Comprehensive Cardiac Rehabilitation for Secondary Prevention After Transient Ischemic Attack or Mild Stroke: PSYCHOLOGICAL PROFILE AND OUTCOMES

• Published in: Journal of cardiopulmonary rehabilitation and prevention Vol. 37; no. 6; pp. 428 - 436
• Main Authors: Prior, Peter L, Hachinski, Vladimir, Chan, Richard, Unsworth, Karen, Mytka, Sharon, Harnadek, Michael, OʼCallaghan, Christina, Suskin, Neville
• Format: Journal Article
• Language: English
• Published: United States Copyright Wolters Kluwer Health, Inc. All rights reserved 01-11-2017
• Subjects: Aged; Cardiac Rehabilitation - methods; Cardiac Rehabilitation - psychology; Cohort Studies; Female; Humans; Ischemic Attack, Transient - prevention & control; Ischemic Attack, Transient - psychology; Male; Middle Aged; Outcome Assessment (Health Care) - methods; Prospective Studies; Psychometrics; Risk Factors; Secondary Prevention - methods; Stroke - prevention & control; Stroke - psychology
• DOI: 10.1097/HCR.0000000000000274
• EISSN: 1932-751X
• ISSN: 1932-7501

PURPOSE:Having previously reported that comprehensive cardiac rehabilitation (CCR) is effective for secondary prevention post-transient ischemic attack (TIA)/mild nondisabling stroke (MNDS), we present psychometric findings for the same sample that elucidate subacute TIA/MNDS psychological outcomes and test whether CCR would be independently associated with psychological improvements.
METHODS:In this prospective cohort trial patients with ≥1 risk factor, recruited from a stroke prevention clinic within 12 months (mean = 11.5 weeks) post-TIA/MNDS, entered CCR.
RESULTS:Of the 110 recruited patients, 100 (mean age = 65.4 years; 46 females) entered CCR and 80 completed CCR (mean duration = 7.6 months). At CCR entry, 16.5% and 39.2% screened positively for depression and anxiety, decreasing nonsignificantly at exit to 4.2%, and significantly to 16.9% (P = .008), respectively. Age-corrected deficits occurred more frequently than expected (P ≤ .03); at entry, mental health status (13.3%), clock-drawing (31.6%), oral-verbal fluency (16.9%), word-list learning (11.2%), and recall (12.6%); at exit, clock-drawing (30.0%). Entry-to-exit, mean depression, anxiety, mental and physical health status, word-list learning, memory, digit-symbol coding, and oral-verbal fluency scores improved significantly (P ≤ .031). No reliable change indices were significant. Psychological service recipients improved significantly more than nonrecipients in depression (P = .049). Baseline North American Adult Reading Test score predicted exercise attendance (R = 0.275; P = .044); New York Heart Association (NYHA) class and depression score predicted exit physical health status (R = 0.770, P < .001); and depression score predicted exit mental health status (R = 0.523, P < .001).
CONCLUSIONS:Anxiety and executive dysfunction persisted post-TIA/MNDS. Although promising for secondary prevention post-TIA/MNDS, CCR was not independently associated with psychological improvements. CCR psychological treatment may benefit depression. Subacute NYHA class and depression may later affect quality of life.