The Efficacy of Chronic Disease Self Management Programs and Tele-Health on Psychosocial Adjustment by Increasing Self-efficacy in Patients with CABG

AbstractAim: Coronary Artery Disease is a chronic and debilitating condition that seriously affects the lives of patients and their families. Despite advances in medical treatment, CAD is still associated with high morbidity and mortality, high hospitalization rates. It is well known that rehabilitation is an integral component of the care of people with chronic disease. Despite the expense associated with rehabilitation following chronic disease, dissatisfaction with psychosocial outcomes is common. The purpose of this study was to test the efficacy of The Chronic ِ Disease Self Management Rehabilitation Program and Telehealth in cardiac patients undergone Coronary Artery Bypass Surgery (CABGS), in order to improve, enhance and maintain their psychosocial adjustment to illness through increasing self efficacy.Method: A total of 300 patients, were recruited through Tehran Heart Center's cardiac rehabilitation clinic. They were randomly assigned to intervention group which received 6 sessions (each session 150minutes in a week) of psycho-educational intervention (N=150), or to a control group which received no intervention (N=150). The patients in both groups completed pretest measures consisting of Psychosocial Adjustment to Illness Scale (PAIS) and Cardiac Self Efficacy Questionnaire (CSEQ). Participants were reassessed 2-months and 3- months later.Results: Multiple regression analysis of the collected data, revealed that both after 2 and 3 months, by enrolling the CDSMRP and Tele-health in the intervention group, enhanced significantly Psychosocial Adjustment to Illness through enhanced self efficacy.Conclusion: The Chronic Disease Self management Rehabilitation Program and Tele-health improved the self efficacy of cardiac patients which then enhanced and maintained their Psychosocial Adjustment to Illness

The Efficacy of Chronic Disease Self Management Program and Tele- Health on Adherence by Increasing Self Efficacy in Patients with CABG

AbstractAimCoronary Artery disease as a chronic disease is the single largest killer of people in the worldwide. Despite advances in medical treatment, CAD is still associated with high morbidity, mortality, high hospitalization rates. Patients with CAD require comprehensive rehabilitation to control symptoms, slow the progressive nature of condition, decrease re hospitalization, and improve survival. To achieve these outcomes, patient adherence to prescribed medications is vital whereas Poor adherence to the long-term treatment of chronic diseases has been a growing problem and a major challenge for health care professionals. The purpose of this study was to test the efficacy of The Chronic ِ Disease Self Management Rehabilitation Programs and Tele- health in cardiac patients undergone Coronary Artery Bypass Surgery (CABGS), in order to improve, enhance and maintain their adherence by increasing the efficacy during intervention sessions.MethodA total of 300 patients, were recruited through Tehran Heart Center's cardiac rehabilitation clinic. They were randomly assigned to intervention group which received 6 sessions (each session 150 minutes in a week) of psycho-educational intervention (N=150), or to a control group which received no intervention (N=150). The patients in both groups completed pretest measures consisting of General Adherence Scale (GAS), Specific Adherence Scale (SAS) and Cardiac Self Efficacy Questionnaire (CSEQ). Participants were reassessed 2-months and 3- months later.ResultMultiple regression analysis of the collected data, revealed that both after 2 and 3 months, by enrolling the CDSMRP and Tele-health in the intervention group, enhanced significantly adherence through enhanced self efficacy.ConclusionThe CDSMRP and Tele-health, improved the self efficacy of cardiac patients which then enhanced and maintained their adherence

Wpływ płci i cukrzycy typu 2 na normalizację częstości rytmu serca u pacjentów z chorobą wieńcową po rehabilitacji kardiologicznej

Introduction: The purpose of this study was to clarify whether type 2 diabetic patients with coronary disease are subject to similar benefits in heart rate recovery (HRR) as non-diabetic counterpatrs after cardiac rehabilitation, assessing men and women subjects separately. Material and methods: The data used for this analysis were from an eight-week, phase-II cardiac rehabilitation including 284 patients with ischaemic heart disease who were managed at Tehran Heart Centre between July 2004 and January 2006. The heart rate parameters were compared between diabetic and non-diabetic patients before and after cardiac rehabilitation. Diabetic and non-diabetic patients had similar age and left ventricular ejection fraction. Results: Among men, the non-diabetic patients achieved a greater improvement in peak heart rate and heart rate recovery (HRR). Additionally, lower resting heart rate was found in nondiabetic men after rehabilitation. In the women &#8805; 50 years old, there was no significant difference between diabetic and non-diabetic. The non-diabetic women < 50 years old showed significantly higher peak heart rate and HRR compared with diabetic women. Conclusions: These results indicate that the benefit of cardiac rehabilitation in HRR is significantly lower in type 2 diabetic men. Improvement of HRR is not associated with diabetic status in women &#8805; 50 years old. The response to cardiac rehabilitation in women may appear to be influenced more by age at menopause rather than diabetes mellitus.Wstęp: Celem badania było wyjaśnienie czy pacjenci z cukrzycą typu 2 i chorobą wieńcową odnoszą podobne korzyści z rehabilitacji kardiologicznej dotyczące normalizacji częstości rytmu serca (HRR, heart rate recovery) jak osoby z chorobą wieńcową bez cukrzycy. Osobno oceniano mężczyzn i kobiety. Materiał i metody: Dane wykorzystane w analizie pochodziły z 8-tygodniowego II stadium rehabilitacji kardiologicznej przeprowadzonej u 284 pacjentów z chorobą niedokrwienną serca leczonych w Tehran Heart Center w okresie pomiędzy lipcem 2004 roku a styczniem 2006 roku. Porównywano parametry opisujące częstość rytmu serca u osób z cukrzycą i bez cukrzycy, przed i po rehabilitacji kardiologicznej. Pacjenci z cukrzycą i bez cukrzycy charakteryzowali się podobnym wiekiem i zbliżoną frakcją wyrzutową lewej komory. Wyniki: U mężczyzn bez cukrzycy uzyskano większą poprawę dotyczącą szczytowej częstości rytmu serca i normalizacji HRR. Dodatkowo po rehabilitacji, u mężczyzn bez cukrzycy stwierdzono mniejszą spoczynkową częstość rytmu serca. Nie zaobserwowano znamiennych różnic pomiędzy kobietami z cukrzycą i bez cukrzycy w wieku 50 lat i starszych. Kobiety bez cukrzycy poniżej 50. roku życia charakteryzowały się istotnie większą szczytową częstością rytmu serca i HRR w porównaniu z kobietami z cukrzycą. Wnioski: Uzyskane wyniki świadczą o tym, że korzyści z rehabilitacji kardiologicznej dotyczące HRR są istotnie gorsze u mężczyzn z cukrzcą typu 2. Poprawa dotycząca HRR u kobiet w wieku 50 lat i starszych nie zależała od obecność cukrzycy. Wydaje się, że u kobiet odpowiedź na rehabilitację kardiologiczną w większym stopniu zależy od wieku, w którym wystąpiła menopauza niż od obecności cukrzycy

Baseline Systolic Blood Pressure Response to Exercise Stress Test Can Predict Exercise Indices following Cardiac Rehabilitation Program

Background: Systolic blood pressure recovery (rSBP) is of prognostic value for predicting the survival and co-morbidity rate in patients with coronary artery disease (CAD). This study investigated the association between rSBP and exercise indices after complete cardiac rehabilitation program (CR) in a population-based sample of patients undergoing coronary artery bypass grafting (CABG).Methods: The sample population consisted of 352 patients who underwent pure CABG. The patients underwent standard symptom-limited exercise testing immediately before and also after the completion of the CR sessions. rSBP was defined as the ratio of the systolic blood pressure at 3 minutes in recovery to the systolic blood pressure at peak exercise.Results: An abnormal baseline rSBP after exercise was a strong predictor of exercise parameters in the last session, including metabolic equivalents (β = -0.617, SE = 0.127, p value < 0.001) and peak O2 consumption (β = -1.950, SE = 0.363, p value < 0.001) measured in the last session adjusted for baseline exercise characteristics, demographics, function class, and left ventricular ejection fraction.Conclusion: The current study strongly emphasizes the predictive role of baseline rSBP after exercise in evaluating exercise parameters following CR. This baseline index can predict abnormal METs value, peak O2 consumption, post-exercise heart rate, and heart rate recovery after a 24-session CR program

Effects of Strength Training and Cardiac Rehabilitation Programs on the Biomechanical Parameters of Blood Flow Velocity and Blood Flow Rate and Its Relation With Arterial Stiffness Index in Brachial and Femoral Arteries with Coronary Artery Bypass Grafting Patients (CABG)

Objective: Assuming that cardiac rehabilitation and exercise significantly reduces mortality rate in coronary artery disease and has an important role in secondary prevention, the purpose of this study is to assess the effects of strength training and cardiac rehabilitation programs on biomechanical parameters of blood flow velocity and blood flow rate and these relationships with the brachial and femoral artery stiffness index in patients with coronary artery bypass graft (CABG) in past 2 months. Materials & Methods: This study was performed on 40 women and men, with 50 to 80 years old who were underwent CABG. Training group had 18 patients who participated in strength training and rehabilitation program for two months. There were three sessions in a week and patients trained according to determined level of each patient's functional capacity. The control group had 14 patients who did not participate in the training program. Variables blood flow velocity and arterial diameter in systole and diastole phases measured with Doppler ultrasound and the mean velocity of blood flow rate in arteries and arterial stiffness index was calculated for both groups. For statistical analysis dependent t-test was used in significance level of 0. 05 and Pearson correlation coefficient was applied for measuring the relation between parameters in significant level of 0.01. Results: The significant changes in velocity, blood flow rate and decreased arterial stiffness index in arteries were observed in the training group. Conclusion: According to our results, we can say strength training and cardiac rehabilitation programs can be effective in improvement of peripheral vascular and bleeding tendency in these patients

The Comparison effects of Selected Aerobic Continues and Interval Exercise Program on Functional Capacity of POST Coronary Artery Bypass Graft Surgery Patients

Objective: Exercise training appears to reduce both all-cause mortality and cardiovascular disease mortality by improving function capacity of heart . The purpose of this study was to assess the effects of selected continuous exercise training compared to an intense selected interval exercise training on functional capacity of POST CABG Patients. Materials & Methods : Thirty three POST CABG patients (30 men, 3 women) 58.33± 9.50 and mean BMI: 27.05±3.55 kg/m2 participated in this study. Selected aerobic continues training (n=12) including: 30 – 60 min continues training with intensity of 70–85% of HR maximum and aerobic interval training (n=12) including three interval, 28-45 min and intensity of 70-90% of HR maximum three times a week for 8 weeks. Control group (n=9) only participate in pre and post tests. Functional capacity was measured with exercise testing (with Modified BRUCE protocol). Statistical methods that were used in this study include t student and ANOVA tests. SPSS Version of 16 used to analyze of all statistics test. Results: There are not any significant differences between continuous and interval training groups (P=0.115). Also after program there is a significant difference between training and control groups (0.017). The precision comparison between groups indicates there is a significant difference between continuous and control (P=0.009) group but not any significant difference between interval and control (P=0.202). Conclusion : The present data may be useful in effective designing intense aerobic continuous or interval training programs for patients with coronary artery disease (CAD) and specially coronary artery bypass surgery (CABG) and also improved health in the future

Evaluation of the Effect of Cardiac Rehabilitation on Left Ventricular Diastolic and Systolic Function and Cardiac Chamber Size in Patients Undergoing Percutaneous Coronary Intervention

Background: Exercise and rehabilitation are important methods for decreasing the risk factors of coronary artery disease (CAD). We aimed to evaluate the effect of the cardiac rehabilitation (CR) exercise program on the cardiac structure and physiology in patients undergoing percutaneous coronary intervention (PCI). Methods: In this randomized controlled study, 146 patients with CAD were divided equally into two groups: case group (undertaking CR after PCI) and control group (without rehabilitation after PCI). All the patients in the case group underwent echocardiography (before and after CR), and echocardiography was performed for the control group simultaneously. The CR exercise program encompassed 24 sessions, twice or three times a week, with each session lasting between 15 and 45 minutes, depending on the individual patient’s tolerance. Left ventricular (LV) ejection fraction, LV diastolic function, LV end-systolic and diastolic diameter, and right ventricular (RV) end-diastolic diameter were measured in the CR group before and after rehabilitation and compared to those in the control group at the same times. Results: In this study, 146 patients (46 female and 100 male) were evaluated: 73 in the rehabilitation group and 73 in the control group. The mean age of the patients in the CR and control groups was 58.05 ± 10.27 and 56.76 ± 10.07 years, respectively. The CR exercise program had useful effects on LV diastolic function after PCI. The distribution of LV diastolic dysfunction after the CR exercise program was changed significantly only in the CR group (p value = 0.043). In the CR group, normal, grade I, grade II, and grade III LV diastolic dysfunction were observed in 20.5%, 69.8%, 6.8%, and 2.7%, respectively. This distribution was changed respectively to 30.1%, 61.6%, 5.4%, and 2.7% following CR, which showed a significant improvement due to CR in LV diastolic function, most prominently in the patients with grade I diastolic dysfunction (p value = 0.390). There was no significant change in LV and RV diameter before and after rehabilitation, while the ejection fraction increased significantly (p value < 0.05) in both groups. Conclusion: The RC exercise program can be effective in the augmentation of LV diastolic dysfunction after PCI, withoutsignificant changes in LV diameters

Effect of Enhanced External Counterpulsation (EECP) on Exercise Time Duration and Functional Capacity in Patients with Refractory Angina Pectoris

Background: Enhanced external counterpulsation (EECP) is a noninvasive technique used for patients with refractory angina pectoris. There are controversial data on the effectiveness of EECP in improving patients with refractory stable angina. The aim of the present study was to evaluate the effectiveness and safety of EECP for the treatment of patients with refractory angina pectoris. Methods: Twenty consecutive patients with refractory angina pectoris were treated with EECP, and their symptoms, echocardiographic measures, treadmill exercise test parameters, and Canadian Cardiovascular Society Class were evaluated before and immediately after EECP. The patients were followed up for 6months post treatment. Results: There were significant differences regarding total exercise time before and after treatment (p value < 0.001). The patients showed a significant reduction in angina classes III and IV immediately after EECP (p value < 0.001); for most of the patients, these beneficial effects were sustained for 6 months (p value = 0.010). There was no significant improvement in the echocardiographic parameters. Conclusion: EECP decreased symptoms and increased total exercise time in our study population. These beneficial effectswere sustained for 6 months

Predictors of early return to work after a coronary artery bypass graft surgery (CABG)

Objectives: Identifying factors predictive of early return to work in patients who underwent a coronary artery bypass graft surgery (CABG). Material and Methods: Two hundred twenty-six working patients who volunteered and underwent a primary coronary artery bypass surgery between September 2013 and May 2014 were selected for the study and followed up for 6 months. Predictors of early return to work (RTW) (within 2 months) were analyzed from variables in a prospectively collected database and the 36-Item Short Form Health Survey (SF-36) questionnaire carried out in the hospital and rehabilitation center as well as from the follow-up performed via the phone. Results: One hundred and two (45.1%) and 155 (68.9%) patients returned to work within 2 and 3 months after the surgery, respectively. Furthermore, 196 patients (87.1%) returned to work within 6 months after the surgery. In the univariate analysis, demographic or socioeconomic factors (such as age, level of education, income), occupational factors (such as occupation type, working hours per week, duration of the preoperative absence from work), psychological factors (such as a patient’s concern about adverse health effects of RTW, feeling depressed, a patient’s attitude towards his/her ability to RTW and a patient’s perception of his/her job stress level) and medical factors (such as serum troponin T and creatine kinase MB (CKMB) level, pump time in surgery, co-surgery and dyslipidemia history) had a statistically significant correlation with early return to work. The patients who early returned to work had significantly higher scores in 3 domains on the SF-36 questionnaire (used for assessing the patients’ quality of life), compared to those who did not return to work early (including physical functioning, role limitations due to physical health and pain). Conclusions: In the present study we identified 4 new medical factors that could be used as predictors of early return to work after CABG. These factors are: normal serum troponin T level, shorter pump time in surgery, normal mean arterial pressure (MAP) before the surgery and higher serum magnesium (Mg) levels. Int J Occup Med Environ Health 2016;29(6):947–95

Predictors of early return to work after a coronary artery bypass graft surgery (CABG)

Objectives: Identifying factors predictive of early return to work in patients who underwent a coronary artery bypass graft surgery (CABG). Material and Methods: Two hundred twenty-six working patients who volunteered and underwent a primary coronary artery bypass surgery between September 2013 and May 2014 were selected for the study and followed up for 6 months. Predictors of early return to work (RTW) (within 2 months) were analyzed from variables in a prospectively collected database and the 36-Item Short Form Health Survey (SF-36) questionnaire carried out in the hospital and rehabilitation center as well as from the follow-up performed via the phone. Results: One hundred and two (45.1%) and 155 (68.9%) patients returned to work within 2 and 3 months after the surgery, respectively. Furthermore, 196 patients (87.1%) returned to work within 6 months after the surgery. In the univariate analysis, demographic or socioeconomic factors (such as age, level of education, income), occupational factors (such as occupation type, working hours per week, duration of the preoperative absence from work), psychological factors (such as a patient’s concern about adverse health effects of RTW, feeling depressed, a patient’s attitude towards his/her ability to RTW and a patient’s perception of his/her job stress level) and medical factors (such as serum troponin T and creatine kinase MB (CKMB) level, pump time in surgery, co-surgery and dyslipidemia history) had a statistically significant correlation with early return to work. The patients who early returned to work had significantly higher scores in 3 domains on the SF-36 questionnaire (used for assessing the patients’ quality of life), compared to those who did not return to work early (including physical functioning, role limitations due to physical health and pain). Conclusions: In the present study we identified 4 new medical factors that could be used as predictors of early return to work after CABG. These factors are: normal serum troponin T level, shorter pump time in surgery, normal mean arterial pressure (MAP) before the surgery and higher serum magnesium (Mg) levels. Int J Occup Med Environ Health 2016;29(6):947–95