Quality of Life Following Participation in Cardiac Rehabilitation Programs of Longer or Shorter than 6 Months: Does Duration Matter?

The impact of cardiopulmonary rehabilitation in phase II cardiac rehabilitation program on the health-related quality of life of patients undergoing coronary artery bypass graft surgery

BACKGROUND

Coronary artery bypass surgery is the leading cause of change in the quality of life and pulmonary function of patients. One strategy to enhance lung muscle strength and improve overall quality of life is pulmonary rehabilitation. This study aimed to investigate the impact of incorporating a pulmonary rehabilitation program into phase II cardiac rehabilitation program on the quality of life of patients undergoing coronary artery bypass graft surgery.

METHODS

This randomized clinical trial study included 53 patients who underwent coronary artery bypass graft surgery at Imam Reza Hospital in Mashhad between September 2019 and March 2020. The research participants were selected based on specific inclusion criteria and divided into two groups. The control group followed the routine rehabilitation program, whereas the intervention group underwent a pulmonary rehabilitation program for 20-30 min after each session of the cardiac rehabilitation program. Data collection tools included a demographic information questionnaire and the Ferrans and Powers' quality of life index. The data were analyzed using the independent t-test, Mann-Whitney test, paired t-test, Spearman correlation, Wilcoxon test, and SPSS25.

RESULTS

The mean quality of life score in the intervention group(20.7±1.8) was significantly higher than that of the control group (18.8±2.3)(P < 0.05). Furthermore, the intervention group exhibited significantly higher mean scores in the physical, psychological-spiritual, and family dimensions than the control group(P < 0.05).

CONCLUSION

The study results demonstrate the positive impact of incorporating a pulmonary rehabilitation program into cardiac rehabilitation on the health-related quality of life of patients undergoing coronary artery bypass graft surgery.

TRIAL REGISTRATION

IRCT20190707044132N1.

Feasibility and results of an intensive cardiac rehabilitation program. Insights from the MxM (Más por Menos) randomized trial

INTRODUCTION AND OBJECTIVES

Cardiac rehabilitation programs (CRP) are a set of interventions to improve the prognosis of cardiovascular disease by influencing patients' physical, mental, and social conditions. However, there are no studies evaluating the optimal duration of these programs. We aimed to compare the results of a standard vs a brief intensive CRP in patients after ST-segment elevation and non-ST-segment elevation acute coronary syndrome through the Más por Menos study (More Intensive Cardiac Rehabilitation Programs in Less Time).

METHODS

In this prospective, randomized, open, evaluator-blind for end-point, and multicenter trial (PROBE design), patients were randomly allocated to either standard 8-week CRP or intensive 2-week CRP with booster sessions. A final visit was performed 12 months later, after completion of the program. We assessed adherence to the Mediterranean diet, psychological status, smoking, drug therapy, functional capacity, quality of life, cardiometabolic and anthropometric parameters, cardiovascular events, and all-cause mortality during follow-up.

RESULTS

A total of 497 patients (mean age, 57.8±10.0 years; 87.3% men) were finally assessed (intensive: n=262; standard: n=235). Baseline characteristics were similar between the 2 groups. At 12 months, the results of treadmill ergometry improved by ≥ 1 MET in ≥ 93% of the patients. In addition, adherence to the Mediterranean diet and quality of life were significantly improved by CRP, with no significant differences between the groups. The occurrence of cardiovascular events was similar in the 2 groups.

CONCLUSIONS

Intensive CRP could be as effective as standard CRP in achieving adherence to recommended secondary prevention measures after acute coronary syndrome and could be an alternative for some patients and centers. Registered at ClinicalTrials.gov (Identifier: NCT02619422).

Influence of health-related quality of life on time from symptom onset to hospital arrival and the risk of readmission in patients with myocardial infarction

BACKGROUND

Despite increased awareness of the importance of early treatment in acute myocardial infarction (AMI), the delay from symptom onset to hospital arrival is still too long and rehospitalisations are frequent. Little is known about how health-related quality of life (HRQL) affects delay time and the frequency of readmissions.

METHOD

We used quality registers to investigate whether patients' HRQL has any impact on delay time with a new AMI, and on the rate of readmissions during the first year. Patients with AMI <75 years, with HRQL assessed with EQ-5D at 1-year follow-up, and who thereafter had a new AMI registered, were evaluated for the correlation between HRQL and delay time (n=454). The association between HRQL and readmissions was evaluated among those who had an additional AMI and a new 1-year follow-up registration (n=216).

RESULTS

Patients who reported poor total health status (EQ-VAS ≤50), compared to those who reported EQ-VAS 81-100, had tripled risk to delay ≥2 h from symptom onset to hospital arrival (adjusted OR 3.01, 95% CI 1.43 to 6.34). Patients scoring EQ-VAS ≤50 had also a higher risk of readmissions in the univariate analysis (OR 3.08, 95% CI 1.71 to 5.53). However, the correlation did not remain significant after adjustment (OR 1.99, 95% CI 0.90 to 4.38). EQ-index was not independently associated with delay time or readmissions.

CONCLUSIONS

Aspects of total health status post-AMI were independently associated with delay time to hospital arrival in case of a new AMI. However, the influence of total health status on the risk of readmissions was less clear.

Cardiac rehabilitation programs and health-related quality of life. State of the art

Cardiovascular disease is the main health problem in developed countries. Prevention is presented as the most effective and efficient primary care intervention, whereas cardiac rehabilitation programs are considered the most effective of secondary prevention interventions; however, these are underused. This literature review examines the effectiveness and the levels of evidence of cardiac rehabilitation programs, their components, their development and role in developed countries, applications in different fields of research and treatment, including their psychological aspects, and their application in heart failure as a paradigm of disease care under this type of intervention. It is completed by a review of the impact of such programs on measures of health-related quality of life, describing the instruments involved in studies in recent scientific literature.