Patient education in the management of coronary heart disease

We did not find strong evidence that education reduced all cause mortality, cardiac morbidity, revascularisation or hospitalisation compared to control. There was some evidence to suggest that education may improve HRQofL and reduce overall healthcare costs. Whilst our findings are generally supportive of current guidelines that CR should include not only exercise and psychological interventions, further research into education is needed

Effects of a psychoeducational program for chronic pain management Efectos de un programa psicoeducativo en el control del dolor crónico Efeitos de um programa psicoeducativo no controle da dor crônica

AIMS: to evaluate the impact of an eight-week psychoeducational program focused on pain intensity, disability and depressive symptoms of patients with chronic pain. METHOD: 79 patients with chronic pain of different etiologies composed the sample. Patients were assessed before, at the end of the intervention and six months after the intervention. The program was developed by a nurse using cognitive-behavioral strategies and was conducted by a multidisciplinary team. The Wilcoxon test was used to compare repeated measures. RESULTS: the participants' mean age was 53 years old, most were female (91%), with an average of 9.5 years of schooling and an average pain duration of 9.9 years. Significant reduction in pain intensity (p<0.001), disability (p<0.001) and depressive symptoms (p<0.001) was found at the end of the program. CONCLUSIONS: the psychoeducational program was effective in reducing pain intensity, reducing disability and in controlling depressive symptoms in this sample.<br>OBJETIVOS: evaluar el impacto de un Programa psicoeducativo de ocho semanas en la intensidad del dolor, incapacidad y síntomas depresivos de pacientes con dolor crónico. MÉTODO: 79 pacientes con dolor crónico de diferentes etiologías compusieron la muestra. Los participantes fueron evaluados antes y al final del Programa y seis meses después. El Programa fue desarrollado por una enfermera, utilizó estrategias cognoscitivo-comportamentales y fue aplicado por un equipo multidisciplinar. La prueba no paramétrico de Wilcoxon fue utilizado para comparar medidas repetidas. RESULTADOS: la mayoría de los participantes eran del sexo femenino (91%), con edad media de 53 años, escolaridad media de 9,5 años y duración media del dolor de 9,9 años. Al final del Programa se observó reducción significativa en la intensidad del dolor (p<0.001), incapacidad (p<0.001) y síntomas depresivos (p<0.001). CONCLUSIONES:el Programa psicoeducativo fue efectivo en el control del dolor, en la reducción de la incapacidad y en el control de los síntomas depresivos en la muestra estudiada.<br>OBJETIVOS: avaliar o impacto de um programa programa psicoeducativo de oito semanas na intensidade da dor, incapacidade e sintomas depressivos de pacientes com dor crônica. MÉTODO: 79 setenta e nove pacientes com dor crônica de diferentes etiologias compuseram a amostra. Os participantes foram avaliados antes e ao final do pPrograma e seis meses após. O pPrograma foi desenvolvido por uma enfermeira, utilizou utilizaram-se estratégias cognitivo-comportamentais, e foi aplicadaso por equipe multidisciplinar. O teste não paramétrico de Wilcoxon foi utilizado para comparar medidas repetidas. RESULTADOS: as maioria doas participantes eram do sexo feminino (91%), com idade média de 53 anos, escolaridade média de 9,5 anos e duração média da dor de 9,9 anos. Ao final do Programa, se observou-se redução significativa na intensidade da dor (p<0,001), incapacidade (p<0,001) e sintomas depressivos (p<0,001). CONCLUSÕES: o pPrograma psicoeducativo foi efetivo no controle da dor, na redução da incapacidade e no controle dos sintomas depressivos na amostra estudada

The association of depression and angina pectoris across 47 countries: findings from the 2002 World Health Survey

Comorbid depression predicts poor health outcomes in patients with angina pectoris (AP). However, epidemiological data on the depression-AP comorbidity is limited and largely restricted to studies from Western countries, making generalizability to other regions uncertain. We aimed to provide additional epidemiological data for non-Western as well as Western countries. The present study used population-based data gathered in 47 countries from four continents (Africa, Asia, South America, and Europe) included in the cross-sectional 2002 WHO World Health Survey. Self-reported indicators of depression included: (a) its diagnosis, (b) its treatment, and (c) seven symptom items to determine presence of a major depressive episode. Similarly, information on AP comprised (a) a self-reported diagnosis, (b) self-reported AP treatment, (c) and a definition according to the WHO Rose questionnaire. In primary analyses, we operationalized depression or AP as positive if any of the respective indicators was present. Associations were estimated by multivariate logistic regression. In the entire sample (n = 213,264), the odds of AP were more than doubled among those with depression [odds ratio (OR) = 2.60, 95 % confidence interval = 2.36, 2.87] versus those without depression. These positive associations were replicated across all continents and were observed in both men and women. Likewise, meaningful associations (ORs ≥ 1.5) were observed in virtually all individual countries (46/47). Application of different operationalizations of depression and AP confirmed the above findings, both in the entire sample and in continent-specific analyses. Our study extends the current evidence accrued in Western populations to non-Western populations. The co-occurrence of AP and depression appears to represent a universal phenomenon. Keywords: Angina pectoris, Depression, Epidemiology, World Health Organizatio

Hypotension-Avoidance Versus Hypertension-Avoidance Strategies in Noncardiac Surgery: An International Randomized Controlled Trial

BACKGROUND: Among patients having noncardiac surgery, perioperative hemodynamic abnormalities are associated with vascular complications. Uncertainty remains about what intraoperative blood pressure to target and how to manage long-term antihypertensive medications perioperatively. OBJECTIVE: To compare the effects of a hypotension-avoidance and a hypertension-avoidance strategy on major vascular complications after noncardiac surgery. DESIGN: Partial factorial randomized trial of 2 perioperative blood pressure management strategies (reported here) and tranexamic acid versus placebo. (ClinicalTrials.gov: NCT03505723). SETTING: 110 hospitals in 22 countries. PATIENTS: 7490 patients having noncardiac surgery who were at risk for vascular complications and were receiving 1 or more long-term antihypertensive medications. INTERVENTION: In the hypotension-avoidance strategy group, the intraoperative mean arterial pressure target was 80 mm Hg or greater; before and for 2 days after surgery, renin-angiotensin-aldosterone system inhibitors were withheld and the other long-term antihypertensive medications were administered only for systolic blood pressures 130 mm Hg or greater, following an algorithm. In the hypertension-avoidance strategy group, the intraoperative mean arterial pressure target was 60 mm Hg or greater; all antihypertensive medications were continued before and after surgery. MEASUREMENTS: The primary outcome was a composite of vascular death and nonfatal myocardial injury after noncardiac surgery, stroke, and cardiac arrest at 30 days. Outcome adjudicators were masked to treatment assignment. RESULTS: The primary outcome occurred in 520 of 3742 patients (13.9%) in the hypotension-avoidance group and in 524 of 3748 patients (14.0%) in the hypertension-avoidance group (hazard ratio, 0.99 [95% CI, 0.88 to 1.12]; P = 0.92). Results were consistent for patients who used 1 or more than 1 antihypertensive medication in the long term. LIMITATION: Adherence to the assigned strategies was suboptimal; however, results were consistent across different adherence levels. CONCLUSION: In patients having noncardiac surgery, our hypotension-avoidance and hypertension-avoidance strategies resulted in a similar incidence of major vascular complications. PRIMARY FUNDING SOURCE: Canadian Institutes of Health Research, National Health and Medical Research Council (Australia), and Research Grant Council of Hong Kong