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Background: Despite well-established evidence of benefit from cardiac rehabilitation, typically fewer than 35% of eligible patients attend., Objective: The purpose of this study was to evaluate whether theory-based invitations increase attendance at cardiac rehabilitation., Method: The study was a randomized controlled trial (RCT) with two by two factorial design. A total of 375 participants with acute myocardial infarction or coronary revascularization was recruited from medical and surgical cardiac wards at Aberdeen Royal Infirmary (ARI). They were randomly assigned to receive either the standard invitation letter or a letter with wording based on the 'theory of planned behavior (TPB)' and the 'common sense model of illness perception', and either a supportive leaflet with motivational messages or not. The primary outcome was one or more attendances at cardiac rehabilitation., Results: The theory-based letter increased attendance at cardiac rehabilitation compared to the standard letter (84% versus 74%, odds ratio (OR) 2.93, 95% confidence interval (CI) 1.54-5.56), independent of age, gender, working status, hypertension, identity and TPB constructs. The number needed to treat (NNT) was 9 (95% CI 7-12). The motivational leaflet had no significant effect on attendance at rehabilitation (OR 1.02, 95% CI 0.57-1.83)., Conclusions: The use of theory-based wording in invitation letters is a simple method to improve attendance at cardiac rehabilitation. Our letter, reproduced in this paper, could provide a template for practitioners and researchers.

Background: Phase 3 is a critical point for cardiac rehabilitation: many problems don't allow achieving a correct secondary prevention, in particular regarding the relationship between patient and cardiologist. Aiming at ensuring continuity of care of phase 3 cardiac rehabilitation patients, we have developed a telemetric educational program to stimulate in them the will and capacity to become active comanagers of their disease., Methods: Nurses specialized in cardiac rehabilitation, with the collaboration of the general practitioners, contact the patients by scheduled phone calls to collect questionnaires about their health status and the result of biochemistry. All the results are analyzed by the nurses and discussed with each patient (educational reinforcement). The effects of this program of comanagement of cardiac disease and secondary prevention are analyzed comparing each patient data at the discharge with data after one year and those coming from our archive (retrospective analysis)., Results: The patients enrolled in this study pay much more attention to the amount of food they eat; they tend not to gain weight, and they restart smoking in a reduced proportion compared to patients not enrolled in the study. However, despite having received better information on their cardiac disease, their compliance to physical training, consumption of healthy food, and pharmacological therapy is not improved., Conclusions: This study focuses on the role of a continuous educational program of a cardiac rehabilitation unit after the patient's discharge. This home control program conducted by nurses specialized in cardiac rehabilitation, with the assistance of cardiologists, psychologists and physiotherapists, and in collaboration with the general practitioner, was quite cheap, and helped maximizing the knowledge of the disease and reinforcing correct life style in the patients. The results are not as good as expected, probably because one year does not represent a sufficient time, or because the educational intervention needs to be improved.

Background: In the treatment of chronic total occlusions (CTOs), some uncertainty exists regarding the effect of drug-eluting stents (DESs) compared with the effects of bare mental stents (BMSs). We reviewed outcomes of DES vs. BMS implantation for CTO lesions, to evaluate the risk-benefit ratio of DES implantation., Methods: Relevant studies of long-term clinical outcomes or angiographic outcomes of both BMS and DES implantation were examined. The primary endpoint comprised major adverse cardiovascular events (MACEs), including all-cause deaths, myocardial infarctions (MIs), and target lesion revascularizations (TLRs). A fixed-effect model and random-effect model were used to analyze the pooling results., Results: Ten studies were included according to the selection criteria. Eight were nonrandomized controlled trials, and two consisted of a randomized controlled comparison between DES and BMS implantation. No significant difference was evident for in-hospital MACE rates between the two groups (odds ratio [OR], 1.07; 95% confidence interval [CI], .53 to 2.13), but the long-term MACE rates in the DES group were significantly lower than in the BMS group (OR, .22; 95% CI, .13 to .38; P < .00001). The rates of stent restenosis and reocclusions were also significantly lower in the DES group (OR, .14; 95% CI, .09 to .20; and OR, .23; 95% CI, .12 to .41, respectively)., Conclusion: Implantation of the DES improves long-term angiographic and clinical outcomes compared with BMS in the treatment of CTO lesions., (Copyright © 2011 Elsevier Inc. All rights reserved.)

Background and Aims: Assessing the health related quality of life (HRQOL) in patients with a disease specific scale is essential. The purpose of this study was to develop the Japanese version of the coronary revascularisation outcome questionnaire (CROQ), a disease-specific scale to measure HRQOL before and after coronary revascularisation., Methods: The English version of the questionnaire was translated into Japanese; some terms were revised, and some items were eliminated to suit the Japanese medical environment. Eight patients filled out the questionnaire, which was then analyzed for face validity. In the field study, subjects were recruited from a university hospital in Tokyo, and questionnaires were given to fill out. In terms of statistical analysis, factor analysis, internal consistency, known-groups validity, concurrent validity with using Short-Form36 (SF-36) and Seattle Angina Questionnaire-Japanese version (SAQ-J), and test-retest reliability were assessed., Results: Informed consents were obtained from 356 patients, and out of 325 patients responded in the field study (91.3%). The factor structure of CROQ-Japanese version (CROQ-J) was similar to that of the original version. Cronbach's α ranged from 0.78 to 0.92. The concurrent validity was mostly supported by the pattern of association between CROQ-J, SAQ-J, and SF-36. Patients without chest symptoms had significantly higher scores of CROQ-J than those with chest symptoms. On the basis of analysis of the test-retest reliability, intra-class correlation coefficients were close to 0.70., Conclusions: The Japanese translation of CROQ is a valid and reliable scale for assessing the patient's HRQOL in CAD., (Copyright © 2010 European Society of Cardiology. Published by Elsevier B.V. All rights reserved.)

A descriptive study aiming to describe a nursing consultation protocol tested for patients after myocardial revascularization. The protocol is implemented in a hospital cardiac unit, has goals that must be achieved during the consultation period or in between. For reaching each goal, it has been established that nursing actions should be implemented by the nurse, displayed in three tables: Strategies for nursing consultation related to the first care; Strategies for nursing consultations related to the second, third and forth nursing visits; Strategies for nursing consultations related to the fifth nursing visit, referring to the sixth month after surgery. It is believed that the implementation of the protocol allows a systematic evaluation of the patient, raising their real problems, for planning and implementation of nursing interventions, especially those related to behavioral changes.

Chronic kidney disease (CKD) is associated with a high burden of coronary artery disease, myocardial infarction and cardiovascular death. Management of patients with CKD presenting with acute coronary syndromes is more complex than in the general population, due to greater diagnostic uncertainty and the lack of direct evidence for therapeutic interventions in this specific population, coupled with concerns about therapy-related adverse effects. However, these patients potentially have much to gain from conventional revascularisation strategies used in the general population. This review summarises the current evidence regarding the treatment of patients with CKD presenting with acute coronary syndromes, in particular with respect to coronary revascularisation strategies.

Background: The DANAMI-2 trial showed that in patients with ST-elevation myocardial infarction (STEMI), a strategy of inter-hospital transfer for primary angioplasty was superior to on-site fibrinolysis at 30 days follow-up. This paper reports on the pre-specified long-term composite endpoint at 3 years follow-up in DANAMI-2., Methods and Results: We randomized 1572 patients with STEMI to primary angioplasty or intravenous alteplase; 1129 patients were enrolled at 24 referral hospitals and 443 patients at 5 angioplasty centres. Ninety-six percent of inter-hospital transfers for angioplasty were completed within 2 h. No patients were lost to follow-up. The composite endpoint (death, clinical re-infarction, or disabling stroke) was reduced by angioplasty when compared with fibrinolysis at 3 years (19.6 vs. 25.2%, P =0.006). For patients transferred to angioplasty compared with those receiving on-site fibrinolysis, the composite endpoint occurred in 20.1 vs. 26.7% (P = 0.007), death in 13.6 vs. 16.4% (P = 0.18), clinical re-infarction in 8.9 vs. 12.3% (P = 0.05), and disabling stroke in 3.2 vs. 4.7% (P = 0.23)., Conclusion: The benefit of transfer for primary angioplasty based on the composite endpoint was sustained after 3 years. For patients with characteristics as those in DANAMI-2, primary angioplasty should be the preferred treatment strategy when inter-hospital transfer can be completed within 2 h.

Purpose: To evaluate the cost-effectiveness of case management by a nurse practitioner (NP) to lower blood lipids in patients with coronary heart disease (CHD) from a managed care perspective., Data Sources: A total of 228 consecutive, eligible adults with hypercholesterolemia and CHD were recruited during hospitalization after coronary revascularization. Patients were randomized to receive lipid management, including individualized lifestyle modification and pharmacologic intervention from an NP for 1 year after discharge in addition to their usual care (NURS) or to receive usual care (EUC) enhanced with feedback on lipids to their primary provider and/or cardiologist. A cost-effectiveness ratio was calculated using incremental costs of the NURS group per unit change and percent change in low-density lipoprotein cholesterol (LDL-C) for 1 year at 2004 values., Conclusions: The annual incremental cost-effectiveness of NP case management was 26.03 dollars per mg/dL and 39.05 dollars per percent reduction in LDL-C. When costs of NURS care for the second 6 months of management were compared to the first 6 months of management, nursing salary costs were lower as patients were established on cholesterol management regimens, but the reduction in costs was offset by the increase in incremental costs of drug treatment as the NP titrated the patient to higher drug dosages that were more costly., Implications for Practice: The findings suggest that case management by an NP is a cost-effective approach for a managed care organization to consider in improving the care of patients with cardiovascular disease.

There has been a recent resurgence in the use of off-pump coronary artery surgery. This article provides the critical care nurse with information about the procedure.

Transitions from one health care system to another are common, but they can affect coordination of care and measurement of patient outcomes. In this project, a community hospital and a tertiary center collaborated to obtain follow-up information on patients 30 days after they underwent cardiac catheterization and revascularization. Results show that patients experienced similar physical and emotional concerns regardless of diagnosis or procedure. Although the intent was to gather information, nurses also provided education and arranged services for patients. This project has implications for the development of collaborative interventions to improve care for patients after undergoing coronary procedures.

This study aims to examine the situation for patients on the waiting list for possible coronary revascularization in terms of waiting time, treatment and various aspects of well-being in relation to gender. Patients on the waiting list for coronary angiography, percutaneous transluminal coronary angioplasty or coronary artery bypass grafting in September 1990 were approached with a questionnaire dealing with various aspects as described above. Of the 831 patients who participated in the evaluation, 174 (21%) were women. Although age was similar for men and women, men had a higher prevalence of previous myocardial infarction and a lower prevalence of previous hypertension. In terms of medication, women were more frequently treated with diuretics and sedatives than men. Women reported a higher frequency than men with regard to the following symptoms: chest pain at rest and at night, dyspnoea when walking, tachycardia, tiredness, headache, dizziness and sweating. Women also suffered more frequently from difficulty going to sleep, difficulty waking up, repeated awakening and insomnia. Men, on the other hand, suffered more frequently from restlessness, inability to act and irritability. Among patients on the waiting list for possible coronary revascularization, women differed from men by being more frequently treated with diuretics, reporting a higher frequency of various cardiovascular symptoms including chest pain and dyspnoea and, furthermore, reporting more sleeping disorders. Gender differences were found but they were not consistent.

Transmyocardial laser revascularization is an alternative treatment option for patients with refractory angina who are not suitable candidates for more conventional coronary intervention or surgery. The laser creates channels that provide blood flow from the left ventricular chamber to areas of ischemic myocardium. Results have been impressive with patients reporting a reduction in angina of two classes according to the Canadian Heart Association Angina Classification. Care of the patient post transmyocardial laser revascularization procedure is comparable to that of other cardiac surgery patients. Innovations in this relatively new procedure include less invasive approaches and using it as an adjunctive or delivery modality for gene therapy.

In the early 1970s, patients underwent myocardial revascularization with a radial artery graft. Soon after its introduction as an additional arterial conduit, postprocedural complications were observed, and the use of this conduit was abandoned. A resurgence of the radial artery as a free graft was seen 20 years later. This article will discuss the background, renewing interests in the use of the radial artery, selection of candidates, perioperative preparation, medical/nursing considerations, and postoperative outcomes from an interdisciplinary approach.

Transmyocardial revascularization (TMR) surgery is a palliative and investigative surgical procedure with the goal of increasing the quality of life for patients with intractable angina pectoris who are unsuitable for percutaneous transluminal coronary angioplasty or coronary artery bypass graft surgery. It improves myocardial perfusion and oxygen supply to the left ventricle, thus decreasing the frequency and intensity of anginal episodes. Many patients continue to have episodes of angina post-operatively but the frequency of those episodes should decrease. TMR may be a good treatment option for otherwise untreatable patients who live with severe, debilitating angina.

Transmyocardial laser revascularization is an investigational cardiovascular surgical procedure that has been trialed in the United States since 1991. The procedure involves the use of a high-energy carbon dioxide (CO2) laser to penetrate ischemic myocardium of the left ventricle. The successful formation of patent laser channels results in the formation of a new circulation within the myocardium. This angiogenesis has shown to improve perfusion to the previously oxygen-deprived tissue. To date, more than 500 patients have undergone this procedure in the United States, and approximately 1,500 cases have been performed in Europe, Asia, and the Middle East. The perioperative nursing care for these patients is multifaceted, including, but not limited to, the need for noninvasive assessment skills, effective pain management, and thorough discharge teaching. Unlike other cardiovascular procedures, this surgery does not immediately repair the ischemic areas; recovery is an insidious process. A realistic understanding of this surgery is needed to assist the patient throughout his or her hospitalization and to properly prepare the individual for expectations of recovery after discharge.

Transmyocardial laser revascularization is a technique to create new vessels in underperfused areas of the ischemic heart. These vessels carry blood directly from the left ventricle of the heart into the myocardium. Clinical trials of this technique are currently underway.

A retrospective and cross-sectional study was carried out on a total of 92 patients admitted at the Intensive Care Unit of the Santiago de Cuba's Heart Center between April 1992 and June 1993, who underwent surgery for myocardial revascularization. We point out the skilled and dedicated attention of the intensive care nurse in the preparation of the patients, during the operation, and in the postoperative period, having a favorable influence on the general mortality which occurred only in 1.8%.

The purpose of the study was to determine the effects of two methods of clot clearance on chest tube drainage in patients undergoing myocardial revascularization. Two hundred adult patients immediately after myocardial revascularization were randomly assigned to a specific chest tube manipulation group. The dependent variables were drainage, incidence of cardiac tamponade, incidence of surgical reentry, hemodynamic values, and number of manipulation episodes. Statistical analyses revealed no difference in any of the dependent variables when milking and stripping were used. Of the 200 patients, 78 did not require any manipulation of the chest tubes in the first 8 hours after surgery. One patient had signs of cardiac tamponade and six other patients required surgical reentry. Positioning of the connecting tube in a nondependent position assisted with the removal of drainage from the chest cavity. In conclusion, patients having myocardial revascularization did not need their chest tubes manipulated the first 8 hours after surgery. Visible drainage in the chest tube did not cause a lack of patency.

The purpose of this study was to investigate the effects of position changes on mixed venous oxygen saturation (SvO2) and to describe the mechanisms responsible for SvO2 changes reported to occur with position changes. The study was done from 4 to 8 hours after surgery in 34 patients after coronary artery bypass grafting. Subjects were put through a series of six position changes, including head of bed elevations and right and left lateral decubitus with return to supine between each. Each position was maintained for 30 minutes. SvO2, arterial oxygen saturation (SaO2), and oxygen consumption (VO2) were measured before and after each position change. Overall mean subject data demonstrated a decrease in SvO2 with each of the lateral position changes. The SvO2 did not drop below 60% in these mean data, and this drop returned to baseline by 5 minutes. There were no significant changes in the mean data for VO2 or SaO2. No significant correlation was found in the mean data between SvO2 and VO2 or SvO2 and SaO2 measurements. Trends were demonstrated in five specific cases that suggested a correlation between changes in SvO2 and changes in VO2 and SaO2. In conclusion, this study demonstrated that subjects were able to tolerate position changes with no clinically significant changes in SvO2, SaO2, or VO2.

The IMA is being utilized with increasing frequency as the graft of choice for myocardial revascularization. Certain postoperative management requirements differ in patients with the internal mammary bypass, which are often challenging. Because it is important that the nursing staff have a thorough understanding of the peculiarities of postoperative care in patients with IMA grafts, this article was prepared to review the anatomic, pathologic, physiologic, and clinical aspects of the IMA in myocardial revascularization. A retrospective comparative chart review of patients with IMA grafts and SVGs was also performed to better define the specific postoperative nursing problems of hemorrhaging, pulmonary support, and pain control that are encountered in these patients.

This study reports the development of a process for the validation of sets of outcome criteria. The process can be simply and inexpensively utilized at the unit level by staff nurses. It was tested by the investigators and did serve to differentiate between valid and invalid outcomes of nursing care.