Family-centered empowerment model may improve physical and mental health following MI

A model that combines cardiac rehabilitation with input from patients and their families may improve the physical and mental health of patients following their MIs, according to a randomized trial.

Lead researcher Amir Vahedian-Azimi, MD, of Baqiyatallah University of Medical Sciences in Tehran, Iran, and colleagues published their results online in Open Heart on April 19.

The researchers evaluated the Family-Centered Empowerment Model (FCEM), which was designed by Fatemah Ahlani, MD, of Tarbiat Modarres University in Iran. The model is focused on empowering patients and their families and includes four stages: the group discussion method; the problem-solving method; the educational participation method; and process and outcome evaluations.

The FCEM, which is intended to improve the care and outcomes of patients with chronic diseases, was shown in a previous study to be effective following CABG. Previous research has also revealed that cardiac rehabilitation following MI improves function, exercise capacity, quality of life, perceived stress and anxiety and decreases morbidity and mortality.

“This study suggests that use of the FCEM to augment home [cardiac rehabilitation] may improve patients’ physical health, mental health and quality of life versus attenuating the decline that may occur following discharge for acute MI,” the researchers wrote. “This may have the greatest clinical implications in resource-limited settings where [cardiac rehabilitation] access is low and attrition rates are high.”

In this study, 70 patients who were admitted for acute MI to an academic teaching hospital from June 2012 to January 2015 were randomized to standard cardiac rehabilitation or cardiac rehabilitation using the FCEM strategy. Patients were included if they were between 45 and 85 years old, were willing to have a family member or friend participate and had not been hospitalized for acute MI or gone through cardiac rehabilitation.

After patients filled out questionnaires on their quality of life, perceived stress and anxiety, they had a rehabilitation routine planned for them for when they left the hospital. Following discharge, they called their study nurse every two days to report problems or complications. They also had cardiologists evaluate them every week and at 30 days with a history and physical examination, an ECG, and echocardiogram and laboratory tests as indicated.

Patients who were randomized to the FCEM group also attended educational and support group sessions and had remote follow-ups using the telephone, Skype, Viber or WhatsApp.

The researchers assessed quality of life, perceived stress and state and trait anxiety by using the 36-Item Short Form Health Survey, the 14-item Perceived Stress, and the 20-item State and 20-item Trait Anxiety questionnaires, respectively.

Patients in the FECM group had significant improvements in exercise tolerance measured as walking distance, ejection fraction, quality of life and perceived stress and state anxiety compared with the cardiac rehabilitation-only group. The groups had similar results when assessing trait anxiety.

The researchers defined state anxiety as a temporary condition in response to some perceived threat and trait anxiety as the differences between people in terms of their tendency to experience state anxiety in response to the anticipation of a threat.

“Further study is needed to discern whether the FCEM is really improving patient health versus attenuating the decline that may occur following discharge for [acute MI],” they wrote. “It may be that the FCEM method augments and maintains the education and empowerment that patients receive during their inpatient course. Additionally, the long- term sustainability of this method in this setting remains to be investigated.”