The Journal of cardiovascular nursing
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Comparative Study
Symptom clusters in men and women with heart failure and their impact on cardiac event-free survival.
Because patients with heart failure (HF) experience multiple symptoms simultaneously, it is necessary to explore symptom clusters rather than individual symptoms to determine their impact on outcomes. Given gender differences in symptom experience, examination of potential gender differences in clusters is reasonable. ⋯ Although distress for individual symptoms may differ between men and women, they both experienced identical symptom clusters. Only the emotional/cognitive cluster predicted a higher risk for a cardiac event. These results suggested that interventions should be developed that consider symptom clusters. Targeting patients who have high distress from emotional/cognitive symptoms may be particularly important as they may be most vulnerable for adverse outcomes.
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The purpose of this secondary analysis was to profile or cluster 226 patients, who had participated in a randomized controlled trial, on symptoms after coronary artery bypass surgery and to examine how these profiles could potentially be used by clinicians to identify groups at risk for impaired functioning during the first 6 months after surgery. Variables measured were symptom presence and burden and functioning. The model-based clustering method was used for cluster analysis of the symptom burden measure, and analyses of covariance were used to determine if there were differences on functioning (physical functioning and physical activity) by symptom burden group at 6 weeks and at 3 and 6 months after dismissal. ⋯ However, there were significant main effects (P < .01) for symptom burden groups for physical functioning (physical and vitality functioning) and physical activity (estimated energy expenditure and mean daily total activity counts). Significant main effects for time indicated physical functioning and physical activity measures, except bodily pain, improved over time (P < .05). Study results indicate that the use of profiling coronary artery bypass surgery patients on their symptoms prior to hospital discharge may assist health care providers to identify patients who could be at risk for having more difficulty with physical functioning and physical activity during the first 6 months after surgery.
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Patients with chronic heart failure (HF) have cognitive deficits in memory, psychomotor speed, and executive function and poor health-related quality of life (HRQL), but the association between cognitive deficits and HRQL is unknown. ⋯ Novel interventions targeted at improving HRQL continue to be urgently needed, particularly among younger patients and patients with depressive symptoms. Measures of HRQL are not sufficient as outcomes when investigating cognitive deficits in HF. Investigators need to include outcome measures of patients' actual abilities to perform daily activities and HF self-care.
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Medication adherence is low among hypertensive patients regardless of ethnic background. However, the prevalence of nonadherence is higher among African Americans when compared with their white American counterparts. Recognizing African American perspectives about their adherence to antihypertensive medications is necessary for the development of successful interventions aimed at improving adherence to prescribed regimens. The purpose of this qualitative study was to explore community-dwelling hypertensive African American behavioral, normative, and control beliefs regarding their adherence to antihypertensive medications. ⋯ Behavioral beliefs associated with medication adherence identified both positive and negative outcomes. Family, friends, neighbors, and God were associated with normative beliefs. Limited financial resources, neighborhood violence, and distrust of healthcare professionals were key control beliefs. Although these results cannot be generalized, they do provide significant insight into the contextual factors associated with the lives of community-dwelling hypertensive African Americans who fit a similar demographic profile. These findings are important because they can be used to tailor interventions to increase their medication adherence.
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Individuals with coronary artery disease undergo coronary artery bypass graft (CABG) surgery to relieve symptoms, improve quality of life, and reduce early death. Pain is the most prevalent symptom identified by persons after CABG surgery. The objective of the study was to compare the prevalence and severity of pain and pain-related interference with activities in men and women 9 weeks after CABG surgery. ⋯ Forty-seven percent of the women (n = 8) had moderate to severe pain described as the "worst pain in previous 24 hours with movement" 9 weeks following discharge from CABG surgery. More women were divorced, widowed, or single (P = .0002). There was a statistically significant between-groups difference, with more women reporting moderate to severe pain with movement (P = .03), as well as greater interference with walking (P = .01) and sleeping (P = .01) due to pain. Further research with larger sample sizes should investigate what conditions lead to the sex differences in the pain experience after CABG surgery, what mechanisms and support structures underlie these differences, and how these differences can inform the clinical management of pain.