Coronary Heart Disease Outpatients Research Articles

The Effectiveness of Dokterkit Application-Based Coronary Heart Risk Monitoring and Education

Background: In 2019, primary diagnoses in coronary heart disease outpatients increased by 1.4% and secondary diagnoses byi6% of patients. Aims: To determine the effectiveness of Edmon (Education & Monitoring) based on the medical kit application on coronary heart disease risk control at Soewandhi Hospital Surabaya. Method: This study is a quantitative study with quasi-experimental non-equivalent group design. This study involved 30 people consistingi of 2 groups (the treatment group that received CHD health education through a dokterkit application and through leaflets). This research was conducted at Soewandi Hospital in Surabaya in August-November 2022. Univariate data analysis techniques were performed on each variable from the research results, then an independenti test was carried out to find out the differencesi betweeni the two groups. Results: The results showed that android-based education and monitoring were effective because they contributed to a 26.7% reductioni in the numberi of patientsi with severe CHD risk and a 40% increase in the numberi of patients with normal urici acidi levelsi in the treatment group. Conclusion: Dokterkit-based education & monitoring is effective in controlling the risk of coronaryi heart diseasei and uric acid levelsi in Soewandhie Hospital Surabaya, but not effective in reducing cholesterol levels, systolic blood pressure, blood sugar levels and not effective in changing smoking behavior.

Predictors of health-related quality of life in outpatients with coronary heart disease.

Health-related quality of life (HRQoL) is an important treatment target in patients with coronary heart disease (CHD) and is associated with poor outcomes. Therefore, it is of clinical importance to identify the key determinants of HRQoL among these patients. There is, however, limited knowledge of how a comprehensive set of psychosocial factors influence HRQoL. We aimed to determine the relative associations of clinical and psychosocial factors with mental and physical components of HRQoL in a sample of CHD outpatients. This cross-sectional study included 1,042 patients 2-36 (mean 16) months after a CHD event recruited from two general Norwegian hospitals with a combined catchment area making up 7% of the Norwegian population, representative with regards to demographic and clinical factors. We collected data on HRQoL, demographics, comorbidities, coronary risk factors, and psychosocial factors. HRQoL was assessed using the Short Form 12 (SF12), which comprises a Mental Component Scale (MCS), and the Physical Component Scale (PCS). Crude and multi-adjusted linear regression analyses were used to investigate the association between covariates and MCS and PCS. Mean age was 61 [standard deviation (SD) 10] years, 20% were females, 18% had type D personality, 20% significant depression symptoms, 14% significant symptoms of anxiety whereas 45% reported insomnia. The presence of type D personality (β: -0.19), significant symptoms of depression (β: -0.15), and the presence of insomnia (β: -0.13) were negatively associated with MCS, but not PCS in multi-adjusted analyses. The presence of chronic kidney disease (β: -0.11) was associated with reduced MCS, whereas the presence of chronic obstructive pulmonary disease (β: -0.08) and low physical activity (β: -0.14) were negatively associated with PCS. Younger age was associated with lower MCS, whereas older age was associated with lower PCS. We conclude that Type D personality, depressive symptoms, insomnia, and chronic kidney disease were the strongest determinants of the mental component of HRQoL. Assessing and managing these psychological factors among CHD outpatients may improve their mental HRQoL.

Health-related quality of life in outpatients with coronary heart disease: impact of type D personality, depression, anxiety and insomnia

Abstract Funding Acknowledgements Type of funding sources: Public hospital(s). Main funding source(s): Drammen hospital, Vestre Viken trust. Background Health-related quality of life (HRQoL) is an important treatment target in patients with coronary heart disease (CHD) and associated with impaired prognosis. Therefore, knowledge about correlates of HRQoL may be of clinical importance. However, there is limited knowledge about how a comprehensive set of psychosocial factors, including type D personality, depression, anxiety, and insomnia influence HRQoL in CHD outpatients. Purpose To determine the relative associations of clinical and psychosocial factors with mental and physical HRQoL in a sample of Norwegian CHD outpatients. Methods This cross-sectional study included 1017 patients 2-36 (mean 16) months after hospitalisation for a coronary heart disease event (80% myocardial infarction). Data on HRQoL, psychosocial factors, coronary risk factors, comorbidity, and demographics were collected from self-report questionnaires, clinical examination with blood samples and hospital medical records. HRQoL was assessed using the Short Form 12 (SF12), which is a 12-item questionnaire comprising two subscales: Mental Component Scale (MCS) and Physical Component Scale (PCS). Type D personality, depression and anxiety, and insomnia were measured using the type D Scale 14 (DS14), Hospital Anxiety and Depression Scale (HADS), and the Bergen Insomnia Scale (BIS), respectively. Crude and multi-adjusted linear regression analyses were used to investigate the association between covariates and MCS and PCS, respectively. Results Mean age was 61 (SD 10) years, 20% were females, 18% had type D personality, 20% depression, 14% anxiety and 45% insomnia. Mean scores for SF12 subscales were 47.1 (6.0) for MCS and 38.5 (4.8) for PCS. Type D personality, symptoms of depression, and insomnia, but not anxiety, were negatively associated with MCS, but not PCS in multi-adjusted analyses. (Table). Chronic kidney disease was associated with reduced MCS, whereas chronic obstructive pulmonary disease and low physical activity were all negatively associated with PCS. Younger age was associated with poor MCS, whereas older age was associated with poor PCS. Conclusions This study found that HRQoL was low among Norwegian CHD outpatients. Type D personality, depressive symptoms, insomnia, and chronic kidney disease were the strongest correlates of the mental component of HRQoL. However, these variables were not significantly associated with the physical subscale of the SF12. Assessing and managing type D personality, depression, and insomnia among these group of CHD outpatients may improve HRQoL.

Clinical Pediatric Exercise Laboratories, Reactive Balance, Sleep, and Muscle Stimulation Considerations

Clinical Pediatric Exercise Laboratories, Reactive Balance, Sleep, and Muscle Stimulation Considerations

Relationships between depression, anxiety, type D personality, and worry and rumination in patients with coronary heart disease.

Psychological distress, including depression and anxiety, and Type-D personality are prevalent in patients with coronary heart disease (CHD) and associated with poor cardiovascular outcomes. Worry and rumination may be among the core features responsible for driving psychological distress in these patients. However, the nature of associations between these constructs remains to be delineated, yet they may have implications for the assessment and treatment of CHD patients. This study aimed to (1) explore the factorial structure and potential overlap between measures of depression, anxiety and the Type-D personality factors known as negative affectivity and social inhibition, and (2) examine how these constructs relate to worry and rumination in a sample of 1,042 CHD outpatients who participated in the in the cross-sectional NORwegian CORonary Prevention study. We conducted confirmatory factor analyses (n = 1,042) and regression analyses (n = 904) within a structural equation modeling framework. Results showed all constructs to have acceptable factor structure and indicated an overlap between the constructs of depression and negative affectivity. Worry was most strongly associated with anxiety, whereas rumination was most strongly associated with depression and negative affectivity. The results suggest conceptual similarities across the measures of depression and negative affectivity. They further suggest that intervention efforts could benefit from targeting worry and/or rumination in the treatment of CHD outpatients presenting with symptoms of psychological distress.

Insomnia as a predictor of recurrent cardiovascular events in patients with coronary heart disease

Insomnia is highly prevalent in patients with coronary heart disease (CHD). However, the potential effect of insomnia on the risk of recurrent major adverse cardiovascular events (MACE) remains uncertain. This prospective cohort study included 1082 consecutive patients 2-36 (mean 16) months after myocardial infarction and/or coronary revascularization. Data on clinical insomnia, coronary risk factors, and comorbidity were collected at baseline. Clinical insomnia was assessed using the Bergen Insomnia Scale (BIS). The primary composite endpoint of MACE (cardiovascular death, hospitalization due to myocardial infarction, revascularization, stroke, or heart failure) was assessed with an average follow-up of 4.2 (SD 0.3) years after baseline. Data were analyzed using Cox proportional hazard regression models stratified by prior coronary events before the index event. At baseline, mean age was 62 years, 21% were females, and 45% reported clinical insomnia. A total of 346 MACE occurred in 225 patients during the follow-up period. For clinical insomnia, the relative risk of recurrent MACE was 1.62 (95% confidence interval [CI]: 1.24-2.11, p < .001) adjusted for age, gender, and previous coronary events. In a multi-adjusted analysis, including coronary risk factors, cardiovascular comorbidity, symptoms of anxiety, and depression, the relative risk was 1.41 (95% CI: 1.05-1.89, p = .023). Clinical insomnia accounted for 16% of the MACE in attributable risk fraction analyses, being third in importance after smoking (27%) and low physical activity (21%). Clinical insomnia was associated with increased risk of recurrent MACE. These results emphasize the importance of identifying and managing insomnia in CHD outpatients.

Insomnia in patients with coronary heart disease: prevalence and correlates.

The aim of this study was to determine the prevalence of insomnia and its association with clinical and psychosocial factors in a large sample of outpatients with coronary heart disease. The sample comprised 1,082 patients, mean age 62 years (21% female), who participated in the cross-sectional NORwegian CORonary Prevention Study. Patients who were hospitalized with myocardial infarction and/or a coronary revascularization procedure in 2011-2014 responded to a self-report questionnaire and participated in a clinical examination with blood samples 2-36 (mean, 16) months later. Insomnia was assessed using the Bergen Insomnia Scale, a questionnaire based on the criteria for the clinical diagnosis of insomnia as described in the Diagnostic and Statistical Manual of Mental Disorders, fourth version. We performed bivariate logistic regressions for crude analysis and backward stepwise logistic regressions for multiadjusted odds ratios (OR). In total, 488 patients (45%) reported insomnia, and 24% of these patients had used sleep medication in the previous week. Anxiety symptoms (OR: 5.61) were the strongest determinants of insomnia, followed by female sex (OR: 1.88), diabetes (OR: 1.83), eating fish fewer than three times a week (OR: 1.69), type D personality (OR: 1.69), and C-reactive protein ≥ 2 mg/L (OR:1.58), in multiadjusted analyses. Insomnia was highly prevalent in coronary heart disease outpatients. Psychological factors, lifestyle factors, and subclinical inflammation were associated with insomnia. Our results emphasize the need to identify patients with insomnia and provide appropriate management of insomnia in outpatients with coronary heart disease.

Prospective Validation of the Chinese Version of the Self-Efficacy for Exercise Scale Among Middle-Aged Patients With Coronary Heart Disease.

The aim of this study was to further evaluate the psychometric properties of the Chinese version of the Self-Efficacy for Exercise Scale (SEE-C) among middle-aged outpatients with coronary heart disease (CHD). Psychometric evaluation design. A convenience sample of 355 CHD patients was recruited and followed up at 3 and 6 months. Cronbach's alpha, construct validity (exploratory factor analysis), and concurrent and predictive validity were examined. The SEE-C had a single-factor structure that was stable over time and had high internal consistency. Baseline SEE-C scores were significantly and positively associated with quality of life and total exercise time per week and significantly and negatively associated with anxiety and depression. They also significantly predicted total exercise per week at the 3- and 6-month follow-ups. The SEE-C is a robust, reliable, and valid measure of exercise self-efficacy for middle-aged Chinese CHD outpatients. The SEE-C can assess patients' exercise self-efficacy, so that appropriate interventions to improve exercise self-efficacy can be provided.

HUBUNGAN ANTARA DUKUNGAN SOSIAL DENGAN DEPRESI PADA PASIEN PENYAKIT JANTUNG KORONER (THE CORRELATION BETWEEN SOCIAL SUPPORT AND DEPRESSION IN CORONARY HEART DISEASE PATIENT )

Introduction : Depression is a major predictor that decreases the quality of life of patient with Coronary Heart Disease (CHD). One of the factors associated with depression is social support. The relationship between social support and depression in coronary heart disease patients has not been researched yet in Indonesia. This study aimed to determine the relationship beetwen social support and depression in patients with CAD. Method: This research used descriptive correlation method with cross sectional approach. This study was conducted 77 CHD outpatients in one of the government hospital. Data were collected through questionnaires. The first was ENRICHD Social Support Inventory (ESSI) questionnaire with validity value r = 0.036-0.663, p <0.01 and Cronbach's α was 0.818. The second is Beck Depression Inventory II (BDI II) questionnaire with validity value r = 0.39 - 0.52, p <0.01 and Cronbach's α was 0.90. The data were analyzed by univariate (frequency distribution) and bivariate (rank spearman). Result: The results showed that non depression patients were 72.7% and depression patients were 27.3%, with mild depression (14.3%), moderate (7.8%) and severe (5.2%). Patients with high social support were 64.9% and low social support were 35.1%. The relationship between social support and depression had a p value of 0,000 (r=-0.467). Conclusion: The relationship between social support and depression was moderate and the direction of the relationship was negative. Higher social support caused lower depression. Therefore, social support should be improved in order to avoid depression in patient with CHD.

Current status and influence factors of ACEI/ARB application in elderly coronary heart disease outpatients complicated with diabetes mellitus in China

Objective: To investigate the current status and influence factors of ACEI/ARB application in elderly coronary heart disease outpatients complicated with diabetes mellitus in 21 provinces of China. Methods: In this multicenter, non-intervention and cross-sectional survey, the elderly coronary heart disease patients aged 60 years or over were recruited from 165 hospitals in 21 provinces across China from April to July 2011. Current status and influence factors of ACEI/ARB application among 1 789 cases with diabetes mellitus were investigated in the survey. Results: Totally, 1 069 patients used ACEI/ARB drugs (59.8%); proportion of ACEI (544 cases, 30.4%) drugs were the same as ARB drugs (533 cases, 29.8%) in terms of usage of drug types, and combination of the two drugs were taken by 28 cases (1.6%) at the same time. ACEI/ARB usage decreased with the increasing of age, and the rate of drug usage in male patients was slightly higher than that in female, however there was no statistical difference (both P>0.05); the rate of usage of ACEI/ARB drugs gradually decreased with increasing of coronary heart disease or diabetes duration (P<0.05); the rates of usage of ACEI/ARB drugs in hypertension, dyslipidemia, myocardial infarction, renal insufficiency patients and patients received revascularization therapy were significantly higher (all P<0.05). Multivariable logistic regression analysis showed that hypertension (OR=3.016, 95%CI: 1.376-4.887), dyslipidemia (OR=1.489, 95%CI: 1.114-2.031), revascularization (OR=2.291, 95%CI: 1.276-3.277), myocardial infarction (OR=2.561, 95%CI: 1.571-4.545), renal insufficiency (OR=1.337, 95%CI: 1.145-2.013), and insulin treatment (OR=1.584, 95%CI: 1.084-2.511) were positively correlated with ACEI/ARB usage (P<0.05); and coronary heart disease duration was negatively correlated with ACEI/ARB drugs usage (duration 5-10 years: OR=0.621, 95%CI: 0.416-0.823; duration >10 years, OR=0.664, 95%CI: 0.471-0.840). Conclusions: The rate of usage of ACEI/ARB drugs in elderly coronary heart disease outpatients complicated with diabetes mellitus is still low, however, patients with hypertension, dyslipidemia, myocardial infarction, renal insufficiency and patients received revascularization therapy and insulin treatment are more likely to use ACEI/ARB drugs.

Effects of body mass index on blood pressure control rate in elderly coronary heart disease outpatients with hypertension

Objective: To explore the influences of body mass index (BMI) on blood pressure control rate in elderly coronary heart disease (CHD) outpatients with hypertension. Methods: In this multicenter, non-intervention and cross-sectional survey, the elderly coronary heart disease patients with hypertension aged 60 years or over were recruited from 165 hospitals in 21 provinces or cities across China from April to July 2011, and 5 140 cases of elderly CHD patients with hypertension were finally included into the study. The cases were divided into low BMI group (n=130 cases), normal body mass index (BMI) group (n=1 390 cases), overweight (n=2 418 cases), obesity group (n=662 cases) according to the different levels of BMI. Clinical data and blood pressure control rate were compared among the groups, and relationships of different BMI levels with blood pressure control rate were analyzed by the binary classification unconditioned Logistic regression equation. Results: There was a statistically significant difference in blood pressure control rate of general population, men and women patients among low BMI group, normal BMI group, overweight and obesity group (χ2=66.346, 58.995, 26.044, respectively, P<0.001), blood pressure failure rate in obesity group (73.7%) was higher than that in overweight group (65.8%) and normal BMI group (57.5%) (P<0.05), and overweight group was also higher than normal BMI group (P<0.05); blood pressure failure rate in obesity men was higher than that in normal BMI and low BMI group (P<0.05), overweight group was higher than normal BMI group (P<0.05); blood pressure failure rate in obesity women was higher than that in normal BMI and low BMI group (P<0.05). There was a statistically significant difference in blood pressure control rate of different age groups (60-70, 71-80, >80 years old) among low BMI group, normal BMI group, overweight and obesity group (χ2=37.729, 20.007, 15.538, respectively, P<0.001). Blood pressure failure rate in obesity patients with 60-70 years old was higher than that in overweight and normal BMI group (P<0.05), blood pressure failure rates in obesity and overweight patients with 71-80 and > 80 years old were also higher than those in normal BMI group (P<0.05). Multivariable Logistic regression equation showed that overweight in overall population (OR=1.313, 95%CI 1.170-1.731, P<0.05), obesity (OR=2.295, 95%CI 2.295-1.496, P<0.05) were independent risk factors for blood pressure failure rate, in addition, obesity was also risk factor for blood pressure failure rate in men and women patients. Conclusions: Increased BMI has an adverse effect on blood pressure control rate in elderly CHD outpatients with hypertension, and may be the independent risk for blood pressure failure rate in those patients. Much more attention should be given to control BMI level so as to increase the blood pressure success rate and improve the patients' prognosis.

Acute Effects of Particulate Air Pollution on the Incidence of Coronary Heart Disease in Shanghai, China.

IntroductionEvidence based on ecological studies in China suggests that short-term exposure to particulate matter (PM) is associated with cardiovascular mortality. However, there is less evidence of PM-related morbidity for coronary heart disease (CHD) in China. This study aims to investigate the relationship between acute PM exposure and CHD incidence in people aged above 40 in Shanghai.MethodsDaily CHD events during 2005–2012 were identified from outpatient and emergency department visits. Daily average concentrations for particulate matter with aerodynamic diameter less than 10 microns (PM10) were collected over the 8-year period. Particulate matter with aerodynamic diameter less than 2.5 microns (PM2.5) were measured from 2009 to 2012. Analyses were performed using quasi-poisson regression models adjusting for confounders, including long-term trend, seasonality, day of the week, public holiday and meteorological factors. The effects were also examined by gender and age group (41–65 years, and >65 years).ResultsThere were 619928 CHD outpatient and emergency department visits. The average concentrations of PM10 and PM2.5 were 81.7μg/m3 and 38.6μg/m3, respectively. Elevated exposure to PM10 and PM2.5 was related with increased risk of CHD outpatients and emergency department visits in a short time course. A 10 μg/m3 increase in the 2-day PM10 and PM2.5 was associated with increase of 0.23% (95% CI: 0.12%, 0.34%) and 0.74% (95% CI: 0.44%, 1.04%) in CHD morbidity, respectively. The associations appeared to be more evident in the male and the elderly.ConclusionShort-term exposure to high levels of PM10 and PM2.5 was associated with increased risk of CHD outpatient and emergency department visits. Season, gender and age were effect modifiers of their association.

Into the cognitive constructs related to adherence to treatment in CHD outpatients: the importance of accepting the disease limitations

Background and aims: Poor adherence to clinical prescriptions has been recognized as a major problem in management of chronic diseases. Only few studies tried to identify which factors could be considered predictive of low adherence to pharmacological and non pharmacological prescriptions in Coronary Heart Disease (CHD) patients. The aims of our observational-longitudinal study were to assess in CHD outpatients admitted to a Cardiological Day Hospital (DH): self-reported knowledge and acceptance about illness, perceived self-efficacy in disease management and emotional status, and the possible relationships among these variables. Methods: Patients were assessed at baseline during the first days of DH and few days before discharge (follow-up) by the Adherence Schedule in Ischemic Heart Disease (ASIHD) and by the Anxiety and Depression Scale (AD). The ASIHD is a tool specifically aimed at evaluating the cognitive, relational and behavioural antecedents of adherence to treatment of patients suffering CHD. The rehabilitation programme comprised: individualized physical training, nutrition monitoring, psychological assessment and psychoeducational interventions, when indicated. Baseline and follow- up clinical data, ASHID and AD scores were analysed both considering the whole sample (n=117) and the subgroup which met the clinical criteria for psychological counselling (n=35, psychologically treated group). Intracorrelation and intercorrelation coefficients of the whole sample baseline data were calculated among ASIHD, AD scores and socio-demographic data. Results: Our CHD outpatients (62.6±9.3 years) were mainly male, married and retired. They had 5,2 years of illness on the average, and only 9% of them were still smokers, whereas 62% had smoked in the past. Total and LDL cholesterol levels showed a significant reduction at follow up evaluation. Among ASIHD baseline item scores, many statistically significant intracorrelations emerged, in particular: disease limitations acceptance showed significant positive correlations with disease knowledge (r=.34, p=.0001), family/friend support (r=.27, p=.003), following dietary prescriptions (r=.38, p=.0001), exercise (r=.35, p=.0001), taking medicines punctually (r=.35, p=.0001), identifying physical/ psychological fatigue (r=.45, p=.0001), monitoring clinical parameters (r=.42, p=.0001), management of stressful situations (r=.26, p=.006), and reducing stress sources (r=.34, p=.0001). Concerning the significant intercorrelations between AD and ASIHD scores, disease acceptance showed negative correlations with anxiety and depression (r=-.27, p=.004; r=-.26, p=.004 respectively). Conclusions: The pathway stemmed from our data enlights that in the area of cognitive and relational antecedents of adeherence, accepting the disease limitations can be considered a central issue in CHD patient’s illness adjustment and prescriptions adherence. Moreover, the ASHID resulted a useful synthetic schedule of psychological/behavioural variables regarding perceived self-efficacy in disease management. This may facilitate a synergic team work on common priorities that respect the point of view of the patient and the clinical-rehabilitation purposes.

Adaptation and evaluation of the measurement properties of the Brazilian version of the Self-efficacy for Appropriate Medication Adherence Scale.

Objectives:to undertake the cultural adaptation of, and to evaluate the measurement properties of, the Brazilian version of the Self-efficacy for Appropriate Medication Adherence Scale in coronary heart disease (CHD) patients, with outpatient monitoring at a teaching hospital. Method:the process of cultural adaptation was undertaken in accordance with the international literature. The data were obtained from 147 CHD patients, through the application of the sociodemographic/clinical characterization instrument, and of the Brazilian versions of the Morisky Self-Reported Measure of Medication Adherence Scale, the General Perceived Self-Efficacy Scale, and the Self-efficacy for Appropriate Medication Adherence Scale. Results:the Brazilian version of the Self-efficacy for Appropriate Medication Adherence Scale presented evidence of semantic-idiomatic, conceptual and cultural equivalencies, with high acceptability and practicality. The floor effect was evidenced for the total score and for the domains of the scale studied. The findings evidenced the measure's reliability. The domains of the Brazilian version of the Self-efficacy for Appropriate Medication Adherence Scale presented significant inverse correlations of moderate to strong magnitude between the scores of the Morisky scale, indicating convergent validity, although correlations with the measure of general self-efficacy were not evidenced. The validity of known groups was supported, as the scale discriminated between "adherents" and "non-adherents" to the medications, as well as to "sufficient dose" and "insufficient dose". Conclusion:the Brazilian version of the Self-efficacy for Appropriate Medication Adherence Scale presented evidence of reliability and validity in coronary heart disease outpatients.

TCTAP A-093 Determinants of Self-Discontinuation of Secondary Prevention Medications by Coronary Heart Disease Outpatients: Focus on the Role of Erectile Dysfunction

TCTAP A-093 Determinants of Self-Discontinuation of Secondary Prevention Medications by Coronary Heart Disease Outpatients: Focus on the Role of Erectile Dysfunction

Understanding Adherence in Patients With Coronary Heart Disease: Illness Representations and Readiness to Engage in Healthy Behaviours

In people with Coronary Heart Disease (CHD), poor adherence to medication, exercise, and dietary recommendations can compromise prognosis. This study investigated respective associations of the Commonsense Self‐Regulation Model (CSM), the Transtheoretical Model (TM), and trait affect with patients’ self‐reported adherence to treatment. One hundred and forty‐two CHD outpatients completed the Illness Perceptions Questionnaire Revised, Self‐Efficacy, Stage of Change, Positive and Negative Affect Scale, and General Adherence Questionnaire. Stage of change and self‐efficacy were associated with self‐reported medication, diet, and exercise adherence. In comparison, the CSM accounted for a smaller proportion of variance in adherence. In hierarchical regression, the variance from CSM variables associated with exercise adherence was no longer significant when TM variables were in the equation. For dietary and medication adherence, in contrast, both emotional representations (CSM) and TM variables contributed independently to the regression equation. There was some evidence that trait affect moderated the association between the CSM variable of emotional representations and dietary adherence. Results suggest that the largest effects for improving adherence to medication, exercise, and dietary recommendations would occur by increasing readiness to change for exercise, increasing domain‐specific self‐efficacy, and decreasing negative emotions about CHD. Additional implications for research and practice are discussed.

A randomized controlled trial of the effectiveness of a self-help psychoeducation programme on outcomes of outpatients with coronary heart disease: study protocol

To develop and examine the effectiveness of a home-based self-help psychoeducation programme on health-related quality of life, stress level, anxiety and depression symptoms, self-efficacy, cardiac risk factors and health service use of outpatients with coronary heart disease. Hospital-based cardiac rehabilitation programmes have been shown to improve, effectively, the quality of life of patients with coronary heart disease. However, a majority of these patients do not participate in these programmes, while those who do enrol in these programmes fail to complete the programmes. Randomized controlled trial with repeated measures. This study was approved and received the grant in July 2013. A convenience sample of 128 coronary heart disease outpatients will be recruited from a tertiary hospital in Singapore. Participants are randomly assigned to the 4-week experimental group and will participate in the programme or the control group who will not participate in the programme. The outcome measures include the: 12-item Short Form Health Survey, Perceived Stress Scale, Hospital Anxiety and Depression Scale and General Self-Efficacy Scale. Data will be collected at baseline, then 4 and 16 weeks from baseline. At the end, a process evaluation will be conducted to assess the acceptability, strengths and weaknesses of our programme based on the participants' perspectives. Our programme offers coronary heart disease patients an additional option to the existing cardiac rehabilitative services in Singapore hospitals. It aims to help them manage their disease effectively by reducing cardiac risk factors and improve their health-related quality of life and psychological well-being.

Use of Traditional Chinese Medicine in Chinese Patients with Coronary Heart Disease

ObjectiveTo study the use of traditional Chinese medicine (TCM) or both TCM and guideline-recommended Western medicine (WM) in Chinese patients with coronary heart disease (CHD). MethodsA cross-sectional nationwide survey of 2803 CHD outpatients was completed by collecting information, including general demographic data, disease history, and use of drugs (including TCM and WM). ResultsOf the 2712 CHD outpatients with complete drug treatment data, only 3.1% received TCM without any WM for CHD, 30.0% received both TCM and WM recommended by current CHD guidelines, and 66.9% received only WM. Patients with a longer history of CHD or with a history of stroke, were more likely to use TCM. However, 90.6% of CHD patients who used TCM also used certain WM. Furthermore, patients who used more types of TCM tended to use much less WM recommended by current guidelines. ConclusionA substantial proportion of Chinese CHD outpatients use both TCM and WM for secondary prevention of CHD. It is important to assess the effect of combined TCM and WM on major clinical outcomes in Chinese CHD patients.

Light transmittance aggregometry with non-adjusted PRP is more suitable for clinical laboratory monitoring antiplatelet therapy

Objective In this study,maximum platelet aggregation rate of Light transmittance aggregometry (LTA) for coronary heart disease (CHD) patients taking antiplatelet drug and patients without antiplatelet therapy was measured in non-adjusted and platelet count-adjusted platelet-rich plasma (PRP).The aim of this study is to compare which method is superior in evaluation of antiplatelet drug effect. Methods This is a methodology comparative research.560 CHD outpatients and inpatients that visited Beijing Anzhen Hospital of the Capital University of Medical Sciences from May to June,2012 were chosen,who were treated with aspirin monotherapy,or patients on combination therapy with aspirin and clopidogrel,as well as patients without antiplatelet therapy.LTA was performed in non-adjusted (improved method) and platelet count (200×109/L) -adjusted PRP (original method),using 6μmol/L adenosine diphosphate (ADP) and 0.5 mmol/L arachidonic acid (ARA) as agonists.The maximum aggregation rates in 5 min were detected,and consistency and differences of the two methods were compared. Results There is no statistically significant correlation between maximum aggregation rate and platelet count in PRP with 6μmol/L ADP or 0.5 mmol/L ARA as agonists in all subgroups including aspirin monotherapy,combination therapy with aspirin and clopidogrel and patients without antiplatelet therapy (-0.21≤r≤0.111,P>0.05).The maximum aggregation rate using ADP as agonists in original method is decreased compared with improved method,there is statistically significant difference in all subgroups including patients without antiplatelet therapy,aspirin monotherapy,combination therapy with aspirin and clopidogrel less than one week and more than one week.The variability of platelet aggregation rate using ADP as agonists with improved method is lower than that with original method in all subgroups.Yet the maximum aggregation rates using ADP as agonists with improved method and original method correlate well with each other in all subgroups (r=0.78,0.73,0.40,0.71,P<0.01).In the subgroup of subjects without antiplatelet therapy using ARA as agonist,platelet aggregation rate is decreased in original method compared with improved method,there is statistically significant difference,and the variability of the aggregation rate with improved method is also lower than that with original method,ranging from 62%-98% relative to 5%-89%.The decrease of aggregation rate using ARA as agonist for patients taking antiplatelet drug compared with patients without antiplatelet therapy can be detected both with improved method and original method. Conclusion Non-adjusted PRP in LTA is more convenient and time-saving,and it also means less effects on platelet in vitro.Therefore,non-adjusted PRP is more suitable for monitoring efficacy of antiplatelet therapy in clinical laboratory.(Chin J Lab Med,2013,36:405-409) Key words: Platelet aggregation inhibitors; Platelet count; Platelet aggregation; Nephelometry and turbidimetry; Treatment outcome

The "Moving Heart Program": an intervention to improve physical activity among patients with coronary heart disease

AIM: this paper reports the results of a nursing-administered theory-based intervention, the "Moving Heart Program", based on the implementation intention theory and pointed at improving physical activity adherence among coronary heart disease outpatients in Brazil. METHODS: this experimental study applied assessments at baseline, 1 and 2 months after baseline. The Consolidated Standards of Reporting Trials statement was followed. Participants were randomly assigned to intervention, comprising action and coping plans on how to deal with anticipated barriers (n=69), or a standard-care control group (n=67). RESULTS: participants submitted to the intervention showed significant higher levels of physical activity 2 months after baseline and were significantly more active than the control group. CONCLUSIONS: the results indicate that the intervention is feasible for patients with coronary heart disease and can be a useful tool to facilitate intended lifestyle changes. This study brings relevant contributions to the Nursing field and other health-related areas, once the intervention presents low cost to health services and can be applied in cardiac rehabilitation programs, showing significant benefits to participants.