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Older Women’s Prehospital Experiences of Their First Myocardial Infarction

Background: Few qualitative studies have been conducted on older women’s experiences of myocardial infarction (MI) and, in particular, the time before they seek medical care. Objective: The aim of this study was to explore older women’s prehospital experiences of their first MI. Methods: Qualitative content analysis was performed on data from individual interviews with 20 women, aged 65 to 80 years (mean, 73.0 years). The participants were interviewed 3 days after admission to a hospital for a confirmed first MI. Results: The women perceived their symptoms as a strange and unfamiliar development from indistinct physical sensations to persistent and overwhelming chest pain. Throughout the prehospital phase, they used different strategies such as downplaying and neglecting the symptoms. The symptoms were seen as intrusions in their daily lives, against which the participants defended themselves to remain in control and to maintain social responsibilities. As their symptoms evolved into constant chest pain, the women began to realize the seriousness of their symptoms. When the pain became unbearable, the women took the decision to seek medical care. Conclusion: Understanding the complex experiences of older women in the prehospital phase is essential to reducing their patient decision times. The findings of this study should be incorporated into the education of professionals involved in the care of cardiac patients, including those who answer informational and emergency telephone lines.
PCNA 19th Annual Symposium: Poster Abstracts

No abstract available
Preventive Cardiovascular Nurses Association

No abstract available
American Heart Association Council on Cardiovascular and Stroke Nursing

No abstract available
The Effects of Smoking Status on Walking Ability and Health-Related Quality of Life in Patients With Peripheral Arterial Disease

Background: Smoking is a leading risk factor for peripheral arterial disease (PAD), yet little is known about the interrelationships among smoking status, walking endurance, calf muscle tissue oxygenation, and quality of life in patients with PAD. Objective: The aim of this study was to explore the differences in factors associated with walking endurance including walk distance, perceived walking ability, measures of skeletal muscle tissue oxygenation (StO2), claudication pain, peak oxygen consumption per unit time, and quality of life in smokers versus nonsmokers. Methods: A total of 105 patients with PAD performed progressive, symptom-limited treadmill test. Ankle-brachial index was measured at baseline. Calf muscle tissue oxygenation measures were obtained during testing. The RAND Short Form-36 and Walking Impairment Questionnaire were used to measure health-related quality of life (HR-QoL). Results: In the total sample (36 current smokers, 69 nonsmokers), smokers had steeper declines in StO2 from baseline to 2 minutes (42.3% vs 33%, P = .05) and shorter distance walked to onset of claudication pain (142.6 vs 247.7 m) than did nonsmokers (P < .0125), despite having no differences in ankle-brachial index, peak oxygen consumption per unit time, or any momentary measure of StO2 during walking. Smokers reported significantly lower HR-QoL on the Short Form-36 in several domains but no differences in the Walking Impairment Questionnaire measures. The smokers were younger than the nonsmokers; however, when age was entered as a covariate in the analyses, the results remained unchanged. Conclusions: These findings suggest that smokers have lower HR-QoL than do nonsmokers with PAD and that smoking confers risks for disrupted tissue oxygenation above those seen in patients who do not smoke.
Mobile Phone Interventions to Increase Physical Activity and Reduce Weight: A Systematic Review

Objective: This systematic review was conducted to determine user satisfaction and effectiveness of smartphone applications and text messaging interventions to promote weight reduction and physical activity. Methods: Studies of smartphone applications and text messaging interventions related to the cardiovascular risk factors of physical inactivity and overweight/obesity published between January 2005 and August 2010 were eligible. Studies related to disease management were excluded. Study characteristics and results were gathered and synthesized. Results: A total of 36 citations from CINAHL, EMBASE, MEDLINE, PsycINFO, and PubMed were identified; 7 articles were eligible for inclusion. The most frequent outcome measured in the studies was change in the weight of participants (57%). More than half of the studies (71%) reported statistically significant results in at least 1 outcome of weight loss, physical activity, dietary intake, decreased body mass index, decreased waist circumference, sugar-sweetened beverage intake, screen time, and satisfaction or acceptability outcomes. Conclusions: All of the technology interventions that were supported by education or an additional intervention demonstrated a beneficial impact of text messaging or smartphone application for reduction of physical inactivity and/or overweight/obesity. More rigorous trials that determine what parts of the technology or intervention are effective as well as establishment of cost-effectiveness are necessary for further evaluation of smartphone and text messaging interventions.
Patterns of Symptom Recognition, Interpretation, and Response in Heart Failure Patients: An Integrative Review

Background: Heart failure (HF) is a chronic illness affecting more than 5 million Americans, and it continues to lead healthcare-related expenditures in the United States. Hospitalization rates remain high and are caused by many factors, including poor self-care behaviors. Self-care research is growing, and a situation-specific theory for the HF population is now published. Self-care management, which is part of self-care, includes a series of responses and actions that the individual living with HF assumes in response to a change in baseline health. A critical aspect of enacting a self-care management plan is the ability to recognize changes in baseline health as being related to HF. Purpose: This integrative review examined research to date on self-reported patterns of symptom recognition, an antecedent to self-care management, and treatment-seeking behaviors in HF patients. Conclusions: Descriptive research strategies were predominantly used to examine symptom recognition, interpretation, and response in HF patients. Seven studies used retrospective approaches, such as chart review or patient recall, to collect data, and 7 studies collected data from the patient prospectively. The quantitative portion of 2 mixed-methods study was also analyzed. Dyspnea was the most frequently reported symptom across all studies reviewed. Dyspnea was characterized in terms of duration and was defined inconsistently across studies. In some studies, duration of dyspnea was associated with treatment-seeking delays. Elderly patients and newly diagnosed HF patients are more likely to delay treatment seeking for onset of symptoms. Clinical Implications: Research is limited on symptom recognition and treatment-seeking behaviors in HF patients. Evidence suggests that symptom recognition may be impaired in the elderly population. Research studies to date on symptom recognition have largely been descriptive; no studies in this review followed patients’ ability to recognize and respond to symptoms prospectively in their home environment. Symptoms may vary and their pattern may influence patients’ recognition and/or response patterns.
Prevalence, Awareness, Treatment, and Control of Hypertension Among Arab Americans

Background: Hypertension (HTN) is a major risk factor for heart disease, which is the leading cause of death in the United States. Hypertension detection and blood pressure (BP) control are critically important for reducing the risk of myocardial infarction and strokes. Although there are more than 3.5 million Arab Americans in the United States, there are no national or regional data on HTN prevalence among Arab Americans. Objective: This study aims to estimate the prevalence of HTN in a community sample of Arab Americans; assess levels of awareness, treatment, and control in hypertensive patients; and describe and compare lifestyle behaviors (eg, physical activity, nutrition, and weight control). Methods: In this cross-sectional, descriptive study, 126 participants completed a self-administered questionnaire to measure physical activity, nutrition, and medical history. Height and weight were measured. Three BP measurements were obtained at 60-second intervals after resting for 5 minutes. Hypertension was defined as a mean systolic BP of 140 mm Hg or higher, or a diastolic BP 90 mm Hg or higher, and/or taking antihypertensive medications. Results: Overall, 36.5% of participants had HTN and 39.7% had pre-HTN. Among hypertensive participants, only 67.4% were aware of their high BP, and 52.2% were taking antihypertensive medication. Among those taking medication, 46% had controlled BP. The prevalence of HTN was higher in men than in women (45.9% and 23.2%, respectively; P = .029) and increased with age (P = .01). Hypertensive participants also had higher body mass index (mean, 31.55 kg/m2) compared with normotensive participants (mean, 28.37 kg/m2; P = .01). Conclusion: Our results indicate that HTN and pre-HTN are highly prevalent in Arab Americans. Hypertension awareness and control rates were inadequate and low compared with national data. These results emphasize the urgent need to develop public health strategies to improve the prevention, detection, and treatment of HTN among Arab Americans.
Early Cognitive Behavioral Therapy for Depression After Cardiac Surgery

Background: Despite high rates of postcardiac surgery depression, studies of depression treatment in this population have been limited. Objective: The aim of this study was to evaluate early cognitive behavioral therapy (CBT) in a home environment in patients recovering from cardiac surgery. Methods: From July 2006 through October 2009, we conducted a randomized controlled trial and enrolled 808 patients who were screened for depressive symptoms using the Beck Depression Inventory (BDI) in the hospital and 1 month later. Patients were interviewed using the Structured Clinical Interview for DSM-IV; those who met criteria for clinical depression (n = 81) were randomized to CBT (n = 45) or usual care (UC; n = 36). After completion of the UC period, 25 individuals were offered later CBT (UC + CBT). Results: Main outcomes (depressive symptoms [BDI] and clinical depression [Structured Clinical Interview for DSM-IV]) were evaluated after 8 weeks using intention-to-treat principles and linear mixed models. Compared with the UC group, in the CBT group, there was greater decline in BDI scores (β = 1.41; 95% confidence interval [CI], 0.81–2.02; P = < .001) and greater remission of clinical depression (29 [64%] vs 9 [25%]; number need to treat, 2.5; 95% CI, 1.7–4.9; P < .001). Compared with the early CBT group (median time from surgery to CBT, 45.5 days) the later UC + CBT group (median time from surgery to CBT, 122 days) also experienced a reduction in BDI scores, but the group × time effect was smaller (β = 0.79; 95% CI, 0.10–1.47; P = .03) and remission rates between the 2 groups did not differ. Conclusions: Early home CBT is effective in depressed postcardiac surgery patients. Early treatment is associated with greater symptom reduction than similar therapy given later after surgery.
Dietary Approaches to Stop Hypertension Patterns in Older Latinos With or at Risk for Hypertension

Background: Older Latinos represent a growing segment of our population, yet little is known about whether older Latinos are following the recommended Dietary Approaches to Stop Hypertension (DASH) eating plan, which promotes certain food groups to reduce blood pressure (BP) over and above established strategies. Among Latinos, greater acculturation to the American society has been associated with suboptimal dietary choices and risk for chronic diseases. Therefore, the purpose of this study was to assess differences in DASH accordance/adherence by BP status taking into account level of acculturation. Methods: This was a descriptive, cross-sectional study involving older Latinos wherein DASH accordance and adherence were calculated on the basis of nutrient analyses of food frequency questionnaires. A DASH score of 4.5 or higher indicated accordance, and a DASH Adherence Index greater than 0 indicated adherence. Blood pressure was measured in triplicate using Omron HEM-907XL and was categorized according to BP level and/or antihypertensive medication. The Acculturation Rating Scale for Mexican Americans-II was used to rate level of acculturation. Results: Participants were 169 Latinos, primarily women (73%) and older (66 ± 9.0 years); the majority were hypertensive (66%), preferred speaking in Spanish (85%), and were more Latino oriented (63%) with respect to acculturation status. Overall, participants were moderately DASH accordant (4.2 ± 1.6) and DASH adherent (−0.8 ± 0.8). Acculturation scores (odds ratio, 1.4–1.7, P < 0.02) were predictive of hypertensive status (defined as BP ≥140/90 mm Hg) regardless of which dietary score was modeled. Conclusion: Based on these findings, greater attention should be paid to identification of traditional Latino foods and food preparation that are consistent and acceptable to this older community in effort to foster greater DASH accordance and improve BP status.