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Abstract
Prevalence of cardiovascular disease (CVD) increases with age and is endemic in the burgeoning population of older adults. Older adults with CVD are susceptible not only to high mortality but also to increased likelihood of disability, dependency, functional decline, and poor quality of life. Cardiac rehabilitation (CR) is a multidimensional and comprehensive treatment program that can potentially address many of the distinctive challenges of older adults with CVD. In this review, the wide range of potential benefits of CR for older adults with CVD is summarized.
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Affiliation(s)
- Deirdre O'Neill
- Department of Medicine and Mazankowski Heart Institute, Division of Cardiology, University of Alberta Hospital, 11220 83 Avenue, Edmonton, AB T6G 2J2, Canada
| | - Daniel E Forman
- Section of Geriatric Cardiology, Divisions of Geriatrics and Cardiology, University of Pittsburgh, Pittsburgh, PA, USA; Geriatric Research, Education, and Clinical Center (GRECC), VA Pittsburgh Healthcare System, Pittsburgh, PA, USA.
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52
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Terada T, Chirico D, Tulloch HE, Scott K, Pipe AL, Reed JL. Sex differences in psychosocial and cardiometabolic health among patients completing cardiac rehabilitation. Appl Physiol Nutr Metab 2019; 44:1237-1245. [DOI: 10.1139/apnm-2018-0876] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Current programs of cardiac rehabilitation (CR) typically provide a standardized approach to all patients. We examined whether CR would produce similar improvements in psychosocial and cardiometabolic health indicators in women compared with men. The records of patients who completed a 3-month outpatient CR program were examined. We compared health-related quality of life (i.e., Physical Component Summary (PCS) and Mental Component Summary (MCS) scores), anxiety, depression, and cardiometabolic health indicators between women and men completing CR. Of the 591 participants who completed CR, 155 (26.2%) were women and 436 (73.8%) were men. At baseline, women were older (64 ± 9 vs. 62 ± 9 years, p = 0.045), had lower PCS (39.5 ± 8.1 vs. 43.9 ± 7.8 points, p < 0.001), and MCS (46.6 ± 10.8 vs. 49.4 ± 9.8 points, p = 0.003) scores, experienced elevated levels of anxiety (6.4 ± 4.0 vs. 5.2 ± 4.0 points, p = 0.001) and depression (4.7 ± 3.5 vs. 3.6 ± 3.3 points, p = 0.001), and had higher low-density lipoprotein cholesterol (2.1 ± 0.9 vs. 1.7 ± 0.7 mmol/L, p < 0.001) and high-density lipoprotein cholesterol (1.4 ± 0.4 vs. 1.1 ± 0.3 mmol/L, p < 0.001) concentrations when compared with men. Following CR, women showed smaller improvements in percent body mass (+1.1% ± 10.1% vs. −2.1% ± 9.7%, p = 0.002) and PCS scores (3.0 ± 8.1 vs. 6.3 ± 7.5 points, p < 0.001) when compared with men. Considering poorer psychosocial health at baseline and smaller improvements in health-related quality of life in women when compared with men, more specific CR strategies addressing the particular needs of women are required to improve their health status and reduce the risk of secondary cardiac events.
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Affiliation(s)
- Tasuku Terada
- Exercise Physiology and Cardiovascular Health Lab, Division of Cardiac Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, ON K1Y 4W7, Canada
| | - Daniele Chirico
- Exercise Physiology and Cardiovascular Health Lab, Division of Cardiac Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, ON K1Y 4W7, Canada
| | - Heather E. Tulloch
- Division of Cardiac Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, ON K1Y 4W7, Canada
- Faculty of Medicine, University of Ottawa, Ottawa, ON K1H 8M5, Canada
| | - Kyle Scott
- Exercise Physiology and Cardiovascular Health Lab, Division of Cardiac Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, ON K1Y 4W7, Canada
| | - Andrew L. Pipe
- Division of Cardiac Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, ON K1Y 4W7, Canada
- Faculty of Medicine, University of Ottawa, Ottawa, ON K1H 8M5, Canada
| | - Jennifer L. Reed
- Exercise Physiology and Cardiovascular Health Lab, Division of Cardiac Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, ON K1Y 4W7, Canada
- Faculty of Medicine, University of Ottawa, Ottawa, ON K1H 8M5, Canada
- School of Human Kinetics, Faculty of Health Sciences, University of Ottawa, Ottawa, ON K1N 6N5, Canada
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Tsutsui H, Isobe M, Ito H, Ito H, Okumura K, Ono M, Kitakaze M, Kinugawa K, Kihara Y, Goto Y, Komuro I, Saiki Y, Saito Y, Sakata Y, Sato N, Sawa Y, Shiose A, Shimizu W, Shimokawa H, Seino Y, Node K, Higo T, Hirayama A, Makaya M, Masuyama T, Murohara T, Momomura SI, Yano M, Yamazaki K, Yamamoto K, Yoshikawa T, Yoshimura M, Akiyama M, Anzai T, Ishihara S, Inomata T, Imamura T, Iwasaki YK, Ohtani T, Onishi K, Kasai T, Kato M, Kawai M, Kinugasa Y, Kinugawa S, Kuratani T, Kobayashi S, Sakata Y, Tanaka A, Toda K, Noda T, Nochioka K, Hatano M, Hidaka T, Fujino T, Makita S, Yamaguchi O, Ikeda U, Kimura T, Kohsaka S, Kosuge M, Yamagishi M, Yamashina A. JCS 2017/JHFS 2017 Guideline on Diagnosis and Treatment of Acute and Chronic Heart Failure ― Digest Version ―. Circ J 2019; 83:2084-2184. [DOI: 10.1253/circj.cj-19-0342] [Citation(s) in RCA: 276] [Impact Index Per Article: 55.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Affiliation(s)
- Hiroyuki Tsutsui
- Department of Cardiovascular Medicine, Kyushu University Graduate School of Medical Sciences
| | | | - Hiroshi Ito
- Department of Cardiovascular and Respiratory Medicine, Akita University Graduate School of Medicine
| | - Hiroshi Ito
- Department of Cardiovascular Medicine, Division of Biophysiological Sciences, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences
| | - Ken Okumura
- Division of Cardiology, Saiseikai Kumamoto Hospital Cardiovascular Center
| | - Minoru Ono
- Department of Cardiac Surgery, Graduate School of Medicine, The University of Tokyo
| | - Masafumi Kitakaze
- Department of Clinical Medicine and Development, National Cerebral and Cardiovascular Center
| | | | - Yasuki Kihara
- Department of Cardiovascular Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University
| | | | - Issei Komuro
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo
| | - Yoshikatsu Saiki
- Department of Cardiovascular Surgery, Tohoku University Graduate School of Medicine
| | - Yoshihiko Saito
- Department of Cardiovascular Medicine, Nara Medical University
| | - Yasushi Sakata
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine
| | - Naoki Sato
- Department of Cardiovascular Medicine, Kawaguchi Cardiovascular and Respiratory Hospital
| | - Yoshiki Sawa
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine
| | - Akira Shiose
- Department of Cardiovascular Surgery, Kyushu University Graduate School of Medical Sciences
| | - Wataru Shimizu
- Department of Cardiovascular Medicine, Nippon Medical School
| | - Hiroaki Shimokawa
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine
| | | | - Koichi Node
- Department of Cardiovascular Medicine, Saga University
| | - Taiki Higo
- Department of Cardiovascular Medicine, Kyushu University Graduate School of Medical Sciences
| | - Atsushi Hirayama
- The Division of Cardiology, Department of Medicine, Nihon University Graduate School of Medicine
| | | | - Tohru Masuyama
- Cardiovascular Division, Department of Internal Medicine, Hyogo College of Medicine
| | - Toyoaki Murohara
- Department of Cardiology, Nagoya University Graduate School of Medicine
| | | | - Masafumi Yano
- Department of Medicine and Clinical Science, Yamaguchi University Graduate School of Medicine
| | - Kenji Yamazaki
- Department of Cardiology Surgery, Tokyo Women’s Medical University
| | - Kazuhiro Yamamoto
- Department of Molecular Medicine and Therapeutics, Faculty of Medicine, Tottori University
| | | | - Michihiro Yoshimura
- Division of Cardiology, Department of Internal Medicine, The Jikei University School of Medicine
| | - Masatoshi Akiyama
- Department of Cardiovascular Surgery, Tohoku University Graduate School of Medicine
| | - Toshihisa Anzai
- Department of Cardiovascular Medicine, Hokkaido University Graduate School of Medicine
| | - Shiro Ishihara
- Department of Cardiology, Nippon Medical School Musashi-Kosugi Hospital
| | - Takayuki Inomata
- Department of Cardiovascular Medicine, Kitasato University Kitasato Institute Hospital
| | | | - Yu-ki Iwasaki
- Department of Cardiovascular Medicine, Nippon Medical School
| | - Tomohito Ohtani
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine
| | | | - Takatoshi Kasai
- Cardiovascular Respiratory Sleep Medicine, Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine
| | - Mahoto Kato
- Department of Cardiovascular Medicine, Nihon University Graduate School of Medicine
| | - Makoto Kawai
- Division of Cardiology, Department of Internal Medicine, The Jikei University School of Medicine
| | | | - Shintaro Kinugawa
- Department of Cardiovascular Medicine, Hokkaido University Graduate School of Medicine
| | - Toru Kuratani
- Department of Minimally Invasive Cardiovascular Medicine, Osaka University Graduate School of Medicine
| | - Shigeki Kobayashi
- Department of Medicine and Clinical Science, Yamaguchi University Graduate School of Medicine
| | - Yasuhiko Sakata
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine
| | | | - Koichi Toda
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine
| | - Takashi Noda
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Kotaro Nochioka
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine
| | - Masaru Hatano
- Department of Cardiovascular Medicine, The University of Tokyo Hospital
| | | | - Takeo Fujino
- Department of Advanced Cardiopulmonary Failure, Kyushu University Graduate School of Medical Sciences
| | - Shigeru Makita
- Department of Cardiac Rehabilitation, Saitama Medical University International Medical Center
| | - Osamu Yamaguchi
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine
| | | | - Takeshi Kimura
- Department of Cardiovascular Medicine, Graduate School of Medicine and Faculty of Medicine, Kyoto University
| | - Shun Kohsaka
- Department of Cardiology, Keio University School of Medicine
| | - Masami Kosuge
- Division of Cardiology, Yokohama City University Medical Center
| | - Masakazu Yamagishi
- Department of Cardiovascular and Internal Medicine, Kanazawa University Graduate School of Medicine
| | - Akira Yamashina
- Medical Education Promotion Center, Tokyo Medical University
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CHAN KA, CISMARU G, ISTRATOAIE S, PUIU M, GUSETU G, CALOIAN 2, B, COMSA H, FRANGU F, GURZAU D, MARTIS A, POP D, ZDRENGHEA D, ROSU R. Cardiac rehabilitation in elderly athletes. Analysis of eldery participation in Wizz Air Cluj-Napoca Marathon. BALNEO RESEARCH JOURNAL 2019. [DOI: 10.12680/balneo.2019.262] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Cardiac rehabilitation remains an indispensable tool of the cardiologist’s arsenal for improving cardiovascular health in his patients. The range of applications of cardiac rehabilitation has increased over time. In recent years outstanding athletic performances of elderly people have been reported. In this article we present the benefits of cardiac rehabilitation for elderly population and for elderly athletes. We also make an analysis of the elderly participation in WizzAir Cluj-Napoca Marathon: number of finishers, best running time, evolution of running time over years, male-to-female ratio participation and results.
Key words: cardiac rehabilitation, elderly, marathon, semimarathon, Wizz Air,
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Affiliation(s)
- Keith Andrew CHAN
- Section of Adult Cardiology, Chong Hua Hospital, Cebu City, Philippines
| | - Gabriel CISMARU
- 2 5th Department of Internal Medicine, Cardiac Rehabilitation, “Iuliu Hatieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Sabina ISTRATOAIE
- 2 5th Department of Internal Medicine, Cardiac Rehabilitation, “Iuliu Hatieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Mihai PUIU
- 2 5th Department of Internal Medicine, Cardiac Rehabilitation, “Iuliu Hatieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Gabriel GUSETU
- 2 5th Department of Internal Medicine, Cardiac Rehabilitation, “Iuliu Hatieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Bogdan CALOIAN 2,
- 2 5th Department of Internal Medicine, Cardiac Rehabilitation, “Iuliu Hatieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Horatiu COMSA
- 2 5th Department of Internal Medicine, Cardiac Rehabilitation, “Iuliu Hatieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Florina FRANGU
- 2 5th Department of Internal Medicine, Cardiac Rehabilitation, “Iuliu Hatieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Diana GURZAU
- 2 5th Department of Internal Medicine, Cardiac Rehabilitation, “Iuliu Hatieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Alexandru MARTIS
- 2 5th Department of Internal Medicine, Cardiac Rehabilitation, “Iuliu Hatieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Dana POP
- 2 5th Department of Internal Medicine, Cardiac Rehabilitation, “Iuliu Hatieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Dumitru ZDRENGHEA
- 2 5th Department of Internal Medicine, Cardiac Rehabilitation, “Iuliu Hatieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Radu ROSU
- 2 5th Department of Internal Medicine, Cardiac Rehabilitation, “Iuliu Hatieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania
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55
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O'Keefe EL, O'Keefe JH, Lavie CJ. Exercise Counteracts the Cardiotoxicity of Psychosocial Stress. Mayo Clin Proc 2019; 94:1852-1864. [PMID: 31451292 DOI: 10.1016/j.mayocp.2019.02.022] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Revised: 01/15/2019] [Accepted: 02/19/2019] [Indexed: 12/12/2022]
Abstract
Physical inactivity and psychosocial stress are prevalent in residents of the United States. The purpose of this article is to review the interaction between these 2 conditions and examine the effects of exercise on stress and cardiovascular (CV) health. A query of scientific references between 1974 to 2018 was performed using the PubMed search engine accessing the MEDLINE database using the search terms psychosocial stress, CV disease (CVD), physical activity, exercise, cardiac rehabilitation, and team sports. Psychosocial stress is a strong independent risk factor for adverse CV events. Conversely, people who experience CV events subsequently have drastically elevated rates of new-onset mental health disorders, including depression and anxiety. Psychosocial stress and CVD often trigger self-reinforcing feedback loops that can worsen mental health and cardiac prognosis. Exercise predictably improves CV health and prognosis and also is effective at lowering levels of psychosocial stress. Group exercise in particular seems to provide social support while at the same time boosting fitness levels and, thus, may be the single most important intervention for patients with concomitant CVD and emotional stress. Collaborative physical activity, such as group exercise, team sports, interactive physical play, and cardiac rehabilitation programs, have the potential to improve mental health and CV prognosis.
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Affiliation(s)
- Evan L O'Keefe
- Ochsner Clinical School, The University of Queensland School of Medicine, New Orleans, LA
| | - James H O'Keefe
- University of Missouri-Kansas City and Saint Luke's Mid America Heart Institute, New Orleans, LA
| | - Carl J Lavie
- Ochsner Clinical School, The University of Queensland School of Medicine, New Orleans, LA; Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute, New Orleans, LA.
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56
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57
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Gaalema DE, Elliott RJ, Savage PD, Rengo JL, Cutler AY, Pericot-Valverde I, Priest JS, Shepard DS, Higgins ST, Ades PA. Financial Incentives to Increase Cardiac Rehabilitation Participation Among Low-Socioeconomic Status Patients: A Randomized Clinical Trial. JACC-HEART FAILURE 2019; 7:537-546. [PMID: 31078475 DOI: 10.1016/j.jchf.2018.12.008] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Revised: 11/25/2018] [Accepted: 12/09/2018] [Indexed: 12/28/2022]
Abstract
OBJECTIVES This study sought to examine the efficacy of financial incentives to increase Medicaid patient participation in and completion of cardiac rehabilitation (CR). BACKGROUND Participation in CR reduces morbidity, mortality, and hospitalizations while improving quality of life. Lower-socioeconomic status (SES) patients are much less likely to attend and complete CR, despite being at increased risk for recurrent cardiovascular events. METHODS A total of 130 individuals enrolled in Medicaid with a CR-qualifying cardiac event were randomized 1:1 to receive financial incentives on an escalating schedule ($4 to $50) for completing CR sessions or to receive usual care. Primary outcomes were CR participation (number of sessions completed) and completion (≥30 sessions completed). Secondary outcomes included changes in sociocognitive measurements (depressive/anxious symptoms, executive function), body composition (waist circumference, body mass index), fitness (peak VO2) over 4 months, and combined number of hospitalizations and emergency department (ED) contacts over 1 year. RESULTS Patients randomized to the incentive condition completed more sessions (22.4 vs. 14.7, respectively; p = 0.013) and were almost twice as likely to complete CR (55.4% vs. 29.2%, respectively; p = 0.002) as controls. Incentivized patients were also more likely to experience improvements in executive function (p < 0.001), although there were no significant effects on other secondary outcomes. Patients who completed ≥30 sessions had 47% fewer combined hospitalizations and ED visits (p = 0.014), as reflected by a nonsignificant trend by study condition with 39% fewer hospital contacts in the incentive condition group (p = 0.079). CONCLUSIONS Financial incentives improve CR participation among lower-SES patients following a cardiac event. Increasing participation among lower-SES patients in CR is critical for positive longer-term health outcomes. (Increasing Cardiac Rehabilitation Participation Among Medicaid Enrollees; NCT02172820).
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Affiliation(s)
- Diann E Gaalema
- Department of Psychiatry, University of Vermont, Burlington, Vermont; Department of Psychology, University of Vermont, Burlington, Vermont.
| | - Rebecca J Elliott
- Department of Psychiatry, University of Vermont, Burlington, Vermont
| | - Patrick D Savage
- Division of Cardiology, University of Vermont Medical Center, Burlington, Vermont
| | - Jason L Rengo
- Division of Cardiology, University of Vermont Medical Center, Burlington, Vermont
| | - Alex Y Cutler
- Department of Psychiatry, University of Vermont, Burlington, Vermont
| | | | - Jeffrey S Priest
- Department of Medical Biostatistics, University of Vermont, Burlington, Vermont
| | - Donald S Shepard
- Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts
| | - Stephen T Higgins
- Department of Psychiatry, University of Vermont, Burlington, Vermont; Department of Psychology, University of Vermont, Burlington, Vermont
| | - Philip A Ades
- Division of Cardiology, University of Vermont Medical Center, Burlington, Vermont
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58
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Jha MK, Qamar A, Vaduganathan M, Charney DS, Murrough JW. Screening and Management of Depression in Patients With Cardiovascular Disease: JACC State-of-the-Art Review. J Am Coll Cardiol 2019; 73:1827-1845. [PMID: 30975301 PMCID: PMC7871437 DOI: 10.1016/j.jacc.2019.01.041] [Citation(s) in RCA: 155] [Impact Index Per Article: 31.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2018] [Revised: 01/02/2019] [Accepted: 01/02/2019] [Indexed: 12/11/2022]
Abstract
Depression is a common problem in patients with cardiovascular disease (CVD) and is associated with increased mortality, excess disability, greater health care expenditures, and reduced quality of life. Depression is present in 1 of 5 patients with coronary artery disease, peripheral artery disease, and heart failure. Depression complicates the optimal management of CVD by worsening cardiovascular risk factors and decreasing adherence to healthy lifestyles and evidence-based medical therapies. As such, standardized screening pathways for depression in patients with CVD offer the potential for early identification and optimal management of depression to improve health outcomes. Unfortunately, the burden of depression in patients with CVD is under-recognized; as a result, screening and management strategies targeting depression have been poorly implemented in patients with CVD. In this review, the authors discuss a practical approach for the screening and management of depression in patients with CVD.
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Affiliation(s)
- Manish K Jha
- Depression and Anxiety Center for Discovery and Treatment, Department of Psychiatry, and Department of Neuroscience, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Arman Qamar
- TIMI Study Group, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; Harvard T.H. Chan School of Public Health, Boston, Massachusetts. https://twitter.com/AqamarMD
| | - Muthiah Vaduganathan
- Heart & Vascular Center, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts. https://twitter.com/mvaduganathan
| | - Dennis S Charney
- Depression and Anxiety Center for Discovery and Treatment, Department of Psychiatry, and Department of Neuroscience, Icahn School of Medicine at Mount Sinai, New York, New York; Office of the Dean, Icahn School of Medicine at Mount Sinai, New York, New York
| | - James W Murrough
- Depression and Anxiety Center for Discovery and Treatment, Department of Psychiatry, and Department of Neuroscience, Icahn School of Medicine at Mount Sinai, New York, New York.
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Sever S, Harrison AS, Golder S, Doherty P. Determinants of depression in patients with comorbid depression following cardiac rehabilitation. Open Heart 2019; 6:e000973. [PMID: 31168379 PMCID: PMC6519417 DOI: 10.1136/openhrt-2018-000973] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Revised: 01/23/2019] [Accepted: 03/04/2019] [Indexed: 11/08/2022] Open
Abstract
Background A prior history of depression, at the point patients start cardiac rehabilitation (CR), is associated with poor outcomes; however, little is known about which factors play a part in determining the extent of benefit following CR. Therefore, we aim to identify and evaluate determinants of CR depression outcomes in patients with comorbid depression. Methods An observational study of routine practice using the British Heart Foundation National Audit of Cardiac Rehabilitation data between April 2012 and March 2017. Baseline characteristics were examined with independent samples t-test and χ2 test. A binary logistic regression was used to predict change in depression outcome following CR. Results The analysis included 2715 CR participants with depression history. The determinants of Hospital Anxiety and Depression Scale (HADS) depression measurement post-CR were higher total number of comorbidities (OR 0.914, 95% CI 0.854 to 0.979), a higher HADS anxiety score (OR 0.883, 95% CI 0.851 to 0.917), physical inactivity (OR 0.707, 95% CI 0.514 to 0.971), not-smoking at baseline (OR 1.774, 95% CI 1.086 to 2.898) and male gender (OR 0.721, 95% CI 0.523 to 0.992). Conclusion Baseline characteristics of patients with comorbid depression such as higher anxiety, higher total number of comorbidities, smoking, physical inactivity and male gender were predictors of their depression levels following CR. CR programmes need to be aware of comorbid depression and these related patient characteristics associated with better CR outcomes.
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Affiliation(s)
| | | | - Su Golder
- Health Sciences, University of York, York, UK
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Simning A, Kittel J, Conwell Y. Late-Life Depressive and Anxiety Symptoms Following Rehabilitation Services in Medicare Beneficiaries. Am J Geriatr Psychiatry 2019; 27:381-390. [PMID: 30655031 PMCID: PMC6431271 DOI: 10.1016/j.jagp.2018.12.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Revised: 12/11/2018] [Accepted: 12/11/2018] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The aim of this study was to determine whether patients who received rehabilitation services had an increased risk of having late-life depressive or anxiety symptoms within the year following termination of services. METHODS The National Health and Aging Trends Study (NHATS) is a population-based, longitudinal cohort survey of a nationally representative sample of Medicare beneficiaries aged 65years and older. This study involved 5,979 participants from the 2016 NHATS survey. The Patient Health Questionnaire-2 and Generalized Anxiety Disorder 2-item assessed for clinically significant depressive and anxiety symptoms. RESULTS The prevalence of depressive and anxiety symptoms was higher in older adults who had received rehabilitation services in the year prior and varied by site: no rehabilitation (depressive and anxiety symptoms): 10.4% and 8.8%; nursing home or inpatient rehabilitation: 38.8% and 23.8%; outpatient rehabilitation: 8.6% and 5.5%; in-home rehabilitation: 35.3% and 20.5%; multiple rehabilitation sites: 20.3% and 14.4%; and any rehabilitation site: 18.4% and 11.8%. In multiple logistic regression analyses, nursing home and inpatient and in-home rehabilitation services, respectively, were associated with an increased risk of having subsequent depressive symptoms (odds ratio: 3.51; 95% confidence interval [CI]: 1.85-6.63; OR: 2.15; 95% CI: 1.08-4.30) but not anxiety symptoms. CONCLUSION Older adults who receive rehabilitation services are at risk of having depressive and anxiety symptoms after these services have terminated. As mental illness is associated with considerable morbidity and may affect rehabilitation outcomes, additional efforts to identify and treat depression and anxiety in these older adults may be warranted.
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Affiliation(s)
- Adam Simning
- Department of Psychiatry (AS, YC), University of Rochester School of Medicine and Dentistry, Rochester, NY.
| | | | - Yeates Conwell
- University of Rochester School of Medicine and Dentistry (URSMD), Department of Psychiatry,University of Rochester Medical Center, Office for Aging Research and Health Services
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61
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Terada T, Chirico D, Tulloch HE, Scott K, Doucet É, Pipe AL, Reed JL. Psychosocial and Cardiometabolic Health of Patients With Differing Body Mass Index Completing Cardiac Rehabilitation. Can J Cardiol 2019; 35:712-720. [PMID: 31151706 DOI: 10.1016/j.cjca.2019.02.024] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2018] [Revised: 02/04/2019] [Accepted: 02/26/2019] [Indexed: 10/27/2022] Open
Abstract
BACKGROUND It remains unclear whether cardiac rehabilitation (CR) provides similar benefits to patients with varying levels of body mass index (BMI). We assessed the psychosocial and cardiometabolic health of patients with increased BMI who completed CR. METHODS The records of 582 patients who completed a 3-month outpatient CR program were analyzed. On the basis of their BMI at baseline, patients were categorized as normal (18.5-24.9 kg/m2), overweight (25.0-29.9 kg/m2), obese (30.0-34.9 kg/m2), or severely obese (≥ 35.0 kg/m2). Analysis of covariance was used to compare health-related quality of life (ie, Physical Component Summary [PCS] and Mental Component Summary scores), anxiety, depression, and cardiometabolic health indicators between BMI categories after CR. RESULTS At baseline, patients with severe obesity, when compared with those with normal BMI, had lower PCS scores (39.7 ± 8.5 vs 44.4 ± 8.4, P < 0.001), elevated levels of anxiety (7.0 ± 3.7 vs 4.8 ± 3.2, P = 0.001) and depression (5.5 ± 4.4 vs 3.4 ± 3.7, P < 0.001), higher glycated hemoglobin A1C (6.5 ± 1.1 vs 5.6 ± 0.7%, P < 0.001) and triglycerides (1.6 ± 0.5 vs 1.1 ± 0.4 mmol/L, P < 0.001), and lower high-density lipoprotein cholesterol (1.1 ± 0.3 vs 1.2 ± 0.4 mmol/L, P = 0.006). After CR, notwithstanding a greater percent weight reduction in obesity (-3.5% ± 6.9% vs +1.1% ± 7.0%, P = 0.002) and severe obesity (-6.5% ± 6.9% vs +1.1% ± 7.0%, P < 0.001), smaller improvements in PCS scores were seen in the obese (4.1 ± 7.4 vs 6.9 ± 7.6, P = 0.011) and severely obese (4.1 ± 7.6 vs 6.9 ± 7.6, P = 0.039) when compared with those with normal BMI. CONCLUSIONS Poorer psychosocial and cardiometabolic health at baseline coupled with smaller improvements in the PCS score suggest that patients with obesity and severe obesity will benefit from enhanced care in the CR setting.
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Affiliation(s)
- Tasuku Terada
- Exercise Physiology and Cardiovascular Health Lab, Division of Cardiac Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Daniele Chirico
- Exercise Physiology and Cardiovascular Health Lab, Division of Cardiac Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Heather E Tulloch
- Exercise Physiology and Cardiovascular Health Lab, Division of Cardiac Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, Ontario, Canada; Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Kyle Scott
- Exercise Physiology and Cardiovascular Health Lab, Division of Cardiac Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Éric Doucet
- School of Human Kinetics, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - Andrew L Pipe
- Exercise Physiology and Cardiovascular Health Lab, Division of Cardiac Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, Ontario, Canada; Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Jennifer L Reed
- Exercise Physiology and Cardiovascular Health Lab, Division of Cardiac Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, Ontario, Canada; Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada; School of Human Kinetics, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada.
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62
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Shariful Islam SM, Chow CK, Redfern J, Kok C, Rådholm K, Stepien S, Rodgers A, Hackett ML. Effect of text messaging on depression in patients with coronary heart disease: a substudy analysis from the TEXT ME randomised controlled trial. BMJ Open 2019; 9:e022637. [PMID: 30787075 PMCID: PMC6398727 DOI: 10.1136/bmjopen-2018-022637] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVE We aimed to evaluate the effects on depression scores of a lifestyle-focused cardiac support programme delivered via mobile phone text messaging among patients with coronary heart disease (CHD). DESIGN Substudy and secondary analysis of a parallel-group, single-blind randomised controlled trial of patients with CHD. SETTING A tertiary hospital in Sydney, Australia. INTERVENTION The Tobacco, Exercise and dieT MEssages programme comprised four text messages per week for 6 months that provided education, motivation and support on diet, physical activity, general cardiac education and smoking, if relevant. The programme did not have any specific mental health component. OUTCOMES Depression scores at 6 months measured using the Patient Health Questionnaire-9 (PHQ-9). Treatment effect across subgroups was measured using log-binomial regression model for the binary outcome (depressed/not depressed, where depressed is any score of PHQ-9 ≥5) with treatment, subgroup and treatment by subgroup interaction as fixed effects. RESULTS Depression scores at 6 months were lower in the intervention group compared with the control group, mean difference 1.9 (95% CI 1.5 to 2.4, p<0.0001). The frequency of mild or greater depressive symptoms (PHQ-9 scores≥5) at 6 months was 21/333 (6.3%) in the intervention group and 86/350 (24.6%) in the control group (relative risk (RR) 0.26, 95% CI 0.16 to 0.40, p<0.001). This proportional reduction in depressive symptoms was similar across groups defined by age, sex, education, body mass index, physical activity, current smoking, current drinking and history of depression, diabetes and hypertension. In particular, the rates of PHQ-9 ≥5 among people with a history of depression were 4/44 (9.1%) vs 29/62 (46.8%) in intervention vs control (RR 0.19, 95% CI 0.07 to 0.51, p<0.001), and were 17/289 (5.9%) vs 57/288 (19.8%) among others (RR 0.30, 95% CI 0.18 to 0.50, p<0.001). CONCLUSIONS Among people with CHD, a cardiac support programme delivered via mobile phone text messaging was associated with fewer symptoms of mild-to-moderate depression at 6 months in the treatment group compared with controls. TRIAL REGISTRATION NUMBER ACTRN12611000161921.
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Affiliation(s)
- Sheikh Mohammed Shariful Islam
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
- Westmead Applied Research Centre, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
- Institute for Physical Activity and Nutrition (IPAN), Deakin University, Melbourne, Victoria, Australia
| | - Clara K Chow
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
- Westmead Applied Research Centre, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
- Department of Cardiology, Westmead Hospital, Westmead, New South Wales, Australia
| | - Julie Redfern
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
- Westmead Applied Research Centre, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Cindy Kok
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Karin Rådholm
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
- Department of Medical and Health Sciences, Linköping University, Linkoping, Sweden
| | - Sandrine Stepien
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Anthony Rodgers
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
- Westmead Applied Research Centre, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Maree L Hackett
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
- School of Health, The University of Central Lancashire, Preston, UK
- School of Public Health, University of Sydney, Sydney, New South Wales, Australia
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63
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De Schutter A, Kachur S, Lavie CJ, Menezes A, Shum KK, Bangalore S, Arena R, Milani RV. Cardiac rehabilitation fitness changes and subsequent survival. EUROPEAN HEART JOURNAL. QUALITY OF CARE & CLINICAL OUTCOMES 2019; 4:173-179. [PMID: 29701805 DOI: 10.1093/ehjqcco/qcy018] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Accepted: 04/25/2018] [Indexed: 02/07/2023]
Abstract
Aims Assessments of cardiac rehabilitation (CR) in coronary heart disease (CHD) cohorts usually examine mortality in aggregate. This study examines the prognosis and characteristics of patients who enrolled and completed CR, stratified by their level of improvement in cardiorespiratory fitness (CRF) by examining the characteristics, outcomes and predictors of non-response in CRF (NonRes) compared with low-responders (LowRes) and high-responders (HighRes) after CR. Methods and results A total of 1171 CHD patients were referred for a phase II CR programme after therapy for an acute coronary syndrome, coronary artery bypass graft procedure or a percutaneous coronary intervention between 1 January 2000 and 30 June 2013 underwent cardiopulmonary exercise testing before and after CR. This cohort was divided according to absolute improvements in CRF (i.e. change in peak oxygen consumption expressed in mL⋅kg-1⋅min-1). Mortality was analysed after 0.5-13.4 years of follow-up (mean 6.4 years). A total of 266 (23%) subjects were NonRes. After adjustment for body mass index, age, gender, left ventricular ejection fraction and baseline CRF, NonRes, and LowRes had a statistically significant three-fold and two-fold higher mortality, respectively, when compared with HighRes (HighRes 8% vs. LowRes 17% vs. NonRes 22%; P < 0.001). Age, female gender, baseline CRF, hostility, and presence of diabetes were significant predictors of NonRes and LowRes. In addition, higher waist circumference was a predictor of NonRes. Conclusion Significant proportions of subjects referred to CR have no/low improvement in CRF and higher associated mortality risks. Greater attention is required to increase improvements in CRF following CR and avoid NonRes.
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Affiliation(s)
- Alban De Schutter
- John Ochsner Heart and Vascular Institute, Ochsner Clinical School, The University of Queensland School of Medicine, 1514 Jefferson Highway, New Orleans, LA, USA
| | - Sergey Kachur
- Department of Graduate Medical Education, Ocala Regional Medical Center, 1431 SW 1st Ave, Ocala, FL, USA
| | - Carl J Lavie
- John Ochsner Heart and Vascular Institute, Ochsner Clinical School, The University of Queensland School of Medicine, 1514 Jefferson Highway, New Orleans, LA, USA
| | - Arthur Menezes
- John Ochsner Heart and Vascular Institute, Ochsner Clinical School, The University of Queensland School of Medicine, 1514 Jefferson Highway, New Orleans, LA, USA
| | - Kelly K Shum
- John Ochsner Heart and Vascular Institute, Ochsner Clinical School, The University of Queensland School of Medicine, 1514 Jefferson Highway, New Orleans, LA, USA
| | - Sripal Bangalore
- Leon H. Charney Division of Cardiology, New York University School of Medicine, 550 First Avenue, New York, NY, USA
| | - Ross Arena
- Department of Physical Therapy and Integrative Physiology Laboratory, College of Applied Health Sciences, University of Illinois at Chicago, 1919 W Taylor St, Chicago, IL, USA
| | - Richard V Milani
- John Ochsner Heart and Vascular Institute, Ochsner Clinical School, The University of Queensland School of Medicine, 1514 Jefferson Highway, New Orleans, LA, USA
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64
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Haybar H, Shirani T, Pakseresht S. Evaluation of cardiac rehabilitation on functional capacity in depressed and nondepressed patients after angioplasty. J Family Med Prim Care 2019; 7:1304-1308. [PMID: 30613516 PMCID: PMC6293924 DOI: 10.4103/jfmpc.jfmpc_306_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Background: About 50% of the annual deaths in the developed countries are as a result of coronary artery disease. Several studies have shown the role of cardiac rehabilitation (CR) in improving cardiovascular indices including functional capacity, reducing depression, and mortality rates in cardiovascular patients. One of the psychological problems observed in cardiovascular patients is depression. Depression is one of the most important barriers to the treatment of heart attack, because it leads to denial of the disease and reduces the patient's motivation to continue treatment. Objectives: There are controversy information about the relationship between the effects of CR on these cases after angioplasty. The aim of this study was to evaluate the effect of CR on functional capacity in depressed and nondepressed patients after angioplasty in patients referred to Imam Khomeini, Ahvaz. Methods: This descriptive epidemiological study was performed on 54 patients referred for angioplasty. Functional capacity and depression score before and after participation in the 2-month CR program were evaluated in two groups of depressed and nondepressed patients. Data were analyzed by SPSS software, and the significance level was considered as P < 0.05. Results: The results of this study showed that in both the groups, the functional capacity after CR was significantly increased compared with the previous period (P < 0.001). Also in depressed patients, there was a significant decrease in depression scores (P < 0.001). Conclusion: Our findings showed improvement of functional capacity index following angioplasty, suggesting that patients participating in CR can be recommended by therapists. In addition, the results of this study showed that the participation in the CR program greatly affects the improvement of functional capacity and reduction in depression in patients undergoing angioplasty.
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Affiliation(s)
- Habib Haybar
- Atherosclerosis Research Center, Ahvaz, Iran.,Department of Cardiology, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Teimoor Shirani
- Atherosclerosis Research Center, Ahvaz, Iran.,Department of Cardiology, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Sirous Pakseresht
- Department of Psychiatry, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
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65
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Gathright EC, Busch AM, Buckley ML, Stabile L, DeAngelis J, Whited MC, Wu WC. Improvements in Depressive Symptoms and Affect During Cardiac Rehabilitation: PREDICTORS AND POTENTIAL MECHANISMS. J Cardiopulm Rehabil Prev 2019; 39:27-32. [PMID: 30142128 PMCID: PMC6309925 DOI: 10.1097/hcr.0000000000000346] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
PURPOSE Depression is indicative of poor prognosis in cardiac patients. Reductions in depression have been observed following cardiac rehabilitation (CR). Whether similar improvements in positive and negative affect occur is unknown. Greater understanding of depressive symptom and affect change is needed to enhance facilitators of emotional improvement after a cardiac event. METHODS Cardiac rehabilitation attendees (n = 637) completed measures of depressive symptoms, affect, health status, and social support at CR intake and discharge. Body mass index, metabolic equivalents, and blood pressure were also measured. Relationships between changes in psychosocial and physical health indicators and depressive symptoms, positive affect, and negative affect were examined. RESULTS From intake to discharge, depressive symptoms (d = 0.40, P < .001) and negative affect (d = 0.26, P < .001) decreased. Positive affect increased (d = 0.34, P < .001). In multivariate regression, predictors of depressive symptom reduction were increased vitality (β = -.26) and decreased bodily pain (β = -.08). Predictors of positive affect increase were increased vitality (β = .25), social support (β = .16), and physical role functioning (β = .09). Predictors of negative affect reduction were increased vitality (β = -.23) and social support (β = -.10). Changes in indicators of physical health were not related to depressive symptom or affect change. CONCLUSIONS Depressive symptom and affect improvements following CR were observed and most strongly associated with improvements in vitality and social support. Future research should explore how enhancement of these mechanisms may further improve depressive symptom and affect during CR.
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Affiliation(s)
- Emily C. Gathright
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, RI
- Department of Psychiatry and Human Behavior, Alpert Medical School, Brown University, Providence, RI
| | - Andrew M. Busch
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, RI
- Department of Psychiatry and Human Behavior, Alpert Medical School, Brown University, Providence, RI
| | - Maria L. Buckley
- Department of Psychiatry and Human Behavior, Alpert Medical School, Brown University, Providence, RI
- The Miriam Hospital, Providence RI
| | | | | | | | - Wen-Chih Wu
- The Miriam Hospital, Providence RI
- Department of Medicine, Alpert Medical School, Brown University, and Veterans Affairs Hospital, Providence, RI
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66
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Liu Y, Zhao Y, Tian J, Tong T, Gao R, Liu Y. The association of depression following percutanous coronary intervention with adverse cardiovascular events: Protocol for a systematic review and meta-analysis. Medicine (Baltimore) 2019; 98:e13952. [PMID: 30633173 PMCID: PMC6336612 DOI: 10.1097/md.0000000000013952] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2018] [Accepted: 12/11/2018] [Indexed: 12/03/2022] Open
Abstract
INTRODUCTION Percutanous coronary intervention (PCI) has been increasingly used for patients suffered from severe coronary artery disease. However, physical trauma and potential adverse events related to the procedure often result in detrimental psychological stress. Accumulating evidences have shown that depression is closely related to coronary artery disease. However, the association of depression following percutanous coronary intervention with adverse cardiovascular events is still unknown. OBJECTIVE This review is designed to assess the prognostic association of depression following PCI with adverse cardiac events. METHODS AND ANALYSIS The following databases will be searched, PubMed, the EMBASE, CINAHL and Web of Science of English-language publications from inception to 30 October 2018. Cross-referencing from retrieved studies will be conducted additionally, and observational studies were included. Two independent review authors will do the study selection on the basis of the study eligibility criteria. Extracted data will be used for quantitative and qualitative evidence synthesis as well as to assess methodological quality of studies using the Newcastle-Ottawa checklist. The primary objective of this review is adverse cardiac events, presented as a composition of myocardial infarction, repeat coronary revascularization, cardiac readmission, and cardiac death. The accumulated evidence is evaluated and graded according to Grading of Recommendations, Assessment, Development and Evaluation (GRADE). RESULTS AND CONCLUSIONS This review will explain the association of depression following percutanous coronary intervention with adverse cardiovascular events, and provide physicians with scientific evidence for psychological intervention in patients after PCI. PROSPERO REGISTRATION NUMBER CRD42018112486.
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Affiliation(s)
- Yanfei Liu
- Graduate School of Beijing University of Chinese Medicine
- Cardiovascular diseases center, Xiyuan hospital of China academy of Chinese medical sciences
- Institute of Clinical Pharmacology of Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing
| | - Yinke Zhao
- School of Chinese Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong, China
| | - Jinfan Tian
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Tiejun Tong
- Department of Mathematics, Hong Kong Baptist University, Kowloon Tong, Hong Kong, China
| | - Rui Gao
- Institute of Clinical Pharmacology of Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing
| | - Yue Liu
- Cardiovascular diseases center, Xiyuan hospital of China academy of Chinese medical sciences
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67
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Caccamo F, Saltini S, Marogna C, Sava V, Carlon R, Vignaga F. The positive impact of a four-week Cardiac Rehabilitation program on depression levels of cardiological patients. COR ET VASA 2018. [DOI: 10.1016/j.crvasa.2017.12.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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68
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Rosen M, Chan P, Saleem M, Herrmann N, Adibfar A, Andreazza A, Oh PI, Lanctôt KL. Longitudinal associations between 4-hydroxynonenal and depression in coronary artery disease patients. Psychiatry Res 2018; 270:219-224. [PMID: 30267986 DOI: 10.1016/j.psychres.2018.09.046] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Revised: 09/13/2018] [Accepted: 09/20/2018] [Indexed: 11/17/2022]
Abstract
Depressive symptoms in patients with coronary artery disease (CAD) attenuate the cardiovascular benefits of cardiac rehabilitation (CR). Given that oxidative stress may be an important mechanism underlying depression, this study aimed to understand the longitudinal relationship between lipid peroxidation markers and depression in CAD. Serum levels of early (lipid hydroperoxides, LPH) and late (4‑hydroxy‑2-nonenal, 4-HNE; 8-isoprotane, 8-ISO) lipid peroxidation markers were measured in 120 CAD patients undergoing CR. The Structured Clinical Interview for DSM Axis I Disorders - Depression Module (SCID) was used to diagnose depression at baseline and the Center for Epidemiological Studies Depression Scale (CES-D) was used to measure depressive symptom severity. Multivariate mixed models compared the trajectories of serum LPH, 4-HNE, and 8-ISO between depressed and non-depressed CAD patients undergoing 6 months of CR. Similar models evaluated the associations between serum LPH, 4-HNE, and 8-ISO and CES-D score over the course of CR. Serum 4-HNE decreased less in CAD patients with depression compared to those without. In addition, a decrease in 4-HNE concentrations was significantly associated with a decrease in CES-D scores over 6 months. These findings suggest that 4-HNE may be an important marker of depressive symptoms in CAD and may be involved in its progression.
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Affiliation(s)
- Michael Rosen
- Neuropsychopharmacology Research Group, Sunnybrook Health Sciences Centre, FG-08, 2075 Bayview Avenue, Toronto, Ontario M4N 3M5, Canada
| | - Parco Chan
- Neuropsychopharmacology Research Group, Sunnybrook Health Sciences Centre, FG-08, 2075 Bayview Avenue, Toronto, Ontario M4N 3M5, Canada; Department of Pharmacology and Toxicology, University of Toronto, Toronto, Ontario, Canada
| | - Mahwesh Saleem
- Neuropsychopharmacology Research Group, Sunnybrook Health Sciences Centre, FG-08, 2075 Bayview Avenue, Toronto, Ontario M4N 3M5, Canada
| | - Nathan Herrmann
- Neuropsychopharmacology Research Group, Sunnybrook Health Sciences Centre, FG-08, 2075 Bayview Avenue, Toronto, Ontario M4N 3M5, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Alexander Adibfar
- Neuropsychopharmacology Research Group, Sunnybrook Health Sciences Centre, FG-08, 2075 Bayview Avenue, Toronto, Ontario M4N 3M5, Canada; Department of Pharmacology and Toxicology, University of Toronto, Toronto, Ontario, Canada
| | - Ana Andreazza
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, Ontario, Canada
| | - Paul I Oh
- Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
| | - Krista L Lanctôt
- Neuropsychopharmacology Research Group, Sunnybrook Health Sciences Centre, FG-08, 2075 Bayview Avenue, Toronto, Ontario M4N 3M5, Canada; Department of Pharmacology and Toxicology, University of Toronto, Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada; Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada.
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69
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Hellem E, Bruusgaard KA. "When what is taken for granted disappears": women's experiences and perceptions after a cardiac event. Physiother Theory Pract 2018; 36:1107-1117. [PMID: 30474458 DOI: 10.1080/09593985.2018.1550829] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND AND PURPOSE On entering Cardiac Rehabilitation (CR), the female cardiac population shows greater fear of overexertion and sense of uncertainty than similarly affected men. The purpose of this study was to explore how women experienced the recovery process after a cardiac event and what impact the event had on bodily experiences. METHODS A qualitative, descriptive design, inspired by a phenomenological approach. Information was collected from 20 women through focus groups and individual in-depth interviews. The material was analyzed with a method of systematic text condensation. RESULTS The women's recovery after a CE could be a lonely and difficult process. Their own perspectives on what they need in the process is often overlooked, focus being on medical care and clinical recovery in the early phase. Returning home, the women suffered vulnerability, fragility, and insecurity, affecting well-being as well as activity levels. Lack of support and follow-up post-discharge seemed to disturb the progress of the recovery process. CONCLUSIONS Helping the women regain confidence in their new bodies, supporting the personal recovery processes, and bridging the gap between discharge and enrolling in a CR-program could reduce personal stress and withdrawal, thereby empowering more women to start and complete CR programs.
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Affiliation(s)
- Elisabet Hellem
- Faculty of Health Sciences, Department of Physiotherapy, Oslo Metropolitan University , Oslo, Norway
| | - Kari Anette Bruusgaard
- Faculty of Health Sciences, Department of Physiotherapy, Oslo Metropolitan University , Oslo, Norway
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70
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Caru M, Curnier D, Bousquet M, Kern L. Evolution of depression during rehabilitation program in patients with cardiovascular diseases. Disabil Rehabil 2018; 42:378-384. [PMID: 30299991 DOI: 10.1080/09638288.2018.1499824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Background: Cardiovascular diseases represent the main cause of death in the world. Rehabilitation through exercise is more and more used in cardiac patients. Given that these patients suffer from depressive symptoms, the risk of having recurrent cardiovascular problems increases. Thus, the aim of this study is to identify the effects of a rehabilitation program on the physiological and psychological parameters; with a particular attention on the depression scores between the scales.Methods: Twenty-eight cardiac patients participated in this study during a cardiovascular rehabilitation program. They are tested at their entry and at their exit with an evaluation of their physical fitness on an electromagnetic cycle ergometer and by four depression scales (Beck Depression Inventory, Hospital Anxiety and Depression Scale (HADS), Center for Epidemiologic Studies - Depression and Geriatric Depression Screening).Results: We observe that 21.4-50% of these patients have depressive symptoms, according to depression scales. The women have depression scores significantly higher than the men. The rehabilitation program improves their maximal oxygen consumption and their maximal aerobic power. At the end of the rehabilitation program, our analysis identifies a significant decrease in the depression score for the HADS. Regardless of the physical deconditioning level and of the improvement of the maximal oxygen consumption, our results show an effect of the rehabilitation program on the depression scores. No correlation between the physical deconditioning and the different depression scores is observed.Conclusions: This study shows the importance of measuring depression and its severity to improve the care of patients. Our findings show that between 21.4% and 50% of patients have depressive symptoms which challenges the categorical approach of the self-report depression scales.Implications for rehabilitationDepression and cardiovascular diseases have an impact on the patients' physical fitness.The rehabilitation program, primarily based around exercise, reduces depressive symptoms.As soon as cardiovascular diseases patients enter in a rehabilitation program, the depression should be measured by a psychologist.Taking into account the depressive symptoms of the patients as soon as their cardiac event occurs makes it possible to improve the care of patients.
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Affiliation(s)
- M Caru
- Department of Psychology, University of Paris Nanterre, Nanterre, France.,Department of Kinesiology, Laboratory of Pathophysiology of EXercise (LPEX), University of Montreal, Montreal, Canada.,Laboratoire EA 4430 - Clinique Psychanalyse Developpement (CliPsyD), University of Paris Ouest Nanterre La Defense, Nanterre, France
| | - D Curnier
- Department of Kinesiology, Laboratory of Pathophysiology of EXercise (LPEX), University of Montreal, Montreal, Canada.,University of Montreal Hospital Research Center (CRCHUM), Montreal, Canada
| | - M Bousquet
- Saint-Orens Cardiovascular and Pulmonary Rehabilitation Center, Saint-Orens-de-Gameville, France
| | - L Kern
- Laboratoire EA 4430 - Clinique Psychanalyse Developpement (CliPsyD), University of Paris Ouest Nanterre La Defense, Nanterre, France.,Department of Science and Technology of Physical Activities and Sports, University of Paris Nanterre, Nanterre, France.,Laboratoire EA 2931 - Centre de recherches sur le sport et le mouvement (CeRSM), UFR STAPS, University of Paris Nanterre, Nanterre, France
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71
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Affiliation(s)
- Carl J Lavie
- John Ochsner Heart and Vascular Institute, Ochsner Clinical School, The University of Queensland School of Medicine, New Orleans, Louisiana, USA
| | - Sergey Kachur
- John Ochsner Heart and Vascular Institute, Ochsner Clinical School, The University of Queensland School of Medicine, New Orleans, Louisiana, USA
| | - Richard V Milani
- John Ochsner Heart and Vascular Institute, Ochsner Clinical School, The University of Queensland School of Medicine, New Orleans, Louisiana, USA
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Vigorito C, Giallauria F. Loneliness, social isolation and risk of cardiovascular disease in the English Longitudinal Study of Ageing. Eur J Prev Cardiol 2018; 25:1384-1386. [PMID: 30086686 DOI: 10.1177/2047487318793456] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Carlo Vigorito
- Internal Medicine and Cardiac Rehabilitation, Department of Translational Medical Sciences, University of Naples Federico II, Italy
| | - Francesco Giallauria
- Internal Medicine and Cardiac Rehabilitation, Department of Translational Medical Sciences, University of Naples Federico II, Italy
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73
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Carlsen T, Salvesen Ø, Sui X, Lavie CJ, Blair SN, Wisløff U, Ernstsen L. Long-term Changes in Depressive Symptoms and Estimated Cardiorespiratory Fitness and Risk of All-Cause Mortality: The Nord-Trøndelag Health Study. Mayo Clin Proc 2018; 93:1054-1064. [PMID: 29625728 DOI: 10.1016/j.mayocp.2018.01.015] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Revised: 12/20/2017] [Accepted: 01/12/2018] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To assess the independent and combined associations of long-term changes in depressive symptoms (DSs) and estimated cardiorespiratory fitness (eCRF) with all-cause mortality. PARTICIPANTS AND METHODS This is a longitudinal cohort study of 15,217 middle-aged and older individuals attending both the second (from August 15, 1995, through June 18, 1997) and third (from October 3, 2006, through June 25, 2008) health surveys of the Nord-Trøndelag Health Study, Norway, and followed until December 31, 2014. Depressive symptoms were estimated using the validated Hospital Anxiety and Depression Scale, and a validated nonexercise model estimated eCRF. Hazard ratios (HRs) were computed using Cox regression. All-cause mortality was ascertained using the Norwegian Cause of Death Registry. RESULTS The mean age was 63.3±8.9 years, and 7932 (52.1%) were women. During the follow-up period of 7.1±1.1 years, 1157 participants (7.6%) died. Multivariable-adjusted analyses revealed that persistently low DSs were independently associated with a 28% risk reduction of all-cause mortality (HR, 0.72; 95% CI, 0.56-0.92; P=.008) as compared with persistently high DSs. Persistently high eCRF independently predicted a 26% lower risk of death (HR, 0.76; 95% CI, 0.66-0.88; P<.001) relative to low eCRF. Analyses of changes in DSs and eCRF revealed that persistently high eCRF combined with decreased or persistently low DSs decreased mortality risk by 49% (HR, 0.51; 95% CI, 0.28-0.91; P=.02) and 47% (HR, 0.53; 95% CI, 0.37-0.76, P=.001), respectively. CONCLUSION Maintaining low DSs and high eCRF was independently associated with a lower risk of all-cause mortality. The lowest mortality risk was observed for persistently high eCRF combined with decreased or persistently low DSs. These results emphasize the effect of preventing DSs and maintaining high CRF on long-term mortality risk, which is potentially important for long-term population health.
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Affiliation(s)
- Trude Carlsen
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway; K.G. Jebsen Center for Exercise in Medicine, Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Øyvind Salvesen
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Xuemei Sui
- Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia
| | - Carl J Lavie
- Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute, Ochsner Clinical School, The University of Queensland School of Medicine, New Orleans, LA
| | - Steven N Blair
- Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia
| | - Ulrik Wisløff
- K.G. Jebsen Center for Exercise in Medicine, Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway; School of Human Movement and Nutrition Sciences, University of Queensland, St Lucia, Australia
| | - Linda Ernstsen
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway.
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Guo Y, Bian J, Li Q, Leavitt T, Rosenberg EI, Buford TW, Smith MD, Vincent HK, Modave F. A 3-minute test of cardiorespiratory fitness for use in primary care clinics. PLoS One 2018; 13:e0201598. [PMID: 30059539 PMCID: PMC6066238 DOI: 10.1371/journal.pone.0201598] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2017] [Accepted: 05/15/2018] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Cardiorespiratory fitness (CRF) is the only major risk factor that is not routinely assessed in the clinical setting, for preventive medicine. A valid and practical CRF test is needed for use in the clinics. The objective of this study is to demonstrate the validity of a 3-minute squat test to assess CRF in primary care. METHODS A cross-sectional study in which the participants performed both the Ruffier squat test and the Balke maximal treadmill test. The study was conducted in a clinical setting from September 2016 to March 2017. We recruited a convenient sample of 40 adults between 18 and 64 years from the general U.S. population. Participants completed 30 squats in 45 seconds, paced by a metronome. Heart rate was measured at rest (P1), immediately after the test (P2), one minute after the test (P3). [Formula: see text] was measured using the Balke maximal treadmill fitness test. RESULTS Of the 40 participants, there were 18 men and 22 women. Mean age was 31.2 years (SD = 9.9). We found that the best [Formula: see text] predictors were HR features P1/height and (P2-P3)/age3. Our best-performing model using these two features predicted individuals' CRF levels with an adjusted R2 of 0.637, sensitivity of 0.79, and specificity of 0.56. CONCLUSIONS The study provided strong evidence for the validity of the squat test in the clinical setting. Further, the equation of our model along with [Formula: see text] normative tables provides an efficient and easy way to assess CRF in a primary care setting.
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Affiliation(s)
- Yi Guo
- Department of Health Outcomes and Biomedical Informatics, University of Florida, Gainesville, FL, United States of America
| | - Jiang Bian
- Department of Health Outcomes and Biomedical Informatics, University of Florida, Gainesville, FL, United States of America
| | - Qian Li
- Department of Health Outcomes and Biomedical Informatics, University of Florida, Gainesville, FL, United States of America
| | - Trevor Leavitt
- Department of Orthopaedics and Rehabilitation, University of Florida, Gainesville, FL, United States of America
| | - Eric I. Rosenberg
- Division of General Internal Medicine, Department of Medicine, University of Florida, Gainesville, FL, United States of America
| | - Thomas W. Buford
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States of America
| | - Megan D. Smith
- Department of Health Outcomes and Biomedical Informatics, University of Florida, Gainesville, FL, United States of America
| | - Heather K. Vincent
- Department of Orthopaedics and Rehabilitation, University of Florida, Gainesville, FL, United States of America
| | - François Modave
- Department of Health Outcomes and Biomedical Informatics, University of Florida, Gainesville, FL, United States of America
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Correlates of memory loss and depression among myocardial infarction patients in Al-Qassim, Saudi Arabia. J Saudi Heart Assoc 2018; 30:240-246. [PMID: 29983498 PMCID: PMC6026394 DOI: 10.1016/j.jsha.2018.04.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Revised: 03/20/2018] [Accepted: 04/18/2018] [Indexed: 11/21/2022] Open
Abstract
Background After myocardial infarction (MI), patients have an elevated risk for depression, which has a negative impact on morbidity and mortality for patients. As depression and memory function are associated, we examined them in the context of one another. Our objectives were to determine the proportion of patients with either depression only, memory loss only, or both depression and memory loss and to examine the correlates with each outcome. Methods This study was a cohort of 264 patients who had myocardial infarction. Data sources included medical records and phone interviews. Results The participants’ mean age was 62 ± 12.2 years and mean body mass index was 28.4 ± 5.8 kg/m2. Of the participants, 6.4% had memory loss alone, 23.17% had depression alone, and 6.1% had combined memory loss and depression. Activity level and poor health were significantly associated with depression only (p < 0.05). Poor health was significantly associated with combined memory loss and depression (p < 0.05). Conclusion Activity level and poor health were identified as correlates of depression as well as combined memory loss and depression. Future studies should aim to improve screening for depression among post-MI patients and develop appropriate interventions to raise the level of activity.
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Lavie CJ, Sui X, Milani RV. Emotional distress after myocardial infarction: Importance of cardiorespiratory fitness. Eur J Prev Cardiol 2018; 25:906-909. [DOI: 10.1177/2047487318770516] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/29/2023]
Affiliation(s)
- Carl J Lavie
- Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute, Ochsner Clinical School, The University of Queensland School of Medicine, USA
| | - Xuemei Sui
- Department of Exercise Science, University of South Carolina, USA
| | - Richard V Milani
- Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute, Ochsner Clinical School, The University of Queensland School of Medicine, USA
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Choo CC, Chew PKH, Lai SM, Soo SC, Ho CS, Ho RC, Wong RC. Effect of Cardiac Rehabilitation on Quality of Life, Depression and Anxiety in Asian Patients. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15061095. [PMID: 29843421 PMCID: PMC6025099 DOI: 10.3390/ijerph15061095] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Revised: 05/25/2018] [Accepted: 05/26/2018] [Indexed: 12/22/2022]
Abstract
This study explored the effect of cardiac rehabilitation on quality of life, depression, and anxiety in Asian patients in Singapore. Out of the 194 patients who were recruited into the study, 139 patients (71.6%) completed both the pre- and post-cardiac rehabilitation questionnaires. Their ages ranged from 28 to 80 (M = 56.66, SD = 8.88), and 103 patients (74.1%) were males and 21 patients (15.1%) were females. As hypothesized, there was a statistically significant difference between the pre- and post-cardiac rehabilitation scores on the combined dependent variables, F (4, 135) = 34.84, p < 0.001; Wilks' Lambda = 0.49; partial eta squared = 0.51. An inspection of the mean scores indicated that patients reported higher levels of physical and mental quality of life and lower levels of depression post-cardiac rehabilitation. The findings were discussed in regards to implications in cardiac rehabilitation in Singapore.
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Affiliation(s)
- Carol C. Choo
- College of Healthcare Sciences, James Cook University, Singapore 387380, Singapore;
- Correspondence: ; Tel.: +65-6709-3760
| | - Peter K. H. Chew
- College of Healthcare Sciences, James Cook University, Singapore 387380, Singapore;
| | - Shuet-Ming Lai
- National University Heart Centre, National University Health System, Singapore 119007, Singapore; (S.-M.L.); (R.C.W.)
| | - Shuenn-Chiang Soo
- Department of Psychological Medicine, National University of Singapore, Singapore 119007, Singapore; (S.-C.S.); (C.S.H.); (R.C.H.)
| | - Cyrus S. Ho
- Department of Psychological Medicine, National University of Singapore, Singapore 119007, Singapore; (S.-C.S.); (C.S.H.); (R.C.H.)
| | - Roger C. Ho
- Department of Psychological Medicine, National University of Singapore, Singapore 119007, Singapore; (S.-C.S.); (C.S.H.); (R.C.H.)
| | - Raymond C. Wong
- National University Heart Centre, National University Health System, Singapore 119007, Singapore; (S.-M.L.); (R.C.W.)
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Abstract
OBJECTIVE Depression is associated with an increased risk of mortality in patients with coronary heart disease (CHD). The risk may be reduced in patients who remit with adequate treatment, but few patients achieve complete remission. The purpose of this study was to identify the symptoms that persist despite aggressive treatment for depression in patients with CHD. METHODS One hundred twenty-five patients with stable CHD who met the DSM-IV criteria for a moderate-to-severe major depressive episode completed treatment with cognitive behavior therapy, either alone or combined with an antidepressant, for up to 16 weeks. Depression symptoms were assessed at baseline and after 16 weeks of treatment. RESULTS The M (SD) Beck Depression Inventory scores were 30.0 (8.6) at baseline and 8.3 (7.5) at 16 weeks. Seventy seven (61%) of the participants who completed treatment met remission criteria (Hamilton Rating Scale for Depression ≤7) at 16 weeks. Loss of energy and fatigue were the most common posttreatment symptoms both in remitters (n = 44, 57%; n = 34, 44.2%) and nonremitters (n = 42, 87.5%; n = 35, 72.9%). These symptoms were not predicted by baseline depression severity, anxiety, demographic, or medical variables including inflammatory markers or cardiac functioning or by medical events during depression treatment. CONCLUSIONS Fatigue and loss of energy often persist in patients with CHD even after otherwise successful treatment for major depression. These residual symptoms may increase the risks of relapse and mortality. Development of effective interventions for these persistent symptoms is a priority for future research.
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Norlund F, Lissåker C, Wallert J, Held C, Olsson EM. Factors associated with emotional distress in patients with myocardial infarction: Results from the SWEDEHEART registry. Eur J Prev Cardiol 2018; 25:910-920. [PMID: 29692223 PMCID: PMC6009178 DOI: 10.1177/2047487318770510] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Background Emotional distress, symptoms of depression and anxiety, is common among patients after a myocardial infarction (MI), and is associated with an increased risk of cardiovascular morbidity. Real world population data on factors associated with emotional distress in MI patients are scarce. The aim was to determine factors associated with incident emotional distress two and 12 months post MI respectively, and with persistent emotional distress, versus remittent, in patients <75 years old. Design This was a registry-based observational study. Methods Data from the national SWEDEHEART registry on 27,267 consecutive patients with a first-time MI, followed up at two and 12 months post MI (n = 22,911), were included in the analyses. Emotional distress was assessed with the EuroQol-5D questionnaire. Several candidate sociodemographic and clinical factors were analysed for their association with emotional distress in multivariate models. Results Symptoms of emotional distress were prevalent in 38% and 33% at two and 12 months post MI respectively. At both time-points, previous depression and/or anxiety, readmission for new cardiovascular event, female gender, younger age, born outside the neighbouring Nordic countries, smoking and being neither employed nor retired showed the strongest associations with emotional distress. Other factors related to medical history, the MI and its care or were only modestly associated with emotional distress. Persistent emotional distress was associated with younger age, female gender, smoking and being born outside of the Nordic countries. Conclusion Previous depression/anxiety, female gender, younger age, smoking, born outside of the Nordic countries, neither employed nor retired and readmission due to cardiovascular events were strongly associated with emotional distress post MI. These factors may be of relevance in tailoring rehabilitation programmes.
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Affiliation(s)
- Fredrika Norlund
- 1 Department of Women's and Children's Health, Clinical Psychology in Healthcare, Uppsala University, Sweden
| | - Claudia Lissåker
- 1 Department of Women's and Children's Health, Clinical Psychology in Healthcare, Uppsala University, Sweden
| | - John Wallert
- 1 Department of Women's and Children's Health, Clinical Psychology in Healthcare, Uppsala University, Sweden
| | - Claes Held
- 1 Department of Women's and Children's Health, Clinical Psychology in Healthcare, Uppsala University, Sweden.,2 Department of Medical Sciences: Cardiology, Uppsala Clinical Research Centre, Uppsala University, Sweden
| | - Erik Mg Olsson
- 1 Department of Women's and Children's Health, Clinical Psychology in Healthcare, Uppsala University, Sweden
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Association Between Depressive Symptoms and Exercise Capacity in Patients With Heart Disease: A META-ANALYSIS. J Cardiopulm Rehabil Prev 2018; 37:239-249. [PMID: 27428818 DOI: 10.1097/hcr.0000000000000193] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
PURPOSE Depression and reduced exercise capacity are risk factors for poor prognosis in patients with heart disease, but the relationship between the 2 is unclear. We assessed the relationship between depressive symptoms and exercise capacity in patients with heart disease. METHODS PubMed, Cochrane Library, Google Scholar, and ProQuest databases were browsed for English-language studies published from January 2000 to September 2013. Studies including adult patients with coronary artery disease, heart failure, congenital heart disease, and implantable cardioverter defibrillator, reporting correlation between a depression scale and exercise capacity ((Equation is included in full-text article.)O2peak, peak watts, estimated metabolic equivalents, and incremental shuttle walk test distance), as well as studies from which such a correlation could be calculated and provided by the authors, were included. Correlation coefficients (CCs) were converted to Fischer z values, and the analysis was performed using a random-effects model. Then, summary effects and 95% CIs were converted back to CCs. RESULTS Fifty-nine studies (25 733 participants) were included. Depressive symptoms were inversely correlated to exercise capacity (CC = -0.15; 95% CI, -0.17 to -0.12). Heterogeneity was significant (I = 64%; P < .001). There was no evidence of publication bias (Fail-safe N = 4681; Egger test: P = .06; Kendall test: P = .29). CONCLUSIONS Patients with heart disease and elevated depressive symptoms may tend to have reduced exercise capacity, and vice versa. This finding has clinical and prognostic implications. It also encourages research on the effects of improving depression on exercise capacity, and vice versa. The effects of potential moderators need to be explored.
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Severity of Depressive Symptoms Pre- and Postcardiac Rehabilitation: A COMPARISON AMONG PATIENTS IN BRAZIL, CANADA, COLOMBIA, THE UNITED STATES, AND VENEZUELA. J Cardiopulm Rehabil Prev 2018; 37:182-190. [PMID: 27182759 DOI: 10.1097/hcr.0000000000000189] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
PURPOSE Depression is 3 times more prevalent in the cardiac than the general population in high-income countries and is particularly high in middle-income countries. Comorbid depression is associated with twice the mortality after a cardiovascular event. The objectives of this study were to describe and compare depressive symptoms pre- and postcardiac rehabilitation (CR) among patients in high-income countries and middle-income countries in the Americas. METHODS The study design was prospective and observational. A convenience sample of CR participants completed the Patient Health Questionnaire-9 (PHQ-9) at CR intake and again at program discharge. Clinical data were extracted from medical charts. RESULTS There were 779 participants: 45 Brazilian (5.8% of sample), 214 Canadian (27.5%), 126 Colombian (16.2%), 309 American (39.7%), and 85 Venezuelan (10.9%). Pre-CR depressive symptoms significantly differed between countries (P < .05), with Colombian participants reporting higher scores than Canadians and Venezuelans. Total PHQ-9 scores significantly decreased during CR in Colombia (mean change =-2.33; P < .001), the United States (mean change =-1.12; P < .001), and Venezuela (mean change =-2.14; P < .001), but not in Brazil (where less psychosocial intervention was offered) or Canada (where pre-CR scores were low). Among the 102 (13.1%) participants with scores in the elevated range pre-CR, the mean change in PHQ-9 scores was -6.57 ± 1.09 and 40 (39.2%) participants no longer had elevated symptoms postprogram. CONCLUSIONS Depressive symptoms are variable among patients with CR in South and North American countries. CR programs incorporating psychosocial components can reduce these symptoms.
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Disparities in Cardiac Rehabilitation Among Individuals from Racial and Ethnic Groups and Rural Communities-A Systematic Review. J Racial Ethn Health Disparities 2018. [PMID: 29536369 DOI: 10.1007/s40615-018-0478-x] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
PURPOSE Despite the well-described benefits of cardiac rehabilitation (CR) on long-term health outcomes, CR is a resource that is underutilized by a significant proportion of patients that suffer from cardiovascular diseases. The main purpose of this study was to examine disparities in CR referral and participation rates among individuals from rural communities and racial and ethnic minority groups with coronary heart disease (CHD) when compared to the general population. METHODS A systematic search of standard databases including MedlLine, PubMed, and Cochrane databases was conducted using keywords that included cardiac rehabilitation, women, race and ethnicity, disparities, and rural populations. Twenty-eight clinical studies from 1990 to 2017 were selected and included 478,955 patients with CHD. RESULTS The majority of available clinical studies showed significantly lower CR referral and participation rates among individuals from rural communities, women, and racial and ethnic groups when compared to the general population. Similar to geographic region, socioeconomic status (SES) appears to directly impact the use of CR programs. Patients of lower SES have significantly lower CR referral and participation rates than patients of higher SES. CONCLUSIONS Data presented underscores the need for systematic referrals using electronic health records for patients with CHD in order to increase overall CR referral and participation rates of minority populations and other vulnerable groups. Educational programs that target healthcare provider biases towards racial and ethnic groups may help attenuate observed disparities. Alternative modalities such as home-based and internet-based CR programs may also help improve CR participation rates among vulnerable populations.
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Choi HY, Han HJ, Choi JW, Jung HY, Joa KL. Superior Effects of High-Intensity Interval Training Compared to Conventional Therapy on Cardiovascular and Psychological Aspects in Myocardial Infarction. Ann Rehabil Med 2018; 42:145-153. [PMID: 29560335 PMCID: PMC5852218 DOI: 10.5535/arm.2018.42.1.145] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2017] [Accepted: 06/20/2017] [Indexed: 12/01/2022] Open
Abstract
Objective To evaluate the effect of high-intensity interval training (HIIT) on psychological symptoms, activity states, and cardiovascular functions in patients with myocardial infarction (MI) of low and moderate risk stratification. Methods This prospective study randomly allocated 44 patients with MI to 18 sessions of HIIT or conventional moderate-intensity continuous training (MICT). Outcome measures were assessed at baseline and after 18 sessions. Results Post-exercise cardiovascular and functional states, maximal oxygen uptake (VO2max), metabolic equivalents (METs), 6-Minute Walking Test (6MWT), and Korean Activity Scale/Index (KASI) scores were significantly improved in the HIIT group compared to those in the MICT group after 18 exercise sessions. In particular, VO2max was significantly (p<0.005) improved in the HIIT group (7.58 mL/kg/min) compared to that in the MICT group (2.42 mL/kg/min). In addition, post-exercise psychological states (i.e., scores of Fatigue Severity Scale [FSS] and depression items of the Hospital Anxiety and Depression Scale [HADS_D]) were significantly improved in the HIIT group compared to those in the MICT group after 18 exercise sessions. HADS-D was improved by 1.89 in the HIIT group compared to decrement of 0.47 in the MICT group. FSS was improved by 6.38 in the HIIT group compared to decrement of 0.77 in the MICT group (p<0.005). Conclusion This study demonstrates that HIIT can improve cardiac function, psychological, and activity states in low and moderate risk MI patients. Compared to conventional MICT, HIIT can improve cardiovascular functions, activity states, depression, and fatigue more effectively.
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Affiliation(s)
- Ha-Yoon Choi
- Department of Physical and Rehabilitation Medicine, Inha University School of Medicine, Incheon, Korea
| | - Hee-Jun Han
- Department of Physical and Rehabilitation Medicine, Inha University School of Medicine, Incheon, Korea
| | - Ji-Won Choi
- Department of Physical and Rehabilitation Medicine, Inha University School of Medicine, Incheon, Korea
| | - Han-Young Jung
- Department of Physical and Rehabilitation Medicine, Inha University School of Medicine, Incheon, Korea
| | - Kyung-Lim Joa
- Department of Physical and Rehabilitation Medicine, Inha University School of Medicine, Incheon, Korea
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Shah NP, AbuHaniyeh A, Ahmed H. Cardiac Rehabilitation: Current Review of the Literature and Its Role in Patients with Heart Failure. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2018; 20:12. [PMID: 29478150 DOI: 10.1007/s11936-018-0611-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE OF REVIEW Cardiovascular (CV) disease remains the leading cause of death in the USA despite major advances in its treatment. With time, cardiac rehabilitation (CR) programs have gathered interest to help increase CV health and improve functional status after a CV event. Patients with heart failure have also been shown to benefit. In this review, we will evaluate the current literature showcasing the benefits of CR, particularly in patients with heart failure, discuss current limitations, and avenues for future investigation. RECENT FINDINGS Studies have shown that CR is beneficial in reducing morbidity, mortality, hospitalizations, activity-related symptoms, and increasing quality of life. Similar findings have also been observed in patients with heart failure who underwent CR in addition to optimal medical management. The positive effects of CR are well established in patients with coronary disease. Recent literature is also showing a trend to benefit in patients with heart failure, though much of the evidence is limited to patients with systolic dysfunction. Despite recommendations by professional societies, the use of CR remains underutilized. Further investigation is needed to better understand the impact of CR in heart failure. Moreover, strategies to increase CR utilization must be explored.
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Affiliation(s)
- Nishant P Shah
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, USA. .,, 9500 Euclid Avenue J3-6, Cleveland, OH, 44095, USA.
| | - Ahmed AbuHaniyeh
- Department of Internal Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Haitham Ahmed
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, USA
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Spatola CAM, Cappella EAM, Goodwin CL, Castelnuovo G, Cattivelli R, Rapelli G, Malfatto G, Facchini M, Mollica C, Molinari E. Cross-Lagged Relations Between Exercise Capacity and Psychological Distress During Cardiac Rehabilitation. Ann Behav Med 2018; 52:963-972. [DOI: 10.1093/abm/kax069] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Affiliation(s)
- Chiara A M Spatola
- Psychology Research Laboratory, Istituto Auxologico Italiano–Istituto di Ricovero e Cura a Carattere Scientifico, Milan, Italy
- Department of Psychology, Catholic University of Milan, Milan, Italy
| | - Emanuele A M Cappella
- Psychology Research Laboratory, Istituto Auxologico Italiano–Istituto di Ricovero e Cura a Carattere Scientifico, Milan, Italy
- Department of Psychology, Catholic University of Milan, Milan, Italy
| | | | - Gianluca Castelnuovo
- Psychology Research Laboratory, Istituto Auxologico Italiano–Istituto di Ricovero e Cura a Carattere Scientifico, Milan, Italy
- Department of Psychology, Catholic University of Milan, Milan, Italy
| | - Roberto Cattivelli
- Psychology Research Laboratory, Istituto Auxologico Italiano–Istituto di Ricovero e Cura a Carattere Scientifico, Milan, Italy
- Department of Psychology, Catholic University of Milan, Milan, Italy
| | - Giada Rapelli
- Psychology Research Laboratory, Istituto Auxologico Italiano–Istituto di Ricovero e Cura a Carattere Scientifico, Milan, Italy
- Department of Psychology, Catholic University of Milan, Milan, Italy
| | - Gabriella Malfatto
- Cardiology Division, Istituto Auxologico Italiano–Istituto di Ricovero e Cura a Carattere Scientifico, Milan, Italy
| | - Mario Facchini
- Cardiology Division, Istituto Auxologico Italiano–Istituto di Ricovero e Cura a Carattere Scientifico, Milan, Italy
| | - Chiara Mollica
- Cardiology Division, Istituto Auxologico Italiano–Istituto di Ricovero e Cura a Carattere Scientifico, Milan, Italy
| | - Enrico Molinari
- Psychology Research Laboratory, Istituto Auxologico Italiano–Istituto di Ricovero e Cura a Carattere Scientifico, Milan, Italy
- Department of Psychology, Catholic University of Milan, Milan, Italy
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Geulayov G, Novikov I, Dankner D, Dankner R. Symptoms of depression and anxiety and 11-year all-cause mortality in men and women undergoing coronary artery bypass graft (CABG) surgery. J Psychosom Res 2018; 105:106-114. [PMID: 29332626 DOI: 10.1016/j.jpsychores.2017.11.017] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Revised: 11/28/2017] [Accepted: 11/29/2017] [Indexed: 11/19/2022]
Abstract
OBJECTIVES To investigate the overall and the sex-specific association of preoperative and one-year post coronary artery bypass (CABG) surgery symptoms of depression and anxiety with 11-year all-cause mortality. METHODS A multicenter prospective study including 1125 patients who completed the Hospital Anxiety and Depression Scale (HADS) before an elective CABG surgery, of whom 850 completed the HADS again at one-year follow-up. Information on all-cause mortality was obtained through the Israeli Ministry of Internal Affairs Register. Multivariable adjusted Cox regression models quantified the association of symptoms of depression and anxiety with all-cause mortality. RESULTS Females comprised 22.7% of the cohort and were 5.5years older than males (70.0±9.3 and 64.4±10.3years, respectively). Controlling for sociodemographic and lifestyle factors, illness severity and post-surgery participation in cardiac rehabilitation, there was little evidence of an association between preoperative symptoms of depression and mortality in males [adjusted hazard ratio (aHRmales)=1.03, 95% CI 0.99-1.07, p=0.21] or females (aHRfemales=1.01, 95% CI 0.95-1.08, p=0.7). One-year postoperative symptoms of depression were associated with mortality in both males (aHRmales=1.05, 95% CI 1.01-1.10, p=0.03) and females (aHRfemales=1.07, 95% CI 1.02-1.13, p=0.013). Preoperative symptoms of anxiety were unrelated to mortality overall, but among females postoperative symptoms of anxiety predicted 11-year mortality (aHRfemales=1.07, 95% CI 1.00-1.14, p=0.049). There was no HADS by sex interaction (p for interaction=0.12-0.99). CONCLUSIONS Symptoms of depression one-year after surgery were positively related to mortality with little evidence for sex differences. These findings underscore the need for identification and treatment of psychiatric symptoms in patients undergoing CABG surgery. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov: NCT00356863.
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Affiliation(s)
- Galit Geulayov
- Unit for Cardiovascular Epidemiology, The Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Tel Hashomer, Israel; Department of Psychiatry, University of Oxford, Oxford, United Kingdom
| | - Ilya Novikov
- Unit for Biostatistics, The Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Tel Hashomer, Israel
| | | | - Rachel Dankner
- Unit for Cardiovascular Epidemiology, The Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Tel Hashomer, Israel; Division of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel-Aviv University, Ramat Aviv, Israel.
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87
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Gostoli S, Roncuzzi R, Urbinati S, Rafanelli C. Clinical and Subclinical Distress, Quality of Life, and Psychological Well-Being after Cardiac Rehabilitation. Appl Psychol Health Well Being 2017; 9:349-369. [PMID: 29171196 DOI: 10.1111/aphw.12098] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND The literature has outlined positive effects of cardiac rehabilitation (CR) on clinical psychological distress (DSM depression and anxiety) and quality of life (QoL). In cardiac settings, subclinical distress (subthreshold depressive and anxious symptomatology) and psychological well-being also showed relevant clinical implications. This research explored these psychological variables, their changes over time and cardiac course of CR patients. METHODS Clinical and subclinical distress, QoL, and psychological well-being were assessed in 108 consecutive patients undergoing CR, at baseline and up to 12 months after the program's completion. RESULTS Of all patients, 25.9 per cent showed high distress with a DSM diagnosis, 31.5 per cent high distress without a DSM diagnosis, and 42.6 per cent low distress. Comparing these subgroups, worse QoL and psychological well-being were significantly linked not only to clinical but also to subclinical distress. After CR completion, a significant reduction in DSM diagnoses was observed, whereas there were no positive effects on subclinical distress, QoL, and well-being, or when they initially occurred, they were not long lasting. Moreover, only the subgroup with high distress without a DSM diagnosis was at greater risk for adverse cardiac outcomes, showing worse scores on items of contentment. CONCLUSIONS These findings confirm data on clinical distress reduction after CR completion. However, a large amount of relevant subclinical distress remains and predicts adverse cardiac events.
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88
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Nordic walking for individuals with cardiovascular disease: A systematic review and meta-analysis of randomized controlled trials. Eur J Prev Cardiol 2017; 24:1938-1955. [DOI: 10.1177/2047487317738592] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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89
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Kachur S, Rahim F, Lavie CJ, Morledge M, Cash M, Dinshaw H, Milani R. Cardiac Rehabilitation and Exercise Training in the Elderly. CURRENT GERIATRICS REPORTS 2017. [DOI: 10.1007/s13670-017-0224-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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90
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Impact of cardiac rehabilitation and exercise training programs in coronary heart disease. Prog Cardiovasc Dis 2017; 60:103-114. [PMID: 28689854 DOI: 10.1016/j.pcad.2017.07.002] [Citation(s) in RCA: 104] [Impact Index Per Article: 14.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Accepted: 07/04/2017] [Indexed: 12/14/2022]
Abstract
Cardiovascular rehabilitation (CR) is the process of developing and maintaining an optimal level of physical, social, and psychological well-being in order to promote recovery from cardiovascular (CV) illness. It is a multi-disciplinary approach encompassing supervised exercise training, patient counseling, education and nutritional guidance that may also enhance quality of life. Beneficial CV effects may include improving coronary heart disease risk factors; particularly exercise capacity, reversing cardiac remodeling, and favorably modifying metabolism and systemic oxygen transport. We review the historical basis for contemporary CR, the indications and critical components of CR, as well as the potential salutary physiological and clinical effects of exercise-based CR.
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91
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Carney RM, Freedland KE. Depression in patients with coronary artery disease: a more significant problem than previously recognized? EUROPEAN HEART JOURNAL. QUALITY OF CARE & CLINICAL OUTCOMES 2017; 3:262-263. [DOI: 10.1093/ehjqcco/qcx019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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92
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Sui X, Ott J, Becofsky K, Lavie CJ, Ernstsen L, Zhang J, Blair SN. Cardiorespiratory Fitness and All-Cause Mortality in Men With Emotional Distress. Mayo Clin Proc 2017; 92:918-924. [PMID: 28499513 PMCID: PMC5524050 DOI: 10.1016/j.mayocp.2017.01.025] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Revised: 01/03/2017] [Accepted: 01/27/2017] [Indexed: 01/05/2023]
Abstract
OBJECTIVE Mental health and emotional disorders are often associated with higher mortality risk. Whether higher cardiorespiratory fitness (CRF) reduces the risk for all-cause mortality in individuals with emotional distress is not well known. PATIENTS AND METHODS Participants were 5240 men (mean age 46.5±9.5 years) with emotional distress (including depression, anxiety, thoughts of suicide, or a history of psychiatric or psychological counseling) who completed an extensive medical examination between 1987 and 2002, and were followed for all-cause mortality through December 31, 2003. Cardiorespiratory fitness was quantified as maximal treadmill exercise test duration and was grouped for analysis as low, moderate, and high. Cox proportional hazards regression was used to calculate hazard ratios (HRs) and 95% CIs. RESULTS During a median of 8.7 years (range, 1.0-16.9 years) and 46,217 person-years of follow-up, there were 128 deaths from any cause. Age- and examination year-adjusted all-cause mortality rates per 10,000 person-years according to low, moderate, and high CRF groups were 64.7 (95% CI, 44.9-89.3), 28.0 (95% CI, 23.8-31.5), and 19.6 (95% CI, 17.1-21.6) (trend P<.001) in men who reported any emotional distress. Overall, the multivariable-adjusted HRs and 95% CIs across incremental CRF categories were 1.00 (referent), 0.54 (0.32-0.90), and 0.47 (0.26-0.85), linear trend P =.03. CONCLUSION Among men with emotional distress, higher CRF is associated with lower risk of dying, independent of other clinical mortality predictors. Our findings underscore the importance of promoting physical activity to maintain a healthful level of CRF in individuals with emotional distress.
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Affiliation(s)
- Xuemei Sui
- Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia, SC
- Reprints and Correspondence: Xuemei Sui, MD, MPH, PhD, 921 Assembly Street, Columbia, SC 29208; Telephone: 803-777-3881; Fax: 803-777-2504;
| | - John Ott
- Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia, SC
- Reprints and Correspondence: Xuemei Sui, MD, MPH, PhD, 921 Assembly Street, Columbia, SC 29208; Telephone: 803-777-3881; Fax: 803-777-2504;
| | - Katie Becofsky
- Department of Kinesiology, University of Massachusetts Amherst, Amherst, MA
| | - Carl J. Lavie
- Department of Cardiovascular Diseases, John Ochsner Hearth and Vascular Institute, Ochsner Clinical School-The University of Queensland School of Medicine, New Orleans, LA
| | - Linda Ernstsen
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Jiajia Zhang
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC
| | - Steven N. Blair
- Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia, SC
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93
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Brinks J, Fowler A, Franklin BA, Dulai J. Lifestyle Modification in Secondary Prevention: Beyond Pharmacotherapy. Am J Lifestyle Med 2017; 11:137-152. [PMID: 30202327 PMCID: PMC6125029 DOI: 10.1177/1559827616651402] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Revised: 04/19/2016] [Accepted: 05/04/2016] [Indexed: 12/17/2022] Open
Abstract
Despite significant advances in medical technology and pharmacology, cardiovascular disease (CVD) remains a major contributor to health care expenses and the leading cause of death in the United States. Patients with established CVD and their health care providers are challenged with achieving cardiovascular risk reduction to decrease the likelihood of recurrent cardiovascular events. This "secondary prevention" can be achieved, in part, through adherence to prescribed pharmacotherapies that favorably modify major coronary risk factors (ie, hypertension, hypercholesterolemia, diabetes, and obesity). However, lifestyle modification can also be helpful in this regard, providing independent and additive benefits to the associated reductions in cardiovascular morbidity and mortality. Accordingly, physicians and other health care providers should routinely counsel their coronary patients to engage in structured exercise and increased lifestyle physical activity, consume a heart-healthy diet, quit smoking and avoid secondhand smoke, and purposefully address psychosocial stressors that may elevate cardiovascular risk. These lifestyle interventions, either as an adjunct to medication therapy or independently in those patients where medications may be poorly tolerated, cost prohibitive, or ineffective, can significantly decrease cardiovascular mortality and the risk of recurrent cardiac events.
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Affiliation(s)
- Jenna Brinks
- Jenna Brinks, MS, Manager, Preventive Cardiology and Cardiac Rehabilitation, William Beaumont Hospital, Beaumont Health Center, Cardiac Rehabilitation, 4949 Coolidge Highway, Royal Oak, MI 48073, USA; e-mail:
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94
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McMahon SR, Ades PA, Thompson PD. The role of cardiac rehabilitation in patients with heart disease. Trends Cardiovasc Med 2017; 27:420-425. [PMID: 28318815 DOI: 10.1016/j.tcm.2017.02.005] [Citation(s) in RCA: 144] [Impact Index Per Article: 20.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Accepted: 02/09/2017] [Indexed: 11/16/2022]
Abstract
Cardiac rehabilitation is a valuable treatment for patients with a broad spectrum of cardiac disease. Current guidelines support its use in patients after acute coronary syndrome, coronary artery bypass grafting, coronary stent placement, valve surgery, and stable chronic systolic heart failure. Its use in these conditions is supported by a robust body of research demonstrating improved clinical outcomes. Despite this evidence, cardiac rehabilitation referral and attendance remains low and interventions to increase its use need to be developed.
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Affiliation(s)
- Sean R McMahon
- Cardiology Unit and Cardiovascular Research Institute, Department of Medicine, Larner College of Medicine at the University of Vermont, Burlington, VT, USA.
| | - Philip A Ades
- Cardiology Unit and Cardiovascular Research Institute, Department of Medicine, Larner College of Medicine at the University of Vermont, Burlington, VT, USA
| | - Paul D Thompson
- Heart and Vascular Institute, Department of Medicine, Hartford HealthCare, Hartford, CT, USA
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95
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Compostella L, Lorenzi S, Russo N, Setzu T, Compostella C, Vettore E, Isabella G, Tarantini G, Iliceto S, Bellotto F. Depressive symptoms, functional measures and long-term outcomes of high-risk ST-elevated myocardial infarction patients treated by primary angioplasty. Intern Emerg Med 2017; 12:31-43. [PMID: 27401331 DOI: 10.1007/s11739-016-1504-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Accepted: 07/05/2016] [Indexed: 10/21/2022]
Abstract
The presence of major depressive symptoms is usually considered a negative long-term prognostic factor after an acute myocardial infarction (AMI); however, most of the supporting research was conducted before the era of immediate reperfusion by percutaneous coronary intervention. The aims of this study are to evaluate if depression still retains long-term prognostic significance in our era of immediate coronary reperfusion, and to study possible correlations with clinical parameters of physical performance. In 184 patients with recent ST-elevated AMI (STEMI), treated by immediate reperfusion, moderate or severe depressive symptoms (evaluated by Beck Depression Inventory version I) were present in 10 % of cases. Physical performance was evaluated by two 6-min walk tests and by a symptom-limited cardiopulmonary exercise test: somatic/affective (but not cognitive/affective) symptoms of depression and perceived quality of life (evaluated by the EuroQoL questionnaire) are worse in patients with lower levels of physical performance. Follow-up was performed after a median of 29 months by means of telephone interviews; 32 major adverse cardiovascular events (MACE) occurred. The presence of three vessels disease and low left ventricle ejection fraction are correlated with a greater incidence of MACE; only somatic/affective (but not cognitive/affective) symptoms of depression correlate with long-term outcomes. In patients with recent STEMI treated by immediate reperfusion, somatic/affective but not cognitive/affective symptoms of depression show prognostic value on long-term MACE. Depression symptoms are not predictors "per se" of adverse prognosis, but seem to express an underlying worse cardiac efficiency, clinically reflected by poorer physical performance.
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Affiliation(s)
- Leonida Compostella
- Preventive Cardiology and Rehabilitation, Inst. Codivilla-Putti, Via Codivilla, 1, 32043, Cortina d'Ampezzo, BL, Italy.
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padova, Italy.
| | - Sonia Lorenzi
- Preventive Cardiology and Rehabilitation, Inst. Codivilla-Putti, Via Codivilla, 1, 32043, Cortina d'Ampezzo, BL, Italy
| | - Nicola Russo
- Preventive Cardiology and Rehabilitation, Inst. Codivilla-Putti, Via Codivilla, 1, 32043, Cortina d'Ampezzo, BL, Italy
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padova, Italy
| | - Tiziana Setzu
- Preventive Cardiology and Rehabilitation, Inst. Codivilla-Putti, Via Codivilla, 1, 32043, Cortina d'Ampezzo, BL, Italy
| | - Caterina Compostella
- Department of Medicine, School of Emergency Medicine, University of Padua, Padova, Italy
| | - Elia Vettore
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padova, Italy
| | - Giambattista Isabella
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padova, Italy
| | - Giuseppe Tarantini
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padova, Italy
| | - Sabino Iliceto
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padova, Italy
| | - Fabio Bellotto
- Preventive Cardiology and Rehabilitation, Inst. Codivilla-Putti, Via Codivilla, 1, 32043, Cortina d'Ampezzo, BL, Italy
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padova, Italy
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96
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Kachur S, Menezes AR, De Schutter A, Milani RV, Lavie CJ. Significance of Comorbid Psychological Stress and Depression on Outcomes After Cardiac Rehabilitation. Am J Med 2016; 129:1316-1321. [PMID: 27480388 DOI: 10.1016/j.amjmed.2016.07.006] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Revised: 07/04/2016] [Accepted: 07/05/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND Depression is associated with increased mortality in stable coronary heart disease. Cardiac rehabilitation and exercise training has been shown to decrease depression, psychological stress, and mortality after a coronary heart disease event. The presence of depression at completion of cardiac rehabilitation and exercise training is associated with increased mortality. However, it is unknown if depression with comorbid psychological risk factors such as anxiety or hostility confers an additional mortality disadvantage. We evaluated the mortality effect of anxiety and hostility on depression after cardiac rehabilitation and exercise training. PATIENTS AND METHODS We studied 1150 patients with coronary heart disease following major coronary heart disease events who had completed formal cardiac rehabilitation and exercise training. Using Kellner questionnaires, stress levels were measured in 1 of 3 domains: anxiety, hostility, and depression (with an aggregated overall psychological stress score) and divided into 3 groups: nondepressed (n = 1072), depression alone (n = 18), and depression with anxiety or hostility (n = 60). Subjects were analyzed for all-cause mortality over 161 months of follow-up (mean 6.4 years) by National Death Index. RESULTS Depression after cardiac rehabilitation was not common (6.8%; mortality 20.8%) but when present, frequently associated with either anxiety or hostility (77% of depressed patients; mortality 22.0%). After adjustment for age, sex, ejection fraction, and baseline peak oxygen consumption, depression alone (hazard ratio [HR] 1.73, P = .04), as well as depression with comorbid psychological stress, was associated with higher mortality (HR 1.98, P = .03). Furthermore, our data showed an increased mortality when both anxiety and hostility were present in addition to depression after cardiac rehabilitation (HR 2.41, P = .04). CONCLUSIONS After cardiac rehabilitation, depression, when present, is usually associated with other forms of psychological stress, which confers additional mortality. More measures are needed to address psychological stress after cardiac rehabilitation.
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Affiliation(s)
- Sergey Kachur
- Graduate Medical Education Department, Ocala Regional Medical Center, Fla
| | - Arthur R Menezes
- Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute, Ochsner Clinical School - The University of Queensland School of Medicine, New Orleans, La
| | - Alban De Schutter
- Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute, Ochsner Clinical School - The University of Queensland School of Medicine, New Orleans, La
| | - Richard V Milani
- Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute, Ochsner Clinical School - The University of Queensland School of Medicine, New Orleans, La
| | - Carl J Lavie
- Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute, Ochsner Clinical School - The University of Queensland School of Medicine, New Orleans, La.
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97
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Korzeniowska-Kubacka I, Bilińska M, Piotrowska D, Stepnowska M, Piotrowicz R. The impact of exercise-only-based rehabilitation on depression and anxiety in patients after myocardial infarction. Eur J Cardiovasc Nurs 2016; 16:390-396. [DOI: 10.1177/1474515116682123] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Iwona Korzeniowska-Kubacka
- Department of Cardiac Rehabilitation and Noninvasive Electrocardiology, Institute of Cardiology, Warsaw, Poland
| | - Maria Bilińska
- Department of Arrhythmia, Institute of Cardiology, Warsaw, Poland
| | - Dorota Piotrowska
- Department of Cardiac Rehabilitation and Noninvasive Electrocardiology, Institute of Cardiology, Warsaw, Poland
| | - Monika Stepnowska
- Department of Cardiac Rehabilitation and Noninvasive Electrocardiology, Institute of Cardiology, Warsaw, Poland
| | - Ryszard Piotrowicz
- Department of Cardiac Rehabilitation and Noninvasive Electrocardiology, Institute of Cardiology, Warsaw, Poland
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98
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99
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Schopfer DW, Regan M, Heidenreich PA, Whooley MA. Depressive Symptoms, Cardiac Disease Severity, and Functional Status in Patients With Coronary Artery Disease (from the Heart and Soul Study). Am J Cardiol 2016; 118:1287-1292. [PMID: 27665203 DOI: 10.1016/j.amjcard.2016.07.062] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2016] [Revised: 07/15/2016] [Accepted: 07/15/2016] [Indexed: 11/16/2022]
Abstract
Patient-reported health status is highly valued as a key measure of health care quality, yet little is known about the extent to which it is determined by subjective perception compared with objective measures of disease severity. We sought to compare the associations of depressive symptoms and objective measures of cardiac disease severity with perceived functional status in patients with stable coronary artery disease. We assessed depressive symptoms, severity of cardiovascular disease, and perceived functional status in a cross-sectional study of 1,023 patients with stable coronary artery disease. We compared the extent to which patient-reported functional status was influenced by depressive symptoms versus objective measures of disease severity. We then evaluated perceived functional status as a predictor of subsequent cardiovascular hospitalizations during 8.8 years of follow-up. Patients with depressive symptoms were more likely to report poor functional status than those without depressive symptoms (44% vs 17%; p <0.001). After adjustment for traditional risk factors and co-morbid conditions, independent predictors of poor functional status were depressive symptoms (odds ratio [OR] 2.68, 95% confidence interval [CI] 1.89 to 3.79), poor exercise capacity (OR 2.30, 95% CI 1.65 to 3.19), and history of heart failure (OR 1.61, 95% CI 1.12 to 2.29). Compared with patients who had class I functional status, those with class II functional status had a 96% greater rate (hazard ratio 1.96, 95% CI 1.15 to 3.34) and those with class III or IV functional status had a 104% greater rate (hazard ratio 2.04, 95% CI 1.12 to 3.73) of hospitalization for HF, adjusted for baseline demographic characteristics, co-morbidities, cardiac disease severity, and depressive symptoms. In conclusion, depressive symptoms and cardiac disease severity were independently associated with patient-reported functional status. This suggests that perceived functional status may be as strongly influenced by depressive symptoms as it is by cardiovascular disease severity.
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Affiliation(s)
- David W Schopfer
- Department of Medicine, University of California San Francisco, San Francisco, California; Department of Medicine, San Francisco VA Medical Center, San Francisco, California.
| | - Mathilda Regan
- Department of Medicine, San Francisco VA Medical Center, San Francisco, California
| | - Paul A Heidenreich
- Department of Cardiology, Stanford University, Palo Alto, California; Department of Cardiology, VA Palo Alto Healthcare System, Palo Alto, California
| | - Mary A Whooley
- Department of Medicine, University of California San Francisco, San Francisco, California; Department of Medicine, San Francisco VA Medical Center, San Francisco, California
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100
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Rauch B, Davos CH, Doherty P, Saure D, Metzendorf MI, Salzwedel A, Völler H, Jensen K, Schmid JP. The prognostic effect of cardiac rehabilitation in the era of acute revascularisation and statin therapy: A systematic review and meta-analysis of randomized and non-randomized studies - The Cardiac Rehabilitation Outcome Study (CROS). Eur J Prev Cardiol 2016; 23:1914-1939. [PMID: 27777324 PMCID: PMC5119625 DOI: 10.1177/2047487316671181] [Citation(s) in RCA: 212] [Impact Index Per Article: 26.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Background The prognostic effect of multi-component cardiac rehabilitation (CR) in the modern era of statins and acute revascularisation remains controversial. Focusing on actual clinical practice, the aim was to evaluate the effect of CR on total mortality and other clinical endpoints after an acute coronary event. Design Structured review and meta-analysis. Methods Randomised controlled trials (RCTs), retrospective controlled cohort studies (rCCSs) and prospective controlled cohort studies (pCCSs) evaluating patients after acute coronary syndrome (ACS), coronary artery bypass grafting (CABG) or mixed populations with coronary artery disease (CAD) were included, provided the index event was in 1995 or later. Results Out of n = 18,534 abstracts, 25 studies were identified for final evaluation (RCT: n = 1; pCCS: n = 7; rCCS: n = 17), including n = 219,702 patients (after ACS: n = 46,338; after CABG: n = 14,583; mixed populations: n = 158,781; mean follow-up: 40 months). Heterogeneity in design, biometrical assessment of results and potential confounders was evident. CCSs evaluating ACS patients showed a significantly reduced mortality for CR participants (pCCS: hazard ratio (HR) 0.37, 95% confidence interval (CI) 0.20–0.69; rCCS: HR 0.64, 95% CI 0.49–0.84; odds ratio 0.20, 95% CI 0.08–0.48), but the single RCT fulfilling Cardiac Rehabilitation Outcome Study (CROS) inclusion criteria showed neutral results. CR participation was also associated with reduced mortality after CABG (rCCS: HR 0.62, 95% CI 0.54–0.70) and in mixed CAD populations. Conclusions CR participation after ACS and CABG is associated with reduced mortality even in the modern era of CAD treatment. However, the heterogeneity of study designs and CR programmes highlights the need for defining internationally accepted standards in CR delivery and scientific evaluation.
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Affiliation(s)
- Bernhard Rauch
- 1 Institut für Herzinfarktforschung Ludwigshafen, Germany
| | - Constantinos H Davos
- 2 Cardiovascular Research Laboratory, Biomedical Research Foundation, Academy of Athens, Greece
| | | | - Daniel Saure
- 4 Institute of Medical Biometry and Informatics (IMBI), University of Heidelberg, Germany
| | - Maria-Inti Metzendorf
- 5 Cochrane Metabolic and Endocrine Disorders Group, Institute of General Practice, University of Düsseldorf, Germany
| | - Annett Salzwedel
- 6 Centre of Rehabilitation Research, University of Potsdam, Germany
| | - Heinz Völler
- 6 Centre of Rehabilitation Research, University of Potsdam, Germany
| | - Katrin Jensen
- 4 Institute of Medical Biometry and Informatics (IMBI), University of Heidelberg, Germany
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