Outpatient Cardiac Rehabilitation Program Research Articles

Impact of cardiac rehabilitation on ventricular-arterial coupling and left ventricular function in patients with acute myocardial infarction.

To maintain efficient myocardial function, optimal coordination between ventricular contraction and the arterial system is required. Exercise-based cardiac rehabilitation (CR) has been demonstrated to improve left ventricular (LV) function. This study aimed to investigate the impact of CR on ventricular-arterial coupling (VAC) and its components, as well as their associations with changes in LV function in patients with acute myocardial infarction (AMI) and preserved or mildly reduced ejection fraction (EF). Effective arterial elastance (EA) and index (EAI) were calculated from the stroke volume and brachial systolic blood pressure. Effective LV end-systolic elastance (ELV) and index (ELVI) were obtained using the single-beat method. The characteristic impedance (Zc) of the aortic root was calculated after Fourier transformation of both aortic pressure and flow waveforms. Pulse wave separation analysis was performed to obtain the reflection magnitude (RM). An exercise-based, outpatient cardiac rehabilitation (CR) program was administered for up to 6 months. Twenty-nine patients were studied. However, eight patients declined to participate in the CR program and were subsequently classified as the non-CR group. At baseline, E' velocity showed significant associations with EAI (beta -0.393; P = 0.027) and VAC (beta -0.375; P = 0.037). There were also significant associations of LV global longitudinal strain (LV GLS) with EAI (beta 0.467; P = 0.011). Follow-up studies after a minimum of 6 months demonstrated a significant increase in E' velocity (P = 0.035), improved EF (P = 0.010), and LV GLS (P = 0.001), and a decreased EAI (P = 0.025) only in the CR group. Changes in E' velocity were significantly associated with changes in EAI (beta -0.424; P = 0.033). Increased aortic afterload and VA mismatch were associated with a negative impact on both LV diastolic and systolic function. The outpatient CR program effectively decreased aortic afterload and improved LV diastolic and systolic dysfunction in patients with AMI and preserved or mildly reduced EF.

Effect of outpatient cardiac rehabilitation on motor function and health-related quality of life in stroke survivors

BackgroundOutpatient cardiac rehabilitation (CR) is a promising tool for improving functional outcome in stroke survivors, however, evidence for improving emotional health is limited. We aimed to clarify the effects of outpatient CR following in-hospital stroke rehabilitation on health-related quality of life (HRQOL) and motor function. MethodsPatients with acute ischemic stroke or transient ischemic attack discharged directly home were recruited, and 128 patients who fulfilled criteria for insurance coverage of CR were divided into the CR (+) group (n = 46) and CR (-) group (n = 82). All patients underwent in-hospital stroke rehabilitation, and within 2 months after stroke onset, patients in the CR (+) group started a 3-month outpatient CR program of supervised sessions. Changes of motor function and HRQOL assessed by the short form-36 version 2 (SF-36) from discharge to 3 months post-discharge were compared between the two groups. ResultsTwenty-six patients in the CR (+) group completed the program and 66 patients in the CR (-) group were followed up at a 3-month examination. Least-square mean changes in 6-minute walk distance and isometric knee extension muscle strength were significantly higher in the CR (+) group than the CR (-) group (52.6 vs. 16.3 m; 10.1 vs. 3.50 kgf/kg). Improvement of HRQOL at 3 months was not observed in the CR (+) group. ConclusionsOutpatient CR following in-hospital stroke rehabilitation within 2 months after stroke onset improved exercise tolerance and functional strength but not HRQOL assessed by the SF-36 after completion of CR in the present cohort.

Characteristics and Outcomes of Cardiac Rehabilitation Patients With and Without Cancer: Insights From Western Sydney

Increased cardiovascular events are common in cancer survivors and contribute to an emerging cardio-oncology patient group requiring secondary prevention strategies including cardiac rehabilitation (CR). This study aimed to compare characteristics and outcomes for patients participating in CR with and without an existing cancer diagnosis. Observational cohort study including consecutive patients enrolled in a single-centre outpatient CR program in Western Sydney between 2018-2022. Clinical history, demographics and CR outcome data were collected as part of standard care at program enrolment and completion. Patients with and without a cancer diagnosis were compared at enrolment and outcomes were analysed in both groups. A total of 1,792 patients enrolled in CR, 191 (11%) had a documented history of cancer; prostate (18%), skin (12%), colon (9%) and breast (8%) malignancies were most prevalent. The most common treatments were surgical resection (80%) and chemotherapy or radiotherapy (37%). Cardio-oncology patients were older (68.8±10.6 vs 59.8±13.7yrs, p<0.001), more likely female (33% vs 21%, p<0.001), born in Australia (46% vs 35%, p=0.004), non-partnered (34% vs 25%, p=0.002) and had a prior history of hypertension (65% vs 56%, p=0.010) or stroke (8% vs 5%, p=0.045). After adjusting for age and sex, the overall cohort improved their mean peak exercise capacity and waist circumference after CR, however there were no differences between groups. There were also no between-group differences for adherence and completion of CR program or any other cardiovascular risk factors. Sub-analyses revealed a clinically meaningful improvement in waist circumference for cancer patients with a history of radiation therapy and a blunted peak exercise capacity adaptation for those with a history of chemotherapy treatment. Despite differences in demographic and clinical characteristics of CR patients with and without cancer, all patients showed significant and clinically relevant improvements in peak exercise capacity and waist circumference after CR. Results also highlighted potential associations between specific cancer treatments and changes in fitness outcomes, which warrants further evaluation.

Employment outcome among cardiac patients following phase two intensive outpatient cardiac rehabilitation program in Sarawak Heart Centre

Employment outcome among cardiac patients following phase two intensive outpatient cardiac rehabilitation program in Sarawak Heart Centre

ASSOCIATION OF ARTERIAL STIFFNESS WITH LEFT VENTRICULAR FUNCTION AND THE IMPACT OF CARDIAC REHABILITATION IN PATIENTS WITH ACUTE MYOCARDIAL INFARCTION

Objective: Arterial stiffness has an important role in the pathophysiology of coronary artery disease and heart failure. The association of arterial stiffness with left ventricular (LV) function and the impact of cardiac rehabilitation in patients with acute myocardial infarction (AMI) were investigated in this study. Design and method: Echocardiographic indexes of LV volumes, systolic function, and diastolic function were measured in the usual way. Effective arterial elastance (EA) and index (EAI) was calculated from stroke volume measured using LV outflow waveform. The exercise-based, outpatient cardiac rehabilitation (CR) program, which was composed of 8 to 12 visits during 4 weeks to 6 months, was provided, and the follow-up (F/U) echocardiographic study was done after 6 months. Results: Twenty-nine patients (age 58.7+/-10.2 years) with AMI were enrolled, but 8 patients denied CR program. At baseline, EAI was significantly associated with E’ (beta -0.379, P = 0.035) and LV global longitudinal strain (GLS) (beta 0.458, P = 0.014). F/U echocardiographic data showed decreased EAI (from 0.95+/-0.24 to 0.85+/-0.28 mmHg/ml/m2, P = 0.039), increased E’ (from 6.34+/-2.34 to 7.40+/-2.86 cm/sec, P = 0.032), and improved LV GLS (from -13.7+/-2.8 to -16.6+/-3.0%, P &lt;0.001) in patients with CR program, but not in patients without CR program. Changes of EAI was significantly associated with changes of E’ (beta -0.396, P = 0.048). Conclusions: Arterial stiffness was associated with LV dysfunction in AMI patients. The CR improved the arterial stiffness and LV dysfunction.

Psychosocial services provided by licensed cardiac rehabilitation programs.

Professional health organizations recommend that outpatient cardiac rehabilitation programs include activities to optimize the physical, mental, and social well-being of patients. The study objectives were to describe among cardiac rehabilitation programs (1) mental health assessments performed; (2) psychosocial services offered; and (3) leadership's perception of barriers to psychosocial services offerings. A cross-sectional survey of North Carolina licensed outpatient cardiac rehabilitation programs on their 2018 services was conducted. Descriptive statistics were used to summarize survey responses. Thematic analysis of free text questions related to barriers to programmatic establishment or expansion of psychosocial services was performed by two team members until consensus was reached. Sixty-eight programs (89%) responded to the survey. Forty-eight programs (70%) indicated offering psychosocial services; however, a majority (73%) of programs reported not directly billing for those services. At program enrollment, mental health was assessed in 94% of programs of which 92% repeated the assessment at discharge. Depression was assessed with the 9-item Patient Health Questionnaire by a majority (75%) of programs. Psychosocial services included individual counseling (59%), counseling referrals (49%), and educational classes (29%). Directors reported lack of internal resources (92%) and patient beliefs (45%) as the top barriers to including or expanding psychosocial services at their facilities. Cardiac rehabilitation programs routinely assess mental health but lack the resources to establish or expand psychosocial services. Interventions aimed at improving patient education and reducing stigma of mental health are important public health opportunities.

Barriers to Establishing Outpatient Cardiac Rehabilitation in the Western Region of Saudi Arabia: A Cross-Sectional Study.

The core of cardiac rehabilitation (CR) is structured exercise training. CR reduces 28-56% hospital readmission rate, and around 25% increases cardiorespiratory fitness but the number of outpatients CR centers in Saudi Arabia (SA) is very limited and there is a need to establish outpatient CR (Phase III) in SA. Furthermore, the awareness of outpatient CR in SA is unknown. To determine the main barriers to establishing an outpatient CR program (Phase III) in the western region of SA, as well as assess the awareness of outpatient CR (Phase III) in the western region of SA. A cross-sectional study survey was conducted between March - July 2021 among physiotherapists, cardiologists and the cardiac surgeon using a questionnaire distributed electronically to determine the awareness level of outpatient CR and barriers to establishing outpatient CR (Phase III) in the western region of SA. Frequencies and percentages were used to report the variables. Of the 141 participants who completed the online survey, our findings showed that 131 (93%) were aware of CR but only 29 (21%) were aware of the four phases of CR. There were three main barriers to establishing CR: lack of appropriate CR 135 (96%); lack of awareness among healthcare professions of CR and its benefits 134 (95%) and the lack of healthcare providers trained in CR 133 (94%). There was a significant relationship between physiotherapists and cardiologists' responses on agreeing to all barriers to establishing CR in SA (r=0.69, P =0.03). To overcome the barriers to establishing CR outpatient centers in the western region of SA, it is recommended to provide more CR outpatient training programs to healthcare providers and raise the awareness of the CR phases, its benefits, and the risk factors for developing cardiac diseases among healthcare providers.

PS-BPC02-4: RELATIONSHIP BETWEEN EXERCISE CAPACITY AND CHANGES OF PULSE WAVE VELOCITY AFTER CARDIAC REHABILITATION IN PATIENTS WITH ACUTE MYOCARDIAL INFARCTION

Objective: Guidelines strongly recommend exercise-based cardiac rehabilitation (CR) to reduce cardiovascular mortality in patients with acute myocardial infarction (AMI). Reduction of central aortic systolic pressure, augmentation index, and pulse wave velocity (PWV) after aerobic exercise may be associated with better clinical outcomes after CR. However, the change of pulse wave velocity after CR in patients with AMI has been rarely investigated. Design and Method: Sixty-five patients (age 55.3 ± 10.1 years, 63 men) with AMI who completed the 6-month CR and evaluation program were included in this study. Maximal oxygen uptake (VO2max) during cardiopulmonary exercise (CPX) testing and brachial-ankle PWV (baPWV) were measured before exercise program and after 6 months. Based on the results of baseline CPX testing, each exercise program which included target metabolic equivalent, target heart rate, and exercise duration, was prescribed. Patients were recommended to attend the outpatient CR program which composed of 8 to 12 visits during 4 to 6 weeks. Self-exercise program was educated for each patient who finished or denied the outpatient CR program. Results: After 6 months, VO2max was increased from 28.9 ± 5.79 to 31.7 ± 6.5 mL/kg/min (p &lt; 0.001) and baPWV was decreased from 14.68 ± 2.66 to 13.54 ± 2.92 m/sec (p &lt; 0.001). Changes of baPWV (Delta-baPWV) showed a significant negative correlation with 6-month VO2max (r = -0.339, p = 0.006). Patient were divided into group 1 (n = 32, Delta-baPWV &lt;-1.13 m/sec) and group 2 (n = 33, Delta-baPWV &gt; = -1.13 m/sec). Group 1 showed higher 6-month VO2max (33.5 ± 6.7 vs. 29.9 ± 5.9 mL/kg/min; p = 0.023). On logistic regression analysis, 6-month VO2max was a significant determining factor for Delta-baPWV (OR 1.159, 95% CI 1.030–1.305, p = 0.014) after adjustment of age, sex, height and baseline baPWV. Conclusions: Patients with better exercise capacity after CR program showed more decreased PWV.

S-48-1: EXERCISE TRAINING CONSIDERING THE CHARACTERISTICS OF SARCOPENIA AND FRAILTY

As Japan's population ages, the number of people with cardiovascular disease is also aging, and the frequency of frailty is increasing. Hypertension is another frequent finding in older patients. Hypertension in older patients is associated with frailty, and hypertension can be a risk factor for frailty. Studies have shown that frailty correlates with systolic blood pressure and that frailty is strongly associated with white matter lesions on brain MRI in hypertensive older patients. Thus, flail prevention is extremely important because of the potential impact of hypertension on the development of organ damage. Hypertension is also recognized as a major risk factor for cardiovascular diseases such as heart failure, atrial fibrillation, and stroke, and the development of these diseases can cause a decline in health status and/or exacerbate the degree of frailty. As people age, more people also experience blood pressure drops on standing (orthostatic hypotension), particularly as they become frail. This increases the likelihood of falls. Hypertension in older patients is also associated with sarcopenia. We, the Juntendo University Cardiac Rehabilitation Team, provide exercise training for older patients with cardiovascular disease based on the characteristics of frailty and sarcopenia. Specifically, we conduct regular frailty assessments, and in addition to aerobic exercise, we have a program that specifically focuses on improving muscle strength, muscle power, and slowness. In addition, older cardiac patients with frailty and sarcopenia may have difficulty participating in outpatient cardiac rehabilitation program due to their own low physical fitness and low physical function, distance to the hospital, and lack of caregivers who can accompany them. To overcome the extremely low participation rate in outpatient cardiac rehabilitation program in Japan, the feasibility studies of tele-cardiac rehabilitation with real-time communication are also being conducted.

Association of Perceived Health Competence With Cardiac Rehabilitation Initiation.

Cardiac rehabilitation (CR), a program of supervised exercise and cardiovascular risk management, is widely underutilized. Psychological factors such as perceived health competence, or belief in one's ability to achieve health-related goals, may play a role in CR initiation. The aim of this study was to evaluate the association of perceived health competence with CR initiation among patients hospitalized for acute coronary syndrome (ACS) after adjusting for demographic, clinical, and psychosocial characteristics. The Vanderbilt Inpatient Cohort Study (VICS) characterized the effect of psychosocial characteristics on post-discharge outcomes in ACS inpatients hospitalized from 2011 to 2015. The primary outcome for this analysis was participation in an outpatient CR program. The primary predictor was the two-item Perceived Health Competence Scale (PHCS-2), which yields a score from 2 to 10 (higher scores indicate greater perceived health competence). Multiple logistic regression was used to evaluate the relationship between the PHCS-2 and CR initiation. A total of 1809 VICS participants (median age: 61 yr, 39% female) with ACS were studied, of whom 294 (16%) initiated CR. The PHCS-2 was associated with a higher odds of CR initiation (OR = 1.15/point increase: 95% CI, 1.06-1.26, P = .001) after adjusting for covariates. Participants with comorbid heart failure had a lower odds of CR initiation (OR = 0.31: 95% CI, 0.16-0.60, P < .001) as did current smokers (OR = 0.64: 95% CI, 0.43-0.96, P = .030). Perceived health competence is associated with outpatient CR initiation in patients hospitalized with ACS. Interventions designed to support perceived health competence may be useful for improving CR participation.

Exploring Social Support for Women Coping with a Cardiac Rehabilitation Programme after Acute Coronary Syndrome: A Systematic Review of Qualitative Studies.

ObjectiveFemale sex is a major barrier to completing a programme of cardiac rehabilitation (CR) after acute coronary syndrome (ACS). Women require significant social support to promote compliance and the ability to cope with CR programme attendance. The aim of this systematic review of qualitative studies was to explore social support among women coping with CR programme attendance at phase II CRP is 3 months after their cardiac event.MethodsArticles were searched through CINAHL (Cumulative Index and Allied Health Literature), Science Direct and PubMed databases using the following terms: “women”, “acute coronary syndrome”, “coping”, “social support” and “cardiac rehabilitation”.ResultsA total of 6 articles were selected based on eligibility criteria. Thematic analysis was used to analyse the data using line to line coding into descriptive themes, interpreting further to generate new insights. The 3 most common themes regarding social support for women attending the CR programme were: family support, female as the primary caregiver in the family, and peer support. For most women who perceived themselves as the primary caregiver in the family there was a negative impact on their ability to cope fully with CR programme attendance. On the other hand, encouraging support from family and peers positively improved their coping mechanism for attending the CR programme, leading to improved compliance.ConclusionWomen with ACS consider that support from their family plays a vital role as a coping mechanism in their attendance at a CR programme. Healthcare providers should teach the importance of social support among women after discharge to help them cope with CR programme attendance.LAY ABSTRACTWomen face a major obstacle to coping with a programme of cardiac rehabilitation (CR) after a cardiac event. In order to promote attendance at a CR programme, women often require significant social support to ensure compliance with the programme. This review evaluated the results of 6 studies that explored women’s experiences and their coping process in attending an outpatient CR programme after a cardiac event. The review found that family support, being female as the primary caregiver in the family, and peer support are the main social supports for compliance with an outpatient CR programme. Women who were extensively involved as the primary caregiver in their families had difficulty complying with attendance at the outpatient CR programme. On the other hand, women with good support from family and peers had better compliance. Therefore, healthcare providers should initiate strategies for promoting good social support among women on an outpatient CR programme in order to enhance compliance with attendance.

Is Physical Activity an Effective Factor for Modulating Pressure Pain Threshold and Pain Tolerance after Cardiovascular Incidents?

The purpose of this study was to investigate whether regular physical activity can alter the pressure pain threshold, pain tolerance, and subjective pain perception in individuals who have experienced a cardiovascular event. The study involved 85 individuals aged 37 to 84 years (M = 65.36) who qualified for outpatient cardiac rehabilitation, which consisted of 24 physical training sessions. The patients were all tested twice: on the first and last day of the outpatient cardiac rehabilitation program. Assessments of the pressure pain threshold and pain tolerance were performed with an algometer. To assess the pain coping strategies, the Pain Coping Strategies Questionnaire (CSQ) and parenting styles were measured retrospectively with subjective survey questions. The main results of the study showed that patients achieved significantly higher pressure pain thresholds after a physical training cycle (ps < 0.05, η2 = 0.05–0.14), but found no differences in the pain tolerance (ps > 0.05). A lower preference for the better pain coping strategy explanation (ß = −0.42, p = 0.013) and growing up in a family with a less neglectful atmosphere (ß = −0.35, p = 0.008) were associated with increased pressure pain threshold after physical training. The results suggest that physical activity is an important factor in modulating the pressure pain threshold.

Support Life Club: A New Model Based on Social Media Group Chats and Social Activities That Can Improve Adherence and Clinical Outcomes in Patients Receiving Cardiac Rehabilitation.

AimTo describe a new model, the Support Life Club (SLC), for participants of Phase II cardiac rehabilitation (CR) programs and to evaluate this model for adherence, completion rates, and clinical outcomes.MethodsThis retrospective study involved 391 consecutive patients who participated in an outpatient CR program between September 2016 and May 2020. The intervention group (SLC) was comprised of 198 patients who participated in education, WeChat-based group activity as well as outdoor activities, while the control group (non-intervention) was comprised of 193 cases. All patients attended a 12-week supervised outpatient CR program (three sessions per week, each lasting 40min). The intervention and control groups were compared for completion rates, Cardiopulmonary Exercise Test (CPET) results, Six-minute Walk Test (6MWT) distances, and Patient Health Questionnaire-9 (PHQ-9) scores.ResultsPatients in the intervention group attended at least 75% of the exercise training sessions more often than those in the control group (72.5% vs 40.41%, adjusted odds ratio (OR): 27.385; 95% CI: 10.2 to 73.6; P = 0.0000). Analysis of variance (2 × 2 ANOVA) revealed a significant group-by-time interaction in PHQ9 and 6MWT test results (p = 0.000).ConclusionThe addition of SLC to a cardiac rehabilitation program resulted in better outcomes for PHQ9 and 6MWT tests and may be a useful strategy to improve exercise adherence.

Benefits of the First Pritikin Outpatient Intensive Cardiac Rehabilitation Program.

Intensive cardiac rehabilitation (ICR) is a comprehensive, medically supervised exercise treatment program covered by Medicare for patients with approved cardiac diagnoses. The aim of this study was to determine the benefits of the first Pritikin outpatient ICR program. This retrospective analysis included patients referred to ICR or traditional cardiac rehabilitation (CR) during the first 7 yr (2013-2019) at the first facility to implement Pritikin ICR. Intensive cardiac rehabilitation is composed of 36 education sessions on nutrition, exercise, and a healthy mindset, in addition to 36 monitored exercise sessions that comprise traditional CR. Assessments included anthropometrics (weight, body mass index, and waist circumference), dietary patterns, physical function (6-min walk test, [6MWT] Short Physical Performance Battery [SPPB: balance, 4-m walk, chair rise], handgrip strength), and health-related quality of life (Dartmouth COOP, 36-item Short Form Survey). Baseline and follow-up measures were compared within and between groups. A total of 1963 patients enrolled (1507 ICR, 456 CR, 66.1 ± 11.4 yr, 68% male, 82% overweight or obese); 1141 completed the program (58%). The ICR patients completed 22 exercise and 18 education sessions in 9.6 wk; CR patients completed 19 exercise sessions in 10.3 wk. ICR resulted in improvements ( P &lt; .001 pre vs post) in all anthropometric measures, dietary patterns, 6MWT distance, all SPPB components, grip strength, and health-related quality of life. The improvements in anthropometrics and dietary patterns were greater in ICR than in CR. The Pritikin outpatient ICR program promoted improvements in several cardiovascular health indices. Critical next steps are to assess long-term health outcomes after ICR, including cardiac events and mortality.

Abstract 250: Psychosocial Assessment And Services Provided By Licensed Cardiac Rehabilitation Programs

Background: Professional health organizations recommend that outpatient cardiac rehabilitation (CR) programs include activities to optimize the physical, mental, and social well-being of patients. How these guidelines are being put into practice is not well known so there is a critical need to describe the real-world implementation of psychosocial guidelines in CR programs. To meet this need, the study objectives were to describe 1) mental health assessments performed and 2) psychosocial services offered among CR programs. Methods: A cross-sectional survey of North Carolina licensed outpatient CR programs was conducted. The online survey was designed to obtain descriptive information on CR personnel, assessments completed, services offered, and the patient population that is served by each program in 2018. Descriptive statistics were used to summarize mental health assessments and other closed-question responses. Standardized differences were computed to detect an imbalance in characteristics between CR programs that did and did not provide psychosocial services. Thematic analysis of free text responses to psychosocial services offered was performed by 2 team members until consensus was reached. Results: Sixty-eight programs (89%) responded to the survey. Forty-eight programs (70%) indicated offering psychosocial services. At program enrollment, mental health was assessed in 94% of programs of which 92% repeated the assessment at discharge. Depression was assessed with the 9-item Patient Health Questionnaire by a majority (75%) of programs. Health-related quality of life (QoL) instruments were used by 60 (88%) programs. Health-related QoL was assessed at program enrollment and conclusion by 95% of programs that completed this type of assessment. Psychosocial services included individual counseling (59%), counseling referrals (49%), and educational classes (29%). Conclusions: Cardiac rehabilitation programs routinely screen for psychosocial distress, a known risk factor for heart disease. CR programs can identify patients at risk for mental health problems following an MI and be a resource for connection to appropriate services.

Home-Based Versus Outpatient-Based Cardiac Rehabilitation Post-Coronary Artery Bypass Graft Surgery: A Randomized Controlled Trial.

The prevalence of coronary heart disease continues to increase in the Kingdom of Saudi Arabia (KSA). Despite advances in cardiac surgery, there are no established outpatient cardiac rehabilitation programs in the KSA. The aim of this study was to investigate the effectiveness of home-based cardiac rehabilitation compared with outpatient-based cardiac rehabilitation and usual care for patients who are post-coronary artery bypass graft surgery. This 3-arm, single-blind, randomized controlled trial was carried out at the King Faisal Specialist Hospital, Riyadh, KSA. A total of 82 patients post-coronary artery bypass graft surgery were randomized and 73 patients completed the study. Recruited patients were distributed to home-based cardiac rehabilitation (n = 24), outpatient-based cardiac rehabilitation (n = 25), or usual care (control group) (n = 24). Participants in the intervention groups completed an individualized exercise program for 2 hours, 3 times a week for 8 weeks. The control group followed usual care (no intervention). The incremental shuttle walk test (ISWT), metabolic equivalence task, Short Form-36, and Hospital Anxiety and Depression Scale (HADS) were measured at baseline, postintervention, and after a 4-week follow-up period. Postintervention, there was an increase in mean ISWT score from baseline in both the home-based cardiac rehabilitation and outpatient-based cardiac rehabilitation groups (66 [0.58] m and 71 [9.19] m, respectively). No difference was observed in the control group. At the 4-week follow-up, both intervention groups showed statistically significant improvements in all outcome measures (ISWT, metabolic equivalence tasks, HADS-A, HADS-D, and Short Form-36) compared with baseline (all P < .001). The home-based cardiac rehabilitation group showed statistically continuous improvement compared with the outpatient-based cardiac rehabilitation group. The control group did not show any significant changes across time in outcome measures. Home-based cardiac rehabilitation is as effective as outpatient-based cardiac rehabilitation. Home-based cardiac rehabilitation appears to be more effective at maintaining improvements follow the end of the intervention.

Clinical Outcomes of Cardiac Rehabilitation in Women with Coronary Artery Disease-Differences in Comparison with Men.

This study evaluated the clinical outcomes of cardiac rehabilitation (CR) in women with coronary artery disease (CAD) in comparison to men. Methods: Patients after acute coronary syndrome or after revascularization procedures (106 women, 180 men) were consecutively admitted to a comprehensive outpatient CR program, comprising of 45-min ergometer interval training three times a week for eight weeks. The training intensity was determined on the basis of training heart rate, calculated following an exercise test. Patients were divided into subgroups according to age (≤55, >55 years), BMI (<25, ≥25 kg/m2), left ventricular ejection fraction (LVEF; ≤40%, 41–49%, ≥50%), and number of affected coronary vessels. Results: After eight weeks, exercise capacity increased significantly by 0.6 ± 0.77 MET (women) and by 1.0 ± 0.74 MET (men). The greatest benefit was observed in men, women under 55 years, women with LVEF 41–49%, and women with single-vessel CAD. An outpatient CR program appears less beneficial for women, especially those over 55 years, with two or three coronary vessels affected with atherosclerosis or with LVEF > 50%. In women with CAD, eight weeks of 45-min interval training, with sessions three times a week, is insufficient to improve exercise capacity to an extent that is considered a predictor of mortality risk reduction.

Outpatient Cardiac Rehabilitation Services, Participants and Workforce in North Carolina: Results of a 2019 Survey of Cardiac Rehabilitation Program Directors.

BACKGROUND Cardiac rehabilitation (CR) can improve quality of life and reduce subsequent hospitalizations for individuals with cardiovascular disease. Nevertheless, CR is underutilized, and less is known about the current content, patient population, and workforce of CR programs in North Carolina.OBJECTIVE To describe CR services, patient participation, and workforce in North Carolina in order to characterize CR infrastructure and identify opportunities to improve CR use.METHODS We distributed an electronic survey to all certified outpatient CR programs in North Carolina in spring 2019. Descriptive statistics were used to summarize program characteristics, participant characteristics, and current workforce. Data were analyzed overall and by region.RESULTS Responding programs (89.5% response rate, n=68) had been in operation for a mean of 24 (SD: 10.4) years. Programs have similar availability across the state, operating 4 days a week with 5 sessions per day. A majority of programs offered nutrition counseling (98.5%), stress management (94.1%), aerobic exercise (86.8%), and weight training (86.8%). Patients were majority male (65%), aged 65 or older (75%), and White (75%). Nearly half of patients referred to CR attended at least 1 session, though 25% discontinued early. Most programs were staffed by a median of 2 full-time nurses (97%) and by a median of 1.5 full-time exercise physiologists (96%). Mental health and administrative professionals were less frequent in CR settings.LIMITATIONS Since this survey was primarily completed by program directors, further research is needed to understand the challenges, experiences, and needs of the frontline CR workforce, as well as the direct experiences of patients who participate in CR.CONCLUSIONS CR programs in North Carolina offer a range of services. While half of patients referred to CR initiate services, interventions are needed to improve initiation and adherence to CR.

Abstract 13703: Outpatient Cardiac Rehabilitation Reduces Heart Failure Re-Hospitalization in Patient With Heart Failure With Reduced Ejection Fraction When Compared to Patients With Heart Failure With Preserved Ejection Fraction

Introduction: Cardiac rehabilitation has been increasingly recognized as an integral part in the management of patients with congestive heart failure. It has been shown to improve the quality of life in this patient population. However, It is unknown how much cardiac rehabilitation reduces heart failure hospitalizations in patients with heart failure with reduced ejection fraction (HFrEF) versus heart failure with preserved ejection fraction (HFpEF). Hypothesis: We hypothesize that outpatient cardiac rehabilitation is associated with reduced re-hospitalization for heart failure symptoms in patients with heart failure with HFrEF when compared with patients with HFpEF. Methods: We retrospectively analyzed data from 128 heart failure patients enrolled in an outpatient cardiac rehabilitation center from January 2015 to December 2020. The number of heart failure re-hospitalizations was measured in each of these patients. A Student t-test was used to analyze the difference between the two groups, while fisher’s test or chi square was used to analyze categorical variables. Results: Among the 128 patients enrolled in the outpatient cardiac rehabilitation center, age 68.1+-14 years, 63 (57.1%) were males. There were 70 patients (54.6%) in the HFrEF group and 58 (55.28%) in the HFpEF group. Hospitalization for acute exacerbation of heart failure symptoms was lower in the patients with HFrEF when compared with patients with HFpEF (41.3% vs 70.69% p value &lt;0.0009). Conclusion: Outpatient cardiac rehabilitation program is associated with reduced hospitalization for heart failure symptoms in patients with HFrEF when compared to patients with HFpEF.

Enrollment and Adherence to Early Outpatient and Maintenance Cardiac Rehabilitation Programs.

Early outpatient (ECR) and maintenance cardiac rehabilitation (MCR) programs are essential, evidence-based services that have received unequivocal endorsement by national and international professional organizations. However, the latest data characterizing ECR enrollment and adherence fell well short of what would be expected for a therapy that has accumulated decades of empirical evidence touting the associated physiologic, physical, psychosocial, and financial benefits. Although national participation levels have remained stagnant, a series of recent publications showcase effective strategies that could bolster both ECR enrollment and adherence levels at the institutional level. Unlike ECR, fewer reports on enrollment and adherence rates exist for MCR, partly due to the lack of standardization of this service. In this review, we aim to highlight current data on enrollment and adherence to ECR and MCR and discuss evidence-based programmatic strategies to support utilization of both services.