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Galappatthy P, Bataduwaarachchi VR, Ranasinghe P, Galappatthy GKS, Wijayabandara M, Warapitiya DS, Sivapathasundaram M, Wickramarathna T, Senarath U, Sridharan S, Wijeyaratne CN, Ekanayaka R. Management, characteristics and outcomes of patients with acute coronary syndrome in Sri Lanka. Heart 2018; 104:1424-1431. [DOI: 10.1136/heartjnl-2017-312404] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Revised: 01/05/2018] [Accepted: 01/15/2018] [Indexed: 11/04/2022] Open
Abstract
BackgroundIschaemic heart disease is the leading cause of in-hospital mortality in Sri Lanka. Acute Coronary Syndrome Sri Lanka Audit Project (ACSSLAP) is the first national clinical-audit project that evaluated patient characteristics, clinical outcomes and care provided by state-sector hospitals.MethodsACSSLAP prospectively evaluated acute care, in-hospital care and discharge plans provided by all state-sector hospitals managing patients with ACS. Data were collected from 30 consecutive patients from each hospital during 2–4 weeks window. Local and international recommendations were used as audit standards.ResultsData from 87/98 (88.7%) hospitals recruited 2177 patients, with 2116 confirmed as having ACS. Mean age was 61.4±11.8 years (range 20–95) and 58.7% (n=1242) were males. There were 813 (38.4%) patients with unstable angina, 695 (32.8%) with non-ST-elevation myocardial infarction (NSTEMI) and 608 (28.7%) with ST-elevation myocardial infarction (STEMI). Both STEMI (69.9%) and NSTEMI (61.4%) were more in males (P<0.001). Aspirin, clopidogrel and statins were given to over 90% in acute setting and on discharge. In STEMI, 407 (66.9%) were reperfused; 384 (63.2%) were given fibrinolytics and only 23 (3.8%) underwent primary percutaneous coronary intervention (PCI). Only 42.3 % had thrombolysis in <30 min and 62.5% had PCI in <90 min. On discharge, beta-blockers and ACE inhibitors/angiotensin II receptor blockers were given to only 50.7% and 69.2%, respectively and only 17.6% had coronary interventions planned.ConclusionsIn patients with ACS, aspirin, clopidogrel and statin use met audit standards in acute setting and on discharge. Vast majority of patients with STEMI underwent fibrinolyisis than PCI, due to limited resources. Primary PCI, planned coronary interventions and timely thrombolysis need improvement in Sri Lanka.
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Abstract
Symptom-limited (maximal) exercise testing before cardiac rehabilitation (CR) was once an unambiguous standard of care. In particular, it served as an important screen for residual ischemia and instability before initiating a progressive exercise training regimen. However, improved revascularization and therapy for coronary heart disease has led many clinicians to downplay this application of exercise testing, especially because such testing is also a potential encumbrance to CR enrollment (delaying ease and efficiency of enrollment after procedures and hospitalizations) and patient burden (eg, added costs, logistic hassle, and anxiety). Nonetheless, exercise testing has enduring value for CR, especially because it reveals dynamic physiological responses as well as ischemia, arrhythmias, and symptoms pertinent to exercise prescription and training and to overall stability and prognosis. Moreover, as indications for CR have expanded, the value of exercise testing and functional assessment is more relevant than ever in the growing population of eligible patients, including those with heart failure, valvular heart disease, and posttransplantation, especially as current patients also tend to be more clinically complex, with advanced ages, multimorbidity, frailty, and obesity. This review focuses on the appropriate use of exercise testing in the CR setting. Graded exercise tests, cardiopulmonary exercise tests, submaximal walking tests, and other functional assessments (strength, frailty) for CR are discussed.
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Supervía M, Medina-Inojosa JR, Yeung C, Lopez-Jimenez F, Squires RW, Pérez-Terzic CM, Brewer LC, Leth SE, Thomas RJ. Cardiac Rehabilitation for Women: A Systematic Review of Barriers and Solutions. Mayo Clin Proc 2017; 92:S0025-6196(17)30026-5. [PMID: 28365100 PMCID: PMC5597478 DOI: 10.1016/j.mayocp.2017.01.002] [Citation(s) in RCA: 142] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Revised: 12/28/2016] [Accepted: 01/04/2017] [Indexed: 10/19/2022]
Abstract
Cardiac rehabilitation (CR) services improve various clinical outcomes in patients with cardiovascular disease, but such services are underutilized, particularly in women. The aim of this study was to identify evidence-based barriers and solutions for CR participation in women. A literature search was carried out using PubMed, EMBASE, Cochrane, OVID/Medline, and CINAHL to identify studies that have assessed barriers and/or solutions to CR participation. Titles and abstracts were screened, and then the full-text of articles that met study criteria were reviewed. We identified 24 studies that studied barriers to CR participation in women and 31 studies that assessed the impact of various interventions to improve CR referral, enrollment, and/or completion of CR in women. Patient-level barriers included lower education level, multiple comorbid conditions, non-English native language, lack of social support, and high burden of family responsibilities. We found support for the use of automatic referral and assisted enrollment to improve CR participation. A small number of studies suggest that incentive-based strategies, as well as home-based programs, may contribute to improving CR attendance and completion rates. A systematic approach to CR referral, including automatic CR referral, may help overcome barriers to CR referral in women and should be implemented in clinical practice. However, more studies are needed to help identify the best methods to improve CR attendance and completion of CR rates in women.
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Affiliation(s)
- Marta Supervía
- Cardiovascular Rehabilitation Program, Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN
| | - Jose R Medina-Inojosa
- Cardiovascular Rehabilitation Program, Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN
| | - Colin Yeung
- Cardiovascular Rehabilitation Program, Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN
| | - Francisco Lopez-Jimenez
- Cardiovascular Rehabilitation Program, Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN
| | - Ray W Squires
- Cardiovascular Rehabilitation Program, Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN
| | - Carmen M Pérez-Terzic
- Cardiovascular Rehabilitation Program, Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN; Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN
| | - LaPrincess C Brewer
- Cardiovascular Rehabilitation Program, Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN
| | - Shawn E Leth
- Cardiovascular Rehabilitation Program, Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN
| | - Randal J Thomas
- Cardiovascular Rehabilitation Program, Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN.
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Ades PA, Keteyian SJ, Wright JS, Hamm LF, Lui K, Newlin K, Shepard DS, Thomas RJ. Increasing Cardiac Rehabilitation Participation From 20% to 70%: A Road Map From the Million Hearts Cardiac Rehabilitation Collaborative. Mayo Clin Proc 2017; 92:234-242. [PMID: 27855953 PMCID: PMC5292280 DOI: 10.1016/j.mayocp.2016.10.014] [Citation(s) in RCA: 296] [Impact Index Per Article: 37.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Revised: 10/11/2016] [Accepted: 10/12/2016] [Indexed: 02/07/2023]
Abstract
The primary aim of the Million Hearts initiative is to prevent 1 million cardiovascular events over 5 years. Concordant with the Million Hearts' focus on achieving more than 70% performance in the "ABCS" of aspirin for those at risk, blood pressure control, cholesterol management, and smoking cessation, we outline the cardiovascular events that would be prevented and a road map to achieve more than 70% participation in cardiac rehabilitation (CR)/secondary prevention programs by the year 2022. Cardiac rehabilitation is a class Ia recommendation of the American Heart Association and the American College of Cardiology after myocardial infarction or coronary revascularization, promotes the ABCS along with lifestyle counseling and exercise, and is associated with decreased total mortality, cardiac mortality, and rehospitalizations. However, current participation rates for CR in the United States generally range from only 20% to 30%. This road map focuses on interventions, such as electronic medical record-based prompts and staffing liaisons that increase referrals of appropriate patients to CR, increase enrollment of appropriate individuals into CR, and increase adherence to longer-term CR. We also calculate that increasing CR participation from 20% to 70% would save 25,000 lives and prevent 180,000 hospitalizations annually in the United States.
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Affiliation(s)
- Philip A Ades
- Cardiac Rehabilitation and Prevention Program, University of Vermont College of Medicine, Burlington, VT.
| | | | - Janet S Wright
- Million Hearts, Centers for Disease Control and Prevention, Atlanta, GA
| | - Larry F Hamm
- Clinical Exercise Physiology Program, Department of Exercise and Nutrition Sciences, George Washington University, Washington, DC
| | | | - Kimberly Newlin
- Cardiac and Pulmonary Rehabilitation, Sutter Roseville Medical Center, Roseville, CA
| | - Donald S Shepard
- Heller School for Social Policy and Management, Brandeis University, Waltham, MA
| | - Randal J Thomas
- Cardiac Rehabilitation Program, Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN
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Dickins KA, Braun LT. Promotion of Physical Activity and Cardiac Rehabilitation for the Management of Cardiovascular Disease. J Nurse Pract 2017. [DOI: 10.1016/j.nurpra.2016.10.026] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Goyal P, Delgado D, Hummel SL, Dharmarajan K. Impact of Exercise Programs on Hospital Readmission Following Hospitalization for Heart Failure: A Systematic Review. CURRENT CARDIOVASCULAR RISK REPORTS 2016; 10. [PMID: 28713480 DOI: 10.1007/s12170-016-0514-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Given persistently high 30-day readmission rates among patients hospitalized for heart failure, there is an ongoing need to identify new interventions to reduce readmissions. Although exercise programs can improve outcomes among ambulatory heart failure patients, it is not clear whether this benefit extends to reducing readmissions following heart failure hospitalization. We therefore conducted a systematic review of the literature to identify randomized controlled trials examining the impact of exercise programs on hospital readmissions among patients recently hospitalized for heart failure. We searched Ovid MEDLINE, EMBASE, and the Wiley Cochrane Library for studies that fulfilled pre-defined criteria, including that the exercise program pre-specify activity type and exercise frequency, duration, and intensity. Exercise interventions could occur at any location including within the hospital, at an outpatient facility, or at home. Among 1213 unique publications identified, only one study fulfilled inclusion criteria. This study was a single-site randomized controlled trial that consisted of a 12-week exercise program in a cohort of 105 patients with a principal diagnosis of HF at a metropolitan hospital in Australia. This study revealed a reduction in 12-month all-cause and cardiovascular-related hospitalization rates. However, inferences were limited by its single-site study design, small sample size, premature termination, and high risk for selection, performance, and detection bias. As no studies have built upon the findings of this study, it remains unknown whether exercise programs can improve readmission rates among patients recently hospitalized for heart failure, a significant gap in the literature.
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Affiliation(s)
- Parag Goyal
- Chief Fellow, Division of Cardiology, Weill Cornell Medicine, 525 East 68 Street, New York, NY 10021, USA, , ,
| | - Diana Delgado
- Weill Cornell Medicine, 1300 York Avenue, New York, NY, USA
| | - Scott L Hummel
- University of Michigan, 1500 E. Medical Center Drive, Ann Arbor, MI, USA
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Employment Status and Participation in Cardiac Rehabilitation: DOES ENCOURAGING EARLIER ENROLLMENT IMPROVE ATTENDANCE? J Cardiopulm Rehabil Prev 2016; 35:390-8. [PMID: 26468632 DOI: 10.1097/hcr.0000000000000140] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE For patients hospitalized for a cardiac event, an earlier appointment to outpatient cardiac rehabilitation (CR) increases participation. However, it is unknown what effect hastening CR enrollment might have among employed patients planning to return to work (RTW). METHODS Using 2 complementary data sets from Henry Ford Hospital (HFH) and Mayo Clinic, we assessed when employed patients eligible for CR anticipated a RTW, the impact of an earlier appointment on CR enrollment, and the effect of employment status on the number of CR sessions attended. Patients at HFH attended CR at either 8 or 42 days (through randomization), whereas Mayo Clinic patients attended 10 days after hospital discharge per standard routines. RESULTS Among 148 patients at HFH, 65 (44%) were employed and planned to RTW. Of these, 67% desired to RTW within 1 to 2 weeks, whereas 28% anticipated an RTW within 1 to 3 days. Home financial strain predicted nonparticipation in CR (P < .001) and was associated with an earlier planned RTW. Among 1030 patients at Mayo Clinic, 393 (38%) were employed. Employed (vs nonemployed) patients enrolled in CR 3.3 days sooner (P < .001), but attended 1.6 fewer CR sessions (P = .04). In employed patients from both health systems, an earlier (vs later) appointment to CR did not result in additional exercise sessions of CR. CONCLUSIONS Employed patients plan to RTW quickly, in part because of home finances. They also enroll earlier into CR than nonemployed patients. Despite these findings, earlier appointments do not seem to favorably impact overall CR participation.
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Hautala AJ, Kiviniemi AM, Mäkikallio T, Koistinen P, Ryynänen OP, Martikainen JA, Seppänen T, Huikuri HV, Tulppo MP. Economic evaluation of exercise-based cardiac rehabilitation in patients with a recent acute coronary syndrome. Scand J Med Sci Sports 2016; 27:1395-1403. [PMID: 27541076 DOI: 10.1111/sms.12738] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/28/2016] [Indexed: 01/14/2023]
Abstract
Health care decision-making requires evidence of the cost-effectiveness of medical therapies. We evaluated the cost-effectiveness of exercise-based cardiac rehabilitation (ECR) implemented according to guidelines. All the patients (n = 204) had experienced a recent acute coronary syndrome and were randomized to a 1-year ECR (n = 109) or usual care (UC) group (n = 95). The patients' health-related quality of life was followed using the 15D instrument and health care costs were collected from electronic health registries. The cost-effectiveness of ECR was estimated based on intervention and health care costs and quality-adjusted life years (QALYs) gained. The total average cost per patient was lower in ECR than in UC. The incremental cost was divided by the baseline-adjusted incremental QALYs (0.045), yielding an incremental cost-effectiveness ratio of -€24511/QALYs. A combined endpoint of mortality, recurrent coronary event, or hospitalization for a heart failure occurred for five patients in ECR and 16 patients in UC (HR 3.9, 95% CI 1.4-10.6, P = 0.004, relative risk reduction 73%, number needed to treat eight). ECR is a dominant treatment option and decreases the occurrence of adverse cardiac events. These results are useful for decision-making when planning optimal utilization of resources in Finnish health care.
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Affiliation(s)
- A J Hautala
- Center for Machine Vision and Signal Analysis, Faculty of Information Technology and Electrical Engineering, University of Oulu, Oulu, Finland
| | - A M Kiviniemi
- Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - T Mäkikallio
- Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - P Koistinen
- Social and Health Services, City of Oulu, Oulu, Finland
| | - O-P Ryynänen
- Kuopio University Hospital, University of Eastern Finland, Kuopio, Finland
| | - J A Martikainen
- Pharmacoeconomics & Outcomes Research Unit, School of Pharmacy, University of Eastern Finland, Kuopio, Finland
| | - T Seppänen
- Center for Machine Vision and Signal Analysis, Faculty of Information Technology and Electrical Engineering, University of Oulu, Oulu, Finland
| | - H V Huikuri
- Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - M P Tulppo
- Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
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Baldasseroni S, Pratesi A, Francini S, Pallante R, Barucci R, Orso F, Burgisser C, Marchionni N, Fattirolli F. Cardiac Rehabilitation in Very Old Adults: Effect of Baseline Functional Capacity on Treatment Effectiveness. J Am Geriatr Soc 2016; 64:1640-5. [DOI: 10.1111/jgs.14239] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Affiliation(s)
- Samuele Baldasseroni
- Department of Experimental and Clinical Medicine; University of Florence and Azienda Ospedaliero Universitaria Careggi; Florence Italy
| | - Alessandra Pratesi
- Department of Experimental and Clinical Medicine; University of Florence and Azienda Ospedaliero Universitaria Careggi; Florence Italy
| | - Sara Francini
- Department of Experimental and Clinical Medicine; University of Florence and Azienda Ospedaliero Universitaria Careggi; Florence Italy
| | - Rachele Pallante
- Department of Experimental and Clinical Medicine; University of Florence and Azienda Ospedaliero Universitaria Careggi; Florence Italy
| | - Riccardo Barucci
- Department of Experimental and Clinical Medicine; University of Florence and Azienda Ospedaliero Universitaria Careggi; Florence Italy
| | - Francesco Orso
- Department of Experimental and Clinical Medicine; University of Florence and Azienda Ospedaliero Universitaria Careggi; Florence Italy
| | - Costanza Burgisser
- Department of Experimental and Clinical Medicine; University of Florence and Azienda Ospedaliero Universitaria Careggi; Florence Italy
| | - Niccolò Marchionni
- Department of Experimental and Clinical Medicine; University of Florence and Azienda Ospedaliero Universitaria Careggi; Florence Italy
| | - Francesco Fattirolli
- Department of Experimental and Clinical Medicine; University of Florence and Azienda Ospedaliero Universitaria Careggi; Florence Italy
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Oosenbrug E, Marinho RP, Zhang J, Marzolini S, Colella TJF, Pakosh M, Grace SL. Sex Differences in Cardiac Rehabilitation Adherence: A Meta-analysis. Can J Cardiol 2016; 32:1316-1324. [PMID: 27129618 DOI: 10.1016/j.cjca.2016.01.036] [Citation(s) in RCA: 120] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Revised: 01/18/2016] [Accepted: 01/19/2016] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Cardiac rehabilitation (CR) participation is associated with significantly lower mortality, and this benefit has been established as dose-dependent. Because it has been suggested that women are adherent to CR programs less than men, the objective of this study was to review CR adherence among women and men, and to determine whether a sex difference exists. METHODS MedLine, CINAHL, EMBASE, PsycINFO, and the Cochrane databases were systematically searched. Titles and abstracts were screened, and selected full-text articles were independently considered on the basis of predefined inclusion/exclusion criteria. Data from included articles were extracted by 2 authors independently and assessed for quality. The meta-analysis was undertaken with predefined subgroup analyses. RESULTS The search identified 5148 articles, of which 149 were fully examined for inclusion consideration. Fourteen studies reporting data on 8176 participants (2234 [27.3%] women) were included. Overall, CR adherence ranged from 36.7% to 84.6% of sessions, with a mean of 66.5 ± 18.2% (median, 72.5%). Men and women enrolled in CR adhered to 68.6% and 64.2% of prescribed sessions, respectively (mean difference = -3.6; 95% confidence interval, -6.9 to -0.3). The sex difference persisted in studies of high quality, that were undertaken in Canada, published since 2010, and where programs were longer than 12 weeks' duration and offered fewer than 3 sessions per week. CONCLUSIONS To our knowledge, this is the first meta-analysis to systematically report CR adherence rates, and results suggest that patients adhere to more than two-thirds of prescribed sessions. CR adherence is significantly lower among women than men. Identified strategies to promote adherence need to be tested among women.
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Affiliation(s)
| | | | - Jie Zhang
- York University, Toronto, Ontario, Canada
| | - Susan Marzolini
- Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
| | - Tracey J F Colella
- Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada; University of Toronto, Toronto, Ontario, Canada
| | - Maureen Pakosh
- Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
| | - Sherry L Grace
- York University, Toronto, Ontario, Canada; Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada; University of Toronto, Toronto, Ontario, Canada.
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Fell J, Dale V, Doherty P. Does the timing of cardiac rehabilitation impact fitness outcomes? An observational analysis. Open Heart 2016; 3:e000369. [PMID: 26870390 PMCID: PMC4746523 DOI: 10.1136/openhrt-2015-000369] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2015] [Revised: 01/07/2016] [Accepted: 01/08/2016] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES To ascertain the characteristics associated with delayed cardiac rehabilitation (CR) and determine if an association between CR timing and fitness outcomes exists in patients receiving routine care. METHODS The study used data from the UK National Audit of Cardiac Rehabilitation, a data set which captures information on routine CR practice and patient outcomes. Data from 1 January 2012 to 8 September 2015 were included. Logistic regression models were used to explore the relationship between timing of CR and fitness-related outcomes as measured by patient-reported exercise level (150 min/week: yes/no), Dartmouth quality of life physical fitness scale and the incremental shuttle-walk test. RESULTS Based on UK data current CR practice shows that programmes do not always adhere to recommendations on the start of prompt CR, that is, start CR within 28 days of referral (42 days for coronary artery bypass graft (CABG)). Wait time exceeded recommendations in postmyocardial infarction (post-MI), elective percutaneous coronary intervention (PCI), MI-PCI and post-CABG surgery patients. This was particularly pronounced in the medically managed post-MI group, median wait time 40 days. Furthermore, statistical analysis revealed that delayed CR significantly impacts fitness outcomes. For every 1-day increase in CR wait time, patients were 1% less likely to improve across all fitness-related measures (p<0.05). CONCLUSIONS With the potential for suboptimal patient outcome if starting CR is delayed, efforts should be made to identify and overcome barriers to timely CR provision.
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Affiliation(s)
- Jennifer Fell
- Department of Health Sciences , University of York , York , UK
| | - Veronica Dale
- Department of Health Sciences , University of York , York , UK
| | - Patrick Doherty
- Department of Health Sciences , University of York , York , UK
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Factors associated with enrollment and adherence in outpatient cardiac rehabilitation in Japan. J Cardiopulm Rehabil Prev 2016; 35:186-92. [PMID: 25622218 DOI: 10.1097/hcr.0000000000000103] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
PURPOSE Despite the effectiveness of cardiac rehabilitation (CR), the participation percentage is low in Japan. Therefore, we investigated factors associated with enrollment and adherence in outpatient cardiac rehabilitation (OCR) in Japan. METHODS This was a single-hospital, case-controlled study. During a 2-year study period, 544 patients were hospitalized for ischemic heart disease, heart failure, or open heart surgery, and recommended for in-hospital CR. Among them, 78 OCR participants and 179 randomly selected nonparticipants were included in the study. These 2 groups were compared to examine factors associated with OCR enrollment. In addition, OCR participants were divided into those who continued OCR for 3 months (adherence group) and those who did not (nonadherence group), and these 2 groups were compared to examine factors associated with OCR adherence. Univariate and multivariate logistic regression analyses were conducted for both objectives and included sociodemographic, clinical, and OCR-related variables. RESULTS OCR enrollment was significantly associated with younger age (OR, 0.96; 95% CI, 0.93-0.98) and shorter distance to the hospital (OR, 0.97; 95% CI, 0.95-0.99). OCR adherence was significantly associated with a history of ischemic heart disease (OR, 6.03; 95% CI, 1.62-22.5) and prescription of antidepressants and/or sleeping pills (OR, 4.14; 95% CI, 1.07-16.0). CONCLUSIONS The main factors associated with OCR enrollment and adherence were sociodemographic factors related to easier hospital access and clinical conditions that reflected high disease awareness, respectively.
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Participation Rates, Process Monitoring, and Quality Improvement Among Cardiac Rehabilitation Programs in the United States: A NATIONAL SURVEY. J Cardiopulm Rehabil Prev 2016; 35:173-80. [PMID: 25763922 DOI: 10.1097/hcr.0000000000000108] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE Although strategies exist for improving cardiac rehabilitation (CR) participation rates, it is unclear how frequently these strategies are used and what efforts are being made by CR programs to improve participation rates. METHODS We surveyed all CR program directors in the American Association of Cardiovascular and Pulmonary Rehabilitation's database. Data collection included program characteristics, the use of specific referral and recruitment strategies, and self-reported program participation rates. RESULTS Between 2007 and 2012, 49% of programs measured referral of inpatients from the hospital, 21% measured outpatient referral from office/clinic, 71% measured program enrollment, and 74% measured program completion rates. Program-reported participation rates (interquartile range) were 68% (32-90) for hospital referral, 35% (15-60) for office/clinic referral, 70% (46-80) for enrollment, and 75% (62-82) for program completion. The majority of programs utilized a hospital-based systematic referral, liaison-facilitated referral, or inpatient CR program referral (64%, 68%, and 60% of the time, respectively). Early appointments (<2 weeks) were utilized by 35%, and consistent phone call appointment reminders were utilized by 50% of programs. Quality improvement (QI) projects were performed by about half of CR programs. Measurement of participation rates was highly correlated with performing QI projects (P < .0001.) CONCLUSIONS : Although programs are aware of participation rate gaps, the monitoring of participation rates is suboptimal, QI initiatives are infrequent, and proven strategies for increasing patient participation are inconsistently utilized. These issues likely contribute to the national CR participation gap and may prove to be useful targets for national QI initiatives.
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Marzolini S, Balitsky A, Jagroop D, Corbett D, Brooks D, Grace SL, Lawrence D, Oh PI. Factors Affecting Attendance at an Adapted Cardiac Rehabilitation Exercise Program for Individuals with Mobility Deficits Poststroke. J Stroke Cerebrovasc Dis 2016; 25:87-94. [DOI: 10.1016/j.jstrokecerebrovasdis.2015.08.039] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Revised: 08/18/2015] [Accepted: 08/26/2015] [Indexed: 11/28/2022] Open
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Pouche M, Ruidavets JB, Ferrières J, Iliou MC, Douard H, Lorgis L, Carrié D, Brunel P, Simon T, Bataille V, Danchin N. Cardiac rehabilitation and 5-year mortality after acute coronary syndromes: The 2005 French FAST-MI study. Arch Cardiovasc Dis 2015; 109:178-87. [PMID: 26711546 DOI: 10.1016/j.acvd.2015.09.009] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Revised: 09/28/2015] [Accepted: 09/30/2015] [Indexed: 11/27/2022]
Abstract
BACKGROUND Clinical studies have shown a beneficial effect of cardiac rehabilitation (CR) on mortality. OBJECTIVE To study the effect of CR prescription at discharge on 5-year mortality in patients with acute myocardial infarction (AMI). METHODS Participants, from the 2005 French FAST-MI hospital registry, were 2894 survivors at discharge, divided according to AMI type: ST-segment elevation myocardial infarction (STEMI; n=1523) and non-STEMI (NSTEMI; n=1371). The effect of CR prescription on mortality was analysed using a Cox proportional hazards model. RESULTS At discharge, 22.1% of patients had a CR prescription. Patients referred to CR were younger (62.4 vs. 67.5years), were more frequently men and more had presented with STEMI (67.8% vs. 48.3%) than non-referred patients. Ninety-four (14.7%) deaths occurred among patients referred to CR and 585 (25.9%) among non-referred patients (P<0.001). After multivariable adjustment, the association between CR and mortality remained significant (hazard ratio [HR] 0.76, 95% confidence interval [CI] 0.60-0.96). Analyses stratified by sex, age (<60 vs.≥60years) and AMI type showed that the inverse association was stronger in men (HR 0.64, 95% CI 0.48-0.87) than in women (HR 0.95, 95% CI 0.64-1.39), in younger (HR 0.34, 95% CI 0.15-0.77) than in older patients (HR 0.84, 95% CI 0.65-1.07) and in NSTEMI (HR 0.63, 95% CI 0.46-0.88) than in STEMI (HR 0.99, 95% CI 0.69-1.40). CONCLUSION After hospitalization for AMI, referral to CR remains a significant predictor of improved patient survival; some subgroups seem to gain greater benefit.
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Affiliation(s)
- Marion Pouche
- Department of Epidemiology, Health Economics and Public Health, UMR1027 Inserm-University of Toulouse III, Toulouse University Hospital (CHU), 31073 Toulouse cedex 7, France
| | - Jean-Bernard Ruidavets
- Department of Epidemiology, Health Economics and Public Health, UMR1027 Inserm-University of Toulouse III, Toulouse University Hospital (CHU), 31073 Toulouse cedex 7, France.
| | - Jean Ferrières
- Department of Epidemiology, Health Economics and Public Health, UMR1027 Inserm-University of Toulouse III, Toulouse University Hospital (CHU), 31073 Toulouse cedex 7, France; Department of Cardiology B, Toulouse Rangueil University Hospital (CHU), 31059 Toulouse cedex 9, France
| | - Marie-Christine Iliou
- Department of Cardiac Rehabilitation, AP-HP, Corentin-Celton Hospital, 92130 Issy-les Moulineaux, France
| | - Hervé Douard
- Department of Cardiology, Bordeaux University Hospital, 33604 Pessac, France
| | - Luc Lorgis
- Department of Cardiology, University Hospital, Laboratory of Cardiometabolic Physiopathology and Pharmacology, Inserm U866, University of Burgundy, 21034 Dijon, France
| | - Didier Carrié
- Department of Cardiology B, Toulouse Rangueil University Hospital (CHU), 31059 Toulouse cedex 9, France
| | - Philippe Brunel
- Department of Cardiology, Nouvelles Cliniques Nantaises, 44277 Nantes cedex 2, France
| | - Tabassome Simon
- Department of Pharmacology and Clinical Research Unit (URCEST), AP-HP, Saint-Antoine Hospital, Pierre-and-Marie-Curie University (UPMC-Paris 06), Inserm U970, 75012 Paris, France
| | - Vincent Bataille
- Department of Epidemiology, Health Economics and Public Health, UMR1027 Inserm-University of Toulouse III, Toulouse University Hospital (CHU), 31073 Toulouse cedex 7, France
| | - Nicolas Danchin
- Department of Cardiology, AP-HP, Georges-Pompidou European Hospital, René-Descartes University, Inserm U970, 75908 Paris, France
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Franklin BA, Brinks J. Cardiac Rehabilitation: Underrecognized/Underutilized. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2015; 17:62. [PMID: 26526338 DOI: 10.1007/s11936-015-0422-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OPINION STATEMENT Unfortunately, too many patients continue to rely on costly coronary revascularization procedures, cardioprotective medications, or both, as first-line strategies to stabilize the course of coronary heart disease. However, these palliative therapies do not address the foundational or most proximal risk factors for coronary disease, that is, unhealthy dietary habits, physical inactivity, and cigarette smoking. Because most acute myocardial infarctions evolve from mild-to-moderate coronary artery stenosis (<70 % obstruction), rather than at the more severe obstructions that are commonly treated with coronary revascularization, these findings help explain the inability to demonstrate a reduction in acute cardiac events in most studies examining coronary artery bypass graft surgery and/or percutaneous coronary interventions. The delivery of comprehensive cardiovascular risk reduction, including exercise-based cardiac rehabilitation as an integral component, offers patients a bona fide treatment intervention to prevent recurrent cardiovascular events and the need for repeated revascularization procedures, while simultaneously providing referring physicians with ongoing surveillance data to potentially enhance their medical management.
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Affiliation(s)
- Barry A Franklin
- Preventive Cardiology and Cardiac Rehabilitation, William Beaumont Hospital, Royal Oak, MI, USA. .,Internal Medicine and Biomedical Engineering, Oakland University William Beaumont School of Medicine, Rochester, MI, USA. .,Beaumont Health Center, Cardiac Rehabilitation, 4949 Coolidge Highway, Royal Oak, MI, 48073, USA.
| | - Jenna Brinks
- Preventive Cardiology and Cardiac Rehabilitation, William Beaumont Hospital, Royal Oak, MI, USA.,Beaumont Health Center, Cardiac Rehabilitation, 4949 Coolidge Highway, Royal Oak, MI, 48073, USA
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Marzolini S, Blanchard C, Alter DA, Grace SL, Oh PI. Delays in Referral and Enrolment Are Associated With Mitigated Benefits of Cardiac Rehabilitation After Coronary Artery Bypass Surgery. Circ Cardiovasc Qual Outcomes 2015; 8:608-20. [DOI: 10.1161/circoutcomes.115.001751] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2015] [Accepted: 09/04/2015] [Indexed: 11/16/2022]
Affiliation(s)
- Susan Marzolini
- From the Toronto Rehabilitation Institute/University Health Network, Toronto, Ontario, Canada (S.M., D.L.A., S.L.G., P.I.O.); Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada (C.B.); and Faculty of Health, York University, Toronto, Ontario, Canada (S.G.)
| | - Chris Blanchard
- From the Toronto Rehabilitation Institute/University Health Network, Toronto, Ontario, Canada (S.M., D.L.A., S.L.G., P.I.O.); Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada (C.B.); and Faculty of Health, York University, Toronto, Ontario, Canada (S.G.)
| | - David A. Alter
- From the Toronto Rehabilitation Institute/University Health Network, Toronto, Ontario, Canada (S.M., D.L.A., S.L.G., P.I.O.); Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada (C.B.); and Faculty of Health, York University, Toronto, Ontario, Canada (S.G.)
| | - Sherry L. Grace
- From the Toronto Rehabilitation Institute/University Health Network, Toronto, Ontario, Canada (S.M., D.L.A., S.L.G., P.I.O.); Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada (C.B.); and Faculty of Health, York University, Toronto, Ontario, Canada (S.G.)
| | - Paul I. Oh
- From the Toronto Rehabilitation Institute/University Health Network, Toronto, Ontario, Canada (S.M., D.L.A., S.L.G., P.I.O.); Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada (C.B.); and Faculty of Health, York University, Toronto, Ontario, Canada (S.G.)
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68
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Hutchinson P, Meyer A, Marshall B. Factors Influencing Outpatient Cardiac Rehabilitation Attendance. Rehabil Nurs 2015; 40:360-7. [PMID: 25771985 DOI: 10.1002/rnj.202] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/30/2014] [Indexed: 11/12/2022]
Abstract
PURPOSE In the current health climate, the length of stay of cardiac patients in hospital has been decreasing, and this has significantly reduced the time nurses and colleagues have for providing inpatient cardiac rehabilitation (CR). The purpose of this research was to determine if inpatient CR has an influence on outpatient cardiac rehabilitation attendance for women, Māori, and older people. METHODS An audit of patients discharged from hospital between November 2011 and July 2012 with a diagnosis of acute coronary syndrome were sent a postal questionnaire. FINDINGS The survey was completed by 143 people: 46% female, 12% Māori, and 70% > 65 years. Only 38% attended outpatient CR on discharge. Reasons for not attending included lack of referral to CR, and 61% understood only some/none of the information given to them while in hospital. The Cardiac Rehabilitation Coordinator most consistently recommended attendance, but this invitation was extended after discharge from hospital. CONCLUSIONS Attendance at outpatient CR is low and may increase with an improved individualized plan of care including greater cultural considerations and attention to discharge planning. An automatic referral tool as well as following evidence-based guidelines for inpatient care may increase participation rates for CR. CLINICAL RELEVANCE Nursing staff have the majority of contact with patients and it appears that very few nurses are discussing CR programs with their patients. The information to attend CR should be offered by all of the health professionals patients meet during their stay in hospital.
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Affiliation(s)
- Pip Hutchinson
- Emergency Department, Hawke's Bay District Health Board, Hastings, New Zealand
| | - Alannah Meyer
- School of Nursing, Eastern Institute of Technology, Napier, New Zealand
| | - Bob Marshall
- Health Sciences, Eastern Institute of Technology, Napier, New Zealand
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Temporal Trends and Factors Associated With Cardiac Rehabilitation Referral Among Patients Hospitalized With Heart Failure. J Am Coll Cardiol 2015; 66:927-9. [DOI: 10.1016/j.jacc.2015.06.1090] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2015] [Accepted: 06/15/2015] [Indexed: 11/19/2022]
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70
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Smith J, Garton-Smith J, Briffa T, Maiorana A. The Development of a New Cardiac Rehabilitation Needs Assessment Tool (CRNAT) for Individualised Secondary Prevention. Heart Lung Circ 2015; 24:458-64. [DOI: 10.1016/j.hlc.2015.01.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2014] [Revised: 12/23/2014] [Accepted: 01/06/2015] [Indexed: 10/24/2022]
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71
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Kulik A, Ruel M, Jneid H, Ferguson TB, Hiratzka LF, Ikonomidis JS, Lopez-Jimenez F, McNallan SM, Patel M, Roger VL, Sellke FW, Sica DA, Zimmerman L. Secondary Prevention After Coronary Artery Bypass Graft Surgery. Circulation 2015; 131:927-64. [DOI: 10.1161/cir.0000000000000182] [Citation(s) in RCA: 298] [Impact Index Per Article: 29.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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72
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Time-to-Referral, Use, and Efficacy of Cardiac Rehabilitation After Heart Transplantation. Transplantation 2015; 99:594-601. [DOI: 10.1097/tp.0000000000000361] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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73
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Safety of early enrollment into outpatient cardiac rehabilitation after open heart surgery. Am J Cardiol 2015; 115:548-52. [PMID: 25543236 DOI: 10.1016/j.amjcard.2014.11.040] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2014] [Revised: 11/17/2014] [Accepted: 11/17/2014] [Indexed: 11/23/2022]
Abstract
The safety of early enrollment (<2 weeks after hospital discharge) into cardiac rehabilitation (CR) after recent coronary artery bypass graft (CABG) surgery or heart valve surgery (HVS) has not previously been assessed and has important policy implications. Consequently, we performed a detailed review of all clinical adverse events within 6 months of hospital discharge. We compared early and late attendees for patients undergoing CABG surgery or HVS and included patients with myocardial infarction (MI) as an additional control group. We analyzed 112 patients undergoing CABG surgery, 69 patients undergoing HVS, and 59 patients with MI. Median time (interquartile range) from hospital discharge to CR enrollment was 10.5 (8 to 15), 12 (8.5 to 21), and 9 days (7 to 14), respectively. There was no difference in major event rates between early and late enrollees (17% vs 17%, respectively, log-rank p = 0.98) or by diagnosis (15%, 16%, and 22% for CABG surgery, HVS, and MI, respectively; log-rank p = 0.50). Sternal instability and wound infection rates were similar. CR-related adverse events trended toward increased event rates in surgical and early enrollees, but of 44 events, only 3 were exercise related, none resulted in permanent harm, and 41 (93%) were managed in CR without need for emergency services. In conclusion, it appears that a policy of encouraging early enrollment into CR in patients with a recent open heart surgery seems unlikely to harm patients when careful individualized assessment and exercise prescription take place within the bounds of an established CR program.
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Johnson DA, Sacrinty MT, Gomadam PS, Mehta HJ, Brady MM, Douglas CJ, Paladenech CC, Robinson KC. Effect of early enrollment on outcomes in cardiac rehabilitation. Am J Cardiol 2014; 114:1908-11. [PMID: 25438920 DOI: 10.1016/j.amjcard.2014.09.036] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2014] [Revised: 09/20/2014] [Accepted: 09/20/2014] [Indexed: 11/16/2022]
Abstract
Outpatient cardiac rehabilitation (CR) is most beneficial when delivered 1 to 3 weeks after the index cardiac event. The effects of delayed enrollment on subsequent outcomes are unclear. A total of 1,241 patients were enrolled in CR after recent (<1 year) treatment of cardiac events or postcardiac surgery. Risk factors and metabolic equivalent levels (METs) during aerobic exercise were calculated before and after CR. The mean CR delay time was 34 days (maximum of 327). Delay time >30 days was associated with older age, female gender, nonwhite race, being unemployed, and increased length of hospital stay before CR after index cardiac event (p <0.05 vs 0 to 15 and 16 to 30 days for all comparisons). Patients with delay time >30 days had significant improvements in all CR metrics, but peak METs and weight improvements were lesser in magnitude compared with patients with CR delay times 0 to 15 and 16 to 30 days. After multivariate adjustment, delay time >30 days remained an independent predictor of decreased MET improvement compared with delay time 0 to 15 days (β = -0.59, p <0.001). In conclusion, time to enrollment in CR varies substantially and is independently linked to demographics and length of index hospital stay. Delayed enrollment in CR is directly related to patient outcomes. Although all patients showed improvements in key metrics regardless of delay time, CR was of greatest benefit, particularly for weight and exercise capacity, when initiated within 15 days of the index event.
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Affiliation(s)
- Dominic A Johnson
- Department of Internal Medicine, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, North Carolina; Department of Cardiology, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, North Carolina
| | - Matthew T Sacrinty
- Department of Internal Medicine, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, North Carolina; Department of Cardiology, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, North Carolina
| | - Pallavi S Gomadam
- Department of Internal Medicine, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, North Carolina; Department of Cardiology, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, North Carolina
| | - Hardik J Mehta
- Department of Internal Medicine, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, North Carolina; Department of Cardiology, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, North Carolina
| | - Molly M Brady
- Department of Internal Medicine, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, North Carolina; Department of Cardiology, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, North Carolina
| | - Christopher J Douglas
- Department of Internal Medicine, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, North Carolina; Department of Cardiology, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, North Carolina
| | - Connie C Paladenech
- Department of Internal Medicine, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, North Carolina; Department of Cardiology, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, North Carolina
| | - Killian C Robinson
- Department of Internal Medicine, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, North Carolina; Department of Cardiology, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, North Carolina.
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Pavy B, Darchis J, Merle E, Caillon M. [Cardiac rehabilitation after myocardial infarction in France: still not prescribed enough]. Ann Cardiol Angeiol (Paris) 2014; 63:369-75. [PMID: 25287145 DOI: 10.1016/j.ancard.2014.09.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2014] [Accepted: 09/10/2014] [Indexed: 01/05/2023]
Abstract
Despite well-documented benefits for patients after myocardial infarction, cardiac rehabilitation is underutilized in most countries. In France, a recent study showed a participation rate of 22.7 %, with huge regional disparities for unknown reasons. In this paper, we analyze some demographic particularities for explaining these curious results. Then, we review in the literature the complex factors influencing patient's referral in cardiac rehabilitation (patient's believes, role of the physician, health system's organization…), and the best ways of improving cardiac rehabilitation rate or finding adequate alternatives.
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Affiliation(s)
- B Pavy
- Service de réadaptation cardiovasculaire, centre hospitalier Loire-Vendée-Océan, boulevard des Régents, 44270 Machecoul, France.
| | - J Darchis
- Service de réadaptation cardiovasculaire, centre hospitalier Loire-Vendée-Océan, boulevard des Régents, 44270 Machecoul, France
| | - E Merle
- Service de réadaptation cardiovasculaire, centre hospitalier Loire-Vendée-Océan, boulevard des Régents, 44270 Machecoul, France; Cardiocéan réadaptation cardiaque, 25, allée de la Tourtillière, 17138 Puilboreau, France
| | - M Caillon
- Service de réadaptation cardiovasculaire, centre hospitalier Loire-Vendée-Océan, boulevard des Régents, 44270 Machecoul, France
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76
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The Current and Potential Capacity for Cardiac Rehabilitation Utilization in the United States. J Cardiopulm Rehabil Prev 2014; 34:318-26. [DOI: 10.1097/hcr.0000000000000076] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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77
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Redfern J, Hyun K, Chew DP, Astley C, Chow C, Aliprandi-Costa B, Howell T, Carr B, Lintern K, Ranasinghe I, Nallaiah K, Turnbull F, Ferry C, Hammett C, Ellis CJ, French J, Brieger D, Briffa T. Prescription of secondary prevention medications, lifestyle advice, and referral to rehabilitation among acute coronary syndrome inpatients: results from a large prospective audit in Australia and New Zealand. Heart 2014; 100:1281-8. [PMID: 24914060 PMCID: PMC4112453 DOI: 10.1136/heartjnl-2013-305296] [Citation(s) in RCA: 81] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2013] [Revised: 04/23/2014] [Accepted: 04/24/2014] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVE To evaluate the proportion of patients hospitalised with acute coronary syndrome (ACS) in Australia and New Zealand who received optimal inpatient preventive care and to identify factors associated with preventive care. METHODS All patients hospitalised bi-nationally with ACS were identified between 14-27 May 2012. Optimal in-hospital preventive care was defined as having received lifestyle advice, referral to rehabilitation, and prescription of secondary prevention pharmacotherapies. Multilevel multivariable logistic regression was used to determine factors associated with receipt of optimal preventive care. RESULTS For the 2299 ACS survivors, mean (SD) age was 69 (13) years, 46% were referred to rehabilitation, 65% were discharged on sufficient preventive medications, and 27% received optimal preventive care. Diagnosis of ST elevation myocardial infarction (OR: 2.64 [95% CI: 1.88-3.71]; p<0.001) and non-ST elevation myocardial infarction (OR: 1.99 [95% CI: 1.52-2.61]; p<0.001) compared with a diagnosis of unstable angina, having a percutaneous coronary intervention (PCI) (OR: 4.71 [95% CI: 3.67-6.11]; p<0.001) or coronary bypass (OR: 2.10 [95% CI: 1.21-3.60]; p=0.011) during the admission or history of hypertension (OR:1.36 [95% CI: 1.06-1.75]; p=0.017) were associated with greater exposure to preventive care. Age over 70 years (OR:0.53 [95% CI: 0.35-0.79]; p=0.002) or admission to a private hospital (OR:0.59 [95% CI: 0.42-0.84]; p=0.003) were associated with lower exposure to preventive care. CONCLUSIONS Only one-quarter of ACS patients received optimal secondary prevention in-hospital. Patients with UA, who did not have PCI, were over 70 years or were admitted to a private hospital, were less likely to receive optimal care.
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Affiliation(s)
- Julie Redfern
- The George Institute for Global Health, Sydney, Australia
- Sydney Medical School, University of Sydney, Sydney, Australia
| | - Karice Hyun
- The George Institute for Global Health, Sydney, Australia
- Sydney Medical School, University of Sydney, Sydney, Australia
| | - Derek P Chew
- Department of Cardiovascular Medicine, Flinders University, Southern Adelaide Local Health Network, Adelaide, Australia
| | - Carolyn Astley
- Statewide Cardiac Clinical Network, South Australian Health; Flinders University, Adelaide, Australia
| | - Clara Chow
- The George Institute for Global Health, Sydney, Australia
- Sydney Medical School, University of Sydney, Sydney, Australia
- Westmead Hospital, Sydney, Australia
| | | | - Tegwen Howell
- The George Institute for Global Health, Sydney, Australia
- Queensland Health, Brisbane, Australia
| | - Bridie Carr
- Cardiac Network, Agency for Clinical Innovation, Sydney, Australia
| | - Karen Lintern
- Cardiac Network, Agency for Clinical Innovation, Sydney, Australia
| | | | | | - Fiona Turnbull
- The George Institute for Global Health, Sydney, Australia
- Sydney Medical School, University of Sydney, Sydney, Australia
| | - Cate Ferry
- National Heart Foundation of Australia (New South Wales Division) Sydney, Australia
| | | | - Chris J Ellis
- Green Lane CVS Service, Auckland City Hospital, Auckland, New Zealand
| | - John French
- Liverpool Hospital Sydney, Australia
- University of New South Wales, Sydney Australia
| | - David Brieger
- Sydney Medical School, University of Sydney, Sydney, Australia
- Cardiology Department, Concord Hospital, Sydney, Australia
| | - Tom Briffa
- School of Population Health, University of Western Australia, Perth, Australia
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Karmali KN, Davies P, Taylor F, Beswick A, Martin N, Ebrahim S. Promoting patient uptake and adherence in cardiac rehabilitation. Cochrane Database Syst Rev 2014:CD007131. [PMID: 24963623 DOI: 10.1002/14651858.cd007131.pub3] [Citation(s) in RCA: 105] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND Cardiac rehabilitation is an important component of recovery from coronary events but uptake and adherence to such programs are below recommended levels. In 2010, our Cochrane review identified some evidence that interventions to increase uptake of cardiac rehabilitation can be effective but there was insufficient evidence to provide recommendations on intervention to increase adherence. In this review, we update the previously published Cochrane review. OBJECTIVES To determine the effects, both harms and benefits, of interventions to increase patient uptake of, or adherence to, cardiac rehabilitation. SEARCH METHODS We performed an updated search in January 2013 to identify studies published after publication of the previous systematic review. We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (Issue 12, 2012), MEDLINE (Ovid), EMBASE (Ovid), CINAHL EBSCO, Conference Proceedings Citation Index - Science (CPCI-S) on Web of Science (Thomson Reuters), and National Health Service (NHS) Centre for Reviews and Dissemination (CRD) databases (Health Technology Assessment (HTA) and Database of Abstracts of Reviews of Effects (DARE)) on The Cochrane Library (Issue 4, 2012). We also checked reference lists of identified systematic reviews and randomised controlled trials (RCTs) for additional studies. We applied no language restrictions. SELECTION CRITERIA Adults with myocardial infarction, coronary artery bypass graft, percutaneous transluminal coronary angioplasty, heart failure, angina, or coronary heart disease eligible for cardiac rehabilitation and RCTs or quasi-randomized trials of interventions to increase uptake or adherence to cardiac rehabilitation or any of its component parts. We only included studies reporting a primary outcome. DATA COLLECTION AND ANALYSIS At least three authors independently screened titles and abstracts of all identified references for eligibility and obtained full papers of potentially relevant trials. At least two authors checked the selection. Three authors assessed included studies for risk of bias. MAIN RESULTS The updated search identified seven new studies (880 participants) of interventions to improve uptake of cardiac rehabilitation and one new study (260 participants) of interventions to increase adherence. When added to the previous version of this review, we included 18 studies (2505 participants), 10 studies (1338 participants) of interventions to improve uptake of cardiac rehabilitation and eight studies (1167 participants) of interventions to increase adherence. We assessed the majority of studies as having high or unclear risk of bias. Meta-analysis was not possible due to multiple sources of heterogeneity. Eight of 10 studies demonstrated increased uptake of cardiac rehabilitation. Successful interventions to improve uptake of cardiac rehabilitation included: structured nurse- or therapist-led contacts, early appointments after discharge, motivational letters, gender-specific programs, and intermediate phase programs for older patients. Three of eight studies demonstrated improvement in adherence to cardiac rehabilitation. Successful interventions included: self monitoring of activity, action planning, and tailored counselling by cardiac rehabilitation staff. Data were limited on mortality and morbidity but did not demonstrate a difference in cardiovascular events or mortality except for one study that noted an increased rate of revascularization in the intervention group. None of the studies found a difference in health-related quality of life and there was no evidence of adverse events. No studies reported on costs or healthcare utilization. AUTHORS' CONCLUSIONS We found only weak evidence to suggest that interventions to increase the uptake of cardiac rehabilitation are effective. Practice recommendations for increasing adherence to cardiac rehabilitation cannot be made. Interventions targeting patient-identified barriers may increase the likelihood of success. Further high-quality research is still needed.
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Affiliation(s)
- Kunal N Karmali
- Departments of Preventive Medicine and Medicine (Cardiology), Northwestern University Feinberg School of Medicine, 680 N. Lake Shore Drive, Suite 1400, Chicago, IL, USA, 60611
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Dunlay SM, Pack QR, Thomas RJ, Killian JM, Roger VL. Participation in cardiac rehabilitation, readmissions, and death after acute myocardial infarction. Am J Med 2014; 127:538-46. [PMID: 24556195 PMCID: PMC4035431 DOI: 10.1016/j.amjmed.2014.02.008] [Citation(s) in RCA: 188] [Impact Index Per Article: 17.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2014] [Revised: 02/05/2014] [Accepted: 02/05/2014] [Indexed: 11/15/2022]
Abstract
BACKGROUND Participation in cardiac rehabilitation has been shown to decrease mortality after acute myocardial infarction, but its impact on readmissions requires examination. METHODS We conducted a population-based surveillance study of residents discharged from the hospital after their first-ever myocardial infarction in Olmsted County, Minnesota, from January 1, 1987, to September 30, 2010. Patients were followed up through December 31, 2010. Participation in cardiac rehabilitation after myocardial infarction was determined using billing data. We used a landmark analysis approach (cardiac rehabilitation participant vs not determined by attendance in at least 1 session of cardiac rehabilitation at 90 days post-myocardial infarction discharge) to compare readmission and mortality risk between cardiac rehabilitation participants and nonparticipants accounting for propensity to participate using inverse probability treatment weighting. RESULTS Of 2991 patients with incident myocardial infarction, 1569 (52.5%) participated in cardiac rehabilitation after hospital discharge. The cardiac rehabilitation participation rate did not change during the study period, but increased in the elderly and decreased in men and younger patients. After adjustment, cardiac rehabilitation participants had lower all-cause readmission (hazard ratio [HR], 0.75; 95% confidence interval [CI], 0.65-0.87; P < .001), cardiovascular readmission (HR, 0.80; 95% CI, 0.65-0.99; P = .037), noncardiovascular readmission (HR, 0.72; 95% CI, 0.61-0.85; P < .001), and mortality (HR, 0.58; 95% CI, 0.49-0.68; P < .001) risk. CONCLUSIONS Cardiac rehabilitation participation is associated with a markedly reduced risk of readmission and death after incident myocardial infarction. Improving cardiac rehabilitation participation rates may have a large impact on post-myocardial infarction healthcare resource use and outcomes.
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Affiliation(s)
- Shannon M Dunlay
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minn; Department of Health Sciences Research, Mayo Clinic, Rochester, Minn.
| | - Quinn R Pack
- Division of Cardiology, Baystate Medical Center, Springfield, Mass
| | - Randal J Thomas
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minn
| | - Jill M Killian
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minn
| | - Véronique L Roger
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minn; Department of Health Sciences Research, Mayo Clinic, Rochester, Minn
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Antypas K, Wangberg SC. An Internet- and mobile-based tailored intervention to enhance maintenance of physical activity after cardiac rehabilitation: short-term results of a randomized controlled trial. J Med Internet Res 2014; 16:e77. [PMID: 24618349 PMCID: PMC3967125 DOI: 10.2196/jmir.3132] [Citation(s) in RCA: 106] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2013] [Revised: 01/04/2014] [Accepted: 02/20/2014] [Indexed: 12/11/2022] Open
Abstract
Background An increase in physical activity for secondary prevention of cardiovascular disease and cardiac rehabilitation has multiple therapeutic benefits, including decreased mortality. Internet- and mobile-based interventions for physical activity have shown promising results in helping users increase or maintain their level of physical activity in general and specifically in secondary prevention of cardiovascular diseases and cardiac rehabilitation. One component related to the efficacy of these interventions is tailoring of the content to the individual. Objective Our trial assessed the effect of a longitudinally tailored Internet- and mobile-based intervention for physical activity as an extension of a face-to-face cardiac rehabilitation stay. We hypothesized that users of the tailored intervention would maintain their physical activity level better than users of the nontailored version. Methods The study population included adult participants of a cardiac rehabilitation program in Norway with home Internet access and a mobile phone. The participants were randomized in monthly clusters to a tailored or nontailored (control) intervention group. All participants had access to a website with information regarding cardiac rehabilitation, an online discussion forum, and an online activity calendar. Those using the tailored intervention received tailored content based on models of health behavior via the website and mobile fully automated text messages. The main outcome was self-reported level of physical activity, which was obtained using an online international physical activity questionnaire at baseline, at discharge, and at 1 month and 3 months after discharge from the cardiac rehabilitation program. Results Included in the study were 69 participants. One month after discharge, the tailored intervention group (n=10) had a higher median level of overall physical activity (median 2737.5, IQR 4200.2) than the control group (n=14, median 1650.0, IQR 2443.5), but the difference was not significant (Kolmogorov-Smirnov Z=0.823, P=.38, r=.17). At 3 months after discharge, the tailored intervention group (n=7) had a significantly higher median level of overall physical activity (median 5613.0, IQR 2828.0) than the control group (n=12, median 1356.0, IQR 2937.0; Kolmogorov-Smirnov Z=1.397, P=.02, r=.33). The median adherence was 45.0 (95% CI 0.0-169.8) days for the tailored group and 111.0 (95% CI 45.1-176.9) days for the control group; however, the difference was not significant (P=.39). There were no statistically significant differences between the 2 groups in stage of change, self-efficacy, social support, perceived tailoring, anxiety, or depression. Conclusions Because of the small sample size and the high attrition rate at the follow-up visits, we cannot make conclusions regarding the efficacy of our approach, but the results indicate that the tailored version of the intervention may have contributed to the long-term higher physical activity maintained after cardiac rehabilitation by participants receiving the tailored intervention compared with those receiving the nontailored intervention. Trial Registration ClinicalTrials.gov: NCT01223170; http://clinicaltrials.gov/show/NCT01223170 (Archived by WebCite at http://www.webcitation.org/6Nch4ldcL).
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81
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Giugliano RP, Braunwald E. The year in acute coronary syndrome. J Am Coll Cardiol 2013; 63:201-14. [PMID: 24239661 DOI: 10.1016/j.jacc.2013.10.041] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2013] [Revised: 09/27/2013] [Accepted: 10/21/2013] [Indexed: 02/06/2023]
Affiliation(s)
- Robert P Giugliano
- TIMI Study Group, Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Eugene Braunwald
- TIMI Study Group, Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
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82
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Graham MM, Galbraith PD, O'Neill D, Rolfson DB, Dando C, Norris CM. Frailty and outcome in elderly patients with acute coronary syndrome. Can J Cardiol 2013; 29:1610-5. [PMID: 24183299 DOI: 10.1016/j.cjca.2013.08.016] [Citation(s) in RCA: 91] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2013] [Revised: 08/27/2013] [Accepted: 08/27/2013] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Frailty is superior to chronological age as a predictor of outcome. The Edmonton Frail Scale (EFS) is a simple valid measure of frailty, covering multiple important domains, with scores ranging from 0 (not frail) to 17 (very frail). The purpose of this pilot study was to assess the EFS in a group of elderly patients with acute coronary syndrome (ACS). METHODS The EFS was administered to 183 consecutive patients with ACS aged ≥ 65 years admitted to a single centre in Edmonton, Alberta, Canada. RESULTS Scores ranged from 0-13. Patients with higher EFS scores were older, with more comorbidities, longer lengths of stay (EFS 0-3: mean, 7.0 days; EFS 4-6: mean, 9.7 days; and EFS ≥ 7: mean, 12.7 days; P = 0.03), and decreased procedure use. Crude mortality rates at 1 year were 1.6% for EFS 0-3, 7.7% for EFS 4-6, and 12.7% for EFS ≥ 7 (P = 0.05). After adjusting for baseline risk differences using a "burden of illness" score, the hazard ratio for mortality for EFS ≥ 7 compared with EFS 0-3 was 3.49 (95% confidence interval [CI], 1.08-7.61; P = 0.002). CONCLUSIONS The EFS is associated with increased comorbidity, longer lengths of stay, and decreased procedure use. After adjustment for burden of illness, the highest frailty category is independently associated with mortality in elderly patients with ACS. Further work is needed to determine whether the use of a validated frailty instrument would better delineate medical decision making in this important, often disadvantaged population.
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Affiliation(s)
- Michelle M Graham
- Department of Medicine and Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada; The Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Alberta, Canada.
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