MacNew Heart Disease Health-related Quality Research Articles

The MacNew heart disease health-related quality of life questionnaire: Updated reference data for users

Background: The key to interpreting patient-reported health-related quality of life [HRQL] scores for use in person-centered healthcare approaches in clinical practice is having normative reference data to place the scores in the context of a meaningful reference group. The purpose of this analysis is to update and extend existing norms for the MacNew HRQL questionnaire.Methods: Patients with angina, myocardial infarction, or heart failure enrolled in the HeartQoL Project provided MacNew HRQL Global scale and Physical, Emotional and Social subscale data from which norms have been generated.Results: Patients (n=6,130; angina, 32.4%; myocardial infarction, 37.5% and heart failure, 30.1%) living in 22 different countries provided MacNew HRQL scores. Mean MacNew Global HRQL in the total group was 5.04 (±1.1); Global scale and Physical, Emotional, and Social subscale scores were higher in patients with MI than in patients with either angina or heart failure (p<0.001) and higher in patients with angina than in patients with heart failure (p<0.001). Mean Physical subscale scores were lower than either Emotional or Social subscale scores. Mean MacNew Global scale and subscale scores were higher in males and older patients than females and younger patients. The minimal important difference of 0.5 points on the 7-point MacNew was consistent with a 0.5 standard deviation around the mean MacNew scores in each diagnosis. Conclusion: Norms for the MacNew questionnaire have been updated permitting meaningful interpretation of HRQL for an individual patient or for groups of patients with angina, myocardial infarction or heart failure.

Test-retest reliability of HeartQoL and its comparability to the MacNew heart disease health-related quality of life questionnaire.

Heart Quality of Life (HeartQoL) is a new "hybrid" developed from the MacNew and two condition-specific questionnaires measuring health-related quality of life (HRQoL) in patients with ischemic heart disease (IHD). This study investigates test-retest reliability of HeartQoL (English version) according to international criteria (e.g., COSMIN, GRRAS). Findings on HeartQoL are compared to the published data on MacNew in view that both serve as the core IHD-specific HRQoL instrument. Out of 105 patients with IHD, 76 completed self-administration of HeartQoL at the clinic followed by at home within a 2-week interval. In retest, patients responded using non-interview methods (phone messaging, email, fax, and post). Phone interviewing was reserved for non-respondents to reminder. Reliability of HeartQoL was good (intraclass correlation coefficients=0.78-0.82), was supported in the Bland-Altman plot, and was comparable to five studies on MacNew of similar retest interval (MacNew-English=0.70-0.75; translated MacNew=0.72-0.91). Applicability of its standard error of measurement (0.20-0.25) and smallest detectable change (0.55-0.70) will depend on availability of normative data in future. The reliability of HeartQoL is comparable to its parent instrument, the MacNew. The HeartQoL is a potentially reliable core IHD-specific HRQoL instrument in measuring group change.

The Italian MacNew heart disease health-related quality of life questionnaire: a validation study.

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.

Participation in Society in Patients With Coronary Artery Disease Before and After Cardiac Rehabilitation

ObjectivesTo assess changes in participation in society (frequency, restrictions, satisfaction) during and after cardiac rehabilitation (CR) and to assess associations between participation and heath-related quality of life (HRQOL). DesignProspective cohort study. SettingOutpatient CR center. ParticipantsPatients with coronary artery disease (N=121; mean age, 57y; 96 men [79%]). InterventionsMultidisciplinary CR. Main Outcome MeasuresParticipation in society was assessed with the Utrecht Scale for Evaluation of Rehabilitation-Participation and HRQOL with the MacNew Heart Disease health-related quality of life questionnaire. All measurements were performed pre-CR, post-CR, and 1 year after the start of CR. ResultsFrequency of participation did not change during and after CR. The proportion of patients experiencing restrictions in participation decreased from 69% pre-CR to 40% post-CR (P<.001) and 29% at 1 year (P<.001 vs post-CR). Pre-CR, 71% of patients were dissatisfied with their participation. This improved to 49% post-CR (P<.001) and 53% at 1 year (P<.001 vs pre-CR). Experienced restrictions explained 5% to 7% of the improvement in HRQOL during CR and satisfaction with participation explained 10% to 19%. ConclusionsParticipation in society improves in patients undergoing CR. Despite these improvements, the presence of coronary artery disease is associated with persistent restrictions and dissatisfaction with participation. Because experienced restrictions and dissatisfaction are related to changes in HRQOL it is important to address these aspects of participation during CR.

Quality of life in patients with coronary heart disease after myocardial infarction and with ischemic heart failure.

IntroductionQuality of life measures are useful when interventions or treatments are indicated for several reasons such as improvement of physical functioning, pain relief, to estimate the effectiveness of therapies or to predict mortality. The aim of the current study was to describe quality of life in patients with stable coronary artery disease, myocardial infarction and heart failure and to evaluate the relationship between depression and health-related quality of life.Material and methodsPatients after STEMI, with stable coronary artery disease, and heart failure (n = 332) completed the MacNew Heart Disease Health-related Quality of Life Questionnaire and the Hospital Anxiety and Depression Scale.ResultsPatients with myocardial infarction had significantly higher scores than patients with stable coronary artery disease or heart failure on the MacNew global scale (p < 0.001) and the physical (p < 0.001), emotional (p < 0.001) and social (p < 0.001) subscales. The anxiety scores were significantly higher in the group of patients with stable coronary artery disease than in patients with myocardial infarction (p < 0.05). The depression scores were significantly higher in patients with heart failure (p < 0.01).ConclusionsIn patients with stable CAD, anxiety correlated mainly with symptoms, i.e. angina, than with the history of MI. Patients with symptoms of angina react to the illness with anxiety more than depression, whereas patients with heart failure with dyspnea react to the illness with depressive symptoms more than anxiety. In patients after MI and with stable CAD, cognitive-behavioral techniques could be useful to quickly reduce the level of anxiety, while patients with heart failure require long-term support therapy to reduce the risk of depressive symptoms.

Validation of the French version of the MacNew heart disease health-related quality of life questionnaire

Assessment of health-related quality of life is widely recommended by European health agencies in relevant research studies as well as in clinical care. To validate the French version of the MacNew heart disease health-related quality of life questionnaire. 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. 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. The French version of MacNew questionnaire is recommended for assessing health-related quality of life in French-speaking patients with ischaemic heart disease.

The MacNew Heart Disease Health-Related Quality of Life Questionnaire: A Scandinavian Validation Study

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.

The psychometric properties of the Russian version of the MacNew Heart Disease Health-related Quality of Life Scale in patients undergoing coronary artery bypass grafting surgery

Rationale and aims: The MacNew questionnaire is a disease-specific health-related quality of life (HRQL) measure designed for patients with heart disease. We aimed to assess the psychometric properties of the Russian MacNew heart-disease health-related quality of life (HRQL) scale in patients undergoing coronary artery bypass grafting (CABG) surgery.Methods: The sample comprised of 226 Russian-speaking CABG patients. Patients were assessed before CABG surgery and 12 months thereafter. They completed the MacNew, the Short Form-36 Health Survey (SF-36), the Hospital Anxiety and Depression Scale and a questionnaire on demographic and lifestyle habits.Results: Of the 226 patients who completed the questionnaires at study entry, 188 (83%) also provided data after 12 months. The internal consistency of the MacNew scales was high (alpha coefficients: 0.88-0.93). There were moderate to high correlations between similar sub-scales of the MacNew and the SF-36 domains (0.69-0.80). The MacNew scales discriminated between patients varying on four variables: gender, depression, anxiety and congestive heart failure. The original 3-factor structure was generally supported. Patients’ scores on the MacNew scale improved over 12 months suggesting it was responsive to change.Conclusions: The Russian version of MacNew was found to be a reliable and valid HRQL tool which is sensitive to change. This instrument offers clinicians and researchers a useful tool for understanding patient’s perspective of the impact of heart disease and its treatment.

Inpatient cardiac rehabilitation and changes in self-reported health related quality of life – a pilot study

To assess changes in self-reported health related quality of life (HRQoL) among cardiac patients who participated in an inpatient rehabilitation programme. Medical Outcomes Study Short Form 36 (SF-36) and the MacNew Heart Disease Health-related Quality of Life Questionnaire (MacNew) was used to assess HRQoL at baseline (T1), after rehabilitation (T2) and 5 months after discharge (T3). The rehabilitation programme consisted of physical exercise, theoretical education, group discussions and individual consultations. Friedman's test with Wilcoxon post-hoc test was used to analyse changes between T1, T2 and T3. Effect size (ES) were calculated. Eighty-nine participants were included (79% male) with mean age of 60.0 ± 8.6 years. All SF-36 and MacNew domains showed significant improvement from T1 to T2 (P < 0.05), and all except the SF-36 domain for emotional role with a moderate to large ES. At T3, change and ES are diminished in all domains, except for the physical and social domains of the MacNew. These findings indicate an improvement in HRQoL over time among cardiac patients attending the rehabilitation programme, particularly so in the domains of physical role and physical function, vitality, bodily pain and emotional-, physical- and social-well-being, all which are important domains for maintaining an active life. Future randomised studies comparing inpatient- and outpatient-programmes with longer follow-up are necessary to ascertain if such improvements persist and if patients are able to change life-style in line with the stated goals of cardiac rehabilitation (CR).

Validation of the Hebrew Version of the MacNew Heart Disease Healthrelated Quality of Life Questionnaire in Patients Undergoing Coronary Artery Bypass Surgery

Background: The MacNew questionnaire is a disease-specific health-related quality of life (HRQL) measure designed for patients with heart disease. We aimed to assess the psychometric property of the MacNew questionnaire in Hebrew-speaking patients undergoing coronary artery bypass grafting (CABG) surgery. Methods: The study sample comprised of 775 Hebrew-speaking patients undergoing CABG surgery. Patients were assessed twice: before CABG surgery and 12-months thereafter. They completed the MacNew, the Short Form-36 Health Survey (SF-36), the Hospital Anxiety and Depression Scale, and a questionnaire on demographic and lifestyle habits. Results: 775 patients completed the questionnaires at study entry, 599 (77%) of whom also provided data after 12 months. The internal consistency of the MacNew sub-scales was high (alpha coefficients: 0.88-0.94). There were moderate to high correlations between sub-scales of the MacNew and similar domains of the SF-36 (0.66-0.80). The MacNew scales discriminated between men and women, patients with and without congestive heart failure and between individuals with clinically significant symptoms of depression or anxiety and all other patients. The original three-factor structure was generally supported as most loadings met the 0.40 threshold on the expected factor. Patients attending cardiac rehabilitation programs after CABG surgery showed greater improvement in all the MacNew scales, particularly in physical functioning, compared to patients who had not participated in cardiac rehabilitation programmes. Conclusions: The Hebrew version of MacNew was found to be a reliable and valid HRQL tool which is sensitive to change in patients undergoing CABG surgery. This instrument offers clinicians and researchers a useful tool for understanding the impact of heart disease and its treatment from the patient‘s perspective.

Psychometric properties of the Flemish version of the MacNew Heart Disease Health-related Quality of Life questionnaire

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.

Psychometric properties of the German version of the MacNew heart disease health-related quality of life questionnaire

BackgroundThere is a lack of German-language, disease-specific health related quality of life instruments applicable in cardiac rehabilitation. The purpose of this project was to investigate the psychometric properties of the German version of the MacNew Heart Disease Health-related Quality of Life Questionnaire (MacNew) in patients undergoing cardiac rehabilitation.MethodsThe MacNew was filled out by 5692 inpatients. We analysed acceptance (number of missing values), ceiling and floor effects, reliability (Cronbach’s α), factor structure (confirmatory factor analysis), construct validity (correlation with a generic health-related quality of life instrument), and sensitivity to change.ResultsTwo items had more than 7% missing data. We observed neither floor nor ceiling effects. Cronbach’s α of the scales ranged from 0.78 (physical scale) to 0.95 (global scale). Confirmatory factor analysis failed to reproduce the proposed factor structure (CFI = 0.882; TLI = 0.871; RMSEA = 0.074). We therefore drafted our own model (CFI = 0.932; TLI = 0.921; RMSEA = 0.064), and observed a correlation pattern largely conforming to the hypotheses with a generic health-related quality of life instrument. The effect sizes we noted between the start and end of rehabilitation fell between 0.66 and 0.74; at the 6-month follow-up they ranged from 0.69 to 0.92.ConclusionsThe German version of the MacNew Heart Disease Health-related Quality of Life Questionnaire is a suitable instrument with which to measure the impairment experienced by individuals with heart disease during inpatient cardiologic rehabilitation. The social and the global scale must be interpreted cautiously.

Validation of an instrument to measure the impact of coronary disease on patient’s daily life

To evaluate the psychometric Instrument to Measure the Impact of Coronary Disease on Patient's Everyday Life (IDCV) when applied on patients with coronary disease being followed at an outpatient clinic. One hundred and fifty-three patients with coronary disease were registered. Patients were analysed in terms of acceptability, ceiling and floor effect, reliability (using Cronbach's alpha coefficient) and convergent construct validity (by means of Spearman correlation) between the domains of IDCV and of 'Medical Outcomes Trust Short-form Health Survey (SF-36)' and 'MacNew Heart Disease Health-related Quality of Life Questionnaire'. Evidence was found for high acceptability of IDCV. No evidence was found for ceiling and floor effects regarding the total score of IDCV; however, ceiling and floor effects were found from the adjustment to the disease domain. Evidence was found for reliability of the instrument as a whole and for its domains (Cronbach's α ranged between 0·70-0·85). Similar domains on the IDCV, MacNew and SF-36 were correlated: Physical impact - symptoms on the IDCV with the physical function domain on MacNew (r = -0·64) and with most domains on the SF-36 related to the physical dimension; Social impact and emotional impact on the IDCV with emotional function (r = -0·53) and social function (r = -0·55) on the MacNew and mental health on SF-36 (r = -0·55). However, smaller correlations of moderate/high magnitude were found between different constructs entre: Social and emotional impact on the IDCV with physical function on the MacNew (r = -0·56) and with the following domains: Functional capacity (r = -0·50), general health (r = -0·52) and vitality (r = -0·50) on SF-36. The IDCV is an instrument with evidence regarding reliability and convergent validity also for the population of patients with coronary disease. Further studies to validate its factor structure could offer contributions for understanding the psychometric performance of the IDCV among patients with coronary disease.

The MacNew Heart Disease Health-Related Quality of Life Questionnaire in Patients with Angina and Patients with Ischemic Heart Failure

ObjectivePatient-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. MethodsCanadian 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. ResultsWe 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. ConclusionsThe 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.

Psychometric Properties of the Norwegian Macnew Heart Disease Health-Related Quality of Life Inventory

MacNew is a health-related quality of life (HQOL) inventory for patients with ischaemic heart disease and includes three domains; emotional, physical and social. The MacNew gives new opportunities to compare directly patients with the three major ischaemic heart diagnoses, angina, myocardial infarction and heart failure. However, this inventory has not earlier been evaluated in Norwegian. The purpose of this study was to validate the Norwegian version of the disease-specific HQOL inventory MacNew by assessing the measurement model, internal consistent reliability and test-retest and convergent validity. Patients with ischaemic heart disease (n=124; angina pectoris, n=53; myocardial infarction, n=35; and heart failure; n=36) participated in this cross-sectional study. Patients completed the self-administered MacNew and the generic HQOL-instrument SF-36. The MacNew and the SF-36 were repeated 2-3 weeks later (test-retest) by 17 patients. The psychometric properties were satisfactory to good. The construct validity assessed by factor analysis explained 61.5% of the variance. The internal consistent reliability was high (exceeded 0.90 in all domains). The test-retest analysis showed equivalent results demonstrating good reproducible properties. The convergent validity within each domain was evaluated with correlation analysis, demonstrating correlations of 0.74, 0.69 and 0.71 on the emotional, physical and social domains, respectively. The Norwegian version of the MacNew inventory demonstrated satisfactory to good psychometric properties and can be recommended for evaluating HQOL for patients with heart diseases in clinical studies.

The long‐term benefits of cardiac rehabilitation on depression, anxiety, physical activity and quality of life

To investigate the long-term benefits of a six-week comprehensive cardiac rehabilitation programme on physical activity, psychological well-being and quality of life in patients with coronary heart disease. Cardiac rehabilitation (CR) in short term improves exercise capacity and quality of life in patients with cardiac disease. However, the long-term benefits of CR are inconclusive. A prospective CR programme with repeated measures follow-up over 12 months. A six-week outpatient cardiac rehabilitation programme was conducted including 147 patients with coronary heart disease. Patients completed the physical activity energy expenditure (seven-day recall activity), MacNew Heart Disease Health-Related Quality of Life (MacNew) and Hospital Anxiety and Depression scale (HADs) at baseline, six weeks, six and 12 months. One hundred and five (71%) patients (76 male) mean age of 61.8 (SD 9.7) completed the four-measurement points. Analysis of variance revealed that total energy expenditure (F (2, 231) = 131, p < 0.001), HADs (F (2, 237) = 19.3, p < 0.001), depression score (F (2, 235) = 21.06, p < 0.001), anxiety score (F (2,237) = 17.02, p < 0.001) and MacNew (F (2, 197) = 77.02, p < 0.001) were all statistically significant over time. Bonferroni pairwise follow-up confirmed significant positive differences (p < 0.05) between baseline values and all subsequent measures over time. Depression was independently explained in 22% of the variance in quality of life at 6 or 12 months. The energy expenditure was significantly higher for men compared to women (F (1, 103) = 31, p < 0.001). A six-week cardiac rehabilitation programme is beneficial in improving quality of life, physical activity status, anxiety and depression. These benefits were maintained at 12 months. Elevated levels of depression were associated with impaired quality of life. All relevant health care staff should be aware of the benefits of CR and routinely refer and encourage patients with cardiac disease to attend a cardiac rehabilitation programme. Depression and anxiety intervention strategies should be incorporated in cardiac rehabilitation programmes.

Evaluation of the Liverpool Cardiac Phase-4 Rehabilitation Programme A service user-led community-based investigation

In Liverpool, standard Cardiac Phase-4 Rehabilitation Programme varied from 3 - 9 months depending on centre attended. Evidence for setting the duration and patient contact frequency for communitybased cardiac rehabilitation is uncertain. This study was carried out to explore how participants rated the 3 months Cardiac Phase-4 Rehabilitation Programme, whether it was long enough and whether it changed their lifestyle for the better. Questionnaires were administered at the end of the Cardiac Phase4 Rehabilitation Programme and during 3 and 6 months follow-up in the community. The results indicated that about 90% of responders rated the programme to be excellent or good and that the score remained similar even when participants were followed-up at 3 and 6 months after discharge from the Cardiac Phase-4 Rehabilitation Programme. A similar pattern of response was observed for active lifestyle and duration of the Cardiac Phase-4 Programme. Interestingly, the MacNew Heart disease health-related quality of life scores remained similar even at 3 and 6 months after rehabilitation was completed. The result of this study indicates that a 3-months Cardiac Phase-4 Rehabilitation Programme in Liverpool was sufficiently long and that service users rated the programme very highly.

Rationale and trial design of a randomized, controlled study on short-term psychotherapy after acute myocardial infarction: the STEP-IN-AMI trial (Short Term Psychotherapy in Acute Myocardial Infarction)

A number of previous studies addressed the effect of psychological interventions in patients after acute myocardial infarction (AMI), but it is not known whether psychotherapy might be beneficial after medical and interventional therapy of AMI. We designed a randomized, controlled study to assess the effects of a short-term psychotherapy (STP) on the clinical outcomes of patients who underwent an emergency percutaneous coronary intervention after AMI. One hundred consecutive patients undergoing an emergency percutaneous coronary intervention will be randomized 1 week after AMI to medical therapy (control group, C group) or to medical therapy and STP (STP group). Clinical follow-up visits are scheduled at 6 months, 1 and 5 years, whereas psychometric tests (Self-Evaluation test, Modified Maastricht Questionnaire, Social Support Questionnaire, Recent Life Change Questionnaire, Beck Depression Inventory, the MacNew Heart Disease Health-Related Quality of Life Questionnaire, Type D Personality test) are scheduled 1 week after AMI and at 1 year. The primary outcome measures of the study are the cumulative incidence of new cardiological events (myocardial reinfarction, death, stroke, life-threatening ventricular arrhythmias, and recurrence of angina) and the occurrence of new medical disorders. Secondary outcome measures are the incidence of rehospitalizations due to cardiological problems, the prevalence of patients with New York Heart Association class > or = II, left ventricular function, as assessed by echocardiography, and mean score of psychometric tests in the two groups at follow-up. Our study has been planned to obtain an insight into how a STP influences clinical outcomes after interventional and medical treatment of AMI.

Caractéristiques psychologiques des patients coronariens en situation de gestion de la frustration

Objectives The aim of the present study is to investigate psychological characteristics of frustration management and their consequences in coronary patients. Methods A sample of N = 58 myocardial infarction patients completed questionnaires measuring self-efficacy (Schwarzer), negative affectivity and social inhibition (type D, Denollet), coping strategies (Coping Questionnaire for Coronary Patients [CQCP], Maës); Anxiety and depression (Hospital Anxiety and Depression Scale [HADS], Zigmond and Snaith), quality of life after myocardial infarction (MacNew Heart Disease Health-related Quality of Life Questionnaire, Hillers) and frustration management (Picture Frustration Study [PFS], Rosenzweig). Results The results show that frustration management in coronary patients differs significantly from that of the reference population. During frustration management the coronary patients present comparatively higher levels of culpability (high I answers) or denial of the responsibility of others (high M answers), as well as lower levels of aggressiveness (low E answers) than the reference population. Furthermore, myocardial infarction patients tend to rather repress their feelings (few ED answers) and to look for active solutions (high NP answers) (Table 1). Patients with a high self-efficacy score look significantly more for active solutions in their frustration management (NP) ( r = 0.27), whereas patients with negative affectivity and social inhibition look for fewer solutions (respectively r = –0.31, r = –0.26). The social inhibition is significantly associated with answers of “Obstacle Dominance” (OD) ( r = 0.28). Within the four coping strategies studied, only the focusing on the problem resolution one is significantly linked to the frustration management responses. Patients using a problem-focused strategy show lower levels of “Ego Defence” for frustration management ( r = –0.31) and higher levels of “Need-Persistence” (NP) ( r = 0.31). Furthermore, results show that “Ego Defence” (ED) is positively related to anxiety ( r = 0.27), whereas “Need persistence” (NP) is negatively linked to anxiety ( r = –0.28) and negatively to depressive affects ( r = –0.29). Patients indicating more extrapunitive answers (E) report significantly lower levels of quality of life ( r = –0.29), whereas non-punitive answers (M) are associated with higher degrees of quality of life ( r = 0.31). No other significant associations were found between frustration answers and quality of life. Conclusions Emotional repression may be a short-term efficient strategy for the patients, allowing a distancing from the myocardial infarction trauma and increasing the quality of life. In the long-term, however, high levels of emotional repression could have negative effects on the global quality of life and the health of the patients.

Psychometric properties of MacNew Heart Disease Health‐related Quality of Life Questionnaire: Brazilian version

. This paper is a report of a study to test the psychometric properties of the Brazilian Version of the MacNew Heart Disease Health-related Quality of Life Questionnaire. Evidence of acceptable psychometric properties of the original MacNew questionnaire has been reported. However, the psychometric performance of the Brazilian version has not been extensively studied. Between November 2004 and June 2005, 159 patients with myocardial infarction completed the Brazilian version of the instrument. Reliability was determined with Cronbach's alpha coefficient; convergent validity with Pearson's correlation between the Brazilian MacNew questionnaire and the SF-36; and the 'known-group' approach was used to test discriminant validity. Ceiling and floor effects and practicality were analyzed. It took an average of 8.9 minutes to complete the instrument. A ceiling effect was detected in the subscales and global scores, with no floor effect. Cronbach's alpha coefficient ranged from 0.87 to 0.92. Scores on similar domains of the SF-36 and the MacNew questionnaire were correlated (r = 0.66; 0.78 and 0.53 for the physical, emotional, and social domains). Correlation between the dissimilar SF-36 mental health and MacNew physical domains was lower at 0.45; correlation between the dissimilar SF-36 physical functioning and MacNew emotional domain was 0.64. Individuals without regional ventricular dysfunction or symptoms had statistically significantly higher scores than those with regional ventricular dysfunction or symptoms. The Brazilian version of the MacNew questionnaire has acceptable levels of validity, reliability and practicality. Further studies are advisable to confirm its divergent validity and to test its responsiveness.