scholarly journals Do Patients Maintain Proper Long-Term Cardiopulmonary Fitness Levels After Cardiac Rehabilitation? A Retrospective Study Using Medical Records

2021 ◽  
Vol 45 (2) ◽  
pp. 150-159
Author(s):  
Chul Kim ◽  
Hee Eun Choi ◽  
Jin Hyuk Jang ◽  
Jun Hyeong Song ◽  
Byung-Ok Kim
Keyword(s):  
Retrospective Study ◽  
Exercise Training ◽  
Cardiac Rehabilitation ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Hospital Setting ◽  
Aerobic Exercise Training ◽  
Cardiopulmonary Fitness ◽  
Coronary Syndrome

Objective To examine whether patients who participated in a cardiac rehabilitation (CR) program after hospitalization for acute coronary syndrome maintained cardiorespiratory fitness (CRF) in the community.Methods We conducted a retrospective study including 78 patients who underwent percutaneous coronary intervention or coronary artery bypass graft surgery at our hospital’s cardiovascular center and participated in a CR program and a 5-year follow-up evaluation. Patients were divided into a center-based CR (CBCR) group, participating in an electrocardiography-monitored exercise training in a hospital setting, and a home-based CR (HBCR) group, receiving aerobic exercise training and performed self-exercise at home.Results No significant differences were found between groups (p>0.05), except the proportion of non-smokers (CBCR 59.5% vs. HBCR 31.7%; p=0.01). In both groups, the maximal oxygen consumption (VO<sub>2max</sub>) increased significantly during the first 12 weeks of follow-up and remained at a steady state for the first year, but it decreased after the 1-year follow-up. Particularly, VO<sub>2max</sub> at 5 years decreased below the baseline value in the HBCR group. In the low CRF group, the CRF level significantly improved at 12 weeks, peaked at 1 year, and was still significantly different from the baseline value after 5 years. The high CRF group did not show any significant increase over time relative to the baseline value, but most patients in the high CRF group maintained relatively appropriate CRF levels after 5 years.Conclusion Continuous support should be provided to patients to maintain optimal CRF levels after completing a CR program.

Abstract 3543: Long-Term Benefits of Cardiac Rehabilitation in Patients With Incomplete Revascularization: 5-Year Follow-up.

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Romualdo Belardinelli ◽  
Francesca Lacalaprice ◽  
GianPiero Piccoli ◽  
Gianfranco Iacobone ◽  
Roberto Piva
Keyword(s):  
Coronary Artery ◽  
Exercise Training ◽  
Cardiac Rehabilitation ◽  
Artery Bypass ◽  
Intervention Group ◽  
Exercise Stress ◽  
Control Group ◽  
Coronary Syndrome ◽  
Peak Vo2 ◽  
Incomplete Revascularization

There is evidence that cardiac rehabilitation (CR) determines important benefits in patients with coronary artery disease(CAD). However, it is unclear whether CR may improve the outcome of pts with incomplete revascularization (IR) after PTCA/stenting and/or coronary artery bypass surgery (CABG). From 1/1/2002 to 30/11/2004, we prospectively studied 259 patients with CAD who underwent PTCA after a SCA or CABG in 1(10/7%, respectively), 2(20/19%) and 3 major coronary arteries (70/74%). Patients were randomized into 2 homogeneous groups on the basis of the results of cardiopulmonary exercise stress testing(CPET) performed twice one week apart: a group with a positive CPET for inducible ischemia (P, n=129), and a group with a negative CPET (N, n=130). Patients were further randomized into 2 groups. The intervention group(Group CR) received CR combining exercise training (60%peak VO2, 3 times a week for 8 weeks)+ nutrition counseling+ standard medications (65P+65N, 25% women, mean age 56±8 years), while the control group (Group C) had no CR (65P+64N, 25% women, mean age 58±8 years). On entry and at 8 weeks all patients underwent CPET, brachial artery flow-mediated dilation (BA-FMD) and blood chemistry. Group CR-N had more marked improvements in peak VO2 and FMD than CR-P (P<0.001 for both). However, CPET became negative in 22% post PTCA CR-P patients and 28% post CABG CR-P (P<0.001 vs initial). After 8 weeks, group CR was recommended to continue a home program of exercise training with periodic supervision at the hospital’s gym, while group C was not. At 5 years, both peak VO2 and FMD were significantly higher in CR (P<0.01 vs C) with no differences between CR-P and CR-N. Cardiovascular risk profile (CVRP) was significantly improved in CR (P<0.01 vs C). Cardiac events were significantly lower in CR than C : new acute coronary syndrome (P<0.001); new PCI (P<0.0001); new CABG(P<0.001); hospital readmission: (P<0.0001); cardiac death (P<0.05). Multivariate analysis demonstrated that the lower rate of events in CR was not collinear with changes in CVRP. In conclusion, IHD patients with IR take advantage from CR and maintain a higher functional capacity and a better control of CVRP at 5 years. These benefits were associated with a better outcome.

scholarly journals Impact of and Reasons for Not Performing Exercise Training After an Acute Coronary Syndrome in the Setting of an Interdisciplinary Cardiac Rehabilitation Program: Results From a Risk-Op- Acute Coronary Syndrome Ambispective Registry

2021 ◽  
Vol 12 ◽  
Author(s):  
Ignacio Cabrera-Aguilera ◽  
Consolació Ivern ◽  
Neus Badosa ◽  
Ester Marco ◽  
Luís Salas-Medina ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Exercise Training ◽  
Cardiac Rehabilitation ◽  
Primary Endpoint ◽  
Multivariable Analysis ◽  
Rehabilitation Program ◽  
Work Schedule ◽  
Structural Barriers ◽  
Coronary Syndrome

Background and Aims: Exercise training (ET) is a critical component of cardiac rehabilitation (CR), but it remains underused. The aim of this study was to compare clinical outcomes between patients who completed ET (A-T), those who accepted ET but did not complete it (A-NT), and those who did not accept to undergo it (R-NT), and to analyze reasons for rejecting or not completing ET.Methods and Results: A unicenter ambispective observational registry study of 497 patients with acute coronary syndrome (ACS) was carried out in Barcelona, Spain, from 2016 to 2019. The primary endpoint was a composite of all-cause mortality, hospitalization for ACS, or need for revascularization during follow-up. Multivariable analysis was carried out to identify variables independently associated with the primary outcome. Initially, 70% of patients accepted participating in the ET, but only 50.5% completed it. The A-T group were younger and had fewer comorbidities. Baseline characteristics in A-NT and R-NT groups were very similar. The main reason for not undergoing or completing ET was rejection (reason unknown) or work/schedule incompatibility. The median follow-up period was 31 months. Both the composite primary endpoint and mortality were significantly lower in the A-T group compared to the A-NT and R-NT (primary endpoint: 3.6% vs. 23.2% vs. 20.4%, p &lt; 0.001, respectively; mortality: 0.8% vs. 9.1% vs. 8.2%, p &lt; 0.001; respectively). During multivariable analysis, the only variables that remained statistically significant with the composite endpoint were ET completion, previous ACS, and anemia.Conclusion: Completion of ET after ACS was associated with improved prognosis. Only half of the patients completed the ET program, with the leading reasons for not completing it being refusal (reason unknown) and work/schedule incompatibility. These results highlight the need to focus on the needs of patients in order to guarantee that structural barriers to ET no longer exist.

scholarly journals Impact of cognitive performance on disease-related knowledge six months after multi-component rehabilitation in patients after an acute cardiac event

2018 ◽  
Vol 26 (1) ◽  
pp. 46-55 ◽  
Author(s):  
Annett Salzwedel ◽  
Maria-Dorothea Heidler ◽  
Karin Meng ◽  
Martin Schikora ◽  
Karl Wegscheider ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Coronary Artery Bypass Graft ◽  
Cardiac Rehabilitation ◽  
Cognitive Performance ◽  
Coronary Artery Bypass ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Medical Knowledge ◽  
Artery Bypass Graft

Background Although associations between cardiovascular diseases and cognitive impairment are well known, the impact of cognitive performance on the success of patient education as a core component of cardiac rehabilitation remains insufficiently investigated so far. Design Prospective observational study in two inpatient cardiac rehabilitation centres between September 2014 and August 2015 with a follow-up six months after cardiac rehabilitation. Method At admission to and discharge from cardiac rehabilitation, the cognitive performance of 401 patients (54.5 ± 6.3 years, 80% men) following an acute coronary syndrome and/or coronary artery bypass graft was tested using the Montreal Cognitive Assessment. Patients’ disease-related knowledge was determined using a quiz (22 items for medical knowledge and 12 items for healthy lifestyle and behaviour) at both times and at follow-up. The change in knowledge after cardiac rehabilitation was analysed in multivariable regression models. Potentially influencing parameters (e.g. level of education, medication, cardiovascular risk factors, coronary artery bypass graft, comorbidities, exercise capacity) were considered. Results During cardiac rehabilitation, disease-related knowledge was significantly enhanced in both scales. At follow-up, the average level of medical knowledge was significantly reduced, while lifestyle knowledge remained at a stable level. The maintenance of knowledge after cardiac rehabilitation was predominantly predicted by prior knowledge, cognitive performance at discharge from cardiac rehabilitation and, in the case of medical knowledge, by coronary artery bypass graft. Conclusion Patient education in cardiac rehabilitation led to enhanced disease-related knowledge, but the maintenance of this essentially depended on patients’ cognitive performance, especially after coronary artery bypass graft. Therefore, patient education concepts in cardiac rehabilitation should be reconsidered and adjusted as needed.

Abstract 164: Adherence to Oral Antiplatelet (OAP) Therapy among ACS Patients Undergoing Percutaneous Coronary Intervention (PCI)

2014 ◽  
Vol 7 (suppl_1) ◽  
Author(s):  
David M Kern ◽  
Durgesh Bhandary ◽  
Ozgur Tunceli ◽  
Bingcao Wu
Keyword(s):  
Medication Adherence ◽  
Antiplatelet Therapy ◽  
Beta Blockers ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Healthcare Providers ◽  
Coronary Intervention ◽  
Index Hospitalization ◽  
Coronary Syndrome

Background: The benefit of oral antiplatelet therapy following PCI is well established. Dual antiplatelet therapy is guideline recommended treatment for one year following a PCI. Objective: To examine discontinuation and adherence rates of oral anti-platelet therapy of patients with acute coronary syndrome (ACS) in the year following a PCI. Methods: From the HealthCore Integrated Research Environment, patients ≥18 years old and hospitalized for ACS (inpatient hospitalization with a primary diagnosis for acute myocardial infarction or unstable angina) during 8/1/09-6/30/13 (index hospitalization) were identified and followed up to 12 months. Patients with an OAP prescription fill within 6 months prior to the index hospitalization, those with a fill for ticagrelor at any time during the study period, those simultaneously starting clopidogrel and prasugrel following the index hospitalization, and those who had a coronary artery bypass graft during index hospitalization were excluded. OAP prescription utilization patterns were examined drug class (clopidogrel or prasugrel) as a whole and by branded versus generic clopidogrel. Medication adherence to OAP therapy was assessed as discontinuation (a period of >45 days not covered by supply of OAP therapy) and the proportion of days covered (PDC; calculated as total day supply during the follow-up divided by days from first fill to end of follow-up). Results: Of 38,626 ACS patients identified, 20,753 were revascularized with PCI during the index hospitalization, and 17,237 (83.1%) went on to fill an OAP prescription (12,714 with clopidogrel as first OAP treatment; 4,523 with prasugrel). On average, patients filled OAP medication 6.7 days following index hospitalization discharge (71% filled on discharge date). The study also found that 20% of patients discontinued OAP therapy during follow-up and 86% of follow-up days were covered by an OAP therapy supply on average. Other medication classes within the same patients had higher discontinuation rates and lower PDC: anti-hypertensive (27% discontinuation; 82% PDC), anti-diabetics (27%; 83%) statins (27%; 82%), and beta-blockers (37%; 72%). Discontinuation rates were considerably lower in patients taking generic clopidogrel versus those filling branded drug (11% for generic vs. 37% for branded) and PDC was higher for generic clopidogrel (90% PDC vs. 75% for branded). Conclusions: Adherence to OAP therapy compares favorably to adherence rates of other cardiovascular/metabolic medications taken by the same patients. Lower out of pocket costs were also associated with better refill compliance. The above findings present healthcare providers with an opportunity to further improve on medication adherence post-PCI in ACS patients by reducing the economic burden on patients.

scholarly journals The Canadian Cardiac Rehabilitation Registry: Inaugural Report on the Status of Cardiac Rehabilitation in Canada

2015 ◽  
Vol 2015 ◽  
pp. 1-6 ◽  
Author(s):  
Sherry L. Grace ◽  
Trisha L. Parsons ◽  
Kristal Heise ◽  
Simon L. Bacon
Keyword(s):  
Cardiac Rehabilitation ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Wait Time ◽  
Coronary Intervention ◽  
Discharge Data ◽  
Beneficial Effects ◽  
Coronary Syndrome ◽  
The Status ◽  
The Impact

Introduction. There are over 200 Cardiovascular Rehabilitation (CR) programs in Canada, providing services to more than 50,000 new patients annually. The objective of this study was to describe the impact of CR in Canada.Methods. A retrospective analysis of Canadian CR Registry data is presented. There were 12 programs participating, with 4546 CR participants.Results. The average wait time between patient referral and CR admission was 68 ± 64 days. Participants were 66.3 ± 11.5 years old, 71% male, and 82% White. The three leading referral events were coronary artery bypass graft surgery, percutaneous coronary intervention, and acute coronary syndrome. At discharge, data were available for ~90% of participants. Significant improvements in blood pressure (systolic pre-CR 123.5 ± 17.0, post-CR 121.5 ± 15.8 mmHg;p<.001), lipids, adiposity, and exercise capacity (peak METs pre-CR 6.5 ± 2.8, post-CR 7.2 ± 3.1;p<.001) were observed. However, target attainment for some risk factors was suboptimal.Conclusions. This report provides the first snapshot of the beneficial effects of CR in Canada. Not all patients are equally represented in these programs, however, leaving room for more referral of diverse patients. Greater attainment of risk reduction targets should be pursued.

Noninvasive Follow-Up of Coronary Artery Bypass Graft Patency Using Multi-Slice Computed Tomography

2006 ◽  
Vol 55 (5) ◽  
pp. 451
Author(s):  
Seung Ho Joo ◽  
Byoung Wook Choi ◽  
Jae Seung Seo ◽  
Young Jin Kim ◽  
Tae Hoon Kim ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Coronary Artery ◽  
Coronary Artery Bypass Graft ◽  
Coronary Artery Bypass ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Graft Patency ◽  
Artery Bypass Graft

Exclusive Bilateral Internal Thoracic Artery Grafts for Myocardial Revascularization Requiring Four Anastomoses or More: Outcomes from a Single Center Experience

2016 ◽  
Vol 65 (04) ◽  
pp. 265-271
Author(s):  
Andrea Perrotti ◽  
Enrica Dorigo ◽  
Camille Durst ◽  
Djamel Kaili ◽  
Sidney Chocron ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Internal Thoracic Artery ◽  
Artery Bypass ◽  
Univariate Analysis ◽  
Bypass Graft ◽  
Myocardial Revascularization ◽  
Wound Complication ◽  
Safe Procedure ◽  
Off Pump

Introduction Multivessel coronary artery bypass graft (CABG) with bilateral internal thoracic arteries (BITA) has only been uncommon and technically demanding. We describe our experience with BITA only CABGs requiring ≥ 4 anastomoses. Material and Methods The department's database was queried for patients undergoing isolated CABG with ≥ 4 anastomoses. The surgical technique included systematically a right internal thoracic artery (ITA) of left ITA Y graft. The multivariate model included variables with a p < 0.3 at univariate analysis. Results Between January 2006 and December 2009, 251 consecutive patients (71 ± 10 years) (on-pump: 130, off-pump: 121) had CABG with ≥ 4 anastomoses, representing 21% of total isolated CABGs for the same period; all patients received a totally arterial BITA only revascularization. Follow-up was 4.9 ± 1.6 years. Overall and cardiac cumulative survivals were 78 and 92%, respectively, at 5 years. The occurrence of any major postoperative complication was associated with overall and cardiac mortality (odds ratio [OR]: 3.6, 95% confidence interval [CI]: 1.3–9.9 and OR: 5.4, 95% CI: 1.3–21.9, respectively). Major sternal wound complication requiring surgical revision was not associated with impaired glucose control (n = 9; diabetics: 6/82, 7.3%; nondiabetics: 3/169, 1.8%, p = 0.06). Preoperative kidney failure was associated with incomplete revascularization (OR: 6.2; 95% CI: 1.2–33.5), that was unfailingly due to ungraftable right coronary artery targets. Discussion BITA only revascularization was a valuable and safe procedure, with favorable results in terms of morbidity and mortality at a 5 years' follow-up.

Impact of cardiac rehabilitation on 3 year outcomes amongst patients after acute coronary syndrome: (ACS) SNAPSHOT ACS follow-up study

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
J Redfern ◽  
K Hyun ◽  
D Brieger ◽  
D Chew ◽  
J French ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Cardiac Rehabilitation ◽  
Data Linkage ◽  
Research Network ◽  
Funding Source ◽  
Cardiovascular Research ◽  
Coronary Syndrome ◽  
Follow Up Study ◽  
Significant Difference

Abstract Background Cardiovascular disease is the leading cause of disease burden globally. With advancements in medical and surgical care more people are surviving initial acute coronary syndrome (ACS) and are in need of secondary prevention and cardiac rehabilitation (CR). Increasing availability of high quality individual-level data linkage provides robust estimates of outcomes long-term. Purpose To compare 3 year outcomes amongst ACS survivors who did and did not participate in Australian CR programs. Methods SNAPSHOT ACS follow-up study included 1806 patients admitted to 232 hospitals who were followed-up by data linkage (cross-jurisdictional morbidity, national death index, Pharmaceutical Benefit Schedule) at 6 and 36 months to compare those who did/not attend CR. Results In total, the cohort had a mean age of 65.8 (13.4) years, 60% were male, only 25% (461/1806) attended CR. During index admission, attendees were more likely to have had PCI (39% v 14%, p&lt;0.001), CABG (11% v 2%, p&lt;0.001) and a diagnosis of STEMI (21% v 5%, p&lt;0.001) than those who did not attend. However, there was no significant difference between CR attendees/non-attendees for risk factors (LDL-cholesterol, smoking, obesity). Only 19% of eligible women attended CR compared to 30% of men (p&lt;0.001). At 36 months, there were fewer deaths amongst CR attendees (19/461, 4.1%) than non-attendees (116/1345, 8.6%) (p=0.001). CR attendees were more likely to have repeat ACS, PCI, CABG at both 6 and 36 months (Table). At 36 months, CR attendees were more likely to have been prescribed antiplatelets (78% v 53%, p&lt;0.001), statins (91% 73%, p&lt;0.001), beta-blockers (11% v 13%, p=0.002) and ACEI/ARBs (72% v 61%, p&lt;0.001) than non-attendees. Conclusions Amongst Australian ACS survivors, participation in CR was associated with less likelihood of death and increased prescription of pharmacotherapy. However, attendance at CR was associated with higher rates of repeat ACS and revascularisation. Funding Acknowledgement Type of funding source: Foundation. Main funding source(s): New South Wales Cardiovascular Research Network, National Heart Foundation

Sign in / Sign up

Export Citation Format

Share Document