RESUMEN
BACKGROUND: Past studies have found that depression is an independent predictor of death in patients after acute myocardial infarction (AMI). Our aim was to investigate whether the adverse effect upon mortality of depression, including mild levels, persisted up to 25 years. METHODS: We used an historical design to study patients who had been consecutively admitted to hospital after transmural AMI during the 1980s and enrolled in an exercise training trial. The Beck Depression Inventory (BDI) was administered to 188 patients in the third week after hospital admission. Scores were trichotomised and classified as low (0-5), mild (6-9) or moderate to severe (≥10) depression. The Australian National Death Index was used to determine mortality status. Cox proportional-hazards modelling was undertaken to determine the relationship between the trichotomised BDI-I scores and all-cause mortality over five time periods up to 25 years. RESULTS: The mean age of patients was 54.15 years. One hundred fourteen (114) (60.4%) had low or no depression, 47 (25.2%) mild depression and 27 (14.3%) moderate to severe depression. The mortality status of 185 (98.4%) patients was established. Depression was a significant predictor of death, independently of age and severity of myocardial infarction, at 5, 10 and 15 years but not at 20 or 25 years. Patients with mild depression had greater mortality than those with low or moderate to severe depression. CONCLUSIONS: Early identification of depression, including milder levels, is important since patients remain at increased risk for many years. They require ongoing monitoring and appropriate treatment.
Asunto(s)
Depresión , Infarto del Miocardio , Adulto , Anciano , Depresión/mortalidad , Depresión/psicología , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Infarto del Miocardio/mortalidad , Infarto del Miocardio/psicología , Estudios Prospectivos , Medición de Riesgo , Factores de RiesgoRESUMEN
OBJECTIVE: Depression is common following an acute cardiac event and can occur at a time when behaviour change is strongly recommended to reduce the risk of further cardiovascular events. The 'Beating Heart Problems' programme was designed to support cardiac patients in behaviour change and mood management. METHODS: The programme was based on cognitive behaviour therapy and motivational interviewing. A randomized controlled trial (RCT) comparing the 8-week group programme with usual care was undertaken between 2007 and 2010. All patients attended a hospital-based clinic for assessment of physiological risk factors at baseline (6 weeks after their acute event), and at 4- and 12-month follow up. Psychological and behavioural indicators were assessed by self-report questionnaires. Of the 275 patients enrolled into the RCT, 42 (15%) had Beck Depression Inventory-II scores >13 at baseline. Treatment and control group comparisons were undertaken for this subgroup, using growth curve modelling and testing for group differences over time in psychological, physiological, health behaviour, and self-efficacy measures. RESULTS: Significantly greater improvements (p < 0.01) in depression symptoms and self-rated health were reported for the intervention group, as well as significantly larger gains in confidence in managing depression (p < 0.05) and anger (p < 0.01). Trends (0.05 < p < 0.10) for larger treatment group improvements were also seen for anxiety symptoms and confidence in managing anxiety. CONCLUSION: A group secondary-prevention programme that integrates behavioural and mood management strategies leads to decreased depression, increased confidence, and improved health perceptions in depressed cardiac patients.
Asunto(s)
Afecto , Terapia Cognitivo-Conductual , Enfermedad Coronaria/terapia , Depresión/prevención & control , Entrevista Motivacional , Prevención Secundaria/métodos , Adaptación Psicológica , Ira , Ansiedad/etiología , Ansiedad/prevención & control , Ansiedad/psicología , Enfermedad Coronaria/complicaciones , Enfermedad Coronaria/diagnóstico , Enfermedad Coronaria/psicología , Depresión/diagnóstico , Depresión/etiología , Depresión/psicología , Femenino , Conductas Relacionadas con la Salud , Conocimientos, Actitudes y Práctica en Salud , Humanos , Masculino , Persona de Mediana Edad , Evaluación de Programas y Proyectos de Salud , Estudios Prospectivos , Escalas de Valoración Psiquiátrica , Autoinforme , Factores de Tiempo , Resultado del Tratamiento , VictoriaRESUMEN
PURPOSE: While behavior change can improve risk factor profiles and prognosis after an acute cardiac event, patients need assistance to achieve sustained lifestyle changes. We developed the "Beating Heart Problems" cognitive-behavioral therapy and motivational interviewing program to support patients to develop behavioral and cognitive self-management skills. We report the results of a randomized controlled trial of the program. METHODS: Patients (n = 275) consecutively admitted to 2 Melbourne hospitals after acute myocardial infarction (32%), coronary artery bypass graft surgery (40%), or percutaneous coronary intervention (28%) were randomized to treatment (T; n = 139) or control (C; n = 136). T group patients were invited to participate in the 8-week group-based program. Patients underwent risk factor screening 6 weeks after hospital discharge (before randomization) and again 4 and 12 months later. At both the followups, T and C groups were compared on 2-year risk of a recurrent cardiac event and key behavioral outcomes, using both intention-to-treat and "completers only" analyses. RESULTS: Patients ranged in age from 32 to 75 years (mean = 59.0 years; SD - 9.1 years). Most patients (86%) were men. Compared with the C group patients, T group patients tended toward greater reduction in 2-year risk, at both the 4- and 12-month followups. Significant benefits in dietary fat intake and functional capacity were also evident. CONCLUSIONS: The "Beating Heart Problems" program showed modest but important benefit over usual care at 4 and, to a lesser extent, 12 months. Modifications to the program such as the inclusion of booster sessions and translation to online delivery are likely to improve outcomes.
Asunto(s)
Terapia Cognitivo-Conductual/métodos , Enfermedad de la Arteria Coronaria/terapia , Estilo de Vida , Calidad de Vida , Autocuidado/métodos , Adulto , Anciano , Puente de Arteria Coronaria , Enfermedad de la Arteria Coronaria/psicología , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Factores de Riesgo , Factores de Tiempo , Resultado del TratamientoRESUMEN
PURPOSE: Research demonstrates that depression at the time of a cardiac event predicts early mortality. However, the best time for depression screening is unknown. We investigated the prognostic importance of inhospital and 2-month depressive symptoms in predicting 12-year mortality in female cardiac patients. METHODS: A consecutive series of 170 women admitted to hospital after acute myocardial infarction or for coronary artery bypass graft surgery completed the Hospital Anxiety and Depression Scale inhospital and 2 months later. Hospital Anxiety and Depression Scale's depression subscale scores of 4 to 7 were classified as "mild" depressive symptoms and 8+ as "moderate/severe" depressive symptoms. Mortality was tracked through the Australian National Death Index and other sources. RESULTS: : One hundred sixty-three (96%) of the 170 women were successfully tracked after 12 years. Of these women, 136 (83%) completed the depression subscale of the Hospital Anxiety and Depression Scale at both assessments and were included in the analyses. Over 12 years, 45 (33%) women died. Using logistic regression and controlling for age, disease severity, and diabetes, mild inhospital depression predicted mortality (P = .02), whereas moderate/severe inhospital depression did not (P = .14). At 2 months, moderate/severe depression predicted mortality (P = .05), whereas mild depression did not (P = .09). Half the patients (49%) changed depression class by the 2-month assessment. The death rate was highest (64%) in those whose mild inhospital depressive symptoms increased to moderate/severe and lowest (14%) in those whose moderate/severe inhospital symptoms remitted. CONCLUSIONS: Mild inhospital depression and moderate/severe 2-month depression were predictive of 12-year deaths. The findings suggest a prognostic benefit in undertaking repeat depression screening 2 months after an acute cardiac event.
Asunto(s)
Puente de Arteria Coronaria/mortalidad , Depresión/diagnóstico , Depresión/epidemiología , Infarto del Miocardio/mortalidad , Enfermedad Aguda , Adulto , Anciano , Anciano de 80 o más Años , Puente de Arteria Coronaria/psicología , Femenino , Hospitalización , Humanos , Modelos Logísticos , Persona de Mediana Edad , Infarto del Miocardio/psicología , Pronóstico , Escalas de Valoración Psiquiátrica , Factores de RiesgoRESUMEN
INTRODUCTION: While there is evidence of poor health behaviours in anxious and depressed cardiac patients, it is possible that sociodemographic factors explain these associations. Few previous studies have adequately controlled for confounders. The present study investigated health behaviours in anxious and depressed cardiac patients, while accounting for sociodemographic confounders. METHOD: A consecutive sample of 275 patients admitted to hospital after acute myocardial infarction (32%) or for coronary bypass surgery (40%) or percutaneous coronary intervention (28%) was interviewed six weeks after hospital discharge. Anxiety and depression were assessed using the Hospital Anxiety and Depression Scale (HADS). Smoking, physical activity, alcohol intake and dietary fat intake were assessed by self-report. Backward stepwise logistic regression was used to identify the factors independently associated with anxiety and depression. RESULTS: In total, 41 patients (15.2%) were 'depressed' (HADS-D ≥8) while 68 (25.2%) were 'anxious' (HADS-A ≥8). Depressed patients reported higher rates of smoking (χ2)= 4.47, p = 0.034), lower physical activity (F = 8.63, p < 0.004) and higher dietary fat intake (F = 7.22, p = 0.008) than non-depressed patients. Anxious patients reported higher smoking rates (χ2)= 5.70, p = 0.024) and dietary fat intake (F = 7.71, p = 0.006) than non-anxious patients. In multivariate analyses, an association with depression was retained for both diet and physical activity, and an association with anxiety was retained for diet. Low social support and younger age were significant confounders with depression and anxiety respectively. CONCLUSIONS: While the high smoking rates evidenced in anxious and depressed patients were explained by sociodemographic factors, their poor diet and low physical activity (depressed patients only) were independent of these factors. Given the impact of lifestyle modification on survival after a cardiac event, anxious and depressed patients should be a priority for cardiac rehabilitation and other secondary prevention programmes.
Asunto(s)
Ansiedad/psicología , Enfermedad de la Arteria Coronaria/psicología , Depresión/psicología , Conductas Relacionadas con la Salud , Conocimientos, Actitudes y Práctica en Salud , Estilo de Vida , Infarto del Miocardio/psicología , Factores Socioeconómicos , Adulto , Afecto , Factores de Edad , Anciano , Consumo de Bebidas Alcohólicas/efectos adversos , Consumo de Bebidas Alcohólicas/epidemiología , Ansiedad/diagnóstico , Ansiedad/epidemiología , Distribución de Chi-Cuadrado , Factores de Confusión Epidemiológicos , Puente de Arteria Coronaria , Enfermedad de la Arteria Coronaria/diagnóstico , Enfermedad de la Arteria Coronaria/epidemiología , Enfermedad de la Arteria Coronaria/terapia , Depresión/diagnóstico , Depresión/epidemiología , Grasas de la Dieta/efectos adversos , Femenino , Humanos , Modelos Logísticos , Masculino , Persona de Mediana Edad , Análisis Multivariante , Infarto del Miocardio/diagnóstico , Infarto del Miocardio/epidemiología , Infarto del Miocardio/terapia , Oportunidad Relativa , Cooperación del Paciente , Intervención Coronaria Percutánea , Factores de Riesgo , Conducta Sedentaria , Fumar/efectos adversos , Fumar/epidemiología , Apoyo Social , Victoria/epidemiologíaRESUMEN
OBJECTIVE: To investigate whether attendance at cardiac rehabilitation (CR) independently predicts all-cause mortality over 14 years and whether there is a dose-response relationship between the proportion of CR sessions attended and long-term mortality. DESIGN: Retrospective cohort study. SETTING: CR programmes in Victoria, Australia PATIENTS: The sample comprised 544 men and women eligible for CR following myocardial infarction, coronary artery bypass surgery or percutaneous interventions. Participants were tracked 4 months after hospital discharge to ascertain CR attendance status. MAIN OUTCOME MEASURES: All-cause mortality at 14 years ascertained through linkage to the Australian National Death Index. RESULTS: In total, 281 (52%) men and women attended at least one CR session. There were few significant differences between non-attenders and attenders. After adjustment for age, sex, diagnosis, employment, diabetes and family history, the mortality risk for non-attenders was 58% greater than for attenders (HR=1.58, 95% CI 1.16 to 2.15). Participants who attended <25% of sessions had a mortality risk more than twice that of participants attending ≥ 75% of sessions (OR=2.57, 95% CI 1.04 to 6.38). This association was attenuated after adjusting for current smoking (OR=2.06, 95% CI 0.80 to 5.29). CONCLUSIONS: This study provides further evidence for the long-term benefits of CR in a contemporary, heterogeneous population. While a dose-response relationship may exist between the number of sessions attended and long-term mortality, this relationship does not occur independently of smoking differences. CR practitioners should encourage smokers to attend CR and provide support for smoking cessation.
Asunto(s)
Causas de Muerte , Infarto del Miocardio/rehabilitación , Anciano , Angioplastia Coronaria con Balón/rehabilitación , Australia , Estudios de Cohortes , Puente de Arteria Coronaria/rehabilitación , Femenino , Humanos , Masculino , Persona de Mediana Edad , Infarto del Miocardio/mortalidad , Evaluación de Resultado en la Atención de Salud , Modelos de Riesgos Proporcionales , Estudios Retrospectivos , Factores de RiesgoRESUMEN
The purpose of this paper is to identify groups of cardiac patients who share similar perceptions about their illness and to examine the relationships between these schemata and psychosocial outcomes such as quality of life and depression. A total of 190 cardiac patients with diagnoses of myocardial infarction, stable angina pectoris or chronic heart failure, completed a battery of psychosocial questionnaires within four weeks of their admission to hospital. These included the Brief Illness Perceptions Questionnaire (BIPQ), Beck Depression Inventory II (BDI II) and The MacNew Health-related Quality of Life instrument (MacNew). BIPQ items were subjected to latent class analysis (LCA) and the resulting groups were compared according to their BDI II and MacNew scores. LCA identified a five-class model of illness perception which comprised the following: (1) Consequence focused and mild emotional impact, n = 55, 29%; (2) Low illness perceptions and low emotional impact, n = 45, 24%; (3) Control focused and mild emotional impact, n = 10, 5%; (4) Consequence focused and high emotional impact, n = 60, 32%; and (5) Consequence focused and severe emotional impact, n = 20, 10%. Gender and diagnosis did not appear to reflect class membership except that class 2 had a significantly higher proportion of AMI patients than did class 5. There were numerous significant differences between classes in regards to depression and health-related quality of life. Notably, classes 4 and 5 are distinguished by relatively high BDI II scores and low MacNew scores. Identifying classes of cardiac patients based on their illness perception schemata, in hospital or shortly afterwards, may identify those at risk of developing depressive symptoms and poor quality of life.
Asunto(s)
Depresión/psicología , Cardiopatías/psicología , Calidad de Vida , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Actitud Frente a la Salud , Comorbilidad , Depresión/epidemiología , Femenino , Cardiopatías/epidemiología , Humanos , Masculino , Persona de Mediana Edad , Adulto JovenRESUMEN
BACKGROUND: People who have had a cardiac event are at increased risk of a subsequent event and death and are, therefore, the priority for preventive cardiology in Australia and elsewhere. Guidelines for physiological and lifestyle risk factors have been developed to encourage risk reduction as a means of secondary prevention. The aim of the present study was to investigate achievement of recommended risk factor targets in a sample of Australian cardiac patients. METHOD: A consecutive sample of 275 patients admitted to one of two Melbourne hospitals after acute myocardial infarction (AMI; 32%) or for coronary artery bypass graft surgery (CABGS; 40%) or percutaneous coronary intervention (PCI; 28%) participated in risk factor screening approximately five weeks after hospital discharge. The 2007 National Heart Foundation (NHF) of Australia 'Guidelines for Reducing Risk in Heart Disease' (1) and the 2001 NHF and Cardiac Society of Australia and New Zealand lipid management guidelines (2) were used to define risk factor targets. Target achievement was compared for AMI, CABGS and PCI patients. RESULTS: Patients ranged in age from 32 to 75 years (mean=59.0; SD=9.1). Most (86%) were male. Almost three quarters of the patients were above recommended targets for waist girth (70%) and almost half were above targets for blood pressure (48%) and below target for high density lipoprotein cholesterol (47%). Around a quarter were over target for total cholesterol (27%) and under target for physical activity (27%). Most patients met the NHF guidelines of non-smoking (95%) and restricted alcohol consumption (88%). For several risk factors, PCI patients were at greater risk of not achieving recommended targets than either CABGS or AMI patients. CONCLUSIONS: Six weeks after an acute cardiac event, substantial proportions of Australian patients do not achieve recommended targets for waist girth, blood pressure, total cholesterol, physical activity, and HDL cholesterol. PCI patients are particularly at risk. Considerable potential remains for improving risk factor management in CHD patients, highlighting the important role of general practitioners, outpatient cardiac rehabilitation and other secondary prevention strategies.
Asunto(s)
Angioplastia , Puente de Arteria Coronaria , Estilo de Vida , Infarto del Miocardio , Cooperación del Paciente/psicología , Adulto , Anciano , Australia , Presión Sanguínea , HDL-Colesterol/sangre , Femenino , Humanos , Masculino , Persona de Mediana Edad , Infarto del Miocardio/sangre , Infarto del Miocardio/fisiopatología , Infarto del Miocardio/prevención & control , Infarto del Miocardio/psicología , Infarto del Miocardio/cirugía , Guías de Práctica Clínica como Asunto , Factores de Riesgo , Factores de TiempoRESUMEN
Candidates for cardiac bypass surgery often experience cognitive decline. Such decline is likely to affect their everyday cognitive functioning. The aim of the present study was to compare cardiac patients' ratings of their everyday cognitive functioning against significant others' ratings and selected neuropsychological tests. Sixty-nine patients completed a battery of standardised cognitive tests. Patients and significant others also completed the Everyday Function Questionnaire independently of each other. Patient and significant other ratings of patients' everyday cognitive difficulties were found to be similar. Despite the similarities in ratings of difficulties, some everyday cognitive tasks were attributed to different processes. Patients' and significant others' ratings were most closely associated with the neuropsychological test of visual memory. Tests of the patients' verbal memory and fluency were only related to significant others' ratings. Test scores of attention and planning were largely unrelated to ratings by either patients or their significant others.
Asunto(s)
Trastornos del Conocimiento/etiología , Trastornos del Conocimiento/psicología , Cardiopatías/complicaciones , Cardiopatías/psicología , Autoevaluación (Psicología) , Esposos/psicología , Atención , Cognición , Función Ejecutiva , Femenino , Humanos , Masculino , Memoria , Persona de Mediana Edad , Pruebas Neuropsicológicas , Habla , Percepción del Habla , Encuestas y Cuestionarios , Percepción VisualRESUMEN
PURPOSE: Given the importance of physical activity (PA) in cardiac rehabilitation and prevention, measuring it in a valid and reliable manner is a practical challenge. Measuring self-reported PA in elderly cardiac patients can be problematic because of the need to assess many activities of short duration that may occur as part of routine daily functions. The primary purpose of this article was to identify and evaluate instruments that have been used over the last 15 years in studies of cardiac patients. METHODS: A comprehensive MEDLINE search was carried out to identify articles from studies undertaken to assess PA in cardiac patients. The self-report PA instruments were subjected to evaluation concerning suitability for use with cardiac patients. RESULTS: The initial electronic and hand searches yielded 203 articles. After removing articles that did not meet the inclusion criteria, a total of 86 articles were selected. Twenty-three self-report instruments were identified for evaluation. Most of the instruments had problems associated with inadequate validation methods or suitability for cardiac patients. Many of the instruments failed to demonstrate adequate validity or reliability, particularly when measuring low-intensity PA. CONCLUSIONS: Some instruments are more suited to epidemiologic research than to clinical interventions where responsiveness to interventions is crucial. Recommendations for the constituents of an acceptable self-report PA instrument for cardiac patients are presented and the most suitable existing instruments are identified.
Asunto(s)
Cardiopatías/rehabilitación , Actividad Motora , Metabolismo Energético , Ejercicio Físico , Humanos , Reproducibilidad de los Resultados , Deseabilidad Social , Encuestas y CuestionariosRESUMEN
BACKGROUND: To target interventions, patients at risk for poor outcomes after a cardiac event need to be identified. We investigated trajectories of anxiety and depression after coronary artery bypass graft surgery (CABGS) and identified patients at risk of persistent or worsening anxiety and depression. METHODS: A consecutive sample of 184 patients on the waiting list for CABGS at The Royal Melbourne Hospital completed self-report questionnaires before surgery, and at 2 and 6 months postsurgery. Anxiety and depression were measured using the Hospital Anxiety and Depression Scale. Growth mixture modelling identified trajectories of anxiety and depression. RESULTS: Two possible trajectories emerged for anxiety, whereas three trajectories emerged for depression. Most patients (92%) followed a trajectory of minor presurgical anxiety that remitted in 6 months after CABGS, with the remainder (8%) following a trajectory of major anxiety that remitted in the same period. Minor remitted depression was also common (72% patients). Two less common depression trajectories indicated worsening or unresolved depression. One trajectory began with major presurgical depression that partially remitted by 6 months (14% patients) and the other began with minor presurgical depression that worsened by 6 months (14% patients). Unpartnered patients, smokers, those with presurgical anxiety, high cholesterol, angina, more severe disease or having repeat CABGS were at increased risk for a poor depression trajectory. CONCLUSION: Although initial anxiety and depression resolved or lessened for most patients, some patients experienced persistent or worsening depression after CABGS. Interventions can be targeted toward 'at risk' patients.
Asunto(s)
Ansiedad/etiología , Puente de Arteria Coronaria/psicología , Depresión/etiología , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Modelos Psicológicos , Pronóstico , Factores SocioeconómicosRESUMEN
OBJECTIVE: To investigate rates and predictors of cardiac rehabilitation (CR) attendance after coronary artery bypass graft surgery (CABGS) at Royal Melbourne Hospital (RMH), Victoria, where current best practice referral and recruitment strategies have been adopted. DESIGN, SETTING AND PARTICIPANTS: Prospective cohort study of 184 patients who underwent CABGS at RMH between July 2001 and April 2004. Patients completed questionnaires pre-operatively, and 170 patients (92%) had their CR attendance tracked after referral to CR either at RMH or elsewhere. MAIN OUTCOME MEASURES: Rates of CR attendance among RMH patients referred to CR either at RMH or elsewhere; sociodemographic, medical, cognitive, psychosocial and geographical predictors of CR non-attendance. RESULTS: The CR attendance rate was 72%. Patients referred to CR at RMH were more than four times more likely to attend than patients referred elsewhere (odds ratio [OR], 4.36; P=0.024). Travel time significantly predicted CR attendance (OR, 0.86; P=0.039). CONCLUSIONS: CR attendance rates were found to be higher than previously reported for CABGS patients, suggesting that best practice referral and recruitment procedures minimise common barriers to CR attendance.
Asunto(s)
Atención Ambulatoria , Puente de Arteria Coronaria/rehabilitación , Cooperación del Paciente , Derivación y Consulta , Anciano , Femenino , Accesibilidad a los Servicios de Salud , Humanos , Masculino , Persona de Mediana Edad , Oportunidad Relativa , Estudios ProspectivosRESUMEN
BACKGROUND: Earlier studies show that medical factors and disease severity predict early readmission to hospital after coronary artery bypass graft surgery (CABGS). Few studies have investigated psychosocial predictors. This study investigated medical, sociodemographic and psychosocial predictors of 30-day hospital readmission. METHODS: A consecutive sample of 181 patients wait-listed for CABGS completed self-report questionnaires before surgery, and at 2 and 6 months after surgery. RESULTS: Twenty-six (14.4%) patients were readmitted within 30 days of hospital discharge. Readmitted patients were older (t=2.12, df=179, P=0.035), and more likely to be unmarried (chi=5.80, df=1, P=0.016), live alone (chi=8.33, df=1, P=0.004), have a history of hypertension (chi=2.731, df=1, P=0.098) and have higher anxiety before surgery (t=1.67, df=175, P=0.097). When these variables were entered into a backward stepwise logistic regression, the only significant unique predictor of 30-day readmission was living alone (Wald=7.08, odds ratio=3.42, P=0.008). Patients living alone were over three times more likely than those living with others to be readmitted to hospital. Disease severity and other medical factors were not associated with readmission. CONCLUSION: Living alone was identified as the single most important risk factor for early readmission after CABGS. Patients who live alone may benefit from additional support during early convalescence. Intervention studies could explore support options for these patients.
Asunto(s)
Puente de Arteria Coronaria , Enfermedad de la Arteria Coronaria/cirugía , Readmisión del Paciente , Persona Soltera , Adaptación Psicológica , Adulto , Anciano , Anciano de 80 o más Años , Puente de Arteria Coronaria/psicología , Enfermedad de la Arteria Coronaria/psicología , Femenino , Humanos , Modelos Logísticos , Masculino , Persona de Mediana Edad , Oportunidad Relativa , Medición de Riesgo , Factores de Riesgo , Persona Soltera/psicología , Apoyo Social , Encuestas y Cuestionarios , Factores de Tiempo , Resultado del TratamientoRESUMEN
OBJECTIVES: Many previous investigations of the recovery of emotional well-being, particularly the resolution of depression, following an acute cardiac event assume that all patients follow a similar, linear trajectory. However, it is possible that there are different groups of patients who follow different trajectories. This study tested for multiple trajectories of anxiety and depression and identified the characteristics of patients most at risk for persistent or worsening anxiety and depression in the 12 months following their cardiac event. METHOD: A consecutive sample of 226 women was interviewed following either acute myocardial infarction (AMI) or coronary artery bypass graft surgery (CABGS). The Hospital Anxiety and Depression Scale were administered on four occasions over 12 months. Growth curve and growth mixture modelling were used to identify trajectories of change and univariate tests were employed to establish predictors of each trajectory. RESULTS: Most women began with relatively low levels of anxiety and/or depression that improved over the 12 month period (84% women showed this trajectory for anxiety, 89% for depression). A smaller group began with relatively high levels of anxiety and/or depression that worsened over time (16% for anxiety, 11% for depression). Patients in the latter group were more likely to report high levels of loneliness, have a first language other than English, perceive their cardiac disease as more severe (anxiety group only) and have diabetes (depression group only). Trajectories were non-linear, with most change occurring in the initial 2-month period. CONCLUSION: Growth modelling techniques highlight that change in anxiety and depression following an acute event follows neither a single nor linear trajectory. Most women showed early resolution of anxiety and depression following their event, indicative of a normal bereavement or adjustment response. A minority of women reported worsening anxiety and/or depression in the year following their cardiac event, particularly those who lacked social support or were from non-English speaking backgrounds. Intervention studies to explore support options for these women are warranted, both prior to and following their event.
Asunto(s)
Trastornos de Ansiedad , Puente de Arteria Coronaria/psicología , Trastorno Depresivo , Infarto del Miocardio , Adulto , Anciano , Anciano de 80 o más Años , Trastornos de Ansiedad/diagnóstico , Trastornos de Ansiedad/epidemiología , Trastornos de Ansiedad/etiología , Trastorno Depresivo/diagnóstico , Trastorno Depresivo/epidemiología , Trastorno Depresivo/etiología , Femenino , Humanos , Persona de Mediana Edad , Infarto del Miocardio/epidemiología , Infarto del Miocardio/psicología , Infarto del Miocardio/cirugía , Valor Predictivo de las Pruebas , Prevalencia , Encuestas y CuestionariosRESUMEN
BACKGROUND: The type and source of health information supplied to patients following cardiac events significantly improve adherence and health behaviours. The impact of health information upon female patients, however, is not well documented. This study investigates women's recall of the type and source of information provided to them in hospital about resuming daily activities after a cardiac event. It also identified women least likely to recall receiving information. METHODS: Interviews were conducted with female cardiac patients consecutively admitted to four metropolitan hospitals after acute myocardial infarction or for coronary artery bypass graft surgery. The women were interviewed on admission and at 2, 4 and 12 months after discharge. Participants were asked about in-hospital information provision at the 2-month interview (n=224). RESULTS: Most women recalled receiving verbal information about medication, exercise and smoking cessation, but few recalled receiving verbal information about gardening, sexual activity, driving or sport. Women who were obese or physically inactive recalled limited advice about diet and physical activity, whereas women with diabetes or hypertension were no more likely than others to recall receiving information about medication, despite the personal relevance of this information. Older women were most at risk of recalling limited advice, including information about cardiac rehabilitation. Over half of the women attended a cardiac rehabilitation programme, with uptake being related to information provision. CONCLUSIONS: The findings support other research suggesting that advice about activities after a cardiac event is inadequate for some women and confirms the influence of information provision on participation in cardiac rehabilitation.
Asunto(s)
Enfermedad de la Arteria Coronaria/rehabilitación , Conocimientos, Actitudes y Práctica en Salud , Hospitales Urbanos , Difusión de la Información , Recuerdo Mental , Infarto del Miocardio/rehabilitación , Educación del Paciente como Asunto , Actividades Cotidianas , Adulto , Anciano , Anciano de 80 o más Años , Puente de Arteria Coronaria , Enfermedad de la Arteria Coronaria/psicología , Enfermedad de la Arteria Coronaria/cirugía , Femenino , Estudios de Seguimiento , Conductas Relacionadas con la Salud , Humanos , Entrevistas como Asunto , Estudios Longitudinales , Persona de Mediana Edad , Infarto del Miocardio/psicología , Satisfacción del Paciente , Factores de Tiempo , VictoriaRESUMEN
OBJECTIVES: Female cardiac patients' health-related quality of life (HRQoL) during the first year after an acute cardiac event was compared with age-weighted Australian population norms. The impact of age, event type and cardiac rehabilitation (CR) programme attendance on recovery was assessed. METHODS: The short form 36-item health survey (SF-36) was administered to 229 women aged from 36 to 84 years consecutively admitted to 4 hospitals after acute myocardial infarction (AMI) or to undergo coronary artery bypass graft surgery (CABGS). Data were collected at 4 time points over 12 months. SF-36 subscale scores were compared with age-weighted norms for Australian women. Mplus was used to analyse growth trajectories for SF-36 subscales. RESULTS: Patients had impaired HRQoL at baseline (except in general health), with progressive improvement over time. Recovery to normative levels was fastest in the areas of bodily pain and mental health (by 2 months) and slowest in the area of physical functioning, and physical and emotional role limitations (by 12 months). By 4 months, general health scores had surpassed population norms. For all scales, most improvement occurred in the first 2 months, with little subsequent improvement. CABGS patients showed significantly more improvement than AMI patients in several areas, partly due to the poorer functioning of CABGS patients at baseline. Rate of improvement was not influenced by patients' age or frequency of CR attendance. CONCLUSIONS: Impairment of HRQoL in female cardiac patients is most pronounced at the time of the event, with most recovery occurring during early convalescence and full recovery in all domains by 12 months post-event.
Asunto(s)
Enfermedades Cardiovasculares/psicología , Dolor Postoperatorio/psicología , Calidad de Vida/psicología , Encuestas y Cuestionarios , Enfermedad Aguda , Adulto , Anciano , Anciano de 80 o más Años , Índice de Masa Corporal , Enfermedades Cardiovasculares/epidemiología , Enfermedades Cardiovasculares/cirugía , Puente de Arteria Coronaria , Demografía , Femenino , Humanos , Persona de Mediana Edad , Dimensión del Dolor , Dolor Postoperatorio/diagnóstico , Dolor Postoperatorio/epidemiologíaRESUMEN
Candidates for coronary artery bypass graft surgery have been found to exhibit reduced cognitive function prior to surgery. However, little is known regarding the factors that are associated with pre-bypass cognitive function. A battery of neuropsychological tests was administered to a group of patients listed for bypass surgery (n = 109). Medical, sociodemographic and emotional predictors of cognitive function were investigated using structural equation modeling. Medical factors, namely history of hypertension and low ejection fraction, significantly predicted reduced cognitive function, as did several sociodemographic characteristics, namely older age, less education, non-English speaking background, manual occupation, and male gender. One emotional variable, confusion and bewilderment, was also a significant predictor whereas anxiety and depression were not. When significant predictors from the three sets of variables were included in a combined model, three of the five sociodemographic characteristics, namely age, non-English speaking background and occupation, and the two medical factors remained significant. Apart from sociodemographic characteristics, medical factors such as a history of hypertension and low ejection fraction significantly predicted reduced cognitive function in bypass candidates prior to surgery.
Asunto(s)
Trastornos del Conocimiento/etiología , Cognición , Puente de Arteria Coronaria/efectos adversos , Anciano , Enfermedad de la Arteria Coronaria , Demografía , Emociones , Femenino , Estado de Salud , Humanos , Masculino , Persona de Mediana Edad , Pruebas Neuropsicológicas , Complicaciones Posoperatorias , Valor Predictivo de las Pruebas , Estudios Retrospectivos , Factores de Riesgo , Aprendizaje VerbalRESUMEN
BACKGROUND: Many studies have demonstrated that health related quality of life (HRQoL) improves, on average, after coronary artery bypass graft surgery (CABGS). However, this average improvement may not be realized for all patients, and it is possible that there are two or more distinctive groups with different, possibly non-linear, trajectories of change over time. Furthermore, little is known about the predictors that are associated with these possible HRQoL trajectories after CABGS. METHODS: 182 patients listed for elective CABGS at The Royal Melbourne Hospital completed a postal battery of questionnaires which included the Short-Form-36 (SF-36), Profile of Mood States (POMS) and the Everyday Functioning Questionnaire (EFQ). These data were collected on average a month before surgery, and at two months and six months after surgery. Socio-demographic and medical characteristics prior to surgery, as well as surgical and post-surgical complications and symptoms were also assessed. Growth curve and growth mixture modelling were used to identify trajectories of HRQoL. RESULTS: For both the physical component summary scale (PCS) and the mental component summary scale (MCS) of the SF-36, two groups of patients with distinct trajectories of HRQoL following surgery could be identified (improvers and non-improvers). A series of logistic regression analyses identified different predictors of group membership for PCS and MCS trajectories. For the PCS the most significant predictors of non-improver membership were lower scores on POMS vigor-activity and higher New York Heart Association dyspnoea class; for the MCS the most significant predictors of non-improver membership were higher scores on POMS depression-dejection and manual occupation. CONCLUSION: It is incorrect to assume that HRQoL will improve in a linear fashion for all patients following CABGS. Nor was there support for a single response trajectory. It is important to identify characteristics of each patient, and those post-operative symptoms that could be possible targets for intervention to improve HRQoL outcomes.
Asunto(s)
Puente de Arteria Coronaria , Enfermedad Coronaria/cirugía , Evaluación de Resultado en la Atención de Salud/estadística & datos numéricos , Calidad de Vida , Medición de Riesgo/estadística & datos numéricos , Actividades Cotidianas , Anciano , Puente de Arteria Coronaria/efectos adversos , Puente de Arteria Coronaria/psicología , Femenino , Hospitales Urbanos , Humanos , Modelos Logísticos , Masculino , Persona de Mediana Edad , Evaluación de Resultado en la Atención de Salud/métodos , Pronóstico , Psicometría/instrumentación , Medición de Riesgo/métodos , Factores de Riesgo , Encuestas y Cuestionarios , VictoriaRESUMEN
BACKGROUND: While many studies have investigated cognitive impairments in patients after coronary artery bypass graft surgery, very few have closely evaluated presurgical cognitive functioning of bypass candidates. METHODS: A battery of neuropsychologic tests was administered to a consecutive series of patients listed for bypass surgery (n = 109). Cognitive function of bypass candidates was compared with that of a healthy control group (n = 25) and published test norms. RESULTS: Cognitive test scores in candidates for bypass were significantly lower than those of the control group on tests of attention, information processing speed, and verbal memory. Additionally, bypass candidates' cognitive test scores were significantly reduced compared with expected values derived from validated test norms, on all but one cognitive test. CONCLUSIONS: Cognitive performances of candidates for bypass were significantly lower than those of a healthy control group and published cognitive test norms.
Asunto(s)
Trastornos del Conocimiento/epidemiología , Cognición , Puente de Arteria Coronaria , Enfermedad Coronaria/psicología , Cuidados Preoperatorios , Anciano , Atención , Trastornos del Conocimiento/diagnóstico , Trastornos del Conocimiento/etiología , Comorbilidad , Puente de Arteria Coronaria/efectos adversos , Puente de Arteria Coronaria/psicología , Puente de Arteria Coronaria Off-Pump , Enfermedad Coronaria/cirugía , Procedimientos Quirúrgicos Electivos , Emociones , Femenino , Humanos , Masculino , Procesos Mentales , Persona de Mediana Edad , Pruebas Neuropsicológicas , Ensayos Clínicos Controlados Aleatorios como Asunto , Valores de Referencia , Estrés Psicológico/psicología , Aprendizaje VerbalRESUMEN
BACKGROUND: Cognitive difficulties have been reported after coronary artery bypass graft surgery using cardiopulmonary bypass. However, the cognitive benefit of off-pump surgery remains unclear. METHODS: Consecutively listed candidates for elective bypass were randomly assigned to either off-pump or on-pump techniques (n = 107). A battery of 11 standardized neuropsychological tests was administered before surgery, and again at 2 and 6 months after surgery. The two groups were compared using a range of statistical procedures, including growth modeling. RESULTS: There were no significant differences in cognitive test scores between the off-pump and on-pump groups using t tests at any of the time points. There were no differences between off-pump and on-pump groups in the incidence of cognitive deficits at 2 months or 6 months, with the exception that fewer off-pump patients showed impairment on one test of verbal fluency at 6 months. When the pattern of cognitive change over time between the two groups was compared using sophisticated modeling techniques, the two groups were again comparable, except for results on the test of verbal fluency, in which the off-pump group showed more rapid postsurgical cognitive gains than the on-pump group. CONCLUSIONS: The off-pump group appears to be generally comparable to the on-pump group in terms of short-term and long-term postsurgical neurocognitive outcomes.