Cristiane Maria Carvalho Costa Dias

Quality of Life of Patients After an Acute Coronary Event: Hospital Discharge

Background The acute coronary syndrome (ACS) has a high morbi-mortality rate, including physical deficiencies and functional limitations with impact on quality of life. Cardiovascular rehabilitation 1 (CVR1) should begin as early as possible, to enable improvement in functional capacity and quality of life. Previous studies have shown association of cardiovascular diseases with quality of life, in which depression and anxiety are the domains most altered. The aim of the study is to verify the impact of an acute coronary event on quality of life at the moment of hospital discharge. Methodology This was a cross-sectional study, with ACS patients hospitalized in ICU of a private hospital in the city of Salvador, Brazil, submitted to CVR1. The quality of life questionnaire Euroqol-5D was applied on discharge from hospital. Patients included in the study were those with ACV, who had medical permission to walk, had not been submitted to acute surgical treatment, were time and space oriented, and over the age of 18 years. Patients excluded from the study were those with cognitive, orthopedic and neurological problems, who used orthesis on a lower limb, and were in any condition of risk at the time of beginning with CVR1. Data were collected by a previously trained ICU team. Results Data were collected of 63 patients who revealed compromise in the domains of pain/feeling ill (20.63%) and anxiety/depression (38.09%). Statistical significance was observed in the association between sex and pain/feeling ill (P < 0.01), sex and anxiety/depression (P < 0.01), diabetes and mobility (P < 0.01), hereditary factors and anxiety/depression (p < 0.01), BMI and pain/feeling ill (P < 0.01). Conclusion In this sample of patients, on discharge from hospital after ACS, the pain/feeling ill and anxiety/depression domains were shown to be compromised.

Resposta circulatória à caminhada de 50 m na unidade coronariana, na síndrome coronariana aguda

FUNDAMENTO: Ausencia de tecnica estandarizada y de monitoreo para iniciarse la rehabilitacion de pacientes con sindrome coronaria aguda (SCA), en la unidad coronaria. OBJETIVO: Describir la tecnica y la respuesta circulatoria a la caminata de 50m (C50m)./ METODOS: Estudio experimental, transversal, con 65 pacientes con SCA; el numero de 36 (54%) de ellos con infarto agudo de miocardio (IAM), Killip I; un total de 29 (45,2%) con angina instable (AI); el 61,5% del sexo masculino, edad 62,8 ± 12,7 anos. Caminata con inicio 45 ± 23 horas post internacion. Se calcularon la presion arterial sistolica (PAS mmHg) y diastolica (PAD mmHg), la frecuencia cardiaca (FC bpm), el doble producto (PAS mmHg X FC bpm), la saturacion periferica de oxigeno (SpO2%), el tiempo de caminata y la percepcion del esfuerzo a traves de la escala de Borg (EB). Se obtuvieron mediciones en las posiciones supina, sentada y ortostasis (fase 1 - estres gravitacional), al final de la caminata y del post reposo de 5 minutos (fase 2 - estres fisico). RESULTADOS: Se observo un aumento de la frecuencia cardiaca (FC) al estres gravitacional en la posicion sentada (Δ = 4,18) y en ortostasis (Δ = 2,69), (p 142 mmHg al sentarse se asocio al aumento significativo (p = 0,031) de 11 mmHg al ejercicio en 13 pacientes con sobrepeso/obesidad y el 85% con hipertension. Se verificaron efectos adversos en 19 (29,2%) pacientes, vertigos en el 23,1%, con interrupcion de la caminata en tres de ellos. CONCLUSION: En esta muestra, tras 24 horas del evento coronario, no se verificaron efectos colaterales graves a la C50m.

Circulatory response to a 50-m walk in the coronary care unit in acute coronary syndrome

FUNDAMENTO: Ausencia de tecnica estandarizada y de monitoreo para iniciarse la rehabilitacion de pacientes con sindrome coronaria aguda (SCA), en la unidad coronaria. OBJETIVO: Describir la tecnica y la respuesta circulatoria a la caminata de 50m (C50m)./ METODOS: Estudio experimental, transversal, con 65 pacientes con SCA; el numero de 36 (54%) de ellos con infarto agudo de miocardio (IAM), Killip I; un total de 29 (45,2%) con angina instable (AI); el 61,5% del sexo masculino, edad 62,8 ± 12,7 anos. Caminata con inicio 45 ± 23 horas post internacion. Se calcularon la presion arterial sistolica (PAS mmHg) y diastolica (PAD mmHg), la frecuencia cardiaca (FC bpm), el doble producto (PAS mmHg X FC bpm), la saturacion periferica de oxigeno (SpO2%), el tiempo de caminata y la percepcion del esfuerzo a traves de la escala de Borg (EB). Se obtuvieron mediciones en las posiciones supina, sentada y ortostasis (fase 1 - estres gravitacional), al final de la caminata y del post reposo de 5 minutos (fase 2 - estres fisico). RESULTADOS: Se observo un aumento de la frecuencia cardiaca (FC) al estres gravitacional en la posicion sentada (Δ = 4,18) y en ortostasis (Δ = 2,69), (p 142 mmHg al sentarse se asocio al aumento significativo (p = 0,031) de 11 mmHg al ejercicio en 13 pacientes con sobrepeso/obesidad y el 85% con hipertension. Se verificaron efectos adversos en 19 (29,2%) pacientes, vertigos en el 23,1%, con interrupcion de la caminata en tres de ellos. CONCLUSION: En esta muestra, tras 24 horas del evento coronario, no se verificaron efectos colaterales graves a la C50m.

Quality of life and pain multidimensional aspects in individuals with HTLV-1

HTLV-1 creates a chronic health condition that involves moderate to severe pain with a negative impact on quality of life (QoL). There is no consensus on which attitudes to pain are more related to the worsening of QoL in HTLV-1 infected patients. The aim of this study was to investigate the correlation between QoL and multidimensional aspects of pain in patients with HTLV-1. A cross-sectional study was conducted in Salvador, Bahia, Brazil. The study included individuals diagnosed with HTLV-1. The Short Form 36 Questionnaire was used to analyze QoL, and the Brief Pain Inventory was used to assess multidimensional aspects of pain. The mean pain intensity was 4.88±3.06 on the visual pain scale, and the average impact on QoL corresponded to a loss of approximately 40%. Moderate to high correlations between pain intensity and all domains of QoL were observed and compared reaction attitudes for general activity, mood, ability to walk, ability to work, relationships, sleep, and ability to enjoy life (r>0.40; p<0.05). Moderate correlations were found between all domains of QoL, pain intensity, and reactive attitudes to pain. The greatest pain intensity impacts involved difficulty to walk and to work, and interpersonal relationships in the emotional aspect of QoL.

Use of 50-M Walk Test as a Tool to Assess Phase-1 Cardiovascular Rehabilitation after Acute Coronary Syndrome

Introduction: In 2009, Dias and colls made a contribution to this field by applying the first functional 50-M Walk Test (50MWT) in the Coronary Intensive care Unit (CICU), being able to direct the exercise prescription as well as evaluate the response to a cardiovascular rehabilitation program during hospitalization. As the Cardiovascular Rehabilitation Program 1 (CVR1) does not yet recommend the 50 MWT in CVR1 due to safety measures and cardiovascular repercussion on the program, the inclusion of this tool is necessary as it concerns a population at risk. Objective: Compare the functional response and cardiovascular 50 MWT in patients with ACS who underwent CVR1. Methodology: Single-arm clinical trial, conducted with ACS patients admitted to the CICU of a private Hospital in Salvador - Brazil, from 24 to 48 hours post-event. The inclusion criteria consisted ACS patients with medical permission to walk, and had not been submitted to acute surgical treatments, aged ≥ 18 years who were oriented in time and space. Exclusion criteria included patients with orthopaedic problems, neurological sequelae and the inability to walk independently. Results: A total of 66 patients were gathered to compare the response to tests before CVR1 and at the time of discharge; data of systolic arterial pressure (SBP), heart rate (HR), perceived exertion rate by the Borg Scale (BS), time and speed of walking were evaluated. Measurements were obtained in the supine, seated and orthostatic positions, at the end of the walk, after 5 minutes rest, and walking duration. Statistical significance for SBP, in the time of walking and BS was observed (p ≤ 0.05). HR presented no statistical significance; predominance was shown in the absence of adverse effects in 89.4% of patients. Conclusion: This sample proved that patients who underwent CVR1 program presented an impact on functional capacity interpreted by an increase in walking speed, perceived exertion rate decreased and better blood pressure control during hospital discharge. Furthermore, 50 MWT might safely be applied as a tool before beginning CVR1, and as a method of assessing cardiovascular repercussion in the hospital phase after the program.

Respuesta circulatoria a la caminata de 50m en la unidad coronaria, en la síndrome coronaria aguda

FUNDAMENTO: Ausencia de tecnica estandarizada y de monitoreo para iniciarse la rehabilitacion de pacientes con sindrome coronaria aguda (SCA), en la unidad coronaria. OBJETIVO: Describir la tecnica y la respuesta circulatoria a la caminata de 50m (C50m)./ METODOS: Estudio experimental, transversal, con 65 pacientes con SCA; el numero de 36 (54%) de ellos con infarto agudo de miocardio (IAM), Killip I; un total de 29 (45,2%) con angina instable (AI); el 61,5% del sexo masculino, edad 62,8 ± 12,7 anos. Caminata con inicio 45 ± 23 horas post internacion. Se calcularon la presion arterial sistolica (PAS mmHg) y diastolica (PAD mmHg), la frecuencia cardiaca (FC bpm), el doble producto (PAS mmHg X FC bpm), la saturacion periferica de oxigeno (SpO2%), el tiempo de caminata y la percepcion del esfuerzo a traves de la escala de Borg (EB). Se obtuvieron mediciones en las posiciones supina, sentada y ortostasis (fase 1 - estres gravitacional), al final de la caminata y del post reposo de 5 minutos (fase 2 - estres fisico). RESULTADOS: Se observo un aumento de la frecuencia cardiaca (FC) al estres gravitacional en la posicion sentada (Δ = 4,18) y en ortostasis (Δ = 2,69), (p 142 mmHg al sentarse se asocio al aumento significativo (p = 0,031) de 11 mmHg al ejercicio en 13 pacientes con sobrepeso/obesidad y el 85% con hipertension. Se verificaron efectos adversos en 19 (29,2%) pacientes, vertigos en el 23,1%, con interrupcion de la caminata en tres de ellos. CONCLUSION: En esta muestra, tras 24 horas del evento coronario, no se verificaron efectos colaterales graves a la C50m.