Psychological interventions for coronary heart disease

A meta-analysis was conducted on 35 trials involving 10,703 individuals who had experienced a myocardial infarction and were randomised to an intervention involving some form of psychological therapy. Ten of these studies involved individuals with confirmed psychiatric diagnoses. Moderate quality evidence found no reduction of risk for total mortality or revascularisation procedures in comparison to usual care. Low quality evidence found no risk reduction for non-fatal MI although there was a 21% reduction in cardiac mortality. There was also some evidence of benefit on measures of psychological morbidity including anxiety, depression, and stress. It is concluded that psychological interventions may reduce cardiac mortality, although stronger evidence is required before this can be definitively concluded. It is also not clear who benefits most from psychological interventions

A randomised controlled clinical trial of a post-discharge, nurse-led educational intervention to reduce anxiety and enhance self-efficacy in percutaneous coronary intervention (PCI) patients within the first week post-discharge: A pilot study

This research investigated the efficacy of a post-discharge nurse-led clinic, for patients who underwent a cardiovascular interventional procedure in Australia. A randomised controlled clinical trial measured the effects of the clinic on patient confidence to self-manage and minimise psychological distress given the strong link between anxiety, depression and coronary heart disease. Hospitalisation for the procedure is short and stressful, and patients may wait up to 7-64 days for post-discharge review. This study provides preliminary quantitative and qualitative evidence that nurse-led clinics undertaken within the first week post-percutaneous coronary intervention may fill a much-needed gap for patients during a potentially vulnerable period

Inter-Rater Reliability of the Tracking and Reporting Outcomes of Procedural Sedation Tool

Clinical guidelines recommend that procedural sedation outcomes should be audited. The Tracking and Reporting Outcomes of Procedural Sedation (TROOPS) tool, developed by the International Consortium for the Advancement of Procedural Sedation, is intended to be suitable for use in all locations by sedation providers. We evaluated the feasibility and reliability of using a modified version of the TROOPS tool for sedation that is administered by nurses in the cardiac catheterization laboratory. The version of TROOPS we used contained items in the minor, intermediate, and sentinel categories. Two nurses independently completed the TROOPS tool for 40 patients who underwent a procedure with sedation. A sedation-related adverse event was selected by at least one of the raters for 21 of the patients (52%; 95% confidence interval [CI] = 0.38 to 0.67). Most were minor events related to the airway and breathing category of the TROOPS tool (n = 17; 42%; 95% CI = 0.29 to 0.58). The remaining were intermediate-severity events related to sedation quality. No events for the other categories of the TROOPS tool were selected. The intraclass correlation coefficient between paired nurse ratings of the TROOPS tool was 0.78 (95% CI = 0.43 to 0.92). Most nurses (85%, 95% CI = 73% to 92%) reported that it took less than 1 minute to complete the tool. In summary, paired ratings of sedation-related adverse events by nurses achieved moderate consistency using a modified version of the TROOPS tool containing items from the minor category of the airway and breathing domain. Use of this tool in clinical practice is feasible and reliable.</p

Outcomes of a randomised pilot trial of a nurse-led clinic for patients after percutaneous coronary intervention

Background Hospitalisation for percutaneous coronary intervention (PCI) in Australia is reducing. Patients who undergo PCI may be discharged home without a post-discharge health management plan, referral for secondary prevention, or understand their chronic condition. Subsequently, negative psychological symptoms such as anxiety and depression may be experienced in the post-discharge period. Objectives This study assessed the effectiveness of a nurse-led clinic on patients' cardiac self-efficacy and negative psychological symptoms of anxiety and depression 1-week post-PCI discharge. Methods One-hundred and eighty-eight potential participants were screened, and 33 participants were block-randomised to study groups. The nurse-led clinic used a person-centred approach and delivered tailored education, health assessment, and post-discharge support. In Phase 1, the Cardiac Self-efficacy Scale and State-Trait Anxiety Inventory measured primary outcomes, while the Cardiac Depression Scale was used to measure secondary outcomes. Phase 2 evaluated participants' experiences and healthcare professionals' perceptions of the intervention through semi-structured interviews. Results In Phase 1, intervention group participants did not show improvements in mental health indicators compared to standard care group participants, except for a moderate reduction in anxiety levels (d = 0.50). Phase 2 qualitative findings; however, highlighted the benefits of the nurse-led clinic. Conclusions Overall, findings suggest that nurse-led clinics may be valuable to reduce anxiety and act as a supportive measure in the early post-discharge period until commencement of a secondary prevention program. Further research with a more powered sample is needed to determine the significance of the findings

PW376 A pilot study of a post-discharge nurse-led, educational intervention on cardiac self-efficacy and anxiety in post-PCI patients

Author version made available in accordance with the publisher's policy for non-mandated open access submission. Under Elsevier's copyright, non-mandated authors are permitted to make work available in an institutional repository. NOTICE: this is the author’s version of a work that was accepted for publication in GLOBAL HEART. Changes resulting from the publishing process, such as peer review, editing, corrections, structural formatting, and other quality control mechanisms may not be reflected in this document. Changes may have been made to this work since it was submitted for publication. A definitive version was subsequently published in GLOBAL HEART, [VOL9, ISSUE1, (2014)] DOI:10.1016/j.gheart.2014.03.243

A pilot study of a post-discharge nurse-led, educational intervention on cardiac self-efficacy and anxiety in post-PCI patients (Conference Abstract)

Introduction Hospitalisation for percutaneous coronary intervention (PCI) is often short, with limited nurse-teaching time and poor information absorption. Currently, patients are discharged home only to wait up to 4-8 weeks to commence a secondary prevention program and visit their cardiologist. This wait is an anxious time for patients and confidence or self-efficacy (SE) to self-manage may be low. Objectives To determine the effects of a nurse-led, educational intervention on participant SE and anxiety in the early post-discharge period. Methods A pilot study was undertaken as a randomised controlled clinical trial. Thirty-three participants were recruited, with n=13 randomised to the intervention group. A face-to-face, nurse-led, educational intervention was undertaken within the first 5-7 days post-discharge. Intervention group participants received standard post-discharge education, physical assessment, with a strong focus on the emotional impact of cardiovascular events and PCI. Early reiteration of post-discharge education was offered, along with health professional support with the aim to increase patients’ SE and to effectively manage their post-discharge health and well being, as well as anxieties. Self-efficacy to return to normal activities was measured to gauge participants’ abilities to manage post-PCI after attending the intervention using the cardiac self-efficacy (CSE) scale. State and trait anxiety was also measured using the State-Trait Anxiety Inventory (STAI) to determine if an increase in SE would influence participant anxiety. Results There were some increases in mean CSE scores in the intervention group participants over time. Areas of increase included return to normal social activities and confidence to change diet. Although reductions were observed in mean state and trait anxiety scores in both groups, an overall larger reduction in intervention group participants was observed over time. Conclusion It is essential that patients are given the education, support, and skills to self-manage in the early post-discharge period so that they have greater SE and are less anxious. This study provides some initial evidence that nurse-led support and education during this period, particularly the first week following PCI, is beneficial and could be trialled using alternate modes of communication to support remote and rural PCI patients and extend to other cardiovascular patients

Evaluating the prevalence and opportunity for technology use in chronic kidney disease patients: a cross-sectional study

Background Chronic kidney disease (CKD) is increasing worldwide and early education to improve adherence to self-management is a key strategy to slow CKD progression. The use of the internet and mobile phone technologies (mHealth) to support patients is considered an effective tool in many other chronic disease populations. While a number of mHealth platforms for CKD exist, few studies have investigated if and how this population use technology to engage in self-management. Methods Using a cross-sectional design across five health districts in Queensland (Australia), a 38-item self-report survey was distributed to adults with CKD attending outpatient clinics or dialysis units to measure current use and type of engagement with mHealth, perceived barriers to use, and opportunities to support CKD self-management. Odds ratio (OR) were calculated to identify associations between demographic characteristic and mHealth use. Results Of the 708 participants surveyed, the majority had computer access (89.2%) and owned a mobile phone (83.5%). The most likely users of the internet were those aged ≤60 years (OR: 7.35, 95% confidence interval [CI]: 4.25-12.75, p<0.001), employed (OR: 7.67, 95% CI: 2.58-22.78, p<0.001), from non-indigenous background (OR: 6.98, 95% CI: 3.50-13.93, p<0.001), or having completed higher levels of education (OR: 3.69, CI: 2.38-5.73, p<0.001). Those using a mobile phone for complex communication were also younger (OR: 6.01, 95% CI: 3.55-10.19, p<0.001), more educated (OR: 1.99, 95% CI: 1.29-3.18, p<0.01), or from non-indigenous background (OR: 3.22, 95% CI: 1.58-6.55, p<0.001). Overall, less than 25% were aware of websites to obtain information about renal healthcare. The mHealth technologies most preferred for communication with their renal healthcare teams were by telephone (56.5%), internet (50%), email (48.3%) and text messages (46%). Conclusion In the CKD cohort, younger patients are more likely than older patients to use mHealth intensively and interactively although all patients’ technology literacy ought to be thoroughly assessed by renal teams before implementing in practice. Further research testing mHealth interventions to improve self-management in a range of patient cohorts is warranted

Evaluating the prevalence and opportunity for technology use in chronic kidney disease patients: a cross-sectional study

Background Chronic kidney disease (CKD) is increasing worldwide and early education to improve adherence to self-management is a key strategy to slow CKD progression. The use of the internet and mobile phone technologies (mHealth) to support patients is considered an effective tool in many other chronic disease populations. While a number of mHealth platforms for CKD exist, few studies have investigated if and how this population use technology to engage in self-management. Methods Using a cross-sectional design across five health districts in Queensland (Australia), a 38-item self-report survey was distributed to adults with CKD attending outpatient clinics or dialysis units to measure current use and type of engagement with mHealth, perceived barriers to use, and opportunities to support CKD self-management. Odds ratio (OR) were calculated to identify associations between demographic characteristic and mHealth use. Results Of the 708 participants surveyed, the majority had computer access (89.2%) and owned a mobile phone (83.5%). The most likely users of the internet were those aged ≤60 years (OR: 7.35, 95% confidence interval [CI]: 4.25-12.75, p<0.001), employed (OR: 7.67, 95% CI: 2.58-22.78, p<0.001), from non-indigenous background (OR: 6.98, 95% CI: 3.50-13.93, p<0.001), or having completed higher levels of education (OR: 3.69, CI: 2.38-5.73, p<0.001). Those using a mobile phone for complex communication were also younger (OR: 6.01, 95% CI: 3.55-10.19, p<0.001), more educated (OR: 1.99, 95% CI: 1.29-3.18, p<0.01), or from non-indigenous background (OR: 3.22, 95% CI: 1.58-6.55, p<0.001). Overall, less than 25% were aware of websites to obtain information about renal healthcare. The mHealth technologies most preferred for communication with their renal healthcare teams were by telephone (56.5%), internet (50%), email (48.3%) and text messages (46%). Conclusion In the CKD cohort, younger patients are more likely than older patients to use mHealth intensively and interactively although all patients’ technology literacy ought to be thoroughly assessed by renal teams before implementing in practice. Further research testing mHealth interventions to improve self-management in a range of patient cohorts is warranted

The effectiveness of post-percutaneous coronary intervention nurse-led clinics: A systematic review

Hospitalisation for percutaneous coronary intervention (PCI) is typically brief. The onset of psychological distress is common between the period from hospital discharge until cardiologist review and or commencement of cardiac rehabilitation. Contributing factors to psychological distress for this population are insufficient education and deficiencies in self-management skills. The aim of this review was to synthesise evidence on the effectiveness of nurse-led clinics delivered in the early discharge period (up to 30 days) after PCI on patient-related and health service-related outcomes

Evaluating the prevalence and opportunity for technology use in chronic kidney disease patients: a cross-sectional study

Abstract Background Chronic kidney disease (CKD) is increasing worldwide and early education to improve adherence to self-management is a key strategy to slow CKD progression. The use of the internet and mobile phone technologies (mHealth) to support patients is considered an effective tool in many other chronic disease populations. While a number of mHealth platforms for CKD exist, few studies have investigated if and how this population use technology to engage in self-management. Methods Using a cross-sectional design across five health districts in Queensland (Australia), a 38-item self-report survey was distributed to adults with CKD attending outpatient clinics or dialysis units to measure current use and type of engagement with mHealth, perceived barriers to use, and opportunities to support CKD self-management. Odds ratio (OR) were calculated to identify associations between demographic characteristic and mHealth use. Results Of the 708 participants surveyed, the majority had computer access (89.2%) and owned a mobile phone (83.5%). The most likely users of the internet were those aged ≤ 60 years (OR: 7.35, 95% confidence interval [CI]: 4.25–12.75, p < 0.001), employed (OR: 7.67, 95% CI: 2.58–22.78, p < 0.001), from non-indigenous background (OR: 6.98, 95% CI: 3.50–13.93, p < 0.001), or having completed higher levels of education (OR: 3.69, CI: 2.38–5.73, p < 0.001). Those using a mobile phone for complex communication were also younger (OR: 6.01, 95% CI: 3.55–10.19, p < 0.001), more educated (OR: 1.99, 95% CI: 1.29–3.18, p < 0.01), or from non-indigenous background (OR: 3.22, 95% CI: 1.58–6.55, p < 0.001). Overall, less than 25% were aware of websites to obtain information about renal healthcare. The mHealth technologies most preferred for communication with their renal healthcare teams were by telephone (56.5%), internet (50%), email (48.3%) and text messages (46%). Conclusion In the CKD cohort, younger patients are more likely than older patients to use mHealth intensively and interactively although all patients’ technology literacy ought to be thoroughly assessed by renal teams before implementing in practice. Further research testing mHealth interventions to improve self-management in a range of patient cohorts is warranted