The natural history of recovery following sudden cardiac arrest and internal cardioverter-defibrillator implantation.

The purposes of this review are to 1) summarize current knowledge regarding the "natural history of recovery" (physical functioning, psychological adjustment, and neurologic impairments) following sudden cardiac arrest and internal cardioverter-defibrillator implantation over the first year; and 2) discuss the implications for the development of nursing intervention programs based on the natural history of recovery. The natural history serves as a basis for understanding the recovery experiences of sudden cardiac arrest survivors as well as determining how intervention programs might help the most.

Theoretical development of nursing interventions for sudden cardiac arrest survivors using social cognitive theory.

This article discusses the theoretical development of a nursing intervention program to enhance recovery over the first year following sudden cardiac arrest. Concepts from social cognitive theory and domains of concern following sudden cardiac arrest underpin a tailored and standardized nursing intervention. The nursing intervention program is designed for delivery by means of telephone and through the mail. Testing of the nursing intervention program is underway using a clinical trial design.

Testing the effectiveness of converting patients to long-acting antianginal medications: The Quality of Life in Angina Research Trial (QUART).

OBJECTIVE: Our purpose was to test the hypothesis that converting patients with stable angina to long-acting antianginal medications would improve their functional status, symptom control, treatment satisfaction, and quality of life. METHODS AND RESULTS: A single-blind randomized trial of 100 patients with stable coronary artery disease was performed in the outpatient clinic of a Veterans Affairs Health System. Outpatients with chronic stable angina taking at least 2 antianginal medications were studied. Patients were randomized to one of two treatments: optimal adjustment of their usual antianginal medications or conversion to solely long-acting medications (long-acting diltiazem +/- nitroglycerin patches +/- atenolol) with subsequent optimization. The primary outcome was the 3-month change in Seattle Angina Questionnaire scores. Although no differences in physical limitation scores were noted, patients randomized to receive long-acting medications had improved symptom control (3-month improvement in anginal stability [19.1 vs 5.6, P =.02] and anginal frequency [17.8 vs 5.5, P =.006]), more treatment satisfaction (3-month improvement of 8.2 vs 3.0, P =.057), and better quality of life (3-month improvement of 11.2 vs 5.6, P =.09) compared with patients whose pretrial medications were optimized. The improvement in symptom control was statistically significant. CONCLUSION: Converting patients with chronic, stable angina to long-acting antianginal medications resulted in substantial improvements in symptom control with a trend toward better treatment satisfaction and quality of life.

Outpatient nursing case management for cardiovascular disease.

Case management has been an effective treatment model for maintaining costs while preserving quality of care for vulnerable populations who are frequent care users. Nursing case management has been effective in improving health outcomes in chronically ill populations. Specifically, nurse practitioner care has been as effective, and in some areas, more effective in managing chronic health problems of patients than care provided by physicians. Cardiovascular disease is a chronic condition, often accompanied by long-term symptoms and disability, that is prevalent in the United States population. Outpatient nursing case management for chronic health problems associated with cardiovascular disease is posited as a model for a heavily used system that maintains quality of care in this group.

Domains of nursing intervention after sudden cardiac arrest and automatic internal cardioverter defibrillator implantation.

PURPOSE: The purpose of the study was to explore individual and family experiences after sudden cardiac arrest and automatic internal cardioverter defibrillator implantation during the first year of recovery. This report specifically addresses the domains of concern expressed and helpful strategies used by participants that are relevant to the development of future intervention programs. DESIGN: A grounded theory approach was used to gain an understanding of areas of concern of sudden cardiac arrest survivors and families that could be used when designing future nursing interventions. Semistructured interviews were conducted with both sudden cardiac arrest survivors and 1 family member each at 5 points during the first year of recovery (hospitalization; 1, 3, 6, and 12 months after hospitalization). Participants were asked to identify those specific areas that most concerned them and that they would like assistance with during the first year. A total of 150 interviews were conducted with 176 hours of data generated. SETTING: The study focused on 10 northwest urban community medical centers and participants' homes within a 50-mile driving distance from the medical centers. SAMPLE: The sample included 15 first-time sudden cardiac arrest survivors (13 men and 2 women) and 1 family member each between the ages of 31 and 72 years. RESULTS: Domains of concern identified by participants that can be used to design future nursing intervention programs included preventive care, dealing with automatic internal cardioverter defibrillator shocks, emotional challenges, physical changes, activities of daily living, partner relationships, and dealing with health care providers. Suggestions of helpful strategies used by participants during the first year are outlined. IMPLICATIONS: Domains of concern and helpful strategies identified by participants provide a framework for the development and testing of nursing intervention programs to enhance recovery following sudden cardiac arrest for survivors and their families.

Comparison of three quality of life instruments in stable angina pectoris: Seattle Angina Questionnaire, Short Form Health Survey (SF-36), and Quality of Life Index-Cardiac Version III.

Three instruments for the assessment of quality of life, the Seattle Angina Questionnaire (SAQ), the Short Form Health Survey (SF-36), and the Quality of Life Index-Cardiac Version III (QLI) were administered to 107 patients with stable angina pectoris in a longitudinal randomized trial comparing the use of alternative anginal medications in the management of chronic stable angina pectoris. This study demonstrated that differences in angina severity as measured by the Canadian Cardiovascular Society Classification (CCSC) were related to each of the SAQ subscales, to selected subscales of the SF-36, but not to the QLI. All quality of life (QOL) instruments demonstrated acceptable test-retest reliability when administered over a 2-week interval. Neither the SF-36 nor the QLI were discriminative of angina severity or sensitive to changes in CCSC angina classification. Both the SAQ and QLI detected changes in heart disease related QOL over time.

Family-focused interventions for survivors of sudden cardiac arrest.

This paper 1) describes what is known about recovery for families of patients who survive sudden cardiac arrest (SCA) and undergo internal cardioverter defibrillator (ICD) implantation, 2) discusses empirical evidence for interventions aimed at affecting recovery following SCA and ICD implantation, 3) presents additional data that suggest interventions for cardiac arrest survivors and their families, and 4) makes recommendations for the development of future intervention programs for SCA survivors and their families. Research supporting the use of educational and support interventions designed for SCA survivors and families is reviewed. Recommendations are made for future design and testing of interventions in the population.

Reconceptualization of the nursing diagnosis decreased cardiac output.

TOPIC: The parameters of the diagnoses decreased cardiac output. PURPOSE: To propose an alternative conceptual structure for cardiac output that links conceptual parameters with clinical and hemodynamic data. SOURCE: Past discussions and research investigations. CONCLUSION: Careful analysis illustrates several diagnoses are contained within cardiac output at differing levels of abstraction. Testing of the model, including linking diagnoses with nursing interventions and outcomes, is suggested.

Psychophysiological responses after sudden cardiac arrest during hospitalization.

A sample of 21 sudden cardiac arrest (SCA) survivors were interviewed every 48 hours during hospitalization to determine emotional, cognitive, and physiological parameters of recovery. On the average, SCA survivors were not excessively anxious, depressed, angry, or confused during hospitalization, but they did report high levels of denial and uncertainty. The two most predominant cognitive impairments at the time of hospital discharge were loss of short-term memory and construction ability. Both the number of cardiac arrhythmias and the types of interventions used to manage them decreased as hospital discharge approached.

Psychological reactions and family adjustment in shock versus no shock groups after implantation of internal cardioverter defibrillator.

PURPOSE: The purpose of this study was to compare psychological reactions and family adjustment after sudden cardiac arrest (SCA) and internal cardioverter defibrillator (ICD) implantation in survivors who did and did not experience defibrillatory shocks the first year of recovery. METHODS: Data were collected as part of a longitudinal prospective study that examined patient and family adjustment after SCA. SCA survivors and one family member per patient were interviewed and completed questionnaires three times within the first year (hospital discharge, 6 months, and 12 months) after SCA. SAMPLE: Fifteen SCA survivors (13 men and 2 women) between the ages of 30 and 74 (mean 57 years) and one respective family member, usually the spouse, (mean age 53 years) participated. All SCA survivors had had primary ventricular fibrillation outside the hospital, had automatic defibrillators implanted while hospitalized, and were monitored for 1 year. RESULTS: Participants were divided into shock and no shock groups based on activation of their ICD the first year. The mean number of shocks received in the shock group survivors was 26, with a range of 3 to 100. Anxiety, depression, anger, and stress levels were higher for both survivors and their family members in the group that received defibrillator shocks. Denial was high throughout the entire year in all survivors. Dyadic adjustment and family coping were not found to be significantly different between the no shock and shock groups. A trend toward reduction in family social support and dyadic satisfaction was noted in both groups with time. CONCLUSIONS: Both SCA survivors and their family members experience more psychological distress in the first year after ICD implantation if the defibrillator fires. Families in both shock and no shock groups report lower levels of family support and marital satisfaction the first year after SCA and ICD implantation.

Longitudinal recovery following sudden cardiac arrest and internal cardioverter defibrillator implantation: survivors and their families.

OBJECTIVE: To describe psychological reactions, neurological sequelae, and family adjustment following sudden cardiac arrest during the first year of recovery. METHODS: 15 sudden cardiac arrest survivors and 1 member of each family were interviewed and completed questionnaires five times within the first year following sudden cardiac arrest (hospital discharge, 1, 3, 6, and 12 months). Psychological reactions assessed included anxiety, depression, anger, denial, and global stress. Neurological sequelae assessed included confusion and neurocognitive functioning. Family adjustment assessed included marital adjustment and family coping. All sudden cardiac arrest survivors suffered primary ventricular fibrillation outside the hospital and had an internal cardioverter defibrillator implanted during hospitalization. RESULTS: Anxiety, depression, anger, stress, and confusion were highest at hospital discharge and decreased over 1 year, with survivors reporting higher levels than spouses. Denial was high throughout the entire year in survivors. Memory and construction ability were impaired throughout the entire year in survivors. Family coping and dyadic satisfaction were highest at hospital discharge and decreased throughout 1 year. Spouses reported fewer coping strategies and lower dyadic satisfaction than survivors. Family social support was lower than previously established norms at all periods during the first year of recovery. CONCLUSION: To develop intervention programs to aid adjustment, healthcare providers need to take into account psychological reactions, neurological deficits, and family coping of sudden cardiac arrest survivors and their family members.

Isolation of a yeast artificial chromosome clone that spans the (12;16) translocation breakpoint characteristic of myxoid liposarcoma.

Cytogenetic analysis of liposarcomas has demonstrated that translocation (12;16) (q13.3;p11.2) is characteristic of the myxoid subtype of this adipose tissue tumor. Our previous results suggested that the GLI gene is close to the translocation breakpoint on chromosome 12. We now describe a yeast artificial chromosome (YAC) that contains GLI and spans the chromosome 12 region involved in the t(12;16) breakpoint. This clone will permit rapid definition of the genetic region surrounding the breakpoint and allow isolation of the gene presumably affected by the translocation.

Comparison of heart rate variability in survivors and nonsurvivors of sudden cardiac arrest.

Imbalances in autonomic nervous system function have been posed as a possible mechanism that produces ventricular fibrillation and sudden cardiac arrest in patients with cardiovascular disease. Heart rate (HR) variability is described in survivors and nonsurvivors of sudden cardiac arrest within 48 hours after resuscitation using time and frequency domain analytic approaches. HR data were collected using 24-hour ambulatory electro-cardiograms in 16 survivors and 5 nonsurvivors of sudden cardiac arrest, and 5 control subjects. Survivors of sudden cardiac arrest were followed for 1 year, with recurrent cardiac events occurring in 4 patients who died within that year. Analysis of 24-hour electrocardiograms demonstrated that control subjects had the highest HR variability (standard deviation of all RR intervals = 155.2 +/- 54 ms), with nonsurvivors demonstrating the lowest HR variability (standard deviation of all RR intervals = 52.3 +/- 6.1 ms) and survivors of sudden cardiac arrest falling between the other 2 groups (standard deviation of all RR intervals = 78 +/- 25.5 ms, p less than or equal to 0.0000). Two other indexes of HR variability (mean number of beat to beat differences in RR intervals greater than 50 ms/hour and root-mean-square of successive differences in RR intervals) did not demonstrate the expected pattern in this sample, indicating that perhaps patterns of HR variability differ between groups of patients with cardiovascular disorders. Spectral analytic methods demonstrated that survivors of sudden cardiac arrest had reduced low- and high-frequency spectral power, whereas nonsurvivors demonstrated a loss of both low- and high-frequency spectral power.(ABSTRACT TRUNCATED AT 250 WORDS)

The nursing diagnosis of decreased cardiac output.

This descriptive study validated the nursing diagnosis of decreased cardiac output in a critical-care population. A cardiac output assessment tool was developed. Nursing interventions associated with decreased cardiac output were identified and classified as independent, collaborative, and dependent.