Ton Gorgels

Effects of health counseling on behavioural risk factors in a high-risk cardiology outpatient population: a randomized clinical trial:

Background An evaluation study of an individual lifestyle advice intervention to reduce cardiovascular risk behaviours (high fat consumption, smoking, physical inactivity). Methods A randomized, controlled trial at the cardiology outpatient clinic of the University Hospital Maastricht. Participants were at high risk of incurring a cardiovascular event. Changes in risk behaviours and behavioural determinants were assessed with self-administered validated questionnaires. Results Questionnaires were completed by 1270 patients at baseline, 1169 after 4 months (92%), and 1032 after 18 months (81.3%). After 4 months, intention-to-treat analyses revealed a decrease in fat consumption (−5.6%, P=0.000), a reduction in the percentage of smokers [odds ratio (OR) 0.57, 95% confidence intervals (CI) 0.33–0.97] and a trend towards a maintained physical activity level (OR 1.28, 95% CI 0.97–1.70). No long-term effects were found. Conclusion The lifestyle advice intervention was potentially effective in changing cardiovascular risk behaviours, but should be further improved to be effective in secondary cardiovascular prevention. The main limitations of the study were related to the randomization procedure and the self-selection of patients and cardiologists.

Long-term Outcome After Survival of a Cardiac Arrest: A Prospective Longitudinal Cohort Study:

Background. A cardiac arrest can lead to hypoxic brain injury, which can affect all levels of functioning. Objective. To investigate 1-year outcome and the pattern of recovery after surviving a cardiac arrest. Methods. This was a multicenter, prospective longitudinal cohort study with 1 year of follow-up (measurements 2 weeks, 3 months, 1 year). On function level, physical/cardiac function (New York Heart Association Classification), cognition (Cognitive Log [Cog-log], Cognitive Failures Questionnaire), emotional functioning (Hospital Anxiety and Depression Scale, Impact of Event Scale), and fatigue (Fatigue Severity Scale) were assessed. In addition, level of activities (Frenchay Activities Index, FAI), participation (Community Integration Questionnaire [CIQ] and return to work), and quality of life (EuroQol 5D, EuroQol Visual Analogue Scale, SF-36, Quality of Life after Brain Injury) were measured. Results. In this cohort, 141 cardiac arrest survivors were included. At 1 year, 14 (13%) survivors scored below cutoff on the Cog-log. Both anxiety and depression were present in 16 (15%) survivors, 29 (28%) experienced posttraumatic stress symptoms and 55 (52%), severe fatigue. Scores on the FAI and the CIQ were, on average, respectively 96% and 92% of the prearrest scores. Of those previously working, 41 (72%) had returned to work. Most recovery of cognitive function and quality of life occurred within the first 3 months, with further improvement on some domains of quality of life up to 12 months. Conclusions. Overall, long-term outcome in terms of activities, participation, and quality of life after cardiac arrest is reassuring. Nevertheless, fatigue is common; problems with cognition and emotions occur; and return to work can be at risk.

Effects of a brief cardiovascular prevention program by a health advisor in primary care; the 'Hartslag Limburg' project, a cluster randomized trial.

OBJECTIVE To determine in primary care patients at high risk for a cardiovascular event, the effects on biomedical risk factors for and incidence of cardiovascular events, of a brief cardiovascular prevention program executed by a health advisor. METHOD DESIGN cluster randomized controlled trial with 1275 patients (24 general practices) in and around Maastricht, the Netherlands (1999-2004). INTERVENTION health advisors were to complete computerized cardiovascular risk profiles, provide multi-factorial tailored health education and advice, and communicate with GPs to optimize treatment. OUTCOME differences in changes in risk factors between baseline and follow up at 6, 18, and 36 months and incidence of cardiovascular events at 36 months. RESULTS PROCESS Because of logistic reasons risk profiles were put on paper instead of in the computerized patient files. On average patients attended 2.3 counseling sessions. Interaction with GPs was less productive than expected. OUTCOME Effect after six months on BMI (-0.20 kg/m(2) (95% CI -0.38 to -0.01, p=0.039), Cohens d: -0.18), and after 18 months on HDL-cholesterol (+0.05 mmol/l (95% CI +0.01 to +0.09, p=0.014), Cohens d: 0.14). No other (subgroup) effects were found. CONCLUSION Given the lack of clinically meaningful effects, implementation of this intervention in its present form is not justified.

Hoe ervaren hoogrisicopatiënten CVRM door een praktijkondersteuner

SamenvattingVoogdt-Pruis H, Gorgels T, Van Ree J, Van Hoef L, Beusmans G. Hoe ervaren hoogrisicopatiënten CVRM door een praktijkondersteuner? Tijdschr praktijkonderst 2010;5:136-43.Doel Chronisch zieken blijken meer tevreden te zijn met de zorg wanneer gezondheidscentra verpleegkundigen bij die zorg betrekken. Wij onderzochten hoe hoogrisicopatiënten cardiovasculair risicomanagement (CVRM) door een praktijkondersteuner ervaren, en of deze ervaringen variëren al naar gelang de achtergrondkenmerken van patiënten. Methode Aan het einde van een gerandomiseerd onderzoek ontvingen patiënten een vragenlijst. Zes gezondheidscentra deden mee aan het onderzoek. In totaal ging het om 701 patiënten met ten minste 10% risico op sterfte aan hart- en vaatziekten (HVZ). Van hen had 90% al een HVZ doorgemaakt. Mensen die diabetes hadden en/of vaker dan 1 keer per jaar een specialist bezochten, vielen buiten het onderzoek. De helft van de patiënten bezocht de praktijkondersteuner en de andere helft ontving reguliere zorg van de huisarts. Resultaten De respons bedroeg 69%. Patiënten waren meer tevreden met CVRM door praktijkondersteuners. Gezondheid en persoonlijke kenmerken (zoals leeftijd, opleidingsniveau en geslacht) van patiënten hingen significant samen met de ervaringen. Vergeleken met niet-rokers zouden rokers de praktijkondersteuner minder aanbevelen aan anderen. Ook voelden rokers zich vaker dan niet-rokers ‘op de vingers getikt’, vonden ze het consult ‘stroef verlopen’ en vonden ze dat de praktijkondersteuner zich minder kon ‘inleven in hun persoonlijke situatie’ en minder ‘goed kon uitleggen’. Conclusie De meeste patiënten zijn positief gestemd over CVRM door de praktijkondersteuner. Het CVRM-spreekuur kan mogelijk nog verbeterd worden door meer aandacht te besteden aan motiverende gespreksvoering aan vooral rokers.

Dealing with a life changing event : The influence of spirituality and coping style on quality of life after survival of a cardiac arrest or myocardial infarction

BACKGROUND Survivors of a cardiac arrest often have cognitive and emotional problems. As a cardiac arrest is also an obvious life-threatening event, other psychological sequelae associated with surviving such as spirituality may also affect quality of life. OBJECTIVES To determine the relationship between spirituality, coping and quality of life in cardiac patients both with and without a cardiac arrest. METHODS In this retrospective cohort study, participants received a questionnaire by post. The primary outcome measure was quality of life (LiSat-9). Secondary outcome measures were spiritual well-being (FACIT-Sp12), coping style (UPCC), emotional well-being (HADS, IES), fatigue (FSS) and daily activities (FAI). Statistical analyses included multiple regression analyses. RESULTS Data were available from 72 (60% response rate) cardiac arrest survivors and 98 (47%) patients with a myocardial infarction. Against our hypothesis, there were no differences in spirituality or other variables between the groups, with the exception of more depressive symptoms in patients with myocardial infarction without arrest. Analysis of the total data set (170 participants) found that a better quality of life was associated with higher levels of meaning and peace in life, higher levels of social and leisure activities, and lower levels of fatigue. CONCLUSIONS Quality of life after a cardiac arrest and after a myocardial infarction without arrest are not different; fatigue, a sense of meaning and peace, and level of extended daily activities are factors related to higher life satisfaction.