title: Pain and Anxiety in Rural Acute Coronary Syndrome Patients Awaiting Diagnostic Cardiac Catheterization.
abstract: BACKGROUND
  In rural areas of Canada, people with acute coronary syndromes (ACS) can wait up to 32 hours for transfer for diagnostic cardiac catheterization (CATH). While awaiting CATH, it is critical that pain and anxiety management be optimal to preserve myocardial muscle and minimize the risk of further deterioration.
  
  
  OBJECTIVE
  The aim of this study was to examine the relationship between clinical management, cardiac pain intensity, and state anxiety for rural ACS patients awaiting diagnostic CATH.
  
  
  METHODS
  In a prospective, descriptive-correlational repeated-measures design involving 121 ACS rural patients, we examined the associations of analgesic and nitroglycerin administration with cardiac pain intensity (numeric rating scale) and state anxiety (Spielberger State Anxiety Inventory) and also nurses' pain knowledge and attitudes (Toronto Pain Management Inventory-ACS Version and Knowledge and Attitudes Survey Regarding Pain) using linear mixed models.
  
  
  RESULTS
  The mean age of patients was 67.6 ± 13, 50% were men, and 60% had unstable angina and the remainder had non-ST-elevated myocardial infarction. During follow-up, cardiac pain intensity scores remained in the mild range from 1.1 ± 2.2 to 2.4 ± 2.7. State anxiety ranged from 44.0 ± 7.2 to 46.2 ± 6.6. Cumulative analgesic dose was associated with a reduction in cardiac pain by 1.0 points (numeric rating scale, 0-10) (t108 = -2.5; SE, -0.25; confidence interval, -0.45 to -0.06; P = .013). Analgesic administration was not associated with state anxiety. Over the course of follow-up, ACS patients reported consistently high anxiety scores.
  
  
  CONCLUSIONS
  Whereas cardiac pain declines in most patients in the early hours after admission, many patients experience a persistent anxious state up to 8 hours later, which suggest that development and testing of protocols for anxiety reduction may be needed. More urgently, the development and examination of a treatment intervention, early on in the ACS trajectory, are warranted that targets pain and anxiety for those for whom immediate angioplasty is not possible and who continue to experience cardiac pain and persistent high levels of anxiety. Moreover, a larger prognostic study is required to determine whether high levels of anxiety in rural ACS patients are predictive of major adverse cardiac events.
authors.affiliation: Sheila O'Keefe-McCarthy, PhD, RN Adjunct Scientist, Ross Memorial Hospital, Lindsay, Ontario, Canada. Michael McGillion, PhD, RN Assistant Professor, Heart and Stroke Foundation/Michael DeGroote Endowed Chair in Cardiovascular Nursing Research, School of Nursing, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada. Sean P. Clarke, PhD, RN, FAAN Professor and Associate Dean, Undergraduate Program, William F. Connell School of Nursing, Boston College, Chestnut Hill, Massachusetts. Judith McFetridge-Durdle, PhD, RN Dean and Professor, College of Nursing, Florida State University, Tallahassee.
authors.forename: Sheila
authors.initials: S
authors.lastname: O'Keefe-McCarthy
authors.forename: Michael
authors.initials: M
authors.lastname: McGillion
authors.forename: Sean P
authors.initials: SP
authors.lastname: Clarke
authors.forename: Judith
authors.initials: J
authors.lastname: McFetridge-Durdle
mesh_terms: D054058:Acute Coronary Syndrome / Q000150:complications / Q000175:diagnosis* / Q000523:psychology*; D000368:Aged; D000700:Analgesics / Q000627:therapeutic use; D001007:Anxiety / Q000175:diagnosis / Q000209:etiology*; D001291:Attitude of Health Personnel; D002170:Canada; D006328:Cardiac Catheterization; D002983:Clinical Competence; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D005996:Nitroglycerin / Q000627:therapeutic use; D009741:Nursing Staff, Hospital; D010146:Pain / Q000175:diagnosis / Q000209:etiology*; D010147:Pain Measurement; D011446:Prospective Studies; D019035:Rural Health Services; D014665:Vasodilator Agents / Q000627:therapeutic use
chemical_list: D000700:Analgesics; D014665:Vasodilator Agents; D005996:Nitroglycerin