51
|
Hnatiak J, Zikmund Galkova L, Winnige P, Batalik L, Dosbaba F, Ludka O, Krejci J. Obstructive Sleep Apnea and a Comprehensive Remotely Supervised Rehabilitation Program: Protocol for a Randomized Controlled Trial. JMIR Res Protoc 2023; 12:e47460. [PMID: 37721786 PMCID: PMC10546260 DOI: 10.2196/47460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 07/18/2023] [Accepted: 08/08/2023] [Indexed: 09/19/2023] Open
Abstract
BACKGROUND Obstructive sleep apnea (OSA) is characterized by recurrent, intermittent partial or complete obstruction of the upper respiratory tract during sleep, which negatively affects the patient's daily quality of life (QoL). Middle-aged and older men who smoke and have obesity are most at risk. Even though the use of continuous positive airway pressure (CPAP) during sleep remains the gold standard treatment, various rehabilitation methods, such as exercise, respiratory therapy, myofunctional therapy, and nutritional lifestyle interventions, also appear to be effective. Moreover, it is increasingly recommended to use alternative or additional therapy options in combination with CPAP therapy. OBJECTIVE This study aims to evaluate if a comprehensive home-based, remotely supervised rehabilitation program (tele-RHB), in combination with standard therapy, can improve OSA severity by decreasing the apnea-hypopnea index (AHI); improve objective parameters of polysomnographic, spirometric, anthropometric, and body composition examinations; improve lipid profile, maximal mouth pressure, and functional capacity tests; and enhance the subjective perception of QoL, as well as daytime sleepiness in male participants with moderate to severe OSA. Our hypothesis is that a combination of the tele-RHB program and CPAP therapy will be more effective by improving OSA severity and the abovementioned parameters. METHODS This randomized controlled trial aims to recruit 50 male participants between the ages of 30 and 60 years with newly diagnosed moderate to severe OSA. Participants will be randomized 1:1, either to a 12-week tele-RHB program along with CPAP therapy or to CPAP therapy alone. After the completion of the intervention, the participants will be invited to complete a 1-year follow-up. The primary outcomes will be the polysomnographic value of AHI, Epworth Sleepiness Scale score, 36-Item Short Form Health Survey (SF-36) score, percentage of body fat, 6-minute walk test distance covered, as well as maximal inspiratory and expiratory mouth pressure values. Secondary outcomes will include polysomnographic values of oxygen desaturation index, supine AHI, total sleep time, average heart rate, mean oxygen saturation, and the percentage of time with oxygen saturation below 90%; anthropometric measurements of neck, waist, and hip circumference; BMI values; forced vital capacity; forced expiratory volume in 1 second; World Health Organization's tool to measure QoL (WHOQOL-BREF) score; and lipid profile values. RESULTS Study recruitment began on October 25, 2021, and the estimated study completion date is December 2024. Analyses will be performed to examine whether the combination of the tele-RHB program and CPAP therapy will be more effective in the reduction of OSA severity and improvement of QoL, body composition and circumferences, exercise tolerance, lipid profile, as well as respiratory muscle and lung function, compared to CPAP therapy alone. CONCLUSIONS The study will evaluate the effect of a comprehensive tele-RHB program on selected parameters mentioned above in male participants. The results of this intervention could help the further development of novel additional therapeutic home-based options for OSA. TRIAL REGISTRATION ClinicalTrials.gov NCT04759456; https://clinicaltrials.gov/ct2/show/NCT04759456. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/47460.
Collapse
Affiliation(s)
- Jakub Hnatiak
- Department of Rehabilitation, University Hospital Brno, Brno, Czech Republic
- First Department of Internal Medicine - Cardioangiology, St Anne´s University Hospital, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Lujza Zikmund Galkova
- First Department of Internal Medicine - Cardioangiology, St Anne´s University Hospital, Faculty of Medicine, Masaryk University, Brno, Czech Republic
- Cardiovascular Sleep Center of the First Department of Internal Medicine - Cardioangiology, St Anne´s University Hospital, Brno, Czech Republic
| | - Petr Winnige
- Department of Rehabilitation, University Hospital Brno, Brno, Czech Republic
- Department of Public Health, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Ladislav Batalik
- Department of Rehabilitation, University Hospital Brno, Brno, Czech Republic
- Department of Public Health, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Filip Dosbaba
- Department of Rehabilitation, University Hospital Brno, Brno, Czech Republic
| | - Ondrej Ludka
- Department of Internal Medicine, Geriatrics and Practical Medicine, University Hospital Brno, Brno, Czech Republic
| | - Jan Krejci
- First Department of Internal Medicine - Cardioangiology, St Anne´s University Hospital, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| |
Collapse
|
52
|
Harzand A, Alrohaibani A, Idris MY, Spence H, Parrish CG, Rout PK, Nazar R, Davis-Watts ML, Wright PP, Vakili AA, Abdelhamid S, Vathsangam H, Adesanya A, Park LG, Whooley MA, Wenger NK, Zafari AM, Shah AJ. Effects of a patient-centered digital health intervention in patients referred to cardiac rehabilitation: the Smart HEART clinical trial. BMC Cardiovasc Disord 2023; 23:453. [PMID: 37700245 PMCID: PMC10496208 DOI: 10.1186/s12872-023-03471-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 08/23/2023] [Indexed: 09/14/2023] Open
Abstract
BACKGROUND Cardiac rehabilitation (CR) improves outcomes in heart disease yet remains vastly underutilized. Remote CR enhanced with a digital health intervention (DHI) may offer higher access and improved patient-centered outcomes over non-technology approaches. We sought to pragmatically determine whether offering a DHI improves CR access, cardiac risk profile, and patient-reported outcome measures. METHODS Adults referred to CR at a tertiary VA medical center between October 2017 and December 2021 were offered enrollment into a DHI alongside other CR modalities using shared decision-making. The DHI consisted of remote CR with a structured, 3-month home exercise program enhanced with multi-component coaching, a commercial smartphone app, and wearable activity tracker. We measured completion rates among DHI participants and evaluated changes in 6-min walk distance, cardiovascular risk factors, and patient-reported outcomes from pre- to post-intervention. RESULTS Among 1,643 patients referred to CR, 258 (16%) consented to the DHI where the mean age was 60 ± 9 years, 93% were male, and 48% were black. A majority (90%) of the DHI group completed the program. Over 3-months, significant improvements were seen in 6MWT (mean difference [MD] -29 m; 95% CI, 10 to 49; P < 0.01) and low-density lipoprotein cholesterol (MD -11 mg/dL; 95% CI, -17 to -5; P < 0.01), and the absolute proportion of patients who reported smoking decreased (10% vs 15%; MD, -5%; 95% CI, -8% to -2%; P < 0.01) among DHI participants with available data. No adverse events were reported. CONCLUSIONS The addition of a DHI-enhanced remote CR program was delivered in 16% of referred veterans and associated with improved CR access, markers of cardiovascular risk, and healthy behaviors in this real-world study. These findings support the continued implementation of DHIs for remote CR in real-world clinical settings. TRIAL REGISTRATION This trial was registered on ClinicalTrials.gov: NCT02791685 (07/06/2016).
Collapse
Affiliation(s)
- Arash Harzand
- Atlanta VA Medical Center, 1670 Clairmont Road (111/CD), Decatur, GA, 30033, USA.
- Division of Cardiology, School of Medicine, Emory University, Atlanta, GA, USA.
| | - Alaaeddin Alrohaibani
- Atlanta VA Medical Center, 1670 Clairmont Road (111/CD), Decatur, GA, 30033, USA
- Department of Pathology, Oregon Health and Science University, Portland, OR, USA
| | - Muhammed Y Idris
- Department of Medicine, Morehouse School of Medicine, Atlanta, GA, USA
| | | | - Cate G Parrish
- Atlanta VA Medical Center, 1670 Clairmont Road (111/CD), Decatur, GA, 30033, USA
| | - Pratik K Rout
- Atlanta VA Medical Center, 1670 Clairmont Road (111/CD), Decatur, GA, 30033, USA
- Division of Cardiology, School of Medicine, Emory University, Atlanta, GA, USA
| | - Rene Nazar
- Atlanta VA Medical Center, 1670 Clairmont Road (111/CD), Decatur, GA, 30033, USA
| | | | - Phyllis P Wright
- Atlanta VA Medical Center, 1670 Clairmont Road (111/CD), Decatur, GA, 30033, USA
| | - Alexander A Vakili
- Division of Cardiology, School of Medicine, Emory University, Atlanta, GA, USA
| | - Smah Abdelhamid
- Atlanta VA Medical Center, 1670 Clairmont Road (111/CD), Decatur, GA, 30033, USA
| | | | | | - Linda G Park
- School of Nursing, University of California, San Francisco, CA, USA
- San Francisco VA Medical Center, San Francisco, CA, USA
| | - Mary A Whooley
- San Francisco VA Medical Center, San Francisco, CA, USA
- Department of Medicine, University of California, San Francisco, CA, USA
| | - Nanette K Wenger
- Division of Cardiology, School of Medicine, Emory University, Atlanta, GA, USA
| | - A Maziar Zafari
- Atlanta VA Medical Center, 1670 Clairmont Road (111/CD), Decatur, GA, 30033, USA
- Division of Cardiology, School of Medicine, Emory University, Atlanta, GA, USA
| | - Amit J Shah
- Atlanta VA Medical Center, 1670 Clairmont Road (111/CD), Decatur, GA, 30033, USA
- Division of Cardiology, School of Medicine, Emory University, Atlanta, GA, USA
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, GA, USA
| |
Collapse
|
53
|
Ramachandran HJ, Seah ACW, Teo JYC, Yeo TJ, Wang W. East meets West: making the case for traditional Chinese exercises in the management of heart disease. Eur J Cardiovasc Nurs 2023; 22:e47-e48. [PMID: 36595034 DOI: 10.1093/eurjcn/zvad006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 12/31/2022] [Indexed: 01/04/2023]
Affiliation(s)
- Hadassah Joann Ramachandran
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Level 2, Clinical Research Centre, Block MD, 11,10 Medical Drive, 117597Singapore
| | - Alvin Chuen Wei Seah
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Level 2, Clinical Research Centre, Block MD, 11,10 Medical Drive, 117597Singapore
| | - Jun Yi Claire Teo
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Level 2, Clinical Research Centre, Block MD, 11,10 Medical Drive, 117597Singapore
| | - Tee Joo Yeo
- Cardiac Rehabilitation, Department of Cardiology, National University Heart Centre, 5 Lower Kent Ridge Rd, 119074 Singapore
| | - Wenru Wang
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Level 2, Clinical Research Centre, Block MD, 11,10 Medical Drive, 117597Singapore
| |
Collapse
|
54
|
Tenforde AS, Alexander JJ, Alexander M, Annaswamy TM, Carr CJ, Chang P, Díaz M, Iaccarino MA, Lewis SB, Millett C, Pandit S, Ramirez CP, Rinaldi R, Roop M, Slocum CS, Tekmyster G, Venesy D, Verduzco-Gutierrez M, Zorowitz RD, Rowland TR. Telehealth in PM&R: Past, present, and future in clinical practice and opportunities for translational research. PM R 2023; 15:1156-1174. [PMID: 37354209 DOI: 10.1002/pmrj.13029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 03/29/2023] [Accepted: 06/09/2023] [Indexed: 06/26/2023]
Abstract
Telehealth refers to the use of telecommunication devices and other forms of technology to provide services outside of the traditional in-person health care delivery system. Growth in the use of telehealth creates new challenges and opportunities for implementation in clinical practice. The American Academy of Physical Medicine and Rehabilitation (AAPM&R) assembled an expert group to develop a white paper to examine telehealth innovation in Physical Medicine and Rehabilitation (PM&R). The resultant white paper summarizes how telehealth is best used in the field of PM&R while highlighting current knowledge deficits and technological limitations. The report identifies new and transformative opportunities for PM&R to advance translational research related to telehealth and enhance patient care.
Collapse
Affiliation(s)
- Adam S Tenforde
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Spaulding Rehabilitation, Charlestown, Massachusetts, USA
| | - Joshua J Alexander
- Department of Physical Medicine and Rehabilitation, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Marcalee Alexander
- Department of Physical Medicine and Rehabilitation, University of Alabama at Birmingham School of Medicine, Birmingham, Alabama, USA
| | - Thiru M Annaswamy
- Department of Physical Medicine and Rehabilitation, Penn State Health Milton S. Hershey Medical Center Penn State College of Medicine, Hershey, Pennsylvania, USA
| | - Conley J Carr
- Department of Physical Medicine and Rehabilitation, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Philip Chang
- Department of Physical Medicine and Rehabilitation, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | | | - Mary A Iaccarino
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Spaulding Rehabilitation, Charlestown, Massachusetts, USA
| | - Stephen B Lewis
- Physiatry-Pharmacy Collaborative, NJ Institute for Successful Aging, Princeton, New Jersey, USA
| | - Carolyn Millett
- American Academy of Physical Medicine and Rehabilitation, Rosemont, Illinois, USA
| | | | | | - Robert Rinaldi
- Department of Physical Medicine and Rehabilitation, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Megan Roop
- American Academy of Physical Medicine and Rehabilitation, Rosemont, Illinois, USA
| | - Chloe S Slocum
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Spaulding Rehabilitation, Charlestown, Massachusetts, USA
| | - Gene Tekmyster
- Department of Orthopedic Surgery, Keck Medicine of USC, Los Angeles, California, USA
| | | | - Monica Verduzco-Gutierrez
- Department of Rehabilitation Medicine, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - Richard D Zorowitz
- Department of Rehabilitation Medicine, MedStar National Rehabilitation Network, Georgetown University, Washington, District of Columbia, USA
| | | |
Collapse
|
55
|
Zaree A, Dev S, Yaseen Khan I, Arain M, Rasool S, Khalid Rana MA, Kanwal K, Bhagat R, Prachi F, Puri P, Varrassi G, Kumar S, Khatri M, Mohamad T. Cardiac Rehabilitation in the Modern Era: Optimizing Recovery and Reducing Recurrence. Cureus 2023; 15:e46006. [PMID: 37900498 PMCID: PMC10602201 DOI: 10.7759/cureus.46006] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Accepted: 09/26/2023] [Indexed: 10/31/2023] Open
Abstract
Cardiovascular diseases (CVDs) continue to be a prominent issue in global health, emphasizing the necessity for efficient cardiac rehabilitation programs. This narrative review provides a detailed analysis of the current state of cardiac rehabilitation, focusing on maximizing recovery and minimizing the likelihood of recurrence. This paper examines the historical progression of cardiac rehabilitation, explores the epidemiological background of cardiovascular disease (CVD), and provides an overview of the many stages of the rehabilitation process. The assessment of patients plays a crucial role in healthcare, serving as a fundamental basis that incorporates medical, psychological, and social aspects. The utilization of risk stratification techniques further enhances this process. The present study investigates exercise training, particularly emphasizing the current recommendations and the mutually beneficial effects of aerobic and resistance regimens. In addition to physical therapies, this study emphasizes the importance of nutrition, lifestyle adjustments, and the significant effects of medication. Psychosocial assistance is a crucial element that addresses the significant psychological effects of cardiac disease and provides comprehensive techniques for overall well-being. Technological advancements are significantly transforming the domain of cardiac rehabilitation, encompassing the integration of wearable technologies and telemedicine solutions. The convergence of artificial intelligence and data analytics can enhance the customization of healthcare services. Through a comprehensive rehabilitation program, patients can achieve an improved quality of life and enhanced functional outcomes. However, it is essential to acknowledge that obstacles still hinder individuals from accessing and completing educational programs. Therefore, it is crucial to engage in a discourse on potential tactics that may be employed to address these issues, considering the various cultural and socioeconomic aspects that contribute to them. The analysis focuses on the economic dimension, examining the cost-effectiveness of rehabilitation programs and their congruence with healthcare policies. In anticipation of future developments, the study provides valuable perspectives on the prospective trajectory of cardiac rehabilitation. It delves into nascent patterns and examines the potential ramifications of precision medicine and genetics for tailoring treatment strategies to individual patients. In brief, this narrative review comprehensively examines the various dimensions of contemporary cardiac rehabilitation. It offers a comprehensive perspective on its significance in enhancing recuperation and mitigating the likelihood of the recurrence of cardiovascular ailments. The significance of this review lies in its ability to enhance patient outcomes, thereby making a valuable contribution to the worldwide endeavor to address the burden of cardiovascular disease.
Collapse
Affiliation(s)
- Amna Zaree
- Medicine, Shalamar Medical and Dental College, Lahore, PAK
| | - Shah Dev
- Internal Medicine, Jinnah Sindh Medical University, Karachi, PAK
| | | | - Mustafa Arain
- Internal Medicine, Civil Hospital Karachi, Karachi, PAK
| | - Sohaib Rasool
- Medicine, Bakhtawar Amin Medical and Dental College, Multan, PAK
| | | | - Kainat Kanwal
- Medicine and Surgery, Khawaja Muhammad Safdar Medical College, Sialkot, PAK
| | - Ridhi Bhagat
- Internal Medicine, Teerthanker Mahaveer Medical College and Reseach Center, Moradabad, IND
| | - Fnu Prachi
- Medicine, Guru Teg Bahadur Hospital, Delhi, IND
| | - Piyush Puri
- Internal Medicine, Adesh Institute of Medical Science and Research, Bathinda, IND
| | | | - Satesh Kumar
- Medicine and Surgery, Shaheed Mohtarma Benazir Bhutto Medical College, Karachi, PAK
| | - Mahima Khatri
- Medicine and Surgery, Dow University of Health Sciences, Karachi, PAK
| | - Tamam Mohamad
- Cardiovascular Medicine, Wayne State University, Detroit, USA
| |
Collapse
|
56
|
Virani SS, Newby LK, Arnold SV, Bittner V, Brewer LC, Demeter SH, Dixon DL, Fearon WF, Hess B, Johnson HM, Kazi DS, Kolte D, Kumbhani DJ, LoFaso J, Mahtta D, Mark DB, Minissian M, Navar AM, Patel AR, Piano MR, Rodriguez F, Talbot AW, Taqueti VR, Thomas RJ, van Diepen S, Wiggins B, Williams MS. 2023 AHA/ACC/ACCP/ASPC/NLA/PCNA Guideline for the Management of Patients With Chronic Coronary Disease: A Report of the American Heart Association/American College of Cardiology Joint Committee on Clinical Practice Guidelines. J Am Coll Cardiol 2023; 82:833-955. [PMID: 37480922 DOI: 10.1016/j.jacc.2023.04.003] [Citation(s) in RCA: 55] [Impact Index Per Article: 55.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/24/2023]
Abstract
AIM The "2023 AHA/ACC/ACCP/ASPC/NLA/PCNA Guideline for the Management of Patients With Chronic Coronary Disease" provides an update to and consolidates new evidence since the "2012 ACCF/AHA/ACP/AATS/PCNA/SCAI/STS Guideline for the Diagnosis and Management of Patients With Stable Ischemic Heart Disease" and the corresponding "2014 ACC/AHA/AATS/PCNA/SCAI/STS Focused Update of the Guideline for the Diagnosis and Management of Patients With Stable Ischemic Heart Disease." METHODS A comprehensive literature search was conducted from September 2021 to May 2022. Clinical studies, systematic reviews and meta-analyses, and other evidence conducted on human participants were identified that were published in English from MEDLINE (through PubMed), EMBASE, the Cochrane Library, Agency for Healthcare Research and Quality, and other selected databases relevant to this guideline. STRUCTURE This guideline provides an evidenced-based and patient-centered approach to management of patients with chronic coronary disease, considering social determinants of health and incorporating the principles of shared decision-making and team-based care. Relevant topics include general approaches to treatment decisions, guideline-directed management and therapy to reduce symptoms and future cardiovascular events, decision-making pertaining to revascularization in patients with chronic coronary disease, recommendations for management in special populations, patient follow-up and monitoring, evidence gaps, and areas in need of future research. Where applicable, and based on availability of cost-effectiveness data, cost-value recommendations are also provided for clinicians. Many recommendations from previously published guidelines have been updated with new evidence, and new recommendations have been created when supported by published data.
Collapse
|
57
|
Virani SS, Newby LK, Arnold SV, Bittner V, Brewer LC, Demeter SH, Dixon DL, Fearon WF, Hess B, Johnson HM, Kazi DS, Kolte D, Kumbhani DJ, LoFaso J, Mahtta D, Mark DB, Minissian M, Navar AM, Patel AR, Piano MR, Rodriguez F, Talbot AW, Taqueti VR, Thomas RJ, van Diepen S, Wiggins B, Williams MS. 2023 AHA/ACC/ACCP/ASPC/NLA/PCNA Guideline for the Management of Patients With Chronic Coronary Disease: A Report of the American Heart Association/American College of Cardiology Joint Committee on Clinical Practice Guidelines. Circulation 2023; 148:e9-e119. [PMID: 37471501 DOI: 10.1161/cir.0000000000001168] [Citation(s) in RCA: 126] [Impact Index Per Article: 126.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/22/2023]
Abstract
AIM The "2023 AHA/ACC/ACCP/ASPC/NLA/PCNA Guideline for the Management of Patients With Chronic Coronary Disease" provides an update to and consolidates new evidence since the "2012 ACCF/AHA/ACP/AATS/PCNA/SCAI/STS Guideline for the Diagnosis and Management of Patients With Stable Ischemic Heart Disease" and the corresponding "2014 ACC/AHA/AATS/PCNA/SCAI/STS Focused Update of the Guideline for the Diagnosis and Management of Patients With Stable Ischemic Heart Disease." METHODS A comprehensive literature search was conducted from September 2021 to May 2022. Clinical studies, systematic reviews and meta-analyses, and other evidence conducted on human participants were identified that were published in English from MEDLINE (through PubMed), EMBASE, the Cochrane Library, Agency for Healthcare Research and Quality, and other selected databases relevant to this guideline. STRUCTURE This guideline provides an evidenced-based and patient-centered approach to management of patients with chronic coronary disease, considering social determinants of health and incorporating the principles of shared decision-making and team-based care. Relevant topics include general approaches to treatment decisions, guideline-directed management and therapy to reduce symptoms and future cardiovascular events, decision-making pertaining to revascularization in patients with chronic coronary disease, recommendations for management in special populations, patient follow-up and monitoring, evidence gaps, and areas in need of future research. Where applicable, and based on availability of cost-effectiveness data, cost-value recommendations are also provided for clinicians. Many recommendations from previously published guidelines have been updated with new evidence, and new recommendations have been created when supported by published data.
Collapse
Affiliation(s)
| | | | | | | | | | | | - Dave L Dixon
- Former Joint Committee on Clinical Practice Guideline member; current member during the writing effort
| | - William F Fearon
- Society for Cardiovascular Angiography and Interventions representative
| | | | | | | | - Dhaval Kolte
- AHA/ACC Joint Committee on Clinical Data Standards
| | | | | | | | - Daniel B Mark
- Former Joint Committee on Clinical Practice Guideline member; current member during the writing effort
| | | | | | | | - Mariann R Piano
- Former Joint Committee on Clinical Practice Guideline member; current member during the writing effort
| | | | | | | | | | | | | | | |
Collapse
|
58
|
Nishitani-Yokoyama M, Shimada K, Fujiwara K, Abulimiti A, Kasuya H, Kunimoto M, Yamaguchi Y, Tabata M, Saitoh M, Takahashi T, Daida H, Nojiri S, Minamino T. Safety and Feasibility of Tele-Cardiac Rehabilitation Using Remote Biological Signal Monitoring System: A Pilot Study. Cardiol Res 2023; 14:261-267. [PMID: 37559714 PMCID: PMC10409546 DOI: 10.14740/cr1530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Accepted: 07/27/2023] [Indexed: 08/11/2023] Open
Abstract
BACKGROUND Cardiac rehabilitation (CR) is categorized as a class I recommendation in the guidelines for the management of patients with cardiovascular disease (CVD). However, the penetration rate of outpatient CR is low in Japan. We designed a pilot study to evaluate the safety and feasibility of tele-CR using a remote biological signal monitoring system. METHODS A total of nine patients (median aged 70.0 (66.0 - 76.0) years (male = 6) with CVD who participated in phase II CR for 1 month under the exercise prescription using the cardiopulmonary exercise test (CPET) were analyzed. They participated in the tele-CR program with a remote biological signal monitoring system (Nipro HeartLineTM, Osaka, Japan, and Duranta, Miyagi, Japan) in the CR room and were instructed by the CR staff from a separate room in the hospital. We evaluated the occurrence and degree of remote biological signal monitoring defects as safety evaluation items, i.e., whether the patients could set the remote biological signal monitoring equipment, as a feasibility evaluation item during a 3-month period. We also performed CPET at the baseline and follow-up. Following the 3-month tele-CR program, a total of 122 remote CR programs were performed using the remote biological signal monitoring system. RESULTS No patient experienced a lack of remote biological signal monitoring during exercise therapy. Significant improvement was noted in the exercise capacity, as assessed using the cardiopulmonary test (from 19.5 (16.7 - 20.2) mL/kg/min to 21.1 (17.3 - 22.8) mL/kg/min, P = 0.01, age ratio from 86% (75-96%) to 99% (78-104%), P = 0.01). One patient required support using the remote biological signal monitoring system, including information technology literacy. CONCLUSIONS This study suggests the safety and feasibility of tele-CR using the remote biological signal monitoring system. However, further investigations are required to explore the suitability, effects, and cost-effectiveness of tele-CR as an alternative to center-based CR in the future.
Collapse
Affiliation(s)
- Miho Nishitani-Yokoyama
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
- Cardiovascular Rehabilitation and Fitness, Juntendo University Hospital, Tokyo, Japan
| | - Kazunori Shimada
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Kei Fujiwara
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Abidan Abulimiti
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Hiroki Kasuya
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Mitsuhiro Kunimoto
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Yurina Yamaguchi
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Minoru Tabata
- Department of Cardiovascular Surgery, Juntendo University Graduate School of Juntendo Medicine, Tokyo, Japan
| | - Masakazu Saitoh
- Faculty of Health Science, Juntendo University, Tokyo, Japan
| | | | - Hiroyuki Daida
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
- Faculty of Health Science, Juntendo University, Tokyo, Japan
| | - Shuko Nojiri
- Medical Technology Innovation Center, Juntendo University, Tokyo, Japan
| | - Tohru Minamino
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| |
Collapse
|
59
|
Kim C, Song JH, Kim SH. Validation of Wearable Digital Devices for Heart Rate Measurement During Exercise Test in Patients With Coronary Artery Disease. Ann Rehabil Med 2023; 47:261-271. [PMID: 37536665 PMCID: PMC10475817 DOI: 10.5535/arm.23019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 06/02/2023] [Accepted: 06/22/2023] [Indexed: 08/05/2023] Open
Abstract
OBJECTIVE To assess the accuracy of recently commercialized wearable devices in heart rate (HR) measurement during cardiopulmonary exercise test (CPX) under gradual increase in exercise intensity, while wearable devices with HR monitors are reported to be less accurate in different exercise intensities. METHODS CPX was performed for patients with coronary artery disease (CAD). Twelve lead electrocardiograph (ECG) was the gold standard and Apple watch 7 (AW7), Galaxy watch 4 (GW4) and Bio Patch Mobicare 200 (MC200) were applied for comparison. Paired absolute difference (PAD), mean absolute percentage error (MAPE) and intraclass correlation coefficient (ICC) were evaluated for each device. RESULTS Forty-four participants with CAD were included. All the devices showed MAPE under 2% and ICC above 0.9 in rest, exercise and recovery phases (MC200=0.999, GW4=0.997, AW7=0.998). When comparing exercise and recovery phase, PAD of MC200 and AW7 in recovery phase were significantly bigger than PAD of exercise phase (p<0.05). Although not significant, PAD of GW4 tended to be bigger in recovery phase, too. Also, when stratified by HR 20, ICC of all the devices were highest under HR of 100, and ICC decreased as HR increased. However, except for ICC of GW4 at HR above 160 (=0.867), all ICCs exceeded 0.9 indicating excellent accuracy. CONCLUSION The HR measurement of the devices validated in this study shows a high concordance with the ECG device, so CAD patients may benefit from the devices during high-intensity exercise under conditions where HR is measured reliably.
Collapse
Affiliation(s)
- Chul Kim
- Department of Rehabilitation Medicine, Inje University Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | - Jun Hyeong Song
- Department of Rehabilitation Medicine, Inje University Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | - Seung Hyoun Kim
- Department of Rehabilitation Medicine, Inje University Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea
| |
Collapse
|
60
|
Taylor RS, Fredericks S, Jones I, Neubeck L, Sanders J, De Stoutz N, Thompson DR, Wadhwa DN, Grace SL. Global perspectives on heart disease rehabilitation and secondary prevention: a scientific statement from the Association of Cardiovascular Nursing and Allied Professions, European Association of Preventive Cardiology, and International Council of Cardiovascular Prevention and Rehabilitation. Eur Heart J 2023; 44:2515-2525. [PMID: 37477626 PMCID: PMC10361025 DOI: 10.1093/eurheartj/ehad225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 01/26/2023] [Accepted: 03/30/2023] [Indexed: 07/22/2023] Open
Abstract
Cardiovascular disease is a leading cause of death, morbidity, disability, and reduced health-related quality of life, as well as economic burden worldwide, with some 80% of disease burden occurring in the low- and middle-income country (LMIC) settings. With increasing numbers of people living longer with symptomatic disease, the effectiveness and accessibility of secondary preventative and rehabilitative health services have never been more important. Whilst LMICs experience the highest prevalence and mortality rates, the global approach to secondary prevention and cardiac rehabilitation, which mitigates this burden, has traditionally been driven from clinical guidelines emanating from high-income settings. This state-of-the art review provides a contemporary global perspective on cardiac rehabilitation and secondary prevention, contrasting the challenges of and opportunities for high vs. lower income settings. Actionable solutions to overcome system, clinician, programme, and patient level barriers to cardiac rehabilitation access in LMICs are provided.
Collapse
Affiliation(s)
- Rod S Taylor
- Former ACNAP Science committee member, Professor of Population Health, School of Health and Well Being, University of Glasgow, Glasgow G12 8QQ, UK
| | - Suzanne Fredericks
- ACNAP Science committee member, Professor, Daphne Cockwell School of Nursing, Toronto Metropolitan University, Toronto, Canada
| | - Ian Jones
- ACNAP Science committee member, Professor of Cardiovascular Nursing, Liverpool Centre for Cardiovascular Science, Liverpool John Moores University, Liverpool, UK
| | - Lis Neubeck
- ACNAP President, Professor and Head of Cardiovascular Health, Centre for Cardiovascular Health, Edinburgh Napier University, Edinburgh, UK
| | - Julie Sanders
- ACNAP Science committee chair, Director of Clinical Research, St Bartholomew’s Hospital, Barts Health NHS Trust, West Smithfield, UK
- Clinical Professor of Cardiovascular Nursing, William Harvey Research Institute, Queen Mary University of London, London, UK
| | - Noemi De Stoutz
- ESC Patient forum representative, Member of ‘Cuore Matto’ and Global ARCH, Zumikon, Switzerland
| | - David R Thompson
- EAPC representative, Professor of Nursing, School of Nursing and Midwifery, Queen’s University Belfast, Belfast, UK
| | - Deepti N Wadhwa
- ACNAP Young community member, Associate Professor, MVPS College of Physiotherapy, Nashik, India
| | - Sherry L Grace
- ICCPR Immediate past-Chair, Professor, Faculty of Health, York University, Toronto, Canada
- KITE-Toronto Rehabilitation Institute & Peter Munk Cardiac Centre, University Health Network, University of Toronto, Canada
| |
Collapse
|
61
|
Zhamaliyeva LM, Zhamankulova DG, Abenova NA, Koshmaganbetova GK. Educational Intervention Effects on Depression and Anxiety in Patients after Myocardial Infarction: A Randomized Controlled Trial. J Cardiovasc Dev Dis 2023; 10:267. [PMID: 37504523 PMCID: PMC10380402 DOI: 10.3390/jcdd10070267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Revised: 06/07/2023] [Accepted: 06/20/2023] [Indexed: 07/29/2023] Open
Abstract
Depression and anxiety in cardiovascular disease worsen the prognosis of patients. Treatments for these disorders often provide limited improvement. The present study aimed to test, for the first time, the impact of educational technology on anxiety and depressive symptoms in patients participating in a cardiac rehabilitation program. A 12-month randomized controlled trial was conducted, in which 207 patients were randomly assigned to either the experimental (n = 76) or control (n = 69) groups. The intervention involved a structured patient education program provided by medical students who had undergone specially designed training in cardiac rehabilitation. The primary outcomes were death, hospitalization, heart failure, and recurrent myocardial infarction. The study also assessed anxiety and depression. A year later, the experimental group showed a statistically significant decrease in anxiety and depression on the HADS scale, with reductions of 2.0 and 1.9 points, respectively (p < 0.05). The control group showed reductions of 1.5 and 1.2 points (p < 0.05). The difference in the Hamilton Rating Scale for Depression between the groups at 12 months was -1.29 in favor of the main group (95% CI, -0.7 to -1.88), and the standardized mean difference was 0.36 (95% CI, 0.03 to 0.69). No treatment-related adverse events were observed. The results suggest that educational interventions can have a positive impact on mental health. The study's strengths include a structured intervention, randomization, and long-term follow-up. The limitations include the lack of blinding of study participants and a relatively small sample size.
Collapse
Affiliation(s)
- Lazzat M Zhamaliyeva
- Department of Family Medicine, West Kazakhstan Marat Ospanov Medical University, Aktobe 030019, Kazakhstan
| | - Damira G Zhamankulova
- Department of Internal Diseases, West Kazakhstan Marat Ospanov Medical University, Aktobe 030019, Kazakhstan
| | - Nurgul A Abenova
- Department of General Practice 1, West Kazakhstan Marat Ospanov Medical University, Aktobe 030019, Kazakhstan
| | - Gulbakit K Koshmaganbetova
- Department of Master's and Doctoral Studies, West Kazakhstan Marat Ospanov Medical University, Aktobe 030019, Kazakhstan
| |
Collapse
|
62
|
White DA, Layton AM, Curran T, Gauthier N, Orr WB, Ward K, Vernon M, Martinez MN, Rice MC, Hansen K, Prusi M, Hansen JE. ehealth technology in cardiac exercise therapeutics for pediatric patients with congenital and acquired heart conditions: a summary of evidence and future directions. Front Cardiovasc Med 2023; 10:1155861. [PMID: 37332590 PMCID: PMC10272804 DOI: 10.3389/fcvm.2023.1155861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 05/18/2023] [Indexed: 06/20/2023] Open
Abstract
Many children and adolescents with congenital and acquired heart disease (CHD) are physically inactive and participate in an insufficient amount of moderate-to-vigorous intensity exercise. Although physical activity (PA) and exercise interventions are effective at improving short- and long-term physiological and psychosocial outcomes in youth with CHD, several barriers including resource limitations, financial costs, and knowledge inhibit widespread implementation and dissemination of these beneficial programs. New and developing eHealth, mHealth, and remote monitoring technologies offer a potentially transformative and cost-effective solution to increase access to PA and exercise programs for youth with CHD, yet little has been written on this topic. In this review, a cardiac exercise therapeutics (CET) model is presented as a systematic approach to PA and exercise, with assessment and testing guiding three sequential PA and exercise intervention approaches of progressive intensity and resource requirements: (1) PA and exercise promotion within a clinical setting; (2) unsupervised exercise prescription; and (3) medically supervised fitness training intervention (i.e., cardiac rehabilitation). Using the CET model, the goal of this review is to summarize the current evidence describing the application of novel technologies within CET in populations of children and adolescents with CHD and introduce potential future applications of these technologies with an emphasis on improving equity and access to patients in low-resource settings and underserved communities.
Collapse
Affiliation(s)
- David A. White
- Ward Family Heart Center, Children’s Mercy Kansas City, Kansas City, MO, United States
- School of Medicine, University of Missouri Kansas City, Kansas City, MO, United States
| | - Aimee M. Layton
- Division of Pediatric Cardiology, Department of Pediatrics, Columbia University Irving Medical Center, New York, NY, United States
| | - Tracy Curran
- Department of Cardiology, Boston Children’s Hospital, Boston, MA, United States
| | - Naomi Gauthier
- Department of Cardiology, Boston Children’s Hospital, Boston, MA, United States
| | - William B. Orr
- Division of Pediatric Cardiology, Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, United States
| | - Kendra Ward
- Division of Cardiology, Department of Pediatrics, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL, United States
| | - Meg Vernon
- Division of Cardiology, Department of Pediatrics, Seattle Children’s Hospital, Seattle, WA, United States
| | - Matthew N. Martinez
- Division of Pediatric Cardiology, Department of Pediatrics, Hassenfeld Children’s Hospital at NYU Langone, New York, NY, United States
| | - Malloree C. Rice
- Division of Pediatric Cardiology, Heart Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, United States
| | - Katherine Hansen
- Department of Cardiology, Boston Children’s Hospital, Boston, MA, United States
| | - Megan Prusi
- Division of Pediatric Cardiology, Department of Pediatrics, C.S. Mott Children’s Hospital, Ann Arbor, MI, United States
| | - Jesse E. Hansen
- Division of Pediatric Cardiology, Department of Pediatrics, C.S. Mott Children’s Hospital, Ann Arbor, MI, United States
| |
Collapse
|
63
|
Shields GE, Rowlandson A, Dalal G, Nickerson S, Cranmer H, Capobianco L, Doherty P. Cost-effectiveness of home-based cardiac rehabilitation: a systematic review. Heart 2023; 109:913-920. [PMID: 36849233 DOI: 10.1136/heartjnl-2021-320459] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Accepted: 02/07/2023] [Indexed: 03/01/2023] Open
Abstract
OBJECTIVE Centre-based cardiac rehabilitation (CR) is recognised as cost-effective for individuals following a cardiac event. However, home-based alternatives are becoming increasingly popular, especially since COVID-19, which necessitated alternative modes of care delivery. This review aimed to assess whether home-based CR interventions are cost-effective (vs centre-based CR). METHODS Using the MEDLINE, Embase and PsycINFO databases, literature searches were conducted in October 2021 to identify full economic evaluations (synthesising costs and effects). Studies were included if they focused on home-based elements of a CR programme or full home-based programmes. Data extraction and critical appraisal were completed using the NHS EED handbook, Consolidated Health Economic Evaluation Reporting Standards and Drummond checklists and were summarised narratively. The protocol was registered on the PROSPERO database (CRD42021286252). RESULTS Nine studies were included in the review. Interventions were heterogeneous in terms of delivery, components of care and duration. Most studies were economic evaluations within clinical trials (8/9). All studies reported quality-adjusted life years, with the EQ-5D as the most common measure of health status (6/9 studies). Most studies (7/9 studies) concluded that home-based CR (added to or replacing centre-based CR) was cost-effective compared with centre-based options. CONCLUSIONS Evidence suggests that home-based CR options are cost-effective. The limited size of the evidence base and heterogeneity in methods limits external validity. There were further limitations to the evidence base (eg, limited sample sizes) that increase uncertainty. Future research is needed to cover a greater range of home-based designs, including home-based options for psychological care, with greater sample sizes and the potential to acknowledge patient heterogeneity.
Collapse
Affiliation(s)
- Gemma E Shields
- Manchester Centre for Health Economics, The University of Manchester, Manchester, UK
| | - Aleix Rowlandson
- Manchester Centre for Health Economics, The University of Manchester, Manchester, UK
| | - Garima Dalal
- Manchester Centre for Health Economics, The University of Manchester, Manchester, UK
| | - Stuart Nickerson
- Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | | | - Lora Capobianco
- Research and Innovation, Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
- School of Psychological Sciences, The University of Manchester, Manchester, UK
| | | |
Collapse
|
64
|
Bernardo Ferreira J, Cabral M, Santos R, Ferreira M, Fonseca-Pinto R, Antunes A, Januário F. Hybrid Cardiac Telerehabilitation After Acute Coronary Syndrome: Self-selection Predictors and Outcomes. Int J Telerehabil 2023; 15:e6475. [PMID: 38046554 PMCID: PMC10687976 DOI: 10.5195/ijt.2023.6475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2023] Open
Abstract
Aims To evaluate the effectiveness of a hybrid cardiac telerehabilitation (HCTR) program after acute coronary syndrome (ACS) on patient quality of life (QoL) and physical activity indices throughout phases 2-3 and establish predictors for hybrid program self-selection. Methodology This single-centre longitudinal retrospective study included patients who attended a cardiac rehabilitation program (CRP) between 2018-2021. Patients self-selected between two groups: Group 1 - conventional CRP (CCRP); Group 2 - HCTR. Baseline characteristics were registered. EuroQol-5D (EQ-5D) and International Physical Activity Questionnaire (IPAQ) were applied at three times: T0 - phase 2 onset; T1 - phase 3 onset; T2 - 3 months after T1. Results 59 patients participated (Group 1 - 27; Group 2 - 32). We found significant between-group differences regarding occupation (p=0.003). Diabetic patients were less likely to self-select into HCTR (OR=0.21; p<0.05). EQ-5D visual analogue scale and IPAQ result significantly improved between T0-T2 only for HCTR (p=0.001; p=0.021). Conclusions HCTR was superior to CCRP on physical activity indices and QoL of ACS patients.
Collapse
Affiliation(s)
- José Bernardo Ferreira
- Physical and Rehabilitation Medicine Department, Leiria Hospital Centre, Leiria, Portugal
| | | | - Rita Santos
- Physical and Rehabilitation Medicine Department, Leiria Hospital Centre, Leiria, Portugal
| | - Marta Ferreira
- Centro De Matemática, Universidade Do Minho, Braga, Portugal
| | - Rui Fonseca-Pinto
- CiTechcare-Center for Innovative Care and Health Technology, Polytechnic of Leiria, Leiria, Portugal
| | - Alexandre Antunes
- Cardiology Department, Leiria Hospital Centre, Leiria, Portugal
- CiTechcare-Center for Innovative Care and Health Technology, Polytechnic of Leiria, Leiria, Portugal
| | - Filipa Januário
- Physical and Rehabilitation Medicine Department, Leiria Hospital Centre, Leiria, Portugal
| |
Collapse
|
65
|
Saeki H, Kuramoto M, Iida Y, Yasumura K, Arita Y, Ogasawara N. Effect of Constant vs. Variable Moderate-Intensity Load on Peak Oxygen Uptake in Outpatient Cardiac Rehabilitation. Circ Rep 2023; 5:167-176. [PMID: 37180472 PMCID: PMC10166670 DOI: 10.1253/circrep.cr-23-0024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 03/06/2023] [Indexed: 04/04/2023] Open
Abstract
Background: In outpatient center-based cardiac rehabilitation (O-CBCR), moderate-intensity continuous training (MICT) based on the anaerobic threshold (AT) determined by cardiopulmonary exercise stress testing is recommended. However, it is unclear whether differences in exercise intensity within the MICT domain affect peak oxygen uptake (%peakV̇O2). Methods and Results: We retrospectively evaluated patients who underwent O-CBCR at Japan Community Healthcare Organization Osaka Hospital. Those treated with the constant-load method were designated as Group A (n=38), whereas those treated with the variable-load method were designated as Group B (n=48). Although the change in exercise intensity was significantly greater in Group B by approximately 4.5 W, the change in %peakV̇O2 was not significantly different between groups. Group A had a significantly longer exercise time than Group B (by approximately 4-5 min). No deaths or hospitalizations occurred in either group. The percentage of episodes with exercise cessation was similar between the 2 groups, but the percentage of episodes with load reduction was significantly higher in Group B, mostly because of the increased heart rate. Conclusions: In supervised MICT based on AT, the variable-load method increased exercise intensity more than the constant-load method without severe complications, but did not improve %peakV̇O2.
Collapse
Affiliation(s)
- Hajime Saeki
- Japan Community Healthcare Organization Osaka Hospital Osaka Japan
| | - Miho Kuramoto
- Japan Community Healthcare Organization Osaka Hospital Osaka Japan
| | - Yoshinori Iida
- Japan Community Healthcare Organization Osaka Hospital Osaka Japan
| | - Kaori Yasumura
- Japan Community Healthcare Organization Osaka Hospital Osaka Japan
| | - Yoh Arita
- Japan Community Healthcare Organization Osaka Hospital Osaka Japan
| | | |
Collapse
|
66
|
Pelly M, Fatehi F, Liew D, Verdejo-Garcia A. Artificial intelligence for secondary prevention of myocardial infarction: A qualitative study of patient and health professional perspectives. Int J Med Inform 2023; 173:105041. [PMID: 36934609 DOI: 10.1016/j.ijmedinf.2023.105041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 01/30/2023] [Accepted: 03/08/2023] [Indexed: 03/14/2023]
Abstract
BACKGROUND Artificial intelligence (AI) has potential to improve self-management of several chronic conditions. However, the perspective of patients and healthcare professionals regarding AI-enabled health management programs, which are key to successful implementation, remains poorly understood. PURPOSE To explore the opinions of people with a history of myocardial infarction (PHMI) and health professionals on the use of AI for secondary prevention of MI. PROCEDURE Three rounds of focus groups were conducted via videoconferencing with 38 participants: 22 PHMI and 16 health professionals. FINDINGS We identified 21 concepts stemming from participants' views, which we classified into five categories: Trust; Expected Functions; Adoption; Concerns; and Perceived Benefits. Trust covered the credibility of information and safety to believe health advice. Expected Functions covered tailored feedback and personalised advice. Adoption included usability features and overall interest in AI. Concerns originated from previous negative experience with AI. Perceived Benefits included the usefulness of AI to provide advice when regular contact with healthcare services is not feasible. Health professionals were more optimistic than PHMI about the usefulness of AI for improving health behaviour. CONCLUSIONS Altogether, our findings provide key insights from end-users to improve the likelihood of successful implementation and adoption of AI-enabled systems in the context of MI, as an exemplar of broader applications in chronic disease management.
Collapse
Affiliation(s)
- Melissa Pelly
- School of Psychological Sciences and Turner Institute for Brain and Mental Health, Monash University, Clayton, VIC 3800, Australia.
| | - Farhad Fatehi
- School of Psychological Sciences and Turner Institute for Brain and Mental Health, Monash University, Clayton, VIC 3800, Australia.
| | - Danny Liew
- School of Public Health and Preventive Medicine, Monash University, Clayton, VIC 3800, Australia; The Alfred Hospital, 55 Commercial Rd, Melbourne, VIC 3800, Australia.
| | - Antonio Verdejo-Garcia
- School of Psychological Sciences and Turner Institute for Brain and Mental Health, Monash University, Clayton, VIC 3800, Australia.
| |
Collapse
|
67
|
Maruf FA, Mohammed J. Unmet Needs for Cardiac Rehabilitation in Africa: A Perennial Gap in the Management of Individuals with Cardiac Diseases. High Blood Press Cardiovasc Prev 2023; 30:199-206. [PMID: 37093446 DOI: 10.1007/s40292-023-00573-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 04/04/2023] [Indexed: 04/25/2023] Open
Abstract
Cardiac rehabilitation (CR) is a standard model of care, and an established component of comprehensive care that has been proven to reduce mortality and morbidity in patients with cardiac diseases. International clinical practice guidelines routinely recommend that cardiac patients participate in CR programs for comprehensive secondary prevention. However, there is scant guidance on how to deliver these programs in low-resourced settings. This dearth of clinical practice guidelines may be an indication of low emphasis placed on CR as a component of cardiac health services in low-income countries, especially in Africa. Indeed, CR programs are almost non-existent in Africa despite the unmet need for CR in patients with ischemic heart disease in Africa reported to be about one million. This figure represents the highest unmet need of any World Health Organization region, and is colossal given the projected accelerated increases in incidence of cardiovascular diseases (CVD) in the region. This narrative review explored the availability of CR programs, potential barriers to CR and strategies that can mitigate such barriers in Africa.
Collapse
Affiliation(s)
- Fatai Adesina Maruf
- Department of Medical Rehabilitation, Faculty of Health Sciences and Technology, Nnamdi Azikiwe University, Nnewi Campus, Nnewi, Nigeria.
| | - Jibril Mohammed
- Department of Physiotherapy, Bayero University, Kano, Nigeria
| |
Collapse
|
68
|
Sachdev V, Sharma K, Keteyian SJ, Alcain CF, Desvigne-Nickens P, Fleg JL, Florea VG, Franklin BA, Guglin M, Halle M, Leifer ES, Panjrath G, Tinsley EA, Wong RP, Kitzman DW. Supervised Exercise Training for Chronic Heart Failure With Preserved Ejection Fraction: A Scientific Statement From the American Heart Association and American College of Cardiology. J Am Coll Cardiol 2023; 81:1524-1542. [PMID: 36958952 DOI: 10.1016/j.jacc.2023.02.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/25/2023]
Abstract
Heart failure with preserved ejection fraction (HFpEF) is one of the most common forms of heart failure; its prevalence is increasing, and outcomes are worsening. Affected patients often experience severe exertional dyspnea and debilitating fatigue, as well as poor quality of life, frequent hospitalizations, and a high mortality rate. Until recently, most pharmacological intervention trials for HFpEF yielded neutral primary outcomes. In contrast, trials of exercise-based interventions have consistently demonstrated large, significant, clinically meaningful improvements in symptoms, objectively determined exercise capacity, and usually quality of life. This success may be attributed, at least in part, to the pleiotropic effects of exercise, which may favorably affect the full range of abnormalities-peripheral vascular, skeletal muscle, and cardiovascular-that contribute to exercise intolerance in HFpEF. Accordingly, this scientific statement critically examines the currently available literature on the effects of exercise-based therapies for chronic stable HFpEF, potential mechanisms for improvement of exercise capacity and symptoms, and how these data compare with exercise therapy for other cardiovascular conditions. Specifically, data reviewed herein demonstrate a comparable or larger magnitude of improvement in exercise capacity from supervised exercise training in patients with chronic HFpEF compared with those with heart failure with reduced ejection fraction, although Medicare reimbursement is available only for the latter group. Finally, critical gaps in implementation of exercise-based therapies for patients with HFpEF, including exercise setting, training modalities, combinations with other strategies such as diet and medications, long-term adherence, incorporation of innovative and more accessible delivery methods, and management of recently hospitalized patients are highlighted to provide guidance for future research.
Collapse
|
69
|
Nery RM, dos Santos AC, Garcia EL. Exercise-Based Cardiac Rehabilitation (ECBR): New Frontiers in the Post-Novel Coronavirus. Arq Bras Cardiol 2023; 120:e20230120. [PMID: 37042881 PMCID: PMC10392857 DOI: 10.36660/abc.20230120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/13/2023] Open
Affiliation(s)
- Rosane Maria Nery
- Hospital de Clínicas de Porto AlegreGrupo de pesquisa em cardiologia do exercícioPorto AlegreRSBrasilHospital de Clínicas de Porto Alegre – Grupo de pesquisa em cardiologia do exercício (CardioEx), Porto Alegre, RS – Brasil
- Hospital de Clínicas de Porto AlegreGrupo de pesquisa em cirurgia vascular e exercícioPorto AlegreRSBrasilHospital de Clínicas de Porto Alegre – Grupo de pesquisa em cirurgia vascular e exercício (VascoEx), Porto Alegre, RS – Brasil
- Hospital de Clínicas de Porto AlegreServiço de fisiatria e reabilitaçãoPorto AlegreRSBrasilHospital de Clínicas de Porto Alegre – Serviço de fisiatria e reabilitação, Porto Alegre, RS – Brasil
| | - Antonio Cardoso dos Santos
- Hospital de Clínicas de Porto AlegreServiço de fisiatria e reabilitaçãoPorto AlegreRSBrasilHospital de Clínicas de Porto Alegre – Serviço de fisiatria e reabilitação, Porto Alegre, RS – Brasil
- Universidade Federal do Rio Grande do SulDepartamento de cirurgiaPorto AlegreRSBrasilUniversidade Federal do Rio Grande do Sul, Departamento de cirurgia, Porto Alegre, RS – Brasil
| | - Eduardo Lima Garcia
- Hospital de Clínicas de Porto AlegreGrupo de pesquisa em cirurgia vascular e exercícioPorto AlegreRSBrasilHospital de Clínicas de Porto Alegre – Grupo de pesquisa em cirurgia vascular e exercício (VascoEx), Porto Alegre, RS – Brasil
| |
Collapse
|
70
|
Youn JC, Kim D, Cho JY, Cho DH, Park SM, Jung MH, Hyun J, Cho HJ, Park SM, Choi JO, Chung WJ, Yoo BS, Kang SM. Korean Society of Heart Failure Guidelines for the Management of Heart Failure: Treatment. Korean Circ J 2023; 53:217-238. [PMID: 37161681 PMCID: PMC10172201 DOI: 10.4070/kcj.2023.0047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 03/22/2023] [Accepted: 04/04/2023] [Indexed: 05/11/2023] Open
Abstract
The Korean Society of Heart Failure (KSHF) guidelines aim to provide physicians with evidence-based recommendations for the management of patients with heart failure (HF). After the first introduction of the KSHF guidelines in 2016, newer therapies for HF with reduced ejection fraction, HF with mildly reduced ejection fraction, and HF with preserved ejection fraction have since emerged. The current version has been updated based on international guidelines and research data on Korean patients with HF. Herein, we present Part II of these guidelines, which comprises treatment strategies to improve the outcomes of patients with HF.
Collapse
Affiliation(s)
- Jong-Chan Youn
- Division of Cardiology, Department of Internal Medicine, Seoul St. Mary's Hospital, Catholic Research Institute for Intractable Cardiovascular Disease, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Darae Kim
- Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jae Yeong Cho
- Department of Cardiovascular Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Dong-Hyuk Cho
- Division of Cardiology, Department of Internal Medicine, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Sang Min Park
- Department of Cardiology, Nowon Eulji Medical Center, Eulji University, Seoul, Korea
| | - Mi-Hyang Jung
- Division of Cardiology, Department of Internal Medicine, Seoul St. Mary's Hospital, Catholic Research Institute for Intractable Cardiovascular Disease, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Junho Hyun
- Division of Cardiology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hyun-Jai Cho
- Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea.
| | - Seong-Mi Park
- Division of Cardiology, Department of Internal Medicine, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Jin-Oh Choi
- Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Wook-Jin Chung
- Division of Cardiology, Department of Internal Medicine, Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
| | - Byung-Su Yoo
- Division of Cardiology, Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Seok-Min Kang
- Division of Cardiology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| |
Collapse
|
71
|
Youn JC, Kim D, Cho JY, Cho DH, Park SM, Jung MH, Hyun J, Cho HJ, Park SM, Choi JO, Chung WJ, Yoo BS, Kang SM. Korean Society of Heart Failure Guidelines for the Management of Heart Failure: Treatment. INTERNATIONAL JOURNAL OF HEART FAILURE 2023; 5:66-81. [PMID: 37180564 PMCID: PMC10172080 DOI: 10.36628/ijhf.2023.0011] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 03/17/2023] [Accepted: 03/27/2023] [Indexed: 05/16/2023]
Abstract
The Korean Society of Heart Failure (KSHF) guidelines aim to provide physicians with evidence-based recommendations for the management of patients with heart failure (HF). After the first introduction of the KSHF guidelines in 2016, newer therapies for HF with reduced ejection fraction, HF with mildly reduced ejection fraction, and HF with preserved ejection fraction have since emerged. The current version has been updated based on international guidelines and research data on Korean patients with HF. Herein, we present Part II of these guidelines, which comprises treatment strategies to improve the outcomes of patients with HF.
Collapse
Affiliation(s)
- Jong-Chan Youn
- Division of Cardiology, Department of Internal Medicine, Seoul St. Mary’s Hospital, Catholic Research Institute for Intractable Cardiovascular Disease, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Darae Kim
- Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jae Yeong Cho
- Department of Cardiovascular Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Dong-Hyuk Cho
- Division of Cardiology, Department of Internal Medicine, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Sang Min Park
- Department of Cardiology, Nowon Eulji Medical Center, Eulji University, Seoul, Korea
| | - Mi-Hyang Jung
- Division of Cardiology, Department of Internal Medicine, Seoul St. Mary’s Hospital, Catholic Research Institute for Intractable Cardiovascular Disease, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Junho Hyun
- Division of Cardiology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hyun-Jai Cho
- Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Seong-Mi Park
- Division of Cardiology, Department of Internal Medicine, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Jin-Oh Choi
- Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Wook-Jin Chung
- Division of Cardiology, Department of Internal Medicine, Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
| | - Byung-Su Yoo
- Division of Cardiology, Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Seok-Min Kang
- Division of Cardiology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | | |
Collapse
|
72
|
Krishnamurthi N, Schopfer DW, Shen H, Rohrbach G, Elnaggar A, Whooley MA. Association of Home-Based Cardiac Rehabilitation With Lower Mortality in Patients With Cardiovascular Disease: Results From the Veterans Health Administration Healthy Heart Program. J Am Heart Assoc 2023; 12:e025856. [PMID: 36856057 PMCID: PMC10111465 DOI: 10.1161/jaha.122.025856] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/02/2023]
Abstract
Background Home-based cardiac rehabilitation (HBCR) and traditional facility-based cardiac rehabilitation (CR) programs have similar effects on mortality in clinical trials and meta-analyses. However, the effect of HBCR on mortality in clinical practice settings is less clear. Therefore, we sought to compare mortality rates in HBCR participants versus nonparticipants. Methods and Results We evaluated all patients who were referred to and eligible for outpatient CR between 2013 and 2018 at the San Francisco Veterans Health Administration. Patients who chose to attend facility-based CR and those who died within 30 days of hospitalization were excluded. Patients who chose to participate in HBCR received up to 9 telephonic coaching and motivational interviewing sessions over 12 weeks. All patients were followed through June 30, 2021. We used Cox proportional hazards regression models with inverse probability treatment weighting to compare mortality in HBCR participants versus nonparticipants. Of the 1120 patients (mean age 68, 98% male, 76% White) who were referred and eligible, 490 (44%) participated in HBCR. During a median follow-up of 4.2 years, 185 patients (17%) died. Mortality was lower among the 490 HBCR participants versus the 630 nonparticipants (12% versus 20%; P<0.01). In an inverse probability weighted Cox regression analysis adjusted for patient demographics and comorbid conditions, the hazard of mortality remained 36% lower among HBCR participants versus nonparticipants (hazard ratio, 0.64 [95% CI, 0.45-0.90], P=0.01). Conclusions Among patients eligible for CR, participation in HBCR was associated with 36% lower hazard of mortality. Although unmeasured confounding can never be eliminated in an observational study, our findings suggest that HBCR may benefit patients who cannot attend traditional CR programs.
Collapse
Affiliation(s)
- Nirupama Krishnamurthi
- Icahn School of Medicine at Mount Sinai New York NY.,Department of Cardiology Mount Sinai Morningside New York NY.,San Francisco Veterans Affairs Medical Center San Francisco CA
| | | | - Hui Shen
- San Francisco Veterans Affairs Medical Center San Francisco CA.,Department of Medicine University of California San Francisco CA
| | | | - Abdelaziz Elnaggar
- San Francisco Veterans Affairs Medical Center San Francisco CA.,Department of Medicine University of California San Francisco CA
| | - Mary A Whooley
- San Francisco Veterans Affairs Medical Center San Francisco CA.,Department of Medicine University of California San Francisco CA.,Department of Epidemiology and Biostatistics University of California San Francisco San Francisco CA
| |
Collapse
|
73
|
Guo M, Gu M, Gu Y, Zhu J, Huo B, Wang D. The impacts of the combination service model of cardiac rehabilitation on patient outcomes: evidence from a hospital experience. Biotechnol Genet Eng Rev 2023:1-20. [PMID: 36823969 DOI: 10.1080/02648725.2023.2180718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 02/06/2023] [Indexed: 02/25/2023]
Abstract
This research is to test whether the combination model (CM) (combining cardiac rehabilitation (CR) with other cardiovascular medical services) impact patients' readmissions, physical and psychological outcomes. We found that CM significantly enhances patients' exercise ability and psychological condition and reduces readmission rates after discharged from the hospital, compared to patients that are admitted to non-CM. Departments' physical resources weaken the impact of CM on patients' physical outcomes and readmission rates while increasing patients' psychological conditions. Human resources strengthen the impact of CM on patients' readmission rates while reducing the impact on patients' physical outcomes. Our results provide empirical evidence for hospital resource constraints puzzle and reallocation. These results provide a possibility of introducing CM as a way to deal with CR implementing challenges.
Collapse
Affiliation(s)
- Mengqiu Guo
- College of Management and Economics, Tianjin University, Tianjin, China
- School of Management, Zhengzhou University, Zhengzhou, Henan, China
| | - Minhao Gu
- College of Management and Economics, Tianjin University, Tianjin, China
| | - Yingchun Gu
- Department of Cardiac Rehabilitation, Zhengzhou Central Hospital Affiliated to Zhengzhou University, Zhengzhou, Henan, China
| | - Jinyun Zhu
- Department of Cardiology, Second Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Baofeng Huo
- School of Management, Zhejiang University, Hangzhou, Zhejiang, China
| | - Dongwei Wang
- Department of Cardiac Rehabilitation, Zhengzhou Central Hospital Affiliated to Zhengzhou University, Zhengzhou, Henan, China
| |
Collapse
|
74
|
Zhong W, Fu C, Xu L, Sun X, Wang S, He C, Wei Q. Effects of home-based cardiac telerehabilitation programs in patients undergoing percutaneous coronary intervention: a systematic review and meta-analysis. BMC Cardiovasc Disord 2023; 23:101. [PMID: 36814188 PMCID: PMC9945630 DOI: 10.1186/s12872-023-03120-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Accepted: 02/13/2023] [Indexed: 02/24/2023] Open
Abstract
BACKGROUND Recent advances in telecommunications technology have raised the possibility of telehealth intervention delivering cardiac telerehabilitation, which may provide the efficacy of health services in patients after percutaneous coronary intervention (PCI). This study aimed to investigate the effects of home-based cardiac telerehabilitation (HBCTR) in patients undergoing PCI. METHODS We performed a comprehensive search of the following electronic databases: PubMed, Cochrane Central, Web of Science, Embase, CNKI, and WANFANG. For the prespecified outcomes, the primary outcomes were results of physical function (the six-minute walking test, 6MWT) and quality of life (QoL) of the participants. The secondary outcomes were results of (1) blood pressure; (2) full lipid profile (3) reliable assessment of anxiety and depression in patients. RESULTS All studies were conducted between 2013 and 2022, and a total of 5 articles could be included in the quantitative meta-analysis. The results showed that there was a statistically significant difference between the HBCTR intervention group and the control group in 6WMT (MD 16.59, 95%CI 7.13 to 26.06, P = 0.0006), but there was no difference in QoL (SMD - 0.25, 95%CI - 1.63 to 1.13, P = 0.73). According to the fixed effects model, there was a statistically significant difference between the HBCTR group versus the control group (MD - 2.88, 95%CI - 5.19 to - 0.57, P = 0.01), but not in diastolic blood pressure. Likewise, significant improvements of triglycerides and in low-density lipoprotein cholesterol were observed in HBTCR groups, but no significant differences were observed regarding total cholesterol and high-density lipoprotein cholesterol. CONCLUSION This systematic review and meta-analysis have proven that the HBCTR is one of the promisingly effective cardiac rehabilitation strategies that improve cardiorespiratory fitness and reduce cardiovascular disease risk factors. With the continuous improvement of the telerehabilitation network, it is expected to serve in clinical.
Collapse
Affiliation(s)
- Wen Zhong
- Department of Rehabilitation Medicine Center and Institute of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China.,Key Laboratory of Rehabilitation Medicine in Sichuan Province, Chengdu, Sichuan, People's Republic of China
| | - Chenying Fu
- State Key Laboratory of Biotherapy and National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China.,Aging and Geriatric Mechanism Laboratory, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China
| | - Lin Xu
- Department of Rehabilitation Medicine Center and Institute of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China.,Key Laboratory of Rehabilitation Medicine in Sichuan Province, Chengdu, Sichuan, People's Republic of China
| | - Xin Sun
- Department of Rehabilitation Medicine Center and Institute of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China.,Key Laboratory of Rehabilitation Medicine in Sichuan Province, Chengdu, Sichuan, People's Republic of China
| | - Shiqi Wang
- Department of Rehabilitation Medicine Center and Institute of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China.,Key Laboratory of Rehabilitation Medicine in Sichuan Province, Chengdu, Sichuan, People's Republic of China
| | - Chengqi He
- Department of Rehabilitation Medicine Center and Institute of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China.,Key Laboratory of Rehabilitation Medicine in Sichuan Province, Chengdu, Sichuan, People's Republic of China
| | - Quan Wei
- Department of Rehabilitation Medicine Center and Institute of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China. .,Key Laboratory of Rehabilitation Medicine in Sichuan Province, Chengdu, Sichuan, People's Republic of China.
| |
Collapse
|
75
|
Lăcraru AE, Busnatu ȘS, Pană MA, Olteanu G, Șerbănoiu L, Gand K, Schlieter H, Kyriazakos S, Ceban O, Andrei CL, Sinescu CJ. Assessing the Efficacy of a Virtual Assistant in the Remote Cardiac Rehabilitation of Heart Failure and Ischemic Heart Disease Patients: Case-Control Study of Romanian Adult Patients. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3937. [PMID: 36900948 PMCID: PMC10002163 DOI: 10.3390/ijerph20053937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 02/17/2023] [Accepted: 02/19/2023] [Indexed: 06/18/2023]
Abstract
Cardiovascular diseases (CVDs) are the leading cause of mortality in Europe, with potentially more than 60 million deaths per year, with an age-standardized rate of morbidity-mortality higher in men than women, exceeding deaths from cancer. Heart attacks and strokes account for more than four out of every five CVD fatalities globally. After a patient overcomes an acute cardiovascular event, they are referred for rehabilitation to help them to restore most of their normal cardiac functions. One effective way to provide this activity regimen is via virtual models or telerehabilitation, where the patient can avail themselves of the rehabilitation services from the comfort of their homes at designated timings. Under the funding of the European Union's Horizon 2020 Research and Innovation program, grant no 769807, a virtual rehabilitation assistant has been designed for elderly patients (vCare), with the overall objective of supporting recovery and an active life at home, enhancing patients' quality of life, lowering disease-specific risk factors, and ensuring better adherence to a home rehabilitation program. In the vCare project, the Carol Davila University of Bucharest (UMFCD) was in charge of the heart failure (HF) and ischemic heart disease (IHD) groups of patients. By creating a digital environment at patients' homes, the vCare system's effectiveness, use, and feasibility was evaluated. A total of 30 heart failure patients and 20 ischemic heart disease patients were included in the study. Despite the COVID-19 restrictions and a few technical difficulties, HF and IHD patients who performed cardiac rehabilitation using the vCare system had similar results compared to the ambulatory group, and better results compared to the control group.
Collapse
Affiliation(s)
- Andreea-Elena Lăcraru
- Department of Cardiology, University of Medicine and Pharmacy “Carol Davila”, Emergency Hospital “Bagdasar-Arseni”, 050474 Bucharest, Romania
| | - Ștefan-Sebastian Busnatu
- Department of Cardiology, University of Medicine and Pharmacy “Carol Davila”, Emergency Hospital “Bagdasar-Arseni”, 050474 Bucharest, Romania
| | - Maria-Alexandra Pană
- Department of Cardiology, University of Medicine and Pharmacy “Carol Davila”, Emergency Hospital “Bagdasar-Arseni”, 050474 Bucharest, Romania
| | - Gabriel Olteanu
- Department of Cardiology, University of Medicine and Pharmacy “Carol Davila”, Emergency Hospital “Bagdasar-Arseni”, 050474 Bucharest, Romania
| | - Liviu Șerbănoiu
- Department of Cardiology, University of Medicine and Pharmacy “Carol Davila”, Emergency Hospital “Bagdasar-Arseni”, 050474 Bucharest, Romania
| | - Kai Gand
- Research Group Digital Health, Faculty of Business and Economics, Technische Universitat Dresden, 01062 Dresden, Germany
| | - Hannes Schlieter
- Research Group Digital Health, Faculty of Business and Economics, Technische Universitat Dresden, 01062 Dresden, Germany
| | - Sofoklis Kyriazakos
- Department of Business Development and Technology, Aarhus University, 7400 Aarhus, Denmark
| | - Octavian Ceban
- Economic Cybernetics and Informatics Department, University of Economic Studies, 010374 Bucharest, Romania
| | - Cătălina Liliana Andrei
- Department of Cardiology, University of Medicine and Pharmacy “Carol Davila”, Emergency Hospital “Bagdasar-Arseni”, 050474 Bucharest, Romania
| | - Crina-Julieta Sinescu
- Department of Cardiology, University of Medicine and Pharmacy “Carol Davila”, Emergency Hospital “Bagdasar-Arseni”, 050474 Bucharest, Romania
| |
Collapse
|
76
|
Leung T, Doyle J, Smith S, Vavasour G, Moran O, Gavin S, Sojan N, Boyle G. Remotely Delivered Cardiac Rehabilitation Exercise for Coronary Heart Disease: Nonrandomized Feasibility Study. JMIR Cardio 2023; 7:e40283. [PMID: 36763453 PMCID: PMC9960022 DOI: 10.2196/40283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 11/10/2022] [Accepted: 11/25/2022] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Exercise-based cardiac rehabilitation (CR) is recommended for coronary heart disease (CHD). However, poor uptake of and poor adherence to CR exercise programs have been reported globally. Delivering CR exercise classes remotely may remove some of the barriers associated with traditional hospital- or center-based CR. OBJECTIVE We have developed a bespoke platform, Eastern Corridor Medical Engineering Centre-Cardiac Rehabilitation (ECME-CR), to support remotely delivered CR exercise. This pilot trial sought to test the ECME-CR platform and examine the efficacy and feasibility of a remote CR exercise program compared to a traditional center-based program. METHODS In all, 21 participants with CHD were recruited and assigned to either the intervention or control group. Both groups performed the same 8-week exercise program. Participants in the intervention group took part in web-based exercise classes and used the ECME-CR platform during the intervention period, whereas participants in the control group attended in-person classes. Outcomes were assessed at baseline and following the 8-week intervention period. The primary outcome measure was exercise capacity, assessed using a 6-minute walk test (6MWT). Secondary outcomes included measurement of grip strength, self-reported quality of life, heart rate, blood pressure, and body composition. A series of mixed between-within subjects ANOVA were conducted to examine the mean differences in study outcomes between and within groups. Participant adherence to the exercise program was also analyzed. RESULTS In all, 8 participants (male: n=5; age: mean 69.7, SD 7.2 years; height: mean 163.9, SD 5.4 cm; weight: mean 81.6, SD 14.1 kg) in the intervention group and 9 participants (male: n=9; age: mean 69.8, SD 8.2 years; height: mean 173.8, SD 5.2 cm; weight: mean 94.4, SD 18.0 kg) in the control group completed the exercise program. Although improvements in 6MWT distance were observed from baseline to follow-up in both the intervention (mean 490.1, SD 80.2 m to mean 504.5, SD 93.7 m) and control (mean 510.2, SD 48.3 m to mean 520.6, SD 49.4 m) group, no significant interaction effect (F1,14=.026; P=.87) nor effect for time (F1,14=2.51; P=.14) were observed. No significant effects emerged for any of the other secondary end points (all P>.0275). Adherence to the exercise program was high in both the intervention (14.25/16, 89.1%) and control (14.33/16, 89.6%) group. No adverse events or safety issues were reported in either group during the study. CONCLUSIONS This pilot trial did not show evidence of significant positive effect for either the remotely delivered or center-based program. The 6MWT may not have been sufficiently sensitive to identify a change in this cohort of participants with stable CHD. This trial does provide evidence that remote CR exercise, supported with digital self-monitoring, is feasible and may be considered for individuals less likely to participate in traditional center-based programs. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.2196/31855.
Collapse
Affiliation(s)
- Tiffany Leung
- NetwellCASALADundalk Institute of TechnologyDundalkIreland
| | - Julie Doyle
- NetwellCASALA, Dundalk Institute of Technology, Dundalk, Ireland
| | - Suzanne Smith
- NetwellCASALA, Dundalk Institute of Technology, Dundalk, Ireland
| | - Grainne Vavasour
- NetwellCASALA, Dundalk Institute of Technology, Dundalk, Ireland
| | - Orla Moran
- NetwellCASALA, Dundalk Institute of Technology, Dundalk, Ireland
| | - Shane Gavin
- NetwellCASALA, Dundalk Institute of Technology, Dundalk, Ireland
| | - Nisanth Sojan
- NetwellCASALA, Dundalk Institute of Technology, Dundalk, Ireland
| | - Gordon Boyle
- NetwellCASALA, Dundalk Institute of Technology, Dundalk, Ireland
| |
Collapse
|
77
|
Bianchettin RG, Lavie CJ, Lopez-Jimenez F. Challenges in Cardiovascular Evaluation and Management of Obese Patients: JACC State-of-the-Art Review. J Am Coll Cardiol 2023; 81:490-504. [PMID: 36725178 DOI: 10.1016/j.jacc.2022.11.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 10/12/2022] [Accepted: 11/02/2022] [Indexed: 02/01/2023]
Abstract
Many unique clinical challenges accompany the diagnosis and treatment of cardiovascular disease (CVD) in people living with overweight/obesity. Similarly, physicians encounter numerous complicating factors when managing obesity among people with CVD. Diagnostic accuracy in CVD medicine can be hampered by the presence of obesity, and pharmacological treatments or cardiac procedures require careful adjustment to optimize efficacy. The obesity paradox concept remains a source of confusion within the clinical community that may cause important risk factors to go unaddressed, and body mass index is a misleading measure that cannot account for body composition (eg, lean mass). Lifestyle modifications that support weight loss require long-term commitment, but cardiac rehabilitation programs represent a potential opportunity for structured interventions, and bariatric surgery may reduce CVD risk factors in obesity and CVD. This review examines the key issues and considerations for physicians involved in the management of concurrent obesity and CVD.
Collapse
Affiliation(s)
| | - Carl J Lavie
- John Ochsner Heart and Vascular Institute, Ochsner Clinical School, The University of Queensland School of Medicine, New Orleans, Louisiana, USA
| | | |
Collapse
|
78
|
Menezes HJ, D' Souza SRB, Padmakumar R, Babu AS, Rao RR, Kamath VG, Kamath A, Grace SL. Technology-based Comprehensive Cardiac Rehabilitation Therapy (TaCT) for women with cardiovascular disease in a middle-income setting: A randomized controlled trial protocol. Res Nurs Health 2023; 46:13-25. [PMID: 36371623 DOI: 10.1002/nur.22276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 10/12/2022] [Accepted: 10/27/2022] [Indexed: 11/15/2022]
Abstract
Women are underrepresented in cardiac rehabilitation (CR) despite the benefits, and this is exacerbated in lower-resource settings where CR is insufficiently available. In this randomized controlled trial, the effectiveness of the Technology-based Comprehensive Cardiac Rehabilitation Therapy (TaCT) electronic cardiac rehabilitation (eCR) intervention on functional capacity, risk factors, quality of life, heart-health behaviors, symptoms, and morbidity will be tested among women with CVD in a middle-income country. Following a pilot study, a single-center, single-blinded, 2 parallel-arm (1:1 SNOSE) superiority trial comparing an eCR intervention (TaCT) to usual care, with assessments pre-intervention and at 3 and 6 months will be undertaken. One hundred adult women will be recruited. Permuted block (size 10) randomization will be applied. The 6-month intervention comprises an app, website, SMS texts with generic heart-health management advice, and bi-weekly 1:1 telephone calls with a nurse trainee. Individualized exercise prescriptions will be developed based on an Incremental Shuttle Walk Test (primary outcome) and dietary plans based on 24 h dietary recall. A yoga/relaxation video will be provided via WhatsApp, along with tobacco cessation support and a moderated group chat. At 3 months, intervention engagement and acceptability will be assessed. Analyses will be conducted based on intent-to-treat. If results of this novel trial of women-focused eCR in a middle-income country demonstrate clinically-significant increases in functional capacity, this could represent an important development for the field considering this would be an important outcome for women and would translate to lower mortality.
Collapse
Affiliation(s)
- Henita Joshna Menezes
- Department of Obstetric and Gynecological Nursing, Manipal College of Nursing, Manipal Academy of Higher Education, Manipal, India
| | - Sonia R B D' Souza
- Department of Obstetric and Gynecological Nursing, Manipal College of Nursing, Manipal Academy of Higher Education, Manipal, India
| | - Ramachandran Padmakumar
- Department of Cardiology, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, India
| | - Abraham Samuel Babu
- Department of Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, India
| | - Rohini R Rao
- Department of Computer Applications, Manipal Institute of Technology, Manipal Academy of Higher Education, Manipal, India
| | - Veena G Kamath
- Department of Community Medicine, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, India
| | - Asha Kamath
- Department of Data Science, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Sherry L Grace
- Faculty of Health, York University, Toronto, Ontario, Canada.,KITE and Director Cardiac Rehabilitation Research, Peter Munk Cardiac Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
79
|
Cronin E, Monaghan K. Online neuropilates classes in chronic stroke patients: Protocol for a randomised controlled feasibility study. Contemp Clin Trials Commun 2023; 32:101068. [PMID: 36747990 PMCID: PMC9898606 DOI: 10.1016/j.conctc.2023.101068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Revised: 12/14/2022] [Accepted: 01/14/2023] [Indexed: 01/22/2023] Open
Abstract
Introduction Stroke survivors often demonstrate low physical activity levels and experience barriers to physical exercise including embarrassment, low self-efficacy and a shortage of tailored community exercise programmes. Access to physical activity programmes for stroke survivors could be improved by providing tailored, online programmes, although little is known about the safety and feasibility of online exercise classes for stroke survivors. One such programme of exercise which has received little attention in the literature is neuropilates. Neuropilates is the practice of a modified pilates programme in those with neurological conditions and is theorised to have beneficial effects on strength, balance and proprioception in stroke survivors. No previous study has been conducted to investigate online, remotely supervised neuropilates exercise classes in the stroke survivors. Method and Analysis This single assessor blinded randomised controlled feasibility study will compare a 6-week online, remotely instructed neuropilates programme to a 6-week online, remotely instructed generalised exercise programme and a 6-week unsupervised generalised home exercise programme in chronic stroke patients. Twenty adults, at least 6 months post stroke, and finished their formal rehabilitation will be recruited to the study. Primary feasibility outcome measures will include patient tolerance of the programme, adherence rates, adverse events, recruitment and retention. Secondary clinical outcomes will include; balance, gait, tone and quality of life. Assessments will be completed at baseline, on programme completion and 3 months post completion by a Physiotherapist blinded to the group allocation. Ethics and dissemination This study has received ethical approval from the Sligo University Hospital Ethics committee and ATU ethics board. Results will be published in peer-reviewed journals and presented at national and international conferences.The trial has been registered on clinicaltrials.gov (Identifier: NCT04491279).
Collapse
Affiliation(s)
- Eimear Cronin
- Neuroplasticity Research Group, ATU Sligo, Ash Lane, Ballytivnan, Sligo, Ireland
- Physiotherapy Department, St. John's Hospital, Sligo, Ireland
- Corresponding author. Neuroplasticity Research Group, ATU Sligo, Ash Lane, Ballytivnan, Sligo, Ireland.
| | - Kenneth Monaghan
- Neuroplasticity Research Group, ATU Sligo, Ash Lane, Ballytivnan, Sligo, Ireland
| |
Collapse
|
80
|
Beatty AL, Beckie TM, Dodson J, Goldstein CM, Hughes JW, Kraus WE, Martin SS, Olson TP, Pack QR, Stolp H, Thomas RJ, Wu WC, Franklin BA. A New Era in Cardiac Rehabilitation Delivery: Research Gaps, Questions, Strategies, and Priorities. Circulation 2023; 147:254-266. [PMID: 36649394 PMCID: PMC9988237 DOI: 10.1161/circulationaha.122.061046] [Citation(s) in RCA: 30] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Cardiac rehabilitation (CR) is a guideline-recommended, multidisciplinary program of exercise training, risk factor management, and psychosocial counseling for people with cardiovascular disease (CVD) that is beneficial but underused and with substantial disparities in referral, access, and participation. The emergence of new virtual and remote delivery models has the potential to improve access to and participation in CR and ultimately improve outcomes for people with CVD. Although data suggest that new delivery models for CR have safety and efficacy similar to traditional in-person CR, questions remain regarding which participants are most likely to benefit from these models, how and where such programs should be delivered, and their effect on outcomes in diverse populations. In this review, we describe important gaps in evidence, identify relevant research questions, and propose strategies for addressing them. We highlight 4 research priorities: (1) including diverse populations in all CR research; (2) leveraging implementation methodologies to enhance equitable delivery of CR; (3) clarifying which populations are most likely to benefit from virtual and remote CR; and (4) comparing traditional in-person CR with virtual and remote CR in diverse populations using multicenter studies of important clinical, psychosocial, and cost-effectiveness outcomes that are relevant to patients, caregivers, providers, health systems, and payors. By framing these important questions, we hope to advance toward a goal of delivering high-quality CR to as many people as possible to improve outcomes in those with CVD.
Collapse
Affiliation(s)
- Alexis L Beatty
- Department of Epidemiology and Biostatistics (A.L.B.), University of California, San Francisco.,Department of Medicine, Division of Cardiology (A.L.B.), University of California, San Francisco
| | - Theresa M Beckie
- College of Nursing (T.M.B.), University of South Florida, Tampa.,College of Medicine, Division of Cardiovascular Sciences (T.M.B.), University of South Florida, Tampa
| | - John Dodson
- Leon H. Charney Division of Cardiology, Department of Medicine (J.D.), New York University School of Medicine, New York.,Department of Population Health (J.D.), New York University School of Medicine, New York
| | - Carly M Goldstein
- The Weight Control and Diabetes Research Center, the Miriam Hospital, Providence, RI (C.M.G.).,Department of Psychiatry and Human Behavior, The Warren Alpert Medical School (C.M.G.), Brown University, Providence, RI
| | - Joel W Hughes
- Department of Psychological Sciences, Kent State University, OH (J.W.H.)
| | - William E Kraus
- Department of Medicine, Division of Cardiology, Duke University, Durham, NC (W.E.K.)
| | - Seth S Martin
- Department of Medicine, Division of Cardiology, Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD (S.S.M.)
| | - Thomas P Olson
- Department of Cardiovascular Medicine, Division of Preventive Cardiology, Mayo Clinic, Rochester, MN (T.P.O., R.J.T.)
| | - Quinn R Pack
- Department of Healthcare Delivery and Population Science, University of Massachusetts Medical School-Baystate, Springfield (Q.R.P.)
| | - Haley Stolp
- ASRT, Inc, Atlanta, GA (H.S.).,Centers for Disease Control and Prevention, Atlanta, GA (H.S.)
| | - Randal J Thomas
- Department of Cardiovascular Medicine, Division of Preventive Cardiology, Mayo Clinic, Rochester, MN (T.P.O., R.J.T.)
| | - Wen-Chih Wu
- Lifespan Cardiovascular Institute (W.-C.W.), Brown University, Providence, RI.,Division of Cardiology, Providence VA Medical Center, RI (W.-C.W.)
| | - Barry A Franklin
- William Beaumont Hospital, Royal Oak, MI (B.A.F.).,Oakland University William Beaumont School of Medicine, Rochester, MI (B.A.F.)
| |
Collapse
|
81
|
MacEachern E, Giacomantonio N, Theou O, Quach J, Firth W, Abel-Adegbite I, Kehler DS. Comparing Virtual and Center-Based Cardiac Rehabilitation on Changes in Frailty. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:1554. [PMID: 36674308 PMCID: PMC9865753 DOI: 10.3390/ijerph20021554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 01/09/2023] [Accepted: 01/11/2023] [Indexed: 06/17/2023]
Abstract
Many patients with cardiovascular disease (CVD) are frail. Center-based cardiac rehabilitation (CR) can improve frailty; however, whether virtual CR provides similar frailty improvements has not been examined. To answer this question, we (1) compared the effect of virtual and accelerated center-based CR on frailty and (2) determined if admission frailty affected frailty change and CVD biomarkers. The virtual and accelerated center-based CR programs provided exercise and education on nutrition, medication, exercise safety, and CVD. Frailty was measured with a 65-item frailty index. The primary outcome, frailty change, was analyzed with a two-way mixed ANOVA. Simple slopes analysis determined whether admission frailty affected frailty and CVD biomarker change by CR model type. Our results showed that admission frailty was higher in center-based versus virtual participants. However, we observed no main effect of CR model on frailty change. Results also revealed that participants who were frailer at CR admission observed greater frailty improvements and reductions in triglyceride and cholesterol levels when completing virtual versus accelerated center-based CR. Even though both program models did not change frailty, higher admission frailty was associated with greater frailty reductions and change to some CVD biomarkers in virtual CR.
Collapse
Affiliation(s)
- Evan MacEachern
- School of Physiotherapy, Dalhousie University, Halifax, NS B3H 4R2, Canada
| | | | - Olga Theou
- School of Physiotherapy, Dalhousie University, Halifax, NS B3H 4R2, Canada
- Division of Geriatric Medicine, Dalhousie University, Halifax, NS B3H 4R2, Canada
| | - Jack Quach
- Faculty of Health, Dalhousie University, Halifax, NS B3H 4R2, Canada
| | - Wanda Firth
- Hearts and Health in Motion, Nova Scotia Health, Halifax, NS B3L 0B7, Canada
| | | | - Dustin Scott Kehler
- School of Physiotherapy, Dalhousie University, Halifax, NS B3H 4R2, Canada
- Division of Geriatric Medicine, Dalhousie University, Halifax, NS B3H 4R2, Canada
| |
Collapse
|
82
|
Mediano MFF, Ribeiro LG, Silva RS, Xavier IGG, Vieira MC, Gonçalves TR, Paravidino VB, Borges JP, Rodrigues Junior LF, Costa HS, Reis MS, Liporagi-Lopes LC, Martinez-Amezcua P, Silva PS, Sperandio Da Silva GM, Sousa AS, Holanda MT, Veloso HH, Carneiro FM, Mazzoli-Rocha F, Costa AR, Saraiva RM, Mendes FSNS, Sangenis LHC, Hasslocher-Moreno AM. Home-based exercise program in the indeterminate form of Chagas disease (PEDI-CHAGAS study): A study protocol for a randomized clinical trial. Front Med (Lausanne) 2023; 9:1087188. [PMID: 36687410 PMCID: PMC9852894 DOI: 10.3389/fmed.2022.1087188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 12/13/2022] [Indexed: 01/07/2023] Open
Abstract
Background Chagas disease (CD) is a neglected endemic disease with worldwide impact due to migration. Approximately 50-70% of individuals in the chronic phase of CD present the indeterminate form, characterized by parasitological and/or serological evidence of Trypanosoma cruzi infection, but without clinical signs and symptoms. Subclinical abnormalities have been reported in indeterminate form of CD, including pro-inflammatory states and alterations in cardiac function, biomarkers and autonomic modulation. Moreover, individuals with CD are usually impacted on their personal and professional life, making social insertion difficult and impacting their mental health and quality of life (QoL). Physical exercise has been acknowledged as an important strategy to prevent and control numerous chronic-degenerative diseases, but unexplored in individuals with the indeterminate form of CD. The PEDI-CHAGAS study (which stands for "Home-Based Exercise Program in the Indeterminate Form of Chagas Disease" in Portuguese) aims to evaluate the effects of a home-based exercise program on physical and mental health outcomes in individuals with indeterminate form of CD. Methods and design The PEDI-CHAGAS is a two-arm (exercise and control) phase 3 superiority randomized clinical trial including patients with indeterminate form of CD. The exclusion criteria are <18 years old, evidence of non-Chagasic cardiomyopathy, musculoskeletal or cognitive limitations that preclude the realization of exercise protocol, clinical contraindication for regular exercise, and regular physical exercise (≥1 × per week). Participants will be assessed at baseline, and after three and 6 months of follow-up. The primary outcome will be QoL. Secondary outcomes will include blood pressure, physical fitness components, nutritional status, fatigability, autonomic modulation, cardiac morphology and function, low back pain, depression and anxiety, stress, sleep quality, medication use and adherence, and biochemical, inflammatory and cardiac biomarkers. Participants in the intervention group will undergo a home-based exercise program whilst those in the control group will receive only general information regarding the benefits of physical activity. Both groups will receive the same general nutritional counseling consisting of general orientations about healthy diets. Conclusion The findings from the present study may support public health intervention strategies to improve physical and mental health parameters to be implemented more effectively in this population. Clinical trial registration [https://ensaiosclinicos.gov.br/rg/RBR-10yxgcr9/], identifier [U1111-1263-0153].
Collapse
Affiliation(s)
- Mauro F. F. Mediano
- Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro, RJ, Brazil
- Department of Research and Education, National Institute of Cardiology, Rio de Janeiro, RJ, Brazil
| | - Leonardo G. Ribeiro
- Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro, RJ, Brazil
| | - Rudson S. Silva
- Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro, RJ, Brazil
| | - Isis G. G. Xavier
- Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro, RJ, Brazil
| | - Marcelo C. Vieira
- Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro, RJ, Brazil
- Center for Cardiology and Exercise, Aloysio de Castro State Institute of Cardiology, Rio de Janeiro, RJ, Brazil
| | - Tatiana R. Gonçalves
- Institute of Collective Health, Federal University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Vitor B. Paravidino
- Institute of Social Medicine, State University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
- Department of Physical Education and Sports, Naval Academy – Brazilian Navy, Rio de Janeiro, RJ, Brazil
| | - Juliana P. Borges
- Institute of Physical Education and Sports, State University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | | | - Henrique S. Costa
- Physical Therapy Department, Federal University of Jequitinhonha and Mucuri Valleys, Diamantina, MG, Brazil
| | - Michel S. Reis
- Faculty of Physical Therapy, School of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | | | - Pablo Martinez-Amezcua
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Paula S. Silva
- Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro, RJ, Brazil
| | | | - Andrea S. Sousa
- Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro, RJ, Brazil
| | - Marcelo T. Holanda
- Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro, RJ, Brazil
| | - Henrique H. Veloso
- Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro, RJ, Brazil
| | - Fernanda M. Carneiro
- Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro, RJ, Brazil
| | - Flavia Mazzoli-Rocha
- Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro, RJ, Brazil
| | - Andrea R. Costa
- Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro, RJ, Brazil
| | - Roberto M. Saraiva
- Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro, RJ, Brazil
| | - Fernanda S. N. S. Mendes
- Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro, RJ, Brazil
| | - Luiz Henrique C. Sangenis
- Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro, RJ, Brazil
| | | |
Collapse
|
83
|
Denton F, Waddell A, Kite C, Hesketh K, Atkinson L, Cocks M, Jones H, Randeva H, Davenport N, Powell R, Clark C, Kyrou I, Harwood AE, McGregor G. Remote maintenance cardiac rehabilitation (MAINTAIN): A protocol for a randomised feasibility study. Digit Health 2023; 9:20552076231152176. [PMID: 36818155 PMCID: PMC9936404 DOI: 10.1177/20552076231152176] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Accepted: 01/03/2023] [Indexed: 02/18/2023] Open
Abstract
Background Long-term adherence to exercise is often poor for people with coronary heart disease (CHD) who have completed supervised, centre-based cardiac rehabilitation. The aim of this study is to assess the feasibility of a remotely prescribed, delivered and monitored cardiac rehabilitation intervention using a wearable device to support long-term adherence to exercise and physical activity during maintenance of cardiac rehabilitation. Methods After completing cardiac rehabilitation, 30 participants with CHD, will be randomised (1:1) to an intervention (n = 15) or a usual care group (n = 15) in a 12-month feasibility randomised controlled trial (RCT). The intervention will comprise of an exercise consultation, personalised exercise prescription delivered via a wearable activity monitor using biometric feedback, regular monitoring via check-ins, and feedback text-messages for 6-months. Participants will be assessed at baseline (following completion of cardiac rehabilitation) and at three-, six-, and 12-months post-randomisation. The primary outcome will be feasibility, including assessment of eligibility, recruitment, adherence, and acceptability. Secondary outcomes will include exercise capacity, physical activity behaviours, cardiovascular disease risk and quality of life. Semi-structured interviews will be conducted at three-, six-, and 12-months post-randomisation (and with those who drop-out) to explore the acceptability of the study intervention and procedures. A questionnaire will be offered to those who decline participation. Discussion The MAINTAIN study will evaluate the feasibility of conducting a future definitive multi-centre RCT testing a remotely prescribed and monitored long-term mHealth maintenance exercise programme, versus usual care, for people with CHD who have completed cardiac rehabilitation. Trial registration number ClinicalTrials.gov, NCT05292287. Registered on 22/03/2022.
Collapse
Affiliation(s)
- Francesca Denton
- Institute of Health and Wellbeing, Coventry University, Coventry, UK
- Francesca Denton, Institute of Health and Wellbeing, Coventry University, Coventry, CV1 2DS, UK.
| | - Alexander Waddell
- Institute of Health and Wellbeing, Coventry University, Coventry, UK
| | - Chris Kite
- Institute of Health and Wellbeing, Coventry University, Coventry, UK
- Warwickshire Institute for the Study of Diabetes, Endocrinology and Metabolism (WISDEM), University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
- School of Public Health Studies, Faculty of Education, Health and Wellbeing, University of Wolverhampton, Wolverhampton, UK
| | - Katie Hesketh
- Research Institute of Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK
| | - Lou Atkinson
- School of Psychology, College of Health and Life Sciences, Aston University, Birmingham, UK
| | - Matthew Cocks
- Research Institute of Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK
| | - Helen Jones
- Research Institute of Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK
| | - Harpal Randeva
- Warwickshire Institute for the Study of Diabetes, Endocrinology and Metabolism (WISDEM), University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Nathan Davenport
- UK Department of Cardiopulmonary Rehabilitation, Centre for Exercise & Health, University Hospitals Coventry & Warwickshire NHS Trust, Coventry, UK
| | - Richard Powell
- Institute of Health and Wellbeing, Coventry University, Coventry, UK
- UK Department of Cardiopulmonary Rehabilitation, Centre for Exercise & Health, University Hospitals Coventry & Warwickshire NHS Trust, Coventry, UK
| | - Cain Clark
- Institute of Health and Wellbeing, Coventry University, Coventry, UK
- Warwickshire Institute for the Study of Diabetes, Endocrinology and Metabolism (WISDEM), University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Ioannis Kyrou
- Institute of Health and Wellbeing, Coventry University, Coventry, UK
- Warwickshire Institute for the Study of Diabetes, Endocrinology and Metabolism (WISDEM), University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
- Aston Medical School, College of Health and Life Sciences, Aston University, Birmingham, UK
- Laboratory of Dietetics and Quality of Life, School of Food and Nutritional Sciences, Department of Food Science & Human Nutrition, Agricultural University of Athens, Athens, Greece
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Amy E Harwood
- Institute of Health and Wellbeing, Coventry University, Coventry, UK
| | - Gordon McGregor
- Institute of Health and Wellbeing, Coventry University, Coventry, UK
- UK Department of Cardiopulmonary Rehabilitation, Centre for Exercise & Health, University Hospitals Coventry & Warwickshire NHS Trust, Coventry, UK
- Warwick Medical School, University of Warwick, Coventry, UK
| |
Collapse
|
84
|
Heidari M, Harandi PN, Moghaddasi J, Kheiri S, Azhari A. Effect of Home-Based Cardiac Rehabilitation Program on Self-Efficacy of Patients With Implantable Cardioverter Defibrillator. SAGE Open Nurs 2023; 9:23779608231166473. [PMID: 37124375 PMCID: PMC10134157 DOI: 10.1177/23779608231166473] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 02/18/2023] [Accepted: 03/07/2023] [Indexed: 05/02/2023] Open
Abstract
Introduction For more effective control and treatment of cardiac dysrhythmias caused by diseases, ischemia, or other causes, an implantable cardioverter defibrillator (ICD) is used. One of the effective ways for secondary prevention is the home-based cardiac rehabilitation (HBCR) which nurses have an effective role in its implementation. Objective The study aimed to investigate the effect of implementing HBCR programs on the self-efficacy of patients with ICD. Methods This is a semi-experimental study conducted on 70 patients who received ICD in Shahid Chamran Heart Center of Isfahan University of Medical Sciences (IUMS) in 2021. The patients were randomly assigned to intervention and control groups and were introduced to the practical concepts of HBCR during four training sessions. In the following, 3-month follow-up and trainings were continued by home visits, telephone follow-up, and use of social messaging networks due to the conditions of coronavirus disease 2019 (COVID-19) pandemic. The data were analyzed with SPSS/21. Results The findings showed that performing HBCR programs was effective in improving the self-efficacy of patients with ICDs. A significant trend in the implementation of the HBCR programs in two groups was shown using chi-square test and independent t-test and variance with repeated measurements (p < .001). There was no significant difference in self-efficacy score in both groups at the beginning of the study (p < .056). Conclusion Considering the effectiveness of HBCR programs on improving the self-efficacy of patients with ICDs, it can be used in the educational care programs of healthcare workers and in the strategic policies of health care services.
Collapse
Affiliation(s)
- Mohammad Heidari
- Community-Oriented Nursing Midwifery
Research Center, Nursing and Midwifery School, Shahrekord University of Medical
Sciences, Shahrekord, Iran
| | - Parviz Nadimi Harandi
- School of Nursing and Midwifery, Shahrekord University of Medical
Sciences, Shahrekord, Iran
- Parviz Nadimi Harandi, School of Nursing
and Midwifery, Ayatollah Kashani Blvd, Shahrekord University of Medical
Sciences, Shahrekord, Iran.
| | - Jaefar Moghaddasi
- Department of Adults and Geriatric
Nursing, School of Nursing and Midwifery, Shahrekord University of Medical
Sciences, Shahrekord, Iran
| | - Soleiman Kheiri
- Department of Epidemiology and
Biostatistics, School of Health, Modeling in Health Research Center, Shahrekord University of Medical
Sciences, Shahrekord, Iran
| | - Amirhossein Azhari
- Department of Cardiology, School of
Medicine Chamran Hospital, Isfahan University of Medical
Sciences, Isfahan, Iran
| |
Collapse
|
85
|
Kaihara T, Falter M, Scherrenberg M, Xu L, Maes J, Meesen E, Dendale P. The impact of dietary education and counselling with a smartphone application on secondary prevention of coronary artery disease: A randomised controlled study (the TeleDiet study). Digit Health 2023; 9:20552076231164101. [PMID: 36960029 PMCID: PMC10028629 DOI: 10.1177/20552076231164101] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Accepted: 02/28/2023] [Indexed: 03/25/2023] Open
Abstract
Objective: In a secondary prevention of coronary artery disease (CAD), nutritional management is an integral part of lifestyle optimisation. However, few studies have investigated the potential of remote nutritional follow-up using digital solutions. This study investigates the effectiveness of a smartphone application for nutrition education and feedback with pictures of meals by a dietitian for patients with CAD. Methods: Sixty participants with CAD were randomised to either a TeleDiet group or a control group. Participants in the TeleDiet group participated in dietary education using a messaging application. The primary outcome was the change of the Mediterranean diet score (MedDietScore). The Nutrition-Score, a modification of the MedDietScore, blood tests (blood lipids, blood glucose and kidney function), body mass index, self-efficacy, medication adherence and health-related quality of life during the observation period were analysed as secondary outcomes. Results: Sixty participants participated in the study. The difference in the MedDietScore in the TeleDiet group was greater than in the control group, but not significant (2.0 [-1.0, 4.0] vs. 0.0 [-3.0, 1.5], p = 0.066). The difference in the Nutrition-Score in the TeleDiet group was significantly greater than in the control group (3.0 [1.0, 3.5] vs. 0.0 [-3.0, 2.0], p = 0.029). Nutrition knowledge of the TeleDiet group improved significantly compared to the control group (1.9 ± 1.7 vs. 0.8 ± 2.1, p = 0.048). Conclusions: A feedback system using a simple messaging application that allows patients with CAD to simply send a picture of their food has a positive effect on nutrition knowledge. It could be a hint for the implementation of the Mediterranean diet.
Collapse
Affiliation(s)
- Toshiki Kaihara
- Heart Centre Hasselt, Jessa Hospital, Hasselt, Belgium
- Faculty of Medicine and Life Sciences / Human-Computer Interaction
and eHealth, UHasselt, Diepenbeek, Belgium
- Division of Cardiology, Department of Internal Medicine, St.
Marianna University School of Medicine, Kawasaki, Japan
- Toshiki Kaihara, Division of Cardiology,
Department of Internal Medicine, St. Marianna University School of Medicine,
2-16-1 Sugao, Miyamae-ku, Kawasaki 216-8511, Japan.
| | - Maarten Falter
- Heart Centre Hasselt, Jessa Hospital, Hasselt, Belgium
- Faculty of Medicine and Life Sciences / Human-Computer Interaction
and eHealth, UHasselt, Diepenbeek, Belgium
- Faculty of Medicine, KULeuven, Leuven, Belgium
| | - Martijn Scherrenberg
- Heart Centre Hasselt, Jessa Hospital, Hasselt, Belgium
- Faculty of Medicine and Life Sciences / Human-Computer Interaction
and eHealth, UHasselt, Diepenbeek, Belgium
- Faculty of Medicine, University of Antwerp, Antwerp, Belgium
| | - Linqi Xu
- Heart Centre Hasselt, Jessa Hospital, Hasselt, Belgium
- Faculty of Medicine and Life Sciences / Human-Computer Interaction
and eHealth, UHasselt, Diepenbeek, Belgium
- School of Nursing, Jilin University, Changchun, People's Republic of
China
| | - Jana Maes
- Faculty of Medicine and Life Sciences / Human-Computer Interaction
and eHealth, UHasselt, Diepenbeek, Belgium
| | - Elise Meesen
- Faculty of Medicine and Life Sciences / Human-Computer Interaction
and eHealth, UHasselt, Diepenbeek, Belgium
| | - Paul Dendale
- Heart Centre Hasselt, Jessa Hospital, Hasselt, Belgium
- Faculty of Medicine and Life Sciences / Human-Computer Interaction
and eHealth, UHasselt, Diepenbeek, Belgium
| |
Collapse
|
86
|
Zhang T, Zhou R, Wang T, Xin Y, Liu X, Huang H. Effects of traditional mind-body movement therapy on chronic cardiopulmonary dyspnoea: a systematic review and meta-analysis. Thorax 2023; 78:69-75. [PMID: 35483892 DOI: 10.1136/thoraxjnl-2021-218030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 02/08/2022] [Indexed: 02/07/2023]
Abstract
PURPOSE To evaluate whether traditional mind-body movement therapy (TMBM) can be used as a complementary or alternative therapy for exercise-based cardiopulmonary rehabilitation (EBCR) on chronic cardiopulmonary dyspnoea. METHODS PubMed, Embase, Scopus, Web of Science and China National Knowledge Infrastructure were searched from their inception to 2 July 2021. Randomised clinical trials evaluating the effectiveness of TMBM versus EBCR, and TMBM +EBCR versus TMBM in the treatment of chronic cardiopulmonary dyspnoea were selected. The outcomes were exercise capacity (6 min walk distance, 6MWD) and quality of life (QoL). RESULTS Thirty-four randomised clinical trials with 2456 patients were included. For TMBM vs EBCR alone, statistically significant improvements in the 6MWD favoured the TMBM for chronic obstructive pulmonary disease (COPD) (mean difference(MD)=12.22 m; 95% CI 5.94 to 18.50; I2=56%) and heart failure (HF) patients (MD=43.65 m; 95% CI 7.91 to 79.38; I2=0%). Statistically significant improvements in QoL also favoured TMBM over EBCR for patients with HF(MD=-9.19; 95% CI -11.05 to -7.32; I2=0%) but non-significant trend for COPD (standardised mean difference (SMD)=-0.31; 95% CI -0.62 to 0.01; I2=78%). Comparisons of TMBM +EBCR versus EBCR alone revealed significant improvements in the QoL for COPD (SMD=-0.52; 95% CI -0.94 to -0.10; I2=86%) and patients with HF (MD=-2.82; 95% CI -4.99 to -0.64; I2=0%). The 6MWD results favoured the TMBM +EBCR for patients with COPD (MD=16.76 m; 95% CI 10.24 to 23.29; I2=0%), but only showed a slight trend towards additional benefits of TMBM +EBCR in the HF studies (MD=13.77 m; 95% CI -1.01 to 28.54; I2=65%) . CONCLUSIONS TMBM has positive effects on patients' 6MWD and QoL, with similar or even better effects than EBCR. It may be beneficial to use TMBM as a supplementary or alternative strategy for EBCR in treatment plans. PROSPERO REGISTRATION NUMBER CRD42021241181.
Collapse
Affiliation(s)
- Tiange Zhang
- The First Clinical Medical School of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Rui Zhou
- The Second Clinical Medical School of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Ting Wang
- The First Clinical Medical School of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Yijun Xin
- The First Clinical Medical School of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Xiaohong Liu
- The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Huiting Huang
- The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| |
Collapse
|
87
|
Liu T, Tang Z, Cai C, Wu N, Jia J, Yang G, Zhang W. Cost-effectiveness analysis of digital therapeutics for home-based cardiac rehabilitation for patients with atrial fibrillation after catheter ablation. Digit Health 2023; 9:20552076231211548. [PMID: 38025109 PMCID: PMC10631335 DOI: 10.1177/20552076231211548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 10/17/2023] [Indexed: 12/01/2023] Open
Abstract
Background In recent years, numerous guidelines and expert consensuses have recommended that digital technologies and products, such as digital therapeutics (DTx), be incorporated into cardiac rehabilitation (CR). Objective The study aims to compare the cost-effectiveness of DTx for home-based CR (HBCR) with that of the conventional HBCR for patients with atrial fibrillation (AF) after catheter ablation in a real-world clinical setting. Methods Based on a single-center, prospective, blinded, randomized, parallel controlled trial of DTx-based HBCR for AF patients after catheter ablation, 100 AF patients undergoing catheter ablation were selected and randomized at a 1:1 ratio into a UC group (conventional HBCR) and DT group (DTx-based HBCR). The intervention lasted for 12 weeks. Medical cost data and clinical efficacy data (VO2max) were acquired from trial data. Effect data (QALYs, anxiety and depression status, health beliefs related to cardiovascular disease, and exercise self-efficacy) were obtained from a patient questionnaire. The cost-effectiveness analysis was conducted to assess the economic benefits of DTx-based HBCR versus conventional HBCR, and the robustness of the results was verified by sensitivity analysis. Results In the DT group (n = 49), the mean QALYs increased 0.119 ± 0.09, VO2max increased 9.3 ± 8.0 mL/(min*kg), anxiety, depression, health belief, and exercise self-efficacy had improved, and the total medical cost was 75,080.55 ± 19,746.62 CNY. In the UC group (n = 48), the mean QALYs increased 0.077 ± 0.06, VO2max increased 4.9 ± 6.6 mL/(min*kg), anxiety, depression, health belief, and exercise self-efficacy had improved, and the total medical cost was 73,972.66 ± 16,582.04 CNY. The difference in the medical cost was 1107.89 CNY, and the incremental cost-effectiveness ratio was 33,572.42 CNY/QALY, which was lower than the willingness-to-pay threshold of 85,698 CNY (China's per capita GDP in 2022). Conclusion DTx-based HBCR is more effective and cost-effective than conventional HBCR.
Collapse
Affiliation(s)
- Tianyi Liu
- School of Business, Nanjing University, Nanjing, China
| | - Zhijie Tang
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Cheng Cai
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Nan Wu
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Jian Jia
- School of Business, Nanjing University, Nanjing, China
- Departments of General Practice, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Gang Yang
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Wenhong Zhang
- School of Business, Nanjing University, Nanjing, China
- National Institute of Healthcare Data Science, Nanjing University, Nanjing, China
| |
Collapse
|
88
|
Wang X, Xu L, Lee G, Song A, Shao J, Chen D, Zhang H, Chen H. Development of an integrated cardiac rehabilitation program to improve the adaptation level of patients after acute myocardial infarction. Front Public Health 2023; 11:1121563. [PMID: 37139361 PMCID: PMC10150700 DOI: 10.3389/fpubh.2023.1121563] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Accepted: 03/24/2023] [Indexed: 05/05/2023] Open
Abstract
Background Individual's adaptation following acute myocardial infarction (AMI) and low attendance of whole-course cardiac rehabilitation (CR) are significant issues. For optimal health post AMI, an integrated CR program aiming at individual's adaptive behaviors is imperative for improving the CR efficiency and patients' outcomes. This study aims to develop theory-guided interventions to increase CR attendance and adaptation level of patients post-AMI. Methods This study was conducted in a tertiary hospital from July 2021 to September 2022 in Shanghai China. Guided by the theory of adaptation to chronic illness (ACI theory), the study followed the Intervention mapping (IM) framework to develop the interventions for CR program. Four phases included: (1) needs assessment of patients and facilitators using a cross-sectional study and semi-structured, in-depth interviews, (2) identification of implementation outcomes and performance objectives, (3) selection of theoretical methods to explain the mechanism of patients' adaptive behaviors and to use for behavior change, and (4) development of implementation protocol from the results of the previous phases. Results A total of 226 AMI patient-caregivers paired samples were eligible for the data analysis, 30 AMI patients participated in the qualitative inquiry, 16 experts in the CR field evaluated the implementation protocol, and 8 AMI patients commented on the practical interventions. Following the IM framework, an integrated cardiac rehabilitation program using mHealth strategies was developed for AMI patients to facilitate CR attendance and completion, to improve their adaptation level and health outcomes. Conclusion Using the IM framework and ACI theory, an integrated CR program was developed to help guide the behavior change and improve adaptation among AMI patients. The preliminary findings suggest that further intervention in enhancing the combination of three-stage CR is required. A feasibility study will be conducted to assess the acceptability and effectiveness of this generated CR intervention.
Collapse
Affiliation(s)
- Xiyi Wang
- School of Nursing, Shanghai Jiao Tong University, Shanghai, China
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King’s College London, London, United Kingdom
- *Correspondence: Xiyi Wang,
| | - Li Xu
- School of Nursing, Shanghai Jiao Tong University, Shanghai, China
- Department of Nursing, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Geraldine Lee
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King’s College London, London, United Kingdom
| | - Antai Song
- School of Nursing, Shanghai Jiao Tong University, Shanghai, China
| | - Jing Shao
- School of Nursing, Zhejiang University School of Medicine, Zhejiang, China
| | - Dandan Chen
- School of Nursing, Zhejiang University School of Medicine, Zhejiang, China
| | - Hui Zhang
- Department of Cardiology, Guizhou Provincial People’s Hospital, Guiyang, Guizhou, China
| | - Hanfen Chen
- Department of Nursing, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| |
Collapse
|
89
|
Vilarinho R, Toledo A, Silva C, Melo F, Tomaz L, Martins L, Gonçalves T, Melo C, Caneiras C, Montes AM. Reference Equation of a New Incremental Step Test to Assess Exercise Capacity in the Portuguese Adult Population. J Clin Med 2022; 12:jcm12010271. [PMID: 36615071 PMCID: PMC9821567 DOI: 10.3390/jcm12010271] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 12/26/2022] [Indexed: 12/31/2022] Open
Abstract
Step tests are important in community- and home-based rehabilitation programs to assess patients' exercise capacity. A new incremental step test was developed for this purpose, but its clinical interpretability is currently limited. This study aimed to establish a reference equation for this new incremental step test (IST) for the Portuguese adult population. A cross-sectional study was conducted on people without disabilities. Sociodemographic (age and sex), anthropometric (weight, height, and body mass index), smoking status, and physical activity (using the brief physical activity assessment tool) data were collected. Participants performed two repetitions of the IST and the best test was used to establish the reference equation with a forward stepwise multiple regression. An analysis comparing the results from the reference equation with the actual values was conducted with the Wilcoxon test. A total of 155 adult volunteers were recruited (60.6% female, 47.8 ± 19.7 years), and the reference equation was as follows: steps in IST = 475.52 - (4.68 × age years) + (30.5 × sex), where male = 1 and female = 0, and r2 = 60%. No significant differences were observed between the values performed and those obtained by the equation (p = 0.984). The established equation demonstrated that age and sex were the determinant variables for the variability of the results.
Collapse
Affiliation(s)
- Rui Vilarinho
- FP-I3ID, Escola Superior de Saúde-Fernando Pessoa, 4200-253 Porto, Portugal
- Center for Rehabilitation Research (CIR), School of Health, Polytechnic Institute of Porto, 4200-072 Porto, Portugal
- Healthcare Department, Nippon Gases Portugal, 4470-177 Maia, Portugal
- Correspondence:
| | - Ana Toledo
- Center for Rehabilitation Research (CIR), School of Health, Polytechnic Institute of Porto, 4200-072 Porto, Portugal
| | - Carla Silva
- Center for Rehabilitation Research (CIR), School of Health, Polytechnic Institute of Porto, 4200-072 Porto, Portugal
| | - Fábio Melo
- Center for Rehabilitation Research (CIR), School of Health, Polytechnic Institute of Porto, 4200-072 Porto, Portugal
| | - Leila Tomaz
- Center for Rehabilitation Research (CIR), School of Health, Polytechnic Institute of Porto, 4200-072 Porto, Portugal
| | - Luana Martins
- Center for Rehabilitation Research (CIR), School of Health, Polytechnic Institute of Porto, 4200-072 Porto, Portugal
| | - Tânia Gonçalves
- Center for Rehabilitation Research (CIR), School of Health, Polytechnic Institute of Porto, 4200-072 Porto, Portugal
| | - Cristina Melo
- Center for Rehabilitation Research (CIR), School of Health, Polytechnic Institute of Porto, 4200-072 Porto, Portugal
| | - Cátia Caneiras
- Healthcare Department, Nippon Gases Portugal, 4470-177 Maia, Portugal
- Microbiology Research Laboratory on Environmental Health (EnviHealthMicroLab), Institute of Environmental Health (ISAMB), Faculty of Medicine, Universidade de Lisboa (ULisboa), 1649-028 Lisbon, Portugal
- Multidisciplinary Research Center of Egas Moniz (CiiEM), Egas Moniz School of Health and Science, 2829-511 Almada, Portugal
- Institute for Preventive Medicine and Public Health, Faculty of Medicine, Universidade de Lisboa (ULisboa), 1649-028 Lisbon, Portugal
| | - António Mesquita Montes
- Center for Rehabilitation Research (CIR), School of Health, Polytechnic Institute of Porto, 4200-072 Porto, Portugal
- Department of Physiotherapy, Santa Maria Health School, 4049-024 Porto, Portugal
| |
Collapse
|
90
|
Van Iterson EH, Laffin LJ, Cho L. National, regional, and urban-rural patterns in fixed-terrestrial broadband internet access and cardiac rehabilitation utilization in the United States. Am J Prev Cardiol 2022; 13:100454. [PMID: 36636124 PMCID: PMC9830103 DOI: 10.1016/j.ajpc.2022.100454] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 12/20/2022] [Accepted: 12/22/2022] [Indexed: 12/25/2022] Open
Abstract
Objective Sparse patterns in fixed-terrestrial broadband internet access are predominantly observed among older adults and low income areas, which are interrelated factors also associated with low center-based cardiac rehabilitation (CR) utilization in the United States (US). Telehealth CR is proposed to increase CR utilization under an assumption that fixed-terrestrial broadband internet access is readily available nationwide and parallels CR utilization demand. We aimed to characterize national, geographical, and urban-rural patterns in fixed-terrestrial broadband internet access, CR eligibility rates, and center-based utilization throughout the US. Methods Centers for Disease Control data were used to estimate CR eligibility rates and center-based utilization for 2017-2018 among Medicare fee-for-service beneficiaries aged ≥65 years. Census Bureau data for 2018 were used to estimate fixed-terrestrial broadband internet access among households of adults aged ≥65 years. Results Southern states exhibited the highest percentage of households without broadband internet [median (IQR): 32% (24-39)] coupled with the highest CR eligibility rates [per 1,000 beneficiaries, median (IQR): 18 (15-21)] and lowest participation rates [percentage completing ≥1 session, median (IQR): 25% (17-33)]. Compared with urban areas, rural areas demonstrated significantly higher eligibility rates [15.5 (13.2-18.4) vs. 17.4 (14.5-21.0)], participation rates [30.6% (22.0-39.4) vs. 34.6% (22.6-48.3)], and percentage of households without broadband internet [23.8% (18.1-29.2) vs. 31.6% (26.5-37.6)], respectively. Conclusion Overlapping patterns in fixed-terrestrial broadband internet access and CR eligibility rates and center-based utilization suggest telehealth CR policies need to account for the possibility that lack of broadband-quality internet access could be a barrier to accessing telehealth CR delivery models.
Collapse
|
91
|
Makita S, Yasu T, Akashi YJ, Adachi H, Izawa H, Ishihara S, Iso Y, Ohuchi H, Omiya K, Ohya Y, Okita K, Kimura Y, Koike A, Kohzuki M, Koba S, Sata M, Shimada K, Shimokawa T, Shiraishi H, Sumitomo N, Takahashi T, Takura T, Tsutsui H, Nagayama M, Hasegawa E, Fukumoto Y, Furukawa Y, Miura SI, Yasuda S, Yamada S, Yamada Y, Yumino D, Yoshida T, Adachi T, Ikegame T, Izawa KP, Ishida T, Ozasa N, Osada N, Obata H, Kakutani N, Kasahara Y, Kato M, Kamiya K, Kinugawa S, Kono Y, Kobayashi Y, Koyama T, Sase K, Sato S, Shibata T, Suzuki N, Tamaki D, Yamaoka-Tojo M, Nakanishi M, Nakane E, Nishizaki M, Higo T, Fujimi K, Honda T, Matsumoto Y, Matsumoto N, Miyawaki I, Murata M, Yagi S, Yanase M, Yamada M, Yokoyama M, Watanabe N, Ito H, Kimura T, Kyo S, Goto Y, Nohara R, Hirata KI. JCS/JACR 2021 Guideline on Rehabilitation in Patients With Cardiovascular Disease. Circ J 2022; 87:155-235. [PMID: 36503954 DOI: 10.1253/circj.cj-22-0234] [Citation(s) in RCA: 64] [Impact Index Per Article: 32.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Shigeru Makita
- Department of Cardiac Rehabilitation, Saitama Medical University International Medical Center
| | - Takanori Yasu
- Department of Cardiovascular Medicine and Nephrology, Dokkyo Medical University Nikko Medical Center
| | - Yoshihiro J Akashi
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine
| | - Hitoshi Adachi
- Department of Cardiology, Gunma Prefectural Cardiovascular Center
| | - Hideo Izawa
- Department of Cardiology, Fujita Health University of Medicine
| | - Shunichi Ishihara
- Department of Psychology, Bunkyo University Faculty of Human Sciences
| | - Yoshitaka Iso
- Division of Cardiology, Showa University Fujigaoka Hospital
| | - Hideo Ohuchi
- Department of Pediatrics, National Cerebral and Cardiovascular Center
| | | | - Yusuke Ohya
- Department of Cardiovascular Medicine, Nephrology and Neurology, Graduate School of Medicine, University of the Ryukyus
| | - Koichi Okita
- Graduate School of Lifelong Sport, Hokusho University
| | - Yutaka Kimura
- Department of Health Sciences, Kansai Medical University Hospital
| | - Akira Koike
- Department of Cardiology, Faculty of Medicine, University of Tsukuba
| | - Masahiro Kohzuki
- Department of Internal Medicine and Rehabilitation Science, Tohoku University Graduate School of Medicine
| | - Shinji Koba
- Division of Cardiology, Department of Medicine, Showa University School of Medicine
| | - Masataka Sata
- Department of Cardiovascular Medicine, Tokushima University Graduate School of Biomedical Sciences
| | - Kazunori Shimada
- Department of Cardiology, Juntendo University School of Medicine
| | | | - Hirokazu Shiraishi
- Department of Cardiovascular Medicine, Kyoto Prefectural University of Medicine
| | - Naokata Sumitomo
- Department of Pediatric Cardiology, Saitama Medical University International Medical Center
| | - Tetsuya Takahashi
- Department of Physical Therapy, Faculty of Health Science, Juntendo University
| | - Tomoyuki Takura
- Department of Healthcare Economics and Health Policy, Graduate School of Medicine, The University of Tokyo
| | - Hiroyuki Tsutsui
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kyushu University
| | | | - Emiko Hasegawa
- Faculty of Psychology and Social Welfare, Seigakuin University
| | - Yoshihiro Fukumoto
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kurume University School of Medicine
| | - Yutaka Furukawa
- Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital
| | | | - Satoshi Yasuda
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine
| | - Sumio Yamada
- Department of Integrated Health Sciences, Nagoya University Graduate School of Medicine
| | - Yuichiro Yamada
- Center for Diabetes, Endocrinology and Metabolism, Kansai Electric Power Hospital
| | | | | | - Takuji Adachi
- Department of Physical Therapy, Nagoya University Graduate School of Medicine
| | | | | | | | - Neiko Ozasa
- Cardiovascular Medicine, Kyoto University Hospital
| | - Naohiko Osada
- Department of Physical Checking, St. Marianna University Toyoko Hospital
| | - Hiroaki Obata
- Division of Internal Medicine, Niigata Minami Hospital.,Division of Rehabilitation, Niigata Minami Hospital
| | | | - Yusuke Kasahara
- Department of Rehabilitation, St. Marianna University Yokohama Seibu Hospital
| | - Masaaki Kato
- Department of Cardiovascular Surgery, Morinomiya Hospital
| | - Kentaro Kamiya
- Department of Rehabilitation, School of Allied Health Sciences, Kitasato University
| | - Shintaro Kinugawa
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kyushu University
| | - Yuji Kono
- Department of Rehabilitation, Fujita Health University Hospital
| | - Yasuyuki Kobayashi
- Department of Medical Technology, Gunma Prefectural Cardiovascular Center
| | | | - Kazuhiro Sase
- Clinical Pharmacology and Regulatory Science, Graduate School of Medicine, Juntendo University
| | - Shinji Sato
- Department of Physical Therapy, Teikyo Heisei University
| | - Tatsuhiro Shibata
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kurume University School of Medicine
| | - Norio Suzuki
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine
| | - Daisuke Tamaki
- Department of Nutrition, Showa University Fujigaoka Hospital
| | - Minako Yamaoka-Tojo
- Department of Rehabilitation, School of Allied Health Sciences, Kitasato University
| | - Michio Nakanishi
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | | | - Mari Nishizaki
- Department of Rehabilitation, National Hospital Organization Okayama Medical Center
| | - Taiki Higo
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kyushu University
| | - Kanta Fujimi
- Department of Rehabilitation, Fukuoka University Hospital
| | - Tasuku Honda
- Department of Cardiovascular Surgery, Hyogo Brain and Heart Center
| | - Yasuharu Matsumoto
- Department of Cardiovascular Medicine, Shioya Hospital, International University of Health and Welfare
| | | | - Ikuko Miyawaki
- Department of Nursing, Kobe University Graduate School of Health Sciences
| | - Makoto Murata
- Department of Cardiology, Gunma Prefectural Cardiovascular Center
| | - Shusuke Yagi
- Department of Cardiovascular Medicine, Tokushima University Graduate School of Biomedical Sciences
| | - Masanobu Yanase
- Department of Transplantation, National Cerebral and Cardiovascular Center
| | | | - Miho Yokoyama
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine
| | | | | | - Takeshi Kimura
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine
| | - Syunei Kyo
- Tokyo Metropolitan Geriatric Medical Center
| | | | | | - Ken-Ichi Hirata
- Department of Internal Medicine, Kobe University Graduate School of Medicine
| | | |
Collapse
|
92
|
Telerehabilitation Approaches for People with Chronic Heart Failure: A Systematic Review and Meta-Analysis. J Clin Med 2022; 12:jcm12010064. [PMID: 36614865 PMCID: PMC9820837 DOI: 10.3390/jcm12010064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 12/14/2022] [Accepted: 12/17/2022] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION Telerehabilitation (TR) for chronic heart failure (CHF) allows for overcoming distance barriers and reducing exacerbations. However, little is known about TR descriptors, components, and efficacy in CHF. METHODS This work systematically reviewed the TR strategies of randomized controlled trials in people with CHF. A meta-analysis was run to test its effect on exercise capacity and quality of life compared to no rehabilitation (NI) and conventional intervention (CI). RESULTS Out of 6168 studies, 11 were eligible for the systematic review, and 8 for the meta-analysis. TR intervention was individual and multidimensional, with a frequency varying from 2 to 5 times per 8-12 weeks. The TR components mainly included an asynchronous model, monitoring/assessment, decision, and offline feedback. A few studies provided a comprehensive technological kit. Minimal adverse events and high adherence were reported. A large effect of TR compared to NI and a non-inferiority effect compared to CI was registered on exercise capacity, but no effects of TR compared to NI and CI on quality of life were observed. CONCLUSIONS TR for people with CHF adopted established effective strategies. Future interventions may identify the precise TR dose for CHF, technological requirements, and engagement components affecting the patient's quality of life.
Collapse
|
93
|
kobayashi T, Hamamoto M, Okazaki T, Tomota M, Fujiwara T, Honma T, Takahashi S. Effectiveness of Unsupervised Exercise Therapy After Endovascular Treatment for an Iliac Occlusive Lesion. Vasc Endovascular Surg 2022; 57:331-338. [PMID: 36525961 DOI: 10.1177/15385744221146669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Objective Exercise therapy has acceptable outcomes for patients with intermittent claudication (IC), but there are few reports on the results of continuous unsupervised exercise therapy after endovascular treatment (EVT) for an iliac lesion. The aim of this study is to analyze the long-term outcomes of unsupervised exercise therapy for patients after EVT. Material and Methods A retrospective analysis was performed in 76 patients (93 limbs) with IC who underwent iliac EVT from 2012 to 2020 at our hospital. Maintenance of unsupervised exercise therapy was evaluated at 6 months after EVT. Long-term outcomes such as primary patency, clinically driven target lesion revascularization (CD-TLR), survival, and major adverse cardiovascular events (MACE) were compared between patients who continued (cET group) or discontinued (dET group) unsupervised exercise therapy. Results A total of 28 patients (37%) continued unsupervised exercise therapy until 6 months after EVT for an iliac lesion. There were no differences in patient background and procedural details between the cET and dET groups. The follow-up rate was 96% in a median follow-up period of 35 [25 – 42] months. The mean exercise time in the cET group was 52 ± 18 minutes daily, with a mean frequency of 5.8 ± 1.1 days per week. The median step count in the cET group was 5559 ± 2908 steps daily. At 3 years, the cET group had significantly higher rates for primary patency (97% vs 71%, P = .002), and freedom from CD-TLR (97% vs 79%, P = .007); and a tendency for higher survival (100% vs 94%, P = .074), and higher freedom from MACE (89% vs 73%, P = .12). Conclusion The findings of this study suggested superior long-term outcomes, including primary patency, freedom from CD-TLR, survival, and freedom from MACE, in patients who maintained continuous unsupervised exercise therapy after EVT.
Collapse
Affiliation(s)
- Taira kobayashi
- Department of Cardiovascular Surgery, JA Hiroshima General Hospital, Hatsukaichi-shi, Hiroshima, Japan
| | - Masaki Hamamoto
- Department of Cardiovascular Surgery, JA Hiroshima General Hospital, Hatsukaichi-shi, Hiroshima, Japan
| | - Takanobu Okazaki
- Department of Cardiovascular Surgery, JA Hiroshima General Hospital, Hatsukaichi-shi, Hiroshima, Japan
| | - Mayu Tomota
- Department of Cardiovascular Surgery, JA Hiroshima General Hospital, Hatsukaichi-shi, Hiroshima, Japan
| | - Takashi Fujiwara
- Department of Cardiology, JA Hiroshima General Hospital, Hatsukaichi-shi, Hiroshima, Japan
| | - Tomoaki Honma
- Department of Rehabilitation, JA Hiroshima General Hospital, Hatsukaichi-shi, Hiroshima, Japan
| | - Shinya Takahashi
- Department of Cardiovascular Surgery, Hiroshima University, Minami-ku, Hiroshima, Japan
| |
Collapse
|
94
|
Liu J, Wang L, Fang H, Wang X, Wu L, Zhang J. Home-based cardiac rehabilitation: A review of bibliometric studies and visual analysis of CiteSpace (2012-2021). Medicine (Baltimore) 2022; 101:e31788. [PMID: 36626492 PMCID: PMC9750688 DOI: 10.1097/md.0000000000031788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Home-based cardiac rehabilitation has been a major area in cardiac rehabilitation research for a long time. However, there are few systematic studies in this field using bibliometric analysis. We collected articles and reviews for home-based cardiac rehabilitation from the Web of Science Core Collection. Our objectives were to perform a bibliometric analysis and visualization study to determine hotspots and trends of home-based cardiac rehabilitation, identify collaboration and influence among authors, countries, institutions, and journals, and assess the knowledge base to develop clinical research in the future. This study will provide a valuable reference for researchers concerned with HBCR.
Collapse
Affiliation(s)
- Jingyu Liu
- College of Nursing, Anhui University of Chinese Medicine, Hefei, China
| | - Lingyu Wang
- College of Nursing, Anhui University of Chinese Medicine, Hefei, China
| | - Haiyan Fang
- College of Nursing, Anhui University of Chinese Medicine, Hefei, China
- * Correspondence: Haiyan Fang, College of Nursing, Anhui University of Chinese Medicine, Hefei 230012, China (e-mail: )
| | - Xiang Wang
- College of Nursing, Anhui University of Chinese Medicine, Hefei, China
| | - Lingsha Wu
- College of Nursing, Anhui University of Chinese Medicine, Hefei, China
| | - Jing Zhang
- College of Nursing, Anhui University of Chinese Medicine, Hefei, China
| |
Collapse
|
95
|
Grigorovich A, Xi M, Lam N, Pakosh M, Chan BCF. A systematic review of economic analyses of home-based telerehabilitation. Disabil Rehabil 2022; 44:8188-8200. [PMID: 34965827 DOI: 10.1080/09638288.2021.2019327] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
PURPOSE Telerehabilitation, or the delivery of rehabilitation using information and communication technologies, may improve timely and equitable access to rehabilitation services at home. A systematic literature review was conducted of studies that formally documented the costs and effects of home-based telerehabilitation versus in-person rehabilitation across all health conditions. MATERIALS AND METHODS Six electronic databases were searched from inception to 13 July 2021 (APA, PsycInfo, CINAHL, Embase, EmCare, Medline (Ovid), and PubMed) using a protocol developed by a medical librarian. A quality appraisal of full economic evaluation studies was conducted using the Drummond 10-point quality checklist. RESULTS Thirty-five studies were included in this review covering various rehabilitation types and diverse populations. The majority were published in the last six years. Available evidence suggests that telerehabilitation may result in similar or lower costs as compared to in-person rehabilitation for the health care system and for patients. However, the impact of telerehabilitation on long-term clinical outcomes and health-related quality of life remains unclear. CONCLUSIONS More high quality and robust economic evaluations exploring the short- and long-term costs and other impacts of telerehabilitation on patients, caregivers, and health care systems across all types of patient populations are still required.Implications for rehabilitationHome-based telerehabilitation may reduce barriers in access to care for individuals living in the community.Economic analyses can inform health care system decision-making by evaluating the costs and effects associated with telerehabilitation.This study found that telerehabilitation may result in similar or lower costs as in-person rehabilitation; however, its impact on health-related quality of life is unclear.
Collapse
Affiliation(s)
- Alisa Grigorovich
- Department of Recreation and Leisure Studies, Brock University, St. Catharines, Canada.,KITE Research Institute, Toronto Rehabilitation Institute - University Health Network, Toronto, Canada
| | - Min Xi
- KITE Research Institute, Toronto Rehabilitation Institute - University Health Network, Toronto, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | - Natascha Lam
- School of Kinesiology, University of British Columbia, Vancouver, Canada
| | - Maureen Pakosh
- Library & Information Services, Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
| | - Brian C F Chan
- KITE Research Institute, Toronto Rehabilitation Institute - University Health Network, Toronto, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| |
Collapse
|
96
|
Ghisi GLDM, Marzolini S, Price J, Beckie TM, Mamataz T, Naheed A, Grace SL. Women-Focused Cardiovascular Rehabilitation: An International Council of Cardiovascular Prevention and Rehabilitation Clinical Practice Guideline. Can J Cardiol 2022; 38:1786-1798. [PMID: 36085185 DOI: 10.1016/j.cjca.2022.06.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 06/10/2022] [Accepted: 06/17/2022] [Indexed: 12/14/2022] Open
Abstract
Women-focused cardiovascular rehabilitation (CR; phase II) aims to better engage women, and might result in better quality of life than traditional programs. This first clinical practice guideline by the International Council of Cardiovascular Prevention and Rehabilitation (ICCPR) provides guidance on how to deliver women-focused programming. The writing panel comprised experts with diverse geographic representation, including multidisciplinary health care providers, a policy-maker, and patient partners. The guideline was developed in accordance with Appraisal of Guidelines for Research and Evaluation (AGREE) II and the Reporting Items for practice Guidelines in HealTh care (RIGHT). Initial recommendations were on the basis of a meta-analysis. These were circulated to a Delphi panel (comprised of corresponding authors from review articles and of programs delivering women-focused CR identified through ICCPR's audit; N = 76), who were asked to rate each on a 7-point Likert scale in terms of impact and implementability (higher scores positive). A Web call was convened to achieve consensus; 15 panelists confirmed strength of revised recommendations (Grading of Recommendations Assessment, Development, and Evaluation [GRADE]). The draft underwent external review from CR societies internationally and was posted for public comment. The 14 drafted recommendations related to referral (systematic, encouragement), setting (model choice, privacy, staffing), and delivery (exercise mode, psychosocial, education, self-management empowerment). Nineteen (25.0%) survey responses were received. For all but 1 recommendation, ≥ 75% voted to include; implementability ratings were < 5/7 for 4 recommendations, but only 1 for effect. Ultimately 1 recommendation was excluded, 1 separated into 2 and all revised (2 substantively); 1 recommendation was added. Overall, certainty of evidence for the final recommendations was low to moderate, and strength mostly strong. These recommendations and associated tools can support all programs to feasibly offer some women-focused programming.
Collapse
Affiliation(s)
- Gabriela Lima de Melo Ghisi
- KITE-Toronto Rehabilitation Institute, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Susan Marzolini
- KITE-Toronto Rehabilitation Institute, University Health Network, University of Toronto, Toronto, Ontario, Canada; Faculty of Health, York University, Toronto, Ontario, Canada
| | | | - Theresa M Beckie
- College of Nursing, Division of Cardiovascular Sciences, University of South Florida, Tampa, Florida, USA; College of Medicine, Division of Cardiovascular Sciences, University of South Florida, Tampa, Florida, USA
| | - Taslima Mamataz
- KITE-Toronto Rehabilitation Institute, University Health Network, University of Toronto, Toronto, Ontario, Canada; Faculty of Health, York University, Toronto, Ontario, Canada
| | - Aliya Naheed
- Initiative for Non-Communicable Diseases, Health System and Population Studies Division, International Centre for Diarrheal Diseases Research Bangladesh, Dhaka, Bangladesh
| | - Sherry L Grace
- KITE-Toronto Rehabilitation Institute, University Health Network, University of Toronto, Toronto, Ontario, Canada; Faculty of Health, York University, Toronto, Ontario, Canada; Peter Munk Cardiac Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada.
| |
Collapse
|
97
|
Varghese MS, Beatty AL, Song Y, Xu J, Sperling LS, Fonarow GC, Keteyian SJ, McConeghy KW, Penko J, Yeh RW, Figueroa JF, Wu WC, Kazi DS. Cardiac Rehabilitation and the COVID-19 Pandemic: Persistent Declines in Cardiac Rehabilitation Participation and Access Among US Medicare Beneficiaries. Circ Cardiovasc Qual Outcomes 2022; 15:e009618. [PMID: 36314139 PMCID: PMC9749950 DOI: 10.1161/circoutcomes.122.009618] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND The impact of the COVID-19 pandemic on participation in and availability of cardiac rehabilitation (CR) is unknown. METHODS Among eligible Medicare fee-for-service beneficiaries, we evaluated, by month, the number of CR sessions attended per 100 000 beneficiaries, individuals eligible to initiate CR, and centers offering in-person CR between January 2019 and December 2021. We compared these outcomes between 2 periods: December 1, 2019 through February 28, 2020 (period 1, before declaration of the pandemic-related national emergency) and October 1, 2021 through December 31, 2021 (period 2, the latest period for which data are currently available). RESULTS In period 1, Medicare beneficiaries participated in (mean±SD) 895±84 CR sessions per 100 000 beneficiaries each month. After the national emergency was declared, CR participation sharply declined to 56 CR sessions per 100 000 beneficiaries in April 2020. CR participation recovered gradually through December 2021 but remained lower than prepandemic levels (period 2: 698±29 CR sessions per month per 100 000 beneficiaries, P=0.02). Declines in CR participation were most marked among dual Medicare and Medicaid enrollees and patients residing in rural areas or socially vulnerable communities. There was no statistically significant change in CR eligibility between the 2 periods. Compared with 2618±5 CR centers in period 1, there were 2464±7 in period 2 (P<0.01). Compared with CR centers that survived the pandemic, 220 CR centers that closed were more likely to be affiliated with public hospitals, located in rural areas, and serve the most socially vulnerable communities. CONCLUSIONS The COVID-19 pandemic was associated with a persistent decline in CR participation and the closure of CR centers, which disproportionately affected rural and low-income patients and the most socially vulnerable communities. Innovation in CR financing and delivery is urgently needed to equitably enhance CR participation among Medicare beneficiaries.
Collapse
Affiliation(s)
- Merilyn S. Varghese
- Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, Boston, MA (M.S.V., Y.S., J.X., R.W.Y., D.S.K.).,Harvard Medical School, Boston, MA (M.S.V., R.W.Y., D.S.K.)
| | - Alexis L. Beatty
- Department of Epidemiology and Biostatistics, Division of Cardiology, Department of Medicine, University of California, San Francisco (A.B.)
| | - Yang Song
- Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, Boston, MA (M.S.V., Y.S., J.X., R.W.Y., D.S.K.)
| | - Jiaman Xu
- Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, Boston, MA (M.S.V., Y.S., J.X., R.W.Y., D.S.K.)
| | - Laurence S. Sperling
- Division of Cardiology, Department of Medicine, Emory Clinical Cardiovascular Research Institute, Emory University School of Medicine, Atlanta, GA (L.S.S.)
| | - Gregg C. Fonarow
- Ahmanson-UCLA Cardiomyopathy Center, University of California Los Angeles (G.C.F.)
| | - Steven J. Keteyian
- Division of Cardiovascular Medicine, Henry Ford Hospital, Detroit, MI (S.J.K.)
| | - Kevin W. McConeghy
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, RI (K.W.M.).,Center of Innovation Long-Term Services and Supports, Providence Veterans Administration Medical Center, RI (K.W.M.)
| | - Joanne Penko
- Department of Epidemiology and Biostatistics, University of California San Francisco (J.P.)
| | - Robert W. Yeh
- Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, Boston, MA (M.S.V., Y.S., J.X., R.W.Y., D.S.K.).,Harvard Medical School, Boston, MA (M.S.V., R.W.Y., D.S.K.)
| | - Jose F. Figueroa
- Department of Health Policy & Management, Harvard T.H. Chan School of Public Health, Boston, MA (J.F.F.).,Division of General Internal Medicine, Department of Medicine, Brigham and Women’s Hospital, Boston, MA (J.F.F.)
| | - Wen-Chih Wu
- Providence VA Medical Center and the Miriam Hospital Cardiovascular Rehabilitation Center, RI (W.-C.W.).,Departments of Medicine, Epidemiology and Center for Global Cardiometabolic Health, Brown University, Providence, RI (W.-C.W.)
| | - Dhruv S. Kazi
- Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, Boston, MA (M.S.V., Y.S., J.X., R.W.Y., D.S.K.).,Harvard Medical School, Boston, MA (M.S.V., R.W.Y., D.S.K.)
| |
Collapse
|
98
|
Zullig LL, Peterson ED, Shah BR, Grambow SC, Oddone EZ, McCant F, Lindquist JH, Bosworth HB. Secondary Prevention Risk Interventions via Telemedicine and Tailored Patient Education (SPRITE): A randomized trial to improve post myocardial infarction management. PATIENT EDUCATION AND COUNSELING 2022; 105:2962-2968. [PMID: 35618550 DOI: 10.1016/j.pec.2022.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Revised: 05/10/2022] [Accepted: 05/15/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVE We evaluated the impact of a low intensity web-based and intensive nurse-administered intervention to reduce systolic blood pressure (SBP) among patients with prior MI. METHODS Secondary Prevention Risk Interventions via Telemedicine and Tailored Patient Education (SPRITE) was a three-arm trial. Patients were randomized to 1) post-MI education-only; 2) nurse-administered telephone program; or 3) web-based interactive tool. The study was conducted 2009-2013. RESULTS Participants (n = 415) had a mean age of 61 years (standard deviation [SD], 11). Relative to the education-only group, the 12-month differential improvement in SBP was - 3.97 and - 3.27 mmHg for nurse-administered telephone and web-based groups, respectively. Neither were statistically significant. Post hoc exploratory subgroup analyses found participants who received a higher dose (>12 encounters) in the nurse-administered telephone intervention (n = 60; 46%) had an 8.8 mmHg (95% CI, 0.69, 16.89; p = 0.03) differential SBP improvement versus low dose (<11 encounters; n = 71; 54%). For the web-based intervention, those who had higher dose (n = 73; 53%; >1 web encounter) experienced a 2.3 mmHg (95% CI, -10.74, 6.14; p = 0.59) differential SBP improvement versus low dose (n = 65; 47%). CONCLUSIONS The main effects were not statistically significant. PRACTICAL IMPLICATIONS Completing the full dose of the intervention may be essential to experience the intervention effect. CLINICAL TRIAL REGISTRATION The unique identifier is NCT00901277 (http://www. CLINICALTRIALS gov/ct2/show/NCT00901277?term=NCT00901277&rank=1).
Collapse
Affiliation(s)
- Leah L Zullig
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, United States; Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, NC, United States
| | | | | | - Steven C Grambow
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC, United States
| | - Eugene Z Oddone
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, NC, United States
| | - Felicia McCant
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, NC, United States
| | - Jennifer Hoff Lindquist
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, NC, United States
| | - Hayden B Bosworth
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, United States; Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, NC, United States.
| |
Collapse
|
99
|
Werren M, Valent F, Di Chiara A. Effectiveness of home-rehabilitation in patients after an acute coronary syndrome and myocardial revascularization. INTERNATIONAL JOURNAL OF CARDIOLOGY. CARDIOVASCULAR RISK AND PREVENTION 2022; 14:200131. [PMID: 35663539 PMCID: PMC9160771 DOI: 10.1016/j.ijcrp.2022.200131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Revised: 04/22/2022] [Accepted: 04/28/2022] [Indexed: 11/21/2022]
Abstract
Physical activity is a mainstay (class IA) of rehabilitation programme after an acute coronary syndrome, but less than 40% of patients is physically active at one year. Home-rehabilitation, initially designed to manage the increasing number of patients in rehabilitation programmes, could result in a better strategy to increase adherence and persistence to physical activity. Objectives To test such hypothesis, At Cardiac Rehabilitation Centre (Institute of Physical Medicine and Rehabilitation, Udine, Italy), physical activity adherence was compared between patients treated with a standard in-office rehabilitation programme and a cohort where home rehabilitation programme was added. Methods From February 2017 to February 2019, 372 patients after an acute coronary syndrome (72 were excluded according to study criteria) were included, 193 patients in standard rehabilitation and 179 in home rehabilitation. At the end of follow-up, patients of both groups were called on the telephone to collect physical activity items according to a standardized questionnaire. Results At a medium follow-up of 30.1 months, there are more physically active patients in home rehabilitation than in standard, respectively 139 vs 108 patients (77,1% vs. 56%, p < 0,0001).At multivariate analysis, including age, gender, and rehabilitation model, the probability to be fully physically active at the end of the rehabilitation programme, is 3 times higher (OR 3.0 CI 1,9-6,0 p < 0,0001) for home rehabilitation programme compared to standard one. Conclusions Home rehabilitation, when applied to selected populations, resulted in a feasible and effective strategy to promote long term physical activity in secondary prevention after an acute coronary syndrome.
Collapse
Affiliation(s)
- Marika Werren
- Cardiologia Riabilitativa, Istituto di Medicina Fisica e Riabilitazione, Azienda Sanitario-Universitaria Friuli Centrale, Udine, Italy
| | - Francesca Valent
- Servizio di Epidemiologia Clinica e Valutativa, Azienda Provinciale per i Servizi Sanitari della Provincia Autonoma di Trento, Trento, Italy
| | - Antonio Di Chiara
- Cardiologia Ospedale Tolmezzo-San Daniele, Azienda Sanitario-Universitaria Friuli Centrale, Udine, Italy
| |
Collapse
|
100
|
Johnson T, Isakazde N, Mathews L, Gao Y, MacFarlane Z, Spaulding EM, Martin SS, Marvel FA. Building a hybrid virtual cardiac rehabilitation program to promote health equity: Lessons learned. CARDIOVASCULAR DIGITAL HEALTH JOURNAL 2022; 3:158-160. [PMID: 36046432 PMCID: PMC9422060 DOI: 10.1016/j.cvdhj.2022.06.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
|