Effect of maximal-intensity and high-intensity interval training on exercise capacity and quality of life in patients with acute myocardial infarction: a randomized controlled trial

BACKGROUND

An increase in V̇O2max is important for acute myocardial infarction morbidity, and recurrence rate and intensity have been suggested as important factors in improving V̇O2max.

AIM

The aim of this study was to compare the effects of maximal-intensity interval training (MIIT) and high-intensity interval training (HIIT) on exercise capacity and health-related Quality of Life (HRQoL) in patients with acute myocardial infarction (MI) at low and moderate cardiac risk in cardiac rehabilitation (CR). This study secondarily aimed to compare the effects of hospital-based phase II CR and usual care.

DESIGN

This study is a randomized controlled trial.

SETTING

Outpatient Rehabilitation Setting.

POPULATION

Fifty-nine patients with acute MI were randomly assigned to the MIIT (N.=30) or HIIT (N.=29) group, and 32 to the usual care group.

METHODS

Twice a week, an intervention was conducted for nine weeks in all groups. The maximum oxygen intake (V̇O2max) and MacNew Heart Disease HRQoL were evaluated before and after intervention.

RESULTS

A significant interaction was observed between time and group for V̇O2max (P<0.001). The MIIT group showed greater improvement than those exhibited by the HIIT and usual care groups (P<0.05). Similarly, a significant time and group interaction was observed on the MacNew Global, Physical, and Emotional scales (P<0.05), but not on the social scale (P>0.05).

CONCLUSIONS

Compared to HIIT and usual care, MIIT significantly increased the V̇O2max and was as safe as HIIT in patients with acute MI with low and moderate cardiac risk in CR. Additionally, MIIT and HIIT were superior to usual care in terms of improving the HRQoL.

CLINICAL REHABILITATION IMPACT

Our results suggest that increased intensity in phase II CR could result in better outcomes in terms of V̇O2max increment in patients with acute MI and low and moderate cardiac risk in CR.

Health-Related Quality of Life and Influencing Factors in Coronary Heart Disease Based on the Scale QLICD-CHD (V2.0): A Cross-Sectional Study

Purpose

Coronary heart disease (CHD) is difficult to cure, so more attention should be paid to improving patients' health-related quality of life (HRQoL). This paper focuses on identifying factors that affect HRQoL.

Patients and Methods

Overall, 189 in-patients with coronary heart disease were investigated at the Affiliated Hospital of Guangdong Medical University between 2015 and 2016. The scale Quality of Life Instruments for Chronic Diseases-Coronary heart disease (QLICD-CHD V2.0) was used to evaluate HRQoL and collect demographic information. Medical records were applied to collect patients' clinical indicators. A simple correlation analysis, Student's t-test, and a one-way analysis of variance were first performed to filter factors that might associate with HRQoL, and multiple linear regression was applied to finally identify related factors.

Results

Findings from multiple linear regression showed that the total score was related to family economy, treatment, indirect bilirubin, and albumin with regression coefficient B=5.209, -6.615, 0.378, and 0.548, respectively. The physical functions were related to treatment, albumin, globular proteins, chloride, and red blood cell count with B=-9.031, 1.000, 0.612, 1.320, and 5.161, respectively. The psychological function was in association with family economy, clinical course, serum phosphorus, and percentage of lymphocyte population with B=7.487, 6.411, -16.458, and 0.090, respectively. The social function was associated with family economy, blood urea nitrogen, serum creatinine, and platelet distribution width with B=7.391, 1.331, -0.060, and -0.929, respectively. The special module was in association with treatment, indirect bilirubin, and serum calcium with B=-7.791, 0.414, and 23.017, respectively.

Conclusion

Clinical indicators including albumin, globular proteins, chloride, red blood cell count, serum phosphorus, percentage of lymphocyte population, blood urea nitrogen, serum creatinine, platelet distribution width, indirect bilirubin, and serum calcium, as well as socio-demographic factors including the family economy, clinical course, and treatment, may affect coronary heart disease patients' HRQoL.

Mediating effects of general self-efficacy on social support and quality of life in patients after surgical aortic valve replacement

AIM

To explore whether general self-efficacy can mediate the relationship between social support and quality of life in patients after surgical aortic valve replacement.

DESIGN

A cross-sectional design.

METHODS

The final analysis included 283 patients who underwent surgical aortic valve replacement from May 2021 to September 2021. They completed a set of questionnaires, including the Chinese version of the General Self-Efficacy Scale, the Chinese Questionnaire of Quality of life in Patients with Cardiovascular Diseases and the Social Support Rating Scale. The PROCESS Macro in SPSS was used to analyse the mediating effect.

RESULTS

Quality of life and all of its dimensions were significantly related to social support and general self-efficacy. A significant indirect effect of social support existed through general self-efficacy in relation to quality of life with the mediation effect ratio of 32.82%.

Responsiveness and minimal clinically important difference of EQ-5D-5L in patients with coronary heart disease after percutaneous coronary intervention: A longitudinal study

Background

Although the five-level version of the EuroQol five-dimensional questionnaire (EQ-5D-5L) has been validated in various diseases, no empirical study has evaluated the responsiveness and minimal clinically important difference (MCID) of the instrument in patients with coronary heart disease (CHD), which limits the interpretability and clinical application of EQ-5D-5L. Therefore, this study aimed to determine the responsiveness and MCID of EQ-5D-5L in patients with CHD who underwent percutaneous coronary intervention (PCI) and identify the relationship between the MCID values and minimal detectable change (MDC).

Methods

Patients with CHD were recruited for this longitudinal study at the Tianjin Medical University’s General Hospital in China. At baseline and 4 weeks after PCI, participants completed the EQ-5D-5L and Seattle Angina Questionnaire (SAQ). Additionally, we used the effect size (ES) to assess the responsiveness of EQ-5D-5L. The anchor-based, distribution-based, and instrument-based methods were used in this study to calculate the MCID estimates. The MCID estimates to MDC ratios were computed at the individual and group levels at a 95% CI.

Results

Seventy-five patients with CHD completed the survey at both baseline and follow-up. The EQ-5D-5L health state utility (HSU) improved by 0.125 at follow-up compared with baseline. The ES of EQ-5D HSU was 0.850 in all patients and 1.152 in those who improved, indicating large responsiveness. The average (range) MCID value of the EQ-5D-5L HSU was 0.071 (0.052–0.098). These values can only be used to determine whether the change in scores were clinically meaningful at the group level.

Conclusion

EQ-5D-5L has large responsiveness among CHD patients after undergoing PCI surgery. Future studies should focus on calculating the responsiveness and MCID for deterioration and examining the health changes at the individual level in CHD patients.

Family functioning and health-related quality of life of inpatients with coronary heart disease: a cross-sectional study in Lanzhou city, China

Background

A key outcome in coronary heart disease (CHD) is Health Related Quality of Life (HRQoL), and family functioning is important in the management of CHD. But few studies have examined both together, and little is known about them among inpatients with CHD in less developed areas of China. Therefore, this study aimed to assess the HRQoL and family functioning status of inpatients with CHD in Lanzhou from Northwest China, and identify the factors that affect their HRQoL.

Methods

A cross‑sectional study was conducted in 224 CHD inpatients at one major hospital. Sociodemographic data and disease information of CHD inpatients were collected by face-to-face using a structured questionnaire and data were also obtained from patient medical records. HRQoL was measured using the Sickness Impact Profile (SIP). Family functioning was measured using the family APGAR index. Multiple binary logistic regression analysis (MBLRA) was used to explore potential risk factors associated with HRQoL, and Pearson’s correlations were used to assess the relationship between family functioning and HRQoL.

Results

The overall, physical and psychosocial SIP scores were 25.03 ± 8.52, 18.61 ± 9.90 and 28.08 ± 9.64, respectively. The total family APGAR score was 6.11 ± 2.45. MBLRA found older age, poorer cardiac function and more severe disease were associated with poorer HRQoL, while better family functioning, higher monthly income, and urban living were associated with better HRQoL. Family functioning was weakly to moderately correlated with total and psychosocial HRQoL.

Conclusions

Older and less affluent inpatients with lower educational level, less family support and more severe CHD have poorest quality of life, and health care providers should consider interventions to support them.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12872-022-02844-x.

Investigation on Family Support System and Willingness of Patients to Participate in Cardiac Rehabilitation after Percutaneous Coronary Intervention

Objective

We attempt to discuss the relationship between family support and willingness to participate in exercise rehabilitation in coronary heart disease patients after PCI to provide effective guidance for improving the quality of life of coronary heart disease patients after PCI.

Methods

By convenient sampling, we selected 90 coronary heart disease patients in cardiology department from September 2021 to January 2022, using general information questionnaire, rehabilitation exercise knowledge, attitude, and behavior questionnaire of patients with coronary heart disease, and the social support scale to investigate the subjects.

Results

The total score of knowledge, belief, and behavior in patients with coronary heart disease was 33.02 ± 6.28 points, the social support scale score was 39.63 ± 6.07 points, the multiple linear regression revealed that the educational level, history of cardiovascular disease, and the number of coronary stents of coronary heart disease patients after PCI are the main influencing factors that affect the willingness of coronary heart disease patients to participate in exercise rehabilitation.

Conclusion

Rehabilitation exercise knowledge, belief, and behavior scores in coronary heart disease patients are low, and social support is negatively correlated with rehabilitation exercise in coronary heart disease patients.

Factors Associated With Hope and Quality of Life in Patients With Coronary Artery Disease

BACKGROUND

Psychological resources such as hope have been suggested to affect quality of life (QoL) positively in patients with heart disease. However, little information regarding the relationship between these two constructs is available.

PURPOSE

This work was aimed at examining the factors associated with hope and QoL in patients with coronary artery disease.

METHODS

In this descriptive work, perceived QoL and hope were assessed in 500 patients with heart disease. The information was collected using the McGill QoL Questionnaire, demographic variables, and the Herth Hope Index. The Pearson correlation test and general linear model were used to examine correlations through SPSS Version 22.

RESULTS

A considerable correlation was discovered between QoL and hope (r = .337, p < .001). Multivariate analyses with regression revealed that religious beliefs and social support both had significant and positive effects on the total perceived hope of patients and that patient age had a considerable negative impact on QoL (p < .05). None of these factors had a significant impact on hope (p < .05). In addition, the total QoL had a significant and positive effect on patient feelings and thoughts, whereas the physical problems component of QoL had a significant and negative effect on hope (p < .05). Participants with higher levels of education reported more hope.

CONCLUSIONS

QoL relates significantly to self-perceived hope in patients. Understanding QoL and hopefulness in patients with coronary artery disease has implications for nurses and other healthcare professionals.

Mobile-Health based physical activities co-production policies towards cardiovascular diseases prevention: findings from a mixed-method systematic review

BACKGROUND

Cardiovascular disease (CVD) is the first cause of death globally, with huge costs worldwide. Most cases of CVD could be prevented by addressing behavioural risk factors. Among these factors, there is physical and amateur sports activity (PASA), which has a linear negative correlation with the risk of CVD. Nevertheless, attempts to encourage PASA, as exercise prescription programmes, achieved little impact at the community-wide level. A new frontier to promote PASA is represented by mobile health tools, such as exergaming, mobile device apps, health wearables, GPS/GIS and virtual reality. Nevertheless, there has not yet been any evident turnabout in patient active involvement towards CVD prevention, and inactivity rates are even increasing. This study aims at framing the state of the art of the literature about the use of m-health in supporting PASA, as a user-centric innovation strategy, to promote co-production health policies aiming at CVD prevention.

METHODS

A mixed-method systematic literature review was conducted in the fields of health and healthcare management to highlight the intersections between PASA promotion and m-health tools in fostering co-produced services focused on CVD prevention. The literature has been extracted by the PRISMA logic application. The resulting sample has been first statistically described by a bibliometric approach and then further investigated with a conceptual analysis of the most relevant contributions, which have been qualitatively analysed.

RESULTS

We identified 2,295 studies, on which we ran the bibliometric analysis. After narrowing the research around the co-production field, we found 10 papers relevant for the concept analysis of contents. The interest about the theme has increased in the last two decades, with a high prevalence of contributions from higher income countries and those with higher CVD incidence. The field of research is highly multi-disciplinary; most of documents belong to the medical field, with only a few interconnections with the technology and health policy spheres. Although the involvement of patients is recognized as fundamental for CVD prevention through PASA, co-design schemes are still lacking at the public management level.

CONCLUSIONS

While the link between the subjects of motor activity, medicine and technology is clear, the involvement of citizens in the service delivery process is still underinvestigated, especially the issue concerning how "value co-creation" could effectively be applied by public agencies. In synthesis, the analysis of the role of co-production as a system coordination method, which is so important in designing and implementing preventive care, is still lacking.

Psychological distress and quality of life following provision of vascular imaging results of the coronary and carotid arteries to asymptomatic adults: a scoping review protocol

Background: Non-invasive screening for atherosclerosis or asymptomatic cardiovascular disease of the coronary and carotid arteries is commonly undertaken, and research has been focussed on how results from these screenings lead to behaviour change. However, no review has focused on the effects of these results on psychological distress and health-related quality of life (HRQoL). This protocol will outline how a scoping review will be conducted to map all available evidence on psychological distress and/or HRQoL outcomes following the provision of vascular imaging results of the coronary and carotid arteries.

Methods: Arksey and O’Malley’s (2005) framework subsequently enhanced by Levac et al. (2010)  and Peters et al (2015, 2017) will guide the scoping review. Databases such as MEDLINE (Clarivate), APA PsychINFO, EMBASE, Social Work Abstracts, Psychology and Behavioural Sciences Collection, and Cumulative Index to Nursing and Allied Health Literature (CINAHL) will be searched using MeSH terms  such as "Coronary stenosis", "Carotid Stenosis", "Psychological Distress" and "Quality of Life" and related terms. Two investigators will screen title and abstract and all articles meeting inclusion criteria will be extracted.  Data on authors, publication year, country of origin, aims/purpose, methodology, intervention, outcome measures as well as key findings that relate to the scoping review questions will be extracted for each included study. The findings will be presented using tables and thematic narrative synthesis. The scoping review will not produce a pooled estimate of the impact of vascular imaging results on psychological distress and HRQoL but will present information from the included studies related to psychological distress and HRQoL.

Conclusion:  The review will highlight and address gaps in knowledge and provide direction for future investigations.

Social and Emotional Support Highly Associated with Helplessness among Coronary Heart Disease Patients

BACKGROUND: Helplessness is a factor that adversely affects patients with coronary heart disease (CHD). The factors related to this situation have become essential to be investigated. Meanwhile, one of the factors that have the potential to reduce this situation is social support. However, there has been no research related to this in the Indonesian population. AIM: Therefore, this study aims to assess the relationship between social support and helplessness among patients with CHD. METHODS: This was a correlational study where 107 outpatient and inpatient patients at a hospital in West Java, Indonesia, were obtained. The data were collected using a demographic questionnaire, Illness Cognition Questionnaire on the dimensions of helplessness, and the Enhancing Recovery in CHD Social Support Inventory. Furthermore, the data were analyzed by Pearson and linear regression. RESULTS: The respondents were 78% of males, while 22% were female. Most of the patients (88%) were married. The bivariate analysis showed that social support and its subvariable emotional support were significantly related to helplessness (p < 0.05, r = −0.248), while the other subvariable structural and instrumental support were not significantly related (p > 0.05). The regression analysis results showed that social and emotional support had a significant effect (p < 0.05) with R2 (95% CI) of 042 and 0.05, respectively. CONCLUSIONS: The social and emotional support among CHD patients was associated with helplessness. The higher the supports obtained, the lower the patient’s helplessness. Therefore, nurses need to encourage family or those closest to patients to provide adequate social and emotional support.

Contemplation-action-maintenance model of behaviour change for persons with coronary heart disease: A qualitative study

AIMS AND OBJECTIVES

To explore factors of health behaviour maintenance from the perspective of coronary heart disease (CHD) patients.

BACKGROUND

The majority of CHD patients do not achieve appropriate theory-based intervention to maintain health behaviours. Previous health behaviour change theories give little importance to behaviour maintenance.

DESIGN

A qualitative descriptive study.

METHODS

Thirty CHD patients were recruited purposively and interviewed from four hospitals in Beijing, China, during January 2017-August 2019. Data were analysed using template analysis methods. The COREQ checklist was used.

RESULTS

Perceived enjoyment and perceived effectiveness from the newly adopted behaviours emerged as vital factors for maintaining health behaviour; contemplation-action-maintenance (CAM) model to explain the behaviour change and maintenance of CHD patients was constructed.

CONCLUSIONS

The CAM model provides insight into the factors of health behaviour action and maintenance among CHD patients. Professionals can develop interventions from the perspective of patients' experiences to promote maintenance of behaviour.

RELEVANCE TO CLINICAL PRACTICE

Professionals need to consider that the goal of behavioural intervention should initially and continuously target patients' perseverance. Interventions of health behaviour that bring enjoyment may aid long-term maintenance. Also, healthcare providers can enhance patients' perception of effectiveness to motivate their behaviour maintenance in lifestyle change programmes.

Types of Perception of Home Visiting Oral Health Care Services for Korean Older Persons: A Q Methodology Study

This study was conducted using the Q methodology to categorize Korean older persons' subjective perceptions of home visiting oral health care services. Various opinions regarding home visiting oral health care services were collected based on related literature, and by conducting in-depth interviews with 12 people. Thirty-two statements were finally selected, and Q classification was applied. Based on data analysis with the PC-QUANL program, six factors (seven types) were derived, which accounted for 49.6% of the total variance. By comprehensive analysis of the types of subjective perceptions of home visiting oral health care services, the following two characteristics were identified. Korean older persons were expected to promote their own oral health activities, or improved access to expert health care services, through the home visiting oral health care services. Additionally, they had a need for social, economic, emotional, and informational support. Therefore, home visiting dental personnel should be able to provide customized visiting oral health care services based on evaluation of the need and type of perception of older persons. Thus, it is essential for visiting dental personnel to be trained in the knowledge of social welfare, and to develop diverse competencies.

Estimation of minimally important difference of the EQ-5D-5L utility scores among patients with either hypertension or diabetes or both: a cross-sectional study in Hong Kong

OBJECTIVE

To estimate and report the minimally important difference (MID) of the EuroQol five-dimensional five-level questionnaire (EQ-5D-5L) using the Hong Kong (HK) utility score among patients with either hypertension or diabetes or both.

DESIGN

Data were analysed using secondary data analysis based on a cross-sectional study assessing patients' experiences in HK.

SETTING

A representative sample was recruited from 26 specialist outpatient clinics in HK.

PARTICIPANTS

We analysed data from 2231 and 662 patients who reported having hypertension or diabetes alone, respectively, and 874 patients had these two diseases.

INTERVENTION

An instrument-defined approach was applied to estimate MID stratified according to sex and age for the three subpopulations.

RESULTS

The overall MID (oMID) estimates were 0.089, 0.086 and 0.089 for patients with hypertension or diabetes alone and with these two diseases, respectively. The adjusted MID (aMID) estimate was smaller than the oMID, and the improved MID was larger than the deteriorated MID. Women had larger oMID but smaller aMID than men. Younger respondents had larger aMID than older respondents. Effect sizes ranged from 0.30 to 0.503, which fit our preset criteria.

CONCLUSION

Four types of MID of the EQ-5D utility score for patients with hypertension or diabetes alone and with these two diseases were reported. Variations in the MID estimates should be further explored in other populations or using different statistical methods.

Predictors of Quality of Life in Patients with Heart Disease

Individuals with heart disease have been found to have more negative psychological and physical effects that impact their quality of life (QoL) than the general population. Spiritual well-being is considered a protective factor associated with QoL in people with heart disease. Therefore, the current research seeks to evaluate whether sociodemographic factors and spiritual well-being predict QoL among patients with heart disease. A total of 500 patients who were selected through a convenient sampling method from an Iranian hospital participated in this descriptive-correlational study. Data were collected using the McGill QoL Questionnaire, the Spiritual Well-being Scale, and demographic variables. The data analysis included descriptive and inferential statistics powered by SPSS (v. 23). Following multivariate analyses, findings revealed that those participants with their main source of income derived from family or a government pension and with College or intermediate educational levels were more likely to have higher QoL. Those participants with average or poor socioeconomic status reported higher QoL than those who were more affluent. Furthermore, younger patients (- 0.2, 95% CI - 0.3 to - 0.003, p = 0.016) and those with higher social support (0.7, 95% CI 0.2 to 1.3, p = 0.006) and spiritual well-being (0.2, 95% CI 0.1 to 0.3, p < 0.001) had significantly better QoL. In the current study, spiritual well-being and social support led to reduced negative psychological sequelae and improved QoL in cardiac patients.

Effect of eHealth cardiac rehabilitation on health outcomes of coronary heart disease patients: A systematic review and meta-analysis

AIMS

To evaluate the effects of eHealth cardiac rehabilitation (CR) on health outcomes of coronary heart disease patients and to identify programme design, which may lead to more effective health benefits.

DESIGN

A systematic review and meta-analysis following Cochrane Handbook for Systematic Reviews of Interventions.

DATA SOURCES

Medline, EMBASE, CLNAHL, Web of Science, Scopus, PsycINFO, Cochrane Central Register of Controlled Trails, PubMed and CNKI were searched over the period from 1806 to April 2019.

REVIEW METHODS

A systematic review and meta-analysis of randomized controlled trials to examine the effect of eHealth CR on health outcomes of coronary heart disease patients. We used RevMan 5.3 for risk of bias assessment and meta-analysis and GRADE software for generating findings.

RESULTS

In all, 14 trials with 1,783 participants were included. eHealth CR has significantly promoted duration of physical activity, daily steps, quality of life (QoL) and re-hospitalization. Using comparative analysis of programme design elements, including mode of delivery, intervention content, motivational strategies and social support, between the effective and ineffective eHealth CR, it was found that comprehensive empowerment strategies and follow-up care by tele-monitoring may be the crucial characteristics leading to more favourable treatment effect.

CONCLUSION

eHealth CR is effective in engaging patients in active lifestyle, improving QoL and reducing re-hospitalization. Future research needs to test the effects of comprehensive CR programmes by incorporating empowerment strategies and tele-monitoring as active components.

IMPACT

eHealth has been increasingly applied to increase accessibility and uptake of CR. Integrative evidence to indicate its effects on health outcomes is lacking. This review identified its positive effects on some behavioural, psychosocial and health service use outcomes. Together with insights about which programme design elements may positively shape the outcomes, this review informs the role and practice of cardiovascular nurses in promoting evidence-based eHealth CR.

Effectiveness of eHealth cardiac rehabilitation on health outcomes of coronary heart disease patients: a randomized controlled trial protocol

BACKGROUND

Cardiac rehabilitation (CR) uptake and adherence remain sub-optimal despite the apparent health benefits of modifying healthy behavior and slowing disease progression. eHealth is the use of information and communication technology (ICT) for health. eHealth lifestyle interventions and disease management have emerged as modalities to enhance CR accessibility, enable an individualized progress page, and enrich real-time contact, video-based information, and technology monitored functionality. This study aims to develop a nurse-led eHealth cardiac rehabilitation (NeCR) intervention and investigate its effectiveness on coronary heart disease (CHD) patients' health outcomes.

METHODS

This single-blinded two-arm parallel randomized controlled trial will randomize 146 patients from the inpatient cardiovascular units of a hospital in Wuhan, China to receive either the NeCR or the usual care. The NeCR intervention uses a hybrid approach consisting of a brief face-to-face preparatory phase and an empowerment phase delivered by health technology. The preparatory phase aims at identifying self-care needs, developing a goal-oriented patient centered action plan, incorporating a peer support network and orientation to the use of the e-platform. The empowerment phase includes use of the multi-media interactive NeCR for promoting symptom management, monitoring lifestyle changes and offering psychological support. A tele-care platform is also integrated to enhance health care dialogue with health professionals and peer groups. The control group will receive the usual care. An evaluation of lifestyle behavioral changes, self-efficacy, health-related quality of life, anxiety and depression, cardiovascular risk parameters, and unplanned health services use will be conducted at baseline, 6 weeks and 12 weeks post-intervention.

DISCUSSION

This protocol proposes an individualized, comprehensive, and interactive NeCR delivered using a hybrid approach and guided by an empowerment model to optimize health outcomes of CHD patients. The intervention content and web-design is based on international health guidelines to improve credibility, comprehensibility and implementation. This study also proposes a new method of peer support in which the researcher shares participants' progress toward goal attainment with the peer group. Results of this research have the potential to increase accessibility and availability of CR, improve cardiac rehabilitation service development in China, and inform eHealth lifestyle interventions.

TRIAL REGISTRATION

Chinese Clinical Trial Registry: ChiCTR1800020411; Date of registration: December 28, 2018.

Chinese Drug Users’ Abstinence Intentions: The Role of Perceived Social Support

This study investigated the relationship between Chinese drug users’ perceived social support and their intentions for choosing abstinence. Both bivariate and multivariate analyses were performed with 3,239 drug users, especially heroin (427) and methamphetamine (890) users. All participants were from multiple Chinese compulsory drug treatment institutions. Perceived support from friends was the factor that showed a strongest positive relationship with Chinese drug users’ abstinence intentions. The positive influence from family support on the willingness to seek and choose abstinence was not as great as scholars have suggested, which challenges previous research findings. Methamphetamine users had a significantly lower chance of pursuing abstinence, but their abstinence intentions were positively related to perceived support from friends. Comparatively, all types of perceived social support had no significant influence on heroin users’ abstinence intentions. This study highlights that, as China’s methamphetamine-addicted population rapidly expands, tailored treatment, especially facilitating positive peer support, is urgently needed.

Effectiveness of a multidisciplinary disease management program on outcomes in patients with heart failure in China: A randomized controlled single center study

BACKGROUND

Multidisciplinary disease management programs (MDMP) for patients with heart failure (HF) have been delivered, but evidence of their effectiveness in China is limited.

OBJECTIVE

To determine if a MDMP improves quality of life (QoL), physical performance, depressive symptoms, self-care behaviors and mortality or rehospitalization in patients with HF in China.

METHODS

This is a randomized controlled single center trial in which patients with HF received either MDMP with discharge education, physical training, follow-up visits and telephone calls for 180 days (n = 31) or standard care (SC, n = 31).

RESULTS

Compared with SC, QoL, depressive symptoms, and self-care behaviors were significantly improved by MDMP from baseline to 180 days (37% vs 66%, 20% vs 61%, and 8% vs 33%, respectively, all p < 0.001). There were no differences in physical performance and mortality or rehospitalization during follow-up.

CONCLUSIONS

A HF MDMP can improve QoL, depressive symptoms and self-care behaviors in China.

Comparing health-related quality of life of Dutch and Chinese patients with traumatic brain injury: do cultural differences play a role?

BACKGROUND

There is growing interest in health related quality of life (HRQoL) as an outcome measure in international trials. However, there might be differences in the conceptualization of HRQoL across different socio-cultural groups. The objectives of current study were: (I) to compare HRQoL, measured with the short form (SF)-36 of Dutch and Chinese traumatic brain injury (TBI) patients 1 year after injury and; (II) to assess whether differences in SF-36 profiles could be explained by cultural differences in HRQoL conceptualization. TBI patients are of particular interest because this is an important cause of diverse impairments and disabilities in functional, physical, emotional, cognitive, and social domains that may drastically reduce HRQoL.

METHODS

A prospective cohort study on adult TBI patients in the Netherlands (RUBICS) and a retrospective cohort study in China were used to compare HRQoL 1 year post-injury. Differences on subscales were assessed with the Mann-Whitney U-test. The internal consistency, interscale correlations, item-internal consistency and item-discriminate validity of Dutch and Chinese SF-36 profiles were examined. Confirmatory factor analysis was performed to assess whether Dutch and Chinese data fitted the SF-36 two factor-model (physical and mental construct).

RESULTS

Four hundred forty seven Dutch and 173 Chinese TBI patients were included. Dutch patients obtained significantly higher scores on role limitations due to emotional problems (p < .001) and general health (p < .001), while Chinese patients obtained significantly higher scores on physical functioning (p < .001) and bodily pain (p = .001). Scores on these subscales were not explained by cultural differences in conceptualization, since item- and scale statistics were all sufficient. However, differences among Dutch and Chinese patients were found in the conceptualization of the domains vitality, mental health and social functioning.

CONCLUSIONS

One year after TBI, Dutch and Chinese patients reported a different pattern of HRQoL. Further, there might be cultural differences in the conceptualization of some of the SF-36 subscales, which has implications for outcome evaluation in multi-national trials.

Examining the health-related quality of life using EQ-5D-5L in patients with four kinds of chronic diseases from specialist outpatient clinics in Hong Kong SAR, China

BACKGROUND

Health-related quality of life (HRQoL) measures have been increasingly employed in the evaluation of health utility. The aim of this study was to evaluate the impact of four different kinds of chronic diseases on the HRQoL of patients from specialist outpatient clinics in Hong Kong (HK) using the 5-level EQ-5D (EQ-5D-5L) value set.

PATIENTS AND METHODS

Patients who attended one of the 26 Hospital Authority's specialist outpatient clinics and met inclusion criteria were potentially sampled. The value of EQ-5D-5L (HK version) that asks the respondent to describe and rate his or her health status was used as the dependent variable. Four kinds of long-term health conditions and other demographic, socioeconomic, and health service use characteristics have been analyzed as independent variables. Chi-square test, robust one-way ANOVA, and the two-part model have been used to analyze the data.

RESULTS

A total of 7,496 (53.7%) patients reported to have at least one kind of chronic diseases. The mean score for hypertension (mean =0.882, standard error [SE] =0.207) is higher than the others, which followed by cancer, diabetes, and heart disease. Patients who were male, young, higher education attainment, and with chronic conditions got a higher EQ-5D score. In the two-part model, all the four long-standing health conditions were statistically significant in logistic model, but the magnitude of coefficients changed significantly in ordinary least squares model.

CONCLUSION

Chronic diseases have a significant negative impact on patients' HRQoL, but there might be a varying effect depending on what kind of chronic diseases patients had. Further research is also needed to plan appropriate strategies to improve patient-centered care.

Competências do enfermeiro na promoção da saúde de indivíduos com cardiopatias crônicas

RESUMO Objetivo: identificar as competências do enfermeiro relacionadas à promoção da saúde de indivíduos com cardiopatas crônicas, à luz do Consenso de Galway. Método: revisão integrativa da literatura, com busca de artigos publicados entre os anos de 2010 e 2014, nas bases de dados LILACS, BDENF, IBECS; e no portal PubMed, em fevereiro de 2015. Os 21 artigos selecionados foram analisados de acordo com os oito domínios de competências: Catalisar mudanças, Liderança, Avaliação das necessidades, Planejamento, Implementação, Avaliação do impacto, Defesa de direitos e Parcerias. Resultados: todos os domínios de competências foram contemplados nas intervenções do enfermeiro na promoção da saúde de cardiopatas crônicos, sendo o Planejamento e a Avaliação os mais evidenciados. Conclusão: os resultados desta pesquisa destacaram o enfermeiro como agente capaz de operar a gestão do cuidado, com vistas a melhorar articulação deste último com o trabalho e educação e, desta maneira, a assistência à saúde da população.

Independent predictors of physical health in community-dwelling patients with coronary heart disease in Singapore

BACKGROUND

Patients with coronary heart disease (CHD) experienced poor physical health which was found to be associated with higher hospital readmission rates and increased mortality. The study aimed to identify the independent predictors of physical health in Singaporean patients with CHD.

METHODS

A consecutive sample of 129 patients with CHD was recruited from the medical heart clinic of a tertiary public hospital in Singapore. A set of questionnaires including the Short Form 12-item health survey version 2, Perceived Stress Scale, Hospital Anxiety and Depression Scale, and Cardiac Self-Efficacy Scale were used to measure the study outcomes. The patients' socio-demographic and clinical data were also collected.

RESULTS

A multivariate linear regression analysis indicated that depression (B = -0.766, p < 0.05) and self-efficacy for maintaining function (B = 2.351, p < 0.05) remained significant while the other variables were adjusted and identified as the independent predictors of physical health in Singaporean patients with CHD.

CONCLUSIONS

This study has shed some light on the key factors influencing the physical health of Singaporean patients with CHD. The finding suggests tailored interventions that target mitigating a patient's depression and promote self-efficacy for maintaining function may be helpful in improving patients' physical health and quality of life.

Profile and Correlates of Health-related Quality of Life in Chinese Patients with Coronary Heart Disease

BACKGROUND

Although coronary heart disease (CHD) is one of the major cardiovascular diseases, risk factors associated with the health-related quality of life (HRQoL) of CHD patients remain unclear. The present study was designed to determine the profile and significant factors of the HRQoL in CHD patients.

METHODS

A cross-sectional study was conducted in rural communities of Fangshan District, Beijing, China. Socio-demographic, lifestyle, and comorbidity information of CHD patients were collected by a structured questionnaire and medical records. HRQoL was measured using European Quality of Life 5-dimensions (EQ-5D) scale and EQ Visual Analog Scale (EQ-VAS). Multiple linear and logistic regressions were performed to explore the association of potential risk factors with HRQoL scores and each EQ-5D, respectively.

RESULTS

Totally, 1928 CHD patients (mean age 61.64 ± 9.24 years; female:male = 2.4:1) were enrolled in the study. The mean score of EQ-5D index and EQ-VAS were 0.889 ± 0.172 and 71.56 ± 17.65, respectively. Multiple linear regression revealed that marital status, physical activity, moderate alcohol drinking, and family's population were positive independent correlates of EQ-VAS, whereas diabetes mellitus and stroke were negative independent correlates (all P < 0.05). Age and stroke were negatively while physical activity, moderate alcohol drinking, family's population and household income were positively correlated with EQ-5D index (all P < 0.05) independently. In addition, each of the five HRQoL dimensions had various specific determinants, including obesity, underweight, smoking or education.

CONCLUSIONS

Findings of the study highlight certain socio-demographic, lifestyle factors, and comorbid stroke or diabetes mellitus as correlates of HRQoL in Chinese CHD patients. Large-scale cohort studies should be carried out to confirm our results in the future.

Association Between Awareness of Hypertension and Health-Related Quality of Life in a Cross-Sectional Population-Based Study in Rural Area of Northwest China

Hypertensive patients have more complex health care needs and are more likely to have poorer health-related quality of life than normotensive people. The awareness of hypertension could be related to reduce health-related quality of life. We propose the use of quantile regression to explore more detailed relationships between awareness of hypertension and health-related quality of life. In a cross-sectional, population-based study, 2737 participants (including 1035 hypertensive patients and 1702 normotensive participants) completed the Short-Form Health Survey. A quantile regression model was employed to investigate the association of physical component summary scores and mental component summary scores with awareness of hypertension and to evaluate the associated factors. Patients who were aware of hypertension (N = 554) had lower scores than patients who were unaware of hypertension (N = 481). The median (IQR) of physical component summary scores: 48.20 (13.88) versus 53.27 (10.79), P < 0.01; the mental component summary scores: 50.68 (15.09) versus 51.70 (10.65), P = 0.03. adjusting for covariates, the quantile regression results suggest awareness of hypertension was associated with most physical component summary scores quantiles (P < 0.05 except 10th and 20th quantiles) in which the β-estimates from -2.14 (95% CI: -3.80 to -0.48) to -1.45 (95% CI: -2.42 to -0.47), as the same significant trend with some poorer mental component summary scores quantiles in which the β-estimates from -3.47 (95% CI: -6.65 to -0.39) to -2.18 (95% CI: -4.30 to -0.06). The awareness of hypertension has a greater effect on those with intermediate physical component summary status: the β-estimates were equal to -2.04 (95% CI: -3.51 to -0.57, P < 0.05) at the 40th and decreased further to -1.45 (95% CI: -2.42 to -0.47, P < 0.01) at the 90th quantile. Awareness of hypertension was negatively related to health-related quality of life in hypertensive patients in rural western China, which has a greater effect on mental component summary scores with the poorer status and on physical component summary scores with the intermediate status.

Reliability and validity of the multidimensional scale of perceived social support in Chinese mainland patients with methadone maintenance treatment

INTRODUCTION

The multidimensional scale of perceived social support (MSPSS) is a valid tool for assessing perceived support from family, friends and significant others. However, evidence about reliability and validity of the MSPSS in Chinese mainland patients with methadone maintenance treatment (MMT) is lacking.

METHODS

The patients (n=1212) being admitted to the first two largest MMT clinics in Xi'an were recruited in the study. Reliability was estimated with Cronbach's α and intra-class correlation (ICC). Convergent and discriminant validity was assessed using item-subscale correlation. Factorial validity was examined using exploratory and confirmatory factor analysis. The patients answered the questions of MSPSS at baseline and re-test after 6months, respectively.

RESULTS

Cronbach's α of the overall MSPSS was 0.92 (subscales range: 0.84-0.89). ICC of the overall MSPSS was 0.65 (subscales range: 0.57-0.64). Better convergent validity (r≥0.40) was demonstrated by the satisfactory hypothesized item-subscale correlation. All of the hypothesized item-subscale correlations were higher than the correlations between the hypothesized items and other subscales, indicating better discriminant validity. Two factors were extracted from the 12 items, with factor 1 mainly covering friends and significant others subscales (explained 55.56% variance) and factor 2 mainly covering family subscale (explained 11.77% variance). In comparison with the proposed three-subscale model, the two-factor observed model did not fit well in this sample according to model fit indices.

CONCLUSIONS

The MSPSS has acceptable reliability and convergent/discriminant validity in Chinese mainland MMT patients. The proposed three-factor model of MSPSS is much better fit than the two-factor observed model in this study. Findings of the study will provide evidence of psychometric properties of the MSPSS in MMT patient population and expand the use of the MSPSS in clinical MMT context.

Quality of Life for Saudi Patients With Heart Failure: A Cross-Sectional Correlational Study

Introduction:

Heart failure is a major public health issue and a growing concern in developing countries, including Saudi Arabia. Most related research was conducted in Western cultures and may have limited applicability for individuals in Saudi Arabia. Thus, this study assesses the quality of life of Saudi patients with heart failure.

Materials and Methods:

A cross-sectional correlational design was used on a convenient sample of 103 patients with heart failure. Data were collected using the Short Form-36 and the Medical Outcomes Study-Social Support Survey.

Results:

Overall, the patients’ scores were low for all domains of Quality of Life. The Physical Component Summary and Mental Component Summary mean scores and SDs were (36.7±12.4, 48.8±6.5) respectively, indicating poor Quality of Life. Left ventricular ejection fraction was the strongest predictor of both physical and mental summaries.

Conclusion:

Identifying factors that impact quality of life for Saudi heart failure patients is important in identifying and meeting their physical and psychosocial needs.

A randomised controlled trial on the effectiveness of a home-based self-management programme for community-dwelling patients with myocardial infarction

AIM

To examine the effectiveness of a four-week home-based self-management rehabilitation programme on health-related quality of life, anxiety and depression levels, cardiac risks and unplanned visits to the health services among community-dwelling patients with myocardial infarction.

METHODS

A randomised controlled trial with repeated measurements was used. A convenience sample of 128 patients with myocardial infarction was recruited from outpatient cardiology clinics at a tertiary hospital in Singapore. Participants were randomly assigned to the intervention group or control group. The outcomes were measured using Short Form 12-item Health Survey Version 2, Myocardial Infarction Dimensional Assessment Scale, and Hospital Anxiety and Depression Scale. The cardiac physiological risk parameters and number of unplanned health service use were also assessed. Data were collected at baseline, and at four weeks and 16 weeks from the baseline.

RESULTS

Over the 16 weeks, the two groups reported significant differences in physical activity (F = 4.23, p = 0.02), dependency (F = 5.16, p = 0.01), concerns over medication (F = 3.47, p = 0.04) on MIDAS, anxiety level (F = 3.41, p = 0.04) and body mass index (F = 3.12, p = 0.04). A significant difference was also found in unplanned cardiac-related emergency room visits (χ(2) = 6.64, p = 0.036) and medical consultation (χ(2) = 9.67, p = 0.046) at the 16-week study point.

CONCLUSION

The study may provide a useful tool to help health care professionals to meet the cardiac rehabilitative care needs of community-dwelling patients with myocardial infarction in Singapore.

Violations of local stochastic independence exaggerate scalability in Mokken scaling analysis of the Chinese Mandarin SF-36

BACKGROUND

Previous work using Mokken scaling analysis with the SF-36 has found subscales appearing to show excellent Mokken scaling properties. However, the values of scalability of the subscales are very large, raising the possibility that these are artificially high and this may result from violations of local stochastic independence between items.

OBJECTIVES

To analyse selected items from the Chinese Mandarin form of the SF-36 scale using Mokken scaling and to investigate if violations of local stochastic independence exaggerate scalability.

METHODS

Exploratory Mokken scaling analysis was run using the online public domain software R by entering 19 items from the Chinese Mandarin form of the SF-36 items into the analysis. The items in the resulting scales, judged by the size of Loevinger's coefficient, were analysed for violations of monotony, 95% confidence intervals and invariant item ordering, including inspection of item pair plots.

RESULTS

Two Mokken scales were obtained, one including items from the Physical Functioning subscale, and one including items from the Mental Health subscale of the Chinese Mandarin form of the SF-36. The Physical Functioning scale was very strong according to Loevinger's coefficient with high invariant item ordering; the Mental Health scale was moderately strong with weak invariant item ordering.

CONCLUSION

The strength of the Physical Functioning Mokken scale derived from the Chinese Mandarin form of the SF-36 is probably the result of an item chain and item overlap which violate local stochastic independence. This is due to the nature of the items in the Physical Functioning subscale, all of which relate to physical ability and some of which can only be achieved if previous items in the subscale have been achieved.

Psychometric testing of the Chinese Mandarin version of the Mental Health Inventory among Chinese patients with coronary heart disease in Mainland China

This study aimed to develop a Chinese Mandarin version of the Mental Health Inventory (CM:MHI). The English version MHI was translated into Chinese (simple Chinese character) using the forward-backward translation method while establishing the semantic equivalence and content validity. A convenience sample of 204 coronary heart disease (CHD) patients was recruited to evaluate the internal consistency, concurrent validity and construct validity of the CM:MHI. Forty patients completed the CM:MHI to evaluate the test-retest reliability after 2 weeks. The CM:MHI demonstrated good semantic equivalent rate (92%) and satisfactory content validity index (0.91). The internal consistency was acceptable for total and all subscales with Cronbach's alpha greater than 0.70, with the exception of the subscale of Emotional Ties (Cronbach's alpha = 0.64). The test-retest reliability was also satisfactory with intraclass correlation coefficients higher than 0.75. The concurrent validity was acceptable with significantly strong correlations between the CM:MHI and the Chinese Mandarin versions of Short Form 36 Health survey and Hospital Anxiety and Depression Scale. Confirmatory factor analysis further supported the five-factor structure of the CM:MHI. The CM:MHI demonstrated to be a valid and reliable measure for assessing psychological distress and well-being in Chinese-speaking CHD patients.

Features of complementary and alternative medicine use by patients with coronary artery disease in Beijing: a cross-sectional study

Background

Complementary and alternative medicine (CAM) is commonly used in China for the management of coronary artery disease (CAD). However, few studies have been conducted to investigate the prevalence, perceived effectiveness, types, and reasons of CAM use in patients diagnosed with CAD.

Methods

A cross-sectional study design was adopted. Questionnaires were distributed at the outpatient cardiac clinics of four tertiary-level teaching general hospitals in Beijing. Quantitative data were analyzed using Student’s t-test. Categorical data were analyzed using chi-square test. Logistic regression was employed to explore factors associated with the use of CAM as well as CAM use features in Chinese medicine (CM) hospitals when significant differences were found upon comparisons.

Results

From May to July, 2009, a total of 600 questionnaires were distributed, and 546 patients with a diagnosis of CAD responded with valid values and were included in the present study. CAM was used by 69.1% of the patients with CAD; the majority (75.9%) of these CAM users believes that CAM is effective. “Few side effects” (49.6%) was the main reason of CAM use; whereas “doubt of effect” (61.5%) was the main reason for non-use. Patent herbal medicine (90.7%) was the most commonly used CAM type. Compared with non-CAM users, CAM users tended to be older (p < 0.01), have a longer disease duration (p = 0.02) and better current health status. In addition, CAM users had significant lower odds for emergency admission and hospitalization within the past one year. Patients with CAD from CM and WM hospitals differ in CAM use frequency, types, perceived effectiveness, as well as reasons for CAM use or non-CAM use.

Conclusion

The present study suggested a group of significant factors which could influence the use of CAM in patients with CAD. CAM use patterns differ in patients from CM and WM hospitals.