Psychosocial experiences of cardiac patients in early recovery: a community-based study

Discovering the Relationship between Anxiety or Depression and Risk Factors of Coronary Artery Disease

BACKGROUND: Psychosocial problems, including anxiety or depression, potentially activate several mechanisms that affect coronary artery disease (CAD) cardiovascular risk factors. Their clinical association, however, remains undiscovered. AIM: The objective of this study was to discover the association between the prevalence of anxiety or depression and risk factors of CAD. METHODS: A cross-sectional study was conducted from July to October 2019. Subject population was CAD patients hospitalized in the Cardiac Care Unit at Hasan Sadikin General Hospital Bandung. We included patients with a history of CAD who underwent revascularization and filled the Hospital Anxiety and Depression Scale (HADS) questionnaire before discharge. Patients were classified according to normal (HADS score of 0–7) or abnormal levels of anxiety or depression (HADS score of 8–21). From each patient, we obtained information on risk factors of CAD, including smoking, physical inactivity, dyslipidemia, hypertension, diabetes mellitus (DM), and family history of CAD. RESULTS: Ninety-nine CAD patients (79% male, mean age: 59 ± 10.5 years) were included in the study; 40% were smokers, 60% had physical inactivity, 11% had dyslipidemia, 57% had hypertension, 13% had DM, 7% had a family history of CAD, and 23% subjects had abnormal levels of anxiety or depression. The relationship between anxiety or depression in CAD patients and smoking behavior (p = 0.802), family history of CAD (p = 0.563), dyslipidemia (p = 0.738), hypertension (p = 0.283), and DM (p = 0.403) was not statistically significant. CONCLUSIONS: The present study showed that the prevalence of anxiety or depression in CAD patients was relatively moderate. We revealed that psychosocial factors are not associated with risk factors of CAD, stressing that psychosocial factors are independent of conventional CAD risk factors in CAD and merit attention for individual management.

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.

Depression: a predictor of coronary heart disease in Saudi Arabia

Aims and Objectives: This research study mainly deals to evaluate the effect of depression in coronary heart disease patients. Background: Depression is one of the common comorbidity among patients presented with acute coronary syndrome or those with major cardiovascular event. Depression has been independently associated or lead to acute cardiac events in patients. Method: The study was conducted from three months followed-up patients with recent diagnosed coronary heart disease and they getting treatment from cardiac centres “Armed Forces Hospitals. Depression was evaluated by using 17-item Hamilton Rating Scale and the cardiac outcome was assessed clinically by echo parameters and cardiac biomarkers such as C-reactive Protein. The data were analysis by SPSS version 23. Results: In this study 83 patients were part of this research. The patients had been picked up from range 18-65 year in which mostly patients were male (75%) than female (25%). Among 83 coronary heart disease patients 29.5% were suffering from depression while 19.5% were on severity. The deterioration factor was significantly influence by depression and smoking. Conclusion: Depression has a great impact on deterioration of the cardiac outcomes. It can serve as a predictive variable for future cardiological morbidity and mortality.

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.

Development of a yoga module targeting cardiovascular health for patients with post-myocardial left ventricular dysfunction in India

BACKGROUND

Yoga is known to contribute towards cardiovascular health. This paper describes the development of a need-based yoga program which is suitable to be integrated into the cardiac rehabilitation of post-myocardial infarction patients with left ventricular dysfunction.

MATERIALS AND METHODS

Based on the assessment of the need of the patients, literature review, and expert opinion, a yoga module was developed using the qualitative method of inquiry. The program included warm-up exercises, yogic asanas, pranayama, meditation and counseling sessions. A structured questionnaire eliciting comments on the contents was given independently to ten experts working in the field of health and yoga for validation. The final module was derived after incorporating the suggestions of the experts.

RESULTS

Using the raters' expertise in cardiology and yoga practice, the practices which constitute the module were optimized. Majority of the experts (raters) agreed with the duration of 1 h training for 1month under supervision as adequate for subsequent practice at home. There was a 0.786 inter-rater reliability estimated using the interclass coefficient (ICC) and 0.789 internal consistency of the questions, measured using Cronbach's alpha. Both values indicate "good" reliability and consistency of the yoga module.

CONCLUSION

The developed yoga module was found to be acceptable. Future randomized control trials will be necessary to validate the effectiveness of this module and if the module demonstrates to be effective by clinical studies, it may add a therapeutic option in the rehabilitation of patients with heart failure following myocardial infarction, which can be applied in the hospitals and community level.

A qualitative study of younger men's experience of heart attack (myocardial infarction)

OBJECTIVES

The effects of heart attack, or myocardial infarction (MI), across psychosocial domains may be particularly acute in younger adults, for whom serious health events are non-normative. MI morbidity is declining in Western countries, but in England MI numbers have plateaued for the under-45 cohort, where approximately 90% of patients are male. Qualitative research on younger adults' experience of MI is limited, and no study has sampled exclusively under-45s. This study aimed to understand how a sample of men under 45 adjusted to and made sense of MI.

DESIGN

Qualitative research design based on semi-structured in-depth interviews.

METHODS

Ten men aged under 45 who had experienced MI in the past 3-6 months were purposively recruited and interviewed. Interviews were transcribed verbatim and analysed using interpretative phenomenological analysis.

RESULTS

Seven superordinate themes were identified. This article focuses in depth on the three most original themes: (1) 'I'm less of a man', which described experiences of losing 'maleness' (strength, independence, ability to provide) post-MI; (2) 'Shortened horizons', which covered participants' sense of foreshortened future and consequent reprioritization; and (3) 'Life loses its colour', describing the loss of pleasure from lifestyle-related changes.

CONCLUSION

Themes broadly overlapped with the qualitative literature on younger adult MI. However, some themes (e.g., loss of 'maleness' post-MI, and ambivalence towards MI risk factors) appeared unique to this study. Themes were also discussed in relation to risk factors for anxiety and depression and how this might inform clinical care for a younger, male population. Statement of contribution What is already known on this subject? Myocardial infarction (MI) morbidity is not declining in England for under-45s. Adjustment to MI is particularly challenging for younger adults, perhaps because it is non-normative. However, little is known about the experience of MI in younger adults. What does this study add? This is the first qualitative study to sample MI patients exclusively under 45, thereby mapping to epidemiological trends. Further support is provided for some themes identified in the existing young adult MI literature. New themes are identified here which can provide insights relevant to clinical care in this population.

Dimensions of the Somatic Health Complaints Questionnaire (SHCQ) in a Sample of Myocardial Infarction Patients

A short health complaints measure may provide information on the degree of recovery from acute myocardial infarction. The present study therefore evaluated a questionnaire-called the Somatic Health Complaints Questionnaire (SHCQ)-that includes 13 items concerning health problems common in cardiac patients. The sample included 114 patients in total, 37 women and 77 men, who had suffered a first-time myocardial infarction 5months prior to the testing. Confirmatory factor analysis was performed to examine whether the factor structure replicated the hypothesized hierarchical model. The results indicated that SHCQ represents four dimensions: breathlessness, fatigue, pain and unrest. It was also found that SHCQ may be treated as one general concept. It is a brief and easily administered questionnaire and may therefore be a useful tool in secondary prevention work, identifying patients at risk for possible negative consequences of a first-time myocardial infarction.

Living with Experiences Following a Myocardial Infarction

Coronary heart disease is a major cause of sudden death and morbidity in the developed world, as well as a cause of great suffering. Research within this area has primarily focused symptoms, risk factors and treatment. The aim of this paper was to explore women's experiences following a myocardial infarction (MI). Eight women were interviewed; the interviews were audiotaped and transcribed into text and analysed using a phenomenological approach. To explore the meaning that is experienced in the lived world of the patient a method of reflective lifeworld research, based upon phenomenological epistemology has been used. The results indicate that the body is vital for the women in their lifeworlds. After a MI the patient's natural and unreflective relationship with the body and the lived world is interrupted. Uncertainty about life and death as well as the body is experienced as a suffering in the women's lifeworlds. In relation to this, the women's existence is characterised by an uncertainty and a loss of context. It is through reconciliation with their bodies and their illnesses that the women can achieve a sense of well-being and harmony in life. In that process the women can re-establish a natural relationship with their bodies and lifeworlds.

Psychological Morbidity after Myocardial Infarction in an Area of Deprivation in the UK: Evaluation of a Self-Help Package

BACKGROUND

Psychological morbidity after an acute myocardial infarction (AMI) is known to be common, but can be addressed by appropriate rehabilitation. The area in which this research was conducted experiences high rates of deprivation and of coronary heart disease and limited access to hospital-based rehabilitation. Responding to concern about psychological needs of AMI patients, a self-help package was introduced and evaluated alongside standard hospital-based cardiac rehabilitation.

AIMS

To evaluate the impact of a home-based self-help package (the Heart Manual), alongside existing cardiac rehabilitation provision, on psychological morbidity and health status after AMI. A secondary aim was to assess the suitability of the Heart Manual for older patients aged over 80 years.

METHODS

A controlled observational study, comparing two cohorts of patients discharged from hospital after AMI. The intervention group was given the self-help package in addition to standard care. The control group received standard care alone. Outcome measures used were the Hospital Anxiety and Depression Scale and the EuroQol.

RESULTS

The intervention group showed significant improvement in anxiety and depression scores after 3 months and nonsignificant improvement in general health status. Patients who attended hospital-based rehabilitation classes, and those aged over 80 years, also benefited from the intervention.

CONCLUSION

A home-based self-help rehabilitation package is an effective tool alongside hospital-based rehabilitation classes and can be given to all age groups.

Insufficient living: experiences of recovery after infective endocarditis. J Cardiovasc Nurs. 2014;30:E11-E19. [PMID: 24704921 DOI: 10.1097/jcn.0000000000000144]

BACKGROUND

Infective endocarditis (IE) is a traumatic health event, and recovery is often associated with massive physical deconditioning and reduced quality of life. Patients also report reduced cognitive functioning and are at risk of developing anxiety and depression as well as posttraumatic stress disorder. Although studies have found that survivors of IE have impaired physical functioning and mental health, little is known about patient experiences contributing to these findings.

OBJECTIVE

The aim of this study was to describe patient experiences of recovery after IE.

SUBJECTS AND METHODS

Within a phenomenological-hermeneutical framework, a qualitative interview study was conducted that included 6 men and 5 women (aged 29-86 years). Patients were interviewed 3 to 6 months after discharge. Analysis consisted of 3 levels: naive reading, structured analysis, and critical interpretation and discussion.

FINDINGS

The overall concept that emerged was "Insufficient Living." Patients all experienced a life after illness, which was perceived as insufficient. The overall concept can be interpreted in terms of the following 3 themes. The first was "an altered life," where participants described a phase of adaptation to a new life situation, which some perceived as manageable and temporary, whereas others found extremely distressing and prolonged. "Shocking weakness" was experienced physically, cognitively, and emotionally, and although it subsided quickly for a few, most experienced a persisting weakness and felt frustrated about the prolonged recovery phase. In "the road to recovery," support from relatives and healthcare professionals, as well as one's own actions, was emphasized as important in facilitating recovery.

CONCLUSIONS

Recovery after IE is perceived as "Insufficient Living." Patients experience an altered life and shocking weakness, and on the road to recovery, support is needed. Research in follow-up care, supporting patients' ability to cope with potential physical and psycho-emotional consequences of IE, is encouraged as a result of these findings.

Importance of spiritual care for cardiac patients admitted to coronary care units in the Gaza Strip: patients' perception

PURPOSE

This study aimed to assess the perception of hospitalized cardiac patients in coronary care units (CCUs) in the Gaza Strip about the importance of assessing and providing spiritual care to them.

DESIGN

This was a cross-sectional study.

METHODS

A valid and reliable instrument previously developed by Musa was used to assess patients' perception about the importance of assessing spiritual needs and providing spiritual care to cardiac patients admitted to CCUs.

FINDINGS

Out of 279 cardiac patients, 275 (response rate of 98.6%) agreed to be involved in this study. Results revealed that both assessing spiritual needs (69.69%) and providing spiritual care (76.97%) were very important to cardiac patients with rating spiritual care intervention as more important than spiritual assessment.

CONCLUSIONS

Assessing and providing spiritual care is crucial to cardiac patients. Therefore, health policy makers need to pay more attention to this group of vulnerable patients and need to adopt a spiritual care policy into the Palestinian health care system, which might help to decrease their stress, length of hospitalization, and the cost of treatment.

Coping Experiences: A Pathway towards Different Coping Orientations Four and Twelve Months after Myocardial Infarction-A Grounded Theory Approach

Background. Patients recovering from a myocardial infarction (MI) are faced with a number of serious challenges. Aim. To create a substantive theory on myocardial infarction patients' coping as a continuum. Methods. Grounded theory method was used. Data were collected by using individual interviews. The informants were 28 MI patients. Results. The core category “coping experiences—a pathway towards different coping orientations” includes 2 main categories: “positive and negative coping experiences” (4 months after MI) and “different coping orientations” (12 months after MI). Conclusion. Coping with a myocardial infarction is a long-term dynamic process of dealing with varied emotions and adjustment needs. Coping is threatened, if the patient denies the seriousness of the situation, suffers from depression and emotional exhaustion, or if there are serious problems in the interaction with family members. This study stresses the importance of recognizing the patient's depressive state of mind and the psychological aspects which affect family dynamics. A more family-centered approach involving a posthospital counseling intervention is recommended. Relevance to Clinical Practice. The results of this study can be used in nursing care practice when organizing support interventions for myocardial infarction patients.

Patient recovery and transitions after hospitalization for acute cardiac events: an integrative review

Despite increased attention to providing seamless transitions after hospitalization, patients often feel unprepared, lack knowledge, and may be confused by what to expect during recovery at home after a cardiac event. Care transition after hospital discharge could be improved by informing and counseling patients more specifically about expected recovery after a cardiac event. Therefore, an integrative review of research was conducted to evaluate cardiac patients' trajectory of recovery after hospitalization. A total of 61 studies were included in this review. Studies included were those of cardiac patients who had been hospitalized for significant cardiac events and those focused on acute coronary syndrome (n = 18), percutaneous coronary intervention (PCI) (n = 12), cardiac surgery (coronary artery bypass surgery and valve surgery; n = 25), and heart failure (n = 6). Studies included quantitative, mixed-methods, and qualitative designs, with sample sizes ranging from 4 to 2121 participants. Notwithstanding the limitations of this review, findings demonstrated that patients' perceptions of their cardiac event evolved over time from uncertainty, fears, anxiety, and depression, which were often associated with a lack of knowledge of their cardiac condition, to a phase of self-management of their cardiac condition. Furthermore, patterns of commonly occurring symptoms and changes in functioning abilities during recovery after hospitalization were apparent among the different cardiac groups. These findings may be useful to both patients and clinicians to inform them about the recovery trajectory after a cardiac event to improve preparation for the transition from hospital to home.

Coping with multimorbidity in old age--a qualitative study

Background

Comparatively few studies address the problems related to multimorbidity. This is surprising, since multimorbidity is a particular challenge for both general practitioners and patients. This study focuses on the latter, analyzing the way patients aged 65–85 cope with multimorbidity.

Methods

19 narrative in-depth interviews with multimorbid patients were conducted. The data was analysed using grounded theory. Of the 19 interviewed patients 13 were female and 6 male. Mean age was 75 years. Participating patients showed a relatively homogeneous socio-economic status. Patients were recruited from the German city of Hamburg and the state of North Rhine-Westphalia.

Results

Despite suffering from multimorbidity, interviewees held positive attitudes towards life: At the social level, patients tried to preserve their autonomy to the most possible extent. At the emotional level, interviewees oscillated between anxiety and strength - having, however, a positive approach to life. At the practical level, patients aimed at keeping their diseases under control. The patients tended to be critical in regards to medication.

Conclusions

These findings might have implications for the treatment of multimorbid patients in primary care and further research: The generally presumed passivity of older individuals towards medical treatment, which can be found in literature, is not evident among our sample of older patients. In future, treatment of these patients might take their potential for pro-active cooperation more strongly into account than it is currently the case.

Coronary patients who returned to work had stronger internal locus of control beliefs than those who did not return to work

OBJECTIVES

Return To Work (RTW) is an important indicator of recovery from coronary artery disease (CAD), associated with social and economical benefits, and improved quality of life. Percutaneous coronary intervention (PCI) and coronary artery bypass graft (CABG) surgery are effective procedures relieving symptoms and reducing the risk for new events, but psychosocial problems are frequent among these patients. The aim was to determine psychosocial and treatment-related factors associated with RTW among PCI and CABG patients in Northern Norway.

DESIGN

Cross-sectional design based on questionnaire data from CABG and PCI patients 3-15 months following discharge, and from hospital records.

METHODS

Of the 348 responding patients, 168 were younger than 67 years and working prior to hospitalization. Factors associated with RTW were examined in a logistic regression analysis.

RESULTS

A total of 108 (64%) had RTW within 3-15 months. Four factors made unique significant contributions to the model, including higher education, time since hospital discharge and Internal Locus of Control (LoC) of the Multidimensional Health Locus of Control Scale (MHLC) as positively associated factors, and Powerful Others LoC as a negatively associated factor. Analyses controlled for data on demographics, emergency status, type of treatment, number of days at the hospital, physical exercise, attending a rehabilitation program, mental distress, Type D personality, and for the CABG patients additional data on coronary health.

CONCLUSIONS

Patients' control beliefs and educational level are significant psychosocial factors associated with RTW following PCI and CABG treatment. Implications for hospital treatment and rehabilitation programs are discussed.

Gender differences and determinants of health related quality of life in coronary patients: a follow-up study

Background

The role of gender differences in Health Related Quality Life (HRQL) in coronary patients is controversial, so understanding the specific determinants of HRQL in men and women might be of clinical importance. The aim of this study was to know the gender differences in the evolution of HRQL at 3 and 6 months after a coronary event, and to identify the key clinical, demographic and psychological characteristics of each gender associated with these changes.

Methods

A follow-up study was carried out, and 175 patients (112 men and 63 women) with acute myocardial infarction (AMI) or unstable angina were studied. The SF-36v1 health questionnaire was used to assess HRQL, and the GHQ-28 (General Health Questionnaire) to measure mental health during follow-up. To study the variables related to changes in HRQL, generalized estimating equation (GEE) models were performed.

Results

Follow-up data were available for 55 men and 25 women at 3 months, and for 35 men and 12 women at 6 months. Observations included: a) Revascularization was performed later in women. b) The frequency of rehospitalization between months 3 and 6 of follow-up was higher in women c) Women had lower baseline scores in the SF-36. d) Men had progressed favourably in most of the physical dimensions of the SF-36 at 6 months, while at the same time women's scores had only improved for Physical Component Summary, Role Physical and Social Functioning; e) the variables determining the decrease in HRQL in men were: worse mental health and angina frequency; and in women: worse mental health, history of the disease, revascularization, and angina frequency.

Conclusions

There are differences in the evolution of HRQL, between men and women after a coronary attack. Mental health is the determinant most frequently associated with HRQL in both genders. However, other clinical determinants of HRQL differed with gender, emphasizing the importance of individualizing the intervention and the content of rehabilitation programs. Likewise, the recognition and treatment of mental disorders in these patients could be crucial.

Psychologic effects of automated external defibrillator training: a randomized trial

OBJECTIVE

The objective of this study was to test whether an automated external defibrillator (AED) training program would positively affect the mental health of family members of high-risk patients.

METHODS

A total of 305 patients with ischemic heart disease and their family members were randomized to 1 of 4 AED training programs: 2 video-based training programs and 2 face-to-face training programs that emphasized self-efficacy and perceived control. Patients and family members were surveyed at baseline and 3 and 9 months postischemic event on demographic characteristics, measures of quality of life (Short Form-36), self-efficacy, and perceived control. For this study, family members were the focus rather than the patients.

RESULTS

Regression analyses showed that family members in the face-to-face training programs did not score better on any of the mental health status variables than family members who participated in the other training programs except for an increase in self-efficacy beliefs at 3 months after training.

CONCLUSION

The findings suggest that a specifically designed AED training program emphasizing self-efficacy and perceived control beliefs is not likely to enhance family member mental health.

[Comparison of cardiovascular health status and health behaviors in Korean women based on household income]

PURPOSE

In this study cardiovascular health status and health behavior of Korean women based on their household income were explored.

METHODS

For this cross-sectional study, 91 women residing in the community were recruited to complete survey questionnaires and biophysical tests including blood pressure (BP), body mass index (BMI), body fat rate, waist circumference (WC), and blood chemistry tests.

RESULTS

Compared to non-low income women (NLIW), low income women (LIW) were more likely to be older, less educated, and jobless, and further more LIW were postmenopause and reported having been diagnosed with hypertension or hypercholesterolemia. Significant differences were found in systolic BP, triglyceride level, BMI, body fat rate, and WC between the groups. Two fifths of the LIW had indications for metabolic syndrome. Their 10-yr risk estimate of myocardial infarction or coronary death demonstrated a higher probability than that of NLIW. Although these significant differences were due to age gap between the groups, advanced age is known to be one of the key characteristics of LIW as well as a non-modifiable risk factor.

CONCLUSION

Effective community programs for vulnerable women at risk of cardiovascular disease should be based on strategies targeting unhealthy behaviors and modifiable risk factors.

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

BACKGROUND

Myocardial infarction (MI) has long been seen as a male disease despite the fact that it is also a health problem for women. Factors that may influence their recovery, such as co-morbidity and requirements for support, have received less scientific attention.

AIM

To explore and describe how women conceived their health and daily life 5 years after an MI.

METHOD

An explorative and descriptive approach inspired by phenomenography was chosen as the design. The present study includes 12 women who have been described in earlier short-term studies.

FINDINGS

The women described how the MI caused limitations in their lives even 5 years after the MI. They experienced physical restrictions, fatigue and also other health complaints. Furthermore, the older women suffered from various co-morbidities such as diabetes, kidney disease, high blood pressure, and stroke. Some women did not perceive their heart disease to interfere in daily life. Many of the women had thoughts about having a new MI. Furthermore, some women were grateful and described it as having a second opportunity.

CONCLUSION

  The present study indicates how women in the recovery process 5 years after an MI still need support to continue with lifestyle changes. The women continue to struggle with different kinds of issues, such as financial stress, co-morbidity and side effects of medication. Support from the health care only in the first year after the MI is not enough. The women should benefit from the possibility to visit or consult professionals in primary care with knowledge of CHD.

Testing a Model of Physical and Psychological Recovery After a Cardiac Event

Little is known about the specific sources and types of support that assist patients in alleviating stress and achieving positive recovery outcomes after a cardiac event. The purpose of this study is to examine the effects of illness-related stress, emotional and tangible support from a significant other, and informational support from a health care provider on physical and psychological recovery outcomes in cardiac patients 8 weeks after their cardiac event. The sample consists of 220 cardiac patients. Data analysis uses structural equation modeling. Final fit indices were as follows: χ2 ( df = 110) = 156.169, comparative fit index = .963, Tucker—Lewis index = .949, and root mean square error of approximation = .044 suggesting an acceptable model. Illness-related stress has direct effects on depression, physical recovery, and activity levels. Partner emotional support has a direct effect on depression. The findings provide direction for developing social support interventions aimed at improving recovery outcomes.

Are older patients' cardiac rehabilitation needs being met?

Aims. The primary aim of this study was to examine the needs of older people in relation to cardiac rehabilitation and to determine if these were currently being met. A secondary aim was to compare illness representations, quality of life and anxiety and depression in groups with different levels of attendance at a cardiac rehabilitation programme.

Background. Coronary heart disease accounted for over seven million cardiovascular deaths globally in 2001. Associated deaths increase with age and are highest in those older than 65. Effective cardiac rehabilitation can assist independent function and maintain health but programme uptake rates are low. We have, therefore, focussed specifically on the older patient to determine reasons for the low uptake.

Design. Mixed methods.

Methods. A purposive sample of 31 older men and women (≥65 years) completed three questionnaires to determine illness representations, quality of life and anxiety and depression. They then underwent a brief clinical assessment and participated in a face-to-face audio-taped interview.

Results.Quantitative: Older adults, who did not attend a cardiac rehabilitation programme, had significantly poorer personal control and depression scores (p < 0·01) and lower quality of life scores than those who had attended. Few achieved recommended risk factor reduction targets. Qualitative: The three main themes identified as reflecting the views and experiences of and attendance at the cardiac rehabilitation programme were: ‘The sensible thing to do’, ‘Assessing the impact’ and ‘Nothing to gain’.

Conclusions. Irrespective of level of attendance, cardiac rehabilitation programmes are not meeting the needs of many older people either in terms of risk factor reduction or programme uptake. More appropriate programmes are needed.

Relevance to clinical practice. Cardiac rehabilitation nurses are ideally placed to identify the rehabilitation needs of older people. Identifying these from the older person’s perspective could help guide more appropriate intervention strategies.

Women's descriptions of symptoms and delay reasons in seeking medical care at the time of a first myocardial infarction: A qualitative study

BACKGROUND

Coronary heart disease (CHD) is a major cause of mortality in women. Women have also been identified as late presenters in seeking medical care.

AIM

The aim of this study was to explore and describe women's symptoms and the reasons for delay in seeking medical care at the time of the first myocardial infarction (MI).

METHODS

The study had an explorative and descriptive design based on content analysis approach. Nineteen women were interviewed at the hospital 2 or 3 days after hospitalisation.

RESULTS

The result showed that the women had difficulties interpreting, understanding and linking the symptoms to CHD. They tried to handle the discomfort and even the chest pain, rather then ask for professional help. The women had problems with making the final decision.

CONCLUSION

Women need to be made aware of the clinical symptoms of CHD, in order to understand the consequences of delay in seeking medical care following an MI.

Stress in women's daily life before and after a myocardial infarction: a qualitative analysis

BACKGROUND

Little is known about women's perceptions of their daily life before and after a myocardial infarction (MI), especially with regard to stress, which is a risk factor for coronary heart disease (CHD).

AIM

To describe and explore women's perceptions of stress before and after an MI.

METHOD

Two interviews with women who suffered an MI, the first at the hospital (n = 20) and the second 4-10 months after the MI (n = 14), were analysed using a phenomenographic approach.

FINDINGS

The stress emanated either from within themselves (personal traits) or as an effect of their immediate surroundings. The period before the MI was stressful due to the different roles they had to maintain in their private and professional lives. They lost control over their daily life. After hospital discharge they both wanted and needed support, as they were terrified when they returned home. They did not know how much they could do and neither did their relatives, while little or no support was provided by the healthcare professionals.

CONCLUSIONS

To prevent CHD in daily life and avoid reinforcing stress, it is important to place greater emphasis on stress as an important risk factor. An understanding of this phenomenon can assist primary healthcare, coronary care unit (CCU) and rehabilitation nurses in supporting these women as well as their partners to adapt their daily lives both before and after an MI. It is essential to formulate and implement individualised treatment plans and to provide support groups for women.

Readjustment 5 months after a first-time myocardial infarction: reorienting the active self

AIM

This paper reports on an interview study exploring the self-regulation process in women and men, 5 months after a first-time myocardial infarction.

BACKGROUND

Somatic, psychological and social factors affect readjustment after a first-time myocardial infarction, and studies have demonstrated substantial rates of depression in patients after myocardial infarction Women report poorer mental health and physical condition than do men. Reconstruction of the self begins when disease poses novel problems and is more likely to occur in cases of long-lasting and disruptive illnesses. Experiencing myocardial infarction is likely to alter a person's mental representation of self. However, the self-regulation process following first-time myocardial infarction is not yet fully understood.

METHOD

Twenty-one people (11 women, 10 men) were interviewed 5 months after first-time myocardial infarction. The grounded theory method provided the strategies for data collection and analysis.

FINDINGS

Interviewees' definition of themselves as active was threatened by fatigue and other health problems that kept them from taking part in activities as they had done before the heart attack. Although reorienting the active self was central to the process of recovery from myocardial infarction, reorienting was restricted by illness perception and coping.

CONCLUSION

Participants had not established a stable health condition 5 months after first-time myocardial infarction. They mainly preferred to moderate rather than radically change their daily life activities. They needed more knowledge and support. Nurses can help with information and advice on managing daily life activities, including dialogue about lifestyle changes at this phase of readjustment.

The effect of individualized education on the transfer anxiety of patients with myocardial infarction and their families

OBJECTIVE

The study determines the effect of individualized education on the anxiety level of patients with myocardial infarction and their families who are being transferred from the coronary care unit (CCU) to the general care unit.

METHODS

The study consisted of experimental and comparison groups, and took place in a CCU of a teaching hospital. The study included 90 patients with myocardial infarction who were admitted to the CCU and 90 individuals who were the relatives of the patients. A personal characteristics information form was used that contained descriptive information about the patients and their relatives, a disease information form containing questions related to the disease and lifestyle habits, and Spielberger's State-Trait Anxiety Inventory.

RESULTS

We found that the relatives and patients in the CCU experienced anxiety on the second day of admission and on the day of transfer. There was a statistically significant difference between the experimental and comparison groups with respect to the level of anxiety for the patients and their relatives on the second CCU day and on the day of transfer (P<.01).

CONCLUSION

Patients in the CCU and their relatives experience anxiety. An individualized education program is effective in decreasing the anxiety of patients and their relatives when the patients are transferred from the CCU to the general care unit.

[Meanings and attitudes of patients who undergo cardiac surgery: influence of sociodemographic variables]

The aim of this study was to verify the influence-of sociodemographic variables on patients' meanings and attitudes related to cardiac surgery. A hundred twenty five patients in preoperative period were interviewed. Data were collected throughout Meanings of Patients related to Cardiac Surgery and Beliefs (MPRCS), Beliefs, Values and Feelings related to Cardiac Surgery (BVFCS) instruments and they were analyzed by using Pearson's correlation coefficient and Mann-Whitney and Kruskal-Wallis tests. It was observed statistical significant correlations between age, number of children, income and the positive factors of MPRCS instrument. Gender, level of education, previous stressing events, living arrangements, and race were the sociodemographic variables that were associated to the patients' meanings and attitudes. It was concluded that meanings and attitudes of these patients were influenced by some sociodemographic variables, and these results can be relevant for planning and implementing some educative practices.

Coping, social support and quality of life over time after myocardial infarction

AIM

This paper describes gender differences in perceived coping, social support and quality of life 1, 4 and 12 months after myocardial infarction.

BACKGROUND

There is a shortage of studies with a longitudinal research design investigating coping, social support and quality of life in women and men after myocardial infarction.

METHODS

A longitudinal, descriptive and comparative design was used for the study, which included 74 women and 97 men. At 12 months, 60 women and 88 men remained. Data were collected using the Jalowiec Coping Scale, a social support questionnaire, the SF-36 Health Survey (health-related quality of life) and the Quality of Life Index-Cardiac version (quality of life). The data were collected during the period 1999-2001.

RESULTS

No statistically significant changes over time in coping assessments emerged in the study group, except for fatalistic coping, which diminished over time in men. Women used more evasive coping than men at 4 and 12 months. The perceived efficiency in coping with physical aspects of the heart disease increased. More women than men perceived available support from grandchildren and staff of the church. Health-related quality of life increased in women and men in physical functioning, role-physical, vitality, social functioning, and role-emotional scales. Moreover, an improvement in the mental health scale was evident in women and a reduction in pain in men. No statistically significant gender differences were found for quality of life at any point in time.

CONCLUSIONS

The findings can be used to inform caregivers that optimistic, self-reliant and confrontational coping were the most frequently used by both women and men over the first year after myocardial infarction, and that confrontational coping has been shown to have positive outcomes in the longer term. Nurses should tell women about the importance of seeking prompt treatment and discuss health problems with caregivers and significant others. Care planning should include family members and significant others so that they can support and encourage patients to cope with problems in daily life.

Depressive mood after a cardiac event: gender inequality and participation in rehabilitation programme

BACKGROUND

Depressive mood after a cardiac event is common with serious consequences for the patient.

AIMS

To compare gender in depressive mood during the first year after a cardiac event and to evaluate the effect of participating in a multidimensional secondary prevention program on depressive mood.

METHODS

166 men and 54 women, <73 years, consecutively answered a questionnaire concerning depressive mood at 2 weeks, 6 weeks, 5 months and 1 year after discharge after a cardiac event. At 2 weeks, each patient met a nurse, and was informed about the disease and received individual support about lifestyle changes. Of those invited to participate in a secondary prevention program, 127 patients accepted, and 93 declined participation.

RESULTS

At each of the four follow-ups, women had significantly higher depression scores than men. Depressive mood in both women and men was significantly reduced at 6 weeks. Thereafter, it increased to the 2-week level in women and to above the 2-week level in men. No differences were seen in patients participating or not in secondary prevention programs.

CONCLUSION

Women had higher depressive mood scores than men and secondary prevention programs failed to improve depressive mood in both women and men.

MacNew Heart Disease Lebensqualitätsfragebogen nach Herzinfarkt:

Zusammenfassung. Theoretischer Hintergrund: Gesundheitsbezogene Lebensqualität (gLQ) stellt einen wichtigen Aspekt in der Evaluation medizinischer Behandlungen dar. Fragestellung: Der MacNew Heart Disease Lebensqualitätsfragebogen (MacNew) wurde entwickelt, um Gefühle von Patienten zu erfassen, die sich auf eine Reihe von Problemen bei Überlebenden eines akuten Herzinfarktes beziehen. Das Ziel dieser Studie war die Validierung der deutschen Version des MacNew an einer Patientengruppe nach Herzinfarkt. Methode: Der MacNew und die Short Form 36 (SF-36) wurden von 199 Patienten ausgefüllt. Die Retest-Reliabilität, die innere Konsistenz, sowie Valditiätsüberprüfungen und eine konfirmatorische Faktorenanalyse wurden berechnet. Ergebnisse: Mehr als 92% der Items wurden vollständig beantwortetet. Die konvergente Valdität mit den Skalen des SF-36 bewegten sich im Bereich von r = 0.36 bis 0.75 (p < .001). Die diskriminante Validität war zufriedenstellend hoch für alle Skalen (ANOVA, p < .01). Die Faktorenanalyse bestätigte die Drei-Faktoren-Struktur und erklärte 54,25% der Varianz. Reliabilitätskoeffizienten rangierten zwischen rtt = 0.72 und 0.87. Die innere Konsistenz liegt zwischen 0.90 und 0.97 auf. Die geringe Anzahl an fehlenden Daten belegt die hohe Akzeptanz der deutschen Version des MacNew bei Herzinfarktpatienten. Schlussfolgerung: Die Ergebnisse deuten darauf hin, dass die deutsche Version des MacNew ein valides, reliables und sensitives Instrument für die Messung der gLQ darstellt und vergleichbar mit der englischen Originalversion ist.

Myocardial infarction: narrations by afflicted women and their partners of lived experiences in daily life following an acute myocardial infarction

BACKGROUND

The review of the literature showed that many people and their family members share feelings of distress after an acute myocardial infarction. Therefore, it is important to show how the illness affects the relationship in the couple's daily life when the closest relatives involved are men.

AIM

The aim was to illuminate the meaning of lived experiences in daily life after an acute myocardial infarction, as narrated by afflicted women and their partners.

METHODS

Nine women and their partners narrated their experiences three and 12 months after an infarction. The interview texts were then interpreted, using a phenomenological hermeneutic method, inspired by the philosophy of Ricoeur. The text was divided into meaning units that were condensed and abstracted. Two themes and eight sub-themes were then extracted from the text.

RESULTS

The first theme was 'living in a changed life situation' with the sub-themes: 'showing consideration', 'taking responsibility', 'living side by side' and 'desiring what to do'. The second theme was 'looking to the future' with the sub-themes: 'feeling uncertain', 'feeling powerless', 'feeling limited' and 'feeling hope'.

CONCLUSIONS

The results revealed that couples lived in a changed life situation, somewhat in 'discordance', and showed consideration to each other in order to protect the partner. There seemed to be a lack of verbal communication, but both women and their partners revealed that they sensed how their partners felt without verbal communication. In this 'discordance', couples may experience loneliness, in that they may not share feelings about the event and the situation it causes.

RELEVANCE TO CLINICAL PRACTICE

Women and their partner have specific needs in daily living following an acute myocardial infarction. Therefore, nurses should acknowledge the specific needs for the female patient and the partner more clearly.

Coronary artery bypass grafting: social support for patients and their significant others

BACKGROUND

Patients and significant others may experience physical and psychological stress symptoms during the recovery time from coronary artery bypass surgery. It has been shown that social support is associated with health and well-being in various situations. It is important to study how patients and significant others describe the social support received.

AIM AND OBJECTIVE

To describe social support for bypass surgery patients and their significant others from the social network and nurses during hospitalization and the association between demographic variables and support received from nurses.

DESIGN

A descriptive study using a questionnaire. This was a pilot study.

METHOD

Questionnaires were mailed to 146 subjects and 103 responded. The questionnaires included background variables, the Social Support from the Social Network Scale and the Support from Nurses during Hospitalization Scale.

RESULTS

In most cases, the spouse, children and friends were the major sources of support for patients and significant others. Patients reported equal amounts of both affect and aid or concrete support while significant others reported the highest level of affect and the lowest level of affirmation from the social network. Patients and significant others reported the highest level of affirmation and the lowest level of aid from nurses during hospitalization.

CONCLUSIONS

Relatives are important sources of support for bypass surgery patients and their significant others. Patients reported higher levels of all types of social support from both the social network and nurses than did significant others.

RELEVANCE TO CLINICAL PRACTICE

The provision of nursing support for significant others can be enhanced by focusing nursing care on the whole family. This would promote the health of the whole family.

The MacNew Heart Disease health-related quality of life instrument: a summary

Background

The measurement of health, the effects of disease, and the impact of health care include not only an indication of changes in disease frequency and severity but also an estimate of patients' perception of health status before and after treatment. One of the more important developments in health care in the past decade may be the recognition that the patient's perspective is as legitimate and valid as the clinician's in monitoring health care outcomes. This has lead to the development of instruments to quantify the patients' perception of their health status before and after treatment.

Methods

We review evidence supporting the measurement properties of the MacNew Heart Disease Health-related Quality of Life [MacNew] Questionnaire which was designed to evaluate how daily activities and physical, emotional, and social functioning are affected by coronary heart disease and its treatment.

Results

Reliability was demonstrated by using internal consistency and the intraclass correlation coefficients for the three domains in the Dutch, English, Farsi, German, and Spanish versions of the MacNew. With internal consistency and intraclass correlation coefficients =>0.73, reliability is high. Validity of the MacNew was examined with factor analysis and three core underlying factors, physical, emotional, and social, were identified, explaining 63.0 – 66.5% of the observed variance and replicated in the translations with psychometric data. Construct validity of the MacNew was further demonstrated by extensive substantiation of the logical relationships, defined a priori, between items and other comparison tools. The MacNew is responsive and sensitive to changes in HRQL following various interventions for patients with heart disease with 11 of 13 effect size statistics >0.80. Taking an average of 10 minutes or less to complete, the respondent-burden for the MacNew is low and its acceptability is demonstrated by response rates of over 90%. Normative data are available for patients with myocardial infarction, angina, and heart failure in the English version.

Conclusion

The MacNew may be a valuable tool for assessing and evaluating health related quality of life in patients with heart disease.

Addressing patients' emotional and spiritual needs

BACKGROUND

A comprehensive, systematic literature review and original research were conducted to ascertain whether patients' emotional and spiritual needs are important, whether hospitals are effective in addressing these needs, and what strategies should guide improvement.

METHODS

The literature review was conducted in August 2002. Patient satisfaction data were derived from the Press Ganey Associates' 2001 National Inpatient Database; survey data were collected from 1,732,562 patients between January 2001 and December 2001.

RESULTS

Data analysis revealed a strong relationship between the "degree to which staff addressed emotional/spiritual needs" and overall patient satisfaction. Three measures most highly correlated with this measure of emotional/spiritual care were (1) staff response to concerns/complaints, (2) staff effort to include patients in decisions about treatment, and (3) staff sensitivity to the inconvenience that health problems and hospitalization can cause.

DISCUSSION

The emotional and spiritual experience of hospitalization remains a prime opportunity for QI. Suggestions for improvement include the immediate availability of resources, appropriate referrals to chaplains or leaders in the religious community, a team dedicated to evaluating and improving the emotional and spiritual care experience, and standardized elicitation and meeting of emotional and spiritual needs. Survey data suggested a focus on response to concerns/complaints, treatment decision making, and staff sensitivity.

Misrepresenting random sampling? A systematic review of research papers in the Journal of Advanced Nursing

AIM

This paper discusses the theoretical limitations of the use of random sampling and probability theory in the production of a significance level (or P-value) in nursing research. Potential alternatives, in the form of randomization tests, are proposed.

BACKGROUND

Research papers in nursing, medicine and psychology frequently misrepresent their statistical findings, as the P-values reported assume random sampling. In this systematic review of studies published between January 1995 and June 2002 in the Journal of Advanced Nursing, 89 (68%) studies broke this assumption because they used convenience samples or entire populations. As a result, some of the findings may be questionable.

DISCUSSION

The key ideas of random sampling and probability theory for statistical testing (for generating a P-value) are outlined. The result of a systematic review of research papers published in the Journal of Advanced Nursing is then presented, showing how frequently random sampling appears to have been misrepresented. Useful alternative techniques that might overcome these limitations are then discussed. REVIEW LIMITATIONS: This review is limited in scope because it is applied to one journal, and so the findings cannot be generalized to other nursing journals or to nursing research in general. However, it is possible that other nursing journals are also publishing research articles based on the misrepresentation of random sampling. The review is also limited because in several of the articles the sampling method was not completely clearly stated, and in this circumstance a judgment has been made as to the sampling method employed, based on the indications given by author(s).

CONCLUSION

Quantitative researchers in nursing should be very careful that the statistical techniques they use are appropriate for the design and sampling methods of their studies. If the techniques they employ are not appropriate, they run the risk of misinterpreting findings by using inappropriate, unrepresentative and biased samples.

"It's like an explosion in your life...": lay perspectives on stress and myocardial infarction

Psychological difficulties are common after myocardial infarction (MI). These difficulties are most often represented to patients through cardiac rehabilitation services and the literature offered to patients after MI as being related to "stress" and its management. However, no research has examined what MI patients understand by the term "stress" or how congruent lay views of stress are with those evident in the professional literature. The aim of the study reported here was to examine post-MI patients' views of stress, its functioning and relationship to their MI. As patients' views of stress were sought, qualitative interviews were used. A philosophical approach was taken (critical realism) that recognizes the legitimacy of both professional and lay perspectives. Data were generated in 44 semistructured interviews with 14 MI patients who were interviewed 48 hours, 1 week, 1 month and 3 months after hospital admission. While participants described their experiences after MI as being difficult, to convey this they used everyday terms such as fear, fright and worry. Rather than viewing stress as being a consequence of their MI, they perceived it to be a common cause of heart problems. Many considered stress as having a more influential role than other risk factors, such as smoking and diet. They expressed a wide variety of sophisticated and diverse views of stress and its functioning. Each of these views placed different weighting on the roles of social, personal and situational factors in contributing to the stressful reaction. Parallels were apparent between these lay accounts and theories of stress developed in the professional literature.

An international perspective on gender differences in anxiety early after acute myocardial infarction

OBJECTIVE

Higher anxiety is linked to poorer outcomes after acute myocardial infarction (AMI), including increased in-hospital reinfarction and potentially life-threatening complications. If clinicians can identify patients at greatest risk for anxiety after AMI, they can institute early treatment. Previous research on the influence of gender on the incidence of anxiety post-AMI reflects inconsistent findings, and differences across cultures have not been studied. Therefore, the purposes of this study were to determine: 1) whether there are gender differences in anxiety in a diverse international sample of AMI patients, and 2) whether there was an interaction between gender and sociodemographic and clinical variables thought to influence anxiety.

METHODS

In this prospective, comparative study, 912 AMI patients were enrolled from Australia, South Korea, Japan, England, and the United States. Anxiety was assessed, using the Brief Symptom Inventory, within the first 72 hours of admission to the hospital for AMI symptoms.

RESULTS

Women had higher anxiety levels than men (0.76 +/- 0.90 vs. 0.57 +/- 0.70, p =.005), and this pattern of higher anxiety in women was seen in each country studied. Neither sociodemographic nor clinical variables interacted with gender to influence anxiety.

CONCLUSION

Across a variety of cultures, women have higher anxiety than men after AMI and this relationship is independent of age, education level, marital status, or presence of comorbidities or severity of AMI.

Fear and anxiety in patients at different time-points in the coronary artery bypass process

The purpose of this study was to examine fear and anxiety of coronary artery bypass patients at different time-points in the coronary artery bypass process and changes between different time-points. Patients (n = 171) from one university hospital completed questionnaires while awaiting surgery at home, in hospital the evening before surgery and 3 months later. The Bypass Grafting Fear scale was developed to measure fear. Anxiety was measured using state-trait-anxiety inventory and HAD. The highest levels of fear and anxiety were measured in the waiting period to coronary artery bypass grafting (CABG). Compared with the waiting period, fear and anxiety levels dropped in hospital and 3 months later. Female gender was related to change in fear and HAD anxiety. Marital status and vocational education were related to changes in STATE-A. Age under 55 years was related to higher TRAIT-A especially in the recovery period. These findings warrant concern for fear and anxiety in patients awaiting CABG, especially women and patients who do not have partner relationship.

Social support and its relation to fear and anxiety in patients awaiting coronary artery bypass grafting

The purpose of this study was to ascertain social support resources available for patients awaiting coronary artery bypass grafting (CABG) and the effect of social support on their fear and anxiety. A postal questionnaire was sent to 270 patients awaiting CABG in one hospital, 207 of whom responded. Norbeck's Social Support Questionnaire (NSSQ) was used. The quality of basic cardiac information (QBCI) and the social support wanted (WSS) by patients were measured with an instrument developed for this study. Fear was measured with the Bypass Grafting Fear Scale (BGFS) developed for this study. Anxiety was measured with Spielberger's State-Trait Anxiety Inventory (STAI). The results were analysed using frequency and percentage distributions, cross-tabulation, non-parametric tests and logistic regression. Heart patients' spouses provided the most emotional and tangible aid. Low emotional support from the social network was associated with high anxiety. Half the patients rated the quality of basic information as good or excellent. Those who perceived the quality of information to be excellent experienced mild fear. Those who displayed high fear wanted informational support from nurses more often than patients with lower fear. We conclude that the fear and anxiety of patients awaiting CABG are connected with their social support resources.

Development and validation of a short measure of health status for individuals with acute myocardial infarction: the myocardial infarction dimensional assessment scale (MIDAS)

The purpose of this study was to develop and validate a disease-specific health status measure for individuals with myocardial infarction (MI). The development of the myocardial infarction dimensional assessment scale (MIDAS) followed three main stages. Stage 1 consisted of in-depth, semi-structured, exploratory interviews conducted on a sample of 31 patients to identify areas of salience and concern to patients with MI. These interviews generated 48 candidate questions. In stage 2 the 48-item questionnaire was used in a postal survey to identify appropriate rephrasing/shortening, to determine acceptability and to help identify sub-scales of the instrument addressing different dimensions of MI. Finally, in stage 3 the construct validity of MIDAS subscales was examined in relation to clinical and other health outcomes. A single centre (district general hospital) in England was used for stages 1 and 3 and a national postal survey was conducted for stage 2. A total of 410 patients were recruited for the national survey (stage 2). Full data were available on 348 (85%) patients. One hundred and fifty-five patients were recruited to test construct validity (stage 3). The MIDAS contains 35 questions measuring seven areas of health status: physical activity, insecurity, emotional reaction, dependency, diet, concerns over medication and side effects. The measure has high face, internal and construct validity and is likely to prove useful in the evaluation of treatment regimes for MI.

Family interventions during the trajectory of recovery from cardiac event: an integrative literature review

The experience of a cardiac event is a source of stress for both patients and their family members that may be viewed as a family crisis. The trajectory of cardiovascular disease, including both the acute and recovery phases, involves continuous adjustment by patients and family members as they attempt to reconcile the impact of the event and adapt to the uncertainties associated with the chronicity of coronary heart disease. This article reviews empirical intervention research available to practitioners and researchers that may guide the use of family centered cardiovascular nursing interventions. Although a significant amount of research has been conducted in this area, conclusions regarding patient and family interventions are varied. Directions for future research focus on the need for family centered interventions that address the needs of patients with cardiovascular disease that are specific to phases in the trajectory of illness.

The MacNew heart disease health-related quality of life instrument: reference data for users

OBJECTIVE

To report reference data for the heart-specific MacNew Heart Disease Health-Related Quality of Life instrument.

METHODS

One thousand five hundred and six patients with myocardial infarction (n = 346), heart failure (n = 201), and ischaemic heart disease (IHD, n = 959) were surveyed 4 months after hospital discharge. Quality of life scores were determined, stratified by diagnostic category, age and sex. Changes in scores from 4 to 8 months post-discharge were calculated for a subset of 830 patients, stratified by age and sex.

RESULTS

At 4 months there were no significant differences in scores between myocardial infarction and electively admitted IHD patients, however the scores of heart failure patients were significantly lower (indicating poorer quality of life) than those of patients with other diagnoses. There were few significant differences between age groups or sexes when comparing within diagnostic groups. Change from 4 to 8 months was not associated with diagnosis, age, or sex but was associated with events within the period (readmission or revascularisation). The change data suggest that a value of 0.5 may be a useful indicator of the minimal clinically important difference.

CONCLUSIONS

These reference data will assist in sample size calculations and with comparison of results in other studies, and will be of use to researchers who are using or intending to use the MacNew instrument.