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McDonagh ST, Dalal H, Moore S, Clark CE, Dean SG, Jolly K, Cowie A, Afzal J, Taylor RS. Home-based versus centre-based cardiac rehabilitation. Cochrane Database Syst Rev 2023; 10:CD007130. [PMID: 37888805 PMCID: PMC10604509 DOI: 10.1002/14651858.cd007130.pub5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2023]
Abstract
BACKGROUND Cardiovascular disease is the most common cause of death globally. Traditionally, centre-based cardiac rehabilitation programmes are offered to individuals after cardiac events to aid recovery and prevent further cardiac illness. Home-based and technology-supported cardiac rehabilitation programmes have been introduced in an attempt to widen access and participation, especially during the SARS-CoV-2 pandemic. This is an update of a review previously published in 2009, 2015, and 2017. OBJECTIVES To compare the effect of home-based (which may include digital/telehealth interventions) and supervised centre-based cardiac rehabilitation on mortality and morbidity, exercise-capacity, health-related quality of life, and modifiable cardiac risk factors in patients with heart disease SEARCH METHODS: We updated searches from the previous Cochrane Review by searching the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (Ovid), Embase (Ovid), PsycINFO (Ovid) and CINAHL (EBSCO) on 16 September 2022. We also searched two clinical trials registers as well as previous systematic reviews and reference lists of included studies. No language restrictions were applied. SELECTION CRITERIA We included randomised controlled trials that compared centre-based cardiac rehabilitation (e.g. hospital, sports/community centre) with home-based programmes (± digital/telehealth platforms) in adults with myocardial infarction, angina, heart failure, or who had undergone revascularisation. DATA COLLECTION AND ANALYSIS Two review authors independently screened all identified references for inclusion based on predefined inclusion criteria. Disagreements were resolved through discussion or by involving a third review author. Two authors independently extracted outcome data and study characteristics and assessed risk of bias. Certainty of evidence was assessed using GRADE. MAIN RESULTS We included three new trials in this update, bringing a total of 24 trials that have randomised a total of 3046 participants undergoing cardiac rehabilitation. A further nine studies were identified and are awaiting classification. Manual searching of trial registers until 16 September 2022 revealed a further 14 clinical trial registrations - these are ongoing. Participants had a history of acute myocardial infarction, revascularisation, or heart failure. Although there was little evidence of high risk of bias, a number of studies provided insufficient detail to enable assessment of potential risk of bias; in particular, details of generation and concealment of random allocation sequencing and blinding of outcome assessment were poorly reported. No evidence of a difference was seen between home- and centre-based cardiac rehabilitation in our primary outcomes up to 12 months of follow-up: total mortality (risk ratio [RR] = 1.19, 95% confidence interval [CI] 0.65 to 2.16; participants = 1647; studies = 12/comparisons = 14; low-certainty evidence) or exercise capacity (standardised mean difference (SMD) = -0.10, 95% CI -0.24 to 0.04; participants = 2343; studies = 24/comparisons = 28; low-certainty evidence). The majority of evidence (N=71 / 77 comparisons of either total or domain scores) showed no significant difference in health-related quality of life up to 24 months follow-up between home- and centre-based cardiac rehabilitation. Trials were generally of short duration, with only three studies reporting outcomes beyond 12 months (exercise capacity: SMD 0.11, 95% CI -0.01 to 0.23; participants = 1074; studies = 3; moderate-certainty evidence). There was a similar level of trial completion (RR 1.03, 95% CI 0.99 to 1.08; participants = 2638; studies = 22/comparisons = 26; low-certainty evidence) between home-based and centre-based participants. The cost per patient of centre- and home-based programmes was similar. AUTHORS' CONCLUSIONS This update supports previous conclusions that home- (± digital/telehealth platforms) and centre-based forms of cardiac rehabilitation formally supported by healthcare staff seem to be similarly effective in improving clinical and health-related quality of life outcomes in patients after myocardial infarction, or revascularisation, or with heart failure. This finding supports the continued expansion of healthcare professional supervised home-based cardiac rehabilitation programmes (± digital/telehealth platforms), especially important in the context of the ongoing global SARS-CoV-2 pandemic that has much limited patients in face-to-face access of hospital and community health services. Where settings are able to provide both supervised centre- and home-based programmes, consideration of the preference of the individual patient would seem appropriate. Although not included in the scope of this review, there is an increasing evidence base supporting the use of hybrid models that combine elements of both centre-based and home-based cardiac rehabilitation delivery. Further data are needed to determine: (1) whether the short-term effects of home/digital-telehealth and centre-based cardiac rehabilitation models of delivery can be confirmed in the longer term; (2) the relative clinical effectiveness and safety of home-based programmes for other heart patients, e.g. post-valve surgery and atrial fibrillation.
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Affiliation(s)
- Sinead Tj McDonagh
- Department of Health and Community Sciences, University of Exeter Medical School, Faculty of Health and Life Sciences, St Luke's Campus, University of Exeter, Exeter, UK
| | - Hasnain Dalal
- Department of Health and Community Sciences, University of Exeter Medical School, Faculty of Health and Life Sciences, St Luke's Campus, University of Exeter, Exeter, UK
| | - Sarah Moore
- Department of Health and Community Sciences, University of Exeter Medical School, Faculty of Health and Life Sciences, St Luke's Campus, University of Exeter, Exeter, UK
| | - Christopher E Clark
- Department of Health and Community Sciences, University of Exeter Medical School, Faculty of Health and Life Sciences, St Luke's Campus, University of Exeter, Exeter, UK
| | - Sarah G Dean
- Department of Health and Community Sciences, University of Exeter Medical School, Faculty of Health and Life Sciences, St Luke's Campus, University of Exeter, Exeter, UK
| | - Kate Jolly
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Aynsley Cowie
- Cardiac Rehabilitation, University Hospital Crosshouse, NHS Ayrshire and Arran, Kilmarnock, UK
| | | | - Rod S Taylor
- MRC/CSO Social and Public Health Sciences Unit & Robertson Centre for Biostatistics, Institute of Health and Well Being, University of Glasgow, Glasgow, UK
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den Uijl I, Ter Hoeve N, Sunamura M, Stam HJ, Boersma E, Lenzen MJ, Brouwers RWM, Tenbült-van Limpt NCCW, Ista E, van den Berg-Emons RJG. Cardiac rehabilitation designed for patients with obesity: OPTICARE XL RCT results on health-related quality of life and psychosocial well-being. Disabil Rehabil 2023; 45:1046-1055. [PMID: 35311438 DOI: 10.1080/09638288.2022.2050428] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Purpose We studied the effectiveness of a new cardiac rehabilitation (CR) program developed for patients with obesity compared with standard CR on HRQOL and psychosocial well-being.Materials and methods OPTICARE XL was a multicentre RCT in patients with cardiac disease and obesity (Netherlands Trial Register: NL5589). Patients were randomized to OPTICARE XL CR (n = 102) or standard CR (n = 99). The one-year OPTICARE XL CR group program included endurance and resistance exercises, behavioural coaching, and after-care. Standard CR consisted of a 6- to 12-week endurance exercise group program, and cardiovascular lifestyle education. Primary endpoint was HRQOL (MacNew) at six months post CR. Second, we assessed anxiety and depression (both HADS), fatigue (FSS), and participation in society (USER-P).Results In both groups, improvements in HRQOL were observed six months post CR. Mean HRQOL improved from 4.92 to 5.40 in standard CR [mean change (95% CI): 0.48 (0.28, 0.67)] and from 4.96 to 5.45 in OPTICARE XL CR (mean change (95% CI): 0.49 (0.29, 0.70), without between-group differences. Psychosocial well-being improvements within both groups were obtained at six months post CR, regardless of allocated program.Conclusions OPTICARE XL CR did not have added value in improving HRQOL and psychosocial well-being in patients with obesity.Implications for rehabilitationMore than a third of cardiac patients suffers from obesity, and standard cardiac rehabilitation (CR) programs are suboptimal in this increasing patient population.The OPTICARE XL CR program is a state-of-the art, one-year CR program designed for patients with obesity including aerobic and strength exercises, behavioural coaching towards a healthy diet and an active lifestyle, and after-care.Improvements in HRQOL and psychosocial well-being were comparable between patients with obesity allocated to standard CR and OPTICARE XL CR.Therefore, there was no additional benefit of OPTICARE XL CR.
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Affiliation(s)
- Iris den Uijl
- Department of Rehabilitation Medicine, Erasmus University Medical Centre, Rotterdam, The Netherlands
- Capri Cardiac Rehabilitation, Rotterdam, The Netherlands
| | - Nienke Ter Hoeve
- Department of Rehabilitation Medicine, Erasmus University Medical Centre, Rotterdam, The Netherlands
- Capri Cardiac Rehabilitation, Rotterdam, The Netherlands
| | | | - Henk J Stam
- Department of Rehabilitation Medicine, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Eric Boersma
- Department of Cardiology, Thoraxcenter, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Mattie J Lenzen
- Department of Cardiology, Thoraxcenter, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | | | | | - Erwin Ista
- Department of Internal Medicine, Nursing Science, Erasmus University Medical Centre, Rotterdam, The Netherlands
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Colas C, Bayle M, Labeix P, Botelho-Nevers E, Gagneux-Brunon A, Cazorla C, Schein F, Breugnon E, Garcin A, Feasson L, Roche F, Hupin D. Management of Long COVID—The CoviMouv' Pilot Study: Importance of Adapted Physical Activity for Prolonged Symptoms Following SARS-CoV2 Infection. Front Sports Act Living 2022; 4:877188. [PMID: 35847457 PMCID: PMC9283867 DOI: 10.3389/fspor.2022.877188] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 06/01/2022] [Indexed: 12/03/2022] Open
Abstract
Context After a COVID-19 infection, some patients have persistent symptoms, the most common is fatigue. To prevent it from becoming chronic (post-COVID-19 syndrome), early management before 3 months could be useful. Exercise and education are recommended. Objective To assess fatigue in patients with prolonged symptoms after COVID-19 infection and who received a mixed program of remote adapted physical activity and therapeutic education. The secondary objective was to evaluate the efficacy and safety of this training method thanks to aerobic and anaerobic parameters. Methods “CoviMouv': From Coaching in Visual to Mouv in real” is a nonrandomized controlled pilot study. Patients in telerehabilitation followed 12 remote exercise sessions and 3 therapeutic education workshops. Patients on traditional rehabilitation followed their program with a community-based physiotherapist. Results Fatigue was reduced after the one-month intervention in both groups (p = 0.010). The majority of aerobic parameters were significantly improved, e.g., maximal oxygen uptake (p = 0.005), walking distance (p = 0.019) or hyperventilation values (p = 0.035). The anaerobic parameter was not improved (p = 0.400). No adverse event was declared. Discussion Telerehabilitation is a good alternative when a face-to-face program is not possible. This care at an early stage of the disease could help prevent the chronicity of post-COVID-19 symptoms and the installation of vicious circles of physical deconditioning. A larger study would be necessary.
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Affiliation(s)
- Claire Colas
- INSERM, U1059, SAINBIOSE, DVH, Lyon University, Jean Monnet University, Saint-Étienne, France
- Department of Clinical and Exercise Physiology, University Hospital Center, Saint-Étienne, France
- Chaire Santé des Ainés, Presage Institute, Jean Monnet University, Lyon University, Saint-Étienne, France
- Chaire ActiFS, Presage Institute, Jean Monnet University, Lyon University, Saint-Étienne, France
- *Correspondence: Claire Colas
| | - Manon Bayle
- Department of Clinical and Exercise Physiology, University Hospital Center, Saint-Étienne, France
| | - Pierre Labeix
- INSERM, U1059, SAINBIOSE, DVH, Lyon University, Jean Monnet University, Saint-Étienne, France
- Department of Clinical and Exercise Physiology, University Hospital Center, Saint-Étienne, France
| | - Elisabeth Botelho-Nevers
- Department of Infectious Diseases, University Hospital Center, Saint-Étienne, France
- Chaire PreVacCI, Presage Institute, Lyon University, Jean Monnet University, Saint-Étienne, France
- CIRI, Team GIMAP, Univ Lyon, Université Jean Monnet, INSERM, U1111, CNRS, UMR530, Saint-Étienne, France
| | - Amandine Gagneux-Brunon
- Department of Infectious Diseases, University Hospital Center, Saint-Étienne, France
- Chaire PreVacCI, Presage Institute, Lyon University, Jean Monnet University, Saint-Étienne, France
- CIRI, Team GIMAP, Univ Lyon, Université Jean Monnet, INSERM, U1111, CNRS, UMR530, Saint-Étienne, France
| | - Céline Cazorla
- Department of Infectious Diseases, University Hospital Center, Saint-Étienne, France
| | - Flora Schein
- Department of Infectious Diseases, University Hospital Center, Saint-Étienne, France
| | - Emma Breugnon
- Department of Infectious Diseases, University Hospital Center, Saint-Étienne, France
| | - Arnauld Garcin
- INSERM, U1059, SAINBIOSE, DVH, Lyon University, Jean Monnet University, Saint-Étienne, France
- Innovation and Pharmacology Clinical Research Unit, University Hospital of Saint-Etienne, Saint-Étienne, France
| | - Léonard Feasson
- Department of Clinical and Exercise Physiology, University Hospital Center, Saint-Étienne, France
- Chaire ActiFS, Presage Institute, Jean Monnet University, Lyon University, Saint-Étienne, France
- Interuniversity Laboratory of Human Movement Biology, EA 7424, Lyon University, Jean Monnet University, Saint-Étienne, France
| | - Frédéric Roche
- INSERM, U1059, SAINBIOSE, DVH, Lyon University, Jean Monnet University, Saint-Étienne, France
- Department of Clinical and Exercise Physiology, University Hospital Center, Saint-Étienne, France
- Chaire Santé des Ainés, Presage Institute, Jean Monnet University, Lyon University, Saint-Étienne, France
| | - David Hupin
- INSERM, U1059, SAINBIOSE, DVH, Lyon University, Jean Monnet University, Saint-Étienne, France
- Department of Clinical and Exercise Physiology, University Hospital Center, Saint-Étienne, France
- Chaire Santé des Ainés, Presage Institute, Jean Monnet University, Lyon University, Saint-Étienne, France
- Department of Medicine, Solna, Karolinska Institute, Stockholm, Sweden
- David Hupin
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Kim YJ, Crane PA, Houmard JA, Swift DL, Wu Q. Minor Improvement in Activity and Participation and Decline in Physical Activity Motivation After Cardiac Rehabilitation Discharge. J Cardiopulm Rehabil Prev 2021; 41:419-425. [PMID: 34727561 DOI: 10.1097/hcr.0000000000000586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE To investigate the changes in activities and participation, and mental and physical functions for 9 mo after cardiac rehabilitation (CR) among adults with chronic cardiac conditions. METHODS Twenty-five adults with chronic cardiac conditions scheduled for discharge from CR were assessed at four different times: within 2-wk window of CR discharge date, 1 mo, 3 mo, and 9 mo after CR discharge. Nine assessments according to the International Classification of Functioning, Disability and Health were used to track the changes post-CR. RESULTS Participants showed significant changes in the Cognitive Instrumental Activities of Daily Living adequacy of Performance Assessment of Self-Care Skills-Clinic (F = 8.10, P = .017) and improvements in the applied cognitive domain of the Activity Measure for Post-Acute Care Outpatient Short Form (F = 4.493, P = .016). Participants also showed significant decline in the CogState Detection test (F = 3.307, P = .045), the Physical Activity and Leisure Motivation Scale (PALMS) (F = 4.749, P = .005), and the affiliation subscale of the PALMS (F = 5.316, P = .002), and improvements in the 6-min walk test (F = 9.000, P = .011). Lastly, participants showed depressive symptoms for 3 mo post-CR. No other significant changes were detected among other outcome measures. CONCLUSIONS Adults with chronic cardiac conditions discharged from site-based CR maintained their activity and participation level following discharge with little improvement. They also showed depressive symptoms and decreased motivation for physical activity post-CR.
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Affiliation(s)
- Young Joo Kim
- Departments of Occupational Therapy (Dr Kim), Kinesiology (Drs Houmard and Swift), and Biostatistics (Dr Wu), East Carolina University, Greenville, North Carolina; and College of Nursing, East Carolina University, Greenville, and School of Nursing, University of North Carolina Charlotte, Charlotte, North Carolina (Dr Crane)
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5
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The effects of maintenance cardiac rehabilitation: A systematic review and Meta-analysis, with a focus on sex. Heart Lung 2021; 50:504-524. [PMID: 33836441 DOI: 10.1016/j.hrtlng.2021.02.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 02/17/2021] [Accepted: 02/19/2021] [Indexed: 11/24/2022]
Abstract
Phase III/IV cardiac rehabilitation (CR) is recommended to promote maintenance of benefits achieved during Phase II; there has been no meta-analysis to test this to date. This study determined the effects of maintenance CR on any outcome, with consideration of sex. Seven databases were searched from inception-January 2020. Randomized controlled trials on the effects of maintenance CR in cardiovascular disease patients who had graduated from CR were included. Level of evidence was evaluated with GRADEPro. 819 citations were identified, with 10 trials (21 papers) included (5238 participants; 859 [16.4%] female). Maintenance CR resulted in lower low-density lipoprotein (mean difference [MD]=-0.58; 95% confidence interval [CI]=-1.06--0.10, n = 392) and greater quality of life (MD = 0.28, 95% CI = 0.05-0.52, n = 118) when compared to usual care only. Outcomes for women and sex differences were mixed. In conclusion, maintenance programs appear to sustain patient's quality of life, but more focus on women's outcomes is needed.
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Mol TI, van Bennekom CA, Schepers VP, Ter Hoeve N, Kruitwagen-van Reenen ET, Visser-Meily JM, Post MW. Differences in Societal Participation Across Diagnostic Groups: Secondary Analyses of 8 Studies Using the Utrecht Scale for Evaluation of Rehabilitation-Participation. Arch Phys Med Rehabil 2021; 102:1735-1745. [PMID: 33757804 DOI: 10.1016/j.apmr.2021.02.024] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 02/16/2021] [Accepted: 02/22/2021] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To determine differences in participation problems between diagnostic groups and to examine diagnosis as a determinant of participation with and without statistically accounting for confounders. DESIGN Secondary analyses of data from 8 studies. SETTING Community, the Netherlands. PARTICIPANTS Participants (N=1735) in diagnostic groups: stroke (n=534), subarachnoid hemorrhage (n=104), other acquired brain injury (n=163), progressive neurologic diseases (n=112), acute coronary syndrome (n=536), and spinal cord injury (n=286). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Participation was measured with the Utrecht Scale for Evaluation of Rehabilitation-Participation. This measure has 3 scales: Restrictions, Satisfaction, and Frequency. In this study, scores were also computed for 3 domains across these scales: Productivity, Leisure, and Social. Scores ranged from 0 (worst) up to 100 (best). Possible confounders were age, sex, level of education, marital status, and time since onset of the condition. RESULTS Significant differences were found in levels of participation between diagnostic groups. Individuals with acute coronary syndrome showed better participation scores in all scales and domains compared with most or all other diagnostic groups, except for the Social domain. Individuals with progressive neurologic diseases showed the lowest (worst) Restriction and Satisfaction scores, whereas those with stroke showed the lowest Frequency scores. After correcting for confounders, diagnosis explained significant proportions of the variance of participation (Frequency, 6.4%; Restrictions, 15.1%; Satisfaction, 5.1%; Productivity, 13.2%; Leisure, 13.8%; Social, 6.9%). CONCLUSIONS Participation problems occurred in all 6 diagnostic groups within this study. Differences were found in participation between diagnostic groups, demonstrating diagnosis-specific participation profiles, including after correcting for confounders.
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Affiliation(s)
- Tanja I Mol
- Center of Excellence for Rehabilitation Medicine, UMC Utrecht Brain Center, University Medical Center Utrecht, and De Hoogstraat Rehabilitation, Utrecht; University of Groningen, University Medical Center Groningen, Department of Rehabilitation Medicine, Groningen
| | - Coen A van Bennekom
- Heliomare Rehabilitation Center, Research and Development and Institute of Vocational Assessment and Education, Wijk aan Zee; Academic Medical Center, University of Amsterdam, Coronel Institute of Occupational Health, Amsterdam
| | - Vera P Schepers
- Center of Excellence for Rehabilitation Medicine, UMC Utrecht Brain Center, University Medical Center Utrecht, and De Hoogstraat Rehabilitation, Utrecht; Department of Rehabilitation, Physical Therapy Science & Sports, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht
| | - Nienke Ter Hoeve
- Capri Cardiac Rehabilitation, Rotterdam; Department of Rehabilitation Medicine, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Esther T Kruitwagen-van Reenen
- Center of Excellence for Rehabilitation Medicine, UMC Utrecht Brain Center, University Medical Center Utrecht, and De Hoogstraat Rehabilitation, Utrecht; Department of Rehabilitation, Physical Therapy Science & Sports, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht
| | - Johanna M Visser-Meily
- Center of Excellence for Rehabilitation Medicine, UMC Utrecht Brain Center, University Medical Center Utrecht, and De Hoogstraat Rehabilitation, Utrecht; Department of Rehabilitation, Physical Therapy Science & Sports, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht
| | - Marcel W Post
- Center of Excellence for Rehabilitation Medicine, UMC Utrecht Brain Center, University Medical Center Utrecht, and De Hoogstraat Rehabilitation, Utrecht; University of Groningen, University Medical Center Groningen, Department of Rehabilitation Medicine, Groningen.
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Jørstad HT, Snaterse M, Ter Hoeve N, Sunamura M, Brouwers R, Kemps H, Scholte Op Reimer WJM, Peters RJG. The scientific basis for secondary prevention of coronary artery disease: recent contributions from the Netherlands. Neth Heart J 2020; 28:136-140. [PMID: 32780344 PMCID: PMC7419404 DOI: 10.1007/s12471-020-01450-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
While the beneficial effects of secondary prevention of cardiovascular disease are undisputed, implementation remains challenging. A gap between guideline-mandated risk factor targets and clinical reality was documented as early as the 1990s. To address this issue, research groups in the Netherlands have performed several major projects. These projects address innovative, multidisciplinary strategies to improve medication adherence and to stimulate healthy lifestyles, both in the setting of cardiac rehabilitation and at dedicated outpatient clinics. The findings of these projects have led to changes in prevention and rehabilitation guidelines.
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Affiliation(s)
- H T Jørstad
- Department of Cardiology, Heart Center, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.
| | - M Snaterse
- ACHIEVE Centre of Applied Research, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands
| | - N Ter Hoeve
- Capri Cardiac Rehabilitation, Rotterdam, The Netherlands
- Department of Rehabilitation Medicine, Erasmus MC, University Medical Centre, Rotterdam, The Netherlands
| | - M Sunamura
- Capri Cardiac Rehabilitation, Rotterdam, The Netherlands
| | - R Brouwers
- Department of Cardiology, Máxima Medical Center, Eindhoven, The Netherlands
| | - H Kemps
- Department of Cardiology, Máxima Medical Center, Eindhoven, The Netherlands
- Eindhoven University of Technology, Eindhoven, The Netherlands
| | - W J M Scholte Op Reimer
- Department of Cardiology, Heart Center, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- ACHIEVE Centre of Applied Research, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands
| | - R J G Peters
- Department of Cardiology, Heart Center, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
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