ABSTRACT
BACKGROUND: The comorbidity of acute coronary syndrome and diabetes affects patient prognoses. Therefore, it is important to manage these diseases simultaneously. PURPOSE: In this study, the effect of nursing counseling on treatment compliance was investigated in patients who had received surgical treatment for acute coronary syndrome and had been recently diagnosed with diabetes. METHODS: A quasi-experimental design with pretest-posttest control group was used. The study sample consisted of 60 patients (intervention group = 30, control group = 30). The data were collected using a patient information form, the Patient Learning Needs Scale, and the Scale for Patient Compliance with Type 2 Diabetes Mellitus Treatment. This study was conducted in compliance with the Transparent Reporting of Evaluations with Nonrandomized Designs checklist. RESULTS: The intervention group earned significantly higher posttest scores on the Patient Learning Needs total scale and subscales than the control group. Moreover, intervention group compliance with treatment was higher than that of the control group. Furthermore, although significant improvements were found in the average posttest body mass index, fasting blood glucose, HbA1c, total cholesterol, triglyceride, and low-density lipoprotein cholesterol values of the control group, the between-group differences in these values were not significant. CONCLUSIONS/IMPLICATIONS FOR PRACTICE: It is important for nurses to provide counseling services that align with the learning needs of their patients. Also, nursing counseling units should be created and staffed by both specialist nurses and nurse trainers working in healthcare institutions.
Subject(s)
Acute Coronary Syndrome , Counseling , Diabetes Mellitus, Type 2 , Humans , Acute Coronary Syndrome/nursing , Acute Coronary Syndrome/psychology , Acute Coronary Syndrome/therapy , Male , Female , Middle Aged , Diabetes Mellitus, Type 2/nursing , Diabetes Mellitus, Type 2/psychology , Diabetes Mellitus, Type 2/therapy , Counseling/methods , Counseling/standards , Counseling/statistics & numerical data , Patient Compliance/statistics & numerical data , Patient Compliance/psychology , Aged , Treatment Adherence and Compliance/statistics & numerical data , Treatment Adherence and Compliance/psychologyABSTRACT
BACKGROUND: Little attention has been placed on language proficiency as a potential variable affecting ACS symptom knowledge, attitudes, and beliefs. OBJECTIVES: To compare the ACS symptom knowledge, attitudes, and beliefs of Hispanic and Latina/o/x/e individuals proficient in English and in those only proficient in Spanish. Secondary aims were to determine if there were differences in ACS symptom knowledge, attitudes, or beliefs based on participants' previous exposure to ACS symptom information and to evaluate instrument characteristics of the new Spanish version of the ACS Response Index. METHODS: This cross-sectional, comparative study included participants (N = 99) from a community-based clinic in Illinois. Knowledge, attitudes, and beliefs related to ACS symptoms were measured using the ACS Response Index. RESULTS: The average participant was 39.8 (SD 15.6) years of age, female (n = 56, 56.6 %), and had a high school education or less (n = 61, 61.6 %). Participants correctly classified a mean 57.5 % (SD 12.8) of symptoms and had mean attitude and belief scores of 12.1 (SD 3.3) and 17.5 (SD 2.9), respectively. There were no significant differences in knowledge, attitudes, and beliefs based on language proficiency. However, there were some statistically significant differences for knowledge and attitude scores based on exposure to ACS symptom information. The ACS Response Index (Spanish Version) also demonstrated favorable internal consistency. CONCLUSIONS: Overall knowledge, attitude, and belief scores were modest in this sample. Higher knowledge and attitude scores were observed for some types of ACS information exposure, supporting the importance of future educational efforts in this population.
Subject(s)
Acute Coronary Syndrome , Health Knowledge, Attitudes, Practice , Hispanic or Latino , Humans , Female , Cross-Sectional Studies , Hispanic or Latino/psychology , Hispanic or Latino/statistics & numerical data , Acute Coronary Syndrome/psychology , Acute Coronary Syndrome/ethnology , Acute Coronary Syndrome/diagnosis , Male , Adult , Middle Aged , Illinois , Surveys and QuestionnairesABSTRACT
OBJECTIVE: This study intends to explore the effect of depressive symptoms on adverse clinical outcomes in middle-aged and elderly hypertensive patients. METHODS: This post hoc analysis was conducted using data from the Systolic Blood Pressure Intervention Trial (SPRINT), and we used cox proportional risk regression to examine the relationship between depressive symptoms and adverse clinical outcomes (primary outcome, all-cause mortality, cardiovascular disease(CVD) mortality, heart failure(HF), myocardial infarction(MI), non-myocardial infarction acute coronary syndrome(non-MI ACS)). RESULTS: In a follow-up study of 9259 participants, we found that depression symptoms was significantly and positively associated with the primary outcome (HR 1.03, 95%CI 1.01-1.05; p for trend = 0.0038), all-cause mortality (HR 1.03, 95%CI 1.01-1.05; p for trend = 0.0308), HF(HR 1.05, 95%CI 1.01-1.08; p for trend = 0.0107), and non-MI ACS(HR 1.06, 95%CI 1.01-1.10; p for trend = 0.0120). Kaplan-Meier survival curves for depression symptoms severity (none, mild, moderate, and above) and adverse clinical outcomes suggested that for all but primary clinical outcomes, the cumulative risk of adverse clinical outcomes increased with increasing depression symptoms severity. CONCLUSION: For middle-aged and elderly hypertensive patients, depression symptoms exacerbates the risk of adverse clinical outcomes (primary outcome, all-cause mortality, CVD death, MI, HF, and non-MI ACS), and the risk increases with the severity of depression symptoms.
Subject(s)
Depression , Hypertension , Myocardial Infarction , Humans , Hypertension/epidemiology , Female , Male , Middle Aged , Aged , Depression/epidemiology , Myocardial Infarction/mortality , Myocardial Infarction/psychology , Myocardial Infarction/epidemiology , Heart Failure/mortality , Follow-Up Studies , Cardiovascular Diseases/mortality , Cardiovascular Diseases/epidemiology , Proportional Hazards Models , Acute Coronary Syndrome/mortality , Acute Coronary Syndrome/complications , Acute Coronary Syndrome/psychologyABSTRACT
Delay in treatment seeking is recognized as a major contributor for Acute Coronary Syndrome (ACS) mortality in Indonesia. Despite the significance of timely treatment, decline in admission and delay in presentation of patients with ACS were consistently reported during the COVID-19 pandemic. These suggested that treatment seeking performance of patients during the pandemic might be different from the previous period. This qualitative study aimed to explore treatment seeking behaviour, barriers in seeking medical treatment, and experiences of patients with ACS in Yogyakarta, Indonesia during COVID-19 pandemic. In depth-interviews were carried out with 30 patients, who were hospitalized with ACS at one of the three selected hospitals in Yogyakarta during the pandemic period. Thematic analysis was performed to create vital explanations for treatment seeking practices of patients with ACS during pandemic. Three significant themes were identified: treatment seeking decisions, barriers in seeking medical treatment during COVID-19, and experiencing both good and bad impression from entering and staying in the hospital. The intensity of ACS symptoms and fear of COVID-19 infection dominated the delay in seeking medical treatment. Strict safety measures, religious belief, and fear of ACS helped patients overcome barriers and seek medical treatment during pandemic. ACS patients also had convenient medical care during the pandemic and believed medical staff would provide excellent care to them. However, visit restriction policy could cause psychological discomfort. Increase awareness of ACS symptoms and the risk of delays ACS treatment are essential to support patients' decisions to seek medical helps in a timely manner at any situations including pandemic. Interventions aim at alleviating psychological distress should also be designed and implemented to improve treatment experiences of ACS patients, who sought medical treatment during the pandemic crisis.
Subject(s)
Acute Coronary Syndrome , COVID-19 , Patient Acceptance of Health Care , Qualitative Research , Humans , COVID-19/epidemiology , COVID-19/psychology , Indonesia/epidemiology , Male , Female , Middle Aged , Acute Coronary Syndrome/therapy , Acute Coronary Syndrome/psychology , Acute Coronary Syndrome/epidemiology , Patient Acceptance of Health Care/psychology , Aged , Adult , SARS-CoV-2/isolation & purification , PandemicsABSTRACT
BACKGROUND: The epidemic of acute coronary syndromes (ACS) poses a great challenge to depression. However, the prevalence of depression among ACS patients has not been fully determined. This meta-analysis aimed to provide an estimation of the global prevalence of depression among ACS patients (ACS depression). METHODS: Online databases including PubMed, Cochrane Library, Web of Science, and Scopus were searched for all relevant studies that reported the prevalence of ACS depression through March 2023. Pooled prevalence of ACS depression with 95% confidence interval (CI) was estimated by the random-effect model. All statistical analyses were performed using comprehensive meta-analysis software. This review was registered in the International Prospective Register of Systematic Reviews (PROSPERO) (identifier CRD42023409338). RESULTS: A total of 28 studies (17 cohort studies, 9 cross-sectional studies, and 2 case-control studies) were included. The overall pooled prevalence of depression in ACS, derived from 28 studies, was 28.5% (95% CI: 0.28-0.29, P = .000, I2 = 99%). 21 included studies showed a prevalence of 20.3% (95% CI: 0.20-0.21, P = .000, I2 = 96%) in men, and the prevalence in women was 13.6% (95% CI: 0.13-0.14, P = .000, I2 = 95%). Subgroup analysis showed the lowest prevalence in Europe (20.7%, 95% CI: 0.20-0.22, P = .000, I2 = 98%); On different diagnostic criteria, the diagnostic and statistical manual of mental disorders (DSM-IV) (36.8%, 95% CI: 0.35-0.38, P = .000, I2 = 96%) has the highest prevalence. In terms of end year of data collection, the prevalence of ACS depression was lower for studies that ended data collection after 2012 (25.7%, 95% CI: 0.25-0.27, P = .000, I2 = 99%) than in studies before 2012 (30%, 95% CI: 0.29-0.31, P = .000, I2 = 98%). CONCLUSION SUBSECTIONS: This systematic review and meta-analysis suggest high global prevalence of depression among ACS patients, underlining the necessity of more preventive interventions among ACS patients especially in Asian and North American regions.
Subject(s)
Acute Coronary Syndrome , Depression , Humans , Acute Coronary Syndrome/epidemiology , Acute Coronary Syndrome/psychology , Prevalence , Depression/epidemiology , Male , FemaleABSTRACT
OBJECTIVE: To determine the predictive value of Cognitive Assessment, Symptom Severity, Personal Control and Self-Efficacy on decision making in the experience of Acute Coronary Syndrome symptoms. METHOD: Quantitative study of cross-sectional analytical design, a probabilistic sampling was carried out for 256 participants diagnosed with coronary syndrome in three health institutions. The effects between the independent variables Cognitive Assessment, Symptom Severity, Personal Control, Self-Efficacy and the dependent Decision-Making were analyzed. Using inferential statistics, a Generalized Linear Regression Model was carried out, which allowed establishing the causal relationships between the variables. RESULTS: Two predictive models were obtained between decision making and cognitive evaluation, in which personal control, severity of symptoms, sex and context were significant. Self-efficacy was not reported as a predictor variable. The values ââof the independent variables showed a behavior directly proportional to the Decision Making score. CONCLUSION: A verification of the conceptual model for the management of symptoms was carried out.
Subject(s)
Acute Coronary Syndrome , Decision Making , Humans , Acute Coronary Syndrome/psychology , Male , Female , Cross-Sectional Studies , Middle Aged , Cognition , Aged , Self EfficacyABSTRACT
OBJECTIVE: Threat perceptions during evaluation for acute coronary syndrome (ACS) in the emergency department (ED) predict posttraumatic stress symptoms (PSS). It is unknown how health insurance status affects threat perceptions. We tested whether lacking health insurance is associated with higher threat perceptions and PSS in patients with suspected ACS in the ED and whether threat perceptions mediate associations between lack of health insurance and subsequent PSS. METHOD: Patients in the Columbia University Irving Medical Center ED with suspected ACS enrolled in an observational cohort study of psychological and cardiovascular outcomes. A multivariable linear regression model tested health insurance status as the predictor of ED threat perceptions and PSS 1-month posthospitalization, adjusting for age, gender, education, Charlson Comorbidity Index, and Global Registry of Acute Coronary Events risk score. A bootstrapped mediation model tested health insurance status as the predictor, PSS 1-month posthospitalization as the outcome, and ED threat perceptions as the mediator, with the same covariates. RESULTS: Of 1,741 patients with suspected ACS in the ED (Mage = 61.01 years, SD = 13.27; 47.1% women), a plurality identified as "Other" race (36.1%), Black (23.9%), and White (22.4%), and 10.3% of patients were uninsured. Lack of health insurance was associated with greater threat perceptions, b = -0.16, 95% CI [-0.26, -0.06], p = .002. Threat perceptions mediated the association between lack of health insurance and higher 1-month PSS, indirect effect = -1.04, 95% CI [-1.98, -0.17]. CONCLUSIONS: Lacking health insurance may heighten threat perceptions during ACS evaluation, which may put patients at risk of developing PSS. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
Subject(s)
Acute Coronary Syndrome , Stress Disorders, Post-Traumatic , Humans , Female , Middle Aged , Male , Stress Disorders, Post-Traumatic/diagnosis , Stress Disorders, Post-Traumatic/epidemiology , Stress Disorders, Post-Traumatic/psychology , Acute Coronary Syndrome/psychology , Cohort Studies , Risk Factors , Emergency Service, Hospital , Insurance, HealthABSTRACT
We aimed to explore the relationship between cortisol response to psychosocial stress, mental distress, fatigue and health related quality of life (HRQoL) in individuals with coronary artery disease (CAD) after recent acute coronary syndrome (ACS). A cross-sectional study initially included 113 subjects (88% men, 53 ± 7 years) 1-3 weeks after ACS. Cortisol response was assessed by measuring salivary cortisol during Trier Social Stress Test. Mental distress was measured with Hospital Anxiety and Depression Scale, State-Trait Anxiety Inventory, and Type D Scale-14. Fatigue symptoms were evaluated using Multidimensional Fatigue Inventory 20-items, while HRQoL was assessed with 36-Item Short Form Medical Outcome Questionnaire. After conducting multivariable linear regression analyses, diminished cortisol response sampled after Public speech (T3-T1, + 15 min) was significantly associated with higher anxiety symptoms (ß = -0.224; p = 0.035), while diminished cortisol response sampled after preparation time (T2-T1, + 10 min) was significantly linked with the presence of Type D personality (ß = -0.290; p = 0.006; ß = -0.282; p = 0.008 respectively), even after controlling for confounders (i.e., sex, age, education, New York Heart Association functional class, beta-blockers and baseline levels of cortisol measures). We found that mental distress, but not fatigue and HRQoL, was linked with blunted cortisol response during anticipation time of psychosocial stress, independently of potential covariates.
Subject(s)
Acute Coronary Syndrome , Coronary Artery Disease , Male , Humans , Female , Hydrocortisone , Quality of Life , Cross-Sectional Studies , Anxiety/psychology , Acute Coronary Syndrome/psychology , Stress, Psychological/psychology , Depression/psychologyABSTRACT
BACKGROUND: Emergency department (ED) crowding is associated with numerous healthcare issues, but little is known about its effect on psychosocial aspects of patient-provider interactions or interpersonal care. We examined whether ED crowding was associated with perceptions of interpersonal care in patients evaluated for acute coronary syndrome (ACS). METHODS: Patients presenting to a quaternary academic medical centre ED in New York City for evaluation of suspected ACS were enrolled between November 2013 and December 2016. ED crowding was measured using the ED Work Index (EDWIN), which incorporates patient volume, triage category, physician staffing and bed availability. Patients completed the 18-item Interpersonal Processes of Care (IPC) survey, which assesses communication, patient-centred decision-making and interpersonal style. Regression analyses examined associations between EDWIN and IPC scores, adjusting for demographics, comorbidities and depression. RESULTS: Among 933 included patients, 11% experienced ED overcrowding (EDWIN score >2) at admission, 11% experienced ED overcrowding throughout the ED stay and 30% reported suboptimal interpersonal care (defined as per-item IPC score <5). Higher admission EDWIN score was associated with modestly lower IPC score in both unadjusted (ß=-1.70, 95% CI -3.15 to -0.24, p=0.02) and adjusted models (ß = -1.77, 95% CI -3.31 to -0.24, p=0.02). EDWIN score averaged over the entire ED stay was not significantly associated with IPC score (unadjusted ß=-1.30, 95% CI -3.19 to 0.59, p=0.18; adjusted ß=-1.24, 95% CI -3.21 to 0.74, p=0.22). CONCLUSION: Increased crowding at the time of ED admission was associated with poorer perceptions of interpersonal care among patients with suspected ACS.
Subject(s)
Acute Coronary Syndrome , Acute Coronary Syndrome/diagnosis , Acute Coronary Syndrome/psychology , Crowding , Emergency Service, Hospital , Humans , Length of Stay , Surveys and Questionnaires , TriageABSTRACT
BACKGROUND: The health belief model is one of the applicable methods of training health preventive behaviors, especially in patients with cardiovascular diseases. Therefore, this study aimed to determine the effect of patient education based on the health belief model on readmission preventive behaviors and readmission rate in patients with a primary diagnosis of acute coronary syndrome. METHODS: The present quasi-experimental study was conducted in 2020 on patients with a primary diagnosis of acute coronary syndrome who were discharging from Seyed Al-Shohada Hospital, Urmia, Iran. In this study, a total of 70 samples were recruited using convenience sampling and then randomly assigned to two groups of intervention and control (n = 35 in each group). A total of 7 face-to-face group training sessions were held with the participation of the patients and one of their family members during 14 days after hospital discharge. These sessions were conducted along with concentration on the structures of the health belief model. Data were collected at three time points of immediately before, one month, and three months after the intervention using a demographic questionnaire, a researcher-made questionnaire of readmission preventive behaviors in cardiovascular diseases, and a checklist of hospital readmission. Data were analyzed using SPSS Statistics for Windows, version 17.0 (SPSS Inc., Chicago, Ill., USA). RESULTS: The results showed that there was a statistically significant difference in the mean score of preventive behaviors between the two groups at time points of one month and three months after the intervention (p < .05). However, there was no statistically significant difference in the readmission rate between the two groups after the intervention (p > .05). CONCLUSION: Health belief model-based education was shown to be effective on readmission preventive behaviors in patients with acute coronary syndrome, although this model had no effect on the readmission rate in these patients. Other factors affecting the readmission rate are recommended to be investigated.
Subject(s)
Acute Coronary Syndrome/therapy , Health Belief Model , Health Knowledge, Attitudes, Practice , Healthy Lifestyle , Patient Education as Topic , Patient Readmission , Risk Reduction Behavior , Acute Coronary Syndrome/diagnosis , Acute Coronary Syndrome/physiopathology , Acute Coronary Syndrome/psychology , Adult , Aged , Female , Heart Disease Risk Factors , Humans , Iran , Male , Middle Aged , Risk Assessment , Single-Blind Method , Treatment OutcomeABSTRACT
This study is aimed at assessing the current status of ACS patients' health literacy and medication compliance, analyzing the relationship between the two, and providing ideas for clinically improving the medication compliance of ACS patients and preventing the recurrence of cardiovascular events. ACS patients need long-term medication to prevent vascular restenosis after surgery, and bad living habits and mood swings will affect postoperative recovery, so clinical interventions are needed to help patients establish a healthy lifestyle. The effect of conventional care is not ideal. Therefore, this paper uses regression analysis to analyze the correlation between the health literacy status of ACS patients and the compliance behavior, combines the investigation and experiment to perform regression analysis and uses mathematical statistics to process data. The connection between health literacy level and compliance behavior is discovered via a study, providing a point of reference for future research.
Subject(s)
Acute Coronary Syndrome/drug therapy , Acute Coronary Syndrome/psychology , Health Literacy , Medication Adherence , Aged , China , Computational Biology , Female , Health Literacy/statistics & numerical data , Humans , Male , Medication Adherence/statistics & numerical data , Middle Aged , Patient Medication Knowledge/statistics & numerical data , Regression AnalysisABSTRACT
INTRODUCTION: There is a growing interest in the study of the relationship between heart disease, including acute coronary syndrome (ACS) and cognitive impairment, and although the factors mediating ACS and cognitive impairment are not well understood, the debate revolves around the role of the left ventricular ejection fraction (LVEF). AIMS: To determine the presence of cognitive impairment in patients with ACS and explore its association with various factors, including sociodemographic, medication use and performance on cardiac function tests (in particular LVEF). PATIENTS AND METHODS: Sociodemographic, medical and neuropsychological variables were collected in 80 patients with ACS participating in a cardiac rehabilitation programme. Their scores on the neuropsychological battery were compared with normative population data to determine which subjects showed deficient performance. Regression analyses were conducted to determine which factors are associated with performance on neuropsychological tests. RESULTS: Compared to their normative group, 37.5% of the subjects had low scores on three or more neuropsychological tests. Age, low educational level and low LVEF explained up to 51% of the variability in neuropsychological test results. CONCLUSIONS: Patients with ACS are more likely to have impaired cognitive functions, such as attention, memory and executive functions, along with a slower information processing speed. An LVEF below 50% could be a major explanatory factor for such cognitive impairment.
TITLE: Variabilidad en el rendimiento neuropsicológico en pacientes con síndrome coronario agudo.Introducción. Existe un interés creciente por el estudio de la relación entre las cardiopatías, incluido el síndrome coronario agudo (SCA) y el deterioro cognitivo, y, aunque no se conocen con concreción los factores que median entre el SCA y el deterioro cognitivo, en el centro de este debate se encuentra el papel de la fracción de eyección del ventrículo izquierdo (FEVI). Objetivos. Determinar la presencia de deterioro cognitivo en pacientes con SCA y explorar su asociación con diversos factores sociodemográficos, consumo de fármacos, rendimiento en pruebas funcionales cardíacas (en particular, la FEVI). Pacientes y métodos. Se recogieron variables sociodemográficas, médicas y neuropsicológicas en 80 pacientes con SCA que participaban en un programa de rehabilitación cardíaca. Se compararon sus puntuaciones en la batería neuropsicológica con los datos normativos poblacionales para determinar qué sujetos mostraban un rendimiento deficitario. Se realizaron análisis de regresión para determinar qué factores se asocian con el rendimiento en las pruebas neuropsicológicas. Resultados. En comparación con su grupo normativo, el 37,5% de los sujetos presentó una baja puntuación en tres o más test neuropsicológicos. La edad, un bajo nivel educativo y una FEVI baja explicaron hasta el 51% de la variabilidad en los resultados de las pruebas neuropsicológicas. Conclusiones. Los pacientes con SCA tienen más posibilidades de presentar un deterioro de funciones cognitivas, como la atención, la memoria y las funciones ejecutivas, junto con un enlentecimiento en la velocidad de procesamiento de la información. Una FEVI inferior al 50% podría ser un factor explicativo destacado de dicho deterioro cognitivo.
Subject(s)
Acute Coronary Syndrome/complications , Acute Coronary Syndrome/psychology , Cognitive Dysfunction/diagnosis , Cognitive Dysfunction/etiology , Cross-Sectional Studies , Female , Humans , Male , Middle Aged , Neuropsychological TestsABSTRACT
ABSTRACT: The aim of the present study is to investigate effect nursing intervention on anxiety, psychology and self-efficacy among elderly patients with acute coronary syndrome after percutaneous coronary intervention, and the correlation between patients' anxiety, psychology and self-efficacy and nursing intervention.One hundred thirty six patients with acute coronary intervention were randomly divided into the experimental group (nâ=â68) and the control group (nâ=â68). The experimental group received nursing intervention measures, and control group received routine nursing. We measured the depression, anxiety score of the 2 groups before and after nursing and multiple regressions was to analysis the correlation between patients' anxiety, psychology and self-efficacy and nursing intervention.The nursing intervention effect of the 2 groups after intervention were improved before intervention (Pâ<â.05), and the Hospital Anxiety and depression scale (HADS) in the was decreased than that of the control group after psychological intervention. The general self-efficacy scale scores of experimental group were obviously improved after receiving the intervention, and the scores in the experimental group were much higher than the control group after receiving the intervention, namely (Pâ<â.05). Furthermore, Single regression analysis showed that single (Marital status) (râ=â0.367, Pâ<â.001), divorced or separated (Marital status) (râ=â0.338, Pâ<â.001), Widowed (Marital status) (râ=â0.458, Pâ<â.001), nursing intervention (râ=â0.431, Pâ<â.001) and Length of hospital stay (râ=â0.276, Pâ=â.003) showed a significant correlation with patients' anxiety, psychology and self-efficacy. Multiple regression analysis showed that Length of hospital stay (Pâ=â.001) and nursing intervention (Pâ<â.001) were significantly correlated with patients' anxiety, psychology and self-efficacy.Nursing intervention maybe significantly improve patients' anxiety, psychology and self-efficacy, and nursing intervention was significantly correlated with patients' anxiety, psychology and self-efficacy. Considering the limited number of studies analyzed, large sample-size clinical trials are necessary to verify the effect nursing intervention on anxiety, psychology and self-efficacy among elderly patients with acute coronary syndrome after percutaneous coronary intervention.
Subject(s)
Acute Coronary Syndrome/psychology , Acute Coronary Syndrome/surgery , Anxiety/nursing , Percutaneous Coronary Intervention , Self Efficacy , Acute Coronary Syndrome/complications , Aged , Aged, 80 and over , Anxiety/etiology , Cohort Studies , Correlation of Data , Female , Humans , Male , Middle Aged , Treatment OutcomeABSTRACT
BACKGROUND: The Life's Simple 7 (LS7) is a guiding metric for primordial/primary prevention of cardiovascular disease. However, little is known about the prevalence and distribution of LS7 metrics in patients with an acute coronary syndrome at the time of hospitalization. METHODS: Data were obtained from patients hospitalized for an acute coronary syndrome at 6 hospitals in Central Massachusetts and Georgia (2011-2013). The LS7 assessed patient's smoking, diet, and physical activity based on self-reported measures, and patients' body mass index, blood pressure, and serum cholesterol and glucose levels were abstracted from medical records. All items were operationalized into 3 categories: poor (0), intermediate (1), or ideal (2). A total summary cardiovascular health score (0-14) was obtained and categorized into tertiles (0-5, 6-7, and 8-14). RESULTS: The average age of study participants (nâ¯=â¯1110) was 59.6 years and 35% were women. Cardiovascular health scores ranged from 0-12 (meanâ¯=â¯6.2). Patients with higher scores were older, white, had lower burden of comorbidities, had fewer symptoms of anxiety, depression, and stress, better quality of life, more social support, and greater healthcare activation. One-third of patients had only 1 ideal cardiovascular health measure, less than 1% had 5, and no participant had more than 5 ideal factors. CONCLUSIONS: Our results indicate that patients with acute coronary syndrome have poor cardiovascular health. Sociodemographic, clinical, and psychosocial characteristics differed across cardiovascular health groups. These findings highlight potential areas for educational and therapeutic interventions to reduce the risk of cardiovascular disease and promote cardiovascular health in adult men and women.
Subject(s)
Acute Coronary Syndrome/epidemiology , Blood Pressure , Body Mass Index , Diet/statistics & numerical data , Exercise , Smoking/epidemiology , Acute Coronary Syndrome/metabolism , Acute Coronary Syndrome/psychology , Aged , Anxiety/psychology , Blood Glucose/metabolism , Cholesterol/metabolism , Depression/psychology , Female , Hospitalization , Humans , Male , Middle Aged , Quality of Life , Social SupportABSTRACT
Coronary heart disease (CHD) is the result of a complex metabolic disorder caused by various environmental and genetic factors, and often has anxiety as a comorbidity. Rupture of atherosclerotic plaque in CHD patients can lead to acute coronary syndrome (ACS). Anxiety is a known independent risk factor for the adverse cardiovascular events and mortality in ACS, but it remains unclear how stress-induced anxiety behavior impacts their blood plasma metabolome and contributes to worsening of CHD. The present study aimed to determine the effect of anxiety on the plasma metabolome in ACS patients. After receiving ethical approval 26 ACS patients comorbid anxiety were recruited and matched 26 ACS patients. Blood plasma samples were collected from the patients and stored at - 80 °C until metabolome profiling. Metabolome analysis was performed by liquid chromatography mass spectrometry (LC-MS), and the data were subjected to multivariate analysis. Disturbance of 39 plasma metabolites was noted in the ACS with comorbid anxiety group compared to the ACS group. These disturbed metabolites were mainly involved in tryptophan metabolism, pyrimidine metabolism, glycerophospholipid metabolism, pentose phosphate pathway, and pentose and glucuronate interconversions. The most significantly affected pathway was tryptophan metabolism including the down-regulation of tryptophan and serotonin. Glycerophospholipids metabolism, pentose and glucuronate interconversions, and pentose phosphate pathway were also greatly affected. These results suggest that anxiety can disturb three translation of material in ACS patients. Besides the above metabolism pathways pyrimidine metabolism was significantly disturbed. Based on the present findings the plasma metabolites monitoring can be recommended and may be conducive to early biomarkers detection for personalized treatment anxiety in CHD patients in future.
Subject(s)
Acute Coronary Syndrome/blood , Acute Coronary Syndrome/psychology , Anxiety/blood , Biomarkers/blood , Metabolome , Metabolomics , Acute Coronary Syndrome/epidemiology , Aged , Anxiety/epidemiology , Chromatography, High Pressure Liquid , Comorbidity , Female , Humans , Male , Metabolomics/methods , Middle Aged , Public Health Surveillance , Spectrometry, Mass, Matrix-Assisted Laser Desorption-IonizationABSTRACT
OBJETIVO: avaliar os principais fatores estressores apontados pelos pacientes em uma unidade cardiointensiva. MÉTODO: pesquisa descritiva, quantitativa, realizada com 25 pacientes maiores de 18 anos, lúcidos, orientados, alfabetizados, com diagnóstico de síndrome coronariana aguda. Aplicou-se questionário relacionado às informações sociodemográficas e clínicas e a escala The Environmental Stressor Questionnaire. Os dados foram analisados através de estatística descritiva simples. RESULTADOS: houve predominância do sexo masculino (16-64%), com idade de 60 a 70 anos (14-56%). O infarto agudo do miocárdio (14-56%%) foi a causa mais prevalente de internação. As afirmativas "sentir dor" (17-68%); seguido de "não conseguir mexer mãos ou braços devido às vias intravenosas" (13-52%); "não ter controle de si mesmo" (11-44%) e "não ter explicações sobre o tratamento" (10-40%) sobressaíram como extremamente estressantes. CONCLUSÃO: conhecer os estressores mais prevalentes contribui para o planejamento do cuidado de enfermagem com ênfase no acolhimento e atendimento às necessidades individualizadas.
OBJECTIVE: to assess the main stressors mentioned by the patients in a cardio-intensive unit. METHOD: a descriptive and quantitative research study, carried out with 25 patients over 18 years old, lucid, oriented, literate, and diagnosed with acute coronary syndrome. A questionnaire related to the sociodemographic and clinical information and the The Environmental Stressor Questionnairewere applied. The data were analyzed using simple descriptive statistics. RESULTS: there was predominance of males (16-64%), aged 60-70 years old (14-56%). Acute myocardial infarction (14-56%) was the most prevalent hospitalization cause. The "Feeling pain" statement (17-68%); followed by "Not being able to move the arms or hands due to the intravenous routes" (13-52%); "Not having control of oneself" (11-44%) and "No explanations given on the treatment" (10-40%) stood out as extremely stressful. CONCLUSION: knowing the most prevalent stressors contributes to Nursing care planning with emphasis on welcoming and assistance to the individualized needs.
OBJETIVO: evaluar los principales factores estresantes señalados por los pacientes en una unidad coronaria. MÉTODO: investigación descriptiva, cuantitativa, realizada con 25 pacientes mayores de 18 años, lúcidos, orientados, alfabetizados, diagnosticados con síndrome coronario agudo. Se aplicó un cuestionario relacionado con información sociodemográfica y clínica y la escala The Environmental Stressor Questionnaire. Los datos se analizaron mediante estadística descriptiva simple. RESULTADOS: predominó el sexo masculino (16-64%), con edades entre 60 y 70 años (14-56%). El infarto agudo de miocardio (14-56 %%) fue la causa más prevalente de hospitalización. Las afirmaciones "sentir dolor" (17-68%); seguido de "no poder mover las manos o los brazos debido a las vías intravenosas" (13-52%); "No tener control de uno mismo" (11-44%) y "no recibir explicaciones sobre el tratamiento" (10-40%) se destacaron como extremadamente estresantes. CONCLUSIÓN: conocer los factores estresantes más predominantes contribuye a la planificación de los cuidados de enfermería enfocados en la hospitalidad y satisfacción de las necesidades individuales.
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Stress, Physiological , Acute Coronary Syndrome/psychology , Inpatients , Intensive Care Units , Critical Care , Cardiovascular NursingABSTRACT
BACKGROUND: In China, there has been a precipitous increase in the number of percutaneous coronary interventions (PCI) conducted. We sought to characterize the clinical and psychosocial trajectory of PCI patients from the time of procedure through 6 months post, and correlates of adverse cardiovascular events (ACEs). METHODS: In this prospective, observational study, patients from 2 hospitals in Shanghai, China were assessed. At follow-up visits at 1, 3 and 6 months post-PCI, clinical indicators were again extracted from patients' clinical records, including ACEs, and they completed validated surveys assessing self-management, as well as psychosocial indicators (Hospital Anxiety and Depression Scale; Pittsburgh Sleep Quality Index; quality of life [QoL]: SF-12, Seattle Angina Questionnaire [SAQ]). Repeated measures analysis of variance, adjusted for Barthel index and PCI indication, was used to assess change over time in risk factors and psychosocial indicators. Logistic regression was used to explore correlates of ACEs. RESULTS: 610 participants (mean age = 63.3; n = 150, 18.2% female) were recruited, of which 491 (80.5%) were retained at 6 months. 82 (16.7%) had an ACE at any time point, including most commonly angina and stroke (only 1 death). Clinical indicators such as blood pressure (p < 0.031 for both), symptom burden (p < .01 on all subscales) and QoL (p < 0.001 for both, but started quite low) improved over 6 months. Anxiety and depressive symptoms were above threshold, and the latter worsened over time (p < 0.001). With adjustment for age and indication, patients with any ACEs had higher sleep latency (odds ratio [OR] = 1.48; 95% confidence interval [CI] = 1.03-2.10]), and depressive symptoms (OR = 1.20; 95% CI = 1.02-1.41), but lower anxiety (OR = 0.79; 95% CI = 0.67-0.93) compared to those without. CONCLUSION: Centers may wish to re-visit patient selection criteria and processes for PCI, as well as implement mental health screening and treatment protocols, as can be achieved through cardiac rehabilitation, given how hazardous psychosocial distress is in this population.
Subject(s)
Acute Coronary Syndrome/therapy , Anxiety/etiology , Coronary Artery Disease/therapy , Depression/etiology , Mental Health , Percutaneous Coronary Intervention/adverse effects , Quality of Life , Acute Coronary Syndrome/diagnosis , Acute Coronary Syndrome/mortality , Acute Coronary Syndrome/psychology , Aged , Anxiety/diagnosis , Anxiety/psychology , China , Clinical Decision-Making , Coronary Artery Disease/diagnosis , Coronary Artery Disease/mortality , Coronary Artery Disease/psychology , Depression/diagnosis , Depression/psychology , Female , Health Status , Humans , Longitudinal Studies , Male , Middle Aged , Percutaneous Coronary Intervention/mortality , Prospective Studies , Recurrence , Risk Assessment , Risk Factors , Risk Reduction Behavior , Time Factors , Treatment OutcomeABSTRACT
Cardiovascular disease is one of the most common causes of hospitalization and is associated with high morbidity and mortality rates. Among the most important modifiable and well-known risk factors are an unhealthy diet and sedentary lifestyle. Nevertheless, adherence to healthy lifestyle regimes is poor. The present study examined longitudinal trajectories (pre-event, 6-, 12-, 24-, 36-, and 60-month follow-ups) of protein intake (fish, legumes, red/processed meat) and physical activity in 275 newly-diagnosed patients with acute coronary syndrome. Hierarchical Generalized Linear Models were performed, controlling for demographic and clinical variables, the season in which each assessment was made, and the presence of anxiety and depressive symptoms. Significant changes in protein intake and physical activity were found from pre-event to the six-month follow-up, suggesting the adoption of healthier behaviors. However, soon after the six-month follow-up, patients experienced significant declines in their healthy behaviors. Both physical activity and red/processed meat intake were modulated by the season in which the assessments took place and by anxiety symptoms over time. The negative long-term trajectory of healthy behaviors suggests that tailored interventions are needed that sustain patients' capabilities to self-regulate their behaviors over time and consider patient preference in function of season.
Subject(s)
Acute Coronary Syndrome , Dietary Proteins/administration & dosage , Exercise , Acute Coronary Syndrome/psychology , Acute Coronary Syndrome/therapy , Aged , Diet , Dietary Proteins/classification , Female , Humans , Longitudinal Studies , Male , Middle AgedABSTRACT
BACKGROUND: Major depression is one of the world's leading causes of disability in adults with long-term physical conditions compared to those without physical illness. This co-morbidity is associated with a negative prognosis in terms of increased morbidity and mortality rates, increased healthcare costs, decreased adherence to treatment regimens, and a substantial decline in quality of life. Therefore, preventing the onset of depressive episodes in adults with long-term physical conditions should be a global healthcare aim. In this review, primary or tertiary (in cases of preventing recurrences in those with a history of depression) prevention are the focus. While primary prevention aims at preventing the onset of depression, tertiary prevention comprises both preventing recurrences and prohibiting relapses. Tertiary prevention aims to address a depressive episode that might still be present, is about to subside, or has recently resolved. We included tertiary prevention in the case where the focus was preventing the onset of depression in those with a history of depression (preventing recurrences) but excluded it if it specifically focused on maintaining an condition or implementing rehabilitation services (relapse prevention). Secondary prevention of depression seeks to prevent the progression of depressive symptoms by early detection and treatment and may therefore be considered a 'treatment,' rather than prevention. We therefore exclude the whole spectrum of secondary prevention. OBJECTIVES: To assess the effectiveness, acceptability and tolerability of psychological or pharmacological interventions, in comparison to control conditions, in preventing depression in adults with long-term physical conditions; either before first ever onset of depressive symptoms (i.e. primary prevention) or before first onset of depressive symptoms in patients with a history of depression (i.e. tertiary prevention). SEARCH METHODS: We searched the Cochrane Common Mental Disorders Controlled Trials Register, CENTRAL, MEDLINE, Embase, PsycINFO and two trials registries, up to 6 February 2020. SELECTION CRITERIA: We included randomised controlled trials (RCTs) of preventive psychological or pharmacological interventions, specifically targeting incidence of depression in comparison to treatment as usual (TAU), waiting list, attention/psychological placebo, or placebo. Participants had to be age 18 years or older, with at least one long-term physical condition, and no diagnosis of major depression at baseline (primary prevention). In addition, we included studies comprising mixed samples of patients with and without a history of depression, which explored tertiary prevention of recurrent depression. We excluded other tertiary prevention studies. We also excluded secondary preventive interventions. Primary outcomes included incidence of depression, tolerability, and acceptability. Secondary outcomes included severity of depression, cost-effectiveness and cost-utility. DATA COLLECTION AND ANALYSIS: We used standard methodological procedures expected by Cochrane. MAIN RESULTS: We included 11 RCTs, with one trial on psychological interventions, and 10 trials on pharmacological interventions. Data analyses on the psychological intervention (problem-solving therapy compared to TAU) included 194 participants with age-related macular degeneration. Data analyses on pharmacological interventions included 837 participants comparing citalopram (one trial), escitalopram (three trials), a mixed sample of fluoxetine/nortriptyline (one trial), melatonin (one trial), milnacipran (one trial), and sertraline (three trials), each to placebo. Included types of long-term physical conditions were acute coronary syndrome (one trial), breast cancer (one trial), head and neck cancer (two trials), stroke (five trials), and traumatic brain injury (one trial). Psychological interventions Very low-certainty evidence of one study suggests that problem solving therapy may be slightly more effective than TAU in preventing the incidence of depression, immediately post-intervention (odds ratio (OR) 0.43, 95% confidence interval (CI) 0.20 to 0.95; 194 participants). However, there may be little to no difference between groups at six months follow-up (OR 0.71, 95% CI 0.36 to 1.38; 190 participants; one study; very low-certainty evidence). No data were available regarding incidence of depression after six months. Regarding acceptability (drop-outs due to any cause), slightly fewer drop-outs occurred in the TAU group immediately post-intervention (OR 5.21, 95% CI 1.11 to 24.40; 206 participants; low-certainty evidence). After six months, however, the groups did not differ (OR 1.67, 95% CI 0.58 to 4.77; 206 participants; low-certainty evidence). This study did not measure tolerability. Pharmacological interventions Post-intervention, compared to placebo, antidepressants may be beneficial in preventing depression in adults with different types of long-term physical conditions, but the evidence is very uncertain (OR 0.31, 95% CI 0.20 to 0.49; 814 participants; nine studies; I2 =0%; very low-certainty evidence). There may be little to no difference between groups both immediately and at six months follow-up (OR 0.44, 95% CI 0.08 to 2.46; 23 participants; one study; very low-certainty evidence) as well as at six to 12 months follow-up (OR 0.81, 95% CI 0.23 to 2.82; 233 participants; three studies; I2 = 49%; very low-certainty evidence). There was very low-certainty evidence from five studies regarding the tolerability of the pharmacological intervention. A total of 669 adverse events were observed in 316 participants from the pharmacological intervention group, and 610 adverse events from 311 participants in the placebo group. There was very low-certainty evidence that drop-outs due to adverse events may be less frequent in the placebo group (OR 2.05, 95% CI 1.07 to 3.89; 561 participants; five studies; I2 = 0%). There was also very low-certainty evidence that drop-outs due to any cause may not differ between groups either post-intervention (OR 1.13, 95% CI 0.73 to 1.73; 962 participants; nine studies; I2 = 28%), or at six to 12 months (OR 1.13, 95% CI 0.69 to 1.86; 327 participants; three studies; I2 = 0%). AUTHORS' CONCLUSIONS: Based on evidence of very low certainty, our results may indicate the benefit of pharmacological interventions, during or directly after preventive treatment. Few trials examined short-term outcomes up to six months, nor the follow-up effects at six to 12 months, with studies suffering from great numbers of drop-outs and inconclusive results. Generalisation of results is limited as study populations and treatment regimes were very heterogeneous. Based on the results of this review, we conclude that for adults with long-term physical conditions, there is only very uncertain evidence regarding the implementation of any primary preventive interventions (psychological/pharmacological) for depression.