The Journal of cardiovascular nursing
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Comparative Study
Prasugrel versus clopidogrel: new management strategies for acute coronary syndrome.
Percutaneous coronary intervention (PCI) is a proven treatment option for patients with acute coronary syndrome (ACS). Treatment of this patient population with antiplatelet therapy before and after percutaneous coronary intervention (PCI) is ever-changing. Combining clopidogrel, a thienopyridine, with aspirin has become the gold standard dual antiplatelet therapy. However, new research reveals several limitations with clopidogrel, including potential drug-drug interactions, slow onset of action, irreversibility of platelet inhibition, and a wide array of patient responses. A new thienopyridine, prasugrel, has been approved and supported by the current guidelines for its faster onset of action, lack of significant drug-drug interaction, and consistent patient response. ⋯ Prasugrel has been shown to be an effective alternative to clopidogrel in treating patients with dual antiplatelet therapy for ACS requiring PCI. Awareness of the risks and benefits when deciding to prescribe clopidogrel or prasugrel for patients with ACS during and after PCI will promote patient safety, improve patient outcomes, and support evidence-based practice.
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Hypertension (HTN) is a major risk factor for heart disease, which is the leading cause of death in the United States. Hypertension detection and blood pressure (BP) control are critically important for reducing the risk of myocardial infarction and strokes. Although there are more than 3.5 million Arab Americans in the United States, there are no national or regional data on HTN prevalence among Arab Americans. ⋯ Our results indicate that HTN and pre-HTN are highly prevalent in Arab Americans. Hypertension awareness and control rates were inadequate and low compared with national data. These results emphasize the urgent need to develop public health strategies to improve the prevention, detection, and treatment of HTN among Arab Americans.
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Multicenter Study
Validity and reliability of the caregiver contribution to self-care of heart failure index.
Caregivers make an important contribution to the self-care of patients with heart failure (HF), but few instruments are available to measure this contribution. ⋯ The CC-SCHFI showed good psychometric properties of validity and reliability and can be used to measure the contribution of caregiver to HF patient self-care.
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Adults with congenitally malformed hearts have knowledge gaps regarding their heart condition, and their level of knowledge is not routinely assessed during follow-up. One reason for this is that there are few validated, user-friendly questionnaires to assess knowledge about congenital heart disease and its effects on daily life. Failure to identify low levels of knowledge could lead to less motivated and insecure individuals not actively involved in treatment and care of their heart condition. Therefore, the objective of this study was to develop and test a knowledge scale for adults with congenitally malformed hearts. ⋯ The KnoCoMH has acceptable psychometric properties for most of the knowledge domains included. It can be used for evaluating knowledge among adults with congenitally malformed hearts and its associations with other outcomes. However, further studies are advisable to test construct validity, predictive validity, and responsiveness.
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Despite its established effectiveness, living with an implantable cardioverter defibrillator (ICD) is associated with ongoing physical and psychosocial distress. Little is known about which factors impact the patients' adjustment to living with the device and whether there are racial or gender differences related to these factors. The purpose of this study was to investigate factors (demographic, clinical, psychosocial, and religiosity) related to patients' ICD acceptance and to examine racial and gender differences in ICD acceptance. ⋯ Although overall patient acceptance was high, AAs in the study had statistically significant lower mean total Florida Patient Acceptance Scale scores and Return to Function scores than whites did and higher Device-Related Distress scores. The strongest predictors of patient acceptance for the total group were shock anxiety, depressive symptoms, and device knowledge. African Americans had significantly lower device knowledge scores and higher shock anxiety scores than whites did. These findings suggest that ICD patients, especially AA ICD patients, may require education and psychosocial measures to enhance acceptance of their device. This study supports a holistic and culturally sensitive approach to focused clinical and psychological assessment and interventions for those living with this life-saving technology.