Eficacia de la intervención psicológica en rehabilitación cardíaca / Effectiveness of psychological intervention in cardiac rehabilitation

OBJETIVO: El objetivo del presente estudio fue describir y analizar los resultados de la intervención cognitivo-conductual en los pacientes beneficiarios del programa multidisciplinar de rehabilitación cardíaca del Hospital General Universitario de Elche. MATERIAL Y MÉTODO: Para ello se dispuso de una muestra de 33 pacientes que habían tenido un infarto agudo de miocardio o que padecían angina de pecho inestable remitidos desde el Servicio de Cardiología para su inclusión en el Programa de Prevención y Rehabilitación Cardíaca durante los meses comprendidos en el período de septiembre de 2014 a octubre de 2015. Todos los participantes fueron evaluados mediante una batería de cuestionarios pre y postratamiento. RESULTADOS: Los resultados obtenidos mostraron una disminución estadísticamente significativa tras la intervención en gran parte de los factores de riesgo, como ansiedad (p < 0,001, d = 0,38), depresión (p < 0,005, d = 0,25) e ira (p < 0,005, d = 0,35). CONCLUSIONES: Este estudio constituye una nueva evidencia de la eficacia de la intervención psicológica en rehabilitación cardíaca

OBJECTIVE: The aim of this study was to describe and analyze the results of the cognitive-behavioral intervention in the patients beneficiaries of the multidisciplinary Cardiac Rehabilitation program of the Hospital General Universitario de Elche (Spain). MATERIAL AND METHOD: A sample that included 33 patients who had suffered an acute myocardial infarction or who suffer from unstable angina pectoris. These patients were referred from the Cardiology Department for inclusion in the Cardiac Prevention and Rehabilitation Program during the period from September 2014 to October 2015. All the patients were evaluated using a battery of pre- and post- treatment questionnaires. RESULTS: The results showed a statistically significant decrease in a large part of the risk factors after the intervention, such as anxiety (P < .001, d = 0.38), depression (P < .005, d = 0.25) and anger (P < .005, d = 0.35). CONCLUSIONS: This study provides new evidence of the effectiveness of psychological intervention in cardiac rehabilitation

[Effectiveness of psychological intervention in cardiac rehabilitation]. / Eficacia de la intervención psicológica en rehabilitación cardíaca.

OBJECTIVE: The aim of this study was to describe and analyze the results of the cognitive-behavioral intervention in the patients beneficiaries of the multidisciplinary Cardiac Rehabilitation program of the Hospital General Universitario de Elche (Spain). MATERIAL AND METHOD: A sample that included 33 patients who had suffered an acute myocardial infarction or who suffer from unstable angina pectoris. These patients were referred from the Cardiology Department for inclusion in the Cardiac Prevention and Rehabilitation Program during the period from September 2014 to October 2015. All the patients were evaluated using a battery of pre- and post- treatment questionnaires. RESULTS: The results showed a statistically significant decrease in a large part of the risk factors after the intervention, such as anxiety (P < .001, d = 0.38), depression (P < .005, d = 0.25) and anger (P < .005, d = 0.35). CONCLUSIONS: This study provides new evidence of the effectiveness of psychological intervention in cardiac rehabilitation.

Social inequality and barriers to cardiac rehabilitation in the rehab-North register.

AIM: Barriers to participation in cardiac rehabilitation (CR) may occur at three levels of the referral process (lack of information, declining to participate, and referral to appropriate CR programme). The aim is to analyse the impact of socioeconomic status on barriers to CR and investigate whether such barriers influenced the choice of referral. METHODS: The Rehab-North Register, a cross-sectional study, enrolled 5455 patients hospitalised at Aalborg University Hospital with myocardial infarction (MI) during 2011-2014. Patients hospitalised with ST-elevated MI and complicated non-ST-elevated MI were to be sent to specialized CR, whereas patients with uncomplicated non-ST-elevated MI and unstable angina pectoris were to be sent to community-based CR. Detailed selected socioeconomic information was gathered from statistical registries in Statistics Denmark. Data was assessed using logistic regression. RESULTS: Patients being retired, low educated, and/or with an annual gross income <27.000 Euro/yr were significantly less informed about cardiac rehabilitation programmes. Patients being older than 70 years, retired, low educated and/or with an annual gross income <27.000 Euro were significantly less willing to participate in CR. Further, this patient population were to a higher extent referred to community-based CR. CONCLUSION: Patients with low socioeconomic status received less information about and were less willing to participate in cardiac rehabilitation. The same patient population was to a higher extent referred to community-based CR. Knowledge about barriers at different levels and the impact of social inequality may help in tailoring a better approach in the referral process to CR.

PREVENTIVE TRAINING PROGRAMME FOR PATIENTS AFTER ACUTE CORONARY EVENT-- CORRELATION BETWEEN SELECTED PARAMETERS AND AGE GROUPS.

AIM: Interventional cardiovascular training programmes provide a prescription of optimal form and safe intensity. They are part of the second phase of cardiovascular rehabilitation which is a key point in the whole tertiary-preventive care for patients with coronary artery disease. The patients are hemodynamically adapted to a normal physical load, their aerobic capacity is gradually increased, and they learn principles of regular aerobic-resistance exercise. The aim of this study is to assess the impact of modified aerobic-resistance exercise on cardiorespiratory indicators in patients after acute coronary event, and evaluate the differences between monitored parameters in different age groups. METHODS: The study was conducted on a group of 106 patients (85% of men) of an average age of 60.4 ± 10.9 years, with left ventricular ejec- tion fraction of 57.4 ± 7.2%. All subjects went through an acute coronary event. The time elapsed between the occurence of a coronary event and the beginning of the training programme was 35 ± 8 days. In patients after coronary artery bypass grafting, the time passed was 50 ± 16 days on average. All patients received a two-month aerobic-resistance training with a frequency of three times a week. The length of a training unit was set to 100 minutes (out of which 60 minutes were allocated to individual aerobic training). RESULTS: A significant negative correlation between age and average values of monitored parameters was observed. Even though the values of all parameters are decreasing with increasing age, a shift towards higher values in all parameters occurred after completing the training programme. The study reveals that there are interindividual differences between the parameter values. Asignificant difference in individual parameters was found between different age groups. The result of the study shows that a given parameter could characterize each age group. Completing the interventional training programme also led to a significant increase of exercise tolerance (1.8 ± 0.3 vs. 2.0 ± 0.4 W/kg; p < 0.001) and of peak oxygen consumption (22.8 ± 4.5 vs. 25.9 ± 5.5 ml/kg/min, p < 0.001). CONCLUSION: Interindividual differences between the parameter values have been identified. This could be helpful in methodological conception of preventive training programmes for patients suffering from cardiovascular disease. The mutual connection between the parameter values and age groups does not relate only to a safer training intensity determination, but also to a more precisely targeted application of different training modalities in order to achieve an optimal final training effect.

Programa cubano de rehabilitación cardíaca. Resultados / Cuban program for cardiac rehabilitation. Results

Introducción: Las enfermedades cardiovasculares constituyen la primera causa de muerte en Cuba desde hace más de 40 años, con una elevada prevalencia y una muy negativa repercusión socioeconómica. Un programa de rehabilitación cardíaca integral se ha desarrollado a nivel de la comunidad en todo el país desde 1989. Objetivos: El propósito principal de este estudio ha sido evaluar el comportamiento y los resultados de dicho programa durante un período de 3 años. Métodos: Fueron incluidos todos los pacientes con infarto miocárdico, angina inestable o después de angioplastia y cirugía coronaria o valvular, dados de alta en los 23 hospitales de la Red Nacional de Cardiología. El programa de rehabilitación cardíaca abarcó sus 3 fases habituales que incluyeron modificación de los factores de riesgo y medidas para cambios en el estilo de vida, así como ejercicios físicos con una intensidad necesaria para alcanzar el pulso de entrenamiento determinado en pruebas ergométricas previas. La fase de convalecencia tuvo una duración de 8 semanas y la de mantenimiento duró por lo menos hasta el primer año de evolución. La prueba de la chi al cuadrado fue empleada para la comparación de los datos cualitativos. Resultados: Fueron incluidos en el estudio 40.738 pacientes, de los cuales se le realizó la fase hospitalaria de la rehabilitación al 79,1%. En el último año evaluado, fueron incorporados a su fase de convalecencia el 62,5%, con un incremento de un 13,5% con relación al año interior; se incorporaron el 58,5% de los pacientes infartados, un 34,4% de aquellos con angina o después de la angioplastia coronaria y el 94,5% de los pacientes después de la cirugía coronaria o valvular. La mayoría de los pacientes rehabilitados en el último año (56,4%) pertenecían a la región occidental del país, donde también se hizo mayor cantidad de pruebas ergométricas (58,3%), así como consultas especializadas de rehabilitación e intervenciones psicológicas. Conclusiones: Aunque debe aun mejorarse la aplicación del programa de rehabilitación cardíaca en Cuba, particularmente en algunas zonas del interior del país, nuestros resultados están a la altura de muchos países con un adecuado desarrollo socioeconómico (AU)

Introduction: Cardiovascular diseases have been the leading cause of death in Cuba for over 40 years, with a high prevalence and very negative socio-economic impact. A national communitybased comprehensive cardiac rehabilitation program has been implemented all over the country since 1989. Objectives: The principal aim of this study was to evaluate the behavior and results of this program over a 3-year period. Methods: All patients with acute myocardial infarction, unstable angina pectoris or after coronary angioplasty and aorto-coronary or valvular surgery discharged alive in the 23 hospitals of the National Heart Network were included in this study. The cardiac rehabilitation program covered its three common phases. These included modification of risk factors and measures to change style of life. Physical exercises were also included with an intensity necessary to achieve the training heart rate identified by previous ergometric tests. The convalescence phase lasted eight weeks and the maintenance one continued until at least the first year of evolution. Chi-square test was used for the comparison of qualitative data. Results: In this study, 40,738 patients, 79.1% of who underwent the hospital rehabilitation phase, were included. In the last year, 62.5% were incorporated into the convalescence phase, this representing an increase of 13.5% in relation to the previous year. A total of 58.5% of infarction patients, 34.4% of those with angina or after coronary angioplasty and 94.5% of patients after coronary artery or valvular surgery were incorporated. The majority of patients rehabilitated in the last year (56.4%) belonged to the Western region of the country, an area where a higher number of ergometric tests (58.3%) were performed and which also had specialized rehabilitation consultations and psychological interventions. Conclusions: Although the implementation of the cardiac rehabilitation program in Cuba still remains to be improved, particularly in some regions of the countryside, our results are at the same level of many countries with an appropriate socio-economic development (AU)

Cardiac rehabilitation uptake and its determinants in the Netherlands.

AIMS: Despite its documented efficacy, cardiac rehabilitation (CR) is still not well implemented in current clinical practice. The aims of the present study were to assess CR uptake rates in the Netherlands, and to identify factors that determine uptake. METHODS: The cohort consisted of persons insured with Achmea Zorg en Gezondheid. Based on insurance claims, we assessed CR uptake rates in 2007 among patients with an acute coronary syndrome (ACS), patients who underwent coronary artery bypass graft surgery, percutaneous coronary intervention (PCI), or valvular surgery, and patients with stable angina pectoris (AP) or chronic heart failure (CHF). In addition, we evaluated the relation between CR uptake and demographic, disease-related, and geographic factors for patients with an ACS and/or intervention. RESULTS: The CR uptake rate in the entire cohort (n = 35,752) was 11.7%. The uptake rate among patients with an ACS and/or intervention (n = 12,201) was 28.5%, as opposed to 3.0% among patients with CHF or stable AP (n = 23,551). The highest CR uptake rate was observed in patients who underwent cardiac surgery (58.7%). Factors associated with lower CR uptake were female gender, older age, elective PCI (as compared to acute PCI), unstable AP (as compared to myocardial infarction), larger distance to the nearest provider of CR, and comorbidity. CONCLUSION: A minority of Dutch patients eligible for CR received CR. Future implementation strategies should focus on females, elderly patients, patients with unstable AP and/or after elective PCI, patients with long travelling distances to the nearest CR provider, and patients with comorbidities.

Randomized controlled trial of a psychoeducation program for the self-management of chronic cardiac pain.

Cardiac pain arising from chronic stable angina (CSA) is a cardinal symptom of coronary artery disease and has a major negative impact on health-related quality of life (HRQL), including pain, poor general health status, and inability to self-manage. Current secondary prevention approaches lack adequate scope to address CSA as a multidimensional ischemic and persistent pain problem. This trial evaluated the impact of a low-cost six-week angina psychoeducation program, entitled The Chronic Angina Self-Management Program (CASMP), on HRQL, self-efficacy, and resourcefulness to self-manage anginal pain. One hundred thirty participants were randomized to the CASMP or three-month wait-list usual care; 117 completed the study. Measures were taken at baseline and three months. General HRQL was measured using the Medical Outcomes Study 36-Item Short Form and the disease-specific Seattle Angina Questionnaire (SAQ). Self-efficacy and resourcefulness were measured using the Self-Efficacy Scale and the Self-Control Schedule, respectively. The mean age of participants was 68 years, 80% were male. Analysis of variance of change scores yielded significant improvements in treatment group physical functioning [F=11.75(1,114), P<0.001] and general health [F=10.94(1,114), P=0.001] aspects of generic HRQL. Angina frequency [F=5.57(1,115), P=0.02], angina stability [F=7.37(1,115), P=0.001], and self-efficacy to manage disease [F=8.45(1,115), P=0.004] were also significantly improved at three months. The CASMP did not impact resourcefulness. These data indicate that the CASMP was effective for improving physical functioning, general health, anginal pain symptoms, and self-efficacy to manage pain at three months and provide a basis for long-term evaluation of the program.

Sexual function in female patients with unstable angina or non-ST-elevation myocardial infarction.

INTRODUCTION: Coronary artery disease is the leading cause of death and disability for both women and men. The psychological impact of acute myocardial infarction, as well as the physiological effects of the illness and its medications, can have a major effect on a patient's ability to resume sexual activity. AIM: To assess sexual activity in female patients with unstable angina or non-ST-elevation myocardial infarction (NSTEMI), and to study the impact of cardiovascular rehabilitation (CR) on resumption of sexual activity. MAIN OUTCOME MEASURES: Doppler-echocardiographic study, exercise tolerance test (ETT), and assessment of sexual activity. METHODS: This study was conducted in the Riyadh National Hospital and included 35 female patients admitted to the intensive care unit for management of unstable angina or NSTEMI. All patients were enrolled into a CR program. All of them were interviewed for assessment of sexual activity, 12 weeks post discharge. The Arizona Sexual Experience Scale (ASEX) was used for the assessment of the severity of sexual dysfunction for patients who resumed their sexual activity. RESULTS: Results indicate that 48.57% of the patients resumed their sexual activity at the time of the interview. However, most of them were either not satisfied at all with their sexual activity or mostly dissatisfied. The remaining patients (51.43%) had not resumed sex yet. CR was completed by 70.59% of those resuming sex, and 38.89% of those not resuming sex. We estimated that rehabilitated patients were 3.77 times more likely to resume sexual activity than those who did not receive rehabilitation. ASEX score ranged from 19 to 30, with a mean of 24.118 +/- 3.42. CONCLUSION: Unstable angina and NSTEMI have a negative impact on frequency of, and satisfaction with, sexual activity, and lead to sexual dysfunction within a large number of female patients. Accurate and complete sexual instructions for both partners with specific attention paid to the woman's concerns and needs should be part of CR programs.

Psychological and clinical predictors of return to work after acute coronary syndrome.

AIMS: Resumption of paid employment following acute coronary syndrome (ACS) is an important indicator of recovery, but has not been studied extensively in the modern era of acute patient care. METHODS AND RESULTS: A total of 126 patients who had worked before hospitalization for ACS were studied with measures of previous clinical history, ACS type and severity, clinical management, and sociodemographic characteristics. Depressed mood (Beck Depression Inventory) and type D personality were measured 7-10 days following admission. Among them, 101 (80.2%) had returned to work 12-13 months later. Failure to resume work was associated with cardiac factors on admission (heart failure, arrhythmia), cardiac complications during the intervening months, and depression scores during hospitalization. It was not related to age, gender, socioeconomic status, type of ACS, cardiac history, acute clinical management, or type D personality. In multivariate analysis, the likelihood of returning to work was negatively associated with depression, independently of clinical and demographic factors [adjusted odds ratio 0.90, CI 0.82-0.99, P=0.032]. CONCLUSION: Depressed mood measured soon after admission is a predictor of returning to work following ACS. The management of early depressed mood might promote the resumption of economic activity and enhance the quality of life of cardiac patients.

Changes in Health Related Quality of Life 3 months after an acute coronary syndrome.

BACKGROUND: The aim of the study was to identify the changes in Health Related Quality of Life (HRQL) 3 months after discharge from hospital, in patients who have had an acute coronary episode, and to determine the clinical and sociodemographic variables that explain those changes. METHODS: HRQL was assessed in 132 patients while they were admitted to the hospital and at 3 months after discharge, using the SF-36 health questionnaire. To identify the variables associated with the change, multiple linear regression models were constructed for two summary dimensions of the SF-36 (PCS and MCS) taking the change in the score of the dimension as dependent variable. RESULTS: There were no significant differences between the patients who completed the monitoring (n = 76) and those who were dropped out. After three months, a significant decrease was observed in the dimensions of physical functioning, general health, vitality, and Physical Summary Component (PCS). The variables revascularisation, age, and the interaction between previous history of coronary heart disease (CHD) and the presence of one or more risk factors explained 16.6% of the decrease in the PCS. The decrease in the PCS was 6.4 points less in the patients who had undergone revascularisation, 0.2 points less for each year of age, and 4.7 points less in the patients who had antecedents of the illness as well as one or more risk factors. CONCLUSION: The dimensions most affected at three months after an acute coronary episode were those related to the physical component. Undergoing revascularisation improved the PCS in patients, but in the younger patients and those without personal antecedents or risk factors, the PCS was affected more, perhaps due to greater expectations for recovery in these patients.

Cost-effectiveness of rehabilitation after an acute coronary event: a randomised controlled trial.

OBJECTIVE: To estimate the incremental effects on cost and quality of life of cardiac rehabilitation after an acute coronary syndrome. DESIGN: Open randomised controlled trial with 1 year's follow-up. Analysis was on an intention-to-treat basis. SETTING: Two tertiary hospitals in Sydney. INTERVENTION: 18 sessions of comprehensive exercise-based outpatient cardiac rehabilitation or conventional care as provided by the treating doctor. PARTICIPANTS: 113 patients aged 41-75 years who were self-caring and literate in English. Patients with uncompensated heart failure, uncontrolled arrhythmias, severe and symptomatic aortic stenosis or physical impairment were excluded. MAIN OUTCOME MEASURES: Costs (hospitalisations, medication use, outpatient visits, investigations, and personal expenses); and measures of quality of life. Incremental cost per quality-adjusted life year (QALY) saved at 1 year (this estimate combines within-study utility effects with reported 1-year risk of survival and treatment effects of rehabilitation on mortality). Sensitivity analyses around a base case estimate included alternative assumptions of no treatment effect on survival, 3 years of treatment effect on survival and variations in utility. RESULTS: The estimated incremental cost per QALY saved for rehabilitation relative to standard care was 42,535 US dollars when modelling included the reported treatment effect on survival. This increased to 70,580 US dollars per QALY saved if treatment effect on survival was not included. The results were sensitive to variations in utility and ranged from 19,685 US dollars per QALY saved to rehabilitation not being cost-effective. CONCLUSIONS: The effects on quality of life tend to reinforce treatment advantages on survival for patients having postdischarge rehabilitation after an acute coronary syndrome. The estimated base case incremental cost per QALY saved is consistent with those historically accepted by decision making authorities such as the Pharmaceutical Benefits Advisory Committee.

Impact of cardiac rehabilitation on quality of life and depression after acute coronary syndrome.

OBJECTIVE: To evaluate the impact of cardiac rehabilitation programs (CRP) on quality of life (QL) and depression at one-year follow-up after acute coronary syndrome (ACS). METHODS: Two hundred and three patients, without previous cardiological follow-up and referred to the outpatient clinic after hospitalization for ACS between 9/1/2001 and 12/31/2002, were randomly allocated to a 12-week, 3-times-a-week CRP or standard cardiology follow-up only, after giving their informed consent. Baseline population characteristics were recorded and, in patients with more than 4 years' education, QL and depression were evaluated during hospitalization and at one-year follow-up by self-reported responses to the SF-36 QL survey and the Beck Depression Inventory (BDI) respectively. Analysis was by intention-to-treat. RESULTS: 31 patients randomized to CRP, mean age 56 years (31-80), 84% male (group A) and 95 patients, mean age 58 years (33-86), 83 % male, allocated to standard follow-up (group B), responded to the questionnaires. There were no significant differences between the two groups in any of the variables evaluated by the questionnaires during hospitalization. At one-year evaluation, the average BDI score was lower in the CRP group (8 vs. 11, p = 0.05). The prevalence of depressive symptoms (37.5 vs. 56.1%) or severe depression (3.1% vs. 12.2%) was also lower, in this group, although not significantly. SF-36 found significant differences in the evaluation of Vitality (average 62 points in A vs. 47 in B, p < 0.02) and General Health (57 points in A vs. 46 points in B, p < 0.02); there were no differences in the other parameters evaluated. When the physical and mental health components were analyzed, a significant difference favoring CRP was found in mental health (70.6 vs. 56.9, p = 0.02) but not in physical health (62.9 in A vs. 56.4 in B, NS). CONCLUSIONS: Despite the small sample size, significant differences favorable to CRP after ACS were found. After one-year follow-up, patients referred to CRP have a better BDI score; the Vitality and General Health parameters, as well as the mental health component evaluated by SF-36, are also significantly improved after CRP.

Longitudinal course of depressive symptomatology after a cardiac event: effects of gender and cardiac rehabilitation.

OBJECTIVE: Recent research has linked depression to cardiac mortality, and shown a high burden of persistent depressive symptomatology among cardiac patients. The objective of this study was to longitudinally examine the prevalence and course of depressive symptomatology among women and men for 1 year after a cardiac event, and the effect of cardiac rehabilitation (CR) on this trajectory. METHODS: Nine hundred thirteen unstable angina (UA) and myocardial infarction patients from 12 coronary care units were recruited, and follow-up data were collected at 6 and 12 months. Measures included CR participation, medication usage, and the Beck Depression Inventory (BDI). The longitudinal analysis was conducted using SAS PROC MIXED. RESULTS: At baseline there were 277 (31.3%) participants with elevated depressive symptomatology (BDI > or = 10), 131 (25.2%) at 6 months, and 107 (21.7%) at 1 year. Overall, approximately 5% were taking an antidepressant medication, and 20% attended CR over their year of recovery. Participants with greater depressive symptomatology participated in significantly fewer CR exercise sessions (r = -0.19, p = .02), and minimal psychosocial interventions were offered. The longitudinal analysis revealed that all participants experienced reduced depressive symptomatology over their year of recovery (p = .04), and younger, UA participants with lower family income fared worst (ps < 0.001). CR did not have an effect on depressive symptomatology over time, but women who attended CR were significantly more depressed than men (p = .01). CONCLUSION: Depressed cardiac patients are undertreated and their symptomatology persists for up to 6 months. CR programs require greater resources to ensure that depressed participants adhere to exercise regimens, and are screened and treated for their elevated symptomatology.

Cardiac rehabilitation services in New Zealand: access and utilisation.

AIM: To identify factors associated with patient referral to, uptake of, and completion of cardiac rehabilitation programmes in New Zealand. METHODS: Information was collected on referrals to cardiac rehabilitation during February 2002. Routinely collected hospitalisation data were obtained for men and women aged over 35 years with specified coronary episodes. The data were merged, and four predictive logistic regression models developed. RESULTS: There were 2001 people either hospitalised or referred to cardiac rehabilitation. Of the 1696 hospitalised, 36% were referred for rehabilitation. After adjusting for ethnicity, women were less likely to be referred: odds ratio (OR)=0.72 [95% confidence interval (CI) 0.57-0.91]. With each 10-year age increase, there was a lower likelihood of referral (OR=0.74; 95%CI 0.67-0.82). Of those people who were referred to inpatient rehabilitation, 83% were referred to an outpatient programme. Lack of access to transport was associated with reduced likelihood of referral (OR=0.44 95%; CI 0.28-0.70) and with attendance (OR=0.54; 95%CI 0.33-0.88). Those who had previously attended a cardiac rehabilitation programme were significantly more likely to attend, and compared to those aged 65 to 74 years, those older or younger were less likely to complete the programme. Some associations with deprivation were found, but none with ethnicity. CONCLUSION: This study demonstrated considerable scope for improvement in referral to, uptake of and completion of cardiac rehabilitation programmes in New Zealand. It highlighted the need to improve referral processes, promotion, provision, delivery and monitoring of cardiac rehabilitation services.

Upper extremity deep vein thrombosis and pulmonary embolism after coronary bypass surgery: a case report and preliminary results from a prospective study evaluating patients during cardiac rehabilitation.

A 78-year-old woman with unstable angina underwent coronary bypass surgery with complete cardiac revascularization and no immediate postoperative complications. Six days after surgery, during hospitalization for cardiac rehabilitation, the patient developed severe respiratory distress and pulmonary embolism was diagnosed. Color duplex ultrasound revealed the presence of concomitant upper extremity deep vein thrombosis (UEDVT), ipsilateral to the site of placement of a central venous line, in the absence of lower extremity deep vein thrombosis. We describe this case and provide preliminary data from a prospective observational study evaluating the prevalence of catheter-related UEDVT and symptomatic pulmonary embolism (55 and 1.4% respectively) in a series of 71 consecutive coronary bypass surgery patients admitted to a cardiac rehabilitation facility. Catheter-related UEDVT and pulmonary embolism may complicate coronary bypass surgery and should be taken into consideration when managing patients after surgery.

Gender differences in health information needs and decisional preferences in patients recovering from an acute ischemic coronary event.

OBJECTIVE: This study examined gender differences in health information needs and decisional preferences after an acute ischemic coronary event (ICE). METHODS: Patients with ICE, recruited in 12 coronary intensive care units, completed a questionnaire on demographic, disease-related, and psychosocial topics. Six and 12 months later, they completed mailed follow-up questionnaires. RESULTS: Nine hundred six patients completed the baseline questionnaire, 541 (69%) completed the 6-month questionnaire, and 522 (64%) completed the 12-month questionnaire after hospital discharge. Men reported significantly more information received and greater satisfaction with healthcare practitioners meeting their information needs. Women wanted more information than men concerning angina and hypertension. Men wanted more information about sexual function and reported receiving more information about the role of each doctor, test results, treatments, cardiac rehabilitation, and how their families could support their lifestyle changes. Patients who reported receiving more information reported less depressive symptomatology and greater self-efficacy, healthcare satisfaction, and preventive health behaviors. Although most patients of both sexes preferred a shared decision-making role with their physician, the majority felt their doctor had made the main decisions. CONCLUSIONS: Patients after ICE, especially women, reported receiving much less information than they wanted from all health professionals. Most patients wanted a shared or autonomous treatment decision-making role with their doctor, but only a minority experienced this. Clinicians must do better, because meeting patients' information needs and respecting their decisional preferences are shown to be associated with better self-efficacy, satisfaction, and health-promoting behavior.