Predictors of cardiac self-efficacy among patients diagnosed with coronary artery disease in tertiary hospitals in Nepal

Background: Cardiac self-efficacy determines how people feel, think, motivate themselves and behave with regards to improving their cardiac health subsequently preventing complications of coronary artery disease (CAD). Given almost one-third of global death is contributed by CAD with 10% of disability adjusted life years lost in low-and middle-income countries (including Nepal), it is important to identify factors that can promote cardiac self-efficacy. There are no studies in Nepal focusing on predictors of self-efficacy. Therefore, we aim to determine the predictors of cardiac self-efficacy of CAD patients in Nepal. Design and Methods: This is a cross-sectional study where we recruited 170 patients (≥30 years) diagnosed with CAD from two tertiary level hospitals. Multiple linear regression model was used to identify the predictors of cardiac self-efficacy. Results: The mean age of the participants was 60.45±10.39 years (range, 31-83). Most of the participants were diagnosed as myocardial infarction (91.2%), rest with unstable angina (6.5%) and stable angina (2.4%). The multivariate analysis shows age (p<0.001), health behaviors (p<0.001) and knowledge of the disease (p<0.001) were statistically significant predictors to cardiac self-efficacy. Every 1-year increase in age was associated with 0.23 units increase in cardiac self-efficacy score. Similarly, every unit increase in health behavior score and knowledge of disease score was associated with 0.432 units and 0.475 units increase in cardiac self-efficacy score respectively. Conclusion: Age and health behaviors were the strongest predictors of cardiac self-efficacy followed by knowledge of the dis-ease. We conclude that those with poor health behavior are at a greater risk of poorer cardiac self-efficacy compared to those with relatively good level of self-efficacy. Public health interventions such as awareness raising about cardiac disease and health behavior modification along with early screening, diagnosis and appropriate care are essential to improving self-efficacy and cardiac care outcomes

Circumstances of the bite and baseline characteristics of victims of snakebite in southern Nepal between April 2010 and October 2012 (n = 194).

<p>Circumstances of the bite and baseline characteristics of victims of snakebite in southern Nepal between April 2010 and October 2012 (n = 194).</p

Flow diagram showing numbers of individuals screened and included in each study centre.

<p>Between 01/04/2010 and the 31/10/2012, 749 victims of snakebite were included in the study and the snake species responsible for the bite could be ascertained in 194 cases.</p

Factors associated with a positive PCR among 565 snake bite victims.

<p>Unadjusted Risk Ratio (RR) and their 95% Confidence Interval (95% CI) were calculated with respect to the baseline category, i.e., absence of the risk factor (RR = 1).</p

List of species responsible for snakebite in southern Nepal between April 2010 and October 2012 (n = 194).

<p>Species were identified either by morphological examination of preserved specimen or through PCR and DNA sequencing performed using bite-site swabs.</p

Clinical features on admission of victims of snakebite in southern Nepal between April 2010 and October 2012 (n=194).

<p>Initial assessment of snakebite victims included vital signs, patients’ complaints and standardized evaluation of envenoming signs.</p

Effectiveness endpoints by biting species.

<p>Effectiveness endpoints by biting species.</p

Safety endpoints.

<p>Figures are numbers of participants (percentage) unless stated otherwise.</p

Flow diagram of the progress of participants through the parallel, randomized trial of high initial dose versus low initial dose of snake antivenom for the treatment of neurotoxic envenoming.

<p>Flow diagram of the progress of participants through the parallel, randomized trial of high initial dose versus low initial dose of snake antivenom for the treatment of neurotoxic envenoming.</p

Cumulative incidence by study arm for primary outcome¹ (left panel) and recovery² (right panel) obtained with Kaplan-Meier survival estimator in 154 patients (modified intent-to-treat population).

<p>Cumulative incidence by study arm for primary outcome¹ (left panel) and recovery² (right panel) obtained with Kaplan-Meier survival estimator in 154 patients (modified intent-to-treat population).</p