Vol 75, No 4 (2017)
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Kardiologia Polska 2017 nr 04-10

 

ARTYKUŁ ORYGINALNY / ORYGINAL ARTICLE

Knowledge on cardiovascular risk factors improves the effectiveness of rehabilitation following acute coronary syndrome

Wojciech S. Kapko1, 2, Łukasz Krzych3, 4

1Centre for Research and Development, EMC Hospitals, Katowice, Poland
2Laboratory of Noninvasive Cardiovascular Diagnostics, SP ZOZ Upper Silesian Rehabilitation Centre “Repty”, Tarnowskie Gory, Poland
3Department of Anaesthesiology and Intensive Care, School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland
4Department of Cardiac Anaesthesia and Intensive Care, Silesian Centre for Heart Diseases, Zabrze, Poland

Address for correspondence:
Wojciech S. Kapko, MSc, Centre for Research and Development, EMC Hospitals, ul. Morawa 31, 40–353 Katowice, Poland, e-mail: wojtek_kapko@wp.pl
Received: 16.08.2016 Accepted: 29.11.2016 Available as AoP: 27.12.2016

Abstract

Background: There is a clear association between knowledge on healthy lifestyle and intensity of healthy behaviours, especially among young people.

Aim: We sought to verify this hypothesis among patients after acute coronary syndrome (ACS), who were subjected to early in-hospital complex cardiac rehabilitation (CCR), by assessing the relationship between initial knowledge on cardiovascular risk factors and efficiency of rehabilitation.

Methods: Two hundred and five consecutive patients (153 man; age 62 ± 9 years) hospitalised between May 2013 and April 2014 were prospectively enrolled. On admission, the knowledge on risk factors was assessed by questionnaire. At the beginning, in the second and in the third week of CCR the six-minute walk test (6MWT) was performed. Effectiveness of rehabilitation was assessed by the 6MWT in the third week. Distance, speed, and metabolic equivalents (METs) were considered markers of improvement.

Results: The most common number of correct answers was 11 (out of 20 questions) about risk factors (on average 54 ± 18%). Knowledge on more than 10 items was found for 99 subjects (48%) (i.e. good level of knowledge). Improvement of haemodynamic parameters and CCR effectiveness was found (‘0’ vs. ‘3’: distance [m]: 442.0 ± 102.2 vs. 485.2 ± 109.3, p < 0.01; speed [km/h]: 4.4 ± 1.0 vs. 4.8 ± 1.1, p < 0.01; METs: 3.1 ± 0.5 vs. 3.3 ± 0.5; p < 0.01). Significantly better indicators of CCR effectiveness characterised patients with better knowledge (good knowledge vs. bad knowledge: distance [m]: 500.5 ± 95.7 vs. 470.8 ± 119.4, p = 0.04; speed [km/h]: 5.0 ± 1.0 vs. 4.7 ± 1.2, p = 0.04; METs: 3.4 ± 0.5 vs. 3.2 ± 0.6, p = 0.04). There was correlation between the percentage of correct answers and distance in 6MWT (R = 0.374, p < 0.001).

Conclusions: Knowledge on the cardiovascular risk factors improves rehabilitation effectiveness among patients after ACS.

Key words: acute coronary syndrome, secondary prevention, knowledge, rehabilitation

Kardiol Pol 2017; 75, 4: 344–350

INTRODUCTION

The results of complex cardiac rehabilitation (CCR) are well known and scientifically documented, and they include: reduced risk of death, especially from cardiovascular (CV) causes, and improvement of the quality of life with possibility of fast return to social and professional activity due to better physical condition and general psychomotor performance [1–3]. From a pathophysiological point of view those positive effects result from a decrease in tension of the sympathetic system, and improvement in the vascular endothelium function and rheology of the blood [4–6].

Knowledge on CV risk factors is an essential part of efficient and permanent modification of patients’ habits concerning diet, physical activity, and addictions [7]. There is positive correlation between high level of self-awareness and patients’ attitudes to comply with guidelines of secondary prevention [8–10]. It is also known that physically active people, independently from demographic and socio-economic factors, are more aware of choosing proper behaviours, especially about diet and stimulants [11]. Better knowledge and awareness on primary or secondary prevention and health promotion practices is also characteristic for this group [11].

Therefore, we sought to investigate the relationship between baseline knowledge on CV risk factors and effectiveness of cardiac rehabilitation in patients after acute coronary syndrome (ACS) treated with percutaneous intervention.

METHODS

Study group

We prospectively enrolled 205 consecutive patients following ACS treated with percutaneous intervention, undergoing early in-hospital CCR during the period 05.2013–04.2014. Basic inclusion criterion was qualification and ability to participate in CCR. Exclusion criteria were: physical disability that made participation in rehabilitation procedures impossible (e.g. state after amputation, significant degree of osteoarthrosis, uncontrolled chronic obstructive pulmonary disease), disability making filling out the questionnaire and educational materials unassisted impossible (e.g. considerable amblyopia despite the correction of the vision defects), intellectual disability making filling out questionnaire unassisted impossible, incomplete rehabilitation cycle, or lack of patient consent.

Complex cardiac rehabilitation programme

Complex cardiac rehabilitation was performed according to the guidelines of the Section of Rehabilitation of the Polish Cardiac Society [12]. A full exercise plan included endurance training, kinesiotherapy, and physiotherapy. At the beginning, in the second, and in the third week of the CCR cycle all subjects underwent a six-minute walk test (6MWT). Effectiveness of rehabilitation was assessed based on results of the 6MWT in the third week of CCR (haemodynamic parameters were considered indicators of cardio-pulmonary fitness and distance; speed and metabolic equivalents (METs) were considered markers of physical improvement).

Knowledge about cardiovascular risk factors

Knowledge on CV risk factors was assessed with the use of an author-based questionnaire prepared according to the Guidelines of the Polish Circulatory System Diseases Prevention Forum [13]. Good (high) knowledge was defined as at least 50% correct answers in the tool. Additional information was obtained from anamnesis and standard medical data on admission to the hospital. Before that, the questionnaire underwent a procedure of validation using ‘test’ — ‘retest’ method, which confirmed its credibility (i.e. it was distributed among 105 randomly selected subjects on hospital admission, and the same tool was distributed again after seven days). The repeatability was within the range 0.9–1.0, and the kappa statistics was within the range 0.82–1.0.

Patient confidentiality was ensured because the dataset was fully anonymised. The project was approved by the Bioethics Committee.

Statistical analysis

Statistical analysis was performed using MedCalc Statistical Software version 14.8.1 (MedCalc Software bvba, Ostend, Belgium). Continuous variables are expressed as median and interquartile range (IQR; 25–75 pc). Qualitative variables are expressed as absolute values and percentage. Between-group differences for quantitative variables were assessed using student t-test or Mann-Whitney U-test. Previously, the type of distribution was verified using Shapiro-Wilk test. For qualitative data the χ2 test was used. Correlation was determined by the use of Spearman rank coefficient. A p value < 0.05 was considered significant.

RESULTS

The study group comprised 205 patients (153 man and 52 woman) aged 62 ± 9 years. Baseline characteristics of the subjects, with distinction between those with high and low knowledge, are shown in Table I.

Table 1. Study group characteristics

Variable

Total

Knowledge (–)

Knowledge (+)

p

Male gender

153 (75%)

81 (76%)

72 (73%)

0.65

Age [years]

62 ± 9

65 ± 8

62 ± 10

0.02

Education:

 

 

 

0.12

Primary school level

107 (52%)

62 (58%)

45 (45.5%)

 

Secondary school level

69 (34%)

32 (30%)

37 (37.5%)

 

College level

10 (5%)

6 (6%)

4 (4%)

 

University level

19 (9%)

6 (6%)

13 (13%)

 

Body mass index [kg/m2]

29 ± 4

28 ± 4

28 ± 4

0.27

Obesity (BMI ≥ 30 kg/m2)

72 (35%)

40 (38%)

32 (32%)

0.41

Type of obesity:

 

 

 

0.81

WHR ≥ 1

48 (68%)

28 (70%)

20 (62.5%)

 

WHR < 1

24 (32%)

12 (30%)

12 (37.5%)

 

Smoking habit

71 (35%)

40 (38%)

31 (31%)

0.41

Smoking – pack-years

16 ± 8

14 ± 4

16 ± 4

0.17

Low physical activity*

36 (18%)

20 (19%)

16 (16%)

0.74

Arterial hypertension

154 (75%)

78 (74%)

76 (76%)

0.72

Diabetes

56 (27%)

31 (28%)

25 (25%)

0.74

Form of treatment of diabetes:

 

 

 

0.66

Diet only

17 (30%)

8 (26%)

9 (36%)

 

Oral medications

28 (50%)

16 (52%)

12 (48%)

 

Insulin

11 (20%)

7 (22%)

4 (16%)

 

Dyslipidaemia

100 (49%)

52 (49%)

48 (48%)

0.95

Family history of cardiovascular diseases

127 (62%)

57 (54%)

70 (70%)

0.02

*i.e. less than 30 minutes of moderate physical activity (fast walking, cycling, aerobic, swimming, etc.) in less than 4 days during week; BMI — body mass index; WHR — waist-to-hip ratio

The results of 6MWT (baseline and follow-up values) are shown in Table 2. Patients statistically significantly improved in terms of haemodynamic parameters and physical condition. Noticeable progress in terms of distance (in metres) was found during the whole CCR cycle (‘0’: 442.0 ± 102.2 vs. ‘2 weeks’: 467.8 ± 104.3 vs. ‘3 weeks’: 485.2 ± 109.3; p < 0.001).

Table 2. Results of a six-minute walk test at baseline and after three weeks of rehabilitation

Parameter

Baseline

After three weeks

Difference

p

Resting HR [1/min]

68.5 ± 8.5

69.2 ± 7.9

0.73 ± 6.4

0.13

Peak HR [1/min]

75.8 ± 10.7

77.8 ± 10.9

2.0 ± 8.8

< 0.01

Resting SBP [mm Hg]

129.4 ± 15.2

127.2 ± 14.0

–2.2 ± 14.5

0.15

Resting DBP [mm Hg]

79.1 ± 9.8

78.0 ± 9.6

–1.2 ± 9.2

0.08

Peak SBP [mm Hg]

139.0 ± 18.2

139.4 ± 16.8

0.4 ± 17.6

0.08

Peak DBP [mm Hg]

83.1 ± 10.8

83.6 ± 10.4

0.5 ± 9.7

0.11

Distance [m]

442.0 ± 102.2

485.2 ± 109.3

43.2 ± 70.6

< 0.01

Speed [km/h]

4.4 ± 1.0

4.8 ± 1.1

0.4 ± 0.7

< 0.01

Borg scale

11.9 ± 1.1

11.6 ± 1.1

-0.3 ± 1.0

< 0.01

Metabolic equivalents (METs)

3.1 ± 0.5

3.3 ± 0.5

0.2 ± 0.3

< 0.01

HR — heart rate; DBP — diastolic blood pressure; SBP — systolic blood pressure

In 20 questions on risk factors and healthy behaviours, subjects showed the best knowledge on overweight/obesity and smoking habit (Table 3). Eleven correct answers was the most common result (54 ± 18% on average), and knowledge on more than 10 items (i.e. ≥ 50%) was found for 99 (48%) subjects (Fig. 1), which was recognised as good knowledge for further analyses.

Table 3. Knowledge on cardiovascular risk factors

Is this a cardiovascular risk factor?

Correct answer

Excessive body weight (overweight/obesity)

184 (90%)

Older age

78 (38%)

Osteoporosis

72 (35%)

Male gender

35 (17%)

Height

86 (42%)

Intake of vegetable fats

54 (26%)

Hypertension

153 (75%)

Excessive physical training

60 (29%)

Cigarette smoking

181 (88%)

Pipe smoking

140 (68%)

Diabetes

135 (66%)

Peptic ulcer disease

67 (33%)

High cholesterol level

157 (77%)

Low level of HDL-C

31 (15%)

Common stress

165 (80%)

Depression

15 (7%)

Environment pollution

86 (42%)

Family history of heart diseases

134 (65%)

Lack of physical activity

142 (69%)

Family history of a stroke

55 (27%)

HDL-C — high-density lipoprotein cholesterol

285915.jpg 

Figure 1. Knowledge on cardiovascular risk factors as number of correct answers in a 20-item questionnaire

Significantly better indicators of CCR effectiveness characterised patients with better knowledge (good knowledge vs. bad knowledge: distance [m]: 500.5 ± 95.7 vs. 470.8 ± 119.4, p = 0.04; speed [km/h]: 5.0 ± 1.0 vs. 4.7 ± 1.2, p = 0.04; METs: 3.4 ± 0.5 vs. 3.2 ± 0.6, p = 0.04) (Table 4). Moreover, all time-dependent changes in studied parameters altered significantly, with more improvement observed in subjects with better knowledge. There was substantial correlation between the percentage of correct answers in the questionnaire and distance in 6MWT (R = 0.374; p < 0.001).

Table 4. Results of a six-minute walk test at the end of rehabilitation and the changes in parameters from baseline to the end of the rehabilitation by knowledge category on cardio-vascular risk factors

Parameter

Knowledge (–)

Knowledge (+)

p for difference in absolute values

p for difference in time period

Absolute values (after 3 weeks)

Difference in values after 3 weeks — at baseline

Absolute values (after 3 weeks)

Difference in values after 3 weeks — at baseline

Resting HR [1/min]

69.5 ± 8.1

1.7 ± 6.3

68.8 ± 7.7

–0.3 ± 6.3

0.55

0.02

Peak HR [1/min]

78.5 ± 11.0

3.2 ± 9.4

77.1 ± 10.7

0.4 ± 6.4

0.46

0.02

Resting SBP [mm Hg]

129.3 ± 13.9

1.2 ± 12.7

124.7 ± 13.7

–5.8 ± 15.4

0.01

< 0.001

Resting DBP [mm Hg]

78.0 ± 10.3

–0.3 ± 9.2

78.0 ± 8.8

–2.1 ± 9.2

0.98

0.07

Peak SBP [mm Hg]

140.6 ± 19.2

3.5 ± 17.7

138.1 ± 13.8

–3.1 ± 16.8

0.74

0.02

Peak DBP [mm Hg]

83.8 ± 12.1

1.8 ± 8.9

83.4 ± 8.1

–0.9 ± 10.2

0.64

0.02

Distance [m]

470.8 ± 119.4

55.8 ± 69.5

500.5 ± 95.7

29.5 ± 69.5

0.04

0.001

Speed [km/h]

4.7 ± 1.2

0.6 ± 0.7

5.0 ± 1.0

0.3 ± 0.7

0.04

0.001

Borg scale

11.7 ± 1.2

–0.3 ± 1.0

11.5 ± 0.9

–0.2 ± 1.0

0.06

0.1

Metabolic equivalents [METs]

3.2 ± 0.6

0.3 ± 0.3

3.4 ± 0.5

0.1 ± 0.3

0.04

0.001

HR — heart rate; DBP — diastolic blood pressure; SBP — systolic blood pressure

DISCUSSION

There is a clear association between knowledge on healthy lifestyle and intensity of healthy behaviours, especially among young people. We decided to verify this hypothesis in subjects after ACS scheduled to early in-hospital CCR. Our study, despite its simplicity, shows that patients with better knowledge on CV risk factors do better in rehabilitation. It may become an important issue while organising and programming cardiac rehabilitation cycles for patients after myocardial infarction [14, 15]. An Individualised approach in education about proper healthy behaviours, burden, and risk factors of CV diseases should become its permanent and important elements [14, 15]. Coordinated care after myocardial infarction should consist of four modules: complete revascularisation, education and rehabilitation programme, electrotherapy, and periodical cardiac consultations. At the first stage the coordinated care programme should last for 12 months. Moreover, the quality of care assessment based on clinical measures, including risk factor control, rate of complete myocardial revascularisation, as well as on the rate of CV events, should be performed [15].

Unfortunately, in everyday practise only a small number of patients after ACS attend early CCR in the hospital environment [16, 17]. Only a few from this group decide to continue rehabilitation in ambulatory programmes [18]. Comfort, accessibility, the psychological and socio-economical profile of the subjects, and other certain patient-related issues (e.g. smoking habit) are some of the reasons for this situation [18, 19]. In our study the demographic and clinical profile of the subjects was comparable to that described in numerous papers on knowledge on CV risk factors and secondary prevention [20–22]. Therefore, we may assume that our findings are representative for the population.

The control of CV risk factors in Polish patients after myocardial infarction remains insufficient [15] and has not improved markedly in the last 20 years. According to the Cracovian Programme for Secondary Prevention of Ischaemic Heart Disease, the proportion of patients with adequate control of all major risk factors in patients one year after hospitalisation due to ischaemic heart disease is only 9% [23]. Moreover, in the nationwide POL-AMI database it was found that during one year after myocardial infarction only 22% of patients were subjected to cardiac rehabilitation, mostly during the first three months after acute myocardial infarction (79% of them) [24].

Physical activity following coronary syndromes improves physical fitness, cardio-metabolic profile, and, combined with adequate diet, efficiently reduces body mass and has a beneficial effect on psycho-social condition as well as quality of life [25–28]. This effect is dependent on the type of training, its intensity, duration of the programme, and effect assessment methods [29, 30]. In our study we intentionally used a simple 6MWT for assessing physical condition. This widely used, standardised method is well tolerated by patients, and its rules are easy to understand, even for older people. Moreover, the 6MWT can be guided by a physiotherapist without direct physician supervision in almost every hospital environment. What is most important, it may be repeated during the hospitalisation to eliminate the learning curve and to observe the real progress of rehabilitation. Implementation of cardiopulmonary exercise testing with the use of ergospirometry or treadmill test is usually theoretically and practically limited (although it gives more reliable results).

A direct comparison of our results to literature data is quite difficult because of the novelty of our project. A lot of valuable information may be found in a paper by Turner et al. [25] basked on a group of 1443 patients aged 60 ± 10 years, who demonstrated a significant improvement of oxygen absorption during treadmill test of 3.2 mL/min/kg (95% CI 3.1–3.4), and in a paper by Lavie et al. [26] based on 104 patients aged 48 ± 6 years, who showed an 11.3% improvement in oxygen absorption during endurance test. The results of Gołuchowska et al. [27] are also of interest, who documented progress of cardio-pulmonary fitness after a two-month cycle of rehabilitation within a group of 63 men after percutaneous coronary intervention; in training on bicycle ergometer Ppeak increased from 94.21 ± 16.94 W to 119.97 ±19.43 W, while peak heart rate decreased from 119.97 ± 19.43 bpm to 108.25 ± 13.36 bpm. Unfortunately, neither of those studies compares the results in terms of knowledge on CV risk factors.

Limitations of the study

Our research has several limitations. First, it is an observational epidemiological study performed within one rehabilitation centre, so uncritical extrapolation of the results onto a larger population is impossible without being exposed to bias. Second, both methods we used to gather data may be burdened with measurement error. However, we tried to overcome this drawback by using a validation procedure in the questionnaire and retaking 6MWT three times. Third, our statistical methods did not cover multivariate analysis, so the influence of confounders cannot be eliminated.

CONCLUSIONS

Knowledge on CV risk factors is associated with effectiveness of rehabilitation.

Conflict of interest: none declared

References

  1. 1. Anderson L, Thompson DR, Oldridge N, et al. Exercise-based cardiac rehabilitation for coronary heart disease. Cochrane Database Syst Rev. 2016; 67(1): CD001800–12, doi: 10.1002/14651858.CD001800.pub3, indexed in Pubmed: 26730878.
  2. 2. Krzych LJ, Woźnica A, Pawlak A, et al. Quality of life in young, professionally active men undergoing on-pump coronary artery bypass grafting — short-term follow-up results. Kardiol Pol. 2009; 67(10): 1078–1085, indexed in Pubmed: 20017073.
  3. 3. Lee JY, Ahn JM, Park DW, et al. Impact of exercise-based cardiac rehabilitation on long-term clinical outcomes in patients with left main coronary artery stenosis. Eur J Prev Cardiol. 2016; 23(17): 1804–1813, doi: 10.1177/2047487316658570, indexed in Pubmed: 27369843.
  4. 4. Hambrecht R, Wolf A, Gielen S, et al. Effect of exercise on coronary endothelial function in patients with coronary artery disease. N Engl J Med. 2000; 342(7): 454–460, doi: 10.1056/NEJM200002173420702, indexed in Pubmed: 10675425.
  5. 5. Malfatto G, Facchini M, Sala L, et al. Relationship between baseline sympatho-vagal balance and the autonomic response to cardiac rehabilitation after a first uncomplicated myocardial infarction. Ital Heart J. 2000; 1(3): 226–232, indexed in Pubmed: 10806991.
  6. 6. Lee KW, Blann AD, Jolly K, et al. BRUM Investigators. Plasma haemostatic markers, endothelial function and ambulatory blood pressure changes with home versus hospital cardiac rehabilitation: the Birmingham Rehabilitation Uptake Maximisation Study. Heart. 2006; 92(12): 1732–1738, doi:10.1136/hrt.2006.092163, indexed in Pubmed: 16807272.
  7. 7. Liew H, Taylor DM, Tjipto A, et al. Investigation of the variables that impact upon the knowledge of cardiac risk factors. Emerg Med Australas. 2006; 18(3): 252–258, doi: 10.1111/j.1742-6723.2006.00848.x, indexed in Pubmed: 16712535.
  8. 8. Alm-Roijer C, Stagmo M, Udén G, et al. Better knowledge improves adherence to lifestyle changes and medication in patients with coronary heart disease. Eur J Cardiovasc Nurs. 2004; 3(4): 321–330, doi: 10.1016/j.ejcnurse.2004.05.002, indexed in Pubmed: 15572021.
  9. 9. Tawalbeh LI, Ahmad MM. The effect of cardiac education on knowledge and adherence to healthy lifestyle. Clin Nurs Res. 2014; 23(3): 245–258, doi:10.1177/1054773813486476, indexed in Pubmed: 23666931.
  10. 10. Zhao S, Zhao H, Wang L, et al. Education is critical for medication adherence in patients with coronary heart disease. Acta Cardiol. 2015; 70(2): 197–204, doi: 10.2143/AC.70.2.3073511, indexed in Pubmed: 26148380.
  11. 11. Kayaniyil S, Ardern CI, Winstanley J, et al. Degree and correlates of cardiac knowledge and awareness among cardiac inpatients. Patient Educ Couns. 2009; 75(1): 99–107, doi: 10.1016/j.pec.2008.09.005, indexed in Pubmed: 18952393.
  12. 12. Dylewicz P, Jegier A, Piotrowicz R, et al. Kompleksowa Rehabilitacja Kardiologiczna. Stanowisko Komisji ds. Opracowania Standardów Rehabilitacji Kardiologicznej Polskiego Towarzystwa Kardiologicznego. Folia Cardiologica. 2004; 11(supl. A): A1–A48.
  13. 13. Polskie Forum Profilaktyki Chorób Układu Krążenia. http://www.pfp.edu.pl/index.php?id=wytyczne.
  14. 14. Jankowski P, Niewada M, Bochenek A, et al. [Optimal model of comprehensive rehabilitation and secondary prevention]. Kardiol Pol. 2013; 71(9): 995–1003, doi: 10.5603/KP.2013.0246, indexed in Pubmed: 24065281.
  15. 15. Jankowski P, Gąsior M, Gierlotka M, et al. [Coordinated care after myocardial infarction. The statement of the Polish Cardiac Society and the Agency for Health Technology Assessment and Tariff System]. Kardiol Pol. 2016; 74(8): 800–811, doi: 10.5603/KP.2016.0118, indexed in Pubmed: 27553352.
  16. 16. Neubeck L, Freedman SB, Clark AM, et al. Participating in cardiac rehabilitation: a systematic review and meta-synthesis of qualitative data. Eur J Prev Cardiol. 2012; 19(3): 494–503, doi: 10.1177/1741826711409326, indexed in Pubmed: 22779092.
  17. 17. Nguyen TN, Abramson BL, Galluzzi A, et al. Canadian GRACE Investigators. Temporal trends and referral factors for cardiac rehabilitation post-acute coronary syndrome in ontario: insights from the Canadian Global Registry of Acute Coronary Events. Can J Cardiol. 2013; 29(12): 1604–1609, doi:10.1016/j.cjca.2013.10.002, indexed in Pubmed: 24267803.
  18. 18. Deskur-Smielecka E, Borowicz-Bieńkowska S, Brychcy A, et al. Why patients after acute coronary syndromes do not participate in an early outpatient rehabilitation programme? Kardiol Pol. 2009; 67(6): 632–638, indexed in Pubmed: 19618319.
  19. 19. Cottin Y, Cambou JP, Casillas JM, et al. Specific profile and referral bias of rehabilitated patients after an acute coronary syndrome. J Cardiopulm Rehabil. 2004; 24(1): 38–44, indexed in Pubmed: 14758102.
  20. 20. Piepoli MF, Hoes AW, Agewall S, et al. Authors/Task Force Members, Additional Contributor: Simone Binno (Italy), Document Reviewers:. 2016 European Guidelines on cardiovascular disease prevention in clinical practice: The Sixth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (constituted by representatives of 10 societies and by invited experts): Developed with the special contribution of the European Association for Cardiovascular Prevention & Rehabilitation (EACPR). Eur J Prev Cardiol. 2016; 23(11): NP1–NP96, doi: 10.1177/2047487316653709, indexed in Pubmed: 27353126.
  21. 21. Giobergia E, Mento C, Pasero E, et al. [Efficacy of team work in health promotion and secondary prevention in patients admitted for cardiovascular rehabilitation]. Monaldi Arch Chest Dis. 2010; 74(4): 172–180, doi: 10.4081/monaldi.2010.258, indexed in Pubmed: 21337806.
  22. 22. Piepoli MF, Corrà U, Benzer W, et al. Cardiac Rehabilitation Section of the European Association of Cardiovascular Prevention and Rehabilitation. Secondary prevention through cardiac rehabilitation: from knowledge to implementation. A position paper from the Cardiac Rehabilitation Section of the European Association of Cardiovascular Prevention and Rehabilitation. Eur J Cardiovasc Prev Rehabil. 2010; 17(1): 1–17, doi:10.1097/HJR.0b013e3283313592, indexed in Pubmed: 19952757.
  23. 23. Jankowski P, Czarnecka D, Lysek R, et al. Secondary prevention in patients after hospitalisation due to coronary artery disease: what has changed since 2006? Kardiol Pol. 2014; 72(4): 355–362, doi: 10.5603/KP.a2013.0350, indexed in Pubmed: 24408064.
  24. 24. Gierlotka M, Zdrojewski T, Wojtyniak B, et al. Incidence, treatment, in-hospital mortality and one-year outcomes of acute myocardial infarction in Poland in 2009-2012-nationwide AMI-PL database. Kardiol Pol. 2015; 73(3): 142–158, doi: 10.5603/KP.a2014.0213, indexed in Pubmed: 25371307.
  25. 25. Turner S, Bethell H, Evans J, et al. Patient characteristics and outcomes of cardiac rehabilitation. J Cardiopulmonary Rehabilitation. 2002; 22(4): 253–260, doi: 10.1097/00008483-200207000-00007.
  26. 26. Lavie CJ, Milani RV. Adverse psychological and coronary risk profiles in young patients with coronary artery disease and benefits of formal cardiac rehabilitation. Arch Intern Med. 2006; 166(17): 1878–1883, doi: 10.1001/archinte.166.17.1878, indexed in Pubmed: 17000945.
  27. 27. Gołuchowska A, Rębowska E, Drygas W, et al. Metabolic risk in men with ischaemic heart disease and their participation in ambulatory comprehensive cardiac rehabilitation. Kardiol Pol. 2015; 73(8): 656–663, doi: 10.5603/KP.a2015.0052, indexed in Pubmed: 25761789.
  28. 28. Deskur-Smielecka E, Borowicz-Bienkowska S, Maleszka M, et al. Early phase 2 inpatient rehabilitation after acute coronary syndrome treated with primary percutaneous coronary intervention: short- and long-term effects on blood pressure and metabolic parameters. Am J Phys Med Rehabil. 2011; 90(7): 589–598, doi: 10.1097/PHM.0b013e3182063bec, indexed in Pubmed: 21273893.
  29. 29. Balsam P, Główczyńska R, Zaczek R, et al. The effect of cycle ergometer exercise training on improvement of exercise capacity in patients after myocardial infarction. Kardiol Pol. 2013; 71(10): 1059–1064, doi: 10.5603/KP.2013.0261, indexed in Pubmed: 24197587.
  30. 30. Goel K, Lennon RJ, Tilbury RT, et al. Impact of cardiac rehabilitation on mortality and cardiovascular events after percutaneous coronary intervention in the community. Circulation. 2011; 123(21): 2344–2352, doi: 10.1161/CIRCULATIONAHA.110.983536, indexed in Pubmed: 21576654.

 

Cite this article as: Kapko WS, Krzych Ł. Knowledge on cardiovascular risk factors improves the effectiveness of rehabilitation following acute coronary syndrome. Kardiol Pol. 2017; 75(4): 344–350, doi: 10.5603/KP.a2016.0188.




Polish Heart Journal (Kardiologia Polska)