Abstract
Aim. The purpose of this study was to examine the health promoting behavior model based on spiritual health, social support and mental capital in people with cardiovascular disease.
Background. Cardiovascular disease affects various aspects of life, including physical, emotional, social and functional health, and one of the factors that affect the quality of life of people with cardiovascular disease is the health promoting behaviors.
Method. In this correlational study, path analysis model was used to examine hypotheses. The statistical population of this study consisted of all people with cardiovascular disease referred to medical centers in Qom in year 2020, out of which 200 people were selected by convenience sampling. Research measurement tools included Lutz Psychological Capital Questionnaire (2007), Zimet et al. Multidimensional Perceived Social Support Scale (1998), Palutzian et al. (1983) Spiritual Health Questionnaire and Walker et al. (1987) Health Promoting Behaviors Questionnaire. Data analysis was performed in AMOS.22 and SPSS.22 software using Pearson correlation method and path analysis model with.
Findings. The results showed that spiritual health (β=0.21, P<0.002) and social support (β= 0.17, P<0.013) had an effect on mental capital. Psychological capital also played a mediating role in the relationship between spiritual health and social support with health promoting behavior (RMSEA=0.067, AGFI=0.98).
Conclusion. It could be concluded that spiritual health, social support and psychological capital play an important role in health promoting behavior of people with cardiovascular disease. Therefore, in developing therapeutic programs for these patients, it is better to emphasize and pay attention to familial, psychological, religious, social and health factors.

Abstract
Aim. This study was conducted to compare the effect of multidimensional spiritual therapy and stress inoculation training (SIT) on physiological and psychological coordination of heart rate variability (HRV) and depression in patients after coronary artery bypass graft (CABG) surgery.
Background. Depression and other emotional disorders play an important role in reducing the physiological and psychological coordination of heart rate in patients after coronary artery bypass graft (CABG) surgery. Depression and other emotional disorders prevent the person from recovering from the pathologic condition. It seems that preparing the patient for proper coping techniques is helpful in improving emotional disorders and preventing recurrence of disease.
Method. This was a clinical trial with two experimental and one control group. The study population included patients after CABG in Tehran Cardiac Research Center, Tehran, Iran. Thirty patients were randomly selected and assigned into three groups. The instrument of this study was the DASS-21 scale and the evaluation of physiological and psychological coordination of heart rate, which was measured before the intervention and at the end of the 10th session in groups. The first experimental group was exposed to the Meichenbaum stress inoculation training for 10 sessions of 90-minute duration, and the second experimental group received multidimensional spiritual therapy. Data were analyzed using Multivariate analysis of covariance in SPSS.
Findings. Multivariate analysis of covariance showed that SIT and multidimensional spiritual therapy interventions both have a statistically significant effect in reducing depression in one-month and three-month follow-up, compared to the control group, but their effects on reducing depression was significantly different (-2.200, P=0.002). However, no statistically significant difference was observed between experimental groups in terms of changes in physiological and psychological coordination (-0.00133, P=0.1).
Conclusion. SIT intervention seems to be less effective than multidimensional spiritual therapy in reducing depression, but its effect on changes in physiological and psychological coordination is the same as multidimensional spiritual therapy.

Abstract
Aim. This study aimed to examine the effects of preoperative preparation of patients and family caregivers on outcomes after coronary artery bypass graft surgery (CABG).
Background. Preoperative preparation can improve patients’ experience of surgery and hospitalization. However, there is limited data about how preoperative preparation affects postoperative outcomes following CABG.
Method. This non-randomized clinical trial was conducted on ninety pairs of patient/ caregiver in the time period from July to November 2018. The participants were purposively selected and non-randomly allocated to either control or experimental group. The intervention was performed one day after admission and the day before CABG in the form of an educational video, an intensive care unit tour, and an educational booklet. In both groups, on the third day after surgery, patients' delirium was assessed in the ICU and family caregivers were asked to complete a family satisfaction questionnaire. Patients and their family caregivers in both groups completed a hospital anxiety and depression questionnaire (HADS) on the first and seventh days after surgery and before discharge. Data were analyzed in SPSS version 16.0 using descriptive and inferential statistics. 
Findings. After intervention, the mean score of patients’ anxiety and depression in the intervention group was significantly less than the control group (P=0.03). After intervention, the mean score of anxiety and depression among family caregivers in the control and experimental groups were not significantly different (P=0.11). Family caregivers’ satisfaction of experimental group was significantly higher than the control group in both healthcare providers’ performance dimension (P=0.01) and comfort dimension (P=0.027). Moreover, the groups did not significantly differ from each other regarding delirium incidence (P=0.6) and length of stay in the intensive care unit (P=0.21).
Conclusion. Considering that the preparation of the patient and family caregiver on the day before CABG can reduce patients' anxiety and depression and increase the satisfaction of the family caregiver, it is recommended to use this intervention for patients and family caregivers before CABG.

Abstract
Aim. This review discusses the exercise training that appear to be effective in cardiovascular patients with Covid-19.
Background. Nowadays, cardiovascular diseases are the pivotal leading causes of death in the world. Given the change of the human lifestyle into a sedentary one, the number of people with cardiovascular disease is rising dramatically. Recently, Covid-19 disease has endangered people's health in many countries and put a lot of pressure on their health care system. It also has had a significant impact on the global economy. The main features of this disease are high transmission rates and mortality. Although the prime cause of death from Covid-19 is respiratory failure, some patients experience severe cardiovascular problems such as congestive heart failure. Although drugs and therapeutic interventions have improved considerably, it is still challenges in prevention and rehabilitation for these diseases, especially in people with Covid-19, and the search for new strategies continues. Cardiac rehabilitation is a set of medical procedures and exercise training that aim to improve the mental status, physical function and overall increase the quality of life. One of the most important parts of cardiac rehabilitation is prescribing exercise.
Method. The keywords “Cardiovascular disease”, “Covid-19”, “Rehabilitation”, and “Exercise training” were searched out in databases, Science Direct, PubMed, Cochrane, Medline, CINAHL, SID, Iran Doc, and Magiran. Out of articles, 210 articles that were more relevant to the research topic were selected. After reviewing the studies thoroughly, 12 studies that were in line with the purpose of the study were selected and reviewed.
Findings. Exercise training prescribed for cardiovascular patients has prescribed over the years ranges from prescribing one type of exercise for all to prescribing exercise for each patient individually based on risk factors, age, and functional status. Continuous aerobic exercise, periodic aerobic exercise, and strength training have been used in most studies. Less intensity should be used when prescribing these exercises to cardiovascular patients with Covid-19.
Conclusion. In general, considering the beneficial effects of rehabilitation training in cardiovascular patients, it seems that a rehabilitation program based on appropriate exercise training can be effective in reducing the complications and mortality of cardiovascular patients with Covid-19. But more studies are needed to get more information.

Aim. The present study was conducted to compare the effect of high-intensity interval training (HIIT) and moderate-intensity continuous training (MIT) (with and without blood flow restriction) on quality of life in cardiotoxic women after breast cancer treatment.
Background. Today, breast cancer is very common and cardiotoxicity is one of the most important non-avoidable complications after chemotherapy, which has a significant impact on patients’ quality of life. Using aerobic exercise training, with and without blood flow restriction, may improve quality of life of cancer survivors experiencing symptoms of cardiotoxicity. Restricting blood flow is already one of the methods used to enhance the effects of exercise training. On the other hand, previous studies show that different types of physical exercise have different physiological and psychological effects.
Methods. In this randomized clinical trial, 20 patients with cardiotoxicity after treatment for breast cancer were randomly divided into four groups including High-Intensity Interval Training (HIIT), Moderate Intensity Continuous Training (MIT), HIIT with Restricted Blood Flow (HIIT+BFR), and MIT with BFR (MIT+BFR). Interventions were applied for 12 weeks and three sessions per week. Patients in all groups completed the IHF-QoL quality of life questionnaire before and after 12 weeks of intervention.
Findings. The results of the present study showed that HIIT as well as the aerobic exercise with limited blood flow affects the quality of life of cardiotoxic patients. Quality of life scores in the HIIT+BFR group was significantly higher than that of the other groups. According to the scoring method in the questionnaire, increasing the individual score in each of the four areas of the questionnaire indicates a decrease in symptoms that disrupt the quality of life.
Conclusion. It seems that HIIT with BFR is a better way to deal with the symptoms that disrupt the quality of life, compared to HIIT without BFR, and also MIT (with and without restricting blood flow).

Abstract
Aim. This Study aimed to examine the effect of social networking education on blood glucose control and post-surgical infections after open heart surgery in diabetic patients.
Background. Cardiovascular surgery is one of the most common surgeries that is performed with the aim of increasing survival and improving the quality of life in diabetic patients.
Method. This randomized clinical trial study was conducted on 120 diabetic patients (age range 18-60 years) who underwent open heart surgery at Shahid Rajaei Cardiovascular Research and Research Center. The participants were randomly divided into experimental (n=60) and control group (n=60). In the experimental group, posts were delivered to patients with educational content (such as nutrition education, blood sugar self-monitoring, and ...) on a daily basis for three months on the WhatsApp social network. Data were collected by a checklist consisting of three parts: demographic characteristics, fasting blood sugar (FBS) and glycosylated hemoglobin (HbA1c) of patients before and 3 months after the intervention.
Findings. In both experimental and control group, 55 percent were male and 45percent were female. The percent of patients with postoperative wound infection in the experimental and control groups was 5.0 and 3.3, respectively. After intervention, in the experimental group, the FBS and Hb1Ac median was significantly reduced compared to before the intervention (p<0.001). The levels of FBS and Hb1Ac before and after the intervention did not differ significantly between the experimental and control group.
Conclusion. There was no different between groups in terms of blood sugar control and wound infections after open heart surgery. Due to the easy access, lack of time and space limitations of using social networks, further studies with longer follow-up are recommended.

Abstract
Aim. This study was conducted to assess family follow-up for children with implantable defibrillators and the role of nurse in patient/ family education
Background. Implantable defibrillators are devices with the capability of rhythm detection and anti-arrhythmia therapy. The proper functioning of these devices highly depends on regular interrogation, analysis, and programming.
Method. This descriptive comparative study was conducted based on the hospital information system (HIS) of Rajaie Cardiovascular Medical and Research Center. All children under 15 years of age, for whom the defibrillator device had been implanted or followed by the first author, from 2009 to 2020, were included. Continuation of follow-up was compared according to age, gender, underlying disease, area of residence, and type of family education. Data were analyzed in SPSS-24 using descriptive and inferential statistics. 
Findings. Sixty-seven implantations had been done for 61 patients. The mean and standard deviation of patients’ age was 9.58±3.72 years (aged 1 to 15 years). The rate of follow-up continuation was significantly reduced during the follow-up period. Ninety-four percent of patients had been visited for the first post-implantation appointment; this rate decreased to 43.6 percent for the 5th year post-implantation visit (p≤0.0001). Follow-up continuation was 71.13 percent with old-type family education compared to 89.64 percent with the new-type one (p=0.002).
Conclusion. Considering the high-risk situation, follow-up continuing is less than those desired for children with defibrillator devices. Family education by interactive methods plays an important role in encouraging the families to regular follow-up.

Abstract
Aim. The aim of this review study was to explain the consequences of pre-hospital delay in patients with acute myocardial infarction.
Background. Studies have shown that patients with acute myocardial infarction who refer to medical centers late, experience adverse mechanical and electrical consequences of acute myocardial infarction.
Method. In this review study, the keywords Outcome, Myocardial infarction, Delay, and Survival were used to search out the relevant papers published between 2000 and 2020, in databases, Up-to-date, Scopus, PubMed, Science Direct, Web of Science, SID, and Magiran. A total of 14 articles were reviewed.
Findings. The review of the articles showed the consequences of pre-hospital delay in patients with acute myocardial infarction as the following: acute heart failure, cardiac arrest, stroke, mortality, decreased cardiac ejection fraction, long-term hospitalization, decreased long-term survival, increased in-hospital mortality, and increased treatment costs.
Conclusion. Pre-hospital delay in patients with acute myocardial infarction is associated with complications and adverse consequences for patients. Health care team should educate patients and their families about the signs and symptoms of cardiovascular disease and the importance of timely treatment.

Abstract
Aim. This review study was conducted to review the effects, challenges and strategies for providing spiritual care in people with heart disease.
Background. The management of people with heart disease is complex and the course of the disease is unpredictable. The needs of people with heart disease are varied. The available evidence confirms the high level of patients' spiritual needs and desire to receive spiritual care.
Method. In this study, scientific databases and search engines such as Google Scholar, SID, Scopus, PubMed and Web of Science were used to find papers published between 2000 and 2020. The keywords included spiritual care, cardiac disease, cardiac patient, heart disease, coronary artery disease and their Persian equivalents. The selected articles for review were those in Persian or English language and about spiritual care and people with heart disease that their full text were available.
Findings. A total of 27 articles were reviewed. The spiritual needs of people with heart disease, the effect of spiritual interventions in reducing the symptoms of these patients and the problems of achieving this goal and the way to solve them were reviewed.
Conclusion. Spiritual care in patients with heart disease improves quality of life, spiritual well-being, reduces anxiety and depression; therefore, it is necessary to include spiritual care in the usual care of people with heart disease.

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 purpose of this study was to explore and clarify the concept of adherence to treatment in people with heart failure.
Background. The concept of adherence to treatment, which determines the consequences of heart failure, is widely used in the literature. But this concept is very complex and needs a clear definition.
Method. In this study, the evolutionary approach of Rogers concept analysis was used. The main criteria for entry were texts published in English between 2004 and 2019. The data sources were the PubMed, Scopus, and EMBASE. A total of 73 articles were found out of which 37 articles were selected after omitting duplications, and after screening the studies based on Prism Diagram, 35 articles were studied.
Findings. After reviewing the studies, 5 words, adherence to medication, medication adherence, non-medication adherence or self-care recommendations, adherence to therapeutic guidelines, and non- adherence treatment were recognized as alternative terms, and two concepts, compliance and self-care were identified as the most important and the most common concepts related to adherence to treatment. Seven concepts were found as the features of the adherence to treatment (adaptability, being multidimensional and complex, participatory, dependent on demographic variables and underlying diseases, being conscious and dependent on education, measurable and predictive, and continuous and follow-up). Outcomes of the concept of adherence to treatment were directly related to the consequences of the concept.
Conclusion. Adherence to treatment is a complex, multidimensional, participatory, conscious, and measurable concept that depends on demographic variables that must be constantly monitored by the health care team. Adherence to treatment is evolving over time, both semantically and conceptually.

Abstract
Aim. The present study was conducted to examine the effect of an empowerment program on the life satisfaction of patients with coronary artery disease.
Background. Because of the chronic and progressive nature of coronary artery disease, patients suffer frequent problems and relapses. Heart disease is considered as one of the debilitating diseases, and as such adversely affects the patient's self-care, quality of life, and health status.
Method. In this randomized clinical trial, 84 people with coronary artery disease, admitted to post-CCU wards in Tehran's Center for Heart diseases, were recruited in 2017. The study subjects were selected based on inclusion criteria. After explaining the study objectives and obtaining written signed consents, patients were assigned to experimental and control groups by blocking random allocation. Both groups completed questionnaires for demographic data and disease history, and Life Engagement Test. The Magic Empowerment Program was performed for experimental group as three workshop sessions for three consecutive days. Intervention continued after patients' discharge from the hospital through phone calls once a week for eight weeks. The Life Engagement Test was completed by the researcher for both groups, data were analyzed in SPSS-16 using descriptive and inferential statistics.
Findings. The results showed no statistically significant difference between groups in terms of demographic variables and disease history. Before intervention, there was no statistically significant difference between the mean scores of life satisfaction of experimental and control group and the two groups were homogeneous. After intervention, a statistically significant difference was observed between the groups in mean score of Life Engagement (P≤0.0001). The mean score of life satisfaction in experimental group, before and after the intervention was statistically significant (P≤0.0001), while in the control group there was no statistically significant difference.
Conclusion. The empowerment program increased life satisfaction of patients with coronary artery disease. Nurses can benefit from the empowerment program to improve life satisfaction, which is one of the dimensions of psychosocial health, in these patients.

Abstract
Aim. The aim of this study was to determine the moderating role of affective temperament in the relationship between biomarkers (troponin, white blood cell count, and neutrophil to lymphocyte ratio) and the severity of coronary artery disease.
Background. Coronary artery disease is the leading cause of death among adults worldwide and is considered as an inflammatory disease. Recent studies, in addition to biological factors, have focused on the role of psychological factors in the incidence and severity of this disease.
Method. In this study, 200 patients (145 males, 55 females) with coronary artery disease admitted to Shahid Rajaei Hospital in Tehran in 2018-2019 were selected by continuous sampling. Participants were asked to complete the positive and negative affectivity scale (Besharat, 2014). Also, the number of biomarkers was assessed through blood tests and the number of involved vessels was assessed through angiography and diagnosis by a specialist physician.
Findings. The results of hierarchical multiple regression showed that in the first step, 62 percent of the variance of coronary artery disease was predicted by biomarkers, and by entering the interaction between predictor variables (severity of coronary artery disease) and moderating variables (positive affectivity and negative affectivity), explanation of variance of the coronary artery disease increased by 9 percent and reached to 71 percent.
Conclusion. Based on the findings of the study, affective temperament affects the relationship between biomarkers and the severity of coronary artery disease, and therefore, as a psychological factor, could plays an important role in preventing coronary artery disease and decrease the number of deaths and the annual cost of this disease.

Abstract
Aim. This study aimed to examine the effect of education about anti-platelet drugs consumption through telephone follow-up on medication adherence in patients with coronary angioplasty.
Background. Regarding the necessity of proper use of antiplatelet drugs after coronary angioplasty, adherence to treatment is of great importance, and it is considered as one of the major concerns.
Method. This quasi-experimental study was conducted on 392 patients with percutaneous coronary intervention. The patients were divided into two experimental (telephone fallow-up) and control (without telephone fallow-up) group for one year. Adherence to treatment was assessed using the Morisky Medication Adherence Scale before and after percutaneous coronary intervention. Data were analyzed using t-test, chi-square and linear regression model in SPSS software.
Findings. The mean age of patients was 61.71±10.28 years in the experimental group and 60.72±11.14 years in the control group. Changes in the mean score of medication adherence was 53.09±1.37 in the experimental group and 18.09±1.30 in the control group, indicating a statistically significant increase in medication adherence in the experimental group compared with the control group (P=0.001). Non-use of anticoagulants in the experimental group increased until the end of the sixth month of telephone follow-up and then, decreased until the end of the twelfth month of follow-up.
Conclusion. Since changes in the mean score of adherence to medication in the experimental and control groups was significant, it is recommended that follow-up interventions in patients be continued continuously for at least one year.

Abstract
Aim. This study aimed to address whether spiritual intelligence was correlated with self-efficacy in patients with acute coronary syndrome (ACS).
Background. Patients experiencing acute coronary syndrome (ACS) are often required to enhance their empowerment skills to manage their signs and symptoms in an effective manner. In this sense, self-efficacy has been considered as a useful factor to develop self-care practices and minimize the risks of coronary artery disease (CAD).
Method. Using a descriptive-correlational research design, a total number of 136 patients admitted to cardiac care units (CCUs) of the hospitals affiliated to Shahid Beheshti University of Medical Sciences, Tehran, Iran, were selected through the convenience sampling. The data were further collected via the demographic characteristics information questionnaire, King’s Spiritual Intelligence Self-Report Inventory (SISRI, 2008), and the Cardiac Self-Efficacy Questionnaire (CSEQ) developed by Sullivan et al. (1998), and then analyzed using the SPSS version 22.
Findings. Most patients in this study (61.8 percent) were male, married (69.1 percent) with a mean age of 58.85. Moreover, the score of spiritual intelligence was 47.18. The patients received a mean score of 13.72 in the “critical existential thinking” subscale and a mean score of 10.19 in the “personal meaning production” subscale. The mean scores for the “transcendental awareness” and “conscious state expansion” subscales were also 9.70 and 9.47, respectively (p=0.01).
Conclusion. It was concluded that higher levels of spiritual intelligence could improve self-efficacy in patients affected with ACS; therefore, adopting strategies to boost this type of intelligence could augment resilience in such individuals.