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Background: Depression is common among patients with coronary heart disease (CHD) and has a major impact on their quality of life, morbidity and mortality. Aim: The aim of this study was to map the 12-month psychosocial outcomes of patients with CHD who were screened positive for depression in an acute cardiac ward. Methods: A prospective cohort study was conducted of the psychosocial trajectory (depression, anxiety, wellbeing, social support, mental health service access) of 212 patients with CHD who were screened for depression after being admitted to acute cardiac wards of a major metropolitan hospital. Outcomes were assessed before hospital discharge and at one, three, six and 12 months post-discharge. Results: Linear mixed models identified that those patients screened at 'moderate to high' risk of depression at baseline had higher levels of depression (F(1,173)=53.93, p<0.0001) and anxiety (F(1,180)=67.01, p<0.001), and lower levels of wellbeing (F(1,186)=42.47, p<0.001) and social support (F(1,177)=25.40, p<0.0001), compared to those at 'no to low' risk of depression. Levels of depression and wellbeing remained fairly constant over the 12-month trajectory. Surgical and medical treatment groups were of similar psychological composition over the 12-month period. Conclusions: These findings attest to the effectiveness and predictive validity of a simple nurse-administered screening tool designed to identify depression in hospital patients with CHD and also indicate that a screening and referral tool alone is not sufficient to achieve optimal disease management. A collaborative care model involving family members and integrated pathways to primary care is recommended. [ABSTRACT FROM AUTHOR]

Introduction: Persistent smoking in patients diagnosed with coronary heart disease (CHD) has a significant effect on morbidity and mortality. Although there has been considerable debate around gender differences in smoking cessation, conclusive evidence on how gender impacts rates of smoking cessation and/or relapse following CHD diagnosis is lacking.Aims and Methods: Our aim was to test the hypothesis that female smokers with CHD were more likely to persist in smoking or relapse post-diagnosis or hospitalization than male smokers. We searched PubMed and Web of Science databases for studies published in the last 10 years. Meta-analyses were conducted using a random effects model.Results: Sixteen studies met the inclusion criteria. The aggregated sample size was 36 591, 20 617 (56%) were smokers of which 2564 (12%) were female. Meta-analyses of eight studies where smoking prevalence could be measured, showed that females were less likely to be smokers at baseline than males (OR = 0.30, 95% CI = 0.13 to 0.70). Overall, one in two (47%) smokers persisted in smoking/relapsed following a diagnosis or hospitalization for CHD; but there was no gender difference in the rate of persistent smoking/relapse (OR = 1.07, 95% CI = 0.95 to 1.21).Conclusions: Female smokers with CHD were relatively uncommon in the included study populations. However, the rate of persistent smoking/relapse was high in both female and male smokers following a diagnosis or hospitalization for CHD. Therefore similar, sustained smoking cessation efforts are warranted for both genders.Implications: There was no gender difference for persistent smoking/relapse following a diagnosis or hospitalization for CHD, but the rate was high in both female and male smokers. Therefore, similar, sustained smoking cessation efforts are warranted for both genders. [ABSTRACT FROM AUTHOR]

BACKGROUND: Routine screening and assessment for depression occurs rarely in clinical practice for a variety of reasons, including the absence of systems to facilitate the process. AIM: To identify nurses' knowledge and practice regarding depression screening and referral for cardiac patients following the implementation of education workshops and a validated screening tool with referral actions. METHODS: Pre and post-test design using surveys and semi-structured interviews was conducted with a purposive sample of nurses in a large Australian metropolitan tertiary referral hospital. Prior to the introduction of the screening and referral tool, nurses engaged in an interactive one hour education workshop on the topic of depression and the tool; introduced to improve depression screening following an acute cardiac event. RESULTS: In the pre and post-survey 40 and 30 nurses, respectively, participated with 14 also engaging in semi-structured interviews. Eighty percent reported a 'good' understanding of depression post-program compared to 30% at baseline. Sixty percent reported routinely using the depression screening and referral tool. The interviews identified three main themes that supported the utility of the education and instrument: knowledge improvement; perceived self-efficacy and new knowledge into practice. CONCLUSION: The vast majority of participants reported increased skill, knowledge and confidence to screen and refer for depression post an acute cardiac event. The substantial increase in the number of nurses who engaged in screening and referral actions further demonstrated the success of the program. These encouraging results provide evidence that screening for depression can be achieved through adopting formalised processes. [ABSTRACT FROM AUTHOR]

Abstract: Background: Inability of heart failure (HF) patients to recognize worsening symptoms that herald an exacerbation is a common reason for HF readmissions. Aims: To examine the relationship between patterns of HF symptom variability, and HF event-free survival. Methods: Patients with HF (N=71) rated HF symptoms daily for 30days. Symptoms were rated on a 10 point scale anchored at the extreme ends by “worst symptom could be” and “best symptom could be”. Patients were followed for an average of 1year to track HF and cardiac rehospitalizations and all-cause mortality. Results: Cox regression comparing event-free survival between patients who had highly variable symptom ratings across the 30-days and those whose symptoms were less variable revealed worse event-free survival in patients with more variable symptoms of shortness of breath or edema. Symptom variability predicted event-free survival independently of severity of symptoms, ejection fraction, comorbidities, age and gender. Symptom severity did not predict rehospitalization or mortality. Conclusion: Regardless of symptom severity, patients whose symptoms fluctuated in an improving and worsening pattern were at substantially greater risk for poorer event-free survival. These patients may become accustomed to this pattern such that they expect symptoms to improve and thus do not seek treatment with worsening symptoms. [ABSTRACT FROM AUTHOR]

Abstract: Background: There are many reasons to explain why achievement of optimal self-care can be difficult for many patients with chronic heart failure (CHF). Aim: To investigate differences in self-care skills between patients with and without experience of CHF symptoms. Methods: On the basis of a confirmed diagnosis and treatment for CHF <2months or >2months, patients were prospectively designated as “novices” or “experienced”. Administration of the Self-Care Heart Failure Index assessed 3 self-care skills: maintenance, management and confidence. A score >70% in each scale is considered adequate self care. Hierarchal regression models were built to test three hypotheses. Results: In 143 elderly patients hospitalised with CHF, novices had lower self-care maintenance (63±16 vs. 71±14, p =0.05) and self-care management scores (48±17 vs. 58±19, p =0.003) than experienced patients. Novices were less likely to have adequate self-care maintenance (OR, 0.73; 95% CI 0.5 to 0.9, LR<0.02) and management (OR, 0.3; 95% CI, 0.1 to 0.8, p =0.02). Patients experienced with CHF had similar confidence levels (66±17 vs. 64±17, p =0.40) to novices. Conclusion: Level of experience is a determinant of self-care skills suggesting this factor should be considered in determining an individual education plan. [Copyright &y& Elsevier]