Susan Barnason

2014 ACC/AHA Guideline on Perioperative Cardiovascular Evaluation and Management of Patients Undergoing Noncardiac Surgery A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines

Jeffrey L. Anderson, MD, FACC, FAHA, Chair Jonathan L. Halperin, MD, FACC, FAHA, Chair-Elect Nancy M. Albert, PhD, RN, FAHA Biykem Bozkurt, MD, PhD, FACC, FAHA Ralph G. Brindis, MD, MPH, MACC Lesley H. Curtis, PhD, FAHA David DeMets, PhD[¶¶][1] Lee A. Fleisher, MD, FACC, FAHA Samuel

2014 ACC/AHA Guideline on Perioperative Cardiovascular Evaluation and Management of Patients Undergoing Noncardiac Surgery: Executive Summary

Preamble 2216 1. Introduction 2217 2. Clinical Risk Factors: Recommendations 2220 3. Approach to Perioperative Cardiac Testing 2221 4. Supplemental Preoperative Evaluation: Recommendations 2221 5. Perioperative Therapy: Recommendations 2224 6. Anesthetic Consideration and Intraoperative Management: Recommendations 2228 7. Surveillance and Management for Perioperative MI: Recommendations 2229 8. Future Research Directions 2230 Appendix 1. Author Relationships With Industry and Other Entities (Relevant) 2237 Appendix 2. Reviewer Relationships With Industry and Other Entities (Relevant) 2239 Appendix 3. Related Recommendations From Other CPGs 2244 References 2230 The American College of Cardiology (ACC) and the American Heart Association (AHA) are committed to the prevention and management of cardiovascular diseases through professional education and research for clinicians, providers, and patients. Since 1980, the ACC and AHA have shared a responsibility to translate scientific evidence into clinical practice guidelines (CPGs) with recommendations to standardize and improve cardiovascular health. These CPGs, based on systematic methods to evaluate and classify evidence, provide a cornerstone of quality …

Functional status outcomes of patients with a coronary artery bypass graft over time

OBJECTIVE To examine functional status outcomes among patients with a coronary artery bypass graft (CABG) over time (ie, at baseline; 3 months, 6 months, and 12 months after surgery) and the impact of selected patient characteristics (ie, age, sex, comorbidities, and cardiac rehabilitation participation) on functional outcomes. DESIGN A prospective, repeated-measures design was used to examine functional status in patients with a CABG over time. SETTING A midwestern community hospital and regional cardiac referral center was the setting for enrolling patients with a CABG. OUTCOME MEASURES Functional status outcomes were measured by using the Medical Outcomes Study (MOS) Short Form 36 (SF-36) and Modified 7-Day Activity instruments. METHODS Baseline data were obtained by patient interview in the hospital setting after CABG surgery. At 3 months, 6 months, and 12 months after surgery, telephone interviews were conducted to administer research instruments. RESULTS Baseline scores on 7 of the 8 subscales of the MOS SF-36 were significantly lower than at 3 months, 6 months, or 12 months after surgery. Role-emotional functioning baseline scores were not significantly lower than 3-month scores; however, baseline scores were significantly lower than 6-month and 12-month scores. Three-month subscale scores were also significantly lower than 6-month or 12-month scores except for the subscales measuring social and general health functioning. Functional status as measured by the Modified 7-Day Activity tool did not demonstrate any significant differences between 3-month, 6-month, or 12-month activity levels. There were no significant differences by age group on any of the 8 subscales of the MOS SF-36 instrument. Women and subjects with more than 1 comorbidity had a significantly lower preoperative level of physical functioning. Cardiac rehabilitation participants had lower preoperative scores on role-emotional functioning than subjects who were not in rehabilitation. CONCLUSION Findings from this study can assist nurses and other health care workers to gain a perspective of the recovery and rehabilitation trajectory of patients with a CABG. The results of the study provide a basis for determining areas of functional limitations during recovery from CABG surgery. Study results can also be the foundation for evaluating outcomes of patients with a CABG when specific interventions (eg, pain management, psychosocial support, physical strengthening, fatigue management) are implemented during hospitalization, home recovery, and rehabilitation to target optimal psychosocial and physiologic functioning of patients with a CABG.

Impact of a home communication intervention for coronary artery bypass graft patients with ischemic heart failure on self-efficacy, coronary disease risk factor modification, and functioning

OBJECTIVE The purpose of this study is to determine the impact of a home communication intervention (HCI) for ischemic heart failure Coronary Artery Bypass Graft (CABG) patients >/= 65 years of age on self-efficacy, coronary artery disease risk factor modification and functioning posthospitalization. DESIGN A randomized clinical trial with repeated measures was used. SAMPLE A subsample of ischemic heart failure CABG surgery patients (n = 35) was drawn from the parent study of 180 CABG patients. RESULTS HCI participants (n = 18) had significantly higher adjusted mean self-efficacy scores [F(1, 29) = 6.40, P <.05] and adjusted mean levels of functioning (physical, general health, mental, and vitality functioning) compared with the routine care group (n = 17), using repeated measures analysis of covariance with baseline scores as covariates. There were also significant effects of time on bodily pain and role emotional functioning. Significantly higher exercise adherence (t = 3.09, P <.01) and lower reported stress (t = 3.77, P <.01) at 3 months after surgery was reported by HCI subjects. CONCLUSIONS Data from this pilot study can be used to strengthen the HCI intervention with more tailored strategies for vulnerable subgroups of CABG patients.

Transitions of Care in Heart Failure A Scientific Statement From the American Heart Association

In patients with heart failure (HF), use of 30-day rehospitalization as a healthcare metric and increased pressure to provide value-based care compel healthcare providers to improve efficiency and to use an integrated care approach. Transition programs are being used to achieve goals. Transition of care in the context of HF management refers to individual interventions and programs with multiple activities that are designed to improve shifts or transitions from one setting to the next, most often from hospital to home. As transitional care programs become the new normal for patients with chronic HF, it is important to understand the current state of the science of transitional care, as discussed in the available research literature. Of transitional care reports, there was much heterogeneity in research designs, methods, study aims, and program targets, or they were not well described. Often, programs used bundled interventions, making it difficult to discuss the efficiency and effectiveness of specific interventions. Thus, further HF transition care research is needed to ensure best practices related to economically and clinically effective and feasible transition interventions that can be broadly applicable. This statement provides an overview of the complexity of HF management and includes patient, hospital, and healthcare provider barriers to understanding end points that best reflect clinical benefits and to achieving optimal clinical outcomes. The statement describes transitional care interventions and outcomes and discusses implications and recommendations for research and clinical practice to enhance patient-centered outcomes.

Sexual Counseling for Individuals With Cardiovascular Disease and Their Partners A Consensus Document From the American Heart Association and the ESC Council on Cardiovascular Nursing and Allied Professions (CCNAP)

Sexual counseling for individuals with cardiovascular disease and their partners: a consensus document from the American Heart Association and the ESC Council on Cardiovascular Nursing and Allied Professions (CCNAP)

2014 ACC/AHA guideline on perioperative cardiovascular evaluation and management of patients undergoing noncardiac surgery

A Report of the American College of Cardiology/ American Heart Association Task Force on Practice Guidelines Developed inCollaborationWith theAmericanCollege of Surgeons, American Society of Anesthesiologists, American Society of Echocardiography, American Society of Nuclear Cardiology, Heart Rhythm Society, Society for Cardiovascular Angiography and Interventions, Society of Cardiovascular Anesthesiologists, and Society of Vascular Medicine Endorsed by the Society of Hospital Medicine

Pilot Testing of a Medication Self-Management Transition Intervention for Heart Failure Patients

This pilot study examined the impact of a hospital transition intervention for older adults (≥ 65 years of age) with heart failure (HF) to promote medication use self-management. Forty subjects, hospitalized with either primary or secondary HF, had a mean age of 76.9 ± 6.5 years; 65% were males. The majority of subjects (55%) had NYHA Class III HF. A prospective, repeated measures experimental design was used. Baseline and follow-up data (1- and 3-months after hospitalization) were obtained using the Medication Regimen Complexity Index, Brief Medication Questionnaire, Drug Regiment Unassisted Grading Scale, and Kansas City Cardiomyopathy Questionnaire. Using repeated measures analysis of covariance (ANCOVA), with baseline measures as covariates, the transition intervention group had higher levels of medication adherence (F(1,35) = 13.4, p < .001), self-efficacy for HF self-care (F(1,35) = 17.9, p < .001) and had significantly fewer HF related symptoms that impaired health related quality of life (F(1,35) = 9.1, p = .006).

Relationships between fatigue and early postoperative recovery outcomes over time in elderly patients undergoing coronary artery bypass graft surgery

BACKGROUND Despite successful coronary artery bypass graft (CABG) surgery, some patients continue to experience fatigue after their surgery. OBJECTIVE The purpose of this secondary analysis study was to examine the relationships of fatigue and early recovery outcomes (psychosocial and physiologic functioning, and physical activity) over time (6 weeks and 3 months) among older adult subjects, age 65 years and older, after CABG surgery. Comparison groups were those subjects who had fatigue at 3 weeks after surgery and nonfatigued subjects. DESIGN A prospective, comparative design was used for this secondary analysis study. SAMPLE Subjects in this study were drawn from the control group of subjects enrolled in the larger parent study. Subjects (N = 119) were dichotomized into fatigue (n = 66) and nonfatigued (n = 53) groups on the basis of their 3-week self-reports of postoperative fatigue. RESULTS At 6 weeks after surgery, fatigued subjects had significantly (P < .05) more impaired psychosocial functioning (role-emotional [t = 1.9], social [t = 2.6], and mental [t = 1.9] functioning) on the basis of the Medical Outcome Study Short Form 36. They had significantly (P < .005) higher mean hospital anxiety (t = -3.6) and depression (t = -2.9) subscale scores, respectively. Anxiety (t = -2.3, P < .05) remained significantly (P < .05) impaired at 3 months. At 6 weeks, role physical functioning, measured by the Medical Outcome Study Short Form 36, was significantly impaired (t = 2.4, P < .01). There were no significant differences in physical activity variables as measured by an RT3 accelerometer (Stayhealthy, Inc., Monrovia, CA) and self-report diary. CONCLUSIONS Persistent fatigue can hamper early recovery after CABG surgery. Tailored interventions are needed to address fatigue management and improve patient outcomes.

Illness perceptions, coping strategies, and symptoms contribute to psychological distress in patients with recurrent symptomatic atrial fibrillation.

Background: Atrial fibrillation (AF) is a prevalent, life-complicating illness associated with psychological distress. Interventions to manage the psychological challenges of living with AF are needed. Evidence suggests that illness perceptions, coping strategies, and symptoms that contribute to psychological distress may be modified by psychoeducational interventions to reduce psychological distress. However, little is known about how illness perceptions, coping strategies, and symptoms contribute to psychological distress in patients with AF. Objective: The aim of this correlational study guided by Levethal’s Common Sense Model of Self-regulation was to identify the extent to which illness perceptions, coping strategies, symptom frequency, and symptom severity contributed to psychological distress in patients with recurrent symptomatic AF. The contribution of these factors was considered with respect to the effects of gender, age, type of AF, and time since AF diagnosis. Methods: Participants (n = 207; 56% male; 64.2 ± 12.3 years old) completed the Illness Perception Questionnaire–Revised, the COPE Inventory, the Symptom Checklist–Frequency and Severity, and the Profile of Mood States. Data were analyzed using Pearson correlation and hierarchical multiple regression. Results: Illness perceptions contributed most to psychological distress, followed by coping strategies and symptom frequency. Illness perceptions explained the largest portion of the total variance for the following: Tension-Anxiety, 44/56%; Depression-Dejection, 38/50%; Fatigue-Inertia, 43/53%; Confusion-Bewilderment, 41/49%; Vigor-Activity, 24/35%; and Total Mood Disturbance, 47/63%. Illness perceptions of AF as having serious consequences, a psychological cause, and perceived poor understanding of AF together contributed more (.47) to Total Mood Disturbance than did coping by focusing on emotion (.08) or symptom frequency (.06). Conclusions: Illness perceptions are important contributors to psychological distress in patients with AF. Assessment of patients’ illness perceptions may reveal those that increase the risk for psychological distress. Research is warranted to evaluate interventions to modify psychological cause and consequence beliefs and to promote understanding of AF.