Abstract
Aim. The aim of this study was to identify the factors affecting the outcomes in people with heart failure.
Background. Heart failure is a complex clinical syndrome. Due to functional and structural problems occurs in the heart failure and its high prevalence and associated financial burden, it is considered a public health problem. Mortality rate and serious complications from the disease are on the rise. Decreased quality of life and frequent hospitalizations are among these complications.
Method. In this review study, a comprehensive search on scientific databases and search engines such as Science Direct, Ovid, PubMed, Google Scholar, Medline was conducted with the keywords heart failure, education, health literacy education, heart failure knowledge, self care, readmission, family support and heart failure outcomes for papers published between 2003 to 2018.
Findings. Heart failure is associated with many problems and several factors affect the patient. Focusing on previous studies on factors influencing the outcomes of heart failure, we can refer to patient health literacy, self-care, heart failure knowledge and patient family support. Education of affected patients has also influenced the outcomes of the disease and frequent hospitalization of patients.
Conclusion. Patient education based on health literacy has effect on heart failure outcomes.

Aim. The aim of this study was to determine the role of resiliency and life expectancy in predicting psychological well-being of heart failure patients.
Background. Regarding the importance of psychological well-being in improving the health of patients with heart failure, examining the affective variables such as resiliency and life expectancy are of great importance.
Method. This research was a descriptive correlational study. Statistical population consisted of all of Rasht heart failure patients in 2018. 265 heart failure patients were selected using convenience sampling. The data collection instruments were Ryff's psychological well-being, Connor and Davidson’s resilience, and Snyder et al's hope. Abstract
Aim. The aim of this study was to determine the role of resiliency and life expectancy in predicting psychological well-being of people with heart failure.
Background. Regarding the importance of psychological well-being in improving the health of patients with heart failure, examining the relationship of affective variables such as resiliency and life expectancy with psychological well-being is of great importance.
Method. This research was a descriptive correlational study. Statistical population consisted of all of heart failure patients in Rasht, Iran, in 2018. In this study, 265 heart failure patients were selected using convenience sampling. The data collection instruments were the questionnaires Ryff's psychological well-being, Connor and Davidson’s resilience, and Snyder et al.’s hope. The collected data were analyzed using Pearson correlation coefficient and stepwise multiple regression.
Findings. There was a positive relationship of psychological well-being with resiliency (r=0.386) and life expectancy (r=0.396). The regression analysis showed that the meaning of life and subscales of factor thinking and spiritual influences can significantly predict 0.228 of psychological well-being in heart failure patients.
Conclusion. Regarding the determinants of psychological well-being in this research, psychological well-being and quality of nursing care in heart failure patients can be increased using interventions such as resiliency education programs and psychological treatments focusing on hope.
The collected data were analyzed using pearson correlation coefficient and stepwise multiple regression.
Findings. The results of this study revealed positive relationship between resiliency and life expectancy with psychological well-being. The regression showed that meaning of life and subscales of factor thinking and spiritual influences can predict psychological well-being of heart failure patients.
Conclusion. Regarding the determinants of resilience in this research, psychological well-being of heart failure patients can be increased using interventions such as resiliency education programs and psychological treatments focusing on hope.

Abstract
Aim. This study aimed to compare the effect of spaced and mass education on stress and anxiety in candidates for angiography.
Background. Regarding the role of education in reducing stress and anxiety before angiography, comparison of the effect of spaced and mass education seems to be important in managing stress and anxiety in people experiencing this procedure.
Method. In this interventional study, statistical population consisted of candidates for angiography referred to selected hospitals of Isfahan in 2018. Sixty candidates for non-emergency angiography were selected by convenience sampling and were randomly divided into two groups of 30. The data collection instruments were the questionnaires demographic information, Cohen`s Perceived Stress (PSS14) and Spielberger`s Anxiety Inventory. Initially, all three questionnaires were completed by the participants. Then the education was provided by the researcher to the participants of the mass education group individually and face to face for 25 to 45 minutes (according to the participants tolerance) and in the end of the session, a 5 to 10 minutes time were given for answering participants’ questions. In the spaced education group, the educational content was provided by the researcher in three stages of 10 to 15 minutes and in groups of 3 to 6 participants. After the training of both groups, stress and anxiety were measured again by the questionnaires. Data were analyzed in SPSS version 16 using descriptive and inferential statistics.
Findings. Before and after intervention, there was no statistically significant difference between two groups in terms of mean scores of stress, state anxiety and trait anxiety. After intervention, a statistically significant decrease in mean scores of stress, state anxiety and trait anxiety were found in each group compared with before intervention.
Conclusion. Regarding the similar effect of spaced and mass education on stress and anxiety in candidates for angiography, it is recommended to use mass education method for candidates before angiography, since it is more cost effective and time saving than spaced education method.
 

Abstract
Aim. The aim of this study was to determine the relationship of family members’ health literacy and performance in face of myocardial infarction.
Background. Myocardial infarction is one of the most important causes of death and disability in developed and developing countries. Proper performance of patients' attendance in early hours of myocardial infarction event plays an important role in reducing mortality and morbidity. Health literacy is also known as one of the major determinants of understanding information about health.
Method. In this descriptive-correlational study, 286 family members of patients experiencing myocardial infarction that witnessed the vent were recruited in the study by convenience sampling method and based on inclusion criteria of reading and writing literacy and age over 18 years old. Data were collected using a demographic form, Iranian adult health literacy questionnaire (HELIA) and the questionnaire performance during myocardial infarction. Data were analyzed in SPSS version 22 using descriptive statistics (frequency distribution, mean, standard deviation) and inferential statistics (mean comparison, correlation and regression tests).
Findings. Health literacy mean score (61.49±21.05) showed an adequate level. “Assessment skills” and “decision making and application of health information” had, respectively, the lowest (52.68±25.30) and the highest (68.07±19.87) mean score among health literacy dimensions. There was a statistically significant relationship of health literacy with age, education and medical profession in the family (P≤0.0001). Only 17.98 percent of the participants had a good level of performance (Scores 6.8 to 10). The history of myocardial infarction in patient and the duration of the patient transition from the onset of pain to arrival to the hospital showed a statistically significant relationship with performance, meaning that family members of patients with a history of myocardial infarction were able to transfer their patient to the hospital in less than half an hour (P≤0.0001). A statistically significant relationship was found between health literacy and performance; those with higher level of health literacy had better performance. Of the health literacy domains, only understanding had a significant relationship with performance (P=0.004).
Conclusion. Although the mean score of health literacy was adequate, the participants hadn't good performance. Therefore, improving the performance of community and family members by health service providers including nurses, mass media, practitioners, and health promotion planners for educational interventions is recommended. Proper planning to increase specific health literacy can prevent adverse outcomes in this area.

Abstract
Aim. This study aimed to determine the effect of health promoting lifestyle training on vitality, psychological well-being and blood pressure of women with cardiovascular disease.
Background. Women with cardiovascular disease have many problems in physical and mental health and one of the effective methods in this field is health promoting lifestyle training method.
Method. This was a quasi-experimental study with pretest-posttest and follow-up design with control group. The study population consisted of women with cardiovascular disease referred to Rajaie Cardiovascular Medical and Research Center in Tehran, Iran, in 2019. The sample consisted of 40 women who were selected by purposeful sampling method and randomly allocated into experimental and control group. The experimental group received eight 75-minute educational session (one session per week) on health promoting lifestyle and the control group placed on the waiting list for training. Data were collected using questionnaires vitality and psychological well-being and sphygmomanometer and were analyzed by Chi-square test, independent t-test, repeated measures and Bonferroni post-hoc test in SPSS Version 19.
Findings. In the pretest stage, there was no statically significant difference between the experimental and control group in terms of vitality, psychological well-being and blood pressure, but in the posttest and follow-up stages, there was found a statically significant difference in terms of all three variables of vitality, psychological well-being and blood pressure, meaning that health promoting lifestyle training method led to increase vitality and psychological well-being and decrease blood pressure of women with cardiovascular disease. This effect continued in follow-up stage.
Conclusion. The method of health promoting lifestyle training led to improve the vitality, psychological well-being and blood pressure of women with cardiovascular disease. It is recommended that health care providers use health promoting lifestyle training method along with other educational and therapeutic modalities to improve the health-related components.

Method. In this descriptive cross sectional-study, data were collected using modified quality of nursing care questionnaire. The questionnaire was adopted from the standardized Quality Patient Care Scale in psychosocial, physical, and communication dimensions. A convenient sampling method was used to recruit 191 registered nurses participated in the study within a 2-month period. The data were analyzed SPSS version 20 using descriptive and inferential statistics.
Findings. The mean score for quality of end-of-life nursing care was 83.62±8.62 in the psychosocial dimension, 85.36±7.74 in the communication dimension, and 92.23±10.88 in the physical dimension. Quality was reported to be favorable in the psychosocial dimension (62 percent), communication (50.3 percent) and physical dimension (81.7 percent), respectively. There was a statistically significant relationship between the quality of end-of-life nursing care and passing educational course.
Conclusion. The quality of end-of-life nursing care was good from the perspective of critical care nurses, but it was not as good as expected in some dimensions. The psychosocial aspect of end-of-life nursing care needs to be improved. Taking measures and planning educational programs to improve the appropriate therapeutic relationship between the nurse and the patient and paying attention to the psychological and social needs of patients as much as possible can be an effective step in improving the quality of end-of-life care.

Abstract
Aim. This study aimed at examining the effect of preoperative fluid therapy on kidney function in patients undergoing heart surgery.
Background. As one of surgery complications, kidney failure occurs with oliguria and rise in creatinine. Decreased heart output leads to reduction in renal perfusion. Acute renal failure is associated with increase in morbidity, mortality and high medical treatment cost. Various studies has indicated an increase in postoperative mortality rate when complications of acute renal failure superimpose the situation. One of the best strategies for kidney protection is optimizing preoperative hemodynamics and fluid therapy.
Method. In this clinical trial study, 107 patients were recruited based on inclusion criteria and randomly allocated to experimental (n=54) and control (n=53) group. Patients in experimental group received Half- Saline, 1cc/kg/hr, during 12 hours before surgery. Patients in control group started as being NPO, 8 hours before the surgery. Creatinine level, BUN, and 24-hours urine output were measured and recorded during two days after surgery. Data were analyzed in SPSS V.22 using descriptive and inferential statistics.
Findings. The groups didn't differ in terms of age, gender, weight, and ejection fraction. There was no statistically significant difference between experimental and control group in terms of creatinine changes during the preoperative day and the first and the second day after surgery. Also, there was no statistically significant difference between groups in BUN on the first and second days after surgery. The urine output of the experimental group was greater than control group on first and second days after operation, but the difference was not significant. The duration of ICU stay were similar in both groups. There were recorded two deaths in control group while there was no death in experimental group.
Conclusion. It was concluded that preoperative fluid therapy has no short-term effect on kidney function. It is recommended to examine the effect of fluid therapy on kidney function in longer periods.

Abstract
Aim. The aim of this study was to compare the effect of mentalization-based therapy and supportive psychotherapy on object relations in people with coronary heart disease.
Background. Cardiovascular diseases are the main cause of disability and death in different countries of the world and despite the development of various treatments, it is still highly prevalent.
Method. This experimental study was conducted in the form of the pretest-posttest design with control group and follow-up stage. The statistical population consisted of all people with coronary heart disease who referred to Imam Khomeini Hospital in Ardabil during 2018. Of this statistical population, 60 people were selected through purposive sampling and according to inclusion criteria, and were randomly assigned to two experimental groups and one control group (20 people in each group). Finally, 55 people remained until the end of interventions and evaluations. The first experimental group received 12 sessions of mentalization-based therapy, the second experimental group received 10 sessions of supportive psychotherapy, while the control group did not receive any intervention. Bell Object Relations Questionnaire was used for data collection in three stages of pre-test, post-test and follow-up. Data were analyzed using repeated measures analysis of variance and LSD post-hoc test using SPSS statistical software (version 22).
Findings. After controlling the pre-test effects, a statistically significant difference was found between the post-test mean scores of the experimental groups (mentalization -based therapy: F=19.69, P≤0.0001; and supportive psychotherapy: F=28.86, P≤0.0001) and the control group (F=0.87, P<0.43) in terms of object relations and its components. Also, the effect of supportive psychotherapy on object relations of patients with coronary heart disease was higher than that of mentalization -based therapy (P<0.01).
Conclusion. The results of the present study provides the basis for using these interventions in people with coronary heart disease.

Abstract
Aim. The present study was conducted to determine the relationship between seasonal changes and incidence of AMI in Sistan and Baluchestan province, Iran.
Background. Although various studies have been carried out to examine the relationship between seasonal changes and incidence of Acute Myocardial Infarction (AMI) in different parts of the world, many of them have limitations and there are many contradictions between their findings. Despite considerable prevalence of AMI in Sistan and Baluchestan Province, similar studies have not been conducted in this area.
Method. This cross-sectional study was done based on medical data of heart center of Sistan and Baluchestan Province from March 2015 to April 2016. In this study, census sampling was achieved of all the patients with AMI symptoms. Variables such as age, sex, marital status, birth date, physical symptoms, and past medical history; and also meteorological parameters such as minimum, maximum and average of temperature (Celsius), and wind direction were collected.
Findings. Except of mean rainfall, mean rate of other parameters had statistically significant differences during 12-month period of the study. Spearman correlation test showed a positive statistically significant correlation of incidence of AMI during one year with sunshine hours (r=0.685, p=0.014), and maximum daily temperature (r=0.626, p=0.030).
Conclusion. Finding revealed that raising temperature had direct relationship with incidence of AMI. The findings could be a foundation for governmental important health plans to control the incidence of AMI.

Abstract
Aim. The aim of this study was to evaluate the effect of cardiac rehabilitation training on patients' quality of life after coronary artery bypass grafting at Dr. Lavasani Hospital in Tehran.
Background. Coronary artery disease is the most common and serious chronic life-threatening disease. This disease affects many aspects of people's lives and reduces the quality of life. In many cases, coronary artery bypass graft surgery is needed to treat cardiac problems. Improving the quality of life is one of the important goals of participating in a cardiac rehabilitation program.
Method. In this one-group quasi-experimental study, 45 patients under coronary artery bypass graft surgery, hospitalized in Dr Lavasani Heart Hospital in Tehran, Iran, were selected by simple random sampling and were studied in a before-after design. Data collection tools included demographic questionnaire and Macnew Heart Disease Health-Related Quality of Life questionnaire. Cardiac rehabilitation training program was implemented in two sessions of 30 to 45 minutes with an interval of at least 24 hours at the time of hospitalization. Quality of life was measured in two stages, before the intervention and one month after the second training session. Data were analyzed in SPSS software version 25 using descriptive and inferential statistics.
Findings. The highest percentage of samples was male (57.8 percent), married (95.7 percent) and had primary education (47.8 percent). The mean age of women was 60.32±9.73 years, and the mean age of men was 60.50±12.60 years. After intervention, the mean quality of life score (128.71±4.95) increased significantly compared to the mean quality of life score before intervention (96.66±9.30) (p≤0.0001).
Conclusion. Cardiac rehabilitation in patients undergoing coronary artery bypass graft surgery can increase their quality of life. Nurses can play an important role in improving the quality of life of these patients through implementing cardiac rehabilitation training.

Abstract
Aim. The aim of this study was to examine the effect of protocol of weaning from mechanical ventilation on the gastrointestinal function in people undergoing CABG.
Background. The most common problems after cardiac surgery in the intensive care unit are change in vital signs, respiratory problems, unsuccessful separation from mechanical ventilation, and gastrointestinal problems. Due to the numerous effects that gastrointestinal problems have on the patient after cardiac surgery and also the economic burden that these complications impose on the patient and the health care system, choosing the best technique to prevent and control these problems is critical for the health care team.
Method. The present study was a randomized clinical trial conducted on 100 people undergoing CABG. They were allocated to control and experimental group based on permuted block randomization. The control group received routine way and experimental group received protocol of weaning. The groups  were compared in terms of nausea and vomiting, the time of beginning oral diet, defecation and bowel sounds before weaning 2, 6, and 12 hours after weaning from mechanical ventilation. Data were analyzed In SPSS version 23 using chi-square, Mann–Whitney U and Fisher tests.
Findings. In experimental group, there was a faster onset of bowel sounds and movements and earlier beginning of oral diet.
Conclusion. Patients who were under the protocol of weaning from mechanical ventilation had better gastrointestinal functional status compared to those who were under routine weaning.

Abstract
Aim. The purpose of this study was to determine the effect of early mobilization program on incidence of arrhythmias in patients after acute myocardial infarction in Imam Khomeini Hospital in Dehdasht, Iran.
Background. Acute myocardial infarction is one of the most common causes of disability and mortality in most countries. Rehabilitation and mobility management of these patients, immediately after admission to the cardiac care unit, can reduces complications and decreases their physical and cognitive function impairment.
Method. This was a clinical trial study, in which 60 patients with acute myocardial infarction, referred to Imam Khomeini Hospital in Dehdasht, Iran were selected by convenience sampling during the year 2019 and randomly assigned to experimental (n=30) and control (n=30) groups. In the experimental group, patients received an organized program in 8 stages, 18 hours after admission to the cardiac care unit, and in control group, the patients got out of bed 48 hours after admission based on the usual protocol. Patients were monitored before, during, and after getting out of bed for the number and type of arrhythmias. Data were analyzed by descriptive and inferential statistics in SPSS version 22.
Findings. There was a statistically significant difference between the experimental and control group in the number and type of arrhythmias, 48 hours and 51 hours after admission in the cardiac care unit. However, this difference was not statistically significant at 54 hours after admission to the cardiac care unit.
Conclusion. Early mobilization can reduce the number of arrhythmias in patients after myocardial infarction. Early mobilization can be included in the cardiac care unit rehabilitation program as a safe mathod. Therefore, it is recommended to use early mobilization program for patients with acute myocardial infarction in cardiac care unit on the first day of hospitalization.

Abstract
Aim. The present study aims to determine the performance of “Tehran 115 medical emergency” dispatchers in providing services to patients with chest pain.
Background. Chest pain is one of the most common problems for which individuals call medical emergency services. The pace, accuracy, and integration of services by medical emergency dispatchers are highly important to decrease mortality and disability rates.
Method. A cross-sectional descriptive study was carried out on 397 voice records of 80 dispatchers in “Tehran 115 medical emergency services” about chest pain in January 2019. Data gathering was done using the Dispatcher Performance Assessment Checklist. All the obtained scores by the checklist were analyzed in SPSS (V.22).
Findings. All voice records demonstrated an acceptable performance of the dispatchers. The mean score of performance in consultation section was 18±2.66 ranged from 9 to 20. The mean score of performance in key questions section was 35.95±2.16 with a score range from 28 to 38. The total mean score of performance was 53.95±3.57 with a score range from 43 to 58. In addition, employment status (P=0.039) and work experience (P=0.020) were significantly related to dispatchers’ performance in terms of assessing chest pain.
Conclusion. Assessment according to the checklist items and provision of proper consultation services to the patients and patient companions by the 115 dispatchers resulted in a better and timely diagnosis, faster dispatch of ambulance, less damages sustained by heart patients, and prevention of death. The findings emphasized on the necessity of adhering to the questions algorithm and uniform work procedure by dispatchers nationwide. This should be an integral part of telephone triage. Observation of national standard prevents probable damages to patients due to wrong or personalized decision making.

Abstract
Aim. The purpose of this study was to examine the effect of Zero-balance (Z-Buf) ultrafiltration on arterial blood gases in patients undergoing coronary artery bypass graft surgery.
Background. Cardiopulmonary bypass can cause complications such as systemic inflammatory response syndrome, ischemic reperfusion injury, decreased cardiac output, and other related complications.
Method. This study was a randomized clinical trial study with control group. Seventy six patients undergoing coronary artery bypass grafting were selected through consecutive sampling method from early January 2016 to the end of June 2017. To allocate the participants into groups, randomized blocking method was used. Patients in the experimental group were connected to the cardiopulmonary bypass system and Zero-balance (Z-Buf) ultrafiltration. Arterial blood gases including BE, Pao2, Pco2, Tco2, PH, Lactate, and O2Sat were measured in the preoperative time, every half hour during the operation, immediately after the operation and 6 hours after transferring the patient to intensive care unit. The data were analyzed by descriptive and inferential statistics in SPSS Version 22.
Findings. The results showed that the changes in PCO2 in both groups were not statistically significant, but the changes in other arterial blood gas parameters (BE, Pao2, Tco2, PH, Lactate, O2Sat) were statistically significant in two groups (P<0.05). There were more changes in arterial blood gases in the control than the experimental group.
Conclusion. The use of Zero-balance ultrafiltration reduces changes in arterial blood gas parameters in patients with undergoing coronary artery bypass graft surgery. The use of this method by heart surgeons and perfusionists can reduces the incidence of clinical complications in these patients.

Abstract
Aim. This study was conducted to examine the relationship of marital satisfaction and self-care behavior in people with chronic heart failure
Background. Chronic heart failure is one of the most important problems in public health and it would impose heavy costs on society and family. Self-care plays an important role in managing heart failure and can be influenced by social support. The patients receive the highest level of social support from their families.
Method. In this descriptive study, 251 patients were selected by convenience sampling method. The instruments were Enrich marital satisfaction questionnaire, and The European Heart Failure Self-care Behavior  (EHFSCB). Collected data were analyzed in SPSS version 16 using descriptive and inferential statistics.
Findings. The results showed that 58.8 percent of participants were male, with a mean age of 59.66 years. The mean score of marital satisfaction was 145.6±41.98. Most participants (46.9 percent) had partial marital satisfaction. The mean score of self-care was 34.5±12.24 and most participants (41.2 percent) reported good self-care. There was a statistically significant negative correlation between the marital satisfaction and self-care scores.
Conclusion. Due to the positive effect of self-care behaviors on marital satisfaction and because most people with chronic heart failure have partial marital satisfaction, it is recommended to study factors influencing these components. It is suggested to support and teach patients and their families in order to improve marital satisfaction and promote self-care behaviors in these patients.

Abstract
Aim. The aim of this study was to examine the relationship between quality of life and hope in people with ischemic heart disease.
Background. The increase in the number of patients with ischemic heart disease in recent years and its psychological and physical consequences and complications necessitates investigating their quality of life and hope.
Method. In this descriptive-correlational study, 150 people with ischemic heart disease hospitalized in Shahid Rajaie Cardiovascular Medical and Research Center in Tehran, Iran, were investigated. Data collection tools were demographic information questionnaire, France and Powers quality of life questionnaire (1999) and Snyder hope scale (1991). Data were analyzed in SPSS using descriptive and inferential statistical.
Finding. The results of the present study showed that the quality of life in people with ischemic heart disease was at a good level (mean score 20.64±3). The level of hope in these patients was high (the mean score 40.33±5). There was a statistically significant relationship between hope and quality of life score (P≤0.0001, r=0.48).
Conclusion. Regarding the positive relationship of quality of life with hope in ischemic heart patients, nurses can be advised to pay attention to these aspects of life in this group of patients and incorporate into their routine care.

Abstract
Aim. The aim of this study was to investigate the relationship between spiritual health and sleep quality in people with heart failure.
Background. The quality of sleep in patients with heart failure is unfavorable compared to healthy individuals. It is stated that in some societies, spirituality is related to mental health and sleep quality.
Method. In this descriptive correlational study, 207 people with heart failure, who were recruited in the study through convenience sampling method, were given demographic questionnaires, Pittsburgh sleep quality and Alison and Palutzian spiritual health questionnaires. Data were analyzed using descriptive and inferential statistics in SPSS V24.
Findings. The mean total score of sleep quality was 8.90±3.16; indicating that the sleep quality of people with heart failure was at an unfavorable level. The mean total score of spiritual health was 93.36±9.20; demonstrating that the level of spiritual health of the people with heart failure was moderately high. There was a statistically significant positive relationship between sleep quality and spiritual health (r=0.175, p=0.026).
Conclusion. People with heart failure who have higher spiritual health experience better sleep quality. It is recommended to pay attention to spiritual health as well as to the physical health of patients when planning caring programs for these people.