Cardiac rehabilitation in Austria: short term quality of life improvements in patients with heart disease

Health related quality of life of patients following mechanical valve replacement surgery for rheumatic mitral stenosis in Tanzania

BACKGROUND

The assessment of outcomes of interventions based on the patient's perspective using patient-reported outcome measures (PROMs) has been increasingly highlighted in clinical practice. However, health related quality of life (HRQoL), one of the common constructs measured by PROMs remain unknown among patients after heart valve replacement (HVR) in Tanzania.

OBJECTIVES

To assess the HRQoL amongst patients operated on for rheumatic mitral stenosis at Jakaya Kikwete Cardiac Institute (JKCI).

METHODS

A prospective study of patients operated on due to rheumatic mitral stenosis at JKCI from January 2020 to April 2021 was undertaken. The HRQoL was assessed by using the MacNew questionnaire, addressing three domains (physical, emotional, and social function); the score ranges from 0 to 7. We categorized HRQoL as low (mean score ≤ 4.9), moderate (5-6) and high (> 6). We analysed several sociodemographic and clinical variables for HRQoL.

RESULTS

Out of 54 patients, there were 34 females and 20 males. Their mean (± SD) age was 37.98 (± 12.58) years. The reliability of translated Kiswahili version of MacNew was good. The mean (± SD) global scores were 3.47 ± 0.59, 4.88 ± 0.71 and 6.14 ± 0.50 preoperatively, at 3 months and 6 months respectively (p-values < 0.001 preoperatively vs. 3 months, preoperatively vs. 6 months and at 3 months vs. 6 months). The median of individual mean difference HRQoL score pre-operatively and at 6 months was 2.67. The preoperative and 6 months mean difference HRQoL scores were higher among patients with vs. without atrial fibrillation (2.95 ± 0.59 vs. 2.45 ± 0.53, p = 0.003) and those on anticoagulants (preoperatively) vs. not on anticoagulants (3.14 ± 0.58 vs. 2.57 ± 0.57, 0.009). The mean difference HRQoL scores were similar for sociodemographic and other clinical parameters, including those with stroke vs. without stroke.

CONCLUSION

Six months after HVR the overall MacNew HRQoL scores improved markedly. This improvement in HRQoL was regardless of the presence of comorbidities (e.g. stroke and atrial fibrillation) which underscores the importance of considering valvular surgery if they fit the criteria. Clinicians and researchers in low-resource settings should collaborate to promote the utilization of PROMs in the routine care of patients.

Effect of Different Endurance Training Protocols During Cardiac Rehabilitation on Quality of Life

BACKGROUND

This study aimed to assess the effect of different types of endurance training during outpatient cardiac rehabilitation on patients' health-related quality of life (HRQL).

METHODS

The MacNew Heart Disease HRQL questionnaire and the Hospital Anxiety and Depression Scale were used to assess changes in HRQL in 66 patients before and after 6 weeks of cardiac rehabilitation. Patients were randomized to 1 of 3 types of supervised endurance training: continuous endurance training, high-intensity interval training, and pyramid training. Two-way analysis of variance for repeated measure and chi-square test were used to analyze changes before and after rehabilitation.

RESULTS

Attendance rate during the 6 weeks of exercise training was 99.2%. Physical work capacity increased from 136.1 to 165.5 watts (+22.9%; P < .001), and there were no statistical differences between training protocols. Fully completed questionnaires at both time points were available in 46 patients (73.9%; 61.3±11.6 years, 34 males, 12 females). Regardless of the type of supervised endurance training, there was significant improvement during rehabilitation in each of the categories of the MacNew questionnaire (ie, emotion, physical, social, global; all P < .05) and the Hospital Anxiety and Depression Scale (anxiety: P = .05; depression: P = .032), without significant differences between protocols.

CONCLUSIONS

All 3 types of endurance training led to significant and well comparable increases in physical work capacity, which was associated with an increase in HRQL independent of the type of training. Our findings support further individualization of training regimes, which could possibly lead to better compliance during life-long home-based exercise training.

EQ-5D in coronary patients: what are they suffering from? Results from the ESC EORP European Survey of Cardiovascular Disease Prevention and Diabetes (EUROASPIRE IV) Registry

OBJECTIVE

Coronary patients often suffer from an impaired health, hence the aim of this study is to assess how coronary patients score on the different EQ-5D dimensions.

METHODS

Analyses are based on the EUROASPIRE IV survey, conducted across 24 European countries. 7567 patients with stable coronary heart disease (mean age = 64.1 (SD = 9.6); males = 75.8%) completed the EQ-5D-5L instrument, 6 months to 3 years after their index hospitalization. Descriptive statistics and multilevel logistic regression was used to assess the differences between patient groups in reported problems on the EQ-5D dimensions. Furthermore, age-standardized country-specific outcomes were reported.

RESULTS

About one out of four patients reported to have no problems on all five dimensions (57.9% reported no problems on mobility, 88.4% reported no problems on self-care, 67.1% reported no problems on usual activities, 41.1% reported no problems on pain/discomfort, and 56.2% reported no problems on anxiety/depression). Elderly patients and females reported more problems. Patients with behavioral risk factors and patients with comorbidities were more likely to have severe or extreme problems. Comparison across countries showed major differences in reported problems.

CONCLUSIONS

Whether or not coronary patients have problems on one or more EQ-5D dimension, as well as the severity of the problems reported is largely associated with the patient profile. The least problems are seen on the self-care dimension and most problems are reported on the pain/discomfort dimension.

Socioeconomic Inequalities in Health-Related Quality of Life among Patients with Cardiovascular Diseases in Vietnam

Purpose

This study aims to explore the sociodemographic differences in health-related quality of life (HRQOL) among Vietnamese patients with cardiovascular diseases (CVD).

Methods

A cross-sectional survey of 600 cardiovascular disease patients (300 inpatients and 300 outpatients) being treated at the Hanoi Heart Hospital was completed between July and December 2016. Data about HRQOL were collected by using the EuroQol-5 Dimensions-5 Levels (EQ-5D-5L) and EuroQOL-visual analogue scale (VAS). Sociodemographic characteristics were collected. A multivariate Tobit regression was used to detect the correlations between HRQOL and sociodemographic factors.

Results

Our sample had an average EQ-5D index of 0.82 (SD=0.21) and VAS score of 77.8 (SD=13.6). Participants were most likely to report problems in pain/discomfort (38.8%) and anxiety/depression (35.2%) and were least likely to report problems related to self-care (19.8%). Age and sex were strongly associated with the EQ-5D index and the VAS. Having health insurance and the number of hospital visits were negatively associated with HRQOL, while participation in the chronic disease management program had the positive relationship.

Conclusions

HRQOL among patients with CVD was moderately lower compared to the Vietnamese general population. Sociodemographic characteristics were strongly associated with HRQOL suggesting that addressing these inequalities should be prioritized in delivering services. Patients should also be encouraged to participate in the chronic disease management program due to its positive effects on quality of life.

Health-Related Quality of Life Improves Similarly in Patients With and Without Type 2 Diabetes After Cardiac Rehabilitation

PURPOSE

Cardiovascular disease is the leading cause of death in the United States and results in substantial healthcare expenditures. Health-related quality of life (HRQoL) is an important aspect in long-term recovery for patients with cardiovascular disease. As such, improvement in HRQoL is a relevant outcome for determining cardiovascular rehabilitation (CR) program efficacy. Increasingly, diabetic patients are participating in CR and face additional challenges to HRQoL, yet there is a lack of research addressing program efficacy in this population. This study tested the hypothesis that CR would effect a favorable change in HRQoL for both diabetic (D; n = 37) and nondiabetic (N-D; n = 58) patients. Furthermore, we tested the hypothesis that the D group would demonstrate a greater overall change compared with the N-D group.

METHODS

In this retrospective study, we reviewed the charts of 95 patients who completed a CR program and collected HRQoL measures using the COOP questionnaire, where lower scores indicate higher HRQoL.

RESULTS

After CR, COOP scores for both the N-D improved (pre: 20.39 ± 0.79 vs post: 16.06 ± 0.75; P < .05) and D (pre: 20.92 ± 0.88 vs post: 15.84 ± 0.80; P < .05). HRQoL was not different between groups at the start of the program (P = .88) or at the end (P = .58), and thus, the improvement in HRQoL was not different between groups (P = .44).

CONCLUSIONS

These results suggest that D and N-D patients do not differ in their HRQoL at the start or end of CR, and that the 2 groups show similar improvements from attending the program. Larger sample studies are needed to confirm these findings.

The MacNew Heart Disease Health-Related Quality of Life Questionnaire in patients with angina and patients with ischemic heart failure

OBJECTIVE

Patient-reported outcomes including health-related quality of life are important in clinical care and research studies. The MacNew Heart Disease Health-Related Quality Of Life Questionnaire has been validated in English-speaking patients with myocardial infarction. The aim of this study was to validate the MacNew in English-speaking patients with angina or ischemic heart failure.

METHODS

Canadian and American patients with angina or ischemic heart failure completed the MacNew, the Short Form-36 Health Survey, and the Hospital Anxiety and Depression Scale.

RESULTS

We administered questionnaires to 276 patients with angina (mean age, 65.9 years) and 155 patients with ischemic heart failure (mean age, 70.3 years). The mean ± SD MacNew global score in patients with ischemic heart failure (5.1 ± 1.2) was statistically (P < 0.001), but not clinically, poorer than in patients with angina (5.3 ± 1.1). The three-factor measurement model explained 46.1% of the observed variance in the MacNew in patients with angina and 46.5% in patients with ischemic heart failure. Internal consistency was ≥0.90, and test-retest reliability was ≥0.70 for each MacNew scale and the a priori convergent and discriminative validity hypotheses were confirmed in both diagnoses. The MacNew was highly accepted by patients with little respondent or administrative burden.

CONCLUSIONS

The English version of the MacNew is reliable and valid in patients with angina or ischemic heart failure. This permits health-related quality of life outcome comparisons in patients with angina, ischemic heart failure, and myocardial infarction with the MacNew and provides a better understanding of the full range of health-related quality of life outcomes.

[Outpatient cardiac phase III rehabilitation at a Viennese institution - retrospective cohort study]

BACKGROUND

This retrospective cohort study analyses effectiveness and sustainability of the current cardiac Phase III (Ph-III) rehabilitation program, provided by the Centre for Outpatient Rehabilitation (ZAR).

METHODS

We analysed routine data of 451 intervention group patients (IG, with Ph-III) and 781 control group patients (KG, without Ph-III).

RESULTS

In a median observation period of 2.73 years we found 30% less cases of death in the IG based on the mortality risk observed in the KG (rr = 0.70; p = 0.108). However, we registered more re-events, mainly stent implantations in the IG (rr = 1.34; p = 0.095). Groups differed in some baseline characteristics.

CONCLUSIONS

The lower mortality risk by trend might be explained by the close-meshed care, the IG patients' more health conscious behaviour or a selection bias of the KG (e.g. more severe underlying disease). The causality of potential positive effects cannot be confirmed by this study because of the study design.

A review of health utilities using the EQ-5D in studies of cardiovascular disease

BACKGROUND

The EQ-5D has been extensively used to assess patient utility in trials of new treatments within the cardiovascular field. The aims of this study were to review evidence of the validity and reliability of the EQ-5D, and to summarise utility scores based on the use of the EQ-5D in clinical trials and in studies of patients with cardiovascular disease.

METHODS

A structured literature search was conducted using keywords related to cardiovascular disease and EQ-5D. Original research studies of patients with cardiovascular disease that reported EQ-5D results and its measurement properties were included.

RESULTS

Of 147 identified papers, 66 met the selection criteria, with 10 studies reporting evidence on validity or reliability and 60 reporting EQ-5D responses (VAS or self-classification). Mean EQ-5D index-based scores ranged from 0.24 (SD 0.39) to 0.90 (SD 0.16), while VAS scores ranged from 37 (SD 21) to 89 (no SD reported). Stratification of EQ-5D index scores by disease severity revealed that scores decreased from a mean of 0.78 (SD 0.18) to 0.51 (SD 0.21) for mild to severe disease in heart failure patients and from 0.80 (SD 0.05) to 0.45 (SD 0.22) for mild to severe disease in angina patients.

CONCLUSIONS

The published evidence generally supports the validity and reliability of the EQ-5D as an outcome measure within the cardiovascular area. This review provides utility estimates across a range of cardiovascular subgroups and treatments that may be useful for future modelling of utilities and QALYs in economic evaluations within the cardiovascular area.

Cardiac rehabilitation in Austria: long term health-related quality of life outcomes

BACKGROUND

The goal of cardiac rehabilitation programs is not only to prolong life but also to improve physical functioning, symptoms, well-being, and health-related quality of life (HRQL). The aim of this study was to document the long-term effect of a 1-month inpatient cardiac rehabilitation intervention on HRQL in Austria.

METHODS

Patients (N = 487, 64.7% male, age 60.9 +/- 12.5 SD years) after myocardial infarction, with or without percutaneous interventions, coronary artery bypass grafting or valve surgery underwent inpatient cardiac rehabilitation and were included in this long-term observational study (two years follow-up). HRQL was measured with both the MacNew Heart Disease Quality of Life Instrument [MacNew] and EuroQoL-5D [EQ-5D].

RESULTS

All MacNew scale scores improved significantly (p < 0.001) and exceeded the minimal important difference (0.5 MacNew points) by the end of rehabilitation. Although all MacNew scale scores deteriorated significantly over the two year follow-up period (p < .001), all MacNew scale scores still remained significantly higher than the pre-rehabilitation values. The mean improvement after two years in the MacNew social scale exceeded the minimal important difference while MacNew scale scores greater than the minimal important difference were reported by 40-49% of the patients.Two years after rehabilitation the mean improvement in the EQ-5D Visual Analogue Scale score was not significant with no significant change in the proportion of patients reporting problems at this time.

CONCLUSION

These findings provide a first indication that two years following inpatient cardiac rehabilitation in Austria, the long-term improvements in HRQL are statistically significant and clinically relevant for almost 50% of the patients. Future controlled randomized trials comparing different cardiac rehabilitation programs are needed.

Benefits of cardiac rehabilitation on lipid profile in patients with coronary artery disease

This cross-sectional study was performed in patients following coronary interventions, to evaluate the effect of cardiac rehabilitation on functional capacity, maximum heart rate on exercise and serum lipid profiles. Consecutive patients after coronary artery intervention randomly referred to cardiac rehabilitation. All patients underwent based exercise tolerance test to define exercise capacity. Blood samples were obtained to measure based plasma lipid profiles and nutritional counseling provided to all participants. Also, psychological evaluation was performed with the some documented questionnaire to explore emotional, behavioral and psychological state. After completion of cardiac rehabilitation in all patients, reassessment of work capacity, plasma lipid profile and psychological state were performed. After cardiac rehabilitation for 8-12 weeks, functional capacity improved in 83% of patients (p<0.001) and maximal heart rate at the same time on exercise decreased in 72%. The average time on treadmill was 7.76 min before and 9.56 min after cardiac recreation (p<0.001). After cardiac rehabilitation, plasma total cholesterol, low-density lipoprotein and triglyceride significantly decreased. At the end, 97% of patients returned to work and had sense of well-being. Cardiac rehabilitation has important impacts on improving functional capacity, well being sensation, return to work and decreasing serum lipid profiles in coronary patients.

[Motivation for physical activity - a survey in a Central European state]

INTRODUCTION

Physical activity has high importance in the prevention of diseases, particularly where lifestyle diseases are concerned. To motivate a person to be physically active often proves to be difficult in clinical practice. Thus it was the aim of this study to find out through interviews how to best motivate most notably the part of the population that is less active.

METHODS

500 persons aged from 15 years onwards were asked in face-to-face interviews about their leisure activities, self-assessment of their personal fitness, and about inhibiting and motivating factors in connection with their physical activity.

RESULTS

Only every second interviewed person is intentionally active in order to improve his/her own fitness. The better part of the inactive population can envisage introducing more physical activity into their everyday life. There are various reasons that instigate to be more active: above all, the recommendation of doctors, but also the wish for physical wellbeing or group dynamics act as a stimulant. Would there be an advertising campaign promoting the importance of physical activity, top athletes and physicians would have the most motivating impact.

CONCLUSION

A sustainable and favourable effect on health promotion could be achieved most notably by motivating people to add more physical activity to their everyday life.

Health-related quality of life in patients with coronary heart disease after residential vs ambulatory cardiac rehabilitation

BACKGROUND

The aim of this study was to evaluate the influence of residential (RCR) vs ambulatory (ACR) cardiac rehabilitation (CR) on health-related quality of life (QOL) connected with changes in exercise capacity of patients with coronary heart disease (CHD).

METHODS AND RESULTS

The 562 patients with CHD were studied: 313 participants in RCR and 249 participants in ACR. The examination was performed at the beginning of CR and after 8 weeks. QOL was assessed using the EuroQuol 5D (EQ-5D) and SF36 questionnaires. Exercise testing was performed with evaluation of workload during the last stage of the test and rate of perceived exertion intensity. In the first examination, patients from both groups did not differ significantly. After 8 weeks, a similar improvement in QOL was observed in both settings of CR according to EQ-5D and SF36 results. Health status was improved by 11.1% in the RCR group and by 10.4% in the ACR group. Last workload's intensity increased significantly by 32.1% in the RCR group and by 38.1% in the ACR group. The rate of perceived exertion intensity did not change despite the bigger workloads during the exercise test.

CONCLUSIONS

Comprehensive CR improves health-related QOL and exercise capacity without differences between residential and ambulatory models.

Psychometric properties of the MacNew heart disease health-related quality of life instrument in patients with heart failure

RATIONALE, AIMS AND OBJECTIVES

Heart failure (HF) is a severe chronic disease and impairs health-related quality of life (HRQL). While validated specific HRQL instruments are required for evaluation of treatment and rehabilitation in patients with HF, a single validated measure to document changes in HRQL for patients with different heart disease diagnoses would be invaluable. The purpose of this analysis was the psychometric analysis of the German MacNew Heart Disease Questionnaire (MacNew) in HF patients, which has previously been shown to be reliable and valid in patients with myocardial infarction, angina pectoris and arrhythmia.

METHODS

We recruited 89 patients (61.7+/-11.5 years; 84.3% male) in two Austrian and one Swiss cardiology department with documented HF (effect sizes 28.9+/-10.1%). The self-administered MacNew, the Short Form-36 (SF-36) and the Hospital Anxiety and Depression Scale were completed. Internal consistency reliability (Cronbach's alpha), discriminative and evaluative validity were assessed.

RESULTS

Cronbach's alpha exceeded 0.80. Each MacNew scale differentiated between patients with and without anxiety (3.9+/-1.0 vs. 5.3+/-0.8, all P<0.001), with and without depression (4.2+/-1.2 vs. 5.2+/-0.9 all P<0.03) and by the SF-36 health transition item (deteriorate=4.39, no change=4.95, improve=5.45, all P<0.02). Evaluative validity was demonstrated with effect sizes >0.70 for a subsample attending a 12-week outpatient rehabilitation programme.

CONCLUSIONS

The German language version of the MacNew demonstrates consistently acceptable psychometric properties of reliability, validity and responsiveness in patients with documented HF. Together with previous documentation of reliability, validity and responsive, these findings strengthen the argument for the MacNew as a potential 'core' HRQL measure, at least in the German language.

The validity and reliability of the Turkish version of the MacNew Heart Disease Questionnaire in patients with angina

AIMS AND OBJECTIVES

Health-related quality of life (HRQL) is an important patient-reported outcome when identifying the effects of the angina and evaluating the efficacy of treatment. The aim of this study was to determine the reliability and validity of the Turkish version of the MacNew Heart Disease HRQL Questionnaire (MacNew) in patients with angina.

METHOD

The Short Form SF-36, the MacNew, and the Hospital Anxiety and Depression Scale were completed by the 125 patients in first 2-3 days after admission to the coronary care unit. Internal consistency reliability (Cronbach's alpha) and reproducibility (intraclass correlation coefficients, ICC) of the MacNew were assessed, and test-retest reproducibility was evaluated over a 2-month period in 25 clinically stable patients.

RESULTS

The original three-factor structure for the Turkish MacNew was confirmed, with construct validity only partially confirmed; reliability statistics show that Cronbach's alpha exceeded 0.80 and the ICC exceeded 0.60 for all MacNew scales. Discriminative validity of the MacNew was confirmed.

CONCLUSION

The MacNew appears to be reliable and valid in Turkish patients with angina.