Association between demographic and psychosocial factors and the participation and effectiveness of rehabilitation and cardiac education program in patients with ischemic heart disease


Wolfshaut-Wolak, Renata


effectiveness ; rehabilitation and cardiac education program ; demographic and psychosocial factors ; ischemic heart disease


Introduction: Participation in the program of cardiac rehabilitation and education reduces risk of recurrent heart attack and death from cardiovascular diseases by ~47% and ~36%, respectively, while the generał mortality rate may be reduced by ~26%. Objective: Evaluation of determinants of the effectiveness of the Cardiac Rehabilitation and Education Program (CRaEP) in patients after hospitalization due to ischemie heart disease (IHD). Methods: The study group consisted of patients hospitalized with diagnosed heart attack or other form of IHD. The study was conducted during the implementation of the program of the European Society of Cardiology "EuroAction". Each evaluation included an interview according to a standardized questionnaire, physical examination and biochemical tests using the same standard methods. Effectiveness of CRaEP was assessed: 1) in terms of exposure to each risk factor separately, 2) using the Scale of Program Efficiency (SPE), and 3) evaluating t4e risk of change after 16 weeks and 1 year after the completion of CRaEP compared to the initial observation. The risk of disease recurrence or death due to IHD was determined using the Framingham risk score and the PRECARD. Statistical analysis involved uni- and multivariate linear regression and logistic regression, as well. Results: The study involved 167 men with a mean age of 55.6 years (SD= ±9.88) and ; 142 women with a mean age of 58.4 years (SD= ±8.88). The CRaEP program enrolled 139 patients (45%). The participation of patients defined as smokers in CRaEP study was two times less (OR = 0.42, 95%CI = 0.16-0.88) than non-smokers. After completion ofCRaEP, difference between men and women in terms of risk change according to the Framingham risk score (0.69%) was found. Participation in supervision physical exercises program increased the effectiveness of.the program in the evaluation of SPE by 0.22 points per each class. In the longitudinal follow-up, a direct correlation between the effectiveness of the program after 1 year and the result of evaluation of the effectiveness immediately after CRaEP completion was found. Moreover, smaller change in risk according to the Framingham risk score in men as compared to women (0.39%) was observed. In addition, a linear correlation between depression and the risk change according to PRECARD (by 0.19% per each point in the HADS scale) was noted. Participation in the program, its impact on the risk change in the assessment using the Framingham risk score and PRECARD, were not associated with diabetes, place of residence, marital status, waist circumference, reduction in body weight, BMI, blood pressure, blood LDL, blood glucose, and the recommended consumption of vegetables and fruits. Conclusions: Despite intensive methods of recruitm ; ent, only 45% patients participated in the CRaEP. Cigarette smoking was associated with twofold lower frequency in the CRaEP participation. Upon completion of CRaEP, it was found that the participation in supervised physical exercise program was associated with significantly greater effectiveness of the program. Additionally, małe sex and older patients had a negative effect on risk change according to the Framingham risk score. Significant correlation between the effectiveness of CRaEP after its completion and its distant consequences were reported. In both, the follow-up upon CRaEP completion and in longitudinal follow up, risk change was slightly higher in women compared to men.

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2 - studia doktoranckie

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epidemiologia ; choroby układu krążenia

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Wydział Nauk o Zdrowiu


Pająk, Andrzej



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Praca doktorska

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