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PubMed1995

Positive life orientation and recovery from myocardial infarction.

The study examined the relationship between positive life orientation (PLO) and recovery from a recent myocardial infarction (MI), i.e. heart attack. PLO was defined as a predisposition to selectively focus one's attention on the brighter side of any situation. An 11-item measure of PLO was developed. Seventy male patients of first MI receiving treatment at a local government hospital were interviewed twice, 4-5 days after their first heart attack (time 1) and a month after their first heart attack (time 2). The interview schedule consisted of measures of PLO, perceived recovery, expected recovery, helplessness, personal control and mood state. At time 1 all these measures were administered but at time 2 measures of only PLO, personal control, perceived recovery and mood state were administered. In addition, the attending doctor assessed the patients' medical recovery at time 1. Results showed positive correlation of patients' PLO scores with their medical recovery, perceived recovery, expected recovery, personal control and mood state but negative with helplessness. PLO scores were not influenced by patients' age, education, or income. Patients' scores on PLO at two time points were not significantly different and were positively correlated. Their scores on sense of personal control and perceived recovery increased significantly at time 2. Significant intercorrelations among variables, under study, often reduced to insignificance on partialling out PLO. PLO, thus emerged as an important factor in recovery from MI.

Adult↗
PubMedDate not supplied

Patients' and spouses' causal explanations of a myocardial infarction.

This study examined lay explanations of an illness episode, myocardial infarction, at acute and convalescent phases of illness. Data were collected by interviews, using a structured questionnaire during the acute phase of illness (in hospital) and convalescent phase (at home) after discharge, from 50 first-time MI patients and 50 spouses or significant others. Tension (at work, in the home situation, and in general) was the most frequent cause given for the heart attack by both patients and spouses at both phases. Half the patients and half the spouses changed their mind regarding the cause of the heart attack between the acute and the convalescent phases. Further, over 50 percent of the patient/spouse pairs disagreed regarding the cause of illness at both phases. A high percentage of patients changed their smoking, diet, and exercise behavior, even when they did not list these factors as causes of the heart attack. Findings also suggested spouses should be included in discharge planning and special problems which spouses may face after patients' discharge should be addressed.

Adult↗
PubMed1981

A study of cardiovascular risk in heterozygotes for homocystinuria.

Early atherosclerotic-like lesions and thromboemobolic problems are prominent in homocystinuric patients. Recent evidence suggested that mild homocyst(e)inemia, such as is present in heterozygotes for homocystinuria due to cystathionine synthase deficiency, may cause a marked excess in early ischemic heart disease. To evaluate the risk due to mild homocyst(e)inemia, the frequencies of heart attacks and strokes in parents and grandparents of homocystinuric children were assessed in the present study. No statistically significant increases in the incidence of heart attacks or strokes were consistently detected. The data available are sufficient to virtually exclude an increase in the cardiovascular risk for homocystinuria heterozygotes of as much as fivefold compared to controls, and to make very improbable a relative risk of as much as threefold. Less than 5% of homocystinuria heterozygotes are likely to have a fatal or nonfatal heart attack by age 50. These results fail to suggest that mild homecyst(e)inemia is an important contributory factor in the overall incidence of cardiovascular disease.

Adult↗
PubMed1978

Randomised trial of a mobile coronary care unit for emergency calls.

A randomised trial was conducted to assess the value of sending a mobile coronary care unit (MCCU) to all emergency calls other than those for children or for patients injured in road-traffic accidents or brawls. Over 15 months 6223 calls for emergency ambulances were considered for the study, but a routine ambulance had to be dispatched on 2583 occasions because the MCCU was not available. A group of 1664 patients was randomly allocated to transport by the MCCU and 1676 patients to routine transport. In these groups the prehospital mortality among patients with heart attacks was 45% and 47%, and no patient survived resuscitation attempts long enough to leave hospital. During the same period general practitioners sent 190 patients with heart attacks to hospital in routine ambulances and none of them died during the interval between the call for the ambulance and arrival at hospital. Although it may be worth equipping all emergency ambulances with a defibrillator, MCCUs as at present envisaged will not appreciably affect mortality from heart attacks.

Ambulances↗
PubMed1977

Health beliefs and smoking patterns in heart patients and their wives: a longitudinal study.

Smoking patterns of 205 male patients were examined over a period of eight years after a primary myocardial infarction. Smoking data from their wives at one year after the heart attack were also examined. A marked, persistent reduction in smoking was found among the men. Smoking patterns of wives remained essentially unchanged. Smoking patterns before the heart attack were not related to demographic variables, except for the associated between smoker-nonsmoker status and social measures. Conceptions of susceptibility, threat, and power of prevention drawn from theoretical models on preventive health behavior were employed for analysis. High proportions of husbands and wives reported belief in smoking as important in the etiology of the heart attack, and in possibilities of prevention. Specific beliefs concerning threat, susceptibility, and prevention were not found to be related to the massive drop in smoking behavior among the men nor to stability in pattern among the wives. Alternative explanations are reviewed.

Adult↗
PubMed1999

[Incidence of myocardial infarct in Germany: prevalence, incidence trends, East-West comparison].

The German National Health Interview and Examination Survey, as a descriptive cross-sectional study, allows the recording of post-myocardial infarct cases, e.g. the number (prevalence) of survivors after an infarct has occurred (non-lethal myocardial infarcts). The 18 to 79 year old residential population in Germany had a lifetime prevalence of 2.45% for conditions after a heart attack. The age-specific lifetime prevalence values increase with increasing age for both men and women. Between the ages of 30 and 59 there are more than 4 male heart attack victims for every woman; between the ages of 60 and 79 this relation is only 1 to 1.5. The 30-< 80 year old population in Germany has around 1,450,000 post-myocardial infarct cases (heart attack victims). There are about 100,000 male post-myocardial infarct cases among relatively young adults between 30 and 49 years of age. There were hardly any cases in the female population in this age group. In regard to post-myocardial infarcts there were no significant morbidity differences between the eastern and western German states in 1997/98. A comparison of the lifetime prevalence rates between 1997/98 and 1990/92 shows the following trend: the number of post-myocardial infarcts in the German population 25-< 70 years old decreased; in Western Germany the lifetime prevalence rates also declined, in Eastern Germany the prevalence rates among both men and women increased in this period of time. In the period 1997/98 there were around 190,000 non-lethal myocardial infarcts in the 18 to 79 year old German population in a full 12 month period (incidence cases of survivors after the occurrence of an acute first and/or acute reinfarcts).

Adolescent↗
PubMed1995

Attributions for illness and treatment interventions by community nurses.

The present study evaluated community nurses' attributions for a case patient's heart attack and their recommendations for treatment. Eighty-nine district nurses and health visitors completed a set of rating scales following a case vignette describing a patient who had suffered a heart attack and prior to which had either adopted a healthy lifestyle (n = 47) or had maintained unhealthy behaviours (n = 42). The results suggest that subjects in the unhealthy-behaviour condition rated the case patient as less likely to follow advice, more responsible for his/her condition and rated the heart attack as more preventable. In addition, the results suggest that subjects were more likely to offer recommendations for behavioural change to the unhealthy case patient and that these recommendations were significantly related to internal attributions of patient responsibility. The results are discussed in terms of theories of health professionals' beliefs and behaviours.

Adult↗
PubMed1993

The impact of contextual cues on the interpretation of and response to physical symptoms: a vignette approach.

This study examined the impact of two contextual cues--stress and aging--on conceptualizations of, and health care responses to, physical symptoms. Eighty-three undergraduates each read four vignettes describing a woman experiencing physical symptoms indicative of either heart attack, depression, ulcer, or flu. Subjects were randomly assigned to one of six age/stress cue combinations. Consistent with predictions, physical symptoms presented with stress cues were less likely to be attributed to acute illness and were seen as more variable. The effect was most pronounced for heart attack symptoms, which, when presented with stress cues, were also less likely (1) to be identified as a heart attack, (2) to be attributed to chronic illness, (3) to elicit recommendations to seek medical care, (4) and to be regarded as serious. The age manipulation did not exert an effect. Implications of these findings and limitations of the vignette approach are discussed.

Adult↗
PubMed1998

Strategies for cardiovascular disease prevention: importance of public and community health programs.

Cardiovascular diseases (CVD), principally coronary heart disease (CHD), stroke, and congestive heart failure, continue to be the leading cause of death claiming nearly 1,000,000 lives annually and accounting for more than 40% of the deaths in the United States (American Heart Association). While cardiovascular disease is often viewed as a problem of the elderly, 45% of heart attacks occur among individuals less than 65 years old. Moreover, CVD is the second leading cause of death for those 45 to 64 years of age and the third leading cause of death for those 25 to 44 years old. In economic terms, the annual direct and indirect costs of heart attack and stroke are approximately $259 billion or $492,444/second, in the United States alone. Thus, from a human and economic perspective, heart and vascular diseases are an enormous burden worthy of significant attention. This review is not intended to ignore the 50% decline in age-adjusted rates for heart attack and stroke events over the preceding three decades, as summarized by the recent report of the Joint National Committee on the Prevention, Detection, Evaluation and Treatment of High Blood Pressure (JNC VI). However, progress has halted as coronary heart disease and stroke mortality rates have reached a plateau in recent years and appear to be rising. Consequently, this is an excellent time for re-examining our approach to the prevention and treatment of CVD. In this article, readers will find an overview of the CVD prevention and treatment topics and not an in-depth analytical or epidemiological assessment of risk factors and outcomes. First, a macroscopic approach to reducing CVD is presented, followed by a discussion emphasizing the critical importance of public health and community-based programs in the effort to significantly reduce the burden of hypertension and related cardiovascular morbidity and mortality. Effective public health programs can play a pivotal role in raising awareness, and more importantly, in facilitating lifestyle change, entry and retention in the healthcare system, and compliance with non-pharmacological as well as drug therapy.

Cardiovascular Diseases↗
PubMed1997

Body weight: implications for the prevention of coronary heart disease, stroke, and diabetes mellitus in a cohort study of middle aged men.

OBJECTIVE: To determine the body mass index associated with the lowest morbidity and mortality. DESIGN: Prospective study of a male cohort. SETTING: One general practice in each of 24 British towns. SUBJECTS: 7735 men aged 40-59 years at screening. MAIN OUTCOME MEASURES: All cause death rate, heart attacks, and stroke (fatal and non-fatal) and development of diabetes, or any of these outcomes (combined end point) over an average follow up of 14.8 years. RESULTS: There were 1271 deaths from all causes, 974 heart attacks, 290 strokes, and 245 new cases of diabetes mellitus. All cause mortality was increased only in men with a body mass index (kg/m2) < 20 and in men with an index > or = 30. However, risk of cardiovascular death, heart attack, and diabetes increased progressively from an index of < 20 even after age, smoking, social class, alcohol consumption, and physical activity were adjusted for. For the combined end point the lowest risks were seen for an index of 20.0-23.9. In never smokers and former smokers, deaths from any cause rose progressively from an index of 20.0-21.9 and for the combined end point, from 20.0-23.9. Age adjusted levels of a wide range of cardiovascular risk factors rose or fell progressively from an index < 20. CONCLUSION: A healthy body mass index in these middle aged British men seems to be about 22.

Adult↗
PubMed2004

Antiinflammatory properties of PPARgamma agonists following ischemia.

Ischemic disease is a leading cause of death and disability worldwide, and its incidence is expected to increase as the population ages. One population at particularly high risk of developing ischemia is patients with diabetes. Type 2 diabetes is associated with a marked increase in atherosclerosis, stroke and heart attack. Furthermore, the outcome following stroke and heart attack in diabetics is worse than in nondiabetic patients. In recent years, peroxisome proliferator-activated receptor (PPAR) agonists have been found to have potent antiinflammatory actions and have emerged as potential therapies for atherosclerosis and ischemia. The use of these agents is particularly attractive, since two PPARgamma agonists, pioglitazone (Actos) and rosiglitazone (Avandia), are already used chronically to treat diabetes. In this article we review the role of inflammation in ischemic disease and the biology of PPARs, and summarize the evidence that PPARgamma ligands suppress inflammation with an emphasis on atherosclerosis, and cerebral and myocardial ischemia.

Anti-Inflammatory Agents↗
PubMed1989

Parental history of cardiovascular disease as an indication for screening for lipoprotein abnormalities in children.

We studied the relationship between parental history of cardiovascular disease and risk for adverse lipid and lipoprotein levels in a total community study of 3313 children (ages 4 to 17 years, 63% white, 37% black). Older white children (11 to 17 years) with a parental history of heart attack or diabetes were 4.3 and 5.6 times, respectively, more likely to have high levels (greater than or equal to 95th percentile) of serum total cholesterol than those without such a history (all p less than 0.05). White children with a parental history of heart attack or diabetes were twice as likely to have an elevated (greater than or equal to 95th percentile) low-density lipoprotein cholesterol (LDL-C) level than those without such a history (both p less than 0.05). In contrast, parental history of cardiovascular disease did not predict elevated levels of total cholesterol or LDL-C in black children. However, older black children with a parental history of heart attack, hypertension, or diabetes were 4 1/2 to 5 times more likely to have low levels (less than or equal to 5th percentile) of high-density lipoprotein cholesterol than those without such a history (all p less than 0.05). Only 40% of white children and 21% of black children with elevated LDL-C levels had a parental history of vascular disease. These findings raise questions about the current practice of screening only children with a family history of cardiovascular disease to identify those with elevated total cholesterol and LDL-C levels.

Adolescent↗
PubMed1998

Development of an ED teaching program aimed at reducing prehospital delays for patients with chest pain.

OBJECTIVE: Delays in providing thrombolytic agents to patients with chest pain occur mainly in the prehospital arena. To reduce prehospital delay in treating patients with chest pain, we created a discharge teaching video that emphasized calling 911 in the event of a possible heart attack and a written action plan to be posted near the telephone. We also gave patients their EKG readings to bring with them on their next visit to the emergency department. SETTING AND SAMPLE: All patients with chest pain admitted to the Chest Pain Observation Unit at Baystate Medical Center, Springfield, Mass, were eligible for this teaching effort. We tracked 127 nonconsecutive patients from January 1997 to May 1997. Of these patients, 108 were included in the study. RESULTS: We interviewed 102 patients (94%) 3 days after they were discharged from the Chest Pain Observation Unit. Within this group, 92% were able to describe what a heart attack might feel like, and 81.4% said they would call 911 or go to the hospital if they had symptoms of a heart attack. If they thought that their symptoms might be indigestion, 69% said they would take an antacid, then go to the hospital if they did not feel better. Fifty-one percent remembered what to do with their EKG readings, and 60.7% knew how to take their nitroglycerin correctly. CONCLUSION: We concluded that patients understood the message they were given and retained some of the material 3 days after discharge from the Chest Pain Observation Unit. The follow-up telephone calls revealed areas for improvement in the discharge teaching tools.

Chest Pain↗
PubMed2002

Differential effects of premorbid physical and emotional health on recovery from acute events.

OBJECTIVES: Emotional health may have an important effect on disease onset, but there has been little work evaluating premorbid emotional health on recovery from disability that results from acute medical events. The aim of this study is to determine whether premorbid emotional health is predictive of recovery in functional ability 1 year after reporting a stroke, heart attack, or hip fracture (event). DESIGN: A prospective cohort study of an older population-based sample from 1986 to 1992. SETTING: Data are from baseline and six annual follow-ups of the North Carolina Established Population for Epidemiological Study of the Elderly. PARTICIPANTS: Two hundred forty whites and blacks aged 65 and older who reported a stroke, heart attack, or hip fracture during one of the first five follow-up interviews and had an increased level of disability at that follow-up. MEASUREMENT: Improvement in disability in activities of daily living (ADLs) 1 year postevent. RESULTS: High depressive symptoms at baseline showed a significant association with poorer recovery in functional ability 1-year postevent after adjustments were made for sociodemographic characteristics, smoking status, ADLs at time of event, cognitive status, and prior history of disease. Compared with nondepressed subjects, depressed subjects had an odds ratio (OR) of 0.38 (95% confidence interval (CI) = 0.16-0.94) for recovery 1 year after reporting a stroke, heart attack, or hip fracture. Additionally, among subjects who reported low depressive symptoms, high positive affect was significantly associated with increased odds of recovery (OR = 2.70, 95% CI = 1.10-6.68), adjusting for the same variables. CONCLUSIONS: Emotional health, independent of other baseline measures, is associated with recovery in functional ability 1 year after a major health event. Our findings suggest that reducing premorbid levels of depressive symptoms or increasing positive affect may help the recovery process.

Activities of Daily Living↗
PubMed2001

Modeling emotion and behavior in animated personas to facilitate human behavior change: the case of the HEART-SENSE game.

The goal of this research is to determine whether a computer based training game (HEART-SENSE) can improve recognition of heart attack symptoms and shift behavioral issues so as to reduce pre-hospitalization delay in seeking treatment. Since treatment delay correlates with adverse outcomes, this research could reduce myocardial infarction mortality and morbidity. In Phase I we created and evaluated a prototype virtual village in which users encounter and help convince synthetic personas to deal appropriately with a variety of heart attack scenarios and delay issues. Innovations made here are: (1) a design for a generic simulator package for promoting health behavior shifts, and (2) algorithms for animated pedagogical agents to reason about how their emotional state ties to patient condition and user progress. Initial results show that users of the game exhibit a significant shift in intention to call 9-1-1 and avoid delay, that multi-media versions of the game foster vividness and memory retention as well as a better understanding of both symptoms and of the need to manage time during a heart attack event. Also, results provide insight into areas where emotive pedagogical agents help and hinder user performance. Finally, we conclude with next steps that will help improve the game and the field of pedagogical agents and tools for simulated worlds for healthcare education and promotion.

Algorithms↗
PubMed1995

The relation of parental cardiovascular disease to risk factors in children and young adults. The Bogalusa Heart Study.

BACKGROUND: Although cardiovascular risk factors relate to family history of cardiovascular disease, it is not clear how the relation changes from children to young adults. METHODS AND RESULTS: As part of a community study for cardiovascular health, parental history of diseases was obtained from 8276 offspring 5 to 31 years old, 36% black and 64% white. Between 5- to 10-year-old children and 25- to 31-year-old young adults, prevalence of parental heart attack increased from 5% to 25%. More prevalent in blacks than in whites, parental stroke increased from 2% to 9% in whites versus 3% to 19% in blacks; parental diabetes rose from 7% to 19% in whites versus 9% to 33% in blacks; and parental hypertension increased from 26% to 59% in whites versus 40% to 72% in blacks. Offspring with parental heart attack history were significantly overweight after 10 years of age and showed elevated levels of total cholesterol, VLDL cholesterol, LDL cholesterol, insulin, and glucose after 17 years of age, irrespective of weight. Offspring of diabetic parents were significantly overweight, irrespective of age. They showed significant increases in levels of insulin, glucose, triglycerides, total cholesterol, VLDL cholesterol, and LDL cholesterol after age 24 years, independent of weight. Offspring of hypertensive parents displayed overweight regardless of age, higher levels of blood pressure after age 10 years, and elevations of triglycerides and VLDL cholesterol after age 24 years irrespective of weight. Analyzed by race and sex in young adults, parental heart attack related strongly to LDL cholesterol in the white offspring, especially white males, and to insulin in the black offspring. Parental diabetes showed a stronger association with overweight and glucose in black females. Also noted was the relation between parental hypertension and overweight in black females. CONCLUSIONS: Parental history is an important surrogate measure for cardiovascular risk in the offspring. However, parental history information alone is not sufficient to designate younger children for selective screening for high cholesterol, because of the young age of parents.

Adolescent↗
PubMed1996

What, if anything, is controversial about calcium antagonists?

Recent publications purporting to show that calcium antagonists, when used for the treatment of hypertension or in the post myocardial infarction patient, would paradoxically increase the rate of heart attack and mortality have cast doubts on the safety and efficacy of this drug class. All three studies are retrospective, and have various drawbacks. Specifically, the metaanalysis of Furberg et al is fraught with mistakes, of borderline significance, and based on old data pertaining to short-acting nifedipine only (which should not be given in patients who have suffered an acute heart attack). The case control study of Psaty et al suggested that hypertensive patients who were treated with short-acting verapamil, diltiazem, and nifedipine had an excessive rate of myocardial infarction when compared with patients who were treated with diuretics. Two out of the three calcium antagonists that were used in this study were not approved for the treatment of hypertension by the US Food and Drug Administration. Some patients were taking these drugs only once a day whereas, because of their short duration of action, at least a three or four times daily regimen would be required to achieve an acceptable blood pressure control throughout a 24-h period. The cohort study of Pahor et al suggested distinct differences among various calcium antagonists with regard to survival. Blood pressure was controlled in < 40% of all patients, and in some patients blood pressure was never even measured. Recent studies, such as the Prospective Randomized Amlodipine Survival Evaluation (PRAISE), the third Vasodilator-Heart Failure Trial (VHeFT-III), the second Doppler Flow and Echocardiography in Functional Cardiac Insufficiency Assessment of Nisoldipine Therapy (DEFIANT II), the Angina Prognosis Study in Stockholm (APSIS), and the Shanghai Trial of Nifedipine in the Elderly (STONE), attest to the safety and efficacy of the newer long-acting calcium antagonists in patients with a wide spectrum of heart disease. Several ongoing trials including the Antihypertensive and Lipid Lowering Treatment to Prevent Heart Attack Trial (ALLHAT) with amlodipine, the International Nifedipine-GITS Study: Intervention as a Goal in Hypertension Treatment (INSIGHT) with nifedipine, the Hypertension Optimal Treatment study (HOT) with felodipine, the Systolic Hypertension in the Elderly in Europe Trial (SYST-EUR) with nicardipine, the Second Swedish Trial in Old Patients with Hypertension (STOP II) with felodipine, and Nordic Diltiazem Study (NORDIL) with diltiazem, will give us morbidity and mortality data in patients with high blood pressure within the next few years. Until these results are available, we can be confident that the lowering of blood pressure and providing relief of patients with symptomatic angina can be achieved safely and efficiently with the presently available long-acting calcium antagonists.

Calcium Channel Blockers↗