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Thomas RJ. Cardiac Rehabilitation - Challenges, Advances, and the Road Ahead. N Engl J Med 2024; 390:830-841. [PMID: 38416431 DOI: 10.1056/nejmra2302291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/29/2024]
Affiliation(s)
- Randal J Thomas
- From the Division of Preventive Cardiology, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
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Beatty AL, Beckie TM, Dodson J, Goldstein CM, Hughes JW, Kraus WE, Martin SS, Olson TP, Pack QR, Stolp H, Thomas RJ, Wu WC, Franklin BA. A New Era in Cardiac Rehabilitation Delivery: Research Gaps, Questions, Strategies, and Priorities. Circulation 2023; 147:254-266. [PMID: 36649394 PMCID: PMC9988237 DOI: 10.1161/circulationaha.122.061046] [Citation(s) in RCA: 30] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Cardiac rehabilitation (CR) is a guideline-recommended, multidisciplinary program of exercise training, risk factor management, and psychosocial counseling for people with cardiovascular disease (CVD) that is beneficial but underused and with substantial disparities in referral, access, and participation. The emergence of new virtual and remote delivery models has the potential to improve access to and participation in CR and ultimately improve outcomes for people with CVD. Although data suggest that new delivery models for CR have safety and efficacy similar to traditional in-person CR, questions remain regarding which participants are most likely to benefit from these models, how and where such programs should be delivered, and their effect on outcomes in diverse populations. In this review, we describe important gaps in evidence, identify relevant research questions, and propose strategies for addressing them. We highlight 4 research priorities: (1) including diverse populations in all CR research; (2) leveraging implementation methodologies to enhance equitable delivery of CR; (3) clarifying which populations are most likely to benefit from virtual and remote CR; and (4) comparing traditional in-person CR with virtual and remote CR in diverse populations using multicenter studies of important clinical, psychosocial, and cost-effectiveness outcomes that are relevant to patients, caregivers, providers, health systems, and payors. By framing these important questions, we hope to advance toward a goal of delivering high-quality CR to as many people as possible to improve outcomes in those with CVD.
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Affiliation(s)
- Alexis L Beatty
- Department of Epidemiology and Biostatistics (A.L.B.), University of California, San Francisco.,Department of Medicine, Division of Cardiology (A.L.B.), University of California, San Francisco
| | - Theresa M Beckie
- College of Nursing (T.M.B.), University of South Florida, Tampa.,College of Medicine, Division of Cardiovascular Sciences (T.M.B.), University of South Florida, Tampa
| | - John Dodson
- Leon H. Charney Division of Cardiology, Department of Medicine (J.D.), New York University School of Medicine, New York.,Department of Population Health (J.D.), New York University School of Medicine, New York
| | - Carly M Goldstein
- The Weight Control and Diabetes Research Center, the Miriam Hospital, Providence, RI (C.M.G.).,Department of Psychiatry and Human Behavior, The Warren Alpert Medical School (C.M.G.), Brown University, Providence, RI
| | - Joel W Hughes
- Department of Psychological Sciences, Kent State University, OH (J.W.H.)
| | - William E Kraus
- Department of Medicine, Division of Cardiology, Duke University, Durham, NC (W.E.K.)
| | - Seth S Martin
- Department of Medicine, Division of Cardiology, Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD (S.S.M.)
| | - Thomas P Olson
- Department of Cardiovascular Medicine, Division of Preventive Cardiology, Mayo Clinic, Rochester, MN (T.P.O., R.J.T.)
| | - Quinn R Pack
- Department of Healthcare Delivery and Population Science, University of Massachusetts Medical School-Baystate, Springfield (Q.R.P.)
| | - Haley Stolp
- ASRT, Inc, Atlanta, GA (H.S.).,Centers for Disease Control and Prevention, Atlanta, GA (H.S.)
| | - Randal J Thomas
- Department of Cardiovascular Medicine, Division of Preventive Cardiology, Mayo Clinic, Rochester, MN (T.P.O., R.J.T.)
| | - Wen-Chih Wu
- Lifespan Cardiovascular Institute (W.-C.W.), Brown University, Providence, RI.,Division of Cardiology, Providence VA Medical Center, RI (W.-C.W.)
| | - Barry A Franklin
- William Beaumont Hospital, Royal Oak, MI (B.A.F.).,Oakland University William Beaumont School of Medicine, Rochester, MI (B.A.F.)
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Kottke TE, Gupta AK, Thomas RJ. Failing Cardiovascular Health. J Am Coll Cardiol 2022; 80:152-154. [DOI: 10.1016/j.jacc.2022.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 05/05/2022] [Accepted: 05/12/2022] [Indexed: 10/17/2022]
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Parry M, Van Spall HG, Mullen KA, Mulvagh SL, Pacheco C, Colella TJF, Clavel MA, Jaffer S, Foulds HJ, Grewal J, Hardy M, Price JA, Levinsson AL, Gonsalves CA, Norris CM. The Canadian Women’s Heart Health Alliance Atlas on the Epidemiology, Diagnosis, and Management of Cardiovascular Disease in Women-Chapter 6: Sex- And Gender-Specific Diagnosis and Treatment. CJC Open 2022; 4:589-608. [PMID: 35865023 PMCID: PMC9294990 DOI: 10.1016/j.cjco.2022.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 04/12/2022] [Indexed: 10/26/2022] Open
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Williamson TM, Rouleau CR, Aggarwal SG, Arena R, Hauer T, Campbell TS. The impact of patient education on knowledge, attitudes, and cardiac rehabilitation attendance among patients with coronary artery disease. PATIENT EDUCATION AND COUNSELING 2021; 104:2969-2978. [PMID: 33994262 DOI: 10.1016/j.pec.2021.04.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 03/02/2021] [Accepted: 04/21/2021] [Indexed: 05/23/2023]
Abstract
OBJECTIVE Patient education (PE) delivered during exercise-based cardiac rehabilitation (CR) aims to promote health behaviour change, including attendance at CR exercise sessions, by imparting knowledge about coronary artery disease (CAD) and improving CR-related attitudes. This study evaluated the impact of PE on aspects of patient motivation (i.e., CAD-related knowledge, attitudes towards CR) and exercise session attendance. METHODS Adults with CAD referred to a 12-week CR program were recruited. CAD knowledge, perceived necessity/suitability of CR, exercise concerns, and barriers to CR were assessed pre/post-PE, and at 12-week follow-up. CR exercise attendance was obtained by chart review. RESULTS Among 90 patients (60 ± 10 years; 88% men), CAD knowledge and perceived necessity of CR improved pre- to post-PE; gains persisted at 12-weeks. Stronger pre-CR intentions to attend exercise sessions predicted greater attendance. Greater knowledge gains did not predict improvements in CR attitudes or exercise attendance. CONCLUSION Whereas PE may be useful for improving knowledge and attitudes regarding CAD self-management, more formative research is needed to determine whether PE can promote CR attendance. PRACTICE IMPLICATIONS Cardiac PE programs may be more successful in promoting exercise attendance if they target patients' behavioural intentions to attend and attitudes toward CR, rather than focussing exclusively on imparting knowledge.
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Affiliation(s)
- Tamara M Williamson
- Department of Psychology, University of Calgary, 2500 University Drive Northwest, Calgary, Alberta T2N 1N4, Canada.
| | - Codie R Rouleau
- Department of Psychology, University of Calgary, 2500 University Drive Northwest, Calgary, Alberta T2N 1N4, Canada; TotalCardiology™ Rehabilitation, 2225 MacLeod Trail South, Calgary, Alberta T2G 5B6, Canada; TotalCardiology Research Network, 2225 MacLeod Trail South, Calgary, Alberta T2G 5B6, Canada; Department of Physical Therapy, Applied Health Sciences, University of Illinois at Chicago, 1919 W. Taylor St., Chicago, IL 60607, USA
| | - Sandeep G Aggarwal
- TotalCardiology™ Rehabilitation, 2225 MacLeod Trail South, Calgary, Alberta T2G 5B6, Canada; TotalCardiology Research Network, 2225 MacLeod Trail South, Calgary, Alberta T2G 5B6, Canada; Libin Cardiovascular Institute of Alberta, University of Calgary, Heritage Medical Research Building (HMRB) Room 72, Foothills Campus, 3310 Hospital Drive NW, Calgary, Alberta T2N 4N1, Canada
| | - Ross Arena
- TotalCardiology Research Network, 2225 MacLeod Trail South, Calgary, Alberta T2G 5B6, Canada; Department of Physical Therapy, Applied Health Sciences, University of Illinois at Chicago, 1919 W. Taylor St., Chicago, IL 60607, USA
| | - Trina Hauer
- TotalCardiology™ Rehabilitation, 2225 MacLeod Trail South, Calgary, Alberta T2G 5B6, Canada; TotalCardiology Research Network, 2225 MacLeod Trail South, Calgary, Alberta T2G 5B6, Canada
| | - Tavis S Campbell
- Department of Psychology, University of Calgary, 2500 University Drive Northwest, Calgary, Alberta T2N 1N4, Canada; TotalCardiology Research Network, 2225 MacLeod Trail South, Calgary, Alberta T2G 5B6, Canada; Libin Cardiovascular Institute of Alberta, University of Calgary, Heritage Medical Research Building (HMRB) Room 72, Foothills Campus, 3310 Hospital Drive NW, Calgary, Alberta T2N 4N1, Canada.
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Jacobs AK, Ali MJ, Best PJ, Bieniarz MC, Bufalino VJ, French WJ, Henry TD, Hollowell L, Jauch EC, Kurz MC, Levy M, Patel P, Spier T, Stone RH, Tataris KL, Thomas RJ, Zègre-Hemsey JK. Systems of Care for ST-Segment-Elevation Myocardial Infarction: A Policy Statement From the American Heart Association. Circulation 2021; 144:e310-e327. [PMID: 34641735 DOI: 10.1161/cir.0000000000001025] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
The introduction of Mission: Lifeline significantly increased timely access to percutaneous coronary intervention for patients with ST-segment-elevation myocardial infarction (STEMI). In the years since, morbidity and mortality rates have declined, and research has led to significant developments that have broadened our concept of the STEMI system of care. However, significant barriers and opportunities remain. From community education to 9-1-1 activation and emergency medical services triage and from emergency department and interfacility transfer protocols to postacute care, each critical juncture presents unique challenges for the optimal care of patients with STEMI. This policy statement sets forth recommendations for how the ideal STEMI system of care should be designed and implemented to ensure that patients with STEMI receive the best evidence-based care at each stage in their illness.
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Carvalho TD, Milani M, Ferraz AS, Silveira ADD, Herdy AH, Hossri CAC, Silva CGSE, Araújo CGSD, Rocco EA, Teixeira JAC, Dourado LOC, Matos LDNJD, Emed LGM, Ritt LEF, Silva MGD, Santos MAD, Silva MMFD, Freitas OGAD, Nascimento PMC, Stein R, Meneghelo RS, Serra SM. Brazilian Cardiovascular Rehabilitation Guideline - 2020. Arq Bras Cardiol 2020; 114:943-987. [PMID: 32491079 PMCID: PMC8387006 DOI: 10.36660/abc.20200407] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Affiliation(s)
- Tales de Carvalho
- Clínica de Prevenção e Reabilitação Cardiosport , Florianópolis , SC - Brasil
- Universidade do Estado de Santa Catarina (Udesc), Florianópolis , SC - Brasil
| | | | | | - Anderson Donelli da Silveira
- Programa de Pós-Graduação em Cardiologia e Ciências Cardiovasculares da Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre , RS - Brasil
- Hospital de Clínicas de Porto Alegre , Universidade Federal do Rio Grande do Sul (HCPA/UFRGS), Porto Alegre , RS - Brasil
- Vitta Centro de Bem Estar Físico , Porto Alegre , RS - Brasil
| | - Artur Haddad Herdy
- Clínica de Prevenção e Reabilitação Cardiosport , Florianópolis , SC - Brasil
- Instituto de Cardiologia de Santa Catarina , Florianópolis , SC - Brasil
- Unisul: Universidade do Sul de Santa Catarina (UNISUL), Florianópolis , SC - Brasil
| | | | | | | | | | | | - Luciana Oliveira Cascaes Dourado
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HC-FMUSP), Rio de Janeiro , RJ - Brasil
| | | | | | - Luiz Eduardo Fonteles Ritt
- Hospital Cárdio Pulmonar , Salvador , BA - Brasil
- Escola Bahiana de Medicina e Saúde Pública , Salvador , BA - Brasil
| | | | - Mauro Augusto Dos Santos
- ACE Cardiologia do Exercício , Rio de Janeiro , RJ - Brasil
- Instituto Nacional de Cardiologia , Rio de Janeiro , RJ - Brasil
| | | | | | - Pablo Marino Corrêa Nascimento
- Universidade Federal Fluminense (UFF), Rio de Janeiro , RJ - Brasil
- Instituto Nacional de Cardiologia , Rio de Janeiro , RJ - Brasil
| | - Ricardo Stein
- Programa de Pós-Graduação em Cardiologia e Ciências Cardiovasculares da Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre , RS - Brasil
- Hospital de Clínicas de Porto Alegre , Universidade Federal do Rio Grande do Sul (HCPA/UFRGS), Porto Alegre , RS - Brasil
- Vitta Centro de Bem Estar Físico , Porto Alegre , RS - Brasil
| | - Romeu Sergio Meneghelo
- Instituto Dante Pazzanese de Cardiologia , São Paulo , SP - Brasil
- Hospital Israelita Albert Einstein , São Paulo , SP - Brasil
| | - Salvador Manoel Serra
- Instituto Estadual de Cardiologia Aloysio de Castro (IECAC), Rio de Janeiro , RJ - Brasil
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Ozemek C, Thomas RJ, Lavie CJ. Cost-Sharing Deters Cardiac Rehabilitation Adherence. Mayo Clin Proc 2019; 94:2372-2374. [PMID: 31806091 DOI: 10.1016/j.mayocp.2019.10.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Accepted: 10/24/2019] [Indexed: 11/25/2022]
Affiliation(s)
- Cemal Ozemek
- Department of Physical Therapy, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL.
| | - Randal J Thomas
- Division of Preventive Cardiology, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | - Carl J Lavie
- Department of Cardiovascular Disease, John Ochsner Heart and Vascular Institute, Ochsner Clinical School, University of Queensland School of Medicine, New Orleans, LA
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Farah M, Abdallah M, Szalai H, Berry R, Lagu T, Lindenauer PK, Pack QR. Association Between Patient Cost Sharing and Cardiac Rehabilitation Adherence. Mayo Clin Proc 2019; 94:2390-2398. [PMID: 31806097 PMCID: PMC6946372 DOI: 10.1016/j.mayocp.2019.07.018] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Accepted: 07/31/2019] [Indexed: 12/28/2022]
Abstract
OBJECTIVE To determine the association between cost sharing and adherence to cardiac rehabilitation (CR). PATIENTS AND METHODS We collected detailed cost-sharing information for patients enrolled in CR at Baystate Medical Center in Springfield, Massachusetts, including the presence (or absence) and amounts of co-pays and deductibles. We evaluated the association between cost sharing and the total number of CR sessions attended as well as the influence of household income on CR attendance. RESULTS In 2015, 603 patients enrolled in CR had complete cost-sharing information. In total, 235 (39%) had some form of cost sharing. Of these, 192 (82%) had co-pays (median co-pay, $20; interquartile range [IQR], $10-$32) and 79 (34%) had an unmet deductible (median, $500; IQR, $250-$1800). The presence of any amount or form of cost sharing was associated with 6 fewer sessions of CR (16; IQR, 4-36 vs 10; IQR, 4-27; P<.001). Patients hospitalized in November or December with deductibles that renewed in January attended 4.5 fewer sessions of CR (8.5; IQR, 3.25-12.50 vs 13; IQR, 5.25-36.00; P=.049). After adjustment for differences in baseline characteristics, every $10 increase in co-pay was associated with 1.5 (95% CI, -2.3 to -0.7) fewer sessions of CR (P<.001). Household income did not moderate these relationships. CONCLUSION Cost sharing was associated with lower CR attendance and exhibited a dose-response relationship such that higher cost sharing was associated with lower CR attendance. Given that CR is cost-effective and underutilized, insurance companies and other payers should reevaluate their cost-sharing policies for CR.
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Affiliation(s)
- Michel Farah
- Department of Internal Medicine, University of Massachusetts Medical School - Baystate, Springfield
| | - Maya Abdallah
- Department of Internal Medicine, University of Massachusetts Medical School - Baystate, Springfield
| | - Heidi Szalai
- Division of Cardiovascular Medicine, Baystate Medical Center, Springfield, MA
| | - Robert Berry
- Division of Preventive Cardiology, Henry Ford Hospital, Detroit, MI
| | - Tara Lagu
- Department of Internal Medicine, University of Massachusetts Medical School - Baystate, Springfield; Institute for Healthcare Delivery and Population Science, University of Massachusetts Medical School - Baystate, Springfield
| | - Peter K Lindenauer
- Department of Internal Medicine, University of Massachusetts Medical School - Baystate, Springfield; Institute for Healthcare Delivery and Population Science, University of Massachusetts Medical School - Baystate, Springfield
| | - Quinn R Pack
- Department of Internal Medicine, University of Massachusetts Medical School - Baystate, Springfield; Institute for Healthcare Delivery and Population Science, University of Massachusetts Medical School - Baystate, Springfield; Division of Cardiovascular Medicine, Baystate Medical Center, Springfield, MA.
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Thomas RJ, Huang HH. Cardiac Rehabilitation for Secondary Prevention of Cardiovascular Disease: 2019 Update. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2019; 21:56. [PMID: 31486974 DOI: 10.1007/s11936-019-0759-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
PURPOSE OF REVIEW To provide updated information on the science and practice of cardiac rehabilitation (CR). RECENT FINDINGS Evidence continues to mount that supports the many benefits of CR as well as the important gap in delivering CR to all eligible patients. Recent studies have identified center-based and home-based strategies to improve the reach and impact of CR. Cardiac rehabilitation is a systematic, evidence-based approach to deliver effective secondary CVD preventive therapies to individuals with cardiovascular conditions. Because of a number of benefits that have been associated with CR, clinical practice guidelines strongly endorse CR services for eligible patients. Research supports CR as a high value service, with evidence of favorable clinical outcomes and costs. Unfortunately, a significant gap exists in CR participation due to a number of patient-, provider-, and system-level barriers. Solutions to most of these barriers have been identified and involve systematic approaches to CR delivery. The future is bright for CR as new strategies, new policies, and new methods of delivery continue to develop to help provide CR services to all eligible patients.
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Affiliation(s)
- Randal J Thomas
- Mayo Clinic Cardiac Rehabilitation Program, Division of Preventive Cardiology, Department of Cardiovascular Medicine, Mayo Clinic, 200 First Street, SW, Rochester, MN, 55905, USA.
| | - Hsu-Hang Huang
- Mayo Clinic Cardiac Rehabilitation Program, Division of Preventive Cardiology, Department of Cardiovascular Medicine, Mayo Clinic, 200 First Street, SW, Rochester, MN, 55905, USA
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Arena R, Ozemek C, Laddu D, Campbell T, Rouleau CR, Standley R, Bond S, Abril EP, Hills AP, Lavie CJ. Applying Precision Medicine to Healthy Living for the Prevention and Treatment of Cardiovascular Disease. Curr Probl Cardiol 2018; 43:448-483. [DOI: 10.1016/j.cpcardiol.2018.06.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Rouleau CR, King-Shier KM, Tomfohr-Madsen LM, Bacon SL, Aggarwal S, Arena R, Campbell TS. The evaluation of a brief motivational intervention to promote intention to participate in cardiac rehabilitation: A randomized controlled trial. PATIENT EDUCATION AND COUNSELING 2018; 101:1914-1923. [PMID: 30017536 DOI: 10.1016/j.pec.2018.06.015] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Revised: 06/22/2018] [Accepted: 06/23/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVES Cardiac rehabilitation (CR) is an effective treatment for cardiovascular disease, yet many referred patients do not participate. Motivational interviewing could be beneficial in this context, but efficacy with prospective CR patients has not been examined. This study investigated the impact of motivational interviewing on intention to participate in CR. METHODS Individuals recovering from acute coronary syndrome (n = 96) were randomized to motivational interviewing or usual care, following CR referral but before CR enrollment. The primary outcome was intention to attend CR. Secondary outcomes included CR beliefs, barriers, self-efficacy, illness perception, social support, intervention acceptability, and CR participation. RESULTS Compared to those in usual care, patients who received the motivational intervention reported higher intention to attend CR (p = .001), viewed CR as more necessary (p = .036), had fewer concerns about exercise (p = .011), and attended more exercise sessions (p = .008). There was an indirect effect of the intervention on CR enrollment (b = 0.45, 95% CI 0.04-1.18) and CR adherence (b = 2.59, 95% CI 0.95-5.03) via higher levels of intention. Overall, patients reported high intention to attend CR (M = 6.20/7.00, SD = 1.67), most (85%) enrolled, and they attended an average of 65% of scheduled CR sessions. CONCLUSION A single collaborative conversation about CR can increase both intention to attend CR and actual program adherence. PRACTICE IMPLICATIONS The findings will inform future efforts to optimize behavioral interventions to enhance CR participation.
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Affiliation(s)
- Codie R Rouleau
- TotalCardiology Rehabilitation, Calgary, Canada; Department of Physical Therapy, University of Illinois at Chicago, Chicago, USA; Department of Psychology, University of Calgary, Calgary, Canada.
| | | | | | - Simon L Bacon
- Montréal Behavioural Medicine Centre, CIUSSS-NIM, Hôpital du Sacré-Cœur de Montréal, Montréal, Canada; Department of Exercise Science, Concordia University, Canada
| | - Sandeep Aggarwal
- TotalCardiology Rehabilitation, Calgary, Canada; Department of Cardiac Sciences, University of Calgary, Calgary, Canada
| | - Ross Arena
- Department of Physical Therapy, University of Illinois at Chicago, Chicago, USA
| | - Tavis S Campbell
- Department of Psychology, University of Calgary, Calgary, Canada
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Hypotensive Effect of Heated Water-Based Exercise Persists After 12-Week Cessation of Training in Patients With Resistant Hypertension. Can J Cardiol 2018; 34:1641-1647. [PMID: 30527153 DOI: 10.1016/j.cjca.2018.09.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Revised: 09/27/2018] [Accepted: 09/29/2018] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Heated water-based exercise (HEx) promotes a marked reduction of blood pressure (BP), but it is not entirely clear whether its effects on BP persist after cessation of HEx. METHODS We analyzed the effects of cessation of HEx on 24-hour ambulatory BP monitoring (ABPM) in patients with resistant hypertension (RH). Thirty-two patients (aged 53 ± 6 years) with RH (4 to 6 antihypertensive drugs) were randomly assigned to HEx (n = 16) or control (n = 16) groups. Antihypertensive therapy remained unchanged during the protocol. The HEx group participated in 36 sessions (60 minutes) in a heated pool (32oC [89.6°F]) for 12 weeks (training), followed by 12 weeks of cessation of training. The control group was evaluated during the same period and instructed to maintain their habitual activities. RESULTS HEx and control groups had similar BP levels at baseline. HEx training reduced the 24-hour systolic (-19.5 ± 4.6 vs 3.0 ± 0.7 mm Hg, P = 0.001) and diastolic BP (-11.1 ± 2.4 vs 2.06 ± 0.9 mm Hg, P = 0.001) at week 12, compared with the control group. After 12 weeks of training cessation (week 24), 24-hour BP remained significantly lower in the HEx group than in the control group (-9.6 ± 3.8 vs 6.3 ± 3.5 mm Hg, P = 0.01 and -7.5±2.2 vs 2.2 ± 1.0 mm Hg, P = 0.009, for systolic and diastolic BP, respectively), although these differences were attenuated. CONCLUSIONS BP remained lower after cessation of 12-week training among patients with RH who underwent HEx compared with the controls. The carryover effects of HEx on BP may help to overcome the challenging problem of exercise compliance in long-term follow-up.
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Stone JA, Alter DA. The Health Economics of Myocardial Infarction: Black Boxes and Black Holes. Can J Cardiol 2018; 34:1253-1255. [DOI: 10.1016/j.cjca.2018.07.415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Revised: 07/20/2018] [Accepted: 07/20/2018] [Indexed: 10/28/2022] Open
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Bittner V. Cardiac Rehabilitation for Women. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2018; 1065:565-577. [DOI: 10.1007/978-3-319-77932-4_34] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Ivers N, Schwalm JD, Witteman HO, Presseau J, Taljaard M, McCready T, Bosiak B, Cunningham J, Smarz S, Desveaux L, Tu JV, Atzema C, Oakes G, Isaranuwatchai W, Grace SL, Bhatia RS, Natarajan M, Grimshaw JM. Interventions Supporting Long-term Adherence aNd Decreasing cardiovascular events (ISLAND): Pragmatic randomized trial protocol. Am Heart J 2017; 190:64-75. [PMID: 28760215 DOI: 10.1016/j.ahj.2017.05.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2017] [Accepted: 05/17/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND Guidelines recommend cardiac rehabilitation and long-term use of cardiac medications for most patients who have had a myocardial infarction (MI), but adherence to these secondary prevention treatments is suboptimal. METHODS This is a multicenter, pragmatic, 3-arm randomized trial. Eligible patients (n = 2,742) with obstructive coronary artery disease are randomized post-MI to usual care or 1 of 2 intervention arms. Patients in the first intervention arm receive mail-outs sent on behalf of their cardiologist at 4, 8, 20, 32, and 44 weeks post-MI; content is designed to address determinants of adherence and facilitate discussion between the patient and their health care team. Patients in the second intervention arm receive mail-outs plus automated interactive voice response system telephone calls 2 weeks after each letter, as well as a telephone call by trained lay health workers if the interactive voice response system identifies challenges with adherence. Outcomes are assessed 12 months post-MI via patient self-report and administrative data sources. Co-primary outcomes are adherence to cardiac medications and completion of cardiac rehabilitation. Secondary outcomes include cardiovascular events and mortality. An embedded, theory-informed process evaluation will explore the mechanism of action; an economic evaluation is also planned. CONCLUSIONS We describe a complete program evaluation of a highly pragmatic, health-system intervention to support adherence to recommended treatments. Research ethics boards approved waiver of consent for patients enrolled in the trial with provision of multiple opportunities to opt out and a debrief at the time of outcome assessment. The methods used here may provide a model for similar interventions.
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Affiliation(s)
- Noah Ivers
- Department of Family and Community Medicine and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; Institute for Health System Solutions and Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada; Institute of Clinical Evaluative Sciences, Toronto, Ontario, Canada.
| | - J-D Schwalm
- Division of Cardiology, Department of Medicine, Hamilton Health Sciences, Hamilton, Ontario, Canada; Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Holly O Witteman
- Department of Family and Emergency Medicine, Faculty of Medicine, Laval University, Quebec City, Quebec, Canada; Office of Education and Professional Development, Faculty of Medicine, Laval University, Quebec City, Quebec, Canada; Université Laval Research Institute for Primary Care and Health Services (CERSSPL-UL), Quebec City, Quebec, Canada; Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Justin Presseau
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, Ontario, Canada; School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, Canada
| | - Monica Taljaard
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, Ontario, Canada; School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, Canada
| | - Tara McCready
- Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Beth Bosiak
- Institute for Health System Solutions and Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada
| | - Jennifer Cunningham
- Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Shelley Smarz
- Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Laura Desveaux
- Institute for Health System Solutions and Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada
| | - Jack V Tu
- Institute of Clinical Evaluative Sciences, Toronto, Ontario, Canada; Division of Cardiology, Department of Medicine, Sunnybrook Health Sciences Centre and University of Toronto, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Clare Atzema
- Institute of Clinical Evaluative Sciences, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; Division of Emergency Medicine, Department of Medicine, Sunnybrook Health Sciences Centre and University of Toronto, Toronto, Ontario, Canada
| | - Garth Oakes
- Cardiac Care Network of Ontario, Toronto, Ontario, Canada
| | - Wanrudee Isaranuwatchai
- Centre for Excellence in Economic Analysis Research, St Michael's Hospital and Institute of Health Policy, Management and Evaluation, University of Toronto, Ontario, Canada
| | - Sherry L Grace
- School of Kinesiology and Health Science, York University, Toronto, Ontario, Canada; Cardiorespiratory Fitness Team, Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
| | - R Sacha Bhatia
- Institute of Clinical Evaluative Sciences, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; Division of Cardiology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada; WCH Institute for Health System Solutions and Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada
| | - Madhu Natarajan
- Division of Cardiology, Department of Medicine, Hamilton Health Sciences, Hamilton, Ontario, Canada; Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Jeremy M Grimshaw
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, Ontario, Canada; Department of Medicine, University of Ottawa, Ottawa, ON, Canada
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Abstract
BACKGROUND Despite the clinical benefits of cardiac rehabilitation (CR) and its cost-effectiveness, it is not widely received. Arguably, capacity could be greatly increased if lower-cost models were implemented. The aims of this review were to describe: the costs associated with CR delivery, approaches to reduce these costs, and associated implications. METHODS Upon finalizing the PICO statement, information scientists were enlisted to develop the search strategy of MEDLINE, Embase, CDSR, Google Scholar and Scopus. Citations identified were considered for inclusion by the first author. Extracted cost data were summarized in tabular format and qualitatively synthesized. RESULTS There is wide variability in the cost of CR delivery around the world, and patients pay out-of-pocket for some or all of services in 55% of countries. Supervised CR costs in high-income countries ranged from PPP$294 (Purchasing Power Parity; 2016 United States Dollars) in the United Kingdom to PPP$12,409 in Italy, and in middle-income countries ranged from PPP$146 in Venezuela to PPP$1095 in Brazil. Costs relate to facilities, personnel, and session dose. Delivering CR using information and communication technology (mean cost PPP$753/patient/program), lowering the dose and using lower-cost personnel and equipment are important strategies to consider in containing costs, however few explicitly low-cost models are available in the literature. CONCLUSION More research is needed regarding the costs to deliver CR in community settings, the cost-effectiveness of CR in most countries, and the economic impact of return-to-work with CR participation. A low-cost model of CR should be standardized and tested for efficacy across multiple healthcare systems.
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Affiliation(s)
- Mahshid Moghei
- School of Kinesiology and Health Science, York University, Toronto, Canada
| | | | - Wanrudee Isaranuwatchai
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | - Nizal Sarrafzadegan
- Isfahan University of Medical Sciences, Isfahan, Iran; School of Population and Public Health, University of British Columbia, Vancouver, Canada.
| | - Paul Oh
- University Health Network, University of Toronto, Canada
| | | | - Sherry L Grace
- School of Kinesiology and Health Science, York University, Toronto, Canada; University Health Network, University of Toronto, Canada
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18
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Arena R, Lavie CJ. Preventing Bad and Expensive Things From Happening by Taking the Healthy Living Polypill: Everyone Needs This Medicine. Mayo Clin Proc 2017; 92:S0025-6196(17)30121-0. [PMID: 28365096 DOI: 10.1016/j.mayocp.2017.02.005] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Accepted: 02/06/2017] [Indexed: 12/12/2022]
Affiliation(s)
- Ross Arena
- College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL.
| | - Carl J Lavie
- Department of Cardiovascular Diseases, Ochsner Clinical School-the University of Queensland School of Medicine, New Orleans, LA
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