Topic category: Rehabilitation

Abstract

Topic category: Rehabilitation European Journal of Cardiovascular Prevention and Rehabilitation, 2007, 14 (suppl 1):S78–S104 019 RCT of a cognitive-behavioural programme for people awaiting CABGS G. Furze, K. Irvine, J.C. Dumville, J.N.V. Miles, D.R. Thompson, R.J.P. Lewin University of York, York, United Kingdom Cardiothoracic Centre, Hull and East Yorkshire Hospitals NHS Trust, Hull, United Kingdom University of Leicester, Leicester, United Kingdom Objectives The aim of this study was to develop and assess through a randomised controlled trial the ‘‘HeartOp Programme’’, a brief, cognitive-behavioural home-based rehabilitation programme for people waiting for coronary artery bypass graft surgery (CABGS). It was designed to help patients maintain or improve their activity levels and quality of life. Nurse counselling and contact by phone calls during the wait period had already been shown to be effective in improving quality of life so we randomised patients to either the HeartOp Programme or to nurse counselling with written educational materials and regular phone contact. Methods A randomised controlled trial (RCT) of 204 people recruited at entry to the waiting list for first time CABGS. All received a 4560 minute interview with a nurse and phone follow-up at weeks 1, 3 and 6. In addition the 104 control patients received British Heart Foundation booklets about their condition. The 100 intervention patients received the HeartOp Programme. Questionnaire measures (including economic data) were collected prior to randomisation (T1) and after 8 weeks (T2). Primary endpoints were: anxiety (State Trait Anxiety Inventory) and length of hospital stay. Secondary endpoints were: depression (Cardiac Depression Scale), physical functioning (Cardiac Limitations and Symptoms Profile (CLASP) Mobility Scale), misconceptions (Cardiac Beliefs Questionnaire) and cost utility (EQ5D). Data were analysed using intention to treat by analysis of covariance controlling for T1 medical and risk factor variables and the T1 measure of the T2 outcome variable. Results Post-intervention there were no differences between groups in the primary endpoints of anxiety or length of hospital stay. There were significant differences in the secondary endpoints of scores for: depression (difference = 7.79, p = 0.008, 95% CI = 2.04-13.54), physical functioning (difference = 0.82, p = 0.001, 95% CI = 0.34-1.3) and cardiac beliefs (difference = 2.56, p < 0.001, 95% CI = 1.64-3.48) in favour of the HeartOp Programme. The economic analysis suggests that the intervention is likely to be cost effective if implemented. Conclusions The HeartOp home-based cardiac rehabilitation programme appears to add worthwhile and cost effective benefits to a regime of nurse counselling and phone calls. It therefore can be recommended as an additional tool for nurses working with CABG patients in the pre-surgery period. 044 Women participating in phase 3 cardiac cehabilitation: a comparison between mixed and female only exercise groups? Shirley Ingram, Noeleen Fallon, Nora Flynn, Caroline Finn, Joan Love Cardiac Rehabilitation Dept Adelaide & Meath Hospital, Dublin, Ireland shirley.ingram@amnch.ie Introduction The natural course of coronary heart disease (CHD) is different for males’ and females. Women were not included in the early cardiac rehabilitation (CR) trials but respond as favourably as men to CR., however women are less likely to be referred to CR and once referred less likely to attend. The number of female participants in CR programmes ranges between 4.4% and 11%. Aim It has been suggested that tailoring CR programmes to women may increase participation. The aim of this study was to compare variables between women who attended female only phase 3 exercise groups to women who attended phase 3 in groups with males. Methodology Women who had agreed to participate in phase 3 were randomly assigned to mixed v female only phase 3 exercise groups. Outcome measurements included attendance, compliance, Hospital Anxiety and Depression scale (HADS), and Duke Activity Status Index (DASI) upon commencement and post cardiac rehabilitation. Paired t tests were used to compare scores pre and post treatment. Results A total of 78 women were offered Phase 3 CR between March 2005 & March 2006. Thirty five women accepted places in the female only group (FO), and 43 in the mixed group (FM). When compliance was analysed for the 2 groups there was 63% compliance in both groups. There was a decrease in anxiety scores for all after cardiac rehab (p < 0.0001). There was no significant difference in the decrease in anxiety scores between women who attended same sex groups and women who attended mixed groups (p = 0.1798). There was a decrease in depression scores for all at the end of cardiac rehab (p < 0.0001). There was no significant difference in the decrease in depression scores between groups (p = 0.1056). There was an increase in METS scores after rehab sessions (p < 0.0001). There was no significant difference in the increase in METS scores between women who attended same sex groups and women who attended mixed groups (p = 0.2429). Discussion There appears to be a good take up of Phase 3 CR amongst women (62.8%) in this centre compared with other research and being in a female only group does not appear to affect this. There are benefits in reduction in anxiety & depression & increases in MET activity for all women who completed this programme with no significant differences between groups. 051 Favourable effects of exercise-based cardiac rehabilitation on left atrial remodeling in postinfarction patients with moderate systolic dysfunction F. Giallauria, R. Lucci, A. De Lorenzo, M. Psaroudaki, S. Moschella, M. D’Agostino, D. Del Forno, C. Vigorito Department of Clinical Medicine, Cardiovascular and Immunological Sciences. Cardiac Rehabilitation Unit, University of Naples ‘‘Federico II’’, Naples (Italy) Objectives Left atrial (LA) enlargement is an important predictor of cardiovascular outcomes in patients after acute myocardial infarction (AMI). While the favourable effect of exercise based Cardiac Rehabilitation (CR) on postinfarction left ventricular (LV) remodeling have been well documented, those on LA remodeling has yet to be defined. This study investigated the effects of exercise-based CR on LA remodeling in postinfarction patients with moderate left ventricular (LV) dysfunction. Methods Sixty postinfarction patients were randomized into two groups, each composed of 30 patients: group T (LV ejection fraction (EF) 43.7 ± 4.2%, mean ± SD) entered a 6-month CR programme, whereas group C (EF 44.2 ± 3.6%, p = NS) did not. Doppler-echocardiography, 1741-8267 c 2007 The European Society of Cardiology Copyright © European Society of Cardiology. Unauthorized reproduction of this article is prohibited. cardiopulmonary exercise test and NT-proBNP assay were performed upon enrolment and at 6-month. Results At 6-month, trained patients showed an improvement in maximal oxygen consumption ( +32%, p < 0.001) and a reduction in LA ( – 6%, p < 0.001) and LV end-diastolic volumes ( – 9%, p < 0.001) and in NT-proBNP ( – 67%, p < 0.001). In trained patients, LA volume changes correlated with LVEDV (r = 0.479, p < 0.01) and NT-proBNP changes (r = 0.564, p < 0.01). In group T patients, we observed a significant correlation between 6-month NT-proBNP and E/A ratio changes (r = – 0.664, p < 0.0001). Untrained patients showed at 6 months (p < 0.001) and LV dilation ( + 9%, p < 0.001; T vs C group, p < 0.001) and a smaller reduction in NT-proBNP ( – 38%, p < 0.001; T vs C group, p < 0.001). Conclusions Six-month exercise-based CR in postinfarction patients with moderate LV dysfunction induced a favourable LA remodeling. LA volume could emerge as a simple and important tool for risk stratification and as a guide for future evaluation and therapeutic interventions in postinfarction patients. 052 Importance of exercise testing protocol for detecting training effects in cardiac patients D. Hansen, P. Dendale, J. Berger, R. Meeusen Vrije Universiteit Brussel, Dept. Human Physiology and Sportsmedicine, Brussels, Belgium Virga Jesse Hospital, Rehabilitation and Health Centre, Hasselt, Belgium Objectives In cardiac rehabilitation, determining changes of peak oxygen uptake (VO2peak) is important. For this determination, exercise testing protocols with one-minute or three-minute stages can be used. Nonetheless, it is not known which protocol is most sensitive for assessing VO2peak changes as result of exercise training in cardiac patients. Methods 42 cardiac patients (mean age 65.4 ± 8.4 years, 33 males) were included into a cardiac rehabilitation programme and randomised in two subgroups. One group of patients was evaluated by a one-minute stage (n = 21) and another group by a three-minute stage (n = 21) exercise testing protocol. In both groups, maximal cardiopulmonary exercise tests on bike with analysis of oxygen uptake (VO2), expiratory volume (VE), respiratory exchange ratio (RER), heart rate (HR), cycling resistance (W) and test duration were executed at the start and end of the programme. Results Subgroups were closely matched and no changes of betablocker treatment occurred during this study. As result of the rehabilitation programme, total test duration and Wpeak improved significantly in both groups (p < 0.05). Nonetheless, VO2peak and VEpeak increased significantly in the one-minute stage duration group (p < 0.05), but not in the three-minute stage duration group (p > 0.05). In addition, change of VO2peak, VEpeak, and total test duration was significantly greater in the one-minute stage duration group, as compared to the three-minute stage duration group (p < 0.05). Conclusion For detecting changes of VO2peak as result of exercise training in cardiac patients, a one-minute stage exercise testing protocol is more sensitive as compared to a three-minute stage exercise testing protocol. 058 Can we of