scholarly journals Importance of Completing Hybrid Cardiac Rehabilitation for Long-Term Outcomes: A Real-World Evaluation

2019 ◽  
Vol 8 (3) ◽  
pp. 290 ◽  
Author(s):  
Neville Suskin ◽  
Salimah Shariff ◽  
Amit Garg ◽  
Jennifer Reid ◽  
Karen Unsworth ◽  
...  
Keyword(s):  
Cardiac Rehabilitation ◽  
Cardiac Event ◽  
Propensity Scores ◽  
Event Rate ◽  
Secondary Analysis ◽  
Cardiac Events ◽  
Community Based ◽  
Metabolic Equivalent ◽  
Major Cardiac Event

Community-based hybrid cardiac rehabilitation (CR) programs offer a viable alternative to conventional centre-based CR, however their long-term benefits are unknown. We conducted a secondary analysis of the CR Participation Study conducted in London, Ontario, between 2003 and 2006. CR eligible patients hospitalized for a major cardiac event, who resided within 60 min, were referred to a hybrid CR program; 381 of 544 (64%) referred patients initiated CR; an additional 1,498 CR eligible patients were not referred due to distance. For the present study, CR participants were matched using propensity scores to CR eligible non-participants who resided beyond 60 min, yielding 214 matched pairs. Subjects were followed for a mean (standard deviation, SD) of 8.56 (3.38) years for the outcomes of mortality or re-hospitalization for a major cardiac event. Hybrid CR participation was associated with a non-significant 16% lower event rate (Hazard Ratio [HR]: 0.84, 95% CI: 0.59–1.17). When restricting to pairs where CR participants achieved a greater than 0.5 metabolic equivalent exercise capacity increase (123 pairs), CR completion was associated with a 51% lower event rate (HR: 0.49, 95% CI: 0.29–0.81). Successful completion of a community-based hybrid CR program may be associated with decreased long-term mortality or recurrent cardiac events.

Feasibility of an Emotion Regulation Intervention for Patients in Cardiac Rehabilitation

2020 ◽  
pp. 019394592094995
Author(s):  
Kelly L. Wierenga ◽  
David M. Fresco ◽  
Megan Alder ◽  
Shirley M. Moore
Keyword(s):  
Risk Factors ◽  
Emotion Regulation ◽  
Cardiac Rehabilitation ◽  
Cardiac Event ◽  
Disease Risk ◽  
Cardiovascular Disease Risk ◽  
Emotion Regulation Strategies ◽  
Perceived Efficacy ◽  
Major Cardiac Event ◽  
Regulation Strategies

Cardiac rehabilitation is important to improve physical activity and reduce cardiovascular disease risk factors among people who have experienced a major cardiac event. However, poor emotion regulation can make it difficult to change cardiovascular risk factors. The purpose of this article was to assess the feasibility of the Regulating Emotions to improve Nutrition Exercise and reduce Stress (RENEwS) intervention, an education program aimed at improving emotion regulation strategies among patients in cardiac rehabilitation. A total of 14 cardiac rehabilitation patients (mean age 61 years) enrolled in five weekly RENEwS sessions. Qualitative analysis of participants’ comments was used to assess eight elements of feasibility. In total 57% of participants completed the intervention. Participants thought the intervention was feasible, with strengths in the areas of acceptability, demand, adaptation, integration, and implementation. Other comments regarding practicality, expansion, and perceived efficacy provide guidance for intervention refinement.

Cardiac rehabilitation

2020 ◽  
pp. 371-384
Keyword(s):  
Coronary Heart Disease ◽  
Cardiac Rehabilitation ◽  
Cardiac Disease ◽  
Cardiac Event ◽  
Cardiovascular Prevention ◽  
Improvement Plan ◽  
National Service Framework ◽  
Long Time

This chapter looks at the role of cardiac rehabilitation for those at risk of cardiac disease or who have sustained a cardiac event. Cardiac rehabilitation has been a priority area for a long time in the National Service Framework for Coronary Heart Disease, NHS Improvement Plan, and now features in the NHS Long Term Plan. The introduction of certification for cardiovascular prevention and rehabilitation programmes (CPRP) has meant that their quality can be measured. The introduction of more technology-based interventions has opened up the opportunity for more people to participate, particularly for individuals who could not, or did not want to attend a traditional CPRP.

A history of smoking does not reduce long-term benefits of cardiac rehabilitation on cardiorespiratory fitness in men and women with cardiovascular disease

2020 ◽  
Author(s):  
Kenneth Shinkichi Noguchi ◽  
Michael Pryzbek ◽  
Kevin Moncion ◽  
Angelica McQuarrie ◽  
Maureen J. MacDonald ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Cardiac Rehabilitation ◽  
Cardiorespiratory Fitness ◽  
Smoking Behaviour ◽  
Smoking History ◽  
Cardiac Events ◽  
Men And Women ◽  
All Cause Mortality ◽  
History Of

Smoking is an important risk factor for cardiovascular disease and all-cause mortality. Cardiac rehabilitation (CR) is effective for reducing the risk of recurrent cardiac events through improving cardiorespiratory fitness (CRF). Little is known about the influence of smoking on CRF throughout long-term CR. The purpose of this analysis was to compare CRF trajectories among individuals with positive and negative smoking history enrolled in long-term CR. Participants had a positive smoking history if they currently smoke or formerly smoked (Smoke+, n=55, mean age=64.9 ± 9.0 years) and had a negative history if they never smoked (Smoke–, n=34, mean age=61.4 ± 9.0 years). CRF (VO2peak) was measured at baseline and annually thereafter for 6 years. The Smoke+ group had lower CRF compared to the Smoke– group over enrollment (β=-3.29 (SE=1.40), 95% CI -6.04, -0.54, p=0.02), but there was no interaction of smoking history and enrollment (β=0.35 (SE=0.21), 95% CI -0.06, 0.77, p=0.10). Moreover, trajectories were not influenced by pack-years (β=0.01 (SE=0.01), 95% CI -0.01, 0.04, p=0.23) or time smoke-free (β=-0.002 (SE=0.01), 95% CI -0.02, 0.02, p=0.80). Although the trajectories of CRF do not appear to be affected by smoking behaviour, individuals without a history of smoking maintained higher CRF throughout enrollment. Novelty bullets: • The benefits of long-term exercise-based cardiac rehabilitation on cardiorespiratory fitness are similar between those who have smoked and those who have never smoked. • Neither the number of pack-years nor the length of time spent smoke-free influence cardiorespiratory fitness trajectories following long-term cardiac rehabilitation.

scholarly journals Acute Surgical Anemia Influences the Cardioprotective Effects of β-Blockade

2010 ◽  
Vol 112 (1) ◽  
pp. 25-33 ◽  
Author(s):  
W Scott Beattie ◽  
Duminda N. Wijeysundera ◽  
Keyvan Karkouti ◽  
Stuart McCluskey ◽  
Gordon Tait ◽  
...  
Keyword(s):  
Beta Blocker ◽  
Major Adverse Cardiac Event ◽  
Cardiac Event ◽  
Propensity Scores ◽  
Beta Blockers ◽  
Adverse Cardiac Event ◽  
Beta Blockade ◽  
Cardiac Events ◽  
Cardioprotective Effects ◽  
The Relationship

Background Despite decreasing cardiac events, perioperative beta-blockade also increases perioperative stroke and mortality. Major bleeding and/or hypotension are independently associated with these outcomes. To investigate the hypothesis that beta-blockade limits the cardiac reserve to compensate for acute surgical anemia, the authors examined the relationship between cardiac events and acute surgical anemia in patients with and without beta-blockade. Methods The records of all noncardiac, nontransplant surgical patients between March 2005 and June 2006 were retrospectively retrieved. The primary outcome was a composite that comprised myocardial infarction, nonfatal cardiac arrest, and in-hospital mortality (major adverse cardiac event). The lowest recorded hemoglobin in the first 3 days defined nadir hemoglobin. Propensity scores estimating the probability of receiving a perioperative beta-blocker were used to match (1:1) patients who did or did not receive beta-blockers postoperatively. The relationship between nadir hemoglobin and major adverse cardiac event was then assessed. Results This analysis identified 4,387 patients in whom nadir hemoglobin could be calculated; 1,153 (26%) patients were administered beta-blockers within the first 24 h of surgery. Propensity scores created 827 matched pairs that were well balanced for all measured confounders. Major adverse cardiac event occurred in 54 (6.5%) beta-blocked patients and in 25 (3.0%) beta-blocker naive patients (relative risk 2.38; 95% CI 1.43-3.96; P = 0.0009). The restricted cubic spline relationship demonstrated that this difference was restricted to those patients in whom the hemoglobin decrease exceeded 35% of the baseline value. Conclusions beta-Blocked patients do not seem to tolerate surgical anemia when compared with patients who are naive to beta-blockers. Prospective studies are required to validate these findings.

Cardiac Morbidity and Mortality after Surgery for Gastrointestinal Carcinomas

2005 ◽  
Vol 71 (10) ◽  
pp. 833-836
Author(s):  
Matthew Lin ◽  
Jason Haukoos ◽  
Amir Tahernia ◽  
Christian De Virgilio
Keyword(s):  
Risk Factors ◽  
Cardiovascular Disease ◽  
Cardiac Event ◽  
Event Rate ◽  
Cardiac Risk ◽  
Clinical Risk Factors ◽  
Cardiac Events ◽  
Cardiac Morbidity ◽  
Clinical Risk ◽  
Cardiac Event Rate

The number of Americans undergoing surgery for gastrointestinal (GI) cancer is increasing, as is the prevalence of cardiovascular disease. Clinical risk factors have been found to be useful in predicting cardiac events after vascular procedures. Their utility for predicting cardiac events after GI carcinoma surgery is unclear. We performed a retrospective review in order to determine whether clinical risk factors are useful in predicting cardiac events in patients undergoing GI carcinoma surgery and to ascertain the incidence of postoperative cardiac events. From 1998 to 2003, 333 patients were identified, with an average age of 56 years. One hundred one (30.3%) patients had one or more clinical risk factors. The overall cardiac event rate was 3.9 per cent. Age >70 years was the only risk factor associated with a cardiac event. There was a trend toward increased cardiac risk with increasing number of risk factors. In the absence of clinical risk factors, cardiac events after surgery for GI carcinoma are low. There is an increased cardiac risk in patients >70 years and a trend toward increased cardiac events as the number of clinical risk factors increases.

scholarly journals Predicting Long-Term Mortality, Morbidity, and Survival Outcomes Following a Cardiac Event: A Cardiac Rehabilitation Study

2019 ◽  
Vol 8 ◽  
pp. 117957271982761 ◽  
Author(s):  
Helen L Graham ◽  
Andrew Lac ◽  
Haeok Lee ◽  
Melissa J Benton
Keyword(s):  
Cardiac Rehabilitation ◽  
Hospital Readmission ◽  
Cardiac Event ◽  
Bypass Graft ◽  
Survival Outcomes ◽  
Prior History ◽  
Participation Rates ◽  
All Cause Mortality ◽  
History Of

Background: Cardiac rehabilitation (CR) has been shown to decrease mortality and morbidity but estimations vary. While there is significant literature supporting short-term benefits, there is not a similarly body of research as to long-term (LT) benefits. Low participation rates in CR are due to several causes and evidence demonstrating positive LT outcomes could be a catalyst to increased participation rates. Objective: To predict LT mortality, readmission, and survival benefits associated with CR participation in a nationally certified program. Methods: Investigators collected mortality and hospital readmission data in a retrospective study to examine a cohort of cardiac patients following a myocardial infarction (MI), MI/percutaneous coronary intervention (PCI), and coronary artery bypass graft (CABG) up to 14 years ago. Hospital electronic medical record (EMR; n = 207) were used to measure hospital readmission outcome and State Health Department records (n = 361) for mortality and survival outcomes. Participation in CR, age, gender prior history of cardiac event, and diagnosis were used to predict readmission, mortality, and survival. Results: Approximately half (52.1%) the sample participated in CR. Participants included 72% males, average age 68 years (38-91 years), and were predominantly Non-Hispanic white. CR participants attended an average of 20 sessions. CR group differed in diagnoses MI (58.5%), CABG (57.4%) and in prior history of heart disease (25.4%) from the non-cardiac rehabilitation (NCR) group (83.2%, 25.4%, 42.2%, respectively) ( P < .05). After controlling for the covariates in logistic regression analyses, the CR group independently predicted lower all-cause mortality (odds ratio, OR = 0.22, 95% CI 0.12 to 0.39) and decreased hospital readmissions (OR = 0.48, 95% CI 0.24 to 0.96). After controlling for the covariates in survival analysis, the CR group significantly contributed to decreased likelihood of death hazard (hazard ratio = 0.36, 95% CI 0.24 to 0.54). Median survivor time for the participants was 5.91 years, SD = 3.81 years. Conclusions: Participation in CR for middle age and elderly patients is associated with increased survival, a marked decrease in all-cause mortality, and a decrease in cardiovascular-related hospital readmission. A referral to a nationally certified outpatient CR program prior to hospital discharge and early enrollment may improve LT outcomes.

Hostility predicts mortality but not recurrent acute coronary syndrome

2020 ◽  
pp. 147451512095091
Author(s):  
Tracey K Vitori ◽  
Susan K Frazier ◽  
Martha J Biddle ◽  
Gia Mudd-Martin ◽  
Michele M Pelter ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Proportional Hazards ◽  
Secondary Analysis ◽  
Cox Proportional Hazards ◽  
Cardiac Events ◽  
Coronary Syndrome ◽  
All Cause Mortality ◽  
Large Randomized Clinical Trial ◽  
The Relationship

Background: Hostility is associated with greater risk for cardiac disease, cardiac events and dysrhythmias. Investigators have reported equivocal findings regarding the association of hostility with acute coronary syndrome (ACS) recurrence and mortality. Given mixed results on the relationship between hostility and cardiovascular outcomes, further research is critical. Aims: The aim of our study was to determine whether hostility was a predictor of ACS recurrence and mortality. Methods: We performed a secondary analysis of data ( N = 2321) from a large randomized clinical trial of an intervention designed to reduce pre-hospital delay among patients who were experiencing ACS. Hostility was measured at baseline with the Multiple Adjective Affect Checklist (MAACL) and patients were followed for 24 months for evaluation of ACS recurrence and all-cause mortality. We used Cox proportional hazards modeling to determine whether hostility was predictive of time to ACS recurrence or all-cause mortality. Results: The majority of patients were married (73%), Caucasian (97%), men (68%), and had a mean age of 67 ± 11 years. Fifty-seven percent of participants scored as hostile based on the established MAACL cut point (mean score = 7.56 ± 3.8). Hostility was an independent predictor of all-cause mortality ( p = < 0.039), but was not a predictor of ACS recurrence ( p = 0.792). Conclusion: Hostility is common in patients with ACS and its relationship to clinical outcomes is important to the design of future interventions to improve long-term ACS mortality.

scholarly journals Effects of Community-Based Cardiac Rehabilitation on Body Composition and Physical Function in Individuals with Stable Coronary Artery Disease: 1.6-Year Followup

2013 ◽  
Vol 2013 ◽  
pp. 1-7 ◽  
Author(s):  
Sandra Mandic ◽  
Claire Hodge ◽  
Emily Stevens ◽  
Robert Walker ◽  
Edwin R. Nye ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Body Composition ◽  
Coronary Artery ◽  
Cardiac Rehabilitation ◽  
Physical Function ◽  
Handgrip Strength ◽  
Stable Coronary Artery Disease ◽  
Community Based ◽  
Artery Disease

Objective. To examine long-term changes in physical function and body composition in coronary artery disease (CAD) patients participating in ongoing community-based cardiac rehabilitation (CR).Design. Thirty-four individuals (69.7±8.2years; 79% men) participated in this longitudinal observational study. Baseline and follow-up assessments included incremental shuttle walk, short physical performance battery, handgrip strength, chair stands, body composition, last year physical activity, and CR attendance.Results. Participants attended38.5±30.3%sessions during1.6±0.2year followup. A significant increase in 30-second chair stands (17.0±4.7to19.6±6.4,P<0.001), body weight (75.8±11.1to77.2±12.1 kg,P=0.001), and body fat (27.0±9.5to29.1±9.6%,P<0.001) and a decline in handgrip strength (36.4±9.4to33.0±10.6kg·f,P<0.001) and muscle mass (40.8±5.6to39.3±5.8%,P<0.001) were observed during followup. There was no significant change in shuttle walk duration. CR attendance was not correlated to observed changes.Conclusions. Elderly CAD patients participating in a maintenance CR program improve lower-body muscle strength but experience a decline in handgrip strength and unfavourable changes in body composition, irrespective of CR attendance.

scholarly journals Cardio-Ankle Vascular Index Reflects Impaired Exercise Capacity and Predicts Adverse Prognosis in Patients With Heart Failure

2021 ◽  
Vol 8 ◽  
Author(s):  
Koichiro Watanabe ◽  
Akiomi Yoshihisa ◽  
Yu Sato ◽  
Yu Hotsuki ◽  
Fumiya Anzai ◽  
...  
Keyword(s):  
Heart Failure ◽  
Exercise Capacity ◽  
Cardiac Event ◽  
Event Rate ◽  
Characteristic Curve ◽  
Cardiopulmonary Exercise Testing ◽  
Multivariate Logistic Regression Analysis ◽  
Cardiac Events ◽  
Post Discharge ◽  
Cardiac Event Rate

Aims: We aimed to assess the associations of CAVI with exercise capacity in heart failure (HF) patients. In addition, we further examined their prognosis.Methods: We collected the clinical data of 223 patients who had been hospitalized for decompensated HF and had undergone both CAVI and cardiopulmonary exercise testing.Results: For the prediction of an impaired peak oxygen uptake (VO2) of &lt; 14 mL/kg/min, receiver-operating characteristic curve demonstrated that the cutoff value of CAVI was 8.9. In the multivariate logistic regression analysis for predicting impaired peak VO2, high CAVI was found to be an independent factor (odds ratio 2.343, P = 0.045). We divided these patients based on CAVI: the low-CAVI group (CAVI &lt; 8.9, n = 145) and the high-CAVI group (CAVI ≥ 8.9, n = 78). Patient characteristics and post-discharge cardiac events were compared between the two groups. The high-CAVI group was older (69.0 vs. 58.0 years old, P &lt; 0.001) and had lower body mass index (23.0 vs. 24.1 kg/m2, P = 0.013). During the post-discharge follow-up period of median 1,623 days, 58 cardiac events occurred. The Kaplan–Meier analysis demonstrated that the cardiac event rate was higher in the high-CAVI group than in the low-CAVI group (log–rank P = 0.004). The multivariate Cox proportional hazard analysis revealed that high CAVI was an independent predictor of cardiac events (hazard ratio 1.845, P = 0.035).Conclusion: High CAVI is independently associated with impaired exercise capacity and a high cardiac event rate in HF patients.

scholarly journals Effects of Renin‐Angiotensin–Aldosterone System Inhibitors on Long‐Term Major Adverse Cardiovascular Events in Sepsis Survivors

2021 ◽  
Author(s):  
Shu‐Yu Ou ◽  
Yi‐Jung Lee ◽  
Yuan Lo ◽  
Chen‐Hsiu Chen ◽  
Yu‐Chi Huang ◽  
...  
Keyword(s):  
Propensity Scores ◽  
Major Adverse Cardiovascular Events ◽  
Cardiac Events ◽  
Renin Angiotensin Aldosterone System ◽  
Renin Angiotensin ◽  
Adverse Cardiac Events ◽  
All Cause Mortality ◽  
Sepsis Survivors ◽  
Renal Hypoperfusion

Background Sepsis is known to increase morbidity and duration of hospital stay and is a common cause of mortality worldwide. Renin‐angiotensin‐aldosterone system inhibitors (RAASis) are commonly used to treat hypertension but are usually discontinued during hospitalization for sepsis because of concerns about renal hypoperfusion. The aim of our study was to investigate whether RAASis should be continued after discharge in sepsis survivors and to identify the effects on the clinical outcomes. Methods and Results A total of 9188 sepsis survivors aged 20 years and older who were discharged from January 1, 2012 to December 31, 2019 were included in our analyses. We further divided sepsis survivors into RAASi users and nonusers. These groups were matched by propensity scores before the outcomes of interest, including all‐cause mortality and major adverse cardiac events (MACE), were examined. After propensity score matching, 3106 RAASi users and 3106 RAASi nonusers were included in our analyses. Compared with RAASi nonusers, RAASi users had lower risks of all‐cause mortality (hazard ratio [HR], 0.68; 95% CI, 0.62–0.75), MACEs (HR, 0.87; 95% CI, 0.81–0.94), ischemic stroke (HR, 0.85; 95% CI, 0.76–0.96), myocardial infarction (HR, 0.74; 95% CI, 0.61–0.90), and hospitalization for heart failure (HR, 0.84; 95% CI, 0.77–0.92). Subgroup analyses stratified by admission to the ICU and the use of inotropes showed similar results. Conclusions In our study, we found that RAASi users had reduced risks of all‐cause mortality and MACEs. These findings suggested a beneficial effect of RAASi use by sepsis survivors after discharge.

Sign in / Sign up

Export Citation Format

Share Document