- Email: [email protected]
Short Acting Nitrate Prescription and Patient Knowledge
Method: Process mapping the elective cardioversion procedure identified areas of potential clinical risk and service gaps. In consultation with WH Cardiologists and the stakeholders the service was reviewed incorporating best practice guidelines. Co-ordination of the elective cardioversion process was assigned to the existing cardiology nurse-led preadmission clinic the role of which is to identify and manage patient risk factors. Results: Following the service re-design and implementing best practice guidelines, day of procedure cancellations have been reduced from 50% to less than 5%. Added benefits include resource alignment and increased teaching and training opportunities for WH staff. Conclusion: A co-ordinated approach has resulted in an aligned and improved level of service delivery. Integral to this success has been the role of the cardiology preadmission clinic in providing a patient-centred approach. doi:10.1016/j.hlc.2009.05.199 198 SHORT ACTING NITRATE PRESCRIPTION AND PATIENT KNOWLEDGE R. Gallagher 1 , J. Belshaw 2 , A. Kirkness 2 , K. Roach 2 , L. Sadler 2 , D. Warrington 2 1 Faculty of Nursing, Midwifery and Health, University of Tech-
nology, Sydney, Australia 2 Northern Sydney Central Coast Area Health Service, Australia
Background: International guidelines recommend coronary heart disease (CHD) patients should be prescribed short acting nitrates (SAN) and taught how to use them appropriately. However, patients’ knowledge of SAN is reported to be poor and prescription rates rarely investigated. Method: We surveyed non-surgical CHD patients, beginning cardiac rehabilitation in Northern Sydney and Central Coast Area Health Service, regarding prescription and knowledge of SAN. Regression analyses identified predictors. Results: Participants (n = 142) were aged an average 63 years (sd 13 years), mostly male (75%) and had a coronary stent (78%) and/or AMI (66%). Only two-thirds (67%) were prescribed SAN, and the odds of being prescribed SAN were increased by a prior cardiac history (OR 2.8, 95% CI 1.01–7.73) but decreased at one program site (OR .30, 95% CI 08–1.2). In those prescribed SAN, less than half (43%) had received instruction, usually given by a nurse (37%) or doctor (23%), with 24% receiving both verbal and written instruction. The mean knowledge score was 8.9 (sd 2.21) (out of possible 14), with 23% knowing less than half the essential SAN information. However, the majority (78%) would call an ambulance if SAN did not lessen chest discomfort. Participants were more knowledgeable if they lived with someone (β = 1.96), were male (β = 1.71), and had
Abstracts
S89
been taught (β = 1.24), but less so if they had an angina diagnosis (β = −1.53). Conclusion: SAN prescription and knowledge is insufficient in CHD patients, which may decrease appropriate SAN use. doi:10.1016/j.hlc.2009.05.200 199 THE EXPERIENCES AND PERCEPTIONS OF HEALTH AND ILLNESS IN PATIENTS SUFFERING THEIR FIRST ACUTE MYOCARDIAL INFARCTION AND UNDERGOING PRIMARY PERCUTANEOUS CORONARY INTERVENTION Ann-Charlotte Vittrup University of New England, 2351, Armidale, NSW, Australia Purpose: There is considerable evidence suggesting that patients who undergo elective percutaneous coronary intervention (PCI), often believe that the procedure has cured their illness as they experience an immediate improvement in functional status. No research has explored the experiences of patients who suffer an acute myocardial infarction (AMI) and undergo primary PCI, to determine whether this rapid procedure and recovery also causes this group to dismiss the seriousness of their illness. This is an important issue, as the meaning that these patients assign to their cardiac event, plays a pivotal role in their subsequent health behaviour, such as Cardiac Rehabilitation (CR) attendance and medication adherence. Thus, the purpose of this study was to explore and interpret the experiences and perceptions of health and illness in patients who suffered their first AMI and underwent primary PCI. Methods: This qualitative study used Hermeneutic Phenomenology to explore the experiences of thirteen participants following their first AMI and primary PCI. Semi-structured, individual in-depth interviews were conducted three to seven months following discharge. Results: The findings clearly indicated that the participants did not dismiss the seriousness of their illness. Instead suffering a first AMI and primary PCI was found to be a life-threatening experience, leading to a process of adjustment to physical, emotional, social and spiritual challenges throughout the period of recovery. This accords with the literature regarding those who have experienced an AMI, regardless of intervention or treatment. Conclusions: It is anticipated that the findings will contribute to the development of new approaches to CR that meet the needs of this group of patients. doi:10.1016/j.hlc.2009.05.201
ABSTRACTS
Heart, Lung and Circulation 2009;18S:S1–S286
nology, Sydney, Australia 2 Northern Sydney Central Coast Area Health Service, Australia
Background: International guidelines recommend coronary heart disease (CHD) patients should be prescribed short acting nitrates (SAN) and taught how to use them appropriately. However, patients’ knowledge of SAN is reported to be poor and prescription rates rarely investigated. Method: We surveyed non-surgical CHD patients, beginning cardiac rehabilitation in Northern Sydney and Central Coast Area Health Service, regarding prescription and knowledge of SAN. Regression analyses identified predictors. Results: Participants (n = 142) were aged an average 63 years (sd 13 years), mostly male (75%) and had a coronary stent (78%) and/or AMI (66%). Only two-thirds (67%) were prescribed SAN, and the odds of being prescribed SAN were increased by a prior cardiac history (OR 2.8, 95% CI 1.01–7.73) but decreased at one program site (OR .30, 95% CI 08–1.2). In those prescribed SAN, less than half (43%) had received instruction, usually given by a nurse (37%) or doctor (23%), with 24% receiving both verbal and written instruction. The mean knowledge score was 8.9 (sd 2.21) (out of possible 14), with 23% knowing less than half the essential SAN information. However, the majority (78%) would call an ambulance if SAN did not lessen chest discomfort. Participants were more knowledgeable if they lived with someone (β = 1.96), were male (β = 1.71), and had
Abstracts
S89
been taught (β = 1.24), but less so if they had an angina diagnosis (β = −1.53). Conclusion: SAN prescription and knowledge is insufficient in CHD patients, which may decrease appropriate SAN use. doi:10.1016/j.hlc.2009.05.200 199 THE EXPERIENCES AND PERCEPTIONS OF HEALTH AND ILLNESS IN PATIENTS SUFFERING THEIR FIRST ACUTE MYOCARDIAL INFARCTION AND UNDERGOING PRIMARY PERCUTANEOUS CORONARY INTERVENTION Ann-Charlotte Vittrup University of New England, 2351, Armidale, NSW, Australia Purpose: There is considerable evidence suggesting that patients who undergo elective percutaneous coronary intervention (PCI), often believe that the procedure has cured their illness as they experience an immediate improvement in functional status. No research has explored the experiences of patients who suffer an acute myocardial infarction (AMI) and undergo primary PCI, to determine whether this rapid procedure and recovery also causes this group to dismiss the seriousness of their illness. This is an important issue, as the meaning that these patients assign to their cardiac event, plays a pivotal role in their subsequent health behaviour, such as Cardiac Rehabilitation (CR) attendance and medication adherence. Thus, the purpose of this study was to explore and interpret the experiences and perceptions of health and illness in patients who suffered their first AMI and underwent primary PCI. Methods: This qualitative study used Hermeneutic Phenomenology to explore the experiences of thirteen participants following their first AMI and primary PCI. Semi-structured, individual in-depth interviews were conducted three to seven months following discharge. Results: The findings clearly indicated that the participants did not dismiss the seriousness of their illness. Instead suffering a first AMI and primary PCI was found to be a life-threatening experience, leading to a process of adjustment to physical, emotional, social and spiritual challenges throughout the period of recovery. This accords with the literature regarding those who have experienced an AMI, regardless of intervention or treatment. Conclusions: It is anticipated that the findings will contribute to the development of new approaches to CR that meet the needs of this group of patients. doi:10.1016/j.hlc.2009.05.201
ABSTRACTS
Heart, Lung and Circulation 2009;18S:S1–S286