Sexual Activity After Acute Coronary Syndrome: A Qualitative Approach to Patient and Partner Experiences.

BACKGROUND: Little is known about how best to support both patients and their partners in the reengagement of sexual activity (SA) after acute coronary syndrome (ACS), with sparse direct data from the partner on their needs and concerns in the area of SA support. OBJECTIVES: We undertook a qualitative study to address this gap in the literature through 3 objectives from a patient and partner perspective: (1) to characterize the experience of reengaging in SA post ACS, (2) to identify needs and priorities in the area of SA support post ACS, and (3) to determine whether cardiac rehabilitation (CR) could be an acceptable point of intervention for SA support. METHODS: Semistructured qualitative interviews were conducted with 6 male patients who were post ACS and their partners (age range, 47-81 years). Patients were criterion sampled from the Alberta Provincial Project for Outcome Assessment in Coronary Heart Disease database. Inductive thematic data analysis was conducted. RESULTS: Four themes were identified: "importance," "support received," "on their own," and "wanting support." Couples reaffirmed the importance of SA pre and post ACS, reported SA support as currently insufficient but articulated ways it could be improved, and reported CR as a current source of SA support but thought there could be room for improvement on the content and delivery of such information. CONCLUSIONS: This study illustrates the potential value of promoting SA support for both patients who are post ACS and their partners and reports that SA support provided at CR would be viewed as important, needed, and acceptable.

The Effect of Cardiac Rehabilitation Attendance on Sexual Activity Outcomes in Cardiovascular Disease Patients: A Systematic Review.

BACKGROUND: Decreased sexual activity (SA) is a common problem in patients with cardiovascular disease (CVD). Although there is evidence that cardiac rehabilitation (CR) is effective in improving physical outcomes and overall quality of life, its effects on SA remain unclear. In this systematic review we assessed the association between CR attendance and SA outcomes in adults with CVD. METHODS: Electronic databases (MEDLINE, PsycINFO, EMBASE, CINAHL) were systematically searched in January 2018. Original studies that compared attendance to CR vs no attendance to CR in adults 18 years and older with diagnosed CVD that also reported on SA outcomes were included. A narrative synthesis was conducted because the data did not permit meta-analysis. RESULTS: Fourteen studies were identified: 6 randomized controlled trials, 5 nonrandomized controlled trials, and 3 prospective cohort studies. All CR programs included an exercise-based component and 4 included an SA-specific component. Seven studies reported a significant benefit in SA outcomes in the CR group, 1 study reported significant harm, and 11 studies reported a nonsignificant difference. CONCLUSIONS: The effect of CR on SA outcomes was generally reported to be equivocal or positive. CR showed some promise in improving sexual functioning and frequency, with mixed results with regard to sexual resumption and satisfaction. In conclusion, it remains uncertain if CR consistently improves sexual outcomes in adults with CVD but these data suggest that further exploration might be justified.

Assessing the role of impulsivity in smoking & non-smoking disordered gamblers.

BACKGROUND: Co-morbidity with other addictive behaviors is common in disordered gambling (DG). In particular, tobacco dependence has been found to be among the most prevalent disorders co-morbid with DG. While the extant literature has firmly established the co-occurrence of DG and smoking, there is a paucity of research examining factors that differentiate DGs who smoke from those who do not. OBJECTIVES: To address this empirical gap, the current study tested whether dimensions of trait impulsivity as measured by the UPPS-P Impulsive Behavior Scale (positive urgency, negative urgency, lack of premeditation, lack of perseverance, and sensation seeking), discriminated between non-DGs and DGs based on their present smoking status: non-smoker, occasional smoker, and daily smoker. METHODS: To this end, 564 community gamblers were recruited through a crowdsourcing platform (Amazon's Mechanical Turk) and completed an online survey, assessing problem gambling severity, tobacco use, and trait impulsivity. RESULTS: MANOVA analyses revealed significant main effects for both gambling severity and smoking status groups. Importantly, a significant gambling by smoking interaction was also found. Pairwise comparisons revealed that DGs who were daily smokers scored higher on negative urgency than those who smoked occasionally or not all. Furthermore, among non-DGs, smoking status failed to discriminate between mean scores on negative urgency. No other significant interaction effects were found for the remaining UPPS-P impulsivity facets. CONCLUSIONS: Results suggest that individual components of trait impulsivity, and more specifically negative urgency, successfully differentiate DGs who do not smoke, or just smoke occasionally, from DGs who smoke daily. These findings suggest that the degree of trait impulsivity may potentially distinguish between DGs and DGs who are dually addicted to other substances such as tobacco.