{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,9,29]],"date-time":"2025-09-29T15:30:28Z","timestamp":1759159828205,"version":"3.41.2"},"reference-count":43,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2024,7,30]],"date-time":"2024-07-30T00:00:00Z","timestamp":1722297600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Cardiovasc. Med."],"abstract":"Background<\/jats:title>This study aimed to quantitatively assess stress, anxiety and obsessive thinking related to coronavirus disease-19 (COVID-19) and qualitatively appraise perceptions in patients after acute myocardial infarction (AMI) undergoing cardiac rehabilitation (CR) during the COVID-19 pandemic.<\/jats:p><\/jats:sec>Methods<\/jats:title>We used mixed-methods design in patients referred for CR in 2 centres which delivered uninterrupted service during COVID-19 pandemic. Coronavirus Anxiety Scale (CAS), Obsession with COVID-19 Scale (OCS), COVID-19 Stress Scale (CSS), Hospital Anxiety and Depression Scale (HADS), and in-person interviews (combination of a priori<\/jats:italic> questions and probing) were used to evaluate patient experience and perceptions with COVID-19 and the healthcare services during pandemic.<\/jats:p><\/jats:sec>Results<\/jats:title>In total, 109 patients (mean age 59\u2009\u00b1\u200910, 20% women) were included in quantitative part and in 30 of them we conducted the in-person interviews. About a quarter of patients met HADS threshold for anxiety and depression while CAS and OCS results demonstrated extremely low possibility of coronavirus related dysfunctional thinking (3%) and anxiety (2%). The CSS indicated the most prevalent concerns were related to COVID-19 vaccines safety (60%) and fear of getting infected (60%). During interviews, patients perceived the CR as well as health care providers as safe, trustworthy and with enough support to avoid or manage COVID-19 related health risks.<\/jats:p><\/jats:sec>Conclusions<\/jats:title>Overall, patients reported AMI affected their lives more than the COVID-19 pandemic. The COVID-19 related stress and anxiety were relatively low and mostly related to general views of infectious disease. CR was perceived safe and trustworthy in terms of primary disease and COVID-19.<\/jats:p><\/jats:sec>Lay summary<\/jats:title>This mixed-method study included 109 patients with acute myocardial infarction who underwent cardiac rehabilitation during the COVID-19 and focused on their experience and perceptions with COVID-19 and the healthcare services during pandemic.<\/jats:p>-<\/jats:label>Patients reported acute myocardial infarction affected their lives more than the COVID-19 pandemic.<\/jats:p><\/jats:list-item>-<\/jats:label>The COVID-19 related concerns were mostly related to general views of infectious disease (vaccine safety, fear of getting infected) whilst cardiac rehabilitation was perceived safe and trustworthy environment during COVID-19.<\/jats:p><\/jats:list-item><\/jats:list><\/jats:sec>","DOI":"10.3389\/fcvm.2024.1373684","type":"journal-article","created":{"date-parts":[[2024,7,30]],"date-time":"2024-07-30T04:35:59Z","timestamp":1722314159000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Cardiac rehabilitation patient perspectives during COVID-19 pandemic: quantitative and qualitative study"],"prefix":"10.3389","volume":"11","author":[{"given":"Borut","family":"Jug","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Natasa","family":"Sedlar Kobe","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dejana","family":"Stojinic","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mitja","family":"Lainscak","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jerneja","family":"Farkas","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2024,7,30]]},"reference":[{"key":"B1","doi-asserted-by":"crossref","first-page":"I2191","DOI":"10.1136\/bmj.l2191","article-title":"Advances in rehabilitation for chronic diseases: improving health outcomes and function","volume":"365","author":"Richardson","year":"2019","journal-title":"Br Med J"},{"key":"B2","doi-asserted-by":"crossref","first-page":"460","DOI":"10.1177\/2047487320913379","article-title":"Secondary prevention through comprehensive cardiovascular rehabilitation: from knowledge to implementation. 2020 update. A position paper from the secondary prevention and rehabilitation section of the European association of preventive cardiology","volume":"28","author":"Ambrosetti","year":"2021","journal-title":"Eur J Prev Cardiol"},{"key":"B3","doi-asserted-by":"publisher","first-page":"180","DOI":"10.1038\/s41569-021-00611-7","article-title":"The role of cardiac rehabilitation in improving cardiovascular outcomes","volume":"19","author":"Taylor","year":"2022","journal-title":"Nat Rev Cardiol"},{"key":"B4","doi-asserted-by":"publisher","first-page":"3227","DOI":"10.1093\/eurheartj\/ehab484","article-title":"2021 ESC guidelines on cardiovascular disease prevention in clinical practice: developed by the task force for cardiovascular disease prevention in clinical practice with representatives of the European Society of Cardiology and 12 medical societies with the special contribution of the European association of preventive cardiology (EAPC)","volume":"42","author":"Visseren","year":"2021","journal-title":"Eur Heart J"},{"key":"B5","doi-asserted-by":"publisher","first-page":"842567","DOI":"10.3389\/fcvm.2022.842567","article-title":"Historical context of cardiac rehabilitation: learning from the past to move to the future","volume":"9","author":"Redfern","year":"2022","journal-title":"Front Cardiovasc Med"},{"key":"B6","doi-asserted-by":"publisher","first-page":"294","DOI":"10.1016\/j.ijcard.2016.12.125","article-title":"Lessons from contemporary trials of cardiovascular prevention and rehabilitation: a systematic review and meta-analysis","volume":"232","author":"van Halewijn","year":"2017","journal-title":"Int J Cardiol"},{"key":"B7","doi-asserted-by":"publisher","first-page":"e338","DOI":"10.1093\/eurjpc\/zwac063","article-title":"Effects of high- and low-load resistance training in patients with coronary artery disease: a randomized controlled clinical trial","volume":"29","author":"Kambic","year":"2022","journal-title":"Eur J Prev Cardiol"},{"key":"B8","doi-asserted-by":"publisher","first-page":"76","DOI":"10.1093\/eurjcn\/zvab015","article-title":"Exercise capacity improvement after cardiac rehabilitation following myocardial infarction and its association with long-term cardiovascular events","volume":"21","author":"Novakovi\u0107","year":"2022","journal-title":"Eur J Cardiovasc Nurs"},{"key":"B9","doi-asserted-by":"publisher","first-page":"43","DOI":"10.5334\/gh.939","article-title":"Impacts of the COVID-19 pandemic on cardiac rehabilitation delivery around the world","volume":"16","author":"Ghisi","year":"2021","journal-title":"Glob Heart"},{"key":"B10","doi-asserted-by":"publisher","first-page":"541","DOI":"10.1093\/eurjpc\/zwaa080","article-title":"Delphi consensus recommendations on how to provide cardiovascular rehabilitation in the COVID-19 era","volume":"28","author":"Ambrosetti","year":"2021","journal-title":"Eur J Prev Cardiol"},{"key":"B11","doi-asserted-by":"publisher","first-page":"67","DOI":"10.1186\/s13102-022-00459-5","article-title":"Impact of COVID-19 lockdown restrictions on cardiac rehabilitation participation and behaviours in the United Kingdom","volume":"14","author":"Kirwan","year":"2022","journal-title":"BMC Sports Sci Med Rehabil"},{"key":"B12","first-page":"CD007130","article-title":"Home-based versus centre-based cardiac rehabilitation","volume":"6","author":"Lindsey Anderson","year":"2017","journal-title":"Cochrane Database Syst Rev"},{"key":"B13","doi-asserted-by":"publisher","first-page":"e046051","DOI":"10.1136\/bmjopen-2020-046051","article-title":"How has technology been used to deliver cardiac rehabilitation during the COVID-19 pandemic? An international cross-sectional survey of healthcare professionals conducted by the BACPR","volume":"11","author":"O'Doherty","year":"2021","journal-title":"BMJ Open"},{"article-title":"Recommendations on how to provide cardiac rehabilitation activities during the COVID-19 pandemic","volume-title":"ESC Practice Tools","year":"2020","key":"B14"},{"key":"B15","doi-asserted-by":"crossref","first-page":"e048151","DOI":"10.1136\/bmjopen-2020-048151","article-title":"Trends in healthcare utilisation during COVID-19: a longitudinal study from the UK","volume":"11","author":"Howarth","year":"2021","journal-title":"BMJ Open"},{"key":"B16","first-page":"950","article-title":"The COVID-19 pandemic, stress, and eating practices in the United States","volume":"10","author":"Khubchandani","year":"2020","journal-title":"Eur J Investig Health Psychol Educ"},{"key":"B17","doi-asserted-by":"publisher","first-page":"438","DOI":"10.1002\/oby.23066","article-title":"The impact of COVID-19 stay-at-home orders on health behaviors in adults","volume":"29","author":"Flanagan","year":"2021","journal-title":"Obesity"},{"key":"B18","doi-asserted-by":"publisher","first-page":"e12453","DOI":"10.1111\/cob.12453","article-title":"Impact of the COVID-19 pandemic lockdown on weight status and factors associated with weight gain among adults in Massachusetts","volume":"11","author":"Mulugeta","year":"2021","journal-title":"Clin Obes"},{"key":"B19","doi-asserted-by":"publisher","first-page":"817912","DOI":"10.3389\/fpsyg.2022.817912","article-title":"Outpatient cardiac rehabilitation closure and home-based exercise training during the first COVID-19 lockdown in Austria: a mixed-methods study","volume":"13","author":"Kulnik","year":"2022","journal-title":"Front Psychol"},{"key":"B20","doi-asserted-by":"publisher","first-page":"88","DOI":"10.1097\/HCR.0000000000000585","article-title":"Cardiac rehabilitation is essential in the COVID-19 era: delivering uninterrupted heart care based on the Cleveland clinic experience","volume":"41","author":"Van Iterson","year":"2021","journal-title":"J Cardiopulm Rehabil Prev"},{"key":"B21","doi-asserted-by":"publisher","first-page":"476","DOI":"10.1016\/j.healthpol.2021.09.011","volume":"126","year":"2022","journal-title":"Health Policy"},{"key":"B22","doi-asserted-by":"publisher","first-page":"393","DOI":"10.1080\/07481187.2020.1748481","article-title":"Coronavirus anxiety scale: a brief mental health screener for COVID-19 related anxiety","volume":"44","author":"Lee","year":"2020","journal-title":"Death Stud"},{"key":"B23","doi-asserted-by":"publisher","first-page":"97","DOI":"10.1016\/j.bbi.2020.04.067","article-title":"How much \u201cthinking\u201d about COVID-19 is clinically dysfunctional?","volume":"67","author":"Lee","year":"2020","journal-title":"Brain Behav Immun"},{"key":"B24","doi-asserted-by":"publisher","first-page":"421","DOI":"10.1177\/0253717620946439","article-title":"Measuring the impact of COVID-19 on mental health: a scoping review of the existing scales","volume":"42","author":"Chaitanya Chandu","year":"2020","journal-title":"Indian J Psych Med"},{"key":"B25","first-page":"102232","article-title":"Development and initial validation of the COVID stress scales","author":"Taylor","year":"2022","journal-title":"J Anxiety Disord"},{"volume-title":"Mplus User\u2019s Guide","year":"","author":"Muth\u00e9n","key":"B26"},{"key":"B27","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1080\/10705519909540118","article-title":"Cutoff criteria for fit indexes in covariance structure analysis: conventional criteria versus new alternatives","volume":"6","author":"Hu","year":"1999","journal-title":"Struct Eq Mod"},{"key":"B28","first-page":"148","article-title":"Validation of the Slovenian version of hospital anxiety and depression scale in female cancer patients","volume":"20","author":"Vu\u010dko Miklav\u010di\u010d","year":"2008","journal-title":"Psychiatr Danub"},{"key":"B29","doi-asserted-by":"publisher","first-page":"180","DOI":"10.1016\/j.jpsychores.2011.06.008","article-title":"Latent structure of the hospital anxiety and depression scale: a 10-year systematic review","volume":"72","author":"Cosco","year":"2012","journal-title":"J Psychosom Res"},{"key":"B30","doi-asserted-by":"publisher","first-page":"E9","DOI":"10.1097\/HCR.0000000000000379","article-title":"Establishing the minimal clinically important difference for the hospital anxiety and depression scale in patients with cardiovascular disease","volume":"39","author":"Lemay","year":"2019","journal-title":"J Cardiopulm Rehabil Prev"},{"key":"B31","doi-asserted-by":"publisher","first-page":"87","DOI":"10.4103\/0976-0105.141942","article-title":"Qualitative research method-interviewing and observation","volume":"5","author":"Jamshed","year":"2014","journal-title":"J Basic Clin Pharm"},{"key":"B32","doi-asserted-by":"publisher","first-page":"107","DOI":"10.1111\/j.1365-2648.2007.04569.x","article-title":"The qualitative content analysis process","volume":"62","author":"Elo","year":"2008","journal-title":"J Adv Nurs"},{"key":"B33","doi-asserted-by":"publisher","first-page":"1277","DOI":"10.1177\/1049732305276687","article-title":"Three approaches to qualitative content analysis","volume":"15","author":"Hsieh","year":"2005","journal-title":"Qual Health Res"},{"key":"B34","doi-asserted-by":"publisher","first-page":"270","DOI":"10.1186\/s12872-022-02707-5","article-title":"A pragmatic effectiveness-implementation study comparing trial evidence with routinely collected outcome data for patients receiving the REACH-HF home-based cardiac rehabilitation programme","volume":"22","author":"Daw","year":"2022","journal-title":"BMC Cardiovasc Disord"},{"key":"B35","doi-asserted-by":"publisher","first-page":"175","DOI":"10.1097\/HCR.0b013e31824cc1f7","article-title":"A comparison of psychosocial risk factors between 3 groups of cardiovascular disease patients referred for outpatient cardiac rehabilitation","volume":"32","author":"Stauber","year":"2012","journal-title":"J Cardiopulm Rehabil Prev"},{"key":"B36","doi-asserted-by":"publisher","first-page":"953","DOI":"10.1016\/S0140-6736(04)17019-0","article-title":"Association of psychosocial risk factors with risk of acute myocardial infarction in 11119 cases and 13648 controls from 52 countries (the INTERHEART study): case-control study","volume":"364","author":"Rosengren","year":"2004","journal-title":"Lancet"},{"key":"B37","doi-asserted-by":"publisher","first-page":"333","DOI":"10.1186\/s12912-022-01115-6","article-title":"Barriers to hospital-based phase 2 cardiac rehabilitation among patients with coronary heart disease in China: a mixed-methods study","volume":"21","author":"Xie","year":"2022","journal-title":"BMC Nurs"},{"key":"B38","doi-asserted-by":"publisher","first-page":"4838","DOI":"10.3390\/jcm11164838","article-title":"Physical activity level and perspectives of participants transitioning from onsite to virtual cardiac rehabilitation during the early COVID-19 pandemic: a mixed-method study","volume":"11","author":"Vanzella","year":"2022","journal-title":"J Clin Med"},{"key":"B39","doi-asserted-by":"publisher","first-page":"524","DOI":"10.1177\/2047487320939671","article-title":"The future is now: a call for action for cardiac telerehabilitation in the COVID-19 pandemic from the secondary prevention and rehabilitation section of the European association of preventive cardiology","volume":"28","author":"Scherrenberg","year":"2021","journal-title":"Eur J Prev Cardiol"},{"key":"B40","doi-asserted-by":"publisher","first-page":"1381","DOI":"10.1080\/13548506.2021.1922719","article-title":"Patients\u2019 and carers\u2019 perspective of the impact of heart failure on quality of life: a qualitative study","volume":"27","author":"Nwosu","year":"2022","journal-title":"Psychol Health Med"},{"key":"B41","doi-asserted-by":"publisher","first-page":"62","DOI":"10.1186\/s41687-023-00607-6","article-title":"Experiences of being at high-risk during the COVID-19 pandemic and its impact on emotional well-being and daily life in people with chronic conditions: a qualitative study","volume":"7","author":"Mejdahl","year":"2023","journal-title":"J Patient Rep Outcomes"},{"key":"B42","doi-asserted-by":"publisher","first-page":"383","DOI":"10.1136\/bmjqs-2022-014695","article-title":"How do hospital inpatients conceptualise patient safety? A qualitative interview study using constructivist grounded theory","volume":"32","author":"Barrow","year":"2023","journal-title":"BMJ Qual Saf"},{"key":"B43","doi-asserted-by":"publisher","first-page":"4","DOI":"10.1002\/ejhf.2333","article-title":"2021 ESC guidelines for the diagnosis and treatment of acute and chronic heart failure: developed by the task force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC). With the special contribution of the heart failure association (HFA) of the ESC","volume":"24","author":"McDonagh","year":"2022","journal-title":"Eur J Heart Fail"}],"container-title":["Frontiers in Cardiovascular Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fcvm.2024.1373684\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,7,30]],"date-time":"2024-07-30T04:36:09Z","timestamp":1722314169000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fcvm.2024.1373684\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,7,30]]},"references-count":43,"alternative-id":["10.3389\/fcvm.2024.1373684"],"URL":"https:\/\/doi.org\/10.3389\/fcvm.2024.1373684","relation":{},"ISSN":["2297-055X"],"issn-type":[{"type":"electronic","value":"2297-055X"}],"subject":[],"published":{"date-parts":[[2024,7,30]]},"article-number":"1373684"}}