1. Rivka Herman 1 *,RN. M.Sc Michal Libergal 1 *, PhD; David Rott 2, MD Michal Libergal 1 *, PhD; David Rott 2, MD 1 Henrietta Szold Hadassah-Hebrew University School of Nursing, in the Faculty of Medicine, Jerusalem, Israel. 2 Department of Medicine, Hadassah-Hebrew University Medical Center, Mt. Scopus, Jerusalem, Israel

2. Coronary Heart Disease In the USA affects 200 men and women out of every 100,000In the USA affects 200 men and women out of every 100,000 In Israel 25,000 hospitalizations every yearIn Israel 25,000 hospitalizations every year CHD is a chronic disease that affects patients and their caregivers in terms of physical, psychological and social conditions.CHD is a chronic disease that affects patients and their caregivers in terms of physical, psychological and social conditions. (Acsis, 2008 ; American Heart Association (2006) (Acsis, 2008 ; American Heart Association (2006)

3. Cardiac rehabilitation Decrease both morbidity and mortality of patients with CHDDecrease both morbidity and mortality of patients with CHD Therefore its application is a class I recommendation in most contemporary cardiovascular clinical practice guidelinesTherefore its application is a class I recommendation in most contemporary cardiovascular clinical practice guidelines The participation rate in such programs, in the central region of Israel, is only between 14-20%The participation rate in such programs, in the central region of Israel, is only between 14-20% (Wenger 2008; Acsis 2008 ; Williams et al. 2006) (Wenger 2008; Acsis 2008 ; Williams et al. 2006)

4. Cardiac Rehabilitation & Quality of Life

5. Quality of life QOL is a broad concept, influenced by personal perceptions, coping mechanisms, and environmental constraints. QOL is a broad concept, influenced by personal perceptions, coping mechanisms, and environmental constraints. Improving QOL is a major goal in the context of preventive and therapeutic cardiology and in cardiac rehabilitation in particular. Improving QOL is a major goal in the context of preventive and therapeutic cardiology and in cardiac rehabilitation in particular. WHOQOL Group (1997)

6. The impetus for conducting this research To evaluate the correlation between participation in a CR program and QOL. To evaluate the correlation between participation in a CR program and QOL. Evaluate the association of demographic parameters and cardiac risk factors on QOL. Evaluate the association of demographic parameters and cardiac risk factors on QOL.

7. Methods A prospective study. A prospective study. The target population included patients with CHD who attended the cardiac rehabilitation center at our institution. The target population included patients with CHD who attended the cardiac rehabilitation center at our institution. Inclusion criteria were: stable CHD; post MI ; age between 30-80 years; ability to answer questionnaires in Hebrew and independence in ADL. Inclusion criteria were: stable CHD; post MI ; age between 30-80 years; ability to answer questionnaires in Hebrew and independence in ADL.

8. Three different tools were utilized in this research General demographic questionnaire. General demographic questionnaire. Cardiac assessment, utilized for admission into the rehabilitation program. Cardiac assessment, utilized for admission into the rehabilitation program. The Mec-New Heart Disease Health- related Quality of Life Questionnaire. The Mec-New Heart Disease Health- related Quality of Life Questionnaire. (Hofer et al. 2004). (Hofer et al. 2004).

9. Mec-New Health Related Quality of Life questionnaire The questionnaire was comprised of 27 questions with a Likert scale in three domains: physical, emotional, and social. The questionnaire was comprised of 27 questions with a Likert scale in three domains: physical, emotional, and social. The questionnaire has a Cronbach's α of 0.93- 0.95 in English. The questionnaire has a Cronbach's α of 0.93- 0.95 in English. The Hebrew version was validated by Dankner et al. (2008) and accepted with a Cronbach's α of 0.93. The Hebrew version was validated by Dankner et al. (2008) and accepted with a Cronbach's α of 0.93.

10. Informed consent The study was approved by the institutional ethics board of the Hadassah- Hebrew University Medical Center and all participants provided written informed consent after having received explanations regarding the study. The study was approved by the institutional ethics board of the Hadassah- Hebrew University Medical Center and all participants provided written informed consent after having received explanations regarding the study.

11. Intervention Assessment by a cardiologist to determine cardiac risk level. Assessment by a cardiologist to determine cardiac risk level. Assessment by a physiologist. Assessment by a physiologist. Admission by a nurse prior to physical activity. The program included variety of lectures presented by the multidisciplinary cardiac rehabilitation team. Admission by a nurse prior to physical activity. The program included variety of lectures presented by the multidisciplinary cardiac rehabilitation team.

12. Statistical methods The correlation in reported QOL between pre- and post- participation in the CR program were assessed by a paired t-test. The correlation in reported QOL between pre- and post- participation in the CR program were assessed by a paired t-test. Spearman’s Coefficient was used to test the correlation between risk factors, risk level and education level. Spearman’s Coefficient was used to test the correlation between risk factors, risk level and education level. Pearson’s Correlation was used to test the relationship between age and QOL. Pearson’s Correlation was used to test the relationship between age and QOL.

13. Rate of compliance 87 patients responded to questionnaires prior to starting a cardiac rehabilitation program. 87 patients responded to questionnaires prior to starting a cardiac rehabilitation program. After 3 months of rehabilitation, 55 (63.2%) patients completed the same questionnaires. After 3 months of rehabilitation, 55 (63.2%) patients completed the same questionnaires.

14. Risk Factor and Demographic Data Most of the patients were 55-61 years of age, married, and underwent at least one event of MI. Most of the patients were 55-61 years of age, married, and underwent at least one event of MI. 40 participants (53%) had a low risk factor for CHD; 26 (33.8%) had a moderate risk factor; and 10 (13%) had a high risk factor for CHD. 40 participants (53%) had a low risk factor for CHD; 26 (33.8%) had a moderate risk factor; and 10 (13%) had a high risk factor for CHD.

15. Results (N-55) The QOL was significantly improved as noted by their general score in the Mec- New Questionnaire and within each domain: emotional, physical limitations, and social function (t (54) = -3.59, p = 0.001) (t (54) = -3.59, p = 0.001)

16. Correlation between risk factors, risk level, age and education level N-87)) CARDIAC RISK LAVEL NUMBER OF RISK FACTORS EDUCATION AGE HRQL GENERAL0.087-0.275-(*)0.184(*)0.088 EMOTIONAL0.126-0.270-(*)0.1270.174 PHYSICAL0.081-0.248-(*)0.1370.021- SOCIAL0.125-0.258-(*)0.202(*)0.120

17. Limitations The study did not include a control group. The study did not include a control group. A convenience sample was comprised of a homogenous sample which may limit generalization. A convenience sample was comprised of a homogenous sample which may limit generalization. Other illnesses, than CHD, can influence QOL. Other illnesses, than CHD, can influence QOL. There was a loss to follow-up. There was a loss to follow-up.

18. Summary and relevance to clinical practice Nurses awareness as Coordinators of multidisciplinary team to QOL and for secondary prevention of, CHD is significantly important. Nurses awareness as Coordinators of multidisciplinary team to QOL and for secondary prevention of, CHD is significantly important. Use the HRQOL Questionnaire. Use the HRQOL Questionnaire. Encourage the participation rate in such programs. Encourage the participation rate in such programs.

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