Pernille Palm Johansen

Cardiac rehabilitation increases physical capacity but not mental health after heart valve surgery: a randomised clinical trial

Objective The evidence for cardiac rehabilitation after valve surgery remains sparse. Current recommendations are therefore based on patients with ischaemic heart disease. The aim of this randomised clinical trial was to assess the effects of cardiac rehabilitation versus usual care after heart valve surgery. Methods The trial was an investigator-initiated, randomised superiority trial (The CopenHeartVR trial, VR; valve replacement or repair). We randomised 147 patients after heart valve surgery 1:1 to 12 weeks of cardiac rehabilitation consisting of physical exercise and monthly psycho-educational consultations (intervention) versus usual care without structured physical exercise or psycho-educational consultations (control). Primary outcome was physical capacity measured by VO2 peak and secondary outcome was self-reported mental health measured by Short Form-36. Results 76% were men, mean age 62 years, with aortic (62%), mitral (36%) or tricuspid/pulmonary valve surgery (2%). Cardiac rehabilitation compared with control had a beneficial effect on VO2 peak at 4 months (24.8 mL/kg/min vs 22.5 mL/kg/min, p=0.045) but did not affect Short Form-36 Mental Component Scale at 6 months (53.7 vs 55.2 points, p=0.40) or the exploratory physical and mental outcomes. Cardiac rehabilitation increased the occurrence of self-reported non-serious adverse events (11/72 vs 3/75, p=0.02). Conclusions Cardiac rehabilitation after heart valve surgery significantly improves VO2 peak at 4 months but has no effect on mental health and other measures of exercise capacity and self-reported outcomes. Further research is needed to justify cardiac rehabilitation in this patient group. Trial registration number NCT01558765, Results.

Women's experiences of sexual health after first-time myocardial infarction.

AIMS AND OBJECTIVES To investigate womens experience of sexual problems after a myocardial infarction. BACKGROUND Sexual problems among female patients with ischaemic heart disease have received little study but have been found to be highly prevalent in the research. Sexual problems have been found to influence quality of life and well-being, and sexual dysfunction has been associated with anxiety and depression. International guidelines recommend that healthcare professionals address sexuality; however, this is rarely done in practice, due to multiple causes, for example ignorance, embarrassment and lack of systematic treatment. Insight into womens sexual challenges after having a myocardial infarction is much needed. DESIGN Qualitative interview study. METHODS Qualitative interviews were conducted with 11 patients representative of the population and later transcribed. The analysis was inspired by Ricoeurs theory of interpretation, which consists of three levels: naive reading, structured analysis, and critical interpretation and discussion. RESULTS The overall finding that emerged regarding the womens sexual health was an anxious resuming of sexual activity. Four themes emerged: (1) the partner, (2) support, (3) the heart diseases influence on sex and (4) the relationship. CONCLUSION The women experienced anxious resuming of sexual activity. The heart disease had influence on their sex life, and relationship with their partner could be affected. Some needed support from health professionals or their network to dare sexual activity again. RELEVANCE TO CLINICAL PRACTICE This study indicates that health professionals should focus more on identifying anxiety and exhaustion after myocardial infarction and articulating their potential influence on womens sexual lives. Whether this should be addressed in the hospital setting, in the phase 2 rehabilitation at the general practitioner level or in combination has to be considered and may be the basis for further research.

Determinants of sexual dysfunction and interventions for patients with obstructive sleep apnoea: a systematic review

Obstructive sleep apnoea (OSA) may negatively affect a couples sexual relationship. This systematic review evaluated what characteristics are determinants of sexual function and dysfunction in women and men with OSA, and what interventions are shown to be effective.

The CopenHeartSF trial - Comprehensive sexual rehabilitation programme for male patients with implantable cardioverter defibrillator or ischaemic heart disease and impaired sexual function : Protocol of a randomised clinical trial

Introduction Sexuality is an important part of people’s physical and mental health. Patients with heart disease often suffer from sexual dysfunction. Sexual dysfunction has a negative impact on quality of life and well-being in persons with heart disease, and sexual dysfunction is associated with anxiety and depression. Treatment and care possibilities seem to be lacking. Studies indicate that non-pharmacological interventions such as exercise training and psychoeducation possess the potential of reducing sexual dysfunction in patients with heart disease. The CopenHeartSF trial will investigate the effect of a comprehensive sexual rehabilitation programme versus usual care. Methods and analysis CopenHeartSF is an investigator-initiated randomised clinical superiority trial with blinded outcome assessment, with 1:1 central randomisation to sexual rehabilitation plus usual care versus usual care alone. Based on sample size calculations, 154 male patients with impaired sexual function due to implantable cardioverter defibrillator or ischaemic heart disease will be included from two university hospitals in Denmark. All patients receive usual care and patients allocated to the experimental intervention group follow a 12-week sexual rehabilitation programme consisting of an individualised exercise programme and psychoeducative consultation with a specially trained nurse. The primary outcome is sexual function measured by the International Index of Erectile Function. The secondary outcome measure is psychosocial adjustment to illness by the Psychosocial Adjustment to Illness Scale, sexual domain. A number of explorative analyses will also be conducted. Ethics and dissemination CopenHeartSF is approved by the regional ethics committee (no H-4-2012-168) and the Danish Data Protection Agency (no 2007-58-0015) and is performed in accordance with good clinical practice and the Declaration of Helsinki in its latest form. Registration Clinicaltrials.gov identifier: NCT01796353.

Determinants of sexual function and dysfunction in men and women with stroke: A systematic review

The aim of this systematic review was to examine determinants of sexual function and dysfunction in men and women poststroke, and to evaluate effectiveness of interventions.

When the topic turns to sex case scenarios in sexual counseling and cardiovascular disease

Patients with cardiovascular disease and their partners frequently have concerns about sexual intimacy, and sexual counseling is needed across health care settings to ensure that patients receive information to safely resume sexual activity. The purpose of this review is to provide practical, evidence-based approaches to enable health care providers to discuss sexual counseling, illustrated by several case scenarios. Evidence shows that patients expect health care providers to initiate sexual activity discussions, although providers may be hesitant and often rely on patients to ask questions. Although some providers cite lack of knowledge or confidence in their ability to provide sexual counseling, others mention time pressures in the clinical setting. Although such barriers exist, sexual counseling can be individualized to the cardiac condition of a patient with a few select questions. The representative examples of patients with angina pectoris, myocardial infarction, coronary artery bypass surgery, heart failure, and implantable cardioverter defibrillator are used to illustrate key points and provide a model for sexual counseling in practice.