Women's experience of a myocardial infarction: 5 years later

Peer-support interventions for women with cardiovascular disease: protocol for synthesising the literature using an evidence map

INTRODUCTION

The leading cause of death for women is cardiovascular disease (CVD), including ischaemic heart disease, stroke and heart failure. Previous literature suggests peer support interventions improve self-reported recovery, hope and empowerment in other patient populations, but the evidence for peer support interventions in women with CVD is unknown. The aim of this study is to describe peer support interventions for women with CVD using an evidence map. Specific objectives are to: (1) provide an overview of peer support interventions used in women with ischaemic heart disease, stroke and heart failure, (2) identify gaps in primary studies where new or better studies are needed and (3) describe knowledge gaps where complete systematic reviews are required.

METHODS AND ANALYSIS

We are building on previous experience and expertise in knowledge synthesis using methods described by the Evidence for Policy and Practice Information (EPPI) and the Coordinating Centre at the Institute of Education. Seven databases will be searched from inception: CINAHL, Embase, MEDLINE, APA PsycINFO, the Cochrane Database of Systematic Reviews and the Cochrane Central Register of Controlled Trials, and Scopus. We will also conduct grey literature searches for registered clinical trials, dissertations and theses, and conference abstracts. Inclusion and exclusion criteria will be kept broad, and studies will be included if they discuss a peer support intervention and include women, independent of the research design. No date or language limits will be applied to the searches. Qualitative findings will be summarised narratively, and quantitative analyses will be performed using R.

ETHICS AND DISSEMINATION

The University of Toronto's Research Ethics Board granted approval on 28 April 2022 (Protocol #42608). Bubble plots (ie, weighted scatter plots), geographical heat/choropleth maps and infographics will be used to illustrate peer support intervention elements by category of CVD. Knowledge dissemination will include publication, presentation/public forums and social media.

Predicting Return to Work Following Myocardial Infarction: A Prospective Longitudinal Cohort Study

This study aimed to determine the proportion of patients who returned to work within three months post-myocardial infarction and the factors that predicted return to work. A total of 136 participants with myocardial infarction completed the study questionnaires at baseline and three months post-discharge between August 2015 and February 2016. At the three-month follow-up, 87.5% (n = 49) of the participants who were working pre-infarction had resumed work. Age, gender, education, smoking, readmission after discharge, number of comorbidities, diabetes, social support, anxiety, and depression were significantly associated with returning to work at three months post-discharge. Age, gender, smoking, anxiety, and depression significantly predicted those patients with myocardial infarction that returned to work, using binary logistic regression. The majority of patients in work who experience myocardial infarction have the capacity to achieve a work resumption by three months post-discharge. Interventions that facilitate returning to work should focus on modifiable risk factors, such as improving these patients’ mental health, comorbid conditions, risk of readmission, smoking, and social support. Healthcare providers should work in partnership with patients’ family members, friends, and employers in developing and implementing interventions to address these modifiable factors to facilitate patients’ return to work.

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.

Conceptual Framework for Personal Recovery in Patients With Acute Myocardial Infarction

Background Although there has been movement in cardiology to advance patient-centered approaches to postacute myocardial infarction (AMI) care, work remains to be done in aligning patient preferences with clinical care. Our objective was to characterize patients' experience of AMI and treatment to develop a new conceptual framework of patient-centered recovery in cardiology. Methods and Results We conducted in-depth interviews with people who previously experienced an AMI (2016-2019). The interview focused on participants' experiences of their recovery, which were audio-recorded, transcribed verbatim, and analyzed using a phenomenological framework. The overarching theme described by the 42 participants was feeling like a "different person" after the AMI. This shift manifested itself in both losses and gains, each of which posed new challenges to everyday life. The experience appeared to be an active process requiring people to take responsibility for their health. In terms of loss, participants describe how the AMI threatened their sense of safety and security and led to social isolation, fragility, uncertainty about the future, and difficulty expressing emotions accompanied this new fear. A conceptual framework describing the relationship between AMI, identity change, and functioning was developed. Conclusions Participants experienced the AMI as an unexpected disruption in their lives that had far-reaching effects on their daily functioning, and were resolved in numerous ways. The conceptual framework may assist in providing a theoretical basis for future interventions in cardiology that not only engage and retain patients in care but also improve long-term adherence to secondary prevention and other aspects of self-care.

"Is My Heart Healing?" A Meta-synthesis of Patients' Experiences After Acute Myocardial Infarction

BACKGROUND

Recovery from acute myocardial infarction (AMI) has been primarily understood in a narrow medical sense. For patients who survive, secondary prevention focuses largely on enhancing clinical outcomes. As a result, there is a lack of descriptive accounts of patients' experiences after AMI and little is known about how people go about the challenge of recovering from such an event.

OBJECTIVE

We conducted a meta-synthesis of the available literature on qualitative accounts of patients' experiences after AMI.

METHODS

We searched for relevant papers that were descriptive, qualitative accounts of participants' experiences after AMI across 4 electronic databases (April 2016). Using an adapted meta-ethnography approach, we analyzed the findings by translating studies into one another and synthesizing the findings from the studies.

RESULTS

After a review of titles/abstracts, reading each article twice in full, and cross-referencing articles, this process resulted in 17 studies with 224 participants (48% women) aged 23 to 90 years. All participants provided a first-person account of an AMI within the 3-day to 25-year time frame. Two major themes emerged that characterized patients' experiences: navigating lifestyle changes and navigating the emotional reaction to the event-consisting of various subthemes.

CONCLUSION

Although AMI tends to be seen as a discrete event, participants are left with little professional guidance as to how to negotiate significant, and often discordant, psychosocial changes that have long-lasting effects on their lives, similar to persons with chronic illnesses but without research in place to figure out how to best support them.

Understanding Women's Cardiovascular Health Using MyStrengths+MyHealth: A Patient-Generated Data Visualization Study of Strengths, Challenges, and Needs Differences

PURPOSE

The purpose of this data visualization study was to identify patterns in patient-generated health data (PGHD) of women with and without Circulation signs or symptoms. Specific aims were to (a) visualize and interpret relationships among strengths, challenges, and needs of women with and without Circulation signs or symptoms; (b) generate hypotheses based on these patterns; and (c) test hypotheses generated in Aim 2.

DESIGN

The design of this visualization study was retrospective, observational, case controlled, and exploratory.

METHODS

We used existing de-identified PGHD from a mobile health application, MyStrengths+MyHealth (N = 383). From the data, women identified with Circulation signs or symptoms (n = 80) were matched to an equal number of women without Circulation signs or symptoms. Data were analyzed using data visualization techniques and descriptive and inferential statistics.

FINDINGS

Based on the patterns, we generated nine hypotheses, of which four were supported. Visualization and interpretation of relationships revealed that women without Circulation signs or symptoms compared to women with Circulation signs or symptoms had more strengths, challenges, and needs-specifically, strengths in connecting; challenges in emotions, vision, and health care; and needs related to info and guidance.

CONCLUSIONS

This study suggests that visualization of whole-person health including strengths, challenges, and needs enabled detection and testing of new health patterns. Some findings were unexpected, and perspectives of the patient would not have been detected without PGHD, which should be valued and sought. Such data may support improved clinical interactions as well as policies for standardization of PGHD as sharable and comparable data across clinical and community settings.

CLINICAL RELEVANCE

Standardization of patient-generated whole-person health data enabled clinically relevant research that included the patients' perspective.

The Canadian Women's Heart Health Alliance Atlas on the Epidemiology, Diagnosis, and Management of Cardiovascular Disease in Women-Chapter 3: Patient Perspectives

In recent years, public awareness campaigns have targeted knowledge gaps and inequities in care while focusing on the unique female experience and heightened cardiovascular disease (CVD) risk profile. Recognizing and understanding the sex and gender constructs, barriers, facilitators, and factors that affect access, treatment, and recovery after an acute cardiac event from the unique patient perspective is a key step in transforming clinical practice and care patterns. The aim of this atlas chapter is to provide a knowledge review and to identify gaps regarding the experience of living with CVD from the perspective of the female survivor. The sections are as follows: (1) experiencing and living with CVD as a woman; (2) "stopped at the gate": barriers to accessing acute cardiovascular care; and (3) action items to "open the gate" to women: what our patients want and need. The final section culminates with targeted recommendations stemming from recent literature and most importantly, from women with the lived experience of CVD.

The experience of women following first acute coronary syndrome: An integrative literature review

AIM

There is lack of evidence and research understanding among women's lived experiences following first acute coronary syndrome, thus their recovery process remains poorly understood. To date research has largely focused on men's experience of acute coronary syndrome while this area of health care and recovery has considerable impact on women's health and quality of life. Our aim was to review the literature exploring lived experience of women following first acute coronary syndrome.

DESIGN

Integrative review of the literature.

DATA SOURCE

We searched PubMed, MEDLINE, EMBASE, CINAHL and Scopus from 2008-2018 for articles published in English.

REVIEW METHOD

Of 1675 publications identified, 18 qualitative, quantitative, and mixed method studies met our inclusion criteria. Quality of included studies was assessed using Joanna Briggs Institute quality assessment tools. Findings were integrated using thematic synthesis.

RESULTS

Experiencing acute coronary syndrome was reported to have significant impacts on women's lives. The most common issues reported were physical limitations, fear, and uncertainties about the future, sexual dissatisfaction, and social isolation. Women also reported to have higher short- and long-term mortality rate, stroke, recurrent, and hospital readmissions compared with men.

CONCLUSION

This review identified current knowledge and gaps about lived experience of women following first acute coronary syndrome. It is anticipated that the information gained from this literature review will support new research aimed at improving the care women receive following acute coronary syndrome and therefore enhance their recovery and quality of life.

IMPACT

This review contributes to the current body of knowledge by addressing women's physical, psychosocial, and sexual state following acute coronary syndrome. Improvement in women's quality of life after acute coronary syndrome necessitates further research which ultimately results in better management and treatment of women and their recovery following first acute coronary syndrome.

"I just can't sit around and do nothing!": A qualitative study of Indonesian women's experiences diagnosed with heart disease

Research into cardiovascular disease and its management in Indonesia, where it currently accounts for 67% of all deaths, has heavily emphasized the biomedical aspects; little is known about the individual's experience of the disease, especially for Indonesian women. This study aimed to understand how gender shapes Indonesian women's experiences of living with heart disease in their daily lives. Twenty-six women aged 30-67 years were interviewed, and the transcriptions analyzed using a qualitative framework informed by intersectional approaches to gender and culture. Three major themes emerged: (i) the effect of cardiovascular disease on women's day-to-day activities, (ii) its effects on women's family relationships, and (iii) the women's coping strategies. The inability to fulfill their required social roles as mother or wife undermined the women's sense of self, a problem particularly acute in a cultural context where responsibility for maintaining harmony in the home and society is ascribed to women. Healthcare professionals should be aware of the ethnic and cultural backgrounds of women with cardiovascular disease, in order to deliver services that meet female patients' social, spiritual, and cultural needs.

The effectiveness and experience of self-management following acute coronary syndrome: A review of the literature

OBJECTIVES

To evaluate the effectiveness of interventions used to support self-management, and to explore patients' experiences after acute coronary syndrome in relation to self-management.

DESIGN

Scoping review.

DATA SOURCES

Keyword search of CINAHL Plus, Medline, the Cochrane Library, and PsycINFO databases for studies conducted with adult population and published in English between 1993 and 2014.

REVIEW METHODS

From title and abstract review, duplicated articles and obviously irrelevant studies were removed. The full texts of the remaining articles were assessed against the selection criteria. Studies were included if they were original research on: (1) effectiveness of self-management interventions among individuals following acute coronary syndrome; or (2) patients' experience of self-managing recovery from acute coronary syndrome.

RESULTS

44 articles (19 quantitative and 25 qualitative) were included. Most studies were conducted in western countries and quantitative studies were UK centric. Self-management interventions tended to be complex and include several components, including education and counselling, goal setting and problem solving skills which were mainly professional-led rather than patient-led. The review demonstrated variation in the effectiveness of self-management interventions in main outcomes assessed - anxiety and depression, quality of life and health behavioural outcomes. For most participants in the qualitative studies, acute coronary syndrome was unexpected and the recovery trajectory was a complex process. Experiences of making adjustment and adopting lifestyle changes following acute coronary syndrome were influenced by subjective life experiences and individual, sociocultural and environmental contexts. Participants' misunderstandings, misconceptions and confusion about disease processes and management were another influential factor. They emphasised a need for ongoing input and continued support from health professionals in their self-management of rehabilitation and recovery, particularly during the initial recovery period following hospital discharge.

CONCLUSIONS

Evidence of the effectiveness of self-management interventions among people with acute coronary syndrome remains inconclusive. Findings from the patients' experiences in relation to self-management following acute coronary syndrome provided important insights into what problems patients might have encountered during self-managing recovery and what support they might need, which can be used to inform the development of self-management interventions. Theoretical or conceptual frameworks have been minimally employed in these studies and should be incorporated in future development and evaluation of self-management interventions as a way of ensuring clarity and consistency related to how interventions are conceptualised, operationalised and empirically studied. Further research is needed to evaluate self-management interventions among people following acute coronary syndrome for sustained effect and within different health care contexts.

Women's experiences of how their recovery process is promoted after a first myocardial infarction: Implications for cardiac rehabilitation care

BACKGROUND

A rapid improvement in the care of myocardial infarction (MI) in the emergency services has been witnessed in recent years. There is, however, a lack of understanding of the factors involved in a successful recovery process, after the initial stages of emergency care among patients, and in particular those who are women. Both preventive and promotive perspectives should be taken into consideration for facilitating the recovery process of women after a MI.

AIM

To explore how women's recovery processes are promoted after a first MI.

METHODS

A qualitative content analysis was used.

FINDINGS

The women's recovery process is a multidirectional process with a desire to develop and approach a new perspective on life. The women's possibility to approach new perspectives on life incorporates how they handle the three dimensions: behaviour, that is, women's acting and engaging in various activities; social, that is, how women receive and give support in their social environment; and psychological, that is, their way of thinking, reflecting, and appreciating life.

CONCLUSIONS

The personal recovery of women is a multidirectional process with a desire to develop and approach a new perspective on life. It is important for cardiac rehabilitation nurses to not only focus on lifestyle changes and social support but also on working actively with the women's inner strength in order to promote the recovery of the women.

Patients' goals, resources, and barriers to future change: A qualitative study of patient reflections at hospital discharge after myocardial infarction

BACKGROUND

Myocardial infarction (MI) patients may find it challenging to adhere to lifestyle advice and medications. Understanding motivational factors and barriers to change is crucial. However, empirical evidence on patients' ability to effect lifestyle changes at the time of discharge is limited.

AIM

The aim of this study was to identify at the time of hospital discharge the goals, resources, and barriers to future change in MI patients.

METHODS

We conducted a qualitative interview study with a purposive sample of 20 MI patients (eight women) in a cardiac department at a university hospital in Norway. All interviews were conducted before hospital discharge, transcribed verbatim, and analysed using qualitative content analysis.

FINDINGS

Three themes suggested that, at the time of discharge, patients' views of their MI were complex and diverse. Patients were motivated to change their lifestyle and contemplated taking their life in new directions, adopting a change of life perspective. Frequently, patients struggled to understand the context of living with an MI, manage symptoms, and understand the precipitating causes of MI. There were also patients who wanted to maintain their present lifestyle and live as normal as possible. They just wanted to keep going.

CONCLUSIONS AND IMPLICATIONS

There is a need for a different approach to communicating with MI patients at the time of discharge. Person-centred care that allows personal narratives to emerge may enable health-care professionals to offer more individualised guidance to MI patients that will help them cope with the everyday challenges they experience after discharge.

Gender differences in the trajectory of recovery in health status among young patients with acute myocardial infarction: results from the variation in recovery: role of gender on outcomes of young AMI patients (VIRGO) study

BACKGROUND

Despite the excess risk of mortality in young women (≤55 years of age) after acute myocardial infarction (AMI), little is known about young women's health status (symptoms, functioning, quality of life) during the first year of recovery after an AMI. We examined gender differences in health status over time from baseline to 12 months after AMI.

METHODS AND RESULTS

A total of 3501 AMI patients (67% women) 18 to 55 years of age were enrolled from 103 US and 24 Spanish hospitals. Data were obtained by medical record abstraction and patient interviews at baseline hospitalization and 1 and 12 months after AMI. Health status was measured by generic (Short Form-12) and disease-specific (Seattle Angina Questionnaire) measures. We compared health status scores at all 3 time points and used longitudinal linear mixed-effects analyses to examine the independent effect of gender, adjusting for time and selected covariates. Women had significantly lower health status scores than men at each assessment (all P values <0.0001). After adjustment for time and all covariates, women had Short Form-12 physical/mental summary scores that were -0.96 (95% confidence interval [CI], -1.59 to -0.32) and -2.36 points (95% CI, -2.99 to -1.73) lower than those of men, as well as worse Seattle Angina Questionnaire physical limitations (-2.44 points lower; 95% CI, -3.53 to -1.34), more angina (-1.03 points lower; 95% CI, -1.98 to -0.07), and poorer quality of life (-3.51 points lower; 95% CI, -4.80 to -2.22).

CONCLUSION

Although both genders recover similarly after AMI, women have poorer scores than men on all health status measures, a difference that persisted throughout the entire year after discharge.

A meta-ethnographic synthesis on phenomenographic studies of patients' experiences of chronic illness

Phenomenography is a qualitative research approach developed within an educational framework, focusing on the qualitative experience of learning. It is also being used, to a lesser degree, in healthcare research. In the present study, we conducted a meta-ethnographic synthesis of phenomenographic studies on chronic illness, in order to give a broader perspective of how chronic illness can be experienced. Our aim was not to describe patients’ various individual experiences of illness, but instead to identify the different ways chronic illness can be experienced by patients. Our synthesis and phenomenographic interpretation of 12 selected articles found that patients’ experiences of chronic illness can be described in terms of a different lived body, a struggle with threat to identity and self-esteem, a diminished lifeworld, and a challenging reality. These experiences relate to each other in a process of recurring loops, where the different ways of experiencing continue to influence each other over time. According to these findings, the use of phenomenography as a research approach has the potential to add to the understanding of how chronic illness can be experienced. Patients may benefit from seeing that their illness can be experienced in many different ways and that it has many aspects, which then can lead to a better understanding and coping with their illness. We suggest that it may be worthwhile to expand the scope of phenomenography outside pedagogics. This presupposes a revision of the application to include a wider and more comprehensive description, for instance, of the different ways illness and healthcare phenomena can be experienced, and how these different ways are related to each other, with less focus on hierarchical relations.

Primary health care resources for rehabilitation and secondary prevention after myocardial infarction - a questionnaire survey

BACKGROUND

During the first year after a cardiac event, many patients are offered participation in a cardiac rehabilitation programme, after which the patients are often not given the opportunity to continue to attend rehabilitation and secondary prevention programmes.

AIM

This study describes the primary health care centres' (PHCC) resources regarding cardiac rehabilitation/secondary prevention programmes for coronary heart disease (CHD) patients in a southern Swedish region.

METHOD

A questionnaire containing 26 dichotomous or multiple choice questions was sent to the responsible manager of all 137 public and private PHCCs in Region Skåne. Questionnaires from 91 (66%) of the PHCCs were completed and returned.

RESULT

Few nurses at the PHCCs had special training regarding CHD (10%), cardiac rehabilitation (8%) or heart failure (32%). Twenty-one per cent of the physicians had special training regarding CHD. One third of the PHCCs did not offer long-term secondary prevention programmes, and few (6%) had any routines for offering socio-economic support to CHD patients. Comparison of private and public PHCCs showed that the private centres could not offer a physiotherapist (61 vs. 84%) or dietician (32 vs. 73%; p = 0.03) to the same extension as the public ones. Furthermore, the majority (91%) of PHCCs had no cooperation with patient organizations.

CONCLUSIONS

The PHCCs need to improve the strategies and long-term rehabilitation programmes. Furthermore, they need to focus on education programme for the staff. The result revealed that the PHCCs lack resources, strategies and long-term care programmes for CHD patients.