Heart Disease

In modern medicine, health risks are often managed through the collection of health data and subsequent intervention. One of the goals of clinical genetics, for example, is to identify genetic predisposition to disease so that individuals can intervene to prevent potential harms. But recently, some clinicians have suggested that patients should undergo less testing and monitoring in an effort to reduce overdiagnosis and overtreatment. In this paper, I explore how clinicians navigate the tension between identifying real disease risks for their (...) patients with concerns about overdiagnosis and overtreatment. I focus on clinicians ordering genetic testing for inherited cardiovascular diseases. Of the genes determined to be “clinically actionable” by the American College of Medical Genetics and Genomics, half are related to cardiovascular diseases. But, due in part to high levels of uncertainty surrounding cardiovascular genetics, there is still disagreement within the field about how to order and interpret these tests. Based on semi-structured, in-depth interviews with 20 clinicians who order genetic testing for cardiovascular diseases, I find that there is considerable variability in the ways that clinicians determine which types of genetic tests are appropriate for their patients and how they interpret test results. Most importantly, I find that many providers do not presume that more genetic data will lead to better care. Instead, increased genetic data can lead to confusion and inappropriate treatment. This re-valuation of the utility of medical data is crucial for bioethicists to explore, especially as medical fields are sorting through increasing amounts of data. (shrink)

Introduction: Heart transplantation is a standard treatment for end-stage cardiac disease. In addition to inducing physical changes and improving the quality of life, it causes unique mental and psychological changes in transplant recipients. Therefore, this study sought to explain and interpret the experience of heart transplant recipients in Iran. Methods: Using a qualitative content analysis approach, this study was performed on 13 heart transplant recipients in Tehran. The data were collected through observation and semi-structured interviews. The participants were selected using (...) purposive sampling, and the interviews continued until data saturation. After obtaining informed consent, interviews were recorded, transcribed, and analyzed using conventional and concurrent content analysis. Results: The analysis of the data revealed two stages experienced by heart transplant recipients. The transition stage was categorized into two concepts of "emotional turmoil" and "feeling of duality". The emotional turmoil was subcategorized into feeling guilty, alienation with the new heart, and gratitude. Besides, the "feeling of duality" was subdivided into personality change and lifestyle changes. The stabilization stage was conceptualized into “self-acceptance” which was subcategorized into three concepts of the acceptance of the new heart, feeling of unity with the donor, and normalization. Conclusion: Adaptation to the new heart is a multistage process in heart transplant recipients. Based on the insights from this study, it can be concluded that healthcare professionals need to improve their knowledge of post-transplant changes, recipients’ feelings, and their adaptation strategies. They are also advised to address the physical needs and mental concerns of transplant recipients. (shrink)

Abstract: Heart diseases are increasing daily at a rapid rate and it is alarming and vital to predict heart diseases early. The diagnosis of heart diseases is a challenging task i.e. it must be done accurately and proficiently. The aim of this study is to determine which patient is more likely to have heart disease based on a number of medical features. We organized a heart disease prediction model to identify whether the person is likely to be diagnosed with a (...) heart disease or not using the medical features of the person. We used many different algorithms of machine learning such as Gaussian Mixture, Nearest Centroid, MultinomialNB, Logistic RegressionCV, Linear SVC, Linear Discriminant Analysis, SGD Classifier, Extra Tree Classifier, Calibrated ClassifierCV, Quadratic Discriminant Analysis, GaussianNB, Random Forest Classifier, ComplementNB, MLP Classifier, BernoulliNB, Bagging Classifier, LGBM Classifier, Ada Boost Classifier, K Neighbors Classifier, Logistic Regression, Gradient Boosting Classifier, Decision Tree Classifier, and Deep Learning to predict and classify the patient with heart disease. A quite helpful approach was used to regulate how the model can be used to improve the accuracy of prediction of heart diseases in any person. The strength of the proposed model was very satisfying and was able to predict evidence of having a heart disease in a particular person by using Deep Learning and Random Forest Classifier which showed a good accuracy in comparison to the other used classifiers. The proposed heart disease prediction model will enhances medical care and reduces the cost. This study gives us significant knowledge that can help us predict the person with heart disease. The dataset was collected from Kaggle depository and the model is implemented using python. (shrink)

Abstract: Heart diseases are increasing daily at a rapid rate and it is alarming and vital to predict heart diseases early. The diagnosis of heart diseases is a challenging task i.e. it must be done accurately and proficiently. The aim of this study is to determine which patient is more likely to have heart disease based on a number of medical features. We organized a heart disease prediction model to identify whether the person is likely to be diagnosed with a (...) heart disease or not using the medical features of the person. We used many different algorithms of machine learning such as Gaussian Mixture, Nearest Centroid, MultinomialNB, Logistic RegressionCV, Linear SVC, Linear Discriminant Analysis, SGD Classifier, Extra Tree Classifier, Calibrated ClassifierCV, Quadratic Discriminant Analysis, GaussianNB, Random Forest Classifier, ComplementNB, MLP Classifier, BernoulliNB, Bagging Classifier, LGBM Classifier, Ada Boost Classifier, K Neighbors Classifier, Logistic Regression, Gradient Boosting Classifier, Decision Tree Classifier, and Deep Learning to predict and classify the patient with heart disease. A quite helpful approach was used to regulate how the model can be used to improve the accuracy of prediction of heart diseases in any person. The strength of the proposed model was very satisfying and was able to predict evidence of having a heart disease in a particular person by using Deep Learning and Random Forest Classifier which showed a good accuracy in comparison to the other used classifiers. The proposed heart disease prediction model will enhances medical care and reduces the cost. This study gives us significant knowledge that can help us predict the person with heart disease. The dataset was collected from Kaggle depository and the model is implemented using python. (shrink)

BackgroundHealth-related quality of life is known to be impaired in individuals with coronary artery disease, especially in those after a recent acute coronary syndrome. Heart failure is a common burden in this population that significantly contributes to worsening HRQoL. To accurately measure the level of HRQoL in individuals with CAD after ACS, disease-specific scales, such as the Minnesota living with heart failure questionnaire, are recommended. Nevertheless, to date, there has not been a study that would comprehensively evaluate the psychometric properties (...) of the MLHFQ in a large sample of individuals with CAD after ACS. The debate regarding the internal structure of MLHFQ is also still present. Hence, this study aimed to translate the MLHFQ and evaluate its internal structure, reliability/precision, and validity in individuals with CAD following ACS in Lithuania.MethodsIn the cross-sectional study, 1,083 participants were evaluated for sociodemographic and clinical characteristics. HRQoL was measured using the MLHFQ and the Short Form-36 health survey. In addition, exercise capacity was also evaluated in the study patients, using a standardized computer-driven bicycle ergometer.ResultsThe internal consistency of the MLHFQ subscales was found to be good. Confirmatory factor analysis provided the support for the three-factor model of the MLHFQ and showed acceptable fit [comparative fit indices = 0.894; goodness-of-fit = 0.898; non-normal fit index = 0.879, and root mean square error of approximation = 0.073]. Regarding convergent evidence, significant associations were found between the MLHFQ domains and the SF-36 domains and EC.ConclusionThe current study completed cultural validation and provided further information on the psychometric characteristics of the MLHFQ in Lithuania, suggesting MLHFQ as a valid and reliable instrument to measure HRQoL. The Lithuanian version of MLHFQ is best described by a three-factor solution, measuring physical, social, and emotional dimensions of HRQoL among individuals with CAD following ACS. (shrink)

BackgroundPositive psychosocial factors can play an important role in the development of cardiovascular disease. Among them, psychological resilience is defined as the capacity of responding positively to stressful events. Our aim was to assess whether PR is associated with CVD or metabolic disturbances through a systematic review.MethodsWe gathered articles from PubMed, Web of Science, PsycInfo, and Google Scholar up to October 28, 2021. We included articles that were in English, were observational, and had PR examined as exposure. The CVD outcomes (...) were either clinical or metabolic outcomes.ResultsOur literature search identified 3,800 studies, of which 17 met the inclusion criteria. Of them, seven were longitudinal and 10 cross-sectional, and 13 were on adults and four on children. The exposure assessment was heterogeneous, i.e., 12 studies used different kinds of self-administered questionnaires and five used interviews with a psychologist. Regarding outcomes, five studies investigated CVD, seven obesity, one metabolic syndrome, two hypertension, four dyslipidemia, and four diabetes. In longitudinal studies, PR was found to have an inverse association with included outcomes in five studies from the Swedish military conscription cohort but had no association with CVD in a study on African-American women and was associated with slower progression of diabetes in a general population. The cross-sectional studies showed that the prevalence of disease was not associated with PR in many cases but the progression of disease was associated with PR.ConclusionPR seems to have a possibly favorable association with CVD and metabolic disturbances that differs according to the type of outcome and population. Our study limitations are given by the small number of studies available and the heterogeneity in PR measurement.Systematic Review Registration[https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=237109], identifier [CRD42021237109]. (shrink)

BackgroundCoronary heart disease is closely associated with cognitive impairment, especially in severe cases of heart failure. However, it is unclear whether cardiac systolic function plays a role in the relationship between pre-existing CHD and cognitive impairment in subjects without clinical heart failure.MethodsIn total, 208 subjects from the First Affiliated Hospital of Xi’an Jiaotong University were recruited from June 2014 to January 2015, and were divided into CHD and non-CHD groups according to the inclusion and exclusion criteria. The global cognitive function (...) of all subjects was assessed by the Mini-Mental State Examination and cognitive impairment was defined as the score lower than the cutoff value. Left ventricular ejection fraction was measured using transthoracic echocardiograms. The relationship among pre-existing CHD, LVEF, and cognitive impairment was analyzed by multivariate logistic regression.ResultsIn total, 34 subjects met the criteria of cognitive impairment. Univariate analysis showed that the cognitive impairment prevalence in the CHD group was significantly higher than that in the non-CHD group. Multivariate logistic analysis revealed that CHD was significantly associated with a higher risk of cognitive impairment after adjusting for confounds except for LVEF. However, the OR of CHD decreased when LVEF was further corrected as a continuous variable, and LVEF was negatively associated with the risk of cognitive impairment.ConclusionPre-existing CHD is associated with a higher risk of cognitive impairment, and such an association can be considerably explained by reduced LVEF. An impaired cardiac systolic function may play a key role in the relationship between CHD and cognitive impairment among patients with pre-heart failure conditions. (shrink)

The cardiac rehab nurse calls out each of our group’s blood pressures and pulse rates. It is my first posthospitalization class and I am relieved to be in the middle of the pack. Although fully aware that numbers are not fate, I cannot help wondering if the worst performers will fully satisfy the dark needs of heart disease statistics. I presume that others are making similar calculations, yet wince at the ugly direction of my mind. Maybe it is not necessary (...) to do better than another; if we take our meds, eat wisely, and exercise to the max, it is possible that our entire group will do well. (shrink)

This study aimed to investigate the status and risk factors of post-traumatic stress disorder in patients with acute myocardial infarction after emergency percutaneous coronary intervention in acute and convalescence phases. A longitudinal study design was used. Two questionnaire surveys were conducted in the acute stage of hospitalization, and 3 months after onset in patients. Logistic regression was used to analyze the risk factors for PTSD in AMI patients. The incidence of PTSD was 33.1 and 20.4% in acute and convalescent patients, (...) respectively. The risk factors related to PTSD were door-to-balloon time, left ventricular ejection fraction, smoking, anxiety, and depression. AMI patients after PCI had PTSD in the acute and convalescent stage. The findings indicate that tailored measures should be developed and carried out to prevent PTSD and improve the mental health of patients with AMI after undergoing PCI. (shrink)

Cardiovascular disease is a major complication of type 2 diabetes mellitus. In addition to traditional risk factors, psychological determinants play an important role in CVD risk. This study applied Deep Neural Network to develop a CVD risk prediction model and explored the bio-psycho-social contributors to the CVD risk among patients with T2DM. From 2017 to 2020, 834 patients with T2DM were recruited from the Department of Endocrinology, Affiliated Hospital of Harbin Medical University, China. In this cross-sectional study, the patients' bio-psycho-social (...) information was collected through clinical examinations and questionnaires. The dataset was randomly split into a 75% train set and a 25% test set. DNN was implemented at the best performance on the train set and applied on the test set. The receiver operating characteristic curve analysis was used to evaluate the model performance. Of participants, 272 were diagnosed with CVD. The developed ensemble model for CVD risk achieved an area under curve score of 0.91, accuracy of 87.50%, sensitivity of 88.06%, and specificity of 87.23%. Among patients with T2DM, the top five predictors in the CVD risk model were body mass index, anxiety, depression, total cholesterol, and systolic blood pressure. In summary, machine learning models can provide an automated identification mechanism for patients at CVD risk. Integrated treatment measures should be taken in health management, including clinical care, mental health improvement, and health behavior promotion. (shrink)

Heart disease is the deadliest disease and one of leading causes of death worldwide. Machine learning is playing an essential role in the medical side. In this paper, ensemble learning methods are used to enhance the performance of predicting heart disease. Two features of extraction methods: linear discriminant analysis and principal component analysis, are used to select essential features from the dataset. The comparison between machine learning algorithms and ensemble learning methods is applied to selected features. The different methods are (...) used to evaluate models: accuracy, recall, precision, F-measure, and ROC.The results show the bagging ensemble learning method with decision tree has achieved the best performance. (shrink)

Coronary Heart Disease (CHD) is one of the leading causes of death nowadays. Prediction of the disease at an early stage is crucial for many health care providers to protect their patients and save lives and costly hospitalization resources. The use of machine learning in the prediction of serious disease events using routine medical records has been successful in recent years. In this paper, a comparative analysis of different machine learning techniques that can accurately predict the occurrence of CHD events (...) from clinical data was performed. Four machine learning classifiers, namely Logistic Regression, Support Vector Machine (SVM), K- Nearest Neighbor (KNN), and Multi-Layer Perceptron (MLP) Neural Networks were identified and applied to a dataset of 462 medical instances and 9 features as well as the class feature from the South African Heart Disease data retrieved from the KEEL repository. The dataset consists of 302 records of healthy patients and 160 records of patients who suffer from CHD. In order to handle the imbalanced classification problem, the K-means algorithm along with Synthetic Minority Oversampling TEchnique (SMOTE) was used in this study. The empirical results of applying the four machine learning classifiers on the oversampled dataset have been very promising. The results reported using different evaluation metrics showed that SVM has achieved the highest overall prediction performance. (shrink)

Phenomenology has contributed to healthcare by providing resources for understanding the lived experience of the patient and their situation. But within a burgeoning literature on the characteristic features of illness, there has not yet been an account appropriate to describe congenital illnesses: conditions which are present from birth and cause suffering or medical threat to their bearers. Congenital illness sits uncomfortably with standard accounts in phenomenology of illness, in which concepts such as loss, doubt, alienation and unhomelikeness presuppose prior health. (...) These accounts reflect, in different ways, Maurice Merleau-Ponty’s assumption that the ways of living of the ill contain allusions to fundamental, healthy functions. The originality of congenital illness complicates this assumption and demands its own original phenomenology. In this paper, I sketch my personal experience living with a single-ventricle heart condition. While some of this story may reflect my own idiosyncratic experience, I hope that much of it will resonate with the congenital illness experience. I argue that the phenomenological literature on illness, grounded in the notion of loss, does not describe the congenital illness experience. I show how a number of other patient-centred theories of health and illness which have been influential on phenomenology can and cannot elucidate congenital illness. In particular, I consider Georges Canguilhem’s account of the normal and the pathological; debates in disability; and the notion of illness as biographical disruption. I show that congenital illness results in the preadmission of its patients to a paradoxical logic of medical palliation, one product of which is existential maturity. (shrink)

In today’s world it became difficult for daily routine check-up. The Heart disease system is an end user support and online consultation project. Here the motto behind it is to make a person to know about their heart related problem and according to it formulate them how much vital the disease is. It will be easy to access and keep track of their respective health. Thus, it’s important to predict the disease as earliest. Attributes such as Bp, Cholesterol, Diabetes are (...) fed into Classification methods of Machine Learning are been used to predict risk of heart disease. (shrink)

IntroductionApproaches to improve heart rate variability and reduce stress such as breathing retraining are more frequently being integrated into psychotherapy but little research on their effectiveness has been done to date. Specifically, no studies to date have directly compared using a breathing pacer at 6 breaths per minute with compassion focused soothing rhythm breathing.Current StudyIn this randomized controlled experiment, 6 breaths per minute breathing using a pacer was compared with compassion focused soothing rhythm breathing, with a nature video being used (...) as a control group condition.MethodsHeart rate variability measures were assessed via electrocardiogram and respiration belt, and an automated blood pressure machine was used to measure systolic diastolic blood pressure, and heart rate. A total of 96 participants were randomized into the three conditions. Following a 5-min baseline, participants engaged in either 6 breath per minute breathing, soothing rhythm breathing, or watched a nature video for 10 min. To induce a stressful state, participants then wrote for 5 min about a time they felt intensely self-critical. Participants then wrote for 5 min about a time they felt self-compassionate, and the experiment ended with a 10-min recovery period.ResultsConditions did not significantly differ at baseline. Overall, HRV, as measured by standard deviation of NN intervals, low frequency HRV, and LF/HF ratio, increased during the intervention period, decreased during self-critical writing, and then returned to baseline levels during the recovery period. High frequency HRV was not impacted by any of the interventions. The participants in the 6 breath per minute pacer condition were unable to consistently breathe at that rate and averaged about 12 breaths per minute. Time by Condition analyses revealed that both the 6 breaths per minute pacer and soothing breathing rhythm conditions lead to significantly higher SDNN than the nature video condition during breathing practice but there were no significant differences between conditions in response to the self-critical and self-compassionate writing or recovery periods. The 6 breath per minute pacer condition demonstrated a higher LF HRV and LF/HF ratio than the soothing rhythm breathing condition, and both intervention conditions had a higher LF HRV and LF/HF ratio than the nature video.ConclusionsAlthough the 6 breath per minute pacer condition participants were not able to breath consistently at the low pace, both the participants attempting to breathe at 6 breaths per minute as well as those in the soothing rhythm breathing condition effectively increased HR variability as measured by SDNN, and attempting to breathe at 6 breaths per minute led to the highest LF HRV and LF/HF ratio. Both breathing approaches impacted HRV more than watching a relaxing nature video and can potentially be used as key adjuncts in psychotherapy to aid in regulating physiological functioning, although it appears that consistent breathing practice would be needed. (shrink)

ObjectivesThis study aimed to describe the experiences and challenges faced by adolescents with moderate and severe congenital heart defects or Chronic Rheumatic Heart Disease and to determine their needs in order to develop an Adolescent Transition Psychoeducational Program.MethodsThe study involved seven adolescents with moderate to severe CHD/CRHD, six parents, and four health care providers in Institute Jantung Negara. Participants were invited for a semi-structured interview. Qualitative data were analyzed through the Atlas.ti 7 program using triangulation methods.Results/conclusionsWe identified five themes concerning (...) the experience and challenges of adolescents relating to: emotional/psychological issues; the progress of the illness; relationship issues; future preparation; and, school and community. These themes were identified together with eleven subcategories. The staff expressed support for the development of the Adolescent Transition Psychoeducational Program and adolescents with CHD/CRHD and their parents were willing to participate in the program if their schedule allowed. Their suggestions to improve the program were classified into six categories, with two main themes, the self-management of illness in life and the future; and, social support. In conclusion, the findings from the situation analysis act as a basis for a conceptual framework that will contribute to the development of an Adolescent Transition Psychoeducational Program that aims to empower adolescents with CHD/CRHD, enabling them to manage challenges during the transition phase between childhood and adulthood. (shrink)

ABSTRACT The use of broad consent for genomics research raises important ethical questions for the conduct of genomics research, including relating to its acceptability to research participants and comprehension of difficult scientific concepts. To explore these and other challenges, we conducted a study using qualitative methods with participants enrolled in an H3Africa Rheumatic Heart Disease genomics study in Zambia to explore their views on broad consent, sample and data sharing and secondary use. In-depth interviews were conducted with RHDGen participants, study (...) staff and with individuals who refused to participate. In general, broad consent was seen to be reasonable if reasons for storing the samples for future research use were disclosed. Some felt that broad consent should be restricted by specifying planned future studies and that secondary research should ideally relate to original disease for which samples were collected. A few participants felt that broad consent would delay the return of research results to participants. This study echoes findings in other similar studies in other parts of the continent that suggested that broad consent could be an acceptable consent model in Africa if careful thought is given to restrictions on re-use. (shrink)

Background and Objectives: The decreased level of self-esteem and life satisfaction is prevalent among patients with coronary artery disease. The present study aimed to investigate the effectiveness of an Islamic approach to hope therapy on the promotion of self-esteem and life satisfaction in comparison with its conventional approach in patients with CAD. Methods: The study was conducted in a quasi-experimental control group pretest-posttest design. The participants were 60 patients with CAD selected by convenience sampling method from one of Qom hospitals. (...) Data collection tools included the Self-Esteem Scale, Satisfaction with Life Scale, and Hope State Scale. After collecting pre-test data, participants were divided into three peer groups, and the intervention was performed in eight sessions each lasting for 90-minute. An experimental group was exposed to Islamic hope therapy and the other received conventional hope therapy, while the control group received a stress management package. Finally, all the groups undertook the same posttests and the data obtained were analyzed in SPSS22 software using the Covariance test. Results: Both Islamic and conventional hope therapy increased hope, life satisfaction )9, 12.8), and self-esteem of the patients with CAD significantly. Moreover, it was found that Islamic hope therapy was more effective in the enhancement of self-esteem and life satisfaction, compared to conventional hope therapy. Conclusion: Islamic hope therapy outperformed the conventional hope therapy in terms of increasing the self-esteem and life satisfaction of patients with CAD. Therefore, it is recommended to use Islamic hope therapy for patients with CAD and other similar chronic diseases. (shrink)

The paper aims to examine the conceptual model on the impact of sociodemographic towards coronary heart disease. There is still limited study on the association between cost of living particularly the cost of food and housing and its impact on coronary heart disease. Therefore, this study incorporates five essential sociodemographic attributes namely, cost of food, children education cost, housing cost, smoking habit and gender. The study provides greater understanding on how the cost of living and lifestyle may give impact to (...) coronary heart disease. It may provide the awareness among the regulators as the society faces burden of high cost of living. The burden may threaten the Malaysians quality of life particularly the lower income group. (shrink)

BackgroundUnderstanding representations of disease in various art genres provides insights into how patients and health care providers view the diseases. It can also be used to enhance patient care and stimulate patient self-management.MethodsThis paper reviews how cardiovascular diseases are represented in novels, films, and paintings: myocardial infarction, aneurysm, hypertension, stroke, heart transplantation, Marfan’s disease, congestive heart failure. Various search systems and definitions were used to help identify sources of representations of different cardiovascular diseases. The representations of the different diseases were (...) considered separately. The Common Sense Model was used a theoretical model to outline illness perceptions and self-management in the various identified novels, films, and paintings.ResultsMyocardial infarction followed by stroke were the most frequently detailed diseases in all three art genres. This reflects their higher prevalence. Representations ranged from biomedical details through to social and psychological consequences of the diseases.ConclusionsArtistic representations of cardiovascular diseases reflect cognitions, emotions, and images of prevalent disease. These representations shape views and behaviour of ill and healthy persons regarding heart diseases. As these representations are amenable to change, they deserve further research, which may be instrumental in improving the quality of life of persons struck by cardiovascular diseases. Changing illness perceptions appears to be a method to improve self-management and thereby quality of life in patients with various cardiovascular diseases. (shrink)

The arts can aid the exploration of individual and collective illness narratives, with empowering effects on both patients and caregivers. The artist, partly acting as conduit, can translate and re-present illness experiences into artwork. But how are these translated experiences received by the viewer—and specifically, how does an audience respond to an art installation themed around paediatric heart transplantation and congenital heart disease? The installation, created by British artist Sofie Layton and titled Making the Invisible Visible, was presented at an (...) arts-and-health event. The piece comprised three-dimensional printed medical models of hearts with different congenital defects displayed under bell jars on a stainless steel table reminiscent of the surgical theatre, surrounded by hospital screens. The installation included a soundscape, where the voice of a mother recounting the journey of her son going through heart transplantation was interwoven with the voice of the artist reading medical terminology. A two-part survey was administered to capture viewers’ expectations and their response to the piece. Participants expected to acquire new knowledge around heart disease, get a glimpse of patients’ experiences and be surprised by the work, while after viewing the piece they mostly felt empathy, surprise, emotion and, for some, a degree of anxiety. Viewers found the installation more effective in communicating the experience of heart transplantation than in depicting the complexity of cardiovascular anatomy. Finally, analysis of open-ended feedback highlighted the intimacy of the installation and the privilege viewers felt in sharing a story, particularly in relation to the soundscape, where the connection to the narrative in the piece was reportedly strengthened by the use of sound. In conclusion, an immersive installation including accurate medical details and real stories narrated by patients can lead to an empathic response and an appreciation of the value of illness narratives. (shrink)

The scientific understanding of common chronic disease began in the mid-19th century, driven in large part by the development of the modern autopsy. For cardiovascular disease, the recognition that rigid plaques were obstructing muscular arteries, especially in the coronary arteries, provided a mechanism to explain what had been a mysterious "chest pain–sudden collapse" syndrome. The origin of these plaques was totally obscure, however, and they were given the descriptive name of "atherosclerosis," or "hardened porridge" in Greek. Not until 50 years (...) later, when animal experimental models serendipitously revealed the hyper-lipidemic consequences of a diet high in animal fat, followed by accretion of lipid... (shrink)

Nostalgia as one of the complex emotions has been challenged over the past few decades due to its psychological and physiological functions. The present experiment investigates the effect of recalling nostalgic memories on amelioration of homeostatic and health state of people with cardiovascular disease. Method: The participants were 30 patients who were hospitalized for angiography procedure. The research was based on an experimental design with randomized and post-test groups. The instruments used included a thermometer with ° C, a checkout manipulation (...) test, a blood pressure monitor, an ice container and a manual timer, a pain intensity perception scale and Batcho’s nostalgia questionnaire. Results: The results showed that there was a significant difference between the two groups in perceived temperature, the resilience in the face of pain, and the perceived pain. The experimental group perceived higher temperature and showed greater resilience in the face of pain and also lower pain intensity was reported. There was no significant difference in blood pressure between the two groups. Conclusion: The results of this study provide significant evidence for the embodiment emotions hypothesis and positive role of Nostalgia in psychological and physiological homeostatic. Further practical implications of results and suggestions for future research were considered. (shrink)

In current mental health care psychiatric conditions are defined as compilations of symptoms. These symptom-based disease categories have been severely criticised as contingent and boundless, facilitating the rise to epidemic proportions of such conditions as depression. In this article we look beyond symptoms and stress the role of epidemiology in explaining the current situation. By analysing the parallel development of cardiovascular disease and depression management in Finland, we argue, firstly, that current mental health care shares with the medicine of chronic (...) somatic conditions an attachment to risk factor epidemiology, which accentuates risk and prevention in disease management. However, secondly, due to the symptom-based definitions of psychiatric conditions, depression management cannot differentiate properly between symptoms, signs and risk factors such as, for example, cardiovascular medicine, but treats symptoms as signs or risk factors in contexts of treatment and prevention. Consequently, minor at-risk conditions have become difficult to separate from proper cases of depression. (shrink)

Suls provides a useful review of research interested in the contribution of chronic negative emotions to coronary heart disease. Despite widespread support for a link between negative emotions and the etiology of disease, it is largely unknown if discrete negative emotions, particularly anger, sadness, and anxiety contribute to the development of physical disease in different ways. In this comment, we argue that answering this question will require a more comprehensive analysis of the unique characteristics of discrete emotions as well as (...) conceptually refined assumptions about how discrete emotions develop and change across the adult lifespan. (shrink)

Three negative affective dispositions—anger, anxiety, and depression—are hypothesized to increase physical disease risk and have been the subject of epidemiological studies. However, the overlap among the major negative affective dispositions, and the superordinate construct of trait negative affectivity are only beginning to be tested. Presented here is a narrative review of recent prospective studies that simultaneously tested anger, anxiety, depression, and trait NA as risk factors for cardiac outcomes. Anxiety and depression emerged as independent risk factors for premature heart disease (...) in population studies of persons nominally healthy at baseline, and for recurrence/mortality among patients with existing heart disease. General trait NA also was a cardiac risk factor in population samples. (shrink)

Based on the growing problem of heart diseases, their efficient diagnosis is of great importance to the modern world. Statistical inference is the tool that most physicians use for diagnosis, though in many cases it does not appear powerful enough. Clustering of patient instances allows finding out groups for which statistical models can be built more efficiently. However, the performance of such an approach depends on the features used as clustering attributes. In this paper, the methodology that consists of combining (...) unsupervised feature selection and grouping to improve the performance of statistical analysis is considered. We assume that the set of attributes used in clustering and statistical analysis phases should be different and not correlated. Thus, the method consisting of selecting reversed correlated features as attributes of cluster analysis is considered. The proposed methodology has been verified by experiments done on three real datasets of cardiovascular cases. The obtained effects have been evaluated regarding the number of detected dependencies between parameters. Experiment results showed the advantage of the presented approach compared to other feature selection methods and without using clustering to support statistical inference. (shrink)

The aim of this study was interpret the existential construct of family caring following Acute Coronary Syndrome. Family support is known to have a positive impact on recovery and adjustment after cardiac events. Few studies provide philosophically-based, interpretative explorations of carer experience following a spouse’s ischaemic event. As carer experiences, behaviours and meaning-making may impact on the quality of the support they provide to patients, further understanding could improve both patient outcomes and family experience. Fourteen spouses of people experiencing Acute (...) Coronary Syndrome in Sydney, Australia were engaged in a single, semi-structured interview. Interviews were audio-recorded and transcribed verbatim. Data were analysed using hermeneutic interpretation within a Heideggerian phenomenological framework. Acute Coronary Syndrome disrupts lived temporality, and the projected potential for carers’ being-alongside. Carers experienced an existential uncertainty that arose from difficulty in diagnosis, and situated fear as an attuned, being-towards-death. They constructed protective strategies to insulate their partner and themselves from further stress and risk, however, unclear boundaries for protection heightened carer anxiety. The existential structure of care included one of two possible Heideggerian modes: leaping-in care was a dominating mode that required a high level of carer vigilance; leaping-ahead care was a metaphorical walking alongside, as carers gave back control, freeing opportunities for the person to ‘own’ care. Supporting carers through the intensive phase of leaping-in care, and equipping them for informed leaping-ahead care should be a focus in both the acute and post-discharge care phases. (shrink)

Advances in genetic and genomic research have introduced challenges in obtaining informed consent for research in low and middle-income settings. However, there are only few studies that have explored challenges in obtaining informed consent in genetic and genomic research in Africa and none in South Africa. To start filling this gap, we conducted an empirical study to investigate the efficacy of informed consent procedures for an H3Africa genomic study on Rheumatic Heart Disease at the University of Cape Town in South (...) Africa. The main aim of the study was to understand ethical challenges in obtaining informed consent in the RHDGen study. We used a qualitative study methodology involving in-depth interviews and participant observations. Our study participants were RHDGen cases, healthy controls and research staff involved in the recruitment of RHDGen cases and controls. In total, we conducted 32 in-depth interviews with RHDGen cases and controls, 2 in-depth interviews with research staff and 57 direct observations of the consent procedures of RHDGen cases and controls. The interviews were conducted in English, audio-recorded and transcribed verbatim. Data were analyzed using thematic content analysis. The study was conducted in 3 sites within Cape Town, South Africa. Most healthy controls joined the RHDGen study in order to be screened for rheumatic heart disease. A majority of RHDGen cases decided to join the RHDGen study because of therapeutic misconception. The ethical challenges that impacted on obtaining informed consent in the RHDGen study were complex. In this study, the main challenges were diagnostic misconception among RHDGen controls and therapeutic misconception among RHDGen cases. (shrink)

Critical congenital heart disease screening is rapidly becoming the standard of care in the United States after being added to the Recommended Uniform Screening Panel in 2011. Newborn screens typically do not require affirmative parental consent. In fact, most states allow parents to exempt their baby from receiving the required screen on the basis of religious or personally held beliefs. There are many ethical considerations implicated with allowing parents to exempt their child from newborn screening for CCHD. Considerations include the (...) treatment of religious exemptions in our current legal system, as well as medical and ethical principles in relation to the rights of infants. Although there are significant benefits to screening newborns for CCHD, when a parent refuses for religious or personal beliefs, in the case of CCHD screening, the parental decision should stand. (shrink)

The aim of this paper is to characterize some personality traits of women with ischemic heart disease, in order to determine their relationship to activity and inactivity, and define the implications of that relationship for ways of coping with coronary pain. The study comprised N = 100 women aged 33 to 80 years, hospitalized in the Department of Cardiology, who underwent angiography for the assessment of coronary arteries. Psychological studies have been conducted using clinical interviews, involving the IPAT Anxiety Scale (...) Questionnaire, the Pain Coping Strategies Questionnaire and the NEO Five-Factor Personality Inventory. The results obtained indicate that where a group of one hundred women with ischemic heart disease was concerned, their level of anxiety and fear stood at an almost neurotic level. In the structure of anxiety and fear one may observe the predominance of a strong tendency towards self-blame, experiencing feelings of guilt, and exhibiting high levels of internal tension. Among the personality traits in question, the following clearly dominated: extroversion, agreeableness and conscientiousness. The principal strategies for dealing with pain on the part of women with IHD were “prayer and hope”, “declarations of coping” and “diverting attention”. In women with ischemic heart disease, it would thus be advisable to employ psychotherapeutic strategies aimed at lowering the tendency towards selfdestructive behaviour and reducing any elevated levels of internal tension. Psychotherapeutic activities conducted among women with IHD should focus on strengthening psychological resilience, and on working out ways to cope with the disease by undertaking tasks which give them a chance to enrich their own development. (shrink)

Background:The theoretical framework of Jϋrgen Habermas suggests that effective communication requires competent participants with an objective attitude that complies with the rules and worlds designated as objective, social and subjective. This situation determines communicative action, which stimulates the search for mutual understanding and results in a process of interaction that promotes self-determination.Objectives:In this study, the discharge letters of patients with myocardial infarction were explored regarding the provision of information. The patient’s right to information and the duty of informing were analysed (...) according to the perspective of Jϋrgen Habermas.Research design:This was a cross-sectional analysis of all discharge letters that were directly related to nursing interventions regarding the provision of information to 106 patients. In this major study, the difficulties faced by patients who experienced a myocardial infarction and the changes in their lifestyles were analysed based on the type of information received.Ethical considerations:The hospital Ethics Committee approved the study, which complied with ethical principles and required informed consent.Findings:In the nursing letters, interventions related to the provision of information were conducted at an average of 3.59 interventions per patient. For 8.5% of the patients, however, no interventions related to the provision of information were performed. The most common area of information during hospitalisation was related to the management of signs and symptoms and applied to 90.6% patients.Discussion:The nursing interventions did not cover patient education, transition processes or awareness of the disease. Thus, the right to information can be questioned.Conclusion:Information is a right, and communication is extremely important. Health professionals should be aware of this importance regarding both care management and the satisfaction guarantee. The sharing of information by health professionals based on their competency is essential for patients to exercise their right to self-determination and decision-making. (shrink)

Background and Objectives: Heart failure is a life-threatening illness in which panic disorder, anxiety, depression, and death expectation are constantly experienced. This study, thus, determined to examine the relationship between spiritual health and depression, anxiety, and stress in patients with heart failure. Methods: This study was a descriptive-correlational investigation that was performed on 150 patients with heart failure in selected Ardabil teaching hospitals in 2014. Data was collected using Demographic Questionnaire, Ellison-Paloutzian Spiritual Well-Being Scale, and Depression, Anxiety, and Stress Scale. (...) They were, then, analyzed using SPSS, descriptive statistical method, Pearson’s correlation coefficient, and multivariable regression analysis. Results: The results of this study showed that the spiritual wellbeing level of most subjects was in the range of medium. Mean scores of religious and existential aspects of spiritual well-being were obtained to be 33.26±1.247 and 45.76±1.328, respectively. In addition, depression, anxiety, and stress levels of most research units were in the medium range. Pearson’s correlation coefficient showed that there was a statistically significant relationship between depression, anxiety, and stress in all aspects of spiritual wellbeing. Conclusion: Results indicated that an increase in spiritual health would be a concomitant of a reduction in depression, anxiety, and stress levels in heart failure patients. Based on the results and importance of spiritual health, an improvement of proficiencies of medical and paramedical communities in offering spiritual healthcares appears to be mandatory. (shrink)

The aim of this study was to evaluate the possibility of incorrect assessment of mortality risk factors in a group of patients affected by acute coronary syndrome, due to the lack of hazard proportionality in the Cox regression model. One hundred and fifty consecutive patients with acute coronary syndrome and no age limit were enrolled. Univariable and multivariable Cox proportional hazard analyses were performed. The proportional hazard assumptions were verified using Schoenfeld residuals, χ2 test and rank correlation coefficient t between (...) residuals and time. In the total group of 150 patients, 33 deaths from any cause were registered in the follow-up time period of 64 months. The non-survivors were significantly older and had increased prevalence of diabetes and erythrocyturia, longer history of coronary artery disease, higher concentrations of serum creatinine, cystatin C, uric acid, glucose, C-reactive protein, homocysteine and B-type natriuretic peptide, and lower concentrations of serum sodium. No significant differences in echocardiography parameters were observed between groups. The following factors were risk of death factors and fulfilled the proportional hazard assumption in the univariable model: smoking, occurrence of diabetes and anaemia, duration of coronary artery disease, and abnormal serum concentrations of uric acid, sodium, homocysteine, cystatin C and NT-proBNP, while in the multivariable model, the risk of death factors were: smoking and elevated concentrations of homocysteine and NT-proBNP. The study has demonstrated that violation of the proportional hazard assumption in the Cox regression model may lead to creating a false model that does not include only time-independent predictive factors. (shrink)

According to the World Health Organization cardiovascular disease is the leading cause of death globally. Over 80% of CVD deaths take place in low- and middle-income countries. It is estimated that 1 million to 2 million people worldwide die each year due to lack of access to an implantable cardiac defibrillator or a pacemaker. Despite the medical, legal, cultural and ethical controversies surrounding the pacemaker reutilization, studies done so far on the reuse of postmortem pacemakers show it to be safe (...) and effective with an infection rate of 1.97% and device malfunction rate of 0.68%. Pacemaker reutilization can be effectively and safely done and does not pose significant additional risk to the recipient. Heart patients with reused pacemakers have an improved quality of life compared to those without pacemakers. The thesis of this paper is that pacemaker reutilization is a life-saving initiative in LMICs of Nigeria and Ghana. It is cost effective; consistent with the principles of beneficence, nonmaleficence, and justice with a commitment to stewardship of resources and the Common Good. Used pacemakers with adequate battery life can be properly sterilized for use by patients in LMICs who cannot afford the cost of a new pacemaker. (shrink)