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Wrzeciono A, Cieślik B, Kiper P, Szczepańska-Gieracha J, Gajda R. Exploratory analysis of the effectiveness of virtual reality in cardiovascular rehabilitation. Sci Rep 2024; 14:281. [PMID: 38168468 PMCID: PMC10762219 DOI: 10.1038/s41598-023-50788-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 12/25/2023] [Indexed: 01/05/2024] Open
Abstract
Virtual reality therapy has been shown to be effective in coping with psychological disorders accompanied by cardiovascular disease. Age appears to be a factor that can affect the effectiveness of psychological therapy in a virtual environment. Therefore, the aim of the study was to explore whether there are age-related differences in the effectiveness of reducing levels of depression and anxiety during a virtual reality psychological intervention implemented for rehabilitation. The study included 25 younger (< 65 years) and 25 older (65 +) patients with cardiovascular disease who participated in virtual reality therapy to cope with anxiety and depression. The Hospital Anxiety and Depression Scale was used to assess anxiety and depressive disorders before and after intervention. Significant reductions in anxiety and depression scores after intervention were observed in both age-matched groups, and no significant differences were found between the younger and older participants. Further evaluation of patient age as a predictor of the effectiveness of psychological intervention in virtual reality did not show a significant effect of age on effectiveness in reducing anxiety and depressive disorders. The results obtained suggest that older patients benefit similarly to younger patients from psychological intervention in a virtual environment. Furthermore, age does not appear to be considered a predictor of effectiveness in reducing the level of anxiety and depression in patients with cardiovascular disease using virtual reality therapy.
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Affiliation(s)
- Adam Wrzeciono
- Faculty of Physiotherapy, Wroclaw University of Health and Sport Sciences, 51-612, Wroclaw, Poland
| | - Błażej Cieślik
- Healthcare Innovation Technology Lab, IRCCS San Camillo Hospital, 30126, Venezia, Italy.
| | - Paweł Kiper
- Healthcare Innovation Technology Lab, IRCCS San Camillo Hospital, 30126, Venezia, Italy
| | | | - Robert Gajda
- Gajda-Med District Hospital, 06-100, Pultusk, Poland
- Department of Kinesiology and Health Prevention, Jan Dlugosz University, 42-200, Czestochowa, Poland
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Ghisi GLDM, Marzolini S, Price J, Beckie TM, Mamataz T, Naheed A, Grace SL. Women-Focused Cardiovascular Rehabilitation: An International Council of Cardiovascular Prevention and Rehabilitation Clinical Practice Guideline. Can J Cardiol 2022; 38:1786-1798. [PMID: 36085185 DOI: 10.1016/j.cjca.2022.06.021] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 06/10/2022] [Accepted: 06/17/2022] [Indexed: 12/14/2022] Open
Abstract
Women-focused cardiovascular rehabilitation (CR; phase II) aims to better engage women, and might result in better quality of life than traditional programs. This first clinical practice guideline by the International Council of Cardiovascular Prevention and Rehabilitation (ICCPR) provides guidance on how to deliver women-focused programming. The writing panel comprised experts with diverse geographic representation, including multidisciplinary health care providers, a policy-maker, and patient partners. The guideline was developed in accordance with Appraisal of Guidelines for Research and Evaluation (AGREE) II and the Reporting Items for practice Guidelines in HealTh care (RIGHT). Initial recommendations were on the basis of a meta-analysis. These were circulated to a Delphi panel (comprised of corresponding authors from review articles and of programs delivering women-focused CR identified through ICCPR's audit; N = 76), who were asked to rate each on a 7-point Likert scale in terms of impact and implementability (higher scores positive). A Web call was convened to achieve consensus; 15 panelists confirmed strength of revised recommendations (Grading of Recommendations Assessment, Development, and Evaluation [GRADE]). The draft underwent external review from CR societies internationally and was posted for public comment. The 14 drafted recommendations related to referral (systematic, encouragement), setting (model choice, privacy, staffing), and delivery (exercise mode, psychosocial, education, self-management empowerment). Nineteen (25.0%) survey responses were received. For all but 1 recommendation, ≥ 75% voted to include; implementability ratings were < 5/7 for 4 recommendations, but only 1 for effect. Ultimately 1 recommendation was excluded, 1 separated into 2 and all revised (2 substantively); 1 recommendation was added. Overall, certainty of evidence for the final recommendations was low to moderate, and strength mostly strong. These recommendations and associated tools can support all programs to feasibly offer some women-focused programming.
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Affiliation(s)
- Gabriela Lima de Melo Ghisi
- KITE-Toronto Rehabilitation Institute, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Susan Marzolini
- KITE-Toronto Rehabilitation Institute, University Health Network, University of Toronto, Toronto, Ontario, Canada; Faculty of Health, York University, Toronto, Ontario, Canada
| | | | - Theresa M Beckie
- College of Nursing, Division of Cardiovascular Sciences, University of South Florida, Tampa, Florida, USA; College of Medicine, Division of Cardiovascular Sciences, University of South Florida, Tampa, Florida, USA
| | - Taslima Mamataz
- KITE-Toronto Rehabilitation Institute, University Health Network, University of Toronto, Toronto, Ontario, Canada; Faculty of Health, York University, Toronto, Ontario, Canada
| | - Aliya Naheed
- Initiative for Non-Communicable Diseases, Health System and Population Studies Division, International Centre for Diarrheal Diseases Research Bangladesh, Dhaka, Bangladesh
| | - Sherry L Grace
- KITE-Toronto Rehabilitation Institute, University Health Network, University of Toronto, Toronto, Ontario, Canada; Faculty of Health, York University, Toronto, Ontario, Canada; Peter Munk Cardiac Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada.
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Schmitz C, Wedegärtner SM, Langheim E, Kleinschmidt J, Köllner V. Heart-Focused Anxiety Affects Behavioral Cardiac Risk Factors and Quality of Life: A Follow-Up Study Using a Psycho-Cardiological Rehabilitation Concept. Front Psychiatry 2022; 13:836750. [PMID: 35615455 PMCID: PMC9124936 DOI: 10.3389/fpsyt.2022.836750] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 02/28/2022] [Indexed: 12/23/2022] Open
Abstract
Background Heart-focused anxiety (HFA) raises the risk for adverse outcomes in patients with heart disease. Despite this great importance, it is rarely assessed in clinical practice. Three dimensions are commonly defined in the context of HFA: heart-related fear, avoidance, and attention. The impact of these aspects on cardiac risk factors is essentially unclear. In this study, we investigated the relationship between HFA and behavioral cardiac risk factors as well as health-related quality of life (HRQoL), which represent important treatment outcomes of inpatient psycho-cardiological rehabilitation. Methods A prospective observational design was used to examine 238 rehabilitation inpatients with comorbidity of cardiac disease and psychiatric disorder. We assessed HFA using the Cardiac Anxiety Questionnaire (CAQ), HRQoL using the SF-12 Health Survey, exercise capacity using the 6-minute walk test, and smoking behavior, respectively at admission (t0) and discharge (t1). Physical activity was assessed at t0 and in a follow-up survey 6 months after discharge (t2) using the International Physical Activity Questionnaire (IPAQ). Multiple regression models were used to analyze the predictive value of HFA for the outcome variables at t0, t1, and t2, adjusted for socio-demographic factors and depression. Predictive values for changes over time were evaluated by the regressor variable approach. Results Exercise capacity and physical activity were negatively predicted by baseline heart-related avoidance, both cross-sectionally and prospectively. Avoidance at t1 also negatively predicted long-term changes over time in physical activity at t2. Total HFA and the subcomponent avoidance negatively predicted physical HRQoL both cross-sectionally and prospectively. Mental HRQoL was cross-sectionally predicted by heart-focused attention at t0, and prospectively predicted by total HFA and by avoidance. Regarding changes in the course of rehabilitation, baseline avoidance negatively predicted improvement in physical HRQoL during rehabilitation. Concerning smoking behavior, no associations with HFA were found. Conclusions HFA is a relevant inhibiting factor for the achievement of therapy goals in psycho-cardiological rehabilitation such as health behavior and HRQoL. Heart-related avoidance in particular, has a negative impact on exercise capacity, physical activity, and self-reported physical health. Its prospective negative predictive value for physical activity and physical health underlines the relevance of HFA for psycho-cardiological interventions.
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Affiliation(s)
- Christoph Schmitz
- Psychosomatic Rehabilitation Research Group, Department of Psychosomatic Medicine, Center for Internal Medicine and Dermatology, Charité – Universitätsmedizin Berlin, Berlin, Germany
- Department of Behavioral Psychotherapy, Technological University Dresden, Dresden, Germany
| | - Sonja Maria Wedegärtner
- Department of Cardiology, Rehabilitation Center Seehof, Federal German Pension Agency, Teltow, Germany
| | - Eike Langheim
- Department of Cardiology, Rehabilitation Center Seehof, Federal German Pension Agency, Teltow, Germany
| | - Judit Kleinschmidt
- Department of Behavioral Therapy and Psychosomatic Medicine, Rehabilitation Center Seehof, Federal German Pension Agency, Teltow, Germany
| | - Volker Köllner
- Psychosomatic Rehabilitation Research Group, Department of Psychosomatic Medicine, Center for Internal Medicine and Dermatology, Charité – Universitätsmedizin Berlin, Berlin, Germany
- Department of Behavioral Therapy and Psychosomatic Medicine, Rehabilitation Center Seehof, Federal German Pension Agency, Teltow, Germany
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Abstract
Cardiovascular disease is a leading cause of morbidity and mortality in males and females in the United States and globally. Cardiac rehabilitation (CR) is recommended by the American Heart Association/American College of Cardiology for secondary prevention for patients with cardiovascular disease. CR participation is associated with improved cardiovascular disease risk factor management, quality of life, and exercise capacity as well as reductions in hospital admissions and mortality. Despite these advantageous clinical outcomes, significant sex disparities exist in outpatient phase II CR programming. This article reviews sex differences that are present in the spectrum of care provided by outpatient phase II CR programming (ie, from referral to clinical management). We first review CR participation by detailing the sex disparities in the rates of CR referral, enrollment, and completion. In doing so, we discuss patient, health care provider, and social/environmental level barriers to CR participation with a particular emphasis on those barriers that majorly impact females. We also evaluate sex differences in the core components incorporated into CR programming (eg, patient assessment, exercise training, hypertension management). Next, we review strategies to mitigate these sex differences in CR participation with a focus on automatic CR referral, female-only CR programming, and hybrid CR. Finally, we outline knowledge gaps and areas of future research to minimize and prevent sex differences in CR programming.
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Affiliation(s)
- Joshua R Smith
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | - Randal J Thomas
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | | | - Shane M Hammer
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | - Thomas P Olson
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
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Miyazaki S, Kanbara K, Kunikata J, Tobiume A, Hayashino S, Namba T, Matsumoto I, Takagi Y, Minamino T. Heartbeat tracking task performance, an indicator of interoceptive accuracy, is associated with improvement of exercise tolerance in patients undergoing home-based cardiac rehabilitation. EUROPEAN HEART JOURNAL. DIGITAL HEALTH 2022; 3:296-306. [PMID: 36713013 PMCID: PMC9707934 DOI: 10.1093/ehjdh/ztac008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 11/16/2021] [Accepted: 02/08/2022] [Indexed: 02/01/2023]
Abstract
Aims Interoception is the sensing function of physiological conditions and is crucial in self-regulation and decision-making. We examined the association of heartbeat tracking task performance, an indicator of interoceptive accuracy, with the degree of improvement in exercise tolerance in patients undergoing home-based cardiac rehabilitation. Methods and results Participants underwent baseline peak oxygen uptake (VO2) measurements and a heartbeat tracking task. The heartbeat tracking task score varies between 0 and 1, with higher scores indicating a better heartbeat perception. After 6 months of home-based exercise training, peak VO2 was measured again, and the percentage change (%Δ peak VO2) relative to the peak VO2 at baseline was calculated. Univariate regression analysis was performed to examine the association between %Δ peak VO2 and the heartbeat tracking task score. Multiple regression analysis was performed to determine the predictors of %Δ peak VO2. Of 120 participants, 100 patients (age 65.9 ± 11.9 years; 86% male) were included. There was a significant positive association between %Δ peak VO2 and the heartbeat tracking task score at baseline (R 2 = 0.236, P < 0.001). In multiple regression analysis, the percentage of measured peak VO2 to the predicted value (%predicted peak VO2) (β = -0.248, P = 0.002), exercise adherence (β = 0.364, P < 0.001), and heartbeat tracking task score at baseline (β = 0.372, P < 0.001) were significantly associated with %Δ peak VO2. Conclusions Heartbeat tracking task performance, an indicator of interoceptive accuracy, at baseline is associated with the degree of improvement in exercise tolerance.
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Affiliation(s)
| | - Kenji Kanbara
- Psychosomatic Medicine, Department of Clinical Psychology, Faculty of Medicine, Kagawa University, 1750-1 Ikenobe, Miki-cho, Kita-gun, Kagawa Prefecture 761-0793, Japan
| | - Jun Kunikata
- Clinical Research Support Center, Kagawa University Hospital, 1750-1 Ikenobe, Miki-cho, Kita-gun, Kagawa Prefecture 761-0793, Japan
| | - Atsushi Tobiume
- Department of Cardiorenal and Cerebrovascular Medicine, Faculty of Medicine, Kagawa University, 1750-1 Ikenobe, Miki-cho, Kita-gun, Kagawa Prefecture 761-0793, Japan
| | - Shusei Hayashino
- Rehabilitation Center, KKR Takamatsu Hospital, 4-18 Tenjinmae, Takamatsu City, Kagawa Prefecture 760-0018, Japan
| | - Tsunetatsu Namba
- Department of Cardiology, KKR Takamatsu Hospital, 4-18 Tenjinmae, Takamatsu City, Kagawa Prefecture 760-0018, Japan
| | - Ichiro Matsumoto
- Department of Cardiology, KKR Takamatsu Hospital, 4-18 Tenjinmae, Takamatsu City, Kagawa Prefecture 760-0018, Japan
| | - Yuichiro Takagi
- Department of Cardiology, KKR Takamatsu Hospital, 4-18 Tenjinmae, Takamatsu City, Kagawa Prefecture 760-0018, Japan
| | - Tetsuo Minamino
- Department of Cardiorenal and Cerebrovascular Medicine, Faculty of Medicine, Kagawa University, 1750-1 Ikenobe, Miki-cho, Kita-gun, Kagawa Prefecture 761-0793, Japan
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Gecaite-Stonciene J, Burkauskas J, Bunevicius A, Steibliene V, Macijauskiene J, Brozaitiene J, Mickuviene N, Kazukauskiene N. Validation and Psychometric Properties of the Minnesota Living With Heart Failure Questionnaire in Individuals With Coronary Artery Disease in Lithuania. Front Psychol 2022; 12:771095. [PMID: 35185680 PMCID: PMC8855069 DOI: 10.3389/fpsyg.2021.771095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Accepted: 12/21/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Health-related quality of life (HRQoL) is known to be impaired in individuals with coronary artery disease (CAD), especially in those after a recent acute coronary syndrome (ACS). Heart failure (HF) is a common burden in this population that significantly contributes to worsening HRQoL. To accurately measure the level of HRQoL in individuals with CAD after ACS, disease-specific scales, such as the Minnesota living with heart failure questionnaire (MLHFQ), are recommended. Nevertheless, to date, there has not been a study that would comprehensively evaluate the psychometric properties of the MLHFQ in a large sample of individuals with CAD after ACS. The debate regarding the internal structure of MLHFQ is also still present. Hence, this study aimed to translate the MLHFQ and evaluate its internal structure, reliability/precision, and validity in individuals with CAD following ACS in Lithuania. METHODS In the cross-sectional study, 1,083 participants (70% men, age M = 58, SD = 9) were evaluated for sociodemographic and clinical characteristics. HRQoL was measured using the MLHFQ and the Short Form-36 health survey (SF-36). In addition, exercise capacity (EC) was also evaluated in the study patients, using a standardized computer-driven bicycle ergometer. RESULTS The internal consistency of the MLHFQ subscales (0.79-0.88) was found to be good. Confirmatory factor analysis (CFA) provided the support for the three-factor model ("physical domain," "social domain," and "emotional domain") of the MLHFQ and showed acceptable fit [comparative fit indices (CFI) = 0.894; goodness-of-fit (GFI) = 0.898; non-normal fit index (NFI) = 0.879, and root mean square error of approximation (RMSEA) = 0.073]. Regarding convergent evidence, significant associations were found between the MLHFQ domains and the SF-36 domains and EC (r's range 0.11-0.58). CONCLUSION The current study completed cultural validation and provided further information on the psychometric characteristics of the MLHFQ in Lithuania, suggesting MLHFQ as a valid and reliable instrument to measure HRQoL. The Lithuanian version of MLHFQ is best described by a three-factor solution, measuring physical, social, and emotional dimensions of HRQoL among individuals with CAD following ACS.
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Affiliation(s)
- Julija Gecaite-Stonciene
- Laboratory of Behavioral Medicine, Neuroscience Institute, Lithuanian University of Health Sciences, Palanga, Lithuania
| | - Julius Burkauskas
- Laboratory of Behavioral Medicine, Neuroscience Institute, Lithuanian University of Health Sciences, Palanga, Lithuania
| | - Adomas Bunevicius
- Laboratory of Behavioral Medicine, Neuroscience Institute, Lithuanian University of Health Sciences, Palanga, Lithuania
| | - Vesta Steibliene
- Laboratory of Behavioral Medicine, Neuroscience Institute, Lithuanian University of Health Sciences, Palanga, Lithuania
| | | | - Julija Brozaitiene
- Laboratory of Behavioral Medicine, Neuroscience Institute, Lithuanian University of Health Sciences, Palanga, Lithuania
| | - Narseta Mickuviene
- Laboratory of Behavioral Medicine, Neuroscience Institute, Lithuanian University of Health Sciences, Palanga, Lithuania
| | - Nijole Kazukauskiene
- Laboratory of Behavioral Medicine, Neuroscience Institute, Lithuanian University of Health Sciences, Palanga, Lithuania
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Xu JX, Wu LX, Jiang W, Fan GH. Effect of nursing intervention based on Maslow's hierarchy of needs in patients with coronary heart disease interventional surgery. World J Clin Cases 2021; 9:10189-10197. [PMID: 34904089 PMCID: PMC8638042 DOI: 10.12998/wjcc.v9.i33.10189] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 08/05/2021] [Accepted: 09/19/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND It is very important to provide effective nursing programs to regulate the physical and mental state of patients and to improve treatment compliance after interventional surgery for coronary heart disease (CHD).
AIM To explore the effect of a nursing intervention based on Maslow’s hierarchy of needs theory on patients with CHD undergoing percutaneous coronary intervention.
METHODS Ninety-four patients with CHD undergoing interventional surgery in our hospital from January 2020 to February 2021 were randomly divided into a research group (n = 47) and a control group (n = 47). The control group received routine nursing, and the research group received a nursing intervention based on Maslow’s hierarchy of needs theory. The scores of self-efficacy, negative emotion [depression (SDS), anxiety (SAS)], intervention compliance (standardized medication, moderate exercise, healthy diet, and regular review), and nursing satisfaction were calculated before and after intervention for the two groups.
RESULTS Before intervention, there was no significant difference in the scores of disease general management self-efficacy, disease management self-efficacy, and total self-efficacy between the two groups (P = 0.795, 0.479, and 0.659, respectively). After intervention, these three scores in the research group were higher than those in the control group (P < 0.001). Before intervention, there was no significant difference in the scores of SAS and SDS between the two groups (P = 0.149 and 0.347, respectively). After intervention, the scores of SAS and SDS in the research group were lower than those in the control group (P < 0.001). The standardized drug use rate (97.87%), moderate exercise rate (97.87%), healthy diet rate (95.74%), and regular reexamination rate (97.87%) in the research group were higher than those in the control group (85.11%, 82.98%, 80.85%, and 87.23%, respectively) (P = 0.027, 0.014, 0.025, and 0.049, respectively). Nursing job satisfaction in the research group (93.62%) was higher than that in the control group (78.72%) (P = 0.036).
CONCLUSION A nursing program based on Maslow’s hierarchy of needs theory can effectively alleviate negative emotion, enhance self-efficacy and intervention compliance, and ensure that the patients are highly satisfied with the nursing work.
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Affiliation(s)
- Ji-Xue Xu
- Department of Nursing, First Affiliated Hospital of Qiqihar Medical College, Qiqihar 161000, Heilongjiang Province, China
| | - Lin-Xue Wu
- Department of Nursing, First Affiliated Hospital of Qiqihar Medical College, Qiqihar 161000, Heilongjiang Province, China
| | - Wei Jiang
- Department of Nursing, First Affiliated Hospital of Qiqihar Medical College, Qiqihar 161000, Heilongjiang Province, China
| | - Gui-Hong Fan
- Department of Nursing, First Affiliated Hospital of Qiqihar Medical College, Qiqihar 161000, Heilongjiang Province, China
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Terada T, Vidal-Almela S, Tulloch HE, Pipe AL, Reed JL. Cardiac Rehabilitation Following Percutaneous Coronary Intervention Is Associated With Superior Psychological Health and Quality of Life in Males but Not in Females. J Cardiopulm Rehabil Prev 2021; 41:345-350. [PMID: 33797456 DOI: 10.1097/hcr.0000000000000597] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE Cardiac rehabilitation (CR) improves psychological health and health-related quality of life (HR-QoL). Yet, available evidence suggests that their degree of improvements following CR may depend on patient sex and the mode of revascularization. We examined the interplay between sex and mode of revascularization on the psychological health and HR-QoL of patients completing CR. METHODS We analyzed the longitudinal records of patients who completed a 3-mo outpatient CR program following coronary revascularization. Levels of anxiety and depression were measured by the Hospital Anxiety and Depression Scale and HR-QoL was measured by the Medical Outcomes Study Short Form-36 before and after CR. A two-by-two analysis of covariance (females vs males by coronary artery bypass graft surgery [CABG] vs percutaneous coronary intervention [PCI]) was used to examine the sex-by-revascularization procedure interaction effect on changes in psychological health and HR-QoL. RESULTS Of the 278 participants (age: 65 ± 9 yr) included in the analysis, 191 (69%) underwent PCI and 55 (20%) were females. Following CR, there was a significant sex-by-revascularization procedure interaction effect on anxiety (P = .033) and mental HR-QoL (mental component summary [MCS]; P = .040). Following CABG, females and males showed similar improvements in anxiety (-1.3 ± 3.4 vs -1.1 ± 3.6 points, P = .460) and MCS scores (5.4 ± 8.9 vs 4.5 ± 8.7 points, P = .887); following PCI, females experienced worse anxiety levels and mental component summary scores while males showed improvements (anxiety: +1.0 ± 3.8 vs -1.3 ± 3.8 points, P = .002; MCS: -1.6 ± 9.3 vs + 4.4 ± 8.9 points, P = .008, respectively). There was no interaction effect on depression. CONCLUSIONS Continued efforts are required to improve anxiety and mental HR-QoL in females treated with PCI participating in CR.
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Affiliation(s)
- Tasuku Terada
- Exercise Physiology and Cardiovascular Health Lab, Division of Cardiac Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, Ontario, Canada (Drs Terada, Tulloch, Pipe, and Reed and Ms Vidal-Almela); Faculty of Medicine (Drs Tulloch, Pipe, and Reed) and School of Human Kinetics, Faculty of Health Sciences (Dr Reed and Ms Vidal-Almela), University of Ottawa, Ottawa, Ontario, Canada; and Institut du savoir Montfort, Hôpital Montfort, Ottawa, Ontario, Canada (Ms Vidal-Almela)
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Li Y, Feng X, Chen B, Liu H. Retrospective analysis of exercise capacity in patients with coronary artery disease after percutaneous coronary intervention or coronary artery bypass graft. Int J Nurs Sci 2021; 8:257-263. [PMID: 34307773 PMCID: PMC8283701 DOI: 10.1016/j.ijnss.2021.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Revised: 05/01/2021] [Accepted: 05/25/2021] [Indexed: 11/15/2022] Open
Abstract
Objectives To describe the current state of exercise capacity as well as to identify its predictors in patients with coronary artery disease (CAD) following percutaneous coronary intervention (PCI) or coronary artery bypass graft (CABG) in the mainland of China. Methods A retrospective study design was employed. We evaluated 230 CAD patients following PCI or CABG in a cardiac rehabilitation center from January 2019 to October 2019. The patients were referred to undergo incremental cardiopulmonary exercise testing with a cycle ergometer. The Zung Self-Rating Anxiety Scale and the Zung Self-Rating Depression Scale were used to evaluate patients’ mental health. Statistical analysis was performed using the chi-square test, Fisher’s exact test, t-test, Mann-Whitney U test, and binary logistic regression. Results Among the 230 patients, 223 patients demonstrated reduced exercise capacity. Resutlts of the logistic regression analysis showed that anxiety (OR = 1.13, 95% CI 1.01–1.32, P = 0.029) was an independent risk factor for reduced exercise capacity in patients following the PCI or CABG. Conclusions Exercise capacity of Chinese CAD patients after PCI or CABG was relatively poor. Alleviating symptoms of anxiety and making exercise prescriptions according to the results of the cardiopulmonary exercise test should be considered during the intervention to improve CAD patients’ exercise capacity.
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Affiliation(s)
- Ying Li
- School of Nursing, Peking Union Medical College, Beijing, China
| | - Xue Feng
- Chinese Academy of Medical Sciences & Peking Union Medical College Fuwai Hospital, Beijing, China
| | - Biyun Chen
- Chinese Academy of Medical Sciences & Peking Union Medical College Fuwai Hospital, Beijing, China
| | - Huaping Liu
- School of Nursing, Peking Union Medical College, Beijing, China
- Corresponding author.
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Gecaite-Stonciene J, Bunevicius A, Burkauskas J, Brozaitiene J, Neverauskas J, Mickuviene N, Kazukauskiene N. Validation of the Multidimensional Fatigue Inventory with Coronary Artery Disease Patients. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17218003. [PMID: 33143183 PMCID: PMC7662819 DOI: 10.3390/ijerph17218003] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 10/23/2020] [Accepted: 10/27/2020] [Indexed: 12/26/2022]
Abstract
BACKGROUND Fatigue is a common distressing symptom in patients with coronary artery disease (CAD). The Multidimensional Fatigue Inventory (MFI) is used for measuring fatigue in various clinical settings. Nevertheless, its multidimensional structure has not been consistent across studies. Thus, we aimed to psychometrically evaluate the MFI in patients with CAD. METHODS In sum, 1162 CAD patients completed questionnaires assessing their subjective fatigue level (MFI-20), mental distress symptoms (HADS, STAI), and health-related quality of life (SF-36). Participants also completed exercise capacity (EC) testing. RESULTS Confirmatory factor analysis of the four-factor model, showed acceptable fit (CFI = 0.905; GFI = 0.895; NFI = 0.893, RMSEA = 0.077). After eliminating four items, confirmatory factor analysis testing showed improvement in the four-factor model of the MFI-16 (CFI = 0.910; GFI = 0.909; NFI = 0.898, RMSEA = 0.077). Internal consistency values were adequate for the total score and four MFI-16 subscales: General fatigue, physical fatigue, reduced activity, and mental fatigue with Cronbach's α range: 0.60-0.82. The inadequate value (Cronbach's α = 0.43) was received for the subscale of reduced motivation in both MFI-20 and MFI-16. Correlations between the MFI-16 and HADS, STAI, SF-36, and EC measures were statistically significant (all p's < 0.001). CONCLUSIONS The Lithuanian version of the modified MFI of 16 items showed good factorial structure and satisfactory psychometric characteristics, except for reduced motivation subscale.
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Bierbauer W, Scholz U, Bermudez T, Debeer D, Coch M, Fleisch-Silvestri R, Nacht CA, Tschanz H, Schmid JP, Hermann M. Improvements in exercise capacity of older adults during cardiac rehabilitation. Eur J Prev Cardiol 2020; 27:1747-1755. [PMID: 32321285 DOI: 10.1177/2047487320914736] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
AIMS Cardiac rehabilitation plays a vital role in secondary prevention of cardiovascular patients. Female sex and higher age, however, are associated with non-referral to cardiac rehabilitation. Improving exercise capacity during cardiac rehabilitation is essential to reduce morbidity and mortality risks. The objective of this study was to closely examine the beneficial changes in exercise capacity of older patients of both sexes during cardiac rehabilitation and to identify the most important predictors of the change in exercise capacity. METHOD A sample of 13,612 patients (mean age = 69.10 ± 11.8 years, 63.7% men, 19% > 80 years) was analysed. Data were prospectively assessed from 2012-2018 in six Swiss in-patient cardiovascular rehabilitation clinics. Improvement in exercise capacity measured with the six-minute walking test represents the outcome variable. Univariate and multivariate analyses, as well as the random forest method were used to estimate variable importance. RESULTS Mean improvement in the six-minute walking test was 113.5 ± 90.5 m (men = 118.7 ± 110.0; women = 104.4 ± 93.0, Cohen's d = 0.16). The presence of heart failure, diabetes mellitus and psychiatric diagnoses was related to reduced but nonetheless clinically relevant six-minute walking test improvement. Random forest analysis suggests that baseline exercise capacity, age, time in rehabilitation and heart failure were the most important predictors for improvement in exercise capacity. Clinically relevant improvements in exercise capacity (>45 m) were also present into old age (85 years) and for both sexes. CONCLUSION As indicated by these results, efforts need to be increased to refer eligible patients to structured rehabilitation programmes, irrespective of patients' age and sex.
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Affiliation(s)
- Walter Bierbauer
- Department of Psychology, University of Zurich, Switzerland.,University Research Priority Program 'Dynamics of Healthy Aging', University of Zurich, Switzerland
| | - Urte Scholz
- Department of Psychology, University of Zurich, Switzerland.,University Research Priority Program 'Dynamics of Healthy Aging', University of Zurich, Switzerland.,Center of Competence Multimorbidity, University of Zurich, Switzerland
| | - Tania Bermudez
- Department of Psychology, University of Zurich, Switzerland.,University Research Priority Program 'Dynamics of Healthy Aging', University of Zurich, Switzerland
| | - Dries Debeer
- Department of Psychology, Psychological Methods, Evaluation and Statistics, University of Zurich, Switzerland
| | - Michael Coch
- Department of Cardiology, Reha Seewis, Switzerland
| | | | | | | | | | - Matthias Hermann
- Zürcher RehaZentrum Wald, Switzerland.,University Heart Center, University Hospital Zurich, Switzerland
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12
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Açıkel MET. Evaluation of Depression and Anxiety in Coronary Artery Bypass Surgery Patients: A Prospective Clinical Study. Braz J Cardiovasc Surg 2019; 34:389-395. [PMID: 31364347 PMCID: PMC6713374 DOI: 10.21470/1678-9741-2018-0426] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE The aim of this clinical study is to determine the depression and anxiety levels in coronary artery bypass graft (CABG) surgery patients in the pre and postoperative periods. METHODS This clinical prospective study was done with 65 patients. Beck's Depression Inventory (BDI) and Beck's Anxiety Inventory (BAI) tests were performed in patients who had a diagnosis of coronary artery disease and were awaiting CABG surgery. These patients presented characteristic symptoms of anxiety and depression and BDI and BAI tests are important to assess these symptoms. RESULTS We found out that depression and anxiety levels were higher in the postoperative than in the preoperative period (P<0.001). Both anxiety and depression levels were increased significantly following CABG operation when compared with preoperative levels in all patients. Statistical correlation of depression and anxiety in different ages, genders, and professions were evaluated too, but we did not found a correlation between them (P>0.05). CONCLUSION We suggest that good management of the psychological condition of cardiac surgery candidates, as well as post-bypass patients, will improve quality of life and cardiovascular outcomes in these patients.
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Affiliation(s)
- Melike Elif Teker Açıkel
- S.B.Ü. Haseki Education and Research Hospital Department of Cardiovascular Surgery İstanbul Turkey Department of Cardiovascular Surgery, S.B.Ü. Haseki Education and Research Hospital, İstanbul, Turkey
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13
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Salzwedel A, Reibis R, Hadzic M, Buhlert H, Völler H. Patients' expectations of returning to work, co-morbid disorders and work capacity at discharge from cardiac rehabilitation. Vasc Health Risk Manag 2019; 15:301-308. [PMID: 31616150 PMCID: PMC6698615 DOI: 10.2147/vhrm.s216039] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Accepted: 06/28/2019] [Indexed: 12/24/2022] Open
Abstract
Objective We aimed to characterize patients after an acute cardiac event regarding their negative expectations around returning to work and the impact on work capacity upon discharge from cardiac rehabilitation (CR). Methods We analyzed routine data of 884 patients (52±7 years, 76% men) who attended 3 weeks of inpatient CR after an acute coronary syndrome (ACS) or cardiac surgery between October 2013 and March 2015. The primary outcome was their status determining their capacity to work (fit vs unfit) at discharge from CR. Further, sociodemographic data (eg, age, sex, and education level), diagnoses, functional data (eg, exercise stress test and 6-min walking test [6MWT]), the Hospital Anxiety and Depression Scale (HADS) and self-assessment of the occupational prognosis (negative expectations and/or unemployment, Würzburger screening) at admission to CR were considered. Results A negative occupational prognosis was detected in 384 patients (43%). Out of these, 368 (96%) expected not to return to work after CR and/or were unemployed before CR at 29% (n=113). Affected patients showed a reduced exercise capacity (bicycle stress test: 100 W vs 118 W, P<0.01; 6MWT: 380 m vs 421 m, P<0.01) and were more likely to receive a depression diagnosis (12% vs 3%, P<0.01), as well as higher levels on the HADS. At discharge from CR, 21% of this group (n=81) were fit for work (vs 35% of patients with a normal occupational prognosis (n=175, P<0.01)). Sick leave before the cardiac event (OR 0.4, 95% CI 0.2–0.6, P<0.01), negative occupational expectations (OR 0.4, 95% CI 0.3–0.7, P<0.01) and depression (OR 0.3, 95% CI 0.1–0.8, P=0.01) reduced the likelihood of achieving work capacity upon discharge. In contrast, higher exercise capacity was positively associated. Conclusion Patients with a negative occupational prognosis often revealed a reduced physical performance and suffered from a high psychosocial burden. In addition, patients’ occupational expectations were a predictor of work capacity at discharge from CR. Affected patients should be identified at admission to allow for targeted psychosocial care.
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Affiliation(s)
- Annett Salzwedel
- Department of Rehabilitation Research, University of Potsdam, Potsdam, Germany
| | - Rona Reibis
- Cardiological Outpatient Clinik Am Park Sanssouci, Potsdam, Germany
| | - Miralem Hadzic
- Department of Rehabilitation Research, University of Potsdam, Potsdam, Germany
| | - Hermann Buhlert
- Department of Cardiology, Klinik Am See, Rehabilitation Centre of Cardiovascular Diseases, Rüdersdorf, Germany
| | - Heinz Völler
- Department of Rehabilitation Research, University of Potsdam, Potsdam, Germany.,Department of Cardiology, Klinik Am See, Rehabilitation Centre of Cardiovascular Diseases, Rüdersdorf, Germany
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Adherence to Treatment of Female Patients With Coronary Heart Disease After a Percutaneous Coronary Intervention. J Cardiovasc Nurs 2019; 34:410-417. [PMID: 31365439 DOI: 10.1097/jcn.0000000000000592] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Adherence to treatment is essential to prevent the progression of coronary heart disease (CHD), which is the most common cause of death among women. Coronary heart disease in women has special characteristics: the conventional risk factors are more harmful to women than men, accumulation of risk factors is common, and women have nontraditional risk factors such as gestational diabetes and preeclampsia. In addition, worse outcomes, higher incidence of death, and complications after percutaneous coronary intervention have been reported more often among females than among male patients. OBJECTIVE The aim of this study was to test a model of adherence to treatment among female patients with CHD after a percutaneous coronary intervention. METHODS A cross-sectional, descriptive, and explanatory survey was conducted in 2013 with 416 patients with CHD, of which the 102 female patients were included in this substudy. Self-reported instruments were used to assess female patient adherence to treatment. Data were analyzed using descriptive statistics and a structural equation model. RESULTS Motivation was the strongest predictor for female patients' perceived adherence to treatment. Informational support, physician support, perceived health, and physical activity were indirectly, but significantly, associated with perceived adherence to treatment via motivation. Furthermore, physical activity was positively associated with perceived health, whereas anxiety and depression were negatively associated with it. CONCLUSIONS Secondary prevention programs and patient education have to take into account individual or unique differences. It is important to pay attention to issues that are known to contribute to motivation rather than to reply on education alone to improve adherence.
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15
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Correlates of memory loss and depression among myocardial infarction patients in Al-Qassim, Saudi Arabia. J Saudi Heart Assoc 2018; 30:240-246. [PMID: 29983498 PMCID: PMC6026394 DOI: 10.1016/j.jsha.2018.04.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Revised: 03/20/2018] [Accepted: 04/18/2018] [Indexed: 11/21/2022] Open
Abstract
Background After myocardial infarction (MI), patients have an elevated risk for depression, which has a negative impact on morbidity and mortality for patients. As depression and memory function are associated, we examined them in the context of one another. Our objectives were to determine the proportion of patients with either depression only, memory loss only, or both depression and memory loss and to examine the correlates with each outcome. Methods This study was a cohort of 264 patients who had myocardial infarction. Data sources included medical records and phone interviews. Results The participants’ mean age was 62 ± 12.2 years and mean body mass index was 28.4 ± 5.8 kg/m2. Of the participants, 6.4% had memory loss alone, 23.17% had depression alone, and 6.1% had combined memory loss and depression. Activity level and poor health were significantly associated with depression only (p < 0.05). Poor health was significantly associated with combined memory loss and depression (p < 0.05). Conclusion Activity level and poor health were identified as correlates of depression as well as combined memory loss and depression. Future studies should aim to improve screening for depression among post-MI patients and develop appropriate interventions to raise the level of activity.
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Nedeljkovic I. Assessment of depression and anxiety in patients before and after percutaneous coronary intervention: A step forward in cardiac rehabilitation? Eur J Prev Cardiol 2018; 25:1015-1016. [PMID: 29707962 DOI: 10.1177/2047487318774094] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Ivana Nedeljkovic
- 1 Cardiology Clinic, Clinical Centre of Serbia, Belgrade, Serbia.,2 School of Medicine, University of Belgrade, Serbia
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