Marriage and long-term survival after coronary artery bypass grafting.

OBJECTIVE: To examine the effects of marital status and marital satisfaction on survival after coronary artery bypass grafting (CABG). METHODS: Participants were 225 people who had CABG between 1987 and 1990. Marital status at the time of surgery and marital satisfaction 1 year after surgery were used to predict survival 15 years after surgery. RESULTS: Married people were 2.5 times (p < .001) more likely to be alive 15 years after CABG than those who were not married. This finding was true for men and women, although the result for women was marginally significant adjusting for age. Those in high-satisfaction marriages were 3.2 times (p < .003) more likely to be alive 15 years after CABG compared with those reporting low marital satisfaction. Highly satisfied men were 2.7 times (p < .03) and highly satisfied women were 3.9 times (p < .15) more likely to be alive adjusting for age. Although the result was not significant for women, the effect size for marital satisfaction was actually larger for women than for men. CONCLUSIONS: Being married, especially being in a highly satisfying marriage, offered a significant benefit to long-term survival after CABG. Why marital status and marital satisfaction have this effect on survival is surely mulitfactorial, most likely a combination of spousal support and survivor motivation to adopt a healthy lifestyle, along with the provision of emotional support to the survivor, which all could have the effect of modulating the physiologic mechanisms responsible for slowing the advancement of CVD.

Montreal Cognitive Assessment and Mini-Mental Status Examination compared as cognitive screening tools in heart failure.

BACKGROUND: Heart failure (HF) patients run four times the risk of developing cognitive impairment than does the general population, yet cognitive screening is not routinely performed. METHODS: This cross-sectional study enrolled 90 community-dwelling adults with HF aged 50 years and above. Participants took the Mini Mental Status Examination (MMSE) and Montreal Cognitive Assessment (MoCA), to measure cognitive function in persons with HF. Participants were predominately men (66%) and Caucasian (78%), aged 50-89 years (62 SD, 9 years), and 77% had an ejection fraction <40%. RESULTS: Fifty-four percent of participants scored ≤26 on the MoCA, suggesting mild cognitive impairment (MCI), and 17% scored ≤22, suggesting moderate cognitive impairment, compared with 2.2% on the MMSE. The MoCA scores were lowest for visuospatial/executive domain, short-term memory, and delayed recall. These findings were similar to those in published reports. CONCLUSION: These preliminary findings support the use of MoCA for cognitive screening in stable HF.

Is a history of gestational diabetes related to risk factors for coronary heart disease?

Coronary heart disease (CHD) risk in 20 non-diabetic women with and 20 without a distant history of gestational diabetes (hGDM), matched on age, body mass index, and time since GDM-affected pregnancy, was compared in a case control study. Women with an hGDM had lower high-density lipoprotein cholesterol (HDL-c), p = .02, and higher triglycerides, p < or = .001, versus controls. The combination of high triglycerides and low HDL-c occurred in 25% of hGDM cases versus 0% of controls, p

Symptom presentation and time to seek care in women and men with acute myocardial infarction.

BACKGROUND: Leventhal's common sense model of illness representation was used to examine symptom presentation, time to seek care, and expectations about the experience of having an acute myocardial infarction (AMI). HYPOTHESES: (1) Women with AMI will report a different symptom set than men, (2) women's expectations about AMI, for level of risk and symptoms, will be different than men's, (3) women will take longer to seek care than men, and (4) as suggested by the common sense model, a match between expected and actual symptoms will be related to shorter time to seek care. METHOD: A descriptive, correlational design was used. Thirty woman and 30 men diagnosed with AMI or an evolving MI treated with thrombolytic therapy or primary percutaneous coronary intervention were interviewed using the Symptom Representation Questionnaire. RESULTS: Gender differences in symptom presentation were limited. The majority of women and men reported that their symptoms were different from what they expected an AMI would be like. Most stated that their pain was less than expected, whereas some reported either the location of discomfort or associated symptoms as different then expected. There was no gender difference in time to seek care. Logistic regression and survival analysis demonstrated that participants who reported a match between symptoms expected and actual symptoms experienced arrived in the emergency department sooner than those whose symptoms did not match their expectations. CONCLUSION: The findings provide support for the use of the common sense model to explain care-seeking behavior in AMI.

Symptom clusters in acute myocardial infarction: a secondary data analysis.

BACKGROUND: Early recognition of acute myocardial infarction (AMI) symptoms and reduced time to treatment may reduce morbidity and mortality. People having AMI experience a constellation of symptoms, but the common constellations or clusters of symptoms have yet to be identified. OBJECTIVES: To identify clusters of symptoms that represent AMI. METHODS: This was a secondary data analysis of nine descriptive, cross-sectional studies that included data from 1,073 people having AMI in the United States and England. Data were analyzed using latent class cluster analysis, an a theoretical method that uses only information contained in the data. RESULTS: Five distinct clusters of symptoms were identified. Age, race, and sex were statistically significant in predicting cluster membership. None of the symptom clusters described in this analysis included all of the symptoms that are considered typical. In one cluster, subjects had only a moderate to low probability of experiencing any of the symptoms analyzed. DISCUSSION: Symptoms of AMI occur in clusters, and these clusters vary among persons. None of the clusters identified in this study included all of the symptoms that are included typically as symptoms of AMI (chest discomfort, diaphoresis, shortness of breath, nausea, and lightheadedness). These AMI symptom clusters must be communicated clearly to the public in a way that will assist them in assessing their symptoms more efficiently and will guide their treatment-seeking behavior. Symptom clusters for AMI must also be communicated to the professional community in a way that will facilitate assessment and rapid intervention for AMI.

Heart and brain matters in heart failure: a literature review.

Heart failure (HF) patients are reported to have twice the risk of having cognitive deficits compared to the general population. Cognitive impairment in this population may cause non-compliance to prescribed self-care regimens and delay in seeking care that may potentially lead to frequent readmissions. Although cognitive deficit is common among people with HF, cognitive screening is not routinely performed due to lack of a simple screening tool and the misconception that cognitive changes are part of normal aging. Therefore, future research needs to focus on identifying a simple screening tool that nurses can use to screen for subtle changes in cognition including forgetfulness and delayed recall. Early identification of subtle cognitive changes has the potential to guide healthcare providers to formulate feasible strategies to understand and/or prevent a low cardiac output state before major cognitive impairment becomes evident.

Hormonal responses to the 6-minute walk test in women and men with coronary heart disease: a pilot study.

BACKGROUND: Women with coronary heart disease (CHD) are more likely than men to develop congestive heart failure (CHF). Dysregulation of sympathetic and volume-regulatory hormones may contribute to the onset of symptomatic CHF. We hypothesized that this hormonal dysregulation develops at an earlier stage of CHD in women than in men. OBJECTIVES: The study goals were (1) to determine the effect of gender on basal and exercise-induced plasma concentrations of catecholamines and volume-regulatory hormones in patients diagnosed with CHD, New York Heart Association class I and (2) to determine efficacy of the 6-minute walk test as a stimulus for release of these hormones. METHODS: Study participants were 9 women and 9 men with normal left ventricular ejection fraction (>50%) and CHD confirmed by arteriography. Data were collected under resting conditions, and after the 6-minute walk test, in the general clinical research center of a northeastern university medical center. RESULTS: Basal plasma vasopressin (VP) concentration was significantly higher in men than in women (P = .018). Exercise, for women and men combined, significantly increased atrial natriuretic peptide (P < .0005), VP (P = .04), norepinephrine (P < .0005), and epinephrine (P = .038) but not plasma renin activity (P = .09). No further gender differences were detected for basal levels, or for the magnitude of exercise-induced increases, for any of the hormones measured. CONCLUSIONS: The 6-minute walk test is an exercise of sufficient intensity and duration to initiate the release of hormones associated with sympathetic activation and fluid-electrolyte regulation in both women and men with CHD. It appears that a gender difference was detected only for basal VP levels.

Comparison of family caregivers. Stroke survivors vs. person with Alzheimer's disease.

The purpose of this study was to compare family caregivers of person with dementia and caregivers of stroke survivors with similar levels of caregiving responsibilities. The design was descriptive and included characteristics of care recipients, caregivers, and care situations. Caregivers of individuals with dementia reported care recipients were more impaired with independent activities of daily living and memory and behavior problems. There were no differences in caregiver depression and fatigue. Even with the benefit of respite care, a substantial number of caregivers had depression scores above the level indicating possible clinical depression. Consultation by advanced practice psychiatric nurses for caregivers and care recipients may be beneficial in detecting depression and making recommendations for appropriate treatment.

Perception of risk for coronary heart disease in women undergoing coronary angiography.

BACKGROUND: Even though coronary heart disease (CHD) is the leading cause of death among women in the United States, most women underestimate their risk of developing CHD. DESIGN: Survey to examine the relationship between women's recollection of being told they were at risk for CHD and the presence of risk factors. SETTING/PARTICIPANTS: A convenience sample of 450 women undergoing coronary angiography at 1 university hospital. MAIN OUTCOME MEASURES: Self-recollection of being told one was at risk for CHD and presence of CHD risk factors. RESULTS: Most women (83.6%) had 3 or more risk factors, 12.2% had 1 or 2 risk factors, and 0.9% had no risk factors. Only 35% of women recalled being told that they were at risk for CHD. Few relationships were found between being told one was at risk for CHD and the presence of individual risk factors. No difference was found in the mean number of risk factors among women who did and did not recall being told they were at risk. In logistic regression analysis, only 5% of the variance in recollection of being told one was at risk was predicted, with only age, education, and having a high cholesterol level significantly contributing to the equation. CONCLUSIONS: Even though women may not remember conversations with their health care provider about CHD risk, the possibility that risk factors were not adequately assessed cannot be discounted. Patient-provider conversations about CHD risk factors should be encouraged as the first step toward successful risk reduction.