Can Illness Perceptions Predict Lower Heart Rate Variability following Acute Myocardial Infarction?

Can acutely ill patients predict their outcomes? A scoping review

INTRODUCTION

The full impact of an acute illness on subsequent health is seldom explicitly discussed with patients. Patients' estimates of their likely prognosis have been explored in chronic care settings and can contribute to the improvement of clinical outcomes and patient satisfaction. This scoping review aimed to identify studies of acutely ill patients' estimates of their outcomes and potential benefits for their care.

METHODS

A search was conducted in PubMed, Embase, Web of Science and Google Scholar, using terms related to prognostication and acute care. After removal of duplicates, all articles were assessed for relevance by six investigator pairs; disagreements were resolved by a third investigator. Risk of bias was assessed according to the Cochrane Handbook for Systematic Reviews of Interventions.

RESULTS

Our search identified 3265 articles, of which 10 were included. The methods of assessing self-prognostication were very heterogeneous. Patients seem to be able to predict their need for hospital admission in certain settings, but not their length of stay. The severity of their symptoms and the burden of their disease are often overestimated or underestimated by patients. Patients with severe health conditions and their relatives tend to be overoptimistic about the likely outcome.

CONCLUSION

The understanding of acutely ill patients of their likely outcomes and benefits of treatment has not been adequately studied and is a major knowledge gap. Limited published literature suggests patients may be able to predict their need for hospital admission. Illness perception may influence help-seeking behaviour, speed of recovery and subsequent quality of life. Knowledge of patients' self-prognosis may enhance communication between patients and their physicians, which improves patient-centred care.

Association between cognitive representation of illness and the outcome of patients with premature coronary artery disease

OBJECTIVE

To assess whether illness perception (IP) in overall and each of its three dimensions (cognitive, emotional and comprehension) have an independent prognostic value in men and women with premature coronary artery disease (CAD).

METHODS

In a prospective cohort, 778 patients (370 men and 408 women) with premature CAD(diagnosed in men aged<45 y and women aged<55 y), who had completed brief illness perception questionnaire were followed up for 4 years. Outcome event was defined as composite of all-cause mortality, nonfatal myocardial infarction(MI), repeated revascularization or/and stroke. Analysis was performed for men and women separately. High scores for each item of illness perception indicate positive perception.

RESULTS

Among men, 90 patients (24.3%) experienced events: 14(3.8%) death, 23(6.2%) nonfatal MI, 9(2.4%) strokes, and 44(11.9%) revascularization. Men with and without event showed no difference regarding the traditional risk factors, depression and anxiety symptoms. Among women, 72(17.6%) had events: 11(2.7%) death, 23(5.6%) nonfatal MI, 7(1.7%) strokes and 31(7.6%) revascularization; who had a lower education, more severe CAD, and more depressive symptoms. After adjustments for potential confounders, overall IP and only its cognitive dimension were significantly associated with the outcome in women:1-score increase in the women's cognitive perception resulted in an 18% decrease in the event (HR = 0.82, 95% CI:0.72 to 0.95; P = 0.007). In the men, this effect remained nonsignificant either for IP or its dimensions.

CONCLUSIONS

Positive cognitive representation of illness was predictive of a decreased likelihood of mortality and/or cardiovascular events in women with premature CAD. Interventional studies are needed to confirm the results.

Trends in Heart-Rate Variability Signal Analysis

Heart rate variability (HRV) is the rate of variability between each heartbeat with respect to time. It is used to analyse the Autonomic Nervous System (ANS), a control system used to modulate the body's unconscious action such as cardiac function, respiration, digestion, blood pressure, urination, and dilation/constriction of the pupil. This review article presents a summary and analysis of various research works that analyzed HRV associated with morbidity, pain, drowsiness, stress and exercise through signal processing and machine learning methods. The points of emphasis with regards to HRV research as well as the gaps associated with processes which can be improved to enhance the quality of the research have been discussed meticulously. Restricting the physiological signals to Electrocardiogram (ECG), Electrodermal activity (EDA), photoplethysmography (PPG), and respiration (RESP) analysis resulted in 25 articles which examined the cause and effect of increased/reduced HRV. Reduced HRV was generally associated with increased morbidity and stress. High HRV normally indicated good health, and in some instances, it could signify clinical events of interest such as drowsiness. Effective analysis of HRV during ambulatory and motion situations such as exercise, video gaming, and driving could have a significant impact toward improving social well-being. Detection of HRV in motion is far from perfect, situations involving exercise or driving reported accuracy as high as 85% and as low as 59%. HRV detection in motion can be improved further by harnessing the advancements in machine learning techniques.

Impact of exercise on the activity of the autonomic nervous system among patients with acute myocardial infarction: A case-control study

Considering the diversity of proposed programs, various studies yielded different findings in this regard. The aim of the present study was to evaluate different types of exercise as a method of rehabilitation after acute myocardial infarction on the activity of the autonomic nervous system.

Patients' illness perception before and after non-surgical periodontal therapy. A pre-post quasi-experimental study

BACKGROUND

Patient's illness perception, assessed through the Brief-Illness Perception Questionnaire (Brief-IPQ), plays a decisive role in the treatment effectiveness of a wide range of chronic diseases; nonetheless, evidence is still lacking regarding periodontitis. The aim of the present pre-post quasi-experimental study was to evaluate the change in the Brief-IPQ before and after non-surgical periodontal treatment (NST) and to evaluate its ability to foresee the efficacy of NST.

METHODS

A total of 126 periodontitis participants starting NST were asked to participate in the study. The nine-item Brief-IPQ together with a full periodontal chart were recorded at baseline and at the 3-month follow up (reevaluation) after NST. Pre-post comparisons of psychometric and periodontal variables were carried out through the Wilcoxon signed-rank test (α = 0.05). A predictive model was built to test the ability of the Brief-IPQ items to foresee the efficacy of NST.

RESULTS

NST led to a significant reduction in all periodontal parameters (P < 0.001); the proportion of pockets closed was 64.18%. Although the overall sum score of the Brief-IPQ remained fairly stable (P = 0.0673), significant changes occurred for items seven ("understanding") (P < 0.001) and 8 ("emotional response") (P < 0.05). The best model (R²  = 0.068, F = 2.15, P = 0.033) obtained from the multivariate linear regression analysis demonstrated that item five ("identity") (β = 2.340, P = 0.017) and item eight ("emotional response") (β = -2.569, P = 0.008) significantly predict the efficacy of NST (i.e., the proportion of pockets closed at reevaluation).

CONCLUSIONS

NST significantly ameliorates patient's understanding and emotional burden related to periodontitis. Baseline values of perceived symptoms and emotional response are predictive for the short-term efficacy of NST.

Illness Perception Predicting Cardiovascular Health Behaviors among Patients with Ischemic Heart Disease in Nepal: A Descriptive Cross-sectional Study

INTRODUCTION

Cardiovascular health behaviors refer to the activities done by individuals to prevent recurrence, minimize risk factors, improve survival, reduce recurrent events, control cardiovascular disease, and help prevent further complications. Illness perception may determine these behaviors. This study is aimed to identify level of illness perception, cardiovascular health behaviors and illness perception predicting cardiovascular health behaviors among patients with ischemic heart disease.

METHODS

The study was a descriptive cross-sectional study. Altogether 114 samples were selected using convenience sampling technique. Data was collected by using pretested semi-structured questionnaire. The data were analyzed using descriptive statistics.

RESULTS

Illness perception was at moderate level (M= 148.05, SD= 12.86) which represented a moderate threatening perception. The score of cardiovascular health behaviors was at a high level (M=92.14, SD=10.72).

CONCLUSIONS

The findings showed that illness perception can be a predictor of cardiovascular health behaviors.

Changes in negative affect and changes in heart rate variability among low-income latinos with type 2 diabetes in a randomized, controlled stress management trial

BACKGROUND

Structural equation modeling examined the relationship between change in negative affect (NA) and change in heart rate variability (HRV) among 121 Latinos with type 2 diabetes.

METHODS

This study leveraged data from the Community Health Workers Assisting Latinos Manage Stress and Diabetes (CALMSD) study which compared diabetes education vs diabetes education plus stress management. Participants completed surveys of NA at baseline and again 8-10 weeks later. They also wore 7‑lead, 3-channel ambulatory ECG monitors for 24 h at both time points. The latent variable NA was modeled by observed scores on symptoms of depression, anxiety, diabetes distress, and wellbeing (reversed). The latent variable HRV was modeled by observed scores in the time domain (the standard deviation of the R-R interval [SDNN] and the root mean square of the successive differences [RMSSD]) and in the frequency domain, i.e., log-transformed ultra-low frequency, very-low frequency, low frequency, and high frequency.

RESULTS

At baseline, there were strong, negative cross-sectional associations between NA and HRV. Baseline NA predicted change in HRV, whereas baseline HRV did not predict change in NA. Controlling for fasting glucose and treatment assignment did not meaningfully alter the findings. Stress management improved NA but not HRV. At followup, a greater reduction (improvement) in NA was associated with a larger increase (improvement) in HRV, with a small-to-medium negative association that approached statistical significance.

CONCLUSIONS

Findings indicate a longitudinal relationship between NA and HRV, and suggest that improvement in one may be associated with improvement in the other.

Associations between brain drawings following mild traumatic brain injury and negative illness perceptions and post-concussion symptoms at 4 years

Characteristics of patient's drawings have been linked to short-term health-related outcomes across a range of health conditions. This study examined associations between brain drawings at 1 month and illness perceptions and post-concussion symptoms at 4 years in 92 adults following mild traumatic brain injury. Greater damage depicted at 1 month was correlated with perceived greater impact on life, duration of injury, symptoms of brain injury, emotional consequences and late-onset post-concussion symptoms. Results indicate that brain drawings shortly after traumatic brain injury offer a simple and insightful tool that may help to identify those who need additional support to improve long-term outcomes.

Illness perception and high readmission health outcomes

This review identified associations between illness perception and health outcomes of patients with a medical diagnosis included in the Hospital Readmissions Reduction Program. Inclusion criteria were English language, use of quantitative methodology, health outcomes specified, and identifiable effect size and statistical significance of the relationship. Most of the 31 studies in this review showed that favorable illness perception has been associated with better health outcomes, while unfavorable illness perception has been associated with worse outcomes. A multifaceted approach might include behavioral, clinical, educational, and psychosocial components to improve one’s illness perception through educative, cognitive-behavioral, or psychodynamic counseling.

Illness perception in overweight and obesity and impact on bio-functional age

PURPOSE

Obesity is pandemic. Yet, the success of most weight loss programmes is poor. The aim of the study was to assess illness perception in overweight/obese people and its impact on bio-functional age (BFA) reflecting physical, mental, emotional and social functioning.

METHODS

75 overweight/obese subjects from the cross-sectional Bern Cohort Study 2014 were included. Participants followed a validated "bio-functional status" test battery amended by the validated questionnaires Patiententheoriefragebogen (illness perception) and AD-EVA (eating and movement behaviour). BFA was calculated in subjects aged ≥ 35 years (n = 56).

RESULTS

(1) Mental occupation with the cause of overweight/obesity was generally moderate to high, but decreasing with age. (2) The predominant theories for being overweight/obese were health behaviour (58.7%) and psychosocial factors (33.3%). (3) Overweight/obese people with psychosocial theories on illness causes were more likely to have emotional or disinhibited eating patterns. (4) Cognitive control of eating patterns increased with age in both sexes. (5) Overweight/obese people were still bio-functionally younger than their chronological age (8.6 ± 0.8 year equivalents), although (6) quality of life was below average and (7) the risk for functional pro-aging was increased in those being especially mentally occupied with causes for overweight/obesity (r = 0.38, p < 0.001) and those having psychosocial (r = 0.32, p < 0.05) or naturalistic theories (r = 0.47, p > 0.001).

CONCLUSIONS

Consciously perceived psychosocial stress was found to be a main factor to disturb health and promote unhealthy cognitive patterns regulating eating and moving habits. Thus, successful weight reduction programmes should integrate subjective illness perceptions to not only improve the therapeutic outcome, but also functioning (BFA).