Depressive mood after a cardiac event: gender inequality and participation in rehabilitation programme

Factors associated with depressive symptoms in patients with acute coronary syndrome undergoing percutaneous coronary intervention: A prospective cohort study

AIM

To identify the association between possible factors and depression among post-percutaneous coronary intervention patients with acute coronary syndrome.

DESIGN

Prospective cohort study.

METHODS

Sixty-eight post-percutaneous coronary intervention patients with acute coronary syndrome were enrolled between January 2016 - June 2017. The Hospital Anxiety and Depression Scale scores at 1-3 months after discharge were regressed onto uncertainty in illness and other clinical factors based on the Roy Adaptation Model.

RESULTS

Thirty-six patients were included in the final analysis. Higher baseline depression scores, higher changes in uncertainty in illness and feeling annoyed by troublesome tasks after discharge were associated with higher depressive scores at 1 month after discharge. Careful observation and support of patients' ineffective responses in self-concept mode may be effective in preventing depression.

Gender, race and cardiac rehabilitation in the United States: is there a difference in care?

Coronary heart disease is the leading cause of death within the United States, involving both genders and among all races and ethnic populations. Cardiac rehabilitation (CR) has been shown to significantly improve morbidity and mortality, and these benefits extend to individuals of both genders and all ages with coronary heart disease. Despite this, referral and participation rates remain surprisingly low. Furthermore, women and minorities have even lower referral rates than do their male and white counterparts. Over the course of this article, we will review CR referral and participation among women, as well as racial and ethnic minorities in the United States. We will also examine barriers to CR participation among these subgroups.

Mobilization Patterns of Patients After an Acute Myocardial Infarction

This study was aimed to identify the mobilization patterns of acute myocardial infarction (AMI) patients during their first three days in the coronary care unit (CCU) by performing a prospective observational pilot study design. The study included 31 diagnosed AMI patients admitted to three CCUs. Mobilization patterns classified as bed rest, semi-fowler, transfer to chair, and standing/walking were documented by CCU nurses for 72 consecutive hours after patient admission to the CCU. Of 2,232 possible mobilization periods (72 hr × 31 patients), 1,385 recorded observations of mobilization (62%) were obtained. Bed rest and semi-fowler positions were the most common mobilization patterns; together they accounted for 70% of the documented positions over the first 72 hr in the CCU. Patients who experience an uncomplicated AMI spend the majority of their first 72 hr in CCU in bed.

A systematic review of patient reported factors associated with uptake and completion of cardiovascular lifestyle behaviour change

BACKGROUND

Healthy lifestyles are an important facet of cardiovascular risk management. Unfortunately many individuals fail to engage with lifestyle change programmes. There are many factors that patients report as influencing their decisions about initiating lifestyle change. This is challenging for health care professionals who may lack the skills and time to address a broad range of barriers to lifestyle behaviour. Guidance on which factors to focus on during lifestyle consultations may assist healthcare professionals to hone their skills and knowledge leading to more productive patient interactions with ultimately better uptake of lifestyle behaviour change support. The aim of our study was to clarify which influences reported by patients predict uptake and completion of formal lifestyle change programmes.

METHODS

A systematic narrative review of quantitative observational studies reporting factors (influences) associated with uptake and completion of lifestyle behaviour change programmes. Quantitative observational studies involving patients at high risk of cardiovascular events were identified through electronic searching and screened against pre-defined selection criteria. Factors were extracted and organised into an existing qualitative framework.

RESULTS

374 factors were extracted from 32 studies. Factors most consistently associated with uptake of lifestyle change related to support from family and friends, transport and other costs, and beliefs about the causes of illness and lifestyle change. Depression and anxiety also appear to influence uptake as well as completion. Many factors show inconsistent patterns with respect to uptake and completion of lifestyle change programmes.

CONCLUSION

There are a small number of factors that consistently appear to influence uptake and completion of cardiovascular lifestyle behaviour change. These factors could be considered during patient consultations to promote a tailored approach to decision making about the most suitable type and level lifestyle behaviour change support.

Sense of coherence as well as social support and network as perceived by patients with a suspected or manifest myocardial infarction: a short-term follow-up study

OBJECTIVE

To compare sense of coherence as well as social support and network as perceived by ischaemic heart disease patients at baseline and two weeks post-discharge in terms of age, sex, educational and marital status.

DESIGN

Multicentre study with a prospective short-term follow-up design.

SETTING

A university hospital, a central hospital and a district hospital in southern Sweden.

SUBJECTS

Consecutive sample of 246 patients with a suspect or manifest myocardial infarction.

MAIN MEASURES

The Lubben Social Network Scale (LSNS-R), the Medical Outcome Study (MOS) Social Support Survey and the Sense of Coherence Scale were included in a self-administered questionnaire and answered twice, together with sociodemographic variables.

RESULTS

Bivariate analyses indicated changes in social support (practical support increased in men and decreased in women; both P= 0.003) and social network (family network increased among >65 year olds; P= 0.001, men; P= 0.013, and women; P= 0.033, those with a low; P=0.017, and intermediate; P= 0.033, educational level, as well as those cohabiting; P= 0.0001), but did not reveal any difference in sense of coherence.

CONCLUSIONS

Sociodemographic variables have no influence on sense of coherence but do affect social support (i.e. practical support and social network, family). Ischaemic heart disease patients' short stay in hospital implies that the network outside the hospital has to assume responsibility, but at the same time it is important for health care professionals to have sufficient knowledge to be able to support the specific needs of patients and their family members.

Do recent life events and social support explain gender differences in depressive symptoms in patients who had percutaneous transluminal coronary angioplasty?

OBJECTIVE

Previous studies have documented that among patients with coronary artery disease (CAD), depressive symptoms are more common in women than in men. The objective of this study was to determine if this disparity was explained by gender differences in stressful life events and in perceived social support.

METHODS

This was a cross-sectional study involving patients who recently had percutaneous transluminal coronary angioplasty (PTCA). Logistic regression was used to test the associations among gender, depressive symptoms, stressful life events, and social support. Depressive symptoms were measured with the Center for Epidemiologic Studies Depression Scale (CES-D).

RESULTS

Of the 660 patients enrolled, 27% were women. A higher proportion of women than men were classified as having substantial depressive symptoms based on a cutoff score of > or =16 on the CES-D (43% vs. 29%, p < 0.01). More women reported experiencing personal stressful life events than men (33% vs. 23%, p < 0.05). Fewer women than men reported having tangible support, which in this study was defined as having someone available to help with chores (68% vs. 85%, p < 0.001). On mediation analysis, the strength of the association between gender and depressive symptoms was diminished after personal stress and tangible social support variables were added to the logistic regression model.

CONCLUSIONS

In this population of postangioplasty patients, more women reported having depressive symptoms than men. This disparity may be partially explained by the finding that compared with men, more women experienced personal stressful life events and perceived less tangible support.

A comprehensive view of sex-specific issues related to cardiovascular disease

Cardiovascular disease (CVD) is the leading cause of mortality in women. In fact, CVD is responsible for a third of all deaths of women worldwide and half of all deaths of women over 50 years of age in developing countries. The prevalence of CVD risk factor precursors is increasing in children. Retrospective analyses suggest that there are some clinically relevant differences between women and men in terms of prevalence, presentation, management and outcomes of the disease, but little is known about why CVD affects women and men differently. For instance, women with diabetes have a significantly higher CVD mortality rate than men with diabetes. Similarly, women with atrial fibrillation are at greater risk of stroke than men with atrial fibrillation. Historically, women have been underrepresented in clinical trials. The lack of good trial evidence concerning sex-specific outcomes has led to assumptions about CVD treatment in women, which in turn may have resulted in inadequate diagnoses and suboptimal management, greatly affecting outcomes. This knowledge gap may also explain why cardiovascular health in women is not improving as fast as that of men. Over the last decades, mortality rates in men have steadily declined, while those in women remained stable. It is also becoming increasingly evident that gender differences in cultural, behavioural, psychosocial and socioeconomic status are responsible, to various degrees, for the observed differences between women and men. However, the interaction between sex-and gender-related factors and CVD outcomes in women remains largely unknown.