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Yin X, Huang C, Lin B. Application of intensive management of risk awareness combined with cardiac rehabilitation nursing in elderly patients with acute myocardial infarction and heart failure. Medicine (Baltimore) 2024; 103:e37381. [PMID: 38758887 PMCID: PMC11098228 DOI: 10.1097/md.0000000000037381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 02/05/2024] [Indexed: 05/19/2024] Open
Abstract
The aim of this study is to assess the impact of intensive risk awareness management along with cardiac rehabilitation nursing in elderly patients with acute myocardial infarction and heart failure. We selected 101 elderly patients with acute myocardial infarction and heart aging treated from January 2022 to March 2023. They were divided into control and observation groups based on hospitalization numbers. The control group (n = 50) received routine nursing, while the observation group (n = 51) received intensive risk awareness management and cardiac rehabilitation nursing. We compared medication possession ratio (MPR), cardiac function, self-care ability scale scores, quality-of-life, incidents, and satisfaction between the 2 groups. Before intervention, there was no significant difference in MPR values between the 2 groups (P > .05). After intervention, MPR values increased in both groups, with a greater increase in the observation group (P < .05). Cardiac function showed no significant difference before intervention (P > .05), but after intervention, the observation group had lower left ventricular end-systolic and diastolic diameters and higher left ventricular ejection fraction compared to the control group (P < .05). Self-care skills, health knowledge, self-responsibility, and self-concept scores improved in both groups after intervention, with higher scores in the observation group (P < .05). The observation group had higher scores in various quality-of-life domains (P < .05). The total incidence of adverse events was lower in the observation group (5.88%) compared to the control group (20.00%) (P < .05). Patient satisfaction was significantly higher in the observation group (96.08%) than in the control group (84.00%) (P < .05). Intensive risk awareness management combined with cardiac rehabilitation nursing in elderly patients with acute myocardial infarction and heart aging can enhance medication compliance, improve quality-of-life, enhance self-care abilities, boost cardiac function, reduce incidents, and increase patient satisfaction.
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Affiliation(s)
- Xiaoli Yin
- Department of Cardiology, Wannan Rehabilitation Hospital, Wuhu, Anhui, China
| | - Cuiping Huang
- Department of Cardiology, Wannan Rehabilitation Hospital, Wuhu, Anhui, China
| | - Binglai Lin
- Department of Cardiology, Wannan Rehabilitation Hospital, Wuhu, Anhui, China
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Gomes-Neto M, Durães AR, Conceição LSR, Saquetto MB, Alves IG, Smart NA, Carvalho VO. Some types of exercise interventions are more effective than others in people with coronary heart disease: systematic review and network meta-analysis. J Physiother 2024; 70:106-114. [PMID: 38503676 DOI: 10.1016/j.jphys.2024.02.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 05/22/2023] [Accepted: 02/26/2024] [Indexed: 03/21/2024] Open
Abstract
QUESTION What are the effects of different types of exercise treatments on oxygen consumption, quality of life and mortality in people with coronary heart disease? DESIGN Systematic review with network meta-analysis of randomised controlled trials. PARTICIPANTS Adults with coronary heart disease. INTERVENTION Exercise interventions including aerobic (continuous or high-intensity interval) training, resistance training, respiratory muscle exercises, water-based exercises, yoga, Tai chi, Qigong exercises and a combination of different types of exercise. OUTCOME MEASURES Oxygen consumption, quality of life and mortality. RESULTS This review included 178 randomised controlled trials with 19,143 participants. Several exercise interventions improved peak oxygen consumption (mL/kg/min): high-intensity interval training (MD 4.5, 95% CI 3.7 to 5.4); combined water-based exercises and moderate-intensity continuous training (MD 3.7, 95% CI 1.3 to 6.0); combined aerobic and resistance exercise (MD 3.4, 95% CI 2.5 to 4.3); water-based exercises (MD 3.4, 95% CI 0.6 to 6.2); combined respiratory muscle training and aerobic exercise (MD 3.2, 95% CI 0.6 to 5.8); Tai chi (MD 3.0, 95% CI 1.0 to 5.0); moderate-intensity continuous training (MD 3.0, 95% CI 2.3 to 3.6); high-intensity continuous training (MD 2.7, 95% CI 1.6 to 3.8); and resistance training (MD 2.2, 95% CI 0.6 to 3.7). Quality of life was improved by yoga (SMD 1.5, 95% CI 0.5 to 2.4), combined aerobic and resistance exercise (SMD 1.2, 95% CI 0.6 to 1.7), moderate-intensity continuous training (SMD 1.1, 95% CI 0.6 to 1.6) and high-intensity interval training (SMD 0.9, 95% CI 0.1 to 1.6). All-cause mortality was reduced by continuous aerobic exercise (RR 0.67, 95% CI 0.53 to 0.86) and combined aerobic and resistance exercise (RR 0.58, 95% CI 0.36 to 0.94). Continuous aerobic exercise also reduced cardiovascular mortality (RR 0.56, 95% CI 0.42 to 0.74). CONCLUSION People with coronary heart disease may use a range of exercise modalities to improve oxygen consumption, quality of life and mortality. REGISTRATION PROSPERO CRD42022344545.
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Affiliation(s)
- Mansueto Gomes-Neto
- Postgraduate Program in Health Science, Federal University of Sergipe, Aracaju, Brazil; Postgraduate Program in Medicine and Health, Federal University of Bahia, Salvador, Brazil.
| | - Andre Rodrigues Durães
- Postgraduate Program in Medicine and Health, Federal University of Bahia, Salvador, Brazil
| | | | | | - Iura Gonzalez Alves
- Department of Medicine, Bahiana School of Medicine and Public Health, Salvador, Brazil
| | - Neil A Smart
- Department of Exercise and Sports Science, University of New England, Armidale, Australia
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Li Z, Guo K, Yang Y, Shuai Y, Fan R, Li Y, DU J, Niu J, Yang K. Exercise-based cardiac rehabilitation for patients with coronary heart disease: a systematic review and evidence mapping study. Eur J Phys Rehabil Med 2024; 60:361-372. [PMID: 38345568 PMCID: PMC11112512 DOI: 10.23736/s1973-9087.23.08165-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 10/20/2023] [Accepted: 12/12/2023] [Indexed: 04/13/2024]
Abstract
INTRODUCTION Exercise-based cardiac rehabilitation (CR) plays a critical role in coronary heart disease (CHD) management. There is a heritage in the effect of exercise-based CR with different exercise programs or intervention settings. This study developed an evidence matrix that systematically assesses, organizes, and presents the available evidence regarding exercise-based CR in CHD management. EVIDENCE ACQUISITION A comprehensive literature search was conducted across six databases. Two reviewers screened the identified literature, extracted relevant data, and assessed the quality of the studies. An evidence-mapping framework was established to present the findings in a structured manner. Bubble charts were used to represent the included systematic reviews (SRs). The charts incorporated information, exercise prescriptions, outcome indicators, associated P values, research quality, and the number of original studies. A descriptive analysis summarized the types of CR, intervention settings, influential factors, and adverse events. EVIDENCE SYNTHESIS Sixty-two SRs were included in this analysis, focusing on six exercise types in addition to assessing major adverse cardiovascular events (MACE), cost and rehabilitation outcomes. The most commonly studied exercise types were unspecified (28 studies, 45.2%) and aerobic (11 studies, 17.7%) exercises. All-cause mortality was the most frequently reported MACE outcome (22 studies). Rehabilitation outcomes primarily centered around changes in cardiac function (135 outcomes from 39 SRs). Only 8 (12.9%) studies were rated as "high quality." No significant adverse events were observed in the intervention group. Despite some variations among the included studies, most SRs demonstrated the benefits of exercise in improving one or more MACE or rehabilitation outcomes among CHD patients. CONCLUSIONS The proportion of high-quality evidence remains relatively low. Limited evidence is available regarding the effectiveness of specific exercise types and specific populations, necessitating further evaluation.
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Affiliation(s)
- Zijun Li
- Evidence-Based Social Science Research Center/Health Technology Assessment Center, School of Public Health, Lanzhou University, Lanzhou, China
| | - Ke Guo
- Evidence-Based Social Science Research Center/Health Technology Assessment Center, School of Public Health, Lanzhou University, Lanzhou, China
| | - Yongqi Yang
- First Clinical Medical College, University of Lanzhou, Lanzhou, China
| | - Yuxi Shuai
- First Clinical Medical College, University of Lanzhou, Lanzhou, China
| | - Rui Fan
- First Clinical Medical College, University of Lanzhou, Lanzhou, China
| | - Yanfei Li
- Evidence-Based Medicine Center, School of Basic Medical Sciences, University of Lanzhou, Lanzhou, China
| | - Jiawei DU
- Second Clinical Medical College, University of Lanzhou, Lanzhou, China
| | - Junqiang Niu
- Evidence-Based Medicine Center, School of Basic Medical Sciences, University of Lanzhou, Lanzhou, China
- First Hospital of Lanzhou University, Lanzhou, China
| | - Kehu Yang
- Evidence-Based Social Science Research Center/Health Technology Assessment Center, School of Public Health, Lanzhou University, Lanzhou, China -
- Evidence-Based Medicine Center, School of Basic Medical Sciences, University of Lanzhou, Lanzhou, China
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Sung J, Kim C, Han JY, Jee S, Lee JW, Lee JH, Kim WS, Bang HJ, Baek S, Joa KL, Kim AR, Lee SY, Kim J, Kim CR, Kwon OP. Comprehensiveness of cardiac rehabilitation program in Korea: a nation-wide survey result. BMC Cardiovasc Disord 2023; 23:186. [PMID: 37024773 PMCID: PMC10079148 DOI: 10.1186/s12872-023-03204-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Accepted: 03/25/2023] [Indexed: 04/08/2023] Open
Abstract
BACKGROUND Cardiac rehabilitation (CR) is an essential component in secondary prevention of cardiovascular diseases. Current guidelines recommend that the program should be comprehensive including multidisciplinary behavioral intervention, not only exercise training. While the utilization of CR is gradually increasing, the comprehensiveness of the program has not been systemically evaluated in Korea. METHODS During the year 2020, nation-wide survey was done to evaluate the current status of CR in Korea. Survey was done by web-based structured questionnaire. Survey was requested to 164 hospitals performing percutaneous coronary intervention. RESULTS Among 164 hospitals, 47 (28.7%) hospitals had CR programs. In hospitals with CR, multidisciplinary intervention other than exercise-based program was provided only partially: nutritional counseling (63%), vocational counseling for return to work (39%), stress management (31%), psychological evaluation (18%). Personnel for CR was commonly not dedicated to the program or even absent: (percentage of dedicated, concurrent with other work, absent) physical therapist (59, 41, 0%), nurse (31, 69, 0%), dietician (6, 65, 29%), clinical psychologist (0, 37, 63%). CONCLUSION Comprehensiveness of CR in Korea is suboptimal and human resource for it is poorly disposed. More awareness of current status by both clinicians and health policy makers is needed and insurance reimbursement for educational program should be improved.
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Affiliation(s)
- Jidong Sung
- Division of Cardiology, Department of Medicine, Sungkyunkwan University School of Medicine, 115 Irwon-ro, Gangnam-gu, Seoul, 06355, Korea.
| | - Chul Kim
- Department of Rehabilitation Medicine, Inje University Sanggye Paik Hospital, Seoul, 01757, Korea
| | - Jae-Young Han
- Department of Physical Medicine and Rehabilitation, Chonnam National University Medical School and Hospital, Gwangju, 61469, Korea
| | - Sungju Jee
- Department of Rehabilitation Medicine, Chungnam National University College of Medicine, Daejeon, 35015, Korea
| | - Jang Woo Lee
- Department of Physical Medicine and Rehabilitation, National Health Insurance Service Ilsan Hospital, Goyang, 10444, Korea
| | - Jong Hwa Lee
- Department of Physical Medicine and Rehabilitation, Dong A University College of Medicine, Busan, 49201, Korea
| | - Won-Seok Kim
- Department of Rehabilitation Medicine, Seoul National University Bundang Hospital, Seongnam, 13620, Korea
| | - Heui Je Bang
- Department of Rehabilitation Medicine, Chungbuk National University Hospital, Cheongju, 28644, Korea
| | - Sora Baek
- Department of Rehabilitation Medicine, Kangwon National University School of Medicine, Chuncheon, 24289, Korea
| | - Kyung-Lim Joa
- Department of Rehabilitation Medicine, Inha University Hospital, Incheon, 22332, Korea
| | - Ae Ryoung Kim
- Department of Rehabilitation Medicine, School of Medicine, Kyungpook National University, Daegu, 41944, Korea
| | - So Young Lee
- Department of Rehabilitation Medicine, Jeju National University School of Medicine, Jeju, 63241, Korea
| | - Jihee Kim
- Department of Rehabilitation Medicine, Wonkwang University School of Medicine, Iksan, 54538, Korea
| | - Chung Reen Kim
- Department of Rehabilitation Medicine, Ulsan University College of Medicine, Ulsan, 44033, Korea
| | - Oh Pum Kwon
- Department of Rehabilitation Medicine, Seoul National University Bundang Hospital, Seongnam, 13620, Korea
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Tonet E, Raisi A, Zagnoni S, Chiaranda G, Pavasini R, Vitali F, Gibiino F, Campana R, Boccadoro A, Scala A, Canovi L, Amantea V, Matese C, Berloni ML, Piva T, Zerbini V, Cardelli LS, Pasanisi G, Mazzoni G, Casella G, Grazzi G, Campo G. Multi-domain lifestyle intervention in older adults after myocardial infarction: rationale and design of the PIpELINe randomized clinical trial. Aging Clin Exp Res 2023; 35:1107-1115. [PMID: 36964866 PMCID: PMC10039445 DOI: 10.1007/s40520-023-02389-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/10/2023] [Indexed: 03/26/2023]
Abstract
BACKGROUND Traditional cardiac rehabilitation (CR) is effective in improving physical performance and prognosis after myocardial infarction (MI). Anyway, it is not consistently recommended to older adults, and its attendance rate is low. Previous studies suggested that alternative, early and tailored exercise interventions are feasible and effective in improving physical performance in older MI patients. Anyway, the demonstration that they are associated also with a significant reduction of hard endpoints is lacking. AIM To describe rationale and design of the "Physical activity Intervention in Elderly patients with myocardial Infarction" (PIpELINe) trial. METHODS The PIpELINe trial is a prospective, randomized, multicentre study with a blinded adjudicated evaluation of the outcomes. Patients aged ≥ 65 years, admitted to hospital for MI and with a low physical performance one month after discharge, as defined as short physical performance battery (SPPB) value between 4 and 9, will be randomized to a multi-domain lifestyle intervention (including dietary counselling, strict management of cardiovascular and metabolic risk factors, and exercise training) or health education. The primary endpoint is the one-year occurrence of the composite of cardiovascular death or re-hospitalization for cardiovascular causes. RESULTS The recruitment started in March 2020. The estimated sample size is 456 patients. The conclusion of the enrolment is planned for mid-2023. The primary endpoint analysis will be available for the end of 2024. CONCLUSIONS The PIpELINe trial will show if a multi-domain lifestyle intervention is able to reduce adverse events in older patients with reduced physical performance after hospitalization for MI. TRIAL REGISTRATION ClinicalTrials.gov NCT04183465.
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Affiliation(s)
- Elisabetta Tonet
- Cardiovascular Institute, Azienda Ospedaliera Universitaria di Ferrara, Cona, FE, Italy
| | - Andrea Raisi
- Center for Sports and Exercise Science, Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy
| | - Silvia Zagnoni
- Cardiology Unit, Ospedale Maggiore, Azienda USL Bologna, Bologna, Italy
| | - Giorgio Chiaranda
- Sports Medicine and Health Promotion Unit, Azienda Unità Sanitaria locale di Piacenza, Piacenza, Italy
| | - Rita Pavasini
- Cardiovascular Institute, Azienda Ospedaliera Universitaria di Ferrara, Cona, FE, Italy
| | - Francesco Vitali
- Cardiovascular Institute, Azienda Ospedaliera Universitaria di Ferrara, Cona, FE, Italy
| | - Federico Gibiino
- Cardiovascular Institute, Azienda Ospedaliera Universitaria di Ferrara, Cona, FE, Italy
| | - Roberta Campana
- Cardiovascular Institute, Azienda Ospedaliera Universitaria di Ferrara, Cona, FE, Italy
| | - Alberto Boccadoro
- Cardiovascular Institute, Azienda Ospedaliera Universitaria di Ferrara, Cona, FE, Italy
| | - Antonella Scala
- Cardiovascular Institute, Azienda Ospedaliera Universitaria di Ferrara, Cona, FE, Italy
| | - Luca Canovi
- Cardiovascular Institute, Azienda Ospedaliera Universitaria di Ferrara, Cona, FE, Italy
| | - Veronica Amantea
- Cardiovascular Institute, Azienda Ospedaliera Universitaria di Ferrara, Cona, FE, Italy
| | - Camilla Matese
- Cardiovascular Institute, Azienda Ospedaliera Universitaria di Ferrara, Cona, FE, Italy
| | - Maria Letizia Berloni
- Cardiovascular Institute, Azienda Ospedaliera Universitaria di Ferrara, Cona, FE, Italy
| | - Tommaso Piva
- Center for Sports and Exercise Science, Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy
| | - Valentina Zerbini
- Center for Sports and Exercise Science, Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy
| | | | - Giovanni Pasanisi
- Rehabilitation Cardiology, Azienda USL di Ferrara, Lagosanto, FE, Italy
| | - Gianni Mazzoni
- Center for Sports and Exercise Science, Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy
| | - Gianni Casella
- Cardiology Unit, Ospedale Maggiore, Azienda USL Bologna, Bologna, Italy
| | - Giovanni Grazzi
- Center for Sports and Exercise Science, Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy
- Healthy Living for Pandemic Event Protection (HL-PIVOT) Network, Chicago, IL, USA
| | - Gianluca Campo
- Cardiovascular Institute, Azienda Ospedaliera Universitaria di Ferrara, Cona, FE, Italy.
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Quality of Coronary Care: Reducing Practice Variability. Can J Cardiol 2023; 39:524-526. [PMID: 36681382 DOI: 10.1016/j.cjca.2023.01.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 01/16/2023] [Indexed: 01/20/2023] Open
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Jiang L, Wan R, Li B, Huang X, Xu Y, Wu K, Xu J, Lu Y. Efficacy and safety of different modes of exercise-based cardiac rehabilitation delivery for patients with heart failure: a protocol for a systematic review and network meta-analysis. BMJ Open 2022; 12:e062152. [PMID: 35926991 PMCID: PMC9358945 DOI: 10.1136/bmjopen-2022-062152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION The prevalence of heart failure (HF) is increasing. Exercise-based cardiac rehabilitation (CR) reduces mortality and further improves the prognosis of patients with HF. However, the effect of different modes of CR delivery on HF remains unclear. Thus, the purpose of this study is to find out the relative efficacy and safety of different modes of CR delivery for individuals with HF using a network meta-analysis. METHODS AND ANALYSIS We will perform a systematic review and network meta-analysis of randomised controlled trials which compare different modes of exercise-based CR delivery for patients with HF. Databases including Embase, Medline, the Cochrane Central Register of Controlled Trials and Web of Science will be searched up to May 2022. The primary outcomes will focus on the functional capacity and the health-related quality of life (hr-QOL). Functional capacity will be evaluated by peak oxygen consumption (mL/kg/min) and 6 min walking test (metres). The Minnesota Living with Heart Failure questionnaire, Short Form-36, Psychometric properties of the Kansas City cardiomyopathy questionnaire and EuroQol five dimensions questionnaire will serve as measures of hr-QOL. As secondary outcomes, we will assess hospital admissions (all-cause and cardiac) and all-cause mortality, which required a minimum follow-up of 6 months, as well as adverse events during exercise training. The risk of bias for individual studies will be evaluated according to the Cochrane Handbook. The quality of evidence will be assessed by the Grading of Recommendations, Assessment, Development and Evaluation approach. ETHICS AND DISSEMINATION This study does not require ethics approval as it is based on published trials. Results of this systematic review and network meta-analysis will be submitted to a peer-reviewed journal for future publication. TRIAL REGISTRATION NUMBER CRD42021278351.
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Affiliation(s)
- Lingjun Jiang
- Department of Sports and Rehabilitation Medicine, Ulm University Hospital, Ulm, Germany
- Department of Molecular and Cellular Sports Medicine, German Sport University Cologne, Cologne, Germany
| | - Ruixuan Wan
- Department of Chemistry, University of Washington, Seattle, Washington State, USA
| | - Bohan Li
- Department of Minimally Invasive Gynecologic Center, Capital Medical University, Beijing, China
| | - XuHui Huang
- Department of Breast Surgery, Baoding First Central Hospital, Baoding, China
| | - Yaning Xu
- Department of Pediatrics, Wangdu County Hospital, Baoding, China
| | - Kaisong Wu
- Department of Pediatrics, The No.2 Hospital of Baoding, Baoding, China
| | - Jie Xu
- Department of Ophthalmology, The Hospital of Yutian County, Tangshan, China
| | - Yan Lu
- Department of Gastroenterology, Children's Hospital of Nanjing Medical University, Nanjing, China
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Taylor JL, Popovic D, Lavie CJ. Exercise Modalities and Intensity to Improve Functional Capacity and Psychological/Mental Health in Cardiac Rehabilitation: A Role for Nordic Walking? Can J Cardiol 2022; 38:1135-1137. [DOI: 10.1016/j.cjca.2022.03.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 03/31/2022] [Accepted: 03/31/2022] [Indexed: 11/30/2022] Open
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Sustained Effects of Different Exercise Modalities on Physical and Mental Health in Patients With Coronary Artery Disease: A Randomized Clinical Trial. Can J Cardiol 2022; 38:1235-1243. [DOI: 10.1016/j.cjca.2022.03.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 03/16/2022] [Accepted: 03/28/2022] [Indexed: 11/19/2022] Open
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Alfaraidhy MA, Regan C, Forman DE. Cardiac rehabilitation for older adults: current evidence and future potential. Expert Rev Cardiovasc Ther 2022; 20:13-34. [PMID: 35098848 PMCID: PMC8858649 DOI: 10.1080/14779072.2022.2035722] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Growth of the older adult demographic has resulted in an increased number of older patients with cardiovascular disease (CVD) in combination with comorbid diseases and geriatric syndromes. Cardiac rehabilitation (CR) is utilized to promote recovery and improve outcomes, but remains underutilized, particularly by older adults. CR provides an opportunity to address the distinctive needs of older adults, with focus on CVD as well as geriatric domains that often dominate management and outcomes. AREAS COVERED Utility of CR for CVD in older adults as well as pertinent geriatric syndromes (e.g. multimorbidity, frailty, polypharmacy, cognitive decline, psychosocial stress, and diminished function) that affect CVD management. EXPERT OPINION Mounting data substantiate the importance of CR as part of recovery for older adults with CVD. The application of CR as a standard therapy is especially important as the combination of CVD and geriatric syndromes catalyzes functional decline and can trigger progressive clinical deterioration and dependency. While benefits of CR for older adults with CVD are already evident, further reengineering of CR is necessary to better address the needs of older candidates who may be frail, especially as remote and hybrid formats of CR are becoming more widespread.
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Affiliation(s)
- Maha A. Alfaraidhy
- Department of Medicine, University of Maryland School of Medicine, Baltimore, MD,Department of Medicine, King Abdulaziz University School of Medicine, Jeddah, KSA
| | - Claire Regan
- University of Maryland School of Nursing, Baltimore, MD
| | - Daniel E. Forman
- Department of Medicine (Geriatrics and Cardiology), Section of Geriatric Cardiology, University of Pittsburgh, Pittsburgh, Pennsylvania, PA,Geriatric Research, Education, and Clinical Center, VA Pittsburgh Healthcare System, University of Pittsburgh, Pittsburgh, PA
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Nathanail SK, Gyenes GT, Van Damme A, Meyer TC, Parent EC, Kennedy MD. Participant exercise attendance in community-based, bridging, and hospital-based cardiac rehabilitation: a retrospective case control study. CJC Open 2021; 4:364-372. [PMID: 35495860 PMCID: PMC9039574 DOI: 10.1016/j.cjco.2021.12.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 12/03/2021] [Indexed: 12/12/2022] Open
Abstract
Background A paucity of studies have investigated participant attendance in community-based and hybrid cardiac rehabilitation programs in the Canadian setting. We compared exercise-session attendance of community-based, bridging (hospital plus community-based), and hospital-based participants who attended a high-volume cardiac rehabilitation program in Alberta, Canada. Methods Exercise sessions attended and participant characteristics were collected and analyzed from 230 records of patients who attended cardiac rehabilitation between 2016 and 2019. Community-based (n = 74) and bridging (n = 41) program participants were age- and sex-matched in a 1:1 ratio to hospital-based participants. The number of exercise sessions attended was compared among program groups, between female and male patients, and for patients with vs without cardiac surgery. The percentage of exercise sessions attended was also compared among program groups. Results Bridging participants attended the greatest number of exercise sessions (median = 10.0 sessions) and demonstrated a significantly higher percentage of sessions attended (91%, 25th and 75th percentile interquartile range [IQR] = 64, 100%) than matched hospital participants (median = 6.0 sessions; 63%, 25, 75 IQR = 13, 94%; P = 0.01). Percentage of sessions attended did not differ for bridging and community-based participants (P = 0.30). Exercise-session attendance was similar for community-based participants (median = 6.0 sessions; 75%, 25, 75 IQR = 38%, 88%) vs their hospital matches (median = 6.0 sessions; 81%, 25, 75 IQR = 38%, 100%; P ≥ 0.37), as well as for female vs male patients (median = 7.0 sessions for both sexes; P = 0.66), and for surgical vs nonsurgical patients (median = 7.0 sessions; P = 0.48). Female patients in the bridging program attended significantly more exercise sessions in the community, compared with male patients in the bridging program (P = 0.02). Conclusions Bridging participants attended the most exercise sessions overall and demonstrated a higher percentage attendance than hospital-based participants. These results suggest that a hybrid program consisting of hospital and community-based exercise was favourable for exercise-session attendance. Given modern approaches to de-medicalize cardiac rehabilitation, our findings further support the provision of community program offerings, without detriment to patient session attendance.
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Angel-Garcia D, Martinez-Nicolas I, Salmeri B, Monot A. Quality of Care Indicators for Hospital Physical Therapy Units: A Systematic Review. Phys Ther 2021; 102:6432446. [PMID: 34935986 PMCID: PMC8807027 DOI: 10.1093/ptj/pzab261] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 06/10/2021] [Accepted: 10/18/2021] [Indexed: 11/12/2022]
Abstract
OBJECTIVE The purpose of this review was to identify quality indicators described in the literature that may be used as quality measures in hospital physical therapy units. METHODS The following sources were searched for quality indicators or articles: Web of Science, MEDLINE, IBECS, Latin American and Caribbean Health Sciences Literature, Cumulative Index of Nursing and Allied Health, Academic Search Complete, SportDiscus, SciELO, PsychINFO, Consejo Superior de Investigaciones Cientificas, and Scopus databases; the Agency for Healthcare Research and Quality, National Health System Indicator Portal, Joint Commission on Accreditation of Healthcare Organizations, and Organisation for Economic Co-operation and Development websites; and the National Quality Forum's measures inventory tool. Search terms included "quality indicator," "quality measure," "physiotherapy," and "physical therapy." Inclusion criteria were articles written in English, Spanish, French, or Portuguese aimed at measuring the quality of care in hospital physical therapy units. Evidence-based indicators with an explicit formula were extracted by 2 independent reviewers and then classified using the structure-process-outcome model, quality domain, and categories defined by a consensus method. RESULTS Of the 176 articles identified, only 19 met the criteria. From these articles and from the indicator repository searches, 178 clinical care indicators were included in the qualitative synthesis and presented in this paper. Process and outcome measures were prevalent, and 5 out of the 6 quality domains were represented. No efficiency measures were identified. Moreover, structure indicators, equity and accessibility indicators, and indicators in the cardiovascular and circulatory, mental health, pediatrics, and intensive care categories were underrepresented. CONCLUSIONS A broad selection of quality indicators was identified from international resources, which can be used to measure the quality of physical therapy care in hospital units. IMPACT This review identified 178 quality of care indicators that can be used in clinical practice monitoring and quality improvement of hospital physical therapy units. The results highlight a lack of accessibility, equity, and efficiency measures for physical therapy units.
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Affiliation(s)
- Daniel Angel-Garcia
- Department of Physiotherapy, Catholic University of Murcia (UCAM), Guadalupe, Murcia, Spain
| | | | - Bianca Salmeri
- Department of Physiotherapy, Catholic University of Murcia (UCAM), Guadalupe, Murcia, Spain
| | - Alizée Monot
- Department of Physiotherapy, Catholic University of Murcia (UCAM), Guadalupe, Murcia, Spain
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Dibben G, Faulkner J, Oldridge N, Rees K, Thompson DR, Zwisler AD, Taylor RS. Exercise-based cardiac rehabilitation for coronary heart disease. Cochrane Database Syst Rev 2021; 11:CD001800. [PMID: 34741536 PMCID: PMC8571912 DOI: 10.1002/14651858.cd001800.pub4] [Citation(s) in RCA: 86] [Impact Index Per Article: 28.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Coronary heart disease (CHD) is the most common cause of death globally. However, with falling CHD mortality rates, an increasing number of people living with CHD may need support to manage their symptoms and prognosis. Exercise-based cardiac rehabilitation (CR) aims to improve the health and outcomes of people with CHD. This is an update of a Cochrane Review previously published in 2016. OBJECTIVES To assess the clinical effectiveness and cost-effectiveness of exercise-based CR (exercise training alone or in combination with psychosocial or educational interventions) compared with 'no exercise' control, on mortality, morbidity and health-related quality of life (HRQoL) in people with CHD. SEARCH METHODS We updated searches from the previous Cochrane Review, by searching CENTRAL, MEDLINE, Embase, and two other databases in September 2020. We also searched two clinical trials registers in June 2021. SELECTION CRITERIA We included randomised controlled trials (RCTs) of exercise-based interventions with at least six months' follow-up, compared with 'no exercise' control. The study population comprised adult men and women who have had a myocardial infarction (MI), coronary artery bypass graft (CABG) or percutaneous coronary intervention (PCI), or have angina pectoris, or coronary artery disease. DATA COLLECTION AND ANALYSIS We screened all identified references, extracted data and assessed risk of bias according to Cochrane methods. We stratified meta-analysis by duration of follow-up: short-term (6 to 12 months); medium-term (> 12 to 36 months); and long-term ( > 3 years), and used meta-regression to explore potential treatment effect modifiers. We used GRADE for primary outcomes at 6 to 12 months (the most common follow-up time point). MAIN RESULTS: This review included 85 trials which randomised 23,430 people with CHD. This latest update identified 22 new trials (7795 participants). The population included predominantly post-MI and post-revascularisation patients, with a mean age ranging from 47 to 77 years. In the last decade, the median percentage of women with CHD has increased from 11% to 17%, but females still account for a similarly small percentage of participants recruited overall ( < 15%). Twenty-one of the included trials were performed in low- and middle-income countries (LMICs). Overall trial reporting was poor, although there was evidence of an improvement in quality over the last decade. The median longest follow-up time was 12 months (range 6 months to 19 years). At short-term follow-up (6 to 12 months), exercise-based CR likely results in a slight reduction in all-cause mortality (risk ratio (RR) 0.87, 95% confidence interval (CI) 0.73 to 1.04; 25 trials; moderate certainty evidence), a large reduction in MI (RR 0.72, 95% CI 0.55 to 0.93; 22 trials; number needed to treat for an additional beneficial outcome (NNTB) 75, 95% CI 47 to 298; high certainty evidence), and a large reduction in all-cause hospitalisation (RR 0.58, 95% CI 0.43 to 0.77; 14 trials; NNTB 12, 95% CI 9 to 21; moderate certainty evidence). Exercise-based CR likely results in little to no difference in risk of cardiovascular mortality (RR 0.88, 95% CI 0.68 to 1.14; 15 trials; moderate certainty evidence), CABG (RR 0.99, 95% CI 0.78 to 1.27; 20 trials; high certainty evidence), and PCI (RR 0.86, 95% CI 0.63 to 1.19; 13 trials; moderate certainty evidence) up to 12 months' follow-up. We are uncertain about the effects of exercise-based CR on cardiovascular hospitalisation, with a wide confidence interval including considerable benefit as well as harm (RR 0.80, 95% CI 0.41 to 1.59; low certainty evidence). There was evidence of substantial heterogeneity across trials for cardiovascular hospitalisations (I2 = 53%), and of small study bias for all-cause hospitalisation, but not for all other outcomes. At medium-term follow-up, although there may be little to no difference in all-cause mortality (RR 0.90, 95% CI 0.80 to 1.02; 15 trials), MI (RR 1.07, 95% CI 0.91 to 1.27; 12 trials), PCI (RR 0.96, 95% CI 0.69 to 1.35; 6 trials), CABG (RR 0.97, 95% CI 0.77 to 1.23; 9 trials), and all-cause hospitalisation (RR 0.92, 95% CI 0.82 to 1.03; 9 trials), a large reduction in cardiovascular mortality was found (RR 0.77, 95% CI 0.63 to 0.93; 5 trials). Evidence is uncertain for difference in risk of cardiovascular hospitalisation (RR 0.92, 95% CI 0.76 to 1.12; 3 trials). At long-term follow-up, although there may be little to no difference in all-cause mortality (RR 0.91, 95% CI 0.75 to 1.10), exercise-based CR may result in a large reduction in cardiovascular mortality (RR 0.58, 95% CI 0.43 to 0.78; 8 trials) and MI (RR 0.67, 95% CI 0.50 to 0.90; 10 trials). Evidence is uncertain for CABG (RR 0.66, 95% CI 0.34 to 1.27; 4 trials), and PCI (RR 0.76, 95% CI 0.48 to 1.20; 3 trials). Meta-regression showed benefits in outcomes were independent of CHD case mix, type of CR, exercise dose, follow-up length, publication year, CR setting, study location, sample size or risk of bias. There was evidence that exercise-based CR may slightly increase HRQoL across several subscales (SF-36 mental component, physical functioning, physical performance, general health, vitality, social functioning and mental health scores) up to 12 months' follow-up; however, these may not be clinically important differences. The eight trial-based economic evaluation studies showed exercise-based CR to be a potentially cost-effective use of resources in terms of gain in quality-adjusted life years (QALYs). AUTHORS' CONCLUSIONS This updated Cochrane Review supports the conclusions of the previous version, that exercise-based CR provides important benefits to people with CHD, including reduced risk of MI, a likely small reduction in all-cause mortality, and a large reduction in all-cause hospitalisation, along with associated healthcare costs, and improved HRQoL up to 12 months' follow-up. Over longer-term follow-up, benefits may include reductions in cardiovascular mortality and MI. In the last decade, trials were more likely to include females, and be undertaken in LMICs, increasing the generalisability of findings. Well-designed, adequately-reported RCTs of CR in people with CHD more representative of usual clinical practice are still needed. Trials should explicitly report clinical outcomes, including mortality and hospital admissions, and include validated HRQoL outcome measures, especially over longer-term follow-up, and assess costs and cost-effectiveness.
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Affiliation(s)
- Grace Dibben
- MRC/CSO Social and Public Health Sciences Unit, Institute of Health and Well Being, University of Glasgow, Glasgow, UK
| | - James Faulkner
- Faculty Health and Wellbeing, School of Sport, Health and Community, University of Winchester, Winchester, UK
| | - Neil Oldridge
- College of Health Sciences, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin, USA
| | - Karen Rees
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - David R Thompson
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK
| | - Ann-Dorthe Zwisler
- REHPA, The Danish Knowledge Centre for Rehabilitation and Palliative Care, Odense University Hospital, Nyborg, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Rod S Taylor
- MRC/CSO Social and Public Health Sciences Unit & Robertson Centre for Biostatistics, Institute of Health and Well Being, University of Glasgow, Glasgow, UK
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
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Overstreet B, Kirkman D, Qualters WK, Kerrigan D, Haykowsky MJ, Tweet MS, Christle JW, Brawner CA, Ehrman JK, Keteyian SJ. Rethinking Rehabilitation: A REVIEW OF PATIENT POPULATIONS WHO CAN BENEFIT FROM CARDIAC REHABILITATION. J Cardiopulm Rehabil Prev 2021; 41:389-399. [PMID: 34727558 DOI: 10.1097/hcr.0000000000000654] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Although cardiac rehabilitation (CR) is safe and highly effective for individuals with various cardiovascular health conditions, to date there are only seven diagnoses or procedures identified by the Centers for Medicare & Medicaid Services that qualify for referral. When considering the growing number of individuals with cardiovascular disease (CVD), or other health conditions that increase the risk for CVD, it is important to determine the extent for which CR could benefit these populations. Furthermore, there are some patients who may currently be eligible for CR (spontaneous coronary artery dissection, left ventricular assistant device) but make up a relatively small proportion of the populations that are regularly attending and participating. Thus, these patient populations and special considerations for exercise might be less familiar to professionals who are supervising their programs. The purpose of this review is to summarize the current literature surrounding exercise testing and programming among four specific patient populations that either do not currently qualify for (chronic and end-stage renal disease, breast cancer survivor) or who are eligible but less commonly seen in CR (sudden coronary artery dissection, left ventricular assist device). While current evidence suggests that individuals with these health conditions can safely participate in and may benefit from supervised exercise programming, there is an immediate need for high-quality, multisite clinical trials to develop more specific exercise recommendations and support the inclusion of these populations in future CR programs.
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Affiliation(s)
- Brittany Overstreet
- Kinesiology and Applied Physiology Department, University of Delaware, Newark (Dr Overstreet); Department of Kinesiology and Health Sciences, Virginia Commonwealth University, Richmond (Dr Kirkman); Division of Cardiovascular Medicine, Henry Ford Health System, Detroit, Michigan (Ms Qualters and Drs Kerrigan, Brawner, Ehrman, and Keteyian); Faculty of Nursing, University of Alberta, Edmonton, Canada (Dr Haykowsky); Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota (Dr Tweet); and Division of Cardiovascular Medicine, Department of Medicine, Stanford University, Stanford, California (Dr Christle)
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Graham H, Prue-Owens K, Kirby J, Ramesh M. Systematic Review of Interventions Designed to Maintain or Increase Physical Activity Post-Cardiac Rehabilitation Phase II. Rehabil Process Outcome 2021; 9:1179572720941833. [PMID: 34497468 PMCID: PMC8282140 DOI: 10.1177/1179572720941833] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 06/18/2020] [Indexed: 12/21/2022] Open
Abstract
Background: Cardiovascular disease (CVD) continues to be the No. 1 cause of death in the United States and globally, and individuals with a history of a cardiac event are at increased risk for a repeat event. Physical inactivity creates health problems for individuals with chronic heart disease. Evidence shows that physical activity (PA), as a central component of cardiac rehabilitation phase II (CRII), decreases hospital readmission and mortality. Yet, individual adherence to PA tends to decline several months following CRII completion. Objective: The purpose of this review was to evaluate current literature for interventions designed to assist individuals diagnosed with myocardial infarction (MI), coronary artery bypass graft (CABG), coronary artery disease (CAD), and percutaneous coronary intervention (PCI) to maintain or increase PA post-CRII. Methods: A systematic search of 5 electronic databases including hand-searched articles between 2000 and 2019. Key Medical Subject Headings (MeSH) search terms included cardiac rehabilitation, intervention, exercise or PA, outcomes, compliance, adherence, or maintenance. Only interventions implemented following CRII program completion were included for review. Results: Based on the inclusion criteria, the search yielded 19 randomized control trials retained for descriptive analysis. Interventions were categorized into 3 domains. The intervention designs varied widely in terms of duration of the intervention and the length of time to outcome measurement. Most interventions were short-term with only 2 studies offering a long-term intervention of greater than 1 year. Interventions using a theoretical approach most often included a cognitive-behavioral model. Conclusions: Interventions offered shortly after completion of CRII may help cardiac patients maintain PA and reduce the risk of experiencing additional cardiac events; however, more quality research is needed. Additional research to examine PA maintenance in older adults (70 years and older) would be valuable based on the increase in average lifespan. Studies with larger and more diverse samples, and less variation in methods and outcomes would greatly increase the ability to conduct a high-quality meta-analysis.
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Affiliation(s)
- Helen Graham
- Helen and Arthur E. Johnson Beth-El College of Nursing and Health Sciences, University of Colorado Colorado Springs, Colorado Springs, CO, USA
| | - Kathy Prue-Owens
- Helen and Arthur E. Johnson Beth-El College of Nursing and Health Sciences, University of Colorado Colorado Springs, Colorado Springs, CO, USA
| | - Jess Kirby
- Helen and Arthur E. Johnson Beth-El College of Nursing and Health Sciences, University of Colorado Colorado Springs, Colorado Springs, CO, USA
| | - Mythreyi Ramesh
- Helen and Arthur E. Johnson Beth-El College of Nursing and Health Sciences, University of Colorado Colorado Springs, Colorado Springs, CO, USA
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Taylor RS, Dibben G, Faulkner J, Dalal H. More Evidence of Cardiac Rehabilitation: Need to Consider Patient Quality of Life. Can J Cardiol 2021; 37:1681-1682. [PMID: 33484838 DOI: 10.1016/j.cjca.2021.01.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 01/05/2021] [Indexed: 10/22/2022] Open
Affiliation(s)
- Rod S Taylor
- MRC/CSO Social and Public Health Sciences Unit & Robertson Centre for Biostatistics, Institute of Health and Well Being, University of Glasgow, Glasgow, UK.
| | - Grace Dibben
- MRC/CSO Social and Public Health Sciences Unit & Robertson Centre for Biostatistics, Institute of Health and Well Being, University of Glasgow, Glasgow, UK
| | - James Faulkner
- MRC/CSO Social and Public Health Sciences Unit & Robertson Centre for Biostatistics, Institute of Health and Well Being, University of Glasgow, Glasgow, UK
| | - Hasnain Dalal
- MRC/CSO Social and Public Health Sciences Unit & Robertson Centre for Biostatistics, Institute of Health and Well Being, University of Glasgow, Glasgow, UK
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More Evidence of Comprehensive Cardiac Rehabilitation Benefits, Even for All-Cause Mortality: Need to Increase Use Worldwide. Can J Cardiol 2021; 37:19-21. [DOI: 10.1016/j.cjca.2020.02.087] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 02/24/2020] [Accepted: 02/24/2020] [Indexed: 01/13/2023] Open
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