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Gamage CKW, De Zoysa PT, Balasuriya A, Fernando NFJ. Anxiety, depression, and Type D personality in ischaemic heart disease patients receiving treatment from outpatient clinics in a government hospital in Sri Lanka. DISCOVER MENTAL HEALTH 2024; 4:26. [PMID: 39120785 PMCID: PMC11315848 DOI: 10.1007/s44192-024-00080-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Accepted: 07/15/2024] [Indexed: 08/10/2024]
Abstract
BACKGROUND Anxiety, depression, and Type D personality are strongly correlated with the prognosis of IHD and the effectiveness of therapy. The main purpose of this study was to assess the proportions and associations of anxiety, depression, and Type D personality among clinically stable IHD patients (aged 18-60) treated at an outpatient clinic operated by a government hospital in Sri Lanka, who were diagnosed with IHD within the preceding three months. METHODS A cross-sectional study design was analysed using SPSS® version 23.0. The validated Sinhalese version of the Hospital Anxiety and Depression Scale (HADS) was used to measure anxiety and depression, while the DS-14 was used to determine Type D personality traits. RESULTS Among the 399 patients, 29.8% (n = 119) had anxiety, 24.8% (n = 99) had depression, and 24.6% (n = 24.6) had Type D personality. The level of anxiety had a significant association with depression (p = 0.002) and Type D personality (p = 0.003). Furthermore, depression was significantly associated with ethnicity (p = 0.014), occupation (p = 0.010), and type D personality (p = 0.009). Type D personality was the strongest predictor of anxiety, with patients being 1.902 times more likely to experience anxiety (95% CI 1.149-3.148; p = 0.012). Anxiety was a significant predictor of depression, with patients being 1.997 times more likely to experience depression (95% CI 1.210-3.296; p = 0.007). Non-Sinhalese ethnic background was also a significant predictor of depression (OR: 0.240; 95% CI 0.073-0.785; p = 0.018). Anxiety increased the likelihood of having Type D personality traits by 1.899 times (95% CI 1.148-3.143; p = 0.013). CONCLUSION The current study recommends the importance of screening and treating the psychological risk factors of IHD patients parallel to their IHD treatment to improve their prognosis. These insights highlight the need for targeted interventions that address depression, anxiety and the impact of Type D personality traits in enhancing the overall management and prognosis of IHD.
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Affiliation(s)
- Chandima Kumara Walpita Gamage
- Department of Nursing and Midwifery, Faculty of Allied Health Sciences, General Sir John Kotelawala Defence University, Dehiwala-Mount Lavinia, Sri Lanka.
| | | | - Aindralal Balasuriya
- Department of Para Clinical Sciences, Faculty of Medicine, General Sir John Kotelawala Defence University, Dehiwala-Mount Lavinia, Sri Lanka
| | - Neil Francis Joseph Fernando
- Department of Clinical Sciences, Faculty of Medicine, General Sir John Kotelawala Defence University, Dehiwala-Mount Lavinia, Sri Lanka
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Rouleau CR, Chirico D, Wilton SB, MacDonald MK, Tao T, Arena R, Campbell T, Aggarwal S. Mortality Benefits of Cardiac Rehabilitation in Coronary Artery Disease Are Mediated by Comprehensive Risk Factor Modification: A Retrospective Cohort Study. J Am Heart Assoc 2024; 13:e033568. [PMID: 38761079 PMCID: PMC11179828 DOI: 10.1161/jaha.123.033568] [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: 01/06/2024] [Accepted: 04/04/2024] [Indexed: 05/20/2024]
Abstract
BACKGROUND Cardiac rehabilitation (CR) is a multicomponent intervention to reduce adverse outcomes from coronary artery disease, but its mechanisms are not fully understood. The aims of this study were to examine the impact of CR on survival and cardiovascular risk factors, and to determine potential mediators between CR attendance and reduced mortality. METHODS AND RESULTS A retrospective mediation analysis was conducted among 11 196 patients referred to a 12-week CR program following an acute coronary syndrome event between 2009 and 2019. A panel of cardiovascular risk factors was assessed at a CR intake visit and repeated on CR completion. All-cause and cardiovascular mortality were ascertained via health care administrative data sets at mean 4.2-year follow-up (SD, 2.81 years). CR completion was associated with reduced all-cause (adjusted hazard ratio [HR], 0.67 [95% CI, 0.54-0.83]) and cardiovascular (adjusted HR, 0.57 [95% CI, 0.40-0.81]) mortality, as well as improved cardiorespiratory fitness, lipid profile, body composition, psychological distress, and smoking rates (P<0.001). CR attendance had an indirect effect on all-cause mortality via improved cardiorespiratory fitness (ab=-0.006 [95% CI, -0.008 to -0.003]) and via low-density lipoprotein cholesterol (ab=-0.002 [95% CI, -0.003 to -0.0003]) and had an indirect effect on cardiovascular mortality via cardiorespiratory fitness (ab=-0.007 [95% CI, -0.012 to -0.003]). CONCLUSIONS Cardiorespiratory fitness and lipid control partly explain the mortality benefits of CR and represent important secondary prevention targets.
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Affiliation(s)
- Codie R Rouleau
- TotalCardiology Research Network Calgary Alberta Canada
- Department of Psychology University of Calgary Calgary Alberta Canada
- Libin Cardiovascular Institute University of Calgary Calgary Alberta Canada
| | | | - Stephen B Wilton
- TotalCardiology Research Network Calgary Alberta Canada
- Libin Cardiovascular Institute University of Calgary Calgary Alberta Canada
| | | | - Tianqi Tao
- Libin Cardiovascular Institute University of Calgary Calgary Alberta Canada
| | - Ross Arena
- TotalCardiology Research Network Calgary Alberta Canada
- Department of Physical Therapy, College of Applied Health Sciences University of Illinois Chicago IL
| | - Tavis Campbell
- TotalCardiology Research Network Calgary Alberta Canada
- Department of Psychology University of Calgary Calgary Alberta Canada
| | - Sandeep Aggarwal
- TotalCardiology Research Network Calgary Alberta Canada
- Libin Cardiovascular Institute University of Calgary Calgary Alberta Canada
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Zhu C, Tran PM, Leifheit EC, Spatz ES, Dreyer RP, Nyhan K, Wang SY, Lichtman JH. Association of marital/partner status and patient-reported outcomes following myocardial infarction: a systematic review and meta-analysis. EUROPEAN HEART JOURNAL OPEN 2023; 3:oead018. [PMID: 36942107 PMCID: PMC10023828 DOI: 10.1093/ehjopen/oead018] [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: 01/09/2023] [Revised: 02/07/2023] [Accepted: 02/24/2023] [Indexed: 06/18/2023]
Abstract
AIMS Little is known about the relationship between marital/partner status and patient-reported outcome measures (PROMs) following myocardial infarction (MI). We conducted a systematic review/meta-analysis and explored potential sex differences. METHODS AND RESULTS We searched five databases (Medline, Web of Science, Scopus, EMBASE, and PsycINFO) from inception to 27 July 2022. Peer-reviewed studies of MI patients that evaluated marital/partner status as an independent variable and reported its associations with defined PROMs were eligible for inclusion. Results for eligible studies were classified into four pre-specified outcome domains [health-related quality of life (HRQoL), functional status, symptoms, and personal recovery (i.e. self-efficacy, adherence, and purpose/hope)]. Study quality was appraised using Newcastle-Ottawa Scale, and data were synthesized by outcome domains. We conducted subgroup analysis by sex. We included 34 studies (n = 16 712), of which 11 were included in meta-analyses. Being married/partnered was significantly associated with higher HRQoL {six studies [n = 2734]; pooled standardized mean difference, 0.37 [95% confidence interval (CI), 0.12-0.63], I 2 = 51%} but not depression [three studies (n = 2005); pooled odds ratio, 0.72 (95% CI, 0.32-1.64); I 2 = 65%] or self-efficacy [two studies (n = 356); pooled β, 0.03 (95% CI, -0.09 to 0.14); I 2 = 0%]. The associations of marital/partner status with functional status, personal recovery outcomes, and symptoms of anxiety and fatigue were mixed. Sex differences were not evident due to mixed results from the available studies. CONCLUSIONS Married/partnered MI patients had higher HRQoL than unpartnered patients, but the associations with functional, symptom, and personal recovery outcomes and sex differences were less clear. Our findings inform better methodological approaches and standardized reporting to facilitate future research on these relationships.
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Affiliation(s)
- Cenjing Zhu
- Department of Chronic Disease Epidemiology, Yale School of Public Health, Yale University, 60 College Street, New Haven, CT 06510, USA
| | - Phoebe M Tran
- Department of Public Health, University of Tennessee, 1914 Andy Holt Ave, Knoxville, TN 37996, USA
| | - Erica C Leifheit
- Department of Chronic Disease Epidemiology, Yale School of Public Health, Yale University, 60 College Street, New Haven, CT 06510, USA
| | - Erica S Spatz
- Center for Outcomes Research and Evaluation, Yale School of Medicine, 195 Church St., 5th Floor, New Haven, CT 06510, USA
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, 333 Cedar St, New Haven, CT 06510, USA
| | - Rachel P Dreyer
- Department of Biostatistics, Yale School of Public Health, 60 College Street, New Haven, CT 06510, USA
- Department of Emergency Medicine, Yale School of Medicine, 333 Cedar St, New Haven, CT 06510, USA
| | - Kate Nyhan
- Harvey Cushing/John Hay Whitney Medical Library, Yale University, 333 Cedar St, New Haven, CT 06510, USA
- Department of Environmental Health Sciences, Yale School of Public Health, 60 College Street, New Haven, CT 06510, USA
| | - Shi-Yi Wang
- Department of Chronic Disease Epidemiology, Yale School of Public Health, Yale University, 60 College Street, New Haven, CT 06510, USA
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Lee D, Wang A, Augustin B, Buajitti E, Tahasildar B, Carli F, Gillis C. Socioeconomic status influences participation in cancer prehabilitation and preparation for surgical recovery: A pooled retrospective analysis using a validated area-level socioeconomic status metric. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2023; 49:512-520. [PMID: 36435646 DOI: 10.1016/j.ejso.2022.10.023] [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: 10/15/2022] [Accepted: 10/31/2022] [Indexed: 11/11/2022]
Abstract
BACKGROUND Prehabilitation employs exercise, nutrition, and psychological interventions to optimize physiological status in preparation for surgery. First, we described the extent to which material deprivation index score (MDIS) influenced prehabilitation participation. Second, we evaluated the extent to which prehabilitation influenced recovery as compared to control. METHODS Pooled patient records from prospective multimodal prehabilitation studies in oncologic surgery were retrospectively examined. Patient postal codes were linked to their MDIS, a validated area-level socioeconomic status (SES) metric, as quintiles 1-5 (1 = highest SES). Functional capacity was evaluated with the 6-min walking test (6MWT) at baseline, before, and 8 weeks post-surgery. Influence of prehabilitation on length of hospital stay (LOS) was explored using generalized linear models with a negative binomial distribution adjusted for age, sex, surgical population, and MDIS. RESULTS Recruitment records were available from 2014 onwards, yielding 1013 eligible patients for prehabilitation participation with MDIS data. Fewer patients with a low SES enrolled (Q1:62% vs. Q5:47%; P = 0.01) and remained in prehabilitation studies (Q1: 59% vs. Q5: 45%; P = 0.07). Prehabilitation study records were available from 2008 onward, yielding 886 enrolled patients with MDIS data (n = 510 prehabilitation, n = 376 control). Preoperative 6MWT similarly improved by > 20 m in response to prehabilitation across SES strata (P < 0.05). Postoperative 6MWT could not be evaluated due to substantial missing data. Prehabilitation had a significant protective influence on LOS, as compared to control, in unadjusted and adjusted models [adjusted IRR:0.77 (95% CI:0.68 to 0.87; P < 0.001]. CONCLUSION Findings suggest that prehabilitation is effective across all SES; however, participation across SES quintiles was not equal. Barriers to participation must be identified and addressed. Once these barriers are addressed, prehabilitation may reduce surgical disparities among SES.
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Affiliation(s)
- Dillon Lee
- Faculty of Medicine, McGill University, Montreal, QC, Canada
| | - Ao Wang
- Medical School for International Health, Ben-Gurion University of the Negev Be'er Sheva, 8410501, Israel
| | - Berson Augustin
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
| | - Emmalin Buajitti
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
| | | | - Francesco Carli
- Department of Anesthesia, McGill University, Montréal, QC, Canada
| | - Chelsia Gillis
- School of Human Nutrition, McGill University, Sainte-Anne-de-Bellevue, Quebec, Canada; Department of Anesthesia, McGill University, Montréal, QC, Canada; Department of Surgery, McGill University, Montreal, QC, Canada.
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Krasieva K, Clair C, Gencer B, Carballo D, Klingenberg R, Räber L, Windecker S, Rodondi N, Matter CM, Lüscher TF, Mach F, Muller O, Nanchen D. Smoking cessation and depression after acute coronary syndrome. Prev Med 2022; 163:107177. [PMID: 35901973 DOI: 10.1016/j.ypmed.2022.107177] [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: 09/14/2021] [Revised: 07/16/2022] [Accepted: 07/20/2022] [Indexed: 11/18/2022]
Abstract
Smoking and depression are risk factors for acute coronary syndrome (ACS) that often co-exist. We investigated the evolution of depression according to smoking cessation one-year after ACS. Data from 1822 ACS patients of the Swiss multicenter SPUM-ACS cohort study were analyzed over a one-year follow-up. Participants were classified in three groups based on smoking status one-year post-ACS - continuous smokers, smokers who quit within the year, and non-smokers. Depression status at baseline and one-year was assessed with the Center for Epidemiologic Studies Depression scale (CES-D) and antidepressant drug use. A CES-D score ≥ 16 defined depression. A multivariate-adjusted logistic regression model was used to calculate odds ratios (OR) between groups. The study sample mean age was 62.4 years and females represented 20.8%. At baseline, 22.6% were depressed, 40.9% were smokers, and 47.5% of these quit smoking over the year post-ACS. In comparison to depressed continuous smokers, depressed smokers who quit had an adjusted OR 2.59 (95% confidence interval (CI) 1.27-5.25) of going below a CES-D score of 16 or not using antidepressants. New depression at one-year was found in 24.4% of non-depressed smokers who quit, and in 27.1% of non-depressed continuous smokers, with an adjusted OR 0.85 (95% CI 0.55-1.29) of moving to a CES-D score of ≥16 or using antidepressants. In conclusion, smokers with depression at time of ACS who quit smoking improved their depression more frequently compared to continuous smokers. The incidence of new depression among smokers who quit after ACS was similar compared to continuous smokers.
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Affiliation(s)
- Kristina Krasieva
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Carole Clair
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Baris Gencer
- Division of Cardiology, Faculty of Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - David Carballo
- Division of Cardiology, Faculty of Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Roland Klingenberg
- Department of Cardiology, University Heart Center, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Lorenz Räber
- Department of Cardiology, University Hospital Bern, Bern, Switzerland
| | - Stephan Windecker
- Department of Cardiology, University Hospital Bern, Bern, Switzerland
| | - Nicolas Rodondi
- Institute of Primary Health Care (BIHAM), University of Bern, Switzerland; Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Christian M Matter
- Department of Cardiology, University Heart Center, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Thomas F Lüscher
- Royal Brompton & Harefield Hospital Trust and Imperial College, London SW3 6NP, UK
| | - François Mach
- Division of Cardiology, Faculty of Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Olivier Muller
- Service of Cardiology, Lausanne University Hospital, Lausanne, Switzerland
| | - David Nanchen
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland.
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Lansky A, Baron SJ, Grines CL, Tremmel JA, Al-Lamee R, Angiolillo DJ, Chieffo A, Croce K, Jacobs AK, Madan M, Maehara A, Mehilli J, Mehran R, Ng V, Parikh PB, Saw J, Abbott JD. SCAI Expert Consensus Statement on Sex-Specific Considerations in Myocardial Revascularization. JOURNAL OF THE SOCIETY FOR CARDIOVASCULAR ANGIOGRAPHY & INTERVENTIONS 2022; 1:100016. [PMID: 39132570 PMCID: PMC11307953 DOI: 10.1016/j.jscai.2021.100016] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 12/21/2021] [Indexed: 08/13/2024]
Affiliation(s)
| | | | - Cindy L. Grines
- Northside Hospital Cardiovascular Institute, Atlanta, Georgia
| | | | | | | | - Alaide Chieffo
- University of Florida Health Sciences Center, Jacksonville, Florida
| | - Kevin Croce
- IRCCS San Raffaele Scientific Institute, Milan, Italy
- Brigham and Women's Hospital, Boston, Massachusetts
| | - Alice K. Jacobs
- Boston University School of Medicine and Boston Medical Center, Boston, Massachusetts
| | - Mina Madan
- Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Akiko Maehara
- Columbia University College of Physicians and Surgeons, New York, New York
| | | | - Roxana Mehran
- Icahn School of Medicine at Mount Sinai, New York, New York
| | - Vivian Ng
- Columbia University Irving Medical Center, New York, New York
| | - Puja B. Parikh
- Stony Brook University Medical Center, Stony Brook, New York
| | - Jacqueline Saw
- Vancouver General Hospital, Vancouver, British Columbia, Canada
| | - J. Dawn Abbott
- Warren Alpert Medical School, Brown University, Providence, Rhode Island
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Prevalence of Moderate to Severe Anxiety Symptoms among Patients with Myocardial Infarction: a Meta-Analysis. Psychiatr Q 2022; 93:161-180. [PMID: 34013389 DOI: 10.1007/s11126-021-09921-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/25/2021] [Indexed: 10/21/2022]
Abstract
This study attempted to synthesize the evidence on the prevalence of moderate to severe anxiety symptoms among myocardial infarction (MI) patients to offer a reliable and accurate estimate on the number of MI patients suffering from moderate to severe anxiety symptoms. Comprehensive electronic searches (PubMed, Embase and Web of Science) were performed from their inception to February 2021. Between-study heterogeneity was analyzed using the Cochran's Q test and [Formula: see text] statistic, and if it was high across the eligible studies, meta-regression and subgroup analyses were conducted to examine the source of heterogeneity. Publication bias and the robustness of the pooled results were also examined. A total of 18 eligible studies covering 8,532 MI patients were included, of which 3,443 were identified with moderate to severe anxiety symptoms. Between-study heterogeneity was high ([Formula: see text]=98.8%) with the reported prevalence ranging from 9.6% to 69.17%, and the pooled prevalence was 38.08% (95% confidence interval: 28.82-47.81%) by a random-effects model. Meta-regression analyses indicated that publication year (β = -0.014) was significant moderators contributing 16.11% to the heterogeneity. Subgroup analyses indicated that studies using the anxiety subscale of Brief Symptom Inventory to assess anxiety were homogenous ([Formula: see text]=0.0). Furthermore, the pooled prevalence of moderate to severe anxiety symptoms varied significantly by geographic region, instrument used to assess anxiety, methodological quality, sex, education level, a history of previous MI and hypercholesterolemia. Additionally, the results of Egger's linear test (t = -0.630) and Begg's rank test (z = -0.190) indicated no evidence of publication bias, and the sensitivity of the pooled results was low. Nearly two fifth of MI patients suffered from moderate to severe anxiety symptoms, which emphasizes the importance of early identification of anxiety symptoms after MI, as well as the need of implementing psychological interventions for those with elevated anxiety symptoms.
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Khadanga S, Gaalema DE, Savage P, Ades PA. Underutilization of Cardiac Rehabilitation in Women: BARRIERS AND SOLUTIONS. J Cardiopulm Rehabil Prev 2021; 41:207-213. [PMID: 34158454 PMCID: PMC8243714 DOI: 10.1097/hcr.0000000000000629] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
PURPOSE Despite the known benefits of cardiac rehabilitation (CR), it remains underutilized particularly among women. The aim of this review was to provide an overview regarding women in CR, addressing barriers that may affect enrollment and attendance as well as to discuss the training response and methods to optimize exercise-related benefits of CR. REVIEW METHODS The review examines original studies and meta-analyses regarding women in CR. SUMMARY Women are less likely to engage in CR compared with men, and this may be attributed to lack of referral or psychosocial barriers on the part of the patient. Furthermore, despite having lower levels of fitness, women do not improve their fitness as much as men in CR. This review summarizes the current literature and provides recommendations for providers regarding participation and adherence as well as optimal methods for exercise training for women in CR.
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Affiliation(s)
- Sherrie Khadanga
- Department of Medicine, Division of Cardiology, University of Vermont, Burlington, VT
- Departments of Psychiatry and Psychology, University of Vermont, Burlington, VT
| | - Diann E. Gaalema
- Departments of Psychiatry and Psychology, University of Vermont, Burlington, VT
- Vermont Center on Behavior and Health, University of Vermont, Burlington, VT
| | - Patrick Savage
- Department of Medicine, Division of Cardiology, University of Vermont, Burlington, VT
| | - Philip A. Ades
- Department of Medicine, Division of Cardiology, University of Vermont, Burlington, VT
- Vermont Center on Behavior and Health, University of Vermont, Burlington, VT
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Bai B, Yin H, Guo L, Ma H, Wang H, Liu F, Liang Y, Liu A, Geng Q. Comorbidity of depression and anxiety leads to a poor prognosis following angina pectoris patients: a prospective study. BMC Psychiatry 2021; 21:202. [PMID: 33879109 PMCID: PMC8056494 DOI: 10.1186/s12888-021-03202-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 04/07/2021] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Depression and anxiety are two common mood problems among patients with cardiovascular disease (CVD) and are associated with poor cardiac prognoses. The comorbidity of depression and anxiety is considered to be a more severe psychological status than non-comorbid mood disorders. However, little is known about the relationship between depression or anxiety and noncardiac readmission. We conducted a prospective study on the prognostic impact of depression, anxiety, and the comorbidity of the two among angina pectoris (AP) patients. METHOD In this prospective study, 443 patients with AP were included in the analysis. Follow-up assessments were performed 1 year, and 2 years after patient discharges. Clinical outcomes of interest included noncardiac readmission, major adverse cardiovascular events (MACEs), and composite events. Depression and anxiety symptom scores derived from the patient health questionnaire-9 (PHQ-9) and generalised anxiety disorder-7 (GAD-7) questionnaire were used to assess mood symptoms at baseline. Participants with symptom scores of ≥10 on both the depression and anxiety questionnaires formed the clinical comorbidity subgroup. We used multivariable Cox proportional hazards models to evaluate the impact of individual mood symptom and comorbidity on clinical outcomes. RESULTS Among all the AP patients, 172 (38. 9%) were determined to have depression symptoms, 127 (28.7%) patients had anxiety symptoms and 71 (16.0%) patients suffered from their comorbidity. After controlling covariates, we found that patients who endured clinical depression (hazard ratio [HR] = 2.38, 95% confidence interval [CI] 1.06-5.33, p = 0.035) and anxiety ([HR] 2.85, 95% [CI] 1.10-7.45, p = 0.032) had a high risk of noncardiac readmission. Compared to participants with no mood symptoms, those with clinical comorbidity of depression and anxiety presented a greater risk of noncardiac readmission ([HR] 2.91, 95% [CI] 1.03-8.18, p = 0.043) MACEs ([HR] 2.38, 95% [CI] 1.11-5.10, p = 0.025) and composite event ([HR] 2.52, 95% [CI] 1.35-4.69, p = 0.004). CONCLUSION Depression and anxiety were found to have predictive value for noncardiac readmission among patients with AP. Furthermore, prognoses were found to be worse for patients with comorbidity of depression and anxiety than those with single mood symptom. Additional attention needs to be focused on the initial identification and long-term monitoring of mood symptom comorbidity.
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Affiliation(s)
- Bingqing Bai
- Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, No.106 Zhongshan Er Road, Yuexiu District, Guangzhou, 510080 People’s Republic of China
| | - Han Yin
- Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, No.106 Zhongshan Er Road, Yuexiu District, Guangzhou, 510080 People’s Republic of China ,grid.79703.3a0000 0004 1764 3838School of Medicine, South China University of Technology, Guangzhou, People’s Republic of China
| | - Lan Guo
- Department of Cardiac Rehabilitation, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, No.106 Zhongshan Er Road, Yuexiu District, Guangzhou, 510080 People’s Republic of China
| | - Huan Ma
- Department of Cardiac Rehabilitation, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, No.106 Zhongshan Er Road, Yuexiu District, Guangzhou, 510080 People’s Republic of China
| | - Haochen Wang
- Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, No.106 Zhongshan Er Road, Yuexiu District, Guangzhou, 510080 People’s Republic of China ,grid.79703.3a0000 0004 1764 3838School of Medicine, South China University of Technology, Guangzhou, People’s Republic of China
| | - Fengyao Liu
- Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, No.106 Zhongshan Er Road, Yuexiu District, Guangzhou, 510080 People’s Republic of China ,grid.79703.3a0000 0004 1764 3838School of Medicine, South China University of Technology, Guangzhou, People’s Republic of China
| | - Yanting Liang
- Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, No.106 Zhongshan Er Road, Yuexiu District, Guangzhou, 510080 People’s Republic of China ,grid.79703.3a0000 0004 1764 3838School of Medicine, South China University of Technology, Guangzhou, People’s Republic of China
| | - Anbang Liu
- Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, No.106 Zhongshan Er Road, Yuexiu District, Guangzhou, 510080 People’s Republic of China ,grid.79703.3a0000 0004 1764 3838School of Medicine, South China University of Technology, Guangzhou, People’s Republic of China
| | - Qingshan Geng
- Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangdong Cardiovascular Institute, No.106 Zhongshan Er Road, Yuexiu District, Guangzhou, 510080, People's Republic of China.
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10
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Heart-Healthy Dietary Intake Improved and Maintained 6 Months After Participation in a Cardiac Rehabilitation Program. TOP CLIN NUTR 2021. [DOI: 10.1097/tin.0000000000000243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Foldes-Busque G, Dionne CE, Turcotte S, Tully PJ, Tremblay MA, Poirier P, Denis I. Epidemiology and prognostic implications of panic disorder and generalized anxiety disorder in patients with coronary artery disease: rationale and design for a longitudinal cohort study. BMC Cardiovasc Disord 2021; 21:26. [PMID: 33435888 PMCID: PMC7801787 DOI: 10.1186/s12872-021-01848-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 01/01/2021] [Indexed: 01/25/2023] Open
Abstract
Background Anxiety is associated with poorer prognosis in patients with coronary artery disease (CAD). Due to their severity and chronic course, anxiety disorders, particularly generalized anxiety disorder (GAD) and panic disorder (PD), are of considerable interest and clinical importance in this population. This study has two main objectives: (1) to estimate the prevalence and incidence of GAD and PD in patients with CAD over a 2-year period and (2) to prospectively assess the association between PD or GAD and adverse cardiac events, treatment adherence, CAD-related health behaviors, quality of life and psychological distress. Design/Method This is a longitudinal cohort study in which 3610 participants will be recruited following a CAD-related revascularization procedure. They will complete an interview and questionnaires at 5 time points over a 2-year period (baseline and follow-ups after 3, 6, 12 and 24 months). The presence of PD or GAD, adherence to recommended treatments, health behaviors, quality of life and psychological distress will be assessed at each time point. Data regarding mortality and adverse cardiac events will be collected with a combination of interviews and review of medical files. Discussion This study will provide essential information on the prevalence and incidence of anxiety disorders in patients with CAD and on the consequences of these comorbidities. Such data is necessary in order to develop clear clinical recommendations for the management of PD and GAD in patients with CAD. This will help improve the prognosis of patients suffering from both conditions.
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Affiliation(s)
- Guillaume Foldes-Busque
- School of Psychology, Université Laval, 2325 rue des Bibliothèques, bureau 1018, Québec, QC, G1V 0A6, Canada. .,Research Center of the Centre Intégré de Santé et de Services Sociaux de Chaudière-Appalaches, Lévis, QC, Canada. .,Research Center of the Quebec Heart and Lung Institute, Québec, QC, Canada.
| | - Clermont E Dionne
- Hôpital du Saint-Sacrement, Québec, QC, Canada.,Department of Rehabilitation, Faculty of Medicine, Université Laval, Québec, QC, Canada
| | - Stéphane Turcotte
- Research Center of the Centre Intégré de Santé et de Services Sociaux de Chaudière-Appalaches, Lévis, QC, Canada
| | - Phillip J Tully
- School of Medicine, The University of Adelaide, Adelaide, Australia
| | - Marie-Andrée Tremblay
- School of Psychology, Université Laval, 2325 rue des Bibliothèques, bureau 1018, Québec, QC, G1V 0A6, Canada.,Research Center of the Centre Intégré de Santé et de Services Sociaux de Chaudière-Appalaches, Lévis, QC, Canada
| | - Paul Poirier
- Research Center of the Quebec Heart and Lung Institute, Québec, QC, Canada.,Faculty of Pharmacy, Université Laval, Québec, QC, Canada
| | - Isabelle Denis
- School of Psychology, Université Laval, 2325 rue des Bibliothèques, bureau 1018, Québec, QC, G1V 0A6, Canada.,Research Center of the Centre Intégré de Santé et de Services Sociaux de Chaudière-Appalaches, Lévis, QC, Canada
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12
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Higher Anxiety and Will to Live Are Associated With Poorer Adherence to Cardiac Rehabilitation. J Cardiopulm Rehabil Prev 2020; 39:381-385. [PMID: 31689265 DOI: 10.1097/hcr.0000000000000438] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE Cardiac rehabilitation (CR) session attendance and rates of completion remain suboptimal. Greater distress (ie, depression and anxiety) has been associated with both better and poorer adherence. Will to live (ie, desire, determination and effort to survive) has been associated with survival among cardiac patients and thus may be relevant for CR adherence. It was hypothesized that depression and anxiety would be negatively associated with adherence, and that will to live would moderate these relationships. METHODS Sixty patients (mean age = 56.9 ± 10.8 yr; 38 males) entering outpatient CR completed self-report measures of will to live (Wish to Prolong Life Questionnaire) and distress (Hospital Anxiety and Depression Scale). Hierarchical regression analyses were performed to predict CR session attendance (%) and program completion (yes/no) from depression and anxiety, as well as the interaction of those variables with will to live. RESULTS Neither depression nor anxiety was associated with CR adherence (Ps > .33). However, there was a significant interaction of will to live with anxiety in predicting attendance (β= -0.31, P = .03, Model R = .19, P = .01), reflecting that anxiety predicted lower attendance only among patients reporting greater will to live. CONCLUSIONS These data help clarify the complex relationship between distress and CR adherence. Findings suggest that higher anxiety is associated with poorer adherence, but only in combination with greater motivation for living. Patients higher in anxiety and will to live may benefit from additional strategies to make actionable behavioral change in the context of CR.
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13
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A Motivational Telephone Intervention to Reduce Early Dropouts in Cardiac Rehabilitation: A FEASIBILITY PILOT STUDY. J Cardiopulm Rehabil Prev 2020; 39:318-324. [PMID: 31343582 DOI: 10.1097/hcr.0000000000000425] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE Cardiac rehabilitation (CR) improves outcomes, yet early dropout is common. The purpose of the study was to determine whether a motivational telephone intervention among patients at risk for nonadherence would reduce early dropouts. METHODS We performed a randomized double-blind pilot study with the intervention group receiving the telephone intervention 1 to 3 d after outpatient CR orientation. The control group received the standard of care, which did not routinely monitor attendance until 2 wk after orientation. The primary outcome was the percentage of patients who attended their second exercise session as scheduled. Secondary outcomes included attendance at the second CR session at any point and total number of sessions attended. Because not everyone randomized to the intervention was able to be contacted, we also conducted a per-protocol analysis. RESULTS One hundred patients were randomized to 2 groups (age 62 ± 15 yr, 46% male, 40% with myocardial infarction) with 49 in the intervention group. Patients who received the intervention were more likely to attend their second session as scheduled compared with the standard of care (80% vs 49%; relative risk = 1.62; 95% CI, 1.18-2.22). Although there was no difference in total number of sessions between groups, there was a statistically significant improvement in overall return rate among the per-protocol group (87% vs 66%; relative risk = 1.31; 95% CI, 1.05-1.63). CONCLUSIONS A nursing-based telephone intervention targeted to patients at risk for early dropout shortly after their CR orientation improved both on-time and eventual return rates. This straightforward strategy represents an attractive adjunct to improve adherence to outpatient CR.
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14
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Krishnamurthi N, Schopfer DW, Shen H, Whooley MA. Association of Mental Health Conditions With Participation in Cardiac Rehabilitation. J Am Heart Assoc 2020; 8:e011639. [PMID: 31115253 PMCID: PMC6585364 DOI: 10.1161/jaha.118.011639] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Background Mental health conditions are associated with adverse cardiovascular outcomes in patients with ischemic heart disease, and much of this risk can be attributed to poor health behaviors. Although all patients with ischemic heart disease should be referred for cardiac rehabilitation (CR), whether patients with mental health conditions are willing to participate in CR programs is unknown. We sought to compare CR participation rates among patients with ischemic heart disease with versus without comorbid depression and/or posttraumatic stress disorder (PTSD). Methods and Results We used national electronic health records to identify all patients hospitalized for acute myocardial infarction or coronary revascularization at Veterans Health Administration hospitals between 2010 and 2014. Multivariable logistic regression models were used to determine whether comorbid depression/PTSD was associated with CR participation during the 12 months after hospital discharge. Of the 86 537 patients hospitalized for ischemic heart disease between 2010 and 2014, 24% experienced PTSD and/or depression. Patients with PTSD and/or depression had higher CR participation rates than those without PTSD or depression (11% versus 8%; P<0.001). In comparison to patients without PTSD or depression, the odds of participation was 24% greater in patients with depression alone (odds ratio, 1.24; 95% CI, 1.15–1.34), 38% greater in patients with PTSD alone (odds ratio, 1.38; 95% CI, 1.24–1.54), and 57% greater in patients with both PTSD and depression (odds ratio, 1.57; 95% CI, 1.43–1.74). Conclusions Among patients with ischemic heart disease, the presence of comorbid depression and/or PTSD is associated with greater participation in CR, providing an important opportunity to promote healthy lifestyle behaviors and reduce adverse cardiovascular outcomes among these patients.
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Affiliation(s)
- Nirupama Krishnamurthi
- 1 Department of Medicine University of California, San Francisco San Francisco CA.,3 San Francisco Veterans Affairs Medical Center San Francisco CA
| | - David W Schopfer
- 1 Department of Medicine University of California, San Francisco San Francisco CA.,3 San Francisco Veterans Affairs Medical Center San Francisco CA
| | - Hui Shen
- 3 San Francisco Veterans Affairs Medical Center San Francisco CA
| | - Mary A Whooley
- 1 Department of Medicine University of California, San Francisco San Francisco CA.,2 Department of Epidemiology and Biostatistics University of California, San Francisco San Francisco CA.,3 San Francisco Veterans Affairs Medical Center San Francisco CA
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15
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Laursen UB, Johansen MN, Joensen AM, Overvad K, Larsen ML. Is Cardiac Rehabilitation Equally Effective in Improving Dietary Intake in All Patients with Ischemic Heart Disease? J Am Coll Nutr 2020; 40:33-40. [PMID: 32459604 DOI: 10.1080/07315724.2020.1755910] [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] [Indexed: 01/20/2023]
Abstract
OBJECTIVE To investigate the association between sociodemographic characteristics and changes in dietary intake in patients with ischemic heart disease who were following a cardiac rehabilitation program. METHODS Longitudinal study among patients with first-time admission to outpatient cardiac rehabilitation after ST-elevation myocardial infarction, non-ST-elevation myocardial infarction, unstable angina pectoris or stable angina pectoris. We used a validated self-administered food frequency questionnaire to assess the dietary intake before rehabilitation, post rehabilitation and 6 months after baseline. The intake was summarized into a fat and fish-fruit-vegetable score for both sexes. To assess the within-patient differences in dietary scores, a paired t-test was applied. Regression analyses were performed to assess the association between sociodemographic characteristics and changes in diet. RESULTS 186 patients completed two measurements, 157 patients completed all three measurements. Fat and fish-fruit-vegetable scores increased statistically significantly and improvements remained statistically significant at follow-up. Fat scores increased less in employed men than in retired men (-11 (95% CI -17; -5)). Fish-fruit-vegetable scores increased less in men with a bachelor degree than in men with a vocational education (-8 (95% CI -13; -3)) as well as in retired women compared with employed women (-18 (95% CI -32; -4)). CONCLUSIONS Patients statistically significantly improved their dietary intake and improvements remained at follow-up. Dietary improvements were sensitive to marital status, living arrangements and employment status. Unemployed and retired women did not seem to improve their diet as much as employed women. Additional dietary intervention may become relevant in some patient groups defined by sociodemographic characteristics. (250).
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Affiliation(s)
- Ulla Bach Laursen
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | | | | | - Kim Overvad
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark.,Department of Public Health, Aarhus University, Denmark
| | - Mogens Lytken Larsen
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark.,Danish Centre against Inequality in Health (DACUS), Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
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16
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Hinde S, Bojke L, Harrison A, Doherty P. Improving cardiac rehabilitation uptake: Potential health gains by socioeconomic status. Eur J Prev Cardiol 2019; 26:1816-1823. [PMID: 31067128 DOI: 10.1177/2047487319848533] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Globally, cardiac rehabilitation (CR) is recommended as soon as possible after admission from an acute myocardial infarction (MI) or revascularisation. However, uptake is consistently poor internationally, ranging from 10% to 60%. The low level of uptake is compounded by variation across different socioeconomic groups. Policy recommendations continue to focus on increasing uptake and addressing inequalities in participation; however, to date, there is a paucity of economic evidence evaluating higher CR participation rates and their relevance to socioeconomic inequality. METHODS This study constructed a de-novo cost-effectiveness model of CR, utilising the results from the latest Cochrane review and national CR audit data. We explore the role of socioeconomic status by incorporating key deprivation parameters and determine the population health gains associated with achieving an uptake target of 65%. RESULTS We find that the low cost of CR and the potential for reductions in subsequent MI and revascularisation rates combine to make it a highly cost-effective intervention. While CR is less cost-effective for more deprived groups, the lower level of uptake in these groups makes the potential health gains, from achieving the target, greater. Using England as a model, we estimate the expenditure that could be justified while maintaining the cost-effectiveness of CR at £68.4 m per year. CONCLUSIONS Increasing CR uptake is cost-effective and can also be implemented to reduce known socioeconomic inequalities. Using an estimation of potential population health gains and justifiable expenditure, we have produced tools with which policymakers and commissioners can encourage greater utilisation of CR services.
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Affiliation(s)
| | - Laura Bojke
- Centre for Health Economics, University of York, UK
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17
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Resurrección DM, Moreno-Peral P, Gómez-Herranz M, Rubio-Valera M, Pastor L, Caldas de Almeida JM, Motrico E. Factors associated with non-participation in and dropout from cardiac rehabilitation programmes: a systematic review of prospective cohort studies. Eur J Cardiovasc Nurs 2018; 18:38-47. [PMID: 29909641 DOI: 10.1177/1474515118783157] [Citation(s) in RCA: 119] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND Although evidence exists for the efficacy of cardiac rehabilitation programmes to reduce morbidity and mortality among patients with cardiovascular disease, cardiac rehabilitation programmes are underused. We aimed systematically to review the evidence from prospective cohort studies on factors associated with non-participation in and/or dropping out from cardiac rehabilitation programmes. METHODS MedLine, Embase, Scopus, Open Grey and Cochrane Database were searched for relevant publications from inception to February 2018. Search terms included (a) coronary heart disease and other cardiac conditions; (b) cardiac rehabilitation and secondary prevention; and (c) non-participation in and/or dropout. Databases were searched following the PRISMA statement. Study selection, data extraction and the assessment of study quality were performed in duplicate. RESULTS We selected 43 studies with a total of 63,425 patients from 10 different countries that met the inclusion criteria. Factors associated with non-participation in and dropout from cardiac rehabilitation were grouped into six broad categories: intrapersonal factors, clinical factors, interpersonal factors, logistical factors, cardiac rehabilitation programme factors and health system factors. We found that clinical factors, logistical factors and health system factors were the main factors assessed for non-participation in cardiac rehabilitation. We also found differences between the factors associated with non-participation and dropout. CONCLUSIONS Several factors were determinant for non-participation in and dropout from cardiac rehabilitation. These findings could be useful to clinicians and policymakers for developing interventions aimed at improving participation and completion of cardiac rehabilitation, such as E-health or home-based delivery programmes. Trial Registration: International Prospective Register of Systematic Reviews (PROSPERO) identifier: CRD42016032973.
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Affiliation(s)
| | - Patricia Moreno-Peral
- 2 SAMSERAP Group, Primary Care Prevention and Health Promotion Research Network (RedIAPP), Spain.,3 SAMSERAP Group, Instituto de Investigación Biomédica de Malaga (IBIMA), Spain
| | | | - Maria Rubio-Valera
- 5 Research and Development Unit, Institut de Recerca Sant Joan de Déu, Spain.,6 Grupo PRISMA, Centro de Investigación Biomédica en Red Epidemiología y Salud Pública, Spain
| | - Luis Pastor
- 7 Unidad Clínica de Cardiología, Hospital Nuestra Señora de Valme, Spain
| | | | - Emma Motrico
- 1 Departamento de Psicología, Universidad Loyola Andalucía, Spain.,2 SAMSERAP Group, Primary Care Prevention and Health Promotion Research Network (RedIAPP), Spain
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18
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Spatola CAM, Cappella EAM, Goodwin CL, Castelnuovo G, Cattivelli R, Rapelli G, Malfatto G, Facchini M, Mollica C, Molinari E. Cross-Lagged Relations Between Exercise Capacity and Psychological Distress During Cardiac Rehabilitation. Ann Behav Med 2018; 52:963-972. [DOI: 10.1093/abm/kax069] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Affiliation(s)
- Chiara A M Spatola
- Psychology Research Laboratory, Istituto Auxologico Italiano–Istituto di Ricovero e Cura a Carattere Scientifico, Milan, Italy
- Department of Psychology, Catholic University of Milan, Milan, Italy
| | - Emanuele A M Cappella
- Psychology Research Laboratory, Istituto Auxologico Italiano–Istituto di Ricovero e Cura a Carattere Scientifico, Milan, Italy
- Department of Psychology, Catholic University of Milan, Milan, Italy
| | | | - Gianluca Castelnuovo
- Psychology Research Laboratory, Istituto Auxologico Italiano–Istituto di Ricovero e Cura a Carattere Scientifico, Milan, Italy
- Department of Psychology, Catholic University of Milan, Milan, Italy
| | - Roberto Cattivelli
- Psychology Research Laboratory, Istituto Auxologico Italiano–Istituto di Ricovero e Cura a Carattere Scientifico, Milan, Italy
- Department of Psychology, Catholic University of Milan, Milan, Italy
| | - Giada Rapelli
- Psychology Research Laboratory, Istituto Auxologico Italiano–Istituto di Ricovero e Cura a Carattere Scientifico, Milan, Italy
- Department of Psychology, Catholic University of Milan, Milan, Italy
| | - Gabriella Malfatto
- Cardiology Division, Istituto Auxologico Italiano–Istituto di Ricovero e Cura a Carattere Scientifico, Milan, Italy
| | - Mario Facchini
- Cardiology Division, Istituto Auxologico Italiano–Istituto di Ricovero e Cura a Carattere Scientifico, Milan, Italy
| | - Chiara Mollica
- Cardiology Division, Istituto Auxologico Italiano–Istituto di Ricovero e Cura a Carattere Scientifico, Milan, Italy
| | - Enrico Molinari
- Psychology Research Laboratory, Istituto Auxologico Italiano–Istituto di Ricovero e Cura a Carattere Scientifico, Milan, Italy
- Department of Psychology, Catholic University of Milan, Milan, Italy
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19
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Aazh H, Moore BCJ. Proportion and characteristics of patients who were offered, enrolled in and completed audiologist-delivered cognitive behavioural therapy for tinnitus and hyperacusis rehabilitation in a specialist UK clinic. Int J Audiol 2018; 57:415-425. [DOI: 10.1080/14992027.2018.1431405] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Hashir Aazh
- Audiology Department, Royal Surrey County Hospital NHS Foundation Trust, Guildford, UK and
| | - Brian C. J. Moore
- Department of Experimental Psychology, University of Cambridge, Cambridge, UK
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20
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AbuRuz ME, Alaloul F, Al-Dweik G. Depressive symptoms are associated with in-hospital complications following acute myocardial infarction. Appl Nurs Res 2018; 39:65-70. [DOI: 10.1016/j.apnr.2017.11.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2017] [Revised: 08/13/2017] [Accepted: 11/01/2017] [Indexed: 12/20/2022]
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21
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Influence of Depression on Utilization of Cardiac Rehabilitation Postmyocardial Infarction: A STUDY OF 158 991 MEDICARE BENEFICIARIES. J Cardiopulm Rehabil Prev 2017; 37:22-29. [PMID: 27755259 DOI: 10.1097/hcr.0000000000000222] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE On the basis of several small studies, depression is often considered a barrier to cardiac rehabilitation (CR) enrollment and program completion. The purpose of this research was to examine the association between depression diagnosis and participation in CR in a large sample of Medicare beneficiaries with recent myocardial infarction (MI). METHODS This was a retrospective study of Medicare beneficiaries with an MI during 2008 (N = 158 991). CR enrollment was determined by the Carrier and Outpatient files using the Healthcare Common Procedure Coding System #93797 or #93798. Depression diagnosis was obtained from the International Classification of Diseases, Ninth Revision (ICD-9) codes in the Medicare Provider Analysis and Review (MEDPAR), Outpatient and Carrier Files. The association between depression diagnosis and CR attendance was evaluated using multivariable logistic regression. RESULTS Overall, 14% (n = 22 735) of the study population attended CR within 1 year of MI diagnosis. Twenty-eight percent (n = 43 827) had a diagnosis of depression, with 96% of cases documented before enrollment in CR. Twenty-eight percent with a diagnosis of depression compared with 9% without depression attended CR. In adjusted analysis, patients with depression were 3.9 (99% CI, 3.7-4.2) times more likely to attend CR compared with those without depression. Program completion (≥25 sessions) was more common in those with depression (56%) than in those without (35%) (P < .001). CONCLUSIONS Diagnosis of depression in Medicare beneficiaries was strongly associated with attending CR and attending more sessions of CR compared with those without depression. Depression is not a barrier to CR participation after MI in Medicare beneficiaries.
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22
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Biswas A, Oh PI, Faulkner GE, Alter DA. A prospective study examining the influence of cardiac rehabilitation on the sedentary time of highly sedentary, physically inactive patients. Ann Phys Rehabil Med 2017; 61:207-214. [PMID: 28923367 DOI: 10.1016/j.rehab.2017.06.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Revised: 06/28/2017] [Accepted: 06/28/2017] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Prolonged sedentary time is recognized as a distinct health risk, and mortality risks are expected to be greatest for individuals with low exercise levels. It is unknown whether participation in exercise-based cardiac rehabilitation (CR) programs influences sedentary behaviour particularly among those patients expected to be at greatest mortality risk. This study examined the influence of CR participation on sedentary behaviour and identified the proportion and characteristics (socio-demographic and clinical) of patients who do not meet exercise recommendations and have prolonged sedentary times. METHODS A prospective study was conducted among patients of an exercise-based CR program and assessments performed at baseline and 3 months. Physical activity and sedentary behaviour information were collected by self-report, and convergent validity was examined on an accelerometer-wearing subsample. RESULTS Of 468 CR patients approached, 130 participants were recruited with an average sedentary time of 8hours/day. Sedentary behaviour remained consistent at follow-up (relative change= -2.4%, P=0.07) notwithstanding a greater proportion meeting exercise recommendations (relative change= 57.4%). 19.2% of participants were classified to have prolonged sedentary time and not meet exercise recommendations at baseline. No significant differences were found between the characteristics of high-risk individuals and lower risk subgroups. Findings were consistent among the accelerometer-derived subgroup and the overall sample despite poor to moderate convergent validity. CONCLUSIONS These results suggest that the exercise-focus of CR may not reduce sedentary behaviours. Future studies are needed to determine whether sedentary behaviour-specific reduction strategies are more effective than traditional exercise-based strategies and lead to meaningful improvements in clinical outcomes.
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Affiliation(s)
- A Biswas
- University Health Network, Toronto rehabilitation institute, Rumsey Centre, 34, Rumsey road, Toronto, ON, Canada
| | - P I Oh
- University Health Network, Toronto rehabilitation institute, Rumsey Centre, 34, Rumsey road, Toronto, ON, Canada
| | - G E Faulkner
- University Health Network, Toronto rehabilitation institute, Rumsey Centre, 34, Rumsey road, Toronto, ON, Canada
| | - D A Alter
- University Health Network, Toronto rehabilitation institute, Rumsey Centre, 34, Rumsey road, Toronto, ON, Canada.
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Breve intervenção psicológica em doentes internados após síndrome coronária aguda: essencial ou acessória? Rev Port Cardiol 2017; 36:651-654. [DOI: 10.1016/j.repc.2017.07.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Abreu A. Brief psychological intervention in patients admitted after acute coronary syndrome: Essential or secondary? REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2017. [DOI: 10.1016/j.repce.2017.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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25
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Gaalema DE, Elliott RJ, Morford ZH, Higgins ST, Ades PA. Effect of Socioeconomic Status on Propensity to Change Risk Behaviors Following Myocardial Infarction: Implications for Healthy Lifestyle Medicine. Prog Cardiovasc Dis 2017; 60:159-168. [PMID: 28063785 PMCID: PMC5498261 DOI: 10.1016/j.pcad.2017.01.001] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2017] [Accepted: 01/02/2017] [Indexed: 01/04/2023]
Abstract
Failure to change risk behaviors following myocardial infarction (MI) increases the likelihood of recurrent MI and death. Lower-socioeconomic status (SES) patients are more likely to engage in high-risk behaviors prior to MI. Less well known is whether propensity to change risk behaviors after MI also varies inversely with SES. We performed a systematized literature review addressing changes in risk behaviors following MI as a function of SES. 2160 abstracts were reviewed and 44 met eligibility criteria. Behaviors included smoking cessation, cardiac rehabilitation (CR), medication adherence, diet, and physical activity (PA). For each behavior, lower-SES patients were less likely to change after MI. Overall, lower-SES patients were 2 to 4 times less likely to make needed behavior changes (OR's 0.25-0.56). Lower-SES populations are less successful at changing risk behaviors post-MI. Increasing their participation in CR/secondary prevention programs, which address multiple risk behaviors, including increasing PA and exercise, should be a priority of healthy lifestyle medicine (HLM).
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Affiliation(s)
- Diann E Gaalema
- Vermont Center on Behavior and Health, University of Vermont, Burlington, VT; Department of Psychiatry, University of Vermont, Burlington, VT; Department of Psychological Science, University of Vermont, Burlington, VT.
| | - Rebecca J Elliott
- Vermont Center on Behavior and Health, University of Vermont, Burlington, VT; Department of Psychiatry, University of Vermont, Burlington, VT
| | - Zachary H Morford
- Vermont Center on Behavior and Health, University of Vermont, Burlington, VT; Department of Psychiatry, University of Vermont, Burlington, VT; Department of Psychological Science, University of Vermont, Burlington, VT
| | - Stephen T Higgins
- Vermont Center on Behavior and Health, University of Vermont, Burlington, VT; Department of Psychiatry, University of Vermont, Burlington, VT; Department of Psychological Science, University of Vermont, Burlington, VT
| | - Philip A Ades
- Vermont Center on Behavior and Health, University of Vermont, Burlington, VT; Department of Medicine, Division of Cardiology, University of Vermont Medical Center, Burlington, VT
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Predictors of Cardiac Rehabilitation Initiation and Adherence in a Multiracial Urban Population. J Cardiopulm Rehabil Prev 2017; 37:30-38. [DOI: 10.1097/hcr.0000000000000226] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Abstract
Anxiety and its associated disorders are common in patients with cardiovascular disease and may significantly influence cardiac health. Anxiety disorders are associated with the onset and progression of cardiac disease, and in many instances have been linked to adverse cardiovascular outcomes, including mortality. Both physiologic (autonomic dysfunction, inflammation, endothelial dysfunction, changes in platelet aggregation) and health behavior mechanisms may help to explain the relationships between anxiety disorders and cardiovascular disease. Given the associations between anxiety disorders and poor cardiac health, the timely and accurate identification and treatment of these conditions is of the utmost importance. Fortunately, pharmacologic and psychotherapeutic interventions for the management of anxiety disorders are generally safe and effective. Further study is needed to determine whether interventions to treat anxiety disorders ultimately impact both psychiatric and cardiovascular health.
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Sumner J, Grace SL, Doherty P. Predictors of Cardiac Rehabilitation Utilization in England: Results From the National Audit. J Am Heart Assoc 2016; 5:e003903. [PMID: 27792657 PMCID: PMC5121492 DOI: 10.1161/jaha.116.003903] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Accepted: 09/14/2016] [Indexed: 01/01/2023]
Abstract
BACKGROUND Cardiac rehabilitation (CR) is grossly underused, with major inequities in access. However, use of CR and predictors of initiation in England where CR contracting is available is unknown. The aims were (1) to investigate CR utilization rates in England, and (2) to determine sociodemographic and clinical factors associated with CR initiation including social deprivation. METHODS AND RESULTS Data from the National Audit of CR, between January 2012 and November 2015, were used. Utilization rates overall and by deprivation quintile were derived. Logistic regression was performed to identify predictors of initiation among enrollees, using the Huber-White-sandwich estimator robust standard errors method to account for the nested nature of the data. Of the 234 736 (81.5%) patients referred to CR, 141 648 enrolled, 97 406 initiated CR, and of those initiating, 37.2% completed a program of ≥8 weeks duration. The significant characteristics associated with CR initiation were younger age (odds ratio [OR] 0.98, 95% CI 0.98-0.99), having a partner (OR 1.31, 95% CI 1.17-1.48), not being employed (OR 0.86, 95% CI 0.77-0.96), not having diabetes mellitus (OR 0.84, 95% CI 0.77-0.92), greater anxiety (OR 1.02, 95% CI 1.003-1.04), not being a medically managed myocardial infarction patient (OR 0.57, 95% CI 0.42-0.76), and having had coronary artery bypass graft surgery (OR 1.64, 95% CI 1.09-2.47). CONCLUSIONS CR enrollment does not meet English National Health Service targets; however it compares with that in other countries. Evidence-based approaches increasing CR enrollment and initiation should be applied, focusing on the identified characteristics associated with CR initiation, specifically older, single, employed individuals with diabetes mellitus and those not revascularized.
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Affiliation(s)
| | - Sherry L Grace
- School of Kinesiology and Health Science, Faculty of Health, York University, Toronto, Canada University Health Network University of Toronto, Canada
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Bäck M, Cider Å, Herlitz J, Lundberg M, Jansson B. Kinesiophobia mediates the influences on attendance at exercise-based cardiac rehabilitation in patients with coronary artery disease. Physiother Theory Pract 2016; 32:571-580. [PMID: 27726471 DOI: 10.1080/09593985.2016.1229828] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
PURPOSE To identify predictors of attendance at exercise-based cardiac rehabilitation (CR) and to test the hypothesis that kinesiophobia mediates the influence on attendance at CR in patients with coronary artery disease (CAD). PATIENTS In total, 332 patients (75 women; mean age 65 ± 9.1 years) with a diagnosis of CAD were recruited at Sahlgrenska University Hospital, Sweden. METHODS The patients were tested in terms of objective measurements, self-rated psychological measurements, and level of physical activity. A path model with direct and indirect effects via kinesiophobia was used to predict participation in CR. An exploratory selection of significant predictors was made. RESULTS A current incidence of coronary bypass grafting (p < 0.001) and a diagnosis of ST-elevation myocardial infarction (p = 0.004) increased the probability of attendance at CR, while kinesiophobia (p = 0.001) reduced attendance. As a mediator, kinesiophobia was influenced by four predictors and the following indirect effects were found. General health and muscle endurance increased the probability of attendance at CR, while self-rated anxiety and current incidence of heart failure had the opposite effect. CONCLUSIONS This study suggests that kinesiophobia has an influence on and a mediating role in attendance at CR. The results need to be further investigated in relation to clinical practice.
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Affiliation(s)
- Maria Bäck
- a Department of Occupational Therapy and Physiotherapy , Sahlgrenska University Hospital , Gothenburg , Sweden.,b Institute of Medicine, Sahlgrenska Academy , University of Gothenburg , Gothenburg , Sweden.,c Department of Medical and Health Sciences , Division of Physiotherapy, Linköping University , Linköping , Sweden
| | - Åsa Cider
- a Department of Occupational Therapy and Physiotherapy , Sahlgrenska University Hospital , Gothenburg , Sweden.,d Institute of Neuroscience and Physiology/Physiotherapy, Sahlgrenska Academy , University of Gothenburg , Gothenburg , Sweden
| | - Johan Herlitz
- e The Center of Preshospital Research Western Sweden , University of Borås , Borås , Sweden
| | - Mari Lundberg
- f Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy , University of Gothenburg , Gothenburg , Sweden
| | - Bengt Jansson
- g Department of Psychology , University of Gothenburg , Gothenburg , Sweden
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Worcester MUC, Murphy BM, Mee VK, Roberts SB, Goble AJ. Cardiac rehabilitation programmes: predictors of non-attendance and drop-out. ACTA ACUST UNITED AC 2016; 11:328-35. [PMID: 15292767 DOI: 10.1097/01.hjr.0000137083.20844.54] [Citation(s) in RCA: 123] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Despite evidence of its benefits, attendance at cardiac rehabilitation (CR) programmes is poor. Past studies to identify predictors of non-attendance have been limited by their small sample size, particularly for female patients. The present study was designed to identify socio-demographic and clinical predictors of non-attendance and drop-out separately for men and women automatically referred to CR programmes. METHOD AND SUBJECTS Prospective study of CR programme attendance amongst 808 patients consecutively admitted over an 11-month period to one of two hospitals in Melbourne, Australia, after acute myocardial infarction (AMI), or to undergo coronary artery bypass graft surgery (CABGS) or percutaneous coronary intervention (PCI). RESULTS Of the 652 eligible patients, 573 (88%) were successfully tracked at 4 months. Of these, 284 (49.6%) had attended a CR programme, while 272 (47.5%) had not. Using logistic regression, the significant predictors of programme non-attendance among men were having had a PCI, being a non-driver, and being aged 70 or more. The only factor predictive of non-attendance for women was being aged 70 or more. Amongst attenders, 67 (23.6%) patients discontinued the programme. Being a smoker, having diabetes and being unemployed at the time of hospital admission were predictive of programme drop-out by men. Being physically inactive at admission was predictive of programme drop-out by women. CONCLUSIONS The present study demonstrated a relatively high rate of CR programme attendance. Special attention needs to be directed towards males who are older, PCI patients, smokers, unemployed or non-drivers, and females who are older or inactive.
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Sarrafzadegan N, Rabiei K, Shirani S, Kabir A, Mohammadifard N, Roohafza H. Drop-out predictors in cardiac rehabilitation programmes and the impact of sex differences among coronary heart disease patients in an Iranian sample: a cohort study. Clin Rehabil 2016; 21:362-72. [PMID: 17613578 DOI: 10.1177/0269215507072193] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective : To determine whether patients who subsequently drop out of a structured cardiac rehabilitation programme could be prospectively distinguished from those who remain in the programme based upon their initial baseline characteristics. Design : A cohort study. Setting : A referral rehabilitation department in a cardiovascular research and training institute. Subjects : One thousand one hundred and fifteen coronary heart disease patients including patients with ischaemic heart disease, and those undergoing bypass surgery or percutaneous coronary interventions. Interventions : Demographic characteristics, coronary heart disease risk factors, ejection fraction, functional capacity and laboratory tests were considered at baseline. Main measures : Patients who completed all 24 sessions of the cardiac rehabilitation programme were compared with drop-out cases who did not. Results : Four hundred and ninety-nine patients (44.8%) completed the whole cardiac rehabilitation programme. Women (adjusted odds ratio (AOR) 1.817, P < 0.001), older patients (AOR 1.015, P = 0.047), patients with lower risk of coronary heart disease (AOR 1.573, P = 0.008) or lower body mass index (BMI) (AOR 0.945, P = 0.001) and higher waist-to-hip ratio (AOR 12.871, P = 0.009) and those who were non-smokers (AOR 1.779, P = 0.001) were significantly more likely to complete cardiac rehabilitation. Conclusions : Developing interventions to address special needs of young, obese, smoker male patients who have a lower waist-to-hip ratio and higher clinical risk may be important, especially in attempts to retain this high-risk group in cardiac rehabilitation therapy.
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Affiliation(s)
- Nizal Sarrafzadegan
- Isfahan Cardiovascular Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.
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Feasibility of a Cognitive-Behavioural Group Intervention for Men Experiencing Psychological Difficulties After Myocardial Infarction. Eur J Cardiovasc Nurs 2016. [DOI: 10.1016/s1474-51510200009-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Background: People experiencing psychological distress after a cardiac event may require special follow-up and targeted interventions in order to effectively decrease levels of distress. Aims: Men who were judged to be experiencing poor emotional adjustment post-myocardial infarction (MI) were invited to a cognitive behaviour therapy group. The current study examines the attendance at such a group and the consequent feasibility of such interventions. Method: The content of the group aimed to help men deal with the uncomfortable psychosocial issues that had arisen since having a MI. Results: Of the 26 men approached only 30% were interested in attending and only 11% actually completed the group. Two men who were committed to attending the group could not complete all the sessions, as heart bypass operations became available to them. Conclusion: Ways of involving men in interventions targeting psychological distress requires ongoing investigation.
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Worcester MUC, Stojcevski Z, Murphy B, Goble AJ. Factors Associated with Non-Attendance at a Secondary Prevention Clinic for Cardiac Patients. Eur J Cardiovasc Nurs 2016; 2:151-7. [PMID: 14622640 DOI: 10.1016/s1474-5151(03)00031-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Background: A randomised controlled trial was undertaken to test the effectiveness of a secondary prevention clinic. Secondary prevention programs can improve prognosis after an acute cardiac illness. It is therefore important to encourage high participation rates. Aim: The present study was a post-hoc analysis to identify factors associated with patients’ non-attendance at the clinic. Methods: We compared the baseline socio-demographic and clinical characteristics of 83 (73.5% male) non-attending patients and a random sample of 96 (85.4% male) attending patients. Self-reported data were gathered during interviews conducted on an average of 30 months after hospital admission to investigate long-term outcomes of the clinic. Results: Using logistic regression analysis, we found that non-attendance was significantly and independently associated with being female, being under 60 years of age, having no history of high cholesterol and having no angina prior to the event. In bivariate analyses, non-attendance was also associated with being born overseas and not having private health insurance. Conclusions: Likely non-attending patients should be identified early and more effective strategies should be devised to facilitate their participation in secondary prevention programs.
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Steele A, Wade TD. The Contribution of Optimism and Quality of Life to Depression in an Acute Coronary Syndrome Population. Eur J Cardiovasc Nurs 2016; 3:231-7. [PMID: 15350233 DOI: 10.1016/j.ejcnurse.2004.06.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2004] [Revised: 06/07/2004] [Accepted: 06/14/2004] [Indexed: 11/23/2022]
Abstract
BACKGROUND Numerous longitudinal studies have revealed that depression following an acute cardiac event poses a risk factor for poor cardiac outcomes. It is therefore important to identify modifiable predictors of depression in order to develop a variety of interventions with this population. AIMS The aim of the present research was to determine whether the relationship between optimism and depressive symptoms was mediated by self-reported quality of life (QOL) in acute coronary syndrome patients. METHODS Two weeks following hospital discharge (Time 1) 59 participants completed a self-report questionnaire. Four weeks later (Time 2), 49 of these participants completed the same questionnaire. RESULTS At Time 1, the relationship between optimism and depressive symptoms was partially mediated by functional QOL and symptom QOL. Furthermore, the relationship between Time 1 optimism and Time 2 depressive symptoms was partially mediated by Time 1 functional QOL. When each of the Time 1 variables were used to predict Time 2 depressive symptoms, only optimism continued to predict depressive symptoms over and above the influence of Time 1 depressive symptoms and other covariates. CONCLUSION These findings suggest the underlying importance of optimism in influencing depressive symptoms in acute coronary syndrome patients, and indicate that optimism and perceptions of functional QOL may be a possible rehabilitation target for this population.
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Affiliation(s)
- Anna Steele
- School of Psychology, Flinders University, GPO Box 2100, Adelaide 5001, Australia.
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Schröder SL, Richter M, Schröder J, Frantz S, Fink A. Socioeconomic inequalities in access to treatment for coronary heart disease: A systematic review. Int J Cardiol 2016; 219:70-8. [PMID: 27288969 DOI: 10.1016/j.ijcard.2016.05.066] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Accepted: 05/12/2016] [Indexed: 11/28/2022]
Abstract
Strong socioeconomic inequalities exist in cardiovascular mortality and morbidity. The current review aims to synthesize the current evidence on the association between socioeconomic status (SES) and access to treatment of coronary heart disease (CHD). We examined quantitative studies analyzing the relationship between SES and access to CHD treatment that were published between 1996 and 2015. Our data sources included Medline and Web of Science. Our search yielded a total of 2066 records, 57 of which met our inclusion criteria. Low SES was found to be associated with low access to coronary procedures and secondary prevention. Access to coronary procedures, especially coronary angiography, was mainly related to SES to the disadvantage of patients with low SES. However, access to drug treatment and cardiac rehabilitation was only associated with SES in about half of the studies. The association between SES and access to treatment for CHD was stronger when SES was measured based on individual-level compared to area level, and stronger for individuals living in countries without universal health coverage. Socioeconomic inequalities exist in access to CHD treatment, and universal health coverage shows only a minor effect on this relationship. Inequalities diminish along the treatment pathway for CHD from diagnostic procedures to secondary prevention. We therefore conclude that CHD might be underdiagnosed in patients with low SES. Our results indicate that there is an urgent need to improve access to CHD treatment, especially by increasing the supply of diagnostic angiographies, to reduce inequalities across different healthcare systems.
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Affiliation(s)
- Sara L Schröder
- Institute of Medical Sociology, Martin Luther University Halle-Wittenberg, Germany.
| | - Matthias Richter
- Institute of Medical Sociology, Martin Luther University Halle-Wittenberg, Germany
| | - Jochen Schröder
- Department of Internal Medicine III (Cardiology and Angiology), Martin Luther University Halle-Wittenberg, Germany
| | - Stefan Frantz
- Department of Internal Medicine III (Cardiology and Angiology), Martin Luther University Halle-Wittenberg, Germany
| | - Astrid Fink
- Institute of Medical Sociology, Martin Luther University Halle-Wittenberg, Germany
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Can We Identify the Active Ingredients of Behaviour Change Interventions for Coronary Heart Disease Patients? A Systematic Review and Meta-Analysis. PLoS One 2016; 11:e0153271. [PMID: 27105435 PMCID: PMC4841549 DOI: 10.1371/journal.pone.0153271] [Citation(s) in RCA: 75] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Accepted: 03/25/2016] [Indexed: 12/19/2022] Open
Abstract
Background The main behaviour change intervention available for coronary heart disease (CHD) patients is cardiac rehabilitation. There is little recognition of what the active ingredients of behavioural interventions for CHD might be. Using a behaviour change technique (BCT) framework to code existing interventions may help to identify this. The objectives of this systematic review are to determine the effectiveness of CHD behaviour change interventions and how this may be explained by BCT content and structure. Methods and Findings A systematic search of Medline, EMBASE and PsycInfo electronic databases was conducted over a twelve year period (2003–2015) to identify studies which reported on behaviour change interventions for CHD patients. The content of the behaviour change interventions was coded using the Coventry Aberdeen and London—Refined (CALO-RE) taxonomy. Meta-regression analyses examined the BCT content as a predictor of mortality. Twenty two papers met the criteria for this review, reporting data on 16,766 participants. The most commonly included BCTs were providing information, and goal setting. There was a small but significant effect of the interventions on smoking (risk ratio (RR) = 0.89, 95% CI 0.81–0.97). The interventions did not reduce the risk of CHD events (RR = 0.86, 95% CI 0.68, 1.09), but significantly reduced the risk of mortality (RR = 0.82, 95% CI 0.69, 0.97). Sensitivity analyses did not find that any of the BCT variables predicted mortality and the number of BCTs included in an intervention was not associated with mortality (β = -0.02, 95% CI -0.06–0.03). Conclusions Behaviour change interventions for CHD patients appear to have a positive impact on a number of outcomes. Using an existing BCT taxonomy to code the interventions helped us to understand which were the most commonly used techniques, providing information and goal setting, but not the active components of these complex interventions.
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Reporting of Posttraumatic Stress Disorder and Cardiac Misconceptions Following Cardiac Rehabilitation. J Cardiopulm Rehabil Prev 2016; 35:238-45. [PMID: 25689163 DOI: 10.1097/hcr.0000000000000100] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE Approximately 15% of cardiac patients experience posttraumatic stress disorder (PTSD), double the incidence seen in the general community. Posttraumatic stress disorder can seriously affect psychological and physical recovery. This study assessed how many patients reported symptoms of PTSD following a cardiac event and examined whether there was any change after completing a cardiac rehabilitation (CR) program. Associations between PTSD and anxiety, depression, and cardiac misconceptions were also explored. METHODS This was a prospective cohort study using repeated measures. All patients eligible for the hospital CR program were invited to complete questionnaires assessing psychological distress and beliefs about heart disease before (T1) and after (T2) completing the CR program. RESULTS Questionnaires at T1 were returned by 105 patients. Of these, 24% reported symptoms of PTSD, 18% high anxiety, and 9% high levels of depression. At T2, 67 patients returned questionnaires, showing that 9% of patients continued to experience PTSD. These patients experienced significantly higher levels of anxiety (t = -4.77; P < .001) and depression (t = -3.64; P < .001). Intrusive thoughts and hyperarousal were significantly lower at T2 (t = 2.32; P = .02 and t = 3.01; P = .01, respectively). More misconceptions were associated with higher levels of anxiety and depression; however, the number of cardiac misconceptions remained similar throughout. Caucasians reported significantly fewer misconceptions than non-Caucasian patients, except for beliefs about myocardial infarction. Patients had fewer misconceptions about their own specific condition. CONCLUSIONS These findings suggest that screening for symptoms of PTSD after completion of a CR program would be helpful in identifying patients who would benefit from specialist psychological support.
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Soo Hoo SY, Gallagher R, Elliott D. Predictors of cardiac rehabilitation attendance following primary percutaneous coronary intervention for ST-elevation myocardial infarction in Australia. Nurs Health Sci 2016; 18:230-7. [DOI: 10.1111/nhs.12258] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2015] [Revised: 09/23/2015] [Accepted: 09/28/2015] [Indexed: 11/29/2022]
Affiliation(s)
- Soon Yeng Soo Hoo
- Department of Cardiology; Royal North Shore Hospital; Sydney Australia
- Faculty of Health, University of Technology Sydney
| | - Robyn Gallagher
- Charles Perkins Centre and Sydney Nursing School; University of Sydney; Sydney New South Wales Australia
| | - Doug Elliott
- Faculty of Health, University of Technology Sydney
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Abstract
This review provides an outline of the association between major depressive disorder (MDD) and coronary heart disease (CHD). Much is known about the two individual clinical conditions; however, it is not until recently, biological mechanisms have been uncovered that link both MDD and CHD. The activation of stress pathways have been implicated as a neurochemical mechanism that links MDD and CHD. Depression is known to be associated with poorer outcomes of CHD. Psychological factors, such as major depression and stress, are now known as risk factors for developing CHD, which is as important and is independent of classic risk factors, such as hypertension, diabetes mellitus, and cigarette smoking. Both conditions have great socioeconomic importance given that depression and CHD are likely to be two of the three leading causes of global burden of disease. Better understanding of the common causal pathways will help us delineate more appropriate treatments.
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Affiliation(s)
- Arup K Dhar
- Human Neurotransmitters Laboratory, Baker IDI Heart and Diabetes Institute, Melbourne, VIC, Australia; Alfred Psychiatry, Alfred Health, Melbourne, VIC, Australia; Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
| | - David A Barton
- Human Neurotransmitters Laboratory, Baker IDI Heart and Diabetes Institute, Melbourne, VIC, Australia; Alfred Psychiatry, Alfred Health, Melbourne, VIC, Australia; Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
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Marke V, Bennett P. Predicting negative emotional states following first onset acute coronary syndrome. J Health Psychol 2015; 22:765-775. [PMID: 26613707 DOI: 10.1177/1359105315614996] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
This study identified predictors of anxiety and depression in patients with acute coronary syndrome. Predictors included illness beliefs, fear/threat at the time of the cardiac event, threat reappraisal over time and social support. A total of 97 participants completed questionnaires in hospital and 1- and 6-month follow-up. Perceived threat and fear at the time of the cardiac event predicted affective response at both time points, partly mediated by threat reappraisal. Contemporaneous measures of illness beliefs contributed additional variance, although not always in the predicted direction: high concern and control over the illness were associated with emotional distress. Assessment of patients for risk of negative emotional outcomes of acute coronary syndrome needs to consider their beliefs about their illness and the degree of threat and fear experienced at the time of the event. Interventions need to help people cope with negative emotional states as well as challenging inappropriate illness beliefs.
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Gaalema DE, Cutler AY, Higgins ST, Ades PA. Smoking and cardiac rehabilitation participation: Associations with referral, attendance and adherence. Prev Med 2015; 80:67-74. [PMID: 25900804 PMCID: PMC4592377 DOI: 10.1016/j.ypmed.2015.04.009] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2015] [Revised: 04/08/2015] [Accepted: 04/14/2015] [Indexed: 01/07/2023]
Abstract
OBJECTIVE Continued smoking after a cardiac event greatly increases mortality risk. Smoking cessation and participation in cardiac rehabilitation (CR) are effective in reducing morbidity and mortality. However, these two behaviors may interact; those who smoke may be less likely to access or complete CR. This review explores the association between smoking status and CR referral, attendance, and adherence. METHODS A systematic literature search was conducted examining associations between smoking status and CR referral, attendance and completion in peer-reviewed studies published through July 1st, 2014. For inclusion, studies had to report data on outpatient CR referral, attendance or completion rates and smoking status had to be considered as a variable associated with these outcomes. RESULTS Fifty-six studies met inclusion criteria. In summary, a history of smoking was associated with an increased likelihood of referral to CR. However, smoking status also predicted not attending CR and was a strong predictor of CR dropout. CONCLUSION Continued smoking after a cardiac event predicts lack of attendance in, and completion of CR. The issue of smoking following a coronary event deserves renewed attention.
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Affiliation(s)
- Diann E Gaalema
- Vermont Center on Behavior and Health, University of Vermont, USA; Department of Psychiatry, University of Vermont, USA; Department of Psychology, University of Vermont, USA.
| | - Alexander Y Cutler
- Vermont Center on Behavior and Health, University of Vermont, USA; Department of Psychiatry, University of Vermont, USA
| | - Stephen T Higgins
- Vermont Center on Behavior and Health, University of Vermont, USA; Department of Psychiatry, University of Vermont, USA; Department of Psychology, University of Vermont, USA
| | - Philip A Ades
- Vermont Center on Behavior and Health, University of Vermont, USA; Department of Medicine, Division of Cardiology, University of Vermont Medical Center, USA
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Granville Smith I, Parker G, Rourke P, Cvejic E, Vollmer-Conna U. Acute coronary syndrome and depression: A review of shared pathophysiological pathways. Aust N Z J Psychiatry 2015. [PMID: 26219293 DOI: 10.1177/0004867415597304] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To examine the evidence for shared pathophysiological pathways in acute coronary syndrome and major depression and to conceptualise the dynamic interplay of biological systems and signalling pathways that link acute coronary syndrome and depression within a framework of neuro-visceral integration. METHODS Relevant articles were sourced via a search of published literature from MEDLINE, EMBASE and PubMed using a variety of search terms relating to biological connections between acute coronary syndrome and depression. Additional articles from bibliographies of retrieved papers were assessed and included where relevant. RESULTS Despite considerable research efforts, a clear understanding of the biological processes connecting acute coronary syndrome and depression has not been achieved. Shared abnormalities are evident across the immune, platelet/endothelial and autonomic/stress-response systems. From the available evidence, it seems unlikely that a single explanatory model could account for the complex interactions of biological pathways driving the pathophysiology of these disorders and their comorbidity. CONCLUSION A broader conceptual framework of mind-body or neuro-visceral integration that can incorporate the existence of several causative scenarios may be more useful in directing future research and treatment approaches for acute coronary syndrome-associated depression.
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Affiliation(s)
- Isabelle Granville Smith
- School of Psychiatry, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Gordon Parker
- School of Psychiatry, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Poppy Rourke
- School of Psychiatry, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Erin Cvejic
- School of Psychiatry, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Uté Vollmer-Conna
- School of Psychiatry, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
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Economic and Social Impact of Increasing Uptake of Cardiac Rehabilitation Services--A Cost Benefit Analysis. Heart Lung Circ 2015; 25:175-83. [PMID: 26442971 DOI: 10.1016/j.hlc.2015.08.007] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Revised: 08/05/2015] [Accepted: 08/18/2015] [Indexed: 11/22/2022]
Abstract
BACKGROUND Cardiac rehabilitation can reduce mortality, improve cardiac risk factor profile and reduce readmissions; yet uptake remains low at 30%. This research aims to investigate the social and economic impact of increasing the uptake of cardiac rehabilitation in Victoria, Australia using cost benefit analysis (CBA). METHODS Cost benefit analysis has been undertaken over a 10-year period to analyse three scenarios: (1) Base Case: 30% uptake; (2) Scenario 1: 50% uptake; and (3) Scenario 2: 65% uptake. Impacts considered include cardiac rehabilitation program costs, direct inpatient costs, other healthcare costs, burden of disease, productivity losses, informal care costs and net deadweight loss. RESULTS There is a net financial saving of $46.7-$86.7 million under the scenarios. Compared to the Base Case, an additional net benefit of $138.9-$227.2 million is expected. This results in a Benefit Cost Ratio of 5.6 and 6.8 for Scenarios 1 and 2 respectively. Disability Adjusted Life Years were 21,117-37,565 years lower than the Base Case. CONCLUSIONS Greater uptake of cardiac rehabilitation can reduce the burden of disease, directly translating to benefits for society and the economy. This research supports the need for greater promotion, routine referral to be made standard practice and implementation of reforms to boost uptake.
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Jelinek MV, Thompson DR, Ski C, Bunker S, Vale MJ. 40years of cardiac rehabilitation and secondary prevention in post-cardiac ischaemic patients. Are we still in the wilderness? Int J Cardiol 2015; 179:153-9. [DOI: 10.1016/j.ijcard.2014.10.154] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2014] [Revised: 10/21/2014] [Accepted: 10/24/2014] [Indexed: 12/15/2022]
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Pogosova NV, Dovzhenko TV, Babin AG, Kursakov AA, Vygodin VA. RUSSIAN VERSION OF PHQ-2 AND 9 QUESTIONNAIRES: SENSITIVITY AND SPECIFICITY IN DETECTION OF DEPRESSION IN OUTPATIENT GENERAL MEDICAL PRACTICE. ACTA ACUST UNITED AC 2014. [DOI: 10.15829/1728-8800-2014-3-18-24] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Aim. Current study aimed to adapt and evaluate the psychometric properties of Russian versions of Patient Health Questionnaires 2 and 9 (PHQ-2 and PHQ-9) used for detection of depression in general medical practice worldwide.Material and methods. Questionnaires were translated into Russian and adapted with regard to linguistic features of population. A study was performed on a sample of 193 patients (130 female, 63 male, mean age 34,6±11,4), who attended general practitioners in outpatient practice department of NRC for Preventive Medicine. Patients filled in PHQ-2 and –9 questionnaires in presence of clinical psychologist and then assessed for depression by a psychiatrist (using ICD-10 criteria).Results. The optimal measures of sensitivity and specificity corresponded to cut-off scores of 3 for PHQ-2 (66,2% and 87,4% respectively) and 10 for PHQ-9 (68,9% and 93,3% respectively). Russian questionnaires were found to success in sensitivity, specificity and their positive predictive values are comparable to similar research data reported in literature. Article discusses the principles of implementation of the studied scales for depression screening in general medical practice.
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Affiliation(s)
- N. V. Pogosova
- FSBI State Scientific Research Centre for Preventive Medicine of the Ministry of Health
| | - T. V. Dovzhenko
- FSBI Moscow Scientific Research Institute for Psychiatry of the Ministry of Health. Moscow, Russia
| | - A. G. Babin
- FSBI State Scientific Research Centre for Preventive Medicine of the Ministry of Health
| | - A. A. Kursakov
- FSBI State Scientific Research Centre for Preventive Medicine of the Ministry of Health
| | - V. A. Vygodin
- FSBI State Scientific Research Centre for Preventive Medicine of the Ministry of Health
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Prince DZ, Sobolev M, Gao J, Taub CC. Racial disparities in cardiac rehabilitation initiation and the effect on survival. PM R 2013; 6:486-92. [PMID: 24321413 DOI: 10.1016/j.pmrj.2013.11.016] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2013] [Revised: 10/04/2013] [Accepted: 11/23/2013] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To examine predictors of initiation and adherence, identify racial disparities, and compare the survival benefit of cardiac rehabilitation between a white and a unique predominantly non-white minority in an urban environment. DESIGN A retrospective cohort study. SETTING The outpatient cardiac rehabilitation program at Montefiore Medical Center, Bronx, New York. PATIENTS Consecutive patients (n = 822) referred to outpatient cardiac rehabilitation were evaluated. METHODS Baseline characteristics and outcomes were ascertained from medical records. Multivariate logistic regression was used to examine the association among initiation, age, gender, race, reason for referral, and copayment. Kaplan-Meier analysis was performed to evaluate mortality outcomes. MAIN OUTCOME MEASUREMENTS Racial disparities in rates of initiation, adherence and completion, and survival benefit associated with cardiac rehabilitation. RESULTS Among 822 patients referred (51.5% non-white minorities, 61.1% male), 59.4% initiated cardiac rehabilitation. Non-white minorities initiated cardiac rehabilitation less often than did white patients (54.4% versus 65.2%, P = .003). After adjustment, white patients were 77.5% more likely to initiate cardiac rehabilitation (odds ratio 1.78; 95% confidence interval 1.13-2.80). Both white populations and non-white minorities who participated in cardiac rehabilitation had a lower risk of death (P = .0022). CONCLUSIONS In a predominantly minority population, racial disparities exist among cardiac rehabilitation participants. Minorities were less likely to initiate cardiac rehabilitation. Gender, referral patterns, and the presence of copayment did not influence initiation. Cardiac rehabilitation initiation was associated with decreased mortality.
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Affiliation(s)
- David Z Prince
- The Arthur S. Abramson Department of Rehabilitation Medicine, Einstein Division/Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY(∗)
| | - Maria Sobolev
- Division of Cardiology, Department of Medicine, Einstein Division/Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY(†)
| | - Ju Gao
- Division of Cardiology, Department of Medicine, Einstein Division/Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY(‡)
| | - Cynthia C Taub
- Division of Cardiology, Department of Medicine, Einstein Division/Montefiore Medical Center, Albert Einstein College of Medicine, 1825 Eastchester Road, Room WT120, Bronx, NY 10461(§).
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Dumas A, Savage M, Stuart S. Anti-normative lifestyles in cardiac rehabilitation: Underprivileged men’s post-heart incident lives. Health (London) 2013; 18:458-75. [DOI: 10.1177/1363459313507587] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Cardiovascular diseases are leading causes of premature mortality and disability. Although health institutions have developed and promoted cardiac rehabilitation programs, they have not attained their desired outcomes, especially among the most vulnerable groups of the population. This study qualitatively examines socially and materially deprived men’s (n = 20) noncompliance with cardiovascular health guidelines following a medical intervention to the heart. By drawing on Pierre Bourdieu’s sociocultural theory of practice, results indicate that precarious living conditions obstruct long-term physical recovery and illness prevention by underemphasizing the value of “health capital” and reducing the capacity to sustain lifestyle change. This study calls into question health policies that have little to no consideration of embodied practical knowledge and lived experiences.
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Savage M, Dumas A, Stuart SA. Fatalism and short-termism as cultural barriers to cardiac rehabilitation among underprivileged men. SOCIOLOGY OF HEALTH & ILLNESS 2013; 35:1211-1226. [PMID: 24266752 DOI: 10.1111/1467-9566.12040] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Cardiovascular diseases are a leading cause of death and disability in Canada, and individuals of low socioeconomic status appear particularly vulnerable to such disorders. Although many health-related institutions have promoted cardiovascular health and have created cardiac rehabilitation programmes, they have not attained their desired outcomes, especially amongst socioeconomically deprived men. Drawing on Pierre Bourdieu's sociocultural theory, this qualitative study aims to understand the social mechanisms underpinning the lifestyles and health practices of men who had suffered a cardiovascular incident requiring hospitalisation. In all, 20 interviews were conducted with francophone men aged 40 to 65 years living in the province of Québec, Canada. The analysis strongly suggests that the respondents' living conditions and disease were significant obstacles to their adoption of a healthy lifestyle. Their despair and pessimism, apparently originating in the harshness of their financial realities, physical limitations and social networks, led them to believe that they could do little to control their lives, thereby limiting the fulfillment of any long-term ambitions. Therefore, the adoption of a habitus characterised by fatalistic and short-term perceptions of health influenced their lifestyle choices, leading them to maintain lives that were in stark contrast with the recommendations made by health promotion experts.
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Affiliation(s)
- Mathieu Savage
- School of Human Kinetics, Faculty of Health Sciences, University of Ottawa, Canada
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McKee G, Biddle M, O’ Donnell S, Mooney M, O’ Brien F, Moser DK. Cardiac rehabilitation after myocardial infarction: What influences patients’ intentions to attend? Eur J Cardiovasc Nurs 2013; 13:329-37. [DOI: 10.1177/1474515113496686] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2012] [Accepted: 06/16/2013] [Indexed: 11/16/2022]
Affiliation(s)
- Gabrielle McKee
- School of Nursing and Midwifery, Trinity College Dublin, Ireland
| | - Martha Biddle
- University of Kentucky, College of Nursing, Lexington, USA
| | | | - Mary Mooney
- School of Nursing and Midwifery, Trinity College Dublin, Ireland
| | - Frances O’ Brien
- School of Nursing and Midwifery, Trinity College Dublin, Ireland
| | - Debra K Moser
- University of Kentucky, College of Nursing, Lexington, USA
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