Factors influencing attendance at cardiac rehabilitation among coronary heart disease patients.

OBJECTIVE: The current study examined predictors of, and reasons for, non-attendance at cardiac rehabilitation (CR) among coronary heart disease patients. METHODS: Measures of demographics, surgical procedures, cardiac risk factors, cardiac damage, and psychological variables (depression, trauma, anxiety and alexithymia) were obtained at baseline in 85 coronary heart disease patients, of whom 34 (40%) attended CR. Patients not attending CR reported reasons for their non-attendance. RESULTS: Men who had a sedentary lifestyle or were obese were significantly more likely to attend CR. Women were significantly more likely to attend CR if they had a partner. Patients reported numerous personal reasons for their non-attendance, some of which reflect a dislike of a group format. CONCLUSION: The results suggest the presence of obstacles to attendance and completion of CR that may differ for men and women. Innovative approaches are needed to encourage participation, including the development and evaluation of alternative formats of CR.     

40例冠状动脉疾病患者门诊康复疗效观察

目的观察冠状动脉疾病患者门诊康复的效果。方法对 40例冠状动脉疾病 (CAD)门诊患者 ,男性 31例 ,女性 9例采用Effraim步行程序训练 6周 ,用 1分钟心率储备法 (HRR)评定康复疗效。结果康复后患者的静息心率降低 ,运动时最大心率提高 ,HRR改善 (均为P <0 .0 5)。结论心脏康复可以提高患者的HRR ,改善患者的心脏功能。     

Women and cardiac rehabilitation: a review of the literature

There is a wide variety of literature available about coronary heart disease (CHD). However much of the research related to CHD has been performed using either exclusively male populations or such small numbers of women that the results from the women studied were unable to be analysed independently. It is apparent that more researchers are focusing on research that examines women's responses to CHD and the care and treatment they receive. The following literature review explores some of the issues related to women's experience of cardiac rehabilitation and demonstrates that women's experience of cardiac rehabilitation may be different to that of men. There is a need for nurses working within this area of practice to have an understanding of women's experience of recovery from a heart attack in order to better meet their needs.     

Factors influencing referral of cardiac patients for cardiac rehabilitation.

This study asked the question: Are there differences in the characteristics and referral rates of men and women who are referred for cardiac rehabilitation? The sample consisted of 203 men (n = 148) and women (n = 55) who were hospitalized with at least one cardiac diagnosis and were eligible for Phase II cardiac rehabilitation. Hospital records were reviewed to obtain information on gender, age, ethnicity, insurance coverage, marital status, employment status, proximity to rehabilitation services, transportation availability, concurrent disease processes, domestic responsibilities, documentation of referral for cardiac rehabilitation, and the attending physician. A survey sent to the patients approximately 3 weeks after their discharge from the hospital also addressed these variables. Logistic regression analysis indicated only one predictor of referral: the gender of the physician. Male physicians were more likely to refer patients for cardiac rehabilitation. This finding must be viewed with caution because of the small number of female patients and female physicians included in the study. The current literature reflects conflicting findings about the proposed relationships; therefore, they merit further investigation.     

冠心病病人药物治疗依从性的影响因素

[目的]分析冠心病病人药物治疗依从性的影响因素.[方法]问卷调查130例住院冠心病病人的一般状况,包括性别、年龄、文化程度、病程、伴随疾病、医疗费用支付方式及报销情况,对这些因素进行Logistic回归分析.[结果]年龄越大、文化程度越高,药物治疗依从性越好.性别、病程、医疗费支付方式等与药物治疗依从性之间无统计学意义.[结论]年龄及文化程度影响冠心病药物治疗依从性;对年轻及文化程度低者应给予重点关注,以提高药物治疗的依从性.     

冠心病病人药物治疗依从性的影响因素

[目的]分析冠心病病人药物治疗依从性的影响因素.[方法]问卷调查130例住院冠心病病人的一般状况,包括性别、年龄、文化程度、病程、伴随疾病、医疗费用支付方式及报销情况,对这些因素进行Logistic回归分析.[结果]年龄越大、文化程度越高,药物治疗依从性越好.性别、病程、医疗费支付方式等与药物治疗依从性之间无统计学意义.[结论]年龄及文化程度影响冠心病药物治疗依从性;对年轻及文化程度低者应给予重点关注,以提高药物治疗的依从性.     

冠心病患者心脏康复依从性的影响因素及干预措施的研究进展

随着21世纪心血管疾病发病率的增加,人们对这类疾病的认识已不单单满足于治疗,而是要求提高全面的健康水平和生活质量,从而以运动为核心的心脏康复逐渐成为心脏病患者较为理想的治疗手段之一[1].心脏康复可以提高冠心病患者的运动能力,促进其社会心理的健康,提高生活质量,降低冠心病患者的再入院率,从而降低住院费用等[2-3],但是只有25%～50%的冠心病患者参加心脏康复方案,而且能够完成心脏康复方案的更少[4-5].心脏康复的依从性问题是国外学者研究的热点,而国内类似的研究还比较少.本文回顾了近十年国内外相关研究,对冠心病患者心脏康复依从性现状及其影响因素,以及提高冠心病患者心脏康复依从性的干预措施进行综述,以期为国内开展心脏康复的依从性研究提供依据.     

重症冠心病患者心脏康复分级护理方案的制订与应用

目的 制订并应用重症冠心病患者心脏康复分级护理方案,评价其应用效果.方法 2019年7月通过文献回顾和临床实践分析重症冠心病患者心脏康复护理特点及难点,成立专项管理小组,制订重症冠心病患者心脏康复分级护理方案,将该方案于2019年8月—2021年1月进行临床应用并收集相关资料.结果 心脏康复分级护理方案共计应用于817...     

冠心病PCI术后患者心脏康复认知现状及影响因素分析*

目的: 探讨冠心病PCI术后的患者心脏康复认知水平,分析影响心脏康复认知水平的相关因素。方法: 采用一般资料调查表、冠心病健康信念量表、自制心脏康复认知度量表对首次行PCI术的115例冠心病患者进行现况调查。结果: 冠心病PCI术后患者的心脏康复认知水平得分为(14.54±3.69)分,处于中下水平;年龄、文化程度、是否接受过相关知识宣教、知觉到益处及知觉到严重度影响冠心病患者的心脏康复认知水平（P<0.05）。结论: 冠心病PCI术后患者的心脏康复认知水平处于中下水平,有较大提升空间。医护人员可针对年龄较大、文化程度较低的冠心病患者开展个性化的心脏康复知识宣教,以促进患者更好地了解心脏康复的益处、改善患者的心脏康复认知现状,从而提高患者心脏康复的依从性及参与水平。     

Kinesiophobia mediates the influences on attendance at exercise-based cardiac rehabilitation in patients with coronary artery disease

Purpose: To identify predictors of attendance at exercise-based cardiac rehabilitation (CR) and to test the hypothesis that kinesiophobia mediates the influence on attendance at CR in patients with coronary artery disease (CAD). Patients: In total, 332 patients (75 women; mean age 65 ± 9.1 years) with a diagnosis of CAD were recruited at Sahlgrenska University Hospital, Sweden.Methods: The patients were tested in terms of objective measurements, self-rated psychological measurements, and level of physical activity. A path model with direct and indirect effects via kinesiophobia was used to predict participation in CR. An exploratory selection of significant predictors was made. Results: A current incidence of coronary bypass grafting (p < 0.001) and a diagnosis of ST-elevation myocardial infarction (p = 0.004) increased the probability of attendance at CR, while kinesiophobia (p = 0.001) reduced attendance. As a mediator, kinesiophobia was influenced by four predictors and the following indirect effects were found. General health and muscle endurance increased the probability of attendance at CR, while self-rated anxiety and current incidence of heart failure had the opposite effect. Conclusions: This study suggests that kinesiophobia has an influence on and a mediating role in attendance at CR. The results need to be further investigated in relation to clinical practice.     

Factors affecting learning in a coronary artery disease rehabilitation class.

One hundred patients with coronary artery disease (CAD) were studied to determine which factors affect their baseline knowledge and retention of knowledge about CAD and whether CAD classes are an effective teaching tool. All patients were given a pretest about CAD. Patients then attended a 1-hour rehabilitation class about CAD. One month later, they were given an identical posttest. Pretest scores had a negative correlation with patient age and positive correlations with the number of years of formal education, the number of previous myocardial infarctions, and the number of previous CAD classes attended. Posttest scores had a positive correlation with the number of previous CAD classes attended. There was a significant relationship between learning and marital status, with married patients learning better than unmarried patients. Comparison of patients' pretest and posttest scores revealed a highly significant improvement. Based on the results of this study, the CAD rehabilitation class is an effective tool for rehabilitation of the cardiac patient; additional teaching effort should be focused on unmarried patients. Factors such as age, education, smoking and alcohol consumption histories, and number of previous CAD classes attended do not affect learning in the interventional phase.     

Screening for coronary artery disease in patients with diabetes

Coronary artery disease (CAD) accounts for a large fraction of the morbidity, mortality, and cost of diabetes. Recognizing this, nearly 10 years ago the American Diabetes Association published a consensus recommendation that clinicians consider a risk factor-guided screening approach to early diagnosis of CAD in both symptomatic and asymptomatic patients. Subsequent clinical trial results have not supported those recommendations. Since the prior consensus statement, newer imaging methods, such as coronary artery calcium scoring and noninvasive angiography with computed tomography (CT) techniques, have come into use. These technologies, which allow quantitation of atherosclerotic burden and can predict risk of cardiac events, might provide an approach to more widespread coronary atherosclerosis screening. However, over this same time interval, there has been recognition of diabetes as a cardiovascular disease (CVD) equivalent, clear demonstration that medical interventions should provide primary and secondary CVD risk reduction in diabetic populations, and suggestive evidence that percutaneous coronary revascularization may not provide additive survival benefit to intensive medical management in patients with stable CAD. This additional evidence raises the question of whether documenting asymptomatic atherosclerosis or ischemia in people with diabetes is warranted. More data addressing this issue will be forthcoming from the BARI 2-D (Bypass Angioplasty Revascularization Investigation 2 Diabetes) trial. Until then, for patients with type 2 diabetes who are asymptomatic for CAD, we recommend that testing for atherosclerosis or ischemia, perhaps with cardiac CT as the initial test, be reserved for those in whom medical treatment goals cannot be met and for selected individuals in whom there is strong clinical suspicion of very-high-risk CAD. Better approaches to identify such individuals based on readily obtained clinical variables are sorely needed.     

Long-term effects of cardiac rehabilitation in elderly individuals with stable coronary artery disease

Purpose: To compare exercise capacity and cardiovascular response to exercise in elderly individuals with coronary artery disease (CAD) who attend ongoing community-based maintenance cardiac rehabilitation (CR) versus age- and gender-matched healthy “very active” (HVA;?≥?2000?kcal/week) and healthy “less active” (HLA; <2000?kcal/week) individuals. Method: Sixty-three participants (age: 72.3?±?5.1 years; 62% men; n?=?21 per group) completed the following assessments: (1) symptom-limited graded exercise test with expired gas analysis and bioimpedance assessment of cardiovascular function during exercise; (2) walking tests; (3) physical function; (4) anthropometry and (5) 12-month physical activity recall. Results: The CR group achieved 98% (range: 73–154%) of age- and gender-predicted peak oxygen consumption for healthy individuals. Peak oxygen consumption was lower in CR compared to HVA but not HLA group (VO_2peak: CR: 19.0?±?4.5, HVA: 23.7?±?2.9, HLA: 20.7?±?4.7?ml ·kg^?1?min^?1, p?=?0.001 versus HVA; p?=?0.390 versus HLA). Peak heart rate was lower in CR compared to both HVA and HLA. Walking test results and cardiovascular and physical function were not different between the groups. Conclusions: Elderly individuals with CAD participating in maintenance CR have similar exercise capacity and cardiorespiratory response to exercise compared to their age- and gender-matched less active healthy peers. The findings support referral of elderly patients to community-based CR.

• Implications for Rehabilitation

• Fitness benefits of long-term maintenance cardiac rehabilitation (CR) programs remain unknown.

• Elderly individuals with coronary artery disease participating in maintenance CR have exercise capacity and cardiorespiratory response to exercise similar to their less active healthy peers.

• Maintenance CR may play an important role prolonging independent living in elderly individuals.

     

Coronary revascularization of coronary artery disease in patients with diabetes

Diabetes mellitus (DM) is increasing in the world wide and a risk factor for the progression of coronary artery disease (CAD). CAD is the major cause of mortality in patients with DM. In the case of combination CAD with DM becomes a great threatening of their lifes. In fact, diabetes patients have about 3-folds risk of mortality from CAD compared to non-diabetic subjects. Furthermore, patients with diabetes undergoing revascularization have worse mortality than non-diabetic patients. Optimal revascularization for CAD in the diabetic patients remains controversial, with availability of drug eluting stents and bypass surgery. Because of the worse prognosis in diabetic patients, making an effort toward an early diagnosis and aggressive medical treatment is necessary and a first step to improve their prognosis.