TY - JOUR
AB - Oral abstract session 1 Friday, 16 March 2012 - 11:00 - 12:00 Location: Auditorium 12 P9 Exploring decision delay in patients presenting with myocardial infarction in Kingdom of Saudi Arabia (KSA) Hassan Alshahrani,1 Donna Fitzsimons,1 Roy Mcconkey,1 Julie Wilson1 and Mustaf Youssef2 1University of Ulster, Belfast, United Kingdom 2King Fahad Medical City, Prince Salman Heart Center, Riyadh, Saudi Arabia Previous research in Western countries has found that there are many factors that can affect decision making to seek care among patients who experience the symptoms of MI; including cognitive, social, cultural and emotional factors. These factors may differ in other cultures. This study is designed to explore the factors that contribute to prehospital delay among patients in KSA. The current study uses a non-experimental design, combining both qualitative (semi-structured interview) and quantitative methods to achieve the study objectives. This cross sectional study was comprised of a convenience sample of research participants (n = 311) who presented with a diagnosis of MI to three hospitals in Riyadh city over a five month period from 15th March 2011 to2nd August 2011. Across 189 eligible patients, (19% female and 81% male), the median time delay was 2.5 hours, the median delay time for male = 2 hours, female = 3 hours. In all 21% of participants tried a self-help remedy when they first noticed their symptoms and 18% had wished or prayed that their symptoms would go away. Only 45% of the participants thought the problem was related to their hearts. Also 87% of the patients had not heard of thrombolytic agent drugs. Moreover, 41% of the total participants delayed because they did not realize the importance of their symptoms. The following factors significantly influenced prehospital delay: participants without a past history of MI had longer delay times (U = 1312, N1 = 22, N2 = 167, p = 0.029, two-tailed); participants who were in a public place when they had MI symptoms delayed more than others (χ2 = 13.66, df = 5, p = 0.018); participants who were asleep when MI symptoms began delayed more than those who were sitting or performing some activity (χ2 = 7.802, df = 2,p = 0.020). These findings allow comparisons to be made with other cultures and provide important evidence to help inform the development of health promotion strategies to minimise delay times for patients with MI symptoms in KSA. P10 Slow-onset and fast-onset ACS presentations S. Sharon O’donnell,1 G. Mckee,1 F. O’brien,1 M. Mooney1 and DK. Moser2 1Trinity College Dublin, Dublin, Ireland 2University of Kentucky, Kentucky, United States of America Purpose: Although most people expect a heart attack to resemble the ‘Hollywood’ heart attack, the majority of people experience something completely different. As such, patients may have difficulties assigning their symptoms to a cardiac cause, resulting in pre- hospital delays to care. This study examines the validity of two ACS presentation phenomena ‘slow-onset’ and ‘fast-onset’ ACS presentations and their influence on pre-hospital delay times. Fast-onset ACS presentation resembles the ‘Hollywood’ heart attack and is characterized by sudden, continuous and severe chest pain. Slow-onset ACS pertains to all other ACS presentations, many of which will involve gradual, mild and intermittent typical/atypical symptoms. Methods: Baseline data pertaining to medical profiles, pre-hospital delay times and ACS symptoms were recorded for all ACS patients who participated in a large multi-site randomized control trial (RCT) in Dublin, Ireland. Patients were interviewed 2–4 days following their ACS event and data was gathered using the ACS Response to Symptom Index. All baseline data from year 2 of the RCT, N = 893 patients, were analysed. Results: ‘Fast-onset’ ACS, the considered archetypal presentation of ACS, was experienced by just 35% (n=316) of patients in this study, whilst its antithesis, ‘slow-onset’ ACS, was experienced by 65% (n = 577) of patients. Patients who experienced slow-onset ACS were significantly more likely to have longer pre-hospital delays than patients with fast-onset ACS (3.50hrs versus 2.00hrs, t = -5.63, d.f. 890, p < .001). Patients with ‘slow-onset’ ACS were more likely than those with ‘fast-onset’ ACS to phone (44% versus 28%, p < .001) or visit (42% versus 24%, p < .001) their GP. Patients with ‘fast-onset’ ACS were more likely to use an ambulance than those with ‘slow-onset’ ACS (50% versus 33%, p < .001). A multivariate analysis of delay revealed that in the presence of other known delay factors, the only independent predictors of delay were ‘slow-onset’/’fast-onset’ ACS (β= -.096, p < .002) and other factors associated with patient behaviour/appraisal. Conclusions: Slow-onset ACS and fast-onset ACS presentations are associated with distinct behavioural patterns which significantly influence pre-hospital time-frames. As such, slow-onset ACS and fast-onset ACS are legitimate ACS presentation phenomena that demand serious consideration when examining the factors associated with pre-hospital delay P11 Dilemmas in treating and caring for elderly ICD patients nearing the end of life J. Jette Svanholm1 and R. Birkelund2 1Aarhus University Hospital, Skejby, Department of Cardiology, Aarhus, Denmark 2Aarhus University, Faculty of Health Sciences, Department of Nursing Science, Aarhus, Denmark Background: More than 20% of Implantable Cardioverter Defibrillators (ICD) and Cardiac Resynchronization Therapy (CRT) devices are used in the elderly population ≥ 80 years of age. Patients with implanted cardiac devices avoid death caused by cardiac conduction abnormalities or malignant dysrhytmias. But the patient may later develop terminal illness due to a non-cardiac disease or progressive heart failure for which the device is not an effective therapy. It is a well known phenomenon that many ICD recipients are afraid of the shocks, feel anxious and are depressive. In 2010 an expert statement recommended that it should be possible for everyone with an ICD nearing the end of life to get the ICD de-activated. How ever knowledge is scarce on treating and caring for patients ≥ 80 years of age with an ICD. The aim of this study was to highlight themes and dilemmas about treating and caring for patients ≥ 80 of age with an ICD. Method: An explorative literature search in the databases PubMed, Cinahl and PsykInfo was made. The search was limited to studies in English, Danish, Norwegian and Swedish language. Age limit was 80 years and 80+years and the timeframe was from 2000 to 2011. Articles were analyzed and categorized into relevant themes. Results: The literature review showed that often normative approaches and best practice are embedded in the studies. The following five themes emerged: 1) Using ICD in patients ≥ 80 years of age is surrounded with the technological imperative, 2) evidence regarding mortality and quality of life of treating and caring for elderly people with an ICD is not unambiguous, 3) typically agreements about end of life treatment and care to patients with an ICD have not been made, 4) physicians find it difficult to talk with patients nearing end of life about de-activation, 5) often elderly patients rely on the physician’s judgment; they want to be informed but not drawn into the decision-making. Conclusion: The interaction between the patient and the physician seems to insist on a relationship with the physician as the authority maintaining treatment to prolong life. This is not in accordance with the overall recommendations of the American and European societies of cardiology as well as the political agenda. Future perspective: To conduct a qualitative study at the University Hospital Department of Cardiology aiming at understanding the experiences of human beings â%¥ 80 years of age living with an ICD concerning life and death. The overall aim is to challenge traditional ways of interacting and creating alternative ways of communicating with elderly ICD patients. P12 One month and one year outcome of patients treated with pci at a tertiary centre in the uk between january to december 2009 S. Susan King,1 A. Pottle,1 N. Crump,1 J. Cottenham,1 S. Deane,1 T. Joseph,1 J. Murphy1 and C. Ilsley1 1Royal Brompton & Harefield NHS Foundation Trust, Harefield, United Kingdom Purpose: Since April 2007 the Cardiology Nurse Specialist team at Harefield Hospital have audited the outcome of patients following percutaneous coronary intervention (PCI). At the authors hospital, a tertiary referal centre, patients undergo PCI either as an elective procedure, as an emergency following acute coronary syndrome (ACS) or as a primary PCI (PPCI) due to acute myocardial infarction. Method: At 1 month and at 1 year after PCI the following data is collected: the consultant responsible for PCI; status (alive/dead); symptoms of chest pain (using CCS class); major adverse cardiac events (MACE); further cardiac investigations undertaken, and additional cardiac interventions. The data is gained from patients follow-up visits to the nurse led PCI clinic, or from hospital computer records if followed up in medical clinics. Patients who have not been followed-up at the authors hospital are sent a postal questionnaire, which may also be sent to the patients general practitioner if no responce is received. Analysis is performed once the data has been obtained and a report, comparing 2 groups of PCI patient - PPCI and elective/emergency (E/E), is produced for the consultant cardiologists. Results: Between January to December 2009 1116 PCIs were performed, and complete data was collected for 91.5% of these procedures. 442 PPCI’s were performed (39.61%) and 674 E/E procedures (60.39%). At one month following PCI 412 (96%) of PPCI and 659 (97.8%) of E/E patients were alive; 339 (76.6%) of PCCI patients and 481 (71.3%) E/E were angina free; 40 (9%) PPCI and 61 (9%) E/E patients had further cardiac investigations (either undergoing exercise tests, myoview scan or restudy angiogram); 8 (2.2%) PPCI and 20 (2.9%) of E/E patients had undergone further cardiac intervention (receiving additional PCI to target vessel, PCI to non target vessel or coronary artery bypass surgery). At 1 year following PCI 394 (92%) of PPCI and 643 (95.8%) of E/E patients were alive; 292 (66.2%)of PPCI patients and 377 (55.9%) were angina free: 51 (11.4%) of PPCI and 125 (18.5%) E/E patients had undergone further cardiac investigations; 31 (7%) of PPCI and 38 (5.3%) of E/E patients had undergone further cardiac intervention. Conclusion: This audit provides details of long-term outcome of patients following PCI at the authors hospital, and shows that PCI, both as a planned and an emergency procedure, is a successful with good long-term outcomes. P13 Advances in the progressive care setting: exploring the new model of a wearable patient monitor at the point of care; the effects of clinical decision support and nurse workflow ML. Jahrsdoerfer1 1Philips Healthcare, Andover, Massachusetts, United States of America Purpose: To measure the impact that a wearable patient monitor has in relation to clinical decision support and nurse workflow in the progressive care telemetry unit. Background and Significance: Nurses are often first to detect early signs of clinical deterioration in their patient, which makes vigilance and timely response to alarms critical. Appropriate interventions to protect patients can only be effective if vital information is communicated rapidly to the nurse. Traditionally information is centrally monitored via telemetry, yet the nurse is unable to visualize clinical data and alarms at the point of care. It is hypothesized that the tele-view device will positively impact patient care. Methods: The study incorporates a convenience sampling of 42 regular staffed nurse participants and 3 technicians on a progressive care telemetry unit at a mid-size teaching hospital. Using a pre/post design, the effects were measured using a threefold approach: 1) nurse worn pedometer, 2) the number of nurse calls to the technician at the central station, 3) nurse perception via survey. Base line data were collected over a 5 week period using their current telemetry system. Staff were then educated on the new tele-view instrument. The subsequent 5 week period was studied using the MX40 tele-view device on every patient that required monitoring. Analysis was done using frequencies and a simple t-Test. Results: Pedometer data were not significant while ‘nurse-call’ model was utilized. However, the opposite outcome was true of their primary routine (call to technician at central station instead of nurse walking back to validate data). 89% less calls were made from patient bedside. The nurse can now see vital waveforms/alarms directly on the telemetry device. Time saved is 243 hours/year (=20 shifts/year); 40 minutes/day. Survey: 98% nurses find tele-view useful as clinical decision support tool at point of care, 100% claim fewer steps back to central-station, 93% find screen data useful prior to administering medication, 100% nurse’s state useful to view waveforms & alarms while transporting or ambulating a patient. Conclusion: The use of the mobile monitor significantly improves clinician workflow by providing vital information at the point of care. It functions as a clinical decision support tool for monitoring during patient transfer, as well as for patient ambulation. Local alarms alert nurses of patient condition changes no matter the patient’s location in the hospital. This outcome improvement correlates with the call to develop hospital-specific processes for remediation strategies for alarm response events. P14 Coronary optimal reperfusion strategy: the collaboration between a pci centre & scottish ambulance service F. Hearl,1 D. Louttit2 and R. Lilly2 1Golden Jubilee National Hospital, West of Scotland Regional Heart & Lung Centre, Glasgow, United Kingdom 2Scottish Ambulance Service, Glasgow, United Kingdom Purpose: Coronary Heart Disease (CHD) is the leading cause of death in the UK, despite rates falling; mortality varies, with highest rates in the West of Scotland. Scottish health boards were directed to develop and implement an Optimal Reperfusion Strategy for ST Elevation Myocardial Infarction (STEMI). The development of national CHD standards &guidelines has been undertaken &disseminated. Endorsing, patients presenting with STEMI be treated with primary Percutaneous Coronary Intervention (pPCI). Where this is not possible within the timed clinical pathway, patients should receive thrombolytic therapy &immediate transfer to a PCI centre. Our aim was to ensure a system to support diagnosis and clinical management of STEMI. Method: This coincided with the ambulance service procurement of next generation defibrillators with enhanced telecommunication capabilities. The defibrillators allow superior data exchange between users, including a new option to send data to clinicians computer accounts or direct to mobile devices. Results: The collaboration between PCI centres and the ambulance service aimed to ensure that all appropriate patients, suitable for optimal reperfusion, received prompt therapy, either pPCI or thrombolysis, within local, regional &national guidelines. Transfers are audited locally against national targets. Local ‘Door to Balloon’ times exceeded and lead the national benchmarks. Ambulance transfer times compare favourably with other PCI centres. Challenges remain for the ambulance service in achieving diagnosis to mobilisation within the proposed 20 minute window. Conclusion: Transmission of 12 lead ECGs direct from the pre-hospital setting, to PCI centres, allows supported clinical decision making in immediate management, for ambulance service and hospital staff. Open in new tabDownload slide P15 Euroaction preventive cardiology programme plus intensive smoking cessation with Varenicline C S Catriona Sian Jennings,1 K. Kotseva,1 D. De Bacquer,2 A. Hoes,3 J. De Velasco,4 S. Brusaferro,5 J. Jones,1 A. Mead,1 S. Tonstad6 and D. Wood1 1Imperial College London, London, United Kingdom 2Ghent University, Ghent, Belgium 3University Medical Center Utrecht - Julius Centre for Health Sciences and Primary Care, Utrecht, Netherlands 4University General Hospital of Valencia, Department of Cardiology, Valencia, Spain 5University Hospital “Santa Maria della Misericordia”, Udine, Italy 6Oslo University Hospital, Oslo, Norway Purpose: Can a nurse-led preventive cardiology programme for high CVD risk smokers, with intensive cessation support including optional varenicline, achieve more effective smoking abstinence in addition to reducing overall CVD risk compared to usual care (UC). Methods: The EUROACTION Plus (EA+) programme was evaluated in general practices across 4 European countries using a RCT design. Smokers 18 to 80 years with vascular disease and 50–80 years at high risk of developing CVD (Heartscore ≥ 5% over 10 years, or treated for risk factors or DM) were randomised to EA+ or UC. The primary outcome was 7 day point prevalence of abstinence (7DPPA) validated by breath CO <10 ppm at 16 weeks. The secondary outcomes included the % patients achieving the European dietary, physical activity, risk factor and therapeutic targets for CVD prevention. Patients in EA+ met with the nurse every two weeks. Results: 696 patients were recruited: 350 randomised to EA+ and 346 to UC. 85% EA+ and 83% UC returned at 16 weeks. The intention to treat (ITT) results are given below. Conclusions: The EUROACTION Plus programme was successful at getting high CVD risk smokers to quit and improve their diet and physical activity together with blood pressure control. EA+ patients gained a mean 1.6kg in weight due to smoking cessation which may have impacted unfavourably on lipid management. No increases were seen in depressive symptoms in EA+ which are a common side effect of stopping smoking. Overall HRQoL was improved. Table 1. ITT Results . EA+ . UC . . . . . % . % . OR . 95% CI . p value . 7DPPA breath CO<10 ppm 51 19 4.52 3.2-6.4 <0.0001 Mediterranean Diet Score ≥9 52 37 1.84 1.3-2.6 0.0005 Physical activity ≥30 mins/day moderate intensity 16 7 2.48 1.4-4.4 0.002 METSmax target achieved (Chester Step Test) 38 27 1.62 1.0-2.6 0.04 BMI <25kg/m2 23 32 0.65 0.5-0.9 0.02 BP <140/90 (130/80 DM or vascular disease) 52 43 1.47 1.1-2.1 0.03 TC <4.5mmol/l 21 24 0.83 0.6-1.3 0.39 HADS-A (mean) 5.3 5.5 0.37 HADS-D (mean) 4.2 4.4 0.37 EQ-VAS >75 48 36 1.64 1.2-2.3 0.005 . EA+ . UC . . . . . % . % . OR . 95% CI . p value . 7DPPA breath CO<10 ppm 51 19 4.52 3.2-6.4 <0.0001 Mediterranean Diet Score ≥9 52 37 1.84 1.3-2.6 0.0005 Physical activity ≥30 mins/day moderate intensity 16 7 2.48 1.4-4.4 0.002 METSmax target achieved (Chester Step Test) 38 27 1.62 1.0-2.6 0.04 BMI <25kg/m2 23 32 0.65 0.5-0.9 0.02 BP <140/90 (130/80 DM or vascular disease) 52 43 1.47 1.1-2.1 0.03 TC <4.5mmol/l 21 24 0.83 0.6-1.3 0.39 HADS-A (mean) 5.3 5.5 0.37 HADS-D (mean) 4.2 4.4 0.37 EQ-VAS >75 48 36 1.64 1.2-2.3 0.005 Open in new tab Table 1. ITT Results . EA+ . UC . . . . . % . % . OR . 95% CI . p value . 7DPPA breath CO<10 ppm 51 19 4.52 3.2-6.4 <0.0001 Mediterranean Diet Score ≥9 52 37 1.84 1.3-2.6 0.0005 Physical activity ≥30 mins/day moderate intensity 16 7 2.48 1.4-4.4 0.002 METSmax target achieved (Chester Step Test) 38 27 1.62 1.0-2.6 0.04 BMI <25kg/m2 23 32 0.65 0.5-0.9 0.02 BP <140/90 (130/80 DM or vascular disease) 52 43 1.47 1.1-2.1 0.03 TC <4.5mmol/l 21 24 0.83 0.6-1.3 0.39 HADS-A (mean) 5.3 5.5 0.37 HADS-D (mean) 4.2 4.4 0.37 EQ-VAS >75 48 36 1.64 1.2-2.3 0.005 . EA+ . UC . . . . . % . % . OR . 95% CI . p value . 7DPPA breath CO<10 ppm 51 19 4.52 3.2-6.4 <0.0001 Mediterranean Diet Score ≥9 52 37 1.84 1.3-2.6 0.0005 Physical activity ≥30 mins/day moderate intensity 16 7 2.48 1.4-4.4 0.002 METSmax target achieved (Chester Step Test) 38 27 1.62 1.0-2.6 0.04 BMI <25kg/m2 23 32 0.65 0.5-0.9 0.02 BP <140/90 (130/80 DM or vascular disease) 52 43 1.47 1.1-2.1 0.03 TC <4.5mmol/l 21 24 0.83 0.6-1.3 0.39 HADS-A (mean) 5.3 5.5 0.37 HADS-D (mean) 4.2 4.4 0.37 EQ-VAS >75 48 36 1.64 1.2-2.3 0.005 Open in new tab P16 A web-based intervention for healthcare professionals and patients B. Barbara Sassen1 1University of Applied Sciences, Utrecht, Netherlands Purpose: Patients with cardiovascular risk factors can reduce their risk of cardiovascular disease by increasing their physical activity and especially their physical fitness. According to guidelines for cardiovascular risk management, healthcare professionals (HCP) should encourage their patients to engage in physical activity. This article provides insight regarding the systematic development of a web-based intervention for both HCP and patients by making use of the development method Intervention Mapping. The different steps of Intervention Mapping are described to open up the black box of web-based intervention development and to support future web-based intervention development. Methods: The development of the Professional and Patient Intention and Behaviour Intervention (PIB2–intervention) was initiated with a needs assessment for both HCP and their patients with cardiovascular risk factors. We formulated performance and change objectives and, subsequently theory and evidence-based intervention methods and strategies were selected that were thought to affect the intention and behaviour of HCP and patients. The rationale of the intervention was based on different behavioural change methods that allowed us to describe the scope and sequence of the intervention and produced the web-based intervention components. The web-based intervention consisted of five modules, comprised of individualized messages and self-completion forms, as well as charts and tables. Results: The systematic and planned development of the PIB2–intervention resulted in an internet-delivered behaviour change intervention. The intervention was not developed as a substitute for face-to-face contact between professionals and patients, but as an application to complement and optimize health services. The focus of the web-based intervention was to extent professional behaviour of HCP and the risk-reduction behaviour of patients with cardiovascular risk factors. Conclusion: The Intervention Mapping Protocol provided a systematic method for developing the intervention and each intervention design choice was carefully thought-out and justified. Although it is neither a rapid nor an easy method for developing an intervention, the protocol guides and directs the development process. The application of evidence-based behaviour change methods used in our intervention offers insight regarding how an intervention may change intention and (health) behaviour. Further research should test the effectiveness of the PIB2–intervention (Trial ID: ECP-92). P17 Depression is independently associated with 7–year mortality in patients treated with percutaneous coronary intervention: results from the reseach registry N L M Nikki Damen,1 H. Versteeg,1 E. Boersma,2 RM. Van Geuns,2 RT. Van Domburg2 and SS. Pedersen1 1Tilburg University, Medical Psychology, Tilburg, Netherlands 2Erasmus Medical Center, Department of Cardiology, Rotterdam, Netherlands Purpose: Depression has been associated with poor prognosis in coronary artery disease (CAD), but little is known about the impact of depression on long-term mortality. We examined whether depression was associated with 7–year mortality in patients treated with percutaneous coronary intervention (PCI). Methods: Consecutive PCI patients (N=1234; 72.0% men; mean age 62.0±11.1 years, range [26–90] years) from the Rapamycin- Eluting Stent Evaluated At Rotterdam Cardiology Hospital (RESEARCH) registry completed the Hospital Anxiety and Depression Scale (HADS) to assess depression at baseline. The endpoint was defined as all-cause mortality. Results: The prevalence of depression was 26.2% (324/1236). After a median follow-up of 7.0±1.6 years, 187 deaths (15.2%) from any cause were recorded. The incidence of all-cause mortality at follow-up in depressive patients was 23.5% (76/324) versus 12.2% (111/910) in non-depressive patients. Cumulative hazard functions differed significantly for depressive versus non-depressive patients (log-rank X2=25.57, p < .001). In multivariable analysis, depression remained independently associated with all-cause mortality (HR=1.56; 95%CI [1.03–2.35], p = .035), after adjusting for socio-demographics and clinical characteristics, and anxiety and the “distressed” (Type D) personality. Conclusions: In the current study, depression was independently associated with a 1,5–fold increased risk for 7–year mortality in patients treated with PCI. Early identification and treatment of depression is important to curb the adverse effects of depression on health outcome. Future studies are warranted to further examine the impact of depression on long-term mortality, in addition to short-term mortality. Oral Abstract Session 2 Friday, 16 March 2012 - 15:30 - 17:00 Location: Auditorium 12 P32 Poor health status in implantable cardioverter defibrillator patients: shock, patient pre implantation personality, or both as culprits? SS. Susanne Pedersen,1 FB. Tekle,1 MT. Hoogwegt,1 L. Jordaens2 and DAMJ. Theuns2 1Assistant Professor DAMJ Theuns, Tilburg University, Tilburg, Netherlands 2Erasmus Medical Center, Rotterdam, Netherlands Open in new tabDownload slide Figure from Abstract P32 Purpose: An implantable cardioverter defibrillator (ICD) shock is a critical event to patients that may influence psychological adaptation and quality of life post implantation. However, given that other factors may play an equally important role, we compared the influence of shock and the patient’s pre implantation personality on health status, using a prospective study design. Methods: Consecutively implanted ICD patients (N = 383; 79% men) completed the Type D Scale at baseline and the Short-Form Health Survey 36 (SF-36) at baseline, 3–, 6–, and 12 months. Results: Of all patients, 23.5% (90/383) had a Type D personality and 13.8% (53/383) experienced a shock during follow-up. Shocked patients reported significantly poorer health status, as did Type D patients. Health status patterns were poorest in patients with combined Type D personality and shock during follow-up (Figure 1). Shock during follow-up was a significant independent predictor of poorer health status for 4/8 subscales of the SF-36 (all ps < .05), with shocked patients scoring between 4.79 to 13.30 points lower than non-shocked patients. Type D personality was an independent predictor of poor post implantation health status for 6/8 of the SF-36 subscales, with Type D patients scoring 3.10 to 8.02 points lower on these domains, adjusting for demographic and clinical characteristics. Conclusions: ICD shock and the patient’s pre implantation personality disposition played an equally important role in determining patients’ health status 12 months post implantation. Identification of the patient’s personality profile prior to ICD implantation may help identify subsets of patients who may need additional care e.g. of a psychosocial nature. P33 Postoperative complications following heart surgery - The Danish experience H. Helle Bang1 and CK. King1 1Rigshospitalet - Copenhagen University Hospital, Heart Centre, Department of Cardiothoracic Surgery, Copenhagen, Denmark Purpose: International nursing research indicates that a significant amount of patients experience complications following discharge from hospital after heart surgery. Common complications described in the literature include fatigue, pain, depression and wound infection. The purpose of this study was to investigate whether these complications were also experienced by Danish heart surgery patients. Another purpose of the study was to investigate the number of complications that required re-hospitalization during the first year after surgery. Method: From 2004 - 2008, all patients over 18 years of age undergoing CABG and/or valve surgery together with surgical treatment for atrial fibrillation were included in the study. 151 patients participated, 37 women and 114 men. All patients were asked to complete a questionnaire 1, 3, 6 and 12 months after surgery. The questionnaire contained 5 items. It was possible for the patients to add personal comments to the questionnaire or elaborate on their answers in their own words. Results: 82 % of the patients experienced postoperative complications. The most common problem was dyspnoea, which was experienced by 61 %. 42 % experienced pain, 35 % complained of palpitations, 29 % felt that their mood was negatively affected by the surgery, 24 % felt tired and 17 % suffered from infection of either the sternum or the leg. 58 %, which is a surprisingly high number of patients, reported complications that required re-hospitalization within the first year after surgery. Conclusion: This study shows that Danish patients have a high incidence of postoperative complications following heart surgery. The most common complications are dyspnoea, pain, palpitations and depression. These results are in agreement with international research. This leaves us with an important question: How can we as nurses assist patients in preventing and treating these complications, before they end up in hospital? To answer this, it would be relevant to explore the patient perspective in further research, preferably using a qualitative approach: How can we improve our pre-surgical information? How do we make professional nursing care more accessible to patients after discharge? To what degree are the daily lives of patients affected by postoperative complications? Consequently, we plan to undertake an interview study in 2012 to properly clarify these and other questions regarding postoperative complications in heart surgery patients. P34 Potentially detrimental lifestyle behaviours in adolescents with congenital heart disease in the transition to adulthood E. Eva Goossens,1 K. Luyckx,2 N. Mommen,1 M. Gewillig,3 W. Budts,4 N. Zupancic5 and P. Moons1 1Center for Health Sevices and Nursing Research, Katholieke Universiteit Leuven, Leuven, Belgium 2Catholic University Leuven, School Psychology and Child and Adolescent Development Leuven, Belgium 3University Hospitals Leuven, Department of Paediatric Cardiology, Leuven, Belgium 4University Hospitals (UZ) Leuven, Department of Congenital & Structural Cardiology Leuven, Belgium 5Department of Nursing and Midwifery, Leuven University College, Leuven, Leuven, Belgium Purpose:To optimize long-term outcomes, adolescents with congenital heart disease (CHD) should adopt health-promoting behaviours. However,adolescents often experiment with the use of illicit drugs, alcohol and tobacco. This study aimed (i) to investigate the prevalence of a health-compromising lifestyle in adolescents with CHD (14–19y); (ii) to compare the prevalence of these behaviours with controls; and (iii) to explore the natural history of lifestyle over a 9–month period. Methods: As part of a 4–wave longitudinal study (i-DETACH), data on lifestyle were collected in 429 adolescents of whom 401 were matched (1:1) with a control. We used the self-report Health Behaviour Scale-CHD, measuring the use of alcohol,cigarettes, and illicit drugs, dental care, and physical activities. This questionnaire allows the calculation of a ‘substance use’ (binge drinking; smoking;drug use) and a ‘dental hygiene’ risk score (no dental visits;not brushing the teeth;not flossing the teeth) both ranging from 0–3. An ‘overall health risk score’(score range 0–7) was computed on the substance use score, dental hygiene risk score, and the absence of participation in physical activities. These 3 risk scores were transformed to a scale ranging from 0 (no risk) to 100 (maximum risk). Scores were compared across age cohorts using the Jonckheere-Terpstra trend test. Intra-individual changes in scores over a 9–month period were evaluated using the Wilcoxon-signed rank test. Results: Data showed an increasing trend in substance use when patients grow older (p < 0.001).Dental hygiene risk scores increased in patients aged ≤ 16.9y, but declined afterwards. Analysis of the overall health risk scores demonstrated an increase in patients until the age of 16.9y. The intra-individual evolution in risk scores over a 9–month period, showed the substance use score (p = 0.005) and the overall health risk score (p = 0.001) to increase significantly. Comparison of the risk scores between adolescents with CHD and matched controls showed the substance use score (p < 0.001) and the health risk score (p < 0.001) to be significantly lower in patients. The dental hygiene risk scores were found to be significantly higher in patients compared to matched controls (p = 0.04). Conclusions: These results showed that the prevalence of health risk behaviours increase in adolescents with CHD as they grow older. Compared to their peers, the substance risk score and the overall health risk score were found to be lower in patients. Although excellent dental hygiene is important for patients with CHD, our study revealed they engage less often in preventive dental behaviours. P37 Self-assessed needs of supportive care in patient-partner dyads affected by heart failure M. Maria Liljeroos,1 S. Agren,1 T. Jaarsma1 and A. Stromberg1 1Linkoping University, Linkoping, Sweden Background: Chronic heart failure (HF) may cause great suffering for both patients and their families. Family members have an important role in supporting the patients managing the self-care. Patients and their families need support in order to be prepared to deal with the HF symptoms and its effects on daily life and well-being and the self-care regimen. However, their needs must be further explored. Aim: To describe the self-assessed needs of supportive care in patient-partner dyads affected by HF. Methods: The study has a family perspective defining the patient-partner dyad as the family. Dyadic processes are based on the assumption that each participant affects and is affected by the other. Focus group interviews were performed with patient-partner dyads affected by HF. The interviews were led by a moderator using an interview guide and with an observer supporting the data collection including documentation of memos and non-verbal activities. The interviews were tape-recorded, transcribed verbatim and analyzed using content analysis. Results: The preliminary analysis is based on 8 focus group interviews including 19 patient-partner dyads (mean age patients 72 years, partners 70 years, 63 % male patients). During the initial analysis seven themes were identified that described the self-assessed needs of supportive care: (1) Continuous regular follow-up visits at a heart failure clinic, (2) Easy access to care through telephone hours, (3) Support from health care professionals, (4) Consolation from other dyads and from health care professionals, (5) Planned joint visits, (6) Education given in patient-partner groups, (7) Learning from others. The patient-partners dyads described their needs for easy access to care and long-term support from HF specialists. To increase knowledge about the heart disease and its self-management and to have a lifeline through someone to turn to for advice and consolation were emphasized. They also suggested that the supportive care should be given to both the patient and the partner and also in groups with other patient-partner dyads in the same situation. Conclusion: The results highlight the importance of including partners in the care. The result can guide the design of new intervention to fulfill the needs of education and support for dyads affected by HF. P38 The contribution of caregivers to self-care in heart failure: development of an instrument E. Vellone,1 B. Riegel,2 A. Cocchieri,1 F. D’Agostino,1 G. Rocco3 and R. Alvaro1 1University Tor Vergata, School of Nursing, Rome, Italy 2University of Pennsylvania, Philadelphia, United States of America 3Center of Excellence for Nursing Culture and Research, Rome, Italy Purpose: The purpose of this study was to develop an instrument for measuring the contribution of caregivers to self-care in adults with heart failure (HF). Contribution of caregivers to self-care was defined as the provision of care in the behalf of another person who needs to perform HF self-care; in some cases caregivers only make recommendations to patients, but when patients are unable to perform self-care, caregivers may substitute for patients. This instrument, referred to as the Caregiver Contribution to Self-Care of Heart Failure Index (CC-SCHFI), was developed modifying the Self-Care of Heart Failure Index version 6.2 (Riegel et al., 2009). Methods: A descriptive design was used to study 291 caregivers of adults with HF recruited from 16 cardiovascular centers located across Italy. Data collected included an investigator-designed survey of socio-demographic and clinical characteristics and the CC-SCHFI. The CC-SCHFI is composed of three scales: the self-care maintenance scale (10 items) that measures the caregiver’s contribution to symptom monitoring and adherence behaviors; the self-care management scale (six items) that evaluates symptom recognition, treatment implementation and treatment evaluation by caregivers; and the self-care confidence scale that measures caregiver’s confidence in his/her contribution to the patient’s self-care. Results: Caregivers were mainly female (65.7%) with a mean age of 59.2 years (SD 14.6). In 89% of cases caregivers were the spouses or the children of the patients. Test-retest reliability showed excellent Intraclass Correlation Coefficient (0.92 for self-care maintenance, 0.94 for self-care management and 0.93 for self-care confidence). Comparing the CC-SCHFI scores of caregivers who had received HF education versus caregivers who had not, significant and clinically meaningful differences were found (p < 0.001). In Confirmatory Factor Analysis, the factor structure of the CC-SCHFI revealed good model fit: Self-care maintenance, Chi-square 33.47, p 0.11, CFI = .980, NNFI.963; Self-care management, Chi-square 11.74, p 0.16, CFI = .971, NNFI.945; Self-care confidence, Chi-square 5.86, p 0.31, CFI = .999, NNFI.99. Conclusions: The CC-SCHFI has good psychometric properties and can be used to measure the extent to which caregivers contribute to HF self-care. Researchers using the CC-SCHFI will be able to identify where caregivers contribute to patients’ self-care efforts, thereby identifying where caregivers need additional support. P39 Validity and reliability of the German version of the 9-item European Heart Failure Self-care Behaviour Scale S. Koeberich,1 M. Glattacker,2 T. Jaarsma,3 C. Lohrmann4 and T. Dassen5 1University Freiburg – Medical Center, Dept. of Cardiology/Angiology, Freiburg, Germany 2University Freiburg – Medical Center, Dept. of Quality Management & Social Medicine, Freiburg, Germany 3Linköping University, Dept. of Social and Welfare Studies (HAV), Norrköping, Sweden 4University Graz, Institute of Nursing Science, Graz, Austria 5Charite – Campus Virchow-Klinikum, Department of Nursing Science, Berlin, Germany Background: Heart failure (HF) is one of the most prevalent diseases in Europe affecting over 15 million people. Promoting self-care in patients with heart failure is a promising strategy to maintain health and to prevent exacerbation of HF with consecutive need of health care services. To assess patient’s self-care valid and reliable instruments are necessary. However there is no psychometric tested instrument for the use in a German HF population. Aim: The aim of the study was to evaluate validity and reliability of the German version of the 9–item European Heart Failure Self-care Behaviour Scale (G9–EHFScBS). Method: Cross-sectional survey with 109 patients with HF. Construct validity including factor analysis and discriminant validity, concurrent validity as well as test-retest- reliability and internal consistency were analysed. Results: Participating patients were predominantly male (71%) with an average age of 62.5 years (SD: ± 11.9), were mostly classified in New York Heart Association (NYHA) class II/III (51%/37%) and had a median left ventricular ejection fraction (LVEF) of 25% (Interquartilerange: 20–35%) Item responses were biased to the answer which indicates adherence towards self-care behaviours leading to a positively skewed distribution. Cronbach’s alpha as a measure for internal consistency was 0.71 (95%CI: 0.63–0.77). Test-retest reliability using Intra-class correlation coefficient showed substantial agreement for the whole scale (ICC: 0.69; 95% CI: 0.56–0.79). The G9-EHFScBS was able to distinguish patients with and without extra heart failure education on a statistics significant level (t = 2.105; p = 0.04). The G9–EHFScBS correlated only weak on a non statistical significant level (Pearson r = 0.096; p = 0.32) with a quality of life questionnaire (Kansas City Cardiomyopathy Questionnaire) approving discriminant validity. Factor analysis distinguished three subscales which is not in line with the theoretical assumption of two subscales of the original version. Conclusion: The G9-EHFScBS deemed to be a valid and reliable instrument to assess HF specific self-care in a German HF population. P40 Discrepancy between improvement in NYHA functional class and patient-reported health status following CRT – who knows best: the physician or the patient? H. Versteeg,1 MM. Meine,2 AE. Tuinenburg,2 PA. Doevendans,2 J. Denollet1 and SS. Pedersen1 1Tilburg University, CoRPS Center of Research on Psychology in Somatic diseases, Tilburg, Netherlands 2University Medical Center, Department of Cardiology, Utrecht, Netherlands Background: A positive clinical response to cardiac resynchronization therapy (CRT) implies improvement in health status, including relief of symptoms, a decline in functional limitation and improved quality of life. In cardiology practice, this is often defined as an improvement in NYHA functional class. We examined the association between improvement in physician-rated NYHA functional class and patient-reported health status in the first 2 months after CRT implantation. Methods: Consecutively implanted CRT patients (N=101; mean age=65.2±10.1; 28 women; NYHA: II (21), III (77), IV (3)) were recruited from the University Medical Center Utrecht, the Netherlands. All patients completed the Kansas City Cardiomyopathy Questionnaire (KCCQ) at the time of implantation and 2 months post implantation. Information on NYHA functional class was obtained from patients’ medical records. Results: Of all patients, 42 (41.6%) improved by ≥1 NYHA class in the first 2 months after CRT implantation. Of the 59 patients whose NYHA functional class remained stable, 61% reported clinically relevant improvements in the KCCQ overall summary score, while only 45% of the patients reporting better health status also improved in NYHA functional class. Logistic regression results (ps≥.05) and c-statistics (range 0.53–0.61) confirmed that improvement in NYHA functional class was not associated with improvement in KCCQ scores. Conclusions: Our results show a large discrepancy between improvement in physician-rated NYHA functional class and patient-reported health status in the first 2 months after CRT implantation. This emphasizes that health status measures may have additional value over NYHA functional class in assessing short-term clinical response to CRT. Moderated Posters Session 1 Friday, 16 March 2012 - 10:00 - 11.00 Location: Moderated Posters area P46 Shock anxiety in ICD recipients: what is the impact of recent tachyarrhythmia - irrespective of shock exposure? I. Ingvild Morken,1 K. Isaksen,1 B. Karlsen,2 TM. Norekval,3 E. Bru2 and AI. Larsen1 1Stavanger University Hospital, Department of Cardiology, Stavanger, Norway 2Haukeland University Hospital, Department of Cardiology, Bergen, Norway 3University of Stavanger, department of health studies, Stavanger, Norway Purpose: Shock anxiety is prevalent also among ICD recipients who have not experienced shocks. Other factors than shock can induce shock anxiety. The presence of tachyarrhythmia may lead to an anticipation of receiving an ICD shock. We hypothesized that ICD recipients with recent documented tachyarrhythmia, irrespective of shock exposure would experience increased shock anxiety. Methods: ICD recipients (n=167) attending the same outpatient pacemaker and ICD clinic in a Norwegian university hospital were included in this cross sectional study. The sample was divided into three sub-samples: 1) Patients with no history of ICD shocks and no documented tachyarrhythmia the last year (low symptom group; n=62), 2) Patients with documented tachyarrhythmia the last year without any ICD-shock (n=48), and 3) Patients with ICD shocks (n=57). We used the Florida Shock Anxiety Scale (FSAS), self-reported NYHA class, self-reported use of anxiolytic medication and reports of gender and age. The questionnaire response rate was 81%. Clinical variables were obtained from the hospital medical records. Analysis was conducted by analyses of covariance controlling for sex, age, NYHA class and use of anxiolytic medication Preliminary results: Patients with a history of ICD shocks had the highest FSAS-scores which was significantly higher than the score in the low-symptom-group(M= 16.56 vs 13.59, p = 0.028). Even more interesting was that the group with recent tachyarrhythmia also scored significantly higher on FSAS compared to the low symptom group (M = 15.65 vs 13.59 p = 0.036). Conclusion: These findings suggest that in addition to having received an ICD-shock recent tachyarrhythmia per se might be associated with elevated shock anxiety. P47 Risk factors for postoperative pulmonary complications in coronary artery bypass graft surgery patients H. Haleh Boroumand1 and HALEH. Boroumand1 1Sheikh Hospital, Mashhad, Iran (Islamic Republic of) Background: Pulmonary complications are among the most frequently reported complications after coronary artery bypass graft (CABG) surgery. However, the risks of postoperative pulmonary complications (PPCs) are not equal for all patients. So despite numerous advances in anesthesia, surgical techniques, and postoperative care for coronary artery bypass graft (CABG) surgery, postoperative pulmonary complications (PPCs) still account for postoperative morbidity. Materials & Methods: To determine current risk factors for PPCs in CABG surgery patients.In Canada (2007, yang and Jensen, Faculty of Nursing ) a retrospective cohort design was used.Health records were reviewed for patients (n = 315) who had CABG surgery at a large quaternary healthcare center over a 4 month period. Pre-, peri-, and postoperative risk factors for PPCs were recorded as binary variables.Data were further assessed according to PPCs and non-PPCs using logistic regression models. Results: PPCs occurred in 99.4% of this CABG surgical cohort.The most frequent PPCs post CABG surgery were: Atelectasis Pleural effusion Atelectasis with pleural effusion Pneumonia This factors were found to be related to the presence of atelectasis: Age >65 years Diabetes No significant risk factors were related to the development of pleural effusion or atelectasis with pleural effusion. Postoperative pneumonia was associated with : Previous myocardial infarction Ventilation >10 h Hospital stay >5 days Postoperative pneumothorax was associated with : History of bronchitis COPD Postoperative pulmonary edema was associated with : history of heart failure COPD And other lung diseases Conclusion: These findings contribute to the understanding of PPCs in post-CABG surgery patients and assist in identification of patients at risk for developing PPCs. Another research in Netherlands were examined in 117 adult patients who had undergone elective CABG surgery at the University Medical Centre show that Preoperative risk factors for developing PPCs were: An age of >/=70 years productive cough Diabetes mellitus A history of cigarette smoking Protective factors against the development of PPCs were a predicted inspiratory vital capacity of (>/=75% and a predicted maximal expiratory pressure of (>/=75%). P48 Sleep, daytime function and quality of life of patients with mechanical circulatory support J. Casida,1 R. Brewer2 and C. Smith2 1Wayne State University College of Nursing, Detroit, Michigan, United States of America 2Henry Ford Hospital Cardiothoracis Surgery Department, Detroit, United States of America Purpose: To identify and describe: (1) characteristics of sleep quality, daytime sleepiness, and quality of life (QOL) pre and post implantation of a left ventricular assist device (LVAD); (2) changes in sleep quality, daytime sleepiness, and QOL at baseline and 6 months post implant; and (3) relationships among the sleep quality, daytime sleepiness, and QOL variables. Methods: We employed an exploratory research design. Fifteen patients with continuous/non-pulsatile flow LVAD consented to partake in the study. However, only 12 patients completed the baseline and 6–month post-LVAD implant data. We used the Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESS), and Minnesota Living with Heart Failure Questionnaire (MLHFQ) to measure study variables. Data were analyzed using IBM SPSS 19.0 software. Results: Patients reported worse sleep quality accompanied by daytime sleepiness particularly at baseline, and persisting up to 6 months post LVAD implant. A significant improvement in QOL was observed at 6 months post implant, but remained at poor levels. Correlations among sleep disturbance and daytime dysfunction components of PSQI and global daytime sleepiness (ESS) with QOL were strong (Pearson’s correlations r >.60; p values <.05). Conclusion: We report the first empirical data describing the characteristics and correlations among sleep quality, daytime sleepiness, and QOL in patients with LVADs. Our findings offer beginning evidence about the sleep-QOL connection in this population which warrants attention in clinical practice and research. Further research is required to clearly elucidate these phenomena in patients with mechanical circulatory support and other implantable artificial organs. P49 Analysis of the validity of the Health Behaviour Scale-CHD in adolescents and adults with congenital heart disease based on test content E. Eva Goossens,1 K. Luyckx,2 N. Mommen,1 M. Gewillig,3 W. Budts,4 N. Zupancic5 and P. Moons1 1Center for Health Sevices and Nursing Research, Katholieke Universiteit Leuven, Leuven, Belgium 2Catholic University Leuven, School Psychology and Child and Adolescent Development Leuven, Belgium 3University Hospitals Leuven, Department of Paediatric Cardiology, Leuven, Belgium 4University Hospitals (UZ) Leuven, Department of Congenital & Structural Cardiology Leuven, Belgium 5Department of Nursing and Midwifery, Leuven University College, Leuven, Leuven, Belgium Purpose: During adolescence, individuals are often amenable to experiment with alcohol, illicit drugs and cigarettes. These health behaviours are potentially harmful and should be discouraged in patients with congenital heart disease (CHD) to optimize long-term outcomes. Studies investigating health risk behaviours in adolescents and young adults with CHD, however, are scarce. To add to this literature, we developed a comprehensive Health Behaviour Scale-CHD (HBS-CHD) to assess health-comprising behaviours such as smoking, use of alcohol and no participation in physical activities. However,before the use of this scale can be recommended for research and practice, the clinimetric properties of the HBS-CHD should be evaluated. Therefore, this study aimed to investigate the validity of the HBS-CHD based on test content. Methods: To evaluate validity based ontest content, ten experts (7 cardiologists, 3 nurses) evaluated the relevance of scale items using a 4-point rating scale (1 = notrelevant; 4 = relevant). Calculation of item (I-CVI) and averaged scale(S-CVI/Ave) level content validity indices was performed. The excellence of the content validity was assessed using generally accepted cut-off values (≥ 0.78I-CVI for ≥ 6 experts; ≥ 0.80 S-CVI/Ave). To adjust for agreement by chance, the modified multi-rater Kappa (ĸ*) was calculated. Results: Nineteen out of 22 (86.4%)HBS-CHD scale items were rated with an excellent to good content validity. Two items (‘Use of hallucinogenic mushrooms during last 12 months?’ and ‘If yes, how long does it take by bike or on foot (there and back)?’) obtained an I-CVI of 0.60 and a ĸ* of 0.50, representing a fair content validity. One item (’How often do you floss your teeth?’) was evaluated as having a poor content validity (I-CVI=0.50; ĸ*=0.34). The S-CVI/Ave was 0.81 and the overall instrument’s Kappa was 0.78, which reflects an adequate content validity. If the 3 items with poor or fair content validity would be removed from the scale,the S-CVI/Ave would increase to 0.85. Conclusions: The HBS-CHD was developed as a comprehensive questionnaire to evaluate the health risk behaviours of adolescents and adults with CHD. This survey contains questions on components of health behaviour which are highly relevant for patients with heart lesions.Our study offered evidence that the HBS-CHD is content valid for its use in research and clinical practice. P50 Health related quality of life and anaemia in elderly hospitalized patients with heart failure H. Kraai,1 MLA. Luttik,1 P. Johansson,2 RM. De Jong,1 DJ. Van Veldhuisen,1 HL. Hillege1 and T. Jaarsma3 1University Medical Center Groningen, Department of Cardiology, Groningen, Netherlands 2Linkoping University Hospital, Department of Cardiology, Linkoping, Sweden 3Linkoping University, Faculty of Health Sciences, Department of Social & Welfare Studies, Norrkoping, Sweden Background: Anaemia is a serious and highly prevalent co-morbidity in chronic heart failure (HF) patients. The influence on health-related quality of life (HR-QoL) is scarcely studied and no data is available regarding this relation in elderly hospitalized HF patients. Objective: To assess the independent association between HR-QoL and anaemia in elderly hospitalized HF patients and to determine if this association is present in specific aspect of HR-QoL. Methods: Baseline data of the COACH study (Coordinating study evaluating Outcomes of Advising and Counselling in Heart Failure) were used. HR-QoL was assessed with generic and disease-specific questionnaires. Analyses were performed with ANOVA and ANCOVA with covariates age, gender, eGFR, diabetes and NYHA classification. Results: In total 1013 hospitalized patients with mean age of 71 (SD 11) years were included; 70% of these patients had no anaemia (n=712), 14% had mild anaemia (n=141) and 16% had moderate-to severe anaemia (n=160). Independent associations were found between anaemia and physical functioning (p = 0.019), role limitations because of physical functioning (p = 0.002), general health (p = 0.024) and global well-being (p = 0.003). Conclusions: In addition to the burden of heart failure itself, anaemia is an important factor influencing health-related quality of life in elderly hospitalized heart failure patients, most pronounced in the domain related to physical functioning and general health. P51 Implementation of a heart failure alert card and implications for continuity of care L. Burey,1 A. Mcbride,1 M. Megahed,2 C. Feldman,2 M. Spence1 and C. Deaton1 1University of Manchester, Manchester, United Kingdom 2University Hospitals of South Manchester NHS Foundation Trust, Manchester, United Kingdom Guidelines recommend early follow-up for patients with heart failure (HF) after discharge from hospital, but poor communication between inpatient and outpatient services may prevent this. The purpose of this project was to improve continuity of care for heart failure patients between hospital and outpatient services. A pilot project was initiated following interviews with health care professionals (HCP) and patients, which indicated an inconsistency of communication between community HF specialist nurses (HFSN) and the hospital on the admission and discharge of patients. Methods: A heart failure patient alert card was developed and piloted with patients on a community HFSN caseload. It is credit card size and contains patient information and contact details of the HFSN. Patients were asked to present this card if admitted to hospital and request that staff contact their HFSN to inform them of their admission. Follow up data were obtained at 6 and 12 months, including information about admissions, notification of HFSN, individual case studies, and interviews with HCP and patients. Results: 119 alert cards were distributed to the community HFSN caseload during the 12 month pilot. The caseload fluctuates around 90 depending on the number of patients who are discharged or have died. At 12 months 60 patients had been admitted to hospital, and the HFSN was notified in 48 (80%) of the admissions by: family (18), newly hired HF link nurse (8), ward staff (10) and district nurses (9). The HFSNs were informed of patient discharge in 57% of admissions. HFSNs believe this improved communication has led to fewer unnecessary tests on admission, and increased their input into inpatient treatment and discharge planning. Individual case studies indicate that the alert card has prevented one admission from the emergency department and that an HFSN has been asked to advise on a diuretic dose for one specific patient. Patients like the card as it gives them a feeling of protection and empowerment, especially if admitted to general wards or for reasons other than HF. The card also acts as a trigger for family members to contact HFSN, if the patient is admitted or puts on weight. Conclusions: Notification of the HFSN on patient admission, and their involvement in care and discharge planning, increased during the pilot project. This complemented the work of the HF link nurse appointed during this time. The alert cards were a trigger to better communication among HCP across inpatient and outpatient services, families and patients. Patients felt empowered by the cards. P52 Initial psychometric evaluation of the council of nutrition appetite questionnaire (CNAQ) in patients with chronic heart failure K. Arestedt,1 C. Andreae2 and A. Stromberg2 1Linnaeus University, School of Health and Caring Sciences, Kalmar, Sweden 2Linkoping University, Faculty of Health Sciences, Linkoping, Sweden Purpose: Malnutrition is common among patients with severe chronic heart failure and is associated with poor prognosis and decreased quality of life. The mechanism behind malnutrition is not fully understood but poor appetite seems to be one contributory factor. Appetite assessments is therefore of importance in care of patients with heart failure. The Council of Nutrition Appetite Scale (CNAQ) is one promising domain specific scale to assess appetite. The CNAQ have been developed and evaluated in patients with cancer but it has not undergone any extensive validation. The aim was therefore to psychometrically evaluate the CNAQ in patients with heart failure. Method: The CNAQ consists of eight items, all with a 5 point response scale. The score can range between 8 and 40, higher score imply better appetite. Four of the items from CNAQ can be used separately and form the shorter Simplified Nutritional Appetite Questionnaire (SNAQ). For the present study, the CNAQ was forward translated from English to Swedish and then back translated into Swedish. The scale was distributed to 111 patients at four heart failure clinics in Sweden. The inclusion criteria was diagnosed HF through echocardiography, functional class corresponding to NYHA II to IV, and ability to read and understand Swedish. The CNAQ was psychometrically evaluated regarding data quality (score distribution), homogeneity (item-total correlations), internal consistency (Cronbach’s alpha), and dimensionality (exploratory factor analysis). A linear regression analysis was performed to evaluate how much of the total variance in CNAQ was explained by SNAQ. Results: This initial evaluation of the CNAQ and SNAQ showed a negative score distribution which deviated significantly from a normal distribution. Three items in CNAQ (item 3, 6 and 8) and one item in SNAQ (item 6) did not reach the critical level of item-total correlations ≥0.3. The Cronbach’s alpha for the CNAQ was satisfactory high (α=0.72, 95% CI =0.63–0.81) in contrast to SNAQ (α=0.64, 95% CI=0.49–0.79). The factor analysis resulted in a two factor solution for CNAQ and a one factor solution for SNAQ. The SNAQ explained 83% of the total variance in CNAQ. Conclusions: Findings from this initial evaluation show that CNAQ probably can be used to assess appetite in patients with chronic heart failure. Before strong conclusions can be drawn, CNAQ needs to be evaluated in larger samples of patients with heart failure. P53 Fatigue after myocardial infarction – to be considered more fully in cardiovascular nursing E. Brink1 1Institute of Health and Care Sciences, Center for Person-Centred Care, University of Gothenburg, Gothenburg, Sweden Purpose: The aim of the present study was to investigate the influences of fatigue, sense of coherence and optimism on health-related quality of life (HRQL) in persons who have been treated for myocardial infarction one year after hospitalisation. Methods: The sample consisted of 98 persons, 33 women and 65 men (response rate, 74%) with a mean (SD) age of 67.88 (9.93) years. They had been treated for myocardial infarction in a coronary care unit at a Swedish rural hospital. Now, they participated in a 1-year follow-up study including questionnaires about fatigue, sense of coherence, optimism and HRQL (SF-36). Correlation and regression analyses were performed to explore relationships between variables and to identify variables that best explained the variance of the physical component score (PCS) and the mental component score (MCS) of HRQL. Results: The two regression models for analyses of PCS and MCS included fatigue, sense of coherence and optimism, controlling for age and gender. The results showed that the explained variance of PCS was 47.4%, F(5, 91) = 16.43 and that fatigue (p < 0.001) and sense of coherence (p < 0.05) contributed significantly to the variance. The explained variance of MCS was 48.9%, F(5, 91) = 17.44 and fatigue (p < 0.001) and optimism (p < 0.01) contributed significantly to the variance. Conclusion: Experiences of fatigue after myocardial infarction will have negative influences on both the physical and mental dimensions of HRQL. Compared to sense of coherence and optimism, fatigue was found to be a stronger predictor of HRQL. Clearly, it is time to take patients who suffer from post-myocardial infarction fatigue seriously. It is of vital importance to develop and evaluate fatigue relief strategies in cardiovascular nursing. P54 Depressive symptoms and health care utilization – a comparison between patients with non-cardiac chest pain and patients with ischemic heart disease G. Mourad,1 T. Jaarsma,1 C. Hallert2 and A. Stromberg3 1Linkoping University, Faculty of Health Sciences, Department of Social & Welfare Studies Norrkoping, Sweden 2Department of Internal Medicine Vrinnevi Hospital, Norrkoping, Sweden 3Linkoping University, Faculty of Health Sciences, Department of Medicine and Health Sciences, Linkoping, Sweden Background: More than half of patients admitted to hospital for acute chest pain are diagnosed as having non-cardiac chest pain (NCCP). While there are well established guidelines for diagnosing and treating patients with ischemic heart disease (IHD), an international consensus approach to treat patients with NCCP is lacking. This lack of structured care may possibly cause mental distress in patients and increased health care utilization. Objectives: To compare depressive symptoms and health care utilization in patients admitted for NCCP and patients with acute myocardial infarction (AMI) and angina pectoris (AP) post-hospitalization and at one-year follow-up. Methods: A cross-sectional, descriptive and comparative design was used. In total 131 patients with NCCP, 66 with AMI and 70 with AP completed two depression screening questionnaires 2–3 weeks after the hospital stay and one year later. Data on health care utilization were collected from a population-based diagnose-related database. Results: Depressive symptoms were found in 27% of the participants post-hospitalization and in 26% one year later. At follow-up, 17 patients had recovered from their depressive symptoms, 37 patients had continuous depressive symptoms, and 26 patients had developed depressive symptoms. No difference in depressive symptoms was found between the different diagnose groups neither at baseline nor at follow-up. Patients diagnosed with NCCP visited health care providers in primary care as often as patients diagnosed with AMI, but had fewer hospital admissions. Patients with AP and patients with depressive symptoms utilized most health care services. Conclusion: Persisting depressive symptoms are frequently seen among patients with NCCP as well as in patients with IHD. NCCP patients utilize as much primary care resources as AMI patients. This might imply a need for interventions targeting depressive symptoms in patients with both NCCP and IHD. P55 Is gender associated with survival after in-hospital cardiac arrest? J. Israelsson1 and K. Arestedt2 1Department of internal medicine, Division of Cardiology, Kalmar, Sweden 2Linnaeus University, School of Health and Caring Sciences, Kalmar, Sweden Purpose: Few studies have focused on gender differences regarding in-hospital sudden cardiac arrest (SCA) and existing studies have shown incongruent findings regarding the association between gender and survival. The aim of this study was therefore to investigate if gender was associated with survival after controlling for the influence of age, time to treatment and shockable initial rhythm. Method: Data was collected using the Swedish national register of in-hospital SCA. All SCA situations between January 2007 and June 2011 at a county hospital in the south of Sweden were included (n=293). Nested multiple logistic regression models were used to investigate if gender was associated with survival after cardiac arrest. Three endpoints were used: alive after treatment, alive at discharge and alive 30 days after the cardiac arrest situation. Gender was included as the predictor in the first block while age, time to treatment and shockable initial rhythm was added as adjusting covariates in the second block. Interaction terms between gender and the adjusting covariates were finally included in the third block. Results: The sample included 93 women and 200 men with a mean age of 73.7 (SD=13.2) years. Gender was not associated with survival in any of the tested models. Having a shockable initial rhythm and shorter time to treatment were associated with a higher survival in all endpoints. Younger age was associated with a higher survival 30 days after the SCA. Including the interaction terms in the models, did not increase the explained variance in survival. Conclusions: It seems that there are no significant differences in survival between women and men suffering in-hospital SCA. Moderated Posters Session 2 Friday, 16 March 2012 - 15:00 - 15:30 Location: Moderated area P56 “I am going to have this clicking sound for the rest of my life, so I have to find a way to get used to it”. A phenomenographic study on how patients adapt to a mechanical aortic valve K. Oterhals,1 B. Fridlund,2 JE. Nordrehaug,3 R. Haaverstad3 and TM. Norekvaal3 1Haukeland University Hospital, Bergen, Norway 2School of Health Sciences Jönköping University, Jönköping, Sweden 3Haukeland University Hospital, University of Bergen, Bergen, Norway Objective: Aortic valve replacement (AVR) with a mechanical prosthesis is preferred for patients who appear to have a life expectancy of more than 10 years as they are more durable than bioprosthetic valves. Mechanical valves have some disadvantages, such as higher risk of thrombosis and embolism, increased risk of bleeding related to lifelong oral anticoagulation treatment and the noise from the valve. The aim of this study was to explore and describe how patients adapt to live with a mechanical aortic valve. Methods: An explorative design with a phenomenographic approach was applied. Interviews were conducted with 20 patients, aged 24 to 74 years, having undergone mechanical AVR six months to 10 years prior to study inclusion. Findings: Four ways of how patients adapted to live with a mechanical aortic valve emerged: The competent patients were well informed about their disease and the implications it brought about. They made the necessary lifestyle modifications to keep the INR level stable and wanted to stay in control with their lives. The adjusted patients considered the implications of the mechanical aortic valve as a part of their daily life and experienced that life was back to normal. The unaware patients missed some information or had misunderstood the information they had received. They were not aware of what implications some food and beverages could have on the INR level and were not attentive to prevent infections. The worried patients were still bothered by the closing sound of the valve. The oral anticoagulation treatment and the frequent INR measurements were considered as the most troublesome parts of having a mechanical valve implanted. Conclusions: Patients adapt to life changes that valve implantation cause in different ways. The implications of oral anticoagulation therapy were considered as the most troublesome consequence and for some the clicking sound of the valve was difficult to accept. Patient education and follow-up can make patients with mechanical aortic valves more confident and competent to manage their own health. We suggest that participation in a rehabilitation program following cardiac surgery should be recommended. P57 Education provided by advanced practice nurses is an independent determinant of knowledge in adolescents and adults with congenital heart disease N. Zupancic,1 K. Van Deyk,2 E. Goossens,1 W. Budts2 and P. Philip Moons1 1Catholic University of Leuven, Center for Health Services and Nursing Research Leuven, Belgium 2University Hospitals (UZ) Leuven, Department of Congenital & Structural Cardiology, Leuven, Belgium Purpose: This study aimed (i) to compare the level of knowledge of patients with congenital heart disease (CHD) who previously received structured CHD education (education group) from Advanced Practice Nurses (APNs) with that of patients who did not receive prior formal education (comparison group); (ii) to explore whether the provision of structured CHD education is an independent determinant of knowledge; and (iii) to evaluate whether patients who received this education reached the targets of ‘sufficient knowledge’ (≥80% correct answers). Methods: In a cross-sectional study, we included 317 patients, 226 [54% males; median age 27.5y] of the education group, and 91 [53% males; median age 17y] of the comparison group. Knowledge was assessed using the “Leuven Knowledge Questionnaire for Congenital Heart Disease”. Results: The mean total knowledge score of 57% (±17) in the education group was significantly higher than the 43% (±12) in the comparison group (t = 8.737; p < 0.001). After adjusting for other potentially confounding factors, multivariable linear regression analysis showed that the provision of structured CHD education was an independent determinant of knowledge (Beta = 0.31;p < 0.001). No significant age (Beta = 0.02; p = 0.790) or interaction effect (Beta = -0.98; p = 0.278) was observed (figure 1). Although the level of knowledge was higher in the education group, the targets for ‘sufficient knowledge’ were only achieved by 24 patients (11%) of the education group. Conclusion: This study showed that structured education by APNs is associated with a better level of knowledge. However, patients who received education still lack knowledge about specific aspects of their condition. Hence, continuous efforts in teaching patients, and the development of alternative education methods are pivotal. Open in new tabDownload slide P58 Systematic review and meta-analysis of antihypertensive medication adherence intervention studies using electronic monitoring T. Todd Ruppar,1 J. Demonceau,2 S. De Geest3 and B. Vrijens2 1University of Missouri, Columbia, United States of America 2Aardex Group, Vise, Belgium 3Universität Basel, Institute for Nursing Science, Basel, Switzerland Purpose: Medication non-adherence prevents patients from receiving the benefit of otherwise effective pharmacological therapy for hypertension. While many varied interventions have been tested to improve antihypertensive medication adherence, the overall and relative efficacy of the strategies developed to date is not known. Methods: We systematically reviewed randomized controlled trials testing the efficacy of medication adherence interventions for adults self-administering blood pressure-lowering medication. Our review included only studies which measured adherence by electronic monitoring, which provides the greatest amount of detail on patients’ dosing histories. Data from the studies were independently coded by two researchers, and random-effects meta-analysis was conducted for those studies reporting sufficient data for calculation of effect size. Results: Nine studies met our inclusion criteria (publication range: 1979—2010). Only seven studies reported sufficient data for inclusion in a meta-analysis. The mean adherence effect size (Cohen’s d) was 0.377 (S.E. 0.059). Our review of results indicates that the clinical effect of antihypertensive adherence interventions remains small. Effects observed are often from preventing the lowering of adherence over time seen in control groups, rather than due to increasing adherence from baseline. Conclusions: Medication adherence interventions have the potential for creating positive improvement in patients’ antihypertensive adherence. Additional high-quality primary studies are needed to develop and test interventions better designed to generate greater improvement in adherence, leading to greater impact in measurable clinical outcomes. Effective interventions should then be moved into translational research and tested for effectiveness in ‘real-life’ clinical practice environments. P59 Effects of sleep disordered breathing, insomnia and excessive daytime sleepiness on cognitive function among patients with heart failure C. Carina Hjelm,1 A. Stromberg,1 K. Arestedt1 and A. Brostrom2 1Department of Medical and Health science, Linkoping, Sweden 2Department of Clinical Neurphysiology, Linkoping, Sweden Background: Heart failure (HF) and cognitive dysfunction are prevalent problems among elderly. HF is associated with sleep disturbances such as sleep disordered breathing (SDB) and insomnia (i.e., difficulties initiating sleep, maintaining sleep and non-restorative sleep) often causing excessive daytime sleepiness (EDS). Sleep is one of several factors affecting cognitive abilities. No studies have investigated the effects of different levels of SDB, insomnia and EDS on cognitive function in people with HF. The aim of the present study was therefore to investigate the association between SDB, insomnia, EDS and cognitive dysfunction among people with HF. Methods: A descriptive cross-sectional design was used and 113 people with HF were recruited from a University hospital and two county hospitals in Sweden. Inclusion criteria; Swedish speaking, age >18 years with HF verified with echocardiography, exclusion criteria’s psychiatric illness, drug abuse, and difficulties in understanding or reading the Swedish language or refusal to participate. Demographic and clinical variables were collected from questionnaires, patient interviews and medical records. HF was classified with New York Heart Association (NYHA) class II-IV. SDB was measured objectively with ApneaLink (ResMed, Sweden AB), insomnia with the Minimal Insomnia Symptom Scale (MISS) and EDS with Epworth Sleepiness Scale (ESS). Cognitive function was measured with the Mini-Mental State Examination (MMSE). Results: 113 patients (32% women) mean age 72 years (SD=11.2), 54% classified in NYHA II were included. Mild impaired systolic function (i.e., LVEF 40–49%), moderately impaired systolic function (i.e., LVEF 30–39%), and severely impaired systolic function (i.e., LVEF <30%) was seen among 34%, 41% and 25%. No, mild, moderate and severe SDB was seen among 21%, 34%, 22% and 23%. Mean AHI was 18 (SD=15.3). The mean value for Nadir desaturation was 80 (SD=21.5), and Desaturation <90% 51 (SD=80.2). Difficulties initiating sleep, maintaining sleep and non-restorative sleep were scored by 19%, 50% and 31% of the population. EDS was found in 43%. The mean MMSE score was 28 (SD=1.7). Cognitive dysfunction, mild cognitive dysfunction and no cognitive dysfunction was found among 3%, 23% and 74%. Preliminary results showed that no significant correlations were found between any of the SDB variables, insomnia variables, EDS or cognitive function (i.e., MMSE score). Conclusion: Cognitive dysfunction was uncommon in this HF population. This might together with the predominance of both mild SDB and HF explain the lack of associations to cognitive function. P60 Patients’ experiences of the ICD from a life perspective; with focus on end-of-life issues I. Johansson,1 C. Fluur,1 A. Stromberg2 and K. Bolse3 1Linkoping University Hospital, Linkoping, Sweden 2 Linkoping University, Department of Medical and Health Sciences, Linkoping, Sweden 3 Halmstad University, School of Social and Health Sciences, Halmstad, Sweden Background: The ICD is a device that continuously monitors heart rhythm and has the capacity to deliver life saving therapy in patients who have survived sudden death due to arrhythmia or are at risk for sudden death due to the underlying heart condition. In spite of its capacity to prevent sudden death, it does not offer protection to all kinds of death only reduces death due to ventricular arrhythmia. Several studies have shown that the presence of ICD chocks will lower quality of life. Some studies on physicians’ views concerning the ethical questions raised when considering deactivation of an implanted device have been performed, but knowledge is limited when it comes to patients’ experiences and deeper thoughts on these matters. Aim: The aim of this study was to describe ICD patients’ conceptions on end-of-life issues, with special reference to deactivation or non replacement of the ICD. Methods: The study was performed in cooperation between Linköping University Hospital and 4 county hospitals in south eastern and south western Sweden. The population consisted of 38 ICD carriers, > 18 years with the exclusion of those nearing end-of-life or with terminal illness. The method used was qualitative interviews analyzed with content analysis. Results: “Being part of an unpredictable illness trajectory” was found to be the main theme of the analysis. Three categories emerged: “Insights for better or for worse” containing of the sub-categories “Awareness of the technology” and “Perceptions of health” “Standing at a crossroads” with the subcategories “The deliberate choice” and “The unreflecting way” “From one phase to another” based on the subcategories “Avoiding to make decisions”, “Choosing life at all hazards” and “Facing finality”. Conclusions: Despite comprehensive guidelines relating to the issue of ICD and deactivation in end-of-life, implementing these discussions with patients in clinical practice can be challenging. The results from this study can help clinicians understanding patients’ experiences and thoughts in relation to end-of-life issues and deactivation. Awareness of the technology with different experiences or imagination of shocks as well as knowledge on health, the illness progression and the ICD indication influence patients. Being at crossroad for continuation of the ICD treatment or not can be influenced both by informed and unreflective choices. When reaching the more final phase of life some patients avoid making a decision, others want to prolong life at any price and others agree with that they have entered the finality. Poster Session 1 Friday, 16 March 2012 - 8:30 - 17:00 Location: Poster area Acute cardiac care P61 Investigeting the Greek nurses knowledge on BLS M. Fantaki,1 I. Hatzina,1 M. Kapela,2 D. Koliva,2 M. Salourou,2 K. Toutouzas1 and C. Stefanadis1 1Hippokration Hospital, University of Athens, 1st Department of Cardiology, Athens, Greece 2Hippokration General Hospital, Athens, Greece Introduction: The survival rate after cardiac arrest (CA) is directly related with the prompt or delayed intervention in the place of an incident. Nurses, mainly, are the first who witnes a inhospital CA. Aim: The present study intents to investigate Greek nurses knowledge in resuscitation. Methods: A specially structured questionnaire (26 questions) based the 2005 ERC Guidelines was used. The sample of the study consisted of 227 nurses working in Internal Medicine departments and ICUs, at a big General Hospital of Athens. Results: According to the findings Greek nurses do not seem to have the adequate knowledge to assist cardiac arrest victims. More specifically 65.6% of the nursing staff did not know how to treat a non breathing patient. Furthermore, 59.5% of the sample could not describe the right compression point and 62.6% the suggested rhythm of compressions. Statistical analysis predicted that MSc degree holders, ICU staff, nurses attending BLS seminars and experienced nurses get better scores (p < 0,05). Finally, only 22.7% of the sample attended a BLS seminar organized by ERC. Conclusion: Tthe present study confirm the results of previous ones, inticated that nurses’ knowledge on BLS is not satisfactory. Thus, Greek nurses seem to need more training on BLS and especially with seminars organized by ERC, to feel more confident in assisting cardiac arrest patients. P62 Experiences of patients affected by the “broken-heart syndrome” -takotsubo cardiomyopathy S. Wallstrom,1 K. Dudas,1 E. Omerovic2 and I. Ekman1 1Sahlgrenska Academy, University of Gothenburg, Institute of Health and Care Sciences Gothenburg, Sweden 2Sahlgrenska University Hospital, Wallenberg Laboratory for Cardiovascular Research, Gothenburg, Sweden Background: Takotsubo cardiomyopathy (TTC) is an increasingly recognized syndrome that mimics acute myocardial infarction and heart failure. There is a strong association with negative emotional stress and TTC mostly affects postmenopausal women. The characteristic hallmark of TTC is the development of regional left ventricular dysfunction, which may lead to acute heart failure, cardiac rapture and death. Due to the limited insight into the pathogenesis and epidemiology of TTC, there are no guidelines regarding the diagnosis, treatment and follow-up of these patients. Similarly, little research attention has been directed toward the patients’ perspective and their life experience. Aim: To illuminate life experiences of patients who have been affected by TTC. Method: A pilot study consisting of three narrative interviews has been conducted. The interviews, which lasted between 20–50 minutes, were recorded and typed verbatim, and analyzed by a phenomenological hermeneutical method. Findings: One main theme; Captured by control, and two themes; Experience of demands; and Sense of powerlessness were found in the analysis. The interviewees desired to maintain a sense of control. This perceived control gave them a sense of safety, which was sought-after, since the unknown was perceived as threatening. The theme; Experience of demands was characterized by the interviewees high demands on themselves. These demands seemed to come both from themselves and expectations from others. Experience of demands was formulated from four sub-themes; 1) Helping and protecting others; 2) Never having time to recuperate; 3) Feeling insufficient; and 4) Superficially happy. The second theme; Sense of powerlessness was derived from the following sub-themes; 1) Feeling sadness for close ones; 2) Fear and anxiety; 3) Injustice; and 4) Denial. The interpretation of the theme Sense of powerlessness was that the interviewees from time to time seemed to lose control of their situation. To have a feeling of powerlessness and not being able to influence the situation was a strain on the interviewees. Conclusion: The main result from the pilot-study is that the patients experience that they are captured by a need to be in control, they cannot get out, neither by their own will nor by external circumstances. The situation is characterized by fear, anxiety of losing control and a sense of powerlessness regarding their ability to influence the situation. The constant strain and the desire to control the situation may take the physical expression of takotsubo. P63 Assessment levels of anxiety and depression in patients admitted to CCU with acute coronary syndrome. Admission Vs 72h R. Raffaele Piccari,1 S. Bartolini,1 M. Franchini,1 D. Proietti,1 S. Pelagalli,1 A. Chiantera,1 MS. Fera,1 L. De Lio1 and F. Fiori1 1San Camillo Forlanini Hospital, Department of Cardiology, Rome, Italy Background: Admission to Cardiac Care Unit (CCU) in acute coronary syndrome (ACS) can have far-reaching psychological effects because of the distinct environment. CCU teams rarely made diagnoses of anxiety (A), depression (D). Furthermore, the high incidence of A and D has demonstrated a potential negative effect on clinical outcomes. As a consequence, targeted intervention should be required and the nurse staff might provide a decisive contribution to accomplish them. Methods: Assessment of prevalence, incidence and levels of A and D symptoms in patients (pts) admitted to CCU for ACS at hospital admission, at 72 hours using the Hospital anxiety-depression scale (HADS) composed by two sub-questionnaires, 7 items each. Exclusion criteria were: age>65, cognitive impairment, III to IV Killip Class and hemodynamic instability. Results: Preliminary data involve 115 consecutive pts aged ≤ 65 y (mean age 51.3±9.1 years; 87,8% males, 67,5% with STEMI, 32.5% with NSTEMI) from March 2009 to Feb 2010. High levels of A (HADS_A score ≥8) were present in 43% of pts at admission, in 36% after 72 hours (p = 0,013). Pts D levels at 72 hours were higher than at admission but no statistically significant (p = ns). D symptoms (HADS_D ≥8) were present in 36% of pts at admission, in 46% of pts at 72 hours. Pts A levels at 72 hours were significantly higher in female (HADS 9.08±4.5 vs 5.96±3.8, p = 0.031) and widowed (HADS 11.5±2.18, p = 0.03) Pts D levels at 72 hours were significantly higher in living alone (at entry HADS 9.44±2.6 vs 6.69±2.7, p = 0.004, a 72 h HADS 9±3.3 vs 6.58±2.7, p = 0.013. No statistically significant differences were found among other assessed variables (age, education, income, lifestyle, PTCA, pre-coronary time, risk factors). Conclusion: The 72 hours follow-up results of our prospective study confirm at baseline high levels of A in pts with ACS tend to decline significantly. On the contrary, D levels showed an increasing trend, although not statistically significant. Working towards providing optimal psychological care will have a positive effect on patients’ psychological recovery and may also help physical recuperation after critical care. P64 Correlation of hemodynamic parameters and subjective evaluation of health status in patients with acute heart failure Z. Marinkovic,1 J. Veselinovic,1 N. Tasic,1 S. Boskovic,1 M. Matic1 and P Petar Otasevic1 1Dedinje Cardiovascular Institute, Belgrade, Serbia Introduction: Acute heart failure is a complex syndrome that requires urgent diagnosis and treatment. Assessment of clinical status and treatment effects in practice, often based on subjective symptoms of patients. Objective indicators, such as right heart catheterization, is sporadically present because of its demanding technical. There is little data on correlation between subjective and objective parameters in patients with acute heart failure. Purpose: To determine the correlation between hemodynamic parameters and subjective evaluation of health status in patients hospitalized due to acute heart failure. Methods: The study enrolled 15 patients hospitalized due to acute heart failure, in whom Swan- Ganze catheter was inserted. Hemodynamic parameters have been measured (pulmonary capillary wedge pressure (PCWP), pulmonary artery pressures- systolic (PAPs), diastolic (PAPd) and mean (PAPm), and also cardiac index (CI) and right atrial pressure(RAP)). These parameters were compared with subjective nurse’s and patient’s evaluation of condition, using Euroqol- VAS, VAS- dyspnea and Likert scale. For evaluating of having correlation between hemodynamic parameters and subjective methods valuation of dyspnea was used statistical method of linear correlation. Results: Nurse assessement of changes in patients’ condition after therapy correlates with PCWP, PAPs, PAPd and PAPm (respectively, p < 0,01), while correlation wasn’t found with CI and RAP (p = 0,191 and p = 0,579). Values of Euroqol- VAS correlates with PCWP, PAPd, PAPm and RAP, unlike PAPs and CI, where correlation wasn’t found (p = 0,142 and p = 0,088). VAS- dyspnea and Likert scale significantly correlates with all hemodynamic parameters, except Likert scale and CI, where correlation was not found (p = 0,174). Conclusion: Nurse assessment, and the others subjective methods, can be used for rapid assessment of degree of congestion and hemodynamic parameters in patients hospitalized due to acute heart failure. P65 Coronary care unit vs cardiac intensive care unit: how changes the nurse’s role M. Marco Pintarelli,1 D. Nait,1 A. Casale,1 I. Geromella,1 N. Pesic,1 T. Canderlic,1 M. Milo1 and G. Sinagra1 1University Hospital “Riuniti”, Department of Cardiology, Trieste, Italy The cardiac intensive care unit (CICU) at Trieste University Hospital has a catchment area of 250.000 inhabitants, serving a supplementary area of 200.000 people. Each year around 1000 patients are admitted, 33% of them are non residents. 68% patients are male, with mean age 67,7 years. Main admission diagnosis are ST elevation myocardial infarction (22%), acute coronary syndrome (33%), major arrhythmia (16%), acute heart failure (15%), pulmonary embolism, cardiac tamponade, aortic dissection and monitoring after complicated percutaneous interventions. The average length of stay is 2,9 days. An aging population and the consequent increase in comorbidities in cardiac patients make the treatment and management of acute heart disease more complex. Thus, in recent years it has been observed a change in patient population admitted to CICU, and in the methods of treatment of acute cardiac conditions. Hence the need for a reorganization of the CICU, including a constantly updated monitoring system of the clinical activity that contributes to a critical review, promotes high quality of care and improved patient outcomes, therefore identifying educational needs, planning the organization, human resources and materials needed. Over the years the number of admitted patients and the average bed occupancy is gradually increasing, mostly due to less frequent but more complex conditions to manage. These patients frequently undergo advanced diagnostic and therapeutic procedures, which are often invasive. Working in such environment of constant change, with increasing technological advances in treatment and care, requires nursing staff with high expertise and knowledge of the function and clinical application of technology and equipment. In order to cope with these demands it is necessary to constantly develop knowledge and competence, undergoing additional education, learning activity, field and hands-on training, aimed to extend the expertise in other nursing fields. The consequence is a drastic change in the role of the nurse. With new and expanding competences there is a risk of losing sight of the patients’ basic needs. To avoid this we must value the role of the assistive personnel, allowing the nurse to concentrate on other tasks: research, planning and management of the nursing care. Such high standards of care need skilled staff, and besides educating ourselves, we have to educate new nurses. This increased workload has an impact on the whole team, and therefore it becomes essential to share common goals in a perspective of equal educational opportunities targeted to achieve a standardized clinical approach. Acute coronary syndromes P66 Long term prognosis of NSTEMI versus STEMI patients admitted to a District General Hospital without invasive capabilities and followed at nurse-led post-MI clinic M. Testa,1 D. Paliotti,1 L. Clementi,1 L. Candelori,1 P. Corradetti,1 E. Palatroni,1 B. Ruggeri,2 C. Di Francia3 and L. Moretti1 1Division of Cardiology, Ascoli Piceno, Italy 2Clinical Governance Service, Mazzoni Hospital, Ascoli Piceno, Italy 3Cardiovascular Clinical Research Unit, Ascoli Piceno, Italy Background: The diagnosis of acute myocardial infarction (MI) is based, in contemporary practice, on chest pain history and elevated biomarkers, while classification is dichotomized by ECG between ST-elevation MI (STEMI) and non-ST-elevation MI (NSTEMI). Several historical studies investigated long-term prognosis on the basis of non-Q-wave versus Q-wave MI classification whereas fewer recent studies have used the newer MI definition and classification. Methods: Although patients with coronary artery disease exposed to a nurse-led clinic are usually targeted to modify risk factors, unhealthy behaviour and adherence to medical treatment we performed a retrospective analysis in order to describe clinical characteristics, in-hospital management and 6.5 years mortality of all patients who survived the acute phase of MI according to the presence of ST elevation (STEMI) or not (NSTEMI). Between January 2004 and December 2005, 350 acute MI patients, pertaining administratively to our catchment area, were consecutively admitted to our Institution. Acute MI was classified as STEMI or NSTEMI. Results: Final diagnosis was STEMI in 46% of cases and NSTEMI in 54%. Median age was 65.9 years (range 39–92) for STEMI vs 71.3 years (range 37–97) for NSTEMI (p < 0.0001); males were 70.2% in the STEMI group and 65.1% in the NSTEMI group (p = 0.31). The proportion of smokers (36% vs. 18%, p = 0.001) and hypercholesterolemic (54% vs. 42.9%, p = 0.037) was higher in the STEMI group, while prior MI (17.5% vs 6.8%, p = 0.003) and prior revascularization by CABG (p = 0.049) were higher in the NSTEMI group. No statistically significant differences were noted for hypertension (70.2% for STEMI and 68.3% for NSTEMI; p = 0.69) and previous stroke (2.5% in STEMI vs 6.3% in NSTEMI; p = 0.08). At discharge all patients received optimal medical therapy according to current guidelines: Aspirin (95.1%), Beta-blockers (91.4%), RAAS Inhibitors (85.1%) and Statins (86.3%). Median length of stay was 11.4 days (range 1–40) for NSTEMI vs 9.7 days (range 1–90) for STEMI (p = 0.03). Overall Mortality at 6.5 years was 38.1% for NSTEMI vs 22.4% for STEMI (p < 0.0001). Conclusions: Among patients attending a nurse-managed post-MI clinic and identified accordingly to current guidelines, NSTEMI was associated with older age, worse cardiovascular history and higher long-term mortality compared to STEMI. P67 Patient participation, from academic discipline to action in clinical practice J. Faerch1 and MN. Grum1 1Rigshospitalet - Copenhagen University Hospital, Copenhagen, Denmark Background: Demands, wishes and expectations from political and professional as well as patients themselves indicate that patients have to take part in their own care and treatment. In generally it is stated that patient participation is desirable and necessary because it has a positive impact on patients. From a Danish perspective no consensus has been concluded how to interpret patient participation and no guidelines exist how to carry out patient participation in clinical practice. Purpose To investigate and test methods that can move patient participation from a rhetoric level to reality in clinical practice. Method: An integrative review was used as a method to explore and clarify the concept of patient participation. The results from the research were used to develop a new model as a guide for implementation of patient participation in clinical practice. The model illustrates requirements, characteristics and consequences for patient participation and was used as a framework for following interventions: – Teaching the entire ward about the concept of patient participation and implication for clinical nursing practice. – Investigation and integration of research about patient experiences related to ischemic heart disease. – Training in communication skills. – Development of a pedagogical reflection model for decision making focusing patient’s perspective. – Development and implementation of a dialogue sheet. Results: Audits from nursing records show: Results from research about patient experiences are reflected in the records. The description of living with a heart disease has increased from 12% to 62%. Decisions about individual nursing plans have increased from 38% to 92%. Other signs of changes Nurses are showing interest in seeing correlation and similarities between scientific knowledge and clinical practice. The scientific knowledge is used in multidisciplinary discussions and as background for decision making. The nurses are facilitating and encouraging patients to participate in higher extent than before. Conclusion: We are well on track to move patient participation from a rhetoric level to reality in clinical practice. Next step is to ask patients themselves in a questionnaire about their view upon patient participation during their hospitalization. P68 Experiences of being in no mans land - a qualitative follow-up study in patients with acute coronary syndromes A. Fors,1 K. Dudas1 and I. Ekman1 1Sahlgrenska Academy, University of Gothenburg, Institute of Health and Care Sciences, Gothenburg, Sweden Title: Experiences of being in no-man’s-land - a qualitative follow-up study in patients with acute coronary syndromes Background: In the context of nursing several authors have described patients’ needs for understanding and support during rehabilitation after acute coronary syndromes (ACS). Many patients report persistent fatigue (with or without concomitant depression) after an event of acute coronary syndrome, which has been shown to negatively affect daily life. Four weeks of sick leave after hospitalization for an ACS event is recommended while the proportion of full-time sick leave was approximately 40% after eight weeks and after one year almost 25% were still on part- or full-time sick leave in Sweden 2007. Patients have also reported that they feel confused about the treatment and the severity of the coronary disease, still there is a need to identify patient-estimated factors in order to optimize care throughout the continuum of care. Purpose: The aim was to identify patient’s experiences over how they view health care in the hospital and the follow-up care in outpatient and primary care during and after they have been cared for acute coronary syndrome. Moreover, we are interested in the progress of sick-leave and their return to work or other preferred activity. Methods: A qualitative method was used. Semi-structured interviews were conducted with 10 men and 2 women, including a telephone follow-up a few months after discharge. Data analysis was performed using a content analysis approach. Results: Tentative findings indicate that patients have marked confidence in the emergency care and in different investigations performed there. On the other hand, patients feel lost, neglected, objectified and abandoned by care-givers with little (or no) follow-up and support in the health care system after discharge. Furthermore they wish to be more carefully listened to by care-givers and in particular about their symptoms, abilities and concerns. In addition, fatigue and lack of support are factors that complicate return to work or other preferred activity. Conclusions: There is a gap between the care that each patient with acute coronary syndromes expect to get and the care that is actually provided, which emphasizes the importance of individual care plans and person-centred care. Arrhythmias P69 The comparison research on the learning level of nursing senior students about interpreting electrocardiogram in two ways (traditional & systematic) H. Bana Derakhshan1 1Nursing and Midwifery Faculty of Shahid Beheshti Medical University, Tehran, Iran (Islamic Republic of) Introduction: Electrocardiogram is one of the most important tools of evaluation of cardiovascular system. This matter is essential for detecting of heart diseases. At first it is obvious that one must know the characteristics of normal ECG. Purpose: This research is done to know the level of senior nursing students about the interpreting the ECG and comparison of it in two ways: Traditional & Systematic. Methods: This research is a descriptive-analytical research that 60 senior nursing students in randomized way were selected and divided into two groups. Then the researcher after the performing of educational program in traditional & systematic ways measured the level of learning of two groups. This education is done by the comparison of pretests & posttests of each group about interpreting of ECG. The gathering data tool of this research was one questionnaire. This questionnaire includes of 40 questions in different domains of interpreting the ECG. (10 questions for the rules of interpreting ECG, 4 questions for sinus rhythms, 5 questions for atrial rhythms, 4 questions for junctional rhythms, 5 questions for ventricular rhythms, 7 questions for the heart blocks and 5 questions for dysrhythmias).The whole of questions were selected among the questions of final examinations in the level of must know. Results: The level of knowledge in the systematic educational group was significant and higher than the traditional group (p < 0.005). The mean marks of systematic group were 80.68 and for the traditional group were 45.32. Conclusions: The findings show that the learning level of interpreting ECG by the systematic way was more effective than traditional way. P70 Atrial fibrillation - a comprehensive clinical nursing guideline PP. Pernille Palm Johansen,1 L. Boehm,1 K. Larsen1 and SL. Johansen1 1Bispebjerg Hospital of the Copenhagen University Hospital, Department of Cardiology, Copenhagen, Denmark Background: Patients with atrial fibrillation are a large and growing patient group in the Western world and for many patients this condition is associated with frequent hospitalizations and numerous hospital contacts. There is only little research on nursing care for this patient group and as far as we know there are no actual suggestions as to what nursing in this area should include and address. The basis of the project has been a wish from the project participants to learn more about this patient group combined with the requirement for evidence-based practice. Purpose: To prepare literature-based guidelines based on patients with atrial fibrillation experiences. Method: A systematic literature search has been conducted in Pubmed and Cinahl with focus on patient experience. Abstracts have been reviewed with predefined inclusion and exclusion criteria in mind, and finally 25 articles have been included. All identified articles have been read by at least 2 persons with competence within critical reading of research literature. Patient experiences have been identified and the essence has been discussed and validated at a plenary session. The contents of the articles have been systematized by means of the documentation model VIPS, which is used at most hospitals in Denmark. Results: The result is a comprehensive literature-based guidelines supporting evidence-based practice. The guidelines act as an inspirational guide for the interview with patients with atrial fibrillation. The guidelines provide an overview of patient experiences related to their atrial fibrillation, systematized based on the VIPS search terms. Issues experienced by patients have been identified in relation to each of the following search terms: Communication, knowledge/development, breathing, circulation, nutrition, excretion, skin/tissue, activity, sleep, pain/sensory impression and psychosocial aspects. The guidelines are structured in such as way that suggestions are made as to what could be relevant to discuss with the patients. This appears from the left column. In addition, the right column shows identified patient experiences in literature on the subject, including references. For example, the VIPS search term knowledge: Table 1. Search term example: Knowledge Search term: . Questions: . Patient experiences identified in literature. The number in parentheses indicates the literature reference. . Knowledge Understanding of causes and symptoms of atrial fibrillation(AF). Knowledge of treatment. Understanding of medication. Not all patients are aware of the symptoms of atrial fibrillation and are able to explain what AF is (2,5,24). Not all patients with AF know when to contact the hospital (5). Many of the patients with AF do not know the purpose of the medicine they receive (2). Search term: . Questions: . Patient experiences identified in literature. The number in parentheses indicates the literature reference. . Knowledge Understanding of causes and symptoms of atrial fibrillation(AF). Knowledge of treatment. Understanding of medication. Not all patients are aware of the symptoms of atrial fibrillation and are able to explain what AF is (2,5,24). Not all patients with AF know when to contact the hospital (5). Many of the patients with AF do not know the purpose of the medicine they receive (2). Open in new tab Table 1. Search term example: Knowledge Search term: . Questions: . Patient experiences identified in literature. The number in parentheses indicates the literature reference. . Knowledge Understanding of causes and symptoms of atrial fibrillation(AF). Knowledge of treatment. Understanding of medication. Not all patients are aware of the symptoms of atrial fibrillation and are able to explain what AF is (2,5,24). Not all patients with AF know when to contact the hospital (5). Many of the patients with AF do not know the purpose of the medicine they receive (2). Search term: . Questions: . Patient experiences identified in literature. The number in parentheses indicates the literature reference. . Knowledge Understanding of causes and symptoms of atrial fibrillation(AF). Knowledge of treatment. Understanding of medication. Not all patients are aware of the symptoms of atrial fibrillation and are able to explain what AF is (2,5,24). Not all patients with AF know when to contact the hospital (5). Many of the patients with AF do not know the purpose of the medicine they receive (2). Open in new tab P71 Death caused by study medication – an actioncard B. Mortensen,1 C. Hellum,1 AM. Korsgaard1 and A. Lauberg1 1Aalborg Hospital of the Aarhus University Hospital, Aalborg, Denmark Background: Deaths caused by study medication in a clinical drug trial, was the starting point for this project. Drug trials concerned patients with atrial fibrillation. Since this situation never had occured before, it became apparent that there were deficiencies in the existing guidelines. There already existed GCP rules describing how the deaths of experimental medicine in a clinical drug trial were to be handled in relation to reporting to the pharmaceutical company, Science Ethics Committee and the medical Products Agency, but none related to the human aspects in relation to patients, relatives, staff or press. Aim: The aim of this project was to develop guidelines to ensure a professional and human handling of both patients and their bereaved relatives as well as personell involved, press and public. Methods: Systematic literatures search in Pubmed with the following keywords: Death, mortality, medication errors, research and clinical trials were done. Furthermore, systematic literatures search of CINAHL with the following keywords: Medication errors, accidental death and mortality were done. This literature search aimed to identify existing guidelines for the handling of deaths caused by study medication. This and the staff’s practical experience should form the basis for better handling of similar situations. Results: Based on hospital policies and guidelines, GCP rules, Helsinki Declaration, literature research and practical experience a written guideline was drafted for handling unexpected death caused by study medication and similar situations. The guideline contains a detailed description of how an appropriate approach may be applied. This has been translated into an actioncard. This process has resulted in a general policy in the Region of Northern Jutland in Denmark on media response. Conclusion: The outlined actioncard has professionalized the overall handling of all relevant parties in connection with deaths caused by study medication. The actioncard is activated in cases of death caused by experimental drugs in clinical trials or similar situations. Cardiothoracic and cardiovascular surgery P72 A nurse led surveillance program for paediatric cardiothoracic wound site infections S. Stefania Baratta,1 E. Laws,1 A. Guerra,1 A. Taddei,1 G. Rossi,1 M. Bernabei1 and M. Marchi1 1Gabriele Monasterio Foundation CNR/Region Toscana, Heart Hospital, Massa, Italy Background: In Italy surgical wound site infections represent 20% of all hospital acquired infections resulting not only in physical damage to the patient but also increasing health care costs.There is a sound evidence base as far back as the 1970s ( project SENIC) which showed nosocomial infection rates could be reduced by 32% if a well organized infection surveillance program was put in place. Aim: Reduce the frequency of surgical site infection rates in paediatric cardiac surgical patients, by surveillance of wound infection, mapping microbiological flora and defining risk factors Method: Project manager : Infection control nurse. Meetings with surgeons and nursing staff. Development of a report card comprising patient details, operation, ASA (American society of Anesthesiologists) score, type and timing of antibiotic prophylaxis, length of stay and operation.Definition of wound site infection (CDC criteria). Results: (see table) Table. Results may-june 2010. may -june 2011 object . 2010 . 2011 . total patient number 98 ( 57% M/42.8% F) 83 ( 59%M/ 41% F) sternotomy approach 86% 90% ASA 4 94% 94% emergency op 3.2% 1.2% colonized patients (pre op) 15% 14% re- operation 26% 24% media duration of op. mins 230 211 patients on bypass 80% 88% media recovery days 3.9/4.8/11/19 4/4.5/10/20 pre-op/ icu/ post-op/ total days patients with 2 ≥ chest drains 80% 77% total infections of surgical site 12 (12.2%) 1(1.2%) p = 0.0005 (Fishers exact test) object . 2010 . 2011 . total patient number 98 ( 57% M/42.8% F) 83 ( 59%M/ 41% F) sternotomy approach 86% 90% ASA 4 94% 94% emergency op 3.2% 1.2% colonized patients (pre op) 15% 14% re- operation 26% 24% media duration of op. mins 230 211 patients on bypass 80% 88% media recovery days 3.9/4.8/11/19 4/4.5/10/20 pre-op/ icu/ post-op/ total days patients with 2 ≥ chest drains 80% 77% total infections of surgical site 12 (12.2%) 1(1.2%) p = 0.0005 (Fishers exact test) M = male F = female Open in new tab Table. Results may-june 2010. may -june 2011 object . 2010 . 2011 . total patient number 98 ( 57% M/42.8% F) 83 ( 59%M/ 41% F) sternotomy approach 86% 90% ASA 4 94% 94% emergency op 3.2% 1.2% colonized patients (pre op) 15% 14% re- operation 26% 24% media duration of op. mins 230 211 patients on bypass 80% 88% media recovery days 3.9/4.8/11/19 4/4.5/10/20 pre-op/ icu/ post-op/ total days patients with 2 ≥ chest drains 80% 77% total infections of surgical site 12 (12.2%) 1(1.2%) p = 0.0005 (Fishers exact test) object . 2010 . 2011 . total patient number 98 ( 57% M/42.8% F) 83 ( 59%M/ 41% F) sternotomy approach 86% 90% ASA 4 94% 94% emergency op 3.2% 1.2% colonized patients (pre op) 15% 14% re- operation 26% 24% media duration of op. mins 230 211 patients on bypass 80% 88% media recovery days 3.9/4.8/11/19 4/4.5/10/20 pre-op/ icu/ post-op/ total days patients with 2 ≥ chest drains 80% 77% total infections of surgical site 12 (12.2%) 1(1.2%) p = 0.0005 (Fishers exact test) M = male F = female Open in new tab Conclusion: Although some data is missing and other variables could be influencing factors ( the type of dressing used for sternal wounds was changed, the infection control nurse became head nurse of the paediatric ward) our study shows that an efficient surveillance program can reduce infection rates. This project was driven by nursing concerns regarding wound infection, feedback has been given to all staff and the project will continue and be enhanced by the introduction of a new computerised system for nursing notes. P73 A preliminary evaluation of the symptom pattern and prevalence before and up to 6 months after implantation of a left ventricular assist device J. Casida1 1Wayne State University College of Nursing, Detroit, Michigan, United States of America Purpose: Little is known about the reoccurrence of common heart failure symptoms (eg, fatigue) after LVAD implantation. This study aimed to describe the prevalence and pattern of select heart failure symptoms and identify changes in symptom patterns before and up to 6 months after LVAD implantation. Methods: We used self-report questionnaires to collect data from patients (n=12) and measure symptoms at baseline, 1 and 2 weeks, and 1, 3 and 6 months after LVAD. Results: We found that high levels of fatigue, anxiety, depression, and sleep disturbance were prevalent across time periods. However, we did not find any significant time effects on the changes in symptom pattern over time. Conclusion: The preliminary findings set the starting point for large scale studies fundamental to the advancement of symptom management research in LVAD and other patients living with artificial organs. P74 Specific nursing care for patients receiving continuous renal replacement therapy after cardiac surgery N. Neli Negrieva,1 V. Ogorodnik,1 H. Mustafova1 and P. Vasileva1 1National Heart Hospital, Sofia, Bulgaria Goal: Acute renal failure /ARF/ is one of the most serious complications for patients after cardiac surgery. The major predictors of acute renal failure are low LV ejection fraction, acute heart failure, and a history of renal disorders. The continuous renal replacement therapy is a system for blood purification. Goal: to monitor the frequency of applied renal replacement therapy from 2007 to 2010, the specific nursing cares which are required and how parameters are controlled during the therapy. Method: An important condition for the length of the applied renal replacement therapy is the choice of the method and medical devices consistent with the clinical preferences. For that purpose we have to make a distinction between the concepts of hemofiltration, hemodialysis, and hemodiafiltration. Retrospective monitoring of a period of 3 years for 34 patients aged 30 to 75 years with applied renal replacement therapy. The therapeutic scheme includes: Preparation of the hemodialysis equipment. Strict monitoring of the fluid and electrolyte balance on an hourly basis and on a 24–hour basis. Monitoring of the hemostasis. Results: Improvement of renal function is found in 15 patients. The continuous renal replacement therapy was applied for 24 to 96 hours. Results show that the continuous renal replacement therapy removing excessive body fluids, uremic toxins and electrolytes decreases the death rate and increases the survival rate of patients with acute renal failure compared to those undergoing intermittent hemodialysis. Discussion: From a nursing point of view, safety and easy manipulation are of great significance for the choice to be made. The easy assembly and maintenance of the equipment reduces the time necessary for its use, which is always welcomed by the constantly busy intensive care nurses, as they are left with more time for the general nursing cares for patients. The ergonomic method of system control is an important factor for preventing occupational accidents which may occur to the nurses. Using such high-tech equipment as the hemodiafiltration device and other automated technologies employed in the intensive care wards cannot replace the expert nursing skills and decisions. Conclusions: The continuous renal replacement therapy is not only a device and a consumable, but it also requires continuous knowledge of the patient’s status, the work of the devices and how they interact. This is an effective and at the same time very risky therapy, requiring constant and competent control by highly qualified and well-trained nursing staff 24 hours a day, 7 days a week. Coronary Intervention P75 Urinary retention after percutaneous coronary interventions A C Andrea Cornelia Augustin,1 A S. De Quadros1 and R E G. Sarmento Leite1 1Institute of Cardiology of Rio Grande do Sul - University Foundation of Cardiology, Porto Alegre, Brazil Introduction: Urinary retention is a common problem after percutaneous coronary interventions (PCI) performed by femoral approach due to the restriction of the patient to bed for several hours and the difficulty to urinate in a lying position, associated with the use of bedpans and the lack of privacy. Purpose: To evaluate the frequency of urinary retention after PCI and its management in a referral hospital for interventional cardiology. Methods: Patients were prospectively analyzed as part of a randomized clinical trial aimed to compare the incidence of major vascular complications after sheath removal and early ambulation versus conservative management in patients undergoing PCI via the femoral approach. We evaluated strategies for the management of urinary retention, giving preference to non-invasive methods. Intermittent catheterization was performed only when these methods did not reach success. Noninvasive maneuvers were defined as applying supra-pubic heat, turning the male patient in a lateral position or standing beside the bed to urinate, and the female patient to sit on the bedpan with the arterial sheath still inserted. When these maneuvers were not effective, bladder catheterization was performed.These maneuvers were evaluated with the “t” test and the Fischer’s exact test.We considered to be significant a p <0.05. Results: We evaluated 174 patients randomized to early ambulation (4 h after PCI, G1) and 175 patients randomized to conventional management (10h ambulation after PCI, G2). The baseline characteristics of patients in groups early ambulation and conventional management were similar, as assessed by age (59.67 ± 9.77 vs 61.01 ± 10.36) males (63.6% vs 57.1%), body mass index (BMI) (26.98 ± 3.86 vs. 26.98 ± 3.61) and activated clotting time (ACT) at the end of the PCI (324.72 ± 101.42 vs 319.57 ± 101.34). The overall rate of non-invasive maneuvers needed to treat urinary retention was 1.7% (3 patients in each group, p = 1.0), whereas 2% of patients in the conventional group required urinary catheterization for bladder emptying (p = 0.248 ), and 7% of patients in group 1 voided immediately after the end of bed rest (p = 0.00). Vascular complications occurred rarely (1.7% vs 0.6%, p = 0.371). Conclusion: Early ambulation post PCI provides comfort and inhibits urinary retention, may be an alternative for those patients with a tendency to hold or have major discomfort after the resting time period.The time to bed rest used in group 1 was consistent with the ability of physiologic urinary retention. Noninvasive maneuvers were not associated with vascular complications. Devices and technology P76 Vacuum assisted closure as an alternative method of wound treatment is cost effective A. Mlynarska,1 R. Mlynarski2 and E. Pilat2 1Medical University of Silesia, Katowice, Poland 2Upper Silesian Cardiology Center, Katowice, Poland Vacuum assisted closure (VAC) can be an alternative method of treatment for late wound healing and wound infections after the implantation of pacemakers, ICDs and CRTs in selected groups of patients. Guidelines for lead extraction exist, but in some circumstances extraction can be difficult or even impossible. VAC is a clinically accepted method in surgery, cardio-surgery, orthopedics etc. We converted these techniques to the requirements of electrocardiology and we were able to confirm the usefulness of VAC therapy in 11 out of 12 pts treated between 2007 and 2010 - it was possible to avoid extraction of the system. Aim: evaluate the cost effectiveness of VAC therapy as an alternative method of treatment for late wound healing and wound infections as compared to system (device + leads) extraction. Methods: Costs are presented from the point of view of the National Health Service (NHS) of Poland. Calculations were made based on diagnosis-related group (DRG) – the standard method in Poland. Costs of procedures are presented in points according to the DRG and recalculated into US$ (1 DRG point = 51 polish zloty ~ 17 US$). Costs include: the procedure itself, hospitalization, drugs etc. If more than one procedure was performed during one hospitalization (e.g. extraction / reimplantation), only the more expensive procedure will be paid for by the NHS. A period of 2 weeks between the 2 procedures outside the hospital are necessary in order for both procedures to be paid for NHS. Results: The cost of system extraction (independent of the type of device): 59 points = $1003. Reimplantation according to the type of the device - pacemaker: 135 points = $2295; ICD: 590 points = $10030; ICD-CRT: 894 points = $15198. The cost of VAC is calculated as system extraction (independent of the type of device) 59 points = $1003. A clear profit for the NHS in the case of using VAC treatment as opposed to the system extraction are: in case of pacemakers $1292, ICDs - $9027, ICD-CRTs - $14195. Those profits are only for NHS and not for the Department because VAC treatment and system extraction procedures are underestimated by NHS. Conclusions: VAC treatment for late wound healing or wound infections in selected patients instead of system extraction is highly cost effective from the point of view of the NHS. P77 3D high speed rotation angiography (Dyna CT) for catheter ablation of atrial fibrillation and atrial tachycardia L. Plevkova,1 I. Weinlichova,1 K. Holdova,1 J. Brada,1 J. Skoda,1 J. Petru,1 L. Sediva,1 M. Chovanec1 and P. Petr Neuzil1 1Na Homolce Hospital, Prague, Czech Republic Background: Real time anatomical 3D imaging supports performing catheter ablation of atrial fibrillation (AF). In terms of safety and efficacy there is critical to orient the catheters in the real topography of complex anatomical structure - left atrium (LA). In our clinical practise we usually used multi-sliced (MSCT) and or magnetic resonance (MR) to get 3D reconstruction. Recently angiography CT (ACT) allows to get 3D structures of the human heart. Method: Fifty patients (28 male, average age: 57 years, average weight: 86 kg) underwent AF ablation under monoplane fluoroscopic guidance. The ACT data was acquired with DynaCT Cardiac on angiography system (AXIOM Artis; Siemens AG, Germany) with 20x20cm flat detector. We tested two injection protocols to acquire 3D data of the LA. Results: In our group of 50 pts we could get optimal 3D reconstruction in 35 of them and we would be able to use this reconstruction as a base for electroanatomical mapping using CARTO (Biosense - Webster Inc). In all other 15 pts which we did in the beginning of the group (early learning curve) we couldn’t distinguish the LA objects. Most of the technical troubles were caused by less quality of filling the contrast in LAA body. Segmentation of LAA in LSPV is critical to get good quality of imaging. EP technical stuff and radiology technicians must cooperate to calculate ideal time delay for contrast injection in concert with high rate stimulation from right ventricle. We proofed this timing is critical to use Dyna - CT for optimal 3D reconstruction of the LA. Also nurses need to cooperate with the patient to eliminate deep breaths and movements. In 5 pts we compare MSCT and Dyna - CT for electroanatomical mapping with clear right upper shift in case of MSCT. In three pts we couldn’t set isocentrum of the heart. Conclusion: After initial learning curve (first 15pts) we evaluated Dyna - CT aqusition and 3D reconstruction as an useful method for catheter ablation navigation which is critically dependent on the team work, specifically nurse, EP and radiology technician. P78 The experience of introducing a nurse-led complex device service into a tertiary centre N. Nicky Margerison1 and R. Lane1 1Royal Brompton and Harefield NHS Foundation Trust, Middlesex, United Kingdom Background: A nurse-led complex device (CD) service was commenced in January 2007, to help achieve the quality requirements set out in Chapter 8 of the National Service Framework (NSF 2005) for Coronary Heart Disease. The service was developed to give patient’s and their families the support, education and care needed to help them manage their condition and the life changing impact of having a CD. It is recognised that patient’s with potentially life threatening conditions who require protection with CD’s including Implantable Cardioverter Defibrillators (ICD’s), cardiac resynchronisation therapy (CRT) with defibrillator (CRT-D) or pacemaker (CRT-P), are at increased risk of anxiety and depression which can further impair quality of life. Establishing appropriate protocols for providing pre and post implant care has been shown to improve quality of life and avoid unnecessary hospitalisations. Service aims: A nurse-led service was initiated in January 2007 to provide pre procedure counselling long term follow up for all patients receiving a CD. The role of the nurse specialist (NS) has evolved and been adapted in response to patient demand and requirements. Pre-implant: Patient information originally consisted of written information, relating to all aspects of CD implantation and post procedure care, this was discussed with the patient and their families at the time of admission. In 2010 a patient information DVD was produced in-house including staff members and a previous ICD patient. This is now available to all patients pre-admission and has had positive feedback. Patients are contacted pre-admission via a telephone call this is to address any concerns or health problems they may have and to check blood results. Post Implant: Patients are telephoned two weeks post implant to check for wound problems and identify patients in need of further psychological care. A nurse led outpatient clinic has been established for patients who have had therapies, an increase in arrhythmias or symptoms of heart failure. These patients are referred from the pacing clinic and this has alleviated the work load of the cardiac physiologists and physicians. Patients have the contact details of the NS, a help line and an emergency out of hours number. In 2007, there were 170 CD’s implanted increasing to 261 in 2010. There were 198 help line telephone calls in 2007 increasing to 535 in 2010. Conclusion: In our experience a nurse led complex device service has provided an enhanced level of pre and post implant care and support for these vulnerable patients. P79 Transapical aortic valve implantation in patient with degenerative aortic stenosis P. Dorazinova,1 L. Sevcikova,1 T. Zajickova,1 M. Jandudova-Palova,1 M. Mates,1 P. Kmonicek,1 L. Tichacek,1 P. Krivacek,1 T. Mraz1 and P. Petr Neuzil1 1Na Homolce Hospital, Prague, Czech Republic Introduction: Degenerative aortic stenosis is the most common acquired valvular heart disease in adults. Its incidence increases with age. Surgical aortic valve replacement is a standard form of treatment, though unavailable for certain number of patients due to the excessive risk of peri- and postoperative mortality and morbidity. Recently transcatheter aortic valve implantation (TAVI) has become and alternative to conventional surgical treatment in high-risk patients. Methods and Results: We present a case report of a patient with severe aortic stenosis who underwent transapical TAVI. Firstly, we give an overview of results of diagnostic imaging methods needed for decision regarding the type and details of planned procedure. Secondly we describe an implantation procedure and postoperative management. Transapical approach is reserved for patients in whom retrograde approach is not possible. Very close cooperation between interventional cardiologist, cardiac surgeons, imaging specialists and other professions forming a multidisciplinary TAVI team was a key factor for a successful initiation of TAVI program in our institution. Conclusion: TAVI procedure is a novel method of management in patient with severe aortic stenosis who are contraindicated for conventional surgical replacements. Diabetes and metabolic syndrome P80 Evaluation of health related quality of life in patients with metabolic syndrome under therapy D. Dimitrios Tziallas,1 C. Kastanioti,2 K. Savvas,1 V. Tziallas,3 D. Kaskanis,1 S. Patronidou,1 V. Tsimihodimos,1 P. Skapinakis,1 MS. Elisaf1 and V. Mavreas1 1University of Ioannina, Ioannina, Greece 2T.E.I. of Kalamata, Kalamata, Greece 3General Hospital of Athens “G. Gennimatas”, Athens, Greece Background: Metabolic syndrome [MetSyn] is a combination of physiological risk factors that can trigger physical and emotional problems. The aim of this study is to investigate whether MetS is associated with lower health related quality of life (HRQoL) and depression. Methods: New consecutive patients referred to an outpatient lipid clinic for evaluation of possible MetSyn were eligible for inclusion in the study. The MetSyn was defined according to the International Diabetes Federation (IDF) diagnostic criteria. The Medical Outcomes Study, Short Form-36 (SF-36) was used to assess HRQoL. Anxiety and depressive symptoms were assessed by a validated Greek version of the Hospital Anxiety and Depression Scale (HADS). Results: Three hundred and fifty-nine subjects were involved of whom 206 [57.4%] met the diagnostic criteria for the MetSyn and 153 [42.6%] did not. Comparisons of SF-36 scores between patients with and without MetSyn revealed statistically significance differences except of bodily pain subscale. A predominance of anxiety [60%] and depressive symptoms [67%] was observed among subjects with MetSyn. Patients with MetSyn undergoing a therapeutic approach showed no improvement in its general and mental health. Conclusions: The presence of MetSyn was associated with more impaired HRQoL as well as depressive behaviours. Education and behavioural aspects P82 COR-PRIM: An etnographic small-scale study on the enactment of PBL in patient education after an event of CHD L. Anna-Lisa Hjelmfors,1 P. Tingstrom2 and A. Karner3 1Linkoping University, Department of Medical and Health Sciences, Linkoping, Sweden 2Department of Medicine and Health, Faculty of Health Science, Linkoping, Sweden 3Linkoping University, Department of Social and Welfare Studies, Linkoping, Sweden Purpose: The aim was to identify and describe problem-based learning (PBL) processes when used as an educational method in patients with coronary heart disease (CHD), and evaluate both the patients’ and the tutors’ enactment of PBL. Method: The current study is a small-scale ethnographic part of the COR-PRIM- study: PBL in patient education after an event of CHD, a randomised study in primary health care of long-term effects on self-care. Groups of 6–8 patients meet 13 occasions during a year and are encouraged to discuss lifestyle changes using PBL to support their learning. District nurses receive a tutorial education in the pedagogy of PBL to function as tutors, facilitating patients to formulate issues and to state self-care goals. An ethnographic approach was used aiming to describe the patients’and the tutors’enactment of PBL as an educational model. The data collected includes participant observations, sound recordings, field notes, and interviews, derived from six sessions of the PBL program during 2011. Data was analysed according to Strauss & Corbin’s version of grounded theory.The study was approved by the regional ethical review board (Dnr 2010/128–31). Preliminary findings: The patients felt that the education was rewarding helping them to change their lifestyle and expressed the PBL sessions as ‘nice, worthwhile and a way to start thinking about self-care’. The scenarios used during the sessions had a noticeable impact of how well the sessions developed and to what extent the patients were engaged in the pedagogical process. The patients expressed that ‘with more knowledge and insight, you take better care of yourself’ and ‘without really reflecting about it, I have become more interested’. The tutors seemed at times insecure and had difficulties avoiding falling back into a more traditional teacher role and provide information. Discussion: The patients are interested and want to learn during the education. Still, they need a good and skilled tutor, which appeared to be a difficult role to play. It also seems crucial that the patients are able to relate to the scenarios discussed during the sessions, and experience that the knowledge which could be achieved, is of high importance to them in order to stay as healthy as possible. To acquire applicable knowledge about self-care, it appears to be of high importance that the tutors could support the patients throughout the whole educational process, helping them to follow every step of the PBL model. The tutors also needed to challenge the patients by stating follow-up questions to take the learning process a bit further. P83 Components of life quality evaluation in heart failure clinic FDC. Cruz,1 VS. Issa,1 SF. Ayub,1 F. Bacal1 and EA. Bocchi1 1Heart Institut, São Paulo, Brazil Background: Trials results involving education and monitoring programs (DMP) in heart failure (HF) have shown controversial results regarding quality of life. Objectives: To test whether a long term follow-up program could influence quality of life (QL) components in a non-uniform way. Methods: The present study was an extension of the REMADHE Trial, a prospective, randomized trial designed to compare a DMP versus control in patients with HF. The Minnesota Living Heart Failure Questionnaires were applied at the inclusion, after six months, and annually thereafter. Primary end-points were changes in MLHFQ components. Results: Four hundred and twelve patients were included, 60.5% male, mean age 50.2±11.4 years, and left-ventricle ejection fraction of 34.7±10.5%. During the follow-up of 3.6±2.2 years, 6.3% of patients were submitted to heart transplantation and 31.8% died. The comparison of basal mean values and follow-up mean values of QL questionnaire in the intervention group were: total QL score (53±23vs. 29±19, p = 0.007) the physical component (24±10 vs. 13±9, p = 0.002, the emotional component (13±7 vs. 9±7, p = 0.03), and the remaining questions (21±9 vs. 11±7, p = 0.001). The emotional component improved later than the other components (24 vs. 6 months). Regarding gender, the total QL score also improved later in male. In the control arm all scores remained statistically unchanged. Post-randomization quality of life score was associated with events. Conclusion: This DMP continues for a long term to improve QL and its components on the follow up of outpatient patients. However, the components of QL may respond differently to intervention. P84 Descriptive study of the factors of cardiovascular risk in nurses of the university of leon hospital (Spain) A Sanchez Bustelo,1 C. Alvarez Castro,1 S. Alvarez Alvarez,1 R. Posadilla Alvarez,1 C. Bernardo Pellitero1 and C. Alonso Ossorio1 1Hospital de Leon, Leon, Spain Introduction: The cardiovascular diseases (CVD) continue being the first reason of death in Spain. According to the National Institute of Statistics, in 2008 resulted in 31,7 % of the total of deaths. Objective: Identify risk factors (RF) for the arterial coronary disease between the nurses of the University of Leon Hospital and correlating the results between the different work shifts. Methods: Cross sectional contemporary study. We applied a questionnaire to identify this risk factors: blood pressure, smoking, sedentary lifestyle, anthropometric data, basal level of glycaemia, the total cholesterol (HDL and LDL), triglycerides and stress symptoms that were assessed according to the criteria for the Diagnostic and Statistical Manual of Mental Disorders (DSM) that was published by the American Psychiatric Association (APA) DSM-IV-TR in year 2000. Results: 290 nurses took part in the study, chosen at random between nurses of Leon’s Hospital. 90% (261 persons) were women and 10% (29 persons) were men with mean age 36 ± 12 years. The most prevalent risk factors were family history (71%), sedentary lifestyle (58%), smoking (52%), overweight (51%), stress (48%) and borderlinecholesterol (34%). Smoking (65% vs. 52% on average)and stress (55% vs. 48% on average) were higher among night-shift nurses, being similar the percentages of the remaining risk factors. Conclusions: Our study shows that the nurses of our Hospital have increased RF of cardiovascular disease. The observation of this sample can reveal surprising results in the future since it refers to a young population with the prevalence of borderline results. We believe that it should be included in programs to provide health promotion towards a more healthy way of life. P85 Importance of eating habits education in the adolescence A. Antonio Madureira Dias,1 Carlos Albuquerque,1 Antonio Oliveira,1 Alexandre Marques1 and Ana Andrade1 1CI&DETS - Superior Health School, Polytechnic Institute of Viseu, Viseu, Portugal Background: The firstcontacts with risk behaviors are verified during the adolescence. Therefore itis urgent to study behaviors such as eating habits, which it’s impact in the-Cardiovascular System are supremely known, in order to adopt early measures andstrategies with a high educational impact, preventing the development of achronic pathological condition that will reflect in the quality of life of theperson throughout its life cycle. Purpose: Identify theeating habits of adolescents; analyze the influence and the causal existence ofsocio demographic, family background, clinical and psychological variables. Methods: Quantitativestudy, non-experimental, descriptive-correlational and cross-sectional; Sample:778 adolescents (male 47.7%, female 52.3%; middle age=14.11 years, St.dv.=1.48years). Data sources obtained through questionnaires: relative to sociodemographic, clinical, psychological, eating habits, Family Functionality Scales(Smilkstein, 1978) and Assertiveness (McIntyre & McIntyre, 1998). Results: From the study sample, 41% have inadequateeating habits, 18.9% reasonable, and 40.1% good eating habits. The MultipleLinear Regression, using the stepwise method, identified the followingvariables that influence eating habits, explaining 5.3% of the variability ofthe same (R2 = 0,053, p = 0.000): sex (B = 0,148, p =0.000), better eatinghabits in females; age (B =- 0,123, p = 0.001), Family Functionality (B = 0,103, p = 0.004), Assertiveness (B= 0,090, p = 0.012), excluding the Body Mass Indices in the final model;Adjusted Final Model for Eating Habits = 50.392 + (0.148 Sex) + (-0.123 age) +(0,103 FF) + (0.090 Assertiveness). Conclusion: Recognizing the high impact of Cardiovascular diseases itshould be implemented early programs that involve not only the individual, butalso the structures that surround him, such as family and educationalinstitutions, as these will be the reference models that will influence it’spersonality, attitudes and behaviors that will follow him throughout life. P86 Degree of knowledge related to oral anticoagulant therapy in cardiac disease elderly inpatients C. Jordan Ferraz,1 AN. Gomez Gonzalez,1 AM. Fernandez Sanchez,1 R. Planelles Romero,1 JR. Peraira Moral,1 E. Grande Garcia,1 JG. Garcia Arranz,1 M. Franco Davila,1 E. Alamo Tomillero1 and J. Castellanos Fernandez1 1Instituto de Cardiología de Madrid, Madrid, Spain Purpose: Oral anticoagulant therapy (OAT) is common among cardiac disease patients, because of aging and the increasing number of therapeutic indications. Proper knowledge of the reason why OAT is prescribed in each case, daily care education (DE), hazard issue problems (HP) and complications(C) about taking this specific medication should, theoretically, be known by each one of our cardiac elderly inpatients (CEI). Little data is published about this topic. Our purpose was to evaluate the degree of knowledge(DK) that CEI had in OAT (acenocoumarol, warfarin, dabigatran), in order to identify every issue that needed to be reinforced by health education. Methods: Descriptive study through questionnaire for CEI in our Hospital, in Cardiology and Internal wards, between November 2010 and April 2011. We reviewed each medical record in order to know every medical reason for OAT prescription. Patients should be independent for daily living activities like preparing and taking their own medication, thus, at most, mild level of cognitive impairment and independency aspects were required (Pfeiffer test>6, Barthel test >60). Nurses designed a 12 questions questionnaire about DE, HP and C of OAT. Evaluation was taken during admission, interviewing each patient, with their relatives in the room, in order to involve them in the knowledge missing issues. Each answer had a score, depending on the knowledge level (KL, 0: minor, 1–2: major). We classified KL in low (0–4 points), medium-low (5–10), medium-high (11–14) and high (15–17). Results: Questionnaire was done in 46 patients (50% women, average age: 81.1 years old, range: 75–93). The main OAT indication (91%) was atrial fibrillation. All patients received acenocoumarol. Average score in Pfeiffer and Barthel tests test was 8.9 and 82.8, respectively. Average DK questionnaire score was 9.96 (women: 10.1; men: 9.83). Questions with less score were referred to feeding, risks and complications due to OAT.Conclusions: In our experience, DK referred to OAT concerning CEI, is medium-low. Subjects to be reinforced were feeding, HP and C related to this medical treatment. Nurse-led education programmes could be considered an interesting tool to improve OAT DK. P87 The participation in clinical trials reduces the cardiovascular risk? Center experience in optimization of lipid profile D. Pais,1 M. Maritza Ribeiro,1 MJ. Simoes,1 C. Costa1 andE. Carvalho1 1University Hospitals of Coimbra, Coimbra, Portugal Introduction - The dyslipidemias are among the most important risk factors for atherosclerotic cardiovascular disease, and the optimization of lipid profile is the crucial risk mitigation strategies in patients with cardiovascular diseases. When inserted in clinical trial monitoring may contribute to reducing the risk factors as we can verify with this patients. Objectives: To assess the impact of a multidisciplinary strategy to optimize cardiovascular risk, focusing on lipid profile in patients of clinical trials in the Cardiology field. Population and methods: We prospectively studied 137 patients with a mean age of 74.97+/-8.68 years, including in a clinical trial in the area of atrial fibrillation. For each patient the value of total cholesterol was determined at the randomization moment, at day 30, months 3 and 6. Results: At the time of randomization, this population had a mean total cholesterol of 177 mg/dL. All the patients were targeted by a multidisciplinary clinical approach, focusing on teaching about healthy lifestyle habits, conducted by research nurses and, when necessary, initiating or reinforcing lipid-lowering therapy. Thanks to this strategy, the average total cholesterol dropped to 172.46 +/-39.44mg/dl after 30 days, to 155.83 +/-36.73 at 3 months and 153.91 +/-32.86 mg/dl at 6 months. On average, each patient has reduced total cholesterol by 8.0% at the end of follow-up period (6 months), 87.9% had total cholesterol levels below 155 mg/dL (reference value of international recommendations). Conclusions: The analysis of the results revealed a significant decrease of total cholesterol values from the randomization moment. These results suggest that close monitoring by the health team in a clinical trial contributes to the reduction of patient risk factors, fact that may contribute to the improvement of their prognosis. P88 Self-injection of heparin in patients with deep vein thrombosis L. Lisbeth Kallestrup1 1Aarhus University hospital, Department of Cardiology, Aarhus, Denmark Background: At a University Hospital in Denmark we observed that the procedure for educating patients in self-injection of low molecular heparin was different in different departments. At some departments patients were even hospitalized for several days either because the nurses did not think that the patient could manage to perform self-injection or because it was too inconvenient to contact the primary care nurse when treatment only lasted a few days. Several studies have shown there is a social and economic benefit if length of hospital stay is reduced. Moreover, mortality as well as the number of recurrent cases of deep vein thrombosis (DVT) is reduced if the patients are treated in their home. Aim: To investigate the number and characteristics of DVT patients able to inject themselves with low-molecular heparin. Method: This retrospective study included patients diagnosed with and treated for DVT; patients had a consultation by a specialist nurses in a outpatient thrombosis clinic. Patients were divided into two groups: group one injected themselves or were helped by a relative and group 2 received help from a primary care nurses. Information about patients was retrieved from medical records. Results: A total of 58 patients were included, 34 females (equivalent to 59% at an average age of 48.6 years) and 24 males (equivalent to 41% at an average age of 58.7 years). A total of 72% were able to inject themselves or received help from a relative. Fifteen patients (26%, 6 females and 9 males) at an average age of 67 years received help from a primary care nurse.. In one patient there was no documentation on who performed the injection.. Ten of the patients receiving help from a primary care nurse had an alcohol/drug or medicine abuse, dementia or terminal cancer. In the remaining five patients there was no documentation on why they received help from a primary care nurse. Conclusion: In our study 72% were able to inject themselves. In comparison a Swedish study showed that 62% were able to inject themselves. Nurses in our clinic focused on developing a step-by-step approach to enable patients to inject themselves. Delegation of nursing tasks to patients requires that nurses trust that patients can perform self-injection and that nurses are willing to pass on this task to the patients. We suggest that consultation and education by a specialist nurse to perform self-injection results in more patients wishing to and having the resources to be able to perform self-injection. P89 Nurses’ knowledge of heart failure self-care principles and contents addressed in patient education K. Ylonen,1 J. Johanna Heikkila2 and M-L. Paananen1 1Jyvaskyla Central Hospital, Jyvaskyla, Finland 2 JAMK University of Applied Sciences, Jyväskylä, Finland Objective: Heart failure (HF) in a significant cause of hospitalization. With efficient self-care, we can prevent the disease from worsening and patients from being readmitted. Therefore, it is crucial that patients themselves are able to take responsibly of the self-care in oder to manage at home. Nurses are responsible of the quality of the evidence-based patient education. The goal of this study was to evaluate nurses’ knowledge about HF patients’ self-management principles, and which contents of HF education were addressed in the patient education situations. This questionnaire and the observations of patient education situations were a part of the intervention to develop nurses knowledge and use motivational interviewing method in HF patient education. Methods: The nurses (N = 29) from the cardiologic ward participated in the HF education program. The questionnaire used was based on the 20–item true/false test developed by Albert (2002) included basic information about HF. The data consisted of the answers to the questionnaire (n = 24) and of the observations (n = 14) of the patient education situations after the education program. The data was analyzed by descriptive statistics, simple linear regression for continuous variables (as age, working experience and education), correlation test, Pearson chi-square-test and Fisher’s Exact test. Results: The mean score of heart failure self-care knowledge was 16,1 (SD, ±1.59) out of possible 20 points. Age, work experience, or education were not significantly related to the scores. The nurses received the highest scores in the items on fluid restriction (100 %), physical activation (100 %) and new onset of worsening fatigue (100 %). The lowest scores they received in the items on assessing the patients’ weight results in comparison with their yesterday’s results, not their ideal or dry weight (41,7%), dizziness or lightheadedness when arising that disappears within 10 to 15 minutes (41,7%) and blood pressure recording of 80/56 without any HF symptoms (16,7%). The nurses had less than 80 % of the answers right in the three different items about the weight (ns.). Even though nurses lacked knowledge about the basic principles of weight assessment, they educated the patients on weight (p = 0.07). Conclusion: In this study, the nurses’ scores of the HF self-care principles were slightly higher than the ones from the previous researches. This difference might have been a result of the prior education. However, there are still contents that nurses need to be better educated in order to give the patients evidence -based education, especially the daily weighting. P90 NANDA diagnosis of anxiety (00146): symptoms, information and comprehension that inpatients show in non- invasive cardiological tests C. Jordan Ferraz,1 JG. Garcia Arranz,1 E. Grande Garcia,1 M. Franco Davila,1 E. Alamo Tomillero,1 JR. Peraira Moral,1 J. Castellanos Fernandez,1 R. Planelles Romero,1 AM. Fernandez Sanchez1 and AN. Gomez Gonzalez1 1Instituto de Cardiología de Madrid, Madrid, Spain It is known that cardiological invasive tests lead to some status of anxiety. There is little information about cardiological non-invasive test such as Electrocardiogram- holter (ECG-H) and echocardiogram (ECO).Our purpose was to identify NANDA diagnosis “anxiety related to health status” (00146) -ARHS- in inpatients who were submitted to these tests. Methods: A transversal descriptive study with 40 patients admitted to Cardiology and Internal Medicine units and submitted to ECG-H (group A, n= 20) or ECO (group B, n= 20).It was carried out between December 2010 and June 2011. Nurses performed a questionnaire with personal data and concrete questions based on the definitory characteristics of NANDA taxonomy diagnosis ARHS, and it was done 24 hours previous to ECG-H placement and 24 hours after removing it. The same questionnaire was done for the ECO group, previously and after 24 hours. Results: Sex distribution was 50/50 in both groups, with a predominant age range over 81(60%) Group A results were that 45% were widower. They were all mainly informed by the physicians and in their room (85%) (10% was not informed by anyone). Oral Language expression was simple and clear (65%) but only in 10 % of the cases whole understanding. In the previous questionnaire only 5–10% of the patients, mentioned any symptom of ARHS. No patients showed these physiological responses in the later questionnaire. In group B (ECO group) it was remarkable that 95% of the patients were not informed by anyone about this test. In the previous questionnaire, just 5% of them had any ARHS and no one after the questionnaire. We did not observe changes in usual sleep patterns in any group through the questionnaires. Conclusions: In our experience, nor ECG-H placement or ECO is related to physiological responses of anxiety, but we found out that inpatients’ degree of information and comprehension about ECG-H and ECO are insufficient. We think that nurse-led health education programmes could improve the comprehension degree and reduce the percentage of misinformed patients about these diagnostic tests. P91 Inpatient education in heart failure: an opportunity to improve outcomes C. Jordan Ferraz,1 AM. Fernandez Sanchez,1 E. Alamo Tomillero,1 E. Grande Garcia,1 R. Planelles Romero,1 L. Diaz T,1 JR. Peraira Moral,1 M. Martin Hinojal,1 JG. Garcia Arranz1 and M. Franco Davila1 1Instituto de Cardiología de Madrid, Madrid, Spain Heart failure (HF) is the main reason for people over 65 to be admitted at hospital,most cases due to poor therapeutic and non-therapeutic adherence. HF education programmes for inpatients and HF Units, have shown lower readmission rates due to a tranining and follow-up self-care of patients. Our purposal was to design a starting up nurse-led HF educational programme for these inpatients analising their self-care results in short and mid-term. Methods: Between July and September 2011, HF patients (primary or secondary diagnosis) admitted to our Centre, were included in a nurse-led HF educational programme (group A, n=29), or were given the ordinary nursing care and usual information exchange (group B, n=27). Both groups were given a HF booklet, but in Group A the information was explained and reinforced every day during admission. We evaluated both groups through European Heart Failure Self-care Behaviour Scale (EHFSc-BS),Spanish Version, at admission and post-discharged (a week and 2 months follow- up telephone call) Results: We included 56 patients (59% women) although we can not give complete data, because our results have not finished yet, due to our last patients were admitted in the lastest september days. Our partial data are the following: Group A: 72% women, average age 82, mean score in EHFSc -BS during admission 33±5.54, post-discharged (1 week)23 ±4.35, 2 months later 28 ±3.57. Group B 44% women, average age 83±4.97, mean score during admission 35±2.93, post-discharge (1week) 32±5.68, 2 months later 35±X. Conclusions: In our experience, nurse-led HF educational programme for inpatients improves self-care degree in short and medium term. We think that similar nurse-led service at Primary Care could help pacients to cope with their self-care management in order to reduce readmissions Family and caregiver P92 Nurses attitudes towards music in the after death care. A focus group study M. Holm,1 N. Falun,1 E. Gjengedal2 and TM. Norekvaal1 1Haukeland University Hospital, Department of Heart Disease, Bergen, Norway 2University of Bergen, Bergen, Norway Background: The intensive care unit (ICU) is not only a place to survive from accidents and serious illness. For many people it is also a place to die. Nursing care does not stop when the patient die, but continue with care of the dead body and family support. The aims of this study were to i) explore experiences and attitudes of nurses towards use of music during after death care and ii) describe the feedback nurses received from relatives when music was used as part of the appearance. Method: A qualitative design using focus groups interviews was applied. Three focus group interviews with 15 nurses were undertaken. All the interviews were audio taped, transcribed verbatim, and analyzed using qualitative content analysis. Findings: Six main themes emerged from the analysis: (1) Different attitudes among nurses towards use of music; (2) Music affects the atmosphere; (3) Music affects emotions; (4) Use of music was situational; (5) Choice of music; (6) Positive feedback from the bereaved. Conclusion: This study demonstrates that music can prove helpful for nurses during after death care as well as in the care of the relatives. Relevance to clinical practice: Including music in an after death programme can be helpful for nurses in order to show respect for the dead person under preparation of the body. Music during the appearance may be a way to help the relatives in the time of grieving. It may ease the situation by giving them a special and memorable moment. It is not appropriate to standardize this intervention. It depended on the particular situation, and how the nurses and relatives are affected by using music. It has to be up to the individual nurse and the family to decide whether music is to be used in the particular situation. P93 Family focused nursing for outpatients with heart failure B Birte Ostergaard Jensen,1 T. Barington,2 M. Praest Knudsen,3 K. Steenvinkel Pedersen,1 L. Videbaek4 and L. Wagner1 1University of Southern Denmark, Research Unit of Nursing, Odense, Denmark 2Odense University Hospital, Odense Patient data Explorative Network, Odense, Denmark 3University of Southern Denmark, Department of Marketing and Management, Odense, Denmark 4Odense University Hospital, Department of Cardiology, Odense, Denmark Purpose: Quality of life is impaired for patients with heart failure and their next of kin, compared to other patients suffering from chronic diseases. Besides, there is a continual great amount of the patients who misunderstand or have difficulties’ with remembering the counseling giving during the course of the illness. Increased focus on relations between patients and health professionals in combination with social support from an active network might contribute to further improvement in health status of the patients. We aimed to evaluate the effect of Family Focused Nursing versus conventional treatment of heart failure outpatients with respect to health-related quality of life, illness management, re-admissions and mortality. Methods: The study is designed as a randomized multi-centre trial at three Danish heart failure clinics, consecutively including 468 patients allocated to one of two groups. Inclusion of patients started in June 2011. Patients’ are centrally randomized to 1 of 2 groups by an external touchtone telephone voice-response system. All patients will receive standard treatment by teams specialising in heart failure. The nurse intervention, focus on identifying problems and resources, and to strengthen the family’s management of the illness, in the areas of cognitive, affective and behavioural functions. Primary outcome is the effect of Family Focused Nursing on health-related quality of life over a period of 12 months. Secondary outcomes are measurements concerning illness management (self-behaviour, family resources, self-efficacy and depression) re-admissions and mortality. Results and Conclusion: The trial is expected to contribute with new and important knowledge about how nurses can support heart failure patients and their relatives by involving the family in a more systematic and focused way than attempted up until now. This knowledge will give cardiac nurses new options in their daily work and generate knowledge of how Family Focused Nursing can increase wellbeing in families living with heart failure. Heart failure P94 Heart failure nurses in Germany: transition from training to everyday nursing O. Deckwart,1 N. Kolbe2 and M. Jaschak3 1Charite-University Medicine Berlin, Campus Mitte, Center for Cardiovascular Telemedicine, Berlin, Germany 2German Society for Health and Nursing Science, Essen, Germany 3Charite - Campus Virchow-Klinikum, Department of Nephrology and Intensive Care Medicine, Berlin, Germany Purpose: Heart failure is one of the most common causes of hospitalization in Germany [1]. By providing support in everyday life and adequate patient education hospital admissions may be averted [2]. A recent amendment of the German Nursing Act has made counselling, education and support of patients and their relatives part of the statutory tasks of nursing personnel in Germany [3]. It makes obvious sense to deploy specially trained nurses for this challenging task such as heart failure nurses (HFN) who have for years been employed in Anglo-American and Scandinavian countries. In Germany since 2009, heart failure nurses have been trained in accordance with the curriculum of the Heart Failure Association of the ESC. The key questions of this survey are: What objectives do graduates of the course have for their field of work in Germany, and what changes have they put into practice since their training as heart failure nurses? Methods: The survey was carried out among participants who had successfully completed their training as heart failure nurses at the German Society for Health and Nursing Science by December 2010. They were asked to answer the following questions in writing: 1. What are your objectives in undergoing further training? 2. What have you been able to put into practice in your field of work since your training? The answers are shown in the results as in vivo codes expressing the degree to which goals were achieved. An abstract analysis was not carried out. Results: Of the 17 persons questioned all 17 (100%) answered the questions. Ten of the graduates stated that they had fully achieved their goals; three said they had been partially successful; and four stated that they still had not attained their objectives. More than half of the graduates have created and implemented informational flyers or brochures for their particular institutions. Lectures for people interested, counselling for patients and their relatives, as well as training sessions and educational courses have been performed. Furthermore, cooperation with health insurance services and visits for training purposes to nursing staff in neighbouring European countries have been initiated. Conclusions: Various approaches have already successfully been put into practice. However, in Germany the resource of highly specialised nursing staff for heart failure patients is still under-utilised. In order to improve nursing services in this area, to make the job description of HFN more widely known, and to promote networking between specialties, in 2010 graduates of the course founded the German Working Group of Heart Failure Nurses. P95 Translation and validation of the family functioning, Health and social support (FAFHES) questionnaire among danish outpatients with heart failure and their next of kin K S. Pedersen,1 MP. Knudsen2 and B. Boestergaard1 1Research Unit of Nursing, Institute of Clinical Research, University of Southern Denmark, Odense, Denmark 2Dept. of Marketing and Management, University of Southern Denmark, Odense, Denmark Abstract: Admission to a nurse-led heart failure clinic with specialized health professionals is standard for Danish heart failure rehabilitation. This study is part of a larger randomized multi-center trial seeking to evaluate the effect of Family Focused Nursing versus conventional treatment of heart failure outpatients with special attention at health-related quality of life, illness management, re-admissions and mortality. The final aim of the large study is to increase the treatment effectiveness by improving the patient’s health related quality of life. In order to measure the effect of the Family Focused Nursing intervention on family functioning, family health and social support from the nurses, the Family Functioning, Health and Social Support (FAFHES) questionnaire is adopted. The questionnaire developed with three scales (and 62 items) and subsequently validated among Finnish families of cardiac patients in two independent clinic settings. Purpose: To translate and validate the FAFHES questionnaire in a Danish setting. Methods: The translation from Finish to Danish was a double process consisting of a translation and re-translation process using two independent Finish speaking persons; one resident in Denmark, the other in Finland. The Danish version FAFHES-DK was face-validated among 18 outpatients with heart failure and their next of kin at three Danish heart failure clinics to assess the quality of the translation. Second the intercorrelation and test-retest reliability of the FAFHES-DK Instrument is tested in a feasibility study based on 46 respondents (23 patients and 23 next of kin). Results: Face validity showed for both patients and next of kin following results. Words as “periodic” and “implement” was difficult to understand wherefore it was changed to “once in a while” and “fit in”. There were comments to the size of types and boxes wherefore these were enlarged in the process. Most items were comprehensible, but there were a few respondents who had problems to distinguish between items including heart pain and items including heart symptoms. Therefore “other than heart pain” was added in parentheses to the items concerning heart symptoms. Furthermore, items concerning heart pain and items concerning heart symptoms were placed after each other instead of randomly in FAFHES. The preliminary findings according to test-retest reliability of the feasibility study will be presented during the meeting. Conclusions: The FAFHES is translated and tested and found valid for use among patients and their next of kin in a Danish heart failure setting. P96 The relationship between self-care maintenance and self-care management in heart failure: a structural equation modeling E Vellone,1 B. Riegel,2 A. Cocchieri,1 R. Fida,3 F. D’agostino,1 G. Rocco4 and R. Alvaro1 1University Tor Vergata, School of Nursing, Rome, Italy 2University of Pennsylvania School of Nursing, Philadelphia, United States of America 3Sapienza University of Rome, Rome, Italy 4Center of Excellence forNursing Culture and Research, Rome, Italy Background: Self-care maintenance (symptom monitoring andtreatment adherence) is theorized to be the foundation for success in the overall self-care process. This proposition has not been previously tested. Purpose: The purpose of this study was to test the model of heart failure (HF) self-care (Riegel et al., 2004). In this model the connection between HF self-care maintenance and HF self-care management (symptom recognition and evaluation, and treatment implementation and evaluation) was tested with structural equation modeling. Methods: A cross-sectional design was used to study 357 symptomatic HF patients who had experienced problem breathing or ankle swellingin the last month. Patients were recruited from 16 outpatient clinics across Italy. Data were collected with a sociodemographic and clinical questionnaire and the Self-care of Heart Failure Index v.6.2. Structural equation modeling was performed using MPlus 5.0. Modification indices were used judiciously to improve model fit. Results: Patients were mainly male (56.3%) with a mean age of 72.7 years (SD 11.8). Most patients (62%) were in NYHA class II or III;12.5% were in NYHA class I and 14.5% were in NYHA class IV. The mean ejection fraction was 42.2% (SD 11.9). The initial model showed poor fit. Three modifications were made that significantly improved model fit: 1) A direct effect of symptom monitoring on treatment implementation (bypassing symptom recognition), 2) symptom recognition on treatment evaluation (bypassing treatment implementation), and 3) a covariance between treatment adherence and treatment evaluation. The final model showed good fit: Chi-Square 4.85, DF 2, p.08, CFI.99, NNFI.94, RMSEA 0.06 (90% CI 0.0 - 0.14), SRMS 0.03. Conclusions: This is the first test of the theoretical structure of Riegel’s HF self-care model. Even though some modifications were needed to fit the model to the data, this study confirms the theoretical underpinnings of the relationship between self-care maintenance (treatment adherence and symptom monitoring) and self-care management (symptom recognition and evaluation, treatment implementation and evaluation). Further testing of this nature will help to identify how best to help HF patients to master the various tasks involved in self-care. P97 The Greek version of the Minnesota living with heart failure questionnaire and the European heart failure self-care behavior scale E. Ekaterini Lambrinou,1 F. Kalogirou,1 D. Lamnisos1 andN. Middleton1 1Cyprus University of Technology, Nicosia, Cyprus Introduction - Quality of life and self-care behavior are important and measurable aspects of the level of care and management of people with heart failure (HF). However, there is currently lack of validated tools for use in Greek populations. Purpose: The psychometric evaluation of the Greek version of the Minnesota living with heart failure questionnaire (MLHFQ) and the translation/validation of the European heart failure self-care behavior scale (EHFScBS). Methods: The study was designed as a cross-sectional survey. A convenience sample of 128 persons with New York Heart Association Class I, II, III and IV chronic failure were recruited after their hospitalization or their visits in cardiovascular outpatient department in four of the general hospitals in Cyprus. They completed the Greek version of the two questionnaires before being discharge from the hospital. Results: The MLHFQ indicated high internal consistency with a Cronbach’s α of 0.96. In terms of construct validity, exploratory factor analysis indicated three factors, explaining up to the 70% of the total variance. By comparison, the EHFScB exhibited lower internal consistency (i.e. Cronbach’s α=0.66), which was nevertheless comparable with the results observed in similar studies elsewhere. Exploratory factor analysis indicated three factors, explaining 65% of the variance. Spearman rank correlation coefficient between the two scales was equal to -0.019 (p-value 0.83). Conclusions: Reliability and validity supported the Greek version of MLHFQ and EHFScBS as reliable and valid tools for future use. The two tools are not correlated and, thus, they can provide important information for the health-related quality of life and the self care behavior of patients with HF when used in conjunction. P98 Investigating barriers to discussing progression of heart failure with patients from healthcare professionals’ perspectives J M Janet Margaret Oppong,1 M. Brice2 and S. Marshall-Lucette2 1Sutton and Merton Community Services, London, United Kingdom 2St George’s University of London and Kingston University, London, United Kingdom In recent years attempts have been made to improve the provision of palliative care to heart failure patients. There is evidence that this has been hampered due to many heart failure patients being unaware of the prognostic implications of the diagnosis. Thus, this study aimed to explore healthcare professionals’ barriers to discussing heart failure progression with their patients by identifying which healthcare professionals consider this to be their role and comparing the barriers from individual professional group perspective. The study employed a cross-sectional survey design. Postal questionnaires were sent to 489 healthcare professionals who manage heart failure patients for a London Primary Care Trust in the UK and 220 participants responded. Descriptive statistics synthesize the data and the Independent Samples Median test was used to test the significance of differences among the 8 healthcare professional groups and the Pearsons Chi Square was found useful to test whether the size of the difference in proportion of participants among the identified groups was significant. The qualitative data generated from the final question were categorised by healthcare professionals’ roles and themes identified, using an ‘anchored’ approach to relate the responses to the general theme of the questionnaire. The results indicate that for 78% (n= 172) of the healthcare professionals surveyed, heart failure patients form < 20% of their caseload. Difficulties in prognostication, high rate of co-morbidity, fear of taking away hope, inadequate time for communication and lack of contact with families were reported to be barriers to discussing disease progression with heart failure patients. Lack of confidence and skills in discussing end of life, misapprehension regarding palliative care and lack of knowledge of when to refer to palliative care were identified as barriers particularly for nurses. Significant differences were also found between the barriers reported by doctors and nurses. Recent work, driven by the National End of Life Care Programme (2010) in the UK, aims to improve the quality of end of life care for heart failure patients. This study has shown degrees of agreement with barriers identified in previous studies. Further training needs have also been identified for nurses, both in skill development, their understanding of the role and the process of palliative care intervention in heart failure. It is therefore recommended that training be focused by healthcare professional group and comparison among groups would also warrant further study with a more generalizeable sample. P99 It will be the age, elderly women and heartfailure C J Caroline Wulffraat1 1rijsselland ziekenhuis, capelle aan den Ijssel, Netherlands Objective: To investigate the feasibility of nurse practitioner group consultation for women 75 years and older diagnosed with chronic heart failure (CHF). The aim was to identify the specific needs of this group with regards to exercise and social interaction and to define the elements necessary for optimal support. Method: In this case study a group of 7 single (widowed) women between the age of 73 and 90 with CHF, NYHA classification II and III were included. CHF was the primary diagnosis, co-morbidity was not an exclusion criterion. Exclusion criteria were end stage heart failure and being unable to answer the questions being asked. The women participated in 3 group visits in 3 months. Following the group visit the participants were asked to perform specially designed exercises under supervision of a physiotherapist. The women were asked to perform these exercises daily at home. At the start and after 3 months the state of health and quality of life were assessed by means of individual interviews, 6MWT, the MLHFQ and the COPM. Results: At the start of the study the participants reported few problems associated with CHF, the restrictions they felt were described as age related. Loneliness was said to be a problem. The state of health, measured by the 6MWT, showed an outcome at around 66% of that of healthy elderly women. During the group visit the women recognized the complaints from the other participants and learnt from listening to each others experiences. The shortage of hard information was seen as a negative. The exercises were useful, and as a group a joyful experience. At home there was little adherence to the daily exercises due to physical restrictions and lack of motivation. After 3 months of group visits and exercises no differences were found in the 6MWT, the MLHFQ, the COPM or during the interviews. Conclusions: A group visit can be a good addition to the standard treatment. The interaction between participants provides a positive addition to the regular visit. A large part of the group visit should be spent on education. These older women didn’t learn to take notice of their own bodies. This may be part of the reason why they inadequately react to increased symptoms of heart failure. Furthermore the complaints are repressed and trivialized by the women. They prefer not to ask for help, certainly not from family and friends, this can put them into social isolation. Exercise in group form is stimulating. For an exercise program to succeed, transport problems need to be solved. Meetings need to be offered close to home and the start time are determining factors. P100 Use of Smartphones in person-centred eHhealth diaries in patients above 75 years A. Axel Wolf,1 L-E. Olsson,1 K. Swedberg2 and I. Ekman3 1University of Gothenburg, The Sahlgrenska Academy, Institute of Health and Care Sciences, Gothenburg, Sweden 2Sahlgrenska University Hospital/Ostra, Institute of Medicine/Dpt Emergency & Cardiovascular, Medicine, Gothenburg, Sweden 3University of Gothenburg, Centre for Person-Centred Care (GPCC), Gothenburg, Sweden Purpose: Remote monitoring in patient with Chronic Heart Failure (CHF) has yielded mixed and often disappointing results. One reason could be that remote monitoring mirrors a disease focused and patriarchal way of looking at the patient, hence only promoting a one-way communication between the patient and the physician/nurse. Therefore, we investigated the feasibility of a simple smartphone application for self-monitoring of signs and symptoms in patients above 75 years. Method: We screened and found 16 eligible patients above 75 years being hospitalized for worsening CHF. Patients were eligible if they had used any kind of cellphone prior to the study and did not present cognitive or severe physical impairment. Twelve of the eligible patients declined participation. Patients were trained to use a Google Android smartphone with the installed application for weight, dyspnea and fatigue. They were also trained how to interpret the visual trends of their signs and symptoms. Patients were encouraged to use the application every other day for the following 3 months. Semi-structured interviews were performed within the first 48 hours after admission and at 3–month focusing on their perception and need for e-health solutions in everyday life. Results: The included patients (n=4) were between 85 and 95 years and were classified as NYHA class III or IV. Little instruction in using the smartphone was needed, and at the 3–month follow up, all patients had used the application frequently. Findings indicated that patients who experience no symptom relief at discharge expressed little meaning of monitoring symptoms alteration. Patients who shifted in severity in their dyspnea or weight expressed both usefulness and self-confidence in monitoring their symptom changes. The visual weight and dyspnea trend were perceived as helpful, the visual trends of fatigue were reported as less useful. Conclusion: To our knowledge, this is the first study to evaluate a smartphone based symptom diary for elderly patient with CHF. Preliminary findings indicate a feasibility of a smartphone application for elderly patients. Our findings suggest that a smartphone based E-health diary should be further explored in patients with symptomatic diseases. Nurse, Allied Professional, other P101 Rituals of medicalization: everyday practice at a coronary care unit. A 16–month ethnographic field study A. Axel Wolf,1 I. Ekman2 and L. Dellenborg1 1University of Gothenburg, The Sahlgrenska Academy, Institute of Health and Care Sciences, Gothenburg, Sweden 2University of Gothenburg, Centre for Person-Centred Care (GPCC), Gothenburg, Sweden Background: Modern hospital care should allegedly be multi-professional and person-centred, still it seems foremost to be driven by a hegemonic positivistic biomedical agenda. Objectives: This study aims at describing professionals’ and the patients’ everyday practices at a Coronary Care Unit, analysing how the particular care environment with its routines, structures and physical environment influences both patients’ and healthcare professionals’ agency and relationships. Method and setting: Ethnographic fieldwork was conducted in parallel by two researchers at a Swedish CCU over a 16–month period (between 2009 and 2011), using participant observation, informal talks as well as formal interviews. The formal interviews were conducted with six registered nurses (RN) including the chief nurse manager (five female, one male), three Assistant nurses (AN) (all female), two Cardiologists and three patients (one female, two male). Results: Based on data interpretation, a care environment with ritualistic structures that either promoted or counteracted the patients’ and healthcare professionals’ different agencies and relationships was described. The care environment, with its minimalistic design, strong focus on routines and modest capacity for dialog, controlled the choices available to the patient and healthcare professionals, inducing feelings of guilt and moral stress, predominantly for the RNs. Conclusions: Ritualistic structures, minimalistic architecture and modest capacity for dialog suppressed person-centred care by creating demarcated routines rather than holistic care. The care environment exercised control over the choices available, effectively reducing the possibilities for health professionals and patients to create a common careplan. In particular the registered nurses reacted to the restriction of choice with feelings of guilt, inadequacy and moral stress. P102 A turkish version of the cardiac patients learning needs inventory; patient questionnaire: reliability-validity assessment H. Hilal Uysal1 and N. Enc1 1Istanbul University, Nursing Faculty, Medical Nursing Department, Istanbul, Turkey Purpose: This study was designed to investigate the validity and reliability of the Turkish adaptation of The Cardiac Patients’ Learning Needs Inventory (TR-CPLNI); Patient Questionnaire to determine the educational needs of patients admitted to hospital following their first MI. Methods: The study included 143 patients (21 women, 122 men; age ≤70 years) who were treated for their first MI, with recovery from the acute period without chest pain. Data were collected using a questionnaire on sociodemographic features and the Turkish version of the CPLNI. Validity studies included language and content validity. For reliability analyses, Cronbach’s alpha coefficients were calculated and, for test-retest reliability, the scale was re-administered after a two-week interval. Results:Content validity index of the scale was 0.96. The overall Cronbach’s alpha coefficient was calculated as 0.96, ranging from 0.78 to 0.92 for eight subscales. Item total correlations were between 0.65 and 0.85 (p < 0.01). The overall test-retest reliability was 0.77 (p = 0.00), ranging from 0.42 to 0.75 for eight subscales. Patients admitted to the clinic determined the important subjects which they wanted to gain information as “medication information”, “anatomy and physiology of heart”, “symptom management” respectively. Conclusion: Our results demonstrate that the Turkish version of the CPLNI can be used as a valid and reliable tool in measure the educational needs of Turkish patients sustaining their first MI. P103 Differential nutrition for heart patients J. Boettcher Nielsen,1 K. Mildahl Kjaergaard1 and L. Dahl1 1Sygehus Nord, Koege, Denmark Background: At the heart medical section service assistants serve food to cardiac patients with the background and knowledge, that all heart patients should receive low-fat food with a large amount of vegetables. Nutritional screening of all hospitalized patients have shown that a large proportion of heart patients are malnourished or at risk of becoming so. There has been a trend of increasing number of elderly and malnourished heart failure patients who have changed the need for diets to patients. There is a need for differentiated services, respectively, the obese AMI patient (with hypercholesterolemia), heart patient, awaiting CABG and underweight heart failure patient. The different nutritional needs create a particular challenge in connection to serving meals to patients. Purpose: To increase focus on nutricion. To offer heart patients a nutritional differentiates services. To increase service assistants understanding and knowledge of nutrition for heart patients. To improve the interdisciplinary teamwork and communication form. Methods: The approach of the empirical study has been exploratory and has been carried out by qualitative interviews and observations. A kick off conference for caregivers and service assistants started the project. Monthly cooperation meetings for caregivers and service groups. Structured training for service groups, organized as a course of 3 full days. Visibility: advertises about when and what meals are served, visibility of a daily nutritional-responsible nurse. Ongoing audits and follow-up qualitative interviews. Results: The results indicate that a focus on nutrition has increased significantly. Both caregivers and service assistants expressed, that visibility of the daily nutritional-responsible nurse has been of great benefit to the interdisciplinary collaboration. The structured training is implemented as planned and has led to increased knowledge and understanding of nutrition for heart patients. This knowledge has led to increasingly differentiate nutritional services for patients. The employees expressed greater satisfaction about the interdisciplinary collaboration and it has created a greater understanding of each other’s work. Conclusions: The results indicate that increased focus, visibility and awareness of the topic nutrition leads to differentiate nutrition services for cardiac patients. The results indicate, that the interdisciplinary cooperation has improved. It is expected to lead to an improved nutritional status in cardiac patients. Prevention and rehabilitation P104 Evaluation of a nurse led telephone intervention after an implantable cardioverter defibrillator M M Millie Marie Schmidt1 1Aarhus University Hospital, Skejby, Department of Cardiology, Aarhus, Denmark Purpose: Heart patients, who have survived sudden cardiac arrest or experienced life threatening heart rhythms, receive treatment with an implantable cardioverter defibrillator- an ICD. After hospital discharge, patients receiving an ICD for the first time are offered a telephone follow-up led by an expert cardiovascular nurse. The intervention usually takes place 4–6 weeks after discharge and its main purpose is to provide professional support by covering physical, psychological and social issues as well as education and information about the device. These follow-up conversations have been evaluated by a survey, which main purpose was to determine the effect of the intervention and improve the level of support and information given during the telephone follow-up. Methods: A survey among 63 ICD recipients took place between March 2009 and March 2010. The study participants were sudden cardiac arrest survivors or individuals who had experienced life-threatening ventricular arrhythmia requiring a first time ICD implantation. The questionnaire consisted of two key components: (1) Structured education and information about the device, (2) physical and psychological support after hospital discharge. Results: 63 ICD recipients received a questionnaire, and 54 participated in the survey, divided by 11 women and 44 men. Approximately, 70% of the participants reported to be satisfied with the nurse led telephone follow-up. They indicated to have received specific information and behavioural skills needed to managed ICD -recovery, and felt that they were given a sufficient amount of support and understanding during the telephone follow-up. 44 % expressed the need for more than one conversation. There was no connection between age and an increased need for more than one conversation. Among those who were less satisfied with the intervention, there was a 2.1 higher range of women compared to men. Women also tended to have a greater need for more than one conversation. Conclusions: The conclusion is that the main part of the study participants were satisfied with the intervention, however 1/3 of the recipients indicate that the follow-up should contain more than is does at this stage. Especially, the female recipients expressed a greater need for more follow-ups. P105 Increased confidence to engage in physical exertion: older ICD recipients’ experiences of participating in an exercise training programme I. Ingvild Morken,1 TM. Norekval,2 K. Isaksen,1 PS. Munk,1 AI. Larsen1 and B. Karlsen3 1Stavanger University Hospital, Department of Cardiology, Stavanger, Norway 2Haukeland University Hospital, Department of Cardiology, Bergen, Norway 3University of Stavanger, department of health studies, Stavanger, Norway Purpose: Research suggests that exercise training (ET) programmes may improve both physical and psychosocial functioning in Implantable Cardioverter Defibrillator (ICD) recipients. However, knowledge of older ICD recipients’ experiences of participating in such programmes is sparse. The aim of the study was therefore to provide qualitative insights into how taking part in an ET programme was experienced by older ICD recipients. Methods: The ET programme was conducted in a rehabilitation centre and led by two experienced physiotherapists specialized in cardiac rehabilitation. The programme consisted of 55–minute training sessions three times a week for three months (a total of 36 sessions). A qualitative design with semi-structured interviews involving 12 older persons (10 men and two women) with an ICD and coronary heart disease were performed the first week after completion of the ET programme. The ICD recipients mean age was 70 years, range 57–80. Mini-disk recordings of the interviews were transcribed verbatim and analysed using content analysis. Results: The analysis revealed two major themes:1) “Increased confidence to engage in physical exertion” and 2) “Increased satisfaction with life”. The first theme was illustrated by three sub-themes: ‘Perceived support from physiotherapists’, ‘Perceiving the heart rate monitor as a motivation to exercise’ and ‘Perceiving peers as motivators for enjoyment and making the effort to exercise’. The second theme was illustrated by the following sub-themes: ‘Perceived psychosocial benefits’, ‘Perceived physical benefits’ and ‘Exercise as a new health habit’. Conclusion: The findings indicate that exercising in a cardiac rehabilitation centre together with peers and supervised by skilled health care professionals may increase motivation to exert oneself, leading to emotional and physical benefits as well as a more social and active lifestyle for older ICD recipients P106 Nurse led follow-up program for patients with coronary heart disease MH. Svavarsdottir,1 EB. Bjornsdottir,1GH. Sveinsdottir,1 S. Gudmundsdottir1 and TB. Hjaltadottir1 1University of Akureyri, Akureyri, Iceland The purpose of the study was to investigate coronary heart disease patient’s satisfaction with a nurse led follow-up program, and to explore how successful the patients were in necessary lifestyle changes. Methods: Semi-structured interviews were conducted, with eight males enrolled in a one year follow up program in a nurse led cardiac clinic at Akureyri Hospital in Iceland. The 30–60 minutes long interviews were tape recorded and documented word by word. The researchers asked the patients about their experience of education they received at the clinic, lifestyle changes performed, factors concerning medication, emotional wellbeing and sexual aspects. BMI, waist circumferenceand blood pressure were measured at the time of enrollment in the program and at the time of interview. The subjects mean age was 49 years. They had all undergone a Percutaneous Coronary Intervention (PCI) in the previous 3–12 months. Results: The patients were pleased with the follow-up program and felt that the educational aspect of the program was practical. They felt that the support and guidance given by the nurses were very important for their recovery and necessary lifestyle changes. The patient emphasized the importance of participation of family members in the follow-up program and recommended more emphasize on information on medication and sexual aspects. All the patients reported improvements in diet and exercising. All except one had their blood pressure levels within normal limits at the time of interview. However none of the patients had met the goal set for BMI or waist circumference. Conclusions: Individuals with coronary heart disease are at risk of further coronary events. Lifestyle measures can contribute significantly to a reduction in cardiovascular mortality in those patients. Professional guidance and support is essential in the process of lifestyle change and adjustment to a chronic disease. Nurse led cardiac clinics can help improve patients lifestyle and well being and meet their emotional and educational need. P107 Copenheart.rfa a randomized clinical trail of integrated rehabilitation for patients treated for atrial fibrillation with radiofrequency ablation S S Signe Stelling Risom,1 SK. Berg,1 JH. Svendsen1 and ADO. Zwisler2 1Rigshospitalet - Copenhagen University Hospital, Heart Centre, Copenhagen, Denmark 2National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark Background: Atrial fibrillation (AF) is the most common sustained heart arrhythmia and affects 1 to 2% of the population in Europe. To preserve sinus rhythm (SR) radiofrequency ablation (RFA) is undertaken in symptomatic patients. Studies show that patients with AF often report low quality of life and are less prone to perform sport activities, because they are afraid to use their body. Small studies show that exercise training has a positive effect on exercise capacity and quality of life in AF patients. To our knowledge there are no published studies of rehabilitation programmes for AF patients treated with RFA that includes an exercise component and psycho-educational component. Regardless of RFA outcome, both patients with recurrent AF and patients in SR should receive rehabilitation to achieve their max potential physically and mentally in managing life with or without arrhythmia. Purpose: To investigate the effect and meaning of a comprehensive cardiac rehabilitation programme that consists of standard follow-up, psycho-educative and an exercise training component. Methods: A randomized clinical trial design is used. The trial is a single centre parallel arm design with a 1:1 randomization to either the intervention group or the control group with blinded outcome assessment. Furthermore qualitative interviews will be conducted in 10 % of the patients in the intervention group. The patients that will be included are: Over 18 years of age treated for AF with RFA. Based on sample size calculation, we plan to include 210 patients. Patients in the intervention group will follow a rehabilitation programme that consist of the standard medical follow-up plus psycho-educative consultations with a specialized nurse (4 consultations) and individualized exercise training following national and international guidelines (12 weeks). Patients in the control group will receive the standard medical follow-up. The primary outcome measure is exercise capacity measured by VO2 peak. The secondary outcome measure is perceived health measured by the questionnaire SF-36, mental health subscale. A large number of explorative and post hoc analyses are planned. Results: The effects of the intervention will provide extensive clinical knowledge that can benefit patients in terms of optimizing physical, mental, cognitive and/or social functioning. Conclusion: The overall aim of CopenHeartRFA is to develop knowledge on rehabilitation among AF patients treated with RFA and to develop and test a rehabilitation program that easily can be implemented into clinical practice. P108 One year prevention does not change cardiometabolic risk profile in old people S. Goga,1 D. Zdrenghea,2 A. Sitar-Taut,3 M. Cebanu1 and D Dana Pop <2 1Rehabilitation Hospital, Cluj-Napoca, Romania 2University of Medicine and Pharmacy, Cluj-Napoca, Romania 3“Babes-Bolyai” University, Cluj-Napoca, Romania Background: in old people the cardiovascular risk factors and the effect of decreasing them are the same as in middle aged people, but the applying of the preventing measures is more difficult and the results less significant. This aspect wasn’t studied until now in Romania. Methods: there was studied a representative urban sample of 515 old people (251 men and 264 women) in Cluj-Napoca, Romania. The risk profile was evaluated using the general practitioner’s files, clinical examination and determination of fasting blood glucose and serum lipid fractions. For all subjects a preventive programme, consisting of 5 minutes discussion during routine checkups (4 times/year), was applied. Brochure about prevention was offered separately for women and simvastatin 20mg/day was administrated in all subjects with total cholesterol more then 200mg/dl. After a year, the cardiovascular risk profile was checked again, using the same parameters in 462 subjects, representing 89.7% of the initial sample. Results: the main values of BMI (27.14±4.54 kg/(m)2 vs 27.4±4.74 kg/(m)2, SBP (152 ±24.34 mmHg vs 151.4±22.71 mmHg), DBP (87.98±12.35mmHg vs 84.9±14.63 mmHg), glycemia (110±34.28 mg/dl vs 112.3±33 mg/dl), TC (209±51.36 mg/dl vs 201.93±55.36 mg/dl), LDL-C (132.39±44.03 mg/dl vs 131.14±46.53 mg/dl), HDL-C (49.44±12.95 mg/dl vs50.42±11.4 mg/dl), TG (138.1±76.61 mg/dl vs 140.34±91.81 mg/dl), were very closed, and insignificantly different during the two examinations. The results were similar when we considered the prevalence of the main CV risk factors: overweight (39.6% vs 43.5%), obesity (25% vs 26%), hypertension (88.2% vs 92.2%), diabetes mellitus (19% vs 22.9%), and smoking habit (12.3% vs 12.5%). In turn, the prevalence of dyslipidemia significantly decreased from 40.6% to 30.3% (p < 0.05). When we considered the gender differences for both examinations, smoking habit was more than double in men (18%) in comparison to women (7.4%) - p < 0.05, but obesity was registered in 29.5% of women and in 20.3 % of men,the difference being significant (p <0.05). Also, dyslipidemia was more prevalent in women (48.5%) than in men (32.3%)- p < 0.05, suggesting an increased cardiometabolic risk, even if dyslipidemia was equally decreased (10%) in men and women, by statins. Conclusion: one year prevention didn’t change the cardiovascular risk profile in romanian urban old people, excepting dyslipidemia, significantly decreased by lipid lowering drugs. Thus, it is suggested that for short term cardiovascular risk reduction, drug prevention is more important than non-pharmacologic preventive measures. P109 Predictors of early ambulation after acute myocardial infarction O Olga Cortes,1 M. Markle-Reid,2 R. Mckelvie3 and A. Dicenso2 1Universidad Industrial de Santander, Bucaramanga, Colombia 2McMaster University, School of Nursing, Hamilton, Canada 3Population Health Research Institute, McMaster University, Hamilton, Canada Purpose: To identify the predictors of first ambulation during hospitalization among patients admitted for acute myocardial infarction and to examine the association between initiation of ambulation and heart rate at discharge and in-hospital mortality. Methods: This retrospective cohort study included 500 diagnosed AMI patients admitted during 2004 to one of three hospitals that form the Hamilton Health Sciences Corporation. The patients were randomly selected from a total of 1,014 charts from the Hamilton Health Sciences Computerized Health Records (SOVERA). Using a chart abstraction tool, the following data were collected from each patient’s chart: demographic information, previous health status, treatment, complications factors and patterns of ambulation while in hospital. The primary outcome was time for the first ambulation Secondary outcomes included heart rate and mortality during hospitalization. We conducted a time to event analysis using a Cox regression and the associations were expressed as hazard ratio. Results: Of the 500 charts, 60 were excluded. 440 patients were included into the analysis, 340 (77.3%) walked during hospitalization. One hundred fifteen (26.1%) walked during the first 48 hours (early walking), 98 (22.3%) walked between 49–96 hours (intermediate walking), and 127 (28.9%) walked after 96 hours (late walking). A total of 100 patients (22.7%) were categorized as non-walkers. Factors that emerged in the survival analysis as more positively associated with early ambulation after AMI were being male (HR 1.61, 95% CI 1.15, 2.24 p = 0.005); killip class I-II (HR 1.42, 95% CI 0.98, 2.05 p = 0.058); received thrombolysis (HR 1.50, 95% CI 1.06, 2.56 p = 0.022); and on beta-blocker (HR 1.76, 95% CI 1.21, 2.56 p = 0.003). Conclusion: This study provides the impact of some factors such as gender, killip I-II, thrombolysis and beta blockers as key elements to modify the care and initiate actions. P110 How we treat and diagnose patients at high cardiovascular risk in primary health care? A. Agnieszka Serafin,1 M. Niewada,2 R. Glowczynska,1 M. Starczewska,1 A. Pietrasik,1 KJ. Filipiak1 and G. Opolski1 1Medical University of Warsaw, 1st Department of Cardiology, Warsaw, Poland Medical 2University of Warsaw, Department of Experimental and Clinical Pharmacology, Warsaw, Poland Aims of study: Assessment of prevalence of major cardiovascular risk factors, frequency of prescription main groups of drugs and perform of diagnostic tests in high cardiovascular risk patients in Polish primary care (PPC). Material and methods: Secondary analysis of data collected during the SPOK (Standard of Cardiology Primary Care - Standard Podstawowej Opieki Kardiologicznej) survey conducted in 2003–2005. This subgroup of patients includes a total number of 21035 patients with high cardiovascular risk assessed using SCORE scale, who were treated in PPC due to various cardiovascular diseases (with the exclusion of myocardial infarction or stroke). In the main analysis, those group of patients was compare with patients after stroke, after MI and with stroke and MI in the past. Study used a scheme of multilevel selection of respondents. The Institute for Social Research in Sopot was involved in PPC patients and physicians’ sampling. Results: Mean cardiovascular risk assessed by primary care physicians using SCORE scale was 6,3% +/- 5,4. Mean “theoretical SCORE percent” assessed by researchers based on separate data collected in questionnaires was 8,33% +/- 9,5. In the analyzed group most were women, 58,9%. Mean age of patients was 62 years +/- 11. Mean weight was 80,3 kg +/- 15 and mean BMI was 29 kg/m2 +/- 5. The percentage of patients with coexisting stable coronary artery diseases (without acute coronary syndromes in the past) was 71,%%, diabetes - 32%, hypertension - 62%, heart failure - 48%, renal failure - 3,3%, peripheral vascular disease - 12,6%, dyslipidaemia - 76.4% and cigarette smoking - 18.3%, respectively. Rate of lifestyle changes advises regarding diet was 81,7%, regular physical activity 82,8%, weight reduction 70,9%. Basic groups of medications recommended for prevention of cardiovascular diseases have been applied in a significant number of patients. Among patients at high cardiovascular risk who have not had a prior history of MI or stroke, 73.2% received aspirin, LBA -56.7%, ACEI - 68.4% and statins 60% of patients. In field of specialist diagnostic tests: coronary angiography was performed in the past in 15,6% of patients, an electrocardiogram in the last 12 months in 76,7%, echocardiography in 19,6%. Conclusions: Rate of prescription main groups of drugs and advises of lifestyle changes is satisfying, but it is necessary to assess the effectiveness of those recommendations. Specialist diagnostic tests are performed too rarely. P112 We can do it differently - in home monitoring of anticoagulation therapy H. Ravnslund Soerensen,1 P. Hoejbak1 and A. Lauberg1 1Aalborg Hospital of the Aarhus University Hospital, Aalborg, Denmark Background:Treatment with vitamin k antagonists (VKA) requires blood sample controls to measure the coagulation of the blood (INR), either in a laboratory or in a medical clinic. The National Board of Health recommend regular monitoring of vitamin k antagonist treatment to reduce bleedings and strokes. Close monitoring is a challenge in management of these necessary regular blood samples due to problems regarding immobilisation and transportation logistics. For this groupe of patients an easy access to monitoring of anticoagulation therapy combined with care and safety, in-home monitoring may be preferable. Aim:This study aimed to explore the possibilities for community nurses to measure INR in the homes of the patients and to develop a more simple time-saving and safe anticoagulation therapy. Methods: A steering committee have designed a exploratory study, including the Thrombosis Research Centre Aalborg, community nurses from the city of Aalborg Vest, a representative from the general practitioners and representatives from the North Denmark Region. Data were collected on the following topics: Time registrations were used before and half a year after inclusion to measure time benefits. Community nurses comments before and after the completion of the study. Patients comments before and after completion of the study. INR within TR (therapeutic range) during the study. An important aspect: working across boundaries, in this case hospital/home care. Results: The first patient was included by informed consent in February 2011 and so far, 20 patients have successfully been included. The community nurses were trained in measuring INR in the home of the patients. When the INR values were outside the therapeutic range (TR), the community nurses consulted the Thrombosis Research Centre Aalborg directly by phone. If a change in the weekly VKA dose was needed, a new prescription was provided by phone and fax. Some of the final results will later be available to support the poster. Conclusions: The study have been active eight months and so far there is no doubt, that cooperation between hospital and home care is recommendable. Employees in the Thrombosis Research Centre Aalborg have gained new insight on creating alternative methods in monitoring anticoagulation treatment. And the community nurses have upgraded their knowledge on a specific group of potential vulnerable patients. When the study by March 2012 have completed, the final results will be available, and a more detailed perspective for the future will be presented. P113 Precautions related to midline sternotomy in cardiac surgery. Is there a connection between mechanical stress factors and sternal complications? CB. Charlotte Brun Thorup1 and B. Brocki1 1Aalborg Hospital of the Aarhus University Hospital, Center for Cardiovascular Research – Cardiology, Aalborg, Denmark Background: Patients with midline sternotomy after cardiac surgery are instructed on activity precautions to avoid sternal wound complications. We questioned how restrictive those precautions should be, since they can lead to a postoperative decrease in quality of life. Aims: To identify mechanical stress factors causing sternal instability and infection in order to draw up evidence based guidelines for activity after sternotomy. Methods: Literature review (CINAHL, Pub Med, Cochrane Library and PEDRO) furthermore crosschecking references. Results: Mechanical stress factors acting upon the sternum and the overlying skin are: constant coughing, BMI ≥ 35, skin stress due to macromastia, excessive bilateral arm movements leading to skin breakdown, and loaded activity with long lever arm. No e s found to support weight limitations, as long as arms are kept close to the body and activity is within pain free range. Our recommendations are: Avoid stretching both arms backwards at the same time Movement which might stress the upper body should be done with the elbows close to the body Only move arms within a pain free range Use the “elbow method” (leg rolling with counterweighting when getting in and out of bed) when getting in and out of bed Perform sternal preservation when coughing (crossing the arms in a “self hugging” posture) Use a sternal support vest when frequent coughing or BMI ≥ 35 Use a supporting brassiere that provides entire chest circumfence support, if bra size ≥ D Conclusion: This study provides insights into mechanical stress factors acting upon sternum and the overlying skin. Recommendations on activity precautions based on these findings have a patient supportive approach focusing on possibilities and not restrictions Professional education P114 How to critique a systematic review: knowledge & gaps of cardiovascular nurses E. Kletsiou,1 M. Kalabaliki,1 I. Koutelia,1 E. Stamatopoulou1 and P. Rammou2 1University Hospital of Athens “Attikon”, Athens, 2Greece Hygeia Hospital Tirana, Tirana, Albania Purpose: Systematic review is a very common type of an overview of primary studies, providing high quality evidence. While methodological quality of published articles is not always given, little is known about the ability of health care professionals in criticizing the methodological quality of a published systematic review article. The aim of this study was to determine the level of knowledge and investigate the presence of any gaps that cardiovascular nurses might have in assessing a systematic review. Material-method: A self-answered, anonymous questionnaire was distributed to cardiovascular nurse delegates’ participants in a clinical workshop on research methodology at a national conference in Thessaloniki, GR in October 2011. The questionnaire consisted of 2 sections: the first was about socio-demographics data and the second, basic principles of the systematic review methodology. Response alternatives in 2nd section were true/false questions (total=12 questions). Results: 67 delegates out of 100 returned completed questionnaires (Response Rate 67%) in a special spot of the congress hall. Mean age of the sample was 39.35 ± 8.6 years old and about 90% were women. All of the participants were registered nurses. Regarding basic studies, the majority (86.6%) was graduated by Technological Educational Institutions and the rest (11.9%) were university alumni. Almost half of the sample (46.9%) had a post-graduate diploma as of specialty, Master of Science or Doctoral degree. Mean time of clinical experience was 13.4±8.8 years, and the current position experience was calculated at 7.6±7.4 years. The test’s mean total score of correct answers was 6.34±1.98, while 72% of the delegated scored at least 7 correct answers. None of the participants answered correctly all twelve questions. There was no statistical significant correlation between the correct answers total score and delegates’ age (p = 0.506), as well as the years of clinical experience and current position experience (p = 0.359 and p = 0.652 irrespectively) or the level of education (p = 0.472) and the post-graduate education (p = 0.712). Conclusions: In the present study, several deficiencies in assessing the methodological quality of a systematic review have been identified. The findings of this study emphasize the need for ongoing and more effective education of healthcare providers and in particular cardiovascular nurses in research methodology. P115 Seeing the person as a patient – or seeing the patient as a person? A. Anna Leimumaki1 1Trinity College Dublin, Dublin, Ireland 2University of Kentucky, Kentucky, United States of America Purpose: There is a strong demand in public discourse that in the future health care should be a client-oriented and efficient service system. It has been admitted that developing such a system requires knowledge of clients’ real needs and views. Still the voices of patients have not often been heard in places where health care service requirements are estimated and decisions are made. The Wedge of Cranes is a project of developing health care from patients’ viewpoint. There are both public and private sector and NGO joined in the project. The aim is to construct a service system that is capable to produce value with the clients: truly to produce health and wellbeing to them. Methods: Illness narratives, told by people who have themselves fallen ill, have been one possibility for us to catch up the experience expertise of falling and being chronically ill. People told in their narratives about their views on health care system and about their personal ways to adapt and cope with those physical, emotional and social challenges they have met in a new life situation. Both aspects are important when we are trying to develop a health care system that meets more strongly patients’ everyday life, and thus is more efficient in its operations. Results: In health care we have had processes based only on different diagnosis or treatment methods, not based on different needs that those patients with the same diagnosis have. We are now trying to construct a new kind of process for patients with heart diseases, as a case. Instead of one path there will be several paths to follow when the patients move on in a process. Patients’ motivation to answer for self care and ability to cope with in their everyday life, in addition to medicine care, are affecting choosing the right path - a clientship strategy - for them. Conclusions: Listening to the experience expertise via illness narratives have elucidated us the current situation: health care is quite a routine and bureaucratic service system that states demands to patients, for example to commit to self care, but do not give tools to them to be able to do so. Clientship strategies enable to give different people just those tools that they need and want to be able to commit to self care, or to get on in their everyday life. Psycho-social P116 Affective disorders and adaptive mechanisms in patients after coronary artery bypass graft surgery A. Kutuzova,1 NN. Petrova,2 EA. Demchenko,3 IN. Chernisheva3 and MV. Goruleva3 1Federal Almazov’s Heart, Blood, Endocrinology center, Pavlov’s state medical university, St.Petersburg, Russian Federation 2St.Petersburg State University, St.Petersburg, Russian Federation 3Federal Almazov’s Heart, Blood, Endocrinology center, St.Petersburg, Russian Federation Affective disorders are well-known in coronary heart disease (CHD) patients, but there are relatively few data for psychological and behaviour impairments in patients after cardiovascular surgery. Purpose: To assess affective disorders and the ability to adapt in patients after coronary artery bypass graft (CABG) surgery. Subjects: 75 CHD patients (65 male, 10 female, age, 59±1 years, with myocardial infarction in 29% cases) after CABG. The majority of patients were married, 49% were university and college graduates. Methods: after admission to the post-operative rehabilitation department patients’ depression, anxiety, alexithymia and coping strategies were assessed using Hospital Anxiety and Depression Scale (HADS), Toronto Alexithymia self-rating scale (TAS), Heim’s coping-inventory. Results: According to HADS patients were mildly depressed and anxious in 10% and 25% cases, respectively; 5% had significant affective disorders. The majority of respondents demonstrated alexithymia tendency: difficulty to identify feelings and distinguish between feelings and the bodily sensations (TAS score 67.8±0.9). The dominating postbypass patients’ behaviour coping model was nonconstructive avoidance of CHD-, and cardiovascular surgery-related stressors: 26% patients did not reflect on health-related problems, 29% used “diverting” coping strategies.Cognitive coping patterns happened to be nonconstructive in 16% cases (“dissimulation”); the dominating patients’ emotional reaction to CABG was positive expectation of the future (71% cases, “optimism”), but 16% subjects preferred to inhibit negative emotions (nonconstructive coping strategy). Pattern for optimism in CHD patients, who avoid health-related problems and therefore life-style changes, could also be determined as a negative coping model. Thereby although anxiety is a probable emotional reaction to cardiovascular surgery intervention, the combination of affective disorders and alexithymia could interfere with adaptive coping strategy formation in postbypass patients. Conclusions: affective disorders and ineffective adaptive coping mechanisms in postbypass patients have to be assessed and need to be a goal of specific treatment and correction within the multidisciplinary individual rehabilitation and lifestyle management after cardiovascular surgery. P118 Preliminary trial for development of an online information service for day surgery patients K. Ken Wacker,1 L. Olsen1 and L. Pape-Haugaard2 1Aalborg University, Aalborg, Denmark 2Aalborg University, Department of Health Science and Technology, Aalborg, Denmark Purpose: Danish health care is under pressure due to technological and demographical development. Patients’ lengths of stay are shortened and more procedures are performed in ambulatory settings. This presents a challenge in regards to conveying patient related information, as the need for information is still high after discharge. It is therefore meaningful to investigate the possibilities for using information technology to create a patient-centered informatical solution to patients undergoing day surgery. An empirical study has been carried out at the Department of Vascular Surgery, Gentofte Hospital, Denmark, with focus on patients with varicose veins. The objective of the study was to identify the need and content of an operational online informatical resource for day surgery patients, in an ambulatory setting. Methods: A broad range of methods were used in triangulation, in order to create a nuanced understanding of the problem area. A registration of telephone calls to the ambulatory was performed in order to validate the quantity of calls. Interviews were carried out with 4 clinicians and 2 secretaries in pursuit of knowledge of the target group. This knowledge formed a starting point of the design of a questionnaire for 100 patients with varicose veins. In designing the questionnaire, a new method was developed, enveloping the gathering of as valid data as possible, when investigating information needs for day surgery patients. Finally a workshop was carried out with 3 patients treated for varicose veins. The purpose of the workshop was utilization of active end user participation in the first steps of design and development of an online information service. Using the results from this workshop and supplementing renowned methods, modeling of use cases and activity diagrams was performed in the process of mediating and operationalizing the data to make them usable for development of an online information service. Results: Patients with varicose veins have a need for information that is not always adequately covered by the present practice. Content and functionalities for communication have been identified through active end user participation and will be elaborated in the presentation. Conclusions: The content and functionalities needed in supporting patients with varicose veins were modeled. The perspectives of the users were not always directly realizable when considering the need for securing health related data. In order to create a sustainable solution, a broader approach involving stakeholders is necessary, including relevant clinicians, the department management and the IT-department. P119 Factors related to do physical activity based on theory of planned behavior in girl students of Shahid Beheshti University of medical sciences in Iran Z. Khavari,1 M. Hosseini,2 P. Haidari1 and M T. Sareban1 1Shahid Sadooghi University of Medical Sciences, Afshar Hosp., Dpt of Cardiovascular Research Center, Yazd, Iran (Islamic Republic of) 2Shahid Beheshti University of Medical Sciences, Tehran, Iran (Islamic Republic of) Introduction: The regular physical activity can lead to social, physiological and physiological health. However the process increasing sedentary is worried in the most of the countries like Iran. Studies have shown that 80percent of Iranian’s people do not physical activity and the amount of doing physical activity among girl in all ages is lower than boys. Therefore to solve this problem a study is required in the field of related factors with doing physical activity based on theoretical framework. Methods: This descriptive -correlational study was conducted to determine factors related to do physical activity based on theory of planned behavior in girl students. 444 students’ girls were selected by stratified Sampling method. A questionnaire was used for data collection. This questionnaire was included 6 parts: 1– external variable 2–attitiude to physical activity 3–subjective norm to physical activity 4– perceived control behavior toward physical activity 5– intention to physical activity and 6–physical activity.Content and face Validity was used this questionnaire and their reliability of the instrument was determined by internal consistency and test-retest methods respectively. Cronbach ‘s alpha coefficiency in parts of attitude, subjective norm, perceived control behavior and intention to physical activity and do it was α=0/89, α=0/85,α=0/80 α=0/87 α=0/82 respectively. Spearman correlation coefficienty in parts of attitude, subjective norm, perceived control behavior and intention to physical activity and do it was r=0/82, r=94, r=0/82, r=0/80 and r= 0/79 respectively.Mean, standard deviation, distribution of frequency regression and path analysis was used to analysis data. Result: Result showed that attitude (β= 0.138) and perceived control behavior (β= 0.136) related to intention and subjective norm (β= 0.103), perceived control behavior (β= 0.208) and intention related to physical activity. Also perceived control behavior via intention (β= 0.136) related to (β= 0.586) physical activity indirectly. Conclusion: Findings showed that attitude, and perceived control behavior related to intention and subjective norm, perceived control behavior and intention related to physical activity. Also perceived control behavior via intention related physical activity indirectly. Stroke P120 Nursing in cardiology: specialty or utopia: skills map and profile of nursing in cardiology A-L. Fernandez-Oliver,1 M. Rojas- Mata,2 R. Mgueraman - Jilali,3 S. Navarro - Rodriguez2 and N. Hevia - Ceva2 1University Hospital Virgen de la Victoria, Unidad de Gestión Clínica del Corazón. Málaga, Spain, Malaga, Spain 2Hospital Regional Carlos Haya. Unidad de Gestión Clínica del Corazón, Malaga, Spain 3University Hospital Clinic Virgen de la Victoria. Cardiology Department, Malaga, Spain Introduction/Objectives: There is no doubt that nurses are fully qualified to provide general nursing care to obtain the degree, but in some cases need to complete their studies with specialized training. Currently the profile of cardiac patients to hospital care is becoming more complex, gravity and dependence. The diagnosis, treatment, rehabilitation and prevention of these patients’ experienced significant changes and advances in recent years, demanding more heart units technically qualified nursing professionals’ most qualified scientific and technological knowledge and clinical practice models to enable them to respond to transformation needs of these units. We outline as objectives: To Analyze the need for specific competence map for nurses in cardiology and agreed to make its design professionals. To identify the average level of nursing competencies needed in the unit. Identify improvements needed to achieve a level of excellence, identifying areas for improvement. Establish a concrete work plan, which should aim to end service quality of the coronary patient, the satisfaction of their needs and demands and your family. Method: Multicenter study was conducted, Qualitative Cross-sectional. Convenience sample (30 nurses), recruiting the best questionnaire (evaluation grid) in three months, all eligible nurses who meet inclusion criteria: working in cardiology over a year. We realized a situational literature review. Results: We design a map of specific skills, agreed with nurses, proving the need for it. We obtained detailed results for each section of the grill for Performance Assessment in the following areas: Methodology in nursing work, organizational commitment, Teamwork, Quality, Patient / client-caregiver attitude of learning and knowledge. Nursing competencies identified in the Cardiology Care Units, identifying improvement areas. Conclusions: The main conclusion, answering the opening question of the paper we consider essential to a map of competencies for nurses in cardiology, for their own specific responsibilities for the care of coronary patients, especially those that are of vital urgency and quick response. Map must be revised periodically to incorporate new knowledge, skills and attitudes necessary for future development and updating of the nursing profession in cardiology. Emphasize the importance of personal and specific nurse to adjust how they engage, how they feel it is theirs, why their professional contribution to contribute to achieving the optimization of nursing care. Oral abstract session 3 Saturday, 17 March - 11:00 - 12.30 Location: Auditorium 12 P132 BHf arrhythmia specialist nurses reduce re-admissions, save health care costs andimprove quality of life H. Hanif Ismail1 and R. Lewin1 1University of York, York, United Kingdom What is an arrhythmia? An arrhythmia is an abnormality of the heart’s rhythm. The heart may beat too slowly, too quickly or in an irregular way Who gets arrhythmia? Cardiac arrhythmias affect over 700,000 people in England, with the most prevalent type, atrial fibrillation (AF), affecting up to 1% of the population and accounting for 1% of the entire NHS budget.1, 2 In the European Union, AF alone affects around 6 million people.3 In England guidance from the Government4 recommended that “people with long term conditions should receive support in managing their illness from a named arrhythmia care co-ordinator (ACCs)”. In 2006 the BHF awarded funding for three years for 32 ACCs across England and Wales. This project is reporting on the evaluation of the impact of these specialist nurses. Aims of the evaluation The evaluation aimed to answer the following questions: How did the ACCs perceive their role and what were the challenges in developing their service? How did patients perceive the ACCs role? How did physicians perceive the ACCs role? Did the ACCs improve the patients’ health related quality of life? Did the appointment of the ACCs help to reduce hospital re-admissions? Evaluation methods The evaluation used multiple data sources and mixed methods: Audit to describe the work load of each ACC and to benchmark and compare this across the centres through an on-line patient management database; Patient questionnaires Surveys Activity diaries Hospital Episode Statistics (HES) Interviews with patients, carers Interviews with ACCS and other health professionals Key findings Conclusions We have estimated that this service have resulted in a cost saving of £29,537 per annum for each ACC employed. Benefits were recorded in patients’ anxiety and health-related quality of life, the patients’ satisfaction with the NHS, the efficiency of clinics and in readmissions when compared with other similar hospitals. All the sources of information in this evaluation confirmed that the ACC role significantly improved the arrhythmia services in which the ACCs were placed Consultants reported that they were able to be more productive as the ACCs took over some of the routine clinical work and often introduced improved pathways and protocols. Patients and consultants greatly valued their work, both praised the ACCs’ role in communicating with patients, in ensuring a holistic service and in acting as a key worker and a single point of contact. P133 Health-related quality of life and survival in patients five years after cardiac surgery – a prospective cohort study KH. Gjeilo,1 A. Wahba,1 P. Klepstad,2 S. Lydersen3 and R. Stenseth4 1St. Olavs Hospital, Dept. of Cardiothorac Surg, Trondheim, Norway 2St. Olavs Hospital, Dept. of Intensive Care Medicine, Trondheim, Norway 3 The Regional Centre for Child and Adolescent Mental Health, Dept. of Neuroscience, NTNU, Trondheim, Norway 4St. Olavs Hospital, Dept. of Cardiothorac Anaesthesiology, Trondheim, Norway Purpose: Health-related quality of life (HRQOL) is an important endpoint following cardiac surgery. Particularly in older age, HRQOL, is the primary goal of treatment. However, longitudinal prospective cohort studies describing HRQOL after cardiac surgery are still scarce. The purpose of the study was to explore HRQOL and survival in patients undergoing cardiac surgery after five years, emphasizing older patients (≥ 75 years). Methods: In a prospective population-based study, 534 patients (23% ≥75 years, 67 % males) were consecutively included before surgery. HRQOL, medical and socio-demographic variables were measured by questionnaires at baseline, 6 and 12 months after surgery and again after five years. HRQOL was measured by the Short-Form Health Survey (SF-36). Results: Five hundred and twenty patients were alive 12 months after surgery with a response rate of 89% at 6 and 12 months. Four hundred and fifty-eight patients were alive after five years, with a response rate of 82%. Older patients had lower five years survival (HR 1.66, P = 0.042) than younger patients. In general the patients had an overall improvement in HRQOL over the first 6 months after cardiac surgery. After five years both older and younger patients had slightly lower scores on some SF-36 dimensions, compared with scores after 6 and 12 months. However, on 7 of 8 subscales of the SF-36, the scores after five years were still higher than before surgery. The improvements were considered to be clinically relevant, with mean changes ranging from 5 to 30 points. Older patients improved less from baseline to follow-up, and had more profound reductions in scores from 12 months to five years on three subscales; Physical Functioning (P = 0.013), Role Physical (P < 0.001) and Vitality (P = 0.036). Conclusions: HRQOL improved from baseline to 6 months postoperatively, and remained relatively stable five years after cardiac surgery. On some dimensions of HRQOL a slight deterioration was found from 12 months to five years, most pronounced in elderly patients. However, also elderly patients had a long term benefit concerning HRQOL. This is of major importance both for the use of health care resources and the decision making concerning individual patients. P134 The effects of guided imagery on sleep and inflammatory response following cardiac surgery J. Casida1 and K. Yaremchuk2 1Wayne State University College of Nursing, Detroit, Michigan, United States of America 2Henry Ford Hospital Head & Neck Surgery/Otolaryngology Department, Detroit, United States of America Purpose: The goal of this study was to evaluate the feasibility and acceptability of using a guided imagery program (Healthful Sleep) as sleep-promoting intervention for post-cardiac surgery patients. We hypothesized that patients who received guided imagery will show (a) shorter sleep latency, (b) higher sleep efficiency and total sleep time, and (c) lower levels of stress (cortisol) and inflammatory (C-reactive protein, [CRP]) markers over time than patients who did not receive the intervention. Methods: We employed pre-test/post-test, repeated measures, control-group design. Fifty two patients were randomly assigned into either intervention (n=27) or no-intervention (n=25) group. Patients in the intervention group used the guided imagery, delivered via an MP3 player with sleep phones¯, for 1 hour between 10:00 pm and 12:00 midnight during post-operative days (POD) 1through 5. Sleep variables were measured with wrist actigraphy (Actiwatch 64W). Salivary cortisol and CRP levels were obtained between 6:00 am and 8:00 am at POD 1 to 5. A 7–item satisfaction questionnaire using 1 to 5 Lickert response scale was administered at POD 6. We used IBM SPSS 19.0 for data management and analyses. Results: Of the 52 patients, 40 (intervention [n=20] and no-intervention [n=20] groups) had completed the study. Two-way repeated measures ANOVA showed no significant group interaction effects on sleep and biomarker variables, despite the data showing that patients in the intervention group had shorter mean sleep onset latencies and lower mean cortisol and CRP levels than the comparative group. It is worth nothing that we found a within group time effects on cortisol levels which significantly decreased at POD 4 to 5 (F=6.047, p = .001). Overall, patients in the intervention group were satisfied (mean = 4.24 ±.80) with the integration of guided imagery program in post-operative care. Conclusion: Guided imagery programs can be successfully integrated as sleep-promoting interventions in adult cardiac surgery population warranting further investigations. Future research should include a larger sample size to establish a definitive conclusion on the effects of guided imagery on the patients’ sleep, stress and CRP levels post-operatively. Nonetheless, the findings contribute to the growing body of knowledge on the use, and acceptance of complementary and alternative therapies in the ICU. P135 Effects on exercise capacity of eHealth encouragements in adolescents with congenital heart disease; development of a prospective and randomised complex intervention S H Susanne Hwiid Klausen,1 UR. Mikkelsen,2 A. Hirth,3 J. Wetterslev,4 H. Kjaergaard,1 L. Sondergaard5 and LL. Andersen6 1Rigshospitalet - The Juliane Marie Centre, Copenhagen, Denmark 2Institute of Sports Medicine, University Hospital Bispebjerg, Copenhagen, Denmark 3Haukeland University Hospital, Department of Heart Disease, Bergen, Norway 4Copenhagen Trial Unit (CTU), Centre for Clinical Intervention Research, Rigshospitalet, Copenhagen, Denmark 5Rigshospitalet - Copenhagen University Hospital, Heart Centre, Department of Cardiology, Copenhagen, Denmark 6National Research Centre for the Working Environment, Copenhagen, Denmark Background: Intensive exercise may be an important part of rehabilitation in patients with Congenital Heart Disease (CHD). However, performing regular physical exercise is challenging for many adolescents. Consequently, effective exercise encouragements may be needed. Little is known on the effect of e-Health encouragements on physical fitness, physical activity and health related Quality of Life (HRQoL) in adolescents. This trial is a nationwide interactive e-Health rehabilitation study lasting one year, centred on interactive use of mobile phone and Internet technology. We hypothesise that e-Health encouragements and interactive monitoring of intensive exercise over one year can improve physical fitness, physical activity and HRQoL. Methods: Two hundred and sixteen adolescents (13–16 years) with surgically corrected complex CHD, (truncus arteriosus, DORV, ccTGA, TGA, AVSD, TOF, CoA, Mb Ebstein, aortic stenosis), but without significant hemodynamic residual defects and no restrictions to participate in physical activity, are in the process of being enrolled by invitation after informed consent. The development, evaluation and implementation of the intervention is structured around recommendations developed by the Medical Research Council (MRC), UK 2008. This presentation elaborates on the first two steps: Development and Feasibility. Development: A systematic review of the existing evidence base was undertaken. A Health Education programme is developed, based on a theoretical framework of motivational theory (Self-efficacy and Theory of Planned Behaviour). Physical fitness is measured as the maximal oxygen uptake (VO2–peak) at baseline and after twelve months by an assessor blinded to the randomization group. After baseline testing, the patients are 1:1 randomized to an intervention group or a control group. Individually tailored e-Health encouragements – SMS, Internet and Mobile applications - aimed at increasing physical activity are delivered to the participants in the intervention group once a week. Feasibility: The Godfrey cycle ergometer protocol has been feasibility tested and seems applicable to adolescents with CHD. The patients could complete the baseline tests and the intervention with good reproducibility (ICC = 0.89). Furthermore, the Health Education programme as well as the e-Health programme was piloted over a period of six weeks. The trial is expected to contribute with new knowledge regarding how physical activity in adolescents with CHD can be increased and possibly co-morbidity reduced. P136 Hematoma incidence after pacemaker implantation: compressive vs non-compressive dressing J L. Jose Luis Cobo Sanchez,1 AR. Alconero Camarero,2 N. Gutierrez Caloca1 and M. Casaus Perez1 1University Hospital Marques de Valdecilla, Santander, Spain2EUE Casa de Salud Valdecilla. Universidad de Cantabria, Santander, Spain Aim: To evaluate the usefulness of compressive dressing to prevent hematoma after pacemaker implantation. Methodology: Quasi-experimental study. Sixty-eight consecutive patients who underwent first implantation of a pacemaker along 4 months period were studied. Interventions were included in both the arrhythmia unit as in the hemodynamic unit: a compressive dressing was performed in one and the other did not (control group). Patients were admitted the evening before implantation and remained hospitalized 24 hours after the same if no complications appeared. The presence of hematoma was assessed by nurses immediately after implantation and 24 h after implantation in the hospitalization unit. Using a standardized registry, demographic and other variables related to the problem under study were collected. Results: By total size, 60% were men and 40% were women, mean age 74.49 years old (range 54–90 years). Thirty-five percent of patients were treated with any anticoagulant drug type: 35% antiplatelet therapy, 7% low molecular weight heparin, 10% oral anticoagulant. All implanted pacemaker were single-chamber pacemaker. Compressive dressing 54.4% (37 patients), non-compressive dressing 45.6% (31 patients). Presence of hematoma immediately after implantation: 0% compressive dressing vs 9.6% non-compressive dressing (p = 0.09). Presence of hematoma 24 hours after implantation in hospitalization unit: 2.7% compressive dressing vs 16.12% non-compressive dressing (p = 0.064). Mean removal of the compressive dressing time: 43.20 hours on 16% of patients. There were no statistically significant differences between the occurrence of hematoma and anticoagulant drug therapy. The left subclavian vein access was related to the occurrence of hematoma (6 hematomas left subclavian vein vs 0 hematomas right subclavian vein). Other variables related to the occurrence of hematoma were the previous levels of platelets (hematoma 254 x 103/mm3 vs no hematoma 216.5 x 103/mm3; p = 0.048), previous prothrombin activity (hematoma 87% vs no hematoma 94.76%; p = 0.064), and device indications (atrioventricular block grade III 1 hematoma, atrial fibrillation 3 hematomas, slowly flutter 1 hematoma, other indications 1 hematoma, p = 0.022). Conclusions: The compressive dressing reduces the incidence of hematomas after pacemaker implantation versus non-compressive dressing. The establishment of the compressive dressing after pacemaker implantation as usual nursing care prevents hematoma incidence. Venous access, coagulation factors and previous diagnosis influence the occurrence of hematoma. P137 The relationship between cardiovascular risk factors- secretory phospholipase A2(sPLA2), arterial stiffness, in metabolic syndrome (MS) patients D T Dumitru Tudor Zdrenghea,1 S. Goga,2 A. Sitar-Taut,3 A. Cosma1 and M. Cebanu2 1University of Medicine and Pharmacy, Cluj-Napoca, Romania 2Rehabilitation Hospital, Cluj-Napoca, Romania 3“Babes-Bolyai’ University, Cluj-Napoca, Romania Background: Metabolic syndrome (MS) is associated with increased cardiovascular risk, being a common cause of atherosclerotic vascular disease. Arterial stiffness is related to the atherosclerosis’s stages. Secretory phospholipase A2 activity represents a strong predictor of future cardiovascular events, both in primary and secondary prevention. Purpose: To investigate the relationship between cardiovascular risk factors - arterial stiffness - phospholipase A2 in patients with MS. Methods: We examined 81 patients, 58 (71.6%) presenting metabolic syndrome (53 women, 28 men), mean age 58.65± 10.38 years (range 36–86 years). As risk factors have been assessed the body weight, smoking habits, glycemia, hypertension and serum lipids fractions. Arterial stiffness (pulse wave velocity) was measured using TensioMedTMArteriograph. Secretory phospholipase A2 activity was quantified in µmol/min/ml from stored serum samples, using chromogenic method. The classification of the MS was based on the IDF guidelines. Results: 18.5% of the patients were current smokers, 34.6% obese, 69.1% hypertensive, 23.5% diabetics, and 74.1% dyslipidaemic. Significant differences were registered between patients with MS vs. those without MS regarding the prevalence of obesity (43.1% vs. 13.0%, p = 0.008), diabetes (32.8% vs. 0%, p = 0.001), hypertension (77.6% vs. 47.8%, p = 0.01). Mean value of sPLA2 and pulse wave velocity were equal to 5.6±1.2 µmol/min/ml, and 10.23±2.11 m/s respectively. Patients with MS presented greater values of sPLA2 (5.74±1.19 µmol/min/ml vs. 5.23±1.19 µmol/min/ml, p = 0.08), but no difference was found regarding the mean values of PWVAo (10.23±1.93 m/s vs. 10.23±2.55 m/s, p = NS). No significant correlation was registered between sPLA2 and PWVAo (Pearson coefficient=-0.03). Comparing women with vs. without MS, greater values of sPLA2 was registered (5.7±1.19 µmol/min/ml vs. 5.26±1.02 µmol/min/ml), but no similar relation was found for PWVAo (9.98±2.01 m/sec in women with MS vs. 10.32±2.71 m/sec in women without MS). On the other hand, men with MS presented greater values of both sPLA2 and PWVAo (5.8±1.2 µmol/min/ml vs. 5.1±2.33 µmol/min/ml, and 10.56 ±1.81 m/s vs. 9.6±1.1 m/s respectively). Conclusion: in our study, patients with metabolic syndrome did not present greater values of pulse wave velocity, but sPLA2 seems to increase earlier than pulse wave velocity in patients with metabolic syndrome (especially in women). The results suggest the fact sPLA2 can be used in early evaluation of patients with MS. P138 Long term follow up after an integrated educational and psychosocial intervention in patient-partner dyads affected by heart failure M. Maria Liljeroos,1 S. Agren,1 T. Jaarsma,1 K. Arestedt2 and A. Stromberg1 1Linkoping University, Linkoping, Sweden 2Linnaeus University, School of Health and Caring Sciences, Kalmar, Sweden Background: Heart failure (HF) is a growing health problem and the disease affects both the patient and their partner. Despite the fact that most HF patients receive self-care education, very few are able to adequately engage in self-care behaviours. Family research is rare in the heart failure population to address the self-care barriers and therefore this study has a family perspective and focuses on the HF patient-partner dyad. Objective: The study aimed to evaluate the long-term effects of an integrated HF dyad care program to dyads consisting of a patient and a partner. Method: A two centre randomized controlled design was used with follow-up after 3, 12 and 24 months. The intervention group (n=71 patients-partners dyads) participated in an integrated care intervention with education and support delivered in three modules through nurse-led face-to-face counselling, a computer based program and written materials. The control group (n=84 patients-partners dyads) received care as usual. The intervention was evaluated regarding perceived health (SF-36), depressive symptoms (Beck Depression Inventory) and perceived control (Control Attitudes Scale). According to the hierarchical structure with patient and partner nested in dyads and different cardiology departments, multilevel modelling was used to evaluate the intervention. Findings: The sample consisted of 155 patients and their partners. The patient mortality rate over the follow up period was 22%. The mean age was 70.1 years (SD = 11.5) and 53% had NYHA class III. Perceived control (p < 0.001) and mental health (p < 0.05) improved significantly over time in both the control and intervention group. The intervention group scored higher levels of physical health (p < 0.05) than the control group but it did not differ over time. The level of depressive symptoms was consistent over the follow up period and no differences were detected between the groups. Patients scored significantly lower health and more depressive symptoms (p < 0.001) than the partners, but there were no differences in the level of perceived control. Conclusion: The effect of the intervention over the 24 months follow up period was minor for the dyads. However, the intervention group scored higher level of physical health than the control group. Additional interventions seem to be necessary to have a higher impact on dyad outcomes. A qualitative analysis exploring the content of dyads’ needs for support is ongoing. P139 Measuring fatigue with the multidimensional fatigue inventory (MFI-20) in persons treated for myocardial infarction U. Fredriksson-Larsson,1 Å. Lundgren-Nilsson,2 C. Cliffordson,3 P. Alsen3 and E. Brink4 1Dep of Nursing, Health and Culture, University West, Trollhättan, Inst of Health and Care Sciences U, Gothenburg, Sweden 2Inst of Neuroscience and Physiology, Center for Person-Centred Care, University of Gothenburg, Sweden, 3Dep of Nursing, Health and Culture, University West Trollhättan, Sweden 4Inst of Health and Care Sciences, Center for Person-Centred Care, University Gothenburg, Sweden Purpose: During recovery from acute myocardial infarction, about 50% of the patients report fatigue. Early identification of a person experiencing fatigue could create conditions for better support in person-centred fatigue relief strategies. In clinical assessment of post-myocardial infarction fatigue, a short instrument is preferable. Therefore, the purpose of the present study was, first, to validate the Multidimensional Fatigue Inventory (MFI-20) and, second, to test whether the subscale General Fatigue could be used in screening for fatigue in persons who have been treated for myocardial infarction. Thus far, validation studies of MFI-20 including patients with coronary heart diseases have been lacking. Method: The sample consisted of 204 consecutive patients (59 women, 145 men, mean age 64 year) who have been treated for myocardial infarction at the coronary care unit in a rural Swedish hospital. Four mounts after the acute heart attack, study participants answered the MFI-20. Data were analysed using Confirmatory factor analysis and Rasch- analysis. Results: The confirmatory factor analyses revealed that the MFI five-factor model had a mediocre fit (RMSEA = 0.091; Chi2 = 432.079, p < 0.001). However, fitting data to the Rasch model with each domain grouped as testlets gave significant item-trait interactions, supporting the five- factor model. Also, when the five MFI-20 domains were analysed separately, they worked according to the model and there was support for using at least four of five MFI subscales - General Fatigue, Physical Fatigue Mental fatigue and Reduced Activity, (PCI between 0.73–0.81) – as measures of post-myocardial infarction fatigue. Conclusion: To conclude, the MFI-20 can be used in assessment of post - myocardial infarction fatigue. If a very short instrument is needed, the subscale General Fatigue can be used as an initial screening instrument. P140 Stroke survivors who like art have a better quality of life than those who do not E Vellone,1 S. Savini,1 S. Simeone,1 N. Barbato,2 G. Carovillano,3 MD. Caramia4 and R. Alvaro1 1University Tor Vergata, School of Nursing, Rome, Italy 2IRCCS San Raffaele Pisana Hospital, Rome, Italy 3San Giovanni Battista Hospital, Rome, Italy 4University Tor Vergata, Department of Publlic Health, Rome, Italy Purpose: A sudden emergence of brain vascular damage can cause functional and psychological disability in stroke survivors (SS). Art exposure might play a significant role in preserving and/or enhancing patients’quality of life (QOL). The aim of the present study was to evaluate how previous exposure to art, as an enrichment of the socio-cultural individual’s background, might have positively influenced the level of quality of life after stroke. Methods: A cross-sectional comparative study was used to analyze 192 SS divided in two groups: group Alpha consisting of 105 patients who were interested in art; group Beta consisting of 87 patients who were not.The following clinical evaluating scales were used: Stroke Impact Scale 3.0, a stroke-specific QOL measure with 8 individual scales; the Barthel Index, to evaluate patients’ functional autonomy; the SF-36, a generic instrument measuring QOL in eight domains; and the National Institute of Health Stoke Scale (NIHSS), in order to assess specific neurological functions. T-test for independent samples was used for statistical comparison of the two groups of SS. Results: Patients were 70 years old on average and were equally distributed between men and women. Patients interested in art (group Alpha) showed better physical functioning (p = 0.043), better general health (p = 0.000), vitality (p = 0.006), mental health (p = 0.000), memory (p = 0.000), emotion (p = 0.000) and communication (p = 0.000) than patients who were not (group Beta). No significant differences were observed between the two groups regarding socio demographic variables, functional autonomy (p = 0.095) and neurological functions (p = 0.086). Conclusions: Stroke survivors who were familiar with art, and expressed appreciation towards music, painting, theatre, etc, showed significantly better quality of life than patients who did not. These findings indicate that art sensitivity might have facilitating effects on clinical recovery after a stroke. Therefore, the introduction of art exposure in nursing care after stroke might contribute to SSs’ quality of life improvement. Moderated Posters Session 3 Saturday, 17 March 2012 - 10:00 -11:00 Location: Moderated Poster area P156 Gender differences in pre-hospital delay times in acute coronary syndrome A R Ana Rosa Alconero Camarero,1 JL. Cobo Sanchez,2 P. Munoz Cacho3 and JM. Revuelta Soba2 1University of Cantabria, EUE Casa de Salud Valdecilla, Santander, Spain 2University Hospital Marques de Valdecilla, Santander, Spain 3Cantabria Health Service, GAP 1, Santander, Spain Background: Cardiovascular disease is the leading cause of death in women, accounting for approximately 40% of deaths. In patients with an acute myocardial infarction (MI), symptom recognition is essential for prompting action. However, women who have an MI often delay seeking care compared with men. Aims: To estimate contact delay time (CDT) and total pre-hospital delay time (TPDT) in patients with acute coronary syndrome (ACS). To evaluate possible gender differences in the CDT and TPDT. To assess the potential genderdifferences in making decisions before the onset of ACS symptoms. Methodology: Five hundred sixty-two patients diagnosed by ACS and admitted in a Coronary Intensive Care Unit by electrocardiographic changes and biomarkers (troponins) of MI were recruited. Within 24 hours after admission and after confirming the ACS diagnosis, an interview related to the aims of the study was conducted to the patients, previous informed consent. CDT was defined as the time (in minutes) from the patient begins with the symptoms until first contact with health services was established. TDPT was defined as the time (in minutes) from the patient begins with the symptoms until their arrival in the Emergency Department. Results: Twenty-seven percent were women and 73% were men. Total sample’s mean age was on 63.6 years old (standard deviation 13.9 years); woman mean age 67.8 years old and for men 62.2 years old. Final diagnosis: 55% ST elevation MI, 28% non ST elevation MI, and 17% unstable angina. Median TDPT was on 120 minutes, interquartile range 23 minutes. Median TDPT in men and women was the same (120 minutes). Median CDT was on 77.5 minutes to women and 65 minutes in men. Regarding who made the decision to go to the Emergency Department, the patient was in 59.3% of cases, and another person was in 40.7% of cases. On taking decisions by gender, men acted quickly in 59.5%, while women did so in 47.5% (p < 0.05). There were no significant gender differences in the person who made the decision to act: women themselves did it in 54.7%, while in male patients this percentage was on 60.8%. Conclusions: Gender differences in the CDT were observed. The TDPT found was similar to other studies. There were no significant differences by gender in the TDPT, and this result remains relevant because the literature refers that women present an increased TDPT than men. P157 Missed appointments in an outpatient clinic for adults with congenital heart disease:prevalence and correlates K. Van Deyk,1 S. Strijbos,2 E. Goossens,2 W. Budts1 and P. Moons2 1University Hospitals (UZ) Leuven, Department of Congenital & Structural Cardiology, Leuven, Belgium 2Catholic University of Leuven, Center for Health Services and Nursing Research, Leuven, Belgium Purpose: Two well-known problems in the follow-up of patients with congenital heart disease (CHD) are lapse of care and lost to follow up. The first indication of an upcoming lapse of care or lost to follow-up may be a “missed appointment” (MA). MA are defined as a no-show at a scheduled outpatient visit. To prevent that patients get completely out of follow-up, it is important to pay attention to MA. MA had never been investigated in this patient population. Therefore the objectives of our study were to determine the prevalence of patients with MA in the Adult Congenital Heart Disease (ACHD) outpatient clinic; and to identify demographic, clinical and organizational determinants of MA. Methods: We conducted a descriptive, observational study at the ACHD outpatient clinic. All adult patients with CHD who were invited to the outpatient clinic from June 2007 to June 2009, were included in this study. For each clinic day, a list of scheduled patients is made. In a two-year period, we recorded on these lists whether or not patients showed up. Multivariable logistic regression analysis was performed to identify determinants of MA. Results: Of the 4002 scheduled visits, we observed missed appointments in 308 visits (8%). More specifically, 206 patients missed one appointment; 45 patients missed 2 appointments; and 4 patients failed to show up even 3 times. Multivariable logistic regression showed that MA were more common in men than women (9.1% vs 6.1%; Beta = 1.55;p < 0.001); in younger patients (median age=28.3y vs 29.3y; Beta = 0.98; p = 0.001); in patients without a history of catheterizations (8.4% vs 5.9%; Beta = 0.70; p = 0.02); in patients without a history of cardiac surgery (9.2% vs 6.5%; Beta=0.61; p < 0.001), and in visits scheduled in the morning (9.3% vs 6.9%; Beta = 1.39; p = 0.007). These factors, however, explained only 3.1% of the variance (Nagelkerke R2). Disease complexity did not play a role in MA. Conclusions: The prevalence of MA is acceptable and appeared not to be higher than in other populations. These analyses help us to identify patients prone to MA and facilitates us to improve the organization of outpatient care in the ACHD outpatient clinic. P158 Substance abuse, dental hygiene and physical activity in adult patients with single ventricle physiology DO Overgaard,1 AMS. Schrader,2 KHL. Holst Lisby,1 CK. King,1 RFC. Friis Christensen,1 HFJ. Friis Jensen3 and PM. Moons4 1Rigshospitalet, The Heart Center, Copenhagen, Denmark 2University College Metropol, Copenhagen, Denmark 3Skejby, Heart Center, Aarhus, Denmark 4Catholic University of Leuven, Center for Health Services and Nursing Research, Leuven, Belgium Background: Single ventricle physiology (SVP) patients are a new and continuously growing patient group, as a consequence of contemporary surgical procedures. SVP patients are particularly at risk for health problems, if they show detrimental health behavior. Their health behaviors are unknown and need to be investigated in order to provide the appropriate clinical care. Aims: To describe substance use, dental hygiene and physical activity in adult survivors with SVP and to compare the behaviors of patients with those of matched controls. Methods: A cross-sectional, case-control survey was conducted, including 59 patients. They were matched on age and gender to 172 healthy controls. Results: In patients with SVP, 85% report alcohol consumption; 26% admit binge drinking; 20% are cigarette smokers; 12% have used cannabis over the past year; 20% have had no dental visits during the last year; 46% are not flossing teeth; and 39% are not physically active. In general, health behaviors are better in patients than in controls, except in the areas of physical activity and dental hygiene, flossing in particular. Only for binge drinking, a significantly lower proportion was found in patients compared to controls (OR=0.56; p = 0.041). Conclusions: Overall health behavior is better in patients than in controls. However, the difference in health behavior is only statistically significant regarding to binge drinking and physical activity. We identified a need for guidance of SVP patients towards a better dental hygiene in order to prevent infective endocarditis. Also, patients should be encouraged to be more physically active, within their capabilities. P159 The association between depressive symptoms and appetite among patients with chronic heart failure C. Andreae,1 K. Arestedt2 and A. Stromberg1 1Department of Medical and Health Sciences, Linköping, Sweden 2Linnaeus University, School of Health and Caring Sciences, Kalmar, Sweden Purpose: Malnutrition is a serious condition in patients with chronic heart failure, leading to impaired quality of life and increased mortality. It is well known that heart failure symptoms e.g fatigue and gastrointestinal oedema cause impaired appetite, but it remains unclear how appetite is related to psychological factors such symptoms of depression. The aim was to investigate if depressive symptoms were associated with decreased appetite among patients with chronic heart failure. Supplementary knowledge in this area is of importance to develop new interventions to prevent and treat malnutrition. Methods: The sample was recruited from three nurse-led heart failure clinics in Sweden. Inclusion criteria were Swedish speaking adults with chronic heart failure due to a reduced systolic left ventricle function confirmed by echocardiography. The Council on Nutrition Appetite Questionnaire (CNAQ) and its derivative, the Simplified Nutritional Appetite Questionnaire (SNAQ), were used to assess appetite. Depressive symptoms were assessed with the Patient Health Questionnaire (PHQ-9). Linear multiple regression models (forced entry) were used to investigate the relationship between depressive symptoms and appetite. All models were adjusted for age, gender and disease severity measured by B-type natriuretic peptide (BNP). Results: Data collection is ongoing. Up to date, the sample consists of 111 patients, 36 women and 75 men. The mean age was 72.2 years (SD=11.1). The majority of the participants were in NYHA II or III (58% and 36% respectively). The mean plasma BNP level was 221 (SD=217) and the patients walked on average 343 meters (SD=150) in the Six minutes Walk Test. The analysis showed that depressive symptoms were significantly associated with decreased appetite and explained 13% of the variance in QNAQ (β=-0.27, t (104) = -3.94, p < 0.001) and 6% of the variance in SNAQ (β=-0.10, t (104) =-2.61, p < 0.01). This association retained after that the models were controlled for age, gender and disease severity. Conclusions: So far, it appears that depression is a contributing factor to decreased appetite in patients with chronic heart failure. Findings from the present study are of importance for the understanding of malnutrition among patients with heart failure. Before stronger conclusions can be drawn, larger samples and prospective studies are needed. P160 Weight monitoring in patients with severe heart failure (WISH) P. Patrik Lynga,1 H. Persson,2 A. Hagg-Martinell,2 E. Hagglund,3 I. Hagerman,3 A. Langius-Eklof4 and M. Rosenqvist1 1Karolinska Institutet, Departement of Clinical Science and Education, Södersjukhuset, Stockholm, Sweden 2Karolinska Institute, Danderyd Hospital, Department of Clinical Sciences, Stockholm, Sweden 3Karolinska University Hospital, Department of Cardiology, Huddinge, Sweden 4Karolinska Institute, Department of Neurobiology, Care Sciences and Society, Stockholm, Sweden Purpose: This multicentre, randomized controlled trial hypothesized that daily electronic transmission of body weight to a heart failure (HF) clinic will reduce cardiac hospitalization in patients recently hospitalized with HF. Methods: A total of 344 patients, mean age 73 years (SD 10.2), 74% males, 55% who had a LVEF <30%, were randomized after being hospitalized for heart failure to either an intervention (IG) or a control group (CG). Six centres participated. Patients in both groups were recommended daily weighing and in case of sudden weight gain >2 kg in 3 days to contact the HF clinic. Patients in the intervention group were given an electronic scale and the weight was automatically transmitted to and monitored at the HF clinic. Results: No significant differences were found for the primary end point, cardiac rehospitalization (76/165 CG, 73/179 IG, Hazard ratio (HR) =0.88, 95% Confidence Interval (CI) =0.64–1.22, p = 0.45), nor for the secondary end points; that included all-cause hospitalization (91/165 CG, 83/179 IG, HR=0.83, 95% CI=0.61–1.11, p = 0.21), death from any cause (9/165 CG, 6/179 IG, HR=0.62, 95% CI=0.22–1.73, p = 0.36) or the composite end point of cardiac hospitalization and death from any cause (85/165 CG, 79/179 IG, HR=0.86, 95% CI=0.63–1.16, p = 0.32). Subgroup analyses did not show any benefits for patients in the IG despite their more frequent monitoring occasions, 411 compared with 35 in the CG. Conclusion: Daily electronic transmission of body weight and monitoring three times a week did not decrease hospitalization or death in HF patients follow-up at a HF clinic. P161 Self-care predictors in patients with non-ischaemic heart failure M. Maria Kaprana,1 C. Deaton,1 A. Caress1 and M. Campbell1 1University of Manchester, Manchester, United Kingdom Purpose: Self-care is considered a means of improving outcomes in patients with heart failure (HF). Little self-care information is available in non-ischaemic HF patients; a conceptual model was developed, testing possible associations between self-care and potential predictors (sociodemographics, psychological status, clinical and healthcare variables) in these patients. Methods: Patients with a primary diagnosis of non-ischaemic dilated cardiomyopathy (DCM) were recruited from two UK hospitals for a postal survey. Data were collected on self-care maintenance (adherence) and management (symptom response) (Self-Care in Heart Failure Index [SCHFI]), sociodemographics, clinical factors, psychological status (Hospital Anxiety and Depression Scale) and symptoms. Results: 207 patients were recruited (44% response rate), mean age 51 years (SD 10.6), 28.5% female, 16.5% living alone, 78% NYHA classes I/II, 22% classes III/IV. Patients received care by cardiologists (54%) or in multidisciplinary HF clinics (46%). 69% reportedly received self-care education, 30% participated in cardiac rehabilitation, while 36% had been hospitalised the previous year (median 6 days, range 1–320). Participants reported relatively low symptom (mean 17.5, SD 14.0), anxiety (mean 7.6, SD 5.0; 48% with scores indicative of anxiety) and depression (mean 6.3, SD 4.7; 40% with scores indicative of depression) scores. Mean scores for SCHFI maintenance, management and confidence were 63.8 (SD 16.5), 57.8 (SD 19.6) and 60.7 (SD 19.5) respectively. The SCHFI maintenance model predicted 22% of score variance (F[18, 115]=3.13, p < 0.001); form of care (HF clinic), social support, NYHA class, anxiety and depression significantly predicted maintenance scores. The SCHFI management model predicted 39% of score variance (F[19, 67]=3.88, p <0.001); previous hospitalisations and self-care confidence significantly predicted management scores. Conclusions: Self-care adherence and symptom management were low, despite specialist care and self-care education in this mostly young and less functionally impaired group. Higher anxiety, social support, attending a HF clinic and worse NYHA class increased adherence, while depression diminished it. Previous hospitalisations and greater self-care confidence determined better self-management. Regression models predicted limited self-care variance indicating that further important factors affect self-care practices. Interventions and programmes of care aiming to improve self-care in these patients should include screening and treatment of anxiety and depression, and developing self-care confidence. P162 Spiritual needs and spiritual support preferences of people with end stage heart failure and their careers L. Ross1 and J. Austin2 1University of Glamorgan, Pontypridd, United Kingdom 2Nevill Hall Hospital, Aneurin Bevan Health Board, Abergavenny, United Kingdom Purpose: Spiritual care is an important part of health care and there is a growing evidence base demonstrating a link between the spiritual part of a person’s life and their health and quality of life. The Department of Health (2004) set out guidelines for the spiritual care of people with heart failure and called for further research. This study aimed to: Identify if end stage heart failure patients/carers experience spiritual needs. Identify how spiritual concerns vary over the course of the illness. Identify how patients/carers perceive that they might be supported in addressing spiritual issues. Develop spiritual support guidelines as part of the palliative care package. Methods: Ethical approvals were obtained before a sample of 16 (from a population of 72) NYHA IV patients & carers were interviewed in their homes at 3 monthly intervals in 2008/9. Fifty interviews were conducted (16 first, 15 second, 11 third, 8 fourth) and 47 were tape recorded, transcribed and analysed. Results: Aim 1: All 16 patients/carers were struggling with spiritual/existential concerns. These related to 6 themes which correspond with the key concepts of spirituality identified in the literature: 1.Love & belonging (e.g. loneliness, isolation, anxiety, strain on carers). 2. Hope & 3. Coping (e.g. keeping busy, keeping dreams alive, hope of new treatments). 4. Meaning & purpose (e.g. why me?, feeling useless). 5. Faith & belief (e.g. fear of dying, being on ‘borrowed time’, importance of religious faith, pondering the eternal). 6. The future (e.g. bleak outlook, making the most of time left, diminishing health). Aim 2: At first many patients were determined to fight their illness and were optimistic of improvement/cure. Over time, however, as their physical condition deteriorated, they became more resigned to the fact that things were not going to improve. The emphasis shifted from ‘fighting’ to making the most of the time they had left. Many feared loss of independence and dignity. Aim 3: Suggestions for addressing spiritual care included: supporting carers, having someone to talk to about existential/spiritual concerns, increasing staff awareness/sensitivity. Aim 4: Focus groups were held with key stakeholders to identify how the gap in service provision for addressing spiritual concerns might be met. A spiritual support home visiting service would be valued, especially by patients living alone. Funding is being sought to pilot this service. Conclusions: Spiritual issues were significant for the sample of patients/ carers included in this study, but are not adequately met within the current care package. P163 Is self-care behaviour associated with self-rated health in elderly patients with heart failure? S. Simone Inkrot,1 E. Tahirovic,1 M. Lainscak,2 LK. Starck,1 M. Osterland,1 Y. Ehmke,1 S. Bernard,1 W. Haverkamp,1 T. Dassen3 and HD. Duengen1 1Charite - Campus Virchow-Klinikum, Department of Internal Medicine-Cardiology, Berlin, Germany 2University Clinic of Respiratory and Allergic Diseases Golnik, Division of Cardiology, Golnik, Slovenia 3Charite - Campus Virchow-Klinikum, Department of Nursing Science, Berlin, Germany Purpose: Good self-care behaviour and good self-rated health (SRH) are associated with improved outcome in heart failure (HF). We aimed to investigate factors other than education associated with self-care and to evaluate whether self-care is associated with SRH. Methods: In this cross-sectional, descriptive, multicentre survey, we measured self-care in 241 elderly patients with HF [mean age 76±6; 46% female; 76% NYHA II-III], using the 3 scales of the Self-care of Heart Failure Index. Higher scores (0–100) indicate better self-care. SRH was measured by asking “How do you rate your health in general?”, using a five-point Likert-scale with lower numbers indicating better SRH: 1=excellent, 2=very good, 3=good, 4=fair, 5=poor. In bivariate analyses, Pearson’s correlation was used for continuous, and Mann-Whitney-U-Test and Kruskal-Wallis-Test for categorical variables. For multivariate analysis, a linear regression was performed. Results: Mean self-care scores were below adequate [maintenance 36±14.5; management 55±22.2; confidence 39±23.0], and mean SRH was 3.35±0.85. Higher maintenance scores were found in married patients [vs. divorced/widowed; 43.8±14.4 vs. 37.3±13.5, p = 0.037] and patients living with someone [vs. living alone; 43.3±14.6 vs. 37.3±13.1, p = 0.020]. Higher management scores were associated with higher NYHA class [r=0.190; p = 0.042], lower LVEF [r= -0.214, p = 0.037] and male sex [62.8±19.0 vs 51.6±23.2, p = 0.007]. Higher self-care confidence was associated with better quality of life (QoL) [SF36 physical score r=0.177, p = 0.009; SF36 psychosocial score r=0.148, p = 0.028], better SRH [r= -0.134, p = 0.041], and less depressive symptoms [PHQ-D; r= -0.224, p = 0.001]. In linear regression [R-square=0.361], lower NYHA class [β=0.203, 95%CI 0.064 to 0.414, p = 0.008], better QoL [SF36 physical component β= -0.304, 95%CI -0.036 to -0.010, p = 0.001; SF36 psychosocial score β= -0.323, 95%CI -0.038 to -0.007, p = 0.004], and more time since heart failure diagnosis [β= -0.194, 95%CI -0.004 to 0.000, p = 0.020] but none of the self-care scores were independently associated with better SRH. Conclusions: The low self-care scores indicate a need for nurses to increase self-care education in elderly patients with HF. Non-modifiable factors such as sex, marital status and living situation play a big role in self-care and must be considered when individualizing patient education. Though higher self-care confidence was associated with a more positive subjective health assessment, SRH does not appear to be influenced by self-care scores when clinical and socio-demographic factors are taken into account. P164 Undertreatment of anxiety and depression in patients with an implantable cardioverter defibrillator: Impact on health status MT. Madelein Hoogwegt,1 N. Kupper,1 DAMJ. Theuns,2 WP. Zijlstra,1 L. Jordaens2 and SS. Pedersen1 1Tilburg University, CoRPS Center of Research on Psychology in Somatic diseases, Tilburg, Netherlands 2Erasmus Medical Center, Thoraxcenter, Department of Cardiology, Rotterdam, Netherlands Purpose: 25–33% of patients with an implantable cardioverter-defibrillator (ICD) experience anxiety and depression, but it is not known whether their symptoms are adequately treated. We investigated (i) whether patients with clinically relevant symptoms of distress received appropriate treatment, and (ii) whether patients not treated for their emotional distress reported poorer health status using a prospective study design. Methods: A consecutive cohort of 448 first-time patients with an ICD (21% women; mean age,58±12 years) completed the Hospital Anxiety and Depression Scale (HADS). Information on psychological treatment was obtained via purpose-designed questions. Results: At baseline, 35.5% of patients were emotionally distressed (defined as reporting clinically significant levels of anxiety and/or depression), of which 70.2% received no psychological treatment. At 12 months post-implantation, 24.3% of all patients had clinically significant levels of distress, of which 58.3% received no treatment. Patients experiencing distress but not receiving treatment reported a significantly lower health status than patients without distress and treatment (all Ps < 0.0001) and compared to patients without emotional distress who did receive treatment (Ps varying between P = 0.027and P < 0.0001 for 6 subscales). Scores were higher on four subscales than for patients with emotional distress and treatment (Ps varying between P = 0.034 and P < 0.0001) Conclusions: There was a serious gap between the need for treatment for emotional distress and the actual delivery of treatment, with consequences to patient health status. Detection and adequate treatment of distress in patients with an ICD remains an important target in this patient group in order to safeguard their health status post-implantation P165 Patients after stroke and myocardial infarction in primary health care in Poland - risk factors, diagnosis and treatment A. Agnieszka Serafin,1 M. Niewada,2 R. Glowczynska,1 M. Starczewska,1 KJ. Filipiak1 and G. Opolski1 1Medical University of Warsaw, 1st Department of Cardiology, Warsaw, Poland 2Medical University of Warsaw, Department of Experimental and Clinical Pharmacology, Warsaw, Poland Aims of study: 1. Description of the prevalence of the cardiovascular risk factors and advises for lifestyle changes in group of patients after stroke and myocardial infarction (MI) treated in Polish primary care (PPC). 2. Establishment of the frequency of diagnostic tests available in PPC in those group of patients. 3. Determination the frequency of prescription of the various groups of drugs recommended for secondary prevention of these diseases in the applicable standards of therapy. Figure. Open in new tabDownload slide Mean health status by treatment group Material and methods: Secondary analysis of data collected during the SPOK (Standard of Cardiology Primary Care - Standard Podstawowej Opieki Kardiologicznej) survey conducted in 2003–2005. The study was based on questionnaire with questions concerning the diagnosis, treatment and prevention activities carried out on patients with cardiovascular diseases. Study used a scheme of multilevel selection of respondents, which allowed the emergence of a statistically representative group of Polish physicians and patients and was financed by Polish Ministry of Health. This analysis included 699 patients (pts) after stroke and MI treated in PPC. In the main analysis those group of patients was compare with patients after stroke, after MI and without stroke and MI in the past but with stable coronary disease. Results: In the analyzed subgroup of patients mean age was 66,3 years +/- 10,4, mean weight and mean BMI was 79,4 kg +/-13,7 and 28,03 kg /m2 +/- 4,4, respectively. Coexisting diabetes was diagnosed in 30%, dyslipidaemia in 75,1%, hypertension in 51,5%, renal failure in 8,7%, heart failure in 78,8% and atrial fibrillation in 27,8% of patients. Despite it, recommendation about: dietary changes were given to 76,1% pts, normalization of body weight to 61,1% and regular physical activity to 73% of pts. Diagnostic tests were performed respectively: coronary angiography in 47.5%, an electrocardiogram in the last 12 months in 74.5%, echocardiography in 39.6 % of pts after MI and stroke. From the basic groups of drugs recommended for secondary prevention, aspirin was use by 77.7 %, beta-blockers by 70.5%, ACEI by 74,1% and statins by 76.3% of pts. Conclusion: Specialized diagnostic tests, recommended groups of drugs and lifestyle recommendations were given too rarely in those subgroup of patients. We need good preparing, multidisciplinary program of care in Polish primary care, containing higher activity of nurse, physiotherapist, dietician and psychologist. Poster Session 2 Saturday, 17 March 2012 - 08:30 - 15:00 Location: Poster area Acute cardiac care P166 Evaluating a new clinical pathway using a patient satisfaction questionnaire S. Sarah Young,1 G. Dixon1 and C. Ashenden1 1Sussex Cardiac Centre, Brighton, United Kingdom Purpose: Direct admission from the ambulance into the cardiac catheter lab was implemented in May 2010 to further reduce time to treatment for patients requiring primary angioplasty. This has significantly reduced time to treatment for patients. Expansion to our catchment area in March 2011 now means that some patients travel past their local hospital to come to our unit for this specialist treatment. Methods: A patient satisfaction questionnaire was developed to evaluate the patients’ experience of the direct entry primary angioplasty pathway. This was sent to primary angioplasty patients 1 month following discharge with a pre-paid envelope for return. Piloted for 3 months: June - August 2011. Results: 54 questionnaires sent out. 34 returned (63%). This is a rolling programme of evaluation thus further returns are expected but were not available for this analysis. The whole group (n=34) came in by ambulance. 76% (n=26) knew why they were being taken to our unit, 6% (n=2) did not. 18% (n=6) could not remember. For those patients who travelled past their local hospital (n=13), it did not pose a problem for any patient but did for 23% of families (n=3) in terms of visiting. 67% (n=23) felt they had information clearly explained before the procedure and 97% (n=33) had explanations afterwards in a way they could understand. Every patient (n=34) responded that they had confidence and trust in the staff treating them. 88% (n=30) remembered seeing a Cardiac Rehabilitation nurse, however on further validation all these patients were seen. 100% (n=34) had medication explained to them in a way they could understand. 91% (n=31) felt prepared for hospital discharge. 94% (n=32) rated the overall experience of their care as good or excellent. The remaining 2 left the question blank but did not raise any issues in the comments box. Conclusions: The overall patient feedback has been extremely positive across the new clinical pathway. Two questions will be re-worded following this pilot. The questionnaire has provided useful insights into the finer details of patient care especially the retention of information, preparation for discharge, and perception of recovery, particularly if the patient needs to come back in for a further procedure. Findings will be presented to the multi-disciplinary teams in particular the ambulance service, cardiac, pharmacy and cardiac rehabilitation teams. This has proved a useful way of gaining a patients perspective on a clinical pathway. This strategy will be used to evaluate other cardiac clinical pathways. P167 Does the severity of pain in acute myocardial infarction is different between women and men? A R Ana Rosa Alconero Camarero,1 JL. Cobo Sanchez,2 P. Munoz Cacho3 and JM. Revuelta Soba1 1University of Cantabria, EUE Casa de Salud Valdecilla, Santander, Spain 2University Hospital Marques de Valdecilla, Santander, Spain 3Cantabria Health Service, GAP 1, Santander, Spain Background: During the acute crisis in myocardial infarction (MI) patients seeking medical care due to presenting pain / discomfort in the chest or in other anatomical regions and the degree of pain. The intensity of pain is one of the most difficult characteristic to assess because of the subjectivity of the person who experiences it, and is not clear if there are gender differences in MI related pain. Aim: To evaluate MI pain intensity. To describe pain intensity by gender.To describe pain intensity by diagnosis. To analyze pain intensity by age. Methodology: Cross-sectional observational study. Three hundred eighty patients diagnosed by MI and admitted in a Coronary Intensive Care Unit from January 2007 to January 2009 were studied. A personal survey was performed in that patients evaluate their pain intensity, between 24 and 48 hours after admission, using a visual analogue scale (VAS). Results: Woman median age was on 70 years old (standard deviation 13.26 years), whereas men mean age was on 71 years old (standard deviation 13.03 years). All participants mean pain intensity was on 7.34 points, with a median pain intensity of 8 points. By gender, women presented more pain intensity (median 8 points) than men (median 7.5 points) (p < 0.01). Diagnosis distribution: non Q wave MI 67.5% of women vs 27.6% of men; Q wave MI 32.5% of women vs 27.6% of men. Pain intensity in Q wave IM patients was the same in men and woman (8 points). Concerning non Q wave MI, women present higher pain intensity than men (woman 7.74 points vs men 6.59 points;p = 0.0009). There were no differences by age between both genders respect to pain intensity. Conclusions: Pain assessment in patients diagnosed by MI ranges from moderate to severe. Women have higher severity of pain than men. Between non Q wave IM patients, women are who suffer significantly greater pain intensity than men. There were not pain intensity differences by age. P168 How spouses experience the acute trajectory, when their partner suffers an acute myocardial infarction B. Lykkeberg1 1Rigshospitalet, Copenhagen, Denmark Background: It is expected, both politically and ethically, that nurses commit to inform and help relatives to take part in the patients care. However, it is not described how this should be carried out in relations to the spouses of patients with myocardial infarction during the acute trajectory. It is known that spouses experience a higher degree of anxiety and depression than the patients themselves during the first months after myocardial infarction Purpose: To identify recent evidence-based literature concerning the experiences of spouses of patients during the acute phase of a myocardial infarction (STEMI) and which factors influence these experiences. Method: A systematic literature search was conducted on the pubmed, cinahl, psycinfo og scopus databases. Overall 35 publications were identified and of these, five qualitative studies were included Results: The literature regarding how spouses experience the acute phase when their partner suffers a myocardial infarction is sparse. It was found that spouses experienced chock, anxiety and uncertainty during the acute phase of their partners’ illness. They faced an existential threat and changes in lifestyle and relationship. Information and support was found to be important for their ability to relate and cope with their partner’s illness. Conclusion: The findings could be regarded as a beginning of our understanding on how spouses experience the acute period when their partner suffers a myocardial infarction. It remains a challenge to draw more attention to the fact that spouses of patients with acute myocardial infarction are overlooked and to facilitate initiatives conducting studies and developing nursing care for spouses of these patients. Acute coronary syndromes P169 How a change in practice in the emergency department can impact on first medical contact to balloon times J. Jill Byrne,1 M. Mcgeough2 and A. Tomlin2 1Mater Hospital, Belfast Health and Social Care Trust, Belfast, United Kingdom 2Royal Victoria, Hospital, Belfast Health and Social Care Trust, Belfast, United Kingdom Purpose: Current European Society of Cardiology (ESC) guidelines on reperfusion for people suffering from ST elevation Myocardial Infarction (STEMI) who present to an Emergency Department (ED) in a non-percutaneous coronary intervention (PCI) capable hospital should receive myocardial reperfusion by means of Primary Percutaneous Coronary Intervention (PPCI) within 120 minutes of first medical contact to balloon inflation (FMC-B). This should occur whether the patient is brought to hospital by ambulance or self-presents. This is a challenge for non-PCI capable hospitals as the patient journey has several stages. If the patient arrives by ambulance, the time taken to assess and transport the patient is added to the time spent passing through the ED. The ED journey entails registration, triage, electrocardiogram (ECG), diagnosis, referral to the PPCI centre, acceptance by the PPCI centre, appropriate management, transfer to the PPCI centre and time to balloon inflation. Delays can occur at every stage, resulting in FMC-B time of 120 minutes not always being achieved. Methods: In the PPCI centre, a PPCI co-ordinator is responsible for accepting patients for PPCI and monitoring all stages of the patient journey and times. In the non-PCI capable hospital site, a Chest Pain Nurse Specialist monitors the patient journey, times and delays. Several delays occurred in getting an electrocardiogram (ECG), either due to incorrect triage or lack of space/dedicated staff member to record a timely ECG, resulting in some prolonged FMC-B times. In order to address this, audit figures were presented to the ED and a change of practice proposed – to provide a dedicated cubicle for recording ECGs and for reception staff to send the patient directly to this cubicle as soon as they booked on at reception with chest pain, regardless of the nature of pain. Triage is bypassed until ECG was recorded and reviewed. Results: FMC-B times were compared for patients presenting to the ED in the non-PCI capable hospital with STEMI on the initial ECG before and after the change of practice. Prior to change of practice median FMC-B time for this cohort was 119 minutes (n = 30). After the change of practice median FMC-B time for this group was 80 minutes (n = 14) Conclusions: Close monitoring of the patient journey for STEMI patients is crucial in identifying delays in the process resulting in less favourable outcomes for the patient. We found that a change of practice resulted in a reduction of 39 minutes in FMC-B times for patients presenting to the non-PCI capable ED with an initial diagnostic ECG, whether arriving by ambulance or self-presenting. P170 Rapid access cardiology clinic - results of referrals for chest pain, shortness of breath and arrythmias in patients with no previous history of coronary artery disease A. Van Goor,1 E. Wolf,1 E. De Haan1 and W. Jaarsma1 1St Antonius Hospital, Department of Cardiology, Nieuwegein, Netherlands Background: Rapid access cardiology clinics are increasing throughout Europe. A nurse specialist-led clinic with direct supervision of a cardiologist was developed and is now part of the outpatient service offered to patients, general practitioners (GP’s) and specialists referring from within the hospital. The one-stop-shop system offers a swift assessment of non-acute chestpain, shortness of breath and/or palpitations. Objectives: To investigate outcomes of referrals for non-acute chestpain, shortness of breath and/or palpitations in patients with no previous cardiac history. Methods: The one-stop-shop-pathway consists of blood tests, ECG, history taking, physical examination, echocardiography and/or exercise testing and discussion of results/treatment plan within one day. Through ongoing prospective audit, data was collected on gender, age,reason for referral, required cardiac investigations and outcomes. Results: until september 2011 198 patients were seen. Preliminary results: 48% female. Average age: 60 years. Reason for referral: chestpain 58%, palpitations 14%, shortness of breath 12%, ECG changes 6%, collaps 4%, murmur 3%. Results after cardiac investigations, including referral for coronary angiogram, CT, myocardial perfusion scanning: cardiac 31%, non-cardiac 57%, yet unknown (as awaiting further investigations at time of audit) 12%. Of the cardiac diagnoses: 36% coronary artery disease, 20% arrythmias, 16% valvular abnormalities, 15% heart failure. In march 2012 we hope to present results on in total 300 patients, including results of a patient satisfaction questionnaire. Conclusion: Only one third of patients presenting to a rapid access cardiology clinic is diagnosed with cardiac disease. This group can be offered an appropriate and timely treatment plan. Moreover, the group without cardiac disease can be offered reassurance and referral back to the GP within a short period of time. P171 Results of platelet agregometry (MULTIPLATE) in patients who had undergone percutaneous coronary intervention (PCI) M. Marina Djordjevic,1 B. Vasovic,1 B. Cesmadzijski,1 S. Sredojevic,1 G. Stevanovic,1 D. Kordic,1 S. Dimkovic1 and N. Markovic Nikolic1 1University Clinical Center Zvezdara, Department of Cardiology, Belgrade, Serbia Background: During percutaneous coronary intervention (PCI), yet there is significant damage to the endothelium, intima and media in the area of artery dilatation. Damage to the vessel wall causes activation of hemostasis and inflammation, two related processes that should be in the service of repairing damaged tissue, but are basically complications after PCI. The central platelet activation has been going on vascular response to PCI, and with the already existing platelet hyperreactivity in patients with occlusive coronary disease, especially in those with acute coronary syndrome (ACS), a predisposing factor for atherothrombotic complications. Objective: To demonstrate that the use of new methods for determining platelet function, these problems can be predicted. In this context, dual antiplatelet therapy (DAT) with aspirin and tienopiridins /Clopidogrel/ basis to prevent possible complications of PCI, including stent thrombosis, myocardial infarction and restenosis. Methods: The device Multiplate measure platelet aggregation by electrical impedance. Analysis is performed in disposable catridge with two pairs of thin wires and sensors to measure electrical resistance. Agregometry is expressed in terms of units and histogram of two parallel lines. Examined patients are divided into the two groups, first one those with acute myocardial infarction /STEMI/ and second group of patients who are prepared for elective PCI. Results: Among 77 patients in whom we performed tests of platelet function: 46,75% had non adequate response to therapy, and demanded an increase in drug doses. Among them 35,06% were non responders on plavix, and 11,68% were non responders on aspirin. Table. Results of agregability test in Responder . Non responder . Number of patients . ASPI test (Li- hep.blood) V1 68 9 (11,68%) 77 ADP test HS (Li-hep.blood) V1 50 27 (35,06%) 77 Number of agreeability tests 118 36 (46,75%) 154 Responder . Non responder . Number of patients . ASPI test (Li- hep.blood) V1 68 9 (11,68%) 77 ADP test HS (Li-hep.blood) V1 50 27 (35,06%) 77 Number of agreeability tests 118 36 (46,75%) 154 Open in new tab Table. Results of agregability test in Responder . Non responder . Number of patients . ASPI test (Li- hep.blood) V1 68 9 (11,68%) 77 ADP test HS (Li-hep.blood) V1 50 27 (35,06%) 77 Number of agreeability tests 118 36 (46,75%) 154 Responder . Non responder . Number of patients . ASPI test (Li- hep.blood) V1 68 9 (11,68%) 77 ADP test HS (Li-hep.blood) V1 50 27 (35,06%) 77 Number of agreeability tests 118 36 (46,75%) 154 Open in new tab Conclusion: Multiplate method is useful and reliable. With great certainty we can assess the native platelet aggregation. At the same time we can determine the effect of antiplatelet drugs and controlle the effect of therapeutic procedures. Arrhythmias P172 Shift from morphine to fentanyl reduces nausea and vomiting after radiofrequency ablation for atrial fibrillation or implantable cardioverter implantation L. Holm Soerensen1 and L. Lotte Hall-Pedersen1 1Aarhus University Hospital, Skejby, Department of Cardiology, Aarhus, Denmark Background:Patients referred for radiofrequency ablation of atrial fibrillation (RFA) or implantation of an implantable cardioverter defibrillator (ICD) undergoes conscious sedation with the use of a combination of midazolam and morphine or fentanyl. After the procedure nausea, vomiting and pain are common complaints.The present study aimed to illuminate the magnitude of these problems and evaluate whether these symptoms could be reduced by exchanging morphine with fentanyl. Methods: We prepared a questionnaire following the patients from the catheterisation laboratory to the ward. We recorded the dosages of morphine, fentanyl and midazolam and asked the patients about the pain intensity. Data were gathered on 200 patients (100 RFA and 100 ICD) treated with morphine and 200 patients (100 RFA and 100 ICD) treated with fentanyl. Median age of the patients included was 63 years, and 95 (24%) were females. Results: Number of patients with nausea was lower with fentanyl than with morphine, both after RFA (16/100 versus 27/100, p = 0.06, Chi-square test) and after ICD (10/100 versus 23/100, p = 0.01). Number of patients vomiting was reduced significantly with fentanyl: 20/100 versus 5/100 after RFA (p = 0.001) and 12/100 versus 4/100 after ICD (p = 0.04). Patients reporting pain after the RFA-procedure was higher with fentanyl (47/100) than with morphine (21/100) (p < 0.001). Among ICD-implantations, 32/100 in the fentanyl group versus 20/100 in the morphine group reported moderate pain (p = 0.05). Conclusion: Patients undergoing radiofrequency ablation of atrial fibrillation or implantation of an implantable cardioverter defibrillator experience less nausea and less vomiting if treated with fentanyl than when morphine is used. However more patients report moderate pain after the procedure with fentanyl. P173 Predictors of the clinical efficacy of double sensor cardiac pacemakers A. Mlynarska,1 R. Mlynarski,2 E. Pilat2 and W. Kargul2 1Medical University of Silesia, Katowice, Poland 2Upper Silesian Cardiology Center, Katowice, Poland Evaluations of the influence of double sensor (DS) cardiac pacemakers on the physical activity of patients with chronotropic incompetence (ChI) have been presented in a few publications. However, none of them were evaluated the characteristic features of patients for whom this technology can have advantages. The purpose of the study was to evaluate the characteristic features of patients for whom the advantages after implantation of DS rate response pacemakers might be the strongest — prospective, randomized, single-blind clinical trial. Methods: 40 pts. with sinus node dysfunction and ChI were included in the study. In the examined group, DS (accelerometer and minute-ventilation) pacemakers (PulsarMaxDR) were implanted. After randomization, patients were placed into one of the two groups: 1-only the accelerometer sensor was activated; 2-both sensors were activated. After the 3-month follow-up, the initial spiroergometrical test (STest) was performed, after cross-over patients were placed in the opposite group for further 3 months. Finally, the second STest was performed. All tests were performed on a Jaeger treadmill ergometer using a modified Bruce protocol (maximal test). The key element of the statistical analyses was the multifactorial analysis of the differences between both STests. Results: Relative differences between groups with and without an improvement were not significant. A positive tendency for the DS group was especially marked for women (p = 0,18), age > 65 years (p = 0,70), oxygen consumption at rest > 5,83 L/kg/min (p = 0,21) and BMI > 28 (p = 0,64). Conclusions: In elderly women who were overweight and had discriminate ventilation, who are primary qualified for rate response pacing, the decision about implanting a DS rate response pacemaker should be considered. P174 Nursing care plan in pulmonary veins ablations procedure A-L. Fernandez-Oliver1 and R. Mgueraman - Jilali2 1University Hospital Virgen de la Victoria, Unidad de Gestión Clínica del Corazón. Málaga, Spain, Malaga, Spain 2University Hospital Clinic Virgen de la Victoria. Cardiology Department, Malaga, Spain Aims/Purpose: Ablation of pulmonary veins (AVP.) is a procedure which by its technical complexity and requires a long-term care and nursing actions specific to the development and implementation. Nursing’s performance is a cornerstone and essential for the optimal development of this therapeutic tool. We set as goals to be achieved: Establish a care plan that specifies and describes the actions of nursing care and in detail before, during and post procedure AVP to decrease the complications of this technique. Design an appropriate protocol for transmitting information to the inpatient unit, to optimize continuity of care. Define and Evaluate nursing diagnoses more prevalent. Methods: We conducted a retrospective, observational, descriptive study of interventions. The sample was of 121 procedures (100 patients) performed in our Unit AVP. Exhaustive literature search conducted. Results: We managed to design and implement a plan of care for these patients in our Unit of Electrophysiology and Arrhythmias and the Cardiology Hospitalization Unit. Developed and implemented continuous record of patient care facility. Nursing develop joint sessions with the inpatient unit to unify criteria, reducing the variables in its implementation. We detected and evaluate nursing diagnoses prevalent during the procedure. Significant increase in nursing knowledge related to the procedure of AVP. Optimization in understanding the fundamental mechanisms of this process, differentiating and setting guidelines, especially in areas such as: Plan the reception and information to patients and families, patient preparation in the electrophysiology laboratory, reset and optimization apparatus, oxygenation and monitoring, sedation protocol ( deep sedation-analgesia), the important transseptal catheterization procedure, Protocol coagulation control, a conclusion procedure, Processing Registration Nursing and Arrhythmia-EP Unit (report data to the cardiology inpatient unit), planning and implementation of continuity of care report at patients discharge from hospitalization unit, Evaluation of more prevalent Nursing Diagnosis. Conclusions: The implementation of protocols and appropriate nursing interventions, as well as data transmission units of hospital and primary care, increases efficiency and safety of the procedure of AVP., Power and gives better tools for nurses to perform the technical and nursing care, while increasing the patient’s perception of safety, quality and continuity of care. P175 A case report on treatment of arrhythmia with Faradarmani E. Eshagh Esmaeili,1 F. Ashrafi-Amineh1 and S. Saie Joeghan1 1Association of Faradarmani & Psymentology, Tehran, Iran (Islamic Republic of) Introduction: Tachyarrhythmias typically refer to isolated premature complexes or to non sustained and sustained forms of tachycardia originating from myocardial foci or reentrant circuits. In patients who present with none life threatening symptoms, such as palpitations or dizziness, (ECG) confirmation of an arrhythmia with the development of recurrent symptoms is essential. Faradarmani as an Iranian alternative complementary medicine that is based on the theory of “the consciousness bond of the parts” or “parts having consciousness in common” could be regarded as an optimum complementary treatment for Aarrhythmia. The presented case attempts to investigate the effectiveness of Faradarmani on treatment of Aarrhythmia. Case report: The patient a 65 years-old woman who had palpitation chest discomfort and cardiac problems. She was diagnosed with cardiac arrhythmia. Patient did not have any improvement with medical therapy and after severe symptoms were developed, she gradually underwent “Faradarmani”. During a Faradarmani session the patient is asked to close their eyes for at least five minutes and manage to dispel the distracting thoughts, and merely observe, impartially, the feelings and experience encountered during the therapy. The patient was required to do this procedure at least once a day and afterwards the details of his treatment and the subsequent outcome and feelings were discussed once a week with the Fara-therapist. In summary; through Faradarmani the patient becomes connected to the Interuniversal Consciousness (the network of awareness and consciousness encompassing the universe) via Fara-therapist and undergoes the Scanning process; due to the nature of this connection, some information is conveyed and the defective parts are treated. Results: After 4 session of Faradarmani, patient gradually became sign & symptom free. and no evidence of cardiac functioning problem or blood circulation issue was observed in “Spect”. Conclusion: The presented case shows effectiveness of Faradarmani on Cardiac arrhythmia. The treatment of Cardiac arrhythmia with myocardial foci includes medication, however, the patient has fully stopped medication and no sign of disease symptoms is observed till this date. Taheri, M. (2010), The Journal of Medical Sciences (Danesh-e-Pezeshki), Specialized Faradarmani Edition, 4th year, Vol.4–No.1–Dec.2010 supplement Cardiothoracic and cardiovascular surgery P176 The reliability and validity of Barnason efficacy expectation scale (bees): cardiac surgery version for turkey Sevcan Avci1 and AZİZE. Karahan1 1Baskent University, Faculty of Medicine, Ankara, Turkey This study was developed in a methodological manner to determine the validity and reliability of the Barnason Efficacy Expectation Scale (BEES) Cardiac Surgery Version for the Turkish Society. The original scale was developed by Susan Barnason in 2002 and consists of 15 items and a single factor. The study was conducted on 120 patients at the cardiovascular intensive care unit of a University Hospital at an Inner Anatolian province. The patients had undergone coronary artery bypass graft surgery. A questionnaire directed toward determining the descriptive features of the patients was used besides the scale in the study. The scale and questionnaire were administered again four weeks later. The scale was presented for a specialist opinion once language validity was ensured and the content validity index was calculated as 0.85. Analysis revealed that the scale contained five factors that were different from the original, that it was suitable to obtain a total scale score by addition and that there was no need to remove any of the items A correlation was present between the test-retest scores for all scale items (r = 0.818; p = 0.000). The internal reliability coefficient (Cronbach) was 0.837 for the scale and 0.75–0.79 for the subscales. The mean score from all items of the scale was 47.26 with a range of 30 to 60. The mean BEES scores were higher in males, patients aged 34 to 59, those with previous hospitalization experience, and those with more than 8 years of education (p < 0.05). In conclusion, we determined that the BEES Cardiac Surgery Version was a valid and reliable scale for the Turkish society. We suggest that the scale be used in larger and different samples and new studies be performed to increase the self-efficacy of patients who have undergone CABG in the postoperative period. P177 Quality of life of patients after cardiac surgery R. Rositsa Gavrilova-Radeva,1 S. Angelova,1 E. Kisiova-Berova,1 A. Nesheva1 and G. Kolentsov1 1Multiprofile Hospital for ActiveTreatment – National Heart Hospital,Sofia, Bulgaria Introduction: After exhausting all options of pharmacotherapy and methods of interventional cardiology, some of the patients with cardiovascular diseases are referred to cardiac surgery. Post-surgical reconvalescence period is individual and varies from few weeks to several months, depending of age, complexity of surgery, and comorbidities.Improving quality of life in medical context is caring for patients with serious illnesses to reduce or eliminate the symptoms of disease and the associated negative psychological and social consequences. Objective: To evaluate and improve the quality of life of patients after cardiac surgery. Methods: Following certain indicators, we make inquiries about quality of life in 122 patients operated between September 2010 and February 2011. For that period the total number of cardiac interventions was 265, the respondents group constitutes 46% of them. The average age of the patients is 63 years /36 - 91 years/. The ratio is 63.9 percent male /n-78/ to 36% women /n-44/. Results: The analysis of the results show a 35% of postoperative complications in respondents group, requiring medical resources. We identified the type and frequency of complications. It is important to note the low percentage of wound complications - 8% in the surveyed group. Registers a high proportion of patients who have a desire for further training and participation in lengthy rehabilitation programs. Although post-surgical complications 48 of the patients determine their overall state as “good” and 45 as “very good”. Conclusion: The education of the patients and their relatives, the conduct of optimal cardiac rehabilitation and the secondary prevention improves the quality of life after cardiac surgery. Without conducting a similar analysis and conclusions will not be possible to optimize our performance and to improve the good outcomes after cardiac surgery. Congenital heart disease P178 Chronic hypoxemia leads to reduced serum IGF-I levels in cyanotic congenital heart disease H. Haleh Boroumand1 1Sheikh Hospital, Mashhad, Iran (Islamic Republic of) Cyanotic congenital heart disease in children commonly causes more pronounced growth retardation in comparison with acyanotic congenital heart disease. Chronic hypoxemia has been suggested as the cause of poor growth in these patients, but the relationship between serum IGF-I levels and chronic hypoxemia is unclear. Some studies shows Serum IGF-I concentrations, oxygen saturation and nutritional status were evaluated in patients with cyanotic congenital heart disease, and serum IGF-I levels were compared with a group of 20 well-nourished, age-matched control children to assess the relationship between IGF-I levels and chronic hypoxemia. The nutritional status of each patient was determined by using anthropometric parameters and calorie and protein intake ratios. The patients were divided into malnourished and well-nourished groups (21 and 8 patients, respectively) according to their nutritional status. Serum IGF-I concentrations were measured in the two patient groups and the controls. The malnourished group had the lowest IGF-I levels. In addition, they found a positive correlation between serum IGF-I levels and oxygen saturation of the patients (r=0.402,p < 0.05). These findings indicate that chronic hypoxemia has a direct or indirect effect to reduce serum IGF-I concentrations and this may be a cause of the increased growth failure in patients with cyanotic congenital heart disease. Chronic hypoxia plays a significant role in the pathogenesis of malnutrition and also believes that IGF-1 deficiency seen in CHD patients may be responsible in the etiology of the decrease in left ventricular mass independently from GH. Coronary Intervention P179 Is immediate ambulation after percutaneous coronary intervention associated with increased vascular complications at the puncture site? a randomized pilot study A B. Jensen,1 CH. Ramlau-Hansen,2 JF. Lassen1 and CF. Christensen1 1Aarhus University Hospital, Skejby, Department of Cardiology, Aarhus, Denmark 2Aarhus University, School of Public Health, Department of Epidemiology, Aarhus, Denmark Background: Percutaneous coronary intervention (PCI) is revascularisation of the coronary arteries, including balloon dilatation and stenting, offering symptom relief and prognosis improvement. After femoral artery access patients are submitted to bed rest to prevent complications at the puncture site. With the development of vascular closure devices, duration of bed rest has been gradually reduced to 1–2 hours. Presumably bed rest can be omitted completely and patients may ambulate immediately after the procedure. Little investigation has been made on ambulation directly after the procedure but results indicate no increased risk of complications. Purpose: To test methods prior to a larger study with the purpose; to investigate if early ambulation directly after elective or sub-acute PCI can be carried out without an increased risk of complications at the puncture site. Method: Randomized pilot study. Sixty patients were included in March-April 2011. Follow-up for complications was time of hospitalization, subsequently telephone follow-up. The association was investigated by a one sided hypothesis that a maximum of 4 % increased complications could be found after early ambulation compared with conventional ambulation. Interpretation was based on 95 % CI. Results: The pilot was dimensioned accordingly and did not have the strength to investigate the association between early ambulation and complications at the puncture site. Arterial complications consisting of hematoma ≥ 5 cm was found in 5 participants (8,3 %) and fewer complications was found after early ambulation (RD: -2,7 %, 95 % CI: -16,7;11,1). None of the participants had registered major complications; hematoma ≥10 cm, large bleeding, retroperitoneal haemorrhage, pseudoaneurysms, or ischemia of the affected leg. At follow-up complications were identified in 15.0 %. Design and randomization were clinically admissible. The collection of data and in- and exclusion was primarily carried out by the nursing staff and was done according to protocol. Conclusion: The association between ambulation and complications was potentially confounded by an uneven distribution of risk factors, while the collective risk of complications at the puncture site was qualified. Based on an estimated risk of complications of 10 % and margin for non-inferiority of 3%, samplesize was determined with a significance level of 5% and power of 80% to a total of 1.237 participants in each group. Methods tested to investigate the association; design, randomization, inclusion and exclusion criteria, intervention and end point, were found clinically admissible. Devices and technology P180 The impact of the implantable cardioverter defibrillator on sexual dysfunction J L. Jose Luis Cobo Sanchez,1 AR. Alconero Camarero2 and N. Gutierrez Caloca1 1University Hospital Marques de Valdecilla, Santander, Spain 2EUE Casa de Salud Valdecilla. Universidad de Cantabria, Santander, Spain Background: Patients with an implantable cardioverter defibrillator (ICD) describe anxiety, fears, and other psychosocial issues as depression and mood disturbance, to adapt to the device. However, changes in sexual life receive minimal attention. The literature indicates that in principle sexual activity should not be altered after ICD implantation, nevertheless diverse studies report concerns about resuming sexual activity, reduction in frequency of sexual activity from pre-ICD to post-ICD implantation and fears of triggering the device with sexual activity. Aim: To assess sexual dysfunction (SD) in patients after ICD implantation. Methodology: Descriptive study in ICD patients. Arizona Sexual Experience Scale(ASEX) was used to evaluate SD. ASEX is a validated, brief five-item scale, designed to assess the core elements of sexual functioning: drive, arousal, penile erection/vaginal lubrication, ability to reach orgasm and satisfaction with orgasm. The female and male versions of ASEX differ on the gender-specific question 3 addressing erection/lubrication. Each item is rated with a six-point Likert system (ranging from hyperfunction (1) to hypofunction (6)), with higher scores reflecting impaired sexual function. The survey was delivered in an arrhythmias nursing consultation with a stamped addressed envelope for its return. In addition, prescribed drugs, sociodemographic and clinical data were collected. Statistical analysis performed by SPSS 15.0 original version for Windows. Results: Seventeen patients were surveyed (16 men and 1 woman). Mean age 60 years old, 53% first-degree studies, 64% married, 47% Class I NYHA classification. Forty-one percent had sexual dysfunction before ICD implantation, the most common impotence and 58% had sexual dysfunction after implantation. ASEX mean score 19.94 ± 4.69 points, those with higher scores showing a higher educational level (p = 0.019). Forty-seven percent considered their sex drive as somewhat weak, being related to not having discharges (p = 0.008), no syncope (p = 0.061), and treating with acenocoumarol (p = 0.041). Fourty-six percent had serious problems becoming sexually aroused, being associated with not treating with digitalis (p = 0.01) and acenocoumarol (p = 0.041); treating with statins (p = 0.036) and being diagnosed with heart failure (p = 0.047). Only 12% of men referred easy to achieve and maintain an erection. Thirty-five percent considered satisfactory orgasms. Conclusions: High prevalence of altered sexuality in patients with ICDs. ICD implantation does not improve sexual dysfunction. P181 Transcatheter implantion of pulmonary valves in the catheterization laboratory (cath lab): new technologies, new challenges M. Mariella Tongiani,1 S. Barbieri,1 S. Giannarelli,1 M. Mantegazza,1 F. Poli,1 S. Rapisarda,1 S. Lais,1 E. Laws,1 L. Cantoni1 and M. Menconi1 1Gabriele Monasterio Foundation CNR/Region Toscana, Heart Hospital, Massa, Italy Background:The cath lab can now resemble an operating theatre presenting a series of new challenges for the nursing staff, who not only need to learn new techniques but also have to make sure that procedures become standardized with patient safety as the main concern. In 2007 our institute began to implant pulmonary valves in the cath lab using the Melody¯ Transcathether Pulmonary Valve (TPV) Mini invasive procedures can be perceived as less dangerous and therefore less complex than surgical interventions but some of the complications that can occur during TPV include the following Rupture of the RVOT conduit, Vascular complications : eg Femoral haemotoma Embolization or migration of the device, Arrhythmia due to coronary artery compression Perforation of a heart chamber or major blood vessel Aim: To monitor and prevent eventual complications and problems during TPV procedures. Method: Training of all cath lab personal in TPV procedures. Multidisciplinary meetings with all personal involved in care. Retrospective analysis of TPV procedures from 1/1/2007 to 30/ 08/2011 Patholgy 4 Fallots tetrology3 pulmonary atresia1 right ventricle outflow tract(RVOT)1 truncus1 rheumatic heart disease Age range years media 16.8 ( stand dev ±7.6 range 34 -10) number of previous surgical ops. media 2.5( range 1–4) complicatios 1 retro peritoneal bleed, 1 cath.site haemorrhage.( both transfused) Patholgy 4 Fallots tetrology3 pulmonary atresia1 right ventricle outflow tract(RVOT)1 truncus1 rheumatic heart disease Age range years media 16.8 ( stand dev ±7.6 range 34 -10) number of previous surgical ops. media 2.5( range 1–4) complicatios 1 retro peritoneal bleed, 1 cath.site haemorrhage.( both transfused) Open in new tab Patholgy 4 Fallots tetrology3 pulmonary atresia1 right ventricle outflow tract(RVOT)1 truncus1 rheumatic heart disease Age range years media 16.8 ( stand dev ±7.6 range 34 -10) number of previous surgical ops. media 2.5( range 1–4) complicatios 1 retro peritoneal bleed, 1 cath.site haemorrhage.( both transfused) Patholgy 4 Fallots tetrology3 pulmonary atresia1 right ventricle outflow tract(RVOT)1 truncus1 rheumatic heart disease Age range years media 16.8 ( stand dev ±7.6 range 34 -10) number of previous surgical ops. media 2.5( range 1–4) complicatios 1 retro peritoneal bleed, 1 cath.site haemorrhage.( both transfused) Open in new tab Results: A total of 10 patients were implanted. All catheterization sites were closed with 2 preclose suture devices which were positioned at the beginning of the procedure. Surgical standby. General anesthetic in 9 cases, non invasive ventilation in 1 case.( see table) Bleeding occured within the first 7 hours post procedure in the 2 youngest patients ( 10 years old) probably due to the large dimension of the catheter. All patients were sent to the intensive care unit post procedure. 7 patients were discharged after 2 days, 1 complex adult case required furher surgery. The 2 patients who bled were discharged after 14 days and 4 days respectively. Conclusion: Nursing staff must be aware not only of how to technically assist the medical staff in these new procedures but what to monitor and what to do if complications occur. Our experience of TPV is not vast but we have managed to create a standardized protocol with all staff aware, which is especially important when procedures are sporadic and not routine. P182 Assessing readiness to implement a transcatheter aortic valve implantation program: key components and required processes of care S. Sandra Lauck1 and JG. Webb1 1St. Paul’s Hospital, Vancouver, Canada Purpose: Transcatheter aortic valve implantation (TAVI) is an established procedure for the management of severe aortic stenosis in patients at excessive risk for conventional surgery. Most patients are elderly, may have additional co-morbidities, and have varying functional capacity. Procedural techniques and technology are rapidly improving and TAVI is increasingly becoming available at multiple institutions. Assessing and supporitng a centre’s readiness to meet the unique needs of this potentially higher risk and vulnerable patient population from referral to follow-up is pivotal to ensure patient safety and program success. This clinical paper outlines proposed TAVI program readiness criteria. Outline: The processes of care required to support TAVI program development necessitate the engagement of multiple stakeholders, areas of care and other partners. The components of pre-procedure care reviewed will include referral process, diagnostic work-up and baseline functional assessment, patient and family teaching and assessment of motivation, interdisciplinary eligibility decision-making and clinical waitlist management. The required engagement of the pre-surgical assessment program, interventional cardiology and cardiac surgery services, and cardiac imaging will be discussed. We will outline the components required to establish a fruitful partnership with industry to provide intraprocedure training and on-going clinical support. The TAVI follow-up requirements will be discussed. The presentation will outline recommendations for managing the complexities of TAVI interdisciplinary teamwork. Significance: The rapid emergence of TAVI as a treatment option for people with severe aortic stenosis warrants the implementation of patient-focused processes of care and the assessment of new centres’ readiness to provide seamless care from referral to follow-up. P183 Teach therapeutic education with e-learning A. Amelie Boireau,1 P. Jourdain,2 M. Desnos,2 F. Strnad,1 F. Voirin1 and Y. Juilliere3 1Rene Dubos Hospital Center, Pontoise, France 2AP-HP - European Hospital Georges Pompidou, Department of Cardiology, Paris, France 3University Hospital of Nancy - Hospital Brabois, Vandoeuvre les Nancy, France Therapeutic education (TE) efficiency in chronic heart failure is strongly substantiated.This impact is comparable to many treatments used in cardiovascular therapeutics. But beyond the concerns of availability, means and premises, the main limitation these last years was the lack of support from the healthcare professionals and the official organizations. At present, it is necessary to add to it the necessity of applying for accreditation with its Health Agency and of proving that the members of the educational team benefited from a training of at least 40 hours specifically dedicated to therapeutic education. The offer of current training is insufficient to answer the request. Therefore, it appears interesting to perform an analysis of the possible contribution of the new technologies. The computing technologies have interesting specificities within the framework of the studied problem: to train quickly a large number of persons, to adapt itself to the busy schedule of various social and professional groups and finally to decrease the costs of training. On the other hand the led challenges are to balance out: the low interactivity between the teacher and the students, the complexity of certain technological research ways, the difficulty of modelling the human relationships which are the base of the therapeutic education. Methodology: Analyze the possibilities of fast development of a computing application for a raising awareness to the therapeutic education of the healthcare professionals. The medical volunteer will receive e-mail a form of evaluation and a clinical case of education analysis to fill in and to send back. He or she will receive then an e-mail every other week with a clinical learning case (analysis of the mastery of the concepts). He or she will have to work on it and then send back number codes giving evidence of his or her training. He or she will receive then a proposition of correction elaborated by 5 experts concerning this clinical case. In the end of 10 clinical cases and three filmed situations he or she will receive a form of evaluation and three clinical cases of education analysis (analysis of the education process). He or she will receive then an analysis of his or her answer to the clinical case made by 3 experts (nursing staff, doctor and educator). Three other filmed situations could be added. The computer assisted remote teaching of TE, is multimodal, realistic, convenient, reproducible, at affordable cost and easily transposable in the other domains of education. The only prerequisite is that every student has an e-mail address. Diabetes and metabolic syndrome P184 Impact of a nutrition education intervention on weight loss in obese adolescents with metabolic syndrome M. Nourian,1 Z. Yassin2 and R. Kelishadi1 1Isfahan University of Medical Sciences, Isfahan, Iran (Islamic Republic of) 2Putra University, Kuala Lumpur, Malaysia Introduction: Metabolic syndrome is a combination of cardiovascular risk factors and obesity as an important component of metabolic syndrome is associated with numerous cardiovascular comorbidities such as coronary heart disease (CHD), hypertension, and type 2 diabetes mellitus. However, not all obese patients develop such complications, a major challenge has been to identify those obese patients at increased risk for CHD to best allocate health care resources. Material and Methods: In this experimental study an educational intervention program conducted on 100 obese adolescents aged 12–18 years, living in Isfahan province of Iran. These subjects will be selected among obese adolescents who refer from healthcare centers and schools to the Obesity and Metabolic Syndrome Research Clinic, a collaborating center of the WHO in Isfahan.The intervention group, participated in 12 education sessions (one session /wk). Control Group has taken the traditional progam in metabolic syndrome research center. Dietary intake and anthropometric variables collected before and after intervention at baseline and at the end of the intervention program in order to evaluate the effectiveness of the nutrition education program. Based on the identified risk factors for the participants,the intervention focused on changes in diet to reduce the CVD and diabetes risk by encouraging the participants to decrease saturated fat and calorie intake,increase consumption of a variety of fruits and vegetables and maintain moderate physical activity. Results: In control group there was an increase in weight (61.71+_17.37 vs 62.48+-16.23) but in intervention group the weight of participants was decreased significantly (63.71+-13.59 vs 62.5+-13.44; p < 0.05).The BMI in control and internention groups was 26.01+-4.0 and 26.54+Z+-3.8 respectively.after intervention in intervention group the BMI was 25.68+-3.9 which was decreasd.In addition, the consumption of fruit and vegetables in intervention groups increased significantly in comparison of control group Conclusion: In spite of the considerable progress in diagnosis, prevention and treatment, noncommunicable diseases will account for approximately three quarters of all deaths in the developing world by the year 2020. The increasing incidence of obesity, leading to metabolic complications or ‘metabolic syndrome’, is now recognized as a major public-health problem. ( Puentea, 2007). Results of this study showed that educational intervention programs is an important way to slow or reverse BMI, overweight complications, and metabolic syndrome risk factors. P185 Prevalence of metabolic syndrome in Iranian obese adolescents M. Mojgan Nourian,1 R. Kelishadi,1 Z. Yassin,2 SH. Memarian3 and A. Heidari1 1Isfahan University of Medical Sciences, Isfahan, Iran (Islamic Republic of) 2Putra University, Kuala Lumpur, Malaysia 3Azad university(Khurasgan/Isfahan), Isfahan, Iran (Islamic Republic of) Introduction: Prospective studies have shown that abdominal obesity predicts the development of the metabolic syndrome and cardiovascular events.There is a direct association of body mass index, waist circumference or waist-to-hip ratio with carotid IMT in overweight or obese individuals with Metabolic syndrome.The most common modifiable risk factor of metabolic syndrome is exessive weight. Alarmingly, 50% of children and adolescents who have been classified as overweight or obese will remain so into their adult years. Material and method: prevalence and distribution of metabolic syndrome were assessed among 300 obese and/or overweight adolescents(12–19 years) which refered to Ifahan Cardiovascular Research Center (ICRC) a collaborate of WHO in Iran at Isfahan university of Mediacal Sciences from November 2008 to September 2010. subjects were diagnosed with metabolic syndrome based on IDF definition. Results: The mean of weight and BMI was 63.14 ± 15.1 kg and 26.5 ± 3.8 kg/m2, respectively. 59% of participants were obese (BMI were at or above the 95th percentile) and 41% were overweight (BMI were at or above the 85th percentile and lower than the 95th percentile) for children of the same age and sex. Results showed that 30% of these overweight and/or obese adolescents aged 12–19 year (51 males and 49 females) were affectaed by Metabolic syndrome based on IDF definition. Conclusion: It is important that children at an unhealthy weight should be screened to determine their risk for Metabolc syndrome and its consequences including high blood pressure, impaired fasting glucose, dyslipidemia, and type 2 diabetes. Education and behavioural aspects P186 Helping australians identify and respond to the warning signs of heart attack J. Julie Smith1 and C. Cunningham1 1Heart Foundation, Perth, Australia Background: Heart attack remains an often fatal event - over half of all deaths occur before the person reaches hospital and about 25% of people die within an hour of their first-ever symptom. Many lives could be saved and the burden of disability reduced if people were able to recognise their heart attack, call Triple Zero (000) and get to hospital fast for treatment. Method: For several decades the National Heart Foundation of Australia has recognised the importance of early treatment for heart attack and used sporadic, short-term campaigns to prompt quick action. For the first time, in 2009, the Heart Foundation launched a comprehensive and ongoing campaign (funded until end 2012) addressing the emotional and system blocks to appropriate action. Focus has been on those at highest risk of heart attack: those aged 45–65 years, coronary heart disease patients and their families, people living in remote locations. Resources have been developed and innovative social marketing strategies used to influence social norms and help facilitate behavioural change at a community, family and individual level. In developing, implementing and evaluating the ‘Will you recognise your heart attack?’ campaign, the Heart Foundation has engaged with health professionals in primary care, hospitals, emergency response, government and the community. Relationships with key community and sporting groups and workplaces have also been leveraged. Results: Initial results of the campaign show positive impacts on; awareness of symptoms, knowledge of what to do, intention to call Triple Zero (000) and behaviour. A number of people have attributed the campaign to saving their lives. Conclusion: Treatment delay, due to people taking too long to recognise their symptoms and not getting to hospital quickly, is an international problem for heart attack and other medical conditions. The prospect of improving outcomes for people experiencing life-threatening emergencies underpins many campaigns. Learnings from the Heart Foundation’s comprehensive approach can help inform future campaigns both within Australia and internationally. P188 The participation in clinical trials helps to monitor the progression of renal disease M. Maritza Ribeiro,1 DP. Pais,1 MJS. Simoes,1 C. Costa1 and E. Carvalho1 1University Hospitals of Coimbra, Coimbra, Portugal Introduction: The creatinine clearance is an excellent diagnostic indicator of the kidney function. The early identification of patients at risk of developing chronic kidney disease enables the intervention of the nursing staff/team that can prevent the onset of kidney disease in a large number of individuals. Objectives: Assess the impact of a multidisciplinary strategy to prevent cardiovascular risk, with emphasis on creatinine clearance, in patients for clinical trials in the field of Cardiology. IPopulation and methods:I We prospectively studied 137 patients with a mean age of 74.97 +/- 8.68 years, including an essay in the field of atrial fibrillation. For each patient the value of creatinine clearance was given at randomization, at month 3 and month 6. Results: At the time of randomization, this population had a mean creatinine clearance of 69.2 +/-21.63ml/min. All the population were targeted by a multidisciplinary clinical approach, conducted by research nurses, focusing on teaching them about healthy lifestyle habits, and, when necessary, improvement or readjustment of cardiovascular therapy was implemented. This strategy has allowed a staggering increase in the average creatinine clearance by 4.45% to 72.49+/-44.33 mL/min. Conclusions: the results revealed, contrary to what we would expect, an increase in the levels of creatinine clearance since the patients entered the trial. These results suggest that close monitoring by the health team in a clinical trial helps controlling the patient’s risk factors, which may contribute to the improvement of their prognosis. P189 Sociodemographic profile and therapeutic adherence A. Antonio Madureira Dias,1 Carlos Pereira,1 Regina Saraiva,1 Joao Duarte,1 Daniel Silva,1 Oliverio Ribeiro,1 Alexandre Marques,1 Maria Joao Monteiro,2 Ana Rita Dias3 and Joao Pedro Dias3 1CI&DETS - Superior Health School, Polytechnic Institute of Viseu, Viseu, Portugal 2Escola Superior de Enfermagem de Vila Real, Universidade deTrás-os-Montes e Alto Douro, Vila Real, Portugal 3Medicina Dentária do Centro Regional das Beiras, Universidade Católica Portuguesa, Viseu, Portugal Background: The adherence to therapeutics plays a particularly important paper inpatients with chronic diseases, especially in the ischemic heart disease, beingthe absence of such, a serious public health problem with enormous impact onthe incidence and prevalence. The adherence to long term treatmentregimens is a dynamic phenomenon determined by five groups of factors withvariable influence that interact between each other (Sabaté, 2003). Despite the sociodemographic context andsocioeconomic status haven’t been considered as predictor, independent of theadherence, it appears that the individual with a low socioeconomic status faceswith the problem of choosing priorities, which include the limited resourcesavailable to meet the needs of its household (Sabaté, 2003; Bugalho and Carneiro,2004). Purpose: Relate the adherence after ischemic heart disease with sociodemographicdeterminants. Methods: It is a quantitative, transversal study. We recurred to a self-appliedquestionnaire for socio demographic,family functioning (FF) and adherence totreatment (MAT) characterization. Non-probability sample, with 196 subjectswith ischemic heart disease in follow-up consultation in the Health Centers ofthe municipality of Viseu, Portugal, aged between 37 and 90 years (62.39 ±12.67). 61.2% are men, most (66.3%) are “Married”, 57.1% live in a“rural environment” and 75.5% have a “highly functionalfamily.” We used the t Student test and the linear regression in SPSS. Results: Most patients (52.0%) reveal a “Good Adherence” to treatment,20.4% “Reasonable Adherence” and 27.6% shows “LowAdherence.” We found that those who adhere to therapeutics are: – Married patients adhering more than widowers (F=2.907, p = 0.036, R2=0.0434,Tukey test – p = 0.025), – The ones that have higher education (F=2.45;p = 0.048; R2=0.048). – Those who are on sick leave (F=3.251; p =0.023; R2=0.048). – We selected age and family functioning. Only the FF was accepted by themodel and explains 8% of the variation of the MAT (β = 0.282 t = 4.101, p =0.000). The remaining variables didn’t showinfluence in the adherence: sex (t = 1.694 p = 0,092), living environment (t=0.476,p = 0.635) and monthly income (F=0.496, p = 0.686). Conclusion: Some sociodemographic variables play a key role (age, marital status,education, employment status, and FF), it is important to target strategies forthe subgroups, promoting an active participation in the decisions related totheir treatment. P190 Deleting a tobacco cessation counsellor position from cardiac inpatient units results in reduced referral to outpatient follow-up MH. Mackay,1 JY. Kwon,2 C. Mak2 and S. Yoon2 1Heart Centre, St. Paul’s Hospital, Vancouver, Canada 2University of British Columbia School of Nursing, Vancouver, Canada Background: Tobacco addiction a significant, yet modifiable risk factor for heart disease, with 30% of all coronary artery disease deaths attributable to smoking. Smoking cessation (SC) reduces mortality from heart disease by up to 50% in asymptomatic patients, and 36% in patients with established disease. Our cardiac centre implemented the “Ottawa Model” for Smoking Cessation for inpatient units, in which best practice in smoking cessation is systematized. A critical component of this program for the first 3.5 years was a tobacco cessation counsellor (TCC), who visited all smokers, delivered a face-to-face intervention, and offered 3 months’ post-discharge follow-up. Due to budget constraints this position was deleted, and responsibility for SC counselling and referral to outpatient follow-up has shifted to the bedside nurse. Nurses’ workload and limited skill and confidence in SC counselling have been identified as possible concerns, so we sought to evaluate the impact of eliminating this position on rates of delivering a brief intervention and referring to post-discharge SC support. Methods: Random audits of screening and referral rates during the tenure of the TCC, and a chart review of all discharges from cardiac inpatient units covering the four months after deletion, were conducted. Differences in pre- and post-deletion rates of evidence-based SC practices were tested using the χ2 statistic. Results: Prevalence of smoking remained constant during both time periods, and rate of delivery of a brief intervention was unchanged. The rate of screening for tobacco use increased significantly after deletion of the TCC (82.5% vs 95.2% p = 0.02), but the rate of referral to follow-up decreased after deletion of the TCC (71.2% vs 40.5%, p = <0.01). Discussion and Conclusions: In this acute cardiac setting, assessment of smoking status is entrenched in nursing practice. However, although there is abundant evidence supporting the improvement in cessation rates when patients receive ongoing cessation support after discharge, this critical step has not been sustained after deletion of the TCC position. Potential barriers (e.g., lack of time, knowledge or confidence in counselling) warrant further study, but adequate clinical resources to support this step are certainly essential. P191 The objective structured clinical examination in assessing cardiac clinical skill in nurse prescribing J. Johanna Heikkila1 and L. Liimatainen1 1JAMK University of Applied Sciences, Jyväskylä, Finland Background: The objective structured clinical examination (OSCE) is a common method of clinical skills assessment used for advanced nurse practitioner roles. The evaluation of nurse prescriber students’ clinical competencies is essential to the educational process. The purpose of OSCE is to assess a nurse prescriber student’s competence and safety in the performance of advanced clinical practice skills. In this study the OSCE was designed to assess students’ clinical skills in prescribing in cardiac care. The patient scenario of a coronary heart disease patient was created. Purpose: The aim of the study was to assess nurse prescriber students’ skills in prescribing in cardiac care by using OSCE. Method: 12 nurse prescriber students’ performed an OSCE after the contents of cardiac patient history taking, assessment, evidence based medicine, current cardiac guidelines and pharmacology had been studied as a part of their 45 credit unit education. Observation against the criteria in five areas (20 points each) of the patient-nurse interaction, the history taking, the clinical assessment, the clinical judgment and the cardiac care were made on a 100 point OSCE. Results: Out of 12 students all passed the OSCE. The level of passing was set to 60 points out of 100. The highest score was 84 and the lowest 60 (mean 71.0; SD 6.20). The nurses had best skills in the nurse-patient interaction (mean 19.3; SD 0.99), in the history taking (mean 16.4; SD 1.48) and the clinical judgment (mean 16.1; SD 2.27). The areas for to develop were the clinical assessment (mean 9.3; SD 4.47) and the cardiac care (mean 10.0 SD; 3.25). The nurses did not assess systematically the risk factors of cardiac diseases. The auscultation skills of heart and lungs need developing. Discussion: The study findings indicate that OSCE is an effective method for assessing nurse prescriber students’ educational development. OSCE is an objective way of assessing skills and gives valuable feedback to students’ about their professional development. P192 The role of nurses in educating patients in secondary prevention of cardiovascular diseases Z. Keca,1 T. Momcilov Popin,1 N. Cemerlic Adzic1 and S. Popin2 1Medical Faculty, Novi Sad, Serbia 2Student, Novi Sad, Serbia Introduction: The incidence of cardiovascular disease (CVD) is still on the leading position at the rate of morbidity and mortality.in the Eastern and Southeastern Europe. Aim of this paper is to analyze the secondary prevention of CVD consisting prevention of progression of the disease and its complications, prevention of new cardiovascular events (KVD), identification of risk factors in patients and providing the highest maximum support in the fight against individual risk factors. A medical nurse, organizer of health care, plays a significant role in direct contact with the patient and to enforce measures of education. Methodology of work: We used these education methods: Individual interviews work in small groups and thematic lectures to patients with similar health problems or risk factors. In the work were used methods of interactive work and videos by using “smart” table ( video) Results: From August 2010 to June 2011 were educated 682 pacijeneta with different CVD in cooperation cardiologist and nurse, organizer of health care. With Individual interviews, planned talks were educated 296 patients (43.5%), working in small group of 199 (29.1%) and thematic lectures were attended by 187 (27.4%). Patients were trained in: harvested risk factors, recognition of the adverse and dangerous circumstances, needs to take her treatment, the procedures in the event of new symptoms. Conclusion: The correction of risk factors, changing lifestyle and applied pharmacological therapy significantly reduces the frequency of new KVD. The nurse has organized health care in collaboration with the cardiologist. P193 How the national indicator projekt is used as a method to increase quality acording to the set-up for patients with heart failure B. Falkesgaard Noergaard,1 T. Lund1 and K. Ersgard1 1Hospitalsenheden Horsens, Horsens, Denmark Background: A cardiac clinic for patients with heart failure was established as a development project in our Hospital in 2007. We wanted to optimize performance for the patients and to fulfil the recommendations from the Danish National Indicator Project (NIP), consisting of quality standards according to the following indicators: Echocardiography, NYHA-classification, Medical treatment, Exercise training, Patient education, Readmissions and Mortality. Aim: The purpose of the development project was to give the patient the whole bundle in the NIP project and to optimize the medication and selfcare for patients living with a chronic illness. Method: A team of clinical expert nurses in cooperation with cardiologists offer the patients individual consultations with the same contact nurse in all consultations (case-manager). Each patient undergoes a clinical examination (blood pressure, weight, NYHA- classification, blood-test) an ecco, x-ray and is referred to the nurse-driven clinic with a plan in the record, where they receive a structured training on the following topics: – Pathophysiology and symptoms – Medication – Self- regulation/ monitoring – Mental state – Diet – Physical training (12 weeks of training as part of the treatment) The consultations are patient-centred ie. the patient is trained in self-care and all consultations are based on what preoccupies the patient; recent events is for instance frequently the first question. This approach envisages that the patient talk about what is important for him or her at the moment. Simultaneously the nurses secure a structured education of each patient and secure that every patient receive the bundle in the NIP project. By providing a holistic care, two paradigms join in our case- manager function. Results: We have shown that it is possible to optimize the treatment and self-care among patients with a chronic illness by introducing a team of doctors and nurses to take care of the patients in a nurse driven clinic. We succeed in fulfilling all the recommendations from NIP, and we have well educated patients, who are able to take care of their chronic illness. Conclusion: We have achieved a higher quality of healthcare services to the patients after having worked systematically with NIP as quality development over the last 4 years and we see NIP catalyzing the increase of quality. Our patients express satisfaction and use words as “lifeline” to describe the meaning of the case- management that we offer, and their compliance is increasing during the consultations. P194 Risk factors of cardiovascular diseases in women after menopause M. Monika Labudova1 and M. Mikatova2 1Trnavska Univerzita, Fakulta zdravotníctva a socialnej prace, Trnava, Slovak Republic, Veria sro, Bratislava, Slovak Republic Purpose: Morbidity and mortality of women caused by cardiovascular diseases (CVD) in developed countries rises particularly since the fifth decade of their lives. Mortality caused by these diseases represents one quarter of death cases in women within the whole European Union. As for mortality, Slovakia occupies one of the worst positions in the EU. 61 percent of women and 47 percent of men die of cardiovascular diseases. Mortality of men until the age of 55 is four times higher than in women, nevertheless, after menopause of women this disproportion evens off. Methods: Analysis and mutual comparison of statistic data describing prevailing of CVD and their complications in women from European countries and Slovakia, with the aim to characterize specific features of the issues concerning cardiovascular mortality and morbidity of Slovak women in climacterium. Results: In spite of a quite good comprehention of prevention of CVD, it is possible to observe a recent growth in smoking, especially in young girls, as well as the growth of hypertension and obesity, increase of the level of cholesterol (pathological changes of the lipid spectrum), and the lack of physical activity. Nevertheless, it is possible to observe slight differences in particular sub-cultures, especially depending on education, social status, geographical background and communication with a physician, or a nurse. Conclusions: Depending of the above mentioned specifications of the lifestyle and underestimation of the risks of the occurance of CVD in women after climacterium in Slovakia, we point at the supple risk factors and possible prevention. We want to concentrate on rarely used resources of specialized nurses in ambulatory care concerning nursing and education of women leading to the changes of their lifestyles that might considerably lessen the risks of manifestation and development of cardiovascular diseases after menopause. Family and caregiver P195 What do relatives experience when patients are transferred from intensive care units to general wards? C. Spaabaek Jakobsen,1 R. Juhl Rahmberg,1 M. Soeholm Woedemann1 and A. Lauberg1 1Aalborg Hospital of the Aarhus University Hospital, Aalborg, Denmark Background: International studies, show the dilemma relatives face, when a patient is transferred from an intensive care unit to a general ward. For the relatives the dilemma stands between the close technological observation on the intensive care unit and less technological observation on a general ward. Also there is the dilemma between the patient being critically ill and being in recovery, which can cause the relatives anxiety and depression. Several studies have shown correlation between coping ability for the relatives and patient progress in the aftermath. It shows that supporting relatives optimizes the effect of the care and rehabilitation that the patient receives. Purpose: The purpose for this study was to investigate relatives’ experiences from the transfer of there loved ones from the intensive care unit to the general ward, with the aim of developing nursing practice. Method: A hermeneutic-phenomenological study was designed, with the intent of gaining insight in relatives’ experiences and perception of the transfer. This was obtained by interviewing six family members. Results: Three themes emerged: The game of interaction, the faces of chaos and getting safe back to life. The game of interaction Three different ways of interaction between the nurse and relatives were identified. Being dynamic cooperative, means that contributions from both parties are respected. Adjusting to the system which means that the nurse defines the relatives’ part in the interaction. Where the relative reacts by saying: Being conflicted cooperative which means that there is no fruitful interaction. The interaction is without common grounds and common goals. The faces of chaos. It has been identified that relatives experience chaos and confusion, due to absence of coherence, they feel powerless and are frustrated over having lack of control. Getting safely back to life.The relatives go through a period, where life is defined by biomedical viewpoints with the notion of the patient being safe. Information and knowledge contributes to the relatives feeling more secure, where relatives are made to understand that less observation is a sign that the patient is recovering and the patient being able to feel secure alone in his room is imperative. Conclusions: The nurses must pay attention to relatives on many levels in order to secure a successful transfer. It is important that the nurse creates a dynamic cooperative interaction. An interaction which can help to reduce chaos and enhance the feeling of security. P196 Nurses perceptions of family presence in the intensive care unit during resuscitation and invasive procedures DL. Carroll1 1Massachusetts General Hospital, Boston MA, United States of America Purpose of Study: The purpose of this study was to measure perceptions of the nurses in the Intensive Care Units regarding family presence during resuscitation and invasive procedures. Background/Significance: In response to a growing demand from consumers, there has been a movement for family presence during resuscitation and invasive procedures. Previous research on family presence has been done with emergency department and pediatric personnel but there is little research from intensive care unit nurses. Method/Design: A convenience sample of nurses that have positions in intensive care units were sent 2 surveys and a demographic form to complete electronically. The first survey, Family Presence Risk-Benefit and the Family Presence Self-Confidence Scales for resuscitation and invasive procedures, was sent to nurses who had positions in 5 intensive care units. The survey consists of 2 scales, the Family Presence Self- Confidence Scale for resuscitation and the Family Presence Self- Confidence Scale for invasive procedures; each is a 17–item self-report measure of the provider’s perception of their self-confidence related to managing resuscitation and invasive procedures with family present. The score ranges from 17 to 85. The second survey, Family Presence Risk-Benefit Scale for resuscitation and the Family Risk-Benefit Scale for Invasive Procedure; each a 22–item self-report measure of the provider’s perceptions of risk and benefits of family presence during resuscitation and invasive procedures. The score ranges from 22 to 110. Findings: The results will be presented at conference Conclusions: Perception of the self-confidence and benefits of family presence during resuscitation and invasive procedures will identify facilitators and beliefs that enhance the nurses’ ability to meet family expectations, and addresses patient/ family belief that presence is a right and not an option. Evidenced based practice would be supported with research that fills the current knowledge gap surrounding the practice of family presence, therefore ultimately promoting professional practice. Heart failure P197 Thirst in heart failure- a systematic review N. Nana Waldreus,1 R. Hahn2 and T. Jaarsma1 1Linkoping University, Department of Social and Welfare Studies, Linkoping, Sweden 2Linkoping University, Department of Medical and Health Sciences, Linkoping, Sweden Purpose: Although thirst is commonly known as a distressful symptom of heart failure (HF), there are only a few studies addressing thirst in HF patients. Increasing knowledge of thirst and thirst distress in patients with HF is essential in understanding and effectively relieving this symptom. Therefore, a systematic review to synthesize research related to thirst in patients with HF was undertaken, and factors considered to be related to the symptom in this population were identified. Methods: The searched databases were PubMed, Cocharane, Cinahl and Medline. The search was restricted to human adults and papers published in English on any date; it could include original research as well as clinical and randomized controlled trials. A combination of keywords was used: thirst and heart failure/ self-care behaviour/osmolality/ sodium/ angiotensin II/ intervention. As a final step, a hand search of the reference lists of all relevant articles was performed. All citations were reviewed for eligibility according to the following inclusion criteria: thirst was a primary or secondary outcome, or a patient statement in the results and sample involved patients with HF. Results: The search yielded 24 citations, of which 10 articles were included. Study sample sizes ranged from 4–4133 patients with HF. Seven quantitative and 3 qualitative studies describe thirst in a stable and worsening phase of HF. In two studies, the intensity of thirst (visual analogue scale: 0–100 mm) in a stable phase of HF was 23 and 54 mm, respectively. In a third study the ratings averaged 75 mm during worsening of HF. Forty-six percent of patients agreed to have moderate to strong discomfort from thirst. Tolvaptan, a vasopressin receptor blocker, was reported to increase thirst in HF. Thirst has been described as a barrier to compliance with fluid restriction. Moderate but significant correlations have been found between thirst distress and all other HF symptoms. Liberal fluid intake decreases the sensation of thirst and is easier to adhere to than a fluid prescription. Another study concluded that thirst and serum sodium remains unchanged regardless of salt intake and fluid restriction. No studies were found on thirst, angiotensin II and/or the osmolality in patients with HF. Conclusions: Thirst is aggravated in HF but the symptom is not well understood. Thirst might be an important factor related not only to medical treatment but also to self-care in HF, which should be considered in the planning of thirst-relieving actions. P198 Improving the quality of heart failure management in primary care M. Spence,1 A H Anne Mcbride,1 L. Burey,1 K. Wild1 and C. Deaton1 1University of Manchester, Manchester, United Kingdom Heart Failure (HF) affects around 900,000 people with 60,000 new cases annually and accounts for 2% of NHS inpatient days and 5% of emergency admissions to hospital. The purpose of this project is to improve the detection, management and care of heart failure within primary care in a large city in the UK. Methods: Working within recognised implementation science and quality improvement frameworks (PARiHS and the Plan Do Study Act cycle), project members and local clinicians piloted a HF improvement process for use in individual practices in primary care. The validation of HF registers (using a register verification tool), review of patient treatments and a systematic search (using a case finding tool) for all patients on the general practice register who might have HF provides a baseline assessment of skill requirements and a traffic light score for the practice. This is followed by feedback, tailored multi-faceted education from specialist nurses and doctors, action planning and re-audit. Thirteen practices have undergone the register validation, case finding, feedback and educational process. Results: Comparable with the UK National Heart Failure Audit 2010, data indicates that the accuracy of HF registers is variable, with 60% of HF patient registrations deemed appropriate, 16% inappropriate and 24% needing further investigation. The data illustrate that only 15% of HF patients are under secondary care and that the HF management guidelines of the National Institute for Health and Clinical Excellence and European Society of Cardiology are followed sporadically in general practices in primary care. The case finding tool identified 232 patients with HF who were not on HF registers and 194 patients who required further investigation to determine if they should be added. Re-audits in two practices indicate an increase in the use of beta blockers and an increase in the number of patients on optimal beta blocker therapy. Conclusions: The combination of comprehensive data with a snapshot traffic light score for the practice caught the attention of clinicians managing HF in primary care. Feedback and follow-up practice-based clinician-to-clinician educational sessions facilitated open discussion of how to manage HF patients more consistently within evidence based guidance and led to changes in practice. P199 Patients descriptions of participation in structured heart failure home care L. Lena Nasstrom,1 E. Idvall2 and A. Stromberg1 1Linkoping University, Department of Medical and Health Sciences, Linkoping, Sweden 2Malmo University, Faculty of Health and Society, Malmo, Sweden Background: A growing number of patients with heart failure (HF) will need lifelong care and one option is to provide advanced HF care in the patient’s home. A European integrated home care model has been developed and tested in the Netherlands and Sweden. The model provides structured home care with the goal that patients will experience participation, safety and have knowledge about their disease and treatment. The aim of this study was to examine how HF patients, who receive a structured home care, describe participation in the care. Method: Swedish HF patients receiving structured home care at four different settings were included in the study. Strategic sampling was used to reach a variation regarding severity of HF, different needs of home-care, age and gender. A total of 19 open ended interviews have been conducted. The interviews were analyzed with qualitative content analysis, where categories were developed inductively. Results: In the preliminary findings 5 categories with associated subcategories emerged on how patients with HF described participation in structured home care. To experience room for communication including having room for dialogue and receiving care-related information was described as important for participation. To have accessibility to care through planned home visits or patient initiated visits facilitated participation. The patients described participation by engaging in self care and to collaborate with the home care team. To have trust in the home care team with confidence for competence and have continuity to meet individual needs was of importance. To have options to make decisions was expressed as a will to make decisions or to entrust decisions to the caregiver, but sometimes patients opportunity to choose was restricted due to different aspects and impeded participation. Conclusion/significance of the study: The findings describe different aspects of participation among patients with HF who receive structured home care. Home visits facilitated communication between the patient and caregiver and enables participation. Getting information was an important condition for participation that often was met during home visits. Good accessibility to care increased feeling of participation as well as to meet caregivers of whom they trust. Own desire to make choices vary depending on what choice it regards and also between different individuals. However, several patients expressed a complex situation with several health care contacts, where the opportunity for participation was limited. P200 State of the art of telemonitoring in Dutch heart failure clinics A E Arjen De Vries,1 T. Jaarsma,2 MHL. Van Der Wal,1 RM. De Jong,1 RB. Van Dijk3 and HL. Hillege1 1University Medical Center Groningen, Department of Cardiology, Groningen, Netherlands 2Linköping University, Department of Social- and Welfare Studies, (HAV), Norrkoping, Sweden 3Martini Hospital, Groningen, Netherlands Background: Telemonitoring (TM) is increasingly used in heart failure (HF) care, but exact numbers are not known. Furthermore, expectations from TM, experiences and organizational implications are only addressed seldom and the optimal profile of a patient who will benefit from TM is not defined yet. Aim: To assess the actual status of use of TM in the Netherlands and to describe expectations, experiences and organizational aspects of working with TM. Methods: In collaboration with the Netherlands Organization for Applied Scientific Research (TNO) a 19– item survey on the use of TM was send to all 109 HF clinics in the Netherlands. Results: at least 31 of 109 HF clinics are currently using TM and 12 HF clinics plan to use TM within 1 year. Motiva, Health Buddy and IPT telemedicine are the most frequently used systems. The number of patients receiving TM varied between 10 and 50 with 2 clinics having more than 75 patients using TM. The main goals for using TM are ‘monitoring physical condition, signs of deterioration or treatment’, ‘adjust medication’ and ‘patient education’. Most patients using TM were in NYHA II and III and could use the TM system ‘as long as needed’ or without time limit. In total 23 of 31 responding HF clinics stated they would consider a different system than the system currently used. The health care professionals experienced most changes due to TM with regard to ‘go along with current development’, ‘being innovative’, improvement of self care of patients’ and ‘providing better care’. Reduction in workload and readmission were only experienced by a few clinics. None of the 11 measured expectations before using TM, reflected the experienced differences after apply. Conclusion: In the Netherlands almost one third of the HF clinics are using TM as part as their care, being it only in a limited number of patients. Our survey shows that TM is not a success story yet. Expectations of introducing TM did not seem to be reflected in the experiences of healthcare providers. No criteria for the duration and specific patient group are used and might lead to disappointment of using TM. This could be a result of a strong focus on the specifications of the TM system itself and not at organizational issues such as protocols or education of staff. P201 Considerations regarding the enhancement of patient’s knowledge and self-management of heart failure M. Michele Hughes,1 C. Kenneally,2 G. O’donovan,1 M. Cleary2 and A. O’connell2 1University College Cork, Cork, Ireland 2Cork University Hospital, Cork, Ireland Background: Knowledge is a cornerstone in the management of chronic Heart Failure (HF) in order that patients reach their optimal self-management. Increased knowledge can be directly related to improved self-management. Nurses are often the critical source of knowledge within HF Clinics through their verbal information and the supplemental formal educational literature. Purpose - aims: To evaluate the effectiveness of education and counselling of Irish HF clinic staff and to explore if HF patients felt they had benefitted from the HF Clinic’s service Methods: The Dutch HF knowledge scale (van der Wal, M., Jaarsma, T., Moser, D. & van Veldhuisen, D. 2005) (translated into English) contains 15 items concerning knowledge of HF and self-care and 3 items for demographic details. This is a valid and reliable instrument for measuring patients’ knowledge and self-management of HF. It was completed by 89 patients both before their first visit to the clinic and again after they had at least two further clinic appointments (involving consultations with nursing staff). On second interview 3 additional items were used to measure whether they considered the HF Clinic beneficial to them and why. During the data collection it was noted that assistance to read the Knowledge Scale was required by many patients. Results: Using the Wilcoxon Signed Ranks Test for repeated-measures data, it was found that knowledge levels were significantly higher following attendance at the clinic (T=568, z=-4.66, p < .001). Patients considered the HF clinic services beneficial. Reliability was tested in both sets of questionnaires. Cronbach’s α of the knowledge scale in this sample was.71 (prior to attending the clinic). Validity of the scale (as a unidimensional scale able to differentiate between high and low levels of HF knowledge) was confirmed using factor analysis and descriptive statistics. Conclusion: The use of the instrument confirmed the value of the HF clinic interventions in improving patients’ knowledge. However the change in data collection from self-completed questionnaires to researcher completed questionnaires (where the Knowledge Scale items were read aloud to participants) needs to be considered along with population literacy levels. These may have implications for strategies used to enhance patients’ knowledge and self-management of HF and need to be acknowledged by all HF clinic staff. P202 Palliative care in heart failure (HF): can we do more? I. Beistegui Alejandre,1 BE. Aguayo Esgueva,1 M. Echavarri Escribano,1 A. Jimenez DeAberasturi Sasiain,1 P. Fernandez Murguiondo1 and LC. Ibarra Barrios1 1Osakidetza- Hospital Universitario Araba Santiago, Vitoria- Gasteiz, Spain Introduction: Heart failure (HF) is a serious condition equivalent to a malignant disease in terms of symptom burden and mortality. Palliative care in heart failure is not well developed despite of being necessary (together with optimal medical treatment) for a proper management of symptoms and to achieve maximum patient comfort. Aims: To assess the current situation of palliative care in HF. To evaluate the effectiveness of nursing care in the management of symptoms in patients with terminal HF. To identify weaknesses and areas for improvement in the care of patients with end-stage HF. Material and methods: Descriptive, retrospective study. Data were obtained from medical and nursing records of patients who died in our hospital with a main diagnosis of HF during the period 2008/09. Results: NIC classification: • NIC 2080 Fluid/Electrolyte Management 70.9% • NIC 6680 Vital Signs Monitoring 100% • NIC 1400 Pain Management 90.9% • NIC 5290 Grief Work Facilitation 5.5% • NIC 5420 Spiritual support 38.2% NOC comparison by means of McNemar-Bowker test.• NOC 0400 Cardiac Pump Effectiveness p < 0.001 • NOC 1302 Coping p = 0.317 • NOC 1101 Tissue Integrity: p = 0,001 • NOC 1307 Dignified Life Closure p =0.035 • NOC 2001 Spiritual Health p = 0.368 Conclusions: Hospital care for patients with end-stage HF focuses on resolving acute symptoms, leaving aside the psychosocial and spiritual needs of the patients and their families and the need to grieve. Patients are not evaluated holistically. It is necessary to coordinate health care professionals from different areas to reduce a fragmentation in patient care and to improve patient support and continuity of care. P204 Heart failure and fatigue. Knowledge translation – can research based knowledge be useful for patients? I. Irene Sommer1 and I. Schjoedt1 1Aarhus University Hospital, Department of Cardiology, Aarhus, Denmark Purpose: To study if research based knowledge on fatigue as a symptom related to heart faliure can support patients to understand and cope with symptoms in their daily living. Method: A literature review on fatigue and heart failure was conducted. The quality of the research articles was assessed, and knowledge about prevalence of fatigue, impairment in daily living and coping strategies was extracted. The results were reported in ordinary language in patient information leaflets. The text was validated by experienced specialist nurses and doctors. To include the patient perspective, 13 patients with heart faliure read and filled in a questionnaire about the content, usability and language of the information leaflets. Results: When reading the information about fatigue and heart failure the patients felt relieved that their feeling of phsycical and mental fatigue is quite normal. They could use the information to understand their own symptoms and to make their spouses, general practitioners, colleagues and employers more informed of their situation. Generally, patients found the information easy to understand. However, minor alterations were changed after patient review. Conclusion: It is possible to make research knowledge useful to patients although barriers have to be overcome. Though, in this study it is possible that the patients who can read and understand the written material also are the ones commenting on the content. Nurses in heart failure clinics can inform patients of fatigue and heart failure inspirered by information material, articles and conference presentations. P205 Designing an internationally grounded one-stop website for local heart failure patients, carers and service providers M. Spence,1 A H Anne Mcbride,1 L. Burey1 and C. Deaton1 1University of Manchester, Manchester, United Kingdom Guidelines recommend co-ordinated, multi-professional management of care for patients with heart failure (HF) and systematic reviews support programmes of care which include acute inpatient phases and discharge planning. The purpose of this project was to improve co-ordination and communication among providers (HCPs) and awareness of available HF services. Methods: Initial discussions with HCPs indicated the desire for a central information base, and patient focus-groups highlighted their interest in a website dedicated to their specific condition. A trawl of internet sources confirmed the lack of local information for HCPs or HF patients and carers. A project team designed a website based on four questions: (1) what information and communication needs are limiting HCPs in their endeavours to provide co-ordinated, multi-professional care to HF patients? (2) What do patients and carers need to manage their conditions? (3) What resources exist to address those needs, what gaps remain? (4) What is the evidence for providing this information through a website? The team employed a local company to develop the website infrastructure and used internal expertise to ensure it was technologically compatible with healthcare systems. The content was derived through an iterative process involving patients, practitioners and local specialists in HF and Public Health, the trawling of recognised specialist websites, good practice guidelines and medical internet research. Results: A nationally and internationally grounded ‘one-stop shop’ HF website was designed for the needs of local HCPs and patients and carers. The website includes a map of local HF services; biographies of HCPs (including photos, contact details and role information); patient advice and stories; links to international and national cardiology and HF websites, and local patient support groups; and a password protected area for HCP information exchange. Discussions are ongoing as to the appropriate coverage of some subjects (e.g. palliative care; exercise). The website went live in September 2010 with a soft launch, receiving HCP and patient support group approval. Further development and evaluation is scheduled for 2012. Conclusions: It is possible to design an internationally grounded, locally-focused, disease specific website which is attractive and accessible to HCPs, patients and carers. It requires the commitment and expertise of a product manager; clinical and technical experts; patients and carers, and a process for achieving a sensitive balance between comprehensive coverage and, accessibility and appropriateness. Nurse, Allied Professional, other P206 The impact of cardiac genetics nurses in a pre-genetic screening clinic J. Oliver,1 J. Goodfellow,1 A. Hammond,1 M. Farrer,1 M. Stewart,2 J. Bourke3 and P. Brennan3 1City Hospitals Sunderland Nhs Foundation Trust, Sunderland, United Kingdom 2James Cook University Hospital, Middlesbrough, United Kingdom 3Newcastle upon Tyne Hospitals NHS foundation trust, Newcastle upon Tyne, United Kingdom Purpose: The cardiac genetics nurse led service was established in January 2009 to triage individuals with potential inheritable cardiac disease i.e. hypertrophic or dilated cardiomyopathy, familial hypercholesterolemia and sudden unexplained deaths in people under 40year olds. The secondary care based service acts as a gate-keeper for the tertiary service and signposts patients to relevant services. Its specific remit was to ensure referrals to the tertiary genetic service were families with a high probability of an inherited cardiac disease. Methods: The service was designed to investigate the probability of an inherited cardiac condition by obtaining a minimum of a three generation family history to draw a pedigree and confirming reported diagnoses. Using the pedigree, other family members at potential risk of an inherited cardiac condition risk were identified. Those relatives were invited to attend a “one stop clinic” which included cardiac investigations. A cardiologist supervised the relatives’ test results and the cardiac genetics nurse would collate the family results with the pedigree to assess the probability of an inherited heart condition. Results: Most families had an intermediate risk at referral (85%) because information was unknown. After drawing the pedigree some families were moved to a high or low risk status. The final risk was assigned after cascade screening, examination of records and post mortem reports etc. 39% had a high risk at the final assessment 35% a low risk and 26%were at an intermediate risk. The referral rates to the regional genetic service had been increasing by 10% a year for the last 10 years. The nurse led pre genetic triage screening has seen a 30% reduction in referrals to the tertiary genetic service over the last 2 years. Conclusions: Nurse led pre-genetic cardiac screening can be undertaken at a secondary care level and has not only provided effective demand management for the tertiary genetic centre, but has signposted patients to the correct level of health care and conserved health care resource.A patient questionnaire demonstrated a very high level of satisfaction with the service. P207 Infective endocarditis: the good care for the patients as a prerequisite for their future better health P. Pavlina Hristova,1 L. Mircheva,1 A. Kisheva,1 Y. Yotov1 and V. Sirakova1 1University Hospital “St. Marina”, Varna, Bulgaria Introduction: Infective endocarditis (IE) remains one of the fatal diseases even in the 21th century. The nurses’ role in hospital and outpatient care for the patients is unquestionable and that’s why it is important they understand the disease process in order to assess and plan appropriate care. The lack of knowledge of this disease and its implication on the patients may lead to complications, especially in the recovery phase of the illness. Aims: To create a standard protocol for nursing care which is going to be incorporated in the complex treatment of IE. This protocol will include information for the patients about their condition in order to make them active participants in the curative process, as well as education of the newly arrived and undergraduate nurses about IE. Methods and results: A retrospective study of the patients who were treated for IE for the period 2008–2010 in our clinic were studied. There were overall 20 patients – 12 men and 8 women. An algorithm of the different steps for patients care from the first encounter till the end of the treatment was created, including blood drawing, monitoring of the important health parameters, follow-up of the antibiotic treatment and its side effects, etc. Conclusion: The treatment of IE needs a multidisciplinary approach including team of cardiologists, nursing staff, experts in infectious diseases, cardiac surgeons, and other healthcare specialists, such as physiotherapists, psychologists. The effective care program focusing on facilitating knowledge and improving patient health is rewarding. P208 How to put “best practice” into practice and keep it there. A proposal for a pilot study E. Laws,1 A. Aliotta,2 A. Frediani,1 N. Furletti,1 I. Innocenti,2 M. Lazzarini,2 A. Marconi,1 M. Mangioni,2 I. Matteoli2 and M. Micalizzi2 1Gabriele Monasterio Foundation CNR/Region Toscana, Heart Hospital, Massa, Italy 2Gabriele Monasterio Foundation-CNR Region Toscana,Pisa, Italy Background: According to Balas and Boren (2000) it takes an average of 17 years for evidence to be put into practice.There are many reasons for this, nurses inabilities to find and understand research, traditional cultures where there is little open- mindedness for change ect. Various strategies have been suggested ( eg the Iowa model) to take research into practice, however it is very hard to keep it there as staff tend to slip back into “bad or unsafe practice “if controls or reminders are not adeguate. Aim: Improve adherance to best practice(BP). Improve communication Method: Training course for nurses on how to seek and evaluate evidence, audits to identify problems with devulgation of the results with suggestions for improvement. Formation of project groups relating to specific arguments eg care of central venous lines. Results: An intial improvement followed the courses (infection rates were reduced in both the adult and paediatric surgical patients) but standards were not wholly maintained therefore an ulterior stragegy was required. We are now computerising all our nursing notes and have decided to Put electronic warnings to help adherence eg-when an intravenous set needs changing. Easy links to protocols-eg isolation policy Electronic scoring of wound infection surveillance and central line sites. Obbligatory check list with reminders for best practice eg “ can the urinary catheter be removed, if not why not ?- with structured responses. Electronic calculation of MEWS (modified early warning) scores. Computerisation of all drug prescriptions and somministrations which will not only provide reminders if a drug dose administration is forgotten and a fairly accurate cost control but will also facilitate audits for the control of BP eg antibiotic use, On paper lots of information is copied eg the operation a patient had ; this will now arrive automatically from the various departments with attached nursing handovers, facilitating accurate comunication. A series of check lists from pre op to pre discharge have been developed, with automatic updates as procedures are done eg echo referals. Conclusion: The program is almost finished and pilot studies will begin in the near future. It is hoped that adherence to best practice and accurate communication will be facilitated thereby improving patient safety. As everything is structured it will not only provide a data base for quality control with future audits giving an almost immediate feedback to tackle problems as they arise, but also the opportunity to collect accurate data for nursing research. Prevention and rehabilitation P209 Copenheart ie 1 – effect and meaning of integrated rehabilitation of patients treated for infectious endocarditis TB. Trine Bernholdt Rasmussen,1 SK. Berg,1 H. Bundgaard1 and ADO. Zwisler2 1Rigshospitalet - Copenhagen University Hospital, Heart Centre, Department of Cardiology, Copenhagen, Denmark 2 National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark Introduction: Infectious endocarditis (IE) is amongst the most serious infectious diseases in the western world. Treatment requires lengthy hospitalization, high dosage antibiotics and possible valve replacement surgery. Studies indicate that patients experience persisting physical symptoms,suffer post traumatic stress disorder symptoms and has difficulty returning to work, up to a year post-discharge. No studies investigating the effect of rehabilitation of patients treated for IE have been published. Aim: The aim of the study is to describe the effect and meaning of an integrated rehabilitation programme. Furthermore the study will explore the post-discharge status and experiences of patients treated for IE. Methods and participants: The CopenHeartIE study combines quantitative and qualitative research methods. The methods are integrated by applying mixed method embedded experimental design. A qualitative and a survey-based pre-study are currently being undertaken, to investigate post-discharge experiences and rehabilitation needs of patients treated for IE. The CopenHeartIE trial is a multi-centre, multidisciplinary, prospective, longitudinal, randomized controlled clinical trial designed to investigate the effect and meaning of integrated rehabilitation. The intervention consists of a six month psycho-educational component and a twelve week exercise training component. Patients discharged after treatment at one of two Heart centres will be screened for inclusion. Patients older than 18 years, having completed treatment for IE will be considered eligible for participation. Based on sample size calculations 190 patients will be included in the trial. A qualitative post-intervention study will explore rehabilitation participation experiences. Outcomes: Primary outcome is self-reported mental health as measured by SF-36. Secondary outcome is peak VO2 measured by bicycle ergometer test. A number of exploratory outcome measures will be assessed, including anxiety and depression, self-rated health, quality of life, fatigue, sleep quality and body image. In addition employment status, health care utilisation, cost-effectiveness and mortality will be assessed in register-based long term follow-up analysis. If a positive effect of integrated rehabilitation is confirmed, it may have considerable impact on the rehabilitation offered to patients treated for IE in the future. Results from the pre-studies are expected during 2012, and from the clinical trial in 2014. P210 Does having an individual interview prior to the specialized ischemic cardiac rehabilitation program make a difference in relation to participation and completion S. Riis Christiansen,1 L. Ravn1 and A. Lauberg1 1Aalborg Hospital of the Aarhus University Hospital, Aalborg, Denmark Background: Rehabilitation is based on the idea of restoring a meaningful life and ensures the highest possible level in terms of physical, mental and social health for people who suffer from heart disease. It has been documented that patients do attend the rehabilitation programs and it has been shown that rehabilitation increases patient satisfaction and quality of life. There is also evidence that rehabilitation programs can reduce mortality from heart disease by 35% and the risk of a new blood clot by 29%. In contrast a study from the Danish Heart Foundation from 2010 showed that only 27% were offered cardiac rehabilitation and only 13% completed a full rehabilitation program. Aim: The aim of the study was to examine whether introduction of individual interviews before the program begins, increases participation and completion of a specialized ischemic cardiac rehabilitation program. Methods: First records of how many patients were attending the rehabilitation program prior to the offer of an interview. Interviews were defined as a conversation with a nurse of approx 45 minutes. The patient was provided with a starting date on discharge and the interview took place approx. 14 days after discharge. The patients were motivated and prepared for the rehabilitation program; written material and practical information were provided based on the patient’s overall situation. Symptoms from the heart disease, side effects from medication or other problems were assessed in close collaboration with a physician. In addition, the patient filled out 2 questionnaires; HADS (anxiety and depression screening) and SF 36 (self experienced quality of life). To conclude the interview an individual treatment plan was made. Data derived from registration forms from April 2009 to June 2011. Attendance and participation was tallied from 8 rehabilitation teams before the introduction of individual interviews and subsequently from 9 rehabilitation teams after the introduction. Results: Results showed a dropout of patients at 44% before the introduction of interviews while dropout had fallen to 11% after. Furthermore, it turned out that the completion of the rehabilitation program had increased from 50% to 78% after introduction of the interviews. Conclusion: It can be concluded that the introduction of an interview prior to the rehabilitation program have had a significantly greater impact on participation and completion of the rehabilitation programs, justified by an increase of patient satisfaction and quality of life. P211 The effect of individual training and guidance program with myocardial infarction patients over patients’ quality of life H. Uysal1 and S. Ozcan1 1Istanbul University, Nursing Faculty, Medical Nursing Department, Istanbul, Turkey Purpose: The aim of the present study is to identify the effect of individual training and guidance program for patients having experienced myocardial infarction over patients’ quality of life. Methods: The sample comprised 90 patients, 45 in the intervention and 45 in the control group, selected by sequential sampling from patients who had myocardial infarction for the first time. Data were collected between April and November 2008 by means of patient information form, MIDAS, and SF-36. Results: In the intervention group more improvement was observed in comparison with the control group in terms of quitting smoking, physical activity, BMI, waist circumference (mean differences p = 0.000). A significant difference was observed in the 3rd month evaluation of both MIDAS and SF-36 quality of life scales in comparison with the baseline values (p = <0.000). Conclusions: The results indicated that individual training and guidance provided to patients having experienced acute myocardial infarction lead to improvement in quality of life and decrease risk factors by increasing behaviors which protect cardiac health. Such educational programs should be applied to patients with AMI prior to discharge. P212 From clinical guideline to evidence-based nursing practice - use of graduated elastic compression stockings to prevent post thrombotic syndrome in patients with deep vein thrombosis I. Inge Schjoedt,1 L. Kallestrup1 and T. Soegaard1 1Aarhus University Hospital, Department of Cardiology, Aarhus, Denmark Background: Post thrombotic syndrome (PTS) is a frequent, serious and burdensome complication following symptomatic deep vein thrombosis (DVT) in the leg and/or pelvis. The use of graduated elastic compression stockings (GECS) to prevent PTS is common. However, recommendations in the literature and clinical practice on use of GECS vary concerning compression strength (mm Hg at the ankle), stocking length (below knee or thigh), timing of application after DVT diagnosis, daily use and duration of GECS therapy. Purpose: To develop and implement a clinical guideline for the use of GECS to prevent PTS in patients with symptomatic DVT. Methods: A systematic review was conducted. Evidence was synthesised into recommendations for clinical practice. Indicators and standards were developed to monitor quality of care. The clinical guideline was pilot tested in 10 patients; this did not lead to any changes in the guideline. In April 2011 the clinical guideline was implemented in our department. Where possible the recommendations were incorporated into the pre-printed care plan for patients with DVT. In the beginning of 2012, monitoring will be ensured by record audits and self-reported questionnaires to patients. Approximately 20–30 patients will be included. Furthermore, the clinical guideline is under approval in the Danish National Clearinghouse for Nursing. Results: The evidence-based recommendations were: A knee-length GECS with an ankle pressure of 30–40 mm Hg should be applied within three weeks after symptomatic DVT is diagnosed. The GECS should be used during daytime, from getting up in the morning until bedtime, for at least two years. Results from the record audit and patient questionnaires will be presented at the Spring Meeting. The clinical guideline is expected to be approved by the Danish National Clearinghouse for Nursing in early November 2011. Conclusions: We expect that we will meet the standards that at least 95% of the patients fulfill recommendations for use of GECS. Once the guideline is approved by the Danish National Clearinghouse for Nursing it can be implemented nationwide. P213 Sedentary time decreased for patients with cardiometabolic risk participating in a structured lifestyle intervention program M. Matthias Lidin,1 E. Ekblom-Bak1 and M-L. Hellenius1 1Karolinska University Hospital (Solna), Department of Cardiology,Stockholm, Sweden Sedentary time decreased for patients with cardiometabolic risk participating in a structured lifestyle intervention program. Objectives: Sedentary time has been recognized as an independent risk factor for cardiovascular disease and total mortality. The aim was to evaluate the effect of a cardiovascular lifestyle intervention program on sedentary time and level of physical activity in patients with multiple cardiovascular risk factors. Method: The intervention program consisted of an individual visit to a nurse for an initial health check-up and lifestyle counselling. The patients received an individual prescription of physical activity and a pedometer. Thereafter, the patients participated in a structured lifestyle course with their spouses. The program included five meetings with a physician and a nurse and the topics highlighted was physical activity, sedentary time, food habits, nicotine, alcohol, stress and cognitive behavior therapy. Sedentary time was measured both at work and leisure time at baseline after six month and one year with a questionnaire. Results: Up to date 85 individuals are enrolled in the intervention program and 54 (mean age 59 years, and 72 % females) have completed a 6 month and a one year visit. Total sedentary time decreased from 7.43 h to 6.11 h (p = 0,001) over one year. Sedentary time at work decreased as did sedentary time at leisure. Level of physical activity improved significantly. In parallel, waist circumference, systolic and diastolic blood pressure decreased significantly and a trend towards favorable changes in S-lipoproteins mostly HDL was also noted. Conclusions: Sedentary time decreased significantly decrease after one year in patients with cardio metabolic risk factors after taking part in a lifestyle intervention program. P214 Patients experience of living with precautions after cardiac surgery with midline sternotomy CB. Charlotte Brun Thorup,1 RV. Lukassen,2 H. Lindstroem2 and HB. Olsen2 1Aalborg Hospital of the Aarhus University Hospital, Center for Cardiovascular Research – Cardiology, Aalborg, Denmark 2University College of Northern Denmark, Aalborg, Denmark Background: After implementing patient supportive precautions following sternotomy in cardiac surgery, the need for knowledge concerning patient’s experiences of living with these precautions occurred. A literature review revealed that there are no studies focusing on patient’s experiences from living with recommendations after cardiac surgery. The patient supportive approach was inspired by Aaron Antonovsky’s salutogenetic theory, based on the understanding that: If the recommendations are meaningful, comprehensive and manageable the patients will experience a high degree of “sense of coherence” (SOC) which might support a healthier convalescence. Aim: To explore how patients experience living with precautions after cardiac surgery with midline sternotomy, with special focus on meaningfulness, comprehensibility and manageability and thereby SOC Methods: The study was conducted in April 2010 and consists of five semi structured interviews of patients six-eight weeks after cardiac surgery. The patients were ensured anonymity and confidentiality. Ethical guidelines for nursing research in Denmark and the Nordic countries were followed. The analysis and interpretation followed the principle of coherent interpretation as formulated by Kvale and Brinkmann. Results: The patient’s experiences can be expressed in the following themes: 1) Logical or bodily experienced meaning in the recommendations. 2) Cognitive or physical comprehension of the recommendations, and 3) Difficulty in managing the recommendations Conclusion: To some degree, the patients experience a SOC in the recommendations and therefore they tend to follow them. The patients experience that the meaning of the recommendations is understood logically and bodily. The lack of meaning occurs if the bodily understood meaning differs from to the logically understood meaning, and the patients tend to trust the bodily understood meaning rather than the logical one. The comprehension of the recommendations is both cognitive and physical, and the physical seems to provide the real comprehension. It is difficult to manage the recommendations in the postoperative period, but still the patients use the recommendations as guidelines. Further more, they are motivated by the notion that they achieve something positive and avoid something negative and the patients suggest reduction of restriction little by little for example by an individual focus. P215 Changes in quality of life for cardiac surgery patients and the impact of cardiac rehabilitation A. Flynn1 and M. Byrne2 1University College Cork, Cork, Ireland 2Cork University Hospital, Cork, Ireland Purpose: A major goal of cardiac rehabilitation is to enhance the quality of life (QoL) experienced by cardiac patients. This study builds on and contributes to work examining the QoL of cardiac surgery patients within the context of participation in a cardiac rehabilitation programme. Although studies in cardiac rehabilitation (CR) have examined the benefits of programmes in terms of lifestyle modification and morbidity, there has not been an extended study of the impact of CR participation on self-reported QoL. The objective of this study of cardiac surgery patients in Ireland, was to provide additional insight into the QoL experienced by post-operative cardiac patients, and specifically, to analyse how participation, or non-participation, in CR might impact on post-operative QoL. Methods: In this study the QoL of 127 patients was measured using the SF-36, a self-report health related Quality of Life measurement tool, both pre and post operatively. Analysis was completed using SPSS to calculate mean physical component summary scores (PCS) and mental component summary scores (MCS). Results: Results from this study demonstrated an improvement in the QoL scores post op when compared to pre op scores. There were statistically significant relationships shown to exist between QoL changes and a range of demographic variables. Changes in all QoL scores for those who participated in a CR programme were not always statistically significantly different from those who did not. Patients reported interesting reasons for non-attendance at CR programme which are deserving of attention in terms of service provision. Conclusions: QoL is improved for most cardiac surgical patients however this finding related closely to the recency of surgery. Rehabilitation has a significant role in supporting patients improve their QoL post operatively however not all patients are enabled to attend a formal programme and can benefit from informal mechanisms of support. P216 Relationship between physical and psychosocial factors and attendance at cardiac rehabilitation J. Julie Blair,1 NJ. Angus,1 I. Atherton,1 WJ. Lauder1 and SJ. Leslie2 1University of Stirling, Stirling, United Kingdom 2NHS Highland, Inverness, United Kingdom Purpose: To examine the relationship between physical and psychosocial factors and attendance at out-patient cardiac rehabilitation classes. Methods: Patients offered hospital-based cardiac rehabilitation at a single regional cardiac centre between 2007 and 2009 were invited to complete a postal survey. The study questionnaire comprised of three data collection instruments (1) The Brief Illness Perception Questionnaire, a 9–item scale used to assess patient beliefs; (2) the Friendship scale, a 6–item scale used to assess social isolation and loneliness and (3) the York Cardiac Beliefs questionnaire, a 22–item scale to assess cardiac misconceptions. Additional information including age, gender, distance from CR centre, marital status and education was collected. A total of 270 eligible patients were issued with a questionnaire. Results: 128 (47.4%) questionnaires were returned. Attendees had lower mean illness perception scores (mean 26.9, CI 24.1–29.7) than non attendees (mean 32.5, CI 27.3–37.6). This difference was found to be statistically significant (t = −2.05, p = 0.042). Non-attendees were significantly more likely to attribute the cause of their disease to non-modifiable risk factors (genetics, age, gender) (t = −2.28, p = 0.026). No significant differences were found between groups in respect to distance from CR, car ownership, age and gender. Similarly, no differences were found in cardiac belief or friendship score between attendees and non-attendees. Conclusion: In this study illness perceptions were related to attendance at CR. Cardiac belief scores were not significantly different between groups, implying that CR may not have rectified cardiac misconceptions in attendees. Attendance status and distance from CR did not have a significant relationship; however this differed from previous study findings. This may be of particular relevance to centres which serve rural populations, and may therefore merit further investigation. P217 Evaluation of a self-management intervention H. Heleen Westland,1 MC. Kars1 and BGM. Sol2 1University Medical Center Utrecht, Division Heart and Lungs, Utrecht, Netherlands 2Utrecht University of Applied Sciences, Utrecht, Netherlands Background: Recognition of risk behaviour and integration of lifestyle recommendations in daily life is of major importance for patients diagnosed with a heart disease. For most patients changing their lifestyle and minimizing risk behaviour appears to be difficult. An intervention was developed to educate patients about a healthy lifestyle and to support their lifestyle change. The intervention consists of an assessment, containing a) a structured screening of self-management skills and risk factors, b) discussing the patients’ motivation to adapt to a healthy lifestyle and goal setting tailored to the patients’ individual needs and skills. Subsequently patients decide whether they will participate in a lifestyle program. This program consists of 5 meetings covering 5 lifestyle themes. 8–12 peer patients work towards targeted improvement of their lifestyle. They are coached by a nurse, a social worker and an expert patient. The program is supported by a website. Objective: Gaining insight in the feasibility and patient satisfaction of a pilot of a self-management intervention. Methods: Structured interviews with both participants and professionals involved in the program. Results: Formulating and working towards individual goals appeared to be difficult. Patients tended to forget the ambitions and goals they had set during the assessment. Also establishing the planned goals at home was complex. Patients lacked a sense of urgency to behaviour change, except for stress management. Patients experienced stress and needed more support. Patients felt safe to speak freely and wanted to share their experiences with peers. They suggested a more interactive approach of the education part. Patients preferred to increase the number and time of the meetings and asked for an extra closing session after 3–6 months. Professionals needed more training to educate and coach interactively and to help setting goals. The expert patient’s role with respect to changing lifestyle can be improved. The website was not optimally used due to the patients’ lack of internet skills and being unfamiliar with the content. Conclusion: On the whole patients evaluated the program positively although it requires several improvements. To carry out the intervention professionals need to be trained on communication and coaching skills. Patients need professional guidance throughout the intervention to enhance their ability to accomplish their goals. The role of the expert patient needs refinement. The website should be more highlighted. P218 Implementation of the heart pathways,the role of the nurse L. Hay Pedersen,1 K. Tander Lindstroem1 and K. Ersgard1 1Hospitalsenheden Horsens, Horsens, Denmark Background: Based on the fact that waiting times for patients with heart disease were unacceptable a political initiative for improvement was taken. In 2008 an agreement between the Danish Government and the Danish Regions on non acute life threatening heart disease was reached. The core was to develop integrated heart pathways as organizational and clinical standards for the diagnostics and treatment and focus on “the journey of the patient through the health care system”. Purpose: The aim of the pathways is reducing processing-times, obtain faster diagnosing and quick onset of treatment. Furthermore it is the objective to ensure that all patients are treated according to national clinical guidelines, to increase the quality of treatment and hereby the survival rates. The purpose of our action was the implementation of this pathway. Methods: To fulfil the recommendations we established an organization consisting of a team with expert nurses, ward nurse, cardiologists and secretary. The nurses guide the patients during “the journey” and their job consist in brief of: Referral of patients in collaboration with the cardiologist Contact with patients (and practitioners) to offer the fastest appointments but at the same time organize the “journey” so it also fits into the patients daily life Provide information on diagnostics tests Ensuring that the biochemical tests, X-ray and echocardiography are performed prior to medical examination Booking of appointments Contact and coordination of workflow and collaboration with the other hospitals Registration and monitoring Besides the above, there is a large nursing and educational role in informing and mentoring the patients about various tests, symptoms, medications, curiosity and anxiety. The broad experience of the nurses and the close cooperation with the cardiologists mean that the nurse can meet the patient needs and questions in a professionally relevant way and help the patient to reduce feelings of insecurity and uncertainty. Results: In 2011 there are approx. 80–100 patients per month who are offered cardiac pathways, and waiting time on echocardiography is an average of 5.7 days, which meets the requirement. The patients seem to be satisfied with the organization and the staff. Conclusion: You may ask the question: “What benefits are obvious according to prefer a nurse instead of a secretary guiding the patient during the journey?” The answer is, that a nurse with specialized knowledge, is able to focus on the needs and demands of the single patient in spite of the already planned sequence and give him or her the opportunity to feel unique. Professional education P219 Use of antimicrobial dressing with chlorhexidine gluconate in infections by staphylococcus aureus in central venous catheters with continuous infusion of iloprost E. Carvalho,1 S. Sandra Mendes1 and M. Santos1 1University Hospitals of Coimbra, Coimbra, Portugal Summary: Central venous accesses are increasingly used to save and prolong the lives of many patients who require complex therapeutic interventions. In Portugal, PAH patients have available an iv iloprost treatment, administered through a tunneled Broviac central venous catheter (CVC); however, this presents a potential risk for infection and sepsis. We report two consecutive patients with CVC-related Staphylococcus aureus sepsis. Objectives: Analyze the effectiveness of the use of an antimicrobial dressing with chlorhexidine gluconate in the control of Staphylococcus aureus infection in patients with CVC for iloprost continuous infusions. Addressing nursing care that will be able to reduce risk of complications Methodology: Weekly performance of the CVC treatment for the control of infection. Results: We obtained a favorable outcome after two months of treatment, with no visible signs of infection. After a negative blood culture result was obtained, the treatment was stopped. Conclusions: Managing CVC local complications is one of the most important nurse responsibilities. Only excellence of care will make it possible to achieve proper functioning of the CVC, to ensure the effectiveness of the treatment and to prevent complications. P220 Mobility protocol for acute myocardial infarction in ICCU Y. Drori,1 N. Gil,1 I. Aziza,1 M. Azriel,1 L. Ilan-Bushari1 and Y. Turgeman1 1Haemek Medical Center, Afula, Israel Background: Complete bed rest has been the primary advised treatment for many diseases. A review of 40 years of literature shows that the suggested time of bed rest after myocardial infarction has shortened from 2 months to 2 weeks. In practice, however, the time of bed rest has not changed. Although mobility after myocardial infarction occurs in stages, dependant on the individual severity of cardiac condition, method of treatment and the quality of equipment used, instructions regarding post infarction mobility have not been evidence based, updated or structured for the individual patient. While nursing decisions regarding pain management, vital signs and hemorrhage assessment are the norm, judgments regarding mobility are still made by the physicians without a standardized, evidence based policy for their decision. In the absence of a clear standardized mobility policy, cardiac ICCU nurses are faced with daily dilemmas. This has motivated the nursing team in our unit to develop a mobility protocol for post infarction and angioplasty patients with no complications, which allows the ICCU nurses independent judgment and action regarding these patients. Objective: To describe the process of development of a mobility protocol for the post infarction and angioplasty patients in the cardiac care unit. Method: investigation by a team of nurses and a physician of the staff’s positions regarding mobility in cardiac critical care, collection of retrospective data of mobility of past patients, evidence based protocol development, implementation and evaluation. Results: half of the staff was dissatisfied with the current mobility policy. A minority of the nurses felt that mobility instructions were given at the appropriate time, most believed that an evidenced based mobility protocol would improve the quality of patient care. We found that only 2/3 of post infarct patients and 1/3 post cardiac angioplasty patients had mobility orders. A new mobility protocol drafted by the team, examined by the medical and nursing staff, and by the risk management unit is now experimentally implemented in our unit. Conclusions: constructive team work and consensus produced a working mobility protocol which has improved patient care and has empowered nurses by allowing them to assume more responsibility. It has also contributed to better cooperation between the medical staff and the nursing staff. Psycho-social P221 Quality of life improves for patients with cardiometabolic risk factors participating in a structured lifestyle intervention program M. Matthias Lidin1 and M-L. Hellenius1 1Karolinska University Hospital (Solna), Department of Cardiology, Stockholm, Sweden Objectives: To investigate improvement of Quality of life in individuals with cardiometabolic risk factors participating in a lifestyle intervention program. Methods: The program consisted of an individual visit to a nurse for an initial health check-up and lifestyle counseling. Thereafter, the patients participated in a structured lifestyle program together with their spouses. The program was five meetings with a nurse and a physician which included lectures about stress, physical activity, food habits, nicotine, alcohol and cognitive behavior therapy. Quality of life was measured whit a questionnaire at baseline, six month and after one year. The questionnaire (The Gothenburg Quality of life Instrument) contained questions about quality at home, work, leisure, mood, energy, patience, self-esteem, sleep, well-being and fitness level. Every question was rated on a scale The Well-being score from, poor (= 1) excellent (=7). Table 1. Well-Being score Well-being score . Baseline n = 85 . 6 month n = 66 . 1 year n = 54 . Mood 4,48 4,80 5,15*** Energy 3,59 4,08* 4,51*** Patience 4,44 4,55 5,56 Sleep 4,06 4,45 4,68 Health 3,54 4,03*** 4,14*** Self-esteem 4,54 4,55 4,68 Memory 4,91 4,58 5,68 Fitness 3,06 3,37* 3,62*** Well-being score . Baseline n = 85 . 6 month n = 66 . 1 year n = 54 . Mood 4,48 4,80 5,15*** Energy 3,59 4,08* 4,51*** Patience 4,44 4,55 5,56 Sleep 4,06 4,45 4,68 Health 3,54 4,03*** 4,14*** Self-esteem 4,54 4,55 4,68 Memory 4,91 4,58 5,68 Fitness 3,06 3,37* 3,62*** Open in new tab Table 1. Well-Being score Well-being score . Baseline n = 85 . 6 month n = 66 . 1 year n = 54 . Mood 4,48 4,80 5,15*** Energy 3,59 4,08* 4,51*** Patience 4,44 4,55 5,56 Sleep 4,06 4,45 4,68 Health 3,54 4,03*** 4,14*** Self-esteem 4,54 4,55 4,68 Memory 4,91 4,58 5,68 Fitness 3,06 3,37* 3,62*** Well-being score . Baseline n = 85 . 6 month n = 66 . 1 year n = 54 . Mood 4,48 4,80 5,15*** Energy 3,59 4,08* 4,51*** Patience 4,44 4,55 5,56 Sleep 4,06 4,45 4,68 Health 3,54 4,03*** 4,14*** Self-esteem 4,54 4,55 4,68 Memory 4,91 4,58 5,68 Fitness 3,06 3,37* 3,62*** Open in new tab Results: Up-to date 85 individuals are enrolled in the intervention program and 54 have completed baseline, 6 month and a one year visit. Well-being score improved significantly from baseline to one year regarding mood, energy, health and fitness and a positive trend was noted in patience, self- esteem and memory. (Table 1) Conclusions: Quality of life improves significantly over one year for patients with cardiometabolic risk factors after participating in a structured life style intervention program. P222 Determinants of health-related quality of life in pulmonary arterial hypertension L A. Matura,1 A. Mc Donough2 and D L. Carroll3 1University of Pennsylvania School of Nursing, Philadelphia, United States of America 2University of Massachusetts-Lowell, Lowell, United States of America 3Massachusetts General Hospital, Boston, United States of America Purpose: The aim of this study was to determine those symptoms, sociodemographic and clinical variables associated with HRQL in patients with pulmonary arterial hypertension (PAH). Methods: This was a prospective, descriptive study. A convenience sample included 151 adult participants with World Health Organization Group I etiology. Participants were asked to complete a sociodemographic and clinical data form, an investigator developed symptom scale, rating symptom intensity on 17 PAH symptoms (score range 0–10; higher score indicates worse symptom intensity) (cronbach alpha = .91), and the Cambridge Pulmonary Hypertension Outcome Review (CAMPHOR) to measure HRQL (score range 0–25; higher scores indicate worse HRQL) (cronbach alpha = .89). Descriptive statistics described the sample. Univariate analysis determined variables associated with HRQL to include in the multiple regression analysis. Results: Mean age was 54 (SD = 15.07) years with 85% female. Fifty-four percent had idiopathic PAH with 70% Functional Class III or IV and a mean of 7 years since diagnosis. Fifty six percent had a college education and 51% were married. The mean score for HRQL was 8.20 + 6.12. Univariate analysis determined variables associated with HRQL (p-value < .20) to include in multiple regression analysis: gender, marital status, education level, fatigue, dizziness, shortness of breath (SOB) on exertion; awakening SOB, swelling ankles/feet, cough, difficulty sleeping, raynaud’s phenomenon symptoms, and calcium channel blocker and digoxin therapy. In multiple regression analysis, HRQL was significantly associated with fatigue (.268, 95% CI=.197–1.091), SOB on exertion (.249, 95% CI =.161–.971) raynaud’s phenomenon (.280, 95% CI =.250–.815), gender (−.191, 95% CI = −5.688−1.000) and education (−.158, 95% CI = -2.201–177). The model explained 50% variance (p = .002). Conclusion: Symptoms influence HRQL in patients with PAH. Future interventions targeting symptom management may be important to improve HRQL. P223 Return to work after acute coronary syndrome: Psychological outcomes A. Antonio Madureira Dias,1 Carlos Pereira,1 Maria Joao Monteiro,2 Regina Saraiva,1 Madalena Cunha,1 Carlos Albuquerque,1 Daniel Silva,1 Joao Duarte1 and Alexandre Marques1 1CI&DETS - Superior Health School, Polytechnic Institute of Viseu, Viseu, Portugal 2Escola Superior de Enfermagem de Vila Real, Universidade de Trás-os-Montes e Alto Douro, Vila Real, Portugal Background: The work is not resumed in the salary, it became a source ofpsychological satisfaction, in which various factors influence determinatelythe psychological adjustment, particularly in the heart disease. Any workactivity involves a lifestyle model that influences personal health andsatisfaction of psychophysiological and psychosocial needs. Several medicalvariables, psychological and sociodemographic have been related to the returnafter a myocardial infarction, being assigned a greater weight tosocio-psychological factors. Purpose: Since returning to work after acutecoronary syndrome (ACS) is an important indicator of recovery, we pretend todetermine the influence of personality type. Methods: Quantitative, transversal study. We used a form for sociodemographics,socioeconomic status (SES), family functioning (FF) and the Eysenck PersonalityInventory (EPI) characterization. We selected our sample from a universe of 392patients with ischemic heart disease who were admitted in the IntensiveCoronary Care Unit, in the first year after hospital discharge. Sample: 164patients who suffered MI, in follow-up consultation, age less than, or equal to,65 years. 81.7% are men, aged between 32 and 65 (54.15, Sd=7.378), the majority(96.3%) is “Married”, 41.5%lives in a “rural environment” and93.9% have a “Highly Functional Family”. We used discriminantanalysis in SPSS. Results: Of the 164 patients, 58.5% returned to work and 41.5% didn’t. Variableswere selected. Of selected variables, extroversion and neuroticism, thestepwise discriminant analysis extracted the neuroticism and explains 100% ofthe variability between groups (L = 0.955, χ2 (1) 7.388,p = 0.007). Weobtained the following final model that allows the differentiation of the twogroups: – Return to Work = 0.704 neuroticism +(-5.080) – Not Returning to Work = 0.808neuroticism + (-6.468) – The percentage of individuals classifiedcorrectly with the original classification was 63.4% and was confirmed bycross-validation. Conclusion: Of the psychological factors, the neutoricismo confirmed as beingpredictor in the returning to work after myocardial infarction in this subgroupof patients. This way, the personality type can promote early return to workactivity and improve the quality of life of cardiac patients. Stroke P224 Drug secondary prevention in postmenopausal women with ischemic stroke S. Goga,1 D. Zdrenghea,2 A. Sitar-Taut,3 M. Cebanu1 and D. Pop 2 1Rehabilitation Hospital, Cluj-Napoca, Romania 2University of Medicine and Pharmacy, Cluj-Napoca, Romania 3“Babes-Bolyai” University, Cluj-Napoca, Romania Background: It is known that women with stroke are under treated, including drug treatment. This aspect was less studied with respect to drugs used for secondary prevention. Methods: In an urban Romanian community, there was studied a representative sample of 108 postmenopausal women with ischemic stroke aged > 55 years. We considered the secondary prevention by drugs. The results were compared with those registered in a similar sample of 84 men aged >55 years with ischemic stroke. The study was carried out using general practitioner’s files, during 2007 year. Results: Women mean age (69.30± 8.90y.) was greater in comparison with men (66.51 ± 7.93y. p = 0.02), but no significant differences were registered between females and males with respect to diabetes mellitus (32.4% vs 26.2%), hypertension (98.1% vs 94%), dyslipidemia (46.3% vs 36.9%). According to literature, there were considered as preventive drugs, antiplatelet agents and statins. Aspirin was used in 72.2% of women and 76.2% of men (p = NS), OR=0.813 (CI 95% 0.422–1.565) and statins in 46.3% and 22.6% p = 0.001, OR= 2.949 (CI 95% 1.562–5.57). Considering separately the patients under and above 75 years, aspirin was similarly used in women (74.3 vs 67.6%, p = NS) and men (75.7% vs 78.6%, p = NS), but statins were significantly less used after 75 years, especially in men (w - 52.7 vs 32.4%, p < 0.05; m - 25.7 vs 7.1 %, p < 0.01). Using univariate and multivariate analysis, aspirin use was not significantly influenced by sex, age, cardiovascular risk factors or cardiovascular disease. In turn, statine use was under the influence of age, female sex, dyslipidemia and diabetes mellitus. Conclusion: In postmenopausal women with ischemic stroke the secondary prevention through aspirin, but mainly through statins is underused, with significant differences in comparison with men in whom the statine use is even less. Sudden Cardiac Death P225 Implementation of physiology guided resuscitation in the coronary intervention laboratory B. Bjarne Madsen Hardig,1 D. Zughaft,2 H. Wagner,2 M. Rundgren,3 J. Harnek,2 M. Gotberg,2 D. Erlinge2 and G. Olivecrona2 1Jolife AB, Ideon Scinece Park, Lund, Sweden 2Lund University, Skane University Hospital, Department of Cardiology, Lund, Sweden 3Lund University Hospital, Lund, Sweden Background: Prolonged cardiac arrest in the coronary intervention laboratory (cath-lab) is mostly due to an occluded coronary artery. These patients are in the need of prolonged resuscitation with chest compressions during simultaneous PCI, a patient category we recently showed a 25 percent survival rate in. However, current standard ALS guidelines might not be suitable in this setting. The hypothesis of this work was: can we implement a cath-lab adjusted guideline focusing on physiology guided resuscitation? Material/method: All persons in the staff were trained according to a modified guideline in the cath-lab setting with focus on physiology guided resuscitation. The two major groups was the medical emergency team which consists of one anaesthesiologist, one registered anaesthetic nurse, one assistant nurse and one cardiologist. The cath lab is staffed with one interventionalist, two registered nurses and one assistant nurse. Results: The training focused on: The medical emergency team should be alerted and arrive within 60–90 seconds. Use mechanical chest compressions (MCC) available but perform manual CPR until/during application of the MCC-device. The monitor in the cath-lab should be optimized for physiological parameters instead of ischemic monitoring. If the patient has a shock resistant VF, maintain circulation by MCC with ongoing VF until coronary flow is restored before further defibrillation attempts. Vital physiologic values should be kept at, ABP: ≥70/40 mmHg, ETCO2: ≥ 15.0 mmHg, SpO2: > 80%, TIMI 3 flow in non occluded vessels and cerebral oximetry: > 40% during chest compressions. If values are not reached, optimize them by medication (dobutamine and/or norepinephrine, avoid repetitive 1 mg epinephrine doses), move the MCC-device or change ventilation strategy. Consider blood gases, adjust acidosis. Consider hypothermia treatment. If successful PCI and the patient still have VF, defibrillate during chest compressions, if unsuccessful, consider bolus injection of epinephrine (1 mg) in the right atria before next defibrillation. If successful PCI and the patient have a non-shockable rhythm, continue chest compressions for 5–10 minutes before termination. If successful PCI and the patient have had vital physiology during chest compressions and RSOC cannot be restored, consider the use of ECMO. Conclusion: We implemented physiology guided resuscitation with the result of better teamwork and achieved better physiological values during resuscitation, we now aim at improving survival rates previously shown. © European Society of Cardiology 2012 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) © European Society of Cardiology 2012
TI - 12th Annual Spring Meeting on Cardiovascular Nursing
JF - European Journal of Cardiovascular Nursing
DO - 10.1177/1474515112441129
DA - 2012-03-01
UR - https://www.deepdyve.com/lp/oxford-university-press/12th-annual-spring-meeting-on-cardiovascular-nursing-61E7srpyVC
SP - S1
EP - S84
VL - 11
IS - 1_suppl
DP - DeepDyve
ER -