Myocardial Infarction, Acute
Conditions
Keywords
Myocardial Infarction, Cardiac Rehabilitation, Rehabilitation Nursing, Primary Health Care, Motivational Interviewing
Brief summary
Introduction: Secondary prevention after acute myocardial infarction may include cardiac rehabilitation and lifestyle changes. Cardiac rehabilitation has mainly taken place in hospitals without coordination with primary healthcare. Motivational interviews have been shown to be effective as a means for change in patients after acute myocardial infarction. The objective of this study is to evaluate the effectiveness of a cardiac rehabilitation program with motivational interviews in patients discharged from hospital after acute myocardial infarction. Methods: Randomized clinical non-pharmacological trial. A minimum sample of 284 participants requiring cardiac rehabilitation after acute myocardial infarction in six primary healthcare centers. Participants will be randomized to cardiac rehabilitation with motivational interviews or normal standard of care. All secondary results will be evaluated at 1,3 and 6 months.
Interventions
BEHAVIORALMotivational interview
The new CR program with MI will be structured in 4 sessions and an optional fifth during the six months after discharge. The methodology of the MI sessions will follow the four phases logical sequence of MI proposed by Rollnick and Millner. 1) engage in a collaborative relationship, 2) focus on a particular change, 3) evoke intrinsic motivations for change, and 4) plan an immediate step for change
BEHAVIORALActive Comparator: Standard care group
All patients in the control group will receive a kit with informative material with the actions and procedures to follow (diet, physical activity, smoking cessation, and other recommendations about secondary prevention).
Sponsors
Instituto de Salud Carlos III
Institut Català de la Salut
Fundacio d'Investigacio en Atencio Primaria Jordi Gol i Gurina
Institut d'Investigacions Biomèdiques August Pi i Sunyer
Hospital Clinic of Barcelona
Consorci d'Atenció Primària de Salut de l'Eixample
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Age \>18 years. * Hospital admission for acute coronary syndrome (diagnostic codes ICD-10: I20-I22). * Post unscheduled cardiac revascularization surgery (procedure code ICD-10: 021x). * Discharge to home with the area of the 7 PHCs. * Indication of RC indication. * Voluntary participation.
Exclusion criteria
* Acute aortic disease, * Severe pulmonary hypertension. * Uncontrolled arrhythmias. * Decompensated Heart Failure or significant valvular or congenital heart disease. * Intervention in heart valves and/or interventricular septum. * Diseases that prevent exercise. * Osteoarticular disease that severely limits exercise. * Severe mental disorder. * Any severe psychiatric disorders. * Cognitive disability. * Verbal communication problems. * Participation in hospital Cardiac Rehabilitation.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Physical functional capacity | 1st month | Improvement in aerobic capacity and resistance, measured by a physical effort test |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Effectiveness of secondary prevention | 1st month | Effectiveness of secondary prevention will be considered (Satisfied / no satisfied) with next conditions (all together): Blood pressure values \<140/90mmHg, plasma cholesterol c-LDL\<70mg/dL, plasma glycosylated hemoglobin \<7%. Absolute cessation or no initiation of smoking Body Mass Index in the range of 18.5-25kg/m\^2. |
| Psychological status | 6th month | Measured with the Psychological General Well-Being Index (PGWBI) |
| Perceived quality of life | 1st month | Physical and mental summaries of perceived quality of life measured with the generic quality of life Short Form questionnaire (SF-12). |
Countries
Spain
Contacts
Primary ContactLuis González de Paz, PhD
Backup ContactRocío Rodríguez Romero, RN
Outcome results
None listed