Hospital-based Cardiac Rehabilitation Research Articles

'The illness isn't the end of the road'-Patient perspectives on the initiation of and early participation in a multi-disease, community-based exercise programme.

Exercise is the cornerstone of cardiac rehabilitation (CR). Hospital-based CR exercise programmes are a routine part of clinical care and are typically 6-12 weeks in duration. Following completion, physical activity levels of patients decline. Multi-disease, community-based exercise programmes (MCEP) are an efficient model that could play an important role in the long-term maintenance of positive health behaviours in individuals with cardiovascular disease (CVD) following their medically supervised programme. To explore patients experiences of the initiation and early participation in a MCEP programme and the dimensions that facilitate and hinder physical activity engagement. Individuals with established CVD who had completed hospital-based CR were referred to a MCEP. The programme consisted of twice weekly group exercise classes supervised by clinical exercise professionals. Those that completed (n = 31) an initial 10 weeks of the programme were invited to attend a focus group to discuss their experience. Focus groups were transcribed and analysed using reflexive thematic analysis. Twenty-four (63% male, 65.5±6.12yrs) patients attended one of four focus groups. The main themes identified were 'Moving from fear to confidence', 'Drivers of engagement,' and 'Challenges to keeping it (exercise) up'. Participation in a MCEP by individuals with CVD could be viewed as a double-edged sword. Whilst the programme clearly provided an important transition from the clinical to the community setting, there were signs it may breed dependency and not effectively promote independent exercise. Another novel finding was the use of social comparison that provided favourable valuations of performance and increased exercise confidence.

Comparing domain- and intensity-specific physical activity in coronary heart disease and non-CHD individuals

Although increase in physical activity is important to improve prognosis of cardiac patients in addition to hospital-based exercise cardiac rehabilitation, their physical activity levels are not properly understood. This study aimed to examine domain- and intensity-specific physical activity in individuals with coronary heart disease (CHD) and compare them with non-CHD individuals. Data from the Korean National Health and Nutrition Examination Survey (KNHANES) from 2014 to 2019 were analyzed, including 1083 CHD patients and 38,532 non-CHD individuals. The inclusion criteria were age 19 years or older and data not missing for CHD information. Before and after propensity score matching (PSM) for age, sex, body mass index, education, household income, alcohol intake, and smoking status, domain (leisure, work, transportation)—and intensity (moderate, vigorous) -specific physical activity participation levels were compared between individuals with and without CHD. Before PSM, CHD individuals were older, less educated, more sedentary, and participated less in PAs compared to non-CHD individuals. After PSM, CHD individuals had similar levels of domain-specific PAs. However, they had higher work-related PA levels (29.7 ± 209.6 vs. 42.1 ± 291.3 min/week p = 0.022) and more sedentary time (487.2 ± 224.2 vs. 514.1 ± 228.7. p = 0.003) than those without CHD. Subgroup analysis revealed lower leisure-related PA in men with CHD (63.5 ± 165.5 vs. 47.3 ± 140.2, p < 0.05) and higher work-related PA in women with CHD (18.9 ± 159.7 vs. 57.1 ± 397.5, p < 0.01). Among those < 65 years of age, individuals with CHD spent more time sedentary than individuals without CHD. CHD individuals are not physically inactive compared with non-CHD individuals who are similar in sociodemographic status and lifestyle. CHD patients’ PA levels may have been underestimated.

Abstract 15475: Comparable Program Delivery Time: Home-Based versus Hospital-Based Cardiac Rehabilitation

Introduction: Home-based cardiac rehabilitation (CR) adds flexibility for patients for whom hospital-based CR may not be accessible. The ERA-NUDGE study is a pragmatic randomized study, conducted at an urban safety-net hospital, which evaluated adherence and clinical outcomes of home- versus hospital-based CR, with mobile phone messaging. The resource requirements associated with home-based CR interactions are not yet well established. We aimed to compare program delivery time between home-based and hospital-based CR programming. Methods: For one random week in each of 22 months, program delivery times were recorded by a research team member who shadowed hospital CR sessions and reviewed chart notes for home-based CR interactions. Among the sub-set of participants who had interactions during these weeks, we compared time spent on four types of interactions and seven educational topics. Results: Among 326 patients that completed the parent study, 157 patients had 415 visits during the microcosting weeks (mean of 3.8 visits per patient). Demographics shown in Table 1. Home-based patients accounted for 134 encounters (32%) during microcosting collection weeks. Six- and twelve-week follow-up visits were split between hospital- and home-based groups (53% and 47%, respectively) (Table 2). Conclusions: Despite documented benefits for patients from CR, access remains low. Home-based CR may present an appealing alternative for patients with difficulties around CR access, but CR program directors may be wary of added staffing requirements to deliver these alternatives. Our analysis suggests that home-based CR can be delivered to patients without increases in personnel time.

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.

Effects of real-time remote cardiac rehabilitation on exercise capacity and quality of life: a quasi-randomised controlled trial

BackgroundThe impact of real-time remote cardiac rehabilitation (CR) on health and disability-related outcomes and its correlation with physical function are unknown. We compared the effectiveness of real-time remote CR with that of hospital-based CR on physical function improvement and physical functions of improvement (Δ) to clarify the relationship between health and disability at baseline.MethodsPatients with cardiovascular diseases (CVDs) were enrolled (n = 38) in this quasi-randomised controlled trial and underwent 4 weeks of hospital-based CR, followed by 12 weeks of remote or hospital-based CR based on quasi-randomised allocation. Patients were assessed at baseline and after 12 weeks of remote or hospital-based CR using the shortened version of the World Health Organization (WHO) Quality of Life scale (WHOQOL-BREF) for subjective satisfaction, WHO Disability Assessment Schedule (WHODAS2.0-J) for objective performance, and cardiopulmonary exercise test for physical function and peak oxygen uptake (peak VO2). The trends in measured variables from baseline to the post-CR stage were analysed.ResultsSixteen patients (mean age, 72.2 ± 10.4 years) completed remote CR, and 15 patients (mean age, 77.3 ± 4.8 years) completed hospital-based CR. The post-CR physical function differed significantly between the groups (Δpeak VO2, 2.8 ± 3.0 versus 0.84 ± 1.8 mL·min−1·kg−1; p < 0.05). The differences in post-CR changes in the WHOQOL-BREF scores between the groups were insignificant. The post-CR changes in the WHODAS2.0-J scores were significantly lower in the remote CR group than in the hospital-based CR group (ΔWHODAS2.0-J score, –8.56 ± 14.2 versus 2.14 ± 7.6; p < 0.01). Forward multiple stepwise regression analysis using overall data showed that the intervention method (β = 0.339, p < 0.05), baseline cognition (β = − 0.424, p < 0.05), and social interaction level (β = 0.658, p < 0.01; WHODAS2.0-J) were significant independent contributors to Δpeak VO2 (r2 = 0.48, F = 8.13, p < 0.01).ConclusionsRemote CR considerably improved physical function and objective performance in patients with CVDs. Remote CR can be used to effectively treat stable patients who cannot visit hospitals.Trial registrationThis interventional trial was registered at the UMIN-CTR registry (trial title: Development of remote programme for cardiac rehabilitation using wearable electrocardiograph; trial ID: UMIN000041746; trial URL: https://center6.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000046564; registration date: 2020/09/09).

Socioeconomic and ethnical disparity in coronary heart disease outcomes in Denmark and the effect of cardiac rehabilitation-A nationwide registry study.

Cardiovascular patients with low socioeconomic status and non-western ethnic background have worse prognostic outcomes. The aim of this nationwide study was first to address whether short-term effects of hospital-based outpatient cardiac rehabilitation (CR) are similar across educational level and ethnic background, and secondly to study whether known disparity in long-term prognosis in patients with cardiovascular disese is diminished by CR participation. All patients with myocardial infarction and/or coronary revascularization from August 2015 until March 2018 in the Danish national patient registry or the Danish cardiac rehabilitation database (DHRD) were included. We used descriptive statistics to address disparity in achievement of quality indicators in CR, and Cox proportional hazard regression to examine the association between the disparity measures and MACE (cardiovascular hospitalization and all-cause mortality) with adjustment for age, gender, index-diagnose and co-morbidity. We identified 34,511 patients of whom 19,383 had participated in CR and 9,882 provided information on CR outcomes from the DHRD. We demonstrated a socioeconomic gradient in improvements in VO2peak, and non-western patients were less often screened for depression or receive dietary consulting. We found a strong socioeconomic gradient in MACE irrespective of CR participation, medication, and risk factor control (adjusted HR 0.65 (95% CI 0.56-0.77) for high versus low education). Non-western origin was associated with higher risk of MACE (adjusted HR 1.2 (1.1-1.4)). We found only minor socioeconomic and ethnic differences in achievement of CR quality indicators but strong differences in CHD prognosis indication that conventional risk factor control and medical treatment following CR do not diminish the socioeconomic and ethnical disparity in CHD prognosis.

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&amp;lt;0.05) and the WHOQOL-BREF score (before: 77.4±12.8 points; after: 93.9±12.9 points; p&amp;lt;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&amp;lt;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&amp;lt;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&amp;lt;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.

Efficacy and Safety of Hybrid Cardiac Telerehabilitation in Patients with Hypertrophic Cardiomyopathy without Left Ventricular Outflow Tract Obstruction and Preserved Ejection Fraction—A Study Design

Hypertrophic cardiomyopathy (HCM) is the most common congenital disease increasing the risk of sudden cardiac death. For many years, HCM patients were excluded from exercise training. However, there are data showing that patients with HCM undergoing supervised exercise training could improve physical performance without serious adverse events. A project was designed as a randomized clinical trial to assess the effectiveness and safety of hybrid cardiac rehabilitation (HCR)—a combination of hospital-based cardiac rehabilitation (1 month) with a new form of home-based telemonitored cardiac rehabilitation (2 months) in HCM patients without left ventricular (LV) outflow tract obstruction and preserved systolic function. Sixty patients who fulfil the inclusion criteria have been randomly assigned (1:1) to either HCR plus usual care (training group) or usual care only (control group). The primary endpoint is a functional capacity evaluated by peak oxygen uptake (pVO2). Secondary endpoints include workload time during the cardiopulmonary exercise testing, a six-minute walk test distance, NT-pro BNP level, echocardiographic parameters of the left ventricular diastolic function (E/A, E/e’, myocardial strain rate), right ventricular systolic pressure, a gradient in the LV outflow tract, and quality of life. The tertiary analysis includes safety, acceptance and adherence to the HCR program. Our research will provide innovative data on the effectiveness and safety of hybrid cardiac rehabilitation in HCM patients without LV outflow tract obstruction and preserved systolic function. Clinical trials registry: ClinicalTrials.gov Identifier NCT03178357.

Effects of Cardiac Rehabilitation on Physical Fitness, Physical Function, and Self-reported Outcomes in Patients ≥80 yr: A RANDOMIZED CONTROLLED TRIAL.

The beneficial effects of exercise-based cardiac rehabilitation (CR) after an acute coronary syndrome (ACS) are well known, but patients ≥80 yr have been less studied. The aim was to evaluate the effects of CR on patients with ACS ≥80 yr on peak cardiorespiratory fitness (CRF), physical function, and patient-reported outcome measures (PROMs) compared with a control group. A total of 26 patients with ACS, median age 82 (81, 84) yr, were randomized to hospital-based CR combined with a home-based exercise program (CR group) or to a control group (C) for 4 mo. Outcomes were assessed at baseline and 4 mo and included the peak CRF (primary outcome), 6-min walk test (6MWT), muscle endurance, Timed Up and Go (TUG), Short Physical Performance Battery (SPPB), one-leg stand test, and PROMs. There were no significant differences between the groups in peak CRF. The CR group improved significantly in terms of the 6MWT ( P = .04), isotonic muscle endurance ( P < .001), one-leg stand test ( P = .001), SPPB total score ( P =.03), Activities-specific Balance Confidence ( P =.01), and anxiety ( P =.03), as compared with C. There were no significant intergroup differences in the TUG, the self-reported health question or depression. Patients with ACS ≥80 yr improved in walking distance, muscle endurance, physical function, and PROMs, but not in peak CRF, by participating in a CR program. These results suggest an increased referral to CR for this growing group of patients to enable preserved mobility and independence in daily living, but this needs to be confirmed in larger studies.

The effect of home-based cardiac rehabilitation on depression score in patients with ischemic heart disease: A longitudinal clinical trial study.

Depression is common in patients with cardiovascular disease (CVD). Home-based cardiac rehabilitation (HBCR) is a program that alleviates depression. This study aimed to determine and compare HBCR programs and usual care (UC) effects on depression control in patients with ischemic heart disease (IHD). This clinical trial study was performed on 259 patients with IHD that were randomly allocated to the HBCR and UC groups for stress management. Data were collected using the "Beck Depression Inventory" (BDI) at baseline and 6 and 12 months. Generalized estimating equation (GEE) models were applied to examine the associations between times of the groups and changes in outcomes over the study times. Data analysis was done in SPSS software at the significance level of 0.05. A total of 247 participants with a mean age of 55.22 ± 7.40 years participated in this study, and 209 (84.6%) of the study participants were men. Among patients, 128 patients in the UC program and 119 patients in the HBCR program attended at least one of the pre-determined visits (months 6 and 12). The patterns of change of the depression parameter were similar through the course of the study between the two groups (P = 0.04). In the HBCR group, the depression reduced continuously from baseline to 6 months, baseline to 12 months, and 6 to 12 months (P < 0.05). In the UC group, depression was significantly reduced from baseline to 6 months and from baseline to 12 months. HBCR was effective in continuous reducing of depression scores in long-term follow-up of patients with IHD. These findings suggest that HBCR can alleviate depression in patients who do not participate in hospital-based cardiac rehabilitation (CR).

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

The effect of home-based cardiac rehabilitation on depression score in patients with Ischemic Heart Disease: A longitudinal clinical trial study

BACKGROUND: Depression is common in patients with cardiovascular disease (CVD). Home-based cardiac rehabilitation (HBCR) is a program that alleviates depression. This study aimed to determine and compare HBCR programs and usual care (UC) effects on depression control in patients with ischemic heart disease (IHD). METHODS: This clinical trial study was performed on 259 patients with IHD that were randomly allocated to the HBCR and UC groups for stress management. Data were collected using the Beck Depression Inventory (BDI) at baseline and 6 and 12 months. Generalized estimating equation (GEE) models were applied to examine the associations between times of the groups and changes in outcomes over the study times. Data analysis was done in SPSS softwareat the significance level of 0.05. RESULTS: A total of 247 participants with a mean age of 55.22 ± 7.40 years participated in this study, and 209 (84.6%) of the study participants were men. Among patients, 128 patients in the UC program and 119 patients in the HBCR program attended at least one of the pre-determined visits (months 6 and 12). The patterns of change of the depression parameter were similar through the course of the study between the two groups (P = 0.04). In the HBCR group, the depression reduced continuously from baseline to 6 months, baseline to 12 months, and 6 to 12 months (P < 0.05). In the UC group, depression was significantly reduced from baseline to 6 months and from baseline to 12 months. CONCLUSION: HBCR was effective in continuous reducing of depression scores in long-term follow-up of patients with IHD. These findings suggest that HBCR can alleviate depression in patients who do not participate in hospital-based cardiac rehabilitation (CR).

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.

Cardiac Rehabilitation: Evaluation of a Long-Term Programme of Physical Training for Out-Patients

A community-based long-term cardiac rehabilitation programme (LTP) has been designed for patients who had completed a two-year hospital-based physical training programme after myocardial infarction (MI) and wished to continue with community-based group training sessions. Since the start of LTP 20% of all patients in a consecutive MI population less than 65 yrs have participated. The programme operates on a low-cost base. Its feasibility is supported by a high attendance rate and by the absence of adverse effects during more than 2,000 patient training hours. In order to evaluate LTP 20 participating MI patients were compared with 20 matched control patients, who had completed the hospital-based training, but did not participate in LTP. The main reason for participation was the need for continued group support and social contact (15/20). Reasons for not participating were preference to exercise at home (10/20), long distance (6/20) and working hours (4/20). When compared with the data of the hospital-based programme one year post MI, both groups showed 4 years (average) post MI a slight but significant increase of systolic blood pressure of 12 vs. 18 mmHg. Work performance levels had been maintained (132 vs. 136 W). No patients had started smoking and there were no differences between the groups as to leisure time activities. It is concluded that a long-term training programme can be provided safely and at low cost for those MI patients who need continued support in order to maintain the effectiveness of the hospital-based cardiac rehabilitation.

Abstract 319: Development of a Knowledge Measure to Evaluate a Decision Aid for Patients Choosing Between Home and Hospital Based Cardiac Rehabilitation

Background: Home-based cardiac rehabilitation (CR) has similar efficacy as center-based CR, but the choice of which meets the needs of individual patients is preference-sensitive. Our objective was to develop a knowledge measure to be used to evaluate a shared decision-making tool for patients choosing between home and center-based CR. Methods: We generated 11 true/false questions about home and hospital-based CR. The statements were reviewed for accuracy by 8 exercise physiologists. Cognitive testing was performed with 10 patients using the “think-aloud” method to understand their interpretation of what each item was asking. The statements were then revised to improve acceptability and clarity. We tested the knowledge statements in a sample of 124 participates from the lay public recruited via mTurk. Psychometric properties of item difficulty, item uncertainty, and index of discrimination were evaluated. Differences between groups based on education level, age, sex, and race/ethnicity were also evaluated. Results: Of 124 respondents 66% were female, 69% were white, 69% were between 18-44 years of age, and 89% had at least some college education. On average respondents answered 70% of questions correctly. Item difficulty ranged from 51% to 98% correct. Item uncertainty ranged from 9% to 36%. Index of discrimination was highest for questions 2 (75%), 7 (74%) and 9 (68%). (see Table) Within each subgroup, the following groups had the highest average score: African Americans, (77%), females (74%), advanced degree (80%) and ages 55-64 (78%). Conclusion: The knowledge measure developed in this study can be used to assesses knowledge about key concepts central to making an informed decision about home vs. hospital-based CR. This knowledge measure will be further validated and used to evaluate a decision aid for patients in our safety net hospital system choosing between home and hospital-based CR.

Underutilization of Hospital-based Cardiac Rehabilitation after Acute Myocardial Infarction in Korea.

BackgroundCardiac rehabilitation (CR) after acute myocardial infarction (AMI) is recommended as a mandatory intervention in several national clinical practice guidelines published in America, Europe, and Korea to reduce recurrence and mortality. However, underutilization of CR is an established worldwide issue. In Korea, the promotion of CR is expected due to coverage by National Health Insurance. Nevertheless, the national status of CR use has not been reported. This retrospective cohort study aimed to investigate the current status of CR use in patients with AMI using nationwide data from the National Health Insurance Service of Korea.MethodsPatients with AMI admitted with the diagnosis of ‘I21’ code (from International Classification of Diseases, 10th revision, Clinical Modification) from July 1st, 2017 to June 30th, 2018 were included. CR use was defined as CR treatment or evaluation being performed during an outpatient follow-up period within 6 months after discharge. Participation rate and density were calculated nationally and by administrative division. Logistic regression analysis was performed to identify the influencing factors of CR participation.ResultsNationally, 1.5% of AMI patients (960/64,982) underwent CR during outpatient treatment after discharge. CR density was approximately 10. Logistic regression analysis revealed that influencing factors included old age, female sex, rural residence, and low Charlson comorbidity index.ConclusionHospital-based CR after AMI is underutilized despite its coverage by the National Health Insurance. More CR facilities have to be installed according to the needs of CR in various regions.

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.