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Aims and Objectives: The study was conducted to describe long-term perceived health among patients after a percutaneous coronary intervention as well as clarify the associations between perceived health and various factors., Background: Perceived health is an important outcome for coronary heart disease patients who have undergone percutaneous coronary intervention. Poor perceived health predicts low adherence to treatment, morbidity and mortality., Design: An explanatory and descriptive survey with a six-year follow-up (STROBE Statement: File S1)., Methods: Baseline data (n = 416) were collected in 2013, with follow-up data collected from the same study group in 2019 (n = 154) at two university hospitals and three central hospitals in Finland. The employed self-reported questionnaire was based on the EuroQoL visual analogue scale and EuroQol five-dimensional scale. Data were analysed using descriptive statistics and multivariate methods., Results: Perceived health did not significantly differ four months or six years after percutaneous coronary intervention. The respondents most commonly reported pain and discomfort (62.1%), problems in mobility (50.3%), issues with usual activities (27.5%), and anxiety and depression (24.0%). Managing self-care (8.5%) was least likely to be an issue for the respondents. A majority of the reported problems were of a mild nature. The consumption of an adequate amount of vegetables, lower systolic blood pressure, regular follow-up treatment, lack of prior invasive procedures, and younger age predicted better scores for both perceived health and its separate dimensions., Conclusion: Regular follow-up is important to ensure after percutaneous coronary intervention to identify patients with pain and discomfort, mobility problems, depression and anxiety. Healthcare professionals should pay particular attention to elderly patients, who have undergone severe invasive procedures., Relevance to Clinical Practice: This study confirms the importance of regular follow-ups for post-percutaneous coronary intervention patients., Patient or Public Contribution: Patients have completed a self-reported questionnaire based on informed consent., (© 2022 The Authors. Journal of Clinical Nursing published by John Wiley & Sons Ltd.)

Background: Adherence to treatment is a crucial factor in preventing the progression of coronary heart disease. More evidence of the predictors of long-term adherence is needed., Aims: The purpose of this study was to identify the predictive factors of adherence to treatment six years after percutaneous coronary intervention., Methods: Baseline data ( n =416) was collected in 2013 and follow-up data in 2019 ( n =169) at two university hospitals and three central hospitals in Finland. The self-reported Adherence of Patients with Chronic Disease Instrument was used. Data were analysed using descriptive statistics and binary logistic regression analysis., Results: The respondents reported higher adherence to a healthy lifestyle six years after percutaneous coronary intervention in comparison to four months post-percutaneous coronary intervention; adherence was seen in their healthy behaviour, such as decreased smoking and reduced alcohol consumption. Participating in regular follow-up control predicted adherence. Support from next of kin predicted physical activity and normal cholesterol levels; this outcome was associated with close relationships, which also predicted willingness to be responsible for treatment adherence. Women perceived lower support from nurses and physicians, and they had more fear of complications. Fear was more common among respondents with a longer duration of coronary heart disease. Physical activity and male gender were associated with perceived results of care., Conclusion: Support from next of kin, nurses and physicians, results of care, responsibility, fear of complication and continuum of care predicted adherence to treatment in long term. These issues should be emphasised among women, patients without a close relationship, physically inactive and those with a longer duration of coronary heart disease.

Aim: To test the hypothetical model of adherence to treatment among patients with coronary disease after percutaneous coronary intervention., Design: A descriptive, explanatory, cross-sectional survey., Methods: The study was conducted in 2013 with 416 patients in five hospitals in Finland. The adherence of patients with chronic disease instrument, the adherence visual analogue scale, the social support for people with coronary heart disease instrument, the EuroQoL five-dimensional scale and EuroQoL visual analogue scale were used. The data were analysed using descriptive statistic. The hypothetical model was tested using structural equation modelling., Results: The hypothetical model explained 30% of perceived adherence to treatment. Structural equation modelling confirmed that motivation, support from physicians and next of kin had direct associations with adherence. Indirectly, informational support, results of care, perceived health, anxiety and depression were associated with adherence. The background variables associated with adherence were gender, relationship, physical activity, consumption of vegetables and consumption of alcohol., Competing Interests: No conflict of interest has been declared by the authors., (© 2019 The Authors. Nursing Open published by John Wiley & Sons Ltd.)

Background: Adherence to treatment is essential to prevent the progression of coronary heart disease (CHD), which is the most common cause of death among women. Coronary heart disease in women has special characteristics: the conventional risk factors are more harmful to women than men, accumulation of risk factors is common, and women have nontraditional risk factors such as gestational diabetes and preeclampsia. In addition, worse outcomes, higher incidence of death, and complications after percutaneous coronary intervention have been reported more often among females than among male patients., Objective: The aim of this study was to test a model of adherence to treatment among female patients with CHD after a percutaneous coronary intervention., Methods: A cross-sectional, descriptive, and explanatory survey was conducted in 2013 with 416 patients with CHD, of which the 102 female patients were included in this substudy. Self-reported instruments were used to assess female patient adherence to treatment. Data were analyzed using descriptive statistics and a structural equation model., Results: Motivation was the strongest predictor for female patients' perceived adherence to treatment. Informational support, physician support, perceived health, and physical activity were indirectly, but significantly, associated with perceived adherence to treatment via motivation. Furthermore, physical activity was positively associated with perceived health, whereas anxiety and depression were negatively associated with it., Conclusions: Secondary prevention programs and patient education have to take into account individual or unique differences. It is important to pay attention to issues that are known to contribute to motivation rather than to reply on education alone to improve adherence.

Aims: Patient-reported outcomes (PROs) are valuable for effectiveness evaluation, but it is unknown whether the patient views obtained represent the actual case mix. We studied the representativeness of the responses obtained to a routinely administered health-related quality of life (HRQoL) questionnaire in a cardiology unit., Methods and Results: Elective coronary artery bypass grafting (CABG; n = 404) and percutaneous coronary intervention (PCI; n = 738) patients operated during June 2012 to August 2014 in the Heart Center, Kuopio University Hospital. The characteristics of the patients with a baseline (n = 260 and 290 for CABG and PCI, respectively) or both baseline and follow-up HRQoL measurements (n = 203 and 189 for CABG and PCI, respectively) were compared with those who did not respond (n = 144 and 448 for CABG and PCI). Baseline questionnaires were less likely obtained from older CABG patients (odds ratio 0.51, 95% confidence interval 0.28-0.91) and those with more severe disease (0.20, 0.05-0.79). Among PCI patients, women (0.64, 0.45-0.91), smokers (0.74, 0.53-1.04), and those with more severe disease (0.26, 0.13-0.52) or more hospital days were underrepresented., Conclusion: Routinely collected PROs in cardiac patients may be biased towards younger and healthier patients. This needs to be recognized when evaluating the representativeness of such data. The routine collection of these data should be adequately resourced.

Aims and Objectives: To identify the predictors of adherence in patients with coronary heart disease after a percutaneous coronary intervention., Background: Adherence is a key factor in preventing the progression of coronary heart disease., Design: An analytical multihospital survey study., Methods: A survey of 416 postpercutaneous coronary intervention patients was conducted in 2013, using the Adherence of People with Chronic Disease Instrument. The instrument consists of 37 items measuring adherence and 18 items comprising sociodemographic, health behavioural and disease-specific factors. Adherence consisted of two mean sum variables: adherence to medication and a healthy lifestyle. Based on earlier studies, nine mean sum variables known to explain adherence were responsibility, cooperation, support from next of kin, sense of normality, motivation, results of care, support from nurses and physicians, and fear of complications. Frequencies and percentages were used to describe the data, cross-tabulation to find statistically significant background variables and multivariate logistic regression to confirm standardised predictors of adherence., Results: Patients reported good adherence. However, there was inconsistency between adherence to a healthy lifestyle and health behaviours. Gender, close personal relationship, length of education, physical activity, vegetable and alcohol consumption, LDL cholesterol and duration of coronary heart disease without previous percutaneous coronary intervention were predictors of adherence., Conclusions: The predictive factors known to explain adherence to treatment were male gender, close personal relationship, longer education, lower LDL cholesterol and longer duration of coronary heart disease without previous percutaneous coronary intervention., Relevance to Clinical Practice: Because a healthy lifestyle predicted factors known to explain adherence, these issues should be emphasised particularly for female patients not in a close personal relationship, with low education and a shorter coronary heart disease duration with previous coronary intervention., (© 2017 John Wiley & Sons Ltd.)

Aims and Objectives: To describe perceived social support among patients with coronary heart disease following percutaneous coronary intervention., Background: A low level of social support is considered a risk factor for coronary heart disease in healthy individuals and reduces the likelihood that people diagnosed with coronary heart disease will have a good prognosis., Design: A descriptive cross-sectional study., Methods: A survey of 416 patients was conducted in 2013. A self-report instrument, Social Support of People with Coronary Heart Disease, was used. The instrument comprises three dimensions of social support: informational, emotional, functional supports and 16 background variables. Data were analysed using descriptive statistics, factor analysis, mean sum variables and multivariate logistic regression., Results: Perceived informational support was primarily high, but respondents' risk factors were not at the target level. The weakest items of informational support were advice on physical activity, continuum of care and rehabilitation. Regarding the items of emotional support, support from other cardiac patients was the weakest. The weakest item of functional support was respondents' sense of the healthcare professionals' care of patients coping with their disease. Background variables associated with perceived social support were gender, marital status, level of formal education, profession, physical activity, duration of coronary heart disease and previous myocardial infarction., Conclusions: Healthcare professionals should pay extra attention to women, single patients, physically inactive patients, those demonstrating a lower level of education, those with a longer duration of CHD, and respondents without previous acute myocardial infarction. Continuum of care and counselling are important to ensure especially among them., Relevance to Clinical Practice: This study provides evidence that healthcare professionals should be more aware of the individual needs for social support among patients with coronary heart disease after percutaneous coronary intervention., (© 2016 John Wiley & Sons Ltd.)

Aim: To test the Theory of Adherence of People with Chronic Disease with regard to adherence to treatment among patients with coronary heart disease after a percutaneous coronary intervention., Background: Increased knowledge of the concept of adherence is needed for the development of nursing interventions and nursing guidelines for patients with coronary heart disease., Design: A cross-sectional, multi-centre study., Methods: This study was conducted from February-December 2013 with 416 patients with coronary heart disease 4 months after undergoing a percutaneous coronary intervention. A self-reported questionnaire was used to assess their adherence to treatment. Data were analysed using structural equation modelling., Results: The theory explained 45% of the adherence to a healthy lifestyle and 7% of the adherence to medication. Structural equation modelling confirmed that motivation and results of care had the highest association with adherence to a healthy lifestyle. Responsibility was associated with adherence to medication. Support from next of kin, support from nurses and physicians, and motivation, co-operation, fear of complications and a sense of normality were associated with adherence., Conclusion: Patients who are motivated to perform self-care and consider the results of care to be important were more likely to adhere to a healthy lifestyle. Responsible patients were more likely to adhere to their medication. It is important to account for these elements as a part of secondary prevention strategies among patients with coronary heart disease after a percutaneous coronary intervention., (© 2015 John Wiley & Sons Ltd.)

Aims: We studied the purchases of medical therapy recommended for coronary artery disease patients before and after elective revascularisation (percutaneous coronary intervention (PCI) or coronary bypass grafting (CABG)). Methods: All patients who underwent an elective PCI (N = 1557) or CABG (N = 1768) at the Heart Center, Kuopio University hospital between 2007 and 2014 were included. Data were collected from the hospital's coronary register and national registers, and obtained for 3 years before and 1 year after the revascularisation. Results: Altogether 85.2% of PCI patients and 88.1% of CABG patients had purchased lipid-modifying agents before the procedure, and 94.9% and 96.8% during the post-procedure follow-up year, respectively. Beta-blocking agents were purchased by 84.9% of PCI patients before and by 87.9% after the procedure and by 86.3% of CABG patients before and 97.1% after the operation. Of PCI patients, 64.3% had purchased organic long-acting nitrates before the procedure and 54.4% also after the procedure. Among CABG patients, the purchase of organic long-acting nitrates fell from 59.7% before to 10.1% after the operation. The use of ADP receptor blocking agents increased in PCI patients (26.3 to 83.9%) and the use of warfarin in CABG patients (9.4 to 21.3%). Medication purchases were more common among those who had greater use of hospital services before and after the procedures. Conclusions: In both PCI and CABG patients, the use of medical therapy before and after revascularisation procedure complied with current guidelines. Purchases of long-acting nitrates were common in the PCI group even after the procedure. [ABSTRACT FROM AUTHOR]

Background: Perceived health (PH) has become an important outcome measure among coronary heart disease (CHD) patients. Poor PH has been shown to predict morbidity and mortality among CHD patients. Objective: The objective of this paper was to examine CHD patients’ PH after percutaneous coronary intervention (PCI). Methods: This descriptive cross-sectional study (n = 416) was conducted across five hospitals in Finland during 2013. A self-report questionnaire of PH was used, which comprises EuroQoL five-dimensional scale (EQ-5D-5L), EuroQoL visual analog scale (EQ-VAS), and 18 background variables. Data were analyzed using descriptive statistics and multivariate methods. Results: Female gender, previous PCI, physical inactivity and slight vegetable consumption were associated with reduced PH among post-PCI patients. Seventy percent of the sample reported problems in some PH dimension. Conclusions: Post-PCI patients should be encouraged to pursue a healthy lifestyle, which seems to have a beneficial effect on PH. Females, elderly, or those demonstrating lower education, physical inactivity, slight vegetable consumption, longer duration of CHD, hypertension, hypercholesterolemia, or previous invasive treatment should be afforded special attention. [ABSTRACT FROM AUTHOR]

Introduction:Administrative registers provide an attractive data source for real-life effectiveness studies. The validity of coronary artery disease diagnoses in the Finnish National Hospital Discharge Register (HDR) is high but the validity of revascularization procedure codes (percutaneous coronary intervention; PCI and coronary artery bypass grafting; CABG) are unknown. Methods:All elective PCIs (n = 1771) and CABGs (n = 1819), performed at the Heart Center, Kuopio University Hospital, Finland between years 2007 and 2014 were identified from the unit’s Special Electronic Medical Records (sEMR). Personal identity codes were used to link these data to the HDR. Sensitivity was estimated as proportion of operations recorded in sEMR and HDR. Results:With the strictest assumption of exactly the same intervention day in HDR and sEMR, the sensitivity for procedure codes were 84.6% for PCI and 97.1% for CABG, respectively. When a one-day difference was allowed in the dates, the sensitivity increased to 87.6% for PCI and 98.0% for CABG. Altogether 62.1% of elective PCIs and 69.2% of CABGs were correctly classified as elective procedures in the HDR. Conclusion:The potential of the research application of the HDR extends beyond traditionally used diagnostic codes. One feasible application is the assessment of real-life effectiveness of different procedures.KEY MESSAGESThe majority of PCIs (87.6%) and CABGs (98.0%), performed in the Heart Center, Kuopio University Hospital responsible for the treatment of approximately one fifth of the Finnish population, were captured by the Finnish National Hospital Discharge Register.However, only 62.1% of elective PCIs and 69.2% of CABGs were correctly classified as elective procedures in the HDR. Electivity data were missing from approximately one third of the procedures.This study produces new information of the potential use of HDR for real-life effectiveness studies to support evidence-based decision making in health care. [ABSTRACT FROM PUBLISHER]