Background Despite its well-established positive effects, exercise-based cardiac rehabilitation (exCR) is underused in patients following an acute myocardial infarction (AMI). The aim of the study was to identify factors associated with non-attendance at exCR in patients post-AMI in a large Swedish cohort. Methods A total of 31,297 patients who have suffered an AMI, mean age 62.4 ± 4 years, were included from the SWEDEHEART registry during the years 2010–2016. Comparisons between attenders and non-attenders at exCR were done at baseline for the following variables: age, sex, body mass index, occupational status, smoking, previous diseases, type of index cardiac event and intervention, and left ventricular function. Distance of residence from the hospital and type of hospital were added as structural variables in logistic regression analyses, with non-attendance at exCR at one-year follow-up as dependent, and with individual and structural variables as independent variables. Results In total, 16,214 (52%) of the patients did not attend exCR. The strongest predictor for non-attendance was distance to the exCR centre (OR 1.75 [95% CI: 1.64–1.86]). Other predictors for non-attendance included smoking, history of stroke, percutaneous coronary intervention (PCI), coronary artery bypass grafting (CABG), AMI or diabetes, male sex, being retired vs. being employed, and being followed-up at a county hospital. Patients with ST-elevation myocardial infarction (STEMI) and those intervened with PCI or CABG were more likely to attend exCR. Conclusions A distance greater than 16 km was associated with increased probability of non-attendance at exCR, as were smoking, a higher burden of comorbidities, and male sex. A better understanding of individual and structural factors can support the development of future rehabilitation services.
Background: Few studies have measured device-based physical activity and sedentary behaviour following a percutaneous coronary intervention (PCI), with no studies comparing these behaviours between countries using the same methods. The aim of the study was to compare device-based physical activity and sedentary behaviour, using a harmonised approach, following a PCI on-entry into centre-based cardiac rehabilitation in two countries. Methods: A cross-sectional study was conducted at two outpatient cardiac rehabilitation centres in Australia and Sweden. Participants were adults following a PCI and commencing cardiac rehabilitation (Australia n = 50, Sweden n = 133). Prior to discharge from hospital, Australian participants received brief physical activity advice (< 5 mins), while Swedish participants received physical activity counselling for 30 min. A triaxial accelerometer (Actigraph GT3X/ActiSleep) was used to objectively assess physical activity (light (LPA), moderate-to-vigorous (MVPA)) and sedentary behaviour. Outcomes included daily minutes of physical activity and sedentary behaviour, and the proportion and distribution of time spent in each behaviour. Results: There was no difference in age, gender or relationship status between countries. Swedish (S) participants commenced cardiac rehabilitation later than Australian (A) participants (days post-PCI A 16 vs S 22, p < 0.001). Proportionally, Swedish participants were significantly more physically active and less sedentary than Australian participants (LPA A 27% vs S 30%, p < 0.05; MVPA A 5% vs S 7%, p < 0.01; sedentary behaviour A 68% vs S 63%, p < 0.001). When adjusting for wear-time, Australian participants were doing less MVPA minutes (A 42 vs S 64, p < 0.001) and more sedentary behaviour minutes (A 573 vs S 571, p < 0.001) per day. Both Swedish and Australian participants spent a large part of the day sedentary, accumulating 9.5 h per day in sedentary behaviour.
In order to find possible factors predicting suicide among psychiatric patients, a prospective study of 2,184 in- and outpatients treated at the Department of Psychiatry, Linköping, Sweden, during 1976 was made. Information was obtained by semi-structured interview covering demographics, diagnosis, symptomatology, life events and received treatment, supplemented by officially registered information about annual income, public assistance, sick-leave and cause of death. During the period of observation (1-2 years), 34 patients had committed suicide. These were matched according to age, sex, diagnosis and in- or outpatient status with controls from the original census. The findings suggest that psychiatric patients who commit suicide, often are drug and alcohol abusers and neurotics with symptoms of depression. They often have made suicide attempts earlier in their lives, are often widowed and have suffered loss of key persons by death. After the initial contact they receive less outpatient treatment than controls. Their method of committing suicide is mainly by intoxication.
Summary Aortic valve surgery is the definitive treatment for aortic stenosis ( AS ). No specific recommendation is available on how exercise training should be conducted and evaluated after aortic valve replacement ( AVR ). This study aimed to examine the effect of aerobic exercise training on exercise capacity following AVR . In addition to our primary outcome variable, peak oxygen uptake (peak VO 2 ), the effect on submaximal cardiopulmonary variables including oxygen uptake kinetics (tau), oxygen uptake efficiency slope ( OUES ) and ventilatory efficiency ( VE / VCO 2 slope) was evaluated. Following AVR due to AS , 12 patients were randomized to either a group receiving 12 weeks of supervised aerobic exercise training ( EX ) or a control group ( CON ). Exercise capacity was assessed by a maximal cardiopulmonary exercise test ( CPET ). There was a significant increase in peak load (+28%, P = 0·031) and in peak VO 2 (+23%, P = 0·031) in EX , corresponding to an increase in achieved percentage of predicted peak VO 2 from 88 to 104% ( P = 0·031). For submaximal variables, there were only non‐statistically significant trends in improvement between CPET s in EX . In CON , there were no significant differences in any maximal or submaximal variable between CPET s. We conclude that 12 weeks of supervised aerobic exercise training induces significant adaptations in cardiopulmonary function following AVR , especially in regard to maximal variables including peak VO 2 . In addition, we provide novel data on the effect on several submaximal variables following exercise training in this group of patients.
BackgroundTo help patients with coronary artery disease (CAD) benefit from the positive health effects attained by exercise-based cardiac rehabilitation (CR), adherence to these programmes according to international guidelines is important. Strategies to increase adherence to exercise-based CR are mainly an unexplored area. The objective of this study is to investigate the effects of a behavioural medicine intervention in physiotherapy, containing goal-setting, self-monitoring and feedback, with the aim of improving rehabilitation outcomes for exercise-based CR, compared with usual care.MethodsThis is a randomised, controlled trial. A total of 160 patients with CAD will be included consecutively at the Coronary Care Unit at a university hospital in Sweden. Patients are randomised 1:1 using sealed envelopes to usual care or a behavioural medicine intervention in physiotherapy, in addition to usual care for 4 months. Outcome assessment at baseline, 4 and 12 months includes submaximal aerobic capacity (primary outcome), exercise adherence, muscle endurance, level of physical activity, biomarkers, anxiety and depression, health-related quality of life, patient enablement and self-efficacy (secondary outcomes).DiscussionThis is the first study to evaluate the role of an integrated behavioural medicine intervention in exercise-based CR in the effects of rehabilitation outcomes. The results of this study will provide valuable information about the effect of these interventions in exercise-based CR and it has the potential to inform and assist in further treatment in secondary prevention for patients with CAD.Trial registrationThe study include all items from the World Health Organization Trial Registration Data Set. Trial registration number: NCT02895451, 2016-08-16, retrospectively registered.
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