Perspectives of cardiac rehabilitation staff on strategies used to assess, monitor and review - a descriptive qualitative study

Women's Health-Related Quality of Life Substantially Improves With Tailored Cardiac Rehabilitation: A SYSTEMATIC REVIEW AND META-ANALYSIS

PURPOSE

Exercise-based cardiac rehabilitation (EBCR) offers an opportunity to improve women's otherwise poorer outcomes from coronary heart disease compared with men. However, synthesized evidence for the benefits of EBCR for health-related quality of life (HRQL) is lacking for women. The current study addresses this gap.

METHODS

Four electronic databases (PubMed, CINAHL, SCOPUS, and Cochrane) were searched for studies reporting HRQL using validated questionnaires in women attending EBCR. Two reviewers independently screened articles and extracted data. A random effects model was used for meta-analysis, where possible.

RESULTS

Eleven studies (1237 women) were included, with seven suitable for meta-analyses. Participation in EBCR improved multiple domains of HRQL, with greatest improvements in Role Physical (mean differences [MD] = 19.09: 95% CI, 2.37-35.81), Physical Functioning (MD = 10.43: 95% CI, 2.60-18.27), and Vitality (MD = 9.59: 95% CI, 0.31-18.86) domains of the 12-Item Short Form Health Survey and the 36-Item Short Form Health Survey. Adding psychosocial components tailored for women to traditional EBCR produced further gains in HRQL in Bodily Pain (MD = 9.82: 95% CI, 4.43-15.21), Role Physical (MD = 8.48: 95% CI, 1.31-9.97), Vitality (MD = 8.17: 95% CI, 3.79-12.55), General Health (MD = 5.64: 95% CI, 1.31-9.97), and Physical Functioning (MD = 5.61: 95% CI, 0.83-10.40) domains.

CONCLUSIONS

Women attending EBCR achieve clinically meaningful improvements in multiple areas of HRQL, with added benefits when strategies were tailored to their needs. These benefits should be highlighted to promote EBCR uptake in women.

Needs of older persons undergoing cardiac surgery: Exploring the perceptions of nurses, patients waiting for and patients having had surgery

Aims

The purpose of this research was to identify the needs of older persons waiting for elective open‐heart surgery.

Design

A qualitative exploratory design methodology, using Focus Groups.

Methods

A purposive sampling technique was used. Three interviews were conducted with experienced nurses, individuals waiting for open‐heart surgery (≥65years) and individuals having had open‐heart surgery (≥65years); enrolling up to 17 participants from October 2019 to January 2020. Qualitative data analysis was conducted using the iteractive model and MaxQDA^® software, and EQUATOR COREQ guidelines were followed.

Results

Three themes were identified from the analysis of all three Focus Groups: (i) Needing health information; (ii) Needing emotional support; and (iii) Needing access to care.

Health-related quality of life and exercise-based cardiac rehabilitation in contemporary acute coronary syndrome patients: a systematic review and meta-analysis

PURPOSE

To review the literature on health-related quality of life (HRQoL) outcomes for exercise-based cardiac rehabilitation (EBCR) in contemporary acute coronary syndrome (ACS) patients.

METHODS

Electronic databases (CENTRAL, MEDLINE, Embase, and CINAHL) were searched from January 2000 to March 2019 for randomised controlled trials (RCTs) comparing EBCR to a no-exercise control in ACS patients recruited after year 2000, follow-up of at least 6 months, and HRQoL as outcome. Potential papers were independently screened by two reviewers. Risks of bias were assessed using the Cochrane Tool. Data analyses were performed using RevMan v5.3, random effects model.

RESULTS

Fourteen RCTs (1739 participants) were included, with eight studies suitable for meta-analyses. EBCR resulted in statistically significant and clinically important improvements in physical performance (mean difference [MD] 7.09, 95% CI 0.08, 14.11) and general health (MD 5.08, 95% CI 1.03, 9.13) (SF-36) at 6 months, and in physical functioning (MD 9.82, 95% CI 1.46, 18.19) at 12 months. Statistically significant and sustained improvements were also found in social and physical functioning. Meta-analysis of two studies using the MacNew Heart Disease HRQoL instrument did not show any significant benefits. Of the six studies unsuitable for meta-analyses, five reported significant changes in overall HRQoL, general physical activity levels and functional capacity, or quality-adjusted life-years (QALYs).

CONCLUSIONS

In an era where adherence to clinical practice guidelines has improved survival, EBCR still achieves clinically meaningful improvements in physical performance, general health, and physical functioning in the short and long term in contemporary ACS patients.

Patient-Reported Quality of Life as a Predictor of Mortality and Ventricular Tachyarrhythmia's During 7 Years' Follow-Up in Patients With an Implantable Cardioverter Defibrillator (from the MIDAS Study)

Preliminary evidence suggests that poor patient-reported quality of life (QoL) predicts mortality on the short term in patients with an implantable cardioverter defibrillator (ICD). It is unclear if this association persists on the long term. We evaluated whether patient-reported QoL at the time of implantation predicts mortality and ventricular tachyarrhythmias (VTa's) during 7 years' follow-up in patients with an ICD. A consecutive cohort of patients (80% men; mean [SD] age = 58 [12]) implanted with an ICD completed the Short Form Health Survey (SF-36). The 8 SF-36 subscales and the 2 component summary scores were used as predictors of VTa's and mortality at 7 years' follow-up. At 7 years' follow-up, 34% (132/392) of patients had died. Baseline physical functioning (hazard ratio [HR]: 1.59; 95% confidence interval [CI]: 1.11 to 2.29), role physical functioning (HR: 1.59; 95% CI: 1.09 to 2.31), vitality (HR: 1.53; 95% CI: 1.05 to 2.22), and general health (HR: 1.57; 95% CI: 1.09 to 2.27) were associated with 7-year mortality in adjusted analyses. There was a trend for low mental health being associated with an increased risk of mortality (HR: 1.38; 95% CI: 0.98 to 1.96). The other SF-36 dimensions were not significantly associated with mortality. Only baseline social functioning was associated with risk of VTa's during follow-up. In conclusion, patients with lower levels of physical functioning, role physical functioning, vitality, or general health had a greater risk of mortality, whereas only poor social functioning was associated with VTa's during 7 years' follow-up. Patient-reported QoL at the time of implant could be used to identify patients at risk for long-term mortality.