The effect of cardiac rehabilitation on recovery of heart rate over one minute after exercise in patients with coronary artery bypass graft surgery

OBJECTIVE: To evaluate the effects of cardiac rehabilitation on the recovery of heart rate over 1 min after peak exercise of patients who received coronary artery bypass graft (CABG) surgery. DESIGN: Thirty subjects who received CABG surgery were randomly assigned to enter or not enter a cardiac rehabilitation exercise programme (cardiac rehabilitation n = 15; control group n = 15). SETTING: Outpatient cardiac rehabilitation centre in a national medical hospital. INTERVENTIONS: Patients assigned to the cardiac rehabilitation group received 36 sessions of the exercise programme, three times a week, with the intensity designed to achieve an individual 60-85% peak heart rate in cardiopulmonary exercise test. Patients assigned to the control group did not get further advice about a specific exercise programme. MAIN OUTCOME MEASURES: Resting heart rate and recovery of heart rate over 1 min after a peak exercise test at discharge and three months later were collected. The heart rates were analysed with computer-recorded electrocardiogram. RESULTS: At follow-up, the 15 patients in the cardiac rehabilitation group had a significantly lower resting heart rate (77.46+/-9.49 versus 92.31+/-10.18 bpm; p<0.001) and a significantly higher recovery of heart rate over 1 min (16.38+/-6.32 versus 11.38+4.81 bpm; p = 0.03) compared with the control group. There were also significant reductions in resting heart rates (cardiac rehabilitation p < 0.001; control p = 0.05) and improvements in recovery on heart rate over 1 min (cardiac rehabilitation p < 0.001; control p = 0.001) compared with baseline measurements in both the cardiac rehabilitation and control groups. CONCLUSION: Cardiac rehabilitation had a positive effect on the improvement of recovery on heart rate over 1 min in patients with coronary artery disease who received CABG surgery.     

冠状动脉搭桥术后康复护理研究进展

文章指出了康复护理的重要性,并从饮食、运动、心理、药物、社会支持方面归纳了冠状动脉搭桥术后康复护理研究现状.在此基础上,对促进冠状动脉搭桥术后患者早期康复及早日回归家庭与社会,提高护理质量,建立完整、连续的康复体系的研究前景进行了展望.     

Cardiac rehabilitation after coronary artery bypass grafting: effects on exercise performance and risk factors

After coronary artery bypass grafting (CABG), 49 nonselected patients followed a cardiac rehabilitation program that included medical follow-up and physical training, both in outpatient groups and on an individual basis at home. The effect of the program on exercise test variables, coronary risk factors, and medication one year after surgery was compared to a nonexercised control group (n = 98). The study group showed less increase in the rate-pressure product, indicating a favorable effect on myocardial oxygen consumption (0.7 +/- 5.4 vs 2.8 +/- 5.6, p less than .05); a lower frequency of angina at exercise testing (6% vs 18%, p less than .01); a reduction in resting systolic and diastolic blood pressure (9/4mmHg, p less than .01); fewer smokers (6% vs 17%, p less than .05); and fewer patients taking long-acting nitrates (0% vs 10.2%, p less than .05). It is suggested, therefore, that an organized cardiac rehabilitation program may be advantageous after CABG.     

CT angiography after coronary artery bypass graft surgery

CT angiography is an emerging technique for the noninvasive assessment of coronary artery disease. The diagnostic performance of different generation CT scanners has been investigated for the detection of significant stenosis (≥ 50% lumen diameter reduction) in patients after coronary artery bypass surgery (CABG). The temporal and spatial resolution of CT scanners are important determinants for reliable evaluation of bypass grafts and native coronary arteries. Important drawbacks of 64-slice CT angiography remain the evaluation of severely calcified native coronary segments and distal graft anastomosis site. Future developments in the latest CT scanners head toward the use of wider detectors and improved coverage, which may be relevant in post-CABG patients. Despite technical advances, the role of CT angiography in the follow-up of patients after bypass surgery has not yet been established.     

冠状动脉搭桥术后护理体会

目的：探讨冠状动脉搭桥（CABG）术后病人护理要点。方法：回顾2007年8月～2008年11月17例搭桥术后护理情况。结果：在对病人实施循环系统、呼吸系统监护,纠正电解质紊乱,补充血容量,加强引流管、低心排及肢体护理后,除1例病人因严重心律失常、低心排死亡外,余16例病人均痊愈出院。结论：术后根据冠状动脉搭桥特点进行严密监测,采取有效护理措施,有助于准确及时防止并发症,提高病人生活质量和延长寿命。     

Relation of heart rate recovery after exercise testing to coronary artery calcification

Background: We examined whether slow heart rate recovery (HRR) after exercise testing as an estimate of impaired autonomic function is related to coronary artery calcification (CAC), an emerging marker of coronary atherosclerosis.

Methods: We evaluated 2088 men who participated in a health-screening program that included measures of CAC and peak or symptom-limited cardiopulmonary exercise testing. HRR was calculated as the difference between peak heart rate (HR) during exercise testing and the HR at 2?min of recovery after peak exercise. We measured CAC using multidetector computed tomography to calculate the Agatston coronary artery calcium score. Advanced CAC was defined as a mean CAC >75th percentile for each age group.

Results: HRR was negatively correlated with CAC (r?=??.14, p?52 bpm). Each 1 bpm decrease in HRR was associated with 1% increase in advanced CAC after adjusting for potential confounders.

Conclusions: An attenuated HRR after exercise testing is associated with advanced CAC, independent of coronary risk factors and other related hemodynamic response.

• KEY MESSAGES

• Slow heart rate recovery (HRR) after maximal exercise testing, indicating decreased autonomic function, is associated with an increased risk of cardiovascular event and mortality.

• Slow HRR has been linked with the occurrence of malignant ventricular arrhythmias, but it remains unclear whether slow HRR is associated with an increased risk of coronary artery calcification (CAC), an emerging marker of coronary atherosclerosis.

• An attenuated HRR after exercise testing was associated with advanced CAC, independent of coronary risk factors and other potential hemodynamic confounder, supporting the hypothesis that slow HRR is related to the burden of atherosclerotic coronary artery disease.

     

Randomized trial of a home recovery intervention following coronary artery bypass surgery

For this study a randomized clinical trial was designed to test the effects of an early home recovery information intervention on physical functioning, psychological distress, and symptom frequency 1 month following coronary artery bypass graft surgery (CABG). Recovery outcomes were compared between two groups: those receiving an audiotape of information on expected physical sensations and their management (Cardiac Home Information Program [CHIP]) in addition to the usual care, and those receiving the usual cardiac discharge information protocol. A nonprobability sample of 180 patients (84 women and 96 men; mean age = 62 years) was equally distributed between the two study groups. When controlling for age, comorbidity, and cardiac functional status, the results showed positive effects on physical functioning in women and psychological distress, vigor and fatigue in men. Consistent with other studies, women had worse physical functioning and more symptom frequency than men. These findings indicate that the CHIP intervention is an effective method to prepare CABG patients for home recovery.     

Caring for a patient after coronary artery bypass graft surgery

Follow this system-by-system approach to keeping your patient stable and steering clear of complications.     

HeartCare: an Internet-based information and support system for patient home recovery after coronary artery bypass graft (CABG) surgery

HeartCare is an Internet-based information and support service for patients recovering at home from coronary artery bypass graft (CABG) surgery. The system is designed to meet the nursing challenges in health information to support needs of CABG patients. HeartCare (a) provides information and support, tailored to patients' individual and changing recovery needs during CABG recovery, (b) makes recovery information more accessible for timely use by patients, and (c) extends the scope of nursing services to CABG patients from hospital through home. An ongoing randomized controlled study is underway to evaluate the clinical outcomes of patients' use of the HeartCare system and to examine its acceptance as a usable resource for postCABG patients who have limited previous computer experience.     

Cardiac home care programs impact patients after coronary artery bypass grafting

Many hospitals have initiated early discharge programs in an effort to transition coronary artery bypass grafting patients home as quickly as possible. To meet the needs of patients who are discharged early, several home care agencies have created special cardiac programs. This article describes the common components of six successful home care cardiac programs.     

Patient-related outcomes five years after coronary artery bypass graft surgery

For five years, we prospectively studied 353 consecutive patients undergoing first-time coronary artery bypass graft surgery (CABG) for stable angina in the North of England. Angina was present before surgery in nearly all patients, in 20% 3 months after surgery, and in 48% after 60 months. The Nottingham Health Profile, showed a significant improvement in perceived health status (PHS) 12 and 60 months after surgery compared with preoperation. However, PHS at 60 months was worse than at 12 months in the dimensions 'pain' and 'physical mobility' in part 1, and in 'looking after the home' and 'taking holidays' in part 2. Employment rates were 36%, 34% and 21%, before, and 12 and 60 months after surgery, respectively. Working at 12 and 60 months was associated with age below retirement age, work preoperation and absence of angina, and at 12 months also with male gender and waiting time < 6 months. This study describes everyday clinical practice. The significant improvement in angina symptoms and PHS after CABG persists for at least 5 years. However, only one third of patients in this geographical area return to work, and this is not solely dependent on clinical symptoms.     

护理干预对冠状动脉旁路移植术后康复的影响

目的 探讨护理干预对冠状动脉旁路移植术患者术后康复的影响.方法 将50例行冠状动脉旁路移植术的患者随机分为研究组和对照组各25例,对照组给予常规药物治疗和行术后一般卫生宣教,研究组在对照组的基础上,采取系统性护理干预措施(疾病知识宣教、饮食指导、运动干预和心理护理)1年.采用生活质量综合评定量表(GQOLI-74)评定2组康复情况.结果 术后1年GQOLI-74各项评分,研究组明显高于对照组(P＜0.01).结论 系统性护理干预促进了冠状动脉旁路移植术后患者的康复.     

护理干预对冠状动脉旁路移植术后康复的影响

目的 探讨护理干预对冠状动脉旁路移植术患者术后康复的影响.方法 将50例行冠状动脉旁路移植术的患者随机分为研究组和对照组各25例,对照组给予常规药物治疗和行术后一般卫生宣教,研究组在对照组的基础上,采取系统性护理干预措施(疾病知识宣教、饮食指导、运动干预和心理护理)1年.采用生活质量综合评定量表(GQOLI-74)评定2组康复情况.结果 术后1年GQOLI-74各项评分,研究组明显高于对照组(P＜0.01).结论 系统性护理干预促进了冠状动脉旁路移植术后患者的康复.     

Indications for coronary artery bypass graft surgery

ACBGS is indicated in patients with stable angina who have left main coronary artery disease; three-vessel disease; three or four of the clinical variables set forth in the Veterans Administration Cooperative Study; obstruction in proximal third of left anterior descending coronary artery as part of two- or three-vessel disease; and two- or three-vessel disease and exercise-induced ischemic ST-segment depression greater than or equal to 1.5 mm. ACBGS may increase survival in patients with limited exercise capacity. Finally, ACBGS may be indicated to increase the quality of life in patients with disabling angina that is refractory to medical treatment. Patients with unstable angina who have an inadequate response to intensive medical therapy should have emergency ACBGS. Indications for elective ACBGS in patients with unstable angina who respond adequately to medical therapy are the same as those for stable angina. Patients with rupture of the ventricular septum, acute severe mitral regurgitation, and cardiogenic shock with vessels suitable for ACBGS should have urgent ACBGS after acute myocardial infarction. Patients with postinfarction angina after the first few days following acute myocardial infarction, especially non-Q-wave infarction, should be considered for ACBGS. Indications for elective ACBGS in postinfarction patients are the same as those in stable angina. Patients with coronary artery disease, especially those with a significant amount of ischemic myocardium, who must undergo cardiac surgery for valvular heart disease or for congenital heart disease should probably have ACBGS performed at the time of surgery.