Risk Parameters In Patients Research Articles

Right Ventricular Energy Failure Predicts Mortality in Patients With Pulmonary Hypertension

Right ventricular (RV) failure has a significant adverse impact on pulmonary hypertension (PH) prognosis. None of the currently used parameters directly assess whether RV fails to provide enough energy output to propel the blood through diseased pulmonary vascular system. Furthermore, most of the current parameters are affected by the volume status of the patient. We aimed to explore whether RV energy failure has a predictive power for mortality on top of the established prognostic risk parameters in patients with PH. We screened 723 cases from our database. A total of 3 sets of binary regression analyses were executed to determine the hazard ratios (HRs) of RV energy failure for 5-year mortality in clinical, echocardiographic, and hemodynamic context, using adjustment variables chosen according to previous studies. The final study population encompassed 549 cases. A total of 77 patients died during the 5-year follow-up (14%). RV energy failure was observed in 146 of 549 patients (26.6%). In the univariate model, RV energy failure strongly associated with increased long-term mortality (HR 4.25, 95% confidence interval [CI] 2.58 to 7.00, p <0.001). It also emerged as a significant predictor of long-term mortality in clinical and hemodynamic multivariate models (HR 2.59, 95% CI 1.43 to 4.67, p = 0.002 and HR 2.05, 95% CI 1.15 to 3.63,p = 0.015,respectively). In conclusion, our study indicates that the presence of RV energy failure independently predicts long-term mortality in PH.

Lipid residual cardiovascular risk parameters in patients with familial hypercholesterolemia - importance of triglyceride to high-density lipoprotein ratio

Introduction. Familial hipercholesterolemia is monogenetic disorder associated with early onset of cardiovascular disease. The measurement of low density cholesterol is the primary therapeutic goal in familial hypercholesterolemia patients, but despite the lipid-lowering therapy cardiovascular disease still occurs. It became clear that it?s necessary to consider residual cardiovascular risk. The aim of study was to evaluate residual cardiovascular risk in familial hipercholesterolemia. Material and Methods. In this cross-sectional study we included 291 familial hipercholesterolemia patients with and without previously diagnosed diabetes. Based on value of the Dutch Lipid Clinical Network score criteria, familial hipercholesterolemia patients without diabetes was further divided into: possible (3-5 points), probable (6-8 points), and definite (&gt;8 points) familial hypercholesterolemia. Triglyceride to high density cholesterol ratio, non-HDL-cholesterol and remnant cholesterol were used as parameters of lipid residual cardiovascular risk. Results. We found statistically significant differences in total cholesterol, low and high density cholesterol, triglycerides and apolipoprotein B between the groups (p&gt;0.05). The definite and probable group had higher non-HDL-cholesterol values than possible and familial hypercholesterolemia with diabetes (p&lt;0.01) groups. Familial hypercholesterolemia with diabetes group had higher values of triglyceride to high density cholesterol ratio and remnant cholesterol than definite and probable group (p&lt;0.01). Regression analysis showed that triglyceride to high density cholesterol ratio was independent predictor of appearance of coronary artery disease in addition to elevated low density cholesterol and non-HDL-cholesterol (p&lt;0.01). Conclusion. Triglyceride to high density cholesterol ratio is the most important parameter of the lipid residual cardiovacular risk that strongly linked with cardiovascular disease in familal hypercholesterolemia patients, especially with associated diabetes.

Does Total Knee Arthroplasty Positively Affect Body Static-Dynamic Balance and Fall Risk Parameters in Patients With Satisfactory Functional Scores?

ObjectiveThe aim of this study was to determine the balance problems and risk of falling by using digital or computerized methods in patients who underwent total knee arthroplasty (TKA) and have satisfactory functional scores in the early postoperative period.MethodologyA total of 31 participants (24 women, seven men; mean age: 61.93 ±10.75 years; range: 49-82 years) who underwent unilateral TKA were included. The fall risk was evaluated using the time up-and-go (TUG) test and computerized platforms. Patient-reported pain, stiffness, and physical functional outcome measures [Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and Oxford Knee Score (OKS)] and posture (New York Posture Rating Chart) were evaluated.ResultsBased on the WOMAC scores, there was a significant impact on self-reported pain (p˂0.001), function (p=0.001), and stiffness (p=0.001) between preoperative and postoperative results. The OKS (p=0.006) and the TUG score (p=0.004) improved significantly, but the posture scores remained the same after the surgery. There was a statistically significant difference between the preoperative and third-month postoperative test results of the stabilometric test, bipedal opened eye, bipedal closed eye, monopedal right, and monopedal left foot static balance tests (p˂0.05). However, the disequilibrium and equilibrium dynamic balance values ​​remained unchanged three months after TKA.ConclusionsSatisfactory functional scores according to WOMAC or OKS were achieved in the early postoperative period. However, posture and dynamic balance problems related to falling risk continued to persist in the same period. Although the TUG test results were statistically significant, they also showed fall risk values. Fall risk and postural problems should be analyzed objectively using computerized methods. Early rehabilitation programs after TKA in elderly individuals should be designed accordingly and close attention must be paid to fall risks.

Expression of PD-L1 is HPV/P16-independent in oral squamous cell carcinoma

ObjectivesThis study aimed to investigate the expression of programmed cell death-ligand 1 (PD-L1) and its associations with human papillomavirus (HPV) 16/18 DNA status, p16 expression, demographic, clinicopathologic and risk parameters in patients with oral squamous cell carcinoma (OSCC). Study designA total of 85 formalin-fixed, paraffin-embedded OSCC specimens were collected. HPV16/18 DNA was detected by polymerase chain reaction. PD-L1 and p16 expressions were assessed using immunohistochemical technique. The immunostaining scores were calculated by combined positive score (CPS), previously described. The positive scoring value was determined at CPS ≥1, recommended by FDA. The associations between PD-L1 expression and HPV16/18 DNA status, p16 expression, demographic, clinicopathologic, and risk parameters were analyzed by Chi-square, Fisher's exact tests, and multivariate logistic regression. ResultsPD-L1 expression was detected in 22 out of 85 cases of OSCC (25.9%). 16.5% of all cases were HPV 16/18-positive and 62.4% were p16-positive. Statistically, there were no significant associations between PD-L1 expression in OSCC and HPV16/18 DNA status, p16 expression, demographic and, clinicopathologic parameters or risk behaviors. ConclusionApproximately one-fourth of OSCC cases were PD-L1-positive, suggesting candidacy for anti-PD-L1 immunotherapy. Furthermore, HPV infection and p16 expression were not involved with PD-L1 expression. Further clinical trials warrant the benefits of immunotherapy in patients with PD-L1-positive OSCC.

Effect of Secukinumab on Traditional Cardiovascular Risk Factors and Inflammatory Biomarkers: Post Hoc Analyses of Pooled Data Across Three Indications.

BackgroundPsoriasis, psoriatic arthritis (PsA), and axial spondyloarthritis (axSpA) are chronic immune-mediated inflammatory diseases (IMIDs) associated with cardiovascular (CV) disease. High-sensitivity C-reactive protein (hsCRP) and, more recently, the neutrophil–lymphocyte ratio (NLR) are important inflammatory biomarkers predictive of CV disease and CV disease-associated mortality. Here, we report the effect of interleukin (IL)-17A inhibition with secukinumab on CV risk parameters in patients with psoriasis, PsA, and axSpA over 1 year of treatment.MethodsThis was a post hoc analysis of pooled data from phase 3/4 secukinumab studies in psoriasis, PsA, and axSpA. CV-related exclusion criteria included uncontrolled hypertension and congestive heart failure. Traditional risk factors assessed were body mass index (BMI) > 25, high fasting glucose and blood pressure (systolic and diastolic), and high cholesterol (low-density lipoproteins [LDL], total cholesterol/HDL ratio, and triglycerides). Inflammatory CV risk parameters assessed were hsCRP and NLR. Statistical analysis was descriptive. Subgroup analyses were performed in high-risk patients defined as having baseline hsCRP > 4 mg/L (patients with psoriasis) and > 10 mg/L (patients with PsA/axSpA).ResultsIn total, 9197 patients from 19 clinical trials (8 in psoriasis, n = 4742; 5 in PsA, n = 2475; 6 in axSpA, n = 1980) were included. All traditional CV risk parameters remained stable in secukinumab-treated patients through 1 year. Secukinumab rapidly reduced both hsCRP and the NLR compared with placebo at week 12 (psoriasis) or week 16 (PsA/axSpA) in the overall population and in high-risk patients (all P < 0.01). This reduction was maintained for at least 1 year of secukinumab therapy in all indications.ConclusionsSecukinumab led to a rapid and sustained reduction in hsCRP and the NLR in patients with IMIDs with a high systemic inflammatory burden. Traditional CV risk factors remained stable for at least 1 year in patients with psoriasis, PsA, and axSpA. Taken together, secukinumab had a favorable effect on systemic inflammation without impact on traditional CV risk factors.Trials RegistrationClinicalTrials.gov, NCT01365455, NCT01358578, NCT01406938, NCT01555125, NCT01636687, NCT02752776, NCT02074982, NCT02826603, NCT01752634, NCT01989468, NCT02294227, NCT02404350, NCT02745080, NCT01863732, NCT01649375, NCT02008916, NCT02159053, NCT02896127, NCT02696031.Supplementary InformationThe online version contains supplementary material available at 10.1007/s40744-022-00434-z.

Risk factors for adverse drug reactions in patients admitted to intensive care units

Patients hospitalized in intensive care units (ICU) are at higher risk of having adverse drug reactions (ADR). To determine risk factors for ADR, through intensive pharmacological surveillance at the ICU. An observational, descriptive and prospective study was made, determining risk parameters in patients who experienced ADR. Eighty-five patients were surveilled and 24 (28%) had an ADR. A total of 48 drugs responsible for at least one ADR were identified. Seventy-three percent ADR were moderate and 27% were severe. The clinical variables significantly associated with ADR were a history of allergies, a high body mass index, the reason for admission, an APACHE II score ≥ 14 points, the use of invasive mechanical ventilation and more than seven days of hospitalization. The pharmacological variables associated with ADR were polypharmacy and medication associations and combinations. The identified risk factors have a great impact on pharmacokinetic and pharmacodynamic parameters, and should be considered to avoid the appearance of ADR.

Effect of Intravitreal Injection of Aflibercept on Cardiovascular Risk Parameters in Patients with Neovascular Age-Related Macular Degeneration.

Systemic administration of anti-Vascular Endothelial Growth Factors (anti- VEGFs) has been associated with severe cardiovascular adverse events in oncologic patients. The purpose of this pilot study is to evaluate the short-term effect of a single intravitreal injection of aflibercept on biomarkers related to increased risk of cardiovascular disease. Forty-seven treatment naïve patients with neovascular age-related macular degeneration in one eye were enrolled in the study. The patients underwent treatment with one intravitreal injection of aflibercept in the affected eye. Laboratory biomarkers of cardiovascular disease were evaluated before the first intravitreal injection of aflibercept and at 7 and 30 days after aflibercept administration. More precisely, we evaluated the levels of homocysteine, total cholesterol, triglycerides, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol and Creactive protein. There was not any statistically significant change in the levels of the evaluated parameters up to one month after the first intravitreal injection of aflibercept. According to our study, the administration of a single dose of aflibercept in eyes with neovascular age-related macular degeneration does not seem to affect the evaluated biomarkers that are related to cardiovascular disease.

Effect of Two Meal Replacement strategies on Cardiovascular Risk Parameters in Advanced Age Patients with Obesity and Osteoarthritis

Background and aims: Meal replacement diets consist of replacing one or more meals with an artificial nutritional supplement. The objective of this study was to compare the effect of one against two meal replacement strategies on body composition and cardiovascular risk parameters in patients with obesity. Methods: A randomized clinical trial was designed with a modified hypocaloric diet with an artificial nutritional preparation replacing one or two meals for three months in patients with obesity and osteoarthritis pending orthopedic surgery. An anthropometric evaluation and a measurement of the body composition were done with bioelectrical impedance measurement at the beginning and at three months. Results: A total of 112 patients were recruited. Fifty-two patients (46.4%) were randomized to one replacement and 60 patients (53.6%) to two meal replacements. Eighty-one patients (72.3%) were women, and the average age was 61 (11.03) years. The percentage of weight loss at three months was 8.27 (4.79)% (one meal replacement: 7.98 (5.97)%; two meal replacements: 8.50 (3.48)%; p = 0.56). A decrease in fat mass measured by the fat mass index (FMI) was detected (one meal replacement: −2.15 (1.45) kg/m2 vs. two meal replacements: −2.78 (2.55) kg/m2; p > 0.05), and a relative increase in fat-free mass was observed (one meal replacement: +3.57 (4.61)% vs. two meal replacements: +2.14 (4.45)%; p > 0.05). A decrease in HOMA-IR, systolic blood pressure (SBP), and total cholesterol was observed in both groups without differences between them. Conclusions: The substitution strategies of one or two meal replacements were effective in weight loss and fat mass decrease without differences between the two groups. An improvement in lipid parameters, glycemic control, and systolic blood pressure was observed without differences between strategies.

The relation of novel cardiovascular risk parameters in patients with familial Mediterranean fever.

ObjectiveIn this study, we aimed at correlating the thickness of epicardial adipose tissue and levels of Vitamin D with cardiac risk in patients with familial Mediterranean fever.MethodsSixty-five patients with familial Mediterranean fever and 38 healthy controls with matching age and sex were included in the study. The patients with a history of familial Mediterranean fever attacks within the previous two weeks or with any history of inflammatory or cardiovascular disease were excluded. Data regarding age, gender, weight, height, waist circumference, body mass index (calculated as weight/height2), pulse wave velocity, serum Vitamin D levels from fasting blood samples, and Homeostatic Model Assessment for insulin resistance were obtained for the patients and controls. The epicardial adipose tissue was visualized as an echo-free space between the outer surface of myocardium and visceral pericardium using two-dimensional echocardiography, and the thickness of epicardial adipose tissue was measured in parasternal long-axis view at the end of diastole.ResultsThe patients with familial Mediterranean fever had significantly higher levels of C-reactive protein, epicardial adipose tissue, and pulse wave velocity (p < 0.001, <0.05, <0.005, respectively) as compared with the control group. However, the serum Vitamin D levels in the two groups were observed to be similar (p = 0.486). Weak but significant positive correlations were observed between epicardial adipose tissue thickness and C-reactive protein (r = 0.302, p < 0.005), epicardial adipose tissue thickness and pulse wave velocity (r = 0.263, p < 0.01), and C-reactive protein and pulse wave velocity (r = 0.235, p < 0.05).ConclusionThickness of epicardial adipose tissue and pulse wave velocity were observed to increase in patients with familial Mediterranean fever.

Selected nutritional risk parameters in patients with laryngeal cancer – a comparison with other patients hospitalized in a Department of Laryngology and patients with colorectal cancer

Background: It is assumed that neoplasm greater in size may affect a patients’ nutritional status and prognosis stronger than smaller one. The aim of this study was to compare the nutritional status and prognosis of patients with laryngeal cancer (LC), recognized as tumour smaller in size, and patients with colorectal cancer (CRC) who were hospitalized in our hospital during the one year period. Methods: The retrospective review of medical documentation of all 1,134 patients hospitalized in a Department of Otolaryngology. Results: The laryngeal tumour was smaller than colorectal. Nutritional risk concerned 9% of patients with LC, was greater than in patients with other laryngeal disorders (1.4%), and lower than in patients with CRC (37%). A Nutritional Risk Screening (NRS) 2002 score ≥ 3 was the only significant factor influencing the risk of in-hospital all-cause mortality, 14- and 30-day readmissions in patients with LC, and the risk of 14-day rehospitalization in patients with CRC. Conclusions: Risk of malnutrition in patients with LC was lower than in counterparts with CRC, and concern 9% and 37% of patients, respectively. Nutritional risk diagnosed in patients with LC had a stronger association with the prevalence of the measured outcomes (in-hospital death, the risk of 14-day and 30-day readmission, length of hospitalization) than in individuals with CRC.

Prospective assessment of cardiovascular risk parameters in patients with rheumatoid arthritis

BackgroundThe study presents a prospective follow-up assessment of cardiovascular (CV) risk parameters in patients with rheumatoid arthritis (RA) in comparison with control subjects.MethodsThe study group consisted of 41 RA patients. The following parameters were assessed at subsequent visits [initial (T0), follow-up after 6 years (T6)]: traditional CV risk factors, carotid intima media thickness (cIMT), QTc duration, serum concentration of amino-terminal pro-brain natriuretic peptide (NT-proBNP). A comparative cIMT assessment was performed on 23 healthy controls of comparable age.ResultsThe mean (SD) cIMT value in RA patients was significantly higher at T6 than at T0 [0.87 (0.21) vs 0.76 (0.15) mm, p < 0.001], the increase in patients with atherosclerotic plaques was noted. Patients with plaques were significantly older, had higher inflammatory parameters. The mean cIMT was significantly higher in RA patients than in controls at both T6, T0 visits. Certain traditional CV risk factors exacerbated during follow up. Unfavorable metabolic parameters and significantly higher cIMT were found in male patients than in female patients at T6. During follow-up, no significant differences in NT-proBNP, QTc were found. There were no significant relationships between cIMT, NT-proBNP, QTc and parameters of disease activity at T6.ConclusionsDuring the 6-year course of established RA, significant exacerbation of atherosclerosis was found, revealed by higher cIMT. A careful monitoring should be applied to patients with atherosclerotic plaques and of male gender due to higher burden of CV risk. In long-standing disease, traditional CV risk factors seem to play a key role, beyond the inflammatory activity.

Periodontal treatment on patients with cardiovascular disease: Systematic review and meta-analysis.

BackgroundAtherosclerotic cardiovascular disease is the main cause of mortality in developed countries. It is a chronic and systemic inflammatory disease with a multifactorial etiology. Periodontal disease is one of the many factors that contribute to its development.ObjectiveTo analyze the effects of periodontal treatment on cardiovascular risk parameters in patients with atherosclerotic cardiovascular disease.Material and MethodsA systematic research was conducted in the Pubmed/Medline databases for clinical trials published up to and including the year 2017.ResultsTen articles were included for analysis. Periodontal treatment reduced C-reactive protein levels (77.8% of clinical trials), tumor necrosis factor-alpha (66.7%), interleukin-6 (100%) and leukocytes (50%). Fibrinogen levels also improved considerably (66.7%). Effects on lipid parameters were more limited, whereby only oxidized low density lipoprotein and very low density lipoprotein cholesterol decreased significantly. Meta-analysis showed a statistically significant decreased in C-reactive protein and leukocytes values when patients were submitted to non-surgical periodontal treatment in contrast to receiving no treatment at all (mean difference 1.199 mg/L, 95% confidence interval: 1.100-1.299, p<0.001; and mean difference 0,79 g/L, 95% confidence interval: 0.717-0.879, p<0.001, respectively).ConclusionsPeriodontal treatment has a beneficial effect on some of the biochemical parameters considered to represent cardiovascular risk. Further randomized clinical trials are necessary, with longer follow-up periods including regular periodic monitoring, in order to determine the extent of the impact of periodontal treatment. Key words:Periodontal disease, cardiovascular disease, atherosclerosis, periodontal therapy, periodontal treatment.

Ambulatory blood pressure monitoring and hypertension related cardiovascular risk in patients with rheumatoid arthritis

Background: To assess hypertension related cardiovascular risk parameters in patients with rheumatoid arthritis. To determine the effect of long-term treatment with corticosteroids, non-steroid antiinflammatory drugs, and methotrexate on diurnal BP variability. Material and methods: 60 patients with clinically stable rheumatoid arthritis and treated hypertension. Casual blood pressure measurement and 24-hour ambulatory blood pressure monitoring. Results: Mean casual systolic blood pressure 139.0 ± 14.6 mmHg, diastolic blood pressure 85.7 ± 6.5 mmHg, and heart rate 74.9 ± 7.2 beats.min-1. Mean 24-hour systolic blood pressure 129.0 ± 12.7 mmHg, diastolic blood pressure 77.6 ± 7.4 mmHg, and heart rate 73.9 ± 8.7 beats.min-1. Mean casual pulse pressure 54.7 ± 15.6 mmHg, and the mean 24-hour ambulatory pulse pressure 50.1 ± 11.0 mmHg. The mean morning surge of systolic blood pressure 35.3 ± 11.00 mmHg. The number of patients with increased short-term variability of their systolic blood pressure using the coefficient of variation 30 (50%). A number of systolic nondippers in the group were treated with corticosteroids and non-steroidal anti-inflammatory drugs 34% and 35%, respectively, and a number of excessive diastolic dippers in the group were treated with methotrexate 49%. Conclusions: Certain hypertension characteristics in patients with rheumatoid arthritis can increase cardiovascular risk: Higher pulse pressure, elevated levels of morning surge of systolic blood pressure, increased short-term 24-hour blood pressure variability, higher number of systolic nondippers treated with corticosteroids and non-steroidal anti-inflammatory drugs, and excessive diastolic dippers treated with methotrexate. In addition increased heart rate may contribute to higher cardiovascular risk.

AB0530 Atherosclerosis in egyptian patients with ankylosing spondylitis

BackgroundAnkylosing spondylitis (AS) is a systemic inflammatory disorder that causes axial and peripheral arthritis with extraarticular features1. Increased mortality is largely attributable to cardiovascular disease (CVD) that has been found...

Reducing the incidence of post‐hepatectomy hepatic complications by preoperatively applying parameters predictive of liver function

To prevent or reduce hepatic complications after hepatectomy, it is important to employ preoperative predictive parameters and to determine the indications for hepatectomy. In the present study, we evaluated risk parameters in patients who underwent hepatectomy between 1994 and 2003, and selected three parameters to modify the surgical indications. Using these indications before surgery in patients who underwent hepatectomy between 2004 and 2008, we compared the prevalences of postoperative complications in the the two groups of patients. We examined 250 consecutive patients who underwent hepatectomy for liver disease [149 in 1994-2003 (termed the early period) and 101 in 2004 to 2008 (termed the later period)]. In the early period, uncontrolled ascites was observed in 55 patients and hepatic failure was observed in 15 of the 149 patients. Multivariate analysis identified volume of the resected liver (> or =50%), intraoperative blood loss (> or =1500 ml), prothrombin activity (<70%), hyaluronic acid level (> or =200 ng/ml), and LHL15 (hepatic uptake ratio of technetium-99m galactosyl human serum albumin ((99m)Tc-GSA) (<0.85) as risk factors; the latter three parameters were evaluated as predictors of outcome. From 2004, we used these three parameters, in addition to the indocyanine green retention rate at 15 min (ICGR15), as criteria for indications for hepatectomy. Despite the lower prevalence of normal liver in the later period, comparisons showed decreases in the rates of uncontrolled ascites (23 vs. 37%, P = 0.03), hepatic failure (4 vs. 10%, P = 0.12), and hepatic complications (25 vs. 44%, P = 0.003) in patients in the later period compared with these rates in the previous period. The use of prothrombin activity, and levels of hyaluronic acid and LHL15, as parameters of functional liver reserve in the selection of candidates for surgery reduced the incidence of hepatic complications after hepatectomy.

A nurse‐led cardiac rehabilitation programme improves health behaviours and cardiac physiological risk parameters: evidence from Chengdu, China

The aim of this study was to examine the effect of a cardiac rehabilitation programme on health behaviours and physiological risk parameters in patients with coronary heart disease in Chengdu, China. Epidemiological studies indicate a dose-, level- and duration-dependent relationship exists between cardiac behavioural and physiological risks and coronary heart disease incidence as well as subsequent cardiac morbidity and mortality. Cardiac risk factor modification has become the very primary goal of modern cardiac rehabilitation programmes. A randomized controlled trial was conducted. Coronary heart disease patients (n = 167) who met the sampling criteria in two tertiary medical centres in Chengdu, south-west China, were randomly assigned to either an intervention group (the cardiac rehabilitation programme) or control group (the routine care). The change of health behaviours (walking performance, step II diet adherence, medication adherence, smoking cessation) and physiological risk parameters (serum lipids, blood pressure, body weight) were assessed to evaluate the programme effect. Patients in the intervention group demonstrated a significantly better performance in walking, step II diet adherence, medication adherence; a significantly greater reduction in serum lipids including triglyceride, total cholesterol, low-density lipoprotein; and significantly better control of systolic and diastolic blood pressure at three months. The majority of these positive impacts were maintained at six months. The effect of the programme on smoking cessation, body weight, serum high-density lipoprotein, was not confirmed. A cardiac rehabilitation programme led by a nurse can significantly improve the health behaviours and cardiac physiological risk parameters in coronary heart disease patients. Nurses can fill significant treatment gaps in the risk factor management of patients with coronary heart disease. This study raises attention regarding the important roles nurses can play in cardiac rehabilitation and the unique way for nurses to meet the rehabilitative care needs of coronary heart disease patients. Furthermore, the hospital-home bridging nature of the programme also created a model for interfacing the acute care and community rehabilitative care.