the effects of depression on functional limitations in patients with chronic heart failure
Y Shimizu1, S Yamada2, H Okumura1, Y Kono1, F Miyake3, T Izumi4
1Nagoya University Graduate School of Medicine, Program in Physical and Occupational therapy, Nagoya, Japan, 2Nagoya University, School of Health Sciences, Nagoya, Japan, 3St. Marianna University School Medicine, Division of Cardiology, Kawasaki, Japan, 4Kitasato University School of Medicine, Department of Cardio-angiology, Sagamihara, Japan
Topic: Cardiovascular rehabilitation
Objective: this study was aimed to examine the effect of depressive symptoms on the course of functional limitations in patients with chronic heart failure (CHF) during recovering phase after hospital discharge.
Methods: Data were obtained from the Preventive effect of exercise for management of daily functioning in patients with CHF (PTMaTCH) study, a prospective cohort study. the Hospital Anxiety and Depression Scale was used to evaluate the depression. Functional limitations were measured by the Performance Measure for Activities of Daily Living-8 (PMADL-8) at 1, 3 and 5 months post-discharge. Relationships of functional limitations to demographic variables, biophysiological variables, physical function variables, and depressive symptoms were examined with bivariate correlations and stepwise multiple regression analyses. Two-way repeated-measures analysis of variance (ANOVA) was used to assess the effects of depressive symptoms on the course of functional limitations. Using a cluster analysis, we identified classes characterized by distinctive courses of functional limitations and then examined their link to depression.
Results: A total of 254 subjects participated in the PTMaTCH study and the data of 148 subjects who answered all the three points (1, 3, 5 months) were analyzed in this study. More than half reported “somewhat hard” or “very hard” in each items (activities of daily living) of the PMADL-8. Worse functional limitations was associated with a more severe depressive symptoms (r = .46, P < .001) and lower grip strength (r = -.40, P < .001). Depressive symptoms and grip strength accounted for 33% of the variance in functional limitations at 5 months post-discharge (P < .001). In two-way ANOVA, depressive symptoms significantly had the effect on the course of functional limitations (F = 30.7, P < .001) but no interacted with time (F = 1.06, P = .35). By the cluster analysis, 4 distinct courses were found and the class of subjects with stable severe functional limitations had a significantly higher rate of depressive symptoms than all other clusters (P < .001).
Conclusion: In our prospective study, depressive symptoms negatively affected the course of functional limitations in patients with CHF. the findings of this study suggest that depression may be a treatment target to improve functional limitations during recovering phase in CHF patients.
P380
Psychosocial variables in adherence to cardiac rehabilitation program
DPGR Guerra Rosas Dinorah, ZL Lugli Zoraide
Simon Bolivar University, Caracas, Venezuela
Topic: Cardiovascular rehabilitation
Objective: To explore the predictive and discriminative ability of psycho-social variables on different patterns of adherence to the cardiac rehabilitation program (CRP). Materials and Methods: using a cross-sectional and comparative design, we evaluated 112 myocardial infarction (MI) survivor patients, referred for CRP from January 2005 through December 2007. the patients were divided into three groups according to their pattern of adherence to CRP: “begin and finished” (Group I), “begin and not finished” (Group II) and “never begin” (Group III). Measured variebles were: Hostility, Coping Strategies, Social Support, Self-efficacy for programmed and daily physical activity. Measurement instruments used were validated for Venezuelan population.
Results: Discriminative analysis reveled that coping directed to the problem, perceived social support and self-efficacy, were statistically significant for discriminating groups according to their pattern of adherence to the CRP; while the variables hostility and emotional coping, were not significant to explain the difference between the groups.
Conclusion: Hostility is a variable associated to cardiovascular disease but not relate to the adherence behavior; rather, different levels of problem-focused coping, perceived social support and self-efficacy, both programmed as daily, predicted belonging to the group. Clinicians staff must to considerate to training this variables to ensure the adherence to CRP.
P381
Overcoming the barriers; increasing completion rates of indigenous cardiac rehabilitation through partnership
S M StewartEadie1, M Tane2
1National Heart Foundation of New Zealand, Auckland, New Zealand, 2Te Hotu Manawa Maori, Auckland, New Zealand
Topic: Cardiovascular rehabilitation
Background: Cardiovascular disease in New Zealand's indigenous Maori is associated with significant inequalities, with mortality rates for those under 65 being more than four times that of mainstream for the same age. Furthermore those that do survive a myocardial infarction are less likely to receive the benefit of cardiac rehabilitation, with attendance and completion rates being half that of mainstream, by percentage of the population. To help readdress this, the Heart Foundation of New Zealand and the Maori equivalent, Te Hotu Manawa Maori partnered together to develop a new home based cardiac rehabilitation programme for both mainstream and Maori, called Heart Guide Aotearoa.
Method: A quantitative and qualitative study was developed to evaluation whether the new model of cardiac rehabilitation would significantly increase uptake and completion of cardiac rehabilitation. 413 participants were enrolled from seven sites, and the results would be compared to an earlier audit of traditional hospital based cardiac rehabilitation services.
Results: Heart Guide Aotearoa resulted in lowering the barriers previously experienced by Maori with completion rates increasing from 21% to 89%. the mean age of those attending also demonstrated improvement falling from 66 years to 58 years old. these results were further reinforced by the qualitative arm of the study that suggested the programme removed the barriers of travel, cost, and illness that often prevent hospital based patients from seeking or completing cardiac rehabilitation. Furthermore many HGA clients demonstrated that they were more able to take control of their condition. they were less fearful and depressed about their future as demonstrated by Hospital Anxiety and Depression Scores and had made a number of positive lifestyle changes.
Summary: this demonstrated that together mainstream and indigenous stakeholders can come together to develop a new and sustainable model of care that helps overcome many of the barriers previously experienced, especially for indigenous Maori. the success of this programme has resulted in the programme being increasingly rolled out across New Zealand and being offered to both mainstream and Maori alike.
P382
Cardiovascular rehabilitation benefits on anxiety and depression scores in patients after valve replacement
M Rada, DV Velimirovici, DMDS Duda-Seiman, SD Dragan, DG Gaita, MBV Berceanu-Vaduva, MDV Velimirovici, SM Mancas
University of Medicine and Pharmacy Victor Babes Timisoara, Timisoara, Romania
Topic: Cardiovascular rehabilitation
Purpose: Anxiety and depression are frequent in patients with history of surgery and are more acute in those with decreased functional reserve. We assessed the influence of comprehensive rehabilitation programme on the anxiety and depression score in patients after valve replacement, depending on gender.
Methods: 73 patients with valve replacement: 46 (63.01%) men, 27 (36.98%) women, mean age: 58±7 years. We considered 2 groups: group A 38 patients with exercise training programme; group B: 35 patients control. All patients had a complete clinical and paraclinical assessment at admission. HAD scale was used to assess the anxiety-depression score, both at admission and after 3 months (after phase II of rehabilitation). the HAD scale was used to assess the anxiety-depression score, with the following interpretation: 0–7 no anxiety and/or depression; 8–10: low anxiety and/or depression; 11–14 moderate; 15–21: severe. Patients in group A had a regular exercise training program 3 times/week, 30–40 min/meeting to 70–75% from the achieved heart rate at the effort test.
Results: In group A there was noticed a significant improvement both in anxiety and in depression scores (anxiety incidence was higher). Comprehensive rehabilitation programmes led to an improvement of pathologic anxiety: group A: 6.2±1.1 after phase II vs. 11.1±1.5 at baseline (<0.01); group B: 6.7±1.3 after phase II vs. 11.3±1.6 at baseline (<0.05).
Depression score was improved more obvious in group A: 5.2±0.6 after phase II vs. 12.2±1.4 at baseline (<0.05).
Conclusions: Anxiety is more frequent than depression in patients after valve replacement. Comprehensive cardiac rehabilitation programmes, where exercise training and psychological counseling play a key role, lead to effort capacity increase and improvement of the anxiety-depression score. Men appear to be a protective factor against anxiety.
P383
the CHARMS Study: Cardiac rehabilitation staff views about discussing sexual issues with coronary heart disease patients: a national survey in Ireland
S Doherty1, M Byrne1, HM Mcgee2, AW Murphy1
1National University of Ireland, Galway, Ireland, 2Royal College of Surgeons in Ireland, Dublin, Ireland
Topic: Cardiovascular rehabilitation
Background: While a healthy sexual life is regarded as an important aspect of quality of life, sexual counselling from healthcare providers for cardiac patients has received little attention in the literature.
Aim: To document current practice and assess the needs of cardiac rehabilitation service providers in Ireland with regard to sexual assessment and management for patients.
Methods: Cardiac rehabilitation staff in all relevant centres in Ireland responded to a postal questionnaire. Sexual health management was assessed by a series of questions on current practice, and staff attitudes, beliefs and perceived barriers to discussing sexual problems.
Results: Staff (N=60;61% response rate) reported a lack of assessment and counselling protocols for addressing sexual health problems, with little or no onward referral system available. Results also suggest staff believe that patients don't expect them to ask about their sexual concerns. Barriers reported included an overall lack of confidence (45%), knowledge (58%) and training (85%).
Conclusion: Development of guidelines, assessment protocols and training for cardiac rehabilitation staff are essential in the area of sexual health problems in order to improve the quality of services for patients with coronary heart disease.
P384
MI patients intentions to attend cardiac rehabilitation programmes, a quantitative survey
G Mckee1, S O Donnell1, M Mooney1, F O Brien1, D Moser2
1Trinity College, Dublin, Ireland, 2University of Kentucky, Lexington, United States of America
Topic: Cardiovascular rehabilitation
National guidelines recommend that all eligible patients be invited to partake in rehabilitation programmes. the literature cites the numerous reasons patients give as to why they do not want to attend cardiac rehabilitation programmes. these include: gender, transport problems, comorbidities psychological reasons, poor motivation and work commitments.
Purpose: To ascertain the proportion of patients who intend to attend Phase III cardiac rehabilitation To describe the reasons why patients do not intend to attend Phase III cardiac rehabilitation programmes
Methods: this study is part of a larger project based in five major academic teaching hospitals. Patients admitted to hospital with ACS symptoms and who fulfilled the eligibility criteria were invited to take part in the study. Each participant then completed an in-depth questionnaire which contained items related to their current cardiac condition. Two of these items were related to the participants intention to attend cardiac rehabilitation and these findings are presented here. Data were analysed using SPSS.
Results: the sample demographics were, age 62.18+ 11.86 years, 68% male, current diagnosis: 44% STEMI, 56% NSTEMI. A total of 1341 patients participated in the study, 1292 completed the question, 1004 (78%) stated that they intended to go to cardiac rehabilitation and the remaining 288 (22%) stated that they did not. the following are the main reasons stated for non attendance: not interested 40%, programme would be of no assistance 11%, previously attended 10%, not yet discussed 9%, difficulty with transport 6%, work or time difficulties 6%.
Conclusions: It was reassuring to note that 78% of patients planned to attend a cardiac rehabilitation programme. the reasons given for not wishing to attend cardiac rehabilitation are clinically very significant. Given the obvious benefits of such a programme for cardiac patients, in relation to education, counselling, exercise, recovery etc it is important that programme co-ordinators are cognisant of everyday issues that may impact on the individuals intention to attend Some of the reasons cited such as “uninterested” and the “programme would be of no assistance”, leave room for further discussion with a cardiac rehabilitation team member. they could encourage, motivate, reinforce the advantages of cardiac rehabilitation and indicate even more clearly that it is not just about exercise and that all aspects of the programme are individualised and autonomous.
P385
Cardiopulmonary exercise training in patients with ischemic heart disease: systolic function and quality of life
J Siegelova, J Pochmonova, L Mifkova, L Vymazalova, A Havelkova, L Konecny, P Vank, B Fiser
Masaryk University, Faculty of Medicine, Brno, Czech Republic
Topic: Cardiovascular rehabilitation
Purpose of the study: the aim of the present paper was to study oxygen transport system, work load and quality of life in two groups of patients with ischemic heart disease (group with ejection fraction EF>40% and group with EF<40%) before and after twelve weeks lasting exercise training.
Methods: Seventy one patients with ischemic heart disease with ejection fraction EF>40% (EF mean value 53±7%), body mass index BMI 28±2 kg.m-2, mean age 61± 10 years, and 17 patients with EF<40% (EF mean value 33±7%), body mass index BMI 28±5 kg.m–2, mean age 66±8 years were examined. Symptom-limited spiroergometry was provided before and after exercise training, which consisted of warmup period, aerobic training, resistance training and cool-down period (twelve weeks 3 times per week). We evaluated capacity of oxygen transport system (VO2SL ml.min–1, VO2SL.kg–1 ml.min–1.kg–1), maximal reached load symptom-limited (WmaxSL W, Wmax SL.kg–1 W.kg–1) and, using Seattle Angina Questionnaire (SAQ 1–5), subjective estimation of quality of life.
Results: In the group with EF>40% we have found (before versus after) significant change of WmaxSL (115.6±34.0 v. 124.4±36.2, p<0.01), WmaxSL.kg–1 (1.4±0.4 v. 1.45±0.43, p<0.01) VO2SL (1739±422 v. 1862±444, p<0.05), VO2SL.kg–1 (20.4±4.9 v. 21.8±5.3, p<0.05), SAQ1 (78.8±18 v. 84±22, p<0.01) SAQ2 (76±22 v. 85±16, p<0.01) SAQ3 (88±15 v. 93±8, p<0.01), SAQ4 (88±15 v. 94±8, p<0.01), SAQ5 (65±16 v. 74±16, p<0.01). In the group with EF<40% we have found WmaxSL (97.2±22.7 v. 112.2±30.9), VO2SL (1510±320 v. 1718±416, p<0.05), VO2SL.kg–1 (17.9±4.0 v. 20.7±6.6, p<0.05). the values of SAQ have not been changed significantly: SAQ1 (83±16 v. 86±14), SAQ2 (85±17 v. 88±14), SAQ3 (87±12 v. 91±10), SAQ4 (87±18 v. 90±15), SAQ5 (71±20 v. 75±21).
Conclusion: Twelve weeks lasting exercise training increased oxygen transport capacity and work load in both groups of patients with ischemic heart disease. the quality of life after exercise training was improved only in the group with EF 53±7%, in the group with EF 33±7% it was not changed.
P386
Comparison of a questionnaire to assess anxiety and depression among executives and non-executives and the cardiovascular reactivity to mental stress
A Coimbra1, RRT Castro2, A Arantes3, R Cruz3, A Leal3, F Varzim3, M Andrade3, ACL Nobrega4
1FAPES/BNDES - Hospital Pró cardiaco, Rio de Janeiro, Brazil, 2Instituto Nacional de Traumatologia e Ortopedia, Rio de Janeiro, Brazil, 3FAPES/BNDES, Rio de Janeiro, Brazil, 4Hospital Pró cardiaco, Rio de Janeiro, Brazil
Topic: Occupational health
Purpose: Working environments has been the subject of research related to stress and there seems to be differences between the level of stress and anxiety among employees at different levels. Our study investigated the relationship between the answers to a validated questionnaire to measure subjective anxiety and depression and the hemodynamic responses to a validated test for measuring cardiovascular reactivity to mental stress among executives and non-executives of a large company.
Methods: Healthy subjects (n=156) who were not taking any medication were submitted to a questionnaire with 14 questions about anxiety and depression and to the Stroop color test with auditory conflict, where they had to identify the changing color of words on a computer screen while other color names are being pronounced through headphones and a standard arithmetic test. Electrocardiogram was continuously and digitally monitored trought the tests. Also, non invasive and intermitent blood pressure with digital esfignomanometer was registered. Subjects were divided in two groups: normal response to mental stress test (N) and exacerbated response (E). Subjects with an increase of heart rate > 15bpm and/or increase in systolic blood pressure > 25mmHg and/or increase in diastolic blood pressure > 15mmHg were included in the E group.
Results: the results were compared between executive and non-executives who had normal response to the questionnaire (n = 109) and those who had abnormal response in the questionnaire (n = 47), suggesting anxiety or depression (x2 = 0.13). We did not observe correlation between executives and anxiety (x2 = 0.28). When compared in relation to the hemodynamic response to mental stress test, we don t found significant correlation between executives or not (x2= 0,28).
Conclusion: the subjective level of anxiety or depression or the position as executive or nonexecutive in a large company does not seem to predict the cardiovascular response to simulated mental stress, suggesting that the objetive measurement of this response should be performed in order to identifiy exaggerated responders.
P388
Prevalence, determinants and prognostic significance of type D personality in elderly patients with stable CAD and normal NT-proBNP levels
J H A J De Sutter, N Van De Veire, J Philippe, M De Buyzere
Ghent University, Ghent, Belgium
Topic: Psychosocial factors and stress
Background and study aims: Type D personality has been proposed as a marker of poor outcome after acute myocardial infarction and in patients with chronic heart failure (CHF). It has also been associated with increased levels of markers of inflammation. Its prevalence, determinants and prognostic significance in elderly patients with stable CAD without CHF has not been studied in detail and is the aim of the present study.
Methods: We prospectively enrolled 176 patients older then 60 years (mean age 71±6 years, 22% women, LVEF 59±13%) with stable CAD (> 6 months after AMI or revascularisation) and NT-proBNP levels < 450 mg/dl. Type D personality was assessed according to the questionnaire developed by Denollet. All patients underwent baseline echocardiography, a maximal spiroergometry for evaluation of VO2max and a 6 minutes walking distance (6 min WD). the following markers of inflammation were determined: high sensitivity CRP (hsCRP), tumour necrosis factor (TNF) soluble TNF receptor I and II (sTNFrecI and II), and interleukin-6 (IL-6). the Minnesota questionnaire was used as measurement of quality of life (QOL). Patients were followed for a median follow-up of 32 months for the combined endpoint of death, acute myocardial infarction, PCI, CABG and hospitalization for CHF.
Results: In total 38 patients (22%) had type D personality according to the criteria of Denollet. their QOL was clearly worse (Minnesota QOL 41±22 vs 21±19, p<0.01). Age, gender, diabetes and cardiovascular medication use were comparable between pts with and without type D personality (all p>0.05).
Also LVEF (57±12% vs 60±13%, p=ns), creatinine (0,93±0,17mg/dl vs 0,98±0,18mg/dl, p=ns) and NT-proBNP levels (160±104pg/ml vs 161±110pg/ml, p=ns) were comparable. All markers of inflammation were also comparable (p>0.05 for hsCRP, IL-6, TNF and sTNFrecI and II) as well as measurements of exercise capacity (VO2max 16,7±5,3 vs 17,2±5,3 ml/kg/min, p=ns, 6 minWD 450±109 m vs 443±99 m, p=ns).
During follow-up 26pts developed cardiac events. Type D personality was not associated with events in univariate and multivariate Cox proportional regression analysis. Event rates were comparable between patients with and without type D personality (Kaplan-Meier Log Rank Chi-Square 0,47, p=0.49)
Conclusions: In elderly patients with stable CAD and normal NT-proBNP levels, type D personality was present in 22% of patients and was associated with a poor quality of life. It was however not associated with parameters of LV dysfunction, increased inflammation or decreased exercise capacity and it did not predict cardiovascular outcome.
P390
Type D personality in patients with multifocal atherosclerosis: prevalence and influence on quality of life
A N Sumin, OI Raih, EV Korok, AV Karpovich, JAE Bohan, OL Barbarash
RAMS Scientific-Research Institute for Complex Studying of Cardiovascular Diseases, Kemerovo, Russian Federation
Topic: Psychosocial factors and stress
Purpose: the presence of Type D (“distressed”) personality is accompanied by the prognosis deterioration in coronary artery disease (CAD) and peripheral arterial disease (PAD). However type D personality did not study at patients with carotid disease (CS) and multifocal ischemic pathology.
the aim of the study was evaluate the prevalence of type D personality and its influence on quality of life (QOL) in patients with multifocal atherosclerosis.
Methods: the study included 499 patients (age 60,7±7,3 years) who were admitted to the hospital for carotid endarterectomy, peripheral arterial reconstruction or coronary artery bypass. All patients were subjected to color duplex examination of the carotid vessels and to lower extremity Doppler study. Coronary angiography was performed on patients with PAD and CS. the patients were divided into 4 groups: group CAD (n=220), group CAD+CS (n=122), group CAD+PAD (n=78), and group CAD+CS+PAD (n=79). Type D personality was measured with the 14-item Type D Personality Scale (DS14). the Short-Form Health Survey 36 (SF-36) was used to assess QOL. the depression scale was used to evaluate depressive symptoms.
Results: (see table). Subscales rates of Type D were higher in the patients with multifocal ischemic pathology. Type D personality was the least often met among CAD group and the most often among patients with coexistence CAD, CS and PAD. Also QOL and depression level were lower in multifocal atherosclerosis in comparison with the isolated CAD.
Conclusion: High prevalence of Type D personality in patients with multifocal ischemic pathology was associated with the deterioration QOL and high level of depression.
Type D in multifocal atherosclerosis
Variables
CAD
CAD+CS
CAD+PAD
CAD+CS+PAD
p
(n=220)
(n=122)
(n=78)
(n=79)
Type D (n,%)
24 (10.9%)
28 (22.9%)
28 (35.9%)
30 (37.9%)
0.0001
NA
7.4±0.2
9.2±0.5
10.6±0.9
10.2±0.6
0.0001
SI
7.8±0.2
9.5±0.5
10.7±0.9
10.2±0.5
0.0001
GH
72,7±1.4
53.8±2.4
36.7±3.5
32.5±2.3
0.0001
PF
75.2±1.3
58.3±2.4
38.6±3.4
36.1±2.8
0.0001
SF
58.5±1.4
49.6±1.8
39.0±3.3
43.3±2.6
0.0001
Depression
46.9 ± 0.5
55.2 ± 0.7
57.6 ±1.6
62.7 ± 0.8
0.0001
NA - Negative Affectivity, SI - Social Inhibition (subscales of DS-14), GH - General health, PF Physical functioning, SF - Social functioning (subscales of SF-36)
P391
Cardiovascular safety of 1-year escitalopram therapy in clinically nondepressed patients with acute coronary syndrome: results from the DECARD tria
J A Hanash, B H Hansen, J F Hansen, O W Nielsen, A Rasmussen, M Birket-Smith
Bispebjerg Hospital of the Copenhagen, University Hospital, Copenhagen, Denmark Topic: Psychosocial factors and stress
DECARD study group
Background: Selective serotonin reuptake inhibitors (SSRIs) are commonly used for treatment of depression in patients with cardiac diseases. However, evidence of cardiovascular (CV) safety from randomized trials is based on studies of no longer than 6-month duration. We examined the effect of 1-year SSRI escitalopram therapy on multiple CV safety domains in nondepressed patients with recent acute coronary syndrome (ACS).
Methods: the DECARD (DEpression in patients with Coronary ARtery Disease) trial assessed the prophylactic effect of escitalopram on depression after ACS. 240 patients were randomised to either escitalopram 10 mg or matching placebo for one year. Serial measures of CV safety including clinical and biochemical parameters, 24-h ECG monitor, resting ECG and echocardiographic assessment were obtained.
Results: Escitalopram and placebo-groups were comparable at baseline with regard to age, gender, sociodemography, depression score, risk factor profile, severity of heart disease and medications. Dropout rates defined as withdrawal for any reason or lost to follow-up during the 12-month study period was 27.2% in the escitalopram group and 23.4% in the placebo group (NS). there were no statistically significant differences between intervention groups in any of CV safety measures including the incidence of ventricular arrhythmia and episodes of ST-segment depression, length of QTc, and systolic and diastolic echocardiographic measures at the 12-month follow-up between groups. After 12 months, 16 and 13 major adverse events (death, recurrent ACS or acute revascularisation) were recorded in the escitalopram and placebo group, respectively (NS).
Conclusion: One-year escitalopram treatment was safe and well-tolerated in patients with recent ACS.
P392
2 year follow up of patients diagnosed with Non Cardiac Chest Pain (NCCP) attending the Rapid Access Chest Pain Clinic (RACPC) in a single tertiary centre
S Kasim, J Groarke, B Walsh, J Crowley
University Hospital Galway, Galway, Ireland
Topic: Psychosocial factors and stress
Background: RACPC have been introduced to expedite investigations of patients suspected of having cardiac chest pain by their general practitioners. Many continue to report symptoms despite normal investigations.
Objective: We aim to report on the outcome at two years on patients diagnosed with NCCP and the impact to their lifestyle and the healthcare system.
Methods: Patients referred to the RACPC between January 2004 and April 2006 in University College Hospital Galway was enrolled. Demographics and risk factor profile were obtained from clinical records during attendance to the service. Patients who proceeded to diagnostic coronary angiography after assessment and subsequently diagnosed with non cardiac chest pain were followed up. Follow up was performed via telephone questionnaire that has been validated in previous studies.
Results: 167 patients (female=102, 61%) were identified with normal angiograms after assessment in RACPC. Mean age was 57 years old. Risk factors were smokers (25%), hypertension (40%), diabetes (5%) and hypercholesterolemia (34%). At 2 years, 97 patients (58%) continue to report similar symptoms to initial presentation. 48% had symptoms lasting for more than a year. 6.9% report limiting symptoms despite a normal angiogram and up to 23% believed that their symptoms are due to cardiac. No specific diagnosis was made in 34% of 167 patients. Half of these continued to have symptoms on a daily basis. Up to 30% of patients attended their GP more than once. 12 patients in the non specific diagnosis group attended the Emergency Department more than once with their symptoms resulting in 6 in patient bed days despite normal angiogram.
Conclusions: A diagnosis of NCCP failed to alleviate symptoms in a significant number of patients attending the RACPC. these patients should be identified and a pathway constructed to reduce the amount of inappropriate resource utilisation to the healthcare system.
P393
Type D personality and prevalence of cardiovascular risk factors in subjects without established cardiovascular disease
G Einvik1, H Hrubos-Strom2, A Randby3, SK Namtvedt3, HK Kristiansen3, T Dammen2, T Omland3
1Akershus University Hospital, Department of Medicine, Lorenskog, Norway, 2University of Oslo, Department of Behavioural Sciences, Oslo, Norway, 3University of Oslo, Faculty Division, Akershus University Hospital, Oslo, Norway
Topic: Psychosocial factors and stress
Purpose: Type D personality has been associated with poor cardiovascular outcome in patients with coronary heart disease. However, there is few data on the role for type D personality in primary development of cardiovascular disease. We investigated whether type D personality was associated with the prevalence of cardiovascular risk factors in subjects without overt cardiovascular disease.
Methods: From an epidemiological survey on symptoms of sleep apnea (Akershus Sleep Apnea Project) 1350 persons were invited to a clinical study, out of whom 535 (39%) were included, 437 without established cardiovascular disease. Type D personality was assessed with DS14. A cardiovascular risk score was calculated by adding the presence or absence of the following risk factors: Hypertension (>140/90 or treatment), diabetes (glucose >7mmol/l or treatment), obesity (BMI25 or waist >102cm men, >88cm women), hyperlipidemia (total cholesterol >5mmol/l or LDL-cholesterol >3mmol/l), current smoking and low physical activity (regular exercise <3h/week).
Results: Persons with type D personality had a significantly higher cardiovascular risk score (figure 1), due to higher prevalence of smoking and low physical activity (Table 1).
Conclusion: Type D personality may be associated with clustering of cardiovascular risk factors in subjects without established cardiovascular disease.
Table 1. Prevalence (%) of cardiovascular risk factors
Hypertension
Diabetes
Obesity
Hyperlipidemia
Smoking
Low physical activity
Non-type D
49
30
75
83
21
40
Type D
49
25
82
86
43
57
Total burden of cardiovascular risk factors for type D vs non-type D subjects
P394
Mind your mind: lack of introspective insight predicts lower heart rate variability in post-myocardial infarction patients
I Nyklicek1, EJ Martens1, BM Szabo1, J Denollet2
Tilburg University, CoRPS Center of Research on Psychology in Somatic Diseases, Tilburg, Netherlands, St. Elisabeth Hospital Tilburg, Department of Cardiology, Tilburg, Netherlands
Topic: Psychosocial factors and stress
Purpose: Introspective insight is insight into one s internal psychological states and processes as a result of being able to reflect upon these phenomena. It is hypothesized to lead to more adaptive behavior in general, including health-promoting behavior, resulting in a better hemodynamic function. We examined the association between introspective insight and heart rate variability (HRV; an important marker of cardiovascular function and prognostic factor) in post-myocardial infarction (MI) patients.
Methods: this study included 82 post-MI patients (82% men, mean age= 56 ±10 years). All patients completed the Lack of Psychological Mindedness scale (Denollet & Nyklicek, 2004) scale, measuring lack of insight, and had a Holter ECG recorder for 24 hours. Both time and frequency domain measures of HRV were obtained.
Results: Patients with a lack of introspective insight showed a tendency for lower HRV across both time and frequency domain measures. After adjustment for sex, age, medication, and disease severity (multi-vessel disease and anterior infarction), significance was retained for vagally mediated time domain measures (rMSSD and pNN50) and for low frequency spectral power (F > 4.22, p< .05). Nonsignificant trends in the same direction were obtained for the vagally mediated high frequency spectral power, the very low frequency power, as well as the overall time domain measures SDNN and SDANN (F > 3.29, p< .08).
Conclusions: Lack of introspective insight was associated with lower heart rate variability in post-MI patients. Future studies should examine whether a lack of introspective insight is also associated with an increased risk of adverse clinical events in post-MI patients.
Low Insight
High Insight
p
VLF
÷25.7 (1.5)
29.5 (1.6)
.054
LF
÷÷14.5 (1.5) ÷
÷÷17.9 (1.5) ÷
.039
HF
10.3(0.9)
÷÷12.2 (0.8) ÷
.074
rMSSD
÷÷25.4 (1.9) ÷
÷÷31.4 (1.9) ÷
.013
pNN50
÷÷6.5(1.3)÷
÷÷9.7 (1.2) ÷
.043
SDANN
÷÷96 (5.7) ÷
÷÷109 (6.1) ÷
.077
SDNN
÷÷111 (6.1) ÷
÷÷127 (6.5) ÷
.052
Means (SD) of HRV indices by level of introspective insight
P395
Prevalence of depressive symptoms and low social support level in Polish obese persons. Results of WOBASZ Study
J Piwonski1, E Sygnowska1, A Piwonska1, W Drygas2, T Zdrojewski3, J Gluszek4, A Pajak5, K Kozakiewicz6
1National Institute of Cardiology, Warsaw, Poland, 2Medical University, Lodz, Poland, 3Medical University, Gdansk, Poland, 4Poznan University of Medical Sciences, Poznan, Poland, 5Jagiellonian University, Cracow, Poland, 6Medical University of Silesia, Katowice, Poland
Topic: Psychosocial factors and stress
WOBASZ group
Purpose: Negative psychosocial risk factors can be both risk factors of obesity due to their effect on person s behaviour as well as they can be a result of being obese because of the lack of acceptance obese persons by family or population. We want to evaluate the prevalence of depressive symptoms and low social support level in obese persons in comparison to the rest of population.
Methods: Data came from the representative sample of polish population − 6392 men and 7153 women, aged 20–74, examined in 2003–2005 in the frame of National Multicenter Health Survey (WOBASZ). Study procedure covered questionnaire (socio-demographic data, habits, medical history, psychological questionnaires), physical examination and laboratory tests. Depressive symptoms were assessed using Beck s depressive scale and social support using Berkman and Syme questionnaire.
Results: 1313 men -M (21%) and 1612 women - W (22%) were obese. Obese persons were older and independently of age had higher levels of risk factors. Both men and women with obesity In comparison to persons without obesity significantly more often had depressive symptoms (M 29% vs 22%, p< 0.0001; W 46% vs 30%, p< 0.0001). Lack or low social support were observed in 58% of obese M and in 79% obese W (In comparison respectively to 64% M and 68% W without obesity). there was observed the significant association between obesity and depressive symptoms and low social support level, both in men and women. In obese, compared to not obese men, the chance of getting depressive symptoms (independently of age) was higher by 14% (OR=1.14, p<0.05), and in women even by 40% (OR=1.40, p<0.0001). In obese man the chance ofgetting low social support level was lower by 29% (OR=0.71, p=0.0014), but in women increased by 19% (OR=1.19, p<0.05) compared to not obese persons.
Conclusions: In obese persons, both men and women, depressive symptoms were observed more often than in persons without obesity, but low social support were observed more often only in obese women.
P396
Lifestyle intervention, quality of life and cost-effectiveness, a randomized controlled trial
MK Eriksson1, EB Malmgren-Olsson2, LA Hagberg3, M Eliasson4
1Björknäs Health Care Center, Boden, Department of Community Medicine and rehabilitation, Umea, Sweden, 2Department of Community medicine and rehabilitation, Umea, Sweden, 3Centre for Health Care Sciences, Orebro County Council, Orebro, Sweden, 4Department of Medicine, Sunder by Hospital, Lulea, Department of Public Health and Clinical Medicine, Lulea, Sweden
Topic: Quality of life
Background and Purpose: Individuals with obesity, diabetes and other cardiovascular risk factors report diminished well-being and quality of life (QOL). Lifestyle interventions reduce cardiovascular risk and delay onset of diabetes, but reports on QOL are rare. For complete evaluation of an intervention program it is essential to incorporate the patient s perspective of physical, mental and social well-being. Also cost-effectiveness analysis relies heavily on valid QOL measurements. the effect of a lifestyle intervention in an ordinary primary care setting on health-related quality of life (QOL) and cost-effectiveness was assessed.
Methods: A total of 151 middle-aged men and womenat moderateto high risk for cardiovascular disease were randomly assigned to either a lifestyle intervention or standard care. the 3-month intervention period was administrated in the primary care setting and consisted of supervised exercise sessions and diet counseling, followed by regular group meetings during 3-yr. Participants were followed-up at 3, 12, 24 and 36 months. Outcomes were change in QOL measured with the use of EuroQol and 36-Item Short Form Health Survey (SF-36), and SF-6D, and change in motivational stage for physical activity. In a cost-utility analysis the costs, gained quality-adjusted life years (QALY) and savings in health care and were considered. Probability of cost-effectiveness was also described using Net Monetary Benefit Method.
Results: Lifestyle intervention significantly increased EQ Rating scale (p<0.01), and SF-36 physical functioning, bodily pain (less pain), physical component summary (p<0.05) and SF-6D (p<0.01) over the 3-yr period and at time point 3-yr. Standardized response mean (SRM) showed a moderate effect. No significant improvement was seen in EQ-5D or in SF-36 mental dimensions after 3-yr but SRM indicated small effects. More participants in the intervention group progressed to active stages of change for physical activity during the 3-year follow-up (p<0.001). there was a net saving of 47 USD per participant. Cost per gained QALY, savings not counted, were 1668–4813 USD. Probabilities of cost-effectiveness were 89–100% when 50 000 USD was used as threshold of willingness to pay for a gained QALY.
Conclusion: A lifestyle intervention in primary care improves several dimensions of QOL and motivation for physical activity, up to 3 years. the intervention method was highly cost-effective in relation to standard care.
P397
Tai chi added to endurance training vs endurance training alone in elderly patients with chronic heart failure: a randomized pilot study
G Caminiti, M Volterrani, A Arisi, A Cerrito, R Massaro, S Bovone, A Carluccio, G Rosano
IRCCS San Raffaele Pisana Hospital, Rome, Italy
Topic: Quality of life
Purpose: To asses if Tai Chi added to endurance training (ET) is more effective than ET alone in improving exercise tolerance and quality of life of elderly male patients with chronic heart failure (CHF).
Methods: Twenty-seven male CHF patients, age 73+/–6 years; ejection fraction 33+/–9, NYHA II-III were enrolled. Eleven pts were randomized to combined training (CT) group performing Tai Chi +ET and 10 patients to ET group (ET only). At baseline and after 12 weeks all patients underwent 6-minute walking test (6MWT), assessment of quadriceps maximal voluntary contraction (MVC) and peaktorque (PT) blood pressure and heart rate (HR). Tai Chi and ET were both performed 3 times/week
Results: Exercise was well tolerated. No patients had adverse events. Distance at 6mwt improved in both groups (CT group: 1280+/–32m; ET group:96+/–23 m) with significant intergroups differences (p 0.041). Rest HR significantly decreased in the CT group while remained unchanged in the ET group (–9 bpm vs 3 bpm, p 0.03). Patients of the CT group had a greater significant improvement in social and emothional QOL than ET group (between groups differences: +8%, p 0.01; +6%, p 0.03 respectivelty). Patients of CT group had a no significant higher increase of both MVC and PT than ET group.
Conclusions: Tai Chi added to ET, significantly improves exercise tolerance and QOL of patients with CHF.
