Predischarge education improves adherence to a healthy lifestyle among Jordanian patients with acute coronary syndrome

Risk factor reduction and modification of patient lifestyle have become the focus of secondary prevention and cardiac rehabilitation programs. Considering the scarcity of resources in developing countries, nurses can potentially provide great benefit to acute coronary syndrome patients by utilizing hospital time to teach the patients how to lower their risk for recurrence and adopt healthier lifestyles after discharge. The purpose of this study was to identify the effectiveness of a predischarge education on acute coronary syndrome patients' lifestyles. Quasi‐experimental pretest–post‐test design was used. The patients assigned to the experimental group were offered predischarge education that stimulates lifestyle modification and adoption of a healthier lifestyle. The experimental group scored significantly higher than the control group in three lifestyle components – health responsibilities, nutrition, and interpersonal relations. In conclusion, predischarge education helps motivate acute coronary syndrome patients to adhere to a healthy lifestyle postdischarge. Therefore, nurses must be educated and prepared to be qualified health educators, and health education should continue as one of the most important daily nursing practices, thus it is invested in the preparation of acute coronary patients' discharge plan.     

药学干预对心肌梗死出院患者用药依从性及预后的影响

目的 探讨在急性心肌梗死(AMI)出院患者中开展药学服务干预的效果。方法 选取我院心血管内科就诊的AMI出院患者140例,随机分为两组各70例,对照组仅给予常规医嘱,观察组在此基础上,由临床药师提供专业的药学干预。两组均随访12个月,比较Morisky用药依从性问卷(MMAS-8)评分、药物漏服率及预后情况。结果 药学干预对用药依从性的影响差异有统计学意义(P<0.01);时间因素对用药依从性的影响差异有统计学意义(P<0.01);组别与时间的交互作用差异有统计学意义(P<0.01);干预3个月、6个月、12个月观察组漏服率低于对照组(均P<0.01);随访12个月,观察组AMI复发率(7.14%)、复住院率(8.57%)低于对照组(18.57%,21.43)(P<0.05)。结论 在AMI出院患者中开展药学服务干预能够提高患者用药依从性,降低疾病复发率,改善患者临床预后。     

Social support and change in vascular risk factors in patients with clinical manifestations of vascular diseases

Background and aims

Vascular risk can be reduced by adequate medical treatment of vascular risk factors and by adopting a healthy lifestyle, a behavioral change that is influenced by social support. We investigated whether social support is associated with change in vascular risk factors in patients with vascular diseases during 1 year.

Methods

140 patients who had 2 modifiable vascular risk factors participated. Social support was measured with a questionnaire about the patient's perception of active involvement, protective buffering, and overprotection.

Results

Most types of social support were not associated with a change in vascular risk factors over 1 year. Having a partner was associated with a reduction in BMI of 1.4 kg/m² (95%CI − 2.2 to − 0.5), less protective buffering was associated with a decrease in blood glucose of 0.47 mmol/l (95%CI 0.09-0.84), and less active involvement was associated with an increase in BMI of 0.42 kg/m² (95%CI 0.05-0.78).

Conclusion

Having a partner and active involvement are only associated with a decrease in BMI but not with changes in other vascular risk factors. Protective buffering is only associated with blood glucose whereas overprotection is not associated with changes in vascular risk factors.     

Profile of atrial fibrillation inpatients: Cardiovascular risk factors and cardiac rehabilitation programme delivery and referral patterns

Atrial fibrillation (AF) is increasingly common; however, the cardiovascular risk factor profile and the patterns of delivery and referral to cardiac rehabilitation (CR) in this population are poorly described. We conducted an audit of medical records (n = 145) of patients admitted with AF in one local health district in Sydney, Australia. Patients were aged a mean 72 years, and 51% were male. Lack of risk factor documentation was common. Despite this, 65% had two or more modifiable cardiovascular risk factors, including hypertension (63%) and hypercholesterolaemia (52%). Referral to Phase II CR occurred for 25% and was decreased with permanent AF diagnosis and increased with more risk factors. AF patients admitted to hospital have multiple cardiovascular risk factors but limited risk factor screening and/or referral to outpatient CR programmes.     

早期综合康复训练对急性脑梗死患者预后的影响及危险因素分析

目的：探讨早期综合康复训练对急性脑梗死患者预后的影响及其预后结局的危险因素分析。方法：将120例急性脑梗死患者随机分对照组和观察组各60例,对照组给予常规药物治疗,观察组在此基础上再给予基础训练、言语训练、针灸等早期综合康复训练;比较2组的汉密尔顿抑郁量表（HAMD）评分、美国国立卫生院神经功能缺损量表（NIHSS）评分、简式Fugl-Meyer运动功能评分（FMA）、日常生活活动能力（ADL）评分;采用多因素分析法来筛选脑梗死患者预后不良的危险因素。结果：治疗3个月后,观察组的 HAMD评分、2组NIHSS评分均较治疗前明显降低（P＜0．01）,且治疗后观察组HAMD、NIHSS评分更低于对照组（P＜0．01）;对照组 HAMD评分治疗前后差异无统计学意义。治疗后,2组 FM A及 ADL 评分均较治疗前明显提高,且观察组更高于对照组（ P＜0．01）。多因素分析显示,年龄、糖尿病、感染、晚就诊、未实施早期康复训练、NIHSS评分低均为脑梗死预后不良的危险因素（ P＜0．05,0．01）。结论：急性脑梗死患者实施早期综合康复训练后,可改善抑郁状态,促进神经功能恢复,提高日常生活质量;脑梗死预后的独立危险因素较多,应制定有针对性的有效预防措施,防治病情加重。     

癌症患者非器质性的性康复障碍高危因素探讨

目的 :了解癌症患者非器质性的性康复障碍高危因素 ,为临床制订治疗策略提供依据。方法 :采用书面问卷调查的形式 ,对 10 0例符合入选条件的癌症住院患者进行调查。结果 :Logistic多因素分析提示“认为病后不能过性生活”、“病前经济收入占家庭总收入 5 0 %以上”及“体力状态 2— 3分”是影响患者性康复重要的独立因素 ,优势比分别约为 12 .3、7.0和 6 .7(P <0 .0 0 1)。结论 :以上三个指标是患者非器质性的性康复障碍高危因素     

河北任丘市老年居民脑梗死复发的相关因素分析

目的 探讨河北任丘市老年居民脑梗死复发的相关因素,为防治提供理论依据。方法 将随机抽取任丘市年龄60~70岁的常驻居民5 010例为筛查对象,其中有首次脑梗死病史且2年未失访的459例居民作为研究对象,2年中脑梗死复发53例。前瞻性分析任丘老年居民脑梗死复发的相关因素。结果 多因素Logistic回归分析显示:低密度脂蛋白胆固醇(LDL-C)(OR=1.502,95%CI=1.023~2.207)、颈动脉斑块(OR=2.298,95%CI=1.085~4.867)是任丘老年居民脑梗死复发的独立危险因素(P＜0.05)。结论 任丘老年居民脑梗死复发的主要危险因素是LDL-C、颈动脉斑块,对其进行充分认识并积极干预,对有效预防脑梗死复发有重要意义。     

Physical and psychological improvements after phase II cardiac rehabilitation in patients with myocardial infarction

We have designed a new 4-week hospitalized phase II cardiac rehabilitation program. The purpose of the present study is to clarify whether the physical and psychological status of patients with myocardial infarction (MI) improves after participation in our program. Twenty-nine patients (27 males, two females) with acute MI who enrolled in the 4-week hospitalized phase II rehabilitation program were assessed. All patients enrolled in this study had received coronary interventions. The rehabilitation consisted of exercise training, education and counseling. We evaluated the physical and psychological status of the patients before and just after the program, and at a 6-month follow up. The physical status was assessed by exercise tolerance measured by the peak oxygen consumption and anaerobic threshold, frequency of exercise, and serum concentrations of triglyceride, total cholesterol, high-density lipoprotein-cholesterol, and low-density lipoprotein-cholesterol. The psychological status was assessed by the Spielberger state-trait anxiety inventory questionnaire (STAI) and the self-rating questionnaire for depression (SRQ-D). Thirty-four patients (27 men, seven women) with MI who did not participate in our rehabilitation program served as a control group. After participation in our rehabilitation program, exercise tolerance and the serum lipid profiles of the patients were improved compared with those before rehabilitation. These parameters had improved significantly 6 months after rehabilitation. The STAI anxiety score was improved significantly and the SRQ-D depression score tended to be improved just after the rehabilitation program. Regular physical activity was continued even 6 months after the completion of the program. Our hospitalized phase II cardiac rehabilitation program improved the management of cardiac risk factors and the psychological status in patients with MI. This comprehensive program may contribute to the secondary prevention of MI as well as the recovery of physical and psychological activities.     

中老年病人再发性心肌梗死的危险因素研究

[目的]探讨再发心肌梗死病人(RAMI)的危险因素。[方法]采用回顾性病例对照方法，从2011年6月-2013年6月住院的明确诊断为再发心肌梗死的病人42例为再发性心肌梗死组(RA-MI组)，按照性别相同、年龄±2岁、1：2匹配原则，随机选择同期住院已确诊首发心肌梗死病人作为心肌梗死组，共84例，记录年龄、性别、既往史、家族史、住院情况等指标。[结果]RAMI 组病人年龄、心率、收缩压、舒张压、体质指数、总胆固醇、空腹血糖以及吸烟者比例、Ⅲ度房室传导阻滞者比例均较高，甘油三酯、高敏C反应蛋白、低密度脂蛋白及射血分数较低。高龄、心率、体质指数、高血压、糖尿病以及吸烟是再发性心肌梗死的危险因素，其OR值依次为1.107、1.032、1.030、1.603、1.610和1.227。[结论]首发急性心肌梗死病人，干预高血压，积极治疗高血脂、控制理想血糖水平，同时戒烟酒、控制体重，才能进一步降低心肌再梗死发病率。     

心脏康复治疗对急性心肌梗死患者心率变异性的影响

目的探讨Ⅰ期心脏康复对急性心肌梗死(AMI)患者心率变异性(HRV)的影响。方法选取我院2016年6月至2018年6月收治的104例急性ST段抬高型心肌梗死(STEMI)患者作为研究对象,按照是否接受院内Ⅰ期心脏康复治疗将其分为观察组(接受心脏康复治疗,48例)和对照组(未接受心脏康复治疗,56例)。比较两组患者的HRV指标、入院时与出院前的心理状态、运动能力。结果观察组患者的SDNN、SDANN、RMSSD、pNN50、VLF、HF均高于对照组(P<0.05);两组患者的LF、LF/HF比较,差异无统计学意义(P>0.05)。出院前,两组患者的SAS评分均低于入院时,且观察组低于对照组(P<0.05)。出院前,观察组患者的心率无氧阈水平高于对照组(P<0.05)。结论Ⅰ期心脏康复能提高STEMI患者的HRV,改善其焦虑情况及运动能力。     

Perceptions of illness as predictive factors for perceived stress in patients participating in a cardiac rehabilitation program

Psychosocial risk factors, such as perceived stress, not only increase the risk of cardiovascular disease, but also act as barriers for treatment adherence and cardiac rehabilitation. In this study, we examined the predictive role of perceptions for illness to perceived stress in Iranian patients participating in a cardiac rehabilitation program. A cross‐sectional study was conducted in 2017 to determine correlations of demographic variables and domains of illness perception with perceived stress, and to develop a predictive model for perceived stress. In total, 150 patients with cardiovascular disease, who were admitted to a cardiac rehabilitation center, completed the questionnaires. (i) demographic and health‐related characteristics; (ii) the Perceived Stress Scale‐14; and (iii) the Brief Illness Perception Questionnaire. The mean perceived stress was 16.2 (8.4), and five illness perception subscales – timeline, personal control, treatment control, understanding and emotional response – were associated with increased perceived stress. Variables in the multi‐variate predictive model accounted for 48% of the total variance in perceived stress. The results demonstrated the value of assessing and managing the patients' perceptions of illness to reduce their perceived stress, which could support adherence to cardiac rehabilitation programs.     

Medication adherence and predictive factors in patients with cardiovascular disease: A comparison study between Australia and Iraq

Background: Adherence to cardiac medication regimes is essential for effective treatment of cardiovascular disease but is unsatisfactory in Australia and little studied in Iraq.Aim: This study evaluated and compared adherence to cardiac medications and potentially predictive factors based on the Theory of Planned Behaviour (TPB) in patients with cardiovascular disease admitted to hospital and attending cardiac services in Australia and Iraq.Methods: A cross-sectional multi-centre comparative study involving 246 cardiac patients was conducted in Australia (one hospital in Sydney) and Iraq (three cardiac hospitals in Baghdad) between October 2016 and December 2017. Adherence to medications and related factors were examined using established, validated questionnaires, formally translated and validated into Arabic for Iraqi participants. Binary logistic regression was conducted to determine those factors independently predictive of cardiac medication adherence, in Australia and Iraq.Findings: A significantly higher proportion (64.3%) of Iraqi than Australian (37.5%) cardiac patients reported medium/low levels of adherence to their cardiac medications. After adjusting for confounding factors, the ability to correctly self-administer and refill medications, and beliefs about cardio-protective medication were identified as independent predictors of cardiac medication adherence behaviour in both Australian and Iraqi participants. In Iraq, patients recruited from out-patient cardiac clinics were significantly more likely to report adherent behaviours that patients recruited as in-patients of the cardiac ward.Conclusion: Non-adherence to cardiac medications differed but was sub-optimal in both Australian and Iraqi patient samples, in both countries, adherence was associated with patients’ beliefs about medications, and ability to self-administer and refill medications. Clinical nurses and pharmacists need to investigate these factors at every point in the cardiac trajectory to optimise medication adherence.     

中青年与老年急性心肌梗死临床特点和危险因素对比分析

目的探讨中青年人和老年人急性心肌梗死(AMI)的临床特点及危险因素的差异,以提高防治效果.方法将187例AMI患者按年龄分为中青年组42例(≤45岁)和老年组145例(≥60岁),比较分析两组间发病的危险因素及性别、梗死部位、并发症的特点.结果临床特点:中青年组女性仅2.4%,老年组女性占46.9%.梗死部位中青年组以前壁、前间壁最多,老年组以广泛前壁为多.并发症老年组明显高于中青年组.危险因素:冠心病家族史和吸烟者中青年组分别为52.4%、83.3%,老年组分别为6.2%、44.1%,两组比较差异有统计学意义(P<0.005);高血压、糖尿病者中青年组分别为33.3%、2.4%,老年组分别为67.6%、18.6%,两组比较差异有统计学意义(P<0.01).血脂水平两组比较差异无统计学意义(P>0.05),但两组均>55%.结论冠心病家族史、吸烟、男性是中青年人AMI的主要危险因素.     

Kinesiophobia mediates the influences on attendance at exercise-based cardiac rehabilitation in patients with coronary artery disease

Purpose: To identify predictors of attendance at exercise-based cardiac rehabilitation (CR) and to test the hypothesis that kinesiophobia mediates the influence on attendance at CR in patients with coronary artery disease (CAD). Patients: In total, 332 patients (75 women; mean age 65 ± 9.1 years) with a diagnosis of CAD were recruited at Sahlgrenska University Hospital, Sweden.Methods: The patients were tested in terms of objective measurements, self-rated psychological measurements, and level of physical activity. A path model with direct and indirect effects via kinesiophobia was used to predict participation in CR. An exploratory selection of significant predictors was made. Results: A current incidence of coronary bypass grafting (p < 0.001) and a diagnosis of ST-elevation myocardial infarction (p = 0.004) increased the probability of attendance at CR, while kinesiophobia (p = 0.001) reduced attendance. As a mediator, kinesiophobia was influenced by four predictors and the following indirect effects were found. General health and muscle endurance increased the probability of attendance at CR, while self-rated anxiety and current incidence of heart failure had the opposite effect. Conclusions: This study suggests that kinesiophobia has an influence on and a mediating role in attendance at CR. The results need to be further investigated in relation to clinical practice.