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1.
Rev. enferm. UERJ ; 26: e23747, jan.-dez. 2018.
Artigo em Português | LILACS, BDENF - Enfermagem | ID: biblio-991146

RESUMO

Objetivo: analisar as mudanças provocadas pela Cirurgia de Revascularização Miocárdica (CRM) e o cuidado de si de indivíduos revascularizados. Método: pesquisa qualitativa realizada com dez indivíduos pós CRM, em um hospital escola do Sul do Brasil. Os dados foram coletados em 2013, por meio de entrevista narrativa e submetidos à análise temática. Projeto aprovado por Comitê de Ética e Pesquisa Resultados: da análise emergiu a categoria, mudanças provocadas pela CRM e o cuidado de si de indivíduos revascularizados com as subcategorias: agora eu me cuido; a mão dupla do cuidado; a imposição do cuidado; a valorização da vida; mudança de atitude nos relacionamentos; e, a família mais próxima. Conclusão: após a cirurgia, os indivíduos passam a repensar suas atitudes consigo e com as outras pessoas, valorizando sua vida, a saúde e a família. Os bens materiais e problemas que permeiam o cotidiano tornam-se menos relevantes, procurando assumir atitudes que lhe tragam prazer e bem-estar.


Objective: to examine changes brought about by myocardial revascularization surgery (coronary artery bypass graft, CABG) and self-care by revascularized individuals. Method: in this qualitative study of ten individuals post-CABG at a teaching hospital in southern Brazil, data were collected by narrative interview and submitted to thematic analysis. Results: analysis revealed the category "changes caused by CABG, and revascularized individuals self-care" with the subcategories "now I take care of myself"; "care as two-way process"; "care as imposition"; "valuing life"; "changed attitude in relationships"; and "closest relatives". Conclusion: after surgery, individuals begin to rethink their attitudes to themselves and other people, valuing their life, health and family. Material possessions and everyday problems become less relevant, and individuals endeavor to act in ways that bring pleasure and well-being.


Objetivo: analizar los cambios producidos por la cirugía de revascularización miocárdica (CRM) y el cuidado de sí de los individuos revascularizados. Método: investigación cualitativa realizada con diez individuos después de CRM, en un hospital universitario en el sur de Brasil. Los datos fueron recolectados por medio de una entrevista narrativa y sometidos al análisis temático. Resultados: del análisis surgió la categoría cambios causados por el CRM y el cuidado de sí de los pacientes revascularizados con subcategorías: ahora me cuido; la doble vía del cuidado; la imposición del cuidado; la valorización de la vida; la actitud en los relacionamientos y la familia más cerca. Conclusión: Después de la cirugía, las personas comienzan a replantearse sus actitudes con usted y otras personas, valorando su vida, la salud y la familia. Materiales y mercancías temas que permean la vida cotidiana se vuelve menos relevante, buscando tomar acciones que dan placer y bienestar.


Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Atitude Frente a Saúde , Autogestão , Revascularização Miocárdica/reabilitação , Cuidados de Enfermagem , Epidemiologia Descritiva , Pesquisa Qualitativa , Enfermagem Cardiovascular
2.
Am J Cardiol ; 121(1): 21-26, 2018 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-29096886

RESUMO

Exercise capacity is a strong predictor of survival rate in patients with and without coronary artery disease. Exercise-based cardiac rehabilitation (CR) with improvements in the peak oxygen uptake (VO2peak) of 3.5 ml/kg/min or more has been shown to be beneficial in earlier observational studies. Long-term results on VO2peak after CR are rare. The aim of this study was to assess if a 12-week outpatient CR program including high-intensity interval training would preserve or improve VO2peak 15 months after CR entry. A total of 133 coronary patients attended the CR program (the Norwegian Ullevaal model). At baseline, at the end of the program, and after 15 months, the patients were evaluated with a cardiopulmonary exercise test, body mass index, blood pressure, self-reported exercise habits, and quality of life (the COOP-WONCA questionnaire). Long-term outcomes were available for 86 patients (65 %). The mean age was 57 ± 9 years and 87% were men. VO2peak improved significantly from baseline (31.9 ± 7.6 ml/kg/min) to program end (35.9 ± 8.6 ml/kg/min) (p <0.001), and further progress was seen at the long-term follow-up (36.8 ± 9.2 ml/kg/min) (p <0.05). COOP-WONCA was significantly enhanced in all domains (p <0.001) with a meaningful clinical improvement in "physical fitness" from baseline to long-term follow-up. In conclusion, at follow-up, the patients still exercised (mean 2.5 ± 1 times per week) and had improved or preserved their VO2peak and quality of life.


Assuntos
Reabilitação Cardíaca , Doença da Artéria Coronariana/reabilitação , Terapia por Exercício , Revascularização Miocárdica/reabilitação , Idoso , Assistência Ambulatorial , Doença da Artéria Coronariana/fisiopatologia , Doença da Artéria Coronariana/cirurgia , Tolerância ao Exercício , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Qualidade de Vida
3.
Artigo em Português | LILACS | ID: biblio-909281

RESUMO

A doença arterial coronariana (DAC) é a principal causa de mortalidade e morbidade entre os portadores de diabetes mellitus (DM). O DM aumenta o risco de DAC e é um preditor independente dos piores resultados após qualquer método de revascularização coronária: intervenção coronária percutânea (ICP) ou cirurgia de revascularização miocárdica (CRM). O tratamento da DAC em diabéticos possui características importantes e sua respectiva presença deve ser utilizada na escolha do método de intervenção, especialmente nos pacientes multiarteriais e/ou com lesão de tronco de coronária esquerda. Além da terapia medicamentosa rigorosa ser um dos pilares fundamentais, a decisão sobre a estratégia de revascularização deve ser tomada por uma equipe multiprofissional e multidisciplinar ("Heart Team"), baseando-se em elementos do quadro clínico, da anatomia coronária, carga isquêmica, função ventricular esquerda, risco cirúrgico hospitalar e do próprio paciente.


Coronary artery disease (CAD) is the leading cause of mortality and morbidity among patients with Diabetes Mellitus (DM). DM increases the risk of CAD and is an independent predictor of poorer outcomes after any method of coronary revascularization: percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG). The treatment of CAD in diabetics has important characteristics, and its presence should not be used in the choice of intervention method, especially in multiarterial patients and/or patients with unprotected left main stem disease. In addition to rigorous drug therapy being one of the fundamental pillars, the decision on the type of revascularization strategy should be made by a multiprofessional and multidisciplinary team ("Heart Team"), based on the clinical presentation, coronary anatomy, ischemic burden, left ventricular function, in-hospital surgical risk and individual patient risk.


Assuntos
Humanos , Doença da Artéria Coronariana/história , Doença da Artéria Coronariana/cirurgia , Diabetes Mellitus/epidemiologia , Revascularização Miocárdica/reabilitação , Acidente Vascular Cerebral/mortalidade , Angioplastia Coronária com Balão/métodos , Stents/história
4.
Rev. chil. cardiol ; 36(3): 185-193, dic. 2017. tab
Artigo em Espanhol | LILACS | ID: biblio-899585

RESUMO

Resumen: Introducción: La rehabilitación cardiovascular ha demostrado tener efectos beneficiosos en pacientes con antecedentes de patología coronaria. Objetivos: Identificar los factores que determinan el resultado de un programa de rehabilitación cardiovascular (PRC) aplicado a pacientes coronarios revascularizados. Métodos: 67 pacientes sometidos a cirugía de bypass o angioplastia fueron evaluados en su capacidad funcional mediante el test de marcha de 6 minutos (TM) al inicio y al completar el programa de rehabilitación cardiovascular. La distancia recorrida en el test de marcha fue correlacionada con la edad, capacidad funcional previa al PRC, tiempo en completar el pro-grama, tiempo que media entre la intervención y el inicio del programa, duración del programa y tipo de revascularización. Además, se comparó el incremento de la capacidad funcional entre los pacientes que fueron derivados a 36 sesiones con los referidos a solo 12. Resultados: 67 pacientes cumplieron los criterios para evaluación del PRC. Globalmente, se observó una mejoría de 12% (511,4 a 573,4 m) en la distancia del TM (p<0.001)). El mayor beneficio, en términos de distancia en el TM se obtuvo al efectuar un programa con más sesiones (36 vs 12) con valores de 20% y 8%, respectivamente (p<0.002). El poder terminar el PRC de 36 sesiones más rápidamente (entre 10 y 13 semanas vs entre 14 y 24 semanas se asoció a una mayor incremente en el TM con valores de 19% vs 10%, respectivamente (p<0,003). El incremento en el TM no difirió entre 3 grupos de edad (desde 49 a 85 años); en el tiempo que transcurre entre la intervención y el inicio del PRC (antes vs después de la 8a semana post revascularización), al tipo de revascularización a la que fue sometido el paciente (cirugía o angioplastía) y a la capacidad funcional previa que estos presentan al inicio del PRC. Conclusión: El PRC es efectivo en mejorar significativamente la capacidad funcional de pacientes revascularizados, especialmente cuando el número de sesiones del programa es mayor y cuando se realiza con una frecuencia de al menos 3 veces por semana. El PRC es igualmente efectivo en pacientes enviados a rehabilitación en forma más precoz, como también lo es en sujetos más añosos. Estos efectos fueron independientes del tipo de revascularización.


Abstracts: Introduction : Background: Cardiovascular Rehabilitation Programs (CRP) have been shown to produce be-neficial effects in patients with coronary artery disease. Aim: to identify factors associated to CRP success in patients who underwent myocardial revascularization Methods: 67 patients who underwent coronary artery bypass surgery (CABG) or percutaneous coronary artery angioplasty (PTCA) were evaluated for functional capacity by means of a standard 6 min walking test (6mWT), before and after completion of the CRP. Distance covered during the test was correlated with age, prior functional class, time employed to complete CRP, time from coronary intervention and CRP initiation, CRP duration and type of revascularization. In addition, patients referred for a 36 sessions CRP were compared to those referred to only 12 sessions. Results: 67 patients met inclusion criteria. Overall, there was a 12% increase (511,4 to 573,4 m) in 6mWT distance (p<0.001). The greatest benefit was obtained with the 36 session CRP as compared to a 12 session CRP (20 vs 8% (p<0.002). Also, completion of a 36 session CRP between 10 and 13 weeks compared to 14 to 24 weeks revealed a greater benefit in the former group (19% vs 10%, respectively (p<0.003). There was no difference in 6minWT distance in 3 groups of age (extending from 49 to 85 years-old); In addition, time from intervention to initiation of CRP (before vs after 8 weeks), type of revascularization or functional capacity at the beginning of CRP showed any difference in 6mWT distance. Conclusion: CRP is a highly effective intervention to improve functional capacity in patients following myocardial revascularization, more so when more sessions are employed and when at least 3 sessions per week are implemented. The program is equally effective in patients starting CRP early after revascularization, and benefit is independent from patient age.


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Doença da Artéria Coronariana/reabilitação , Reabilitação Cardíaca/métodos , Revascularização Miocárdica/reabilitação , Fatores de Tempo , Doença da Artéria Coronariana/fisiopatologia , Exercício Físico/fisiologia , Fatores Etários , Teste de Esforço , Marcha/fisiologia
5.
Cochrane Database Syst Rev ; 6: CD007130, 2017 06 30.
Artigo em Inglês | MEDLINE | ID: mdl-28665511

RESUMO

BACKGROUND: Cardiovascular disease is the most common cause of death globally. Traditionally, centre-based cardiac rehabilitation programmes are offered to individuals after cardiac events to aid recovery and prevent further cardiac illness. Home-based cardiac rehabilitation programmes have been introduced in an attempt to widen access and participation. This is an update of a review previously published in 2009 and 2015. OBJECTIVES: To compare the effect of home-based and supervised centre-based cardiac rehabilitation on mortality and morbidity, exercise-capacity, health-related quality of life, and modifiable cardiac risk factors in patients with heart disease. SEARCH METHODS: We updated searches from the previous Cochrane Review by searching the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (Ovid), Embase (Ovid), PsycINFO (Ovid) and CINAHL (EBSCO) on 21 September 2016. We also searched two clinical trials registers as well as previous systematic reviews and reference lists of included studies. No language restrictions were applied. SELECTION CRITERIA: We included randomised controlled trials, including parallel group, cross-over or quasi-randomised designs) that compared centre-based cardiac rehabilitation (e.g. hospital, gymnasium, sports centre) with home-based programmes in adults with myocardial infarction, angina, heart failure or who had undergone revascularisation. DATA COLLECTION AND ANALYSIS: Two review authors independently screened all identified references for inclusion based on pre-defined inclusion criteria. Disagreements were resolved through discussion or by involving a third review author. Two authors independently extracted outcome data and study characteristics and assessed risk of bias. Quality of evidence was assessed using GRADE principles and a Summary of findings table was created. MAIN RESULTS: We included six new studies (624 participants) for this update, which now includes a total of 23 trials that randomised a total of 2890 participants undergoing cardiac rehabilitation. Participants had an acute myocardial infarction, revascularisation or heart failure. A number of studies provided insufficient detail to enable assessment of potential risk of bias, in particular, details of generation and concealment of random allocation sequencing and blinding of outcome assessment were poorly reported.No evidence of a difference was seen between home- and centre-based cardiac rehabilitation in clinical primary outcomes up to 12 months of follow up: total mortality (relative risk (RR) = 1.19, 95% CI 0.65 to 2.16; participants = 1505; studies = 11/comparisons = 13; very low quality evidence), exercise capacity (standardised mean difference (SMD) = -0.13, 95% CI -0.28 to 0.02; participants = 2255; studies = 22/comparisons = 26; low quality evidence), or health-related quality of life up to 24 months (not estimable). Trials were generally of short duration, with only three studies reporting outcomes beyond 12 months (exercise capacity: SMD 0.11, 95% CI -0.01 to 0.23; participants = 1074; studies = 3; moderate quality evidence). However, there was evidence of marginally higher levels of programme completion (RR 1.04, 95% CI 1.00 to 1.08; participants = 2615; studies = 22/comparisons = 26; low quality evidence) by home-based participants. AUTHORS' CONCLUSIONS: This update supports previous conclusions that home- and centre-based forms of cardiac rehabilitation seem to be similarly effective in improving clinical and health-related quality of life outcomes in patients after myocardial infarction or revascularisation, or with heart failure. This finding supports the continued expansion of evidence-based, home-based cardiac rehabilitation programmes. The choice of participating in a more traditional and supervised centre-based programme or a home-based programme may reflect local availability and consider the preference of the individual patient. Further data are needed to determine whether the effects of home- and centre-based cardiac rehabilitation reported in the included short-term trials can be confirmed in the longer term and need to consider adequately powered non-inferiority or equivalence study designs.


Assuntos
Reabilitação Cardíaca/métodos , Insuficiência Cardíaca/reabilitação , Serviços de Assistência Domiciliar , Infarto do Miocárdio/reabilitação , Revascularização Miocárdica/reabilitação , Centros de Reabilitação , Adulto , Idoso , Tolerância ao Exercício , Feminino , Insuficiência Cardíaca/mortalidade , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/mortalidade , Revascularização Miocárdica/mortalidade , Pacientes Desistentes do Tratamento , Qualidade de Vida , Ensaios Clínicos Controlados Aleatórios como Assunto , Fatores de Risco
6.
Rev Bras Enferm ; 70(2): 257-264, 2017 Apr.
Artigo em Português, Inglês | MEDLINE | ID: mdl-28403306

RESUMO

OBJECTIVE: to evaluate the quality of life of patients who underwent revascularization surgery. METHOD: a descriptive, cross sectional study, with quantitative approach carried out with 75 patients. The questionnaire WHOQOL-Bref was used to evaluate the quality of life (QOL). RESULTS: patients' QOL evaluation presented a moderate result, with need of improvement of all domains. Low income patients had the worst evaluation of QOL in the domain environment (p=0,021), and the ones from Recife/metropolitan area, in the domain social relationship (p=0,021). Smoker (p=0,047), diabetic (p=0,002) and alcohol consumption (p=0,035) patients presented the worst evaluation of the physical domain. Renal patients presented the worst evaluation of QOL in the physical (P=0,037), psychological (p=0,008), social relationship (p=0,006) domains and total score (p=0,009). CONCLUSION: the improvement of QOL depends on the individual's process of behavioral change and the participation of health professionals is essential to formulate strategies to approach these patients, especially concerning health education.


Assuntos
Procedimentos Cirúrgicos Cardíacos/normas , Revascularização Miocárdica/psicologia , Revascularização Miocárdica/reabilitação , Qualidade de Vida/psicologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Brasil , Procedimentos Cirúrgicos Cardíacos/métodos , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Comportamento de Redução do Risco , Inquéritos e Questionários
7.
Mayo Clin Proc ; 92(2): 234-242, 2017 02.
Artigo em Inglês | MEDLINE | ID: mdl-27855953

RESUMO

The primary aim of the Million Hearts initiative is to prevent 1 million cardiovascular events over 5 years. Concordant with the Million Hearts' focus on achieving more than 70% performance in the "ABCS" of aspirin for those at risk, blood pressure control, cholesterol management, and smoking cessation, we outline the cardiovascular events that would be prevented and a road map to achieve more than 70% participation in cardiac rehabilitation (CR)/secondary prevention programs by the year 2022. Cardiac rehabilitation is a class Ia recommendation of the American Heart Association and the American College of Cardiology after myocardial infarction or coronary revascularization, promotes the ABCS along with lifestyle counseling and exercise, and is associated with decreased total mortality, cardiac mortality, and rehospitalizations. However, current participation rates for CR in the United States generally range from only 20% to 30%. This road map focuses on interventions, such as electronic medical record-based prompts and staffing liaisons that increase referrals of appropriate patients to CR, increase enrollment of appropriate individuals into CR, and increase adherence to longer-term CR. We also calculate that increasing CR participation from 20% to 70% would save 25,000 lives and prevent 180,000 hospitalizations annually in the United States.


Assuntos
Reabilitação Cardíaca/normas , Infarto do Miocárdio/reabilitação , Revascularização Miocárdica/reabilitação , Cooperação do Paciente/estatística & dados numéricos , Prevenção Secundária/normas , American Heart Association , Reabilitação Cardíaca/estatística & dados numéricos , Centers for Disease Control and Prevention, U.S. , Centers for Medicare and Medicaid Services, U.S. , Humanos , Guias de Prática Clínica como Assunto , Prevenção Secundária/métodos , Estados Unidos
9.
Eur J Prev Cardiol ; 23(18): 1914-1939, 2016 12.
Artigo em Inglês | MEDLINE | ID: mdl-27777324

RESUMO

Background The prognostic effect of multi-component cardiac rehabilitation (CR) in the modern era of statins and acute revascularisation remains controversial. Focusing on actual clinical practice, the aim was to evaluate the effect of CR on total mortality and other clinical endpoints after an acute coronary event. Design Structured review and meta-analysis. Methods Randomised controlled trials (RCTs), retrospective controlled cohort studies (rCCSs) and prospective controlled cohort studies (pCCSs) evaluating patients after acute coronary syndrome (ACS), coronary artery bypass grafting (CABG) or mixed populations with coronary artery disease (CAD) were included, provided the index event was in 1995 or later. Results Out of n = 18,534 abstracts, 25 studies were identified for final evaluation (RCT: n = 1; pCCS: n = 7; rCCS: n = 17), including n = 219,702 patients (after ACS: n = 46,338; after CABG: n = 14,583; mixed populations: n = 158,781; mean follow-up: 40 months). Heterogeneity in design, biometrical assessment of results and potential confounders was evident. CCSs evaluating ACS patients showed a significantly reduced mortality for CR participants (pCCS: hazard ratio (HR) 0.37, 95% confidence interval (CI) 0.20-0.69; rCCS: HR 0.64, 95% CI 0.49-0.84; odds ratio 0.20, 95% CI 0.08-0.48), but the single RCT fulfilling Cardiac Rehabilitation Outcome Study (CROS) inclusion criteria showed neutral results. CR participation was also associated with reduced mortality after CABG (rCCS: HR 0.62, 95% CI 0.54-0.70) and in mixed CAD populations. Conclusions CR participation after ACS and CABG is associated with reduced mortality even in the modern era of CAD treatment. However, the heterogeneity of study designs and CR programmes highlights the need for defining internationally accepted standards in CR delivery and scientific evaluation.


Assuntos
Reabilitação Cardíaca/métodos , Inibidores de Hidroximetilglutaril-CoA Redutases/uso terapêutico , Isquemia Miocárdica , Revascularização Miocárdica/reabilitação , Humanos , Isquemia Miocárdica/tratamento farmacológico , Isquemia Miocárdica/reabilitação , Isquemia Miocárdica/cirurgia , Prognóstico , Resultado do Tratamento
10.
Braz J Cardiovasc Surg ; 31(2): 106-14, 2016 04.
Artigo em Inglês | MEDLINE | ID: mdl-27556308

RESUMO

INTRODUCTION: Antiplatelet therapy after coronary artery bypass graft (CABG) has been used. Little is known about the predictors and efficacy of clopidogrel in this scenario. OBJECTIVE: Identify predictors of clopidogrel following CABG. METHODS: We evaluated 5404 patients who underwent CABG between 2000 and 2009 at Duke University Medical Center. We excluded patients undergoing concomitant valve surgery, those who had postoperative bleeding or death before discharge. Postoperative clopidogrel was left to the discretion of the attending physician. Adjusted risk for 1-year mortality was compared between patients receiving and not receiving clopidogrel during hospitalization after undergoing CABG. RESULTS: At hospital discharge, 931 (17.2%) patients were receiving clopidogrel. Comparing patients not receiving clopidogrel at discharge, users had more comorbidities, including hyperlipidemia, hypertension, heart failure, peripheral arterial disease and cerebrovascular disease. Patients who received aspirin during hospitalization were less likely to receive clopidogrel at discharge (P≤0.0001). Clopidogrel was associated with similar 1-year mortality compared with those who did not use clopidogrel (4.4% vs. 4.5%, P=0.72). There was, however, an interaction between the use of cardiopulmonary bypass and clopidogrel, with lower 1-year mortality in patients undergoing off-pump CABG who received clopidogrel, but not those undergoing conventional CABG (2.6% vs 5.6%, P Interaction = 0.032). CONCLUSION: Clopidogrel was used in nearly one-fifth of patients after CABG. Its use was not associated with lower mortality after 1 year in general, but lower mortality rate in those undergoing off-pump CABG. Randomized clinical trials are needed to determine the benefit of routine use of clopidogrel in CABG.


Assuntos
Ponte de Artéria Coronária/reabilitação , Revascularização Miocárdica/reabilitação , Inibidores da Agregação de Plaquetas/uso terapêutico , Complicações Pós-Operatórias/mortalidade , Ticlopidina/análogos & derivados , Aspirina/administração & dosagem , Aspirina/uso terapêutico , Ponte Cardiopulmonar/reabilitação , Clopidogrel , Ponte de Artéria Coronária/métodos , Quimioterapia Combinada/mortalidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Revascularização Miocárdica/métodos , North Carolina , Alta do Paciente/estatística & dados numéricos , Inibidores da Agregação de Plaquetas/administração & dosagem , Inibidores da Agregação de Plaquetas/normas , Cuidados Pós-Operatórios/mortalidade , Complicações Pós-Operatórias/tratamento farmacológico , Período Pós-Operatório , Prevalência , Prognóstico , Taxa de Sobrevida , Ticlopidina/administração & dosagem , Ticlopidina/normas , Ticlopidina/uso terapêutico
11.
Cochrane Database Syst Rev ; (1): CD001800, 2016 Jan 05.
Artigo em Inglês | MEDLINE | ID: mdl-26730878

RESUMO

BACKGROUND: Coronary heart disease (CHD) is the single most common cause of death globally. However, with falling CHD mortality rates, an increasing number of people live with CHD and may need support to manage their symptoms and prognosis. Exercise-based cardiac rehabilitation (CR) aims to improve the health and outcomes of people with CHD. This is an update of a Cochrane systematic review previously published in 2011. OBJECTIVES: To assess the effectiveness and cost-effectiveness of exercise-based CR (exercise training alone or in combination with psychosocial or educational interventions) compared with usual care on mortality, morbidity and HRQL in patients with CHD.To explore the potential study level predictors of the effectiveness of exercise-based CR in patients with CHD. SEARCH METHODS: We updated searches from the previous Cochrane review, by searching Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library, Issue 6, 2014) from December 2009 to July 2014. We also searched MEDLINE (Ovid), EMBASE (Ovid), CINAHL (EBSCO) and Science Citation Index Expanded (December 2009 to July 2014). SELECTION CRITERIA: We included randomised controlled trials (RCTs) of exercise-based interventions with at least six months' follow-up, compared with a no exercise control. The study population comprised men and women of all ages who have had a myocardial infarction (MI), coronary artery bypass graft (CABG) or percutaneous coronary intervention (PCI), or who have angina pectoris, or coronary artery disease. We included RCTs that reported at least one of the following outcomes: mortality, MI, revascularisations, hospitalisations, health-related quality of life (HRQL), or costs. DATA COLLECTION AND ANALYSIS: Two review authors independently screened all identified references for inclusion based on the above inclusion and exclusion criteria. One author extracted data from the included trials and assessed their risk of bias; a second review author checked data. We stratified meta-analysis by the duration of follow up of trials, i.e. short-term: 6 to 12 months, medium-term: 13 to 36 months, and long-term: > 3 years. MAIN RESULTS: This review included 63 trials which randomised 14,486 people with CHD. This latest update identified 16 new trials (3872 participants). The population included predominantly post-MI and post-revascularisation patients and the mean age of patients within the trials ranged from 47.5 to 71.0 years. Women accounted for fewer than 15% of the patients recruited. Overall trial reporting was poor, although there was evidence of an improvement in quality of reporting in more recent trials.As we found no significant difference in the impact of exercise-based CR on clinical outcomes across follow-up, we focused on reporting findings pooled across all trials at their longest follow-up (median 12 months). Exercise-based CR reduced cardiovascular mortality compared with no exercise control (27 trials; risk ratio (RR) 0.74, 95% CI 0.64 to 0.86). There was no reduction in total mortality with CR (47 trials, RR 0.96, 95% CI 0.88 to 1.04). The overall risk of hospital admissions was reduced with CR (15 trials; RR 0.82, 95% CI 0.70 to 0.96) but there was no significant impact on the risk of MI (36 trials; RR 0.90, 95% CI 0.79 to 1.04), CABG (29 trials; RR 0.96, 95% CI 0.80 to 1.16) or PCI (18 trials; RR 0.85, 95% CI 0.70 to 1.04).There was little evidence of statistical heterogeneity across trials for all event outcomes, and there was evidence of small study bias for MI and hospitalisation, but no other outcome. Predictors of clinical outcomes were examined across the longest follow-up of studies using univariate meta-regression. Results show that benefits in outcomes were independent of participants' CHD case mix (proportion of patients with MI), type of CR (exercise only vs comprehensive rehabilitation) dose of exercise, length of follow-up, trial publication date, setting (centre vs home-based), study location (continent), sample size or risk of bias.Given the heterogeneity in outcome measures and reporting methods, meta-analysis was not undertaken for HRQL. In five out of 20 trials reporting HRQL using validated measures, there was evidence of significant improvement in most or all of the sub-scales with exercise-based CR compared to control at follow-up. Four trial-based economic evaluation studies indicated exercise-based CR to be a potentially cost-effective use of resources in terms of gain in quality-adjusted life years.The quality of the evidence for outcomes reported in the review was rated using the GRADE method. The quality of the evidence varied widely by outcome and ranged from low to moderate. AUTHORS' CONCLUSIONS: This updated Cochrane review supports the conclusions of the previous version of this review that, compared with no exercise control, exercise-based CR reduces the risk of cardiovascular mortality but not total mortality. We saw a significant reduction in the risk of hospitalisation with CR but not in the risk of MI or revascularisation. We identified further evidence supporting improved HRQL with exercise-based CR. More recent trials were more likely to be well reported and include older and female patients. However, the population studied in this review still consists predominantly of lower risk individuals following MI or revascularisation. Further well conducted RCTs are needed to assess the impact of exercise-based CR in higher risk CHD groups and also those presenting with stable angina. These trials should include validated HRQL outcome measures, explicitly report clinical event outcomes including mortality and hospital admissions, and assess costs and cost-effectiveness.


Assuntos
Doença das Coronárias/reabilitação , Terapia por Exercício , Doença das Coronárias/mortalidade , Feminino , Nível de Saúde , Hospitalização , Humanos , Masculino , Infarto do Miocárdio/mortalidade , Infarto do Miocárdio/reabilitação , Revascularização Miocárdica/reabilitação , Revascularização Miocárdica/estatística & dados numéricos , Avaliação de Resultados em Cuidados de Saúde , Qualidade de Vida , Ensaios Clínicos Controlados Aleatórios como Assunto
12.
In. Kalil Filho, Roberto; Fuster, Valetim; Albuquerque, Cícero Piva de. Medicina cardiovascular reduzindo o impacto das doenças / Cardiovascular medicine reducing the impact of diseases. São Paulo, Atheneu, 2016. p.655-664.
Monografia em Português | LILACS | ID: biblio-971559
13.
Rev. mex. enferm. cardiol ; 23(3): 103-109, sep-dic. 2015.
Artigo em Espanhol | LILACS, BDENF - Enfermagem | ID: biblio-1035506

RESUMO

Antecedentes: las enfermedades cardiovasculares constituyen la primera causa de morbimortalidad a nivel mundial y nacional; sobresale la enfermedad coronaria. Esto ha contribuido para que el tratamiento quirúrgico de revascularización miocárdica sea considerado como un procedimiento de rutina. Éste es uno de los avances más importantes de la medicina durante el siglo XX. En Bogotá, los registros estadísticos muestran que más del 50% del total de cirugías cardiovasculares corresponde a ella. Objetivo: realizar la caracterización de pacientes que se encuentran en posoperatorio temprano de revascularización miocárdica, quienes presentan cambios fisiológicos en su esfera biológica, secundarios al procedimiento, a nivel neurológico, cardiovascular, respiratorio, gastrointestinal, de eliminación y de la piel. Metodología: se realizó un estudio descriptivo, de seguimiento prospectivo. Se observaron y revisaron las historias clínicas de 151 pacientes en posoperatorio de 48 a 96 horas. La revisión de la historia clínica se realizó por el investigador. Se consignó la información en una hoja de registro de información y se procesó mediante métodos de análisis exploratorio multidimensional: análisis factorial de correspondencias múltiples combinado con el Método Cluster de Clasificación. Resultados: estuvieron relacionados con clases de pacientes de acuerdo con los eventos clínicos presentes en cada uno de los sistemas estudiados donde se evidencia que presentan alteración de los sistemas neurológico, cardiovascular, respiratorio y de la piel. Conclusión: la caracterización de los pacientes en posoperatorio de una revascularización miocárdica permite que el cuidado de enfermería sea enfocado hacia la solución de problemas de los sistemas antes mencionados.


Background: cardiovascular diseases are the leading cause of morbidity and mortality at global and national level; stands out coronary disease. This has contributed to make the surgical treatment of coronary artery bypass grafting being considered a routine procedure. This is one of the most important advances in medicine during the twentieth century. In Bogota, statistical records show that more than 50% of all cardiovascular surgeries corresponds to it. Objective: to characterize patients who are in early postoperative myocardial revascularization, who present physiological changes secondary to procedure, in the biological area at neurological, cardiovascular, respiratory, and gastrointestinal level, elimination system and skin. Methodology: a descriptive study was performed and followed prospectively. The medical records of 151 patients in postoperative 48 to 96 hours were seen and reviewed. The review of the medical history was performed by the researcher. The information was collected on a recording sheet and then recorded and processed by methods of multidimensional exploratory analysis: Multiple correspondence analysis combined with Cluster Classification Method. Results: they were related to the kind of patient according to clinical events present in each of the studied systems where there is evidence of alteration of the neurological, cardiovascular and respiratory systems, and skin. Conclusion: the characterization of patients in postoperative of myocardial revascularization allows nursing care to be focused on solving problems of the aforementioned systems.


Assuntos
Humanos , Revascularização Miocárdica/educação , Revascularização Miocárdica/efeitos adversos , Revascularização Miocárdica/enfermagem , Revascularização Miocárdica/estatística & dados numéricos , Revascularização Miocárdica/métodos , Revascularização Miocárdica/mortalidade , Revascularização Miocárdica/reabilitação , Doença das Coronárias/cirurgia , Doença das Coronárias/complicações , Doença das Coronárias/enfermagem , Doença das Coronárias/epidemiologia , Doença das Coronárias/etiologia , Doença das Coronárias/fisiopatologia , Doença das Coronárias/história , Doença das Coronárias/mortalidade , Doença das Coronárias/patologia , Doença das Coronárias/reabilitação
14.
Cochrane Database Syst Rev ; (8): CD007130, 2015 Aug 18.
Artigo em Inglês | MEDLINE | ID: mdl-26282071

RESUMO

BACKGROUND: Cardiovascular disease is the most common cause of death globally. Traditionally, centre-based cardiac rehabilitation programmes are offered to individuals after cardiac events to aid recovery and prevent further cardiac illness. Home-based cardiac rehabilitation programmes have been introduced in an attempt to widen access and participation. This is an update of a review originally published in 2009. OBJECTIVES: To compare the effect of home-based and supervised centre-based cardiac rehabilitation on mortality and morbidity, health-related quality of life, and modifiable cardiac risk factors in patients with heart disease. SEARCH METHODS: To update searches from the previous Cochrane review, we searched the Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library, Issue 9, 2014), MEDLINE (Ovid, 1946 to October week 1 2014), EMBASE (Ovid, 1980 to 2014 week 41), PsycINFO (Ovid, 1806 to October week 2 2014), and CINAHL (EBSCO, to October 2014). We checked reference lists of included trials and recent systematic reviews. No language restrictions were applied. SELECTION CRITERIA: Randomised controlled trials (RCTs) that compared centre-based cardiac rehabilitation (e.g. hospital, gymnasium, sports centre) with home-based programmes in adults with myocardial infarction (MI), angina, heart failure or who had undergone revascularisation. DATA COLLECTION AND ANALYSIS: Two authors independently assessed the eligibility of the identified trials and data were extracted by a single author and checked by a second. Authors were contacted where possible to obtain missing information. MAIN RESULTS: Seventeen trials included a total of 2172 participants undergoing cardiac rehabilitation following an acute MI or revascularisation, or with heart failure. This update included an additional five trials on 345 patients with heart failure. Authors of a number of included trials failed to give sufficient detail to assess their potential risk of bias, and details of generation and concealment of random allocation sequence were particularly poorly reported. In the main, no difference was seen between home- and centre-based cardiac rehabilitation in outcomes up to 12 months of follow up: mortality (relative risk (RR) = 0.79, 95% confidence interval (CI) 0.43 to 1.47, P = 0.46, fixed-effect), cardiac events (data not poolable), exercise capacity (standardised mean difference (SMD) = -0.10, 95% CI -0.29 to 0.08, P = 0.29, random-effects), modifiable risk factors (total cholesterol: mean difference (MD) = 0.07 mmol/L, 95% CI -0.24 to 0.11, P = 0.47, random-effects; low density lipoprotein cholesterol: MD = -0.06 mmol/L, 95% CI -0.27 to 0.15, P = 0.55, random-effects; systolic blood pressure: mean difference (MD) = 0.19 mmHg, 95% CI -3.37 to 3.75, P = 0.92, random-effects; proportion of smokers at follow up (RR = 0.98, 95% CI 0.79 to 1.21, P = 0.83, fixed-effect), or health-related quality of life (not poolable). Small outcome differences in favour of centre-based participants were seen in high density lipoprotein cholesterol (MD = -0.07 mmol/L, 95% CI -0.11 to -0.03, P = 0.001, fixed-effect), and triglycerides (MD = -0.18 mmol/L, 95% CI -0.34 to -0.02, P = 0.03, fixed-effect, diastolic blood pressure (MD = -1.86 mmHg; 95% CI -0.76 to -2.95, P = 0.0009, fixed-effect). In contrast, in home-based participants, there was evidence of a marginally higher levels of programme completion (RR = 1.04, 95% CI 1.01 to 1.07, P = 0.009, fixed-effect) and adherence to the programme (not poolable). No consistent difference was seen in healthcare costs between the two forms of cardiac rehabilitation. AUTHORS' CONCLUSIONS: This updated review supports the conclusions of the previous version of this review that home- and centre-based forms of cardiac rehabilitation seem to be equally effective for improving the clinical and health-related quality of life outcomes in low risk patients after MI or revascularisation, or with heart failure. This finding, together with the absence of evidence of important differences in healthcare costs between the two approaches, supports the continued expansion of evidence-based, home-based cardiac rehabilitation programmes. The choice of participating in a more traditional and supervised centre-based programme or a home-based programme should reflect the preference of the individual patient. Further data are needed to determine whether the effects of home- and centre-based cardiac rehabilitation reported in these short-term trials can be confirmed in the longer term. A number of studies failed to give sufficient detail to assess their risk of bias.


Assuntos
Insuficiência Cardíaca/reabilitação , Serviços de Assistência Domiciliar , Infarto do Miocárdio/reabilitação , Revascularização Miocárdica/reabilitação , Centros de Reabilitação , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Ensaios Clínicos Controlados Aleatórios como Assunto , Fatores de Risco
15.
Int J Occup Med Environ Health ; 28(1): 52-61, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-26159947

RESUMO

INTRODUCTION: Research into work reintegration following invasive cardiac procedures is limited. The aim of this prospective study was to explore predictors of job satisfaction among cardiac patients who have returned to work after cardiac rehabilitation (CR). MATERIAL AND METHODS: The study population consisted of 90 cardiac patients who have recently been treated with coronary angioplasty or heart surgery. They were evaluated during their CR and 12 months after the discharge using validated self-report questionnaires measuring job satisfaction, work stress-related factors, emotional distress and illness perception. Information on socio-demographic, medical and occupational factors has also been collected. RESULTS: After adjusting for demographic, occupational and medical variables, baseline job satisfaction (p < 0.001), depression (p < 0.01) and ambition (p < 0.05) turned out to be independent, significant predictors of job satisfaction following return to work (RTW). Patients who had a partial RTW were more satisfied with their job than those who had a full RTW, controlling for baseline job satisfaction. CONCLUSIONS: These findings recommend an early assessment of patients' psychosocial work environment and emotional distress, with particular emphasis on job satisfaction and depressive symptoms, in order to promote satisfying and healthy RTW after cardiac interventions.


Assuntos
Satisfação no Emprego , Revascularização Miocárdica/reabilitação , Retorno ao Trabalho/psicologia , Adulto , Depressão/psicologia , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Motivação , Estudos Prospectivos , Autorrelato , Estresse Psicológico/psicologia
17.
Med. intensiva (Madr., Ed. impr.) ; 39(4): 199-206, mayo 2015. ilus, tab
Artigo em Espanhol | IBECS | ID: ibc-138284

RESUMO

Objetivo Describir las características epidemiológicas de las paradas cardiorrespiratorias extra hospitalarias (PCEH) y determinar los factores asociados a la recuperación de la circulación espontánea (RCE). Diseño Estudio observacional de cohorte de PCEH registradas de forma continua en la base de datos del SAMU 061 (2009-2012). Ámbito Islas de Mallorca, Ibiza, Menorca y Formentera. Pacientes PCEH ≥ de 18 años. Variables principales de interés: sexo, edad, sospecha etiológica, lugar, testigo, si fue presenciada, soporte vital básico (SVB), ritmo desfibrilable, intervalos de tiempos, desfibrilador semiautomático (DEA), duración de parada cardiaca (PC) y RCE. Las variables independientes fueron definidas según el estilo Utstein y la variable dependiente fue la RCE. Resultados Se atendió a 1.170 PC (28/100.000 habitantes/año). Se incluyeron 1.130 casos. La edad media fue de 61,4 años. El 72,3% fueron de etiología cardiaca y el 84,7% fueron presenciadas. En 840 (74,3%) se practicó SVB y en 400 (47,6%) se realizó previamente a la llegada del SAMU (45 por familiares). En 330 paradas (29,2%) se utilizó el DEA (96 indicó desfibrilación). Los intervalos alerta-SVB y alerta-SVA fueron de 8,4 y 15,8 min respectivamente. Se monitorizó ritmo desfibrilable en 257 PC (22,7%). La RCE se consiguió en 261 casos (23,1%). Los factores asociados a RCE fueron la edad, el ritmo desfibrilable, SVB previo a la llegada del SAMU y duración de PC ≤ 30min. Conclusiones La incidencia de PCEH es baja. El SVB realizado por la familia fue poco frecuente. La edad, ritmo desfibrilable y SVB previo al SAMU se asocian a RCE (AU)


Objective To describe the epidemiology of out-of-hospital cardiorespiratory arrest (OHCA) and identify factors associated with recovery of spontaneous circulation (ROSC). Design Observational study of OHCA registered on a continuous basis in the Emergency Medical Services (EMS) database during 2009-2012. Setting The islands of Mallorca, Ibiza, Menorca and Formentera (Balearic Islands, Spain). Patients OHCA in patients ≥ 18 years of age. The main variables were: Patient sex, age, probable cause, place of arrest, bystander, witnessed, basic life support (BLS), shockable rhythm, intervention time, semi-automatic defibrillator (AED), duration of cardiopulmonary arrest (CA), and ROSC. Independent variables were defined according to the Utstein protocol, and the dependent variable was defined as ROSC. Results The EMS treated 1170 OHCAs (28/100,000 persons-year). We included 1130 CA. The mean age was 61.4 years (73.4% males). Most CA (72.3%) were of cardiac etiology, and 84.7% were witnessed. A total of 840 (74.3%) received BLS and 400 (47.6%) did so before arrival of the EMS (45 by bystander relatives). AED was available in 330 cases CA (29.2%) (96 with shockable rhythm). The interval between emergency call and BLS and between emergency call and advanced life support was 8.4 and 15.8min, respectively. Shockable rhythm was monitored in 257 CAs (22.7%). ROSC occurred in 261 (23.1%). Factors associated with ROSC were age, shockable rhythm, BLS before EMS arrival, and CA duration less than 30min.ConclusionThe incidence rate of the OHCA is low. The proportion of patients receiving BLS from relatives was low. Age, shockable rhythm and BSL before EMS arrival were associated with ROSC (AU)


Assuntos
Humanos , Parada Cardíaca Extra-Hospitalar/epidemiologia , Tratamento de Emergência/métodos , Registros de Doenças/estatística & dados numéricos , Serviços Médicos de Emergência/estatística & dados numéricos , Estudos de Coortes , Revascularização Miocárdica/reabilitação , Reanimação Cardiopulmonar/estatística & dados numéricos
18.
Eur Heart J ; 36(24): 1519-28, 2015 Jun 21.
Artigo em Inglês | MEDLINE | ID: mdl-25888007

RESUMO

AIMS: To assess the effects of multi-disciplinary cardiac rehabilitation (CR) on survival in the full population of patients with an acute coronary syndrome (ACS) and patients that underwent coronary revascularization and/or heart valve surgery. METHODS AND RESULTS: Population-based cohort study in the Netherlands using insurance claims database covering ∼22% of the Dutch population (3.3 million persons). All patients with an ACS with or without ST elevation, and patients who underwent coronary revascularization and/or valve surgery in the period 2007-10 were included. Patients were categorized as having received CR when an insurance claim for CR was made within the first 180 days after the cardiac event or revascularization. The primary outcome was survival time from the inclusion date, limited to a total follow-up period of 4 years, with a minimum of 180 days. Propensity score weighting was used to control for confounding by indication. Among 35 919 patients with an ACS and/or coronary revascularization or valve surgery, 11 014 (30.7%) received CR. After propensity score weighting, the adjusted hazard ratio (HR) associated with receiving CR was 0.65 (95% CI 0.56-0.77). The largest benefit was observed for patients who underwent coronary artery bypass grafting (CABG) and/or valve surgery (HR = 0.55, 95% CI 0.42-0.74). CONCLUSION: In a large and representative community cohort of Dutch patients with an ACS and/or intervention, CR was associated with a substantial survival benefit up to 4 years. This survival benefit was present regardless of age, type of diagnosis, and type of intervention.


Assuntos
Síndrome Coronariana Aguda/reabilitação , Implante de Prótese de Valva Cardíaca/reabilitação , Síndrome Coronariana Aguda/mortalidade , Síndrome Coronariana Aguda/cirurgia , Idoso , Estudos de Coortes , Fatores de Confusão Epidemiológicos , Feminino , Implante de Prótese de Valva Cardíaca/mortalidade , Humanos , Masculino , Pessoa de Meia-Idade , Revascularização Miocárdica/reabilitação , Países Baixos/epidemiologia , Análise de Sobrevida , Resultado do Tratamento
20.
Adv Gerontol ; 27(2): 382-8, 2014.
Artigo em Russo | MEDLINE | ID: mdl-25306675

RESUMO

Factors significant for clinical-and-labor prognosis in elderly patients with ischemic heart disease after surgical myocardial revascularization are considered in the article. The authors demonstrate that for each level of the problem there are their own significant factors. Besides, the most essential correlations between investigated factors are marked out. The results obtained will enable to determine more correctly clinical-and-labor prognosis for patients with ischemic heart disease and develop their efficient rehabilitation programs. It is demonstrated that elderly patients have some features of vital activity restriction which are necessary to take into account while medical social expertise and rehabilitation program development.


Assuntos
Adaptação Psicológica/fisiologia , Isquemia Miocárdica , Revascularização Miocárdica , Retorno ao Trabalho , Ajustamento Social , Fatores Etários , Idoso , Avaliação da Deficiência , Feminino , Disparidades nos Níveis de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Isquemia Miocárdica/epidemiologia , Isquemia Miocárdica/psicologia , Isquemia Miocárdica/cirurgia , Revascularização Miocárdica/métodos , Revascularização Miocárdica/psicologia , Revascularização Miocárdica/reabilitação , Período Pós-Operatório , Prognóstico , Retorno ao Trabalho/psicologia , Retorno ao Trabalho/estatística & dados numéricos , Federação Russa/epidemiologia , Apoio Social , Resultado do Tratamento
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