A qualitative study: Perceptions of the psychosocial consequences and access to support after an acute myocardial infarction

Protocol for a feasibility randomized trial of a social support intervention plus usual care versus usual care, targeting patients treated for cardiac disease who experience loneliness

INTRODUCTION

In patients treated for cardiac disease, loneliness is known to contribute negatively to health behavior, health outcome, and increase risk of cardiac and all-cause mortality. Even so, in health care research, social support interventional studies targeting patients who experience loneliness are lacking.

AIM

To determine the feasibility of an individually structured social support intervention targeting patients treated for cardiac disease who experience loneliness.

DESIGN

A feasibility study based on randomized clinical trial design with 1:1 randomization to a 6-month social support program, plus usual care (intervention) versus usual care, (i.e., regular guidelines-based follow-up).

INTERVENTION

Patients classified as high risk lonely according to the High Risk Loneliness tool will be provided with an informal caregiver in the 6 months rehabilitation phase following cardiac disease treatment. The informal caregiver will be designated by the patient from the existing social network or a peer, depending on patients' preferences. The core content of the intervention is through nurse consultations at baseline and 1, 3, and 6 months, to enhance and reinforce the informal caregiver's competences to be a social support resource. The theoretical framework of the nurse consultations will be based on middle-range theory of self-care.

OUTCOME

Feasibility will be evaluated in terms of acceptability and adherence according to predefined feasibility criteria. The preliminary effect of the intervention on patient-reported outcomes, health behaviors, and health outcomes will be evaluated in the intervention and the control group at baseline and 1, 3, 6, and 12 months.

DISCUSSION

The present study will contribute with knowledge on how to implement a feasible social support intervention targeting patients treated for cardiac disease who experience loneliness and, furthermore, investigate the preliminary effect on health behavior and health outcome in the early rehabilitation period.

TRIAL REGISTRATION

The trial is registered on clinicaltrials.gov (NCT05503810) 18.08.2022.

Being Uncertain: Rural-Living Cardiac Patients' Experience of Seeking Health Care

Cardiovascular disease (CVD) is a leading cause of morbidity and mortality worldwide. Secondary prevention strategies reduce disease progression to heart failure. Rural cardiac patients typically have less access to health care resources to support them in managing secondary prevention, and services to improve quality of life tend to be lacking in rural settings. The study aim was to examine the process that rural cardiac patients go through to access health care and cardiac rehabilitation (CR) following myocardial infarction (MI). In-depth interviews with 11 post-MI participants using Straussian grounded theory were undertaken. Analysis revealed a linear process from hospital discharge to maintaining health. There were five elements: comfort with health information, relationship with health care providers, social support, taking ownership, and availability of/for CR. The core category was "being uncertain." Findings can be used to identify ways to improve access and address uncertainty stemming from a lack of perceived information and supports following discharge.

Who Cares? Perception of Loneliness in Patients Treated for Coronary Heart DiseaseHvem bekymrer sig? Oplevelsen af ensomhed hos patienter med iskæmisk hjertesygdom

Social support is known to be essential to cope with the physical and psychological aftermath following coronary heart disease treatment. Consequently, patients experiencing loneliness may be placed in a vulnerable situation. The aim of this study was to provide insight into the nuances and complexity of loneliness and its impact on health behaviour in the early rehabilitation period following treatment. The study used a hermeneutic philosophical approach. Patients classified as lonely were interviewed in either a focus group ( n = 7) or in an individual interview ( n = 10). We analysed the empirical material using inductive content analysis. The analysis illuminated various dimensions of patients’ perceived loneliness; ‘Loneliness as an emotional pain’, ‘A changed, but unmet need for social support’ and ‘Striving for symmetry in relationships’. Loneliness negatively influenced patients’ ability to adapt to the critical event and manage health behaviour changes. Insight into the mechanisms that aggravate loneliness may inform future social support interventions.

Social støtte er beskrevet som essentiel i forbindelse med håndteringen af de fysiske og psykiske følger af iskæmisk hjertesygdom. Derfor kan patienter som oplever ensomhed være i en særlig sårbar situation. Formålet med dette kvalitative studie var at opnå en nuanceret indsigt i patients oplevelse af ensomhed, samt hvordan ensomhed influerer på sundhedsadfærd i den tidlige rehabiliteringsperiode efter behandlingen for iskæmisk hjertesygdom. I studiet havde vi en hermeneutisk filosofisk tilgang. Patienter klassificeret som ensomme blev interviewet enten individuelt (n = 10) eller i fokusgruppe (n = 7). Vi analyserede det empiriske materiale med induktiv indholdsanalyse. Analysen tydeliggjorde forskellige dimensioner af patienternes oplevede ensomhed: ”Ensomhed som en emotionel smerte”, ”Et ændret, men ikke imødekommet behov for social støtte”, Stræben efter symmetri i relationer”. Ensomhed havde en negativ indflydelse på patienternes mulighed for at håndtere den kritiske hændelse og på sundhedsadfærd. En øget indsigt i de mekanismer som forværrer ensomhed, har relevans ved udarbejdelsen af fremtidige sociale støtteinterventioner.

One size does not fit all: A qualitative study exploring preferences and barriers towards the design of a loneliness reduction intervention in patients with coronary heart disease

Aim

To explore preferences and barriers towards the design of a loneliness reduction intervention in patients treated for coronary heart disease who experience loneliness.

Design

A qualitative study using patient involvement methodology.

Methods

Seventeen patients participated in either focus groups or individual interview sessions. The interview guide was based on patient involvement methodology. Interviews were analysed using deductive content analysis.

Results

Four overall findings emerged as follows: (a) An intervention involving a social network member must comply with patients perceived social norms; (b) An intervention involving a peer provides benefits from reciprocity and shared experiences, but also requires surplus mental energy; (c) The history of an existing relationship can act as both provider and barrier for confidentiality and (d) Start‐up, timeframe and structure of the intervention should be individually tailored to the patient's preferences. Findings illuminated preferences and barriers towards the design of a loneliness reduction intervention in patients with coronary heart disease.

Heart-Focused Anxiety: An Evolutionary Concept Analysis

Although heart-focused anxiety is a common experience of patients following a myocardial infarction, it is one rarely addressed in nursing research. I used Rodger's evolutionary method of concept analysis to review uses of heart-focused anxiety in literature from several disciplines including nursing and synthesized a definition to guide future research. Heart-focused anxiety is an experience of avoidance, fear, and heart-focused attention that follows from cardiac diagnoses, somatic symptoms, and familial factors and results in adverse health outcomes, reassurance seeking, disruption of life, and recurrent chest pain. Although heart-focused anxiety is an evolving concept, the updated definition should help provide a foundation for future research. A Supplemental Digital Content video abstract is available at http://links.lww.com/ANS/A32.

Cardiovascular disease and meaning in life: A systematic literature review and conceptual model

OBJECTIVES

Previous studies have shown that psychological stress and mental health problems increase the risk for cardiovascular disease (CVD) events, such as heart attack or stroke. Furthermore, after CVD events, the majority of patients report large stress. However, psychological treatments have only modest effects in CVD patients. Therefore, it has been argued that new conceptual models are needed to understand the aetiology of stress and mental health problems in CVD patients. Therefore, this study included a systematic literature review and a conceptual model on the role of meaning in life for psychological stress, mental health, and CVD risks.

METHODS

A systematic literature review was conducted on relationships between CVD and meaning in life. PRISMA/MOOSE review guidelines were followed. These findings were used to build a conceptual model.

RESULTS

The literature review included 113 studies on meaning and CVD. The included studies described meaning as a predictor of cardiovascular risks and health, meaning-centered needs of patients in conversations with medical staff, meaning-centered changes after CVD events, meaning-centered coping with CVD, meaning as motivator of CVD-related lifestyle changes, and meaning as an element in psychological treatments of CVD patients. In sum, the literature showed that a central clinical concern for patients is their question how to live a meaningful life despite CVD. Meaning-centered concerns seem to lead to lower motivation to make lifestyle changes, more psychological stress, lower quality-of-life, worse physical well-being, and increased CVD risk. The ability to live a meaningful life after CVD events is related with lower stress, better mental health, and several biomarkers.

SIGNIFICANCE OF RESULTS

An evidence-based conceptual framework was developed for the relationship between meaning and CVD. It may be hypothesized CVD patients may benefit from psychological therapies focused on meaning.

Men's Positive and Negative Experiences Following Acute Myocardial Infarction

(1) Objective: To describe men's experiences as acute myocardial infarction sufferers from a social phenomenological perspective, a year after the event (2) Methods: The phenomenological interview was used to capture the participants' discourse. The data were analyzed according to the theoretical methodological approach of social phenomenology. (3) Results: The discourse analysis of the content produced the following categories, set out according reasons "why": personal biography, knowledge set, warning signs prior to the illness, experience at the intensive care unit, and rehabilitation process; and reasons "for": expectations as regards the illness, health professionals, and future social life and work prospects. (4) Conclusions: Participants had not established a healthy condition one year after myocardial infarction, perceiving a very thin line between life and death. Personal biography influences the coping of the disease. They feel like the illness helped them to create new meanings and value of life. They envisage a future full of great restrictions and uncertainty. The results of this study have underlined the need to involve care at all stages of the illness: the physical and emotional dependence upon admittance at the intensive care unit, the need to be cured, the constant demand for information about the illness, the difficulties encountered upon returning home, uncertainty about the future, etc. All these moments indicate that proper nursing care adapted to the specific needs of each individual and their family members must be provided in order to help them to overcome all the stages involved in this process. It is necessary to individualize care because the sense of reality is common and universal, but the ways of expressing are subjective, and it depended on the totality of experiences accumulated throughout life.

Nurses' perceptions of patient participation in the myocardial infarction pathway

Aim

To explore nurses' perceptions of patient participation in different phases of the myocardial infarction pathway.

Design

Qualitative design with a hermeneutical approach.

Methods

Five focus groups were conducted at two hospitals, one with and one without percutaneous coronary intervention facilities, between February-November 2018. Participants were recruited through purposive sampling. Twenty-two nurses experienced in cardiac care participated. The analysis had a hermeneutical approach.

Results

The findings revealed nurses' perceptions of patient participation in different phases of the myocardial infarction pathway. Four themes were identified: (a) variation between paternalism and autonomy in the acute phase; (b) individualization of dialogue and patient participation during treatment; (c) lack of coherence in the pathway hinders patient participation at discharge; and (d) cardiac rehabilitation promotes patients' autonomous decisions in lifestyle changes.

The effect of problem-based learning after coronary heart disease - a randomised study in primary health care (COR-PRIM)

BACKGROUND

Cardiac rehabilitation is effective after coronary heart disease (CHD). However, risk factors remain, and patients report fear for recurrence during recovery. Problem-based learning is a pedagogical method, where patients work self-directed in small groups with problem solving of real-life situations to manage CHD risk factors and self-care. We aimed to demonstrate the better effectiveness of problem-based learning over home-sent patient information for evaluating long-term effects of patient empowerment and self-care in patients with CHD. Hypothesis tested: One year of problem-based learning improves patients' empowerment- and self-efficacy, to change self-care compared to 1 year of standardised home-sent patient information after CHD.

METHODS

Patients (N = 157) from rural and urban areas in Sweden between 2011 and 2015 (78% male; age. 68 ± 8.5 years) with CHD verified by percutaneous coronary intervention (PCI) (70.1%) or coronary artery by-pass surgery (CABG) and CABG+PCI or myocardial infarction (29.9%) were randomly assigned to problem-based learning (experimental group; n = 79) or home-sent patient information (controls; n = 78). The problem-based learning intervention consisted of patient education in primary care by nurses tutoring groups of 6-9 patients on 13 occasions over 1 year. Controls received home-sent patient information on 11 occasions during the study year.

RESULTS

At one-year follow-up, the primary outcome, patient empowerment, did not significantly differ between the experimental group and controls. We found no significant differences between the groups regarding the secondary outcomes e.g. self-efficacy, although we found significant differences for body mass index (BMI) [- 0.17 (SD 1.5) vs. 0.50 (SD 1.6), P = 0.033], body weight [- 0.83 (SD) 4.45 vs. 1.14 kg (SD 4.85), P = 0.026] and HDL cholesterol [0.1 (SD 0.7) vs. 0.0 mmol/L (SD 0.3), P = 0.038] favouring the experimental group compared to controls.

CONCLUSIONS

The problem-based learning- and the home-sent patient information interventions had similar results regarding patient empowerment, self-efficacy, and well-being. However, problem-based learning exhibited significant effects on weight loss, BMI, and HDL cholesterol levels, indicating that this intervention positively affected risk factors compared to the home-sent patient information.

TRIAL REGISTRATION

NCT01462799 (February 2020).

Do Illness Perception Predict Perceived Learning Needs Among Patients Treated With Percutaneous Coronary Intervention

BACKGROUND

The number of coronary heart disease (CHD) patients treated with percutaneous coronary intervention (PCI) has increased. The illness perception (IP) of PCI recipients needs to be evaluated. Yet, little is known whether patients' IP predicts perceived learning needs among patients treated with PCI.

OBJECTIVE

The aim of this study was to assess patients' IP and to examine its influence on perceived learning needs post PCI.

METHODS

A cross-sectional design was used. A convenience sample of 208 patients who had undergone first-time PCI participated in the study. Data were collected before patients were discharged from the hospital using the Brief Illness Perception Questionnaire and the Percutaneous Coronary Intervention Learning Need Scale.

RESULTS

Patients were highly concerned about their illness and perceived high consequences and symptoms related to CHD. They perceived low levels of personal and treatment control over their illness. Patients reported high learning needs. Multiple linear regression showed that low perception of personal control (P < .037), treatment control (P < .041), and high perception of disease symptoms (P < .018) significantly predicted high perceived learning needs.

CONCLUSION

Hence, the patients' IP influences perceived learning needs, which may be included in routine clinical assessments. Tailored health education programs are needed for patients treated with PCI; such a program should target patients who perceived low levels of personal and treatment control over illness and have a high perception of symptoms.

Factors that influence adherence to treatment plans amongst people living with cardiovascular disease: A review of published qualitative research studies

BACKGROUND

Treatment plan adherence is recognized as a worldwide health issue, particularly important in the management of cardiovascular patients. Healthcare professionals are the primary sources of information and support for people diagnosed with CVD and those who have experienced a cardiac event, yet we know little about how healthcare professionals contribute to the process of adherence to treatment plans that aim to prevent and/or reduce disease and adverse events. Qualitative evidence that explores factors that influence adherence to treatment plans is limited.

OBJECTIVE

This systematic review identified and synthesised the best available evidence on factors that influence adherence to treatment plans amongst people living with cardiovascular disease.

DESIGN

Systematic review and qualitative synthesis.

METHODS

Data were collected from Medline, Web of Science, CINAHL, PsychINFO, Embase- Non-Medline, Scopus, Cochrane Library, ProQuest Central (Grey Literature). Pre-defined keywords and MeSH terms were used to identify qualitative methods English-language studies published between 2001 and 2018. Quality appraisal of each paper was completed using the JBI Critical Appraisal Checklist and two reviewers extracted the data independently.

RESULTS

Twenty-two articles were included. Eight key themes were identified that related to facilitators and barriers to adherence to treatment plans. Facilitators were identified as engaging in exercise, having support and mentorship, lifestyle modification, and the perceived value of taking medication. Barriers were identified as a perceived lack of support, concerns about taking medication, and lack of engagement in exercise and lifestyle changes.

CONCLUSIONS

The findings highlight the factors that support adherence and healthcare professionals can build on also the areas that can be targeted to support and improve adherence to treatment plans. Nurses can play an important role in enhancing the provision of information pre hospital discharge and support in the community on taking medication, the value of physical activity and dietary changes.

Patients' narratives of their patient participation in the myocardial infarction pathway

AIM

To explore how patients in areas without local percutaneous coronary intervention (PCI) facilities experience patient participation in different phases of the myocardial infarction pathway.

BACKGROUND

Acute treatment of myocardial infarction often involves PCI. In Norway, this treatment is centralized at certain hospitals; thus, patients often require long-distance transportation and experience frequent hospital transfers. Short hospital stays, transfers between hospitals and the patient's emotional state pose challenges to promoting patient participation.

DESIGN

A qualitative design with a narrative approach.

METHODS

Participants were recruited through purposive sampling. Eight men and two women were interviewed in 2016.

FINDINGS

Four themes related to the patients' experiences at the beginning, middle and end of the pathway were identified: (a) Lack of verbal communication in the acute phase; (b) trust in healthcare professionals and treatment; (c) lack of participation and coordination at discharge; and (d) shared decision-making in rehabilitation. The findings showed how the patients moved from a low level of patient participation in the acute phase to a high level of patient participation in the rehabilitation phase.

CONCLUSION

This is the first study to explore patient participation in different phases of the myocardial infarction pathway. We argue that individual plans for information and patient participation are important to improve patient involvement in an earlier stage of the pathway. Further research from a healthcare professional perspective can be valuable to understand this topic.

IMPACT

This study gives new insight that can be valuable for healthcare professionals in implementing patient participation throughout the pathway.

Telephone-based mindfulness training to reduce stress in women with myocardial infarction: Rationale and design of a multicenter randomized controlled trial

BACKGROUND

Elevated stress is associated with adverse cardiovascular disease outcomes and accounts in part for the poorer recovery experienced by women compared with men after myocardial infarction (MI). Psychosocial interventions improve outcomes overall but are less effective for women than for men with MI, suggesting the need for different approaches. Mindfulness-based cognitive therapy (MBCT) is an evidence-based intervention that targets key psychosocial vulnerabilities in women including rumination (i.e., repetitive negative thinking) and low social support. This article describes the rationale and design of a multicenter randomized controlled trial to test the effects of telephone-delivered MBCT (MBCT-T) in women with MI.

METHODS

We plan to randomize 144 women reporting elevated perceived stress at least two months after MI to MBCT-T or enhanced usual care (EUC), which each involve eight weekly telephone sessions. Perceived stress and a set of patient-centered health outcomes and potential mediators will be assessed before and after the 8-week telephone programs and at 6-month follow-up. We will test the hypothesis that MBCT-T will be associated with greater 6-month improvements in perceived stress (primary outcome), disease-specific health status, quality of life, depression and anxiety symptoms, and actigraphy-based sleep quality (secondary outcomes) compared with EUC. Changes in mindfulness, rumination and perceived social support will be evaluated as potential mediators in exploratory analyses.

CONCLUSIONS

If found to be effective, this innovative, scalable intervention may be a promising secondary prevention strategy for women with MI experiencing elevated perceived stress.

A phenomenological construct of caring among spouses following acute coronary syndrome

The aim of this study was interpret the existential construct of family caring following Acute Coronary Syndrome. Family support is known to have a positive impact on recovery and adjustment after cardiac events. Few studies provide philosophically-based, interpretative explorations of carer experience following a spouse's ischaemic event. As carer experiences, behaviours and meaning-making may impact on the quality of the support they provide to patients, further understanding could improve both patient outcomes and family experience. Fourteen spouses of people experiencing Acute Coronary Syndrome in Sydney, Australia were engaged in a single, semi-structured interview. Interviews were audio-recorded and transcribed verbatim. Data were analysed using hermeneutic interpretation within a Heideggerian phenomenological framework. Acute Coronary Syndrome disrupts lived temporality, and the projected potential for carers' being-alongside. Carers experienced an existential uncertainty that arose from difficulty in diagnosis, and situated fear as an attuned, being-towards-death. They constructed protective strategies to insulate their partner and themselves from further stress and risk, however, unclear boundaries for protection heightened carer anxiety. The existential structure of care included one of two possible Heideggerian modes: leaping-in care was a dominating mode that required a high level of carer vigilance; leaping-ahead care was a metaphorical walking alongside, as carers gave back control, freeing opportunities for the person to 'own' care. Supporting carers through the intensive phase of leaping-in care, and equipping them for informed leaping-ahead care should be a focus in both the acute and post-discharge care phases.

Nurse mentor perceptions in the delivery of a home-based cardiac rehabilitation program to support patients living in rural areas: An interpretive study

Home-based cardiac rehabilitation (CR) programs improve health outcomes for people diagnosed with heart disease. Mentoring of patients by nurses trained in CR has been proposed as an innovative model of cardiac care. Little is known however, about the experience of mentors facilitating such programs and adapting to this new role. The aim of this qualitative study was to explore nurse mentor perceptions of their role in the delivery of a home-based CR program for rural patients unable to attend a hospital or outpatient CR program. Seven nurses mentored patients by telephone providing patients with education, psychosocial support and lifestyle advice during their recovery. An open-ended survey was administered to mentors by email and findings revealed mentors perceived their role to be integral to the success of the program. Nurses were satisfied with the development of their new role as patient mentors. They believed their collaborative skills, knowledge and experience in coronary care, timely support and guidance of patients during their recovery and use of innovative audiovisual resources improved the health outcomes of patients not able to attend traditional programs. Cardiac nurses in this study perceived that they were able to successfully transition from their normal work practices in hospital to mentoring patients in their homes.

The meaning of being in uncertainty after heart transplantation - an unrevealed source to distress

BACKGROUND

As many as 88% of heart transplant recipients (HTRs) suffer from psychological distress. Both psychosocial factors and physical health are associated with increased psychological distress. However, the causes and impacts of psychological distress are unclear. HTRs strive for a sense of control over their health and daily lives in order to improve their psychological well-being. Perceived control was found to be related to the patients' construction of normality, their emotional state, as well as their thoughts and feelings of uncertainty about the future.

AIM

An in-depth exploration of the meaning of uncertainty during the first year after a heart transplantation (HTX).

METHOD

A phenomenological-hermeneutic method was employed. Interviews were conducted with 14 patients, four women and ten men, with a mean age of 51 years (range: 28-67 years).

RESULTS

Being in uncertainty after HTX means losing a sense of coherence, which shatters the HTR's whole worldview. The HTRs search for meaning and strive for coherence, which is no longer achievable. By using a nursing theory, we understand that uncertainty should be seen as a natural state among HTRs. It constitutes the starting point from which the HTRs can reorganise their self-structure and find a new view of life. When striving for normality, certainty and predictability (i.e., the healthcare professional's perspective), we block or prolong this process, thus causing distress among HTRs because they are unable to create a new orientation in life.

CONCLUSION

This study presents a hypothesis of the primary cause of psychological distress after HTX and provides a useful framework for how to approach this condition.

Efficacy of psychosocial interventions on psychological outcomes among people with cardiovascular diseases: a systematic review and meta-analysis

OBJECTIVES

This systematic review aimed to examine empirical evidence concerning the efficacy of psychosocial interventions in ameliorating the psychosocial problems of people with cardiovascular diseases (CVDs).

METHODS

A comprehensive literature search was undertaken to identify both published and non-published English randomised controlled trials (RCTs) from 2000 to 2015. Two reviewers independently screened, assessed risks for bias, and extracted data. Comprehensive meta-analysis software was used to analyse the extracted data. Hedges's g effect size was used to determine the effects of psychosocial interventions.

RESULTS

Thirty studies were included in the review but only 18 studies reported significant short-term effects of psychosocial interventions in CVD patients. Most studies did not report long-term effects. Average effect sizes for stress, anxiety, depression, and combined depression/anxiety were 0.34, 1.04, 0.42 and 0.67 respectively at post-tests. Those numbers became 0.09, 0.65, 0.22 and 0.09 at follow-up assessments. Psychosocial programmes with psychoeducation and stress management helped reduce patients' stress and anxiety levels. Programmes including psychotherapy, counselling, mindfulness-based intervention (MBI), and stress management helped mitigate depression and anxiety.

CONCLUSIONS

The findings support the efficacy of some psychosocial interventions in people with CVDs.

PRACTICE IMPLICATIONS

Healthcare providers should monitor patients' psychological problems and may integrate psychosocial interventions as part of treatment plans.

Heart-focused anxiety in patients with chronic heart failure before implantation of an implantable cardioverter defibrillator: baseline findings of the Anxiety-CHF Study

AIMS

We analysed heart-focused anxiety (HFA) and its predictors in patients with heart failure before implantation of an implantable cardioverter defibrillator (ICD). Herein, we report the baseline data of the Anxiety-CHF Study which investigates HFA before and after ICD implantation.

METHODS AND RESULTS

HFA, general anxiety and depression, perceived quality of life (QoL) and type D personality were measured with validated psychological instruments. Clinical parameters such as severity of heart failure measured by NYHA class and left ventricular ejection fraction (EF) were determined. One hundred and ten patients were interrogated before ICD implantation (70 % male, mean age = 60.5 ± 14.9 years, mean EF = 31 % ± 9 %, 91 % NYHA II-III, 92 % primary prevention). HFA was present in 53 patients (48.6 %); 37 participants (33.9 %) showed increased levels of general anxiety and 33 patients (30.3 %) showed increased levels of depression with clinical significant levels in 16 subjects (14.7 %) for general anxiety and 13 subjects (11.9 %) for depression. Poor QoL was reported in 30 patients (27.5 %). HFA was correlated with QoL, general anxiety, depression, type D personality, myocardial infarction (MI), and systolic blood pressure. QoL, general anxiety and former MI were significant predictors of HFA (R (2) = 0.453).

CONCLUSION

Heart-focused anxiety is highly prevalent in heart failure patients prior to ICD implantation. Measures of disease severity such as EF or NYHA class do not predict HFA, neither does Type D personality. HFA is predicted by a history of MI and psychological parameters such as general anxiety and impaired QoL. CLINICALTRIALS.

GOV IDENTIFIER

NCT02226770.

Fatigue two months after myocardial infarction and its relationships with other concurrent symptoms, sleep quality and coping strategies

AIMS AND OBJECTIVES

To explore fatigue levels two months after myocardial infarction and examine the associations with other concurrent symptoms, sleep quality and coping strategies.

BACKGROUND

Fatigue has been found to be the most frequent and bothersome symptom after myocardial infarction, influencing health-related quality of life negatively.

DESIGN

The present study was explorative and cross-sectional. The focus was on fatigue two months postmyocardial infarction, complemented with a comparative analysis of fatigue dimension levels.

METHODS

The sample included 142 persons (mean age 63 years), treated for myocardial infarction, who responded to a questionnaire package measuring fatigue, depression, health complaints (symptoms), sleep quality and coping strategies.

RESULTS

The main results showed that a global fatigue score two months postmyocardial infarction was associated with concurrent symptoms, such as breathlessness and stress, and coping strategies such as change in values, intrusion and isolation. In comparisons of present fatigue dimension levels (general fatigue, physical fatigue, reduced activity and mental fatigue) two months postmyocardial infarction with baseline measurements (first week in hospital), the results showed that levels of fatigue dimensions had decreased. In comparisons with levels of fatigue four months postmyocardial infarction in a reference group, we found lower levels of fatigue two months postmyocardial infarction.

CONCLUSION

The present findings indicated that postmyocardial infarction fatigue is lowest two months postmyocardial infarction. This may thus be the right time to identify persons experiencing postmyocardial infarction fatigue, as timely fatigue relief support may prevent progression into a state of higher levels of fatigue.

RELEVANCE TO CLINIC PRACTICE

Measuring fatigue two months postmyocardial infarction would enable healthcare professionals to identify persons experiencing fatigue and to introduce fatigue relief support. Tailored rehabilitation support should include stress management and breathlessness relief support. If maladaptive use of the coping strategies isolation and intrusion is observed, these strategies could be discussed together with the patient.

Behavioral changes following experimentally-induced acute myocardial infarction in rats

Rats with experimentally-induced acute myocardial infarction (AMI) have proven to be a clinically relevant model for visceral pain. As there are no behavioral data available on rats in the postinfarction period, we aimed to identify specific pain-related behavioral changes following AMI to increase the validity of the model. AMI was induced by left coronary artery ligation and pain-related behavior was analyzed using the open field test (OFT) and elevated plus maze (EPM). Morphine was applied following AMI induction to differentiate pain-related changes from those related to nonspecific global changes in responsiveness. AMI was histologically confirmed. Hypolocomotion was consistently evident in all behavioral tests for both the infarcted group and sham group. In the OFT, both AMI and sham rats exhibited less exploratory behavior and less activity. A similar pattern of behavior was observed in EPM, where both surgical groups showed fewer entries to the open arms and spent less time in the open arms. The sham group with an intact pericardium showed the same pattern of activity as control rats. The reduction in activity and rearing observed following AMI was successfully reversed following morphine injection. This effect was abolished after naloxone application allowing us to attribute observed changes specifically to pain.This study demonstrates that pain-related behavior in the acute postinfarction period is generally characterized by reduced mobility and explorative behavior. Our results showed that cardiac ischemia as a consequence of experimentally-induced infarction is a less important source of pain behavior than manipulation of the pericardium.