Hospital-based Cardiac Rehabilitation Program Research Articles

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

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

Reasons for dropout in the transition from hospital to municipality during exercise-based cardiac rehabilitation in a Danish cross-sectorial setting: a qualitative study

ObjectivesDespite documented benefits of cardiac rehabilitation (CR), attrition rates remain relatively high. Insights on patient perspectives concerning dropout during transition phases are deficient. This deeper understanding may help to inform...

Effect of real-time remote-based cardiac rehabilitation on subjective satisfaction and objective performance during the coronavirus disease 2019 pandemic

Abstract Background Real-time remote-based cardiac rehabilitation (CR) programmes improve exercise capacity. However, satisfaction and performance improvements after remote-based CR remain unclear. In addition to physical function, subjective satisfaction and objective performance may be adversely affected during the coronavirus disease 2019 pandemic. Purpose This study aimed to compare the effectiveness of real-time remote-based CR versus hospital-based CR in improving physical function, subjective satisfaction, and objective performance (i.e., activity limitations and participation restrictions). Methods We conducted a quasi-randomised controlled trial and recruited 38 patients with cardiovascular disease (CVD). The patients participated in 4 weeks of hospital-based CR, followed by 12 weeks of remote or hospital-based CR based on quasi-randomised allocation. We assessed the participants at baseline and after 12 weeks of remote or hospital-based CR using the shortened version of the World Health Organization Quality of Life scale (WHOQOL-BREF) for subjective satisfaction, the World Health Organization Disability Assessment Schedule (WHODAS 2.0) for objective performance, and peak oxygen uptake (peak VO2) using the cardiopulmonary exercise test, for physical function. We evaluated individual results by measuring baseline to post-CR changes (i.e., delta [Δ]) (paired t-test) and then compared the remote and hospital-based CR programmes (unpaired t-test). Results Sixteen patients (72.2±10.4 years) completed remote-based CR and fifteen patients (77.3±4.8 years) completed hospital-based CR. Seven patients were excluded owing to other health complications (n=2) and inability to attend hospital based-CR (n=5). In the remote-based CR group, the peak VO2 (before: 12.0±2.7 mL min–1 kg–1; after: 14.9±3.9 mL min–1 kg–1; p<0.05) and the WHOQOL-BREF score (before: 77.4±12.8 points; after: 93.9±12.9 points; p<0.001) were significantly higher, whereas the WHODAS 2.0 score was significantly lower (before: 19.9±13.2 points; after: 11.3±6.8 points; p<0.05) after rehabilitation than at baseline. The post-CR physical function differed significantly between the two groups (Δpeak VO2, remote: 2.8±3.0 mL min–1 kg–1; hospital: 0.84±1.8 mL min–1 kg–1; p<0.05). The post-CR change in the WHOQOL-BREF score was not significantly different between the groups. The post-CR change in the WHODAS 2.0 score was significantly lower in the remote-based CR group than in the hospital-based CR group. (ΔWHODAS 2.0 score, remote: –8.56±14.2 points; hospital: 2.14±7.6 points; p<0.01). Conclusions Remote-based CR significantly improved physical function and objective performance in patients with CVD. Remote-based CR could be an effective treatment for stable patients who are unable to visit the hospital during the coronavirus disease 2019 pandemic. In the future, risk stratification according to severity of illness is needed. Funding Acknowledgement Type of funding sources: Private company. Main funding source(s): Sanei Medicis company.

Risk stratification model for telemedicine-based cardiac rehabilitation

Abstract Background Physical training (PhT) is highly cost-benefit maneuver in patients with heart disease, as a part of an integral Cardiac Rehabilitation Program. Exercise-related adverse outcomes are low, mainly due to an adequate cardiovascular risk stratification and the correct prescription and supervision of PhT. Exercise testing (ET) is the cornerstone of this process. Advances in telecommunication technologies have boosted the possibility to deliver cardiac rehabilitation via the internet, a low cost and non-face-to-face intervention. However, it is not advisable to perform a remote stress test through digital media. Purpose The aim of this study is to estimate the effect of excluding exercise test data from the traditional risk stratification model on the prediction of individual adverse outcomes. Methods A cohort of patients with heart disease who participated in an outpatient hospital-based cardiac rehabilitation program was studied. All patients underwent a clinical evaluation, along with an ET. The data obtained were used to stratify the risk of adverse events during PhT. The physical exercise program was prescribed on an individual basis. Each patient performed 30 minutes of cycle ergometry, five times a week, with a moderate effort perception (6–20 Borg scale). All sessions were supervised by a cardiologist using continuous ECG telemetry and blood pressure measurement. Resistance training was complemented with a gymnastic circuit (kinesiotherapy). A bivariate and a logistic regression multivariable analysis were performed with clinical or paraclinical variables that had been previously used in risk stratification models and showed a statistically association with the outcome (traditional model). In order to simulate the lack of an exercise stress test, these data were excluded from multivariate regression model (TELERISK), Figure 1. Results Six hundred and thirty-nine patients with cardiovascular disease were studied. No major adverse outcome was recorded. Patients presented several minor adverse outcomes, including mainly arrhythmias (n=485), such as sinus bradycardia, sinus pauses, premature supraventricular complexes, supraventricular tachycardia, atrial fibrillation, premature ventricular complexes, ventricular bigeminy, ventricular couplets and non-sustained ventricular tachycardia. Other minor outcomes were exercise-induced ischemia (n=31), exercise-induced hypotension (n=15), hypertensive response to exercise (n=31) and dizziness (n=7). The predictive capacity of the TELERISK model was significantly lower (AUC=0.661) than that observed for the traditional model (AUC=0.766), Figure 2. Conclusion The predictive capacity of the risk stratification model for adverse events during physical training in patients with cardiovascular disease decreases significantly when excluding data from the exercise test. Funding Acknowledgement Type of funding sources: None. Figure 1. Telerisk multivariable modelFigure 2. Outcome prediction ROC curve

Feasibility of integrating survivors of stroke into cardiac rehabilitation: A mixed methods pilot study.

Survivors of stroke are often deconditioned and have limited opportunities for exercise post-rehabilitation. Cardiac Rehabilitation (CR), a structured exercise program offered post-cardiac event in the United States (U.S.), may provide an opportunity for continued exercise. The purpose of this study was to examine the feasibility of integrating survivors of stroke into an existing, hospital-based CR program through an assessment of (1) recruitment, uptake and retention, (2) adherence and fidelity, (3) acceptability and (4) safety. A mixed methods design combined a single group, pre-post design, pilot feasibility study with an imbedded qualitative inquiry. Survivors of stroke were recruited into a standard 12-week, 36 visit CR program. Fifty-three survivors were referred, 29 started and 24 completed the program. Program uptake rate was 55% and completion rate was 83%. Eleven completers and one non-completer participated in the qualitative interviews. Program completers attended an average of 25.25 (SD 5.82) sessions with an average of 38.93 (SD 5.64) exercise minutes per session while reaching targeted rate of perceived exertion levels. Qualitative themes included perceived benefits of an individualized program in a group setting, positive interactions with qualified staff, opportunities for socialization, and regular monitoring and staff attentiveness promoting feelings of safety. Survivors of stroke were able to meet Medicare standard dosage (frequency and session duration) and rate of perceived intensity goals, and perceived the program as needed regardless of their mobility limitations or previous exercise experience. Primary challenges included managing referrals and uptake. Results support feasibility and benefit for survivors to integrate into U.S. CR programs.

Can exercise-based cardiac rehabilitation increase physical activity in patients who have undergone total thoracoscopic ablation?

Evidence of the effect of exercise therapy in patients who have undergone total thoracoscopic ablation is lacking. This study aimed to evaluate the effects of eight weeks exercise-based cardiac rehabilitation on cardiopulmonary fitness and adherence to exercise in patients who underwent total thoracoscopic ablation and followed a regimen of exercise therapy. Twenty-four patients were involved in the study and were divided into two groups. The exercise group underwent exercise therapy, which included aerobic and resistance exercises, twice a week as part of an eight weeks hospital-based outpatient cardiac rehabilitation program. Cardiopulmonary exercise test was used to evaluate exercise capacity and the International Physical Activity Questionnaire was utilized to identify the amount of physical activity and confirm adherence to exercise at six months postoperatively. There were significant differences between the groups in moderate activity level (p = 0.004) and extent of total physical activity (p = 0.0001). Complications such as recurrent atrial fibrillation did not occur during the exercise training. Exercise-based cardiac rehabilitation was beneficial in maintaining the activity level at six months postoperatively. Early exercise intervention at four weeks post-surgical ablation is a safe and effective therapy that can increase physical activity. Further studies are needed to verify the effect of exercise intervention in a larger sample size of patients who have undergone total thoracoscopic ablation.

Exercise-based cardiac rehabilitation for postcoronary artery bypass grafting and its effect on hemodynamic responses and functional capacity evaluated using the Incremental Shuttle Walking Test: A retrospective pilot analysis

BackgroundCoronary artery bypass grafting (CABG) is a common surgical procedure for the restoration of blood flow into stenotic or blocked coronary arteries. Cardiac rehabilitation has been implemented to some extent worldwide for the management of postoperative CABG. However, studies about the effect of exercise training on hemodynamic responses of the heart using the Incremental Shuttle Walking (ISWT) test are limited in Saudi Arabia. ObjectivesTo investigate the effect of exercise-based cardiac rehabilitation (Phase 3, hospital-based) on some hemodynamic responses including blood pressure, heart rate (HR) and heart rate recovery (HRR), and rate pressure product (RPP) using ISWT on post-CABG patients. MethodsFifteen CABG (51.4 ± 6.4 years, 14 male, 1 female) patients without altering their medication were enrolled in a hospital-based cardiac rehabilitation program (Phase 3) between 2011 and 2012 for supervised individual exercise training sessions (three times per week for 8 weeks; 60-minute session at a moderate intensity). Patients performed two tests (ISWT1 and ISWT2) and one before exercise training program and one after, during which resting systolic blood pressure (SBP) and diastolic blood pressure (DBP), post-ISWT SBP and DBP, resting HR, peak HR, HRR (which was defined as the absolute change from peak HR to 1-minute post peak HR), and RPP at rest and at the end of the ISWT were measured. Exercise training sessions included both aerobic and resistance exercises, which were preceded by a cooling down period and followed by a recovery period. ResultsPaired t-test showed a significant reduction in both resting SBP (p = 0.04) and DBP (p = 0.03), and a significant increase in post-ISWT2 SBP (p = 0.004), peak HR (p = 0.003), HRR (p = 0.03), and RPP at maximum (p = 0.002) after 8 weeks of supervised exercise training. In addition, there was a significant increase in the speed and distance achieved on ISWT2 (p < 0.001) after the training program. ConclusionSupervised exercise training (cardiac rehabilitation) for 8 weeks was effective in improving hemodynamic responses and functional exercise capacity in CABG patients. Cardiac rehabilitation should be implemented more frequently and health-care providers should be aware of its importance. Further research is needed in this area to confirm these findings in the region.

P3101Risk stratification model for exercise training complications in patients with heart disease (EXERISK study)

Abstract Background Exercise training is worldwide recommended to treat patients with heart disease, but sometimes, it can trigger adverse outcomes (ischemia, arrhythmias or sudden death). Several clinical tools are used to stratify patients, usually developed by expert consensus without any clinical validation during exercise sessions. Purpose The aim of this study was to develop up and validate a contemporary risk stratification calculator to identify patients at high risk of adverse outcomes during physical training. Methods A cohort of patients with heart disease that participated in a cardiac rehabilitation program were studied. A data base was constructed using several variables of interest derived from clinical records, patient evaluations, paraclinical reports along with stress testing. All patients participated in an ambulatory hospital-based cardiac rehabilitation program. Every patient exercised 5 times a week, 30 minutes continuously at a moderate-intensity, using a high-tech cyclergometer. Aerobic training was complemented with a three times a week, general gymnastics circuit. All sessions were highly supervised by trained personal, including a cardiologist. Major outcome variables were sudden death, coronary acute syndrome, syncope or stroke. Minor outcomes were any kind of arrhythmia and the presence of ischemia (angina or ST depression). Nominal, categorical or numerical variables were presented as appropriate. A bivariate analysis was performed. Those statistically significant variables (p&lt;0.05), were used in a logistic regression multivariable analysis with a step by step forward-Wald method. The obtained linear general model (G) was incorporated into a logistic equation and results were compared with traditional risk-stratification scales. Results A total of 639 patients were included, and no major adverse outcome occurred. Seventy six percent of patients presented arrhythmias and 5% showed ischemia. Seventeen stochastically significant variables were obtained from clinical records and paraclinical tests, and were included in two multivariable models, focusing on arrhythmia (EXERISK-A) or ischemia (EXERISK-I). After analysis, three variables remained associated with arrhythmia (maximal METs, left ventricle ejection fraction and frequent premature ventricular complexes) and three with ischemia (history of angina, METs and SYNTAX score). Once logistic equations were obtained, traditional risk-stratification scales were applied to the sample. Figure 1 shows ROC curve comparison of both models with traditional stratification scales. The area under the curve was 0.730 (EXERISK-A) and 0.856 (EXERISK-I) EXERISK Conclusion Exercise-induced arrhythmias are a very common finding in patients with heart disease, few patients showed ischemia and no mayor adverse cardiovascular outcomes were demonstrated. Both risk stratification models (EXERISK-A and EXERISK-I), can accurately predict arrhythmias or ischemia in a simple and rapid fashion.

The effect of an expanded long-term periodization exercise training on physical fitness in patients with coronary artery disease: study protocol for a randomized controlled trial

BackgroundBenefits from cardiac rehabilitation (CR) programs are evidence-based and widely recognized. Less than 50% of people who participate in hospital-based CR programs maintain an exercise regime for as long as six months after completion. Little is known about interventions making the patients continue to exercise after the hospital-based formal program has ended. Methods to ensure sustained benefits of CR need to be tackled. Exercise periodization is a method typically used in sports training, but the impact of periodized exercise to yield optimal beneficial effects in cardiac patients is unclear. Therefore, the purpose of this trial is to evaluate the effects of a long-term exercise periodization on health-related physical fitness components such as cardiorespiratory endurance, muscular strength, skeletal muscle function, and body composition.MethodsFifty patients with coronary artery disease will be recruited among those who underwent the hospital-based CR phase. These patients will be randomized (1:1) into one of the following exercise groups: (1) periodized group; and (2) non-periodized group (exercise prescription based on standard guidelines). There will be four assessment time points: at baseline, and 3, 6, and 12 months after starting the exercise training program. At each time point, maximal and submaximal cardiorespiratory fitness, skeletal muscle deoxygenation dynamics, body composition by dual energy radiographic absorptiometry, functional fitness, maximal isometric and dynamic strength, physical activity, and quality of life will be assessed. This experimental design will last for 48 weeks with a frequency of three times per week for both groups.DiscussionMost medium- to long-term exercise-based CR programs do not employ periodization or exercise progression. Randomized controlled trials are necessary to evaluate long-term periodization outcomes and assess the length of change observed in supervised CR programs. This study will contribute to generate evidence-based exercise prescription approaches to prolong the exercise training after the end of hospital-based CR programs.Trial registrationClinicalTrials.gov, NCT03335319. Registered on 22 October 2017.

What Do Patients Talk About? A Qualitative Analysis of Online Chat Sessions with Health Care Specialists During a "Virtual" Cardiac Rehabilitation Program.

Cardiac rehabilitation programs (CRPs) are effective at reducing cardiovascular disease (CVD) risk, yet attendance in these programs remains low due to geographic constraints. In a previously conducted randomized trial we demonstrated that a virtual CRP (vCRP) delivered over the Internet reduced risk for CVD. The current investigation has reviewed the online chat sessions between participants and healthcare providers (HCP) to describe the content of discussions during the vCRP intervention. Participants were recruited from two geographically isolated areas in British Columbia, Canada without in-person CRP or a cardiologist serving the area. The vCRP, among other elements, included scheduled one-on-one chat sessions with a dietician, exercise specialist, and nurse to mimic standard CRP consultations. The chat sessions were reviewed for content and themes. Multiple chat sessions between participants and a single care provider were also analyzed to describe how chat content progressed through multiple sessions. A total of 38 participants participated in the vCRP intervention. From the 122 chat sessions between participants and HCP during the vCRP, the main themes identified were Managing Health and Lifestyle, Continuity of Care, and Getting Care from a Distance. Within each theme, sub-themes were also identified. The vCRP chat sessions fulfilled the role of face-to-face consultations with HCP that are standard in hospital-based CRP and addressed patient concerns, facilitating remote patient-provider interaction and covering topics on exercise, diet, and positive behavior changes to limit risk factors for future heart problems.

Electronic Health Physical Activity Behavior Change Intervention to Self-Manage Cardiovascular Disease: Qualitative Exploration of Patient and Health Professional Requirements.

Cardiovascular diseases are a leading cause of premature death worldwide. International guidelines recommend routine delivery of all phases of cardiac rehabilitation. Uptake of traditional cardiac rehabilitation remains suboptimal, as attendance at formal hospital-based cardiac rehabilitation programs is low, with community-based cardiac rehabilitation rates and individual long-term exercise maintenance even lower. Home-based cardiac rehabilitation programs have been shown to be equally effective in clinical and health-related quality of life outcomes and yet are not readily available. Given the potential that home-based cardiac rehabilitation programs have, it is important to explore how to appropriately design any such intervention in conjunction with key stakeholders. The aim of this study was to engage with individuals with cardiovascular disease and other professionals within the health ecosystem to (1) understand the personal, social, and physical factors that inhibit or promote their capacity to engage with physical activity and (2) explore their technology competencies, needs, and wants in relation to an eHealth intervention. Fifty-four semistructured interviews were conducted across two countries. Interviews were audiotaped, transcribed verbatim, and analyzed using thematic analysis. Barriers to the implementation of PATHway were also explored specifically in relation to physical capability and safety as well as technology readiness and further mapped onto the COM-B model for future intervention design. Key recommendations included collection of patient data and use of measurements, harnessing hospital based social connections, and advice to utilize a patient-centered approach with personalization and tailoring to facilitate optimal engagement. In summary, a multifaceted, personalizable intervention with an inclusively designed interface was deemed desirable for use among cardiovascular disease patients both by end users and key stakeholders. In-depth understanding of core needs of the population can aid intervention development and acceptability.

Effects of hospital-based cardiac rehabilitation and home-based exercise program in patients with previous myocardial infarction

Amac: Miyokard infarktusu (MI) geciren hastalarda, egzersiz temelli rehabilitasyon, tedavinin onemli bir parcasidir. Calismamizin amaci, MI geciren hastalarda, hastanede yapilan kardiyak rehabilitasyon ile ev egzersiz programinin kardiyak parametreler uzerindeki etkisini karsilastirmakti. Yontem: Calismaya 1 ay oncesinde MI geciren stabil 35 hasta alindi. Hastalar rastgele iki gruba randomize edildi: aerobik egzersiz egitimi grubu (I), ev egzersiz grubu (II). Grup I, hastanede 6 haftalik aerobik egzersiz programina katildi. Grup II icin evde asamali fiziksel aktivite programi ongoruldu. Bulgular: Grup I’de, ejeksiyon fraksiyonu (EF), alti dakika yurume testi (6-DYT), kol ergometresi testi, VO2max ve anaerobik zaman (AT) degerlerinde artis oldugu bulundu. Ayni zamanda grup II’deki 6-DYT, kol ergometresi testi ve AT degerlerinde de anlamli artislar vardi. Kol ergometresi testi degerlerindeki degisim orani, hastane grubunda daha yuksekti. Sonuclar: Hastanede yapilan egzersiz programina katilamayacak dusuk veya orta riskli hastalar icin, evde yapilan egzersiz programlari, iyi bir alternatif olabilir.

The development and codesign of the PATHway intervention: a theory-driven eHealth platform for the self-management of cardiovascular disease.

Cardiovascular diseases (CVDs) are a leading cause of premature death worldwide. International guidelines recommend routine delivery of all phases of cardiac rehabilitation (CR). Uptake of traditional CR remains suboptimal, as attendance at formal hospital-based CR programs is low, with community-based CR rates and individual long-term exercise maintenance even lower. Home-based CR programs have been shown to be equally effective in clinical and health-related quality of life outcomes and yet are not readily available. The aim of the current study was to develop the PATHway intervention (physical activity toward health) for the self-management of CVD. Increasing physical activity in individuals with CVD was the primary behavior. The PATHway intervention was theoretically informed by the behavior change wheel and social cognitive theory. All relevant intervention functions, behavior change techniques, and policy categories were identified and translated into intervention content. Furthermore, a person-centered approach was adopted involving an iterative codesign process and extensive user testing. Education, enablement, modeling, persuasion, training, and social restructuring were selected as appropriate intervention functions. Twenty-two behavior change techniques, linked to the six intervention functions and three policy categories, were identified for inclusion and translated into PATHway intervention content. This paper details the use of the behavior change wheel and social cognitive theory to develop an eHealth intervention for the self-management of CVD. The systematic and transparent development of the PATHway intervention will facilitate the evaluation of intervention effectiveness and future replication.

Neurocognitive impairment after acute coronary syndrome: Prevalence and characterization in a hospital-based cardiac rehabilitation program sample

Introduction: Prospective studies have shown the relation between acute coronary syndrome (ACS) and neurocognitive dysfunction with prevalence ranging between 10.51% and 66.8%. The present study aims to determine the prevalence level of neurocognitive dysfunction; the relations between sociodemographic, clinical and emotional variables and neurocognitive functioning in a sample of ACS patients. Methods: The sample comprised of 53 patients engaged in cardiac rehabilitation within 3 months after an ACS. Patients with any medical history of neuropsychiatric problems prior to the ACS and illiterate subjects were not included in the study. Results: The majority of the sample (85%) exhibits some degree of cognitive impairment, with 84.8% showing verbal fluency impairment, 60.3% memory impairment and only 26,4% had language compromised. Neurocognitive general functioning was correlated with age. Memory domain was negatively correlated with the number of daily smoked cigarettes before the ACS. Verbal fluency was influenced by schooling. Language domain was correlated with mean diastolic pressure and with the type of profession, visuospatial domain was correlated with schooling, number of cardiovascular risk factors, distress, anxiety levels and type of ACS. Conclusion: Prevalence rate of neurocognitive dysfunction is considerably high. Besides global neurocognitive functioning, verbal fluency and memory are the most affected domains. Several variables were related to neurocognitive performance: sociodemographic; cardiovascular risk factors; clinical; psychological. The underlying mechanisms of neurocognitive dysfunction should be further explored.

Evaluation of an mHealth-Based Adjunct to Outpatient Cardiac Rehabilitation.

A pilot study was conducted to determine if a smartphone-based adjunct to standard care could increase the completion rate of a cardiac rehabilitation program (CRP). Based on historical completion rates, 66 participants who were about to commence a hospital-based CRP were randomized so that half received three devices embedded with near-field communication, namely, a smartphone [pre-installed with an application (app) designed specifically for cardiac rehabilitation], portable blood pressure monitor, and weight scale while completing the CRP. The completion rate among participants who were randomized to the intervention group was 88%, compared to 67% in the control group ( = 0.038). This combined with the week-to-week frequency with which participants in the intervention group measured their blood pressure ( 5/week) demonstrated the ability of the intervention to increase the proportion of patients who completed the CRP. No significant differences were found between the treatment groups for the measurements taken at baseline and prior to discharge from the CRP. A statistically significant correlation ( = 0.472; = 0.013) was found between the average time participants walked each day (as estimated via the smartphone app) and participants' six minute walking distance (6MWD) before they were discharged from the CRP (a clinically validated measurement).

Impact of Community-Based Cardiac Rehabilitation on Clinical Parameters of Patients with Cardiovascular Diseases.

Background:Cardiac rehabilitation (CR) programmes have been shown to improve patient outcomes, but vary widely in their components. The impact of Singapore’s CR programme on clinical outcomes is currently not known.Objective:To evaluate the effects of a community-based CR programme on important clinical parameters in patients with cardiovascular disease in Singapore.Method:A retrospective cohort study was conducted. Cardiovascular patients who had completed a hospital-based CR programme were included. Patients who continued with community-based CR (n = 94) during the period of 2009-2013 were compared with patients who received regular care (n = 157). Changes in clinical and physical examination parameters between baseline and one-year post follow-up were analyzed. Within-group differences were compared using the paired t-test, while multivariate linear regression was used to compare the changes in the various parameters between the intervention and control groups. The primary outcome measure was low density lipoprotein (LDL) levels.Results:Patients in the intervention group had significant lowering of LDL (2.5 to 2.2 mmol/L, p<0.01), while the control group’s LDL increased (2.2 to 2.4 mmol/L, p<0.01). The intervention group had greater improvements in LDL (-0.3 vs. +0.2 mmol/L, p<0.01), triglycerides (-0.1 vs. +0.1 mmol/L, p=0.01), total cholesterol (-0.3 vs. +0.3 mmol/L, p<0.01), fasting blood glucose (-0.5 vs. +0.3 mmol/L, p<0.01), systolic blood pressure (-3.2 vs. +5 mmHg, p<0.01) and diastolic blood pressure (-2.6 vs. +2.8 mmHg, p<0.01).Conclusion:The community-based CR programme in Singapore is associated with improvements in several cardiovascular clinical parameters and may be of benefit to cardiovascular patients.

Sexual counselling for patients with cardiovascular disease: protocol for a pilot study of the CHARMS sexual counselling intervention

IntroductionSexual problems are common with cardiovascular disease, and can negatively impact quality of life. To address sexual problems, guidelines have identified the importance of sexual counselling during cardiac rehabilitation, yet...

Improvement In Functional Exercise Capacity Differs By Attendance Duration But Not Intake Diagnosis In A Hospital-based Phase Ii Outpatient Cardiac Rehabilitation Program.

PURPOSE: Investigate differences and interactions between intake diagnosis and time-to-completion on functional exercise capacity (FEC) improvement in a hospital-based outpatient cardiac rehabilitation (CR) program in New Mexico. METHODS: During a 12-month span, 10 women and 39 men eligible for participation in a CR program completed all authorized 36-sessions in the Phase II CR program. Eligible diagnoses were: heart failure (HF), acute coronary syndrome (ACS), and cardiothoracic surgery (CT). A modified Atterbom protocol (2-min stages of increasing treadmill speed and incline) was used to assess differences between FEC at intake and immediately following completion of the 36-session program. Handrail support was allowed during the exercise tests as needed. FEC was determined by the attainment of an RPE of 15 (Borg 6-20 scale) and reported in METs. As part of a chart review, all data were deidentified prior to collection and analyses. Patients were separated into groups based on time-to-completion (≤4mo and >4mo) and diagnosis. Separate, group-specific independent t-tests were initially applied to examine changes in FEC by diagnosis and time-to-completion. All groups significantly improved FEC (p<.05). Consequently, ΔFEC ((post- pre/pre)*100) was calculated and analyzed. A 2 (time) by 3 (diagnosis) analysis of variance (ANOVA) was applied to assess group differences and interactions for ΔFEC. RESULTS: Forty-nine patients (61.6 ± 11.0 yr, 171.5 ± 8.9 cm, 79.7 ± 16.0 kg) completed the 36-session CR program during the 12-mo period. Group means ± SD for improvement in METs at ≤4mo (n=33) and >4mo (n=16) were 3.30 ± 1.92 METs, and 1.97 ± 1.27 METs, respectively. Group means ± SD for ΔFEC among HF (n=12), ACS (n=25), and CT (n=12) were 108.0 ± 95.5%, 60.4 ± 41.8%, and 54.1 ± 40.2%, respectively. Group means ± SD for ΔFEC at ≤4mo (n=33) and >4mo (n=16) were 82.2 ± 68.7%, and 46.5 ± 34.8%, respectively. Results indicate a significant (F (1,43)= 6.344, p = .016, partial η2 = .129) effect between ΔFEC and the time to complete the 36 sessions. CONCLUSIONS: These results highlight the effectiveness of a completed hospital-based outpatient CR program to elicit positive health outcomes across intake diagnoses. Completing the 36 sessions in 4mo or less produced the greatest improvement in FEC regardless of intake diagnosis.

Efficacy of Telecardiology in improving the results of Cardiac Rehabilitation after acute myocardial infarction

This study was addressed to verify if Telecardiology (TC) improves the results of Cardiac Rehabilitation in patients following a home-based Cardiac Rehabilitation Program (CRP) after acute myocardial infarction (AMI). We studied three groups of patients after AMI: Group A (control group): 15 patients, who followed a standard in-hospital CRP of 3 weekly sessions of 2 months duration; Group B (study group): 15 patients, who were enrolled in a home-based CRP of similar duration and were monitored by TC with the aid of an ecg-device (Sorin Life Watch CG 6106); Group C (second control group): 15 patients, who followed a home-based CRP without ecg-monitoring by TC. All patients performed a symptom-limited exercise testing at the beginning of the CRP. Psychometric data (STAI-Y1, STAI-Y2, BDI) were also evaluated. At the end of the CRP all patients underwent repeated exercise testing and psychometric evaluation. TC applied to the home-based CRP was associated with a good compliance to the program. Compared to Group C, in Group B we observed an increase of maximal heart rate, exercise duration, maximal work-load, and an improvement of anxiety, a trend to reduction of depression, and an improvement of quality of life. These results were very similar to Group A patients following a hospital-based CRP. TC improves compliance, functional capacity and psychological profile of patients undergoing a home-based CRP, compared to patients enrolled in a home-based CRP without ecg-monitoring by Telecardiology.

Abstract 12461: Strength of Physician Recommendation Increases Home-based Exercise Participation in Patients With Coronary Heart Disease

The majority of individuals with coronary heart disease (CHD) do not meet current exercise guidelines and less than half enroll in hospital-based cardiac rehabilitation (CR) exercise programs. Strength of physician referral can positively affect participation in a hospital-based CR program, but it is unknown how the strength of physician referral may impact home exercise in patients with CHD. It was hypothesized that the strength of physician recommendation would positively impact home exercise participation. A total of 251 patients with CHD completed the Cardiac Rehabilitation Exercise Participation Tool 3 months after hospital discharge. Participants were typical of the CHD population, with 165 being male (65.7%) and a mean age of 65 years (SD= 9.8). Of the total sample, 188 (75%) reported receiving physician referral for home exercise, with the mean strength of the referral being 2.9 (SD= 1.9) on a scale of 0 (none) to 5 (strong). One hundred twenty-two patients (48.6%) reported exercising 3 or more days a week at home. Logistic regression was used to evaluate the impact of the strength of physician referral on the likelihood that patients would participate in home exercise after hospital discharge. Covariates included age, sex, race, marital status, employment status, education level, insurance type, cardiac procedure type, history of CHD, history of depression, functional status, and exercise prior to hospitalization. Increased strength of physician referral was predictive of increased home exercise participation (adjusted OR 1.5, 95% CI [1.3-1.7], p&lt; 0.001). Male sex was also predictive, with 58.4% of males, as compared to 40% of females, reporting home exercise (adjusted OR 1.9, 95% CI [1.0-3.6], p= 0.049). Exercise prior to hospitalization was a final predictor, with 58.4% of prior exercisers, as compared to 41.7% of non-exercisers, reporting home exercise participation after hospital discharge (adjusted OR 2.0, 95% CI [1.1-3.6], p= 0.03). These findings demonstrate the beneficial effect of a strong physician recommendation for home-based exercise in patients with CHD. Physician referral is particularly important for women and patients who have not exercised before a cardiac event, as they reported doing less exercise after discharge home.