Impact Of Cardiac Rehabilitation Research Articles

Abstract 10431: Impact of Cardiac Rehabilitation on Reducing Cardiovascular Events and Subsequent Medical Expenses for One Year in Patients with Transcatheter Aortic Valve Implantation

Introduction: It remains unclear whether cardiac rehabilitation (CR) can reduce medical expenses (ME)in patients with Transcatheter Aortic Valve Implantation (TAVI). Hypothesis: Outpatients CR reduced the cardiovascular events (CEs) and the total ME for one year in patients after TAVI. Methods: This retrospective analysis enrolled consecutive 148 patients who admitted TAVI treatment at the Showa University Hospital, between December 2015 and September 2019. Exclusion criteria was in-hospital death, difficulty walking at discharge and patients who could not be followed up after the hospital discharge. The subsequent ME for outpatient clinic and/or rehospitalization due to CEs in avarage 1.5 years after the discharge were compared between the CR group and non-CR group. CEs were defined as death, ACS, angina, stroke, and heart failure. Results: The CR group was significantly reduced the CEs compared with the non-CR group (logrank = 4.538 p = 0.033). (figure1)The CR group was significantly increased the outpatient ME (p < 0.001). However, rehospitalization and total ME were significantly lower in the CR group (p = 0.003, p = 0.002). (figure2) Conclusions: Outpatients CR reduced the CEs and the total ME for one year in patients after TAVI.

Impact of cardiac rehabilitation on inflammation in patients with ischaemic cardiomyopathy

Abstract Introduction The benefits of cardiac rehabilitation (CR) in patients with ischaemic cardiomyopathy are well-known. However, inflammatory states have been associated to an increased risk of cardiovascular events. Purpose Evaluate the impact of CR in the serum levels of inflammatory biomarkers and identify potential predictors of that effect. Methods We retrospectively studied consecutive patients with ischaemic cardiomyopathy who completed a CR programme between 2011 and 2017. Patients underwent a supervised exercise training protocol, twice a week during a period of 8 to 12 weeks. Functional capacity was evaluated by metabolic equivalents assessed prior the beginning and 3 months after the programme with a symptom limited exercise treadmill test. Patients without levels of serum C-reactive protein at beginning and at the end of CR programme were excluded. Median variation of serum C-reactive protein was assessed and two groups were defined: one with levels above that and one with levels below. Results Of 250 patients (60.3±11.1 years, 84% male), 67% were admitted after an acute myocardial infarction. Left ventricular ejection fraction ≤40% before CR was present in 32% of individuals. Median levels of serum C-reactive protein before CR were 8.8 (3.1–21.7) mg/L and median variation after CRP was a decrease of 5.1 (0.9–17.7) mg/L (p<0.001). Before CR, higher levels of serum C-reactive protein were seen in obese (15.7 [8–52.7] versus 8.8 [3.2–27.8], p=0.04) and those with higher NT-proBNP (p<0.001). Patients with decrease of >5.1mg/L of serum C-reactive protein had lower prevalence of hypertension (18% versus 30%, p=0.02), higher prevalence of obesity (16% versus 7%, p=0.03), lower levels of HDL cholesterol (38.3 [11.1] versus 43.2 [12.6], p<0.001) and higher levels of NT-proBNP (1079 [610.3–1988] versus 488 [215–777], p<0.001) at baseline. An increase of at least of 10% of functional capacity after CR was reached in 65% of patients, similar between groups. Patients with decrease of serum C-reactive protein >5.1mg/L had also higher reduction of NT-proBNP after CR comparing to baseline (491.1 [142.7–948.5] versus 162.0 [30.9–295.2], p<0.001). Conclusions Serum levels of inflammatory biomarkers decreased after CR in patients with ischaemic cardiomyopathy. Normotension, obesity, lower HDL and higher levels of natriuretic peptides are associated to a better response. Funding Acknowledgement Type of funding sources: None.

Evaluation of Qatar's First Cardiac Rehabilitation Program: A Brief Report.

Background:There are few studies on the impact of cardiac rehabilitation (CR) in the Eastern Mediterranean Region (EMR), where the burden of risk factors and context is somewhat different from Western countries where much of the evidence is derived.Objective:To evaluate patient engagement in, and outcomes associated with, participation in Qatar’s first and only CR program, from inception.Methods:This was a retrospective, observational study of patients referred to Heart Hospital’s CR program from January 2013-September, 2018. The program offered 3 sessions/week over 6–12 weeks, depending on patient risk. An initial assessment was performed, and outcomes (i.e., functional capacity, risk factors, and psychosocial well-being (quality of life [SF-36] and depressive symptoms) were re-assessed post-program in those who did not drop-out. Session attendance was recorded.Results:682 patients enrolled; they attended 77.6% of prescribed sessions; 554 (81.2%) completed the program and post-assessment. Improvements in functional capacity were statistically and clinically meaningful (METs 9.3 ± 3.3 pre and 11.1 ± 3.7 post; p < 0.001). There were significant improvements in body mass index (28.7 ± 5.2 kg/m2 pre and 28.2 ± 5.4 post; p < 0.001), waist circumference (102.8 ± 13.0 cm pre and 101.8 ± 13.2 post; p < 0.001), low-density lipoprotein (LDL 1.9 ± 0.9 mmol/L pre and 1.6 ± 0.8 post; p = < 0.001), total cholesterol (3.6 ± 1.1 mmol/L pre and 3.3 ± 0.8 post; p < 0.001), systolic blood pressure (SBP 128.5 ± 17.7 mmHg pre and 123.7 ± 14.8 post; p < 0.001), hemoglobin A1c (6.8 ± 1.6% pre and 6.5 ± 1.3 post; p < 0.001) and depressive symptoms (Cardiac Depression Scale score 78.3 ± 23.9 pre and 66.3 ± 21.3 post; p < 0.001). Improvements on 7 of the 8 quality of life domains were also observed (all p < .05; e.g., physical functioning 68.2 ± 24.0 pre and 74.9 ± 24.4 post).Conclusion:The new Qatari CR program is very engaging to patients, and resulted in clinically significant risk factors (LDL, SBP, and cholesterol) as well as functional capacity and health-related quality of life improvements, which likely translate to reduced morbidity and mortality.

Cancer and cardiovascular disease: The impact of cardiac rehabilitation and cardiorespiratory fitness on survival

BackgroundCancer survivors are at increased risk for cardiovascular disease (CVD)-related morbidity and mortality. Exercise-based cardiac rehabilitation (CR) programs improve CVD risk factors, including cardiorespiratory fitness (CRF). The purpose of this study was to investigate: (1) the association between CR completion and survival, and (2) whether CRF improvements translate to increased survival among patients with comorbid cancer and CVD. MethodsPatients with CVD and pre-existing cancer (any type) were referred to a 12-week exercise-based CR program between 01/1996 and 03/2016. Peak metabolic equivalents (METs) were assessed by graded exercise test pre-CR and at 12-weeks. Kaplan-Meier survival and multivariate cox regressions were performed to evaluate impact of CR completion and clinically-meaningful CRF improvements [ΔMETs≥1] on survival, adjusting for relevant covariates. ResultsAmong 442 patients with CVD and cancer referred to CR (67 ± 10 years; 22% women), 361 (82%) completed CR. 102 deaths were recorded during the 12-year observation period. Compared to patients who did not complete CR, patients with comorbid cancer who completed CR demonstrated a survival advantage (63% vs 80.1%, p < .001). CRF improved among completers during the 12-week program (mean change = 0.87 ± 0.93 METs, p < .001); 41% experienced a clinically-meaningful ΔMETs≥1. A survival advantage was not observed in completers who experienced a ΔMETs≥1 improvement (p = .254). ConclusionCompleting a 12-week exercise-based CR program improved CRF and increased survival in patients with CVD and comorbid cancer. The results highlight the survival benefits of completing a CR program among CVD patients who experience added barriers imposed by cancer treatment and survival.

Impact of cardiac rehabilitation on left ventricular diastolic function and exercise capacity in patients treated with percutaneous coronary intervention after acute coronary event

Background Study examines the influence of cardiac rehabilitation program (CR) on left ventricular diastolic dysfunction (LVDD), functional capacity and major cardiovascular risk factors (CVRF) in patients after with PCI resolved acute coronary syndrome (ACS). Methods We performed a non-randomised study included a total of 85 subjects after resolved ACS, with left ventricular ejection fraction (LVEF) ≥ 45% and LVDD, without heart failure. Subjects were divided into control (N = 29) and intervention group (N = 56), depending on CR program attendance consisted of exercise training sessions for 12 weeks, 3 times per/week, 30 min per session. Initially and after 12 weeks, patients were subjected to echocardiography to assess LV filling pressure (E/e’) as well as CPET to asses improvement in peak VO2. Results Initially subjects were similar in CVRF, LVDD and CPET parameters (p > 0.05). Following CR, the intervention group demonstrated a significant improvement in E/e’ (8.0 ± 3.0 vs 7.0 ± 2.2; p < 0.05), compared to the control group (8.4 ± 3.0 vs 9.0 ± 3.1; p > 0.05), as well as a significant improvement in peak VO2 (23.2 ± 5.0 ml/kg/min vs 24.8 ± 5.8 ml/kg/min; p < 0.001). Control group also exhibited significant worsening in peak VO2 without CR (23.0 ± 4.0 vs 21.2 ± 4.1 ml/kg/min; p = 0.02). CVRF improved in both groups, except for glycaemia levels and body mass index, which improved only in the intervention group (p < 0.001). Conclusions Following ACS treated with PCI, CR had a positive effect on major CVRFs, the degree of LVDD and exercise capacity and should be considered as effective tool to reduce morbidity in such patients.

Changes in fear of movement in patients attending cardiac rehabilitation: responsiveness of the TSK-NL Heart

Abstract Funding Acknowledgements Type of funding sources: None. Background An important factor related to low physical activity in cardiac patients is fear of movement (kinesiophobia). The setting of cardiac rehabilitation (CR) seems suitable for targeting kinesiophobia. Nevertheless, the impact of CR on kinesiophobia is currently unknown, partly due to the absence of information on the responsiveness of instruments to measure kinesiophobia. Purpose To determine the responsiveness of the Dutch version of the Tampa Scale for Kinesiophobia questionnaire (TSK-NL Heart), to asses changes in kinesiophobia during participation in CR and to assess predictors of high levels of kinesiophobia at completion of CR. Methods This study was performed among 109 patients (mean age: 61 years; 76% men) who participated in a 6- till 12-week CR program. Kinesiophobia was measured using the TSK-NL Heart questionnaire. To determine the responsiveness of the TSK-NL Heart, the Cardiac Anxiety Questionnaire (CAQ) and the general anxiety scale of the Hospital Anxiety and Depression Scale (HADS-A) were used as external measures. All questionnaires were completed pre- and post-CR. Internal responsiveness was estimated by calculating the effect size (ES) and standardized response mean (SRM). External responsiveness was determined by calculating the correlation between change scores on the TSK-NL heart and on the external measures. Furthermore, univariate logistic regression analysis was performed with the dichotomized TSK-NL Heart score post-CR as dependent variable (high vs low scores) and baseline characteristics (age, sex, reason for referral and pre-CR scores on the TSK-NL Heart, CAQ and HADS) as predictor variables. Results Prevalence of a high levels of kinesiophobia improved from 40.4% pre-CR to 25.7% at completion of CR (p = 0.05). Both the ES and the SRM of the TSK change score were moderate for patients with an improved CAQ and HADS-A score (respectively ES = 0.52; SRM = 0.57 and ES = 0.54; SRM = 0.60) and small for patients with a stable score (ES = 0; SRM = 0 and ES = 0.26; SRM = 0.36). There was a moderate correlation between the TSK-NL Heart change score and the CAQ (Rs = 0.30, p = 0.023) and a small correlation between the TSK-NL Heart change score and the HADS-A (Rs =0.21, p = 0.107). The odds of having high kinesiophobia levels post-CR were increased by having a high level of kinesiophobia pre-CR (OR= 9.83, 95%CI: 3.52-27.46), a higher baseline score on the CAQ (OR = 1.12, 95%CI: 1.06-1.19), and a higher baseline score on the HADS-A (OR = 1.26, 95% CI: 1.11-1.42). Conclusion The TSK-NL Heart has moderate responsiveness. In addition, this study shows that there are reductions in kinesiophobia during the course of CR. Nevertheless, a large number of patients (26%) still had high levels of kinesiophobia at completion of CR. Interventions targeting kinesiophobia should focus on patients that enter CR with high levels of kinesiophobia, cardiac anxiety and generic anxiety.

Left ventricular remodeling: is there a real impact of cardiac rehabilitation?

Abstract Funding Acknowledgements Type of funding sources: None. Introduction A number of randomized controlled trials have examined the effect of exercise training on left ventricle (LV) remodeling in individuals with cardiovascular disease. However, the results of these trials have been inconclusive. Purpose Evaluation of the impact of a cardiac rehabilitation program (CRP) on left ventricle remodelling evaluated by echocardiogram. Methods Observational single centre study including consecutive patients, undergoing structured CRP since June 2016 until February 2020. Phase II CRP included 3 months of exercise training, aerobic and strength exercise, individually prescribed, 3 times a week, 60 minutes sessions. All patients were submitted to a clinical evaluation, echocardiogram, and cardiopulmonary exercise test before and after the CRP. Results 205 patients (62.6 ± 11 years, 83.4% men, 82.3% ischemic disease) were included in a phase II CRP. Most patients had ischemic disease (82.3%) and 23.5% of patients had left ventricular ejection fraction (LVEF) &amp;lt;40%. Of the cardiovascular risk factors, hypertension was the most prevalent (76%), followed by dyslipidaemia (67.4%), active smoking (45.9%) and diabetes (26.9%). After the CRP, there was a significant improvement of LVEF (from 48.3 ± 13 to 52 ± 11.6 %, p = 0.001) and a significant reduction of LV volumes (LV end-diastolic volume, LVEDV , decreased from 140 ± 81 to 121 ± 57, p = 0.002; LV end-systolic volume , LVESV , reduced from 80 ± 75 to 64 ± 48, p = 0.004). Considering only the patients with LVEF &amp;lt; 40% (n = 38), the improvement was even greater: LVEF increased from 30 ± 8 to 39 ± 13 (p = 0.002); LVEDV reduced from 206 ± 107 to 159 ± 81 (p = 0.001) and LVESV reduced from 142 ± 99 to 101 ± 66 (p = 0.002). 63.6%(n = 14) of these patients improved at least 10% of LVEF and only 1 of them had a cardiac resynchronization therapy device. Conclusions A phase II CR program was associated with significant improvements in left ventricular reverse remodelling irrespective of baseline EF classification. Those with reduced baseline EF derived an even greater improvement, highlighting the great importance of CR in this subgroup of patients.

Exercise-based cardiac rehabilitation for adults after heart valve surgery.

The impact of exercise-based cardiac rehabilitation (CR) following heart valve surgery is uncertain. We conducted an update of this systematic review and a meta-analysis to assess randomised controlled trial evidence for the use of exercise-based CR following heart valve surgery. To assess the benefits and harms of exercise-based CR compared with no exercise training in adults following heart valve surgery or repair, including both percutaneous and surgical procedures. We considered CR programmes consisting of exercise training with or without another intervention (such as an intervention with a psycho-educational component). We searched the Cochrane Central Register of Clinical Trials (CENTRAL), in the Cochrane Library; MEDLINE (Ovid);Embase(Ovid); the Cumulative Index to Nursing and Allied Health Literature(CINAHL; EBSCO);PsycINFO (Ovid);Latin American Caribbean Health Sciences Literature(LILACS; Bireme);and Conference Proceedings Citation Index-Science (CPCI-S) on the Web of Science (Clarivate Analytics) on10January 2020. We searched for ongoing trials from ClinicalTrials.gov, Clinical-trials.com, and the World Health Organization International Clinical Trials Registry Platform on 15 May 2020. We included randomised controlled trials that compared exercise-based CR interventions with no exercise training. Trial participants comprised adults aged 18 years or older who had undergone heart valve surgery for heart valve disease (from any cause) and had received heart valve replacementor heart valve repair. Both percutaneous and surgical procedures were included. Two review authors independently extracted data. We assessed the risk of systematic errors ('bias') by evaluating risk domains using the 'Risk of bias' (RoB2) tool. We assessed clinical and statistical heterogeneity. We performed meta-analyses using both fixed-effect and random-effects models. We used the GRADE approach to assess the quality of evidence for primary outcomes (all-cause mortality, all-cause hospitalisation, and health-related quality of life). We included six trials with a total of 364 participants who have had open or percutaneous heart valve surgery. For this updated review, we identified four additional trials (216 participants). One trial had an overall low risk of bias, and we classified the remaining five trials as having some concerns. Follow-up ranged across included trials from 3 to 24 months. Based on data at longest follow-up, a total of nine participants died: 4 CR versus 5 control (relative risk (RR) 0.83, 95% confidence interval (CI)0.26 to 2.68; 2 trials, 131 participants; GRADE quality of evidencevery low). No trials reported on cardiovascular mortality. One trial reportedone cardiac-related hospitalisation in the CR group and none in the control group (RR 2.72, 95% CI0.11 to 65.56; 1 trial, 122 participants; GRADE quality of evidencevery low). We are uncertain abouthealth-related quality of life at completion of the intervention in CR compared to control (Short Form (SF)-12/36 mental component: mean difference (MD) 1.28, 95% CI-1.60 to 4.16; 2 trials, 150 participants;GRADE quality of evidencevery low; and SF-12/36 physical component: MD 2.99, 95% CI-5.24 to 11.21; 2 trials, 150 participants; GRADE quality of evidencevery low), or at longest follow-up (SF-12/36 mental component: MD -1.45, 95% CI-4.70 to 1.80; 2 trials, 139 participants; GRADEquality of evidencevery low; and SF-12/36 physical component: MD -0.87, 95% CI-3.57 to 1.83; 2 trials, 139 participants; GRADE quality of evidencevery low). AUTHORS' CONCLUSIONS: Dueto lack of evidence and the very low quality of available evidence, this updated review is uncertain aboutthe impact of exercise-CR in this population in terms of mortality, hospitalisation, and health-related quality of life. High-quality (low risk of bias) evidence on the impact of CR is needed to inform clinical guidelines and routine practice.

Impact of cardiac rehabilitation on ventricular repolarization indices following coronary artery bypass grafting.

Background The aim of this study was to evaluate the effect of cardiac rehabilitation on electrocardiographic changes in patients undergoing isolated coronary artery bypass grafting. Methods Between January 2016 and July 2019, a total of 625 patients (485 males, 140 females; mean age: 59.6 years; range, 50.6 to 68.6 years) who underwent isolated coronary artery bypass grafting and survived were retrospectively analyzed. The patients were divided into two groups according to the participation in the cardiac rehabilitation program as follows: the Rehab(+) group (n=363) and the Rehab(-) group (n=262). Electrocardiographic parameters of both groups were compared. Results There was a significant decrease in the electrocardiographic findings of heart rate (p<0.001), QTc (p<0.001), Tpe duration (p<0.001), Tpe/QT ratio (p<0.001), and Tpe/QTc ratio (p<0.001) in the Rehab(+) group before and after surgery. There was a significant decrease in the Rehab(+) group, compared to the Rehab(-) group, in terms of parameters of QT interval (p=0.001), QTc (p=0.017), Tpe duration (p<0.001), Tpe/QT ratio (p<0.001), and Tpe/QTc ratio (p<0.001). Conclusion Cardiac rehabilitation program after coronary artery bypass grafting decreases ventricular repolarization indices of electrocardiography. Based on these changes, postoperative cardiac rehabilitation program may reduce the risk of ventricular arrhythmia and sudden cardiac death during follow-up.

Impact of cardiac rehabilitation on mortality and morbidity in diabetic versus non-diabetic patients: protocol for a systematic review and meta-analysis

BackgroundCardiac rehabilitation (CR) decreases the morbidity and mortality risk among patients with cardiac diseases; however, the impact of CR on patients with diabetes remains underexplored. This is a protocol for...

Remote Monitoring of Cardiac Implantable Electronic Devices in Patients Undergoing Hybrid Comprehensive Telerehabilitation in Comparison to the Usual Care. Subanalysis from Telerehabilitation in Heart Failure Patients (TELEREH-HF) Randomised Clinical Trial.

Background: The impact of cardiac rehabilitation on the number of alerts in patients with remote monitoring (RM) of cardiac implantable electronic devices (CIEDs) is unknown. We compared alerts in RM and outcomes in patients with CIEDs undergoing hybrid comprehensive telerehabilitation (HCTR) versus usual care (UC). Methods: Patients with heart failure (HF) after a hospitalization due to worsening HF within the last 6 months (New York Heart Association (NYHA) class I-III and left ventricular ejection fraction (LVEF) ≤40%) were enrolled in the TELEREH-HF study and randomised 1:1 to HCTR or UC. Patients with HCTR and CIEDs received RM (HCTR-RM). Patients with UC and CIEDs were offered RM optionally (UC-RM). Data from the initial 9 weeks of the study were analysed. Results: Of 850 enrolled patients, 208 were in the HCTR-RM group and 62 in the UC-RM group. The HCTR-RM group was less likely to have alerts of intrathoracic impedance (TI) decrease (p < 0.001), atrial fibrillation (AF) occurrence (p = 0.031) and lower mean number of alerts per patient associated with TI decrease (p < 0.0001) and AF (p = 0.019) than the UC-RM group. HCTR significantly decreased the occurrence of alerts in RM of CIEDs, 0.360 (95%CI, 0.189–0.686; p = 0.002), in multivariable regression analysis. There were two deaths in the HCTR-RM group (0.96%) and no deaths in the UC-RM group (p = 1.0). There were no differences in the number of hospitalised patients between the HCTR-RM and UC-RM group (p = 1.0). Conclusions: HCTR significantly reduced the number of patients with RM alerts of CIEDs related to TI decrease and AF occurrence. There were no differences in mortality or hospitalisation rates between HCTR-RM and UC-RM groups.

Abstract 15622: Impact of Cardiac Rehabilitation on Six-Month Adherence to Cardiovascular Pharmacotherapy: Insights From the Ami-Optima 2 Study

Introduction: It remains unclear whether cardiac rehabilitation (CR) can enhance adherence to cardiovascular (CV) medications. We aim to determine the impact of CR on 6-month adherence to CV pharmacotherapy. Methods: We conducted a prospective observational cohort study of patients hospitalized for acute coronary syndromes (ACS) in Quebec, Canada, during 2016-2018. The primary endpoint was 6-month adherence to all of these drugs (dual anti-platelets, beta-blockers, hypocholesterolemiants, angiotensin pathway inhibitors). The secondary endpoints were adherence to each individual class of CV medication. Adherence was determined by measuring the proportion of days covered (PDC) (evaluated by pharmacies refills). PDC was measured both as continuous and categorical variables. Suboptimal adherence was defined as PDC&lt; 80%. We used inverse probability weighting to adjust for various factors which may have influenced the referral for CR and confounded the impact of CR on 6-month adherence (age, sex, coronary angioplasty, marital status, education, and occupation). All patients signed informed consent. Results: We enrolled 318 patients. Their mean age was 66±12 years; 30% were females. Of these patients, 152 undertook CR and 166 received standard follow-up. The mean age was 68 and 64 years, respectively. The proportions of females were similar in both groups. Overall PDC were 96%±13% vs 93%±17%; 7.2% and 11.2% patients had 6-month suboptimal adherence, respectively in patients who had CR vs patients without CR. After inverse weighting adjustment, CR was independently associated with improved adherence only with hypocholesterolemiants (Table 1). Conclusion: CR was not associated with improved 6-month overall adherence. However, patients who undertook CR were more adherent to hypocholesterolemiants than patients who did not undergo CR. CR programs should reinforce further to patients the importance of adherence to all ACS medications.

Sedentary behaviour in cardiovascular disease patients: Risk group identification and the impact of cardiac rehabilitation

BackgroundSedentary behaviour (SB) is potentially an important target to improve cardiovascular health. This study 1) compared SB between cardiovascular disease (CVD) patients and age-matched controls, 2) identified characteristics associated with high SB levels, and 3) determined the impact of contemporary cardiac rehabilitation (CR) on SB. MethodsFor objective 1, we recruited 131 CVD patients and 117 controls. All participants were asked about their general characteristics and medical history. SB was assessed by an objective accelerometer (activPAL3 micro). For objective 2, 2584 CVD patients were asked to fill in a questionnaire about their general characteristics, lifestyle, medical history and their SB. For objective 3, 131 CVD patients were followed over time and measured, pre-, directly post- and 2 months post-CR. ResultsObjective 1. CVD patients spent 10.4 h/day (Q25 9.5; Q75 11.2) sedentary which was higher compared to healthy controls (9.4 h/day [Q25 8.4; Q75 10.29]). Objective 2. CVD patients being male, single or divorced, employed, physically inactive, reporting high alcohol consumption, living in an urban environment, having comorbidities and cardiac anxiety demonstrated a greater odds for large amounts of SB. Objective 3. The CR program significantly reduced sedentary time (−0.4 h/day [95%CI -0.7; −0.1]), which remained lower at 2-months post-CR (−0.3 h/day [95%CI -0.6; −0.03]). ConclusionsCVD patients had greater amounts of objectively measured sedentary time compared to healthy controls. Sedentarism was associated with personal- and lifestyle characteristics, and comorbidities. Participation in a contemporary CR program slightly reduced sedentary time, but tailored interventions are needed to target SB in CVD patients.

Sedentary behaviour in cardiovascular disease patients: risk factor identification and the impact of cardiac rehabilitation

Abstract Background Cardiovascular disease (CVD) patients typically report low physical activity levels. Therefore sedentary behaviour (SB) is potentially an important target to improve survival and to reduce recurrence risk. However, information about SB in CVD patients is scarce. Purpose In this study, we 1) compared SB between CVD patients and age-matched controls, 2) identified patient- and disease characteristics associated with high SB levels, and 3) determined the impact of contemporary cardiac rehabilitation on SB. Methods For objective 1, we recruited 131 patients and 117 healthy, age-matched individuals. All participants were asked about their general characteristics and medical history. SB was assessed objectively by an accelerometer. For objective 2, 2,584 patients completed a questionnaire about their general characteristics, lifestyle, medical history and their SB. For objective 3, SB was examined before, after and 2 months after cardiac rehabilitation among 131 patients using an accelerometer. Results Objective 1. Patients spent 10.4 hrs/day (Q25 9.5; Q75 11.2) sedentary which was higher compared to healthy controls (9.4 hrs/day [Q25 8.4; Q75 10.29]). Similarly, patients reported more prolonged sedentary bouts (&amp;gt;30 min) compared to controls (5.9 versus 4.8 bouts/day; P&amp;lt;0.001). Objective 2. Patients being male, single or divorced, employed, physically inactive, reporting high alcohol consumption, living in an urban environment, having comorbidities and cardiac anxiety demonstrated a greater odds for large amounts of sedentary time (&amp;gt;8 hrs/day). Objective 3. Cardiac rehabilitation significantly reduced sedentary time (−0.4 hrs/day [95% CI: −0.7; −0.1]), which remained lower at 2 months after cardiac rehabilitation (−0.3 hrs/day [95% CI: −0.6; −0.03]). In addition, prolonged sedentary bouts decreased significantly after cardiac rehabilitation (−0.4 bouts/day [95% CI: −0.7; −0.1]), but this effect diminished within 2 months after the programme (−0.2 bouts/day [95% CI: −0.5; 0.1]). Conclusions CVD patients had greater amounts of objectively measured sedentary time compared to healthy controls, with more frequent engagement in prolonged sedentary bouts. Sedentarism was associated with personal- and lifestyle characteristics, and comorbidities. Participation in a contemporary cardiac rehabilitation programme slightly reduced sedentary time, but tailored interventions are needed to target the high amount of sedentary time in CVD patients. Funding Acknowledgement Type of funding source: Foundation. Main funding source(s): Dutch Heart Foundation

Impact of cardiac rehabilitation on 3 year outcomes amongst patients after acute coronary syndrome: (ACS) SNAPSHOT ACS follow-up study

Abstract Background Cardiovascular disease is the leading cause of disease burden globally. With advancements in medical and surgical care more people are surviving initial acute coronary syndrome (ACS) and are in need of secondary prevention and cardiac rehabilitation (CR). Increasing availability of high quality individual-level data linkage provides robust estimates of outcomes long-term. Purpose To compare 3 year outcomes amongst ACS survivors who did and did not participate in Australian CR programs. Methods SNAPSHOT ACS follow-up study included 1806 patients admitted to 232 hospitals who were followed-up by data linkage (cross-jurisdictional morbidity, national death index, Pharmaceutical Benefit Schedule) at 6 and 36 months to compare those who did/not attend CR. Results In total, the cohort had a mean age of 65.8 (13.4) years, 60% were male, only 25% (461/1806) attended CR. During index admission, attendees were more likely to have had PCI (39% v 14%, p&amp;lt;0.001), CABG (11% v 2%, p&amp;lt;0.001) and a diagnosis of STEMI (21% v 5%, p&amp;lt;0.001) than those who did not attend. However, there was no significant difference between CR attendees/non-attendees for risk factors (LDL-cholesterol, smoking, obesity). Only 19% of eligible women attended CR compared to 30% of men (p&amp;lt;0.001). At 36 months, there were fewer deaths amongst CR attendees (19/461, 4.1%) than non-attendees (116/1345, 8.6%) (p=0.001). CR attendees were more likely to have repeat ACS, PCI, CABG at both 6 and 36 months (Table). At 36 months, CR attendees were more likely to have been prescribed antiplatelets (78% v 53%, p&amp;lt;0.001), statins (91% 73%, p&amp;lt;0.001), beta-blockers (11% v 13%, p=0.002) and ACEI/ARBs (72% v 61%, p&amp;lt;0.001) than non-attendees. Conclusions Amongst Australian ACS survivors, participation in CR was associated with less likelihood of death and increased prescription of pharmacotherapy. However, attendance at CR was associated with higher rates of repeat ACS and revascularisation. Funding Acknowledgement Type of funding source: Foundation. Main funding source(s): New South Wales Cardiovascular Research Network, National Heart Foundation

The Impact of Cardiac Rehabilitation on CVD Risk Factors in Diabetic Patients

Presentation given at the 21th Annual Phi Kappa Phi Student Research and Fine Arts Conference

Impact of cardiac rehabilitation on patients with heart failure with preserved ejection fraction

Impact of cardiac rehabilitation on patients with heart failure with preserved ejection fraction

The prevalence and impact of depression and anxiety in cardiac rehabilitation: A longitudinal cohort study.

Co-morbid depression and anxiety symptoms are frequently under-recognised and under-treated in heart disease and this negatively impacts self-management. The purpose of this study was to determine the prevalence, correlates and predictors of depression and anxiety in cardiac rehabilitation programmes, the impact of cardiac rehabilitation on moderate depression, anxiety and stress symptoms, and the relationship between moderate depression, anxiety and stress symptoms and cardiac rehabilitation adherence. This was a retrospective cohort study of 5908 patients entering cardiac rehabilitation programmes from 2006-2017, across two Sydney metropolitan teaching hospitals. Variables included demographics, diagnoses, cardiovascular risk factors, medication use, participation rates, health status (Medical Outcomes Study Short Form-36) and psychological health (Depression Anxiety Stress Scales) subscale scores. Moderate depression, anxiety or stress symptoms were prevalent in 18%, 28% and 13% of adults entering cardiac rehabilitation programmes, respectively. Adults with moderate depression (24% vs 13%), anxiety (32% vs 23%) or stress (18% vs 10%) symptoms were significantly less likely to adhere to cardiac rehabilitation compared with those with normal-mild symptoms (p < 0.001). Anxiety (odds ratio 4.395, 95% confidence interval 3.363-5.744, p < 0.001) and stress (odds ratio 4.527, 95% confidence interval 3.315-6.181, p < 0.001) were the strongest predictors of depression. Depression (odds ratio 3.167, 95% confidence interval 2.411-4.161) and stress (odds ratio 5.577, 95% confidence interval 4.006-7.765, p < 0.001) increased the risk of anxiety on entry by more than three times, above socio-demographic factors, cardiovascular risk factors, diagnoses and quality of life. Monitoring depression and anxiety symptoms on entry and during cardiac rehabilitation can assist to improve adherence and may identify the need for additional psychological health support. Exploring the relevance and use of adjunct psychological support strategies within cardiac rehabilitation programmes is warranted.

P632Long-term benefits of cardiac rehabilitation in patients with diabetes mellitus after percutaneous coronary intervention

Abstract Introduction After percutaneous coronary intervention (PCI), patients with diabetes have a worse prognosis than non-diabetics and are at increased risk of recurrent cardiovascular events, hospitalization and higher mortality. Purpose The aim of our study was to evaluate the impact of cardiac rehabilitation (CR) in this high-risk group of patients. Methods We performed a retrospective cohort study of 318 consecutive patients with type 2 diabetes mellitus (DM2) who underwent PCI in our hospital between 2004 and 2011. We classified the patients in two cohorts according to their participation (n=154) or not (n=164) in a CR programme. We collected the events ocurring during a median follow-up of 9 years. Results Using multivariate logistic regression, we found that CR participation was associated with significantly reduced all-cause mortality (53% vs 23%, OR 2.10; IC 95%; 1.16–3.82; p 0.014) and cardiac mortality (3.9% vs 23.8%, OR 8.69; IC95% 2.80–26.99; p&lt;0.0005). CR aslo associated with a singnificant decrease in a heart failure hospitalization (26.6% vs 10.6%, OR 2.4; IC 95% 1.06–5.52; p&lt;0.035). No significant differences were observed in non fatal myocardial infarction, stent restenosis and non fatal stroke. Basal characteristics Rehabilitation (n=153) No Rehabilitation (n=164) P vaule Male sex 138 (86.4%) 100 (61.0%) &lt;0.0005 Age (years) 59 (38–74) 65 (47–74) &lt;0.0005 Hypertension 113 (73.9%) 111 (67.7%) NS Hypercholesterolemia 112 (73.7%) 115 (70.1%) NS HbA1c ≥7% 88 (66.2%) 73 (64.6%) NS Prior myocardial infarction 24 (15.6%) 32 (19.5%) NS Chronic kidney disease 6 (3.9%) 19 (11.6%) 0.012 FEVI &lt;50% 30 (20%) 39 (25%) NS Three vessel disease 53 (34.4%) 58 (35.4%) NS Incomplete revascularization 80 (51.9%) 81 (49.4%) NS Drug-eluting stent 110 (78.6%) 127 (80.4%) NS Stent length 22.4±11.9 24.6±14.8 NS Stent diameter 2.7±0.3 2.8±0.4 NS Conclusion CR participation after PCI is associated with lower all-cause mortality, cardiac mortality and heart failure hospitalization rates in patients with DM2 during long-term follow-up.

P2515Cardiac rehabilitation in patients with refractory angina: preliminary results

Abstract Introduction Refractory angina (RA) implies important impairment of quality of life. Cardiac rehabilitation (CR) is still not recommended by guidelines due to few evidence regarding its effects in this population. This study evaluated the impact of CR on physical performance and on angina/ischemia threshold. Methods 36 RA patients undergoing optimal medical therapy were randomly assigned to a 12-week exercise based CR program or stablished clinical follow-up (CF). Clinical evaluation, exercise bicycle stress echocardiography (SE) and cardiopulmonary exercise testing (CP) were performed before and after the protocol. CR group performed in-hospital exercise sessions, and the aerobic training prescription was based on CP parameters or ischemia/ angina threshold. Each CR class was 60 min in duration (5min warm-up, 30min aerobic and 5min cooldown, 15min low load resistance training and 5min stretching). Bonferroni multiple comparison and t test were used in statistical analysis. Results Baseline characteristics didn't differ between groups. In RC group, 40% presented CCS 2, 25% CCS 3 and 35% CCS 4, while in CF group, 41%, 23.5% and 35.5%, respectively (p=0.5). There was no change in CCS between groups after intervention. CR group presented an increase in ischemic threshold in SE when compared to CF group (234.6±87.9s to 293.8±130.9 s vs. 200.9±78.6s to 203.7±93.7s, p=0.044), increase in angina threshold in SE (156.00±62.2s to 260.1±152.8s vs. 190.6±96.6s to 152.9±76, 7s, p=0.041) and increase in CP total duration (347.9±143.2s to 489.8±170.2s vs. 331.7±128.5s to 323.5±101.0s, p=0,016). Baseline characteristics in both groups Variables CR group (n=19) CF group (n=17) p Male sex (%) 63.2 58.8 0.8 Age, years (mean ± SD) 61.2±8.7 62.9±8.8 0.6 LVEF, % (mean ± SD) 55.7±7.3 50.0±10.4 0.08 SBP, mmHg (mean ± SD) 125.6±18.0 122.6±14.5 0.6 DBP, mmHg (mean ± SD) 77.5±9.6 76.2±13,1 0.7 HR, bpm (mean ± SD) 60.5±6.2 60.6±7.1 0.9 BMI, kg/m2 (mean ± SD) 28.8±4.1 26.1±10.9 0.4 Fasting glucose, mg/dl (mean ± SD) 136.4±33.6 153.6±64.7 0.3 HBA1C, % (mean ± SD) 6.8±1.2 7.2±1.6 0.4 LDL-c, mg/dl (mean ± SD) 77.8±29.0 84.7±28.6 0.5 Results CR seems to be an effective adjuvant treatment in RA, increasing ischemia and angina threshold, improving physical performance. Acknowledgement/Funding FAPESP