Saudi Cultural Missions Theses & Dissertations
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Item Restricted Does Integrating Cognitive Behavioural Therapy into Cardiac Rehabilitation Improve Depression and Quality of Life in Adults with Cardiovascular Disease? A Systematic Review.(Cardiff University, 2025) Alqahtani, Ola; Gale, NicholaDoes Integrating Cognitive Behavioural Therapy into Cardiac Rehabilitation Improve Depression and Quality of Life in Adults with Cardiovascular Disease? A Systematic Review. Background & Rationale Cardiovascular disease (CVD) is the world’s leading cause of death and disability, placing significant clinical and economic burdens on healthcare systems. While cardiac rehabilitation (CR) encompassing exercise, education, and routine psychosocial support has been shown to improve clinical outcomes, up to thirty percent of cardiac patients experience clinically meaningful depressive symptoms which reduce CR adherence and long-term success. Cognitive behavioural therapy (CBT) offers a structured approach to modifying maladaptive thoughts and behaviours, potentially addressing psychological barriers more effectively than generic psychosocial support. However, many reviews have evaluated heterogeneous ‘psychological interventions’ rather than isolating CBT’s specific impact. This systematic review set out to determine whether CBT, when integrated into CR, alleviates depression and enhances health-related quality of life (HRQoL) more effectively than CR alone. Methods A systematic literature search was conducted across five major databases (Medline, EMBASE, CINAHL, Cochrane CENTRAL, and PsycINFO) from inception to the most recent feasible date, adhering to PRISMA guidelines for study selection and reporting. Six randomised controlled trials, totalling 708 participants, satisfied the inclusion criteria by focusing on adults (≥18 years) undergoing CR for various cardiac conditions (such as myocardial infarction, heart failure, or post-cardiac surgery). Studies which integrated structured CBT sessions into standard CR were compared to CR alone or other forms of standard care. The primary outcome was the reduction in depressive symptoms, measured by validated scales (e.g., the Hamilton Rating Scale for Depression or the Hospital Anxiety and Depression Scale (HADS)). Secondary outcomes involved changes in HRQoL, assessed by either generic or cardiac-specific instruments (such as the Minnesota Living with Heart Failure Questionnaire). Quality appraisal followed the Joanna Briggs Institute guidelines and due to heterogeneity in intervention formats, population characteristics, and outcome measures, a narrative synthesis approach was applied rather than a meta-analysis. Key Findings and Discussion Although the six trials varied in terms of sample size, intervention intensity, and follow-up duration, they shared an overarching conclusion that integrating CBT within CR can lead to notable reductions in depressive symptoms and meaningful improvements in HRQoL. The degree of benefit was generally greater in patients presenting with moderate-to-severe baseline depression. Face-to-face CBT delivery typically achieved better adherence (often exceeding 75%) and larger effect sizes, whereas fully digital CBT programmes suffered from low engagement (approximately 15% module completion). These findings suggest that the personal interaction and therapeutic alliance inherent in face-to-face sessions remain critical for maximising CBT’s clinical impact in cardiac populations, particularly those facing multiple stressors related to their disease. CBT combined with exercise, in several trials, appeared to deliver synergistic benefits for depression and HRQoL, possibly through complementary behavioural (cognitive restructuring and skill-building) and physiological (improved cardiovascular function) mechanisms. The interplay between exercise encouragement and cognitive-behavioural strategies against fear-avoidance thinking also emerged as an important determinant of enhanced functional capacity and sustained improvements in mood. Limitations Several limitations may constrain the generalisability of these results. First, the overall sample predominantly comprised of male participants (approximately two-thirds were male), leaving questions regarding whether women, who often exhibit different depressive symptom profiles and a greater prevalence of depression post-myocardial infarction, would experience similar outcomes. Second, varied measures of depression and HRQoL, along with wide differences in the intervention ‘dose’ (ranging from five-session brief interventions to twelve-week combined programmes), precluded direct quantitative comparisons across studies. Some trials were also underpowered and only a few extended follow-up beyond six to twelve months. Digital CBT approaches did not yield strong results in this review but that may reflect poor adherence rather than intrinsic ineffectiveness, highlighting a need for more engaging and personalised technological platforms. Finally, these RCTs spanned multiple healthcare settings in Europe and the United States where infrastructural and cultural factors might influence both the feasibility of CBT delivery and participant engagement. Conclusions and Recommendations This review provides evidence that structured CBT, when delivered in tandem with cardiac rehabilitation, can significantly alleviate depressive symptoms and promote better quality of life. The most robust outcomes were observed in trials that targeted moderate-to-severe depression, employed face-to-face group or individual CBT sessions, and ensured consistent patient follow-up. These findings strengthen the case for systematically screening CR entrants for depressive symptoms and offering a dedicated CBT component to those above a certain severity threshold. Practical feasibility can be enhanced by training nurses, physiotherapists, or other allied professionals in CBT skills, as illustrated in studies where task shifting maintained strong outcomes. Policy-making bodies, such as national cardiac societies and health agencies, may wish to recommend CBT as a priority psychological intervention in CR programmes, particularly for patients with moderate or severe depression. Future research should further refine the optimal ‘dose’ of CBT, compare blended or stepped-care digital and in-person models, and evaluate the cost-effectiveness to guide broader adoption. By focusing on cognitive restructuring and behaviour change within the supportive framework of CR, healthcare systems can potentially improve both the mental health and functional recovery of individuals with CVD.7 0Item Restricted Metabolic and Bariatric Surgery: Utilization, Statin Discontinuation, and Cardiovascular Risk Stratification in the Modern Era(University of Cincinnati, 2024) Alsuhibani, Abdulrahman; Hincapie, AnaBackground: Bariatric surgery, as a pivotal intervention to treat obesity, has seen dynamic utilization trends over recent years, and the subsequent pharmacological implications, particularly concerning statin discontinuation, hold significance. With the world grappling with the cardiovascular epidemic and its associated mortality, there's an imperative need to understand the cardiovascular outcomes post-bariatric surgery, especially when linked with discontinuation of critical medications like statins. Aims: This dissertation aimed to delineate the trends in bariatric surgery utilization and the corresponding shifts in surgical techniques in the U.S. Furthermore, it sought to understand the patterns and repercussions of statin discontinuation post-surgery, with an emphasis on discerning the risks associated with discontinuing statin therapy, particularly among patients with a history of Atherosclerotic Cardiovascular Disease (ASCVD). Methods: Comprehensive retrospective analyses were conducted utilizing the TriNetX electronic medical records network, spanning the years 2012 to 2021. The trends in bariatric surgeries were examined alongside their procedural variations. In parallel, patients on statin therapy undergoing bariatric surgery were identified, with their subsequent statin discontinuation patterns being analyzed. The consequences of such discontinuations, especially regarding ASCVD events, were also explored, taking into consideration both primary and secondary prevention cohorts. Results: There was a steady upswing in bariatric surgeries until 2018, which saw a decline during 2020 and 2021, coinciding with the COVID-19 pandemic. The surgical landscape depicted a decline in the Roux-en-Y (RYGB) procedure, substituted by an uptake in the sleeve gastrectomy (SG) procedure. Among statin therapy users, 48% of primary prevention and 34.5% of secondary prevention patients discontinued statin therapy within six months post-bariatric surgery. Alarmingly, within a statin therapy discontinuation post bariatric surgery, secondary prevention patients manifested significantly higher ASCVD event rates compared to their primary prevention counterparts. Distinctly, Hispanic/Latino patients exhibited heightened ASCVD risks post-statin discontinuation, as opposed to non-Hispanic/Latino individuals. Conclusion: The trends in bariatric surgery, amidst their shifting preferences, underscore the importance of understanding the aftermath of such surgeries, especially regarding medication discontinuation. The discontinuation of statins post-bariatric surgery, particularly among those with prior ASCVD, poses discernible risks, accentuating the need for individualized, equitable healthcare strategies. Addressing ethnic disparities and ensuring tailored therapeutic approaches based on comprehensive cardiovascular determinants is crucial. Future research endeavors are essential to further finetune these interventions and recommendations.15 0Item Restricted Pattern Recognition & Predictive Analysis of Cardiovascular Diseases: A Machine Learning Approach(Saudi Digital Library, 2023-11-23) Alseraihi, Faisal Fahad; Naich, AmmarCardiovascular disease (CVD) is a predominant global health concern, with its impact becoming increasingly pronounced in low- and middle- income countries due to challenges like limited healthcare access, inadequate public awareness, and lifestyle-related risks. Addressing CVD's multifactorial origins, which span genetic, environmental, and behavioral domains, requires advanced diagnostic techniques. This research leverages the UCI Heart Disease dataset to develop a deep learning predictive model for CVD, incorporating 14 vital heart health parameters. The models performance is critically assessed against conventional machine learning approaches, shedding light on its efficiency and areas of refinement. Utilizing sophisticated Neural Network structures, this study strives to enhance predictive health analytics, aiming for timely CVD identification and intervention. As the integration of machine learning into healthcare deepens, it's crucial to ensure that these tools are robust, thoroughly evaluated, and augment clinical insights to reduce misdiagnosis risks.77 0