Component Of Cardiac Rehabilitation Research Articles

Clinical Practice Guideline for Cardiac Rehabilitation in Korea.

ObjectiveThough clinical practice guidelines (CPGs) for cardiac rehabilitation (CR) are an effective and widely used treatment method worldwide, they are as yet not widely accepted in Korea. Given that cardiovascular disease is the second leading cause of death in Korea, it is urgent that CR programs be developed. In 2008, the Government of Korea implemented CR programs at 11 university hospitals as part of its Regional Cardio-Cerebrovascular Center Project, and three additional medical facilities will be added in 2019. In addition, owing to the promotion of CR nationwide and the introduction of CR insurance benefits, 40 medical institutions nationwide have begun CR programs even as a growing number of medical institutions are preparing to offer CR. The purpose of this research was to develop evidence-based CPGs to support CR implementation in Korea.MethodsThis study is based on an analysis of CPGs elsewhere in the world, an extensive literature search, a systematic analysis of multiple randomized control trials, and a CPG management, development, and assessment committee comprised of 33 authors—primarily rehabilitation specialists, cardiologists, and thoracic surgeons in 21 university hospitals and two general hospitals. Twelve consultants, primarily rehabilitation, sports medicine, and preventive medicine specialists, CPG experts, nurses, physical therapists, clinical nutritionists, and library and information experts participated in the research and development of these CPGs. After the draft guidelines were developed, three rounds of public hearings were held with staff members from relevant academic societies and stakeholders, after which the guidelines were further reviewed and modified.Principal ConclusionsCR involves a more cost-effective use of healthcare resources relative to that of general treatments, and the exercise component of CR lowers cardiovascular mortality and readmission rates, regardless of the type of coronary heart disease and type and setting of CR. Individualized CR programs should be considered together with various factors, including differences in heart function and lifestyle, and doing so will boost participation and adherence with the CR program, ultimately meeting the final goals of the program, namely reducing the recurrence of myocardial infarction and mortality rates.

Clinical Practice Guideline for Cardiac Rehabilitation in Korea: Recommendations for Cardiac Rehabilitation and Secondary Prevention after Acute Coronary Syndrome.

Though clinical practice guidelines (CPGs) for cardiac rehabilitation (CR) are an effective and widely used treatment method worldwide, they are as yet not widely accepted in Korea. Given that cardiovascular (CV) disease is the second leading cause of death in Korea, it is urgent that CR programs be developed. In 2008, the Government of Korea implemented CR programs at 11 university hospitals as part of its Regional Cardio-Cerebrovascular Center Project, and 3 additional medical facilities will be added in 2019. In addition, owing to the promotion of CR nationwide and the introduction of CR insurance benefits, 40 medical institutions nationwide have begun CR programs even as a growing number of medical institutions are preparing to offer CR. The purpose of this research was to develop evidence-based CPGs to support CR implementation in Korea. This study is based on an analysis of CPGs elsewhere in the world, an extensive literature search, a systematic analysis of multiple randomized control trials, and a CPG management, development, and assessment committee comprised of thirty-three authors—primarily rehabilitation specialists, cardiologists, and thoracic surgeons in 21 university hospitals and 2 general hospitals. Twelve consultants, primarily rehabilitation, sports medicine, and preventive medicine specialists, CPG experts, nurses, physical therapists, clinical nutritionists, and library and information experts participated in the research and development of these CPGs. After the draft guidelines were developed, 3 rounds of public hearings were held with staff members from relevant academic societies and stakeholders, after which the guidelines were further reviewed and modified. CR involves a more cost-effective use of healthcare resources relative to that of general treatments, and the exercise component of CR lowers CV mortality and readmission rates, regardless of the type of coronary heart disease and type and setting of CR. Individualized CR programs should be considered together with various factors, including differences in heart function and lifestyle, and doing so will boost participation and adherence with the CR program, ultimately meeting the final goals of the program, namely reducing the recurrence of myocardial infarction and mortality rates.

What factors are associated with patients walking fitness when starting cardiac rehabilitation?

IntroductionPatients with heart failure (HF) are now a priority group for cardiac rehabilitation (CR). A fundamental component of CR is increasing physical fitness through exercise training. Even though studies show fitness benefits, there is little evidence in routine populations of individual factors that may influence fitness. This study aims to evaluate the extent to which demographics and clinical measures predict physical fitness in patients with HF and develop reference values to guide practice. MethodsData from the National Audit Cardiac Rehabilitation (NACR) was analysed. 2047 patients (73% male) with HF completed an incremental shuttle walk test (ISWT). Backward regression accounting for patient characteristics and new comorbidity groups were used to identify predictors of distance using ISWT. Reference values were produced from the percentiles of the ISWT distance. ResultsPopulation age was 64.43 years (12.39 SD) with an average ISWT distance of 278.57 m (SD 158.57). Demographics, risk factors and comorbidities explained 26% of the variance in distance (adjusted R2 = 0.256, p value < 0.001). Diuretics (−33.01 m ±8.07 SD) and socioeconomic status (9.12 m ±2.91 SD) were significant predictors of baseline walking fitness. Furthermore, respiratory obstructions, musculoskeletal issues and metabolic diseases were associated with reduced walking distance of 29.8 m, 26.6 m and 18.4 m respectively. ConclusionUse of diuretics, socioeconomic status and presence of comorbidities were significant predictors of walking performance in patients with HF who attended CR and were fit enough to carry out an ISWT. Reference values, to aid clinical practice, were developed that included age, gender and comorbidities status.

Perspectives of cardiac rehabilitation staff on strategies used to assess, monitor and review – a descriptive qualitative study

BackgroundThe mechanisms contributing to the success of cardiac rehabilitation (CR) are poorly understood and may include assessment, monitoring and review activities enabled by continuity of care and this is investigated in this study. ObjectivesTo identify active assessment components of CR. MethodsA qualitative study using focus groups and individual interviews. CR staff (n = 39) were recruited via professional association email and network contacts and organised into major themes. ResultsCR staff assessment strategies and timely actions undertaken provided a sophisticated post-discharge safety net for patients. Continuity of care enabled detection of adverse health indicators, of which medication issues were prominent. Interventions were timely and personalised and therefore likely to impact outcomes, but seldom documented or reported and thus invisible to audit. ConclusionCR staff assessment and intervention activities provide an unrecognised safety net of activities enabled by continuity of care, potentially contributing to the effectiveness of CR.

Factors influencing change in walking ability in patients with heart failure undergoing exercise-based cardiac rehabilitation

ObjectivesExercise-based cardiac rehabilitation (CR) is an effective intervention for patients with heart failure (HF), in which one of the main targets is to increase physical capacity. In the HF population this is traditionally assessed using distance covered during a walking test. This study aims to establish the extent to which change in walking ability, in HF patients attending CR, is determined by patient characteristics and service provision. MethodsThe study utilised routine clinical data from the National Audit of Cardiac Rehabilitation to perform a robust analysis. Change, in metres, between pre- and post-CR six-minute walk tests was calculated. Multivariate linear regression models were used to explore the relationship between patient characteristics, service-level variables, and change in metres walked. ResultsComplete and valid data from 633 patients was analysed, and a mean change of 51.30 m was calculated. Female gender (−34.13 m, p = 0.007), being retired (−36.41 m, p = 0.001) and being married/in a relationship (−32.54 m, p = 0.023) were all significant negative predictors of change. There was an additional negative relationship with body mass index (BMI) whereby for every unit increase in BMI, predicted change reduces by 2.48 m (p = 0.006). ConclusionsThis study identified significant patient-level characteristics strongly associated with limited improvement in walking ability following CR. Improving physical capacity is a core component of CR, therefore services should aim to account for baseline characteristics identified in this study as part of tailoring the CR intervention around the individual. Pre- and post-CR physical capacity assessments, which constitute minimum standards for CR, are worryingly low and should be given high priority.

Validation of the Brazilian Version of CADE-Q II to Assess Knowledge of Coronary Artery Disease Patients.

BackgroundThe Coronary Artery Disease Education Questionnaire (CADE-Q), an instrument aimed at assessing patients’ knowledge about coronary artery disease (CAD), was originally developed and psychometrically validated in Brazil. It was later translated, cross-culturally adapted, and validated to English. Although both versions demonstrated good reliability and validity, new studies in the area have pointed out the need of implementing the CADE-Q with other components of cardiac rehabilitation (CR) programs, such as psychologic factors, which had not been considered in previous version and were added in the subsequent, adapted version. Thus, a second version of CADE-Q was developed in English, the CADE-Q II.Objectiveto translate, culturally adapt and psychometrically validate the CADE-Q II in Brazilian Portuguese.MethodsAfter translation and review by a Committee of specialists in CR, a version in Brazilian Portuguese was generated and tested in 307 patients in CR. Test-retest reliability was assessed by intraclass correlation coefficient (ICC) in 49 patients; internal consistency was assessed using Cronbach’s alpha (α); and, criterion validity was assessed regarding patients’ educational level and family income. The level of significance adopted for all tests was 5%.ResultsAfter the ICC analysis, 4 items were excluded. The questionnaire was considered internally consistent (α > 0.7). Associations were found between the mean total scores and the variables schooling (p < 0.001) and income (p < 0.001). Median total score was 53 (14) points corresponding to 65.4% of the total possible score.ConclusionThe Portuguese version of the CADE-Q II showed sufficient reliability, consistency and validity, supporting its use in future studies.

Subjective correlates of stress management in outpatient cardiac rehabilitation: the predictive role of perceived heart risk factors.

Introduction: The causal attributions and perceived risk factors can affect patients’ health behaviors. Therefore, the present study aimed to assess (i) the effect of an outpatient cardiac rehabilitation (CR) program on perceived heart risk factors (PHRFs) and on psychological stress, and (ii) the role of changes of PHRFs at pre-post CR in predicting changes in psychological stress. Methods: In this longitudinal study, 110 CR patients were assessed from June to November 2016 in a hospital in Iran. Perceived heart risk factors and perceived stress were investigated using the PHRFs scale and the Depression, Anxiety, Stress Scale-21, respectively. PHRFs and DASS-21 Stress scale scores were compared before and after 26 sessions of exercise-based CR through paired sample t-tests. In addition, we investigated the effect of PHRF’s change scores on DASS-21 Stress scale scores using linear regression analysis. Results: Results showed that CR has a little impact in improving the patients’ perception of heart risk factors, However, CR is significantly effective in reducing stress (P < 0.05). Regression analysis evidenced that improvements in patients’ perception of risk factors can significantly predict a reduction in psychological stress (P = 0.030). The model explained 11.2% of the variance in the results. Conclusion: PHRFs appear to be significant predictive components of CR’s stress reduction. Practitioners should focus on patients’ perception of risk factors to facilitate stress management in CR program.

P3429Correlations between components of cardiac rehabilitation and attaining risk factor goals after myocardial infarction - the Perfect-CR study

P3429Correlations between components of cardiac rehabilitation and attaining risk factor goals after myocardial infarction - the Perfect-CR study

Exercise Telemonitoring and Telerehabilitation Compared with Traditional Cardiac and Pulmonary Rehabilitation: A Systematic Review and Meta-Analysis.

Background: Despite exercise capacity and quality-of-life benefits, pulmonary rehabilitation (PR) and cardiac rehabilitation (CR) programmes are not easily accessed because of several barriers. A solution may be telerehabilitation (TR), in which patients exercise in their communities while they are monitored via teletechnology. However, the benefits of TR for the purposes of PR and CR have not been systematically reviewed. Objective: To determine whether the benefits of the exercise component of PR and CR using TR are comparable to usual-care (UC) programmes. Methods: A comprehensive literature search was performed of the Medline, Embase, and CINAHL databases up to July 13, 2015. Meta-analyses were performed for peak oxygen consumption, peak workload, exercise test duration, and 6-minute walk test (6MWT) distance using the I2 statistic and forest plots displaying standardized mean difference (SMD). Results: Of 1,431 citations found, 8 CR studies met the inclusion criteria. No differences were found in exercise outcomes between UC and TR groups for CR studies, except in exercise test duration, which slightly favoured UC (SMD 0.268, 95% CI: 0.002, 0.534, p<0.05). Only 1 PR study was included, and it showed similar improvements on the 6MWT between the UC and TR groups. Conclusion: TR for patients with cardiac conditions provided benefits similar to UC with no adverse effects reported. Similar studies of TR for patients with pulmonary conditions need to be conducted.

Cardiac rehabilitation delivery model for low-resource settings

ObjectiveCardiovascular disease is a global epidemic, which is largely preventable. Cardiac rehabilitation (CR) is demonstrated to be cost-effective and efficacious in high-income countries. CR could represent an important approach to mitigate the epidemic of cardiovascular disease in lower-resource settings. The purpose of this consensus statement was to review low-cost approaches to delivering the core components of CR, to propose a testable model of CR which could feasibly be delivered in middle-income countries.MethodsA literature review regarding delivery of each core CR component, namely: (1) lifestyle risk factor management (ie, physical activity, diet, tobacco and mental health), (2) medical risk factor management (eg, lipid control, blood pressure control), (3) education for self-management and (4) return to work, in low-resource settings was undertaken. Recommendations were developed based on identified articles, using a modified GRADE approach where evidence in a low-resource setting was available, or consensus where evidence was not.ResultsAvailable data on cost of CR delivery in low-resource settings suggests it is not feasible to deliver CR in low-resource settings as is delivered in high-resource ones. Strategies which can be implemented to deliver all of the core CR components in low-resource settings were summarised in practice recommendations, and approaches to patient assessment proffered. It is suggested that CR be adapted by delivery by non-physician healthcare workers, in non-clinical settings.ConclusionsAdvocacy to achieve political commitment for broad delivery of adapted CR services in low-resource settings is needed.

The influence of physical exercise as a component of cardiac rehabilitation on endothelial dysfunction – review of the related research

The influence of physical exercise as a component of cardiac rehabilitation on endothelial dysfunction – review of the related research

EFFECTS OF CARDIAC REHABILITATION ON FUNCTIONAL CAPACITY AND CARDIOVASCULAR RISK FACTORS IN BRAZILIAN PATIENTS ASSISTED BY PUBLIC HEALTH CARE: PROTOCOL OF A RANDOMIZED CONTROLLED TRIAL

BACKGROUND: The leading non-communicable disease globally, namely cardiovascular disease (CVD), is also the leading cause of mortality, with over 80% of deaths occurring in low and middle-income countries (LMICs). In the MIC of Brazil, CVD is also the leading cause of mortality. To lessen the impact of CVDs on individuals and societies, a comprehensive approach such as cardiac rehabilitation (CR) is needed. Although there are many trials conducted in high-income countries, which show benefits and feasibility of CR, there have only been trials in the LMICs of China and Thailand. Therefore it is unclear whether similar results can be achieved in Brazil. The objective of this trial is to investigate whether participation in a comprehensive CR program in the MIC Brazil results in better functional capacity, cardiovascular risk factor control, health behaviour and disease-related knowledge when compared to exercise-based CR or usual care. METHODS: The design is a single-blinded pragmatic RCT with 3 parallel arms: comprehensive CR (includes education) vs. exercise-based CR (no education) vs. usual care (no CR). Random allocation is concealed. Patients in the CR group will be referred for 6 months of exercise classes (3 times/week at the beginning to 1 time/week), based on an individualized prescription from an exercise test. The comprehensive CR group will also receive 24 weekly educational sessions regarding the core components of CR and a workbook (developed empirically in Canada, and translated and crossculturally adapted for Brazil). The target sample size is 186. The primary outcome is functional capacity assessed by the Shuttle Walk Test at pre-test, and again after 3 and 6-months. The secondary outcomes of risk factor control will be assessed by blood pressure (hypertension), body mass index plus waist circumference (obesity), smoking, and lipids (dyslipidemia). The tertiary outcomes of heart-healthy behaviors, namely exercise, cardiac medication adherence, diet, depressive symptoms, and CVD knowledge will be evaluated by psychometrically-validated questionnaires pre and post-program and pedometers. MANCOVAs will be performed, adjusting for pre-test values. RESULTS: To date, 18 participants have been randomized. Preliminary results will be presented. We anticipate that participants exposed to either CR arm will have better functional capacity, and those exposed to comprehensive CR will have better risk factor control and behaviour than participants randomized to usual care. CONCLUSION: This trial may provide the evidence basis for the benefits of CR in Brazil. This can then be used to advocate for greater availability and reimbursement of CR services. 032 COMPLICATIONS OF 7,397 PERSANTINE MIBI SCANS PERFORMED IN A COMMUNITY CARDIOLOGY CLINIC

COMPLICATIONS OF 7,397 PERSANTINE MIBI SCANS PERFORMED IN A COMMUNITY CARDIOLOGY CLINIC

BACKGROUND: The leading non-communicable disease globally, namely cardiovascular disease (CVD), is also the leading cause of mortality, with over 80% of deaths occurring in low and middle-income countries (LMICs). In the MIC of Brazil, CVD is also the leading cause of mortality. To lessen the impact of CVDs on individuals and societies, a comprehensive approach such as cardiac rehabilitation (CR) is needed. Although there are many trials conducted in high-income countries, which show benefits and feasibility of CR, there have only been trials in the LMICs of China and Thailand. Therefore it is unclear whether similar results can be achieved in Brazil. The objective of this trial is to investigate whether participation in a comprehensive CR program in the MIC Brazil results in better functional capacity, cardiovascular risk factor control, health behaviour and disease-related knowledge when compared to exercise-based CR or usual care. METHODS: The design is a single-blinded pragmatic RCT with 3 parallel arms: comprehensive CR (includes education) vs. exercise-based CR (no education) vs. usual care (no CR). Random allocation is concealed. Patients in the CR group will be referred for 6 months of exercise classes (3 times/week at the beginning to 1 time/week), based on an individualized prescription from an exercise test. The comprehensive CR group will also receive 24 weekly educational sessions regarding the core components of CR and a workbook (developed empirically in Canada, and translated and crossculturally adapted for Brazil). The target sample size is 186. The primary outcome is functional capacity assessed by the Shuttle Walk Test at pre-test, and again after 3 and 6-months. The secondary outcomes of risk factor control will be assessed by blood pressure (hypertension), body mass index plus waist circumference (obesity), smoking, and lipids (dyslipidemia). The tertiary outcomes of heart-healthy behaviors, namely exercise, cardiac medication adherence, diet, depressive symptoms, and CVD knowledge will be evaluated by psychometrically-validated questionnaires pre and post-program and pedometers. MANCOVAs will be performed, adjusting for pre-test values. RESULTS: To date, 18 participants have been randomized. Preliminary results will be presented. We anticipate that participants exposed to either CR arm will have better functional capacity, and those exposed to comprehensive CR will have better risk factor control and behaviour than participants randomized to usual care. CONCLUSION: This trial may provide the evidence basis for the benefits of CR in Brazil. This can then be used to advocate for greater availability and reimbursement of CR services. 032 COMPLICATIONS OF 7,397 PERSANTINE MIBI SCANS PERFORMED IN A COMMUNITY CARDIOLOGY CLINIC

Cardiac rehabilitation in heart failure patients with devices

Cardiac rehabilitation (CR) for heart failure by systolic dysfunction benefits from a recommendation of level IA by all the scientific societies. The main core components of CR include: evaluation, personalized physical training, patient education, treatments optimization and psycho-social counselling. Heart failure patients are sometimes, and more and more often, implanted by simple or sophisticated pacemakers, resynchronization and/or automatic defibrillators for rhythm and/or hemodynamic indications. The management of these patients requires the knowledge of the functioning of every device, constraints and limits of these and risks associated to the disease and to the equipment in different situations. The cardiologic evaluation at exercise by a cardiopulmonary exercise test will allow the prescription of the training but it happens that some adjustments of the settings are required. The demonstrated benefits of exercise training are an improvement of exercise capacities, and consequently of quality of life and also a reduction on re-hopitalizations. If education is mandatory for all the heart failure patients, in implanted patients, specific knowledge and behavior modifications were also implemented. Optimization of the treatments needs to take on account the patient profile. Psychological consequences (particularly for implanted cardiac defibrillators) should be managed and possibilities to return to a normal of possible life (including return to work) evaluated. Accordingly, management of implanted heart failure patients requires a specific skills and cardiologic supervision adapted to the patient situation.

Cardiac rehabilitation: impact of graded exercise in the recovery period following myocardial infarction

Cardiac rehabilitation: impact of graded exercise in the recovery period following myocardial infarction Simon WhiteSchool of Pharmacy, Keele University, Staffordshire, UKAbstract: This paper reviews the impact of graded exercise undertaken as part of a cardiac rehabilitation (CR) program in the recovery period following a myocardial infarction, focusing on how CR may be best provided and the evidence-base relating to exercise-based CR. Essential components of CR are considered here to include education about healthy behavior, lifestyle modification where necessary (especially in relation to smoking, diet, and physical exercise), medical risk factor management, use of cardioprotective medicines and implantable devices, and psychosocial health management. It is argued that the totality of the evidence continues to demonstrate benefits of exercise-based CR in terms of mortality and morbidity, despite the debate about the magnitude of that benefit. However, given the wide variance in the quality and nature of CR service provision, there is no guarantee that patients eligible for CR will benefit fully. In line with national and international standards, CR should be tailored to the patient&#39;s individual needs, but structured exercise is recommended for most patients. Exercise sessions, whether based in hospital, in the community, or at home, should be designed to vary the frequency, intensity, duration, and type of exercise. They must include an initial warm-up period, before a conditioning period, and finish with a cool-down period. Patients should be taught to self-monitor so that they can exercise safely on their own. In designing interventions to support patients to change health behavior, health professionals should recognize that patients may only make lifestyle modifications to aspects of lifestyle perceived as causes of their cardiovascular disease and so, for example, may not do the recommended amount of exercise if they do not perceive lack of exercise to be a cause of their cardiovascular disease.Keywords: cardiovascular disease, public health, education programs, cardiac rehabilitation, lifestyle change, physical activity

Abstract 335: Cardiac Rehabilitation Referral After Acute Myocardial Infarction: Variation in Referral Rates and Association with Core Components of Risk Factor Management

Background: Although currently an endorsed performance measure of quality, cardiac rehabilitation (CR) referral rates remain quite low. Established guidelines describe recommended core components of CR programs for risk factor management: nutritional counseling; physical activity counseling; exercise training; smoking cessation; and weight, hypertension, lipid, diabetes, and psychosocial management. We sought to determine the variability in hospital referral rates for CR and assess whether patients are more likely to be referred who have risk factors that are intervention targets of the core components of CR. Methods: We assessed referral to outpatient CR among 3632 MI patients from 22 US hospitals in the TRIUMPH study who were discharged home with risk factor data available. Variation in CR referral rates across hospitals was quantified by the median rate ratio (MRR). The prediction of CR referral by 8 individual risk factors that are intervention targets of CR was assessed using hierarchical modified Poisson regression, adjusting for study site and 16 demographic and clinical patient characteristics. Results: Upon hospital discharge, only 39.1% (n=1420) of patients were referred to CR. Referral rates varied greatly across sites, ranging from 2.6% to 88.2%. After adjusting for potentially confounding patient factors, the MRR was 2.47 (95% CI 1.67, 3.23), indicating an average 2.5 times greater likelihood of 2 hypothetically identical patients being referred to CR upon discharge from 1 random hospital as compared with another. Only 1 of 8 risk factors modifiable by CR core components was associated with increased referral (see figure), with overweight patients (BMI &gt; 25 or waist circumference &gt; 40 in. for men, &gt; 35 in. for women) being more likely to be referred than non-overweight patients (RR 1.09; 95% CI 1.03, 1.15; p&lt;0.01). Conclusion: Among patients discharged home after MI hospitalization, there are marked differences in outpatient CR referral rates by study site, but relatively little association with patient risk factors that the core components of CR programs are specifically designed to modify. This suggests that site-specific factors strongly influence CR referral and site-level interventions to improve referral are likely to most effectively improve compliance with this performance measure.

Ventricular assist device patients on the horizon of cardiovascular prevention and rehabilitation. Can we convert challenges into opportunities?

The first cardiac rehabilitation (CR) programmes appeared around the 1960s when Turell and Hellerstein advocated comprehensive rehabilitation for patients recovering from acute cardiac events. The focus was on the successful integration of patients back into society, improving recovery times and functional status, and reducing the hospital stay; therapeutic exercise was the core component of CR. Since then, CR has undergone profound changes, with programmes now embracing secondary prevention activities and covering a wide spectrum of cardiovascular conditions. Today, CR and prevention programmes include patients post-percutaneous coronary intervention, after cardiac surgery including heart transplantation (HT), and with chronic heart failure (HF). Hence, the CR revolution has occurred in two directions: the type of interventions offered and type of patients referred. The management of patients with recent ventricular assist device (VAD) implantation represents a natural and legitimate development for contemporary CR and prevention programmes.

Cardiac Rehabilitation After Heart Valve Surgery

Cardiac rehabilitation (CR) is approved by the Centers for Medicare and Medicaid Services for patients who have had heart valve surgery. Analysis of data shows that CR increases exercise capacity and quality of life, and facilitates return to work, with minimal risk of significant adverse effects. In spite of this, CR is vastly underused. Recommendations to improve this include an automatic referral system, liaison assistance to speak with inpatients about CR, and establishment of CR programs in areas that have poor access to the large hospital-based facilities. Components of CR for patients who have had heart valve surgery also are discussed in this review.

Long-term retention of aerobic fitness improvements following participation in cardiac rehabilitation

Significant improvements in aerobic capacity, immediately following participation in cardiac rehabilitation (CR), are well documented [1]. Given the strong association between higher aerobic capacity and favorable prognosis in those with coronary artery disease (CAD) [2], it should be no surprise that improving fitness is a core component of CR [3,4]. While the acute benefits of CR on aerobic capacity are established, it is unclear if these improvements are retained over the long term once patients are discharged and expected to exercise independently.

Uptake of a technology‐assisted home‐care cardiac rehabilitation program

The prevalence of cardiovascular disease, a major cause of disease burden in Australia and other developed countries, is increasing due to a rapidly ageing population and environmental, biomedical and modifiable lifestyle factors. Although cardiac rehabilitation (CR) programs have been shown to be beneficial and effective, rates of referral, uptake and utilisation of traditional hospital or community centre programs are poor. Home-based CR programs have been shown to be as effective as centre-based programs, and recent advances in information and communication technologies (ICT) can be used to enhance the delivery of such programs. The Care Assessment Platform (CAP) is an integrated home-based CR model incorporating ICT (including a mobile phone and the internet) and providing all the core components of traditional CR (education, physical activity, exercise training, behaviour modification strategies and psychological counselling). The mobile phone given to patients has an integrated accelerometer and diary application for recording exercise and health information. A central database, with access to these data, allows mentors to assess patients' progress, assist in setting goals, revise targets and give weekly personal feedback. Mentors find the mobile-phone modalities practical and easy to use, and preliminary results show high usage rates and acceptance of ICT by participants. The provision of ICT-supported home-based CR programs may enable more patients in both metropolitan and remote settings to benefit from CR.