behavioural and psychological aspects of cardiac rehabilitation

Question 1

what percentage of patients report high levels of anxiety and depression following a cardiac event?

Answer 1

• anxiety = 20-20%
• depression = 15-20%

Question 2

higher levels of anxiety and depression are associated with who?

Answer 2

younger adults

Question 3

what type of patients is more likely to drop out of cardiac rehab?

Answer 3

those with elevated anxiety and depression

Question 4

what age group has the highest dropout rate out of cardiac rehab programs?

Answer 4

those below 65

Question 5

what is the percent increase of coronary artery disease in those with anxiety?

Answer 5

26%

Question 6

anxiety is associated with what percentage risk of cardiovascular mortality?

Answer 6

41%

Question 7

what percent higher are those of stroke when also having anxiety?

Answer 7

71%

Question 8

what percent higher are those at risk of heart failure when experiencing anxiety?

Answer 8

35%

Question 9

what physiological pathways contribute to cardiovascular risk factors/mortality?

Answer 9

• increased inflammation
• ventricular, platelet and autonomic dysfunction (elevated heart rate)

Question 10

what are the 2 most common causes of disability in high-income countries

Answer 10

• cardiovascular disease
• depression

Question 11

what are the key health system and economic indicators relating to CVS and depression?

Answer 11

• rising medical costs
• increased health service utilization
• lost productivity

Question 12

what is commonly experienced as a reaction to an acute coronary event?

Answer 12

• depressed mood
• can be of a temporary nature = an adjustment disorder

Question 13

does CVD or depression come first?

Answer 13

either, or both

Question 14

what needs to be demonstrated for depression to be causally related to CVD?

Answer 14

depression was a ‘risk factor’ rather than just a ‘risk marker’

Question 15

what studies suggest that the presence of depression doubles the risk of developing new CVD?

Answer 15

aetiological studies

Question 16

whata are some putative (causation) mechanisms that are biologically plausible for the connection between depression and cvd?

Answer 16

• alterations in the autonomic nervous system
• platelet receptors and function
• coagulopathic factors
  
  • plasminogen activator inhibitor-1
  • fibrinogen
  • pro-inflammatory cytokines
• poor adherence to medical treatment

Question 17

what are soem treatment methods for depression in CVD?

Answer 17

• cardiac rehabilitation
• pharmacotherapy or medications
• disease management programs
• cognitive behaviour therapy

Question 18

what are some barriers to rehabilitation?

Answer 18

• location
  
  • those living in more rural areas may have to travel far distances to complete the programs
• work responsibilities
• lack of time
• work, family, and/or caregiving responsibilities that limit their time availability

Question 19

what are some sex differences when it comes to CVD and rehab?

Answer 19

• women present with a greater number of modifiable risk factors and have worse physical and mental health compared to men
• women have a greater period of perceived barrier to cardiac rehab program
  
  • women tend to bear the majority of family/caretaker responsibilities

Question 20

what are disease management programs (DMP)?

Answer 20

structured treatment plans that aim to help people better manage their chronic disease and maintain and improve their quality of life

Question 21

who are DMPs available to?

Answer 21

those with

• asthma
• COPD
• breast cancer
• type 1 & 2 diabetes
• coronary artery disease

Question 22

what is the main aim of disease management programs?

Answer 22

• reduce symptoms associated with a chronic disease and keep them from getting worse
• help people cope with their disease and to show them ways of dealing with the demands of their treatment in everyday life

Question 23

how is treatment provided in a disease management program?

Answer 23

• the doctor will prepare an individual treatment plan based on the specification of the DMP
  
  • includes medication, training courses, and regular check-ups

Question 24

what is done to assure quality in a DMP?

Answer 24

documenting and evaluating patient data regularly

Question 25

what is needed to prevent cardiac rehab dropout in women?

Answer 25

modular and flexible programs

Question 26

what is the leading cause of death in women?

Answer 26

cardiovascular disease (51%)

Question 27

what are the reasons for women dropping out of cardiac rehab?

Answer 27

• self-reported health
• health beliefs
• family caregiver role
• work conflicts
• transportation
• distance
• perception of the objective
• exercise component
• bad timing
• CR equipment
• financial assistance for transportation
• long waiting list