Cardiac rehabilitation
BMJ 2015; 351 doi: https://doi.org/10.1136/bmj.h5000 (Published 29 September 2015) Cite this as: BMJ 2015;351:h5000
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Nowhere in this article is the role of the 'carer' mentioned. My experience of looking after a close family member in the weeks following coronary bypass surgery is that - I don't exist. The surgery and post-operative period in hospital was excellent, and I was happy to let the cardiac team get on with their job. However, at no point from discharge onwards have I been informed of, or invited to participate in the rehabilitation program, nor has any professional asked how I am coping with the considerable burden of helping my husband recover. Indeed, the local rehab programme specifically states that I am not permitted to join in the exercise programme. I cannot believe that involving close family members directly, from discharge onwards could be anything other than beneficial? Both in terms of encouraging important lifestyle changes as a whole family - and in providing some crucial support to primary carers during the highly stressful recovery period.
Sally Macgregor
Competing interests: No competing interests
Doctors Chamsi-Pasha make a point which ought to be explored. In the interest of the patient and the Chancellor of the Exchequer.
I suggest that-
1. The Church Commissioners
2. The Dept of Health
3. The Kingdom of Saudi Arabia
Should set up, in England, a joint cardiac centre with three separate wards and outpatients. One for Cof E patients, one for the atheists and agnostics ( like me). One for Sunni Moslems.
The progress of the patients should be compared.
There must be something wrong with my idea. Otherwise, somebody would have thought of it before.
Competing interests: I like to see progress in medicine, even in spheres other than pharmacology and surgery
Patients must follow the advice with regard to diet, exercise along medications.
Patients compliance needs to be checked .
Role of family members play an important role.
Positive environment ( plants, flowers, color of the wall, painting & sceneries ).
Human touch, feeling & emotions & spirituality .
Combination of factors play the role in cardiac rehabilitation.
Pleasure to read the article
With regards.
Competing interests: No competing interests
Spiritual and religious practices are often used to cope with illness across adult populations and may be associated with positive clinical outcomes and less disease progression.1
Strong spiritual experiences in life may be a protective and positive factor in cardiovascular diseases. However, spirituality is often neglected in cardiac rehabilitation (CR) programs.2 Some CR patients rely on their religious practices and spiritual beliefs to deal with the onset of and recovery from cardiac disease.3 Yet, the R/S of patients with heart disease and the role of R/S in coping with the illness are rarely discussed during participation in CR programs. 2, 3
A recently published study was set to evaluate the role of R/S in 105 individuals with a first-time myocardial infarction or coronary artery bypass surgery who were referred to a 12-week CR program.4 The demonstrated relationships between R/S and outcomes in cardiac patients support the development of spiritual care interventions for cardiac patients and evaluation of the impact of these interventions on medical, and psychological outcomes in these patients.4
Spiritual care interventions may not be a universal intervention for CR programs and may not be applicable, or even appropriate for some patients. It is obvious that some patients may not be religious or consider their religious beliefs a personal issue to be dealt with outside of their medical management. Thus, spiritual care interventions must be individualized as a matter of voluntary choice by the patients.4 There is a need for controlled clinical trials that use rigorous research design to test well-formulated spiritual interventions on patients’ outcome and determine the efficacy of such approaches.
Patients with stronger religious beliefs tend to be more meticulous about their lifestyle changes and adherence to recommended practices.5 Although not outwardly mentioned in the Qur’an and Prophet Muhammad traditions, the lifestyle that the Qur’an encourages, drastically decreases the chances of individuals developing cardiovascular diseases via the following ways: engaging in spiritual activities, moderate eating, physical labor, and abstention from forbidden foods and drinks.6 Overeating has been strongly condemned and prohibited in the Qur’an. Though we do not find much in the Qur’an about specific exercise recommendation, the Islamic prayer is performed at least five times a day and consists of a series of movements entailing standing, prostrating and sitting. The lifestyle prescribed by these Islamic traditions promotes longevity of life, prevention of cardiovascular diseases, and discourages risk factors associated with such diseases.8
Hassan Chamsi-Pasha, FRCP, FACC. Cardiac department, King Fahd Armed Forces Hospital, Jeddah, Saudi-Arabia. (drhcpasha@hotmail.com)
Majed Chamsi-Pasha, MBBS. Medical department, King Fahd Armed Forces Hospital, Jeddah, Saudi-Arabia.
References
1. Bekelman DB, Rumsfeld JS, Havranek EP, et al. Symptom burden, depression, and spiritual well-being: a comparison of heart failure and advanced cancer patients. J Gen Int Med. 2009 ; 24 : 592-598
2. Nadarajah S, Berger AM, Thomas SA. Current status of spirituality in cardiac rehabilitation programs: a review of literature. J Cardiopulm Rehabil Prev. 2013 May-Jun;33(3):135-43
3. McConnell TR, Trevino KM, Klinger TA. Demographic differences in religious coping after a first-time cardiac event. J Cardiopulm Rehabil Prev. 2011; 31: 298-302.
4. Trevino KM, McConnell TR. Religiosity and Spirituality During Cardiac Rehabilitation: A LONGITUDINAL EVALUATION OF PATIENT-REPORTED OUTCOMES AND EXERCISE CAPACITY. J Cardiopulm Rehabil Prev. 2015 Jul-Aug; 35(4):246-54.
5. Nabolsi MM, Carson AM. Spirituality, illness and personal responsibility: the experience of Jordanian Muslim men with coronary artery disease. Scand J Caring Sci. 2011; 25: 716-724.
6. Turgut O, Yalta K, Tandogan I. Islamic legacy of cardiology: inspirations from the holy sources. Int J Cardiol. 2010; 145(3):496.
7. Chamsi-Pasha H. Islam and the cardiovascular patient – pragmatism in practice (Editorial). Br J cardiol.2013;20 (3):1-2
Competing interests: No competing interests
Re: Cardiac rehabilitation and carers
Sally Macgreror raises a pertinent point about the involvement and role of care givers in cardiac rehabilitation. We believe that caregivers play a key role and can enhance the recovery and well-being of patients after cardiac surgery or after a recent diagnosis of a cardiac illness such as a heart attack or heart failure.
We appreciate that we could have given more information about the role of carers and only made a passing reference to carers in the last line of our clinical review. May we draw attention to the resources for patients and carers that were included in the article. The following link has personal stories from patients who have had a heart attack with stories from 37 people - including four carers:
Healthtalkonline. www.healthtalk.org/peoples-experiences/heart-disease/heart-attack/cardia..., www.healthtalk.org/peoples-experiences/heart-disease/heart-attack/topics...
The role of care givers in people with long term conditions was recently the subject of a BMJ editorial and we have responded to this outlining our special interest and the research we are conducting in this important but neglected area. http://www.bmj.com/content/352/bmj.i1651/rr
In our current National Institute for Health Research(NIHR) funded study for the management of heart failure we are specifically looking at the effect of carers on patients and also how it affects their quality of life. Further information is available on:
http://www.rcht.nhs.uk/RoyalCornwallHospitalsTrust/WorkingWithUs/Teachin...
Hasnain M Dalal, Honorary clinical associate professor, University of Exeter Medical School (Primary Care), Knowledge Spa, Royal Cornwall Hospital, Truro, Cornwall, TR1 3HD.
Jenny Wingham, Senior Clinical Researcher, Knowledge Spa Royal Cornwall Hospitals Trust Truro TR1 3HD
Rod S Taylor, chair of health services research, academic lead for Exeter Clinical Trials Support Network, NIHR senior investigator, Institute of Health Research, University of Exeter Medical School, South Cloisters St Luke’s Campus, Exeter, EX1 2LU, UK
Competing interests: No competing interests