Effectiveness of e-Health cardiac rehabilitation program on quality of life associated with symptoms of anxiety and depression in moderate-risk patients

Raquel Bravo-Escobar, Alicia González-Represas, Adela María Gómez-González, Ángela Heredia-Torres, Raquel Bravo-Escobar, Alicia González-Represas, Adela María Gómez-González, Ángela Heredia-Torres

Abstract

Exploring new models of medical care requires evaluating the impact of new care strategies not only on physiological parameters but also on the quality of life of the patient. On the other hand the presence of anxiety together with depression requires further consideration when planning appropriate management strategies. The aim of this study was to examine the effectiveness of a home-based cardiac rehabilitation program incorporating an e-Health technology on health-related quality of life associated with symptoms of anxiety and depression in moderate-risk patients. A multicenter, randomized controlled clinical trial was designed to compare a traditional hospital based cardiac rehabilitation program (n = 38, 35 male) with a mixed home surveillance program where patients exercised at home with a remote electrocardiographic monitoring device (n = 33, 31 male). The Short Form-36 (SF-36) Health Survey and the Goldberg questionnaire were used to evaluate quality of life and the presence of symptoms of anxiety and depression respectively. The results of this study show that the type of cardiac rehabilitation program did not influence the improvement in quality of life (p = 0.854), but the presence of symptoms of anxiety and depression did (p = 0.001). Although both programs achieved a decrease in anxiety and depression symptoms and improved functional capacity (p ≤ 0.001), a significant interaction effect was found between the group with or without anxiety and depression symptoms and the type of program in the bodily pain dimension (p = 0.021). Trial registration: Retrospectively registered NCT02796404 (10/06/2016) in clinialtrials.gov.

Conflict of interest statement

The authors declare no competing interests.

References

    1. Frasure-Smith N, Lesperance F, Talajic M. Depression and 18-month prognosis after myocardial infarction. Circulation. 1996;91:999–1005. doi: 10.1161/01.CIR.91.4.999.
    1. Barefoot J, et al. Depression and long-term mortality risk in patients with coronary artery disease. Am. J. Cardiol. 1996;78(6):613–617. doi: 10.1016/S0002-9149(96)00380-3.
    1. Annelieke M, Roest A, Martens E, De Jonge P, Denollet J. Anxiety and risk of incident coronary heart disease. A meta-analysis. Am. J. Cardiol. 2010;56(1):38–46. doi: 10.1016/j.jacc.2010.03.034.
    1. Szpakowski N, Qiu F, Masih S, Kurdyak P, Wijeysundera HC. Economic impact of subsequent depression in patients with a new diagnosis of stable angina: A population-based study. J. Am. Heart Assoc. 2017;6(10):e006911. doi: 10.1161/JAHA.117.006911.
    1. Chisholm D, Sweeny K, Sheehan P, Rasmussen B, Smit F, Cuijpers P, Saxena S. Scaling-up treatment of depression and anxiety: A global return on investment analysis. Lancet Psychiatry. 2016;3(5):415–424. doi: 10.1016/S2215-0366(16)30024-4.
    1. Palacios J, Khondoker M, Mann A, Tylee A, Hotopf M. Depression and anxiety symptom trajectories in coronary heart disease: Associations with measures of disability and impact on 3-year health care costs. J. Psychosom. Res. 2018;104:1–8. doi: 10.1016/j.jpsychores.2017.10.015.
    1. Serber E, Todaro J, Tilkemeier P, Niaura P. Prevalence and characteristics of multiple psychiatric disorders in cardiac rehabilitation patients. J. Cardiopulm. Rehabil. Prev. 2009;29(3):161–168. doi: 10.1097/HCR.0b013e3181a33365.
    1. Huffman J, Celano C, Januzzi J. The relationship between depression, anxiety and cardiovascular outcomes in patients with acute coronary syndromes. Neuropsychiatr Dis. Treat. 2010;6:123–136. doi: 10.2147/NDT.S6880.
    1. Hare D, Toukhsati S, Johansson P, Jaarsma T. Depression and cardiovascular disease: A clinical review. Eur. Heart J. 2014;35(21):1365–1372. doi: 10.1093/eurheartj/eht462.
    1. Pogosova N, et al. Psychosocial aspects in cardiac rehabilitation: From theory to practice. A position paper from the cardiac rehabilitation section of the European association of cardiovascular prevention and rehabilitation of the European Society of cardiology. Eur. J. Prev. Cardiol. 2015;22(10):1290–1306. doi: 10.1177/2047487314543075.
    1. Norris C, et al. Referral rate and outcomes of cardiac rehabilitation after cardiac catheterization in a large Canadian city. J. Cardiopulm. Rehabil. 2004;24(6):392–400. doi: 10.1097/00008483-200411000-00006.
    1. Bjarnason-Wehrens B, et al. Cardiac rehabilitation in Europe: Results from the European cardiac rehabilitation inventory survey. Eur. J. Cardiovasc. Prev. Rehabil. 2010;17(4):410–418. doi: 10.1097/HJR.0b013e328334f42d.
    1. Suaya J, et al. Use of cardiac rehabilitation by Medicare beneficiaries after myocardial infarction or coronary bypass surgery. Circulation. 2007;116(15):1653–1662. doi: 10.1161/CIRCULATIONAHA.107.701466.
    1. Kotseva K, Wood D, De Backer G, De Bacquer D. Use and effects of cardiac rehabilitation in patients with coronary heart disease: Results from the EUROASPIRE III survey. Eur. J. Prev. Cardiol. 2013;20(5):817–826. doi: 10.1177/2047487312449591.
    1. Kraal J, Peek N, Van den Akker-Marle M, Kemps H. Effects and costs of home-based training with telemonitoring guidance in low to moderate risk patients entering cardiac rehabilitation: The FIT@Home study. BMC Cardiovasc. Disord. 2013;13:82. doi: 10.1186/1471-2261-13-82.
    1. Clark R, et al. Alternative models of cardiac rehabilitation: A systematic review. Eur. J. Prev. Cardiol. 2015;22(1):35–74. doi: 10.1177/2047487313501093.
    1. Bravo-Escobar R, et al. Effectiveness and safety of a home-based cardiac rehabilitation programme of mixed surveillance in patients with coronary heart disease at moderate cardiovascular risk: A randomised, controlled clinical trial. BMC Cardiovasc. Disord. 2017;17:66. doi: 10.1186/s12872-017-0499-0.
    1. Yohannes A, Doherty P, Bundy C, Yalfani A. The long-term benefits of cardiac rehabilitation on depression, anxiety, physical activity and quality of life. J. Clin. Nurs. 2010;19(19–20):2806–2813. doi: 10.1111/j.1365-2702.2010.03313.x.
    1. Anderson L, Oldridge N, Thompson D, Zwisler A, Rees K, Martin N, Taylor R. Exercise-based cardiac rehabilitation for coronary heart disease: Cochrane systematic review and meta-analysis. J. Am. Coll. Cardiol. 2016;67(1):1–12. doi: 10.1016/j.jacc.2015.10.044.
    1. Velasco J, et al. Guidelines of the Spanish society of cardiology for cardiovascular disease prevention and cardiac rehabilitation. Rev. Esp. Cardiol. 2000;53(8):1095–1120. doi: 10.1016/S0300-8932(00)75211-0.
    1. Gómez-González A, et al. Recomendaciones sobre rehabilitación cardiaca en la cardiopatía isquémica de la Sociedad de rehabilitación Cardio-respiratoria (SORECAR) Rehabilitación. 2015;49(2):102–124. doi: 10.1016/j.rh.2014.12.002.
    1. Castillo J, Moreno-Atanasio E, Tinoco-González J, Pleguezuelos-Cobo E. In: Rehabilitación Cardiaca en el Síndrome Coronario Agudo. Pleguezuelos E, Miranda G, Gómez A, Capellas L, editors. Madrid: Editorial Médica Panamericana; 2011. pp. 170–181.
    1. Castillo Marín J, Miranda Vivas T, Rozalén Pinedo M, Jiménez Esteso J. Rehabilitación cardiaca en el síndrome coronario agudo. Rehabilitación. 2006;40(6):318–332. doi: 10.1016/S0048-7120(06)74917-9.
    1. Failde I, Ramos I. Validity and reliability of the SF-36 Health survey questionnaire in patients with coronary artery disease. J. Clin. Epidemiol. 2000;53(4):359–365. doi: 10.1016/S0895-4356(99)00175-4.
    1. Dempster M, Donnelly M. Measuring the health-related quality of life of people with ischaemic heart disease. Heart. 2000;83(6):641–644. doi: 10.1136/heart.83.6.641.
    1. Thompson D, Yu C. Quality of life in patients with coronary heart disease-I: Assessment tools. Health Qual. Life Outcomes. 2003;1:42. doi: 10.1186/1477-7525-1-42.
    1. Vilagut G, et al. El Cuestionario de Salud SF-36 español: una década de experiencia y nuevos desarrollos. Gac Sanit. 2005;19(2):135–150. doi: 10.1157/13074369.
    1. Goldberg D, Bridges K, Duncan-Jones P, Grayson D. Detecting anxiety and depression in general medical settings. Br. Med. J. 1988;297(6653):897–899. doi: 10.1136/bmj.297.6653.897.
    1. Montón C, Pérez-Echevarría M, Campos R, García Campayo J, Lobo A. Escalas de ansiedad y depresión de Goldberg: una guía de entrevista eficaz para la detección del malestar psíquico. Aten Primaria. 1993;12(6):345–349.
    1. Martínez-Bernardos R, Baylín-Larios A, Ortiz-Jiménez M. Podemos detectar trastornos mentales en atención primaria? Utilidad y concordancia de dos instrumentos diagnósticos. Aten Primaria. 1999;23:285–288.
    1. Holm J, Holm L, Bech P. Monitoring improvement using a patient-rated depression scale during treatment with anti-depressants in general practice. A validation study on the Goldberg Depression Scale. Scand. J. Prim. Health Care. 2001;19(4):263–266. doi: 10.1080/02813430152706819.
    1. Unsar S, Sut N, Durna Z. Health-related quality of life in patients with coronary artery disease. J. Cardiovasc. Nurs. 2007;22(6):501–507. doi: 10.1097/01.JCN.0000297382.91131.8d.
    1. Lalonde L, Clarke A, Joseph L, Mackenzie T, Grover S. Health-related quality of life with coronary heart disease prevention and treatment. J. Clin. Epidemiol. 2001;54(10):1011–1018. doi: 10.1016/S0895-4356(01)00361-4.
    1. Anderson L, et al. Patient education in the management of coronary heart disease. Cochrane Database Syst. Rev. 2011;6(6):8895. doi: 10.1002/14651858.CD008895.pub3.
    1. Zhang L, Zhang L, Wang J, Ding F, Zhang S. Community health service center-based cardiac rehabilitation in patients with coronary heart disease: A prospective study. BMC Health Serv. Res. 2017;17(1):128. doi: 10.1186/s12913-017-2036-3.
    1. Giallauria F, et al. Efficacy of telecardiology in improving the results of cardiac rehabilitation after acute myocardial infarction. Monaldi Arch. Chest Dis. 2006;66(1):8–12.
    1. Jolly K, Taylor R, Lip G, Stevens A. Home-based cardiac rehabilitation compared with centre-based rehabilitation and usual care: A systematic review and meta-analysis. Int. J. Cardiol. 2006;111(3):343–351. doi: 10.1016/j.ijcard.2005.11.002.
    1. Dalal H, et al. Home-based versus hospital-based rehabilitation after myocardial infarction: A randomized trial with preference arms–Cornwall Heart attack rehabilitation management Study (CHARMS) Int. J. Cardiol. 2007;119(2):202–211. doi: 10.1016/j.ijcard.2006.11.018.
    1. Jolly K, Lip G, Taylor R, Raftery J, Mant J, Lane D, Greenfield S, Stevens A. The Birmingham Rehabilitation Uptake Maximisation study (BRUM): A randomised controlled trial comparing home-based with centre-based cardiac rehabilitation. Heart. 2009;95(1):36–42. doi: 10.1136/hrt.2007.127209.
    1. Kraal J, Niels P, Van den Akker-Van Marle M, Kemps H. Effects of home-based training with telemonitoring guidance in low to moderate risk patients entering cardiac rehabilitation: Short-term results of FIT@home study. Eur. J. Prev. Cardiol. 2014;21(2S):26–31. doi: 10.1177/2047487314552606.
    1. Ades P, Pashkow F, Fletcher G, Pina I, Zohman L, Nestor J. A controlled trial of cardiac rehabilitation in the home setting using electrocardiographic and voice transtelephonic monitoring. Am. Heart J. 2000;139(3):543–548. doi: 10.1016/S0002-8703(00)90100-5.
    1. Smith K, Arthur H, McKelvie R, Kodis J. Differences in sustainability of exercise and health-related quality of life outcomes following home or hospital-based cardiac rehabilitation. Eur. J. Cardiovasc. Prev. Rehabil. 2004;11(4):313–319. doi: 10.1097/01.hjr.0000136414.40017.10.
    1. Arthur HM, Smith KM, Kodis J, McKelvie R. A controlled trial of hospital versus home-based exercise in cardiac patients. Med. Sci. Sports Exerc. 2002;34(10):1544–1550. doi: 10.1097/00005768-200210000-00003.
    1. Knox S, King M. Validation and calibration of the SF-36 health transition question against an external criterion of clinical change in health status. Qual. Life Res. 2009;18(5):637–645. doi: 10.1007/s11136-009-9467-1.
    1. Connerney I, Shapiro P, McLaughlin J, Bagiella E, Sloan R. Relation between depression after coronary artery bypass surgery and 12-month outcome: A prospective study. Lancet. 2001;358(9295):1766–1771. doi: 10.1016/S0140-6736(01)06803-9.
    1. Meneghetti C, Guidolin B, Zimmer-man P, Sfoggia A. Screening for symptoms of anxiety and depression in patients admitted to a University hospital with acute coronary syndrome. Trends Psychiatry Psychother. 2017;39(1):12–18. doi: 10.1590/2237-6089-2016-0004.
    1. Mateu-Molláa J, Valero-Morenoa S, Lacomba-Trejoa L, Català-Cortés L. Ansiedad y depresión: Impacto en la calidad de vida de pacientes tras Infarto Agudo de Miocardio. Revista de Investigación en Psicología Social. 2018;6(1):5–13.
    1. Larsen K, Vestergaard M, Søndergaard J, Christensen B. Rehabilitation status three months after first-time myocardial infarction. Scand. J. Prim. Health Care. 2011;29(4):210–215. doi: 10.3109/02813432.2011.629147.
    1. Meyer T, Hussein S, Lange H, Herrmann-Lingen C. Anxiety is associated with a reduction in both mortality and major adverse cardiovascular events five years after coronary stenting. Eur. J. Prev. Cardiol. 2015;22(1):75–82. doi: 10.1177/2047487313505244.
    1. Moryś J, Bellwon J, Adamczyk K, Gruchała M. Depression and anxiety in patients with coronary artery disease measured by means of self-report measures and clinician-rated instrument. Kardiol Pol. 2016;74(1):53–60.
    1. Watkins L, et al. Association of anxiety and depression with all-cause mortality in individuals with coronary heart disease. J. Am. Heart Assoc. 2013;2(2):e000068. doi: 10.1161/JAHA.112.000068.
    1. Pajak A, et al. Depression, anxiety, and risk factor control in patients after hospitalization for coronary heart disease: The EUROASPIRE III Study. Eur. J. Prev. Cardiol. 2013;20(2):331–340. doi: 10.1177/2047487312441724.
    1. Doering L, et al. Persistent comorbid symptoms of depression and anxiety predict mortality in heart disease. Int. J. Cardiol. 2010;145(2):188–192. doi: 10.1016/j.ijcard.2009.05.025.
    1. Walters P, Barley E, Mann A, Phillips R, Tylee A. Depression in primary care patients with heart disease: Baseline findings from the UPBEAT UK study. PLoS ONE. 2014;9(6):e98342. doi: 10.1371/journal.pone.0098342.
    1. Subramaniam V, Stewart M, Smith J. The development and impact of a chronic pain support group: A qualitative and quantitative study. J. Pain Symptom. Manag. 1999;17(5):376–383. doi: 10.1016/S0885-3924(99)00012-3.
    1. Melody A. Hertzog considerations in determining sample size for pilot studies. Res. Nurs. Health. 2008;31:180–191. doi: 10.1002/nur.20247.

Source: PubMed

3
订阅