Participation In Cardiac Rehabilitation Programs Research Articles

Ethnic minorities who complete cardiac rehabilitation achieve equivalent functional capacity outcomes after cardiac rehabilitation but only half complete

Abstract Background Cardiac rehabilitation (CR) reduces the risk of death and repeat cardiac events and improves multiple patient outcomes. Ethnic minority backgrounds experience significant health disparities, often due to lack of fluency in dominant language and higher rates of cardiovascular disease risk factors. Despite these issues, outcomes for ethnic minorities from CR are rarely differentiated and participation in CR programs infrequently reported. Purpose To compare participation in and exercise outcomes from CR programs for patients from ethnic minorities versus the majority. Methods A secondary analysis from a national CR audit including 2335 CR participants. Ethnic minority was defined as having poor English language fluency requiring an interpreter for CR assessment. Functional capacity was assessed using 6-minute walk test (6MWT) or metabolic equivalent of tasks (METs). Binary logistic regression model was created to identify independent predictors of completion, accounting for baseline variables. Multiple linear regression models were used to determine if ethnic minority status was an independent predictor of change in 6MWT and METs after adjusting for baseline characteristics. Results Of the 2335 participants, 326 (14%) were from ethnic minorities. The mean age was 66.3±12.4 years and 70% males. There were no differences between minority and majority groups in relation to baseline characteristics. The most common referral diagnosis was myocardial infarction (27%), angina (25%), other – arrhythmias, cardiac devices, valve diseases/procedures (24%), and cardiac surgery (24%). Ethnic minorities were half as likely to complete CR (OR 0.49, 95% CI 0.38, 0.65) adjusted for age, sex, diagnosis, minority status, smoking, referral site and wait time (Table 1). Other factors that increase completion likelihood included all other cardiac diagnoses (compared to myocardial infarction as reference) and non-smokers, whereas major referral centre and female sex negatively impacted completion. Patients from ethnic minority backgrounds had less functional capacity at CR entry compared to the majority (379.9±118 versus 430.7±103 metres, p<0.001), though METs were comparable (6.69±2.73 versus 6.46±2.28 mg/kg/min, p=0.69). However, improvements were equivalent for 6MWT: minority 71.03±58.57 versus majority 71.37±61.16 (p=0.96), and for METs: minority 3.01±1.66 versus majority 3.13±1.74 mg/kg/min (p=0.77). Ethnic minority status was not an independent predictor of change in 6MWT and METs after accounting for age, sex, diagnosis, smoking, referral site, and wait time. Conclusion For patients from ethnic minority groups who completed CR, exercise/functional capacity outcomes were equivalent to majority participants, however less than one-in-two completed. CR programs should consider the needs of ethnic minority groups, particularly in relation to language and tailor content and delivery to promote participation and ensure more equitable access.

Association of sedentary behavior and physical activity with occurrence of signs and symptoms in participants of a cardiac rehabilitation program

Sedentary behavior (SB) is associated with health impairments, while physical activity (PA) has been a protective factor. It is unclear whether SB and PA are associated with occurrence of signs and/or symptoms (SS) during cardiac rehabilitation program (CRP) exercise sessions. The objective was to evaluate the association between SB and PA with occurrence of SS. Was included 48 patients from a CRP program (64.7 ± 10.4 years-old). Daily time and % of time of SB and weekly time in moderate-to-vigorous-intensity [MVPA], % of MVPA time, steps/day, and steps/minute were accelerometer-measured. Patients were followed-up during 24 CRP sessions, for accompaniment of SS. Age, sex, and comorbidities (hypertension, diabetes, dyslipidemia, obesity) were covariates. Log-transformed values of SB, MVPA and steps/day were also analyzed. As results, 43.7% (n = 21) of participants presented occurrence of signs, 62.5% (n = 30) presented occurrence of symptoms, and 81.2% (n = 39) present occurrence of SS. In fully adjusted model, % of time in MVPA (β: −0.449,p = 0.045) and steps/minute (β: −0.244,p = 0.026) were inversely associated with occurrence of symptoms. No association was observed between SB and PA and occurrence of signs. The occurrence of symptoms and SS among CRP participants was directly associated with SB and inversely associated with variables of PA.

Cardiac Rehabilitation in Geriatric Individuals

Background: The aim of the study is a current review in the field of cardiac rehabilitation in geriatric individuals. Methods: Literature searches were conducted using PubMed, Embase and Scopus. Additional articles were identifed by searching reference lists. Results: Aging is a physiological condition in the normal process of life and leads to changes in all organs and systems. The aging process significantly affects the cardiovascular, pulmonary, musculoskeletal, and metabolic systems. Cardiac rehabilitation provides numerous psychological and physiological benefits to older adults. All comorbidities, frailty status, and social and financial factors should be comprehensively evaluated while planning cardiac rehabilitation programs that consist of the main components of exercise training, risk factor management, and psychosocial counseling in older adults. Conclusions: Regular participation in cardiac rehabilitation programs can reduce morbidity and mortality rates and improve cardiorespiratory fitness and overall health outcomes by modifying coronary artery disease risk factors in older adults with chronic conditions, including cardiovascular disease, stroke, and respiratory disease

Digital health intervention in patients undergoing cardiac rehabilitation: systematic review and meta-analysis.

Cardiovascular disease (CVD) continues to be the foremost mortality internationally. Cardiac rehabilitation has proven as an effective program in reducing CVD burden. Participation in cardiac rehabilitation programs is very low. Digital health intervention emerged as an alternative method to deliver Cardiac rehabilitation. This review aimed to investigate the impact of digital health intervention on the outcomes of interest. the following databases: PubMed, CINAHL, Scopus, and Cochrane Library have been searched to retrieve randomized controlled trials that examine the impact of digital health intervention on blood pressure, body mass index, lipid profile, blood glucose, Six-Minute Walk Test, and peak oxygen consumption. filters were set to include studies published in English between 2000-2023. Nineteen studies were included in this review. Six-Minute Walk Test (MD = 16.70; 95% CI: 6.00 to 27.39, p = 0.000) and maximal oxygen consumption (SMD = 0.27; 95% CI: 0.08 to 0.45, p = 0.004) significantly improved following digital health intervention, after employing the sensitivity analysis significant improvement was observed in systolic (MD = -2.54; 95% CI: -4.98 to -0.11, p = 0.04) and diastolic blood pressure (SMD = -2.0182; 95% CI: -3.9436 to -0.0928, p = 0.04) favoring experimental groups. Subgroup analysis revealed significant improvement in quality of life after three months of follow-up (SMD = 0.18; 95% CI: 0.05 to 0.31, p = 0.00), no significant differences have been observed in body mass index, lipid profile, and blood glucose. The findings emphasize the significant impact of digital vs CBCR or usual care on physical capacity, blood pressure, and quality of life. Despite the non-statistically significant differences in body mass index and lipid profile, the comparable effect between the two methods suggests the superiority of digital over CBCR or usual care due to its convenient nature, accessibility, and cost-effectiveness.

Patients' experiences and perspectives regarding the use of digital technology to support exercise-based cardiac rehabilitation: a qualitative interview study.

Despite the well-known benefits of exercise-based cardiac rehabilitation for the secondary prevention of cardiovascular disease, participation in cardiac rehabilitation programmes and adherence to secondary prevention recommendations remain limited. Digital technologies have the potential to address low participation and adherence but attempts at implementing digital health interventions in real-life clinical practice frequently encounter various barriers. Studies about patients' experiences and perspectives regarding the use of digital technology can assist developers, researchers and clinicians in addressing or pre-empting patient-related barriers. This study was therefore conducted to investigate the experiences and perspectives of cardiac rehabilitation patients in Austria with regard to using digital technology for physical activity and exercise. Twenty-five current and former cardiac rehabilitation patients (18 men and 7 women, age range 39 to 83) with various cardiac conditions were recruited from a clinical site in Salzburg, Austria. Semi-structured qualitative interviews were audio-recorded and transcribed verbatim. The analysis followed a descriptive phenomenological approach, applying the framework analysis method. The sample was diverse, including interviewees who readily used digital devices to support their physical activity, exercise and health monitoring, and interviewees who did not. Simplicity, convenience and accessibility were highlighted as important facilitators for the use of digital technology, while annoyance with digital devices, concerns about becoming dependent on them, or simply a preference to not use digital technology were commonly stated reasons for non-use. Interviewees' views on data protection, data sharing and artificial intelligence revealed wide variations in individuals' prior knowledge and experience about these topics, and a need for greater accessibility and transparency of data protection regulation and data sharing arrangements. These findings support the importance that is attributed to user-centred design methodologies in the conceptualisation and design of digital health interventions, and the imperative to develop solutions that are simple, accessible and that can be personalised according to the preferences and capabilities of the individual patient. Regarding data protection, data sharing and artificial intelligence, the findings indicate opportunity for information and education, as well as the need to offer patients transparency and accountability in order to build trust in digital technology and digital health interventions.

Optimization of Cardiorespiratory Fitness and Quality of Life in Women with Chronic Heart Failure after a Cardiac Rehabilitation Program

Introduction: Women with heart failure (HF) tend to experience a greater symptom burden and lower quality of life, possibly due to phenotypic differences and unique gender-associated risk factors. Despite evidence on the effects of cardiac rehabilitation programs (CRP) in the general population, there is underrepresentation of women in these programs. Additionally, the impact of CRP on cardiorespiratory variables obtained through cardiopulmonary exercise testing (CPET) and health-related quality of life (HRQoL) in women with HF remains unknown. Objective: To assess the impact of a CRP on cardiorespiratory fitness (CRF) in cardiorespiratory variables obtained through CPET and HRQoL in women with HF. Methods: A quasi-experimental study included HF patients who completed a CRP from June 2019 to December 2023. The CRP involved nutritional assessment, psychosocial evaluation, educational sessions, and concurrent training. It comprised 30 minutes of aerobic resistance training at 65-80% of heart rate reserve (HRR) and 30 minutes of strength training at 30-50% of 1-repetition maximum (1RM), with a frequency of 3 sessions per week for 4 to 6 weeks. CPET was conducted at the beginning and end of the program, analyzing cardiorespiratory variables. HRQoL was assessed using the SF-36 questionnaire. Gains in CRF and HRQoL at the end of the program in both men and women were analyzed. Results: Out of 217 included patients, 29.9% were women. At the program's onset, women showed lower exercise tolerance than men (workload 5.4±2.57 METs vs. 6.62±2.53 METs) and worse HRQoL (62.03%±18.37 vs. 68.38%±18.37). However, post-intervention, they optimized their CRF (%predicted VO2 [%VO2p] initial 56.62%±20.11 vs final 80.12%±30.32, p=<0.001). Significant improvements in cardiorespiratory variables were observed in both cases: delta METs-load 3.02, p=<0.001, delta peak oxygen consumption (VO2peak) 1.83 ml/kg/min, p=<0.001, delta oxygen pulse (PO2) 1.21, p=0.021, delta cardiac power output (CPO) 1917, p=0.004, with a rightward shift in ventilatory thresholds and improvement in HRQoL (62.03%±18.37 vs. 78.81%±12.9, p=<0.001) post-CRP. The only variable with no significant changes in either case was VE/VCO2 slope (delta -0.51, p=0.736). Additionally, in women with reduced left ventricular ejection fraction (<50%), variables with no significant improvement included CPO (delta 959.22, p=0.283) and time to recovery of VO2 kinetics (TRCVO2) (delta -0.74, p=0.957). In patients with preserved left ventricular ejection fraction (≥50%), variables with no significant change included PO2 (delta 1.08, p=0.173), TRCVO2 (delta 26.82, p=0.099), and the first ventilatory threshold (VT1) (delta 0.09, p=0.504). Program attendance was 87.5% in both groups. Conclusion: Implementing a CRP in women with HF resulted in significant improvements in all evaluated cardiorespiratory variables (except for VE/VCO2 slope) and quality of life. These findings support the importance of ensuring women's access and participation in cardiac rehabilitation programs. Addressing existing barriers is crucial to maximize the long-term benefits of CRP in the female population with HF.

Behavioral theories and models to enhance compliance in cardiac rehabilitation programs for acute myocardial infarction – A narrative review

Acute myocardial infarction (AMI) is a serious and common illness that affects the cardiovascular system. Its sudden onset, high fatality rate, and recurrence rate significantly impact patients’ safety and quality of life. Owing to considerable improvement in living standards, AMI has become a major cause of death and disability, seriously increasing the burden on society. The cardiac rehabilitation program, which involves a multidisciplinary approach to assist patients with daily life guidance, diet guidance, exercise guidance, disease knowledge guidance, medication guidance, psychological guidance, risk factor control guidance, and other comprehensive guidance, has been proven to play a decisive role in the recovery of patients’ cardiac function and the improvement of their quality of life. In addition, these programs help reduce treatment costs and prevent the reoccurrence of disease as well as adverse effects in cardiac patients. However, the introduction and execution of these initiatives are currently in their early stages, characterized by a gradual pace and encountering numerous challenges. Specifically, in the context of AMI, there have been documented instances of reduced engagement, adherence, and compliance with rehabilitation programs, even within industrialized nations. Diverse treatment phases and models have been designed to enhance patient care, patient participation, compliance, and effectiveness of rehabilitation programs. Participation in post-myocardial infarction management CR programs has been reported under par levels which is posing a great threat and burden on society. Various theories and models of behavioral change are proposed to improve patient participation and compliance in cardiac rehabilitation. These theories and models have been utilized in the past to improve patient health and can also improve patients’ perception, and behavior toward active participation in cardiac rehabilitation programs.

Clinical Utility of the Cardiorespiratory Optimal Point in Patients with Heart Failure.

We assessed the cardiorespiratory optimal point (COP)-the minimal V̇E /V̇O 2 in a given minute of an incremental cardiopulmonary exercise test-in patients with heart failure (HF) and aimed to determine 1) its association with patient and disease characteristics, 2) changes after an exercise-based cardiac rehabilitation program (CR), and 3) the association with clinical outcomes. We studied 277 HF patients (67 (58-74) yr, 30% female, 72% HF with restricted ejection fraction) between 2009 and 2018. Patients participated in a 12- to 24-wk CR program, and COP was assessed pre- and post-CR. Patient and disease characteristics and clinical outcomes (mortality and cardiovascular-related hospitalization) were extracted from patient files. The incidence of clinical outcomes was compared across COP tertiles (low, <26.0; moderate, 26.0-30.7; high, >30.7). Median COP was 28.2 (24.9-32.1) and was reached at 51% ± 15% of V̇O 2peak . Lower age, female sex, higher body mass index, the absence of a pacemaker or the absence of chronic obstructive pulmonary disease, and lower N-terminal prohormone brain natriuretic peptide concentrations were associated with a lower COP. Participation in CR reduced COP (-0.8; 95% confidence interval, -1.3 to -0.3). Low COP had a reduced risk (adjusted hazard ratio, 0.53; 95% confidence interval, 0.33-0.84) for adverse clinical outcomes as compared with high COP. Classic cardiovascular risk factors are associated with a higher, more unfavorable, COP. CR-based exercise training reduces COP, whereas a lower COP is associated with a better clinical prognosis. As COP can be established during a submaximal exercise test, this may offer novel risk stratification possibilities for HF care programs.

The relationship between anxiety sensitivity and clinical outcomes in cardiac rehabilitation: A scoping review

BackgroundDespite well-established efficacy for patients with a cardiovascular diagnosis or event, exercise-based cardiac rehabilitation program participation and completion has remained alarmingly low due to both system-level barriers and patient-level factors. Patient mental health, particularly depression, is now recognized as significantly associated with reduced enrollment, participation, attendance, and completion of a cardiac rehabilitation program. More recently, anxiety sensitivity has emerged as an independent construct, related to but distinct from both depression and anxiety. Anxiety sensitivity has been reported to be adversely associated with participation in exercise and, thus, may be important for patients in cardiac rehabilitation. Accordingly, the objective of this study was to conduct a scoping review to summarize the evidence for associations between anxiety sensitivity and cardiovascular disease risk factors, exercise, and clinical outcomes in cardiac rehabilitation. MethodsA formal scoping review, following PRISMA-ScR guidelines, was undertaken. Searches of MEDLINE, Web of Science, CINAHL, PSYCINFO, and Scopus databases were conducted, supplemented by hand searches; studies published through December of 2020 were included. The initial screening was based on titles and abstracts and the second stage of screening was based on full text examination. ResultsThe final search results included 28 studies. Studies reported statistically significant associations between anxiety sensitivity and exercise, cardiovascular disease, and participation in cardiac rehabilitation. Many studies, however, were conducted in non-clinical, community-based populations; there were few studies conducted in cardiovascular disease and cardiac rehabilitation clinical patient populations. Additionally, significant gaps remain in our understanding of the sex-based differences in the complex relationships between anxiety sensitivity, exercise and cardiac rehabilitation. ConclusionMore research is needed to understand specific associations between anxiety sensitivity and clinical outcomes among clinical cardiovascular disease patients and participants in cardiac rehabilitation programs. Treatment of anxiety sensitivity to optimize clinical outcomes in cardiac rehabilitation programs should be investigated in future studies.

Efficacy of remotely monitored cardiac rehabilitation in patients after cancer treatment: A pilot study

Abstract Funding Acknowledgements Type of funding sources: Public hospital(s). Main funding source(s): This research was funded by the Ministry of Health, Czech Republic; conceptual development of research organization (FNBr, 65269705). Background Cardiovascular diseases are usually a partial cause of mortality in patients after cancer treatment. The increased cardiovascular risk in cancer patients is obtained from the cumulation of risk factors and the side effects of anticancer therapy. A multimodal model of cardiac rehabilitation (CR) can improve cardiorespiratory fitness (CRF), cardiovascular risk, and prognosis in this population. Despite the benefits of CR, patient participation in CR programs is very low. One of the main reasons for the low utilization and completion is the geographical distance from a specialized CR center. The remotely monitored CR method can solve a fundamental barrier that prevents CR programs' extensive and effective use. Purpose To examine the feasibility of remotely monitored CR as an alternative approach in hemato-oncological patients after cancer treatment. We assumed that the 12 weeks of remotely monitored CR would be feasible and improve the CRF. Methods From March to September 2021, a 12-week study of remotely monitored CR was performed in hemato-oncology patients after cancer treatment. The intervention was based on the principles of phase II CR and consisted of standardized exercise-based in a home-based model with regular telemonitoring and remote supervision. After a cardiovascular assessment, echocardiogram, troponin, brain natriuretic peptides, cardiopulmonary exercise test-CRF were examined, patients were instructed to perform prescribed exercise 3 times per week, for 30 - 50 minutes, at the target heart rate (HR) zone (70 - 90% HRmax) determined by baseline cardiopulmonary exercise testing. Patients were instructed to record their exercise training intensity using a HR monitor and the Borg scale (level 12 - 14 out of 20). Results Eight hemato-oncological patients (50% males; mean age 59.4 ± 12.0 years) enrolled in a remotely monitored CR program. All patients were post-cancer treatment, including cancer systemic chemotherapy-based treatment with recommended supportive care. The analysis showed a statistically significant increase in CRF by 13.7% (∆ 20.5 watts, p &amp;lt; 0.05, Abstract Figure). Overall training adherence was high (33.25 / 36 sessions). No exercise-related adverse events were recorded. Conclusions The pilot study results support the feasibility assumption of remotely monitored CR in hemato-oncological patients after cancer treatment. CR could lead to significant improvements in CRF. The study results can be useful for sample size estimation of future controlled studies to explore more significant evidence in this area.

Secondary prevention of coronary heart disease in Poland: does sex matter? Results from the POLASPIRE survey.

Adherence to health‑promoting behaviors intended to mitigate modifiable risk factors plays an important role in secondary cardiovascular prevention. We aimed to evaluate sex differences in the prevalence and control of risk factors in patients with coronary heart disease (CHD). The study included 1236 patients who experienced acute coronary syndrome or coronary revascularization within the last 6 to 24 months. Definitions of risk factors and treatment goals were based on the 2016 European Society of Cardiology guidelines on cardiovascular prevention. The prevalence of modifiable risk factors in both sexes was high, and their control inadequate. Women were older (P <0.001) and had a higher accumulation of multiple cardiovascular risk factors than men (P = 0.036). They more frequently had central obesity (P <0.001) and reduced values of glomerular filtration rate (P <0.001). Women more often experienced anxiety (P <0.001), reported lower levels of education (P <0.001) and lower income (P = 0.001), and those in the youngest age group were more likely to be exposed to second‑hand smoking (P = 0.01). A large fraction of the study patients, men and women alike, did not meet the recommended therapeutic goals. For both sexes, participation in cardiac rehabilitation programs was associated with more frequent attainment of the recommended level of physical activity (P = 0.046) and smoking cessation (P = 0.01). The prevalence of cardiovascular risk factors in patients with CHD is high, especially in women. Therapeutic goals are met infrequently in both sexes. This situation calls for widening the access to educational programs and paying greater attention to their proper implementation.

Infarto agudo de miocardio. SCACEST

Acute coronary syndrome (ACS) occurs when there is an imbalance between the supply and demand of oxygen to the myocardium. When this ACS is accompanied by ST segment elevation (STSE ACS) it is usually due to the rupture of an atheroma plaque forming a thrombus acutely occluding the coronary artery. The most common clinical presentation of STSE ACS is oppressive, persistent central chest pain and ST segment elevation on the electrocardiogram. However, atypical clinical or electrocardiographic manifestations are occasionally observed, which complicate diagnosis and can delay treatment. It is essential to develop structured STSE ACS care systems (infarction code) to ensure quality of care and reduce time to treatment. Treatment is based on revascularisation and opening the affected vessel using two procedures: primary angioplasty (of choice) or fibrinolysis. Secondary prevention and participation in cardiac rehabilitation programmes are key elements in the long-term management of these patients.

Cardiac Rehabilitation and Diastolic Function

Cardiac Rehabilitation (CR) can reduce mortality and prevent Cardiovascular Diseases (CVD) recurrence, but published data do not indicate an improvement in systolic function. However, there still has not been much research into the relationship between diastolic function and functional capacity during CR. The primary goal of our study is to objectively assess the evolution of clinical data and echocardiographic measurements (including diastolic function) before and after 20 sessions of CR. We carried out a prospective, cross-sectional study in the Bastia CR department from December 2018 to July 2019. All patients with an indication for CR and a left ventricle ejection fraction (LVEF) superior to 50% were invited to participate in the study. The assessment on inclusion and after CR included clinic measurements, the INTERHEART score and the maximum effort load (Wattmax). Using echocardiography, we measured the LVEF, the Tei index, and the tricuspid annular plane systolic excursion (TAPSE), septal and lateral E/e’ ratio and the isovolumetric relaxation time (IVRT). 93 patients were included. After exclusion, there are 54 patients left for study. CR had no impact on the LVEF ( P = 0.06). CR allowed a significant decrease in weight (−1 kg with P = 0.004), abdominal perimeter (−1.3 cm with P < 0.0001) and the INTERHEART risk score (−17% with P < 0.0001). Maximum physical effort capacities also were increased by 27,6% ( P < 0.0001). These improvements are correlated with significant variations in Tei index ( P = 0.009), TAPSE ( P = 0.004), septal E/e’ ratio ( P = 0.04) and the IVRT ( P < 0.0001). These elements are prognostic markers of morbidity, mortality and quality of life ( Fig. 1 ). Thus, the benefit shown by the CR program is evidenced from both an echographic, an ergometric and a clinical point of view. These data strongly support physicians in the prescription of CR and patients in their participation in CR programmes, within the scope of CVD prevention.

The Correlations between the Number of Cardiac Rehabilitation Program Participation and Its Effects

The Correlations between the Number of Cardiac Rehabilitation Program Participation and Its Effects

Symptom experience as a predictor of cardiac rehabilitation education programme attendance after percutaneous coronary intervention: A prospective questionnaire survey.

Despite evidence that participation in cardiac rehabilitation programmes after percutaneous coronary intervention is associated with better clinical outcomes, many patients with coronary artery disease do not participate in such programmes. A traditional educational approach is recommended to provide patients with information regarding the benefits of cardiac rehabilitation in relation to their underlying coronary artery disease and modification of risk factors. The purpose of this study was to examine the role of patient factors (symptom experience and health belief) on cardiac rehabilitation education programme attendance among Korean patients subjected to percutaneous coronary intervention. A prospective survey was conducted enrolling 173 patients who underwent percutaneous coronary intervention. Information on symptom experience, health belief (perceived susceptibility/severity/benefits/ barriers) and sociodemographic and clinical characteristics was collected at baseline (after percutaneous coronary intervention). Three to four weeks later, information on disease-related knowledge and health behaviour was compared between cardiac rehabilitation education programme attendees and non-attendees. Eighty of 173 (46.2%) patients surveyed attended the cardiac rehabilitation education programme. Symptom experience before percutaneous coronary intervention was the most significant predictor of programme attendance (odds ratio=3.46; 95% confidence interval 1.45-8.27), followed by higher perceived socioeconomic status (odds ratio=2.90; 95% confidence interval 1.28-6.58), perceived susceptibility (odds ratio=1.22, 95% confidence interval 1.08-1.39), perceived benefits (odds ratio=1.09; 95% confidence interval 1.02-1.17) and perceived severity (odds ratio=1.04; 95% confidence interval 1.00-1.08). Better disease-related knowledge and health behaviour were significantly associated with cardiac rehabilitation education programme attendance. This study provides evidence that educational programmes to help improve patients' perceptions of their disease susceptibility and severity, especially health behaviour benefits in patients without symptom experience before percutaneous coronary intervention, are necessary.

THE EFFECTS OF EARLY EDUCATIONAL INTERVENTION ON PATIENTSWITH ACUTE CORONARY SYNDROME (ACS): A REVIEW

Participation in cardiac rehabilitation program (CRP) had proven to promote a healthy lifestyle to improve quality of life after cardiac event. Early educational intervention is very important to prepare the patient before discharged home due to the poor enrolment in the CRP. The aims of this review are to describe the early educational interventions offered to the patients with ACS and to review its effectiveness. A literature review was conducted by analyzing related research studies published since 2009 to 2018. There were eight studies included in this review. Alternative approaches need to be considered for cardiac rehabilitation, where appropriate programs for patients that suits with the patients' needs especially while the patients are still in the hospital. The early educational intervention that inculcates the self-efficacy enhancement should be considered to guide the patients to manage themselves at home and lead a healthy lifestyle to prevent the recurrence of the disease.

Awareness regarding cardiac rehabilitation among patients with coronary heart disease attending a cardiac care centre, Kathmandu valley

Introduction: Coronary heart disease (CHD) is gradually emerging as a leading cause of morbidity and mortality of many low middle income countries like Nepal. Cardiac rehabilitation awareness program has been proved to be effective for reducing the mortality as well as improving the quality of life among CHD patients. The aim of this study was to explore the awareness on cardiac rehabilitation (CR) in patients with CHD attending a cardiac care centre, Nepal.&#x0D; Method: A descriptive cross sectional study design was used to examine 100 CHD patients attending out-patient departments of Shahid Gangalal National Heart Centre (SGNHC), Kathmandu, Nepal. Purposive sampling technique was used for data collection by face to face interview technique with self developed tool. Data was analyzed with descriptive and inferential statistics.&#x0D; Results: Of all 100 respondents, 55.0% were male and the mean age was 53.23±14.22 years. The median score of awareness was 17 with interquartile range (IQR) 14.0-19.75 and majority (57.0%) of respondents were unaware about CR. The awareness regarding CR was found highest in awareness regarding CHD (75.0%) whereas lowest score was found in time and duration needed for exercise per week (14.0%). The significant influencing variables were age, education status, duration of treatment and participation in CR program for CHD patients.&#x0D; Conclusion: The awareness on CR program in CHD patients in Nepal is not optimal, especially among 54 and above age group, illiterate people, those receiving treatment equal &amp; more than 1 year duration and the CHD patients who didn’t get chance to participate on awareness programs. Hence, it is strongly recommended that health professionals including nurses should organize and promote CR programs including counseling session to improve the awareness level and ultimately enhance quality of life of CHD patients.

THE EFFECTS OF EARLY EDUCATIONAL INTERVENTION ON PATIENTS WITH ACUTE CORONARY SYNDROME (ACS): A REVIEW

Participation in cardiac rehabilitation program (CRP) had proven to promote a healthy lifestyle to improve quality of life after cardiac event. Early educational intervention is very important to prepare the patient before discharged home due to the poor enrolment in the CRP. The aims of this review are to describe the early educational interventions offered to the patients with ACS and to review its effectiveness. A literature review was conducted by analyzing related research studies published since 2009 to 2018. There were eight studies included in this review. Alternative approaches need to be considered for cardiac rehabilitation, where appropriate programs for patients that suits with the patients' needs especially while the patients are still in the hospital. The early educational intervention that inculcates the self-efficacy enhancement should be considered to guide the patients to manage themselves at home and lead a healthy lifestyle to prevent the recurrence of the disease.

What is the Most Serious Obstacle to Participation in Outpatient Cardiac Rehabilitation Programs among Iranian Patients?

Dear Editor, Cardiac rehabilitation programs (CRs) are among the most important third‑level prevention services that can have positive health outcomes and reduce cardiac death.[1] Despite the numerous evidences that indicate the usefulness of CRs, few patients-especially in developing countries-participate in these programs.[2] Compared to developed countries with over 70% participation in CRs,[3] less than 15% of Iranian patients participate in the programs.[2].....

Increased Physical Activity Post-Myocardial Infarction Is Related to Reduced Mortality: Results From the SWEDEHEART Registry.

BackgroundWith increasing survival rates among patients with myocardial infarction (MI), more demands are placed on secondary prevention. While physical activity (PA) efforts to obtain a sufficient PA level are part of secondary preventive recommendations, it is still underutilized. Importantly, the effect of changes in PA after MI is largely unknown. Therefore, we sought to investigate the effect on survival from changes in PA level, post‐MI.Methods and ResultsData from Swedish national registries were combined, totaling 22 227 patients with MI. PA level was self‐reported at 6 to 10 weeks post‐MI and 10 to 12 months post‐MI. Patients were classified as constantly inactive, increased activity, reduced activity, and constantly active. Proportional hazard ratios were calculated. During 100 502 person‐years of follow‐up (mean follow‐up time 4.2 years), a total of 1087 deaths were recorded. Controlling for important confounders (including left ventricular function, type of MI, medication, smoking, participation in cardiac rehabilitation program, quality of life, and estimated kidney function), we found lower mortality rates among constantly active (hazard ratio: 0.29, 95% confidence interval: 0.21–0.41), those with increased activity (0.41, 95% confidence interval: 0.31–0.55), and those with reduced activity (hazard ratio: 0.56, 95% confidence interval: 0.45–0.69) during the first year post‐MI, compared with those being constantly inactive. Stratified analyses indicated strong effect of PA level among both sexes, across age, MI type, kidney function, medication, and smoking status.ConclusionsThe present article shows that increasing the PA level, compared with staying inactive the first year post‐MI, was related to reduced mortality.