The Impact of Inadequate Energy Intake on Readmission Burden of Patients With Heart Failure.

BACKGROUND: Adequate energy intake is essential for good clinical outcomes. The association between energy intake and readmission burden of patients with heart failure (HF) still needs to be clarified. OBJECTIVE: In this study, our aim was to determine the association between energy intake and readmission in patients with HF. METHODS: A total of 311 inpatients with HF were recruited. Demographic and clinical information were collected during hospitalization; the daily diets of the participants were collected in the second week after discharge using the 3-day diet record, and the energy intake was calculated using a standardized nutrition calculator. The inadequate energy intake was defined as <70% × 25 kcal/kg of ideal body weight. The participants were followed up for 12 weeks after discharge. The number, reasons, and length of stay of unplanned readmissions were collected. Regression analyses were used to evaluate the associations between inadequate energy intake, and readmission rate and readmission days. RESULTS: The median of the energy intake of participants was 1032 (interquartile range, 809-1266) kcal/d. The prevalence of inadequate energy intake was 40%. Patients with inadequate energy intake had a higher risk of unplanned readmission (odds ratio, 5.616; 95% confidence interval, 3.015-10.462; P < .001) and more readmission days (incidence rate ratio, 5.226; 95% confidence interval, 3.829-7.134, P < .001) after adjusting for potential confounders. CONCLUSIONS: Patients with HF had a high incidence of inadequate dietary energy intake, and it increases the burden of readmission.

The Influence of Informal Caregivers' Preparedness on Psychological Symptoms and Quality of Life Among Patients With Heart Failure And Insufficient Self-care.

BACKGROUND: Most patients with heart failure find self-care difficult to perform and rely on family caregivers for support. Informal caregivers, however, often face insufficient psychological preparation and challenges in providing long-term care. Insufficient caregiver preparedness not only results in psychological burden for the informal caregivers but may also lead to a decline in caregiver contributions to patient self-care that affects patient outcomes. OBJECTIVE: Our objective was to test (1) the association of baseline informal caregivers' preparedness with psychological symptoms (anxiety and depression) and quality of life 3 months after baseline among patients with insufficient self-care and (2) the mediating effects of caregivers' contributions to self-care of heart failure (CC-SCHF) on the relationship of caregivers' preparedness with patients' outcomes at 3 months. METHODS: A longitudinal design was used to collect data between September 2020 and January 2022 in China. Data analyses were conducted using descriptive statistics, correlations, and linear mixed models. We used model 4 of the PROCESS program in SPSS with bootstrap testing to evaluate the mediating effect of CC-SCHF of informal caregivers' preparedness at baseline with psychological symptoms or quality of life among patients with HF 3 months later. RESULTS: Caregiver preparedness was positively associated with CC-SCHF maintenance ( r = 0.685, P < .01), CC-SCHF management ( r = 0.403, P < .01), and CC-SCHF confidence ( r = 0.600, P < .01). Good caregiver preparedness directly predicted lower psychological symptoms (anxiety and depression) and higher quality of life for patients with insufficient self-care. The associations of caregiver preparedness with short-term quality of life and depression of patients with HF with insufficient self-care were mediated by CC-SCHF management. CONCLUSIONS: Enhancing the preparedness of informal caregivers may improve psychological symptoms and quality of life of heart failure patients with insufficient self-care.

Effects of psychological interventions on clinical outcomes in patients with cardiovascular diseases: A systematic review and meta-analysis.

OBJECTIVE: To perform a systematic review and meta-analysis to evaluate the effects of psychological interventions on the clinical outcomes of patients with cardiovascular diseases (CVDs). METHODS: We searched PubMed, Web of Science, Embase, the Cochrane Library, and CINAHL from the establishment of each database to August 1, 2023. Randomized controlled trials (RCTs) on psychological interventions in patients with CVDs were included. Statistical analyses were performed using Review Manager 5.3 and Stata 17.0, and pooled measures were presented as the relative risk (RR) and 95 % confidence interval (CI). RESULTS: A total of 32 studies were included, involving 15,814 patients. Our results showed that psychological interventions could reduce cardiac mortality (RR = 0.81, 95 % CI = 0.68 to 0.96) and the occurrence of myocardial infarction (MI) (RR = 0.79, 95 % CI = 0.69 to 0.89), arrhythmia (RR = 0.61, 95 % CI = 0.42 to 0.89) and angina (RR = 0.92, 95 % CI = 0.87 to 0.97). However, no statistically significant differences were detected in the risk of all-cause mortality, all-cause rehospitalization rates, cardiac rehospitalization rates, revascularization, heart failure (HF), or stroke between the psychological intervention and control groups. CONCLUSIONS: Psychological interventions can reduce cardiac mortality and the occurrence of MI, arrhythmia, and angina in patients with CVDs. It is crucial to incorporate psychological interventions into the existing treatment and management of patients with CVDs. High-quality RCTs should be conducted to explore the optimal psychological intervention methods and the maximum beneficiaries.

The Content and Nature of Rumination in Chinese Young and Middle-Aged Patients with Acute Coronary Syndrome: A Qualitative Study.

Individuals have different rumination patterns after experiencing traumatic events in different cultural backgrounds and situations. This study aimed to explore the experience of Chinese young and middle-aged patients with acute coronary syndrome (ACS) to understand the content and nature of their rumination. Sixteen participants were selected using the purposive sampling method in the First Affiliated Hospital of Soochow University from May 2023 to December 2023. Data were collected using semi-structured interviews and analyzed using Colaizzi's seven-step phenomenological method. The participants went through two successive stages: non-adaptive rumination and adaptive rumination. During the initial admission phase, all the participants experienced varying degrees of non-adaptive rumination. Non-adaptive rumination included four sub-themes: worry or anxiety of daily activities and medical therapy (37.50%), fear of unpredictable outcomes and death (37.50%), sadness of maladjustment (25.00%), and remorse of carelessness (12.50%). During the period of stable condition and pre-discharge, the participants received health education and gradually all transitioned to adaptive rumination. Adaptive rumination included four sub-themes: tracing of disease processes (100%), enhancement of disease cognition (81.25%), improvement of health awareness (62.50%), and adjustment of lifestyle cognition (100%). In conclusion, although the Chinese young and middle-aged patients with ACS experienced negative emotions after a traumatic cardiac event, they gradually made positive changes, and optimism and information support played important roles in this transition. The results of this study provide a fundamental understanding of rumination experiences in Chinese young and middle-aged patients with ACS and provide new data for healthcare providers when designing intervention programs to enhance post-traumatic growth in these patients.

Effects of weight loss in heart failure patients with overweight and obesity: a systematic review and meta-analysis.

AIMS: To perform a systematic review and meta-analysis to evaluate the impact of weight loss (WL) on the prognosis of overweight and obese patients with heart failure (HF). METHODS AND RESULTS: We reviewed the literature up to 1 February 2023 from PubMed, Web of Science, Embase, Cochrane Library, and Chinese databases for cohort studies, and randomized controlled trials (RCTs). Data from eligible studies were extracted, and statistical analyses were performed using Review Manager 5.3. A total of 19 studies (involving 449 882 patients) were included in the systematic review and meta-analyses. The results showed that WL did not reduce the mortality and rehospitalization rates in overweight and obese HF patients, but could improve the quality of life (P = 0.002), cardiac function (P = 0.0001), and exercise capacity (P = 0.03). The subgroup analysis showed that WL from bariatric surgery (BS) reduced the risk of death (P < 0.00001), WL from medication or exercise was not significantly associated with the risk of death (P = 0.18), and WL was associated with a higher mortality in the subgroup with unspecified WL modality or unintentional WL (P < 0.00001). In addition, it did not reduce the risk of short-term rehospitalization (P = 0.11), but reduced the rehospitalization rates over the long-term (P = 0.03). CONCLUSION: WL improves the long-term rehospitalization (>3 months), quality of life, cardiac function, and exercise capacity in overweight and obese HF patients. Although overall WL is not proven effective, subgroup analysis shows that BS can reduce mortality.

We used mortality, rehospitalization rates, quality of life, the New York Heart Association (NYHA), and 6-min walk test (6 MWT) to assess the impact of weight loss (WL) on the prognosis of overweight and obese heart failure (HF) patients. Key findings: WL is associated with improvements in long-term rehospitalization rates, quality of life, cardiac function, and exercise capacity.Bariatric surgery (BS) may reduce mortality in overweight and obese HF patients. Unintentional WL of more than 5% may mean a bad condition and could increase mortality.

The impact of informal caregivers' preparedness on short-term outcomes of heart failure patients with insufficient self-care.

AIMS: Even though self-care is essential in the long-term management of heart failure (HF), it is often not performed adequately in HF populations. Mobilizing informal caregivers may be one way to help patients perform self-care, support individual needs, and maintain health. However, informal caregivers often face insufficient preparation for providing long-term care. This insufficient caregiver preparedness may lead to a decline in caregiver contributions and affect the outcomes of care in patients with HF. This study aimed to explore whether informal caregivers' preparedness is a predictor that influences short-term outcomes of HF patients; to analyse whether caregiver contribution to self-care of HF (CC-SCHF) plays a mediating role between informal caregivers' preparedness and HF short-term outcomes. METHODS AND RESULTS: A prospective observational study was conducted in China. After controlling for covariates, higher levels of informal caregivers' preparedness were significantly associated with lower 3-month mortality [odds ratio (OR) = 0.919, 95% confidence interval (CI) = (0.855-0.988), P = 0.022] and 3-month readmission rate [OR = 0.883, 95% CI = (0.811-0.961), P = 0.004] and shorter length of hospital stay (ß = -0.071, P < 0.001). The informal caregiver's preparedness was positively associated with CC-SCHF maintenance (r = 0.708, P < 0.01), CC-SCHF management (r = 0.431, P < 0.01), and CC-SCHF confidence (r = 0.671, P < 0.01). The CC-SCHF management was a mediator in the relationship between informal caregivers' preparedness and 3-month readmission rate [effect 95% CI = (-0.054 to -0.001)] and length of hospital stay [effect 95% CI = (-0.235 to -0.042)]. CONCLUSION: A higher level of informal caregivers' preparedness is associated with better short-term outcomes of HF patients with insufficient self-care.

Implementation of the Flipped Classroom Combined with Problem-Based Learning in a Medical Nursing Course: A Quasi-Experimental Design.

Background: Medical Nursing is one of the most important core courses in nursing education, and the emergence of the flipped classroom has made up for the shortcomings of traditional teaching and improved the effectiveness of teaching. However, it is worth exploring how to maximize the effect of students' self-study before class while making full use of classroom teaching to promote the cultivation of students' abilities, so that the flipped classroom can have a maximal teaching effect. Therefore, this study explored the effect of a flipped-classroom teaching mode based on a small private online course (SPOC) combined with problem-based learning (PBL) in a course of Medical Nursing. Methods: Nursing undergraduates from the years 2018 (control group) and 2019 (experimental group), respectively, used the traditional lecture method and the flipped-classroom teaching mode based on a SPOC combined with PBL. The teaching effect was evaluated by teaching-mode-recognition evaluation, critical thinking measurement, and academic achievement. Results: The scores of teaching-mode recognition evaluated by the students in the experimental group were higher than those in the control group in the following five aspects: "helping to improve learning interest" (p = 0.003), "helping to improve autonomous learning ability" (p = 0.002), "helping to improve communication and cooperation ability" (p < 0.001), "helping to cultivate clinical thinking" (p = 0.012), and "helping to promote self-perfection and sense of achievement" (p = 0.001). Compared with the control group, the score on the "analytical ability" dimension of the Critical Thinking Disposition Inventory in the experimental group was higher (p = 0.030). The excellent rates of the final theoretical examination (p = 0.046) and comprehensive case analysis (p = 0.046) in the experimental group were higher than those in the control group. Conclusions: The flipped-classroom teaching mode based on a SPOC combined with PBL can promote students' abilities of autonomous learning, communication and cooperation, and clinical and critical thinking; improves their academic performance; and is recognized and welcomed by them. However, to extend the flipped-classroom teaching model of a SPOC combined with PBL to other nursing education courses, more optimization and evaluation are required.