Readiness for Behavior Change in Patients Living With Ischemic Heart Disease.

BACKGROUND: Readiness for behavioral change may be evaluated by assessing the patient's stage of change, as described in the transtheoretical model. Identifying readiness to change in patients with ischemic heart disease may enhance the effectiveness of interventions that target risk reduction and lifestyle modification. PURPOSE: This study was designed to assess the readiness of patients with ischemic heart disease to change health behaviors as well as to identify the factors that significantly predict this change. METHODS: A descriptive correlation design approach was adopted, and a convenience sample of 122 patients with ischemic heart disease was recruited from an outpatient cardiac clinic. Readiness for behavioral change was evaluated by assessing the stages of change of the participants, as described in the transtheoretical model. Data on readiness to change were collected using the "readiness for lifestyle change inventory." RESULTS: A total of 62.2% and 43.4% of the participants were in the precontemplation phase of change for "cease smoking" and "be physically active," respectively; about 33% of the patients were in the maintenance phase for "control weight"; 36.1% were in the maintenance phase for "reduce consumption of high-fat foods"; and 51.6% and 57.4% were in the maintenance phase for "eat fruits and vegetables" and "practice relaxation," respectively. Participants who were overweight or obese showed higher readiness to practice physical activity, and those with high cholesterol levels showed a higher readiness to reduce the amount of fat in their diet. Higher income was found to predict higher readiness to eat fruits and vegetables. CONCLUSIONS: Patients are not adequately ready to change their health-related behaviors. Higher cardiovascular risk predicts higher readiness to change health behaviors.

Accuracy of EASI 12-lead ECGs in monitoring ST-segment and J-point by nurses in the Coronary Care Units.

AIMS AND OBJECTIVES: To confirm the accuracy of the EASI system compared to the standard 12-lead electrocardiogram, which is the gold standard, in monitoring the two major parameters used in the Coronary Care Units to detect myocardial ischaemia: ST-segment and J-point. BACKGROUND: Continuous electrocardiograph monitoring is used in the Coronary Care Units to detect cardiac conduction abnormalities and to show the morphology of electrocardiographic waves and tracts. Its accuracy is essential for efficient nursing vigilance, particularly for monitoring the ST segment and the J-point, in which alterations may indicate the onset of myocardial ischaemia. DESIGN: An observational study was conducted. METHODS: The enrolled patients (n = 253) simultaneously underwent standard electrocardiogram (10 electrodes) and EASI electrocardiogram (five electrodes). Data were collected by the Coronary Care Units nurses. Tests to compare differences in means and medians between the two sets of measurements were performed, and the Bland-Altman plots were used to illustrate their agreement. RESULTS: All 6·072 electrocardiographic leads (3·036 standard and 3·036 EASI) were recorded and analysed. Between the two measurement methods, very small statistically significant differences were found in some leads which are not clinically relevant for both the ST-segment or the J-point. CONCLUSIONS: This study confirms that the accuracy of the EASI 12-leadelectrocardiogram, compared to the standard 12-leadelectrocardiogram, which is the gold standard, is acceptable for clinical practice to monitor the two major parameters used in the Coronary Care Units for detecting myocardial ischaemia: ST-segment and J-point. RELEVANCE TO CLINICAL PRACTICE: The EASI system ensures: (1) ease of use and comfort for patients admitted to Coronary Care Units because it only requires five electrodes; (2) increased efficacy of nursing vigilance in the early detection of changes in ST-segment and J- point measurements.

'What Do I Do Next?' Nurses' Confusion and Uncertainty with ECG Monitoring.

The prevalence of telemetry monitoring is increasing on medical- surgical units, but no evidence-based guidelines standardize nursing education. Research indicates nurses feel uncertain and report a lack of knowledge when caring for patients with telemetry monitoring.

Nurses' Practices and Lead Selection in Monitoring for Myocardial Ischemia: An Evidence-Based Quality Improvement Project.

BACKGROUND: The 5-lead electrocardiogram (ECG) provides key information, including clues that a patient may be experiencing myocardial ischemia, usually demonstrated in the ST segment. Studies have shown that nursing knowledge regarding ischemia monitoring is suboptimal, even though national guidelines for ECG monitoring were published in 2004 by the American Heart Association and endorsed by the American Association of Critical Care Nurses. PURPOSE: The aims of this study were to identify best practice regarding 5-lead ECG myocardial ischemia monitoring, assess current unit-level practice at 1 institution, and to educate nurses on proper monitoring using a nurse-led, evidence-based intervention. METHODS: The authors created an educational PowerPoint designed to educate nurses on proper lead selection to monitor the ST segment for patients admitted with known or suspected myocardial ischemia and developed a 3-part online survey to assess current unit practice and to assess knowledge before and after intervention. RESULTS: A total of 18 registered nurses (RNs) completed the survey. Results indicated that RNs lacked knowledge regarding continuous ECG monitoring for ischemia and had room for improvement in their everyday practice habits. The knowledge preintervention test mean score (out of 9) was 3.11 (SD, 1.68), and the postintervention test mean score was 6.94 (SD, 1.55), which was significant (P = .000). The intervention also significantly improved the monitoring comfort level of RNs, with a preintervention comfort level of 2.53 (SD, 1.07) and a postintervention level of 3.41 (SD, 1.00) (P = .007). The process allowed the authors to reflect on the key steps of implementing evidence-based projects in nursing units. CONCLUSIONS: Continuous, 5-lead ECG monitoring is an active process that requires clinical decision making by the nurse and is not a passive activity. Registered nurses in this sample demonstrated a lack of knowledge regarding ECG monitoring for ischemia that was improved with an online educational intervention and reported intentional daily practice pattern changes postintervention testing. A unit-level intervention driven by nurses may be successful at improving fellow RNs' knowledge and evidence-based practice.

Tomografía Computada Multidetector en el paciente con síndrome coronario agudo / Multidetector computed tomography in patients with acute coronary syndrome

La tomografía computada multidetector es una técnica no invasiva que permite visualizar las arterias coronarias y detectar en ellas la presencia de lesiones. Los tiempos de adquisición son muy breves. La tomografía computada multicorte permite hacer un diagnóstico precoz de la presencia de arterosclerosis con un estudio en el que no se requiere la administración de contraste en el sistema circulatorio. En los pacientes con dolor torácico sospechoso de síndrome coronario agudo, la tomografía computada multidetector inmediata ayuda a dar de alta más rápidamente a los pacientes, reduciendo el costo de la asistencia. Los cuidados de enfermería en la realización del estudio son fundamentales para el buen fin de la prueba y tratamiento.

Multidetector computed tomography is a noninvasive technique to visualize the coronary arteries and detect in them the presence of lesions . The acquisition times are very short . Multislice computed tomography allows early diagnosis of the presence of atherosclerosis in a study in which contrast administration is required in the circulatory system. In patients with chest pain suspected of acute coronary syndrome , computed tomography multidetector immediate help to enlist patients more quickly , reducing the cost of care. Nursing care in the study are fundamental to the success of the testing and treatment.

Perioperative management of cardiac disease.

Pre-existing cardiac disease contributes significantly to morbidity and mortality amongst patients undergoing non cardiac surgery. Patients with pre-existing cardiac disease or with risk factors for it, have as much as a 3.9% risk of suffering a major perioperative cardiac event (Lee et al 1999, Devereaux 2005). Furthermore, the incidence of perioperative myocardial infarction (MI) is increased 10 to 50 fold in patients with previous coronary events (Jassal 2008).

Troponin.

Troponin T and I can be found within the myocardial filaments. Measuring these cardiac troponin levels in full-term newborns and premature infants has not become a common practice in the neonatal intensive care unit and newborn nurseries. Research studies are discovering that an elevation in troponin T and I levels can be directly correlated with the severity of the infant's illness, and it can be potentially prognostic of morbidity. This literature analysis discusses what can be considered normal cardiac troponin levels along with what elevated levels are and possible conditions associated with those elevations.

Outcomes and opportunities: a nurse-led model of chronic disease management in Australian general practice.

The Australian government's commitment to health service reform has placed general practice at the centre of its agenda to manage chronic disease. Concerns about the capacity of GPs to meet the growing chronic disease burden has stimulated the implementation and testing of new models of care that better utilise practice nurses (PN). This paper reports on a mixed-methods study nested within a larger study that trialled the feasibility and acceptability of a new model of nurse-led chronic disease management in three general practices. Patients over 18 years of age with type 2 diabetes, hypertension or stable ischaemic heart disease were randomised into PN-led or usual GP-led care. Primary outcomes were self-reported quality of life and perceptions of the model's feasibility and acceptability from the perspective of patients and GPs. Over the 12-month study quality of life decreased but the trend between groups was not statistically different. Qualitative data indicate that the PN-led model was acceptable and feasible to GPs and patients. It is possible to extend the scope of PN care to lead the routine clinical management of patients' stable chronic diseases. All GPs identified significant advantages to the model and elected to continue with the PN-led care after our study concluded.

Life style modification for patients with ischemic heart disease.

With a view to assess the effectiveness of lifestyle modification in patients with ischemic heart disease, a quasi-experimental study with quantitative approach was undertaken on 60 patients of ischemic heart disease. Purposive sampling technique was used in selecting the patients. The results showed that educating the patients about cessation of smoking, taking proper diet, anxiety reduction and counselling helped in preventing the progression of ischaemic heart disease.

Panoramic ECG display versus conventional ECG: ischaemia detection by critical care nurses.

AIM: To compare accuracy and certainty of diagnosis of cardiac ischaemia using the Panoramic ECG display tool plus conventional 12-lead electrocardiogram (ECG) versus 12-lead ECG alone by UK critical care nurses who were members of the British Association of Critical Care Nurses (BACCN). BACKGROUND: Critically ill patients are prone to myocardial ischaemia. Symptoms may be masked by sedation or analgesia, and ECG changes may be the only sign. Critical care nurses have an essential role in detecting ECG changes promptly. Despite this, critical care nurses may lack expertise in interpreting ECGs and myocardial ischaemia often goes undetected by critical care staff. METHOD: British Association of Critical Care Nurses (BACCN) members were invited to complete an online survey to evaluate the analysis of two sets of eight ECGs displayed alone and with the new display device. RESULTS: Data from 82 participants showed diagnostic accuracy improved from 67·1% reading ECG traces alone, to 96·0% reading ECG plus Panoramic ECG display tool (P < 0·01, significance level α = 0·05). Participants' diagnostic certainty score rose from 41·7% reading ECG alone to 66·8% reading ECG plus Panoramic ECG display tool (P < 0·01, α = 0·05). CONCLUSION: The Panoramic ECG display tool improves both accuracy and certainty of detecting ST segment changes among critical care nurses, when compared to conventional 12-lead ECG alone. This benefit was greatest with early ischaemic changes. Critical care nurses who are least confident in reading conventional ECGs benefit the most from the new display. RELEVANCE TO CLINICAL PRACTICE: Critical care nurses have an essential role in the monitoring of critically ill patients. However, nurses do not always have the expertise to detect subtle ischaemic ECG changes promptly. Introduction of the Panoramic ECG display tool into clinical practice could lead to patients receiving treatment for myocardial ischaemia sooner with the potential for reduction in morbidity and mortality.

Fatores associados a óbito e hospitalizações em uma clínica de insuficiência cardíaca / Factors associated with death and hospitalization in a heart failure clinic

Trata-se de um estudo descritivo, retrospectivo, com abordagem quantitativa cujo objetivo geral foi descrever e analisar o perfil epidemiológico dos pacientes com Insuficiência Cardíaca atendidos pela Clinica de IC de um Hospital Universitário. Os objetivos específicos orientam-se para:(a)Caracterizar os casos de Insuficiência Cardíaca segundo variáveis demográficas, variáveis clínicas, de diagnóstico e co morbidades;(b)Comparar as características clínicas e demográficas dos pacientes conforme grupos etiológicos identificados e fração de ejeção;(c)Determinar a taxa de mortalidade e hospitalização dos pacientes acompanhados pela clínica. Os dados analisados neste estudo são oriundos de um banco de dados onde são alocadas informações dos pacientes em atendimento ambulatorial da referida clinica.Para a análise dos dados foi utilizada a estatística descritiva, freqüências e porcentagens assim como tabelas e gráficos para a demonstração dos dados levantados.Os mesmos foram analisados através do software SPSS v.18.0, no qual se utilizou a estatística multivariada e curvas de sobrevida de Kaplan-Meyer.Os resultados apontam para uma predominância masculina de 60,1%, com idade de ± 63,5 anos. Na caracterização quanto à classe funcional observa-se que a predominante é a classe funcional I e II com 73,6% do total. Os pacientes assistidos apresentam uma média de 42% da fração de ejeção do ventrículo esquerdo e 61,7% possuem etiologia não isquêmica. Em nosso estudo, descrevemos 71,8% de portadores de disfunção sistólica. Os pacientes com etiologia isquêmica tinham predomínio do sexo masculino(70,7%), e a etiologia não isquêmica com uma prevalência maior do sexo feminino(45,5%vs 29,3%;p<0,001). Além disso, os pacientes isquêmicos eram mais idosos (p<0,001), com historia familiar de DAC(p<0,041), presença de diabetes (p<0,001). A disfunção sistólica(FE<50%) era predominante no grupo de pacientes isquêmicos(77%vs 69%; p=0,048)...

It is a descriptive, retrospective, study with quantitative approach whose general objective was to describe and analyze the epidemiological profile of patients with heart failure treated in a heart failure clinic of a university hospital. The specific objectives are oriented to a) characterize the cases of heart failure according to demographic variables, clinical variables, diagnosis and comorbidities, (b) compare clinical and demographic characteristics of patients according to the main groups identified and etiologic fraction ejection, (c) Determine mortality and hospitalization rates of patients followed by the HF clinic. The data analyzed in this study come from a database which is allocated information of ambulatory patients referred to the clinic. For data analysis was used descriptive statistics with mean, median and standard deviation, frequencies and percentages ,tables and graphs to demonstrate the data collected as well multivariate statistical analysis and Kaplan-Meyer’s survival curves. They were analyzed using the software SPSS v.18.0. The results indicate a male predominance of 60.1% with an average age of 63.5 years±. The functional class observed that was the predominant class I and II, 73.6% of the total. Patients have attended an average of 42% ejection fraction of left ventricle and 61.7% had non ischemic etiology. In our study, we describe 71.8% of patients with systolic dysfunction. Patients with ischemic etiology were predominantly male (70.7%), and non ischemic etiology with a higher prevalence of females (45.5% vs 29.3%, p<0.001). In addition, ischemic patients were older (p<0.001), family history of CAD (p<0.041), diabetes (p<0.001). Systolic dysfunction (EF<50%) was predominant in the group of ischemic patients (77% vs 69%, p=0.048)...

Continuous ST-segment monitoring: nurses' attitudes, practices, and quality of patient care.

BACKGROUND: Continuous ischemia monitoring helps identify patients with acute, but often silent, myocardial ischemia. Evidence suggests nurses do not activate ischemia monitoring because they think it is difficult to use. ST-Map software incorporates graphic displays to make monitoring of ongoing ischemia easier. OBJECTIVES: To determine if nurses' use of and attitude toward ischemia monitoring and the quality of patient care improve with use of ST-Map. METHODS: The study included 61 nurses and 202 patients with acute coronary syndrome in a cardiac intensive care unit. Baseline data on nurses' use of and attitude toward ischemia monitoring and quality of care were obtained. Education was then provided and ST-Map software was installed on all monitors. Follow-up data were obtained 4 months later. RESULTS: The percentage of nurses who had ever used ischemia monitoring was 13% before ST Map and 90% afterward (P < .001). The most common reason for not using ischemia monitoring before ST Map was inadequate knowledge (62%). The most common reason for liking ischemia monitoring after ST Map was knowing when a patient has ischemia (80%). Time to acquisition of a 12-lead electrocardiogram in response to symptoms or ST-segment changes was 5 to 15 minutes before ST Map and always less than 5 minutes afterward (P < .001). Time to return to the catheterization laboratory did not differ before and after ST Map. CONCLUSIONS: ST Map was associated with more frequent use of ischemia monitoring, improved attitudes of nurses toward ischemia monitoring, and shorter time to obtaining 12-lead electrocardiograms.

Illness experiences of patients with ischemic heart disease during their transitional phase from hospitalization to discharge in Japan.

The purpose of this study was to explore the experience of patients with ischemic heart disease (IHD) during the transitional phase from hospitalization to discharge. Twenty-four patients who experienced IHD for the first time comprised the sample of the study. Semi-structured interviews were conducted during the transitional phase. The results of the qualitative inductive analysis showed two categories of illness experience: (i) the connection of heart attack experience with the self, and (ii) the instability of the self as a patient with heart disease. The participants were found to vacillate between the self as patient with a heart disease and the typical self before the disease onset. The transitional phase is the time when patients experience changes in their symptoms and physical conditions rather than a condition of stability signifying recovery. Patients are expected to manage the symptoms of their heart disease by themselves; however the participants showed signs and symptoms of confusion and anxiety about facilitating their own care. These findings suggest the importance of outpatient nursing practice focusing on the support and emphasis on nursing interventions for patient anxiety and alleviation of confusion through the management of symptoms of heart disease after discharge.

Influence of dialysis therapies in the development of cardiac disease in CKD.

It is well recognised that dialysis patients suffer excess morbidity and mortality and that this is mainly due to cardiac failure and sudden cardiac death rather than conventional risk factors. Dialysis patients are primed by a number of structural, functional and microcirculatory abnormalities to experience demand myocardial ischaemia. We have shown that haemodialysis induces repetitive myocardial ischaemia in the majority of patients. In this way, haemodialysis itself may contribute to the development of heart failure and the risk of sudden death. There is recent appreciation that peritoneal dialysis is also capable of exerting short-term effects on cardiovascular performance through mechanisms both mutual and exclusive to haemodialysis. The aim of this paper is to give an appreciation of the possibility that modification of the dialysis procedure is capable of improving treatment tolerability and has the potential to reduce the excessive rates of cardiovascular morbidity and mortality.

Estratificação de risco para evento isquêmico coronariano em adultos jovens na sala de emergência / The stratification of risk for coronarian ischemic event in young adults carried through by the nurse in the emergency room

Trata o estudo da estratificação de risco para evento isquêmico coronariano em adultos jovens realizada pelo enfermeiro na sala de emergência. Os objetivos propostos constam de descrever os problemas comumente observados pelos enfermeiros na sala de emergência durante a investigação de eventos isquêmicos coronariano em adultos jovens; e analisar a aproximação ao algoritmo para a clinica de dor torácica a partir da abordagem semiológica do enfermeiro na investigação de evento isquêmico coronariano em adulto jovem na sala de emergência. Trata-se de um estudo exploratório descritivo, com abordagem qualitativa realizado no serviço de emergência do Hospital Municipal Souza Aguiar, no município do Rio de Janeiro. Para este estudo, os sujeitos foram compostos por 8 enfermeiros da sala vermelha do serviço de emergência. Os dados foram coletados através de entrevistas por meio de três questões semi-estruturadas voltadas para obter depoimentos acerca da inserção desses enfermeiros no contexto assistencial do paciente adulto jovem portador de síndrome isquêmica coronariana atendido nesse cenário...

It deals with the study the stratification of risk for coronarian ischemic event in youngadults carried through by the nurse in the emergency room. The considered objectivesconsist to describe the problems usualy observed by the nurses in the emergency roomduring the inquiry of ischemic events coronarian in young adults; e to analyze the approachto the algorithm for the chest clinic of pain from the semiologic boarding of the nurse in theinquiry of coronarian ischemic event in young adult in the emergency room. One is about adescriptive exploratory study, with qualitativeboarding carried through in the service ofemergency of the Municipal Hospital Souza Aguiar, in the city of Rio de Janeiro. For thisstudy, the citizens had been composites for 8 nurses of the red room of the emergencyservice. The data had been collected through interviews by means of three half-structuralized questions come back to get depositions concerning the insertion of thesenurses in the assistencial context of the adult patient young carrier of taken care ofcoronarian ischemic syndrome in this scene...