What is the Best Measure of Daytime Sleepiness in Adults With Heart Failure?

Purpose To identify the best screening measure of daytime sleepiness in adults with heart failure (HF). Data sources A total of 280 adults with HF completed the Epworth Sleepiness Scale, the Stanford Sleepiness Scale, and a single Likert item measuring daytime sleepiness. The sensitivity and specificity of these self-report measures were assessed in relation to a measure of daytime dysfunction from poor sleep quality. Conclusions Only 16% of the sample reported significant daytime dysfunction because of poor sleep quality. Those reporting daytime dysfunction were likely to be younger (p \u3c .001), to be unmarried (p = .002), to have New York Heart Association (NYHA) functional class IV HF (p = .015), and to report low income (p = .006) and fewer hours of sleep (p = .015). The measure of daytime sleepiness that was most sensitive to daytime dysfunction was a single Likert item measured on a 10-point (1–10) scale. Patients with a score ≥4 were 2.4 times more likely to have daytime dysfunction than those with a score \u3c4. Implications for practice Complaints of daytime dysfunction because of poor sleep are not common in adults with HF. Routine use of a single question about daytime sleepiness can help nurse practitioners to identify those HF patients with significant sleep issues that may require further screening

Correlates of Self-Care in Emerging Adults with Congenital Heart Disease: A Mixed-Methods Study

BACKGROUND: In the United States, approximately one million adults are living with congenital heart defects requiring lifelong specialty adult follow-up care. A goal of the transition to adult care is that patients will be able to perform self-care, a set of behaviors that has never been tested in congenital heart disease. Achieving independence in self-care occurs over time and is thought to be influenced by many variables, but most importantly, the participant‘s knowledge and beliefs about self-care and congenital heart disease (CHD) care. For the purposes of this study, self-care was defined as a decision-making process of choosing behaviors to maintain physiologic stability and monitoring, recognizing and responding to symptoms as they occur. Methods: A descriptive, cross-sectional study using a concurrent nested (QUAN+qual) mixed methods design was conducted to identify the correlates of self-care and to describe the performance of self-care in emerging adults with CHD. The sample (n=57) was recruited from two outpatient Adult Congenital Heart Disease Centers in the Northeastern United States. A subset of participants (n=35) participated in qualitative interviews. Inclusion criteria were age 18-25 years, a diagnosis of CHD, attended one of the clinics within a year and a willingness to participate. Exclusion criteria included diagnosis of a genetic syndrome, cognitive delay and medical instability as identified by the provider. Multivariate regression analysis was used to test the correlates of self-care. Content analysis was used to develop themes and subthemes. Data were integrated during the analysis and interpretive phase. Results: The major findings in this study are that 1) self-care confidence is influential in self-care; 2) the individual\u27s developmental stage is influential in self-care, suggesting that self-care is a developmental task; 3) participants‘ specific understanding of CHD and associated therapies is more helpful than general knowledge of CHD; 4) cognitive function and depression did not influence self-care; 5) similarities exist between self-care and transition; 6) self-care is expressed inconsistently, is an iterative process, and is enhanced with experience and skill development; 7) responsibility is shared for a period of time; 8) definitions of self-care differed between providers and participants 9) participants used CHD to their advantage to avoid peer pressure; 10) number of repairs rather than complexity was influential in the performance of self-care; 11) readiness enhances self-care; and 12) families are influential in the performance of self-care. Conclusions: We have just begun to understand self-care in this population. If self-care and transition are approached as developmental tasks, the burden of self-care may be eased and fewer persons with CHD may be lost to follow-up. Future research should focus on self-care to confirm these findings, identify interventions to increase self-care confidence and the approach to self-care as a developmental task. Shared responsibility for appointments needs further exploration

Attitude toward and current practice of transfer and transition of adolescents with congenital heart disease in the United States of America and Europe

The objective of this study was to explore the current practice and attitudes of pediatric cardiologists in the United States and Europe on the transfer and transition of children with congenital heart disease (CHD). A survey among pediatric cardiology programs in the United States and Europe was undertaken. Sixty-nine centers completed and returned the 61-item questionnaire that was specifically devised for this survey. Of 69 participating centers, 74% reported that they transfer their patients to adult-focused care. When a center transfers its patients, 80% transfer them to a formalized Adult Congenital Heart Disease Program. The median age of transfer is 18 years. Comorbidities, pregnancy, and patient/family request to leave pediatric cardiology were identified as initiators for transfer. Complexity of the heart defect was relatively less important when deciding whether to transfer patients. Only one-third of the centers that transfer their patients provide a structured preparation for patients and family. Development of a formal transition program is planned at 59% of the centers that transfer patients. In conclusion, timely transfer and a structured transition process of children with CHD are not implemented in all pediatric cardiology programs. Health-care providers working in pediatric cardiology should make their transfer policies explicit and transition programs ought to be developed.status: publishe

Development of an international research agenda for adult congenital heart disease nursing

BACKGROUND: Since the population of adults with congenital heart disease (CHD) is growing, the role of nurse specialists is expanding. In order to advance ACHD nursing, the establishment of an international nursing research agenda is recommended. We aimed to investigate research priorities as perceived by nurse specialists and researchers in ACHD. METHODS: We applied a sequential quan-qual design. In the quantitative phase, a two-round Delphi study was conducted, in which 37 nurse specialists and nurse researchers in ACHD care participated. Respondents assessed the level of priority of 21 research topics using a 9-point rating scale (1 = no priority at all; 9 = very high priority). In the qualitative phase, semi-structured interviews were performed with six selected Delphi panelists, to scrutinize pending research questions. RESULTS: This study revealed that priority should be given to studies investigating knowledge and education of patients, outcomes of Advanced Practice Nursing, quality of life, transfer and transition, and illness experiences and psychosocial issues in adults with CHD. A low priority was given to post-operative pain, sexual functioning, transplantation in ACHD, and health care costs and utilization. Agreement about the level of priority was obtained for 14 out of 21 research topics. CONCLUSION: Based on this study, we could develop an international research agenda for ACHD. Researchers ought to focus on these areas of highest priority, in order to expand and strengthen the body of knowledge in ACHD nursing.status: publishe

What do cardiovascular nurses know about the hematological management of patients with Eisenmenger syndrome?

Aim: We investigated the level of knowledge of hematological management of patients with Eisenmenger syndrome among general cardiovascular nurses and nurses who specialize in congenital heart disease (CHD). Methods: We conducted a survey at two international conferences attended by cardiovascular nurses. Nurses were asked to complete a questionnaire comprising two questions and three clinical case scenarios. Overall, 89 nurses participated (response rate 90.8%), 43 of whom specialized in CHD. Results: The level of knowledge displayed among cardiovascular nurses is poor. About one-third of nurses not specialized in CHD recognized the definition of Eisenmenger syndrome and knew what normal hematocrit levels are. With respect to the cases presented, less than 10% of the nurses could give a correct answer. The level of knowledge of specialized nurses was significantly higher, but also here, important gaps in the level of knowledge could be observed. Less than two-thirds knew the reference values of hematocrit and knew the appropriate management in two cases. Less than half of the specialized nurses knew about the procedure of isovolumic phlebotomy. Conclusion: The level of knowledge displayed by cardiovascular nurses regarding the hematological management of patients with Eisenmenger syndrome is poor. Also the knowledge of nurses specialized in CHD could be improved

Excessive daytime sleepiness is associated with poor medication adherence in adults with heart failure

A relationship between excessive daytime sleepiness (EDS) and poor treatment adherence has been suspected but not confirmed. We hypothesized that medication adherence would be poorer in adults with heart failure (HF) and EDS and that cognitive status would be the mechanism of effect