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AB - 1 1768—The nurse's role in patient education post-myocardial infarction through the phases of cardiac rehabilitation Lynch C. St James Hospital, Ireland This literature review examines the research literature on patient education post myocardial infarction through the phases of cardiac rehabilitation. The four phases are: (1) in hospital=7–10 days; (2) immediate=2–6 weeks; (3) intermediate=2–6 months; (4) maintenance/long term (See appendix 1). The level of patient education in each phase is assessed. Nurses are identified in the literature as being in an ideal position to deliver and co-ordinate cardiac rehabilitation programmes (Thompson and Bowman, 1998). According to Sanford, 2000 patient education is unique to the nursing profession when it is given through caring in a caring environment. Models of patient education post MI can be used to guide nursing practice (Lane, 1997; Egan, 1999 cites Mirka, 1994). Phase one, the in hospital phase is extensively researched. It is not realistic to expect patients to learn the vast amount of information that patient education programmes contain during the in hospital phase (Chan, 1990). Patients are too preoccupied with issues of survival at this time (Steele and Ruzicki, 1987; Murray, 1989; Turton, 1998). The perspectives of patients and nurses of patients information needs post MI are identified using CPLNI, cardiac patients learning needs inventory, an instrument designed by Gerard and Peterson (1984) cited in Hughes (2000). An imbalance between the perspectives of nurses and cardiac patients was found. Risk factors rated consistently as the category of primary concern for patients whereas nurses rated risk factors of lesser importance (Karlik and Yarcheski, 1987; Hughes, 2000). In an age of shorter hospital stays and reduced nurse-patient contact time, Hughes, 2000 recommends the use of an instrument or tool, CPLNI (modified, updated) to rapidly assess and identify patient needs post MI. Phase two, the immediate phase is identified at a time when patients experience psychological and emotional difficulty when discharged home (Thompson et al., 1995; Jaarsma et al., 1995; Stewart et al., 2000, Dixon et al., 2000). Phase three, the intermediate phase is well established in the literature. The nurse's role is emphasised particularly as co-ordinators of the out-patient programme. The final phase, phase four is under-researched. Ford (1989) explored the experience of MI, in the maintenance phase and found that patients have unmet needs up to two years after the event. Services that provide information and support need to be established in phases two and four so that patient education is reinforced over time, thus linking the four phases of cardiac rehabilitation. 2 1769—Pre-operative education and support for partners of patients awaiting Coronary Artery Bypass Surgery: a comparison of two methods Brown A., Smith K.M., Elliott L., Glen S. Ninewells Hospital and Medical School, UK. Introduction: Waiting for an extended period for coronary artery bypass surgery (CABS) is a harrowing experience for both the patient and the family. Despite previous research alluding to the difficulties faced by the partners during the surgical wait, most studies concentrate on the patients experiences in the pre-and post-operative periods. Little research has been undertaken to investigate whether pre-operative support affects partners of patients awaiting CABS. Study Aims: To assess levels of distress and knowledge in partners of patients awaiting CABS. To investigate if partners show any difference in distress and knowledge after participating in one of two programmes of education and support during the surgical waiting time. Methods: From a sample of 50 patients waiting for CABS who were randomly allocated to receive either an extended home-based or a short hospital-based programme, 24 partners participated in the study. Outcome assessment of partners was planned at baseline and after 6 months, prior to the patients’ surgery. Data was collected on: (1) Knowledge to determine correct knowledge, misconceptions and uncertainty and (2) Distress to determine anxiety and depression using the hospital anxiety and depression scale (HADS). Since many patients went for surgery before the planned 6-month assessment, 14 partners were followed up before and 10 after their partner had undergone CABS. Results: 70.8% of partners demonstrated elevated levels of anxiety at baseline (20.8% clinically anxious). Most partners (83.3%) did not however, appear depressed at baseline. Partners knowledge of heart disease and CABS was moderate (mean correct=17.58 out of possible 26). There was a significant difference in anxiety levels (P=0.01) with increased anxiety in the home based intervention and decreased anxiety in the hospital group. Irrespective of the intervention received, partners’ knowledge of heart disease and surgery improved over time. Their misconceptions, however, did not change. Conclusion: Although providing education and support generally improves partners’ knowledge during the surgical wait, a home-based intervention appears to increase anxiety compared to a hospital programme. Due to the small sample size and the unexpected early surgery, the results should be interpreted with caution. However, this is an area, which would benefit from further investigation in a larger scale study. 3 1770—A transmural management model to improve care of heart failure in general practice and cardiology practice Janssen J.J.J., Gommers W.S.A., Gorgels A.P.M., Jans J.D.J.M., Beijer M.W.A., Pol P.E.J., Lencer N.H.M., Doevendans P.A.F.M., Beusmans G.H.M.I., Ree v J.W. University of Maastricht, The Netherlands Background: Presently, care of heart failure patients occurs either in general practice or by cardiologists. It has been shown that treatment is more effective when appropriate care for HF patients is delivered as close as possible to the home situation of the patient. Care in general practice is hampered by sufficient diagnostic support and frequently by under-treatment of patients. Cardiologists these days can nearly manage the increasing number of HF patients. We developed a transmural management model for HF patients with collaboration between GP's, Cardiologists and HF nurses directed at optimal care at the right place by the right person (TrazoHart, Transmural care of Heart failure). Model development: TraZoHart, started in 2000, wants to improve care by optimising co-operation between:—Hospital professionals (specialised heart failure cardiologists, other cardiologists and heart failure nurse specialists) and—General practitioners (with specialised education) and for this purpose two newly developed care professionals—The transmural heart failure nurse specialist and—General practice nurse specialist. The model is based on 5 principles: (1) The Quattromodel; this is the care plan, determining the amount of care given to an individual patient by the above named caregivers. This is assessed by (2) NIM classification, where N is New York Heart Association Class (1–4), I is instability of heart failure class (1–4), and M stand for mobility (unrelated to heart failure) class (1–4). The transmural nurse specialist functions as a case manager for individual patients. (3) Horizontal and vertical substition of care i.e. transferring expertise to general practitioners and nurse specialists respectively. (4) Protocollised diagnostic, therapeutic and management procedures and (5) Development of a shared (electronic) patient record system, accessible for all involved care providers. Preliminary Results: At this moment 405 heart failure patients, attending the HF outpatient clinic, are classified according to the NIM system. Plans for appropriate care for each patient were assessed by the above mentioned classification method. It was found that in one third of these patients the actual given care could be substituted. This implies that care could be transferred to the general practice in co-operation with the transmural heart failure nurses. In one fourth of these 405 patients the highly specialised care could be transferred to the care of a general cardiologist. Conclusion: The developed NIM-classification method appeared to be very effective. This method gives the possibility to a systematic and standardised estimation of the level of care. This means that in a substantial part of the heart failure outpatient clinic population care could be substituted. Also this method enables to rationalise the distribution and substitution of care and may lead to more adequate care. The role of nurse specialists is very important, not only for substituting care but also as case managers, planning (and re-adjusting) the care program for individual patients. Regarding the management of heart failure as a capacity problem, it will make the actual needs more transparant. With this model we hope to unload the heart failure outpatient clinic, to improve heart failure care in general practice and to reduce hospital (re)admissions. 4 1774—Towards community cardiac rehabilitation — A journey from Sligo to Leitrim McGowan A. Sligo General Hospital, Ireland This paper will provide an insight into the process of establishing a cardiac rehabilitation programme in the community setting some 35 miles from the acute general hospital. Sligo General Hospital, Ireland provides a comprehensive and highly developed cardiac service including a hospital based cardiac rehabilitation programme for a patient group covering four counties. Recognising the geographical spread of patients within the region, the problems clients have with transport and that many patients receiving this service are of an older age group, a decision was taken in 2000 to undertake a pilot community based cardiac rehabilitation programme. A needs assessment was carried out to ascertain a suitable location, the potential number of patients from the region, and any new skills or networks required by staff. New partnerships were developed with the primary health care team and staff from the leisure centre in Carrick-on-Shannon, Co. Leitrim. The programme ran from 02/07/2001–07/09/2001 in the above leisure centre and an evaluation has been completed. The purpose of this presentation is to: (1) share the experiences ‘warts and all’ of setting up a new programme, and to provide feedback from clients participating in the programme provided in their own locality; (2) present the findings of the evaluation and (3) outline future service plans. 5 1775—Lay beliefs and coronary heart disease Thomson P. University of Stirling, UK Individual's beliefs about their illness play a pivotal role in health behaviour including lifestyle change, medication adherence and functional status. They may be used to explain variations in the way patients respond to their illness and the huge burden coronary heart disease (CHD) generates for the patient, partner or significant other. There is a need to focus less on episodes of prevention and care and to examine more closely the complex factors that interact to influence lifestyle change and quality of life across the health-illness continuum. This is the first in a series of studies that examine individual's beliefs about coronary heart disease. Stage 1 examined Lay Beliefs and coronary heart disease, Stage 2 the patient's perspective following angiography and Stage 3 the views of the patient–partner pair about coronary artery bypass surgery. The contribution of certain beliefs about the risks and benefits of treatment: lifestyle change, medication and revascularisation and any agreement or differences in beliefs will be examined. This paper describes Stage 1 of the study that examined the beliefs of the general public about CHD and health protective behaviour. Subjects (n=350) were recruited from train stations and shopping areas in the Stirling and Glasgow area. The instrument used was developed and administered by the investigator. The questions were guided theoretically by the Determinants of Health Model (Evans and Stoddard, 1995) and the Health Belief Model (Becker, 1974). The findings suggest that a relationship exist between subject's personal health behaviours and their perception of risk. There was a hierarchy of beliefs identified in which healthy subjects ranked their own need for personal lifestyle change differently from those of the ‘at risk’ individual and the heart attack victim. The likely benefits in life expectancy from lifestyle modification were overestimated. Subject's beliefs about the ‘other things’ that might affect a person's lifetime chance of getting CHD and sources of information were identified. 6 1776—Computerised clinical guidance tree for hypertension Thomson P. University of Stirling, UK Hypertension is a major modifiable risk factor in the primary prevention of coronary heart disease and stroke. As patients with hypertension have no symptoms, time should be taken to explain why it is that they are being asked to make, in some cases, major changes to their lifestyles with no obvious short-term benefit to themselves. Research in the field of behavioural change is extensive. Many models have been developed to try to help us understand the complex nature of health actions but none have been able to fully explain human behaviour and despite much counselling and staged-matched interventions many people fail to adhere to medication and lifestyle advice. There is a need to consider innovative ways of providing good evidence-based information that facilitates and supports lifestyle modification and promotes shared decision making between health care professionals and patients. This paper describes the development of a computerised clinical guidance tree for Hypertension, based on decision analysis. The pilot test results are reported. The program was pilot tested on 10 individuals with hypertension and 8 health care professionals. The computerised tree collects information from the user, so that information that is seen is individualised to the person's risk factors. Another clinical guidance tree has been developed for Benign Prostatic Hyperplasia using the computer program, which is in itself generic. Overall, most participants found the hypertension program useful and informative. The nurses who took part in the pilot felt that it would be a useful tool to aid them in providing advice and information to patients in the primary care setting. The program is currently being evaluated in a randomised-controlled trial. 7 1777—Reasons why patients with acute myocardial infarction delay in seeking hospital care Johannsson I., Swahn E. Linkoping University Hospital, Sweden Background: A dramatic reduction in myocardial infarction mortality is mainly the result of the use of thrombolysis. However, far from all patients seek medical care in time. The aim of this study was to find explanations why the majority of patients with acute MI admitted to Coronary Care Unit delay seeking medical care. Methods: 110 CCU-patients hospitalized because of acute MI filled in a survey regarding their symptoms, thoughts and acts before the present hospital admittance. Results: 48% delayed >1 h before seeking medical care. The patients stated in average 3 symptoms in connection with falling ill, where the most common symptom was chest pain (81%) and the dominating character of the pain was oppression (42%). They experienced their symptoms as anxiety, discomfort and troublesome. Altogether 77% considered their symptoms to be related to the heart, 42% of these delayed >1 h. A total of 26% contacted their GP for advice before the hospital admittance. The majority of the patients begin to think of going to hospital when the symptoms did not disappear (45%), when somebody else told them to go (28%) or when the symptoms became worse (20%). In a multiple regression analysis the reasons for delay turned out to be (in falling order) an earlier history of hypertension, discomforting and tiring symptoms. The patients who thought their symptoms were related to the heart had a shorter delay, whereas there was no difference regarding gender, age, diabetes and previous MI. Conclusion: The majority of the MI patients stated that they did not hesitate to seek medical care. Among those who hesitated the most frequently reason was the thought that the symptoms should disappear and that there symptoms was not serious enough. The patient's subjective feeling of the seriousness of symptoms turned out to be a predictor for delay times. 8 1778—Effects of education and multidisciplinary co-operation on patient delays and treatment practices of thrombolytic therapy Kuutti K., Paukama M., Melin J., Heikkila J. Central Hospital of Central Finland, Finland A study of delays of thrombolytic therapy (TT) in Central Finland was conducted in 1994. Consequently recommendations were given to health centers (HC) to initiate TT instead of transporting patients to the Central Hospital (CH). Information about acute myocardial infarction (AMI) and advantages of early TT was given to professionals and the public. Ambulances and HC:s were equipped with ECG transfer facilities. After training paramedics were given authority to initiate TT (consultation required). The objective was to examine changes in patient delays (PD) and treatment practices between 1994–2001. Data were collected between February and October 2001. There were 349 AMI patients, 93 patients (27%) received TT. 3 were excluded (insufficient data). Of the 90 patients 60 were men. The median age was 70.5 years. In 1994 there were 381 AMI patients, 175 (44%) received TT. 6 were excluded. Median age was 64, 127 patients were men. Results: From 1994 the number of patients treated in CH has decreased (76.3 vs. 36.7%) and increased in HCs (23.7 vs. 53.3%). In 2001 10% of patients were treated in ambulances. The median PD in CH was 60 min (−20 min), HCs 85 min (−5 min) and ambulances 26 min. Men's median PD was 60 min (−5 min) and women's 70 min (−25 min). Conclusions: The number of AMIs is increasing because unstable angina pectoris patients are now considered as AMI. This explains why only 27% of patients received TT. Though efforts to shorten PD succeeded, this delay still attributes to most of the total delay. With constant education and multidisciplinary co-operation the PDs can be shortened. With improving technology treatment can be taken closer to patients, even to their homes. 9 1780—Validation of a new software for the assessment of quality of life and psychological distress in chronic heart failure Carboni G.P., Botti R., Goffredo C. Bio Medico University, Italy Quality of life (QOL) of patients (pts) with chronic heart failure (CHF) is associated with severe reduction in functional capacity (FC), limitations in social life (SL), alterations of the emotional (E) status, therapy compliance (TC) and psychological distress (PD). The alterations in FC, SL, E and TC of 73 consecutive pts with CHF were calculated with a score from 32 graded questions on their QOL. All information was then stored in software for comparison with those of 50 control pts. All pts were also invited to self-rating in a visual graded scale (0=normal, 100=maximal values) their PD burden. The amount of pts PD was also determined by their close relatives, with the same method. A Modified Maastricht Questionnaire (MMQ), was also submitted to all pts. Browsing on the computer screen, the software provides the clinical information's of these 73 pts: mean age of 69±10 years, 37±12% mean ejection fraction (EF) on echocardiography, 3±1 mean New York Heart Association (NYHA) class. Then, the software illustrates with graphics that the percentage reduction in FC, SL, E and TC was of 60±13, 45±16, 35±32 and 24±17%, respectively. Conversely, the self and pts relative's ratings of PD showed a percentage increase of 56±27 and 54±28%, respectively. These last values were significantly correlated (Spearman r >0.4, P<0.001) with the MMQ data. Results indicate that a reduction of QOL parallels a high level of PD burden in CHF. The use of this software is rapid and objective and it may facilitate counseling and treatment in CHF. 10 1781—Effectiveness of patient education Hughes M. University College Cork, Ireland Over three decades ago patient education was not given the rightful place within our clinical remit that it now appears to hold today. However, some feel that within the last decade its development has been stunted and refinement of its structure has been unclear (Redman, 1993). Patient education has always been accepted as a crucial component of the care of patients and families associated with cardiac conditions. The uncertainty regarding the efficacy of cardiac rehabilitation (Thompson and Stokes, 2002) has left some professionals questioning whether part of the fault lies with the educational component of cardiac rehabilitation. Egan (1999) suggests that failure of current cardiac teaching programmes to achieve behavioural changes may be due to an absence of individualised approaches or structured programmes. It is therefore important to have available research based tools to assist practitioners in doing so (Hughes, 2000). Perhaps another problem is the paternalistic stance taken by some professionals (Woodward, 1998). The aim of their practice appears to be to change patient behaviour to one thought of as being ‘healthier’ and which will reduce the level of risk factors. However, it is known that psychological ill health following the diagnosis of a cardiac condition or event is not an uncommon experience of patients (Roebuck, Furze and Thompson, 2001). Have we been trying to change a person's habitual lifestyle without properly acknowledging the effect of social surroundings of culture and policies that may be unsupportive of the required changes? Perhaps we need to investigate the effect of including those significant others, who may also exhibit potential cardiac risk factors, in the individualised programme. In doing so we will also be contributing to secondary as well as tertiary prevention of cardiovascular disease in a combined and possibly more effective way. 11 1782—Supporting improvements in CHD risk: A qualitative study of decision making regarding cardiac rehabilitation attendance Clark A.M., Barbour R.S., White M., MacIntyre P.D. Royal Alexandra Hospital, UK Introduction: Cardiac rehabilitation (CR) can improve mortality, morbidity and quality of life in those with Coronary Heart Disease (CHD). Yet between 44–94% of individuals who are eligible for CR do not participate. There has been little study of the factors that individuals identify as influencing their attendance. This study aimed to provide the patient's perspective through an examination of user's perceptions to CR and their reasons for pursuing or declining invitations to participate. Methods: Focus groups were held with individuals who were eligible for a twelve-week CR programme at a district general hospital in Scotland serving a mixed urban and rural population. A purposive sample was selected from all those eligible to attend the hospital's CR programme (n=277) to represent individuals with different attendance rates. A total of 44 individuals attended the focus groups from three categories: those with high attendance (greater than 60% attendance) (n=27), high rates of drop-out (less than 60% attendance) (n=9) and non-attendance (0% attendance) (n=8). Findings: All the groups recognised the existence of risk factors for CHD and recognised the most common causes of CHD. Those who dropped out or did not attend CR were far more sceptical about the accuracy and validity of health education and CR and health professional ‘expert’ status. While discussions in the high attendance and drop-out groups centred on the embarrassment that was experienced when first exercising with a group, those in the attenders’ groups agreed that this lessened over time with participation. Moreover, for these individuals, the group came to serve as a major factor in increasing their confidence, motivation and fitness. People who participated in exercise were characterised by those who dropped-out or did not attend as being old, illness focused and socially needy. Conclusions: A range of health beliefs about the self, health professionals, CHD risk and CR were invoked to explain and provide justification for varying levels of attendance at CR. Exercise-embarrassment also was seen to influence willingness to attend. A more positive approach to the marketing of cardiac rehabilitation as an inclusive health-promoting activity should be taken to increase attendance. 12 1784—Developing a community rehabilitation programme in an out of hospital setting Noonan O. Letterkenny General, Ireland Introduction: Traditionally in Ireland, Cardiac Rehabilitation programmes have been carried out in an acute hospital setting. As a response to the recommendations within the Cardiovascular Strategy, the North Western Health Board decided to develop a community based Cardiac Rehabilitation programme. There were two pilot sites chosen this presentation will focus on the Dungloe site, Co. Donegal. The decision to locate the programme here was that this area was 40 miles from the nearest hospital based programme. AIM To establish a community-based programme. Objectives: (1) To establish if a hospital based programme could be implemented in the community. (2) To take a hospital based programme to an isolated rural community. (3) To facilitate access to those otherwise unable to attend. (4) To promote awareness of available community resources. Methods: A proposal was drawn up outlining the funding, equipment, facilities and personnel necessary to develop this service. Adequate preparation was put into the development of the programme, viewing the site to ensure suitability regarding space and safety. A meeting was arranged with the relevant community and hospital personnel, in an attempt to outline the structure of the programme and secure medical support. As the service was modelled on the existing hospital subjects, discussions were held with the multidisciplinary team to ensure their support and assistance. Six low risk patients were chosen with a history of coronary artery disease having being referred by the hospital consultant. The programme was two days per week over fifteen weeks. Emergency equipment was transported and available during all classes. Leisure centre staff were trained in basic CPR. Conclusion: Six patients completed the community programme safely in October 2001. It demonstrated that a community programme could be implemented. The programme is currently being evaluated externally by the department of public health. 13 1785—Heart failure patients’ experiences about patient education and self-care in Finland Heikkila J., Heinaaho J., Lahtinen K., Matilainen A. Jyvaskyla Polytechnic, Finland Approximately 100000–140000 people suffer from chronic heart failure in Finland. It is the most common reason for hospitalisation among elderly people. Heart Failure is a significant disease from the point of view of the national economy, since patients are repeatedly hospitalised. Therefore, patient education and counselling as well as encouragement to self-care are important with regard to keeping the disease under control. In Finland there are no heart failure clinics or nurse led services to offer disease specific patient education, nursing care and follow-up. The purpose of this study was to describe heart failure patient's experiences of patient education and self-care in one Finnish Central Hospital. The information received from this study is used as baseline descriptive information for a larger study which will focus on the impact of intensified patient education and follow-up on heart failure patient's quality of life and the health care costs. The ultimate goal of the research project is to develop heart failure patients’ care in Finland. The method of data collection was a structured interview. 30 consecutive heart failure patients were interviewed in May–August 2001. The research method was mainly qualitative, but quantitative data were also used. The qualitative data was analysed by using inductive content analysis. The results from the quantitative responses were analysed in terms of percentages and frequency distributions. Only 17% of the patients experienced that they had enough information about heart failure as a disease and 3% about the symptoms of heart failure. One third of the patients felt that they knew enough about the diet in general. Almost half of the patients said they received enough information about salt restriction, however, only 10% were satisfied with the information about fluid restriction. There were surprisingly many patients that had no information about monitoring their weight (25%) and about resting (43%). Only 13% of the patients knew the names and the doses of their medication and as many as 20% knew nothing about their medication. These inadequacies in information led to problems in following the self-care. For example only 10% were following the fluid restriction, 37% were following their weight and 50% followed the salt restriction. This study revealed the fact that most of the heart failure patients do not have sufficient knowledge to live with their disease and to control it. The information about the state of patient education helps to develop the intensified patient education program by giving detailed information about the most important areas in patient education in hospital as well as in the health centres. 14 1786—Competency framework — The heart of cardiology nurse development Sloey A. Wisman District General Hospital, UK The move to a new district general hospital at Wishaw in May of 2001 resulted in a reorganisation in the way that cardiac services would be delivered. Services were streamlined to focus on patient needs and rationalise care in planning and delivery. Prior to the move, apart from the coronary care unit, all other cardiac patients were accommodated in the general medical wards. At Wishaw all cardiac patients are now accommodated in a dedicated cardiology ward, which facilitates specialist intervention and seamless care for this client group. The result of this was that there was a significant change in the nurse's role in this speciality. Nurses would now need to develop skills across the patient's journey in this acute setting. There was a need to develop a programme of training/education, which would ensure that all staff regardless of grade or experience would have the necessary competencies to deliver high quality care to patients in this speciality. The approach, which was taken, was a tripartite one: (1) Development of a Competency Framework, which is based on Benners Novice to Expert Model. (2) Supported rotation of staff throughout the various branches of cardiology to obtain practical experience within a proactive learning environment. (3) Workbased education programme both theoretical and practical to underpin the Competency Framework. An evaluation programme was devised to run in tandem with the development programme. 15 1787—Improving the secondary prevention of IHD; the role of a population based register Chan K.L., Bell N., Hancock T., Liratsopulos G. Stockport Primary Care Trust, UK Background: Effective strategies to prevent secondary events among coronary heart disease (CHD) patients exist1, but often only a fraction of them receive maximum preventive therapy2. Population based cardiovascular disease registers (CDR) may improve secondary prevention in primary care settings but no clear evidence of their effectiveness exists. In Stockport, a population-based CDR was created by the Primary Care Trust. Eligible patients were identified through computerised searches3. The development was supported by dissemination of local guidelines and educational seminars. Feedback was provided to practices at years 1 and 2. Aim: To examine the effect of a population-based CDR on the delivery of secondary prevention for circulatory diseases in primary care. Method: The management of patients in the register aged up to and including 75 was assessed in relation to surrogate markers of effective risk modification. The χ2 test was used to assess statistical significance of differences between year 1 (baseline) and 2. Results: 55 (population: 285652) and 29 (population: 161926) of 60 practices were covered by the CHD and hypertension registers. 3.7% of patients were identified with CHD and 8.6% with hypertension at year 1 and 3.9% and 9.3% at year 2, respectively. Of eligible CHD patients, 72% were receiving aspirin at year 1 and 78% at year 2 (χ2 P<0.001∗∗∗). Of the same patients, 38% reached the cholesterol target of less than or equal to 5 mmol/l at year 1 and 46% at year 2, respectively (P<0.001∗∗∗). Among hypertensives, 45% achieved the target BP of <150/90 at year 1 and 54% at year 2 (P<0.001∗∗∗). Conclusion: Prevalence estimates for IHD and hypertension are in agreement with previous research4. A significant improvement was noted in the secondary prevention of IHD. The CDR proved an important tool for improving quality of healthcare. Further monitoring of trends in secondary prevention management is required in the future. 1 Modern standards and service models, 2000 London: Stationery Office 2000. 2 Bowker TJ et al. A British Cardiac Society survey of the potential for the secondary prevention of coronary disease: ASPIRE (Action on Secondary Prevention through Intervention to Reduce Events) Heart 1996 Apr; 75(4): 334–42. 3 Majeed A et al. Identifying patients with ischaemic heart disease in general practice: cross sectional study of paper and computerised medical records, BMJ 2000; 321; 548–550. 4 Royal College of General Practitioners, the Office of Population Censuses and Surveys and the Department of Health (1995) Morbidity Statistics from general practice, Fourth National Study 1991–1992. HMSO: London. 16 1789—A partnership for a healthy heart lifestyle maintenance programme Raleigh A., Bolger J., Brickley K., Dudley R. Nottingham City Hospital, UK A survey of post Phase 3 cardiac rehab programme clients found that ‘graduates’ encountered regression in sustaining behaviour changes achieved during the programme. Aim and Objectives: (1) To explore the creation of infrastructure and support to positively influence health related behaviour change in clients who have participated in a phase 3 cardiac rehab programme in Tullamore Hospital. (2) To enable the development of health enhancing behaviours in this group on a phased basis commencing with physical activity via a multi tiered approach. (3) To create long term commitment, expansion and sustainability of cardiac health by empowering ex cardiac rehab clients to take an active and participatory role in secondary prevention. (4) To foster community ownership of the project and to maximize the potential for the eventual sustainability of the initiatives. (5) To augment national and local health strategies Methodology/Link of topic to HPH i. It was developed as a comprehensive approach (project management style) that focused equal attention on each of the 5 axis of the Ottawa Charter of Health Promotion [environmental support, strengthen community action, develop personal skills of the participants, re-orient health services and building healthy public policy] ii. Central to this approach was individual behavioral change (based on Prochaska Stages of Change theory) awareness, and client advocacy. Results/Conclusions: An evaluation was conducted to collect demographic information on participants, assess the success of phase 1, to determine changes in knowledge and attitudes and to determine any behavior change pre/post. Pre project data were collected in 2000 Analysis in Jan 2002 found statistically improvement in activity levels, knowledge and attitudes, participant ownership and phase 1 is now effective and cost efficient 17 1790—Diabetes and heart disease — from a nursing prospective Fallon N. Adelaide and Meath Hospital, Ireland The World Health Organisation has confirmed there are 200 million people world-wide with diabetes, greater than 90% diagnosed with Type 2 Diabetes or non-insulin dependent diabetes mellitus (NIDDM). Alarmingly its prevalence appears to be increasing all over the world. In the USA, due to an increased ageing population and a greater prevalence of obesity and sedentary lifestyle, type 2 diabetes is nearing epidemic proportions. The incidence of NIDDM in the UK and Ireland is 2–4% of the population, but the same incidence for undiagnosed cases. Type 2 diabetes is associated with a 2–4 fold incidence of heart disease, compared to non-diabetic populations. Diabetics who have sustained a MI have an increased short term and long-term risk of recurrent infarction and death. When diabetes is associated with other risk factors such as increased blood cholesterol level, hypertension and cigarette smoking, the risk of a MI and cerebral vascular accident (CVA) is excessively high. Today the mere presence of diabetes is considered as much a risk for a future MI as in someone who previously had a MI. Early diagnoses, subsequent treatment and patient education are vital in preventing the complications of diabetes. In February 2000 specialists from cardiac rehabilitation met with specialists from the diabetic centre in AMNCH in order to increase and update our knowledge about both specialities. During Phase 1 of cardiac rehabilitation, cardiac rehab specialists documented all patients with elevated fasting blood sugar level. Additional information on impaired glucose tolerance and diabetes were given to these patients. To allow these ‘at risk’ patients to be seen quickly we instigated a nurse to nurse referral where the cardiac rehab nurse specialist referred the patient to the diabetic nurse specialist. There were 45 patients recorded with elevated BSL's between April 2000–June 2001 44% were known diabetics. Eighteen percent were non-diabetic on follow-up. Sixteen percent were referred to a specialist to outrule any impaired glucose tolerance. Twenty percent were newly diagnosed diabetics. One percent died. Cardiovascular disease is still the major cause of death in NIDDM and the major cause of premature mortality. The cardiac rehabilitation professionals are in a key position to help monitor and motivate the diabetic patient to comply with their medications, diet and exercise program. The prompt referral from one nurse speciality to another ensures early diagnosis and initiation of treatment. This will delay the onset of complications, which will reduce morbidity and mortality. 18 1791—To identify predictors for continued smoking in smokers hospitalized due to an acute manifestation of ischaemic heart disease Attenbring M. Sahlgrenska University Hospital, Gothenburg, Sweden Background: Most patients with an acute coronary syndrome quit smoking in connection with hospitalization, but many of them relapse within three months. Aim: To identify predictors for continued smoking in smokers hospitalized due to an acute manifestation of ischaemic heart disease. Patients and Methods: Patients below the age of 75, admitted consecutively to the coronary care unit of Sahlgrenska University Hospital, with an acute coronary syndrome. Smoking habits were obtained at baseline and three months after discharge. Patients who continued to smoke were compared with those who had stopped smoking at three months with regard to age, sex, previous history, clinical course and intention to quit smoking. Results: On admission, 33% (434 of 1320) were current smokers. Of these, 51% reported that they smoked at follow-up. There were no significant differences in age, gender or marital status between non-quitters and quitters. In a multivariate analysis, continued smoking was more likely if patients had a history of a previous cardiac event, a chronic obstructive pulmonary disease (COPD) or chronic bronchitis, cerebral vascular disease or were using sedatives or antidepressants prior to admission. Smoking was less likely if patients had participated in the heart rehabilitation program. Conclusions: Our data show that approximately half of the smoking patients continue to smoke after having suffered from an acute coronary syndrome. For those patients with factors predictive of continued smoking, new methods for smoking cessation might be considered. Heart rehabilitation program seems to have a positive impact on patients smoking status. Furthermore, it is important to be very active with anti-smoking help when the cardiovascular diagnosis is new to the patients, since here chances for quitting are good. Keywords: Ischaemic heart disease; Predictors; Smoking cessation. 19 1792—Fatigued elderly patients with chronic heart failure: Do patient reports and nursing documentation correspond? Ekman I., Ehrenberg A. Sahlgrenska Academy at Gotenberg, Sweden Purpose: To compare descriptions of fatigue from interviews with elderly people with chronic heart failure (CHF) and data recorded by nurses at an outpatient heart failure clinic. Methods: Patients were screened for moderate to severe CHF. Totally, 158 patients were interviewed using a revised form of the Fatigue Interview Schedule (FIS). Of these patients, half (79) were offered visits at a nurse-monitored heart failure clinic. Nursing documentation of fatigue at the heart failure clinic was compared with the patient interviews. Findings: Results indicated poor concordance in patients’ descriptions and record content concerning fatigue. Decreased libido was linked to fatigue according to the patients but not according to the nurses’ records. Whereas cognitive characteristics of fatigue occurred rarely in the records, they were more frequent in the patient interviews. Conclusions: It is vital that nurses recognize characteristics and factors related to fatigue in patients with CHF and develop strategies to help patients cope with their restricted ability in daily life. Using the words and expressions of the patients and the diagnostic characteristics of fatigue in recording can support the nurses understanding of patients living with CHF. 20 1793—Knowledge in patients with coronary artery disease participating in problem-based learning (PBL) rehabilitation programme Tingstrom P., Karner A., Kamwendo K., Bergdahl B. Linkoping University Hospital, Sweden Introduction: In order for patients with CAD to handle life, it is important that they possess knowledge related to their particular situation. It is known that in order for learning to take place the information supplied must be meaningful. Nurses and patients have different opinions about what is important to learn. In a problem-based learning (PBL) rehabilitation programme participants themselves decide what is meaningful. The aim of the present study was to evaluate knowledge at the end of a one-year PBL programme. Method: 207 patients <70 years with myocardial infarction, PTCA or CABG, were randomised to a PBL programme or a control group. 200 patients took part in the testing after one year. The overall curriculum included topics related to CAD. Examples are risk factors, smoking, diet, exercise, stress and work. Groups of 6–8 patients met with a tutor from the rehabilitation team for 1.5 h on 13 occasions during one year. The groups chose what topics to study and generated questions according to a structured process. A 66-item knowledge-questionnaire, that included six main knowledge areas, was administered before the programme and after one year. Each item employed a three-point rating-scale: ‘true’, ‘false’ and ‘unsure’. Result: At the end of the programme there was a significant increase in knowledge within the PBL group. There was also a significant difference in knowledge between the two groups. Of the six areas, only two did not show an increase in knowledge: knowledge of smoking and stress and psychosocial risk factors. Discussion: One assumption in patient education is that knowledge is necessary for lifestyle changes to take place. This study shows that an education programme built on PBL, can increase knowledge. 21 1794—Multidisciplinary education and counselling in patients with heart failure van der Wal M., Cazemier A. University Hospital Groningen, The Netherlands Patients with heart failure are readmitted frequently. From recent studies it seems that structured education on heart failure, the treatment and the management of heart failure can have a positive effect on readmission, compliance and quality of life. Patient education can be structured by using a protocol. In the University Hospital of Groningen several healthcare providers that are involved in the cure and the care for patients with heart failure formulated bottlenecks in the care and the education of patients with heart failure; It was not quite clear what, by whom and when (www) the patient should receive information. There was no agreement about the content of the education. There was a lack of co-ordination and continuity of patient education between the various disciplines. There was no agreement about the use of (written) educational materials. Goals of the project: to improve structured education for patients with heart failure, to improve the co-ordination between the disciplines, to guarantee continuity of care and education after discharge, to improve the use of (written) educational materials, Participants: clinical nurse specialist, cardiac ward nurse, home care nurse, cardiologist, dietician, physiotherapist, general practitioner, patient, Method: review of recent literature, interviews with healthcare providers and patients to assess bottlenecks, present situation and recommendations for improvement, to construct a checklist with aspects for patient education, to describe the content of the education (including practical advice), to assess and develop educational materials, testing and evaluation, implementation, Products that are developed: multidisciplinary education protocol, manual, heart failure diary, 22 1795—Complications of transradial cardiac catheterization Andre M., Alvarez A., Guillen P., Argibay V., Gomez M., Sanmartin M., Ruiz-Salmeron R., Mantilla R., Meneses D., Goicolea J. St Jude Medical Spain, Spain Objectives: We determinate the rate of complications in a consecutive serie of patients who underwent cardiac catheterization from radial approach. Introduction: Transradial access has rapidly become an accepted alternative to traditional transfemoral access for both diagnostic and interventional coronary procedures, and is clearly preferred by patients because of lessened periprocedural discomfort, faster time to ambulation, and improved post-procedural physical and social functioning. Furthermore, length of stay and some complications after diagnostic angiography have previously been shown to be reduced significantly. Methods: During a period of 15 months, 3260 cardiac catheterization were performed in our laboratory, 418 (12.8%) were done by radial access (90% right hand). The approach was successful in 95.5% of cases. 75% of the procedures were coronary angiography and the rest percutaneous coronary intervention. Sheath size employed was mainly 4 F (69%) and 6 F (25%). Procedural complication was assessed upon discharge (100% cases) and at follow up 15 days later (98.5%). Results: There were 1% (n=4) of major complications: two patients experienced hand claudication and two finger dysesthesis. Minor complications were 9% (n=36) and included radial artery occlusion (0.8%), hematoma over 1 cm (2.8%) lesser 1 cm (2.3%) and early bleeding (2.5%). Independent predictors of complications were female sex (P=0.04) and Diabetes (P=0.01). Conclusion: The transradial approach during cardiac angiography and coronary intervention has both a high success rate and a low rate of complications. 23 1796—Intracoronary radiation for the treatment of in-stent restenosis Armengol F., Sabate M., Angiolillo D., Rodriguez L., Menal D. H. Clinico S. Carlos, Spain Introduction: In-stent restenosis is an outstanding problem in interventional cardiology. Recently, intracoronary radiation has shown to be effective as an adjuvant treatment to angioplasty in this group of patients. The aim of this study is to present the experience of patients with in-stent restenosis treated with brachytherapy in our department. Methods: Two catheter-based Beta-emitting systems are available in our institution: Novoste and Guidant. Dose and dwell time are based on intraluminal diameter measurements. Three different departments (interventional cardiology, radiooncology and medical physics) must interact to start a brachytherapy program. Results: From November 2000 to November 2001, 47 patients with in-stent restenosis were included. Treated arteries were right coronary artery (47%), left anterior descending artery (34%), circumflex (13%) bypass graft (4%) and left internal mammary artery (2%). The mean restenosis length was 22.4±0.7 mm. Angioplasty were performed either with cutting balloon system (27 cases) or conventional balloon system (20 cases); additional stent implantation was needed in 7 cases. Radiation was performed with Novoste in 30 patients and with Guidant in 17 patients. No procedural complications were observed. Six months follow-up is still under way. Conclusions: Intracoronary brachytherapy for the treatment of patients with in-stent restenosis is a safe and a feasible technique with excellent acute results. 24 1797—Investigation of satisfaction level in a nurse-led heart failure clinic Nielsen P.H., Bartholdy H., Henriksen I. Frederiksberg Hospital, Denmark Background: In September 1999 we established a heart failure outpatient clinic in which the nurse should have the primary contact with the patient and the physician acted as a consultant. This clinic was one of the first of its kind in Denmark. In the daily contact with the patients we get a positive feed-back from a great majority regarding their course in the clinic. Design: To participate in the investigation the patient should suffer from heart failure and be enrolled into the clinic from September 1st 1999 until January 31st 2001. The satisfaction questionaire was sent out to 198 patients in the spring/summer 2001. The questionnaire explored, e.g. quality of our telephone arrangements, perceived competence of the nursing team, lack of contact to the physician and the use of flexible diuretic-regimen. Furthermore, the questionnaire featured statements to validate, ruler of satisfaction, and additional free-text space for comments. Selected Results: The response rate was 78.8%, 90% of the patients were satisfied with the answers provided for their health problems and felt that they got a satisfactory and intelligible explanation about illness and the medicine from the nurse. Twenty percent stated that they were missing the ordinary outpatient contact to the physician. Twelve percent had been taking extra diuretics without consulting a nurse or a physician. Conclusion: The response of the patients confirms our supposition about a high patient satisfaction regarding their course in the clinic and that the nurse has a crucial function in a heart failure clinic. Taken together quite a lot of our patients have become more independent and avoided admissions due to their course in the heart failure clinic. 25 1798—What is most important for your quality of life?: A pilot study on individual quality of life of adults with congenital heart disease Moons P., Raes E., Van Deyk K., De Geest S., Gewillig M., Budts W. Catholic University Leuven, Belgium Many patients with congenital heart disease experience the heart defect intruding on their daily life. The aim of this study was to examine quality of life (QOL) and its individual determinants in adults with congenital heart disease. Methods: This cross-sectional study included 134 patients (67.2% males). QOL and its determinants were measured using a Visual Analogue Scale (VAS) ranging from 0 to 100, and the SEIQoL-DW, respectively. This latter instrument comprises 3 successive steps: (1) nomination by the respondent of the 5 areas most important for his/her QOL; (2) rating of the actual status for each specified area on a VAS from 0 to 100 and (3) quantification of the relative importance of each nominated area in comparison with each other, using a 5-segment disk. Results: Patients perceive their overall QOL as good (VAS median 80; Q[sub]1[/sub]=73; Q[sub]3[/sub]=86). The SEIQoL-DW identified 13 areas affecting patients’ QOL. The table describes the percentage of patients reporting the respective areas (step 1), the median actual status (step 2), and the relative importance for each cue (step 3). Domains important for the quality of Step 1 Step 2 Step 3 life Significant others 73.9% 85.5 23% Job/education 51.5% 68 18% Leisure 50% 74 17% Health 49.3% 76 23% Social network 49.3% 75 20% Personal values with respect to others, 47% 79 20% life and society Financial means and material well-being 29.9% 67 16% Psychological well-being 14.2% 76 19% Capacities and impediments due to the 11.9% 49 17% heart defect Future 10.4% 80 20% Health care 3% 87.5 16.5% Nourishment 3% 76 12% Pets 2.2% 91 27% Domains important for the quality of Step 1 Step 2 Step 3 life Significant others 73.9% 85.5 23% Job/education 51.5% 68 18% Leisure 50% 74 17% Health 49.3% 76 23% Social network 49.3% 75 20% Personal values with respect to others, 47% 79 20% life and society Financial means and material well-being 29.9% 67 16% Psychological well-being 14.2% 76 19% Capacities and impediments due to the 11.9% 49 17% heart defect Future 10.4% 80 20% Health care 3% 87.5 16.5% Nourishment 3% 76 12% Pets 2.2% 91 27% Open in new tab Domains important for the quality of Step 1 Step 2 Step 3 life Significant others 73.9% 85.5 23% Job/education 51.5% 68 18% Leisure 50% 74 17% Health 49.3% 76 23% Social network 49.3% 75 20% Personal values with respect to others, 47% 79 20% life and society Financial means and material well-being 29.9% 67 16% Psychological well-being 14.2% 76 19% Capacities and impediments due to the 11.9% 49 17% heart defect Future 10.4% 80 20% Health care 3% 87.5 16.5% Nourishment 3% 76 12% Pets 2.2% 91 27% Domains important for the quality of Step 1 Step 2 Step 3 life Significant others 73.9% 85.5 23% Job/education 51.5% 68 18% Leisure 50% 74 17% Health 49.3% 76 23% Social network 49.3% 75 20% Personal values with respect to others, 47% 79 20% life and society Financial means and material well-being 29.9% 67 16% Psychological well-being 14.2% 76 19% Capacities and impediments due to the 11.9% 49 17% heart defect Future 10.4% 80 20% Health care 3% 87.5 16.5% Nourishment 3% 76 12% Pets 2.2% 91 27% Open in new tab Conclusion: Individual QOL assessment in adults with congenital heart disease provides a detailed picture of issues relevant for QOL. These issues should be addressed in comprehensive health care, aiming at improving patients’ QOL. 26 1799—Early reactions and experiences of patients being referred for coronary artery bypass graft (CABG) surgery Screeche-Powell C. Guys and ST Thomas NHS Hospital, UK Introduction. The needs of patients on waiting lists for CABG surgery are well documented. These patients are specifically targeted in the National Service Framework. Various interventions are in place to reduce their risk factors and improve the overall experience of being on the waiting list. To date, the needs of patients awaiting acceptance onto the these lists has been largely overlooked Main Objectives. To identify the needs of patients who are awaiting acceptance onto the CABG waiting list and determine whether they perceive the support/information given to them is adequate. Methodology/Study Design. A qualitative technique, using in-depth interviews, was employed to identify the concerns and experiences of patients being referred for CABG surgery. Participants had been told on the day of angiography they required surgery and were interviewed three weeks later. Main Findings. Six patients were interviewed. Although expressing general satisfaction with the information/support they received, the interviews went on to reveal the following themes (fig 1): Fig 1: Thematic content analysis Major themes • Uncertainty (all participants) • Fear/anxiety Common themes • Hope • Acceptance (3 or more participants) • Avoidance • Confusion • Frustration Additional themes • Guilt (1 or 2 participants but central • Shock themes individually) Fig 1: Thematic content analysis Major themes • Uncertainty (all participants) • Fear/anxiety Common themes • Hope • Acceptance (3 or more participants) • Avoidance • Confusion • Frustration Additional themes • Guilt (1 or 2 participants but central • Shock themes individually) Open in new tab Fig 1: Thematic content analysis Major themes • Uncertainty (all participants) • Fear/anxiety Common themes • Hope • Acceptance (3 or more participants) • Avoidance • Confusion • Frustration Additional themes • Guilt (1 or 2 participants but central • Shock themes individually) Fig 1: Thematic content analysis Major themes • Uncertainty (all participants) • Fear/anxiety Common themes • Hope • Acceptance (3 or more participants) • Avoidance • Confusion • Frustration Additional themes • Guilt (1 or 2 participants but central • Shock themes individually) Open in new tab Discussion. The major themes have previously been identified in patients on waiting lists for CABG surgery. This study reinforces their existence, amongst the population awaiting such surgery. Patients in the early stages of referral for CABG surgery may experience confusion, avoidance, guilt and shock in addition to the major themes. Conclusion: Despite the general satisfaction expressed, the existence of negative emotions reveals that the patients interviewed, who were in the process of being referred for CABG surgery, required additional support during this time. © 2002 European Society of Cardiology This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (https://academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model) © 2002 European Society of Cardiology
TI - 2nd Annual Spring Meeting of the ESC Working Group on Cardiovascular Nursing: Key Issues in Cardiac Care: Dublin, Ireland 5–6 April, 2002
JF - European Journal of Cardiovascular Nursing
DO - 10.1016/s1474-51510200011-7
DA - 2002-06-01
UR - https://www.deepdyve.com/lp/oxford-university-press/2nd-annual-spring-meeting-of-the-esc-working-group-on-cardiovascular-0lyPHQu0G4
SP - 153
EP - 163
VL - 1
IS - 2
DP - DeepDyve
ER -