1. Rankin, Sally H. PhD, RN, FAAN, Guest Editor

Article Content

Cost-effective and innovative interventions to reduce morbidity following cardiac events become increasingly important as the North American population ages and healthcare resources become more strained. Low technology interventions such as the provision of peer support to vulnerable cardiac patients may be a promising strategy to decrease depression and anxiety following cardiac events in certain populations. Other interventions that require more technology but also utilize peer support, and at times professional support, include electronic health (eHealth) technology. This issue addresses various strategies to improve the health of cardiac patients, especially older patients. Intervention research is presented (n = 3) and thoughtful literature reviews (n = 2) address the clinical implications and challenges of applying newer technology to cardiac recovery.


Riegel et al and Winder and colleagues present pioneering interventions to decrease morbidity in chronic heart failure patients and groups recovering from myocardial infarction (MI) and coronary artery bypass graft (CABG). Riegel and Carlson's carefully planned intervention utilized trained heart failure mentors to support patients who had recently been hospitalized with heart failure. Winder, Hiltunen, Sethares, and Butzlaff describe a similar intervention for MI and CABG patients and portray the process of peer advisor/patient collaboration through the analysis of contacts between the advanced practice nurse (APN) and the peer advisor. Peer advisors were trained and supported by APNs in the Mending Hearts study in a similar fashion to Riegel's study. Riegel's findings demonstrated that the intervention had no effect on perceived social support or self-care and that heart failure readmission rate was 89% higher in the treatment group. Although these results are disappointing they may be understood within the context of heart failure and the ongoing needs related to exacerbations as well as the authors' conjecture that the intervention might have increased patient dependence. Although Winder does not present outcomes for the MI and CABG intervention as they were unavailable when the manuscript was prepared, very recent preliminary examination of the unpartnered subjects (n = 181) in this study has revealed that the patients who had access to a peer advisor were significantly less depressed and anxious at the end of the 3-month intervention, reported less pain, and were more likely to be walking for exercise than were patients in the control group. Although not significant, patients in the experimental group also had higher scores on measures of social support than did the control group patients.


Kim and her coauthors' study utilized a similar approach; however, their focus was on health promotion and prevention of cardiovascular disease in groups of Latina women who were exposed to an intervention that utilized Latina lay health advisors. Using a health promotion questionnaire that was analyzed by paired t-tests, Kim and colleagues were able to demonstrate change at the end of the intervention in the areas of nutrition, physical activity, and smoke-free behavior. Themes that emerged from qualitative data demonstrated the importance of including lifestyle changes that could be incorporated into the daily lives of these women and that also did not devalue the cultural and family values of Latina women. This study is especially important because it employs the concept of peer support in a culturally diverse group that has a high prevalence of cardiovascular disease.


The 2 manuscripts on eHealth technology and its promise for cardiovascular patient populations provide insight into the burgeoning growth of eHealth and its applicability for cardiac patients. Nguyen and colleagues' comprehensive literature review of 3 types of programs provided on-line suggest that although the research findings are limited and inconclusive regarding the efficacy of such programs, they may provide creative strategies for closing the gap experienced by many patients as they interface with the health care system. Although Nguyen points out many of the problems mitigating against successful use of eHealth technology, Cashen extends the discussion by carefully enumerating the issues faced by vulnerable populations who may benefit the most from such strategies. These issues included health literacy, cultural and language differences, lack of access to technology, and limited education. Cashen and her coauthors describe methods of overcoming some of the barriers to eHealth technology in their review of innovative community-based programs but caution readers that underlying factors such as social isolation, discrimination, poor physical health, and depression may make widespread use of eHealth interventions difficult.


Cardiovascular nursing has launched exciting and novel interventions to improve the health of some of the most vulnerable patients-those who are elderly, unpartnered, and isolated. Although interventions using peer support to promote cardiovascular health and improve cardiac outcomes are relatively recent research approaches, the interventions presented in this issue offer innovative direction for future cardiovascular nursing research. Likewise, the comprehensive reviews by Nguyen and Cashen suggest the perils and promise of eHealth interventions for clinicians who are trying to pilot new approaches to improving cardiovascular health.