Douglas R. Southard

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

The American Heart Association and the American Association of Cardiovascular and Pulmonary Rehabilitation recognize that all cardiac rehabilitation/secondary prevention programs should contain specific core components that aim to optimize cardiovascular risk reduction, foster healthy behaviors and compliance to these behaviors, reduce disability, and promote an active lifestyle for patients with cardiovascular disease. This update to the previous statement presents current information on the evaluation, interventions, and expected outcomes in each of the core components of cardiac rehabilitation/secondary prevention programs, in agreement with the 2006 update of the American Heart Association/American College of Cardiology Secondary Prevention Guidelines, including baseline patient assessment, nutritional counseling, risk factor management (lipids, blood pressure, weight, diabetes mellitus, and smoking), psychosocial interventions, and physical activity counseling and exercise training.

Core Components of Cardiac Rehabilitation/Secondary Prevention Programs A Statement for Healthcare Professionals From the American Heart Association and the American Association of Cardiovascular and Pulmonary Rehabilitation Writing Group

Cardiac rehabilitation/secondary prevention programs are recognized as integral to the comprehensive care of patients with cardiovascular disease.1 2 In 1994, the American Heart Association stated that cardiac rehabilitation programs should consist of a multifaceted and multidisciplinary approach to overall cardiovascular risk reduction, and that programs that consist of exercise training alone are not considered cardiac rehabilitation.1 This concept has been further developed in the Agency for Health Care Policy and Research clinical practice guideline on cardiac rehabilitation,2 which provides the most comprehensive review of the scientific literature and evidence-based recommendations regarding all aspects of the discipline. …

Clinical trial of an Internet-based case management system for secondary prevention of heart disease.

PURPOSE Despite demonstrated benefits of cardiac rehabilitation and risk factor reduction, only 11% to 38% of eligible patients with cardiovascular disease (CVD) participate in cardiac rehabilitation programs. Women and older adults are particularly less likely to participate in cardiac rehabilitation. In an effort to broaden access to cardiac rehabilitation, the authors developed an alternative Internet-based program that allows nurse case managers to provide risk factor management training, risk factor education, and monitoring services to patients with CVD. METHODS The evaluation consisted of a randomized, clinical trial involving 104 patients with CVD, 53 of whom used the program as a special intervention (SI) for 6 months and 51 of whom received usual care (UC). RESULTS The results indicate that fewer cardiovascular events occurred among the SI subjects (15.7%) than among the UC subjects (4.1%) (P =.053), resulting in a gross cost savings of

Sex differences in cardiovascular reactivity: Effects of the gender relevance of the stressor.

1418 US dollars per patient. With a projected program cost of

Relationship Between Mood and Blood Pressure in the Natural Environment: An Adolescent Population

453 USD per patient, the return on investment is estimated at 213%. More weight loss occurred in the SI group (-3.68 pounds) than in the UC group (+.47 pounds) (P =.003). The differences between the two groups in terms of blood pressure, lipid levels, depression scores, minutes of exercise, and dietary habits were not statistically significant. CONCLUSION An Internet-based case management system could be used as a cost-effective intervention for patients with CVD, either independently or in conjunction with traditional cardiac rehabilitation.

Depression screening in cardiac rehabilitation: AACVPR Task Force Report.

Suggests that sex differences in cardiovascular reactivity (CVR) in past research are a function of differences in cognitive appraisal of stressors as masculine or feminine tasks. In the present study, we examined the role of the gender relevance of the stressor as a mediator of sex differences in CVR. The CVR of male and female college students (n = 95) to the cold pressor test (CPT) was compared under masculine and gender-neutral instructions during an anticipation phase, a stressor phase, and a recovery phase. Men were expected to show greater CVR than women to the masculine CPT but not to the gender-neutral CPT. Results supported this prediction for systolic blood pressure reactivity and heart rate reactivity but not for diastolic blood pressure reactivity. The potential influence of sex differences in appraisal of situations on CVR and coronary heart disease is discussed.

Sex differences in cardiovascular reactivity as a function of the appraised gender relevance of the stressor.

We examined the relation between psychological variables and blood pressure (BP) as 28 adolescents engaged in their customary activities over a 24-hr period in their natural environment. Each subject had previously participated in a laboratory study of cardiovascular reactivity. During the ambulatory monitoring period, subjects monitored mood state, perceptions of the environment, and ambulatory BP at 30-min intervals. Mood ratings and BP were averaged across the waking hours. Systolic blood pressure (SBP) reactivity to laboratory stressors was significantly correlated with average SBP in the home environment. Ambulatory SBP was positively associated with worried, hostile, depressed, and tense mood ratings as well as perceptions of the environment as hostile, demanding, and noisy. Ambulatory diastolic blood pressure was correlated with hostile, depressed, and upset mood ratings as well as with hostile and demanding perceptions of the environment. In general, average ambulatory BP appeared to be associated with negative emotions and perceptions of the environment.

Empirical support for a Type A belief system

more impressive, with several studies suggesting that the impact of depression on QOL exceeds that of cardiac symptoms, ejection fraction, and coronary artery anatomy.6,7 Whether effective treatment of depression can diminish cardiac mortality or morbidity remains a question for future research. However, there are numerous biological links between depression and heart disease, some of which have been shown to be potentially reversible with appropriate treatment of depression.8-11 Although not definitive, existing data do suggest that the treatment of depression in patients with coronary disease is appropriate because depression (1) causes suffering in a variety of contexts; (2) negatively affects treatment compliance; and (3) is associated with adverse clinical events. Furthermore, numerous effective treatments exist including a variety of empirically validated treatments and pharmacotherapy. Indeed, the selective serotonin reuptake inhibitors (SSRIs) class of antidepressants has been shown to be both effective and safe in post-AMI and unstable angina patients.12 Cognitive behavioral therapy has also been shown to improve clinical depression, alone or with the use of SSRIs.13 A A C V P R P O S I T I O N S T A T E M E N T

The type A belief system : relationships to hostility, social support, and life stress

Previous research suggests that sex differences in cardiovascular reactivity are a function of the gender relevance of the stressor. The authors examined the role of a stressors gender relevance as a mediator of sex differences in cardiovascular reactivity. The cardiovascular reactivity of 121 male and female college students to the cold-pressor test was compared under feminine- and masculine-relevant stressor instructions. The women were expected to show greater cardiovascular reactivity than the men were to the test relevant to women, whereas the men were expected to show greater cardiovascular reactivity than the women were to the masculine cold-pressor test. Results supported these predictions for systolic blood pressure reactivity, but not heart rate reactivity. Diastolic blood pressure results were mixed. The women showed greater diastolic reactivity than the men did to the feminine-relevant test, but the men did not show greater diastolic reactivity than the women did to the masculine test. The influence of sex differences in cognitive appraisal of situations on cardiovascular reactivity and coronary heart disease is discussed.

Assessing the Relationship of Type A Beliefs to Cardiovascular Disease Risk and Psychosocial Distress

Much of the research on Type A behavior has focused on overt manifestations of the pattern; consequently, the underlying psychological dimensions are poorly understood (Matthews, 1982). Price (1982) has proposed an elaborate, but empirically unvalidated, model suggesting that a specific set of beliefs underlies the Type A behavior pattern. A series of experiments was conducted to test the validity of Prices model and to develop a device for assessing these beliefs. The internal consistency and test-retest reliability of this measure were .94 and .84, respectively. Significant positive correlations were found with traditional measures of Type A behavior as well as various facets of anger and anxiety. Finally, subjects who endorsed a high degree of Type A beliefs set significantly higher performance standards and were less likely to achieve these standards than their low-scoring counterparts. Results are discussed with regard to the theoretical construct of Type A as well as their implications for future research and treatment.