Patient’s emotional reactions in cardiac rehabilitation: analysis and perspectives

Subject: Evaluation and treatment of psychological diseases are often included in cardiology rehabilitation programs. The aim of this study was to analyze the emotional reactions in a very consistent sample of cardiac patients, hospitalized for a rehabilitation program. Materials and methods: The sample consisted of 5417 patients, 4563 males and 854 females, with a mean age of 57.36±9.15 (range 18-83). They were admitted in the period between 1995 and 2005 and completed the Cognitive Behavioral Assessment, Hospital form (CBA-H) Results: Significant level of state- anxiety was shown by 27.8% of the subjects, 22.1% reported health-related fears and 10% depressive symptoms. Women show higher scores in all of the three scales, and patients over 65 years scored higher in the depression scale. It is interesting to note that the mean scores in the three scales showed a progressive and significant decrease over the years. Conclusions: These data confirm that an accurate psychological screening can be extremely useful to support the Psychologist working in cardiac rehabilitation as it helps to plan more specifically the interventions, focusing on the objective patients’ educational and psychological needs

Analysis of the vital exhaustion construct in a female population during cardiac rehabilitation

Background: Vital Exhaustion (VE) is a psychological construct that has been shown to be predictive for cardiac morbidity and mortality. There are not sufficient data which clarify whether the female population express this construct differentely comparing to males. This study aims to analyze the construct of Vital Exhaustion in a population of women admitted to a cardiac rehabilitation program. Material and Method: The selected sample consisted of 854 women with an average age of 58 years (SD ± 10.2). All patients were at their first hospitalization for a cardiac rehabilitation program. The tool used to analyze the construct of Vital Exhaustion was the B scale of the Cognitive Behavioural Assessment Hospital form (CBA-H). The study also analyzed the answers to the D scale of the CBA-H concerning aspects of lifestyle and behavioral habits. Results: The percentage of women with considerable value of Vital Exhaustion was very high (67.7%). Moreover, the group of women with higher Vital Exhaustion showed more dysfunctional habits (smoking, poor physical activity, incorrect diet) and more referred psychological problems as well as job and/or family distress and insomnia. 207 women (24.2%) of the sample belonged to economically active population; 136 (69%) of these women presented a high value of VE and 61 (31%) a low one. Among the employed women, 24% of the group with high VE value reported to be unsatisfied, while the same condition lowered at 9.6% in the group with low VE value (p=.004); moreover, 41.7% versus 18.5% (p=.000) described their working life as a source of tension. Conclusions: Considering a sample of female cardiac patients, this study shows that the construct of Vital Exhaustion is particularly present. It also appears that the construct of Vital Exhaustion can be interpreted as an indicator of lifestyle problems in women, helping health-professionals in selecting efficient educational and/or psychological interventions

Left ventricular assist device: which emotional impact on the patient?

Background: Advanced heart failure is a challenging disease; the implantable Left Ventricular Assist Device (L-VAD) is becoming a good chance for relieving symptoms and prolong survival in most CHF patients. The emotional impact of L-VAD implantation is thought to be high but, at present, published data are scant about that. Aim of this study was to evaluate the modifications of perceived quality of life (QoL) in a group of patients recently treated with L-VAD implantation, admitted to a residential cardiac rehabilitation program, and to compare the results to those obtained in patients awaiting heart transplantation and recently transplanted. Material and Method: We enrolled 66 patients (pts) with a recent implant of L-VAD, 51 with refractory heart failure awaiting heart transplantation (HT) and 55 recently treated with HT. On day two after admission, all patients underwent a complete psychometric assessment consisting in the compilation of: – Minnesota Living with Heart Failure Questionnaire (MLHFQ) – Beck Anxiety Inventory (BAI) – Beck Depression Inventory-II (BDI - II) Results: L-VAD recipients had significantly higher scores at MLHFQ. Both the total score and the 2 subscales scores (respectively physical and emotional disturbances) were statistically significant when compared with posttransplant patients. Post- transplant pts had the lowest scores regarding anxiety symptoms, while the bearers of device had the highest ones. The same results were obtained for depression scores (BDI - II), both in total score and in the subscales (somatic symptoms and affective symptoms). Conclusions: With an opening scoring, this study showed the development of more relevant psychological troubles in patients treated with L-VAD when compared to those awaiting for heart transplantation and those transplanted

Application of the general perceived self-efficacy scale in cardiovascular rehabilitation

Psychosocial support, education and self-management are important complements of rehabilitation programs. A central concept in self-management is self-efficacy, which refers to oneself confidence in reaching a desired goal. The General Perceived Self-Efficacy scale (GSE), developed to measure self-efficacy at the broadest level, could be useful in the rehabilitation setting, in order to assess patients’ selfmanagement difficulties as well as to design specific interventions for specific diseases. Aim of this work is to verify the GSE Italian version psychometric properties applied to the rehabilitation setting. Data were analyzed from 395 in-patients attending cardiac (83.8%) and neurological (16.2%) rehabilitation. Cardiac patients suffered from post-MI, CABG or heart-failure; all of the neurological patients suffered from amiotrophic lateral sclerosis (ALS). They were mostly males (84.5%), and the mean age was 55.7 years. Principal component factor analysis confirmed that GSE has a monofactorial structure with internal consistency of .85. As in previous studies, a gender difference emerged. There was no difference in cardiac patients, on the basis of their specific disease, but they showed higher self-efficacy perception compared to ALS patients. The findings confirm that GSE is a valid measure of self-efficacy in settings characterised by different levels of functional abilities, as in cardiac and neurological rehabilitation

organization of psychological activities in italian cardiac rehabilitation and prevention survey on the implementation of guidelines for psychological activities in cardiac rehabilitation and prevention

The present study was developed as part of a comprehensive evaluation of the state of the art of knowledge and implementation of the Italian Guidelines for psychological activities in Cardiac Rehabilitation, published in 2003 by the Working Group of Psychology of the Italian Society of Cardiac Rehabilitation (GICR). Methods. A questionnaire was designed to collect detailed information on facilities, organization, staffing level, professional background and activities carried out by psychologists working in Italian Cardiac Rehabilitation Units (CRU). Out of 144 Italian CRU (inventory 2004), 107 reported structured psychological programmes. The questionnaires were sent by conventional mail to the referring psychologist of these 107 CRU; they were invited to participate in the survey on a purely voluntary basis. Results. Responses were received from 70 (65.4%) of 107 CRU. 55 CRU (79.8%) report a good knowledge of the published GL; 10.1% declare that the psychologists did not know the current GL. 84.5% consider the GL to be fully applicable, while 15.5% believe that they are only partly applicable. Psychological assessment is performed through clinical interview (94.3%) and psychometric tests (81.4%). 92.8% of the CRU use screening instruments in order to evaluate psychosocial risk factors, in particular anxiety and depression (64.3%). Quality of life (22.8%) and cognitive impairment (17.1%) are not routinely assessed. Educational interventions are planned in 87.1% of the CR programme and are extended to the family members (51%) as well as counselling (57%). Psychological programme includes smoking (56%) and eating behaviour (55%) group interventions. Stress management is routinely planned in 69% of the CRU. Psychological intervention tailored to individual needs of the patients is performed in 62.9% CRU. Written final reports are available in 88.6% cases. The follow-up is carried out by 48.6% of the CRU, 15.7% in a structured way. Conclusions. The survey shows wide discrepancies in the provision of psychological activities in Italian CRU. Nevertheless psychological assessment and interventions seem acceptably coherent with current national GL on CR

ISYDE-Ψ* First step of the implementation of guidelines for psychology activities in cardiac rehabilitation and prevention *Italian SurveY on CarDiac REhabilitation – Psychology

The Italian SurveY on CarDiac REhabilitation – Psychology (ISYDE-Ψ) was developed, in line with the indications of the Italian National Guidelines Program, as part of a project to implement and apply the guidelines for psychology interventions in cardiac rehabilitation and prevention published in 2003. The Task Force on Psychological Interventions in Cardiac Rehabilitation conducted this pilot survey of the existing situation of Psychology in order to prepare the ground for implementation of the guidelines through interactive training. As part of the evaluation of training requirements a questionnaire was elaborated to gather information on the models of organization of and activities carried out by psychologists working in the surveyed cardiac rehabilitation facilities. Data collection for ISYDE-Ψ terminated at the end of March 2005, with replies from 68/107 (63.6%) structures. In the light of this response, the Task Force has developed a training project for psychologists working in cardiac rehabilitation, sponsored by the Italian Council of Psychologists, that will be implemented in different regions of the country with the aim of disseminating the guidelines and promoting their correct application despite the existing regional disparities in organization

Analysis of the vital exhaustion construct in a female population during cardiac rehabilitation

Background: Vital Exhaustion (VE) is a psychological construct that has been shown to be predictive for cardiac morbidity and mortality. There are not sufficient data which clarify whether the female population express this construct differentely comparing to males. This study aims to analyze the construct of Vital Exhaustion in a population of women admitted to a cardiac rehabilitation program. Material and Method: The selected sample consisted of 854 women with an average age of 58 years (SD ± 10.2). All patients were at their first hospitalization for a cardiac rehabilitation program. The tool used to analyze the construct of Vital Exhaustion was the B scale of the Cognitive Behavioural Assessment Hospital form (CBA-H). The study also analyzed the answers to the D scale of the CBA-H concerning aspects of lifestyle and behavioral habits. Results: The percentage of women with considerable value of Vital Exhaustion was very high (67.7%). Moreover, the group of women with higher Vital Exhaustion showed more dysfunctional habits (smoking, poor physical activity, incorrect diet) and more referred psychological problems as well as job and/or family distress and insomnia. 207 women (24.2%) of the sample belonged to economically active population; 136 (69%) of these women presented a high value of VE and 61 (31%) a low one. Among the employed women, 24% of the group with high VE value reported to be unsatisfied, while the same condition lowered at 9.6% in the group with low VE value (p=.004); moreover, 41.7% versus 18.5% (p=.000) described their working life as a source of tension. Conclusions: Considering a sample of female cardiac patients, this study shows that the construct of Vital Exhaustion is particularly present. It also appears that the construct of Vital Exhaustion can be interpreted as an indicator of lifestyle problems in women, helping health-professionals in selecting efficient educational and/or psychological interventions

Italian registry of patients with alpha-1 antitrypsin deficiency: General data and quality of life evaluation

Alpha1-antitrypsin Deficiency (AATD) is a rare hereditary disorder with an estimated prevalence of about 1/5000 individuals in Italy. Deficient patients are at a higher risk of developing lung emphysema and chronic liver disease. The low estimated prevalence of AATD prompted the establishment of a registry with the aim of learning more about the natural history and the quality of care of these patients. The Italian registry for AATD was established in 1996. In this study, genetic and clinical findings of Italian AATD patients are presented. Moreover, we also evaluated the changes in health-related quality of life (HRQoL) in patients with COPD and AAT deficiency over a three-year period, in relation to augmentation therapy. In a period spanning 18 years (1996-2014) a total of 422 adult subjects with severe AATD were enrolled, namely 258 PI*ZZ, 74 PI*SZ, 4 PI*SS and 86 patients with at least one rare deficient allele. The 21.3% frequency for AATD patients with at least one deficient rare variant is the highest so far recorded in national registries of AATD. The registry data allow a detailed characterization of the natural course of the disease and the level of patient care, as well as confirm the usefulness of early AATD detection