Exercise reduces morbidity and mortality for patients with heart disease. Despite clear guidelines and known benefits, most cardiac patients do not meet current exercise recommendations. Physician endorsement positively affects patient participation in hospital-based Phase II cardiac rehabilitation programs, yet the importance of physician recommendation for home-based cardiac rehabilitation exercise is unknown. A prospective observational design was used to examine predictors of both home-based and Phase II rehabilitation exercise in a sample of 251 patients with coronary heart disease. Regression analyses were done to examine demographic and clinical characteristics, physical functioning, and patient's report of physician recommendation for exercise. Patients with a strong physician referral, who were married and older, were more likely to participate in Phase II exercise. Increased strength of physician recommendation was the unique predictor of home-based exercise. Further research is needed to examine how health professionals can motivate cardiac patients to exercise in home and outpatient settings.

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Objective The aim of this study was to evaluate the reliability and validity of the State-Trait Hopelessness Scale (STHS) in patients with heart disease who report moderate to severe state hopelessness. Methods Reliability, concurrent validity, and convergent validity were evaluated for 20 patients. Results Cronbach's α for the State and Trait subscales were .81 and .79, respectively. Strong correlations between the State Hopelessness Subscale and Patient Health Questionnaire-9 (r = 0.77, P < .001), State Hope Scale (r = −0.75, P < .001), EQ-5D-5L (r = 0.59, P < .005), and PROMIS-29 domains of depression (P = .72, P < .001), fatigue (P = .61, P < .001), and social roles (P = .45, P = .047) were found. There were strong correlations between the Trait Hopelessness Subscale and Trait Hope Scale (r = −0.58, P < .005), State Hope Scale (r = −0.49, P = .03), and PROMIS-29 fatigue domain (r = 0.54, P = .015). Conclusions Findings support the reliability and validity of the STHS for evaluation of hopelessness in patients with heart disease.

Background Investigators conducting studies that include potentially suicidal individuals are obligated to develop a suicide risk management (SRM) protocol. There is little available in the literature to guide researchers in SRM protocol development. Objectives The aim of the study was to describe an SRM protocol developed for a randomized controlled trial (RCT) currently enrolling cardiac patients who report moderate to severe levels of hopelessness. Methods The SRM protocol identifies suicidal ideation and measures ideation severity through use of the Columbia-Suicide Severity Rating Scale risk factor questions. Based on responses, study participants are deemed safe or at low, moderate, or high risk for suicide. The SRM protocol guides research staff through a plan of action based on risk level. The protocol further guides staff through a plan over the course of this prospective study—from hospital enrollment to home-based visits. Results Research staff are well trained to identify suicidal ideation risk factors, initiate specific questioning about suicidal intent, determine level of risk, identify protective factors and a safe environment, and make referrals if needed. Of the 51 patients hospitalized with cardiac disease who reported moderate to severe hopelessness, 43 scored at a safe suicide risk level and 8 scored at low risk. Thirty-five of the 51 patients enrolled in the RCT. Of the 35 participants who received home visits to date, there have been three instances of low and one instance of moderate suicide risk. The SRM protocol has been consistently and accurately used by research personnel in both hospital and home settings. One modification has been made to the protocol since study activation, namely, the addition of an assessment of counseling history and encouragement of continued counseling. Booster training sessions of research staff will continue throughout the course of the RCT. Discussion Use of the SRM protocol identifies study participants who are safe or at risk for suicide in both hospital and home settings, and research staff can refer participants accordingly. Conclusion The SRM protocol developed for this RCT can serve as a model in the development of SRM protocols for future research in acute care, community, or home-based settings.

Introduction: Hopelessness is associated with increased adverse events and decreased survival in patients with coronary heart disease (CHD). Hopelessness can persist in these patients and reduce their participation in hospital-based cardiac rehabilitation (CR) exercise following an acute event. Because the majority of CHD patients do not attend a hospital-based CR exercise program, examination of factors affecting home exercise is needed. The purpose of this study was to describe the impact of hopelessness levels on both home- and hospital based CR exercise participation in patients with CHD. Hypothesis: It was hypothesized that higher state and trait hopelessness levels would adversely affect both home- and hospital-based CR exercise participation. Methods: The Theory of Hopelessness Depression was used as a foundation for study aims. Using a descriptive, longitudinal design, 282 patients who had been hospitalized with a CHD event were asked to complete the State-Trait Hopelessness Scale (STHS) during their hospitalization and the STHS and the Cardiac Rehabilitation Exercise Participation Questionnaire at 3, 8, and 12 months after hospital discharge. Patients who provided data at any two concurrent time points over the year were included in the analyses. Regular exercise was defined as walking or biking ≥3 days/week in a home- or hospital-based Phase II CR exercise program. Logistic regression was used to evaluate the relationship between STHS scores on the likelihood that patients would participate in regular exercise in home- or hospital-based Phase II CR settings. Results: Patients were predominantly male (64.9%) with a mean age of 65.4±9.7 years. Patients had persistent, modest levels of state and trait hopelessness across all time points. High levels of state and trait hopelessness were predictive of lower home-based exercise participation (state: OR 0.4, 95% CI [0.1, 0.7], p=0.002; trait: OR 0.4, 95% CI [0.2, 0.8], p=0.01) but not hospital-based Phase II CR exercise, after adjusting for age and sex. Conclusions: These findings demonstrate the importance of assessing hopelessness in patients with CHD and provide critical evidence of the need for clinicians to encourage CHD patients who are feeling hopeless to participate in CR exercise, particularly in the home setting.