ICF-based approach to evaluating functionality in cardiac rehabilitation patients after heart surgery.

BACKGROUND: Heart surgery is a frequent reason for admission to in-patient cardiac rehabilitation programmes. ICF approach has never been used to evaluate cardiac patients after major heart surgery. AIM: The aim was to evaluate and measure functionality in cardiac patients who have undergone heart surgery, using for the first time the ICF-based approach and to assess whether such approach can be feasible and useful in cardiac rehabilitation. DESIGN: Observational study. SETTING: In-patients cardiac Rehabilitation Unit in Milan. POPULATION: Fifty consecutively admitted patients who had undergone heart surgery (34 males, 16 females; mean age 65.7±12.5 years). METHODS: We prepared a ICF-core set short enough to be feasible and practical. Patients were individually interviewed by different healthcare professionals (randomly selected from a group of two physicians, two physiotherapists and two psychologists) at the beginning (T1) and end of cardiac rehabilitation (T2) RESULTS: The sum of the scores of each ICF body function, body structure, activity and participation code significantly decreased between T1 and T2 (P<0.001). The environmental code scores significantly decreased in the case of facilitators between T1 and T2 (P=0.0051), but not in the case of barriers. There were significant correlations between the ICF body function scores and Barthel's index (ρ=0.381; P=0.006), NYHA class (ρ=0.404; P=0.004) and plasma Cr-P levels (r=0.31; P=0.03), between the ICF body structure codes and the Conley scale (ρ=0.306; P=0.02), and between the activity/participation codes and SpO2 (ρ=0.319; P=0.04). There were no correlations between the ICF environmental codes and clinical parameters. CONCLUSION: The ICF-based data provided functional information that was consistent with the patients' clinical course. CLINICAL REHABILITATION IMPACT: The core set used allowed to quantify important body functions and activities, including some areas that are generally insufficiently considered by healthcare professionals during cardiac rehabilitation, and document their improvement.

[Use of nitrates after recent myocardial infarction: when, how, and why]. / Impiego dei farmaci nitroderivati dopo recente infarto miocardico: quando, come e perché.

Nitrates are useful drugs in patients affected by recent myocardial infarction: they have an anti-ischemic and anti-anginal effect; moreover they are effective on left ventricular remodeling, with few side-effects. Meta-analysis studies performed on patients treated with nitrates intravenously for acute myocardial infarction in the pre-thrombolytic era showed a reduction of the necrotic area and of the global mortality. On the contrary experimental studies conducted using nitrates orally showed no significant clinical effects. Two post-thrombolytic studies, ISIS-4 and GISSI-3, enrolling large numbers of patients after an acute myocardial infarction, randomized to assume placebo or nitrates, administered orally and/or transdermally, demonstrated moderate and significant reductions in mortality only in some subgroups of patients treated with the active drug compared to placebo. Nitrates as drugs are "imperfect imitators" of endogenous nitrates and so can produce some negative effects. In this review the different modes of drug administration and the respective posologies of the various sublingual, spray, and oral formulations in standard, long-acting or transdermal preparations are considered. Three problems should be considered by clinicians using nitrates: resistance, tolerance and rebound. The strategies to counteract these phenomena, as well as the clinical indications and the favorable effects that can be obtained using nitrates in post-infarct patients are also discussed.