Paper
Wednesday, 19 July 2006
This presentation is part of : Health Promotion for Cardiac Patients
Hopelessness and its Effect on Cardiac Rehabilitation Exercise Participation Following Hospitalization for Acute Coronary Syndrome
Susan L. Dunn, PhD, RN1, Manfred Stommel, PhD2, William Corser, RN, PhD, and Margaret Holmes-Rovner, PhD3. (1) Nursing Department, Hope College, Holland, MI, USA, (2) College of Nursing, Michigan State University, East Lansing, MI, USA, (3) College of Nursing and College of Human Medicine, Michigan State University, East Lansing, MI, USA
Learning Objective #1: Describe how hopelessness persists among patients with acute coronary syndrome at three and eight months after hospital discharge.
Learning Objective #2: Explain the effect of hopelessness on participation in hospital-based cardiac rehabilitation exercise among patients with acute coronary syndrome.
Hopelessness has been associated with increased risk of fatal and nonfatal coronary heart disease, yet very few studies have examined hopelessness after a cardiac event. This investigation focused on the effect of hopelessness on participation in a hospital-based cardiac rehabilitation exercise program among patients with acute coronary syndrome (ACS) at three and eight months after hospital discharge. The effects of other variables on exercise participation were also examined, including a telephone counseling intervention, depression, physical functioning, comorbidity burden, left ventricular ejection fraction, cardiovascular procedures, and sociodemographic variables. Measures included one factor of the Beck Hopelessness Scale,® the Center for Epidemiologic Studies- Depression Scale (CES-D), the Activity Status Index, the Charlson Comorbidity Index, and a cardiac rehabilitation exercise participation tool. A total of 207 subjects who received a physician referral to a hospital-based cardiac rehabilitation exercise program were followed for up to eight months. Employing a random-effects logistic regression model, the analysis revealed that hopelessness persisted over time and was a significant predictor of decreased participation in a cardiac rehabilitation exercise program. In contrast, depression showed no significant influence on exercise participation. Increased comorbidity burden and increased or absent left ventricular ejection fraction scores were predictive of increased participation in an exercise program, while a Medicaid insurance status predicted lower participation. Study findings emphasize the need to assess for hopelessness in patients with ACS and to encourage hopeless patients to participate in exercise. Further research is needed to examine hopelessness and its effect on exercise participation at later time points and the effects of hopelessness on other outcomes. Future research could ultimately lead to evidence-based interventions focused on the prevention and treatment of hopelessness symptoms and improved ACS patient recovery.

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