Rehabilitation outcomes following percutaneous coronary interventions (PCI).

This prospective study evaluated the effect of an individualized, comprehensive, home-based cardiac rehabilitation program combining exercise training with risk factor modification and psychosocial counseling on risk factors, psychological well-being, functional capacity, and work resumption in 99 post-percutaneous coronary interventions (PCI) patients randomized to control (standard care plus telephone follow-up, n=49) or intervention (individualized, comprehensive, home-based cardiac rehabilitation, n=50) groups. Data were collected at time 1 (T(1)) during hospital admission, time 2 (T(2)) approximately 2 months post-PCI, and time 3 (T(3)) approximately 12 months post-PCI. Results suggest that the allocation to an individualized, comprehensive, home-based cardiac rehabilitation program provided more advantageous outcomes. At both follow-ups, the intervention group showed within-group improvement in serum cholesterol levels (P<0.02; P<0.01) and exercise participation (P<0.001; P<0.001) with differences in exercise participation favoring the intervention group (P<0.01) at T(2). Repeated measures ANOVA showed significant improvements over time in body mass index (BMI) (P<0.01), psychological well-being (P<0.001), and functional capacity (P<0.001) for both groups. More patients in the intervention group had returned to work at T(2) (P<0.001) and did so more quickly (P<0.01). These findings suggest that an individualized, comprehensive, home-based cardiac rehabilitation program improves risk factor profiles and work resumption patterns for patients following PCI.

Prediction of functional and psychological status after percutaneous transluminal coronary angioplasty.

OBJECTIVE: To examine symptom, functional status, and psychological status profiles after percutaneous transluminal coronary angioplasty (PTCA) and determine indicators of outcome. DESIGN: Descriptive and correlational with repeated measures. SETTING: Hospital or home (2.1 days before PTCA) and home (3.9 and 10.2 months after discharge). MEASURES: Self-administered questionnaires (developed for study) for functional status (personal and instrumental activities of daily living), and cardiac symptoms (chest pain and shortness of breath at rest and on exertion). General Health Questionnaire(16) for psychological status. PATIENTS: One hundred thirty with PTCA (mean age 57 years, 84% male, 15% with prior PTCA). RESULTS: Chest pain and shortness of breath at rest and on exertion decreased and functional and psychological status improved 3.9 months after PTCA, with measures maintained at 10.2 months. At 3.9 months after PTCA, poorer psychological status was predicted by having had a longer duration of coronary artery disease before PTCA. Post-PTCA indicators of poor psychological status were continued chest pain and shortness of breath on exertion and not working. The presence of post-PTCA chest pain on exertion and not working were also correlated with reduced functional status. CONCLUSIONS: Although pre-PTCA variables such as duration of coronary artery disease can predict post-PTCA outcome, the use of variables measured after PTCA may also provide clinicians with accurate estimates of functional and psychological status after PTCA.

Pre-admission education/counselling for patients undergoing coronary angioplasty: impact on knowledge and risk factors.

This study aimed to evaluate whether a pre-procedural education/counselling program can improve knowledge and coronary risk factors in 130 patients (65 experimental; 65 comparison) approximately four months after having percutaneous transluminal coronary angioplasty (PTCA). Knowledge and physical activity levels (p = 0.00) improved for both groups from pre-PTCA to the follow-up. Further, the experimental group showed favourable change in total cholesterol level (p = 0.02) at follow-up. That participation in the intervention did not improve knowledge or risk factor prevalence may reflect the adequacy of standard ward care, the influence of factors not under the control of the study or the overall experience of PTCA. Limitations of educational programs without follow-up sessions are discussed and alternate rehabilitation approaches suggested.

Coronary risk factor status after percutaneous transluminal coronary angioplasty.

OBJECTIVE: To determine whether patients modify their risk factors after undergoing percutaneous transluminal coronary angioplasty (PTCA). DESIGN: One-group, pretest-posttest. Pretest data were collected on the day before PTCA, and posttest data were collected at a mean follow-up of 11 months after PTCA. Data were collected from medical records and by patient self-report. SETTING: University-affiliated, metropolitan public and private hospitals. PATIENTS: Two hundred nine patients undergoing PTCA. OUTCOME MEASURES: Patients' smoking and exercise habits were assessed by self-report. Serum cholesterol level and body mass index were determined from entries in medical charts. RESULTS: All measured risk factors, with the exception of smoking, underwent favorable change (p < 0.001) after PTCA. The number of current smokers, however, increased significantly (p < 0.001), as did the number of cigarettes these patients smoked per day (p < 0.05). CONCLUSION: Evaluation of the effect of intervention strategies on reducing patients' smoking behavior after PTCA is required.

Percutaneous transluminal coronary angioplasty: clinical and quality of life outcomes one year later.

BACKGROUND: The quality of life status of patients prior to and following percutaneous transluminal coronary angioplasty (PTCA) has not been comprehensively investigated. AIM: This study was carried out to determine the effect that PTCA has on patients' quality of life. METHODS: Data on 209 patients were collected one day pre-PTCA and at a mean of two and 11 months post-PTCA. Data on symptomatic status, functional capacity, life satisfaction and psychological well-being were analysed quantitatively. Clinical outcomes, patient perception of PTCA and employment status wee analysed by descriptive statistics. RESULTS: Highly significant improvement in all quality of life measures was found at the early follow-up (p < .001). This improvement was sustained at the late follow-up. At the late follow-up, 58% of patients felt that PTCA had been very beneficial to their health and well-being, and 79% of workers had returned to work. PTCA was primarily successful in 91% of vessels dilated. There were no procedural-related deaths, 12 patients (6%) developed acute occlusion and three patients (1.5%) experienced myocardial infarction (MI). A symptomatic restenosis rate of 16% was found, including 19 patients (9%) requiring repeat PTCA and 14 (7%) undergoing coronary artery bypass grafting (CABG). CONCLUSION: These findings suggest that, after PTCA, the majority of patients experienced improved quality of life which was sustained one year later.

Clinical results and quality of life after percutaneous transluminal coronary angioplasty: a preliminary report.

To evaluate the effect of percutaneous transluminal coronary angioplasty (PTCA) on quality of life, data on symptomatic status, functional capacity, life satisfaction, and psychological wellness were collected on 102 patients at 1 day pre-PTCA and 2 months post-PTCA, and on the first 50 of these patients at 10 months post-PTCA. There were highly significant changes (p < 0.001) in all quality of life measures between pre-PTCA and the 1st follow-up measurements. No further significant changes occurred in these measures between the 1st and 2nd follow-up measurements, indicating that the initial improvement in quality of life was sustained over this period. Data on primary success rate, complications, and pre- and post-PTCA risk factor scores are also reported.