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Svavarsdóttir MH, Ingadottir B, Oldridge N, Årestedt K. Translation and evaluation of the HeartQoL in patients with coronary heart disease in Iceland. Health Qual Life Outcomes 2023; 21:84. [PMID: 37559128 PMCID: PMC10410800 DOI: 10.1186/s12955-023-02161-7] [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] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 07/11/2023] [Indexed: 08/11/2023] Open
Abstract
BACKGROUND Health-related quality of life (HRQoL) reflects an individual's own perception of their symptom burden, functional limitations, prognosis, overall health and changes associated with treatment. The HeartQoL is a validated heart disease-specific questionnaire with a physical and an emotional subscale that is used internationally to assess HRQoL in patients with coronary heart disease (CHD). The aim of this study was to translate and evaluate the psychometric properties of the HeartQoL in patients with CHD in Iceland. METHODS Patients ≥ 18 years (n = 396; mean age 64.4 ± 8.8 years; 79.6% male) admitted with CHD were recruited from two hospitals in Iceland and completed the Icelandic versions of the HeartQoL, Short-Form 12v2 Health Survey (SF-12v2), and Hospital Anxiety and Depression Scale (HADS). A subsample of 47 patients completed the HeartQoL 14 days later. Confirmatory factor analysis for ordinal data was used to evaluate the measurement model with a physical and an emotional subscale. Convergent and divergent validity, internal consistency, and test-retest reliability were evaluated. RESULTS Overall, the hypothesized two-factor structure of the Icelandic version of the HeartQoL was supported. However, problems with cross-loadings and correlated error variances were identified. Convergent and divergent validity were supported in correlational analyses between HeartQoL, SF-12v2, and HADS. Internal consistency reliability, measured by ordinal alpha, was good for the physical (α = 0.96) and emotional (α = 0.90) subscale. According to intraclass correlations (ICC), acceptable test-retest reliability was demonstrated (ICC = 0.79-0.86). CONCLUSION With the two-factor structure confirmed, the Icelandic HeartQoL demonstrated satisfactory psychometric properties in the sample of patients with CHD. Users of the instrument can use the original scoring.
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Affiliation(s)
| | - Brynja Ingadottir
- Faculty of Nursing and Midwifery, University of Iceland, Reykjavik, Iceland
- Landspitali University Hospital, Reykjavik, Iceland
| | - Neil Oldridge
- College of Health Sciences, University of Wisconsin-Milwaukee, Milwaukee, WI, USA
| | - Kristofer Årestedt
- Faculty of Health and Life Sciences, Linnaeus University, Kalmar, Sweden
- Department of Research, Region Kalmar County, Kalmar, Sweden
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Dibben GO, Faulkner J, Oldridge N, Rees K, Thompson DR, Zwisler AD, Taylor RS. Exercise-based cardiac rehabilitation for coronary heart disease: a meta-analysis. Eur Heart J 2023; 44:452-469. [PMID: 36746187 PMCID: PMC9902155 DOI: 10.1093/eurheartj/ehac747] [Citation(s) in RCA: 37] [Impact Index Per Article: 37.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 10/31/2022] [Accepted: 11/30/2022] [Indexed: 02/08/2023] Open
Abstract
AIMS Coronary heart disease is the most common reason for referral to exercise-based cardiac rehabilitation (CR) globally. However, the generalizability of previous meta-analyses of randomized controlled trials (RCTs) is questioned. Therefore, a contemporary updated meta-analysis was undertaken. METHODS AND RESULTS Database and trial registry searches were conducted to September 2020, seeking RCTs of exercise-based interventions with ≥6-month follow-up, compared with no-exercise control for adults with myocardial infarction, angina pectoris, or following coronary artery bypass graft, or percutaneous coronary intervention. The outcomes of mortality, recurrent clinical events, and health-related quality of life (HRQoL) were pooled using random-effects meta-analysis, and cost-effectiveness data were narratively synthesized. Meta-regression was used to examine effect modification. Study quality was assessed using the Cochrane risk of bias tool. A total of 85 RCTs involving 23 430 participants with a median 12-month follow-up were included. Overall, exercise-based CR was associated with significant risk reductions in cardiovascular mortality [risk ratio (RR): 0.74, 95% confidence interval (CI): 0.64-0.86, number needed to treat (NNT): 37], hospitalizations (RR: 0.77, 95% CI: 0.67-0.89, NNT: 37), and myocardial infarction (RR: 0.82, 95% CI: 0.70-0.96, NNT: 100). There was some evidence of significantly improved HRQoL with CR participation, and CR is cost-effective. There was no significant impact on overall mortality (RR: 0.96, 95% CI: 0.89-1.04), coronary artery bypass graft (RR: 0.96, 95% CI: 0.80-1.15), or percutaneous coronary intervention (RR: 0.84, 95% CI: 0.69-1.02). No significant difference in effects was found across different patient groups, CR delivery models, doses, follow-up, or risk of bias. CONCLUSION This review confirms that participation in exercise-based CR by patients with coronary heart disease receiving contemporary medical management reduces cardiovascular mortality, recurrent cardiac events, and hospitalizations and provides additional evidence supporting the improvement in HRQoL and the cost-effectiveness of CR.
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Affiliation(s)
| | - James Faulkner
- School of Sport, Health and Community, Faculty Health and Wellbeing, University of Winchester, Winchester, UK
| | - Neil Oldridge
- College of Health Sciences, University of Wisconsin-Milwaukee, Milwaukee, WI, USA
| | - Karen Rees
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - David R Thompson
- School of Nursing and Midwifery, Queen’s University Belfast, Belfast, UK
| | - Ann-Dorthe Zwisler
- REHPA, The Danish Knowledge Centre for Rehabilitation and Palliative Care, Odense University Hospital, Nyborg, Denmark,Department of Clinical Research, University of Southern Denmark, Odense, Denmark,Department of Cardiology, Odense University Hospital, Odense, Denmark
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Fattirolli F, Argirò A, Angelino ME, Balestroni G, Giallauria F, Miani D, Vigorito C, Piccioli L, Genta FT, Höfer S, Marchionni N, Oldridge N. Validation of the Italian HeartQoL: a short health-related quality of life questionnaire for patients with ischemic heart disease. Intern Emerg Med 2022; 17:123-134. [PMID: 34110564 PMCID: PMC8841307 DOI: 10.1007/s11739-021-02780-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 05/27/2021] [Indexed: 01/16/2023]
Abstract
The psychometric properties of the core disease-specific 14-item Italian HeartQoL health-related quality of life questionnaire have been evaluated in this study. The Italian version of the HeartQoL, the MacNew questionnaire, and the Hospital Anxiety and Depression Scale were completed by 472 patients (angina, N = 183; myocardial infarction, N = 167; or ischemic heart failure, N = 122) who were recruited in five Italian centers (Florence, Veruno, Turin, Udine, and Naples) between 2015 and 2017. Patients with myocardial infarction reported significantly higher HeartQoL scores than patients with angina or ischemic heart failure. Floor and ceiling effects were always minor on the HeartQoL global scale and physical subscale with moderate ceiling effects on the emotional subscale in the total group and in patients with myocardial infarction. The bifactorial structure of the original HeartQoL questionnaire was confirmed with strong physical, emotional, and global scale H coefficients (> 0.50). The HeartQoL scales demonstrated optimal internal consistency (Cronbach's alpha > 0.84). Convergent and divergent validity were confirmed. Discriminative validity was not confirmed for age, largely confirmed for sex, and fully confirmed for anxiety, depression, and distress. The Italian HeartQoL questionnaire demonstrated adequate key psychometric attributes of internal consistency reliability and validity in Italian-speaking patients with ischemic heart disease.
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Affiliation(s)
- Francesco Fattirolli
- Department of Experimental and Clinical Medicine, University of Florence and Cardiothoracovascular Department Azienda Ospedaliero-Universitaria Careggi, Largo Brambilla 3, 50141, Firenze, Italy.
| | - Alessia Argirò
- Department of Experimental and Clinical Medicine, University of Florence and Cardiothoracovascular Department Azienda Ospedaliero-Universitaria Careggi, Largo Brambilla 3, 50141, Firenze, Italy
| | | | | | - Francesco Giallauria
- Department of Translational Medical Sciences, Federico II University of Naples, Naples, Italy
| | - Daniela Miani
- Cardiology Unit, University Hospital S. Maria Della Misericordia, Udine, Italy
| | - Carlo Vigorito
- Department of Translational Medical Sciences, Federico II University of Naples, Naples, Italy
| | - Lucrezia Piccioli
- Department of Experimental and Clinical Medicine, University of Florence and Cardiothoracovascular Department Azienda Ospedaliero-Universitaria Careggi, Largo Brambilla 3, 50141, Firenze, Italy
- Psychology Unit, Istituti Clinici Scientifici Maugeri, Turin, Italy
- Psychology Unit, Istituti Clinici Scientifici Maugeri, Veruno, Italy
- Department of Translational Medical Sciences, Federico II University of Naples, Naples, Italy
| | - Franco Tarro Genta
- Department of Cardiology Istituti Clinici Scientifici Maugeri, Turin, Italy
| | - Stefan Höfer
- Department of Medical Psychology, Medical University of Innsbruck, Innsbruck, Austria
| | - Niccolò Marchionni
- Department of Experimental and Clinical Medicine, University of Florence and Cardiothoracovascular Department Azienda Ospedaliero-Universitaria Careggi, Largo Brambilla 3, 50141, Firenze, Italy
| | - Neil Oldridge
- College of Health Sciences, University of Wisconsin-Milwaukee, Milwaukee, WI, USA
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Abstract
BACKGROUND Coronary heart disease (CHD) is the most common cause of death globally. However, with falling CHD mortality rates, an increasing number of people living with CHD may need support to manage their symptoms and prognosis. Exercise-based cardiac rehabilitation (CR) aims to improve the health and outcomes of people with CHD. This is an update of a Cochrane Review previously published in 2016. OBJECTIVES To assess the clinical effectiveness and cost-effectiveness of exercise-based CR (exercise training alone or in combination with psychosocial or educational interventions) compared with 'no exercise' control, on mortality, morbidity and health-related quality of life (HRQoL) in people with CHD. SEARCH METHODS We updated searches from the previous Cochrane Review, by searching CENTRAL, MEDLINE, Embase, and two other databases in September 2020. We also searched two clinical trials registers in June 2021. SELECTION CRITERIA We included randomised controlled trials (RCTs) of exercise-based interventions with at least six months' follow-up, compared with 'no exercise' control. The study population comprised adult men and women who have had a myocardial infarction (MI), coronary artery bypass graft (CABG) or percutaneous coronary intervention (PCI), or have angina pectoris, or coronary artery disease. DATA COLLECTION AND ANALYSIS We screened all identified references, extracted data and assessed risk of bias according to Cochrane methods. We stratified meta-analysis by duration of follow-up: short-term (6 to 12 months); medium-term (> 12 to 36 months); and long-term ( > 3 years), and used meta-regression to explore potential treatment effect modifiers. We used GRADE for primary outcomes at 6 to 12 months (the most common follow-up time point). MAIN RESULTS: This review included 85 trials which randomised 23,430 people with CHD. This latest update identified 22 new trials (7795 participants). The population included predominantly post-MI and post-revascularisation patients, with a mean age ranging from 47 to 77 years. In the last decade, the median percentage of women with CHD has increased from 11% to 17%, but females still account for a similarly small percentage of participants recruited overall ( < 15%). Twenty-one of the included trials were performed in low- and middle-income countries (LMICs). Overall trial reporting was poor, although there was evidence of an improvement in quality over the last decade. The median longest follow-up time was 12 months (range 6 months to 19 years). At short-term follow-up (6 to 12 months), exercise-based CR likely results in a slight reduction in all-cause mortality (risk ratio (RR) 0.87, 95% confidence interval (CI) 0.73 to 1.04; 25 trials; moderate certainty evidence), a large reduction in MI (RR 0.72, 95% CI 0.55 to 0.93; 22 trials; number needed to treat for an additional beneficial outcome (NNTB) 75, 95% CI 47 to 298; high certainty evidence), and a large reduction in all-cause hospitalisation (RR 0.58, 95% CI 0.43 to 0.77; 14 trials; NNTB 12, 95% CI 9 to 21; moderate certainty evidence). Exercise-based CR likely results in little to no difference in risk of cardiovascular mortality (RR 0.88, 95% CI 0.68 to 1.14; 15 trials; moderate certainty evidence), CABG (RR 0.99, 95% CI 0.78 to 1.27; 20 trials; high certainty evidence), and PCI (RR 0.86, 95% CI 0.63 to 1.19; 13 trials; moderate certainty evidence) up to 12 months' follow-up. We are uncertain about the effects of exercise-based CR on cardiovascular hospitalisation, with a wide confidence interval including considerable benefit as well as harm (RR 0.80, 95% CI 0.41 to 1.59; low certainty evidence). There was evidence of substantial heterogeneity across trials for cardiovascular hospitalisations (I2 = 53%), and of small study bias for all-cause hospitalisation, but not for all other outcomes. At medium-term follow-up, although there may be little to no difference in all-cause mortality (RR 0.90, 95% CI 0.80 to 1.02; 15 trials), MI (RR 1.07, 95% CI 0.91 to 1.27; 12 trials), PCI (RR 0.96, 95% CI 0.69 to 1.35; 6 trials), CABG (RR 0.97, 95% CI 0.77 to 1.23; 9 trials), and all-cause hospitalisation (RR 0.92, 95% CI 0.82 to 1.03; 9 trials), a large reduction in cardiovascular mortality was found (RR 0.77, 95% CI 0.63 to 0.93; 5 trials). Evidence is uncertain for difference in risk of cardiovascular hospitalisation (RR 0.92, 95% CI 0.76 to 1.12; 3 trials). At long-term follow-up, although there may be little to no difference in all-cause mortality (RR 0.91, 95% CI 0.75 to 1.10), exercise-based CR may result in a large reduction in cardiovascular mortality (RR 0.58, 95% CI 0.43 to 0.78; 8 trials) and MI (RR 0.67, 95% CI 0.50 to 0.90; 10 trials). Evidence is uncertain for CABG (RR 0.66, 95% CI 0.34 to 1.27; 4 trials), and PCI (RR 0.76, 95% CI 0.48 to 1.20; 3 trials). Meta-regression showed benefits in outcomes were independent of CHD case mix, type of CR, exercise dose, follow-up length, publication year, CR setting, study location, sample size or risk of bias. There was evidence that exercise-based CR may slightly increase HRQoL across several subscales (SF-36 mental component, physical functioning, physical performance, general health, vitality, social functioning and mental health scores) up to 12 months' follow-up; however, these may not be clinically important differences. The eight trial-based economic evaluation studies showed exercise-based CR to be a potentially cost-effective use of resources in terms of gain in quality-adjusted life years (QALYs). AUTHORS' CONCLUSIONS This updated Cochrane Review supports the conclusions of the previous version, that exercise-based CR provides important benefits to people with CHD, including reduced risk of MI, a likely small reduction in all-cause mortality, and a large reduction in all-cause hospitalisation, along with associated healthcare costs, and improved HRQoL up to 12 months' follow-up. Over longer-term follow-up, benefits may include reductions in cardiovascular mortality and MI. In the last decade, trials were more likely to include females, and be undertaken in LMICs, increasing the generalisability of findings. Well-designed, adequately-reported RCTs of CR in people with CHD more representative of usual clinical practice are still needed. Trials should explicitly report clinical outcomes, including mortality and hospital admissions, and include validated HRQoL outcome measures, especially over longer-term follow-up, and assess costs and cost-effectiveness.
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Affiliation(s)
- Grace Dibben
- MRC/CSO Social and Public Health Sciences Unit, Institute of Health and Well Being, University of Glasgow, Glasgow, UK
| | - James Faulkner
- Faculty Health and Wellbeing, School of Sport, Health and Community, University of Winchester, Winchester, UK
| | - Neil Oldridge
- College of Health Sciences, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin, USA
| | - Karen Rees
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - David R Thompson
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK
| | - Ann-Dorthe Zwisler
- REHPA, The Danish Knowledge Centre for Rehabilitation and Palliative Care, Odense University Hospital, Nyborg, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Rod S Taylor
- MRC/CSO Social and Public Health Sciences Unit & Robertson Centre for Biostatistics, Institute of Health and Well Being, University of Glasgow, Glasgow, UK
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
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Oldridge N, Höfer S, McGee H, Saner H. Evaluation of health-related quality of life in cardiovascular research: a call for action. Eur J Prev Cardiol 2021; 29:e79-e81. [PMID: 34038521 DOI: 10.1093/eurjpc/zwab008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Indexed: 11/12/2022]
Affiliation(s)
- Neil Oldridge
- College of Health Sciences, University of Wisconsin-Milwaukee, Milwaukee, USA
| | - Stefan Höfer
- Department of Medical Psychology, Innsbruck Medical University, Innsbruck, Austria
| | - Hannah McGee
- Division of Population Health Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Hugo Saner
- Institute for Social and Preventive Medicine, University of Bern, Mittelstrasse 43, CH-3012 Bern, Switzerland
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Huber A, Höfer S, Saner H, Oldridge N. A little is better than none: the biggest gain of physical activity in patients with ischemic heart disease. Wien Klin Wochenschr 2020; 132:726-735. [PMID: 33259002 PMCID: PMC7732791 DOI: 10.1007/s00508-020-01767-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 10/31/2020] [Indexed: 11/25/2022]
Abstract
Background: There is a relationship between physical activity and health-related quality of life (HRQL) in healthy people and in patients with ischemic heart disease (IHD). The purpose of this study was to determine whether this relationship between sports or recreational physical activity levels and HRQL has a dose-response gradient in patients with IHD. Methods: Using one generic and three IHD-specific HRQL questionnaires, differences in HRQL scores (adjusted for confounders) were determined for physically a) inactive vs. active patients and b) inactive vs. patients being active 1–2, 3–5, or >5 times per week. Results: Data were provided by 6143 IHD-patients (angina: N = 2033; myocardial infarction: N = 2266; ischemic heart failure: N = 1844). Regardless of diagnosis or instrument used, when patients were dichotomized as either inactive or active, the latter reported throughout higher physical and emotional HRQL (all p < 0.001; d = 0.25–0.70). When categorized by physical activity levels, there was a positive HRQL dose-response gradient by increasing levels of physical activity that was most marked between inactive patients and those being active 1–2 times per week (63 82%). Conclusions: Using generic and IHD-specific HRQL questionnaires, there seems to be an overall dose-dependent gradient betweenincreasing levels of sports or recreational physical activity and higher HRQL in patients with angina, myocardial infarction, and ischemic heart failure. The greatest bang for the public health buck still lies on putting all the effort in changing sedentary lifestyle to at least a moderate active one (1–2 times per week), in particular in cardiac rehabilitation settings.
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Affiliation(s)
- Alexandra Huber
- Department of Medical Psychology, Medical University of Innsbruck, Christoph-Probst-Platz 1, 6020, Innsbruck, Austria
| | - Stefan Höfer
- Department of Medical Psychology, Medical University of Innsbruck, Christoph-Probst-Platz 1, 6020, Innsbruck, Austria.
| | - Hugo Saner
- Preventive Cardiology and Sports Medicine, Clinic for Cardiology, Inselspital Bern, University of Bern, Bern, Switzerland
| | - Neil Oldridge
- College of Health Sciences, University of Wisconsin-Milwaukee, Milwaukee, WI, USA
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Oldridge N, Taylor RS. Cost-effectiveness of exercise therapy in patients with coronary heart disease, chronic heart failure and associated risk factors: A systematic review of economic evaluations of randomized clinical trials. Eur J Prev Cardiol 2019; 27:1045-1055. [DOI: 10.1177/2047487319881839] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Aims Prescribed exercise is effective in adults with coronary heart disease (CHD), chronic heart failure (CHF), intermittent claudication, body mass index (BMI) ≥25 kg/m2, hypertension or type 2 diabetes mellitus (T2DM), but the evidence for its cost-effectiveness is limited, shows large variations and is partly contradictory. Using World Health Organization and American Heart Association/American College of Cardiology value for money thresholds, we report the cost-effectiveness of exercise therapy, exercise training and exercise-based cardiac rehabilitation. Methods Electronic databases were searched for incremental cost-effectiveness and incremental cost–utility ratios and/or the probability of cost-effectiveness of exercise prescribed as therapy in economic evaluations conducted alongside randomized controlled trials (RCTs) published between 1 July 2008 and 28 October 2018. Results Of 19 incremental cost–utility ratios reported in 15 RCTs in patients with CHD, CHF, intermittent claudication or BMI ≥25 kg/m2, 63% met both value for money thresholds as ‘highly cost-effective’ or ‘high value’, with 26% ‘not cost-effective’ or of ‘low value’. The probability of intervention cost-effectiveness ranged from 23 to 100%, probably due to the different populations, interventions and comparators reported in the individual RCTs. Confirmation with the Consolidated Health Economic Evaluation Reporting checklist varied widely across the included studies. Conclusions The findings of this review support the cost-effectiveness of exercise therapy in patients with CHD, CHF, BMI ≥25 kg/m2 or intermittent claudication, but, with concerns about reporting standards, need further confirmation. No eligible economic evaluation based on RCTs was identified in patients with hypertension or T2DM.
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Affiliation(s)
- Neil Oldridge
- College of Health Sciences, University of Wisconsin-Milwaukee, USA
| | - Rod S Taylor
- Institute of Health and Well Being, University of Glasgow, UK
- Institute of Health Services Research, University of Exeter Medical School, UK
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Huber A, Höfer S, Saner H, Oldridge N. East-West divide in health-related quality of life across Europe: Results from the HeartQoL sub-study. Eur J Prev Cardiol 2019; 27:1112-1115. [PMID: 31630541 DOI: 10.1177/2047487319876042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Alexandra Huber
- Department of Medical Psychology, Medical University Innsbruck, Austria
| | - Stefan Höfer
- Department of Medical Psychology, Medical University Innsbruck, Austria
| | - Hugo Saner
- Preventive Cardiology and Sports Medicine, University Hospital Bern, Inselspital Bern, Switzerland
| | - Neil Oldridge
- College of Health Sciences, University of Wisconsin-Milwaukee, USA
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Oldridge N, Pakosh M, Grace SL. A systematic review of recent cardiac rehabilitation meta-analyses in patients with coronary heart disease or heart failure. Future Cardiol 2019; 15:227-249. [PMID: 31161796 DOI: 10.2217/fca-2018-0085] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Aim: The aim of the project was to conduct a systematic review of meta-analyses of supervised, home-based or telemedicine-based exercise cardiac rehabilitation (CR) published between July 2011 and April 2018. Materials & methods: Evidence on mortality, hospitalization, peak VO2, exercise capacity, muscle strength and health-related quality of life in patients with coronary heart disease or heart failure referred to CR was obtained by searching six electronic databases. Results: Of the 127 point estimates identified in the 30 CR meta-analyses identified (mortality, n = 12; hospitalization, n = 11; VO2, n = 40; exercise capacity, n = 20; strength, n = 18; health-related quality of life, n = 26), 60% were statistically significant and 35% clinically important. Conclusion: The statistical data are sufficiently robust to promote strategies to improve referral to and participation in CR although evidence for clinical importance needs to be further investigated.
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Affiliation(s)
- Neil Oldridge
- College of Health Sciences, University of Wisconsin-Milwaukee, Milwaukee, WI, USA
| | - Maureen Pakosh
- University Health Network, Toronto Rehabilitation - Rumsey Cardiac Centre Library, Toronto, ON, Canada
| | - Sherry L Grace
- School of Kinesiology & Health Science, York University, & University Health Network Toronto, ON, Canada
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Oldridge N, Cho C, Thomas R, Low M, Höfer S. Validation of the English Version of the HeartQoL Health-Related Quality of Life Questionnaire in Patients With Coronary Heart Disease. J Cardiopulm Rehabil Prev 2018; 38:92-99. [DOI: 10.1097/hcr.0000000000000248] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Hansen TB, Zwisler AD, Berg SK, Sibilitz KL, Thygesen LC, Kjellberg J, Doherty P, Oldridge N, Søgaard R. Cost–utility analysis of cardiac rehabilitation after conventional heart valve surgery versus usual care. Eur J Prev Cardiol 2017; 24:698-707. [DOI: 10.1177/2047487317689908] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Tina Birgitte Hansen
- Department of Cardiology, Zealand University Hospital, Roskilde, Denmark
- National Institute of Public Health, University of Southern Denmark, Odense, Denmark
- The Heart Centre, Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Ann Dorthe Zwisler
- The Heart Centre, Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
- Danish Centre for Rehabilitation and Palliative Care, University of Southern Denmark and University Hospital of Odense, Odense, Denmark
| | - Selina Kikkenborg Berg
- The Heart Centre, Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Kirstine Lærum Sibilitz
- The Heart Centre, Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Lau Caspar Thygesen
- National Institute of Public Health, University of Southern Denmark, Odense, Denmark
| | - Jakob Kjellberg
- National Institute for Regional and Local Government Research, Copenhagen, Denmark
| | | | - Neil Oldridge
- College of Health Sciences, University of Wisconsin-Milwaukee, Milwaukee, WI, USA
| | - Rikke Søgaard
- Department of Public Health, Aarhus University, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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Kristensen MS, Zwisler AD, Berg SK, Zangger G, Grønset CN, Risom SS, Pedersen SS, Oldridge N, Thygesen LC. Validating the HeartQoL questionnaire in patients with atrial fibrillation. Eur J Prev Cardiol 2016; 23:1496-503. [DOI: 10.1177/2047487316638485] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Accepted: 02/22/2016] [Indexed: 01/22/2023]
Affiliation(s)
- Marie S Kristensen
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Ann-Dorthe Zwisler
- Danish knowledge Centre for Rehabilitation and Palliative Care, University of Southern Denmark and Odense University Hospital, Denmark
- Department of Cardiology, Copenhagen University Hospital, Denmark
| | - Selina K Berg
- Department of Cardiology, Copenhagen University Hospital, Denmark
| | - Graziella Zangger
- Danish knowledge Centre for Rehabilitation and Palliative Care, University of Southern Denmark and Odense University Hospital, Denmark
- Department of Cardiology, Copenhagen University Hospital, Denmark
| | - Charlotte N Grønset
- Department of Occupational Therapy and Physiotherapy, Copenhagen University Hospital, Denmark
| | - Signe S Risom
- Department of Cardiology, Copenhagen University Hospital, Denmark
- Department of Nursing, Faculty of Health and Technology, Metropolitan University College, Copenhagen, Denmark
| | - Susanne S Pedersen
- Department of Psychology, University of Southern Denmark, Odense, Denmark
- Department of Cardiology, Odense University Hospital, Denmark
| | - Neil Oldridge
- College of Health Sciences, University of Wisconsin-Milwaukee, USA
| | - Lau C Thygesen
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
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Abstract
PURPOSE International reference data for the SF-36 health survey (version 1) are presented based on a sample of 5508 adult patients with ischemic heart disease. METHODS Patients with angina, myocardial infarction and ischemic heart failure completed the SF-36. Data were analyzed by diagnosis, gender, age, region and country within region and presented as mean ± standard deviation (SD), minimum, maximum, 25th, 50th and 75th percentile of the physical (PCS) and mental component summary (MCS) measures. RESULTS Mean PCS scores were reported as being more than one SD below the normal range (standardized mean of 50 ± 10) by more than half of the patient subgroups (59 %) with all of the mean MCS scores falling within the normal range. Patients with angina and patients with ischemic heart failure reported the poorest mean PCS scores with both diagnoses reporting scores more than one SD below the standardized mean. Females, older patients (especially >70 years) and patients from Eastern Europe reported significantly worse mean PCS scores than male, younger and non-Eastern European patients. The cardiac diagnosis had no effect on the mean MCS scores; however, females, younger patients (especially <51 years) and patients from Eastern Europe reported significantly worse mean MCS scores than male, older and non-Eastern European patients. CONCLUSIONS These international reference SF-36 values for patients with IHD are useful for clinicians, researchers and health-policy makers when developing improved health services.
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Affiliation(s)
- Alexandra Huber
- Department of Medical Psychology, Medical University of Innsbruck, Speckbacherstraße 23/III, 6020, Innsbruck, Austria. .,Institute of Psychology, Leopold Franzens University Innsbruck, Innrain 52f, Bruno-Sander-Haus, 6020, Innsbruck, Austria.
| | - Neil Oldridge
- College of Health Sciences, University of Wisconsin-Milwaukee, 6975 N. Elm Tree Road, Glendale, WI, 53217, USA
| | - Stefan Höfer
- Department of Medical Psychology, Medical University of Innsbruck, Speckbacherstraße 23/III, 6020, Innsbruck, Austria
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Anderson L, Oldridge N, Thompson DR, Zwisler AD, Rees K, Martin N, Taylor RS. Exercise-Based Cardiac Rehabilitation for Coronary Heart Disease: Cochrane Systematic Review and Meta-Analysis. J Am Coll Cardiol 2016; 67:1-12. [PMID: 26764059 DOI: 10.1016/j.jacc.2015.10.044] [Citation(s) in RCA: 1033] [Impact Index Per Article: 129.1] [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: 07/14/2015] [Revised: 10/12/2015] [Accepted: 10/14/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND Although recommended in guidelines for the management of coronary heart disease (CHD), concerns have been raised about the applicability of evidence from existing meta-analyses of exercise-based cardiac rehabilitation (CR). OBJECTIVES The goal of this study is to update the Cochrane systematic review and meta-analysis of exercise-based CR for CHD. METHODS The Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, CINAHL, and Science Citation Index Expanded were searched to July 2014. Retrieved papers, systematic reviews, and trial registries were hand-searched. We included randomized controlled trials with at least 6 months of follow-up, comparing CR to no-exercise controls following myocardial infarction or revascularization, or with a diagnosis of angina pectoris or CHD defined by angiography. Two authors screened titles for inclusion, extracted data, and assessed risk of bias. Studies were pooled using random effects meta-analysis, and stratified analyses were undertaken to examine potential treatment effect modifiers. RESULTS A total of 63 studies with 14,486 participants with median follow-up of 12 months were included. Overall, CR led to a reduction in cardiovascular mortality (relative risk: 0.74; 95% confidence interval: 0.64 to 0.86) and the risk of hospital admissions (relative risk: 0.82; 95% confidence interval: 0.70 to 0.96). There was no significant effect on total mortality, myocardial infarction, or revascularization. The majority of studies (14 of 20) showed higher levels of health-related quality of life in 1 or more domains following exercise-based CR compared with control subjects. CONCLUSIONS This study confirms that exercise-based CR reduces cardiovascular mortality and provides important data showing reductions in hospital admissions and improvements in quality of life. These benefits appear to be consistent across patients and intervention types and were independent of study quality, setting, and publication date.
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Affiliation(s)
- Lindsey Anderson
- Institute of Health Research, University of Exeter Medical School, Exeter, United Kingdom
| | - Neil Oldridge
- College of Health Sciences, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin
| | - David R Thompson
- Centre for the Heart and Mind, Australian Catholic University, Melbourne, Australia
| | - Ann-Dorthe Zwisler
- National Centre of Rehabilitation and Palliation, University Hospital Odense, and University of Southern Denmark, Odense, Denmark
| | - Karen Rees
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - Nicole Martin
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Rod S Taylor
- Institute of Health Research, University of Exeter Medical School, Exeter, United Kingdom.
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16
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Grace SL, Turk-Adawi KI, Contractor A, Atrey A, Campbell N, Derman W, Melo Ghisi GL, Oldridge N, Sarkar BK, Yeo TJ, Lopez-Jimenez F, Mendis S, Oh P, Hu D, Sarrafzadegan N. Cardiac rehabilitation delivery model for low-resource settings. Heart 2016; 102:1449-55. [PMID: 27181874 PMCID: PMC5013107 DOI: 10.1136/heartjnl-2015-309209] [Citation(s) in RCA: 93] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Accepted: 04/13/2016] [Indexed: 12/18/2022] Open
Abstract
Objective Cardiovascular disease is a global epidemic, which is largely preventable. Cardiac rehabilitation (CR) is demonstrated to be cost-effective and efficacious in high-income countries. CR could represent an important approach to mitigate the epidemic of cardiovascular disease in lower-resource settings. The purpose of this consensus statement was to review low-cost approaches to delivering the core components of CR, to propose a testable model of CR which could feasibly be delivered in middle-income countries. Methods A literature review regarding delivery of each core CR component, namely: (1) lifestyle risk factor management (ie, physical activity, diet, tobacco and mental health), (2) medical risk factor management (eg, lipid control, blood pressure control), (3) education for self-management and (4) return to work, in low-resource settings was undertaken. Recommendations were developed based on identified articles, using a modified GRADE approach where evidence in a low-resource setting was available, or consensus where evidence was not. Results Available data on cost of CR delivery in low-resource settings suggests it is not feasible to deliver CR in low-resource settings as is delivered in high-resource ones. Strategies which can be implemented to deliver all of the core CR components in low-resource settings were summarised in practice recommendations, and approaches to patient assessment proffered. It is suggested that CR be adapted by delivery by non-physician healthcare workers, in non-clinical settings. Conclusions Advocacy to achieve political commitment for broad delivery of adapted CR services in low-resource settings is needed.
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Affiliation(s)
- Sherry L Grace
- Faculty of Health, School of Kinesiology and Health Science, York University, and Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
| | - Karam I Turk-Adawi
- School of Health Policy and Management, York University, Toronto, Ontario, Canada
| | - Aashish Contractor
- Rehabilitation and Sports Medicine, Sir H. N. Reliance Foundation Hospital, Mumbai, India
| | | | - Norm Campbell
- Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada
| | - Wayne Derman
- Institute of Sport and Exercise Medicine (SEM), Faculty of Medicine and Health Sciences, University of Stellenbosch, Cape Town, South Africa
| | - Gabriela L Melo Ghisi
- Department of Exercise Sciences, Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, Ontario, Canada
| | - Neil Oldridge
- College of Health Sciences, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin, USA
| | - Bidyut K Sarkar
- Research Division, Public Health Foundation of India, ISID Campus, New Delhi, India
| | - Tee Joo Yeo
- Department of Cardiology, National University Heart Centre Singapore, Singapore
| | - Francisco Lopez-Jimenez
- Cardiovascular Health Clinic and Cardiometabolic Program, Mayo Clinic, Rochester, Minnesota, USA
| | - Shanthi Mendis
- Chronic Diseases Prevention and Management, NCD, WHO, Geneva, Switzerland
| | - Paul Oh
- UHN Cardiovascular Prevention and Rehabilitation Program, Toronto, Ontario, Canada
| | - Dayi Hu
- Heart Center, People Hospital of Peking University, Beijing, China
| | - Nizal Sarrafzadegan
- Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
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17
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De Smedt D, Clays E, Höfer S, Oldridge N, Kotseva K, Maggioni AP, Pogosova N, Dolzhenko M, De Bacquer D. The use of HeartQoL in patients with coronary heart disease: Association with risk factors and European reference values. The EUROASPIRE IV study of the European Society of Cardiology. Eur J Prev Cardiol 2016; 23:1174-86. [PMID: 26862122 DOI: 10.1177/2047487316631400] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [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: 10/14/2015] [Accepted: 01/19/2016] [Indexed: 01/22/2023]
Abstract
BACKGROUND HeartQoL is a recently developed core health-related quality of life instrument for patients with coronary heart disease. The current study aims to investigate its association with patients' coronary risk profile and to provide reference values for patients with coronary heart disease across Europe. DESIGN Analyses are based on the EUROASPIRE IV (EUROpean Action on Secondary and Primary prevention through Intervention to Reduce Events) cross-sectional survey. METHODS Patients with a diagnosis of coronary heart disease were examined and interviewed six months to three years after their coronary event. The HeartQoL questionnaire was completed by 7261 coronary heart disease patients. Reference values were calculated and the association with the coronary risk profile was assessed. RESULTS Significantly worse outcomes were observed in higher-risk patient groups. Both metabolic and behavioural risk factors were associated with worse HeartQoL outcomes. Further, the HeartQoL scores decreased as the number of risk factors increased. The mean global reference values in males were 2.27 ± 0.65 (<60 years), 2.30 ± 0.61 (between 60 and 69 years) and 2.19 ± 0.64 (≥70 years). Likewise, in females, the respective global HeartQoL reference values were 2.02 ± 0.67, 2.01 ± 0.66 and 1.83 ± 0.70. The ceiling effect in males was 11.4%, 10.4% and 7.4% for the three age classes respectively, whereas in females the ceiling effect was 5.2%, 3.5% and 1.9%, respectively. CONCLUSION HeartQoL scores were associated with patients' coronary risk profile. The reference values may help other researchers to interpret HeartQoL scores. Further research should focus on the minimal important difference needed to evaluate the effect of therapies and lifestyle changes.
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Affiliation(s)
| | - Els Clays
- Department of Public Health, Ghent University, Belgium
| | - Stefan Höfer
- Department of Medical Psychology, Innsbruck Medical University, Austria
| | - Neil Oldridge
- College of Health Sciences, University of Wisconsin-Milwaukee, USA
| | - Kornelia Kotseva
- Department of Public Health, Ghent University, Belgium Department of Cardiovascular Medicine, National Heart and Lung Institute, Imperial College London, UK
| | - Aldo Pietro Maggioni
- EURObservational Research Programme Department, European Society of Cardiology, Sophia Antipolis, France
| | - Nana Pogosova
- National Research Centre for Preventive Medicine, Moscow, Russian Federation
| | - Maryna Dolzhenko
- Shupik's National Medical Academy of Postgraduation Education, Kiev, Ukraine
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18
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Abstract
BACKGROUND Coronary heart disease (CHD) is the single most common cause of death globally. However, with falling CHD mortality rates, an increasing number of people live with CHD and may need support to manage their symptoms and prognosis. Exercise-based cardiac rehabilitation (CR) aims to improve the health and outcomes of people with CHD. This is an update of a Cochrane systematic review previously published in 2011. OBJECTIVES To assess the effectiveness and cost-effectiveness of exercise-based CR (exercise training alone or in combination with psychosocial or educational interventions) compared with usual care on mortality, morbidity and HRQL in patients with CHD.To explore the potential study level predictors of the effectiveness of exercise-based CR in patients with CHD. SEARCH METHODS We updated searches from the previous Cochrane review, by searching Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library, Issue 6, 2014) from December 2009 to July 2014. We also searched MEDLINE (Ovid), EMBASE (Ovid), CINAHL (EBSCO) and Science Citation Index Expanded (December 2009 to July 2014). SELECTION CRITERIA We included randomised controlled trials (RCTs) of exercise-based interventions with at least six months' follow-up, compared with a no exercise control. The study population comprised men and women of all ages who have had a myocardial infarction (MI), coronary artery bypass graft (CABG) or percutaneous coronary intervention (PCI), or who have angina pectoris, or coronary artery disease. We included RCTs that reported at least one of the following outcomes: mortality, MI, revascularisations, hospitalisations, health-related quality of life (HRQL), or costs. DATA COLLECTION AND ANALYSIS Two review authors independently screened all identified references for inclusion based on the above inclusion and exclusion criteria. One author extracted data from the included trials and assessed their risk of bias; a second review author checked data. We stratified meta-analysis by the duration of follow up of trials, i.e. short-term: 6 to 12 months, medium-term: 13 to 36 months, and long-term: > 3 years. MAIN RESULTS This review included 63 trials which randomised 14,486 people with CHD. This latest update identified 16 new trials (3872 participants). The population included predominantly post-MI and post-revascularisation patients and the mean age of patients within the trials ranged from 47.5 to 71.0 years. Women accounted for fewer than 15% of the patients recruited. Overall trial reporting was poor, although there was evidence of an improvement in quality of reporting in more recent trials.As we found no significant difference in the impact of exercise-based CR on clinical outcomes across follow-up, we focused on reporting findings pooled across all trials at their longest follow-up (median 12 months). Exercise-based CR reduced cardiovascular mortality compared with no exercise control (27 trials; risk ratio (RR) 0.74, 95% CI 0.64 to 0.86). There was no reduction in total mortality with CR (47 trials, RR 0.96, 95% CI 0.88 to 1.04). The overall risk of hospital admissions was reduced with CR (15 trials; RR 0.82, 95% CI 0.70 to 0.96) but there was no significant impact on the risk of MI (36 trials; RR 0.90, 95% CI 0.79 to 1.04), CABG (29 trials; RR 0.96, 95% CI 0.80 to 1.16) or PCI (18 trials; RR 0.85, 95% CI 0.70 to 1.04).There was little evidence of statistical heterogeneity across trials for all event outcomes, and there was evidence of small study bias for MI and hospitalisation, but no other outcome. Predictors of clinical outcomes were examined across the longest follow-up of studies using univariate meta-regression. Results show that benefits in outcomes were independent of participants' CHD case mix (proportion of patients with MI), type of CR (exercise only vs comprehensive rehabilitation) dose of exercise, length of follow-up, trial publication date, setting (centre vs home-based), study location (continent), sample size or risk of bias.Given the heterogeneity in outcome measures and reporting methods, meta-analysis was not undertaken for HRQL. In five out of 20 trials reporting HRQL using validated measures, there was evidence of significant improvement in most or all of the sub-scales with exercise-based CR compared to control at follow-up. Four trial-based economic evaluation studies indicated exercise-based CR to be a potentially cost-effective use of resources in terms of gain in quality-adjusted life years.The quality of the evidence for outcomes reported in the review was rated using the GRADE method. The quality of the evidence varied widely by outcome and ranged from low to moderate. AUTHORS' CONCLUSIONS This updated Cochrane review supports the conclusions of the previous version of this review that, compared with no exercise control, exercise-based CR reduces the risk of cardiovascular mortality but not total mortality. We saw a significant reduction in the risk of hospitalisation with CR but not in the risk of MI or revascularisation. We identified further evidence supporting improved HRQL with exercise-based CR. More recent trials were more likely to be well reported and include older and female patients. However, the population studied in this review still consists predominantly of lower risk individuals following MI or revascularisation. Further well conducted RCTs are needed to assess the impact of exercise-based CR in higher risk CHD groups and also those presenting with stable angina. These trials should include validated HRQL outcome measures, explicitly report clinical event outcomes including mortality and hospital admissions, and assess costs and cost-effectiveness.
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Affiliation(s)
- Lindsey Anderson
- University of Exeter Medical SchoolInstitute of Health ResearchVeysey Building, Salmon Pool LaneExeterUKEX2 4SG
| | - David R Thompson
- University of MelbourneDepartment of PsychiatrySt Vincent's HospitalMelbourneVictoriaAustraliaVIC 3000
| | - Neil Oldridge
- Aurora Sinai/Aurora St. Luke's Medical CenterUniversity of Wisconsin School of Medicine & Public Health and Aurora Cardiovascular ServicesMilwaukeeWisconsinUSA
| | - Ann‐Dorthe Zwisler
- Copenhagen University Hospital, RigshospitaletDepartment of Cardiology, The Heart CentreBlegsdamsvej 9CopenhagenDenmark2100
| | - Karen Rees
- Warwick Medical School, University of WarwickDivision of Health SciencesCoventryUKCV4 7AL
| | - Nicole Martin
- University College LondonFarr Institute of Health Informatics Research222 Euston RoadLondonUKNW1 2DA
| | - Rod S Taylor
- University of Exeter Medical SchoolInstitute of Health ResearchVeysey Building, Salmon Pool LaneExeterUKEX2 4SG
- University of Southern DenmarkNational Institute of Public HealthCopenhagenDenmark
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De Smedt D, Clays E, Höfer S, Oldridge N, Kotseva K, De Bacquer D. Validity and reliability of the HeartQoL questionnaire based on the EUROASPIRE IV study. Arch Public Health 2015. [PMCID: PMC4582196 DOI: 10.1186/2049-3258-73-s1-p8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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20
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Benzer W, Philippi A, Hoefer S, Friedrich O, Oldridge N. Health-related quality of life predicts unplanned rehospitalization following coronary revascularization. Herz 2015; 41:138-43. [PMID: 26394779 DOI: 10.1007/s00059-015-4351-y] [Citation(s) in RCA: 12] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2015] [Revised: 08/06/2015] [Accepted: 08/08/2015] [Indexed: 12/17/2022]
Abstract
BACKGROUND Health-related quality of life (HRQL) is an increasingly well-recognized measure of health outcome in cardiology. We examined HRQL as a predictor of unplanned rehospitalization for cardiac reasons in patients after coronary revascularization over a period of 3 years. PATIENTS AND METHODS Out of 791 patients enrolled in the study, 743 completed the MacNew HRQL questionnaire after coronary revascularization. MacNew HRQL scores were used as predictors of unplanned rehospitalization. RESULTS Within the 3-year follow-up period, 125 patients (16.8 %) were rehospitalized. After adjustment for age, gender, and myocardial infarction as the initiating event, there were significant differences in unplanned rehospitalization rates between patients with low or moderate vs. high MacNew HRQL global scores (HR: 1.8, 95 % CI: 1.2-2.7) and both physical (HR: 2.2, 95 % CI: 1.4-3.5) and social (HR: 1.8, 95 % CI: 1.2-2.7) subscale scores. CONCLUSION Poor HRQL assessed after coronary revascularization appears to be a powerful predictor of rehospitalization over a 3-year period.
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Affiliation(s)
- W Benzer
- Department of Interventional Cardiology, Cardiac Disease Management Centre, Academic Hospital Feldkirch, Carinagasse 47, 6800, Feldkirch, Austria. .,Reha Sports Institute, Feldkirch, Austria.
| | - A Philippi
- Reha Sports Institute, Feldkirch, Austria
| | - S Hoefer
- Department of Medical Psychology, Innsbruck Medical University, Innsbruck, Austria
| | - O Friedrich
- Karl Landsteiner Institute for Scientific Research in Clinical Cardiology, Vienna, Austria
| | - N Oldridge
- College of Health Sciences, University of Wisconsin, Milwaukee, WI, USA
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21
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De Smedt D, Clays E, Höfer S, Oldridge N, Kotseva K, Maggioni AP, Janssen B, De Bacquer D. Validity and reliability of the HeartQoL questionnaire in a large sample of stable coronary patients: The EUROASPIRE IV Study of the European Society of Cardiology. Eur J Prev Cardiol 2015; 23:714-21. [PMID: 26358990 DOI: 10.1177/2047487315604837] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [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: 06/16/2015] [Accepted: 08/18/2015] [Indexed: 01/22/2023]
Abstract
BACKGROUND The aim of this study was to investigate the validity and reliability of the HeartQoL instrument in a population of stable coronary patients. DESIGN Analyses are based on the cross-sectional EUROASPIRE IV (EUROpean Action on Secondary and Primary prevention through Intervention to Reduce Events) survey. METHODS Patients with a diagnosis of coronary heart disease were examined and interviewed 6 months to 3 years after their coronary event. During the interview patients were asked to fill out the HeartQoL health-related quality of life questionnaire as well as the EQ-5D and the hospital anxiety and depression scale questionnaire. Psychometric analyses assessing the reliability and validity of the HeartQoL instrument were performed. RESULTS A total of 7449 patients completed the HeartQoL instrument. Cronbach's alpha indicated excellent internal consistency for the global HeartQoL scale (α = 0.92) and the physical subscale (α = 0.91) and good internal consistency for the emotional subscale (α = 0.87). Factor analysis confirmed the two-dimensional construct although mixed results were found regarding the model fit. Discriminative validity analysis confirmed better HeartQoL results in men, younger patients and higher educated persons. Likewise, convergent validity was confirmed with moderate to strong correlations among hypothesised constructs. CONCLUSION Overall, psychometric analyses of the HeartQoL instrument in a population of patients with stable coronary heart disease showed good reliability and validity both at the European as well as the country-specific level. However, further research should focus on the responsiveness of the HeartQoL, the possible ceiling effect of the emotional subscale, construct validity and the minimal clinically important difference.
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Affiliation(s)
| | - Els Clays
- Department of Public Health, Ghent University, Belgium
| | - Stefan Höfer
- Department of Medical Psychology, Innsbruck Medical University, Austria
| | - Neil Oldridge
- College of Health Sciences, University of Wisconsin-Milwaukee, USA
| | - Kornelia Kotseva
- Department of Cardiovascular Medicine, National Heart and Lung Institute, Imperial College London, UK
| | - Aldo Pietro Maggioni
- EURObservational Research Programme Department, European Society of Cardiology, France
| | - Bas Janssen
- Department of Medical Psychology and Psychotherapy, Erasmus University, The Netherlands
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Fattirolli F, Marchionni N, Höfer S, Giannuzzi P, Angelino E, Fioretti P, Miani D, Oldridge N. The Italian MacNew heart disease health-related quality of life questionnaire: a validation study. Intern Emerg Med 2015; 10:359-68. [PMID: 25666514 DOI: 10.1007/s11739-015-1203-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2014] [Accepted: 01/23/2015] [Indexed: 01/22/2023]
Abstract
Patient-centered treatment outcomes such as health-related quality of life are recommended in clinical care and research studies. Health-related quality of life questionnaires need to be validated in the language of the target population. The reliability and validity of the Italian version of the MacNew Questionnaire was determined in patients with angina, myocardial infarction, or ischemic heart failure. Sociodemographic and clinical data were collected on 298 patients [angina, n = 88; MI, n = 106; heart failure, n = 104; mean age, 64.8 (±10.6) years] at three centers in Italy. MacNew mean scores were higher (p < 0.001) in patients with myocardial infarction than in patients with either angina or heart failure with no floor and minimal ceiling effects. The three-factor structure of the original MacNew form was largely confirmed explaining 54.6% of the total variance. The Italian MacNew version demonstrates high internal consistency reliability (Cronbach's α ≥ 0.86), confirms the convergent validity hypotheses with strong correlations on six of eight comparisons (r ≥ 0.86), partially confirms discriminative validity with the SF-36 health transition item, and fully confirms discriminative validity with the Hospital Anxiety and Depression Scale. The Italian version of the MacNew Questionnaire demonstrates satisfactory psychometric properties, and is reliable and valid in Italian-speaking patients with angina, MI, or heart failure. Responsiveness could not be tested due to the cross-sectional design of the parent study, and needs to be investigated in an intervention study.
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Affiliation(s)
- Francesco Fattirolli
- Department of Experimental and Clinical Medicine, University of Florence and Azienda Ospedaliero Universitaria Careggi, Via delle Oblate 4, 50141, Florence, Italy,
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Alphin S, Höfer S, Perk J, Slørdahl S, Zwisler ADO, Oldridge N. The MacNew Heart Disease Health-Related Quality of Life Questionnaire: A Scandinavian Validation Study. Soc Indic Res 2015; 122:519-537. [PMID: 26346324 PMCID: PMC4555195 DOI: 10.1007/s11205-014-0694-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/28/2014] [Indexed: 05/06/2023]
Abstract
The aim of this study is to validate the Danish, Norwegian and Swedish versions of the self-administered MacNew Heart Disease Health-related Quality of Life questionnaire in patients with ischemic heart disease. The MacNew questionnaire, the Short Form SF-36, and the Hospital Anxiety and Depression Scale were completed at baseline by 976 patients (Denmark n = 353, Norway n = 328, Sweden n = 295) with a diagnosis of angina (n = 335), myocardial infarction (n = 352), or heart failure (n = 289). Each language version of the MacNew satisfied reliability criteria with Cronbach's α values for the total group data (0.90-0.94) as well as the diagnostic group data (0.91-0.96). The test-retest correlations exceeded the criteria for group comparison (r ≥ 0.70) in Danish and Norwegian patients. The multidimensionality of the MacNew was confirmed although the original three-factor solution did not fully meet the criteria for good fit. Convergent and discriminative validity were confirmed in each language and diagnosis group with the exception of discriminative validity in Swedish angina patients. The psychometric properties of the Danish, Norwegian, and Swedish versions of the MacNew are largely confirmed. The MacNew can be recommended as a specific instrument for assessing and evaluating HRQL in Danish, Norwegian, and Swedish patients with angina, MI, and heart failure. However, the MacNew factor structure needs to be revisited in future studies.
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Affiliation(s)
- Shan Alphin
- Department of Cardiology, Holbæk Hospital, Copenhagen, Denmark
| | - Stefan Höfer
- Department of Medical Psychology, Innsbruck Medical University, Innsbruck, Austria
| | - Joep Perk
- Department of Cardiology, Public Health Department, Kalmar County, Oskarshamm, Sweden
| | - Stig Slørdahl
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
| | | | - Neil Oldridge
- School of Medicine and Public Health, University of Wisconsin, Milwaukee, WI USA
- Aurora Cardiovascular Services, Aurora St. Luke’s Medical Center, Milwaukee, WI USA
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Pavy B, Iliou MC, Höfer S, Vergès-Patois B, Corone S, Aeberhard P, Curnier D, Henry J, Ponchon-Weess A, Oldridge N. Validation of the French version of the MacNew heart disease health-related quality of life questionnaire. Arch Cardiovasc Dis 2014; 108:107-17. [PMID: 25453715 DOI: 10.1016/j.acvd.2014.09.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [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: 05/19/2014] [Revised: 09/16/2014] [Accepted: 09/18/2014] [Indexed: 12/20/2022]
Abstract
BACKGROUND Assessment of health-related quality of life is widely recommended by European health agencies in relevant research studies as well as in clinical care. AIMS To validate the French version of the MacNew heart disease health-related quality of life questionnaire. METHODS As part of the International HeartQoL Project, 323 French-speaking patients with ischaemic heart disease (angina, n=76; myocardial infarction [MI], n=155; heart failure, n=91; mean age 58.6±11.3 years) were recruited at seven cardiac rehabilitation centres. All patients completed the French versions of the MacNew questionnaire, the Short Form-36 Health Survey (SF-36) and the Hospital Anxiety and Depression Scale, to evaluate the psychometric properties of the French version of the MacNew instrument. RESULTS The mean MacNew global scale scores were 4.6±0.8, 5.0±1.0 and 4.8±0.9 in patients with angina, MI and heart failure, respectively (P<0.05, MI versus angina). We observed minimal missing items and ceiling effects and no floor effects. Factor analysis confirmed a three factorial structure explaining 55.9% of the observed variance. Internal consistency reliability (Cronbach's α) ranged from 0.86 to 0.94 and test-retest reliability ranged from 0.68 to 0.73 Convergent validity was confirmed in the total group and each diagnosis, although the correlations between the MacNew physical subscale and the SF-36 mental component summary were higher than expected. Discriminative validity was partially confirmed with the SF-36 health transition item and fully confirmed with anxiety and depression as predictor variables. CONCLUSION The French version of MacNew questionnaire is recommended for assessing health-related quality of life in French-speaking patients with ischaemic heart disease.
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Affiliation(s)
- Bruno Pavy
- Cardiovascular rehabilitation department, Loire-Vendée-Océan hospital, boulevard des Régents, 44270 Machecoul, France.
| | - Marie-Christine Iliou
- Cardiac rehabilitation department, Corentin-Celton hospital, AP-HP, Issy-Les-Moulineaux, France
| | - Stefan Höfer
- Department of medical psychology, Innsbruck medical university, Innsbruck, Austria
| | | | - Sonia Corone
- Cardiac rehabilitation department, Bligny, France
| | | | - Daniel Curnier
- Research center, Sainte-Justine hospital, Montreal, QC, Canada; Cardiovascular and pulmonary rehabilitation centre, Saint-Orens, France
| | | | | | - Neil Oldridge
- College of Health Sciences, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin, USA
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Hansen TB, Thygesen LC, Zwisler AD, Helmark L, Hoogwegt M, Versteeg H, Höfer S, Oldridge N. Self-reported health-related quality of life predicts 5-year mortality and hospital readmissions in patients with ischaemic heart disease. Eur J Prev Cardiol 2014; 22:882-9. [PMID: 24821733 DOI: 10.1177/2047487314535682] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [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: 11/01/2013] [Accepted: 04/24/2014] [Indexed: 11/16/2022]
Abstract
BACKGROUND Patient health-related quality of life (HRQL) is an important health outcome with lower HRQL associated with adverse events in patients with ischaemic heart disease (IHD). DESIGN Baseline health-related quality of life was investigated as a predictor of 5-year all-cause mortality and cardiac readmissions in Danish patients with IHD. METHODS The international HeartQoL Project survey was designed to develop a core HRQL questionnaire for patients with IHD. Baseline scores on each of the 14 items ultimately included in the HeartQoL questionnaire were linked to Danish national health registries and hazard ratios for mortality and readmissions were estimated using Cox regression models. RESULTS Among 938 eligible Danish patients with IHD, 662 (70.6%) participated in the international HeartQoL Project. During the 5-year follow-up, 83 patients died and 196 patients were readmitted. Adjusted analyses showed a significant linear association between all-cause mortality and both lower global HRQL (HR = 1.67, 95% CI: 1.26-2.23; p<0.001) and physical scores (HR=1.71, 1.33-2.21; p<0.001) and between readmission and both lower global (HR=1.73, 1.41-2.12; p < 0.001) and physical scores (HR = 1.63, 1.35-1.96; p < 0.001). A significant, but non-linear, effect was found for emotional HRQL score on outcomes. CONCLUSION This study shows a significant and linear relationship between lower global and physical HRQL scores in patients with IHD and 5-year all-cause mortality and cardiac readmission.
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Affiliation(s)
- Tina Birgitte Hansen
- National Institute of Public Health, University of Southern Denmark Department of Cardiology, Holbaek Hospital, Denmark Department of Cardiology, Roskilde Hospital, Denmark
| | | | - Ann Dorthe Zwisler
- National Institute of Public Health, University of Southern Denmark Department of Cardiology, Holbaek Hospital, Denmark Department of Cardiology, Rigshospitalet, Denmark
| | - Lotte Helmark
- Department of Cardiology, Roskilde Hospital, Denmark
| | - Madelein Hoogwegt
- Center of Research on Psychology in Somatic diseases (CoRPS), Tilburg University, Tilburg, The Netherlands
| | - Henneke Versteeg
- Center of Research on Psychology in Somatic diseases (CoRPS), Tilburg University, Tilburg, The Netherlands
| | - Stefan Höfer
- Department of Medical Psychology, Innsbruck Medical University, Austria
| | - Neil Oldridge
- College of Health Sciences, University of Wisconsin-Milwaukee, University of Wisconsin School of Medicine and Public Health, and Aurora Cardiovascular Services, Aurora St. Luke's Medical Center, Milwaukee, WI, USA
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Lidell E, Höfer S, Saner H, Perk J, Hildingh C, Oldridge N. Health-related quality of life in European women following myocardial infarction: a cross-sectional study. Eur J Cardiovasc Nurs 2014; 14:326-33. [PMID: 24821717 DOI: 10.1177/1474515114535330] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2013] [Accepted: 04/22/2014] [Indexed: 11/15/2022]
Abstract
BACKGROUND Coronary heart disease is a major contributor to women's health problems. DESIGN Self-perceived social support, well-being and health-related quality of life (HRQL) were documented in the cross-sectional HeartQoL survey of European women one and six months after a myocardial infarction. METHODS European women were recruited in 18 European countries and grouped into four geographical regions (Southern Europe, Northern Europe, Western Europe and Eastern Europe). Continuous socio-demographic variables and categorical variables were compared by age and region with ANOVA and χ(2), respectively; multiple regression models were used to identify predictors of social support, well-being and HRQL. RESULTS Women living in the Eastern European region rated social support, well-being and HRQL significantly lower than women in the other regions. Older women had lower physical HRQL scores than younger women. Eastern European women rated social support, well-being and HRQL significantly lower than women in the other regions. Prediction of the dependent variables (social support, well-being and HRQL) by socio-demographic factors varied by total group, in the older age group, and by region; body mass index and managerial responsibility were the most consistent significant predictors.
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Affiliation(s)
- Evy Lidell
- School of Social and Health Sciences, Halmstad University, Sweden
| | - Stefan Höfer
- Department of Medical Psychology, Innsbruck Medical University, Austria
| | - Hugo Saner
- Cardiovascular Prevention, Rehabilitation and Sports Medicine, University Hospitals Inselspital, Bern, Switzerland
| | - Joep Perk
- Institute of Health and Caring Sciences, Linnaeus University, Kalmar, Sweden
| | | | - Neil Oldridge
- College of Health Sciences, University of Wisconsin-Milwaukee, School of Medicine and Public Health, University of Wisconsin-Madison, and Aurora Cardiovascular Services, Aurora Medical Group, Milwaukee, Wisconsin, USA
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Pogosova NV, Kursakov AA, Boycharov IH, Höfer S, Oldridge N. VALIDATION OF THE MACNEW QUESTIONNAIRE FOR THE ASSESSMENT OF HEALTH-RELATED QUALITY OF LIFE IN PATIENTS WITH ISHEMIC HEART DISEASE. Racionalʹnaâ farmakoterapiâ v kardiologii 2014. [DOI: 10.20996/1819-6446-2014-10-6-584-596] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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De Franco AC, Oldridge N. Health-related quality of life in patients with acute coronary syndromes and treated with ticagrelor or clopidogrel. Expert Rev Pharmacoecon Outcomes Res 2013; 14:23-6. [PMID: 24308450 DOI: 10.1586/14737167.2014.861743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Evaluation of: Levin LA, Wallentin L, Bernfort L et al. Health-related quality of life of ticagrelor versus clopidogrel in patients with acute coronary syndromes results from the PLATO trial. Value Health 16(4), 574-580 (2013). Antiplatelet therapy is considered essential treatment for acute coronary syndromes with or without ST-segment elevation and after stent procedures. The PLATelet inhibition and patient Outcomes (PLATO) trial compared ticagrelor or clopidogrel for the prevention of cardiovascular events. Prespecified substudies included a health-related quality of life (HRQL) study; the EQ-5D, a self-report, standardized, nondisease-specific utility measure with a single index value for health status, was used to assess HRQL. In the primary HRQL analysis, the mean 12-month HRQL score in 15,212 patients was reported to be 0.840 in the ticagrelor group and 0.832 in the clopidogrel group (p = 0.046). Excluding patients who died resulted in no difference in HRQL between patients treated with ticagrelor or clopidogrel (0.864 and 0.863, respectively; p = 0.69). The improved survival and reduction in cardiovascular events with ticagrelor as demonstrated in the main PLATelet inhibition and patient Outcomes trial are apparently obtained with no difference in quality of life.
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Affiliation(s)
- Anthony C De Franco
- Aurora Cardiovascular Services, Aurora Sinai/Aurora St Luke's Medical Centers, Milwaukee, WI, USA
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Hansen TB, Zwisler AD, Thygesen LC, Helmark L, Hoogwegt M, Versteeg H, Hoefer S, Oldridge N. Global and physical dimensions of self-reported health-related quality of life predict outcomes at 5 years in patients with ischaemic heart disease. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht308.p1543] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Abstract
Cardiac rehabilitation that includes either exercise training alone or exercise training in addition to psychosocial, risk factor management and/or educational interventions is considered a Class I indication [i.e., useful and effective] for patients with coronary heart disease. This overview of six independent cardiac rehabilitation meta-analyses published since 2000 includes a total of 71 randomized clinical trials (n = 13,824 patients) and clearly demonstrates significant clinical outcomes (reduced all-cause and cardiac mortality, nonfatal reinfarction and reduced hospitalization rates) and significant positive changes in modifiable risk factors (total cholesterol, triglycerides and systolic blood pressure). Despite the observation that the elderly, females, minority ethnic groups, low socioeconomic status patients and patients with comorbidities have not been well represented in the randomized clinical trials. Recent guidelines in the UK and USA have concluded with the recommendation that cardiac rehabilitation is reasonable and necessary and should be promoted by healthcare professionals, including senior medical staff.
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Affiliation(s)
- Neil Oldridge
- University of Wisconsin School of Medicine & Public Health, Aurora Cardiovascular Services, Aurora Medical Group, Glendale, Milwaukee, WI 53217, USA.
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Busch JC, Lillou D, Wittig G, Bartsch P, Willemsen D, Oldridge N, Bjarnason-Wehrens B. Resistance and Balance Training Improves Functional Capacity in Very Old Participants Attending Cardiac Rehabilitation After Coronary Bypass Surgery. J Am Geriatr Soc 2012; 60:2270-6. [DOI: 10.1111/jgs.12030] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- John C. Busch
- Institute of Cardiology and Sports Medicine; German Sport University Cologne; Cologne Germany
- Institute of Cardiology and Sports Medicine; German Sport University Cologne; Cologne Germany
| | - Dorothea Lillou
- Rehabilitation; Schuechtermann Clinic; Bad Rothenfelde Germany
| | - Godehard Wittig
- Rehabilitation; Schuechtermann Clinic; Bad Rothenfelde Germany
| | - Petra Bartsch
- Rehabilitation; Schuechtermann Clinic; Bad Rothenfelde Germany
| | | | - Neil Oldridge
- School of Medicine and Public Health; University of Wisconsin; Milwaukee Wisconsin
- Aurora Cardiovascular Services; Aurora Sinai/Aurora St. Luke's Medical Center; Milwaukee Wisconsin
| | - Birna Bjarnason-Wehrens
- Institute of Cardiology and Sports Medicine; German Sport University Cologne; Cologne Germany
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Oldridge N, Höfer S, McGee H, Conroy R, Doyle F, Saner H. The HeartQoL: part II. Validation of a new core health-related quality of life questionnaire for patients with ischemic heart disease. Eur J Prev Cardiol 2012; 21:98-106. [PMID: 22822180 DOI: 10.1177/2047487312450545] [Citation(s) in RCA: 126] [Impact Index Per Article: 10.5] [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: 11/16/2022]
Abstract
BACKGROUND Evaluation of health-related quality of life (HRQL) is important in improving the quality of patient care. The aim of this study was to determine the psychometric properties of the HeartQoL in patients with ischemic heart disease (IHD), specifically angina, myocardial infarction (MI), or ischemic heart failure. METHODS Data for the interim validation of the HeartQoL questionnaire were collected in (a) a cross-sectional survey and (b) a prospective substudy of patients undergoing either a percutaneous coronary intervention (PCI) or referred to cardiac rehabilitation (CR) and were then analyzed to determine the reliability, validity, and responsiveness of the HeartQoL questionnaire. RESULTS We enrolled 6384 patients (angina, n = 2111, 33.1%; MI, n = 2351, 36.8%; heart failure, n = 1922, 30.1%) across 22 countries speaking 15 languages in the cross-sectional study and 730 patients with IHD in the prospective substudy. The HeartQoL questionnaire comprises 14-items with physical and emotional subscales and a global score (range 0-3 (poor to better HRQL). Cronbach's α was consistently ≥0.80; convergent validity correlations between similar HeartQoL and SF-36 subscales were significant (r ≥ 0.60, p < 0.001); discriminative validity was confirmed with predictor variables: health transition, anxiety, depression, and functional status. HeartQoL score changes following either PCI or CR were significant (p < 0.001) with effect sizes ranging from 0.37-0.64. CONCLUSION The HeartQoL questionnaire is reliable, valid, and responsive to change allowing clinicians and researchers to (a) assess baseline HRQL, (b) make between-diagnosis comparisons of HRQL, and (c) evaluate change in HRQL in patients with angina, MI, or heart failure with a single IHD-specific HRQL instrument.
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Affiliation(s)
- Neil Oldridge
- School of Medicine and Public Health, University of Wisconsin, USA
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Oldridge N, Höfer S, McGee H, Conroy R, Doyle F, Saner H. The HeartQoL: Part I. Development of a new core health-related quality of life questionnaire for patients with ischemic heart disease. Eur J Prev Cardiol 2012; 21:90-7. [DOI: 10.1177/2047487312450544] [Citation(s) in RCA: 84] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Affiliation(s)
- Neil Oldridge
- School of Medicine and Public Health, University of Wisconsin, USA
- Aurora Cardiovascular Services, Aurora St. Luke’s Medical Center, USA
| | - Stefan Höfer
- Department of Medical Psychology, Innsbruck Medical University, Austria
| | - Hannah McGee
- Division of Population Health Sciences (Psychology), Royal College of Surgeons in Ireland, Ireland
| | - Ronan Conroy
- Division of Population Health Sciences (Epidemiology and Public Health Medicine), Royal College of Surgeons in Ireland, Ireland
| | - Frank Doyle
- Division of Population Health Sciences (Psychology), Royal College of Surgeons in Ireland, Ireland
| | - Hugo Saner
- Cardiovascular Prevention and Rehabilitation, Bern University Hospital, Switzerland
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Vandereyt F, Dendale P, Vanhees L, Roosen J, Höfer S, Oldridge N. Psychometric properties of the Flemish version of the MacNew heart disease health-related quality of life questionnaire. Acta Cardiol 2012; 67:31-9. [PMID: 22455087 DOI: 10.1080/ac.67.1.2146563] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Assessment of health-related quality of life, increasingly being used as an outcome measure in cardiovascular disease research studies and clinical practice, requires questionnaires with sound psychometric properties. The aim of this study was to evaluate the psychometric properties of the Flemish version of the MacNew Heart Disease Health-related Quality of Life questionnaire in Flemish-speaking Belgian patients. METHOD Between 2002 and 2008, as part of the international HeartQol Project, 344 Belgian patients with a diagnosis of angina, ischaemic heart failure or myocardial infarction completed the Flemish versions of the MacNew, the Short-Form 36 and the Hospital Anxiety and Depression Scale. Ceiling and floor effects of the MacNew were analysed. Internal consistency was assessed by Cronbach's a and reproducibility (intra-class correlation coefficients) was assessed in a subsample of patients over a 2-3 week period with repeated tests. Convergent validity (Pearson's correlation between MacNew and Short-Form 36 constructs) and discriminant validity ('known-group' approach) were tested. RESULTS The Flemish version of the MacNew appears to be a reliable instrument with a high internal consistency, demonstrating strong discriminative validity and satisfactory construct validity. The results of factor analysis are similar to the factor structure of the original MacNew explaining 59.8% of the total variance. CONCLUSION The Flemish version of the MacNew demonstrates good psychometric properties. It can be recommended as a specific instrument for assessing and evaluating health-related quality of life in Flemish-speaking patients in each of the three major ischaemic heart disease diagnoses: angina, ischaemic heart failure and myocardial infarction. However, responsiveness to change could not be tested in this cross-sectional study and should be further investigated in a larger sample of patients following an intervention likely to induce a change in health-related quality of life.
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Affiliation(s)
- Frank Vandereyt
- Rehabilitation and Health Centre, Hartcentrum Hasselt, Jessa Hospital, Hasselt, Belgium
| | - Paul Dendale
- Rehabilitation and Health Centre, Hartcentrum Hasselt, Jessa Hospital, Hasselt, Belgium
- University of Hasselt, Belgium
| | - Luc Vanhees
- Research Centre for Cardiovascular and Respiratory Rehabilitation, Department of Rehabilitation Sciences, Katholieke Universiteit Leuven, Belgium
| | - John Roosen
- Department of Cardiology, Imelda Hospital, Bonheiden, Belgium
| | - Stefan Höfer
- Innsbruck Medical University, Department of Medical Psychology, Innsbruck, Austria
| | - Neil Oldridge
- University of Wisconsin School of Medicine & Public Health and Aurora Cardiovascular Services, Aurora Sinai/Aurora St. Luke’s Medical Center, Milwaukee, Wisconsin, USA
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Höfer S, Saleem A, Stone J, Thomas R, Tulloch H, Oldridge N. The MacNew Heart Disease Health-Related Quality of Life Questionnaire in patients with angina and patients with ischemic heart failure. Value Health 2012; 15:143-50. [PMID: 22264982 DOI: 10.1016/j.jval.2011.07.003] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
OBJECTIVE Patient-reported outcomes including health-related quality of life are important in clinical care and research studies. The MacNew Heart Disease Health-Related Quality Of Life Questionnaire has been validated in English-speaking patients with myocardial infarction. The aim of this study was to validate the MacNew in English-speaking patients with angina or ischemic heart failure. METHODS Canadian and American patients with angina or ischemic heart failure completed the MacNew, the Short Form-36 Health Survey, and the Hospital Anxiety and Depression Scale. RESULTS We administered questionnaires to 276 patients with angina (mean age, 65.9 years) and 155 patients with ischemic heart failure (mean age, 70.3 years). The mean ± SD MacNew global score in patients with ischemic heart failure (5.1 ± 1.2) was statistically (P < 0.001), but not clinically, poorer than in patients with angina (5.3 ± 1.1). The three-factor measurement model explained 46.1% of the observed variance in the MacNew in patients with angina and 46.5% in patients with ischemic heart failure. Internal consistency was ≥0.90, and test-retest reliability was ≥0.70 for each MacNew scale and the a priori convergent and discriminative validity hypotheses were confirmed in both diagnoses. The MacNew was highly accepted by patients with little respondent or administrative burden. CONCLUSIONS The English version of the MacNew is reliable and valid in patients with angina or ischemic heart failure. This permits health-related quality of life outcome comparisons in patients with angina, ischemic heart failure, and myocardial infarction with the MacNew and provides a better understanding of the full range of health-related quality of life outcomes.
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Affiliation(s)
- Stefan Höfer
- Department of Medical Psychology, Innsbruck Medical University, Innsbruck, Austria.
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Wicks J, Oldridge N, Nielsen L, Vickers C. An Equation Allowing Heart Rate Index to be Used as a Predictor of Oxygen Uptake. Heart Lung Circ 2012. [DOI: 10.1016/j.hlc.2012.05.757] [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: 10/28/2022]
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Kupper N, Pedersen SS, Höfer S, Saner H, Oldridge N, Denollet J. Cross-cultural analysis of type D (distressed) personality in 6222 patients with ischemic heart disease: a study from the International HeartQoL Project. Int J Cardiol 2011; 166:327-33. [PMID: 22078395 DOI: 10.1016/j.ijcard.2011.10.084] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2011] [Accepted: 10/18/2011] [Indexed: 10/15/2022]
Abstract
BACKGROUND Type D (distressed) personality, the conjoint effect of negative affectivity (NA) and social inhibition (SI), predicts adverse cardiovascular outcomes, and is assessed with the 14-item Type D Scale (DS14). However, potential cross-cultural differences in Type D have not been examined yet in a direct comparison of countries. AIM To examine the cross-cultural validity of the Type D construct and its relation with cardiovascular risk factors, cardiac symptom severity, and depression/anxiety. METHODS In 22 countries, 6222 patients with ischemic heart disease (angina, 33%; myocardial infarction, 37%; or heart failure, 30%) completed the DS14 as part of the International HeartQoL Project. RESULTS Type D personality was assessed reliably across countries (αNA>.80; αSI>.74; except Russia, which was excluded from further analysis). Cross-cultural measurement equivalence was established for Type D personality at all measurement levels, as the factor-item configuration, factor loadings, and error structure were not different across countries (fit: CFI=.91; NFI=.88; RMSEA=.018), as well as across gender and diagnostic subgroups. Type D personality was more prevalent in Southern (37%) and Eastern (35%) European countries compared to Northern (24%) and Western European and English-speaking (both 27%) countries (p<.001). Type D was not confounded by cardiac symptom severity, but was associated with a higher prevalence of hypertension, smoking, sedentary lifestyle, and depression. CONCLUSION Cross-cultural measurement equivalence was demonstrated for the Type D scale in 21 countries. There is a pan-cultural relationship between Type D personality and some cardiovascular risk factors, supporting the role of Type D personality across countries and cardiac conditions.
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Affiliation(s)
- Nina Kupper
- Tilburg University, Tilburg, The Netherlands.
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Abstract
BACKGROUND The burden of coronary heart disease (CHD) worldwide is one of great concern to patients and healthcare agencies alike. Exercise-based cardiac rehabilitation aims to restore patients with heart disease to health. OBJECTIVES To determine the effectiveness of exercise-based cardiac rehabilitation (exercise training alone or in combination with psychosocial or educational interventions) on mortality, morbidity and health-related quality of life of patients with CHD. SEARCH STRATEGY RCTs have been identified by searching CENTRAL, HTA, and DARE (using The Cochrane Library Issue 4, 2009), as well as MEDLINE (1950 to December 2009), EMBASE (1980 to December 2009), CINAHL (1982 to December 2009), and Science Citation Index Expanded (1900 to December 2009). SELECTION CRITERIA Men and women of all ages who have had myocardial infarction (MI), coronary artery bypass graft (CABG) or percutaneous transluminal coronary angioplasty (PTCA), or who have angina pectoris or coronary artery disease defined by angiography. DATA COLLECTION AND ANALYSIS Studies were selected and data extracted independently by two reviewers. Authors were contacted where possible to obtain missing information. MAIN RESULTS This systematic review has allowed analysis of 47 studies randomising 10,794 patients to exercise-based cardiac rehabilitation or usual care. In medium to longer term (i.e. 12 or more months follow-up) exercise-based cardiac rehabilitation reduced overall and cardiovascular mortality [RR 0.87 (95% CI 0.75, 0.99) and 0.74 (95% CI 0.63, 0.87), respectively], and hospital admissions [RR 0.69 (95% CI 0.51, 0.93)] in the shorter term (< 12 months follow-up) with no evidence of heterogeneity of effect across trials. Cardiac rehabilitation did not reduce the risk of total MI, CABG or PTCA. Given both the heterogeneity in outcome measures and methods of reporting findings, a meta-analysis was not undertaken for health-related quality of life. In seven out of 10 trials reporting health-related quality of life using validated measures was there evidence of a significantly higher level of quality of life with exercise-based cardiac rehabilitation than usual care. AUTHORS' CONCLUSIONS Exercise-based cardiac rehabilitation is effective in reducing total and cardiovascular mortality (in medium to longer term studies) and hospital admissions (in shorter term studies) but not total MI or revascularisation (CABG or PTCA). Despite inclusion of more recent trials, the population studied in this review is still predominantly male, middle aged and low risk. Therefore, well-designed, and adequately reported RCTs in groups of CHD patients more representative of usual clinical practice are still needed. These trials should include validated health-related quality of life outcome measures, need to explicitly report clinical events including hospital admission, and assess costs and cost-effectiveness.
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Affiliation(s)
- Balraj S Heran
- Department of Anesthesiology, Pharmacology and Therapeutics, University of British Columbia, Vancouver, Canada
| | - Jenny MH Chen
- Department of Anesthesiology, Pharmacology and Therapeutics, University of British Columbia, Vancouver, Canada
| | - Shah Ebrahim
- Department of Non-communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Tiffany Moxham
- Wimberly Library, Florida Atlantic University, Boca Raton, Florida, USA
| | - Neil Oldridge
- University of Wisconsin School of Medicine & Public Health and Aurora Cardiovascular Services, Aurora Sinai/Aurora St. Luke’s Medical Center, Milwaukee, Wisconsin, USA
| | - Karen Rees
- Health Sciences Research Institute, Warwick Medical School, University of Warwick, Coventry, UK
| | - David R Thompson
- Cardiovascular Research Centre, Australian Catholic University, Melbourne, Australia
| | - Rod S Taylor
- Peninsula College of Medicine and Dentistry, Universities of Exeter & Plymouth, Exeter, UK
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Oldridge N, Höfer S, Saleem A, Stone J, Thomas R, Tulloch H. The MacNew Heart Disease Health-related Quality Of Life Questionnaire In Patients With Angina And Patients With Ischemic Heart Failure. Med Sci Sports Exerc 2011. [DOI: 10.1249/01.mss.0000403002.12724.56] [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: 11/21/2022]
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Reid RD, Morrin LI, Higginson LAJ, Wielgosz A, Blanchard C, Beaton LJ, Nelson C, McDonnell L, Oldridge N, Wells GA, Pipe AL. Motivational counselling for physical activity in patients with coronary artery disease not participating in cardiac rehabilitation. Eur J Prev Cardiol 2011; 19:161-6. [PMID: 21450579 DOI: 10.1177/1741826711400519] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Many patients with coronary artery disease (CAD) fail to attend cardiac rehabilitation following acute coronary events because they lack motivation to exercise. Theory-based approaches to promote physical activity among non-participants in cardiac rehabilitation are required. DESIGN A randomized trial comparing physical activity levels at baseline, 6, and 12 months between a motivational counselling (MC) intervention group and a usual care (UC) control group. METHOD One hundred and forty-one participants hospitalized with acute coronary syndromes not planning to attend cardiac rehabilitation were recruited at a single centre and randomized to either MC (n = 69) or UC (n = 72). The MC intervention, designed from an ecological perspective, included one face-to-face contact and eight telephone contacts with a trained physiotherapist over a 52-week period. The UC group received written information about starting a walking programme and brief physical activity advice from their attending cardiologist. Physical activity was measured by: 7-day physical activity recall interview; self-report questionnaire; and pedometer at baseline, 6, and 12 months after randomization. RESULTS Latent growth curve analyses, which combined all three outcome measures into a single latent construct, showed that physical activity increased more over time in the MC versus the UC group (µ(add) = 0.69, p < 0.05). CONCLUSION Patients with CAD not participating in cardiac rehabilitation receiving a theory-based motivational counselling intervention were more physically active at follow-up than those receiving usual care. This intervention may extend the reach of cardiac rehabilitation by increasing physical activity in those disinclined to participate in structured programmes.
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Affiliation(s)
- Robert D Reid
- Minto Prevention and Rehabilitation Centre, University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, Ontario, Canada.
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Thomas RJ, King M, Lui K, Oldridge N, Piña IL, Spertus J, Masoudi FA, DeLong E, Erwin JP, Goff DC, Grady K, Green LA, Heidenreich PA, Jenkins KJ, Loth AR, Peterson ED, Shahian DM. Reprint--AACVPR/ACCF/AHA 2010 update: performance measures on cardiac rehabilitation for referral to cardiac rehabilitation/secondary prevention services: a report of the American Association of Cardiovascular and Pulmonary Rehabilitation and the American College of Cardiology Foundation/American Heart Association Task Force on Performance Measures (Writing Committee to Develop Clinical Performance Measures for Cardiac Rehabilitation). Phys Ther 2010; 90:1373-82. [PMID: 20889928 DOI: 10.1093/ptj/90.10.1373] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Endorsed by the American College of Chest Physicians, the American College of Sports Medicine, the American Physical Therapy Association, the Canadian Association of Cardiac Rehabilitation, the European Association for Cardiovascular Prevention and Rehabilitation, the Inter-American Heart Foundation, the National Association of Clinical Nurse Specialists, the Preventive Cardiovascular Nurses Association, and the Society of Thoracic Surgeons.
This document was approved by the American College of Cardiology Foundation Executive Committee in April 2010, by the American Heart Association Science Advisory and Coordinating Committee in April 2010, and by the AACVPR Document Oversight Committee and Board of Directors in June 2010.
The American College of Cardiology Foundation requests that this document be cited as follows: Thomas RJ, King M, Lui K, Oldridge N, Piña IL, Spertus J. AACVPR/ACC/AHA 2010 update: performance measures on cardiac rehabilitation for referral to cardiac rehabilitation/secondary prevention services. J Am Coll Cardiol 2010;56:1159–1167.
This article is copublished in Circulation and the Journal of Cadiopulmonary Rehabilitation and Prevention.
Copyright ©2010 by the American Association of Cardiovascular and Pulmonary Rehabilitation, American College of Cardiology Foundation, and American Heart Association, Inc. Published by Elsevier Inc.
CPT™ contained in the online data supplement is ©2009 American Medical Association.
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Affiliation(s)
- Randal J. Thomas
- R.J. Thomas, MD, MS, FAACVPR, FACC, FAHA, is Chair of the Writing Committee; and M. King, MD, FAACVPR, FACC, K. Lui, RN, MS, FAACVPR, N. Oldridge, PhD, FAACVPR, FACSM, I.L. Piña, MD, FACC, and J. Spertus, MD, MPH, FACC, are Members of the Writing Committee
| | - Marjorie King
- R.J. Thomas, MD, MS, FAACVPR, FACC, FAHA, is Chair of the Writing Committee; and M. King, MD, FAACVPR, FACC, K. Lui, RN, MS, FAACVPR, N. Oldridge, PhD, FAACVPR, FACSM, I.L. Piña, MD, FACC, and J. Spertus, MD, MPH, FACC, are Members of the Writing Committee
| | - Karen Lui
- R.J. Thomas, MD, MS, FAACVPR, FACC, FAHA, is Chair of the Writing Committee; and M. King, MD, FAACVPR, FACC, K. Lui, RN, MS, FAACVPR, N. Oldridge, PhD, FAACVPR, FACSM, I.L. Piña, MD, FACC, and J. Spertus, MD, MPH, FACC, are Members of the Writing Committee
| | - Neil Oldridge
- R.J. Thomas, MD, MS, FAACVPR, FACC, FAHA, is Chair of the Writing Committee; and M. King, MD, FAACVPR, FACC, K. Lui, RN, MS, FAACVPR, N. Oldridge, PhD, FAACVPR, FACSM, I.L. Piña, MD, FACC, and J. Spertus, MD, MPH, FACC, are Members of the Writing Committee
| | - Ileana L. Piña
- R.J. Thomas, MD, MS, FAACVPR, FACC, FAHA, is Chair of the Writing Committee; and M. King, MD, FAACVPR, FACC, K. Lui, RN, MS, FAACVPR, N. Oldridge, PhD, FAACVPR, FACSM, I.L. Piña, MD, FACC, and J. Spertus, MD, MPH, FACC, are Members of the Writing Committee
| | - John Spertus
- R.J. Thomas, MD, MS, FAACVPR, FACC, FAHA, is Chair of the Writing Committee; and M. King, MD, FAACVPR, FACC, K. Lui, RN, MS, FAACVPR, N. Oldridge, PhD, FAACVPR, FACSM, I.L. Piña, MD, FACC, and J. Spertus, MD, MPH, FACC, are Members of the Writing Committee
| | - Frederick A. Masoudi
- F.A. Masoudi, MD, MSPH, FACC, FAHA, is Chair of the ACCF/AHA Task Force on Performance Measures; and E. DeLong, PhD, J.P. Erwin III, MD, FACC, D.C. Goff Jr, MD, PhD, FAHA, FACP, K. Grady, PhD, RN, FAHA, FAAN, L.A. Green, MD, MPH, P.A. Heidenreich, MD, FACC, K.J. Jenkins, MD, MPH, FACC, A.R. Loth, RN, MS, CNS, E.D. Peterson, MD, MPH, FACC, FAHA, and D.M. Shahian, MD, FACC, are Members of the ACCF/
| | - Elizabeth DeLong
- F.A. Masoudi, MD, MSPH, FACC, FAHA, is Chair of the ACCF/AHA Task Force on Performance Measures; and E. DeLong, PhD, J.P. Erwin III, MD, FACC, D.C. Goff Jr, MD, PhD, FAHA, FACP, K. Grady, PhD, RN, FAHA, FAAN, L.A. Green, MD, MPH, P.A. Heidenreich, MD, FACC, K.J. Jenkins, MD, MPH, FACC, A.R. Loth, RN, MS, CNS, E.D. Peterson, MD, MPH, FACC, FAHA, and D.M. Shahian, MD, FACC, are Members of the ACCF/
| | - John P. Erwin
- F.A. Masoudi, MD, MSPH, FACC, FAHA, is Chair of the ACCF/AHA Task Force on Performance Measures; and E. DeLong, PhD, J.P. Erwin III, MD, FACC, D.C. Goff Jr, MD, PhD, FAHA, FACP, K. Grady, PhD, RN, FAHA, FAAN, L.A. Green, MD, MPH, P.A. Heidenreich, MD, FACC, K.J. Jenkins, MD, MPH, FACC, A.R. Loth, RN, MS, CNS, E.D. Peterson, MD, MPH, FACC, FAHA, and D.M. Shahian, MD, FACC, are Members of the ACCF/
| | - David C. Goff
- F.A. Masoudi, MD, MSPH, FACC, FAHA, is Chair of the ACCF/AHA Task Force on Performance Measures; and E. DeLong, PhD, J.P. Erwin III, MD, FACC, D.C. Goff Jr, MD, PhD, FAHA, FACP, K. Grady, PhD, RN, FAHA, FAAN, L.A. Green, MD, MPH, P.A. Heidenreich, MD, FACC, K.J. Jenkins, MD, MPH, FACC, A.R. Loth, RN, MS, CNS, E.D. Peterson, MD, MPH, FACC, FAHA, and D.M. Shahian, MD, FACC, are Members of the ACCF/
| | - Kathleen Grady
- F.A. Masoudi, MD, MSPH, FACC, FAHA, is Chair of the ACCF/AHA Task Force on Performance Measures; and E. DeLong, PhD, J.P. Erwin III, MD, FACC, D.C. Goff Jr, MD, PhD, FAHA, FACP, K. Grady, PhD, RN, FAHA, FAAN, L.A. Green, MD, MPH, P.A. Heidenreich, MD, FACC, K.J. Jenkins, MD, MPH, FACC, A.R. Loth, RN, MS, CNS, E.D. Peterson, MD, MPH, FACC, FAHA, and D.M. Shahian, MD, FACC, are Members of the ACCF/
| | - Lee A. Green
- F.A. Masoudi, MD, MSPH, FACC, FAHA, is Chair of the ACCF/AHA Task Force on Performance Measures; and E. DeLong, PhD, J.P. Erwin III, MD, FACC, D.C. Goff Jr, MD, PhD, FAHA, FACP, K. Grady, PhD, RN, FAHA, FAAN, L.A. Green, MD, MPH, P.A. Heidenreich, MD, FACC, K.J. Jenkins, MD, MPH, FACC, A.R. Loth, RN, MS, CNS, E.D. Peterson, MD, MPH, FACC, FAHA, and D.M. Shahian, MD, FACC, are Members of the ACCF/
| | - Paul A. Heidenreich
- F.A. Masoudi, MD, MSPH, FACC, FAHA, is Chair of the ACCF/AHA Task Force on Performance Measures; and E. DeLong, PhD, J.P. Erwin III, MD, FACC, D.C. Goff Jr, MD, PhD, FAHA, FACP, K. Grady, PhD, RN, FAHA, FAAN, L.A. Green, MD, MPH, P.A. Heidenreich, MD, FACC, K.J. Jenkins, MD, MPH, FACC, A.R. Loth, RN, MS, CNS, E.D. Peterson, MD, MPH, FACC, FAHA, and D.M. Shahian, MD, FACC, are Members of the ACCF/
| | - Kathy J. Jenkins
- F.A. Masoudi, MD, MSPH, FACC, FAHA, is Chair of the ACCF/AHA Task Force on Performance Measures; and E. DeLong, PhD, J.P. Erwin III, MD, FACC, D.C. Goff Jr, MD, PhD, FAHA, FACP, K. Grady, PhD, RN, FAHA, FAAN, L.A. Green, MD, MPH, P.A. Heidenreich, MD, FACC, K.J. Jenkins, MD, MPH, FACC, A.R. Loth, RN, MS, CNS, E.D. Peterson, MD, MPH, FACC, FAHA, and D.M. Shahian, MD, FACC, are Members of the ACCF/
| | - Ann R. Loth
- F.A. Masoudi, MD, MSPH, FACC, FAHA, is Chair of the ACCF/AHA Task Force on Performance Measures; and E. DeLong, PhD, J.P. Erwin III, MD, FACC, D.C. Goff Jr, MD, PhD, FAHA, FACP, K. Grady, PhD, RN, FAHA, FAAN, L.A. Green, MD, MPH, P.A. Heidenreich, MD, FACC, K.J. Jenkins, MD, MPH, FACC, A.R. Loth, RN, MS, CNS, E.D. Peterson, MD, MPH, FACC, FAHA, and D.M. Shahian, MD, FACC, are Members of the ACCF/
| | - Eric D. Peterson
- F.A. Masoudi, MD, MSPH, FACC, FAHA, is Chair of the ACCF/AHA Task Force on Performance Measures; and E. DeLong, PhD, J.P. Erwin III, MD, FACC, D.C. Goff Jr, MD, PhD, FAHA, FACP, K. Grady, PhD, RN, FAHA, FAAN, L.A. Green, MD, MPH, P.A. Heidenreich, MD, FACC, K.J. Jenkins, MD, MPH, FACC, A.R. Loth, RN, MS, CNS, E.D. Peterson, MD, MPH, FACC, FAHA, and D.M. Shahian, MD, FACC, are Members of the ACCF/
| | - David M. Shahian
- F.A. Masoudi, MD, MSPH, FACC, FAHA, is Chair of the ACCF/AHA Task Force on Performance Measures; and E. DeLong, PhD, J.P. Erwin III, MD, FACC, D.C. Goff Jr, MD, PhD, FAHA, FACP, K. Grady, PhD, RN, FAHA, FAAN, L.A. Green, MD, MPH, P.A. Heidenreich, MD, FACC, K.J. Jenkins, MD, MPH, FACC, A.R. Loth, RN, MS, CNS, E.D. Peterson, MD, MPH, FACC, FAHA, and D.M. Shahian, MD, FACC, are Members of the ACCF/
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Thomas RJ, King M, Lui K, Oldridge N, Piña IL, Spertus J. AACVPR/ACCF/AHA 2010 Update: Performance Measures on Cardiac Rehabilitation for Referral to Cardiac Rehabilitation/Secondary Prevention Services. Circulation 2010; 122:1342-50. [DOI: 10.1161/cir.0b013e3181f5185b] [Citation(s) in RCA: 81] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Allaqaband S, Jan MF, Banday WY, Schlemm A, Ahmed SH, Mori N, Oldridge N, Gupta A, Bajwa T. Impact of 24-hr in-hospital interventional cardiology team on timeliness of reperfusion for ST-segment elevation myocardial infarction. Catheter Cardiovasc Interv 2010; 75:1015-23. [PMID: 20517963 DOI: 10.1002/ccd.22419] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE We studied the effect of 24 hr a day, 7 days a week interventional cardiology staff on door-to-balloon (D2B) time and mortality in patients undergoing primary percutaneous coronary intervention (PPCI) for ST-segment elevation myocardial infarction (STEMI). BACKGROUND Any delay in PPCI in acute STEMI is associated with higher mortality and, therefore, time to treatment should be as short as possible. Despite the use of several strategies, goal D2B time of <90 min remains elusive. METHODS The study examined 790 consecutive STEMI patients treated with PPCI as the reperfusion therapy of choice. Patients were grouped into a pre-24 x 7 and post-24 x 7 cohort to study the impact of the new protocol on D2B time and major adverse cardiovascular events (MACE) and mortality. RESULTS Median D2B time decreased from 99 min in the pre-24 x 7 group to 55 min in the post-24 x 7 group (P = 0.001) and was not influenced by time of day or day of week. Adjusted for patient and clinical characteristics, the pre-24 x 7 group had increased in-hospital cardiovascular mortality (odds ratio 1.94, 95% confidence interval 0.95-3.94; P = 0.048) and MACE (odds ratio 1.66, 95% confidence interval 1.10-2.49; P = 0.009) compared with the post-24 x 7 group. Prolonged D2B time was also associated with higher 1-year overall mortality in the pre-24 x 7 group compared with the post-24 x 7 group (12.8% vs. 8.1%; hazard ratio 1.17, 95% confidence interval 1.04-2.66; P = 0.044). CONCLUSIONS Round-the-clock, in-hospital interventional cardiology team consistently and significantly reduces D2B time, in-hospital cardiovascular mortality, MACE, and 1-year mortality in patients with STEMI.
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Thomas RJ, King M, Lui K, Oldridge N, Piña IL, Spertus J. AACVPR/ACCF/AHA 2010 Update: Performance Measures on Cardiac Rehabilitation for Referral to Cardiac Rehabilitation/Secondary Prevention Services. J Am Coll Cardiol 2010; 56:1159-67. [DOI: 10.1016/j.jacc.2010.06.006] [Citation(s) in RCA: 96] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abbatt J, Oldridge N, Symington A, Chukalovskiy V, McWhinney R, Sjostedt S, Cox R. Release of Gas-Phase Halogens by Photolytic Generation of OH in Frozen Halide−Nitrate Solutions: An Active Halogen Formation Mechanism? J Phys Chem A 2010; 114:6527-33. [DOI: 10.1021/jp102072t] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- J. Abbatt
- Department of Chemistry, University of Toronto, 80 St. George St., Toronto, ON, M5S 3H6, and Department of Chemistry, University of Cambridge, Lensfield Road, Cambridge, U.K., CB2 1EW
| | - N. Oldridge
- Department of Chemistry, University of Toronto, 80 St. George St., Toronto, ON, M5S 3H6, and Department of Chemistry, University of Cambridge, Lensfield Road, Cambridge, U.K., CB2 1EW
| | - A. Symington
- Department of Chemistry, University of Toronto, 80 St. George St., Toronto, ON, M5S 3H6, and Department of Chemistry, University of Cambridge, Lensfield Road, Cambridge, U.K., CB2 1EW
| | - V. Chukalovskiy
- Department of Chemistry, University of Toronto, 80 St. George St., Toronto, ON, M5S 3H6, and Department of Chemistry, University of Cambridge, Lensfield Road, Cambridge, U.K., CB2 1EW
| | - R.D. McWhinney
- Department of Chemistry, University of Toronto, 80 St. George St., Toronto, ON, M5S 3H6, and Department of Chemistry, University of Cambridge, Lensfield Road, Cambridge, U.K., CB2 1EW
| | - S. Sjostedt
- Department of Chemistry, University of Toronto, 80 St. George St., Toronto, ON, M5S 3H6, and Department of Chemistry, University of Cambridge, Lensfield Road, Cambridge, U.K., CB2 1EW
| | - R.A. Cox
- Department of Chemistry, University of Toronto, 80 St. George St., Toronto, ON, M5S 3H6, and Department of Chemistry, University of Cambridge, Lensfield Road, Cambridge, U.K., CB2 1EW
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Nakajima KM, Rodrigues RCM, Gallani MCBJ, Alexandre NMC, Oldridge N. Psychometric properties of MacNew Heart Disease Health-related Quality of Life Questionnaire: Brazilian version. J Adv Nurs 2009; 65:1084-94. [DOI: 10.1111/j.1365-2648.2009.04962.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Höfer S, Schmid JP, Frick M, Benzer W, Laimer H, Oldridge N, Saner H. Psychometric properties of the MacNew heart disease health-related quality of life instrument in patients with heart failure. J Eval Clin Pract 2008; 14:500-6. [PMID: 18462292 DOI: 10.1111/j.1365-2753.2007.00905.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
RATIONALE, AIMS AND OBJECTIVES Heart failure (HF) is a severe chronic disease and impairs health-related quality of life (HRQL). While validated specific HRQL instruments are required for evaluation of treatment and rehabilitation in patients with HF, a single validated measure to document changes in HRQL for patients with different heart disease diagnoses would be invaluable. The purpose of this analysis was the psychometric analysis of the German MacNew Heart Disease Questionnaire (MacNew) in HF patients, which has previously been shown to be reliable and valid in patients with myocardial infarction, angina pectoris and arrhythmia. METHODS We recruited 89 patients (61.7+/-11.5 years; 84.3% male) in two Austrian and one Swiss cardiology department with documented HF (effect sizes 28.9+/-10.1%). The self-administered MacNew, the Short Form-36 (SF-36) and the Hospital Anxiety and Depression Scale were completed. Internal consistency reliability (Cronbach's alpha), discriminative and evaluative validity were assessed. RESULTS Cronbach's alpha exceeded 0.80. Each MacNew scale differentiated between patients with and without anxiety (3.9+/-1.0 vs. 5.3+/-0.8, all P<0.001), with and without depression (4.2+/-1.2 vs. 5.2+/-0.9 all P<0.03) and by the SF-36 health transition item (deteriorate=4.39, no change=4.95, improve=5.45, all P<0.02). Evaluative validity was demonstrated with effect sizes >0.70 for a subsample attending a 12-week outpatient rehabilitation programme. CONCLUSIONS The German language version of the MacNew demonstrates consistently acceptable psychometric properties of reliability, validity and responsiveness in patients with documented HF. Together with previous documentation of reliability, validity and responsive, these findings strengthen the argument for the MacNew as a potential 'core' HRQL measure, at least in the German language.
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Affiliation(s)
- Stefan Höfer
- Department of Medical Psychology and Psychotherapy, Medical University Innsbruck, Austria.
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Daskapan A, Höfer S, Oldridge N, Alkan N, Muderrisoglu H, Tuzun EH. The validity and reliability of the Turkish version of the MacNew Heart Disease Questionnaire in patients with angina. J Eval Clin Pract 2008; 14:209-13. [PMID: 18093106 DOI: 10.1111/j.1365-2753.2007.00834.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
AIMS AND OBJECTIVES Health-related quality of life (HRQL) is an important patient-reported outcome when identifying the effects of the angina and evaluating the efficacy of treatment. The aim of this study was to determine the reliability and validity of the Turkish version of the MacNew Heart Disease HRQL Questionnaire (MacNew) in patients with angina. METHOD The Short Form SF-36, the MacNew, and the Hospital Anxiety and Depression Scale were completed by the 125 patients in first 2-3 days after admission to the coronary care unit. Internal consistency reliability (Cronbach's alpha) and reproducibility (intraclass correlation coefficients, ICC) of the MacNew were assessed, and test-retest reproducibility was evaluated over a 2-month period in 25 clinically stable patients. RESULTS The original three-factor structure for the Turkish MacNew was confirmed, with construct validity only partially confirmed; reliability statistics show that Cronbach's alpha exceeded 0.80 and the ICC exceeded 0.60 for all MacNew scales. Discriminative validity of the MacNew was confirmed. CONCLUSION The MacNew appears to be reliable and valid in Turkish patients with angina.
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Affiliation(s)
- Arzu Daskapan
- Baskent University, Faculty of Health Science, Department of Physical Therapy and Rehabilitation, Ankara, Turkey.
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Thomas RJ, King M, Lui K, Oldridge N, Piña IL, Spertus J. AACVPR/ACC/AHA 2007 performance measures on cardiac rehabilitation for referral to and delivery of cardiac rehabilitation/secondary prevention services. J Cardiopulm Rehabil Prev 2008; 27:260-90. [PMID: 17885506 DOI: 10.1097/01.hcr.0000291295.24776.7b] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Djelmami-Hani M, Mouanoutoua M, Hashim A, Solis J, Bergen L, Oldridge N, Egbujiobi LC, Allaqaband S, Akhtar M, Bajwa T. Elective percutaneous coronary intervention without on-site surgical backup: a community hospital experience. WMJ 2007; 106:481-485. [PMID: 18237072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
CONTEXT The American College of Cardiology guidelines consider elective percutaneous coronary intervention (PCI) without on-site surgical backup (OSB) a Class-III indication. OBJECTIVE Our objective was to determine the safety of elective PCI without OSB. DESIGN The study is a prospective analysis of a cohort of patients who underwent elective PCI without OSB at our institution. All patients were at our community satellite institution in Beloit, Wis. Three hundred twenty-one elective interventions were performed (mean age 64 +/-12, 68% male). The prevalence of diabetes and hypertension was 28% and 82.5% respectively. INTERVENTION A predefined protocol was designed to transfer patients to a cardiac surgical facility if necessary. An experienced interventional cardiologist reviewed the diagnostic angiograms. Patients with complex lesions were excluded from the study. MAIN OUTCOME MEASURE Any procedure-related death or emergency coronary artery bypass graft surgery. RESULTS Three hundred eighty-two vessels were stented. Multi-vessel intervention was performed in 61 patients (19%). Only 5% of lesions were type C. Four hundred thirty-seven stents were deployed. IIb-IIIa inhibitors were used in 77 (24%) cases. Procedural success was 99.7%. There were no deaths, myocardial infarctions nor need for urgent target vessel revascularization at 6 months. CONCLUSION With careful patient/lesion selection, an experienced interventional cardiologist and a predefined transfer protocol, elective PCI without OSB can be performed safely.
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Affiliation(s)
- M Djelmami-Hani
- Aurora Sinai/Aurora St. Luke's Medical Centers, University of Wisconsin School of Medicine and Public Health, Milwaukee Clinical Campus, Milwaukee, Wis, USA
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