Aim. The purpose of the present study was to investigate the effect of cardiac rehabilitation on quality of life and return to work in patients with Acute coronary syndrome (ACS).

Background. ACS is one of the major cardiovascular diseases that can affects the patients’ quality of life and return to work.

Method. This was a clinical trial study conducted on 50 patients with ACS admitted to the coronary care units of the selected hospital of Isfahan University of Medical Sciences in 2013-2014. The participants were randomly assigned to control (n=25) or experimental  group (n=25). The experimental group received phase 1 and 2 cardiac rehabilitation program, however, the control group received usual care. The data was collected via demographic questionnaire and SF-36 quality of life questionnaire, before and one month after intervention. Return to work  was estimated through questions  and then was compared in both groups.

Findings. There was no statistically significant difference between experimental and control groups in terms of demographic variables and cardiovascular risk factors. After intervention, in the experimental group, the mean scores in all domains of quality of life increased significantly (p<0.0001). In the control group, the mean score of quality of life, before and after the intervention was not significantly different. A statistical significant difference was found between the experimental and control groups in all domains of quality of life, except for general health and social function, in favor of the experimental group. No statistically significant difference was found between the groups in terms of the duration of  return to work.

Conclusion. The results of this study showed that cardiac rehabilitation program can improve the quality of life in patients with ACS.

Aim. This study was conducted to examine the effect of family-centered education on the quality of life patients after coronary artery bypass graft surgery.

Background. Following coronary artery bypass graft surgery, the patients face many physical, mental and social problems, which reduce their quality of life. Teaching the patient's family provides an opportunity for family members to cooperate actively in taking care and supporting patient, thereby, improve patients' quality of life.

Method. This was an experimental study in which 96 patients with their active family members were recruited according to inclusion criteria and randomly allocated to experimental (n=48) and control group (n=48). Before intervention, SF-12 Quality of Life Questionnaire (QOL) was completed by participants in both groups. Then, experimental group received family-centered education in three sessions and control group received only hospital routine educational program. Quality of life was again measured one month later. The data were analyzed by SPSS version 22.

Findings. There were no statistically significant differences between the two groups regarding demographic characteristics. Based on Mann-Whitney test, a statistically significant increase was observed in scores of QOL dimensions after intervention in the experimental group as compared with control group (P<0.0001).

Conclusion: Family-centered education in patients under coronary artery bypass graft can improve quality of life in these patients.

Aim. The aim of this study was to investigate the role of social capital in healthy lifestyle promotion among people with Coronary Artery Disease (CAD).

Background. Social capital, one of the social determinants of health, plays an important role in promoting healthy lifestyle among people. Due to increasing incidence of CAD, research is needed about social capital and its relationship with healthy lifestyle among people with CAD.

Method. This cross-sectional study was conducted on 412 patients with CAD, including 239 men and 173 women, in 4 different wards (i.e. men and women internal wards, Diplomat and VIP wards) in Shahid Rajaie Cardiovascular, Medical and Research Center from January 2015 to June 2015. Data were collected by demographic characteristic form, Miyamoto et al. social capital questionnaire and researcher-made questionnaire of healthy lifestyle. Validity and reliability were confirmed by content analysis and Cronbach's alpha methods. The data were analyzed using SPSS with appropriate statistical tests. 

Findings. There was a statistically significant difference between social capital in terms of gender (p=0.015). A statistically ssignificant correlation was found between social capital and healthy lifestyle (r=0.418, P<0.01). The highest correlation was observed between social capital and “health responsibility” component (r=0.384, P<0.01) and the lowest correlation was observed between social capital and “abstain from tobacco and alcohol’’ (r=0.107, P<0.01). Among social capital components, “social relationships” had the highest correlation with healthy lifestyle (r=0.511, P<0.01).

Conclusion. Social capital and its components have positive and important effects on healthy lifestyle and its subscales. It is necessary to emphasize community-based programs, such as strengthening social capital in the society to prevent and control chronic diseases, especially heart disease.

Aim. This study was conducted to determine the effect of Lemon Balm (Melissa Officinalis) on depression in patients after coronary artery bypass graft.

Background. Coronary artery bypass grafting (CABG) is the most common operation among patients with coronary artery disease. Many of these patients are faced with depression after cardiac surgery.

Method. In this randomized clinical trial, 80 patients undergoing coronary artery bypass graft were randomly assigned to treatment and placebo groups. Data collection tools included demographic and clinical sheet and the Hospital Anxiety and Depression Scale (HADS). Each patient randomly received either a capsule containing 500 mg lemon balm or a placebo, 3 times a day. After 7 days, depression in both groups was measured and compared. Data analysis was performed using SPSS (version 16).

Findings. After the intervention, herbal balm decreased depression more in intervention group compared with the placebo group (P=0.008).

Conclusion. According to findings , Lemon balm may reduce depression after coronary artery bypass graft.

Aim. The aim of this study was to determine the effect of patient education and  nurse-led  telephone follow-up (telenursing) on adherence to treatment in patients with acute coronary syndrome admitted to cardiac care units hospitals affiliated to Alborz University of  Medical Sciences.

Background. Increasing adherence to treatment is essential in patients with acute coronary syndrome to reduce readmissions and improve the recovery, but only patient education does not guarantee the adherence to treatment and it is necessary to follow-up patients after discharge.

Method. This randomized clinical trial study was conducted on patients with acute coronary syndrome admitted to the selected hospitals of Karaj, Iran, in 2014. In this study, 90 patients were selected purposively and randomly allocated  in  three groups of education (n=30), education/ telephone follow-up (n=30), and control (n=30). Data collection instrument was questionnaire. Data were gathered at baseline and 12 weeks after the intervention. Patients in educational groups  (education, and education/ telephone follow-up groups) were trained before discharge using educational pamphlets. Telephone follow-up were implemented for education/ telephone follow-up group for 3 months; twice a week in the first six weeks and weekly in the second six weeks. The data was analyzed by descriptive and inferential statistics in SPSS version16.

Results. After intervention, there was a statistically significant difference between the groups in terms of adherence to treatment (P=0.001). Participants in the education/ telephone follow-up group and education group experienced more improvement in adherence to treatment than the control group.

Conclusion. Both patient education and education/ telephone follow-up have effect on improvement of adherence to treatment, but education/ telephone follow-up results in more improvement in adherence in comparison to education. It is recommended to implement education/ telephone follow-up for patients with acute coronary syndrome.

Aim. This study was conducted to examine the effect of deep and slow breathing on pain and pain outcomes during arterial sheath removal after undergoing coronary angioplasty.

Background. During the last 30 years, coronary angioplasty has been the most common method for management of coronary artery stenosis. Lack of control or treatment of the pain caused by arterial sheath removal may have some consequences, most notably increased heart rate and blood pressure in patients.

Method. This is a clinical trial study conducted on 60 patients undergoing coronary angioplasty, hospitalized between April and August 2015 in the catheterization laboratory of Shariati hospital, Tehran, Iran. Patients were divided into two groups using random number table. The intervention was slow, deep breathing techniques by inhale and exhale ratio of 4 to 6. Data were analyzed using SPSS.

Findings. Immediately and 5 minutes after sheath removal, the average pain score in the intervention group  was significantly lower rather than control group (P<0.05). There was no statistically significant difference between groups in terms of blood pressure and heart rate average. The average number of vasovagal attack was significantly different between the groups. The average number of vascular complications was not significantly different between intervention and control group.

Conclusion. The use of slow and deep breathing and relaxation technique is effective on pain management and the incidence of vasovagal attacks after arterial sheath removal, and can be used as an easy and safe method to decrease patients’ discontent caused by pain.

Abstract

Aim.The present study aimed to examine the relationship of perfectionism with procrastination and coping styles in people with coronary heart diseases (CHD), compared with healthy controls.   

Background. Psychological factors may increase the risk of CHD by influencing physiological risk factors. Although psychological factors play an important role in development of CHD, more research in this area is necessary.

Method. In this descriptive correlational study, 218 male people (107 people with CHD as case group, and 111 people without CHD as their controls) were selected by convenience sampling. Data were collected by Mann’s Decisional Procrastination Scale, Lay’s Behavioral Procrastination Scale, coping styles Scale by Endler and Parker and Tehran Multidimensional Perfectionism Scale. Pearson correlation coefficient and linear regression were used for data analysis.

Findings.According to the findings, other-oriented perfectionism was directly associated with behavioral and decisional procrastination in case group, while in the control group, other-oriented perfectionism was negatively associated with decisional procrastination, however, the association was not significant. The effect of other-oriented perfectionism on decisional procrastination was significant in both groups. In case group, other-oriented perfectionism had a significant effect on behavioral procrastination, however other-oriented perfectionism had a significant effect on problem solving style in control group.

Conclusion.Other-oriented perfectionism had positive, but not strong relationship with both aspects of procrastinations in case group. In regression models of different aspects of perfectionism on procrastination, only the effect of other-oriented perfectionism was significant. Although the regressions were significant, fitted models had low predictive power. Only the other-oriented perfectionism could somewhat predict behavioral and decisional procrastination.

Abstract

Aim. This study aimed to determine the relationship of spiritual experiences with the life expectancy and death anxiety in patients undergoing coronary artery bypass grafting (CABG).

Background. The patients undergoing CABG experience a critical situation that requires taking into account such factors as life expectancy, spiritual experience, and death anxiety. During taking care of these patients, nurses must consider these experiences and their relationship.

Method. In this descriptive-analytic study, 150 patients undergoing coronary artery bypass surgery in hospitals located in Kerman city, Iran, were recruited within an 8 months period in 2015. Data were collected using a questionnaire including demographic data, Templer Death Anxiety Scale, Adult Hope Scale and the Scale of Daily Spiritual Experiences (DSES). Data were analyzed in SPSS version 20 using Pearson correlation test, Independent T-test, ANOVA and multiple linear regression.

Findings. There was a statistically significant negative correlation of daily spiritual experiences with death anxiety (p=0.004) and death anxiety with life expectancy (p≤0.0001). There was also a statistically significant positive correlation between spiritual experiences and life expectancy (p≤0.0001). Multiple linear regression analysis showed that age and life expectancy predicted 61 percent of changes related to spiritual experiences.

Conclusion. The findings suggest that paying attention to spiritual experiences of patients may increase life expectancy and reduce the death anxiety. It is suggested to include supporting, facilitating and attending to the spiritual needs of patients in nursing care plans for these patients.

Abstract

Aim. The aim of this study was to investigate the sexual satisfaction in patients with acute coronary syndrome.

Background. Sexual relationship is a multidimensional phenomenon which is affected by many psychological, individual and social factors. Satisfaction of sexual relationship leads to the strength of the family.

Method. In this descriptive-analytical cross-sectional study, 254 patients with acute coronary syndrome admitted to the coronary angiography ward in Shahid Beheshti hospital in Kashan, Iran, were recruited by convenience sampling in 2014. Data collection was done using the demographic and clinical data questionnaire and Larson's sexual satisfaction questionnaire. Data were analyzed in SPSS version 13 using descriptive and inferential statistics.

Findings. The mean score of sexual satisfaction was 101.7±15.3. The mean score of sexual satisfaction for men and women were 104.53±9.8, and 98.94±18.9, respectively (P=0.04). The results of linear regression showed that the relationship between sexual satisfaction and gender by taking other confounding variables was statistically significant (P=0.026). A history of diabetes (p=0.048), smoking (p=0.001) and hypertension (p=0.001) were affecting this relationship.

Conclusion. The level of sexual satisfaction in patients with acute coronary syndrome was high. The satisfaction in men were more than women. Also, a history of diabetes, hypertension and smoking in patients with acute coronary syndrome affected sexual satisfaction. Nurses should consider sexual needs of female patients with acute coronary syndrome, and also, that of acute coronary syndrome patient with a history of diabetes, hypertension and smoking.

Abstract

Aim. The aim of this study was to review studies about advantages and disadvantages of transradial and transfemoral coronary angiography. Transradial coronary angiography procedure is newer than transfemoral approach and inadequate knowledge and experience in this area needs to be considered for minimizing possible complications. 

Background. An increasing trend of cardiovascular diseases is of great importance. Although any different methods have been suggested for diagnosing coronary artery diseases, but coronary angiography remains as the best diagnostic and therapeutic method. Transradial and transfemoral coronary angiography as two approaches for diagnosing coronary artery diaseses have their own advantages and disadvantages.

Method. In this review study, various databases such as Google Scholar, PubMed, AHA journal and Elsevier were searched out by Persian and English forms of the keywords “Transradial coronary angiography”, “Transfemoral coronary angiography”, “Nursing care in coronary angiography” and “complications of coronary angiography”.

Findings. The findings are presented as follows: Comparison of the advantages and disadvantages of both radial and femoral approach, nursing care in radial angiography procedures and comparing patients’ satisfaction of experiencing radial or femoral angiography.

Conclusion. If the preparation and care before, during and after coronary angiography is properly settled and there is trained staff and physicians, it is suggested to use transradial approach for coronary angiography because of its fewer side effects and greater convenience the patients have with.

Abstract

Aim. The aim of this study was to examine the effect of early mobilization on hemodynamic parameters in patients undergoing coronary artery bypass graft (CABG) surgery.

Background. CABG is one of the most common surgeries that can increase quality of life and reduce mortality in most cases. It seems that early mobilization of patients from bed may reduce complications after surgery. The most important concern regarding early mobilization is the possible effect on hemodynamic parameters based on which this important intervention is neglected.

Method. In a clinical trial with 100 patients who were candidate for CABG. The patients were randomly assigned to experimental and control group. The experimental group were mobilized from bed in the first, second and third day after surgery. The control group received the hospital routine treatments and mobilization was done in the third day after the operation. The effect of early mobilization on hemodynamic parameters were compare between the groups. Other treatment programs were the same for both group. Data were analyzed in SPSS version 18 and using independent t-test, Chi-square and ANOVA statistical testes.

Findings. There was no statistically significant difference between groups regarding demographic variables and underlying diseases. In the experimental group, blood pressure was higher in the second and third days  compared with that control group. Chest tube drainage on the third day were 495±241 ml for experimental group and 556±285 ml for the control group, and no statistically significant difference was found between the groups in terms of chest tube drainage. None of the patients showed any complication during the mobilization.

Conclusion. The experimental group experienced a minimal increase in blood pressure, but it was not clinically significant. The results of this study indicate that early mobilization from bed in patients undergoing coronary artery bypass graft is a safe and applicable intervention, and don’t increase bleeding and acute hemodynamic changes.

Abstract

Aim. This study was conducted to examine the effect of combined inhalation of lavender oil, chamomile and Neroli oil on vital signs of patients with acute coronary syndrome.

Background. Increase in vital signs in patients with acute coronary syndrome worsens the disease and increases anxiety. The use of complementary medicine for better patient outcomes has been usually considered by the nurses due to the low complications and relatively low costs.

Method. This was a single-blinded, randomized clinical trial that carried out at the Emam Sajad Hospital in Shahryar, Tehran, Iran in 2016.  After obtaining the approval from the Ethics Committee of Iran University of Medical Sciences, 75 patients aged 20 to 80 years who signed the informed consent were recruited and randomly allocated into three groups (control, placebo, and intervention groups) using block randomization design (25 subjects in each group). In the intervention group, patients were asked to strew 2 drops of the aroma on an eye pad, keep their hands at the distance of 5 cm from their nose and take deep breath 10 times. After this, the pad was placed beside the pillow of the patient until the next morning. In the placebo group, this process was carried out using distilled water and the control group received routine care. The patients’ vital signs were measured before intervention, one hour after and every four hours after intervention until the next morning. Data were analyzed in SPSS, version 22, using chi-square test, t-test and ANOVA.

Findings. Before intervention, there was no statistically significant difference between three groups in terms of demographic characteristics as well as pulse rate, respiratory rate, systolic and diastolic blood pressure. The results showed that the combination of three aromas decreased pulse rate, respiration rate, systolic and diastolic blood pressure in one, four, eight and twelve hours after the intervention in the aromatherapy group compared to the time before the intervention.

Conclusion. The use of aroma as a complementary method in patients with acute coronary syndrome could decrease their pulse rate, respiratory rate, systolic and diastolic blood pressure. Due to the low risk and suitable accessibility to these aromas, the results can be used by nurses in the critical care unit and patient caregivers to improve patients' vital signs.

Abstract

Aim. This study aimed to review indications, benefits, limitations and procedure of continuous ST segment monitoring in critical care unites.

Background. Although the 12-lead electrocardiography is a standard and reliable tool to detecti ischemia in Acute Coronary Syndrome (ACS) patients, but it provides only a static snapshot. The American Heart Association (AHA) and American Association of Critical Care Nurses (AACCN) practice standards for ECG monitoring recommend continuous ischemia monitoring for all patients at risk of myocardial ischemia.

Method. This was a review study. International databases such as Proquest, CINAHL, PubMed, Scopus and one national database (SID) were searched out using the keywords; ST-segment Monitoring, Cardiac Monitoring and Acute Coronary Syndrome to find out materials published between years 2000 and 2015. About 189 citations were evaluated, out of which 15 citations were recruited in the final review.

Findings. Although continuous monitoring of ST segment has been introduced many years, but this technology is not widely used.Continuous monitoring of ST segment provides a frequent and dynamic assessment of changes associated with ischemia.Continuous ST segment monitoring as an effective method can be used to provide continuous and dynamic snapshot of ischemia, to evaluate response to reperfusion and anticoagulant therapy and also, can be used for prognostic or research purposes.  

Conclusion. Despite some limitations, the use of continuous ST segment monitoring is recommended for patients with ACS, besides routine assessment. 

Abstract

Aim. The aim of this study was to compare quality of life (QoL) before and after angioplasty in people with coronary artery disease.

Background. The quality of life among people with CAD who undergo angioplasty treatment is of great interest because of the increasing number of patients receiving this treatment modality.

Method. In this descriptive analytical study, 473 patients with CAD admitted to all teaching hospitals of medical sciences universities located in Tehran were recruited through stratified random sampling over the years 2015-16.Quality of life in patients was measured before angioplasty, and one month and three months after angioplasty using SF-36 questionnaire. Reliability of this questionnaire has been reported in previous studies as 0.77-0.90 (Cronbach's alpha coefficient). Data were analyzed by Wilcoxon, Mann-Whitney and Kruskal-Wallis tests in SPSS version 23.

Findings. The results showed that angioplasty has increased the mean score of quality of life in total and also, in all dimensions, one and three months after surgery (P≤0.0001). The relationship of quality of life  with all demographic variables (age, marital status, occupation, education level, place of residence, conditions of residence and type of insurance) was statistically significant except for gender.

Conclusion. The angioplasty is well able to improve the quality of life in different dimensions in the short term.Angioplasty can be recommended as a procedure with strong and positive effect on the health conditions and quality of life in people with CAD.

Abstract

Aim. The aim of this study was to examine the effect of Mindfulness Based Stress Reduction (MBSR) on physical functioning and Health Related Quality Of Life in people with Coronary Artery Disease (CAD).

Background. According to the studies, CAD can affects physical functioning and HRQOL. Developing and examining psychological therapeutic models for improving quality of life and physical functioning would be appropriate.

Method. In this randomized clinical trial study with control group, 30 people with CAD were selected from coronary care unit of Abbasi Hospital of Mian-E-doab city, Iran, by convenience sampling and assigned randomly to experimental and control group. Data were collected by Seattle Angina Questionnaire (SAQ) for measuring for assessing health related quality of life and SF-36 for measuring physical functioning. The experimental group received mindfulness-based stress reduction program in eight 2.5 hours sessions, weekly. The control group did not receive any intervention.

Findings. The results showed that after controlling the pre-test effect, mindfulness-based stress reduction had a statistically significant effect on physical functioning and health related quality of life and their dimensions.

Conclusion. It can be concluded that mindfulness-based stress reduction influences physical functioning and health related quality of life by modulating biological and psychological processes.

Abstract

Aim. The aim of this study was to examine the effect of incentive spirometry and deep breathing exercises on arterial blood gas parameters after coronary artery bypass graft (CABG) surgery.

Background. After CABG, pulmonary complications and oxygenation disorders are common and play an important role in post-operative mortality and morbidity. The different methods are being used for improvement of pulmonary function and oxygenation after CABG.

Method. In this clinical trial study, 75 patients who were candidate for CABG surgery were recruited and randomly allocated to two intervention groups (incentive spirometry group and deep breathing exercise group) and control group. The groups were compared in terms of arterial blood gas parameters (PaO2, PaCO2 and SaO2) before surgery, and on the first day, the second day, and the third day after surgery.

Findings. The study findings showed that in the third postoperative day, there was a statistically significant difference between intervention groups and control group in terms of the mean of arterial blood gas parameters (PaO2, PaCO2 and SaO2). 

Conclusion. Incentive spirometry and deep breathing exercise are both significantly effective on improvement of arterial blood gas parameters (PaO2, PaCO2 and SaO2).