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Mamoun N, Rosser MA, Manning M, Raghunathan K, McCartney S, Mehta S, Ingle K, Bottiger B. Pain trajectories after bilateral orthotopic lung transplantation surgery performed via a clamshell incision. Clin Transplant 2024; 38:e15262. [PMID: 38369849 DOI: 10.1111/ctr.15262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 01/10/2024] [Accepted: 01/29/2024] [Indexed: 02/20/2024]
Abstract
INTRODUCTION The nature, intensity, and progression of acute pain after bilateral orthotopic lung transplantation (BOLT) performed via a clamshell incision has not been well investigated. We aimed to describe acute pain after clamshell incisions using pain trajectories for the study cohort, in addition to stratifying patients into separate pain trajectory groups and investigating their association with donor and recipient perioperative variables. METHODS After obtaining IRB approval, we retrospectively included all patients ≥18 years old who underwent primary BOLT via clamshell incision at a single center between January 1, 2017, and June 30, 2022. We modeled the overall pain trajectory using pain scores collected over the first seven postoperative days and identified separate pain trajectory classes via latent class analysis. RESULTS Three hundred one adult patients were included in the final analysis. Three separate pain trajectory groups were identified, with most patients (72.8%) belonging to a well-controlled, stable pain trajectory. Uncontrolled pain was either observed in the early postoperative period (10%), or in the late postoperative period (17.3%). Late postoperative peaking trajectory patients were younger (p = .008), and sicker with a higher lung allocation score (p = .005), receiving preoperative mechanical ventilation (p < .001), or VV-ECMO support (p < .001). CONCLUSION Despite the extensive nature of a clamshell incision, most pain trajectories in BOLT patients had a well-controlled stable pain profile. The benign nature of pain profiles in our patient population may be attributed to the routine institutional practice of early thoracic epidural analgesia for BOLT patients unless contraindicated.
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Affiliation(s)
- Negmeldeen Mamoun
- Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina, USA
| | - Morgan A Rosser
- Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina, USA
| | - Michael Manning
- Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina, USA
| | - Karthik Raghunathan
- Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina, USA
| | - Sharon McCartney
- Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina, USA
| | - Sachin Mehta
- Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina, USA
| | - Krista Ingle
- Department of Psychiatry and Behavioral Science, Duke University Medical Center, Durham, North Carolina, USA
| | - Brandi Bottiger
- Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina, USA
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Blumenthal JA, Smith PJ, Mabe S, Hinderliter A, Craighead L, Watkins LL, Ingle K, Tyson CC, Lin PH, Kraus WE, Liao L, Sherwood A. Effects of Lifestyle Modification on Psychosocial Function in Patients With Resistant Hypertension: SECONDARY OUTCOMES FROM THE TRIUMPH RANDOMIZED CLINICAL TRIAL. J Cardiopulm Rehabil Prev 2024; 44:64-70. [PMID: 37220236 PMCID: PMC10667561 DOI: 10.1097/hcr.0000000000000801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
PURPOSE In a secondary analysis of the TRIUMPH clinical trial, psychological outcomes in patients with resistant hypertension (RH) receiving a diet and exercise intervention delivered in a cardiac rehabilitation setting were compared with those receiving a similar prescription of diet and exercise provided in a single counseling session by a health educator. METHODS One hundred forty patients with RH were randomly assigned to a 4-mo program of dietary counseling, behavioral weight management, and exercise (C-LIFE) or a single counseling session providing standardized education and physician advice (SEPA). Participants completed a battery of questionnaires to assess psychological functioning before and after the intervention. A global measure of psychological functioning was derived from the General Health Questionnaire (GHQ), Perceived Stress Scale (PSS), Medical Outcomes Study 36-item Short Form Health Survey, Spielberger State-Trait Anxiety Inventory, Hospital Anxiety and Depression Scale (HADS), Beck Depression Inventory-II, and Patient-Reported Outcomes Measurement Information System (PROMIS) Anger scale. RESULTS Participants in the C-LIFE intervention achieved greater improvements in psychological functioning compared with SEPA (C-LIFE: 58.9 [56.1, 61.8] vs SEPA: 66.5 [62.1, 70.9]; P = .024). Greater improvements were especially evident for the GHQ, PSS, and HADS. Examination of mediation revealed that greater weight loss ( B =-0.17, P = .004) and improved oxygen uptake ( B =-0.12, P = .044) were associated with improved psychological functioning. CONCLUSION Compared with standard education and physician advice, a structured program of diet and exercise not only reduced blood pressure but also improved psychological functioning in patients with RH.
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Affiliation(s)
- James A. Blumenthal
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina (Drs Blumenthal, Watkins, Ingle, and Sherwood and Ms Mabe); Departments of Psychiatry (Dr Smith) and Medicine (Dr Hinderliter), University of North Carolina at Chapel Hill, Chapel Hill; Department of Psychology, Emory University, Atlanta, Georgia (Dr Craighead), and Department of Medicine, Duke University Medical Center, Durham, North Carolina (Drs Tyson, Lin, Kraus, and Liao)
| | - Patrick J. Smith
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina (Drs Blumenthal, Watkins, Ingle, and Sherwood and Ms Mabe); Departments of Psychiatry (Dr Smith) and Medicine (Dr Hinderliter), University of North Carolina at Chapel Hill, Chapel Hill; Department of Psychology, Emory University, Atlanta, Georgia (Dr Craighead), and Department of Medicine, Duke University Medical Center, Durham, North Carolina (Drs Tyson, Lin, Kraus, and Liao)
| | - Stephanie Mabe
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina (Drs Blumenthal, Watkins, Ingle, and Sherwood and Ms Mabe); Departments of Psychiatry (Dr Smith) and Medicine (Dr Hinderliter), University of North Carolina at Chapel Hill, Chapel Hill; Department of Psychology, Emory University, Atlanta, Georgia (Dr Craighead), and Department of Medicine, Duke University Medical Center, Durham, North Carolina (Drs Tyson, Lin, Kraus, and Liao)
| | - Alan Hinderliter
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina (Drs Blumenthal, Watkins, Ingle, and Sherwood and Ms Mabe); Departments of Psychiatry (Dr Smith) and Medicine (Dr Hinderliter), University of North Carolina at Chapel Hill, Chapel Hill; Department of Psychology, Emory University, Atlanta, Georgia (Dr Craighead), and Department of Medicine, Duke University Medical Center, Durham, North Carolina (Drs Tyson, Lin, Kraus, and Liao)
| | - Linda Craighead
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina (Drs Blumenthal, Watkins, Ingle, and Sherwood and Ms Mabe); Departments of Psychiatry (Dr Smith) and Medicine (Dr Hinderliter), University of North Carolina at Chapel Hill, Chapel Hill; Department of Psychology, Emory University, Atlanta, Georgia (Dr Craighead), and Department of Medicine, Duke University Medical Center, Durham, North Carolina (Drs Tyson, Lin, Kraus, and Liao)
| | - Lana L. Watkins
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina (Drs Blumenthal, Watkins, Ingle, and Sherwood and Ms Mabe); Departments of Psychiatry (Dr Smith) and Medicine (Dr Hinderliter), University of North Carolina at Chapel Hill, Chapel Hill; Department of Psychology, Emory University, Atlanta, Georgia (Dr Craighead), and Department of Medicine, Duke University Medical Center, Durham, North Carolina (Drs Tyson, Lin, Kraus, and Liao)
| | - Krista Ingle
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina (Drs Blumenthal, Watkins, Ingle, and Sherwood and Ms Mabe); Departments of Psychiatry (Dr Smith) and Medicine (Dr Hinderliter), University of North Carolina at Chapel Hill, Chapel Hill; Department of Psychology, Emory University, Atlanta, Georgia (Dr Craighead), and Department of Medicine, Duke University Medical Center, Durham, North Carolina (Drs Tyson, Lin, Kraus, and Liao)
| | - Crystal C. Tyson
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina (Drs Blumenthal, Watkins, Ingle, and Sherwood and Ms Mabe); Departments of Psychiatry (Dr Smith) and Medicine (Dr Hinderliter), University of North Carolina at Chapel Hill, Chapel Hill; Department of Psychology, Emory University, Atlanta, Georgia (Dr Craighead), and Department of Medicine, Duke University Medical Center, Durham, North Carolina (Drs Tyson, Lin, Kraus, and Liao)
| | - Pao-Hwa Lin
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina (Drs Blumenthal, Watkins, Ingle, and Sherwood and Ms Mabe); Departments of Psychiatry (Dr Smith) and Medicine (Dr Hinderliter), University of North Carolina at Chapel Hill, Chapel Hill; Department of Psychology, Emory University, Atlanta, Georgia (Dr Craighead), and Department of Medicine, Duke University Medical Center, Durham, North Carolina (Drs Tyson, Lin, Kraus, and Liao)
| | - William E. Kraus
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina (Drs Blumenthal, Watkins, Ingle, and Sherwood and Ms Mabe); Departments of Psychiatry (Dr Smith) and Medicine (Dr Hinderliter), University of North Carolina at Chapel Hill, Chapel Hill; Department of Psychology, Emory University, Atlanta, Georgia (Dr Craighead), and Department of Medicine, Duke University Medical Center, Durham, North Carolina (Drs Tyson, Lin, Kraus, and Liao)
| | - Lawrence Liao
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina (Drs Blumenthal, Watkins, Ingle, and Sherwood and Ms Mabe); Departments of Psychiatry (Dr Smith) and Medicine (Dr Hinderliter), University of North Carolina at Chapel Hill, Chapel Hill; Department of Psychology, Emory University, Atlanta, Georgia (Dr Craighead), and Department of Medicine, Duke University Medical Center, Durham, North Carolina (Drs Tyson, Lin, Kraus, and Liao)
| | - Andrew Sherwood
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina (Drs Blumenthal, Watkins, Ingle, and Sherwood and Ms Mabe); Departments of Psychiatry (Dr Smith) and Medicine (Dr Hinderliter), University of North Carolina at Chapel Hill, Chapel Hill; Department of Psychology, Emory University, Atlanta, Georgia (Dr Craighead), and Department of Medicine, Duke University Medical Center, Durham, North Carolina (Drs Tyson, Lin, Kraus, and Liao)
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Avorgbedor F, Blumenthal JA, Hinderliter A, Ingle K, Lin P, Craighead L, Tyson C, Kraus W, Sherwood A, Smith PJ. Inflammation moderates the effects of lifestyle modification on neurocognition among individuals with resistant hypertension. J Clin Hypertens (Greenwich) 2022; 25:106-110. [PMID: 36541028 PMCID: PMC9832225 DOI: 10.1111/jch.14591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Revised: 10/06/2022] [Accepted: 10/09/2022] [Indexed: 12/24/2022]
Abstract
Individuals with resistant hypertension (RH) have the greatest risk of cerebrovascular disease and cognitive impairment among individuals with hypertension. Elevated levels of pro-inflammatory cytokines may represent a critical yet unexamined factor influencing the impact of healthy lifestyle changes on cognitive function. We explored the influence of inflammation on changes in cognition following lifestyle modification among individuals with RH participating in the TRIUMPH clinical trial. One hundred forty participants with RH completed a battery of neurocognitive tests along with the inflammatory marker C-reactive protein (hsCRP) and were subsequently randomized to an intensive 4-month lifestyle modification intervention or to education and physician advice control. Results indicated that the effects of lifestyle modification on Executive Function and Learning were moderated by pre-intervention hsCRP levels (P = .049), with treatment efficacy increasing across levels of baseline inflammation levels (low: d = 0.12; mild: d = 0.43; moderate: d = 0.81). We conclude that inflammatory profiles may help identify individuals more likely to improve executive functioning resulting from lifestyle modification.
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Affiliation(s)
- Forgive Avorgbedor
- School of NursingUniversity of North Carolina at GreensboroNorth CarolinaUSA,Department of Psychiatry and Behavioral SciencesDuke University Medical CenterDurhamNorth CarolinaUSA
| | - James A. Blumenthal
- Department of Psychiatry and Behavioral SciencesDuke University Medical CenterDurhamNorth CarolinaUSA
| | - Alan Hinderliter
- Department of MedicineUniversity of North Carolina at Chapel HillNorth CarolinaUSA
| | - Krista Ingle
- Department of Psychiatry and Behavioral SciencesDuke University Medical CenterDurhamNorth CarolinaUSA
| | - Pao‐Hwa Lin
- Department of MedicineDuke University Medical CenterDurhamNorth CarolinaUSA
| | | | - Crystal Tyson
- Department of MedicineDuke University Medical CenterDurhamNorth CarolinaUSA
| | - William Kraus
- Department of MedicineDuke University Medical CenterDurhamNorth CarolinaUSA
| | - Andrew Sherwood
- Department of Psychiatry and Behavioral SciencesDuke University Medical CenterDurhamNorth CarolinaUSA
| | - Patrick J. Smith
- Department of Psychiatry and Behavioral SciencesDuke University Medical CenterDurhamNorth CarolinaUSA
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Blumenthal JA, Hinderliter AL, Smith PJ, Mabe S, Watkins LL, Craighead L, Ingle K, Tyson C, Lin PH, Kraus WE, Liao L, Sherwood A. Effects of Lifestyle Modification on Patients With Resistant Hypertension: Results of the TRIUMPH Randomized Clinical Trial. Circulation 2021; 144:1212-1226. [PMID: 34565172 DOI: 10.1161/circulationaha.121.055329] [Citation(s) in RCA: 44] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND Although lifestyle modifications generally are effective in lowering blood pressure (BP) among patients with unmedicated hypertension and in those treated with 1 or 2 antihypertensive agents, the value of exercise and diet for lowering BP in patients with resistant hypertension is unknown. METHODS One hundred forty patients with resistant hypertension (mean age, 63 years; 48% female; 59% Black; 31% with diabetes; 21% with chronic kidney disease) were randomly assigned to a 4-month program of lifestyle modification (C-LIFE [Center-Based Lifestyle Intervention]) including dietary counseling, behavioral weight management, and exercise, or a single counseling session providing SEPA (Standardized Education and Physician Advice). The primary end point was clinic systolic BP; secondary end points included 24-hour ambulatory BP and select cardiovascular disease biomarkers including baroreflex sensitivity to quantify the influence of the baroreflex on heart rate, high-frequency heart rate variability to assess vagally mediated modulation of heart rate, flow-mediated dilation to evaluate endothelial function, pulse wave velocity to assess arterial stiffness, and left ventricular mass to characterize left ventricular structure. RESULTS Between-group comparisons revealed that the reduction in clinic systolic BP was greater in C-LIFE (-12.5 [95% CI, -14.9 to -10.2] mm Hg) compared with SEPA(-7.1 [-95% CI, 10.4 to -3.7] mm Hg) (P=0.005); 24-hour ambulatory systolic BP also was reduced in C-LIFE (-7.0 [95% CI, -8.5 to -4.0] mm Hg), with no change in SEPA (-0.3 [95% CI, -4.0 to 3.4] mm Hg) (P=0.001). Compared with SEPA, C-LIFE resulted in greater improvements in resting baroreflex sensitivity (2.3 ms/mm Hg [95% CI, 1.3 to 3.3] versus -1.1 ms/mm Hg [95% CI, -2.5 to 0.3]; P<0.001), high-frequency heart rate variability (0.4 ln ms2 [95% CI, 0.2 to 0.6] versus -0.2 ln ms2 [95% CI, -0.5 to 0.1]; P<0.001), and flow-mediated dilation (0.3% [95% CI, -0.3 to 1.0] versus -1.4% [95% CI, -2.5 to -0.3]; P=0.022). There were no between-group differences in pulse wave velocity (P=0.958) or left ventricular mass (P=0.596). CONCLUSIONS Diet and exercise can lower BP in patients with resistant hypertension. A 4-month structured program of diet and exercise as adjunctive therapy delivered in a cardiac rehabilitation setting results in significant reductions in clinic and ambulatory BP and improvement in selected cardiovascular disease biomarkers. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT02342808.
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Affiliation(s)
- James A Blumenthal
- Department of Psychiatry and Behavioral Sciences (J.A.B., P.J.S., S.M., L.L.W., K.I., A.S.), Duke University Medical Center, Durham, NC
| | - Alan L Hinderliter
- Department of Medicine, University of North Carolina at Chapel Hill (A.L.H.)
| | - Patrick J Smith
- Department of Psychiatry and Behavioral Sciences (J.A.B., P.J.S., S.M., L.L.W., K.I., A.S.), Duke University Medical Center, Durham, NC
| | - Stephanie Mabe
- Department of Psychiatry and Behavioral Sciences (J.A.B., P.J.S., S.M., L.L.W., K.I., A.S.), Duke University Medical Center, Durham, NC
| | - Lana L Watkins
- Department of Psychiatry and Behavioral Sciences (J.A.B., P.J.S., S.M., L.L.W., K.I., A.S.), Duke University Medical Center, Durham, NC
| | - Linda Craighead
- Department of Psychology, Emory University, Atlanta, GA (L.C.)
| | - Krista Ingle
- Department of Psychiatry and Behavioral Sciences (J.A.B., P.J.S., S.M., L.L.W., K.I., A.S.), Duke University Medical Center, Durham, NC
| | - Crystal Tyson
- Department of Medicine (C.T., P.-H.L., W.E.K., L.L.), Duke University Medical Center, Durham, NC
| | - Pao-Hwa Lin
- Department of Medicine (C.T., P.-H.L., W.E.K., L.L.), Duke University Medical Center, Durham, NC
| | - William E Kraus
- Department of Medicine (C.T., P.-H.L., W.E.K., L.L.), Duke University Medical Center, Durham, NC
| | - Lawrence Liao
- Department of Medicine (C.T., P.-H.L., W.E.K., L.L.), Duke University Medical Center, Durham, NC
| | - Andrew Sherwood
- Department of Psychiatry and Behavioral Sciences (J.A.B., P.J.S., S.M., L.L.W., K.I., A.S.), Duke University Medical Center, Durham, NC
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Krukowski RA, DiLillo V, Ingle K, Harvey JR, West DS. Design and Methods of a Synchronous Online Motivational Interviewing Intervention for Weight Management. JMIR Res Protoc 2016; 5:e69. [PMID: 27095604 PMCID: PMC4858594 DOI: 10.2196/resprot.5382] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Revised: 01/11/2016] [Accepted: 01/28/2016] [Indexed: 01/20/2023] Open
Abstract
Background While Internet-based weight management programs can facilitate access to and engagement in evidence-based lifestyle weight loss programs, the results have generally not been as effective as in-person programs. Furthermore, motivational interviewing (MI) has shown promise as a technique for enhancing weight loss outcomes within face-to-face programs. Objective This paper describes the design, intervention development, and analysis of a therapist-delivered online MI intervention for weight loss in the context of an online weight loss program. Methods The MI intervention is delivered within the context of a randomized controlled trial examining the efficacy of an 18-month, group-based, online behavioral weight control program plus individually administered, synchronous online MI sessions relative to the group-based program alone. Six individual 30-minute MI sessions are conducted in private chat rooms over 18 months by doctoral-level psychologists. Sessions use a semistructured interview format for content and session flow and incorporate core MI components (eg, collaborative agenda setting, open-ended questions, reflective listening and summary statements, objective data, and a focus on evoking and amplifying change talk). Results The project was funded in 2010 and enrollment was completed in 2012. Data analysis is currently under way and the first results are expected in 2016. Conclusions This is the first trial to test the efficacy of a synchronous online, one-on-one MI intervention designed to augment an online group behavioral weight loss program. If the addition of MI sessions proves to be successful, this intervention could be disseminated to enhance other distance-based weight loss interventions. Trial Registration Clinicaltrials.gov NCT01232699; https://clinicaltrials.gov/ct2/show/NCT01232699
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Affiliation(s)
- Rebecca Anne Krukowski
- Center for Population Sciences, Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN, United States.
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Blumenthal JA, Sherwood A, Smith PJ, Watkins L, Mabe S, Kraus WE, Ingle K, Miller P, Hinderliter A. Enhancing Cardiac Rehabilitation With Stress Management Training: A Randomized, Clinical Efficacy Trial. Circulation 2016; 133:1341-50. [PMID: 27045127 DOI: 10.1161/circulationaha.115.018926] [Citation(s) in RCA: 146] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2015] [Accepted: 02/12/2016] [Indexed: 12/31/2022]
Abstract
BACKGROUND Cardiac rehabilitation (CR) is the standard of care for patients with coronary heart disease. Despite considerable epidemiological evidence that high stress is associated with worse health outcomes, stress management training (SMT) is not included routinely as a component of CR. METHODS AND RESULTS One hundred fifty-one outpatients with coronary heart disease who were 36 to 84 years of age were randomized to 12 weeks of comprehensive CR or comprehensive CR combined with SMT (CR+SMT), with assessments of stress and coronary heart disease biomarkers obtained before and after treatment. A matched sample of CR-eligible patients who did not receive CR made up the no-CR comparison group. All participants were followed up for up to 5.3 years (median, 3.2 years) for clinical events. Patients randomized to CR+SMT exhibited greater reductions in composite stress levels compared with those randomized to CR alone (P=0.022), an effect that was driven primarily by improvements in anxiety, distress, and perceived stress. Both CR groups achieved significant, and comparable, improvements in coronary heart disease biomarkers. Participants in the CR+SMT group exhibited lower rates of clinical events compared with those in the CR-alone group (18% versus 33%; hazard ratio=0.49; 95% confidence interval, 0.25-0.95; P=0.035), and both CR groups had lower event rates compared with the no-CR group (47%; hazard ratio=0.44; 95% confidence interval, 0.27-0.71; P<0.001). CONCLUSIONS CR enhanced by SMT produced significant reductions in stress and greater improvements in medical outcomes compared with standard CR. Our findings indicate that SMT may provide incremental benefit when combined with comprehensive CR and suggest that SMT should be incorporated routinely into CR. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT00981253.
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Affiliation(s)
- James A Blumenthal
- From the Departments of Psychiatry and Behavioral Sciences (J.A.B., A.S., P.J.S., L.W., S.M., K.I.) and Medicine (W.E.K.), Duke University Medical Center, Durham, NC; and Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill (P.M., A.H.).
| | - Andrew Sherwood
- From the Departments of Psychiatry and Behavioral Sciences (J.A.B., A.S., P.J.S., L.W., S.M., K.I.) and Medicine (W.E.K.), Duke University Medical Center, Durham, NC; and Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill (P.M., A.H.)
| | - Patrick J Smith
- From the Departments of Psychiatry and Behavioral Sciences (J.A.B., A.S., P.J.S., L.W., S.M., K.I.) and Medicine (W.E.K.), Duke University Medical Center, Durham, NC; and Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill (P.M., A.H.)
| | - Lana Watkins
- From the Departments of Psychiatry and Behavioral Sciences (J.A.B., A.S., P.J.S., L.W., S.M., K.I.) and Medicine (W.E.K.), Duke University Medical Center, Durham, NC; and Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill (P.M., A.H.)
| | - Stephanie Mabe
- From the Departments of Psychiatry and Behavioral Sciences (J.A.B., A.S., P.J.S., L.W., S.M., K.I.) and Medicine (W.E.K.), Duke University Medical Center, Durham, NC; and Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill (P.M., A.H.)
| | - William E Kraus
- From the Departments of Psychiatry and Behavioral Sciences (J.A.B., A.S., P.J.S., L.W., S.M., K.I.) and Medicine (W.E.K.), Duke University Medical Center, Durham, NC; and Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill (P.M., A.H.)
| | - Krista Ingle
- From the Departments of Psychiatry and Behavioral Sciences (J.A.B., A.S., P.J.S., L.W., S.M., K.I.) and Medicine (W.E.K.), Duke University Medical Center, Durham, NC; and Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill (P.M., A.H.)
| | - Paula Miller
- From the Departments of Psychiatry and Behavioral Sciences (J.A.B., A.S., P.J.S., L.W., S.M., K.I.) and Medicine (W.E.K.), Duke University Medical Center, Durham, NC; and Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill (P.M., A.H.)
| | - Alan Hinderliter
- From the Departments of Psychiatry and Behavioral Sciences (J.A.B., A.S., P.J.S., L.W., S.M., K.I.) and Medicine (W.E.K.), Duke University Medical Center, Durham, NC; and Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill (P.M., A.H.)
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Kain V, Ingle K, Prabhu S, Serhan C, Joshi M, Halade G. RvD1 Activates Resolution of Inflammation Following Myocardial Infarction Leading To Improved Ventricular Function. FASEB J 2015. [DOI: 10.1096/fasebj.29.1_supplement.285.4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- V Kain
- MedicineThe University of Alabama at BirminghamAL
| | - K Ingle
- MedicineThe University of Alabama at BirminghamAL
| | - S Prabhu
- MedicineThe University of Alabama at BirminghamAL
| | - C Serhan
- MedicineHarvard Medical SchoolMA
| | - M Joshi
- PharmacologyMidwestern UniversityIL
| | - G Halade
- MedicineThe University of Alabama at BirminghamAL
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Ingle K, Gage Obrien S. The Importance of the Integration of a Registered Dietitian in the Care of HIV Positive Patients. J Acad Nutr Diet 2014. [DOI: 10.1016/j.jand.2014.06.105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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