Component Of Cardiac Rehabilitation Research Articles

Identifying Elements for a Cardiac Rehabilitation Program for Caregivers: An International Delphi Consensus.

Background/Objectives: Caregivers of patients with heart disease may often feel physically, emotionally, and psychologically overwhelmed by their role. The analysis of cardiac rehabilitation (CR) components and caregivers' needs suggests that some interventions may benefit them. Therefore, this study aimed to identify a consensus on the CR components targeting caregivers of patients with heart disease. Methods: A three-round international e-Delphi study with experts on CR was conducted. In round 1, experts provided an electronic level of agreement on a set of initial recommendations originating from a previous scoping review. In round 2, experts were asked to re-rate the same items after feedback and summary data were provided from round 1. In round 3, the same experts were asked to re-rate items that did not reach a consensus from round 2. Results: A total of 57 experts were contacted via e-mail to participate in the Delphi panel, and 43 participated. The final version presents seven recommendations for caregivers of patients with heart disease in CR programs. Conclusions: These recommendations are an overview of the evidence and represent a tool for professionals to adapt to their context in the different stages of CR, integrating the caregiver as a care focus and as support for their sick family members. By identifying the components/interventions, there is potential to benchmark the development of a cardiac rehabilitation strategy to be used and tested by the healthcare team for optimizing the health and role of these caregivers.

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.

A systematic review and meta-analysis of Nordic walking for chronic heart failure with low left ventricular ejection fraction.

Nordic walking (NW) has been reported to be beneficial in various chronic diseases. To determine whether NW improves function in patients with heart failure (HF) with low left ventricular ejection fraction more than conventional cardiac rehabilitation or usual care. Systematic literature searches in PubMed, ScienceDirect, and Web of Science were conducted. According to patient, intervention, comparison, and outcome (PICO) principles, a stepwise selection process was completed to identify eligible studies. Only randomized controlled trials (RCTs) were included in this systematic review and meta-analysis. Pooled effects were determined using a random effect analysis model for the meta-analysis. A total of 282 participants from four RCTs were included. The improvement of peak oxygen consumption (peak VO2) was greater in the NW group than in the control group (mean difference [MD] = 2.18 mL/kg/min; 95% confidence interval [CI] = 1.35-3.01; p < .01). The improvement of the 6-minute walk test (6MWT) distance was also greater in the NW group than in the control group (MD = 16.51 meters; 95% CI = 3.23-29.80; p = .01). This systematic review highlights the benefits of NW training in patients with chronic HF, particularly those with systolic dysfunction. Specifically, NW walking was associated with increased peak VO2 and 6MWT improvement compared to conventional cardiac rehabilitation or usual care. These results suggest that NW may be a useful component of cardiac rehabilitation. However, additional larger studies with a wider range of patients are needed.

Development and Preliminary Efficacy of a Mindfulness-Based Counseling Program as Part of Comprehensive Cardiac Rehabilitation: A Pilot Study

Background: While psychological intervention is recognized as a core component of cardiac rehabilitation (CR), its application in CR remains limited. This study aimed to develop a psychological counseling program (the Mindfulness-Based Counseling Program [MBCP]) as a component of comprehensive CR for the patients with cardiovascular disease and to explore its preliminary efficacy.Methods: We developed a psychological counseling program (MBCP) as part of comprehensive CR. The MBCP consisted of six-week psychological counseling and mindfulness practice. Through this program, we aimed to promote health maintenance behaviors and stress management. Thirteen subjects with either acute myocardial infarction or congestive heart failure with reduced EF (≤40%) participated, randomized into either comprehensive CR including MBCP (n=7) or exercise-based CR (n=6). Psychological-status assessments included life satisfaction (DSQ), health-related quality of life (HRQoL), depression (PHQ-9), anxiety (GAD-7), type D personality, and stress (PSS).Results: The comprehensive CR group (n=7) experienced a significant decrease in anxiety and improvements in general health and mental aspects of HRQoL. The exercise CR group (n=6) experienced reduced depression and significantly increased mental aspects of HRQoL. Additionally, the overall satisfaction and participation rate for MBCP was high.Conclusions: The MBCP developed in this study showed preliminary efficacy for CR and is anticipated to enhance psychological wellbeing and the quality of life among cardiac patients.

Temporal Trends in Cardiac Rehabilitation Participation and Its Core Components: A Nationwide Cohort Study From the Netherlands.

Patient- and disease-specific data on cardiac rehabilitation (CR) participation and changes over time are limited. The objective of this study was to describe time trends in CR participation between 2013 and 2019 and provides insights into the utilization of CR components. Patients with cardiovascular disease (CVD) with an indication for CR were enrolled between 2013 and 2019. Dutch health insurance claims data were used to identify CR participation and its components. In total, 106 212 patients with CVD were included of which 37% participated in CR. Participation significantly increased from 28% in 2013 to 41% in 2016 but remained unchanged thereafter. Participation was highest in the youngest age groups (<50 yrs 52%; 50-65 yrs 50%), men (48%), patients with ST-segment elevation myocardial infarction (73%), non-ST-segment elevation myocardial infarction (59%), and coronary artery bypass grafting (82%). In contrast, it was the lowest in the oldest age group (≥85yrs 8%), women (30%), and in patients with heart failure (11%). Most participants in CR received referral plus an admission session (97%) and exercise training (82%), whereas complementary services related to dietary (14%) and mental health counseling (10%) had a low utilization. CR participation rates increased to 41% in 2016 but remained unchanged thereafter. Participation modulators included age, sex, CVD diagnosis, and undergoing a cardiothoracic procedure. Education and exercise sessions were frequently adopted, but dietary and mental health counseling had a low utilization rate. These findings suggest the need for reinvigorated referral and novel enrollment strategies in specific CVD subgroups to further promote CR participation and its associated underutilized adjunctive services.

Exercise Preferences and Barriers Among Patients With Heart Failure With Reduced Ejection Fraction or Myocardial Infarction.

Although cardiac rehabilitation (CR) is highly recommended in patients with cardiovascular disease (CVD), participation in CR is low mainly due to access barriers. Home-based CR (HBCR) has been recommended to overcome access barriers. Exercise is a core component of CR and should be developed and implemented based on individual characteristics. We aimed to assess physical activity behaviors, exercise preferences, and exercise barriers to understand physical activity characteristics of CVD patients. Participants were patients between the ages 19 to 75 years with a history of heart failure with reduced ejection fraction (HFrEF) or myocardial infarction (MI). They completed a cross-sectional survey at a tertiary hospital's outpatient clinic from April to June 2021. Survey data included physical activity levels, patterns, preference, and barriers of exercise. Participants (n=189; 143 males, 46 females, 62.1±12.0 years) were diagnosed as either HFrEF (n=160, 84.7%) or a history of MI (n=97, 51.3%). Only 26.5% of patients engaged in moderate to vigorous exercise for more than 150 minutes per week. Participants preferred exercising alone or with families. Walking (65.6%) and resistance exercises (35.4%) were favored, with outdoor (37%) and home-based (30.2%) settings preferred over fitness centers (10.6%) and hospitals (0.5%). Barriers to exercise included fatigue (34.4%), poor health perception (31.7%), and low fitness levels (30.7%). The results of this study can be used to develop tailored HBCR programs that consider individual preferences and address specific barriers, facilitating adequate physical activity engagement.

Cardiac telerehabilitation: current status and future perspectives.

Multidisciplinary cardiac rehabilitation (CR) improves the prognosis and quality of life of patients with cardiovascular disease and has therefore received strong recommendations in international guidelines for the treatment of patients with chronic coronary syndromes and chronic heart failure. Aiming to both resolve several barriers that impede participation in CR and to improve the effectiveness of CR, cardiac telerehabilitation (CTR) has emerged as acost-effective alternative to traditional, centre-based CR. Although the body of evidence for the feasibility and effectiveness of CTR is large and still growing, real-life implementations are scarce, which may be due to insufficient knowledge about CTR interventions and due to the challenges its implementation comes with. Up to now, mainly exercise-related core components of CR and e‑coaching have been investigated in the setting of CTR. Translation of research findings to clinical practice may be hampered by methodological limitations present in most CTR studies, being selection bias of participants, lack of long-term follow-up, heterogeneity of studied interventions and the lack of robust outcome measures. Besides conducting highly needed implementation studies for CTR interventions, their implementation could be facilitated by the development of guideline-based, multidisciplinary and personalised CTR programmes and widespread reimbursement for CTR.

Hatay’da kardiyovasküler hastalığı olan kişilerde kardiyak rehabilitasyon farkındalığı: Kesitsel bir çalışma

Aim: This study aimed to assess the awareness of cardiac rehabilitation (CR) among patients with cardiovascular disease (CVD) in Hatay.&#x0D; &#x0D; Methods: In the study, 218 patients (44.5% male, 55.5% female) in an age range of 18 to 84 [median 57(46.75–65.25) years] with CVD completed an awareness questionnaire, which included 35 items that addressed knowledge about CVD, CR features and content, CR effectiveness, reasons for not participating in CR programs, and general knowledge about CR.&#x0D; &#x0D; Results: Ninety-seven (44.5%) participants stated that they had knowledge about CVD, and 29.5% thought CR was required to prevent heart diseases. Fifty-nine subjects expressed they knew the exercises they needed to practice for CVD. Participants mostly accepted that CR effectively regulated blood lipids and blood pressure and managed blood glucose, obesity, and general well-being. One hundred patients (45.7%) reported that they did not participate in a CR program because they had no knowledge of CR. Most participants (60.6%) were undecided about whether the CR program was available in their city and whether it would be beneficial in treating heart diseases (50.5%). Men, young people, and people with higher education levels were more aware of the components of CR (p

A living lab approach to define patients needs and expectations for eHealth-based cardiac rehabilitation in Germany and Spain: the TIMELY study

Abstract Funding Acknowledgements Type of funding sources: Public grant(s) – EU funding. Main funding source(s): H2020. Background eHealth solutions may be used for personalized care and to provide assistance for disease control to CAD patients over the compendium of the disease. TIMELY is the first artificial intelligence-driven eHealth approach based on cardiac rehabilitation (CR) components connected with internet of things devices. For usability and acceptance of the TIMELY eHealth solution, patients are actively involved in development through a Living Lab approach. Purpose To define patients’ needs for an eHealth-based self-care support CR maintenance program. Methods The Living Lab used a guided survey among CAD patients at CR centers in Germany and Spain during inpatient or outpatient CR, respectively. Questions referred to use of technology and patients’ opinion on usefulness of suggested eHealth features. Importance/usefulness was rated on a 5-point Likert scale (median score). Results 79 CAD patients (20% female) participated (Spain, n=30; Germany, n=49). Patients’ mean age was 57 years (range 37–79), educational level was 87% ≤high school. All patients owned a smartphone also used for information (76%) and documentation (43%). Patients rated the importance of CR components (diet, stress management, regular exercise, risk factor reduction, smoking cessation) along the continuum of care as "very high" (5/5), with no difference between the two centers. Individual support for regular exercise after structured CR was rated "high" (4/5). Renewal of recommended training intensity (heart rate), evaluation of training progress, and suggestions on activities were rated "useful" (4/5) to "very useful" (5/5). The importance of support for stress management, risk factor management, diet, and medication adherence was rated 3/5. Usefulness of an education platform was rated 4/5, motivational messages scored 3/5. Individual feedback by a person was rated over feedback by a virtual agent (4/5 vs. 3/5). The availability of electronic health records was evaluated as "very useful" (5/5) remote blood pressure management and ECG monitoring were rated as "useful" (4/5). All items ranged between 1-5, indicating large interindividual differences. No differences between nationalities were detected for exercise-/medical-related features. For other CR features, overall progression documentation was significantly rated as more useful by German patients compared to Spanish patients (5/5 vs. 4/5, p&amp;lt;0.001) and German patients rated individual feedback of a real person higher than Spanish patients (5/5 vs. 4/5, p=0.005). No differences existed between women and men. Conclusions Patients expressed a strong need for individual support of physical exercise and updated training recommendations during CR maintenance. The observed inter-individual differences regarding usefulness and acceptance indicate the need for an adaptive system to reduce barriers for eHealth access. Patients from Germany and Spain showed equally high acceptance of eHealth components for the management of CAD.

Cardiac Rehabilitation in Coronary Artery Disease: Improving Outcomes and Adherence

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

Cardiac rehabilitation participation and risk of falls in older individuals with cardiovascular disease

Abstract Funding Acknowledgements Type of funding sources: None. Background Falls are the leading cause of injury-related morbidity and mortality among older adults in the United States, including those with cardiovascular disease. Cardiac rehabilitation (CR) helps to optimize functional capacity, strength, and balance in patients with cardiovascular disease and, in theory, may reduce the risk of falls. However, little evidence has been published in this regard. Purpose The purpose of this study was to assess the association between CR participation and risk of falls in a community-based sample of individuals 65 years of age and older with cardiovascular disease who were eligible for CR participation. Methods Individuals from Southeastern MN and Western WI, USA, 65 years of age and older who had experienced a cardiovascular event that qualified them for CR (MI, PCI, CABG, Valve Surgery, Transplant) between January 1, 2000, and December 31, 2018, were included in this study. Participation in CR (≥1 sessions, CR-group) and subsequent falls (moderate or severe, using the Campbell classification system) were ascertained using the Rochester Epidemiology Project records-linkage system. Logistic model to create propensity weighting were used to test the association between CR participation and falls after adjustment for potentially confounding factors. Results A total of 5004 individuals met inclusion criteria for the study, with 2183 (44%) included in the CR group and 2821 (56%) in the non-CR group (CR was indicated, but the individual did not participate). Overall, 1122 patients experienced a fall within the first 5 years (16% of those in the CR-group, 23% of those in the non-CR group). After adjustment, CR participation was not associated with falls, but older individuals, females, and those with a history of falls were more likely to have had a fall, compared to young individuals, males, and those without a history of a fall. Conclusions While CR is beneficial for patients with cardiovascular disease, our study did not find evidence of an association between CR participation and fall risk in individuals 65 years of age and older who have cardiovascular disease. Additional research is needed to evaluate the role of CR components that may potentially reduce modifiable risk factors for falls and thereby reduce the risk of falls.

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

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

Web-Based Questionnaire Survey on Heart Failure in Elderly Patients Using Outpatient Rehabilitation - Actual Conditions of Cardiac Rehabilitation in Long-Term Care Insurance Systems.

Background: The purpose of this study was to investigate the actual conditions of cardiac rehabilitation (CR) for elderly patients with heart failure (HF) in outpatient rehabilitation (OR) facilities using long-term care insurance systems. Methods and Results: This was a cross-sectional web-based questionnaire survey conducted at 1,258 facilities in the Kansai region (6 prefectures) of Japan from October to December 2021. In all, 184 facilities responded to the web-based questionnaire (response rate 14.8%). Of these facilities, 159 (86.4%) accepted patients with HF. Among the patients with HF, 94.3% were aged ≥75 years and 66.7% were classified as New York Heart Association functional class I/II. Facilities treating patients with HF generally provided exercise therapy, patient education, and disease management, which were components of CR. Many facilities not currently treating patients with HF responded positively stating they will accept HF patients in the future. However, a few facilities responded by stating that they are waiting for clearer evidence demonstrating the beneficial effect of OR on patients with HF. Conclusions: The present results show the possibility that outpatient CR can be performed for elderly patients with HF in other than medical insurance.

Top 50 cited articles on cardiac rehabilitation: A bibliometric and altmetric analysis study

Background/Aim: Cardiovascular disease (CVD) is the leading cause of death globally, with an estimated 18.6 million deaths each year. Cardiac rehabilitation (CR) has positive effects on reducing the mortality and morbidity of CVD, so there is a growing interest in this field. The aim of this study was to analyze the top 50 cited articles in the field of CR. Methods: The Web of Science (WoS) database was searched for articles published between 1986 and 2021. A record was made of the following information for the bibliometric analysis: article title, year of publication, number of authors and their names, number of citations, citation index, journal of publication, impact factor, type of article, and source of funding. The altmetric attention score (AAS) was recorded using automatic software calculation. Results: The majority of articles were published in the journal “Circulation” (n=14) and the “Journal of the American College of Cardiology” (n=8). The country with the highest number of articles was the US (n=27), and the most cited author was P.A. Ades. Studies evaluating exercise-based rehabilitation, key components of CR, and secondary prevention were among the top cited articles. In terms of AAS, in addition to the titles mentioned, mobile health services that rely on communication technologies have also received attention. Conclusion: This study provides useful information for researchers interested in CR, including trends, topics of interest in the field, and potential research collaborations. It is intended to guide future, more comprehensive, and in-depth studies on CR.

Patient Preferences for Cardiac Rehabilitation – A Systematic Review

Although a large number of studies have demonstrated the effectiveness of cardiac rehabilitation(CR), patient preferences for CR remain unclear. Knowing patient preferences may contribute to increasing patient participation and adherence, thus improving patient prognosis. A systematic search was carried out using electronic databases and manual reference checks from inception until 15th June 2022. Quantitative studies, qualitative studies and mixed methods studies assessing patient preferences for CR were included. Two researchers independently conducted study selectionand data extraction. CR preferences were divided into three categories: CR settings, CR components, and CR contents. A narrative synthesis was applied to integrate the results of the included studies. The Mixed Methods Appraisal Tool (MMAT) was used to assess the quality of included studies. Ultimately, 17 publications were included in this study. Regarding CR settings, most patients preferred the hospital to home, some considered both, and a few were willing to accept the local CR club as an alternative setting to the hospital. For CR components, regardless of age and gender, patients considered exercise training and nutrition counseling to be the most important and smoking cessation to be the least important. In exercise intervention of CR contents, progress discussion and encouragement were rated as most critical, and non-conflicting with other activities was rated as least critical. In psychological intervention of CR contents, most patients were willing to accept psychological intervention, and a few patients wanted to heal the trauma with the passage of time. This systematic review provides important insights into patient preferences for CR, clarifying patient preferences for CR settings, components, and contents, along with possible influencing factors. Patient preferences may change due to the COVID-19 epidemic, and there is still a need to focus on patient preferences for CR and conduct more relevant primary research to validate the findings of this paper in the future.

Defining patients needs and expectations for eHealth-based cardiac rehabilitation in Germany and Spain: living lab data from the TIMELY study

Abstract Background eHealth innovations have set the stage to optimize personalized care and provide assistance for disease control to patients with CAD. TIMELY is the first artificial intelligence (AI)-driven eHealth approach that employs internet of things devices and is based on cardiac rehabilitation (CR) components. To guarantee acceptance and usability of eHealth solutions, patients are actively participating in development through a Living Lab approach. Purpose To define patients' needs for an eHealth-based lifestyle intervention and self-care support. Methods The Living Lab approach included a guided survey conducted among CAD patients at CR centers in Germany and Spain during inpatient or outpatient CR, respectively. Questions referred to current use of technology and patients' opinion on the usefulness of suggested features of a future eHealth application. Ratings for usefulness/importance were recorded on a 5-point Likert scale reported as median score. Results 79 patients (20% female) were interviewed (DE, n=49; ES, n=30). Patients' mean age was 57 years (range 37–79), educational level was 87% ≤ high school and 13% &amp;gt; high school. All patients owned a smartphone that they also used for information (76%) and documentation (43%). Patients rated the importance of all CR components (regular exercise, healthy diet, stress management, smoking cessation, risk factor reduction) along the continuum of care as “very high” (5/5). Individual need for regular exercise support after structured CR was rated “high” (4/5). Exercise reminders, suggestions on activities, update of recommended training heart rate, evaluation of training progress, and achieved goals were rated “useful” (4/5) to “very useful” (5/5). The importance of support for diet, stress management, overall risk factor management, and medication was rated 3/5. Usefulness of a learning/education tool was rated 4/5, while motivational messages scored 3/5 and individual feedback of a person or virtual agent scored 4/5 and 3/5, respectively. The availability of electronic health records was evaluated as “very useful” (5/5) remote ECG monitoring and blood pressure management were rated as “useful” (4/5). The range of all items accessed was 1–5, indicating large interindividual differences. No significant differences existed between female and male patients or German and Spanish patients, though the importance of sharing training progress with family/ friends was rated higher by men (3/5) compared to women (1/5) and higher by Spanish (4/5) compared to German patients (2/5). Conclusions CR patients expressed a strong need for individual support of regular physical exercise and updated training recommendations. The observed inter-individual differences regarding usefulness and acceptance indicate the need for a highly adaptive system to prevent exclusion from eHealth access. CR patients from Germany and Spain showed equally high acceptance of eHealth components for the management of CAD. Funding Acknowledgement Type of funding sources: Public grant(s) – EU funding. Main funding source(s): European Commission Horizon 2020

심장재활 운동처방의 실전 적용

Coronary heart disease is the leading cause of death worldwide, and cardiovascular disease has risen to the second largest cause of death among Koreans. Cardiac rehabilitation (CR) has proven its safety and is an essential treatment worldwide. Among the elements of CR, interventions on physical activity are the main components of CR. Exercise reduces mortality and readmission rates and improves quality of life. Inpatient CR can be initiated once the patient

Defining patients needs and expectations for eHealth-based cardiac rehabilitation in Germany and Spain: living lab data from the TIMELY study

Abstract Background eHealth innovations have set the stage to optimize personalized care and provide assistance for disease control to patients with CAD. TIMELY is the first artificial intelligence (AI)-driven eHealth approach that employs internet of things devices and is based on cardiac rehabilitation (CR) components. To guarantee acceptance and usability of eHealth solutions, patients are actively participating in development through a Living Lab approach. Purpose To define patients' needs for an eHealth-based lifestyle intervention and self-care support. Methods The Living Lab approach included a guided survey conducted among CAD patients at CR centers in Germany and Spain during inpatient or outpatient CR, respectively. Questions referred to current use of technology and patients' opinion on the usefulness of suggested features of a future eHealth application. Ratings for usefulness/importance were recorded on a 5-point Likert scale reported as median score. Results 79 patients (20% female) were interviewed (DE, n=49; ES, n=30). Patients' mean age was 57 years (range 37–79), educational level was 87% ≤ high school and 13% &amp;gt; high school. All patients owned a smartphone that they also used for information (76%) and documentation (43%). Patients rated the importance of all CR components (regular exercise, healthy diet, stress management, smoking cessation, risk factor reduction) along the continuum of care as “very high” (5/5). Individual need for regular exercise support after structured CR was rated “high” (4/5). Exercise reminders, suggestions on activities, update of recommended training heart rate, evaluation of training progress, and achieved goals were rated “useful” (4/5) to “very useful” (5/5). The importance of support for diet, stress management, overall risk factor management, and medication was rated 3/5. Usefulness of a learning/education tool was rated 4/5, while motivational messages scored 3/5 and individual feedback of a person or virtual agent scored 4/5 and 3/5, respectively. The availability of electronic health records was evaluated as “very useful” (5/5) remote ECG monitoring and blood pressure management were rated as “useful” (4/5). The range of all items accessed was 1–5, indicating large interindividual differences. No significant differences existed between female and male patients or German and Spanish patients, though the importance of sharing training progress with family/ friends was rated higher by men (3/5) compared to women (1/5) and higher by Spanish (4/5) compared to German patients (2/5). Conclusions CR patients expressed a strong need for individual support of regular physical exercise and updated training recommendations. The observed inter-individual differences regarding usefulness and acceptance indicate the need for a highly adaptive system to prevent exclusion from eHealth access. CR patients from Germany and Spain showed equally high acceptance of eHealth components for the management of CAD. Funding Acknowledgement Type of funding sources: Public grant(s) – EU funding. Main funding source(s): European Commission Horizon 2020

Internal medicine resident education improves cardiac rehabilitation knowledge, attitudes, and referral rates: A pilot study

BackgroundReferrals to cardiac rehabilitation (CR) remain low despite evidence showing reduction in cardiovascular mortality and hospital readmissions. Resident education and awareness may be an opportunity to address barriers to CR referrals. MethodsThis pilot study involves 20 internal medicine residents rotating at an ambulatory primary care clinic. Voluntary surveys were sent through an online-based survey platform. Following survey completion, residents received a 10-minute scripted lecture and an educational handout outlining CR components, availability, indications, insurance eligibility criteria, and referral process. Surveys were redistributed 2 months post-education to assess changes in mean aggregate knowledge scores and attitude ratings on a 5-point Likert scale. CR referral rates of eligible patients pre- and post-education were obtained through review of electronic medical records. ResultsSixteen (80%) residents completed both pre and post surveys, and 13 (81%) reported no education on CR in the prior year. There was a significant increase in mean aggregate knowledge scores on CR components (5.1 versus 7.0, P = 0.001), insurance coverage (2.4 versus 5.6, P< 0.001), and eligible diagnoses (7.1 versus 9.9, P = 0.03) following education. Attitudes towards CR also improved following education, particularly in self-reported comfort level with explaining CR to patients (3.69 versus 2.06, P<0.001) and perceived familiarity with CR referral process (4.00 versus 2.18, P<0.001). CR referrals increased from 0% (0 out of 10 eligible patients) to 33% (3 out of 9 eligible patients) over a 2-month period before and after education, respectively (P = 0.09). ConclusionsInternal medicine resident knowledge and attitudes towards CR significantly improved after formal education. Although there was a modest increase in the rates of CR referrals following resident education, this pilot study was not powered to detect statistical significance.

Telerehabilitation In Monitoring Treatment of Heart Disease Patients: Literature Review

Aims: Heart disease is a chronic disease that affects the patient's physical and psychological adaptation. Currently, cardiac rehabilitation focuses on delivering rehabilitation components remotely using technology via telerehabilitation. Objective: The purpose of this review is to identify the use of telerehabilitation in monitoring signs and symptoms of heart disease. Methods: Literature review method with four databases PubMed, Proquest, Ebsco, Cochrane Library, Taylor &amp; Francis database, and identification of gray literature, spanning 2011-2021, and 24 articles were reviewed. Results: The results of the review show that cardiac rehabilitation components are provided through various tele media mobile phones, messenger applications (SMS, QQ, and WeChat), videoconferencing, online information (websites, emails), e-visit, and virtual reality (VR). Telerehabilitation is useful in monitoring exercise capacity, resting systolic blood pressure, blood pressure control, ECG monitoring media, monitoring of dysrhythmias (atrial fibrillation/AF), complaints of fatigue, monitoring of dyspnoea symptoms, hemoglobin and electrolyte levels. sodium and potassium), and depressive symptoms. Conclusions: Telerehabilitation can be an alternative for continuous care of patients in monitoring signs and symptoms of heart disease, both physical and psychological aspects.