American Association Of Cardiovascular And Pulmonary Rehabilitation Research Articles

PULMONARY REHABILITATION IN ROMANIA: FROM THE BEGINNINGS TO THE PRESENT

Pulmonary rehabilitation is the standard of care for patients with chronic lung disease. Material and method: Starting from the systematic review of specialized literature and practical expertise obtained both internationally and nationally, the exposition emphasizes the aspects related to pulmonary rehabilitation in patients with chronic lung diseases. Results: The cornerstone of pulmonary rehabilitation is the American Thoracic Society (ATS)/European Respiratory Society (ERS) Statement on Pulmonary Rehabilitation published in 2006 and developed based on the documents of the American College of Chest Physicians (ACCP) and American Association of Cardiovascular and Pulmonary Rehabilitation (AACVPR) published in 1997 and 2004. The document was subsequently updated in 2007, 2013, 2015, 2021 and 2023, with the concept of pulmonary rehabilitation constantly evolving over the years. In Romania, pulmonary rehabilitation is carried out according to these guidelines and international standards, Iasi being a reference center in this field. Conclusions: Pulmonary rehabilitation is one of the most powerful evidence-based therapies for patients with chronic lung disease. Keywords: COPD, exercise capacity, training, quality of life.

Building a hybrid virtual cardiac rehabilitation program to promote health equity: Lessons learned

Building a hybrid virtual cardiac rehabilitation program to promote health equity: Lessons learned

From the Editor

I recently reviewed a report performed for the American College of Cardiology (ACC) titled Survey Report: Cardiac Rehab Industry Insights and Best Practices (1). Only a fraction of the cardiac rehabilitation (CR) programs in the United States were assessed (N = 72 of 800+ programs). The survey provided information on a wide array of topics including eligible patient participation, intensive versus traditional CR use (10% and 90%, respectively), the number sessions attended, maintenance program charges, “virtual” CR services (only 13% offering), other offerings (e.g., pulmonary, PAD, oncology), American Association of Cardiovascular and Pulmonary Rehabilitation (AACVPR) program certification (75% certified), program revenues (50% reported positive net revenue), and barriers to growth.Another area of focus was on staffing. Two items related to the reporting of staffing caught my attention. First, and I have mentioned this previously, is the disappointment I had in the listing of “Exercise Physiologist” (EP) and not “Clinical Exercise Physiologist” (CEP). A goal of those individuals who belong to the organizations that allow access to this journal (CEPA, ESSA, and CSEP) should be to promote the specialty of clinical exercise physiology. The American College of Sports Medicine recognizes CEPs and EPs as distinctly separate professionals (2). The CEP is an allied healthcare professional with specific education and practical skills to guide those with existing chronic disease (many who are newly diagnosed and with complex comorbidities) through an exercise and lifestyle modification program. I urge anyone reading this article to recognize the differences between CEPs and EPs, and when the term EP is used when CEP should have been use, please notify the author or organization of this mistake. For example, I recently asked the current president of the AACVPR to change from EP to CEP on their registration to the annual meeting and provided rationale. It was met with acceptance, and he stated they will be making this change.The other area in the staffing section of the ACC CR survey had to do with use of various disciplines for program staffing. It was heartening to read that 95% of programs surveyed employed exercise professionals (stated as EPs in the survey—see above). CR remains the primary location of employment of the CEP, particularly in the United States. Additionally, 89% of the programs reported using a registered nurse. Nursing involvement in CR has been traditional since its inception. However, our program at Henry Ford Hospital has not used nurses for the past 20 years. We have relied solely on appropriately trained and experienced CEPs, with physician support, to implement programming and deal with the variety of medical situations that occur (blood glucose issues, chest pain, hypotensive responses, the need for CPR and/or defibrillation). We have been able to provide safe and effective CR programming in the settings of hospital and standalone clinic while serving an extremely sick and frail population. And this has also included the implementation of several important National Institutes of Health trials (HF-ACTION, CLEVER, iATTEND) (3). Importantly, staffing with only CEPs meets the 2006 Medicare and Medicaid definition for staffing of CR programs (4). I urge you to read the point:counterpoint from the 2015 issue of the Journal of Clinical Exercise Physiology (only 1 issue per year at that time and any article older than 18 months is freely available) in which I debate that the CEP is the best and logical choice for the majority of staffing in CR programs (5). My goal is to continue to promote the primary use of CEPs in all exercise settings catering to those with chronic disease.

Evaluation of the American Association of Cardiovascular and Pulmonary Rehabilitation Exercise Risk Stratification Classification Tool Without Exercise Testing.

The American Association of Cardiovascular and Pulmonary Rehabilitation (AACVPR) recommends that patients starting cardiac rehabilitation (CR) undergo stratification to identify risk for exercise-related adverse events (AE), but this tool has not been recently evaluated. Among patients who enrolled in CR in 2016, we used the AACVPR risk stratification tool to evaluate the risk for AE and clinical events (CE). We defined AE as signs or symptoms that precluded or interrupted exercise during CR, and CE as events requiring an urgent evaluation outside of CR exercise sessions. During the study period, 657 patients with cardiovascular diagnoses were included and classified as high (58%), medium (31%), or low risk (11%). Over the course of CR (76 d, 17 sessions), there were 63 AE and 33 CE. Adverse events were mostly minor (no cardiac arrests or deaths) and managed by CR staff members. When compared with the low- or medium-risk groups, the high-risk group was more likely to have AE (HR 3.0 [95% CI, 1.7-5.9], P = .002) and CE (HR 3.7 [95% CI, 1.5-10.8], P = .002) with fair model discrimination (area under the curve: 0.637, P < .001). The AACVPR risk stratification tool was predictive of both AE and CE with fair discrimination, although event rates were low and mostly minor. Thus, the AACVPR model may require reevaluation to better identify truly at-risk patients for major AE.

An investigation into whether cardiac risk stratification protocols actually predict complications in cardiac rehabilitation programs?

Objectives: This study evaluated the capacity of cardiac risk stratification protocols on simple complications that occur during activities of a cardiovascular rehabilitation program. Design: Observational longitudinal cohort study. Setting: Outpatient clinic of cardiovascular rehabilitation. Subject: Patients diagnosed with cardiovascular disease and/or risk factors. Interventions: Not applicable. Main measures: The relationship between the cardiac risk classes of seven risk stratification protocols and the occurrence of simple complications (such angina, abnormal changes in blood pressure, arrhythmias, fatigue, muscle pain, pallor) was assessed using the chi-square test, and when statistical significance was observed, sensitivity, specificity and accuracy were determined. Results: About 76 patients were analyzed. The American Association of Cardiovascular and Pulmonary Rehabilitation (AACVPR) protocol showed a statistically significant relationship between simple complications and cardiac risk classes (P-value = 0.046), however the results of sensitivity (0.53), specificity (0.52), and accuracy (0.53) were not significant. The other protocols analyzed were not significant: American College of Sports Medicine (P-value = 0.801), Brazilian Society of Cardiology (P-value = 0.734), American Heart Association (P-value = 0.957), Pashkow (P-value = 0.790), Society French Cardiology (P-value = 0.314), and Spanish Society of Cardiology (P-value = 0.078). Conclusion: The AACVPR protocol showed a significant relationship between the risk classes and the occurrence of simple complications, however, the low values obtained for sensitivity, specificity and accuracy show that it is not useful for this purpose. Clinical trials registration: NCT03446742.

Patient factors associated with enrollment, adherence, and change in cardiac risk factors among cardiac rehabilitation patients in Qatar

Background: Cardiovascular disease is the number one killer in Qatar1. Cardiac rehabilitation (CR) is a secondary prevention model of care for cardiac patients. It is well-documented that CR reduces cardiovascular morbidity and mortality by 20%2. However, CR is underutilized worldwide, with low enrolment and adherence rates3. This study aims to investigate factors associated with enrolment and adherence, and to examine the relationship between adherence and change in cardiac risk factors. Methods: There were 714 cardiac patients, aged ≥ 18 years, referred to a CR program in Qatar. Retrospective cohort study using data from (January 2013-September 2018) were analyzed. Logistic regression models were used to assess factors associated with enrolment, adherence, and predictors of adherence. A paired sample t-test was used to identify mean change in cardiac risk factors: body mass index, low-density lipoprotein, high-density lipoprotein and total cholesterol) pre/post-CR. An independent sample t-test was used to identify change between groups (adherents vs. non-adherents). Results: The majority of our patients were males (n = 641, 89.8%) and non-Qatari (n = 596, 83.5%), i.e., similar to the Qatar population profile of 75% males and 15% Qatari, one fourth were smokers (n = 185, 25.91%), and one fifth (n = 128, 18.8%) were diagnosed with severe depression. Significant patient factors positively associated with enrolment (p < 0.05) were nationality, percutaneous coronary intervention (PCI), coronary artery bypass grafting, and coronary artery disease (Table 1). The number of sessions attended by patients is shown in Figure 1. Patients with American Association of Cardiovascular and Pulmonary Rehabilitation (AACVPR) moderate and high-risk levels were more likely to adhere compared to those with low risk. Percutaneous coronary intervention (PCI) and musculoskeletal disease were negatively associated with adherence (Table 1). We found clinically significant health improvements among adherents compared to non-adherents; reduction of 10% in cholesterol, and 15% in LDL (low-density lipoprotein). Conclusion: This study provides new insights into the factors that lead patients to enrol in and adhere to CR in the Qatar setting. These factors represent opportunities for targeted interventions to improve CR utilization.

From the Editor.

Greetings. Our Journal of Cardiopulmonary Rehabilitation and Prevention (JCRP) Editor group and also our JCRP Editorial Board had the opportunity to meet in September while attending the American Association of Cardiovascular and Pulmonary Rehabilitation (AACVPR) Annual Meeting. Our editorial meetings provided the opportunity for our Wolters Kluwer representative, Senior Publisher Andrea Allison-Williams, to provide the 2019 Publisher report; our Managing Editor Kate Maude to provide feedback from the JCRP Editorial Office; discussions with AACVPR Executive Director Megan Cohen and Operations Manager Mollie Corbett; overviewing JCRP operations with the Associate Editors; and providing information and getting feedback from our Editorial Board. The discussions provided valuable information for our Editorial group and included a range of factors that could further improve the Journal. I think we all came away from the meetings with a sense that 2019 has been a good year for JCRP. Personally, I am thankful for the excellent people who are working with JCRP and are dedicated to providing a journal that is focused on improving multidisciplinary clinical practice and expanding research evidence specific to both cardiovascular and pulmonary rehabilitation, as well as prevention. Next year will bring Volume 40 of JCRP and with it will be a number of initiatives to celebrate our 40th anniversary. Each of the first 3 issues will begin with an Invited Commentary that will provide an overview of the past work that has been in JCRP related to Cardiac Rehabilitation (Issue 1), Pulmonary Rehabilitation (Issue 2), and Prevention (Issue 3). These commentaries will provide excellent perspectives on these 3 key areas of focus for JCRP. We are also discussing other ways to celebrate 40 years of JCRP, including some sessions at next year's AACVPR Annual Meeting that will take place September 30-October 3, 2020 in West Palm Beach, Florida. One of the highlights you will find in the 6th issue of JCRP Volume 39 are 5 articles that are related to depression and cardiovascular disease.1–5 Depression is recognized as a risk factor for cardiovascular disease and has been reported to have a prevalence between 15-30% in patients with coronary heart disease. According to the World Health Organization, more than 300 million people are affected by depression. Interestingly, these JCRP articles originate from author groups in 4 different countries, which demonstrates the global nature of this condition. This last JCRP issue of 2019 provides a number of excellent Original Investigations and Brief Reports related to both Cardiac Rehabilitation and Pulmonary Rehabilitation. Again, I ask for your assistance in sharing the information from this issue with your colleagues and collaborators, particularly via your social media outlets. I know the authors of these reviews and studies would be most grateful for your assistance in helping disseminate their research. Also, patients may benefit from the findings of these studies which are advancing the evidence-base of both cardiac and pulmonary rehabilitation programs. I hope you find the information provided in this issue to be useful in your work with patients in your rehabilitative programs, your research, or both. Lenny Kaminsky, PhD, FAACVPR, FACSM, FAHA Editor-in-Chief Journal of Cardiopulmonary Rehabilitation and Prevention

2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA Guideline on the Management of Blood Cholesterol: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines.

2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA Guideline on the Management of Blood Cholesterol: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines.

Disparities in Geographic Access to Hospital Outpatient Pulmonary Rehabilitation Programs in the United States

For individuals with COPD, pulmonary rehabilitation (PR) improves outcomes in terms of exercise capacity, severity of dyspnea, and health-related quality of life. However, many US patients with COPD do not use PR services. There has been limited research on geographic access to needed health-care services for individuals who live in rural communities in the United States. This study: (1) examines the geographic distribution of hospital-based outpatient PR programs in the US; and (2) compares the organizational characteristics of hospitals that offer PR programs and those that do not. A multistep process supported the determination of whether a hospital provided PR services and included: program directory data from the American Association of Cardiovascular and Pulmonary Rehabilitation (AACVPR) website and websites for AACVPR state affiliates and other COPD-relevant organizations; searches of hospital websites; e-mails with state contacts and other state organizations; and phone calls with hospital staff and state contacts. The study population included all Medicare-certified short-term acute care general medical and surgical hospitals. Data were collected and analyzed from January to November 2018. Medicare Provider of Service and American Hospital association data were used to compare the characteristics of hospitals with and without PR programs, using descriptive and bivariate statistics. 1,776 US counties do not have a hospital outpatient PR program located in a short-term acute care general medical or surgical hospital in the county, including 697 counties that do not have a hospital. The availability of a hospital outpatient PR program varies significantly by county type, hospital type and Census region. Hospitals located in a noncore county, designated as a Critical Access Hospital, or located in the South and the West were less likely to have an outpatient PR program. Significant geographic disparities exist in access to hospital outpatient PR. Potential strategies for addressing these disparities include: increasing clinician and patient awareness of the potential benefits of PR; offering staff training and incentives to supervise and provide PR services; improving Medicare reimbursement rates for PR services; replicating PR programs that have success serving rural areas; expanding cardiac rehabilitation programs to include PR; and assessing the use of telehealth technologies to provide PR in isolated areas.

2018 ACC/AHA Clinical Performance and Quality Measures for Cardiac Rehabilitation: A Report of the American College of Cardiology/American Heart Association Task Force on Performance Measures.

The American College of Cardiology (ACC)/American Heart Association (AHA) performance measurement sets serve as vehicles to accelerate translation of scientific evidence into clinical practice. Measure sets developed by the ACC/AHA are intended to provide practitioners and institutions that deliver cardiovascular services with tools to measure the quality of care provided and identify opportunities for improvement. Writing committees are instructed to consider the methodology of performance measure development1 and to ensure that the measures developed are aligned with ACC/AHA clinical guidelines. The writing committees also are charged with constructing measures that maximally capture important aspects of care quality, including …

From the Editor.

In the previous issue of JCRP, I announced that Leonard Kaminsky, PhD was appointed to the new JCRP Associate Editor-in-Chief position. He had formerly been an associate editor with the journal. I am now pleased to announce that Patrick Savage, MS is our newest associate editor and will be assuming the position formerly held by Dr. Kaminsky. Patrick is Associate Director and Senior Exercise Physiologist in the Cardiac Rehabilitation Program, Division of Cardiology at the University of Vermont Medical Center in South Burlington, Vermont, where he has been an integral contributor to the program for the past 23 years. He is an American Association of Cardiovascular and Pulmonary Rehabilitation (AACVPR) Fellow and has been active on various AACVPR national committees including chair of the Research Committee and the Cardiac Rehabilitation Program Certification Expert Panel. Patrick has a rich research history and an impressive list of nearly 60 publications in peer-reviewed journals. Additionally, he has been an author of 8 book chapters and is also a member of the JCRP Editorial Board. All of us associated with JCRP extend a warm welcome to Patrick. Larry F. Hamm, PhD, MAACVPR, FACSM Editor-in-Chief Journal of Cardiopulmonary Rehabilitation and Prevention

Assessing Physical Activity as a Core Component in Cardiac Rehabilitation

Physical inactivity is a well-established major risk factor for cardiovascular disease. As such, physical activity counseling is 1 of the 10 core components of cardiac rehabilitation/secondary prevention programs recommended by the American Heart Association and the American Association of Cardiovascular and Pulmonary Rehabilitation (AACVPR). In addition, the ability to perform a physical activity assessment and report outcomes is 1 of the 10 core competencies of cardiac rehabilitation/secondary prevention professionals published by the AACVPR. Unfortunately, standardized procedures for physical activity assessment of cardiac rehabilitation patients have not been developed and published. Thus, the objective of this AACVPR statement is to provide an overview of physical activity assessment concepts and procedures and to provide a recommended approach for performing a standardized assessment of physical activity in all comprehensive cardiac rehabilitation programs following the core components recommendations.

The current and potential capacity for cardiac rehabilitation utilization in the United States.

Prior studies suggest that program capacity restraints may be an important reason for outpatient cardiac rehabilitation (CR) underutilization. We sought to measure current CR capacity and growth potential. We surveyed all CR program directors listed in the American Association of Cardiovascular and Pulmonary Rehabilitation (AACVPR) database in November 2012. Respondents reported current enrollment levels, program capacity, expansion potential, and obstacles to growth. Of the 812 program directors in the AACVPR database, 290 (36%) completed the full survey. Respondents represented somewhat larger programs than nonrespondents but were otherwise representative of all registered AACVPR programs. Current enrollment, estimated capacity, and estimated expansion capacity were reported at a median (interquartile range) of 140 (75, 232), 192 (100, 300), and 240 (141, 380) patients annually, respectively. Using these data, we estimated that, in the year 2012, national CR utilization was 28% (min, max: 20, 38) of eligible patients. Even with modest expansion of all existing programs operating at capacity, a maximum of 47% (min, max: 32, 67) of qualifying patients in the United States could be serviced by existing CR programs. Obstacles to increasing patient participation were primarily controllable system-related problems such as facility restraints and staffing needs. Even with substantial expansion of all existing CR programs, there is currently insufficient capacity to meet national service needs. This limit probably contributes to CR underutilization and has important policy implications. Solutions to this problem will likely include the creation of new CR programs, improved CR reimbursement strategies, and new models of CR delivery.

Clinical competency guidelines for pulmonary rehabilitation professionals: position statement of the American Association of Cardiovascular and Pulmonary Rehabilitation.

The American Association of Cardiovascular and Pulmonary Rehabilitation (AACVPR) recognizes that interdisciplinary health care professionals providing pulmonary rehabilitation services need to have certain core competencies. This statement updates the previous clinical competency guidelines for pulmonary rehabilitation professionals, and it complements the AACVPR's Guidelines for Pulmonary Rehabilitation Programs. These competencies provide a common core of 13 professional and clinical competencies inclusive of multiple academic and clinical disciplines. The core competencies include patient assessment and management; dyspnea assessment and management; oxygen assessment, management, and titration; collaborative self-management; adherence; medication and therapeutics; non-chronic obstructive pulmonary diseases; exercise testing; exercise training; psychosocial management; tobacco cessation; emergency responses for patient and program personnel; and universal standard precautions.

Abstract 144: Residual Cardiovascular Risk After Cardiac Rehabilitation

Background: CAD is the leading cause of death and disability in US. Cardiac rehabilitation (CR) program is an important secondary-prevention intervention to reduce mortality, cardiovascular (CV) events, &amp; disability. At start of CR program, patients undergo extensive risk assessment to guide risk reduction goals. However, the residual risk at CR completion is not well studied. We sought to investigate the residual modifiable risk factors of patients completing CR Methods: We retrospectively reviewed our center’s data on consecutive patients between October 2012 and November 2013 who were entered into the American Association of Cardiovascular and Pulmonary Rehabilitation (AACVPR) registry and identified those who completed the CR program. We calculated their residual risk using the newly released ACC/AHA’s ‘Pooled Cohort Equations CV Risk Calculator’ (ACC/AHA risk) and Framingham risk (FR) calculator Results: Out of 128 consecutive CR participants, 44 (34%) completed the program. Patient characteristics and risk assessment are summarized in table 1. As per AACVPR risk stratification algorithm, 37 (84%) of patients were intermediate to high risk. Compared to the start, at completion of CR program, there was a significant improvement in 6-minute walk distance (365±107 vs 484± 137, p&lt;0.001), favorable reduction in total cholesterol, LDL-C, non-HDL-C (p&lt;0.001) and metabolic syndrome (p=0.02). At time of completion, calculated 10 year CV risk using ACC/AHA risk calculator was still elevated (14±10%), while 64% of patients had elevated risk≥7.5% (mean 19.3±9%). FR estimation was low (9±4%). The two risk scores showed moderate correlation (Pearson’s r=0.6, p&lt;0.001), but the ACC/AHA risk was significantly higher than the FR estimation (p&lt;0.001). In multivariate linear regression model, waist circumference (WC) at discharge was significant modifiable independent predictor of ASCVD risk, while systolic BP showed a trend towards significance Conclusion: Successful completion of CR program is associated with improvement in CV risk profile. However, the residual CV risk remains elevated at time of CR completion and is driven by WC &amp; systolic BP. Elevated WC from central adiposity is the main residual atherogenic CV risk factor post CR completion. Further research on significant WC reduction during CR is needed

Programming Considerations for Including Patients With Heart Failure Into Phase 2 Cardiac Rehabilitation

Programming Considerations for Including Patients With Heart Failure Into Phase 2 Cardiac Rehabilitation

Learn from the past and create the future: the 2013 ATS/ERS statement on pulmonary rehabilitation

Pulmonary rehabilitation is an established intervention for the management of chronic obstructive pulmonary disease (COPD); indeed, the delivery of rehabilitation has become routine care for individuals with moderate to severe disease [1]. To guide the delivery of pulmonary rehabilitation, practitioners have looked to the European Respiratory Society (ERS) and the American Thoracic Society (ATS) to offer support in terms of describing the evidence for the intervention and to guide best practice [2]. The new ATS/ERS statement on pulmonary rehabilitation aims to harness international scientific expertise and clinical experience to achieve this challenge [3]. Why a new statement? The 2006 statement provided an excellent reference point for pulmonary rehabilitation [2], but over the past few years there have been several significant developments in the field to warrant a reconsideration of the current position. There is also an obligation to the endorsing societies to ensure that these documents are current and reflect best practice. In June 2010, the process of developing a new statement began. There have been significant developments in our understanding of COPD and the systemic manifestations of the disease, the importance of the intervention in other chronic respiratory disease and the timing of the intervention. The document is complemented by the evidence-based guidelines from the American College of Chest Physicians and American Association of Cardiovascular and Pulmonary Rehabilitation (AACVPR) [4], which formally graded the quality of the scientific evidence, and the AACVPR guidelines for pulmonary rehabilitation programs, which give practical recommendations [5]. By the very nature of a statement, recommendations cannot be made in the 2013 ATS/ERS statement on pulmonary rehabilitation, as these are the preserve of guidelines. The current ATS/ERS task force was represented by a broad range of professions that are reflected in the interdisciplinary …

Patient and Program Characteristics of Early Outpatient Cardiac Rehabilitation Programs in the United States

The purpose of this study was to perform a brief survey to determine the patient and program characteristics associated with early outpatient cardiac rehabilitation (EOCR) in the United States. To assess these characteristics, a brief survey (13 items, some with multiple responses) was sent by the American Association of Cardiovascular and Pulmonary Rehabilitation (AACVPR) to all program administrators or directors on the AACVPR mailing list in 2009. Responses were received from 138 program administrators or directors in 44 states, accounting for 19 689 patients who completed at least 1 EOCR exercise session. More men (68%) were enrolled in EOCR programs, and the 3 most prevalent primary diagnoses were percutaneous coronary intervention or stent (31%), coronary artery bypass graft surgery (30%), and myocardial infarction (22%). Seventy-two percent of responding programs were AACVPR certified and had staff trained primarily (66%) in either nursing or exercise physiology. Eighty-four percent of the programs offered an outpatient maintenance cardiac rehabilitation program, and 62% were located in a rural setting. This study provides valuable information on use and patient demographics of EOCR programs in the United States. This information may be beneficial for health care professionals, health care institutions, third-party payers, and regulatory agencies that seek to quantify health care quality.

Abstract 180: What is the Potential Capacity for Increasing Cardiac Rehabilitation Utilization in the United States?

Introduction: Cardiac rehabilitation (CR) is an effective but highly underutilized therapy for heart disease. Efforts are underway to increase CR referral and enrollment, but little is known about the potential capacity for growth in CR utilization in the United States. To address this concern, we estimated the current national capacity of CR programs across the United States and assessed obstacles to potential growth. Methods: We surveyed all CR Program Directors listed in the American Association of Cardiovascular and Pulmonary Rehabilitation (AACVPR) database in November of 2012. Respondents reported current enrollment levels, current program capacity, program capacity given reasonable expansion, and obstacles to growth. Results: Of 812 Program Directors in the AACVPR database, 290 (36%) completed the full survey. Respondents represented somewhat larger programs compared to non-respondents (4.0 vs. 4.6 full time employees, p = 0.01), but were otherwise similar. Current enrollment levels demonstrated a median [IQ range] of 140 [75,232] patients per year and a current estimated capacity of 192 [100,300] patient per year. Respondents estimated that programs could expand services by 25% to 240 [141,380] patients annually, assuming a significant increase in patient demand and a feasible increase in resources. We estimate that if programs filled to their current capacity, national CR utilization rates would increase from 34.7% to 46.4% (95% CI, 43.9 to 48.9) of eligible US patients each year. Given feasible program expansion, utilization could increase to a maximum of 58.4% (95% CI, 55.2 to 61.6) of qualifying patients. Capacity projections based upon absolute patient numbers and national statistics revealed concordant results. The most commonly cited obstacles to increasing patient participation are shown in the figure. As seen, the majority (88%) are controllable system-related factors unrelated to patient behavior. Conclusions: Even with substantial expansion of all existing CR programs, there is currently insufficient capacity in current CR programs to meet national service needs. Solutions to this problem will likely include the creation of new CR programs, and new policies that improve reimbursement for CR and also embrace new models of CR delivery.

O efeito de um programa de exercício físico na qualidade de vida em doentes cardíacos

The public health policies and the cardiac rehabilitation program, together with physical exercise, are essential in the care provided to heart patients, allowing the restoration of the patient to society or regaining of the status as a person in the community and increasing their quality of live. ObjectiveTo apply the supervised exercise (SE group) in the early outpatient phase, to analyze and compare the results of this application with the data obtained by the patients receiving conventional treatment (usual care group). MethodThe study lasted more than three months, dividing the cardiac patients into two groups (supervised exercise (SE) vs. conventional treatment (usual care)), which were presented, through informed consent, with the purpose and procedures of the study. After division, patients subjected to physical exercise (SE group) underwent a structured intervention plan in three phases (initial, improvement and maintenance combining the frequency, intensity, time and type of exercise, according to the stratification due risk and recommendations of the American Association of Cardiovascular and Pulmonary Rehabilitation (AACVPR). Patients underwent two evaluations at the Hospital of Vila Franca de Xira, using the questionnaire MacNew to assess the quality of life related to the heart disease condition. The mean and standard deviation were evaluated for all the variables under study using the non-parametric and parametric tests for a significance level of alfa=0,05. ResultsThere were significant differences observed between the groups, in terms of and overall quality of life (p<0,01), as well as in the percentage changes obtained by the SE group (+53.86%). ConclusionThe supervised exercise held in the community after hospital discharge, implied in early clinical phase, with at least a moderate intensity, enhances the quality of life in cardiac patients.