Cardiac Rehabilitation Facilities Research Articles

Barriers to Cardiac Rehabilitation among Patients Diagnosed with Cardiovascular Diseases-A Scoping Review.

Cardiovascular diseases (CVDs) are a rising global burden. Preventative strategies such as cardiac rehabilitation (CR) have shown a marked reduction in disease burden. Despite this, CR is underutilized worldwide. This study aims to identify the barriers to CR among patients diagnosed with CVD. A scoping review of the literature was conducted following the Joanna Briggs Institute (JBI) guidelines. Four major databases, including CINAHL, PubMed, EBSCOhost, and Scopus, were used to obtain studies published between 2010 and 2023. Search terms such as "Cardiac rehab*", "Barrier*", "Cardiovascular", "Disease", and "diagnosis*" were utilized in order to obtain subject-specific studies relevant to the research question. From the initial 2098 studies, only 14 were included in the final analysis, consisting of both qualitative and quantitative designs. The thematic analysis included "healthcare system-related factors", "Socioeconomic factors", and "individual characteristics". Healthcare system-related factors were mostly related to the poor availability of CR programs, lack of proper referral strategies, inadequate knowledge of CR provider and inter-provider communication issues, and lack of alternative methods of CR delivery. The socioeconomic barriers were lack of education, longer distance to CR facilities, high cost of care, unemployment, and poor income status. The identified individual characteristics were female gender, older age, and comorbidities. Lack of resources, poor access, educational attainment, and high cost of care were some of the barriers to CR, particularly in low- and middle-income countries (LMICs). Health policymakers and healthcare providers should implement strategies incorporating the issues identified in this scoping review. Systematic reviews may be required to confirm these findings.

Relationship Between Community-Level Distress and Cardiac Rehabilitation Participation, Facility Access, and Clinical Outcomes After Inpatient Coronary Revascularization.

Although disparities in cardiac rehabilitation (CR) participation are well documented, the role of community-level distress is poorly understood. This study evaluated the relationship between community-level distress and CR participation, access to CR facilities, and clinical outcomes. A retrospective cohort study was conducted on a 100% sample of Medicare beneficiaries undergoing inpatient coronary revascularization between July 2016 and December 2018. Community-level distress was defined using the Distressed Community Index quintile at the beneficiary zip code level, with the first and fifth quintiles representing prosperous and distressed communities, respectively. Outpatient claims were used to identify any CR use within 1 year of discharge. Beneficiary and CR facility zip codes were used to describe access to CR facilities. Adjusted logistic regression models evaluated the association between Distressed Community Index quintiles, CR use, and clinical outcomes, including one-year mortality, all-cause hospitalization, and acute myocardial infarction hospitalization. A total of 414 730 beneficiaries were identified, with 96 929 (23.4%) located in the first and 67 900 (16.4%) in the fifth quintiles, respectively. Any CR use was lower for beneficiaries in distressed compared with prosperous communities (26.0% versus 46.1%, P<0.001), which was significant after multivariable adjustment (odds ratio, 0.41 [95% CI, 0.40-0.42]). A total of 98 458 (23.7%) beneficiaries had a CR facility within their zip code, which increased from 16.3% in prosperous communities to 26.6% in distressed communities. Any CR use was associated with absolute reductions in mortality (-6.8% [95% CI, -7.0% to -6.7%]), all-cause hospitalization (-5.9% [95% CI, -6.3% to -5.6%]), and acute myocardial infarction hospitalization (-1.3% [95% CI, -1.5% to -1.1%]), which were similar across each Distressed Community Index quintiles. Although community-level distress was associated with lower CR participation, the clinical benefits were universally received. Addressing barriers to CR in distressed communities should be considered a significant priority to improve survival after coronary revascularization and reduce disparities.

Cardiopulmonary exercise testing in cardiac rehabilitation: From the reporting form to structured exercise prescription. A proposal from the Italian alliance for cardiovascular rehabilitation and prevention (Itacare-P)

The cardiopulmonary exercise test (CPET) is the gold standard for the diagnostic evaluation of exercise intolerance, as for individualized prescription of structured physical training. Exercise is a core component of cardiovascular prevention and rehabilitation activites, but unfortunately the limited availability of CPET-derived informations often leads to unpowered program's prescription in real life. The Italian Alliance for Cardiovascular Rehabilitation and Prevention (ITACARE-P) has developed a CPET reporting form specifically oriented to exercise prescription, in order to facilitate interventions on lifestyle and during phase II/phase III cardiac rehabilitation programmes. The ITACARE-P CPET reporting form includes a limited number of key variables for clinical practice and individual domains of exercise intensity, suitable both for threshold-based and range-based aerobic training protocols. The adoption of the ITACARE-P CPET reporting form could improve non-pharmacological intervention in preventive cardioloy and facilitate collaborative research on physical training within the network of cardiac rehabilitation facilities.

Timed up and go test associated and may predict peak vo2

Abstract Funding Acknowledgements Type of funding sources: None. Main funding source(s): No funding. Background the Timed Up And Go test (TUG) is a form of mobility and functional capacity evaluation, but is still not well studied in cardiac patients. Objective test TUG association and prediction capacity for peak VO2. Methods cross sectional study. Patients with cardiophaties, admitted to a cardiac rehabilitation facility, who were submitted to TUG and a cardiopulmonary exercise test (CPET). Pearson correlation, multiple linear regression, ROC curves and Bland-Altman analysis were applied. From the total 2/3 were designated to the creation and 1/3 to the validation population. A p value &amp;lt; 0.05 was admitted as significant. Results 201 patients, mean age of 67±13 years, 30% were female, 70% had ischaemic cardiopathy. Heart failure was present in 30%, 53% were NYHA I, 37% NYHA II, the mean left ventricle ejection fraction was 56±16%. Mean peak VO2 was 17±6 ml.kg-1.min-1 and mean TUG was 7±2.5 seconds (s). The correlation between TUG and peak VO2 was: r= -0.53 (IC95%= -0.62 -0.42; p&amp;lt;0.001) with a R² of 0.28. The AUC to predict a peak VO2 ≥20 ml.kg-1.min-1 based on TUG was 0.80 (IC95% 0.74-0.86; p&amp;lt;0.001) and the best cut point ≤5.47s (sensitivity 83% and specificity 63%). Based in 134 patients (2/3 of the total), the following equation was described to peak VO2 prediction based in TUG results: peak VO2= 33.553+ (-0.149*age) + (-0.738*TUG) + (-2.870*sex); male=0, female=1. In the validation population (1/3 of the total), the peak VO2 estimated by TUG was 18.8±3.2 ml.kg-1.min-1 and the CPET measured was 18.1±5.9 ml.kg-1.min-1 (p &amp;gt; 0.05). Conclusion TUG and peak VO 2 were moderately but significantly associated. A equation to predict peak VO2 based on TUG was described and validated with good performance. Achieving 5.47s or less in TUG was related levels of peak VO2 that are related to better prognosis.

Participation and Prognostic Impact of Cardiac Rehabilitation After Acute Coronary Syndrome: Big-Data Study of the Korean National Health Insurance Service.

To investigate the actual rate and quality of cardiac rehabilitation (CR) participation in South Korea and its short-term impact on clinical outcomes after acute coronary syndrome (ACS). Data, including confirmed ACS diagnosis, socio-demographics, comorbidities, clinical outcomes, and CR claim codes, were collected from the Korean National Health Insurance Service claims database and compared between the CR and non-CR groups. Overall, 102,544 patients were included in the study, of which only 5.8% attended CR. Regarding testing, 83.6% of CR patients performed the cardiopulmonary exercise test, but follow-up testing was infrequently performed; in addition, 53.1% of them participated in an electrocardiogram monitoring exercise, but over half participated in only one session. After 1:1 propensity score matching, post-ACS cardiovascular events were significantly lower in the CR group than in the non-CR group. The cumulative 3-year hazard ratio for all-cause death was 0.612 (95% confidence interval [CI], 0.495-0.756), recurrent ACS was 0.92 (95% CI, 0.853-0.993), CR readmission was 0.817 (95% CI, 0.768-0.868), and major adverse cardiovascular events (MACE) was 0.827 (95% CI, 0.781-0.874) in the CR group. CR was associated with a significant dose-response effect on MACE, with a reduction in incidence from 0.854 to 0.711. The actual rate of CR participation in South Korea remains low, and participation quality was not outstanding despite National Health Insurance coverage. Nevertheless, the impact of CR on cardiovascular outcomes after ACS was significantly superior. Efforts to increase CR participation should be increased by establishing new CR facilities and strategies to resolve associated barriers.

Abstract 14253: Distance to Cardiac Rehabilitation is Associated With Participation and Completion

Background: Despite the known benefits for patients undergoing coronary revascularization, cardiac rehabilitation (CR) use remains low, with few studies evaluating geographic barriers to care. In this analysis, we examined geographic access (i.e. distance) to a CR facility and its relationship to CR participation and completion. Methods: A cohort of 414,730 Medicare beneficiaries with coronary revascularization were identified from 2016-2018. Geographic access was defined as the presence of a CR facility within the beneficiary’s home zip code (yes vs. no) and the distance to the nearest CR facility: within the same zip code (0 miles), 0-10 miles, 10-20 miles, 20+ miles. We then used claims data to determine any CR participation within one year of discharge and completion of the full CR program (36 sessions). Multivariable logistic regression was used to identify the relationships, adjusting for patient factors. Results: A total of 155,872 (37.6%) beneficiaries participated in CR during the study period, with 45,591 (29.3%) completing 36 sessions. Nearly a quarter of beneficiaries had a CR facility located within their residential zip code (23.7%), with the majority of beneficiaries having a CR facility within 10 miles of the center of their home zip code ( Table 1). Beneficiaries without a CR facility in their zip code were more likely to be younger in age, men, non-white race categories, dual eligible for Medicare/Medicaid, and increasingly comorbid. Adjusting for patient factors, increasing distance category was associated with an absolute reduction in CR participation and completion (Table 1) . Conclusions: Distance to the nearest CR facility is an important predictor of CR participation and completion, with overall use declining as distance increased. Interventions to address geographic barriers, such as transportation programs or virtual/hybrid CR, may be necessary to improve CR participation in areas with limited facility access.

Abstract 14924: Gender Differences in Cardiac Rehabilitation Participation and Outcomes in a National Medicare Sample: An Instrumental Variable Approach

Background: Cardiac rehabilitation (CR) participation following percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) decreases patient morbidity and mortality. Many studies are underpowered to evaluate gender differences. We aimed to look at gender differences in CR use and short term outcomes including 1-year mortality in a national Medicare sample. Methods: We identified Medicare beneficiaries over 65 years undergoing PCI and CABG from 07/2016-12/2018. Primary exposures included female vs. male sex and CR use within one year of discharge based on outpatient claims. Clinical outcomes included 1-year mortality and readmissions. We analyzed differences in characteristics, CR use, and associated outcomes between females and males using multivariable and instrumental variable analyses using distance to CR facility as the instrument. Results: 414,730 beneficiaries underwent PCI and CABG, of which 145,512 (35.1%) were female. Females were more likely to be older, Black race, dual eligible, live in distressed communities, and have a CR facility in their zip code, and were less likely to be Hispanic, elective procedures, or undergo CABG. CR use was lower for females than males (32.2% vs. 40.5%, p&lt;0.001), which remained significant after adjustment for patient covariates (OR=0.91, 95% CI: 0.89-0.92, p&lt;0.001). One-year mortality for CR users vs. non-CR users was 2.1% / 2.4% and 15.4% / 14.5% for women and men, respectively. One-year readmissions for CR users and non users was 34.3% / 31.2% and 52.8% / 45.0% for women and men, respectively. The adjusted and IV-adjusted average absolute effect of CR use on mortality was similar for females and males but was stronger on 1-year readmissions for females vs. males (Figure). Conclusion: Female Medicare beneficiaries attend CR following PCI and CABG at lower rates than men, but have increased benefit with CR participation on 1-year readmissions with similar mortality benefit relative to men.

Disparities in Geographic Access to Cardiac Rehabilitation in Los Angeles County.

Background Exercise-based cardiac rehabilitation (CR) is known to reduce morbidity and mortality for patients with cardiac conditions. Sociodemographic disparities in accessing CR persist and could be related to the distance between where patients live and where CR facilities are located. Our objective is to determine the association between sociodemographic characteristics and geographic proximity to CR facilities. Methods and Results We identified actively operating CR facilities across Los Angeles County and used multivariable Poisson regression to examine the association between sociodemographic characteristics of residential proximity to the nearest CR facility. We also calculated the proportion of residents per area lacking geographic proximity to CR facilities across sociodemographic characteristics, from which we calculated prevalence ratios. We found that racial and ethnic minorities, compared with non-Hispanic White individuals, more frequently live ≥5 miles from a CR facility. The greatest geographic disparity was seen for non-Hispanic Black individuals, with a 2.73 (95% CI, 2.66-2.79) prevalence ratio of living at least 5 miles from a CR facility. Notably, the municipal region with the largest proportion of census tracts comprising mostly non-White residents (those identifying as Hispanic or a race other than White), with median annual household income <$60 000, contained no CR facilities despite ranking among the county's highest in population density. Conclusions Racial, ethnic, and socioeconomic characteristics are significantly associated with lack of geographic proximity to a CR facility. Interventions targeting geographic as well as nongeographic factors may be needed to reduce disparities in access to exercise-based CR programs. Such interventions could increase the potential of CR to benefit patients at high risk for developing adverse cardiovascular outcomes.

Evaluating the Feasibility of a Statewide Collaboration to Improve Cardiac Rehabilitation Participation: THE MICHIGAN CARDIAC REHAB NETWORK.

Regional quality improvement collaboratives may provide one solution to improving cardiac rehabilitation (CR) participation through performance benchmarking and provider engagement. The objective of this study was to evaluate the feasibility of the Michigan Cardiac Rehab Network to improve CR participation. Multipayer claims data from the Michigan Value Collaborative were used to identify hospitals and CR facilities and assemble a multidisciplinary advisory group. Univariate analyses described participating hospital characteristics and hospital-level rates of CR performance across eligible conditions including enrollment within 1 yr, mean days to first CR visit, and mean number of CR visits within 1 yr. Three diverse CR facilities were chosen for virtual site visits to identify areas of success and barriers to improvement. A total of 95 hospitals and 84 CR facilities were identified, with 48 hospitals (51%) providing interventional cardiology services and 33 (35%) providing cardiac surgical services. A 17-member multidisciplinary advisory group was assembled representing 13 institutions and diverse roles. Statewide CR enrollment across eligible admissions was 33.4%, with wide variation in CR performance measures across participating hospitals and eligible admissions. Virtual site visits revealed individual successes in improving CR participation but a variety of barriers to participation related to referrals, capacity and staffing constraints, and geographic and financial barriers. This study demonstrated the feasibility of creating a statewide collaboration of hospitals and CR facilities centered around the goal of equitably improving CR enrollment for all eligible patients in Michigan that is supported by a multidisciplinary advisory group and performance benchmarking.

Sustainability of physical work capacity two years post outpatient cardiac rehabilitation

Objective To determine if supervised training, after the completion of cardiac rehabilitation program, performed for a further two years would help maintain beneficial effects achieved during prolonged outpatient cardiac rehabilitation. Design Longitudinal parallel-grouped intervention study. Subjects Patients with coronary artery disease (n = 41, age 59.5 ± 9.3 years), who finished cardiac rehabilitation phase III in our outpatient cardiac rehabilitation facility. Intervention Two years of supervised exercise training consisting of endurance (either high intensity interval training or pyramid training) and resistance training sessions once a week. Main measurement Peak physical work capacity was assessed via an ergometry testing at the beginning and at the end of the study. Results Comparisons between end-of-cardiac rehabilitation and two years post cardiac rehabilitation revealed maintenance of peak physical work capacity after two years (begin vs end: 170 ± 59 W vs 167 ± 60 W; −0.5 ± 12.8%; p = 0.521). This was independent of exercise training protocols (percent change begin vs end: pyramid: 1.5 ± 11.8%; interval: −1.6 ± 13.4%; p = 0.459). Conclusion Improvement of physical exercise capacity gained during outpatient cardiac rehabilitation can be maintained for up to two years by once-weekly supervised exercise training. Long-term, group-based exercise programs offered at the end of cardiac rehabilitation might be an effective tool to help patients maintain their physical work capacity.

Abstract 29: Evaluating The Feasibility Of A Statewide Collaboration To Improve Cardiac Rehabilitation Participation: The Michigan Cardiac Rehabilitation Consortium

Background: Regional quality improvement collaboratives may provide one solution to improving cardiac rehabilitation (CR) participation through performance benchmarking and provider engagement. The objective of this descriptive study was to evaluate the feasibility of the Michigan Cardiac Rehab Consortium to improve CR participation Methods and Results: Multipayer claims data from the Michigan Value Collaborative were used to identify hospitals and CR facilities. Univariate analyses described participating hospital characteristics and hospital-level rates of CR enrollment within 1-year. A total of 95 hospitals and 85 CR facilities with 48 hospitals (51%) providing interventional cardiology services and 33 (35%) provided cardiac surgical services. The overall consortium-wide enrollment rate into CR across all conditions was 19.8% (26,398 of 133,641 eligible admissions), which was highest for CABG (58.4%), followed by SAVR (54.8%), PCI (34.6%), TAVR (33.1%), AMI (12.7%), and CHF (3.4%). There was wide variation in CR participation across participating eligible admissions and hospitals (Figure). A 17-member multidisciplinary stakeholder group was assembled representing 12 institutions and diverse roles, including exercise physiologists, cardiologist, program directors, and patients. Three diverse CR facilities participated in virtual site visits, which revealed individual successes in improving CR participation, but a variety of barriers to participation related to referrals, capacity and staffing constraints, and geographic and financial barriers. Conclusions: This study demonstrated the feasibility of a statewide collaboration centered around the goal of equitably improving CR enrollment for all eligible patients that is supported by a multidisciplinary stakeholder group and performance benchmarking. Future work will seek to continuously improve and evaluate the impact of this consortium on CR participation in Michigan.

Situation der kardiologischen Rehabilitation im Rahmen der COVID-19-Pandemie in Deutschland – eine Blitzumfrage der Deutschen Gesellschaft für Rehabilitation und Prävention von Herz-Kreislauferkrankungen (DGPR) zur aktuellen Situation (August 2020)

BackgroundIn Germany, the COVID-19 pandemic has significantly changed cardiological care in both the outpatient and inpatient setting, including the cancellation of elective interventions. The investigation presented here was carried out in order to obtain information on the extent to which this also applies to cardiac rehabilitation facilities. MethodsIn August 2020, all 107 member institutions of the DGPR were contacted and asked to take part in an online survey containing 12 sets of questions on the topic. ResultsAt the end of August, data were available from 45 institutions. 31.1 % of the institutions provided rehabilitation services for patients with cardiac complications/manifestations of COVID-19 disease, mainly after acute coronary syndrome (29.6 %) and pulmonary artery embolism (25.9 %). More than 40 % of the facilities were required to close down partially or completely, and 14 % feared a partial or complete closure by the end of 2020. The costs for testing, if SARS-CoV-2 infection was suspected (72.1 %), were mainly borne by the rehabilitation facilities. ConclusionsDespite the limitations of a short-term data collection and a response rate of approx. 45 %, the present study gives indications of the challenging situation of the COVID-19 pandemic for cardiological rehabilitation facilities in Germany.

Temporal Trends and Factors Associated With Cardiac Rehabilitation Participation Among Medicare Beneficiaries With Heart Failure

ObjectivesThe purpose of this study was to assess temporal trends and factors associated with cardiac rehabilitation (CR) enrollment and participation among Medicare beneficiaries after the 2014 Medicare coverage expansion. BackgroundCR improves exercise capacity, quality of life, and clinical outcomes in heart failure (HF) with reduced ejection fraction (HFrEF). In 2014, Medicare coverage for CR was expanded to include chronic HFrEF. MethodsAmong Medicare beneficiaries from quarter (Q) 1 2014 to Q2 2016, 11,696 patients from 14,258 hospitalizations with primary discharge diagnosis of HF were identified. Patients with HF with preserved ejection fraction were excluded. Quarterly CR participation rates among hospitalized HF patients within 6 months of discharge were identified through outpatient administrative claims. The predictors of CR participation were assessed with the use of a multivariable logistic regression model that included patient- and hospital-level characteristics. A secondary analysis to assess participation rates of CR after outpatient encounters for HF was performed. ResultsOverall, only 611 (4.3%) and 349 (2.2%) eligible patients participated CR after primary hospitalization or outpatient visit for HF, respectively. There was a modest, statistically significant increase in CR participation after HF admissions (2.8% in Q1 2014; 5.0% in Q2 2016; p < 0.001) without significant increase after outpatient visits for HF (2.6% to 3.8%; p = 0.21). Younger age, male sex, nonblack race, previous cardiovascular procedures, and hospitalization at hospitals with available CR facilities were all independently associated with CR participation. ConclusionsCR participation among eligible Medicare beneficiaries with HFrEF was low with minimal increase since 2014 Medicare coverage decision. Sex, race, and institution-dependent variables were independent predictors of CR participation.

Cardiac rehabilitation barriers in the Czech Republic: Determination of key barriers in East-Central Europe

Funding AcknowledgementsType of funding sources: Public grant(s) – National budget only. Main funding source(s): the Ministry of Health, Czech Republic - conceptual development of research organization (65269705)BackgroundCardiovascular diseases are leading causes of morbidity and mortality worldwide, including in Central Europe. Cardiac rehabilitation (CR) represents an efficient secondary prevention model, but it is highly underutilised. Barriers to CR in the Czech Republic (and in Central Europe) are not well-characterised, and therefore we present a study to define these barriers.PurposeThrough this study, a reliable and valid means of assessing patient"s CR barriers will be established. Results will be used to identify ways to help patients overcome barriers to CR and potentially contribute to improving CR utilisation in this region.MethodsThis is a multi-method study. First, in 2019, we professionally translated and cross-culturally validated the Cardiac Rehabilitation Barriers Scale to Czech (CRBS-CZE), and piloting it in 50 cardiac patients. A prospective study was undertaken to psychometrically-validate the CRBS-CZE, where patients eligible for phase II/outpatient CR were recruited. The internal reliability of the scale was assessed with Cronbach"s alpha.In total, 143 eligible patients (target of 200-300 patients) in the University Hospital Brno was approached from January 2020 for one year. Consenting participants were informed about the CR program and their sociodemographic (age, sex, highest educational attainment, work status, travel time), clinical characteristics (diagnosis, anthropometrics, blood pressure, lipids levels, diabetes), heart-healthy behaviours (level of physical activity, tobacco use, harmful use of alcohol), and the CRBS-CZE administered.Mean CRBS-CZE scores (21-items/barriers, five-point Likert scale) were analysed to determine key barriers in this setting. To test construct validity, differences in CRBS-CZE total scores were compared by patient characteristics outlined above, using a t-test and Pearson"s correlation. Patient"s enrollment, adherence, and completion of the CR program (% of 24 prescribed sessions attended) were tracked.Results (preliminary)The CRBS-CZE had good internal consistency (Cronbach’s alpha = .74). Mean total perceived barriers were significantly greater among non-enrollers (2.1, SD = .57) than CR enrollers (1.8, SD = .53), and among rural (2.2, SD = .54) than urban inhabitants (1.7, SD = .46) (p < .05). The long distance from CR facilities (mean commuting time about 50 mins), a little free time, and the transportation problems were identified as the greatest barriers. From all eligible patients, 19.6% entered and 10.5% completed the CR program. The mean completion rate was 70.6%. The main limitations of the study were a small number of participants and the COVID-19 pandemic.ConclusionThe CRBS-CZE has shown adequate validity and reliability, which supports its use in future studies. Results also point to suboptimal CR availability in the Czech Republic. This finding, especially in the pandemic situation, promotes the need for CR alternatives like home-based programs and telerehabilitation.

Comprehensive multicomponent cardiac rehabilitation in cardiac implantable electronic devices recipients: a consensus document from the European Association of Preventive Cardiology (EAPC; Secondary prevention and rehabilitation section) and European Heart Rhythm Association (EHRA).

Cardiac rehabilitation (CR) is a multidisciplinary intervention including patient assessment and medical actions to promote stabilization, management of cardiovascular risk factors, vocational support, psychosocial management, physical activity counselling, and prescription of exercise training. Millions of people with cardiac implantable electronic devices live in Europe and their numbers are progressively increasing, therefore, large subsets of patients admitted in CR facilities have a cardiac implantable electronic device. Patients who are cardiac implantable electronic devices recipients are considered eligible for a CR programme. This is not only related to the underlying heart disease but also to specific issues, such as psychological adaptation to living with an implanted device and, in implantable cardioverter-defibrillator patients, the risk of arrhythmia, syncope, and sudden cardiac death. Therefore, these patients should receive special attention, as their needs may differ from other patients participating in CR. As evidence from studies of CR in patients with cardiac implantable electronic devices is sparse, detailed clinical practice guidelines are lacking. Here, we aim to provide practical recommendations for CR in cardiac implantable electronic devices recipients in order to increase CR implementation, efficacy, and safety in this subset of patients.

Variation in Cardiac Rehabilitation for Pediatric Ventricular Assist Device Recipients Across North America.

Despite increasing utilization of continuous-flow pediatric ventricular assist devices (VAD) in children, data on exercise testing and cardiac rehabilitation (CR) are unknown. We described variation in CR practices and identified barriers to exercise testing and CR. A survey was performed through the Advanced Cardiac Therapies Improving Outcomes Network (ACTION) representing pediatric VAD centers across North America. Descriptive statistics were performed. A multidisciplinary cohort of 52 respondents from 28 pediatric VAD centers responded. Although 38% reported performing exercise testing, most (65%) used 6 minute walk tests rather than formal cycle or treadmill exercise testing. While all respondents refer to physical therapy during the initial inpatient stay for VAD placement, only 52% refer to a CR program. When performed, CR was performed at an ACTION center (84%), a local specialized center (21%), or a home-based CR program (26%). Commonly cited barriers to either CR or exercise testing were inadequate resources, inadequate implementation logistics knowledge, concerns about safety, inability of patients to travel to a CR facility, and concern about utility of exercise testing or CR. Over 90% of centers were interested in implementing a standardized pediatric VAD CR program. Utilization of exercise testing and CR after VAD placement is variable. Despite perceived barriers, most pediatric VAD centers are interested in implementing a standardized CR program for recipients. In response to this interest, we plan to implement a standardized CR protocol to all ACTION pediatric VAD centers in an effort to improve pretransplant waitlist rehabilitation and post-transplant outcomes.

Comprehensive multicomponent cardiac rehabilitation in cardiac implantable electronic devices recipients: a consensus document from the European Association of Preventive Cardiology (EAPC; Secondary prevention and rehabilitation section) and European Heart Rhythm Association (EHRA).

Cardiac rehabilitation (CR) is a multidisciplinary intervention including patient assessment and medical actions to promote stabilization, management of cardiovascular risk factors, vocational support, psychosocial management, physical activity counselling, and prescription of exercise training. Millions of people with cardiac implantable electronic devices live in Europe and their numbers are progressively increasing, therefore, large subsets of patients admitted in CR facilities have a cardiac implantable electronic device. Patients who are cardiac implantable electronic devices recipients are considered eligible for a CR programme. This is not only related to the underlying heart disease but also to specific issues, such as psychological adaptation to living with an implanted device and, in implantable cardioverter-defibrillator patients, the risk of arrhythmia, syncope, and sudden cardiac death. Therefore, these patients should receive special attention, as their needs may differ from other patients participating in CR. As evidence from studies of CR in patients with cardiac implantable electronic devices is sparse, detailed clinical practice guidelines are lacking. Here, we aim to provide practical recommendations for CR in cardiac implantable electronic devices recipients in order to increase CR implementation, efficacy, and safety in this subset of patients.

Professional Doctorate in Clinical Exercise Physiology

Professional Doctorate in Clinical Exercise Physiology

Evaluation of effort tolerance in diabetic and non-diabetic patients undergoing cardiac rehabilitation after cardiac surgery

Introduction: Complex cardiac rehabilitation is a basic procedure of therapeutic treatment for patients after cardiac surgeries. The course of operations depends on many factors. The aim of this article is to investigate connections between type 2 diabetes and results of 6-minute walk test among patients after cardiac surgery. Materials and methods: This research was conducted among 111 patients who had cardiac surgery. Those patients were qualified to stay at a stationary cardiac rehabilitation facility. They were divided into two groups: patients with and without diabetes. In the analysis, patients’ medical data and 6-minute walk test results before and after complex rehabilitation were taken into consideration. Results: On the basis of our analysis it was found that patients who have diabetes achieve worse results of 6-minute walk test before (OR=0.995; p=0.005) and after (OR=0.994, p=0.006) complex cardiac rehabilitation in comparison with patients without diabetes. Conclusions: Type 2 diabetes has impact on physical effort tolerance among patients after cardiac surgery. Despite improvement of 6-minute walk test results thanks to complex cardiac rehabilitation, patients with type 2 diabetes walked shorter distance than patients without diabetes.

Abstract 279: Outcomes From Integrating Stroke Survivors Into Cardiac Rehabilitation

Purpose: Lack of physical activity after stroke results in increased risk of stroke recurrence and other health problems. While some survivors receive physical therapy (PT), it is often discontinued within a year. Cardiac Rehabilitation (CR) is a community exercise program for people with cardiac dysfunction; however, stroke is not a covered diagnosis despite high cardiovascular risk. CR for stroke survivors is an opportunity to bridge the gap between PT and community physical activity. The study evaluated the impact of CR participation on stroke survivors. Materials and Methods: A pilot study was completed at a phase 3 CR facility. Participants were screened for eligibility and entered the CR program (3 x per week for 12 weeks) with an aerobic fitness focus. Individual outcomes were taken pre- and post-program, and 6-months follow up. Program impact was measured by paired t-tests (24 participants) and repeated measures ANOVA (18 participants) for 6-month follow up. Results: Twenty-four participants completed the study. Participants were 79% (19/24) male with an average age of 62.2 years old (range 33.5 -81.5) with a time since stroke of 29.7 months (range 3-123). Most participants (20/24) were community ambulators at the start of the study (six-minute walk test (6MWT) &gt; 288 m). Pre-Post Program: The six-minute walk test (6MWT) (endurance) improved by 62 ± 66 m (p&lt;0.005). The five times sit to stand test (5xSS) (strength) improved by 3.8 ± 5.8 sec (P=0.004). The Stroke Impact Scale Mobility Subscale improved by 7.3% ± 11.8%, (p=0.006), the Activities of Daily Living Subscale improved by 6.2% ± 9.9%, (p=0.006) and the Memory Subscale by 6.4% ± 14.7%, (p=0.043). Fast Walking Speed, Self-Efficacy and Exercise Outcome Expectation Scales improved with statistical significance but lacked clinical significance. No other outcomes had statistically significant changes. Six-month Follow up: At 6-month follow up, 89.5% (16/18) of participants were still exercising at least once a week. The CR program elicited statistically significant participant improvements over time in the 6MWT (p=0.001) and 5xSS (p&lt;0.001). Post-hoc analysis revealed a statistically significant improvement from pre-program to 6-month follow up in 6MWT distance (66.52 ± 53.73m, p=0.013), 5xSS (-3.44 ± 2.20s, p=0.003) but not post-program to 6 months follow up 6MWT (-5.2 ± 26.4m, p=1.00) and 5xSS (-0.24 ± 1.69s, p=1.00) demonstrating maintenance of gains, but no additional gains. Conclusions: CR elicited meaningful improvements for stroke survivors (exceeding minimal clinically important differences) in walking endurance, strength, perceived memory and perceived mobility with gains maintained for endurance and strength at 6-month follow up. CR enhances exercise habits and physical activity through structured exercise after discharge from PT and may improve community participation.