Measuring the health related quality of life of people with ischaemic heart disease

Effectiveness of an Interactive mHealth App (EVITE) in Improving Lifestyle After a Coronary Event: Randomized Controlled Trial

BACKGROUND

Coronary heart disease is one of the leading causes of mortality worldwide. Secondary prevention is essential, as it reduces the risk of further coronary events. Mobile health (mHealth) technology could become a useful tool to improve lifestyles.

OBJECTIVE

This study aimed to evaluate the effect of an mHealth intervention on people with coronary heart disease who received percutaneous coronary intervention. Improvements in lifestyle regarding diet, physical activity, and smoking; level of knowledge of a healthy lifestyle and the control of cardiovascular risk factors (CVRFs); and therapeutic adherence and quality of life were analyzed.

METHODS

This was a randomized controlled trial with a parallel group design assigned 1:1 to either an intervention involving a smartphone app (mHealth group) or to standard health care (control group). The app was used for setting aims, the self-monitoring of lifestyle and CVRFs using measurements and records, educating people with access to information on their screens about healthy lifestyles and adhering to treatment, and giving motivation through feedback about achievements and aspects to improve. Both groups were assessed after 9 months. The primary outcome variables were adherence to the Mediterranean diet, frequency of food consumed, patient-reported physical activity, smoking, knowledge of healthy lifestyles and the control of CVRFs, adherence to treatment, quality of life, well-being, and satisfaction.

RESULTS

The study analyzed 128 patients, 67 in the mHealth group and 61 in the control group; most were male (92/128, 71.9%), with a mean age of 59.49 (SD 8.97) years. Significant improvements were observed in the mHealth group compared with the control group regarding adherence to the Mediterranean diet (mean 11.83, SD 1.74 points vs mean 10.14, SD 2.02 points; P<.001), frequency of food consumption, patient-reported physical activity (mean 619.14, SD 318.21 min/week vs mean 471.70, SD 261.43 min/week; P=.007), giving up smoking (25/67, 75% vs 11/61, 42%; P=.01), level of knowledge of healthy lifestyles and the control of CVRFs (mean 118.70, SD 2.65 points vs mean 111.25, SD 9.05 points; P<.001), and the physical component of the quality of life 12-item Short Form survey (SF-12; mean 45.80, SD 10.79 points vs mean 41.40, SD 10.78 points; P=.02). Overall satisfaction was higher in the mHealth group (mean 48.22, SD 3.89 vs mean 46.00, SD 4.82 points; P=.002) and app satisfaction and usability were high (mean 44.38, SD 6.18 out of 50 points and mean 95.22, SD 7.37 out of 100).

CONCLUSIONS

The EVITE app was effective in improving the lifestyle of patients in terms of adherence to the Mediterranean diet, frequency of healthy food consumption, physical activity, giving up smoking, knowledge of healthy lifestyles and controlling CVRFs, quality of life, and overall satisfaction. The app satisfaction and usability were excellent.

TRIAL REGISTRATION

Clinicaltrials.gov NCT04118504; https://clinicaltrials.gov/study/NCT04118504.

Evaluation of the efficacy and safety of Suxiao Jiuxin Pill in the treatment of stable angina: A randomized, double-blind, placebo-controlled, multi-center clinical trial

ETHNOPHARMACOLOGICAL RELEVANCE

The Suxiao Jiuxin Pill (SJP) has been used for treating chronic stable angina (SA) for more than 40 years in China. SJP is composed of two Chinese herbs and has the effect of activating blood and promoting qi, according to traditional Chinese medicine (TCM) theory.

AIM OF THE STUDY

The study aims to determine the effects of adjunct SJP on conventional therapy in patients with SA which provides a complementary choice and its evidence for clinical medication for treating SA.

MATERIALS AND METHODS

Participants with SA were recruited and randomized 1:1 to either the SJP group or the control group for 24 weeks. Both groups received conventional treatment according to local tertiary hospital protocols, and the participants received additional SJP (composed of Ligusticum wallichii and Borneol) or placebo in treatment and control groups respectively. The primary outcome was the curative efficacy rate at week 4. Secondary outcomes are the curative efficacy rate, the total score of angina pectoris symptoms, CCS Angina Classification improvement, Seattle Angina Questionnaire (SAQ) score, TCM syndrome scores (TCMSS), and the curative efficacy rate of TCMSS. Adverse events and adverse drug reactions were observed and recorded for safety analysis.

RESULTS

A total of 324 participants with SA from 13 hospitals in China were enrolled in this trial. Compared with the control group, the curative efficacy rate of SA, the curative efficacy rate of TCMSS significantly increased, and the total score of angina pectoris symptoms and TCMSS significantly reduced in the SJP group at week 4, 12, and 24, accompanied by the statistically significant improvement in the curative efficacy rate based on CCS grade reduction (all P < 0.05). Furthermore, the SAQ score (physical limitation, angina stability, and treatment satisfaction) was evaluated as the quality of life significantly improved after treatment (P < 0.05). The medication compliance, concomitant medication, and rates of adverse events were similar between the two groups (P > 0.05).

CONCLUSION

The present prospective, multicenter, randomized, double-blind, placebo-controlled, clinical trial confirms that adjunct SJP to conventional treatment increased the curative efficacy and life quality of SA patients with no significant adverse drug reactions during the clinical application.

CLINICAL TRIAL REGISTRATION

(ID, ChiCTR1900021876, URL = http://www.chictr.org.cn/showproj.aspx?proj=34955).

Beyond MACE: a multidimensional approach to outcomes in clinical trials for older adults with stable ischemic heart disease

The global population of older adults is expanding rapidly resulting in a shift towards managing multiple chronic diseases that coexist and may be exacerbated by cardiovascular illness. Stable ischemic heart disease (SIHD) is a predominant contributor to morbidity and mortality in the older adult population. Although results from clinical trials demonstrate that chronological age is a predictor of poor health outcomes, the current management approach remains suboptimal due to insufficient representation of older adults in randomized trials and the inadequate consideration for the interaction between biological aging, concurrent geriatric syndromes, and patient preferences. A shift towards a more patient-centered approach is necessary for appropriately and effectively managing SIHD in the older adult population. In this review, we aim to demonstrate the distinctive needs of older adults who prioritize holistic health outcomes like functional capacity, cognitive abilities, mental health, and quality of life alongside the prevention of major adverse cardiovascular outcomes reported in cardiovascular clinical trials. An individualized, patient-centered approach that involves shared decision-making regarding outcome prioritization is needed when any treatment strategy is being considered. By prioritizing patients and addressing their unique needs for successful aging, we can provide more effective care to a patient population that exhibits the highest cardiovascular risks.

Evaluation of Arterial Stiffness and Its Relation to Innovative Anthropometric Indices in Persian Adults

Background

BMI has been evaluated as an old criterion to evaluate obesity in individuals, but it does not assess abdominal obesity and lean mass. We aimed to evaluate the possible relationship of new anthropometric indices (namely, a body shape index (ABSI), the body roundness index (BRI), the visceral adiposity index (VAI), the visceral fat area (VFA), and waist-hip ratio (WHR)), with one of the known critical factors of atherosclerosis, arterial stiffness.

Methods

Overall 5921 individuals were enrolled and were divided into four groups according to BMI. Novel anthropometric parameters including, ABSI, BRI, VAI, VFA, and WHR were calculated. The carotid-femoral pulse wave velocity (cf-PWV) was used to evaluate arterial stiffness. Multiple regression analysis was performed to assess the relationship between cf-PWV and innovative Anthropometric indices.

Results

This study population consisted of 3109 women and 2812 males. In men with overweight, cf-PWV was significantly related to BMI, ABSI, BRI, WC, VAI, VFA, and WHR. However, among men with obesity, cf-PWV was associated with BRI, VAI, and VFA. Among women with overweight, cf-PWV was also related to all mentioned indices except ABSI; although, cf-PWV was only associated with VFA and WHR in women with obesity.

Conclusion

Our results showed that VFA in women and VAI in men are strongly related to arterial stiffness and can be used to identify predictors of vascular disease or organic vascular dysfunction.

Effect of Patient-Reported Preprocedural Physical and Mental Health on 10-Year Mortality After Percutaneous or Surgical Coronary Revascularization

BACKGROUND

Clinical and anatomical characteristics are often considered key factors in deciding between percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) in patients with complex coronary artery disease (CAD) such as left-main CAD or 3-vessel disease. However, little is known about the interaction between self-reported preprocedural physical/mental health and clinical outcomes after revascularization.

METHODS

This subgroup analysis of the SYNTAXES trial (SYNTAX Extended Survival), which is the extended follow-up of the randomized SYNTAX trial (Synergy Between PCI With Taxus and Cardiac Surgery) comparing PCI with CABG in patients with left-main CAD or 3-vessel disease, stratified patients by terciles of Physical (PCS) or Mental Component Summary (MCS) scores derived from the preprocedural 36-Item Short Form Health Survey, with higher PCS and MCS scores representing better physical and mental health, respectively. The primary end point was all-cause death at 10 years.

RESULTS

A total of 1656 patients with preprocedural 36-Item Short Form Health Survey data were included in the present study. Both higher PCS and MCS were independently associated with lower 10-year mortality (10-point increase in PCS adjusted hazard ratio, 0.84 [95% CI, 0.73-0.97]; P=0.021; in MCS adjusted hazard ratio, 0.85 [95% CI, 0.76-0.95]; P=0.005). A significant survival benefit with CABG over PCI was observed in the highest PCS (>45.5) and MCS (>52.3) terciles with significant treatment-by-subgroup interactions (PCS P_interaction=0.033, MCS P_interaction=0.015). In patients with both high PCS (>45.5) and MCS (>52.3), 10-year mortality was significantly higher with PCI compared with CABG (30.5% versus 12.2%; hazard ratio, 2.87 [95% CI, 1.55-5.30]; P=0.001), whereas among those with low PCS (≤45.5) or low MCS (≤52.3), there were no significant differences in 10-year mortality between PCI and CABG, resulting in a significant treatment-by-subgroup interaction (P_interaction=0.002).

CONCLUSIONS

Among patients with left-main CAD or 3-vessel disease, patient-reported preprocedural physical and mental health status was strongly associated with long-term mortality and modified the relative treatment effects of PCI versus CABG. Patients with the best physical and mental health had better 10-year survival with CABG compared with PCI. Assessment of self-reported physical and mental health is important when selecting the optimal revascularization strategy.

REGISTRATION

URL: https://www.

CLINICALTRIALS

gov; SYNTAXES Unique identifier: NCT03417050. URL: https://www.

CLINICALTRIALS

gov; SYNTAX Unique identifier: NCT00114972.

The role of cardiac rehabilitation in improving cardiovascular outcomes

Cardiac rehabilitation is a complex intervention that seeks to improve the functional capacity, wellbeing and health-related quality of life of patients with heart disease. A substantive evidence base supports cardiac rehabilitation as a clinically effective and cost-effective intervention for patients with acute coronary syndrome or heart failure with reduced ejection fraction and after coronary revascularization. In this Review, we discuss the major contemporary challenges that face cardiac rehabilitation. Despite the strong recommendation in current clinical guidelines for the referral of these patient groups, global access to cardiac rehabilitation remains poor. The COVID-19 pandemic has contributed to a further reduction in access to cardiac rehabilitation. An increasing body of evidence supports home-based and technology-based models of cardiac rehabilitation as alternatives or adjuncts to traditional centre-based programmes, especially in low-income and middle-income countries, in which cardiac rehabilitation services are scarce, and scalable and affordable models are much needed. Future approaches to the delivery of cardiac rehabilitation need to align with the growing multimorbidity of an ageing population and cater to the needs of the increasing numbers of patients with cardiac disease who present with two or more chronic diseases. Future research priorities include strengthening the evidence base for cardiac rehabilitation in other indications, including heart failure with preserved ejection fraction, atrial fibrillation and congenital heart disease and after valve surgery or heart transplantation, and evaluation of the implementation of sustainable and affordable models of delivery that can improve access to cardiac rehabilitation in all income settings.

Long-term exercise effects after cardiac telerehabilitation in patients with coronary artery disease: 1-year follow-up results of the randomized study

BACKGROUND

Home-based cardiac telerehabilitation (HBCT) is a feasible and effective alternative to traditional center-based cardiac rehabilitation (CBCR). Currently, there are only limited studies focusing on a long-term effect of HBCT, which means it is essential to do more research in this study field.

AIM

This study aimed at investigating a 1-year effect of a randomized controlled study using Cardiac Rehabilitation through the Global Position System (CR-GPS) compared to outpatient cardiac rehabilitation. Study focused on cardiorespiratory fitness (CRF) and health-related quality of life (HRQL) in patients with coronary heart disease (CAD).

DESIGN

A long-term follow-up of a randomized study.

SETTING

Patients were enrolled, and the intervention was performed in an outpatient or home-based model. The results were obtained and evaluated in a hospital.

POPULATION

Patients who participated in the CR-GPS study were diagnosed with CAD with low to moderate cardiovascular risk.

METHODS

Patients enrolled in the study were eligible participants who had previously completed a 12-week HBCT program using a wrist heart rate (HR) monitor or attended a traditional CBCR. Primary outcome was the change in CRF expressed in peak oxygen uptake (pVO<inf>2</inf>), and the secondary outcomes were self-reported HRQL, objectively measured anthropometric characteristics, and mortality and hospitalization rates.

RESULTS

Forty-four patients (76%) completed the long-term follow-up. The average peak of pVO<inf>2</inf> was higher after 1-year follow-up in the telerehabilitation group (HBCT 25.5 mL/kg/min compared to the active control group CBCR 23.6 mL/kg/min P=0.047). No statistically significant difference between the two groups was found after long-term follow-up for the parameter HRQL. For both groups, there was a significant improvement in the range of perceptions of general health. There was no death case and no difference in hospitalization rate between the groups.

CONCLUSIONS

This study supports the HBCT model. It has been demonstrated that it induces satisfactory long-term effects in pVO<inf>2</inf>, exercise performance, and perceived general health in CAD patients with low to moderate cardiovascular risk.

CLINICAL REHABILITATION IMPACT

Cardiovascular telerehabilitation using wrist HR monitors is a feasible and effective rehabilitation method that can help patients eliminate barriers that prevent them from using CBCR programs. Especially in the current global situation with the COVID-19 pandemic, this topic is becoming increasingly important.

Quality of Life Assessment in Trials of Revascularization for Chronic Stable Angina: Insights from ORBITA and the Implications of Blinding

The main aims of therapy in chronic stable angina are to reduce the risk of myocardial infarction and death and improve symptoms and quality of life (QoL). Unblinded trials have shown that revascularization does not reduce the risk of myocardial infarction or death but does appear to improve symptoms. However, symptoms are susceptible to the placebo effect which can bias therapies to appear more effective than they are. To assess the true physical impact of a treatment on symptoms, placebo-controlled trials with patients and medical and research teams blinded to treatment allocation are necessary. Symptoms and QoL can be reported directly by the patient or indirectly by the physician. Patient-reported outcome measures in angina trials can include angina frequency, frequency of nitrate use, exercise capacity, and questionnaires such as the Seattle Angina Questionnaire (SAQ) and the generic EuroQOL-5D-5L (EQ-5D-5L) QoL questionnaire. Physician-assessed outcome measures include Canadian Cardiovascular Society Class. The Objective Randomised Blinded Investigation with Optimal Medical Therapy of Angioplasty in Stable Angina (ORBITA) trial was the first blinded placebo-controlled study investigating the role of percutaneous coronary intervention (PCI) in chronic stable angina. The trial showed a smaller than expected and not statistically significant effect of placebo-controlled PCI on the primary endpoint of change in exercise time at 6 weeks follow-up in single-vessel coronary artery disease. There was also no significant placebo-controlled treatment effect of PCI for the prespecified secondary endpoints of SAQ or EQ-5D-5L, although PCI did result in 20% more patients becoming free from angina than placebo in a non-prespecified secondary analysis. ORBITA has demonstrated the need for symptomatic and QoL effects of PCI to be studied using placebo control. Here, we describe ways of measuring QoL, the impact of the unblinded and blinded trials to date, what we have learned from ORBITA, and what is next for this common and complex condition.

Lifestyle and Treatment Adherence Intervention after a Coronary Event Based on an Interactive Web Application (EVITE): Randomized Controlled Clinical Trial Protocol

Coronary heart disease is one of the main causes of morbimortality around the world. Patients that survive a coronary event suffer a high risk of readmission, relapse and mortality, attributed to the sub-optimal control of cardiovascular risk factors (CVRF), which highlights the need to improve secondary prevention strategies aimed at improving their lifestyle and adherence to treatment. Through a randomized controlled clinical trial, this study aims to evaluate the effect of an intervention involving an online health application supported by a mobile telephone or tablet (mHealth) on lifestyle (diet, physical activity, and tobacco consumption) and treatment adherence among people with coronary heart disease after percutaneous coronary intervention. The sample will comprise 240 subjects (120 in each arm: intervention and usual care). They are assessed immediately and nine months after their hospital discharge about sociodemographic, clinical, CVRF, lifestyle, and treatment adherence characteristics. The educative intervention, involving a follow-up and self-monitoring, will be performed using an online mHealth tool consisting of an application for mobile phones and tablets. The quantitative primary outcomes from the two groups will be compared using an analysis of covariance (ANCOVA) adjusted for age and gender. A multivariate analysis will be performed to examine the association of the intervention with lifestyle habits, the control of CVRFs, and outcomes after discharge in terms of the use of health services, emergency visits, cardiovascular events and readmissions.

Supporting parents of children with chronic conditions: A randomized controlled trial of web-based and self-help ACT interventions

OBJECTIVE

Many parents of children with chronic conditions and developmental disabilities experience high rates of burnout and psychological distress. The aim of the current study was to examine the effects of two differently delivered interventions based on acceptance and commitment therapy (ACT) on symptoms of burnout, depression, quality of life, psychological flexibility, and mindfulness skills.

METHOD

A total of 110 parents of children aged 0.8 to 17 years with chronic conditions and developmental disabilities participated in a randomized controlled trial lasting 13 weeks with two intervention groups: (1) an iACT intervention, including three psychologist-led video conferencing sessions, and (2) a self-help ACT, which received self-help material: an ACT-based booklet with the possibility of using ACT-based online exercises.

RESULTS

For the main outcome measure burnout, a similar decrease was found in both groups. The supported iACT intervention produced significantly larger improvements in depressive symptoms (d = 0.49), psychological flexibility (d = 0.64), and mindfulness (d = 0.55) compared to the self-help ACT intervention. For health-related quality of life, only the dimension of role limitations caused by emotional problems showed a significant difference in favor of the supported iACT (d = 0.58).

CONCLUSIONS

The results suggest that the iACT intervention including three video conferencing sessions with a psychologist produced broader improvements in parents' psychological well-being than the self-help ACT. Overall, Internet-delivered interventions and video conferencing technology may offer a feasible alternative to psychological support and self-care for parents of children with chronic conditions. Further research is needed to investigate the long-term effects of the current delivery models.

Effectiveness of e-Health cardiac rehabilitation program on quality of life associated with symptoms of anxiety and depression in moderate-risk patients

Exploring new models of medical care requires evaluating the impact of new care strategies not only on physiological parameters but also on the quality of life of the patient. On the other hand the presence of anxiety together with depression requires further consideration when planning appropriate management strategies. The aim of this study was to examine the effectiveness of a home-based cardiac rehabilitation program incorporating an e-Health technology on health-related quality of life associated with symptoms of anxiety and depression in moderate-risk patients. A multicenter, randomized controlled clinical trial was designed to compare a traditional hospital based cardiac rehabilitation program (n = 38, 35 male) with a mixed home surveillance program where patients exercised at home with a remote electrocardiographic monitoring device (n = 33, 31 male). The Short Form-36 (SF-36) Health Survey and the Goldberg questionnaire were used to evaluate quality of life and the presence of symptoms of anxiety and depression respectively. The results of this study show that the type of cardiac rehabilitation program did not influence the improvement in quality of life (p = 0.854), but the presence of symptoms of anxiety and depression did (p = 0.001). Although both programs achieved a decrease in anxiety and depression symptoms and improved functional capacity (p ≤ 0.001), a significant interaction effect was found between the group with or without anxiety and depression symptoms and the type of program in the bodily pain dimension (p = 0.021). Trial registration: Retrospectively registered NCT02796404 (10/06/2016) in clinialtrials.gov.

Cardiac rehabilitation in older patients: Indication or limitation?

OBJECTIVE

To assess the clinical impact of a cardiac rehabilitation program in an older population.

METHODS

This is a retrospective analysis of 731 coronary patients who attended phase 2 of a cardiac rehabilitation program between January 2009 and December 2016. We compared the response to the program of older (≥65 years) and younger (<65 years) patients, analyzing changes in metabolic profile (including body mass index, waist circumference and lipid profile), exercise capacity, cardiac autonomic regulation parameters (such as chronotropic index and resting heart rate), and health-related quality of life scores.

RESULTS

Older patients represented 15.9% of our cohort. They showed significant reductions in waist circumference (male patients: 98.0±7.9 cm vs. 95.9±7.9 cm, p<0.001; female patients: 90.5±11.4 cm vs. 87.2±11.7 cm, p<0.001), LDL cholesterol (102.5 [86.3-128.0] mg/dl vs. 65.0 [55.0-86.0] mg/dl, p<0.001) and triglycerides (115.0 [87.8-148.5] mg/dl vs. 97.0 [81.8-130.0] mg/dl, p<0.001). Post-training data also showed a noticeable improvement in older patients' exercise capacity (7.6±1.8 METs vs. 9.3±1.8 METs, p<0.001), along with a higher chronotropic index and lower resting heart rate. Additionally, health-related quality of life indices improved in older subjects. However, our overall analysis found no significant differences between the groups in changes of the studied parameters.

CONCLUSION

Older coronary patients benefit from cardiac rehabilitation interventions, similarly to their younger counterparts. Greater involvement of elderly patients in cardiac rehabilitation is needed to fully realize the therapeutic and secondary preventive potential of such programs.

Effect of home-based high-intensity interval training using telerehabilitation among coronary heart disease patients

INTRODUCTION

Cardiovascular diseases are the world's most common causes of morbidity and mortality in the population, including Central Europe. Cardiac rehabilitation (CR) is an effective preventive approach that includes several core components. Physical training is identified as an integral and essential part of CR. Training can positively influence several cardiovascular risk factors in people diagnosed with coronary heart disease and prevent them from clinical events. Our study aims to research the method of high-intensity interval training (HIIT) in a home environment using telerehabilitation. We assume that the HIIT form of telerehabilitation, using a heart rate monitor as a tool for backing up training data, can improve cardiorespiratory fitness and lead to higher peak oxygen uptake than the traditional moderate-intensity continuous training (MICT).

METHODS

This study is designed as a monocentral randomized controlled trial at University Hospital Brno in the Czech Republic. After the coronary heart event, the suitable patients will be randomized (1:1 ratio) and separated into 2 groups: the experimental HIIT group and the control MICT group. Both groups undergo a 12-week telerehabilitation with a 1-year follow-up period. Study participants will be telemonitored during physical training in their home environment via a heart rate monitor and a web platform. Once a week, the patients will give their feedback and motivation by a telephone call.The primary outcome observed will be the effect of intervention expressed by changes in cardiorespiratory fitness. Secondary outcomes will be the health-related quality of life, anxiety, training adherence, body composition, safety, and satisfaction.

DISCUSSION

The HIIT is widely researched predominantly in a center-based supervised form. Our study differs from others by the use of telemedicine and smart technologies in home-based settings. Previous home-based cardiac telerehabilitation studies have focused primarily on MICT, which has demonstrated feasibility, and results have shown similar improvements as center-based CR. There is a presumption that HIIT may be superior to MICT. However, it can be complicated to self-dose the method in the home environment. Investigators expect that HIIT research will provide insight into the possibilities of telemedicine feasibility, effect, and limitations of coronary heart disease patients' use at low to moderate cardiovascular risk.

Benefits and effectiveness of using a wrist heart rate monitor as a telerehabilitation device in cardiac patients: A randomized controlled trial

BACKGROUND

Telerehabilitation in cardiology has the potential to become the alternative to regular outpatient cardiac rehabilitation. Our study focuses on the wrist heart rate monitor as a telerehabilitation device, defines detected limitations, and compares results between home-based and regular outpatient rehabilitation methods, related to physical fitness, quality of life, and training adherence. The study design was a randomized controlled trial.

METHODS

Eligible 56 cardiac rehabilitation patients were randomized into a 12-week regular outpatient training group (ROT) and interventional home-based telerehabilitation group (ITG). For both groups, the intensity of the training was prescribed to be performed at 70% to 80% of heart rate reserve for 60 minutes, 3 times a week. The ITG patients started their training with a wrist heart rate monitor in their home environment. These patients received feedback once a week, reflecting data uploaded on the internet application. The ROT patients performed their exercise under the direct supervision of a physical specialist in a regular outpatient clinic. Physical fitness and health-related quality of life were assessed at baseline and after 12 weeks. Training adherence in both groups was determined and compared.

RESULTS

Fifty-one patients comleted the intervention (91%); no serious adverse events were recorded. Physical fitness expressed as peak oxygen uptake showed significant improvement (P < .001) in ROT group from 23.4 ± 3.3 to 25.9 ± 4.1 mL/kg/min and (P < .01) in ITG group from 23.7 ± 4.1 to 26.5 ± 5.7 mL/kg/min without significant between-group differences after 12 weeks of intervention. The training adherence between groups was similar.

CONCLUSION

Our study shows that telerehabilitation via wrist heart rate monitor could become an alternative kind of cardiac rehabilitation which deserves attention and further analyzing.

Assessment of the Quality of Life in Patients before and after Coronary Artery Bypass Grafting (CABG): A Prospective Study

The aim of this study was to examine the quality of life and to report on the utility and QALY measures in patients before and after coronary artery bypass grafting (CABG); to investigate whether the SF-12 is comparable with the SF-36 for measuring health-related quality of life of patients with CABG; and to determine the impact of individual predictors on poor quality of life assessment after rehabilitation. This prospective study was conducted between January 2017 and December 2018 at the University Hospital Center Osijek, at three time points: pre-operation, 1 month after surgery, and after rehabilitation. The study was conducted with the SF-36 and SF-12 health questionnaires on 47 participants. After rehabilitation, there was a significant improvement in all domains of quality of life. The highest score was given to the change in pain (BP); mean scores were 63.8 (95% CI 56.9 to 70.6) (p = 0.001). The lowest grade (the lowest quality) after rehabilitation was in the domain of limitations due to physical difficulties (RP); arithmetic mean was 48.5 (95% CI 41 to 55.9) (p < 0.001). Quality-adjusted life-year was 0.41 (95% CI 0.38–0.44) after the CABG. The results of this study show that patients with coronary heart disease have poor quality of life before surgery. One month after the surgery, the quality of life improved, but was still inadequate. One year after surgery, satisfactory results were obtained in almost all subscales. The SF-36, SF-12, and its components, can be used effectively in patients with CABG. Age, gender, lifestyle, and risk factors in our sample of participants are not predictors of poor quality of life assessment after rehabilitation.

Improvement of quality of life in diabetic patients treated with percutaneous transluminal angioplasty

To assess the quality of life (QoL) of treated patients in order to evaluate the success of peripheral transluminal angioplasty (PTA) and correlate physical parameters with clinical progress at 6 months post-PTA.According to TASC II classifications, 69 patients were selected for PTA. Clinical evaluation and diagnostic tests were performed before, after and after 6 months following PTA. The SF-36 QoL questionnaire was added as an additional parameter.Fifty one patients were included in the study. The ankle-brachial index (ABI) increased from 0.49 ± 0.11 before PTA, to 0.81 ± 0.14 after PTA (P < .001) and 0.76 ± 0.10 at 6 months following PTA (P < .001). Transcutaneous oxygen pressure (TcPO2) increased from 28.05 ± 3.15 mm Hg before PTA, to 39.89 ± 4.12 after PTA (P < .001) and 46.4 ± 3.81 at 6 months following PTA (P < .001). The lumen of the affected blood vessel increased from 29 ± 18% before PTA, to 81 ± 10.3% after PTA (P < .001). SF-36 values increased from 29 ± 18 before PTA, to 81 ± 10.36 at 6 months following PTA (P < .001).The improvement of QoL is the parameter that best describes the symptoms and functionality of the patient, therefore, should be used to determine the successful PTA. Although ABI and TcPO2 with arteries functionality and tissue oxygenation, they are not show a significant correlation with all parameters determined in the QoL questionnaire.

Relationships among medication adherence, lifestyle modification, and health-related quality of life in patients with acute myocardial infarction: a cross-sectional study

Background

The healthy adherer effect is a phenomenon in which patients who adhere to medical therapies tend to pursue health-seeking behaviors. Although the healthy adherer effect is supposed to affect health outcomes in patients with coronary artery disease, evaluation of its presence and extent is not easy. This study aimed to assess the relationship between medication adherence and lifestyle modifications and health-related quality of life among post-acute myocardial infarction (AMI) patients.

Methods

A cross-sectional study was conducted in 417 post-AMI patients who underwent percutaneous coronary intervention (PCI). Patients were recruited from 11 university hospitals from December 2015 to March 2016 in South Korea. Details regarding socio-demographic factors, six health behaviors (low-salt intake, low-fat diet and/or weight-loss diet, regular exercise, stress reduction in daily life, drinking in moderation, and smoking cessation), medication adherence using the Modified Morisky Scale (MMS), and HRQoL using the Coronary Revascularization Outcome Questionnaire (CROQ) were surveyed in a one-on-one interview.

Results

In the univariate logistic analysis, sex (female), age (≥70 years), MMS score (≥5), and CROQ score were associated with adherence to lifestyle modification. In the multiple logistic analysis, a high MMS score (≥5) was associated with adherence to lifestyle modification after adjusting for sex, age, marital status, education, and family income (adjusted odds ratio [OR] = 11.7, 95% confidence interval [CI] = 1.5–91.3). After further adjusting for the CROQ score, the association between high MMS score and adherence to lifestyle modification was significant (adjusted OR = 11.5, 95% CI = 1.4–93.3).

Conclusions

Adherence to medication was associated with adherence to lifestyle modification, suggesting the possible presence of the healthy adherer effect in post-AMI patients. After further adjusting for HRQoL, the association remained. To improve health outcome in post-AMI patients, early detection of patients with poor adherence to medication and lifestyle modification and motivational education programs to improve adherence are important. In addition, the healthy adherer effect should be considered in clinical research, in particular, in studies evaluating the effects of therapies on health outcomes.

Electronic supplementary material

The online version of this article (10.1186/s12955-018-0921-z) contains supplementary material, which is available to authorized users.

Association Between Severity of Depression and Cardiac Risk Factors Among Women Referred to a Cardiac Rehabilitation and Prevention Clinic

PURPOSE

Depression comorbid with cardiovascular disease is associated with higher rates of morbidity and mortality, with studies suggesting that this is especially true among women. This study examined depressive symptoms and their relationship to cardiac risk factors among women referred to a women's cardiac rehabilitation and primary prevention program.

METHODS

A secondary analysis of data collected between 2004 and 2014 for 1075 women who completed a baseline assessment at the Women's Cardiovascular Health Initiative, a women-only cardiac rehabilitation and prevention program in Toronto, Canada. Descriptive statistics for sociodemographic variables, quality of life (SF-36), and cardiac risk factors were stratified by depression symptom severity using cutoff scores from the Beck Depression Inventory-2nd version (BDI-II) and compared with analysis of variance and χ statistics. Prevalence of antidepressant use among those with moderate to high depressive symptoms was assessed as an indicator of under- or untreated depression.

RESULTS

Overall, 38.6% of women scored above the BDI-II cutoff for depression; 23.6% in the moderate or severe range. Socioeconomic status and quality of life decreased with increasing depression severity. Body mass index increased with depressive severity (P < .001), as did the percentage of individuals with below target age predicted fitness (P < .001). Only 39.0% of women in the moderate and severe BDI-II groups were taking antidepressants.

CONCLUSION

In this sample, we found a significant prevalence of untreated and undertreated depressive symptoms among women with, or at high risk of developing, cardiovascular disease. Additional strategies are needed to identify these patients early and link them to appropriate treatment.

Patients expectations and fulfilment of expectations before and after treatment for suspected coronary artery disease assessed with a newly developed questionnaire in combination with established health-related quality of life questionnaires

Background

Clinical decision-making is often based on evidence of outcome after a specific treatment. Healthcare providers and patients may, however, have different perceptions and expectations of what to achieve from a certain healthcare measure.

Aims

To evaluate patients’ expectations, perceptions and health related quality of life (HRQoL) before a care process including coronary angiography for suspected coronary artery disease and to evaluate the fulfilment of these expectations in relation to established patient reported outcome measures (PROMs) 6 months later. Furthermore, an aim was to try to define meaningful patient reported experience measures (PREMs) in this population.

Methods

544 patients planned for coronary angiography completed a newly developed questionnaire to assess expectations and perceptions of treatment, the expectation questionnaire (ExpQ) and two established HRQoL questionnaires together with the established generic Short-Form 36 (SF36) and the disease specific Seattle Angina Questionnaire (SAQ).

Results

Patients had before the intervention, in general, high expectations of improvement after investigation and treatment and there was a positive attitude towards life style changes, medication and participation in decision-making regarding their own treatment. Only, 56.4% of the patients, however, reported fulfilment of treatment expectations. Fulfilment of treatment expectations correlated strongly with improvement in HRQoL after the care process.

Conclusions

To measure patients ´ expectations and fulfilments of these may offer simple and meaningful outcomes to evaluate a healthcare process from a patient ´s perspective. To approach patients’ expectations may also strengthen patient involvement in the care process with the possibilities of both higher patient satisfaction and medical results of the treatment.

Cognitive Behavioural Therapy and Mindfulness for Health-Related Quality of Life: Comparing Treatments for Parents of Children with Chronic Conditions - A Pilot Feasibility Study

Background:

Research on parents of children with chronic conditions has shown that this parent group frequently suffers from psychological problems such as deteriorating life quality and stress-related disorders.

Objective:

The present feasibility study focuses on Health-Related Quality of Life (HRQOL) and life satisfaction of parents of children with chronic conditions.

Method:

The study was conducted using a repeated measures design and applied either group-based cognitive behavioural therapy (CBT; n = 10) or a group-based mindfulness programme (MF; n = 9). The study participants were wait-listed for six months.

Results:

The results indicate improvements for participants in both treatment groups regarding certain areas of HRQOL and life satisfaction. After eight group therapy sessions, parents in the two treatment groups significantly improved their Mental Component Summary (MCS) scores as well as their scores on the mental subscales Vitality, Social functioning, Role emotional and Mental health. In addition, some of the physical subscales, Role physical, Bodily pain and General health, showed considerable improvement for the MF group. When testing for clinical significance by comparing the samples with mean values of a norm population, the MCS scores were significantly lower at pre-measurements, but no significant differences were observed post-measurement. For the Physical component summary (PCS) scores, a significantly higher score was observed at post-measurement when compared to the norm population. Moreover, the results indicate improvement in life satisfaction regarding Spare time, Relation to child and Relation to partner.

Conclusion:

The study concludes that CBT and mindfulness may have a positive effect on areas of HRQOL and life satisfaction.

International SF-36 reference values in patients with ischemic heart disease

PURPOSE

International reference data for the SF-36 health survey (version 1) are presented based on a sample of 5508 adult patients with ischemic heart disease.

METHODS

Patients with angina, myocardial infarction and ischemic heart failure completed the SF-36. Data were analyzed by diagnosis, gender, age, region and country within region and presented as mean ± standard deviation (SD), minimum, maximum, 25th, 50th and 75th percentile of the physical (PCS) and mental component summary (MCS) measures.

RESULTS

Mean PCS scores were reported as being more than one SD below the normal range (standardized mean of 50 ± 10) by more than half of the patient subgroups (59 %) with all of the mean MCS scores falling within the normal range. Patients with angina and patients with ischemic heart failure reported the poorest mean PCS scores with both diagnoses reporting scores more than one SD below the standardized mean. Females, older patients (especially >70 years) and patients from Eastern Europe reported significantly worse mean PCS scores than male, younger and non-Eastern European patients. The cardiac diagnosis had no effect on the mean MCS scores; however, females, younger patients (especially <51 years) and patients from Eastern Europe reported significantly worse mean MCS scores than male, older and non-Eastern European patients.

CONCLUSIONS

These international reference SF-36 values for patients with IHD are useful for clinicians, researchers and health-policy makers when developing improved health services.

Health utility indexes in patients with acute coronary syndromes

Background

Acute coronary syndromes (ACS) have been associated with lower health utilities (HUs) compared with the general population. Given the prognostic improvements after ACS with the implementation of coronary angiography (eg, percutaneous coronary intervention (PCI)), contemporary HU values derived from patient-reported outcomes are needed.

Methods

We analysed data of 1882 patients with ACS 1 year after coronary angiography in a Swiss prospective cohort. We used the EuroQol five-dimensional questionnaire (EQ-5D) and visual analogue scale (VAS) to derive HU indexes. We estimated the effects of clinical factors on HU using a linear regression model and compared the observed HU with the average values of individuals of the same sex and age in the general population.

Results

Mean EQ-5D HU 1-year after coronary angiography for ACS was 0.82 (±0.16) and mean VAS was 0.77 (±0.18); 40.9% of participants exhibited the highest utility values. Compared with population controls, the mean EQ-5D HU was similar (expected mean 0.82, p=0.58) in patients with ACS, but the mean VAS was slightly lower (expected mean 0.79, p<0.001). Patients with ACS who are younger than 60 years had lower HU than the general population (<0.001). In patients with ACS, significant differences were found according to the gender, education and employment status, diabetes, obesity, heart failure, recurrent ischaemic or incident bleeding event and participation in cardiac rehabilitation (p<0.01).

Conclusions

At 1 year, patients with ACS with coronary angiography had HU indexes similar to a control population. Subgroup analyses based on patients' characteristics and further disease-specific instruments could provide better sensitivity for detecting smaller variations in health-related quality of life.

The Association of Health-Related Quality of Life with Severity of Visual Impairment among People Aged 40-64 Years: Findings from the 2006-2010 Behavioral Risk Factor Surveillance System

PURPOSE

To examine the association of health-related quality of life (HRQoL) with severity of visual impairment among people aged 40-64 years.

METHODS

We used cross-sectional data from the 2006-2010 Behavioral Risk Factor Surveillance System to examine six measures of HRQoL: self-reported health, physically unhealthy days, mentally unhealthy days, activity limitation days, life satisfaction, and disability. Visual impairment was categorized as no, a little, or moderate/severe. We examined the association between visual impairment and HRQoL using logistic regression accounting for the survey's complex design.

RESULTS

Overall, 23.0% of the participants reported a little difficult seeing, while 16.8% reported moderate/severe difficulty seeing. People aged 40-64 years with moderate/severe visual impairment had more frequent (≥14) physically unhealthy days, mentally unhealthy days, and activity limitation days in the last 30 days, as well as greater life dissatisfaction, greater disability, and poorer health compared to people reporting no or a little visual impairment. After controlling for covariates (age, sex, marital status, race/ethnicity, education, income, state, year, health insurance, heart disease, stroke, heart attack, body mass index, leisure-time activity, smoking, and medical care costs), and compared to people with no visual impairment, those with moderate/severe visual impairment were more likely to have fair/poor health (odds ratio, OR, 2.01, 95% confidence interval, CI, 1.82-2.23), life dissatisfaction (OR 2.06, 95% CI 1.80-2.35), disability (OR 1.95, 95% CI 1.80-2.13), and frequent physically unhealthy days (OR 1.69, 95% CI 1.52-1.88), mentally unhealthy days (OR 1.84, 95% CI 1.66-2.05), and activity limitation days (OR 1.94, 95% CI 1.71-2.20; all p < 0.0001).

CONCLUSION

Poor HRQoL was strongly associated with moderate/severe visual impairment among people aged 40-64 years.

Psychometric evaluation of the Sinhalese version of MacNew Heart Disease Health Related Quality of Life Questionnaire in patients with stable angina

BACKGROUND

A Sinhalese version of a validated, disease-specific patient-reported heart disease health related quality of life instrument is lacking. The purpose of this study was to validate the interviewer-administered Sinhalese version of the MacNew Heart Disease Health-related Quality of Life Questionnaire (MacNew) in patients with clinically diagnosed stable angina.

METHODS

The Sinhalese translation of the MacNew was carried using standard forward- backward translation technique. In this validation study, the MacNew was administered to 200 patients with stable angina. Reliability was assessed by internal consistency and test-retest reliability. Construct validity was explored by exploratory factor analysis using principal component analysis and confirmed by confirmatory factor analysis using the robust maximum likelihood method and known group comparison. The correlation between compatible domain scores of MacNew and the World Health Organization's quality of life -brief questionnaire was used to assess concurrent validity.

RESULTS

The original 3-factor model (Physical, Emotional and Social) of the MacNew with cross-loadings was confirmed: principal component analysis with 53.42 % of the explained variance and confirmatory factor analysis with adequate fit for each of the three model fit criteria considered [root mean square error of approximation = 0.044 (90 % CI = 0.031 to 0.056); comparative fit index = 0.99; χ(2)/df = 1.39]. Internal consistency of the MacNew was acceptable with Cronbach's α of 0.92 on the Global scale and on the domain scales ranging from 0.85-0.91. Test-retest reliability was also found to be satisfactory with intraclass correlation coefficients of >0.9 for total and domain scores. A satisfactory level of concurrent validity was demonstrated with statistically significant correlations between compatible domain scores of MacNew and the World Health Organization's quality of life questionnaire (Pearson correlation ranging from 0.36-0.79).

CONCLUSIONS

The interviewer-administered Sinhalese MacNew is a valid and reliable patient-reported outcome measure to assess disease specific health-related quality of life among Sinhalese patients with stable angina.

Psychometric properties of the Farsi version of the Myocardial Infarction Dimensional Assessment Scale

Assessment of quality of life is an important measure of the impact of disease and effectiveness of treatment. The Myocardial Infarction Dimensional Assessment Scale (MIDAS) is a disease-specific questionnaire developed for the evaluation of health-related quality of life in patients following myocardial infarction. The purpose of this study was to determine the psychometric properties of the Farsi version of MIDAS. The translated MIDAS was checked for validity and reliability with 350 patients who had suffered a myocardial infarction within the last 90 days. Participants were recruited from five inpatient wards and two outpatient departments at four university hospitals in Tehran between June 2013 and March 2014. Exploratory factor analysis indicated a six-factor solution for the questionnaire: ‘physical activity’, ‘insecurity’, ‘emotional reaction’, ‘dependency’, ‘diet’, and ‘concerns over medication and side effects’. Together, these accounted for 81.63% of variance observed. Cronbach’s alpha of the subscales ranged from 0.88 to 0.98, and test–retest reliability intraclass correlation coefficients ranged from .81 to .97, indicating that the instrument was reliable. The Farsi version of the MIDAS was reliable and valid for Iranian patients with myocardial infarction. The MIDAS can be used to measure health outcomes in different clinical settings and research centres, and by nurses for measuring health-related quality of life and determining the effects of medical and nursing interventions on patients’ quality of life.

Adult Congenital Heart Disease-Coping And REsilience (ACHD-CARE): Rationale and methodology of a pilot randomized controlled trial

INTRODUCTION

One-third of North American adults with congenital heart disease (CHD) have diagnosable mood or anxiety disorders and most do not receive mental health treatment. There are no published interventions targeting the psychosocial needs of patients with CHD of any age. We describe the development of a group psychosocial intervention aimed at improving the psychosocial functioning, quality of life, and resilience of adults with CHD and the design of a study protocol to determine the feasibility of a potential full-scale randomized controlled trial (RCT).

METHODS/DESIGN

Drawing upon our quantitative and qualitative research, we developed the Adult CHD-Coping And REsilience (ACHD-CARE) intervention and designed a feasibility study that included a 2-parallel arm non-blinded pilot RCT. Eligible participants (CHD, age ≥ 18 years, no planned surgery, symptoms suggestive of a mood and/or anxiety disorder) were randomized to the ACHD-CARE intervention or Usual Care (1:1 allocation ratio). The group intervention was delivered during eight 90-minute weekly sessions. Feasibility will be assessed in the following domains: (i) process (e.g. recruitment and retention), (ii) resources, (iii) management, (iv) scientific outcomes, and (v) intervention acceptability.

DISCUSSION

This study underscores the importance of carefully developing and testing the feasibility of psychosocial interventions in medical populations before moving to full-scale clinical trials. At study conclusion, we will be poised to make one of three determinations for a full-scale RCT: (1) feasible, (2) feasible with modifications, or (3) not feasible. This study will guide the future evaluation and provision of psychosocial treatment for adults with CHD.

Cross-Country Differences in the Additive Effects of Socioeconomics, Health Behaviors and Medical Comorbidities on Disability among Older Adults with Heart Disease

BACKGROUND

Patients with heart disease experience limited activities of daily living (ADL). This is a cross-country comparison of the additive effects of Socioeconomics, health behaviors, and the number of medical comorbidities on disability among patients with heart disease.

METHODS

The current study used a cross-sectional design. Data came from the Research on Early Life and Aging Trends and Effects (RELATE). The current analysis utilized data on elderly individuals (age ≥60 y) from 13 countries. The outcome was any ADL limitation (i.e. bathing, dressing, using toilet, transferring, lifting heavy things, shopping, and eating meals). Socioeconomics (i.e. age, gender, education, and income), health behaviors (i.e. exercise, smoking, and drinking), and number of chronic medical conditions (i.e. hypertension, respiratory, arthritis, stroke, and diabetes) were entered into country-specific logistic regressions, considering at least one limitation in ADL as the main outcome.

RESULTS

Number of comorbid medical conditions and age were positively associated with disability in 85% of the countries. Physical activity and drinking were linked to disability in 54%and 31% of countries, respectively. Higher education and income were associated with lower disability in 31% and 23% of the countries, respectively. Female gender was associated with higher disability only in 15% of the countries. Smoking was not associated with disability, while the effects of socioeconomics, drinking, exercise, and medical comorbidities were controlled.

CONCLUSION

Determinants of disability depend on the country; accordingly, locally designed health promotion interventions may be superior to the universal interventions for patients with heart disease. Medical comorbidities, however, should be universally diagnosed and treated.

Effect of a telephone-delivered coronary heart disease secondary prevention program (proactive heart) on quality of life and health behaviours: primary outcomes of a randomised controlled trial

BACKGROUND

Participation in coronary heart disease secondary prevention programs is low. Innovative programs to meet this treatment gap are required.

PURPOSE

To aim of this study is to describe the effectiveness of a telephone-delivered secondary prevention program for myocardial infarction patients.

METHODS

Four hundred and thirty adult myocardial infarction patients in Brisbane, Australia were randomised to a 6-month secondary prevention program or usual care. Primary outcomes were health-related quality of life (Short Form-36) and physical activity (Active Australia Survey).

RESULTS

Significant intervention effects were observed for health-related quality of life on the mental component summary score (p = 0.02), and the social functioning (p = 0.04) and role-emotional (p = 0.03) subscales, compared with usual care. Intervention participants were also more likely to meet recommended levels of physical activity (p = 0.02), body mass index (p = 0.05), vegetable intake (p = 0.04) and alcohol consumption (p = 0.05).

CONCLUSIONS

Telephone-delivered secondary prevention programs can significantly improve health outcomes and could meet the treatment gap for myocardial infarction patients.

Psychometric testing of the Chinese Mandarin version of the MacNew Heart Disease Health-related Quality of Life questionnaire for patients with myocardial infarction in mainland China

Tools to measure the quality of life of Chinese myocardial infarction (MI) patients in mainland China are small in numbers. For this study, 210 Chinese patients with MI were recruited to examine the psychometric properties of the Chinese Mandarin version of the MacNew Heart Disease questionnaire. Thirty-five participants managed to complete the retest after 2 weeks. The MacNew Heart Disease questionnaire had acceptable internal consistency, test-retest reliability and concurrent validity. The principal components analysis identified three factors which accounted for 56.6% of the variance. The MacNew Heart Disease questionnaire demonstrated good reliability and validity to be used as a health status measurement tool, and is ready for clinical use in the assessment of the quality of life of Chinese MI patients in mainland China.

Evaluation of an individualised programme to promote self-care in sleep-activity in patients with coronary artery disease -- a randomised intervention study

AIMS AND OBJECTIVES

To evaluate the effectiveness of an individualised programme to promote self-care in sleep-activity in patients with coronary artery disease.

BACKGROUND

Recent scientific findings have shown that low physical exercise and stress interfere with coronary artery disease patients' sleep quality and sleep efficiency independent of gender, age and co-morbidity.

DESIGN

A randomised pretest-post-test control design.

METHODS

Forty-seven patients who had undergone a coronary revascularisation procedure and/or pharmacological treatment three to seven weeks earlier at a general hospital were randomised to either an intervention group or a control group. Data collection was carried out by questionnaires, a study-specific sleep diary and actigraphy registration for 10 consecutive 24-hour periods, with a follow-up after three to four months. The intervention group underwent a nurse-led individualised education programme to promote self-care of sleep-activity. Sleep habits and sleep-related lifestyle together formed the basis for setting up individual goals together with the nurse. Individual advice on physical training, relaxation exercise and a CD-based relaxation programme was provided by a physiotherapist. Both groups received a brochure about sleep and stress.

RESULTS

At a three- to four-month follow-up, the main improvements were seen in the intervention group regarding sleep quality, sleep duration and sleep efficiency in the sleep diary and sleep efficiency in actigraphy. Statistical improvements in health-related quality of life were revealed. This was not so obvious in the control group.

CONCLUSIONS

An individualised intervention programme to promote self-care of sleep-activity including relaxation in patients with coronary artery disease led by a nurse may improve sleep quality. However, a longitudinal study to promote self-care in sleep-activity should be performed using a larger sample and multiple sites with continuous follow-ups to determine whether any positive effects remain stable over time.

RELEVANCE TO CLINICAL PRACTICE

Implementation of a multiprofessional individualised programme to promote self-care of sleep-activity including relaxation based on patients' needs, supported by a healthcare team and led by nurses, is important in clinical practice.

B vitamin and/or n-3 fatty acid supplementation and health-related quality of life: ancillary findings from the SU.FOL.OM3 randomized trial

Background

Despite growing attention to nutrition and quality of life in cardiovascular disease survivors, the impact of dietary factors according to disease type or to quality of life domain is poorly understood. We investigated the effects of B vitamin and/or n-3 fatty acid supplementation on health-related quality of life among survivors of stroke, myocardial infarction, or unstable angina.

Methods

We performed ancillary analyses of the SU.FOL.OM3 trial (2003–2009; France). In total, 2,501 men (mean age = 61 y) and women (mean age = 63 y) were randomized in a 2×2 factorial design to: 1) 0.56 mg 5-methyl-tetrahydrofolate, 3 mg vitamin B6, 0.02 mg vitamin B12; 2) 600 mg eicosapentaenoic and docosahexaenoic acids in a 2∶1 ratio; 3) B vitamins and n-3 fatty acids combined; or 4) placebo. Health-related quality of life was evaluated at follow-up with the Medical Outcomes Study 36-Item Short Form Health Survey. Data from 2,029 individuals were used in this analysis.

Results

After 3.1±0.4 y, no effects of supplementation with either B vitamins or n-3 fatty acids on quality of life (physical or mental health domains) were found. However, participants receiving B vitamins had slightly more activity limitations due to emotional problems compared with those not receiving B vitamins (mean difference = 3.8; 95% CI: 0.4, 7.1). A significant interaction of treatment by prior disease revealed an inverse association between n-3 fatty acids and vitality among myocardial infarction survivors (mean difference = 2.9; 95% CI: 0.5, 5.2).

Conclusions

There were no beneficial effects of supplementation with relatively low doses of B vitamins or n-3 fatty acids on health-related quality of life in cardiovascular disease survivors. The adverse effects of B vitamins on activity limitations and of n-3 fatty acids on vitality among individuals with prior myocardial infarction merit confirmation.

Effects of community based cardiac rehabilitation: Comparison with a hospital-based programme

BACKGROUND

With typically fewer than 35% of eligible patients attending outpatient cardiac rehabilitation (CR), more accessible provision is required. Community-based cardiac rehabilitation is one option but its effects need to be compared with those of hospital-based CR.

AIMS

The purpose of this study was to compare changes in health-related quality of life (HRQOL), anxiety and depression, and exercise and smoking rates, between attendees at community-based and hospital-based CR programmes.

METHOD

A prospective comparative cohort design was used. Consecutive patients admitted to Aberdeen Royal Infirmary and eligible for CR were recruited and followed up by self-report questionnaire. Outcomes were health status (RAND-36), Hospital Anxiety and Depression Scale (HADS), Godin Leisure-Time Exercise and smoking status.

RESULTS

There were 136 of 179 (75%) attenders at community-based CR, compared to 169 of 209 (80%) at hospital-based CR (p=0.242). In univariate analysis, there were no significant differences between the two groups in health status, HADS, and frequency or intensity of exercise immediately after the CR programme or six months later. Adjusting for other significant factors, patients who attended community CR reported higher RAND-36 energy scores at six months compared with attenders at hospital CR (p=0.020), but were less likely to undertake frequent exercise (p=0.041).

CONCLUSIONS

Community-based CR appears to achieve similar attendance rates and effects on health status and health behaviour as hospital-based CR. This option might help overcome the poor attendance of patients with long travelling times to hospital-based CR.

Predictors of physical and mental health-related quality of life outcomes among myocardial infarction patients

Background

Health-related quality of life (HRQoL) is an important outcome for patients diagnosed with coronary heart disease. This report describes predictors of physical and mental HRQoL at six months post-hospitalisation for myocardial infarction.

Methods

Participants were myocardial infarction patients (n=430) admitted to two tertiary referral centres in Brisbane, Australia who completed a six month coronary heart disease secondary prevention trial (ProActive Heart). Outcome variables were HRQoL (Short Form-36) at six months, including a physical and mental summary score. Baseline predictors included demographics and clinical variables, health behaviours, and psychosocial variables. Stepwise forward multiple linear regression analyses were used to identify significant independent predictors of six month HRQoL.

Results

Physical HRQoL was lower in participants who: were older (p<0.001); were unemployed (p=0.03); had lower baseline physical and mental HRQoL scores (p<0.001); had lower confidence levels in meeting sufficient physical activity recommendations (p<0.001); had no intention to be physically active in the next six months (p<0.001); and were more sedentary (p=0.001). Mental HRQoL was lower in participants who: were younger (p=0.01); had lower baseline mental HRQoL (p<0.001); were more sedentary (p=0.01) were depressed (p<0.001); and had lower social support (p=0.001).

Conclusions

This study has clinical implications as identification of indicators of lower physical and mental HRQoL outcomes for myocardial infarction patients allows for targeted counselling or coronary heart disease secondary prevention efforts.

Trial registration

Australian Clinical Trials Registry, Australian New Zealand Clinical Trials Registry, CTRN12607000595415.

Sleep-wake activity rhythm and health-related quality of life among patients with coronary artery disease and in a population-based sample--an actigraphy and questionnaire study

The aim of this study was to explore whether there are gender differences in sleep and health-related quality of life in patients with coronary artery disease (CAD) and a matched population-based sample and to see how subjectively rated sleep is associated with actigraphy. Secondly, to explore whether factors that predict patients' sleep quality could be identified. Fifty-seven patients with stable CAD and 47 participants from a population-based sample were included. All participants completed the Uppsala Sleep Inventory (USI), the Epworth Sleepiness Scale and the SF-36. Actigraphy recordings and a sleep diary were performed for seven 24-h periods. Multiple stepwise regression analysis showed that sleep duration, sleep onset latency, nocturnal awakenings, vitality (SF-36) and body mass index explained 60% of the sleep quality outcome (USI). Sleep duration, sleep efficiency and fragmentation index assessed with actigraphy and sleep diary accounted for 36% of the sleep quality outcome (diary). The result can form the basis for a non-pharmacological, self-care programme supported and led by nurses.

Tobacco smoking predicts depression and poorer quality of life in heart disease

Background

We report on the prospective association between smoking and depression and health-related quality of life (HRQOL) in patients with coronary artery disease (CAD).

Methods

Prospective study of 193 patients with assessment of depression occurring 3-, 6- and 9- months (T1, 2, and 3, respectively) following discharge from hospital for a cardiac event. HRQOL was assessed at T3. T1 depression was assessed by clinical interview; T2 and T3 depression was assessed by self-report. Smoking at time of cardiac event was assessed by self-report. Multivariate analyses controlled for known demographic, psychosocial and clinical correlates of depression.

Results

Smoking at the time of index cardiac event increased the likelihood of being diagnosed with Major Depressive Disorder (MDD) at T1 by 4.30 [95% CI, 1.12-16.46; p < .05]. The likelihood of receiving a diagnosis of minor depression, dysthymia or MDD as a combined group was increased by 8.03 [95% CI, 2.35-27.46; p < .01]. Smoking did not reliably predict depression at T2 or T3 and did not reliably predict persistent depression. Smoking increased the likelihood of being classified as depressed according to study criteria at least once during the study period by 5.19 [95% CI, 1.51-17.82; p < .01]. Smoking independently predicted worse mental HRQOL.

Conclusions

The findings support a role for smoking as an independent predictor of depression in CAD patients, particularly in the first 3 months post-cardiac event. The well-established imperative to encourage smoking cessation in these patients is augmented and the findings may add to the evidence for smoking cessation campaigns in the primary prevention of depression.

Inpatient cardiac rehabilitation and changes in self-reported health related quality of life--a pilot study

OBJECTIVE

To assess changes in self-reported health related quality of life (HRQoL) among cardiac patients who participated in an inpatient rehabilitation programme.

PATIENTS AND METHODS

Medical Outcomes Study Short Form 36 (SF-36) and the MacNew Heart Disease Health-related Quality of Life Questionnaire (MacNew) was used to assess HRQoL at baseline (T1), after rehabilitation (T2) and 5 months after discharge (T3). The rehabilitation programme consisted of physical exercise, theoretical education, group discussions and individual consultations. Friedman's test with Wilcoxon post-hoc test was used to analyse changes between T1, T2 and T3. Effect size (ES) were calculated.

RESULTS

Eighty-nine participants were included (79% male) with mean age of 60.0 ± 8.6 years. All SF-36 and MacNew domains showed significant improvement from T1 to T2 (P < 0.05), and all except the SF-36 domain for emotional role with a moderate to large ES. At T3, change and ES are diminished in all domains, except for the physical and social domains of the MacNew.

CONCLUSION

These findings indicate an improvement in HRQoL over time among cardiac patients attending the rehabilitation programme, particularly so in the domains of physical role and physical function, vitality, bodily pain and emotional-, physical- and social-well-being, all which are important domains for maintaining an active life. Future randomised studies comparing inpatient- and outpatient-programmes with longer follow-up are necessary to ascertain if such improvements persist and if patients are able to change life-style in line with the stated goals of cardiac rehabilitation (CR).

An office-based approach to emotional and behavioral risk factor reduction for cardiovascular disease

There are many psychological risk factors for cardiovascular disease, and the ability to reduce mortality depends on an ability to integrate care of these risk factors with traditional Framingham cardiovascular risk and use them both in routine practice. The aim of this article is to provide an update of all the major emotional and behavioral cardiovascular risk factors along with a practical treatment model for implementation. First, we provide a review of major emotional and behavioral cardiovascular risk factors, the associated primary effect, and proposed mechanism of action. Second, we provide an office-based approach to cardiovascular risk factor reduction and methods of reducing barriers to implementation, called Prevention Oriented Primary Care-Abridged. The approach integrates several forms of detection, assessment using the 3As (ask, assess, assist), and Stages of Change approaches, and subsequent efficient and targeted treatment with either Motivational Interviewing or further office intervention. A case example is provided to help illustrate this process.

Quality-of-Life measures for cardiac surgery practice and research: a review and primer

Declining mortality and major morbidity rates after cardiac surgery have led to increasing focus on patient quality of life (QOL). Beyond longevity, the impact of cardiac surgery on day-to-day functioning is incredibly salient to patients, their spouses, and families. As such, QOL measures are a welcome and sometimes necessary addition to clinical trials. However, how does one navigate the expansive market of QOL questionnaires, which QOL measures are applicable to cardiac surgery units, and how can they be used meaningfully in clinical practice? Because nearly two decades have passed since QOL measures were reviewed for relevance to cardiac surgery settings, an overview is provided of various generic (Short Form Health Survey [SF-36], Sickness Impact Profile, Nottingham Health Profile) and disease-specific QOL measures (Duke Activity Status Index, Seattle Angina Questionnaire, MN Living with Heart Failure Questionnaire; Heart-QOL) with examples from cardiac surgery studies. Recommendations are provided for the application of QOL measures to clinical trials and the impact on clinical decision-making is discussed. The paucity of methodologically sound QOL studies highlights the necessity for further rigorous empirical data to better inform treatment efficacy studies and clinical decision-making.

A Comparative Analysis of the SF-12 and the SF-36 among Ischaemic Heart Disease Patients

This paper investigated whether the SF-12 could replace the SF-36 in the measurement of health status among ischaemic heart disease patients. The SF-36 and SF-12 were administered to 105 cardiac patients. The SF-36 summary scores were strongly correlated and similar to the SF-12 summary scores. Also, the SF-12 scores were as powerful as the SF-36 summary scores in discriminating between subgroups of patients categorized according to their self-reported health status or angina classification. It is suggested that when there is a need to collect routine information about cardiac patients' general physical and mental health, the SF-12 is preferable to the SF-36 because of its brevity and acceptability to patients.

Utility of the late life function and disability instrument as an outcome measure in patients participating in outpatient cardiac rehabilitation: a preliminary study

PURPOSE

The purpose of this study was to examine the concurrent validity of the Late Life Function and Disability Instrument (LLFDI) in patients with coronary heart disease (CHD) and to evaluate the accuracy of information obtained through self-report questionnaire versus interview formats.

METHODS

The study included 29 patients older than 60 years attending an outpatient cardiac rehabilitation program. Participants completed the LLFDI, three additional self-report criterion measures, and six performance-based tests; they completed the LLFDI a second time via interview. We used descriptive statistics, correlations, and t-tests to analyze the data.

RESULTS

All LLFDI components were correlated (rs=0.36-0.83) with the self-report criterion measures. The Function Component of the LLFDI was moderately correlated with the 6-Minute Walk Test (r=0.62), timed up-and-go (r=-0.58), walking speed (r=-0.57), and timed sit-to-stand (r=-0.56) scores. The LLFDI demonstrated a ceiling effect (10%) only in the Disability Limitation component. All LLFDI component scores obtained via self-report questionnaire were correlated with scores obtained via interview; except in a single subcategory, there was no difference between LLFDI scores obtained through self-report questionnaire and those obtained through interview.

CONCLUSIONS

RESULTS indicate that the LLFDI has appropriate validity for older patients (>60 years) with CHD and can be completed independently by patients rather than administered by clinicians.

Sense of coherence as an independent predictor of health-related quality of life among coronary heart disease patients

PURPOSE

The aim of this study was to determine whether sense of coherence (SOC) at baseline predicts health-related quality of life (HRQoL) at 12-28-month follow-up among patients with coronary heart disease when controlled for sociodemographic and medical variables.

METHODS

A total of 179 consecutive patients (58.28 ± 6.52 years, 16.8% women) scheduled for coronary angiography (CAG) were interviewed before CAG and 12-28 months after. SOC was measured with the 13-item Orientation to Life Questionnaire. HRQoL was measured using the Short Form Health Survey 36 (SF-36), from which the mental and physical component summaries (MCS, PCS) were calculated. The relationship between SOC and HRQoL was examined using regression analyses.

RESULTS

SOC proved to be a significant predictor of the MCS-score (B = 0.29; 95% CI = 0.17-0.41) and PCS-score (B = 0.18; 95% CI = 0.06-0.31) when not adjusted for possible confounding sociodemographic and medical variables. After adjustment for sociodemographic and medical variables, SOC remained a predictor of the MCS-score (B = 0.26; 95% CI = 0.14-0.39). SOC also remained a predictor of the PCS-score when controlled for gender, age and family income; however, the association disappeared after adjustment for functional status (B = 0.07; 95% CI = -0.05 to 0.19).

CONCLUSIONS

SOC is a predictor of mental and physical HRQoL at 12-28-month follow-up, crude and also after adjustment. Patients undergoing CAG with low SOC thus deserve particular attention in regard to the maintenance and improvement of their HRQoL.