1
|
Kontoangelos K, Soulis D, Soulaidopoulos S, Antoniou CK, Tsiori S, Papageorgiou C, Martinaki S, Mourikis I, Tsioufis K, Papageorgiou C, Katsi V. Health Related Quality of Life and Cardiovascular Risk Factors. Behav Med 2024; 50:186-194. [PMID: 37224009 DOI: 10.1080/08964289.2023.2202847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 04/10/2023] [Accepted: 04/10/2023] [Indexed: 05/26/2023]
Abstract
Cardiovascular diseases (CVD) is associated with deteriorating of quality of life (QOL) and exercise capacity (EC) but less is known on how EC interplays with QOL. The present study explores the relationship between quality of life and cardiovascular risk factors in people who present in cardiology clinics. A total of 153 adult presentations completed the SF-36 Health Survey and provided data for hypertension, diabetes mellitus, smoking, obesity, hyperlipidemia and history of coronary heart disease. Physical capacity was assessed by treadmill test. were correlated with the scores of the psychometric questionnaires. Participants with longer duration on treadmill exercise score higher on the scale of physical functioning. The study found that treadmill exercise intensity and duration were associated with improved scores in dimensions of the physical component summary and the physical functioning of SF-36, respectively. The presence of cardiovascular risk factors is related to a decreased quality of life. Patients with cardiovascular diseases should undergo particularly detailed analysis of the quality of life along with specific mental factors such as depersonalization and posttraumatic stress disorder.
Collapse
Affiliation(s)
- Konstantinos Kontoangelos
- 1st Department of Psychiatry, Eginition Hospital, Medical School National & Kapodistrian University of Athens, Athens, Greece
- University Mental Health Neurosciences and Precision Medicine Research Institute "Costas Stefanis", Athens, Greece
| | - Dimitris Soulis
- 1st Department of Cardiology, "Hippokration" Hospital, Medical School, National & Kapodistrian University of Athens, Athens, Greece
| | - Stergios Soulaidopoulos
- 1st Department of Cardiology, "Hippokration" Hospital, Medical School, National & Kapodistrian University of Athens, Athens, Greece
| | - Christos Konstantinos Antoniou
- 1st Department of Cardiology, "Hippokration" Hospital, Medical School, National & Kapodistrian University of Athens, Athens, Greece
| | - Sofia Tsiori
- 1st Department of Psychiatry, Eginition Hospital, Medical School National & Kapodistrian University of Athens, Athens, Greece
| | - Christos Papageorgiou
- University Mental Health Neurosciences and Precision Medicine Research Institute "Costas Stefanis", Athens, Greece
| | - Sofia Martinaki
- 1st Department of Psychiatry, Eginition Hospital, Medical School National & Kapodistrian University of Athens, Athens, Greece
| | - Iraklis Mourikis
- 1st Department of Psychiatry, Eginition Hospital, Medical School National & Kapodistrian University of Athens, Athens, Greece
| | - Konstantinos Tsioufis
- 1st Department of Cardiology, "Hippokration" Hospital, Medical School, National & Kapodistrian University of Athens, Athens, Greece
| | - Charalabos Papageorgiou
- University Mental Health Neurosciences and Precision Medicine Research Institute "Costas Stefanis", Athens, Greece
| | - Vasiliki Katsi
- 1st Department of Cardiology, "Hippokration" Hospital, Medical School, National & Kapodistrian University of Athens, Athens, Greece
| |
Collapse
|
2
|
de Carvalho Costa IMNB, Silva DGD, Oliveira JLM, Silva JRS, Pereira LMC, Alves LVS, de Andrade FA, Góes Jorge JD, Oliveira LMSMD, Almeida RRD, Oliveira VB, Martins LS, Costa JO, de Souza MFC, Voci SM, Almeida-Santos MA, Abreu VV, Aidar FJ, Baumworcel L, Sousa ACS. Adherence to secondary prevention measures after acute coronary syndrome in patients associated exclusively with the public and private healthcare systems in Brazil. Prev Med Rep 2022; 29:101973. [PMID: 36161134 PMCID: PMC9502285 DOI: 10.1016/j.pmedr.2022.101973] [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: 04/22/2022] [Revised: 07/28/2022] [Accepted: 08/27/2022] [Indexed: 11/24/2022] Open
Abstract
Adherence to secondary prevention measures after acute coronary syndrome (ACS) is essential to prevent disease recurrence. In Brazil, the Brazilian Unified Health System (SUS, in Portuguese), and the private healthcare system (PHCS) coexist. We aimed to evaluate the adherence to secondary prevention in patients with ACS who were assisted by either SUS or PHCS. In this longitudinal prospective study, patients with ACS were admitted to the four cardiological reference hospitals of Sergipe, three of which assisted PHCS users, and one, SUS users. We analyzed the two patient care models with multiple logistic regression models for adherence to physical activity, pharmacotherapy, and smoking cessation. We enrolled 581 volunteers in this study: 44.1 % from SUS and 55.9 % from PHCS. PHCS users showed greater adherence to pharmacotherapy at both 30 and 180 (p = 0.001) days after ACS with better results in all classes of medications (p < 0.05) than SUS users did. They also showed better adherence to physical activity (p = 0.047). There was no distinction between the groups regarding smoking cessation. The secondary prevention measures after ACS were more effective in PHCS users than in SUS users due to better adherence, especially to pharmacotherapy and regular physical activity.
Collapse
Affiliation(s)
| | - Danielle Góes da Silva
- Program of Post-Graduation in Nutrition Sciences, Federal University of Sergipe, São Cristóvão, Sergipe, Brazil
| | - Joselina Luzia Meneses Oliveira
- Program of Post-Graduation in Health Sciences, Federal University of Sergipe, São Cristóvão, Sergipe, Brazil
- Department of Medicine, Federal University of Sergipe, São Cristóvão, Sergipe, Brazil
- São Lucas Clinic and Hospital / Rede D Or São Luiz, Aracaju, Sergipe, Brazil
- Division of Cardiology, University Hospital, Federal University of Sergipe, Aracaju, Sergipe, Brazil
| | - José Rodrigo Santos Silva
- Department of Statistics and Actuarial Sciences, Federal University of Sergipe, São Cristóvão, Sergipe, Brazil
| | | | - Luciana Vieira Sousa Alves
- Program of Post-Graduation in Health Sciences, Federal University of Sergipe, São Cristóvão, Sergipe, Brazil
| | | | - Juliana de Góes Jorge
- Program of Post-Graduation in Health Sciences, Federal University of Sergipe, São Cristóvão, Sergipe, Brazil
- Department of Physiotherapy, Tiradentes University, Aracaju, Sergipe, Brazil
| | | | - Rebeca Rocha de Almeida
- Program of Post-Graduation in Health Sciences, Federal University of Sergipe, São Cristóvão, Sergipe, Brazil
| | - Victor Batista Oliveira
- Program of Post-Graduation in Health Sciences, Federal University of Sergipe, São Cristóvão, Sergipe, Brazil
| | - Larissa Santos Martins
- Program of Post-Graduation in Nutrition Sciences, Federal University of Sergipe, São Cristóvão, Sergipe, Brazil
| | - Jamille Oliveira Costa
- Program of Post-Graduation in Health Sciences, Federal University of Sergipe, São Cristóvão, Sergipe, Brazil
| | | | - Silvia Maria Voci
- Program of Post-Graduation in Nutrition Sciences, Federal University of Sergipe, São Cristóvão, Sergipe, Brazil
| | - Marcos Antonio Almeida-Santos
- São Lucas Clinic and Hospital / Rede D Or São Luiz, Aracaju, Sergipe, Brazil
- Postgraduate Program in Health and Environment, Tiradentes University, Aracaju, Sergipe, Brazil
| | - Victoria Vieira Abreu
- Program of Post-Graduation in Nutrition Sciences, Federal University of Sergipe, São Cristóvão, Sergipe, Brazil
| | - Felipe J. Aidar
- Group of Studies and Research in Performance, Sport, Health and Paralympic Sports – GEPEPS, Federal University of Sergipe (UFS), São Cristóvão, Sergipe, Brazil
| | - Leonardo Baumworcel
- São Lucas Clinic and Hospital / Rede D Or São Luiz, Aracaju, Sergipe, Brazil
| | - Antônio Carlos Sobral Sousa
- Program of Post-Graduation in Health Sciences, Federal University of Sergipe, São Cristóvão, Sergipe, Brazil
- Department of Medicine, Federal University of Sergipe, São Cristóvão, Sergipe, Brazil
- São Lucas Clinic and Hospital / Rede D Or São Luiz, Aracaju, Sergipe, Brazil
- Division of Cardiology, University Hospital, Federal University of Sergipe, Aracaju, Sergipe, Brazil
| |
Collapse
|
3
|
de Carvalho Costa IMNB, da Silva DG, Oliveira JLM, Silva JRS, de Andrade FA, de Góes Jorge J, de Oliveira LMSM, de Almeida RR, Oliveira VB, Martins LS, Costa JO, de Souza MFC, Pereira LMC, Alves LVS, Voci SM, Almeida-Santos MA, Aidar FJ, Baumworcel L, Sousa ACS. Quality of Life among Patients with Acute Coronary Syndromes Receiving Care from Public and Private Health Care Systems in Brazil. Clin Pract 2022; 12:513-526. [PMID: 35892441 PMCID: PMC9326766 DOI: 10.3390/clinpract12040055] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Revised: 06/27/2022] [Accepted: 07/04/2022] [Indexed: 11/22/2022] Open
Abstract
(1) Background: Quality of life (QOL) is used as a health indicator to assess the effectiveness and impact of therapies in certain groups of patients. This study aimed to analyze the QOL of patients with acute coronary syndrome (ACS) who received medical treatment by a public or private health care system. (2) Methods: This observational, prospective, longitudinal study was carried out in four referral hospitals providing cardiology services in Sergipe, Brazil. QoL was evaluated using the Medical Outcomes Study 36-Item Short-Form Health Survey. The volunteers were divided into two groups (public or private health care group) according to the type of health care provided. Multiple linear regression models were used to evaluate QoL at 180 days after ACS. (3) Results: A total of 581 patients were eligible, including 44.1% and 55.9% for public and private health care, respectively. At 180 days after ACS, the public health care group had lower QoL scores for all domains (functional capacity, physical aspects, pain, general health status, vitality, social condition, emotional profile, and health) (p < 0.05) than the private group. The highest QoL level was associated with male sex (p < 0.05) and adherence to physical activity (p ≤ 0.003) for all assessed domains. (4) Conclusions: This shows that social factors and health status disparities influence QoL after ACS in Sergipe.
Collapse
Affiliation(s)
- Ingrid Maria Novais Barros de Carvalho Costa
- Graduation Program in Health Sciences, Federal University of Sergipe, São Cristóvão 49100-000, Brazil; (I.M.N.B.d.C.C.); (J.L.M.O.); (J.d.G.J.); (L.M.S.M.d.O.); (V.B.O.); (J.O.C.); (L.M.C.P.); (L.V.S.A.); (L.B.); (A.C.S.S.)
- Federal Institute of Sergipe, São Cristóvão 49100-000, Brazil
| | - Danielle Góes da Silva
- Department of Nutrition, Federal University of Sergipe, São Cristóvão 49100-000, Brazil; (D.G.d.S.); (S.M.V.)
| | - Joselina Luzia Meneses Oliveira
- Graduation Program in Health Sciences, Federal University of Sergipe, São Cristóvão 49100-000, Brazil; (I.M.N.B.d.C.C.); (J.L.M.O.); (J.d.G.J.); (L.M.S.M.d.O.); (V.B.O.); (J.O.C.); (L.M.C.P.); (L.V.S.A.); (L.B.); (A.C.S.S.)
- Department of Medicine, Federal University of Sergipe, São Cristóvão 49100-000, Brazil
- São Lucas Clinic and Hospital/Rede D’Or São Luiz, Aracaju 49015-380, Brazil;
- Division of Cardiology, University Hospital, Federal University of Sergipe, Aracaju 49060-025, Brazil
| | - José Rodrigo Santos Silva
- Department of Statistics and Actuarial Sciences, Federal University of Sergipe, São Cristóvão 49100-000, Brazil;
| | | | - Juliana de Góes Jorge
- Graduation Program in Health Sciences, Federal University of Sergipe, São Cristóvão 49100-000, Brazil; (I.M.N.B.d.C.C.); (J.L.M.O.); (J.d.G.J.); (L.M.S.M.d.O.); (V.B.O.); (J.O.C.); (L.M.C.P.); (L.V.S.A.); (L.B.); (A.C.S.S.)
| | - Larissa Marina Santana Mendonça de Oliveira
- Graduation Program in Health Sciences, Federal University of Sergipe, São Cristóvão 49100-000, Brazil; (I.M.N.B.d.C.C.); (J.L.M.O.); (J.d.G.J.); (L.M.S.M.d.O.); (V.B.O.); (J.O.C.); (L.M.C.P.); (L.V.S.A.); (L.B.); (A.C.S.S.)
| | - Rebeca Rocha de Almeida
- Graduation Program in Health Sciences, Federal University of Sergipe, São Cristóvão 49100-000, Brazil; (I.M.N.B.d.C.C.); (J.L.M.O.); (J.d.G.J.); (L.M.S.M.d.O.); (V.B.O.); (J.O.C.); (L.M.C.P.); (L.V.S.A.); (L.B.); (A.C.S.S.)
| | - Victor Batista Oliveira
- Graduation Program in Health Sciences, Federal University of Sergipe, São Cristóvão 49100-000, Brazil; (I.M.N.B.d.C.C.); (J.L.M.O.); (J.d.G.J.); (L.M.S.M.d.O.); (V.B.O.); (J.O.C.); (L.M.C.P.); (L.V.S.A.); (L.B.); (A.C.S.S.)
| | - Larissa Santos Martins
- Graduate Program in Nutrition Sciences, Federal University of Sergipe, São Cristóvão 49100-000, Brazil;
| | - Jamille Oliveira Costa
- Graduation Program in Health Sciences, Federal University of Sergipe, São Cristóvão 49100-000, Brazil; (I.M.N.B.d.C.C.); (J.L.M.O.); (J.d.G.J.); (L.M.S.M.d.O.); (V.B.O.); (J.O.C.); (L.M.C.P.); (L.V.S.A.); (L.B.); (A.C.S.S.)
| | | | - Larissa Monteiro Costa Pereira
- Graduation Program in Health Sciences, Federal University of Sergipe, São Cristóvão 49100-000, Brazil; (I.M.N.B.d.C.C.); (J.L.M.O.); (J.d.G.J.); (L.M.S.M.d.O.); (V.B.O.); (J.O.C.); (L.M.C.P.); (L.V.S.A.); (L.B.); (A.C.S.S.)
| | - Luciana Vieira Sousa Alves
- Graduation Program in Health Sciences, Federal University of Sergipe, São Cristóvão 49100-000, Brazil; (I.M.N.B.d.C.C.); (J.L.M.O.); (J.d.G.J.); (L.M.S.M.d.O.); (V.B.O.); (J.O.C.); (L.M.C.P.); (L.V.S.A.); (L.B.); (A.C.S.S.)
| | - Silvia Maria Voci
- Department of Nutrition, Federal University of Sergipe, São Cristóvão 49100-000, Brazil; (D.G.d.S.); (S.M.V.)
| | - Marcos Antonio Almeida-Santos
- São Lucas Clinic and Hospital/Rede D’Or São Luiz, Aracaju 49015-380, Brazil;
- Graduate Program in Health and Environment, Tiradentes University, Aracaju 49032-490, Brazil
| | - Felipe J. Aidar
- Group of Studies and Research in Performance, Sport, Health and Paralympic Sports–GEPEPS, Federal University of Sergipe, São Cristóvão 49100-000, Brazil
| | - Leonardo Baumworcel
- Graduation Program in Health Sciences, Federal University of Sergipe, São Cristóvão 49100-000, Brazil; (I.M.N.B.d.C.C.); (J.L.M.O.); (J.d.G.J.); (L.M.S.M.d.O.); (V.B.O.); (J.O.C.); (L.M.C.P.); (L.V.S.A.); (L.B.); (A.C.S.S.)
- São Lucas Clinic and Hospital/Rede D’Or São Luiz, Aracaju 49015-380, Brazil;
| | - Antônio Carlos Sobral Sousa
- Graduation Program in Health Sciences, Federal University of Sergipe, São Cristóvão 49100-000, Brazil; (I.M.N.B.d.C.C.); (J.L.M.O.); (J.d.G.J.); (L.M.S.M.d.O.); (V.B.O.); (J.O.C.); (L.M.C.P.); (L.V.S.A.); (L.B.); (A.C.S.S.)
- Department of Medicine, Federal University of Sergipe, São Cristóvão 49100-000, Brazil
- São Lucas Clinic and Hospital/Rede D’Or São Luiz, Aracaju 49015-380, Brazil;
- Division of Cardiology, University Hospital, Federal University of Sergipe, Aracaju 49060-025, Brazil
| |
Collapse
|
4
|
Lenasi H, Novak A, Jug B, Dervišević E, Karpljuk D, Videmšek M, Sorić M, Hadžić V. An Alternative Prediction Equation for Evaluation of Six-Minute Walk Distance in Stable Coronary Artery Disease Patients. Front Physiol 2022; 13:844847. [PMID: 35432004 PMCID: PMC9008480 DOI: 10.3389/fphys.2022.844847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Accepted: 03/17/2022] [Indexed: 11/13/2022] Open
Abstract
Background: As cardio-vascular diseases are the leading cause of death worldwide, establishing measures to improve cardiovascular health is of crucial importance. Exercise plays an essential role in cardiac rehabilitation of patients with coronary artery disease (CAD), in whom an evaluation of the cardiorespiratory fitness (CRF) is necessary. CRF of CAD patients could be assessed using 6-min walk test (6MWT), and the results interpreted by using Enright-Sherill prediction equation which has mainly been designed and evaluated for a healthy population. Hypothesizing that the Enright-Sherill prediction equation might not be best suited for CAD patients, our aim was to reevaluate this equation in CAD patients, and potentially establish a more accurate 6MWD prediction equation to be applied in these patients.Methods: 6MWD was measured in a cross-sectional study in 67 CAD patients (44 women) who were members of the Coronary club Ljubljana, Slovenia. In addition, the predicted 6MWD was calculated for men and women using Enright-Sherill gender specific regression equation. Multivariate regression analysis was used to obtain a new prediction equation, and the agreement between the measured and the predicted 6MWD analyzed using the repeated measures ANOVA.Results: Men achieved 451 ± 122 m and women 485 ± 69 m without significant differences between sexes (F = 0.022, p = 0.882) when adjusted for age, height, body mass, and waist circumference. When comparing the measured (473 ± 91 m) and the predicted (422 ± 57 m) values of 6MWD in CAD patients we found that the Enright-Sherill prediction equation significantly (F = 27.734, p < 0.001) underestimated the 6MWD by 52 ± 81 m. A significant regression equation was established [F (3,63) = 44.663, p < 0.001], with a R2 of 0.680 where 6MWD equals 1,057 m—4.966 x age (years)—0.614 x WC (cm)–68.629 x NYHA class.Conclusion: The results of this study stress the importance of regular and actual walking ability testing in patients with stable CAD to obtain their CRF, rather than simply predicting it from regression equations obtained from non-representative or non-comparable samples. Our developed prediction equation warrants additional validation and may represent a good substitute for currently used predictions obtained from a healthy population.
Collapse
Affiliation(s)
- Helena Lenasi
- Institute of Physiology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Ana Novak
- Sports & Medicine Department, Faculty of Sport, University of Ljubljana, Ljubljana, Slovenia
| | - Borut Jug
- Department of Vascular Diseases, Division of Internal Medicine, University Medical Center, Ljubljana, Slovenia
| | - Edvin Dervišević
- Sports & Medicine Department, Faculty of Sport, University of Ljubljana, Ljubljana, Slovenia
| | - Damir Karpljuk
- Sports & Medicine Department, Faculty of Sport, University of Ljubljana, Ljubljana, Slovenia
| | - Mateja Videmšek
- Sports & Medicine Department, Faculty of Sport, University of Ljubljana, Ljubljana, Slovenia
| | - Maroje Sorić
- Department of Sport and Exercise Medicine, Faculty of Kinesiology, University of Zagreb, Zagreb, Croatia
| | - Vedran Hadžić
- Sports & Medicine Department, Faculty of Sport, University of Ljubljana, Ljubljana, Slovenia
- *Correspondence: Vedran Hadžić,
| |
Collapse
|
5
|
Dibben G, Faulkner J, Oldridge N, Rees K, Thompson DR, Zwisler AD, Taylor RS. Exercise-based cardiac rehabilitation for coronary heart disease. Cochrane Database Syst Rev 2021; 11:CD001800. [PMID: 34741536 PMCID: PMC8571912 DOI: 10.1002/14651858.cd001800.pub4] [Citation(s) in RCA: 104] [Impact Index Per Article: 34.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Coronary heart disease (CHD) is the most common cause of death globally. However, with falling CHD mortality rates, an increasing number of people living with CHD may need support to manage their symptoms and prognosis. Exercise-based cardiac rehabilitation (CR) aims to improve the health and outcomes of people with CHD. This is an update of a Cochrane Review previously published in 2016. OBJECTIVES To assess the clinical effectiveness and cost-effectiveness of exercise-based CR (exercise training alone or in combination with psychosocial or educational interventions) compared with 'no exercise' control, on mortality, morbidity and health-related quality of life (HRQoL) in people with CHD. SEARCH METHODS We updated searches from the previous Cochrane Review, by searching CENTRAL, MEDLINE, Embase, and two other databases in September 2020. We also searched two clinical trials registers in June 2021. SELECTION CRITERIA We included randomised controlled trials (RCTs) of exercise-based interventions with at least six months' follow-up, compared with 'no exercise' control. The study population comprised adult men and women who have had a myocardial infarction (MI), coronary artery bypass graft (CABG) or percutaneous coronary intervention (PCI), or have angina pectoris, or coronary artery disease. DATA COLLECTION AND ANALYSIS We screened all identified references, extracted data and assessed risk of bias according to Cochrane methods. We stratified meta-analysis by duration of follow-up: short-term (6 to 12 months); medium-term (> 12 to 36 months); and long-term ( > 3 years), and used meta-regression to explore potential treatment effect modifiers. We used GRADE for primary outcomes at 6 to 12 months (the most common follow-up time point). MAIN RESULTS: This review included 85 trials which randomised 23,430 people with CHD. This latest update identified 22 new trials (7795 participants). The population included predominantly post-MI and post-revascularisation patients, with a mean age ranging from 47 to 77 years. In the last decade, the median percentage of women with CHD has increased from 11% to 17%, but females still account for a similarly small percentage of participants recruited overall ( < 15%). Twenty-one of the included trials were performed in low- and middle-income countries (LMICs). Overall trial reporting was poor, although there was evidence of an improvement in quality over the last decade. The median longest follow-up time was 12 months (range 6 months to 19 years). At short-term follow-up (6 to 12 months), exercise-based CR likely results in a slight reduction in all-cause mortality (risk ratio (RR) 0.87, 95% confidence interval (CI) 0.73 to 1.04; 25 trials; moderate certainty evidence), a large reduction in MI (RR 0.72, 95% CI 0.55 to 0.93; 22 trials; number needed to treat for an additional beneficial outcome (NNTB) 75, 95% CI 47 to 298; high certainty evidence), and a large reduction in all-cause hospitalisation (RR 0.58, 95% CI 0.43 to 0.77; 14 trials; NNTB 12, 95% CI 9 to 21; moderate certainty evidence). Exercise-based CR likely results in little to no difference in risk of cardiovascular mortality (RR 0.88, 95% CI 0.68 to 1.14; 15 trials; moderate certainty evidence), CABG (RR 0.99, 95% CI 0.78 to 1.27; 20 trials; high certainty evidence), and PCI (RR 0.86, 95% CI 0.63 to 1.19; 13 trials; moderate certainty evidence) up to 12 months' follow-up. We are uncertain about the effects of exercise-based CR on cardiovascular hospitalisation, with a wide confidence interval including considerable benefit as well as harm (RR 0.80, 95% CI 0.41 to 1.59; low certainty evidence). There was evidence of substantial heterogeneity across trials for cardiovascular hospitalisations (I2 = 53%), and of small study bias for all-cause hospitalisation, but not for all other outcomes. At medium-term follow-up, although there may be little to no difference in all-cause mortality (RR 0.90, 95% CI 0.80 to 1.02; 15 trials), MI (RR 1.07, 95% CI 0.91 to 1.27; 12 trials), PCI (RR 0.96, 95% CI 0.69 to 1.35; 6 trials), CABG (RR 0.97, 95% CI 0.77 to 1.23; 9 trials), and all-cause hospitalisation (RR 0.92, 95% CI 0.82 to 1.03; 9 trials), a large reduction in cardiovascular mortality was found (RR 0.77, 95% CI 0.63 to 0.93; 5 trials). Evidence is uncertain for difference in risk of cardiovascular hospitalisation (RR 0.92, 95% CI 0.76 to 1.12; 3 trials). At long-term follow-up, although there may be little to no difference in all-cause mortality (RR 0.91, 95% CI 0.75 to 1.10), exercise-based CR may result in a large reduction in cardiovascular mortality (RR 0.58, 95% CI 0.43 to 0.78; 8 trials) and MI (RR 0.67, 95% CI 0.50 to 0.90; 10 trials). Evidence is uncertain for CABG (RR 0.66, 95% CI 0.34 to 1.27; 4 trials), and PCI (RR 0.76, 95% CI 0.48 to 1.20; 3 trials). Meta-regression showed benefits in outcomes were independent of CHD case mix, type of CR, exercise dose, follow-up length, publication year, CR setting, study location, sample size or risk of bias. There was evidence that exercise-based CR may slightly increase HRQoL across several subscales (SF-36 mental component, physical functioning, physical performance, general health, vitality, social functioning and mental health scores) up to 12 months' follow-up; however, these may not be clinically important differences. The eight trial-based economic evaluation studies showed exercise-based CR to be a potentially cost-effective use of resources in terms of gain in quality-adjusted life years (QALYs). AUTHORS' CONCLUSIONS This updated Cochrane Review supports the conclusions of the previous version, that exercise-based CR provides important benefits to people with CHD, including reduced risk of MI, a likely small reduction in all-cause mortality, and a large reduction in all-cause hospitalisation, along with associated healthcare costs, and improved HRQoL up to 12 months' follow-up. Over longer-term follow-up, benefits may include reductions in cardiovascular mortality and MI. In the last decade, trials were more likely to include females, and be undertaken in LMICs, increasing the generalisability of findings. Well-designed, adequately-reported RCTs of CR in people with CHD more representative of usual clinical practice are still needed. Trials should explicitly report clinical outcomes, including mortality and hospital admissions, and include validated HRQoL outcome measures, especially over longer-term follow-up, and assess costs and cost-effectiveness.
Collapse
Affiliation(s)
- Grace Dibben
- MRC/CSO Social and Public Health Sciences Unit, Institute of Health and Well Being, University of Glasgow, Glasgow, UK
| | - James Faulkner
- Faculty Health and Wellbeing, School of Sport, Health and Community, University of Winchester, Winchester, UK
| | - Neil Oldridge
- College of Health Sciences, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin, USA
| | - Karen Rees
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - David R Thompson
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK
| | - Ann-Dorthe Zwisler
- REHPA, The Danish Knowledge Centre for Rehabilitation and Palliative Care, Odense University Hospital, Nyborg, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Rod S Taylor
- MRC/CSO Social and Public Health Sciences Unit & Robertson Centre for Biostatistics, Institute of Health and Well Being, University of Glasgow, Glasgow, UK
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| |
Collapse
|
6
|
Muthukrishnan R, Malik GS, Gopal K, Shehata MA. Power walking based outpatient cardiac rehabilitation in patients with post-coronary angioplasty: Randomized control trial. PHYSIOTHERAPY RESEARCH INTERNATIONAL 2021; 26:e1919. [PMID: 34231290 DOI: 10.1002/pri.1919] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 05/06/2021] [Accepted: 06/22/2021] [Indexed: 01/03/2023]
Abstract
PURPOSE The purpose of this trial was to compare the effectiveness of standardized outpatient cardiac rehabilitation combined with treadmill power walking versus standardized outpatient cardiac rehabilitation alone on health-related quality of life (HQoL), functional exercise capacity (FEC), left ventricular ejection fraction (LVEF) and metabolic equivalent of tasks (METs) in patients who went post coronary angioplasty (CA). Further this study evaluated the association between average numbers of steps taken with above clinical outcomes. METHODS In a pragmatic sequential randomized clinical trial, 24 patients were randomized into two groups (n = 12) and participated in a standardized outpatient cardiac rehabilitation program (SOCRP) with treadmill power walking as an intervention group and SOCRP alone in control group. Scores obtained before and after 4 weeks of intervention, that is, after 12 treatment sessions were assessed using a HQoL questionnaire and 6-min walk test (6 MWT). Average number of steps taken throughout the 4 weeks, METs and LVEF values were obtained by pedometer, exercise stress testing and echocardiogram respectively. RESULTS Significant improvements were found in intergroup and intragroup comparison after 4 weeks of cardiac rehabilitation (p < 0.05). Scores of 6 MWT and LVEF significantly improved in the intervention group (p < 0.003) compared to the control group (p < 0.032). HQoL components that is, global and physical, MET values and average number of steps were significantly higher in the intervention group compared to the control group (p < 0.001). CONCLUSION SOCRP with power walking was more effective in improving HQoL, FEC, LVEF, METs and average numbers of steps than SOCRP alone although both interventions were significant after 4 weeks in patients underwent CA and completed cardiac rehabilitation program. Positive significant associations were found between the average number of steps taken with scores of METs and scores of global and physical domains of HQoL.
Collapse
Affiliation(s)
- Ramprasad Muthukrishnan
- Department of Physiotherapy, College of Health Science, Gulf Medical University, Ajman, UAE.,Thumbay Physical Therapy & Rehabilitation Hospital, Ajman, UAE
| | - Gulshan Shahzadi Malik
- Department of Physiotherapy, College of Health Science, Gulf Medical University, Ajman, UAE.,Department of Physiotherapy, Thumbay Hospital Dubai, Dubai, UAE
| | - Kumaraguruparan Gopal
- Department of Physiotherapy, College of Health Science, Gulf Medical University, Ajman, UAE
| | - Mohamed Abdelsamie Shehata
- Department of Physiotherapy, Thumbay Hospital Dubai, Dubai, UAE.,Department of Cardiology, Thumbay Hospital Dubai, Dubai, UAE.,Ain Shams University Hospital, Cairo, Egypt
| |
Collapse
|
7
|
Serrano-Rosa MÁ, León-Zarceño E, Giglio C, Boix-Vilella S, Moreno-Tenas A, Pamies-Aubalat L, Arrarte V. Psychological State after an Acute Coronary Syndrome: Impact of Physical Limitations. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18126473. [PMID: 34203851 PMCID: PMC8296290 DOI: 10.3390/ijerph18126473] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 06/09/2021] [Accepted: 06/13/2021] [Indexed: 11/16/2022]
Abstract
The aim of this study was to investigate how physical limitations after ACS influence patients' quality of life and health perception. This was a longitudinal clinical study. We recruited 146 patients diagnosed with ACS. The patients performed a stress test (Bruce's protocol) for the evaluation of physical limitations and were classified according to the test result: without physical limitations (more than 10 METS), with some physical limitations (7 to 9 METS), and with high physical limitations (less than 6 METS). Significant differences were found between the three groups immediately after the diagnosis of ACS and after a period of three months, regarding health perception, anxiety, depression, sexual relationships, distress, and adjustment to disease. These differences resulted larger between the group with less limitations and the group with higher limitations. After 3 months, however, there was an overall improvement in all variables. In conclusion, physical limitations after ACS seem to influence perceived quality of life determined by measuring general health, vitality, total adaptation, emotional role, social adaptation, depression, and anxiety. Therefore, the highest the physical limitations, the poorer the psychological conditions and vice versa, even 3 months after ACS diagnosis.
Collapse
Affiliation(s)
| | - Eva León-Zarceño
- Departamento de Ciencias del Comportamiento y Salud, Universidad Miguel Hernández de Elche, 03202 Elche, Spain; (A.M.-T.); (L.P.-A.)
- Correspondence:
| | - Cristina Giglio
- Department of Psychobiology, University of Valencia, 46010 Valencia, Spain; (M.-Á.S.-R.); (C.G.)
| | - Salvador Boix-Vilella
- Facultad de Humanidades y Ciencias Sociales, Universidad Isabel I. Burgos, 09003 Burgos, Spain;
| | - Antonio Moreno-Tenas
- Departamento de Ciencias del Comportamiento y Salud, Universidad Miguel Hernández de Elche, 03202 Elche, Spain; (A.M.-T.); (L.P.-A.)
| | - Lidia Pamies-Aubalat
- Departamento de Ciencias del Comportamiento y Salud, Universidad Miguel Hernández de Elche, 03202 Elche, Spain; (A.M.-T.); (L.P.-A.)
| | - Vicente Arrarte
- Cardiology Unit, Hospital of Alicante, 03010 Alicante, Spain;
| |
Collapse
|