European Journal of Cardiovascular Nursing

BACKGROUND: Interest in Traditional Chinese Medicine (TCM) is growing rapidly beyond China. This interest is driven by a combination of factors including recognition of potential benefits of TCM; dissatisfaction with the traditional Western medical model; an increasing commitment to holistic care and increasing evidence for the interaction of psychological factors and outcomes of disease and treatment and health consumer demand. AIMS: This review article was prompted by the need to understand and interpret the increasing trend towards the use of TCM in heart disease. In particular, this article defines and describes TCM, and analyses implications and challenges for Western health care delivery models. LITERATURE SEARCH: This article provides a review of accessible evidence, to English speaking health care professionals. The CINAHL, MEDLINE, HealthSTAR, Academic ASAP and Cochrane databases were searched, identifying literature published from 1982. Search engines on the Internet were also used. Examples of keywords used were ‘Traditional Chinese Medicine’ and ‘heart’. CONCLUSION: Difficulties in accessing information regarding TCM have implications for health education in coronary heart disease and patient safety. The rapid uptake of TCM in both Western and Chinese societies mandates an understanding of the principles and potential interactions when TCM is complemented with Western medical treatment for heart disease. Development of this knowledge and understanding is essential in order to provide safe and effective health care to patients who use combination therapies.

BACKGROUND: Recently published guidelines from the ESC and practical recommendations from an international group of experts support the up-titration of ACE inhibitors at 1- to 2-week intervals. Observance of these guidelines could contribute to the under-dosing of ACE inhibitors at discharge in patients admitted with heart failure. Specialist heart failure nurse supervision of ACE inhibitor titration during the in-hospital stay could be a safe and effective means of avoiding this problem. OBJECTIVE: This observational study examines the feasibility of specialist heart failure nurse supervised rapid titration of ACE inhibition to at least target dose in sequential, class IV heart failure patients admitted to the cardiology service with left ventricular failure and not previously treated with an ACE inhibitor. METHODS: Fifty-two patients (mean age 71.9±11.6 years) were initiated on perindopril and titrated to maximally tolerated dose during the in-hospital phase. Indices of renal function (creatinine, urea, potassium) and systolic blood pressure were observed at baseline and at discharge from hospital and at 3 months. Lengths of stay and titration intervals were recorded. RESULTS: The mean length of stay was 10.3±7.7 days and 98% of patients achieved at least target dose of perindopril before discharge. The average time to titration to final dose was 5.5±4.2 days. Systolic blood pressure decreased significantly from 132±28 mmHg on admission to 117±18 mmHg on discharge. Mean baseline urea, creatinine and potassium did not change from admission to discharge (urea 8.4±2.5 to 9.2±3.9 mmol/l, P=0.15; creatinine 122.7±30.3 to 122.4±35.4 μmol/l, P=0.93; potassium 4.0±0.5 to 4.0±0.3 mEq/l, P=0.86). No significant changes were observed in these parameters at 12 weeks. There were no recorded incidences of symptomatic hypotension or progressive renal dysfunction even in patients (n=25) with evidence of chronic renal impairment (creatinine >120 μmol/l). CONCLUSIONS: Specialist heart failure nurse supervised initiation and rapid in-hospital titration of ACE inhibitor to at least target dose is feasible and safe in a severe heart failure population admitted with class IV heart failure. Routine application of this approach may help avoid under-dosing of ACE inhibitors without increasing length of hospital stay, and may reduce outpatient visits to heart failure clinics for titration.

The purpose of this study was to describe the experiences of persons whose spouses have newly diagnosed coronary artery disease (CAD). The purpose was to obtain knowledge that would help us to understand better the life of persons with a chronically ill spouse and to develop the education and rehabilitation of both the patients and their spouses. Data were collected from healthy spouses by an open-ended question. There were 146 informants. They were asked to write about their experiences of everyday life after their spouse had been diagnosed for CAD. The data were analyzed by methods of content analysis. The following categories were formulated to describe the healthy spouses’ experiences: slow pace of life, limited life and unsure life. Slow pace of life meant that the disease had been adopted as a normal part of life. Life was organized in a new way, and the earlier busy and work-oriented lifestyle had been given up. The informants whose spouses had medication considered their personal freedom to be limited, because they had to assume responsibility for the care of their spouses. The spouses of the patients who had undergone bypass surgery (CABS) or angioplasty (PTCA) had a new role in the family. They had to monitor for symptoms, treat symptoms, take care, understand and support. They had to assume responsibility for everyday life. They felt themselves to be alone in that situation. They did not receive support from health care providers. All informants felt uncertainty due to financial problems, poorly planned care and unexpected changes in the course of the disease. As a conclusion, it can be said that life was limited by the sick spouse's needs. The disease caused changes in emotional balance, a need for continuous control of life, fears about a new myocardial infarction and worries about many issues of everyday life.

BACKGROUND: International expansion of indications for implantable cardioverter defibrillator (ICD) implant means increasing numbers of patients with devices worldwide. However, smaller numbers of patients with ICDs in the UK has meant that clinical expertise available to care for this specialized group is limited. Whilst North American patients’ experiences of living with an ICD are well documented, European perspectives remain underrepresented. AIM: The aim of this study was to explore and describe patient's experiences around the time of their ICD device implant and after they returned home from one UK centre. METHODS AND RESULTS: Eligible patients were recruited from one regional cardiothoracic centre and interviewed in their own homes using semi-structured schedules. Analysis of data elicited three themes; non-individualised nature of information, adjustments to living with the device and future outlook. Unique findings identified were; (a) concealment of concerns and symptoms; (b) funding issues; and (c) unavailability of appropriate support and advice during and after time in hospital. CONCLUSION: Individualized care and support for these ICD patients appeared lacking according to respondents. Opportunities to discuss concerns appeared non-existent, which may indicate that UK patients are disadvantaged in the domain of psychological support compared with their European and North American counterparts. Findings remain tentative until explored with a larger, more representative and international sample.

OBJECTIVE: The current study examined predictors of, and reasons for, non-attendance at cardiac rehabilitation (CR) among coronary heart disease patients. METHODS: Measures of demographics, surgical procedures, cardiac risk factors, cardiac damage, and psychological variables (depression, trauma, anxiety and alexithymia) were obtained at baseline in 85 coronary heart disease patients, of whom 34 (40%) attended CR. Patients not attending CR reported reasons for their non-attendance. RESULTS: Men who had a sedentary lifestyle or were obese were significantly more likely to attend CR. Women were significantly more likely to attend CR if they had a partner. Patients reported numerous personal reasons for their non-attendance, some of which reflect a dislike of a group format. CONCLUSION: The results suggest the presence of obstacles to attendance and completion of CR that may differ for men and women. Innovative approaches are needed to encourage participation, including the development and evaluation of alternative formats of CR.

Background: Despite today's modern therapy, the advancement of chronic heart failure (CHF) has not been curbed (Dying from heart failure: lessons from palliative care, BMJ, 317, 1998, 961–962, Editorial). Consequently, the suffering in patients with end-stage CHF is still present. The knowledge on the frequency of symptoms in these patients is scarce. Aims: The aim of this study was to achieve a deeper understanding of patients with end-stage CHF and to describe symptoms in these patients during the last 6 months of life by examining documentation in medical records. Methods: The study adopted a descriptive, retrospective design using record reviews to collect data, in which 80 medical records of patients hospitalised for CHF in 1995 were reviewed. Descriptive statistics and Student's t-tests were performed. Results: Breathlessness was the most common symptom (men 90%, women 86%). The largest gender difference was on limitation in physical activity (men=77%, women=37%, total=49%, P=0.001). Conclusion: (1) Twenty-one symptoms were observed, implicating that, patients with CHF in later stages of the disease experience a wide range of symptoms. (2) Despite the fact that several symptoms were documented by both nurses and physicians, it is quite remarkable that symptom-controlling measures were only provided sparingly. (3) A palliative care approach may benefit patients suffering from end-stage CHF.

BACKGROUND: Non-adherence in hypertension is a global problem and promoting adherence is necessary to decrease cardiovascular mortality. AIMS: The purpose of this paper is to examine the measurement of adherence to medication taking in hypertensive patients. Adherence was evaluated primarily by means of MEMS (Medication Event Monitoring System, Aprex Corporation, Fremont, California) an electronic system that records the date and time of opening of the study medication container. Additional measurements such as change in urinary potassium level, capsule count, client self report and physician estimate of adherence were recorded. METHODS: A randomised clinical trial was used to assign patients to receive the study medication (potassium) or placebo. Descriptive statistics were used to answer the research questions. Frequency and percentage of responses to different measures of adherence were carried out as well as correlation between the measures. RESULTS: One hundred and seven subjects between the ages of 26 and 80 participated in the clinical trial. The results showed that adherence measures varied with lowest adherence from two items of self-report related to forgetfulness (46 and 55%) and stringent electronic monitoring with the MEMS (58%) to percentages in the 80–90 range for other self-report items and the general adherence scale. Electronic monitoring correlated best with capsule count at visit 5. Implications for health care providers are discussed.

Coronary heart disease is a major cause of sudden death and morbidity in the developed world, as well as a cause of great suffering. Research within this area has primarily focused symptoms, risk factors and treatment. The aim of this paper was to explore women's experiences following a myocardial infarction (MI). Eight women were interviewed; the interviews were audiotaped and transcribed into text and analysed using a phenomenological approach. To explore the meaning that is experienced in the lived world of the patient a method of reflective lifeworld research, based upon phenomenological epistemology has been used. The results indicate that the body is vital for the women in their lifeworlds. After a MI the patient's natural and unreflective relationship with the body and the lived world is interrupted. Uncertainty about life and death as well as the body is experienced as a suffering in the women's lifeworlds. In relation to this, the women's existence is characterised by an uncertainty and a loss of context. It is through reconciliation with their bodies and their illnesses that the women can achieve a sense of well-being and harmony in life. In that process the women can re-establish a natural relationship with their bodies and lifeworlds.

Thirst is a common and troublesome symptom for patients with moderate to severe heart failure. The pharmacological and non-pharmacological treatment as well as the nature of the disease itself causes increased thirst. There is no evidence in the literature about the usefulness of fluid restriction for heart failure patients. Formerly, when very little pharmacological treatment was available, fluid restriction was one of the few interventional options but nowadays when the pharmacological treatment has improved, its importance may be questioned. This article describes the design of an ongoing study with the aim to determine if an individualised and less restrictive fluid prescription can improve the quality of life, cardiac function and exercise capacity, and decrease in hospital admissions and thirst. This study will be performed as a two-group, 1:1 randomised cross-over study. In group 1, the patients are instructed to comply with a maximum fluid intake of 1.5 l. This is a standard treatment today. In group 2, the patients are recommended to intake a fluid, based on the physiological need of 30 ml/kg body weight/24 h, and are allowed to increase the fluid intake to a maximum of 35 ml/kg body weight/24 h. After 16 weeks, the patients will cross over to the other intervention strategy and continue for another 16 weeks.