Core Components Of Cardiac Rehabilitation Research Articles

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.

Nurses' knowledge, attitudes, and practices about rehabilitation of patients after heart valve surgery in Namibia.

A cardiac rehabilitation programme is a medically supervised intervention to assist patients in recovery after heart surgeries and to prevent potential complications. Nurses should have the knowledge, a positive attitudes, and good practices to improve patient quality of life during the recovery process. This study aimed to describe the knowledge, attitudes, and practices of the nurses regarding cardiac rehabilitation for patients after heart valve surgery. The study setting was Windhoek Central Hospital, Cardiac Unit, in Windhoek, Namibia. A quantitative and descriptive research design was used for convenient non-probability sampling of (N = 23) nurses who consented to participate in the study. Data were collected through self-administered questionnaires and analyzed using SPSS Version 26. Descriptive statistics were used and Fischer's Exact test for associations of variables was performed. The study results showed a high level of knowledge, good attitudes, and poor to fair practices toward cardiac rehabilitation. However, the respondents demonstrate a lack of knowledge about the indications, and benefits of cardiac rehabilitation, negative attitudes regarding counselling of patients on sexual activities, and poor practice regarding exercises and counseling of patients and caregivers on cardiac rehabilitation. Furthermore, there is a positive relationship between the respondents' older age, senior rank, and having been trained I cardiac conditions and their knowledge, attitudes and practices regarding some core components of cardiac rehabilitation with P-value < 0.050. There is a need for a cardiac rehabilitation programme to improve nurses' attitudes and practices toward cardiac rehabilitation. Understanding the gap in knowledge, attitudes, and practices among the nurses regarding cardiac rehabilitation would guide the Ministry of Health and Social Services (MoHSS) in the implementation of the cardiac rehabilitation for patients after heart valve surgery.

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.

Effectiveness of cardiac rehabilitation programs on medication adherence in patients with cardiovascular disease: A systematic review and meta-analysis

BackgroundEducation to improve medication adherence is one of the core components of cardiac rehabilitation (CR) programs. However, the evidence on the effectiveness of CR programs on medication adherence is conflicting. Therefore, we aimed to summarize the effectiveness of CR programs versus standard care on medication adherence in patients with cardiovascular disease. MethodsA systematic review and meta-analysis was conducted. Seven databases and clinical trial registries were searched for published and unpublished articles from database inception to 09 Feb 2022. Only randomised controlled trials and quasi-experimental studies were included. Two independent reviewers conducted the screening, extraction, and appraisal. The JBI methodology for effectiveness reviews and PRISMA 2020 guidelines were followed. A statistical meta-analysis of included studies was pooled using RevMan version 5.4.1. ResultsIn total 33 studies were included with 16,677 participants. CR programs increased medication adherence by 14 % (RR = 1.14; 95 % CI: 1.07 to 1.22; p = 0.0002) with low degree of evidence certainty. CR also lowered the risk of dying by 17 % (RR = 0.83; 95 % CI: 0.69 to 1.00; p = 0.05); primary care and emergency department visit by mean difference of 0.19 (SMD = −0.19; 95 % CI: −0.30 to −0.08; p = 0.0008); and improved quality of life by 0.93 (SMD = 0.93; 95 % CI: 0.38 to 1.49; p = 0.0010). But no significant difference was observed in lipid profiles, except with total cholesterol (SMD = −0.26; 95 % CI: −0.44 to −0.07; p = 0.006) and blood pressure levels. ConclusionsCR improves medication adherence with a low degree of evidence certainty and non-significant changes in lipid and blood pressure levels. This result requires further investigation.

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.

Randomised control trial of a novel digital system to provide contextualised data feedback to augment physical activity behaviour change in a free-living environment as part of cardiac rehabilitation

Abstract Background Physical activity (PA) is a core component of cardiac rehabilitation (CR) and is crucial for enhancing cardiovascular (CV) fitness[1]. In the UK, CR programmes involve 1-2 hours of face-to-face contact per week over 6-8 weeks, implying that 98-99% of the intervention period is currently unmonitored and not optimised for potential positive lifestyle interventions. Consequently, CR staff are blind to PA that occurs outside of the clinical setting, which could be of too low or high intensity and/or duration, according to the Association of Certified Physiotherapists in Cardiac Rehabilitation (ACPICR) guidelines[2]. A previous pilot study showed a novel digital system to be feasible, acceptable and effective for CR patients[3], making it a promising intervention to assess in a randomised control trial (RCT). Purpose To conduct a RCT to examine whether contextualised data feedback delivered using a novel digital service, in conjunction with usual care (UC) promotes positive PA behavioural change, with direct comparison to UC alone. Methods This prospective, parallel group, open-label, RCT enrolled 130 patients eligible for CR and consisted of an 8-week intervention period with follow-up at 8-weeks. The intervention group received the novel digital CR service plus UC, with the control group receiving UC alone. The primary outcome was changes in PA to achieve the ACPICR guidelines. Both groups wore a PA monitor to collect minute-level energy expenditure data that underwent processing using a patented method to extract the specific PA metrics required for analysis. The secondary outcome was changes in CV fitness between pre and post assessments, measured using Incremental Shuttle Walk Test (ISWT). Results Patient characteristics are shown in Table 1. Adherence to data collection was good, with an average of 37 complete days (≥768 minutes per day) of PA data per person. Fifty-six intervention group patients and 49 control group patients were analysed for the primary outcome. A significant difference (p&amp;lt;0.025) in the probability of achieving the ACPICR ‘Daily Activity’ guideline was found between groups, with the intervention group more likely to achieve the guideline at week-8 versus control. Despite Covid-19 challenges, pre and post ISWT measurements were obtained for 33 intervention group patients and 37 control group patients. No significant differences between groups were found. However, the average improvement seen in the intervention group, +89 metres (m), exceeded the minimum clinically important difference for the ISWT (+70 m), and was more than double that seen in the control group, +44 m. Conclusion This RCT builds on previous evidence supporting the use of the novel digital service in CR[3]. Engagement with, and completion of, the digital CR service was excellent. Participation was associated with statistically significant improved PA in relation to ACPICR guidelines and clinically important increases in CV fitness versus UC alone.Table 1

Provision of dietary education in UK-based cardiac rehabilitation: a cross-sectional survey conducted in conjunction with the British Association for Cardiovascular Prevention and Rehabilitation.

Dietary education is a core component of cardiac rehabilitation (CR). It is unknown how or what dietary education is delivered across the UK. We aimed to characterise practitioners who deliver dietary education in UK CR and determine the format and content of the education sessions. A fifty-four-item survey was approved by the British Association for Cardiovascular Prevention and Rehabilitation (BACPR) committee and circulated between July and October 2021 via two emails to the BACPR mailing list and on social media. Practitioners providing dietary education within CR programmes were eligible to respond. Survey questions encompassed: practitioner job title and qualifications, resources, and the format, content and individual tailoring of diet education. Forty-nine different centres responded. Nurses (65·1 %) and dietitians (55·3 %) frequently provided dietary education. Practitioners had no nutrition-related qualifications in 46·9 % of services. Most services used credible resources to support their education, and 24·5 % used BACPR core competencies. CR programmes were mostly community based (40·8 %), lasting 8 weeks (range: 2-25) and included two (range: 1-7) diet sessions. Dietary history was assessed at the start (79·6 %) and followed up (83·7 %) by most centres; barriers to completing assessment were insufficient time, staffing or other priorities. Services mainly focused on the Mediterranean diet while topics such as malnutrition and protein intake were lower priority topics. Service improvement should focus on increasing qualifications of practitioners, standardisation of dietary assessment and improvement in protein and malnutrition screening and assessment.

Perceptions of physical activity levels after a diagnosis of acute coronary syndrome and in the context of cardiac rehabilitation

Abstract Funding Acknowledgements Type of funding sources: None. Background Physical activity [PA] is a core component of cardiac rehabilitation [CR] but those who consider themselves active are less likely to participate. It is unclear how CR services can better engage with this group and what support they should offer to encourage a return to PA at appropriate levels. Purpose We aimed to identify individuals from four UK CR services who considered themselves active prior to acute coronary syndrome [ACS] diagnosis and understand their PA support requirements. Methods A sequential mixed methods study, with data collected between October 2019 and April 2020. A quantitative survey examined self-reported PA levels, illness perceptions, and physical self-concept of ACS patients using validated questionniaires after their event but before the start of CR. Data were analysed via descriptive, correlational, and multiple regression analysis. Qualitative individual semi-structured telephone interviews were conducted with participants who self-reported to be at least moderately active. Data were thematically analysed. Data were integrated during study design and discussion stage. Results Sixty-seven participants (male n=53, 79.1%) with a median age of 63 (IQR = 56-71) completed the survey. Of these, 50 (74.6%) self-reported being at least moderately active before starting CR. During regression analysis, only physical self-concept for being physically active (F (9,56)=3.59, p&amp;lt;.005, adjusted R2 0.26) was significantly associated with PA level. Twenty-six participants completed qualitative interviews. Participants who perceived that they were active prior to their event based this on recollections of past PA, and step count monitoring. They made decisions about whether to engage with CR based on pre-CR information and comparison with peers. Despite considering themselves to be active, this group still required support to return to PA at appropriate intensity levels to gain secondary prevention benefits. This included information about how to self-monitor intensity effectively. Conclusions CR services should recognise that ACS survivors who consider themselves to be active prior to their event require support to return to PA at appropriate levels. Support should include exploring what patients mean when they say they are active so that CR professionals are better informed to provide indivualised advice.

Feasibility of a Virtual Educational Programme for Behaviour Change in Cardiac Patients from a Low-Resource Setting.

Patient education is an integral part of recovery from a critical cardiac life event and a core component of cardiac rehabilitation (CR) programmes. This study addressed the feasibility of a virtual educational programme for behaviour change in CR patients from a low-resource setting in Brazil. Cardiac patients from a CR programme closed due to the pandemic received a 12-week virtual educational intervention (WhatsApp messages and bi-weekly calls from healthcare providers). Acceptability, demand, implementation, practicality, and limited efficacy were tested. Overall, 34 patients and 8 healthcare providers agreed to participate. The intervention was considered practical and acceptable by the participants, who reported a satisfaction median of 9.0 (7.4-10.0)/10 (patients) and 9.8 (9.6-10.0)/10 (providers). The main difficulties in carrying out the intervention activities were related to technology, motivation to self-learning, and a lack of in-person orientation. All the patients reported that the information included in the intervention was aligned with their information needs. The intervention was associated with changes in exercise self-efficacy, sleep quality, depressive symptoms, and performance of high-intensity physical activity. In conclusion, the intervention was considered feasible to educate cardiac patients from a low-resource setting. It should be replicated and expanded to support patients that face barriers to onsite CR participation. Challenges related to technology and self-learning should be addressed.

Implementation of systematic screening for anxiety and depression in cardiac rehabilitation: Real world lessons from a longitudinal study

AimsSystematic screening for anxiety and depression is widely recommended as a core component of cardiac rehabilitation in ischemic heart disease, however, recommendation-practice gaps are common and limited knowledge exists about factors hindering and supporting implementation. The study aimed to assess adherence to national clinical guideline recommendations and to gain a greater understanding of the implementation of screening in real-world practice. MethodsAn observational, longitudinal mixed-methods design including hospitals and municipalities in Denmark. We retrieved nationwide survey data from 2013, 2015, 2018 and 2021 to assess adherence to screening on programme level, and clinical quality registry data from 2016 to 2020 to assess proportion of patients screened. Data were analysed descriptively. Semi-structured interviews with healthcare professionals were conducted in 2015 (n = 11) and 2020 (n = 11) to explore how screening was conducted and factors supporting implementation. Normalization Process Theory guided interviews and content analysis. ResultsScreening on programme level increased from 61% to 88% in hospitals and 20% to 89% in municipalities. The individual proportion of patients screened remained relatively stable in both hospitals and municipalities overall, however with considerable inter-site differences. Screening practices became more aligned to guidelines, pushed by formal recommendations and monitoring, and pulled by activities strengthening the knowledge and motivation among staff. ConclusionScreening for anxiety and depression improved considerably over the seven-year period, from a scattered practice driven by individuals to a movement where healthcare professionals had a feeling of going with the flow. Nationwide implementation of screening requires national and local supporting activities and a continuous effort.

Hybrid cardiac rehabilitation – The state of the science and the way forward

Cardiac rehabilitation (CR) improves exercise capacity and health-related quality of life (HRQoL) in a broad range of patients, including those with coronary artery disease, heart failure (HF), after heart valve surgery, and after heart transplantation. Unfortunately, in traditional center-based CR programs participation and adherence are low. A hybrid model of CR, combining center-based and home-based CR services, has been proposed and is currently being studied as a potential way to help bridge the participation gap, while maintaining the beneficial patient outcomes from CR. However, the ideal composition of a hybrid CR program has not been universally agreed upon. In the present review, we define hybrid CR as any combination of supervised center-based and monitored home-based exercise, where at least two of the core components of CR are addressed. Using this definition, we searched for studies comparing hybrid CR with: (1) traditional center-based CR among CAD patients, (2) usual care among CAD patients, and (3) usual care among HF patients. We found nine studies which fit both our definition and comparison groups. The structure of the hybrid CR programs differed for each study, but typically began with a center-based component lasting 2–11 weeks and transitioned to a home-based component lasting 10–22 weeks, with 3–5 exercise sessions per week composed of either walking (usually with a treadmill) or cycling for 25–35 min at 60–75% maximal heart rate. Patients recorded data from home exercise sessions, via either a digital heart rate monitor or accelerometer, into logbooks which were reviewed by a therapist at specified intervals (often via telephone). Counseling on risk factor management was predominantly provided during the center-based component. In these studies, hybrid CR led to similar short-term outcomes compared to traditional CR in patients with coronary artery disease (CAD), as well as increased adherence and reduced delivery costs. Compared with usual care, in patients with CAD, hybrid CR reduced cardiovascular events, and improved lipid profiles, exercise capacity, and HRQoL. In patients with HF, compared with usual care, hybrid CR improved physical function, exercise capacity, and HRQoL. Ongoing studies may clarify the combination of center-based and home-based CR which produces superior outcomes, and may also better define the role that technology should play in CR interventions.

Asynchronous and Synchronous Delivery Models for Home-Based Cardiac Rehabilitation: A SCIENTIFIC REVIEW.

To review the principles, advantages, and disadvantages of asynchronous and synchronous delivery models of home-based cardiac rehabilitation (HBCR). We reviewed recently published systematic reviews and other publications of randomized studies of asynchronous and synchronous HBCR to assess principles, outcomes, and limitations of those delivery methods compared with center-based cardiac rehabilitation (CBCR). While most studies prior to 2016 involved asynchronous HBCR approaches to care, studies since 2016 have included asynchronous or synchronous delivery models. Both delivery models have been shown to help provide core components of cardiac rehabilitation (CR). Studies using either method have been shown to have similar short-term patient outcomes as CBCR, at least in low- to moderate-risk patients who have been studied. Asynchronous HBCR offers greater flexibility for patients and CR staff, while synchronous HBCR provides greater real-time oversight and feedback to patients.Asynchronous and synchronous HBCR is an option to consider for patients eligible for CR. Additional research is needed for both delivery models, applied separately or in combination, to compare their impact on shorter- and longer-term patient outcomes and to assess their impact in patient subgroups (referral diagnosis, women, elderly, underrepresented racial and ethnic minority groups, patients at a higher cardiovascular disease risk, patients with multiple comorbid conditions, etc).

심장재활의 개요 및 국내 현실

Cardiac rehabilitation (CR) is an integral component of the continuum of care for patients with cardiovascular disease (CVD). Today, the efficacy and safety of CR are well established and it is practiced in 111 countries, but the participation rate of CR is low. The actual rate of CR practice for acute myocardial infarction patients in Korea is very low only 1.5%. CR restores a patient’s exercise capacity and decreases recurrence, re-hospitalization, and re-intervention, as well as mortality. The core components of CR are patient evaluation, dietary treatment, weight management, blood pressure management, blood lipid management, diabetes management, smoking cessation, psycho-social management, physical activity counseling, and exercise training. In order for exercise training to be safely conducted, the risk stratification for exercise-related CV complication needs to be evaluated and high-risk patients should be exercised under the supervision including ECG monitoring. Currently CR programs have been practiced in 47 hospitals (28%) out of 164 CV specialty hospitals which practice percutaneous coronary intervention, but there were not many hospitals with active CR practice. In order for CR to be actively practiced in Korea, CR programs need to be developed in as many CV specialty hospitals as possible, and to increase participation rate, education to clinical staff and patients, more systematic consultation systems, less financial burden to patients, and more flexible CR environment including utilization of home-based CR and non-contact tele-CR technique are needed. These efforts by medical professionals should be accompanied by governmental support in policy making and budget execution.

Delivering a dietetic intervention to cardiovascular patients in the Covid era

Abstract Funding Acknowledgements Type of funding sources: Public Institution(s). Main funding source(s): Department of Health Introduction Healthy diet and body composition are core components of cardiac rehabilitation. Following the COVID outbreak in March 2020, our face-to-face cardiac rehabilitation programme (Our Hearts Our Minds) was suspended. The programme was then quickly moved to a virtual platform to continue to deliver the programme. Purpose Here we describe how the OHOM programme adapted our service to deliver the dietetic assessment and intervention on a virtual platform. Methods Pre-Covid the dietary component of OHOM consisted of a face-to-face Initial Assessment (IA) with a dietitian, group education sessions and an End of Programme assessment (EOP). Anthropometric measures and dietary habits were assessed including adherence to the Mediterranean diet via the Mediterranean Diet Score (MDS) toolkit. Using behaviour change techniques, tailored dietary advice was provided and goals agreed to educate on healthier food choices, increase adherence to Mediterranean diet and (if appropriate) promote weight loss and reduce central obesity. The assessment and intervention is now delivered virtually via telephone or video. Anthropometrics are self-reported with tape-measures supplied to assess waist circumference and advice provided on home-weighing. MDS is still assessed. The programme includes fortnightly coaching telephone consultations to review and reset goals, the option to attend a dietitian-led virtual group education session, access to a filmed educational video and submission of food diaries via the Fitbit app. Results From April to November 2020, 114 patients completed the virtual programme (65 telephone, 39 video). Dietetic outcomes are outlined in Table 1 with inclusion of data for a similar period one year previously (face-to-face) for comparison. Reductions in anthropometric measures and increased adherence to a cardio-protective diet were noted and the results for the two time periods are remarkably similar. Conclusion Delivery of a virtual dietetic component in cardiac rehabilitation is feasible, acceptable and just as effective as face-to-face based on preliminary data. Table 1: Dietary outcomes at IA and EOP Face-to-face assessments (April - March 2019) Virtual assessments (April - November 2020) IA EOP Change IA EOP Change Mean weight (in those with BMI &amp;gt;25kg/m2) 86.5 85.2 -1.3 91.4 88.6 -2.8 Waist circumference (cm) 104.3 103 -1.3 107 102 -5 Mean MDS (Range 1-14) 4.4 7.5 +3.1 4.8 7.8 +3 % Consuming oily fish once per week 20 57 +37 25 68 +43 Achieving fruit and vegetable target 16 61 +45 21 57 +36 Abstract Figure. Dietitian waist circumference tutorial

Home-based cardiac rehabilitation during COVID-19 pandemic: effectiveness of an educational intervention

Funding AcknowledgementsType of funding sources: None.IntroductionPatient education is considered a core component of cardiac rehabilitation (CR) and nowadays, particularly during the COVID-19 pandemic, online education programs are critical. However, the best strategy for implementing these digital programs to increase patients’ adherence and learning is not fully established.PurposeTo assess the uptake and effectiveness of an educational intervention transmitted through video sessions integrated into a home-based CR program (CR-HB).MethodsProspective cohort study including patients (pts) who were participating in a centre-based CR program and accepted to participate in a CR-HB program during COVID-19 pandemic. The CR-HB program consisted of a multidisciplinary online program with educational videos for pts and family members / caregivers, that aimed to educate on necessary behavioural and lifestyle changes. Weekly, a 15-minute video was uploaded and lectured by the correspondent health professional from the CR team. The educational sessions covered the following topics: COVID-19 and cardiovascular (CV) disease, coronary artery disease, hypertension, dyslipidemia, smoking cessation, diabetes, medical therapy and adherence, healthy diet, exercise and physical activity, sedentary behaviour and sexual dysfunction and CV disease.At the end of the program we applied a 10 questions questionnaire to evaluate the knowledge of pts about the topics of educational sessions. All the pts answered the questionnaire and results were compared between the pts who attended the educational sessions and the ones who didn’t.Results 116 pts with CV disease were included in the CR-HB program (62.6 ± 8.9 years, 95 males). Almost 90% (n = 103) of the participants had coronary artery disease and the mean LVEF was 52 ± 11%. Obesity was the most common risk factor (75%) followed by hypertension (60%), family history of CV disease (42%), dyslipidemia (38%), diabetes (18%), and smoking (13%).The pts participated, on average, in 1.45 ± 2.6 education sessions (rate participation of 13.2%). About half of the pts (49%) attended, at least, one session and these pts attended, on average, 3 sessions (2.96 ± 3.0). The questionnaire results were better in pts who attended at least 1 educational session than in those who did not attend any (7.4 ± 1.9 vs 7,1 ± 1.7), however this difference was not statistically significant.Regarding education status, 33 pts (45.2%) had a bachelor degree and this group of pts had a significant higher result in questionnaire (7.8 ± 1.9 vs 6.7 ± 1.8; p = 0.015) and tended to participate more often in education sessions (2.13 vs 1.6, p = 0.06).ConclusionsOur study showed a low rate of participation in sessions, highlighting the importance of developing strategies to increase motivation and adherence to online educational programs. Also, more literate patients had significantly greater health knowledge and adherence to educational sessions, suggesting that this population could benefit more from this type of programs.

The efficacy of cardiac rehabilitation on exercise performance in men and women

Abstract Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Slovenian Research Agency Background Over the last years exercise training has gained IA class recommendation as a core component of cardiac rehabilitation (CR) in patients with coronary artery disease (CAD). Despite the strong evidence of higher mortality and rehospitalisation rates in women compared with men with CAD, women are less frequently enrolled in CR programs and show lower exercise adherence. However, when enrolled women showed similar improvement as men, but this remains to be further elucidated. Purpose The aim of this study was to examine the gender differences in improvement of exercise performance in patients with CAD following CR programme. Methods A total of 91 patients with CAD (74 men and 17 women, mean (SD), aged 59 (11) years and 60 (10) years, p &amp;gt; 0.05; median (interquartile range), height 177 (173, 181) cm and 159 (158, 167) cm, p &amp;lt; 0.001; weight 92.1 (82.4, 98.6) kg and 72.3 (69.1, 79.6) kg, p = 0.001, respectively) participated in out-patient CR. Each patient completed 36 exercise sessions comprised of general warm up with calisthenics, followed by 5 aerobic intervals of cycling on stationary bikes (5 minutes of loaded cycling at the intensity of 50 %-70% of peak power separated by 2 minutes intervals of unloading cycling) and finished with stretching and breathing exercises. Training load and target training heart rate were increased every two weeks. The exercise test was performed at baseline and after CR. Results At baseline, there was a significant difference between men and women in peak power (P max) (men 122 (25) W vs. women 74 (19) W, p &amp;lt; 0.001), maximum oxygen consumption (VO2 max; men 19.45 (3.60) ml/kg/min vs. women 16.00 (3.35) ml/kg/min, p &amp;lt; 0.001) and exercise test time (men 658 (150) s vs. women 363 (115) s, p &amp;lt; 0.001). During the training both genders increased training intensity (men: +34 (12) W and women: +25 (9) W, both p &amp;lt; 0.001) and target heart rate (men: +10 (5, 19) bpm and women: +10 (5, 20) bpm, both p &amp;lt; 0.001), whereas training intensity was increased more in men than women (+9 W, p = 0.003). Exercise training led to improvement in P max (men: +15 (20) W, p &amp;lt; 0.001, women: +14 (12) W, p &amp;lt; 0.001), VO2 max (men: +1.87 (2.52) ml/kg/min, p &amp;lt; 0.001, women: +2.47 (2.05) ml/kg/min, p &amp;lt; 0.001) and exercise test time (men: +99 (134) s, p &amp;lt; 0.001, women +95 (90) s, p &amp;lt; 0.001). In addition, after adjusting for baseline values there were no sex differences in post training P max, VO2 max and exercise test time. Conclusions CR improved the exercise performance similarly in men and women, thus, more women should be encouraged to enrol into CR programmes. Still, larger and adequately powered randomised studies are warranted to further elucidate this issue.

An evaluation of medication optimisation following myocardial infarction within a cardiac rehabilitation service

Background/Aims Managing patients' medical risk is a core component of cardiac rehabilitation. However, the optimisation of medical therapy for patients post myocardial infarction has frequently been found to be suboptimal. This article evaluates the evidence-based prescribing practice for patients post myocardial infarction who attended a local cardiac rehabilitation service that included an advanced cardiac rehabilitation nurse. The focus is on dose optimisation of angiotensin-converting enzyme inhibitors, angiotensin II receptor antagonists and beta-blocker therapies. Methods Data were collected retrospectively from 100 patient records at a cardiac rehabilitation service. Explored variables included demographic factors, prescribing rates at hospital discharge, left ventricular function, drug types and doses, and drug optimisation rates and timings. Data regarding the practitioner who carried out the optimisation and any documented reasons for not pursuing further dose titration were also collected. Results The advanced cardiac rehabilitation nurse was well placed to optimise pharmacotherapy post myocardial infarction, although the optimisation process was found to be complex, often requiring an overlapping multidisciplinary team approach. Conclusions Care should be taken not to overlook patients with normal left ventricular function or mild left ventricular impairment post myocardial infarction. More advanced practitioner roles are needed to allow the team to take responsibility for the medication optimisation of all patients post myocardial infarction within the cardiac rehabilitation service. The optimisation time target set by the National Institute for Health and Care Excellence was not always reached, as it was not always feasible to safely optimise medications so quickly.

Best practice in cardiac rehabilitation for patients after heart valve repair or replacement surgery in Namibia: A literature review

Heart valve repair and replacement is an invasive surgery which may compromise quality of life for the patients concerned. Therefore, patients who had heart valve surgery need rehabilitation interventions to prevent potential complications, and to promote quality of health. A rehabilitation programme is a medically supervised intervention which can assist patients coping with challenges related to heart surgeries and prevent potential complications. This review was undertaken to identify core components of a cardiac rehabilitation programme which can feasibly be adopted for the rehabilitation of patients who had heart valve surgeries locally. A literature review of articles on best practices regarding the core components of cardiac rehabilitation for patients who underwent heart valve repair or replacement surgery was undertaken. Published international guidelines of best practice for cardiac rehabilitation from 1993 to 2018, available in English language were identified through a search of electronic database and reviewed. A total of 20 articles with concepts on cardiac rehabilitation programme were retrieved. Out of the total, only 8 articles meet the criteria and the data were collected from the 8 articles. The findings indicated that patient assessment, exercise, physical counselling, diet/nutritional counselling, tobacco cessation, mental health, return to work, lipids, hypertension, cardio-protective therapies are essential components for the rehabilitation after heart valve surgeries, to support patients and their families to cope with challenges related to surgeries. These in return improve quality of life for the patients concerned. The core components for the cardiac rehabilitation programmes as highlighted by the international guidelines can be adapted to the cardiac rehabilitation programme in Namibia if tailored to the contextualized needs for the cardiac patients in Namibia.

Are survivors of cardiac arrest provided with standard cardiac rehabilitation? - Results from a national survey of hospitals and municipalities in Denmark.

To quantify the provision of standard cardiac rehabilitation to Danish survivors of cardiac arrest at a programme level, and to analyse whether organizational factors influenced the provision. We mapped the provision of cardiac rehabilitation core components to survivors of cardiac arrest and compared this with a reference group of patients after acute myocardial infarction using data from a cross-sectional programme-level survey among all hospitals (n = 34) and municipalities (n = 98) in Denmark. Organizational factors of potential importance to service provision were considered: health care region, size of catchment area/population, type of department/municipality and socioeconomic index. Response rates for the provision of each core component of cardiac rehabilitation ranged from 64% to 98%. All hospitals and municipalities provided some aspect of cardiac rehabilitation to survivors of cardiac arrest. Across hospitals, provision of four core components of cardiac rehabilitation to survivors of cardiac arrest was lower compared with post acute myocardial infarction patients: patient education (relative risk (RR) = 0.45 (95% confidence interval (CI) 0.27 to 0.75)), exercise training (RR = 0.69 (95% CI 0.49 to 0.98)), screening for anxiety and depression (RR = 0.64 (95% CI 0.46 to 0.90) and nutritional counselling RR = 0.76 (95% CI 0.62 to 0.93)). No difference was found in the provision of core components across municipalities. Overall, the provision of cardiac rehabilitation to survivors of cardiac arrest was not affected by organizational factors. This study indicates a need for future research to inform the development, adoption and implementation of equal access to all components of cardiac rehabilitation for survivors of cardiac arrest in Denmark.

The future is now: a call for action for cardiac telerehabilitation in the COVID-19 pandemic from the secondary prevention and rehabilitation section of the European Association of Preventive Cardiology.

The role of comprehensive cardiac rehabilitation is well established in the secondary prevention of cardiovascular diseases such as coronary artery disease and heart failure. Numerous trials have demonstrated both the effectiveness as well as the cost-effectiveness of comprehensive cardiac rehabilitation in improving exercise capacity and quality of life, and in reducing cardiovascular mortality and morbidity. However, the current COVID-19 pandemic has led to closure of many cardiac rehabilitation centres in Europe resulting in many eligible patients unable to participate in the optimisation of secondary prevention and physical performance. This elicits an even louder call for alternatives such as cardiac telerehabilitation to maintain the delivery of the core components of cardiac rehabilitation to cardiovascular disease patients. The present call for action paper gives an update of recent cardiac telerehabilitation studies and provides a practical guide for the setup of a comprehensive cardiac telerehabilitation intervention during the COVID-19 pandemic. This set up could also be relevant to any cardiovascular disease patient not able to visit cardiac rehabilitation centres regularly after the COVID-19 pandemic ceases.