D.Litt. et Phil. (Psychology) / Over the past four decades we have witnessed the emergence of amazingly sophisticated means of cardiovascular diagnosis and therapy. For the first time in many years, some Western countries could report a decline in cardiovascular deaths. During this same span of years we have witnessed the remarkable development of an array of technological achievements that include the means for invasive diagnostic procedure such as cardiac catherization, and non-invasive methods of echocardiography, magnetic, radio-isotopic and positron imagery which provide detailed diagnostic and prognostic information. This innovations along with synthetic grafts have permitted surgical interventions that would not have been conceivable at the outset of this cardiovascular odyssey. Another major advance has been the appearance of new pharmacological modalities; the diuretics, the beta-adrenergic receptors and angiotension converting enzyme inhibitors, the calcium antagonists and other anti-hypersensitive agents, a spectrum of antiarrhythmic compounds, anticoagulants and fibrinolytic therapy, and the promise of still more innovative and novel modes of therapy which will appear via genetic engineering. Over the past years there has been equally significant development in the area of cardiovascular epidemiology. These advances include the demonstration of validity and the efficacy of various therapeutic programmes by the unique development of complex multi-center trials, as well as long-term population-based studies. Through this endeavours specific risk factors that impart independent risk ofpremature cardiovascular morbidity and mortality has been identified. Some of these risk factors are clearly not modifiable such as advancing years, male gender and race. Others are at least partly modifiable: predisposition to diabetes myelitis and increased body mass. By virtue of multi-center trials we have clear evidence that cigarette smoking, rising systolic and diastolic arterial pressures, serum cholesterol levels, and diabetes are modifiable. It is a known fact that not all individuals with coronary artery disease are cured by medication or by means of a surgical intervention. In addition to this, the reduction of traditional biomedical risk factors have been shown to be insufficient in averting the reocclusion and the further occlusion of coronary arteries in patient populations.

M.Cur. (Intensive General Nursing) / It appears that the emotions of patients in.the process of undergoing coronary artery bypass graft surgery have an influence on the rate of mortality. Patients that must undergo this surgery often find themselves in a short term dependent position. The purpose of this study is to determine if the life-style functioning of the patients can be improved by means of a pre-operative rehabilitative educational programme introduced by the professional nurse. A conceptual framework of reference was compiled after completion of the literature review. This served as the preliminary structure of the pre-operative educational programme. The programme consists of three three components, viz. an education booklet, an educational evaluating model and the educationist. A quasi-experimental study was performed on 4 groups (2 experimental groups and 2 control groups) to determine the effect of the structured pre-operative educational programme on the following three factors: - satisfaction with self, others and life; -avoidance of hope threats and -anticipation of a future. From these factors three null hypotheses were formed. An analysis of the data indicated a significant difference between the groups that followed the programme and the groups that did not follow the programme. The null hypotheses were thereafter rejected. The primary recommendation of the study is that all patients in the process of undergoing coronary artery bypass graft surgery should follow a pre-operative educational programme. This programme has a positive influence on the life-style functioning of the patient and will thus promote the process of rehabilitation.

Coronary Artery Disease (CAD) is one of the most common cardiovascular disorder in adults. CAD often results in myocardial infarction or angina (Wilson, 2003:21). It is an accepted fact that the incidence of CAD has reached endemic proportions in South Africa (Venter, 1993:15). Coronary Artery Bypass Graft (CABG) surgery, Percutaneous Transluminal Coronary Angioplasty (PTCA) and insertion of a coronary stent are major therapeutic approaches to the treatment of CAD. However, these procedures do nothing to correct the underlying disease process (Hunt, Hendrata, Myles, 2000:389; Venter, 1993:15). Due to physiological changes patients suffering from CAD are expected to make lifestyle adaptations, in order to improve quality of life and prevent further damage to coronary arteries (Gotto, 1987:29). It is suspected that patients do not always adapt their lifestyle when they suffer from CAD, or if they do, do not maintain these adaptations. The following question emerges: • Do patients with coronary artery disease adapt their lifestyle and if they do, do they maintain these adaptations? The purpose of this study is to explore and describe the extent to which patients with CAD who underwent CABG, PTCA or insertion of a coronary stent adapt their lifestyles and to what extent they maintain these adaptations. Secondly, the purpose is to set guidelines to help with the improvement of lifestyle adaptations and contingency of adaptations. The objectives of the study is to explore and describe the extent to which patients with CAD adapt their lifestyles following CABG surgery, PTCA or insertion of a i coronary stent, the comparison of the extent of these lifestyle adaptations after two and four months and to set guidelines to improve the extent and contingency of lifestyle adaptations. An explorative and descriptive study was done in order to explore and describe the extent to which patients with CAD, who underwent CABG surgery, PTCA or insertion of coronary a stent, adapted their lifestyle, and to determine the maintenance of these lifestyle adaptations. For the purpose of this study questionnaires, based on a conceptual framework, were designed. The questionnaires enabled the researcher to explore and describe the lifestyle adaptations that patients with CAD underwent. The study was conducted in five private hospitals in Gauteng. The data obtained confirmed that patients suffering from CAD do adapt their lifestyle after having CABG surgery, PTCA or insertion of a coronary stent. Data also showed that the presence of a cardiac rehabilitation centre at the hospital where participants were treated, has a significant influence on patients’ ability to adapt their lifestyle and to maintain this new lifestyle. / Dr. W.O.J. Nel Ms. W. Jacobs

Thesis (MCur)--Stellenbosch University, 2015. / ENGLISH ABSTRACT: Background: Coronary artery disease is a form of cardiovascular disease (CVD) which manifests itself in three ways: angina pectoris, acute coronary syndrome and cardiac death. Thirty-three people die daily of a myocardial infarction (cardiac death) and 7.5 million deaths annually are caused by CVD (51% from strokes and 45% from coronary artery disease) worldwide. Globally, the CVD death rate is a mere 4% compared to South Africa which has a 42% death rate. It is predicted that by the year 2030 there will be 25 million deaths annually from CVD, mainly in the form of strokes and heart disease. The WHO compared the death rates of high-income countries to those of low- and middle-income countries, like South Africa, and the results show that CVD deaths are declining in high-income countries but rapidly increasing in low- and middle-income countries. Although there are several risk prediction tools in use worldwide, to predict ischemic risk, South Africa does not use any of these tools. Current practice in South Africa to diagnose acute coronary syndrome is the use of a physical examination, ECG changes and positive serum cardiac maker levels. Internationally the same practice is used to diagnose acute coronary syndrome but risk assessment tools are used additionally to this practise because of limitations of the ECG and serum cardiac markers when it comes to NSTE-ACS. Objective: The aim of this study was to systematically appraise evidence on the accuracy of acute coronary syndrome risk prediction tools in adults. Methods: An extensive literature search of studies published in English was undertaken. Electronic databases searched were Cochrane Library, MEDLINE, Embase and CINAHL. Other sources were also searched, and cross-sectional studies, cohort studies and randomised controlled trials were reviewed. All articles were screened for methodological quality by two reviewers independently with the QUADAS-2 tool which is a standardised instrument. Data was extracted using an adapted Cochrane data extraction tool. Data was entered in Review Manager 5.2 software for analysis. Sensitivity and specificity was calculated for each risk score and an SROC curve was created. This curve was used to evaluate and compare the prediction accuracy of each test. Results: A total of five studies met the inclusion criteria of this review. Two HEART studies and three GRACE studies were included. In all, 9 092 patients participated in the selected studies. Estimates of sensitivity for the HEART risks score (two studies, 3268 participants) were 0,51 (95% CI 0,46 to 0,56) and 0,68 (95% CI 0,60 to 0,75); specificity for the HEART risks score was 0,90 (95% CI 0,88 to 0,91) and 0,92 (95% CI 0,90 to 0,94). Estimates of sensitivity for the GRACE risk score (three studies, 5824 participants) were 0,03 (95% CI0,01 to 0,05); 0,20 (95% CI 0,14 to 0,29) and 0,79 (95% CI 0,58 to 0,93). The specificity was 1,00 (95% CI 0,99 to 1,00); 0,97 (95% CI 0,95 to 0,98) and 0,78 (95% CI 0,73 to 0,82). On the SROC curve analysis, there was a trend for the GRACE risk score to perform better than the HEART risk score in predicting acute coronary syndrome in adults. Conclusion: Both risk scores showed that they had value in accurately predicting the presence of acute coronary syndrome in adults. The GRACE showed a positive trend towards better prediction ability than the HEART risk score. / AFRIKAANSE OPSOMMING: Agtergrond: Koronêre bloedvatsiekte is ‘n vorm van kardiovaskulêre siekte. Koronêre hartsiekte manifesteer in drie maniere: angina pectoris, akute koronêre sindroom en hartdood. Drie-en-dertig mense sterf daagliks aan ‘n miokardiale infarksie (hartdood). Daar is 7,5 miljoen sterftes jaarliks as gevolg van kardiovaskulêre siektes (51% deur beroertes en 45% as gevolg van koronêre hartsiektes) wêreldwyd. Globaal is die sterfte syfer as gevolg van koronêre vaskulêre siekte net 4% in vergelyking met Suid Afrika, wat ‘n 42% sterfte syfer het. Dit word voorspel dat teen die jaar 2030 daar 25 miljoen sterfgevalle jaarliks sal wees, meestal toegeskryf aan kardiovaskulêre siektes. Die hoof oorsaak van sterfgevalle sal toegeskryf word aan beroertes en hart siektes. Die WHO het die sterf gevalle van hoeinkoms lande vergelyk met die van lae- en middel-inkoms lande, soos Suid Afrika, en die resultate het bewys dat sterf gevalle as gevolg van kardiovaskulêre siekte is besig om te daal in hoe-inkoms lande maar dit is besig om skerp te styg in lae- en middel-inkoms lande. Daar is verskeie risiko-voorspelling instrumente wat wêreldwyd gebruik word om isgemiese risiko te voorspel, maar Suid Afrika gebruik geen van die risiko-voorspelling instrumente nie. Huidiglik word akute koronêre sindroom gediagnoseer met die gebruik van n fisiese ondersoek, EKG verandering en positiewe serum kardiale merkers. Internationaal word die selfde gebruik maar risiko-voorspelling instrumente word aditioneel by gebruik omdat daar limitasies is met EKG en serum kardiale merkers as dit by NSTE-ACS kom. Doelwit: Die doel van hierdie sisematiese literatuuroorsig was om stelselmatig die bewyse te evalueer oor die akkuraatheid van akute koronêre sindroom risiko-voorspelling instrumente vir volwassenes. Metodes: 'n Uitgebreide literatuursoektog van studies wat in Engels gepubliseer is was onderneem. Cochrane biblioteek, MEDLINE, Embase en CINAHL databases was deursoek. Ander bronne is ook deursoek. Die tiepe studies ingesluit was deurnsee-studies, kohortstudies en verewekansigde gekontroleerde studies. Alle artikels is onafhanklik vir die metodologiese kwaliteit gekeur deur twee beoordeelaars met die gebruik van die QUADAS-2 instrument, ‘n gestandaardiseerde instrument. ‘n Aangepaste Cochrane data instrument is gebruik om data te onttrek. Data is opgeneem in Review Manager 5.2 sagteware vir ontleding. Sensitiwiteit en spesifisiteit is bereken vir elke risiko instrument en ‘n SROC kurwe is geskep. Die SROC kurwe is gebruik om die akkuraatheid van voorspelling van elke instrument te evalueer en te toets. Resultate: Twee HEART studies en drie GRACE studies is ingesluit. In total was daar 9 092 patiente wat deelgeneeem het in die gekose studies. Skattings van sensitiwiteit vir die HEART risiko instrument (twee studies, 3268 deelnemers) was 0,51 (95% CI 0,47 to 0,56) en 0,68 (95% CI 0,60 to 0,75) spesifisiteit vir die HEART risiko instrument was 0,89 (95% CI 0,88 to 0,91) en 0,92 (95% CI 0,90 to 0,94). Skattings van sensitiwiteit vir die GRACE risiko instrument (drie studies, 5824 deelnemers) was 0,28 (95% CI 0,13 to 0,53); 0,20 (95% CI 0,14 to 0,29) en 0,79 (95% CI 0,58 to 0,93). Die spesifisiteit vir die GRACE risiko instrument was 0,97 (95% CI 0,95 to 0,99); 0,97 (95% CI 0,95 to 0,98) en 0,78 (95% CI 0,73 to 0,82). Met die SROC kurwe ontleding was daar ‘n tendens vir die GRACE risiko instrument om beter te vaar as die HEART risiko instrument in die voorspelling van akute koronêre sindroom in volwassenes. Gevolgtrekking: Altwee risiko instrumente toon aan dat albei instrumente van waarde is. Albei het die vermoë om die teenwoordigheid van akute koronêre sindroom in volwassenes te voorspel. Die GRACE toon ‘n positiewe tendens teenoor beter voorspelling vermoë as die HEART risiko instrument.

The direct effect of spouse presence during graded exercise testing on anxiety and performance has not been previously delineated. Therefore, the purposes of this study were to (a) ascertain if spouse presence during graded exercise testing affects state anxiety or physiological performance variables, and (b) determine differences in psychological status between cardiac patients and healthy adults.

A knowledgeable person can deal with problems in a confident and flexible manner. This statement is certainly applicable in the area of health where an adequate knowledge helps clients to avoid complications. This study was conducted to explore the perceptions of ischemic heart disease patients and their families regarding the content and format of health education they need, before discharge from the hospital. A non-experimental survey study was conducted in the coronary care unit (ccu) of three governmental hospitals in Abu Dhabi, United Arab Emirates (UAE). A convenient sample of one hundred and twelve (112) participants consisting of eighty (80) patients and thirty two (32) relatives, were selected over a three month period. A self-report approach was used to collect data and a questionnaire in the form of five point Likert scale, was developed with appropriate content matching the study purpose. Reliability was tested by test- retest for nine (9) patients not participating in the sample. A panel of experts tested its validity. The confidentiality of the participants was carefully considered. The study has revealed that patients and their families indicate a strong need for health education. Most of the sample prefers health education during the hospital stay by the doctor, although nurses and different health service members were also seen as being important. The respondents perceived the health education function as increasing their confidence in dealing with the disease, while reducing their readmission and anxiety. They preferred a member of the family to attend the session. They wanted comprehensive health education addressing a wide range of topics. Since the study result agreed with other previous research results, it confirmed that people's perceptions about the need for information is similar in the UAE and everywhere else in the world. / Thesis (M.Cur.)-University of Natal, Durban, 2002.

This study was designed to answer the following research questions: "Are those at risk for coronary heart disease being screened for high blood cholesterol?" and "Are those with high blood cholesterol being treated according to the national guidelines?" The importance of early detection and treatment of high blood cholesterol is vital for preventive health care. A chart review of patient records was conducted to determine the behavior of the family practice residents. From the analysis of data it was determined that the residents screened their patients 83.0% of the time and when compared with national guidelines, treated those patients identified with high blood cholesterol 52.8% of the time. Third year residents screened their patients more (88.7%) for blood cholesterol than first (82.1%) or second (74.7%) year residents. Male residents screened a higher percent of their patients (84.8%) than female residents (75.0%). / Department of Physiology and Health Science

Cardiac rehabilitation has been shown to improve outcomes in patients with heart disease. Determining the effect cardiac rehabilitation (CR) has on the quality of life (QOL) of patients who have participated in a CR program is an important health outcome measure. The majority of QOL studies have focused primarily on younger patients with little attention devoted to the elderly. The purpose of this descriptive, comparative study was to determine whether participation or lack of participation in a CR program will affect the perceived QOL of elderly patients with coronary heart disease (CHD). The Sickness Impact Profile (SIP) was used to measure QOL of two groups, those who participated in CR and those who did not participate in CR. A demographic inventory was used to collect sociodemographic information. The mean SIP scores for the physical and psychosocial dimensions, as well as the overall SIP score revealed less dysfunction for the group that participated in CR thereby indicating a better quality of life for this group. However, other methods of data analysis were not statistically significant. Although the results of this study were not statistically significant, they may be of clinical significance as indicated by the mean SIP scores and the percent of non-overlap scores. Education of the older patient and the public about the beneficial effects of CR on QOL is a prime responsibility of nurse practitioners.

D.Litt. et Phil. / This research investigated the effectiveness of the treatment programme used by the South African Recurrent Coronary Prevention Project (SARCPP) in reducing the risk of not only recurrent heart disease, but also of original occurrence of heart disease. Heart disease can often be attributed to lifestyle factors such as obesity, high fat content diets and smoking (Friedman & Ulmer, 1995 and Richards & Baker, 1988). Another lifestyle risk factor of heart disease is Type A behaviour, as first discovered by Rosenman and Friedman (1959). Type A behaviour is made up of various components, such as hostility, time urgency and insecurity. The SARCPP has effectively reduced Type A behaviour in past studies (Venter, 1993; Viljoen, 1993; MacLennan, 1994 and Webster, 1994) and it has been found that reducing Type A behaviour through this programme increases high density lipoproteins and decreases total triglycerides, thus decreasing physiological risk factors of heart disease (Wolff, Thoresen, Viljoen, & Venter, 1994). The SARCPP thus far had only been used with Type A persons who had already suffered a form of heart disease, such as myocardial infarction and angina pectoris (here called "unhealthy" Type As). Other interventions have been used to decrease Type A behaviour in subjects who had not yet suffered heart disease (or "healthy" Type As). A leading researcher in this field is Ethel Roskies (1979-1990). Due to ineffective measurement and ineffective treatment programmes, her attempts were not successful, though. This research study applied the treatment used in the SARCPP to both "healthy" and "unhealthy" Type As and it was found that it was as successful in reducing Type A behaviour in both the "healthy" subjects as in the "unhealthy" subjects. Not only was global Type A behaviour as measured by the Videotaped Structured Interview decreased in the treatment groups, but so were the components of Hostility, Time Urgency and Insecurity (although Insecurity was not decreased in the "unhealthy" subjects). The tendency by the subjects to repress angry feelings was reduced in both "unhealthy" and "healthy" subjects, as was cynical hostility in the "healthy" subjects. It was found that the "unhealthy" subjects had significantly more State and Trait anxiety before the treatment took place than the "healthy" subjects and that the treatment reduced that anxiety in the "unhealthy" subjects significantly. Depression was decreased in both "healthy" and "unhealthy" subjects. Thus, the treatment programme of the SARCPP was effective in reducing coronary-prone behavioural factors and can be used as both prevention in recurrence and prevention in original occurrence of heart disease.