Quality of work experience after angioplasty or heart surgery: a monocentric cohort study.

PURPOSE: The study evaluated work experience changes and its determinants after return to work (RTW) in angioplasty or heart surgery patients. METHODS: During a 1-year period (2014) in a Rehabilitation Hospital in northwestern Italy, we approached 253 patients (19.3% of inpatients). 199 patients consented to complete a survey on job characteristics, job satisfaction, job involvement, illness perception, depression, anxiety, adherence to therapy, and sociodemographic characteristics. The data were analysed with paired sample t tests and random intercept regression models. RESULTS: 156 patients completed both the baseline and the 6-month follow-up assessments. After 6 months, 137 (88%) patients return to work (86% male, M age = 51.9 ± 8.1). The patients predominantly underwent angioplasty/bypass (46%) or valve replacement/repair (38%). Work hours (WO), job satisfaction (JS), and job involvement (JI) significantly decreased after RTW (WO: t (132) = 2.07, p < 0.05; JS: t (134) = 2.56, p < 0.05; JI: t (129) = 4.14, p < 0.001). The decrease in work hours over time was associated with a within-subjects decrease in psychological job demands (ß = 5.107, t (112.1) = 2.21, p < 0.05) and job satisfaction (ß = 2.498, t (112.92) = 2.265, p < 0.05) and an increase in physical job demands (ß = - 1.314, t (112.07) = - 2.416, p < 0.05). The decrease in job satisfaction over time was related to a within-subjects decrease in decision latitude (ß = 0.505, t (116.43) = 2.825, p < 0.01) and an increase in psychological job demand (ß = - 0.586, t (116.78) = - 3.141, p < 0.01). The decrease in job involvement over time was associated with a decrease in physical job demands (ß = 0.063, t (117.19) = 2.157, p < 0.05) within-subjects. CONCLUSIONS: The study showed that many patients who RTW after angioplasty or heart surgery have poorer work experiences relative to changes in psychological and physical demands and more passive roles.

Depressive symptoms, functional measures and long-term outcomes of high-risk ST-elevated myocardial infarction patients treated by primary angioplasty.

The presence of major depressive symptoms is usually considered a negative long-term prognostic factor after an acute myocardial infarction (AMI); however, most of the supporting research was conducted before the era of immediate reperfusion by percutaneous coronary intervention. The aims of this study are to evaluate if depression still retains long-term prognostic significance in our era of immediate coronary reperfusion, and to study possible correlations with clinical parameters of physical performance. In 184 patients with recent ST-elevated AMI (STEMI), treated by immediate reperfusion, moderate or severe depressive symptoms (evaluated by Beck Depression Inventory version I) were present in 10 % of cases. Physical performance was evaluated by two 6-min walk tests and by a symptom-limited cardiopulmonary exercise test: somatic/affective (but not cognitive/affective) symptoms of depression and perceived quality of life (evaluated by the EuroQoL questionnaire) are worse in patients with lower levels of physical performance. Follow-up was performed after a median of 29 months by means of telephone interviews; 32 major adverse cardiovascular events (MACE) occurred. The presence of three vessels disease and low left ventricle ejection fraction are correlated with a greater incidence of MACE; only somatic/affective (but not cognitive/affective) symptoms of depression correlate with long-term outcomes. In patients with recent STEMI treated by immediate reperfusion, somatic/affective but not cognitive/affective symptoms of depression show prognostic value on long-term MACE. Depression symptoms are not predictors "per se" of adverse prognosis, but seem to express an underlying worse cardiac efficiency, clinically reflected by poorer physical performance.

Bilateral post-arterial puncture pseudoaneurysm in a patient with amyloidosis / Pseudoaneurisma bilateral pós-punção arterial em paciente com amiloidose

Amyloidosis consists of deposition of insoluble fibrillar proteins in tissues and, causing dysfunction. In association with other factors, the condition can contribute to emergence of complications, such as pseudoaneurysms at arterial puncture sites. Pseudoaneurysms are becoming an ever-more common complication, which underscores the importance of identifying risk factors, so that their incidence can be minimized...

A amiloidose consiste em um depósito de proteínas fibrilares insolúveis em tecidos e órgãos, causando disfunção nos mesmos, e pode contribuir, associada a outros fatores, para formação de complicações, como pseudoaneurisma em locais de punção arterial. O pseudoaneurisma consiste de uma complicação cada vez mais frequente e, por isso, a importância de se identificarem seus fatores de risco, para que, então, sua incidência possa ser minimizada...

Devemos suspender os agentes antiagregantes plaquetários para procedimentos de dispositivos cardíacos implantáveis? / Should we discontinue antiplatelet agents in implantable cardiac devices procedures?

A cardiopatia isquêmica está comumente associada a arritmias ventriculares malignas, sendo ocardiodesfibriladorimplantável indicado para pacientes selecionados. Essa população faz uso de agentesantiagregantes plaquetários como terapia única ou com duas medicações combinadas. Embora fundamentaispara o tratamento da coronariopatia, os antiagregantes plaquetários aumentam o risco de sangramento nessespacientes, em especial ao se tratar de intervenção cirúrgica. Os autores relatam o caso de paciente portador dedesfibrilador cardíaco implantável e cardiopatia isquêmica, que precisou suspender o uso de antiagregantesplaquetários em decorrência de indicação cirúrgica de troca da unidade geradora por desgaste de bateria. Apóssuspensão da dupla antiagregação, o paciente apresentou choque apropriado decorrente de fibrilação ventricularsecundária a trombose aguda intrastent.

Ischemic heart disease is commonly associated with malignant ventricular arrhythmias and theimplantable cardiac defibrillator is indicated for selected patients. This population uses single or dual antiplatelettherapy. Although they are essential for the treatment of coronary artery disease, anti-platelet agents increase therisk of bleeding in these patients, especially in surgical interventions. The authors report the case of a patient withimplantable cardiac defibrillator and ischemic heart disease, who had to discontinue the use of antiplatelet agentsdue to the indication for device replacement surgery. After discontinuation of dual antiplatelet therapy, the patienthad appropriate shock resulting from ventricular fibrillation secondary to acute in-stent thrombosis.

Endovascular treatment of occlusive central venous disease: one center's experience / Tratamento endovascular da doença venosa oclusiva central: experiência de um centro

INTRODUCTION: The majority of cases of stenosis or occlusion of central veins are the result of central catheters, arteriovenous fistulas, neoplasms or traumas and these conditions can cause severe cases of venous hypertension or reduce the flow through fistulas. The objective of this study is to analyze the results of central venous angioplasties conducted at our hospital. METHODOLOGY: We conducted a retrospective and descriptive study to analyze the results of central venous angioplasties conducted from 2010 to 2012 at a university hospital run by the Universidade Estadual de Londrina, Brazil. We calculated primary and secondary success rates and analyzed whether or not stents were used and complications occurred during a 6-month follow-up period. RESULTS: A total of 25 central venous angioplasties were conducted. Twenty-four (96%) of these were because of catheter-related intimal hyperplasia and one was to treat the effects of compression by a tumor. Fifteen (60%) angioplasties were to correct stenosis and ten (40%) were because of occlusions, with a one-hundred percent success rate for all stenosis-related procedures. However, none of the cases of occlusion could be treated endovascularly. Patency during the 6-months follow-up period was 80% after reinterventions. CONCLUSIONS: Despite good results observed after primary interventions for stenoses, it must be accepted that all current treatment options for chronic occlusive venous disease will, sooner or later, lead to restenosis or occlusion. Venous occlusions constitute a challenge demanding the development of new techniques and new materials. Prevention is paramount, through avoidance of central catheterization and early creation of arteriovenous fistulas...

INTRODUÇÃO: A estenose ou a oclusão de veias centrais ocorre, na maioria das vezes, em consequência de catéteres centrais, fístulas arteriovenosas, neoplasias e traumas, podendo levar a quadros severos de hipertensão venosa e de redução do débito dessas fístulas. O presente trabalho tem como objetivo analisar os resultados obtidos nas angioplastias venosas centrais em nosso hospital. METODOLOGIA: Realizamos um estudo retrospectivo, descritivo, analisando os resultados obtidos nas angioplastias venosas centrais realizadas no Hospital Universitário da Universidade Estadual de Londrina durante os anos de 2010 a 2012. Verificamos as taxas de sucesso primário e secundário, a utilização ou não de stents e as complicações, analisadas durante um período de acompanhamento de seis meses. RESULTADOS: Foram realizadas 25 angioplastias venosas centrais, sendo 24 (96%) por hiperplasia intimal relacionada ao uso de catéteres e uma por compressão tumoral. Destas, 15 (60%) eram estenoses e dez (40%) eram oclusões, obtendo-se sucesso primário técnico em todos os procedimentos relacionados à estenose. Contudo, nenhum caso de oclusão pode ser tratado por via endovascular. No acompanhamento de seis meses, após reintervenções, observamos perviedade de 80%. CONCLUSÃO: Apesar dos bons resultados observados nas intervenções primárias sobre as estenoses, indiscutivelmente todas as opções atuais para o tratamento da doença venosa oclusiva crônica irão levar, precoce ou tardiamente, à reestenose ou à oclusão. As oclusões venosas constituem uma incitação para o desenvolvimento de novas técnicas e novos materiais. A prevenção assume papel preponderante, com redução da implantação de catéteres...

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)

Twelve-months follow-up of supervised exercise after percutaneous transluminal angioplasty for intermittent claudication: a randomised clinical trial.

UNLABELLED: The aim of this study was to explore the effects during 12 months follow-up of 12 weeks of supervised exercise therapy (SET) after percutaneous transluminal angioplasty (PTA) compared to PTA alone on physical function, limb hemodynamics and health-related quality of life (HRQoL) in patients with intermittent claudication. Fifty patients were randomised to an intervention or a control group. Both groups received usual post-operative care and follow-up measurements at three, six and 12 months after PTA. The intervention group performed 12 weeks of SET after PTA. The control group did not receive any additional follow-up regarding exercise. During the 12 months' follow-up, the members of the intervention group had significantly better walking distance than the control group. The intervention group had a significantly higher HRQoL score in the physical component score of the SF-36, and the domains of physical function, bodily pain and vitality. For limb hemodynamics, there was a non-significant trend towards better results in the intervention group compared to the control group. CONCLUSION: SET after PTA yielded statistically significantly better results for walking distance and HRQoL in the intervention group than the control group during the 12 months of follow-up.

Does job satisfaction predict early return to work after coronary angioplasty or cardiac surgery?

PURPOSE: Few studies have analyzed the relationship between job satisfaction and return to work (RTW) in cardiac patients. The aim of this paper was to investigate whether job satisfaction predicted early RTW in patients sick listed after cardiac invasive procedures. METHODS: A 6-month prospective study was carried out in a sample of 83 patients in working age who had recently been treated with angioplasty or cardiac surgery. Job satisfaction was measured using the scale from the Occupational Stress Indicator during cardiac rehabilitation. Time to RTW was assessed at the 6-month occupational physician examination. Logistic regression analyses were used to study the association between job satisfaction at baseline and early RTW at follow-up, adjusted for socio-demographic, medical (type of cardiac intervention, ejection fraction) and psychological (depression, locus of control, illness perception) factors. RESULTS: Participants with high job satisfaction were more likely to return early to work, with an odds ratio (OR) of 5.92 (95 % CI, 1.69-20.73) in the most-adjusted model, compared to participants with low job satisfaction. Satisfaction with organizational processes was the job satisfaction component most strongly associated with early RTW (OR, 4.30; 95 % CI, 1.21-15.03). CONCLUSIONS: To the best of our knowledge, this is the first prospective study that investigated whether job satisfaction predicts time to RTW after cardiac interventions. The results suggested that when patients are satisfied with their job and positively perceived their work environment, they will be more likely to early RTW, independently of socio-demographic, medical and psychological factors.

Angioplastia subintimal após trombose tardia de stent implantado em artéria hepática de fígado transplantado / Subintimal angioplasty after late thrombosis of hepatic artery stent implanted in liver transplantation

Os autores relatam um caso de estenose de artéria hepática transplantada tratada com angioplastia e stent, que evoluiu para trombose completa após 30 dias do procedimento. Realizada trombólise intra-arterial e angioplastia subintimal com sucesso. Controle angiotomográfico após 90 dias demonstra perviedade da artéria hepática.

The present study reports a case of hepatic artery stenosis treated by percutaneous transluminal angioplasty and stent. After 30 days, this artery occluded and the patient was submitted successfully to thrombolysis and subintimal percutaneous angioplasty. Ninety days after the procedure a computed tomography showed patency of hepatic artery.

Effects of long-term exercise training on cardiac baroreflex sensitivity in patients with coronary artery disease: a randomized controlled trial.

OBJECTIVE: To investigate whether a structured long-term exercise training programme in patients with coronary artery disease affects baroreflex function and cardiorespiratory efficiency. PATIENTS: Twenty-five elderly male patients with coronary artery disease. METHODS: The patients were randomized into exercise (group A) or control group (group B). Group A followed a seven-month supervised exercise programme, consisting of three sessions of aerobic interval training weekly at moderate intensity. Twenty patients completed the study (group A: 10 patients and group B: 10 patients). At the beginning and end of the study, all subjects underwent a tilt test for the baroreflex sensitivity assessment and a graded exercise treadmill test with spiroergometry for the evaluation of their cardiorespiratory efficiency. RESULTS: There were no differences between the two groups for any baseline variable. After training in group A, peak oxygen consumption, maximal treadmill tolerance time and anaerobic threshold were significantly increased by 21.9% (P < 0.001), 19.8% (P < 0.001) and 18.6% (P < 0.05), respectively. There were also significant increases in baroreflex sensitivity by 21.2% (P < 0.01), in baroreflex effectiveness index by 23.9% (P < 0.01), in event count by 45.1% (P < 0.01) and in ramp count by 13.2% (P < 0.05). Moreover, significant correlations were observed between the autonomic and cardiorespiratory parameters in group A at the end. CONCLUSION: The results suggest that long-term exercise training leads to beneficial effects on baroreflex activity and cardiorespiratory performance in coronary patients, and thus could constitute an efficient nonpharmacological intervention in this population.

An examination of psychosocial correlates of exercise tolerance in cardiac rehabilitation participants.

This study explored the influence of psychosocial factors on an important prognostic indictor among heart patients, exercise tolerance (ET). Prior to attending cardiac rehabilitation (CR), 100 men and 24 women completed a survey assessing social support and self-efficacy for exercise in CR followed by an ET test (ETT) measured in metabolic equivalents (METS) 1 month later. Regression analyses showed that age was the strongest predictor of METS, but that income and the psychosocial variables also significantly impacted on METS. Overall, 50% of the variance in METS was explained by the predictor variables. These results show that psychosocial factors affect the ET of heart patients. Future research should examine the prognostic role of these psychosocial factors as they affect ET as well as their influence on behavioral mechanisms such as exercise.

Clinical life: expectation and the double edge of medical promise.

This article introduces the concept of clinical life to capture a form of life produced in the pursuit and wake of medically achieved longevity. Relying on the retrospective accounts of 28 individuals over age 70 who have undergone cardiac bypass surgery, angioplasty or a stent procedure, as well as interviews with their families and with clinicians, we examine three features of clinical life. First, patients do not distinguish between clinical possibility and clinical promise, and thus assume that life can and will be improved by medical intervention in late life. Rather than anticipating a range of potential treatment outcomes, patients therefore expect the best-case scenario: that medical procedures will reverse aging, disease and the march of time. Second, patients then assess the value of their post-procedure lives in accordance with that expectation. Norms regarding what life 'should be like' at particular ages are continually recalibrated to the horizon of what is clinically possible. And third, the price of living longer entails a double-edged relationship with the clinic--it generates opportunities for bodily restoration and increased self-worth but also creates ambivalence about the value of life. This latter feature of clinical life is rarely publicly acknowledged in an environment that emphasizes medical promise.

[Does the method of treatment in patients with an acute myocardial infarction influence the results of an early cardiac rehabilitation?]. / Czy metoda leczenia pacjentów w swiezym zawale serca wplywa na wynik wczesnej rehabilitacji kardiologicznej?

UNLABELLED: Does the method of treatment in patients with an acute myocardial infarction influence the results of an early cardiac rehabilitation? Post-myocardial infarction recovery depends on various complimentary factors. The aim of this study was to evaluate whether the type of reperfusion in an acute myocardial infarction (MI) - primary angioplasty (PCI) or fibrinolysis - influence the recovery period and the final result of an early cardiac rehabilitation. METHODS: Retrospective analysis of case histories of 60 patients undergoing reperfusion procedures for an acute myocardial infarction was performed 30 pts (mean age 56 (9) were treated with fibrinolysis (group I) and 30 pts (mean age 53 (7) with PCI (group II). All the patients underwent cardiac rehabilitation in postMI period according to Rudnicki's model A and B. ECG exercise test was performed before start of rehabilitation and at the end. RESULTS: In both groups a significant prolongation of exercise test duration (0.89 and 1.13 min, p<0.005) as well as an increase in exercise capacity (0.86 and 0.96 METS, p<0.005) were observed. Both exercise duration time as well as maximum workload achieved did not differ among two groups at the beginning and at the end of cardiac rehabilitation. Independently on the reperfusion strategy used no significant differences were noted between two groups in the setting of all studied parameters. CONCLUSIONS: Early cardiac stationary rehabilitation in postMI patients leads to a significant improvement in physical capacity expressed as an increase in exercise ECG test duration and workload achieved. The method of reperfusion, if successful, does not influence the final result of rehabilitation.

Radiodermitis crónica secundaria a cateterismo cardíaco / Chronic radiodermatitis following cardiac catheterization

Presentamos un paciente de 55 años, de sexo masculino, al que le aparecieron dos placas de aspecto poiquilodérmico a ambos lados del costado derecho, tras la práctica de dos angioplastias percutáneas y coronariografía debido a enfermedad isquémica coronaria (AU)

Cardiac rehabilitation: not just exercise anymore.

SUMMARY: The treatment of older and sicker patients and decreasing length of stays are forcing a rethinking of approaches to cardiac rehabilitation. As a result, cardiac rehabilitation programs are becoming more flexible, emphasizing life-style changes and psychosocial support to meet patient needs. KEY POINTS: Today's rehabilitation patients are likely to be older and to stay in the hospital fewer days than patients in the past, and they may have congestive heart failure or be candidates for cardiac transplantation. Newer therapies, such as angioplasty, result in some patients being diagnosed, treated, and discharged quickly. These patients often do not stay in the hospital long enough to undergo the first phase of cardiac rehabilitation. With the decreasing length of stays for most cardiac events, it is not reasonable to expect that inpatient rehabilitation will produce tangible improvement in physical capacity or significant retention of information and instructions. Rehabilitation programs need to be changed accordingly. Low-risk patients undergoing angioplasty may still need cardiac rehabilitation to decrease the risk of restenosis and to reduce cardiac risk factors. Programs that include aggressive risk-factor modification may produce regression in stenosis of coronary arteries, but compliance is difficult to elicit and maintain.

[Principle of treatment of intermittent claudication due to arteriosclerosis obliterans--reconstruction or conservative treatment].

MATERIALS AND METHODS: Two hundred and one patients of arteriosclerosis obliterans (ASO) with intermittent claudication (IC) were studied. Improvement of IC, score of return to social life, change of life condition and prognosis were compared between the two groups of reconstructive and conservative treatment. RESULTS: Improvement of IC was seen in 88.0% of the patients in the group of reconstruction and only 30.4% in the conservative treatment group. In the reconstructive group, the score of return to social life improved from 2.10 to 1.31 and the score of life condition also improved from 2.71 to 1.66. However in the conservative treatment group these score showed no significant improvement. Moreover the long term mortality rate was lower in the treatment group of reconstruction. CONCLUSION: The arterial reconstruction for IC is significant for improving the quality of life and exerts a favorable effect on life prognosis.