Rivka Herman 1 * ,RN. M.Sc Michal Libergal 1 *, PhD; David Rott 2 , MD

1. Rivka Herman1*,RN.M.Sc Michal Libergal1*, PhD; David Rott2, MD 1Henrietta Szold Hadassah-Hebrew University School of Nursing, in the Faculty of Medicine, Jerusalem, Israel. 2 Department of Medicine, Hadassah-Hebrew University Medical Center, Mt. Scopus, Jerusalem, Israel The Correlation between Participation in a Cardiac Rehabilitation Program and Quality of Life of CHD Patient’s

2. Coronary Heart Disease • In the USA affects 200 men and women out of every 100,000 • In Israel 25,000 hospitalizations every year • CHD is a chronic disease that affects patients and their caregivers in terms of physical, psychological and social conditions. (Acsis, 2008 ; American Heart Association (2006)

3. Cardiac rehabilitation • Decrease both morbidity and mortality of patients with CHD • Therefore its application is a class I recommendation in most contemporary cardiovascular clinical practice guidelines • The participation rate in such programs,in the central region of Israel, is only between 14-20% (Wenger 2008; Acsis 2008 ; Williams et al. 2006)

4. Cardiac Rehabilitation&Quality of Life

5. Quality of life • QOL is a broad concept, influenced by personal perceptions, coping mechanisms, and environmental constraints. • Improving QOL is a major goal in the context of preventive and therapeutic cardiology and in cardiac rehabilitation in particular . WHOQOL Group (1997)

6. The impetus for conducting this research • To evaluate the correlation between participation in a CR program and QOL. • Evaluate the association of demographic parameters and cardiac risk factors on QOL.

7. Methods • A prospectivestudy. • The target population included patients with CHD who attended the cardiac rehabilitation center at our institution. • Inclusion criteria were: stable CHD; post MI ; age between 30-80 years; ability to answer questionnaires in Hebrew and independence in ADL.

8. Three different tools were utilized in this research • General demographic questionnaire. • Cardiac assessment, utilized for admission into the rehabilitation program. • The Mec-New Heart Disease Health-related Quality of Life Questionnaire. (Hofer et al. 2004).

9. Mec-New Health Related Quality of Lifequestionnaire • The questionnaire was comprised of 27 questions with a Likert scale in three domains: physical, emotional, and social. • The questionnaire has a Cronbach's α of 0.93-0.95 in English. • The Hebrew version was validated by Dankner et al. (2008) and accepted with a Cronbach's α of 0.93.

10. Informed consent • The study was approved by the institutional ethics board of the Hadassah-Hebrew University Medical Center and all participants provided written informed consent after having received explanations regarding the study.

11. Intervention • Assessment by a cardiologist to determine cardiac risk level. • Assessment by a physiologist. • Admission by a nurse prior to physical activity. The program included variety of lectures presented by the multidisciplinary cardiac rehabilitation team.

12. Statistical methods • The correlation in reported QOL between pre- and post- participation in the CR program were assessed by a paired t-test. • Spearman’s Coefficient was used to test the correlation between risk factors, risk level and education level. • Pearson’s Correlation was used to test the relationship between age and QOL.

13. Rate of compliance • 87 patients responded to questionnaires prior to starting a cardiac rehabilitation program. • After 3 months of rehabilitation, 55 (63.2%) patients completed the same questionnaires.

14. Risk Factor and Demographic Data • Most of the patients were 55-61 years of age, married, and underwent at least one event of MI. • 40 participants (53%) had a low risk factor for CHD; 26 (33.8%) had a moderate risk factor; and 10 (13%) had a high risk factor for CHD.

15. Results (N-55) The QOL was significantly improved as noted by their general score in the Mec-New Questionnaire and within each domain: emotional, physical limitations, and social function (t (54) = -3.59, p = 0.001)

16. Correlation between risk factors, risk level, age and education level N-87))

17. Limitations • The study did not include a control group. • A convenience sample was comprised of a homogenous sample which may limit generalization. • Other illnesses, than CHD, can influence QOL. • There was a loss to follow-up.

18. Summary and relevance to clinical practice • Nurses awareness as Coordinators of multidisciplinary team to QOL and for secondary prevention of, CHD is significantly important. • Use the HRQOL Questionnaire. • Encourage the participation rate in such programs.

20. References • Hofer, S., Lim, L., Guyatt, G.,Oldridge, N. (2004). The MacNew Heart Disease Health- related quality of life instrument: A summery International Journal of behavioral Nutrition and physical Activity , 10, 1477-7525. • Williams MA, Ades PA, Hamm LF, et al. Clinical evidence for a health benefit from cardiac rehabilitation: an update. Am Heart J. 2006;152(5):835-841 • Lloyd-Jones D, Adams R, Carnethon M, et al. Heart disease and stroke statistics -- 2009 update: a report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Circulation. 2009; 119(3):e21-181. • Rosamond W, Flegal K, Furie K, et al. Heart disease and stroke statistics -- 2008 update: a report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Circulation. 2008; 117(4):e25-146. • Skevington SM. Qualities of life, educational level and human development: an international investigation of health. Soc Psychiatry PsychiatrEpidemiol. 2010; 45(10):999-1009 • WHOQOL Group (1997). Measuring quality of life: Geneva Switzerland. (2009, June 10) Retrieved from: http://www.who.int/mental_health/media/68.pdf