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Outcomes from a Multidisciplinary Cardiac Rehabilitation Programme: Are Angioplasty Patients Address

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Title: Outcomes from a Multidisciplinary Cardiac Rehabilitation Programme: Are Angioplasty Patients Address


1
Outcomes from a Multi-disciplinary Cardiac
Rehabilitation Programme Are Angioplasty
Patients Addressing Lifestyle Changes?
  • Eve Scarle,
  • Mark Giles, Maggie Gallacher, Julian Bath, Julia
    Harrison, Alison Anderson
  • Gloucestershire Cardiac Rehabilitation Service
  • Gloucestershire Hospitals NHS Foundation Trust

2
Background
  • Death rates from CHD have fallen by 44 in those
    under 65 years old (1)
  • 2.6 million people in the UK living with CHD (1)
  • Growth of RACPC and interventional cardiology
  • 6,000 PTCA in 1982 increased to 54,000 in 2003
    (1)
  • NSF for CHD (2000) (2)
  • Once Trusts have an effective system
    recruiting
  • people who have survived an MI or undergone
    surgery
  • to a high quality cardiac rehabilitation, they
    should
  • then extend their rehabilitation services to
    people
  • admitted to hospital with other manifestations of
    CHD.
    (Chapter 74)

3
(No Transcript)
4
Rationale
  • Limited studies on first time PTCA patients with
    no history of MI
  • May feel cured by the procedure or less sick than
    other CHD patients- ?motivation to change
  • Evidence suggests 30-40 of individuals
    experience recurrent angina or a cardiac event by
    2 years (4) (5)
  • Less compliance to behaviour changes when
    compared to CABG patients (3)
  • Low levels of CR participation (0-10) (6) and
    twice as likely to drop out (7)

5
Method- Comparative Study
Initial sample- baseline data n1387
CABG n285
MI n936
PTCA n166
CR programme Accepted and attended n590
Completed initial questionnaire and attended 7
weeks rehab Measures- IPQ, SF-12, HADS,
Self-efficacy, Risk factor profile
Dropped out of CR Programme 13
Follow-up of patients at 6 months post cardiac
event completed second questionnaire
6
Cardiac Rehab Programme
  • Seven sessions for two hours
  • Multi-disciplinary
  • nurse, physiotherapist, psychologist, dietitian
  • Exercise and education component
  • Based around cognitive behavioural model
  • Two follow-ups at six months and one year post
    cardiac event

7
Results
  • Attendance
  • Quality of Life (SF-12)- physical and mental
  • Anxiety and Depression (HADS)
  • Illness Perceptions (IPQ)
  • Risk behaviours
  • Self-efficacy

8
Results
  • SF-12
  • Mental health improved in all 3 groups
  • Physical health better for PTCA at baseline
  • Improvements in physical health in MI and CABG
    group
  • HADS
  • Reductions in anxiety and depression scores
  • Greater improvement in those who had clinically
    meaningful scores

9
Results
  • Illness Perception (IPQ)
  • Increased timeline scores
  • Patients who accepted their condition to be
    long-term (timeline) had better diet and exercise
    self-efficacy scores (8).
  • Perceiving CHD as chronic may be instrumental in
    engaging individuals in making long-term changes.
  • MI thought consequences of illness were more
    serious
  • Following rehab PTCA patients had increased
    consequences scores
  • CR may facilitate a raising of awareness of the
    consequences of CHD and enhance motivation to
    make behavioural changes

10
Results
  • Self-efficacy
  • No group differences
  • Increased SE for stress reduction and dietary
    changes
  • High SE scores for stopping smoking and
    increasing fitness
  • Risk Factor Modification
  • No group differences
  • 80.4 abstinence from smoking at 6 months
  • Significant increases in fruit and vegetable and
    oily consumption, and frequency of exercise
  • No significant improvements in BMI

11
Study Limitations
  • Lack of control group
  • No assessment on individuals who refuse CR
  • Threats to internal validity
  • Data collection difficult with lengthy
    questionnaire
  • Need all answers for each measure at each time
    point
  • Data only available up to six months post event

12
Conclusion
  • No significant differences between three groups
    in success at CR
  • CR a worthwhile venture for PTCA patients
  • PTCA motivated to attend CR and make favourable
    lifestyle changes
  • Evidence suggests only 5-10 of PTCA patients are
    offered the chance to attend CR (6)

13
Future Directions
  • Long-term follow-up period beyond one year
  • Investigate individuals that refuse CR
  • Investigate patient activity levels outside CR
  • Explore alternative tools for CR
  • Home programme
  • Videos/dvds
  • Evening classes

14
Any Questions?
15
References
  • 1. Heart Stats Website
  • http//www.heartstats.org/ (2005) accessed on
    the 25th July 2005.
  • 2. Department of Health (2000) The National
    Service Framework for Coronary Heart Disease,
    London HMSO.
  • 3. Crouse, J. and Hagaman, A. (1991) Smoking
    Cessation in relation to Cardiac Procedures,
    Amercian Journal of Epidemiology, 134 (7), pp.
    699-703.
  • 4. Hlatky, M. Charles, E. Norbrega, F. Gelmen, K.
    Johnstome, I. Melvin, J. (1995) Comparison of
    Coronary Bypass Surgery with Angioplasty in
    Patients with Multi-Vessel Disease (BARI) , New
    England Medical Journal, 335, pp. 217-25.
  • 5. Tuniz, D. Bernardi, G. Molinis, G. Valente, M.
    DOdorico, N. Mirolo, R. Morocuttl, G. Spedicato,
    L. Fioretti, P. (2004) Ambulatory Cardiac
    Rehabilitation with Individualised Care after
    Elective Coronary Angioplasty One Year Outcome,
    European Heart Journal Supplements, 6 (A), A1-10.
  • 6. Bethell, H. Turner, S. Evans, M. Rose, L.
    (2001) Cardiac Rehabilitation in the United
    Kingdom. How Complete is the Provision?,
    Cardiopulmonary Rehabilitation, 21 (2), pp.
    111-15.
  • 7. Turner, S. Bethell, H. Evans, J. Goddard, J.
    Mullee, M. (2002) Patient Characteristics and
    Outcomes of Cardiac Rehabilitation, Journal of
    Cardiopulmonary Rehabilitation, 22, pp. 253-260.
  • 8. Lau-Walker, M. (2004) Relationship between
    Illness Representation and Self-Efficacy, Journal
    of Advanced Nursing, 48 (3), pp. 216-225.

Contact details for further information escarle_at_g
los.ac.uk eve.scarle_at_glos.nhs.uk
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