The Correlation between Participation in a Cardiac Rehabilitation

The Correlation between Participation in a Cardiac Rehabilitation Program and Quality of Life of CHD Patient’s Rivka Herman 1* , RN. M. Sc Michal Libergal 1*, Ph. D; David Rott 2, MD 1 Henrietta Szold Hadassah-Hebrew University School of Nursing, in the Faculty of Medicine, Jerusalem, Israel. 2 Department of Medicine, Hadassah-Hebrew University Medical Center, Mt. Scopus, Jerusalem, Israel

Coronary Heart Disease • In the USA affects 200 men and women out of every 100, 000 • In Israel 25, 000 hospitalizations every year • CHD is a chronic disease that affects patients and their caregivers in terms of physical, psychological and social conditions. (Acsis, 2008 ; American Heart Association (2006)

Cardiac rehabilitation • Decrease both morbidity and mortality of patients with CHD • Therefore its application is a class I recommendation in most contemporary cardiovascular clinical practice guidelines • The participation rate in such programs, in the central region of Israel, is only between 14 -20% (Wenger 2008; Acsis 2008 ; Williams et al. 2006)

Cardiac Rehabilitation & Quality of Life

Quality of life QOL is a broad concept, influenced by personal perceptions, coping mechanisms, and environmental constraints. • Improving QOL is a major goal in the context of preventive and therapeutic cardiology and in cardiac rehabilitation in particular. • WHOQOL Group (1997)

The impetus for conducting this research To evaluate the correlation between participation in a CR program and QOL. • Evaluate the association of demographic parameters and cardiac risk factors on QOL. •

Methods A prospective study. • The target population included patients with CHD who attended the cardiac rehabilitation center at our institution. • Inclusion criteria were: stable CHD; post MI ; age between 30 -80 years; ability to answer questionnaires in Hebrew and independence in ADL. •

Three different tools were utilized in this research General demographic questionnaire. • Cardiac assessment, utilized for admission into the rehabilitation program. • The Mec-New Heart Disease Healthrelated Quality of Life Questionnaire. • (Hofer et al. 2004).

Mec-New Health Related Quality of Life questionnaire The questionnaire was comprised of 27 questions with a Likert scale in three domains: physical, emotional, and social. • The questionnaire has a Cronbach's α of 0. 930. 95 in English. • The Hebrew version was validated by Dankner et al. (2008) and accepted with a Cronbach's α of 0. 93. •

Informed consent • The study was approved by the institutional ethics board of the Hadassah. Hebrew University Medical Center and all participants provided written informed consent after having received explanations regarding the study.

Intervention Assessment by a cardiologist to determine cardiac risk level. • Assessment by a physiologist. • Admission by a nurse prior to physical activity. The program included variety of lectures presented by the multidisciplinary cardiac rehabilitation team. •

Statistical methods The correlation in reported QOL between pre- and post- participation in the CR program were assessed by a paired t-test. • Spearman’s Coefficient was used to test the correlation between risk factors, risk level and education level. • Pearson’s Correlation was used to test the relationship between age and QOL. •

Rate of compliance 87 patients responded to questionnaires prior to starting a cardiac rehabilitation program. • After 3 months of rehabilitation, 55 (63. 2%) patients completed the same questionnaires. •

Risk Factor and Demographic Data Most of the patients were 55 -61 years of age, married, and underwent at least one event of MI. • 40 participants (53%) had a low risk factor for CHD; 26 (33. 8%) had a moderate risk factor; and 10 (13%) had a high risk factor for CHD. •

Results (N-55) The QOL was significantly improved as noted by their general score in the Mec. New Questionnaire and within each domain: emotional, physical limitations, and social function (t (54) = -3. 59, p = 0. 001)

Correlation between risk factors, risk level, age and education level (N-87) AGE NUMBER OF RISK CARDIAC EDUCATION FACTORS RISK LAVEL 0. 088 (*)0. 184 (*)0. 275 - 0. 087 - HRQL GENERAL 0. 174 0. 127 (*)0. 270 - 0. 126 - EMOTIONAL 0. 021 - 0. 137 (*)0. 248 - 0. 081 - PHYSICAL 0. 120 (*)0. 202 (*)0. 258 - 0. 125 - SOCIAL

Limitations The study did not include a control group. • A convenience sample was comprised of a homogenous sample which may limit generalization. • Other illnesses, than CHD, can influence QOL. • There was a loss to follow-up. •

Summary and relevance to clinical practice Nurses awareness as Coordinators of multidisciplinary team to QOL and for secondary prevention of, CHD is significantly important. • Use the HRQOL Questionnaire. • Encourage the participation rate in such programs. •

References • • • Hofer, S. , Lim, L. , Guyatt, G. , Oldridge, N. (2004). The Mac. New Heart Disease Health- related quality of life instrument: A summery International Journal of behavioral Nutrition and physical Activity , 10, 1477 -7525. Williams MA, Ades PA, Hamm LF, et al. Clinical evidence for a health benefit from cardiac rehabilitation: an update. Am Heart J. 2006; 152(5): 835 -841 Lloyd-Jones D, Adams R, Carnethon M, et al. Heart disease and stroke statistics -- 2009 update: a report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Circulation. 2009; 119(3): e 21 -181. Rosamond W, Flegal K, Furie K, et al. Heart disease and stroke statistics -- 2008 update: a report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Circulation. 2008; 117(4): e 25 -146. Skevington SM. Qualities of life, educational level and human development: an international investigation of health. Soc Psychiatry Psychiatr Epidemiol. 2010; 45(10): 999 -1009 WHOQOL Group (1997). Measuring quality of life: Geneva Switzerland. (2009, June 10) Retrieved from: http: //www. who. int/mental_health/media/68. pdf