Frequency: Quarterly E- ISSN: Awaited P- ISSN: Awaited
Quarterly published in print and online "Inventi Impact: Cardiovascular Nursing" publishes high quality unpublished as well as high impact pre-published research and reviews catering to the needs of researchers and professionals. The journal focuses on physiologic, psychologic, and social needs of cardiovascular patients and their families in a variety of environments.
Background: Chest pain remains one of the most challenging serious complaints in the emergency department (ED). A prompt and accurate risk stratification tool for chest pain patients is paramount to help physcian effectively progrnosticate outcomes. HEART score is considered one of the best scores for chest pain risk stratification. However, most validation studies of HEART score were not performed in populations different from those included in the original one. Objective: To validate HEART score as a prognostication tool, among Tunisian ED patients with undifferentiated chest pain. Methods: Our prospective, multicenter study enrolled adult patients presenting with chest pain at chest pain units. Patients over 30 years of age with a primary complaint of chest pain were enrolled. HEART score was calculated for every patient. The primary outcome was major cardiovascular events (MACE) occurrence, including all-cause mortality, non-fatal myocardial infarction (MI), and coronary revascularisation over 30 days following the ED visit. The discriminative power of HEART score was evaluated by the area under the ROC curve. A calibration analysis of the HEART score in this population was performed using Hosmer–Lemeshow goodness of test. Results: We enrolled 3880 patients (age 56.3; 59.5% males). The application of HEART score showed that most patients were in intermediate risk category (55.3%). Within 30 days of ED visit, MACE were reported in 628 (16.2%) patients, with an incidence of 1.2% in the low risk group, 10.8% in the intermediate risk group and 62.4% in the high risk group. The area under receiver operating characteristic curve was 0.87 (95% CI 0.85–0.88). HEART score was not well calibrated (χ2 statistic = 12.34; p = 0.03). Conclusion: HEART score showed a good discrimination performance in predicting MACE occurrence at 30 days for Tunisian patients with undifferentiated acute chest pain. Heart score was not well calibrated in our population....
Background Intimal sarcomas are an extremely rare type of primary cardiac malignancy. They most commonly present with symptoms of cardiac dysfunction. We present a case of intimal sarcoma identified without any cardiac signs or symptoms. Cardiac sarcomas historically carry a very poor prognosis. Presentation A 57-year-old man presented with a sudden onset of left limb weakness and disorientation. MRI brain identified an acute ischaemic stroke in the right anterior temporal lobe. Four months later, he presented again with transient left arm weakness. The patient had a normal cardiovascular examination and ECG. All other initial investigations for cryptogenic stroke were non-contributory. The patient did not initially get an echocardiogram. When this investigation was performed, after his second presentation, a large pedunculated mass was present in his left atrium. This was resected and identified histologically as a primary intimal sarcoma of his left atrium. The patient was treated with post-operative radiotherapy but declined chemotherapy. He recovered well post-operatively but subsequently passed away 14 months after diagnosis. Conclusions It is possible for primary cardiac malignancies to present with only symptoms of systemic emboli. For this reason, echocardiography is a crucial investigation in cases of cryptogenic stroke. Some stroke guidelines do not definitively support routine echocardiography. Primary intimal cardiac sarcoma is a very rare condition with a poor prognosis. The literature is limited to case reports and optimal management is with surgical resection where possible. The role of post operative radiotherapy and chemotherapy is uncertain....
Background: Patients scheduled for coronary artery bypass graft (CABG) surgery tend to have persistent symptoms of anxiety and depression. Course of hospital stay post-CABG procedure has become increasingly shorter over the last few decades. This pilot study was conducted to develop and test feasibility of MyEducation: CABG application as a learning tool to reduce anxiety and depression levels among patients undergoing CABG Surgery. Methods: This study was quasi-experimental in design. Forty-five patients scheduled for CABG surgery were recruited via consecutive sampling from a Tertiary Referral Centre at Kuala Lumpur, Malaysia. MyEducation:CABG application (Web-based education application) was administered among the intervention group (N = 23); while the control group (N = 22) underwent standard care. Web-based education application were implemented by nurses at admission and prior to discharge. Patients were assisted in terms of queries and concerns, upon which corresponding information and support was provided. Sociodemographic data were obtained from patients, prior to administration of Hospital Anxiety and Depression Scale which was used to measure levels of anxiety and depression. The educational application was used to obtain satisfaction rating among intervention group. These measures were administered upon admission, on discharge and one-month post-discharge. Results: Mean anxiety and depression scores among the intervention group were lower compared to the control. This was significant for anxiety upon admission, on discharge and one-month post-discharge (p < 0.05). Reduced mean depression scores was only significant at one month post-discharge (p < 0.05). Intervention group were generally satisfied with design, content and usability of the application. Conclusions: Utilisation of MyEducation: CABG application as an educational platform were associated with reduced anxiety and depression among CABG patients, which probably explains positive user satisfaction levels reported. Hence, the study recommends implementation of this application among larger sample as a way to support patient scheduled for CABG aside, with further possibility of preventing complications....
Background Pheochromocytoma is rare in pregnant women. It presents as diverse symptoms, including hypertension and sweating. The symptoms of pregnant women with pheochromocytoma and comorbid hypertension often mimic the clinical manifestations of preeclampsia, and these women are often misdiagnosed with preeclampsia. Case presentation In this case, a pregnant woman presented with chest pain as the primary symptom, and a diagnosis of pheochromocytoma was considered after ruling out myocardial ischemia and aortic dissection with the relevant diagnostic tools. This patient then underwent successful surgical resection using a nontraditional management approach, which resulted in a positive clinical outcome. Conclusions It is essential to consider pheochromocytoma as a potential cause of chest pain and myocardial infarction-like electrocardiographic changes in pregnant women, even if they do not have a history of hypertension....
Coronary Artery Disease (CAD) when exposed to a prolonged period of extreme cold.\nDesign: This research study utilized descriptive qualitative research design.\nMethods: Face-to-\nface\ninterview sessions with audio recording were conducted.\nThere were 30 informants who participated in the study. Descriptive phenomenology\nwith Colaizzi�s method of data analysis was used.\nResults: Results revealed three themes, namely: (i) elucidating cold exposure; (ii) challenges\nof cold exposure; and (iii) translating adverse exposure to self-management.\nThe\nresults further revealed the significance of nursing health care especially to health promotion,\ndisease prevention and health restoration especially in community setting.\nConclusion: In conclusion, manifestations of CAD are triggered when exposed to a\nprolonged period of extremely low environmental temperature....
Background: Despite substantial investment in detection, early intervention and evidence-based treatments, current\nmanagement strategies for diabetes-associated retinopathy and cardiovascular disease are largely based on real-time\nand face-to-face approaches. There are limited data re telehealth facilitation in type 2 diabetes management. Therefore,\nwe aim to investigate efficacy of telehealth facilitation of diabetes and cardiovascular disease care in high-risk\nvulnerable Aboriginal and Torres Strait Islanders in remote/very remote Australia.\nMethods: Using a pre-post intervention design, 600 Indigenous Australians with type 2 diabetes will be recruited from\nthree primary-care health-services in the Northern Territory. Diabetes status will be based on clinical records. There will\nbe four technological interventions: 1. Baseline retinal imaging [as a real-time patient education/engagement tool and\ntelehealth screening strategy]. 2. A lifestyle survey tool administered at ââ?°Ë? 6-months. 3. At ââ?°Ë? 6ââ?¬â? and 18-months, an\nelectronic cardiovascular disease and diabetes decision-support tool based on current guidelines in the Standard\nTreatment Manual of the Central Australian Rural Practitionerââ?¬â?¢s Association to generate clinical recommendations.\n4. Mobile tablet technology developed to enhance participant engagement in self-management. Data will\ninclude: Pre-intervention clinical and encounter-history data, baseline retinopathy status, decision-support and\nsurvey data/opportunistic mobile tablet encounter data. The primary outcome is increased participant adherence\nto clinical appointments, a marker of engagement and self-management. A cost-benefit analysis will be performed.\nDiscussion: Remoteness is a major barrier to provision and uptake of best-practice chronic disease management.\nTelehealth, beyond videoconferencing of consultations, could facilitate evidence-based management of diabetes and\ncardiovascular disease in Indigenous Australians and serve as a model for other conditions....
Background. To differentiate acute coronary syndrome (ACS) from other causes in patients presenting with chest pain at the\nemergency department (ED) is crucial and can be performed by the nurse triage. We evaluated the effectiveness of the ED nurse\ntriage for ACS of the tertiary care hospital. Methods.We retrospectively enrolled consecutive patients who were identified as ACS\nat risk patients by the ED nurse triage. Patients were categorized as ACS and non-ACS group by the final diagnosis. Multivariate\nlogistic analysis was used to predict factors associated with ACS. An online model predictive of ACS for the ED nurse triage was\nconstructed. Results.There were 175 patients who met the study criteria. Of those, 28 patients (16.0%) were diagnosed with ACS.\nPatients with diabetes, patients with previous history of CAD, and those who had at least one character of ACS chest pain were\nindependently associated with having ACS by multivariate logistic regression. The adjusted odds ratios (95% confidence interval)\nwere 4.220 (1.445, 12.327), 3.333 (1.040, 10.684), and 12.539 (3.876, 40.567), respectively. Conclusions. The effectiveness of the ED\nnurse triage for ACS was 16%. The online tool is available for the ED triage nurse to evaluate risk of ACS in individuals....
Atrial fibrillation (AF) is an important public health problem that is increasing at an alarming rate, worldwide. The most common\ntype is permanent AF followed by the paroxysmal and persistent AF. Purpose. This study was aimed at exploring anxiety and\ndepression and the associated factors in patients with permanent AF. Materials and Methods.The sample of the study included 170\nAF patients. Data collection was performed by the method of interview using the ââ?¬Å?Hospital Anxiety and Depression Scaleââ?¬Â\n(HADS) to assess anxiety and depression and a questionnaire including patientsââ?¬â?¢ characteristics. Results. 70% of the participants\nwere men, and 32.4% were above 70 years old. Furthermore, 34.9% of the patients had high levels of anxiety, and 20.2% had high\nlevels of depression. Anxiety levels were statistically significantly associated with gender (p 0.022), age (p 0.022), educational\nlevel (p 0.025), years having the disease (p 0.005), and relations with nursing staff (p 0.040). Depression levels were\nstatistically significantly associated with age (p 0.037), degree of information of the state of health (p<0.001), years having the\ndisease (p<0.001), and relations with medical staff (p 0.041). Conclusions. Patientsââ?¬â?¢ characteristics are associated with anxiety\nand depression and need to be evaluated when treating this frequently encountered arrhythmia....
Background: Left dominant arrhythmogenic cardiomyopathy (LDAC) is a rare condition characterised by progressive\nfibrofatty replacement of the myocardium of the left ventricle (LV) in combination with ventricular arrhythmias of LV\norigin.\nCase presentation: A thirty-five-year-old male was referred for evaluation of recurrent sustained monomorphic\nventricular tachycardia (VT) of 200 bpm and right bundle branch block (RBBB) morphology. Cardiac magnetic resonance\nimaging showed late gadolinium enhancement distributed circumferentially in the epicardial layer of the LV free wall\nmyocardium including the rightward portion of the interventricular septum (IVS). The clinical RBBB VT was reproduced\nduring the EP study. Ablation at an LV septum site with absence of abnormal electrograms and a suboptimum pacemap\nrendered the VT of clinical morphology noninducible. Three other VTs, all of left bundle branch block (LBBB) pattern, were\ninduced by programmed electrical stimulation. The regions corresponding to abnormal electrograms were identified and\nablated at the mid-to-apical RV septum and the anteroseptal portion of the right ventricular outflow tract. No abnormalities\nwere found at the RV free wall including the inferolateral peritricuspid annulus region. Histological examination confirmed\nthe presence of abnormal fibrous and adipose tissue with myocyte reduction in endomyocardial samples taken from both\nthe left and right aspects of the IVS.\nConclusion: LDAC rarely manifests with sustained monomorphic ventricular tachycardia. In this case, several VTs of both\nRBBB and LBBB morphology were amenable to endocardial radiofrequency catheter ablation....
Background: Around 17 % of people eligible for UK cardiac rehabilitation programmes following an acute coronary\nsyndrome report moderate or severe depressive symptoms. While maximising psychological health is a core goal of\ncardiac rehabilitation, psychological care can be fragmented and patchy. This study tests the feasibility and\nacceptability of embedding enhanced psychological care, composed of two management strategies of proven\neffectiveness in other settings (nurse-led mental health care coordination and behavioural activation), within\nthe cardiac rehabilitation care pathway.\nMethods/Design: This study tests the uncertainties associated with a large-scale evaluation by conducting an\nexternal pilot trial with a nested qualitative study. We aim to recruit and randomise eight comprehensive cardiac\nrehabilitation teams (clusters) to intervention (embedding enhanced psychological care into routine cardiac\nrehabilitation programmes) or control (routine cardiac rehabilitation programmes alone) arms. Up to 64 patients\n(eight per team) identified with depressive symptoms upon initial assessment by the cardiac rehabilitation team\nwill be recruited, and study measures will be administered at baseline (before starting rehabilitation) and at 5 months\nand 8 months post baseline. Outcomes include depressive symptoms, cardiac mortality and morbidity, anxiety,\nhealth-related quality of life and service resource use. Trial data on cardiac team and patient recruitment, and the\nretention and flow of patients through treatment will be used to assess intervention feasibility and acceptability.\nQualitative interviews will be undertaken to explore trial participants� and cardiac rehabilitation nurses� views and\nexperiences of the trial methods and intervention, and to identify reasons why patients declined to take part in\nthe trial. Outcome data will inform a sample size calculation for a definitive trial.\nDiscussion: The pilot trial and qualitative study will inform the design of a fully powered cluster randomised\ncontrolled trial to evaluate the effectiveness and cost-effectiveness of the provision of enhanced psychological\ncare within cardiac rehabilitation programmes...
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