A Survey on Cardiovascular Nursing Occupational Standard: Meeting the Needs of Employers.

Occupational standard is the result of the agreement between relevant stakeholders in the labor market and education on optimal content for a particular occupation. While drafting occupational standard, the primary instrument for researching competencies at a workplace is a survey on occupational standard. This study identifies key competencies, roles, and responsibilities that are deemed necessary by employers of cardiovascular nurses. The survey addressed the responses of 41 organizations from 11 out of 21 counties in Croatia which were represented by the head nurses of cardiology departments in the hospitals. The survey consisted of 24 questions that covered the main responsibilities, competencies, generic skills, and psychometric abilities. Descriptive statistics were used to analyze the data. Conducting diagnostic and therapeutic procedures, health care, education, administration of medications, monitoring, and documentation were listed as the main responsibilities of cardiovascular nurses. The most common skills included assessment, monitoring patient's condition, knowledge of the diagnostic or therapeutic procedures and cardiovascular diseases, interpreting the electrocardiograms, preparing patients for checkups, conducting patient's education, and following practice guidelines. Generic skills included communication and organizational skills, teamwork, and responsibility. Reaction time and attention span were the most assessed psychomotor abilities. Artificial lighting and radiation were the most important environmental risk factors. The most appropriate level of education for cardiovascular nursing was specialist graduate studies. The results of the study could be used to develop occupational standards for cardiovascular nursing and to guide the curriculum for the educational program development.

Mild Depression Predicts Long-Term Mortality After Acute Myocardial Infarction: A 25-Year Follow-Up.

BACKGROUND: Past studies have found that depression is an independent predictor of death in patients after acute myocardial infarction (AMI). Our aim was to investigate whether the adverse effect upon mortality of depression, including mild levels, persisted up to 25 years. METHODS: We used an historical design to study patients who had been consecutively admitted to hospital after transmural AMI during the 1980s and enrolled in an exercise training trial. The Beck Depression Inventory (BDI) was administered to 188 patients in the third week after hospital admission. Scores were trichotomised and classified as low (0-5), mild (6-9) or moderate to severe (≥10) depression. The Australian National Death Index was used to determine mortality status. Cox proportional-hazards modelling was undertaken to determine the relationship between the trichotomised BDI-I scores and all-cause mortality over five time periods up to 25 years. RESULTS: The mean age of patients was 54.15 years. One hundred fourteen (114) (60.4%) had low or no depression, 47 (25.2%) mild depression and 27 (14.3%) moderate to severe depression. The mortality status of 185 (98.4%) patients was established. Depression was a significant predictor of death, independently of age and severity of myocardial infarction, at 5, 10 and 15 years but not at 20 or 25 years. Patients with mild depression had greater mortality than those with low or moderate to severe depression. CONCLUSIONS: Early identification of depression, including milder levels, is important since patients remain at increased risk for many years. They require ongoing monitoring and appropriate treatment.

Depression as a risk factor for poor prognosis among patients with acute coronary syndrome: systematic review and recommendations: a scientific statement from the American Heart Association.

BACKGROUND: Although prospective studies, systematic reviews, and meta-analyses have documented an association between depression and increased morbidity and mortality in a variety of cardiac populations, depression has not yet achieved formal recognition as a risk factor for poor prognosis in patients with acute coronary syndrome by the American Heart Association and other health organizations. The purpose of this scientific statement is to review available evidence and recommend whether depression should be elevated to the status of a risk factor for patients with acute coronary syndrome. METHODS AND RESULTS: Writing group members were approved by the American Heart Association's Scientific Statement and Manuscript Oversight Committees. A systematic literature review on depression and adverse medical outcomes after acute coronary syndrome was conducted that included all-cause mortality, cardiac mortality, and composite outcomes for mortality and nonfatal events. The review assessed the strength, consistency, independence, and generalizability of the published studies. A total of 53 individual studies (32 reported on associations with all-cause mortality, 12 on cardiac mortality, and 22 on composite outcomes) and 4 meta-analyses met inclusion criteria. There was heterogeneity across studies in terms of the demographic composition of study samples, definition and measurement of depression, length of follow-up, and covariates included in the multivariable models. Despite limitations in some individual studies, our review identified generally consistent associations between depression and adverse outcomes. CONCLUSIONS: Despite the heterogeneity of published studies included in this review, the preponderance of evidence supports the recommendation that the American Heart Association should elevate depression to the status of a risk factor for adverse medical outcomes in patients with acute coronary syndrome.

Factors Predicting Dependence on Waterpipe Smoking Among Waterpipe Exclusive Smokers.

ABSTRACT: The current study targeted a sample of waterpipe (WP) exclusive smokers to identify the levels and predictors of dependence on this smoking pattern and to examine the relationship between WP smoking (WPS) dependence and depressive symptoms. A cross-sectional research design was employed with a community sample of 270 subjects who are currently WP exclusive smokers. Assessment of WPS dependence and depressive symptoms was performed using self-report measures. About 62.6% of the subjects were WPS dependent. The unique significant predictors of WPS dependence were age, depression levels, age of starting WPS, duration of WPS, income, smoking WP daily, the belief of being attracted to WPS, and the desire to stop WPS. These predictors explained 35% of the variance in WPS dependence. WPS dependence was associated with increased depressive symptoms. Although few studies have been conducted, the WPS dependence prevalence appears to be alarmingly high among WP exclusive smokers. Factors associated with WPS dependence provide useful information that can be used to tailor WP prevention interventions.

Adequacy of early enteral nutrition in adult patients in the intensive care unit.

AIMS AND OBJECTIVES: To evaluate the adequacy of energy and protein intake of patients in a Korean intensive care unit in the first four days after initiation of enteral feeding and to investigate the factors that had impact on adequate intake. BACKGROUND: Underfeeding is a common problem for patients hospitalised in the intensive care unit and is associated with severe negative consequences, including increased morbidity and mortality. DESIGN: A prospective, cohort study was conducted in a medical intensive care unit of a university hospital in Korea. METHODS: A total of 34 adult patients who had a primary medical diagnosis and who had received bolus enteral nutrition for the first four days after initiation of enteral nutrition were enrolled in this study. The data on prescription and intake of energy and protein, feeding method and feeding interruption were recorded during the first four days after enteral feeding initiation. Underfeeding was defined as the intake <90% of required energy and protein. RESULTS: Most patients (62%) received insufficient energy, although some (29%) received adequate energy. More than half of patients (56%) had insufficient protein intake during the first four days after enteral feeding was initiated. Logistic regression analysis showed that the factors associated with underfeeding of energy were early initiation of enteral nutrition, under-prescription of energy and prolonged interruption of prescribed enteral nutrition. CONCLUSION: Underfeeding is frequent in Korean critically ill patients owing to early initiation, under-prescription and prolonged interruption of enteral feeding. RELEVANCE TO CLINICAL PRACTICE: Interventions need to be developed and tested that address early initiation, under-prescription and prolonged interruption of enteral nutrition. Findings from this study are important as they form the foundation for the development of evidence-based care that is badly needed to eliminate underfeeding in this large vulnerable Korean intensive care unit population.

Factors predicting blood pressure control in older Chinese immigrants to the United States of America.

AIM: This paper is a report of a study of the extent to which demographic characteristics, medication-related factors, hypertension-related knowledge and medication adherence predict systolic and diastolic blood pressure. BACKGROUND: Little is known about predictors of hypertension control in Chinese elders. METHODS: A longitudinal study with a 3-month follow-up was conducted with 90 Chinese immigrants to the United States of America aged ≥65 years and recruited from 2006 to 2007. The independent variables were measured at baseline. Blood pressure was measured at 3 months. Multiple linear regression analysis was used to evaluate the independent effects of seven variables on change in blood pressure at 3 months. RESULTS: Participants ranged in age from 66 to 92 years (Mean 76.7, sd 6.6). The overall regression model for systolic blood pressure was statistically significant (R² = 0.32, F = 4.37, P < 0.01). A higher number of prescribed oral medications (sr² = 0.06, t = 2.42, P = 0.02) and lower medication adherence (sr² = 0.07, t = -2.60, P = 0.01) were statistically significant determinants of an increased systolic blood pressure. The overall regression model for diastolic blood pressure was statistically significant (R² = 0.21, F = 2.39, P = 0.03). Male gender (sr² = 0.06, t = 2.26, P = 0.03) and lower medication adherence (sr² = 0.11, t = -3.03, P < 0.01) were statistically significant determinants of an increased diastolic blood pressure. CONCLUSION: A greater number of prescribed medications and lower adherence predicted higher level of systolic blood pressure. Male gender and lower adherence were significantly associated with higher level of diastolic blood pressure. These predictors should be considered when designing interventions to help Chinese elders achieve better hypertension management.

Frequency of nurses' smoking cessation interventions: report from a national survey.

AIMS AND OBJECTIVES: To describe the frequency of nurses' delivery of tobacco cessation interventions ('Five A's': Ask, Advise, Assess, Assist, Arrange) and to determine the relationship of interventions to nurses' awareness of the Tobacco Free Nurses initiative. BACKGROUND: Tobacco cessation interventions can be effectively provided by nurses. The delivery of smoking cessation interventions by healthcare providers is mandated by several organisations in the USA and around the world. Lack of education and resources about tobacco cessation may contribute to the minimal level of interventions. The Tobacco Free Nurses initiative was developed to provide nurses with easy access to web-based resources about tobacco control. DESIGN: Cross-sectional survey of nurses (n = 3482) working in 35 Magnet-designated hospitals in the USA (21% response rate). METHOD: A valid and reliable questionnaire used in previous studies to assess the frequency of the nurse's delivery of smoking cessation interventions ('Five A's') was adapted for use on the web. RESULTS: The majority of nurses asked (73%) and assisted (73%) with cessation. However, only 24% recommended pharmacotherapy. Only 22% referred to community resources and only 10% recommended use of the quitline. Nurses familiar with TFN (15%) were significantly more likely to report delivery of all aspects of interventions, including assisting with cessation (OR = 1.55, 95% CI 1.27, 1.90) and recommending medications (OR = 1.81, 95% CI 1.45, 2.24). CONCLUSIONS: Nurses' delivery of comprehensive smoking cessation interventions was suboptimal. Awareness of Tobacco Free Nurses was associated with increased interventions. Relevance to clinical practice. Further efforts are needed to ensure that nurses incorporate evidence-based interventions into clinical practice to help smokers quit. These findings support the value of Tobacco Free Nurses in providing nurses with information to support patients' quit attempts.

Characteristics of nurses who used the Internet-based nurses QuitNet for smoking cessation.

BACKGROUND: Smoking among nurses is higher than other health care professionals but nurse-specific cessation programs are limited. Nurses QuitNet, launched in January 2004, provided an evidence-based online smoking cessation program for nurses and nursing students. OBJECTIVES: To describe Nurses QuitNet registrants and relationships among the demographic and smoking characteristics, program dissemination strategies, and site utilization patterns. DESIGN: Cross-sectional study. SAMPLE: 1,790 Nurses QuitNets registrants. MEASUREMENTS: Demographics and smoking characteristics on the Nurses QuitNet intake questionnaire. RESULTS: Most registrants were female (92.5%), 45-54 years old (34.3%), Caucasian (84.5%), and college graduates (57.5%). Over 68% smoked 10-20 cigarettes/day; 66.4% smoked within 30 min of waking. Half of those with previous quit attempts did not use evidence-based methods; 30% had not made a quit attempt in the past year. "Read-only" social support was the most frequently used Nurses Quitnet feature. CONCLUSIONS: The Internet can be a viable option to support nurses' cessation and is available to accommodate their work schedules. The sample is similar to the general nursing population, except for higher levels of education. Efforts are needed to assist nurses struggling with nicotine addiction and disseminate cessation resources, particularly targeting nurses with the highest prevalence of current smoking, for example licensed practical nurses.

Cardiovascular risk factors among career firefighters.

Sudden cardiac death is the leading cause of on-duty death among firefighters. Determining firefighters' risk of cardiovascular death or all-cause mortality, cardiovascular risk factor profiles, and energy demands while firefighting may aid in understanding why this occupational group is at risk for on-duty sudden cardiac death. A literature review conducted between 2006 and 2009 did not demonstrate that firefighters are at increased risk of all-cause death compared to the general population. In addition, cardiovascular risk profiles of firefighters are similar to those of the general population. Firefighters may be part of the national obesity epidemic; their hypertension and hypercholesteremia often are not diagnosed or are undertreated. The combination of personal cardiovascular risk factors and extreme physical work demands may contribute to sudden cardiac death in this population.

The Women's Initiative for Nonsmoking (WINS) XI: age-related differences in smoking cessation responses among women with cardiovascular disease.

Smoking cessation has immediate health benefits; however, the efficacy of smoking cessation interventions among older adults and women has received limited research attention. The original Women's Initiative for Nonsmoking (WINS) study was a randomized controlled trial that tested the efficacy of a smoking cessation intervention for Bay Area women hospitalized with cardiovascular disease. The current study, which used the WINS dataset, compares participants 62 and older with those younger than 62 years. The sample (n=277) contained 136 older smokers and 141 younger smokers. At the 6-month follow-up, 52.1% of older smokers had quit smoking compared with 40.6% of younger smokers. At the 12-month follow-up, 52.0% of older smokers had quit smoking compared with 38.1% of younger smokers. The difference at 12 months was statistically significant, and a Kaplan-Meier survival analysis further supported these findings. Clinicians should be sure to also include older smokers in smoking assessments and smoking cessation interventions.

Self-care behaviors in indigent patients with heart failure.

BACKGROUND: Self-care has been shown to be an effective strategy to decrease heart failure (HF) costs and improve patient outcomes. However, high symptom burden, overall poor health, and economic and financial concerns in socioeconomically disadvantaged populations such as those of low socioeconomic status and those who are indigent or uninsured may have difficulty performing self-care behaviors. Currently, little is known about this group and their self-care behaviors. Therefore, the purpose of this study was to describe the demographic and clinical characteristics of indigent HF patients and their performance of self-care behaviors and explore the challenges and barriers they face in managing their HF. SUBJECT AND METHODS: This was a descriptive, cross-sectional study using one-time structured interviews. Participants with HF were recruited from 3 cardiology clinics and 1 hospital. The patients were asked to answer questions regarding demographics and clinical risk factors, the Self-care of Heart Failure Index, and 3 open-ended questions regarding the challenges and barriers of managing their HF. RESULTS: The sample (N = 65) was composed of 55% women, with a mean (SD) age of 59 (14), 35% were nonwhite, 86% were unemployed, and 52% were indigent. Major concerns included increasing symptoms, fear of death, lack of information, and financial challenges. Self-care was low. CONCLUSION: Patients with low socioeconomic status and indigent HF patients face unique challenges that contribute to poor self-care. Future research is needed to explore ways to improve self-care behaviors in this population.

Hypertension control, predictors for medication adherence and gender differences in older Chinese immigrants.

AIM: This paper is a report of a study to explore the relationship between demographic and cultural factors and antihypertensive medication adherence in older Chinese immigrants. BACKGROUND: Hypertension is a well-known controllable risk factor for cardiovascular diseases worldwide, but only 20-80% of patients who take antihypertensive medications adhere adequately to their treatment regimen. METHODS: A cross-sectional study was conducted between 2002 and 2003, with a convenience sample of 75 older men and 69 older women (n = 144, response rate 80%). Medication adherence was defined as > or =80% of the total score on the Morisky scale. FINDINGS: Age (75.2 +/- 5.7 vs. 75.9 +/- 7.0 years, P = 0.51) and length of stay in the United States of America (12.7 +/- 6.4 vs. 12.7 +/- 6.6 years, P = 0.97) were similar for men and women. More men were married (85% vs. 46%, P < 0.01). A smaller proportion of men were poor (39% vs. 65%, P < 0.01), believed in religion (49% vs. 70%, P = 0.01), and could speak no English (32% vs. 57%, P < 0.01). Fewer men used Chinese herbs to treat hypertension (4% vs.13%). Hypertension control was low for men and women (53% and 48%, P = 0.51). Adherence in men and women was 69% and 75% (P = 0.42) respectively. For men, shorter length of stay in the United States of America was negatively associated with non-adherence (OR = 0.16; 95% CI: 0.05, 0.57). No association between length of stay and non-adherence was found for women. CONCLUSION: More research, including gender-specific studies, is needed to understand better how to develop an effective and culturally sensitive strategy to help older Chinese immigrants manage their hypertension.

Jordanian nursing students' knowledge of osteoporosis.

The aim of this study was to explore baccalaureate nursing students' knowledge of osteoporosis for beginning practice in the community. A cross-sectional study design was used. Students were selected by convenience sampling (n = 85) from one University in Jordan in the final of 4 years. Students were asked to complete a 23-item-knowledge questionnaire based on two earlier published studies of osteoporosis. Results indicated poor level of knowledge of osteoporosis on all dimensions: prevention (11 items) 62.6%; SD 14.2; general (5 items) 59.5%; SD 20.6; and the pathophysiology (7 items) 39.6%; SD 15.6, and an overall mean grade of 54.9%; SD 10.3. This result provides information that graduating nursing students have limited knowledge to undertake the role of health promotion and disease prevention in the community.

Conceptualizing physical activity behavior of older Korean-Americans: an integration of Korean culture and social cognitive theory.

People can live longer and healthier lives by engaging in physical activity (PA). The purpose of this article is to assess the social cognitive theory (SCT) in relation to its relevance to produce cultural-specific directions for gerontological nursing practice in order to guide the design of PA interventions for Korean-American elders. SCT is compared to the Korean cultural, social, and health belief system and is analyzed and evaluated based on 3 criteria: assumptions of the theory, completeness and consistency, and essence of nursing. Within the Korean culture, as presumed in the SCT and the nursing paradigm, health-promoting behavior, such as PA, is conceptualized as the desire for a higher level of health rather than a fear of disease as is proposed by other health behavior theories. SCT with the integration of Korean culture recognizes cultural, developmental, societal, and other external constraints that may help in formulating interventions and better understanding of the limits faced by older Korean-Americans (OKAs) in their pursuit of routine PA.

Awareness and behavior about Pap smear testing in family medicine practice.

OBJECTIVE: To describe and estimate the effect of 5 socio-demographic variables and insurance status on awareness of pap smear, and the influence of sociodemographic characteristics, health insurance and knowledge score on having a pap smear test. METHODS: This is a cross-sectional study of 674 female patients, aged 17 years and above between October and December 2006, and attending family medicine clinics at Jordan University Hospital, Amman, Jordan. We collected data on socio-demographic factors, future intention to take the test and barriers to screening. RESULTS: Of 674 patients, 68.1% were aware of the Pap smear as a medical test. Of married women, 40.3% had a screening history. Women who were aware of the test were more likely to be <35 years of age, married, and have higher than secondary education. Women who have had a Pap test were younger and had higher knowledge scores of the Pap smear. The physicians were the main source of information regarding awareness and having the test. Female physicians, particularly gynecologists, were preferred to perform the Pap smear. Fear of the procedure and the results of the test were the major obstacles to having the test. CONCLUSION: There is an imminent need for an awareness campaign; a simple 5-item knowledge test can identify a group of women, who can most benefit from targeted interventions.

Prevalence of dyslipidemia in patients with type 2 diabetes in Jordan.

OBJECTIVE: To determine the frequency and patterns of dyslipidemia in patients with type 2 diabetes mellitus (DM) and to estimate the effects of sociodemographic and clinical variables on dyslipidemia. METHODS: The setting took place in The National Center for Diabetes, Endocrinology and Genetics (NCDEG) at the University of Jordan, Amman, Jordan. The NCDEG is the only referral center in the country; therefore, the patients represent the population in different parts of the country. A cross-sectional design was used. A total of 702 patients with DM from the NCDEG aged > or =20 years were consecutively enrolled between June 2005 and July 2006. Medical record abstraction of sociodemographic, clinical, and laboratory data was performed. RESULTS: The frequency of hypercholesterolemia was 77.2%, low high-density lipoprotein (HDL) was 83.9%, high low-density lipoprotein (LDL) was 91.5%, and hypertriglyceridemia was 83.1%. Females had greater abnormalities in lipid profiles. High LDL-cholesterol was the most common dyslipidemia in combination (91.5%) and in isolation (12.8%). Gender and hemoglobin A1C (HbA1c) predicted high total cholesterol; age and hypothyroidism predicted low HDL-cholesterol, gender predicted high LDL-cholesterol; and use of beta-blockers predicted high triglycerides. CONCLUSION: Over 90% of patients with type 2 DM had one or more types of dyslipidemia. The most common dyslipidemia in our study was high LDL-cholesterol and high triglycerides as reported in the literature. We recommend aggressive drug management, education, counseling, and behavioral interventions.

Hypertension among 1000 patients with type 2 diabetes attending a national diabetes center in Jordan.

BACKGROUND AND OBJECTIVES: In Jordan, there is a paucity of research on hypertension and its risk factors among patients with type 2 diabetes mellitus. This study was designed to assess the prevalence of hypertension, risk factors, and the level of awareness and control of hypertension among outpatients with type 2 diabetes. SUBJECTS AND METHODS: A cross-sectional study was carried out on a sample of 1000 patients with type 2 diabetes who were attending the National Center for Diabetes, Endocrine and Genetic Diseases for follow-up during the period of June to December 2006. Data were collected from medical records and through a structured interview questionnaire. Logistic regression analysis was used to assess the independent effect of variables on hypertension. RESULTS: The prevalence of hypertension (BP >130/80 or on medication for high blood pressure) was 72.4% (70.9% of males and 73.9% of females). The logistic regression indicated that hypertension was positively associated with age (P=.001), body mass index (P=.001), and duration of diabetes (P=.001). About one-half of patients who were aware of having hypertension failed to keep their blood pressure under control. CONCLUSION: Hypertension is a common co-morbidity among diabetic patients. Despite a high rate of awareness of hypertension among study subjects (93%), hypertension was not controlled to the recommended levels of blood pressure in about one-half (50.4%) of patients.

Knowledge, attitudes, beliefs and patterns of waterpipe use among Jordanian adults who exclusively smoke waterpipes.

BACKGROUND: Widespread waterpipe smoking (WPS) is reported worldwide. Although remarkable numbers of waterpipe smokers do not smoke cigarettes, very few studies have explored the phenomenon of WPS in people who smoke water pipes exclusively. The aim of this study was to assess levels of knowledge, attitudes, beliefs and patterns of WPS among Jordanian waterpipe-only smokers. METHODS: A cross-sectional descriptive design was used; with 247 participants who were recruited through convenience sampling from 23 cafés offering waterpipes. An interview and self-reported questionnaire was used to collect data. RESULTS: The average age for starting WPS was 19.4 ± 5.6 years, of whom 71% started as teenagers. Participants like WPS because they like its flavor and social environment (46.3% and 29.5% respectively). The majority of participants reported that they smoked a waterpipe for the first time with their friends (66.8%), they usually smoke in the company of others (63.2%), and believe that quitting cigarettes smoking is harder than quitting WPS (61.6%). More than half (56.7%) of participants have extremely poor knowledge about the health effects of WPS. Participants who had smoked cigarettes in the past, were more knowledgeable than those who had never smoked cigarettes. The majority of participants, and specifically women, have high positive feelings and emotions (attitude) toward WPS, and 88.3% of them reported that it is a socially acceptable behavior. CONCLUSIONS: Waterpipe smoking participants started WPS at an early age, and are attracted to the social environment that accompanies WPS. Participants have high positive attitude about WPS however they lack knowledge about harmful health effects of WPS.

Gender differences in Chinese immigrants: predictors for antihypertensive medication adherence.

The purpose of this study was to describe gender differences in predictors for antihypertensive medication adherence in Chinese immigrants. A cross-sectional design was used with recruitment with a convenience sample of 100 men and 100 women with hypertension. Measurements for demographics, cultural factors, clinical factors, and medication adherence were self-administered by the participants. Blood pressure was checked twice. A multivariate logistic regression was used to establish a parsimonious prediction model for medication adherence. It was found that in men, longer length of stay in the United States was a predictor for nonadherence. The predictor of nonadherence in women was lower perceived benefits of antihypertensive medications. To increase adherence in women, the benefits of antihypertensive medications should be emphasized. For men who have lived in the United States for 12 years or more, their adherence should be closely monitored.

Knowledge and perception of cardiovascular disease risk among patients with rheumatoid arthritis.

Patients with rheumatoid arthritis are at increased risk for cardiovascular disease. The prerequisites for reducing the risk of cardiovascular disease are adequate levels of knowledge and being aware of the risk. In this study, the levels of knowledge about cardiovascular disease among patients with rheumatoid arthritis and the perception were evaluated in relation to their actual 10-year risk of cardiovascular disease. This cross-sectional study of 200 patients with rheumatoid arthritis was conducted in a university-affiliated hospital in South Korea. The patients' actual risk of cardiovascular disease was estimated using the Framingham Risk Score. The most common risk factor was physical inactivity, with 77% of the patients not engaging in regular exercise. The patients lacked knowledge about the effects of physical inactivity and anti-inflammatory medication on the development of cardiovascular disease. Misperceptions about the risk of cardiovascular disease were common, i.e., 19.5% of the patients underestimated their risk and 41% overestimated. Hypertension, diabetes, obesity, and smoking were the most prevalent among the patients who underestimated their risk, and these same patients had the lowest level of knowledge about cardiovascular disease. This study demonstrated the rheumatoid arthritis patients' lack of knowledge about the effects of physical inactivity and anti-inflammatory medications on the development of cardiovascular disease, and their misperception of cardiovascular risk was common. As a preventive measure, educational programs about cardiovascular disease should be tailored specifically for patients with rheumatoid arthritis, and behavioral interventions, including routine exercise, should be made available at the time of diagnosis.