Prevalence of anxiety in coronary patients with improvement following cardiac rehabilitation and exercise training

Numerous studies have indicated that psychological distress, including anxiety, is a significant risk factor for coronary artery disease (CAD). We studied 500 consecutive patients after recent CAD events and demonstrated a very high prevalence of generalized anxiety and moderate to severe anxiety symptoms, particularly in younger patients. In addition, our data demonstrate the abnormal CAD risk profiles in these anxious patients with CAD and the marked improvements in the overall risk profiles, levels of anxiety, and overall quality of life after cardiac rehabilitation and exercise training programs. Greater attention at detecting and treating chronic anxiety, particularly with formal cardiac rehabilitation, is needed for the secondary prevention of CAD.     

Results of cardiac rehabilitation in patients with diabetes mellitus

To study the prevalence, risk profile, and outcomes of diabetics in cardiac rehabilitation, data on 952 consecutively enrolled patients were evaluated. Diabetics on entry had poor glycemic control, and compared with nondiabetics, had a greater adverse risk profile (body mass index, waist circumference, hypertension, triglycerides, peripheral vascular disease, and lower fitness levels), and a lower program adherence rate. Although exercise capacity significantly improved, it is clear from the outcomes reported in this study that more effective interventions in weight management, lipid lowering, and glycemic control are needed. This study emphasizes the need to identify diabetic patients in contemporary cardiac rehabilitation programs and target them for an aggressive program of risk factor management, including exercise training.     

Comparison of various approaches used to assess the functional state of the cardiac and respiratory system in patients undergoing rehabilitation following cardiac surgery

A total of 338 patients aged 10 to 56 years, who had undergone various cardiac operations, were divided, on the basis of a spiroergometric examination, performed together with the determination of maximal oxygen intake (MOI), into 4 functional classes. Determination of functional aerobic impairment, i.e. the magnitude of deviation of the established MOI value from that theoretically anticipated in view of the patient's age and sex, made it possible to determine the degree of decrease in the reserve capacity of the patient's cardiac and respiratory system (CRS). Comprehensive assessment of the functional state of the CRS, while taking into account the patient's individual characteristics, is a prerequisite for a differentiated quantitative approach to the design of rehabilitation programmes.     

Improved functional outcomes following exercise rehabilitation in patients with intermittent claudication

BACKGROUND: The purposes of this study were to identify predictors of increased claudication distances following exercise rehabilitation in peripheral arterial occlusive disease (PAOD) patients with intermittent claudication and determine whether improved claudication distances translated into increased free-living daily physical activity in the community setting. METHODS: Sixty-three patients were recruited (age, 68+/-1 years, mean +/- standard error). Patients were characterized on treadmill claudication distances, walking economy, peripheral circulation, cardiopulmonary function, self-perceived ambulatory function, body composition, baseline comorbidities, and free-living daily physical activity before and after a 6-month treadmill exercise program. RESULTS: Exercise rehabilitation increased distance to onset of claudication pain by 115% (178+/-22 m to 383+/-34 m; p < .001) and distance to maximal claudication pain by 65% (389+/-29 m to 641+/-34 m; p < .001). The increased distance to onset of pain was independently related to a 27% increase in calf blood flow (r = .42, p < .001) and to baseline age (r = -.26, p < .05), and the increased distance to maximal pain was predicted by a 10% increase in peak oxygen uptake (r = .41, p < .001) and by a 10% improvement in walking economy (r = -.34, p < .05). Free-living daily physical activity increased 31% (337+/-29 kcal/day to 443+/-37 kcal/day; p < .001) and was related to the increases in treadmill distances to onset (r = .24, p < .05) and to maximal pain (r = .45, p < .001). CONCLUSIONS: Increased claudication distances following exercise rehabilitation are mediated through improvements in peripheral circulation, walking economy, and cardiopulmonary function, with younger patients having the greatest absolute ambulatory gains. Furthermore, improved symptomatology translated into enhanced community-based ambulation.     

Neurocognitive functioning and improvement in quality of life following participation in cardiac rehabilitation

We investigated the relationship between neurocognitive functioning and quality of life/self-perceived health status (QOL) among cardiac rehabilitation (CR) patients to determine whether level of neurocognitive functioning is related to baseline QOL and improvement following CR. CR patients (n = 35) were given a neurocognitive screening before participation in CR, and also completed a behavioral inventory (SF-36) before and after CR to measure QOL associated with medical illness. At baseline, CR patients obtained relatively low SF-36 scores compared with published norms, and as reported previously, demonstrated inferior neurocognitive performance compared with healthy controls. Furthermore, neurocognitive performance was strongly positively correlated to SF-36 scores. Significant improvements were evident on many of the SF-36 subscales following rehabilitation. These improvements were relatively greater among SF-36 indexes of physical health status compared with SF-36 indexes of mental health status. Baseline neurocognitive performance also correlated strongly to the degree of improvement in SF-36 scores following rehabilitation. These findings indicate a strong relationship between baseline neurocognitive functioning and QOL before CR, and the degree to which QOL improves following this intervention.     

Deep vein thrombosis among patients entering cardiac rehabilitation after coronary artery bypass surgery

BACKGROUND: Little information is available about the prevalence of deep vein thrombosis (DVT) after discharge from cardiac surgery units and its impact on rehabilitation programs. OBJECTIVES: To estimate the rate of DVT, in relation to different thromboprophylaxis strategies, in patients with a recent coronary artery bypass graft (CABG) entering cardiac rehabilitation. METHODS: Two hundred seventy consecutive patients admitted to three rehabilitation facilities after CABG surgery from 19 cardiac surgery units (male patients, 81%; mean +/- SD age, 64 +/- 9 years; interval after operation, 4 to 19 days) underwent serial leg venous ultrasound examination on admission to three rehabilitative units. RESULTS: At admission, antiplatelet treatment was present in all patients except 10 with absolute contraindications. In 171 patients (63%), heparin prophylaxis (low-molecular-weight heparin once daily, 87%; unfractionated heparin twice daily, 13%) was reported, limited to the early postoperative period (< or = 3 days) in 102 patients (38%). DVT was detected in 47 patients (17.4%). The rate of proximal and isolated distal DVT was 2.6% (7 cases) and 14.8% (40 cases), respectively. DVT was complicated in two cases (0.7%) by symptomatic pulmonary embolism, fatal in one case (0.4%). Clots were found in the leg contralateral to the saphenous vein harvest site in half of all DVT cases. Forty-three DVT cases (91%) were diagnosed at admission, while serial ultrasound testing allowed diagnosis of an additional 4 distal DVT cases. At multivariate analysis, female sex (p < 0.001) and length of stay in the surgery unit > 8 days (p < 0.05) were independently associated with risk of DVT in the rehabilitation setting. The adoption of heparin prophylaxis until discharge predicted the absence of DVT after adjustment for immobility (p < 0.05). CONCLUSIONS: This study showed a high rate of DVT in patients entering cardiac rehabilitation after CABG surgery. Wearing unilateral graded compression stockings after CABG surgery had limited efficacy, as clots were often localized in legs contralateral to the saphenous vein harvest site.     

Neurobehavioral improvement after brief rehabilitation in patients with chronic obstructive pulmonary disease

PURPOSE: Depressive symptoms, physiologic function, and cognition were examined in patients with chronic obstructive pulmonary disease (COPD) after 3 weeks of rehabilitation. METHODS: Patients with COPD completed measures of depression, neuropsychological function, exercise, and spirometry before and after a 3-week rehabilitation program. The 30 rehabilitation patients with COPD were compared with 29 untreated patients with COPD and 21 healthy controls similar in age, education, and gender. RESULTS: A significant group by time interaction effect was found on the Beck Depression Inventory (BDI). A significant interaction effect was also found on the 6-minute walk. Patients in the COPD rehabilitation program had decreased depressive symptoms and increased 6-minute walk distance compared with the untreated groups. Across the 3 groups, no significant interaction effects were found on neuropsychological tests. However, clinically significant improvement in sustained visual attention, verbal retention, and visuospatial ability were reported in the most impaired patients with COPD in the rehabilitation group. CONCLUSION: Compared with control groups, decline in depressive symptoms and increased exercise capacity occurred in patients with COPD after brief rehabilitation. Clinical improvement in visual attention, verbal memory, and visuospatial functions occurred in the impaired patients with COPD participating in treatment. Neurobehavioral improvements after such a brief rehabilitation intervention are relevant for clinical care and warrant continued investigation in well-designed clinical trials.     

Effects of a functional foods nutrition education program with cardiac rehabilitation patients

PURPOSE: This study educated cardiac rehabilitation patients about the potential health benefits obtained from specific "heart healthy" functional foods and evaluated whether a targeted education program about these foods leads to their increased consumption or positive attitude changes. METHODS: The targeted audience was 69 cardiac rehabilitation patients (phases 2 and 3). Four foods (soy, oats, sterol/stanol ester-enhanced margarine, and nuts) were discussed in two 90-minute education sessions conducted 2 months apart. These sessions provided scientific information about each food, allowed participants to sample products, and collected data using both preeducation and follow-up surveys. RESULTS: The findings showed a significant increase in the reported consumption of all four functional foods (soy in particular), and several positive attitude changes concerning the relation between diet and heart health. Most of the participants (88%) either agreed or strongly agreed that they intended to continue incorporating functional foods into their diet to improve heart health. CONCLUSION: According to the reported attitudinal and behavioral intentions, the education of cardiac rehabilitation patients may lead to beneficial dietary changes conducive to the reduction of cardiovascular disease risk.     

Nosocomial pneumonia in elderly patients following cardiac surgery

OBJECTIVE: To identify modifiable risk factors of nosocomial pneumonia (NP) in elderly patients post-cardiac surgery. DESIGN: A case-control study. SETTING: Post-operative intensive care unit of a tertiary-level university affiliated hospital. SUBJECTS: Seventy three case-control pairs. Case patients referred to elderly patients who developed pneumonia post-cardiac surgery. Controls subjects were matched for age, gender, type of surgery, forced expiratory volume in 1s (FEV(1)), and ejection fraction. MEASUREMENTS: Baseline sociodemograpahic information, Charlson Comorbidity Index score, intra- and post-operative data were collected. When suspected, the presence of NP was confirmed by quantitative culture of protected bronchoalveolar lavage fluid 10(3) colony forming unit/ml or positive blood/pleural fluid culture identical to that recovered from respiratory samples. RESULTS: The incidence of NP in elderly post-heart surgery was 8.3%. The mean duration after heart surgery to the occurrence of pneumonia was 7.2+/-4.9 days. Four variables were found to be significantly related to the development of NP by multivariate analysis: Charlson Index >2 (adjusted odds ratio [AOR] 4.7; 95% confidence interval [CI], 1.9-11.4; P<0.001), reintubation (AOR 6.2; 95% CI, 1.1-36.1; P=0.04), transfusion 4 units of PRBC (AOR 2.8; 95% CI, 1.2-6.3; P=0.01), and the mean equivalent daily dose of morphine (AOR 4.6; 95% CI, 1.4-14.6; P=0.01). CONCLUSIONS: Although there are limited effective measures to lessen the burden of comorbidities, avoiding reintubation, finding a substitute to allogenic blood transfusion, and improved assessment of pain management could reduce the rate of NP in the post-operative period of cardiac surgery in the elderly population.     

Effect of cardiac rehabilitation on functional outcomes after coronary revascularization

Background Current guidelines recommending cardiac rehabilitation (CR) after coronary revascularization are largely based on early studies that evaluated only a subset of the population and failed to assess the impact of CR on a patient's perception of their functional status. The main objective of this study was to evaluate the impact of CR in a diverse contemporary population on patient functional outcomes. Methods We studied the effect of CR on 6-month SF-36 Physical Functioning (PF) in 700 patients (mean age 67 ± 11 years, 37% women) who underwent coronary bypass grafting or percutaneous intervention from August 1998 to July 2000. Results Overall CR participation was 24%. At baseline, CR participants had higher PF (mean 62.5 vs 52.5, P < .001). After adjusting for baseline clinical variables and PF score, CR was associated with significant improvement in 6-month PF (+5.0, 95% CI 1.0-9.0). This improvement was observed in all patient subgroups, but tended to be greater in magnitude in men versus women, patients aged <70 years versus ≥70 years, and patients with coronary bypass grafting versus patients with percutaneous intervention. CR participants also tended to be more likely to engage in regular exercise (63% vs 55%, P = .06) and modify their diet (82% vs 73%, P = .07). Rates of rehospitalization and repeat revascularization were similar among CR participants and nonparticipants. Conclusions CR after coronary revascularization is associated with improved functional outcomes and adoption of secondary preventive measures. Innovative strategies to facilitate CR enrollment and tailoring programs to better address the needs of all patient subgroups would extend these benefits to more eligible patients. (Am Heart J 2003;145:445-51.)