Cardiac Rehabilitation Availability Research Articles

Telerehabilitation after acute coronary syndrome warrants a similar improvement in physical performance as stationary rehabilitation regardless of the age profile of the compared groups

Abstract During the COVID-19 pandemic, the availability of cardiac rehabilitation (CR) was limited. On the other hand, during the epidemic hazard period, patients after acute coronary syndromes (ACS) required careful control and ensuring their improvement after the coronary event. The aim of this study was to assess whether CR conducted during the epidemic threat in remote mode ensures similar improvement in physical performance as rehabilitation conducted in stationary mode before the pandemic COVID-19. Material and methods In this one-center study, the demographic and clinical profiles in the groups of patients after ACS who completed a stationary CR before COVID-19 era or telerehabilitation during the COVID-19 pandemic were compared. The workload on the initial and final exercise tests (ExT) obtained by patients was assessed, as well as the values of differences between the final and initial ExT were compared. 359 patients (pts) participating in stationary CR before October 2020 and 60 pts - in telerehabilitation after July 2021 were included. Both, stationary and tele- CR were performed according to the guidelines of Working Group for Cardiac Rehabilitation of the national cardiac society. Telemedic platform was used to control ECG, blood pressure and body mass of pts participating in telerehabilitation. Statistical analysis included U Mann-Whitney test, T Student test and chi square test. Results The improvment of physical performance did not differ significantly between both groups. The pts who completed telerehabilitation were significantly older than those who completed stationary CR. The values of other parameter, like percent of females, BMI, percent of pts with arterial hypertension and diabetes mellitus type 2 or ejection fraction of left ventricle did not differ significanty between compared groups. The results of statistical analysis are presented in the table below. Conclusions In our center, telerehabilitation after acute coronary syndrome guaranteed an equally good improvement in physical capacity, which was observed in stationary rehabilitation patients, regardless of the difference in the age profile of the compared groups. These results encourage popularization of the cardiac rehabilitation mode with the remote control of the ECG, blood pressure and body weight.Comparison of the study groups

Home-based cardiac rehabilitation and health-related quality of life in people with heart failure: the SCOT:REACH-HF study

British Journal of Cardiac NursingVol. 18, No. 5 Short ReportHome-based cardiac rehabilitation and health-related quality of life in people with heart failure: the SCOT:REACH-HF studyRod S Taylor, Carrie PurcellRod S TaylorCorrespondence to: Rod S Taylor; ???MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UKRobertson Centre for Biostatistics, University of Glasgow, Glasgow, UKSearch for more papers by this author, Carrie PurcellFaculty of Wellbeing, Education and Language Studies, Open University, Edinburgh, UKSearch for more papers by this authorRod S Taylor; Carrie PurcellPublished Online:31 May 2023AboutSectionsView articleView Full TextPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InEmail View article References Dalal HM, Taylor RS, Jolly K et al. The effects and costs of home-based rehabilitation for heart failure with reduced ejection fraction: The REACH-HF multicentre randomized controlled trial. Eur J Prev Cardiol. 2019;26:262-272. https://doi.org/10.1177/2047487318806358 Crossref, Google ScholarDalal HM, Doherty P, McDonagh ST et al. Virtual and in-person cardiac rehabilitation. Br Med J. 2021;3;373:n1270. https://doi.org/10.1136/bmj.n1270 Google ScholarGhisi GLM, Taylor RS, Seron P et al. Factors hindering cardiac rehabilitation in low-and middleincome countries, by level and setting. J Cardiopulm Rehabil Prev. 2023;43(2):143-144. https://doi.org/10.1097/HCR.0000000000000774 Google ScholarPurcell C, Purvis A, Cleland JGF et al. Home-based cardiac rehabilitation for people with heart failure and their caregivers: a mixed-methods analysis of the roll out an evidence-based programme in Scotland (SCOT:REACH-HF study). Eur J Cardiovasc Nurs. 2023;zvad004. https://doi.org/10.1093/eurjcn/zvad004 Google ScholarTaylor RS, Sadler S, Dalal HM et al. The cost effectiveness of REACH-HF and home-based cardiac rehabilitation compared with the usual medical care for heart failure with reduced ejection fraction: A decision model-based analysis. Eur J Prev Cardiol. 2019;26(12):1252-1261. https://doi.org/10.1177/2047487319833507 Google ScholarTurk-Adawi K, Supervia M, Lopez-Jimenez F et al. Cardiac rehabilitation availability and density around the globe. EClinicalMedicine 2019;13:31-45. https://doi.org/10.1016/j.eclinm.2019.06.007 Google Scholar FiguresReferencesRelatedDetails 2 May 2023Volume 18Issue 5ISSN (online): 2052-2207 Metrics History Published online 31 May 2023 Published in print 2 May 2023 Information© MA Healthcare LimitedPDF download

Cardiac Rehabilitation and the COVID-19 Pandemic: Persistent Declines in Cardiac Rehabilitation Participation and Access Among US Medicare Beneficiaries.

The impact of the COVID-19 pandemic on participation in and availability of cardiac rehabilitation (CR) is unknown. Among eligible Medicare fee-for-service beneficiaries, we evaluated, by month, the number of CR sessions attended per 100 000 beneficiaries, individuals eligible to initiate CR, and centers offering in-person CR between January 2019 and December 2021. We compared these outcomes between 2 periods: December 1, 2019 through February 28, 2020 (period 1, before declaration of the pandemic-related national emergency) and October 1, 2021 through December 31, 2021 (period 2, the latest period for which data are currently available). In period 1, Medicare beneficiaries participated in (mean±SD) 895±84 CR sessions per 100 000 beneficiaries each month. After the national emergency was declared, CR participation sharply declined to 56 CR sessions per 100 000 beneficiaries in April 2020. CR participation recovered gradually through December 2021 but remained lower than prepandemic levels (period 2: 698±29 CR sessions per month per 100 000 beneficiaries, P=0.02). Declines in CR participation were most marked among dual Medicare and Medicaid enrollees and patients residing in rural areas or socially vulnerable communities. There was no statistically significant change in CR eligibility between the 2 periods. Compared with 2618±5 CR centers in period 1, there were 2464±7 in period 2 (P<0.01). Compared with CR centers that survived the pandemic, 220 CR centers that closed were more likely to be affiliated with public hospitals, located in rural areas, and serve the most socially vulnerable communities. The COVID-19 pandemic was associated with a persistent decline in CR participation and the closure of CR centers, which disproportionately affected rural and low-income patients and the most socially vulnerable communities. Innovation in CR financing and delivery is urgently needed to equitably enhance CR participation among Medicare beneficiaries.

Приверженность к участию в программе дистанционной реабилитации у пациентов, перенесших операцию на открытом сердце, в зависимости от особенностей внутренней картины болезни

To increase the availability of cardiac rehabilitation and prevent psycho-emotional disorders after heart surgery, specialists from the Research Institute for Complex Issues of Cardiovascular Diseases (CPSSZ) developed the program “Remote Rehabilitation of Patients After Heart Surgery”. The aim of the study was to assess the relationship between indicators of the attitude of the disease and the frequency of using the remote rehabilitation program. The program included 46 patients who underwent cardiac surgery at the Research Institute of CPSSZ. The TOBOL test method was used to determine preoperative psychological parameters. On the 2nd-3rd day after undergoing heart surgery, the patient installed on their smartphone an application for remote rehabilitation, which consisted of 5 sections: Precribed walking, Therapeutic exercises, Diet, Psychology and Chat. Within 4 months after inclusion in the program, using a telephone survey, an analysis was made of the patient's adherence to this program and an assessment of its relationship with indicators of the internal picture of the disease. From the results of the study, it was confirmed that the main reason for refusing to participate in remote rehabilitation was the insufficient psychological attitude of patients to work together with medical specialists. Namely, “maladaptive” shock of melancholic and dysphoric variants of the internal picture of the disease on adherence to remote rehabilitation, which requires additional psycho-corrective work.

Cardiac rehabilitation availability and characteristics in Latin America and the Caribbean: A Global Comparison

This study aimed to establish availability and characteristics of cardiac rehabilitation (CR) in Latin America and the Caribbean (LAC), where cardiovascular disease is highly prevalent. In this cross-sectional sub-analysis focusing on the 35 LAC countries, local cardiovascular societies identified CR programs globally. An online survey was administered to identified programs, assessing capacity and characteristics. CR need was computed relative to ischemic heart disease (IHD) incidence from the Global Burden of Disease study. ≥1 CR program was identified in 24 LAC countries (68.5% availability; median=3 programs/country). Data were collected in 20/24 countries (83.3%); 139/255 programs responded (54.5%), and compared to responses from 1082 programs in 111 countries. LAC density was 1 CR spot per 24 IHD patients/year (vs 18 globally). Greatest need was observed in Brazil, Dominican Republic and Mexico (all with >150,000 spots needed/year). In 62.8% (vs 37.2% globally P < .001) of CR programs, patients pay out-of-pocket for some or all of CR. CR teams were comprised of a mean of 5.0 ± 2.3 staff (vs 6.0 ± 2.8 globally; P < .001); Social workers, dietitians, kinesiologists, and nurses were significantly less common on CR teams than globally. Median number of core components offered was 8 (vs 9 globally; P < .001). Median dose of CR was 36 sessions (vs 24 globally; P < .001). Only 27 (20.9%) programs offered alternative CR models (vs 31.1% globally; P < .01). In LAC countries, there is very limited CR capacity in relation to need. CR dose is high, but comprehensiveness low, which could be rectified with a more multidisciplinary team.

Cardiac Rehabilitation Availability and Density around the Globe

BackgroundDespite the epidemic of cardiovascular disease and the benefits of cardiac rehabilitation (CR), availability is known to be insufficient, although this is not quantified. This study ascertained CR availability, volumes and its drivers, and density. MethodsA survey was administered to CR programs globally. Cardiac associations and local champions facilitated program identification. Factors associated with volumes were assessed using generalized linear mixed models, and compared by World Health Organization region. Density (i.e. annual ischemic heart disease [IHD] incidence estimate from Global Burden of Disease study divided by national CR capacity) was computed. FindingsCR was available in 111/203 (54.7%) countries; data were collected in 93 (83.8% country response; N = 1082 surveys, 32.1% program response rate). Availability by region ranged from 80.7% of countries in Europe, to 17.0% in Africa (p < .001). There were 5753 programs globally that could serve 1,655,083 patients/year, despite an estimated 20,279,651 incident IHD cases globally/year. Volume was significantly greater where patients were systematically referred (odds ratio [OR] = 1.36, 95% confidence interval [CI] = 1.35–1.38) and programs offered alternative models (OR = 1.05, 95%CI = 1.04–1.06), and significantly lower with private (OR = .92, 95%CI = .91–.93) or public (OR = .83, 95%CI = .82–84) funding compared to hybrid sources.Median capacity (i.e., number of patients a program could serve annually) was 246/program (Q25-Q75 = 150–390). The absolute density was one CR spot per 11 IHD cases in countries with CR, and 12 globally. InterpretationCR is available in only half of countries globally. Where offered, capacity is grossly insufficient, such that most patients will not derive the benefits associated with participation.

Cardiac rehabilitation availability and delivery in Brazil: a comparison to other upper middle-income countries

BackgroundBrazil has insufficient cardiac rehabilitation capacity, yet density and regional variation in unmet need is unknown. Moreover, South America has CR guidelines, but whether delivery conforms has not been described. ObjectiveThis study aimed to establish: (1) cardiac rehabilitation volumes and density, and (2) the nature of programmes, and (3) compare these by: (a) Brazilian region and (b) to other upper middle-income countries (upper-MICs). MethodsIn this cross-sectional study, a survey was administered to cardiac rehabilitation programmes globally. Cardiac associations were engaged to facilitate programme identification. Density was computed using Global Burden of Disease study ischaemic heart disease incidence estimates. Results were compared to data from the 29 upper-MICs with cardiac rehabilitation (N=249 programmes). ResultsCardiac rehabilitation was available in all Brazilian regions, with 30/75 programmes initiating a survey (40.0% programme response rate). There was only one cardiac rehabilitation spot for every 99 ischaemic heart disease patient. Most programmes were funded by government/hospital sources (n=16, 53.3%), but in 11 programmes (36.7%) patients depended on private health insurance. Guideline-indicated conditions were accepted in ≥70% of programmes. Programmes had a team of 3.8±1.9 staff (versus 5.9±2.8 in other upper-MICs, p<0.05), offering 4.0±1.6/10 core components (versus 6.0±1.5 in other upper-MICs, p<0.01; more tobacco cessation and return-to-work counselling needed in particular) over 44.5 sessions/patient (Q25–75=29–65) vs. 32 sessions/patient (Q25–75=15–40) in other upper-MICs (p<0.01). ConclusionBrazilian cardiac rehabilitation capacity must be augmented, but where available, services are consistent across regions, but differ from other upper-MICs in terms of staff size and core components delivered.

Effectiveness of Planned Teaching Programme on Knowledge Regarding cardiac Rehabilitation among patients Undergone Coronary artery bypass Grafting Surgery

Cardiac rehabilitation involves delivery of structured exercise, education and risk reduction, in a cost-effective manner. Robust evidence demonstrates it reduces mortality up to 25%, improves functional capacity, as well as decreases re-hospitalization. Despite its benefits, and clinical practice guideline recommendations to refer cardiac patients, cardiac rehabilitation programs are grossly under-used. Worldwide, there is low availability of cardiac rehabilitation; only 38.8% of countries globally have cardiac rehabilitation programs. Specifically, 68.0% of high-income and 23% of lower middle income class have cardiac rehabilitation. Cardiac rehabilitation density estimates ranged from 1 program per 0.1–6.4 million inhabitants. Cardiac rehabilitation availability is much lower than that of other evidence-based secondary prevention therapies, such as revascularization and pharmacological therapies. Multi-level strategies to augment cardiac rehabilitation capacity and availability at national and international levels such as supportive public health policies, systematic referral strategies, and alternative models of delivery are needed.

MS06.6 Cardiac Rehabilitation Availability and Density Around the Globe

MS06.6 Cardiac Rehabilitation Availability and Density Around the Globe

Cardiac Rehabilitation Availability and Delivery in Canada: How Does It Compare With Other High-Income Countries?

BackgroundCanada has insufficient cardiac rehabilitation (CR) capacity, yet unmet need is unknown. Moreover, Canada has CR guidelines, but whether delivery conforms has not been characterized by province/territory. This study aimed to establish (1) CR volumes, capacity, and density, as well as (2) the nature of programs, and (3) compare these (a) by province/territory and (b) with other high-income countries (HICs). MethodsIn this cross-sectional study, an online survey was administered to CR programs globally. National cardiac associations were engaged to facilitate program identification where available, or local champions. Density was computed using Canada’s Chronic Disease Surveillance System ischemic heart disease incidence estimates. Twenty-eight HICs with CR were selected for comparison (N = 619 programs), and multilevel analyses performed. ResultsCR was available in 10 of 13 (76.9%) provinces (no programs in Canada’s North), with 74 of 182 programs initiating a survey (40.7% response). Program volumes (median = 250) were greatest in Ontario, but ultimately there was only 1 CR spot per 4.55 patients with ischemic heart disease nationally (similar in other HICs), and 186,187 more spots are needed annually. Most programs were funded by government/hospital sources (n = 48, 66.7%), but in 23 (31.5%), patients paid some or all of program costs out-of-pocket. Guideline-indicated conditions were accepted in more than 90% of programs. Programs had a multidisciplinary team of 6.2 ± 2.1 staff, offering 7.7 ± 1.5/10 core components (varied by province, P = 0.001; return-to-work offered less frequently than other HICs; P = 0.03), over 42.0 ± 26.0 hours (provincial and other HIC differences, P < 0.001). ConclusionsCanadian CR capacity must be augmented, but where available, services are consistent with other HICs.

Cardiac Rehabilitation: The emerging role of home-based approaches and telemedicine

Outpatient cardiac rehabilitation programs provide supervised exercise training in addition to secondary prevention interventions. They are designed to speed recovery from acute cardiovascular events, benefit chronic patients and to improve quality of life. Alternative approaches to the delivery of supervised cardiac rehabilitation include home-based programs, disease management and lifestyle health coaching interventions, and other internet-based case management systems. The effectiveness of home-based programs was evaluated in several randomized trials. There was no evidence of a difference in mortality, reinfarction, revascularization, cardiac-associated hospitalization, or exercise capacity between the two modes of intervention. Other alternatives include community-based group programs and the use of telemedicine. Use of mobile health technologies may further expand cardiac rehabilitation availability. Telehealth exercise cardiac rehabilitation appears to be at least as effective as center-based cardiac rehabilitation in improving modifiable cardiovascular risk factors and functional capacity. It identifies the option of telehealth and the technologic advances to provide more comprehensive, responsive, and interactive interventions for individuals for whom center-based rehabilitation is not feasible. The attractiveness of telemedicine models is the potential to improve participation of patients in structured with its short term and long-term benefits.

Limited availability of cardiac rehabilitation for heart failure patients in the United Kingdom: findings from a national survey

Participation of patients with heart failure in cardiac rehabilitation in the UK is low. This study investigated the availability of cardiac rehabilitation services for patients with heart failure in the UK and the views of service coordinators on ideal service models. Our study was a cross-sectional national postal survey that was mailed to 342 service coordinators in the UK between April and June 2009. We developed a 38-item questionnaire to survey all cardiac rehabilitation service coordinators on the National Audit of Cardiac Rehabilitation register in the UK in 2009. The survey response rate was 71% (244/342). Forty three per cent (105/244) of coordinators did not accept patients with heart failure to their cardiac rehabilitation services. Most coordinators who did accept patients with heart failure offered their services to patients with a variety of cardiac conditions, though referral criteria and models of care varied widely. Services inconsistently used New York Heart Association classes and left ventricular ejection fraction measures to select patients. Few offered separate dedicated heart failure programmes (14%; 33/244) but where these existed they ran for longer than programmes which included patients with heart failure alongside other cardiac patients (10.9 vs 8.5 weeks; F = 4.04; p = 0.019). Few offered home-based options for patients with heart failure (11%; 27/244). Coordinators accepting patients with heart failure to their cardiac rehabilitation services tended to agree that patients with heart failure should be included in services alongside other cardiac patients (χ(2) = 6.2; p = 0.013). There is limited access for patients with heart failure to cardiac rehabilitation in the UK. Local policies on referral and selection criteria differ and reflect coordinators' views rather than clinical guidance.

Cardiac Rehabilitation After Stroke—Need and Opportunity

In North America, established long-term rehabilitation programs are commonly available for individuals following a cardiac event but are largely unavailable for stroke survivors. The purpose of this study was to determine (1) the availability of cardiac rehabilitation (CR) for individuals poststroke (survey of all programs in Ontario, Canada) and (2) the effects of CR, comparing individuals with primary and secondary diagnoses of stroke versus those with cardiac diagnoses only (retrospective review of a large outpatient North American program). An Ontario-wide survey was disseminated to CR programs to determine barriers to enrollment of stroke participants. Additionally, a retrospective analysis of data from 9,173 participants in 1 CR program in Toronto, Ontario, compared 3 subgroups (n = 19 each): (1) primary diagnosis of stroke or transient ischemic attack (TIA), (2) primary cardiac diagnosis and occurrence of stroke or TIA, and (3) cardiac diagnoses only. Twenty-four of 40 (60%) programs surveyed included stroke participants, although the proportion was small (<5% of total enrollment). Barriers to enrollment included issues around primary diagnosis and degree of stroke-related disability. While those with a history of stroke or TIA had a lower baseline peak oxygen uptake, all 3 groups showed comparable postprogram improvements in peak oxygen uptake and anaerobic threshold (time effect, P < .001). There were no group-time interaction effects. Despite the common cardiovascular etiology of stroke and heart disease, individuals with stroke are not routinely included in CR in Ontario. However, individuals with stroke demonstrated similar training-related improvements in exercise capacity compared with nonstroke participants.