The impact of secondary prevention programs incorporating remote technologies on psychological well-being and quality of life in coronary heart disease patients with abdominal obesity

Abstract

Background. Quality of life, which is determined both by the physical symptoms and by psychosocial risk factors, is among the primary treatment goals in coronary heart disease (CHD). Therefore, it is reasonable to assess the impact of any therapeutic interventions in CHD on these measures. Aim: To assess the changes of psychological status and quality of life in patients with CHD and abdominal obesity (AO) over time during 2 secondary prevention programs using two different modalities of remote support. Materials and methods. An open-label randomized study with 3 parallel groups enrolling hospitalized patients with stable CHD and AO (most hospitalizations were due to elective revascularization procedures). The patients were randomized into 2 intervention groups (Group 1 and Group 2) and into Group 3 (control). Both intervention groups received secondary prevention programs including one in-hospital preventive counselling session with focus on healthy eating habits and subsequent remote support for 6 months (Month 1 to 3: once a week; Month 4 to 6: once a month). Group 1 received this subsequent counselling via phone calls and Group 2 received text messages via different platforms according to patient preferences. Group 3 received standard advice at discharge only. During 1 year of follow-up motivation for lifestyle changes and continued participation in secondary prevention programs, anxiety and depression symptoms (HADS), stress levels (10-point VAS) and quality of life (HeartQol) were assessed. A total of 120 patients were enrolled (mean age±SD, 57.75±6.25 years; men, 83.4%) who had a high baseline motivation to participate in preventive programs. Results. At 1 year of follow-up there was a substantial improvement in anxiety and depression symptoms in Groups 1 and 2 which was absent in Group 3. As a result, the proportion of patients with HADS-A score ≥8 dropped from 45.0% to 10.0% in Group 1 and from 40.0% to 7.5% in Group 2 (both р values <0.01 vs control), and the proportion of participants with HADS-D ≥8 decreased from 30.0% to 10.0% (р<0.01 vs control) and from 12.5% to 0% (р<0.05 vs control), respectively. Stress level decreased in Groups 1 and 2 by 3.95±0.38 and 3.56±0.39 points, respectively (both р values <0.01 vs control). The HeartQol global score increased by 1.07±0.08 points in Group 1 and by 0.98±0.13 points in Group 2 (both р values <0.01 vs control). Conclusion. Both secondary prevention programs with long-term remote support targeting obese CHD patients resulted in improvement of pivotal measures of their psychological status i.e. into a decline of anxiety and depression symptomatology, stress reduction and into a better quality of life.