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Wang Z, Elkoustaf R, Batiste C, Lahti D, Yao JF, Funahashi T. Home based cardiac rehabilitation: A retrospective cohort analysis on all-cause mortality and hospital readmission rates across sexes and races. Am J Prev Cardiol 2024; 19:100708. [PMID: 39157645 PMCID: PMC11328006 DOI: 10.1016/j.ajpc.2024.100708] [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: 12/14/2023] [Revised: 06/12/2024] [Accepted: 07/09/2024] [Indexed: 08/20/2024] Open
Abstract
Objective Studies have shown that both home-based cardiac rehabilitation (HBCR) and center-based cardiac rehabilitation (CBCR) exhibit comparable efficacy in reducing mortality during short-term follow-up periods of up to 12 months. However, research on sex- and race-specific outcomes associated with HBCR is limited. This study examines all-cause mortality and hospital readmission among patients referred to HBCR, with stratification by sex and race. Methods This Kaiser Permanente Southern California (KPSC) retrospective cohort study followed 6,868 patients from HBCR referral until death, disenrollment, or December 31, 2021. There were 3,835 HBCR graduates, 722 non-graduates, and 2,311 non-enrolled patients. Cox models were used to estimate hazard ratios (HR) and 95 % confidence intervals (CI) comparing 1) HBCR graduates vs. non-enrolled, and 2) HBCR graduates vs. non-graduates, stratified by sex and race. Differential outcomes among strata were analyzed using Kaplan-Meier curves. Results Among the 6,868 patients referred to HBCR, 4693 (68.3 %) were male, 2,175 (31.7 %) female, 870 (12.7 %) Asian/Pacific Islander, 731 (10.6 %) African American, 1,612 (23.6 %) Hispanic/Latino, and 3,646 non-Hispanic White (53.1 %). Over a mean follow-up period of 2.28 years, HBCR graduates, compared to patients who did not enroll in HBCR, had overall significantly lower risks of all-cause mortality and hospitalization. These results remained significant with stratification by sex and race. Compared to HBCR non-graduates, HBCR graduates overall had significantly lower risks of all-cause mortality and hospitalization. In the same comparison, mortality risk was significantly reduced for male and White patients; risk of hospital readmission was significantly reduced in both sexes, African American, and White patients. Among HBCR graduates, no significant differences in all-cause mortality or hospital readmission were observed across sexes and races. Conclusion HBCR participation is associated with reduction of all-cause mortality and hospital readmission rates across sexes and races. Notably, we observed benefits at varying levels of engagement, which suggests that even partial completion of HBCR is associated with risk reduction. Among HBCR graduates, we found similar outcomes across sexes and races, which suggests that the program can be effective among diverse patient groups.
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Affiliation(s)
- Zhengran Wang
- Susan Samueli Integrative Health Institute, University of California, Irvine, Irvine, CA, USA
- Division of Cardiology, University of California, Irvine School of Medicine, Irvine CA, USA
| | | | | | - Debora Lahti
- Kaiser Permanente Center for Health Innovation, Tustin, CA, USA
| | - Janis F. Yao
- Kaiser Permanente Department of Research and Evaluation, Pasadena, CA, USA
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Raidou V, Mitete K, Kourek C, Antonopoulos M, Soulele T, Kolovou K, Vlahodimitris I, Vasileiadis I, Dimopoulos S. Quality of life and functional capacity in patients after cardiac surgery intensive care unit. World J Cardiol 2024; 16:436-447. [DOI: 10.4330/wjc.v16.i8.436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Revised: 06/24/2024] [Accepted: 07/22/2024] [Indexed: 08/26/2024] Open
Abstract
Coronary heart disease and aortic stenosis are prevalent cardiovascular diseases worldwide, leading to morbidity and mortality. Coronary artery bypass grafting (CABG) and surgical aortic valve replacement (SAVR) have therapeutic benefits, including improved postoperative quality of life (QoL) and enhanced patient functional capacity which are key indicators of cardiac surgery outcome. In this article, we review the latest studies of QoL outcomes and functional capacity in patients who underwent cardiac surgery. Many standardized instruments are used to evaluate QoL and functional conditions. Preoperative health status, age, length of intensive care unit stay, operative risk, type of procedure, and other pre-, intra-, and postoperative factors affect postoperative QoL. Elderly patients experience impaired physical status soon after cardiac surgery, but it improves in the following period. CABG and SAVR are associated with increases of physical and mental health and functional capacity in the immediate postoperative and the long long-term. Cardiac rehabilitation improves patient functional capacity, QoL, and frailty following cardiac surgery.
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Affiliation(s)
- Vasiliki Raidou
- Clinical Ergospirometry, Exercise, and Rehabilitation Laboratory, Department of First Critical Care Medicine, Evangelismos Hospital, National and Kapodistrian University of Athens, Athens 10676, Greece
| | - Katerina Mitete
- Clinical Ergospirometry, Exercise, and Rehabilitation Laboratory, Department of First Critical Care Medicine, Evangelismos Hospital, National and Kapodistrian University of Athens, Athens 10676, Greece
| | - Christos Kourek
- Clinical Ergospirometry, Exercise, and Rehabilitation Laboratory, Department of First Critical Care Medicine, Evangelismos Hospital, National and Kapodistrian University of Athens, Athens 10676, Greece
| | - Michael Antonopoulos
- Cardiac Surgery Intensive Care Unit, Onassis Cardiac Surgery Center, Athens 17674, Greece
| | - Theodora Soulele
- Cardiac Surgery Intensive Care Unit, Onassis Cardiac Surgery Center, Athens 17674, Greece
| | - Kyriaki Kolovou
- Cardiac Surgery Intensive Care Unit, Onassis Cardiac Surgery Center, Athens 17674, Greece
| | - Ioannis Vlahodimitris
- Cardiac Surgery Intensive Care Unit, Onassis Cardiac Surgery Center, Athens 17674, Greece
| | - Ioannis Vasileiadis
- Clinical Ergospirometry, Exercise, and Rehabilitation Laboratory, Department of First Critical Care Medicine, Evangelismos Hospital, National and Kapodistrian University of Athens, Athens 10676, Greece
| | - Stavros Dimopoulos
- Clinical Ergospirometry, Exercise, and Rehabilitation Laboratory, Department of First Critical Care Medicine, Evangelismos Hospital, National and Kapodistrian University of Athens, Athens 10676, Greece
- Cardiac Surgery Intensive Care Unit, Onassis Cardiac Surgery Center, Athens 17674, Greece
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German CA, Davis AM, Polonsky TS. Management of Patients With Chronic Coronary Disease. JAMA 2024; 332:585-586. [PMID: 39046710 DOI: 10.1001/jama.2024.9813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/25/2024]
Abstract
This JAMA Clinical Guidelines Synopsis summarizes the 2023 American Heart Association (AHA)/American College of Cardiology (ACC) guideline on management of patients with chronic coronary disease.
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Affiliation(s)
- Charles A German
- Section of Cardiology, Department of Medicine, University of Chicago, Chicago, Illinois
| | - Andrew M Davis
- Section of General Internal Medicine, Department of Medicine, University of Chicago, Chicago, Illinois
| | - Tamar S Polonsky
- Section of Cardiology, Department of Medicine, University of Chicago, Chicago, Illinois
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Fransplass Storli M, Steiro Fimland M, Engan HK, Sandmæl JA. Validity of the Ekblom-Bak Cycle Ergometer Test in Patients with Cardiovascular Disease. J Rehabil Med 2024; 56:jrm39901. [PMID: 39136289 PMCID: PMC11334349 DOI: 10.2340/jrm.v56.39901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Accepted: 07/04/2024] [Indexed: 08/22/2024] Open
Abstract
OBJECTIVE To assess the validity of the Ekblom-Bak cycle ergometer test in patients with cardiovascular disease admitted to cardiac rehabilitation. METHODS Estimated peak oxygen consumption from the Ekblom-Bak test was compared with directly measured peak oxygen consumption from a treadmill cardiopulmonary exercise test. Patients completed the cardiopulmonary exercise test first, followed by the Ekblom-Bak test after 24 h rest. Pearson's correlation coefficient (r) was used to establish the correlation between estimated and measured peak oxygen consumption, and Bland-Altman plots with limits of agreement were used to determine the bias between the 2 tests. RESULTS Twenty-six patients were included in the final analysis. The Ekblom-Bak test significantly overestimated peak oxygen consumption. Agreement between estimated and measured peak oxygen consumption was: bias = 4.3 mL/kg/min (limits of agreement: -4.0-12.6 mL/kg/min). CONCLUSION The Ekblom-Bak test overestimated peak oxygen consumption to such an extent that it cannot accurately assess cardiorespiratory fitness in patients with cardiovascular disease. Thus, the cardiopulmonary exercise test remains the test of choice.
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Affiliation(s)
- Magnus Fransplass Storli
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, NTNU Norwegian University of Science and Technology, Trondheim, Norway.
| | - Marius Steiro Fimland
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, NTNU Norwegian University of Science and Technology, Trondheim, Norway; Unicare Helsefort Rehabilitation Centre, Rissa, Norway
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Bilbrey T, Martin J, Zhou W, Bai C, Vaswani N, Shah R, Chokshi SK, Chen X, Bhusri S, Niemi S, Meng H, Lei Z. A Dual-Modality Home-Based Cardiac Rehabilitation Program for Adults with Cardiovascular Disease: Single-Arm Remote Clinical Trial. JMIR Mhealth Uhealth 2024. [PMID: 39150858 DOI: 10.2196/59098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/18/2024] Open
Abstract
BACKGROUND Cardiac rehabilitation (CR) is a safe and effective intervention for individuals with cardiovascular disease (CVD). However, the majority of eligible patients do not complete CR. Growing evidence suggests that home-based CR (HBCR) programs are comparable in effectiveness and safety to traditional center-based programs. More research is needed to explore different ways to deliver HBCR programs to CVD patients. OBJECTIVE This study aims to assess the feasibility and impact of a digital HBCR program (RecoveryPlus.Health, RPH-D) that integrates both telehealth and mHealth modalities on functional exercise capacity, resting heart rate, and quality of life among adults with cardiovascular disease (CVD). METHODS This 12-week prospective, single-arm remote clinical trial used a within-subject design. We recruited adults with CVD (age 40+) from the community with a CR-eligible diagnosis (stable angina pectoris, myocardial infarction, heart failure, etc.) between May and August of 2023. All enrolled patients referred to the RPH clinic in Roanoke, TX were included. The care team provided guideline-concordant CR services to study participants via two modalities: 1) a synchronous telehealth exercise training via video conferencing; and 2) an asynchronous mHealth virtual coaching App (RPH App). Baseline intake survey, electronic health record (EHR), and app log data were used to extract individual characteristics, care processes, and telehealth/mHealth engagement data. Feasibility was measured by program completion rate and CR services use. Efficacy was measured by changes in 6-minute walk test (6MWT), resting heart rate, and quality of life (SF-12) before and after the 12-week program. Paired t tests were used to examine the changes in the outcome variables pre-post intervention. RESULTS A total of 162 met the inclusion criteria, 75 (46.3%) consented and were enrolled. The participants' average age was 64.24 (SD 10.30) years; 37 (49%) were male, and 46 (61%) were White. Heart failure was the most common diagnosis (49%). A total of 62 (83%) participants completed the 12-week study, 62 (83%) used the telehealth modality with an average of 9.63 (SD 3.33) sessions completed, and 59 (79%) used the mHealth modality with an average of 10.97 (SD 11.70) sessions completed. Post intervention, 50 (81%) participants had improved 6MWT, with an average improvement of 40.0 meters (95% CI, 25.6 to 57.1). The average SF-12 physical and mental summary scores improved by 2.7 points (95% CI, 1.1 to 4.3) and 2.2 points (95% CI, 0.1 to 4.5), respectively. There were no changes in resting heart rate and no exercise-related adverse events were reported. CONCLUSIONS The RecoveryPlus.Health digital HBCR program showed feasibility and efficacy in a group of nationally recruited CVD patients. The findings add to the evidence that a telehealth and mHealth dual-modality HBCR program may be a promising approach to overcome some of the main barriers to improving CR access in the U.S. CLINICALTRIAL ClinicalTrials.gov NCT05804500.
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Affiliation(s)
| | | | - Wen Zhou
- RecoveryPlus.Health, Inc., New York, US
| | | | | | | | | | - Xi Chen
- RecoveryPlus.Health, Inc., New York, US
| | | | | | - Hongdao Meng
- School of Aging Studies, University of South Florida, 13301 Bruce B Downs BlvdMHC1300, Tampa, US
| | - Zhen Lei
- RecoveryPlus.Health, Inc., New York, US
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Lee MK, Lee CJ, Goo SY, Moon JY, Lee TH, Kang SM, Chung IM, Jeon JY. Exercise Preferences and Barriers Among Patients With Heart Failure With Reduced Ejection Fraction or Myocardial Infarction. Korean Circ J 2024; 54:54.e91. [PMID: 39175348 DOI: 10.4070/kcj.2024.0097] [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: 03/18/2024] [Revised: 06/17/2024] [Accepted: 07/10/2024] [Indexed: 08/24/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Although cardiac rehabilitation (CR) is highly recommended in patients with cardiovascular disease (CVD), participation in CR is low mainly due to access barriers. Home-based CR (HBCR) has been recommended to overcome access barriers. Exercise is a core component of CR and should be developed and implemented based on individual characteristics. We aimed to assess physical activity behaviors, exercise preferences, and exercise barriers to understand physical activity characteristics of CVD patients. METHODS Participants were patients between the ages 19 to 75 years with a history of heart failure with reduced ejection fraction (HFrEF) or myocardial infarction (MI). They completed a cross-sectional survey at a tertiary hospital's outpatient clinic from April to June 2021. Survey data included physical activity levels, patterns, preference, and barriers of exercise. RESULTS Participants (n=189; 143 males, 46 females, 62.1±12.0 years) were diagnosed as either HFrEF (n=160, 84.7%) or a history of MI (n=97, 51.3%). Only 26.5% of patients engaged in moderate to vigorous exercise for more than 150 minutes per week. Participants preferred exercising alone or with families. Walking (65.6%) and resistance exercises (35.4%) were favored, with outdoor (37%) and home-based (30.2%) settings preferred over fitness centers (10.6%) and hospitals (0.5%). Barriers to exercise included fatigue (34.4%), poor health perception (31.7%), and low fitness levels (30.7%). CONCLUSIONS The results of this study can be used to develop tailored HBCR programs that consider individual preferences and address specific barriers, facilitating adequate physical activity engagement.
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Affiliation(s)
- Mi Kyung Lee
- Frontier Research Institute of Convergence Sports Science, FRICSS, Yonsei University, Seoul, Korea
| | - Chan Joo Lee
- Division of Cardiology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Seon Young Goo
- Department of Sport Industry Studies, Yonsei University, Seoul, Korea
| | - Jin Young Moon
- Department of Sport Industry Studies, Yonsei University, Seoul, Korea
| | - Tae Ho Lee
- Department of Sport Industry Studies, Yonsei University, Seoul, Korea
| | - Seok-Min Kang
- Division of Cardiology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Ick-Mo Chung
- Division of Cardiology, Department of Internal Medicine, Ewha Womans University Mokdong Hospital, School of Medicine, Ewha Womans University, Seoul, Korea.
| | - Justin Y Jeon
- Frontier Research Institute of Convergence Sports Science, FRICSS, Yonsei University, Seoul, Korea
- Department of Sport Industry Studies, Yonsei University, Seoul, Korea
- Exercise Medicine Center for Diabetes and Cancer Patients, ICONS, Yonsei University, Seoul, Korea
- Cancer Prevention Center, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea.
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Chamradova K, Batalik L, Winnige P, Dosbaba F, Hartman M, Batalikova K, Janikova A, Nehyba S, Felsoci M, Pepera G, Su JJ. Effects of home-based exercise with telehealth guidance in lymphoma cancer survivors entering cardio-oncology rehabilitation: rationale and design of the tele@home study. CARDIO-ONCOLOGY (LONDON, ENGLAND) 2024; 10:46. [PMID: 39080734 PMCID: PMC11289918 DOI: 10.1186/s40959-024-00249-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 07/19/2024] [Indexed: 08/02/2024]
Abstract
BACKGROUND Participation in cardio-oncological rehabilitation is low, and the effects incline to decrease after the initial rehabilitation term. Home-based exercise has the potential to enhance involvement in cardio-oncology rehabilitation and was demonstrated to be feasible, safe, and helpful in increasing short-term cardiorespiratory fitness. The lasting effects on cardiorespiratory fitness and physical activity are uncertain. Hence, a novel approach via telehealth management based on objectively measured exercise at home was proposed. OBJECTIVES To improve self-monitoring, such as self-confidence, behavioral change, and goal setting for individual exercise, and afterward, increase long-term effects concerning cardiorespiratory fitness. DESIGN This randomized controlled trial compares a 12-week guided home exercise telehealth intervention with a center-based exercise intervention of the same duration and intensity of exercise in lymphoma cancer survivors entering cardio-oncology rehabilitation after treatment. Participants will be instructed to exercise gradually at 60-85% of their maximum heart rate for 30-50 min 3 times a week. Participants will receive individual remote guidance (feedback about frequency, duration, and exercise intensity) by preferred contact (phone call, text message) once a week based on shared exercise data through the web platform. The primary outcome is a change in cardiorespiratory fitness expressed as maximal oxygen uptake assessed through cardiopulmonary exercise test at baseline, 12 weeks, and 1 year. Secondary objectives are quality of life, muscle strength, body composition, incidence of adverse events, and exercise adherence. This study will determine whether a telehealth model is effective and safe compared to a center-based model in cancer survivors and whether exercise prescriptions are followed by participants. Additionally, an overview of the long-term effectiveness of telehealth cardio-oncology rehabilitation will be provided. This approach aligns with the trend of moving non-complex healthcare services into the patients' home environment. TRIAL REGISTRATION ClinicalTrials.Gov Identifier: NCT05779605.
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Affiliation(s)
- Katerina Chamradova
- Department of Rehabilitation, University Hospital Brno, Brno, Czech Republic
- Department of Rehabilitation and Sports Medicine, 2nd Faculty of Medicine, Charles University, University Hospital Motol, Prague, Czech Republic
| | - Ladislav Batalik
- Department of Rehabilitation, University Hospital Brno, Brno, Czech Republic.
- Department of Physiotherapy and Rehabilitation, Faculty of Medicine, Masaryk University, Brno, Czech Republic.
| | - Petr Winnige
- Department of Rehabilitation, University Hospital Brno, Brno, Czech Republic
- Department of Physiotherapy and Rehabilitation, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Filip Dosbaba
- Department of Rehabilitation, University Hospital Brno, Brno, Czech Republic
- Department of Physiotherapy and Rehabilitation, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Martin Hartman
- Department of Rehabilitation, University Hospital Brno, Brno, Czech Republic
- Department of Rehabilitation and Sports Medicine, 2nd Faculty of Medicine, Charles University, University Hospital Motol, Prague, Czech Republic
| | - Katerina Batalikova
- Department of Rehabilitation, University Hospital Brno, Brno, Czech Republic
| | - Andrea Janikova
- Department of Internal Medicine-Hematology and Oncology, University Hospital Brno, Brno, Czech Republic
| | - Svatopluk Nehyba
- Department of Internal Medicine and Cardiology, University Hospital Brno, Brno, Czech Republic
| | - Marian Felsoci
- Department of Internal Medicine and Cardiology, University Hospital Brno, Brno, Czech Republic
| | - Garyfallia Pepera
- Clinical Exercise Physiology and Rehabilitation Research Laboratory, Physiotherapy Department, School of Health Sciences, University of Thessaly, Lamia, Greece
| | - Jing Jing Su
- School of Nursing, Tung Wah College, Hong Kong, China.
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Child CE, Ho LA, Lachant D, Gupta N, Moss J, Jones A, Krishna R, Holland AE, Han MK, McCarthy C, Ataya A, Baqir M, Dilling D, Swigris J, Swenson ER, Brown MB. Unsupervised Exercise in Interstitial Lung Disease: A Delphi Study to Develop a Consensus Preparticipation Screening Tool for Lymphangioleiomyomatosis. Chest 2024:S0012-3692(24)04613-0. [PMID: 39025205 DOI: 10.1016/j.chest.2024.06.3803] [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: 02/26/2024] [Revised: 06/13/2024] [Accepted: 06/25/2024] [Indexed: 07/20/2024] Open
Abstract
BACKGROUND Little research is available to provide practical guidance to health-care providers for exercise preparticipation screening and referral of patients with interstitial lung diseases (ILDs), including lymphangioleiomyomatosis (LAM), to participate in remote, unsupervised exercise programs. RESEARCH QUESTION What exercise preparticipation screening steps are essential to determine whether a patient with LAM is medically appropriate to participate in a remote, unsupervised exercise program? STUDY DESIGN AND METHODS Sixteen experts in LAM and ILD participated in a two-round modified Delphi study, ranking their level of agreement for 10 statements related to unsupervised exercise training in LAM, with an apriori definition of consensus. Additionally, 60 patients with LAM completed a survey of the perceived risks and benefits of remote exercise training in LAM. RESULTS Seven of the 10 statements reached consensus among experts. Experts agreed that an in-person clinical exercise test is indicated to screen for exercise-induced hypoxemia and prescribe supplemental oxygen therapy as indicated prior to initiating a remote exercise program. Patients with recent pneumothorax should wait to start an exercise program for at least 4 weeks until after resolution of pneumothorax and clearance by a physician. Patients with high cardiovascular risk for event during exercise, severe resting pulmonary hypertension, or risk for falls may be more appropriate for referral to a rehabilitation center. A LAM-specific remote exercise preparticipation screening tool was developed from the consensus statements and agreed upon by the panelists. INTERPRETATION A modified Delphi study approach was useful to develop disease-specific recommendations for safety and preparticipation screening prior to unsupervised, remotely administered exercise in LAM. The primary product of this study is a clinical decision aid for providers to use when medically screening patients prior to participation in the newly launched LAMFit remote exercise program.
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Affiliation(s)
- Claire E Child
- Department of Rehabilitation Medicine, Division of Physical Therapy, University of Washington, Seattle, WA
| | | | | | | | - Joel Moss
- Critical Care Medicine and Pulmonology Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD
| | - Amanda Jones
- Critical Care Medicine and Pulmonology Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD
| | | | - Anne E Holland
- Monash University and Alfred Health, Melbourne, VIC, Australia; Institute for Breathing and Sleep, Melbourne, VIC, Australia
| | | | - Cormac McCarthy
- St. Vincent's University Hospital Dublin, Dublin, Ireland; University College Dublin, Dublin, Ireland
| | - Ali Ataya
- University of Florida, Gainesville, FL
| | | | - Daniel Dilling
- Loyola University Chicago, Chicago, IL; Loyola University Medical Center, Maywood, IL
| | | | | | - Mary Beth Brown
- Department of Rehabilitation Medicine, Division of Physical Therapy, University of Washington, Seattle, WA.
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Thompson MP, Hou H, Likosky DS, Pagani FD, Falvey J, Bowles KH, Wadhera RK, Sterling MR. Home Health Care Use and Outcomes After Coronary Artery Bypass Grafting Among Medicare Beneficiaries. Circ Cardiovasc Qual Outcomes 2024; 17:e010459. [PMID: 38770653 PMCID: PMC11251853 DOI: 10.1161/circoutcomes.123.010459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 04/24/2024] [Indexed: 05/22/2024]
Abstract
BACKGROUND Home health care (HHC) has been increasingly used to improve care transitions and avoid poor outcomes, but there is limited data on its use and efficacy following coronary artery bypass grafting. The purpose of this study was to describe HHC use and its association with outcomes among Medicare beneficiaries undergoing coronary artery bypass grafting. METHODS Retrospective analysis of 100% of Medicare fee-for-service files identified 77 331 beneficiaries undergoing coronary artery bypass grafting and discharged to home between July 2016 and December 2018. The primary exposure of HHC use was defined as the presence of paid HHC claims within 30 days of discharge. Hierarchical logistic regression identified predictors of HHC use and the percentage of variation in HHC use attributed to the hospital. Propensity-matched logistic regression compared mortality, readmissions, emergency department visits, and cardiac rehabilitation enrollment at 30 and 90 days after discharge between HHC users and nonusers. RESULTS A total of 26 751 (34.6%) of beneficiaries used HHC within 30 days of discharge, which was more common among beneficiaries who were older (72.9 versus 72.5 years), male (79.4% versus 77.4%), White (90.2% versus 89.2%), and not Medicare-Medicaid dual eligible (6.7% versus 8.8%). The median hospital-level rate of HHC use was 31.0% (interquartile range, 13.7%-54.5%) and ranged from 0% to 94.2%. Nearly 30% of the interhospital variation in HHC use was attributed to the discharging hospital (intraclass correlation coefficient, 0.296 [95% CI, 0.275-0.318]). Compared with non-HHC users, those using HHC were less likely to have a readmission or emergency department visit, were more likely to enroll in cardiac rehabilitation, and had modestly higher mortality within 30 or 90 days of discharge. CONCLUSIONS A third of Medicare beneficiaries undergoing coronary artery bypass grafting used HHC within 30 days of discharge, with wide interhospital variation in use and mixed associations with clinical outcomes and health care utilization.
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Affiliation(s)
- Michael P. Thompson
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, Michigan, USA
- Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, Michigan, USA
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan, USA
| | - Hechuan Hou
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Donald S. Likosky
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, Michigan, USA
- Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, Michigan, USA
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan, USA
| | - Francis D. Pagani
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, Michigan, USA
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan, USA
| | - Jason Falvey
- Department of Physical Therapy and Rehabilitation Science, Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Kathryn H. Bowles
- University of Pennsylvania School of Nursing, Philadelphia, PA
- VNS Health, New York, NY
| | - Rishi K. Wadhera
- Richard A. and Susan F. Smith Center for Outcomes Research, Beth Israel Deaconess Medical Center, Boston, Massachusetts
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Keteyian SJ, Grimshaw C, Ehrman JK, Kerrigan DJ, Abdul-Nour K, Lanfear DE, Brawner CA. The iATTEND Trial: A Trial Comparing Hybrid Versus Standard Cardiac Rehabilitation. Am J Cardiol 2024; 221:94-101. [PMID: 38670326 PMCID: PMC11144075 DOI: 10.1016/j.amjcard.2024.04.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Revised: 03/22/2024] [Accepted: 04/19/2024] [Indexed: 04/28/2024]
Abstract
The improving ATTENDance (iATTEND) to cardiac rehabilitation (CR) trial tested the hypotheses that hybrid CR (HYCR) (combination of virtual and in-facility CR sessions) would result in greater attendance compared with traditional, facility-based only CR (FBCR) and yield equivalent improvements in exercise capacity and health status. Patients were randomized to HYCR (n = 142) or FBCR (n = 140), stratified by gender and race. Attendance was assessed as number of CR sessions completed within 6 months (primary end point) and the percentage of patients completing 36 CR sessions. Other end points (tested for equivalency) included exercise capacity and self-reported health status. HYCR patients completed 1 to 12 sessions in-facility, with the balance completed virtually using synchronized, 2-way audiovisual technology. Neither total number of CR sessions completed within 6 months (29 ± 12 vs 28 ± 12 visits, adjusted p = 0.94) nor percentage of patients completing 36 sessions (59 ± 4% vs 51 ± 4%, adjusted p = 0.32) were significantly different between HYCR and FBCR, respectively. The between-group changes for exercise capacity (peak oxygen uptake, 6-minute walk distance) and health status were equivalent. Regarding safety, no sessions required physician involvement, there was 1 major adverse event after a virtual session, and no falls required medical attention. In conclusion, although we rejected our primary hypothesis that attendance would be greater with HYCR versus FBCR, we showed that FBCR and HYCR resulted in similar patient attendance patterns and equivalent improvements in exercise capacity and health status. HYCR which incorporates virtually supervised exercise should be considered an acceptable alternative to FBCR. NCT Identifier: 03646760; The Improving ATTENDance to Cardiac Rehabilitation Trial - Full-Text View - ClinicalTrials. gov; https://classic.clinicaltrials.gov/ct2/show/NCT03646760.
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Affiliation(s)
- Steven J Keteyian
- Division of Cardiovascular Medicine, Department of Medicine, Henry Ford Health Detroit, Michigan.
| | - Crystal Grimshaw
- Division of Cardiovascular Medicine, Department of Medicine, Henry Ford Health Detroit, Michigan
| | - Jonathan K Ehrman
- Division of Cardiovascular Medicine, Department of Medicine, Henry Ford Health Detroit, Michigan
| | - Dennis J Kerrigan
- Division of Cardiovascular Medicine, Department of Medicine, Henry Ford Health Detroit, Michigan
| | - Khaled Abdul-Nour
- Division of Cardiovascular Medicine, Department of Medicine, Henry Ford Health Detroit, Michigan
| | - David E Lanfear
- Division of Cardiovascular Medicine, Department of Medicine, Henry Ford Health Detroit, Michigan
| | - Clinton A Brawner
- Division of Cardiovascular Medicine, Department of Medicine, Henry Ford Health Detroit, Michigan
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11
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Ma LC, Lou SN, Zhu XL, Zhang RL, Wu L, Xu JY, Ding XJ, Liu J, Wang Y. Needs and Constraints for Cardiac Rehabilitation Among Patients with Coronary Heart Disease Within a Community-Based Setting: A Study Based on Focus Group Interviews. Patient Prefer Adherence 2024; 18:1141-1150. [PMID: 38863947 PMCID: PMC11166145 DOI: 10.2147/ppa.s462138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Accepted: 05/23/2024] [Indexed: 06/13/2024] Open
Abstract
Objective This study aimed to explore the needs and constraints to cardiac rehabilitation (CR) among patients diagnosed with coronary heart disease (CHD) in a community-based setting, and thereby facilitating the implementation of effective CR programs for this population. Methods Focus group interviews were used as the primary research methodology. A total of 11 community-dwelling individuals diagnosed with CHD were selected from a community hospital to participate in in-depth interviews, aiming to discern and analyze their requirements and constraints experienced concerning medical resources and healthcare agency. The textual data underwent examination using Colaizzi's method of descriptive data analysis. Results Deficits existed in the perceptions of patients with CHD within a community-based setting about their condition and CR, and in the social support for this disease. Patients expressed expectations for professional guidance during CR, gained an understanding about the beneficial effects of emotional stability on cognitive function. Patients expressed their thoughts and feelings regarding the diversity of physical exercise options. Two main themes and seven sub-themes were identified: (a) "Insufficient CR resources for patients": Lack of awareness about CHD; inadequate knowledge about secondary prevention/CR; insufficient support from family and friends. (b) "Patient CR initiative": Patient self-adjustment; expectation of professional rehabilitation guidance; stable emotions improving cognition; diverse attitudes and awareness of exercise. Conclusion For more effective CR, community-based medical teams should provide more comprehensive and individualized rehabilitation programs. They should focus on individual variations and preferences of patients, as well as enhance the autonomy of patients and improve their self-care ability through effective empowerment measures.
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Affiliation(s)
- Li-Chao Ma
- School of Nursing, Hebei University, Baoding, Hebei, 071000, People’s Republic of China
- Operating Room, The Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei, 050000, People’s Republic of China
| | - Shi-Ning Lou
- Department of Traditional Chinese Medicine, Work’s Hospital of China Lucky Group Corporation, Baoding, Hebei, 07100, People’s Republic of China
| | - Xiao-Li Zhu
- Department of Traditional Chinese Medicine, Work’s Hospital of China Lucky Group Corporation, Baoding, Hebei, 07100, People’s Republic of China
| | - Ruo-Lan Zhang
- School of Nursing, Hebei University, Baoding, Hebei, 071000, People’s Republic of China
| | - Lin Wu
- School of Nursing, Hebei University, Baoding, Hebei, 071000, People’s Republic of China
| | - Jiang-Yuan Xu
- School of Nursing, Hebei University, Baoding, Hebei, 071000, People’s Republic of China
| | - Xiao-Juan Ding
- School of Nursing, Hebei University, Baoding, Hebei, 071000, People’s Republic of China
| | - Juan Liu
- Department of Rehabilitation Medicine, Affiliated Hospital of Hebei University, Baoding, Hebei, 071000, People’s Republic of China
| | - Yan Wang
- School of Nursing, Hebei University, Baoding, Hebei, 071000, People’s Republic of China
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12
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Mitropoulos A, Anifanti M, Koukouvou G, Ntovoli A, Alexandris K, Kouidi E. Exploring the effects of real-time online cardiac telerehabilitation using wearable devices compared to gym-based cardiac exercise in people with a recent myocardial infarction: a randomised controlled trial. Front Cardiovasc Med 2024; 11:1410616. [PMID: 38903965 PMCID: PMC11188591 DOI: 10.3389/fcvm.2024.1410616] [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: 04/01/2024] [Accepted: 05/15/2024] [Indexed: 06/22/2024] Open
Abstract
Background Exercise-based cardiac rehabilitation (CR) is a non-pharmacological multidisciplinary programme for individuals after myocardial infarction (MI) that offers multiple health benefits. One of the greatest barriers to CR participation is the travel distance to the rehabilitation centre. Remotely monitored CR appears to be at least as effective in improving cardiovascular risk factors and exercise capacity as traditional centre-based CR. Nevertheless, the efficacy of remotely monitored CR in individuals with a recent MI has yet to be examined. Methods A total of 30 individuals (8 women, 22 men) after a recent (i.e., <4 weeks) MI were randomly allocated into two groups (online home-based and gym-based groups). Both groups underwent a 26-week CR programme three times per week. All patients performed baseline and 24-week follow-up measurements where peak oxygen uptake (VO2peak), mean daily steps, distance, and calories were assessed. Results The online group showed an improvement in mean daily steps (p < 0.05) and mean daily distance (p < 0.05) at 24 weeks compared to the gym-based group. The paired-sample t-test showed that all the assessed variables were statistically (p < 0.001) improved for both groups at 24 weeks. Pearson's r demonstrated positive correlations between VO2peak and mean daily distance (r = 0.375), and negative correlations between VO2peak and muscle (r = -0.523) and fat masses (r = -0.460). There were no exercise-induced adverse events during the study. Conclusion Our findings might indicate that a real-time online supervised CR exercise programme using wearable technology to monitor the haemodynamic responses in post-MI patients is equally effective as a gym-based exercise programme.
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Affiliation(s)
- A. Mitropoulos
- Laboratory of Sport Medicine, Department of Physical Education and Sport Science, Aristotle University of Thessaloniki, Thessaloniki, Greece
- Lifestyle, Exercise and Nutritional Improvement (LENI) Research Group, Department of Nursing and Midwifery, Sheffield Hallam University, Sheffield, United Kingdom
| | - M. Anifanti
- Laboratory of Sport Medicine, Department of Physical Education and Sport Science, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - G. Koukouvou
- Laboratory of Sport Medicine, Department of Physical Education and Sport Science, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - A. Ntovoli
- Laboratory of Management of Sports Recreation and Tourism, Department of Physical Education and Sport Science, Aristotle University of Thessaloniki, Thessaloniki, Greece
- Department of Physical Education, Sports Sciences Frederick University, Nicosia, Cyprus
| | - K. Alexandris
- Laboratory of Management of Sports Recreation and Tourism, Department of Physical Education and Sport Science, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - E. Kouidi
- Laboratory of Sport Medicine, Department of Physical Education and Sport Science, Aristotle University of Thessaloniki, Thessaloniki, Greece
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13
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Yang Z, Hu N, Zhang F, Gao Y, Zhang C, Wang A. A Practical Tool for Measuring Home-Based Cardiac Rehabilitation Self-Management Behavior: A Multiphase Cross-Sectional Study. J Am Heart Assoc 2024; 13:e034486. [PMID: 38639372 PMCID: PMC11179869 DOI: 10.1161/jaha.124.034486] [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: 01/15/2024] [Accepted: 03/25/2024] [Indexed: 04/20/2024]
Abstract
BACKGROUND Optimal self-management is the key to home-based cardiac rehabilitation for patients with heart disease. At present, there is a lack of a specific assessment tool to evaluate the home-based cardiac rehabilitation self-management behavior in patients with heart disease. Therefore, the aim of this study was to develop the Home-Based Cardiac Rehabilitation Self-Management Scale and validate its psychometric properties among patients with coronary heart disease. METHODS AND RESULTS A multiphase cross-sectional study was conducted that study covered 3 phases: (1) item generation and revision, (2) item evaluation and preliminary exploration, and (3) assessment of the psychometric properties of the scale. A scale with 21 items was developed to measure the home-based cardiac rehabilitation self-management behavior. The content validity index of the scale was 0.980. In exploratory factor analysis, the 5-factor structure supported by eigenvalues and screen plot explained 74.326% of the total variation. In confirmatory factor analysis, all fitting indicators were acceptable, further supporting the construct validity of the scale. The criterion validity of the scale was 0.783. In the reliability analysis, the Cronbach's α coefficient of the scale was 0.882, with a dimensionality range of 0.780 to 0.936. The split-half reliability coefficient and test-retest reliability coefficient were 0.774 and 0.770, respectively. CONCLUSIONS This study is the first to develop and validate a practical tool. This scale can comprehensively and accurately assess the self-management behavior of patients with heart disease in a home-based cardiac rehabilitation environment.
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Affiliation(s)
- Zhen Yang
- The First Affiliated Hospital of China Medical UniversityShenyangLiaoning ProvinceChina
| | - Na Hu
- The First Affiliated Hospital of China Medical UniversityShenyangLiaoning ProvinceChina
| | - Fengpei Zhang
- The First Affiliated Hospital of China Medical UniversityShenyangLiaoning ProvinceChina
| | - Yu Gao
- The First Affiliated Hospital of Jinzhou Medical UniversityJinzhouLiaoning ProvinceChina
| | - Chunqi Zhang
- The First Affiliated Hospital of Jinzhou Medical UniversityJinzhouLiaoning ProvinceChina
| | - Aiping Wang
- The First Affiliated Hospital of China Medical UniversityShenyangLiaoning ProvinceChina
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14
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Khadanga S, Beebe-Peat T. Optimal Medical Therapy for Stable Ischemic Heart Disease in 2024: Focus on Exercise and Cardiac Rehabilitation. Med Clin North Am 2024; 108:509-516. [PMID: 38548460 DOI: 10.1016/j.mcna.2023.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/02/2024]
Abstract
Given the prevalence of chronic coronary disease, efforts should be made toward risk factor modification. Cardiac rehabilitation is a secondary prevention program consisting of tailored exercise and lifestyle counseling and has been shown to not only reduce cardiovascular morbidity and mortality but also improve quality of life and exercise capacity. Despite the benefits, it remains underutilized. Efforts should be made to increase referral for patients with chronic coronary disease to aid in symptom management and reduction of cardiovascular risk factors.
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Affiliation(s)
- Sherrie Khadanga
- Division of Cardiology, Department of Medicine, University of Vermont, Burlington, VT, USA; Vermont Center on Behavior and Health, University of Vermont, Burlington, VT, USA.
| | - Tanesha Beebe-Peat
- Department of Medicine, University of Vermont Medical Center, Burlington, VT, USA
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15
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Arena S. Rehabilitation Management of Heart Failure in Home Care. Home Healthc Now 2024; 42:185-186. [PMID: 38709586 DOI: 10.1097/nhh.0000000000001257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/08/2024]
Affiliation(s)
- Sara Arena
- Sara Arena, PT, MS, DScPT, is a Professor, Physical Therapy Program, School of Health Sciences, Oakland University, Rochester, Michigan
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16
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Lee S, Quinn L, Fritschi C, Fink AM, Park C, Reutrakul S, Collins EG. Physical Activity After Heart Surgery: Associations With Psychosocial and Sleep Factors. West J Nurs Res 2024; 46:333-343. [PMID: 38533821 DOI: 10.1177/01939459241240432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/28/2024]
Abstract
BACKGROUND Heart surgery is an effective intervention for managing heart disease, the leading cause of death globally. After surgery, physical activity is key to improving patients' quality of life and decreasing mortality, but patients are frequently physically inactive after heart surgery. OBJECTIVE This cross-sectional pilot study aimed to examine how psychosocial and sleep factors influenced physical activity in patients after heart surgery. The mediating role of sleep factors between psychosocial factors and physical activity was also examined. METHODS Thirty-three patients who had undergone heart surgery were recruited. Psychosocial and sleep factors and physical activity were measured using an online survey and a wrist-worn ActiGraph for 7 days and nights. RESULTS The participants had heart surgery an average of about 7 years previously. They exceeded the recommended 150 minutes per week of moderate-intensity physical activity for Americans; however, 64% of them showed poor sleep quality (Pittsburgh Sleep Quality Index >5). Higher anxiety and depressive symptoms, lower self-efficacy, and greater sleep disturbances were associated with lower physical activity. Moreover, self-efficacy, sleep duration, sleep disturbance, sleep efficiency, and wake after sleep onset were predictors for physical activity. No mediating role of sleep factors was observed between psychosocial factors and physical activity. CONCLUSIONS Psychosocial and sleep factors should be considered when developing and implementing physical activity strategies for patients after heart surgery. Researchers should examine the relationships among the study variables with larger samples of postsurgical cardiac patients during different periods after heart surgery.
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Affiliation(s)
- Sueyeon Lee
- Marcella Niehoff School of Nursing, Loyola University Chicago, Maywood, IL, USA
| | - Lauretta Quinn
- College of Nursing, University of Illinois Chicago, Chicago, IL, USA
| | - Cynthia Fritschi
- College of Nursing, University of Illinois Chicago, Chicago, IL, USA
| | - Anne M Fink
- College of Nursing, University of Illinois Chicago, Chicago, IL, USA
| | - Chang Park
- College of Nursing, University of Illinois Chicago, Chicago, IL, USA
| | - Sirimon Reutrakul
- Department of Medicine, University of Illinois Chicago, Chicago, IL, USA
| | - Eileen G Collins
- College of Nursing, University of Illinois Chicago, Chicago, IL, USA
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17
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Ski CF, Taylor RS, McGuigan K, Long L, Lambert JD, Richards SH, Thompson DR. Psychological interventions for depression and anxiety in patients with coronary heart disease, heart failure or atrial fibrillation. Cochrane Database Syst Rev 2024; 4:CD013508. [PMID: 38577875 PMCID: PMC10996021 DOI: 10.1002/14651858.cd013508.pub3] [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] [Indexed: 04/06/2024]
Abstract
BACKGROUND Depression and anxiety occur frequently (with reported prevalence rates of around 40%) in individuals with coronary heart disease (CHD), heart failure (HF) or atrial fibrillation (AF) and are associated with a poor prognosis, such as decreased health-related quality of life (HRQoL), and increased morbidity and mortality. Psychological interventions are developed and delivered by psychologists or specifically trained healthcare workers and commonly include cognitive behavioural therapies and mindfulness-based stress reduction. They have been shown to reduce depression and anxiety in the general population, though the exact mechanism of action is not well understood. Further, their effects on psychological and clinical outcomes in patients with CHD, HF or AF are unclear. OBJECTIVES To assess the effects of psychological interventions (alone, or with cardiac rehabilitation or pharmacotherapy, or both) in adults who have a diagnosis of CHD, HF or AF, compared to no psychological intervention, on psychological and clinical outcomes. SEARCH METHODS We searched the CENTRAL, MEDLINE, Embase, PsycINFO and CINAHL databases from 2009 to July 2022. We also searched three clinical trials registers in September 2020, and checked the reference lists of included studies. No language restrictions were applied. SELECTION CRITERIA We included randomised controlled trials (RCTs) comparing psychological interventions with no psychological intervention for a minimum of six months follow-up in adults aged over 18 years with a clinical diagnosis of CHD, HF or AF, with or without depression or anxiety. Studies had to report on either depression or anxiety or both. DATA COLLECTION AND ANALYSIS We used standard Cochrane methods. Our primary outcomes were depression and anxiety, and our secondary outcomes of interest were HRQoL mental and physical components, all-cause mortality and major adverse cardiovascular events (MACE). We used GRADE to assess the certainty of evidence for each outcome. MAIN RESULTS Twenty-one studies (2591 participants) met our inclusion criteria. Sixteen studies included people with CHD, five with HF and none with AF. Study sample sizes ranged from 29 to 430. Twenty and 17 studies reported the primary outcomes of depression and anxiety, respectively. Despite the high heterogeneity and variation, we decided to pool the studies using a random-effects model, recognising that the model does not eliminate heterogeneity and findings should be interpreted cautiously. We found that psychological interventions probably have a moderate effect on reducing depression (standardised mean difference (SMD) -0.36, 95% confidence interval (CI) -0.65 to -0.06; 20 studies, 2531 participants; moderate-certainty evidence) and anxiety (SMD -0.57, 95% CI -0.96 to -0.18; 17 studies, 2235 participants; moderate-certainty evidence), compared to no psychological intervention. Psychological interventions may have little to no effect on HRQoL physical component summary scores (PCS) (SMD 0.48, 95% CI -0.02 to 0.98; 12 studies, 1454 participants; low-certainty evidence), but may have a moderate effect on improving HRQoL mental component summary scores (MCS) (SMD 0.63, 95% CI 0.01 to 1.26; 12 studies, 1454 participants; low-certainty evidence), compared to no psychological intervention. Psychological interventions probably have little to no effect on all-cause mortality (risk ratio (RR) 0.81, 95% CI 0.39 to 1.69; 3 studies, 615 participants; moderate-certainty evidence) and may have little to no effect on MACE (RR 1.22, 95% CI 0.77 to 1.92; 4 studies, 450 participants; low-certainty evidence), compared to no psychological intervention. AUTHORS' CONCLUSIONS Current evidence suggests that psychological interventions for depression and anxiety probably result in a moderate reduction in depression and anxiety and may result in a moderate improvement in HRQoL MCS, compared to no intervention. However, they may have little to no effect on HRQoL PCS and MACE, and probably do not reduce mortality (all-cause) in adults who have a diagnosis of CHD or HF, compared with no psychological intervention. There was moderate to substantial heterogeneity identified across studies. Thus, evidence of treatment effects on these outcomes warrants careful interpretation. As there were no studies of psychological interventions for patients with AF included in our review, this is a gap that needs to be addressed in future studies, particularly in view of the rapid growth of research on management of AF. Studies investigating cost-effectiveness, return to work and cardiovascular morbidity (revascularisation) are also needed to better understand the benefits of psychological interventions in populations with heart disease.
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Affiliation(s)
- Chantal F Ski
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK
- Australian Centre for Heart Health, Deakin University, Melbourne, Australia
| | - Rod S Taylor
- MRC/CSO Social and Public Health Sciences Unit & Robertson Centre for Biostatistics, Institute of Health and Well Being, University of Glasgow, Glasgow, UK
| | - Karen McGuigan
- Queen's Communities and Place, Queen's University Belfast, Belfast, UK
| | - Linda Long
- MRC/CSO Social and Public Health Sciences Unit, School of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | | | | | - David R Thompson
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK
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18
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Sato R, Matsuzawa Y, Yoshii T, Akiyama E, Konishi M, Nakahashi H, Minamimoto Y, Kimura Y, Okada K, Maejima N, Iwahashi N, Kosuge M, Ebina T, Kimura K, Tamura K, Hibi K. Impact of Low-Density Lipoprotein Cholesterol Levels at Acute Coronary Syndrome Admission on Long-Term Clinical Outcomes. J Atheroscler Thromb 2024; 31:444-460. [PMID: 37821363 PMCID: PMC10999725 DOI: 10.5551/jat.64368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 08/21/2023] [Indexed: 10/13/2023] Open
Abstract
AIM Low-density lipoprotein cholesterol (LDL-C) level reduction is highly effective in preventing the occurrence of a cardiovascular event. Contrariwise, an inverse association exists between LDL-C levels and prognosis in some patients with cardiovascular diseases-the so-called "cholesterol paradox." This study aimed to investigate whether the LDL-C level on admission affects the long-term prognosis in patients who develop acute coronary syndrome (ACS) and to examine factors associated with poor prognosis in patients with low LDL-C levels. METHODS We enrolled 410 statin-naïve patients with ACS, whom we divided into low- and high-LDL-C groups based on an admission LDL-C cut-off (obtained from the Youden index) of 122 mg/dL. Endothelial function was assessed using the reactive hyperemia index 1 week after statin initiation. The primary composite endpoint included all-cause death, as well as myocardial infarction and ischemic stroke occurrences. RESULTS During a median follow-up period of 6.1 years, 76 patients experienced the primary endpoint. Multivariate Cox regression analysis revealed that patients in the low LDL-C group had a 2.3-fold higher risk of experiencing the primary endpoint than those in the high LDL-C group (hazard ratio, 2.34; 95% confidence interval, 1.29-4.27; p=0.005). In the low LDL-C group, slow gait speed (frailty), elevated chronic-phase high-sensitivity C-reactive protein levels (chronic inflammation), and endothelial dysfunction were significantly associated with the primary endpoint. CONCLUSIONS Patients with low LDL-C levels at admission due to ACS had a significantly worse long-term prognosis than those with high LDL-C levels; frailty, chronic inflammation, and endothelial dysfunction were poor prognostic factors.
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Affiliation(s)
- Ryosuke Sato
- Division of Cardiology, Yokohama City University Medical Center, Yokohama, Japan
| | - Yasushi Matsuzawa
- Division of Cardiology, Yokohama City University Medical Center, Yokohama, Japan
- Department of Cardiovascular Medicine, Kumamoto University Hospital, Kumamoto, Japan
| | - Tomohiro Yoshii
- Division of Cardiology, Yokohama City University Medical Center, Yokohama, Japan
| | - Eiichi Akiyama
- Division of Cardiology, Yokohama City University Medical Center, Yokohama, Japan
| | - Masaaki Konishi
- Department of Medical Science and Cardiorenal Medicine, Yokohama City University, Graduate School of Medicine, Yokohama, Japan
| | - Hidefumi Nakahashi
- Division of Cardiology, Yokohama City University Medical Center, Yokohama, Japan
| | - Yugo Minamimoto
- Division of Cardiology, Yokohama City University Medical Center, Yokohama, Japan
| | - Yuichiro Kimura
- Division of Cardiology, Yokohama City University Medical Center, Yokohama, Japan
| | - Kozo Okada
- Division of Cardiology, Yokohama City University Medical Center, Yokohama, Japan
| | - Nobuhiko Maejima
- Division of Cardiology, Yokohama City University Medical Center, Yokohama, Japan
| | - Noriaki Iwahashi
- Division of Cardiology, Yokohama City University Medical Center, Yokohama, Japan
| | - Masami Kosuge
- Division of Cardiology, Yokohama City University Medical Center, Yokohama, Japan
| | - Toshiaki Ebina
- Division of Cardiology, Yokohama City University Medical Center, Yokohama, Japan
| | - Kazuo Kimura
- Division of Cardiology, Yokohama City University Medical Center, Yokohama, Japan
| | - Kouichi Tamura
- Department of Medical Science and Cardiorenal Medicine, Yokohama City University, Graduate School of Medicine, Yokohama, Japan
| | - Kiyoshi Hibi
- Division of Cardiology, Yokohama City University Medical Center, Yokohama, Japan
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19
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Garfein J, Chen Y, Swabe G, Guhl E, Forman DE, Magnani JW. Race or ethnicity and education in cardiac rehabilitation enrollment. J Cardiol 2024; 83:280-283. [PMID: 37562543 PMCID: PMC10850430 DOI: 10.1016/j.jjcc.2023.08.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 07/21/2023] [Accepted: 07/27/2023] [Indexed: 08/12/2023]
Abstract
BACKGROUND Although cardiac rehabilitation (CR) has established benefits for cardiovascular health, it remains significantly underutilized, with substantial differences in participation related to factors such as educational attainment (EA), race, and ethnicity. We studied a geographically and racially diverse cohort of insured individuals in a health claims database to (1) evaluate differences in CR participation by EA and race or ethnicity and (2) assess how EA modifies associations between race or ethnicity and CR participation. METHODS We conducted a retrospective cohort study of individuals identified in Optum's de-identified Clinformatics® database between 1/1/2016 and 12/31/2019. Eligible individuals included those aged ≥18 years with a hospitalization for an incident CR-qualifying diagnosis. We calculated incidence rates of CR enrollment by EA and race or ethnicity, as well as associations of EA and race or ethnicity with CR enrollment, and evaluated interaction between EA and race or ethnicity with respect to CR participation. RESULTS We identified 171,297 individuals eligible for CR with a mean ± SD age of 70.4 ± 11.6 years; 37.4 % were female, and 68.3 % had >high school education. We observed a dose-response association between EA and rate of participation in CR. After adjustment, compared to White individuals, the odds of attending CR was 24 % lower for Asian individuals [95 % confidence interval (CI): 17 %, 30 %], 13 % lower for Black individuals (95 % CI: 9 %, 17 %), and 32 % lower for Hispanic individuals (95 % CI: 28 %, 35 %), all p < 0.0001. However, Black individuals with ≥bachelor's degree had a similar odds of CR enrollment as White individuals with ≥bachelor's degree (odds ratio 1.01, 95 % CI: 0.85, 1.20, p = 0.95). CONCLUSIONS EA was positively associated with CR enrollment across racial and ethnic groups. Higher EA might partially attenuate racial and ethnic differences in CR participation, but significant disparities persist. Our findings support increased attention to individuals with limited education to improve CR enrollment.
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Affiliation(s)
- Joshua Garfein
- Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Yimin Chen
- Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Gretchen Swabe
- Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Emily Guhl
- Division of Cardiology, UPMC Heart and Vascular Institute, University of Pittsburgh, Pittsburgh, PA, USA; Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Daniel E Forman
- Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA; Division of Cardiology, UPMC Heart and Vascular Institute, University of Pittsburgh, Pittsburgh, PA, USA
| | - Jared W Magnani
- Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA; Division of Cardiology, UPMC Heart and Vascular Institute, University of Pittsburgh, Pittsburgh, PA, USA; Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA; Center for Research on Health Care, Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA.
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20
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Nohria R, Antono B. Acute Coronary Syndrome. Prim Care 2024; 51:53-64. [PMID: 38278573 DOI: 10.1016/j.pop.2023.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2024]
Abstract
One percent of primary care visits are due to chest pain. It is critical for the primary care physician to have a high index of suspicion for acute coronary syndrome and understand the management of this important condition. This article reviews the outpatient evaluation and management of chest pain and summarizes the key points of inpatient evaluation and treatment of acute coronary syndrome.
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Affiliation(s)
- Raman Nohria
- Department of Family Medicine and Community Health, Duke University School of Medicine, 2100 Erwin Road, Durham, NC 27705, USA.
| | - Brian Antono
- Department of Family Medicine and Community Health, Duke University School of Medicine, 2100 Erwin Road, Durham, NC 27705, USA
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21
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Douma ER, Wirtz S, Fernandez MS, Schäfer H, Widdershoven JW, Habibović M, Gil CP, Bosch JA, Schmitz B, Kop WJ. Patient-reported preferences in eHealth-based cardiac rehabilitation: A qualitative investigation of behavior change techniques, barriers and facilitators. Internet Interv 2024; 35:100728. [PMID: 38405384 PMCID: PMC10883827 DOI: 10.1016/j.invent.2024.100728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 02/07/2024] [Accepted: 02/15/2024] [Indexed: 02/27/2024] Open
Abstract
Background Cardiac rehabilitation (CR) reduces recurrent cardiac events and mortality in patients with cardiovascular diseases (CVD). Innovative eHealth methods can facilitate CR uptake and effectiveness by addressing barriers associated with clinic-based rehabilitation. Tailoring eHealth-based CR to patient preferences is needed to further enhance CR. Purpose To identify preferred behavior change techniques (BCTs) as well as barriers and facilitators for the different health behaviors targeted in eHealth-based CR among patients who have been referred to CR. Methods Thirty-nine patients were interviewed in nine focus groups in The Netherlands, Germany, and Spain. A thematic analysis, using a combined deductive and inductive approach to coding, was conducted to identify BCTs and barriers and facilitators to behavior change. Behaviors under investigation included physical activity, medication adherence, eating a cardiac healthy-diet, stress reduction and smoking cessation. Results The perceived helpfulness of BCTs depended on the specific behavior targeted. Common barriers were negative emotional state and physical limitations. A desire to feel physically or mentally well and having experienced a cardiac life event were the most common facilitators across health behaviors. Specific BCTs, barriers and facilitators were found for each of the health behavior. Conclusions Behavior change techniques that patients preferred for each health behavior targeted in eHealth-based CR were identified. A negative emotional state, experiencing a life event, and improving physical functioning are important barriers and facilitators in multiple behaviors targeted in eHealth-based CR programs. Additional tailoring of interventions to patient preferences for BCTs and patient-specific barriers and facilitators per health behavior could lead to further improvement of eHealth-based CR.
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Affiliation(s)
- Emma R. Douma
- Tilburg University, Department of Medical and Clinical Psychology, Center of Research on Psychological Disorders and Somatic Diseases (CoRPS), Tilburg, the Netherlands
| | - Svenja Wirtz
- DRV Clinic Königsfeld, Center for Medical Rehabilitation, Ennepetal, Germany
- Department of Rehabilitation Sciences, Faculty of Health, University of Witten/Herdecke, Witten, Germany
| | - Manuela Sestayo Fernandez
- Hospital Universitario de Santiago de Compostela, Servizo Galego De Saude, Santiago de Compostela, Spain
| | - Hendrik Schäfer
- DRV Clinic Königsfeld, Center for Medical Rehabilitation, Ennepetal, Germany
- Department of Rehabilitation Sciences, Faculty of Health, University of Witten/Herdecke, Witten, Germany
| | - Jos W.M.G. Widdershoven
- Tilburg University, Department of Medical and Clinical Psychology, Center of Research on Psychological Disorders and Somatic Diseases (CoRPS), Tilburg, the Netherlands
- Elisabeth-TweeSteden Hospital, Department of Cardiology, Tilburg, the Netherlands
| | - Mirela Habibović
- Tilburg University, Department of Medical and Clinical Psychology, Center of Research on Psychological Disorders and Somatic Diseases (CoRPS), Tilburg, the Netherlands
| | - Carlos Peña Gil
- Hospital Universitario de Santiago de Compostela, Servizo Galego De Saude, Santiago de Compostela, Spain
| | - Jos A. Bosch
- University of Amsterdam, Faculty of Social and Behavioral Sciences, Amsterdam, the Netherlands
| | - Boris Schmitz
- DRV Clinic Königsfeld, Center for Medical Rehabilitation, Ennepetal, Germany
- Department of Rehabilitation Sciences, Faculty of Health, University of Witten/Herdecke, Witten, Germany
| | - Willem J. Kop
- Tilburg University, Department of Medical and Clinical Psychology, Center of Research on Psychological Disorders and Somatic Diseases (CoRPS), Tilburg, the Netherlands
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22
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Zhou Y, Gao X, Xu J, Ding X, Yuan J, Du S, Shi X, Wang Y. Network analysis of perception of exercise benefits/barriers and kinesiophobia among patients with cardiovascular diseases. Heart Lung 2024; 64:182-188. [PMID: 38281371 DOI: 10.1016/j.hrtlng.2023.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 12/19/2023] [Accepted: 12/31/2023] [Indexed: 01/30/2024]
Abstract
BACKGROUND Perception of exercise benefits/barriers and kinesiophobia are important predictors of low exercise behaviors in patients with cardiovascular diseases (CVDs). Little is known about the complex intercorrelations between different components of perception of exercise benefits/barriers and kinesiophobia. OBJECTIVES To identify the central components of kinesiophobia and to explore the interconnectedness between perception of exercise benefits/barriers and kinesiophobia. METHODS A total of 258 patients with CVDs were recruited in this study. The Tampa Scale for Kinesiophobia Heart and the Exercise Benefits/Barriers Scale were used to assess kinesiophobia and perception of exercise benefits/barriers. R software was used to visualize the networks and analyze the centrality of the networks. The index "expected influence" and "bridge expected influence" were employed to identify the central components and the bridge components of the networks. RESULTS In the item network of kinesiophobia, three items ("It is really not safe for a person in my condition to be physically active/exercise", "I cannot do the same things as others because there is a too big risk that I will get heart problems", and "If I tried to be physically active/exercise my heart problem would increase") had the highest expected influence. In the exercise benefits/barriers-kinesiophobia network, the dimension of physical exertion had the highest positive bridge expected influence, while psychological outlook had highest negative value. CONCLUSIONS The three central components of kinesiophobia and the two bridge components (perception exercise barriers of physical exertion and perception exercise benefits of psychological outlook) should be targeted in specific intervention for relieving kinesiophobia and further promoting exercise behaviors.
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Affiliation(s)
- Yi Zhou
- School of Nursing, Hebei University, No.342 Yuhuadong Road, Lianchi District, Baoding, Hebei 071000, China
| | - Xiaopei Gao
- School of Nursing, Hebei University, No.342 Yuhuadong Road, Lianchi District, Baoding, Hebei 071000, China
| | - Jiangyuan Xu
- School of Nursing, Hebei University, No.342 Yuhuadong Road, Lianchi District, Baoding, Hebei 071000, China
| | - Xiaojuan Ding
- School of Nursing, Hebei University, No.342 Yuhuadong Road, Lianchi District, Baoding, Hebei 071000, China
| | - Jing Yuan
- School of Nursing, Hebei University, No.342 Yuhuadong Road, Lianchi District, Baoding, Hebei 071000, China
| | - Shaoying Du
- School of Nursing, Hebei University, No.342 Yuhuadong Road, Lianchi District, Baoding, Hebei 071000, China
| | - Xiaoyang Shi
- School of Nursing, Hebei University, No.342 Yuhuadong Road, Lianchi District, Baoding, Hebei 071000, China.
| | - Yan Wang
- School of Nursing, Hebei University, No.342 Yuhuadong Road, Lianchi District, Baoding, Hebei 071000, China.
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23
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Kenny E, Coyne R, McEvoy JW, McSharry J, Taylor RS, Byrne M. Behaviour change techniques and intervention characteristics in digital cardiac rehabilitation: a systematic review and meta-analysis of randomised controlled trials. Health Psychol Rev 2024; 18:189-228. [PMID: 36892523 DOI: 10.1080/17437199.2023.2185653] [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: 06/18/2022] [Accepted: 02/18/2023] [Indexed: 03/10/2023]
Abstract
Evidence suggests that digitally delivered cardiac rehabilitation (CR) is likely to be an effective alternative to centre-based CR. However, there is limited understanding of the behaviour change techniques (BCTs) and intervention characteristics included in digital CR programmes. This systematic review aimed to identify the BCTs and intervention characteristics that have been used in digital CR programmes, and to study those associated with effective programmes. Twenty-five randomised controlled trials were included in the review. Digital CR was associated with significant improvements in daily steps, light physical activity, medication adherence, functional capacity, and low-density lipoprotein-cholesterol when compared to usual care, and produced effects on these outcomes comparable to centre-based CR. The evidence for improved quality of life was mixed. Interventions that were effective at improving behavioural outcomes frequently employed BCTs relating to feedback and monitoring, goals and planning, natural consequences, and social support. Completeness of reporting on the TIDieR checklist across studies ranged from 42% to 92%, with intervention material descriptions being the most poorly reported item. Digital CR appears effective at improving outcomes for patients with cardiovascular disease. The integration of certain BCTs and intervention characteristics may lead to more effective interventions, however better intervention reporting is required.
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Affiliation(s)
- Eanna Kenny
- Health Behaviour Change Research Group, School of Psychology, University of Galway, Galway, Republic of Ireland
| | - Rory Coyne
- School of Psychology, University of Galway, Galway, Republic of Ireland
| | - John W McEvoy
- National Institute for Prevention and Cardiovascular Health, School of Medicine, University of Galway, Galway, Republic of Ireland
| | - Jenny McSharry
- Health Behaviour Change Research Group, School of Psychology, University of Galway, Galway, Republic of Ireland
| | - Rod S Taylor
- MRC/CSO Social and Public Health Sciences Unit & Robertson Centre for Biostatistics, Institute of Health and Well Being, University of Glasgow, Glasgow, UK
| | - Molly Byrne
- Health Behaviour Change Research Group, School of Psychology, University of Galway, Galway, Republic of Ireland
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24
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Thomas RJ. Cardiac Rehabilitation - Challenges, Advances, and the Road Ahead. N Engl J Med 2024; 390:830-841. [PMID: 38416431 DOI: 10.1056/nejmra2302291] [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] [Indexed: 02/29/2024]
Affiliation(s)
- Randal J Thomas
- From the Division of Preventive Cardiology, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
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25
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Lee MK, Lee CJ, Goo SY, Lee TH, Moon JY, Jung J, Kim MJ, Shin SH, Kim JN, Han SN, Lee JE, Lee JY, Chung IM, Jeon JY. Development and application of a home-based exercise program for patients with cardiovascular disease: a feasibility study. BMC Sports Sci Med Rehabil 2024; 16:51. [PMID: 38378630 PMCID: PMC10880299 DOI: 10.1186/s13102-024-00835-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 01/30/2024] [Indexed: 02/22/2024]
Abstract
BACKGROUND Cardiac rehabilitation (CR) is recommended for patients with cardiovascular disease. However, the participation and completion rates for hospital-based CR are low, and home-based CR has been suggested as an alternative. This study aimed to develop a home-based CR program and assess the feasibility of the program over a 6-week period in patients with left ventricular dysfunction or a history of myocardial infarction. METHODS This feasibility study consisted of two phases. The initial phase (Study 1) focused on developing the home-based exercise protocol. Systematic approaches to developing evidence-based home-based exercise intervention were implemented including systematic review, patient surveys, and expert consensus. Study 2 aimed to evaluate the feasibility of a 6-week home-based CR program that was based on the results of Study 1. Study 2 included two exercise education sessions and four telephone counseling sessions. During this stage of the exercise program, the participants exercised on two separate days and their experiences while performing the aerobic and resistance exercises were surveyed. Eight participants participated in Study 1 and 16 participated in Study 2. RESULTS Participants expressed overall satisfaction with the exercise program in Study 1. Heart rate increased in response to exercise, but this did not correspond with perceived exertion. The aim of the home-based CR exercise program was for participants to achieve exercise goals (≥150 min/week of aerobic type exercises as well as at least twice weekly resistance exercise using own body weights). We aimed to increase compliance and adherence to the home-based CR program. In Study 2, 13 out of 16 participants (81.3%) completed the 6-week home-based CR program, with a participation rate of 100% in both exercise education and phone counseling sessions. Adherence to the home-based exercise protocol was 83.1% and no serious adverse events were observed. At the beginning of the study, only three out of 13 participants (23.1%) met the requirements for both aerobic and resistance exercises, but at the end of the 6-week program, 10 out of 13 participants (76.9%) fulfilled the requirements. CONCLUSION The exercise program developed in this study was safe and feasible, and the 6-week home-based CR program was feasible for patients with cardiovascular disease without any reported adverse effects.
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Affiliation(s)
- Mi Kyung Lee
- Frontier Research Institute of Convergence Sports Science, FRICSS, Yonsei University, Seoul, South Korea
| | - Chan Joo Lee
- Division of Cardiology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Seon Young Goo
- Department of Sport Industry Studies, Yonsei University, Seoul, South Korea
| | - Tae Ho Lee
- Department of Sport Industry Studies, Yonsei University, Seoul, South Korea
| | - Jin Young Moon
- Department of Sport Industry Studies, Yonsei University, Seoul, South Korea
| | - Jiyoung Jung
- Cardiology Division, Ewha Womans University Mokdong Hospital, Seoul, South Korea
| | - Min Jung Kim
- Department of Educational Psychology, Seoul Women's University, Seoul, South Korea
| | - Sang Hee Shin
- Cardiology Division, Ewha Womans University Mokdong Hospital, Seoul, South Korea
| | - Jong Nam Kim
- Department of Educational Psychology, Seoul Women's University, Seoul, South Korea
| | - Sung Nim Han
- Department of Food and Nutrition, College of Human Ecology, Seoul National University, Seoul, South Korea
| | - Jung Eun Lee
- Department of Food and Nutrition, College of Human Ecology, Seoul National University, Seoul, South Korea
| | - Jong Young Lee
- Division of Cardiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Ick-Mo Chung
- Division of Cardiology, Department of Internal Medicine, Mokdong Hospital, School of Medicine, Ewha Womans University, Seoul, South Korea.
- Division of Cardiology, Ewha Womans University Mokdong Hospital, 1071 Anyangcheon-ro, Yangcheon-gu, Seoul, Republic of Korea.
| | - Justin Y Jeon
- Frontier Research Institute of Convergence Sports Science, FRICSS, Yonsei University, Seoul, South Korea.
- Department of Sport Industry Studies, Yonsei University, Seoul, South Korea.
- Exercise Medicine Center for Diabetes and Cancer Patients, ICONS, Yonsei University, Seoul, South Korea.
- Cancer Prevention Center, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Republic of Korea.
- Department of Sport Industry Studies and Exercise Medicine Center for Diabetes and Cancer Patients, Yonsei University, 50 Yonsei-ro, Seodaemun-gu, Seoul, Republic of Korea.
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26
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Bourgeois N, Lands LC, Prévost K, Poirier C, Janaudis-Ferreira T. Virtual Physical Prehabilitation in Lung Transplant Candidates: A Proof-of-Concept Study. Transpl Int 2024; 37:12355. [PMID: 38433973 PMCID: PMC10904465 DOI: 10.3389/ti.2024.12355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 02/07/2024] [Indexed: 03/05/2024]
Abstract
This study aimed to preliminary test the effectiveness of 12-week virtual physical prehabilitation program followed by a maintenance phase. The main objective was to estimate the extent to which it affects exercise capacity, frailty, lower limb strength and health-related quality of life (HRQOL) in lung transplant candidates. The program offered supervised strengthening exercises, independent aerobic exercises and weekly phone calls (maintenance phase). Primary outcome was the six-minute walk distance (6MWD). Secondary outcomes: the Short Physical Performance Battery (SPPB), five-times sit-to-stand test (5STS), the St George's Respiratory Questionnaire (SGRQ) for HRQOL. Twenty patients were included (mean age 57.9; 6 women/14 men); fourteen completed the prehabilitation program and 5 completed the maintenance phase. There was no statistically significant improvement in 6MWD, SPPB or SGRQ after the 12-week program. Most patients either maintained or improved the 6MWT and SPPB scores. There was a significant improvement in the 5STS. After the maintenance phase, most patients either improved or maintained their scores in all outcomes except for the sub-score of symptoms in the SGRQ. A 12-week virtual physical prehabilitation program with a 12-week maintenance phase can help lung transplant candidates improve or maintain their physical function while waiting for transplantation.
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Affiliation(s)
- Nicholas Bourgeois
- Lung Transplant Program, Centre Hospitalier de l’Université de Montréal, Montreal, QC, Canada
- School of Physical and Occupational Therapy, McGill University, Montreal, QC, Canada
- Canadian Donation and Transplantation Research Program, Edmonton, AB, Canada
| | - Larry C. Lands
- Lung Transplant Program, Centre Hospitalier de l’Université de Montréal, Montreal, QC, Canada
- Department of Pediatrics, Montreal Children’s Hospital-McGill University Health Centre, Montreal, QC, Canada
| | - Karina Prévost
- Lung Transplant Program, Centre Hospitalier de l’Université de Montréal, Montreal, QC, Canada
| | - Charles Poirier
- Lung Transplant Program, Centre Hospitalier de l’Université de Montréal, Montreal, QC, Canada
| | - Tania Janaudis-Ferreira
- School of Physical and Occupational Therapy, McGill University, Montreal, QC, Canada
- Canadian Donation and Transplantation Research Program, Edmonton, AB, Canada
- Respiratory Epidemiology and Clinical Research Unit, Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, QC, Canada
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27
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Khadanga S, Savage P, Keteyian S, Yant B, Gaalema D, Ades P. Cardiac rehabilitation: the gateway for secondary prevention. Heart 2024:heartjnl-2023-323152. [PMID: 38302263 DOI: 10.1136/heartjnl-2023-323152] [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] [Indexed: 02/03/2024] Open
Abstract
Cardiac rehabilitation (CR) is a multidisciplinary supervised programme which typically consists of tailored exercise and education on lifestyle management and risk factor modification in cardiac patients. Participation in CR reduces morbidity and mortality, while improving quality of life following major cardiovascular events. Despite the benefits of CR, it is underutilised, generally in the 20%-30% range for eligible patients. Participation and adherence rates are particularly suboptimal in vulnerable populations, such as those of lower socioeconomic status and women. Interventions such as automated referral to CR or hybrid/virtual programmes can increase enrolment to CR. This review summarises the components of CR and provides recommendations for providers regarding participation and adherence. To better engage a larger proportion of CR-eligible patients, CR programmes may need to expand or adjust ways to deliver secondary prevention.
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Affiliation(s)
| | - Patrick Savage
- Medicine, University of Vermont, Burlington, Vermont, USA
| | - Steven Keteyian
- Preventive Cardiology, Henry Ford Hospital, Detroit, Michigan, USA
| | - Blair Yant
- Psychiatry, University of Vermont, Burlington, Vermont, USA
| | - Diann Gaalema
- Psychiatry, University of Vermont, Burlington, Vermont, USA
| | - Philip Ades
- Medicine, University of Vermont, Burlington, Vermont, USA
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28
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Bhatla A, Kim CH, Nimbalkar M, Ng‐Thow‐Hing AS, Isakadze N, Spaulding E, Zaleski A, Craig KJ, Verbrugge DJ, Dunn P, Nag D, Bankar D, Martin SS, Marvel FA. Cardiac Rehabilitation Enabled With Health Technology: Innovative Models of Care Delivery and Policy to Enhance Health Equity. J Am Heart Assoc 2024; 13:e031621. [PMID: 38226509 PMCID: PMC10926793 DOI: 10.1161/jaha.123.031621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 10/11/2023] [Indexed: 01/17/2024]
Affiliation(s)
- Anjali Bhatla
- Division of Cardiology, Department of MedicineJohns Hopkins University School of MedicineBaltimoreMD
- Digital Health Innovation Laboratory, Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of MedicineJohns Hopkins University School of MedicineBaltimoreMD
| | - Chang H. Kim
- Division of Cardiology, Department of MedicineJohns Hopkins University School of MedicineBaltimoreMD
- Digital Health Innovation Laboratory, Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of MedicineJohns Hopkins University School of MedicineBaltimoreMD
- Center for Mobile Technologies to Achieve Equity in Cardiovascular Health (mTECH Center), an AHA Health Technology & Innovation SFRN CenterBaltimoreMD
| | - Mansi Nimbalkar
- Digital Health Innovation Laboratory, Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of MedicineJohns Hopkins University School of MedicineBaltimoreMD
- Center for Mobile Technologies to Achieve Equity in Cardiovascular Health (mTECH Center), an AHA Health Technology & Innovation SFRN CenterBaltimoreMD
| | - Anthony Sky Ng‐Thow‐Hing
- Digital Health Innovation Laboratory, Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of MedicineJohns Hopkins University School of MedicineBaltimoreMD
| | - Nino Isakadze
- Division of Cardiology, Department of MedicineJohns Hopkins University School of MedicineBaltimoreMD
- Digital Health Innovation Laboratory, Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of MedicineJohns Hopkins University School of MedicineBaltimoreMD
- Center for Mobile Technologies to Achieve Equity in Cardiovascular Health (mTECH Center), an AHA Health Technology & Innovation SFRN CenterBaltimoreMD
| | - Erin Spaulding
- Digital Health Innovation Laboratory, Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of MedicineJohns Hopkins University School of MedicineBaltimoreMD
- Center for Mobile Technologies to Achieve Equity in Cardiovascular Health (mTECH Center), an AHA Health Technology & Innovation SFRN CenterBaltimoreMD
- School of NursingJohns Hopkins UniversityBaltimoreMD
- Welch Center for Prevention, Epidemiology, and Clinical ResearchJohns Hopkins Bloomberg School of Public HealthBaltimoreMD
| | | | | | | | | | | | | | - Seth S. Martin
- Division of Cardiology, Department of MedicineJohns Hopkins University School of MedicineBaltimoreMD
- Digital Health Innovation Laboratory, Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of MedicineJohns Hopkins University School of MedicineBaltimoreMD
- Center for Mobile Technologies to Achieve Equity in Cardiovascular Health (mTECH Center), an AHA Health Technology & Innovation SFRN CenterBaltimoreMD
| | - Francoise A. Marvel
- Division of Cardiology, Department of MedicineJohns Hopkins University School of MedicineBaltimoreMD
- Digital Health Innovation Laboratory, Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of MedicineJohns Hopkins University School of MedicineBaltimoreMD
- Center for Mobile Technologies to Achieve Equity in Cardiovascular Health (mTECH Center), an AHA Health Technology & Innovation SFRN CenterBaltimoreMD
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29
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Liu HN, Gao B. Exploration of cardiac rehabilitation nursing for elderly patients with myocardial infarction based on individualized cardiac rehabilitation. World J Clin Cases 2024; 12:256-266. [PMID: 38313651 PMCID: PMC10835703 DOI: 10.12998/wjcc.v12.i2.256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 11/24/2023] [Accepted: 12/25/2023] [Indexed: 01/11/2024] Open
Abstract
BACKGROUND Myocardial infarction is a high-risk condition prevalent among the elderly population, often leading to adverse clinical manifestations such as reduced cardiopulmonary function, anxiety, and depression post-surgery. Consequently, cardiac rehabilitation holds immense importance in mitigating these complications. AIM To evaluate the effect of individualized cardiac rehabilitation on blood pressure variability (BPV) and baroreflex sensitivity (BRS) in elderly patients with myocardial infarction. METHODS A cohort of 74 elderly patients diagnosed with myocardial infarction and admitted to our hospital between January 2021 and January 2022 were subjected to random selection. Subsequently, all patients were divided into two groups, namely the research group (n = 37) and the control group (n = 37), utilizing the number table method. The control group received conventional drug treatment and nursing guidance intervention, while the study group underwent individualized cardiac rehabilitation in addition to the interventions received by the control group. All patients were continuously intervened for 12 wk, and the BPV of these two groups in the 1st wk (T0), the 4th wk (T1) and the 12th wk (T2) were compared, BRS, changes in cardiopulmonary function measures, and adverse cardiovascular events. RESULTS Of 24 h diastolic BPV, 24 h systolic BPV, carbon dioxide ventilation equivalent slope of the research group were lower than those of the control group at T1 and T2, BRS, peak heart rate and systolic blood pressure product, 1 min heart rate recovery were higher than those of the control group, and the incidence of adverse events in the research group was lower than that of the control group, the difference was statistically significant (P < 0.05). CONCLUSION In this study, we found that after individualized cardiac rehabilitation in elderly patients with myocardial infarction, BPV and BRS can be effectively improved, cardiac function is significantly enhanced, and a better prognosis is obtained.
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Affiliation(s)
- Hua-Ning Liu
- Department of Geriatrics, General Hospital of the YangTze River Shipping, Wuhan Brain Hospital, Wuhan 430015, Hubei Province, China
| | - Bo Gao
- Department of Cardiology, Suizhou Central Hospital, Affiliated Hospital of Hubei University of Medicine, Suizhou 441300, Hubei Province, China
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30
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Whellan DJ. Physical Activity for Patients With Heart Failure With Reduced Ejection Fraction: Pump up the Volume. Circulation 2024; 149:189-191. [PMID: 37955620 DOI: 10.1161/circulationaha.123.067588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 11/07/2023] [Indexed: 11/14/2023]
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31
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Isakadze N, Kim CH, Marvel FA, Ding J, MacFarlane Z, Gao Y, Spaulding EM, Stewart KJ, Nimbalkar M, Bush A, Broderick A, Gallagher J, Molello N, Commodore-Mensah Y, Michos ED, Dunn P, Hanley DF, McBee N, Martin SS, Mathews L. Rationale and Design of the mTECH-Rehab Randomized Controlled Trial: Impact of a Mobile Technology Enabled Corrie Cardiac Rehabilitation Program on Functional Status and Cardiovascular Health. J Am Heart Assoc 2024; 13:e030654. [PMID: 38226511 PMCID: PMC10926786 DOI: 10.1161/jaha.123.030654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 12/01/2023] [Indexed: 01/17/2024]
Abstract
BACKGROUND Cardiac rehabilitation (CR) is an evidence-based, guideline-recommended intervention for patients recovering from a cardiac event, surgery or procedure that improves morbidity, mortality, and functional status. CR is traditionally provided in-center, which limits access and engagement, most notably among underrepresented racial and ethnic groups due to barriers including cost, scheduling, and transportation access. This study is designed to evaluate the Corrie Hybrid CR, a technology-based, multicomponent health equity-focused intervention as an alternative to traditional in-center CR among patients recovering from a cardiac event, surgery, or procedure compared with usual care alone. METHODS The mTECH-Rehab (Impact of a Mobile Technology Enabled Corrie CR Program) trial will randomize 200 patients who either have diagnosis of myocardial infarction or who undergo coronary artery bypass grafting surgery, percutaneous coronary intervention, heart valve repair, or replacement presenting to 4 hospitals in a large academic health system in Maryland, United States, to the Corrie Hybrid CR program combined with usual care CR (intervention group) or usual care CR alone (control group) in a parallel arm, randomized controlled trial. The Corrie Hybrid CR program leverages 5 components: (1) a patient-facing mobile application that encourages behavior change, patient empowerment, and engagement with guideline-directed therapy; (2) Food and Drug Administration-approved smart devices that collect health metrics; (3) 2 upfront in-center CR sessions to facilitate personalization, self-efficacy, and evaluation for the safety of home exercise, followed by a combination of in-center and home-based sessions per participant preference; (4) a clinician dashboard to track health data; and (5) weekly virtual coaching sessions delivered over 12 weeks for education, encouragement, and risk factor modification. The primary outcome is the mean difference between the intervention versus control groups in distance walked on the 6-minute walk test (ie, functional capacity) at 12 weeks post randomization. Key secondary and exploratory outcomes include improvement in a composite cardiovascular health metric, CR engagement, quality of life, health factors (including low-density lipoprotein-cholesterol, hemoglobin A1c, weight, diet, smoking cessation, blood pressure), and psychosocial factors. Approval for the study was granted by the local institutional review board. Results of the trial will be published once data collection and analysis have been completed. CONCLUSIONS The Corrie Hybrid CR program has the potential to improve functional status, cardiovascular health, and CR engagement and advance equity in access to cardiac rehabilitation. REGISTRATION URL: https://www.clinicaltrials.gov; Unique identifier: NCT05238103.
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Affiliation(s)
- Nino Isakadze
- Division of Cardiology, Department of Medicine Johns Hopkins University School of Medicine Baltimore MD USA
- Digital Health Innovation Laboratory, Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine Johns Hopkins University School of Medicine Baltimore MD USA
- Center for Mobile Technologies to Achieve Equity in Cardiovascular Health (mTECH Center) Baltimore MD USA
| | - Chang H Kim
- Division of Cardiology, Department of Medicine Johns Hopkins University School of Medicine Baltimore MD USA
- Digital Health Innovation Laboratory, Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine Johns Hopkins University School of Medicine Baltimore MD USA
- Center for Mobile Technologies to Achieve Equity in Cardiovascular Health (mTECH Center) Baltimore MD USA
| | - Francoise A Marvel
- Division of Cardiology, Department of Medicine Johns Hopkins University School of Medicine Baltimore MD USA
- Digital Health Innovation Laboratory, Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine Johns Hopkins University School of Medicine Baltimore MD USA
- Center for Mobile Technologies to Achieve Equity in Cardiovascular Health (mTECH Center) Baltimore MD USA
| | - Jie Ding
- Division of Cardiology, Department of Medicine Johns Hopkins University School of Medicine Baltimore MD USA
- Digital Health Innovation Laboratory, Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine Johns Hopkins University School of Medicine Baltimore MD USA
- Center for Mobile Technologies to Achieve Equity in Cardiovascular Health (mTECH Center) Baltimore MD USA
| | - Zane MacFarlane
- Division of Cardiology, Department of Medicine Johns Hopkins University School of Medicine Baltimore MD USA
- Digital Health Innovation Laboratory, Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine Johns Hopkins University School of Medicine Baltimore MD USA
- Center for Mobile Technologies to Achieve Equity in Cardiovascular Health (mTECH Center) Baltimore MD USA
| | - Yumin Gao
- Division of Cardiology, Department of Medicine Johns Hopkins University School of Medicine Baltimore MD USA
- Digital Health Innovation Laboratory, Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine Johns Hopkins University School of Medicine Baltimore MD USA
- Center for Mobile Technologies to Achieve Equity in Cardiovascular Health (mTECH Center) Baltimore MD USA
| | - Erin M Spaulding
- Division of Cardiology, Department of Medicine Johns Hopkins University School of Medicine Baltimore MD USA
- Digital Health Innovation Laboratory, Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine Johns Hopkins University School of Medicine Baltimore MD USA
- Center for Mobile Technologies to Achieve Equity in Cardiovascular Health (mTECH Center) Baltimore MD USA
- Johns Hopkins University School of Nursing Baltimore MD USA
- Welch Center for Prevention, Epidemiology, and Clinical Research Johns Hopkins University Baltimore MD USA
| | - Kerry J Stewart
- Division of Cardiology, Department of Medicine Johns Hopkins University School of Medicine Baltimore MD USA
| | - Mansi Nimbalkar
- Division of Cardiology, Department of Medicine Johns Hopkins University School of Medicine Baltimore MD USA
| | - Alexandra Bush
- Division of Cardiology, Department of Medicine Johns Hopkins University School of Medicine Baltimore MD USA
| | - Ashley Broderick
- Division of Cardiology, Department of Medicine Johns Hopkins University School of Medicine Baltimore MD USA
| | - Jeanmarie Gallagher
- Division of Cardiology, Department of Medicine Johns Hopkins University School of Medicine Baltimore MD USA
| | - Nancy Molello
- Johns Hopkins Center for Health Equity Baltimore MD USA
| | - Yvonne Commodore-Mensah
- Center for Mobile Technologies to Achieve Equity in Cardiovascular Health (mTECH Center) Baltimore MD USA
- Johns Hopkins University School of Nursing Baltimore MD USA
- Johns Hopkins Center for Health Equity Baltimore MD USA
| | - Erin D Michos
- Division of Cardiology, Department of Medicine Johns Hopkins University School of Medicine Baltimore MD USA
- Digital Health Innovation Laboratory, Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine Johns Hopkins University School of Medicine Baltimore MD USA
- Center for Mobile Technologies to Achieve Equity in Cardiovascular Health (mTECH Center) Baltimore MD USA
| | - Patrick Dunn
- Center for Health Technology and Innovation, American Heart Association Dallas TX USA
- Department of Neurology Johns Hopkins University School of Medicine Baltimore MD USA
| | - Daniel F Hanley
- Department of Neurology Johns Hopkins University School of Medicine Baltimore MD USA
- Division of Neurosurgery, Department of Surgery Johns Hopkins University School of Medicine Baltimore MD USA
- Department of Anesthesiology and Critical Care Medicine Johns Hopkins University School of Medicine Baltimore MD USA
| | - Nichol McBee
- Ginsburg Institute for Health Equity, Nemours Children's Health Orlando FL USA
- Department of Neurology Johns Hopkins University School of Medicine Baltimore MD USA
| | - Seth S Martin
- Division of Cardiology, Department of Medicine Johns Hopkins University School of Medicine Baltimore MD USA
- Digital Health Innovation Laboratory, Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine Johns Hopkins University School of Medicine Baltimore MD USA
- Center for Mobile Technologies to Achieve Equity in Cardiovascular Health (mTECH Center) Baltimore MD USA
- Johns Hopkins Center for Health Equity Baltimore MD USA
| | - Lena Mathews
- Division of Cardiology, Department of Medicine Johns Hopkins University School of Medicine Baltimore MD USA
- Digital Health Innovation Laboratory, Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine Johns Hopkins University School of Medicine Baltimore MD USA
- Center for Mobile Technologies to Achieve Equity in Cardiovascular Health (mTECH Center) Baltimore MD USA
- Johns Hopkins Center for Health Equity Baltimore MD USA
- Welch Center for Prevention, Epidemiology, and Clinical Research Johns Hopkins University Baltimore MD USA
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Kupnovytska IH, Romanyshyn NM, Fitkovska IP, Gubina NV, Krasnopolsky SZ, Klymenko VI, Kalugina SM. Effect of ivabradine on structural and functional changes of myocardium and NT-proBNP levels in patients with stable coronary heart disease after coronary stenting. WIADOMOSCI LEKARSKIE (WARSAW, POLAND : 1960) 2024; 77:800-810. [PMID: 38865640 DOI: 10.36740/wlek202404128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2024]
Abstract
OBJECTIVE Aim: To investigate the effect of ivabradine on the hemodynamics and contractility of the myocardium and the features of NT-pro-BNP production in patients with stable ischemic heart disease after endovascular revascularization of the myocardium depending on the number of affected coronary arteries during 12 months of therapy. PATIENTS AND METHODS Materials and Methods: The object of the study was 120 patients with stable coronary artery disease: angina pectoris of functional class III with heart failure IIA FC III with preserved and moderately reduced ejection fraction of the left ventricle, who underwent coronary artery stenting. The examined patients were randomized according to the number of affected coronary vessels and the method of treatment. RESULTS Results: Ivabradine in patients with stable ischemic heart disease after 12 months of therapy had a significant beneficial effect on the structural and functional parameters of the myocardium (contributed to the reverse remodeling of the left ventricle), which did not depend on the number of stented coronary arteries (p<0.05). In patients with stented one coronary artery, all structural and functional indicators of the heart after 12 months of treatment reached the values of practically healthy individuals from the control group. The use of ivabradine in patients with stable ischemic heart disease with heart failure with preserved and intermediate ejection fraction of the left ventricle after coronary stenting made it possible to ensure the correction of a number of clinical and pathogenetic links of the disease, which generally contributed to the improvement of metric and volumetric parameters of the heart. CONCLUSION Conclusions: Ivabradine made it possible to significantly increase the effectiveness of standard therapy, which was manifested by a faster recovery of the geometry and contractility of the left ventricle. Therefore, the use of ivabradine along with standard therapy was appropriate for such a contingent of patients. The management of patients with stable coronary heart disease should combine adequate (surgical and pharmacological) treatment of the underlying disease, further individual medication correction of symptoms and circulatory disorders inherent in coronary heart disease and heart failure.
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Affiliation(s)
| | | | - Iryna P Fitkovska
- IVANO-FRANKIVSK NATIONAL MEDICAL UNIVERSITY, IVANO-FRANKIVSK, UKRAINE
| | - Nataliia V Gubina
- IVANO-FRANKIVSK NATIONAL MEDICAL UNIVERSITY, IVANO-FRANKIVSK, UKRAINE
| | | | - Vira I Klymenko
- IVANO-FRANKIVSK NATIONAL MEDICAL UNIVERSITY, IVANO-FRANKIVSK, UKRAINE
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Lee JY, Joo KC, Brubaker PH, Yoon DS, Choi KS. Efficacy of Intensive Lifestyle Education and Forest-Based Exercise for the Primary Prevention of the Risk of Coronary Artery Disease. Pulse (Basel) 2024; 12:40-48. [PMID: 39022561 PMCID: PMC11250654 DOI: 10.1159/000538517] [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: 02/14/2024] [Accepted: 03/19/2024] [Indexed: 07/20/2024] Open
Abstract
Introduction Despite its efficacy, conventional center-based cardiac rehabilitation has several limitations which have led to the emergence of home-based programs and intensive cardiac rehabilitation as alternative methods for overcoming these limitations. Alternative methods for primary prevention have been recommended for similar reasons. Lifestyle modification is considered key to success in both primary and secondary prevention. Therefore, this primary prevention study aimed to investigate the efficiency of intensive lifestyle education and home-based programs involving unstructured exercise in urban forests to prevent coronary artery disease (CAD). The availability of urban forests as preventive exercise environments was also examined. Methods Patients with risk factors for CAD participated in primary prevention using either FBEG (forest-based exercise group (FBEG, n = 11) or CBEG (center-based exercise group (CBEG, n = 17) for 12 weeks. The FBEG was provided with intensive residential lifestyle education and followed a home program that included performing exercise in an urban forest. The CBEG followed a conventional supervised exercise program at a fitness facility. Changes in body composition, cardiometabolic variables, and functional capacity were tested using a 2-way repeated ANOVA measurement. An independent t-test was used to examine the differences in weekly energy expenditure between the two groups. Results Significant within-group differences were identified in body composition, cardiometabolic variables, and the 10-yr probability of CAD in both groups. However, the functional capacity, weekly energy expenditure, and attendance rate showed between-group differences, with superiority in the FBEG. Conclusion Intensive lifestyle education and subsequent home-based programs with unstructured exercise in the forest were as effective as a conventional center-based program, with superiority in terms of the change of some variables. Intensive education on experiencing and habituating a healthy lifestyle seemed to play an important role in improving motivation.
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Affiliation(s)
- Jong-Young Lee
- Division of Cardiology, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | | | | | - Dae-Sik Yoon
- ACE Exercise Science Center, Seosan, Republic of Korea
| | - Kyung-Su Choi
- Department of Physical Education, Graduate School of Social Culture, Jungwon University, Goesan, Republic of Korea
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Jia Y, Cui N, Jia T, Jabbar Abdl Sattar Hamoudi H, Song J. Measurement properties of assessment tools of Kinesophobia in patients with cardiovascular disease: A systematic review. Int J Nurs Sci 2024; 11:57-65. [PMID: 38352287 PMCID: PMC10859577 DOI: 10.1016/j.ijnss.2023.12.016] [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: 08/12/2023] [Revised: 12/10/2023] [Accepted: 12/30/2023] [Indexed: 02/16/2024] Open
Abstract
Objectives This study aimed to evaluate the measurement properties and methodological quality of assessment tools for Kinesophobia among patients with cardiovascular disease and provide a reference for healthcare professionals in selecting high-quality assessment tools. Methods A systematic search was performed on specific databases: Embase, the Cochrane Library, PubMed, Web of Science, China National Knowledge Infrastructure, Wanfang database, China Biological Medicine disc, CINAHL, and China Science and Technology Journal Database, from inception to April 1, 2023. The researchers retrieved studies on the measurement attributes of the exercise fear scale in patients with cardiovascular diseases. They also traced back the references of the included studies to supplement relevant literature. According to the inclusion and exclusion criteria, screening and data extraction were independently undertaken by two reviewers. Two researchers individually used the Consensus-based Standards for the selection of health Measurement Instruments (COSMIN) Risk of Bias Checklist to assess the methodological quality of the scale, applied the COSMIN criteria to evaluate the measurement properties of the scale, and used a modified Grading, Recommendations, Assessment, Development, and Evaluation system to assess the certainty of evidence. Results Seventeen studies were identified that reported the psychometric properties of six patient reported outcome measurement tools (included different languages version) The methodological quality of content validity was adequate in only two studies, the remaining patient-reported outcome measures demonstrated doubtful content validity. Limited information on cross-cultural validity/measurement invariance, measurement error, and responsiveness was retrieved. The Swedish version and the Chinese version of the Tampa Scale for Kinesiophobia Heart were graded "A." The remaining instruments were graded "B." Conclusions The methodological and measurement attributes of the Swedish and Chinese versions of the Tampa Scale for Kinesiophobia Heart are relatively high quality and can be tentatively recommended. The measurement properties of the remaining scales remain to be verified.
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Affiliation(s)
- Yingying Jia
- Nursing Department, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
- Nursing Department, Zhejiang University School of Medicine, Hangzhou, China
| | - Nianqi Cui
- School of Nursing, Kunming Medical University, Kunming, China
| | - Tingting Jia
- General Surgery Cadre Ward, Gansu Provincial People’s Hospital, Lanzhou, China
| | | | - Jianping Song
- Nursing Department, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
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Oehler AC, Holmstrand EC, Zhou L, Harzand A, Vathsangam H, Kendall K, Gabriel G, Murali S. Cost Analysis of Remote Cardiac Rehabilitation Compared With Facility-Based Cardiac Rehabilitation for Coronary Artery Disease. Am J Cardiol 2024; 210:266-272. [PMID: 37973439 DOI: 10.1016/j.amjcard.2023.08.061] [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: 06/29/2023] [Accepted: 08/14/2023] [Indexed: 11/19/2023]
Abstract
Remote cardiac rehabilitation (RCR) represents a promising, noninferior alternative to facility-based cardiac rehabilitation (FBCR). The comparable cost of RCR in US populations has yet to be extensively studied. The purpose of this prospective, patient-selected study of traditional FBCR versus a third-party asynchronous RCR platform was to assess whether RCR can be administered at a comparable cost and clinical efficacy to FBCR. Adult insured patients were eligible for enrollment after an admission for a coronary heart disease event. Patients selected either FBCR or Movn RCR, a 12-week telehealth intervention using an app-based platform and internet-capable medical devices. Clinical demographics, intervention adherence, cost-effectiveness, and hospitalizations at 1-year after enrollment were assessed from the Highmark claims database after propensity matching between groups. A total of 260 patients were included and 171 of those eligible (65.8%) received at least 1 cardiac rehabilitation session and half of the patients chose Movn RCR. The propensity matching produced a sample of 41 matched pairs. Movn RCR led to a faster enrollment and higher completion rates (80% vs 50%). The total medical costs were similar between Movn RCR and FBCR, although tended toward cost savings with Movn RCR ($10,574/patient). The cost of cardiac rehabilitation was lower in those enrolled in Movn RCR ($1,377/patient, p = 0.002). The all-cause and cardiovascular-related hospitalizations or emergency department visits in the year after enrollment in both groups were similar. In conclusion, this pragmatic study of patients after a coronary heart disease event led to equivalent total medical costs and lower intervention costs for an asynchronous RCR platform than traditional FBCR while maintaining similar clinically important outcomes.
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Affiliation(s)
- Andrew C Oehler
- Allegheny Health Network Cardiovascular Institute, Allegheny Health Network, Pittsburgh, Pennsylvania.
| | | | - Lulu Zhou
- Evaluation Analytics, Highmark Health, Pittsburgh, Pennsylvania
| | | | - Harshvardhan Vathsangam
- Movn Health, Irvine, California; Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Kellee Kendall
- VITAL Innovation Program, Highmark Health, Pittsburgh, Pennsylvania
| | - George Gabriel
- Allegheny Health Network Cardiovascular Institute, Allegheny Health Network, Pittsburgh, Pennsylvania
| | - Srinivas Murali
- Allegheny Health Network Cardiovascular Institute, Allegheny Health Network, Pittsburgh, Pennsylvania
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Patel L, Dhruve R, Keshvani N, Pandey A. Role of exercise therapy and cardiac rehabilitation in heart failure. Prog Cardiovasc Dis 2024; 82:26-33. [PMID: 38199321 DOI: 10.1016/j.pcad.2024.01.002] [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: 01/07/2024] [Accepted: 01/07/2024] [Indexed: 01/12/2024]
Abstract
Heart failure (HF) is a common cause of hospitalization and death, and the hallmark symptoms of HF, including dyspnea, fatigue, and exercise intolerance, contribute to poor patient quality of life (QoL). Cardiac rehabilitation (CR) is a comprehensive disease management program incorporating exercise training, cardiovascular risk factor management, and psychosocial support. CR has been demonstrated to effectively improve patient functional status and QoL among patients with HF. However, CR participation among patients with HF is poor. This review details the mechanisms of dyspnea and exercise intolerance among patients with HF, the physiologic and clinical improvements observed with CR, and the key components of a CR program for patients with HF. Furthermore, unmet needs and future strategies to improve patient participation and engagement in CR for HF are reviewed.
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Affiliation(s)
- Lajjaben Patel
- Division of Cardiology, Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX, USA
| | - Ritika Dhruve
- Division of Cardiology, Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX, USA
| | - Neil Keshvani
- Division of Cardiology, Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX, USA
| | - Ambarish Pandey
- Division of Cardiology, Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX, USA.
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Felix CMDM, Pereira DAG, Pakosh M, da Silva LP, Ghisi GLDM. A Scoping Review of Measurement Tools Evaluating Awareness and Disease-Related Knowledge in Peripheral Arterial Disease Patients. J Clin Med 2023; 13:107. [PMID: 38202114 PMCID: PMC10780123 DOI: 10.3390/jcm13010107] [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: 11/27/2023] [Revised: 12/22/2023] [Accepted: 12/22/2023] [Indexed: 01/12/2024] Open
Abstract
BACKGROUND Peripheral arterial disease (PAD) is the third leading cause of atherosclerotic cardiovascular morbidity worldwide, with high prevalence and associated complications, and is often overlooked and undertreated. Research has shown that there is a profound lack of PAD-related knowledge and awareness; additionally, information sources are not often reliable and accessible. The objective of this scoping review was: (1) to identify and critically appraise instruments that measure patients' disease-related knowledge/awareness about PAD, and (2) to characterize the current state of knowledge/awareness levels among these patients. METHODS This systematic review was conducted and reported in accordance with the PRISMA statement. Six databases (APA PsycInfo, CINAHL Ultimate, Embase, Emcare Nursing, Medline ALL and Web of Science Core Collection) were searched, and search strategies were developed utilizing the PICO framework. Potential studies of any methodological design were considered for inclusion through a snowball hand search. Data from the included articles were extracted by a reviewer, and the extraction accuracy was independently cross-checked by another author. RESULTS The initial database search yielded 9832 records, of which sixteen studies (thirteen quantitative and three qualitative) were included. Only three questionnaires had their psychometric properties assessed. Questionnaire items focused on the following topics: definition/characteristics, risk factors/causes, treatment, complications, and personal issues regarding the perception/management of the disease. Overall, knowledge/awareness about PAD was low among patients. CONCLUSIONS This study identified major gaps in PAD education, including the lack of availability of a validated measurement tool addressing all educational topics relevant to care and low knowledge/awareness of patients about their condition.
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Affiliation(s)
- Carolina Machado de Melo Felix
- Graduate Program in Rehabilitation Sciences, Department of Physiotherapy, Universidade Federal de Minas Gerais, Belo Horizonte 31270-901, Brazil; (C.M.d.M.F.); (D.A.G.P.)
| | - Danielle Aparecida Gomes Pereira
- Graduate Program in Rehabilitation Sciences, Department of Physiotherapy, Universidade Federal de Minas Gerais, Belo Horizonte 31270-901, Brazil; (C.M.d.M.F.); (D.A.G.P.)
| | - Maureen Pakosh
- Library & Information Services, Toronto Rehabilitation Institute, University Health Network, Toronto, ON M5G 2A2, Canada;
| | - Lilian Pinto da Silva
- Graduate Program in Rehabilitation Sciences and Physical Functional Performance, Faculty of Physiotherapy, Universidade Federal de Juiz de Fora, Juiz de Fora 36036-900, Brazil;
| | - Gabriela Lima de Melo Ghisi
- Library & Information Services, Toronto Rehabilitation Institute, University Health Network, Toronto, ON M5G 2A2, Canada;
- KITE Research Institute, University Health Network, Toronto, ON M4G 1R7, Canada
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Yang Z, Zheng X, Hu N, Zhang F, Wang A. "Challenges to Normalcy"- Perceived Barriers to Adherence to Home-Based Cardiac Rehabilitation Exercise in Patients with Chronic Heart Failure. Patient Prefer Adherence 2023; 17:3515-3524. [PMID: 38146500 PMCID: PMC10749573 DOI: 10.2147/ppa.s440984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 12/18/2023] [Indexed: 12/27/2023] Open
Abstract
Purpose The aim of this study was to explore perceived barriers to adherence to home-based cardiac rehabilitation exercise in patients with chronic heart failure. Patients and Methods A qualitative descriptive study was conducted in this study from May to July 2023. A purposive sampling approach was adopted to select patients with chronic heart failure. Semi-structured interviews were completed to collect qualitative data for exploring the perceived barriers. In addition, information saturation and validation strategies were adopted to prove the adequacy of qualitative data. Transcripts were analysed using thematic analysis. Results A total of 16 patients with chronic heart failure were included in this study. Analysis of the data revealed five main barriers to adherence to home-based cardiac rehabilitation in patients with chronic heart failure. These include (1) lack of knowledge, (2) activity intolerance, (3) exercise fear, (4) role conflict, and (5) lower exercise self-efficacy. Conclusion This study delved deeper into understanding the challenges faced by chronic heart failure patients in adhering to home-based cardiac rehabilitation exercise. The development of precise and effective management and intervention strategies based on these barriers is necessary to improve patient compliance with home-based cardiac rehabilitation exercise.
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Affiliation(s)
- Zhen Yang
- Department of Public Services, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning Province, People’s Republic of China
| | - Xutong Zheng
- Department of Public Services, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning Province, People’s Republic of China
| | - Na Hu
- Department of Public Services, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning Province, People’s Republic of China
| | - Fengpei Zhang
- Department of Public Services, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning Province, People’s Republic of China
| | - Aiping Wang
- Department of Public Services, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning Province, People’s Republic of China
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Zou J, Yuan J, Liu J, Geng Q. Impact of cardiac rehabilitation on pre- and post-operative transcatheter aortic valve replacement prognoses. Front Cardiovasc Med 2023; 10:1164104. [PMID: 38152609 PMCID: PMC10751363 DOI: 10.3389/fcvm.2023.1164104] [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: 02/12/2023] [Accepted: 11/28/2023] [Indexed: 12/29/2023] Open
Abstract
Transcatheter aortic valve replacement (TAVR) is a relatively new treatment method for aortic stenosis (AS) and has been demonstrated to be suitable for patients with varying risk levels. Indeed, among high-risk patients, TAVR outcomes are comparable to, or even better, than that of the traditional surgical aortic valve replacement (SAVR) method. TAVR outcomes, with respect to post-surgical functional capacity and quality of life, have also been found to be improved, especially when combined with cardiac rehabilitation (CR). CR is a multidisciplinary system, which integrates cardiology with other medical disciplines, such as sports, nutritional, mind-body, and behavioral medicine. It entails the development of appropriate medication, exercise, and diet prescriptions, along with providing psychological support, ensuring the cessation of smoking, and developing risk factor management strategies for cardiovascular disease patients. However, even with CR being able to improve TAVR outcomes and reduce post-surgical mortality rates, it still has largely been underutilized in clinical settings. This article reviews the usage of CR during both pre-and postoperative periods for valvular diseases, and the factors involved in influencing subsequent patient prognoses, thereby providing a direction for subsequent research and clinical applications.
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Affiliation(s)
- Jieru Zou
- The Second Clinical Medical College, Jinan University, Shenzhen, Guangdong, China
| | - Jie Yuan
- The Second Clinical Medical College, Jinan University, Shenzhen, Guangdong, China
- Department of Cardiology, Shenzhen People's Hospital (The Second Clinical Medical College, Jinan University; The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen, Guangdong, China
- Department of Cardiology, Shenzhen Cardiovascular Minimally Invasive Medical Engineering Technology Research and Development Center, Shenzhen People's Hospital (The Second Clinical Medical College, Jinan University; The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen, China
- Department of Geriatrics, Shenzhen People's Hospital (The Second Clinical Medical College, Jinan University, The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen, Guangdong, China
| | - Jingjin Liu
- The Second Clinical Medical College, Jinan University, Shenzhen, Guangdong, China
- Department of Cardiology, Shenzhen People's Hospital (The Second Clinical Medical College, Jinan University; The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen, Guangdong, China
- Department of Cardiology, Shenzhen Cardiovascular Minimally Invasive Medical Engineering Technology Research and Development Center, Shenzhen People's Hospital (The Second Clinical Medical College, Jinan University; The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen, China
- Department of Geriatrics, Shenzhen People's Hospital (The Second Clinical Medical College, Jinan University, The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen, Guangdong, China
| | - Qingshan Geng
- The Second Clinical Medical College, Jinan University, Shenzhen, Guangdong, China
- Department of Cardiology, Shenzhen People's Hospital (The Second Clinical Medical College, Jinan University; The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen, Guangdong, China
- Department of Cardiology, Shenzhen Cardiovascular Minimally Invasive Medical Engineering Technology Research and Development Center, Shenzhen People's Hospital (The Second Clinical Medical College, Jinan University; The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen, China
- Department of Geriatrics, Shenzhen People's Hospital (The Second Clinical Medical College, Jinan University, The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen, Guangdong, China
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40
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Brewer LC, Abraham H, Clark D, Echols M, Hall M, Hodgman K, Kaihoi B, Kopecky S, Krogman A, Leth S, Malik S, Marsteller J, Mathews L, Scales R, Schulte P, Shultz A, Taylor B, Thomas R, Wong N, Olson T. Efficacy and Adherence Rates of a Novel Community-Informed Virtual World-Based Cardiac Rehabilitation Program: Protocol for the Destination Cardiac Rehab Randomized Controlled Trial. J Am Heart Assoc 2023; 12:e030883. [PMID: 38014699 PMCID: PMC10727355 DOI: 10.1161/jaha.123.030883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Accepted: 09/14/2023] [Indexed: 11/29/2023]
Abstract
BACKGROUND Innovative restructuring of cardiac rehabilitation (CR) delivery remains critical to reduce barriers and improve access to diverse populations. Destination Cardiac Rehab is a novel virtual world technology-based CR program delivered through the virtual world platform, Second Life, which previously demonstrated high acceptability as an extension of traditional center-based CR. This study aims to evaluate efficacy and adherence of the virtual world-based CR program compared with center-based CR within a community-informed, implementation science framework. METHODS Using a noninferiority, hybrid type 1 effectiveness-implementation, randomized controlled trial, 150 patients with an eligible cardiovascular event will be recruited from 6 geographically diverse CR centers across the United States. Participants will be randomized 1:1 to either the 12-week Destination Cardiac Rehab or the center-based CR control groups. The primary efficacy outcome is a composite cardiovascular health score based on the American Heart Association Life's Essential 8 at 3 and 6 months. Adherence outcomes include CR session attendance and participation in exercise sessions. A diverse patient/caregiver/stakeholder advisory board was assembled to guide recruitment, implementation, and dissemination plans and to contextualize study findings. The institutional review board-approved randomized controlled trial will enroll and randomize patients to the intervention (or control group) in 3 consecutive waves/year over 3 years. The results will be published at data collection and analyses completion. CONCLUSIONS The Destination Cardiac Rehab randomized controlled trial tests an innovative and potentially scalable model to enhance CR participation and advance health equity. Our findings will inform the use of effective virtual CR programs to expand equitable access to diverse patient populations. REGISTRATION URL: https://www.clinicaltrials.gov; Unique identifier: NCT05897710.
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Affiliation(s)
- LaPrincess C. Brewer
- Department of Cardiovascular MedicineMayo Clinic College of MedicineRochesterMN
- Center for Health Equity and Community Engagement ResearchMayo ClinicRochesterMN
| | - Helayna Abraham
- Department of Internal MedicineMayo Clinic College of MedicineRochesterMN
| | - Donald Clark
- Division of CardiologyUniversity of Mississippi Medical CenterJacksonMS
| | - Melvin Echols
- Department of Cardiovascular MedicineMorehouse School of MedicineAtlantaGA
| | - Michael Hall
- Division of CardiologyUniversity of Mississippi Medical CenterJacksonMS
| | - Karen Hodgman
- Department of Cardiovascular MedicineMayo Clinic College of MedicineRochesterMN
| | - Brian Kaihoi
- Global Products and ServicesMayo Clinic Center for InnovationRochesterMN
| | - Stephen Kopecky
- Department of Cardiovascular MedicineMayo Clinic College of MedicineRochesterMN
| | - Ashton Krogman
- Department of Cardiovascular MedicineMayo Clinic College of MedicineRochesterMN
| | - Shawn Leth
- Department of Cardiovascular MedicineMayo Clinic College of MedicineRochesterMN
| | - Shaista Malik
- Division of Cardiology, Department of MedicineUniversity of CaliforniaIrvineCA
| | - Jill Marsteller
- Center for Health Services and Outcomes ResearchJohns Hopkins Bloomberg School of Public HealthBaltimoreMD
| | - Lena Mathews
- Division of CardiologyJohns Hopkins School of MedicineBaltimoreMD
| | - Robert Scales
- Department of Cardiovascular MedicineMayo Clinic College of MedicinePhoenixAZ
| | - Phillip Schulte
- Division of Clinical Trials and BiostatisticsMayo ClinicRochesterMN
| | - Adam Shultz
- Department of Cardiovascular MedicineMayo Clinic College of MedicineRochesterMN
| | - Bryan Taylor
- Department of Cardiovascular MedicineMayo Clinic College of MedicineJacksonvilleFL
| | - Randal Thomas
- Department of Cardiovascular MedicineMayo Clinic College of MedicineRochesterMN
| | - Nathan Wong
- Division of Cardiology, Department of MedicineUniversity of CaliforniaIrvineCA
| | - Thomas Olson
- Department of Cardiovascular MedicineMayo Clinic College of MedicineRochesterMN
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Darvishzadehdaledari S, Harrison A, Gholami F, Azadnia A. Examining the effectiveness of home-based cardiac rehabilitation programs for heart failure patients with reduced ejection fraction: a critical review. BMC Cardiovasc Disord 2023; 23:593. [PMID: 38053086 PMCID: PMC10696730 DOI: 10.1186/s12872-023-03640-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Accepted: 11/29/2023] [Indexed: 12/07/2023] Open
Abstract
BACKGROUND Heart failure (HF) is the most common cardiovascular reason for hospital admission, particularly among patients older than 60 years old. Heart failure with reduced ejection fraction (HFrEF) comprises approximately 50% of all heart failure cases. Home-based cardiac rehabilitation (HBCR) is an alternative option to enhance the participation rate in cardiac rehabilitation (CR) interventions for patients who are not able to attend center-based cardiac rehabilitation (CBCR). The purpose of this review is to clarify the extent to which present studies of HBCR align with the core components defined by both the European Society of Cardiology (ESC) and the British Association for Cardiac Prevention and Rehabilitation (BACPR). METHODS A critical review was conducted through four databases, MEDLINE, Embase, Cochrane Central Register of Controlled Trials, and Cochrane Database of Systematic Reviews, to identify randomized controlled trials up until June 2022. We scrutinized the commonalities between BACPR and ESC and developed a list of standards. The risk of bias was assessed using the RoB 2 tool. RESULTS Among the 87 papers selected for full-text screening, 11 studies met the inclusion criteria. Six papers possessed a high proportion of fidelity to essential standards, four studies had a medium alliance, and one intervention had a low level of alliance. CONCLUSION Overall, the majority of included studies had medium to high alignment with standards and core components. However, a need for more attention to long-term strategy as an important standard is revealed. Rapid identification and initial assessment are the most met standards; however, lifestyle risk factor management and long-term outcomes were recognized as the least met standards.
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Affiliation(s)
| | | | - Fatemeh Gholami
- Department of Epidemiology, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
- Social Determinants of Health Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Arian Azadnia
- Research and Technology Deputy, Maragheh University of Medical Sciences, Maragheh, Iran.
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de Moel-Mandel C, Lynch C, Issaka A, Braver J, Zisis G, Carrington MJ, Oldenburg B. Optimising the implementation of digital-supported interventions for the secondary prevention of heart disease: a systematic review using the RE-AIM planning and evaluation framework. BMC Health Serv Res 2023; 23:1347. [PMID: 38049862 PMCID: PMC10694952 DOI: 10.1186/s12913-023-10361-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 11/22/2023] [Indexed: 12/06/2023] Open
Abstract
BACKGROUND mHealth technologies are now widely utilised to support the delivery of secondary prevention programs in heart disease. Interventions with mHealth included have shown a similar efficacy and safety to conventional programs with improvements in access and adherence. However, questions remain regarding the successful wider implementation of digital-supported programs. By applying the Reach-Effectiveness-Adoption-Implementation-Maintenance (RE-AIM) framework to a systematic review and meta-analysis, this review aims to evaluate the extent to which these programs report on RE-AIM dimensions and associated indicators. METHODS This review extends our previous systematic review and meta-analysis that investigated the effectiveness of digital-supported programs for patients with coronary artery disease. Citation searches were performed on the 27 studies of the systematic review to identify linked publications that reported data for RE-AIM dimensions. All included studies and, where relevant, any additional publications, were coded using an adapted RE-AIM extraction tool. Discrepant codes were discussed amongst reviewers to gain consensus. Data were analysed to assess reporting on indicators related to each of the RE-AIM dimensions, and average overall reporting rates for each dimension were calculated. RESULTS Searches found an additional nine publications. Across 36 publications that were linked to the 27 studies, 24 (89%) of the studies were interventions solely delivered at home. The average reporting rates for RE-AIM dimensions were highest for effectiveness (75%) and reach (67%), followed by adoption (54%), implementation (36%) and maintenance (11%). Eleven (46%) studies did not describe relevant characteristics of their participants or of staff involved in the intervention; most studies did not describe unanticipated consequences of the intervention; the ongoing cost of intervention implementation and maintenance; information on intervention fidelity; long-term follow-up outcomes, or program adaptation in other settings. CONCLUSIONS Through the application of the RE-AIM framework to a systematic review we found most studies failed to report on key indicators. Failing to report these indicators inhibits the ability to address the enablers and barriers required to achieve optimal intervention implementation in wider settings and populations. Future studies should consider alternative hybrid trial designs to enable reporting of implementation indicators to improve the translation of research evidence into routine practice, with special consideration given to the long-term sustainability of program effects as well as corresponding ongoing costs. REGISTRATION PROSPERO-CRD42022343030.
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Affiliation(s)
| | - Chris Lynch
- School of Psychology & Public Health, La Trobe University, Melbourne, VIC, Australia.
- Baker Heart and Diabetes Institute, Melbourne, VIC, Australia.
- NHMRC CRE in Digital Technology to Transform Chronic Disease Outcomes, Melbourne, VIC, Australia.
- Northern Health, Melbourne, VIC, Australia.
| | - Ayuba Issaka
- Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
- NHMRC CRE in Digital Technology to Transform Chronic Disease Outcomes, Melbourne, VIC, Australia
| | - Justin Braver
- Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
- NHMRC CRE in Digital Technology to Transform Chronic Disease Outcomes, Melbourne, VIC, Australia
- Baker Department of Cardiometabolic Health, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, VIC, Australia
| | - Georgios Zisis
- Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
- NHMRC CRE in Digital Technology to Transform Chronic Disease Outcomes, Melbourne, VIC, Australia
- Northern Health, Melbourne, VIC, Australia
- Baker Department of Cardiometabolic Health, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, VIC, Australia
| | - Melinda J Carrington
- Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
- Baker Department of Cardiometabolic Health, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, VIC, Australia
- Western Health, Melbourne, VIC, Australia
| | - Brian Oldenburg
- School of Psychology & Public Health, La Trobe University, Melbourne, VIC, Australia
- Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
- NHMRC CRE in Digital Technology to Transform Chronic Disease Outcomes, Melbourne, VIC, Australia
- Northern Health, Melbourne, VIC, Australia
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Sharma R, Kashyap J, Olanrewaju OA, Jabbar A, Someshwar F, Saeed H, Varrassi G, Qadeer HA, Kumar S, Cheema AY, Khatri M, Wazir M, Ullah F. Cardio-Oncology: Managing Cardiovascular Complications of Cancer Therapies. Cureus 2023; 15:e51038. [PMID: 38269231 PMCID: PMC10806352 DOI: 10.7759/cureus.51038] [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: 12/19/2023] [Accepted: 12/24/2023] [Indexed: 01/26/2024] Open
Abstract
This narrative review explores the complex relationship between cancer medicines and cardiovascular health in the junction of oncology and cardiology, known as cardio-oncology. The study examines the historical development of cancer treatments and highlights the growing importance of cardiovascular problems in patient care. This text delves into the topic of cardiotoxicity, examining both conventional chemotherapeutic drugs like anthracyclines and more recent tyrosine kinase and immune checkpoint inhibitors. The complex molecular and cellular mechanisms that control cardiovascular problems are explained, including an understanding of how genetic predisposition influences an individual's sensitivity. The narrative expands into the crucial realm of risk stratification and evaluation, revealing advanced instruments for identifying cardiovascular risk in cancer patients. The importance of non-invasive imaging methods and biomarkers in early detection and continuous monitoring is emphasized. The prioritization of preventive tactics emphasizes the need to take proactive measures incorporating therapies to protect the heart throughout cancer treatment. It also highlights the significance of making lifestyle improvements to reduce risk factors. The narrative emphasizes the changing collaborative treatment environment, advocating for merging oncologists and cardiologists in a coordinated endeavor to maximize patient outcomes. In addition to clinical factors, the review explores the critical domain of patient education and support, acknowledging its crucial role in promoting informed decision-making and improving overall patient well-being. The latter portions of the text anticipate and consider upcoming treatments and existing research efforts that offer the potential for the future of cardio-oncology. This review seeks to provide a detailed viewpoint on the intricate connection between cancer treatments and cardiovascular well-being. Its objective is to encourage a more profound comprehension of the subject and prompt careful contemplation regarding the comprehensive care of cancer patients who confront the intricate difficulties presented by their treatment plans.
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Affiliation(s)
- Roshan Sharma
- Medicine, Sanjay Gandhi Memorial Hospital, Delhi, IND
| | - Jyoti Kashyap
- Medicine, Sri Balaji Action Medical Institute, Delhi, IND
| | - Olusegun A Olanrewaju
- Pure and Applied Biology, Ladoke Akintola University of Technology, Ogbomoso, NGA
- General Medicine, Stavropol State Medical University, Stavropol, RUS
| | - Abdul Jabbar
- Medicine, Jinnah Sindh Medical University, Karachi, PAK
| | - Fnu Someshwar
- Medicine, Liaquat National Hospital and Medical College, Karachi, PAK
| | - Hira Saeed
- Medicine, Federal Medical College, Islamabad, PAK
| | | | | | - Satish Kumar
- Medicine, Shaheed Mohtarma Benazir Bhutto Medical College, Karachi, PAK
| | - Asfand Yar Cheema
- Medicine, Services Hospital Lahore, Lahore, PAK
- Internal Medicine, Lahore Medical & Dental College, Lahore, PAK
| | - Mahima Khatri
- Internal Medicine/Cardiology, Dow University of Health Sciences, Karachi, PAK
| | - Maha Wazir
- Medicine, Khyber Teaching Hospital, Peshawar, PAK
| | - Farhan Ullah
- Internal Medicine, Khyber Teaching Hospital, Peshawar, PAK
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44
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Adedinsewo D, Eberly L, Sokumbi O, Rodriguez JA, Patten CA, Brewer LC. Health Disparities, Clinical Trials, and the Digital Divide. Mayo Clin Proc 2023; 98:1875-1887. [PMID: 38044003 PMCID: PMC10825871 DOI: 10.1016/j.mayocp.2023.05.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 05/03/2023] [Indexed: 12/05/2023]
Abstract
In the past few years, there have been rapid advances in technology and the use of digital tools in health care and clinical research. Although these innovations have immense potential to improve health care delivery and outcomes, there are genuine concerns related to inadvertent widening of the digital gap consequentially exacerbating health disparities. As such, it is important that we critically evaluate the impact of expansive digital transformation in medicine and clinical research on health equity. For digital solutions to truly improve the landscape of health care and clinical trial participation for all persons in an equitable way, targeted interventions to address historic injustices, structural racism, and social and digital determinants of health are essential. The urgent need to focus on interventions to promote health equity was made abundantly clear with the coronavirus disease 2019 pandemic, which magnified long-standing social and racial health disparities. Novel digital technologies present a unique opportunity to embed equity ideals into the ecosystem of health care and clinical research. In this review, we examine racial and ethnic diversity in clinical trials, historic instances of unethical research practices in biomedical research and its impact on clinical trial participation, and the digital divide in health care and clinical research, and we propose suggestions to achieve digital health equity in clinical trials. We also highlight key digital health opportunities in cardiovascular medicine and dermatology as exemplars, and we offer future directions for development and adoption of patient-centric interventions aimed at narrowing the digital divide and mitigating health inequities.
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Affiliation(s)
| | - Lauren Eberly
- Division of Cardiovascular Medicine, Perelman School of Medicine, Center for Cardiovascular Outcomes, Quality, and Evaluative Research, and Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia
| | - Olayemi Sokumbi
- Department of Dermatology, Mayo Clinic, Jacksonville, FL; Department of Laboratory Medicine and Pathology, Mayo Clinic, Jacksonville, FL
| | - Jorge Alberto Rodriguez
- Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Christi A Patten
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN
| | - LaPrincess C Brewer
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN; Center for Health Equity and Community Engagement Research, Mayo Clinic, Rochester, MN.
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45
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Hilu R, Haskiah F, Khaskia A, Assali A, Baron I, Gabarin M, Chen J, Pereg D. Effectiveness and Safety of Remote Cardiac Rehabilitation for Patients After Acute Coronary Syndrome. Am J Cardiol 2023; 207:54-58. [PMID: 37722202 DOI: 10.1016/j.amjcard.2023.08.168] [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: 07/24/2023] [Revised: 08/19/2023] [Accepted: 08/25/2023] [Indexed: 09/20/2023]
Abstract
Cardiac rehabilitation improves cardiovascular outcomes in patients after acute coronary syndrome (ACS). Recently there has been a growing interest in remote cardiac rehabilitation (RCR) programs. We aimed to evaluate the effectiveness of RCR compared with center-based cardiac rehabilitation (CBCR). This is an observational study including patients after hospital admission for ACS. The study group included patients at low-to-moderate risk for cardiovascular complications who were referred for RCR. The control group included patients at similar risk who participated in CBCR. The primary end points were the improvement of at least 10% to 25% in exercise capacity after 6 months of cardiac rehabilitation. Included were 305 patients who completed 6 months of cardiac rehabilitation. Of them, 107 patients participated in RCR and 198 in CBCR. RCR patients were younger and more frequently males. Improvement of ≥10% in exercise capacity after 6 months was achieved more frequently in patients participating in RCR compared with CBCR (69.3% and 55% respectively, p = 0.03). A similar trend was observed for improvement of ≥25% in exercise capacity after 6 months (33.8% and 22.7% in RCR and CBCR, respectively, p = 0.05). While weight reduction and the increase in muscle mass were similar in the 2 groups, fat percent reduction was significantly greater in the RCR compared with the CBCR (2.5% and 1.4% respectively, p <0.005). We conclude that RCR program is an effective and safe option for low-risk patients after hospital admission for ACS. It enables optimizing the utilization of this important service for patients with coronary artery disease.
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Affiliation(s)
- Ranin Hilu
- Cardiology Department, Meir Medical Center, Kfar Saba, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Feras Haskiah
- Cardiology Department, Meir Medical Center, Kfar Saba, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Abid Khaskia
- Cardiology Department, Meir Medical Center, Kfar Saba, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Abid Assali
- Cardiology Department, Meir Medical Center, Kfar Saba, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Igal Baron
- Cardiology Department, Meir Medical Center, Kfar Saba, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Mustafa Gabarin
- Cardiology Department, Meir Medical Center, Kfar Saba, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Jacob Chen
- Cardiology Department, Meir Medical Center, Kfar Saba, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - David Pereg
- Cardiology Department, Meir Medical Center, Kfar Saba, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
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46
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Cascino TM, Schopfer DW, Meyer CS, Zhang N, Barnes GD, McLaughlin VV, Jackson EA, Whooley MA. Exercise Rehabilitation is Underutilized Among Veterans With Pulmonary Hypertension. Am J Cardiol 2023; 207:4-6. [PMID: 37717285 DOI: 10.1016/j.amjcard.2023.08.095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 08/10/2023] [Accepted: 08/17/2023] [Indexed: 09/19/2023]
Affiliation(s)
- Thomas M Cascino
- Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, Michigan.
| | - David W Schopfer
- San Francisco Veterans Affairs Medical Center, San Francisco, California; Department of Medicine, University of California, San Francisco, California
| | - Craig S Meyer
- San Francisco Veterans Affairs Medical Center, San Francisco, California; Department of Medicine, University of California, San Francisco, California
| | - Ning Zhang
- San Francisco Veterans Affairs Medical Center, San Francisco, California; Department of Medicine, University of California, San Francisco, California
| | - Geoffrey D Barnes
- Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, Michigan
| | | | - Elizabeth A Jackson
- Division of Cardiovascular Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Mary A Whooley
- San Francisco Veterans Affairs Medical Center, San Francisco, California; Department of Medicine, University of California, San Francisco, California
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47
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Filippini T, Malavolti M. Education and Disparities in Cardiac Rehabilitation Effectiveness. Am J Cardiol 2023; 207:499-500. [PMID: 37735059 DOI: 10.1016/j.amjcard.2023.09.005] [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: 09/01/2023] [Accepted: 09/04/2023] [Indexed: 09/23/2023]
Affiliation(s)
- Tommaso Filippini
- CREAGEN - Environmental, Genetic and Nutritional Epidemiology Research Center, Section of Public Health, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Italy; School of Public Health, University of California Berkeley, Berkeley, California.
| | - Marcella Malavolti
- CREAGEN - Environmental, Genetic and Nutritional Epidemiology Research Center, Section of Public Health, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Italy
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48
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Zhang W, Zhu G, Li B, Chen C, Zhu Y. Effect of cardiac rehabilitation therapy on depressed patients with cardiac insufficiency after cardiac surgery. Open Med (Wars) 2023; 18:20230821. [PMID: 38025544 PMCID: PMC10656761 DOI: 10.1515/med-2023-0821] [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: 07/09/2023] [Revised: 08/24/2023] [Accepted: 09/21/2023] [Indexed: 12/01/2023] Open
Abstract
This study aims to analyze the effect of cardiac rehabilitation therapy on cardiac autonomic nervous function in patients with cardiac insufficiency complicated with anxiety depression after cardiac operation to provide a reference for clinical practice. A total of 109 patients subject to cardiac operation in our hospital from January 2020 to March 2023 were enrolled as study subjects, including 50 patients who received conventional rehabilitation therapy (control group) and 69 patients who received cardiac rehabilitation therapy (research group). Before and after treatment, the left ventricular ejection fraction (LVEF) and central venous pressure (CVP) were determined, and the level of N-terminal pro-B-type natriuretic peptide (NT-proBNP) was measured. Low frequency/high frequency (LF/HF), standard deviation of normal to normal (SDNN), and root mean of successive square differences (RMSSD) were measured by a multi-lead ECG system. Self-rating Anxiety Scale (SAS), Self-rating Depression Scale (SDS), Pittsburgh Sleep Quality Index (PSQI), Activity of daily living (ADL), and Barthel Index (BI) were applied for corresponding investigations, as well as the 6-min walk test (6MWT). After treatment, the research group showed higher LVEF, CVP, LF/HF, SDNN, and RMSSD, and lower NT-proBNP, SAS, and SDS than the control group (P < 0.05). Significantly elevated ADL score, BI, and 6MWT and reduced PSQI were observed in both groups after treatment, with more remarkable changes in the research group (P < 0.05). In conclusion, cardiac rehabilitation therapy effectively improved the cardiac function of patients with cardiac insufficiency complicated with anxiety and depression after the cardiac operation and alleviated their negative emotions.
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Affiliation(s)
- Wenyu Zhang
- Department of Cardiology, Affiliated Nanjing Brain Hospital, Nanjing Medical University, Nanjing, Jiangsu, 210029, China
| | - Guangjian Zhu
- Department of Cardiology, Affiliated Nanjing Brain Hospital, Nanjing Medical University, Nanjing, Jiangsu, 210029, China
| | - Beibei Li
- Department of Cardiology, Affiliated Nanjing Brain Hospital, Nanjing Medical University, Nanjing, Jiangsu, 210029, China
| | - Chen Chen
- Department of Cardiology, Affiliated Nanjing Brain Hospital, Nanjing Medical University, Nanjing, Jiangsu, 210029, China
| | - Yingzhi Zhu
- Department of Cardiology, Affiliated Nanjing Brain Hospital, Nanjing Medical University, Nanjing, Jiangsu, 210029, China
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49
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Liu T, Zhan Y, Chen S, Zhang W, Jia J. Cost-effectiveness analysis of digital therapeutics for home-based cardiac rehabilitation for patients with chronic heart failure: model development and data analysis. COST EFFECTIVENESS AND RESOURCE ALLOCATION 2023; 21:82. [PMID: 37932748 PMCID: PMC10626728 DOI: 10.1186/s12962-023-00489-x] [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: 07/25/2023] [Accepted: 10/20/2023] [Indexed: 11/08/2023] Open
Abstract
BACKGROUND In recent years, numerous guidelines and expert consensus have recommended the inclusion of digital technologies and products in cardiac rehabilitation. Digital therapeutics (DTx) is an evidence-based medicine that uses digital means for data collection and monitoring of indicators to control and optimize the treatment, management, and prevention of disease. OBJECTIVE This study collected and reviewed real-world data and built a model using health economics assessment methods to analyze the potential cost-effectiveness of DTx applied to home-based cardiac rehabilitation for patients with chronic heart failure. From the perspective of medical and health decision-makers, the economic value of DTx is evaluated prospectively to provide the basis and reference for the application decision and promotion of DTx. METHODS Markov models were constructed to simulate the outcomes of DTx for home-based cardiac rehabilitation (DT group) compared to conventional home-based cardiac rehabilitation (CH group) in patients with chronic heart failure. The model input parameters were clinical indicators and cost data. Outcome indicators were quality-adjusted life years (QALYs) and incremental cost-effectiveness ratios (ICERs). The robustness of the evaluation methods and results was tested using sensitivity analyses. Clinical indicators, cost data, and health utility values were obtained from real-world data, including clinical study data, published literature, and public website information. RESULTS The Markov model simulated a time span of 10 years, with a cycle set at one month, for 120 cycles. The results showed that the per capita cost of the CH group was 38,442.11 CNY/year, with a QALY of 0.7196 per person per year. The per capita cost of the DT group was 42,300.26 CNY/year, with a QALY of 0.81687 per person per year. The ICER per person was 39,663.5 CNY/QALY each year, which was below the willingness-to-pay threshold of 85,698 CNY (China's GDP per capita in 2022). CONCLUSIONS DTx for home-based cardiac rehabilitation is an extremely cost-effective rehabilitation option compared with conventional home-based cardiac rehabilitation. DTx for home-based cardiac rehabilitation is potentially valuable from the perspective of healthcare decision-makers.
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Affiliation(s)
- Tianyi Liu
- School of Business, Nanjing University, Nanjing, 210093, China
| | - Yiyang Zhan
- Departments of Geriatric Practice, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China
| | - Silei Chen
- Medical School, Nanjing University, Nanjing, China
| | - Wenhong Zhang
- School of Business, Nanjing University, Nanjing, 210093, China.
- National Institute of Healthcare Data Science, Nanjing University, Nanjing, China.
| | - Jian Jia
- School of Business, Nanjing University, Nanjing, 210093, China.
- Departments of General Practice, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
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50
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Gao Y, Wang N, Zhang L, Liu N. Effectiveness of home-based cardiac telerehabilitation in patients with heart failure: A systematic review and meta-analysis of randomised controlled trials. J Clin Nurs 2023; 32:7661-7676. [PMID: 37062028 DOI: 10.1111/jocn.16726] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 03/13/2023] [Accepted: 04/05/2023] [Indexed: 04/17/2023]
Abstract
AIMS AND OBJECTIVES To evaluate the effectiveness of home-based cardiac telerehabilitation in patients with heart failure. DESIGN This systematic review and meta-analysis of randomised controlled trials were designed and reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. METHODS Two researchers independently screened eligible studies. The Cochrane Handbook for Systematic Reviews of Interventions was used to assess the risk of bias within the included studies. A fixed- or random-effects meta-analysis model was used to determine the mean difference, based on the results of the heterogeneity test. DATA SOURCES A librarian-designed search of the Cochrane Library, PubMed, Web of Science, EMBASE, CINAHL, CBM, CNKI and Wanfang databases was conducted to identify studies in English or Chinese on randomised controlled trials up to 15 August 2022. RESULTS A total of 2291 studies were screened. The meta-analysis included data from 16 studies representing 4557 participants. The results indicated that home-based cardiac telerehabilitation could improve heart rate, VO2 peak, 6-minute walk distance, quality of life and reduce readmission rates. No significant differences were observed in the left ventricular ejection fraction percentages between the home-based cardiac telerehabilitation and usual care groups. Compared with centre-based cardiac rehabilitation, home-based cardiac telerehabilitation showed no significant improvement in outcome indicators. CONCLUSION Patients with heart failure benefit from home-based cardiac telerehabilitation intervention. With the rapid development of information and communication technology, home-based cardiac telerehabilitation has great potential and may be used as an adjunct or substitute for centre-based cardiac rehabilitation. IMPACT This systematic review and meta-analysis found that patients with heart failure would benefit from home-based cardiac telerehabilitation intervention in terms of cardiac function, functional capacity, quality-of-life management and readmission rate. Future clinical interventions should consider home-based cardiac telerehabilitation as an alternative to conventional cardiac rehabilitation in patients with heart failure to improve their quality of life. NO PATIENT OR PUBLIC CONTRIBUTION Our paper is a systematic review and meta-analysis, and such details do not apply to our work.
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Affiliation(s)
- Yan Gao
- Department of Rehabilitation, Shengjing Hospital of China Medical University, Shenyang, China
| | - Nan Wang
- Department of Rehabilitation, Shengjing Hospital of China Medical University, Shenyang, China
| | - Lixin Zhang
- Department of Rehabilitation, Shengjing Hospital of China Medical University, Shenyang, China
| | - Naiquan Liu
- Department of Nephrology, Shengjing Hospital of China Medical University, Shenyang, China
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