Better risk factor control in patients who attend cardiac rehabilitation

Kari Peersen‘s research results show suboptimal secondary prevention among patients with coronary artery disease, even in those who have attended organized cardiac rehabilitation.


MAIN RESULTS:

  1. Only 2 % of patients with coronary artery disease achieve full risk factor control.
  2. Participation in cardiac rehabilitation is associated with slightly better risk factor control.
  3. Heart patients who smoke, are obese, have an unhealthy diet and are depressed are also the least physically active.

THESIS DEFENCE:

Thesis: Cardiac rehabilitation, physical activity and risk factor control after coronary events: Methodological and clinical aspects
Candidate: Kari Peersen
Time: May 10, 2019 at 13:15
Place: Oslo University Hospital, Ullevål, Øyeavdelingen (building 36): Blue auditorium
Link to university website


SUMMARY:

The NOR-COR study includes 1127 patients with coronary artery disease treated at the hospitals in Drammen and Vestfold. Data was collected between two months and three years after PCI or coronary artery bypass grafting.

(1) 63 % of heart patients have three or more risk factors for a new cardiovascular event. 79 % are overweight, 60 % are not physically active enough, 57 % have elevated LDL cholesterol levels, and 46 % have hypertension. Moreover, less than half of the smokers manage to quit smoking, and less than half of the patients with diabetes achieve recommended levels of HbA1c.

(2) In Vestfold, 75 % of the patients participated in organized cardiac rehabilitation. In Drammen, only 18 % took part. The study participants from Vestfold were more physically active on follow-up compared to patients in Drammen. They also had better adherence to prescribed medication, reported higher quality of life and fewer symptoms of anxiety.

Moreover, cardiac rehabilitation was associated with smoking cessation, lower levels of LDL cholesterol, better self-reported health and better adherence to medication. However, risk factor control in general remained low also in the patients who participated in cardiac rehabilitation.

(3) The 249-item questionnaire used in the study was highly reproducible for all key items and instruments. 99 patients retested the questionnaire four weeks after they first answered it, and reprocibility was good for lifestyle factors, medical factors, psychosocial factors, patient perceptions, motivation, needs and preferences.

(4) Those who were insufficiently physically active were also more often smokers, obese and had an unfavourable diet, compared to the sufficiently active patients. Physical inactivity was also associated with depression and poor quality of life.

The patients who reported to have increased their physical activity after the event also reported higher motivation and better illness perception than the rest of the patients.


REFERENCES:

(1) Sverre, E., Peersen, K., Husebye, E., Gjertsen, E., Gullestad, L., Moum, T., Otterstad, J. E., Dammen, T. & Munkhaugen, J. (2017). Unfavourable risk factor control after coronary events in routine clinical practiceBMC Cardiovascular Disorders17(1), 40.

(2) Peersen, K., Munkhaugen, J., Gullestad, L., Dammen, T., Moum, T., & Otterstad, J. E. (2017). Reproducibility of an extensive self-report questionnaire used in secondary coronary preventionScandinavian journal of public health45(3), 269-276.

(3) Peersen, K., Munkhaugen, J., Gullestad, L., Liodden, T., Moum, T., Dammen, T., Perk, J., & Otterstad, J. E. (2017). The role of cardiac rehabilitation in secondary prevention after coronary events. European journal of preventive cardiology24(13), 1360-1368.

(4) Peersen, K., Otterstad, J. E., Sverre, E., Perk, J., Gullestad, L., Moum, T., Dammen, T., & Munkhaugen, J. (2019). Medical and Psychosocial Factors Associated With Low Physical Activity and Increasing Exercise Level After a Coronary Event. Journal of cardiopulmonary rehabilitation and prevention.