Rehabilitation Interventions and Health-Related Quality of Life after Myocardial Infarction
Myocardial infarction (MI) is a widespread occurrence, with approximately 610,000 new and 325,000 recurrent MIs experienced every year in the United States. While 84% of these victims will survive the attack, many will suffer poor outcomes as a result. These outcomes include increased risk for another MI, sudden death, heart failure, and stroke; chest pain; depression; and poor quality of life. The American Heart Association recommends that all MI patients participate in a cardiac rehabilitation program (CRP) to help reduce mortality and morbidity, control risk factors, and improve quality of life. CRPs are interventions that start soon after an MI and consist of a variety of components, including exercise programs, education, counseling, and stress management.
Health-related quality of life (HRQoL) is a measure of how persons believe their general health status and any illnesses affect their physical, social, and mental functioning. HRQoL is an important patient outcome and should be considered when evaluating the effectiveness of any rehabilitation intervention. MI survivors have been shown to have a decreased HRQoL immediately after the MI and for up to 4 years thereafter. It is clear that any CRP should be designed to help return patients HRQoL to its pre-MI level. While many studies have looked at how CRPs influence HRQoL after an MI, a systematic review has not been found that specifically considers this outcome. The purpose of this study was to conduct a comprehensive review of how CRPs affect HRQoL following an MI, and which CRP designs are effective at improving HRQoL.
A comprehensive literature search yielded 13 articles that studied HRQoL differences before and after a CRP following an MI. These studies were analyzed by CRP length; time between MI and CRP start; CRP components, type, and intensity; and effect on HRQoL. Findings indicated that CRPs do seem to positively influence HRQoL following an MI, regardless of design and components, possibly excluding inpatient CRPs and those that use only a few counseling sessions. Limitations included many non-controlled studies, heterogeneity of designs, and a bias towards younger, male participants.
Advisor:Jon C. Rittenberger, MD, MS; Margo B. Holm, PhD, OTR/L; Ketki D. Raina, PhD, OTR/L; Denise Chisholm, PhD, OTR/L
School:University of Pittsburgh
School Location:USA - Pennsylvania
Source Type:Master's Thesis
Date of Publication:05/22/2009