Investigation on Family Support System and Willingness of Patients to Participate in Cardiac Rehabilitation after Percutaneous Coronary Intervention.

Objective: We attempt to discuss the relationship between family support and willingness to participate in exercise rehabilitation in coronary heart disease patients after PCI to provide effective guidance for improving the quality of life of coronary heart disease patients after PCI.
Methods: By convenient sampling, we selected 90 coronary heart disease patients in cardiology department from September 2021 to January 2022, using general information questionnaire, rehabilitation exercise knowledge, attitude, and behavior questionnaire of patients with coronary heart disease, and the social support scale to investigate the subjects.
Results: The total score of knowledge, belief, and behavior in patients with coronary heart disease was 33.02 ± 6.28 points, the social support scale score was 39.63 ± 6.07 points, the multiple linear regression revealed that the educational level, history of cardiovascular disease, and the number of coronary stents of coronary heart disease patients after PCI are the main influencing factors that affect the willingness of coronary heart disease patients to participate in exercise rehabilitation.
Conclusion: Rehabilitation exercise knowledge, belief, and behavior scores in coronary heart disease patients are low, and social support is negatively correlated with rehabilitation exercise in coronary heart disease patients.

1. Introduction

Coronary heart disease (CHD) is one of the most common cardiovascular diseases [1]. Percutaneous coronary intervention (PCI) is an important means of treating acute myocardial infarction, which can effectively promote blood reperfusion and improve myocardial blood supply in patients and their living quality [2]. However, patients after PCI still face problems such as coronary artery disease and in-stent restenosis. In order to promote the improvement of cardiac function in coronary heart disease patients after PCI they should pay attention to the development of postoperative cardiac rehabilitation training. Exercise therapy is an important basis for the rehabilitation of coronary heart disease, which is beneficial for to control blood pressure, and blood lipids and improve the heart function of patients [3]. Jia et al. [4] found that cardiac rehabilitation exercise training was helpful to reduce the mortality of cardiovascular disease, make it drop by 7% to 38%. Patients who participated in exercise training had a 21% to 34% lower 5-year mortality rate than patients who did not participate in exercise training.

Social support refers to the emotional and material support and encouragement that individuals receive from society, family, and other aspects under stressful conditions. Generally speaking, when an individual receives social support, their stress state will be buffered or even weakened to a certain extent, which will have a positive impact on the individual's physical and mental health [5]. Studies have shown [6] that social support has a positive correlation with quality of life in coronary heart disease patients. However, the current concept of cardiac rehabilitation has not been deeply rooted in the hearts of people, which has affected the development of cardiac rehabilitation [7]. Similarly, the development of cardiac rehabilitation is inseparable from the willingness of patients to participate. This study investigated and analyzed the social support and the willingness of rehabilitation exercise training after PCI, learned about the factors that influence patients' willingness to participate in cardiac rehabilitation, explored the influence of social support on rehabilitation exercise in patients after PCI and provided a basis for clinical medical staff to effectively carry out cardiac rehabilitation nursing intervention.

2. Objects and Methods

2.1. Research Target

By convenient sampling, we selected 90 coronary heart disease patients after PCI in the Cardiology Department of a class 3A hospital in Wenzhou City who met the inclusion and exclusion criteria as the research target. The survey was anonymous and voluntary, and all respondents were aware of the purpose of this research before conducting the questionnaire survey. Inclusion criteria: age ≥18 years old and meet the international diagnostic criteria for coronary heart disease; stable condition and informed consent to participate in this study; (3) normal language and communication skills, understanding of their own disease status. Exclusion criteria: currently in the acute phase of mental illness; patients who are seriously ill and unable to complete the questionnaire. Elimination criteria: questionnaire unanswered items are greater than 5% of the total items; those with regular options in the questionnaire.

2.2. Research Tool

2.2.1. General Information Questionnaire

General information questionnaires designed by the investigators included: age, gender, annual income, education level, career, marital status, medical payment method, combined with other chronic diseases, course of disease, interventional therapy, and so on.

2.2.2. Questionnaire on Knowledge, Belief, and Behavior of Rehabilitation Exercise in Coronary Heart Disease Patients

Compiled by Zhao Mengli [8] in 2019 to investigate the knowledge, attitude, and behavior of rehabilitation exercise in coronary heart disease patients, the scale's Cronbach's α ratio was 0.722. The scale consisted of 3 dimensions of rehabilitation exercise knowledge (12 items), exercise attitude (5 items), and exercise behavior (6 items), 23 items in total. The dimension of exercise knowledge is multiple-choice, with a score ranging from 0 to 2 points (0 points for errors, 1 point for some correct answers, and 1 point for all correct answers), with a full score of 24 points; the exercise attitude and exercise behavior adopted the Likert 5-level scoring method, ranging from “completely disagree” to “strongly agree” with a score of 1 to 5, with a full score of 25 points and 30 points, respectively. The total scale score is the sum of the scores of each dimension, ranging from 11 to 79 points. The higher the score, the better the knowledge, belief, and behavior of coronary heart disease patients in rehabilitation exercise.

2.2.3. Social Support Questionnaire

The selected social support rating scale was compiled by Xiao Shuiyuan in 1986. The scale has 10 items, included objective support (3 items), subjective support (4 items), and utilization of social support (3 items). The total score of 10 items is 12 to 66 points, 12 to 21 points meant low level social support, 22 to 44 points meant medium-level social support, 45 to 66 points meant high-level social support. The higher the score the higher the level of social support [9]. Cronbach's α ratio of the questionnaire in this study was 0.718.

2.3. Statistical Analysis

SPSS 22.0 was adopted to conduct statistical analysis. α = 0.05 was taken as the inspection standard. was used to express measurement data, and frequency, and percentage (%) was used to express enumeration data. χ2 test was adopted for comparison between groups, and linear regression was used to analyze influencing factors of rehabilitation exercise participation willingness.

3. Results

3.1. Demographic Data and PCI-Related Conditions of Coronary Heart Disease Patients after PCI

Of the 90 post-PCI patients with coronary artery disease, 77 (85.5%) were male. The age of the patients was concentrated in 41–65 years and >65 years 44, accounting for 50.0% and 48.9%, respectively. 61.1% of patients had a rural residence and 94.4% had a married marital status. Other information is shown in Table 1.

Table 1

Demographic data and PCI-related conditions of coronary heart disease patients after PCI (n = 90).

Item	Group	Number of people (case)	Percentage	Item	Group	Number of people (case)	Percentage
Gender	Male	77	85.6	Medical expense	At their own expense	4	4.4
	Female	13	14.4	Payment method	New rural cooperative medical system	49	54.4
Age	30∼40	1	1.1		Urban medical insurance	36	40.0
	41∼65	45	50.0		Green channel	1	1.1
	>65	44	48.9	Family history of coronary heart disease	Yes	10	11.1
Place of residence	city	35	38.9		No	64	71.1
	countryside	55	61.1		Unclear	16	17.8
Marital status	unmarried	1	1.1	Medical history	<1 year	30	33.3
	married	85	94.4		1–5 years	24	26.7
	divorce	1	1.1		5–10 years	17	18.9
	Widowed	3	3.3		>10 years	19	21.1
Education level	Primary school and below	51	56.7	Number of coronary angiography	once	62	68.9
	Middle school	33	27.7		2–3 times	26	28.9
	College degree or above	5	5.6		>3 times	2	2.2
Annual income	≤50 thousand	58	64.4	Coronary stent number	0	30	33.3
	>50 thousand	32	35.6		1	38	42.2
Basic disease history	Cardiovascular disease	51	56.7		1–3	19	21.1
	Noncardiovascular disease	39	43.3		>3	3	3.3

3.2. Rehabilitation Exercise Knowledge, Belief, and Behavior Scores in Coronary Heart Disease Patients after PCI

The lowest total score of 90 patients with knowledge, belief, and behavior exercise was 21 points, and the highest score was 46 points. The total score of the knowledge, belief, and behavior exercise was 33.02 ± 6.28 points. The exercise knowledge score was 4.99 ± 2.42 points. The exercise belief score was 11.69 ± 3.03 points. The exercise behavior score was 16.34 ± 4.36 points as shown in Table 2.

Table 2

The total score of knowledge, belief, and behavior and the scores of each dimension in coronary heart disease patients after PCI (n = 90).

Item	Number of entries (n)	Score range (point)	Score (point, X¯±S)
Exercise knowledge	12	0∼24	4.99 ± 2.42
Exercise belief	5	5∼25	18.69 ± 3.03
Exercise behavior	6	6∼30	16.34 ± 4.36
Total score	23	11∼79	33.02 ± 6.28

3.3. Univariate Analysis of Factors Influencing the Willingness to Exercise Rehabilitation after PCI in Coronary Heart Disease Patients

Univariate analysis showed that when comparing education level, family history of coronary heart disease, history of cardiovascular disease, number of coronary stents, and risk stratification of coronary heart disease on patients' willingness to exercise rehabilitation, the difference possessed statistical significance (P < 0.05). Medical history had no statistical significance on patient willingness (P < 0.05) as shown in Table 3.

Table 3

Univariate analysis of factors influencing the willingness to exercise rehabilitation after PCI in coronary heart disease patients (n = 90).

Item		Willingness score	F Value	P value
Education level	Primary school and below	17.33 ± 4.21	2.94	0.038
	Middle school	15.73 ± 4.17
	High school	17.36 ± 4.59
	College degree or above	18.60 ± 3.21
Family history of coronary heart disease	Yes	13.80 ± 3.08	3.674	0.029
	No	16.23 ± 4.57
	Unclear	18.38 ± 3.22
History of cardiovascular disease	Yes	15.37 ± 4.47	6.203	0.015
	No	17.62 ± 3.90
Number of coronary stents	0	18.97 ± 3.07	10.35	<0.01
	1	15.32 ± 4.42
	1–3	13.58 ± 3.53
	>3	20.67 ± 3.06
Medical history	<1 year	17.30 ± 4.54	2.62	0.056
	1–5 years	16.08 ± 4.32
	5–10 years	17.47 ± 3.50
	>10 years	14.16 ± 4.23
Risk stratification	Low risk	16.98 ± 4.31	3.404	0.038
	Medium risk	13.88 ± 4.00
	High risk	16.38 ± 4.17

3.4. Analysis of Influencing Factors on Willingness to Exercise Rehabilitation in Coronary Heart Disease Patients after PCI

Used the patient's willingness to participate in rehabilitation exercise score was used as the dependent variable, and the general data (education level, family history of coronary heart disease, history of cardiovascular disease, number of coronary stents, and risk stratification) with statistical significance in univariate analysis as independent variables, to perform multiple linear regression analysis. The results showed that the educational level, history of cardiovascular disease, and the number of coronary stents of coronary heart disease patients were the main influencing factors of the willingness to exercise rehabilitation (P < 0.05) as shown in Table 4.

Table 4

Regression analysis of influencing factors of rehabilitation exercise willingness in CHD patients.

Item	B	Se value	β value	T value	P Value
Constant term	21.057	2.835		7.427	<0.01
Education level	-1.03	0.474	-0.214	-2.174	0.033
Family history of coronary heart disease	0.893	0.838	0.111	1.065	0.290
History of cardiovascular disease	-1.88	0.857	-0.215	-2.192	0.031
Number of coronary stents	-1.03	0.474	-0.214	-2.174	0.033
Risk stratification	-0.754	0.568	-0.255	-1.328	0.188

Note. R = 0.472; R2 = 0.186; △R2 = 0.186; F = 6.016; P < 0.01.

3.5. Social Support and Scores of Various Dimensions in Coronary Heart Disease Patients after PCI

The total score of social support in coronary heart disease patients after PCI was 39.63 ± 6.07 points, and the score ranged from 18 to 51 points, including 18 cases of high-level social support, 71 cases of medium-level social support, and 1 case of low-level social support.

3.6. Influence of Social Support on Knowledge, Belief, and Behavior of Rehabilitation Exercise in Coronary Heart Disease Patients after PCI

The study divided the social support of coronary heart disease patients after PCI into a high-level group and a middle-low level group. The high-level group had a lower total score of knowledge, belief and behavior, and attitude score than the middle-low level group. The difference possessed statistical significance (P < 0.05) as shown in Table 5.

Table 5

Influence of different social supports on knowledge, belief, and behavior of rehabilitation exercise in coronary heart disease patients after PCI.

Social support	n	Total score of knowledge, belief, and behavior	Attitude score
High level	18	30.33 ± 6.56	10.27 ± 3.27
Middle-low level	72	33.69 ± 6.07	12.00 ± 2.89
T value		-2.07	-2.20
P value		0.042	0.031

4. Discussion

4.1. The Cognition of Rehabilitation Exercise on Cardiac Rehabilitation in Coronary Heart Disease Patients after PCI Needs to Be Improved

The patient's mastery of disease knowledge is the premise of the patient's behavior change, correct and effective health knowledge is the basis for improving patients' self-management ability, thus effectively control the disease and reduce the rate of rehospitalization [10]. The results of this study showed that the patients' total score of rehabilitation exercise knowledge, belief, and behavior was 33.02 ± 6.28 points, which was at a low level. The patients' understanding of disease knowledge was low, and the score of rehabilitation exercise knowledge was 4.99 ± 2.42 points. Analyze the reasons: (1) Age factor, the number of people over 60 years old accounted for 62.2%. The elderly have poor memory, relative lack of learning ability, and insufficient self-care ability. (2) The factor of education level, the education level of primary school and below accounted for 56.7%. (3) Disease course factors, the number of patients with disease course <1 year accounted for 33.3%. The above reasons lead to a low level of awareness of the disease and a lack of awareness of the knowledge of diet, exercise, medication, etc. Exercise rehabilitation is an important component of cardiac rehabilitation, and compared with drugs and diet, patients lack the knowledge of exercise. In this survey, patients did not fully understand the frequency, time, form and exercise intensity of rehabilitation exercise for patients with coronary heart disease, 26.4% of the patients believed that only aerobic exercise was possible, 50.0% of them believed that the frequency of exercise was 3 times a week for at least 30 min/time, 16.5% of them believed that the method of evaluating the best exercise intensity was the self-perceived fatigue rating method. 50.8% of the patients in the survey would warm up before exercising, only 15.2% of them performed relaxation exercises after exercise, 86.5% were unaware of resistance exercise.

The exercise attitude score (18.69 ± 3.03) was at the upper-middle level. The survey found patients have positive attitudes that exercise contributes to normal health, but doubt or denial that exercise aids recovery during or after illness. Studies [11] have confirmed that the cardiac rehabilitation compliance rate of coronary heart disease patients in my country is closely related to patients' knowledge of the disease, self-efficacy, and health literacy. The exercise behavior score was 16.34 ± 4.36 points, and the survey showed that 70% of the patients in this study had daily exercise behavior. Among them, walking accounted for 80% and cycling accounted for 70%. The author found that the weekly participation rate for aerobic exercise was 78.9%, while the resistance exercise participation rate was 13.3%. The participation rate of aerobic exercise is remarkably higher than resistance exercise. The expert consensus on exercise therapy for patients with coronary heart disease points out that [12], both aerobic and resistance exercise improve fitness and health-related risk factors. Due to the different age, educational level, and disease experience of patients, they have different needs for health education guidance and rehabilitation information [13]. Secondary prevention regimens should be tailored to individual patient conditions. In the survey, the educational information received by patients was not equal to their actual needs. When implementing secondary prevention strategies, patients needed practical solutions.

4.2. Analysis on the Current Situation and Influencing Factors of Rehabilitation Willingness of Patients with Coronary Heart Disease

The coronary heart disease patients' willingness to exercise rehabilitation score was 16.34 ± 4.36 points, and the willingness to participate was low. The results of this study showed that while comparing educational level, family history of coronary heart disease, history of cardiovascular disease, and the number of coronary stents with patients' willingness to exercise for rehabilitation, the difference possessed statistical significance (P < 0.05). (1) Education level: generally speaking, the higher the educational level, the higher the willingness of patients to participate in rehabilitation exercise. The results are the same as those of Fan Xi et al. [13], but the patients with primary school education are more willing to recover than those with middle high school education. It could be that highly educated patients have rich knowledge reserves, strong understanding of disease knowledge, and pay more attention to their own health. Low-educated patients are highly receptive to home rehabilitation exercises, and aerobic exercise is beneficial to disease recovery without additional cost. (2) Family history of coronary heart disease: patients with a family history of coronary heart disease are less willing to exercise for rehabilitation. It may be related to the patient's low understanding of the disease and insufficient attention to the disease. (3) History of cardiovascular disease: Patients with a history of cardiovascular disease are less willing to exercise for rehabilitation. It may be related to the lack of knowledge about rehabilitation exercise in patients, and it is wrongly believed that rehabilitation exercise is not beneficial to disease recovery. (4) Number of coronary stents: The greater the number of coronary stents, the higher the willingness of patients to exercise for rehabilitation. It may be related to the patient's increased emphasis on the disease and the enhanced understanding of the disease knowledge. (5) Risk stratification: according to the consensus of exercise rehabilitation experts [14], the risk stratification of patients after PCI is carried out according to the left ventricular ejection fraction, and the high-risk patients are less willing to participate in rehabilitation exercise.

Some studies [15] have shown that carrying out cardiac rehabilitation education for patients is conducive to improving patients' self-management behavior, improving their quality of life, and reducing medical costs. The community should strengthen the publicity and guidance of cardiac rehabilitation exercises and increase the awareness rate of cardiac rehabilitation exercise among community residents. Nurses strengthen the publicity and education of cardiac rehabilitation exercise knowledge through pictures, texts, videos, etc. during hospitalization and improve the participation rate and compliance of patients' rehabilitation exercise by formulating exercise prescriptions, professional follow-up, and other methods [16].

4.3. The Effect of Social Support on the Willingness to Exercise Rehabilitation in Coronary Heart Disease Patients

As an important external resource that affects people's physical and mental health, social support is closely related to the outcome of the disease. Molloy et al. [17] have shown that practical support can improve patients' medication compliance and rehabilitation care. The results showed that a high level of social support is negatively correlated with the total score of knowledge, belief, behavior, and attitude scores of rehabilitation exercise in patients with coronary heart disease. Patients generally tend to obtain disease-related knowledge from close people, such as family members or friends, but due to their insufficient cognition or even cognition error of cardiac rehabilitation knowledge, patients have the wrong cognition of rehabilitation exercise.

5. Conclusion

Cardiac rehabilitation exercise is a secondary preventive measure after PCI for coronary heart disease. Many scholars at home and abroad suggest that discharged patients actively participate in cardiac rehabilitation exercise. According to the results of this study, the overall level of rehabilitation exercise knowledge, belief, and behavior in coronary heart disease patients is relatively low. The patient's education level, history of cardiovascular disease, and the number of coronary stents are the main influencing factors of the willingness to exercise rehabilitation. The inadequacies of this study are that the research target came from only one 3A grade hospital, the sample lacks diversity and breadth, and is poorly represented, so it can not reflect the overall rehabilitation exercise willingness level of coronary heart disease patients. In the future, it is necessary to expand the research scope, conduct research in more regions and hospitals, and further explore the knowledge, belief, and behavior level of rehabilitation exercise in patients with coronary heart disease.