Abstract
Aim.The aim of this study was to compare clinical manifestations of ACS in middle-aged and elderly people who were hospitalized in ShahidRajai Cardiovascular Medical and Research Center in 2016 .
Background. ACS is one of the most important health challenges in the world. The most important diagnostic marker of ACS is the clinical symptoms, but the symptoms of the disease are different among middle-aged and elderly people.
Method. This study was a cross-sectional study. The sample consisted of 384 patients with ACS admitted to ShahidRajai Cardiovascular Medical and Research Center in 2016. Data collection tools included demographics form, a questionnaire for recording signs and symptoms of ACS and the pain questionnaire. Data were analyzed in SPSS 18.
Findings. The most common symptom was chest pain in both groups. Typical symptoms between the two groups showed no statistically significant difference. Of non-typical symptoms, hiccup was reported more in middle-age group than the elderly group (P=0.001). In terms of the location of the pain, left arm in the elderly was higher than the middle-aged group (P=0.001). The quality of pain in both groups was not significantly different.
Conclusion. Chest pain is the most common symptom in both middle-aged and elderly people. Among the non-typical symptoms, only hiccups in the middle-aged people are more common than the elderly people. Health care providers should pay more attention to the initial assessment.

Abstract
Aim.  This study aimed to determine barriers to patient education from the perspective of patients, nurses and doctors.
Background. Patient education is one of the indicators of quality of heath care services. Patient education could lead to a reduction in the cost of health care and increase the quality of care and ultimately, help the patient to become independent and self-sufficient.
Method. A cross-sectional descriptive study was carried out. The research population included physicians, nurses and patients admitted to different wards of the Rajaee cardiovascular medical and research center. The sampling method was stratified random sampling for each population of the participants (patients, nurses and doctors). Data collection tool was a researcher-made questionnaire that measured the obstacles to patient education. The collected data were analyzed by SPSS software.
Findings. According to physicians, the most important barriers to education for patients was related to patients, and then related to physicians. From the viewpoint of nurses, the most important barriers to patient education were related to nurses. Patients evaluated themselves as the most important barrier to patient education, and then, the most important barriers were  related to nurses from patients’ perspectives.
Conclusion. Regarding the importance of teaching to the patient, it is suggested that the managers take actions to increase the number of nursing staff, provide patients with educational brochures, allocate sufficient funds for patient education, supervise and encourage nurses and doctors, and prioritize training in daily tasks.

Abstract
Aim. The purpose of this study was to determine the effect of supportive interventions on resiliency components and quality of life among family caregivers of people with advanced heart failure.
Background. Advanced heart failure is a costly, progressive and chronic disease that reduces resilience and quality of life among family caregivers.
Method. In a randomized clinical trial study that was conducted as a before-after design with control group and follow-up one month after intervention. One hundred family caregivers of people with advanced heart failure, admitted to Shahid Rajaie Cardiovascular and Medical Research Center, were randomly assigned into experimental and control group. The family support interventions package included participation in group training workshops for 6 sessions (2 sessions/week in three consecutive weeks) for the experimental group. Resilience Scale (Connor-Davidson) and Quality of Life (SF-36) questionnaire were used to collect the data, before, after and one month after intervention. Data were analyzed in statistical software SPSS 23 using statistical tests related to the distribution of variables including Chi-square, Fisher, Wilcoxon and Mann-Whitney test, and independent and paired t-test.
Findings. At baseline, the mean score of resilience and the overall score of quality of life showed no statistically significant difference between the groups. After intervention, there was a statistically significant difference in terms of the mean score of resilience between the experimental (64.06±11) and control (48.34±16.23) group (P<0.05). Also, the overall score of quality of life after intervention was statistically significant between the experimental (70±12.91) and control (50.82±17.73) group (P<0.05). The results of paired t-test showed that one month after the end of the intervention, in the experimental group, the mean score of resilience (63.08 ± 10.15) and the overall score of quality of life (69.82±12.70) remained constant, indicating the sustainability of the effect of interventions after one month (P>0.05).
Conclusion. As part of a holistic program, the results of this study can be a guide to setting up a centralized unit for the education and support of family caregivers of people with chronic heart disease, a unit in which, in addition to social support and mental health education, their needs in terms of knowledge of the disease and participation in the care of their patients would be met.

Abstract
Aim. The aim of this study was to review studies that investigate the factors affecting adherence to treatment in people with cardiovascular disease.
Background. Adherence to treatment is a comprehensive term that is used to convey acceptance of treatment process and following professional advice by the patient to increase the quality of life. Given the importance of adhering to treatment plans and being aware that many people do not follow treatment plans, understanding the factors that lead to patients' effective adherence to the treatment regimen can lead to the development of strategies to increase patients' adherence to the therapeutic regimen.
Method. Articles published between years 2010-2020 were searched out in databases Science Direct, PubMed, Cochrane, Medline, SID, Scopus, CINAHL, OVID, Iran Doc and Magiran using the keywords adherence to treatment, cardiovascular diseases and their Persian Equivalents. Research articles in Persian and English focusing on the factors affecting the adherence to treatment in cardiovascular patients were selected for the study. In total, 167 articles were found in primary search by reviewing the title and abstract and in some cases after studying the full text of the articles; out of them, 11 were selected that were in accordance with the research purpose of this study.
Findings. The most effective methods for improving adherence to treatment were tele-nursing and educating colleagues on how to follow up patients. Also, recognizing differences between personal and psychological aspects of patients and adopting an appropriate method for each person to pursue treatment and increase adherence to the treatment regimen are very important known factors in the care of cardiovascular patients.
Conclusion. In general, the care and training provided and continuous follow-up by the health care professionals have the greatest impact on increasing adherence to the treatment regimen among patients.

ABSTRACT
Aim. The aim of this study was to investigate the effect of education by Teach Back method and group education on self-efficacy of patients with myocardial infarction.
Background. Cardiovascular diseases are among the leading causes of death worldwide. Effective education of patients requires the use of educational methods whose effectiveness have been identified.
Methods. The present study was a clinical trial conducted at Rajaie Cardiovascular Medical and Research Center in Tehran during 2020 and 2021. Sampling was performed continuously until 105 people were completed. Patients were randomly divided into three groups of 35, including group (Teach Back, group training, and Control), based on blocking randomization (size=6). The training sessions were conducted in two one hour sessions for two consecutive days. The control group received routine ward training. Data were collected using demographic information form and Sullivan Cardiac Self-Efficacy Questionnaire that completed before training by patients and two weeks after training by telephone by the researcher. Finally, data on 93 patients admitted to cardiac care unit were analyzed using SPSS software version 24.
Findings. Groups were homogenous in terms of demographic characteristics and disease history. The mean and standard deviation of self-efficacy score before training was 8.03±1.84 in teach back group, 7.58±2.16 in the group training and 6.90±1.40 in the control group. One-way analysis of variance showed that the mean score of self-efficacy before the intervention in the study groups was not statistically different, but two weeks after training, the mean and standard deviation of self-efficacy score was 51.6±7.85 in the teach back training, 45.77±8.39 in the group training group, and 23.16±9.13 in the control group. Increase in self-efficacy mean score in patients under teach back training was significantly higher than patients under group training and control group (P≤0.0001), and in patients under group training was significantly higher than patients in control group (P≤0.0001).
Conclusion. Teach Back training and group training increase the self-efficacy of patients with myocardial infarction. Due to the role of nurses in patient education, this educational methods can be used.

Abstract
Aim. The aim of this study was to design and examine the psychometrics of post-traumatic stress disorder tool for children undergoing heart surgery
Background. Heart disease is one of the most important health issues and traumatic events that cause great harm to children, one of which is the experience of surgery. Therefore, we need a standard tool to assess post-traumatic stress disorder in children.
Method. In this methodological study, researchers compiled a questionnaire for measuring post-traumatic stress disorder in children undergoing heart surgery. The questionnaire was provided to 10 experts to examine the validity. In the next step, 40 items, revised by experts, were examined for construct validity and reliability based on the responses of 200 children 12-18 years old to questionnaire. The data were analyzed in SPSS version 24 and LISREL version 10.
Findings. After preparing the draft, the questionnaire was given to 10 experts to determine face and content validity. For face validity, the impact score of the items was computed and due to similar meaning of some items they were merged. In order to determine the content validity, two indexes of content validity ratio (CVR) and content validity index (CVI) were considered. According to Lauche's table, items with a content validity ratio less than 0.62 were excluded (7 items), items with a content validity ratio greater than 0.79 were accepted, and items with a content validity ratio between 0.70 and 0.79 were revised. In the construct validity stage, to ensure the sufficient sample size, the Kaiser-Meier-Elkin (KMO) test was performed and the results of Bartlett's Sphericity test were significant (P≤0.0001). Finally, exploratory factor analysis was performed with Varimax rotation on 40 items, and 7 items with a factor loading of less than 0.4 were removed, and in the end, 33 items remained. To determine the reliability of the questionnaire using the internal consistency method, Cronbach's alpha of the questions were computed and it was above 0.80 for all items. The test-retest results confirmed the significant relationship between the pre-test and post-test scores in 7 factors of the questionnaire (P≤0.0001).
Conclusion. In order to achieve more accurate results in research, it is necessary to use valid and reliable tools. The results of this study showed the strength of the factor structure and acceptable reliability of the post-traumatic stress tool for children undergoing heart surgery. The tool designed in this study is valid and reliable and can be used to determine post-traumatic stress in children undergoing heart surgery.