Cardiovascular Rehabilitation Program Research Articles

Cardiovascular complications in COVID-19: acute management, long-term sequelae, and post-acute care strategies: a brief review

Background: The COVID-19 pandemic, driven by the SARS-CoV-2 virus, has significantly impacted individuals with pre-existing cardiovascular disease (CVD), elevating their risk of severe complications and mortality. Cardiovascular complications, such as myocarditis, acute coronary syndrome (ACS), arrhythmias, and venous thromboembolism (VTE), have been widely observed in COVID-19 patients, with mechanisms including viral myocardial injury, systemic inflammation, and a hypercoagulable state. These complications not only contribute to acute morbidity but also increase the risk of long-term cardiovascular sequelae, highlighting the need for optimized post-acute care in this population. Methods and Materials: A review was conducted based on a comprehensive search strategy using the PICO framework. Studies published from December 2019 onwards, focusing on COVID-19 patients with cardiovascular complications, were identified from databases including PubMed and Google Scholar. Objectives: This review aims to evaluate the cardiovascular complications of COVID-19, with particular attention to the acute and long-term management strategies. It seeks to assess whether comprehensive post-acute care programs tailored to cardiovascular health can reduce the incidence of long-term cardiovascular events and improve outcomes compared to standard care in COVID-19 survivors with pre-existing CVD. Discussion: The findings from this review underscore the significant cardiovascular burden faced by COVID-19 patients, particularly those with pre-existing conditions. Acute complications such as myocarditis, ACS, and VTE are common, with direct myocardial injury and systemic inflammation playing critical roles. Long-term sequelae, including persistent myocardial injury, heart failure, and arrhythmias, are increasingly being recognized, necessitating specialized post-acute care interventions. Evidence suggests that comprehensive cardiovascular rehabilitation programs incorporating lifestyle modification, pharmacotherapy optimisation, and regular monitoring may improve long-term outcomes. However, further research is required to establish the most effective management strategies, particularly for high-risk groups, such as patients with pre-existing CVD and pediatric populations.

Dynamics of cardio-muscular networks in exercise and fatigue.

A fundamental question in cardiovascular and muscle physiology is how the heart operates in synchrony with distinct muscles to regulate homeostasis, enable movement and adapt to exercise demands and fatigue. Here we investigate how autonomic regulation of cardiac function synchronizes and integrates as a network with the activity of distinct muscles during exercise. Further, weestablish how the network of cardio-muscular interactions reorganizes with fatigue. Thirty healthy young adults performed two body weight squat tests until exhaustion. Simultaneous recordings were taken of a 3-lead electrocardiogram (EKG) along with electromyography (EMG) signals from the left and right vastus lateralis, and left and right erector spinae. We first obtained instantaneous heart rate (HR) derived from the EKG signal and decomposed the EMG recordings in 10 frequency bands (F1-F10). We next quantified pair-wise coupling (cross-correlation) between the time series for HR and all EMG spectral power frequency bands in each leg and back muscle. We uncovered the first profiles of cardio-muscular network interactions, which depend on the role muscles play during exercise and muscle fibre histochemical characteristics. Additionally, we observed a significant decline in the degree of cardio-muscular coupling with fatigue, characterized by complex transitions from synchronous to asynchronous behaviour across a range of timescales. The network approach we utilized introduces new avenues for the development of novel network-based markers, with the potential to characterize multilevel cardio-muscular interactions to assess global health, levels of fatigue, fitness status or the effectiveness of cardiovascular and muscle injury rehabilitation programmes. KEY POINTS: The heart operates in synchrony with muscles to regulate homeostasis, enable movement, and adapt to exercise demands and fatigue. However, the precise mechanisms regulating cardio-muscular coupling remain unknown. This study introduces a pioneering approach to assess cardio-muscular network interactions by examining the synchronization of cardiac function with muscle activity during exercise and fatigue. We uncover the first profiles of cardio-muscular interactions characterized by specific hierarchical organization of link strength. We observe a significant decline in the degree of cardio-muscular coupling with fatigue, marked by complex transitions from synchronous to asynchronous behaviour. This network approach offers new network-based markers to characterize multilevel cardio-muscular interactions to assess global health, levels of fatigue, fitness status or the effectiveness of cardiovascular and muscle injury rehabilitation programmes.

Motivational and emotional correlates of physical activity and sedentary behavior after cardiac rehabilitation: an observational study

BackgroundThe present study assessed physical activity (PA) and sedentary behavior (SB) levels and their motivational and emotional health-related correlates, in outpatients following a cardiovascular rehabilitation (CR) program, and compared these variables with those of a healthy control group.MethodsThe study included 119 participants: 68 CR outpatients (Mage 57.76 ± 10.76; 86.76% males) and 51 control participants matched on age (Mage 57.35 ± 6.33 years; 45.10% males). PA and SB were assessed using accelerometers during the first week post-discharge for outpatients and during a typical week for controls. Motivational (i.e., perceived capabilities, affective and instrumental attitudes, intention, approach-avoidance tendencies) and emotional health-related variables (i.e., anxiety, depressive symptoms, fatigue, pain intensity) were measured using validated scales. PA and SB data from 17 outpatients and 42 controls were valid for analysis, resulting in a final sample of 59 participants.ResultsCR outpatients engaged an average of 60.21 (± 34.79) min of moderate-to-vigorous PA (MVPA), and 548.69 (± 58.64) min of SB per day, with 18 more minutes of MVPA per day than controls (p = .038). Univariate and multivariate regressions indicated that positive affective attitudes were associated with higher MVPA (b = 10.32, R2 = 0.07, p = .029), and that males spent more time in SB than females (b = 40.54, R2 = 0.09, p = .045). Univariate and multivariate logistic regressions showed that meeting the World Health Organization’s weekly guidelines for MVPA was associated with higher perceived capabilities toward PA and more positive affective attitudes (OR = 1.17, p = .030; OR = 1.26, p < .001, respectively). Interaction tests showed no significant differences in these results between outpatients and controls.ConclusionThe study highlights an association between higher perceived capabilities and positive affective attitudes toward PA with higher PA levels after outpatient CR. While these findings suggest that enhancing these motivational variables may be beneficial for increasing PA levels after CR, longitudinal and experimental studies are needed to further establish their role.

Cardiotoxicity in Oncology: Prevention and Management Through Cardiovascular Rehabilitation

Abstract With advancements in screening, diagnosis, and treatment, cancer-related mortality is declining, and life expectancy for cancer patients is increasing by up to 30%. However, these patients often face increased cardiovascular risks due to hypertension, metabolic syndrome, and type 2 diabetes, as well as the cardiotoxic effects of cancer therapies. Chemotherapy drugs like anthracyclines, trastuzumab, and 5-fluorouracil can hurt the heart through oxidative stress, apoptosis, and mitochondrial dysfunction. This can cause heart failure, coronary heart disease, and arrhythmias, among other problems. Cardiovascular rehabilitation (CR) has emerged as a key strategy to mitigate these effects. Studies involving breast cancer patients and other cancer populations have demonstrated that CR programs, involving high-intensity interval training and moderate-intensity exercises, improve cardiorespiratory fitness and reduce cardiovascular risks in cancer patients. Despite challenges such as patient reluctance due to distance from specialized centers, telerehabilitation has proven to be a viable alternative. CR not only improves peak VO2 but also reduces systemic inflammation and promotes muscle mass gain while lowering mortality and healthcare costs associated with post-cancer therapy complications. Multidisciplinary involvement-integrating cardiologists, oncologists, psychologists, and nutritionists-enhances outcomes, improving both cardiac fitness and quality of life for cancer patients. Further research highlights the need for early intervention and customized CR programs to minimize cardiovascular toxicity and optimize patient recovery post-chemotherapy.

The role of physical exercise in modifying cardiovascular parameters in hypertensive patients

Hypertension is among the top risk factors for cardiovascular diseases. Diversified rehabilitation programs are needed to limit the progression of the high blood pressure condition. The welfare of aquatic therapy is acknowledged, but hydrotherapeutic procedures are rarely used in cardiovascular diseases. The study aims to assess the impact of an exhaustive hydro-kinetic thermo therapeutic program compared to other methods of treatment, i.e., cardiovascular rehabilitation program, recommendation for a healthy life, and antihypertensive medication. Four groups of patients (46 years ±0,32) diagnosed with hypertension participated in four different rehabilitation programs to analyze the impact on their effort capacity. Their ability to achieve average effort without the appearance of fatigue symptoms was studied for a period of eight weeks by monitoring six parameters: systolic blood pressure (SBP), diastolic blood pressure (DBP), Borg Scale, Medical Research Council Dyspnoea Scale (MRC-DS), pulse (P) and oxygen saturation (O2). Group A, which benefited only of recommendations for a healthy life, didn’t register any significant p values between the initial and final evaluation; group B, which had medications and recommendations for a healthy life, registered significant p values for 2 parameters (SBP and P have p&lt;0.0001); group C, which took part in a cardiovascular rehabilitation program, obtained significant p values for 5 parameters (SBP, DBP, Borg, MRC-DS and O2 have p&lt;0.0001); Group D, the recipient of hydrotherapeutic program, registered significant p values for all statistically 6 monitored parameters (SBP, DBP, Borg, MRC-DS, P and O2 have p&lt;0.0001). Physical activity in water performed regularly within a controlled therapeutic program with the thermal and electrotherapy components, leading to improved capacity for the effort by decreasing blood pressure values and dyspnea parameters.

Cardiovascular Rehabilitation Program and Its Effect on Cardiac Coherence.

The Article Abstract is not available.

Effectiveness of Cardiac Rehabilitation in Enhancing Clinical Outcomes for Coronary Artery Disease: A Systematic Analysis.

Cardiac rehabilitation (CR) is a structured intervention aimed at improving the clinical outcomes for patients with coronary artery disease (CAD). This systematic review assesseshow well different types of CR, such as high-intensity interval training (HIIT), moderate-intensity continuous training (MICT), Nordic walking (NW), and home-based cardiac rehabilitation (HBCR), improve exercise capacity, quality of life, and lower death and illness rates. The objective is to assess the effectiveness of cardiovascular rehabilitation programs in enhancing clinical outcomes for patients diagnosed with CAD. A comprehensive literature search was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) model across Google Scholar, EMBASE, PubMed, Medline, and web browsers. Keywords such as "cardiac rehabilitation," "coronary artery disease," "exercise testing," "VO2 peak," and "physical activity" were used in different combinations. Studies were included if they were randomized controlled trials, observational studies, or longitudinal studies published after 2013 in English, with a focus on the impact of CR on CAD. Articles were excluded if they were reviews, meta-analyses, or did not meet the keyword requirements. A total of 375 articles were initially identified with relevant citations. After further screening, 10 studies met the inclusion criteria for analysis. The studies reviewed demonstrated that all forms of CR, including HIIT, MICT, NW, and HBCR, significantly improved exercise capacity and quality of life, and reduced depression severity among CAD patients. Nordic walking showed marked improvements in functional capacity, while HIIT resulted in higher VO2 peak levels compared to moderate-intensity exercise. Home-based CR showed greater adherence rates, especially among older patients and those with strong family support. The results also highlighted the importance of individualized exercise programs to enhance adherence and outcomes. Cardiac rehabilitation is a vital component of secondary prevention in CAD patients, significantly improving clinical outcomes, including exercise capacity, quality of life, and mortality rates. The findings underscore the importance of maintaining and expanding access to CR programs and tailoring interventions to patient needs to optimize long-term health outcomes. Future research should explore the comparative effectiveness of different CR modalities and strategies to increase patient adherence.

Long-term attendance and dropout rates in a phase 3 cardiovascular rehabilitation program: differences between men and women

Long-term attendance and dropout rates in a phase 3 cardiovascular rehabilitation program: differences between men and women

Effets médiateurs de la symptomatologie de stress post-traumatique et des symptômes de dissociation somatoforme sur la relation entre l’attachement et la qualité de vie liée à la santé après un infarctus du myocarde

Myocardial infarction (MI) is a particularly frequent coronary disease: the number of new cases of MI recorded each year amounts to nearly 90,000 in France and nearly 790,000 in the United States. Over the past 15 years, the number of people who can survive this major cardiac event has substantially increased, as a result of advances in medical treatment and a reduction in delay to intervention. However, patients often report a decrease in their health-related quality of life following myocardial infarction. In other words, some patients perceive that the disease negatively affects various aspects of their daily lives, including physical functioning, emotional state, social relationships, and overall well-being. Furthermore, studies have shown that health-related quality of life is a prognostic indicator of the evolution of patients’ health status: the more health-related quality of life is reduced, the greater the risk of all-cause mortality, recurrence of cardiovascular events, and re-hospitalization for heart disease. In view of these elements, the identification of potentially modifiable factors, and in particular psychological factors, having an impact on health-related quality of life is particularly relevant. More specifically, insecure attachment, post-traumatic stress symptomatology and somatoform dissociation symptoms could have an impact on the health related-quality of life of people who have experienced a major cardiac event. ObjectivesThe objective of this study was to investigate the mediating role of posttraumatic stress symptoms and somatoform dissociative symptomatology in the relationship between insecure attachment and health related-quality of life after a myocardial infarction. Materials and methodsA total of 73 participants, having suffered a myocardial infarction and participating in a cardiovascular rehabilitation program, completed questionnaires to assess the degree of insecurity of their attachment (Experiences in Close Relationship Scale-12; ECR-12), the severity of post-traumatic stress symptoms (Post-Traumatic Stress Disorder Checklist Scale; PCL-5) and somatoform dissociation symptoms (Somatoform Dissociation Questionnaire; SDQ-20), and their health related-quality of life (MacNew Heart Disease-Health Related Quality of Life; MacNew). Mediation analyses were conducted according to the recommendations formulated by Baron and Kenny. ResultsOur results showed that only anxious attachment was positively and significantly associated with the severity of posttraumatic stress symptomatology, whereas such a link was not observed for avoidant attachment. The importance of posttraumatic symptomatology fully explained why individuals with high levels of fear of abandonment also have the poorest emotional, physical, and social quality of life after myocardial infarction. The importance of dissociative somatoform symptomatology partially explained why individuals with an insecure attachment style characterized by a high level of abandonmen were also those with the poorest health-related quality of life following myocardial infarction. ConclusionsThe results of this study tend to demonstrate the importance of taking into account the specificities of attachment, posttraumatic stress symptoms and somatoform dissociation phenomena in the context of interventions aimed at improving the health related-quality of life of people after a myocardial infarction. Insofar as secure attachment appears to be a protective factor against the risk of developing posttraumatic stress disorder, a psychotherapeutic approach aimed at promoting this form of attachment seems to be well justified. Specifically, it may be helpful to provide patients with a psychotherapeutic framework that takes into account their attachment experiences to allow them to change their beliefs about themselves and others, while helping them develop coping strategies appropriate to the stress. Psychotherapeutic interventions aimed jointly at increasing of the degree of attachment security and reducing the symptoms of posttraumatic stress and somatoform dissociation could be relevant to improve the health-related quality of life after a myocardial infarction.

Hybrid Cardiac Rehabilitation Program in a Low-Resource Setting

While effective, cardiovascular rehabilitation (CR) as traditionally delivered is not well implemented in lower-resource settings. To test the noninferiority of hybrid CR compared with traditional CR in terms of cardiovascular events. This pragmatic, multicenter, parallel arm, open-label randomized clinical trial (the Hybrid Cardiac Rehabilitation Trial [HYCARET]) with blinded outcome assessment was conducted at 6 referral centers in Chile. Adults aged 18 years or older who had a cardiovascular event or procedure, no contraindications to exercise, and access to a mobile telephone were eligible and recruited between April 1, 2019, and March 15, 2020, with follow-up until July 29, 2021. Participants were randomized 1:1 in permuted blocks to the experimental arm, which received 10 center-based supervised exercise sessions plus counseling in 4 to 6 weeks and then were supported at home via telephone calls and text messages through weeks 8 to 12, or the control arm, which received the standard CR of 18 to 22 sessions with exercises and education in 8 to 12 weeks. The primary outcome was cardiovascular events or mortality. Secondary outcomes were quality of life, return to work, and lifestyle behaviors measured with validated questionnaires; muscle strength and functional capacity, measured through physical tests; and program adherence and exercise-related adverse events, assessed using checklists. A total of 191 participants were included (mean [SD] age, 58.74 [9.80] years; 145 [75.92%] male); 93 were assigned to hybrid CR and 98 to standard CR. At 1 year, events had occurred in 5 unique participants in the hybrid CR group (5.38%) and 9 in the standard CR group (9.18%). In the intention-to-treat analysis, the hybrid CR group had 3.80% (95% CI, -11.13% to 3.52%) fewer cardiovascular events than the standard CR group, and relative risk was 0.59 (95% CI, 0.20-1.68) for the primary outcome. In the per-protocol analysis at different levels of adherence to the intervention, all 95% CIs crossed the noninferiority boundary (eg, 20% adherence: absolute risk difference, -0.35% [95% CI, -7.56% to 6.85%]; 80% adherence: absolute risk difference, 3.30% [95% CI, -3.70% to 10.31%]). No between-group differences were found for secondary outcomes except adherence to supervised CR sessions (79.14% [736 of 930 supervised sessions] in the hybrid CR group vs 61.46% [1201 of 1954 sessions] in the standard CR group). The results suggest that a hybrid CR program is noninferior to standard center-based CR in a low-resource setting, primarily in terms of recurrent cardiovascular events and potentially in terms of intermediate outcomes. Hybrid CR may induce superior adherence to supervised exercise. Clinical factors and patient preferences should inform CR model allocation. ClinicalTrials.gov Identifier: NCT03881150.

Efekti kardiovaskularne rehabilitacije na toleranciju fizičkog napora i kvalitet života starijih sa koronarnom arterijskom bolešću

Introduction/Aim. Cardiovascular rehabilitation (CVR) is of utmost importance in primary and (especially) in secondary prevention of coronary artery disease (CAD). The aim of our paper was to examine whether elderly patients with CAD benefit equally from CVR program as CAD patients of younger age. Methods. The study involved 1,697 patients referred to the CVR program after surviving myocardial infarction, percutaneous coronary intervention or surgical myocardial revascularization. Patients were divided in two groups: group I involved patients younger than 65 years (1099 patients, 64.76%), whereas group II comprised patients 65 years old or older (598 patients, 35.24%). At the beginning and at the end of CVR, exercise stress tests were done (EST1 and EST2). Also, the quality of life (QOL) was assessed at the beginning and at the end of CVR by validated questionnaire Short-Form 36 Health Status Survey (SF-36). The results were compared between the groups. Results. Younger patients showed better exercise tolerance on EST1 and EST2. However, both groups showed better exercise tolerance on EST2. Namely, in both groups, patients achieved higher strain level and longer duration on EST2 compared to EST1. Also, higher percentage of patients finished the test by achieving submaximal heart rate on EST2 compared to EST1. Also, our patients showed a significant improvement in all QOL areas except emotional health of patients ≥ 65 of age due to borderline statistically significant limitation. Conclusion. Our study showed that CVR improves the quality of life and physical exercise tolerance in elderly CAD patients. This is why the utilization rate and adherence of these patients to CVR programs should be vigorously encouraged.

The Impact of Comprehensive Rehabilitation on the Exercise Capacity of Patients after COVID-19.

Coronavirus Disease 2019 (COVID-19) is a complex disease that affects multiple body systems, including the respiratory, cardiovascular, neurological, and muscular systems. It is estimated that approximately half of the patients after the treatment for COVID-19 experience persistent symptoms that lead to a decreased physical capacity. Scientific recommendations suggest that cardiovascular and respiratory rehabilitation programs should be implemented in patients who have completed treatment for COVID-19. Therefore, the objective of this study was to evaluate the impact of comprehensive rehabilitation on the exercise capacity of patients after COVID-19 treatment. The study included 146 patients after the treatment for COVID-19 who were eligible for therapeutic rehabilitation. The exercise capacity was assessed using the 6-minute walk test (6MWT). The results showed that patients who underwent rehabilitation had an average increase of 23.83% in their 6MWT score compared to the baseline. A comprehensive rehabilitation program including breathing exercises, aerobic training, and strength and endurance exercises is an effective intervention that can improve the physical capacity of patients after COVID-19 treatment.

Development and Evaluation of the International Council of Cardiovascular Prevention and Rehabilitation (ICCPR) Program Certification for Low-Resource Settings.

Cardiac rehabilitation (CR) is a proven model of secondary prevention, but new sites, providing quality care, are needed in low-resource settings. This study (1) described the development of International Council of Cardiovascular Prevention and Rehabilitation's (ICCPR) Program Certification and (2a) tested its implementation, considering (b) appropriateness of quality standards for these settings. The Steering Committee finalized 13 standards, requiring 70% be met. They are assessed initially through International CR Registry (ICRR) program survey and patient data; if Certification appears possible, a two-hour virtual site assessment is arranged to corroborate. Standard operating procedures for Assessor training were developed. A multi-method pilot study was then undertaken with a quantitative (description of quality indicators) and qualitative (focus groups on MS Teams) component. ICRR sites with post-program data by April 2022 were invited to participate. Two team members independently analyzed focus group transcripts, using a deductive-thematic approach with NVIVO. Five CR programs from the Eastern Mediterranean, South-East Asian and American regions participated. Upon application, with some data cleaning, initially four programs were eligible to proceed to virtual site assessment. Ultimately, all five programs were certified, each meeting a minimum of 12/13 standards (peak MET increase and program completion rate were not met by some centres). Four themes resulted from the two focus groups of 13 site data stewards: motivation and benefits (eg, international recognition, additional program resources), logistics (eg, communication, cost, site visit process), the standards and their assessment (eg, balance of rigor and feasibility), and suggestions for improvement (eg, website). ICCPR's Program Certification has been demonstrated to be feasible, rigorous, and acceptable. Standards are attainable in low-resource settings. Certified programs reap benefits including additional resources. This first international Certification is suitable for low-resource settings, to complement that from the American and European CR Societies.

Relationship Between Handgrip Strength with the 6-Minute Walking Test Distance in Heart Failure Patients

Heart failure is a complex clinical syndrome characterized by objective evidence of an underlying structural abnormality or cardiac dysfunction that reduces the ability of the ventricles to fill or pump blood. One of the essential indicators in evaluating the condition of heart failure patients in treatment undergoing a cardiovascular rehabilitation program is an assessment of the ability to perform physical activity. Evaluation of physical activity ability can be determined through exercise capacity assessments such as the 6-minute walk test and Handgrip strength method. The aim of this study was to determine the relationship between handgrip strength and the distance travelled in a 6-minute walking test in patients with heart failure. This was a cross-sectional study of 55 heart failure patients at the Integrated Heart Center Department of RSUP Dr M. Djamil Padang from February 2022 to December 2022. Based on the Pearson correlation test, there was a statistically significant result between handgrip strength and distance in the 6-minute walking test with a P value of 0.01 (p&lt;0.05). There is a positive and statistically significant relationship between handgrips strength with a 6-minute walking test distance in heart failure patients.

Validity of nursing diagnoses/outcomes and interventions for people with heart failure

Objective: To validate the content of nursing diagnosis/outcome and intervention statements for the care of people with heart failure. Method: This is methodological study, according to the steps for building terminology subsets in Brazil. Survey conducted from 2019-2020. Statements and interventions were organized according to the mid-range theory for nursing in cardiovascular rehabilitation. Results: a total of 58 experts participated in the study. A total of 39 nursing diagnoses/outcomes and 168 interventions were validated. The statements with the highest agreement were related to rehabilitation care followed by the supervised cardiovascular rehabilitation program. Conclusion: The study validated the content of statements of a terminology subset for people with heart failure, and allowed the composition of a nursing language based on a classification system recognized worldwide.

ASSESSMENT OF THE PHYSICAL CAPABILITIES OF HEART FAILURES AFTER CARDIOVASCULAR REHABILITATION: ABOUT 125 CASES FROM FEBRUARY 2021 TO DECEMBER 2022

Objective: The objective of this work was to evaluate the effects of cardiac rehabilitation on the physical abilities of patients with heart failure, to compare the parameters of the stress test, the 6-min walk test and cardiac ultrasound before and after cardiac rehabilitation. Design and method: This is a descriptive and analytical cross-sectional study with retrospective and prospective data collection which took place from February 1, 2021 to December 31, 2022. Patients with heart failure of all etiologies combined who received an outpatient cardiovascular rehabilitation program. Data were collected on a pre-established survey form and included anamnestic, clinical, paraclinical and 6-min walk test data. Informed consent was obtained. Data analysis was performed with SPSS version 18 software. Any difference less than 0.05 was considered statistically significant. Results: During this study, the frequency of rehabilitated heart failure patients out of the total number of rehabilitated patients for all etiologies was 45.59%. The average age was 57.97 with extremes at 41 and 74 years. The most represented age group was that of 61 to 70 years (35.5%). The predominance was male with a sex ratio of 2.1. The cardiovascular risk factors found were dominated by dyslipidemia (80.6%), physical inactivity (71%), high blood pressure (41.90%) and diabetes (38.70%). The level of cardiovascular risk was high in 48.39% and very high in 35.48% of cases. Coronary disease was the main etiology of heart failure with 80.65% of cases. Systolic blood pressure increased from 126.87 to 126.42 mmhg (p = 0.91), diastolic blood pressure from 78.74 to 74.48 mmhg (p = 0.090) and resting heart rate from 79.23 bpm to 67.06 bpm (p = 0.000). The average LVEF increased from 38.75 to 45.26% (p = 0.001), the number of METS from 4.42 to 7.48 (p = 0.000), as well as the 06-minute walk test from 328 m to 470 m (p = 0.000). No deaths or rehospitalizations were observed during the study. Conclusions: The study shows that cardiovascular rehabilitation is beneficial in heart failure patients with a marked improvement in symptoms, physical capacity and quality of life.

Characteristics of women attending a phase 3 cardiovascular rehabilitation program: is there a need for a more tailored intervention?

Abstract Funding Acknowledgements Type of funding sources: None. Background Cardiovascular disease (CVD) remains the main reason for mortality in women, however there are well identified discrepancies between men and women attending cardiovascular rehabilitation (CR) programs. Men are usually more referred and have higher adherence to CR programs than women. Understanding the characteristics of women attending long-term CR programs might be useful to better adapt and motivate future women with CVD to adhere in a higher scale. Purpose To describe characteristics of women with CVD attending a long-term phase III CR program and to compare with men the attendance rates and chosen exercise modality preferences. Methods Patients with CVD in a phase III long-term CR program were screened for the following assessments: 1) cardiorespiratory fitness through cardiopulmonary exercise testing; 2) body mass index (BMI); 3) physical activity (accelerometery); 4) social, demographic variables (questionnaires); 5) attendance rates (sessions attended/sessions planned) and dropout. When admitted, CVD patients chose to attend either the supervised exercise phase III CR sessions in a face-to-face model or an online model, and if they wanted to attend 2x or 3x/week. Chi-square and independent-samples Mann-Whitney U test was used. Results From the 206 CVD patients assessed, 19.9% were women (n=41, mean age 61 ± 11 years, 70.7% coronary artery disease, 53.7% married, 73.2% higher education, 43.9% retired, 39% working full time). From the 41 women screened, 39 enrolled the CR program and 17.9% dropped out before 12 months of program completion (4 women dropped before 6 month of program completion). The main reason of dropout was due to work/CR sessions conciliation. When asked to select the exercise modality, 56.4% chose the 3x/week face-to-face model, 28.2% the 2x/week face-to-face model and 15.4% the online model. When compared to men, women tend to choose the online modality and the 2x/week face-to-face model more than men (x2= 9.298; df=2; p=0.010). Regarding baseline assessments, 63.4% of women completed the assessment for cardiorespiratory fitness (VO²peak=17.11 ± 3.71 ml/kg/min), 80.5% for BMI (29.17 ± 5.58 kg/m²) and 78% for physical activity (38.55 ± 23.88 min/day of moderate to vigorous physical activity). When comparing attendance at 6 months, women have significantly lower attendance rates than men (56.87 ± 2.86% vs 70.24 ± 1.63%, p=0.001). Conclusion The low sample of women, compared to men, in this CR program, their characteristics, types of session modalities chosen, and lower attendance rates suggests that changes in long-term phase III CR programs are needed to tackle this disparity. Individualized and personalized strategies should be created targeting this population according to their needs, motivations and characteristics. A women-tailored phase III long-term CR program, with different session modalities and schedules, might be the future path to undertake.

Attendance analysis in a phase 3 cardiovascular rehabilitation program: can behaviour regulation in exercise predict long-term attendance?

Abstract Funding Acknowledgements Type of funding sources: None. Background After a phase II cardiovascular rehabilitation (CR) program, cardiovascular disease (CVD) patients ideally continue to a phase III long-term CR program. Enrolment, attendance rates and barriers are well established for phase II or short-term CR programs (≤ 12 weeks). However, keeping CVD patients motivated and with high attendance rates (≥ 80%) in a long-term CR program (over 6 months) is more challenging. Self-Determination Theory states that more internalized types of behaviour regulation lead to feelings of self-determination and a higher behavioural adherence. Therefore, more studies analysing attendance rates and behaviour regulation of CVD patients in long-term CR programs are needed. Purpose To compare the attendance of CVD patients enrolled in a long-term CR community-based program between 3, 6 and 12 months and to assess if behavioural regulation in exercise questionnaire (BREQ-2) can predict long term attendance. Methods Patients with CVD attending for, at least, 6 months a phase III community-based CR program were selected. Enrolled patients chose to attend 60 minutes exercise CR sessions either 3 or 2 times/week. Attendance rates were calculated at 3 months, 6 months and 12 months of program completion dividing the number of sessions attended by the number of sessions planned. When admitted to the program, each patient was asked to answer BREQ-2 (19 items, 5-point lickert-type scale, 5 groups: amotivated, external, introjected, identified and intrinsic). One way ANOVA for repeated measures, paired sample t test and pearson correlations were used. Results One hundred and eighteen CVD patients (61 ± 9 years; 78.8% male; 85% with coronary artery disease) completed at least 6 months of CR exercise sessions. Attendance rates decreased significantly from 3 months to 6 months (73.38 ± 18.09% vs 68.14 ± 17.15%, p-value&amp;lt;0.001) with higher scores in intrinsic motivation being correlated with higher rates of attendance (r= 0.330; p&amp;lt;0.001) and higher scores in external motivation being correlated with lower rates of attendance (r= -0.182; p=0.048) at 6 months. Amotivated, introjected and identified motivation showed no significant correlation. A sub analysis with 92 CVD patients (62 ± 9 years, 78.3% male, 87% with coronary artery disease) that completed 12 months of CR exercise sessions was made and a significant decrease in attendance was found between 3, 6 and 12 months (75.5 ± 17.05%, 70.7 ± 15.93% and 66.8 ± 18.34%; p-value&amp;lt;0.001). Conclusion Our results show that attendance rates to exercise CR sessions tend to decrease over the first year of the CR program and that external motivation at baseline is correlated with lower rates of attendance contrary to intrinsic motivation. These findings suggest that BREQ-2 questionnaire might be a good predictor of long-term attendance and help identify CVD patients that could benefit from additional motivational strategies to keep higher attendance rates.

Potential for optimizing management of overweight and obesity in patients with established atherosclerotic coronary artery disease

Abstract Funding Acknowledgements Type of funding sources: None. Obesity and overweight play a key role in the development of cardiovascular disease or myocardial ischemia, particularly today, as does their relationship to traditional and non-traditional risk factors. Despite, diet and weight management are grossly under-met per desired body mass index (BMI) threshold goals among very high-risk patients with established atherosclerotic cardiovascular disease (ASCVD). Thus, we aimed to investigate the presence of overweight and obesity in patients with established atherosclerotic cardiovascular disease who were admitted to our center. Patients and methods: Out of 790 patients admitted in our center between May and October 2021, we analyzed 341 patients who underwent isolated coronary artery by-pass surgery. Risk factors were noted as well as previous drug therapy, previous COVID 19 infection and vaccination. Anthropometric data were measured and BMI was determined. Obesity was defined as a BMI &amp;gt;_30 kg/m2 and overweight as a BMI between 25 and 30 kg/m2 . Patients with a BMI &amp;gt;_40 kg/m2 were considered morbidly obese. Early cardiac rehabilitation (phase 1) was performed by using personalized approach in all patients. Results Out of 341 patients (64.68±7.91 years of age), 275 were males (80.6%). The total of 97 (28.44%) had previous myocardial infarction. Blood pressure was well controlled. Majority of the patients reached the step 2 goals according to EAPC Guidelines on prevention (130.7±6.45/75.27±6.54mmHg), and were adherent to prescribed drugs. Mean heart rate was 65±5.65/minute. Only 27% of females and 22% of males had normal weight with BMI between 18.5 and 24.9.kg/m2. The mean BMI was 27.76 kg/m2. 50% of males and females were overweight. Obesity was noted in 23% of females and 27% of males (0.7% morbidly obese. Early cardiac rehabilitation was performed in all patients and they were all referred to participate the phase 2 programs. Conclusions Diet and body weight reduction in overweight and obese ASCVD patients should continue to be a priority given the impact on cardiovascular risk. There is a potential for optimizing management of overweight and obesity in patients. In addition to a better risk factor profile, weight loss also leads to a better quality of life. Cardiovascular prevention and rehabilitation programs should include weight loss intervention. Different forms of self-support and use of digital health might be used as a specific component of a comprehensive intervention to reduce total cardiovascular risk, extend life expectancy, and improve quality of life.

Cardiovascular rehabilitation with a WCD

Abstract Funding Acknowledgements Type of funding sources: Private company. Main funding source(s): ZOLL Background The wearable cardioverter-defibrillator (WCD) is a temporary treatment option for patients at high risk for sudden cardiac death (SCD) in whom implantation of a cardioverter defibrillator (ICD) is temporarily not possible. Exercise training and rehabilitation has an IA recommendation in these patients. There are no data on safety and outcomes of patients with a WCD undergoing cardiac rehabilitation. Purpose The aim of this study is to evaluate the safety and feasibility of wearing a WCD while undergoing a cardiac rehabilitation program. Methods We performed a retrospective analysis of all patients with a successfully completed stationary rehabilitation program. Results 55/896 patients (6.1%) registered in the Austrian WCD registry completed a stationary rehab program (60±11 years, 1% female). Underlying cardiac disease was ischaemic cardiomyopathy (CMP) in 27/55 (49%), dilatative CMP in 15/55 (27%), inflammatory CMP in 10/55 (18%) patients. One patient had valvular CMP, one patient had tako tsubo CMP, one patient had a primary electrical disease (each 1,8%). The baseline LVEF at rehab start was 36% [12;80%], duration of rehab was 28 days [18;42] compared to a total prescription duration of 94 days [26;294]. 75.6% (41/55) patients completed a regular rehab duration with a WCD, 3.6% (2/55) got their WCD stopped during rehab due to recovery of the LV function, 21,8% (12/55) got a WCD prescribed during rehab. The daily wearing duration was 23.4h [12.6;23.9]. 2848 (mean 52±117/patient) automatic alarms and 340 (mean 6±9/patient) manual alarms were generated. Within this cohort 3,6% (2/55) patients had shocks for VT/VF during prescription: one patient for a VF event that was terminated with the first shock, another patient had three VT events that were also terminate with the first WCD shock. All events happened before rehabilitation, so no patient had a WCD treatment during rehab, neither appropriate, nor inappropriate. Two patient had recurrent stable VTs that were controlled with antiarrhythmic drugs during prescription, only one of them during rehab. 3 patients had a reported syncope during rehab, all of them associated with hypotension, one patient had an ambulatory check-up at the CIED clinic because of false automatic alarms due to artefacts. Following a relevant weight loss through rehab measurements, the fabric garment of the WCD had a poor fit and was adapted. The LVEF after rehab was 42% [23;73%]. At the end of WCD prescription 33/55 (60%) had a restitution of their cardiac function with no need for an ICD, 19/55 (35%) patients were implanted with an ICD. One patient (1,8%) had a heart transplantation, one patient (1,8%) had the desire to stop WCD prescription and one patient (1,8%) had a terminal non-cardiac disease. Conclusion Completing a cardiovascular rehabilitation program is feasible and safe for patients prescribed with a WCD and may contribute positively to the restitution of the cardiac function.