The measure of effectiveness of a short-term 2-week intensive Cardiac Rehabilitation program in decreasing levels of anxiety and depression

Research on heart disease have found a strong and consistent evidence of association between some psychosocial risk factors, including depression, anxiety, self-efficacy, lack of social support and outcome of disease. Depression increases the risk of cardiac death and is highly predictive of reduced adherence to recommended treatments; anxiety appears to be linked to adverse cardiac outcomes. It was demonstrated that Cardiac Rehabilitation (CR) leads to substantial improvements and positive outcomes because combines the prescription of physical activity with the modification of risk factors and aims to reduce symptoms related to the disease and the risk of new cardiovascular events. The main objective of this study is to determine if a short and intense CR program can produce a positive impact on anxious and depressive symptoms revealed in cardiac patients, confirming results of previous researches. The protocol was proposed to all patients referred for an outpatient CR after an acute event who attended the short 2-week intensive rehabilitation program. A total of 157 patients recruited at the operating unit of Cardiology, in the Hospital of Cittadella (Italy), was included in the analysis. The Beck Depression Inventory-II and the State-Trait Anxiety Inventory-Y were administered to the patients. SPSS 17.0 was used for statistical analysis. T-tests for paired samples were used to evaluate differences between the beginning and the end of the CR program. There was a statistically significant difference between the beginning and the end of the CR program. Results for paired samples showed significant differences in all factors of the BDI-II and in the total score. In addition, a statistically significant difference was found even in the state - anxiety subscale. No significant difference was detected for the trait anxiety. According to recent studies, this research shows that the CR program has a significant impact on levels of anxiety and depression, because all activities focus their commitment on changing the patient’s personal beliefs and perception of illness, promoting the exchange of information and sharing of concerns and fears, increasing the patient’s resilience with the aim of enabling him/her to reorganize positively his/her personal, family and professional sphere

Cardiac Rehabilitation in the Region of Veneto

In Italy there has been a progressive shifting of the legislative and fiscal activity from a national level to a regional one. In the Venetian district a series of documents, also concerning the cardiac rehabilitation, has been produced. A document elaborated in 1999 contains a detailed account of eligibility criteria for cardiac rehabilitation as well as of structural and organizational requirements. Other documents contain the updated price lists for admission episode (DRG 462) or days of stay in hospital and diurnal hospital activity, according to the type of structure which supplies the service. For outpatients, cardiac rehabilitation is identified by the code 93.36 and the ticket fare is 19,50€. In the enclosure no.6 of the Sanitary Regional Plan, still under definitive approval, it is stated that for each Intensive Therapy there will be a functional connector with a cardiac rehabilitation service which, except for few Centers, will carry on its activity with outpatients. At present the regional Cardiac Rehabilitation includes 3 complex units (for in- and outpatients) and 13 simple units (for outpatients only), with a total of 3031 patients rehabilitated in 2004

The perception of the illness and the self-efficacy in the management of emotions in cardiac patients

Cardiac rehabilitation is the sum of psychological, physical and social treatments that are offered to cardiac patients to maintain or regain an active position in society. This study wants to evaluate changes in the perception of the illness and in the self-efficacy of the management of positive and negative emotions in patients who went through cardiac rehabilitation. Sixty-seven patients (20 females, 47 males) were selected within the cardiac rehabilitation unit in the Hospital of Cittadella (Italy). Illness Perception Questionnaire - revised version and the Scale for the self-efficacy of the management of positive and negative emotions were submitted at the beginning and at the end of the rehabilitation program. One-way analyses-of-variance were performed to evaluate different answers in questionnaires between pre- and post-evaluation, and to explore gender differences. A significant change was found in the perception of duration of illness, perceived as permanent and longer after the cardiac rehabilitation program. Furthermore, at the end of the cardiac rehabilitation program men perceived the illness more chronic than women, even if they are less worried and anxious. Intensive cardiac rehabilitation has a great emotional impact on cardiac patients, influencing their perception and management of the illness. Working on emotions, through psychological groups, helps patients change their beliefs by offering them a different perspective to approach the illness

Why cardiovascular rehabilitation services should include patients with intermittent claudication?

Chronic peripheral arterial disease represents a frequent and underestimated localization of atherosclerosis and its management often appears to be inadequate. The association with ischemic heart disease, the weighty prevalence of coronary disease risk factors, the high cardiovascular rate of morbidity and mortality, the sharp reduction in the tenor of life and the well-being supervised physical training efficacy constitute the main reasons that transform Cardiac Rehabilitation into an ideal setting for the treatment of patients suffering from intermittent claudication. Thanks to the cultural patrimony of cardiologists, together with other professionals, such as psychologists, dieticians, physiotherapists and nurses, it is possible to initiate an multi- comprehensive treatment program. Besides, this type of management may decrease both morbidity and mortality as well as reduce symptoms and improve the patients’ quality of life

Is obesity still a coronary risk factor?

a risk factor for developing coronary artery disease, once coronary artery disease has been established, the correlation of obesity with total mortality, cardiovascular mortality, myocardial infarction, and revascularization is unclear and still remains a matter of debate. The relationship between obesity and mortality in patients with coronary artery disease has so far only been investigated by posthoc analysis of cohort studies, which have produced contradictory results. When a higher percentage body fat has been found to be a strong independent predictor of event-free survival, the phenomenon has been described as an ‘obesity paradox’ or ‘reverse epidemiology’. A recent meta-analysis, appearing in the August 19 issue of Lancet on 250.152 patients with documented coronary artery disease, suggests that after grouping 40 cohort studies with adjusted risks, overweight patients were consistently associated with a better survival and lower cardiovascular events than patients with a low body mass index, whereas obesity was associated with a higher total mortality only in patients with history of coronary artery bypass graft, and severe obesity was associated with a significantly higher cardiovascular mortality but not with an increased risk for total mortality. Far from proving that obesity is harmless, these findings suggest that alternative methods might be required to better characterize individuals who truly have excess body fat and that additional studies with different methods are needed. Moreover, still unknown is the unique contribution of higher muscle-to-fat ratio, which may be merely a surrogate of increased physical fitness. Future research is needed to assess the link between high muscle mass, high body fat and clinical outcomes