Completion Of Cardiac Rehabilitation Research Articles

Clinical effectiveness of cardiac rehabilitation and barriers to completion in patients of low socioeconomic status in rural areas: A mixed-methods study.

To investigate cardiac rehabilitation utilisation and effectiveness, factors, needs and barriers associated with non-completion. We used the mixed-methods design with concurrent triangulation of a retrospective cohort and a qualitative study. Economically disadvantaged areas in rural Australia. Patients (≥18 years) referred to cardiac rehabilitation through a central referral system and living in rural areas of low socioeconomic status. A Cox survival model balanced by inverse probability weighting was used to assess the association between cardiac rehabilitation utilization and 12-month mortality/cardiovascular readmissions. Associations with non-completion were tested by logistic regression. Barriers and needs to cardiac rehabilitation completion were investigated through a thematic analysis of semi-structured interviews and focus groups (n = 28). Among 16,159 eligible separations, 44.3% were referred, and 11.2% completed cardiac rehabilitation. Completing programme (HR 0.65; 95%CI 0.57-0.74; p < 0.001) led to a lower risk of cardiovascular readmission/death. Living alone (OR 1.38; 95%CI 1.00-1.89; p = 0.048), having diabetes (OR 1.48; 95%CI 1.02-2.13; p = 0.037), or having depression (OR 1.54; 95%CI 1.14-2.08; p = 0.005), were associated with a higher risk of non-completion whereas enrolment in a telehealth programme was associated with a lower risk of non-completion (OR 0.26; 95%CI 0.18-0.38; p < 0.001). Themes related to logistic issues, social support, transition of care challenges, lack of care integration, and of person-centeredness emerged as barriers to completion. Cardiac rehabilitation completion was low but effective in reducing mortality/cardiovascular readmissions. Understanding and addressing barriers and needs through mixed methods can help tailor cardiac rehabilitation programmes to vulnerable populations and improve completion and outcomes.

Understanding what factors underpin change in walking distance in patients with depression following completion of cardiac rehabilitation: commentary.

Understanding what factors underpin change in walking distance in patients with depression following completion of cardiac rehabilitation: commentary.

Opting out of cardiac rehabilitation in local community healthcare services: Patients'perspectives and reflections.

Despite cardiac rehabilitation and medical treatment being integrated parts of the pathway of patients with cardiovascular disease, as well as the well-establish positive effect, cardiac rehabilitation remains underutilised. In recent years, cardiac rehabilitation has increasingly been moved from the hospitals to the community healthcare services. This transition may be challenging for patients with cardiovascular disease. To investigate reflections and perspectives of patients opting out of cardiac rehabilitation in community healthcare services to improve participation and adherence to cardiac rehabilitation in the future. A total of eight patients opting out of cardiac rehabilitation participated in individual interviews. Opting out of cardiac rehabilitation is defined as never enroled or did not complete cardiac rehabilitation. The Interpretive Description methodology was used in the analysis where two themes and six subthemes were identified: (1) 'Structural and organisational factors' with three subthemes; Being a patient in the healthcare system, Enroling into CR when it is meaningful, and Getting back to work is vital, and (2) 'Patients'internal factors' with three subthemes; Feeling a desire to regain control, Seeing yourself as recovered, and Being aware of own needs. The analysis indicates that patients'decision to opt out of CR was multidimensional and based on a combination of factors. Ensuring that the healthcare professionals in the community have sufficient information regarding the patient and a clear communication plan between the healthcare professionals and the patient may reduce the transition causing confusion and frustrations for patients. Incorporating a vocational element in CR and ensuring that employers understand the importance of CR may hamper returning to work as a challenge to CR. Ensuring timely CR referral and enrolment and a transition coordinator may reduce the challenge of patients not viewing CR as meaningful. However, further studies are needed to fully understand how CR could become meaningful for patients opting out of CR.

Impact of Prior COVID-19 Infections on Cardiac Rehabilitation Completion Rates and Outcomes.

This is a retrospective cohort study designed to evaluate the impact of having a prior COVID-19 infection on cardiac rehabilitation (CR) completion rates and outcomes. Participants enrolled into the CR program from June 1, 2020, to March 30, 2022. They completed both physical and mental health assessments prior to enrollment and upon completion of the program. The cohort was divided into (-) COVID and (+) COVID based on whether they self-reported a prior COVID-19 infection. Outcome measures included General Anxiety Disorder-7, Patient Health Questionnaire-9, Mental Composite Score (Short Form Health Survey-36), Physical Composite Score (Short Form Health Survey-36), and exercise capacity (reported in METs). Program completion rates and outcome measures were compared between (-) COVID and (+) COVID cohorts. A total of 806 participants were enrolled in the study. Program completion rates were 58.7% in the (-) COVID group and 67.2% in the (+) COVID group ( P = .072). African Americans ( P = .017), diabetics ( P = .017), and current smokers ( P = .003) were less likely to complete the program. Both (-) COVID and (+) COVID groups showed significant improvement in all outcome measures after completing the CR program. However, there was no difference in outcomes between groups. Having a prior COVID-19 infection did not negatively impact the mental and physical health benefits obtained by completing the CR program, regardless of the American Association of Cardiovascular and Pulmonary Rehabilitation risk category.

Applying Exercise Capacity and Physical Activity as Single vs Composite Endpoints for Trials of Cardiac Rehabilitation Interventions: Rationale, Use-case, and a Blueprint Method for Sample Size Calculation

ObjectiveTo conceptualize a composite primary endpoint for parallel-group RCTs of exercise-based cardiac rehabilitation (CR) interventions and to explore its application and statistical efficiency. DesignWe conducted a statistical exploration of sample size requirements. We combined exercise capacity and physical activity for the composite endpoint (CE), both being directly related to reduced premature mortality in patients with cardiac diseases. Based on smallest detectable and minimal clinically important changes (change in exercise capacity of 15 W and change in physical activity of 10 min/day), the CE combines 2 dichotomous endpoints (achieved/not achieved). To examine statistical efficiency, we compared sample size requirements based on the CE to single endpoints using data from 2 completed CR trials. SettingCardiac rehabilitation phase III. ParticipantsPatients in cardiac rehabilitation. InterventionsNot applicable. Main Outcome Measure(s)Exercise capacity (Pmax assessed by incremental cycle ergometry) and physical activity (daily minutes of moderate to vigorous physical activity assessed by accelerometry). ResultsExpecting, for example, a 10% between-group difference and improvement in the clinical outcome, the CE would increase sample size by up to 21% or 61%, depending on the dataset. When expecting a 10% difference and designing an intervention with the aim of non-deterioration, the CE would allow to reduce the sample size by up to 55% or 70%. ConclusionsTrialists may consider the utility of the CE for future studies in exercise-based CR to reduce sample size requirements. However, perhaps surprisingly at first, the CE could also lead to an increased sample size needed, depending on the observed baseline proportions in the trial population and the aim of the intervention.

Cardiac Rehabilitation During the COVID-19 Pandemic and the Potential for Digital Technology to Support Physical Activity Maintenance: Qualitative Study.

Social distancing from the COVID-19 pandemic may have decreased engagement in cardiac rehabilitation (CR) and may have had possible consequences on post-CR exercise maintenance. The increased use of technology as an adaptation may benefit post-CR participants via wearables and social media. Thus, we sought to explore the possible relationships of both the pandemic and technology on post-CR exercise maintenance. This study aimed to (1) understand CR participation during the COVID-19 pandemic, (2) identify perceived barriers and facilitators to physical activity after CR completion, and (3) assess willingness to use technology and social media to support physical activity needs among older adults with cardiovascular disease. We recruited participants aged 55 years and older in 3 different CR programs offered at both public and private hospitals in Northern California. We conducted individual interviews on CR experiences, physical activity, and potential for using technology. We used thematic analysis to synthesize the data. In total, 22 participants (n=9, 41% female participants; mean age 73, SD 8 years) completed in-depth interviews. Themes from participants' feedback included the following: (1) anxiety and frustration about the wait for CR caused by COVID-19 conditions, (2) positive and safe participant experience once in CR during the pandemic, (3) greater attention needed to patients after completion of CR, (4) notable demand for technology during the pandemic and after completion of CR, and (5) social media networking during the CR program considered valuable if training is provided. Individuals who completed CR identified shared concerns about continuing physical activity despite having positive experiences during the CR program. There were significant challenges during the pandemic and heightened concerns for safety and health. The idea of providing support by leveraging digital technology (wearable devices and social media for social support) resonated as a potential solution to help bridge the gap from CR to more independent physical activity. More attention is needed to help individuals experience a tailored and safe transition to home to maintain physical activity among those who complete CR.

Clinical Effectiveness and Utilisation of Cardiac Rehabilitation After Hospital Discharge: Data Linkage Analysis of 84,064 Eligible Discharged Patients (2016–2021)

Despite the highest levels of evidence on cardiac rehabilitation (CR) effectiveness, its translation into practice is compromised by low participation. This study aimed to investigate CR utilisation and effectiveness in South Australia. This retrospective cohort study used data linkage of clinical and administrative databases from 2016 to 2021 to assess the association between CR utilisation (no CR received, commenced without completing, or completed) and the composite primary outcome (mortality/cardiovascular re-admissions within 12 months after discharge). Cox survival models were adjusted for sociodemographic and clinical data and applied to a population balanced by inverse probability weighting. Associations with non-completion were assessed by logistic regression. Among 84,064 eligible participants, 74,189 did not receive CR, with 26,833 of the 84,064 (31.9%) participants referred. Of these, 9,875 (36.8%) commenced CR, and 7,681 of the 9,875 (77.8%) completed CR. Median waiting time from discharge to commencement was 40 days (interquartile range, 23-79 days). Female sex (odds ratio [OR] 1.12; 95% CI 1.01-1.24; p=0.024), depression (OR 1.17; 95% CI 1.05-1.30; p=0.002), and waiting time >28 days (OR 1.15; 95% CI 1.05-1.26; p=0.005) were associated with higher odds of non-completion, whereas enrolment in a telehealth program (OR 0.35; 95% CI 0.31-0.40; p<0.001) was associated with lower odds of non-completion. Completing CR (hazard ratio [HR] 0.62; 95% CI 0.58-0.66; p<0.001) was associated with a lower risk of 12-month mortality/cardiovascular re-admissions. Commencing without completing was also associated with decreased risk (HR 0.81; 95% CI 0.73-0.90; p<0.001), but the effect was lower than for those completing CR (p<0.001). Cardiac rehabilitation (CR) attendance is associated with lower all-cause mortality/cardiovascular re-admissions, with CR completion leading to additional benefits. Quality improvement initiatives should include promoting referral, women's participation, access to telehealth, and reduction of waiting times to increase completion.

MHealth intervention including text messaging and behaviour change techniques to support maintenance of physical activity after cardiac rehabilitation: A single-arm feasibility study.

To evaluate the feasibility of a mobile health-supported intervention in patients with cardiovascular diseases after completion of a cardiac rehabilitation programme. The feasibility study was performed in two hospitals and one municipality in Region Zealand, Denmark. Eligible participants were ≥18 years old, participated in a supervised cardiac rehabilitation programme, had access to a mobile phone, and could walk 3 m independently. Participants received a 12-week intervention utilizing behaviour change techniques, consisting of action planning, text messages, and phone support. Feasibility was assessed using pre-defined progression criteria, which included recruitment (≥75%), retention (≥80%), accelerometer data completeness (≥80%), coordinator (phone support) time (≤30 min), the response rate on patient-reported outcomes (≥90%), adherence (≥75% respond to ≥75% of messages), and acceptability (≥75%). The secondary outcome of objective physical activity was assessed with accelerometers. Ten women and 30 men with cardiovascular diseases aged 63.5 (±9.8 SD) participated. The progression criteria for retention (90%), accelerometer data completeness (83%), coordinator time (9.9 min), adherence (83%), and acceptability (82%) were at acceptable levels, exceptions were progression criteria for recruitment (35%) being below acceptable levels for recruitment, and response rate on patient-reported outcomes (75%). High satisfaction (92.6%) with the intervention was found. All objectively measured physical activity levels remained unchanged from baseline to follow-up. No serious adverse events related to the intervention were reported. Mobile health-supported maintenance of physical activity after cardiac rehabilitation completion was feasible, safe, and acceptable. Yet, changes to improve recruitment and response rate are needed before conducting a large-scale effect evaluation.

Dyadic patterns of mental health and quality of life change in partners and patients during three months of cardiac rehabilitation.

The effects of mental health on quality of life (QoL) over the course of a couple's recovery from a patient's cardiac event are unknown as partner outcomes are rarely considered within cardiac rehabilitation. To capture the transactional nature of recovery from a cardiac event, this research investigated the link between longitudinal changes in the mental health of couples in which at least one of the partners had cardiac disease and changes in their QoL during cardiac rehabilitation. Participants (N = 184 dyads) completed questionnaires measuring anxiety, depression, and QoL at baseline (enrollment) and 3 months (discharge). Dyadic data were analyzed using the Actor-Partner Interdependence Model with integrated latent change scores. The results indicated that improved anxiety was associated with significant positive changes in physical and emotional QoL for both the patient and partner (actor effects). A reduction in depression in both partners from baseline to follow-up predicted an increase in emotional QoL for patients and partners, and an increase in physical QoL for partners (actor effects). Patients whose depression decreased from enrollment to the completion of cardiac rehabilitation were associated with partners' greater positive changes in emotional QoL than were patients whose depression did not decrease, and reductions in partners' anxiety over time predicted positive changes in patients' physical QoL (partner effects). Findings underscore the need to screen for and attend to patients' and partners' mental health outcomes postcardiac event, as positive changes in mental health symptoms may optimize changes in patients' and partners' emotional and physical QoL. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Abstract 13300: Recovery From Acute Cardiac Events in Lower-Socioeconomic Status Patients: Physical and Psychological Outcomes Over Time

Introduction: Participation in cardiac rehabilitation (CR) reduces morbidity, and mortality, while improving quality of life following major cardiovascular events. Patients with lower-socioeconomic status (SES), such as those enrolled in Medicaid, are much less likely to attend and complete CR, despite being at increased risk for recurrent cardiovascular events. Methods: A secondary analysis was performed on a randomized controlled trial in which 130 individuals enrolled in Medicaid, with a CR-qualifying cardiac event, were randomized 1:1 to receive financial incentives for completing CR sessions or to usual care. Participants were assessed on clinical and cognitive outcomes soon after discharge as well as at 4 months, and 1 year following entry. The current analyses focused on how outcomes changed over the three timepoints. Outcomes included changes in psychological measurements (depressive/anxious symptoms, quality of life), body composition (waist circumference, body mass index), and fitness (peak VO2/METS). Mixed model repeated measures analyses of variance were used to test for main effects while controlling for sex, smoking status, age, and qualifying diagnosis. Results: Lower-SES patients entering CR had remarkably low levels of fitness and high rates of psychological issues. Fitness improved between intake and 4-months, and gains were maintained through one year (p&lt;0.001) (Table 1) however gains were less in females and those who completed fewer sessions of CR. Body composition measurements significantly worsened between 4-months and 1-year (p&lt;0.03). Psychological measures did not improve in the year following the event. Conclusion: While fitness improved in lower-SES patients, especially among those who completed more sessions of CR, psychological symptoms were elevated and did not improve. Future research should seek to understand how we can better serve this population, especially in the area of psych symptoms.

Abstract 16487: Implementation of a Web-Based Cardiac Rehabilitation Program in Rural Australia Improves Access

Introduction: Involvement in cardiac rehabilitation (CR) programs reduces death, reoccurring cardiac events, also improving quality of life. Globally, CR attendance and completion is poor, with referral and non-attendance rates ranging from 20-50%. Hypothesis: To evaluate the effectiveness of an interactive web-based CR program as an alternative mode of delivery, to improve access and attendance. Methods: The RE-AIM implementation framework. Patients eligible for CR, residing in a rural and remote areas between July 2021-June 2022 Results: A total of 828 rural patients participated, 50 choosing the web-based mode of delivery. Web patients were younger, (60, SD 11.9 vs 68.5 years, SD 11.9; p&lt;0.001). Sex distribution did not differ between web and non-web, 17 (34%) males in web and 195 (23.5%) non-web (p=0.167). Myocardial infarction was the predominant reason for referral in both groups (64.3% vs 35.6%, p=0.049). Mean BMI was higher in the web compared to non-web (33.6, SD 8.0 vs 29.8, SD 6.0; p=0.025). Program completion was higher for non-web than for the web-based patients (17; 34% vs 553;71.4% p=&lt;0.001). Web-based patients reported overall program satisfaction (77.8%). Clinicians reported the web-based program as high quality (71.4%). There was an increase in web-based enrolments with concurrent reduction in usual care resulting from COVID pandemic restrictions. Patient fidelity to entry of self-reported data was high in the web-based with all patients completing a pre-assessment and 50% a post-assessment. Change in risk factor control did not differ between the groups. There was no significant difference in patients’ preference by age or gender for web-based or other modes of CR. Web-based program enrolment was associated with a lower chance of CR completion (OR 0.19; 95% CI: 0.100, 0.372; p&lt;0.001) after adjustment for age and gender. Conclusions: The web-based program provides an alternative flexible mode to complete CR, having met the demands of COVID pandemic restrictions. It has been integrated and successfully used by patients and clinicians, capturing a cohort who fit into the 20-50% not attending a CR program. Strategies for improving completion of web-based programs need further investigation.

Behavioral Weight Loss Interventions for Overweight and Obese Cardiac Rehabilitation Patients: A Systematic Review.

The purpose of this systematic review was to identify evidence pertaining to the effectiveness of behavioral weight loss interventions for overweight and obese cardiac rehabilitation participants. A database search of PUBMED, CINAHL, PsycINFO, and PROSPERO yielded 10 eligible studies. Quantitative studies implementing behavioral weight loss interventions for overweight and obese adult cardiac rehabilitation participants were reviewed. Evidence supported the usefulness and effectiveness of behavioral weight loss interventions for overweight cardiac rehabilitation participants. With the limited number of studies and inclusion of quasi-experimental studies with comparative groups, it was not possible to determine the relative power of behavioral weight loss interventions across studies. In conclusion, behavioral weight loss interventions can be incorporated into cardiac rehabilitation or offered following cardiac rehabilitation to improve weight loss of overweight and obese cardiac rehabilitation participants. Findings reinforce national guidelines emphasizing the role of cardiac rehabilitation to address secondary cardiovascular disease risk factor modification, including integrating behavioral weight loss programs in cardiac rehabilitation, or referring overweight patients to weight management programs following completion of cardiac rehabilitation.

Cardiac Rehabilitation in Abu Dhabi: A Retrospective Investigation of Program Delivery, Participants, and Factors Associated with Program Completion Utilizing a Hospital Registry.

Investigations into the provision of cardiac rehabilitation from the Arabian Gulf countries are rare, despite suffering from an unusually high prevalence of cardiovascular disease. This study reports patient and program characteristics from an exercise-based cardiac rehabilitation program in Abu Dhabi, and factors associated with program completion. Data was drawn from the institution's cardiac rehabilitation registry, populated from the electronic medical record of patients enrolled in the hospital-based cardiac rehabilitation program, from 2015 to 2022. The program was administered by physical therapist and nurse specialists and guided by individualized exercise parameters. Completion of the program was defined as attendance of ten or more sessions. Relationships between program completion and demographic characteristics, quality of life, depression, and physical function were explored statistically. A total of 1774 patients attended at least one session, with a total of 15,563 sessions. The number of patients and sessions trended upward since program inception. The most common referral diagnoses of participants who completed the program were coronary artery bypass grafting, valve surgery, and percutaneous coronary intervention. Among all 1774 attendees, median age was 56, comprised of 61.6% male, and 77.1% residents of Abu Dhabi, and 73.5% Emirati nationals. 527 (29.7%) patients completed the program, and this group was significantly lower in BMI (29.4 vs 30.4 kg/m2), had lower prevalence of moderate to severe depression (9.0 vs 13.0%), were more often Abu Dhabi residents or Emirati nationals (88.2 vs 72.2%, and 76.9 and 72.0%, respectively), and more likely to have completed the 6-min walk test at the first visit (80.5 vs 72.5%). There were no differences between those who did and did not complete cardiac rehabilitation with respect to age, gender, quality of life, or first 6-min walk test distance. There is a growing demand for cardiac rehabilitation in Abu Dhabi, particularly among Emirati nationals and residents of Abu Dhabi. Potential risk factors for non-completion such as higher body-mass index, depression, lower physical function, non-residence in Abu Dhabi, and non-Emirati nationality warrant further exploration.

The Effect of Cardiac Rehabilitation on Quality of Life and 6-Minute Walk Test in Breast Cancer Survivors

Background Breast cancer (BC) is the most diagnosed cancer in women, contributing to 24.6% of malignancies in females and responsible for 15% of all cancer-related deaths among women worldwide.[1] Over the last 20 years, BC survival rates have significantly improved.[1] However, this survivorship is often marked by fatigue, poor quality of life (QoL), reduced functional capacity along with treatment-related adverse effects.[2] The implementation of a model similar to cardiac rehabilitation (CR) program as a preventive strategy may provide a potential solution to improve functional capacity, quality of life and reduce cardiovascular disease (CVD) risk in cancer survivors.[3] Objective to investigate the effect of 12-week completed cardiac rehabilitation program on quality of life (using FACT-B questionnaire) and 6-minute walk test in breast cancer survivors. Patients and Methods In this 2-arm parallel prospective, randomized, controlled clinical trial, sixty breast cancer survivors 3 months to 1 year after completion of chemotherapy were recruited at Ain Shams University hospitals and divided into two groups Study group (n = 30); participated in 12-week CR program and Control group (n = 30) did not participate in CR program but still received the usual cancer care. Cardiac rehabilitation program consisted of education, diet control, drug adherence, 12 weeks exercise sessions, Behavior and psychosocial management, Sexual activity education Smoking cessation. Functional capacity was assessed before and after study period by sixminute walk test (6MWT) and exercise test (using modified Bruce protocol). All patients were personally interviewed for assessment of quality of life before and after study period using (FACT-B) questionnaire. In addition patients underwent echocardiography assessment before and after study period. Result Sixty female breast cancer survivors were enrolled. Nine patients dropped from CR program, some due to social commitments (n = 2), others due to long distance issues (n = 2), and the remaining were not interested in continuing the program (n = 5). There were no significant differences between the two groups regarding age, baseline BMI, hemoglobin (Hb) levels, medical history, chemotherapy protocol, and radiation. When comparing two groups, the study group showed significant increase in age-predicted 6MWD (p = 0.02), ET (p &amp;lt; 0.001), METs (p &amp;lt; 0.001), QoL score (p &amp;lt; 0.001), along with significant decrease in SBP (p &amp;lt; 0.001), HR (p &amp;lt; 0.001), RPP (p &amp;lt; 0.001). Conclusion The results of this study demonstrated that completed cardiac rehabilitation program improves functional capacity and quality of life in breast cancer survivors. Recommendation We recommend that multicomponent supervised cardiac rehabilitation program should be incorporated within the usual care of breast cancer survivor

Key participant characteristics influencing completion of a phase II cardiac rehabilitation program: A cross-sectional analysis

Study objectiveCardiac rehabilitation (CR) programs are effective at reducing cardiovascular disease risk factors, yet programs in the United States (US) have poor participation and completion. The current study evaluates characteristics related to completion and drop-out for CR participants. DesignA cross-sectional study design compared participants who completed the program (finishers) and those did not finish (non-finishers). Variables were compared to determine differences between the dichotomous groups included demographic data, initial six-minute walk test, Zung Depression Index, and Quality of Life Measure (QLM). Logistical regression using variables with differences between groups determined impact on program completion. SettingPhase two outpatient hospital based cardiac rehabilitation program. ParticipantsNinety-seven participants were part of the sample; 61 completed the program, and 36 dropped out. Main outcome measureCompletion of CR. ResultsNinety-seven participants are included; 61 (63 %) were finishers and 36 (37 %) were non-finishers. Finishers were older, had a higher proportion of females and Medicare insurance recipients, had lower depression scores, and reported higher quality of life. Results of the final logistic regression revealed finishers were more likely to have Medicare (odds ratio (OR) = 5.215, confidence interval (CI) 1.897–14.338), be female (OR = 4.597, 95 % CI 1.532–13.795) and have higher QLM Family Sub scores (OR = 1.129, 95 % CI 1.023–1.246). The model correctly classified 71.9 % of cases. ConclusionThe analysis highlights Medicare insurance and family support are associated with program completion. Interventions to increase family and social support, and to provide financial assistance for those with financial burden through lack of insurance or high co-pays may increase cardiac rehabilitation completion rates.

Barriers and facilitators of cardiac rehabilitation uptake and completion in south Asian minorities: a meta-synthesis

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Cardiac rehabilitation is a proven modality to prevent future cardiac events and complications in cardiac patients. However, the uptake and completion rate are suboptimal in cardiac patients and even worse in ethnic minorities and women. South Asian minorities experience several barriers and facilitators to cardiac rehabilitation uptake and completion. Aim To develop a comprehensive understanding of barriers and facilitators to cardiac rehabilitation uptake and completion by South Asian minorities. Methods A meta-synthesis was conducted, and findings were reported using PRISMA guidelines. The following databases: Medline, Embase, APA PsycInfo, Cochrane Database of Systematic Review, CINHAL, Scopus, and Web of Science were searched from inception to July 2022. The inclusion criteria comprised the studies that focused on South Asian adult minorities’ barriers and/or facilitators of a structured cardiac rehabilitation program. Studies were critically appraised using the Mixed Methods Appraisal Tool. Thematic synthesis was used in the analysis. Results A total of 7110 records were retrieved and eight studies from Canada and United Kingdom met the inclusion criteria. There were more identified barriers than facilitators. Communication constraints resulted in inadequate health education, while conservative socio-religious beliefs, negative attitudes about healthcare professionals, and systemic constraints (e.g., transportation problems, and work schedule concerns) were the key barriers themes. Peer and family support and patient-preferred specific mechanisms for cardiac rehabilitation implementation were substantial facilitators. Conclusion South Asian minorities experience multilevel barriers and facilitators to cardiac rehabilitation uptake and completion. Further research with a robust and culturally contextual intervention and methodology can help improve the uptake and cardiac rehabilitation completion in this population. Healthcare professionals and policymakers can utilize these findings to develop tailored cardiac rehabilitation programs for South Asian minorities.

Comparison of Cardiac Rehabilitation (CR) Completion Rate Achieved With a Digital CR Program Management Application (Cardihab) Compared to Other Modes of Delivery

Comparison of Cardiac Rehabilitation (CR) Completion Rate Achieved With a Digital CR Program Management Application (Cardihab) Compared to Other Modes of Delivery

Cardiac Rehabilitation Facebook Intervention: Feasibility Randomized Controlled Trial.

The adherence to cardiac rehabilitation is low. Social media has been used to improve motivation and cardiac rehabilitation completion, but the authors did not find Facebook interventions for these purposes in the literature. The purpose of this study was to determine the feasibility of the Cardiac Rehabilitation Facebook Intervention (Chat) for affecting changes in exercise motivation and need satisfaction and adherence to cardiac rehabilitation. The Behavioral Regulation in Exercise Questionnaire-3 and Psychological Need Satisfaction for Exercise were used to measure motivation and need satisfaction (competence, autonomy, and relatedness) before and after the Chat intervention. To support need satisfaction, the intervention included educational posts, supportive posts, and interaction with peers. The feasibility measures included recruitment, engagement, and acceptability. Groups were compared using analysis of variance and Kruskal-Wallis tests. Paired t tests were used to assess motivation and need satisfaction change, and Pearson or Spearman correlations were used for continuous variables. A total of 32 participants were lost to follow-up and 22 were included in the analysis. Higher motivation at intake (relative autonomy index 0.53, 95% CI 0.14-0.78; P=.01) and change in need satisfaction-autonomy (relative autonomy index 0.61, 95% CI 0.09-0.87; P=.02) were associated with more completed sessions. No between-group differences were found. Engagement included "likes" (n=210) and "hits" (n=157). For acceptability, mean scores on a 1 (not at all) to 5 (quite a bit) Likert scale for feeling supported and in touch with providers were 4.6 and 4.4, respectively. Acceptability of the Chat group was high; however, intervention feasibility could not be determined due to the small sample size. Those with greater motivation at intake completed more sessions, indicating its importance in cardiac rehabilitation completion. Despite challenges with recruitment and engagement, important lessons were learned. ClinicalTrials.gov NCT02971813; https://clinicaltrials.gov/ct2/show/NCT02971813. RR2-10.2196/resprot.7554.

Facility-Based and Virtual Cardiac Rehabilitation in Young Patients with Heart Disease During the COVID-19 Era.

Cardiac rehabilitation (CR) is an important tool for improving fitness and quality of life in those with heart disease (HD). Few pediatric centers use CR to care for these patients, and virtual CR is rarely used. In addition, it is unclear how the COVID-19 era has changed CR outcomes. This study assessed fitness improvements in young HD patients participating in both facility-based and virtual CR during the COVID-19 pandemic. This retrospective single-center cohort study included new patients who completed CR from March 2020 through July 2022. CR outcomes included physical, performance, and psychosocial measures. Comparison between serial testing was performed with a paired t test with P < 0.05 was considered significant. Data are reported as mean ± standard deviation. There were 47 patients (19 ± 7.3years old; 49% male) who completed CR. Improvements were seen in peak oxygen consumption (VO2, 62.3 ± 16.1 v 71 ± 18.2% of predicted, p = 0.0007), 6-min walk (6MW) distance (401 ± 163.8 v 480.7 ± 119.2m, p = < 0.0001), sit to stand (16.2 ± 4.9 v 22.1 ± 6.6 repetitions; p = < 0.0001), Patient Health Questionnaire-9 (PHQ-9) (5.9 ± 4.3 v 4.4 ± 4.2; p = 0.002), and Physical Component Score (39.9 ± 10.1 v 44.9 ± 8.8; p = 0.002). Facility-based CR enrollees were less likely to complete CR than virtual patients (60%, 33/55 v 80%, 12/15; p = 0.005). Increases in peak VO2 (60 ± 15.3 v 70.2 ± 17.8% of predicted; p = 0.002) were seen among those that completed facility-based CR; this was not observed in the virtual group. Both groups demonstrated improvement in 6MW distance, sit-to-stand repetitions, and sit-and-reach distance. Completion of a CR program resulted in fitness improvements during the COVID-19 era regardless of location, although peak VO2 improved more for the in-person group.

Surveillance of the Initiation of, Participation in, and Completion of Cardiac Rehabilitation in Minnesota, 2017-2018.

Cardiac rehabilitation (CR) is an evidence-based secondary prevention program designed to improve cardiovascular health after a cardiac event. The objective of our study was to identify gaps in CR use among publicly and privately insured people in Minnesota to assist in developing shared goals among public health, cardiac rehabilitation professionals, and program delivery sites to improve CR delivery. We applied a published claims-based surveillance methodology to the Minnesota All Payer Claims Database to assess eligibility for, initiation of, participation in, and completion of CR by patients with qualifying events in 2017. We stratified results by sociodemographic and geographic factors and qualifying condition and used adjusted prevalence ratios to make statistical comparisons. Less than half (47.6%) of qualifying patients initiated CR within 1 year of their qualifying event; the rate was higher among men (vs women), adults aged 45 to 64 years (vs ≥65 y), and patients with commercial or Medicaid insurance coverage (vs Medicare). Among those who initiated CR, only 14.0% completed the full series of 36 sessions. Participation in at least 12 sessions and completion of 36 sessions was less likely among adults aged 18 to 64 (vs 65-74 y) and among patients covered by Medicaid (vs Medicare). Patterns of CR initiation, participation, and completion also varied geographically. This analysis expands on previous Medicare fee-for-service population CR surveillance and provides a first detailed look at the CR landscape in Minnesota, renewing attention to CR as a key secondary prevention strategy. Collaboration and sharing with partners has established the Minnesota Department of Health as a valuable partner in driving health system change to improve equitable provision of CR in Minnesota.