None listed
Conditions
Brief summary
Pakistan being the developing country is facing non-communicable disease burden of 21%. Ischemic heart disease in the leading cause of mortality among Pakistani population. The aspect of secodary prevention of ischemic heart disease in developing countries is the dire need for public health specialists, clinicians and policy makers. There are some evidence that psychotherapeautic measures, including psychotherapy, recreation, exercise and stress management training have positive impact on secondary prevention of cardiovascular diseases but there are some contradictory findings as well. Cardiac rehabilitation program (CRP) post myocardial infarction (MI) is an unexplored aspect in Pakistan specifically Khyber Pakhtunkhwa province. Psychological, physical and specific health-related quality of life (HRQoL) outcomes needs assessment with respect to its practicality, effectiveness and success. Overall there is lack of published randomized control trials regarding secondary prevention of cardiovascular diseases, particularly in South Asian Region. While searching through search engines like Pub Med and Google Scholar, till January 15th 2015, no such study was found which has been conducted on Pakistani population. This study will give us the true picture and practicality of the effectiveness of cardiac rehabilitation program (CRP) in post myocardial infarction patients in a tertiary health care setup. This study will also provide evidence based medicine to the clinicians and public health physicians regarding secondary prevention of myocardial infarction patients through cost effective strategy i.e. CRP.
Interventions
Description of intervention(s) / exposure: Cardiac rehabilitation (CR) program was the intervention which was a medically supervised program in post myocardial infarction patient. After patients were diagnosed with myocardial infarction by a cardiologist, they were recruited, baseline information recorded and randomized into casual care or casual care plus CR program.
The participants of the CR program (intervention group) were enrolled for a total period of 8 weeks, which was conducted in 2 ph
Description of intervention(s) / exposure: Cardiac rehabilitation (CR) program was the intervention which was a medically supervised program in post myocardial infarction patient. After patients were diagnosed with myocardial infarction by a cardiologist, they were recruited, baseline information recorded and randomized into casual care or casual care plus CR program. The participants of the CR program (intervention group) were enrolled for a total period of 8 weeks, which was conducted in 2 phases in hospital premises. CR program team consisted of one cardiac consultant, two trained nurses, 1 physiotherapist and 1 dietitian. CR program consisted following components according to the two phases: Phase 1: This CR program was of 1-2 weeks duration during hospital stay: 1. Psychological reassurance: A consultant cardiologist conducted a single session of 15-30 minutes at the very start of the patient admission. Participants was encouraged to ask questions or any queries. Any misconceptions were cleared and he/she was reassurance regarding his/her health status and preventive aspects were given. 2. Early mobilization: A trained nurse having an experience of at least 2 years ensured early mobilization of the participant while admitted in the hospital ward. Session consisted of gradual mobilization starting from 1-3 minutes’ walk. 3. Dietary counselling: A dietitian having at least 2 years’ experience conducted two dietary counselling session of 15-30 minutes session per week according to WHO guideline of healthy diet. Healthy food choices were given and unhealthy food were identified by interactive communicative session. 4. Future risk stratification: A consultant cardiologist conducted approximately 15-30 minutes session regarding the participant modifiable risks and how to decrease them. Phase 2: After 02 weeks they were offered 06 weeks structured exercise program. In this phase, patient were asked to come to the hospital weekly. A schedule appointment was communicated to each patient according to their convenience. 1. Structured exercise program (SEP): The SEP was conducted once weekly by CR team consisting of a trained doctor, physiotherapist and a trained nurse. The program included reassessment by CR team and structured exercise protocol was started for each participant. It consisted of a supervised 30 minutes aerobic and strength exercise training sessions. A total of 6 SEP was conducted in a period of 6 weeks in hospital premises. 2. Health education: A trained nurse having at least 5 years’ experience conducted a 15-30 minutes session on the same day of SEP but before the start of the SEP session. Aim was to increase the understanding of disease process, risk factors, medical compliance and follow up visit. 3. Dietician counselling: A trained dietitian after SEP conducted 15-30 minutes session and reinforced and encouraged the healthy food choices. The CR program was not individualize or titrated and adherence was not measured.
Sponsors
Dr. Aliya Hisam
Study design
Allocation
Randomised controlled trial
Intervention model
Parallel
Primary purpose
Educational / counselling / training
Masking
Open (masking not used)
Eligibility
Sex/Gender
All
Age
18 Years to 70 Years
Healthy volunteers
No
Inclusion criteria
Inclusion criteria consisted of patients of 70 years or below with first attack of myocardial infarction, who received primary treatment in cardiology ward and were discharged from the ward. Those who were willing to participate in the study and came for the sessions of proposed intervention.
Exclusion criteria
Exclusion criteria included participants with mental illness, who were unable to communicate and who were having physical disability. Patients having “resting systolic BP > 200 mm Hg, diastolic BP >100 mm Hg, ongoing chest pain at rest, decompensated heart failure, severe symptomatic valvular heart disease, complex ventricular arrhythmia, resting paroxysmal supraventricular tachycardia, complex arrhythmia induced by exercise, third degree atrioventricular block without permanent pacemaker, endocarditis, pericarditis, arterial thromboembolism, unable to perform physical exertion” were also excluded from the study.
Outcome results
None listed