Gill Furze

Prehabilitation prior to CABG surgery improves physical functioning and depression.

Background Many patients demonstrate psychological distress and reduced physical activity before coronary artery bypass graft surgery (CABG). Here we evaluated the addition of a brief, cognitive-behavioural intervention (the HeartOp Programme) to routine nurse counselling for people waiting for CABG surgery. Methods Randomised controlled trial comparing nurse counselling with the HeartOp programme to routine nurse counselling in 204 patients awaiting first time elective CABG. Primary outcome measures were: anxiety and length of hospital stay; secondary outcome measures were: depression, physical functioning, cardiac misconceptions and cost utility. Measures were collected prior to randomisation and after 8 weeks of their intervention prior to surgery, excepting length of hospital stay which was collected after discharge following surgery. Results 100 patients were randomised to intervention, 104 to control. At follow-up there were no differences in anxiety or length of hospital stay. There were significant differences in depression (difference = 7.79, p = 0.008, 95% CI = 2.04–13.54), physical functioning (difference = 0.82, p = 0.001, 95%CI = 0.34–1.3) and cardiac misconceptions (difference = 2.56, p < 0.001, 95%CI = 1.64–3.48) in favour of the HeartOp Programme. The only difference to be maintained following surgery was in cardiac misconceptions. The HeartOp Programme was found to have an Incremental Cost Effectiveness Ratio (ICER) of £288.83 per Quality-Adjusted Life Year. Conclusions Nurse counselling with the HeartOp Programme reduces depression and cardiac misconceptions and improves physical functioning before bypass surgery significantly more than nurse counselling alone and meets the accepted criteria for cost efficacy.

Quality‐of‐life measurement in chronic heart failure: do we take account of the patient perspective?

The modern management of chronic heart failure has led to improved life expectancy, functioning and health‐related quality of life (HRQL). HRQL measures the effects of an illness or a treatment from the patients perspective. It is now recognised that the patients perspective is as legitimate and valid as the clinicians in monitoring health care outcomes. Although there are a number of quality‐of‐life measures, which can be separated into two types—generic and disease specific—many have been developed, with little or no account being taken of the patients perspective. Because most of the widely used measures are not patient centred, they may lack sensitivity and specificity in determining those aspects of HRQL important to individual patients.

Development of the York Angina Beliefs Questionnaire

It is known that people who have suffered a heart attack can hold misconceived or maladaptive beliefs and that these can have a deleterious effect on quality of life and functioning. It has also been noted that clinicians do not routinely elicit these maladaptive beliefs. It is probable that angina sufferers also hold such beliefs. As angina is a great burden in the western world, with over two million people with angina in the UK alone, there may be large numbers of people who suffer from these frightening and unhelpful misconceptions. We believe that there is a need for a simple questionnaire that could assist the delivery of tailored education directed at dispelling common misconceptions. This article details the development and psychometric properties of just such a brief questionnaire, designed for use both in research and in clinical practice.

Randomized controlled trials of interventions to change maladaptive illness beliefs in people with coronary heart disease: systematic review

AIM This paper is a report of a systematic review of randomized controlled trials of interventions to change maladaptive illness beliefs in people with coronary heart disease, and was conducted to determine whether such interventions were effective in changing maladaptive beliefs, and to assess any consequent change in coping and outcome. BACKGROUND An increasing body of evidence suggests that faulty beliefs can lead to maladaptive behaviours and, in turn, to poor outcomes. However, the effectiveness of interventions to change such faulty illness beliefs in people with coronary heart disease is unknown. DATA SOURCES Multiple data bases were searched using a systematic search strategy. In addition, reference lists of included papers were checked and key authors in the field contacted. REVIEW METHODS The systematic review included randomized controlled trials with adults of any age with a diagnosis of coronary heart disease and an intervention aimed at changing cardiac beliefs. The primary outcome measured was change in beliefs about coronary heart disease. RESULTS Thirteen trials met the inclusion criteria. Owing to the heterogeneity of these studies, quantitative synthesis was not practicable. Descriptive synthesis of the results suggested that cognitive behavioural and counselling/education interventions can be effective in changing beliefs. The effects of changing beliefs on behavioural, functional and psychological outcomes remain unclear. CONCLUSION While some interventions may be effective in changing beliefs in people with coronary heart disease, the effect of these changes on outcome is not clear. Further high quality research is required before firmer guidance can be given to clinicians on the most effective method to dispel cardiac misconceptions.

Avoidance coping styles predict mortality among patients with congestive heart failure: a 6-year follow-up study

The present study was undertaken to evaluate the effects of avoidance coping styles upon mortality risk among patients with symptomatic congestive heart failure. Proportional hazard models were used to evaluate the effect of avoidance coping styles on mortality among 119 clinically stable patients (71.4% men; mean age 66.0±9.1 years), recruited from an outpatient cardiology practice. Fifty-one deaths were registered during the 6-year follow-up period, all from cardiac causes. The results showed that behavioural disengagement was significantly associated with increased risk of mortality. This finding is of concern to health care professionals and should have implications for treatment of patients with CHF. Given the link between avoidance-oriented coping styles and mortality demonstrated in the present study, it is important to explore possible ways in which counselling in active coping skills might help patients to manage their disease and thereby increase their longevity.

Attributions and Misconceptions in Angina: An Exploratory Study

Although there have been a number of studies regarding attributions and misconceptions in people following a heart attack, there have been no comparable studies in people with angina. Semi-structured interviews were held with 20 people suffering from angina to discover their beliefs about angina, particularly those that may be misconceived or associated with maladaptive coping. Nineteen of the 20 participants held such beliefs. Stress was the most frequent causal attribution and misconceived angina avoidance strategies were cited by the majority. The beliefs about angina held by this sample may have implications for their health-related quality of life, if their experience mirrors that found within heart attack populations.

Randomized controlled trial of a lay-facilitated angina management programme.

Aims This article reports a randomized controlled trial of lay-facilitated angina management (registered trial acronym: LAMP). Background Previously, a nurse-facilitated angina programme was shown to reduce angina while increasing physical activity, however most people with angina do not receive a cardiac rehabilitation or self-management programme. Lay people are increasingly being trained to facilitate self-management programmes. Design A randomized controlled trial comparing a lay-facilitated angina management programme with routine care from an angina nurse specialist. Methods Participants with new stable angina were randomized to the angina management programme (intervention: 70 participants) or advice from an angina nurse specialist (control: 72 participants). Primary outcome was angina frequency at 6 months; secondary outcomes at 3 and 6 months included: risk factors, physical functioning, anxiety, depression, angina misconceptions and cost utility. Follow-up was complete in March 2009. Analysis was by intention-to-treat; blind to group allocation. Results There was no important difference in angina frequency at 6 months. Secondary outcomes, assessed by either linear or logistic regression models, demonstrated important differences favouring the intervention group, at 3 months for: Anxiety, angina misconceptions and for exercise report; and at 6 months for: Anxiety; Depression; and angina misconceptions. The intervention was considered cost-effective. Conclusion The angina management programme produced some superior benefits when compared to advice from a specialist nurse.

Development and validation of a patient-centered health-related quality-of-life measure: the chronic heart failure assessment tool.

Objective: Despite the importance of health-related quality of life (HRQL) as an outcome measure in chronic heart failure (CHF), instruments currently available have been developed by clinicians or researchers; none have been derived from the patients perspective. The purpose of this study was to develop and validate a patient-derived, disease-specific HRQL measure. Methods: The psychometric testing of the Chronic Heart Failure Assessment Tool (CHAT) followed 2 phases: testing the psychometric properties (n = 223) of the 51-item version of the CHAT in a postal survey and validation of the CHAT (n = 68) using the Medical Outcomes Study 36-Item Short-Form Health Survey and the Minnesota Living With Heart Failure questionnaire. Results: The CHAT contains questions measuring 7 themes of HRQL: physical ability, emotional state, self-perception, relationships, coping with symptoms, maintaining social/lifestyle status, and cognitive aspects in respect to CHF. Factor analysis was used to analyze these themes. Four domains emerged: symptoms, activity levels, psychosocial aspects, and emotions. Conclusion: The CHAT comprises dimensions of HRQL identified by patients in the study population that may more appropriately reflect the concerns of patients. Further work is recommended to develop this tool for use as an HRQL measure in a CHF population.

Cardiac misconceptions: comparisons among nurses, nursing students and people with heart disease in Taiwan

AIM This paper is a report of a study to examine the misconceived and potentially maladaptive beliefs (cardiac misconceptions) about heart disease held by nurses, nursing students and people with heart disease in Taiwan. BACKGROUND Research suggests that misconceived and maladaptive beliefs about heart disease influence outcomes in people with heart disease, and that eliciting and dispelling incorrect beliefs can reduce disability in this population. However, nurses do not routinely elicit maladaptive beliefs or attempt to dispel them. METHOD Between October 2005 and March 2006, a survey was conducted using version 1 of the York Cardiac Beliefs Questionnaire to measure cardiac misconceptions in 64 hospital-based nurses (13 of whom were cardiac nurses), 134 nursing students and 238 people with heart disease. RESULTS Nursing students held fewer cardiac misconceptions than nurses (P = 0.042). There were no statistically significant differences in the numbers of misconceptions between cardiac and general nurses, and no statistically significant associations between level of qualification, years of nursing experience and number of misconceptions. Nurses with higher levels of education were more likely to hold fewer misconceptions (P = 0.24). Patients held statistically significantly more misconceptions about heart problems than nurses (P < 0.001). CONCLUSION Nurses who are involved in the care for people with heart disease have a responsibility to assess and dispel peoples misconceptions about their condition, and therefore continuing professional education is required to develop this clinical expertise. Future research should focus on methods of dispelling cardiac misconceptions in both nursing and patient education.

An intervention to reassure patients about test results in rapid access chest pain clinic: a pilot randomised controlled trial

BackgroundMost people referred to rapid access chest pain clinics have non-cardiac chest pain, and in those diagnosed with stable coronary heart disease, guidance recommends that first-line treatment is usually medication rather than revascularisation. Consequently, many patients are not reassured they have the correct diagnosis or treatment. A previous trial reported that, in people with non-cardiac chest pain, a brief discussion with a health psychologist before the tests about the meaning of potential results led to people being significantly more reassured. The aim of this pilot was to test study procedures and inform sample size for a future multi-centre trial and to gain initial estimates of effectiveness of the discussion intervention.MethodsThis was a two-arm pilot randomised controlled trial in outpatient rapid access chest pain clinic in 120 people undergoing investigation for new onset, non-urgent chest pain. Eligible participants were randomised to receive either: a discussion about the meaning and implication of test results, delivered by a nurse before tests in clinic, plus a pre-test pamphlet covering the same information (Discussion arm) or the pre-test pamphlet alone (Pamphlet arm). Main outcome measures were recruitment rate and feasibility for a future multi-centre trial, with an estimate of reassurance in the groups at month 1 and 6 using a 5-item patient-reported scale.ResultsTwo hundred and seventy people attended rapid access chest pain clinic during recruitment and 120/270 participants (44%) were randomised, 60 to each arm. There was no evidence of a difference between the Discussion and Pamphlet arms in the mean reassurance score at month 1 (34.2 vs 33.7) or at month 6 (35.3 vs 35.9). Patient-reported chest pain and use of heart medications were also similar between the two arms.ConclusionsA larger trial of the discussion intervention in the UK would not be warranted. Patients reported high levels of reassurance which were similar in patients receiving the discussion with a nurse and in those receiving a pamphlet alone.Trial registrationCurrent Controlled Trials ISRCTN60618114 (assigned 27.05.2011).