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Sexual Identity, Adverse Life Experiences, and Cardiovascular Health in Women
Caceres, Billy A. PhD, RN, AGPCNP-BC; Markovic, Nina PhD; Edmondson, Donald PhD; Hughes, Tonda L. PhD, RN, FAAN
The Journal of Cardiovascular Nursing: 9/10 2019 - Volume 34 - Issue 5 - p 380-389
doi: 10.1097/JCN.0000000000000588
Abstract
Background:Adverse life experiences (ALE; eg, discrimination and sexual abuse) may contribute to cardiovascular disease (CVD) risk in sexual minority women (SMW), but few studies have tested whether ALE explain the association of sexual identity with cardiovascular health (CVH) markers in women.
Objective:The aim of this study was to examine sexual identity differences in CVH among women and the role of ALE.
Methods:In the Epidemiologic Study of Risk in Women, we used multinomial logistic regression to assess sexual identity differences (SMW vs heterosexual women [reference group]) in CVH markers (ideal vs poor, intermediate vs poor) using the American Heart Association's Life's Simple 7 metric and the total score. Next, we tested whether the association of sexual identity with the total CVH score was attenuated by traditional CVD risk factors or ALE.
Results:The sample consisted of 867 women (395 heterosexual, 472 SMW). Sexual minority women were more likely to have experienced discrimination (P < .001) and lifetime sexual abuse (P < .001) than heterosexual women. Sexual minority women were also less likely to meet ideal CVH criteria for current tobacco use (adjusted odds ratio, 0.43; 95% confidence interval, 0.24–0.73) or intermediate CVH criteria for body mass index (adjusted odds ratio, 0.60; 95% confidence interval, 0.40–0.92). Sexual minority women had a lower cumulative CVH score (B [SE] = −0.35 [0.14], P < .01) than heterosexual women. This difference was not explained by traditional CVD risk factors or ALE.
Conclusions:Smoking, body mass index, and fasting glucose accounted for much of the CVH disparity due to sexual identity, but those differences were not explained by ALE. Health behavior interventions tailored to SMW should be considered.
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Sympathetic Markers are Different Between Clinical Responders and Nonresponders After Left Ventricular Assist Device ImplantationDenfeld, Quin E. PhD, RN; Lee, Christopher S. PhD, RN, FAAN, FAHA, FHFSA; Woodward, William R. PhD; Hiatt, Shirin O. MS, RN, MPH; Mudd, James O. MD; Habecker, Beth A. PhDThe Journal of Cardiovascular Nursing: 7/8 2019 - Volume 34 - Issue 4 - p E1-E10doi: 10.1097/JCN.0000000000000580https://journals.lww.com/jcnjournal/pages/articleviewer.aspx?year=2019&issue=07000&article=00011&type=FulltextAbstractBackgroundClinical response to left ventricular assist devices (LVADs), as measured by health-related quality of life, varies among patients after implantation; however, it is unknown which pathophysiological mechanisms underlie differences in clinical response by health-related quality of life.ObjectiveThe purpose of this study was to compare changes in sympathetic markers (β-adrenergic receptor kinase-1 [βARK1], norepinephrine [NE], and 3,4-dihydroxyphenylglycol [DHPG]) between health-related quality of life clinical responders and nonresponders from pre– to post–LVAD implantation.MethodsWe performed a secondary analysis on a subset of data from a cohort study of patients from pre– to 1, 3, and 6 months after LVAD implantation. Clinical response was defined as an increase of 5 points or higher on the Kansas City Cardiomyopathy Questionnaire Clinical Summary score from pre– to 6 months post–LVAD implantation. We measured plasma βARK1 level with an enzyme-linked immunosorbent assay and plasma NE and DHPG levels with high-performance liquid chromatography with electrochemical detection. Latent growth curve modeling was used to compare the trajectories of markers between groups.ResultsThe mean (SD) age of the sample (n = 39) was 52.9 (13.2) years, and most were male (74.4%) and received LVADs as bridge to transplantation (69.2%). Preimplantation plasma βARK1 levels were significantly higher in clinical responders (n = 19) than in nonresponders (n = 20) (P = .001), but change was similar after LVAD (P = .235). Preimplantation plasma DHPG levels were significantly lower in clinical responders than in nonresponders (P = .002), but the change was similar after LVAD (P = .881). There were no significant differences in plasma NE levels.ConclusionsPreimplantation βARK1 and DHPG levels are differentiating factors between health-related quality of life clinical responders and nonresponders to LVAD, potentially signaling differing levels of sympathetic stimulation underlying clinical response.
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Patterns of Heart Failure Dyadic Illness Management: The Important Role of GenderLee, Christopher S. PhD, RN, FAHA, FAAN, FHFSA; Sethares, Kristen A. PhD, RN, CNE, FAHA; Thompson, Jessica Harman PhD, RN, CCRN-K; Faulkner, Kenneth M. PhD, RN, ANP; Aarons, Emily; Lyons, Karen S. PhD, FGSAhttps://journals.lww.com/jcnjournal/Fulltext/2020/09000/Patterns_of_Heart_Failure_Dyadic_Illness.2.aspx?context=FeaturedArticles&collectionId=2
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Patterns of Heart Failure Dyadic Illness Management: The Important Role of Gender
Lee, Christopher S. PhD, RN, FAHA, FAAN, FHFSA; Sethares, Kristen A. PhD, RN, CNE, FAHA; Thompson, Jessica Harman PhD, RN, CCRN-K; Faulkner, Kenneth M. PhD, RN, ANP; Aarons, Emily; Lyons, Karen S. PhD, FGSA
The Journal of Cardiovascular Nursing: 9/10 2020 - Volume 35 - Issue 5 - p 416-422
doi: 10.1097/JCN.0000000000000695
https://journals.lww.com/jcnjournal/Fulltext/2020/09000/Patterns_of_Heart_Failure_Dyadic_Illness.2.aspx?context=FeaturedArticles&collectionId=2
AbstractBackgroundThe ways in which patients with heart failure (HF) and their care partners work together to manage HF are often overlooked.
ObjectiveThe aim of this study was to identify and compare different patterns of HF dyadic illness management.
MethodsThis was a secondary analysis of data on HF dyads. Heart failure management was measured using patient and care partner versions of the Self-Care of HF Index and European HF Self-care Behavior Scale. Latent class modeling was used to identify patterns of HF dyadic management.
ResultsThe mean age of the 62 patients and their care partners was 59.7 ± 11.8 and 58.1 ± 11.9 years, respectively. A majority of patients (71.0%) had class III/IV HF, and a majority of the couples (95.2%) were married. Two distinct dyadic patterns were observed, 1 collaborative management type (n = 42, 67.7%) and 1 autonomous management type (n = 20, 32.3%). Dyads in the autonomous pattern were mostly female patients with male care partners; patients in this pattern also were more anxious and depressed, and reported worse relationship quality compared with collaborative dyads.
ConclusionThere is an engendered spectrum of collaboration in how HF patient–care partner dyads work together to manage HF that needs to be considered in clinical care and research.
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Liu, Xiaoyue BSN, RN; Logan, Jeongok PhD, RN; Alhusen, Jeanne PhD, CRNP, RN, FAAN
The Journal of Cardiovascular Nursing: 7/8 2020 - Volume 35 - Issue 4 - p 400-414
doi: 10.1097/JCN.0000000000000654
Abstract
BackgroundCardiovascular disease (CVD) and intimate partner violence (IPV) are 2 major chronic problems that prevalently affect women's health and quality of life in the United States. However, whether female IPV survivors are at risk for developing adverse cardiovascular outcomes has not been clearly understood.
ObjectiveThis integrative review was conducted to bridge the literature gap by examining cardiovascular health in female adults with a history of IPV experience.
MethodsThree electronic databases including PubMed, CINAHL, and Web of Science were used to search for studies published between 1998 and 2019. The search process followed the Preferred Reporting Items for Systematic Review and Meta-Analyses guidelines.
ResultsOf the 229 records retrieved from the literature, 19 met the criteria for review. All included studies were quantitative research. Although the overall findings showed a mixed relationship between IPV and CVD, women who experienced abuse were more likely to engage in unhealthy behaviors, have higher levels of CVD biomarkers, experience cardiovascular symptoms, and exhibit long-term cardiovascular complications when compared with non-abused women.
ConclusionsIntimate partner violence is a stressor that directly and indirectly influences women's cardiovascular health. Therefore, it is essential for healthcare providers to routinely screen IPV status in clinical practice. Targeted interventions, such as assessing women's coping strategies and evaluating their cardiovascular health using a total risk factor approach, are recommended to prevent or reduce the deleterious effects of violence on this large, vulnerable group of women.
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Mobile Electrocardiogram Monitoring and Health-Related Quality of Life in Patients With Atrial Fibrillation
Findings From the iPhone Helping Evaluate Atrial Fibrillation Rhythm Through Technology (iHEART) Study
Caceres, Billy A. PhD, RN, AGPCNP-BC; Hickey, Kathleen T. EdD, FNP, ANP, FAHA, FAAN; Bakken, Suzanne B. PhD, RN, FAAN, FACMI; Biviano, Angelo B. MD, MPH; Garan, Hasan MD; Goldenthal, Isaac L. MS; Koleck, Theresa A. PhD, RN; Masterson-Creber, Ruth PhD, MPH, RN, FAHA; Turchioe, Meghan Reading PhD, MPH, RN; Jia, Haomiao PhD
The Journal of Cardiovascular Nursing: 7/8 2020 - Volume 35 - Issue 4 - p 327-336
doi: 10.1097/JCN.0000000000000646
Abstract
Background
Atrial fibrillation (AF) is associated with high recurrence rates and poor health-related quality of life (HRQOL) but few effective interventions to improve HRQOL exist.
Objective
The aim of this study was to examine the impact of the “iPhone Helping Evaluate Atrial Fibrillation Rhythm through Technology” (iHEART) intervention on HRQOL in patients with AF.
Methods
We randomized English- and Spanish-speaking adult patients with AF to receive either the iHEART intervention or usual care for 6 months. The iHEART intervention used smartphone-based electrocardiogram monitoring and motivational text messages. Three instruments were used to measure HRQOL: the Atrial Fibrillation Effect on Quality of Life (AFEQT), the 36-item Short-Form Health survey, and the EuroQol-5D. We used linear mixed models to compare the effect of the iHEART intervention on HRQOL, quality-adjusted life-years, and AF symptom severity.
Results
A total of 238 participants were randomized to the iHEART intervention (n = 115) or usual care (n = 123). Of the participants, 77% were men and 76% were white. More than half (55%) had an AF recurrence. Both arms had improved scores from baseline to follow-up for AFEQT and AF symptom severity scores. The global AFEQT score improved 18.5 and 11.2 points in the intervention and control arms, respectively (P < .05). There were no statistically significant differences in HRQOL, quality-adjusted life-years, or AF symptom severity between groups.
Conclusions
We found clinically meaningful improvements in AF-specific HRQOL and AF symptom severity for both groups. Additional research with longer follow-up should examine the influence of smartphone-based interventions for AF management on HRQOL and address the unique needs of patients diagnosed with different subtypes of AF. -
We know how busy life can be and we would like to introduce a new feature of our podcast. We will be using this platform to record and disseminate manuscript abstracts from our current issues onto our podcasting and social media outlets.
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Join us as we discuss nursing research in the era of COVID-19. Dr. Kelly Wierenga and Dr. Scott Emory Moore will be discussing a new project that they have developed and their experience launching a new study about behavioral outcomes related to social distancing during the pandemic.
Dr. Kelly Wierenga is an assistant professor of nursing at Indiana University. Her program of research focuses on improving self-management behaviors and secondary prevention for patients recovery following a major adverse cardiac event. Her research interests lie in how improving abilities to adaptively regulate emotions during a stressful period of recovery can improve symptoms of emotional distress in these individuals. These improvements in psychological symptoms paired with traditional recovery efforts may increase the uptake and sustaining of healthy self-management behaviors long-term. She has developed a treatment using mechanisms of emotion regulation to support recovery in the cardiovascular rehabilitation population. This treatment has demonstrated early efficacy in a small pilot sample and is continuing to be refined by her team. Dr. Wierenga has been funded as a principle investigator, co-investigator, and trainee through foundation and NIH funded projects. She has published and presented work related to cardiovascular health, health disparities, illness perceptions, symptoms of psychological distress, self-management behaviors, emotion regulation, and intervention development.
Scott Emory Moore, Ph.D., APRN, AGPCNP-BC, is an assistant professor at the Frances Payne Bolton School of Nursing at Case Western Reserve University. Dr. Moore’s program of research and scholarship focuses on improving quality of life and aging outcomes among marginalized populations particularly sexual and gender minorities and people living with HIV. His clinical background as a Registered Nurse and an Adult-Gerontological Primary Care Nurse Practitioner (AGPCNP) has included serving a range of vulnerable populations in rural and urban community settings for both acute and chronic care needs. His research and practice has focused on providing affirming care for sexual and gender minority adults and other marginalized populations with a specific focus on aging and the psychosocial and behavioral factors that influence health outcomes. Dr. Moore has been PI and Co-PI on foundation and NIH funded projects, and published and presented work related to mHealth, aging, sex-based differences, sexual and gender minority populations, symptoms, biomarkers, HIV, behavioral economics, and decision making.
