Cardiac rehabilitation engagement and associated factors among heart failure patients: a cross-sectional study

Status of anxiety and depression among chronic heart failure patients: Factors influencing poor fluid restriction adherence

BACKGROUND

Anxiety and depression are prevalent among patients with chronic heart failure (CHF) and can adversely contribute to treatment adherence and clinical outcomes. Poor fluid restriction adherence is a widespread challenge in the management of CHF. To effectively manage disease progression and alleviate symptoms, it is crucial to identify key influencing factors to facilitate the implementation of targeted interventions.

AIM

To investigate the status of anxiety and depression among patients with CHF and determine the factors contributing to poor fluid restriction adherence.

METHODS

Three hundred CHF patients seeking medical treatment at The First Hospital of Hunan University of Traditional Chinese Medicine between June 2021 and June 2023 were included in the study. Questionnaires, including the Psychosomatic Symptom Scale, Self-Rating Anxiety Scale, Self-Rating Depression Scale, and Fluid Restriction Adherence Questionnaire were administered to patients. Based on their anxiety and depression scores, patients were categorized into anxiety/depression and non-anxiety/depression groups, as well as fluid restriction adherence and fluid restriction non-adherence groups. General patient data were collected, and univariate and logistic regression analyses were conducted to determine the occurrence of depression and anxiety. Logistic regression analysis was used to identify independent factors influencing fluid restriction adherence.

RESULTS

Statistically significant differences in age, New York Heart Association (NYHA) grading, marital status, educational attainment, and family support were observed between depressed and non-depressed CHF patients (P < 0.05). Age, NYHA grading, marital status, educational attainment, and family support were identified as factors influencing the development of depression. The anxiety and non-anxiety groups differed statistically in terms of gender, age, NYHA grading, smoking history, alcohol consumption history, monthly income, educational attainment, and family support (P < 0.05). Gender, smoking, alcohol consumption, monthly income, and educational attainment affected anxiety in these patients. The fluid restriction adherence rate was 28.0%, and thirst sensation, anxiety, and depression were identified as independent influencing factors.

CONCLUSION

CHF patients are susceptible to anxiety and depression, with multiple associated influencing factors. Moreover, anxiety and depression are independent factors that can influence fluid restriction adherence in these patients.

Perception of Social Support and Disease Acceptance Among Patients Undergoing Cardiac Rehabilitation-Cross-Sectional Study

BACKGROUND

Cardiovascular diseases (CVD), the leading cause of mortality worldwide, require a multidisciplinary approach, with cardiac rehabilitation being a recommended component. The rehabilitation process may be directly influenced by social support, which enhances motivation to cope with the disease and fosters its acceptance.

AIMS

This study aims to assess the level of social support among patients undergoing cardiac rehabilitation and its impact on disease acceptance.

METHODS

The study included a sample of 150 patients currently participating in cardiac rehabilitation. Data were collected through direct contact using the validated, anonymous Acceptance of Illness Scale questionnaire, supplemented with a demographic section addressing social support.

RESULTS

The majority of respondents reported receiving strong family support (51.3%) and good institutional support (47.3%) during treatment. The mean score for illness acceptance was 29.6 ± 6.9, indicating a high acceptance level observed in most patients (57.3%). The p-values for the association between illness acceptance and support from family and institutions were p = 0.43 and p = 0.82, respectively, suggesting no statistically significant relationship.

CONCLUSIONS

Patients undergoing cardiac rehabilitation generally experience strong family support, good institutional support, and a high level of disease acceptance. No statistically significant relationship was observed between family or institutional support and the level of disease acceptance.

Single-cell multi-omics analysis reveals the mechanism of action of a novel antioxidant polyphenol nanoparticle loaded with STAT3 agonist in mediating cardiomyocyte ferroptosis to ameliorate age-related heart failure

BACKGROUND

Heart failure (HF) is a prevalent and critical cardiac condition that leads to profound structural and functional changes in the heart. Although traditional treatments have shown partial efficacy, the long-term outcomes remain suboptimal. Emerging research has highlighted the pivotal role of oxidative stress and ferroptosis in HF progression. This study investigates a new therapeutic approach utilizing antioxidant polyphenol nanoparticles loaded with a STAT3 agonist (PN@Col) to target these pathways and improve age-related HF.

RESULTS

Key cells and genes contributing to HF progression were identified via analysis of the GEO database, with single-cell RNA sequencing (scRNA-seq) and AUCell analysis used to evaluate differential gene expression. The STAT3 gene was highlighted as essential, and its functionality was further validated in vitro through cell experiments, confirming its impact on cardiomyocytes (CMs) in HF. Following the development of PN@Col, in vitro experiments showed that PN@Col effectively reduced oxidative stress and ferroptosis in CMs. In vivo studies in elderly HF mice demonstrated significant improvements in cardiac function following PN@Col treatment.

CONCLUSIONS

PN@Col offers a promising therapeutic approach to age-related HF by mitigating oxidative stress and ferroptosis in cardiomyocytes. These findings provide a solid scientific foundation for PN@Col as a potential novel treatment strategy for HF, supporting further exploration toward clinical application.

Patient engagement in rehabilitation: An evolutionary concept analysis

OBJECTIVE

The purpose of this study was to clarify the concept of engagement in rehabilitation by analyzing its application in both theoretical and empirical literature.

DATA SOURCES

PubMed, Web of Science, CINAHL, Embase, and Scopus were searched for relevant studies published from January 1, 2003 to July 14, 2024.

REVIEW METHODS

A literature-based concept analysis was carried out using Rogers' six-step evolutionary concept analysis method. Literature screening and data extraction were conducted separately by two researchers according to predetermined inclusion and exclusion criteria. The basic information and the relevant primary data of the included studies were extracted in detail.

RESULTS

In total, 41 studies were included and analyzed. The antecedents included demographic factors, physical health, psychological and emotional factors, cognitive factors, behavioral factors, socio-cultural factors, environmental factors, and rehabilitation programs. The attributes contained collaborative therapeutic relationships, continual commitment and investment, a dynamic process and state, and goal-oriented. The consequences included multidisciplinary collaborations, communication, functional recovery, future independent exercise, and mental health.

CONCLUSION

This study clarified the concept of engagement in rehabilitation and identified antecedents, attributes, and consequences of the concept. Further research is required to investigate and apply this concept to specific populations and settings.

Effect of a patient health engagement (PHE) model on rehabilitation participation in patients with acute myocardial infarction after PCI: a study protocol for a randomized controlled trial

BACKGROUND

Participation in cardiac rehabilitation is low in patients with acute myocardial infarction (AMI) after percutaneous coronary intervention (PCI). Although existing rehabilitation methods have achieved certain results, patient participation in exercise rehabilitation is not ideal. The Patient Health Engagement (PHE) model is designed to ensure that patients improve their participation in cognitive, emotional, behavioral, and other aspects in all phases of exercise rehabilitation. The purpose of this study is to confirm whether the rehabilitation method based on the PHE model improves the rate of patient participation and enhances the rehabilitation effect during cardiac rehabilitation in patients with acute myocardial infarction compared with the traditional rehabilitation model.

METHODS/DESIGN

This is a single-center, double-blind, randomized, controlled trial that will enroll 128 patients. Patients with stable acute myocardial infarction after undergoing PCI who received cardiac rehabilitation and postoperative LVEF ≥ 40%, categorized into Killip class I ~ II and with age ≥ 18 years, will be included in the study. Exclusion criteria are mainly malignant arrhythmias, acute heart failure, congestive heart failure, and patients requiring intra-aortic balloon counterpulsation. Patients will be randomized in a 1:1 ratio to the intervention (1) and control (2) groups. Physicians, rehabilitation specialists, patients, and data collectors will be blinded during the study. A rehabilitator and a specialist nurse will conduct the cardiac rehabilitation. The specialist nurse will hand over the sealed bag containing patient information (group 1 or 2) to the physician. Group 1 will undergo cardiac rehabilitation through the PHE model, three times a week for 3 months. The rehabilitation program will be evaluated and adjusted in time from each period of the rehabilitation. Group 2 will be treated with routine cardiac rehabilitation. The rehabilitation participation rate of the two groups will be evaluated before and after 3 months of intervention. The primary outcome will be the level of patient participation in rehabilitation, and the secondary outcome will include general data of patients, postoperative rehabilitation indicators, cardiac rehabilitation knowledge-attitude-practice questionnaire, cardiovascular adverse events, and a brief mood scale.

EXPECTED OUTCOMES

We expect improved cardiac rehabilitation participation rates and rehabilitation outcomes in patients with acute myocardial infarction after undergoing PCI using the PHE model.

DISCUSSION

This approach may increase patient participation in rehabilitation, improve rehabilitation outcomes, and be widely implemented in hospitals and rehabilitation centers.

TRIAL REGISTRATION

ClinicalTrials.gov identifier, ChiCTR2400085276 (Version 2.0 June 04, 2024),  https://www.chictr.org.cn .

TRIAL SPONSOR

Shandong Second Medical university, Weifang, Shandong. Contact name: Dechun Qin, Address: Shandong Second Medical university, Weifang Shandong. Email: 13562666589@163.com.

Cardio-Oncology: Managing Cardiovascular Complications of Cancer Therapies

This narrative review explores the complex relationship between cancer medicines and cardiovascular health in the junction of oncology and cardiology, known as cardio-oncology. The study examines the historical development of cancer treatments and highlights the growing importance of cardiovascular problems in patient care. This text delves into the topic of cardiotoxicity, examining both conventional chemotherapeutic drugs like anthracyclines and more recent tyrosine kinase and immune checkpoint inhibitors. The complex molecular and cellular mechanisms that control cardiovascular problems are explained, including an understanding of how genetic predisposition influences an individual's sensitivity. The narrative expands into the crucial realm of risk stratification and evaluation, revealing advanced instruments for identifying cardiovascular risk in cancer patients. The importance of non-invasive imaging methods and biomarkers in early detection and continuous monitoring is emphasized. The prioritization of preventive tactics emphasizes the need to take proactive measures incorporating therapies to protect the heart throughout cancer treatment. It also highlights the significance of making lifestyle improvements to reduce risk factors. The narrative emphasizes the changing collaborative treatment environment, advocating for merging oncologists and cardiologists in a coordinated endeavor to maximize patient outcomes. In addition to clinical factors, the review explores the critical domain of patient education and support, acknowledging its crucial role in promoting informed decision-making and improving overall patient well-being. The latter portions of the text anticipate and consider upcoming treatments and existing research efforts that offer the potential for the future of cardio-oncology. This review seeks to provide a detailed viewpoint on the intricate connection between cancer treatments and cardiovascular well-being. Its objective is to encourage a more profound comprehension of the subject and prompt careful contemplation regarding the comprehensive care of cancer patients who confront the intricate difficulties presented by their treatment plans.

Predictors of home-based cardiac rehabilitation exercise adherence among patients with chronic heart failure: a theory-driven cross-sectional study

BACKGROUND

The factors influencing home-based cardiac rehabilitation exercise adherence among patients with chronic heart failure remain unclear. This study aimed to explore predictors of home-based cardiac rehabilitation exercise adherence in these patients, based on the theory of planned behavior.

METHODS

This theory-driven, cross-sectional study used convenience sampling to recruit patients with chronic heart failure undergoing home-based cardiac rehabilitation. Instruments used included the Home-Based Cardiac Rehabilitation Exercise Adherence Scale, the Multidimensional Self-Efficacy for Exercise Scale, the Perceived Social Support Scale, and the Tampa Scale for Kinesiophobia Heart. Multivariate linear hierarchical regression analysis was employed to examine the factors influencing exercise adherence.

RESULTS

A total of 215 patients with chronic heart failure undergoing home-based cardiac rehabilitation participated in the study. The overall score for home cardiac rehabilitation exercise adherence was (48.73 ± 3.92). Multivariate linear hierarchical regression analysis revealed that age (β=-0.087, p = 0.012), education level (β = 0.080, p = 0.020), fear of movement (β=-0.254, p < 0.001), perceived social support (β = 0.451, p < 0.001), and exercise self-efficacy (β = 0.289, p < 0.001) influenced home-based cardiac rehabilitation exercise adherence. In the second model, fear of exercise explained 23.60% of the total variance, while perceived social support and exercise self-efficacy explained 26.60% of the total variance in the third model.

CONCLUSION

This study found that home-based cardiac rehabilitation exercise adherence in patients with chronic heart failure was suboptimal, and identified its influencing factors. Targeted interventions addressing these factors, such as tailored education, support, and addressing fear of exercise, may help improve exercise adherence.

Revolutionizing Cardiac Care: A Comprehensive Narrative Review of Cardiac Rehabilitation and the Evolution of Cardiovascular Medicine

Cardiovascular disease (CVD) stands as a global health crisis, with its complex web of conditions, including coronary artery disease, heart failure, hypertension, and stroke, continuing to exact a heavy toll on individuals and healthcare systems worldwide. Despite substantial advances in medical technology and pharmaceutical interventions, CVD remains a formidable adversary, necessitating innovative prevention, management, and rehabilitation approaches. In tracing the historical trajectory of CVD, the narrative reveals the antiquated practices of early 20th-century medicine, marked by extended bed rest as the primary modality for heart-related conditions. It underscores the critical juncture when exercise was first recognized as a therapeutic tool for cardiac health, setting the stage for the evolution of cardiac rehabilitation (CR). CR programs have transcended their initial focus on exercise, expanding to encompass dietary guidance, psychosocial support, and comprehensive risk factor modification. These holistic interventions enhance physical recovery and address the psychosocial and lifestyle aspects of CVD management, ultimately improving patients' overall well-being. CR programs increasingly leverage advanced technologies and personalized strategies to tailor interventions to individual patient needs, ultimately enhancing outcomes and reducing the burden of CVD. In conclusion, this narrative review illuminates the transformative journey of cardiac care, with a particular spotlight on the indispensable role of CR in reshaping the landscape of cardiovascular medicine. By evolving from historical practices to comprehensive, patient-centered interventions, CR has made significant strides in improving the prognosis, quality of life, and holistic well-being of individuals grappling with the complexities of CVD. Understanding this historical context and the contemporary advancements is paramount for healthcare professionals and policymakers as they navigate the intricate terrain of cardiovascular medicine and endeavor to mitigate the impact of this pervasive disease.