Assessment of Major Behavioral Risk Factors for Coronary Heart Disease among Patients Admitted to coronary care unit in Rania General Hospital

Ahmed, Shakhawan

doi:10.33899/mjn.2023.176948

Assessment of Major Behavioral Risk Factors for Coronary Heart Disease among Patients Admitted to coronary care unit in Rania General Hospital

Mosul Journal of Nursing, 2023, Volume 11, Issue 1, Pages 69-78
10.33899/mjn.2023.176948

Abstract

Coronary Heart Disease (CHD) occurs when decreases or stops blood flow to the heart muscles. This is resulting from the gradual narrowing of coronary arteries and atherosclerosis. Tobacco use, abnormal lipid profile, obesity, high blood pressure, diabetes, physical inactivity, emotional distress, high alcohol consumption and reduction in the consumption of fruit and vegetables are the predominant risks of cardiovascular diseases such as CHD.
      The study aims to assess the behavioral risk factors for coronary heart disease among patients admitted to the coronary care unit.
This is to identify the major behavioral risk factors for coronary heart disease in patients who admitted to the coronary care unit and to determine whether there are any relations between modifiable risk factors and socio-demographic characteristics of the data.
     This descriptive study of quantitative method was carried out, with a non-probability (convenience) sample of (50) Adults diagnosed with coronary heart disease and admitted to the coronary care unit in Rania general hospital.
     In the study, physical inactivity and smoking are the most common behaviors that worsen CHD among participants. Moreover, smoking behavior is increasingly detected in males. This study therefore, recommends that further studies on this topic need to be conducted. Public awareness should be raised toward unhealthy behaviors, in particular physical inactivity and smoking

Keywords:

Coronary Heart Disease

Behavioral Risk Factors

Assessment of Major Behavioral Risk Factors for Coronary Heart Disease among Patients Admitted to coronary care unit in Rania General Hospital

Shakhawan Azad Ahmed

Department of Community Health Nursing, College of Nursing, University of Raparin, Iraq

Corresponding author: Shakhawan Azad Ahmed

Email: shaxawanazad641@gamil.com

Shakhawanazad@uor.edu.krd

ORCID

ABSTRACT

The study aims to assess the behavioral risk factors for coronary heart disease among patients admitted to the coronary care unit.

This is to identify the major behavioral risk factors for coronary heart disease in patients who admitted to the coronary care unit and to determine whether there are any relations between modifiable risk factors and socio-demographic characteristics of the data.

This descriptive study of quantitative method was carried out, with a non-probability (convenience) sample of (50) Adults diagnosed with coronary heart disease and admitted to the coronary care unit in Rania general hospital.

In the study, physical inactivity and smoking are the most common behaviors that worsen CHD among participants. Moreover, smoking behavior is increasingly detected in males. This study therefore, recommends that further studies on this topic need to be conducted. Public awareness should be raised toward unhealthy behaviors, in particular physical inactivity and smoking.

Keywords: Coronary Heart Disease, Behavioral Risk Factors

Received: 03 September 2021, Accepted: 15 December 2021, Available online: 20 January 2022

INTRODUCTION

Coronary heart disease (CHD), also known as coronary artery disease (CAD). Refers to any narrowing or obstruction of arterial Lumina that interferes with cardiac perfusion. As a result of the limitation of sufficient blood to the cardiac muscles, the myocardium can develop various ischemic diseases, including angina pectoris, MI, heart failure, sudden death, and cardiac arrhythmias. (Robinson, Hallowell, and Pottage 2012).Coronary heart disease also is a major cause of morbidity and disability worldwide (Gaziano et al, 2010). It has been expected to be the most typical factor of disability by the 2020s. Moreover, there is an estimation of 2.7million people living with CHD in the UK (Bitton and Gaziano, 2010).

Coronary heart disease is the widest factor of death, estimated as three-quarters of global death (Gaziano et al. 2010). Recently, the World Health Organization (WHO) fact sheet introduced the top ten leading causes of death from 2000-2012 in the world, with ischemic heart disease (IHD) placed at the top. This life-threatening disease kills 7.4 million people over the period (WHO 2014). Moreover, CHD is the main cause of death in the United States of America among adults, representing approximately one–third of all dead people, who are over the age of 35 years (Arabi, 2007). In the UK for instance, 82000 Britons die due to CHD annually (NFC.NHS .UK,2014, NHS. UK 2014), in which about one in five men and one in eight women die from the disease (patient.co.uk, 2014).

Tobacco use, abnormal lipid profile, obesity, high blood pressure, diabetes, physical inactivity, emotional stress, high alcohol consumption, and under consumption of fruit and vegetables are the predominant risk factors for the disease (NICE, 2010, Yusuf et al., 2004, Nissinen, Berrios and Puska, 2001). in addition to the socio-economic factors in which for example, Kakinami et al. (2013) have demonstrated that low socio-economic status can prominently increase the risk factors of cardiovascular disease such as CHD. According to the previous statements, CHD is A descriptive study has been performed to explore the major behavioral risk factors for coronary heart disease in patients admitted Coronary Care Unit in Rani General Hospital. In the study, a quantitative method has been applied. Under the affiliation of the University of Raparin, College of Nursing.

In this study convenience sample is a non-probability sample. In which units are selected utilizing the data availability. Moreover, the sample may comprise primarily those with a particular social class or event (Parahoo 2006). This means that only those who have met the inclusion criteria participated in a standard questionnaire different kinds of questionnaire about behavioral risks for CHD is organized. It consists of closed questions including two-way questions, checklists, and multiple choice questions. These sets of questions are asked to all participants in the same order. Many textbooks and articles explained that a questionnaire is the commonest way of data collection (Cormarck 2000, Gerrish, Parahoo 2006 & Lacey 2006).

Methodology

A descriptive study has been performed to explore the major behavioral risk factors for coronary heart disease in patients admitted Coronary Care Unit in Rani General Hospital. In the study, a quantitative method has been applied. Under the affiliation of the University of Raparin, College of Nursing.

The study has been proved by the ethics committee at the University of Raprin. Regarding participants, informed consent has been obtained from all participants. In the informed consent, the participant’s rights and some of the study processes were explained.

In this descriptive study, the quantitative methodology has been accomplished, in which 50 cardiac patients were involved. The process of data collection was carried out in the Coronary Care Unit in the hospital as the study setting.

Data analysis took place using the SPSS program after the processes of coding and tabulating. Consequently, among the behavioral risk factors in the study, physical

inactivity and cigarette smoking were the most frequent variables, and consuming too much alcohol was the less frequent variable in which the results are found to be statistically significant. Physical inactivity, consuming too much alcohol, and cigarette smoking are among the major behavioral risk factors for CHD worldwide.

However, drinking too much alcohol in the current study is ranked down. This may be because of religious considerations in Kurdish society. Following this, cigarette smoking is still one of the leading causes of health disasters among the population including CHD. In the study, the ratio of smoking among male participants is dramatically higher among than females. This can confirm that in regard to behavioral risks, there are gender influences for CHD in Rania City.

RESULTS

Table (1) indicates that the higher percentage is good (>39years) representing 90.0% of the sample, 6.0% of them are aged between (31-39years), (4.0%) of them are aged (≤39years), and (Mean and Standard deviation 3.82 ±4.00). 64.0% of the study sample were Male and 36.0% of the study sample were Female, Regarding marital status, the higher percentage (72.0%) of the study sample was married, and (Mean and Standard Deviation 2.20±2.00), the highest percentage of the sample represents (45.7%), while very few of them was single which represent (4.0%) of the study sample. This table reveals that the education level of mothers ranged from illiterate to graduate, the majority of them are illiterate which represent (44.0%), and the lowest percentage of the study sample are Secondary Schools representing (6.0%) of all the study, at the same time in this table indicates that the highest percentage (32.0)were housewife. The highest percentage (46.0%) of the study sample was sufficient, 18.0%, and 36.0% of the study sample were barely sufficient and insufficient, the same table indicates that the highest percentage (32.0%) were housewife while table 2 indicates the highest percentage (48.0%) of the study sample used Oil in Diet, 58.0% of the study sample always used Salt in Diet. The same table shows the majority (88.0%) of the study sample consumed Fruit Diet. The rate of sample who consumed vegetable, nuts, beans and eggs, sweet were (78.0%), (62.0%) (54.0%) (42.0%) and (36.0%) respectively. The highest percentage (86.0%) of the study sample consumed chicken meat per week. Also, the rate of the study sample who consumed red meat, fish, and organ meat liver, and kidney, was (68.0%), (56.0%), (34.0%) respectively. The same table shows that the highest percentage (86.0%) of the study sample didn’t take exercise regularly, the highest percentage (82.0%) of the study sample were nonsmokers, and (18.0%) of the study sample were smokers, other while (86.0%) of the study sample were smoker fothe r duration (>20years). The same table represented that the lowest percentage (4.0%) uses alcohol, (2.0%) uses alcohol for (<10years) and (2.0%) uses alcohol for 10-20 years.

Table 3 indicated the relationship between the age group of the study sample with their behavioral risk factor related to coronary heart disease as followings. There was no statistical significant relationship between age and all behavioral risk factors related to Coronary Heart Disease (modification dietary, dietary consumption per day and week, regular exercise and alcohol use, and smoking but there

Was a statistically significant relationship between sweet and age group

Result Table 1: Demographic characteristics of the study sample

*Variable*	NO	%	*Mean*	SD
*Age*
≤30	2	4.0	3.82	4.00
31-39	3	6.0
>39	45	90.0
Gender
Male	32	64.0	1.36	1.00
Female	18	36.0	1.36	1.00
*Marital Status*
Single	2	4.0	2.20	2.00
Married	36	72.0
Widows	12	24.0
Divorce	0	0
*No. of Children*
<3	10	20.0	2.26	2.00
3-6	17	34.0
>6	23	46.0
*Education levels*
Illiterate	22	44.0	2.24	2.00
Able to read and write	9	18.0
Primary	10	20.0
Secondary	3	6.0
Graduate	6	12.0
*Occupation*
Employ	11	22.0	3.14	4.00
Private	11	22.0
Student	0	0
Housewife	16	32.0
Retired	12	24.0
*Economic status*
Sufficient	23	46.0	1.90	2.00
Barely sufficient	9	18.0
Insufficient	18	36.0

Table 2: Behavioural risk factors related to the Coronary Heart Disease

*Variable*			NO	%
*A-Dietary Modification-types of oil used in Diet*

Fat			3	6.0
Oil			24	48.0
Both Fat and Oil			23	46.0
Unknown			0	0
*Slat uses in Diet*
Never			4	8.0
Occasionally			17	34.0
Always			29	58.0
Unknown			0	0
*B-Dietary consumption per day*
Vegetables			39	78.0
Fresh fruits			44	88.0
Nuts			21	42.0
Eggs			27	54.0
Sweet			27	36.0
Beans			31	62.0
*-Dietary consumption per week*
Red meat			34	68.0
Chicken meat			43	86
Fish			28	56.0
Organ meat liver &kidney			17	34.0
*-Physical Activity*
Regular exercise	Yes		7	14.0
	No		43	86.0
Smoking pattern	Yes		9	18.0
	No		41	82.0
*Duration of smoking*
<10			2	4.0
10-20			5	10.0
>20			43	86.0
*-No of cigarette per day*
<10			3	6.0
10-20			4	8.0
>20			43	86.0
*-Alcohol*
Alcohol use		Yes	2	4.0
		No	48	96.0
*-Duration of alcohol*
<10			1	20.0
10-20			1	20.0

Table 3: Relationship between age group and Behavioral risk factors related to Coronary Heart Disease

*Variable*		*Age Group*						*Total (No=50)*			*p-value*
		*≤30*		*30-39*		*≥39*		*Total (No=50)*
		No	%	No	%	No	%	No	%
A-Dietary modification
-Types of oil used in diet
Fat		0	0	1	33.3	2	66.7	3		50	*0.259 NS
Oil		1	4.2	2	8.3	21	87.5	24
Both Oil and Fat		1	4.3	0	0	22	95.7	23
-Salt uses in Diet
Never		1	25.0	0	0	3	75.0	4		50	*0.403 NS
Occasionally		0	0	1	5.9	16	94.1	17
Always		1	3.4	2	6.9	26	89.7	29
*B-Dietary consumption per week*
Red meat	*Yes*	2	5.9	2	5.9	30	88.2	34		50	*0.453 NS
	No	0	0	1	6.3	15	93.8	15		50	*0.453 NS
Chicken meat	*Yes*	2	4.7	3	7.0	38.	88.4	43		50	*0.450 NS
	no	0	0	0	0	7	10.0	7		50	*0.450 NS
Fish	*Yes*	1	3.6	2	7.1	25	89.3	28		50	*0.916 NS
	No	1	4.5	1	4.5	20	90.9	22		50	*0.916 NS
Organ meat liver &kidney	*Yes*	2	11.8	1	5.9	14	82.4	17		50	*0.1000 NS
	No	0	0	2	6.1	31	93.9	13		50	*0.1000 NS
*-Physical activity*
Regular exercise	Yes	1	14.3	1	14.3	5	71.4	7		50	*0.285 NS
	No	1	2.3	2	4.7	40	93.0	43		50	*0.285 NS
*-Smoking pattern*
Smoking	*Yes*	1	11.1	1	11.1	7	77.8	9		50	*0.439 NS
	No	1	2.4	2	4.9	38	92.7	42		50	*0.439 NS
*-Alcohol*
*Alcohol use*	*Yes*	1	50.0	1	50.0	0	0	2		50	*0.006 NS
	No	1	2.1	2	4.2	4.5	93.8	48		50	*0.006 NS

Table 4 Relationship between gender and behavioural risk factors related to the coronary heart disease

*Variables*		*N =50*				*p-value*
		*Male*		*Female*
		No	%	No	%
*A-Dietary modification*
Types of Oil used in Diet						*0.221 NS
Fat		3	100.0	0	0
Oil		14	58.3	10.0	41.7
Both Fat and Oil		15	65.2	8.0	34.8
*-Salt uses in Diet*
Never		2	50.0	2	50.0	*0.120 NS
Occasionally		8	47.1	9	52.9
Always		22	75.9	7	24.1
*B- Dietary consumption per a day*
-Vegetable	*Yes*	25	64.1	15	35.9	*0.618 NS
	No	6	60.0	4	40.0	*0.618 NS
-Fruit	*Yes*	29	65.9	15	34.1	*0.758 NS
	No	3	50.0	3	50.0	*0.758 NS
-Egg	*Yes*	18	67.6	9	60.9	*0.771 NS
	No	14	33.3	9	44.8	*0.771 NS
-Sweet	*Yes*	14	77.8	4	22.2	*0.144 NS
	No	18	56.3	14	43.8	*0.144 NS
-Beans	*Yes*	22	71.0	9	29.0	*0.233 NS
	No	10	52.6	9	47.4	*0.233 NS
-Nut	*Yes*	16	76.2	5	23.8	*0.149 NS
	No	16	55.2	13	44.8	*0.149 NS
*C-Dietary consumption per week*
-Red meat	Yes	25	73.5	9	26.5	*0.060 NS
	No	7	43.8	9	56.2	*0.060 NS
-Chicken meat	Yes	27	62.8	16	37.2	*0.659 NS
	No	5	71.4	2	28.6	*0.659 NS
-Fish	Yes	18	64.3	10	35.7	*0.1000 NS
	No	14	63.6	8	36.4	*0.1000 NS
-Organ meat liver kidney	Yes	13	76.5	4	23.5	*0.227 NS
	No	19	57.6	14	42,4	*0.227 NS
*D-Physical Activity*
-Exercise	*Yes*	6	85.7	1	14.3	*0.197 NS
	No	26	60.5	17	39.5	*0.197 NS
*4-smoking pattern*
-Smoking	*yes*	9	100.0	0	0	*0.018 NS
	No	23	56.1	18	43.9	*0.018 NS
*F-Alcohol use*	*Yes*	2	100.0	0	0	*0.530 NS

DISCUSSION

When observing behavioral risk factors of coronary heart disease, there will be an assumption that there are several negative behavioral modes, which they frequently occur in societies. To illustrate the negative behavioral modes, smoking, dietary imbalance, sedentary lifestyle, and consuming too much alcohol. However, these risk factors are responsible for Cardiovascular Diseases (CVD) including, CHD, Stroke, and peripheral vascular diseases. They mainly affect coronary and heart health in all ages (Leon 2009).

In this study, physical inactivity and smoking are the most frequent risk factors among the participants. Physical inactivity has been detected among 43 patients out of the total including 50 patients. They comprised 86% of the total population in the study, by which this risk factor ranked the top.

Sedentary lifestyle and physical inactivity is been highlighted in a substantial amount of literature, which has a crucial effect on increasing morbidity and mortality among CHD patients. Moreover, physical inactivity is one of the major leading causes of obesity and atherosclerosis (Yusuf et al. 2001).

Smoking is another modifiable risk factor that has a significant impact on this study. Among participants in this study, 82% are smokers, in which 41 patients confirm that they had a history of smoking for about 10 years or more. Literature has explored that cigarette smoking is one of the most dangerous causes of CHD and atherosclerosis (Jajich 2004). Following this, a study by Shaten (1991) confirms that rates per thousand person-years of CHD mortality were higher for smokers than for nonsmokers at every level of baseline risk factors when examined.

On the other hand, there are some relations between the Bio-demographic distributions of the participants and risk factors. The study found a positive correlation between gender identity and cigarette smoking. This relation has been proved by statistical analysis, in which P-value shows

CONCLUSIONS

Coronary heart disease is a major global health impact recently. It causes disability and death more than any other disease. Several factors exacerbate the consequences of the disease among societies, particular modifiable risk factors. Tobacco use, abnormal lipid profile, obesity, high blood pressure, diabetes, physical inactivity, emotional distress, and high alcohol consumption are outstanding among them. In the current study, 50 cardiac patients were investigated to find the major behavioral risk factors among them. Consequently, physical inactivity and smoking were the commonest among patients admitted Coronary Care Unit in Hospital. It can be suggested that, modifiable risk factors vary greatly among different societies. This paper, therefore, calls for further studies on the current topic and public health education should be enhanced on toward the risk factors.

ETHICALCONSIDERATIONSCOMPLIANCEWITHETHICALGUIDELINES

The protocol of the study was accepted by the council of the College of Nursing / University of Raparin.

FUNDING
This research did not receive any grant from funding agencies in the public, commercial, or non-profit sectors.

AUTHOR’SCONTRIBUTIONS

Study concept; Writing the original draft; Data collection; Data analysis and Reviewing the final edition

DISCLOSURESTATEMENT:

The authors report no conflict of interest

ACKNOWLEDGEMENTS

We thank the anonymous referees for their useful suggestions.

REFERENCES

Naoum, E. E., Leffert, L. R., Chitilian, H. V., Gray, K. J., & Bateman, B. T. (2019). Acute fatty liver of pregnancy: pathophysiology, anesthetic implications, and obstetrical management. Anesthesiology, 130(3), 446-461.

"Cardiovascular Disease Risk Factors – Physical Inactivity | World Heart Federation". World-heart-federation.org. N.P., 2016. Web.

Birrane, J. P., Lim, Z. L., Liew, C. H., Rosseel, L., Heerey, A., Coleman, K., ... & McEvoy, J. W. (2022). A survey of general practitioners’ knowledge and clinical practice in relation to valvular heart disease. Irish Journal of Medical Science (1971-), 191(2), 777-784.

World Health Organization. (2014). Salt reduction and iodine fortification strategies in public health: report of a joint technical meeting convened by the World Health Organization and The George Institute for Global Health in collaboration with the International Council for the Control of Iodine Deficiency Disorders Global Network, Sydney, Australia, March 2013.

Suryadinata, R. V., Lorensia, A., & Sari, R. K. (2017). Perbedaan Asupan Nutrisi Makanan dan Indeks Massa Tubuh (IMT) Antara Perokok Aktif dengan Non-perokok pada Usia Dewasa. Jurnal Farmasi Klinik Indonesia, 6(3).

Jarvis, D., Luczynska, C., Chinn, S., & Burney, P. (1995). The association of age, gender and smoking with total IgE and specific IgE. Clinical and experimental allergy: journal of the British Society for Allergy and Clinical Immunology, 25(11), 1083-1091.

What Is Atherosclerosis? - NHLBI, NIH". Nhlbi.nih.gov. N.P., 2016. Web. 31 May 2016. Evidence-based cardiology, peter J. shares, and Christopher P. cannon, 2000 Gossett et al. Smoking intensity and lipoprotein abnormalities in active smokers. Journal of Clinical Lipidology 2009; 3(6): 372-378

Aarabi, M. (2007). Risk stratification of coronary heart disease in UK South Asians (Doctoral dissertation, University of Sheffield).

Bitton, A., & Gaziano, T. (2010). The Framingham Heart Study's impact on global risk assessment. Progress in cardiovascular diseases, 53(1), 68-78.

Smeltzer, S. C. C., & Bare, B. G. (1992). Brunner & Suddarth's textbook of medical-surgical nursing. Philadelphia: JB Lippincott.

Daniels, R., and Nicoll, LH, (2012). Contemporary Medical-Surgical Nursing. Second edition. Clifton Park, NY: Thomson Delmar Learning. P(615, 617-618)

Gaziano, T. A., Bitton, A., Anand, S., Abrahams-Gessel, S., & Murphy, A. (2010). Growing epidemic of coronary heart disease in low-and middle-income countries. Current problems in cardiology, 35(2), 72-115.

Jajich, Cindy L. "Smoking and Coronary Heart Disease Mortality in the Elderly". JAMA252.20 (2004): 2831. Web.

Joan M. Robinson, Lorrain M. Hallowell and Marian Pottage (2012), Medical-Surgical Nursing Made Incredibly Easy! Philadelphia, second edition: Wolters Kluwer Health/Lippincott Williams & Wilkins. P (293, 295).

Leon, A. S., Connett, J., Jacobs, D. R., & Rauramaa, R. (1987). Leisure-time physical activity levels and risk of coronary heart disease and death: the Multiple Risk Factor Intervention Trial. Jama, 258(17), 2388-2395.

Bhardwaj, P. R., & Bhardwaj, A. K. (2015). Therapeutic applications of yoga for weight reduction in an obese population: an evidence-based overview. Online Journal of Multidisciplinary Research, 1(1), 1-5.

Patient. Co.uk (2014). Epidemiology of coronary heart disease/Doctor/ Patient. Co.uk. [online] Available at:http://www.patient.couk./doctor/epidemiology of coronary- heart -disease [Acessed 10 June. 2014].

Polit, D., & Hungler, B. (1999). Nursing Research Ā Principles & Methods, 6th eds. JB Philadelphia.

Powell, K. E., Thompson, P. D., Caspersen, C. J., & Kendrick, J. S. (1987). Physical Activity and the Incidence Of Coronary Heart. Ann. Rev, 8, 253-87.

Primatesta, P., Falaschetti, E., Gupta, S., Marmot, M. G., & Poulter, N. R. (2001). Association between smoking and blood pressure: evidence from the health survey for England. Hypertension, 37(2), 187-193.

Rhoades, Rodney and George A Tanner. (2003) Medical Physiology. Second edition Philadelphia: Lippincott Williams & Wilkins, P (555,556)

Shaten, B. J., Kuller, L. H., Neaton, J. D., & MRFIT Research Group. (1991). Association between baseline risk factors, cigarette smoking, and CHD mortality after 10.5 years. Preventive medicine, 20(5), 655-669.

Shinton, R., & Beevers, G. (1989). Meta-analysis of relation between cigarette smoking and stroke. British Medical Journal, 298(6676), 789-794.

Suzuki, K., Takeda, A., & Matsushita, S. (1995). Coprevalence of bulimia with alcohol abuse and smoking among Japanese male and female high school students. Addiction, 90(7), 971-975.

Joubert, J. D. (2014). Body composition profiles of 14-year-old adolescents attending high schools within the Tlokwe municipality area: The PAHL-study (Doctoral dissertation, North-West University).

Wiles, R. (1998). Patients' perceptions of their heart attack and recovery: the influence of epidemiological “evidence” and personal experience. Social Science & Medicine, 46(11), 1477-1486.

Zoghbi, W. A., Duncan, T., Antman, E., Barbosa, M., Champagne, B., Chen, D. & Wood, D. A. (2014). Sustainable development goals and the future of cardiovascular health: a statement from the global cardiovascular disease taskforce. Journal of the American Heart Association, 3(5), e000504.

Yusuf, S., Reddy, S., Ôunpuu, S., & Anand, S. (2001). Global burden of cardiovascular diseases: part I: general considerations, the epidemiologic transition, risk factors, and impact of urbanization. Circulation, 104(22), 2746-2753.APA 7^TH EDITION STYLE.

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