PREDICTORS OF OUTCOME FOLLOWING PERCUTANEOUS CORONARY INTERVENTIONS (PCI)
H.C. Higgins*, K.T. McKenna, P.T. McEniery, C.N. Aroney, J. Cameron, M. Dooris, P. Garrahy, G. Holt, J.H.N. Bett.
Department of Occupational Therapy, The University of Queensland; Cardiology Department, The Prince Charles Hospital, Brisbane, Queensland.
Objective: To assess the effects of an individualised cardiac rehabilitation program and personal, occupational, clinical and risk factor variables on risk factor status, psychological well-being, functional capacity and work resumption patterns following PCI.
Method: Ninety-nine patients (mean age 47 years; 90% male) were randomised to control [CG](n=49) or intervention [IG](n=50) groups. Risk factor profiles, psychological well-being (Psychosocial Adjustment to Illness Scale [PAIS]) and functional capacity (Canadian Cardiovascular Society anginal classes [CCS] and the Specific Activity Questionnaire [SAQ] estimated VO2 (mls/kg/min) were measured on admission and at 10 weeks and 51 weeks post PCI. Work resumption patterns were measured at follow-up. Between and within subjects differences were examined by Analysis of Variance and c2. Predictors were determined using standard multiple and logistic regression.
Results: At early and late follow-ups respectively, significant within subjects improvements in Body Mass Index [BMI] (early p<.001, late p<.01) were demonstrated. A significant interaction effect at early follow-up (p<.01) suggested more rapid weight loss for IG patients. IG patients showed improved exercise participation (p<.001; p<.001) with differences favouring the IG at early follow-up (p<.01). First follow-up predictors for exercise participation included group allocation (OR 40.01, 95% CI 6.67-240.07; p<.001) and pre-PCI exercise history (OR 19.49, 95% CI 4.64 - 81.74; p<.001). At each follow-up within subjects improvement in psychological well-being and functional capacity was significant(p<.001). Pre-PCI PAIS total score predicted PAIS total score at both follow-ups (sr2 = .28, p<.001;sr2 = .26, p<.001). Pre-PCI VO2 (mls/kg/min) predicted follow-up VO2 (mls/kg/min) (sr2 = .41, p<.001; sr2 = .43, p<.001). IG patients returned to work more quickly (p<.01) and more were working at early follow-up (p<.001). Group allocation (sr2 = .05, p<.001) and the number of days not working pre-PCI (sr2 = .19, p<.01) predicted lagtime to return to work post-PCI. Group allocation (OR 12.56, 95% CI 2.27-69.49; p<.01) predicted work status at first follow-up. The number of non-working days pre-PCI (OR 1.19, 95% CI 1l08-1.31; p<.001: OR 1.10, 95% CI 1.03-1.17; p<.01) predicted work status at both follow-ups.
Conclusion: Individualised cardiac rehabilitation improves risk factor profiles and work resumption patterns following PCI independently of other factors.
