151
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Mavrides N, Nemeroff C. Treatment of depression in cardiovascular disease. Depress Anxiety 2013; 30:328-41. [PMID: 23293051 DOI: 10.1002/da.22051] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2012] [Revised: 12/06/2012] [Accepted: 12/08/2012] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Depression in patients with Cardiovascular Disease (CVD) is extremely common, with a prevalence of 17-47%, and is associated with increased risk of morbidity and mortality. Treatment of depression has been hypothesized to reduce cardiac mortality. Pharmacologic and psychotherapeutic interventions have been studied and appear to be safe and in some studies effective in reducing depressive symptoms in patients with cardiac disease. The impact on cardiac outcomes remains unclear. This review briefly focuses on the prevalence of depression in patients with CVD, the physiological links between depression and CVD, and largely is concerned with the clinical trials that seek to demonstrate efficacy and safety of antidepressant medications and psychotherapy in this patient population. METHODS PubMed and PsycINFO databases were searched through July 2012. Publications were included if they were in English, a review article, or a clinical trial in the CVD population with comorbid depression. The search was completed with key words of antidepressants, CVD, coronary artery syndrome, SSRIs, depression, treatment of depression, post-MI (where MI is myocardial infarction), major depression, and cardiac disease. Trials were included if the patients were above the age of 18, both male and female genders, and had cardiac comorbidity. No trials were excluded. RESULTS A total of 61 articles and/or book chapters were included. The majority were from North America and Europe. There were 7 clinical trials of tricyclic antidepressants (TCAs), one of TCAs and bupropion, and 10 trials of selective serotonin reuptake inhibitors (SSRIs). We also evaluated five trials involving psychotherapeutic techniques and/or collaborative care. CONCLUSIONS There is considerable evidence from randomized controlled clinical trials that antidepressants, especially SSRIs, are safe in the treatment of major depression in patients with CVD. Although efficacy has been demonstrated in some, but not all, trials for both antidepressants and certain psychotherapies, large, well-powered trials are urgently needed. There are virtually no data available on predictors of antidepressant response in depressed patients with CVD. Whether successful treatment of depression is associated with a reduction in cardiac morbidity and mortality remains unknown.
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Affiliation(s)
- Nicole Mavrides
- Department of Psychiatry and Behavioral Sciences, Center on Aging, Miller School of Medicine, University of Miami, Miami, Florida
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152
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153
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Correlation and Discrepancies Between Obesity by Body Mass Index and Body Fat in Patients With Coronary Heart Disease. J Cardiopulm Rehabil Prev 2013; 33:77-83. [DOI: 10.1097/hcr.0b013e31828254fc] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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154
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Kaminsky LA, Arena R, Beckie TM, Brubaker PH, Church TS, Forman DE, Franklin BA, Gulati M, Lavie CJ, Myers J, Patel MJ, Piña IL, Weintraub WS, Williams MA. The Importance of Cardiorespiratory Fitness in the United States: The Need for a National Registry. Circulation 2013; 127:652-62. [DOI: 10.1161/cir.0b013e31827ee100] [Citation(s) in RCA: 265] [Impact Index Per Article: 24.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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155
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Effect of exercise-based cardiac rehabilitation on multiple atherosclerotic risk factors in patients taking antidepressant medication. Am J Cardiol 2013. [PMID: 23178050 DOI: 10.1016/j.amjcard.2012.10.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Antidepressants might increase compliance with cardiovascular disease risk reduction interventions. However, antidepressants have been linked to deleterious metabolic effects. In the present multicenter study, we sought to determine whether patients who take antidepressants derive the expected benefits from cardiac rehabilitation in terms of improvements in multiple atherosclerotic risk factors. A cohort of 26,957 patients who had completed a baseline assessment before participating in an exercise-based cardiac rehabilitation program constituted the study population. The patients were stratified into 3 cohorts (i.e., nondepressed, depressed unmedicated, and depressed medicated) at baseline according to a self-reported history of depression and the current use of antidepressants. Risk factors were assessed at baseline and after ∼12 weeks of program participation. A self-reported history of depression was present at baseline in 5,172 patients (19.2%). Of these patients, 2,147 (41.5%) were taking antidepressants. Patients in the nondepressed cohort (49.4% completion) were more likely (p <0.001) to complete the exit assessment than patients in the depressed unmedicated (44.5% completion) or depressed medicated (43.5% completion) cohorts. Patients in all 3 cohorts who completed the exit assessment showed significant improvement in multiple risk factors. Moreover, the magnitude of improvement in blood pressure, serum lipids and lipoproteins, fasting glucose, weight, and body mass index was similar (p >0.05) in patients taking antidepressants and those who were not. In conclusion, our study is the first to show that antidepressants do not offset the average magnitude of improvement in multiple atherosclerotic risk factors that occurs with completion of a cardiac rehabilitation program.
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156
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Swift DL, Lavie CJ, Johannsen NM, Arena R, Earnest CP, O'Keefe JH, Milani RV, Blair SN, Church TS. Physical activity, cardiorespiratory fitness, and exercise training in primary and secondary coronary prevention. Circ J 2013; 77:281-92. [PMID: 23328449 DOI: 10.1253/circj.cj-13-0007] [Citation(s) in RCA: 219] [Impact Index Per Article: 19.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Substantial data have established that higher levels of physical activity (PA), participating in exercise training (ET), and higher overall cardiorespiratory fitness (CRF) provide considerable protection in the primary and secondary prevention of coronary heart disease (CHD). This review surveys data from epidemiological and prospective ET studies supporting the favorable impact of PA, ET, and CRF in primary CHD prevention. Clearly, cardiac rehabilitation and ET (CRET) programs have been underutilized for patients with CHD, particularly considering the effect of CRET on CHD risk factors, including CRF, obesity indices, fat distribution, plasma lipids, inflammation, and psychological distress, as well as overall morbidity and mortality. These data strongly support the routine referral of patients with CHD to CRET programs and that patients should be vigorously encouraged to attend CRET following major CHD events.
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Affiliation(s)
- Damon L Swift
- Department of Preventive Medicine, Pennington Biomedical Research Center, Louisiana State University System, Baton Rouge, LA, USA
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157
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Salzwedel A, Nosper M, Röhrig B, Linck-Eleftheriadis S, Strandt G, Völler H. Outcome quality of in-patient cardiac rehabilitation in elderly patients – identification of relevant parameters. Eur J Prev Cardiol 2012; 21:172-80. [DOI: 10.1177/2047487312469475] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Annett Salzwedel
- Department of Clinical Pharmacology and Toxicology, Charité (CBF) Berlin, Germany
- Centre of Rehabilitation Research, University Potsdam, Germany
- Klinik am See, Rehabilitation Centre for Internal Medicine, Rüdersdorf, Germany
| | - Manfred Nosper
- Medical Advisory Service of Statutory Health Insurance Funds in Rhineland-Palatinate, Alzey, Germany
| | - Bernd Röhrig
- Medical Advisory Service of Statutory Health Insurance Funds in Rhineland-Palatinate, Alzey, Germany
| | | | | | - Heinz Völler
- Department of Clinical Pharmacology and Toxicology, Charité (CBF) Berlin, Germany
- Centre of Rehabilitation Research, University Potsdam, Germany
- Klinik am See, Rehabilitation Centre for Internal Medicine, Rüdersdorf, Germany
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158
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Impact of cardiac rehabilitation exercise program on left ventricular diastolic function in coronary artery disease: a pilot study. Int J Cardiovasc Imaging 2012; 29:777-85. [PMID: 23160976 DOI: 10.1007/s10554-012-0152-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2012] [Accepted: 11/02/2012] [Indexed: 01/14/2023]
Abstract
Diastolic dysfunction is common in coronary artery disease (CAD). Exercise-based cardiac rehabilitation (CR) improves survival and quality of life but its effect on diastolic function is unclear. We sought to determine the impact of CR on diastolic function. We conducted a prospective study of CAD patients referred for 3-month outpatient CR, with pre-CR and post-CR echocardiograms. Twenty-five outpatients (age [mean ± SD], 66 ± 11 ! years; 7 [28 %] women; 22 [88 %] with recent acute coronary syndrome) were recruited upon beginning CR; one patient lacking follow-up was excluded from analysis. Before CR, patients' mean ejection fraction was 61 ± 7 %; regional wall motion score index was 1.18 ± 0.28; and left ventricular diastolic dysfunction existed in 21 (88 %). Of the 24 (96 %) patients with post-CR follow-up, 12 (50 %) had improved diastolic function, 2 of the 24 (8 %) had normal diastolic function throughout, nine (38 %) remained at the same grade, and one (4 %) had worsened diastolic function. The E/e' ratio improved significantly after CR (11.9 ± 4.5 vs. 10.7 ± 4.5; P = .048). Fourteen patients with normal or improved diastolic function had a greater decrease in left atrial volume index (-4.2 ± 6.3 vs. 1.6 ± 6.3 mL/m(2); P = .04) and a greater increase in peak untwisting rate (20 ± 36 vs. -42 ± 45 °/s; P = .003) than did patients with no diastolic improvement. Three-month, exercise-based CR was associated with improved left ventricular diastolic function in half of our patients. Further large studies are needed to clarify the effect of CR on diastolic dysfunction in patients with CAD.
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159
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Prevalence of Chest Pain, Depression, Somatization, Anxiety, Global Distress, and Substance Use among Cardiac and Pulmonary Rehabilitation Patients. PAIN RESEARCH AND TREATMENT 2012; 2012:138680. [PMID: 23213509 PMCID: PMC3503475 DOI: 10.1155/2012/138680] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/31/2012] [Accepted: 10/12/2012] [Indexed: 12/03/2022]
Abstract
Psychosocial factors of cardiovascular disease receive a preponderance of attention. Little attention is paid to psychosocial factors of pulmonary disease. This paper sought to describe psychosocial characteristics and to identify differences between cardiac and pulmonary patients entering a phase II rehabilitation program. Parametric and nonparametric analyses were conducted to examine scores on the Brief Symptom Inventory-18 (BSI-18) and the CAGE-D, administered at entry as standard clinical care. Participants were 163 cardiac and 63 pulmonary patients. Scores on the BSI-18 “chest pain” item indicated that more cardiac patients report chest pain than pulmonary patients. Among all subjects, chest pain ratings were positively related to anxiety, depression, and global distress. There were equivocal proportions of anxiety and somatization in patient groups. Pulmonary patients were more likely to endorse clinically significant levels of depression and global psychological distress than cardiac patients. Cardiac patients were significantly more likely to screen positively on the CAGE-D than pulmonary patients. Findings show a relationship between symptoms of chest pain and psychological distress. Despite equivalent proportions of anxiety and somatization between groups, a greater proportion of pulmonary patients reported symptoms of depression and global psychological distress, while more cardiac patients reported chest pain. Further research is needed to examine this paradigm.
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160
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Daniels KM, Arena R, Lavie CJ, Forman DE. Cardiac rehabilitation for women across the lifespan. Am J Med 2012; 125:937.e1-7. [PMID: 22748403 DOI: 10.1016/j.amjmed.2011.10.028] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2011] [Revised: 10/24/2011] [Accepted: 10/24/2011] [Indexed: 01/24/2023]
Abstract
Cardiac rehabilitation improves function and compliance and also reduces morbidity and mortality in female and male cardiovascular disease patients but remains significantly underutilized. At every age, and especially in their senior years, female cardiovascular disease patients are under-referred relative to men. Lack of standardized referral processes, misconceptions by physicians and patients, and idiosyncrasies of female pathophysiology contribute to this pattern. Moreover, confounding factors of age, socioeconomic status, and sex-specific roles and responsibilities exacerbate the problem. This review summarizes barriers to cardiac rehabilitation for female cardiac patients, and highlights opportunities for increased participation and benefit.
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Affiliation(s)
- Karla M Daniels
- New England Geriatric Research, Education, and Clinical Center, VA Boston Healthcare System, MA, USA
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161
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An Investigation of the Benefits of Stress Management Within a Cardiac Rehabilitation Population. J Cardiopulm Rehabil Prev 2012; 32:296-304. [DOI: 10.1097/hcr.0b013e318265e0eb] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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162
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Marano G, Traversi G, Romagnoli E, Catalano V, Lotrionte M, Abbate A, Biondi-Zoccai G, Mazza M. Cardiologic side effects of psychotropic drugs. J Geriatr Cardiol 2012; 8:243-53. [PMID: 22783311 PMCID: PMC3390089 DOI: 10.3724/sp.j.1263.2011.00243] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2011] [Revised: 09/22/2011] [Accepted: 09/29/2011] [Indexed: 02/05/2023] Open
Abstract
Psychotropic drugs can produce cardiovascular side effects associated with a degree of cardiotoxicity. The coexistence of a heart disease complicates the management of mental illness, can contribute to a reduced quality of life and a worse illness course. The co-occurrence of psychiatric disorders in cardiac patients might affect the clinical outcome and morbidity. Moreover, the complex underlying mechanism that links these two conditions remains unclear. This paper discusses the known cardiovascular complications of psychotropic drugs and analyzes the important implications of antidepressive treatment in patients with previous cardiac history.
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Affiliation(s)
- Giuseppe Marano
- Department of Neurosciences, Institute of Psychiatry, Università Cattolica del Sacro Cuore, Rome 00168, Italy
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163
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Abstract
BACKGROUND Depression is a common and important cause of morbidity and mortality worldwide. Depression is commonly treated with antidepressants and/or psychotherapy, but some people may prefer alternative approaches such as exercise. There are a number of theoretical reasons why exercise may improve depression. This is an update of an earlier review first published in 2009. OBJECTIVES To determine the effectiveness of exercise in the treatment of depression. Our secondary outcomes included drop-outs from exercise and control groups, costs, quality of life and adverse events. SEARCH METHODS We searched the Cochrane Depression, Anxiety and Neurosis (CCDAN) Review Group's Specialised Register (CCDANCTR), CENTRAL, MEDLINE, EMBASE, Sports Discus and PsycINFO for eligible studies (to February 2010). We also searched www.controlled-trials.com in November 2010. The CCDAN Group searched its Specialised Register in June 2011 and potentially eligible trials were listed as 'awaiting assessment'. SELECTION CRITERIA Randomised controlled trials in which exercise was compared to standard treatment, no treatment or a placebo treatment in adults (aged 18 and over) with depression, as defined by trial authors. We excluded trials of postnatal depression. DATA COLLECTION AND ANALYSIS For this update, two review authors extracted data on outcomes at the end of the trial. We used these data to calculate effect sizes for each trial using Hedges' g method and a standardised mean difference (SMD) for the overall pooled effect, using a random-effects model. Where trials used a number of different tools to assess depression, we included the main outcome measure only in the meta-analysis. We systematically extracted data on adverse effects and two authors performed the 'Risk of bias' assessments. MAIN RESULTS Thirty-two trials (1858 participants) fulfilled our inclusion criteria, of which 30 provided data for meta-analyses. Randomisation was adequately concealed in 11 studies, 12 used intention-to-treat analyses and nine used blinded outcome assessors. For the 28 trials (1101 participants) comparing exercise with no treatment or a control intervention, at post-treatment analysis the pooled SMD was -0.67 (95% confidence interval (CI) -0.90 to -0.43), indicating a moderate clinical effect. However, when we included only the four trials (326 participants) with adequate allocation concealment, intention-to-treat analysis and blinded outcome assessment, the pooled SMD was -0.31 (95% CI -0.63 to 0.01) indicating a small effect in favour of exercise. There was no difference in drop-outs between exercise and control groups. Pooled data from the seven trials (373 participants) that provided long-term follow-up data also found a small effect in favour of exercise (SMD -0.39, 95% CI -0.69 to -0.09). Of the six trials comparing exercise with cognitive behavioural therapy (152 participants), the effect of exercise was not significantly different from that of cognitive therapy. There were insufficient data to determine risks, costs and quality of life.Five potentially eligible studies identified by the search of the CCDAN Specialised Register in 2011 are listed as 'awaiting classification' and will be included in the next update of this review. AUTHORS' CONCLUSIONS Exercise seems to improve depressive symptoms in people with a diagnosis of depression when compared with no treatment or control intervention, however since analyses of methodologically robust trials show a much smaller effect in favour of exercise, some caution is required in interpreting these results.
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Affiliation(s)
- Jane Rimer
- University Hospitals Division, NHS Lothian, Edinburgh, Scotland, UK
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164
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Blumenthal JA, Smith PJ, Hoffman BM. Is Exercise a Viable Treatment for Depression? ACSMS HEALTH & FITNESS JOURNAL 2012; 16:14-21. [PMID: 23750100 DOI: 10.1249/01.fit.0000416000.09526.eb] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Depression is a common disorder that is associated with compromised quality of life, increased health care costs, and greater risk for a variety of medical conditions, particularly coronary heart disease. This review examines methods for assessing depression and discusses current treatment approaches. Traditional treatments include psychotherapy and antidepressant medications, but such treatments are not effective for all patients and alternative approaches have recently received increased attention, especially the use of aerobic exercise. This review examines evidence that exercise is effective in improving depressive symptoms among patients with major depression and offers practical suggestions for helping patients initiate and maintain exercise in their daily lives.
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Affiliation(s)
- James A Blumenthal
- Duke University Medical Center Department of Psychiatry and Behavioral Sciences Box 3119, DUMC South, Trent Drive Durham, NC 27710
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165
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Pavy B, Iliou MC, Vergès-Patois B, Brion R, Monpère C, Carré F, Aeberhard P, Argouach C, Borgne A, Consoli S, Corone S, Fischbach M, Fourcade L, Lecerf JM, Mounier-Vehier C, Paillard F, Pierre B, Swynghedauw B, Theodose Y, Thomas D, Claudot F, Cohen-Solal A, Douard H, Marcadet D. French Society of Cardiology guidelines for cardiac rehabilitation in adults. Arch Cardiovasc Dis 2012; 105:309-28. [DOI: 10.1016/j.acvd.2012.01.010] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2012] [Accepted: 01/23/2012] [Indexed: 12/18/2022]
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166
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Bäck M, Cider Å, Herlitz J, Lundberg M, Jansson B. The impact on kinesiophobia (fear of movement) by clinical variables for patients with coronary artery disease. Int J Cardiol 2012; 167:391-7. [PMID: 22305808 DOI: 10.1016/j.ijcard.2011.12.107] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2011] [Revised: 12/19/2011] [Accepted: 12/26/2011] [Indexed: 01/22/2023]
Abstract
BACKGROUND The impact on kinesiophobia (fear of movement) for patients with coronary artery disease (CAD) is not known. The aims were to describe the occurrence of kinesiophobia in patients with CAD, and to investigate the influence on kinesiophobia by clinical variables. MATERIALS AND METHODS In total, 332 patients, mean age, 65 ± 9.1 years diagnosed with CAD at a university hospital were included in the study. The Tampa Scale for Kinesiophobia Heart (TSK-SV Heart) was used to assess kinesiophobia. Comparisons between high versus low levels of kinesiophobia were measured for each variable. Binary logistic regression analyses were performed with a high level of kinesiophobia (TSK-SV Heart>37) as dependent variable, and with the observed variables as independent. The study had an exploratory, cross-sectional design. RESULTS A high level of kinesiophobia was found in 20% of the patients. The following variables decreased the odds ratio (OR) for a high level of kinesiophobia: Attending cardiac rehabilitation (yes vs no: -56.7%), level of physical activity (medium vs high: -80.8%), Short-Form 36: general health (-4.3%), physical functioning (-1.8%). Two variables increased the OR for a high level of kinesiophobia: heart failure as complication at hospital (yes vs no: 418.7%), anxiety (19.2%). Previous heart failure (yes vs no) was unexpectedly found to reduce kinesiophobia (-88.3%) due to suppression. CONCLUSIONS Several important clinical findings with impact on rehabilitation and prognosis for patients with CAD were found to be associated with a high level of kinesiophobia. Therefore, kinesiophobia needs to be considered in secondary prevention for patients with CAD.
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Affiliation(s)
- Maria Bäck
- Department of Physiotherapy and Occupational Therapy, Sahlgrenska University Hospital/Sahlgrenska, Gothenburg, Sweden.
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167
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Abstract
Depression is a risk factor for cardiac morbidity and mortality in patients with coronary heart disease, especially in those with a recent history of acute coronary syndrome. To improve risk stratification and treatment planning, it would be useful to identify the characteristics or subtypes of depression that are associated with the highest risk of cardiac events. This paper reviews the evidence concerning several putative depression subtypes and symptom patterns that may be associated with a high risk of morbidity and mortality in cardiac patients, including single-episode major depressive disorder, depression that emerges after a cardiac event, somatic symptoms of depression, and treatment-resistant depression.
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Affiliation(s)
- Robert M Carney
- Behavioral Medicine Center, Department of Psychiatry, Washington University School of Medicine, 4320 Forest Park Avenue, Suite 301, St. Louis, MO 63108, USA.
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168
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De Schutter A, Lavie CJ, Milani RV. Relative importance of comorbid psychological symptoms in patients with depressive symptoms following phase II cardiac rehabilitation. Postgrad Med 2012; 123:72-8. [PMID: 22104456 DOI: 10.3810/pgm.2011.11.2497] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND Previous research has demonstrated a high prevalence of psychological risk factors in patients with coronary heart disease (CHD), as well as the benefits of cardiac rehabilitation (CR) on psychological distress (PD) in showing its potential to improve mortality. We examined the impact of CR on mortality by anxiety and/or hostility symptoms in a large population of CHD patients with symptoms of depression following CR. PATIENTS AND METHODS We studied 538 patients with CHD who had completed formal CR. Using a validated questionnaire, symptoms of PD were obtained in 3 domains: anxiety, hostility, and depression. Subjects were divided into 3 groups: nondepressed (n = 502), depression alone (n = 14), and depression with anxiety and/or hostility (n = 22). A multivariate analysis for mortality was performed using a composite PD score (PD = sum of scores for anxiety, depression, and hostility). Subjects were analyzed by total mortality over 3-year follow-up by the National Death Index. RESULTS Mortality was significantly higher in the group with depressive symptoms compared with those without depressive symptoms (19% vs 3%; P < 0.0001). The comorbid depressed group had a slight trend toward higher mortality (22.7% [5 of 22 patients] vs 14% [2 of 14 patients]; P = 0.52). After adjusting for age, body mass index (BMI), ejection fraction, exercise tolerance, and sex using Cox proportional regression, the number of psychiatric comorbidities (ie, depression, anxiety, and hostility), as well as the sum of their raw scores, were significantly associated with increased mortality. However, this effect disappeared after adjusting for depression score (comorbidity hazard ratio, 1.7; 95% confidence interval, 1.0-2.8 vs comorbidity hazard ratio, 1.2; 95% confidence interval, 0.4-3.7 after adjusting). CONCLUSION Psychological distress is an independent predictor of mortality in stable CHD patients following CR; although anxiety and hostility may also modulate this effect, the overall impact seems to be mostly mediated through depression. Patients with persistent depression following CR may need further intervention.
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Affiliation(s)
- Alban De Schutter
- Department of Internal Medicine, Cleveland Clinic Florida, Weston, FL, USA
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169
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Vanhees L, Rauch B, Piepoli M, van Buuren F, Takken T, Börjesson M, Bjarnason-Wehrens B, Doherty P, Dugmore D, Halle M. Importance of characteristics and modalities of physical activity and exercise in the management of cardiovascular health in individuals with cardiovascular disease (Part III). Eur J Prev Cardiol 2012; 19:1333-56. [DOI: 10.1177/2047487312437063] [Citation(s) in RCA: 137] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
| | - B Rauch
- Centre for Ambulatory Cardiac and Angiologic Rehabilitation, Ludwigshafen, Germany
| | - M Piepoli
- Guglielmo da Saliceto Hospital, Piacenza, Italy
| | | | - T Takken
- University Medical Center Utrecht, Utrecht, The Netherlands
| | - M Börjesson
- Sahlgrenska University Hospital/Ostra, Goteborg, Sweden
| | | | | | - D Dugmore
- Wellness International Medical Centre, Stockport, UK
| | - M Halle
- University Hospital ‘Klinikum rechts der Isar’, Technische Universitaet Muenchen, Munich, Germany
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170
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Milani RV, Lavie CJ, Mehra MR, Ventura HO. Exercise training as treatment of depression in heart failure. J Am Coll Cardiol 2012; 59:291. [PMID: 22240137 DOI: 10.1016/j.jacc.2011.08.074] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2011] [Accepted: 08/02/2011] [Indexed: 10/14/2022]
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171
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Lavie CJ, Lee JH, Milani RV. Vitamin D and cardiovascular disease will it live up to its hype? J Am Coll Cardiol 2012; 58:1547-56. [PMID: 21958881 DOI: 10.1016/j.jacc.2011.07.008] [Citation(s) in RCA: 140] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2011] [Revised: 06/28/2011] [Accepted: 07/05/2011] [Indexed: 12/16/2022]
Abstract
Substantial evidence suggests that a large portion of the population have suboptimal levels of vitamin D, which may adversely affect the cardiovascular (CV) system, including increasing levels of parathyroid hormone, activating the renin-angiotensin-aldosterone system, and increasing insulin resistance, thus leading to hypertension and left ventricular hypertrophy, metabolic syndrome/diabetes mellitus, systemic inflammation, and increased risk of atherosclerosis and CV disease events. We review the evidence that vitamin D deficiency is associated with incident CV disease events, as well as evidence that vitamin D supplementation is associated with reduction in CV diseases. Although the current evidence has created substantial hype, randomized controlled trials are needed to determine whether routine vitamin D assessment and supplementation will improve CV outcomes.
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Affiliation(s)
- Carl J Lavie
- Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute, Ochsner Clinical School, University of Queensland School of Medicine, New Orleans, LA, USA.
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172
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Eliminating untimely deaths of women from heart disease: highlights from the Minnesota Women's Heart Summit. Am Heart J 2012; 163:39-48.e1. [PMID: 22172435 DOI: 10.1016/j.ahj.2011.09.020] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2011] [Accepted: 09/26/2011] [Indexed: 11/20/2022]
Abstract
Despite national campaigns to increase awareness and reduce cardiovascular disease (CVD) mortality in women, CVD remains their leading cause of death, annually killing more women than men. Although some progress has been made in our understanding and treatment of CVD in women, the causes, extent, and demographic trends of observed sex differences and disparities remain uncertain, and the growing burden of CVD and its risk factors among younger women is concerning. The Minnesota Women's Heart Summit was convened to chart a course to eliminate premature deaths of women from heart disease. The multidisciplinary summit was hosted by the Minneapolis Heart Institute, Minneapolis Heart Institute Foundation, University of Minnesota, and Mayo Clinic. Presentations highlighted sex-based differences in symptoms, treatment, and outcomes, and panel experts provided commentary. Invited faculty and summit participants worked in small-group sessions to identify strategies to dissolve barriers, improve primary and secondary prevention, and enhance women's care and outcomes. This report summarizes strategies identified during the conference to serve as springboards for more substantive future initiatives. These include, for example, standardized data collection and use of existing data sets to inform perspectives on sex-related cardiovascular issues, mandatory reporting of sex-specific data, and increased attention to underserved/high-risk women. Participants acknowledged that implementing these ideas would be challenging and recommended key priorities/next action steps such as providing services close to "point-of-life" rather than "point-of-care" and creation of policies and regulations so that resources and environmental modifications encouraging healthier lifestyle choices are promoted. Additional research is needed to improve identification, treatment, and health behaviors and to address continued lack of awareness, symptom recognition delays, barriers to care, and outcome disparities-especially in diverse populations.
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173
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Lavie CJ, Church TS, Milani RV, Earnest CP. Impact of physical activity, cardiorespiratory fitness, and exercise training on markers of inflammation. J Cardiopulm Rehabil Prev 2011; 31:137-45. [PMID: 21427600 DOI: 10.1097/hcr.0b013e3182122827] [Citation(s) in RCA: 138] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Physical activity and exercise training (ET) enhance overall cardiorespiratory fitness (ie, fitness), thus producing many benefits in the primary and secondary prevention of cardiovascular diseases. Substantial evidence also indicates that acute and chronic inflammation is involved in the development and progression of atherosclerosis and major cardiovascular events. The most commonly utilized marker of inflammation is C-reactive protein (CRP). In this review, we discuss the importance of inflammation, especially CRP, as a cardiovascular risk marker by reviewing an abundant cross-sectional and clinical intervention literature providing evidence that physical activity, enhanced fitness, and ET are inversely associated with CRP and that being overweight or obese is directly related with inflammation/CRP. Although we discuss the controversy regarding whether or not ET reduces CRP independent of weight loss, clearly physical activity, improved fitness, and ET are associated with reductions in inflammation and overall cardiovascular risk in both primary and secondary prevention.
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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.
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174
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Do antioxidant vitamins ameliorate the beneficial effects of exercise training on insulin sensitivity? J Cardiopulm Rehabil Prev 2011; 31:211-6. [PMID: 21427602 DOI: 10.1097/hcr.0b013e318211e3d8] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE Exercise training has numerous health benefits, and in patients with type 2 diabetes mellitus and metabolic syndrome, it can improve insulin sensitivity and glucose control. A recent publication suggests that antioxidant vitamins (C and E) block these effects on blood glucose. This investigation was undertaken to determine whether antioxidant vitamins ameliorate the beneficial effects of cardiac rehabilitation and exercise training (CRET) on insulin sensitivity and glucose metabolism in patients with coronary heart disease (CHD). METHODS We assessed CHD risk factors, including clinical indices of glucose metabolism, and evaluated the effects of exercise training in 315 patients with CHD with diabetes mellitus and/or metabolic syndrome before and after a 3-month program of CRET. Patients were divided into 2 groups based on self-reported antioxidant vitamin (vitamins C and E) consumption. RESULTS Both groups, 113 patients (36%) consuming vitamins (Vits group) and 202 patients (64%) who reported no vitamin use (no-Vits group) were statistically similar at baseline. Following CRET, patients improved exercise capacity (10%, P < .0001), fasting blood glucose (-7%, P < .0001), percent body fat (-3%, P = .0001), high-sensitive Creactive protein (-31%, P = .003), and various lipids and behavioral parameters, but there was no significant improvement in glycosylated hemoglobin following formal CRET. Both Vits group and no-Vits group achieved statistically similar improvements in fasting blood glucose, body fat, and other CHD risk factors. CONCLUSIONS Commercially available antioxidant supplements (mean dose of 400 IU of vitamin E and 500 mg of vitamin C) do not ameliorate the health benefits of exercise training, including fasting blood glucose, in CHD patients
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175
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Menezes AR, Lavie CJ, Milani RV, O'Keefe J, Lavie TJ. Psychological risk factors and cardiovascular disease: is it all in your head? Postgrad Med 2011; 123:165-76. [PMID: 21904099 DOI: 10.3810/pgm.2011.09.2472] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Psychological stress has been shown to be associated with cardiovascular disease. Over the past few decades, there has been an increasing interest in this relationship, leading to a growing pool of clinical and epidemiological data on the subject. Psychological stress has multiple etiologies, which include behavioral causes, acute events or stressors, and/or chronic stress. Cardiac rehabilitation and exercise therapy have been shown to provide protection in primary and secondary coronary heart disease prevention, as well as improve overall morbidity and mortality. In this article, we review the available data regarding the association between psychological stress and cardiovascular disease, as well as the impact of cardiac rehabilitation and exercise therapy on psychological stress-related cardiovascular events.
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Affiliation(s)
- 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 70121-2483, USA
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Franklin BA, Lavie CJ. Triggers of acute cardiovascular events and potential preventive strategies: prophylactic role of regular exercise. PHYSICIAN SPORTSMED 2011; 39:11-21. [PMID: 22293764 DOI: 10.3810/psm.2011.11.1934] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
There is now considerable evidence to suggest that acute myocardial infarction, sudden cardiac death, and stroke can be triggered by physical, chemical, and psychological stressors, including heavy physical exertion and situations that create heightened emotional stress. The increased risk appears to be largely limited to a susceptible subset of the population, that is, individuals with known or occult cardiovascular (CV) disease. In this article, we summarize the evidence supporting the impact of selected triggers in the pathogenesis of acute CV events, as well as the potential role of various preventive strategies, especially regular exercise training and improvements in cardiorespiratory fitness to reduce the CV risk imposed by various triggers.
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Affiliation(s)
- Barry A Franklin
- Department of Cardiology, Preventive Cardiology and Rehabilitation, William Beaumont Hospital, Royal Oak, MI, USA.
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177
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Savage PD, Sanderson BK, Brown TM, Berra K, Ades PA. Clinical research in cardiac rehabilitation and secondary prevention: looking back and moving forward. J Cardiopulm Rehabil Prev 2011; 31:333-41. [PMID: 21946418 PMCID: PMC3219833 DOI: 10.1097/hcr.0b013e31822f0f79] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Cardiac rehabilitation/secondary prevention (CR/SP) programs are considered standard of care and provide critically important resources for optimizing the care of cardiac patients. The objective of this article is to briefly review the evolution of CR/SP programs from a singular exercise intervention to its current, more comprehensive multifaceted approach. In addition, we offer perspective on critical concerns and suggest future research considerations to optimize the effectiveness and utilization of CR/SP program interventions.
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Affiliation(s)
- Patrick D. Savage
- Division of Cardiology, Cardiac Rehabilitation & Prevention, University of Vermont College of Medicine, Fletcher Allen Health Care, Burlington, VT
| | | | - Todd M. Brown
- Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, AL
| | - Kathy Berra
- Stanford Prevention Research Center, Stanford University School of Medicine, Palo Alto, CA
| | - Philip A. Ades
- Division of Cardiology, Cardiac Rehabilitation & Prevention, University of Vermont College of Medicine, Fletcher Allen Health Care, Burlington, VT
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178
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Dodd S, Malhi GS, Tiller J, Schweitzer I, Hickie I, Khoo JP, Bassett DL, Lyndon B, Mitchell PB, Parker G, Fitzgerald PB, Udina M, Singh A, Moylan S, Giorlando F, Doughty C, Davey CG, Theodoras M, Berk M. A consensus statement for safety monitoring guidelines of treatments for major depressive disorder. Aust N Z J Psychiatry 2011; 45:712-25. [PMID: 21888608 PMCID: PMC3190838 DOI: 10.3109/00048674.2011.595686] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVE This paper aims to present an overview of screening and safety considerations for the treatment of clinical depressive disorders and make recommendations for safety monitoring. METHOD Data were sourced by a literature search using MEDLINE and a manual search of scientific journals to identify relevant articles. Draft guidelines were prepared and serially revised in an iterative manner until all co-authors gave final approval of content. RESULTS Screening and monitoring can detect medical causes of depression. Specific adverse effects associated with antidepressant treatments may be reduced or identified earlier by baseline screening and agent-specific monitoring after commencing treatment. CONCLUSION The adoption of safety monitoring guidelines when treating clinical depression is likely to improve overall physical health status and treatment outcome. It is important to implement these guidelines in the routine management of clinical depression.
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Affiliation(s)
- Seetal Dodd
- School of Medicine, Deakin University, Geelong, Victoria, Australia; Department of Psychiatry, University of Melbourne, Victoria, Australia
| | - Gin S Malhi
- Discipline of Psychiatry, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - John Tiller
- Department of Psychiatry, University of Melbourne, Victoria, Australia
| | - Isaac Schweitzer
- Department of Psychiatry, University of Melbourne, Victoria, Australia
| | - Ian Hickie
- Brain and Mind Research Institute, University of Sydney, Sydney, New South Wales, Australia
| | - Jon Paul Khoo
- Toowong Specialist Clinic, Level 2/54 Jephson St, Toowong, Brisbane, Queensland, Australia
| | - Darryl L Bassett
- School of Psychiatry and Clinical Neurosciences, University of Western Australia, Australia; School of Medicine, University of Notre Dame, Western Australia, Australia
| | - Bill Lyndon
- Discipline of Psychiatry, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - Philip B Mitchell
- School of Psychiatry, University of New South Wales, Sydney, Australia; Black Dog Institute, Sydney, Australia
| | - Gordon Parker
- School of Psychiatry, University of New South Wales, Sydney, Australia; Black Dog Institute, Sydney, Australia
| | - Paul B Fitzgerald
- Monash Alfred Psychiatry Research Centre, Alfred and Monash University School of Psychology and Psychiatry, Melbourne, Victoria, Australia
| | - Marc Udina
- Bipolar Disorders Program, Clinical Institute of Neuroscience, Hospital Clinic, University of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Barcelona, Catalonia, Spain
| | - Ajeet Singh
- School of Medicine, Deakin University, Geelong, Victoria, Australia; Department of Psychiatry, University of Melbourne, Victoria, Australia
| | - Steven Moylan
- School of Medicine, Deakin University, Geelong, Victoria, Australia
| | | | - Carolyn Doughty
- Child and Family Specialty Service, Canterbury District Health Board; Department of Public Health and General Practice, University of Otago, Christchurch, New Zealand
| | | | - Michael Theodoras
- Eating Disorders Program, New Farm Clinic, Brisbane, Queensland, Australia
| | - Michael Berk
- School of Medicine, Deakin University, Geelong, Victoria; Department of Psychiatry, University of Melbourne, Victoria; Mental Health Research Institute, Parkville, Victoria; Orygen Youth Health Research Centre, Parkville, Victoria, Australia
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179
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Thieszen CL, Aldana SG, Mahoney ML, Vermeersch DA, Merrill RM, Diehl HA, Greenlaw RL, Englert H. The Coronary Health Improvement Project (CHIP) for Lowering Weight and Improving Psychosocial Health. Psychol Rep 2011; 109:338-52. [DOI: 10.2466/06.10.13.17.pr0.109.4.338-352] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This study extends previous research evaluating the association between the CHIP intervention, change in body weight, and change in psychological health. A randomized controlled health intervention study lasting 4 wk. was used with 348 participants from metropolitan Rockford, Illinois; ages ranged from 24 to 81 yr. Participants were assessed at baseline, 6 wk., and 6 mo. The Beck Depression Inventory (BDI) and three selected psychosocial measures from the SF–36 Health Survey were used. Significantly greater decreases in Body Mass Index (BMI) occurred after 6 wk. and 6 mo. follow-up for the intervention group compared with the control group, with greater decreases for participants in the overweight and obese categories. Significantly greater improvements were observed in BDI scores, role-emotional and social functioning, and mental health throughout follow-up for the intervention group. The greater the decrease in BMI through 6 wk., the better the chance of improved BDI score, role-emotional score, social functioning score, and mental health score, with odds ratios of 1.3 to 1.9. Similar results occurred through 6 mo., except the mental health variable became nonsignificant. These results indicate that the CHIP intervention significantly improved psychological health for at least six months afterwards, in part through its influence on lowering BMI.
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Affiliation(s)
| | | | | | | | - Ray M. Merrill
- Department of Health Science, Brigham Young University, Provo, Utah
| | - Hans A. Diehl
- Lifestyle Medicine Institute, Loma Linda, California
| | - Roger L. Greenlaw
- Swedish American Center for Complementary, Medicine, Rockford, Illinois
| | - Heike Englert
- Department of Nutrition, University of Applied Sciences, Muenster, Germany
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180
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181
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Lavie CJ, Milani RV. Cardiac rehabilitation and exercise training in secondary coronary heart disease prevention. Prog Cardiovasc Dis 2011; 53:397-403. [PMID: 21545925 DOI: 10.1016/j.pcad.2011.02.008] [Citation(s) in RCA: 90] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Substantial evidence indicates that increased levels of physical activity, exercise training, and overall cardiorespiratory fitness provide protection in primary and secondary coronary heart disease (CHD) prevention. Clearly, cardiac rehabilitation and exercise training (CRET) programs have been greatly underused in patients with CHD. We review the benefits of formal CRET programs on CHD risk factors including exercise capacity, obesity indices, plasma lipids, inflammation, and psychosocial stress as well as overall morbidity and mortality. These data support the fact that patients with CHD, especially after major CHD events, need routine referral to CRET programs; and patients should be vigorously encouraged to attend these valuable programs.
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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, New Orleans, LA 70121, USA.
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182
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Drozda J, Messer JV, Spertus J, Abramowitz B, Alexander K, Beam CT, Bonow RO, Burkiewicz JS, Crouch M, Goff DC, Hellman R, James T, King ML, Machado EA, Ortiz E, O'Toole M, Persell SD, Pines JM, Rybicki FJ, Sadwin LB, Sikkema JD, Smith PK, Torcson PJ, Wong JB. ACCF/AHA/AMA–PCPI 2011 Performance Measures for Adults With Coronary Artery Disease and Hypertension. Circulation 2011; 124:248-70. [DOI: 10.1161/cir.0b013e31821d9ef2] [Citation(s) in RCA: 90] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
| | - Joseph Drozda
- ACCF/AHA Representative. Recused from voting on Measures 3 and 4. American Geriatrics Society Representative. American Heart Association Consumer Council Representative. American Society of Health-System Pharmacists Representative. American Academy of Family Physicians Representative. ACCF/AHA Task Force on Performance Measures Liaison. American Association of Clinical Endocrinologists Representative. American Association of Cardiovascular and Pulmonary Rehabilitation Representative. Involved in
| | - Joseph V. Messer
- ACCF/AHA Representative. Recused from voting on Measures 3 and 4. American Geriatrics Society Representative. American Heart Association Consumer Council Representative. American Society of Health-System Pharmacists Representative. American Academy of Family Physicians Representative. ACCF/AHA Task Force on Performance Measures Liaison. American Association of Clinical Endocrinologists Representative. American Association of Cardiovascular and Pulmonary Rehabilitation Representative. Involved in
| | - John Spertus
- ACCF/AHA Representative. Recused from voting on Measures 3 and 4. American Geriatrics Society Representative. American Heart Association Consumer Council Representative. American Society of Health-System Pharmacists Representative. American Academy of Family Physicians Representative. ACCF/AHA Task Force on Performance Measures Liaison. American Association of Clinical Endocrinologists Representative. American Association of Cardiovascular and Pulmonary Rehabilitation Representative. Involved in
| | | | - Karen Alexander
- ACCF/AHA Representative. Recused from voting on Measures 3 and 4. American Geriatrics Society Representative. American Heart Association Consumer Council Representative. American Society of Health-System Pharmacists Representative. American Academy of Family Physicians Representative. ACCF/AHA Task Force on Performance Measures Liaison. American Association of Clinical Endocrinologists Representative. American Association of Cardiovascular and Pulmonary Rehabilitation Representative. Involved in
| | - Craig T. Beam
- ACCF/AHA Representative. Recused from voting on Measures 3 and 4. American Geriatrics Society Representative. American Heart Association Consumer Council Representative. American Society of Health-System Pharmacists Representative. American Academy of Family Physicians Representative. ACCF/AHA Task Force on Performance Measures Liaison. American Association of Clinical Endocrinologists Representative. American Association of Cardiovascular and Pulmonary Rehabilitation Representative. Involved in
| | - Robert O. Bonow
- ACCF/AHA Representative. Recused from voting on Measures 3 and 4. American Geriatrics Society Representative. American Heart Association Consumer Council Representative. American Society of Health-System Pharmacists Representative. American Academy of Family Physicians Representative. ACCF/AHA Task Force on Performance Measures Liaison. American Association of Clinical Endocrinologists Representative. American Association of Cardiovascular and Pulmonary Rehabilitation Representative. Involved in
| | - Jill S. Burkiewicz
- ACCF/AHA Representative. Recused from voting on Measures 3 and 4. American Geriatrics Society Representative. American Heart Association Consumer Council Representative. American Society of Health-System Pharmacists Representative. American Academy of Family Physicians Representative. ACCF/AHA Task Force on Performance Measures Liaison. American Association of Clinical Endocrinologists Representative. American Association of Cardiovascular and Pulmonary Rehabilitation Representative. Involved in
| | - Michael Crouch
- ACCF/AHA Representative. Recused from voting on Measures 3 and 4. American Geriatrics Society Representative. American Heart Association Consumer Council Representative. American Society of Health-System Pharmacists Representative. American Academy of Family Physicians Representative. ACCF/AHA Task Force on Performance Measures Liaison. American Association of Clinical Endocrinologists Representative. American Association of Cardiovascular and Pulmonary Rehabilitation Representative. Involved in
| | - David C. Goff
- ACCF/AHA Representative. Recused from voting on Measures 3 and 4. American Geriatrics Society Representative. American Heart Association Consumer Council Representative. American Society of Health-System Pharmacists Representative. American Academy of Family Physicians Representative. ACCF/AHA Task Force on Performance Measures Liaison. American Association of Clinical Endocrinologists Representative. American Association of Cardiovascular and Pulmonary Rehabilitation Representative. Involved in
| | - Richard Hellman
- ACCF/AHA Representative. Recused from voting on Measures 3 and 4. American Geriatrics Society Representative. American Heart Association Consumer Council Representative. American Society of Health-System Pharmacists Representative. American Academy of Family Physicians Representative. ACCF/AHA Task Force on Performance Measures Liaison. American Association of Clinical Endocrinologists Representative. American Association of Cardiovascular and Pulmonary Rehabilitation Representative. Involved in
| | | | - Marjorie L. King
- ACCF/AHA Representative. Recused from voting on Measures 3 and 4. American Geriatrics Society Representative. American Heart Association Consumer Council Representative. American Society of Health-System Pharmacists Representative. American Academy of Family Physicians Representative. ACCF/AHA Task Force on Performance Measures Liaison. American Association of Clinical Endocrinologists Representative. American Association of Cardiovascular and Pulmonary Rehabilitation Representative. Involved in
| | - Edison A. Machado
- ACCF/AHA Representative. Recused from voting on Measures 3 and 4. American Geriatrics Society Representative. American Heart Association Consumer Council Representative. American Society of Health-System Pharmacists Representative. American Academy of Family Physicians Representative. ACCF/AHA Task Force on Performance Measures Liaison. American Association of Clinical Endocrinologists Representative. American Association of Cardiovascular and Pulmonary Rehabilitation Representative. Involved in
| | | | | | | | - Jesse M. Pines
- ACCF/AHA Representative. Recused from voting on Measures 3 and 4. American Geriatrics Society Representative. American Heart Association Consumer Council Representative. American Society of Health-System Pharmacists Representative. American Academy of Family Physicians Representative. ACCF/AHA Task Force on Performance Measures Liaison. American Association of Clinical Endocrinologists Representative. American Association of Cardiovascular and Pulmonary Rehabilitation Representative. Involved in
| | - Frank J. Rybicki
- ACCF/AHA Representative. Recused from voting on Measures 3 and 4. American Geriatrics Society Representative. American Heart Association Consumer Council Representative. American Society of Health-System Pharmacists Representative. American Academy of Family Physicians Representative. ACCF/AHA Task Force on Performance Measures Liaison. American Association of Clinical Endocrinologists Representative. American Association of Cardiovascular and Pulmonary Rehabilitation Representative. Involved in
| | | | - Joanna D. Sikkema
- ACCF/AHA Representative. Recused from voting on Measures 3 and 4. American Geriatrics Society Representative. American Heart Association Consumer Council Representative. American Society of Health-System Pharmacists Representative. American Academy of Family Physicians Representative. ACCF/AHA Task Force on Performance Measures Liaison. American Association of Clinical Endocrinologists Representative. American Association of Cardiovascular and Pulmonary Rehabilitation Representative. Involved in
| | - Peter K. Smith
- ACCF/AHA Representative. Recused from voting on Measures 3 and 4. American Geriatrics Society Representative. American Heart Association Consumer Council Representative. American Society of Health-System Pharmacists Representative. American Academy of Family Physicians Representative. ACCF/AHA Task Force on Performance Measures Liaison. American Association of Clinical Endocrinologists Representative. American Association of Cardiovascular and Pulmonary Rehabilitation Representative. Involved in
| | - Patrick J. Torcson
- ACCF/AHA Representative. Recused from voting on Measures 3 and 4. American Geriatrics Society Representative. American Heart Association Consumer Council Representative. American Society of Health-System Pharmacists Representative. American Academy of Family Physicians Representative. ACCF/AHA Task Force on Performance Measures Liaison. American Association of Clinical Endocrinologists Representative. American Association of Cardiovascular and Pulmonary Rehabilitation Representative. Involved in
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Hasnain M, Vieweg WVR, Lesnefsky EJ, Pandurangi AK. Depression screening in patients with coronary heart disease: a critical evaluation of the AHA guidelines. J Psychosom Res 2011; 71:6-12. [PMID: 21665006 DOI: 10.1016/j.jpsychores.2010.10.009] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2010] [Revised: 10/21/2010] [Accepted: 10/21/2010] [Indexed: 10/18/2022]
Abstract
OBJECTIVE We lack evidence that routine screening for depression in patients with coronary heart disease (CHD) improves patient outcome. This lack has challenged the advisory issued by the American Heart Association (AHA) to routinely screen for depression in CHD patients. We assess the AHA advisory in the context of well-established criteria of screening for diseases. METHODS Using principles and criteria for screening developed by the World Health Organization and the United Kingdom National Screening Committee, we generated criteria pertinent to screening for depression in CHD patients. To find publications relevant to these criteria and clinical setting, we performed a broadly based literature search on "depression and CHD," supplemented by more focused literature searches. RESULTS Evidence for an association between depression and CHD is strong. Despite this, the AHA advisory has several limitations. It did not account for the complexity of the association between depression and CHD. It acknowledged there was no evidence that screening for depression leads to improved outcomes in cardiovascular populations but still recommended routine screening without providing an alternative evidence-based explanation. It ignored the paucity of literature about the safety and cost-effectiveness of routine screening for depression in CHD and failed to define the nature and extent of resources needed to implement such a program effectively. CONCLUSION We conclude that the AHA advisory is premature. We must first demonstrate the efficacy, safety, and cost-effectiveness of screening and define the resources necessary for its implementation and monitoring. Meanwhile, organizations representing cardiologists, psychiatrists, and general practitioners must coordinate efforts to manage depression and CHD through collaborative care, and work with the policy makers to develop the necessary infrastructure and services delivery system needed to optimize the outcome of depressed and at-risk-for-depression patients suffering from CHD.
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Affiliation(s)
- Mehrul Hasnain
- Department of Psychiatry, Memorial University of Newfoundland, St. John's, Newfoundland, Canada.
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185
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Drozda J, Messer JV, Spertus J, Abramowitz B, Alexander K, Beam CT, Bonow RO, Burkiewicz JS, Crouch M, Goff DC, Hellman R, James T, King ML, Machado EA, Ortiz E, O'Toole M, Persell SD, Pines JM, Rybicki FJ, Sadwin LB, Sikkema JD, Smith PK, Torcson PJ, Wong JB. ACCF/AHA/AMA-PCPI 2011 performance measures for adults with coronary artery disease and hypertension: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Performance Measures and the American Medical Association-Physician Consortium for Performance Improvement. J Am Coll Cardiol 2011; 58:316-36. [PMID: 21676572 DOI: 10.1016/j.jacc.2011.05.002] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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186
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Kurdyak PA, Chong A, Gnam WH, Goering P, Alter DA. Depression and self-reported functional status: impact on mortality following acute myocardial infarction. J Eval Clin Pract 2011; 17:444-51. [PMID: 20545794 DOI: 10.1111/j.1365-2753.2010.01446.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE The cause of increased post-AMI (acute myocardial infarction) mortality associated with depression remains poorly elucidated. The objective of this study was to examine the extent to which self-reported cardiac functional status accounted for depression-mortality associations following AMI. METHODS Using a prospective cohort design (n = 1941), the authors obtained self-reported measures of depression and developed profiles of the patients' pre-hospitalization cardiac risks, co-morbid conditions and drugs and revascularization procedures during or following index AMI hospitalization. To create these profiles, the patients' self-reports were retrospectively linked to no less than 12 years' worth of previous hospitalization data. Mortality rates 2 years after acute MI were examined with and without sequential risk adjustment for age, sex, income, cardiovascular risk, co-morbid conditions, selected process-of-care factors and self-reported cardiac functional status. RESULTS Depression was strongly correlated with 2-year mortality rate [crude hazard ratio (HR) of severe vs. minimal depression category, 2.48 (95% CI 1.20-5.15); P = 0.01]. However, after sequential adjustment for age, sex, income and self-reported cardiac functional status, the effect of depression was greatly attenuated [adjusted HR for severe vs. minimal depression category, 1.35 (95% CI 0.63-2.87); P = 0.44]. Cardiac risk factors and non-cardiac co-morbidities had negligible explanatory effect. DISCUSSION The main factor determining the increased mortality rate in depressed patients is self-reported cardiac functional status. Efforts to address increased mortality in depressed patients with cardiovascular illnesses should focus on processes that impact cardiac functional status.
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Affiliation(s)
- Paul A Kurdyak
- Centre for Addiction and Mental Health and Institute for Clinical Evaluative Sciences, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
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187
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Lavie CJ, Milani RV. Depression, autonomic function, and cardiorespiratory fitness: comment on Hughes, et al. (2010). Percept Mot Skills 2011; 112:319-21. [PMID: 21466105 DOI: 10.2466/02.06.15.20.pms.112.1.319-321] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
A recent paper by Hughes and colleagues suggested that dysfunction of the autonomic nervous system in depressed cardiac patients was partly explained by reduced physical activity and fitness. Other data demonstrate that exercise training and improvements in fitness not only lead to improvements in autonomic function in coronary patients but also reduce depression and depression-related increased mortality.
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Affiliation(s)
- Carl J Lavie
- Division of Cardiovascular Diseases, John Ochsner Heart & Vascular Institute, Ochsner Clinical School, The University of Queensland School of Medicine, New Orleans, LA 70121, USA.
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188
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Brinks J, Franklin BA. Suboptimal Exercise Compliance: Common Barriers to an Active Lifestyle and Counseling Strategies to Overcome Them. Am J Lifestyle Med 2011. [DOI: 10.1177/1559827610391971] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Adherence to a structured exercise program provides numerous health benefits, including reductions in body weight, fat stores, and blood pressure, improved blood glucose management and lipid/lipoprotein profiles, increased cardiorespiratory fitness, decreased cardiovascular risk, and enhanced psychosocial well-being. Despite these benefits, many individuals find it difficult to comply with a regular exercise program, predisposing them to an increased risk of chronic diseases and other medical conditions. Several barriers to participation in structured exercise, including time and financial constraints, psychosocial factors, and physical limitations, contribute to low adherence rates. Accordingly, health care professionals should use varied counseling strategies to assist their patients in overcoming habitual physical inactivity and our increasingly hypokinetic lifestyle. Motivational interviewing, goal setting, using stages of readiness to change, and identifying physical/psychosocial limitations are effective ways for helping patients to achieve the health and fitness benefits of structured exercise, increased lifestyle physical activity, or both.
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Affiliation(s)
- Jenna Brinks
- Department of Medicine, Division of Cardiology, Cardiac Rehabilitation and Exercise Laboratories, William Beaumont Hospital, Royal Oak, Michigan,
| | - Barry A. Franklin
- Department of Medicine, Division of Cardiology, Cardiac Rehabilitation and Exercise Laboratories, William Beaumont Hospital, Royal Oak, Michigan
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189
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Doering LV, Eastwood J. A Literature Review of Depression, Anxiety, and Cardiovascular Disease in Women. J Obstet Gynecol Neonatal Nurs 2011; 40:348-61. [DOI: 10.1111/j.1552-6909.2011.01236.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
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190
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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, New Orleans, LA 70121, USA.
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191
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Lavie CJ, Masvidal D, Milani RV, Franklin BA. Exercise training, cardiorespiratory fitness, and cardiovascular triggers. Am J Cardiol 2011; 107:1252. [PMID: 21457809 DOI: 10.1016/j.amjcard.2011.01.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2011] [Accepted: 01/11/2011] [Indexed: 11/16/2022]
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192
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193
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Kerins M, McKee G, Bennett K. Contributing Factors to Patient Non-Attendance at and Non-Completion of Phase III Cardiac Rehabilitation. Eur J Cardiovasc Nurs 2011; 10:31-6. [DOI: 10.1016/j.ejcnurse.2010.03.006] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2009] [Revised: 02/25/2010] [Accepted: 03/31/2010] [Indexed: 10/19/2022]
Affiliation(s)
- Mary Kerins
- Cardiac Rehabilitation Unit, CReST Directorate, St James's Hospital, James Street, Dublin 8, Ireland
| | - Gabrielle McKee
- School of Nursing and Midwifery, Trinity College Dublin, Ireland
| | - Kathleen Bennett
- Department of Pharmacology and Therapeutics, Trinity College Dublin, Ireland
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194
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Milani RV, Lavie CJ, Mehra MR, Ventura HO. Impact of exercise training and depression on survival in heart failure due to coronary heart disease. Am J Cardiol 2011; 107:64-8. [PMID: 21146688 DOI: 10.1016/j.amjcard.2010.08.047] [Citation(s) in RCA: 88] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2010] [Revised: 08/13/2010] [Accepted: 08/13/2010] [Indexed: 01/22/2023]
Abstract
Depression is prevalent in patients with heart failure (HF) and is associated with increased mortality. In patients with coronary heart disease (CHD) without HF, exercise training (ET) can effectively decrease depressive symptoms resulting in improved survival. We evaluated 189 patients with American College of Cardiology/American Heart Association stage C HF due to CHD (mean left ventricular ejection fraction 35 ± 10%) enrolled in a structured ET program from January 2000 to December 2008, including a group of 151 who completed the program and 38 patients with HF who dropped out of rehabilitation without ET. Depressive symptoms were assessed by standard questionnaire at baseline and after ET, and mortality was determined at a mean follow-up of 4.6 ± 2.6 years. Prevalence of depressive symptoms decreased by 40% after ET, from 22% to 13% (p <0.0001). Patients initially classified as depressed who remained depressed after ET had nearly a fourfold higher mortality than patients whose depression resolved after ET (43% vs 11%, p = 0.005). Depressed patients who completed ET had a 59% lower mortality (44% vs 18%, p <0.05) compared to depressed dropout subjects not undergoing ET. Survival benefits after ET were concentrated to those patients with depression who improved exercise capacity. In conclusion, depressive symptoms are prevalent in patients with HF and are associated with increased mortality. Structured ET is effective in decreasing depressive symptoms, a factor that correlates with improved long-term survival.
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Affiliation(s)
- Richard V Milani
- Department of Cardiology, Ochsner Clinic Foundation, Ochsner Clinical School-The University of Queensland School of Medicine, New Orleans, Louisiana, USA.
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195
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Shin NM, Choi J. Relationship Between Survivors' Perceived Health Status Following Acute Coronary Syndrome and Depression Symptoms During Early Recovery Phase. Asian Nurs Res (Korean Soc Nurs Sci) 2010; 4:174-84. [DOI: 10.1016/s1976-1317(11)60002-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2010] [Revised: 10/28/2010] [Accepted: 11/18/2010] [Indexed: 10/18/2022] Open
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196
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Pelle AJ, Pedersen SS, Erdman RAM, Kazemier M, Spiering M, van Domburg RT, Denollet J. Anhedonia is associated with poor health status and more somatic and cognitive symptoms in patients with coronary artery disease. Qual Life Res 2010; 20:643-51. [PMID: 21082266 PMCID: PMC3102190 DOI: 10.1007/s11136-010-9792-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/01/2010] [Indexed: 01/22/2023]
Abstract
Purpose The effectiveness of cardiac rehabilitation (CR) in patients with coronary artery disease (CAD) is moderated by negative emotions and clinical factors, but no studies evaluated the role of positive emotions. This study examined whether anhedonia (i.e. the lack of positive affect) moderated the effectiveness of CR on health status and somatic and cognitive symptoms. Methods CAD patients (n = 368) filled out the Hospital Anxiety and Depression Scale (HADS) to assess anhedonia at the start of CR, and the Short-Form Health Survey (SF-36) and the Health Complaints Scale (HCS) at the start of CR and at 3 months to assess health status and somatic and cognitive symptoms, respectively. Results Adjusting for clinical and demographic factors, health status improved significantly during the follow-up (F(1,357) = 10.84, P = .001). Anhedonic patients reported poorer health status compared with non-anhedonic patients, with anhedonia exerting a stable effect over time (F(1,358) = 34.80, P < .001). Somatic and cognitive symptoms decreased over time (F(1,358) = 3.85, P = .05). Anhedonics experienced more benefits in terms of somatic and cognitive symptoms over time (F(1,358) = 13.00, P < .001). Conclusion Anhedonic patients reported poorer health status and higher levels of somatic and cognitive symptoms prior to and after CR. Somatic and cognitive symptoms differed as a function of anhedonia over time, but health status did not. Anhedonia might provide a new avenue for secondary prevention in CAD.
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Affiliation(s)
- Aline J Pelle
- Center of Research on Psychology in Somatic Diseases (CoRPS), Department of Medical Psychology, Tilburg University, Tilburg, The Netherlands
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197
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Gary RA, Dunbar SB, Higgins MK, Musselman DL, Smith AL. Combined exercise and cognitive behavioral therapy improves outcomes in patients with heart failure. J Psychosom Res 2010; 69:119-31. [PMID: 20624510 PMCID: PMC4143390 DOI: 10.1016/j.jpsychores.2010.01.013] [Citation(s) in RCA: 136] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2009] [Revised: 01/15/2010] [Accepted: 01/15/2010] [Indexed: 12/24/2022]
Abstract
OBJECTIVE The purpose of this study is to compare the effectiveness of a combined 12-week home-based exercise (EX)/cognitive behavioral therapy (CBT) program (n=18) with CBT alone (n=19), EX alone (n=20), and with usual care (UC, n=17) in stable New York Heart Association Class II to III heart failure (HF) patients diagnosed with depression. METHODS Depressive symptom severity [Hamilton Rating Scale for Depression (HAM-D)], physical function [6-min walk test (6MWT)], and health-related quality of life (HRQOL) (Minnesota Living with Heart Failure Questionnaire) were evaluated at baseline (T1), after the 12-week intervention/control (T2), and following a 3-month telephone follow-up (T3). A repeated measures analysis of variance was used to determine group differences. Depression severity was dichotomized as minor (HAM-D, 11-14) and moderate-to-major depression (HAM-D, >/=15), and group intervention and control responses were also evaluated on that basis. RESULTS The greatest reduction in HAM-D scores over time occurred in the EX/CBT group (-10.4) followed by CBT (-9.6), EX (-7.3), and UC (-6.2), but none were statistically significant. The combined group showed a significant increase in 6-min walk distance at 24 weeks (F=13.5, P<.001). Among all groups with moderate-to-major depression, only those in CBT/EX had sustained lower HAM-D scores at 12 and 24 weeks, 6MWT distances were significantly greater at 12 (P=.018) and 24 (P=.013) weeks, and the greatest improvement in HRQOL also occurred. CONCLUSIONS Interventions designed to improve both physical and psychological symptoms may provide the best method for optimizing functioning and enhancing HRQOL in patients with HF.
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Affiliation(s)
- Rebecca A. Gary
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA 30322, USA,Corresponding author. Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA 30322, USA. Tel.: +1 404 727 0537; fax: +1 404 727 9382., (R.A. Gary)
| | - Sandra B. Dunbar
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA 30322, USA
| | - Melinda K. Higgins
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA 30322, USA
| | | | - Andrew L. Smith
- Department of Cardiology, School of Medicine, Emory University, Atlanta, GA 30322, USA
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198
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Beckie TM, Beckstead JW, Schocken DD, Evans ME, Fletcher GF. The effects of a tailored cardiac rehabilitation program on depressive symptoms in women: A randomized clinical trial. Int J Nurs Stud 2010; 48:3-12. [PMID: 20615504 DOI: 10.1016/j.ijnurstu.2010.06.005] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2010] [Revised: 06/03/2010] [Accepted: 06/09/2010] [Indexed: 12/25/2022]
Abstract
BACKGROUND Depression is known to co-occur with coronary heart disease (CHD). Depression may also inhibit the effectiveness of cardiac rehabilitation (CR) programs by decreasing adherence. Higher prevalence of depression in women may place them at increased risk for non-adherence. OBJECTIVE To assess the impact of a modified, stage-of-change-matched, gender-tailored CR program for reducing depressive symptoms among women with CHD. METHODS A two-group randomized clinical trial compared depressive symptoms of women in a traditional 12-week CR program to those completing a tailored program that included motivational interviewing guided by the Transtheoretical Model of behavior change. Women in the experimental group also participated in a gender-tailored exercise protocol that excluded men. The Center for Epidemiological Studies Depression (CES-D) Scale was administered to 225 women at baseline, post-intervention, and at 6-month follow-up. Analysis of Variance was used to compare changes in depression scores over time. RESULTS Baseline CES-D scores were 17.3 and 16.5 for the tailored and traditional groups, respectively. Post-intervention mean scores were 11.0 and 14.3; 6-month follow-up scores were 13.0 and 15.2, respectively. A significant group by time interaction was found for CES-D scores (F(2, 446)=4.42, p=.013). Follow-up tests revealed that the CES-D scores for the traditional group did not differ over time (F(2, 446)=2.00, p=.137). By contrast, the tailored group showed significantly decreased CES-D scores from baseline to post-test (F(1, 223)=50.34, p<.001); despite the slight rise from post-test to 6-month follow-up, CES-D scores remained lower than baseline (F(1, 223)=19.25, p<.001). CONCLUSION This study demonstrated that a modified, gender-tailored CR program reduced depressive symptoms in women when compared to a traditional program. To the extent that depression hinders CR adherence, such tailored programs have potential to improve outcomes for women by maximizing adherence. Future studies should explore the mechanism by which such programs produce benefits.
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199
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Abstract
Depression and heart disease affect millions of people worldwide. Studies have shown that depression is a significant risk factor for new heart disease and that it increases morbidity and mortality in established heart disease. Many hypothesized and studied mechanisms have linked depression and heart disease, including serotonergic pathway and platelet dysfunction, inflammation, autonomic nervous system and hypothalamic-pituitary-adrenal axis imbalance, and psychosocial factors. Although the treatment of depression in cardiac patients has been shown to be safe and modestly efficacious, it has yet to translate into reduced cardiovascular morbidity and mortality. Understanding the impact and mechanisms behind the association of depression and heart disease may allow for the development of treatments aimed at altering the devastating consequences caused by these comorbid illnesses.
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Affiliation(s)
- Yelizaveta Sher
- Department of Psychiatry and Behavioral Sciences, Stanford University Medical Center, 401 Quarry Road, Suite 2336, Stanford, CA 94305, USA
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200
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Summers KM, Martin KE, Watson K. Impact and clinical management of depression in patients with coronary artery disease. Pharmacotherapy 2010; 30:304-22. [PMID: 20180613 DOI: 10.1592/phco.30.3.304] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
The rates of major adverse coronary events, including recurrent ischemic events and death, in patients with coronary artery disease (CAD) have been shown to be significantly increased in patients with depression. In addition, health care costs are higher and health-related quality of life is lower in depressed patients with CAD. Several pathophysiologic mechanisms have been proposed for the association of increased events seen in this population. Studies have focused on antidepressants (specifically, selective serotonin reuptake inhibitors and mirtazapine), psychotherapy (cognitive behavioral therapy and interpersonal psychotherapy), and a wide range of other nonpharmacologic interventions. Pharmacologic and nonpharmacologic treatments are known to improve depressive symptoms in patients with CAD, but their effects on outcomes such as mortality and hospital admissions remain controversial. If treatment of depression is warranted, strategies should include sertraline or citalopram, with or without cognitive behavioral therapy, based on the known efficacy and safety of the drugs in this population. Nonpharmacologic therapy such as aerobic exercise has been shown to improve not only depression but also cardiovascular health. When selecting an appropriate antidepressant, clinicians should consider their patients' comorbid conditions and the potential for drug interactions, and treatment should be frequently monitored. Screening for depression in patients with cardiac disease should be instituted on a routine basis by using either case-finding or symptom-triggered approaches. Based on the high prevalence of depression and its known adverse effects in patients with CAD, future research is needed to help determine the role of antidepressants and nonpharmacologic strategies in improving outcomes in patients with both comorbidities.
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Affiliation(s)
- Kelly M Summers
- Department of Pharmacy Practice and Science, School of Pharmacy, University of Maryland, Baltimore, Maryland 21201, USA.
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