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Wrzeciono A, Mazurek J, Cieślik B, Kiper P, Gajda R, Szczepańska-Gieracha J. Psychologically-enhanced cardiac rehabilitation for psychological and functional improvement in patients with cardiovascular disease: a systematic review with meta-analysis and future research directions. Physiotherapy 2024; 125:101412. [PMID: 39098055 DOI: 10.1016/j.physio.2024.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 05/24/2024] [Accepted: 07/03/2024] [Indexed: 08/06/2024]
Abstract
OBJECTIVE To systematically review the effectiveness of psychologically-enhanced cardiac rehabilitation (CR) in improving psychological and functional outcomes in patients with cardiovascular disease. DATA SOURCES A systematic search was performed in PubMed, Scopus, Cochrane Library, Embase, and Web of Science, up to January 31, 2024. STUDY SELECTION Two reviewers independently identified randomized clinical trials that evaluated the effectiveness of psychologically-enhanced CR in improving psychological and functional outcomes in patients with cardiovascular disease. The search yielded 1848 results. Finally, data from 14 studies (1531 participants) were included in the review. DATA EXTRACTION AND DATA SYNTHESIS Information regarding cardiac rehabilitation phase, duration of the intervention, group characteristics, measured outcomes, and the conclusions drawn by the authors was extracted. The Revised Cochrane risk-of-bias tool for Randomized Trials was used to evaluate the methodological quality. RESULTS Pooled results indicate that psychologically-enhanced CR is more effective than specific cardiac training alone in maintaining lower resting blood pressure, with a mean difference of -3.09 (95% CI: -5.18 to -1.00). Furthermore, psychologically-enhanced CR shows superiority in improving patients' quality of life compared to specific cardiac training alone, with a standardized mean difference of 0.15 (95% CI: 0.01 to 0.31). Analyses of depression and anxiety level, exercise tolerance, and blood lipid profile did not show significant differences between the two treatment conditions. CONCLUSION Psychologically-enhanced CR shows a positive effect on reducing resting blood pressure and improving the quality of life. However, the supportive methods were of limited effectiveness in addressing the psychological aspects of health. SYSTEMATIC REVIEW REGISTRATION NUMBER PROSPERO CRD42022304063. CONTRIBUTION OF THE PAPER.
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Affiliation(s)
- Adam Wrzeciono
- Department of Physiotherapy, Wroclaw University of Health and Sport Sciences, 51-612 Wroclaw, Poland
| | - Justyna Mazurek
- University Rehabilitation Centre, Wroclaw Medical University, 50-367 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
- Department of Kinesiology and Health Prevention, Jan Dlugosz University in Częstochowa, 42-200 Częstochowa, Poland; Center for Sports Cardiology at the Gajda-Med Medical Center in Pultusk, 06-102 Pultusk, Poland
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Magán I, Jurado-Barba R, Casado L, Barnum H, Jeon A, Hernandez AV, Bueno H. Efficacy of psychological interventions on clinical outcomes of coronary artery disease: Systematic review and meta-analysis. J Psychosom Res 2022; 153:110710. [PMID: 34999380 DOI: 10.1016/j.jpsychores.2021.110710] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Revised: 12/18/2021] [Accepted: 12/18/2021] [Indexed: 01/26/2023]
Abstract
OBJECTIVES Psychological factors influence clinical outcomes in patients with coronary artery disease (CAD). Therefore, psychological interventions (PIs) may have beneficial effects in these patients. We evaluated the efficacy of PIs based on cognitive-behavioral therapy (CBT) and positive psychology therapy (PPT) on clinical and laboratory outcomes in CAD. METHODS Randomized controlled trials evaluating CBT or PPT in CAD patients published until May 2020 were systematically reviewed and analyzed. Primary outcomes were all-cause mortality, cardiovascular mortality, any cardiovascular event, myocardial infarction (MI), stroke, coronary revascularization, angina, and readmission. Random effects meta-analyses using the inverse variance method were performed. Effects were expressed as risk ratios (RR) or standardized mean difference (SMD) with 95% confidence intervals (CIs). RESULTS Twenty-five trials were included (n = 8119); 22 evaluating the effects of multi-component CBT (n = 7909), and three PPT (n = 210). Thirteen RCTs were at high risk of bias due to limitations in randomization or blinding. Compared with control groups any cardiovascular event (RR 0.82; 0.70 to 0.97; 5 studies), MI (RR 0.72; 0.52 to 0.98; 9 studies), and angina duration and intensity (SMD -0.64; -0.98 to -0.30; 4 studies; and -0.64; -1.17 to -0.11; 2 trials) were significantly reduced with PIs at the end of follow-up. PIs had no effect on other primary outcomes, laboratory or anthropometrical results and presented a moderate to high heterogeneity. CONCLUSIONS CBT- and PPT-based PIs reduce the risk of cardiovascular events, MI and angina in patients with CAD. Future research should assess the individual role of CBT and PPT in CAD populations.
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Affiliation(s)
- Inés Magán
- Department of Psychology, Facultad de Salud, Universidad Camilo José Cela, Madrid, Spain.
| | - Rosa Jurado-Barba
- Department of Psychology, Facultad de Salud, Universidad Camilo José Cela, Madrid, Spain; Instituto de Investigación Biomédica del Hospital 12 de Octubre (Imas12), Madrid, Spain
| | - Laura Casado
- Department of Psychology, Facultad de Salud, Universidad Camilo José Cela, Madrid, Spain
| | - Haley Barnum
- Health Outcomes, Policy, and Evidence Synthesis (HOPES) Group, University of Connecticut School of Pharmacy, Storrs, CT, USA
| | - Anne Jeon
- Health Outcomes, Policy, and Evidence Synthesis (HOPES) Group, University of Connecticut School of Pharmacy, Storrs, CT, USA
| | - Adrian V Hernandez
- Health Outcomes, Policy, and Evidence Synthesis (HOPES) Group, University of Connecticut School of Pharmacy, Storrs, CT, USA; Vicerrectorado de Investigación, Universidad San Ignacio de Loyola (USIL), Lima, Peru
| | - Héctor Bueno
- Instituto de Investigación Biomédica del Hospital 12 de Octubre (Imas12), Madrid, Spain; Department of Cardiology, Hospital Universitario 12 de Octubre, Madrid, Spain; Multidisciplinary Translational Cardiovascular Research Group, Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain; Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
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Albus C, Herrmann-Lingen C, Jensen K, Hackbusch M, Münch N, Kuncewicz C, Grilli M, Schwaab B, Rauch B. Additional effects of psychological interventions on subjective and objective outcomes compared with exercise-based cardiac rehabilitation alone in patients with cardiovascular disease: A systematic review and meta-analysis. Eur J Prev Cardiol 2019; 26:1035-1049. [PMID: 30857429 PMCID: PMC6604240 DOI: 10.1177/2047487319832393] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Background Exercise-based cardiac rehabilitation (ebCR) often includes various
psychological interventions for lifestyle change or distress management.
However, the additional benefit of specific psychological interventions on
depression, anxiety, quality of life, cardiac morbidity and cardiovascular
or total mortality is not well investigated. Design Systematic review and meta-analysis. Methods Randomized controlled trials and controlled cohort trials published between
January 1995 and October 2017 comparing ebCR with or without pre-specified
psychosocial interventions were selected and evaluated on the basis of
predefined inclusion and outcome criteria. Results Out of 15,373 records, 20 studies were identified, including 4450 patients
with coronary artery disease (88.5%) or congestive heart failure (11.5%),
respectively. Studies were of low to moderate quality and methodological
heterogeneity was high. As compared with ebCR alone, additional
psychological interventions for lifestyle change or distress management
showed a trend to reduce depressive symptoms (standardized mean difference
–0.13, 95% confidence interval (CI) –0.30; 0.05). Furthermore, during a
follow-up of five years, distress management was associated with a trend to
reduce cardiac morbidity (risk ratio 0.74, 95% CI 0.51; 1.07). There was no
evidence for an additional impact of either psychological lifestyle change
interventions or distress management on anxiety, quality of life,
cardiovascular or total mortality. Conclusions Specific psychological interventions offered during ebCR may contribute to a
reduction of depressive symptoms and cardiac morbidity, but there remains
considerable uncertainty under which conditions these interventions exert
their optimal effects. (CRD42015025920).
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Affiliation(s)
- Christian Albus
- 1 Department of Psychosomatics and Psychotherapy, University of Cologne, Germany
| | - Christoph Herrmann-Lingen
- 2 Department of Psychosomatic Medicine and Psychotherapy, University of Göttingen Medical Centre, Germany.,3 German Centre for Cardiovascular Research, partner site Göttingen, Germany
| | - Katrin Jensen
- 4 Institute of Medical Biometry and Informatics, University of Heidelberg, Germany
| | - Matthes Hackbusch
- 4 Institute of Medical Biometry and Informatics, University of Heidelberg, Germany
| | - Nina Münch
- 1 Department of Psychosomatics and Psychotherapy, University of Cologne, Germany
| | - Catharina Kuncewicz
- 2 Department of Psychosomatic Medicine and Psychotherapy, University of Göttingen Medical Centre, Germany
| | - Maurizio Grilli
- 5 Library of the Medical Faculty, University of Mannheim, Germany
| | | | - Bernhard Rauch
- 7 IHF-Institut für Herzinfarktforschung, Ludwigshafen am Rhein, Germany
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Anderson L, Brown JP, Clark AM, Dalal H, Rossau HK, Bridges C, Taylor RS. Patient education in the management of coronary heart disease. Cochrane Database Syst Rev 2017; 6:CD008895. [PMID: 28658719 PMCID: PMC6481392 DOI: 10.1002/14651858.cd008895.pub3] [Citation(s) in RCA: 72] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Coronary heart disease (CHD) is the single most common cause of death globally. However, with falling CHD mortality rates, an increasing number of people live with CHD and may need support to manage their symptoms and improve prognosis. Cardiac rehabilitation is a complex multifaceted intervention which aims to improve the health outcomes of people with CHD. Cardiac rehabilitation consists of three core modalities: education, exercise training and psychological support. This is an update of a Cochrane systematic review previously published in 2011, which aims to investigate the specific impact of the educational component of cardiac rehabilitation. OBJECTIVES 1. To assess the effects of patient education delivered as part of cardiac rehabilitation, compared with usual care on mortality, morbidity, health-related quality of life (HRQoL) and healthcare costs in patients with CHD.2. To explore the potential study level predictors of the effects of patient education in patients with CHD (e.g. individual versus group intervention, timing with respect to index cardiac event). SEARCH METHODS We updated searches from the previous Cochrane review, by searching the Cochrane Central Register of Controlled Trials (CENTRAL) (Cochrane Library, Issue 6, 2016), MEDLINE (Ovid), Embase (Ovid), PsycINFO (Ovid) and CINAHL (EBSCO) in June 2016. Three trials registries, previous systematic reviews and reference lists of included studies were also searched. No language restrictions were applied. SELECTION CRITERIA 1. Randomised controlled trials (RCTs) where the primary interventional intent was education delivered as part of cardiac rehabilitation.2. Studies with a minimum of six-months follow-up and published in 1990 or later.3. Adults with a diagnosis of CHD. DATA COLLECTION AND ANALYSIS Two review authors independently screened all identified references for inclusion based on the above inclusion criteria. One author extracted study characteristics from the included trials and assessed their risk of bias; a second review author checked data. Two independent reviewers extracted outcome data onto a standardised collection form. For dichotomous variables, risk ratios and 95% confidence intervals (CI) were derived for each outcome. Heterogeneity amongst included studies was explored qualitatively and quantitatively. Where appropriate and possible, results from included studies were combined for each outcome to give an overall estimate of treatment effect. Given the degree of clinical heterogeneity seen in participant selection, interventions and comparators across studies, we decided it was appropriate to pool studies using random-effects modelling. We planned to undertake subgroup analysis and stratified meta-analysis, sensitivity analysis and meta-regression to examine potential treatment effect modifiers. We used the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach to evaluate the quality of the evidence and the GRADE profiler (GRADEpro GDT) to create summary of findings tables. MAIN RESULTS This updated review included a total of 22 trials which randomised 76,864 people with CHD to an education intervention or a 'no education' comparator. Nine new trials (8215 people) were included for this update. We judged most included studies as low risk of bias across most domains. Educational 'dose' ranged from one 40 minute face-to-face session plus a 15 minute follow-up call, to a four-week residential stay with 11 months of follow-up sessions. Control groups received usual medical care, typically consisting of referral to an outpatient cardiologist, primary care physician, or both.We found evidence of no difference in effect of education-based interventions on total mortality (13 studies, 10,075 participants; 189/5187 (3.6%) versus 222/4888 (4.6%); random effects risk ratio (RR) 0.80, 95% CI 0.60 to 1.05; moderate quality evidence). Individual causes of mortality were reported rarely, and we were unable to report separate results for cardiovascular mortality or non-cardiovascular mortality. There was evidence of no difference in effect of education-based interventions on fatal and/or non fatal myocardial infarction (MI) (2 studies, 209 participants; 7/107 (6.5%) versus 12/102 (11.8%); random effects RR 0.63, 95% CI 0.26 to 1.48; very low quality of evidence). However, there was some evidence of a reduction with education in fatal and/or non-fatal cardiovascular events (2 studies, 310 studies; 21/152 (13.8%) versus 61/158 (38.6%); random effects RR 0.36, 95% CI 0.23 to 0.56; low quality evidence). There was evidence of no difference in effect of education on the rate of total revascularisations (3 studies, 456 participants; 5/228 (2.2%) versus 8/228 (3.5%); random effects RR 0.58, 95% CI 0.19 to 1.71; very low quality evidence) or hospitalisations (5 studies, 14,849 participants; 656/10048 (6.5%) versus 381/4801 (7.9%); random effects RR 0.93, 95% CI 0.71 to 1.21; very low quality evidence). There was evidence of no difference between groups for all cause withdrawal (17 studies, 10,972 participants; 525/5632 (9.3%) versus 493/5340 (9.2%); random effects RR 1.04, 95% CI 0.88 to 1.22; low quality evidence). Although some health-related quality of life (HRQoL) domain scores were higher with education, there was no consistent evidence of superiority across all domains. AUTHORS' CONCLUSIONS We found no reduction in total mortality, in people who received education delivered as part of cardiac rehabilitation, compared to people in control groups (moderate quality evidence). There were no improvements in fatal or non fatal MI, total revascularisations or hospitalisations, with education. There was some evidence of a reduction in fatal and/or non-fatal cardiovascular events with education, but this was based on only two studies. There was also some evidence to suggest that education-based interventions may improve HRQoL. Our findings are supportive of current national and international clinical guidelines that cardiac rehabilitation for people with CHD should be comprehensive and include educational interventions together with exercise and psychological therapy. Further definitive research into education interventions for people with CHD is needed.
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Affiliation(s)
- Lindsey Anderson
- Institute of Health Research, University of Exeter Medical School, Veysey Building, Salmon Pool Lane, Exeter, UK, EX2 4SG
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Al Dera H, Aldahash R. Physical therapy program improves the physiological impact towards better quality of life and low cardiac risk factors in patients following coronary artery bypass grafting. Systematic review. ACTA MEDICA INTERNATIONAL 2016. [DOI: 10.5530/ami.2016.1.38] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Cramer H, Lauche R, Paul A, Langhorst J, Michalsen A, Dobos G. Mind-Body Medicine in the Secondary Prevention of Coronary Heart Disease. DEUTSCHES ARZTEBLATT INTERNATIONAL 2015; 112:759-67. [PMID: 26585187 PMCID: PMC4660854 DOI: 10.3238/arztebl.2015.0759] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/24/2015] [Revised: 07/02/2015] [Accepted: 07/02/2015] [Indexed: 01/16/2023]
Abstract
BACKGROUND In mind-body medicine (MBM), conventional lifestyle modification measures such as dietary counseling and exercise are supplemented with relaxation techniques and psychological motivational elements. This review studied the effect of MBM on cardiac events and mortality in patients with coronary heart disease (CHD). METHODS This review is based on publications up to and including January 2015 that were retrieved by a systematic search in PubMed, the Cochrane Library, and Scopus. Randomized controlled trials of the effect of MBM programs (versus standard treatment) on cardiac events, overall mortality, and/or cardiac mortality were analyzed. Atherosclerosis, blood pressure, LDL cholesterol, and the body mass index (BMI) were chosen as secondary outcomes. Random-effects meta-analyses were performed. The risk of bias was assessed with the Cochrane tool. RESULTS Twelve trials, performed on a total of 1085 patients, were included in the analysis. Significant differences between groups were found with respect to cardiac events (odds ratio [OR]: 0.38; 95% confidence interval [CI]: 0.23-0.61; p<0.01; heterogeneity [I2]: 0%), but not overall mortality (OR: 0.82; 95% CI: 0.46-1.45; p = 0.49; I2: 0%) or cardiac mortality (OR: 0.98; 95% CI: 0.43-2.25; p = 0.97; I2: 0%). Significant differences between groups were also found with respect to atherosclerosis (mean difference [MD] = -7.86% diameter stenosis; 95% CI: -15.06-[-0.65]; p = 0.03; I2: 0%) and systolic blood pressure (MD = -3.33 mm Hg; 95% CI: -5.76-[-0.91]; p<0.01; I2: 0%), but not with respect to diastolic blood pressure, LDL cholesterol, or BMI. CONCLUSION In patients with CHD, MBM programs can lessen the occurrence of cardiac events, reduce atherosclerosis, and lower systolic blood pressure, but they do not reduce mortality. They can be used as a complement to conventional rehabilitation programs.
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Affiliation(s)
- Holger Cramer
- Department of Internal and Integrative Medicine, Kliniken Essen-Mitte, Faculty of Medicine, University of Duisburg-Essen, Essen
| | - Romy Lauche
- Department of Internal and Integrative Medicine, Kliniken Essen-Mitte, Faculty of Medicine, University of Duisburg-Essen, Essen
| | - Anna Paul
- Department of Internal and Integrative Medicine, Kliniken Essen-Mitte, Faculty of Medicine, University of Duisburg-Essen, Essen
| | - Jost Langhorst
- Department of Internal and Integrative Medicine, Kliniken Essen-Mitte, Faculty of Medicine, University of Duisburg-Essen, Essen
| | - Andreas Michalsen
- Department of Internal and Complementary Medicine, Immanuel Hospital, Berlin
- Institute for Social Medicine, Epidemiology, and Health Economics, Charité-Universitätsmedizin, Berlin
| | - Gustav Dobos
- Department of Internal and Integrative Medicine, Kliniken Essen-Mitte, Faculty of Medicine, University of Duisburg-Essen, Essen
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Dayan V, Ricca R. [Cardiac rehabilitation after coronary artery bypass surgery]. ARCHIVOS DE CARDIOLOGIA DE MEXICO 2014; 84:286-92. [PMID: 25240582 DOI: 10.1016/j.acmx.2014.03.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2013] [Revised: 01/29/2014] [Accepted: 03/12/2014] [Indexed: 11/26/2022] Open
Abstract
Ischemic heart disease is the leading cause of death worldwide with an increase in the incidence in younger populations. Today revascularization strategies are capable of alleviating acute ischemia and/or chronic ischemia. These can be performed percutaneously or through surgery. Even if we improve myocardial perfusion by these methods, the main determinant in maintaining patency of coronary arteries and bypass is a correctly instituted secondary prevention. This is the main focus of cardiac rehabilitation proposals. Although much has been published about the role of cardiac rehabilitation after percutaneous revascularization, there is little work able to synthesize the current state of cardiac rehabilitation in patients undergoing coronary artery bypass surgery. The aim of this paper is to review the effect of rehabilitation in the return to work, survival, functional capacity, depression and anxiety, as well as compare centralized vs. home rehabilitation in this patient population.
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Affiliation(s)
- Victor Dayan
- Cátedra de Cirugía Cardiaca, Centro Cardiovascular Universitario, Hospital de Clínicas, Universidad de la República, Montevideo, Uruguay.
| | - Roberto Ricca
- Cátedra de Cardiología, Centro Cardiovascular Universitario, Hospital de Clínicas, Universidad de la República, Montevideo, Uruguay
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Hoseini S, Soltani F, Babaee Beygi M, Zarifsanaee N. The effect of educational audiotape programme on anxiety and depression in patients undergoing coronary artery bypass graft. J Clin Nurs 2013; 22:1613-9. [DOI: 10.1111/jocn.12125] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/03/2012] [Indexed: 12/01/2022]
Affiliation(s)
- Shirzad Hoseini
- Fatemeh (P.B.U.H) School of Nursing and Midwifery; Shiraz University of Medical Sciences; Shiraz Iran
| | - Fahimeh Soltani
- Fatemeh (P.B.U.H) School of Nursing and Midwifery; Shiraz University of Medical Sciences; Shiraz Iran
| | | | - Nahid Zarifsanaee
- Center of Excellence for Electronic Learning in Medical Sciences, School of Medicine; Shiraz University of Medical Sciences; Shiraz Iran
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Janssen V, Gucht VD, Dusseldorp E, Maes S. Lifestyle modification programmes for patients with coronary heart disease: a systematic review and meta-analysis of randomized controlled trials. Eur J Prev Cardiol 2012; 20:620-40. [DOI: 10.1177/2047487312462824] [Citation(s) in RCA: 144] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
| | | | | | - Stan Maes
- Leiden University, Leiden, The Netherlands
- TNO, Leiden, The Netherlands
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Strid C, Lingfors H, Fridlund B, Mårtensson J. Lifestyle changes in coronary heart disease—Effects of cardiac rehabilitation programs with focus on intensity, duration and content—A systematic review. ACTA ACUST UNITED AC 2012. [DOI: 10.4236/ojn.2012.24060] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Brown JP, Clark AM, Dalal H, Welch K, Taylor RS. Patient education in the management of coronary heart disease. Cochrane Database Syst Rev 2011:CD008895. [PMID: 22161440 DOI: 10.1002/14651858.cd008895.pub2] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Cardiac rehabilitation (CR) is a complex multifaceted intervention consisting of three core modalities: education, exercise training and psychological support. Whilst exercise and psychological interventions for patients with coronary heart disease (CHD) have been the subject of Cochrane systematic reviews, the specific impact of the educational component of CR has not previously been investigated. OBJECTIVES 1. Assess effects of patient education on mortality, morbidity, health-related quality of life (HRQofL) and healthcare costs in patients with CHD.2. Explore study level predictors of the effects of patient education (e.g. individual versus group intervention, timing with respect to index cardiac event). SEARCH METHODS The following databases were searched: The Cochrane Library, (CENTRAL, CDSR, DARE, HTA, NHSEED), MEDLINE (OVID), EMBASE (OVID), PsycINFO (EBSCOhost) and CINAHL (EBSCOhost). Previous systematic reviews and reference lists of included studies were also searched. No language restrictions were applied. SELECTION CRITERIA 1. Randomised controlled trials (RCTs) where the primary interventional intent was education.2. Studies with a minimum of six-months follow-up and published in 1990 or later.3. Adults with diagnosis of CHD. DATA COLLECTION AND ANALYSIS Two review authors selected studies and extracted data. Attempts were made to contact all study authors to obtain relevant information not available in the published manuscript. For dichotomous variables, risk ratios and 95% confidence intervals (CI) were derived for each outcome. For continuous variables, mean differences and 95% CI were calculated for each outcome. MAIN RESULTS Thirteen RCTs involving 68,556 subjects with CHD and follow-up from six to 60 months were found. Overall, methodological quality of included studies was moderate to good. Educational 'dose' ranged from a total of two clinic visits to a four-week residential stay with 11 months of follow-up sessions. Control groups typically received usual medical care. There was no strong evidence of an effect of education on all-cause mortality (Relative Risk (RR): 0.79, 95% CI 0.55 to 1.13), cardiac morbidity (subsequent myocardial infarction RR: 0.63, 95% CI 0.26 to 1.48, revascularisation RR: 0.58, 95% CI 0.19 to 1.71) or hospitalisation (RR: 0.83, 95% CI:0.65 to 1.07). Whilst some HRQofL domain scores were higher with education, there was no consistent evidence of superiority across all domains. Different currencies and years studies were performed making direct comparison of healthcare costs challenging, although there is evidence to suggest education may be cost-saving by reducing subsequent healthcare utilisation.This review had insufficient power to exclude clinically important effects of education on mortality and morbidity of patients with CHD. AUTHORS' CONCLUSIONS We did not find strong evidence that education reduced all cause mortality, cardiac morbidity, revascularisation or hospitalisation compared to control. There was some evidence to suggest that education may improve HRQofL and reduce overall healthcare costs. Whilst our findings are generally supportive of current guidelines that CR should include not only exercise and psychological interventions, further research into education is needed.
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Affiliation(s)
- James Pr Brown
- Anaesthetics Department, Musgrove Park Hospital, Taunton, Somerset, UK, TA1 5DA
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Reibis RK, Bestehorn K, Pittrow D, Jannowitz C, Wegscheider K, Völler H. Elevated risk profile of women in secondary prevention of coronary artery disease: a 6-year survey of 117,913 patients. J Womens Health (Larchmt) 2009; 18:1123-31. [PMID: 19630543 DOI: 10.1089/jwh.2008.1082] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND AND AIMS The prognosis of female patients after acute coronary syndrome (ACS) has been shown to be inferior to that of male patients. Little is known about gender differences during the secondary prevention phase. METHODS After ACS, 117,913 patients (30.7% female) were enrolled in two large-scale German registries from 2000 to 2005 during phase II cardiac rehabilitation (CR). Demographic parameters, reperfusion strategies, cardiovascular risk factors, exercise capacity, and medication use at admission and discharge were assessed. Temporary changes (trends) and gender-specific differences were determined. RESULTS Compared to 2000, patients in 2005 were significantly older (females: 66.4 vs. 68.0 years; males: 62.3 vs. 63.3 years; p = 0.001) and had a higher body mass index (BMI) (females: 27.7 vs. 28.6 kg/m(2); males: 27.6 vs. 28.1 kg/m(2), in 2000 and 2005, respectively, p < 0.001). Target blood pressure <140/90 mm Hg at discharge was obtained in a smaller proportion of women than men (81.0 vs. 83.0%, p < 0.001). Low-density lipoprotein cholesterol (LDL-C) levels at discharge were significantly higher in female patients (95.0 vs. 93.2 mg/dL, p < 0.001); 80.9% of female vs. 83.8% of male patients achieved a target fasting glucose <126 mg/dL during the CR (p < 0.001). Large between-center variability was noted for age, total cholesterol at entry, and exercise capacity at entry and discharge. CONCLUSIONS Although control of cardiovascular risk factors has improved in both genders, over a recent 6-year period, female patients compared with males were less likely to achieve target values for blood pressure, fasting glucose, and lipid values in the early period after acute coronary events.
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Affiliation(s)
- Rona K Reibis
- Department of Cardiology, Klinik am See, Rehabilitation Center of Cardiovascular Disease, Ruedersdorf/Berlin, Germany.
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Toufan M, Afrasiabi A. Benefits of cardiac rehabilitation on lipid profile in patients with coronary artery disease. Pak J Biol Sci 2009; 12:1307-1313. [PMID: 20387745 DOI: 10.3923/pjbs.2009.1307.1313] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
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.
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Affiliation(s)
- M Toufan
- Department of Echocardiography, Shahid Madani Heart Center, Tabriz University of Medical Sciences, Tabriz, Iran
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Jegier A, Jegier A, Szmigielska K, Bilinska M, Brodowski L, Galaszek M, Mrozek P, Olszewska B, Piotrowski W, Przywarska I, Rybicki J, Zielinska D. Health-related quality of life in patients with coronary heart disease after residential vs ambulatory cardiac rehabilitation. Circ J 2009; 73:476-83. [PMID: 19179772 DOI: 10.1253/circj.cj-08-0407] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
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.
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Affiliation(s)
- Anna Jegier
- Department of Sports Medicine, Medical University of Lodz, 90-647 Lodz, Plac Hallera 1, Poland.
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