The effect of a nurse-led cardiac rehabilitation programme on patients with coronary heart disease in Chengdu, China

Abstract

Title: The Effect of a Nurse-led Cardiac Rehabilitation Programme on Patients with Coronary Heart Disease in Chengdu, China Background: Coronary heart disease has been increasing rapidly in the past two decades and has become the leading cause of death in China. The clinical presentations of coronary heart disease, such as angina pectoris and myocardial infarction, can induce a profound physiopsychosocial impact and impose a great burden on affected individuals. Strategies directed at the enhancement of the recovery process and secondary preventive care are highly needed so as to prevent the subsequent cardiac morbidity and mortality, promote the health status of patients, and ultimately help patients with coronary heart disease develop a positive attitude towards their life and a sense of control. Aim: This study aimed to evaluate the effect of a hospital-initiated home-based multi-faceted cardiac rehabilitation programme for Chinese patients with coronary heart disease in Chengdu. Method: An experimental design was adopted. One hundred and sixty-seven subjects were recruited in the study. They were randomly assigned to an intervention group and a control group. Subjects in the intervention group joined a 12-week hospital-initiated home-based cardiac rehabilitation programme that included medication management, angina management, physical exercise, smoking cessation, dietary management, and family support besides the conventional care. The outcome measurement included health behaviours, cardiac physiological risk parameters, anginal pain and sublingual glyceryl trinitrate use, quality of life and unplanned health service use. Data collection was conducted at programme entry (T1), programme exit (T2), and three months follow-up (T3). Results: On completion of the programme, patients in the intervention group demonstrated (1) a significantly better performance in walking (p=0.000), Step II diet adherence (p=0.000), and medication adherence (p=0.0l3); (2) a significantly greater reduction in serum lipids including triglyceride (p=0.032), total cholesterol (p=0.000), and low density lipoprotein (p=0.000). and better control of systolic (p=0.015) and diastolic (p=0.021) blood pressure; (3) significantly fewer anginal pain attacks (p=0.029) and less sublingual glyceryl trinitrate use (p=0.045); (4) significantly better improvements in six SF-36 quality of life domains, including general health (p=0.042), physical functioning (r=0.007), role physical (p=0.0l4), bodily pain (p=0.020), mental health (p=0.002), and vitality (p=0.043); and (5) significantly less unplanned cardiac-related medical consultation (p=0.022). The majority of these positive impacts were maintained at three months follow-up. The effect of the programme on smoking cessation, body weight, serum high-density lipoprotein, angina severity, social functioning and role emotional domains of SF-36 quality of life, as well as cardiac-related hospital readmission and emergency room attendance, was not confirmed. Conclusion: This was a pioneer study of nursing initiative on the effect of a hospital-initiated home-based multi-faceted cardiac rehabilitation intervention on patients with coronary heart disease in China. The findings of this study provide useful evidence of areas that can be influenced by such a rehabilitation strategy. The study also generates much-needed impetus and direction for the development of cardiac rehabilitation nursing, especially transitional and home-based rehabilitative care in China.