Essentials of evidence based practice

The Mindfulness-Based Interventions in Reducing 
Stress and Anxiety in Patients with Coronary Heart 

Disease

Adebusola Balogun

Walden University

Essentials of Evidence Base Practice

NURS 6052 

April 2nd, 2023.

 The chosen clinical issue is the effectiveness of 
mindfulness-based interventions in reducing stress 
and anxiety in patients with coronary heart disease.

 PICO(T) question: 
◦ P – Patients with coronary heart disease 
◦ I – Mindfulness-based interventions 
◦ C – Standard treatment or no treatment 
◦ O – Reduction in stress and anxiety 
◦ T – Time (length of follow-up)

Clinical Issue and PICOT Question

 The four Peer-reviewed research article databases 
utilized include:
◦ PubMed
◦Walden University Library
◦ PsycINFO
◦ CINAHL

 The levels of evidence and strengths of using 
systematic reviews are as described in the following 
slides of the articles used in the review.

Article Databases, Levels of Evidence and
Strengths

 The first article is a systematic review and meta-analysis of 
randomized controlled trials (RCTs) that investigated the 
effects of mindfulness-based interventions on stress and 
anxiety in patients with coronary heart disease (O’Doherty, et 
al., 2015). 

 This systematic review provides the highest level of evidence 
and includes a comprehensive search strategy, a transparent 
selection process, and a statistical synthesis of the results. 

 One of the strengths of using systematic reviews includes the 
ability to synthesize and analyze data from multiple studies.

 Another strength is providing a more reliable estimate of the 
treatment effect, and reducing the risk of bias.

Article 1

 The second article is an RCT that compared the effects of 
a mindfulness-based stress reduction program to a control 
group on patients with cardiovascular disease (Marino, et 
al., 2021). 

 This study provides a high level of evidence and includes 
a clear description of the intervention and outcome 
measures.

 One of the strengths of using RCTs include the ability to 
control for confounding variables and randomize 
participants to treatment groups.

 Another strength is the ability to reduce the risk of bias.

Article 2

 The third article is a systematic review of RCTs that 
investigated the effects of mindfulness-based 
interventions on psychological outcomes in patients with 
cardiovascular disease (Jalali, et al., 2019). 

 This review provides a high level of evidence and 
includes a detailed search strategy and selection process. 

 One strength of using systematic reviews include the 
ability to provide a more comprehensive overview of the 
lit

1

Clinical Issue Identified: Causes of Heart Disease among the Elderly Population

Adebusola Balogun

Walden University

Essentials of Evidence-Based Practice

NURS 6052

March 19th, 2023.

2

Clinical Issue Identified: Causes of Heart Disease among the Elderly Population

Relevant Peer Reviewed Articles from Walden Library

Fuchs, F. D., & Whelton, P. K. (2020). High blood pressure and cardiovascular disease.

Hypertension, 75(2), 285-292.

https://doi.org/10.1161/HYPERTENSIONAHA.119.14240

Groenewegen, A., Rutten, F. H., Mosterd, A., & Hoes, A. W. (2020). Epidemiology of heart

failure. European journal of heart failure, 22(8), 1342-1356.

https://doi.org/10.1002/ejhf.1858

Hayes, R. B., Lim, C., Zhang, Y., Cromar, K., Shao, Y., Reynolds, H. R. … & Thurston, G. D.

(2020). PM2. 5 air pollution and cause-specific cardiovascular disease mortality.

International journal of epidemiology, 49(1), 25-35. https://doi.org/10.1093/ije/dyz114

Jankowski, J., Floege, J., Fliser, D., Böhm, M., & Marx, N. (2021). Cardiovascular disease in

chronic kidney disease: pathophysiological insights and therapeutic options. Circulation,

143(11), 1157-1172. https://doi.org/10.1161/CIRCULATIONAHA.120.050686

Each Study Results from Review

The first study in the list masks the overall cardiovascular disease picture. The results in

this article indicated that the right-sided population shift in blood pressure distribution causes

cardiovascular disease. The study demonstrated less rise in blood pressure with aging, more so

among the Indian communities in Brazil who had minimal salt. The findings indicated that BP

would reduce vascular effects associated with aging (Fuchs & Whelton, 2020). Cohort studies in

this study showed that high blood pressure is a vital risk factor for dementia, heart failure, aortic

syndromes, atrial fibrillation, heart valve disease, and chronic kidney disease.

3

The second research article’s findings indicate a slow decline in heart failure and that the

mortality rate associated with heart failure is rising among individuals living in low-income

countries because of the western lifestyle and the communicable diseases’ double burden

(Groenewegen et al., 2020). The results show that although the number of mixed heart failure

incidences has reduced among the young, there are still opposite trends thought to be caused by

obesity.

The third study results show that increased particulate matter by 10 milligrams per square

meter with completely adjusted models increased ischemic heart disease mortality by 16% and

stroke-related

4/7/23, 12:07 AM Module 4: Assignment

https://waldenu.instructure.com/courses/53151/assignments/323784?module_item_id=1043736 1/6

Due Apr 16 by 10:59pm Points 100 Submitting a text entry box or a file upload Attempts 0
Allowed Attempts 2

Start Assignment

Back to Module at a Glance
(https://waldenu.instructure.com/courses/53151/modules/items/1043734)

Realtors rely on detailed property appraisals—conducted using appraisal tools—to assign market values to houses and other properties.
These values are then presented to buyers and sellers to set prices and initiate offers.

Research appraisal is not that different. The critical appraisal process utilizes formal appraisal tools to assess the results of research to
determine value to the context at hand. Evidence-based practitioners often present these findings to make the case for specific courses of
action.

In this Assignment, you will use an appraisal tool to conduct a critical appraisal of published research. You will then present the results of
your efforts.

EVIDENCE-BASED PROJECT, PART 3: CRITICAL
APPRAISAL OF RESEARCH

RESOURCES

https://waldenu.instructure.com/courses/53151/modules/items/1043734

4/7/23, 12:07 AM Module 4: Assignment

https://waldenu.instructure.com/courses/53151/assignments/323784?module_item_id=1043736 2/6

To Prepare:

Reflect on the four peer-reviewed articles you selected in Module 2 and the four systematic reviews (or other filtered high- level
evidence) you selected in Module 3.
Reflect on the four peer-reviewed articles you selected in Module 2 and analyzed in Module 3.
Review and download the Critical Appraisal Tool Worksheet Template provided in the Resources.

The Assignment (Evidence-Based Project)

Part 3A: Critical Appraisal of Research

Conduct a critical appraisal of the four peer-reviewed articles you selected by completing the Evaluation Table within the Critical Appraisal
Tool Worksheet Template. Choose a total of four peer- reviewed articles that you selected related to your clinical topic of interest in Module
2 and Module 3.

Note: You can choose any combination of articles from Modules 2 and 3 for your Critical Appraisal. For example, you may choose two
unfiltered research articles from Module 2 and two filtered research articles (systematic reviews) from Module 3 or one article from Module
2 and three articles from Module 3. You can choose any combination of articles from the prior Module Assignments as long as both
modules and types of studies are represented.

Part 3B: Critical Appraisal of Research

Based on your appraisal, in a 1-2-page critical appraisal, suggest a best practice that emerges from the research y

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