Predictors of quit success in Belgian participants of a varenicline observational smoking cessation study.

BACKGROUND: We evaluated efficacy, predictors of quitting success and the safety profile of varenicline for smoking cessation in the Belgian participants in an observational, "real world" study. METHODS: In this post-hoc analysis of a prospective, observational, non-comparative study, participants were adult smokers who were motivated to quit and were prescribed varenicline in accordance with the recommendations of the European Summary of Product Characteristics. The 7-day point prevalence of abstinence at Weeks 12 and 24 was determined based on patient reporting, and these data were further analysed by time to first cigarette on waking and by the use of behavioural support. The safety profile of varenicline was also assessed. RESULTS: Overall, 61.1% of participants (n= 226) successfully quit smoking by the end of Week 12. There was a significant association between abstinence and time to first cigarette on waking (Week 12: OR, 0.69 [95% CI, 0.50-0.94], p = 0.02; Week 24: OR, 0.70 [95% CI, 0.52-0.94], p=0.02) and the use of behavioural support (Week 12: OR, 6.18 [95% CI, 3.41-11.2], p<0.01; Week 24: OR, 5.37 [95% CI, 2.89-9.98], p<0.01). The most frequent treatment-emergent adverse event was nausea (9.3%). CONCLUSIONS: In this post-hoc analysis, varenicline was an effective smoking cessation aid with an acceptable safety profile in real world clinical practice in Belgian smokers. Significant predictors of abstinence were time to first cigarette on waking and use of behavioural support.

Psychological status and the role of coping style after coronary artery bypass graft surgery. Results of a prospective study.

The results of a prospective study in patients who underwent a first coronary artery bypass graft operation are presented. The goals of this project consisted in assessing the psychological changes during the first year after surgery. For that purpose, 330 consecutive patients were recruited. They were assessed by means of several psychological scales before and on three occasions after surgery. These scales were: the Heart Patients' Psychological Questionnaire (HPPQ), the State-Trait Anxiety Scale (STAI), the Symptom Check List (SCL-90), the Maastricht Questionnaire (MQ) and the Marlowe Crowne Desirability Scale. Furthermore, the study focused on the differential influence of three coping styles. The data demonstrate a clear overall improvement in psychological status over the first year, more specifically during the first 6 months after CABG. Patients were less anxious, less depressed, less exhausted and experienced more subjective well-being. However, almost 30% of all patients did not experience that average favourable evolution. The final psychological end-state was predicted by psychological variables, measured pre-operatively (somatic complaints, hostility and dysphoria) and short-term post-operatively (anxiety). No single medical variable could predict patients' psychological end-state. Finally, the most favourable change was made by patients who display the sensitising coping style, resulting in lower anxiety and depression. Health care providers, physicians as well as nursing staff and psychologists, should therefore use psychodiagnostic tools in order to identify patients at risk for negative psychological outcome. Appropriate therapeutic interventions may consequently be developed and evaluated in future research.

Recent findings on return to work after an acute myocardial infarction or coronary artery bypass grafting.

OBJECTIVE: To examine during recent years the rate of work resumption after an acute myocardial infarction or coronary artery bypass surgery, and to analyse variables that predicted return to work. SETTING: Referral centre for cardiac rehabilitation at the university hospital in Gent. PATIENTS: 227 consecutive patients (90 after a first AMI; 137 after a first CABG) were selected for participation. All patients were less than 60 years old and in a social state that still allowed return to work. During hospitalisation, a set of questionnaires, validated as well as self-developed, was presented, measuring psychological and social variables. Medical variables were collected from the medical records. One year later, a follow-up questionnaire was sent by mail, measuring return to work, reasons for not returning, morbidity, and psychological well-being. RESULTS: Return to work was observed in 185/222 (83.3%) of the total study group; 75/86 (87.2%) of the AMI patients and 110/136 (80.8%) of the CABG patients. The mean delay for return to work was 14.8 weeks. After one year, patients who returned to work, showed more positive affect, less negative affect, less somatic complaints and less cognitive complaints. This better psychological profile was not affected by the morbidity score. Variables predicting return to work in CABG patients were different from those in AMI patients. Only two medical variables could be retained in CABG patients (good left venticular function and a larger degree of revascularisation). Mainly psychological variables had predictive power (trust, job security, positive expectations concerning return, no attribution to stress, less somatic complaints, less physical exertion of the job). CONCLUSIONS: Return to work remains one of the main issues in cardiac rehabilitation after AMI or CABG. If resumption is sufficiently emphasized, a high success rate can be achieved. This approach should include a psychosocial strategy starting already during hospitalisation.

Quality of life in patients with complete heart block and paroxysmal atrial tachyarrhythmias: a comparison of permanent DDIR versus DDDR pacing with mode switch to DDIR.

A prospective double-blind randomized crossover study was done in 15 patients with complete heart block and intermittent ATs. The pacemaker was randomly programmed to dual chamber inhibited rate responsive pacing (DDIR) and to DDDR with mode switch, for 1 month each. An event recorder was given to the patients and after each period, a QOL questionnaire was obtained. Based on telemetric data, all but two patients had AT during follow-up. The duration and frequency of these episodes were not related to mode settings. AV synchrony was better preserved in DDDR (P < 0.05). Most symptom-related event recordings during DDIR showed loss of AV synchrony; DDDR with mode switch caused symptoms due to tracking of ST. Overall the QOL score was not different between the modes. Fewer somatic complaints were noted during DDDR pacing than during baseline. DDIR stimulation showed no difference. Twelve patients preferred the period of DDDR pacing; one experienced severe symptoms during DDIR. In conclusion, patients with paroxysmal AT, DDDR with mode switch, and DDIR had no influence on the occurrence, nor on the duration of AT episodes. AV synchrony was better preserved in DDDR, which was also associated with fewer somatic complaints compared to the baseline. In DDDR, symptoms were observed when ST was tracked. QOL was comparable, although more patients preferred DDDR.

Return to work after myocardial infarction: results of a longitudinal population based study.

Return to work was studied in all men who had entered the infarct register in the city of Ghent between 1983 and 1988 because of a first myocardial infarction before the age of 60 years. Information on work resumption was collected in 1991 using a postal survey; 78% of the 295 eligible subjects participated. Sixty-nine percent of all responders and 85% of all those who were at work before the infarct returned to work. Age, the perceived importance of the job, support from friends and the participation in a comprehensive cardiac rehabilitation programme were significantly related to work resumption.