Cardiac Rehabilitation Attendance Research Articles

Mortality Benefits of Cardiac Rehabilitation in Coronary Artery Disease Are Mediated by Comprehensive Risk Factor Modification: ARetrospective Cohort Study.

Cardiac rehabilitation (CR) is a multicomponent intervention to reduce adverse outcomes from coronary artery disease, but its mechanisms are not fully understood. The aims of this study were to examine the impact of CR on survival and cardiovascular risk factors, and to determine potential mediators between CR attendance and reduced mortality. A retrospective mediation analysis was conducted among 11 196 patients referred to a 12-week CR program following an acute coronary syndrome event between 2009 and 2019. A panel of cardiovascular risk factors was assessed at a CR intake visit and repeated on CR completion. All-cause and cardiovascular mortality were ascertained via health care administrative data sets at mean 4.2-year follow-up (SD, 2.81 years). CR completion was associated with reduced all-cause (adjusted hazard ratio [HR], 0.67 [95% CI, 0.54-0.83]) and cardiovascular (adjusted HR, 0.57 [95% CI, 0.40-0.81]) mortality, as well as improved cardiorespiratory fitness, lipid profile, body composition, psychological distress, and smoking rates (P<0.001). CR attendance had an indirect effect on all-cause mortality via improved cardiorespiratory fitness (ab=-0.006 [95% CI, -0.008 to -0.003]) and via low-density lipoprotein cholesterol (ab=-0.002 [95% CI, -0.003 to -0.0003]) and had an indirect effect on cardiovascular mortality via cardiorespiratory fitness (ab=-0.007 [95% CI, -0.012 to -0.003]). Cardiorespiratory fitness and lipid control partly explain the mortality benefits of CR and represent important secondary prevention targets.

Clinical Effectiveness and Utilisation of Cardiac Rehabilitation After Hospital Discharge: Data Linkage Analysis of 84,064 Eligible Discharged Patients (2016–2021)

Despite the highest levels of evidence on cardiac rehabilitation (CR) effectiveness, its translation into practice is compromised by low participation. This study aimed to investigate CR utilisation and effectiveness in South Australia. This retrospective cohort study used data linkage of clinical and administrative databases from 2016 to 2021 to assess the association between CR utilisation (no CR received, commenced without completing, or completed) and the composite primary outcome (mortality/cardiovascular re-admissions within 12 months after discharge). Cox survival models were adjusted for sociodemographic and clinical data and applied to a population balanced by inverse probability weighting. Associations with non-completion were assessed by logistic regression. Among 84,064 eligible participants, 74,189 did not receive CR, with 26,833 of the 84,064 (31.9%) participants referred. Of these, 9,875 (36.8%) commenced CR, and 7,681 of the 9,875 (77.8%) completed CR. Median waiting time from discharge to commencement was 40 days (interquartile range, 23-79 days). Female sex (odds ratio [OR] 1.12; 95% CI 1.01-1.24; p=0.024), depression (OR 1.17; 95% CI 1.05-1.30; p=0.002), and waiting time >28 days (OR 1.15; 95% CI 1.05-1.26; p=0.005) were associated with higher odds of non-completion, whereas enrolment in a telehealth program (OR 0.35; 95% CI 0.31-0.40; p<0.001) was associated with lower odds of non-completion. Completing CR (hazard ratio [HR] 0.62; 95% CI 0.58-0.66; p<0.001) was associated with a lower risk of 12-month mortality/cardiovascular re-admissions. Commencing without completing was also associated with decreased risk (HR 0.81; 95% CI 0.73-0.90; p<0.001), but the effect was lower than for those completing CR (p<0.001). Cardiac rehabilitation (CR) attendance is associated with lower all-cause mortality/cardiovascular re-admissions, with CR completion leading to additional benefits. Quality improvement initiatives should include promoting referral, women's participation, access to telehealth, and reduction of waiting times to increase completion.

Anxiety Predicts Worse Cardiorespiratory Fitness Outcomes in Cardiac Rehabilitation for Lower Socioeconomic Status Patients.

The purpose of this study was to show that patients in cardiac rehabilitation (CR) with lower socioeconomic status (SES) have worse clinical profiles and higher rates of psychiatric difficulties and they have lower cardiorespiratory fitness (CRF) improvements from CR than their counterparts with higher SES. Improvement in CRF during CR predicts better long-term health outcomes. Research suggests that higher anxiety impairs CRF in structured exercise regimes and is overrepresented among patients with lower SES. However, no study has determined whether this relationship holds true in CR. This study is a secondary analysis of a randomized controlled trial to improve CR attendance among patients with lower SES. Anxiety (ASEBA ASR; Achenbach System of Empirically Based Assessment, Adult Self Report) and CRF measures (metabolic equivalent tasks [METs peak ]) were collected prior to CR enrollment and 4 mo later. Regression was used to examine the association of anxiety with CRF at 4 mo while controlling for other demographic and clinical characteristics. Eight-eight participants were included in the analyses, 31% of whom had clinically significant levels of anxiety ( T ≥ 63). Higher anxiety significantly predicted lower exit CRF when controlling for baseline CRF, age, sex, qualifying diagnosis, and number of CR sessions attended ( β =-.05, P = .04). Patients with clinically significant levels of anxiety could be expected to lose >0.65 METs peak in improvement. The results from this study suggest that anxiety, which is overrepresented in populations with lower SES, is associated with less CRF improvement across the duration of CR. The effect size was clinically meaningful and calls for future research on addressing psychological factor in CR.

Temporal trends in admission for cardiac rehabilitation after an acute coronary syndrome in France from 2009 to 2021: Persistent sex, age and social disparities

BackgroundCardiac rehabilitation after an acute coronary syndrome is recommended to decrease patient morbidity and mortality and to improve quality of life. AimsTo describe time trends in the rates of patients undergoing cardiac rehabilitation after an acute coronary syndrome in France from 2009 to 2021, and to identify possible disparities. MethodsAll patients hospitalized for acute coronary syndrome in France between January 2009 and June 2021 were identified from the national health insurance database. Cardiac rehabilitation attendance was identified within 6 months of acute coronary syndrome hospital discharge. Age-standardized cardiac rehabilitation rates were computed and stratified for sex and acute coronary syndrome subtypes (ST-segment elevation and non-ST-segment elevation). Patient characteristics and outcomes were described and compared. Factors independently associated with cardiac rehabilitation attendance were identified. ResultsIn 2019, among 134,846 patients with an acute coronary syndrome, 22.3% underwent cardiac rehabilitation within 6 months of acute coronary syndrome hospital discharge. The mean age of patients receiving cardiac rehabilitation was 62 years. The median delay between acute coronary syndrome hospitalization and cardiac rehabilitation was 32 days, with about 60% receiving outpatient cardiac rehabilitation. Factors significantly associated with higher cardiac rehabilitation rates were male sex, younger age (35–64 years), least socially disadvantaged group, ST-segment elevation, percutaneous coronary intervention and coronary artery bypass graft. Between 2009 and 2019, cardiac rehabilitation rates increased by 40% from 15.9% to 22.3%. Despite greater upward trends in women, their cardiac rehabilitation rate was significantly lower than that for men (14.8% vs. 25.8%). In 2020, cardiac rehabilitation attendance dropped because of the coronavirus disease 2019 pandemic. ConclusionsDespite the health benefits of cardiac rehabilitation, current cardiac rehabilitation attendance after acute coronary syndrome remains insufficient in France, particularly among the elderly, women and socially disadvantaged people.

Lower cardiac rehabilitation enrolment occurs in acute coronary syndrome patients who report low levels of physical activity at four weeks post-event: A prospective observational study using physical activity tracker data

BackgroundPhysical activity (PA) and cardiac rehabilitation (CR) attendance are important for recovery and prognosis following acute coronary syndrome (ACS). However, PA patterns early post-ACS are not well known. ObjectivesInvestigate the level of PA at 4-weeks post-ACS and any potential associations with CR enrolment. MethodsWe recruited patients admitted for ACS from cardiac wards and clinics at two hospital sites in Sydney, Australia. PA data were collected using wearable activity trackers worn at 4-weeks post-ACS, and CR enrolment was self-reported. ResultsParticipants (n = 61) were aged 66.7 ± 10.3 years, 74 % male, 61 % were married or partnered, and 33 % were diagnosed with ST-elevation myocardial infarction. Patients engaged in 7514±3355 steps per day and 44.6 ± 37.5 min of moderate-to-vigorous physical activity (MVPA). Patients who enrolled in CR exhibited higher daily step counts (p = 0.044), MVPA minutes (p = 0.001), and were more likely to meet PA guidelines. ACS patients who engaged in higher levels of MVPA were more likely to enrol in CR (odds ratio [OR] 1.46; 95 % confidence interval [CI] 1.08, 1.98). CR enrolment was also positively associated with being married or in an intimate partnership (OR 9.93; 95 % CI 1.83, 53.85) and absence of depressive symptoms (OR 11.86; 95 % CI 1.91, 73.74). ConclusionLower CR enrolment rates were observed among less physically active patients at 4-weeks post-ACS. However, each 10 min increment in MVPA increased the odds of CR enrolment by 46 %. Future research should explore strategies to target this inactive and high-risk group, given the potential for a large prognostic gain with CR participation.

Cardiac rehabilitation reduces risk of overall mortality within 12 months after a heart failure hospitalization: data linkage analysis of 9,023 patients in Australia

Abstract Background Meta-analyses of randomized trials show that cardiac rehabilitation (CR) prevents cardiovascular (CV) and heart failure (HF)-specific hospitalizations. However, globally only 30-50% of eligible patients participate in CR which might affect CR effectiveness. Purpose To investigate CR utilization and clinical outcomes after an admission for HF. Methods This is a retrospective cohort study of patients &amp;gt;=18 years old discharged from public hospitals in South Australia with a diagnosis of HF from 2016-2021. We linked the statewide clinical CR database to hospital administrative and death databases to assess CR utilization (non-attendance vs attendance without completion vs completion of &amp;gt;= 70% of the sessions), the composite primary outcome (CV re-admission or CV death within 12 months after the index hospitalization) and the secondary outcome (all-cause death within 12 months after the index hospitalization). To investigate factors associated with not attending CR, we adjusted a logistic model by age, sex, Index of Relative Socioeconomic Advantage and Disadvantage (IRSAD), remoteness; admission during the COVID pandemic, acute myocardial infarction (MI), procedures, arrhythmias, Charlson comorbidities index, history of diabetes, hypertension, obesity, prior stroke, and peripheral vascular disease. To investigate the association of the primary and secondary outcomes with CR utilization, we adjusted Cox survival models by age; sex; IRSAD; remoteness; ACS; revascularization, valve and implantable devices procedures; AF; other arrhythmias; Charlson comorbidities index; history of diabetes, hypertension, obesity, prior stroke and peripheral vascular disease; remoteness. Results Of the 9023 eligible separations (52.0% male with mean age 77, SD 13.8 years), 8572 (95%) did not attend CR. Among the 451 patients commencing CR, 352 (78.0%) completed it. CABG (118; 1.3%), PCI (252; 2.8%), diabetes (3031; 33.6%), hypertension (1332; 14.8%) and MI (607; 6.7%) were common diagnoses. Women (OR1.62; 95%CI 1.31-2.02); and older age (OR1.03; 95%CI 1.02-1.04) were associated with a higher risk of not attending CR. Within 12 months of the index hospitalization, there were 4056 (45.0%) CV readmissions/CV deaths and 3486 (38.6%) deaths. After adjustment for demographic, clinical and social factors, CR attendance without completion (p=0.60) or completion (p=0.43) was not associated with CV readmission/CV death. The risk of all-cause death was lower in the groups attending without completing (HR 0.57; 95%CI 0.36-0.91; p=0.02) and completing CR (HR 0.52; 95%CI 0.39-0.71; p=0.02) compared to those not attending CR (Figure 1). Conclusion CR attendance and completion reduces the risk of death within 12 months after a HF hospitalization. Strategies focusing on increasing CR participation should target women and older people who are less likely to attend. A limitation of this study is that we could not control for the utilization of HF-specialist clinics.Survival within 12 months

Abstract 16487: Implementation of a Web-Based Cardiac Rehabilitation Program in Rural Australia Improves Access

Introduction: Involvement in cardiac rehabilitation (CR) programs reduces death, reoccurring cardiac events, also improving quality of life. Globally, CR attendance and completion is poor, with referral and non-attendance rates ranging from 20-50%. Hypothesis: To evaluate the effectiveness of an interactive web-based CR program as an alternative mode of delivery, to improve access and attendance. Methods: The RE-AIM implementation framework. Patients eligible for CR, residing in a rural and remote areas between July 2021-June 2022 Results: A total of 828 rural patients participated, 50 choosing the web-based mode of delivery. Web patients were younger, (60, SD 11.9 vs 68.5 years, SD 11.9; p&lt;0.001). Sex distribution did not differ between web and non-web, 17 (34%) males in web and 195 (23.5%) non-web (p=0.167). Myocardial infarction was the predominant reason for referral in both groups (64.3% vs 35.6%, p=0.049). Mean BMI was higher in the web compared to non-web (33.6, SD 8.0 vs 29.8, SD 6.0; p=0.025). Program completion was higher for non-web than for the web-based patients (17; 34% vs 553;71.4% p=&lt;0.001). Web-based patients reported overall program satisfaction (77.8%). Clinicians reported the web-based program as high quality (71.4%). There was an increase in web-based enrolments with concurrent reduction in usual care resulting from COVID pandemic restrictions. Patient fidelity to entry of self-reported data was high in the web-based with all patients completing a pre-assessment and 50% a post-assessment. Change in risk factor control did not differ between the groups. There was no significant difference in patients’ preference by age or gender for web-based or other modes of CR. Web-based program enrolment was associated with a lower chance of CR completion (OR 0.19; 95% CI: 0.100, 0.372; p&lt;0.001) after adjustment for age and gender. Conclusions: The web-based program provides an alternative flexible mode to complete CR, having met the demands of COVID pandemic restrictions. It has been integrated and successfully used by patients and clinicians, capturing a cohort who fit into the 20-50% not attending a CR program. Strategies for improving completion of web-based programs need further investigation.

Rehabilitation Support via Postcard (RSVP): A Randomised Controlled Trial of a Postcard to Promote Uptake of Cardiac Rehabilitation.

The aim was to increase cardiac rehabilitation (CR) uptake using a novel intervention, Rehabilitation Support Via Postcard (RSVP), among patients with acute myocardial infarction discharged from two major hospitals in Hunter New England Local Health District (HNELHD), New South Wales, Australia. The RSVP trial was evaluated using a two-armed randomised controlled trial design. Participants (N=430) were recruited from the two main hospitals in HNELHD, and enrolled and randomised to either the intervention (n=216) or control (n=214) group over a six-month period. All participants received usual care; however, the intervention group received postcards promoting CR attendance between January and July 2020. The postcard was ostensibly written as an invitation from the patient's admitting medical officer to promote timely and early uptake of CR. The primary outcome was CR attendance at outpatient HNELHD CR services in the 30-days post-discharge. Fifty-four percent (54%) of participants who received RSVP attended CR, compared to 46% in the control group; however this difference was not statistically significant (odds ratio [OR]=1.4, 95% confidence interval [CI]=0.9-2.0, p=0.11). Exploratory post-hoc analysis among four sub-groups (i.e., Indigeneity, gender, age and rurality), found that the intervention significantly increased attendance in males (OR=1.6, 95%CI=1.0-2.6, p=0.03) but had no significant impact on attendance for other sub-groups. While not statistically significant, postcards increased overall CR attendance by 8%. This strategy may be useful to increase attendance, particularly in men. Alternative strategies are necessary to increase CR uptake among women, Indigenous people, older people and people from regional and remote locations.

Experiences of older vulnerable people with ischemic heart disease and their peer mentors: a qualitative process evaluation

Abstract Funding Acknowledgements Type of funding sources: Foundation. Main funding source(s): VELUX FONDEN Background Peer-mentoring is a low-cost intervention with the potential of improving self-efficacy and cardiac rehabilitation attendance among older vulnerable patients with cardiovascular disease. The present study is part of an ongoing research program, developing and testing the feasibility of a 24-week peer-mentor intervention. Objectives The objective was to understand the content and context of the realized peer-mentor intervention, and to explore how mentors and mentees experienced the intervention. Methods The study was designed as a qualitative process evaluation. Semi-structured individual interviews were conducted in a purposeful sample of mentees (n=13), and peer-mentors (n=12), and thematic analysis was used to analyse, categorize, and interpret interview data. Results Five themes captured the content and context of the peer-mentor intervention as experienced by peer-mentors and mentees. ‘Takes one to know one’, stressing the importance of the mentor-mentee matching process; ‘Varying demand for mentors’, illustrating the difficulties in predicting who has the greatest need for mentoring; ‘Varying degree of familiarity’, describing the mentor-mentee relationship as a continuum from formal mentor to informal friend; ‘Putting the patient first’, illustrating how mentors support mentees based on their personal experiences of successful recovery while letting the mentee set the pace and goals; and ‘Varying view of success’, showing how intervention success is perceived differently by mentors and mentees. Conclusions The study provides new knowledge on how and under what circumstances a mentor intervention works. These findings are important to the implementation of future peer-mentor interventions to achieve successful peer-mentor support and improve cardiac rehabilitation attendance among older vulnerable patients with ischemic heart disease.

Te Kaahui Ora Māori Health Team Offering Whanau Ora and Secondary Prevention in Te Whatu Ora – Counties Manukau

Cardiac rehabilitation (CR) is an important evidence-based secondary prevention intervention following acute coronary syndrome (ACS). In this catchment, Māori uptake of CR is persistently low. A partnership with the Māori health team was introduced during the COVID pandemic to deliver a Te Kaahui Ora model of care. Using the ACS and CR database, 100 consecutive Māori patients—50 preintervention and 50 postintervention—were retrospectively audited. All patients were discharged alive after ACS with similar characteristics: 78% vs 72%, revascularised, 93% vs 94% discharged on standard ACS medications. Risk factors: smoking 53% vs 56%, mean SBP 145.4 vs 146.3, LDL >2, 86.3% vs 74%, BMI >30 67% vs 63%, and diabetes 34% vs 34%. The majority were male 64% vs 68% and mean age was 54 vs 58.6 years. Cardiac rehabilitation attendance declined 44% vs 28%; however, 96% in the intervention cohort received 20% home visits and 100% telephone support with often multiple contacts. The introduction of a wide-ranging intervention in Māori post-ACS patients resulted in a decrease in traditional CR attendance but also a significant increase in phase 1 and 2 contacts, and addressed a wide range of issues unlikely to be addressed in standard CR interventions.

Development of an integrated cardiac rehabilitation program to improve the adaptation level of patients after acute myocardial infarction.

Individual's adaptation following acute myocardial infarction (AMI) and low attendance of whole-course cardiac rehabilitation (CR) are significant issues. For optimal health post AMI, an integrated CR program aiming at individual's adaptive behaviors is imperative for improving the CR efficiency and patients' outcomes. This study aims to develop theory-guided interventions to increase CR attendance and adaptation level of patients post-AMI. This study was conducted in a tertiary hospital from July 2021 to September 2022 in Shanghai China. Guided by the theory of adaptation to chronic illness (ACI theory), the study followed the Intervention mapping (IM) framework to develop the interventions for CR program. Four phases included: (1) needs assessment of patients and facilitators using a cross-sectional study and semi-structured, in-depth interviews, (2) identification of implementation outcomes and performance objectives, (3) selection of theoretical methods to explain the mechanism of patients' adaptive behaviors and to use for behavior change, and (4) development of implementation protocol from the results of the previous phases. A total of 226 AMI patient-caregivers paired samples were eligible for the data analysis, 30 AMI patients participated in the qualitative inquiry, 16 experts in the CR field evaluated the implementation protocol, and 8 AMI patients commented on the practical interventions. Following the IM framework, an integrated cardiac rehabilitation program using mHealth strategies was developed for AMI patients to facilitate CR attendance and completion, to improve their adaptation level and health outcomes. Using the IM framework and ACI theory, an integrated CR program was developed to help guide the behavior change and improve adaptation among AMI patients. The preliminary findings suggest that further intervention in enhancing the combination of three-stage CR is required. A feasibility study will be conducted to assess the acceptability and effectiveness of this generated CR intervention.

Self-Reported Executive Function in Hospitalized Cardiac Patients and Associations With Patient Characteristics and Cardiac Rehabilitation Attendance.

Executive function (ExF), the ability to do complex cognitive tasks like planning and refraining from impulsive behavior, is associated with compliance with medical recommendations. The present study identified associations between self-reported ExF and demographics of patients with cardiac disease as well as with cardiac rehabilitation (CR) attendance. Self-reported ExF impairment was measured using the Behavior Rating Inventory of Executive Function (BRIEF) on 316 individuals hospitalized for CR-qualifying cardiac events. Scores were calculated for a global measure (Global Executive Composite [GEC]) and the two BRIEF indices: Behavioral Regulation Index and Metacognition Index (MCI). Participants were followed up post-discharge to determine CR attendance. Univariate logistic regressions between ExF measures and demographic variables were conducted, as were multiple logistic regressions to identify significant, independent predictors. Analyses were conducted using clinical (T scores ≥ 65) and subclinical (T scores ≥ 60) criteria for significant ExF impairment as outcomes. One-way analyses of variance were performed between ExF impairment and CR attendance. Self-reported ExF deficits were relatively rare; 8.9% had at least subclinical scores on the GEC. Using the subclinical criterion for the MCI, having diabetes mellitus (DM) and being male were significant, independent predictors of MCI impairment. No significant relationship was found between ExF and CR attendance. Using the subclinical criterion only, individuals with DM and males were significantly more likely to have MCI impairment. No significant effect of ExF impairment on CR attendance was found, suggesting that self-reported ExF measured in the hospital may not be an appropriate measure for predicting behavioral outcomes.

Predictors of Changes in Peak Oxygen Uptake After Outpatient Cardiac Rehabilitation: Importance of Cardiac Rehabilitation Attendance.

ObjectiveTo determine whether the number of cardiac rehabilitation (CR) sessions attended and selected clinical characteristics were predictive of patients who exhibited improvement in peak oxygen uptake (VO2peak) after CR.Patients and MethodsUsing the Rochester Epidemiology Project records-linkage system, we identified all consecutive patients aged 18 years or older from Olmsted County, Minnesota, who underwent cardiopulmonary exercise testing before and after CR from 1999 to 2017. Regression models were created to assess the clinical predictors of VO2peak improvement (>0% baseline) after CR.ResultsThe analysis included 671 patients, of which 524 (78%) patients exhibited VO2peak improvement after CR. The significant univariate predictors of VO2peak improvement included younger age (odds ratio [OR], 0.98; 95% CI, 0.96-0.99), lower pre-CR VO2peak (OR, 0.96; 95% CI, 0.94-0.99), and no history of peripheral artery disease (OR, 0.50; 95% CI, 0.31-0.81) (all, P<.005). The significant independent predictors of VO2peak improvement from the multivariable analysis included the number of CR sessions (OR, 1.04; 95% CI, 1.02-1.05), younger age (OR, 0.96; 95% CI, 0.94-0.98), lower pre-CR VO2peak (OR, 0.92; 95% CI, 0.89-0.95), and no history of peripheral artery disease (OR, 0.47; 95% CI, 0.28-0.78) (all, P<.005).ConclusionThese findings highlight the importance of patient participation in CR sessions and individual clinical characteristics in influencing VO2peak improvement after CR in patients with cardiovascular disease.

Racial Disparities In Cardiac Rehabilitation Attendance After Percutaneous Coronary Intervention

Racial Disparities In Cardiac Rehabilitation Attendance After Percutaneous Coronary Intervention

Peer-mentor support for older vulnerable myocardial infarction patients referred to cardiac rehabilitation: single-arm feasibility study

BackgroundThe positive effects of cardiac rehabilitation are well established. However, it has an inherent challenge, namely the low attendance rate among older vulnerable patients, which illustrates the need for effective interventions. Peer mentoring is a low-cost intervention that has the potential to improve cardiac rehabilitation attendance and improve physical and psychological outcomes among older patients. The aim of this study was to test the feasibility and acceptability of a peer-mentor intervention among older vulnerable myocardial infarction patients referred to cardiac rehabilitation.MethodsThe study was conducted as a single-arm feasibility study and designed as a mixed methods intervention study. Patients admitted to a university hospital in Denmark between September 2020 and December 2020 received a 24-week peer-mentor intervention. The feasibility of the intervention was evaluated based on five criteria by Orsmond and Cohn: (a) recruitment capability, (b) data-collection procedures, (c) intervention acceptability, (d) available resources, and (e) participant responses to the intervention. Data were collected through self-administrated questionnaires, closed-ended telephone interviews, semi-structured interviews, and document sheets.ResultsTwenty patients were offered the peer-mentor intervention. The intervention proved feasible, with a low dropout rate and high acceptability. However, the original inclusion criteria only involved vulnerable women, and this proved not to be feasible, and were therefore revised to also include vulnerable male patients. Peer mentors (n = 17) were monitored during the intervention period, and the findings indicate that their mentoring role did not cause any harm. The peer-mentor intervention showed signs of effectiveness, as a high rate of cardiac rehabilitation attendance was achieved among patients. Quality of life also increased among patients. This was the case for emotional, physical, and global quality of life measures at 24-week follow-up.ConclusionThe peer-mentor intervention is a feasible and acceptable intervention that holds the potential to increase both cardiac rehabilitation attendance and quality of life in older vulnerable patients. This finding paves the way for peer-mentor interventions to be tested in randomized controlled trials, with a view toward reducing inequality in cardiac rehabilitation attendance. However, some of the original study procedures were not feasible, and as such was revised.Trial registrationThe feasibility study was registered at ClinicalTrials.gov (ClinicalTrials.gov identification number: NCT04507529), August 11, 2020.

Smoking Cessation in People With and Without Diabetes After Acute Coronary Syndrome.

People with diabetes smoke at similar rates as those without diabetes, with cardiovascular consequences. Smoking cessation rates were compared between people with and without diabetes 1 year after an acute coronary syndrome (ACS). People with ACS who smoked and were part of an observational prospective multicenter study in Switzerland were included from 2007 to 2017 and followed for 12 months. Seven-day point prevalence abstinence was assessed at 12 months follow-up. Association between diabetes and smoking cessation was assessed using multivariable-adjusted logistical regression model. 2457 people with ACS who smoked were included, the mean age of 57 years old, 81.9% were men and 13.3% had diabetes. At 1 year, smoking cessation was 35.1% for people with diabetes and 42.6% for people without diabetes (P-value .01). After adjustment for age, sex, and educational level, people with diabetes who smoked were less likely to quit smoking compared with people without diabetes who smoked (odds ratio [OR] 0.76, 95% confidence interval [CI] 0.59-0.98, P-value = .037). The multivariable-adjusted model, with further adjustments for personal history of previous cardiovascular disease and cardiac rehabilitation attendance, attenuated this association (OR 0.85, 95% CI 0.65-1.12, P-value = .255). Among people with diabetes, cardiac rehabilitation attendance was a positive predictor of smoking cessation, and personal history of cardiovascular disease was a negative predictor of smoking cessation. People with diabetes who smoke are less likely to quit smoking after an ACS and need tailored secondary prevention programs. In this population, cardiac rehabilitation is associated with increased smoking cessation. This study provides new information on smoking cessation following ACSs comparing people with and without diabetes. After an ACS, people with diabetes who smoked were less likely to quit smoking than people without diabetes. Our findings highlight the importance of tailoring secondary prevention to people with diabetes.

An observational study examining utilization of prehabilitation and its association with postoperative cardiac rehabilitation participation and risk factors following coronary artery bypass grafting

BackgroundGrowing evidence supports the use of prehabilitation before coronary artery bypass grafting (CABG) to improve surgical outcomes, but its feasibility and impact on risk factor management in real-world clinical settings remain unknown. This observational study examined prehabilitation utilization and its association with postoperative cardiac rehabilitation (CR) participation and cardiovascular risk profile. MethodsAs standard care in a large Canadian city, eligible patients were referred to prehabilitation upon entering the elective CABG waitlist then were re-referred to CR following surgery. Prehabilitation consisted of medically supervised exercise training and multidisciplinary support with health behavior change until the scheduled surgery. An assessment of cardiorespiratory fitness, blood pressure, body habitus, psychological distress, lipids, glycated hemoglobin, and smoking status was completed during a prehabilitation intake visit then was repeated after surgery prior to starting CR. ResultsAmong 97 prehabilitation referrals over a 20-month period, only 49% attended an intake visit. Most patients who enrolled (n = 39) also completed (n = 37) prehabilitation. Completion of prehabilitation was significantly associated with higher CR referral (OR = 6.92, 95% CI 1.50–32.00), enrollment (OR = 14.08, 95% CI 5.09–38.94) and attendance [t(62) = 4.48, p < .001], and with improvements in cardiorespiratory fitness, body mass index, and symptoms of depression and anxiety (p < .004). ConclusionsPrehabilitation may improve CR participation and risk factors among individuals undergoing elective CABG, but more work is needed to disseminate this service to eligible patients.

Health literacy and long-term health outcomes following myocardial infarction: protocol for a multicentre, prospective cohort study (ENHEARTEN study)

IntroductionLow health literacy is common in people with cardiovascular disease and may be one factor that affects an individual’s ability to maintain secondary prevention health behaviours following myocardial infarction (MI)....

Abstract 178: Improving Cardiac Rehab Attendance By Providing Transportation Services And Removing Cost

For more than a decade, Cardiac Rehabilitation (CR) has been a Class IA indication for cardiovascular patient populations. While the benefits of CR are well published, enrollment and attendance barriers persist. The overall objective of the PACE Project is to increase enrollment and completion of a CR program in an urban academic health center. It addresses two known barriers to patient CR participation: transportation and affordability. Our hypothesis is that Phase II CR enrollment and attendance can be increased by providing free transportation and removing patient out-of-pocket expenses. The study recruitment period was October 2019 to March 2021, with a pause in services and recruitment during the initial COVID-19 pandemic lockdown. Patient were offer PACE participation during their hospitalization. Once consents were obtained, the standard processes to schedule and enroll in Phase II cardiac rehab and exercise prescription were adhered. Patients were responsible for calling and scheduling transportation services for their CR sessions. Upon completion of the study, 73% (41/56) patients attended at least one Phase II session, with an average of 15 session per attendee. This compared to previously published national participation of 8.2% or 32.6%, of at least one session, depending upon in-patient CR referral. The study had a Phase II graduation rate of 32% (13/41). Transportation was utilized in 10.7% (6/56) of participants, with billed mileage ranging from 1-5 miles. Those utilizing transportation services were all female, with 83% (5/6) being women of color. Out-of-pocket co-payments were observed for 41.4% (17/41) of attendees. For those with co-payments, an average of $40, with a range $2-$60, per session was observed. CR is a proven guideline directed intervention to reduce secondary cardiac events. Our study suggest the removal of frequently cited barriers to participation, cost and transportation, is associated with improved CR participation.

Effect of a Lifestyle-Focused Web-Based Application on Risk Factor Management in Patients Who Have Had a Myocardial Infarction: Randomized Controlled Trial.

BackgroundCardiac rehabilitation is central in reducing mortality and morbidity after myocardial infarction. However, the fulfillment of guideline-recommended cardiac rehabilitation targets is unsatisfactory. eHealth offers new possibilities to improve clinical care.ObjectiveThis study aims to assess the effect of a web-based application designed to support adherence to lifestyle advice and self-control of risk factors (intervention) in addition to center-based cardiac rehabilitation, compared with cardiac rehabilitation only (usual care).MethodsAll 150 patients participated in cardiac rehabilitation. Patients randomized to the intervention group (n=101) received access to the application for 25 weeks where information about lifestyle (eg, diet and physical activity), risk factors (eg, weight and blood pressure [BP]), and symptoms could be registered. The software provided feedback and lifestyle advice. The primary outcome was a change in submaximal exercise capacity (Watts [W]) between follow-up visits. Secondary outcomes included changes in modifiable risk factors between baseline and follow-up visits and uptake and adherence to the application. Regression analysis was used, adjusting for relevant baseline variables.ResultsThere was a nonsignificant trend toward a larger change in exercise capacity in the intervention group (n=66) compared with the usual care group (n=40; +14.4, SD 19.0 W, vs +10.3, SD 16.1 W; P=.22). Patients in the intervention group achieved significantly larger BP reduction compared with usual care patients at 2 weeks (systolic −27.7 vs −16.4 mm Hg; P=.006) and at 6 to 10 weeks (systolic −25.3 vs −16.4 mm Hg; P=.02, and diastolic −13.4 vs −9.1 mm Hg; P=.05). A healthy diet index score improved significantly more between baseline and the 2-week follow-up in the intervention group (+2.3 vs +1.4 points; P=.05), mostly owing to an increase in the consumption of fish and fruit. At 6 to 10 weeks, 64% (14/22) versus 46% (5/11) of smokers in the intervention versus usual care groups had quit smoking, and at 12 to 14 months, the respective percentages were 55% (12/22) versus 36% (4/11). However, the number of smokers in the study was low (33/149, 21.9%), and the differences were nonsignificant. Attendance in cardiac rehabilitation was high, with 96% (96/100) of patients in the intervention group and 98% (48/49) of patients receiving usual care only attending 12- to 14-month follow-up. Uptake (logging data in the application at least once) was 86.1% (87/101). Adherence (logging data at least twice weekly) was 91% (79/87) in week 1 and 56% (49/87) in week 25.ConclusionsComplementing cardiac rehabilitation with a web-based application improved BP and dietary habits during the first months after myocardial infarction. A nonsignificant tendency toward better exercise capacity and higher smoking cessation rates was observed. Although the study group was small, these positive trends support further development of eHealth in cardiac rehabilitation.Trial RegistrationClinicalTrials.gov NCT03260582; https://clinicaltrials.gov/ct2/show/NCT03260582International Registered Report Identifier (IRRID)RR2-10.1186/s13063-018-3118-1