). Post-trial eight-year economic evaluation was conducted.

STUDY DESIGN

A total of 1,535 patients (≥45 years) were randomized to the intervention (n = 1034) and control groups (n = 501). The intervention group received monthly telephone health coaching for 12 months. Usual health care and LTC were provided for both groups.

PRINCIPAL FINDINGS

Intention-to-treat analysis showed no significant change in total health and long-term care costs (intervention effect €1248 [3 percent relative reduction], CI -6347 to 2217) in the intervention compared to the control group. There were also no significant changes among subgroups of patients with T2D or CAD.

CONCLUSIONS

Health coaching had a nonsignificant effect on health care and long-term care costs in the 8-year follow-up among patients with T2D or CAD. More research is needed to study, which patient groups, at which state of the disease trajectory of T2D and cardiovascular disease, would best benefit from health coaching.

Does a Nurse-Led Program of Support and Lifestyle Management for patients with coronary artery disease significantly improve psychological outcomes among the patients?: A meta-analysis

BACKGROUND

Nowadays, secondary prevention of coronary heart disease (CHD) is commonly provided by nurse-coordinated prevention programs (NCPPs). NCPPs were recommended to be incorporated into the healthcare systems by the European Society of Cardiology (ESC) as stated in their 2012 European Guideline. Even if Nurse-Led Programs of Support and Lifestyle Management are beneficial to the patients with CHD, it is not clear whether these programs significantly improve psychological outcomes among the patients. Therefore, in this analysis, we aimed to systematically compare anxiety and depression reported among CHD patients who were assigned to a Nurse-Led Programs of Support and Lifestyle Management versus patients who were assigned to a normal usual care setting.

METHODS

Online databases were searched for English publications assessing anxiety and depression in CHD patients who were assigned to a Nurse Interventional program versus patients who were assigned to a normal usual care setting. This analysis was carried out by RevMan software (version 5.3). For dichotomous data, odds ratios (ORs) and 95% confidence intervals (CIs) were generated whereas for continuous data, weight mean difference (WMDs) and 95% CIs were calculated.

RESULTS

A total number of 3110 patients were analyzed (1526 participants were assigned to the Nurse Interventional group whereas 1584 participants were assigned to the normal usual care group). Patients' enrollment time period varied from the year 2008 to the year 2015. Results of this analysis showed that depression among participants who were assigned to a Nurse-Led Program of Support and Lifestyle Management was not significantly different (OR: 0.90, 95% CI: 0.68-1.20; P = .47) compared to participants who were assigned to the normal usual care setting. When continuous data were used, still no significant difference was observed (WMD: -0.83, 95% CI: -1.68-0.02; P = .06). A similar result was obtained even when anxiety was assessed (WMD: -1.38, 95% CI: -3.21-0.45; P = .14).

CONCLUSIONS

The current analysis did not show any significant improvement in reduction of depression and anxiety among CHD patients who were assigned to a Nurse-Led Program of Support and Lifestyle Management versus those patients who were assigned to a normal usual care setting. Therefore, according to this analysis, even if a Nurse-Led Program of Support and Lifestyle Management might be clinically effective, it does not improve mental well-being in these patients with CHD.

'Who Cares?' The experiences of caregivers of adults living with heart failure, chronic obstructive pulmonary disease and coronary artery disease: a mixed methods systematic review

OBJECTIVE

To assess the experiences of unpaid caregivers providing care to people with heart failure (HF) or chronic obstructive pulmonary disease (COPD) or coronary artery disease (CAD). Design Mixed methods systematic review including qualitative and quantitative studies. Data sources Databases searched: Medline Ebsco, PsycInfo, CINAHL Plus with Full Text, Embase, Web of Science, Ethos: The British Library and ProQuest. Grey literature identified using: Global Dissertations and Theses and Applied Sciences Index and hand searches and citation checking of included references. Search time frame: 1 January 1990 to 30 August 2017.

ELIGIBILITY CRITERIA FOR SELECTING STUDIES

Inclusion was limited to English language studies in unpaid adult caregivers (>18 years), providing care for patients with HF, COPD or CAD. Studies that considered caregivers for any other diagnoses and studies undertaken in low-income and middle-income countries were excluded. Quality assessment of included studies was conducted by two authors.

DATA ANALYSIS/SYNTHESIS

A results-based convergent synthesis was conducted.

RESULTS

Searches returned 8026 titles and abstracts. 54 studies-21 qualitative, 32 quantitative and 1 mixed method were included. This totalled 26 453 caregivers who were primarily female (63%), with median age of 62 years. Narrative synthesis yielded six concepts related to caregiver experience: (1) mental health, (2) caregiver role, (3) lifestyle change, (4) support for caregivers, (5) knowledge and (6) relationships. There was a discordance between paradigms regarding emerging concepts. Four concepts emerged from qualitative papers which were not present in quantitative papers: (1) expert by experience, (2) vigilance, (3) shared care and (4) time.

CONCLUSION

Caregiving is life altering and complex with significant health implications. Health professionals should support caregivers who in turn can facilitate the recipient to manage their long-term condition. Further longitudinal research exploring the evolution of caregiver experiences over time of patients with chronic cardiopulmonary conditions is required.

TRIAL REGISTRATION NUMBER

CRD42016053412.

The criterion-related validity of the Northwick Park Dependency Score as a generic nursing dependency instrument for different rehabilitation patient groups

Objective: To investigate the criterion or concurrent validity of the Northwick Park Dependency Score (NPDS) for determining nursing dependence in different rehabilitation groups, with the Barthel Index (BI) and the Care Dependency Scale (CDS).

Design: Cross-sectional study.

Setting: Centre for Rehabilitation of the University Medical Center Groningen, The Netherlands.

Subjects: Patients after stroke, spinal cord injury, multitrauma, head injury, amputation, rheumatoid arthritis, diabetes mellitus, lung diseases, tuberculosis and coronary artery disease. One hundred and fifty-four patients were included.

Measures: The Northwick Park Dependency Score (NPDS), the Barthel Index (BI) and the Care Dependency Scale (CDS).

Results: The correlation (rho) between the NPDS and the BI for all groups was -0.87; R2=0.76 ( n=154). Per patient group rho varied from -0.70 ( R2=0.49) to -0.93 ( R2=0.86). The overall correlation between the NPDS and CDS was larger than the criterion of rho=0.60 ( r=-0.74; R2=0.55) but was <0.60 in the rheumatoid arthritis and tuberculosis group. The overall correlation between BI and CDS exceeded the criterion ( r=0.75; R2=0.56).

Conclusions: The NPDS is a generic nursing dependency instrument that can be used as a valid measure across various patient groups in rehabilitation.

Women's Social Support and Social Network after Their First Myocardial Infarction; A 4-Year Follow-Up with Focus on Cardiac Rehabilitation

Background: Knowledge about women's recovery following a myocardial infarction (MI) with focus on how their social support and network change over time as a result of participation in a cardiac rehabilitation programme (CRP) is not well established.

Aim: The aim of this study was to describe and compare social support and network changes over a 4-year period in women with a first MI, based on socio-demographic and situational data.

Method: A longitudinal, comparative study with a non-randomised design including pre- and post-tests (1 and 4 years after MI) was carried out in 18 hospitals in Sweden. Consecutively chosen women ( N = 240) answered a questionnaire on the subject of social support and network.

Results: The women who participated in a CRP were mainly dependent upon professional support during the first year after MI ( p < 0.0001), while those who declined to participate in a CRP needed professional support throughout the whole 4-year period ( p = 0.001). Participation in CRP was dependent on the women's age, those under 60 years ( p = 0.050).

Conclusion: There is a need to develop CRPs that are specifically designed for women based on their age and family relationships. Nurses' training programmes should place greater emphasis on cardiac rehabilitation from the perspective of women with focus on professional support.

Effects of a Problem-Based Learning Rehabilitation Programme on Quality of Life in Patients with Coronary Artery Disease

Background: The aim of cardiac rehabilitation (CR) is not only physical improvement but also increased quality of life (QoL). A CR programme based upon problem based learning (PBL) philosophy was developed, to achieve and apply new knowledge related to coronary artery disease (CAD). The aim of this paper was to evaluate the impact of the PBL programme on QoL.

Methods: 207 consecutive patients < 70 years of age with a recent event of CAD were randomised to a PBL group ( n = 104) or a control group ( n = 103). In addition to standard treatment, the PBL patients participated in 13 group sessions during 1 year, where individual learning needs and behavioural changes were focused upon. QoL was measured by the Ladder of Life, Self-Rated Health (SRH), SF 36, and Cardiac Health Profile (CHP).

Results: Significant differences between the groups, favouring the PBL patients, were found by global instruments: more optimistic expectations of the future QoL and a better general condition. No differences were found by SRH, SF 36 or subscales of CHP, but QoL increased in both groups during the year.

Conclusions: The main outcome was that QoL improved in both groups with some effects favouring the PBL programme.

Exploring the Perceptions and Health Behaviours of Patients Following an Elective Ad-hoc Percutaneous Coronary Intervention: A Qualitative Study

RESULTS

Participants expressed uncertainty about their future health and feared disease recurrence, which appeared to provide motivation for adopting a healthier lifestyle. Although two participants voiced the belief that the elective PCI cured their disease, this perception did not appear to influence their engagement in risk reduction behaviours. However, systemfactors such as a lack of information, direction, and/or support from health care providers appeared to play a limiting role in their ability to move forward with lifestyle change.

BACKGROUND

Elective ad-hoc percutaneous coronary interventions (PCIs) are increasingly used to manage the symptoms of coronary artery disease (CAD). However, we have limited understanding of the patients' experiences and health behaviours post-procedure.

PURPOSE

Explore the factors that influence the perceptions and health behaviours of patients after elective ad-hoc PCI.

METHODS

This interpretive descriptive study used purposive sampling to recruit participants (N = 10) aged 44 to 65 years following an elective ad-hoc PCI from a cardiac catheterization laboratory at a tertiary centre in Winnipeg, MB. Participants were interviewed 11 to 35 days following their procedure. Recruitment continued until no new substantive themes emerged. The Health Belief Model provided the frameworkfor developing, exploring, interpreting, and analyzing the data.

PRACTICE IMPLICATIONS

Nurses have a key role in the education of patients and in providingpatient-centred care that supports lifestyle change. Nurses need to develop strategies that decrease barriers to engaging in risk reduction behaviours following elective ad-hoc PCI if patients are to experience improved health and longevity.

Community-based comprehensive lifestyle programs in patients with coronary artery disease: Objectives, design and expected results of Randomized Evaluation of Secondary Prevention by Outpatient Nurse SpEcialists 2 trial (RESPONSE 2)

Patients with coronary artery disease (CAD) are at high risk of recurrent events. A healthy lifestyle can significantly reduce this risk. A previous trial, Randomized Evaluation of Secondary Prevention by Outpatient Nurse SpEcialists (RESPONSE), demonstrated that nurse-coordinated outpatient clinics improve drug treatment of cardiovascular risk factors. However, lifestyle-related risk factors, including smoking, overweight, and physical inactivity, were common and remained largely unchanged at follow-up in most patients (66%). The aim of the current study is to evaluate the impact of 3 community-based lifestyle programs in patients after hospitalization for CAD. We are conducting a multicenter (n = 15), randomized trial that will recruit 800 patients to test the efficacy of up to 3 widely available commercial lifestyle programs, aimed at patients and their partners, on top of usual care. These programs are aimed at smoking cessation (Luchtsignaal(®)), weight loss (Weight Watchers(®)), and improving physical activity (Philips DirectLife(®)).

OUTCOMES

The primary outcome at 12months is the proportion of patients in whom at least 1 lifestyle risk factor is improved without deterioration in any of the other 2, and a relative increase of at least 30% in this proportion is considered clinically relevant.

Care of the Patient Undergoing Radial Approach Heart Catheterization: Implications for Medical-Surgical Nurses

Primary treatment for coronary vascular disease focuses on therapeutic lifestyle changes. However, additional medical management or even coronary intervention may be required. Access sites for catheterization include the brachial, radial, and femoral arteries. As an increasing number of providers implement transradial cardiac catheterization, education for nurses is a priority.

Specialized nursing practice for chronic disease management in the primary care setting: an evidence-based analysis

BACKGROUND

In response to the increasing demand for better chronic disease management and improved health care efficiency in Ontario, nursing roles have expanded in the primary health care setting.

OBJECTIVES

To determine the effectiveness of specialized nurses who have a clinical role in patient care in optimizing chronic disease management among adults in the primary health care setting.

DATA SOURCES AND REVIEW METHODS

A literature search was performed using OVID MEDLINE, OVID MEDLINE In-Process and Other Non-Indexed Citations, OVID EMBASE, EBSCO Cumulative Index to Nursing & Allied Health Literature (CINAHL), the Wiley Cochrane Library, and the Centre for Reviews and Dissemination database. Results were limited to randomized controlled trials and systematic reviews and were divided into 2 models: Model 1 (nurse alone versus physician alone) and Model 2 (nurse and physician versus physician alone). Effectiveness was determined by comparable outcomes between groups in Model 1, or improved outcomes or efficiency in Model 2.

RESULTS

Six studies were included. In Model 1, there were no significant differences in health resource use, disease-specific measures, quality of life, or patient satisfaction. In Model 2, there was a reduction in hospitalizations and improved management of blood pressure and lipids among patients with coronary artery disease. Among patients with diabetes, there was a reduction in hemoglobin A1c but no difference in other disease-specific measures. There was a trend toward improved process measures, including medication prescribing and clinical assessments. Results related to quality of life were inconsistent, but patient satisfaction with the nurse-physician team was improved. Overall, there were more and longer visits to the nurse, and physician workload did not change.

LIMITATIONS

There was heterogeneity across patient populations, and in the titles, roles, and scope of practice of the specialized nurses.

CONCLUSIONS

Specialized nurses with an autonomous role in patient care had comparable outcomes to physicians alone (Model 1) based on moderate quality evidence, with consistent results among a subgroup analysis of patients with diabetes based on low quality evidence. Model 2 showed an overall improvement in appropriate process measures, disease-specific measures, and patient satisfaction based on low to moderate quality evidence. There was low quality evidence that nurses working under Model 2 may reduce hospitalizations for patients with coronary artery disease. The specific role of the nurse in supplementing or substituting physician care was unclear, making it difficult to determine the impact on efficiency.

PLAIN LANGUAGE SUMMARY

Nurses with additional skills, training, or scope of practice may help improve the primary care of patients with chronic diseases. This review found that specialized nurses working on their own could achieve health outcomes that were similar to those of doctors. It also found that specialized nurses who worked with doctors could reduce hospital visits and improve certain patient outcomes related to diabetes, coronary artery disease, or heart failure. Patients who had nurse-led care were more satisfied and tended to receive more tests and medications. It is unclear whether specialized nurses improve quality of life or doctor workload.

Annual review for housebound patients with coronary heart disease

The care of people with long-term conditions is a priority for the NHS. While there are many strategies in place in primary care to support the management of patients with long-term conditions, there is a paucity of services for people who are housebound. Coronary heart disease (CHD) is the most common cause of death in the UK and costs more than £9 billion every year (British Heart Foundation, 2012). This article describes a pilot project set up by a nurse, working under an honourary contract within a general practice. The project's aim was to deliver a service, to housebound patients with CHD, which would provide an annual review of their condition in the home. This pilot provided some justification for the expansion of the service to all housebound patients who have a long-term condition, ensuring that they receive the same equitable assessment, treatment and health promotion advice afforded to those able to come into the practice. Some of the findings from the patient visits are discussed and a case is made for the expansion of the project beyond the pilot.

Internet based vascular risk factor management for patients with clinically manifest vascular disease: randomised controlled trial

OBJECTIVE

To investigate whether an internet based, nurse led vascular risk factor management programme promoting self management on top of usual care is more effective than usual care alone in reducing vascular risk factors in patients with clinically manifest vascular disease.

DESIGN

Prospective randomised controlled trial.

SETTING

Multicentre trial in secondary and tertiary healthcare setting.

PARTICIPANTS

330 patients with a recent clinical manifestation of atherosclerosis in the coronary, cerebral, or peripheral arteries and with at least two treatable risk factors not at goal.

INTERVENTION

Personalised website with an overview and actual status of patients' risk factors and mail communication via the website with a nurse practitioner for 12 months; the intervention combined self management support, monitoring of disease control, and drug treatment.

MAIN OUTCOME MEASURES

The primary endpoint was the relative change in Framingham heart risk score after 1 year. Secondary endpoints were absolute changes in the levels of risk factors and the differences between groups in the change in proportion of patients reaching treatment goals for each risk factor.

RESULTS

Participants' mean age was 59.9 (SD 8.4) years, and most patients (n=246; 75%) were male. After 1 year, the relative change in Framingham heart risk score of the intervention group compared with the usual care group was -14% (95% confidence interval -25% to -2%). At baseline, the Framingham heart risk score was higher in the intervention group than in the usual care group (16.1 (SD 10.6) v 14.0 (10.5)), so the outcome was adjusted for the separate variables of the Framingham heart risk score and for the baseline Framingham heart risk score. This produced a relative change of -12% (-22% to -3%) in Framingham heart risk score for the intervention group compared with the usual care group adjusted for the separate variables of the score and -8% (-18% to 2%) adjusted for the baseline score. Of the individual risk factors, a difference between groups was observed in low density lipoprotein cholesterol (-0.3, -0.5 to -0.1, mmol/L) and smoking (-7.7%, -14.9% to -0.4%). Some other risk factors tended to improve (body mass index, triglycerides, systolic blood pressure, renal function) or tended to worsen (glucose concentration, albuminuria).

CONCLUSION

An internet based, nurse led treatment programme on top of usual care for vascular risk factors had a small effect on lowering vascular risk and on lowering of some vascular risk factors in patients with vascular disease.

TRIAL REGISTRATION

Clinical trials NCT00785031.

Psychosocial predictors of change in quality of life in patients after coronary interventions

OBJECTIVE

Health-related quality of life (HRQOL) after coronary interventions (coronary artery bypass grafting, percutaneous transluminal coronary angioplasty) usually improves in patients, but not in all patients. Some patients actually show a significant decline in HRQOL. Our aim was to explore the potential of psychologic well-being (anxiety, depression), vital exhaustion, Type D personality, and socioeconomic position as predictors of HRQOL in patients with coronary disease.

METHODS

A total of 106 patients scheduled for coronary angiography were interviewed before (baseline) and 12 to 24 months after coronary angiography. Socioeconomic status was evaluated by education. The General Health Questionnaire 28 was used for measuring psychologic well-being (anxiety, depression), the Maastricht interview was used for measuring vital exhaustion, and the Type D questionnaire was used for measuring personality. HRQOL was assessed using the Short Form-36 (physical and mental components) questionnaire. Functional status was assessed with a combination of New York Heart Association and Canadian Cardiovascular Society classifications. Linear regressions were used to analyze data.

RESULTS

A change in physical HRQOL was predicted by baseline psychologic well-being (β = -.39; 95% confidence interval [CI], -1.00 to -.16) and baseline HRQOL (β = -.61; 95% CI, -.83 to -.34). A change in mental HRQOL was predicted by (baseline) psychologic well-being (β = -.37; 95% CI, -.99 to -.09), vital exhaustion (β = -.21; 95% CI, -.69 to -.03), and baseline HRQOL (β = -.76; 95% CI, -1.03 to -.44). Ejection fraction did not significantly predict HRQOL.

CONCLUSION

Psychosocial factors (psychologic well-being, vital exhaustion) seem to be more important predictors of change in HRQOL compared with some objective medical indicators (ejection fraction) among patients with coronary disease.

Integrating telehealth as a strategy for patient management after discharge for cardiac surgery: results of a pilot study

Advances in telecommunication technologies have improved access and availability of telehealth for use in healthcare. In cardiac care, telehealth has predominantly been used to manage patients with heart failure. The use of telehealth as a strategy for patient management after discharge for cardiac surgery can be beneficial in monitoring postoperative status and in the early detection of complications. This article provides an overview of the use of telehealth and telemanagement in cardiac patients and discusses the results of a pilot study as an example of an application of the use of telehealth for elderly cardiac surgery patients at high risk of postoperative complications.

C-reactive protein and cardiovascular disease in people with diabetes: high-sensitivity CRP testing can help assess risk for future cardiovascular disease events in this population

Having both diabetes and an elevated C-reactive protein (CRP) level compounds one's risk of developing cardiovascular disease, for which people with diabetes are at particularly high risk. CRP is both a biomarker for infectious and noninfectious disorders associated with inflammation and a risk factor for such conditions. Many researchers now believe that the protein also plays a role in the disease processes. The American Heart Association and the Centers for Disease Control and Prevention recently defined three cardiovascular risk categories relative to CRP levels. This article reviews the relevant literature and explores how CRP levels can be used in cardiovascular disease risk assessment, prevention, and treatment.

See beyond invasive coronary angiography

Computerized tomography angiography and magnetic resonance angiography are rapidly positioning themselves as the emerging imaging technology for diagnosing coronary artery disease.

Genetic advances in coronary artery disease

Traditionally, many health care providers consider clinical genetics to be a field that only applies to specialists who provide services to individuals with rare single-gene or chromosomal disorders. But this concept is changing rapidly. In the year 2000, nine of the ten leading causes of mortality, including heart disease, have identified genetic components. As patient advocates and health care providers, nurses have a responsibility to become familiar with genetic advances and translate this knowledge into improved individualized care for patients.

Primary care strategies to reduce the risk of coronary heart disease

The prevalence of CHD in the UK is high, with many people suffering related conditions or at high risk of developing problems. Nurses in primary care are ideally placed to target patients for effective interventions to reduce the risks. This paper summarises the recommendations set out in the National Service Framework for Coronary Heart Disease to enable nurses to fulfill this role.

Removal of a femoral sheath following PTCA in cardiac patients

Patients with coronary heart disease may require a percutaneous transluminal coronary angioplasty, involving the use of a balloon catheter to dilate the arteries introduced via a sheath. It is now increasingly common for the removal of the sheath to be a nursing procedure. This paper reviews the literature, best practice, potential complications and post-removal nursing care.

Clinical trial evidence for cardiovascular risk reduction in type 2 diabetes

Major clinical trials have shown that excellent glycemic control, sustained over time, can prevent or delay the microvascular complications of diabetes, including retinopathy, nephropathy, and neuropathy. No prospective trial has clearly shown that glycemic intervention can prevent the macrovascular complications of diabetes, such as myocardial infarction, cerebrovascular accident, and amputation. However, a number of landmark clinical trials have shown the efficacy of control of blood pressure and lipids and use of antiplatelet agents (mainly aspirin) in protecting the macrovasculature of individuals with diabetes. In this article, glycemic, blood pressure, lipid, and antiplatelet trials relevant to the treatment of people with type 2 diabetes are reviewed.

You can do it if you set your mind to it: a qualitative study of patients with coronary artery disease

AIMS OF THE STUDY

To gain increased knowledge and understanding of what it means to be afflicted with coronary artery disease (CAD) and how it affects the life/lifestyle of the individual.

BACKGROUND

Research has documented that education, counselling and behavioural interventions are important elements of cardiac rehabilitation and compliance with treatment. Compliance is generally better with medical treatment than with recommended lifestyle changes. Another influencing aspect is locus of control, i.e. people's own understanding of control is the foundation for the decisions patients make more or less consciously regarding compliance with caring/nursing, treatment and lifestyle changes.

METHODS

Eight individuals with diagnosed coronary artery disease were interviewed about their life situation, and the opportunities and obstacles they encountered in making lifestyle changes. These interviews were transcribed and then analysed using a hermeneutic approach.

FINDINGS

The findings included three areas: (1) The causes of coronary artery disease describing different factors, such as heredity, lifestyle and demands. (2) Difficulties in the work of rehabilitation, which was explained in terms of informants' feelings of confusion, uncertainty and sadness. (3) Successful rehabilitation consisted of two factors: the personality of the individual patient and external support.

CONCLUSIONS

Patients may comply well with follow-up visits but less with lifestyle changes. By identifying different 'characteristics', 'prerequisites' and 'difficulties' that describe patients' compliance, it should be possible to make treatment more individual. Nurses have a significant role in supporting these patients since they are more accessible than physicians. Nurses also have a responsibility to work together with patients to empower them, in order to make their lifestyle changes and self-care activities manageable.

Adherence to cardiac therapy for men with coronary artery disease

A study developed and executed within Orem's (1995) Self-Care Deficit Theory of Nursing uncovered factors that influence men's adherence to cardiac therapy. Data obtained from individual audiotaped interviews with five men 60 to 70 years of age in northwestern Ohio were analyzed using Colaizzi's (1978) method. Specific self-care factors, possessed by all the men and responsible for facilitating and inhibiting adherence to cardiac therapy, were found within the components for self-care agency and basic conditioning factors. Identification of these factors is critical, as the completion of the requirements of the prescribed cardiac therapy regimen can assist persons in achieving maximal cardiac efficiency while promoting independence, which ultimately affects their self-care agency. This study makes valuable contributions by (a) becoming aware of factors that influence men's adherence to cardiac therapy, (b) offering direction for interventions focused on self-care, and (c) serving as an impetus for further research.

Comprehensive versus holistic care. Case studies of chronic disease

Persons with chronic disease often experience an involvement of multiple body systems. A comprehensive care approach to patient care is often used with the belief that a health care team will ensure that a patient's needs will be covered. Instead, this approach is reductionist in practice and leads to fragmentation of care, and the difficult patients often slip through the cracks of the health care system. However, a holistic theory-based approach puts a patient's perceived needs first and offers care not only for the body but also for the human spirit. Two case studies of patients with chronic disease are reviewed, both of whom began in a comprehensive care model and ended up with holistic care. Suggestions for assisting in the movement of a comprehensive care model toward a holistic model are offered for the practicing nurse.

Lasers: applications in cardiovascular atherosclerotic disease

Laser angioplasty is a new, yet experimental intervention in the vascular setting. This technique forces artificially stimulated electrons to generate light energy. This energy can be used to achieve tissue abatement by a variety of mechanisms. Reducing resultant complications from this technique is the goal of current laser research. Techniques like angioscopy, photochemical interaction, pulsing modes, and alternative catheter designs have the common goal of improved tissue abatement, with minimal or the absence of secondary normal tissue injury. This population of patients requires comprehensive nursing care aimed at meeting the patient's nursing diagnoses and collaborative medical problems. In this manner, both the acute needs of the patient during hospitalization and his or her functional needs out of the hospital are identified. A plan of action is then formulated, performed, and evaluated.

[Cardiopathies in the elderly. The diagnostic and treatment problems]

The author presents data obtained by the study of a group of 729 patients aged between 60 and 90 years with regard to cardiopathies. The most frequently encountered diseases were arterial hypertension (35.6%) and atherosclerotic heart disease (49.7%). There were small differences in the number of patients by sex. The more severe aspects were those determined by hypertensive cardiopathy and myocardial infarctions (acute, in antecedents, iterative). Congestive heart disease with failure of the myocardium is frequently associated with atrial fibrillation. Some particularities related to pharmacokinetics (such as reduction of intestinal absorption, slow elimination of drugs, the reduction in the number of active nephrons) make mandatory a different kind of medical treatment, with lower doses of drugs as compared to adults. Particular attention should be given to the risk of dehydration in the aged, to complication determined by digitalic preparation and anticoagulants, to associated affections and to complications of the cardiopathies. A diet with low amounts of sodium, predominantly alkaline, careful hygiene of the patients, correct administration of the drugs, and health education should be permanently considered by the ancillary personnel caring for such patients.