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Background Clinician burnout, stress and job dissatisfaction among Advance Practice Registered Nurses (APRNS) may have impacted work-related quality of life (WRQoL) during the COVID-19 pandemic. No studies describe burnout and resilience in APRNs who manage care for patients with HF. Objectives Among APRNs who manage care for patients with HF, study aims included: 1) Describe burnout and WRQoL levels; 2) Determine the relationship between burnout and WRQoL; 3) Examine whether resilience moderates the association between WRQoL and burnout.An online survey of American Association of Heart Failure Nurses and the Heart Failure Society of America APRN members were queried.APRN's who practiced in ambulatory or inpatient cardiology settings at least 8 h weekly.Burnout, WRQoL, and resilience. Results Participants' (N = 101) mean age was 50 (±10) years and 93% identified as female. APRNs worked more than 42 h weekly and reported moderate levels of resilience, high levels of personal (M = 51.7, norm-referenced mean: 35.9) and work-related burnout (M = 50.1, norm-referenced mean: 33.0). Correlations between high levels of burnout and low WRQoL (r range: -0.74 - -0.39 -, p.001) were found. Burnout moderated the relationships among resilience and WRQoL. Conclusion APRNs had high levels of burnout during the COVID-19 pandemic. Patient-related burnout was not high. Level of burnout influenced the relationships among resilience and WRQoL suggesting that burnout is from workplace and personal sources, and that level of resilience could not overcome the effect of burnout. Interventions are needed regarding systems changes to uplift and support our workforce.

Cardiac rehabilitation (CR) improves health outcomes and quality of life for patients with cardiovascular disease, yet only a quarter of eligible patients enroll. A myriad of CR models that use either an alternative location (ie, home-based) and/or an alternative exercise have been developed to overcome known attendance and physical limitation barriers; however, patient experiences with these models have not been systematically reviewed. Our aim is to review patient experiences with these models of CR.We conducted a systematic review and thematic analysis of qualitative studies published between 2009 and January of 2022 from CINAHL, PubMed, Web of Science, and PsycINFO.Twenty-five studies were included, representing the perspectives of 487 individuals who participated in an alternative model of CR. Exercises included walking, tai chi, yoga, aquatic exercise, exergaming, chair-based exercises, aerobics, physical activity trackers, and individualized exercise plans. Nineteen of 25 studies used home-based models and two used live video. Twelve studies included patients with heart failure. Patient perspectives comprised three central themes: exercise benefits, exercise facilitators, and participation barriers. Some thematic categories were reported variably by particular model/study design (eg, home-based) than by others. All alternative models of CR were found to be physically, psychologically, and/or socially beneficial to patients. Participants described facilitators and barriers that were influential in the decision to initiate or continue exercise. These patient insights are critical for innovative delivery of CR that is appealing, accommodates physical limitations, and broadens access to improve health equity.

Patients with heart failure (HF) experience decreased functional capacity (FC) and poor quality of life (QOL). Exercise and cardiac rehabilitation programs are an integral part of managing HF because they have been shown to provide a multitude of benefits including improved FC and QOL. In recent years, nonconventional exercise interventions have offered a promising approach for promoting physical activity in patients with HF, thus leading to improved FC and QOL.This review aimed to assess the effects of either supervised or unsupervised, nonconventional exercise interventions on FC and QOL in patients with HF.A literature search using PubMed, Web of Science, Cochrane Library, and Science Direct for relevant studies was conducted. Experimental studies that examined nonconventional exercise interventions in adults with HF were eligible for inclusion. Two reviewers independently selected the studies, assessed the quality of the studies, and then narratively synthesized each study.The authors identified 14 studies that included 879 patients with HF. Most studies were ranked moderate to high quality where 13 studies found significantly improved FC and 10 found significantly improved QOL after nonconventional exercises.This review provides preliminary evidence that patients with HF may benefit from alternative forms of exercise to improve FC and QOL. Walking was the most frequent exercise, but other nonconventional exercises such as aquatic exercise, dance, resistance training, stretching, Tai Chi, and yoga are also promising interventions that may improve FC and QOL in patients with HF.Nonconventional exercise can be a convenient and alternative method of exercise versus traditional cardiac rehabilitation, thereby providing new opportunities that can lead to improved FC and QOL.

Background Family caregivers experience psychological distress or physical strain that may lead to an increased risk of cardiovascular disease (CVD) morbidity and mortality. Objective This systematic review aimed to describe the current evidence and gaps in the literature on measures used to assess CVD outcomes in family caregivers, the association of caregiving with CVD incidence/risk outcomes, and associated factors in family caregivers of patients with chronic disease. Methods Medline, PubMed, CINAHL, Web of Science, and Google Scholar were searched for English-language, peer-reviewed studies published from 2008 to 2020 that examined CVD incidence and risk among family caregivers of adults with chronic conditions. Results Forty-one studies were included in this review. The measures used to assess CVD risk were categorized into biochemical, subclinical markers, components of metabolic syndrome, and global risk scores. Compared with noncaregivers, caregivers were more likely to have higher CVD incidence rates and objectively measured risk. Cardiovascular disease risks were also increased by their caregiving experience, including hours/duration of caregiving, caregivers' poor sleep status, psychological symptoms, poor engagement in physical/leisure activities, and care recipient's disease severity. Conclusions Although there were limited longitudinal studies in caregivers of patients with diverse health conditions, we found evidence that caregivers are at high risk of CVD. Further research for various caregiver groups using robust methods of measuring CVD risk is needed. Caregiver factors should be considered in developing interventions aimed at reducing CVD risk for caregivers.

Background: The incidence of mortality five years after the onset of symptomatic heart failure is about 50%. Lifestyle behaviors differ substantially and likely lead to prognostic differences. Aims: We sought to determine the factors associated with all-cause mortality in patients with heart failure, particularly the impact of a sedentary lifestyle on mortality. Methods: This is a secondary analysis of a randomized controlled trial (REMOTE-HF) to improve self-care through education and counseling ( N=602). We conducted an unadjusted Cox proportional hazards regression analysis with sedentary lifestyle as a predictor of mortality, then added depressive symptoms as a confounder. A Kaplan–Meier survival analysis assessed time to event comparing sedentary lifestyle. Cox models included variables of clinical relevance as well as all significant variables from baseline characteristics associated with all-cause mortality. Results: The mean ± SD age was 66 ± 12.4 years, 41% were women, and 90% were of white race. There were 125 all-cause deaths over 24 months. Sedentary lifestyle was associated with a 75% increase in the expected hazard of all-cause mortality (hazards ratio 1.75; p = 0.003; 95% CI 1.21–2.54) after adjusting for moderate to severe depressive symptoms. Two Cox models showed an 89 and 95% increase, respectively, in all-cause mortality in sedentary participants holding all other variables constant. Conclusions: Sedentary lifestyle is strongly associated with all-cause mortality, independent of having moderate to severe depressive symptoms. Clinicians and researchers have an important role in promoting sustained and safe physical activity to improve survival. Other important modifiable targets to improve survival include depressive symptoms, low literacy, and low body mass index. Clinical Trial Registration— URL: https://www.clinicaltrials.gov . Unique Identifier: NCT00415545

Family caregivers experience psychological distress or physical strain that may lead to an increased risk of cardiovascular disease (CVD) morbidity and mortality.This systematic review aimed to describe the current evidence and gaps in the literature on measures used to assess CVD outcomes in family caregivers, the association of caregiving with CVD incidence/risk outcomes, and associated factors in family caregivers of patients with chronic disease.Medline, PubMed, CINAHL, Web of Science, and Google Scholar were searched for English-language, peer-reviewed studies published from 2008 to 2020 that examined CVD incidence and risk among family caregivers of adults with chronic conditions.Forty-one studies were included in this review. The measures used to assess CVD risk were categorized into biochemical, subclinical markers, components of metabolic syndrome, and global risk scores. Compared with noncaregivers, caregivers were more likely to have higher CVD incidence rates and objectively measured risk. Cardiovascular disease risks were also increased by their caregiving experience, including hours/duration of caregiving, caregivers' poor sleep status, psychological symptoms, poor engagement in physical/leisure activities, and care recipient's disease severity.Although there were limited longitudinal studies in caregivers of patients with diverse health conditions, we found evidence that caregivers are at high risk of CVD. Further research for various caregiver groups using robust methods of measuring CVD risk is needed. Caregiver factors should be considered in developing interventions aimed at reducing CVD risk for caregivers.

Author(s): Howie-Esquivel, Jill; Dracup, Kathleen; Whooley, Mary A; McCulloch, Charles; Jin, Chengshi; Moser, Debra K; Clark, Robyn A; Pelter, Michele M; Biddle, Martha; Park, Linda G | Abstract: AimsHeart failure (HF) patients are taught to identify a rapid 5nlb body-weight gain for early detection of cardiac decompensation. Few data support this common advice. The study aim was to determine whether a 5nlb weight gain in 1nweek and signs and symptoms of HF increased risk for unplanned physician or emergency department (ED) visits or hospital admission in rural HF patients.Methods and resultsThis was a secondary analysis of a randomized trial. Patients tracked body weight and HF symptoms using diaries. We included patients adherent to daily diaries g50% over 24nmonths (Nn=n119). Mean age was 69n±n11nyears; 77% (65) were male, and 67% completed diaries. A weight gain of 5nlb over 7ndays was associated with a greater risk for ED visits but not hospital admission [hazard ratio (HR) 1.06, 95% confidence interval (CI) 1.04, 1.08; Pnln0.0001 vs. HR 1.01, 95% CI 0.88, 1.16; Pn=n0.79]. Increased dyspnoea over 7ndays was associated with a greater risk of ED visits and hospital admissions (HR 9.64, 95% CI 3.68, 25.22; Pnln0.0001 vs. HR 5.89, 95% CI 1.73, 20.04; Pn=n0.01). Higher diary adherence was associated with older age, non-sedentary behaviour, lower depression, and HF knowledge.ConclusionsHeart failure patients are counselled to observe for body-weight gain. Our data do not support that a 5nlb weight gain was associated with hospital admission. Dyspnoea was a better predictor of ED visits and hospital admissions. Daily tracking of dyspnoea symptoms may be an important adjunct to daily weight to prevent hospitalization.

Background Intensive care unit nurses experience moral distress when they feel unable to deliver ethically appropriate care to patients. Moral distress is associated with nurse burnout and patient care avoidance. Objectives To evaluate relationships among moral distress, empowerment, ethical climate, and access to palliative care in the intensive care unit. Methods Intensive care unit nurses in a national database were recruited to complete an online survey based on the Moral Distress Scale–Revised, Psychological Empowerment Index, Hospital Ethical Climate Survey, and a palliative care delivery questionnaire. Descriptive, correlational, and regression analyses were performed. Results Of 288 initiated surveys, 238 were completed. Participants were nationally representative of nurses by age, years of experience, and geographical region. Most were white and female and had a bachelor’s degree. The mean moral distress score was moderately high, and correlations were found with empowerment (r = −0.145; P = .02) and ethical climate scores (r = −0.354; P < .001). Relationships between moral distress and empowerment scores and between moral distress and ethical climate scores were not affected by access to palliative care. Nurses reporting palliative care access had higher moral distress scores than those without such access. Education, ethnicity, unit size, access to full palliative care team, and ethical climate explained variance in moral distress scores. Conclusions Poor ethical climate, unintegrated palliative care teams, and nurse empowerment are associated with increased moral distress. The findings highlight the need to promote palliative care education and palliative care teams that are well integrated into intensive care units.

Background Heart Failure (HF) guidelines recommend HF self-care education. An optimal method of educating HF patients does not currently exist. Objectives To evaluate the effectiveness of supplementing usual HF education with video education and evaluate patients’ satisfaction with video education. Methods A mixed methods design was used. A convenience sample of 70 patients was recruited from an academic medical center. Participants completed the Atlanta Heart Failure Knowledge Test and the Self-care of Heart Failure Index before and after receiving video education, to measure HF knowledge, self-efficacy, and self-care respectively. Video usage and satisfaction with video education data were collected. All-cause 30-day readmissions data were compared to a historical group. Results HF knowledge and self-care maintenance scores increased significantly. Self-efficacy, self-care management and all-cause 30-day readmissions did not significantly improve. Most HF patients were highly satisfied. Conclusion Supplementing usual HF education with VE was associated with improved HF knowledge and self-care maintenance.

Background Seamless communication and coordinated teamwork is paramount in high stakes clinical practice settings, such as the emergency department (ED), to prevent medical errors and ensure high quality patient care delivery. Ineffective communication in this fast-paced environment can be detrimental for patient outcomes and staff collaboration. Purpose The purpose of this project was to evaluate the effect of TeamSTEPPS® training (Team strategies and Tools to Enhance Performance and Patient Safety), an evidenced based communication-training toolkit, on staff perception of teamwork and communication in an academic Level I Emergency and Trauma Center. Methods A prospective, single group, pre-post design with a convenience sample was employed. The sample consisted of thirty-five clinical staff members, including registered nurses (RNs) and patient care technicians (PCTs), recruited from an academic Level I Emergency and Trauma Center. A pre-intervention T-TPQ (TeamSTEPPS® teamwork and Perceptions Questionnaire) measuring staff perception of teamwork and collaboration was administered followed by a one-hour TeamSTEPPS® education session from freely-available published materials. Three weeks later, a post-intervention T-TPQ was administered. A paired samples t-test and Wilcoxon signed-rank test was used to analyze changes in scores from pre-post-test for outcome measures. Results 23 females and 12 males with a mean age of 30 years and 9 years of experience participated. T-TPQ scores showed a mean of 121.4 pre-training and mean of 128.2 after training. Paired t-test demonstrated overall pre-intervention (mean = 3.52, SD ± 0.5) and post-intervention (mean = 3.78, SD = 0.4) scores were significantly improved overall (-0.29 to −0.13, p Conclusion TeamSTEPPS® was an effective communication collaboration program to improve teamwork and communication perceptions in the ED suggesting that an evidence-based multifaceted, multimedia instructional toolkit may promote a collaborative culture of effective communication and teamwork. Long term effects of TeamSTEPPS® training in the ED requires further study.

Aims Heart failure (HF) patients are taught to identify a rapid 5 lb body‐weight gain for early detection of cardiac decompensation. Few data support this common advice. The study aim was to determine whether a 5 lb weight gain in 1 week and signs and symptoms of HF increased risk for unplanned physician or emergency department (ED) visits or hospital admission in rural HF patients. Methods and results This was a secondary analysis of a randomized trial. Patients tracked body weight and HF symptoms using diaries. We included patients adherent to daily diaries >50% over 24 months (N = 119). Mean age was 69 ± 11 years; 77% (65) were male, and 67% completed diaries. A weight gain of 5 lb over 7 days was associated with a greater risk for ED visits but not hospital admission [hazard ratio (HR) 1.06, 95% confidence interval (CI) 1.04, 1.08; P

Background: Childhood obesity has become a global health issue, yet little is known about the influence of maternal factors on children’s weight-related health behaviors (dietary habits and physical activity), especially in China. The purpose of this study was to examine the influence of maternal factors on children’s eating behaviors and physical activity in Chinese preschool-age children. Method: A cross-sectional study was utilized to describe weight-related health behaviors among preschool-aged children and identify maternal factors that are associated with children’s weight-related health behaviors in China. Mothers completed questionnaires regarding family eating and activity habits, child feeding practices, and maternal self-efficacy regarding their child’s health-related health behaviors. Results: A total of 222 mother–child dyads participated in this study. Maternal health-related behavior and attitudes regarding feeding practices and self-efficacy were associated with children’s health-related behaviors, including eating behaviors and physical and sedentary activities. The influence of maternal behaviors and attitudes were domain specific. Discussion: Improvement of children’s health behaviors, promoting a healthy lifestyle of the mother and self-efficacy, and providing health home environment for the child are critical in obesity prevention. Implications for Practice: Because children’s health is critical to the health of the nation and to global development, understanding the factors related to children’s health-related behaviors is an important first step toward development of tailored, culturally sensitive interventions for promoting a healthy lifestyle and preventing obesity.

Background: The objective of this study was to evaluate the effect of a disease management intervention on rehospitalization rates in hospitalized heart failure (HF) patients. Methods: Patients treated with the TEACH-HF intervention that included Teaching and Education, prompt follow-up Appointments, Consultation for support services, and Home follow-up phone calls (TEACH-HF) from January 2010 to January 2012 constituted the intervention group (n = 548). Patients treated from January 2007 to January 2008 constituted the usual care group (n = 485). Results: Group baseline characteristics were similar with 30-day readmission rates significantly different (19% usual care vs. 12% for the intervention respectively (P = 0.003)). Patients in the usual care group were 1.5 times more likely to be hospitalized (95% CI: 1.2 - 1.9; P = 0.001) compared to the intervention group. A savings of 641 bed days with potential revenue of $640,000 occurred after TEACH-HF. Conclusions: The TEACH-HF intervention was associated with significantly fewer hospital readmissions and savings in bed days. Cardiol Res. 2015;6(1):201-208 doi: http://dx.doi.org/10.14740/cr384w

Aims To examine the relationship between child, mother, and environmental factors and increased body mass index in preschool-aged children in China. Background There are about 120 million children in China are classified as overweight or obese. Understanding the key factors associated with childhood obesity (i.e. child, mother and environment) is the first step in combating the growing obesity epidemic in China, as well as in the global community, where large numbers of Chinese immigrants can be found. Methods A cross-sectional design was used. Each child's weight and height were measured by trained assistants, whereas mothers were asked to complete several questionnaires including family demographic, family eating and activity habit and child feeding practices. Mothers also reported their own as well as the father's height, weight and waist circumference. Linear regression models were used. Findings The overweight and obesity prevalence was 22% for children, 7% for mothers and 82% for fathers. Children spent an average of 1.2 h (72 min) engaged in physical activities and 0.76 h (46 min) in sedentary time including TV watching or computer and video games playing per day. Factors associated with a child's higher body mass index included maternal beliefs regarding the child's susceptibility to obesity, their own susceptibility to obesity, a child's more advanced age and more unhealthy food stimulus exposure at home. Conclusion Because a mother's health behaviours may influence their child's health behaviours and they are a crucial model for the family and children, childhood obesity prevention needs to include mothers and focus on building a healthy home environment for the family. Implications for nursing and health policy Understanding factors associated with childhood obesity can assist researchers and clinicians to develop culturally sensitive and evidence-based programmes and policy to reduce this global epidemic.

Background: Attention to symptoms of weight gain and dyspnea are central tenets of patient education in heart failure (HF). However, it is not known whether diary use improves patient outcomes. The aims of this study were to compare mortality among rural patients with HF who completed versus did not complete a daily diary of weight and symptom self-assessment and to identify predictors of diary use. Methods and Results: This is a secondary analysis of a 3-arm randomized controlled trial on HF education of self-care with 2 intervention groups versus control who were given diaries for 24 months to track daily weight, HF symptoms, and response to symptom changes. Mean age was 66±13, 58% were men, and 67% completed diaries (n=393). We formed 5 groups (no use, low, medium, high, and very high) based on the first 3 months of diary use and then analyzed time to event (cardiac mortality, all-cause mortality, and HF-related readmission) starting at 3 months. Compared with patients with no diary use, high and very high diary users were less likely to experience all-cause mortality ( P =0.02 and P =0.01, respectively). Self-reported sedentary lifestyle was associated with less diary use in an adjusted model (odds ratio, 0.66; 95% confidence interval, 0.46–0.95; P =0.03). Depression and sex were not significant predictors of diary use in the adjusted model. Conclusions: In this study of 393 rural patients with HF, we found that greater diary use was associated with longer survival. These findings suggest that greater engagement in self-care behaviors is associated with better HF outcomes. Clinical Trial Registration: URL: https://www.clinicaltrials.gov . Unique Identifier: NCT00415545.

Serum 25-hydroxyvitamin D (25(OH)D) levels have been found to be inversely associated with both prevalent and incident cardiovascular disease (CVD) risk factors; dyslipidemia, hypertension and diabetes mellitus. This review looks for evidence of a causal association between low 25(OH)D levels and increased CVD risk. We evaluated journal articles in light of Hill’s criteria for causality in a biological system. The results of our assessment are as follows. Strength of association: many randomized controlled trials (RCTs), prospective and cross-sectional studies found statistically significant inverse associations between 25(OH)D levels and CVD risk factors. Consistency of observed association: most studies found statistically significant inverse associations between 25(OH)D levels and CVD risk factors in various populations, locations and circumstances. Temporality of association: many RCTs and prospective studies found statistically significant inverse associations between 25(OH)D levels and CVD risk factors. Biological gradient (dose-response curve): most studies assessing 25(OH)D levels and CVD risk found an inverse association exhibiting a linear biological gradient. Plausibility of biology: several plausible cellular-level causative mechanisms and biological pathways may lead from a low 25(OH)D level to increased risk for CVD with mediators, such as dyslipidemia, hypertension and diabetes mellitus. Experimental evidence: some well-designed RCTs found increased CVD risk factors with decreasing 25(OH)D levels. Analogy: the association between serum 25(OH)D levels and CVD risk is analogous to that between 25(OH)D levels and the risk of overall cancer, periodontal disease, multiple sclerosis and breast cancer. Conclusion: all relevant Hill criteria for a causal association in a biological system are satisfied to indicate a low 25(OH)D level as a CVD risk factor.

Aims To evaluate the characteristics and efficacy of mobile phone interventions to improve medication adherence. Secondary aims are to explore participants’ acceptability and satisfaction with mobile phone interventions and to evaluate the selected studies in terms of study rigour, impact, cost and resource feasibility, generalizability and implications for nursing practice and research. Background Medication non-adherence is a major global challenge. Mobile phones are the most commonly used form of technology worldwide and have the potential to promote medication adherence. Design Guidelines from the Centre for Reviews and Dissemination were followed for this systematic review. Data Sources A comprehensive search of databases (PubMed, Web of Science, CINAHL, PsycInfo, Google Chrome and Cochrane) and bibliographies from related articles was performed from January 2002–January 2013 to identify the included studies. Review Methods A quantitative systematic review without meta-analysis was conducted and the selected studies were critically evaluated to extract and summarize pertinent characteristics and outcomes. Results The literature search produced 29 quantitative research studies related to mobile phones and medication adherence. The studies were conducted for prevention purposes as well as management of acute and chronic illnesses. All of the studies used text messaging. Eighteen studies found significant improvement in medication adherence. Conclusion While the majority of investigators found improvement in medication adherence, long-term studies characterized by rigorous research methodologies, appropriate statistical and economic analyses and the test of theory-based interventions are needed to determine the efficacy of mobile phones to influence medication adherence.

Objective Pharmacologic treatment for secondary prevention of coronary heart disease (CHD) is critical to prevent adverse clinical outcomes. In a randomized controlled trial, we compared antiplatelet and statin adherence among patients with CHD who received: (1) text messages (TM) for medication reminders and education, (2) educational TM only, or (3) No TM. Methods A mobile health intervention delivered customized TM for 30 days. We assessed and analyzed medication adherence with electronic monitoring devices [Medication Event Monitoring System (MEMS)] by one-way ANOVA and Welch tests, two-way TM response rates by t -tests, and self-reported adherence (Morisky Medication Adherence Scale) by Repeated Measures ANOVA. Results Among 90 patients (76% male, mean age 59.2 years), MEMS revealed patients who received TM for antiplatelets had a higher percentage of correct doses taken ( p =0.02), percentage number of doses taken ( p =0.01), and percentage of prescribed doses taken on schedule ( p =0.01). TM response rates were higher for antiplatelets than statins ( p =0.005). Self-reported adherence revealed no significant differences among groups. Conclusion TM increased adherence to antiplatelet therapy demonstrated by MEMS and TM responses. Practice implications Feasibility and high satisfaction were established. Mobile health interventions show promise in promoting medication adherence.

Background Patient education is recommended to enhance self-care in all heart failure (HF) guidelines. The optimal method of educating HF patients is not known, but video education (VE) can provide a standardized and cost-effective method to deliver HF patient education. In addition, mobile technology can be an efficient and convenient way to deliver patient education as patients transition from hospital to home. Purpose The purpose of this study was twofold: 1) Evaluate whether HF knowledge, self-efficacy, self-care skills, and readmission rates improved after adding VE to usual care, and 2) Evaluate patient satisfaction with VE. Methods A convenience sample of adult HF inpatients was recruited over 11 weeks at an academic medical center. Participants received access via tablet, smartphone, or computer to 26 videos, each between 2-4 minutes in length, and lasting a total of 1.5 hours. The first video was shown while inpatient and subsequent videos were viewed at participants’ discretion while inpatient as well as after discharge. Participants received a “Managing Your Heart Failure With Video Education” booklet to aid accessing the videos. HF knowledge and self-care were measured before and after VE using the Atlanta Heart Failure Knowledge Test and the Self-care of Heart Failure Index. A patient log and satisfaction with each video was collected. Seventy participants enrolled and 30 completed the questionnaires. All-cause 30-day readmission data were compared to a randomly selected historical group from the previous months and year. Results Participants’ mean age was 66 years, 70% (21) were female, 67% (20) were Caucasian, 63% (19) high school educated or less, 83% (25) had hypertension, 73% (22) were New York Heart Association Class III-IV, and 43% (13) had HF with reduced ejection fraction. Mean Charlson Comorbidity Index scores was 6.2 ± 2.3. HF knowledge and self-maintenance scores increased (mean 1.7, + 3.2, p =.008, mean 13.96 + 20.99, p =.001 respectively). Participants’ scores improved by at least 5% on 20 of the 30 questions on the HF knowledge test. Self-efficacy (self-care confidence) and self-care management did not significantly improve (mean 1.67, SD 26.69, p = .735; mean 9.4, SD 22.7, p =.073 respectively). All-cause 30-day hospital readmissions did not significantly decrease (9 to 7, p= .276). HF patients were satisfied with the VE information (96%) and all would recommend the videos (100%). The videos rated most helpful were: Heart Failure Medications: Diuretics (71.4%), Managing Heart Failure: Limiting Sodium (65%), and Taking Your Heart Failure Medications (61.9%). Conclusion VE was associated with improved HF knowledge and self-maintenance with high patient satisfaction. HF Knowledge scores may further be used to tailor patient education based on identified knowledge gaps. Future work is needed to investigate whether self-efficacy and self-management improves with continued follow-up.

Background Little is known about the prevalence and prognostic significance of long QT interval among patients with chest pain during the acute phase of suspected cardiovascular injury. Objectives Our aim was to investigate the prevalence and prognostic significance of long QT interval among patients presenting to the emergency department (ED) with chest pain using an optimum QT rate correction formula. Methods We performed secondary analysis on data obtained from the IMMEDIATE AIM trial (N, 145). Data included 24-hour 12-lead Holter electrocardiographic recordings that were stored for offline computer analysis. The QT interval was measured automatically and rate corrected using seven QTc formulas including subject specific correction. The formula with the closer to zero absolute mean QTc/RR correlation was considered the most accurate. Results Linear and logarithmic subject specific QT rate correction outperformed other QTc formulas and resulted in the closest to zero absolute mean QTc/RR correlations (mean ± SD: 0.003 ± 0.002 and 0.017 ± 0.016, respectively). These two formulas produced adequate correction in 100% of study participants. Other formulas (Bazett’s, Fridericia’s, Framingham's, and study specific) resulted in inadequate correction in 47.6 to 95.2% of study participants. Using the optimum QTc formula, linear subject specific, the prevalence of long QTc interval was 14.5%. The QTc interval did not predict mortality or hospital admission at short and long term follow-up. Only the QT/RR slope predicted mortality at 7 year follow-up (odds ratio, 2.01; 95% CI, 1.02–3.96; p Conclusions Adequate QT rate correction can only be performed using subject specific correction. Long QT interval is not uncommon among patients presenting to the ED with chest pain.

Many hospitalized adults cannot reposition themselves in their beds. Therefore, they are regularly turned by their nurses, primarily to prevent pressure ulcer formation. Earlier research indicates that turning is painful and that patients are rarely premedicated with analgesics. Nonpharmacologic interventions may be used to help with this painful procedure. However, no published research was found on the use of nonpharmacologic interventions for turning of hospitalized patients. The objectives of this study were: 1) to describe patient pain characteristics during turning and their association with patient demographic and clinical characteristics; 2) to determine the frequency of use of various nonpharmacologic interventions for hospitalized adult patients undergoing the painful procedure of turning; and 3) to identify factors that predict the use of specific nonpharmacologic interventions for pain associated with turning. Hospitalized adult patients who experienced turning, the nurses caring for them, and others who were present at the time of turning were asked if they used various nonpharmacologic interventions to manage pain during the turning. Out of 1,395 patients, 92.5% received at least one nonpharmacologic intervention. Most frequently used were calming voice (65.7%), information (60.6%), and deep breathing (37.9%). Critical-care patients were more likely to receive a calming voice (odds ratio [OR] 1.66, p < .01), receive information (OR 1.62, p < .001), and use deep breathing (OR= 1.36, p < .05) than those who were not critical-care patients. Those reporting higher pain were consistently more likely to receive each of the three interventions (OR 1.01, p < .05 for all 3). In conclusion, nonpharmacologic interventions are used frequently during a turning procedure. The specific interventions used most often are ones that can be initiated spontaneously. Our data suggest that patients, nurses, and family members respond to patients' turning-related pain by using nonpharmacologic interventions.

Objective Little is known about the practice patterns of nurses who work in the specialty of heart failure (HF). This specialty includes inpatient and outpatient sites for practice that incorporate intensive care to rehabilitation. The purpose of this study was to describe the current practice of nurses who are members of the American Association of Heart Failure Nurses (AAHFN). Methods A convenience sample of nurses attending the 2010 Annual Meeting of AAHFN was surveyed to determine current practice patterns. Results The mean age of the nurses completing the survey was 48 years (standard deviation [SD] +10), and the majority were white (85%) and female (98%). Approximately half (48%) completed a Master’s degree. The mean time worked as a nurse was 23 years (SD +10), with a mean of 11 years (SD +8.2) caring for patients with HF. Both HF education and physical assessment were reported to be provided frequently. Conclusion This survey provides insight into the practice patterns of HF nurses. Continued monitoring of this role is warranted and can serve to assist the AAHFN in advancing HF knowledge and skills.

Background Sociodemographic variables that are predictors of rehospitalization for heart failure may better inform hospital discharge strategies. Objectives (1) To determine whether sociodemographic variables are predictors of hospital readmission, (2) to determine whether sociodemographic or laboratory variables differ by age group as predictors of readmission, and (3) to compare whether patients’ discharge disposition differs by age group in predicting readmission. Methods Retrospective chart review of hospitalized patients with heart failure admitted in 2007. Results Mean age was 68 (SD, 17) years for the 809 patients, with slightly more than one-third (n = 311, 38%) reporting a legal partner. Fewer than half (n = 359, 44%) were white. Almost one-third (n = 261, 32%) were rehospitalized within 90 days. Multivariable analysis revealed that patients younger than 65 years old and not partnered were at 1.8 times greater risk for being readmitted 90 days after discharge (P = .02; 95% CI, 0.33–0.92). Patients who were 65 years and older and not partnered were at 2.2 times greater risk for readmission (P = .01; 95% CI, 0.25–0.85) after creatinine level and discharge disposition were controlled for. For older patients discharged to home or to home with home services, the risk of readmission was 2.6 times greater than that for patients discharged to a skilled nursing facility (P = .02; 95% CI, 1.20–5.56). Conclusions The absence of a partner was predictive of readmission in all patients. Older patients with heart failure who were discharged to a skilled nursing facility had lower readmission rates. The effect of partner and disposition status may suggest a proxy for social support. Strategies to provide social support during discharge planning may have an effect on hospital readmission rates.

Background Complementary therapies such as yoga practice have become commonplace, yet the safety, physical, and psychological effects on patients with heart failure (HF) are unknown. The purpose of this study was to determine whether an 8-week yoga program was safe and would positively influence physical and psychological function in HF patients. Methods and Results Stable HF patients were recruited (n = 15) and completed (n = 12) 8 weeks of yoga classes. Data collected were: safety (cardiac and orthopedic adverse events); physical function (strength, balance, endurance, flexibility); and psychological function (quality of life [QOL], depression scores, mindfulness) before and after 8 weeks of yoga classes. Results Mean age was 52.4 ± 11.6 with three-fourths (n = 9) being male and Caucasian. No participant had any adverse events. Endurance ( P P = .04 and lower body P = .01) significantly improved. Balance improved by 13.6 seconds (26.9 ± 19.7 to 40.0 ± 18.5; P = .05). Symptom stability, a subscale of QOL, improved significantly ( P = .02). Although no subject was depressed, overall mood was improved. Subjects subjectively reported improvements in overall well-being. Conclusions Yoga practice was safe, with participants experiencing improved physical function and symptom stability. Larger studies are warranted to provide more nonpharmacological options for improved outcomes in patients with HF.

Cardiovascular disease today remains a formidable foe affecting 1 in 3 Americans. The emergence of cardiac biochemical markers has provided clinicians unique insight into the state of the myocardium. In fact, cardiac biomarkers now represent an essential criterion in the definition of acute myocardial infarction. There has been impressive development of efficient and reliable assays to detect biomarkers in the serum. Together with patient history and electrocardiographic analysis, the invaluable information gained from serum cardiac biomarkers supports diagnosis, therapy selection, and determination of prognosis. Biomarkers such as troponin and creatine kinase MB have received well-deserved attention for their ability to detect myocardial ischemia. Clinicians today use cardiac markers to identify ischemia as well as alternate clinical states. B-type natriuretic peptide, for instance, reflects myocardial stretch as seen in heart failure exacerbations and may well have promising prognostic significance. The purpose of this review is to discuss current and emerging cardiac biomarkers in acutely ill patients. The advantages and disadvantages of biomarkers will also be presented in the context of their clinical uses. Present markers are highly sensitive and specific to myocardial injury; however they do not specifically identify the method of injury. An exciting potential exists for future biomarkers to demonstrate enhanced specificity and earlier detection of compromised myocardium.

Predicting rehospitalization risk may enable more tailored therapies for patients at high risk of rehospitalization. The objective of this study was to determine whether demographic, clinical, or psychological variables conferred increased risk of rehospitalization in a multiethnic, hospitalized, heart failure (HF) population. Demographic and clinical data were collected, with psychological and functional (6-minute walk test [6MWT]) variables obtained within 48 hours of discharge. Patients with HF (n = 72) were followed up for 90 days after discharge. Subjects' mean age was 62 +/- 18 years, with almost 1/2 nonwhite (n = 32) and 2/3 men (n = 47). Mean discharge brain natriuretic peptide was 825 +/- 716 ng/L, mean quality-of-life score was 34 +/- 21, and mean 6MWT distance was 186 +/- 99 m. Almost 1/2 (n = 34) were rehospitalized for cardiac reasons within 90 days. Women had a 2.5 times greater risk for rehospitalization than men. Both female gender and nonwhite ethnicity incurred > or =2 times greater risk of cardiac rehospitalization. Brain natriuretic peptide and 6MWT score did not predict rehospitalization risk. In conclusion, sociodemographic factors may be more powerful predictors of rehospitalization than known clinical markers in multiethnic patients hospitalized for HF. Evaluation for support services is needed to prevent rehospitalization, especially in women and nonwhites.

Introduction: Both prevalent and incident CVD are negatively associated with 25-hydroxyvitamin D (25[OH] D) levels but the existence of a causal mechanism has yet to be determined. Vitamin D (D) supplementation may increase total HDL-c or one of the HDL subclasses; HDL2 and HDL3 and decrease CVD. The effect of D supplementation with HMG-CoA reductase inhibitor use on HDL-c, HDL2, and HDL3 also remains unclear. Hypotheses: We assessed the following two hypotheses; 1) HDL-c, HDL2, or HDL3 levels will increase with D supplementation for 12 weeks versus placebo and 2) HDL-c, HDL2, or HDL3 levels will increase with D supplementation for 12 weeks with HMG-CoA reductase inhibitor use versus without HMG-CoA reductase inhibitor use. Methods: Serum sample data, including 25(OH) D, HDL-c, HDL2, and HDL3 levels, from a randomized double-blinded placebo-controlled trial conducted between 2008 and 2012 were secondarily analyzed. Statistical analyses included Pearson correlation and Repeated-Measures ANOVA. Results: Hypothesis #1; of the 59 participants (mean age=56.0 years), 39 had a deficient (< 20 ng/mL) baseline 25(OH) D level. Hypothesis #2; of the 40 participants (mean age=56.5 years) 23 had a deficient (< 20 ng/mL) baseline 25(OH) D level. Pearson correlation showed 12-week 25(OH) D levels were moderately positively correlated with 12-week HDL-c (0.337, p ≤ 0.05) and 12-week HDL3 (0.356 p ≤ 0.05) levels but not at baseline. Hypotheses #1 and #2; baseline and 12-week levels for HDL-c, HDL2, and HDL3 were moderately to strongly positively correlated with female gender and moderately to strongly negatively correlated with BMI. Some participants did not achieve sufficient 25(OH) D levels. Repeated-Measures ANOVA with one between-subjects factor; group, and one within-subjects factor; time, showed no statistically significant difference in the mean change in HDL-c, HDL2 or HDL3 for D supplementation versus placebo or for D supplementation with versus without HMG-CoA reductase inhibitor use. Conclusions: Future studies may provide more informative results if they include; more participants, deficient 25(OH) D level as an inclusion criteria, and continued D supplementation until sufficiency is attained versus discontinuation after a pre-specified time period.

Introduction: Attention to symptoms of weight gain and dyspnea are central tenets in heart failure (HF) patient education. Daily diary use can be one method for HF patients to acknowledge and attend to their symptoms. However, it is not known whether diary use improves patient outcomes. We aimed to compare mortality among rural HF patients who did versus did not complete a daily diary of weight and symptom self-assessment. Methods: This study was a secondary analysis of a 3-arm randomized controlled trial with two intervention groups (Fluid Watchers LITE and PLUS) and usual care. The two intervention groups were given daily diaries for 2 years to track daily weight, HF symptoms, and response to symptom changes. Intervention group patients received self-care education and a script to call their health care provider, but the 2 groups varied on the number of follow-up phone calls received. Patient groups were categorized by duration of adherence to diary use: None, Low (1-3 months), Medium (4-12 months), and High (13-24 months). Cox regression analysis assessed survival from cardiac and non-cardiac death for 2 years while controlling for age and depression. Results: The mean age was 66 ± 13, 58% (n=227) were male, and 67% (264/393) completed diaries with no difference in diary use between the 2 intervention groups. As compared with the 129 patients with no diary use, the 117 patients with High diary use had fewer non-cardiac (p=0.001) and cardiac (p=0.01) deaths; the 89 patients with Medium diary use had fewer non-cardiac deaths (p=0.007) but similar cardiac deaths (p=0.79). Conclusions: This is the largest trial to examine daily diary use in HF patients over 2 years. Improved non-cardiac survival was associated with at least 4 months of diary use, while cardiac survival was associated with at least 12 months of diary use. It is unclear why non-cardiac survival improved, but it is speculated that attention to cardiac symptoms may have increased attention to non-cardiac symptoms.

Introduction: Health care providers regularly counsel heart failure (HF) patients to monitor symptoms and weight changes daily in order to detect and quickly treat HF exacerbations. We found diary use is associated with higher survival rates in chronic HF patients; however, the factors related to diary use are unknown. Therefore, the aim of this study was to determine the factors associated with diary use. Methods: We conducted a secondary analysis of a 3-arm randomized controlled trial among rural HF patients with two intervention groups (Fluid Watchers LITE and PLUS) and usual care. The two intervention groups were asked to use daily diaries for 2 years to track weight, HF symptoms, and response to symptom changes. The intervention groups received education on HF self-care and a script to call their health care provider; however, the 2 groups varied on the number of follow-up phone calls received. Patient groups were categorized by duration of adherence to diary use: None, Low (1-3 months), Medium (4-12 months), and High (13-24 months). Multivariable ordinal logistic regression using step-wise forward selection was conducted to determine factors that were associated with diary use. Results: Patients were 66 ± 13 years old, 58% were male, and 50% had systolic HF with 67% (N=264/393) of patients who completed diaries. After controlling for age, depression, and death in the multivariable logistic ordinal regression, depression (OR, 0.95; 95% CI, 0.92-0.98; P=0.002) and sedentary lifestyle (OR, 0.61; 95% CI, 0.42-0.89; P=.01) were associated with less diary use. In contrast, older age (OR, 1.59; 95% CI, 1.07-2.3; P=.02) and HF self-care (OR, 1.03; 95% CI, 1.01-1.06; P=.01) were associated with more diary use. Conclusions: Since diary use is associated with higher survival rates in HF patients, it is important to recognize that depression and sedentary lifestyle were negatively associated with diary use whereas older age and HF self-care were positively associated with diary use. Addressing modifiable psychosocial factors may have meaningful impact on improving survival in this vulnerable population of HF patients who suffer from frequent rehospitalizations and early death related to their disease.

There is a 70% higher age-adjusted incidence of heart failure (HF) among Aboriginal and Torres Strait Islander people, three times more hospitalisations and twice as many deaths as among non-Aboriginal people. There is a need to develop holistic yet individualised approaches in accord with the values of Aboriginal community health care to support patient education and self-care.b/bThe aim of this study was to re-design an existing HF educational resource (Fluid Watchers-Pacific Rim) to be culturally safe for Aboriginal and Torres Strait Islander peoples, working in collaboration with the local community, and to conduct feasibility testing.This study was conducted in two phases and utilised a mixed-methods approach (qualitative and quantitative). Phase 1 used action research methods to develop a culturally safe electronic resource to be provided to Aboriginal HF patients via a tablet computer. An HF expert panel adapted the existing resource to ensure it was evidence-based and contained appropriate language and images that reflects Aboriginal culture. A stakeholder group (which included Aboriginal workers and HF patients, as well as researchers and clinicians) then reviewed the resources, and changes were made accordingly. In Phase 2, the new resource was tested on a sample of Aboriginal HF patients to assess feasibility and acceptability. Patient knowledge, satisfaction and self-care behaviours were measured using a before and after design with validated questionnaires. As this was a pilot test to determine feasibility, no statistical comparisons were made.Phase 1: Throughout the process of resource development, two main themes emerged from the stakeholder consultation. These were the importance of identity, meaning that it was important to ensure that the resource accurately reflected the local community, with the appropriate clothing, skin tone and voice. The resource was adapted to reflect this, and members of the local community voiced the recordings for the resource. The other theme was comprehension; images were important and all text was converted to the first person and used plain language. Phase 2: Five Aboriginal participants, mean age 61.6±10.0 years, with NYHA Class III and IV heart failure were enrolled. Participants reported a high level of satisfaction with the resource (83.0%). HF knowledge (percentage of correct responses) increased from 48.0±6.7% to 58.0±9.7%, a 20.8% increase, and results of the self-care index indicated that the biggest change was in patient confidence for self-care, with a 95% increase in confidence score (46.7±16.0 to 91.1±11.5). Changes in management and maintenance scores varied between patients.By working in collaboration with HF experts, Aboriginal researchers and patients, a culturally safe HF resource has been developed for Aboriginal and Torres Strait Islander patients. Engaging Aboriginal researchers, capacity-building, and being responsive to local systems and structures enabled this pilot study to be successfully completed with the Aboriginal community and positive participant feedback demonstrated that the methodology used in this study was appropriate and acceptable; participants were able to engage with willingness and confidence.

INTRODUCTION: There is a 70% higher age-adjusted incidence of heart failure (HF) among Aboriginal and Torres Strait Islander people, three times more hospitalisations and twice as many deaths as among non-Aboriginal people. There is a need to develop holistic yet individualised approaches in accord with the values of Aboriginal community health care to support patient education and self-care. The aim of this study was to re-design an existing HF educational resource (Fluid Watchers-Pacific Rim) to be culturally safe for Aboriginal and Torres Strait Islander peoples, working in collaboration with the local community, and to conduct feasibility testing. METHODS: This study was conducted in two phases and utilised a mixed-methods approach (qualitative and quantitative). Phase 1 used action research methods to develop a culturally safe electronic resource to be provided to Aboriginal HF patients via a tablet computer. An HF expert panel adapted the existing resource to ensure it was evidence-based and contained appropriate language and images that reflects Aboriginal culture. A stakeholder group (which included Aboriginal workers and HF patients, as well as researchers and clinicians) then reviewed the resources, and changes were made accordingly. In Phase 2, the new resource was tested on a sample of Aboriginal HF patients to assess feasibility and acceptability. Patient knowledge, satisfaction and self-care behaviours were measured using a before and after design with validated questionnaires. As this was a pilot test to determine feasibility, no statistical comparisons were made. RESULTS: Phase 1: Throughout the process of resource development, two main themes emerged from the stakeholder consultation. These were the importance of identity, meaning that it was important to ensure that the resource accurately reflected the local community, with the appropriate clothing, skin tone and voice. The resource was adapted to reflect this, and members of the local community voiced the recordings for the resource. The other theme was comprehension; images were important and all text was converted to the first person and used plain language. Phase 2: Five Aboriginal participants, mean age 61.6±10.0 years, with NYHA Class III and IV heart failure were enrolled. Participants reported a high level of satisfaction with the resource (83.0%). HF knowledge (percentage of correct responses) increased from 48.0±6.7% to 58.0±9.7%, a 20.8% increase, and results of the self-care index indicated that the biggest change was in patient confidence for self-care, with a 95% increase in confidence score (46.7±16.0 to 91.1±11.5). Changes in management and maintenance scores varied between patients. CONCLUSIONS: By working in collaboration with HF experts, Aboriginal researchers and patients, a culturally safe HF resource has been developed for Aboriginal and Torres Strait Islander patients. Engaging Aboriginal researchers, capacity-building, and being responsive to local systems and structures enabled this pilot study to be successfully completed with the Aboriginal community and positive participant feedback demonstrated that the methodology used in this study was appropriate and acceptable; participants were able to engage with willingness and confidence.

BackgroundHeart failure (HF) and chronic obstructive pulmonary disease (COPD) are highly prevalent and associated with a large symptom burden, that is compounded in a dual HF-COPD diagnosis. Yoga has potential benefit for symptom relief; however functional impairment hinders access to usual yoga classes. We developed a Tele-Yoga intervention and evaluated it in a controlled pilot trial. This paper reports on the appropriateness and acceptability of the intervention and the evaluation design.MethodsA controlled, non-randomised trial was conducted of an 8-week Tele-Yoga intervention versus an educational control (information leaflets mailed to participants with one phone call a week). Biweekly one-hour Tele-Yoga classes were implemented via multipoint videoconferencing that connected participants to live classes via an Internet connection to their televisions. Semi-structured qualitative interviews were conducted with participants post study exit to explore reasons for and experiences of participating, including views of study outcome measures and physiological tests. Transcribed interviews were analysed using thematic content analysis.ResultsFifteen people participated in the pilot study (7 in the intervention group, 8 in the control). Of these, 12 participants were interviewed, 6 in each group, mean age 71.2 years (SD 10.09); 3 were male. Themes are reported in the following categories: acceptability and appropriateness of the intervention, potential active ingredients of the intervention, acceptability and appropriateness of the control, participation in the research, and acceptability of the testing procedures. The intervention was acceptable and appropriate: the intervention group reported enjoying yoga and valuing the home-based aspect and participants described a high symptom burden and social isolation. However, technological problems resulted in poor video-streaming quality for some participants. Potential active ingredients included physical postures, breathing exercises and guidance in relaxation and meditation. The educational control intervention was acceptable and appropriate, with participants reporting little effect on their well-being and no impact on mechanisms hypothesised to explain yoga’s effectiveness. The questionnaires and home physiological testing were acceptable to participants.ConclusionsTele-Yoga is an acceptable and appropriate intervention in people with HF and COPD and further research is warranted to refine the technology used in its delivery. Findings provide guidance for researchers working in tele-interventions, yoga, and similar populations.Trial registrationClinicalTrials.gov Identifier: NCT02078739 (4 March 2014).

The newest nurse practitioner role is the acute care nurse practitioner. This paper presents the latest data on the role from both a US and international perspective.Now present in the USA for at least 15 years, the acute care nurse practitioner role has become well established in critical care settings and is moving into international healthcare. The few outcome studies conducted to date demonstrate the acute care nurse practitioner provides quality patient and family care, improves patient satisfaction, is cost effective, and is an answer to the hospital's shortage of medical residents with new restrictions on working hours.The role of acute care nurse practitioners in critical care is increasing worldwide. Most countries are experimenting with this latest nurse practitioner as an extended-role healthcare provider with many potential benefits to patients and their families, as well as the healthcare system.

Background: Hispanics constitute the largest US ethnic group and have been shown to have more frequent heart failure (HF) hospitalizations than non-Hispanic whites. Disease management programs can reduce HF hospitalizations and mortality by increasing patient self-care, but most programs are limited to patients who speak English. Therefore, we hypothesize that Project Fluido, a culturally appropriate self-care education intervention, will improve self-care behaviors and knowledge in Hispanic patients with HF compared with usual care (UC). Methods: Project Fluido (N = 42) was a randomized controlled pilot trial over 3 months. Patients in the experimental group (n = 22) received individualized education in Spanish using the “teach-back” method on the following: high salt foods, when to call the physician, when to report weight gain and the use of diuretics. They also received a nurse-initiated phone call every 2 weeks, a script for calling their physician with increased symptoms, a weight scale and a daily diary to complete. The UC group (n = 20) received a scale and written information. Self-care was measured using the self-care heart failure index and knowledge using teach-back scores. Four knowledge topics were included when using teach-back. Results: Participants’ mean age was 57 ± 14 years, 57% (24) were male, 64% (27) had hypertension, 86% (36) were New York Heart Association Class I-III and 65% (26) had HF with reduced ejection fraction. Participant health literacy scores showed poor health literacy in 31% (n = 13) and 67% (n = 28) spoke Spanish only. Household income was reported as < $ 20,000 in 93% (n = 39). Self-care and knowledge scores significantly improved (P < 0.04 and P < 0.02, respectively) in the intervention group compared to UC. Conclusion: The intervention utilized in Project Fluido was a remarkably effective method to improve self-care and HF knowledge in a group of Spanish-speaking HF patients. This improvement is in spite of low physical function, health literacy, acculturation and economic challenges. In addition, teach-back was an effective teaching strategy to improve HF knowledge. Future work is needed to investigate the relationship between increased self-care knowledge, readmissions, and mortality in Spanish-speaking patients with HF. Cardiol Res. 2014;5(3-4):91-100 doi: http://dx.doi.org/10.14740/cr346w

The measurement of medication adherence is important in both clinical practice and research settings to offer effective medical therapy, improve clinical outcomes, and determine the efficacy of therapy. The aims of this article are to (a) present an overview of current and developing electronic methods of medication measurement, (b) explore the advantages and disadvantages to each approach, and (c) discuss the implications of using electronic monitoring devices for clinical practice and research. A comprehensive review of electronic forms of medication measurement was performed. A description of each method is presented including oral medication monitors, personal electronic devices, electronic blisters, wirelessly observed therapy, inhaled medication monitors, mobile phones, video/photo-assisted observation, and electronic health records. Familiarity with using electronic devices and advances in technology will continue to develop and influence the measurement of medication adherence.

Background. Heart failure (HF) is a prevalent chronic condition where patients experience numerous uncomfortable symptoms, low functional status, and high mortality rates.Objective. To determine whether function and/or symptoms predict cardiac event-free survival in hospitalized HF patients within 90 days of hospital discharge.Methods. Inpatients (N=32) had HF symptoms assessed with 4 yes/no questions. Function was determined with NYHA Classification, Katz Index of Activities of Daily Living (ADLs), and directly with the short physical performance battery (SPPB). Survival was analyzed with time to the first postdischarge cardiac event with events defined as cardiac rehospitalization, heart transplantation, or death.Results. Mean age was 58.2 ± 13.6 years. Patient reported ADL function was nearly independent (5.6 ± 1.1) while direct measure (SPPB) showed moderate functional limitation (6.4 ± 3.1). Within 90 days, 40.6% patients had a cardiac event. At discharge, each increase in NYHA Classification was associated with a 3.4-fold higher risk of cardiac events (95% CI 1.4–8.5). Patients reporting symptoms of dyspnea, fatigue, and orthopnea before discharge had a 4.0-fold, 9.7-fold, and 12.8-fold, respectively, greater risk of cardiac events (95% CI 1.2–13.2; 1.2–75.1; 1.7–99.7).Conclusions. Simple assessments of function and symptoms easily performed at discharge may predict short-term cardiac outcomes in hospitalized HF patients.

Medication adherence is a complex behavior that is influenced by numerous factors. Applying self-efficacy theory, the primary aim of this randomized controlled trial was to compare medication self-efficacy among patients with coronary heart disease who received: (a) text messages (TMs) for medication reminders and education, (b) TMs for education, or (c) no TMs. The second aim was to identify the personal (sociodemographic and clinical characteristics) and psychosocial factors that were associated with and predicted medication adherence.Customized TMs were delivered over 30 days. Repeated measures analysis of variance was used to analyze medication self-efficacy. A multiple regression analysis was performed at baseline and follow-up to determine variables that were associated with and predicted self-reported medication adherence.Among 90 subjects with mean age 59.2 years (standard deviation (SD) 9.4, range 35-83), total scores for medication self-efficacy improved over 30 days; however, there was no significant difference in this improvement as a function of the different treatment groups (p=0.64). Controlling for other variables in the model (age, education, depression, and social support), less depression (p=0.004) and higher social support (p=0.02) positively predicted higher medication adherence in the final model.TM medication reminders and/or health education did not improve medication self-efficacy. Further theory testing of current and future models and interventions are required to understand variables related to self-efficacy and medication adherence. Addressing psychosocial factors such as depression and social support should be a priority to improve medication adherence among patients with coronary heart disease.

Background Sympathetic hyperactivity is linked with several adverse cardiovascular events in patients with acute coronary syndrome (ACS). Sympathetic activity increases early in the process of ischemia through 2 mechanisms. One originates from the central nervous system and leads to enhanced sympathetic activity. The other mechanism originates at the infarct zone and leads to B receptor up-regulation and catecholamine supersensitivity. Nevertheless, sympathetic hyperactivity accompanied by an underlying myocardial structural damage is likely to increase the ventricular repolarization duration measured as QT interval on the body surface electrocardiogram. Purpose The aims of the current review of the literature were to examine the physiological processes underlying the use of long QT interval as a risk prediction tool in patients with ACS and to critically review and critique the existing evidence related to this matter. Conclusion The available evidence is contradictory and includes serious limitations in design and QT measurement and correction. Until accurate and reliable data are available, it is difficult to determine the additional clinical value and prognostic significance of long QT interval in patients with ACS beyond that in other patients. Clinical implications Long QT interval is not uncommon among patients with ACS. Automated continuous QT interval monitoring is superior to manual QT interval measurement with the standard 10-second electrocardiogram. Optimum care for patients with ACS requires nurses to keep monitoring the QT interval several days after the initial event.

Background: Patients with heart failure (HF) experience frequent rehospitalizations and poor functional capacity. Early hospital mobility may prevent functional decline, but mobility patterns among hospitalized HF patients are not yet known. Accelerometers may provide a method to monitor and measure patient mobility objectively. Therefore, the purpose of this study was to describe mobility and function using accelerometers among hospitalized HF patients. Methods : Wireless accelerometers were attached to the thigh and ankle of previously ambulatory hospitalized HF patients (n = 32) continuously for up to 5 days, beginning on the second day of hospitalization. The mean proportion of time spent lying, sitting, and standing or walking daily was measured. Ability to perform activities of daily living (ADLs) and physical function was measured using the Katz Index and Short Physical Performance Battery (SPPB). Results: Patients’ mean age was 58.2 ± 13.6 and 78% (n = 25) were male. Mean New York Heart Association Class upon enrollment and at the end of the study period was 2.9 ± 0.8 and 2.2 ± 0.8 respectively. A mean Katz Index of 5.6 ± 1.1 upon enrollment demonstrated minimal dependence on assistance for completion of ADLs (possible scores 0 - 6). However, mobility testing revealed low physical function, with mean SPPB scores of 6.4 ± 3.1 (possible scores 0 - 12). During hospitalization, 70% of the measured hospital stay (16.8 hours/day) was spent lying in bed. The average time spent standing or walking was 4.1%, or 59 minutes per day and the range was 0-10% (0 - 150 minutes). Conclusions: Immobility was pervasive as HF patients spent almost all of their time sitting or lying in bed despite their baseline ambulatory status and improved NYHA class. Cardiol Res. 2013;4(1):15-25 doi: https://doi.org/10.4021/cr244w

Background Communication with heart failure (HF) patients about their condition and wishes for end-of-life care is recommended in all HF guidelines. Aims The aims of this study were to: 1) identify whether hospitalized HF patients want to communicate regarding disease management, prognosis and resuscitation wishes, and 2) to identify the relationship of communication with clinical variables and quality of life (QOL). Methods Hospitalized HF patients (n = 47) were asked: 1) Did they want more information about their HF? 2) Did they want to discuss their prognosis? 3) Did they discuss their resuscitation wishes since being hospitalized? Results Patients' mean age was 62.8 ± 17.0, mean QOL score was 29.4 (0-100) and approximately half (n = 22, 47%) were rehospitalized within 3 months. Twenty-eight (62%) wanted more information regarding disease self-management while 20 (44%) wanted more communication regarding their prognosis. Twenty-four (51%) did not recall a conversation about resuscitation during their hospitalization. Multivariate analysis showed patients who wanted more HF information were 4.4 times more likely to have better NYHA class (p = .02). Patients wanting more communication about their prognosis were more than 4 times more likely to experience future rehospitalizations (p = .03). Conclusion The majority of patients desired more information about HF. A minority had not discussed issues around prognosis, despite their desire to do so. Health care professionals are encouraged to communicate with HF patients about self-management when patients are less symptomatic. More research is needed to explain why patients who wanted more discussion about their prognosis were more likely to be rehospitalized.

Hospital readmission rates among the elderly are attracting increasing attention. Readmission is costly, especially as proposed new guidelines could deny reimbursement for readmissions. Identifying key factors at discharge that can serve as prognostic indicators for readmission is an important step toward developing and targeting interventions to reduce hospital readmissions rates. Published literature has listed predominantly demographic, clinical, and health care utilization characteristics to describe the factors that put the elderly at risk. However, additional factors are proposed that include social, clinical, individual-level, environmental, and system-level factors. Multimodal interventions have been tested and some reduction in readmissions has been shown. Whether these additional factors might lead to a further reduction remains unclear. In addition to possible factors at discharge, factors identified after the patient has been discharged also must be identified and addressed. The patient safety literature characterizes factors that put the elderly at risk for adverse drug events, which function as antecedent factors for readmission and likely include the environmental and system-level factors. Synthesizing these factors from the readmission and patient safety literature provides the basis to develop a more comprehensive conceptual framework to identify research gaps aimed at reducing hospital readmissions among the elderly.

Background: Heart failure (HF) is a chronic and costly condition that affects approximately 5.8 million people in the United States, with an additional 670 000 diagnosed yearly. With high 30-day hospital readmission rates, the importance of determining effective means of preventing readmissions is imperative. Despite published guidelines emphasizing the importance of education in preventing readmissions, the most effective means of educating hospitalized patients with HF about their self-care remains unknown. Objective: The aim of this study was to determine if hospitalized HF patients educated with the teach-back method retain self-care educational information and whether it is associated with fewer hospital readmissions. Methods: A prospective cohort study design included 276 patients older than 65 years hospitalized with HF over a 13-month period. Patients were educated and evaluated using the teach-back method as part of usual care. Data on ability to recall educational information while hospitalized and during follow-up approximately 7 days after hospital discharge were collected. Readmissions were confirmed through follow-up telephone calls and review of medical records. Results: Patients correctly answered 3 of 4, or 75%, of self-care teach-back questions 84.4% of the time while hospitalized and 77.1% of the time during follow-up telephone call. Greater time spent teaching was significantly associated with correctly answered questions (P G .001). Patients who answered teach-back questions correctly while hospitalized and during follow-up had nonsignificant (P = .775 and .609) reductions in all-cause 30-day hospital readmission rates, but a trend toward significance (P = .15) was found in patients who had readmissions for HF. Conclusions: The teach-back method is an effective method used to educate and assess learning. Patients educated longer retained significantly more information than did patients with briefer teaching. Correctly answered HF-specific teach-back questions were not associated with reductions in 30-day hospital readmission rates. Future studies that include patients randomized to receive usual care or teach-back education to compare readmissions and knowledge acquisition would provide further comparison of teach-back effectiveness.

Background Factors that affect the impact of caregiving on patients’ family members who provide care to patients with heart failure have not been adequately addressed. In addition, social support and positive aspects of caregiving have received little attention. Objective To identify factors associated with the impact of caregiving. Methods Self-report data were collected from 76 dyads of patients with heart failure and their family caregivers. Clinical data were obtained from medical records. Results A sense of less family support for caregiving was associated with a higher New York Heart Association class of heart failure, being a nonspousal caregiver, lower caregivers’ perceived control, and less social support. More disruption of caregivers’ schedules was associated with higher class of heart failure, more care tasks, and less social support. Greater impact of caregiving on caregivers’ health was related to more recent patient hospitalization, lower caregivers’ perceived control, and less social support. Nonwhite caregivers and caregivers whose family member had fewer emergency department visits felt more positive about caregiving than did other caregivers. Social support had a moderating effect on the relationship between patients’ comorbid conditions and positive aspects of caregiving. Conclusions Caregiving has both positive and negative effects on family caregivers of patients with heart failure. The findings suggest the need for interventions to increase caregivers’ sense of control and social support. Family caregivers may need additional support immediately after patient hospitalizations to minimize the negative impact of caregiving.