Results of a hybrid cardiovascular rehabilitation program (in-hospital plus home) in patients with low income

Background

One of the main problems facing cardiovascular rehabilitation (CR) is patient care and adherence. However, due to the low level of economic income of the patients who are cared for in our center, the possibility of going to CR in a conventional way is very difficult since they do not have the necessary resources to cover transportation, cost of the sessions, among others.

It has been shown that the greater the number of sessions attended by the patient, the greater the reduction in cardiovascular risk, however the role of a hybrid program with a decreased number of face-to-face sessions has not been established.

Purpose

Present the results of a hybrid training program (in-hospital plus home) in a low-income population. Education through supervised sessions plus home physical training in a patient with bases for exercise can improve their adherence with better results.

Methods

A cohort of patients with heart disease who were referred to the Cardiovascular Rehabilitation program between May 2017 and February 2019 was included. The socioeconomic level was classified into 6 strata according to occupation, income, housing, economic dependents, place of origin and family health status. After risk stratification, the patients participated in a hybrid program that consisted of 6 in-hospital sessions, once a week, in which the training to be carried out at home was prescribed by means of a triptych. An exercise test was performed before and after completing the program, as well as psychological and nutritional intervention. Statistical analysis was performed using SPSS 21.0 software. All p values less than 0.05 were considered significant.

Results

In the study period, of the total number of patients discharged for heart disease from the hospital, 61% were referred to cardiovascular rehabilitation, of which only 45% (n=39) completed the program, the reasons for dropping out were multiple and the lowest socioeconomic level (1) was the most frequent (figure 1). The main referral diagnosis was ischemic heart disease in 82%. The majority of patients were men, 95%. A significant improvement was observed in load METs, maximum heart rate, heart rate recovery (figure 2).

Conclusion

The implementation of a hybrid cardiovascular rehabilitation program (in-hospital + home) was associated with an improvement in the exercise test parameters of patients who successfully completed the program.

Funding Acknowledgement

Type of funding sources: None. Figure 1Figure 2

Severity of depression and its relationship with the parameters obtained in the cardiopulmonary exercise test in patients of a cardiac rehabilitation program

Background

Cardiovascular diseases are the leading cause of global morbidity and mortality. Depression causes specific disorders such as autonomic nervous system dysfunction, neurohormonal axis imbalance, proinflammatory and prothrombotic states. The alteration profiles in the parameters measured in the cardiopulmonary exercise testing (CPET) associated with the different severities of depression have not yet been characterized.

Purpose

To determine the association of the degree of depression and the parameters obtained in the CPET in patients undergoing a cardiac rehabilitation program.

Methods

Observational, comparative, cross-sectional, retrospective study of adult patients examined in the period from January 1, 2010 to December 31, 2017. Independent variables were degrees of depression according to Beck depression inventory, dependent variables were parameters reported in the CPET. Categorical variables were reported in frequency and continuous variables as averages. The comparison between groups was made with x2, T test, ANOVA according to type and number of variables and their distribution. Pearson's correlation to determine association.

Results

From a total of 594 patients: 490 were men (82.4%), age 57.34±11.3. Maximum METs 7.49±2.42, heart rate (HR) response (percentage of theoretical maximum heart rate achieved) 82.79±12.69 and systolic blood pressure response (SBP) (ratio of peak SBP to resting SBP) 1.29±0.18. Bivariate analysis found significant differences between Beck's depression scale and study variables: Male (p<0.0001), married (p=0.022), diabetes (p=0.012), surgical revascularization (p=0.05), use of angiotensin II receptor antagonists (p=0.027).

Conclusions

The present study found association of depressive symptoms with male gender, married marital status, diabetes, surgical myocardial revascularization and treatment with angiotensin II receptor antagonists. In the CPET, significant differences were found in exercise tolerance measured by METs, HR response and SBP response between subjects without depression and those with mild and moderate depression.

Depression and Exercise Tolerance

Funding Acknowledgement

Type of funding source: None

P639Benefits and safety of exercise training in patients with severe three coronary vessels disease

Background

Coronary heart disease is the leading cause of death in the world. Nowadays, there are still patients with untreatable coronary obstructions and exercise therapy could be an option to improve their quality of life and probably diminish mortality. Cardiac rehabilitation programs are recommended worldwide due its effectiveness and safety. However very high risk patients are often not included.

Purpose

To evaluate the benefit and safety of exercise therapy as a part of a cardiac rehabilitation program in patients with untreatable severe coronary heart disease.

Methods

A cohort of patients with coronary heart disease included in a cardiac rehabilitation program were studied. Those with severe coronary heart disease (Syntax score ≥33, group A) were identified. Patients were stratified using clinical records and cardiopulmonary exercise testing. They trained for 30 minutes, five times a week of aerobic exercise (cycle ergometer) and this therapy was complemented with general strength, coordination, balance and flexibility maneuvers. After twenty exercise sessions, a second cardiopulmonary exercise test was performed. Symptom limited cardiopulmonary exercise testing was undertaken using a ramp Balke protocol and cardiopulmonary variables were recorded. These patients were compared with their counterparts without severe coronary heart disease (Control group, group B). Studied variables were presented as frequencies (%), mean (SD), median (range) as appropriate. Comparisons between groups were made using chi square or paired T test as needed. All p values <0.05 were considered stochastically significant.

Results

From a total of 546 patients, seventy-one had severe coronary heart disease (Syntax score ≥33). There were no significant differences between groups on change of METs value and number of sessions assisted. No major adverse cardiovascular outcome was observed. The percentage of exercise induced arrhythmias was 75% in very high risk group vs 76% in control group, (p>0.05). Results are shown in table 1.

Table 1. Characteristics between groups Patients Group A (n=75) Group B (n=471) p value Assisted training sessions 15±7 14±6 ns Increment in MET (ml/kg/min) 1.32±1.34 1.35±1.56 ns Arrhythmias, n (%) 56 (75) 370 (76) ns Angor/ST depression, n (%) 11 (15) 15 (3) <0.01 Differences in workload (Watts) 20±13 22±13 ns

Conclusion

Exercise training could be performed in an effective and safe manner in patients with very high risk untreated coronary heart disease.