Completion Of Cardiac Rehabilitation Program Research Articles

A Systematic Review of the Completion of Cardiac Rehabilitation Programs for Adults Aged 18-50 Years.

To perform a systematic review of completion rates of cardiac rehabilitation (CR) in adults aged 18 to 50yr and describe how core components were reported, measured, and tailored to those under 50yr. Database search of MEDLINE, Embase, Emcare, PsycINFO, CINAHL, Scopus, and the Cochrane Library based on keywords, including articles from January 1, 1990. The last search was performed on April 21, 2023. Following the Preferred Reporting Items for Systematic Review and Meta-Analyses protocol, eligible articles contained adults (aged between 18 and 50yr) who had participated in a CR program. Out of the articles screened (n=24,517), 33 reports across 31 independent studies were considered eligible (n=1958 patients aged ≤50yr). Cardiac rehabilitation completion rates ranged from 64% to 100%; however, only 5 studies presented a completion rate definition. The length of the program ranged from 7d to 20wk, with most (65%) ranging between 6 and 12wk. While the studies included in this systematic review indicated relatively high rates of completing CR, these are likely to overrepresent the true completion rates as few definitions were provided that could be compared to completion rates used in clinical practice. This systematic review also found that all interventions prescribed exercise (eg, aerobic alone or combined with resistance training or yoga) but had very limited inclusion or description of other integral components of CR (eg, initial assessment and smoking cessation) or how they were assessed and individualized to meet the needs of younger attendees.

Data-driven collaborative QUality improvement in Cardiac Rehabilitation (QUICR) to increase program completion: protocol for a cluster randomized controlled trial

BackgroundCoronary heart disease (CHD) is the leading cause of deaths and disability worldwide. Cardiac rehabilitation (CR) effectively reduces the risk of future cardiac events and is strongly recommended in international clinical guidelines. However, CR program quality is highly variable with divergent data systems, which, when combined, potentially contribute to persistently low completion rates. The QUality Improvement in Cardiac Rehabilitation (QUICR) trial aims to determine whether a data-driven collaborative quality improvement intervention delivered at the program level over 12 months: (1) increases CR program completion in eligible patients with CHD (primary outcome), (2) reduces hospital admissions, emergency department presentations and deaths, and costs, (3) improves the proportion of patients receiving guideline-indicated CR according to national and international benchmarks, and (4) is feasible and sustainable for CR staff to implement routinely.MethodsQUICR is a multi-centre, type-2, hybrid effectiveness-implementation cluster-randomized controlled trial (cRCT) with 12-month follow-up. Eligible CR programs (n = 40) and the individual patient data within them (n ~ 2,000) recruited from two Australian states (New South Wales and Victoria) are randomized 1:1 to the intervention (collaborative quality improvement intervention that uses data to identify and manage gaps in care) or control (usual care with data collection only). This sample size is required to achieve 80% power to detect a difference in completion rate of 22%. Outcomes will be assessed using intention-to-treat principles. Mixed-effects linear and logistic regression models accounting for clusters within allocated groupings will be applied to analyse primary and secondary outcomes.DiscussionAddressing poor participation in CR by patients with CHD has been a longstanding challenge that needs innovative strategies to change the status-quo. This trial will harness the collaborative power of CR programs working simultaneously on common problem areas and using local data to drive performance. The use of data linkage for collection of outcomes offers an efficient way to evaluate this intervention and support the improvement of health service delivery.EthicsPrimary ethical approval was obtained from the Northern Sydney Local Health District Human Research Ethics Committee (2023/ETH01093), along with site-specific governance approvals.Trial registrationAustralian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12623001239651 (30/11/2023) (https://anzctr.org.au/Trial/Registration/TrialReview.aspx?id=386540&isReview=true).

Characteristics and Outcomes of Cardiac Rehabilitation Patients With and Without Cancer: Insights From Western Sydney

Increased cardiovascular events are common in cancer survivors and contribute to an emerging cardio-oncology patient group requiring secondary prevention strategies including cardiac rehabilitation (CR). This study aimed to compare characteristics and outcomes for patients participating in CR with and without an existing cancer diagnosis. Observational cohort study including consecutive patients enrolled in a single-centre outpatient CR program in Western Sydney between 2018-2022. Clinical history, demographics and CR outcome data were collected as part of standard care at program enrolment and completion. Patients with and without a cancer diagnosis were compared at enrolment and outcomes were analysed in both groups. A total of 1,792 patients enrolled in CR, 191 (11%) had a documented history of cancer; prostate (18%), skin (12%), colon (9%) and breast (8%) malignancies were most prevalent. The most common treatments were surgical resection (80%) and chemotherapy or radiotherapy (37%). Cardio-oncology patients were older (68.8±10.6 vs 59.8±13.7yrs, p<0.001), more likely female (33% vs 21%, p<0.001), born in Australia (46% vs 35%, p=0.004), non-partnered (34% vs 25%, p=0.002) and had a prior history of hypertension (65% vs 56%, p=0.010) or stroke (8% vs 5%, p=0.045). After adjusting for age and sex, the overall cohort improved their mean peak exercise capacity and waist circumference after CR, however there were no differences between groups. There were also no between-group differences for adherence and completion of CR program or any other cardiovascular risk factors. Sub-analyses revealed a clinically meaningful improvement in waist circumference for cancer patients with a history of radiation therapy and a blunted peak exercise capacity adaptation for those with a history of chemotherapy treatment. Despite differences in demographic and clinical characteristics of CR patients with and without cancer, all patients showed significant and clinically relevant improvements in peak exercise capacity and waist circumference after CR. Results also highlighted potential associations between specific cancer treatments and changes in fitness outcomes, which warrants further evaluation.

The effect of resistance training on PCSK9 levels in patients undergoing cardiac rehabilitation after coronary artery bypass grafting: a randomized study

BackgroundResistance training is commonly recommended as part of secondary prevention for post-coronary artery bypass graft (CABG) patients in conjunction with aerobic exercise. Despite its potential benefits, there is currently a lack of studies investigating the impact of resistance training on proprotein convertase subtilisin kexin 9 (PCSK9).AimTo evaluate the effect of intensive resistance training on proprotein convertase subtilisin kexin 9 (PCSK9) levels among post-CABG patients undergoing cardiac rehabilitation (CR).MethodsIn this prospective, open-label, randomized trial, 87 post-coronary artery bypass graft (CABG) patients were randomly assigned into two groups: moderate to high intensity resistance training and aerobic training (n = 44) or aerobic training alone (n = 43) for a total of 12 sessions. Changes in PCSK9 levels was determined as a primary endpoint, while secondary endpoints included changes in the six-minute walk test (6-MWT) results, aerobic capacity, WHO-5 well-being index, fasting blood glucose, and lipid profile. Both groups underwent intention-to-treat analysis.ResultsFollowing completion of cardiac rehabilitation program, the intervention group demonstrated a significant decrease in mean PCSK9 levels when compared to the control group (β = -55 ng/ml, 95% CI -6.7 to -103.3, p = 0.026), as well as significant improvements in the 6-MWT result (β = 28.2 m, 95% CI 2.4–53.9, p = 0.033), aerobic capacity (β = 0.9 Mets, 95% CI 0.1–1.7, p = 0.021), and WHO-5 well-being index (β = 8.1, 95% CI 2.0–14.4, p = 0.011) in patients who received resistance and aerobic training. No statistically significant changes were observed in fasting blood glucose, cholesterol, LDL-C, HDL-C, and triglyceride levels.ConclusionResistance training in CR significantly reduced PCSK­9 levels and increases patient’s functional capacity and quality of life. (NCT02674659 04/02/2016).

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.

Implementing hybrid telerehabilitation following major cardiac surgery during COVID-19 pandemic in Hong Kong

Abstract Funding Acknowledgements Type of funding sources: Public hospital(s). Main funding source(s): Department budget Background Aerobic exercise is a critical component of cardiac rehabilitation (CR) for patients (pts) who have undergone cardiac surgery. Exercise-based CR is ideally home-based and directly supervised by a trained physiotherapist. During COVID-19 pandemic in Hong Kong, there was increasing emphasis on social distancing and caregiving strategies to better reach pts outside hospital. As most cardiac surgeries were performed on urgent clinical needs including heart transplantation and aortic dissection, we implemented hybrid telerehabilitation (HTR) with transition to the use of remote care in order to continue comprehensive CR. We report the functional outcome of HTR group compared with usual care (UC) group. Methods From 7/2020 to10/2021, 36 pts ( 67% men, mean age 57±9.2 years) were enrolled into HTR (n=18) and UC (n=18) groups respectively for 12 weeks’ duration. Demographics in both groups were similar. Types of cardiac surgeries were heart transplant (n=5; 14%), CABG (n=6;17%), valvular surgery (n=17; 47%) and aorta operation (n=8; 22%). An individualized exercise prescription for HTR at home was determined based on initial standardized assessments in hospital and tailored to fit lifestyle and home environment. For HTR group, the goal is set at 150 minutes of low to moderate-intensity aerobic exercise per week at home. Exercise is progressed weekly based on daily metrics recorded by wearable device (exercise log and % target heart rate reserve (THRR) attained) and rate of perceived exertion (RPE). These were reported by pts through an online survey after each exercise session which were reviewed daily, with progress follow-up by phone calls or text messages on a weekly basis. Functional capacity parameters were evaluated using symptom limited exercise treadmill test (ETT) and 6 minute walk test (6MWT). The advised level is based on the current activity level of the patient using a MET score list at intake by the physiotherapist. Handgrip and quadriceps strength were measured. Results All pts participated the programs. Both groups demonstrated significant improvement in MET scores and 6MWT after completion of CR programs.(Table ) Average exercise time at home was reported to be 379 ±98 minutes/ week (72% achieved &amp;gt;150 minutes/ week). Compared with UC, HTR showed significantly increased % change in MET score at baseline and upon completion of CR (22.1% vs 7%; p=0.02) and 6MWT (11.1% vs 5.3%; p=0.01). The effect muscle strength were similar in both groups with improving trend but no significant % change at baseline and end of CR. Conclusion Significant improvement in functional status can be demonstrated in comprehensive individualized HTR program in pts after major cardiac surgery. Adoption of digital technology with full integration into standard cardiac rehabilitation program should be recommended.

How the COVID pandemic affected utilisation of cardiac rehabilitation in rural Australia?

Abstract Funding Acknowledgements Type of funding sources: Public Institution(s). Main funding source(s): Caring Futures Institute Background Provision of cardiac rehabilitation (CR) was disrupted in 31% of the 155 countries according to the World Health Organisation during the early months of the COVID pandemic. This might have been associated with worsening clinical outcomes and is of particular concern to patients living in rural and remote areas. In Australia, these patients have a higher prevalence of cardiovascular diseases, higher rates of adverse outcomes due to acute myocardial infarction and limited availability to regional services. Purpose We aimed to investigate how the COVID affected the delivery of CR services in rural and remote South Australia (SA) during the first wave of the COVID pandemic. Methods CR attendance, completion and waiting times in the pre-COVID period (February-July 2019) was compared to data during the first wave of COVID (February-July 2020) using data from CR services across six regional local health networks recorded in the Country Access to Cardiac Health (CATCH) database. Results There were 922 patients (32.2% females; mean age 69.2 years; 36.6% living in areas with high socio-economic disadvantage) referred to CR in the pre-COVID period, and 1032 patients (30.7% females; mean age 68.1 years; 35.7% living in areas with high socio-economic disadvantage) in the COVID period across the six regional areas in South Australia. Acute coronary syndrome was the main reason for referral both pre (251; 27.2%) and during COVID (273; 26.5%). The proportion of CR attendance was higher in the pre (522; 56.6%) compared to the COVID period (431, 41.8%; p &amp;lt; 0.001). Completion was higher pre (413, 79.1%) compared to during COVID period (205,47.6%) completed CR during the COVID period (p &amp;lt; 0.001). The waiting time was 35 (SD 27) days pre-COVID and 34 (SD 25) days in the COVID period (p = 0.37). Conclusion Our data show that attendance and completion of CR programs were significantly reduced during the COVID period in rural and remote Australia. Limited service access during the pandemic and fear to physically attend health services during the period of social and physical restrictions might have contributed to this. Telehealth-delivered CR can provide opportunities to continuity of cardiovascular care and secondary prevention during pandemic restrictions.

The Role of Lifestyle and Cardiovascular Risk Factors in Dropout From an Australian Cardiac Rehabilitation Program. A Longitudinal Cohort Study

Cardiac rehabilitation (CR) programs reduce the risk of further cardiac events and improve the ability of people living with cardiovascular disease to manage their symptoms. However, many people who experience a cardiac event do not attend or fail to complete their CR program. Little is known about the characteristics of people who drop out compared to those who complete CR. To identify subgroups of patients attending a cardiac rehabilitation program who are more likely to dropout prior to final assessment by (1) calculating the dropout rate from the program, (2) quantifying the association between dropout and socio-demographic, lifestyle, and cardiovascular risk factors, and (3) identifying independent predictors of dropout. The study population is from a large metropolitan teaching hospital in Sydney, Australia, and consists of all participants consecutively enrolled in an outpatient CR program between 2006 and 2017. Items assessed included diagnoses and co-morbidities, quality of life (SF-36), psychological health (DASS-21), lifestyle factors and physical assessment. Dropout was defined as failure to complete the outpatient CR program and post CR assessment. Of the 3,350 patients enrolled in the CR program, 784 (23.4%; 95%CI: 22.0-24.9%) dropped out prior to completion. The independent predictors of dropout were smoking (OR 2.4; 95%CI: 1.9-3.0), being separated or divorced (OR 2.0; 95%CI: 1.5-2.6), younger age (<55 years) (OR 1.9; 95%CI: 1.6-2.4), obesity (OR 1.6; 95%CI: 1.3-2.0), diabetes (OR 1.6; 95%CI: 1.3-2.0), sedentary lifestyle (OR 1.3; 95%CI: 1.1-1.6) and depressive symptoms (OR 1.3; 95%CI: 1.1-1.6). To improve the CR program completion rate, clinicians need to consider the impact of socio-demographic, lifestyle, and cardiovascular risk factors on their patients' ability to complete CR. Tailored strategies which target the independent predictors of dropout are required to promote adherence to CR programs and thereby potentially reduce long-term cardiovascular risk.

BENEFITS OF EXERCISE-BASED CARDIAC REHABILITATION ON EXERCISE CAPACITY AND SURVIVAL AMONG PATIENTS WITH CANCER AND CARDIOVASCULAR DISEASE

Cancer survivors are at increased risk for cardiovascular disease (CVD)-related morbidity and mortality. Cardiac rehabilitation (CR) improves CVD risk factors, including cardiorespiratory fitness (CRF), and may improve cardiovascular outcomes among patients with comorbid cancer and CVD. The impact of improvements in CRF on survivorship among patients with cancer attending CR has not been investigated. This study aimed to: (1) characterize the impact of CR program completion on survival, and (2) explore whether improvements in CRF translate to increased survival among patients with comorbid cancer and CVD.

PCV1 Cardiac Rehabilitation Program in a Tertiary Hospital in Peninsular Malaysia: Outcome and Associations

Cardiovascular disease (CVD) is the leading cause of mortality in Malaysia. Outpatient cardiac rehabilitation program(CRP) is a supervised six sessions program offered to patients with coronary heart disease in Hospital Serdang since 2007. It aims to restore patient’s function to normalcy of life. Exercise based CRP is a cost-effective secondary prevention for cardiac mortality and rehospitalisation. This study assess effectiveness of CRP in improving physical functional capacity by 6-minute walk test distance(6MWD). Association of erectile dysfunction severity and number of diseased vessels was evaluated. A retrospective cohort study conducted in the rehabilitation department of Hospital Serdang among 139 CRP graduates from January 2014 to December 2019. Student’s t-tests was done to compare pre and post CRP 6MWD. Logistic regression was done to check for association. This study involved 139 participants (112 male, 27 female). The mean± SD of age and BMI were 52.93 ± 10.52 and 28.10 ± 4.98, respectively. Cardiology referral attributed to 77.7% of participants, and 61.9% participants had underwent percutaneous intervention. Family history of early CVD (70.5%) and dyslipidemia (76.3%) were main risk factors in this cohort. There is a positive correlation between pre and post CRP 6MWD{r(137)=0.661,p=0.000}, with improvement of mean 6MWD by 7% (394.29m to 421.95m). After completion of CRP, 50.4% showed an improvement of more than 30m in the 6MWT. 33.8% showed change of exercise habit post CRP. From 2017 to 2019, 56.5% (n=26) of the men answered the SHIM questionnaire. Erectile dysfunction, indicated by SHIM score did not show significant association with number of diseased coronary vessels (AOR 0.38, 95% CI 0.001-1.45, p=0.078). Although the mean improvement in physical functional capacity was not marked, 50.4% showed meaningful improvement, indicating room for optimization of the program. Erectile dysfunction is still a screening predictor of CVD; despite weak association with number of diseased coronary vessels.

Age-Related Improvements in Peak Cardiorespiratory Fitness among Coronary Heart Disease Patients Following Cardiac Rehabilitation

While cardiorespiratory fitness (VO2peak) can be improved with exercise and training, it is unclear whether older age is associated with an attenuated VO2peak improvement among patients with coronary artery disease (CAD) who complete a cardiac rehabilitation (CR) program. A retrospective review of patient demographics and VO2peak data from January 2012 to December 2017 was performed. CAD patients were included if they had successfully completed the supervised 6-month CR program (>75% of exercise prescription) and two VO2peak assessments (respiratory exchange ratio (RER) >1.0). Among all patients, there was an improvement in VO2peak from 21.1 ± 6.3 mL/kg/min to 26.5 ± 7.9 mL/kg/min (+26% ΔVO2peak). Patients in the younger age category (age category 1: 30–39 years old) tended to have a greater percent of relative VO2peak improvement when compared to all other age categories (e.g., adults 50 years of age and older). In the regression analysis, VO2peak improvement was associated with younger age (β = −0.286, p < 0.0001), after adjustment for the baseline VO2peak (β = −0.456, p < 0.0001), final prescribed exercise speed at CR program completion (β = 0.254, p < 0.0001), body mass index (β = −0.172, p < 0.0001), and male sex (β = 0.153, p < 0.0001). Nonetheless, the study findings indicate that older adults who complete CR may be able to obtain clinically relevant improvements in VO2peak of greater than 20%, and therefore, should be referred for CR.

A Standard Form of Cardiac Rehabilitation Can Improve Self-Reported Positive Behavior Changes in the Short- to Medium-Term.

Little is known about the impact of standard cardiac rehabilitation (CR), consisting of health education and exercise, on self-reported behavior change among people who have completed rehabilitation. This qualitative study aimed to explore the lived experiences of participants' behaviors toward exercise and diet in the short- to medium-term after CR program completion. Using a phenomenological framework, we interviewed participants who had completed a 4-wk CR program and then 6 mo later. The program included education and exercise in a private outpatient facility. A thematic analysis was conducted to explore changes in self-reported behavior. These themes were triangulated with Bandura's self-efficacy scales and Stages of Readiness for Change questionnaires to identify any convergence of themes. A total of 21 participants were recruited to the study. One main theme and 4 subthemes emerged from analysis of the data. Most participants reported that they had either maintained or initiated positive lifestyle changes in both exercise and diet in the short- and medium-term. Fear of having another myocardial infarction, seeing the benefits of adhering with recommendations, and family involvements were motivating factors along with the involvement of the multidisciplinary staff in the program. The themes converged with the results from the questionnaires. A standard form of CR can result in positive self-reported behavior change in the short- to medium-term. Further trials are needed to determine whether a standard form of rehabilitation is sufficient to change health behaviors at sufficient levels to result in long-term health benefits.

The Feasibility of Financial Incentives to Increase Exercise Among Canadian Cardiac Rehabilitation Patients.

To examine the feasibility of conducting a randomized controlled trial investigating the effectiveness of financial incentives for exercise self-monitoring in cardiac rehabilitation (CR). A 12-week, 2 parallel-arm, single-blind feasibility study design was employed. A volunteer sample of CR program graduates was randomly assigned to an exercise self-monitoring intervention only (control; n = 14; mean age ± SD, 62.7 ± 14.6 years), or an exercise self-monitoring plus incentives approach (incentive; n = 13; mean age ± SD, 63.6 ± 11.8 years). Control group participants received a "home-based" exercise self-monitoring program following CR program completion (exercise diaries could be submitted online or by mail). Incentive group participants received the "home-based" program, plus voucher-based incentives for exercise diary submissions ($2 per day). A range of feasibility outcomes is presented, including recruitment and retention rates, and intervention acceptability. Data for the proposed primary outcome of a definitive trial, aerobic fitness, are also reported. Seventy-four CR graduates were potentially eligible to participate, 27 were enrolled (36.5% recruitment rate; twice the expected rate), and 5 were lost to followup (80% retention). Intervention acceptability was high with three-quarters of participants indicating that they would likely sign up for an incentive program at baseline. While group differences in exercise self-monitoring (the incentive "target") were not observed, modest but nonsignificant changes in aerobic fitness were noted with fitness increasing by 0.23 mL·kg-·min- among incentive participants and decreasing by 0.68 mL·kg-·min- among controls. This preliminary study demonstrates the feasibility of studying incentives in a CR context, and the potential for incentives to be readily accepted in the broader context of the Canadian health care system.

Smoking and cardiac rehabilitation program completion

Smoking and cardiac rehabilitation program completion

Cardiac rehabilitation improves the ischemic burden in patients with ischemic heart disease who are not suitable for revascularization.

Ischemic heart diseases including stable angina & acute events, represent a huge burden on both the individual & the society and represent an important source of disability. We aimed to identify the effect of cardiac rehabilitation program (CRP) on the ischemic burden in patients with ischemic heart disease (IHD) unsuitable for coronary revascularization. The study included 40 patients with IHD who were not suitable for coronary revascularization either by PCI or CABG (due to unsuitable coronary anatomy, co morbidities, high surgical/procedural risk or patient preference). All patients were subjected to sophisticated CRP protocols, including patient education, nutritional, medical, psychological and sexual counseling and group smoking cessation. All patients participated in low intensity exercise program twice weekly. The patient's symptoms, vitals and medications were evaluated at each visit and clinical and laboratory data, echocardiography and stress myocardial perfusion imaging (SPECT) were evaluated before and 3months after the end of the study. The mean age was 56.8±3.1years and only 2 patients (5%) were females. 22 (55%) patients were diabetic, 21 (53%) were hypertensive and 30 (75%) were smokers. It was found that 3months after completion of CRP, there was a significant decrease in BMI (30.3±2.9 vs. 31.2±1.9, p<0.001), and mean blood pressure (93.4±11 vs. 105±10.6mmHg, p<0.001). There was also a favorable effect on lipid profile and a significant improvement of the functional capacity in terms of NYHA functional class (2.1±0.62 vs. 1.4±0.6, p<0.001). Despite that wall motion score index did not significantly change after CRP, there was a strong trend toward a better ejection fraction (53.7±7.8 vs. 54.5±6.3 %, p=0.06) and significant improvement of Canadian cardiovascular class (1.42±0.6 vs. 1.95±0.5, p<0.001) post CRP. Importantly, the difference between the SPECT-derived summed segmental scores at peak stress and at rest (SDS) was significantly lower after CRP (4.4±3 vs. 7.2±3, p<0.001). Participation in cardiac rehabilitation program improves ischemic burden in patients with IHD who are unfit or not suitable for conventional cardiac revascularization. In addition the decreased ischemic burden, functional capacity, hemodynamic and metabolic profiles also improve for this group of patients and thus, cardiac rehabilitation should be implemented for routine management of those patients.

Abstract 144: Residual Cardiovascular Risk After Cardiac Rehabilitation

Background: CAD is the leading cause of death and disability in US. Cardiac rehabilitation (CR) program is an important secondary-prevention intervention to reduce mortality, cardiovascular (CV) events, &amp; disability. At start of CR program, patients undergo extensive risk assessment to guide risk reduction goals. However, the residual risk at CR completion is not well studied. We sought to investigate the residual modifiable risk factors of patients completing CR Methods: We retrospectively reviewed our center’s data on consecutive patients between October 2012 and November 2013 who were entered into the American Association of Cardiovascular and Pulmonary Rehabilitation (AACVPR) registry and identified those who completed the CR program. We calculated their residual risk using the newly released ACC/AHA’s ‘Pooled Cohort Equations CV Risk Calculator’ (ACC/AHA risk) and Framingham risk (FR) calculator Results: Out of 128 consecutive CR participants, 44 (34%) completed the program. Patient characteristics and risk assessment are summarized in table 1. As per AACVPR risk stratification algorithm, 37 (84%) of patients were intermediate to high risk. Compared to the start, at completion of CR program, there was a significant improvement in 6-minute walk distance (365±107 vs 484± 137, p&lt;0.001), favorable reduction in total cholesterol, LDL-C, non-HDL-C (p&lt;0.001) and metabolic syndrome (p=0.02). At time of completion, calculated 10 year CV risk using ACC/AHA risk calculator was still elevated (14±10%), while 64% of patients had elevated risk≥7.5% (mean 19.3±9%). FR estimation was low (9±4%). The two risk scores showed moderate correlation (Pearson’s r=0.6, p&lt;0.001), but the ACC/AHA risk was significantly higher than the FR estimation (p&lt;0.001). In multivariate linear regression model, waist circumference (WC) at discharge was significant modifiable independent predictor of ASCVD risk, while systolic BP showed a trend towards significance Conclusion: Successful completion of CR program is associated with improvement in CV risk profile. However, the residual CV risk remains elevated at time of CR completion and is driven by WC &amp; systolic BP. Elevated WC from central adiposity is the main residual atherogenic CV risk factor post CR completion. Further research on significant WC reduction during CR is needed

The Quality of Cardiac Rehabilitation in Canada: A Report of the Canadian Cardiac Rehab Registry

Cardiac rehabilitation (CR) significantly reduces morbidity and mortality compared with usual care. CR quality indicators (QIs) have recently been established in Canada. This article presents an assessment of real-world CR program achievement of process and outcome QIs in Canada, using the Canadian Cardiac Rehab Registry (CCRR). The CR QIs were developed through the Canadian Cardiovascular Society's Best Practice Methodology. After reconciling the QI with CCRR definitions, it was identified that 14 (46.7%) of the 30 QIs could be assessed through the CCRR. There were 5447 patient records from 11 CR programs in the CCRR. Wait times exceeded the 30-day QI target, at a median of 84 days from referral to enrollment. Assessment of QIs of blood pressure (90%) and adiposity (85%) were high, however assessment of QIs for lipids (41%), blood glucose among patients with diabetes (23%), and depression overall (13%) were low. A majority of the participants (68%) achieved the half metabolic equivalent increase in the exercise capacity QI from CR program entry to exit. Of smokers, only 61% were offered smoking cessation therapy. Thirty percent of participants were offered stress management. The CR program completion QI was met in 90% of patients. Areas for care and quality improvement have been identified for the CR community in Canada. Efforts to engage more CR programs assess a greater number of QIs, and to feed back the findings to participating programs quarterly are currently under way.

Systematic Liaised Inpatient Cardiac Referral (SLICRR), III. Characterization of Program Completers Vs. Non-Completers in a Context of Increased Referrals and Fixed Capacity

Systematic Liaised Inpatient Cardiac Rehabilitation Referral (SLICRR) is recommended nationally, to increase cardiac rehabilitation (CR) referral. From prospective cohort analyses, we have reported that SLICRR increased CR referral of acute coronary syndrome (ACS: myocardial infarction/unstable angina) inpatients; decreased referral bias, in favour of women; increased CR program completion by women; but decreased completion overall and among men. From the same cohort we now report characteristics at CR intake, of patients who subsequently did and did not complete CR.

199 Systematic Liaised Inpatient Cardiac Rehabilitation Referral (SLICRR): II - Effects of Increased Referrals With Fixed Program Capacity

199 Systematic Liaised Inpatient Cardiac Rehabilitation Referral (SLICRR): II - Effects of Increased Referrals With Fixed Program Capacity

Predictors of Metabolic Syndrome in Participants of a Cardiac Rehabilitation Program

Metabolic syndrome increases the risk of all-cause mortality, cardiovascular mortality and cardiovascular events in patients with cardiovascular disease (CVD). This study assessed the predictors of metabolic syndrome, both its incidence and resolution in a cohort of cardiac rehabilitation program graduates. Methods. A total of 154 and 80 participants without and with metabolic syndrome respectively were followed for 48 months. Anthropometric measurements, metabolic risk factors, and quality of life were assessed at baseline and at 48 months. Logistic regression models were used to assess the predictors of metabolic syndrome onset and resolution. Results. Increasing waist circumference (OR 1.175, P ≤ 0.001) was an independent predictor for incident metabolic syndrome (R 2 for model = 0.46). Increasing waist circumference (OR 1.234, P ≤ 0.001), decreasing HDL-C (OR 0.027, P = 0.005), and increasing triglycerides (OR 3.005, P = 0.003) were predictors of metabolic syndrome resolution. Conclusion. Patients with CVD that further develop metabolic syndrome are particularly susceptible for the cascade of cardiovascular events and mortality. Increasing waist circumference confers a higher risk for future onset of metabolic syndrome in this group of patients. They will require closer follow-up and should be targeted for further prevention strategies after cardiac rehabilitation program completion.