Ho Yu Cheng

Effects of a nurse-led heart failure clinic on hospital readmission and mortality in Hong Kong

Background Heart failure (HF) is a physically and socially debilitating disease that carries the burden of hospital re-admission and mortality. As an aging society, Hong Kong urgently needs to find ways to reduce the hospital readmission of HF patients. This study evaluates the effects of a nurse-led HF clinic on the hospital readmission and mortality rates among older HF patients in Hong Kong. Methods This study is a retrospective data analysis that compares HF patient in a nurse-led HF clinic in Hong Kong compared with HF patients who did not attend the clinic. The nurses of this clinic provide education on lifestyle modification and symptom monitoring, as well as titrate the medications and measure biochemical markers by following established protocols. This analysis used the socio-demographic and clinical data of HF patients who were aged ≥ 65 years old and stayed in the clinic over a six-month period. Results The data of a total of 78 HF patients were included in this data analysis. The mean age of the patients was 77.38 ± 6.80 years. Approximately half of the HF patients were male (51.3%), almost half were smokers (46.2%), and the majority received ≤ six years of formal education. Most of the HF patients (87.2%) belonged to classes II and III of the New York Heart Association Functional Classification, with a mean ejection fraction of 47.15 ± 20.31 mL. The HF patients who attended the clinic (n = 38, 75.13 ± 5.89 years) were significantly younger than those who did not attend the clinic (n = 40, 79.53 ± 6.96 years) (P = 0.04), and had lower recorded blood pressure. No other statistically significant difference existed between the socio-demographic and clinical characteristics of the two groups. The HF patients who did not attend the nurse-led HF clinic demonstrated a significantly higher risk of hospital readmission [odd ratio (OR): 7.40; P < 0.01] than those who attended after adjusting for the effect of age and blood pressure. In addition, HF patients who attended the clinic had lower mortality (n = 4) than those who did not attend (n = 14). However, such a difference did not reach statistical significance when the effects of age and blood pressure were adjusted. A significant reduction in systolic blood pressure [F (2, 94) = 3.39, P = 0.04] and diastolic blood pressure [F (2, 94) = 8.48, P < 0.01] was observed among the HF patients who attended the clinic during the six-month period. Conclusions The finding of this study suggests the important role of nurse-led HF clinics in reducing healthcare burden and improving patient outcomes among HF patients in Hong Kong.

Psychometric Evaluation of the Caregiving Competence Scale Among Chinese Family Caregivers.

Purpose: The aim of the study was to develop a Chinese version of the Caregiving Competence Scale (CCS) and evaluate its psychometric properties. Design: A multicenter, cross-sectional study design. Methods: Brislin’s translation method was used to translate the CCS into Chinese. Its psychometric properties were tested with 118 Chinese family caregivers of stroke survivors. Findings: The Chinese version of the Caregiving Competence Scale (CCS-C) demonstrated adequate internal consistency (Cronbach’s &agr; = .81) and stability (weighted kappa statistics: .67–.78). Convergent and discriminative validities were supported by a significant correlation between the CCS-C and the General Self-Efficacy Scale scores (r = .46, p < .01) and a significant difference in the CCS-C scores between depressed and nondepressed caregivers (p = .03), respectively. Conclusions: Study results suggested that the CCS-C could be a valid and reliable self-reported instrument for family caregivers of Chinese stroke survivors. Clinical Relevance: This scale can be used to evaluate the caregiving competence of stroke caregivers in nursing research and in clinical settings.

Tai Chi exercise is more effective than brisk walking in reducing cardiovascular disease risk factors among adults with hypertension: A randomised controlled trial

BACKGROUND Physical inactivity is a major modifiable lifestyle risk factor associated with cardiovascular disease. Tai Chi is a safe and popular form of physical activity among older adults, yet direct comparisons are lacking between Tai Chi and brisk walking in their ability to reduce cardiovascular disease risk factors and improve psychosocial well-being. METHODS 246 adults (mean age = 64.4 ± 9.8 years, age range = 30-91 years, 45.5% men) with hypertension and at least two but not more than three modifiable cardiovascular disease risk factors (diabetes, dyslipidaemia, overweight, physical inactivity and smoking) were randomly assigned to either Tai Chi (n = 82), brisk walking (n = 82) or control (n = 82) groups. The Tai Chi and brisk walking groups engaged in moderate-intensity physical activity 150 min/week for 3 months; daily home-based practice was encouraged for another 6 months. The primary outcome was blood pressure. Secondary outcomes were fasting blood sugar, glycated haemoglobin, total cholesterol, triglycerides, high- and low-density lipoprotein, body mass index, waist circumference, aerobic endurance, perceived stress, quality of life and exercise self-efficacy. Data were collected at baseline, post-intervention at 3 months and follow-up assessments at 6 and 9 months. Generalised estimating equation models were used to compare the changes in outcomes over time between groups. RESULTS At baseline, the participants had an average blood pressure = 141/81 and average body mass index = 26; 58% were diabetics, 61% presented with dyslipidemia and 11% were smokers. No significant difference was noted between groups. Tai Chi significantly lowered blood pressure (systolic -13.33 mmHg; diastolic -6.45 mmHg), fasting blood sugar (-0.72 mmol/L), glycated haemoglobin (-0.39%) and perceived stress (-3.22 score) and improved perceived mental health (+4.05 score) and exercise self-efficacy (+12.79 score) at 9 months, compared to the control group. In the Tai Chi group, significantly greater reductions in blood pressure (systolic -12.46 mmHg; diastolic -3.20 mmHg), fasting blood sugar (-1.27 mmol/L), glycated haemoglobin (-0.56%), lower perceived stress (-2.32 score), and improved perceived mental health (+3.54 score) and exercise self-efficacy (+12.83 score) were observed, compared to the brisk walking group. No significant changes in the other cardiovascular disease risk indicators were observed over time between groups. CONCLUSION Nurses play a key role in promoting exercise to reduce cardiovascular disease risk and foster a healthy lifestyle among adults. Tai Chi is better than brisk walking in reducing several cardiovascular disease risk factors and improving psychosocial well-being, and can be recommended as a viable exercise for building a healthy life free of cardiovascular disease.

A smartphone-based exercise adherence intervention for people with metabolic syndrome: a feasibility pilot study

BACKGROUND Despite well-established benefits of exercise in the management of metabolic syndrome, evidence to support exercise adherence after program completion is lacking. We used a smartphone-based exercise adherence intervention (Virtual Trainer; Ex-VT) for adults with metabolic syndrome in Hong Kong, China. The objectives were to measure the feasibility, potential effectiveness, and implementation of Ex-VT in sustaining prescribed exercise practice for risk reduction in metabolic syndrome. METHODS In this multisite, randomised controlled trial, participants with metabolic syndrome were randomly allocated to either intervention (Ex-VT) or exercise reference (control) groups using block randomisation with a block size of ten. Both groups attended four once-weekly group exercise sessions. The Ex-VT group received goal-directed, person-centered exercise adherence coaching via a smartphone virtual trainer application. Data was collected at baseline and at 12 weeks. Primary outcome was adherence to exercise prescription, as measured using pedometers and International Physical Activity Questionnaire. Changes in metabolic syndrome risk indicators (waist circumference, blood pressure, and blood lipid and glucose concentrations) were also measured after a 12 h fast. Data analysis was based on intention to treat. The trial is registered with Chinese University of Hong Kong Centre for Clinical Research and Biostatistics, number CUHK_TMP00056. Ethics approval was obtained from the Joint Chinese University of Hong Kong-New Territories East Clinical Research Ethics Committee and written consent were obtained from participants. FINDINGS Twenty subjects were recruited to the study (recruitment rate: 71·4%), and randomly assigned, 1:1, to Ex-VT or control groups. They were aged 30-69 (mean 56·85 [SD 7·08]), 65% women, and 55% worked full-time. Two subjects (one per group) dropped out (retention rate: 90% for both groups). At 12 weeks, participants in the Ex-VT group demonstrated better adherence with exercise prescription (72%) than those in the control group (48%; p=0·036). Reductions from baseline in systolic blood pressure (p=0·02), diastolic blood pressure (p=0·045), and waist circumference (p=0·048) were seen in the Ex-VT group, despite no between-group difference. We found no significant changes in blood lipid and glucose concentrations. No adverse events were reported. INTERPRETATION High retention rates suggest that Ex-VT is an acceptable intervention for this population. Preliminary findings on adherence and metabolic syndrome risk indicators suggest that a large randomised controlled trial to explore the effects of Ex-VT would be safe, feasible, and warranted. FUNDING Departmental Research Fund, Cardiac and Acute Care Research Theme Group, The Nethersole School of Nursing, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong, China (CV1502).

Evolvement of left ventricular assist device: the implications on heart failure management

Heart failure (HF) is a potentially fatal disease that affects increasing number of people worldwide. Although heart transplant is the “gold standard” therapy for HF, due to the limited availability of organs, many patients died when waiting for the transplant. Left ventricular assist device (LVAD), as a mechanical circulatory support, has become a new light for patients with HF. With the technical advancements, LVADs work not only as a bridge to transplant, but also assist heart recovery and even as a destination therapy in long-term treatment. This observation paper reviewed the development of LVAD and its clinical roles. The challenges and possible solutions in nursing care for patients with LVAD at different stage of implantation were discussed. The healthcare professionals could obtain a better understanding about the LVAD treatment for HF patients.

Social support as a predictor of diet and exercise self-efficacy in patients with coronary artery disease

Objectives: This study examined the role of social support and other factors in relation to exercise and diet self-efficacy in Chinese patients with coronary heart disease in Hong Kong. Methods: A cross-sectional study was conducted on a convenience sample identified from two cardiac rehabilitation centers. Eighty-five participants joined the study. Results: Both self-efficacy measures correlated with social support, in particular in the domains of emotional/informational support and positive social interactions. Stronger social support was independently associated with a higher level of exercise and diet self-efficacy. Patients with a higher body mass index had a lower level of exercise self-efficacy, whereas social drinkers had a lower level of diet self-efficacy. Conclusions: Our data supported an association between social support and self-efficacy. It was suggested that social companions would help patients get greater confidence in overcoming barriers to lifestyle modification. Further studies may investigate what type of social support contributes to improving the self-efficacy beliefs of patients.