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Observational studies involving adult and older adult populations were selected from major electronic databases. Data extraction and quality appraisal were independently performed by multiple reviewers. Effect measures were synthesized using a random-effects model, with heterogeneity assessed across studies.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Findings<\/jats:title>\n                    <jats:p>Sixty-three studies were included, the majority with cohort designs. Key risk factors identified for decreased cardiac output were lower body surface area and lower body weight, with advanced age and female sex recognized as significant risk population characteristics. Associated conditions contributing to elevated risk included a history of stroke, shock, emergency cardiac surgery, diabetes, renal and pulmonary diseases, lower ejection fraction, and heart failure. Methodological variability in cardiac output measurement and significant heterogeneity among studies were notable challenges.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Several significant risk factors for decreased cardiac output were identified and classified, providing scientific support for the theoretical-causal validation process of this nursing diagnosis. Addressing study heterogeneity and standardizing measurement methods are recommended for future research.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Implications for Nursing Practice<\/jats:title>\n                    <jats:p>The findings reinforce the clinical relevance of the nursing diagnosis Risk for Decreased Cardiac Output and highlight the need for tailored interventions by nursing professionals to prevent complications among at-risk cardiovascular patients.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/20473087261460960","type":"journal-article","created":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T10:41:33Z","timestamp":1784544093000},"page":"596-609","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Theoretical-Causal Validation of Risk Factors for the Nursing Diagnosis of Decreased Cardiac Output: A Systematic Review of the Literature with Meta-Analysis"],"prefix":"10.1177","volume":"37","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7965-3095","authenticated-orcid":false,"given":"Jos\u00e9 Antonio da","family":"Silva J\u00fanior","sequence":"first","affiliation":[{"name":"Universidade do Estado do Rio Grande do Norte"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9851-8363","authenticated-orcid":false,"given":"Ana Beatriz","family":"Silva","sequence":"additional","affiliation":[{"name":"Universidade do Estado do Rio Grande do Norte"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5867-8023","authenticated-orcid":false,"given":"Marcos Venicios de Oliveira","family":"Lopes","sequence":"additional","affiliation":[{"name":"Universidade Federal do Cear\u00e1"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7615-416X","authenticated-orcid":false,"given":"\u00cdsis Kelly","family":"dos Santos","sequence":"additional","affiliation":[{"name":"Universidade do Estado do Rio Grande do Norte"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2544-046X","authenticated-orcid":false,"given":"Daria Raquel Queiroz de","family":"Almeida","sequence":"additional","affiliation":[{"name":"Universidade do Estado do Rio Grande do Norte"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0264-8842","authenticated-orcid":false,"given":"Cleber de Mesquita","family":"Andrade","sequence":"additional","affiliation":[{"name":"Universidade do Estado do Rio Grande do Norte"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4559-8918","authenticated-orcid":false,"given":"Thales Allyrio Ara\u00fajo de Medeiros","family":"Fernandes","sequence":"additional","affiliation":[{"name":"Universidade do Estado do Rio Grande do Norte"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4014-6242","authenticated-orcid":false,"given":"Ellany Gurgel Cosme","family":"do Nascimento","sequence":"additional","affiliation":[{"name":"Universidade do Estado do Rio Grande do Norte"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,7,20]]},"reference":[{"key":"e_1_3_2_2_1","doi-asserted-by":"publisher","DOI":"10.1097\/HJH.0000000000003534"},{"key":"e_1_3_2_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjcard.2006.06.031"},{"key":"e_1_3_2_4_1","doi-asserted-by":"publisher","DOI":"10.59958\/hsf.7095"},{"key":"e_1_3_2_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.athoracsur.2011.06.017"},{"key":"e_1_3_2_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijsu.2010.10.007"},{"key":"e_1_3_2_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijsu.2010.11.006"},{"issue":"7","key":"e_1_3_2_8_1","article-title":"Glycosylated hemoglobin (HbA1C) as a predictor of early postoperative outcomes after coronary artery bypass grafting: A single-center observational study","volume":"16","author":"Alshair F. 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