Abstract
Aim. The present study was conducted with the aim of comparing the effect of the cognitive behavioral group therapy based on mindful walking with the dialectical behavior therapy on psychological symptoms, quality of life and blood pressure in people with hypertension.
Background. High blood pressure can cause kidney failure and eye problems. High blood pressure is a health problem in industrialized and developing countries due to its high prevalence and association with cardiovascular diseases.
Method. The present study was conducted based on a semi-experimental pre-test post-test design with two experimental groups and one control group. Out of 87 volunteers, 45 patients were allocated to three groups based on random sampling. Data collection tools were the Beck Depression Questionnaires (1960), the Beck Anxiety Questionnaire (1990), and the World Health Organization Quality of Life Questionnaire. Cognitive-behavioral group therapy based on the Leahy Group Conscious Mind Walk (2011) and Dialectical Behavior therapy (Linehan, 1993) were implemented as interventions. Data were collected and analyzed in SPSS version 22 using descriptive and inferential statistics.
Findings. The results indicated a statistically significant difference of the effects of the two interventions with control group in terms of depression, anxiety, quality of life, and blood pressure (P≤0.0001). Also, the cognitive behavioral group therapy based on mindful walking had a greater effect on the quality of life and blood pressure of hypertensive patients compared with the dialectical behavior therapy.
Conclusion. To improve the quality of life and reduce the blood pressure of hypertensive patients, it is better to benefit from the cognitive behavioral group therapy based on mindful walking and to reduce the cognitive symptoms (depression and anxiety) of hypertensive patients, dialectical behavior therapy is beneficial.

Abstract
Aim. The present study was conducted with the aim of examining the effect of multimedia education with the Leventhal model approach based on follow-up on understanding of patients with atrial fibrillation.
Background. One of the basic tools in changing the patient's perception of the disease is the existence of an educational program using modern teaching methods.
Methods. In this semi-experimental study, 48 patients with atrial fibrillation were randomly divided into intervention (24 people) and control (24 people) group in Kashani Shahrekord Hospital in 2022. In the intervention group, two virtual training sessions were held for patients through multimedia software (sound, video, image and animation) under the title of 4-hour training workshop on the date and time coordinated with the help of Adobe Connect program. There was no intervention in the control group. After the workshop, disease perception were measured using disease perception questionnaire. Data analysis was done using independent t and paired t tests in SPSS version 21.
Findings. There was no statistically significant difference in the mean score of disease perception between the two intervention and control group before the study, and the two groups were homogeneous. However, after implementation of the intervention, the mean score of disease perception was significantly difference between the groups (p≤0.0001).
Conclusion. Based on the results of the present study, patients with atrial fibrillation gained a better understanding of their disease after the educational intervention. Therefore, it is recommended to carry out educational interventions to improve the understanding of patients with atrial fibrillation.

Abstract
Aim. The aim of this study was to compare the effect of acceptance and commitment-based therapy and emotion regulation education on chronic pain and self-care in women with coronary artery disease.
Background. Research shows that coronary heart disease is one of the leading causes of death and disability in the world, which reduces the useful efficiency of people. Psychological factors can change many aspects of patients' lives and relationships.
Method. The research design was quasi-experimental pre-test-post-test with control group. The statistical population in this study included all women with coronary artery disease referred to Tabriz Heart Hospital in 2020. Women who had inclusion criteria were selected and randomly assigned to the first experimental group (n=15), the second experimental group (n=15) and the control group (n=15). The first experimental group (emotion regulation education) was subjected to 12 sessions of 90-minute duration (three sessions per week), The second experimental group (acceptance and commitment-based therapy) received 8 sessions of 90-minute duration, and the control group did not receive any intervention. The chronic pain scale of Von Korff et al. and the self-care scale of Rigel et al. were used to collect the data. Data were analyzed by multivariate analysis of covariance and LSD post hoc test in SPSS Version 21.
Findings. The results showed that treatment based on acceptance and commitment and emotion regulation education have an effect on chronic pain and self-care of patients with coronary artery occlusion (P ≤0.0001), as they reduced chronic pain and improve patients' self-care. The results also showed that acceptance and commitment therapy has a greater effect on chronic pain and patients' self-care than emotion regulation education.
Conclusion. Attention to acceptance and commitment therapy and emotion regulation education can play a role in reducing the psychological problems of women with coronary artery disease.

Abstract
Aim. The aim of this study was to examine the effect of treatment based on choice theory (reality therapy) on self-efficacy of people with hypertension.
Background. Hypertension and its complications leads to high mortality and therefore, is considered as a major health problem affecting individual self-efficacy. In addition to drug therapy, psychological treatments can be a significant and important prerequisite for behavior change and self-care promotion in people with hypertension.
Method. The present study was quasi-experimental with a pretest-posttest design and control group. The statistical population of the study included all people with high blood pressure under coverage of the health centers of Meybod city Yazd province) in the fall-winter 2018, who were recruited in the study based on convenience sampling (n=30) and were randomly allocated to experimental and control group. The samples responded to the self-efficacy questionnaire of hypertensive patients (DMSES) before and after intervention. The treatment program based on choice theory was carried out in 8 sessions. The data were analyzed by covariance analysis according to the research hypothesis.
Findings. The results showed that after controlling for the pre-test effect, there was a statistically significant difference between the post-test self-efficacy scores of the group. After the treatment based on the selection theory, the scores of the dimensions of diet, physical activity, drug consumption and blood pressure control of patients with hypertension increased significantly in experimental group compared with the control group.
Conclusion. Implementation of treatment based on choice theory can be a suitable method for increasing self-efficacy in people with hypertension. It's suggested that by applying the theory-based treatment of choice for people with hypertension, an effective step can be taken to improve their self-efficacy.
 

Abstract
Aim. This study aimed at investigating the obstacles to the implementation of evidence-based care from the perspective of the staff nurses in Rajaie Cardiovascular Medical and Research Center, Tehran, Iran
Background. Evidence-based care plays a crucial role in enhancing the nursing care quality due to the up-to-date care measures and procedures, and the cost-effectiveness for patients. However, there are some obstacle to implement it that should be addressed.
Method. This is a descriptive cross-sectional study conducted on 215 nurses from different departments of Rajaie Cardiovascular Medical and Research Center, Tehran, Iran. They were selected using simple random sampling method. The data collection tool was a questionnaire measuring the obstacles to the implementation of evidence-based care. The collected data were analyzed using descriptive and inferential statistics in SPSS version 20.
Findings. According to the nursing staff, the obstacles to the implementation of evidence-based care in the management dimension were the insufficient number of staff (80 percent), the large number of patients (71 percent), and the lack of motivation in the staff (68 percent) and in the individual-care dimension the obstacles were the lack of enough time for nurses to study the conducted research (72 percent).
Conclusion. The obstacles to the implementation of evidence-based care are in both individual and managerial areas, so it is suggested to correct arrangement of human resources, holding training workshops and meetings, creating interaction with the centers implementing evidence-based care, and using their life experiences considering the available facilities.

Abstract
Aim. This review study was conducted with the aim of highlighting the importance of a preoperative preventive approach in the recovery of patients undergoing coronary artery bypass surgery.
Background. With the increase in the number of patients who are candidated for heart surgery, improving the health status before the operation is of great importance to optimize the results after the operation. This review has been conducted with the aim of evaluating the evidence related to the pre-rehabilitation of patients undergoing coronary artery bypass surgery.
Method. The present literature review was conducted by searching out library resources and databases, Scopus, Chochrane Library, Magiran, SID, PubMed, Up-to-date, OVID, CINAHL, and Web of Science with the keywords, coronary artery bypass surgery, pre-rehabilitation, cardiovascular disease and their Persian equivalents without time limit. From a total of 104 articles, 63 full texts articles entered the review stage, of which 17 articles entered the literature review.
Findings. The findings indicate the favorable effects of pre-rehabilitation on improving the quality of life and preventing complications in the early postoperative period. Pre-rehabilitation programs should adopt multifaceted approaches including nutrition, exercise, and anxiety reduction to improve patient resilience in the preoperative period. The pre-operative period is a critical opportunity to implement pre-rehabilitation interventions for vulnerable patients awaiting cardiac surgery.
Conclusion. Cardiac pre-rehabilitation includes a wide range of preventive interventions that can be taught by nurses to patients undergoing cardiac surgery. Pre-rehabilitation requires an interdisciplinary approach, because it suggests a change from the current model of health care and transformation from one-dimensional care to interdisciplinary care, which can be an effective tool for the medical and nursing system in timely identification of physical and mental disorders in initial preoperative assessment, preoperative education and management, as well as prevention of postoperative complications.

Abstract
Aim. The present descriptive study was conducted with the aim of evaluating the knowledge and skill of pre-hospital emergency technicians in Neyshabour, Iran, in the management of patients with acute coronary syndrome.
Background. Pre-hospital emergency personnel who have sufficient knowledge and skill to diagnose, giving care and transfer of patients can increase the chance of survival and decrease the possibility of acute and chronic complications of the disease.
Method. In this descriptive cross-sectional study, 126 operational personnel working in the emergency medical center of Neyshabour City, Iran, were recruited by census sampling and participated in the study during a one year period in 2021. The data was collected using a researcher-made questionnaire including demographic information, knowledge level questionnaire, and a pre-hospital emergency personnel skill checklist measuring the management of patients with acute coronary syndrome. The data were analyzed in SPSS version 19 through descriptive statistics.
Findings. The overall knowledge score of the majority of participants in the management of patients with acute coronary syndrome was at a good level (58.7 percent); the highest knowledge score was reported in the interpretation of electrocardiography and the lowest knowledge score was in diagnosing the symptoms of acute coronary syndrome. Finally, the overall skill score of the majority of pre-hospital emergency technicians was at a good level (79.4 percent); the highest skill score was reported in the principles of cardiopulmonary resuscitation and the lowest skill score was in performing cardiac monitoring and detecting arrhythmias.
Conclusion. The majority of pre-hospital emergency technicians had an acceptable level of knowledge and skill in the field of managing patients with acute coronary syndrome, but some skills were far from the desired level. Therefore, due to the importance of strengthening the knowledge and skills of pre-hospital emergency personnel, as the first members of the emergency team dealing with cardiac patients, in the management of patients with acute coronary syndrome, regular training and awareness of updated guidelines are recommended.

Abstract
Aim. This literature review was conducted to investigate determinants of readmission among Iranian people with heart failure.
Background. Heart failure (HF) as a chronic progressive syndrome may reduce the quality of life and increase their treatment costs. The rate of readmission is relatively high in these patients, presenting a major health problem.
Method. In the present literature review, the literature on the topic were searched out in databases PubMed, Google Scholar, Web of Science, ProQuest, Magiran, SID, and IranMedex. The terms heart failure, congestive heart failure, readmission, rehospitalization, and Iran were searched without time limit. Literature search and evaluating the articles were independently conducted by two researchers, and all eligible studies were included in the review process.
Findings. Out of 601 studies found in the initial search, seven articles meeting the inclusion criteria entered the final phase of the study and were reviewed. According to these studies, the readmission rate varied from 10.9 to 40 percent. Some of the important factors affecting the readmission rate in patients with heart failure included age, gender, education, job status, underlying disease, disease stage, poor adherence to the therapeutic regimen, insurance coverage status, and place of residence.
Conclusion. Based on the results of the present study, the rate of readmission was high among Iranian patients with heart failure. It is recommended to consider interventions such as educational programs to improve patients’ awareness about this condition and their adherence to self-care activities.

Abstract
Aim. This study was conducted to compare the effect of “mindfulness-based cognitive therapy” and “acceptance and commitment therapy” on fatigue and quality of life in men with heart failure.
Background. Fatigue, as one of the important symptoms and complications of heart failure, affects the quality of life of the patients, their self-care and daily task performance. Mindfulness-based cognitive therapy and acceptance and commitment therapy may have an effect on these problems.    

Method. This research was semi-experimental with a pre-test post-test design and control group within a three-month follow-up period. Forty five men with heart failure were purposefully selected and randomly allocated to two experimental groups and one control group (15 people in each group). Data were collected in three stages using the Iowa Fatigue Scale, and Minnesota Living with Heart Failure Questionnaire. Data analysis was done in SPSS-25 software with mixed analysis of variance test.

Findings. After intervention and in follow-up stages, both mindfulness-based cognitive therapy and acceptance and commitment therapy were effective on fatigue and quality of life in men with heart failure. The follow-up test showed a greater effect of acceptance and commitment therapy on quality of life and no statistically significant difference was found between the experimental groups in terms of effect on fatigue. 

Conclusion. Both interventions, especially acceptance and commitment therapy, can be used as effective interventions on fatigue and quality of life along with medical treatments for men with heart failure in medical centers.      

Abstract
Aim. This study was conducted to examine the compliance of the administration of Carbapenems in patients undergoing open heart surgery with antibiotic monitoring guidelines of the Ministry of Health and Medical Education in Iran.
Background. Antibiotic resistance is a significant challenge for healthcare systems and can lead to increased costs, prolonged treatment duration, and higher mortality rates among hospitalized patients.
Methods. This cross-sectional descriptive study included 70 patients (35 women and 35 men) who underwent heart surgery between March 2021 and the end of August 2021 at Shahid Rajaei Heart Hospital in Tehran, Iran. Data were collected through direct patient interactions and reviewing patients' medical records and were analyzed using SPSS software version 26.
Findings. The data revealed that 81 percent of patients received appropriate Carbapenem prescriptions, while 19 percent received an incorrect prescription. The most prescribed antibiotic, with a frequency of 92.9 percent, was Meropenem, and the average number of antibiotics prescribed for each patient was 1.87. The highest rate of Carbapenem prescription was observed in patients with ventilator-induced pneumonia (55.7 percent) and those undergoing coronary artery bypass graft (CABG) surgery (45.7 percent). Approximately 55.7 percent of patients required dose adjustments 72 hours after receiving Carbapenem due to increased creatinine clearance, and 15.7 percent needed to discontinue the drug. The most common causative infection agents were Candida Albicans, Klebsiella Pneumoniae, and Staphylococcus Aureus, respectively.
Conclusion. Antibiotic management programs can limit the irrational use of antibiotics such as Carbapenems and help improve the treatment of infections by preventing the development of antibiotic resistance.

Abstract
Aim. The aim of the study was to examine the effect of lifestyle education using a mobile phone application on adherence to the treatment regimen in patients with hypertension.
Background. High blood pressure is the most important risk factor for cardiovascular diseases and mortality. Educational applications have provided an effective method for self-care and blood pressure control of patients.
Method. This research is a clinical trial study. The number of samples in control and experimental group was 60 people. In the experimental group, the training was conducted using the mobile application at least three times a week for two months and was followed up during the course through phone calls and virtual networks. In the control group, the usual training of the health center was provided. The degree of adherence to the treatment plan of the patients was measured by a researcher-made questionnaire, before and two weeks after the end of the intervention. Data analysis was done in SPSS version 21 using t-test, multivariate covariance analysis and post-hoc test.
Findings. Comparing the adherence to the treatment program between the two groups after the educational intervention, the mean and standard deviation of the scores of the control and experimental group was 337±22 and 441±20, respectively. There was a statistically significant difference between groups after the intervention in all variables including blood pressure, diet, physical activity, drug regimen, and other domains of compliance with the treatment program (p≤0.0001), which indicated the effectiveness of lifestyle training using a mobile phone application on blood pressure and adherence to the treatment plan.
Conclusion. The use of mobile phone application can be effective and useful for improving and controlling blood pressure among patients with hypertension. Nurses, as one of the most important members of the health care team, can have a direct impact on patients’ quality of life through educational interventions

Abstract
Aim. In this review article, the cost-effectiveness of disposable suction bottles in Iran was discussed.
Background. Healthcare-associated infections (HAIs) cause mortality and morbidity in patients, especially in the intensive care unit. There are different methods and instructions to control HAI, which is an important and fundamental problem related to suction.
Method. Searching out for articles through databases including Science Direct, PubMed, Cochrane, Medline, SID, Scopus, CINAHL, OVID, Iran Doc and Magiran using the keywords "disposable suction", "hospital infection", "waste management" and their English equivalent were conducted. Articles that were published between 2000 and 2022 and were more related to the main focus of the research topic were selected. The inclusion criteria included their publication in reputable scientific journals, publication in Farsi or English, and access to the full text of the article. Exclusion criteria included publishing articles in weak and invalid journals.
Findings. Disposable suction bottles was evaluated in five domain including hospital infection control and prevention, water consumption management, ease of use, waste management, and cost effectiveness.
Conclusion. Considering the lack of manpower for disinfecting disposable suction bottles, the costs of disinfectant solutions and their improper use in diluting them, and the management of waste water from used solutions and emptying suction cups; disposable suction bottles have priority over reusable suction bottles in Iran.

Abstract
Aim. This study aimed to compare the effect of Adaptive Support Ventilation (ASV) and Synchronized Intermittent Mandatory Ventilation-Pressure Support (SIMV-PS) modes on consequence of weaning off patients from mechanical ventilator after coronary artery bypass surgery
Background. The ventilation mode used for respiratory support in patients after coronary artery bypass graft surgery is very important. In addition to avoiding pressure on patient's sternotomy incision, the ventilation mode should also provide the possibility of rapid weaning of patient to avoid complications caused by long-term ventilation.
Method. In a semi-experimental study, 26 patients were ventilated with ASV as the experimental group and 26 patients were ventilated with SIMV-PS mode as the control group after coronary artery bypass graft surgery in Rajaie Cardiovascular Medical and Research Center, Tehran, Iran. Mechanical ventilation time and endotracheal tube removal time, hemodynamic variables, and arterial blood gas analysis were compared between the two groups. Data were analyzed using an independent t-test, repeated measures ANOVA and chi-square.
Findings. Out of 52 patients, 36 (69.2 percent) were male and 16 (30.8 percent) were female. The mean time for the endotracheal tube removal was 89.42±33.83 minutes in the experimental group and 101.53±44.91 minutes in control group, which did not have a statistically significant difference (p=0.843). The mean duration of mechanical ventilation of patients in the experimental group was 483.84±158.153 minutes and in the control group, it was 541.92±257.81 minutes, which were not statistically different (p=0.332).
Conclusion. The use of ASV mode for mechanical ventilation after coronary artery bypass graft did not affect reducing the duration of mechanical ventilation and the time of endotracheal tube removal compared to SIMV-PS mode. Therefore, the use of ASV mode for respiratory support of patients undergoing coronary artery bypass surgery should be considered according to the patient's condition and the nurses' expertise.

Abstract
Aim. This paper aims to investigate barriers and opportunities of the virtual visiting in intensive care unit during Covid-19 pandemic.
Background. Face-to-face visits of hospitalized patients in intensive care units reduce separation anxiety and stress caused by hospitalization, as well as increase the feeling of comfort and safety in patients. In addition, it is the key to patient/family-centered care. However, the Covid-19 pandemic and its related restrictions ruled out the possibility of using the family's potential and providing patient/family-centered care. Virtual visiting has been proposed as a solution to remove the family's distance from the patient.
Method. This review was conducted by searching out databases, Web of Science, Scopus, PubMed, Magiran, SID and Cochrane with the keywords, Covid-19, Video calls, Family-patient center care, Intensive care unit, and Virtual visiting without time limitation. The inclusion criteria were the publication of the article in Persian or English language and the availability of the full text of the articles. In total, 45 articles were found, most of which focused on virtual appointments and virtual patient visits by physicians. After removing irrelevant papers, and the cases without full text, 29 articles were evaluated in terms of quality. Finally, 10 articles were evaluated in terms of subject, and the purpose related to the present study.
Findings. During Covid-91 pandemic, virtual visits were done in intensive care units in most medical centers using cell phones and tablets through social networks facilities. In all cases, families and health care providers were satisfied with this communication method, but they considered it was not a suitable substitute for face-to-face meetings. They believed that this method combined with face-to-face meetings would be more effective. Lack of regular and systematic planning, ambiguities in the duties of health care providers in the field of holding virtual visiting, lack of access to the internet at a suitable speed, and the complexity of working with smartphones for some families, were barriers of this method.
Conclusion. Virtual visiting provides a form of presence for families who are far away from their patients. Via this method, not only one but also all the family members can visit the patient. Although this method did not affect the stress and anxiety of the family and patients, but it was able to create a positive experience for them during hospitalization in intensive care units. Moreover, by involving the family in treatment process and informing them opens the ways to reach the patient/family-centered care in intensive care units.

Abstract
Aim. The aim of the present study was to investigate the relationship of sleep quality and perceived stress with depression in women with acute myocardial infarction and anxiety symptoms.
Background. Depression is a common disorder with a lifetime prevalence of about 15 percent, and today it is considered the main cause of disability worldwide and ranks fourth among the ten main causes of the global burden of disease, which is characterized by long-term periods, a variety of symptoms. It is accompanied by a high rate of recurrence and many physical and mental disorders.
Method. Descriptive-correlational research design was selected for conducting the study. Statistical population included the women with acute heart attack living in Tehran in year 2022. Seventy people who scored higher than average in the anxiety questionnaire were selected as the research sample. The tools of data collection in this research were anxiety, depression, sleep quality and perceived stress questionnaires.
Findings. The results showed that there was a positive and statistically significant relationship between sleep quality and negative perceived stress and depression, and also a negative and statistically significant relationship was found between positive perceived stress and depression. Sleep quality, negative perceived stress, and positive perceived stress could predict respectively 0.18, 0.20, and 0.08 of changes in depression score.
Conclusions. Sleep problems can cause psychological distress and decrease concentration in people, so it can be expected that an increase in sleep problems can reduce a person's energy, and by increasing anxiety, it can cause an increase in psychological problems such as depression. Therefore, people who suffer from heart disease often endure a high level of anxiety due to the risk of the disease, which can be associated with increased sleep problems, thus leading to depression in them.

Abstract
Aim. The purpose of this study was to investigate the effect of mindfulness training on Corona anxiety in patients with Covid-19 and underlying cardiovascular disease in Imam Ali Hospital, Amol, Iran.
Background. Since its outbreak, the corona virus has shown that it defeats more people with underlying diseases and puts them at risk of death than those who have a healthy body.
Method. This was a quasi-experimental study with control group. The accecible population of this research was all corona patients with a history of cardiovascular disease in Imam Ali Hospital, Amol, Iran, in 2021-2022. Sampling was done from the patients admitted to the hospital based on convenience sampling method. To collect information, the Corona Virus Anxiety Questionnaire developed by Alipour et al. (2018) was used. Mindfulness training based on Kabat-Zinn (2005) educational plan was implemented in experimental group in 8 sessions of 2-hour duration per week.
Findings. The results of multivariate covariance analysis showed that mindfulness training has an effect on reducing anxiety of Corona in patients with Covid-19 and underlying cardiovascular disease to the extent of 0.87 (p≤0.001). Univariate covariance analysis showed that mindfulness training has an effect on reducing the mental symptoms of Corona anxiety in patients with Covid-19 and underlying cardiovascular disease to the extent of 0.83 (p≤0.001). Also, mindfulness training has an effect on reducing physical symptoms of Corona anxiety in patients with Covid-19 and underlying cardiovascular disease by 0.79 (p≤0.001).
Conclusion. Mindfulness exercises can enable patients with Covid-19 and underlying cardiovascular disease to pause and reflect a little before responding, and these pauses provide them with an opportunity. It allows them to get rid of judgment in many situations that can lead to anger, fear and anxiety. This will provide conditions that patients, even in the worst and acute state of their illness, are more likely to be able to maintain their mental peace and thereby, reduce the physical signs and symptoms of anxiety.

Aim. The present study was conducted with the aim of reviewing the role of serum albumin in heart failure.
Background. Heart failure is a complex clinical syndrome that affects a large population worldwide yearly, and its mortality is even higher than that of many cancers. Although the identification of traditional risk factors has helped in primary prevention, the death rate due to this disease is still increasing. Identifying potential and modifiable risk factors that are not known yet seems necessary in this situation. Serum albumin has been known for many years as a strong prognostic biomarker in many pathological conditions. In recent years, studies have been conducted regarding the role of serum albumin in the prediction, prognosis and treatment of heart failure symptoms.
Method. This narrative study was conducted in 2023. For this purpose, the data bases, PubMed, Scopus, Web of Sciences, SID, MagIran were searched out with the keywords albumin, heart failure, diastolic failure, systolic failure, and a total of 30 articles were included in the study.
Findings. Hypoalbuminemia is a common finding in patients with heart failure, and among its main causes in heart failure are malnutrition, inflammation, lack of intestinal function, lack of kidney function, and liver disease. According to clinical and experimental evidence, hypoalbuminemia is related to fluid retention and exacerbation of pulmonary edema in these patients. Also, hypoalbuminemia can independently predict the onset of a new heart failure and can be measured as a prognostic factor of heart failure outcomes. However, there is still no evidence that directly shows the benefit of albumin injection in patients with heart failure.
Conclusion. Serum albumin can be measured as a modifiable risk factor and a prognostic factor in heart failure, but it is necessary to limit its use to cases where its effectiveness has been confirmed.

Abstract
Aim. This study aimed at examining the convergence of calculated HEART pathway by physician and nurse along its utility to predict the 3-month occurrence of major adverse cardiac even (MACE) in patients with chest pain admitted to emergency department (ED).
Background. The HEART pathway is a tool to predict MACE in patients with chest pain admitted to ED, to help risk stratification for early discharge and reduce unnecessary cardiac tests.
Method. In the present study, a diagnostic tool was evaluated. Ninety-seven ED patients with acute chest pain, hospitalized in Rajaie Cardiovascular Medical and Research Center, were recruited prospectively. Risk stratification was performed by an ED nurse, a cardiology resident, and a cardiology attending physician. The correlation and the 3-month MACE outcomes were analyzed. 
Findings. Pairwise agreements were excellent between the raters. The Intraclass Correlation Coefficient (ICC) among raters were 0.84 (95% CI: 0.73–0.97) and thus, overall agreement was excellent. The HEART pathway score showed a high predictive power (AUC: 0.85 for 3-month MACE). For a cut-off score of 4, sensitivity, specificity, and negative predictive values were 87.5, 58.9, and 95.8 percent, respectively.
Conclusion. The HEART pathway score predicted effectively 3-month MACE in patients with acute non-traumatic chest pain. The high agreement among the three different raters suggests that nurses might use efficiently the score.

Abstract
Aim. This study was conducted with the aim of determining the effect of emotion-focused couple therapy on marital life quality, covert relational aggression and psychological health of couples with cardiovascular disease.
Background. Patients with cardiovascular disease face many problems in their marital life and psychological health, and the use of couple therapy methods is necessary to improve them.
Method. This study was a semi-experimental pretest-posttest design with control group. The study population was patients with cardiovascular disease (including hypertension, acute coronary syndrome, infarction, angina pectoris and constrictive pericarditis) referred to Razi Hospital in Ahvaz city, Iran in 2023. The sample size for each group was considered to be 13 couples, and these couples were selected by purposive sampling method based on inclusion criteria. The experimental group received 8 sessions of 90 minutes duration (two sessions per week) in the form of emotion-focused couple therapy and during this time, the control group did not receive any intervention. Data were collected with the scales marital life quality (Zhang et al., 2013), covert relational aggression (Nelsno & Carroll, 2006) and psychological health (Najarian & Davoodi, 2001) and were analyzed with Chi-square test, independent t-test and multivariate analysis of covariance in SPSS-26 software.
Findings. There was no statistically significant difference between the experimental and control groups in terms of age, education, illness duration and type of couple illness. In the pre-test stage, the groups did not differ significantly in terms of the mean score of marital life quality, covert relational aggression and psychological health, but in the post-test stage, there was a statistically significant difference in the mean score of all three variables (P≤0.0001). In this way, the emotion-focused couple therapy improved married life quality (F=125.366, P≤0.0001), reduced covert relational aggression (F=206.601, P≤0.0001) and improved psychological health (F=175.052, P≤0.0001) in couples with cardiovascular disease.
Conclusion. The results of this study showed the effect of emotion-focused couple therapy on improving the marital life quality, reducing the covert relational aggression, and improving the psychological health of couples with cardiovascular disease. Therefore, counselors and therapists can use emotion-focused couple therapy along with other effective treatment methods to improve variables related to marital life and psychological health.