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This 2023 update of the Core Curriculum in Cardiovascular Nursing (2015) embraces the formation of the Association of Cardiovascular Nursing and Allied Professionals and reflects the diverse professional backgrounds of our members, including nurses, allied health professionals, and healthcare scientists (in this document referred to collectively as Nurses and Allied Professionals).

Aims Physical activity (PA) is important in patients with heart failure (HF) to improve health outcomes. The adherence to PA is low, and therefore, novel approaches are necessary to increase PA. We aimed to determine the difference in PA in patients with HF who have access to exergaming compared to patients who received motivational support and to explored predictors of a clinically relevant change in non-sedentary time between baseline and 3 months. Methods and results In total, 64 patients (mean age 69 ± 9 years, 27% female) wore an accelerometer 1 week before and 1 week after the intervention. Data were analysed using logistic regression analysis. Patients spent 9 h and 43 min (±1 h 23 min) during waking hours sedentary. There were no significant differences in PA between patients who received an exergame intervention or motivational support. In total, 30 of 64 patients achieved a clinically relevant increase in non-sedentary time. Having grandchildren [odds ratio (OR) 7.43 P = 0.03], recent diagnosis of HF (OR 0.93 P = 0.02), and higher social motivation (OR 2.31 P = 0.03) were independent predictors of a clinically relevant increase of non-sedentary time. Conclusion Clinicians should encourage their patients to engage in alternative approaches to improve PA and reduce sedentary habits. Future exergaming interventions should target individuals with chronic HF who have low social motivation and a low level of light PA that may benefit most from exergaming. Also (non-familial), intergenerational interaction is important to enabling patients in supporting patients in becoming more active.

Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Swedish research council Expectations of tele-yoga in persons with long-term illness Background Rehabilitation for people with long-term illness, such as various cardiac disease including heart failure or patients with an Internal Cardioverter Defibrillator (ICD), can be a challenge due to the severity of the illness and the ability to participate in group training. Yoga is a mind-body exercise that is feasible and safe, and can lead to long-term positive effects on both physical and mental well-being. Tele-yoga is a new approach of rehabilitation for this group who may have difficulty leaving their home, where participants practice group yoga with a live-streamed yoga-instructor digitally via a tablet from home. Purpose The aim of the study was to explore the expectations of tele-yoga in people with long-term illness before starting a remotely group yoga intervention at home. Methods The study had a qualitative design and is part of a process evaluation in an ongoing randomised controlled trial, where participants in the intervention group receive yoga online in a group, twice a week for 12 weeks. In total 89 participants were interviewed of which 67 participants were diagnosed with heart failure, 22 participants had an ICD or were admitted to intensive care. The interviews took place before the start of a tele-yoga intervention. The average age was 64.8 (±11.6) year, 67% were male. The interview guide included questions about perceptions about yoga and what expectations they had of participating in tele-yoga. Interviews were recorded, transcribed and analysed with qualitative content analysis. Results Participants described expectations of tele-yoga to improve physical function and health, improved breathing, relief from discomfort, ache and pain, increased flexibility and coordination. They also expected improved psychological well-being and performance, get strategies to manage stress, anger, and anxiety and strengthened motivation drive. Some expectations were based on previous experiences. When asked about expectations some thought it was difficult to know what to anticipate but described a general excitement. The participants described that it would be exciting and fun that yoga took place in a group and expected that they could inspire and encourage each other. They also described tele-yoga as a new and exciting technical solution for being physically active in groups, the technology expected to be easy to use and would facilitate the delivery of yoga. Conclusions The expectations for tele-yoga varied, improved physical function and health together with increased mental well-being and performance emerged. Also, expectation that technical solution could facilitate the delivery of yoga, and the group could be supportive. By studying the expectations of participants in tele-yoga, we can more easily understand what influences to participate and how expectations might influence barriers and adherence to the tele-yoga intervention and be related to outcomes.

AimsThe European Heart Failure Self-care Behaviour Scale (EHFScBS) is frequently used to assess self-care behaviours in patients with heart failure. This scale has been translated into several languages. The COnsensus-based Standards for the selection of health status Measurement INstrument (COSMIN) Risk of Bias checklist for a systematic review has recently been published. The aim of the study was to assess the methodological quality of studies reporting on psychometric evaluations of the EHFScBS using the COSMIN methodology.Methods and resultsTo identify relevant studies, a systematic literature search was performed using PubMed and CINAHL databases in December 2019 and the search was updated in June 2020. The COSMIN Risk of Bias checklist was used to assess the methodological quality. In total, 21 relevant studies were rated. The overall methodological quality of content validity was rated as inadequate in 17 studies and a main reason of the inadequate rating was a lack of patient involvement. Structural validity was adequately addressed in 12 studies, internal consistency in seven, and eight of 11 studies reporting on construct validity and had good methodological quality.ConclusionAlthough the use of the EHFScBS has grown rapidly and the validity and reliability are reported to be good, the methodological quality of studies reporting on psychometric properties of the scale is not optimal. Further studies are necessary to strengthen the evidence on validity and reliability of the EHFScBS.

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Background Relationship satisfaction is generally positively correlated with sexual satisfaction, but this relation has been poorly examined in people with cardiovascular disease who are at increased risk of sexual problems compared with the general population. Aim To document reported changes to sex after a diagnosis of cardiac disease and determine whether there is an association between sexual function and relationship satisfaction. Methods Semistructured telephone interviews focused on relationship satisfaction and sexual problems were conducted with 201 people with cardiovascular disease who were currently in a sexual relationship with one main partner and were recruited from six hospital cardiac rehabilitation centers in Ireland. Comparisons between groups were conducted using t-tests and multivariate analysis of variance for continuous variables and χ2 tests for categorical variables. Predictors of relationship satisfaction were assessed using multiple linear regression analysis. Outcomes Data were gathered on demographic and clinical variables, sexual problems, and relationship satisfaction, including satisfaction with the physical, emotional, affection, and communication aspects of relationships. Results Just less than one third of participants (n = 61, 30.3%) reported that sex had changed for the worse since their cardiac event or diagnosis, with approximately half of these stating that this was a serious problem for them. Satisfaction with relationships was high among patients surveyed; more than 70% of the sample reported being very or extremely satisfied with the physical and emotional aspects and showing affection during sex. Satisfaction with communication about sex was lower, with only 58% reporting being very or extremely satisfied. We did not find significant associations between reporting of sexual problems or deterioration of sex as a result of disease and relationship satisfaction. Clinical Implications Cardiac rehabilitation programs should address these sexual problems, potentially by enhancing communication within couples about sex. Strengths and Limitations The strength is that data are presented on the sexual experiences and relationship satisfaction of a relatively large sample of people diagnosed with cardiac disease, a relatively underexplored research area. Limitations include the possibility of selection bias of study participants and bias associated with self-report measurement. Conclusions Sexual problems were significant in this population but were not related to relationship satisfaction in this cross-sectional survey.

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Background: The results of research into the outcomes of physical rehabilitation and its relationship with post-myocardial ischaemia survival and readmissions are inconclusive. Our primary aim was to evaluate the efficacy of a supervised exercise training programme in terms of decreasing hospital cardiac readmission in patients with myocardial ischaemia. Methods: We conducted a randomised controlled trial including patients with myocardial ischaemia. Eligible patients were assigned to a control group receiving standard care or to an intervention group that took part in a supervised exercise training programme. The follow-up period was 12 months after hospital discharge. Results: Of 478 patients assessed for eligibility, 86 were randomised to the control group (n=44) or the intervention group (n=42). Cardiac readmission rates were 14% versus 5% (p=0.268) in the control and intervention groups, respectively, and all-cause readmission rates were 23% versus 15% (p=0.34). There were no deaths in either group. More control patients were treated in the emergency services (50% vs. 24%; p= 0.015). In terms of health-related quality of life, patients in the intervention group presented with significant increases in functional capacity and mobility. More intervention patients returned to work (77.3% vs. 36.0%; p=0.005). Conclusions: The supervised physical exercise programme was effective at reducing the number of emergency room visits and at increasing the percentage of patients who returned to work. It also improved patients exercise capacity and increased their health-related quality of life. Although the results were promising, the programme was not associated with a significant reduction in cardiac and all-cause readmission rates. Funding Agencies|Collegi de Fisioterapeutes de Catalunya [R01/08-09]

Many heart failure (HF) patients have palliative care needs, but communication about prognosis and end-of-life care is lacking. HF nurses can play an important role in such communication, but their views on this have rarely been sought.This study aims to describe HF nurses' perspectives on, and daily practice regarding, discussing prognosis and end-of-life care with HF patients in outpatient care. It further aims to explore barriers, facilitators and related factors for discussing these issues.A national survey including nurses from outpatient clinics and primary health care centres was performed. Data was collected using a questionnaire on communication with HF patients about prognosis and end-of-life care.In total, 111 (82%) of the HF nurses completed the questionnaire. Most of them reported that physicians should have the main responsibility for discussing prognosis (69%) and end-of-life care (67%). Most nurses felt knowledgeable to have these discussions, but 91% reported a need for further training in at least one of the areas. Barriers for communication about prognosis and end-of-life care included the unpredictable trajectory of HF, patients' comorbidities and the opinion that patients in NYHA class II-III are not in the end-of-life.Although HF nurses feel competent discussing prognosis and end-of-life care with the HF patient, they are hesitant to have these conversations. This might be partly explained by the fact that they consider the physician to be responsible for such conversations, and by perceived barriers to communication. This implies a need for clinical policy and education for HF nurses to expand their knowledge and awareness of the patients' possible needs for palliative care.

Background: Physical activity can improve exercise capacity, quality of life and reduce mortality and hospitalization in patients with heart failure (HF). Adherence to exercise recommendations in patients with HF is low. The use of exercise games (exergames) might be a way to encourage patients with HF to exercise especially those who may be reluctant to more traditional forms of exercise. No studies have been conducted on patients with HF and exergames. Aim: This scoping review focuses on the feasibility and influence of exergames on physical activity in older adults, aiming to target certain characteristics that are important for patients with HF to become more physically active. Methods: A literature search was undertaken in August 2012 in the databases PsychInfo, PUBMED, Scopus, Web of Science and CINAHL. Included studies evaluated the influence of exergaming on physical activity in older adults. Articles were excluded if they focused on rehabilitation of specific limbs, improving specific tasks or describing no intervention. Fifty articles were found, 11 were included in the analysis. Results: Exergaming was described as safe and feasible, and resulted in more energy expenditure compared to rest. Participants experienced improved balance and reported improved cognitive function after exergaming. Participants enjoyed playing the exergames, their depressive symptoms decreased, and they reported improved quality of life and empowerment. Exergames made them feel more connected with their family members, especially their grandchildren. Conclusion: Although this research field is small and under development, exergaming might be promising in order to enhance physical activity in patients with HF. However, further testing is needed.

After a cardiovascular event, patients and their families often cope with numerous changes in their lives, including dealing with consequences of the disease or its treatment on their daily lives and functioning. Coping poorly with both physical and psychological challenges may lead to impaired quality of life. Sexuality is one aspect of quality of life that is important for many patients and partners that may be adversely affected by a cardiac event. The World Health Organization defines sexual health as ‘… a state of physical, emotional, mental and social well-being in relation to sexuality; it is not merely the absence of disease, dysfunction or infirmity. Sexual health requires a positive and respectful approach to sexuality and sexual relationships, as well as the possibility of having pleasurable and safe sexual experiences ….’1(p4) The safety and timing of return to sexual activity after a cardiac event have been well addressed in an American Heart Association scientific statement, and decreased sexual activity among cardiac patients is frequently reported.2 Rates of erectile dysfunction (ED) among men with cardiovascular disease (CVD) are twice as high as those in the general population, with similar rates of sexual dysfunction in females with CVD.3 ED and vaginal dryness may also be presenting signs of heart disease and may appear 1–3 years before the onset of angina pectoris. Estimates reflect that only a small percentage of those with sexual dysfunction seek medical care;4 therefore, routine assessment of sexual problems and sexual counselling may be of benefit as part of effective management by physicians, nurses, and other healthcare providers.

Background:Heart failure (HF) self-care is an important component of disease management and the focus of many interventions.Aim:The aim of this study was to evaluate the validity and reliability of the nine-item European HF Self-care Behavior Scale (EHFScB-9) in a sample of 200 adults from the USA with symptomatic HF.Methods:Psychometric tests included item and confirmatory factor analyses, convergent and discriminant validity, and internal consistency.Results:Item-total correlations ranged from 0.25 to 0.65. Many fit indices for the EHFScB-9 and the four-item consulting behaviors scale reached thresholds of acceptability. As expected, the EHFScB-9 was associated with other measures of HF self-care but not with quality-of-life. Coefficient α was 0.80 for the EHFScB-9 and 0.85 for the consulting behaviors subscale.Conclusion:The EHFScB-9 was a valid and reliable measure of HF self-care among English-speaking US adults with symptomatic HF.

ESC guidelines for the diagnosis and treatment of acute and chronic heart failure 2012 : The Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2012 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association (HFA) of the ESC

Cardiac nurses and allied professionals often take care of patients who also have anaemia or iron deficiency. To deliver optimal care, professionals should be knowledgeable about the prevalence, diagnosis, pathophysiology, and therapeutic management of these conditions. We therefore set out a survey to get a first impression on the current knowledge of nurses and allied professionals on anaemia and iron deficiency. A questionnaire was designed for this study by the Undertaking Nursing Interventions Throughout Europe (UNITE) Study Group. Data were collected from 125 cardiovascular nurses and allied professionals visiting the 11th Annual Spring Meeting of the Council on Cardiovascular Nursing and Allied Professionals of the European Society of Cardiology. Most respondents had general knowledge on the definition of anaemia and iron deficiency and 54% of the respondents rated anaemia and iron deficiency as important when evaluating a cardiac patient. Specific knowledge regarding anaemia and more prominently of iron deficiency was not optimal. Although cardiac nurses and allied professionals have basic knowledge of anaemia and iron deficiency, they would benefit from additional knowledge and skills to optimally deliver patient care.

Cardiovascular disease (CVD) today is responsible for approximately one-third of deaths worldwide, and that figure will surely increase in both developing and developed countries as risk factors for the disease — primarily dyslipidemia, hypertension, obesity, diabetes, physical inactivity, poor diet, and smoking — continue to increase. Although these risk factors are modifiable, to date there is a relative paucity of measures to prevent or control them, particularly in developing countries. A population strategy combined with a high-risk strategy for CVD prevention could greatly reduce the burden of disease in the coming decades. Many initiatives are working, but many more are needed. This chapter provides background on the global burden of CVD and provides the context for the subsequent chapters addressing nurses' roles in reversing the bleak predictions for the ravages of CVD if risk factors are left unchecked in the coming decades.

Background: Heart failure (HF) knowledge as well as compliance are considered to be underlying mechanisms of the effects of HF management programs. However, there are no valid and reliable measurement instruments available which measures knowledge of HF patients. Aim: To develop a reliable and valid instrument, which measures the knowledge, patients have on their disease and the HF-related health care regimen. Methods: The HF knowledge scale was developed in 3 phases; (1) concept analysis and first construction, (2) revision of items and (3) testing for validity and reliability. Results: The Dutch HF knowledge scale is a 15-item, self-administered questionnaire that covers items concerning HF knowledge in general, knowledge on HF treatment (including diet and fluid restriction) and HF symptoms and symptom recognition. Face validity as well as content and construct validity was tested in HF patients in 19 hospitals in the Netherlands. The scale was able to differentiate between HF patients with high and low level of HF knowledge. Cronbach's α of the knowledge scale in this population ( n = 902) was .62. Conclusion: The instrument is a valid and reliable scale that can be used in research to gain insight in the effect of education and counselling of HF patients. After additional testing, the instrument seems to be a valid and reliable scale to be used in clinical practice to measure HF knowledge.

ESC Committee for Practice Guidelines (CPG), Silvia G. Priori (Chairperson) (Italy), Jean-Jacques Blanc (France), Andrzej Budaj (Poland), John Camm (UK), Veronica Dean (France), Jaap Deckers (The Netherlands), Kenneth Dickstein (Norway), John Lekakis (Greece), Keith McGregor (France), Marco Metra (Italy), Joao Morais (Portugal), Ady Osterspey (Germany), Juan Tamargo (Spain), Jose Luis Zamorano (Spain) Document Reviewers, Marco Metra (CPG Review Coordinator) (Italy), Michael Bohm (Germany), Alain Cohen-Solal (France), Martin Cowie (UK), Ulf Dahlstrom (Sweden), Kenneth Dickstein (Norway), Gerasimos S. Filippatos (Greece), Edoardo Gronda (Italy), Richard Hobbs (UK), John K. Kjekshus (Norway), John McMurray (UK), Lars Ryden (Sweden), Gianfranco Sinagra (Italy), Juan Tamargo (Spain), Michal Tendera (Poland), Dirk van Veldhuisen (The Netherlands), Faiez Zannad (France) Guidelines and Expert Consensus Documents aim to present all the relevant evidence on a particular issue in order to help physicians to weigh the benefits and risks of a particular diagnostic or therapeutic procedure. They should be helpful in everyday clinical decision-making. A great number of Guidelines and Expert Consensus Documents have been issued in recent years by the European Society of Cardiology (ESC) and by different organizations and other related societies. This profusion can put at stake the authority and validity of guidelines, which can only be guaranteed if they have been developed by an unquestionable decision-making process. This is one of the reasons why the ESC and others have issued recommendations for formulating and issuing Guidelines and Expert Consensus Documents. In spite of the fact that standards for issuing good quality Guidelines and Expert Consensus Documents are well defined, recent surveys of Guidelines and Expert Consensus Documents published in peer-reviewed journals between 1985 and 1998 have shown that methodological standards were not complied with in the vast majority of cases. It is therefore of great importance that guidelines and recommendations are presented in formats that are …

Heart failure (HF) care in Europe is going through a lot of changes. Nurses have increasingly important roles in providing optimal care for these chronically ill patients in the Netherlands. The first steps to organise HF nurses have been taken and an overview of HF management programmes in Netherlands has been recently made available. A descriptive study was performed consisting of: (1) a screening phase in which all hospitals ( n=109) and 105 home care organisations were approached by telephone to assess availability of HF management programmes and (2) a questionnaires in which content and organisation of the programmes were described. At the moment, the majority of all the hospitals (75%) have, or are currently developing a HF management programme. In 19 home care organisations (18%) a programme was available and 3 organisations had concrete plans to start on short notice. Components of HF programmes differ considerably, with follow-up after discharge from the hospital as the most often reported component. Other components of programmes include patient education, increased access to health care professionals and adjusting medication. Exercise programmes are not often available. Organisational aspects in regard to setting, financing and staffing also differ between various programmes. It was concluded that there is a considerable increase in the number of HF management programmes in the Netherlands, both hospital based and home based. A lot of questions in regard to the most optimal content and the organisation of HF management programmes remain unanswered.

This paper described the formal collaboration between the American Heart Association's Council on Cardiovascular Nursing and the European Society of Cardiology's Working Group on Cardiovascular Nursing. This collaboration comprises following dimensions: (1). further expansion on collaboration on annual conferences; (2). development of mentoring initiatives; (3). initiation of research collaboration; (4). development of joint guidelines; and (5). appointment of liaison persons of AHA to ESC and vice versa.

In 2010, the Council of Cardiovascular Nursing and Allied Professions (CCNAP) initiated the forming of a Science Committee (SC) with the aim to take responsibility for activities related to researc ...

P161 Poster COR-PRIM : Longitudinal Study on PBL in Self-Care after CVD Preliminary Results from a Pilot Study

With interest, we read the article by Ferketich and Binkley1 in which they examined psychological distress; depressive symptoms, and anxiety are among individuals with heart disease. Psychological distress was measured with an uncomplicated six-item questionnaire that was developed for this study. The results showed that the greatest proportion of psychological distress (10%) was estimated among participants with self-reported chronic heart failure (CHF). Self-reported CHF was associated …