Dyslipidemia and associated factors among adult cardiac patients: a hospital-based comparative cross-sectional study

BACKGROUND

Atherosclerotic vascular diseases are a leading global cause of morbidity and mortality. Dyslipidemia, a major modifiable risk factor for cardiovascular disease, remains poorly understood among adult cardiac patients in in the study area. This study aims to determine the prevalence of dyslipidemia and identify associated factors in this population.

METHODS

Hospital-based comparative cross-sectional study was conducted from May to August 2021. A total of 319 participants (153 cardiac cases, 166 healthy controls, aged ≥ 18) were included in the study. Socio-demographic, anthropometric, behavioral, and clinical data were collected using the WHO STEPS survey instrument through systematic sampling. Overnight fasting blood samples were obtained, and serum lipid profiles were analyzed using a COBAS 6000 analyzer. Data were analyzed with SPSS version 20.0, employing bivariable and multivariable logistic regression. Statistical significance was set at p < 0.05.

RESULTS

The overall prevalence of dyslipidemia, encompassing at least one lipid abnormality, was 80.3% among 256 participants. Among cardiac cases, the prevalence rates were as follows: 72.5% for low HDL-cholesterol, 12.4% for hypercholesterolemia, 9.8% for elevated LDL-cholesterol, and 30.1% for hypertriglyceridemia. In controls, corresponding rates were 69.9%, 9.6%, 7.2%, and 32.5%. Significant factors linked to low HDL- cholesterol were female gender (AOR: 2.8, 95% CI 1.7-4.7) and obesity (AOR: 2.8, 95% CI 1.1-7.5). Abdominal obesity was associated with hypercholesterolemia (AOR: 5.2, 95% CI 1.9-14.3) and elevated LDL-cholesterol (AOR: 5.1, 95% CI 1.6-15.8). High blood pressure, overweight, and abdominal obesity were significantly linked to hypertriglyceridemia (p < 0.05).

CONCLUSION

Dyslipidemia was high among the study participants. Overweight, obesity, central adiposity, and high blood pressure were significantly associated with dyslipidemia in cardiac patients. This alarms the need for lipid profile assessment for patients periodically, with treatment follow-up to monitor any rising patterns and cardiovascular-related risks.

The mediating role of cardiac patients' perception of nursing care on the relationship between kinesiophobia, anxiety and depression in rural hospitals: a cross-sectional study

BACKGROUND

Kinesiophobia could act as a significant barrier against physical activity following cardiac procedures worsening cardiovascular health problems and potentially leading to conditions like hospital-acquired anxiety and depression among patients with cardiovascular disease (CVD). Nurses are the vanguard health care team who can aid patients in taking proactive steps to overcome fear of movement following cardiac procedures.

AIM

The overarching aim is to investigate the relationship between kinesiophobia, anxiety and depression, and patients' perception of nursing care.

METHOD

A descriptive correlational research design in two rural hospitals, conducted at cardiac intensive care units of Kafr Eldawar Hospital and Damanhur Medical National Institute. Data were collected from 265 nurses, using the following patient-reported outcome measures, the Tampa Scale for Kinesiophobia (TSK), the Hospital Anxiety and Depression Scale (HADS), the Person-Centered Critical Care Nursing Questionnaire (PCCNP) and the patients' demographic and clinical profile.

RESULT

A significant negative correlation was found between HADS and PCCNP (r: -0.510, p < 0.001) however, Kinesiophobia was significantly and positively correlated (r: 0.271, p < 0.001). A direct effect of PCCNP in the presence of the mediator was found to be not statistically significant (-0.015, CR = 0.302, p = 0.763). Nonetheless, PCCNP indirectly affects kinesiophobia through HADS (p=-0.099).

IMPLICATION FOR NURSING PRACTICE

Customizing individualized cardiac rehabilitation (CR) programs based on the emotional experience of cardiac patients will be conducive to rehabilitation and prognosis for patients, thereby lessening the physical burden and improving their quality of life.

Assessing exposure to secondhand smoke among Iranian patients with cardiac diseases; a cross-sectional study

Introduction

Studies have linked secondhand smoke (SHS) exposure to adverse health effects. The high prevalence of heart disease necessitates the need for studies in this field. Therefore, the aim of the present study was to assess the exposure to SHS in cardiac patients.

Method

This study is a cross-sectional descriptive study. A total of 430 patients who were referred to Imam Ali Hospital in Kermanshah, Iran, in 2020 were included in the study based on predetermined inclusion and exclusion criteria. The researchers collected and recorded demographic information, disease history, and exposure to secondhand smoke (SHS) through a digital questionnaire. Bivariate analysis was conducted using a chi-square test and an independent T-test, depending on the variable scale.

Results

The results of the study showed that 237 patients were male (55.12 %) and 193 were female (44.8 %). The prevalence of exposure to secondhand smoke was 72.09 %. Notably, the highest rate of exposure to secondhand smoke was associated with 'exposure to tobacco smoke in public places' with a rate of 69.30 %. Additionally, it was observed that approximately 39.07 % of patients reported exposure to secondhand smoke in public places at least once a week.

Conclusion

The present study has found that cardiac patients frequently experience secondhand smoking exposure, with public settings being the primary location of exposure. Implementing intervention strategies and enacting laws that prohibit smoking can effectively mitigate the negative impact of SHS exposure.

Screening for anxiety and depression in clinical practice: translating scores from World Health Organization-5/Anxiety Symptom Scale-2/Major Depression Inventory-2 to Hospital Anxiety and Depression Scale

AIMS

The aim of this study was to evaluate if a combination of World Health Organization-5 (WHO-5), Anxiety Symptom Scale-2 (ASS-2), and Major Depression Inventory-2 (MDI-2) can replace the Hospital Anxiety and Depression Scale (HADS) as screening tool for anxiety and depression in cardiac patients across diagnoses and whether it is feasible to generate crosswalks (translation tables) for use in clinical practice.

METHODS AND RESULTS

We used data from the Danish 'Life with a heart disease' survey, in which 10 000 patients with a hospital contact and discharge diagnosis of ischaemic heart disease, heart failure, heart valve disease, or atrial fibrillation in 2018 were invited. Potential participants received an electronic questionnaire including 51 questions on health, well-being, and evaluation of the health care system. Crosswalks between WHO-5/ASS-2 and HADS anxiety dimension (HADS-A) and between WHO-5/MDI-2 and HADS depression dimension (HADS-D) were generated and tested using item response theory (IRT). A total of 4346 patients responded to HADS, WHO-5, ASS-2, and MDI-2. Model fit of the bi-factor IRT models illustrated appropriateness of a bi-factor structure and thus of essential uni-dimensionality [root mean square error of approximation (RMSEA) (P value) range 0.000-0.053 (0.0099-0.7529) for anxiety and 0.033-0.061 (0.0168-0.2233) for depression]. A combination of WHO-5 and ASS-2 measured the same trait as HADS-A, and a combination of WHO-5 and MDI-2 measured the same trait as HADS-D. Consequently, crosswalks (translation tables) were generated.

CONCLUSIONS

Our study shows that it is feasible to use crosswalks between HADS-A and WHO-5/ASS-2 and HADS-D and WHO-5/MDI-2 for screening cardiac patients across diagnoses for anxiety and depression in clinical practice.

Utilization of Prophylactic Antibiotics for Cardiac Patients Undergoing Dental Procedures in Saudi Arabia: A Retrospective Study

Objectives

This study aimed to determine the characteristics of antibiotic prophylaxis (AP) utilization and the level of adherence of King Saud University Medical City (KSUMC) staff to the latest American Heart Association (AHA) guidelines for AP for infective endocarditis (IE) in cardiac patients undergoing dental procedures.

Methods

The study was conducted as a retrospective cohort study to investigate the relationship between AP in dental procedures and cardiac patients admitted in the surgical wards of KSUMC between 2015 and 2021. All cardiac patients who underwent dental procedures were included in the study. We excluded patients with long-term or concurrent antibiotic use for other indications.

Results

Overall, 170 (69.4%) cardiac patients received AP before undergoing a dental procedure. The most common comorbidities were hypertension (39.1%) and diabetes (34.2%). Most of the low-risk (69.4%) and moderate-risk (70.5%) patients received AP, despite the guideline's recommendation to limit AP to high-risk patients only. Moreover, only 53.8% of high-risk patients were prescribed AP. In total, 95.9% of the 170 patients who received AP did so without following the recommendations. Only one patient developed IE during the 1-year follow-up. Tooth extraction was the only significant predictor of AP prescription in our study (P = 0.001; OR: 3.73; 95% CI; 1.678-8.298).

Conclusion

There was an exceeding level of inconsistency (95.9%) in AP utilization by cardiac patients in our sample compared with the recommendations of the latest AHA guidelines.

Exploring barriers and facilitators of behavioural changes in dietary intake and physical activity: a qualitative study in older adults undergoing transcatheter aortic valve implantation

PURPOSE

The majority of older patients, scheduled for a cardiac procedure, do not adhere to international dietary intake and physical activity guidelines. The purpose of this study was to explore barriers and facilitators regarding dietary intake and physical activity behaviour change in older patients undergoing transcatheter aortic valve implantation (TAVI).

METHODS

We conducted a qualitative study using semi-structured interviews with patients undergoing TAVI. Interviews were analysed by two independent researchers using thematic analysis, the capability, opportunity and motivation behaviour model was used as a framework.

RESULTS

The study included 13 patients (82 ± 6 years old, 6 females) until data saturation was reached. Six themes were identified, which were all applicable to both dietary intake and physical activity. Three following themes were identified as barriers: (1) low physical capability, (2) healthy dietary intake and physical activity are not a priority at an older age and (3) ingrained habits and preferences. Three following themes were identified as facilitators: (1) knowledge that dietary intake and physical activity are important for maintaining health, (2) norms set by family, friends and caregivers and (3) support from the social environment.

CONCLUSION

Our study found that older patients had mixed feelings about changing their behaviour. The majority initially stated that dietary intake and physical activity were not a priority at older age. However, with knowledge that behaviour could improve health, patients also stated willingness to change, leading to a state of ambivalence. Healthcare professionals may consider motivational interviewing techniques to address this ambivalence.

Management of Cardiac Patients in Epidemic Outbreak

In times of COVID-19 epidemic/pandemic, cardiac patients are vulnerable group with many specific conditions that could aggravate their condition. In this narrative review, we present possible measures adequate in managing cardiac patients in epidemic outbreak. An overview of the role of cardiologists and Crisis Management Team in management of cardiac patients is given. Protocols and measures implemented in COVID-19 crises are presented in light of risk assessment and disease prevention of cardiac patients and measures that should be taken for each cardiac condition. Specificity of epidemics calls for specific measures in addressing cardiac patients as part of the affected population. Many possible outcomes could be expected in an epidemic outbreak in relation to cardiovascular diseases, but tailored measures will keep cardiac patients safe. Proposed preventive measures for cardiac patients could be implemented in existing protocols for epidemic outbreak.

Exploring patient experiences in the student outpatient clinic - A contribution to learning

OBJECTIVE

To understand how patients experience participation in student encounters.

METHODS

Qualitative semi-structured telephone interviews with ten cardiac surgery patients who had attended voluntary postoperative consultations in a student outpatient clinic. The interview guide included questions about reasons for and experiences of being part of a teaching situation. Interviews were analysed through inductive thematic analysis where pieces of text in each interview were assigned different codes and condensed into themes.

RESULTS

The patients expressed a duality in their reasons for participating in student consultations: (1) a personal need for assurance (safety) and (2) a wish to help students (altruism). Students were perceived as professional and sometimes insecure. Being part of an educational situation was meaningful to the patients because they did not feel objectified. Knowing that there was a backup supervisor made the patients feel safe even though the supervisor was not present during all parts of the consultation.

CONCLUSIONS

Patients experienced safety, understood their role in all parts of the consultation, and shared a wish to help students learn.

PRACTICE IMPLICATIONS

A sequential consultation model alternating between student- and supervisor-driven supervision can balance student autonomy and patient safety. This knowledge could guide future patient-centred medical education in student clinics.

Are patient-reported outcomes at discharge associated with employment status after cardiac hospitalization? Results from the national DenHeart study

INTRODUCTION 

In patients hospitalized for cardiac disease, a more comprehensive understanding of the potential predictors of returning to the workforce or detachment from employment is lacking.

AIM 

The aims were (i) to explore the patterns of employment status within 1 year following hospital discharge and (ii) to investigate the association between self-reported physical health, mental health, and symptom burden at discharge and employment status at 13, 26, and 52 weeks, respectively, following discharge.

METHODS AND RESULTS 

Patients discharged from Danish heart centres from April 2013 to April 2014 who were a part of the workforce prior to hospitalization and aged 18-63 were included. Questionnaires were used to measure physical and mental health and symptom burden. Information on comorbidity and return to the workforce was obtained from registers. Multiple logistic regression models were used to estimate the associations between self-reported health status and returning to the workforce. Of the 5365 patients, 14.1% had not returned to the workforce 52 weeks after discharge. Patients admitted due to 'observation for a cardiac disease' had the highest proportion (89.4%) and patients with heart failure had the lowest proportion (72.6%) of returning to the workforce. Poor self-reported physical and mental health and high symptom burden were associated with detachment from the workforce.

CONCLUSION 

Self-reported health status measured at discharge may be beneficial for identifying patients at increased risk of detachment from the workforce. Occupational initiatives may be implemented in the initial period after discharge, remembering that not all patients will benefit from returning to the workforce.

Major cardiac concerns in therapy and vaccinations for COVID-19

The necessity and impact of SARS-CoV-2 on the world's health have led to the development and production of practical and useful vaccines for this deadly respiratory virus. Since April 2020, a vaccine for the virus has been developed. Given that comorbidities such as diabetes, hypertension, and cardiovascular disease are more prone to viruses and the risk of infection, vaccines should be designed to protect against high-risk respiratory illnesses. In this review, we discussed the cardiovascular alteration in SARS-CoV-2 treatment, and we also reviewed the vaccination information and studies that have been done to primary considerations for cardiac patients.

Remote monitoring of implantable defibrillators is associated with fewer inappropriate shocks and reduced time to medical assessment in a remote and rural area

BACKGROUND

Implantable cardioverter defibrillators (ICDs) and cardiac resynchronisation therapy with defibrillators (CRT-D) reduce mortality in certain cardiac patient populations. However, inappropriate shocks pose a problem, having both adverse physical and psychological effects on the patient. The advances in device technology now allow remote monitoring (RM) of devices to replace clinic follow up appointments. This allows real time data to be analysed and actioned and this may improve patient care.

AIM

To determine if RM in patients with an ICD is associated with fewer inappropriate shocks and reduced time to medical assessment.

METHODS

This was a single centre, retrospective observational study, involving 156 patients implanted with an ICD or CRT-D, followed up for 2 years post implant. Both appropriate and inappropriate shocks were recorded along with cause for inappropriate shocks and time to medical assessment.

RESULTS

RM was associated with fewer inappropriate shocks (13.6% clinic vs 3.9% RM; P = 0.030) and a reduced time to medical assessment (15.1 ± 6.8 vs 1.0 ± 0.0 d; P < 0.001).

CONCLUSION

RM in patients with an ICD is associated with improved patient outcomes.

Diagnostic accuracy and suitability of instruments that screen for obstructive sleep apnoea, insomnia and sleep quality in cardiac patients: a meta-analysis

BACKGROUND

A number of clinical guidelines recommend that all cardiac rehabilitation patients should be screened for potential sleep disorders with a validated screening instrument. There is currently no consensus on what specific tools should be used.

OBJECTIVE

To identify tools that are practical to use in the clinical environment and have high diagnostic accuracy.

METHODS

We systematically searched online databases to identify patient reported outcome instruments that have been used in published research studies to assess the likelihood of obstructive sleep apnoea (OSA) in cardiac patients. In studies that provided diagnostic data, these data were extracted and verified via an evidence-based diagnostic calculator. Where sufficient numbers of studies were available, a meta-analysis was conducted to determine pooled estimates of specificity, sensitivity and diagnostic odds ratios. Selected papers were qualitatively assessed using the Standards for Reporting Diagnostic accuracy studies (STARD).

RESULTS

Of the 21 instruments identified, six detected likelihood of OSA, two assessed daytime sleepiness, five assessed insomnia and eight examined sleep quality. A meta-analysis of 14 studies that assessed diagnostic accuracy of moderate OSA, revealed moderate sensitivity for the Berlin Questionnaire, Sens = 0.49 (95% CI 0.45-0.52) and good sensitivity for the Stop-BANG, Sens = 0.93 (95% CI 0.87-0.96) but poor specificity at standard cut-off criteria.

CONCLUSION

There are promising practical tools available to screen patients with OSA and other sleep disorders in cardiac rehabilitation settings, but specificity could be improved. Additional assessment of sleep quality may enhance prognostic ability with both OSA and insomnia screening.

The Effect of Religious Intervention Using Prayer for Quality of Life and Psychological Status of Patients with Permanent Pacemaker

The development of heart disease, followed by the pacemaker implantation, has reduced the quality and psychological problems for patients. Thus, the present study was conducted to determine the effect of prayer on the quality of life and the psychological status of patients with permanent pacemaker. This is a quasi-experimental study in which 75 patients were assigned to experimental and control groups. Religious intervention was conducted for the experimental group, including the Tavasol prayer and four recommended (mustahab) remembrances in 7 sessions. Before and after the intervention, the patients were provided with the quality of life questionnaire and psychological status. Then, the questionnaires were analyzed using descriptive and analytical tests. Before intervention, there was no difference between quality of life status and psychological status of patients, but after intervention, their quality of life increased and their psychological status improved significantly. The implementation of religious intervention based on prayer positively affects the quality of life and psychological status of patients; thus, implementing this intervention is necessary for patients.

Psychometric properties of the Danish Hospital Anxiety and Depression Scale in patients with cardiac disease: results from the DenHeart survey

BACKGROUND

Anxiety and depression symptoms are common among cardiac patients. The Hospital Anxiety and Depression Scale (HADS) is frequently used to measure symptoms of anxiety and depression; however, no study on the validity and reliability of the scale in Danish cardiac patients has been done. The aim, therefore, was to evaluate the psychometric properties of HADS in a large sample of Danish patients with the four most common cardiac diagnoses: ischemic heart disease, arrhythmias, heart failure and heart valve disease.

METHODS

The DenHeart study was designed as a national cross-sectional survey including the HADS, SF-12 and HeartQoL and combined with data from national registers. Psychometric evaluation included analyses of floor and ceiling effects, structural validity using both exploratory and confirmatory factor analysis and hypotheses testing of convergent and divergent validity by relating the HADS scores to the SF-12 and HeartQoL. Internal consistency reliability was evaluated by Cronbach's alpha, and differential item functioning by gender was examined using ordinal logistic regression.

RESULTS

A total of 12,806 patients (response rate 51%) answered the HADS. Exploratory factor analysis supported the original two-factor structure of the HADS, while confirmatory factor analysis supported a three-factor structure consisting of the original depression subscale and two anxiety subscales as suggested in a previous study. There were floor effects on all items and ceiling effect on item 8. The hypotheses regarding convergent validity were confirmed but those regarding divergent validity for HADS-D were not. Internal consistency was good with a Cronbach's alpha of 0.87 for HADS-A and 0.82 for HADS-D. There were no indications of noticeable differential item functioning by gender for any items.

CONCLUSIONS

The present study supported the evidence of convergent validity and high internal consistency for both HADS outcomes in a large sample of Danish patients with cardiac disease. There are, however, conflicting results regarding the factor structure of the scale consistent with previous research.

TRIAL REGISTRATION

ClinicalTrials.gov: NCT01926145.

Cardiac patients' beliefs about their illness and treatment: A sequential exploratory mixed methods design

Background: Cardiac patients’ beliefs about illness and treatment can disturb their treatment process, treatment regimen adherence, and daily activities. Exploring these beliefs by the use of appropriate, valid, and accurate scales can be helpful in false beliefs reforming by nurses and finally, result in life quality promotion. Therefore, this study is conducted to design and psychometry a questionnaire probing about cardiac patients’ beliefs about illness and treatment.

Methods: The sequential combination exploratory mixed methods design was used to develop the questionnaire format, which involved two sections: the quantitative and qualitative step. The qualitative step included probing the role of cultural beliefs about illness and treatment in two steps, including the literature and related tools review and fieldwork (semi-structured interviews with cardiac patients). Seventeen studies were checked in the literature review. Twenty-two cardiac patients were selected and interviewed by purposive sampling. The interviews continued up to the data saturation. The data analysis was conducted in both steps using conventional content analysis and textual content analysis. The quantitative step was a methodology study accomplished in two parts. The questionnaire items were formed using the data and items pool in the first part while the psychometric properties of the questionnaire were checked using face, content and construct validity and the reliability was probed using internal consistency and stability in the second part. The data were transferred into SPSS software program, version 18.0 for Windows (α<0.05).

Results: 319 codes were extracted from the analyzing phase which formed 6 categories including prognosis, prevention, contexts, treatment efficiency, mentality and lifestyle as well as 9 sub-categories including understanding the danger, attitude toward disease, attitude toward treatment, society’s culture, feeling hopeless, treatment regimen ignorance, self-curing, trying to survive and physical outcomes. The items pool was formed using literature reviews and interviews. A 30-itemed questionnaire was formed after the psychometric process. The Kaiser-Meyer-Olkin (KMO) index and the Bartlett’s test of sphericity showed good results. Six components from the exploratory content analysis including prognosis, prevention, contexts, treatment efficiency, mentality, and lifestyle gained 51.7% variance totally. The interclass correlation coefficient was 0.83 in responding to the items for two times.

Conclusion: This study developed a questionnaire about cardiac patients’ beliefs regarding their illness and treatment. It can be used for the educational, research, and treatment purposes as a questionnaire with short, easy, and grammatically simple items that have appropriate validity and reliability. Using this scale can be helpful in evaluating clients’ beliefs and recognize their educational needs.

Patterns of tobacco use among smokers prior to hospitalization for an acute cardiac event: Use of combusted and non-combusted products

Use of tobacco products before or after a cardiac event increases risk of morbidity and mortality. Unlike cigarette smoking, which is generally screened in the healthcare system, identifying the use of other tobacco products remains virtually unexplored. This study aimed at characterizing the use of other non-combusted tobacco products in addition to combusted products among cardiac patients and identifying a profile of patients who are more likely to use non-combusted products. Patients (N = 168) hospitalized for a coronary event who reported being current cigarette smokers completed a survey querying sociodemographics, cardiac diagnoses, use of other tobacco products, and perceptions towards these products. Classification and regression tree (CART) analysis was used to identify which interrelationships of participants characteristics led to profiles of smoking cardiac patients more likely to also be using non-combusted tobacco products. Results showed that non-combusted tobacco product use ranged from 0% to 47% depending on patient characteristic combinations. Younger age and lower perception that cigarette smoking is responsible for their cardiac condition were the strongest predictive factors for use of non-combusted products. Tobacco product use among cardiac patients extends beyond combusted products (13.7% non-combusted product use), and consequently, screening in health care settings should be expanded to encompass other tobacco product use. This study also characterizes patients likely to be using non-combusted products in addition to combusted, a group at high-risk due to their multiple product use, but also a group that may be amenable to harm reduction approaches and evidence-based tobacco treatment strategies.

Circulating n-3 fatty acids and linoleic acid as indicators of dietary fatty acid intake in post-myocardial infarction patients

BACKGROUND AND AIMS

Population-based studies often use plasma fatty acids (FAs) as objective indicators of FA intake, especially for n-3 FA and linoleic acid (LA). The relation between dietary and circulating FA in cardiometabolic patients is largely unknown. We examined whether dietary n-3 FA and LA were reflected in plasma lipid pools in post-myocardial infarction (MI) patients.

METHODS AND RESULTS

Patients in Alpha Omega Cohort filled out a 203-item food-frequency questionnaire from which eicosapentaenoic acid (EPA), docosahexaenoic acid (DHA), alpha-linolenic acid (ALA), and LA intake were calculated. Circulating individual FA (% total FA) were assessed in cholesteryl esters (CE; n = 4066), phospholipids (PL; n = 838), and additionally in total plasma for DHA and LA (n = 739). Spearman correlation coefficients (r_s) were calculated for dietary vs. circulating FA. Circulating FA were also compared across dietary FA quintiles, overall and in subgroups by sex, obesity, diabetes, statin use, and high alcohol intake. Patients were on average 69 years old and 79% was male. Moderate correlations between dietary and circulating levels were observed for EPA (r_s∼0.4 in CE and PL) and DHA (r_s ∼0.5 in CE and PL, ∼0.4 in total plasma), but not for ALA (r_s ∼0.0). Weak correlations were observed for LA (r_s 0.1 to 0.2). Plasma LA was significantly lower in statin users and in patients with a high alcohol intake.

CONCLUSIONS

In post-MI patients, dietary EPA and DHA were well reflected in circulating levels. This was not the case for LA, which may partly be influenced by alcohol use and statins.

Microvascular reactivity in rehabilitating cardiac patients based on measurements of retinal blood vessel diameters

BACKGROUND

Exercise-based rehabilitation improves general cardiovascular fitness. The impact on the microvascular system has been studied in less detail. We measured changes in retinal blood vessel diameters, as a proxy for microvascular reactivity, in cardiac patients and we assessed the impact of a rehabilitation program on retinal vessel diameters.

DESIGN

Cardiac patients (n = 78) and age-matched healthy controls (n = 32) performed an initial maximal endurance cycling test. Patients then participated in a 12-week rehabilitation program with additional endurance tests being performed six and twelve weeks after the initial test.

METHODS

Fundus images were collected immediately before and 0, 5, 10, 15 and 30 min after the endurance test. Widths of retinal blood vessels, represented as Central Retinal Arteriolar/Venular Equivalent (CRAE/CRVE) were calculated from the images.

RESULTS

At the start of the rehabilitation program, CRAE and CRVE values of the patients changed immediately after the endurance test with respectively -1.90 μm (95% CI: -3.58; -0.22) and -5.32 μm (95% CI: -7.33; -3.30) compared to baseline values. In contrast, CRAE and CRVE values of healthy controls were respectively increased [3.52 μm (95% CI: 2.34; 4.69)] and decreased [-3.17 μm (95% CI: -5.27; -1.07)]. After six and twelve weeks, CRAE responses of patients immediately after endurance test increased respectively with 5.98 μm (95% CI: 4.25; 7.71) and 4.44 μm (95% CI: 3.18; 5.71). These responses were similar to the microvascular reactions observed in the control group.

CONCLUSIONS

Arteriolar and venular retinal microvascular responses in cardiac patients were different from the ones of healthy controls. Retinal microvascular response of cardiac patients improved during rehabilitation.

Listening to the patients: using participatory design in the development of a cardiac telerehabilitation web portal

BACKGROUND

Cardiovascular disease is the leading cause of all deaths worldwide. Cardiac rehabilitation is an effective approach for preventing secondary complications, but it remains a complex intervention because of the need for lifestyle changes. One solution is to employ interactive telerehabilitation or eHealth web portals. However, these have not been implemented as intended by developers. The aim of this study was to evaluate the design and usability of a cardiac telerehabilitation web portal, called the 'HeartPortal', for use among heart failure (HF) patients.

METHODS

The HeartPortal was designed using participatory design (PD). The design process involved HF patients, their relatives, healthcare professionals (HCP), healthcare company specialists and researchers. Self-determination theory (SDT) was used to enable the design to elicit intrinsic motivation within the patients. With eHealth literacy skills in mind, the goal of the HeartPortal was to successfully target the end-users. The PD process and data collection techniques included cultural probes, workshops, participant-observation, questionnaires, and problem-solving tasks.

RESULTS

The PD process helped us design an interactive web portal, the HeartPortal. Based on participants' feedback, the design incorporated features such as being able to make notes and to communicate with HCP, view data from self-tracking devices in a graphic form, and to obtain information on rehabilitation in the form of text, audio, and video. More than half of those testing the HeartPortal found that it was easy to navigate, and most of the users stated that it had an excellent structure and that using it could possibly improve their condition.

CONCLUSIONS

Overall, the HeartPortal was found to be logical and easy to navigate and will now be tested in a clinical trial within the Future Patient Telerehabilitation Program.

Mental health is a risk factor for poor outcomes in cardiac patients: Findings from the national DenHeart survey

OBJECTIVE

To explore (i) the prevalence of cardiac risk factors (obesity, smoking, excessive alcohol consumption and medication non-adherence) among cardiac patients with depression and anxiety, (ii) associations between depression and anxiety scores and cardiac risk factors and (iii) the association of depression and anxiety and cardiac risk factors with mortality, and their population attributable risk.

METHODS

A national cross-sectional study using patient-reported outcomes at discharge and national register data. For one year (April 15th 2013 to April 15th 2014) all patients discharged or transferred from the five Danish Heart Centres were included in the study. A total of 14,239 patients answered the HADS questionnaire, response rate 51%.

RESULTS

Mean age was 64.8 years and 69% were male. Patients with depression or anxiety (HADS-D or HADS-A score ≥ 8) had 30% and 45%, respectively, higher odds of being current smokers; 19% and 37% higher odds of being obese and 31% and 24% higher odds of excessive alcohol consumption. Depressive patients had 34% higher odds of being non-adherent to their medication. At one-year follow-up, patients with depression (HADS-D score ≥ 11) had the highest attributable risk associated with mortality followed by: smoking, ischemic heart disease, anxiety, diabetes, hypertension chronic obstructive pulmonary disease and excessive alcohol consumption.

CONCLUSION

Depression and anxiety in patients with cardiac disease is associated with cardiac risk behaviour such as smoking, obesity, excessive alcohol consumption and medication non-adherence. Depression and anxiety have an attributable risk associated with mortality that is comparable to other well-known risk factors such as smoking.

The utilization of nonprescription medications in Saudi patients with cardiovascular diseases

Background

Cardiovascular diseases (CVDs) are the most common cause of disease-related death in Saudi Arabia. The incidence of CVDs continues to increase, presenting a major health care problem. Nonprescription medications are widely used by patients with CVD and may cause adverse drug events, either by worsening the disease or by harmfully interacting with prescribed medications. We investigated the patterns of nonprescription medication utilization and the factors associated with their use in patients with CVD.

Methods

This was a cross-sectional study conducted at the Cardiology Clinics of an academic tertiary health care center. Participants were asked about their sociodemographic characteristics, medical history and frequency of using nonprescription medications including over-the-counter (OTC) products, dietary supplements, and herbal products. Moreover, we investigated the participants' sources of information about nonprescription medications. Multivariate logistic regression analysis was conducted to examine the predictors of nonprescription medication use.

Results

A total of 209 participants were interviewed. The mean age of the participants was 56 ± 15 years, and 110 (52.6%) were female. Of the 209 participants, 116 (55%) reported routine use of nonprescription medications. Black seeds and garlic were the most frequently used herbal products. Acetaminophen, cold/cough remedies, and ibuprofen were the most commonly reported OTC drugs. Of the surveyed patients, 54 (46.5%) used nonprescription medications to manage cardiovascular conditions specifically. Compared with other comorbidities, diabetes mellitus was associated with a higher use of nonprescription medications.

Conclusion

In patients with CVD, the routine use of nonprescription medications was common for a number of reasons. Health care providers should proactively discuss nonprescription use with their CVD patients to avoid potential harmful outcomes.

Respiratory muscle strength in relation to sarcopenia in elderly cardiac patients

BACKGROUND AND AIMS

Little information exists on the relation between respiratory muscle strength such as maximum inspiratory muscle pressure (MIP) and sarcopenia in elderly cardiac patients. The present study aimed to determine the differences in MIP, and cutoff values for MIP according to sarcopenia in elderly cardiac patients.

METHODS

We enrolled 63 consecutive elderly male patients aged ≥65 years with cardiac disease in this cross-sectional study. Sarcopenia was defined based on the European Working Group on Sarcopenia in Older People algorithm, and, accordingly, the patients were divided into two groups: the sarcopenia group (n = 24) and non-sarcopenia group (n = 39). The prevalence of sarcopenia in cardiac patients and MIP in the patients with and without sarcopenia were assessed to determine cutoff values of MIP.

RESULTS

After adjustment for body mass index, the MIP in the sarcopenia group was significantly lower than that in the non-sarcopenia group (54.7 ± 36.8 cmH₂O; 95 % CI 42.5-72.6 vs. 80.7 ± 34.7 cmH₂O; 95 % CI 69.5-92.0; F = 4.89, p = 0.029). A receiver-operating characteristic curve analysis of patients with and without sarcopenia identified a cutoff value for MIP of 55.6 cmH₂O, with a sensitivity of 0.76, 1-specificity of 0.37, and AUC of 0.70 (95 % CI 0.56-0.83; p = 0.01) in the study patients.

CONCLUSION

Compared with elderly cardiac patients without sarcopenia, MIP in those with sarcopenia may be negatively affected. The MIP cutoff value reported here may be a useful minimum target value for identifying elderly male cardiac patients with sarcopenia.

The relationship of abdominal girth with blood pressure, blood sugar and lipid profile among cardiac patients

Objectives

This study aimed to characterize and identify the relationship of abdominal girth with blood pressure, blood sugar and lipid profile among cardiac patients.

Methods

A total of 100 patients with diagnosed cardiac problems were recruited from the outpatient clinic of a multi-speciality hospital. For data collection, a self-administered questionnaire was used to gather information about patients' demographics and socio-economic status. In addition, an assessment tool on the Physical and Laboratory Characteristics was employed. The data were analysed using t tests, Pearson correlations and chi squared tests.

Results

The findings of the study showed that there was a significant positive correlation of abdominal girth with blood pressure, blood sugar and lipid profile, as the R-values were reported to be 0.32, 0.28, 0.02, 0.32, 0.32, 0.28 and 0.18. There was no significant association of the selected demographic variables with abdominal girth, blood pressure, blood sugar or lipid profile among the selected cohort of patients.

Conclusion

Lifestyle factors contribute significant risk in the development of abdominal obesity, metabolic syndrome and cardiovascular diseases. This study recommends a careful monitoring of risk factors at an early age, which would go a long way towards reducing the burden of abdominal obesity and obesity related cardio metabolic risk.

Treatment rates for PTSD and depression in recently hospitalized cardiac patients

OBJECTIVE

Posttraumatic stress disorder (PTSD) and depression are common after evaluation for suspected acute coronary syndrome (ACS), and are associated with poor prognosis. However, it is unclear whether patients discharged after suspected ACS access treatments for subsequent psychological distress. We examined self-reported rates of receiving psychotherapy and/or medication for psychological distress in patients one month after a suspected ACS event.

METHODS

A sample of 448 adults (age 60.4±12.5; 47.8% female; 52.7% Hispanic, 32.1% Black) presenting to the emergency department with suspected ACS were recruited for the REactions to Acute Care and Hospitalization (REACH) study, an ongoing cohort study of medical and psychological outcomes after ACS evaluation. Socio-demographics and depressive symptoms were assessed in-hospital, and PTSD symptoms related to the suspected ACS event were queried via phone one month after enrollment. Participants also indicated whether they received either medication or counseling to deal with their emotions and coping after their heart problem.

RESULTS

Approximately 15% (n=68) of the sample reported receiving some form of treatment. Treatment rate did not differ significantly as a function of demographics, ACS status, or insurance coverage, ps>0.1. Over a quarter of participants (25.3%) who screened positive for PTSD and/or depression reported receiving treatment. Participants with PTSD and depression had a higher treatment rate (47.6%) vs. those with only depression (12.8%) or PTSD (30%) or no psychopathology (10.3%).

CONCLUSION

Findings suggest that 1 in 4 patients who screened positive for PTSD and/or depression reported receiving counseling or medication in the first month after a suspected ACS event.

Mediation and moderation of the effects of watching the angiography screen on patients

It has been reported that allowing patients to watch the coronary angiography screen during the procedure results in psychological benefits. This study aimed to investigate the roles of illness perceptions as mediators of this outcome and to examine whether individual differences in monitoring coping style moderated these effects. The experiment compared patients who were instructed to watch the monitor screen (n = 57) with those who were not (n = 51). Questionnaires were used to measure the research variables at one day and one month after the procedure. Results showed that watching the angiography screen increased patients' personal and treatment control perceptions that mediated changes in self-assessed health, risk perceptions, negative affect, general and diet outcome expectancies, and diet and physical activity intentions. The behavior-related outcomes were moderated by monitoring coping style. These findings illustrate the significance of illness perceptions, perceived control and monitoring coping style in achieving desirable outcomes among patients undergoing coronary angiography, and reveal opportunities for interventions using medical imaging technologies.

Prevalence of hospital malnutrition among cardiac patients: results from six nutrition screening tools

Malnutrition is highly prevalent among hospitalized patients, ranging from 30% to 50% depending on the patient population and the criteria used for diagnosis. Identifying early those who are malnourished and at risk of malnutrition and intervening at an early stage will improve patients overall prognosis and will reduce the costs to the state. Even though cardiac patients are at risk of malnutrition, data on the prevalence of malnutrition among cardiology inpatients is limited. The aim of the study was to assess malnutrition status of the newly admitted patients in a specialist cardiology institution in Sri Lanka by internationally recommended nutrition screening and assessment tools. During study period, 322 (61.22%) males and 204 (38.78%) females were recruited. Malnutrition status assessed by each screening tool had a wide variation. According to Mini Nutritional Assessment tool 69.6% were having possible malnutrition. Malnutrition Screening Tool 47.9% to be at risk of malnutrition. Subjective Global Assessments categorized only 4.2% as malnourished on the other hand Malnutrition Universal Screening Tool categorized 20.4% and 19.6% subjects as at medium risk and high risk of malnutrition respectively. Nutritional Risk Screening detected 6.3%, 25.1% and 24.9% patients to be mildly, moderately and severely malnourished respectively. Short Nutrition Assessment Questionnaire categorized 5.0% and 17.7% patients to be moderately malnourished and severely malnourished correspondingly. In conclusion, Although malnutrition was prevalent among this population, a wide variation in the nutritional status when assessed by widely used internationally recognized tools was observed.

Association between VO₂ peak estimated by a 1-km treadmill walk and mortality. A 10-year follow-up study in patients with cardiovascular disease

PURPOSE

The aim of this study is to assess the association between peak oxygen uptake (VO2 peak), determined using a perceptually regulated 1-km walking test (1k-TWT), and all-cause mortality in cardiac patients.

METHODS

1255 male patients, aged 25-85 years, completed a moderate 1k-TWT to estimate VO2 peak. Subjects were followed for all-cause mortality for up to 10 years. Cox proportional hazard models were employed to determine variables associated with mortality. Based on the estimated VO2 peak, the sample was subdivided into quartiles and mortality risks were calculated. To assess the discriminatory accuracy of the estimated VO2 peak for estimating survival, receiver-operating-characteristics curves were constructed.

RESULTS

During a median 8.2 year follow-up, a total of 141 deaths from any cause occurred, yielding an average annual mortality of 1.4%. The strongest predictor of all-cause mortality was the estimated VO2 peak (c-statistic 0.71, 95% confidence intervals: 0.69-0.74, P<0.0001). Survival decreased in a graded fashion from the highest estimated VO2 peak quartile to the lowest quartile. Compared to the lowest quartile, the hazard ratios (95% confidence intervals) for the second, third, and fourth quartiles were 0.77 (0.35-1.33), 0.43 (0.20-0.91), and 0.16 (0.05-0.54) respectively (P for trend <0.0001). An 89% reduction in mortality risk was observed among a subset of subjects in the fittest quartile who improved their estimated VO2 peak over the follow-up period relative to subjects in the least fit quartile who did not improve.

CONCLUSION

VO2 peak estimated by a novel 1k-TWT predicts survival in subjects with stable cardiovascular disease.

PCT as a Prognostic Marker in Cardiac Patients with Neutropenic Sepsis: Two Case Reports

Procalcitonin (PCT) is an innovative and highly specific marker for diagnosis of clinically relevant bacterial infection and sepsis. PCT supports early diagnosis and Clinical decision making. A retrospective study of two classical cases of neutropenic sepsis with elevated PCT levels in cardiac ICU was done. PCT was analyzed using Elecsys Brahms PCT kit. Serum PCT levels <0.5 ng/ml and ANC <1,000/mm(3) was taken as cutoff. The first patient had initial high levels of PCT 100 ng/ml, TLC 13,600/mm(3) and ANC 12,250/mm(3). It was followed by drop with subsequent rise in PCT levels and drop in TLC 1,000/mm(3) and ANC 70/mm(3). The second patient had normal PCT 0.116 ng/ml, TLC 5,600/mm(3) and ANC 4,420/mm(3) levels followed with sharp increase in all the values with subsequent drop in TLC 2,000/mm(3) and ANC 880 cells/mm(3). Both the patients died of neutropenic sepsis with multiorgan failure. The case reports showed the correlation of PCT with TLC and ANC levels in predicting the mortality of patients with neutropenic sepsis in cardiac ICU.