Heart & Lung最新文献

{"title":"Exploring intensive care unit nurses’ decision-making in alarm management: A qualitative study","authors":"Nikola Haskell ,&nbsp;Davina Banner ,&nbsp;Shelley Raffin Bouchal ,&nbsp;Kathryn King-Shier","doi":"10.1016/j.hrtlng.2025.09.013","DOIUrl":"10.1016/j.hrtlng.2025.09.013","url":null,"abstract":"<div><h3>Background</h3><div>Alarm fatigue occurs when there is frequent exposure to an increased amount of false or nonactionable alarms. Alarm fatigue can lead to alarm desensitization and reduced clinical response by nurses, posing a significant risk to patient safety. Alarm fatigue is an important and growing safety concern that needs to be explored and addressed.</div></div><div><h3>Objectives</h3><div>The purpose of this qualitative study was to better understand how Intensive Care Unit (ICU) nurses make decisions about and respond to alarms, specifically how they recognize different alarms, and how they triage and manage them within the ICU setting.</div></div><div><h3>Methods</h3><div>Twelve nurses from three ICUs participated in-depth semi-structured interviews. Using Interpretive Description methodology, the decision-making regarding alarm response was explored. Thematic analysis was used to identify key themes.</div></div><div><h3>Results</h3><div>The ICU nurses’ decision-making consisted of three steps: their awareness, including how they heard the alarms; how different alarms were triaged; and how they responded and prioritized different alarms. Factors that affected nurses’ awareness included competing tasks and priorities, the busy nature of the unit, inadequate staffing, increased unit noise, and an increased amount of false/nonactionable alarms. Next, nurses triaged their alarm response based on their experience, character/nature, situational fatigue and burnout. Lastly, nurses incorporated multiple factors when considering how quickly to respond to an alarm. Urgent responses occurred with high priority electrocardiogram alarms, alarms on more acute patients, bed alarms and intravenous (IV) pumps infusing life sustaining medication.</div></div><div><h3>Conclusion</h3><div>A positive safety culture, standardized alarm-related education, and mentorship should be evaluated to implement an effective alarm response and management and reduce alarm fatigue.</div></div>","PeriodicalId":55064,"journal":{"name":"Heart & Lung","volume":"75 ","pages":"Pages 117-124"},"PeriodicalIF":2.6,"publicationDate":"2025-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145107417","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Novel inflammatory markers predict cardiovascular events after percutaneous coronary intervention in patients with acute coronary syndrome","authors":"Nemeh Alhawamdeh RN, MSc ,&nbsp;Dania A. Bani Hani RN, MSN, PhD ,&nbsp;Jafar A. Alshraideh PhD (Professor) ,&nbsp;Afaf S. Yousef RN, MSN, PhD (C) ,&nbsp;Akram Saleh MD, FRCP (Professor of Internal Medicine)","doi":"10.1016/j.hrtlng.2025.09.014","DOIUrl":"10.1016/j.hrtlng.2025.09.014","url":null,"abstract":"<div><h3>Introduction</h3><div>Inflammation plays a crucial role in the pathophysiology of acute coronary syndrome (ACS) and is associated with the risk of major adverse cardiovascular events (MACE). Novel inflammatory biomarkers such as the Systemic Immune-Inflammation Index (SII), Systemic Inflammatory Response Index (SIRI), and Systemic Immune-Inflammation Response Index (SIIRI) have recently been proposed as potential novel inflammatory biomarkers that may offer a valuable insight into cardiovascular risk prediction.</div></div><div><h3>Objective</h3><div>To evaluate the association between inflammatory and immune-inflammation indices at admission, and occurrence of major adverse cardiovascular events 30 days after Percutaneous Coronary Intervention (PCI) in patients with ACS.</div></div><div><h3>Methods</h3><div>A prospective cohort design was used to collect data from ACS patients undergoing PCI. Inflammatory biomarkers (SII, SIRI, SIIRI) were calculated based on pre-procedural blood tests, and MACE was assessed at 30 days post PCI. Logistic regression and ROC analysis were utilized to evaluate predictors.</div></div><div><h3>Results</h3><div>A total of 150 ACS patients were included. 24.7 % experienced MACE during the 30 days after PCI. Patients with MACE were older and had higher neutrophil counts, lower lymphocyte counts, and longer smoking durations. SIRI was significant predictor of MACE (OR=0.96, p=0.03), with ROC analysis confirming its highest predictive value (AUC=0.67, p=0.002). In contrast, SII and SIIRI were not significant predictors.</div></div><div><h3>Conclusion</h3><div>SIRI was an independent predictor for the occurrence of MACE 30 days after PCI. SIRI potentially could be used to identify patients at higher risk of developing MACE post-PCI. Further studies with longer follow-ups and control are recommended.</div></div>","PeriodicalId":55064,"journal":{"name":"Heart & Lung","volume":"75 ","pages":"Pages 111-116"},"PeriodicalIF":2.6,"publicationDate":"2025-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145106911","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pathogen detection and analysis in patients with sepsis complicated with new- onset atrial fibrillation: a retrospective observational study","authors":"Ao-Ling Yang ,&nbsp;Li Li ,&nbsp;Zhao-Hui Zhang ,&nbsp;Xin-Xin Li ,&nbsp;Xiao-Xue You ,&nbsp;Jin Sun","doi":"10.1016/j.hrtlng.2025.09.011","DOIUrl":"10.1016/j.hrtlng.2025.09.011","url":null,"abstract":"<div><h3>Background</h3><div>Patients with sepsis are prone to complications such as cardiac damage and arrhythmias, including atrial fibrillation (AF). Previous studies have suggested an association between certain pathogens and new-onset atrial fibrillation (NOAF) in sepsis, but a detailed and comprehensive analysis is lacking.</div></div><div><h3>Objective</h3><div>This study aimed to detect and analyze pathogens in patients with sepsis complicated by NOAF to provide a scientific basis for its prevention.</div></div><div><h3>Methods</h3><div>In this retrospective observational study, we selected 123 septic patients with NOAF as the case group and 2000 septic patients without AF as the control group. NOAF was detected only during hospitalization; post-discharge events were excluded. Sociodemographic characteristics, comorbidities, laboratory indicators, pathogenic microorganisms, hospital course, and outcomes were compared between groups. Logistic regression was used to identify risk factors for NOAF.</div></div><div><h3>Results</h3><div>In the adjusted multivariable analysis, infection with <em>Pseudomonas aeruginosa</em> (OR 4.163; 95 % CI 2.199–7.880) and <em>Streptococcus pneumoniae</em> (OR 5.729; 95 % CI 1.666–19.706), infection through central venous catheterization (OR 3.954; 95 % CI 1.651–9.470) were identified as independent risk factors for NOAF in sepsis patients.</div></div><div><h3>Conclusions</h3><div>Beyond traditional risk factors, <em>Pseudomonas aeruginosa</em> infection, <em>Streptococcus pneumoniae</em> infection and central venous catheter infection also contributed to the risk of NOAF in sepsis patients. NOAF was associated with increased in-hospital mortality and higher hospitalization costs.</div></div>","PeriodicalId":55064,"journal":{"name":"Heart & Lung","volume":"75 ","pages":"Pages 104-110"},"PeriodicalIF":2.6,"publicationDate":"2025-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145106949","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diagnostic value of the Vereckei electrocardiographic score in patients with pulmonary embolism","authors":"Oğuzhan Örentaş ,&nbsp;Yahya Kemal Günaydin ,&nbsp;Serdal Ateş ,&nbsp;Dilber Üçöz Kocaşaban ,&nbsp;Canan Tuna ,&nbsp;Cansu Uludağ Tuncel","doi":"10.1016/j.hrtlng.2025.09.009","DOIUrl":"10.1016/j.hrtlng.2025.09.009","url":null,"abstract":"<div><h3>Background</h3><div>Pulmonary embolism (PE) continues to represent a major cause of cardiovascular mortality, despite an increasing incidence and declining mortality rates. Given the potentially fatal nature of the condition, early and accurate diagnosis is essential, underscoring the need for rapid and highly sensitive diagnostic tools.</div></div><div><h3>Objective</h3><div>This study aimed to evaluate the diagnostic utility of a Vereckei ECG (vECG) score, which incorporates right-sided ECG leads in addition to the standard 12-lead ECG, for the early detection of acute PE.</div></div><div><h3>Methods</h3><div>A prospective observational cohort study was conducted in the Emergency Medicine Department of a tertiary care hospital between May 2022 and August 2022. Patients presenting with clinical features suggestive of PE were included. Vital parameters, standard 12-lead and right-sided ECGs, along with laboratory data were collected. Patients with a confirmed diagnosis of PE based on pulmonary artery angiography or ventilation-perfusion scintigraphy were classified as the PE group.</div></div><div><h3>Results</h3><div>A total of 122 patients presenting with suspected PE were initially assessed, with 101 patients meeting the inclusion criteria and enrolled in the study. The diagnostic performance of various clinical scoring systems and laboratory tests was compared. Receiver operating characteristic (ROC) curve analysis demonstrated that both D-dimer levels (AUC: 0.927) and the vECG score (AUC: 0.953) exhibited the highest diagnostic accuracies.</div></div><div><h3>Conclusion</h3><div>The findings of this study suggest that the vECG score provides high diagnostic accuracy for the detection of PE and outperforms existing clinical scoring systems. Particularly in time-sensitive environments such as emergency departments, the vECG score may serve as a rapid and reliable diagnostic adjunct.</div></div>","PeriodicalId":55064,"journal":{"name":"Heart & Lung","volume":"75 ","pages":"Pages 98-103"},"PeriodicalIF":2.6,"publicationDate":"2025-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145107418","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of moderate to severe tricuspid regurgitation on long-term clinical outcomes in heart failure: A systematic review and meta-analysis of 456,353 patients","authors":"Sachin Singh MD ,&nbsp;Adil Sarvar Mohammed MD ,&nbsp;Joel DeJonge ,&nbsp;Anoop Venkat Puskoor MD ,&nbsp;Rupak Desai MBBS ,&nbsp;Muhammad Usman Ghani MD ,&nbsp;Paritharsh Ghantasala MD FACP ,&nbsp;Peter G. Fattal MD FACC ,&nbsp;Nishtha Sareen MD MPH FACC FSCAI","doi":"10.1016/j.hrtlng.2025.09.015","DOIUrl":"10.1016/j.hrtlng.2025.09.015","url":null,"abstract":"<div><h3>Introduction</h3><div>Tricuspid regurgitation (TR) may have detrimental effects on heart failure (HF) patients clinically. We aimed to study the impact of severity of TR on the long-term outcomes in patients with HF.</div></div><div><h3>Objectives</h3><div>To understand the association between moderate-to-severe TR and long-term clinical outcomes, including mortality and HF-related hospitalizations, in adults with HF.</div></div><div><h3>Methods</h3><div>We screened PubMed, SCOPUS, and Google Scholar databases up to May 2024 using appropriate keywords. Pooled odds ratios (OR) and confidence intervals (95 % CI) were estimated using a binary random effects model. Heterogeneity was assessed using I2 statistics, and a leave-one-out analysis was performed.</div></div><div><h3>Results</h3><div>Ten studies with 456,353 HF patients were included. The mean age was 71.2 years. Severe TR showed a significant association with higher odds of 1-year mortality (OR=1.25 [1.02–1.52], <em>p</em> = 0.03; I2=78.15 %), 2-year mortality (OR=1.63 [1.28–2.09], <em>p</em> &lt; 0.01; I2=0 %), HF hospitalization (OR=1.39 [1.14–1.71], <em>p</em> &lt; 0.01; I2=61.58 %), and composite events (OR=1.44 [1.10–1.88], <em>p</em> &lt; 0.01; I2=73.46 %). However, it showed no association with cardiovascular deaths (OR=1.35 [0.82–2.24], <em>p</em> = 0.24; I2=78.31 %). Upon performing a leave-one-out sensitivity analysis, we found that excluding Adamo et al.’s 2024 study changed the overall OR to 1.34 (95 % CI: 1.29, 1.39), indicating its influence on the estimate.</div></div><div><h3>Conclusion</h3><div>Severe TR is associated with a higher risk of 1-year and 2-year mortality, HF hospitalizations, and composite events among HF patients. Therefore, HF patients with comorbid TR should be promptly screened and managed [Figure 1]</div></div>","PeriodicalId":55064,"journal":{"name":"Heart & Lung","volume":"75 ","pages":"Pages 90-97"},"PeriodicalIF":2.6,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145093089","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Board of Directors","authors":"","doi":"10.1016/S0147-9563(25)00198-0","DOIUrl":"10.1016/S0147-9563(25)00198-0","url":null,"abstract":"","PeriodicalId":55064,"journal":{"name":"Heart & Lung","volume":"74 ","pages":"Page vi"},"PeriodicalIF":2.6,"publicationDate":"2025-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145094853","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of smoking on all-cause mortality in individuals with preserved ratio impaired spirometry: A population-based cohort study","authors":"Ping Lin,&nbsp;Mingjing Yu,&nbsp;Faming Jiang ,&nbsp;Zongan Liang","doi":"10.1016/j.hrtlng.2025.09.010","DOIUrl":"10.1016/j.hrtlng.2025.09.010","url":null,"abstract":"<div><h3>Background</h3><div>The impact of smoking on the prognosis of subjects with preserved ratio impaired spirometry (PRISm) remains unclear.</div></div><div><h3>Objective</h3><div>This study aimed to evaluate the impact of smoking on all-cause mortality in individuals with PRISm.</div></div><div><h3>Methods</h3><div>Data from the National Health and Nutrition Examination Survey 2007–2012 were analyzed. Survey-weighted Cox proportional hazards models were used to calculate hazard ratios (HRs) with 95 % confidence intervals (CIs) for all-cause mortality.</div></div><div><h3>Results</h3><div>A total of 741 participants with PRISm (weighted <em>n</em> = 7741,021) were included in the study, comprising 354 never smokers (weighted <em>n</em> = 3798,528), 219 former smokers (weighted <em>n</em> = 2383,778), and 168 current smokers (weighted <em>n</em> = 1558,715). Multivariable Cox regression analysis indicated that current smokers had a significantly increased risk of all-cause mortality compared to never smokers (HR: 2.57; 95 % CI: 2.48–2.67). In contrast, former smokers showed no significant difference in mortality risk compared to never smokers (HR: 1.00; 95 % CI: 0.64–1.57). When compared with current smokers, the HRs for those who had quit smoking ≤10 years, 10–20 years, and &gt;20 years prior to personal interviews were 0.48 (95 % CI: 0.30–0.77), 0.29 (95 % CI: 0.28–0.30), and 0.40 (95 % CI: 0.23–0.92), respectively.</div></div><div><h3>Conclusion</h3><div>Among individuals with PRISm, current smoking was significantly associated with increased all-cause mortality, whereas former smoking was not linked to an elevated risk.</div></div>","PeriodicalId":55064,"journal":{"name":"Heart & Lung","volume":"75 ","pages":"Pages 65-70"},"PeriodicalIF":2.6,"publicationDate":"2025-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145087933","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"AI-driven ECG diagnostics: A game-changer for hypertrophic cardiomyopathy. A systematic review and diagnostic test accuracy meta-analysis","authors":"Paweł Łajczak ,&nbsp;Bruno Branco Righetto ,&nbsp;Ogechukwu Obi ,&nbsp;Prajna Wijaya ,&nbsp;Oguz Kagan Sahin ,&nbsp;Sherif Eltawansy ,&nbsp;Issa Salha ,&nbsp;Anna Łajczak ,&nbsp;Michele Schincariol","doi":"10.1016/j.hrtlng.2025.09.012","DOIUrl":"10.1016/j.hrtlng.2025.09.012","url":null,"abstract":"<div><h3>Background</h3><div>Hypertrophic cardiomyopathy (HCM) is a common inherited cardiovascular disorder that may cause serious complications. Accurate diagnosis of HCM is essential to mitigate adverse outcomes. The electrocardiogram (ECG), combined with advancements in machine learning (ML), presents a promising alternative for HCM diagnosis and this systematic review aimed to assess ECG-ML performance.</div></div><div><h3>Objectives</h3><div>This study aims to evaluate diagnostic accuracy of ECG-ML.</div></div><div><h3>Methods</h3><div>A search was conducted across five major electronic databases. Studies were included if they assessed ML algorithms for diagnosing HCM using ECG data. Bivariate random-effects meta-analysis was employed to pool diagnostic metrics, and subgroup analyses were performed to explore heterogeneity.</div></div><div><h3>Results</h3><div>A total of 21 studies were included. The pooled area under curve was 0.964 (95% CI 0.906–0.979) Sensitivity and specificity were 0.914 (95% CI 0.847–0.953) and 0.965 (95% CI 0.889–0.989), respectively. The diagnostic odds ratio (DOR) was 250.796, and the overall accuracy was 0.959 (95% CI 0.893–0.985). Heterogeneity was observed (I² &gt; 90%). Subgroup analyses indicated variations in diagnostic performance based on ML model type, validation methods, and geographic origin. Quality concerns were found.</div></div><div><h3>Conclusion</h3><div>ML models demonstrated exceptional diagnostic accuracy in identifying HCM from ECG data, showing potential as effective diagnostic tools in resource-limited settings and primary care. However, heterogeneity and quality concerns highlight the need for standardized ML development and validation. Future research should focus on addressing these limitations, exploring explainable AI methods, and conducting to ensure clinical applicability.</div></div>","PeriodicalId":55064,"journal":{"name":"Heart & Lung","volume":"75 ","pages":"Pages 71-82"},"PeriodicalIF":2.6,"publicationDate":"2025-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145087881","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Is body mass index associated with mortality in patients with sepsis?","authors":"Milo Engoren MD, FCCM ,&nbsp;Cynthia Arslanian-Engoren PhD, RN","doi":"10.1016/j.hrtlng.2025.09.008","DOIUrl":"10.1016/j.hrtlng.2025.09.008","url":null,"abstract":"<div><h3>Background</h3><div>There is controversy whether patients with higher body mass indexes (BMI) have better survival after sepsis.</div></div><div><h3>Objective</h3><div>To determine if the association between BMI and mortality persists after adjustment for weight loss, comorbidities, and nutritional status.</div></div><div><h3>Method</h3><div>In this single-center retrospective study of patients meeting Sepsis-3 criteria between July 10, 2009 and September 7, 2019, we used logistic regression to adjust BMI for weight loss, comorbidities, culture results, demographics, laboratory values, and processes of care. We transformed BMI using fractional polynomials. In a sensitivity analysis, we categorized BMI using the World Health Organization six levels of underweight, normal, overweight, class I, class II, and class III obesity.</div></div><div><h3>Results</h3><div>5254 (25 %) of 20,990 patients died by 90 days. Unadjusted mortality was lowest at BMI of 32 kg/m². After adjustment, BMI showed only a minimal association with 90-day mortality. Compared to a patient with BMI = 25 kg/m², a patient with BMI = 15 kg/m² had a slightly increased odds ratio (1.022 with 95 % confidence interval (1.020, 1.031), while patients with BMI = 35 or 45 kg/m² had tiny reductions in risk, OR = 0.994 (0.992, 0.995) and 0.992 (0.988, 0.992), respectively. The sensitivity analysis using the World Health Organization levels had similar results. Compared to normal weight patients, underweight patients had a 1.004 (1.001, 1.007) odds ratio of dying, while Class II obese patients had a 0.994 (0.992, 0.996) of dying by 90-days.</div></div><div><h3>Conclusion</h3><div>After adjusting for comorbidities and nutritional status, BMI had only a tiny association with 90-day mortality.</div></div>","PeriodicalId":55064,"journal":{"name":"Heart & Lung","volume":"75 ","pages":"Pages 83-89"},"PeriodicalIF":2.6,"publicationDate":"2025-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145088188","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The association of social determinants of health and depressive symptoms with quality of life among rural patients with coronary heart disease and heart failure","authors":"Ashmita Thapa Ph.D., RN (Post-doctoral Research Associate) ,&nbsp;Geunyeong Cha Ph.D., RN (Post-doctoral Research Associate) ,&nbsp;Jia-Rong Wu Ph.D., RN, FAHA, FAAN (Professor) ,&nbsp;Martha J. Biddle Ph.D., RN, APRN, CCNS, FAHA (Professor) ,&nbsp;Abigail Latimer PhD, MSW, LCSW, APHSW-C (Assistant Professor) ,&nbsp;Mark B Dignan PhD, MPH (Professor) ,&nbsp;Chin-Yen Lin Ph.D., RN (Assistant Professor) ,&nbsp;JungHee Kang Ph.D., RN (Assistant professor) ,&nbsp;Debra K. Moser PhD, RN, FAHA, FAAN (Professor)","doi":"10.1016/j.hrtlng.2025.09.006","DOIUrl":"10.1016/j.hrtlng.2025.09.006","url":null,"abstract":"<div><h3>Background</h3><div>There are significant health disparities among rural populations, especially in the prevalence and management of coronary heart disease and heart failure. Social determinants of health (SDOH) play a crucial role in these disparities, influencing access to care, mental health, and overall quality of life (QOL). Depressive symptoms, common among rural patients with coronary heart disease and heart failure, may further exacerbate these challenges by mediating the relationship between SDOH and QOL.</div></div><div><h3>Objectives</h3><div>We aimed to examine the association between SDOH and QOL among rural patients with coronary heart disease and heart failure, as well as to determine whether depressive symptoms mediate this relationship.</div></div><div><h3>Methods</h3><div>A cross-sectional analysis (<em>N</em> = 124) was conducted using data from a randomized controlled trial. The Protocol for Responding to and Assessing Patient Assets, Risks, and Experiences questionnaire was used to measure SDOH, depressive symptoms were assessed using the Patient Health Questionnaire-9, and QOL was evaluated using Short Form-12. We performed hierarchical multiple regression and mediation analyses.</div></div><div><h3>Results</h3><div>Higher SDOH risk scores were significantly associated with lower QOL (<em>B</em>= -0.319; <em>p</em> &lt; 0.001). Depressive symptoms mediated this relationship (indirect effect: a*<em>b</em> = -0.624, 95 % confidence interval (CI)= [-1.045, -0.273]), suggesting that individuals with higher SDOH risk had worse depressive symptoms, which in turn led to lower QOL.</div></div><div><h3>Conclusion</h3><div>The SDOH were associated with QOL in rural patients with coronary heart disease and heart failure, and depressive symptoms mediated this relationship. Findings highlight the need for targeted interventions addressing both social determinants and mental health to improve QOL.</div></div>","PeriodicalId":55064,"journal":{"name":"Heart & Lung","volume":"75 ","pages":"Pages 58-64"},"PeriodicalIF":2.6,"publicationDate":"2025-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145088231","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}