[Prognostic effects of cardiac rehabilitation in patients with acute coronary syndrome]. / Impacto pronóstico de la realización de un programa de rehabilitación cardiaca tras un síndrome coronario agudo.

AIM: Reduction of major adverse cardiovascular events (MACE) at 5 years in patients with acute coronary syndrome (ACS) and percutaneous coronary intervention who completed a cardiac rehabilitation program. METHODS: We included 230 consecutive men with a diagnosis of ACS and percutaneous coronary intervention in the first half of 2015 according to the inclusion criteria. Two cohorts of 115 patients each were compared, one of them (rehabilitated group) with patients who completed the cardiac rehabilitation program and the other (control group) who received conventional outpatient care. Base-line characteristics and MACE at 5-years follow-up were compared and analyzed. MACE included re-infarction, heart failure, cerebrovascular accident and all-cause mortality. RESULTS: At 5 years of follow-up, a statistically significant reduction in MACE (27.19% vs 7.83%; OR 0.23 [IC 0.10-0.50]; P=.0001), all-cause mortality (OR 0.12 [IC 0.01-0.94]; P=0.01), re-infarction rate (OR 0.29 [IC 0.11-0.77]; P=.007) and cerebrovascular accident (P=.014) was found in the rehabilitated group (RG). MACE-free survival was significantly longer in the RG, regardless of risk (HR 0.25 [IC 0.12-0.53]; P=.000). CONCLUSION: In our sample, cardiac rehabilitation programs showed a prognostic benefit in patients with ACS and percutaneous coronary intervention, with a statistically significant reduction in MACE, re-infarction rate and CVA at five-year follow-up.

[Anti-smoking intervention in the acute phase of acute coronary syndrome: Is there additional benefit in patients included in a cardiac rehabilitation program?] / Intervención antitabaco en fase aguda del síndrome coronario agudo: ¿existe beneficio adicional en pacientes incluidos en un programa de rehabilitación cardiaca?

BACKGROUND: Smoking is a challenge in secondary prevention after acute coronary syndrome (ACS). The objective was to assess whether the early anti-smoking intervention (ASI), in the acute hospitalization phase, improves the abstinence rate obtained during a cardiac rehabilitation program (CRP). METHODS: Multicenter clinical trial in which smoker patients admitted for ACS were randomized 1:1 to receive or not ASI from the first day of admission. Upon discharge, both groups were referred to the CRP, performing abstinence controls using co-oximetry. Patients lost were considered smokers. RESULTS: 72 patients were included, 58 men (80.5%), mean age 53 ± 8.1 years. They were admitted for ST elevation myocardial infarction 42 (58%), non-ST elevation myocardial infarction 29 (40%) and unstable angina 1 (1.3%). They smoked an average of 22 ± 11.3 cigarettes/day (pack-year index 37 ± 20). They completed the Richmond test (8.8 ± 1.3) and Fagestrom (5.69 ± 2.1). 36 patients (50%) were randomized to ASI, with no differences in the baseline characteristics of both groups. The dropout rate at the time of inclusion in CRP was higher in the ASI group (69 vs. 44%; p 0.034; OR 2.84), without statistical significance at discharge from the CRP (58 vs. 50%; p 0.478; OR 1.4) or at 12 months (58 vs. 44%; p 0.24; OR 1.75). CONCLUSIONS: The ASI during admission significantly improves the smoking cessation rate at the time of inclusion in the CRP. Part of these beneficial effects are reduced in the follow-up losing statistical significance with respect to the control group.

[Evaluation of the efficacy of a psychological intervention program in a Cardiac Rehabilitation Unit after acute coronary syndrome]. / Evaluación de la eficacia de un programa de intervención psicológica en una Unidad de Rehabilitación Cardíaca tras un síndrome coronario agudo.

INTRODUCTION: Psychosocial factors influence the prognosis of cardiovascular disease. The improvement of these variables through cardiac rehabilitation programs showed inconclusive results. Our objective was to evaluate the benefits of a psychological intervention program in heart disease patients participating in a cardiac rehabilitation program. MATERIAL AND METHODS: Quasi-experimental retrospective study that included 157 consecutive patients referred to the Cardiac Rehabilitation Unit from September 2017 to May 2018. Participants completed a battery of questionnaires at the beginning and at the end of the rehabilitation program in order to evaluate 9 psychosocial variables. Five of these variables were reevaluated at 12months. Finally, a comparative analysis was carried out between the group that performed a specific psychological intervention and the control group. RESULTS: Average age 55±8 years. 77% (n=122) were male. 72% (n=113) carried out a specific psychological intervention program. After completing the program, the psychological intervention group improved statistically significantly in 8of the 9variables analyzed compared to only 2in the control group and with a higher effect size (medium or large size: Cohen's d> 0.5). Furthermore, this benefit was maintained at one year for the psychological intervention group. CONCLUSIONS: Overall, face-to-face cardiac rehabilitation programs improve the psychological sphere of the patient with acute coronary syndrome. In addition, those patients who complete a specific psychological intervention program significantly improve a greater number of psychological variables and to a greater extent compared to those who do not.