Background:Patients' understanding of heart diseases and their related experiences can affect education and prevention of coronary heart diseases. As the patients' beliefs play a crucial role in the development of effective therapeutic relationship, psychological adjustment, and compliance with treatment recommendations. Objectives: The purpose of this study was to investigate the attitudes toward psychological risk factors for cardiovascular disease among patients referred to a cardiac rehabilitation center in Imam Ali Hospital in Kermanshah, Iran. Patients and Methods:This cross-sectional study was performed on 775 patients referred to a cardiac rehabilitation unit in Imam Ali hospital in Kermanshah, Iran. Data were collected using clinical interview, patients' medical records, and Millon clinical multiaxial inventory (MCMI-III), and analyzed by descriptive statistics, including mean, standard deviation, and chi-square test. Statistical analyses were performed using SPSS software version 18. Results: The patients believed that the main cause of their illness is behavioral risk factors (42.0%). Then, they referred to psychological (36.3%), biological (4.3%), and environmental (3.8%) factors, respectively. 10.4% of the patients were not aware of the cause of their illness. Also, stress is the most important factor among the psychological factors (27.5%). The results showed that there was a significant difference among the patients in term of four attitudes (χ 2 = 820.356; P < 0.01); and behavioral and psychological attitudes (χ 2 = 6.025; P < 0.05). In fact, the patients identified behavioral problems as the main cause of their illness. Conclusions: According to the patients' attitudes, after the behavioral factors, psychological factors are the second cause of heart diseases. Therefore, ignoring these factors by members of the medical teams may lead to a poor performance of the treatments. As these factors are controllable, learning to control and manage them can prevent the development of subsequent cardiovascular events.

ObjectiveTo investigate the role of sociodemographic factors in failure to complete outpatient cardiac rehabilitation (CR).MethodsThis was a retrospective study that used information obtained from the database of the cardiac rehabilitation department of a cardiac hospital in Iran. Data from 1,050 CR patients treated at the hospital between January 2001 and January 2013 was analyzed using binary logistic regression analysis.ResultsOnly 49% of the patients completed the CR program. After adjustment for baseline variables, it was found that the following were significantly associated with failure to complete the CR program: illiteracy (p<0.001), old age (p<0.001), being an employee or retired (p<0.05), having a low capacity for exercise (p<0.001), depression (p<0.001), low anxiety (p<0.001), and not currently being a smoker (p<0.001).ConclusionPaying more attention to older patients with low literacy levels and limited exercise capacity, who are employed or retired, and who are not current smokers, and taking therapeutic measures to control psychological complications such as depression, may be effective in ensuring that patients complete outpatient cardiac rehabilitation.

Background:In a cardiac patient, anxiety is the result of the individual’s perception of the treatment and is characterized by inability to predict, control, or achieve the desired treatment outcomes.Objectives:This study was carried out to investigate the extent of clinical anxiety in patients who underwent a cardiac rehabilitation program with different attitudes toward the disease risk factors.Patients and Methods:The administrative data of this retrospective study were obtained from the database of the cardiac rehabilitation department of a hospital in Iran. The demographic and clinical information of 603 patients from April 2006 to April 2011 was collected using compiled forms of this database, the Beck anxiety inventory, and the structured clinical interview for axis I disorders. The univariate analysis of variance and the Bonferroni post-hoc analysis were used for data analysis.Results:After controlling for gender and educational level, we observed statistically significant differences in the modified means between the patients who considered the behavioral risk factors and those who considered the physiological risk factors (P = 0.012, MD = 5.03) and between the patients who regarded the behavioral risk factors and those who regarded the psychological risk factors (P = 0.0005, MD = 5.32) as the underlying cause of their cardiac condition, which means that the level of anxiety in the physiological and psychological groups was higher than that in the behavioral group.Conclusions:The anxiety of patients can be controlled through alteration in their attitudes toward the disease risk factors on the grounds that psychological or physiological factors per se do not trigger the occurrence of the disease, whereas behavioral risk factors, as the controlling agent, significantly influence its occurrence.

ObjectiveTo investigate predictors of depressive symptom aggravation at the end of a cardiac rehabilitation (CR) program.MethodsThe design of the study was retrospective. The administrative data were obtained from the database of the CR department of a heart hospital in Iran. The demographic and clinical information of 615 CR patients between January 2000 and January 2010 was analyzed using binary logistic regression analysis.ResultsThe results showed that 10.7% of the patients completed the CR program with aggravated depressive symptoms. After adjustment for gender, age, and pre-intervention depression score, lower education level (p<0.05) and smoking (p<0.01) were significant predictors of increased depressive symptoms at the end of the program. Our model variables could explain 6% to 13% of the dependent variable variance.ConclusionThe results suggest that targeting patients who are less literate or who smoke could allow for taking the required measures to prevent or control depression at the end of a CR program. It is suggested that future studies consider other variables.

BackgroundPatients suffering from non-cardiac chest pain (NCCP) can interpret their chest pain wrongly despite having received a correct diagnosis. The objective of this study was to compare the efficacy of the relaxation method with metaphor therapy for reducing irrational beliefs and pain severity in patients with NCCP.MethodsUsing a randomized controlled trial, 33 participants were randomly divided into a relaxation training group (n= 13), a metaphor therapy group (n = 10), and a control group (n = 10), and were studied for 4 weeks. The two tools used in this research were the Brief Pain Inventory (BPI) index for determining the degree of pain and the short version of the Jones Irrational Belief Test. Metaphor therapy and a relaxation technique based on Öst's treatment were used as the interventions. The collected data were analyzed with a multivariate analysis of covariance (MANCOVA), a Chi-square test, and the Bonferroni procedure of post-hoc analysis.ResultsThe relaxation training method was significantly more effective than both metaphor therapy and the lack of treatment in reducing the patients' beliefs of hopelessness in the face of changes and emotional irresponsibility, as well as the pain severity. Metaphor therapy was not effective on any of these factors. In fact, the results did not support the effectiveness of metaphor therapy.ConclusionsRegarding the effectiveness of the relaxation method as compared with metaphor therapy and the lack of treatment in the control group, this study suggests that relaxation should be paid greater attention as a method for improving the status of patients. In addition, more studies are needed to determine the effectiveness of metaphor therapy in this area.