Non-pharmacological strategies to decrease anxiety in cardiac catheterization: integrative review

Estratégias não farmacológicas para diminuição da ansiedade no cateterismo cardíaco: revisão integrativa

Estrategias no farmacológicas para disminuir la ansiedad en el cateterismo cardíaco: revisión integradora

Natany da Costa Ferreira Ercília da Silva Ramalho Juliana de Lima Lopes About the authors

ABSTRACT

Objective:

to identify and review the literature on non-pharmacological strategies used for reducing anxiety in patients receiving cardiac catheterization.

Method:

this study was an integrative literature review. The research was conducted using the databases LILACS, SciELO, Medline (through BVS and PubMed) and Scopus. Studies were analyzed according to their objective, method, instruments used for evaluating patients' anxiety, and the results obtained.

Results:

the most used strategy for reducing anxiety in patients receiving cardiac catheterization was music therapy. However, no study identifying the most appropriate time for this intervention (before, during and/or after the procedure) was found. Other strategies identified in this review were educational videos, massage, and palm therapy.

Conclusion:

the results found suggest that anxiety can be reduced using non-pharmacological strategies.

Keywords:
Anxiety; Nursing; Cardiac Catheterization

RESUMO

Objetivo:

identificar na literatura estudos que abordam as estratégias não farmacológicas utilizadas para redução da ansiedade de pacientes que se submetem ao cateterismo cardíaco.

Método:

trata-se de uma revisão integrativa da literatura, realizada nas bases de dados LILACS, SciELO, Medline (via BVS e PubMed) e Scopus. Os estudos foram analisados de acordo com seu objetivo, métodos, instrumentos utilizados para avaliar ansiedade dos pacientes e resultados obtidos.

Resultados:

a musicoterapia foi a estratégia mais abordada para a redução da ansiedade. Entretanto, não foi encontrado nenhum estudo que identificasse o momento mais adequado para esta intervenção (antes, durante e/ou após o procedimento hemodinâmico). Outras estratégias identificadas nesta revisão foram o vídeo educacional, massagem e terapia na palma das mãos.

Conclusão:

os resultados encontrados sugerem que a ansiedade pode ser diminuída com o emprego de estratégias não farmacológicas.

Descritores:
Ansiedade; Enfermagem; Cateterismo Cardíaco

RESUMEN

Objetivo:

identificar y revisar los estudios de literatura que abordan las estrategias no farmacológicas utilizadas para reducir la ansiedad en los pacientes que reciben un cateterismo cardíaco.

Método:

revisión integradora. La investigación se llevó a cabo utilizando las bases de datos LILACS, SciELO, Medline (BVS y PubMed) y Scopus. Los estudios se analizaron de acuerdo con sus objetivos, la metodo, los instrumentos utilizados para la evaluación de la ansiedad de los pacientes, y los resultados obtenidos.

Resultados:

la estrategia dirigida más para reducir la ansiedad en los pacientes que recibieron cateterización cardíaca fue la musicoterapia. No se encontró estudio, sin embargo, identificando el momento más adecuado para esta intervención (antes, durante y / o después de este procedimiento). Otras estrategias identificados en esta revisión eran videos educativos, masajes y terapia de palma.

Conclusión:

los resultados sugieren que la ansiedad se puede reducir el uso de estrategias no farmacológicas.

Palabras clave:
Ansiedad; Enfermería; Cateterismo Cardíaco

INTRODUCTION

Cardiovascular diseases are the main causes of morbidity and mortality worldwide. According to the American Heart Association (AHA), more than 2,150 Americans die of cardiovascular diseases each day, an average of one death every 40 seconds(11 American Heart Association. Heart Disease and Stroke Statistics: 2013 Update: a report from the American Heart Association. Circulation [Internet]. 2013[cited 2014 Dec 2]; Available from: Available from: http://www.circ.ahajournals.org/content/127/1/e6
http://www.circ.ahajournals.org/content/...
). Projections suggest that by 2030, 40.8% of the American population will have some cardiovascular disease(11 American Heart Association. Heart Disease and Stroke Statistics: 2013 Update: a report from the American Heart Association. Circulation [Internet]. 2013[cited 2014 Dec 2]; Available from: Available from: http://www.circ.ahajournals.org/content/127/1/e6
http://www.circ.ahajournals.org/content/...
).

In patients with ischemic heart disease, acute coronary syndrome is the most dramatic and frightening condition. The treatment for ischemic heart disease can be clinical (by using drugs), surgical (consisting of myocardial revascularization when cardiac catheterization indicates severe obstructive lesions) or vascular (angioplasty), depending on the patient's clinical situation and the degree of coronary artery obstruction(22 Nicolau JC, Timerman A, Marin-Neto JA, Piegas LS, Barbosa CJDG, Avezum Junior A, et al. Guidelines of the Brazilian Society of Cardiology on unstable angina and myocardial acurte infartion without ST-segment elevation (II Edition, 2007) - Atualization 2013/2014. Arq Bras Cardiol [Internet]. 2014[cited 2014 May 30];102(3supl 1):1-75. Available from: Available from: http://publicacoes.cardiol.br/consenso/2014/Diretriz_de_IAM.pdf
http://publicacoes.cardiol.br/consenso/2...
). Vascular procedures consist of percutaneous coronary intervention, and the method of accessing the heart and the coronary arteries is cardiac catheterization, which can be classified as primary (performed under emergency circumstances) and elective (performed without emergency circumstances)(33 Harold JG, Bass TA, Bashore TM, Brindis RG, Brush JE, Burke JA, et al. ACCF/AHA/SCAI 2013 update of the clinical competence statement on coronary artery interventional procedures: a report of the American College of Cardiology Foundation/American Heart Association/American College of Physicians Task Force on Clinical Competence and Training (Writing Committee to Update the 2007 Clinical Competence Statement on Cardiac Interventional Procedures). Circulation[Internet]. 2013[cited 2014 Jul 25]; 8:1-87. Available from: Available from: http://circ.ahajournals.org/content/128/4/436
http://circ.ahajournals.org/content/128/...
). Coronary patients undergoing cardiac catheterization experience several unpleasant feelings, including anxiety, fear, discomfort and distress, anxiety being one of the most common(44 Trotter R, Gallagher R, Donoghue J. Anxiety in patients undergoing percutaneous coronary interventions. Heart Lung [Internet]. 2011[cited 2014 Aug 24];40(3):185-92. Available from: Available from: http://www.sciencedirect.com/science/article/pii/S0147956310002098
http://www.sciencedirect.com/science/art...
-55 Munk PS, Isaksen K, Bronnick K, Kurz MW, Butt N, Larsen AI. Symptoms of anxiety and depression after percutaneous coronary intervention are associated with decreased heart rate variability, impaired endothelial function and increased inflammation. Int J Cardiol [Internet]. 2012[cited 2014 May 12]; 58(1):173-6. Available from: Available from: http://www.sciencedirect.com/science/article/pii/S0167527312005062
http://www.sciencedirect.com/science/art...
).

Anxiety is characterized by symptoms such as palpitations, sweating, trembling or shaking, shortness of breath or smothering sensations, chest pain or discomfort, and/or stomach distress(66 American Psichiatric Association. DSM-V. Manual Diagnóstico e Estatístico de Transtornos Mentais. São Paulo: Artmed, 2014.). Anxiety activates the sympathetic nervous system leading to a variety of physiological responses(77 Player MS, Peterson LE. Anxiety disorders, hypertension, and cardiovascular risk: a review. Int J Psychiatry Med [Internet]. 2011[cited 2014 May 12];41(4):365-77. Available from: Available from: http://ijp.sagepub.com/content/41/4/365.long
http://ijp.sagepub.com/content/41/4/365....
), such as tachycardia, sweating, increased oxygen consumption, hypertension, which can worsen the evolution of the patient. In addition, anxiety can have a negative effect on a patient's clinical outcomes such as treatment refusal and reduced tolerance to pain before, during and after the catheterization intervention. Nurses should implement effective non-pharmacological strategies in order to control patients' anxiety.

In this context, identifying non-pharmacological strategies to reduce anxiety in patients undergoing cardiac catheterization is very important to improve nursing care and to prevent the negative effects of anxiety on patients' clinical outcomes, such as tachycardia and chest pain. To our knowledge, no literature reviews to date have identified non-pharmacological strategies to reduce anxiety in this patient population despite the need for this type of research.

The objective of this review was to identify studies in the published literature about non-pharmacological strategies to reduce anxiety in patients who underwent cardiac catheterization.

METHOD

An integrative literature(88 Broome ME. Integrative literature reviews in the development of concepts. In: Rodgers BL, Knafl KA. Concept development in nursing: foundations, techniques and applications. Philadelphia: W.B. Saunders; 1993. p.193-215.-99 Ganong LH. Integrative reviews of nursing research. Res Nurs Health 1987;10:1-11.) review was performed in the databases LILACS, SciELO, Medline (through BVS and PubMed) and Scopus. The controlled descriptors

used for article search in the databases included "anxiety" and "cardiac catheterization" or "catheterization", and the keyword "apprehension". Inclusion criteria for article selection were studies published from 2002 to 2014, in Portuguese, English or Spanish.

Titles and abstracts were concurrently read and analyzed independently by two researchers, who compared and selected studies to be included. Studies that met all the inclusion criteria were fully read by both researchers. In addition, we included studies in the review that were cited by the articles originally selected but not identified in the databases when the controlled descriptors were used. The authors of the articles that could not be obtained in full through the databases were contacted electronically (Figure 1).

Figure 1
Article retrieval and selection, São Paulo, Brazil, 2015

Data from the selected articles were extracted by three researchers using an instrument validated by Ursi(1010 Ursi ES, Gavão MC. Perioperative prevention of skin injury: an integrative literature review. Rev Latino-Am Enfermagem [Internet]. 2006 Feb[cited 2015 Jan 23];14(1):124-131. Available from: Available from: http://www.scielo.br/pdf/rlae/v14n1/v14n1a17.pdf
http://www.scielo.br/pdf/rlae/v14n1/v14n...
), ensuring that all relevant data were extracted. The instrument includes identification of article, journal, authors, country, language, year of publication, institution where the study is based, type of publication, objective or research question, sample, data analysis, interventions, results, analysis, implications, level of evidence and limitations of the study.

The methodological quality of the articles was evaluated through the Jadad scale. This is an instrument with 3 items (randomization, blinding and an account of all patients), totaling 5 points, with a minimum possible score of 2(1111 Jadad AR, Moore RA, Carroll D, Jenkinson C, Reynolds DJ, Gavaghan DJ, et al. Assessing the quality of reports of randomized clinical trials: is blinding necessary? Control Clin Trial. 1996;17(1):1-12.). Studies with more than 3 points were considered of good quality.

RESULTS

The twelve selected studies were all clinical trials (two non-randomized) and published in English(1212 Lee D, Henderson A, Shum D. The effect of music on procedure anxiety in Hong Kong Chinese day patients. J Clin Nurs [Internet]. 2004[cited 2014 May 15];13(3):297-303. Available from: Available from: http://onlinelibrary.wiley.com/doi/10.1046/j.1365-2702.2003.00888.x/full
http://onlinelibrary.wiley.com/doi/10.10...

13 Chair SY, Chau MY, Sit JWH, Wong EML, Chan AWK. The psychological effects of a videotape educational intervention on cardiac catheterization patients. Contemp Nurse [Internet]. 2012[cited 2014 May 15];40(2):225-33. Available from: Available from: http://www.tandfonline.com/doi/abs/10.5172/conu.2012.40.2.225
http://www.tandfonline.com/doi/abs/10.51...

14 Harkness K, Morrow L, Smith K, Kiczula M, Arthur HM. The effect of early education on patient anxiety while waiting for elective cardiac catheterization. Eur J Cardiovasc Nurs. 2003[cited 2015 Jan 25];2(2):113-21. Available from: Available from: http://cnu.sagepub.com/content/2/2/113.long
http://cnu.sagepub.com/content/2/2/113.l...

15 Argstatter H, Haberbosch W, Bolay HV. Study of the effectiveness of musical stimulation during intracardiac catheterization. Clin Res Cardiol [Internet]. 2006[cited 2015 Jul 30];95(10):514-22. Available from: Available from: http://link.springer.com/article/10.1007%2Fs00392-006-0425-4
http://link.springer.com/article/10.1007...

16 Nilsson U, Lindell L, Eriksson A, Kellerth T. The effect of music intervention in relation to gender during coronary angiographic procedures: a randomized clinical trial. Eur J Cardiovasc Nurs[Internet]. 2009[cited 2014 Dec 12];8(3):200-6. Available from Available from http://cnu.sagepub.com/content/8/3/200.full
http://cnu.sagepub.com/content/8/3/200.f...

17 Moradipanah F, Mohammadi E, Mohammadil AZ. Effect of music on anxiety, stress, and depression levels in patients undergoing coronary angiography. East Mediterr Health J [Internet]. 2009[cited 2015 Jul 30];15(3):639-47. Available from: Available from: http://www.ncbi.nlm.nih.gov/pubmed/19731780
http://www.ncbi.nlm.nih.gov/pubmed/19731...

18 Hui-Kuan C, Peng TC, Wang JH, Lai HL. Psychophysiological responses to sedative music in patients awaiting cardiac catheterization examination: a randomized controlled trial. J Cardiovasc Nurs [Internet]. 2011[cited 2015 Jul 30];26(5):E11-8. Available from: Available from: http://www.ncbi.nlm.nih.gov/pubmed/21372737
http://www.ncbi.nlm.nih.gov/pubmed/21372...

1 Goertz W, Dominick K, Heussen N, Dahl JV. Music in the cath lab: who should select it? Clin Res Cardiol[Internet]. 2011[cited 2015 Jul 30];100(5):395-402. Available from: Available from: http://link.springer.com/article/10.1007%2Fs00392-010-0256-1
http://link.springer.com/article/10.1007...

20 Taylor- Piliae RE, Chair SY. The effect of nursing interventions utilizing music therapy or sensory information on Chinese patients" anxiety prior to cardiac catheterization: a pilot study. Eur J Cardiovasc Nurs[Internet]. 2002[cited 2015 Jul 30];1(3):203-11. Available from: Available from: http://cnu.sagepub.com/content/1/3/203.long
http://cnu.sagepub.com/content/1/3/203.l...

21 Bally K, Campbell D, Chesnick K, Tranmer JE. Effects of patient-controlled music therapy during coronary angiography on procedural pain and anxiety distress syndrome. Crit Care Nurse [Internet]. 2003[cited 2014 Nov 23];23(2):50-8. Available from: Available from: http://ccn.aacnjournals.org/content/23/2/50.full
http://ccn.aacnjournals.org/content/23/2...

22 Wentworth LJ, Briese LJ, Timimi FK, Sanvick CL, Bertel DC, Cutshall SM, et al. Massage Therapy reduces tension, anxiety, and pain in patients awaiting invasive cardiovascular procedures. Prog Cardiovasc Nurs [Internet]. 2009[cited 2015 Jul 30];24(4):155-61. Available from: Available from: http://onlinelibrary.wiley.com/doi/10.1111/j.1751-7117.2009.00054.x/epdf
http://onlinelibrary.wiley.com/doi/10.11...
-2323 Blaer Y, Jafari J, Podberezsky A, David T, Reizin L, Benjamin J. Single-blind and double blind randomized controlled trials of palmtherapy, an alternative medical approach, for anxiety before cardiac catheterization. Evid Based Complement Alternat Med [Internet]. 2008[cited 2015 Jul 30];5(1):103-5. Available from: Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2249735/pdf/nel111.pdf
http://www.ncbi.nlm.nih.gov/pmc/articles...
), in 2012 (n = 1), 2011 (n=2), 2009 (n = 3), 2008 (n = 1), 2006 (n = 1), 2004 (n = 1), 2003 (n = 2), and 2002 (n = 1). The continent where most of them were developed was Asia (5 studies, from Iran, Israel, China, Taiwan and Japan), followed by North America with 4 studies (2 from the USA and 2 from Canada), while 2 studies were developed in Germany and 1 in Australia. In addition, all cardiac catheterizations were elective procedures. The non-randomized clinical trials used music(1212 Lee D, Henderson A, Shum D. The effect of music on procedure anxiety in Hong Kong Chinese day patients. J Clin Nurs [Internet]. 2004[cited 2014 May 15];13(3):297-303. Available from: Available from: http://onlinelibrary.wiley.com/doi/10.1046/j.1365-2702.2003.00888.x/full
http://onlinelibrary.wiley.com/doi/10.10...
) and educational videotapes(1313 Chair SY, Chau MY, Sit JWH, Wong EML, Chan AWK. The psychological effects of a videotape educational intervention on cardiac catheterization patients. Contemp Nurse [Internet]. 2012[cited 2014 May 15];40(2):225-33. Available from: Available from: http://www.tandfonline.com/doi/abs/10.5172/conu.2012.40.2.225
http://www.tandfonline.com/doi/abs/10.51...
) as strategies to reduce patients' anxiety. Lee et al.(1212 Lee D, Henderson A, Shum D. The effect of music on procedure anxiety in Hong Kong Chinese day patients. J Clin Nurs [Internet]. 2004[cited 2014 May 15];13(3):297-303. Available from: Available from: http://onlinelibrary.wiley.com/doi/10.1046/j.1365-2702.2003.00888.x/full
http://onlinelibrary.wiley.com/doi/10.10...
) randomized patients based on the day of the procedure (patients submitted to the procedure on Wednesdays were assigned to the control group and patients submitted to the procedure on Thursdays were assigned to the intervention group). Chair et al.(1313 Chair SY, Chau MY, Sit JWH, Wong EML, Chan AWK. The psychological effects of a videotape educational intervention on cardiac catheterization patients. Contemp Nurse [Internet]. 2012[cited 2014 May 15];40(2):225-33. Available from: Available from: http://www.tandfonline.com/doi/abs/10.5172/conu.2012.40.2.225
http://www.tandfonline.com/doi/abs/10.51...
) randomized patients into two groups based on the presence of patients at the pre-admission educational assessment session (patients who were present at the pre-admission assessment session were allocated to the experimental group, whereas the remaining patients were allocated to the control group).

Box 1 shows that the instruments most frequently used to assess patients' anxiety were Spielberger's State-Trait Anxiety Inventory (n = 9), the Visual Analogy Scale (n = 3), the Numerical Value Scale (n = 2) and the Depression, Anxiety and Stress Scale (DASS-21) (n = 1); three of the studies reviewed used two distinct scales to assess patients' anxiety(1414 Harkness K, Morrow L, Smith K, Kiczula M, Arthur HM. The effect of early education on patient anxiety while waiting for elective cardiac catheterization. Eur J Cardiovasc Nurs. 2003[cited 2015 Jan 25];2(2):113-21. Available from: Available from: http://cnu.sagepub.com/content/2/2/113.long
http://cnu.sagepub.com/content/2/2/113.l...

15 Argstatter H, Haberbosch W, Bolay HV. Study of the effectiveness of musical stimulation during intracardiac catheterization. Clin Res Cardiol [Internet]. 2006[cited 2015 Jul 30];95(10):514-22. Available from: Available from: http://link.springer.com/article/10.1007%2Fs00392-006-0425-4
http://link.springer.com/article/10.1007...
-1616 Nilsson U, Lindell L, Eriksson A, Kellerth T. The effect of music intervention in relation to gender during coronary angiographic procedures: a randomized clinical trial. Eur J Cardiovasc Nurs[Internet]. 2009[cited 2014 Dec 12];8(3):200-6. Available from Available from http://cnu.sagepub.com/content/8/3/200.full
http://cnu.sagepub.com/content/8/3/200.f...
).

Box 1
Distribution of the selected studies by objectives, intervention, number of participants, instrument, the moment when anxiety was assessed, main results and Jadad scale (quality of reports of randomized clinical trials), São Paulo, Brazil, 2015

The following non-pharmacological strategies were utilized to reduce the anxiety of patients undergoing cardiac catheterization: music therapy (n = 8; 66.7%)(1212 Lee D, Henderson A, Shum D. The effect of music on procedure anxiety in Hong Kong Chinese day patients. J Clin Nurs [Internet]. 2004[cited 2014 May 15];13(3):297-303. Available from: Available from: http://onlinelibrary.wiley.com/doi/10.1046/j.1365-2702.2003.00888.x/full
http://onlinelibrary.wiley.com/doi/10.10...
,1515 Argstatter H, Haberbosch W, Bolay HV. Study of the effectiveness of musical stimulation during intracardiac catheterization. Clin Res Cardiol [Internet]. 2006[cited 2015 Jul 30];95(10):514-22. Available from: Available from: http://link.springer.com/article/10.1007%2Fs00392-006-0425-4
http://link.springer.com/article/10.1007...

16 Nilsson U, Lindell L, Eriksson A, Kellerth T. The effect of music intervention in relation to gender during coronary angiographic procedures: a randomized clinical trial. Eur J Cardiovasc Nurs[Internet]. 2009[cited 2014 Dec 12];8(3):200-6. Available from Available from http://cnu.sagepub.com/content/8/3/200.full
http://cnu.sagepub.com/content/8/3/200.f...

17 Moradipanah F, Mohammadi E, Mohammadil AZ. Effect of music on anxiety, stress, and depression levels in patients undergoing coronary angiography. East Mediterr Health J [Internet]. 2009[cited 2015 Jul 30];15(3):639-47. Available from: Available from: http://www.ncbi.nlm.nih.gov/pubmed/19731780
http://www.ncbi.nlm.nih.gov/pubmed/19731...

18 Hui-Kuan C, Peng TC, Wang JH, Lai HL. Psychophysiological responses to sedative music in patients awaiting cardiac catheterization examination: a randomized controlled trial. J Cardiovasc Nurs [Internet]. 2011[cited 2015 Jul 30];26(5):E11-8. Available from: Available from: http://www.ncbi.nlm.nih.gov/pubmed/21372737
http://www.ncbi.nlm.nih.gov/pubmed/21372...

1 Goertz W, Dominick K, Heussen N, Dahl JV. Music in the cath lab: who should select it? Clin Res Cardiol[Internet]. 2011[cited 2015 Jul 30];100(5):395-402. Available from: Available from: http://link.springer.com/article/10.1007%2Fs00392-010-0256-1
http://link.springer.com/article/10.1007...

20 Taylor- Piliae RE, Chair SY. The effect of nursing interventions utilizing music therapy or sensory information on Chinese patients" anxiety prior to cardiac catheterization: a pilot study. Eur J Cardiovasc Nurs[Internet]. 2002[cited 2015 Jul 30];1(3):203-11. Available from: Available from: http://cnu.sagepub.com/content/1/3/203.long
http://cnu.sagepub.com/content/1/3/203.l...
-2121 Bally K, Campbell D, Chesnick K, Tranmer JE. Effects of patient-controlled music therapy during coronary angiography on procedural pain and anxiety distress syndrome. Crit Care Nurse [Internet]. 2003[cited 2014 Nov 23];23(2):50-8. Available from: Available from: http://ccn.aacnjournals.org/content/23/2/50.full
http://ccn.aacnjournals.org/content/23/2...
), educational videos (n = 2; 16.7%)(1313 Chair SY, Chau MY, Sit JWH, Wong EML, Chan AWK. The psychological effects of a videotape educational intervention on cardiac catheterization patients. Contemp Nurse [Internet]. 2012[cited 2014 May 15];40(2):225-33. Available from: Available from: http://www.tandfonline.com/doi/abs/10.5172/conu.2012.40.2.225
http://www.tandfonline.com/doi/abs/10.51...
-1414 Harkness K, Morrow L, Smith K, Kiczula M, Arthur HM. The effect of early education on patient anxiety while waiting for elective cardiac catheterization. Eur J Cardiovasc Nurs. 2003[cited 2015 Jan 25];2(2):113-21. Available from: Available from: http://cnu.sagepub.com/content/2/2/113.long
http://cnu.sagepub.com/content/2/2/113.l...
), massage (n = 1; 8.3%)(2222 Wentworth LJ, Briese LJ, Timimi FK, Sanvick CL, Bertel DC, Cutshall SM, et al. Massage Therapy reduces tension, anxiety, and pain in patients awaiting invasive cardiovascular procedures. Prog Cardiovasc Nurs [Internet]. 2009[cited 2015 Jul 30];24(4):155-61. Available from: Available from: http://onlinelibrary.wiley.com/doi/10.1111/j.1751-7117.2009.00054.x/epdf
http://onlinelibrary.wiley.com/doi/10.11...
), palm therapy (n = 1; 8.3%)(2323 Blaer Y, Jafari J, Podberezsky A, David T, Reizin L, Benjamin J. Single-blind and double blind randomized controlled trials of palmtherapy, an alternative medical approach, for anxiety before cardiac catheterization. Evid Based Complement Alternat Med [Internet]. 2008[cited 2015 Jul 30];5(1):103-5. Available from: Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2249735/pdf/nel111.pdf
http://www.ncbi.nlm.nih.gov/pmc/articles...
) and psychoeducational training (n = 1; 8.3%) (1515 Argstatter H, Haberbosch W, Bolay HV. Study of the effectiveness of musical stimulation during intracardiac catheterization. Clin Res Cardiol [Internet]. 2006[cited 2015 Jul 30];95(10):514-22. Available from: Available from: http://link.springer.com/article/10.1007%2Fs00392-006-0425-4
http://link.springer.com/article/10.1007...
). One study(1515 Argstatter H, Haberbosch W, Bolay HV. Study of the effectiveness of musical stimulation during intracardiac catheterization. Clin Res Cardiol [Internet]. 2006[cited 2015 Jul 30];95(10):514-22. Available from: Available from: http://link.springer.com/article/10.1007%2Fs00392-006-0425-4
http://link.springer.com/article/10.1007...
) used two interventions (music therapy and psychoeducational training); however, music was its main intervention. Music therapy was shown to be effective in most of the studies, with p-values ranging from <0.001 to 0.033, as shown in Box 1(1212 Lee D, Henderson A, Shum D. The effect of music on procedure anxiety in Hong Kong Chinese day patients. J Clin Nurs [Internet]. 2004[cited 2014 May 15];13(3):297-303. Available from: Available from: http://onlinelibrary.wiley.com/doi/10.1046/j.1365-2702.2003.00888.x/full
http://onlinelibrary.wiley.com/doi/10.10...
,1515 Argstatter H, Haberbosch W, Bolay HV. Study of the effectiveness of musical stimulation during intracardiac catheterization. Clin Res Cardiol [Internet]. 2006[cited 2015 Jul 30];95(10):514-22. Available from: Available from: http://link.springer.com/article/10.1007%2Fs00392-006-0425-4
http://link.springer.com/article/10.1007...
,1717 Moradipanah F, Mohammadi E, Mohammadil AZ. Effect of music on anxiety, stress, and depression levels in patients undergoing coronary angiography. East Mediterr Health J [Internet]. 2009[cited 2015 Jul 30];15(3):639-47. Available from: Available from: http://www.ncbi.nlm.nih.gov/pubmed/19731780
http://www.ncbi.nlm.nih.gov/pubmed/19731...
-1818 Hui-Kuan C, Peng TC, Wang JH, Lai HL. Psychophysiological responses to sedative music in patients awaiting cardiac catheterization examination: a randomized controlled trial. J Cardiovasc Nurs [Internet]. 2011[cited 2015 Jul 30];26(5):E11-8. Available from: Available from: http://www.ncbi.nlm.nih.gov/pubmed/21372737
http://www.ncbi.nlm.nih.gov/pubmed/21372...
). Several studies showed that music therapy reduced anxiety(1212 Lee D, Henderson A, Shum D. The effect of music on procedure anxiety in Hong Kong Chinese day patients. J Clin Nurs [Internet]. 2004[cited 2014 May 15];13(3):297-303. Available from: Available from: http://onlinelibrary.wiley.com/doi/10.1046/j.1365-2702.2003.00888.x/full
http://onlinelibrary.wiley.com/doi/10.10...
,1515 Argstatter H, Haberbosch W, Bolay HV. Study of the effectiveness of musical stimulation during intracardiac catheterization. Clin Res Cardiol [Internet]. 2006[cited 2015 Jul 30];95(10):514-22. Available from: Available from: http://link.springer.com/article/10.1007%2Fs00392-006-0425-4
http://link.springer.com/article/10.1007...
,1717 Moradipanah F, Mohammadi E, Mohammadil AZ. Effect of music on anxiety, stress, and depression levels in patients undergoing coronary angiography. East Mediterr Health J [Internet]. 2009[cited 2015 Jul 30];15(3):639-47. Available from: Available from: http://www.ncbi.nlm.nih.gov/pubmed/19731780
http://www.ncbi.nlm.nih.gov/pubmed/19731...

18 Hui-Kuan C, Peng TC, Wang JH, Lai HL. Psychophysiological responses to sedative music in patients awaiting cardiac catheterization examination: a randomized controlled trial. J Cardiovasc Nurs [Internet]. 2011[cited 2015 Jul 30];26(5):E11-8. Available from: Available from: http://www.ncbi.nlm.nih.gov/pubmed/21372737
http://www.ncbi.nlm.nih.gov/pubmed/21372...
-191 Goertz W, Dominick K, Heussen N, Dahl JV. Music in the cath lab: who should select it? Clin Res Cardiol[Internet]. 2011[cited 2015 Jul 30];100(5):395-402. Available from: Available from: http://link.springer.com/article/10.1007%2Fs00392-010-0256-1
http://link.springer.com/article/10.1007...
), stress, depression(1717 Moradipanah F, Mohammadi E, Mohammadil AZ. Effect of music on anxiety, stress, and depression levels in patients undergoing coronary angiography. East Mediterr Health J [Internet]. 2009[cited 2015 Jul 30];15(3):639-47. Available from: Available from: http://www.ncbi.nlm.nih.gov/pubmed/19731780
http://www.ncbi.nlm.nih.gov/pubmed/19731...
) and physiological markers of anxiety, such as systolic blood pressure, heart rate and respiratory frequency(1313 Chair SY, Chau MY, Sit JWH, Wong EML, Chan AWK. The psychological effects of a videotape educational intervention on cardiac catheterization patients. Contemp Nurse [Internet]. 2012[cited 2014 May 15];40(2):225-33. Available from: Available from: http://www.tandfonline.com/doi/abs/10.5172/conu.2012.40.2.225
http://www.tandfonline.com/doi/abs/10.51...
), with statistically significant differences in comparison with control groups, as shown in Box 1. Regarding the moment when the intervention was carried out, some studies performed the interventions before catheterization(1212 Lee D, Henderson A, Shum D. The effect of music on procedure anxiety in Hong Kong Chinese day patients. J Clin Nurs [Internet]. 2004[cited 2014 May 15];13(3):297-303. Available from: Available from: http://onlinelibrary.wiley.com/doi/10.1046/j.1365-2702.2003.00888.x/full
http://onlinelibrary.wiley.com/doi/10.10...
,1818 Hui-Kuan C, Peng TC, Wang JH, Lai HL. Psychophysiological responses to sedative music in patients awaiting cardiac catheterization examination: a randomized controlled trial. J Cardiovasc Nurs [Internet]. 2011[cited 2015 Jul 30];26(5):E11-8. Available from: Available from: http://www.ncbi.nlm.nih.gov/pubmed/21372737
http://www.ncbi.nlm.nih.gov/pubmed/21372...
,2020 Taylor- Piliae RE, Chair SY. The effect of nursing interventions utilizing music therapy or sensory information on Chinese patients" anxiety prior to cardiac catheterization: a pilot study. Eur J Cardiovasc Nurs[Internet]. 2002[cited 2015 Jul 30];1(3):203-11. Available from: Available from: http://cnu.sagepub.com/content/1/3/203.long
http://cnu.sagepub.com/content/1/3/203.l...
), others during the procedure(1515 Argstatter H, Haberbosch W, Bolay HV. Study of the effectiveness of musical stimulation during intracardiac catheterization. Clin Res Cardiol [Internet]. 2006[cited 2015 Jul 30];95(10):514-22. Available from: Available from: http://link.springer.com/article/10.1007%2Fs00392-006-0425-4
http://link.springer.com/article/10.1007...
,1818 Hui-Kuan C, Peng TC, Wang JH, Lai HL. Psychophysiological responses to sedative music in patients awaiting cardiac catheterization examination: a randomized controlled trial. J Cardiovasc Nurs [Internet]. 2011[cited 2015 Jul 30];26(5):E11-8. Available from: Available from: http://www.ncbi.nlm.nih.gov/pubmed/21372737
http://www.ncbi.nlm.nih.gov/pubmed/21372...
-191 Goertz W, Dominick K, Heussen N, Dahl JV. Music in the cath lab: who should select it? Clin Res Cardiol[Internet]. 2011[cited 2015 Jul 30];100(5):395-402. Available from: Available from: http://link.springer.com/article/10.1007%2Fs00392-010-0256-1
http://link.springer.com/article/10.1007...
), another before and after the hemodynamic procedure(1717 Moradipanah F, Mohammadi E, Mohammadil AZ. Effect of music on anxiety, stress, and depression levels in patients undergoing coronary angiography. East Mediterr Health J [Internet]. 2009[cited 2015 Jul 30];15(3):639-47. Available from: Available from: http://www.ncbi.nlm.nih.gov/pubmed/19731780
http://www.ncbi.nlm.nih.gov/pubmed/19731...
) and another before, during and after the cardiac catheterization(2121 Bally K, Campbell D, Chesnick K, Tranmer JE. Effects of patient-controlled music therapy during coronary angiography on procedural pain and anxiety distress syndrome. Crit Care Nurse [Internet]. 2003[cited 2014 Nov 23];23(2):50-8. Available from: Available from: http://ccn.aacnjournals.org/content/23/2/50.full
http://ccn.aacnjournals.org/content/23/2...
). However, no study identified whether before or during the procedure was the most effective for the intervention.

Patients did not choose their preferred music in most of the studies(1515 Argstatter H, Haberbosch W, Bolay HV. Study of the effectiveness of musical stimulation during intracardiac catheterization. Clin Res Cardiol [Internet]. 2006[cited 2015 Jul 30];95(10):514-22. Available from: Available from: http://link.springer.com/article/10.1007%2Fs00392-006-0425-4
http://link.springer.com/article/10.1007...

16 Nilsson U, Lindell L, Eriksson A, Kellerth T. The effect of music intervention in relation to gender during coronary angiographic procedures: a randomized clinical trial. Eur J Cardiovasc Nurs[Internet]. 2009[cited 2014 Dec 12];8(3):200-6. Available from Available from http://cnu.sagepub.com/content/8/3/200.full
http://cnu.sagepub.com/content/8/3/200.f...
-1717 Moradipanah F, Mohammadi E, Mohammadil AZ. Effect of music on anxiety, stress, and depression levels in patients undergoing coronary angiography. East Mediterr Health J [Internet]. 2009[cited 2015 Jul 30];15(3):639-47. Available from: Available from: http://www.ncbi.nlm.nih.gov/pubmed/19731780
http://www.ncbi.nlm.nih.gov/pubmed/19731...
,2020 Taylor- Piliae RE, Chair SY. The effect of nursing interventions utilizing music therapy or sensory information on Chinese patients" anxiety prior to cardiac catheterization: a pilot study. Eur J Cardiovasc Nurs[Internet]. 2002[cited 2015 Jul 30];1(3):203-11. Available from: Available from: http://cnu.sagepub.com/content/1/3/203.long
http://cnu.sagepub.com/content/1/3/203.l...
-2121 Bally K, Campbell D, Chesnick K, Tranmer JE. Effects of patient-controlled music therapy during coronary angiography on procedural pain and anxiety distress syndrome. Crit Care Nurse [Internet]. 2003[cited 2014 Nov 23];23(2):50-8. Available from: Available from: http://ccn.aacnjournals.org/content/23/2/50.full
http://ccn.aacnjournals.org/content/23/2...
). One study demonstrated that patients who did not get to choose the type of music had a significant reduction in anxiety compared to patients able to choose their preferred music (p = 0.0176)(191 Goertz W, Dominick K, Heussen N, Dahl JV. Music in the cath lab: who should select it? Clin Res Cardiol[Internet]. 2011[cited 2015 Jul 30];100(5):395-402. Available from: Available from: http://link.springer.com/article/10.1007%2Fs00392-010-0256-1
http://link.springer.com/article/10.1007...
). Generally, the music was relaxing (60 to 80 beats per minute) with no drastic volume or rhythm changes.

In addition to music therapy, other strategies were identified to reduce anxiety in patients undergoing to cardiac catheterization, although there were very few of these. Other interventions discussed in this review include: educational videos, massage, and palm therapy.

Two studies showed that educational videos were effective in reducing anxiety in patients who underwent cardiac catheterization(1313 Chair SY, Chau MY, Sit JWH, Wong EML, Chan AWK. The psychological effects of a videotape educational intervention on cardiac catheterization patients. Contemp Nurse [Internet]. 2012[cited 2014 May 15];40(2):225-33. Available from: Available from: http://www.tandfonline.com/doi/abs/10.5172/conu.2012.40.2.225
http://www.tandfonline.com/doi/abs/10.51...
-1414 Harkness K, Morrow L, Smith K, Kiczula M, Arthur HM. The effect of early education on patient anxiety while waiting for elective cardiac catheterization. Eur J Cardiovasc Nurs. 2003[cited 2015 Jan 25];2(2):113-21. Available from: Available from: http://cnu.sagepub.com/content/2/2/113.long
http://cnu.sagepub.com/content/2/2/113.l...
). This strategy was effective because the videos contained information about the procedure and discussed and anticipated feelings that may arise during the procedure.

It was observed that the strategy of administering a massage for 20 minutes was also effective for anxiety reduction in these patients(2222 Wentworth LJ, Briese LJ, Timimi FK, Sanvick CL, Bertel DC, Cutshall SM, et al. Massage Therapy reduces tension, anxiety, and pain in patients awaiting invasive cardiovascular procedures. Prog Cardiovasc Nurs [Internet]. 2009[cited 2015 Jul 30];24(4):155-61. Available from: Available from: http://onlinelibrary.wiley.com/doi/10.1111/j.1751-7117.2009.00054.x/epdf
http://onlinelibrary.wiley.com/doi/10.11...
). A study by Blaer et al.(2323 Blaer Y, Jafari J, Podberezsky A, David T, Reizin L, Benjamin J. Single-blind and double blind randomized controlled trials of palmtherapy, an alternative medical approach, for anxiety before cardiac catheterization. Evid Based Complement Alternat Med [Internet]. 2008[cited 2015 Jul 30];5(1):103-5. Available from: Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2249735/pdf/nel111.pdf
http://www.ncbi.nlm.nih.gov/pmc/articles...
) showed that anxiety levels were reduced in the group that received palm therapy for 45 minutes. Palm therapy is a moderate continuous pressure on specific points of the palm that are supposed to represent specific areas of the brain and may be effective for reducing some signs and symptoms presented by patients(2323 Blaer Y, Jafari J, Podberezsky A, David T, Reizin L, Benjamin J. Single-blind and double blind randomized controlled trials of palmtherapy, an alternative medical approach, for anxiety before cardiac catheterization. Evid Based Complement Alternat Med [Internet]. 2008[cited 2015 Jul 30];5(1):103-5. Available from: Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2249735/pdf/nel111.pdf
http://www.ncbi.nlm.nih.gov/pmc/articles...
).

DISCUSSION

There is very little evidence in the literature about the effectiveness of non-pharmacological strategies for anxiety reduction in patients undergoing cardiac catheterization. In the majority of the studies identified in this review, non-pharmacological interventions were effective, music therapy being the most commonly used.

Music can help eliminate pain and reduce stress and tension, besides inducing relaxation(2424 Tan X, Yowler CJ, Super DM, Fratianne RB. The efficacy of music therapy protocols for decreasing pain, anxiety, and muscle tension levels during burn dressing changes: a prospective randomized crossover trial. J Burn Care Res [Internet]. 2010[cited 2015 Jul 30];31(4):590-7. Available from: Available from: http://www.ncbi.nlm.nih.gov/pubmed/20498613
http://www.ncbi.nlm.nih.gov/pubmed/20498...
). Music is an ideal non-pharmacological intervention in that it is easily accessible, inexpensive and favors anxiety reduction and physiological activity(2525 Hamel WJ. The effects of music intervention on anxiety in the patient waiting for cardiac catheterization. Intensive Crit Care Nurs [Internet]. 2001[cited 2015 Jul 30];17(5):279-85. Available from: Available from: http://www.sciencedirect.com/science/article/pii/S0964339701915940
http://www.sciencedirect.com/science/art...
).

Among the studies that used music therapy as an intervention to reduce anxiety and let subjects choose their preferred music, it was observed that the most common music style chosen was classical music. However, from our review, it appeared that choosing the music did not influence patients' level of anxiety. One explanation may be that patients frequently expressed doubt in their decision and worried that health professionals may not like their choice(191 Goertz W, Dominick K, Heussen N, Dahl JV. Music in the cath lab: who should select it? Clin Res Cardiol[Internet]. 2011[cited 2015 Jul 30];100(5):395-402. Available from: Available from: http://link.springer.com/article/10.1007%2Fs00392-010-0256-1
http://link.springer.com/article/10.1007...
), subsequently increasing anxiety levels.

In spite of music being the intervention most frequently used as a strategy for anxiety reduction in patients undergoing cardiac catheterization, there was no consensus about the best type of music, or the best time for listening to it. This consensus may not be established due to the heterogeneity of methods used in the reviewed studies. In this context, future studies should be conducted with consistent methodology.

Although the other strategies identified in this review (educational video, massage and palm therapy) have shown positive results in reducing anxiety in patients undergoing cardiac catheterization, there are few publications to highlight their clinical benefits. For this reason, further studies are needed to validate these findings.

The use of educational sessions before admission, such as instructions about the procedure through videos, showed effective improvements in the knowledge of hospital procedures and a reduction in patients' anxiety(2626 Stern C, Lockwood C. Knowledge retention from preoperative patient information. Int J Evid Based Healthc [Internet]. 2005[cited 2015 Jul 30];3(3):45-63. Available from: Available from: http://www.ncbi.nlm.nih.gov/pubmed/21631744
http://www.ncbi.nlm.nih.gov/pubmed/21631...
). Studies show that patients become calmer when they have the opportunity to know more about the upcoming procedure; nurses can mitigate patient anxiety by offering systematized information about the procedure to the patient(1313 Chair SY, Chau MY, Sit JWH, Wong EML, Chan AWK. The psychological effects of a videotape educational intervention on cardiac catheterization patients. Contemp Nurse [Internet]. 2012[cited 2014 May 15];40(2):225-33. Available from: Available from: http://www.tandfonline.com/doi/abs/10.5172/conu.2012.40.2.225
http://www.tandfonline.com/doi/abs/10.51...
-1414 Harkness K, Morrow L, Smith K, Kiczula M, Arthur HM. The effect of early education on patient anxiety while waiting for elective cardiac catheterization. Eur J Cardiovasc Nurs. 2003[cited 2015 Jan 25];2(2):113-21. Available from: Available from: http://cnu.sagepub.com/content/2/2/113.long
http://cnu.sagepub.com/content/2/2/113.l...
). However, a few studies were performed with the aim of identifying the effectiveness of educational videos to reduce the level of anxiety of patients undergoing cardiac catheterization.

In relation to the study on massage, it was observed that it promotes relaxation, and reduces stress and anxiety(2727 Buttagat V, Eungpinichpong W, Chatchawan U, Kharmwan S. The immediate effects of traditional Thai massage on heart rate variability and stress related parameters in patients with back pain associated with myofascial trigger points. J Bodyw Mov Ther [Internet]. 2011[cited 2015 Jan 2];15(1):15-23. Available from: Available from: http://www.sciencedirect.com/science/article/pii/S1360859209000801
http://www.sciencedirect.com/science/art...
). The study that used palm therapy was based on the theory that the palm of the hand represents the entire body in miniature and that certain points correspond to specific areas of the brain, both motor and sensory. Hence, moderate continuous pressure on specific points of the palm of the hand can reduce anxiety effectively(2323 Blaer Y, Jafari J, Podberezsky A, David T, Reizin L, Benjamin J. Single-blind and double blind randomized controlled trials of palmtherapy, an alternative medical approach, for anxiety before cardiac catheterization. Evid Based Complement Alternat Med [Internet]. 2008[cited 2015 Jul 30];5(1):103-5. Available from: Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2249735/pdf/nel111.pdf
http://www.ncbi.nlm.nih.gov/pmc/articles...
). Studies show that alternative therapies are increasingly being used to reduce patients' anxiety(2828 Ravindran AV, da Silva TL. Complementary and alternatives therapies as add-on to phamarcotherapy for mood and anxiety disorders: a systematic review. J Affect Disord [Internet]. 2013[cited 2014 Nov 13];150(3):707-19. Available from Available from: http://www.sciencedirect.com/science/article/pii/S0165032713004217
:http://www.sciencedirect.com/science/ar...
-2929 Bystritsky A, Hovav S, Sherbourne C, Stein MB, Rose RD, Campbell-Sills L, et al. Use of complementary and alternative medicine in a large sample of anxiety patients. Psychosomatics [Internet]. 2012[cited 2014 Nov 21];53(3):266-72. Available from: Available from: http://www.sciencedirect.com/science/article/pii/S0033318211003598
http://www.sciencedirect.com/science/art...
), and these interventions must be considered by health professionals when dealing with anxious patients.

It is worth emphasizing the methodological quality of the reviewed studies. The majority of studies were considered of good quality. The studies classified as poor did not describe how the authors performed the randomization(1818 Hui-Kuan C, Peng TC, Wang JH, Lai HL. Psychophysiological responses to sedative music in patients awaiting cardiac catheterization examination: a randomized controlled trial. J Cardiovasc Nurs [Internet]. 2011[cited 2015 Jul 30];26(5):E11-8. Available from: Available from: http://www.ncbi.nlm.nih.gov/pubmed/21372737
http://www.ncbi.nlm.nih.gov/pubmed/21372...
-191 Goertz W, Dominick K, Heussen N, Dahl JV. Music in the cath lab: who should select it? Clin Res Cardiol[Internet]. 2011[cited 2015 Jul 30];100(5):395-402. Available from: Available from: http://link.springer.com/article/10.1007%2Fs00392-010-0256-1
http://link.springer.com/article/10.1007...
), did not explain the account of all patients(1212 Lee D, Henderson A, Shum D. The effect of music on procedure anxiety in Hong Kong Chinese day patients. J Clin Nurs [Internet]. 2004[cited 2014 May 15];13(3):297-303. Available from: Available from: http://onlinelibrary.wiley.com/doi/10.1046/j.1365-2702.2003.00888.x/full
http://onlinelibrary.wiley.com/doi/10.10...
,1818 Hui-Kuan C, Peng TC, Wang JH, Lai HL. Psychophysiological responses to sedative music in patients awaiting cardiac catheterization examination: a randomized controlled trial. J Cardiovasc Nurs [Internet]. 2011[cited 2015 Jul 30];26(5):E11-8. Available from: Available from: http://www.ncbi.nlm.nih.gov/pubmed/21372737
http://www.ncbi.nlm.nih.gov/pubmed/21372...
) or did not randomize the patients(1212 Lee D, Henderson A, Shum D. The effect of music on procedure anxiety in Hong Kong Chinese day patients. J Clin Nurs [Internet]. 2004[cited 2014 May 15];13(3):297-303. Available from: Available from: http://onlinelibrary.wiley.com/doi/10.1046/j.1365-2702.2003.00888.x/full
http://onlinelibrary.wiley.com/doi/10.10...
-1313 Chair SY, Chau MY, Sit JWH, Wong EML, Chan AWK. The psychological effects of a videotape educational intervention on cardiac catheterization patients. Contemp Nurse [Internet]. 2012[cited 2014 May 15];40(2):225-33. Available from: Available from: http://www.tandfonline.com/doi/abs/10.5172/conu.2012.40.2.225
http://www.tandfonline.com/doi/abs/10.51...
). The majority of the articles reviewed did not describe the study settings and did not control some aspects that could have changed patients' anxiety, such as the light color(3030 Choi CJ, Kim KS, Kim CM, Kim SH, Choi WS. Reactivity of heart rate variability after exposure to colored lights in healthy adults with symptoms of anxiety and depression. In J Psychophysiol [Internet]. 2011[cited 2014 Dec 2];79(2):83-88. Available from: Available from: http://www.sciencedirect.com/science/article/pii/S0167876010007117
http://www.sciencedirect.com/science/art...
). Another result that should be emphasized is that, although most of the studies were clinical trials, sample sizes were small, ranging from 17 to 238 participants; some studies did not calculate sample size. Others studies are needed to validate these results. Another limitation is that we did not include all relevant studies due to the exclusion criteria "full text not available".

CONCLUSION

This review identified strategies used to reduce anxiety in patients submitted to cardiac catheterization, including music therapy, palm therapy, educational videos and massage. These studies suggested that anxiety can be reduced through these four strategies and may be administered by nursing staff. It is known that reducing anxiety can decrease heart rate and blood pressure, thereby reducing oxygen consumption, which may be beneficial for the patient's prognosis. However, because this is an integrative literature review, we did not perform a meta-analysis and future systematic literature reviews should be performed in order to identify the effectiveness of these strategies.

  • How to cite this article:
    Ferreira NC, Ramalho ES, Lopes JL. Non-pharmacological strategies to decrease anxiety in cardiac catheterization: integrative review. Rev Bras Enferm. 2015;68(6):784-93.

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    Hui-Kuan C, Peng TC, Wang JH, Lai HL. Psychophysiological responses to sedative music in patients awaiting cardiac catheterization examination: a randomized controlled trial. J Cardiovasc Nurs [Internet]. 2011[cited 2015 Jul 30];26(5):E11-8. Available from: Available from: http://www.ncbi.nlm.nih.gov/pubmed/21372737
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    Taylor- Piliae RE, Chair SY. The effect of nursing interventions utilizing music therapy or sensory information on Chinese patients" anxiety prior to cardiac catheterization: a pilot study. Eur J Cardiovasc Nurs[Internet]. 2002[cited 2015 Jul 30];1(3):203-11. Available from: Available from: http://cnu.sagepub.com/content/1/3/203.long
    » http://cnu.sagepub.com/content/1/3/203.long
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    Bally K, Campbell D, Chesnick K, Tranmer JE. Effects of patient-controlled music therapy during coronary angiography on procedural pain and anxiety distress syndrome. Crit Care Nurse [Internet]. 2003[cited 2014 Nov 23];23(2):50-8. Available from: Available from: http://ccn.aacnjournals.org/content/23/2/50.full
    » http://ccn.aacnjournals.org/content/23/2/50.full
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    Wentworth LJ, Briese LJ, Timimi FK, Sanvick CL, Bertel DC, Cutshall SM, et al. Massage Therapy reduces tension, anxiety, and pain in patients awaiting invasive cardiovascular procedures. Prog Cardiovasc Nurs [Internet]. 2009[cited 2015 Jul 30];24(4):155-61. Available from: Available from: http://onlinelibrary.wiley.com/doi/10.1111/j.1751-7117.2009.00054.x/epdf
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Publication Dates

  • Publication in this collection
    Nov-Dec 2015

History

  • Received
    01 Aug 2015
  • Accepted
    06 Oct 2015
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