Gianluigi Balestroni

Fondazione Salvatore Maugeri IRCCS, Ticinum, Lombardy, Italy

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Publications (24)16.94 Total impact

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    ABSTRACT: Advanced heart failure is a challenging disease; the implantable Left Ventricular Assist Device (L-VAD) is becoming a good chance for relieving symptoms and prolong survival in most CHF patients. The emotional impact of L-VAD implantation is thought to be high but, at present, published data are scant about that. Aim of this study was to evaluate the modifications of perceived quality of life (QoL) in a group of patients recently treated with L-VAD implantation, admitted to a residential cardiac rehabilitation program, and to compare the results to those obtained in patients awaiting heart transplantation and recently transplanted. We enrolled 66 patients (pts) with a recent implant of L-VAD, 51 with refractory heart failure awaiting heart transplantation (HT) and 55 recently treated with HT. On day two after admission, all patients underwent a complete psychometric assessment consisting in the compilation of: Minnesota Living with Heart Failure Questionnaire (MLHFQ). Beck Anxiety Inventory (BAI). Beck Depression Inventory-II (BDI-II). L-VAD recipients had significantly higher scores at MLHFQ. Both the total score and the 2 subscales scores (respectively physical and emotional disturbances) were statistically significant when compared with post-transplant patients. Posttransplant pts had the lowest scores regarding anxiety symptoms, while the bearers of device had the highest ones. The same results were obtained for depression scores (BDI-II), both in total score and in the subscales (somatic symptoms and affective symptoms). With an opening scoring, this study showed the development of more relevant psychological troubles in patients treated with L-VAD when compared to those awaiting for heart transplantation and those transplanted.
    Monaldi archives for chest disease = Archivio Monaldi per le malattie del torace / Fondazione clinica del lavoro, IRCCS [and] Istituto di clinica tisiologica e malattie apparato respiratorio, Università di Napoli, Secondo ateneo 06/2014; 82(2):55-60.
  • Gianluigi Balestroni, Giorgio Bertolotti
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    ABSTRACT: The aim of this paper was to provide a detailed description of the EuroQol- 5 Dimension (EQ-5D) useful for those member of staff in rehabilitation setting who wish to use it properly. EQ-5D is an instrument which evaluates the generic quality of life developed in Europe and widely used. The EQ-5D descriptive system is a preference-based HRQL measure with one question for each of the five dimensions that include mobility, self-care, usual activities, pain/discomfort, and anxiety/depression. The answers given to ED-5D permit to find 243 unique health states or can be converted into EQ-5D index an utility scores anchored at 0 for death and 1 for perfect health. The EQ-5D questionnaire also includes a Visual Analog Scale (VAS), by which respondents can report their perceived health status with a grade ranging from 0 (the worst possible health status) to 100 (the best possible health status). Finally the specific utility (in clinical and research setting) of each one of them is discussed.
    Monaldi archives for chest disease = Archivio Monaldi per le malattie del torace / Fondazione clinica del lavoro, IRCCS [and] Istituto di clinica tisiologica e malattie apparato respiratorio, Università di Napoli, Secondo ateneo 09/2012; 78(3):155-9.
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    ABSTRACT: Over the years left ventricular assist devices (VADs) have become more durable and reliable, smaller, simpler, easier to implant and more comfortable. The extensive experience now acquired shows successful hospital discharge with VAD use. We are entering an era in which long-term mechanical circulatory support will play an increasing role in the approach to end-stage heart failure (HF); at the same time, the extension of VADs into destination therapy has revealed the limitations of our understanding of these populations. This second paper on cardiovascular prevention and rehabilitation for patients with left VADs will deal with the management of patients outside the highly specialized HF centers and surgical setting, with particular focus on postoperative patient management. Outpatient management of VAD patients is time-intensive, and a multidisciplinary approach is ideal in long-term care. Although the new devices have definite advantages over the older pumps, some challenges still remain, i.e. infection, stroke, device thrombosis, gastrointestinal bleeding, recurrent HF symptomatology with or without multisystem organ failure, and occurrence of ventricular arrhythmias.
    Monaldi archives for chest disease = Archivio Monaldi per le malattie del torace / Fondazione clinica del lavoro, IRCCS [and] Istituto di clinica tisiologica e malattie apparato respiratorio, Università di Napoli, Secondo ateneo 09/2011; 76(3):136-45.
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    ABSTRACT: Vital Exhaustion (VE) is a psychological construct that has been shown to be predictive for cardiac morbidity and mortality. There are not sufficient data which clarify whether the female population express this construct differentely comparing to males. This study aims to analyze the construct of Vital Exhaustion in a population of women admitted to a cardiac rehabilitation program. The selected sample consisted of 854 women with an average age of 58 years (SD +/- 10.2). All patients were at their first hospitalization for a cardiac rehabilitation program. The tool used to analyze the construct of Vital Exhaustion was the B scale of the Cognitive Behavioural Assessment Hospital form (CBA-H). The study also analyzed the answers to the D scale of the CBA-H concerning aspects of lifestyle and behavioral habits. The percentage of women with considerable value of Vital Exhaustion was very high (67.7%). Moreover, the group of women with higher Vital Exhaustion showed more dysfunctional habits (smoking, poor physical activity, incorrect diet) and more referred psychological problems as well as job and/or family distress and insomnia. 207 women (24.2%) of the sample belonged to economically active population; 136 (69%) of these women presented a high value of VE and 61 (31%) a low one. Among the employed women, 24% of the group with high VE value reported to be unsatisfied, while the same condition lowered at 9.6% in the group with low VE value (p = .004); moreover, 41.7% versus 18.5% (p = .000) described their working life as a source of tension. Considering a sample of female cardiac patients, this study shows that the construct of Vital Exhaustion is particularly present. It also appears that the construct of Vital Exhaustion can be interpreted as an indicator of lifestyle problems in women, helping health-professionals in selecting efficient educational and/or psychological interventions.
    Monaldi archives for chest disease = Archivio Monaldi per le malattie del torace / Fondazione clinica del lavoro, IRCCS [and] Istituto di clinica tisiologica e malattie apparato respiratorio, Università di Napoli, Secondo ateneo 03/2011; 76(1):22-6.
  • Gianluigi Balestroni, Pantaleo Giannuzzi
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    ABSTRACT: Evaluation and treatment of psychological diseases are often included in cardiology rehabilitation programs. The aim of this study was to analyze the emotional reactions in a very consistent sample of cardiac patients, hospitalized for a rehabilitation program. The sample consisted of 5417 patients, 4563 males and 854 females, with a mean age of 57.36 +/- 9.15 (range 18-83). They were admitted in the period between 1995 and 2005 and completed the Cognitive Behavioral Assessment, Hospital form (CBA-H). Significant level of state- anxiety was shown by 27.8% of the subjects, 22.1% reported health-related fears and 10% depressive symptoms. Women show higher scores in all of the three scales, and patients over 65 years scored higher in the depression scale. It is interesting to note that the mean scores in the three scales showed a progressive and significant decrease over the years. These data confirm that an accurate psychological screening can be extremely useful to support the Psychologist working in cardiac rehabilitation as it helps to plan more specifically the interventions, focusing on the objective patients' educational and psychological needs.
    Monaldi archives for chest disease = Archivio Monaldi per le malattie del torace / Fondazione clinica del lavoro, IRCCS [and] Istituto di clinica tisiologica e malattie apparato respiratorio, Università di Napoli, Secondo ateneo 03/2010; 74(1):9-15.
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    ABSTRACT: The Depression Questionnaire (QD) is an instrument designed to measure depression in an inpatient-rehabilitation setting. This study proposes a reduced version of the original 24-item QD, to make it better suited to the characteristics of patients in this setting. The study population consisted of 801 individuals admitted to cardiac rehabilitation (564 males and 237 females) who had validly completed the original version of the QD. Data were analyzed first through confirmatory factor analysis and then using logistic models. Factor analysis of QD-24 items form, confirmed the plausibility of the monofactorial solution, both for males and females. Factor analysis combined with clinical observation suggested the possibility of reducing the QD to 17 items. Two further items were eliminated through use of simple logistic models. We thus obtained a shortened 15-item version of the QD (QD-R) that maintains a good index of separation (0.80), that is, good capacity to discriminate between individuals with different levels of depression, and a good item-trait interaction (chi(2)153=165.37, P>0.05). A second confirmatory factor analysis applied to the 15-item monofactorial model confirmed the validity of this shortened version of the instrument. The QD-R scores significantly correlated with metres walked during the 6 minute walking test (r=-0.316; P<0.01). Combined use of confirmatory factor analysis and simple logistic models together with observations drawn from clinical experience constitutes a valid method for shortening a questionnaire while at the same time maintaining, if not improving, its psychometric properties. The QD-R, seems adequate to how much is required in rehabilitation to point out the outcome, in case of variation of depression, easily to fill in by the debilitated individual or elderly, mainly because some item excessively influenced by the pathology or the hospital context were removed.
    European journal of cardiovascular prevention and rehabilitation: official journal of the European Society of Cardiology, Working Groups on Epidemiology & Prevention and Cardiac Rehabilitation and Exercise Physiology 03/2010; 17(2):187-97. DOI:10.1097/HJR.0b013e328333edc8 · 3.69 Impact Factor
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    ABSTRACT: Secondary prevention is not adequately implemented after myocardial infarction (MI). We assessed the effect on quality of care and prognosis of a long-term, relatively intensive rehabilitation strategy after MI. We conducted a multicenter, randomized controlled trial in patients following standard post-MI cardiac rehabilitation, comparing a long-term, reinforced, multifactorial educational and behavioral intervention with usual care. A total of 3241 patients with recent MI were randomized to a 3-year multifactorial continued educational and behavioral program (intervention group; n = 1620) or usual care (control group; n = 1621). The combination of cardiovascular (CV) mortality, nonfatal MI, nonfatal stroke, and hospitalization for angina pectoris, heart failure, or urgent revascularization procedure was the primary end point. Other end points were major CV events, major cardiac and cerebrovascular events, lifestyle habits, and drug prescriptions. End point events occurred in 556 patients (17.2%). Compared with usual care, the intensive intervention did not decrease the primary end point significantly (16.1% vs 18.2%; hazard ratio [HR], 0.88; 95% confidence interval [CI], 0.74-1.04). However, the intensive intervention decreased several secondary end points: CV mortality plus nonfatal MI and stroke (3.2% vs 4.8%; HR, 0.67; 95% CI, 0.47-0.95), cardiac death plus nonfatal myocardial infarction (2.5% vs 4.0%; HR, 0.64; 95% CI, 0.43-0.94), and nonfatal MI (1.4% vs 2.7%; HR, 0.52; 95% CI, 0.31-0.86). A marked improvement in lifestyle habits (ie, exercise, diet, psychosocial stress, less deterioration of body weight control) and in prescription of drugs for secondary prevention was seen in the intervention group. The GOSPEL Study is the first trial to our knowledge to demonstrate that a multifactorial, continued reinforced intervention up to 3 years after rehabilitation following MI is effective in decreasing the risk of several important CV outcomes, particularly nonfatal MI, although the overall effect is small. ClinicalTrials.gov Identifier: NCT00421876.
    Archives of internal medicine 12/2008; 168(20):2194-204. DOI:10.1001/archinte.168.20.2194 · 13.25 Impact Factor
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    ABSTRACT: The present study was developed as part of a comprehensive evaluation of the state of the art of knowledge and implementation of the Italian Guidelines for psychological activities in Cardiac Rehabilitation, published in 2003 by the Working Group of Psychology of the Italian Society of Cardiac Rehabilitation (GICR). METHODS: A questionnaire was designed to collect detailed information on facilities, organization, staffing level, professional background and activities carried out by psychologists working in Italian Cardiac Rehabilitation Units (CRU). Out of 144 Italian CRU (inventory 2004), 107 reported structured psychological programmes. The questionnaires were sent by conventional mail to the referring psychologist of these 107 CRU; they were invited to participate in the survey on a purely voluntary basis. RESULTS: Responses were received from 70 (65.4%) of 107 CRU. 55 CRU (79.8%) report a good knowledge of the published GL; 10.1% declare that the psychologists did not know the current GL. 84.5% consider the GL to be fully applicable, while 15.5% believe that they are only partly applicable. Psychological assessment is performed through clinical interview (94.3%) and psychometric tests (81.4%). 92.8% of the CRU use screening instruments in order to evaluate psychosocial risk factors, in particular anxiety and depression (64.3%). Quality of life (22.8%) and cognitive impairment (17.1%) are not routinely assessed. Educational interventions are planned in 87.1% of the CR programme and are extended to the family members (51%) as well as counselling (57%). Psychological programme includes smoking (56%) and eating behaviour (55%) group interventions. Stress management is routinely planned in 69% of the CRU. Psychological intervention tailored to individual needs of the patients is performed in 62.9% CRU. Written final reports are available in 88.6% cases. The follow-up is carried out by 48.6% of the CRU, 15.7% in a structured way. CONCLUSIONS. The survey shows wide discrepancies in the provision of psychological activities in Italian CRU. Nevertheless psychological assessment and interventions seem acceptably coherent with current national GL on CR.
    Monaldi archives for chest disease = Archivio Monaldi per le malattie del torace / Fondazione clinica del lavoro, IRCCS [and] Istituto di clinica tisiologica e malattie apparato respiratorio, Università di Napoli, Secondo ateneo 04/2008; 70(1):6-14.
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    ABSTRACT: Psychosocial support, education and self-management are important complements of rehabilitation programs. A central concept in self-management is self-efficacy, which refers to oneself confidence in reaching a desired goal. The General Perceived Self-Efficacy scale (GSE), developed to measure self-efficacy at the broadest level, could be useful in the rehabilitation setting, in order to assess patients' self-management difficulties as well as to design specific interventions for specific diseases. Aim of this work is to verify the GSE Italian version psychometric properties applied to the rehabilitation setting. Data were analyzed from 395 in-patients attending cardiac (83.8%) and neurological (16.2%) rehabilitation. Cardiac patients suffered from post-MI, CABG or heart-failure; all of the neurological patients suffered from amiotrophic lateral sclerosis (ALS). They were mostly males (84.5%), and the mean age was 55.7 years. Principal component factor analysis confirmed that GSE has a monofactorial structure with internal consistency of .85. As in previous studies, a gender difference emerged. There was no difference in cardiac patients, on the basis of their specific disease, but they showed higher self-efficacy perception compared to ALS patients. The findings confirm that GSE is a valid measure of self-efficacy in settings characterised by different levels of functional abilities, as in cardiac and neurological rehabilitation.
    Monaldi archives for chest disease = Archivio Monaldi per le malattie del torace / Fondazione clinica del lavoro, IRCCS [and] Istituto di clinica tisiologica e malattie apparato respiratorio, Università di Napoli, Secondo ateneo 10/2007; 68(3):178-83.
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    ABSTRACT: In the rehabilitation setting it is important to identify clinically significant conditions of distress so as to be able to provide, in addition to the conventional multidisciplinary rehabilitation treatment, specific psychotherapeutic interventions targeted to the individual's problems. This paper presents the findings from a psychometric test for the measurement of anxiety and depression (AD-R Scale) administered at the start and end of a rehabilitation program in patients with cardiopulmonary disease. The study population consisted of 765 patients affected by cardiac and pulmonary disease undergoing an in-hospital course of intensive rehabilitation. We observed that AD-R scores are related to sex, age and diseases. Among anxiety and depression scores there are statistically significant differences regarding sex: women achieved higher AD-R scores compared with men. Depression scores are influenced by age: younger subjects reached lower scores compared with the older ones. Among patients with respiratory disease, the subjects affected by chronic respiratory failure showed statistically significant higher depression scores compared to subjects affected by chronic obstructive pulmonary disease and bronchial asthma. Anxiety and depression scores among subjects affected by cardiac diseases did not show important differences. At the end of the multidisciplinary rehabilitation program, a significant reduction in both anxiety and depression scores was observed, compared to values at the start, particularly for those that, at the beginning of the rehabilitation program, reached clinically remarkable AD-R scores and in general for the youngest subjects. The paper also presents the means, standard deviations and percentile range of scores for anxiety and depression in the population studied, according to age, sex, underlying pathology or hospital division. The Scale AD-R appears to be a valid instrument for the screening of patients undergoing cardio-pulmonary rehabilitation and as an outcome index.
    Monaldi archives for chest disease = Archivio Monaldi per le malattie del torace / Fondazione clinica del lavoro, IRCCS [and] Istituto di clinica tisiologica e malattie apparato respiratorio, Università di Napoli, Secondo ateneo 01/2007; 66(4):255-63.
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    ABSTRACT: The Italian SurveY on CarDiac REhabilitation-Psychology (ISYDE-Psi) was developed, in line with the indications of the Italian National Guidelines Program, as part of a project to implement and apply the guidelines for psychology interventions in cardiac rehabilitation and prevention published in 2003. The Task Force on Psychological Interventions in Cardiac Rehabilitation conducted this pilot survey of the existing situation of Psychology in order to prepare the ground for implementation of the guidelines through interactive training. As part of the evaluation of training requirements a questionnaire was elaborated to gather information on the models of organization of and activities carried out by psychologists working in the surveyed cardiac rehabilitation facilities. Data collection for ISYDE-Psi terminated at the end of March 2005, with replies from 68/107 (63.6%) structures. In the light of this response, the Task Force has developed a training project for psychologists working in cardiac rehabilitation, sponsored by the Italian Council of Psychologists, that will be implemented in different regions of the country with the aim of disseminating the guidelines and promoting their correct application despite the existing regional disparities in organization.
    Monaldi archives for chest disease = Archivio Monaldi per le malattie del torace / Fondazione clinica del lavoro, IRCCS [and] Istituto di clinica tisiologica e malattie apparato respiratorio, Università di Napoli, Secondo ateneo 04/2005; 64(1):53-8.
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    ABSTRACT: All the previous studies showed an increase in survival after cardiac transplantation. Nevertheless, a certain number of patients persist, in the short- and long-term period, in leading an incorrect lifestyle. Owing to this high-risk behavioral profile clinical, psychological and social problems could arise. We have analyzed the quality of life and adherence to the recommended treatments in 107 patients at least 6 months (range 6-132 months) after they had been submitted to heart transplant and returned to their preoperative social and family environments. Data analysis has shown, in these patients, the return to their previous high-risk lifestyle habits: 18.4% of them did not adhere to the suggested diet, 13.2% did not perform physical activity, and 36.7% of the smokers took up the habit again after the transplant. Perceptions of emotional distress were still there: anxiety in 10.3% of cases and depression in 13.1%. An unsatisfactory sexuality was reported by 27.1% and only 27% returned to their previous job. Their outlook towards their self-efficacy seems to be predictive of the quality of life as perceived by the patient after the heart transplant: the better their outlook towards their self-efficacy, the better the quality of life. These data show that following heart transplant, before implementing postoperative preparation and rehabilitation programs one must carefully study those problem areas that unfortunately still exist.
    Italian heart journal. Supplement: official journal of the Italian Federation of Cardiology 07/2002; 3(6):652-8.
  • G Balestroni
    Italian heart journal. Supplement: official journal of the Italian Federation of Cardiology 01/2001; 1(12):1646-7.
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    ABSTRACT: To develop a model for assessing cognitive-behavioral dysfunction in patients with heart failure, through the analysis of data gathered from clinical interviews. One hundred sixty-six consecutive inpatients with previous or current heart failure: 125 males and 41 females, mean age 59 +/- 9.3 yrs. Three professional psychologists independently analyzed the clinical reports of the interviews. The cognitive-behavioral dysfunction recorded was correlated to age and sex, history of heart failure and cardiac function indices (ejection fraction, NYHA Class). The concordance index among the three psychologists was 97%. Illness management was found to be more difficult for younger subjects (p = 0.03), in those with a longer history of heart failure (p = 0.04) and in those with advanced NYHA class (p = 0.008). An incorrect behavioral style, as defined by the variables "type A", "risk factors", and "vital exhaustion", was significantly correlated with the level of cardiac impairment (ejection fraction) (p = 0.04) and with inadequate illness management (p = 0.02). Clinical interviews seem to be a simple and accurate tool for assessing cognitive behavioral dysfunction in patients with heart failure and for detecting the areas that require further investigation and more adequate psychological support. The key element that emerges with regard to both diagnosis and treatment is a dysadaptive behavioral style, as defined by the "type A" variables, "risk factors" and "vital exhaustion".
    Giornale italiano di cardiologia 07/1998; 28(6):653-60.
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    ABSTRACT: BACKGROUND. Studies on the quality of life after coronary artery by-pass grafting (CABG) have yielded discordant results. Several studies have described psychological and social improvements while others have reported a lack of change in behavioural risk factors and return to work. There have been no reports on Italian patients, and, because of the wide range of psychological measures used in previous studies, it is difficult to draw any general conclusions. The aim of this study was to assess the psychological sequelae of CABG. METHODS. A total of 164 patients (142 men and 22 women, aged 60 years) with myocardial ischemia, completed the CBA-H Questionnaire 3-5 days before elective CABG and again after 6 months. RESULTS. State anxiety scores were lower after surgery (p < .000) as were health fears (p < .000), depression (p < .009) and life stress (p < or = .000) scores. There were also improvements in well-being (p < .003), affective relationships (p < .000) and sexual relations (p < .0007). There was a decline in behavioural risk factors, namely: smoking behaviour (p < .09), alcohol consumption (p < .002), over-eating (p < .0000) and sedentary life-style (p < .02). Clinical post-operative complications did not negatively influence patients' psychological state and return to work. Preoperative health fears (p < .04) and social anxiety (p < .02) did influence patients' return to work. CONCLUSIONS. In conclusion, psychosocial function, health state and quality of the life generally improved after elective CABG. Return to work was found to be an unreliable measure of the success of surgery. Pre- and post-operative data revealed a general denial trait which identifies patients at greater risk of cardiovascular events after CABG.
    Giornale italiano di cardiologia 03/1995; 25(3):289-300.
  • G Bertolotti, G Balestroni, G Maiani, A M Zotti
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    ABSTRACT: In the present study cognitive-verbal differences are evaluated in chronic obstructive lung disease (COLD) patients. Nineteen subjects with chronic respiratory failure (CRF) and sixty subjects without CRF completed two psychometric instruments: CBA-2.0 primary scales and the respiratory illness opinion survey. The results show that social and psychological problems are connected to the severity of illness.
    The European respiratory journal. Supplement 08/1989; 7:660s-662s.
  • G Balestroni, V Lopriore, A M Zotti, P Rizzon
    Cardiologia (Rome, Italy) 02/1987; 32(1):73-6.
  • Cardiologia (Rome, Italy) 10/1985; 30(9):649-54.
  • G Balestroni, G Omarini, P Omarini, A M Zotti
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    ABSTRACT: EuroQol-5D (EQ-5D) is a well-known generic instrument measuring quality of life in different diseases; it includes 5 dimensions (mobility, self-care, daily activities, pain-discomfort, anxiety and depression) and a Visual Analogue Scale that evaluates patients' perceived health status. The aim of this study was to verify the utility of the EQ-5D in the Italian Cardiac Rehabilitation setting. The study population consisted of 248 consecutive cardiac rehabilitation inpatients (176 males and 72 females, aged 65.3 +/- 10.75 years), 200 of whom had recently undergone cardiac surgery (aortocoronary by-pass and/or valve replacement). Patients filled in the EQ-5D and A-D schedule (on anxiety and depression) on their second day in hospital. Exploratory and Confirmatory Factor Analysis confirmed the robust nature of the EQ-5D and its mono-factorial structure (EFA: Total Variance 50.39% - CFA: chi2 = 3.596; p approximately equal .60; RMSEA = 00; CFI = 1.00; RMR = .007). The instrument showed a good internal consistency (a .73) despite the limited number of items. T test and ANOVA showed the independence of the EQ-5D dimensions and VAS evaluation with respect to patients' education level, but an influence of age and sex. In general, females reported a lower quality of life than males, and older patients a lower quality of life than younger. Furthermore, cardiac-surgery patients reported more problems in self-care and pain-discomfort than ischemic/heart failure patients, and patients in NYHA Classes III and IV reported more difficulties in mobility than patients in lower NYHA classes. In 15% of patients, of heterogeneous socio-demographic and clinical characteristics, no problems in any of the 5 EQ-5D dimensions were reported: this group was characterised by scores under the clinical cut-off on anxiety and depression and showed a better quality of life on the VAS. Results confirm the robustness of the EuroQol-SD psychometric properties and the instrument's utility for the routine assessment of quality of life in the Italian Cardiac Rehabilitation setting.
    Giornale italiano di medicina del lavoro ed ergonomia 29(3 Suppl B):B56-62.