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A Novel Digital Platform for a Monitored Home-based Cardiac Rehabilitation Program
Published on: April 19, 2019
Cardiac rehabilitation programs markedly improve high-risk profiles in coronary patients with high psychological
Surya M Artham1, Carl J Lavie, Richard V Milani
1Ochsner Medical Center, New Orleans, LA 70121-2483, USA.
Insights
Cardiac rehabilitation and exercise training significantly improve psychological distress, weight, and quality of life in coronary artery disease patients. These programs are vital for managing high-risk behavioral characteristics and improving patient outcomes.
Area of Science:
- Cardiology
- Behavioral Medicine
- Rehabilitation Science
Background:
- Adverse behavioral profiles like depression and hostility are linked to increased coronary artery disease (CAD) risk and poorer recovery.
- Patients with CAD experiencing high psychological distress often present with poorer health markers and quality of life.
Purpose of the Study:
- To evaluate the impact of outpatient phase II cardiac rehabilitation and exercise training (CRET) programs on CAD patients exhibiting high levels of psychological distress.
- To compare outcomes between CAD patients with high distress (HD) and low distress (LD) following CRET.
Main Methods:
- A cohort of 500 consecutive CAD patients was assessed before and after phase II CRET.
- 109 patients in the highest quintile of psychological distress (HD) were compared with 115 patients in the lowest quintile (LD).
Main Results:
- Baseline HD patients were younger, heavier, had higher BMI, triglycerides, and glycosylated hemoglobin, with worse depression, hostility, anxiety, and somatization scores.
- HD patients also had lower exercise capacity, HDL cholesterol, and quality of life (QoL) at baseline compared to LD patients.
- Post-CRET, HD patients showed significant reductions in weight, BMI, and psychological distress scores, alongside improvements in exercise capacity, HDL cholesterol, and QoL, with greater improvements than LD patients in several key areas.
Conclusions:
- Routine assessment of high-risk behavioral characteristics in CAD patients is recommended.
- Phase II CRET programs yield substantial improvements in CAD patients with high psychological distress, positively impacting behavioral and clinical outcomes.
Objectives:
Adverse behavioral profiles, particularly depression and hostility, increase the risk of coronary artery disease (CAD) and affect recovery after CAD events. We sought to determine the effects of outpatient phase II cardiac rehabilitation and exercise training (CRET) programs in CAD patients with high levels of psychological distress.
Methods:
We studied 500 consecutive patients both before and after phase II CRET programs and compared 109 patients with the highest quintile of psychological distress (HD) with 115 patients with the lowest quintile of psychological distress (LD).
Results:
At baseline, patients with HD were younger (P < 0.001), had higher weight (+11%; P < 0.001), body mass indices (BMI) (+9%; P < 0.01), triglycerides (+66%; P < 0.0001), and glycosylated hemoglobin (+9%; P = 0.03), and had higher scores for depression, hostility, anxiety, and somatization (all P < 0.0001), but had lower values for exercise capacity (-15%; P = 0.02), high-density lipoprotein (HDL) cholesterol (-10%; P < 0.01), and total quality of life (QoL) (-26%; P < 0.0001), and all 6 major components of QoL compared with LD. After CRET, patients with HD had significant reductions in weight (-2%; P < 0.01), % fat (-6%; P < 0.001), BMI (-2%, P < 0.01), and scores for anxiety (-49%), depression (-47%), somatization (-34%) and hostility (-38%) (all P < 0.0001), and increases in exercise capacity (+54%; P < 0.0001), HDL cholesterol (+10%; P < 0.0001), and total QoL (+23%; P < 0.0001), and the 6 components of QoL studied. Compared with patients with LD, those with HD had statistically greater improvements in HDL (P = 0.03), triglycerides (P = 0.03), BMI (P = 0.02), as well as all behavioral characteristics and QoL (P < 0.0001), and had similar improvements in all other factors assessed.
Conclusions:
These data support the routine assessment of high-risk behavioral characteristics in patients with CAD and demonstrate the marked improvements that occur after phase II CRET programs in CAD patients with high psychological distress.
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