Cardiac Rehabilitation Services Research Articles

Utilizing the REDCap platform in a cardiac rehabilitation service

Utilizing online health data records helps in disseminating, organizing, and securing vital medical data, yet their availability remains scarce. To address this gap, we implemented an online database, REDCap®, in a cardiac rehabilitation service, in addition to describing the clinical profile of program patients. The electronic health record implementation was carried out across four stages, from organizational setup to record initiation. Four forms were created, with 83 input fields in total, and 75 patients were registered. The majority of patients were male, white, elderly, employed, and diagnosed with ischemic heart disease. The implementation of an online database on the REDCap electronic platform in a cardiovascular rehabilitation service enhances data security and insights into patient demographics. These patient data can promote the dissemination of the importance of this service in preventing and treating cardiovascular diseases.

Understanding adaptive tasks in cardiac rehabilitation among patients with acute myocardial infarction: a qualitative study

Background While Cardiac Rehabilitation (CR) programs have shown effectiveness in improving cardiac outcomes, there is limited understanding of how patients perceive and adapt to these interventions. Furthermore, alternative modes of delivering CR that have received positive evaluations from participants remain underexplored, yet they have the potential to enhance CR uptake. Objectives To explore the patient experience in CR programmes following Acute Myocardial Infarction (AMI) and describe their adaptive processing. Patients and Methods This qualitative study was conducted at a nationally certified centre in China between July 2021 and September 2022, encompassing three stages: in-hospital, centre-based, and home-based CR programs. Purposive sampling was used to select eligible AMI patients for in-depth semi-structured interviews. The interview outline and analytical framework were aligned with the key concepts derived from the middle-range theory of adaptation to chronic illness and the normalization process theory. The findings were reported following the Consolidated Criteria for Reporting Qualitative Research checklist. Results Forty AMI patients were recruited. Four main themes describing the process of AMI patients normalizing CR intervention were identified, including (1) experiencing CR service driving by role’s responsibilities, (2) engaging in collaborative relationship based on interpersonal trust, (3) exploring a personalized rehabilitation plan by complex integration, and (4) expecting a promised outcome to shape decision-making. Conclusion Integrated care interventions for AMI patients could benefit from a collaborative co-designed approach to ensure that CR interventions are normalized and fit into patients’ daily lives. Organizational-level CR services should align with the rehabilitation needs and expectations of patients.

Patient-reported experiences of cardiac rehabilitation services and the Country Heart Attack Prevention model of care

Background/Aims Patient-centred care is the delivery of a high-quality healthcare service that appropriately responds to the needs and preferences of patients. Addressing participants' needs and preferences in healthcare services is essential to improving patients' experiences and clinical outcomes. This article aimed to evaluate patient-reported experiences of standard cardiac rehabilitation programmes and the Country Heart Attack Prevention model of care, as well as design and standardise patient-reported experience measures. Methods This was a cross-sectional study with a multi-method analysis. Participants (n=818) ≥18 years old with cardiovascular disease who attended cardiac rehabilitation programmes across all modes of delivery before (1 January 2017 to 30 June 2021), during (1 July 2021 to 30 June 2022) and after implementation of the Country Heart Attack Prevention model (1 July 2022 to 30 December 2022) responded to the patient satisfaction surveys. Participant data from before and after implementation of the model were categorised as ‘not exposed’, while those who received cardiac rehabilitation during this period were categorised as ‘exposed’. A total of 170 participants provided qualitative feedback. Summary t-test was used to compare the means of the quantitative responses, and thematic analysis was used to generate themes from the qualitative feedback. Results The overall patient-reported satisfaction scores for those not exposed (n=685) and exposed (n=133) to the Country Heart Attack Prevention model of care were 77.1% and 85.9%, respectively (mean difference=−8.8; 95% confidence interval=−10.2, −7.4; P≤0.05). Themes for positive feedback included education and information, communication and friendly advice. Themes for improvement included follow-up duration, more face-to-face contact and waiting time. Conclusions Overall patient-reported satisfaction scores were significantly higher for participants who were exposed to the Country Heart Attack Prevention model of care compared with those who were not exposed. Addressing feedback on areas for improvement in cardiac rehabilitation services can promote attendance, completion and improved health outcomes of patients.

Implementation of Home-based Cardiac Rehabilitation Program in Patients with Coronary Artery Disease: A Literature Review

Introduction: Coronary artery disease (CAD) is the major cause of disability and death worldwide. The cardiac rehabilitation (CR) program is the management strategy for CAD patients with exercise as the main component to increase functional capacity. This program has been proven beneficial in reducing mortality and morbidity due to CAD. It also reduced the healthcare burden and improved the quality of life. Although the benefits of CR are widely proven, participation and adherence of CAD patients to this program are low. The home-based cardiac rehabilitation (HBCR) program is the strategy developed to increase the coverage of CR services. This program is equally effective as center-based cardiac rehabilitation (CBCR) and is considered safe. This review aimed to find out more about the HBCR program with a focus on its implementation in CAD patients.
 Methods: Original articles and systematic or narrative reviews were searched using PubMed, Google Scholar, and Research Gate databases. Further exploration of literature citations was also done to meet the inclusion criteria needed to explain the topic.
 Results: Compared to CBCR, the HBCR program provide comparable benefits, both in medical and functional outcomes. The HBCR program is proven to be feasible and safe with better adherence. The components of the HBCR program are generally the same as the CBCR program and direct supervision given in the CBCR program can be replaced by remote supervision through communication devices or home visits.
 Conclusion: The HBCR program can be used as an alternative to CBCR in managing patients with CAD.

Effectiveness of Cardiac Rehabilitation Services in Low- and Middle-Income Countries: A Systematic Review.

Cardiac rehabilitation (CR) is a cost-effective intervention that can reduce cardiovascular disease (CVD) morbidity and mortality by 20%. Despite the clear benefits of CR, it remains unavailable and underutilized. This study aimed to assess the effectiveness of different CR models in reducing CVD-related morbidity and mortality in low-and middle-income countries. We conducted a systematic review of studies conducted in low- and middle-income countries that assessed at least one of the three phases of CR (inpatient rehabilitation, outpatient rehabilitation in a hospital, or community setting and maintenance). The primary outcomes of interest were mortality (all-cause and CVD-specific), CVD-related morbidity, functional capacity, risk factor reduction, and quality of life (QoL). The electronic search retrieved 1,102 studies, of which 22 were retrieved and included in the review. These studies were conducted between 2011 and 2022 and the majority (18) were conducted in Asia. All studies except one were randomized controlled trials (RCTs), and all except one were conducted at a single site. The target population in most studies (16) included patients with coronary artery disease (CAD). Seven studies have incorporated digital technology. Only one study has reported a significant reduction in all-cause mortality. Thirteen studies reported data on functional capacity, and 16 on quality of life (QoL), showing statistically significant improvements. Data on risk factors, anxiety, and depression have shown mixed results. CR is effective in low- and middle-income countries, and strategies to scale it up using locally available resources tailored to the patient population should be adopted.

Assessment of on-site and remote cardiac rehabilitation in Romania

: Introduction: It is well known that cardiovascular diseases are the leading cause of death worldwide. In Romania in 2015, cardiovascular diseases led to 153.953 deaths, representing 59.3% of deaths from all causes. Most people in Romania today have an unhealthy lifestyle, characterised mainly by a poor nutritious diet, low physical activity and a lack of medical screening. Purpose: Considering these deficits of secondary prevention in the treatment line of the Romanian cardiovascular patient, we aimed through this study to assess the current access of the Romanian population to on-site and remote cardiac rehabilitation programs as well as their opinion regarding the telemedicine for future cardiovascular care modelling. Methods: It was a prospective observational study, which was carried out by means of an online questionnaire composed of 26 items. It was dispersed in the online environment, including Social Media platforms, where it was active for ten weeks. Results: Our online evaluation questionnaire had 1115 participants, with a minimum age of 18 years old, a preponderance of female sex and a predominantly urban background. The study participants were from all educational levels, from low to superior. We observed that most participants have an internet connection at home and use at least one form of technology daily, but most have never used a telemedicine service. Conclusions: In conclusion, the access of cardiovascular patients to on-site cardiac rehabilitation services is extremely low and for remote ones, it is almost non-existent. For a middle-income country like Romania with such a high incidence of cardiovascular disease, it is almost mandatory to provide publicly funded cardiac telerehabilitation services also for the future.

The effect of web-based education delivered as part of cardiac rehabilitation on healthy lifestyle behaviors, and quality of life in patients with coronary artery disease in Turkey: A randomised controlled trial

ObjectiveThis study was conducted to evaluate the effect of web-based education delivered as part of cardiac rehabilitation (CR) on healthy lifestyle behaviors, and quality of life in patients with coronary artery disease (CAD) in Turkey. MethodThis study is a randomized controlled trial. The experimental group (n = 35) received web-based education and telephone counseling for 12 weeks after discharge, while the control group (n = 35) received standard care. ResultsPost-test healthy lifestyle behaviors scale total score and total scores of all sub-dimensions except nutrition were higher in the experimental group (p < 0.05). The post-test international physical activity total score, and VAS scale scores of the experimental group and were significantly higher (p < 0.05). The number of non-smoking patients in the post-test was statistically significantly higher in the experimental group (p < 0.05). ConclusionThe results showed that web-based education delivered as part of CR in a Turkish hospital improved healthy lifestyle behaviors, physical activity level, and quality of life in CAD. Practice ImplicationsOur study proved that web-based education delivered as part of CR, nurse follow-up, and telephone counseling services may be effective tools for CAD patients to adhere to healthy lifestyle behaviors, and to promote quality of life and smoking cessation.

Randomised control trial of a novel digital system to provide contextualised data feedback to augment physical activity behaviour change in a free-living environment as part of cardiac rehabilitation

Abstract Background Physical activity (PA) is a core component of cardiac rehabilitation (CR) and is crucial for enhancing cardiovascular (CV) fitness[1]. In the UK, CR programmes involve 1-2 hours of face-to-face contact per week over 6-8 weeks, implying that 98-99% of the intervention period is currently unmonitored and not optimised for potential positive lifestyle interventions. Consequently, CR staff are blind to PA that occurs outside of the clinical setting, which could be of too low or high intensity and/or duration, according to the Association of Certified Physiotherapists in Cardiac Rehabilitation (ACPICR) guidelines[2]. A previous pilot study showed a novel digital system to be feasible, acceptable and effective for CR patients[3], making it a promising intervention to assess in a randomised control trial (RCT). Purpose To conduct a RCT to examine whether contextualised data feedback delivered using a novel digital service, in conjunction with usual care (UC) promotes positive PA behavioural change, with direct comparison to UC alone. Methods This prospective, parallel group, open-label, RCT enrolled 130 patients eligible for CR and consisted of an 8-week intervention period with follow-up at 8-weeks. The intervention group received the novel digital CR service plus UC, with the control group receiving UC alone. The primary outcome was changes in PA to achieve the ACPICR guidelines. Both groups wore a PA monitor to collect minute-level energy expenditure data that underwent processing using a patented method to extract the specific PA metrics required for analysis. The secondary outcome was changes in CV fitness between pre and post assessments, measured using Incremental Shuttle Walk Test (ISWT). Results Patient characteristics are shown in Table 1. Adherence to data collection was good, with an average of 37 complete days (≥768 minutes per day) of PA data per person. Fifty-six intervention group patients and 49 control group patients were analysed for the primary outcome. A significant difference (p&amp;lt;0.025) in the probability of achieving the ACPICR ‘Daily Activity’ guideline was found between groups, with the intervention group more likely to achieve the guideline at week-8 versus control. Despite Covid-19 challenges, pre and post ISWT measurements were obtained for 33 intervention group patients and 37 control group patients. No significant differences between groups were found. However, the average improvement seen in the intervention group, +89 metres (m), exceeded the minimum clinically important difference for the ISWT (+70 m), and was more than double that seen in the control group, +44 m. Conclusion This RCT builds on previous evidence supporting the use of the novel digital service in CR[3]. Engagement with, and completion of, the digital CR service was excellent. Participation was associated with statistically significant improved PA in relation to ACPICR guidelines and clinically important increases in CV fitness versus UC alone.Table 1

Expanding access to telehealth in Australian cardiac rehabilitation services: a national survey of barriers, enablers, and uptake.

Cardiac rehabilitation (CR) is traditionally delivered in-person; however, the COVID-19 pandemic provided impetus for alternative offerings such as telehealth. We investigated uptake, barriers, and enablers in a national survey during the pandemic in Australia. We surveyed CR programmes between April and June 2021 using professional association networks. The anonymous online questionnaire addressed programme characteristics, COVID-19 impacts, and barriers to and enablers of telehealth use. Open-text responses were coded and presented as themes. In total, there were responses from 105 programmes (33% response rate). All states and geographical areas were represented. The use of every modality of telehealth care (telephone, video conferencing, text messaging, and web-based) increased significantly during and after COVID with a strong preference for telephone (85% of services). Respondents perceived video (53%) and telephone (47%) formats as safe and effective for delivering CR. The most common barriers to telehealth were difficulties conducting assessments and reduced engagement with patients. Prominent enablers were increased reach and reduced patient barriers to CR access. Telehealth use by CR programmes increased during the peak pandemic period. However, additional support is required to ensure that telehealth services can be maintained. There is considerable potential to increase the reach of CR by embedding telehealth into existing models of care.

The Prevention and Cardiac Rehabilitation Group of the Saudi Heart Association Recommendations Regarding Establishing a Cardiac Rehabilitation Service.

Cardiac rehabilitation (CR) is a cornerstone in the secondary prevention of cardiovascular disease (CVD). Comprehensive cardiac rehabilitation has obtained the highest class of recommendation and the level of evidence for the treatment of patients with ST-segment elevation myocardial infarction, after myocardial revascularization, with chronic coronary syndromes, and in patients with heart failure (HF). Comprehensive cardiac rehabilitation should be implemented as soon as possible, be multi-phasic, and adjusted to the individual needs of the patient. CR is still suboptimally used, and many cardiac centers do not have such services (2). The provision of CR services should be based on standards and key performance indicators, and guidelines containing a minimum standard of cardiac rehabilitation utilization should be published to improve the quality of the CR program. This document presents an expert opinion that summarizes the current medical knowledge concerning the goals, target population, organization, clinical indications, and implementation methods of the CR program in the Kingdom of Saudi Arabia.

Understanding cardiac rehabilitation delivery in Scotland during the COVID-19 pandemic: lessons for the future

Background/Aims Cardiac rehabilitation services were disrupted during the early stages of the COVID-19 pandemic because of limitations on interpersonal contact, exercise facility closures and clinical service reorganisation. This necessitated urgent service redesign. The authors aimed to understand the changes to cardiac rehabilitation service delivery in Scotland, the impacts on staff and participant experiences, and implications for future delivery. Methods A concurrent mixed-methods study was conducted between April and December 2021. A quantitative online survey compared service provision before the pandemic (21 March 2019 to 20 November 2019) with provision after the onset of the pandemic (21 March 2020–20 November 2020). Quantitative data were analysed descriptively. Semi-structured telephone interviews were conducted with cardiac rehabilitation professionals and participants. These qualitative data were thematically analysed using the framework approach. Results Representatives (n=11) from 11 services completed the survey, while 11 staff and 17 patients completed the interviews. Services reported staffing reductions, delayed initial patient contact, replacement of face-to-face rehabilitation with telephone and online support, compromised initial assessments and reduced exit assessments. Patients relied more heavily on cardiac rehabilitation staff as a result of reduced access to other health professionals, and experienced issues with continuity of care. Technology presented remote service opportunities, but challenges around poor access to systems and technological literacy issues created barriers to service delivery. Service evaluation data were inaccessible. Conclusions Scottish cardiac rehabilitation services were adversely impacted by the COVID-19 pandemic and responded by developing remote options. These can be enhanced by screening patients to assess their access to technology and identify any literacy issues, as well as developing online educational videos and downloadable resources. Staff education is needed to encourage use of technology, including exercise monitoring via wearables. A national audit is required to assess delivery and outcomes.

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.

Spontaneous coronary artery dissection in cardiac rehab: an exploration of lived experiences of patients and the knowledge, understanding, and perceptions of healthcare professionals

Abstract Funding Acknowledgements Type of funding sources: None. Background Spontaneous coronary artery dissection (SCAD) is a non-atherosclerotic type of cardiovascular disease (CVD) that affects young and middle-aged women more than men. Many aspects of SCAD, however, remain unclear, including the outcomes of cardiac rehabilitation (CR) and the lived experiences of people with this condition in the programme. Furthermore, the awareness and knowledge of healthcare professionals (HCPs) regarding SCAD may be an important factor in determining patient engagement with rehabilitation services. A longitudinal study examining changes in physical and mental health outcomes of patients with SCAD is yet to be performed. Similarly, an in-depth exploration of HCPs' perspectives on SCAD is also needed. Objectives The objectives of this project are to understand the lived experiences of patients with SCAD, examine the knowledge of HCPs about the management of SCAD, and analyse the outcomes of CR on physical activity, diet, body mass index, waist circumference, stress, anxiety, depression and health-related quality of life upon completion of phase III and phase IV CR, and a year post-event. Methods A mixed-methods longitudinal observational study will be performed with four time points (pre-phase III CR, post-phase III CR, post-phase IV CR, and a year follow-up after SCAD event). Lived experiences of both male and female patients with SCAD, their pathways of care and barriers to engagement to CR will be explored through semi-structured interviews. Physical activity (short-form IPAQ questionnaire), dietary intake, anthropometric measures (waist circumference and body mass index), stress (PSS-10 questionnaire), anxiety (GAD-7 questionnaire), depression (PHQ-9 questionnaire) and health-related quality of life (EQ-5D-5L questionnaire) will be assessed at each timepoint. Patients with SCAD who are not engaged with CR will be used as a control group. Outcome measures will be compared between two groups using a mixed model ANOVA (time x intervention). A qualitative cross-sectional study using semi-structured interviews with HCPs will explore their understanding and management of SCAD. Discussion: The findings of this project will indicate weather current CR needs are met in this patient group and what changes need to be made to existing CR services to improve uptake in patients with SCAD. This could lead to a larger clinical trial that examines the effectiveness of tailored CR for this group of patients. Additionally, the information received from HCPs will indicate if there is an unmet educational need regarding SCAD, which may ultimately lead to better recognition, medical and lifestyle management for this patient group.

Patients’ Need for Sexual Counseling in the Cardiac Rehabilitation Service

Objective: To evaluate the need for sexual counseling among patients with heart disease Materials and Methods: Data were collected from 363 patients with heart disease attending a cardiac rehabilitation outpatient clinic. Participants completed the questionnaire independently. Results: The participants consisted of 241 males (66.4%) and 122 females (33.6%) with a mean age of 57.69±14.50 years. Among them, 248 (68.3%) were married. Most participants (91.2%) agreed that healthcare providers should offer sexual counseling to all heart patients of reproductive age, and they wanted their healthcare providers to initiate the counseling. Factors related to the need for counseling were being male (OR=2.07; 95% CI =1.05-4.07), being married (OR=2.04; 95% CI =1.03-4.05) and being 50 years of age or younger (OR 9.05; 95%CI =2.06-39.82). The main obstacles affecting conversations about sexual activity with healthcare providers were feeling embarrassed (45.7%), being physically impaired (45.4%), and having a third person present during counseling (44.9%). Conclusion: Most patients with heart disease want to receive counseling on how to safely resume sexual activity following their illness. They expect healthcare providers to initiate such counseling during visits to cardiac rehabilitation clinics. It is crucial that healthcare providers provide counseling in a format that is tailored to the needs and preferences of each patient.

Identification of Needs and Preferences of Women in Rural Australia to Co-design an Existing Web-based Cardiac Rehabilitation service: The Cardiac Rehabilitation Especially for Women (CREW) Project

Identification of Needs and Preferences of Women in Rural Australia to Co-design an Existing Web-based Cardiac Rehabilitation service: The Cardiac Rehabilitation Especially for Women (CREW) Project

Health Care Implications of the COVID-19 Pandemic for the Cardiovascular Practitioner.

There has been substantial excess morbidity and mortality during the COVID-19 pandemic, not all of which was directly attributable to SARS-CoV-2 infection, and many non-COVID-19 deaths were cardiovascular. The indirect effects of the pandemic have been profound, resulting in a substantial increase in the burden of cardiovascular disease and cardiovascular risk factors, both in individuals who survived SARS-CoV-2 infection and in people never infected. In this report, we review the direct effect of SARS-CoV-2 infection on cardiovascular and cardiometabolic disease burden in COVID-19 survivors as well as the indirect effects of the COVID-19 pandemic on the cardiovascular health of people who were never infected with SARS-CoV-2. We also examine the pandemic effects on health care systems and particularly the care deficits caused (or exacerbated) by health care delayed or foregone during the COVID-19 pandemic. We review the consequences of: (1) deferred/delayed acute care for urgent conditions; (2) the shift to virtual provision of outpatient care; (3) shortages of drugs and devices, and reduced access to: (4) diagnostic testing, (5) cardiac rehabilitation, and (6) homecare services. We discuss the broader implications of the COVID-19 pandemic for cardiovascular health and cardiovascular practitioners as we move forward into the next phase of the pandemic.

The role of tele-rehabilitation in post-myocardial infarction populations during the covid-19 pandemic in a tertiary care centre

Abstract Funding Acknowledgements Type of funding sources: None. Background The role of teleconsultation has been highly valued for health care professionals in cardiovascular field in recent years as the ongoing Covid-19 pandemic has affected the face-to-face patient visits to specialist heart centres. Moreover, the cardiac rehabilitation is the key element of post-coronary care, and the role of remote real-time tele-rehabilitation would play a promising future for post-myocardial ischaemia patient populations during the covid-19 crisis. (1) Purpose Our primary aim was to study the role of tele-rehabilitation on long-term patient safety and positive compliance rates. Further objectives were to understand the reasons for patient satisfaction following remote consultation. Methods A total of 50 patients were enrolled into cardiac rehabilitation clinics from 1st April 2022 to 31st October 2022. Out of them,40 attended virtual tele-rehabilitation service due to ongoing covid-19 pandemic. The study questionnaire was created upon the level of perception of patient satisfaction in three domains, including easy access to remote consultations, positive compliance and quality of overall teleconsultation especially the voice quality, and delivery of exercise regimes with remote control. A final survey of patient satisfaction was recorded from the day patients receiving the first virtual appointment up to next 6 weeks remote consultations. Results It was found that 32 out of 40 patients (80%) received a positive response upon overall virtual consultations and tele-rehabilitation services. In 8 (20%) of the 40 patients who did not meet the level of satisfaction, the main reasons were lack of clear instructions among exercise regimes and poor explanation of patient concerns during the remote tele-rehabilitation sessions. However, we identified the main reasons for which positive satisfaction in virtual rehabilitation sessions, and these revealed reduced patient waiting times, avoidance of infection risks in vulnerable post-coronary intervention patient groups and flexible accessibility for varieties of cardiac tele-rehabilitation sessions during the ongoing covid-19 crisis. (3) Conclusion The implementation of remote real-time consultations in cardiac rehabilitation services has led to significant improvement in patient quality of care especially reduced patient waiting times, and cost-effectiveness due to flexible opportunities for tele-exercise sessions. Moreover, it can provide speedy, focused interaction on specific issues of care during the post-coronary rehabilitation periods, often circumventing the need for patient travel. (2)

Cardiac Rehabilitation in Coronary Artery Disease: Improving Outcomes and Adherence

Cardiac rehabilitation (CR) is a program that aims to improve the cardiovascular health of patients with coronary artery disease (CAD) through a multidisciplinary approach. CR typically includes exercise training, risk factor modification, psychosocial support, and education. Studies have shown that CR can improve exercise capacity, reduce angina symptoms, enhance overall quality of life, and reduce the risk of recurrent cardiovascular events. Despite the benefits of CR, adherence remains a challenge, and many patients with CAD do not participate in these programs. Strategies to improve adherence to CR include patient education, personalized goal setting, motivational interviewing, and peer support. Encouraging and supporting patients with CAD to participate in CR programs is crucial for the secondary prevention and long-term management of their condition. CR programs are typically supervised by healthcare professionals, such as cardiac rehabilitation specialists, exercise physiologists, and dietitians, who work together to develop personalized treatment plans for each patient. Exercise training is a key component of CR, and programs may involve aerobic and resistance training, as well as other forms of physical activity such as yoga or tai chi. Risk factor modification focuses on controlling blood pressure, reducing cholesterol levels, managing diabetes, and promoting smoking cessation. Psychosocial support and education may include counseling, stress management, and education on nutrition and medication management. While CR programs are effective, access to these programs may be limited for some patients, particularly those in underserved communities or rural areas. Tele-rehabilitation, which uses technology to provide remote delivery of CR services, has shown promise in increasing access to CR for patients who may not have access to traditional in-person programs. Overall, CR is a vital component of the management of CAD, and its benefits extend beyond cardiovascular health to include improvements in overall quality of life. It is important to raise awareness about the importance of CR and to work towards increasing access to these programs for all patients with CAD. J Medicine 2023; Vol. 34, No. 2(1) Supplement: 213

Optimal outcomes from cardiac rehabilitation are associated with longer-term follow-up and risk factor status at 12 months: An observational registry-based study

AimThe purpose of Cardiac Rehabilitation (CR) is to promote and reduce risk factors in the short and long term, however, the latter has, to date, been poorly evaluated. We explored characteristics associated with provision and outcomes of a long-term assessment in CR. MethodData from the UK National Audit of CR between April 2015 and March 2020 was used. Programmes were selected if they had an established mechanism and routine methodology to collect the 12-month assessments. Risk factors pre and post phase II CR and at the 12-month assessment were explored; BMI ≤30, ≥150 min of physical activity per week, hospital anxiety and depression scale (HADS) scores <8. The data came from 32 programmes, 24,644 patients with coronary heart disease. Patients being in at least one optimal risk factor stage throughout phase II CR (OR = 1.43 95% CI 1.28 to 1.59) or successfully reaching an optimal stage during phase II CR (OR = 1.61 95% CI 1.44 to 1.80) had an increased likelihood of being assessed at 12 months compared to those who did not. Patients being in the optimal stage upon completion of phase II CR had an increased likelihood of still being in the optimal stage at 12 months. Most prominent was BMI; (OR = 14.6 (95% CI 11.1 to 19.2) for patients reaching an optimal stage throughout phase II CR. ConclusionBeing in an optimal stage upon routine CR completion could be an overlooked predictor in the provision of a long-term CR service and prediction of longer-term risk factor status.

Editorial: Cardiac Rehabilitation; An Essential Component of Cardiovascular Disease Management

Cardiovascular disease (CVD) is a significant global health issue and remains a leading cause of mortality worldwide. According to the World Health Organization (WHO), CVD is responsible for approximately 17.9 million deaths annually, accounting for 31% of all global deaths (1). However, the good news is that many CVD risk factors are modifiable, and lifestyle interventions can significantly reduce the incidence and progression of CVD. Cardiac rehabilitation (CR) is a comprehensive program that includes exercise, education, and behavioral interventions to help individuals with CVD recover and improve their quality of life.&#x0D; CR has been shown to improve functional capacity, reduce symptoms, decrease hospitalizations, and increase survival rates in patients with CVD (2-3). Exercise training is a key component of CR and has been shown to improve cardiovascular fitness, decrease blood pressure, and reduce insulin resistance (4). In addition, education and counseling regarding medication adherence, smoking cessation, and nutrition can help patients better manage their disease and improve their overall health (5).&#x0D; Despite the proven benefits of CR, participation rates remain low. Many patients are not referred to CR by their healthcare providers, and those who are referred may face barriers such as lack of transportation, cost, or lack of social support (6). In addition, there is a shortage of trained professionals to deliver CR programs, particularly in rural or underserved areas (7).&#x0D; To address these issues, healthcare providers should prioritize CR as an essential component of CVD management and ensure that all eligible patients are referred to CR programs. Public health campaigns and education initiatives can also help increase awareness of the benefits of CR among patients and healthcare providers (8). Finally, policymakers should allocate resources to improve access to CR, particularly in underserved areas, and promote reimbursement for CR services (9).&#x0D; One of the challenges in promoting CR is the perception that it is primarily for older individuals who have already had a cardiac event. However, CR is beneficial for a much wider range of patients, including those with heart failure, peripheral arterial disease, and those who have undergone cardiac surgery or percutaneous coronary intervention (10). Additionally, CR can help prevent future cardiac events in individuals who are at high risk due to their family history, lifestyle choices, or other factors.&#x0D; Another challenge is ensuring that CR programs are tailored to the needs of individual patients. CR programs should take into account a patient's medical history, age, fitness level, and personal preferences. In addition, CR programs should be culturally sensitive and tailored to meet the needs of diverse populations. This can include providing materials in multiple languages, incorporating cultural preferences into dietary recommendations, and ensuring that CR programs are accessible to individuals with disabilities or other special needs.&#x0D; Finally, technology can play a critical role in expanding access to CR. Telemedicine and mobile health applications can allow patients to participate in CR programs from home or remote locations. These technologies can also facilitate communication between patients and healthcare providers, improve medication adherence, and provide patients with real-time feedback on their progress (11).&#x0D; In conclusion, CR is an essential component of CVD management and can significantly improve outcomes for patients with CVD. Healthcare providers, policymakers, and patients should work together to ensure that CR is widely available and accessible to all those who need it. By doing so, we can reduce the burden of CVD and improve the overall health and well-being of our communities.&#x0D; &#x0D; Keywords: Cardiac rehabilitation, cardiovascular disease, lifestyle modification