Beginning Of Cardiac Rehabilitation Research Articles

Changes in functional capacity after a cardiac rehabilitation program in Spain: defining the profile of those who improve

Abstract Background Improvement in functional capacity (FC) is one of the most notable benefits patients experience after cardiac rehabilitation (CR) and it is highly important as low levels of FC are associated with a high risk of cardiovascular (CV) disease and all cause mortality. Purpose To study the changes in FC after a CR program in Spain and to define the profile of those patients that improve. Methods Single-centre observational study from 793 patients with ischaemic heart disease (15.3% women, age 61.79±10.70 years), participating in a CR program from 2015 to 2020 with a stress test performed, both at beginning of CR (conventional stress test, n=436; CPET, n=340; imaging stress test, n=17) and at end of CR (conventional stress test, n=468; CPET, n=322; imaging stress test, n=3). A comparative analysis of patients with “improved FC” and “non-improved FC” at end of CR, was performed. Relevant clinical improvement was defined as a 10% increase of VO2, in accordance with reviewed literature. Additionally, a descriptive analysis of patient exercise capacity parameters was performed at beginning of CR and at end CR, for the complete sample. Results A total of 1586 exercise tests were analysed. All exercise capacity parameters analysed showed significant improvement at end of CR, with p values <0.01, (Graph 1). Clinically relevant FC improvement was observed in 54.2% of patients that participated in CR; 45.5% of all women and 55.8% of all men. Patients that improved FC completed significantly more CR training sessions (p<0.05) than those who did not improve FC (21.39±4.53, 20.37±5.84). Those who improved FC were significantly older (62.74±10.90), presented with significantly more STEMI (n=197, 45.8%), and achieved significantly less METS (7.42±3.01) at baseline, (p<0.05, Table 1). Conclusions Our CR rehabilitation program improves patient's functional capacity significantly. Patients with clinically relevant functional capacity improvement, are significantly older patients with STEMI as diagnosis at CV event, complete significantly more CR training sessions and showed significantly worst physical performance (METS) at baseline. Funding Acknowledgement Type of funding sources: None.

Changes in smoking status after a cardiac rehabilitation program in Spain: description of a smoker's profile

Abstract Background Cigarette smoking is a major cardiovascular (CV) risk factor and aids to the development and progression of CV disease. Purpose To study the prevalence of smoking in a contemporary Spanish cardiac rehabilitation (CR) cohort, study changes in smoking status over time and define smoker's profile after CR. Methods Single-centre, observational retrospective study from all consecutive patients with ischaemic heart disease (n=1379, 6.6% women, age 65.78±11.02 years) that participated in a CR program from 2015 to 2020. Prevalence of smokers was studied over time, from CV event to 6 months after end of CR, including a stratified description of smokers per age group at CV event. Additionally, a comparative analysis of patient profile for those who continued smoking and patients that quitted smoking after CR, was performed. Results N=516 patients (37.4%) were active smokers at CV event, including 72 women (31% of all women) and 444 men (38.6% of all men). Highest percentage of smokers was distributed among the youngest age groups: with a 72.6% prevalence among those aged <45 years and 57.9% among those aged 45–55 years. Smoking prevalence decreased with age. Also, there were less female than male smokers in all analysed age groups (Figure 1). At the beginning of CR, the global proportion of active smokers decreased significantly (p<0.01) to a 15.3% (n=210) and continued to significantly decrease at end of CR (10%, n=124), maintaining similar levels at 6 months follow-up (9.9%, n=96). 58% of active smokers at CV event quitted smoking by end of CR. Ongoing smokers were significantly more (p<0.05) depressed (n=20, 16.3%); and had significantly worse (p<0.05) HADS scores at beginning of CR (anxiety: 6.49±3.98, depression: 5.41±4.46), Table 1. Conclusions Smoking is nowadays still highly prevalent among CR patients in our setting, especially among young men. Despite a significant fall in the prevalence of smokers after the end of the CR program, there is a non-negligible percentage of patients that keep smoking. Targeted smoking cessation interventions should be aimed at smokers that have more depression and have worse HADS scores at baseline. Funding Acknowledgement Type of funding sources: None.

Effects of Phase II Cardiac Rehabilitation on Physical Function and Anxiety Levels in Frail Patients.

Background: Frailty is an important prognostic factor in patients with cardiovascular diseases (CVD), and patients with CVD have a high rate of concurrent psycho-emotional stress, as well as depressive mood and anxiety symptoms. Despite this, few reports have examined the effects of the efficacy of Phase II cardiac rehabilitation (CR) in frail patients, including improvements in anxiety levels.Methods and Results: In all, 137 patients (mean [±SD] age 65.8±13.0 years; 71% male) who participated in Phase II CR and were assessed after CR completion were included in this study. Patients were evaluated using the Kihon Checklist (KCL) form at the beginning of CR and were divided into the 3 groups according to KCL scores: frail (n=34, 25%), pre-frail (n=40, 29%), and non-frail (n=63, 46%). Physical function and anxiety levels were compared among the 3 groups. The pre-frail and frail groups had significantly higher state anxiety and trait anxiety than the non-frail group (P<0.01). At the end of Phase II CR, all 3 groups showed significant improvements in the 6-min walking distance (P<0.05). State anxiety improved significantly in the non-frail and pre-frail groups, whereas trait anxiety only improved in the non-frail group.Conclusions: Physical function was improved in frail patients who participated in Phase II CR. However, there was no significant improvement in their level of anxiety.

E valuation of M aintained Physic A l Ca P acity 1-yr After Coronary Patient Cardiac Rehabilitation (EMAP) : A FRENCH MULTICENTER STUDY.

Data are scarce concerning the sustainable effects of cardiac rehabilitation (CR), on cardiorespiratory fitness (CRF) of patients with coronary artery disease (CAD). This study, carried out using data from a French multicenter study, aimed to clarify the evolution of the CRF of patients with CAD 1 yr after the end of a CR stay. Patients were included after an acute coronary syndrome (77%) and/or coronary revascularization, occurring <3 mo beforehand. All underwent a CR program with CRF evaluation by exercise testing (ET) on a cycle ergometer at the beginning of CR (ET1), at its end (ET2), and 1 yr later (ET3)-all ETs were performed with medication. Two hundred fifty-nine patients were included (age 60 ± 10 yr, 89% male) in 16 French CR centers. Left ventricular ejection fraction was 55.3 ± 9%. Revascularization was complete (82%). Maximal workloads were 110 ± 37 (ET1), 139 ± 43 (ET2), and 144 ± 46 W (ET3) ( P < .001). The estimated metabolic equivalents of the task (METs) were respectively 5.3 ± 1.4, 6.4 ± 1.6 ( P < .001), and 6.6 ± 1.7 ( P < .002). One year later, 163 patients (63%) improved or maintained their CRF (ET3 ≥ ET2), 73 (28%) decreased (ET1 < ET3 < ET2), and 23 (9%) lost the benefit of CR (ET3 ≤ ET1). Among completers who agreed to enroll in this study, most patients with CAD seem to maintain their CRF 1 yr after CR.

Relationship between skin autofluorescence levels and clinical events in patients with heart failure undergoing cardiac rehabilitation

BackgroundAdvanced glycation end-products, indicated by skin autofluorescence (SAF) levels, could be prognostic predictors of all-cause and cardiovascular mortality in patients with diabetes mellitus (DM) and renal disease. However, the clinical usefulness of SAF levels in patients with heart failure (HF) who underwent cardiac rehabilitation (CR) remains unclear. This study aimed to investigate the associations between SAF and MACE risk in patients with HF who underwent CR.MethodsThis study enrolled 204 consecutive patients with HF who had undergone CR at our university hospital between November 2015 and October 2017. Clinical characteristics and anthropometric data were collected at the beginning of CR. SAF levels were noninvasively measured with an autofluorescence reader. Major adverse cardiovascular event (MACE) was a composite of all-cause mortality and unplanned hospitalization for HF. Follow-up data concerning primary endpoints were collected until November 2017.ResultsPatients’ mean age was 68.1 years, and 61% were male. Patients were divided into two groups according to the median SAF levels (High and Low SAF groups). Patients in the High SAF group were significantly older, had a higher prevalence of chronic kidney disease, and more frequently had history of coronary artery bypass surgery; however, there were no significant between-group differences in sex, prevalence of DM, left ventricular ejection fraction, and physical function. During a mean follow-up period of 590 days, 18 patients had all-cause mortality and 36 were hospitalized for HF. Kaplan–Meier analysis showed that patients in the high SAF group had a higher incidence of MACE (log-rank P < 0.05). After adjusting for confounding factors, Cox regression multivariate analysis revealed that SAF levels were independently associated with the incidence of MACE (odds ratio, 1.86; 95% confidence interval, 1.08–3.12; P = 0.03).ConclusionSAF levels were significantly associated with the incidence of MACE in patients with HF and may be useful for risk stratification in patients with HF who underwent CR.

Effectiveness of Distance Technology in Promoting Physical Activity in Cardiovascular Disease Rehabilitation: Cluster Randomized Controlled Trial, A Pilot Study.

BackgroundPhysical activity is beneficial for cardiovascular rehabilitation. Digitalization suggests using technology in the promotion of physical activity and lifestyle changes. The effectiveness of distance technology interventions has previously been found to be similar to that of conventional treatment, but the added value of the technology has not been frequently studied.ObjectiveThe aim of this pilot study was to investigate whether additional distance technology intervention is more effective in promoting physical activity than non-technology–based treatment in 12 months of cardiac rehabilitation.MethodsThe cardiovascular disease rehabilitation intervention consisted of three 5-day inpatient periods in a rehabilitation center and two 6-month self-exercise periods at home in between. Participants were recruited from among cardiac patients who attended the rehabilitation program and were cluster-randomized into unblinded groups: conventional rehabilitation control clusters (n=3) and similar rehabilitation with additional distance technology experimental group clusters (n=3). Experimental groups used Fitbit Charge HR for self-monitoring, and they set goals and reported their activity using Movendos mCoach, through which they received monthly automated and in-person feedback. Physical activity outcomes for all participants were measured using the Fitbit Zip accelerometer and the International Physical Activity Questionnaire.ResultsDuring the first 6 months, the experimental group (n=29) engaged in light physical activity more often than the control group (n=30; mean difference [MD] 324.2 minutes per week, 95% CI 77.4 to 571.0; P=.01). There were no group differences in the duration of moderate to vigorous physical activity (MD 12.6 minutes per week, 95% CI –90.5 to 115.7; P=.82) or steps per day (MD 1084.0, 95% CI –585.0 to 2752.9; P=.20). During the following 6 months, no differences between the groups were observed in light physical activity (MD –87.9 minutes per week, 95% CI –379.2 to 203.3; P=.54), moderate to vigorous physical activity (MD 70.9 minutes per week, 95% CI –75.7 to 217.6; P=.33), or steps per day (MD 867.1, 95% CI –2099.6 to 3833.9; P=.55).ConclusionsThe use of additional distance technology increased the duration of light physical activity at the beginning of cardiac rehabilitation (for the first 6 months), but statistically significant differences were not observed between the two groups for moderate or vigorous physical activity or steps per day for both 6-month self-exercise periods.Trial RegistrationISRCTN Registry ISRCTN61225589; https://doi.org/10.1186/ISRCTN61225589

Cardiac-specific experiential avoidance predicts change in general psychological well-being among patients completing cardiac rehabilitation.

Previous studies have shown that experiential avoidance (EA) is associated with physical and psychological well-being in medical and non-medical samples. The aims of the present study were to evaluate the reciprocal association between psychological well-being and EA over time among cardiac rehabilitation (CR) patients with moderately to severely low levels of psychological well-being. Pre-CR data on demographic characteristics, measures of psychological well-being, and cardiac-specific EA were collected from 915 CR patients, as well as post-CR psychological well-being and EA data, from 800 of these patients. A cross-lagged model was estimated to examine the relationship between EA and psychological well-being among patients with moderately to severely low levels of psychological well-being based on questionnaire scores. Both EA and psychological well-being significantly changed during CR and were negatively associated with each other at both pre- and post-CR. Results from cross-lagged structural equation modeling supported a nonreciprocal association between EA and psychological well-being during CR. Pre-CR assessment of EA in patients showing low levels of well-being at the beginning of CR could help to identify patients at risk for worse psychological outcomes. EA could be a promising target of psychological treatments administered during CR.

Prediction of peak oxygen consumption by incremental 6minutes walking test in patients with Ischemic heart disease after cardiac rehabilitation

For ischemic heart disease patients (IHD), Cardiac rehabilitation (CR) helps to recover the functional capacity. Stress test with oxygen peak consumption (VO2 max at peak) at CR discharge is a key point to determine physical capacity. There was no regression equation available to predict oxygen peak consumption (VO2 max at peak) at discharge. The aim of our study was to develop an equation to predict VO2 peak values at discharge. It is a retrospective study including 68 patients with IHD admitted for CR. They all had of 6 minutes walking Test before and after CR and also underwent a stress test with Ergospirometry at the beginning of CR. The study end point was to develop an equation to predict VO2 max at peak at their discharge using only the results of the two six minutes walking tests (entry and at discharge) and the VO2max at peak exercice at the beginning of their Cardiac rehab. The average age of patients was 52,14 ± 10,1 years with male predominance (80%), they had more than three cardiovascular risk factors dominated by smoking and hypertension. After 20 sessions of CR, they significantly increase 6 minutes walking test (from 488,18 ± 101,29 m to 560,61 ± 100,20 m) and their VO2max(from 20,74 ± 5,41 ml/kg/min to 23,52 ± 6,46 ml/kg/min). Using linear regression analysis, we developed an equation to calculate the Final VO2 max at peak (predicted) = 1,167 + (0,95x initial VO 2 peak) + (0,002x initial 6MWT) + (0,003x final 6MWT). There was no statistically significant difference between the VO2 peak measured directly and the predicted one with our equation. This study showed that cardiac rehabilitation, can avoid a final stress test with VO2max using our predicted equation. This new method to predict the VO2max at peak at discharge from CR is easy to use and can be cost effective saving a whole test with ergospirometry at discharge. This study needs to be confirmed by a larger number of patients included.

Inflammatory Cytokines During Cardiac Rehabilitation After Heart Surgery and Their Association to Postoperative Atrial Fibrillation

Inflammation is associated with atrial fibrillation (AF), but little is known about the association of AF with the inflammatory serum cytokines after the acute postoperative phase. Thus, we aimed to explore how plasma cytokines concentrations modify during a 3-week cardiac rehabilitation after heart surgery, comparing patients who developed postoperative AF (POAF) and those with permanent AF with patients free from AF (NoAF group). We enrolled 100 consecutive patients and 40 healthy volunteers as a control group. At the beginning of cardiac rehabilitation, 11 days after surgery, serum levels of MPO, PTX3, ADAM17, sST2, IL-25, and IL-33 were dramatically higher, whereas TNFα and IL-37 levels were much lower in NoAF, POAF, and permanent AF patients than in the healthy volunteers. After rehabilitation, most of the cytokines changed tending towards normalization. POAF patients (35% of the total) had higher body mass index and abdominal adiposity than NoAF patients, but similar general characteristics and risk factors for POAF. However, ADAM-17 and IL-25 were always lower in POAF than in NoAF patients, suggesting a protective role of IL-25 and ADAM 17 against POAF occurrence. This finding could impact on therapeutic strategies focusing on the postoperative prophylactic antiarrhythmic interventions.

Association between the tissue accumulation of advanced glycation end products and exercise capacity in cardiac rehabilitation patients

BackgroundAdvanced glycation end products (AGEs) are associated with aging, diabetes mellitus (DM), and other chronic diseases. Recently, the accumulation of AGEs can be evaluated by skin autofluorescence (SAF). However, the relationship between SAF levels and exercise capacity in patients with cardiovascular disease (CVD) remains unclear. This study aimed to investigate the association between the tissue accumulation of AGEs and clinical characteristics, including exercise capacity, in patients with CVD.MethodsWe enrolled 319 consecutive CVD patients aged ≥40 years who underwent early phase II cardiac rehabilitation (CR) at our university hospital between November 2015 and September 2017. Patient background, clinical data, and the accumulation of AGEs assessed by SAF were recorded at the beginning of CR. Characteristics were compared between two patient groups divided according to the median SAF level (High SAF and Low SAF).ResultsThe High SAF group was significantly older and exhibited a higher prevalence of DM than the Low SAF group. The sex ratio did not differ between the two groups. AGE levels showed significant negative correlations with peak oxygen uptake and ventilator efficiency (both P < 0.0001). Exercise capacity was significantly lower in the high SAF group than in the low SAF group, regardless of the presence or absence of DM (P < 0.05). A multivariate logistic regression analysis showed that SAF level was an independent factor associated with reduced exercise capacity (odds ratio 2.10; 95% confidence interval 1.13–4.05; P = 0.02).ConclusionHigh levels of tissue accumulated AGEs, as assessed by SAF, were significantly and independently associated with reduced exercise capacity. These data suggest that measuring the tissue accumulation of AGEs may be useful in patients who have undergone CR, irrespective of whether they have DM.

Are Trait Emotional Competencies and Heart Rate Variability Linked to Mental Health of Coronary Heart Disease Patients?

Depression and anxiety have been extensively associated with adverse outcomes in coronary heart disease patients. However, psychological and physiological processes underlying the persistence of these troubles in coronary heart disease patients attending cardiac rehabilitation are poorly investigated. Trait emotional competencies and heart rate variability could be some of these processes. Thus, the aim of this study was to assess the predictive value of trait emotional competencies and heart rate variability on depression and anxiety symptoms persistence in coronary heart disease patients. Eighty-four patients who recently presented a myocardial infarction were evaluated at the beginning of cardiac rehabilitation. Forty-two patients continued their rehabilitation program and were then assessed three months later. They completed the Profile of Emotional Competence as well as the Hospital Anxiety and Depression Scale and underwent a 5-minute resting heart rate variability measure. Low trait emotional competencies score predicted depression symptoms persistence, but unexpectedly, high trait emotional competencies score was also associated with withdrawal from cardiac rehabilitation. Contrary to our expectations, heart rate variability did not predict depression or anxiety symptoms persistence and was not associated with trait emotional competencies. This study is the first to report an association between trait emotional competencies and depression symptoms persistence in coronary heart disease patients. However, heart rate variability was not associated with either depression or anxiety supporting the idea of mixed literature and highlighting the need of future research.

Relationship Between Kihon Checklist Score and Anxiety Levels in Elderly Patients Undergoing Early Phase II Cardiac Rehabilitation.

BackgroundThe frailty state consists of not only physical but also psycho-emotional problems, such as cognitive dysfunction and depression as well as social problems. However, few reports have examined the relationship between frailty and anxiety levels in elderly patients undergoing cardiac rehabilitation (CR).MethodsWe analyzed 255 patients (mean age: 74.9 ± 5.8 years, 67% male) who participated in early phase II CR at Juntendo University Hospital. At the beginning of CR, patients carried out self-assessments based on the Kihon Checklist (KCL) and the State Trait Anxiety Inventory Form (STAI). Patients were divided into three groups: frailty group (n = 99, 39%), pre-frailty group (n = 81, 32%), and non-frailty group (n = 75, 29%) according to the KCL. We assessed results from the KCL scores and its relationship with anxiety levels.ResultsAmong the three groups, there were no significant differences in age, underlying illnesses, or the prevalence of coronary risk factors. Depressive mood domains of the KCL were significantly higher in the frailty and pre-frailty groups than in the non-frailty groups (3.0 ± 1.5 vs. 1.4 ± 1.2 vs. 0.4 ± 0.6; P < 0.01). The state anxiety level was significantly higher in the frailty group than in the non-frailty group (41.6 ± 0.9 vs. 34.9 ± 1.0; P < 0.01). The trait anxiety levels were significantly higher in the frailty group and pre-frailty group than in the non-frailty group (45.5 ± 0.9 vs. 39.2 ± 1.0 vs. 35.1 ± 1.1; P < 0.01). State anxiety and trait anxiety also showed a significantly positive correlations with the KCL scores (r = 0.32 vs. 0.41, P < 0.01).ConclusionsFrailty scores were positively correlated not only with physical function but also with depression mood and anxiety levels in elderly patients undergoing early phase II CR. These results suggest that assessment of depressive mood and anxiety is also important in elderly patients undergoing early phase II CR.

P6209Relationship between skin autofluorescence levels and clinical outcomes in heart failure patients undergoing cardiac rehabilitation

Abstract Background Advanced glycation end-products, indicated by skin autofluorescence (SAF) levels, could be prognostic predictors of all-cause and cardiovascular mortality in patients with diabetes mellitus (DM) and renal disease. However, the clinical usefulness of SAF levels in patients with heart failure (HF) who underwent cardiac rehabilitation (CR) remains unclear. Purpose The purpose of this study was to investigate the prognostic value of SAF levels in patients with HF who underwent CR. Methods This study enrolled 204 consecutive patients with HF who had undergone CR at our university hospital between November 2015 and October 2017. Clinical characteristics and anthropometric data were collected at the beginning of CR. SAF levels were noninvasively measured with an autofluorescence reader. The major adverse cardiovascular event (MACE) was a composite of all-cause mortality and unplanned hospitalization for HF. Follow-up data concerning primary endpoints were collected until November 2018. Results Patients' mean age was 68.1 years, and 61% were males. Patients were divided into two groups according to the median SAF levels (high and low SAF groups). Patients in the high SAF group were significantly older, had a higher prevalence of chronic kidney disease, and histories of coronary artery bypass surgery; however, there were no significant between-group differences in sex, prevalence of DM, left ventricular ejection fraction, and physical function. During a median follow-up period of 623 days, 25 patients experienced all-cause mortality and 34 were hospitalized for HF. Kaplan–Meier analysis showed that patients in the high SAF group had a higher incidence of MACE (log-rank P&lt;0.05), whereas when patients were divided into two groups according to the median hemoglobin A1c level, no significant between-group difference was observed for the incidence of MACE (Figure). After adjusting for confounding factors, Cox regression multivariate analysis revealed that SAF levels were independently associated with the incidence of MACE (hazard ratio: 1.74, 95% confidence interval: 1.12–2.65, P&lt;0.05). Figure 1 Conclusion SAF levels were significantly associated with the incidence of MACE in patients with HF and may be useful for risk stratification in patients with HF who undergo CR.

Stability in Cardiac Attributions Before and After Cardiac Rehabilitation.

This study examined temporal patterns in causal attributions generated by patients with cardiovascular disease before and after cardiac rehabilitation (CR). Qualitative, descriptive survey. Eighty-six participants were asked what they believed was the primary cause of their cardiac events. Cardiac attributions were collected at the beginning of CR, at the end of CR, and 15 months after baseline. Content analyses showed that heredity and behavior were the most commonly generated causes. Most participants showed stability in attributions over time, although we found a trend for more participants endorsing behavioral attributions at the end of the study. Cardiac attributions remain relatively stable across time. Cardiac rehabilitation staff should approach patients differently, depending on their causal narratives. Some patients enter CR understanding that behavior played a causal role, whereas some do not. Encouraging appreciation of the importance of behavior in cardiovascular disease onset and recurrence is vital.

The impact of perceived control on psychological distress and health behavior adherence in patients with cardiovascular disease

Background: Symptoms of depression and anxiety have been shown to negatively impact physical health outcomes among individuals with cardiovascular disease (CVD). Therefore, an important step in developing interventions to reduce risk for cardiac event recurrence is to identify the emotional and cognitive predictors of psychological distress. This study examined one possible cognitive predictor: perceived control (PC). Specifically, this study tested whether symptoms of depression and anxiety mediate the relationship between PC and adherence to health behavior recommendations in patients participating in a cardiac rehabilitation (CR) program.Methods: Self-report measures were administered to 146 CR patients at the beginning of CR and 12-weeks later, at the end of CR.Results: Anxiety and depressive symptoms did not mediate the relationship between PC and health behavior adherence. Rather, PC was cross-sectionally related to symptoms of psychological distress, and it predicted health behavior adherence 12-weeks later.Conclusions: Results imply that PC has long-term effects on health behavior adherence, an important outcome in CR that reduces risk for recurrence.

Clustering of Lifestyle Risk Factors in Acute Coronary Syndrome: Prevalence and Change after the First Event.

Healthy lifestyles are modifiable risk factors for acute coronary syndrome (ACS) onset and recurrence. While unhealthy lifestyles tend to cluster together within the general healthy population, little is known about the prevalence and clustering of these behaviours in people with ACS before and after the first acute event. The aim of this study was to identify lifestyle profiles of patients with ACS and to explore their change after their first coronary event. Three hundred and fifty-six patients completed self-report measures of healthy habits at the beginning of cardiac rehabilitation and 6months later. By adopting a person-oriented approach, we analysed lifestyle clustering and its change over time. Differences in depression, anxiety, and negative illness perception among lifestyle profiles were assessed. We identified seven profiles, ranging from more maladaptive to healthier clusters. Findings showed a strong interrelation among unhealthy habits in patients. We highlighted a moderate individual and group stability of cluster membership over time. Moreover, unhealthier lifestyle profiles were associated with higher levels of depression, anxiety, and negative illness perception. These results may have implications for the development and implementation of multimodal interventions addressing wider-ranging improvement in lifestyles by targeting multiple unhealthy behaviours in patients with ACS.

Stability and change of lifestyle profiles in cardiovascular patients after their first acute coronary event.

BackgroundAcute coronary syndrome (ACS) is a major cause of morbidity and mortality. Lifestyle and health behavior changes play an important role in the primary and secondary prevention of ACS recurrence. Changes in unhealthy lifestyles after an acute coronary event have been analyzed by considering separate behaviors individually, even though research on the healthy population has demonstrated that unhealthy behaviors tend to co-occur.PurposeThe aim of this study was to identify lifestyle profiles of ACS patients and to explore their pathways of change for one year after their first coronary event by adopting a typological approach.MethodsTwo hundred and twenty-three patients (84% male; mean age = 57.14) completed self-report measures of health-related behaviors at the beginning of cardiac rehabilitation, and six months and twelve months after. At each wave depression, anxiety and heart rate were also evaluated. Cluster analysis was performed to identify lifestyle profiles and to analyze their change over time. Differences in psychological factors and heart rate among clusters were assessed.ResultsPatients' diet, physical activity, and smoking behavior greatly improved six months after their first coronary event. No further improvements were detected after one year. At each wave specific lifestyle profiles were identified, ranging from more maladaptive to healthier clusters. Patients with multiple unhealthy behaviors experience greater difficulties in maintaining a healthier lifestyle over time. Moreover, the results demonstrated the association between lifestyle profiles at twelve months after the acute coronary event and depression measured six months earlier. Finally, the most maladaptive lifestyle profile had many members with elevated heart rate at twelve months after the cardiac rehabilitation.ConclusionsCurrent findings may have a strong practical impact in the development and implementation of personalized secondary prevention programs targeting lifestyles of ACS patients.

Exercise Self-efficacy and Symptoms of Depression After Cardiac Rehabilitation

Cardiac rehabilitation is often recommended after experiencing a cardiac event and has been shown to significantly improve health outcomes among patients. Several psychosocial variables have been linked with cardiac rehabilitation program success, including exercise self-efficacy. However, little is known about temporal patterns in patients' exercise self-efficacy after program completion. This study examined changes in exercise self-efficacy among 133 cardiac rehabilitation patients and whether symptoms of depression impacted the rate of change in exercise self-efficacy. Participants completed questionnaires at the beginning and end of cardiac rehabilitation and at 6-month intervals for 2 years. Growth curve analyses showed that exercise self-efficacy levels were highest at the beginning of cardiac rehabilitation, significantly declined 6 months after cardiac rehabilitation, and leveled off over the next 18 months. Results also showed that baseline depressive symptoms interacted with time: Compared with participants with fewer symptoms, participants high in depressive symptoms began cardiac rehabilitation with lower levels of exercise self-efficacy and evidenced significant declines 6 months after cardiac rehabilitation. At no time were they equal to their counterparts in exercise self-efficacy, and their means were lower 2 years after cardiac rehabilitation than before cardiac rehabilitation. Our findings imply that patients show unrealistic optimism surrounding the ease of initiating and maintaining an exercise program and that integrating efficacy-building activities into cardiac rehabilitation, especially for patients who show signs of distress, is advisable.

Health literacy predicts cardiac knowledge gains in cardiac rehabilitation participants

Objective: Health literacy is increasingly recognised as a potentially important patient characteristic related to patient education efforts. We evaluated whether health literacy would predict gains in knowledge after completion of patient education in cardiac rehabilitation. Method: This was a re-post observational analysis study design based on Summa Health System’s Phase-II cardiac rehabilitation programme in Akron, Ohio, USA. The Medical Term Recognition Test, the Short Test of Functional Health Literacy in Adults, and the Newest Vital Sign were administered to 191 patients enrolled in cardiac rehabilitation between May 2010–April 2011. The Cardiac Knowledge Assessment Tool is routinely administered at the beginning and prior to discharge from cardiac rehabilitation. Consent was obtained in order to access patients’ cardiac rehabilitation medical chart for information such as age and education level. Results: Participants were 72% men with a mean of 66.4 years of age, and with an average level of education of 13.7 years. Health literacy was strongly related to cardiac knowledge at both the beginning and end of cardiac rehabilitation ( r=0.46, p&lt;0.001; r=0.41, p&lt;0.001). Controlling for cardiac knowledge at the beginning of cardiac rehabilitation, health literacy predicted gains in cardiac knowledge at the end of cardiac rehabilitation ( p&lt;0.01). Conclusion: Health literacy can be used to predict gains in knowledge from patient education programming in cardiac rehabilitation. Health literacy screening may help to identify those who may struggle with patient-education portions of cardiac rehabilitation or who may need additional education to reach a desired knowledge level.

Patient attributions for cardiac events: predictors of physical and psychological recovery

AbstractThis study examined cardiac rehabilitation (CR) patients' causal attributions for their cardiac events, and used those attributions as predictors of cross‐sectional and prospective health status. Data were collected from 163 participants at the beginning and end of their CR programs. Results showed that patients' attributions can be categorized into controllable ones that are behavioral in nature, uncontrollable ones that are biological in nature, and a separate category for stress‐related causes. Findings showed that stress attributions at the beginning of CR were associated with engaging in healthy behaviors in the last month of CR, which, in turn, were positively associated with metabolic equivalence levels at the end of CR. Results imply a motivational component to believing that cardiac events are caused by stress.