Skip to main content

Advertisement

SpringerLink
Log in

The effects of a comprehensive rehabilitation and intensive education program on anxiety, depression, quality of life, and major adverse cardiac and cerebrovascular events in unprotected left main coronary artery disease patients who underwent coronary artery bypass grafting

  • Original Article
  • Published:
Irish Journal of Medical Science (1971 -) Aims and scope Submit manuscript

Abstract

Objective

This study aimed to explore the effect of a comprehensive rehabilitation and intensive education (CRIE) program on anxiety, depression, quality of life (QoL), and major adverse cardiac and cerebrovascular events (MACCE) risk in unprotected left main coronary artery disease (ULMCAD) patients who underwent coronary artery bypass grafting (CABG).

Methods

In total, 300 ULMCAD patients who underwent CABG were randomly assigned to the CRIE group or usual care (UC) group in a 1:1 ratio. During a 12-month intervention, anxiety and depression were evaluated by Hospital Anxiety and Depression Scale (HADS), QoL was evaluated by 12-Item Short-Form Health Survey (SF-12), on discharge day from hospital (M0), and at 3 months after the discharge (M3), M6, and M12. All patients were further followed up until occurrence of MACCE or for an additional 24 months, and MACCE accumulating occurrence rate was calculated.

Results

At M12, HADS-anxiety score and anxiety prevalence (17.3% vs. 29.3%) were decreased in the CRIE group than those in the UC group, meanwhile HADS-depression score and depression prevalence (15.3% vs. 24.7%) were also reduced in the CRIE group than those in the UC group. For QoL, SF-12 Physical Component Summary (PCS) score at M6/M12, and SF-12 PCS score change (M12 − M0) were increased in the CRIE group than those in the UC group; meanwhile, SF-12 Mental Component Summary (MCS) score at M12 and SF-12 PCS score change (M12 − M0) were increased in the CRIE group than those in the UC group as well. Besides, MACCE accumulating occurrence rate was numerically lower in the CRIE group compared with that in the UC group but without statistical significance.

Conclusions

CRIE is an effective approach in improving anxiety, depression, and QoL in ULMCAD patients who underwent CABG.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References

  1. Mathers CD, Loncar D (2006) Projections of global mortality and burden of disease from 2002 to 2030. PLoS Med 3(11):e442. https://doi.org/10.1371/journal.pmed.0030442

    Article  PubMed  PubMed Central  Google Scholar 

  2. Alexander JH, Smith PK (2016) Coronary-artery bypass grafting. N Engl J Med 374(20):1954–1964. https://doi.org/10.1056/NEJMra1406944

    Article  CAS  PubMed  Google Scholar 

  3. Collet C, Capodanno D, Onuma Y, Banning A, Stone GW, Taggart DP, Sabik J, Serruys PW (2018) Left main coronary artery disease: pathophysiology, diagnosis, and treatment. Nat Rev Cardiol 15(6):321–331. https://doi.org/10.1038/s41569-018-0001-4

    Article  PubMed  Google Scholar 

  4. Braunwald E (2016) Treatment of left main coronary artery disease. N Engl J Med 375(23):2284–2285. https://doi.org/10.1056/NEJMe1612570

    Article  PubMed  Google Scholar 

  5. Palmerini T, Serruys P, Kappetein AP, Genereux P, Riva DD, Reggiani LB, Christiansen EH, Holm NR, Thuesen L, Makikallio T, Morice MC, Ahn JM, Park SJ, Thiele H, Boudriot E, Sabatino M, Romanello M, Biondi-Zoccai G, Cavalcante R, Sabik JF, Stone GW (2017) Clinical outcomes with percutaneous coronary revascularization vs coronary artery bypass grafting surgery in patients with unprotected left main coronary artery disease: a meta-analysis of 6 randomized trials and 4,686 patients. Am Heart J 190:54–63. https://doi.org/10.1016/j.ahj.2017.05.005

    Article  PubMed  Google Scholar 

  6. Carney RM, Blumenthal JA, Freedland KE, Youngblood M, Veith RC, Burg MM, Cornell C, Saab PG, Kaufmann PG, Czajkowski SM, Jaffe AS, Investigators E (2004) Depression and late mortality after myocardial infarction in the Enhancing Recovery in Coronary Heart Disease (ENRICHD) study. Psychosom Med 66(4):466–474. https://doi.org/10.1097/01.psy.0000133362.75075.a6

    Article  PubMed  Google Scholar 

  7. Carney RM, Freedland KE, Sheps DS (2004) Depression is a risk factor for mortality in coronary heart disease. Psychosom Med 66(6):799–801. https://doi.org/10.1097/01.psy.0000146795.38162.b1

    Article  PubMed  Google Scholar 

  8. Watkins LL, Koch GG, Sherwood A, Blumenthal JA, Davidson JR, O'Connor C, Sketch MH (2013) Association of anxiety and depression with all-cause mortality in individuals with coronary heart disease. J Am Heart Assoc 2(2):e000068. https://doi.org/10.1161/JAHA.112.000068

    Article  PubMed  PubMed Central  Google Scholar 

  9. Kotb A, Hsieh S, Wells GA (2014) The effect of telephone support interventions on coronary artery disease (CAD) patient outcomes during cardiac rehabilitation: a systematic review and meta-analysis. PLoS One 9(5):e96581. https://doi.org/10.1371/journal.pone.0096581

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  10. Taylor RS, Brown A, Ebrahim S, Jolliffe J, Noorani H, Rees K, Skidmore B, Stone JA, Thompson DR, Oldridge N (2004) Exercise-based rehabilitation for patients with coronary heart disease: systematic review and meta-analysis of randomized controlled trials. Am J Med 116(10):682–692. https://doi.org/10.1016/j.amjmed.2004.01.009

    Article  PubMed  Google Scholar 

  11. Balady GJ, Williams MA, Ades PA, Bittner V, Comoss P, Foody JM, Franklin B, Sanderson B, Southard D, American Heart Association Exercise CR, Prevention Committee tCoCC, American Heart Association Council on Cardiovascular N, American Heart Association Council on E, Prevention, American Heart Association Council on Nutrition PA, Metabolism, American Association of C, Pulmonary R (2007) Core components of cardiac rehabilitation/secondary prevention programs: 2007 update: a scientific statement from the American Heart Association Exercise, Cardiac Rehabilitation, and Prevention Committee, the Council on Clinical Cardiology; the Councils on Cardiovascular Nursing, Epidemiology and Prevention, and Nutrition, Physical Activity, and Metabolism; and the American Association of Cardiovascular and Pulmonary Rehabilitation. Circulation 115(20):2675–2682. https://doi.org/10.1161/CIRCULATIONAHA.106.180945

    Article  PubMed  Google Scholar 

  12. Park SJ, Kim YH, Park DW, Yun SC, Ahn JM, Song HG, Lee JY, Kim WJ, Kang SJ, Lee SW, Lee CW, Park SW, Chung CH, Lee JW, Lim DS, Rha SW, Lee SG, Gwon HC, Kim HS, Chae IH, Jang Y, Jeong MH, Tahk SJ, Seung KB (2011) Randomized trial of stents versus bypass surgery for left main coronary artery disease. N Engl J Med 364(18):1718–1727. https://doi.org/10.1056/NEJMoa1100452

    Article  CAS  PubMed  Google Scholar 

  13. Fletcher GF, Ades PA, Kligfield P, Arena R, Balady GJ, Bittner VA, Coke LA, Fleg JL, Forman DE, Gerber TC, Gulati M, Madan K, Rhodes J, Thompson PD, Williams MA, American Heart Association Exercise CR, Prevention Committee of the Council on Clinical Cardiology CoNPA, Metabolism CoC, Stroke N, Council on E, Prevention (2013) Exercise standards for testing and training: a scientific statement from the American Heart Association. Circulation 128(8):873–934. https://doi.org/10.1161/CIR.0b013e31829b5b44

    Article  PubMed  Google Scholar 

  14. Zigmond AS, Snaith RP (1983) The hospital anxiety and depression scale. Acta Psychiatr Scand 67(6):361–370

    Article  CAS  Google Scholar 

  15. Lam CL, Tse EY, Gandek B (2005) Is the standard SF-12 health survey valid and equivalent for a Chinese population? Qual Life Res 14(2):539–547

    Article  Google Scholar 

  16. Ware J, Kosinski M, Keller S (1995) SF-12 how to score the Sf-12 physical and mental health summary scales. The Health Health Institute, New England Medical Center, Boston

  17. Kang SH, Ahn JM, Lee CH, Lee PH, Kang SJ, Lee SW, Kim YH, Lee CW, Park SW, Park DW, Park SJ (2017) Differential event rates and independent predictors of long-term major cardiovascular events and death in 5795 patients with unprotected left main coronary artery disease treated with stents, bypass surgery, or medication: insights from a large international multicenter registry. Circ Cardiovasc Interv 10(7). https://doi.org/10.1161/CIRCINTERVENTIONS.116.004988

  18. Zhang L, Zhang L, Wang J, Ding F, Zhang S (2017) Community health service center-based cardiac rehabilitation in patients with coronary heart disease: a prospective study. BMC Health Serv Res 17(1):128. https://doi.org/10.1186/s12913-017-2036-3

    Article  PubMed  PubMed Central  Google Scholar 

  19. Ku SL, Ku CH, Ma FC (2002) Effects of phase I cardiac rehabilitation on anxiety of patients hospitalized for coronary artery bypass graft in Taiwan. Heart Lung 31(2):133–140

    Article  Google Scholar 

  20. Borzou SR, Amiri S, Salavati M, Soltanian AR, Safarpoor G (2018) Effects of the first phase of cardiac rehabilitation training on self-efficacy among patients undergoing coronary artery bypass graft surgery. J Tehran Heart Cent 13(3):126–131

    PubMed  PubMed Central  Google Scholar 

  21. Socha M, Wronecki K, Sobiech KA (2017) Gender and age-dependent differences in body composition changes in response to cardiac rehabilitation exercise training in patients after coronary artery bypass grafting. Ann Agric Environ Med 24(3):517–521. https://doi.org/10.5604/12321966.1230731

    Article  PubMed  Google Scholar 

  22. Pinto R, Angarten V, Santos V, Melo X, Santa-Clara H (2019) The effect of an expanded long-term periodization exercise training on physical fitness in patients with coronary artery disease: study protocol for a randomized controlled trial. Trials 20(1):208. https://doi.org/10.1186/s13063-019-3292-9

    Article  PubMed  PubMed Central  Google Scholar 

  23. Intarakamhang P, Intarakamhang U (2012) Effects of the comprehensive cardiac rehabilitation program on psychological factors and quality of life among coronary heart disease patients. Global J Health Sci 5(2):145–152. https://doi.org/10.5539/gjhs.v5n2p145

    Article  Google Scholar 

  24. Hojskov IE, Moons P, Egerod I, Olsen PS, Thygesen LC, Hansen NV, La Cour S, Bech KH, Borregaard B, Gluud C, Winkel P, Lindschou J, Kikkenborg Berg S (2019) Early physical and psycho-educational rehabilitation in patients with coronary artery bypass grafting: a randomized controlled trial. J Rehabil Med 51(2):136–143. https://doi.org/10.2340/16501977-2499

    Article  PubMed  Google Scholar 

  25. Sepehri A, Beggs T, Hassan A, Rigatto C, Shaw-Daigle C, Tangri N, Arora RC (2014) The impact of frailty on outcomes after cardiac surgery: a systematic review. J Thorac Cardiovasc Surg 148(6):3110–3117. https://doi.org/10.1016/j.jtcvs.2014.07.087

    Article  PubMed  Google Scholar 

  26. Yau DKW, Wong MKH, Wong WT, Gin T, Underwood MJ, Joynt GM, Lee A (2019) PREhabilitation for improving QUality of recovery after ELective cardiac surgery (PREQUEL) study: protocol of a randomised controlled trial. BMJ Open 9(5):e027974. https://doi.org/10.1136/bmjopen-2018-027974

    Article  PubMed  PubMed Central  Google Scholar 

  27. Jolliffe JA, Rees K, Taylor RS, Thompson D, Oldridge N, Ebrahim S (2000) Exercise-based rehabilitation for coronary heart disease. Cochrane Database Syst Rev 4:CD001800. https://doi.org/10.1002/14651858.CD001800

    Article  Google Scholar 

  28. Wang X, Cai G, Wang Y, Liu R, Xi Z, Li G, Wen W, Wu Y, Wang C, Ji Q, Wang X, Zhang Q, Zeng Y, Wang L, Liu W, Zhou Y (2019) Comparison of long-term outcomes of young patients after a coronary event associated with familial hypercholesterolemia. Lipids Health Dis 18(1):131. https://doi.org/10.1186/s12944-019-1074-8

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  29. Brostow DP, Warsavage TJ, Abbate LM, Starosta AJ, Brenner LA, Plomondon ME, Valle JA (2019) Mental illness and obesity among veterans undergoing percutaneous coronary intervention: insights from the VA CART program. Clin Obes 9(2):e12300. https://doi.org/10.1111/cob.12300

    Article  PubMed  Google Scholar 

  30. Singh B, Singh A, Goyal A, Chhabra S, Tandon R, Aslam N, Mohan B, Wander GS (2019) The prevalence, clinical spectrum and the long term outcome of ST-segment elevation myocardial infarction in young - a prospective observational study. Cardiovasc Revasc Med 20(5):387–391. https://doi.org/10.1016/j.carrev.2018.07.020

    Article  PubMed  Google Scholar 

Download references

Funding

The research was supported by National Clinical Key Specialty Construction Project.

Author information

Authors and Affiliations

  1. Department of Cardiovascular Surgery, The First Affiliated Hospital of Harbin Medical University, 23 Youzheng Street, Harbin, 150001, Heilongjiang, China

    Liyuan Ma, Li Deng & Hui Yu

Authors
  1. Liyuan Ma
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Li Deng
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Hui Yu
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Hui Yu.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This study was approved by the Institutional Review Board of The First Affiliated Hospital of Harbin Medical University and was performed in line with Declaration of Helsinki and Good Clinical Practice guidelines. All patients provided written informed consents before recruitment.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Ma, L., Deng, L. & Yu, H. The effects of a comprehensive rehabilitation and intensive education program on anxiety, depression, quality of life, and major adverse cardiac and cerebrovascular events in unprotected left main coronary artery disease patients who underwent coronary artery bypass grafting. Ir J Med Sci 189, 477–488 (2020). https://doi.org/10.1007/s11845-019-02129-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11845-019-02129-x

Keywords

Search

Navigation