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Abstract: Objective: The aim of this study is to examine the association between changes in misconceived or maladaptive beliefs about angina and patients'' functional and psychological status. Method: The method used was a prospective follow-up study over 1 year of 133 people with angina. Results: Beliefs about angina were significantly associated with functional and psychological status. People with more misconceived or maladaptive beliefs were more anxious and physically limited than were people with fewer such beliefs, with differences in physical functioning that were clinically significant. Change in angina beliefs over 1 year was the most significant predictor for physical functioning at follow-up, after controlling for the effects of demographic variables and the outcome variable at baseline, whereas change in the frequency of angina did not contribute significantly to this model. Conclusion: Misconceived and maladaptive beliefs about angina are associated with reductions in both functional and psychological status. These beliefs are easily and quickly identified using a simple questionnaire and should be corrected. [Copyright &y& Elsevier]

Abstract: Objective: The aim of this study was to examine the extent to which illness perceptions predict attendance at cardiac rehabilitation and quality of life following myocardial infarction (MI). Methods: The illness perceptions of 194 MI patients were assessed whilst the patients were still in hospital following an MI. The mean age was 63.3 years (S.D.=10.6), and 142 of the patients were men. Cardiac rehabilitation attendance and quality of life were assessed via a postal questionnaire 6 months later. Results: In contrast to previous work reported in this area, illness perceptions were not significantly associated with attendance at cardiac rehabilitation. Illness perceptions measured within 24 h of an acute MI were predictive of quality of life 6 months later. Conclusion: Previous reports may have overestimated the extent to which illness perceptions predict attendance at cardiac rehabilitation. The relationship between illness perceptions and quality of life at 6 months suggests that interventions to alter illness perceptions, especially perceptions of consequences, may be useful in improving health-related quality of life (HRQoL) following an MI. [Copyright &y& Elsevier]

The utility of the Hospital Anxiety and Depression Scale (HADS) as a screening instrument for coronary care patients following acute myocardial infarction (MI) was investigated. A confirmatory factor analysis was conducted on the HADS to determine its psychometric properties in 335 MI patients over three observation points (1 week, 6 weeks and 6 months). Internal and test–retest reliabilities of the HADS total and HADS sub-scale scores were generally found to be acceptable. The underlying factor structure of the HADS comprised three distinct factors. Support was found for the use of the HADS sub-scales to assess dimensions of anhedonia, psychic anxiety and psychomotor agitation. The HADS may be a useful screening instrument to assess post-MI patients for symptoms of psychological distress. Further research is required to determine the three-factor structure of the HADS in other clinical groups. [Copyright &y& Elsevier]

Background: The study was performed to examine the effects of giving patients with acute myocardial infarction an advice and relaxation audio tape within 24 h of admission to hospital. Methods: A prospective, two-group design was used with 243 subjects randomised to receive either the advice and relaxation tape or a music tape of their choice within 24 h of sustaining a myocardial infarction. Outcomes comprised anxiety, cardiac misconceptions, lifestyle change, attendance at a cardiac rehabilitation programme, and quality of life. Results: Although the advice and relaxation tape reduced the number of cardiac misconceptions this did not lead to any improvements in outcome, whilst in hospital or at 6 months. Both tapes were equally appreciated by the patients, 98% of whom said that they would recommend them to other patients. Conclusions: An advice and relaxation tape reduces cardiac misconceptions but does not confer any other benefits over a music tape. [Copyright &y& Elsevier]

Although there have been a number of studies regarding attributions and misconceptions in people following a heart attack, there have been no comparable studies in people with angina. Semi-structured interviews were held with 20 people suffering from angina to discover their beliefs about angina, particularly those that may be misconceived or associated with maladaptive coping. Nineteen of the 20 participants held such beliefs. Stress was the most frequent causal attribution and misconceived angina avoidance strategies were cited by the majority. The beliefs about angina held by this sample may have implications for their health-related quality of life, if their experience mirrors that found within heart attack populations. [ABSTRACT FROM AUTHOR]

Aim. This paper is a report of a study of the choices patients make when offered home-based or hospital-based cardiac rehabilitation. Background. In some countries, patients may be offered a choice of home-based or hospital-based cardiac rehabilitation. While evaluating a home-based programme, Road to Recovery, developed by the British Heart Foundation, we examined patients' experiences of being offered this choice. Methods. Interviews were conducted with 35 patients and 12 staff members delivering the pilot programme in five rehabilitation services during 2006-2008. Findings. While the staff members interviewed reported that all patients were given a clear choice between a home-based and hospital-based or community-based programme, this choice was less clear-cut in the patient interviews. When choice was offered, the choice of a home-based programme was often based on constraints rather than on being a positive choice. Obstacles patients faced in making the choice included lack of information on which to base a choice; inadequate systems of referral; insufficient appropriately trained staff; restricted choice of times to attend the hospital programmes; the geographical location of services and restrictive socio-economic factors (inflexible working hours, access to transport). Conclusion. The possibility of informed choice relies in the first instance on the availability and accessibility of appropriate services. Nurses need awareness and commitment to finding out about and overcoming obstacles that impede patient participation in cardiac rehabilitation. Only in this manner will it be possible to fulfil the calls in national and some international clinical guidelines for 'individualized' or 'menu-based' programmes tailored to specific patient needs. [ABSTRACT FROM AUTHOR]

Abstract Objective: To identify the themes that influence decision making processes used by patients with symptoms of acute myocardial infarction. Design: Qualitative study using semistructured interviews. Setting: Two district hospitals in North Yorkshire. Participants: 22 patients admitted to hospital with confirmed second, third, or fourth acute myocardial infarction. Main outcome measure: Patients' perceptions of their experience between the onset of symptoms and the decision to seek medical help. Results: Six main themes that influence the decision making process were identified: appraisal of symptoms, perceived risk, previous experience, psychological and emotional factors, use of the NHS, and context of the event. Conclusions: Knowledge of symptoms may not be enough to promote prompt action in the event of an acute myocardial infarction. Cognitive and emotional processes, individual beliefs and values, and the influence of the context of the event should also be considered in individual interventions designed to reduce delay in the event of symptoms of acute myocardial infarction. [ABSTRACT FROM AUTHOR]

Aim This paper is a report of a qualitative study conducted as part of a randomized controlled trial comparing a lay-facilitated angina management programme with usual care. Its aim was to explore participants' beliefs, experiences, and attitudes to the care they had received during the trial, particularly those who had received the angina management intervention. Background Angina affects over 50 million people worldwide. Over half of these people have symptoms that restrict their daily life and would benefit from knowing how to manage their condition. Design A nested qualitative study within a randomized controlled trial of lay-facilitated angina management. Method We conducted four participant focus groups during 2008; three were with people randomized to the intervention and one with those randomized to control. We recruited a total of 14 participants to the focus groups, 10 intervention, and 4 control. Findings Although recruitment to the focus groups was relatively low by comparison to conventional standards, each generated lively discussions and a rich data set. Data analysis demonstrated both similarities and differences between control and intervention groups. Similarities included low levels of prior knowledge about angina, whereas differences included a perception among intervention participants that lifestyle changes were more easily facilitated with the help and support of a lay-worker. Conclusion Lay facilitation with the Angina Plan is perceived by the participants to be beneficial in supporting self-management. However, clinical expertise is still required to meet the more complex information and care needs of people with stable angina. [ABSTRACT FROM AUTHOR]

furze g., cox h., morton v., chuang l.-h., lewin r.j.p., nelson p., carty r., norris h., patel n. & elton p. (2012) Randomized controlled trial of a lay-facilitated angina management programme. Journal of Advanced Nursing 68(10), 2267-2279. Abstract Aims. This article reports a randomized controlled trial of lay-facilitated angina management (registered trial acronym: LAMP). Background. Previously, a nurse-facilitated angina programme was shown to reduce angina while increasing physical activity, however most people with angina do not receive a cardiac rehabilitation or self-management programme. Lay people are increasingly being trained to facilitate self-management programmes. Design. A randomized controlled trial comparing a lay-facilitated angina management programme with routine care from an angina nurse specialist. Methods. Participants with new stable angina were randomized to the angina management programme (intervention: 70 participants) or advice from an angina nurse specialist (control: 72 participants). Primary outcome was angina frequency at 6 months; secondary outcomes at 3 and 6 months included: risk factors, physical functioning, anxiety, depression, angina misconceptions and cost utility. Follow-up was complete in March 2009. Analysis was by intention-to-treat; blind to group allocation. Results. There was no important difference in angina frequency at 6 months. Secondary outcomes, assessed by either linear or logistic regression models, demonstrated important differences favouring the intervention group, at 3 months for: Anxiety, angina misconceptions and for exercise report; and at 6 months for: Anxiety; Depression; and angina misconceptions. The intervention was considered cost-effective. Conclusion. The angina management programme produced some superior benefits when compared to advice from a specialist nurse. [ABSTRACT FROM AUTHOR]

Abstract: Background: Many patients demonstrate psychological distress and reduced physical activity before coronary artery bypass graft surgery (CABG). Here we evaluated the addition of a brief, cognitive-behavioural intervention (the HeartOp Programme) to routine nurse counselling for people waiting for CABG surgery. Methods: Randomised controlled trial comparing nurse counselling with the HeartOp programme to routine nurse counselling in 204 patients awaiting first time elective CABG. Primary outcome measures were: anxiety and length of hospital stay; secondary outcome measures were: depression, physical functioning, cardiac misconceptions and cost utility. Measures were collected prior to randomisation and after 8 weeks of their intervention prior to surgery, excepting length of hospital stay which was collected after discharge following surgery. Results: 100 patients were randomised to intervention, 104 to control. At follow-up there were no differences in anxiety or length of hospital stay. There were significant differences in depression (difference=7.79, p =0.008, 95% CI=2.04–13.54), physical functioning (difference=0.82, p =0.001, 95%CI=0.34–1.3) and cardiac misconceptions (difference=2.56, p <0.001, 95%CI=1.64–3.48) in favour of the HeartOp Programme. The only difference to be maintained following surgery was in cardiac misconceptions. The HeartOp Programme was found to have an Incremental Cost Effectiveness Ratio (ICER) of £288.83 per Quality-Adjusted Life Year. Conclusions: Nurse counselling with the HeartOp Programme reduces depression and cardiac misconceptions and improves physical functioning before bypass surgery significantly more than nurse counselling alone and meets the accepted criteria for cost efficacy. [Copyright &y& Elsevier]

Abstract: Chronic refractory angina is an increasingly prevalent, complex chronic pain condition, which results in frequent hospitalization for chest pain. We have previously shown that a novel outpatient cognitive-behavioral chronic disease management program (CB-CDMP) improves angina status and quality of life in such patients. In the present study of 271 chronic refractory angina patients enrolled in our CB-CDMP, total hospital admissions were reduced from 2.40 admissions per patient per year to 1.78 admissions per patient per year (P <0.001). The rising trend of total hospital bed day occupancy prior to enrollment fell from 15.48 days per patient per year to a stable10.34 days per patient per year (P <0.001). There were 32 recorded myocardial infarctions prior to enrollment compared to eight in the year following enrollment (14% vs. 2.3%, P <0.001) and overall mortality was lower that comparable groups treated with surgery. This study shows that educating patients and demystifying angina using a brief outpatient CB-CDMP produces an immediate and sustained reduction in hospital admission costs that represents a major potential health care saving. This benefit accrues in addition to the known effects of CB-CDMP on symptoms and quality of life. These data suggest that a CB-CDMP approach to symptom palliation represents a low cost alternative to palliative revascularization. [Copyright &y& Elsevier]