Comprehensive Review of Cardiovascular Involvement in COVID-19.

COVID-19 has emerged as one of the most devastating and clinically significant infectious diseases of the last decade. It has reached global pandemic status at an unprecedented pace and has placed significant demands on health care systems worldwide. Although COVID-19 primarily affects the lungs, epidemiologic reports have shown that the disease affects other vital organs of the body, including the heart, vasculature, kidneys, brain, and the hematopoietic system. Of importance is the emerging awareness of the effects of COVID-19 on the cardiovascular system. The current state of knowledge regarding cardiac involvement in COVID-19 is presented in this article, with particular focus on the cardiovascular manifestations and complications of COVID-19 infection. The mechanistic insights of disease causation and the relevant pathophysiology involved in COVID-19 as they affect the heart are explored and described. Relevant practice essentials and clinical management implications for patients with COVID-19 with a cardiac pathology are presented in light of recent evidence.

Mnemonic to assist in the treatment of NSTE-ACS.

Acute care NPs are in an ideal position to diagnose and manage non-ST-segment elevation (NSTE)-acute coronary syndrome (ACS) by implementing guideline-driven medical interventions. Utilizing mnemonics improves efficiency of clinicians in practice. This article introduces a mnemonic to assist NPs in their response to patients with NSTE-ACS.

Exploring the complex interactions of baseline patient factors to improve nursing triage of acute coronary syndrome.

Emergency department (ED) nurses need to identify patients with potential acute coronary syndrome (ACS) rapidly because treatment delay could impact patient outcomes. Aims of this secondary analysis were to identify key patient factors that could be available at initial ED nurse triage that predict ACS. Consecutive patients with chest pain who called 9-1-1, received a 12-lead electrocardiogram in the prehospital setting, and were transported via emergency medical service were included in the study. A total of 750 patients were recruited. The sample had an average age of 59 years old, was 57% male, and 40% Black. One hundred and fifteen patients were diagnosed with ACS. Older age, non-Caucasian race, and faster respiratory rate were independent predictors of ACS. There was an interaction between heart rate by Type II diabetes receiving insulin in the context of ACS. Type II diabetics requiring insulin for better glycemic control manifested a faster heart rate. By identifying patient factors at ED nurse triage that could be predictive of ACS, accuracy rates of triage may improve, thus impacting patient outcomes.

Octogenarian preferences and expectations for acute coronary syndrome treatment.

BACKGROUND: The number of elderly persons with cardiovascular disease is increasing. In Sweden, the incidence of acute myocardial infarction is the highest among individuals aged 85 years and over. However, there is still little evidence about whether this population benefits from established treatments. Furthermore, the values and preferences of octogenarians (age ⩾80 years), as well as how they could be involved in treatment decisions, have been largely overlooked in research. Overall, increased knowledge about the preferences and expectations of octogenarians is needed to incorporate their treatment expectations into the decision-making process. AIMS: This study aimed to describe the treatment choice preferences and post-treatment life expectations of octogenarians with acute coronary syndrome. METHODS: A total of 19 patients (eight women, 11 men) aged 80 years and older and diagnosed with non-ST-elevation myocardial infarction or unstable angina were enrolled in this qualitative study. Data were collected between May 2011 and June 2013 through semistructured interviews. The data were analysed using qualitative content analysis. RESULTS: We identified two main categories: Wanting the best and Hope for increased wellbeing. Participant preferences were influenced by their own and others' previous experiences and their confidence in healthcare professionals. With respect to treatment outcomes, the participants hoped to get well, stay active, experience fewer symptoms and regain vitality. CONCLUSION: The studied octogenarians desired the best treatment option and trusted that their healthcare providers will make appropriate recommendations. These patients expected their treatment to result in increased wellbeing and fewer symptoms.

Relationship between the frequency of nursing activities and adverse outcomes in patients with acute coronary syndrome: A retrospective cohort study.

The aim of this retrospective cohort study was to identify the relationship between the frequency of nursing activities during the first hospitalization and adverse outcomes in patients with acute coronary syndrome by using electronic health records. Patients diagnosed with acute coronary syndrome from April 2010 to April 2015 were examined for eligibility based on 36 months of major adverse cardiac events as the main outcome. Among the 652 patients who were enrolled, 66 patients experienced major adverse cardiac events. The average frequency of nursing activities was 1098.7 (±2703.8), and four variables (length of hospital stay, albumin level, hemoglobin level, and frequency of nursing activities) were significantly associated with 36 months of major adverse cardiac events. After adjusting for these variables, the frequency of nursing activities was found to be the only significant factor associated with the incidence of 36 months of major adverse cardiac events. This finding suggests that patients with acute coronary syndrome who require more frequent nursing activities during the first hospitalization could be vulnerable to adverse outcomes and should be closely monitored.

Nurses' recognition and response to clinical deterioration in the cardiac catheterisation laboratory.

BACKGROUND: Patients presenting to the cardiac catheter laboratory for treatment of unstable acute coronary syndromes (ACS) experience a mismatch in myocardial oxygen supply and demand, causing vital sign abnormalities prior to neurological, cardiac and respiratory deterioration. Delays in detecting clinical deterioration and escalating care increases risk of adverse events, unplanned intensive care (ICU) admission, cardiac arrest, and in-hospital mortality. OBJECTIVES: The objective of the study was to explore how nurses in the cardiac catheter laboratory (CCL) recognise and respond to clinical deterioration in patients with unstable ACS undergoing primary percutaneous coronary intervention (PCI). METHODS: A prospective exploratory descriptive design was used with 30 participants completing 10 written clinical scenarios. Participants scored their level of concern for each physiological cue and then then ranked their preferred immediate response based on the deterioration identified. RESULTS: Hypotension and the presence of pain were the physiological cues of highest concern. The most common responses to clinical deterioration were to increase vital sign assessment to 5-minutely intervals, administer pain relief or provide reassurance. Despite the presence of clinical deterioration fulfilling organisational escalation of care criteria, calling cardiac arrest or rapid response team (RRT) were not commonly selected responses. CONCLUSION: Nurses most commonly use hypotension and the presence of pain to recognise clinical deterioration in patients presenting to the CCL with an unstable ACS. Once clinical deterioration is identified, interventional cardiac nurses delay the escalation of care to the RRT or cardiac arrest team, preferring to implement local nurse initiated interventions.

Prevalence and Associations Between Related Factors and Defining Characteristics of the Nursing Diagnosis Sedentary Lifestyle in Patients with Acute Coronary Syndrome.

PURPOSE: To identify the prevalence of Sedentary Lifestyle (SL) and associations between its defining characteristics (DC) and related factors (RF) in patients with acute coronary syndrome (ACS). DATA SOURCES: 123 patients with ACS were assessed for SL through the International Physical Activity Questionnaire. Associations between DC and RF was investigated by Pearson's Chi square and Fisher's exact test. DATA SYNTHESIS: 56.1% had SL. Insufficient motivation and Insufficient resources for physical activity were associated with two DC. CONCLUSION: SL was frequent and there were associations between RF and DC. IMPLICATIONS FOR NURSING PRACTICE: Multi-professional interventions should aim at motivating patients to adopt physical activities.

Patient-reported symptoms improve prediction of acute coronary syndrome in the emergency department.

Early diagnosis is critical in the management of patients with acute coronary syndrome (ACS), particularly ST-elevation myocardial infarction (STEMI), because effective therapies are time-dependent. Aims of this secondary analysis were to determine: (i) the prognostic value of symptoms for an ACS diagnosis in conjunction with electrocardiographic (ECG) and troponin results; and (ii) if any of 13 symptoms were associated with prehospital delay in those presenting to the emergency department (ED) with potential ACS. Patients receiving a cardiac evaluation in the ED were eligible for the study. Thirteen patient-reported symptoms were assessed in triage. Prehospital delay time was calculated as the time from symptom onset until registration in the ED. A total of 1,064 patients were enrolled in five EDs. The sample was 62% male, 70% white, and had a mean age of 60.2 years. Of 474 participants diagnosed with ACS, 118 (25%) had STEMI; 251 (53%) had non-ST elevation myocardial infarction (NSTEMI); and 105 (22%) had unstable angina. Sweating (OR = 1.42 CI [1.01, 2.00]) and shoulder pain (OR = 1.64 CI [1.13, 2.38]) added to the predictive value of an ACS diagnosis when combined with ECG and troponin results. Shortness of breath (OR = 0.71 CI [0.50, 1.00]) and unusual fatigue (OR = 0.60 CI [0.42, 0.84]) were predictive of a non-ACS diagnosis. Sweating predicted shorter prehospital delay (HR = 1.35, CI [1.10, 1.67]); shortness of breath (HR = 0.73 CI [0.60, 0.89]) and unusual fatigue (HR = 0.72, CI [0.57, 0.90]) were associated with longer prehospital delay. Patient-reported symptoms are significantly associated with ACS diagnoses and prehospital delay. Sweating and shoulder pain combined with ECG signs of ischemia may improve the timely detection of ACS in the ED.

ALLiance for sEcondary PREvention after an acute coronary syndrome. The ALLEPRE trial: A multicenter fully nurse-coordinated intensive intervention program.

The main objective of cardiovascular disease prevention is to reduce morbidity and mortality by promoting a healthy lifestyle, reducing risk factors, and improving adherence to medications. Secondary prevention after an acute coronary syndrome has proved to be effective in reducing new cardiovascular events, but its limited use in everyday clinical practice suggests that there is considerable room for improvement. The short-term results of evidence-based studies of nurse-coordinated secondary prevention programs have been positive, but there is a lack of long-term outcome data. The Alliance for the Secondary Prevention of Cardiovascular Disease in the Emilia-Romagna region (ALLEPRE) is a multicenter, randomized, controlled trial designed to compare the effects of a structured nurse-coordinated intensive intervention on long-term outcomes and risk profiles after an acute coronary syndrome with those of the standard of care. All of the patients randomized to the intervention group take part in 9 one-to-one sessions with an experienced nurse from the participating centers with the aim at promoting healthy lifestyles, reducing risk factors, and increasing adherence to medication over a mean period of 5 years. The primary clinical end point is the reduction in the risk of the 5-year occurrence of major adverse events (a composite of cardiovascular mortality, nonfatal reinfarction, and nonfatal stroke). The primary surrogate end point is the achievement of prespecified targets relating to classical risk factors, lifestyle modifications, and adherence to pharmacological therapy after 2 years of follow-up. Coronary heart disease is a chronic degenerative disease, and patients who recover from an acute coronary syndrome (ACS) are at high risk of developing recurrent events.1 Although secondary prevention measures have proved to be effective and are strongly recommended by all of the international guidelines,2., 3. the 4 EUROASPIRE surveys4., 5., 6., 7., 8. showed that there was still a high prevalence of conventional risk factors, that secondary prevention measures were inadequately implemented, and that their main goals were often not reached. In addition, there were considerable discrepancy in secondary prevention practices between centers and countries, and a widespread underuse of cardiac prevention and rehabilitation programs despite their demonstrated effectiveness in reducing cardiovascular risk over time.9., 10. Over the last 10 years, nurses have been increasingly involved in successful cardiovascular risk management,11., 12., 13. but although this has improved levels of cardiovascular risk, no clear reduction in hard end points such as major cardiovascular adverse events and mortality has been demonstrated.10 The aim of the ALLEPRE trial is to evaluate the benefit of a homogeneous, structured, secondary prevention intervention program, fully coordinated by nurses from in- and outpatient clinics, in terms of cardiovascular risk profiles and major clinical events in ACS patients living in the large Emilia-Romagna region of Italy.

I-CARE randomized clinical trial integrating depression and acute coronary syndrome care in low-resource hospitals in China: Design and rationale.

Depression and acute coronary syndromes (ACS) are both common public health challenges. Patients with ACS often develop depression, which in turn adversely affects prognosis. Low-cost, sustainable, and effective service models that integrate depression care into the management of ACS patients to reduce depression and improve ACS outcomes are critically needed. Integrating Depression Care in ACS patients in Low Resource Hospitals in China (I-CARE) is a multicenter, randomized controlled trial to evaluate the efficacy of an 11-month integrated care (IC) intervention compared to usual care (UC) in management of ACS patients. Four thousand inpatients will be recruited and then randomized in a 1:1 ratio to an IC intervention consisting of nurse-led risk factor management, group-based counseling supplemented by individual problem-solving therapy, and antidepressant medications as needed, or to UC. The primary outcomes are depression symptoms measured by the Patient Health Questionnaire-9 at 6 and 12 months. Secondary endpoints include anxiety measured by the Generalized Anxiety Disorder-7; quality of life measured by the EQ-5D at 6 and 12 months; and major adverse events including the combined end point of all-cause death, suicide attempts, nonfatal myocardial infarction, nonfatal stroke, and all-cause rehospitalization at yearly intervals for a median follow-up of 2 years. Analyses of the cost-effectiveness and cost-utility of IC also will be performed. I-CARE trial will be the largest study to test the effectiveness of an integrated care model on depression and cardiovascular outcomes among ACS patients in resource-limited clinical settings.

Improvement of Door-to-Electrocardiogram Time Using the First-Nurse Role in the ED Setting.

INTRODUCTION: This quality improvement project compared door-to-electrocardiogram (ECG) times for patients presenting with symptoms suggestive of acute coronary syndrome within a community hospital emergency department before and after first-nurse (emergency nurse stationed in the ED waiting room) training. METHOD: Door-to-ECG time was compared before and after the educational intervention using Acute Coronary Treatment and Intervention Outcomes Network (ACTION) registry data reported by the facility. RESULTS: Statistical significance was not achieved using a 2-group t-test. However, when comparing monthly means, data trend lines showed favorable improvement for door-to-ECG time after the intervention. DISCUSSION: Limitations included using only those patients in the ACTION registry and not accounting for RN turnover with first-nurse education. Future studies should focus on all patients presenting with symptoms of acute coronary syndrome as well as other patients presenting with time-sensitive needs to determine the efficacy of the first-nurse role.

Practical Care Support During the Early Recovery Period After Acute Coronary Syndrome.

OBJECTIVE: To describe the prevalence and predictors of receipt of practical support among acute coronary syndrome (ACS) survivors during the early post-discharge period. METHOD: 406 ACS patients were interviewed about receipt of practical (instrumental and informational) support during the week after discharge. Demographic, clinical, functional, and psychosocial predictors of instrumental and informational practical support were examined. RESULTS: 81% of participants reported receiving practical support during the early post-discharge period: 75% reported receipt of instrumental support and 51% reported receipt of informational support. Men were less likely to report receiving certain types of practical support, whereas married participants and those with higher education, impaired health literacy, impaired activities of daily living, and in-hospital complications were more likely to report receiving certain types of practical support. CONCLUSION: Receipt of practical support is very common among ACS survivors during the early post-discharge period, and type of support received differs according to patient characteristics.

Decision making in practice: influences, management and reflection.

During placements, student nurses encounter a multitude of scenarios where decisions are made that influence patient outcomes. Many factors help support these decisions and this article will use a number of theories and models to analyse a clinical decision. It will critically discuss what influences health professionals' decision making and how they present treatment options to patients. The importance of reflection in decision making and its role in broadening students' knowledge on key nursing skills and best practice techniques in preparation for registered practice are also discussed.

Interações medicamentosas na síndrome coronariana aguda: gerenciamento de segurança / Drug drug interactions in acute coronary syndrome: safety management

A doença cardiovascular apresenta-se entre as principais causas de morte no Brasil e no mundo ocidental. Neste escopo, a síndrome coronariana aguda (SCA) ocupa lugar de destaque. A terapia medicamentosa instituída em sua maioria demanda a polifarmácia, ou seja, o uso de cinco ou mais medicamentos concomitantes e em diferentes classes. Tal evento predispõe a ocorrência de potenciais interações medicamentosas (PIM), podendo resultar na redução da segurança e eficácia do processo terapêutico. Partindo da perspectiva do enfermeiro na segurança do paciente, associada ao complexo processo de utilização dos medicamentos, o presente estudo apresenta como objetivo, a análise das PIM em pacientes com SCA. Realizou-se uma pesquisa do tipo descritiva retrospectiva de corte transversal, com coleta de dados em prontuários de janeiro a dezembro de 2015, na unidade cardiointensiva de um hospital universitário no município do Rio de Janeiro. Foi realizada caracterização sociodemográfica e clínica da população, análise do perfil farmacológico e classificação das PIM quanto à gravidade, mecanismo, tempo de início, nível de documentação e índice de risco. Para tal utilizou-se a base de dados Micromedex® e literatura específica. Empregou-se análise descritiva para variáveis qualitativas e quantitativas. Para análise bivariada foi aplicado o Teste X2 (Qui-Quadrado) de Pearson, Teste T e U de Mann-Whitney. Os dados foram analisados pelos softwares Microsoft Excel® e Stata 11.0.®. Foram analisadas 390 prescrições onde a média de idade foi de 58,8 ± 9,6 anos. Os principais fatores de risco encontrados foram: hipertensão arterial sistêmica (95,4%), tabagismo (46,2%) e dislipidemia (40,0%). O número médio de fármacos por prescrição foi 7,151,48. Foram identificadas 2062 PIM, com número médio por prescrição de 5,22,2, houve prevalência do nível de gravidade maior 1.505 (73,0%), tempo de inicio rápido 740 (35,9%), mecanismo farmacodinâmico 910 (44,1%), nível de documentação bom 1.025 (49,7%), e 1.166 (56,4%) demandam monitoramento da terapia (índice de risco C). Quanto às associações, o grupo SCA CSSST apresentou número médio maior de PIM quando comparado ao grupo SCA SSSST (p=0,022). Conclui-se que a população do estudo apresentou alto grau de vulnerabilidade as PIM, cuja principal consequência identificada foi o risco de sangramento, desta forma, é de suma importância a implementação de intervenções clínicas e gerenciais de enfermagem para monitoramento e prevenção de possíveis eventos adversos advindos da terapia medicamentosa.

Cardiovascular disease presents itself among the leading causes of death in Brazil and in the Western world. At this scope, acute coronary syndrome (ACS) occupies a prominent place. Drug therapy administered mostly demand polypharmacy, that is, use of five or more drugs and different classes. Such an event predisposes the occurrence of potential drug drug interactions (PDDI), reducing the safety and efficacy of the therapeutic process. From the nursing perspective on patient safety, associated with the complex process of use of medicines, the present study has as objective the analysis of PDDI in patients with ACS. We conducted a retrospective descriptive cross-sectional study, with data collected from medical charts from january to december 2015, in cardiac intensive care unit of a university hospital in the city of Rio de Janeiro. Socio-demographic and clinical characteristics of the population was carried out, the pharmacological profile analysis and classification of PDDI in severity, mechanism, start time, level of documentation and risk index. For that, we used the database Micromedex® and scientific literature. Was used descriptive data analysis of qualitative and quantitative variables. For bivariate analysis, was applied the X2 test (chi-square) Pearson, T test and Mann-Whitney. The data were analyzed by the software Microsoft Excel® and Stata 11.0.® software. 390 prescriptions were analyzed where the average age was 58.8 ± 9.6 years, the main risk factors were: hypertension (95.4%), smoking (46.2%) and dyslipidemia (40,0%). The average number of drugs per prescription was 7,15±1,48. 2062 PIM were identified, with the average number of prescription 5,2±2,2, there was prevalence of the most severe level of 1,505 (73.0%), quick start time 740 (35.9%), pharmacodynamic mechanism 910 (44.1%), level of documentation good 1.025 (49.7%) and risk index C 1,166 (56.4%). About associations, the SCA CSSST group had a higher average number of PDDI compared to SCA SSSST group (p = 0.022). It was concluded that the study population presented a high level of vulnerability to PDDI, whose main consequence was the risk of bleeding, so it is of great importance to the implementation of clinical and managerial nursing interventions for monitoring and prevention of possible adverse events from drug therapy.

Actualización en atención de Enfermería al paciente con síndrome coronario agudo en Urgencias / Update in Nursing Care for Acute Coronary Syndrome patients at the ER Unit

OBJETIVO: aportar una actualización para los equipos de Enfermería, sobre las definiciones, manejo y cuidados del paciente con síndrome coronario agudo (SCA) en el ámbito de Urgencias o Unidades de dolor torácico (UDT), basada en protocolos, guías clínicas y otras aportaciones actualizadas y relevantes sobre cuidados. MÉTODO: se realizó una revisión narrativa limitada al intervalo de los años 2011-2015 en las bases de datos Cochrane, Medline, Joanna Briggs Institute, CUIDEN y MEDES con los descriptores 'síndrome coronario agudo', 'cuidados', 'guías', y 'acute coronary syndrom', 'nursing care', 'guidelines', 'emergency nursing', y revisando los protocolos actualizados en atención al paciente con SCA de la European Society of Cardiology y el European Resucitation Council. RESULTADOS: se seleccionaron un total de 15 documentos que incluían guías clínicas, protocolos, revisiones y originales. El síndrome coronario agudo comprende la angina inestable, el infarto agudo de miocardio con elevación de segmento ST (IAMCEST) e infarto agudo de miocardio sin elevación de ST (IAMSEST). El dolor típico está presente en el 70% de los pacientes. El atípico se asocia a peor pronóstico. La identificación precoz se garantiza con un ECG antes de 10 min tras la llegada a Urgencias. El tratamiento de elección es la intervención coronaria percutánea (ICP) sin esperar resultados de troponinas en un rango de 90-120 min. CONCLUSIONES: mantener una constante actualización en la administración de los cuidados es clave para una óptima actuación ante pacientes con SCA en Urgencias

OBJECTIVE: to provide an update for Nursing Teams regarding definitions, management and care for patients with Acute Coronary Syndrome (ACS) in the ER or Thoracic Pain Units (TPUs), based on protocols, clinical guidelines, and other updated and relevant contributions on patient care. METHOD: a narrative review was conducted, limited to the 2011-2015 year interval, in the Cochrane, Medline, Joanna Briggs Institute, CUIDEN and MEDES databases, with the descriptors: 'Síndrome Coronario Agudo', 'Cuidados', 'Guías', and 'Acute Coronary Syndrome', 'Nursing Care', 'Guidelines', 'Emergency nursing', and reviewing the updated protocols for ACS patient care from the European Society of Cardiology and the European Resuscitation Council. RESULTS: in total, 15 documents were selected, including clinical guidelines, protocols, reviews and original articles. Acute Coronary Syndrome includes Unstable Angina, Acute ST Segment Elevation Myocardial Infarction (STEMI) and Acute Non-ST Segment Elevation Myocardial Infarction (NSTEMI). Typical pain is present in 70% of patients; atypical patient is associated with a worse prognosis. An early identification is guaranteed through ECG within the first 10 minutes after arrival at ER. The treatment of choice is Percutaneous Coronary Intervention (PCI) without waiting for troponin results within a 90 to 120-minute range. CONCLUSIONS: a constant update in patient care administration is a key factor for an optimal action when faced with ACS patients at the ER Unit