Quality of life – ABC CARDIOL

IJCS

Review Article

Home-Based Vs. Usual and Center-Based Cardiac Rehabilitation: Effects on Aerobic Fitness and Quality of Life

Cauã Teixeira Mota et al. Claudia Lucia de Moraes Forjaz

Abstract

Home-based cardiac rehabilitation has been proposed as an alternative to expand access to treatment for patients with cardiovascular diseases. This systematic review evaluated the effects of home-based cardiac rehabilitation, with emphasis on physical exercise, on aerobic fitness, quality of life, and adverse events compared with usual cardiac rehabilitation and center-based cardiac rehabilitation. A literature search was conducted in the PubMed database, including only randomized controlled clinical trials involving adults and older adults with coronary artery disease or heart failure. Twenty-three studies conducted in different countries were identified; however, none was performed in Brazil. The total sample comprised 2,298 participants, of whom 24% were women. All studies implemented aerobic training, either alone or combined with resistance training, and the vast majority maintained remote contact with participants every one to two weeks. Comparisons between pre- and post-intervention outcomes showed that home-based cardiac rehabilitation improved aerobic fitness and/or quality of life in 22 studies, with greater improvements than those observed with usual cardiac rehabilitation and outcomes comparable to those achieved with center-based cardiac rehabilitation. Furthermore, the incidence of adverse events was low and similar across the three rehabilitation models. Overall, home-based cardiac rehabilitation improves aerobic fitness and quality of life more effectively than usual cardiac rehabilitation and provides benefits comparable to those of center-based cardiac rehabilitation without increasing the risk of adverse events, supporting its use in the treatment of cardiovascular diseases. Nevertheless, the absence of studies conducted in Brazil highlights the need for further research on this rehabilitation model in the Brazilian context.

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Original Article

Quality of Life Assessment of Patients Infected With COVID-19 and Prior Coronary Artery Bypass Graft Surgery in Brazil: Four Years Follow-up

Adnaldo da Silveira Maia et al. Matheus Maia Adnaldo Lucas da Silveira Maia Magaly Arrais dos Santos

Abstract

Background

The COVID-19 pandemic has been a worldwide challenge. In patients with coronary artery disease (CAD), previously submitted to coronary artery bypass graft surgery (CABG), such impact should be analyzed.

Objectives

Evaluate the impact on quality of life of COVID-19 infection in patients with prior CABG.

Methods

Patients undergoing isolated CABG between July 2016 and July 2017 were enrolled. This is an observational, cross-sectional, prospective study. Patients were divided into two groups: Group (COVID-19) and Group (No-COVID), for analysis of variables. The World Health Organization’s (WHO) definitions of confirmed cases were used to define the diagnosis of COVID-19 infection. Quality of life was assessed using the Quality of Life in Cardiovascular Surgery (QLCS) questionnaire, applied 30 days, 6 months, 1 year, and 4 years after surgery. The primary endpoint was improvement in quality of life at 4 years after CABG. The local ethics committee approved the study. Continuous variables were described by their means and standard deviations (SD). Categorical variables were described using absolute or relative frequencies. The items that make up the quality of life questionnaire were added together to calculate the score. A linear mixed model was used to assess the effect of time on the score. The significance level adopted was 5%. The analyses were carried out using R software, version 4.2.1.

Results

The total sample consisted of 434 patients who underwent isolated CABG; the mean age was 63 years, with a prevalence of males (71%). Among the patients followed up at the 4-year follow-up (115), 60 (52%) were positive according to the WHO’s definitions. After multiple comparisons, there was a statistical difference in quality of life in all periods (P<0.001). Between patients with and without COVID-19, a statistical difference was observed at 1 and 4 years (p = 0.0039).

Conclusion

Patients who underwent CABG and had a history of COVID-19 infection experienced worsening quality of life within 4 years. There was no difference between groups regarding new acute myocardial infarction (AMI), stroke, or hospitalization.

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IJCS

Editorial

Assessment of Quality of Life after Diagnosis of Reflex Syncope: A Subjective Outcome of Great Clinical Importance with Multifactorial Cause

Nágela Nunes et al. Alfredo de Souza Bomfim

Syncope, a clinical syndrome characterized by transient loss of consciousness (TLOC), is defined by specific elements, namely: sudden onset and rapid recovery, loss of postural tone, full recovery of consciousness, amnesia of the event, nonresponsiveness, and a typical event duration of up to 5 minutes (usually lasting seconds). The pathophysiology of syncope involves global cerebral hypoperfusion, primarily due to a drop in blood pressure (BP), with various factors contributing individually or in combination to syncope (). Even brief periods of cessation of cerebral blood flow (6–8 s) or a systolic BP of 50–60 mmHg at the level of the heart (equivalent to 30–45 mmHg at the level of the brain in the upright position) can lead to TLOC. Pathophysiological mechanisms may include a decrease in peripheral vascular resistance, cardiac output, or a decrease in both. The etiology of syncope is didactically classified into three types: 1) orthostatic hypotension (OH); 2) reflex syncope (also termed vasovagal or neurally mediated syncope); and 3) cardiac syncope.

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IJCS

Original Article

Quality of Life After Diagnosis of Neurally Mediated Reflex Syncope by Tilt Test

Claudia Madeira Miranda et al. Rose Mary Ferreira Lisboa da Silva Edson Del Amore Filho Izabela Maria Azeredo Nascimento Pedro Santos Carvalho

Abstract

Background:

Vasovagal syncope (VVS) results in impaired quality of life (QoL). The response during the head-up tilt test (HUTT) influences QoL and recurrence.

Objectives:

To analyze the influence of the type of HUTT response on QoL in patients with VVS and recurrence of events after the exam.

Methods:

The SF-36 and Impact of Syncope on Quality of Life (ISQL) questionnaires were applied over 12 months after the HUTT. Unpaired Student’s t test was used for differences between 2 groups of quantitative data with normal distribution. The recurrence of syncope episodes was analyzed using a Kaplan-Meier curve, and the log-rank test was applied to compare the curves regarding responses to the HUTT. Statistical significance was set at p value < 0.05.

Results:

We analyzed 82 patients (43.7 years old), 69% with previous recurrence (2.8 prior episodes). Cardioinhibitory response occurred in 46 patients; vasodepressor response occurred in 36, and 85.4% of patients received non-pharmacological treatment after the HUTT. During clinical follow-up, 43.9% had recurrence, mainly young patients (35.7 years; p = 0.002). On the SF-36, the best score was in functional capacity in men (p = 0.04) and patients without prior trauma (p = 0.001). There were lower limitations due to pain in patients without prior trauma (p = 0.003) and patients without prodromes (p = 0.009). On the ISQL, there were better mean scores in men (p = 0.002) and in patients without prior trauma (p = 0.02). Patients with cardioinhibitory response had better SF-36 and ISQL scores (p < 0.001). There was greater VVS recurrence in the cardioinhibitory response group (log-rank p = 0.011; hazard ratio: 8.48; 95% confidence interval: 7.59 to 9.3) from the second to the fourth month, with stabilization in the eighth month after the HUTT, when compared to patients with vasodepressor response.

Conclusion:

The majority of patients with VVS reproduced during the HUTT under non-pharmacological treatment did not report worsening of QoL during clinical follow-up. Worse QoL was observed in non-young patients and in patients with vasodepressor response, and it was not influenced by recurrence after the HUTT.

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Original Article

Sociodemographic, Clinical Condition, and Functional Aerobic Capacity in Patients With Heart Failure With Varying Ventricular Ejection Fraction

Jhonatan Betancourt Peña et al. Iago Portela Pino Maria Jose Martinez Patino

Abstract

Background

Recently, a new heart failure (HF) classification was made considering the left ventricular ejection fraction (LVEF) phenotype. Comprehensive assessments of the groups are required to guide patient management.

Objective

To determine the differences in sociodemographic, clinical, functional aerobic capacity, and health-related quality of life (HRQOL) variables in patients with HF classified with different LVEFs and to explore the correlations between the variables.

Methods

This work is a cross-sectional descriptive and correlational study. Three groups of patients with HF (LVEF≥50%, LVEF<40%, and LVEF40-49%) were compared. Sociodemographic, clinical variables and functional aerobic capacity with Sit to Stand (STS), 6-minute walk test (6MWT), Duke Activity Status Index (DASI), Minnesota Living with HF Questionnaire (MLFHQ), and Patient Health Questionnaire 9 (PHQ-9) were considered. The Chi-square test, one-way analysis of variance (ANOVA) test, and Spearman's correlation were used for statistical analysis. The statistical significance level was set at 5%.

Results

A total of 209 patients were admitted with a diagnosis of HF, with a more significant number of men. Marital status was a predominantly stable union in the HF with preserved ejection fraction (HFpEF) and HF with mid-range ejection fraction (HFmrEF) groups. A sedentary lifestyle was lower in the HF with reduced ejection fraction (HFrEF) group 59 (84.3%), p-value = 0.033, and the angina pectoris was higher in the HFpEF 30 (42.9%). Systolic blood pressure at the end of the 6MWT evidenced a higher score in HFpEF 132.0±17.25 concerning HFrEF 128.0±16.57, p-value=0.043. The fat percentage was higher in HFpEF 30.20±8.80 regarding the HFmrEF group 26.51±7.60, p-value = 0.028.

Conclusion

There were significant differences according to the LVEF classification in marital status, angina symptoms, fat percentage, and blood pressure at rest.

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IJCS

Editorial

Quality of Life Assessment in Patients With ST-Elevation Myocardial Infarction (STEMI): An Opportunity to Improve the Quality of Care That Should Not Be Missed

Ana Teresa Timóteo

In chronic diseases, the Quality of Life (QoL) is one of the most important patient-reported outcomes. Cardiovascular diseases are the main cause of death worldwide and ischemic heart disease represents an important health burden. In a large population-based cohort, individuals with self-reported previous myocardial infarction (MI) presented worse self-perceived health statuses in all domains, particularly in mobility and anxiety / depression. However, QoL was not independently associated with MI but instead was associated with age, sex and number of comorbidities, which were significantly higher in patients with prior MI. In this study, long-term QoL was more impaired in men, as compared to women. Nevertheless, in population-based cohorts, we have many possible pitfalls, considering that a diagnosis of MI and other chronic diseases is self-reported; therefore, it is impossible to confirm this diagnosis. It is also impossible to differentiate between ST-elevation MI (STEMI) and non-STEMI, and it is rarely possible to assess the QoL at the same point in time after MI. In fact, we can expect QoL to be much different in the first few months after MI when compared with the QoL several years later.

A more structured study was performed in Australia, in which the QoL was assessed at earlier time points (4 weeks and 6 months). The study sample consisted primarily of males (representing more than 75%), but with a mean age similar to previous studies in MI populations. Health-related QoL improved at 6 months following primary percutaneous coronary intervention for physical and mental health. All aspects of cardiac-specific health status had improved (physical limitation, anginal frequency, treatment satisfaction, and QoL), except for angina stability. Patients aged ≥ 70 years had poorer physical QoL and physical limitations, but better mental QoL at both time points. However, patients were from a specific remote geographic region and were included in 2010 and 2011. Therefore, this did not represent a contemporary sample of patients, and it does not reflect current treatment standards. All in all, those results are not comparable with current populations of STEMI patients from different regions around the world.

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IJCS

Original Article

Quality of Life in Patients After Acute ST-Segment Elevation Myocardial Infarction

Bárbara de Matos Santos et al. Itana Samara Santana Guimarães Katia de Miranda Avena Ivan de Mattos Paiva Filho Pollianna de Souza Roriz

Abstract

Background:

ST-segment elevation myocardial infarction (STEMI) is the acute coronary syndrome with the highest severity and mortality. It can affect physical health and well-being of patients, and consequently their quality of life (QoL).

Objective:

To describe the QoL of patients at 30 days and 180 days after STEMI, focusing on sex differences and repercussions on physical and mental dimensions.

Methods:

Observational study with 174 STEMI patients included in the study on STEMI conducted in the city of Salvador, Brazil (PERSISST). The QoL of patients at 30 days (D30) and 180 days (D180) after the coronary event was assessed using the 12-item short form health survey (SF-12). Physical and mental components of QoL were calculated using the SF-12 OrthoToolKit. Descriptive analysis of data was made using the IBM SPSS software, version 25.0.

Results:

Mean age of participants at D30 and D180 was 57.1±11.4 years and 60.5±10.9 years, respectively, with a higher prevalence of men (55.8% and 56.8%). In general, patients had a poor QoL at both time points (scores 49.1±8.9 and 49.9±8.4, respectively). Analysis by sex, however, showed that men had a good QoL at both 30D (score 51.8±7.4) and 180 D (score 51.3±7.7), whereas a poor QoL was found among women at these time points (45.7±9.6 and 48.1±9.0, respectively). Men showed higher physical and mental health scale scores than women at both D30 and D180, and there was a greater impairment of the physical component in both sexes.

Conclusion:

Patients had poor QoL at 30 days and 180 days after STEMI, with a greater impairment of the physical component and a worse QoL perception among women than men at both time points.

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Original Article

Adherence and Quality of Life in Non-Valvular Atrial Fibrillation With Direct Oral Anticoagulants Versus Vitamin K Antagonists: A Systematic Review

Vanelise Zortea et al. Karine Duarte Curvello Diogo Pilger Antonios Douros … Lisiane Freitas Leal Tatiana da Silva Sempé Tatiane da Silva Dal Pizzol

Abstract

Background

Direct anticoagulants (DOACs) and vitamin K antagonists (VKAs) differ in pharmacokinetic characteristics, intensity of required laboratory monitoring, and costs. These differences could affect patients’ adherence to treatment and quality of life (QoL).

Objective

To assess whether patients with non-valvular atrial fibrillation (AF) using DOACs have better treatment adherence and QoL when compared to patients using VKAs.

Methods

We conducted a systematic review in Medline, Embase, LILACS, SciELO, CINAHL, and Cochrane Central, until June 9, 2021. We included studies that estimated and compared treatment adherence and QoL between DOACs and VKAs in adults with non-valvular AF. The methodological quality of the studies was assessed using the Joanna Briggs Institute (JBI) tools. The protocol was registered in the PROSPERO (CRD 42020165238).

Results

Sixteen studies, including 122,458 patients with non-valvular AF, evaluated adherence, and eleven studies, including 5,687 patients, assessed QoL. A variety of methods was used to measure adherence. Eleven studies showed no difference in adherence between DOACs and VKAs, while three studies favored VKAs over DOACs and two studies favored DOACs over VKAs. QoL was measured by specific (n = 3) or generic questionnaires (n = 8); results favored DOACs over VKAs in four studies, while in the other seven studies the results showed no difference between the groups. Meta-analyses were not performed due to high methodological heterogeneity among studies.

Conclusions

Available evidence regarding treatment adherence and QoL with DOACs and VKAs is characterized by methodological heterogeneity and conflicting findings.

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Editorial

Editorial: Effects of Physical Exercise on Left Ventricular Function in Type 2 Diabetes Mellitus: A Systematic Review

Gustavo Oliveira da Silva et al. Marilia de Almeida Correia Raphael Mendes Ritti-Dias

Diabetes mellitus is characterized by a group of metabolic disorders marked by high blood glucose levels. Over 90% of people with diabetes have type 2 diabetes (T2DM). The prevalence of T2DM has been increasing over the last decades worldwide, making it a serious global health concern. T2DM leads to an increased risk of the development of several health problems that result in high medical costs, poor quality of life, and higher mortality rates. More specifically, high blood glucose levels can eventually cause overall vascular harm that can affect the heart, eyes, kidneys, and nerves leading to serious complications. The vascular impairments of T2DM are amid the gravest consequences of the disease. Atherosclerosis is the main cause of the lower life expectancy in T2DM, with diabetic nephropathy and retinopathy being the leading factors responsible for end-stage renal disease and blindness. The risk of cardiovascular events is increased in patients with T2DM in comparison to nondiabetic subjects. In patients with cardiovascular diseases, such as peripheral arterial disease, T2DM is associated with a worse clinical and functional profile.

Heart failure (HF) has been shown to be a frequent cardiovascular complication in T2DM patients. There is a high number of T2DM in patients with the two most common forms of HF: impaired systolic left ventricular function and HF with preserved ejection fraction. Patients with T2DM have a high risk to develop HF, and T2DM patients with HF have a mortality rate four times greater than T2DM patients without HF.^, Therefore, T2DM has been recognized as an independent risk factor for HF leading to the establishment of the term ‘diabetic cardiomyopathy’, that is defined as a myocardial disease in T2DM patients, not related to hypertension, coronary artery disease or other cardiac diseases.^,

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Editorial

Family Functioning and Congenital Heart Disease

Klébia Magalhães Pereira Castello Branco et al. Maria Verônica Câmara dos Santos

In the last decades, we have been watching a remarkable increase in survival of children with congenital heart disease (CHD), due to advances in surgical and medical management, leading to a significant growth in the number of adolescents and young adults with the disease. In developed countries, the number of adults with CHD surpasses the number of children with CHD.

Unfortunately, prolonged survival has been achieved at a high cost, as an expressive number of patients continue to suffer from significant medical, psychological and social issues. The knowledge that CHD brings an individual burden is not a new concept. In 1964, Glaser concluded that “Despite benefits derived from these remarkable therapeutic gains, children with CHD face many difficulties in their efforts toward social and emotional adjustment.”

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Editorial

The Present and Future of the Cardioprotective Food Model for the Brazilian Population

Thais de Rezende Bessa Guerra

In recent decades, researchers have found important changes in the health pattern and food consumption of the Brazilian population. These changes have been associated with chronic non-communicable diseases, especially cardiovascular disease.

The Global Burden of Disease Study (2019), which analyzed data on chronic non-communicable diseases in 204 countries and territories between 1990 and 2019, estimated that cardiovascular disease, which is attributable to modifiable risk factors such as cholesterol level, is the main health care burden worldwide. High LDL cholesterol and its associated mortality remain a major threat to public health. The report recommends that national health systems focus on new approaches that can reverse these trends, since there is an urgent need to implement effective policies and interventions to achieve a 30% reduction in premature mortality from non-communicable diseases.

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Editorial

Weight Excess: The Great Villain in the Development of Hypertension in Adolescents

Erika Maria Gonçalves Campana et al. Maria Eliane Campos Magalhães Andréa Araujo Brandão

The relationship between arterial hypertension (AH) and excess weight in young populations is well established. This association involves several conditions including hyperinsulinemia, altered adipokine profile, elevated markers of subclinical inflammation, and inadequate habits, including physical inactivity.^–

In a study^– conducted in the city of Rio de Janeiro, Brazil, an increased body mass index in adolescents was correlated with a higher prevalence of elevated blood pressure (BP) and higher risk of developing AH at young adult age. From a longitudinal perspective, an interesting aspect in the assessment of cardiovascular risk factors is the tracking effect, in which children and adolescents with altered clinical and metabolic parameters (BP, body mass index and cholesterol levels) are likely to maintain an abnormal profile of these variables throughout life and become adults at increased cardiovascular risk.^– This fact highlights the continuous, unfavorable impact of persistent obesity from childhood to adulthood on cardiovascular risk factors.

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Editorial

The Complex Relationship Between Emotions and the Heart: Should We Care?

Sarah Fagundes Grobe et al. Lídia Zytynski Moura

Knowing how to live with negative emotions is not easy, and developing mechanisms to overcome them can be even more challenging. The attempt to determine the physical effects of emotions and establish their profound influence on the heart has challenged physicians for centuries. Mood disorders, such as depression and anxiety, significantly impact quality of life and increase morbidity and mortality.

At least 30% of patients diagnosed with heart failure (HF) have depressive symptoms, and these numbers have progressively increased since the 1990s. A meta-analysis found that the rates of mortality and cardiovascular events were twice as high in patients with HF and associated depression, and this was often independent of functional class.^, Some behavioral patterns contribute to these results, since patients with depression or anxiety often do not adhere to pharmacological treatment, are less active, have poor eating habits, and use tobacco.^,

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Editorial

A New Look at the Importance of Multidisciplinary Group Interventions in Cardiac Rehabilitation

Gabrielle de Souza Rocha et al. Julio Cesar Fraulob Aquino

Chronic non-communicable diseases (NCDs) are the main cause of death worldwide, being responsible for premature deaths, loss of quality of life, with great socioeconomic impact. More than 17 million (around 45%) of NCD deaths in the world are caused by cardiovascular (CV) diseases. Similar findings are found in Brazil, where 72% of all deaths are attributed to NCDs, 30% due to CV disease.

There is increasing evidence that staying physically active contributes to preserve and recover physical and emotional health, and that a sedentary lifestyle is strongly related to CV disease and early mortality. In this context, the benefits of CV rehabilitation, with emphasis on physical exercise, have emerged in the literature, and correlated with a reduction in CV morbidity and mortality, significant improvement of quality of life and longer life expectancy.

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Original Article

Effectiveness of Telemedicine in Reducing Hospitalizations in Patients Discharged from the Hospital Due to Heart Failure: A Randomized Clinical Trial Protocol

Edmar Geraldo Ribeiro et al. Luisa Brant Lilian Cristina Rezende Renato Azeredo Teixeira … Laura Carvalho Parreiras Tulio Batista Franco Antônio Ribeiro Deborah Malta

Abstract

Fundament:

Telemedicine for follow-up in heart failure (HF) patients is effective in reducing hospitalizations, total and cardiovascular mortality. However, few studies were conducted in low and middle income, where lower access to technology and illiteracy could impact the results.

Objective:

To assess the effectiveness of associating telemedicine strategies, when compared to usual care, in reducing hospitalizations related to HF in patients discharged from the hospital due to HF.

Methods:

Controlled, randomized, multicenter, parallel-arm clinical trial, with an allocation ratio of 1:1, blinded to outcome evaluation, in which 340 patients who were discharged from public hospitals in Belo Horizonte due to HF will be randomized. Patients will be followed for 6 months and the intervention group will receive, in addition to the usual care, Structured Telephone Support (STS) from a nurse, a doctor, and an educational program. Counseling will be according to a clinical decision tree. The level of significance in the statistical analysis will be 5%.

Expected results:

Reduction in the number of hospital readmissions and/or in hospitalization time, in addition to developing a software with a clinical decision tree for remote follow-up and patient education about HF adapted to local culture.

Conclusions:

The intention of this study is to develop a telemedicine strategy and assess whether or not, in addition to the usual care, it is effective in reducing hospitalizations and mortality from HF. If effective, the aforementioned strategy could reduce costs and hospital needs in the Unified Health System (SUS, in Portuguese) for patients with HF. These results will be even more relevant considering the pandemic of COVID-19.

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Original Article

Interdisciplinary Group Intervention on Nutritional Profile, Quality of Life, and Stress During Cardiopulmonary Rehabilitation: A Randomized Clinical Trial

Giana de Freitas Rodrigues et al. Daniela da Rosa Vieira Patrícia Pereira Ruschel Cynthia Seelig … Christian Coronel Sandra Mari Barbiero

Abstract

Background:

Participating in therapeutic operative groups with nutritional and psychological interventions might influence the recovery of patients in cardiopulmonary rehabilitation programs.

Objective:

To evaluate the effectiveness of group interventions on the nutritional profile, stress, and quality of life of patients in cardiopulmonary rehabilitation.

Methods:

In this randomized clinical trial, adult patients of the Cardiopulmonary and Metabolic Rehabilitation (CPMR) unit were randomized into control group (CG), receiving standard follow-up assessment by the CPMR unit, and intervention group (IG), which additionally participated in 6 meetings of an interdisciplinary group with a nutritionist and a psychologist. Anthropometric data and results from a food frequency questionnaire (FFQ), Lipp’s Inventory of Stress Symptoms for Adults (ISSL), and the 12-Item Short Form Health Survey (SF-12) were analyzed. Student’s t-tests, Generalized Estimation Equations (GEE), Mann-Whitney tests, and Bonferroni tests were used for statistical analyses, with a significance level of 5%.

Results:

The sample consisted of 76 patients: 31 in the IG (64±9.2 years old) and 45 in the CG (61.4±11.8 years old). There was a significant reduction (p<0.001) in weight, body mass index, and waist circumference, and an increase (p=0.010) in the consumption of healthy food only in the IG. The consumption of unhealthy food was reduced in both groups (p<0.001), the physical aspect of quality of life improved (p=0.018), and women presented better physical (p=0.011) and mental results (p=0.008).

Conclusions:

This group intervention was effective regarding the nutritional status of patients in cardiopulmonary rehabilitation. The physical aspect of quality of life showed improvements in both groups.

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Viewpoint

Physical Activity and Cardiovascular Health: Practical Strategies to Reduce Sedentary Time in Adult Population

Karolinny Borinelli de Aquino Moura et al. Simone Savaris Janice Debastiani Juliana Beust de Lima

Introduction

Cardiovascular disease (CVD) is highly prevalent worldwide and is the main cause of death in the general population. The practice of physical activity (PA) has emerged as a primary prevention strategy for CVD, with the potential to control risk factors, and promote a better quality of life and longer survival.

However, despite the scientifically proven benefits, and formal recommendations for the practice of PA for adults, ( ), published data on the world population are alarming. Recent estimates indicate that one in four (27.5%) adults worldwide and almost half of the population in Brazil do not follow the recommendations made by the World Health Organization (WHO). Additionally to physical inactivity, the growing prevalence of sedentary behavior is a current concern ( ).

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Original Article

Spirituality, Religiosity and Quality of Life of Hypertensive and Diabetic Patients in a Referral Hospital in Pernambuco

Gabriela de Paula Lopes Brito et al. Maria Eduarda Farias Barbosa Vera Azevedo Bérgamo Barrêto Bruna Almeida Andrade Velloso … Rafaela Siqueira Duarte Ribeiro Sophia Barreto Tenório Luna Leopoldo Nelson Fernandes Barbosa Arturo de Pádua Walfrido Jordán

Abstract

Background

Religiosity is a system of worship and doctrine that is shared by a group, and spirituality is the individual search for the meaning of life. The relationship between spirituality/religiosity (S/R) and health has a long history, and a positive correlation between spirituality and chronic diseases has been described in scientific literature, showing a decrease in morbidity and mortality in general.

Objective

To evaluate the association between S/R and the quality of life of patients with diabetes and/or systemic arterial hypertension.

Method

An observational, analytical, cross-sectional, quantitative study was conducted with a sample consisting of 40 patients treated at the hypertension and diabetes outpatient clinic of a medical center in Recife. The collection used three assessment instruments (SSRS, Duke-DUREL scale, and WHOQOL-BREF). Data from the questionnaires were analyzed using descriptive (frequency and percentage) and inferential statistics (chi-square test and F test) using the R software, version 3.4.3. The level of significance in all analyses was 5%. The study was approved by CEP/IMIP, according to report no. 2.890.126.

Result

All four domains of the quality-of-life scale (WHOQOL-BREF) showed a positive relationship when correlated with the religiosity scale (DUREL), with statistical significance in the relationship between organizational religiosity and the environmental domain. When correlated with the spirituality scale (SSRS), WHOQOL-BREF also showed a positive relationship, except in the physical domain.

Conclusion

A positive relationship between quality of life and S/R was shown, thus confirming its importance for patients with diabetes and SAH.

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Review Article

Effectiveness of Mindfulness Meditation Programs in the Promotion of Quality of Life in Patients with Heart Failure: A Systematic Review

Vaisnava Nogueira Cavalcante et al. Ana Carla Dantas Cavalcanti Juliana de Melo Vellozo Pereira Tinoco Lyvia da Silva Figueiredo Evandro Tinoco Mesquita

Abstract

Background:

Despite optimal medical treatment, many heart failure (HF) patients continue to show a high prevalence of symptoms, which contributes to a high morbidity and poor health-related quality of life (HRQL). Mindfulness meditation may be effective in improving the quality of life in these patients.

Objective:

A systematic review was conducted to evaluate if mindfulness meditation programs are effective in promoting and improving the quality of life in patients with heart failure.

Methods:

The PubMed (MEDLINE), Cumulative Index of Nursing and Allied Health (CINAHL), LILACS, Cochrane Library, and Scopus databases were searched between October and November of 2019. Articles were selected if they evaluated mindfulness intervention, with an experimental or quasi-experimental design, in adults with heart failure and measured health-related quality of life.

Results:

This systematic review identified 108 studies through database searches. After applying the inclusion and exclusion criteria, a total of three studies were considered qualified. These studies took place in the Netherlands, the USA, and Brazil, and occurred between 2005 and 2015. Sample sizes varied from 19 to 215, and the average range of participants within each study varied from 43.2 to 75.4 years. Compared to control programs, mindfulness-based meditation programs improved the quality of life in two studies (p= 0.041 and p=0.03).

Conclusion:

Mindfulness-based meditation programs improved the quality of life in patients with HF. Therefore, there is limited data to strengthen this recommendation to this population, and future research is warranted in order to present consistency in the intervention protocols.

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Editorial

Climacteric Period and Cardiovascular risk: a Golden Opportunity to Watch and Succeed!

The gradual loss of ovarian function with concomitant decrease in estrogen levels, characteristic of the climacteric period, leads to several metabolic changes and symptoms. Significant effects on the health and quality of life of women occur, and vasomotor symptoms during this transitional period are almost universally recognized. Among physical symptoms, hot flushes and night sweats are very prevalent and may be very disturbing.

However, cardiovascular risk is frequently neglected not only by these women, but surprisingly, also by part of the medical community. Metabolic changes of the climaterium are associated with increased risk of diabetes mellitus, metabolic syndrome and cardiovascular disease. Additionally, the rate of cardiovascular events markedly increases after the age of 45. This is extremely relevant, as cardiovascular disease is the single most frequent cause of death among women.

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Original Article

Cardiovascular Risk Factors, Functionality, and Quality of Life in Climacteric Women

João Vítor Costa dos Santos Chaves et al. Keila Lindineia Silva Pinto Kleicillainy Mota de Sousa Lucas Oliveira Soares André Luiz Lisboa Cordeiro

Abstract

Background:

Cardiovascular disease (CVD) comprises a group of cardiac and circulatory diseases. Despite the high incidence in males, women after menopause have an exponential increase in the risk of CVD.

Objective:

To identify the leading risk factors for CVD and describe quality of life and functionality in women hospitalized for cardiac causes during the climacteric period.

Materials and methods:

Observational descriptive study. Quality of life was assessed through the SF-36 questionnaire, and functionality through the Functional Independence Measurement (FIM) scale. Records were used to identify the main risk factors associated with CVD in climacteric women.

Results:

We included 30 patients (mean age, 55 ± 6 years). The mean FIM score was 118 ± 3, and the mean SF-36 score, 20 ± 10. Hypertension and sedentary lifestyle were the most prevalent cardiovascular risk factors in these women.

Conclusion:

Hypertension and sedentary lifestyle were the most prevalent cardiovascular risk factors in this sample of climacteric women hospitalized for cardiac causes. Quality of life was strongly affected, with social, emotional, and mental health domains showing the most impact.

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Original Article

Effect of the Brazilian Cardioprotective Nutritional Program on the Quality of Life of Atherosclerotic Disease Patients

Patrícia Regina Thomé Martins et al. Annie Seixas Bello Moreira Elisa Maia dos Santos Luiz Fernando Rodrigues Júnior Bernadete Weber

Abstract

Background

Cardiovascular diseases (CVD) accounted for 27% of deaths in Brazil in 2017. Most of the recorded deaths caused by CVD would be preventable if patients controlled risk factors including inadequate diet. The Brazilian Cardioprotective Nutritional Program (Dica Br) adapted the Mediterranean diet pattern to Brazilian typical foods and evaluated the effectiveness of a nutritional program based on cardioprotective foods on cardiovascular events and death of patients with cardiovascular diseases.

Objectives

To evaluate the effect of Dica Br on the QoL of patients with atherosclerotic disease from two health centers in the city of Rio de Janeiro.

Method

Randomized clinical trial with 273 participants of both sexes, over 45 years old, followed for four years. The intervention group (IG) received individualized dietary prescription, educational program, individual and group consultations, and phone calls. The control group (CG) received general dietary guidance. The SF-36 was used to assess QoL. The Student’s t-test and the Mann-Whitney test was used to compare means between the groups. The mixed model test was used to compare the course of variables over time between the groups. Statistical significance was set at 5%.

Result

Most patients were male, with an average age of 64.2 ± 8.2 years in the IG and 65±9.5 years in the CG. Most were physically inactive, overweight, and had incomplete elementary school. The most prevalent comorbidity was systemic arterial hypertension, followed by dyslipidemia. QoL improved in both groups at four years. Waist circumference decreased in both groups over time, and low-density lipoprotein cholesterol (LDL-C) levels decreased in the IG but not in the CG after four years of follow-up.

Conclusion

The cardioprotective diet was effective in reducing LDL-C in the IG, and an improvement in QoL was observed in both intervention and control groups.

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IJCS

Original Article

Does Hypertension Knowledge Influence Levels of Physical Activity in Hypertensive Patients From a Southern Brazilian Community?

Rafaella Zulianello dos Santos et al. Andrea Schaefer Korbes Eliara Ten Caten Martins Mateus De Lucca … Leonardo De Lucca Marlus Karsten Magnus Benetti

Abstract

Background:

Increased level of physical activity (PA) and health education are known as non-pharmacological treatments of hypertension (HP). There is a lack of studies investigating the influence of HP knowledge on the level of PA among hypertensive patients.

Objective:

To examine the influence of patient’s knowledge about HP on PA level and the relationship between these variables.

Methods:

A cross-sectional study was conducted in in a primary care center located in a city in the southern Brazil. A total of 199 hypertensive patients (median 61.2 [13] years; body mass index (BMI) 21.9 (7.5) kg/m2; 72.4% women) were included. The level of PA was assessed by measuring the number of steps taken daily. The knowledge about HP was assessed by a standardized questionnaire (HIPER-Q). The Kruskall-Wallis test was used to compare age, BMI and PA level between HP knowledge categories, and the Spearman test was used to assess correlations (p <0.05).

Results:

The median score of knowledge about HP for patients categorized as insufficient (n=6, 3%), poor (n=24; 12.1%), acceptable (n=101; 50.8%) and good (n=68; 34.2%) was 11.0 (8.0), 20.0 (4.0), 26.0 (5.0) and 38.0 (2.0), respectively. No patient has achieved an “excellent” level of knowledge. There was no significant difference in PA level (p = 0.341), BMI (p = 0.510) or age (p = 0.073) between these categories. Age was negatively correlated with knowledge about HP (p <0.05 and rho = 0.02).

Conclusions:

Patient’s knowledge about HP did not influence the level of PA in hypertensive patients. Age, number of steps per day and BMI were not significantly different between the categories of knowledge. Public policies and organizational strategy should be addressed to improve health education and avoid sedentary behavior in this population. (Int J Cardiovasc Sci. 2020; [online].ahead print, PP.0-0)

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Letter to the Editor

The Big Mistake of not Considering Physical Activity an Essential Element of Care During the Covid-19 Pandemic

Francisco José Gondim Pitanga et al. Carmem Cristina Beck Cristiano Penas Seara Pitanga

Dear Editor,

In response to the letter to the editor entitled “Declaring physical activity as ‘essential’ during the Covid-19 pandemic may not be a good measure” that presented contributions to our point of view entitled “Should physical activity be considered essential activity during the Covid-19 pandemic?” we thank you for the suggestions and we present a reply letter with our arguments:

[…]

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