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van Mierlo RFR, Houben VJG, Rikken SAOF, Gómez-Doblas JJ, Lozano-Torres J, van ’t Hof AWJ. Cardiac (tele)rehabilitation in routine clinical practice for patients with coronary artery disease: protocol of the REHAB + trial. Front Cardiovasc Med 2024; 11:1387148. [PMID: 39224752 PMCID: PMC11367104 DOI: 10.3389/fcvm.2024.1387148] [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: 02/16/2024] [Accepted: 07/02/2024] [Indexed: 09/04/2024] Open
Abstract
Introduction Cardiac rehabilitation programs face the challenge of suboptimal participation, despite being a level Ia recommendation. Cardiac telerehabilitation, with its potential to engage patients who might otherwise not show interest, necessitates the adaption of existing center-based cardiac rehabilitation programs to facilitate rehabilitation at home. REHAB + is a mobile cardiac telerehabilitation program cocreated with patients and rehabilitation centers, aiming to future-proof cardiac rehabilitation and improve accessibility. The REHAB + application enables users to remotely communicate with their coach, receive on-demand feedback on health goal progression, and reduces the need for frequent in-person meetings at the cardiac rehabilitation center. The REHAB + study seeks to compare patient-related outcomes and characteristics of patients between those offered the option to participate in cardiac telerehabilitation and those attending center-based cardiac rehabilitation over a twelve-month period. Methods The REHAB + study is a multicenter, prospective, matched controlled, observational study that includes (N)STEMI patients eligible for cardiac rehabilitation. We aim to enroll 300 participants for cardiac telerehabilitation and 600 for center-based cardiac rehabilitation. Participants opting for cardiac telerehabilitation (REHAB+) will be matched with center-based cardiac rehabilitation participants. Additionally, characteristics of patients unwilling to participate in either center-based rehabilitation or telerehabilitation but are willing to share their demographics will be collected. The primary endpoint is quality of life measured with the SF-36 questionnaire at three and twelve months, with patient-related characteristics driving intervention choice as the most important secondary endpoint. Secondary endpoints include physical activity, modifiable risk factors, and digital health experience. The trial is registered at clinicaltrials.gov with registration number NCT05207072. Discussion The REHAB + trial is unique by offering patients freedom to choose between cardiac telerehabilitation and center-based rehabilitation. The integration of digital components into cardiac rehabilitation has the potential to complement behavioral change strategies for specific patient groups. Offering patients the option of cardiac telerehabilitation next to center-based rehabilitation could enhance overall cardiac rehabilitation participation rates.
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Affiliation(s)
- Rutger F. R. van Mierlo
- Department of Cardiology, Maastricht University Medical Center (MUMC+), Maastricht, Netherlands
- Department of Cardiology, Zuyderland Medical Center, Heerlen and Geleen/Sittard, Netherlands
- Department of Radiation Oncology (Maastro), Research Institute for Oncology and Reproduction (GROW), Maastricht University, Maastricht, Netherlands
| | - Vitalis J. G. Houben
- Department of Cardiology, Maastricht University Medical Center (MUMC+), Maastricht, Netherlands
- Department of Cardiology, Zuyderland Medical Center, Heerlen and Geleen/Sittard, Netherlands
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, Netherlands
| | - Sem A. O. F. Rikken
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, Netherlands
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, Netherlands
| | - Juan Jose Gómez-Doblas
- Department of Cardiology, Hospital Universitario Virgen de la Victoria, Málaga, Spain
- Centro de Investigación en Red de Enfermedades Cardiovasculares (CIBERCV), IBIMA-Plataforma BIONAND, Universidad de Málaga, Málaga, Spain
| | - Jordi Lozano-Torres
- Department of Cardiology, Hospital Universitari Vall D’Hebron, Barcelona, Spain
| | - Arnoud W. J. van ’t Hof
- Department of Cardiology, Maastricht University Medical Center (MUMC+), Maastricht, Netherlands
- Department of Cardiology, Zuyderland Medical Center, Heerlen and Geleen/Sittard, Netherlands
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, Netherlands
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2
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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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3
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Marzolini S. Clinician's Commentary on Moncion et al. 3. Physiother Can 2024; 76:134-136. [PMID: 38465316 PMCID: PMC10919357 DOI: 10.3138/ptc-2021-0118-cc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/12/2024]
Affiliation(s)
- Susan Marzolini
- KITE Research Institute, Toronto Rehabilitation Institute-University Health Network, Toronto, ON, Canada; Rehabilitation Sciences Institute, University of Toronto, ON, Canada; Faculty of Kinesiology and Physical Education, University of Toronto, ON, Canada;
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4
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Moncion K, Pryzbek M, Noguchi KS, Roig M, MacDonald MJ, Richardson J, Tang A. Cardiorespiratory Fitness Benefits of Long-Term Maintenance-Phase Cardiac Rehabilitation in Males and Females: A Retrospective Cohort Study. Physiother Can 2024; 76:124-133. [PMID: 38465298 PMCID: PMC10919366 DOI: 10.3138/ptc-2021-0118] [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: 11/07/2021] [Revised: 04/25/2022] [Accepted: 04/25/2022] [Indexed: 03/12/2024]
Abstract
Purpose This study investigated if associations exist between enrolment delay and VO2peak over five years of maintenance-phase cardiac rehabilitation (CR) in males and females. Method Data were extracted from the records of participants who had enrolled for ≥ 1 year in CR and completed ≥ 2 cardiopulmonary exercise tests. Mixed model analyses examined VO2peak trajectories for up to five years of enrolment. Interactions between enrolment delay × enrolment duration, baseline age × enrolment duration, and baseline VO2peak × enrolment duration were explored for inclusion in the model. Results The charts of 151 males (aged 63.9 ± 9.4 y) and 32 females (aged 65.3 ± 9.0 y) were included in the analyses. The enrolment delay following a cardiovascular event was 1.8 ± 3.0 years for males and 1.3 ± 1.7 years for females. No associations were found between enrolment delay × enrolment duration on VO2peak in males (β[SEj, 0.07[0.05]; 95% CI -0.02, 0.16, p = 0.12) or in females (β[SE], 0.07[0.13j; 95% CI -0.18, 0.33, p = 0.57), but predicted trajectories suggest clinically significantly improvements in VO2 peak (range, 1.3 to 1.6 mL/kg/min). Conclusions Early enrolment in CR is recommended and encouraged, but the benefits of long-term CR are possible despite delays.
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Affiliation(s)
- Kevin Moncion
- From the:School of Rehabilitation Science, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Mike Pryzbek
- From the:School of Rehabilitation Science, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Kenneth S. Noguchi
- From the:School of Rehabilitation Science, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Marc Roig
- Memory and Motor Rehabilitation, Feil-Oberfeld Research Centre, Jewish Rehabilitation Hospital, Montreal Centre for Interdisciplinary Research in Rehabilitation, Laval, Quebec, Canada
- School of Physical & Occupational Therapy, Faculty of Medicine, McGill University, Montreal, Quebec, Canada
| | - Maureen J. MacDonald
- Department of Kinesiology, Faculty of Science, McMaster University, Hamilton, Ontario, Canada
| | - Julie Richardson
- From the:School of Rehabilitation Science, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Ada Tang
- From the:School of Rehabilitation Science, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
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5
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Falter M, Scherrenberg M, Martens R, Mennes J, Nys Y, Polat I, Kaihara T, Dendale P. Determinants of participation in cardiac telerehabilitation during the first surge of COVID-19. Acta Cardiol 2023; 78:823-827. [PMID: 36880518 DOI: 10.1080/00015385.2023.2182036] [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: 12/01/2021] [Revised: 01/27/2023] [Accepted: 02/10/2023] [Indexed: 03/08/2023]
Abstract
BACKGROUND Participation rates in cardiac rehabilitation (CR) are low. In multiple trials, telerehabilitation (TR) has been demonstrated to be effective. Still, real-life evidence is scarce. During the first surge of the COVID-19 pandemic our centre deployed a TR programme. This study aimed to characterise the patient population that had, for the first time, the opportunity to participate in cardiac TR and to analyse if there were determining factors for participation or non-participation in TR. METHODS All patients enrolled in CR in our centre during the first wave of the COVID-19 pandemic were included in this retrospective cohort study. Data was collected from the hospital electronic records. RESULTS 369 patients were contacted in the setting of TR. 69 patients could not be reached and were excluded from further analysis. 208 (69%) patients that were contacted agreed to participate in cardiac TR. No significant differences in baseline characteristics were seen between TR participants and TR non-participants. A full model logistic regression did not reveal any significant determinants on participation rate in TR. CONCLUSION This study demonstrates that the rate of participation in TR was high (69%). Of the analysed characteristics, none was directly correlated with the willingness to participate in TR. Further research is needed to further assess determinants, barriers and facilitators of TR. Also, research is needed on better delineating digital health literacy and on how to reach also those patients that are less motivated and or less digitally literate.
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Affiliation(s)
- Maarten Falter
- Heart Centre Hasselt, Jessa Hospital, Hasselt, Belgium
- Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium
- Faculty of Medicine, Department of Cardiology, KULeuven, Leuven, Belgium
| | - Martijn Scherrenberg
- Heart Centre Hasselt, Jessa Hospital, Hasselt, Belgium
- Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium
- Faculty of Medicine and Health Sciences, Antwerp University, Antwerp, Belgium
| | - Roy Martens
- Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium
| | - Jonas Mennes
- Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium
| | - Yorni Nys
- Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium
| | - Ihsan Polat
- Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium
| | - Toshiki Kaihara
- Heart Centre Hasselt, Jessa Hospital, Hasselt, Belgium
- Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Paul Dendale
- Heart Centre Hasselt, Jessa Hospital, Hasselt, Belgium
- Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium
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Kapoor G, Chahal A, Sharma A, Sidiq M, Vajrala KR, Vats S, Jain M, Sharma N, Ramanandi V, Bachkaniwala A. Dietary and Physical Exercise Facilitation for Cardiovascular Health in Indian Subcontinent. J Lifestyle Med 2023; 13:97-100. [PMID: 37970324 PMCID: PMC10630721 DOI: 10.15280/jlm.2023.13.2.97] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 07/17/2023] [Accepted: 08/06/2023] [Indexed: 11/17/2023] Open
Abstract
The advent of industrialization and outburst of urbanization significantly influences the lifestyle of people. Further, the incidence of noncommunicable diseases, such as chronic lung conditions, cancer, cardiovascular diseases (including conditions affecting the heart and blood vessels), diabetes, hypertension, and obesity, has increased. The prevalence of cardiovascular diseases in India in 2016 was reported to be 54.5 million. One out of four deaths was associated with cardiovascular diseases. With time, the prevalence of cardiovascular diseases is exerting more impact on the younger Indian population aged 20-29 years. The foremost risk factors for disability-adjusted life-years include poor dietary habits, tobacco use, and low physical activity. A healthy diet and an optimum physical activity level should be projected as primary interventions for noncommunicable diseases in the Indian subcontinent. Government health organizations and associations should concentrate and prioritize the current situation and scale up cost-effective policies and innovative techniques with interventional research and funding, especially on diet and exercise facilitation, as comprehensive management toward minimizing cardiovascular diseases to safeguard Indian economy's future.
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Affiliation(s)
- Gaurav Kapoor
- Department of Physiotherapy, NIMS College of Physiotherapy and Occupational Therapy, NIMS University, Rajasthan, India
| | - Aksh Chahal
- Department of Physiotherapy, School of Medical and Allied Health Sciences, Galgotias University, Uttar Pradesh, India
| | - Abhishek Sharma
- Department of Physiotherapy, Arogyam Institute of Paramedical and Allied Sciences, Uttarakhand, India
| | - Mohammad Sidiq
- Department of Physiotherapy, School of Medical and Allied Health Sciences, Galgotias University, Uttar Pradesh, India
| | - Krishna Reddy Vajrala
- Department of Physiotherapy, School of Medical and Allied Health Sciences, Galgotias University, Uttar Pradesh, India
| | - Sakshi Vats
- Department of Allied Healthcare Sciences, Vivekananda Global University, Rajasthan, India
| | - Mansi Jain
- Department of Musculoskeletal Physiotherapy, Maharishi Markandeshwar Institute of Physiotherapy and Rehabilitation, Maharishi Markandeshwar (Deemed to be University), Haryana, India
| | - Nidhi Sharma
- Department of Physiotherapy, Uttaranchal College of Health Sciences, Uttaranchal University, Uttarakhand, India
| | - Vivek Ramanandi
- Department of Neurological Physiotherapy, SPB Physiotherapy College, Veer Narmad South Gujarat University, Gujrat, India
| | - Aparna Bachkaniwala
- Department of Neurological Physiotherapy, SPB Physiotherapy College, Veer Narmad South Gujarat University, Gujrat, India
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van Bakel BMA, de Koning IA, Bakker EA, Pop GAM, Cramer E, van Geuns RM, Thijssen DHJ, Eijsvogels TMH. Rapid Improvements in Physical Activity and Sedentary Behavior in Patients With Acute Myocardial Infarction Immediately Following Hospital Discharge. J Am Heart Assoc 2023; 12:e028700. [PMID: 37158085 PMCID: PMC10227295 DOI: 10.1161/jaha.122.028700] [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: 01/25/2023] [Accepted: 03/28/2023] [Indexed: 05/10/2023]
Abstract
Background Little is known about changes in physical activity (PA) and sedentary behavior (SB) patterns in the acute phase of a myocardial infarction (MI). We objectively assessed PA and SB during hospitalization and the first week after discharge. Methods and Results Consecutively admitted patients hospitalized with an MI were approached to participate in this prospective cohort study. SB, light-intensity PA, and moderate-vigorous intensity PA were objectively assessed for 24 h/d during hospitalization and up to 7 days after discharge in 165 patients. Changes in PA and SB from the hospital to home phase were evaluated using mixed-model analyses, and outcomes were stratified for predefined subgroups based on patient characteristics. Patients (78% men) were aged 65±10 years and diagnosed with ST-segment-elevation MI (50%) or non-ST-segment-elevation MI (50%). Sedentary time was high during hospitalization (12.6 [95% CI, 11.8-13.7] h/d) but substantially decreased following transition to the home environment (-1.8 [95% CI, -2.4 to -1.3] h/d). Furthermore, the number of prolonged sedentary bouts (≥60 minutes) decreased between hospital and home (-1.6 [95% CI, -2.0 to -1.2] bouts/day). Light-intensity PA (1.1 [95% CI, 0.8-1.6] h/d) and moderate-vigorous intensity PA (0.2 [95% CI, 0.1-0.3] h/d) were low during hospitalization but significantly increased following transition to the home environment (light-intensity PA: 1.8 [95% CI, 1.4-2.3] h/d; moderate-vigorous intensity PA: 0.4 [95% CI, 0.3-0.5] h/d; both P<0.001). Improvements in PA and SB were similar across groups, except for patients who underwent coronary artery bypass grafting and who did not improve their PA patterns after discharge. Conclusions Patients with MI demonstrate high levels of SB and low PA volumes during hospitalization, which immediately improved following discharge at the patient's home environment. Registration URL: trialsearch.who.int/; Unique identifier: NTR7646.
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Affiliation(s)
- Bram M. A. van Bakel
- Department of PhysiologyRadboud University Medical Center, Radboud Institute for Health SciencesNijmegenthe Netherlands
| | - Iris A. de Koning
- Department of PhysiologyRadboud University Medical Center, Radboud Institute for Health SciencesNijmegenthe Netherlands
| | - Esmée A. Bakker
- Department of PhysiologyRadboud University Medical Center, Radboud Institute for Health SciencesNijmegenthe Netherlands
| | - Gheorghe A. M. Pop
- Department of Cardiology, Radboud University Medical CenterRadboud Institute for Health SciencesNijmegenthe Netherlands
| | - Etienne Cramer
- Department of Cardiology, Radboud University Medical CenterRadboud Institute for Health SciencesNijmegenthe Netherlands
| | - Robert‐Jan M. van Geuns
- Department of Cardiology, Radboud University Medical CenterRadboud Institute for Health SciencesNijmegenthe Netherlands
| | - Dick H. J. Thijssen
- Department of PhysiologyRadboud University Medical Center, Radboud Institute for Health SciencesNijmegenthe Netherlands
- Research Institute for Sports and Exercise SciencesLiverpool John Moores UniversityLiverpoolUnited Kingdom
| | - Thijs M. H. Eijsvogels
- Department of PhysiologyRadboud University Medical Center, Radboud Institute for Health SciencesNijmegenthe Netherlands
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Ngaage DL, Mitchell N, Dean A, Mitchell A, Hinde S, Akowuah E, Doherty P, Nichols S, Fairhurst C, Flemming K, Hewitt C, Ingle L, Watson J. A randomised controlled, feasibility study to establish the acceptability of early outpatient review and early cardiac rehabilitation compared to standard practice after cardiac surgery and viability of a future large-scale trial (FARSTER). Pilot Feasibility Stud 2023; 9:79. [PMID: 37170367 PMCID: PMC10172724 DOI: 10.1186/s40814-023-01304-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 04/21/2023] [Indexed: 05/13/2023] Open
Abstract
OBJECTIVE To determine the acceptability and feasibility of delivering early outpatient review following cardiac surgery and early cardiac rehabilitation (CR), compared to standard practice to establish if a future large-scale trial is achievable. METHODS A randomised controlled, feasibility trial with embedded health economic evaluation and qualitative interviews, recruited patients aged 18-80 years from two UK cardiac centres who had undergone elective or urgent cardiac surgery via a median sternotomy. Eligible, consenting participants were randomised 1:1 by a remote, centralised randomisation service to postoperative outpatient review 6 weeks after hospital discharge, followed by CR commencement from 8 weeks (control), or postoperative outpatient review 3 weeks after hospital discharge, followed by commencement of CR from 4 weeks (intervention). The primary outcome measures related to trial feasibility including recruitment, retention, CR adherence, and acceptability to participants/staff. Secondary outcome measures included health-rated quality of life using EQ-5D-5L, NHS resource-use, Incremental Shuttle Walk Test (ISWT) distance, 30- and 90-day mortality, surgical site complications and hospital readmission rates. RESULTS Fifty participants were randomised (25 per group) and 92% declared fit for CR. Participant retention at final follow-up was 74%; completion rates for outcome data time points ranged from 28 to 92% for ISWT and 68 to 94% for follow-up questionnaires. At each time point, the mean ISWT distance walked was greater in the intervention group compared to the control. Mean utility scores increased from baseline to final follow-up by 0.202 for the intervention (0.188 control). Total costs were £1519 for the intervention (£2043 control). Fifteen participants and a research nurse were interviewed. Many control participants felt their outpatient review and CR could have happened sooner; intervention participants felt the timing was right. The research nurse found obtaining consent for willing patients challenging due to discharge timings. CONCLUSION Recruitment and retention rates showed that it would be feasible to undertake a full-scale trial subject to some modifications to maximise recruitment. Lower than expected recruitment and issues with one of the clinical tests were limitations of the study. Most study procedures proved feasible and acceptable to participants, and professionals delivering early CR. TRIAL REGISTRATION ISRCTN80441309 (prospectively registered on 24/01/2019).
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Affiliation(s)
- Dumbor L. Ngaage
- Castle Hill Hospital, Hull University Teaching Hospitals NHS Trust, Castle Road Cottingham, Hull, UK
| | - Natasha Mitchell
- Department of Health Sciences, University of York, ARRC Building, York, UK
| | - Alexandra Dean
- Department of Health Sciences, University of York, ARRC Building, York, UK
| | - Alex Mitchell
- Department of Health Sciences, University of York, ARRC Building, York, UK
| | - Sebastian Hinde
- Centre for Health Economics, Alcuin A Block, University of York, York, UK
| | - Enoch Akowuah
- James Cook Hospital, South Tees Hospitals NHS Foundation Trust, Marton Road, Middlesbrough, UK
| | - Patrick Doherty
- Department of Health Sciences, University of York, ARRC Building, York, UK
| | - Simon Nichols
- Sport and Physical Activity Research Centre, Sheffield Hallam University, Collegiate Campus, Sheffield, UK
| | - Caroline Fairhurst
- Department of Health Sciences, University of York, ARRC Building, York, UK
| | - Kate Flemming
- Department of Health Sciences, University of York, ARRC Building, York, UK
| | - Catherine Hewitt
- Department of Health Sciences, University of York, ARRC Building, York, UK
| | - Lee Ingle
- Department of Sport, Health and Exercise Science, University of Hull, Hull, UK
| | - Judith Watson
- Department of Health Sciences, University of York, ARRC Building, York, UK
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Loureiro Diaz J, Foster LD, Surendran PJ, Jacob P, Ibrahim O, Gupta P. Developing and delivering a hybrid Cardiac Rehabilitation Phase II exercise program during the COVID-19 pandemic: a quality improvement program. BMJ Open Qual 2023; 12:bmjoq-2022-002202. [PMID: 37257915 DOI: 10.1136/bmjoq-2022-002202] [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: 11/30/2022] [Accepted: 04/25/2023] [Indexed: 06/02/2023] Open
Abstract
The COVID-19 pandemic resulted in the cessation of approximately 75% of cardiac rehabilitation (CR) programmes worldwide. In March 2020, CR phase II (CRP2) services were stopped in Qatar. Multiple studies had shown safety, effectiveness, reduced cost of delivery and improved participation with hybrid CR. A multidisciplinary team reviewed various alternative models for delivery and decided to implement a hybrid CRP2 exercise programme (HCRP2-EP) to ensure continuation of our patient care. Our aim was to enrol in the HCRP2-EP 70% of all eligible patients by 30 September 2020. Institute for Health Care Improvement's collaborative model was adopted. Multiple plan-do-study-act cycles were used to test change ideas. The outcomes of the project were analysed using standard run chart rules to detect the changes in outcomes over time. This project was implemented from March 2020, and the male patients enrolled between August 2020 and April 2021, with sustained monthly median enrolment above target of 70% throughout. As for our secondary outcome, 75.8% of the male patients who completed HCRP2-EP showed a meaningful change in peak exercise capacity of ≥10% (mean change 17%±6%). There were no major adverse events reported, and the median Patient Satisfaction Score was 96% well above the institutional target of 90%. This shows a well-designed quality improvement programme is an appropriate strategy for implementing HCRP2-EP in a clinical setting, and HCRP2-EP is a feasible, effective and safe intervention in eligible male patients with cardiovascular disease.
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Affiliation(s)
- Javier Loureiro Diaz
- Cardiac Rehabilitation Department, Heart Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Liam David Foster
- Cardiac Rehabilitation Department, Cardiff and Vale University Health Board, Cardiff, UK
| | | | - Prasobh Jacob
- Cardiac Rehabilitation Department, Heart Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Omar Ibrahim
- Cardiac Rehabilitation Department, Heart Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Poonam Gupta
- Performance Improvement Department, Heart Hospital, Hamad Medical Corporation, Doha, Qatar
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10
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Zhong W, Fu C, Xu L, Sun X, Wang S, He C, Wei Q. Effects of home-based cardiac telerehabilitation programs in patients undergoing percutaneous coronary intervention: a systematic review and meta-analysis. BMC Cardiovasc Disord 2023; 23:101. [PMID: 36814188 PMCID: PMC9945630 DOI: 10.1186/s12872-023-03120-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Accepted: 02/13/2023] [Indexed: 02/24/2023] Open
Abstract
BACKGROUND Recent advances in telecommunications technology have raised the possibility of telehealth intervention delivering cardiac telerehabilitation, which may provide the efficacy of health services in patients after percutaneous coronary intervention (PCI). This study aimed to investigate the effects of home-based cardiac telerehabilitation (HBCTR) in patients undergoing PCI. METHODS We performed a comprehensive search of the following electronic databases: PubMed, Cochrane Central, Web of Science, Embase, CNKI, and WANFANG. For the prespecified outcomes, the primary outcomes were results of physical function (the six-minute walking test, 6MWT) and quality of life (QoL) of the participants. The secondary outcomes were results of (1) blood pressure; (2) full lipid profile (3) reliable assessment of anxiety and depression in patients. RESULTS All studies were conducted between 2013 and 2022, and a total of 5 articles could be included in the quantitative meta-analysis. The results showed that there was a statistically significant difference between the HBCTR intervention group and the control group in 6WMT (MD 16.59, 95%CI 7.13 to 26.06, P = 0.0006), but there was no difference in QoL (SMD - 0.25, 95%CI - 1.63 to 1.13, P = 0.73). According to the fixed effects model, there was a statistically significant difference between the HBCTR group versus the control group (MD - 2.88, 95%CI - 5.19 to - 0.57, P = 0.01), but not in diastolic blood pressure. Likewise, significant improvements of triglycerides and in low-density lipoprotein cholesterol were observed in HBTCR groups, but no significant differences were observed regarding total cholesterol and high-density lipoprotein cholesterol. CONCLUSION This systematic review and meta-analysis have proven that the HBCTR is one of the promisingly effective cardiac rehabilitation strategies that improve cardiorespiratory fitness and reduce cardiovascular disease risk factors. With the continuous improvement of the telerehabilitation network, it is expected to serve in clinical.
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Affiliation(s)
- Wen Zhong
- Department of Rehabilitation Medicine Center and Institute of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China.,Key Laboratory of Rehabilitation Medicine in Sichuan Province, Chengdu, Sichuan, People's Republic of China
| | - Chenying Fu
- State Key Laboratory of Biotherapy and National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China.,Aging and Geriatric Mechanism Laboratory, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China
| | - Lin Xu
- Department of Rehabilitation Medicine Center and Institute of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China.,Key Laboratory of Rehabilitation Medicine in Sichuan Province, Chengdu, Sichuan, People's Republic of China
| | - Xin Sun
- Department of Rehabilitation Medicine Center and Institute of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China.,Key Laboratory of Rehabilitation Medicine in Sichuan Province, Chengdu, Sichuan, People's Republic of China
| | - Shiqi Wang
- Department of Rehabilitation Medicine Center and Institute of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China.,Key Laboratory of Rehabilitation Medicine in Sichuan Province, Chengdu, Sichuan, People's Republic of China
| | - Chengqi He
- Department of Rehabilitation Medicine Center and Institute of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China.,Key Laboratory of Rehabilitation Medicine in Sichuan Province, Chengdu, Sichuan, People's Republic of China
| | - Quan Wei
- Department of Rehabilitation Medicine Center and Institute of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China. .,Key Laboratory of Rehabilitation Medicine in Sichuan Province, Chengdu, Sichuan, People's Republic of China.
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11
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Stamm-Balderjahn S, Bernert S, Rossek S. Promoting patient self-management following cardiac rehabilitation using a web-based application: A pilot study. Digit Health 2023; 9:20552076231211546. [PMID: 37954686 PMCID: PMC10637162 DOI: 10.1177/20552076231211546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 10/16/2023] [Indexed: 11/14/2023] Open
Abstract
Background The use of health-related mobile apps has become an important component of healthcare. Patients can use a range of tools to strengthen their health literacy and promote disease management. The aim of the project was to develop a web-based application for use on smartphones, tablets and computers for patients with cardiovascular diseases (cardio-app). Methods A semi-standardized written survey was conducted among rehabilitation patients with cardiovascular diseases (n = 158). The usability of the cardio-app was assessed using the System Usability Scale (SUS). The usage behaviour was conducted with a self-developed questionnaire. Results The study enrolled 158 eligible rehabilitation patients. The SUS of the cardio-app determined was 74.4 (SD ± 17.4). For 86%, the menu navigation was self-explanatory and logical. The visual presentation appealed to 92% of respondents. The content of the texts used in the app was understandable for 95%, and 93% found the technical terms used in the glossary well explained. For 57%, the app was helpful in planning their physical activities. 83% of the rehabilitation patients would recommend the app to others. The main criticisms of the app were the lack of synchronization options with other apps. Of those who did not use the app, the following reasons for non-use were most frequently cited: too much effort (43%), lack of time (29%) and pandemic-related reasons (29%). Conclusions The cardio-app revealed high agreement values. Whether the use of the app is associated with improved clinical state and outcome would have to be verified in further studies.
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Affiliation(s)
- Sabine Stamm-Balderjahn
- Institute of Medical Sociology and Rehabilitation Science, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Sebastian Bernert
- Institute of Medical Sociology and Rehabilitation Science, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Susanne Rossek
- Institute of Medical Sociology and Rehabilitation Science, Charité – Universitätsmedizin Berlin, Berlin, Germany
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12
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Arora A, Demb J, Cummins DD, Deviren V, Clark AJ, Ames CP, Theologis AA. Development and internal validation of predictive models to assess risk of post-acute care facility discharge in adults undergoing multi-level instrumented fusions for lumbar degenerative pathology and spinal deformity. Spine Deform 2023; 11:163-173. [PMID: 36125738 PMCID: PMC9768002 DOI: 10.1007/s43390-022-00582-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 08/27/2022] [Indexed: 12/24/2022]
Abstract
PURPOSE To develop a model for factors predictive of Post-Acute Care Facility (PACF) discharge in adult patients undergoing elective multi-level (≥ 3 segments) lumbar/thoracolumbar spinal instrumented fusions. METHODS The State Inpatient Databases acquired from the Healthcare Cost and Utilization Project from 2005 to 2013 were queried for adult patients who underwent elective multi-level thoracolumbar fusions for spinal deformity. Outcome variables were classified as discharge to home or PACF. Predictive variables included demographic, pre-operative, and operative factors. Univariate and multivariate logistic regression analyses informed development of a logistic regression-based predictive model using seven selected variables. Performance metrics included area under the curve (AUC), sensitivity, and specificity. RESULTS Included for analysis were 8866 patients. The logistic model including significant variables from multivariate analysis yielded an AUC of 0.75. Stepwise logistic regression was used to simplify the model and assess number of variables needed to reach peak AUC, which included seven selected predictors (insurance, interspaces fused, gender, age, surgical region, CCI, and revision surgery) and had an AUC of 0.74. Model cut-off for predictive PACF discharge was 0.41, yielding a sensitivity of 75% and specificity of 59%. CONCLUSIONS The seven variables associated significantly with PACF discharge (age > 60, female gender, non-private insurance, primary operations, instrumented fusion involving 8+ interspaces, thoracolumbar region, and higher CCI scores) may aid in identification of adults at risk for discharge to a PACF following elective multi-level lumbar/thoracolumbar spinal fusions for spinal deformity. This may in turn inform discharge planning and expectation management.
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Affiliation(s)
- Ayush Arora
- Department of Orthopaedic Surgery, University of California-San Francisco (UCSF), 500 Parnassus Ave, MUW 3rd Floor, San Francisco, CA, 94143, USA
| | - Joshua Demb
- Division of Gastroenterology, Department of Medicine, University of California-San Diego, La Jolla, CA, USA
| | - Daniel D Cummins
- Department of Orthopaedic Surgery, University of California-San Francisco (UCSF), 500 Parnassus Ave, MUW 3rd Floor, San Francisco, CA, 94143, USA
| | - Vedat Deviren
- Department of Orthopaedic Surgery, University of California-San Francisco (UCSF), 500 Parnassus Ave, MUW 3rd Floor, San Francisco, CA, 94143, USA
| | - Aaron J Clark
- Department of Neurological Surgery, UCSF, San Francisco, CA, USA
| | | | - Alekos A Theologis
- Department of Orthopaedic Surgery, University of California-San Francisco (UCSF), 500 Parnassus Ave, MUW 3rd Floor, San Francisco, CA, 94143, USA.
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13
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Qin S, Tian Z, Boidin M, Buckley BJR, Thijssen DHJ, Lip GYH. Irisin is an Effector Molecule in Exercise Rehabilitation Following Myocardial Infarction (Review). Front Physiol 2022; 13:935772. [PMID: 35845994 PMCID: PMC9276959 DOI: 10.3389/fphys.2022.935772] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 06/01/2022] [Indexed: 11/29/2022] Open
Abstract
Background: Regular exercise is an effective non-pharmacological therapy for treatment and prevention of cardiovascular disease (CVD). The therapeutic benefits of exercise are mediated partly through improved vascular and increase in metabolic health. Release of exercise-responsive myokines, including irisin, is associated with beneficial effects of exercise in CVD patients. Observations: The present review provides an overview of the role of exercise in cardiac rehabilitation of patients with myocardial infarction (MI). Further, the role of irisin as a motion-responsive molecule in improving vascular and metabolic health is explored. Possible mechanism of cardioprotective effect of irisin-mediated exercise on myocardial infarction are also summarized in this review. Conclusion and significance of the review: Irisin is associated with reduced inflammation, antioxidant properties, and anti-apoptotic effect, implying that it is a potential key mediator of the beneficial effects of exercise on vascular and metabolic health. The findings show that irisin is a promising therapeutic target for treatment of patients with cardiovascular disease, particularly post-MI. Further research should be conducted to elucidate the potential mechanisms of cardioprotective effects of irisin and explored whether irisin induced by exercise exerts rehabilitation effects post-MI.
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Affiliation(s)
- Shuguang Qin
- Institute of Sports and Exercise Biology, School of Physical Education, Shaanxi Normal University, Xi’an, China
- Department of Cardiology, The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | - Zhenjun Tian
- Institute of Sports and Exercise Biology, School of Physical Education, Shaanxi Normal University, Xi’an, China
- *Correspondence: Zhenjun Tian,
| | - Maxime Boidin
- Liverpool Centre for Cardiovascular Science, Liverpool John Moores University, Liverpool, United Kingdom
- Cardiovascular Prevention and Rehabilitation (EPIC) Center, Montreal Heart Institute, Montreal, QC, Canada
- School of Kinesiology and Exercise Science, Faculty of Medicine, Université de Montréal, Montreal, QC, Canada
| | - Benjamin J. R. Buckley
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
- Cardiovascular and Metabolic Medicine, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, United Kingdom
| | - Dick H. J. Thijssen
- Liverpool Centre for Cardiovascular Science, Liverpool John Moores University, Liverpool, United Kingdom
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, United Kingdom
| | - Gregory Y. H. Lip
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
- Cardiovascular and Metabolic Medicine, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, United Kingdom
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14
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Ennis S, Lobley G, Worrall S, Evans B, Kimani PK, Khan A, Powell R, Banerjee P, Barker T, McGregor G. Effectiveness and Safety of Early Initiation of Poststernotomy Cardiac Rehabilitation Exercise Training: The SCAR Randomized Clinical Trial. JAMA Cardiol 2022; 7:817-824. [PMID: 35731506 DOI: 10.1001/jamacardio.2022.1651] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Importance Guidelines recommend that cardiac rehabilitation (CR) exercise training should not start until 6 weeks after sternotomy, although this is not evidence based. Limited data suggest that starting earlier is not detrimental, but clinical trials are needed. Objective To compare the effectiveness and safety of CR exercise training started either 2 weeks (early CR) or 6 weeks (usual-care CR) after sternotomy. Design, Setting, and Participants This was an assessor-blind, noninferiority, parallel-group, randomized clinical trial that conducted participant recruitment from June 12, 2017, to March 17, 2020. Participants were consecutive cardiac surgery sternotomy patients recruited from 2 outpatient National Health Service rehabilitation centers: University Hospital, Coventry, UK, and Hospital of St Cross, Rugby, UK. Interventions Participants were randomly assigned to 8 weeks of twice-weekly supervised CR exercise training starting either 2 weeks (early CR) or 6 weeks (usual-care CR) after sternotomy. Exercise training adhered to existing guidelines, including functional strength and cardiovascular components. Main Outcomes and Measures Outcomes were assessed at baseline (inpatient after surgery), after CR (10 or 14 weeks after sternotomy), and 12 months after randomization. The primary outcome was the change in 6-minute walk test distance from baseline to after CR. Secondary outcomes included safety, functional fitness, and quality of life. Results A total of 158 participants (mean [SD] age, 63 [11.5] years, 133 male patients [84.2%]) were randomly assigned to study groups; 118 patients (usual-care CR, 61 [51.7%]; early CR, 57 [48.3%]) were included in the primary analysis. Early CR was not inferior to usual-care CR (noninferiority margin, 35 m); the mean change in 6-minute walk distance from baseline to after CR was 28 m greater in the early CR group (95% CI, -11 to 66; P = .16). Mean differences for secondary outcomes were not statistically significant, indicating noninferiority of early CR. There were 46 vs 58 adverse events and 14 vs 18 serious adverse events in usual-care CR and early CR, respectively. There was no difference between the groups in the likelihood of participants having an adverse or serious adverse event. Conclusions and Relevance Starting exercise training from 2 weeks after sternotomy was as effective as starting 6 weeks after sternotomy for improving 6-minute walk distance. With appropriate precautions, clinicians and CR professionals can consider starting exercise training as early as 2 weeks after sternotomy. Trial Registration ClinicalTrials.gov Identifier: NCT03223558.
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Affiliation(s)
- Stuart Ennis
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, United Kingdom.,Department of Cardiopulmonary Rehabilitation, Centre for Exercise & Health, University Hospital Coventry and Warwickshire National Health Service Trust, Coventry, United Kingdom
| | - Grace Lobley
- Department of Cardiopulmonary Rehabilitation, Centre for Exercise & Health, University Hospital Coventry and Warwickshire National Health Service Trust, Coventry, United Kingdom
| | - Sandra Worrall
- Department of Cardiopulmonary Rehabilitation, Centre for Exercise & Health, University Hospital Coventry and Warwickshire National Health Service Trust, Coventry, United Kingdom
| | - Becky Evans
- Department of Cardiopulmonary Rehabilitation, Centre for Exercise & Health, University Hospital Coventry and Warwickshire National Health Service Trust, Coventry, United Kingdom
| | - Peter K Kimani
- Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - Amir Khan
- Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - Richard Powell
- Department of Cardiopulmonary Rehabilitation, Centre for Exercise & Health, University Hospital Coventry and Warwickshire National Health Service Trust, Coventry, United Kingdom.,Centre for Sport, Exercise and Life Sciences, Research Institute for Health & Wellbeing, Coventry University, Coventry, United Kingdom
| | - Prithwish Banerjee
- Warwick Medical School, University of Warwick, Coventry, United Kingdom.,Department of Cardiology, University Hospital Coventry and Warwickshire National Health Service Trust, Coventry, United Kingdom
| | - Tom Barker
- Department of Cardiothoracic Surgery, University Hospital Coventry and Warwickshire National Health Service Trust, Coventry, United Kingdom
| | - Gordon McGregor
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, United Kingdom.,Department of Cardiopulmonary Rehabilitation, Centre for Exercise & Health, University Hospital Coventry and Warwickshire National Health Service Trust, Coventry, United Kingdom.,Centre for Sport, Exercise and Life Sciences, Research Institute for Health & Wellbeing, Coventry University, Coventry, United Kingdom
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15
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Gray EA, Skinner MA, Hale LA, Bunton RW. Preparation and support for physical activity following hospital discharge after coronary artery bypass graft surgery: A survey of current practice in New Zealand. PHYSIOTHERAPY RESEARCH INTERNATIONAL 2022; 27:e1940. [PMID: 35120260 DOI: 10.1002/pri.1940] [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: 08/29/2021] [Revised: 10/31/2021] [Accepted: 12/30/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND AND PURPOSE Engagement in physical activity following coronary artery bypass graft (CABG) surgery has many benefits and also many potential barriers, especially during the first few months. It is important to explore current clinical practice before investigating ways to optimally prepare and support people to progressively increase their physical activity post-hospital discharge and to navigate the challenges. The aim of the study was to explore current practice in New Zealand hospital services for preparing and supporting people who have had CABG surgery to engage in physical activity following hospital discharge. METHODS Locality authorisation to participate in the study was sought from all 11 hospitals providing cardiac surgery services in New Zealand. The most senior health professional responsible for preparing people to engage in physical activity following CABG surgery was invited to participate by completing a purpose designed questionnaire on behalf of their hospital service. Respondents were also requested to provide any patient information handouts regarding progressive physical activity engagement following CABG surgery. RESULTS Responses were received from all nine hospitals that granted locality authorisation. All nine hospitals prepared people to engage in aerobic exercise prior to discharge, predominantly through the provision of a walking schedule. In contrast, no hospitals provided information about engagement in resistance exercise. There was wide variability in both the advice provided regarding sternal precautions and time to return to activities of daily living. Additionally, the facilitation of some elements of self-management for physical activity, in particular problem solving and providing follow up support outside of the cardiac rehabilitation setting was provided infrequently. DISCUSSION The findings demonstrated variability in service delivery in a number of areas and highlighted potential areas for improvement in light of what is known from the literature. Provision of follow up support for those unable to access outpatient cardiac rehabilitation is a key need.
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Affiliation(s)
- Emily Anne Gray
- Centre for Health, Activity and Rehabilitation Research, School of Physiotherapy, University of Otago, Dunedin, New Zealand
| | - Margot Alison Skinner
- Centre for Health, Activity and Rehabilitation Research, School of Physiotherapy, University of Otago, Dunedin, New Zealand
| | - Leigh Anne Hale
- Centre for Health, Activity and Rehabilitation Research, School of Physiotherapy, University of Otago, Dunedin, New Zealand
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16
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M. Ghisi G, Loures J, S. Chaves G, Ribas R, Britto R, Marchiori M. Socioeconomic and clinical factors associated with disease-related knowledge of cardiac rehabilitation patients in Brazil. HEART AND MIND 2022. [DOI: 10.4103/hm.hm_64_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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17
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Ades PA, Khadanga S, Savage PD, Gaalema DE. Enhancing participation in cardiac rehabilitation: Focus on underserved populations. Prog Cardiovasc Dis 2022; 70:102-110. [PMID: 35108567 PMCID: PMC9119375 DOI: 10.1016/j.pcad.2022.01.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Accepted: 01/23/2022] [Indexed: 02/07/2023]
Abstract
Participation in cardiac rehabilitation (CR) significantly decreases morbidity and mortality and improves quality of life following a wide variety of cardiac diagnoses and interventions. However, participation rates and adherence with CR are still suboptimal and certain populations, such as women, minorities, and those of lower socio-economic status, are particularly unlikely to engage in and complete CR. In this paper we review the current status of CR participation rates and interventions that have been used successfully to improve CR participation. In addition, we review populations known to be less likely to engage in CR, and interventions that have been used to improve participation specifically in these underrepresented populations. Finally, we will explore how CR programs may need to expand or change to serve a greater proportion of CR-eligible populations. The best studied interventions that have successfully increased CR participation include automated referral to CR and utilization of a CR liaison person to coordinate the sometimes awkward transition from inpatient status to outpatient CR participation. Furthermore, it appears likely that maximizing secondary prevention in these at-risk populations will require a combination of increasing attendance at traditional center-based CR programs among underrepresented populations, improving and expanding upon tele- or community-based programs, and alternative strategies for improving secondary prevention in those who do not participate in CR.
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Affiliation(s)
- Philip A Ades
- Department of Medicine, Division of Cardiology, University of Vermont Larner College of Medicine, Cardiac Rehabilitation and Prevention, Burlington, VT, United States of America.
| | - Sherrie Khadanga
- Department of Medicine, Division of Cardiology, University of Vermont Larner College of Medicine, Cardiac Rehabilitation and Prevention, Burlington, VT, United States of America
| | - Patrick D Savage
- Department of Medicine, Division of Cardiology, University of Vermont Larner College of Medicine, Cardiac Rehabilitation and Prevention, Burlington, VT, United States of America
| | - Diann E Gaalema
- Department of Psychiatry, University of Vermont Larner College of Medicine, Cardiac Rehabilitation and Prevention, Burlington, VT, United States of America
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18
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Harzand A, Weidman AC, Rayl KR, Adesanya A, Holmstrand E, Fitzpatrick N, Vathsangam H, Murali S. Retrospective Analysis and Forecasted Economic Impact of a Virtual Cardiac Rehabilitation Program in a Third-Party Payer Environment. Front Digit Health 2021; 3:678009. [PMID: 34901923 PMCID: PMC8653769 DOI: 10.3389/fdgth.2021.678009] [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: 03/08/2021] [Accepted: 10/15/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Participation in cardiac rehabilitation (CR) is recommended for all patients with coronary artery disease (CAD) following hospitalization for acute coronary syndrome or stenting. Yet, few patients participate due to the inconvenience and high cost of attending a facility-based program, factors which have been magnified during the ongoing COVID pandemic. Based on a retrospective analysis of CR utilization and cost in a third-party payer environment, we forecasted the potential clinical and economic benefits of delivering a home-based, virtual CR program, with the goal of guiding future implementation efforts to expand CR access. Methods: We performed a retrospective cohort study using insurance claims data from a large, third-party payer in the state of Pennsylvania. Primary diagnostic and procedural codes were used to identify patients admitted for CAD between October 1, 2016, and September 30, 2018. Rates of enrollment in facility-based CR, as well as all-cause and cardiovascular hospital readmission and associated costs, were calculated during the 12-months following discharge. Results: Only 37% of the 7,264 identified eligible insured patients enrolled in a facility-based CR program within 12 months, incurring a mean delivery cost of $2,922 per participating patient. The 12-month all-cause readmission rate among these patients was 24%, compared to 31% among patients who did not participate in CR. Furthermore, among those readmitted, CR patients were readmitted less frequently than non-CR patients within this time period. The average per-patient cost from hospital readmissions was $30,814 per annum. Based on these trends, we forecasted that adoption of virtual CR among patients who previously declined CR would result in an annual cost savings between $1 and $9 million in the third-party healthcare system from a combination of increased overall CR enrollment and fewer hospital readmissions among new HBCR participants. Conclusions: Among insured patients eligible for CR in a third-party payer environment, implementation of a home-based virtual CR program is forecasted to yield significant cost savings through a combination of increased CR participation and a consequent reduction in downstream healthcare utilization.
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Affiliation(s)
- Arash Harzand
- Emory University School of Medicine, Atlanta, GA, United States
| | - Aaron C Weidman
- VITAL Innovation, Highmark Health, Pittsburgh, PA, United States
| | - Kenneth R Rayl
- VITAL Innovation, Highmark Health, Pittsburgh, PA, United States
| | | | | | | | | | - Srinivas Murali
- Cardiovascular Institute, Allegheny Health Network, Pittsburgh, PA, United States
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19
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Gray E, Dasanayake S, Sangelaji B, Hale L, Skinner M. Factors influencing physical activity engagement following coronary artery bypass graft surgery: A mixed methods systematic review. Heart Lung 2021; 50:589-598. [PMID: 34087676 DOI: 10.1016/j.hrtlng.2021.04.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 04/18/2021] [Accepted: 04/20/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND Engagement in physical activity during the initial months following coronary artery bypass graft (CABG) surgery is important in order to improve health, quality of life and functional outcomes. There are, however, many potential barriers to physical activity engagement during the recovery period. No review studies have focused on barriers and facilitators to engagement in physical activity during the early stages of recovery following CABG surgery. OBJECTIVE To explore the factors that influence engagement in physical activity during the first three months following CABG surgery. METHODS Four electronic databases were searched. Extracted data from selected studies were synthesised using the Joanna Briggs Institute convergent integrated approach. RESULTS Nineteen studies met the inclusion criteria. Four main themes that influenced engagement were identified: sociodemographic variables; physical symptoms; psychosocial factors; and environmental factors. More barriers were identified than facilitating factors. Psychosocial factors were the most commonly reported barriers in the literature. CONCLUSIONS The findings of this review provide insights into factors that inhibit and facilitate engagement in physical activity following CABG surgery. Further research specifically exploring factors that influence engagement, especially facilitators, is required.
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Affiliation(s)
- Emily Gray
- Centre for Health, Activity and Rehabilitation Research, School of Physiotherapy, Division of Health Sciences, University of Otago, Dunedin, New Zealand.
| | - Suranga Dasanayake
- Centre for Health, Activity and Rehabilitation Research, School of Physiotherapy, Division of Health Sciences, University of Otago, Dunedin, New Zealand.
| | - Bahram Sangelaji
- Centre for Health, Activity and Rehabilitation Research, School of Physiotherapy, Division of Health Sciences, University of Otago, Dunedin, New Zealand.
| | - Leigh Hale
- Centre for Health, Activity and Rehabilitation Research, School of Physiotherapy, Division of Health Sciences, University of Otago, Dunedin, New Zealand.
| | - Margot Skinner
- Centre for Health, Activity and Rehabilitation Research, School of Physiotherapy, Division of Health Sciences, University of Otago, Dunedin, New Zealand.
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20
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Scherrenberg M, Frederix I, De Sutter J, Dendale P. Use of cardiac telerehabilitation during COVID-19 pandemic in Belgium. Acta Cardiol 2021; 76:773-776. [PMID: 32602812 DOI: 10.1080/00015385.2020.1786625] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND The COVID-19 pandemic has forced many cardiac rehabilitation centres to focus more on the remote delivery of cardiac rehabilitation (CR) components. This increased focus and the lessons learned from this period could enhance the implementation of telerehabilitation and increase the participation in CR in Belgium. METHODS We conducted a survey between April and May 2020 about the implementation of telerehabilitation services during the COVID-19 pandemic. The electronic questionnaire was sent via email to the heads of 42 Belgian CR centres. Three reminders via email were sent during the study period. RESULTS 27 CR centres (64%) returned completed questionnaires after three mailings. 52% of the CR centres provided remote CR services during the lockdown due to the COVID-19 pandemic. All CR centres that provided remote CR services delivered exercise training. The most used medium to deliver the CR components were online videos (71%) followed by online information on the website (64%) and emails (64%). CONCLUSION It is interesting that the COVID-19 pandemic has encouraged many CR centres to implement remote delivery of CR components. This can help to speed up the research and implementation of telerehabilitation in daily clinical practice. The COVID-19 pandemic could be the push for a large multicentre implementation study that could prove that telerehabilitation is feasible and effective in the Belgian setting.
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Affiliation(s)
- Martijn Scherrenberg
- Faculty of Medicine and Life Sciences, Hasselt University, Diepenbeek, Limburg, Belgium
- Department of Cardiology, Jessa Hospital, Hasselt, Belgium
| | - Ines Frederix
- Faculty of Medicine & Health Sciences, Antwerp University, Antwerp, Belgium
- Intenisve Care Unit, Antwerp University Hospital, Edegem, Belgium
| | - Johan De Sutter
- Department of Cardiology, AZ Maria Middelares Gent, Gent, Belgium
- University Gent, Vakgroep Inwendige Ziekten en Pediatrie, Gent, Belgium
| | - Paul Dendale
- Faculty of Medicine and Life Sciences, Hasselt University, Diepenbeek, Limburg, Belgium
- Department of Cardiology, Jessa Hospital, Hasselt, Belgium
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21
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Shields GE, Wright S, Wells A, Doherty P, Capobianco L, Davies LM. Delivery preferences for psychological intervention in cardiac rehabilitation: a pilot discrete choice experiment. Open Heart 2021; 8:openhrt-2021-001747. [PMID: 34426529 PMCID: PMC8383873 DOI: 10.1136/openhrt-2021-001747] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Accepted: 08/02/2021] [Indexed: 11/13/2022] Open
Abstract
Background Cardiac rehabilitation (CR) is a programme of care offered to people who recently experienced a cardiac event. There is a growing focus on home-based formats of CR and a lack of evidence on preferences for psychological care in CR. This pilot study aimed to investigate preferences for delivery attributes of a psychological therapy intervention in CR patients with symptoms of anxiety and/or depression. Methods A discrete choice experiment (DCE) was conducted and recruited participants from a feasibility trial. Participants were asked to choose between two hypothetical interventions, described using five attributes; intervention type (home or centre-based), information provided, therapy manual format, cost to the National Health Service (NHS) and waiting time. A separate opt-out was included. A conditional logit using maximum likelihood estimation was used to analyse preferences. The NHS cost was used to estimate willingness to pay for aspects of the intervention delivery. Results 35 responses were received (39% response rate). Results indicated that participants would prefer to receive any form of therapy compared with no therapy. Statistically significant results were limited, but included participants being keen to avoid not receiving information prior to therapy (β=−0.270; p=0.03) and preferring a lower cost to the NHS (β=−0.001; p=0.00). No significant results were identified for the type of psychological intervention, format of therapy/exercises and programme start time. Coefficients indicated preferences were stronger for home-based therapy compared with centre-based, but this was not significant. Conclusions The pilot study demonstrates the feasibility of a DCE in this group, it identifies potential attributes and levels, and estimates the sample sizes needed for a full study. Preliminary evidence indicated that sampled participants tended to prefer home-based psychological therapy in CR and wanted to receive information before initiating therapy. Results are limited due to the pilot design and further research is needed.
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Affiliation(s)
| | - Stuart Wright
- Manchester Centre for Health Economics, The University of Manchester, Manchester, UK
| | - Adrian Wells
- School of Psychological Sciences, The University of Manchester, Manchester, UK.,Research and Innovation, Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Patrick Doherty
- Department of Health Sciences, University of York, York, North Yorkshire, UK
| | - Lora Capobianco
- Research and Innovation, Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Linda Mary Davies
- Manchester Centre for Health Economics, The University of Manchester, Manchester, UK
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22
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Nguyen CH, Thomas SG, Marzolini S. Factors Associated With Change in Cardiovascular Fitness for Patients With Peripheral and Coronary Artery Disease in Cardiac Rehabilitation. J Cardiopulm Rehabil Prev 2021; 41:230-236. [PMID: 33186202 DOI: 10.1097/hcr.0000000000000559] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE Cardiac rehabilitation (CR) yields improvements in cardiorespiratory fitness (peak oxygen uptake [V˙o2peak]). Predictors of change in V˙o2peak have been reported among patients with coronary artery disease (CAD) but have not been compared with peripheral artery disease (PAD). This study determined predictors of improved V˙o2peak among patients with PAD, CAD, and concomitant PAD and CAD (PAD/CAD) following a 6-mo home-based outpatient CR program (1supervised and 4 home weekly sessions). METHODS This study was a retrospective (2006-2017) multiple linear regression analysis of CR patients with PAD (n = 63), CAD (n = 63), and PAD/CAD (n = 164). Peripheral artery disease and CAD were matched for age, sex, smoking status, diabetes, and year in program. RESULTS Mean age of all patients was 68.9±10.1 yr, 72% were male, and mean improvement in V˙o2peak was 2.1 ± 3.3 mL/kg/min (14.5% improvement) following CR. In CAD, younger age (β = .30, P = .015), male sex (β = -.29, P = .019), and more recent year of entry (β = .26, P = .035) were predictors of improved V˙o2peak. In PAD, only male sex (β = -.36, P = .004) and in PAD/CAD, not having diabetes (β = -.24, P = .002), not smoking (β = -.25, P = .001), and shorter elapsed time from referring diagnosis to entry (β = -.19, P = .016) were predictors. CONCLUSIONS While younger age and male sex were predictors of improved V˙o2peak in CAD, age did not influence PAD, and neither age nor sex influenced PAD/CAD. Peripheral artery disease-related limitations may override some demographic factors, and strategies for improving V˙o2peak should be explored. Managing smoking and comorbid diagnoses including diabetes and a timely entry to CR may yield greater improvements in V˙o2peak among individuals with PAD.
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Affiliation(s)
- Cindy H Nguyen
- Department of Exercise Sciences, Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, Canada (Ms Nguyen and Drs Thomas and Marzolini); and KITE Research Institute, Toronto Rehab-University Health Network, Cardiovascular Prevention and Rehabilitation Program, Toronto, Canada (Drs Thomas and Marzolini)
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Scherrenberg M, Falter M, Dendale P. Providing comprehensive cardiac rehabilitation during and after the COVID-19 pandemic. Eur J Prev Cardiol 2021; 28:520-521. [PMID: 33623986 PMCID: PMC7717272 DOI: 10.1093/eurjpc/zwaa107] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- Martijn Scherrenberg
- Heart Centre Hasselt, Jessa Hospital, Stadsomvaart 11, 3500 Hasselt, Belgium.,Mobile Health Unit, Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium
| | - Maarten Falter
- Heart Centre Hasselt, Jessa Hospital, Stadsomvaart 11, 3500 Hasselt, Belgium.,Mobile Health Unit, Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium
| | - Paul Dendale
- Heart Centre Hasselt, Jessa Hospital, Stadsomvaart 11, 3500 Hasselt, Belgium.,Mobile Health Unit, Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium
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Scherrenberg M, Wilhelm M, Hansen D, Völler H, Cornelissen V, Frederix I, Kemps H, Dendale P. The future is now: a call for action for cardiac telerehabilitation in the COVID-19 pandemic from the secondary prevention and rehabilitation section of the European Association of Preventive Cardiology. Eur J Prev Cardiol 2021; 28:524-540. [PMID: 32615796 PMCID: PMC7928994 DOI: 10.1177/2047487320939671] [Citation(s) in RCA: 117] [Impact Index Per Article: 39.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 06/15/2020] [Indexed: 12/13/2022]
Abstract
The role of comprehensive cardiac rehabilitation is well established in the secondary prevention of cardiovascular diseases such as coronary artery disease and heart failure. Numerous trials have demonstrated both the effectiveness as well as the cost-effectiveness of comprehensive cardiac rehabilitation in improving exercise capacity and quality of life, and in reducing cardiovascular mortality and morbidity. However, the current COVID-19 pandemic has led to closure of many cardiac rehabilitation centres in Europe resulting in many eligible patients unable to participate in the optimisation of secondary prevention and physical performance. This elicits an even louder call for alternatives such as cardiac telerehabilitation to maintain the delivery of the core components of cardiac rehabilitation to cardiovascular disease patients. The present call for action paper gives an update of recent cardiac telerehabilitation studies and provides a practical guide for the setup of a comprehensive cardiac telerehabilitation intervention during the COVID-19 pandemic. This set up could also be relevant to any cardiovascular disease patient not able to visit cardiac rehabilitation centres regularly after the COVID-19 pandemic ceases.
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Affiliation(s)
- Martijn Scherrenberg
- />Faculty of Medicine and Life Sciences, UHasselt – Hasselt University, Belgium
- />Department of Cardiology, Jessa Hospital, Belgium
| | - Matthias Wilhelm
- />Department of Cardiology, University Hospital of Bern, Switzerland
| | - Dominique Hansen
- />Faculty of Rehabilitation Sciences, UHasselt – Hasselt University, Belgium
- />BIOMED/REVAL (Rehabilitation Research Centre), Belgium
- />Heart Centre Hasselt, Jessa Hospital, Belgium
| | - Heinz Völler
- />Department of Rehabilitation Medicine, University of Potsdam, Germany
- />Rehabilitation Centre for Internal Medicine, Klinik am See, Germany
| | | | - Ines Frederix
- />Faculty of Medicine and Health Sciences, Antwerp University, Belgium
- />Intenisve Care Unit, Antwerp University Hospital, Belgium
| | - Hareld Kemps
- />Department of Cardiology, Máxima Medical Center, The Netherlands
- />Department of Industrial Design, Technical University Eindhoven, The Netherlands
| | - Paul Dendale
- />Faculty of Medicine and Life Sciences, UHasselt – Hasselt University, Belgium
- />Department of Cardiology, Jessa Hospital, Belgium
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Scherrenberg M, Falter M, Dendale P. Patient experiences and willingness-to-pay for cardiac telerehabilitation during the first surge of the COVID-19 pandemic: single-centre experience. Acta Cardiol 2021; 76:151-157. [PMID: 33183162 DOI: 10.1080/00015385.2020.1846920] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND The first surge of the ongoing COVID-19 pandemic led to a shutdown of all non-urgent medical services such as cardiac rehabilitation. Therefore, centres had to develop remote and innovative ways to deliver the core components of CR during this shutdown. This increase in usage of remote rehabilitation services provides a chance to assess patients' experiences and willingness-to-pay of remote CR sessions. METHODS This was a prospective single-centre study. From 17 July 2020, to 19 August 2020, we conducted an anonymous survey about the patient experiences of the cardiac telerehabilitation services provided at Jessa Hospital Hasselt during the COVID-19 pandemic. A link to an electronic questionnaire was sent via email to 155 patients who were invited to participate in the cardiac telerehabilitation sessions during the closure of the rehabilitation centre due to COVID-19. RESULTS Fifty-five patients (35% of all invited patients) did participate in remote CR and completed the questionnaire. The mean age of the respondents was 65.4 ± 10.5 years, 63% were male and 70% of the participants were retired. A total of 91% possessed a smartphone and all those patients used their smartphone regularly to send text messages. Ninety-four per cent of the participants were satisfied with the provided telerehabilitation sessions and 70% of the participants would be prepared to pay for these sessions like for centre-based CR sessions. Twenty per cent of patients would even prefer the telerehabilitation sessions above centre-based CR sessions. CONCLUSION Most patients believed that remote CR could be an option after the COVID-19 pandemic when it is combined with centre-based CR sessions. Patients are willing to pay the same amount for a telerehabilitation session as a centre-based CR session. This demonstrates that highly motivated patients are open to shift certain parts of CR from face-to-face interactions to digital interactions.
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Affiliation(s)
- Martijn Scherrenberg
- Faculty of Medicine and Life Sciences, UHasselt – Hasselt University, Agoralaan, Diepenbeek, Belgium
- Department of Cardiology, Jessa Hospital, Hasselt, Belgium
| | - Maarten Falter
- Faculty of Medicine and Life Sciences, UHasselt – Hasselt University, Agoralaan, Diepenbeek, Belgium
- Department of Cardiology, Jessa Hospital, Hasselt, Belgium
| | - Paul Dendale
- Faculty of Medicine and Life Sciences, UHasselt – Hasselt University, Agoralaan, Diepenbeek, Belgium
- Department of Cardiology, Jessa Hospital, Hasselt, Belgium
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Thompson S, Wiebe N, Arena R, Rouleau C, Aggarwal S, Wilton SB, Graham MM, Hemmelgarn B, James MT. Effectiveness and Utilization of Cardiac Rehabilitation Among People With CKD. Kidney Int Rep 2021; 6:1537-1547. [PMID: 34169194 PMCID: PMC8207316 DOI: 10.1016/j.ekir.2021.03.889] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 03/02/2021] [Accepted: 03/15/2021] [Indexed: 01/23/2023] Open
Abstract
Introduction Cardiac rehabilitation (CR) is a proven therapy for reducing cardiovascular death and hospitalization. Whether CR participation is associated with improved outcomes in patients with chronic kidney disease (CKD) is unknown. Methods We obtained data on all adult patients in Calgary, Alberta, Canada with angiographically proven coronary artery disease from 1996 to 2016 referred to CR from The Alberta Provincial Project for Outcome Assessment in Coronary Heart Disease and TotalCardiology Rehabilitation. An estimated glomerular filtration rate (eGFR) <60 ml/min/1.73 m2 or kidney replacement therapy defined CKD. Predictors of CR use were estimated with multinomial logistic regression. The association between starting versus not starting and completion versus noncompletion of CR and clinical outcomes were estimated using multivariable Cox proportional hazards models. Results Of 23,215 patients referred to CR, 12,084 were eligible for inclusion. Participants with CKD (N = 1322) were older, had more comorbidity, lower exercise capacity on graded treadmill testing, and took longer to be referred and to start CR than those without CKD. CKD predicted not starting CR: odds ratio 0.73 (95% confidence interval [CI] 0.64-0.83). Over a median 1 year follow-up, there were 146 deaths, 40 (0.3%) from CKD and 106 (1.0%) not from CKD. Similar to those without CKD, the risk of death was lower in CR completers (hazard ratio [HR] 0.24 [95% CI 0.06-0.91) and starters (HR 0.56 [95% CI 0.29- 1.10]) with CKD. Conclusion CR participation was associated with comparable benefits in people with moderate CKD as those without who survived to CR. Lower rates of CR attendance in this high-risk population suggest that strategies to increase CR utilization are needed.
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Affiliation(s)
- Stephanie Thompson
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
- Correspondence: Stephanie Thompson, Division of Nephrology and Immunology, University of Alberta, 11-112R CSB, 152 University Campus NW, University of Alberta, Edmonton, AB, T6G 2G3 Canada.
| | - Natasha Wiebe
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Ross Arena
- Department of Physical Therapy, University of Illinois at Chicago, Chicago, Illinois, USA
- TotalCardiology Research Network, Calgary, Alberta, Canada
| | - Codie Rouleau
- TotalCardiology Research Network, Calgary, Alberta, Canada
- Department of Psychology, University of Calgary, Calgary, Alberta, Canada
| | - Sandeep Aggarwal
- TotalCardiology Research Network, Calgary, Alberta, Canada
- Department of Cardiac Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Stephen B. Wilton
- Libin Cardiovascular Institute of Alberta and O'Brien Institute of Public Health, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Michelle M. Graham
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
- Mazankowksi Alberta Heart Institute, Calgary, Alberta, Canada
| | - Brenda Hemmelgarn
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Matthew T. James
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
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Thompson MP, Yaser JM, Hou H, Syrjamaki JD, DeLucia A, Likosky DS, Keteyian SJ, Prager RL, Gurm HS, Sukul D. Determinants of Hospital Variation in Cardiac Rehabilitation Enrollment During Coronary Artery Disease Episodes of Care. Circ Cardiovasc Qual Outcomes 2021; 14:e007144. [PMID: 33541107 DOI: 10.1161/circoutcomes.120.007144] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Cardiac rehabilitation (CR) is associated with improved outcomes for patients with coronary artery disease (CAD). However, CR enrollment remains low and there is a dearth of real-world data on hospital-level variation in CR enrollment. We sought to explore determinants of hospital variability in CR enrollment during CAD episodes of care: medical management of acute myocardial infarction (AMI-MM), percutaneous coronary intervention (PCI), and coronary artery bypass grafting (CABG). METHODS A cohort of 71 703 CAD episodes of care were identified from 33 hospitals in the Michigan Value Collaborative statewide multipayer registry (2015 to 2018). CR enrollment was defined using professional and facility claims and compared across treatment strategies: AMI-MM (n=18 678), PCI (n=41 986), and CABG (n=11 039). Hierarchical logistic regression was used to estimate effects of predictors and hospital risk-adjusted rates of CR enrollment. RESULTS Overall, 20 613 (28.8%) patients enrolled in CR, with significant differences by treatment strategy: AMI-MM=13.4%, PCI=29.0%, CABG=53.8% (P<0.001). There were significant differences in CR enrollment across age groups, comorbidity status, and payer status. At the hospital-level, there was over 5-fold variation in hospital risk-adjusted CR enrollment rates (9.8%-51.6%). Hospital-level CR enrollment rates were highly correlated across treatment strategy, with the strongest correlation between AMI-MM versus PCI (R2=0.72), followed by PCI versus CABG (R2=0.51) and AMI-MM versus CABG (R2=0.46, all P<0.001). CONCLUSIONS Substantial variation exists in CR enrollment during CAD episodes of care across hospitals. However, within-hospital CR enrollment rates were significantly correlated across all treatment strategies. These findings suggest that CR enrollment during CAD episodes of care is the product of hospital-specific rather than treatment-specific practice patterns.
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Affiliation(s)
- Michael P Thompson
- Department of Cardiac Surgery (M.P.T., H.H., D.S.L., R.L.P.), Michigan Medicine, Ann Arbor MI.,Michigan Value Collaborative, University of Michigan, Ann Arbor (M.P.T., J.M.Y., J.D.S.)
| | - Jessica M Yaser
- Michigan Value Collaborative, University of Michigan, Ann Arbor (M.P.T., J.M.Y., J.D.S.)
| | - Hechuan Hou
- Department of Cardiac Surgery (M.P.T., H.H., D.S.L., R.L.P.), Michigan Medicine, Ann Arbor MI
| | - John D Syrjamaki
- Michigan Value Collaborative, University of Michigan, Ann Arbor (M.P.T., J.M.Y., J.D.S.)
| | - Alphonse DeLucia
- Department of Cardiac Surgery, Bronson Methodist Hospital, Kalamazoo, MI (A.D.)
| | - Donald S Likosky
- Department of Cardiac Surgery (M.P.T., H.H., D.S.L., R.L.P.), Michigan Medicine, Ann Arbor MI.,Michigan Society of Thoracic and Cardiovascular Surgeons Quality Collaborative, Ann Arbor, MI (D.S.L., R.L.P.)
| | - Steven J Keteyian
- Division of Cardiovascular Medicine, Henry Ford Health System, Detroit, MI (S.J.K.)
| | - Richard L Prager
- Department of Cardiac Surgery (M.P.T., H.H., D.S.L., R.L.P.), Michigan Medicine, Ann Arbor MI.,Michigan Society of Thoracic and Cardiovascular Surgeons Quality Collaborative, Ann Arbor, MI (D.S.L., R.L.P.)
| | - Hitinder S Gurm
- Division of Cardiovascular Medicine, Department of Internal Medicine (H.S.G., D.S.), Michigan Medicine, Ann Arbor MI.,Blue Cross Blue Shield of Michigan Cardiovascular Consortium, (BMC2), Ann Arbor, MI (H.S.G., D.S.)
| | - Devraj Sukul
- Division of Cardiovascular Medicine, Department of Internal Medicine (H.S.G., D.S.), Michigan Medicine, Ann Arbor MI.,Blue Cross Blue Shield of Michigan Cardiovascular Consortium, (BMC2), Ann Arbor, MI (H.S.G., D.S.)
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A Gap in Post-Stroke Blood Pressure Target Attainment at Entry to Cardiac Rehabilitation. Can J Neurol Sci 2020; 48:487-495. [PMID: 33059775 DOI: 10.1017/cjn.2020.231] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Recurrent events account for approximately one-third of all strokes and are associated with greater disability and mortality than first-time strokes. Blood pressure (BP) is the most important modifiable risk factor. Objectives were to determine the proportion of post-stroke patients enrolled in cardiac rehabilitation (CR) meeting systolic and diastolic BP (SBP/DBP) targets and to determine correlates of meeting these targets. METHODS A retrospective study of 1,804 consecutively enrolled post-stroke patients in a CR program was conducted. Baseline data (database records 2006-2017) included demographics, anthropometrics, clinical/medication history, and resting BP. Multivariate analyses determined predictors of achieving BP targets. RESULTS Mean age was 64.1 ± 12.7 years, median days from stroke 210 (IQR 392), with most patients being male (70.6%; n = 1273), overweight (66.8%; n = 1196), and 64.2% diagnosed with hypertension (n = 1159), and 11.8% (n = 213) with sleep apnea. A mean of 1.69 ± 1.2 antihypertensives were prescribed, with 26% (n = 469) of patients prescribed 3-4 antihypertensives. SBP target was met by 71% (n = 1281) of patients, 83.3% (n = 1502) met DBP target, and 64.3% (n = 1160) met both targets. Correlates of meeting SBP target were not having diabetes, younger age, fewer prescribed antihypertensives, and more recent program entry. Correlates of meeting DBP target were not having diabetes, older age, fewer prescribed antihypertensives, and more recent stroke. CONCLUSIONS Up to one-third of patients were not meeting BP targets. Patients with diabetes, and those prescribed multiple antihypertensives are at greater risk for poorly controlled SBP and DBP. Reasons for poor BP control such as untreated sleep apnea and medication non-adherence need to be investigated.
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Karkhanis R, Wijeysundera HC, Tam DY, Oh P, Alter DA, Yu B, Kiss A, Fremes SE. Cardiac Rehabilitation Is Associated With Improved Long-Term Outcomes After Coronary Artery Bypass Grafting. CJC Open 2020; 3:167-175. [PMID: 33644730 PMCID: PMC7893191 DOI: 10.1016/j.cjco.2020.10.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 10/03/2020] [Indexed: 12/26/2022] Open
Abstract
Background Although cardiac rehabilitation (CR) has proven to have short- and mid-term benefit in treatment of coronary artery disease, its long-term benefit in patients who have undergone coronary artery bypass grafting (CABG) is less certain. Our objective was to examine the late outcomes of patients who attended CR within the first year after CABG. Methods Adult CABG patients referred to Toronto Rehabilitation Institute (CR group: were referred and attended at least 1 session; No-CR group: were referred but did not attend) between January 1996 and September 2008 were identified through linkages with clinical and provincial administrative databases for comorbidities and outcome ascertainment. The primary outcome was a composite of all-cause mortality, acute myocardial infarction, stroke or repeat revascularization (major adverse cardiac and cerebrovascular events [MACCE]). The secondary outcome was all-cause mortality. Multivariable Cox proportional hazard models were used to assess the CR treatment effect, adjusting for baseline characteristics. Results The study cohort consisted of 5,000 patients-3,685 (73.7%) in the CR group and 1,315 (26.3%) in the No-CR group. Median referral time was 32.5 days, and follow-up was 13.1 years. The CR group patients, compared with the No-CR group, were younger (age 62.6 ± 9.6 vs 64.0 ± 10.5 years), were more likely to be male (85.0% vs 79.5%), and had fewer cardiac comorbidities. In adjusted analyses, the CR group was associated with decreased MACCE (hazard ratio 0.83, 95% confidence interval 0.75-0.91, P < 0.0001) and a higher adjusted survival at 15 years (66.3% vs 60.1%, hazard ratio 0.76, 95% confidence interval 0.68-0.84, P < 0.0001), as compared with the No-CR group. Conclusions There was a reduction in MACCE and late mortality associated with CR attendance, highlighting the importance of patient referral and participation in CR after CABG.
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Affiliation(s)
- Reena Karkhanis
- Division of Cardiac Surgery, Schulich Heart Centre, Department of Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Harindra C. Wijeysundera
- ICES, Toronto, Ontario, Canada
- Division of Cardiology, Schulich Heart Centre, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Derrick Y. Tam
- Division of Cardiac Surgery, Schulich Heart Centre, Department of Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Paul Oh
- Toronto Rehabilitation Institute, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - David A. Alter
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Toronto Rehabilitation Institute, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Bing Yu
- ICES, Toronto, Ontario, Canada
| | - Alex Kiss
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
| | - Stephen E. Fremes
- Division of Cardiac Surgery, Schulich Heart Centre, Department of Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Corresponding author: Dr Stephen E. Fremes, Professor of Surgery, University of Toronto, Schulich Heart Centre, Sunnybrook Health Sciences Centre, 2075 Bayview Ave, Room H4 05, Toronto, Ontario M4N 3M5, Canada. Tel.: +1-416-480-6073; fax: +1-416-480-4439.
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Marzolini S, Ghisi GLDM, Hébert AA, Ahden S, Oh P. Cardiac Rehabilitation in Canada During COVID-19. CJC Open 2020; 3:152-158. [PMID: 33521613 PMCID: PMC7833488 DOI: 10.1016/j.cjco.2020.09.021] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 09/27/2020] [Indexed: 12/13/2022] Open
Abstract
Background Cardiac rehabilitation programs (CRPs) had to change quickly in response to a shift in clinical priorities related to to the coronavirus disease 2019 (COVID-19). Yet, no study has examined the effect of COVID-19 on CRPs and if there has been an adequate transition to alternative programming. Methods To examine the status of CRPs during the COVID-19 pandemic, a web-based questionnaire was completed by CRP managers from April 23rd to May 14th, 2020. Results Overall, 114 representatives of 144 CRPs (79.1% of Canadian programs) responded. Of respondents, 41.2% (n = 47) reported CRP closure; primary reasons were staff redeployment and facility closure (41% of 51 responses, for both). Redeployment occurred in open CRPs and closed CRPs (30% ± 34% and 47% ± 38% of employees, respectively; P = 0.05) and reduced hours in 17.8% ± 31% and 22.5% ± 33% for remaining employees; P = 0.56. Of open CRPs, 84.8% accepted referrals for medically high-risk patients pre-COVID-19; this level fell to only 43.5% during the COVID-19 pandemic, P < 0.001. There was a significant reduction in patients with cognitive/communication/mobility deficits who were eligible to participate during the COVID-19 pandemic. Of respondents, 57%-82.6% reported safety concerns related to prescribing exercise to medically high-risk and vulnerable populations. CRPs transitioned from group-based to one-to-one delivery models->80% by phone and/or e-mail. Any tele-rehabilitation (one-to-one/group) was also used by 32.7% and 43.5% of CRPs to deliver exercise and education, respectively (mostly one-to-one). Resource barriers cited by open and closed CRPs were related to technology-no tele-rehabilitation, lack of equipment and patient access (35% of all barriers)-and 25.3% of barriers were owing to greater demands on staff time. Conclusions Within 2-months of COVID-19 being declared a pandemic, 41.2% of CRPs were closed and almost half of employees redeployed. Less time-efficient one-to-one models of remote care, mostly by phone/e-mail, were adopted. Vulnerable populations were disproportionately affected, becoming ineligible owing to safety concerns. Strategies to open closed CRPs, admission of high-risk/vulnerable populations, and offering of group-based tele-rehabilitation should be a national priority.
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Affiliation(s)
- Susan Marzolini
- KITE Research Institute, Toronto Rehab-University Health Network, Toronto, Ontario, Canada.,Healthy Living for Pandemic Event Protection (HL - PIVOT) Network, Toronto, Ontario, Canada.,Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada.,Rehabilitation Sciences Institute, University of Toronto, Toronto, Onatario, Canada
| | | | - Andrée-Anne Hébert
- Programme de Prévention Secondaire et Réadaptation Cardiovasculaire (PREV), Centre Intégré de Santé et Services Sociaux (CISSS) de Chaudière-Appalaches, Lévis, Québec, Canada
| | - Shobhit Ahden
- Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
| | - Paul Oh
- KITE Research Institute, Toronto Rehab-University Health Network, Toronto, Ontario, Canada
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Shorter Wait Times to Cardiac Rehabilitation Associated With Greater Exercise Capacity Improvements: A MULTISITE STUDY. J Cardiopulm Rehabil Prev 2020; 41:243-248. [PMID: 32947326 DOI: 10.1097/hcr.0000000000000548] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE Comprehensive exercise-based cardiac rehabilitation (CR) results in improved, though highly variable, exercise capacity outcomes. Whether modifiable factors such as CR program wait time and session duration are associated with exercise capacity outcomes has not been adequately investigated. METHODS Patients with coronary heart disease (±primary and elective percutaneous coronary interventions, cardiac surgery) who participated in CR programs involved in a three-state audit (n = 32 sites) were eligible. Exercise capacity was measured using the 6-min walk test before and after a 6- to 12-wk supervised exercise program. CR program characteristics were also recorded (wait time, number of sessions). Correlations and linear mixed-effects models were used to identify associations between sociodemographic and CR program characteristics and change in exercise capacity. RESULTS Patients (n = 894) had a mean age of 65.9 ± 11.8 yr, 71% were males, 33% were referred for cardiac surgery, and median wait time was 16 d (interquartile range 9, 26). Exercise capacity improved significantly and clinically (mean increase 70.4 ± 61.8 m). After adjusting for statistically significant factors including younger age (<50 vs ≥80 yr [β = 52.07]), female sex (β = -15.86), exercise capacity at CR entry (β = 0.22) and those nonsignificant (ethnicity, risk factors, and number of sessions), shorter wait time was associated with greater exercise capacity improvement (β = 0.23). CONCLUSIONS This study confirms that greater exercise capacity improvements occur with shorter wait times. Coordinators should prioritize implementing strategies to shorten wait time to optimize the benefits of CR.
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Sex- and Gender-Related Factors Associated With Cardiac Rehabilitation Enrollment: A SECONDARY ANALYSIS AMONG SYSTEMATICALLY REFERRED PATIENTS. J Cardiopulm Rehabil Prev 2020; 39:259-265. [PMID: 30252783 DOI: 10.1097/hcr.0000000000000364] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
PURPOSE To assess sex- and gender-related factors associated with cardiac rehabilitation (CR) enrollment following acute coronary syndrome among systematically referred patients. METHODS This secondary analysis of a randomized controlled trial used an exploratory approach to examine the TRANSITion process for patients between the coronary care unit and CR (TRANSIT-UC). The present analysis examined the relationship between sex- and gender-related factors and CR enrollment in systematically referred women (n = 35) and men (n = 207). We performed χ and logistic regression analyses to identify statistically significant results. Using the Bonferroni method, a P value of .002 or less was considered a significant statistical result. A raw difference of 15% or more between enrolled and nonenrolled participants was considered a difference worthy of further investigation. RESULTS Men who were regularly engaged in physical activity prior to their hospitalization and who lived near the CR center showed a statistically higher CR enrollment rate. In women and men, a radial entry site for percutaneous coronary intervention resulted in a clinically significant difference in favor of CR enrollment. In women, 3 sex-related and 9 gender-related variables were associated with a difference of 15% or more between enrolled and nonenrolled participants. CONCLUSION Factors related to CR enrollment in women and men are suggested. As women keep showing a lower rate of CR enrolment, the investigation of these factors in a larger sample of patients may hold valuable insights to improve CR enrolment.
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Marzolini S, Colella TJF. Factors That Predispose Women to Greater Depressive Symptoms: A Sex-, Age-, and Diagnosis-Matched Cardiac Rehabilitation Cohort. Can J Cardiol 2020; 37:382-390. [PMID: 32882330 DOI: 10.1016/j.cjca.2020.08.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 08/21/2020] [Accepted: 08/25/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Depressive symptoms (DS) disproportionately affect women with cardiac disease; however, no analyses have been conducted that would allow for focused sex-specific interventions. METHODS Consecutively enrolled women (n = 663) were matched with men postcardiac revascularization at cardiac rehabilitation (CR) entry by primary diagnosis, age, and year of CR entry from database records (2006 to 2017). Multivariate analyses were conducted to determine predictors of DS (≥16 on the Center for Epidemiologic Studies Depression Scale) in all patients and men and women separately. RESULTS In bivariate analysis, women were more likely than men to have DS (30.2% vs 19.3%; P < 0.001) in the matched cohort. A greater proportion of women than men had DS in all 10-year age categories (P < 0.05) except youngest (<50 years; 37% vs 30.4%; P = 0.7) and oldest (≥80; 12.3% vs 10.3%; P = 0.8). DS peaked in women aged 50 to 59 (42.5%) and men <50 years (30.4%). In all patients, independent predictors of DS were younger age, lower cardiorespiratory fitness (VO2peak), being unemployed, greater comorbidities, smoking, anxiolytics, antidepressants, not being married, but not sex. Shared predictors in women-only and men-only analyses were younger age, lower VO2peak, antidepressants, and being unemployed. Unique predictors for women were obesity, smoking, and delayed CR entry and, for men, hypertension, myocardial infarction, anxiolytics, and not being married. CONCLUSIONS Despite matching for age and diagnosis, women were more likely to have DS than men. However, sex was not a predictor of DS in multivariate analyses. This suggests that the profile of women predisposes them to greater DS. Obesity, smoking, and greater delayed CR entry were unique correlates for women and targets for intervention.
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Affiliation(s)
- Susan Marzolini
- KITE Research Institute, Toronto Rehabilitation Institute/University Health Network, Toronto, Ontario, Canada; Department of Exercise Sciences, Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, Ontario, Canada; Healthy Living for Pandemic Event Protection (HL-PIVOT) Network, Toronto, Ontario, Canada; Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada.
| | - Tracey J F Colella
- KITE Research Institute, Toronto Rehabilitation Institute/University Health Network, Toronto, Ontario, Canada; Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada; Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
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Montesano M, Reed JL, Tulloch HE, Pipe AL, Terada T. Cardiac rehabilitation is associated with greater improvements in psychological health following coronary artery bypass graft surgery when compared with percutaneous coronary intervention. Appl Physiol Nutr Metab 2020; 45:1339-1344. [PMID: 32544341 DOI: 10.1139/apnm-2020-0213] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Following coronary revascularization, patients treated with coronary artery bypass graft surgery (CABG) have lower risk of major adverse cardiovascular events when compared with those treated with percutaneous coronary intervention (PCI). We compared changes in cardiovascular risk factors, such as psychological and cardiometabolic health indicators, among patients who completed cardiac rehabilitation (CR) following CABG and PCI. Longitudinal records of 278 patients who completed an outpatient CR program following CABG or PCI were analyzed. We compared changes in anxiety and depression assessed by the Hospital Anxiety and Depression Scale (HADS); health-related quality of life (HR-QoL) measured by the Medical Outcomes Study Short Form-36 (SF-36); and indicators of cardiometabolic health (i.e., body mass, blood pressure, glucose, and lipid profiles) between CABG and PCI groups using analysis of covariance (ANCOVA). At baseline, patients treated with PCI (n = 191) had superior physical function (i.e., physical functioning: 62.5 ± 22.1 vs. 54.3 ± 23.0 points, p = 0.006; and role limitations due to physical health: 31.2 ± 36.8 vs. 20.6 ± 31.8 points, p = 0.024) when compared with those treated with CABG (n = 87). Following CR, patients treated with PCI showed significantly smaller improvements in depression (-0.4 ± 3.1 vs. -1.3 ± 2.7 points, p = 0.036) and mental HR-QoL (mental component summary: 2.4 ± 10.8 vs. 5.7 ± 10.7 points, p = 0.020) when compared with those treated with CABG. Novelty Patients with coronary artery disease treated with PCI have smaller functional limitations but similar psychological health when compared with those treated with CABG at CR enrollment. Patients participating in CR following PCI appear to achieve smaller psychological health benefits from CR when compared with those recovering from CABG.
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Affiliation(s)
- Matthew Montesano
- Exercise Physiology and Cardiovascular Health Lab, Division of Cardiac Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, ON K1Y 4W7, Canada.,Department of Surgery, Amsterdam UMC, Location VU University Medical Centre, Amsterdam 1081 HV, the Netherlands
| | - Jennifer L Reed
- Exercise Physiology and Cardiovascular Health Lab, Division of Cardiac Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, ON K1Y 4W7, Canada.,Faculty of Medicine, University of Ottawa, Ottawa, ON K1H 8M5, Canada.,School of Human Kinetics, Faculty of Health Sciences, University of Ottawa, Ottawa, ON K1Y 4W7, Canada
| | - Heather E Tulloch
- Division of Cardiac Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, ON K1Y 4W7, Canada.,Faculty of Medicine, University of Ottawa, Ottawa, ON K1H 8M5, Canada
| | - Andrew L Pipe
- Division of Cardiac Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, ON K1Y 4W7, Canada.,Faculty of Medicine, University of Ottawa, Ottawa, ON K1H 8M5, Canada
| | - Tasuku Terada
- Exercise Physiology and Cardiovascular Health Lab, Division of Cardiac Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, ON K1Y 4W7, Canada
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Abreu A, Frederix I, Dendale P, Janssen A, Doherty P, Piepoli MF, Völler H, Davos CH. Standardization and quality improvement of secondary prevention through cardiovascular rehabilitation programmes in Europe: The avenue towards EAPC accreditation programme: A position statement of the Secondary Prevention and Rehabilitation Section of the European Association of Preventive Cardiology (EAPC). Eur J Prev Cardiol 2020; 28:496-509. [PMID: 33611459 DOI: 10.1177/2047487320924912] [Citation(s) in RCA: 56] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Accepted: 12/21/2019] [Indexed: 12/17/2022]
Abstract
Despite the proven efficacy and cost-effectiveness of contemporary cardiovascular rehabilitation programmes, the referral to/uptake of and adherence to cardiovascular rehabilitation remains inadequate. In addition, heterogeneity persists amongst different cardiovascular rehabilitation centres in Europe, despite the available scientific documents describing the evidence-based rehabilitation format/content. This position statement was elaborated by the Secondary Prevention and Rehabilitation (SP/CR) section of EAPC. It defines the minimal and optimal cardiovascular rehabilitation standards. In addition, it describes the relevant quality indicators of cardiovascular rehabilitation programmes to date. Compliance of European cardiovascular rehabilitation centres with these standards will improve cardiovascular rehabilitation process standardization in Europe and hence increase the quality of cadiovascular rehabilitation programmes.
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Affiliation(s)
- Ana Abreu
- Cardiology Department, Hospital Universitário de Santa Maria/Centro Hospitalar Universitário Lisboa Norte (CHULN), Portugal.,Centro Académico de Medicina de Lisboa (CAML), Universidade de Lisboa, Portugal.,Exercise and Cardiovascular Rehabilitation Laboratory, Centro Cardiovascular da Universidade de Lisboa (CCUL)
| | - Ines Frederix
- Exercise and Cardiovascular Rehabilitation Laboratory, Centro Cardiovascular da Universidade de Lisboa (CCUL).,Faculty of Medicine and Life Sciences, Hasselt University, Belgium.,Department of Cardiology, Jessa Hospital, Belgium.,Faculty of Medicine & Health Sciences, Antwerp University, Belgium
| | - Paul Dendale
- Exercise and Cardiovascular Rehabilitation Laboratory, Centro Cardiovascular da Universidade de Lisboa (CCUL).,Faculty of Medicine and Life Sciences, Hasselt University, Belgium
| | - Arne Janssen
- Faculty of Medicine & Health Sciences, Antwerp University, Belgium
| | | | - Massimo F Piepoli
- Department of Health Sciences, University of York, UK.,Heart Failure Unit, G da Saliceto Hospital, AUSL Piacenza and University of Parma, Italy
| | - Heinz Völler
- Institute of Life Sciences, Sant'Anna School of Advanced Studies, Pisa, Italy.,Department of Cardiology, Klinik am See, Germany
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- Department of Rehabilitation Medicine, Faculty of Health Sciences Brandenburg, University of Potsdam, Germany
| | - Constantinos H Davos
- Department of Cardiac Rehabilitation, Istituti Clinici Scientifici Maugeri IRCCS, Italy
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Byiringiro S, Nyirimanzi N, Mucumbitsi J, Kamanzi ER, Swain J. Cardiac Surgery: Increasing Access in Low- and Middle-Income Countries. Curr Cardiol Rep 2020; 22:37. [PMID: 32430786 DOI: 10.1007/s11886-020-01290-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF THE REVIEW Low- and middle-income countries (LMICs) have long-battled communicable diseases, and now, a rise in non-communicable diseases (NCD) is conferring tremendous burden in these areas. Cardiovascular disease (CVD) remains the number one cause of death among NCDs across the globe. The current review provides insight regarding this disease burden and highlights challenges as well as strategies for establishing functional cardiac surgery centers and sustainable access to comprehensive cardiovascular care within LMICs. RECENT FINDINGS Without effective prevention and treatment strategies, estimates suggest that deaths from CVDs will reach 24 million by the year 2030. Surgery exists as a limited option for selected patients with advanced cardiac disease in LMICs in comparison with its availability in developed countries. Multi-lateral or public-private initiatives, government investment, philanthropic efforts, innovative financing systems to strengthen Universal Health Coverage, and expansion of training options through centers of excellence appear to be the way forward to broadening the availability of cardiovascular services, inclusive of surgery, to LMICs.
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Affiliation(s)
- Samuel Byiringiro
- School of Nursing, The Johns Hopkins University, 525 North Wolfe St., Baltimore, MD, USA.
| | | | | | | | - JaBaris Swain
- Division of Cardiovascular Surgery, Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
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Hinde S, Harrison A, Bojke L, Doherty P. Quantifying the impact of delayed delivery of cardiac rehabilitation on patients' health. Eur J Prev Cardiol 2020; 27:1775-1781. [PMID: 32212842 PMCID: PMC7564289 DOI: 10.1177/2047487320912625] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Background Despite its role as an effective intervention to improve the long-term health of patients with cardiovascular disease and existence of national guidelines on timeliness, many health services still fail to offer cardiac rehabilitation in a timely manner after referral. The impact of this failure on patient health and the additional burden on healthcare providers in an English setting is quantified in this article. Methods Two logistic regressions are conducted, using the British Heart Foundation National Audit of Cardiac Rehabilitation dataset, to estimate the impact of delayed cardiac rehabilitation initiation on the level of uptake and completion. The results of these regressions are applied to a decision model to estimate the long-term implications of these factors on patient health and National Health Service expenditure. Results We demonstrate that the failure of 43.6% of patients in England to start cardiac rehabilitation within the recommended timeframe results in a 15.3% reduction in uptake, and 7.4% in completion. These combine to cause an average lifetime loss of 0.08 years of life expectancy per person. Scaled up to an annual cohort this implies 10,753 patients not taking up cardiac rehabilitation due to the delay, equating to a loss of 3936 years of life expectancy. We estimate that an additional £12.3 million of National Health Service funding could be invested to alleviate the current delay. Conclusions The current delay in many patients starting cardiac rehabilitation is causing quantifiable and avoidable harm to their long-term health; policy and research must now look at both supply and demand solutions in tackling this issue.
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Affiliation(s)
| | | | - Laura Bojke
- Centre for Health Economics, University of York, UK
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McIntyre D, Chow CK. Waiting Time as an Indicator for Health Services Under Strain: A Narrative Review. INQUIRY : A JOURNAL OF MEDICAL CARE ORGANIZATION, PROVISION AND FINANCING 2020; 57:46958020910305. [PMID: 32349581 PMCID: PMC7235968 DOI: 10.1177/0046958020910305] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Revised: 12/08/2019] [Accepted: 01/13/2020] [Indexed: 11/18/2022]
Abstract
As pressure increases on public health systems globally, a potential consequence is that this is transferred to patients in the form of longer waiting times to receive care. In this review, we overview what waiting for health care encompasses, its measurement, and the data available in terms of trends and comparability. We also discuss whether waiting time is equally distributed according to socioeconomic status. Finally, we discuss the policy implications and potential approaches to addressing the burden of waiting time. Waiting time for elective surgery and emergency department care is the best described type of waiting time, and it either increases or remains unchanged across multiple developed countries. There are many challenges in drawing direct comparisons internationally, as definitions for these types of waiting times vary. There are less data on waiting time from other settings, but existing data suggest waiting time presents a significant barrier to health care access for a range of health services. There is also evidence that waiting time is unequally distributed to those of lower socioeconomic status, although this may be improving in some countries. Further work to better clarify definitions, identify driving factors, and understand hidden waiting times and identify opportunities for reducing waiting time or better using waiting time could improve health outcomes of our health services.
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Affiliation(s)
| | - Clara K. Chow
- The University of Sydney, Westmead, NSW,
Australia
- Westmead Hospital, Westmead, NSW,
Australia
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Ngaage D, Mitchell N, Dean A, Hirst C, Akowuah E, Doherty PJ, Fairhurst C, Flemming K, Hewitt C, Hinde S, Mitchell A, Nichols S, Watson J. Feasibility study of early outpatient review and early cardiac rehabilitation after cardiac surgery: mixed-methods research design-a study protocol. BMJ Open 2019; 9:e035787. [PMID: 31888947 PMCID: PMC6937080 DOI: 10.1136/bmjopen-2019-035787] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Revised: 11/28/2019] [Accepted: 12/02/2019] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION Following cardiac surgery, patients currently attend an outpatient review 6 weeks after hospital discharge, where recovery is assessed and suitability to commence cardiac rehabilitation (CR) is determined. CR is then started from 8 weeks. Following a median sternotomy, cardiac surgery patients are required to refrain from upper body exercises, lifting of heavy objects and other strenuous activities for 12 weeks. A delay in starting CR can prolong the recovery process, increase dependence on family/carers and can cause frustration. However, current guidelines for activity and exercise after median sternotomy have been described as restrictive, anecdotal and increasingly at odds with modern clinical guidance for CR. This study aims to examine the feasibility of bringing forward outpatient review and starting CR earlier. METHODS AND ANALYSES This is a multicentre, randomised controlled, open feasibility trial comparing postoperative outpatient review 6 weeks after hospital discharge, followed by CR commencement from 8 weeks (control arm) versus, postoperative outpatient review 3 weeks after hospital discharge, followed by commencement of CR from 4 weeks (intervention arm). The study aims to recruit 100 eligible patients, aged 18-80 years who have undergone elective or urgent cardiac surgery involving a full median sternotomy, over a 7-month period across two centres. Feasibility will be measured by consent, recruitment, retention rates and attendance at appointments and CR sessions. Qualitative interviews with trial participants and staff will explore issues around study processes and acceptability of the intervention and the findings integrated with the feasibility trial outcomes to inform the design of a future full-scale randomised controlled trial. ETHICS AND DISSEMINATION Ethics approval was granted by East Midlands-Derby Research Ethics Committee on 10 January 2019. The findings will be presented at relevant conferences disseminated via peer-reviewed research publications, and to relevant stakeholders. TRIAL REGISTRATION NUMBER ISRCTN80441309.
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Affiliation(s)
- Dumbor Ngaage
- Castle Hill Hospital, Hull University Teaching Hospitals NHS Trust, Hull, UK
| | - Natasha Mitchell
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | - Alexandra Dean
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | - Claire Hirst
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | - Enoch Akowuah
- James Cook Hospital, South Tees Hospitals NHS Foundation Trust, Middlesbrough, UK
| | | | - Caroline Fairhurst
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | - Kate Flemming
- Department of Health Sciences, University of York, York, UK
| | - Catherine Hewitt
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | | | - Alex Mitchell
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | - Simon Nichols
- Centre for Sport and Exercise Science, Sheffield Hallam University - Collegiate Crescent Campus, Sheffield, UK
| | - Judith Watson
- York Trials Unit, Department of Health Sciences, University of York, York, UK
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Functional Capacity but Not Early Uptake of Cardiac Rehabilitation Predicts Readmission in Patients With Metabolic Syndrome. J Cardiovasc Nurs 2019; 33:306-312. [PMID: 29303869 DOI: 10.1097/jcn.0000000000000454] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Phase II cardiac rehabilitation reduces hospital readmissions and cardiovascular disease risk factors and improves functional capacity. Cardiovascular disease risk factors double with patients with metabolic syndrome, a population less likely to adhere to cardiac rehabilitation. PURPOSE The aim of this study was to determine relationships between cardiac rehabilitation uptake timing, demographic variables and functional capacity, and readmission in patients with metabolic syndrome. METHODS This retrospective, medical records study involved 353 patients with metabolic syndrome who subsequently received cardiac rehabilitation. Logistic regression was used to examine relationships between time from discharge to cardiac rehabilitation uptake and readmission. Unordered categorical factors were compared between readmission groups using Pearson χ tests. Multivariable logistic regression was used to identify predictors of readmission. RESULTS Patients readmitted within 30 and 90 days of hospitalization were more often women (P ≤ .018) and nonwhite (P ≤ .002) and had lower functional capacity (P < .001). In multivariable analysis, white race (odds ratio [OR], 0.50 [95% confidence interval (CI), 0.25-0.99]; P = .045) and higher functional capacity (OR, 0.80 [95% CI, 0.68-0.93]; P = .005) were protective against hospital readmission within the first 90 days. Race, sex, and functional capacity remained significant predictors of readmission at 1 year. In multivariable analysis, only race (OR, 0.41 [95% CI, 0.22-0.79]; P = .007) and functional capacity (OR, 0.83 [95% CI, 0.73-0.95]; P = .007) were significant. Early cardiac rehabilitation was not associated with readmission at any time point (P > .05). CONCLUSIONS Sex, race, and functional capacity were important predictors of readmission for metabolic syndrome, even when cardiac rehabilitation intake was delayed. Results raise questions about the unique traits of patients with metabolic syndrome and need for novel approaches to improve cardiac rehabilitation utilization and functional capacity in metabolic syndrome.
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Liu H, Wilton SB, Southern DA, Knudtson ML, Maitland A, Hauer T, Arena R, Rouleau C, James MT, Stone J, Aggarwal S. Automated Referral to Cardiac Rehabilitation After Coronary Artery Bypass Grafting Is Associated With Modest Improvement in Program Completion. Can J Cardiol 2019; 35:1491-1498. [PMID: 31604671 DOI: 10.1016/j.cjca.2019.08.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2019] [Revised: 08/01/2019] [Accepted: 08/12/2019] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Cardiac rehabilitation (CR) is a guideline-indicated modality for reducing residual cardiovascular risk among patients undergoing coronary artery bypass grafting (CABG) surgery. However, many referred patients do not initiate or complete a CR program; even more patients are never even referred. METHODS All post-CABG patients in Calgary, Alberta, Canada, from January 1, 1996, to March 31, 2016, were included. Data were obtained from the Alberta Provincial Project for Outcome Assessment in Coronary Heart Disease and TotalCardiology Rehabilitation databases. Automated referral to CR at discharge after CABG was instituted on July 1, 2007. We used interrupted time series analysis to evaluate the impact of automated referral on CR referral and completion rates and studied the association of these CR process markers with mortality. RESULTS A total of 8,118 patients underwent CABG surgery during the study period: 5,103 before automation and 3,015 after automation. Automation increased referral rates from 39.5% to 75.0% (P < 0.001). Automated referral was associated with a 7.2% increase in CR completion in the overall population (33.3% vs 26.1%; P < 0.001). In adjusted models, CR referral alone was not associated with reduced mortality (hazard ratio [HR] 0.84, 95% CI 0.64-1.11), but CR completion was (HR 0.43, 95% CI 0.31-0.61). CONCLUSION Automated referral in post-CABG patients resulted in modest improvement in CR program completion. Therefore, even when CR referral is automated to include all eligible patients, additional strategies to support CR program enrollment and completion remain necessary to achieve the desired health benefits.
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Affiliation(s)
- Hongwei Liu
- Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada; Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada.
| | - Stephen B Wilton
- Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada; Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada; TotalCardiology Research Network, Calgary, Alberta, Canada
| | - Danielle A Southern
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada; O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada
| | - Merril L Knudtson
- Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada
| | - Andrew Maitland
- Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada
| | - Trina Hauer
- TotalCardiology Research Network, Calgary, Alberta, Canada; TotalCardiology Rehabilitation, Calgary, Alberta, Canada
| | - Ross Arena
- TotalCardiology Research Network, Calgary, Alberta, Canada; Department of Physical Therapy, College of Applied Health Sciences, University of Illinois, Chicago, Illinois, USA
| | - Codie Rouleau
- TotalCardiology Research Network, Calgary, Alberta, Canada; TotalCardiology Rehabilitation, Calgary, Alberta, Canada; Department of Psychology, University of Calgary, Calgary, Alberta, Canada
| | - Matthew T James
- Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada; Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - James Stone
- Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada; TotalCardiology Research Network, Calgary, Alberta, Canada
| | - Sandeep Aggarwal
- Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada; TotalCardiology Research Network, Calgary, Alberta, Canada; TotalCardiology Rehabilitation, Calgary, Alberta, Canada
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Ventura M, Belleudi V, Sciattella P, Di Domenicantonio R, Di Martino M, Agabiti N, Davoli M, Fusco D. High quality process of care increases one-year survival after acute myocardial infarction (AMI): A cohort study in Italy. PLoS One 2019; 14:e0212398. [PMID: 30785928 PMCID: PMC6382131 DOI: 10.1371/journal.pone.0212398] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Accepted: 02/03/2019] [Indexed: 11/19/2022] Open
Abstract
Background The relationship between guideline adherence and outcomes in patients with acute myocardial infarction (AMI) has been widely investigated considering the emergency, acute, post-acute phases separately, but the effectiveness of the whole care process is not known. Aim The study aim was to evaluate the effect of the multicomponent continuum of care on 1-year survival after AMI. Methods We conducted a cohort study selecting all incident cases of AMI from health information systems during 2011–2014 in the Lazio region. Patients’ clinical history was defined by retrieving previous hospitalizations and drugs prescriptions. For each subject the probability to reach the hospital and the conditional probabilities to survive to 30 days from admission and to 31–365 days post discharge were estimated through multivariate logistic models. The 1-year survival probability was calculated as the product of the three probabilities. Quality of care indicators were identified in terms of emergency timeliness (time between residence and the nearest hospital), hospital performance in treatment of acute phase (number/timeliness of PCI on STEMI) and drug therapy in post-acute phase (number of drugs among antiplatelet, β-blockers, ACE inhibitors/ARBs, statins). The 1-year survival Probability Ratio (PR) and its Bootstrap Confidence Intervals (BCI) between who were exposed to the highest level of quality of care (timeliness<10', hospitalization in high performance hospital, complete drug therapy) and who exposed to the worst (timeliness≥10', hospitalization in low performance hospital, suboptimal drug therapy) were calculated for a mean-severity patient and varying gender and age. PRs for patients with diabetes and COPD were also evaluated. Results We identified 38,517 incident cases of AMI. The out-of-hospital mortality was 27.6%. Among the people arrived in hospital, 42.9% had a hospitalization for STEMI with 11.1% of mortality in acute phase and 5.4% in post-acute phase. For a mean-severity patient the PR was 1.19 (BCI 1.14–1.24). The ratio did not change by gender, while it moved from 1.06 (BCI 1.05–1.08) for age<65 years to 1.62 (BCI 1.45–1.80) for age >85 years. For patients with diabetes and COPD a slight increase in PRs was also observed. Conclusions The 1-year survival probability post AMI depends strongly on the quality of the whole multicomponent continuum of care. Improving the performance in the different phases, taking into account the relationship among these, can lead to considerable saving of lives, in particular for the elderly and for subjects with chronic diseases.
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Affiliation(s)
- Martina Ventura
- Department of Epidemiology of Lazio Regional Health Service, Rome, Italy
| | - Valeria Belleudi
- Department of Epidemiology of Lazio Regional Health Service, Rome, Italy
| | - Paolo Sciattella
- Department of Statistical Sciences, “Sapienza” University of Rome, Rome, Italy
| | | | - Mirko Di Martino
- Department of Epidemiology of Lazio Regional Health Service, Rome, Italy
| | - Nera Agabiti
- Department of Epidemiology of Lazio Regional Health Service, Rome, Italy
- * E-mail:
| | - Marina Davoli
- Department of Epidemiology of Lazio Regional Health Service, Rome, Italy
| | - Danilo Fusco
- Department of Epidemiology of Lazio Regional Health Service, Rome, Italy
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Boyde M, Rankin J, Whitty JA, Peters R, Holliday J, Baker C, Hwang R, Lynagh D, Korczyk D. Patient preferences for the delivery of cardiac rehabilitation. PATIENT EDUCATION AND COUNSELING 2018; 101:2162-2169. [PMID: 30025615 DOI: 10.1016/j.pec.2018.07.010] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Revised: 07/05/2018] [Accepted: 07/10/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE To elicit patients' preferences for cardiac rehabilitation(CR). METHODS A Discrete Choice Experiment was used to quantify patients' preferences for the delivery of CR. This survey-based method elicited the relative importance of different characteristics of a program. RESULTS 200 in-patients eligible to attend CR completed the survey. Over half of the patients strongly preferred a centre-based compared to a home-based program. Many but not all preferred a program starting within two rather than six weeks of discharge and exercise delivered in a group rather than individual setting, with exercise via the internet using telehealth strongly disliked. Some respondents preferred lifestyle information delivered one-to-one by a health professional, and there was an overall preference against delivery by smart phone Apps. Some preferred a program out of rather than within working hours and a shorter program (four weeks compared to eight weeks). CONCLUSIONS This study provides further insight into patient preferences for a CR program. Although the strongest preferences were for centre-based programs with healthcare professionals facilitating exercise classes and one-on-one education, it is important to offer flexible delivery as one approach will not suit everyone. PRACTICE IMPLICATIONS There is the potential to improve CR programs by focusing on patient preferences.
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Affiliation(s)
- Mary Boyde
- Cardiology, Princess Alexandra Hospital, Brisbane, Australia; The University of Queensland, Brisbane, Australia.
| | - Jenny Rankin
- Health Economics Group, Norwich Medical School, University of East Anglia, Norwich, Norfolk, UK.
| | - Jennifer A Whitty
- The University of Queensland, Brisbane, Australia; Health Economics Group, Norwich Medical School, University of East Anglia, Norwich, Norfolk, UK.
| | - Robyn Peters
- Cardiology, Princess Alexandra Hospital, Brisbane, Australia; The University of Queensland, Brisbane, Australia.
| | - Julie Holliday
- Cardiology, Princess Alexandra Hospital, Brisbane, Australia.
| | - Charmaine Baker
- Cardiology, Princess Alexandra Hospital, Brisbane, Australia.
| | - Rita Hwang
- The University of Queensland, Brisbane, Australia; Physiotherapy Princess Alexandra Hospital, Brisbane, Australia.
| | - Donna Lynagh
- Metro South Medicine and Chronic Disease Health, Brisbane, Australia.
| | - Dariusz Korczyk
- Cardiology, Princess Alexandra Hospital, Brisbane, Australia; The University of Queensland, Brisbane, Australia.
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Lewis AK, Harding KE, Snowdon DA, Taylor NF. Reducing wait time from referral to first visit for community outpatient services may contribute to better health outcomes: a systematic review. BMC Health Serv Res 2018; 18:869. [PMID: 30458761 PMCID: PMC6245820 DOI: 10.1186/s12913-018-3669-6] [Citation(s) in RCA: 94] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Accepted: 10/31/2018] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Many people wait long periods for community outpatient services. However little is known about the impact of waiting from referral to first visit on patient outcomes. The aim of this systematic review is to investigate whether waiting for community outpatient services is associated with adverse effects on patient outcomes. METHODS Medline, Embase, Psych Info and CINAHL databases were searched, combining the key concepts of waiting for healthcare and patient outcomes. Studies were included if they reported data comparing health outcomes for patients with different waiting times for the same period. Three reviewers applied inclusion and exclusion criteria to identified studies and assessed quality using the McMaster Critical Review Forms. Levels of evidence were assessed using National Health and Medical Research Council guidelines. Included studies were analysed using a descriptive synthesis, and summarised according to levels of evidence and clinical significance for key outcomes. RESULTS Fourteen studies that included 69,606 adult patients were selected. Selected studies included patients referred for treatment for musculoskeletal disorders (n = 28,722) or to cardiac rehabilitation (n = 40,884). There was low-level evidence that reduced wait time is associated with moderate improvement in workplace participation for patients seeking care for musculoskeletal conditions; and moderate improvement in exercise tolerance for patients referred to cardiac rehabilitation. There was inconsistent evidence that improvements in quality of life, patient satisfaction and psychological symptoms may be associated with shorter wait times. Pain, function and physical activity outcomes were not associated with wait time. CONCLUSIONS This review found low-level evidence suggesting an association between early access to community outpatient services and improvement of some patient outcomes. Specifically, shorter wait times from referral to first visit for musculoskeletal pain services may improve patient work participation. Shorter wait times for cardiac rehabilitation may improve patient exercise capacity. The effects of a short wait time for other patient conditions and patient outcomes, including quality of life, psychological symptoms and patient experience, are inconclusive. The modest benefits in health outcomes observed in reducing wait time for community outpatient services suggest that other possible benefits such as increasing patient flow should be explored. TRIAL REGISTRATION PROSPERO registration no: CRD42016047003.
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Affiliation(s)
- Annie K. Lewis
- Allied Health Clinical Research Office, Eastern Health, Level 2/5 Arnold Street, Box Hill, VIC 3128 Australia
- La Trobe University, Bundoora, VIC 3086 Australia
| | - Katherine E. Harding
- Allied Health Clinical Research Office, Eastern Health, Level 2/5 Arnold Street, Box Hill, VIC 3128 Australia
- La Trobe University, Bundoora, VIC 3086 Australia
| | - David A. Snowdon
- Allied Health Clinical Research Office, Eastern Health, Level 2/5 Arnold Street, Box Hill, VIC 3128 Australia
- La Trobe University, Bundoora, VIC 3086 Australia
| | - Nicholas F. Taylor
- Allied Health Clinical Research Office, Eastern Health, Level 2/5 Arnold Street, Box Hill, VIC 3128 Australia
- La Trobe University, Bundoora, VIC 3086 Australia
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Ennis S, Lobley G, Worrall S, Powell R, Kimani PK, Khan AJ, Banerjee P, Barker T, McGregor G. Early initiation of post-sternotomy cardiac rehabilitation exercise training (SCAR): study protocol for a randomised controlled trial and economic evaluation. BMJ Open 2018; 8:e019748. [PMID: 29574443 PMCID: PMC5875596 DOI: 10.1136/bmjopen-2017-019748] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
INTRODUCTION Current guidelines recommend abstinence from supervised cardiac rehabilitation (CR) exercise training for 6 weeks post-sternotomy. This practice is not based on empirical evidence, thus imposing potentially unnecessary activity restrictions. Delayed participation in CR exercise training promotes muscle atrophy, reduces cardiovascular fitness and prolongs recovery. Limited data suggest no detrimental effect of beginning CR exercise training as early as 2 weeks post-surgery, but randomised controlled trials are yet to confirm this. The purpose of this trial is to compare CR exercise training commenced early (2 weeks post-surgery) with current usual care (6 weeks post-surgery) with a view to informing future CR guidelines for patients recovering from sternotomy. METHODS AND ANALYSIS In this assessor-blind randomised controlled trial, 140 cardiac surgery patients, recovering from sternotomy, will be assigned to 8 weeks of twice-weekly supervised CR exercise training commencing at either 2 weeks (early CR) or 6 weeks (usual care CR) post-surgery. Usual care exercise training will adhere to current UK recommendations. Participants in the early CR group will undertake a highly individualised 2-3 week programme of functional mobility, strength and cardiovascular exercise before progressing to a usual care CR programme. Outcomes will be assessed at baseline (inpatient), pre-CR (2 or 6 weeks post-surgery), post-CR (10 or 14 weeks post-surgery) and 12 months. The primary outcome will be change in 6 min walk distance. Secondary outcomes will include measures of functional fitness, quality of life and cost-effectiveness. ETHICS AND DISSEMINATION Recruitment commenced on July 2017 and will complete by December 2019. Results will be disseminated via national governing bodies, scientific meetings and peer-reviewed journals. TRIAL REGISTRATION NUMBER NCT03223558; Pre-results.
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Affiliation(s)
- Stuart Ennis
- Department of Cardiac Rehabilitation, Centre for Exercise and Health, University Hospital, Coventry, UK
- Cardiff Centre for Exercise and Health, Cardiff Metropolitan University, Cardiff, UK
| | - Grace Lobley
- Department of Cardiac Rehabilitation, Centre for Exercise and Health, University Hospital, Coventry, UK
| | - Sandra Worrall
- Department of Cardiac Rehabilitation, Centre for Exercise and Health, University Hospital, Coventry, UK
| | - Richard Powell
- Department of Cardiac Rehabilitation, Centre for Exercise and Health, University Hospital, Coventry, UK
| | - Peter K Kimani
- Statistics and Epidemiology, Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Amir Jahan Khan
- Health and Life Sciences Research Centre, Coventry University, Coventry, UK
| | - Prithwish Banerjee
- Health and Life Sciences Research Centre, Coventry University, Coventry, UK
- Department of Cardiology, University Hospitals, Coventry, UK
| | - Thomas Barker
- Department of Cardiothoracic Surgery, University Hospital, Coventry, UK
| | - Gordon McGregor
- Department of Cardiac Rehabilitation, Centre for Exercise and Health, University Hospital, Coventry, UK
- Health and Life Sciences Research Centre, Coventry University, Coventry, UK
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Compromised Cardiopulmonary Exercise Capacity in Patients Early After Endoscopic Atraumatic Coronary Artery Bypass Graft. Am J Phys Med Rehabil 2017; 96:84-92. [DOI: 10.1097/phm.0000000000000544] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Marzolini S, Danells C, Oh PI, Jagroop D, Brooks D. Feasibility and Effects of Cardiac Rehabilitation for Individuals after Transient Ischemic Attack. J Stroke Cerebrovasc Dis 2016; 25:2453-63. [DOI: 10.1016/j.jstrokecerebrovasdis.2016.06.018] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2016] [Revised: 06/08/2016] [Accepted: 06/13/2016] [Indexed: 11/29/2022] Open
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Lau ET, Thompson EA, Burr RL, Dougherty CM. Safety and Efficacy of an Early Home-Based Walking Program After Receipt of an Initial Implantable Cardioverter-Defibrillator. Arch Phys Med Rehabil 2016; 97:1228-36. [DOI: 10.1016/j.apmr.2016.02.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2016] [Revised: 02/03/2016] [Accepted: 02/09/2016] [Indexed: 01/06/2023]
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Almodhy M, Ingle L, Sandercock GR. Effects of exercise-based cardiac rehabilitation on cardiorespiratory fitness: A meta-analysis of UK studies. Int J Cardiol 2016; 221:644-51. [PMID: 27423084 DOI: 10.1016/j.ijcard.2016.06.101] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Revised: 05/20/2016] [Accepted: 06/21/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND Exercise-based cardiac rehabilitation can promote meaningful improvements in cardiorespiratory fitness (fitness) but the magnitude of such improvements varies according to local characteristics of exercise programmes. We aimed to determine if cardiac rehabilitation (CR), as practised in the United Kingdom (UK), could promote meaningful changes in fitness and to identify programme characteristics which may moderate these changes. METHODS Electronic and manual searches to identify UK CR studies reporting fitness at baseline and follow up. Change in fitness (Δfitness) was expressed as mean difference (95% CI) and effect size (ES). A random effects model was used to calculate the mean estimate for change in Δfitness. Between-group heterogeneity was quantified (Q) and investigated using planned sub-group analyses. RESULTS We identified n=11 studies containing 16 patient groups (n=1 578) which used the incremental shuttle walking test (ISWT) (distance walked) to assess fitness. The overall mean estimate for Δfitness showed a significant increase in distance walked (ES=0.48, P<0.001), but this estimate was highly heterogeneous (Q=77.1, P<0.001, I(2)=81%). Sub-group analyses showed significantly greater ES (Q=3.94, P=0.046) for Δfitness in patients prescribed n>12 exercise sessions compared with those receiving n≤12 sessions. CONCLUSION We found significant increases in fitness (based on ISWT) in patients attending exercise-based CR in the UK. However, UK studies provide approximately one-third of the exercise "dose", and produce gains in fitness less than half the magnitude reported in international studies.
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Affiliation(s)
- Meshal Almodhy
- Centre for Sport & Exercise Science, University of Essex, Colchester, CO43SQ, UK
| | - Lee Ingle
- Department of Sport, Health & Exercise Science, University of Hull, Hull, UK
| | - Gavin R Sandercock
- Centre for Sport & Exercise Science, University of Essex, Colchester, CO43SQ, UK.
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