Home-based cardiac rehabilitation improves quality of life, aerobic capacity, and readmission rates in patients with chronic heart failure

A smartphone model for post-acute care decreases all-cause mortality with improved left ventricular ejection fraction in patients hospitalized with heart failure in Taiwan

OBJECTIVES

This study investigates the impact of the use of a smartphone application on outcomes for patients with heart failure receiving post-acute care.

METHODS

We employed a propensity score-matched analysis of patients who underwent post-acute care following hospitalization for heart failure. The smartphone application consisted of immediate feedback, recommendations, and a knowledge platform. We assessed seven variables before and after post-acute care: left ventricular ejection fraction, and scores on the Minnesota Living with Heart Failure Questionnaire, Mini-Nutritional Assessment-Short Form, Instrumental Activities of Daily Living, Brief Symptom Rating Scale-5, 6-minute walk test, and European Quality of Life-5 Dimensions Questionnaire. The functional progression dose effect was evaluated using receiver operating characteristic curves. Application users and non-users were matched to minimize the impacts of confounding variables, including age, gender, and education. The Cox proportional hazards model and the sub-distribution hazard method assessed the impact of the smartphone application on post-discharge outcomes.

RESULTS

From 2018 to 2023, 493 patients (average age 65.4 ± 15.1 years) participated in the study. Over an average follow-up of 2.35 years, the results indicated that each additional unit of functional improvement was associated with a 38 % reduction in overall mortality, a 23 % decrease in readmissions or emergency room visits, and a 36 % lower risk of cardiovascular mortality. Among 119 matched pairs, application users demonstrated significantly lower mortality risk and better left ventricular ejection fraction than non-users. Kaplan-Meier curves showed that application users with improved left ventricular ejection fraction had the best survival outcomes, followed by non-application users with improved left ventricular ejection fraction, application users without improved left ventricular ejection fraction, and non-application users without improved left ventricular ejection fraction (P < 0.001).

CONCLUSIONS

The findings suggest that smartphone applications could enhance transitional care for patients with heart failure by improving left ventricular ejection fraction and reducing mortality.

Nudging Health Behavior Change Among Home-Based Cardiac Rehabilitation Patients: A Scoping Review

Background

In home-based cardiac rehabilitation practices, nudging has emerged and was actively explored to promote health behavior change among patients with heart disease. The literature on nudging strategy is fragmented and lacks comprehensive reviews.

Objective

This study aimed to identify nudging interventions to promote health behavior change among patients undergoing home-based cardiac rehabilitation, focusing on the scope, characteristics and delivery.

Methods

A scoping review was conducted from July to September 2023, during which databases including PubMed, Web of Science, and OVID (Embase, Cochrane Library, JBI) were searched. Search terms were constructed based on population-concept-context mnemonics approach. Reviewers screened articles independently and reviewed the included articles to extract key information about each nudge intervention.

Results

In included 25 studies, the majority (n=21) with the nudging strategy had positive results. 14 nudge strategies were identified and coded with the primary objective of changing health behaviors. The most common nudging strategy was goal setting, followed by feedback, and reminders and alerts. To capture the heterogeneity of nudging strategies, two independent dimensions were introduced to further classify them into four quadrants (active vs passive and synchronous vs passive). For example, some nudging strategies usually occur when the target behavior must be performed (synchronization) and requires the immediate participation of the home-based cardiac rehabilitation patients (active). In addition, digital nudging technology with gamification elements may become the mainstream in future research.

Conclusion

These studies reflected different objectives and implement nudging strategies in different ways. Despite the multiple nudging strategies are widely adopted, identifying the contributing components remains challenging.

Exercise Training in Heart Failure: Current Evidence and Future Directions

Heart Failure (HF) is a prevalent condition which places a substantial burden on healthcare systems worldwide. Medical management implemented with exercise training (ET) plays a role in prognostic and functional capacity improvement. The aim of this review is to determine the effect of exercise training (ET) on HFpEF and HFrEF patients as well as exercise modality recommendations in frail and sarcopenic subpopulations. Pharmacological therapy structures the cornerstone of management in HF reduced ejection fraction (HFrEF) and aids improved survival rates. Mortality reduction with pharmacological treatments in HF preserved ejection fraction (HFpEF) are yet to be established. Cardiac rehabilitation (CR) and ET can play an important role in both HFrEF and HFpEF. Preliminary findings suggest that CR significantly improves functional capacity, exercise duration, and quality of life. ET has shown beneficial effects on peak oxygen consumption (pVO2) and 6 min walk test distance in HFrEF and HFpEF patients, as well as a reduction in hospitalisation and mortality rates; however, the limited scope of larger trials reporting on this underscores the need for further research. ET also has been shown to have beneficial effects on depression and anxiety levels. High-intensity training (HIT) and moderate continuous training (MCT) have both shown benefits, while resistance exercise training and ventilatory assistance may also be beneficial. ET adherence rates are higher when enrolled to a supervised programme, but prescription rates remain low worldwide. Larger robust trials are required to determine ET's effects on HF, as well as the most efficacious and personalised exercise prescriptions in HF subtypes.

Strategies for enhancing home-based cardiac rehabilitation self-management for patients with coronary heart disease: a qualitative study

BACKGROUND

Self-management is regarded as a crucial factor influencing the effectiveness of home-based cardiac rehabilitation for patients with coronary heart disease. In nursing practice, nurses employ a variety of strategies to enhance self-management of patients. However, there exists a disparity in nurses' perceptions and practical experiences with these strategies. This study aimed to explore the experiences and strategies of clinical nurses in enhancing home-based cardiac rehabilitation self-management for patients with coronary heart disease.

METHODS

A descriptive qualitative study was conducted across two large cardiac rehabilitation centers. Clinical nurses were selected using purposive sampling with maximum variation strategies. Semi-structured interviews were conducted to capture nurses' experiences and strategies for enhancing home-based cardiac rehabilitation self-management. Content analysis was utilized to analyze the textual data.

RESULTS

A total of 18 eligible clinical nurses participated in this study. The interviews resulted in the extraction of seven subthemes, which were consolidated into three main themes: (1) Personalized and Engaging Educational Approaches, including Precision Education-Tailored, Adaptive Approaches and Visual Aided Education-Beyond Simplification to Deep Engagement; (2) Contextual and Psychologically Grounded Nudging Strategies, comprising Information Framing-Psychological Leveraging for Informed Choices, Social Norms-Leveraging Peer Influence for Motivation, and Verbal Reminders-The Power of Consistency and Reinforcement; (3) Continuous and Personalized Support Systems, involving Regular Follow-Up-Dynamic Support for Ongoing Engagement and Collaborative Management-Building a Team for Long-Term Success. These robust strategies can effectively enhance self-management behaviors and quality of life in patients undergoing home-based cardiac rehabilitation.

CONCLUSIONS

From the perspective of clinical nurses, this study explored a variety of strategies for improving home-based cardiac rehabilitation self-management in patients with coronary heart disease. This provides theoretical support for optimizing intervention measures and promotes the effective delivery and application of self-management strategies in practice.

CLINICAL TRIAL NUMBER

Not applicable.

Effects of exercise based cardiac rehabilitation delivery modes on chronic heart failure: a systematic review and network meta-analysis

Chronic heart failure (CHF) represents one of the most severe and advanced stages of cardiovascular disease. Despite the critical importance of cardiac rehabilitation (CR) in CHF management, while studies have explored the effectiveness of various CR delivery modes and offered valuable context-specific insights, their relative efficacy remains inconsistent across different patient groups, healthcare environments, and intervention approaches. A clearer understanding requires comprehensive comparisons and in-depth analyses to address these variations. Systematic searches were conducted in databases including Pubmed, Embase, Cochrane Central Register of Controlled Trials, and Web of Science, up to August 2024. Two researchers independently screened the literature according to strict inclusion criteria, extracted relevant data, and assessed the quality of included studies using Cochrane Collaboration tools and the Jadad scale. Subsequent pairwise and network meta-analyses were performed using statistical software, including Stata 17.0, to present the results graphically. The network meta-analysis included 9,552 articles, with 33 meeting the inclusion criteria and examining eleven different interventions. All interventions outperformed routine care. Combined CR with aerobic exercise and resistance training (HCR [AE + RE]) significantly improved Minnesota Living with Heart Failure Questionnaire (MLHFQ) scores and 6-min walk test (6MWT) performance, and reduced rehospitalization rates [SUCRA = 96%]. Center-based cardiac rehabilitation (CBCR) with high-intensity interval training (HIIT) was the most effective in enhancing left ventricular ejection fraction (LVEF), while CBCR(AE) demonstrated the greatest improvement in peak oxygen uptake (Peak VO2) [RR = 3.64, 95% CI: 1.66-7.95]. Our analysis identifies HCR (AE + RE) as the most effective intervention for improving quality of life (MLHFQ), exercise capacity (6MWT), and reducing hospital readmissions. CBCR (HIIT) was optimal for enhancing cardiac function through improved LVEF, while CBCR (AE) effectively boosted peak VO2.PROSPERO: CRD42024517039, Review Completed not published.

Assessment of detraining through a six-minute walk test in patients with heart disease

BACKGROUND

Detraining can partially or completely reduce training-induced metabolic adaptations. However, the duration for which the rehabilitation effects persist after detraining, especially in patients with heart disease, remains unclear.

OBJECTIVES

To evaluate the principle of reversibility/detraining in patients with heart disease via the 6-minute walk test (6MWT) after a period of rest.

DESIGN AND SETTING

A retrospective cohort study developed at the Rehabilitation Center of the Universidade Federal do Triângulo Mineiro in Uberaba/MG, Brazil.

METHODS

This clinical, retrospective longitudinal study involved 20 patients with heart disease who underwent 5 months of supervised cardiac rehabilitation (CR). The mean age of participants was 64.05 ± 9.25 years. The initial rehabilitation was followed by an interruption period and rehabilitation for another 5 months. Functional capacity was assessed using the 6MWT.

RESULTS

In the specific analysis of the distance covered, values of P = 0.03 and P = 0.01 were obtained on comparing post-training (669.64 ± 58.80 meters) with post-detraining (640.82 ± 101.23 meters) and post-detraining with post-retraining (650.82 ± 96.28 meters), respectively. No significant difference was observed for the comparison between training and retraining (P = 0.83).

CONCLUSION

Cardiovascular rehabilitation positively stimulates functional capacity, whereas detraining significantly reduces it. The 6MWT is effective in measuring changes in physical capacity.

Effect of Home-Based Cardiac Telerehabilitation in Patients After Percutaneous Coronary Intervention: A Randomized Controlled Trial

Low adherence to hospital-based cardiac rehabilitation has been observed in patients after percutaneous coronary intervention. The effectiveness of home-based cardiac telerehabilitation in this setting is unclear. This study aimed to investigate the impact of home-based cardiac telerehabilitation on exercise endurance, disease burden status, cardiac function, and quality of life in patients after percutaneous coronary intervention. A total of 106 patients after percutaneous coronary intervention were randomly assigned to either the intervention group (receiving routine rehabilitation care and home-based cardiac telerehabilitation) or the control group (receiving routine care only), with 53 patients in each group. The 6-minute walking test, anerobic threshold, physical component summary score, mental component summary score, V o2max , and left ventricular ejection fraction were measured in both groups before and 3 months after the intervention. Additionally, the Short-Form 12 scale and Family Burden Interview Schedule were used to assess quality of life and disease burden status. The intervention group demonstrated significant improvements in 6-minute walking test, anerobic threshold, V o2max , physical component summary score, mental component summary score, Short-Form 12 scale, and Family Burden Interview Schedule scale scores compared with the control group ( P <0.05). Results suggest that home-based cardiac telerehabilitation may improve exercise endurance and quality of life and reduce disease burden status in patients after percutaneous coronary intervention.

Rehabilitation Services Improve Activities of Daily Living and Instrumental Activities of Daily Living Capability in Patients After Discharge From Convalescent Rehabilitation Wards

BACKGROUND/OBJECTIVES

There is a notable lack of evidence regarding the long-term effects of rehabilitation services, particularly concerning functional recovery and daily living activities of patients following discharge from convalescent rehabilitation wards. This study aimed to clarify the longitudinal changes in activities of daily living and instrumental activities of daily living of patients after discharge from a convalescent rehabilitation ward and the association between the use of rehabilitation services and clinical outcomes.

METHODS

 Patients discharged from Japanese convalescent rehabilitation wards in August 2021 were included. They were classified into two groups (rehabilitation and nonrehabilitation services use) based on whether they used rehabilitation services (outpatient rehabilitation, older adult day care, or home-based rehabilitation) after discharge. The primary outcomes, including the Barthel Index, functional independence measure, Frenchay Activities Index, and life-space assessment scores at 6 months after discharge, were analyzed by multivariate analysis.

RESULTS

 A total of 293 patients (median age: 75 years; 148 females) were included in the analysis. The use of rehabilitation services was independently associated with the Barthel Index (partial regression coefficient [B]: 7.224; 95% confidence interval [CI]: [1.760, 12.688]), functional independence measure (B: 2.659; 95% CI: [0.194, 5.125]), Frenchay Activities Index (B: 2.351; 95% CI: [0.5088, 4.192]), and life-space assessment at 6 months after discharge (B: 8.226, 95% CI: [3.902, 12.550]).

CONCLUSIONS

 The use of rehabilitation services was independently associated with patients' Barthel Index, functional independence measure, Frenchay Activities Index, and life-space assessment after discharge from a convalescent rehabilitation ward. This study emphasizes crucial role of postdischarge interventions for improved patient outcomes.

The heterogeneous depression trajectory and its predictors in coronary heart disease patients undergoing home-based cardiac rehabilitation: a cohort study

BACKGROUND

Psychological management, particularly addressing depression, is crucial for the effectiveness of home-based cardiac rehabilitation. This study aimed to explore the depression trajectories of coronary heart disease patients during home-based cardiac rehabilitation, identify trajectories associated with cardiovascular readmission, and integrate them into a heterogeneous depression trajectory while examining its predictors.

METHODS

A prospective cohort study was conducted at a large cardiac rehabilitation center in mainland China. Participants completed the Patient Health Questionnaire-9 to assess depression levels during the 6-month home-based cardiac rehabilitation, with monthly follow-ups. Using latent class growth models to explore depression trajectories. The relationship between different trajectories and cardiovascular readmission was determined using Cox proportional hazards regression, identifying heterogeneous depression trajectory. Logistic regression analysis was employed to explore the influencing factors of heterogeneous depression trajectory.

RESULTS

A total of 346 eligible patients with coronary heart disease participated in the study. Four distinct depression trajectories were identified: sustained no depression (48.0%), delayed onset (15.9%), low U-shaped depression (25.1%), and sustained depression (11.0%). Depression trajectories significantly impacted cardiovascular readmission rates, with higher risks observed in the delayed onset (HR: 4.707, 95% CI: 1.766-12.544) and sustained depression (HR: 8.832, 95% CI: 3.281-23.773) groups. These two groups were combined and termed heterogeneous depression trajectory. Importantly, education level, number of chronic diseases, resilience, social support, and anxiety were independent predictors of heterogeneous depression trajectory.

CONCLUSIONS

Depression trajectories during home-based cardiac rehabilitation are significantly heterogeneous and influence cardiovascular outcomes. Early identification and management of high-risk factors can enhance psychological health and reduce readmission rates.

Remote exercise services for people with cystic fibrosis: experiences and perceptions from people with cystic fibrosis and members of cystic fibrosis multidisciplinary teams

PURPOSE

This study aimed to explore the experiences and perceptions of people with cystic fibrosis (PwCF) and multidisciplinary team (MDT) members on remote exercise services (RES) and to inform recommendations for future RES.

METHODS

Participants were recruited from an adult CF centre and through social media. Individual online semi-structured interviews were conducted. Interviews were recorded, transcribed verbatim, and thematically analysed.

RESULTS

Themes from MDT members: Accessibility and convenience offered by remote exercise services; Enhanced connections between MDT members and PwCF; Perceived health and wellness benefits of remote exercise services for PwCF; Barriers to engagement; and Suggested improvements for future remote exercise services. Themes from PwCF: Remote exercise enables activity with multifaceted benefits; Perceived limitations of remote exercise services; and Enhancing participation.

CONCLUSIONS

Participants' overall perceptions towards RES were positive, and perceived benefits of RES included time and cost saving, improving work efficiency, and having peer support. Perceived barriers to RES were largely technological or related to lacking visual cues. Perceived recommendations to future RES included personalising exercise options, developing user-friendly platforms, and providing funding for buying equipment.

Impact of Long-Term Exercise-Based Cardiac Rehabilitation in Patients With Chronic Heart Failure - A Systematic Review and Meta-Analysis

BACKGROUND

This study aimed to clarify the effects of exercise-based cardiac rehabilitation (CR) on patients with heart failure.

METHODS AND RESULTS

Patients were divided into groups according to intervention duration (<6 and ≥6 months). We searched for studies published up to July 2023 in Embase, MEDLINE, PubMed, and the Cochrane Library, without limitations on data, language, or publication status. We included randomized controlled trials comparing the efficacy of CR and usual care on mortality, prehospitalization, peak oxygen uptake (V̇O2), and quality of life. Seventy-two studies involving 8,495 patients were included in this review. It was found that CR reduced the risk of rehospitalization for any cause (risk ratio [RR] 0.80; 95% confidence interval [CI] 0.70-0.92) and for heart failure (RR 0.88; 95% CI 0.78-1.00). Furthermore, CR was found to improve exercise tolerance (measured by peak V̇O2and the 6-min walk test) and quality of life. A subanalysis performed based on intervention duration (<6 and ≥6 months) revealed a similar trend.

CONCLUSIONS

Our meta-analysis showed that although CR does not reduce mortality, it is effective in reducing rehospitalization rates and improving exercise tolerance and quality of life, regardless of the intervention duration.

Effect of Luhong formula on the cardiac rehabilitation of patients with chronic heart failure

BACKGROUND

Current treatments for chronic heart failure (CHF) are therapeutically ineffective. The optimization of treatments for this disease needs to be explored and analyzed.

AIM

To analyze the effect of using Luhong Formula in the cardiac rehabilitation of patients with CHF and its influence on cardiopulmonary function (CPF) and prognosis.

METHODS

In total, 160 patients with CHF admitted between June 2022 and June 2023 were selected, including 75 receiving perindopril (control group) and 85 receiving Luhong Formula (research group). We conducted comparative analyses on the curative effects of traditional Chinese medicine (TCM) syndromes and cardiac function, CPF [oxygen consumption at the anaerobic threshold (VO2 AT) and at peak exercise (peak VO2)], echocardiographic indexes [left atrial volume index (LAVI), left ventricular muscle mass index (LVMI), left ventricular ejection fraction (LVEF)], and prognosis [major adverse cardiovascular events (MACEs) at 6 months follow-up].

RESULTS

The research group showed markedly higher curative effects of TCM syndromes and cardiac function than the control group. In addition, post-treatment VO2 AT, peak VO2, LVMI and LVEF in the research group were significantly higher, whereas LAVI was significantly lower, than those of the control group. Furthermore, fewer patients in the research group developed MACEs at the 6-month follow-up.

CONCLUSION

Luhong Formula is more therapeutically effective than perindopril for the cardiac rehabilitation of patients with CHF, specifically in enhancing CPF and prognosis.

Development of a core outcome set for cardiac rehabilitation in patients with myocardial infarction: a study protocol

INTRODUCTION

Heterogeneous outcome reporting is common in clinical trials focused on cardiac rehabilitation for myocardial infarction (MI); this practice often results in the exclusion of data from clinical trials in systematic reviews. Developing a core outcome set (COS) may solve this problem.

METHODS AND ANALYSIS

We will first identify a preliminary list of outcomes through a systematic review. Next, we will conduct semistructured interviews with patients to explore additional potential outcomes deemed important by patients. Then, we will engage various stakeholders such as clinicians, researchers and methodologists in two Delphi survey tends to refine and prioritise the identified outcomes. Subsequently, we will gather insights directly from patients with MI by administering plain language patient surveys; patients will be involved in questionnaire development. Finally, we will hold two face-to-face consensus meetings for patients and other stakeholders to develop the final COS for cardiac rehabilitation in MI.

ETHICS AND DISSEMINATION

The Ethics Committee of Dongzhimen Hospital, Beijing University of Chinese Medicine approved this study (2022DZMEC-349). The final COS will be published in a peer-reviewed journal and disseminated in conferences.

TRIAL REGISTRATION

We registered this study in the Core Outcome Measures in Effectiveness Trials Initiative (COMET) platform.

REGISTRATION NUMBER

1725 (http://www.comet-initiative.org/studies/details/1725).

The Impact of Home Cardiac Rehabilitation on Quality of Life and Psychological Well-Being in Patients with Coronary Heart Disease: A Randomized Controlled Study

BACKGROUND Percutaneous coronary intervention (PCI), a therapeutic approach to coronary heart disease, significantly alleviates symptoms of coronary heart disease (CHD) and substantially improves quality of life. This study aimed to investigate the effect of home cardiac rehabilitation (HCR) on patients after PCI. MATERIAL AND METHODS We randomly divided 106 patients after PCI into an Intervention group (n=52) and a Control group (n=53). Left ventricular ejection fraction (LVEF), blood pressure, blood glucose, and low-density lipoprotein were measured in both groups before hospital discharge and after 3 months of engaging in the intervention. Patients were assessed using the short-form health survey (SF-12) scale and Hospital Anxiety and Depression Scale (HADS) scale. RESULTS After 3 months of HCR intervention, SF-12 scores of patients in the Intervention group were significantly higher compared to patients in the Control group (physical component summary (PCS): 47.46±9.86 vs 43.28±8.21; and Mental Component Summary (MCS): 50.68±9.82 vs 48.26±9.69) (P.

Home-based rehabilitation versus centre-based programs in patients with temporomandibular disorders-a systematic review and meta-analysis

To compare the effects of home-based rehabilitation and occlusal splints or centre-based rehabilitation in patients with temporomandibular joint disorders (TMD). A systematic review and meta-analysis. PubMed, Embase, Cochrane Library, Web of Science and ClinicalTrials.gov electronic databases were consulted from inception to August 2023, searching for randomized controlled trials (RCTs) that compared home-based rehabilitation for TMD with splints or centre-based rehabilitation. The risk of bias was assessed using the Cochrane risk of bias tool. 23 RCTs (1402 participants, three comparator interventions) were identified. Very low-certainty evidence suggested there are no clinically difference between home-based rehabilitation and splints in pain intensity (mean difference (MD) 7.75, 95% confidence interval (CI): 2.17 to 13.32), maximal mouth opening (MMO) (MD 1.83, 95% CI: -0.27 to 3.93) at short and long-term follow-up, in sleep quality (MD: 1.67, 95% CI: -2.04 to 3.56) and quality of life (psychological: MD 0.94, 95% CI: -4.43 to 6.31; general: MD -1.18, 95% CI: -5.72 to 5.37) at short-term follow-up. Low-certainty evidence suggested that home-based rehabilitation plus manual therapy is more effective for TMD treatment compared to home-based rehabilitation at short-term follow-up (pain intensity: MD: 14.93, 95% CI: 7.72 to 21.93; MMO: MD -2.93, 95% CI: -5.3 to -0.54; sleep quality: MD 1.4, 95% CI: 0.09 to 2.71). Compared with home-based rehabilitation, Transcutaneous Electrical Nerve Stimulation (TENS) and Low-Level Laser Therapy (LLLT) was superior in pain relief at short-term follow-up. Low and very low-certainty evidence suggests home-based rehabilitation could be considered a low-cost, beneficial therapy alternative for TMD patients to relieve symptoms.

Evaluating the Effects of an Enhanced Strength Training Program in Remote Cardiological Rehabilitation: A Shift from Aerobic Dominance-A Pilot Randomized Controlled Trial

(1) Background: Cardiac rehabilitation often emphasizes aerobic capacity while overlooking the importance of muscle strength. This study evaluated the impact of an enhanced remote strength training program (RCR-ST) on cardiac rehabilitation. (2) Methods: In this randomized prospective study (RCT registration number SMC-9080-22), 50 patients starting cardiac rehabilitation were assessed for muscle strength, aerobic capacity, and self-reported outcomes at baseline and after 16 weeks. Participants were divided into two groups: the RCR-ST group received a targeted resistance training program via a mobile app and smartwatch, while the control group received standard care with general resistance training advice. (3) Results: The RCR-ST group demonstrated significant improvements in muscle endurance, notably in leg extension and chest press exercises, with increases of 92% compared to 25% and 92% compared to 13% in the control group, respectively. Functional assessments (5-STS and TUG tests) also showed marked improvements in agility, coordination, and balance. Both groups improved in cardiorespiratory fitness, similarly. The RCR-ST group reported enhanced physical health and showed increased engagement, as evidenced by more frequent use of the mobile app and longer participation in the rehabilitation program (p < 0.05). (4) Conclusions: Incorporating a focused strength training regimen in remote cardiac rehabilitation significantly improves muscle endurance and patient engagement. The RCR-ST program presents a promising approach for optimizing patient outcomes by addressing a crucial gap in traditional rehabilitation protocols that primarily focus on aerobic training.

A behavioural driving model of adherence to home-based cardiac rehabilitation exercise among patients with chronic heart failure: A mixed-methods study

AIMS AND OBJECTIVES

To develop and validate a behavioural driving model for adherence to home-based cardiac rehabilitation exercise in patients with chronic heart failure, and to explain the potential driving mechanism of social support on exercise adherence.

BACKGROUND

Despite the benefits of home-based cardiac rehabilitation exercise, adherence among patients with chronic heart failure remains suboptimal. Several factors contributing to adherence have been confirmed; however, the specific pathway mechanisms by which these factors impact exercise adherence have not been thoroughly explored.

DESIGN

An exploratory sequential mixed-methods study was conducted in this study.

METHODS

A total of 226 patients with chronic heart failure were recruited using convenience sampling. Quantitative data were collected using a series of self-report questionnaires. Hierarchical regression analysis was performed to verify multiple pathways. Subsequently, 12 patients with chronic heart failure were drawn from the quantitative stage. The interview data were thematically analysed. This study followed the Good Reporting of a Mixed Methods Study (GRAMMS) guidelines (Appendix S1).

RESULTS

Perceived social support had a direct positive predictive effect on exercise adherence. Importantly, exercise self-efficacy and exercise fear played a chain-mediating role between perceived social support and exercise adherence. As a result of the qualitative phase, scale, tightness and homogeneity of social support networks emerged as potential drivers of the effectiveness of social support on exercise adherence.

CONCLUSIONS

This study reveals a potential pathway mechanism for social support to improve adherence to home-based cardiac rehabilitation exercises. Social support network plays a crucial role in the effect of social support on exercise adherence.

RELEVANCE TO CLINICAL PRACTICE

To enhance exercise adherence in home-based cardiac rehabilitation for patients with chronic heart failure, establishing a social support network is recommended. This strategy has the potential to promote exercise self-efficacy and alleviate exercise fear.

PATIENT OR PUBLIC CONTRIBUTION

None.

Home-Based Cardiac Rehabilitation Among Patients Unwilling to Participate in Hospital-Based Programs

PURPOSE

Asynchronous home-based cardiac rehabilitation (HBCR) is a viable alternative to center-based cardiac rehabilitation (CBCR). However, to achieve significant functional improvement, a high level of adherence and activity must be achieved. The effectiveness of HBCR among patients who actively avoid CBCR has not been effectively investigated. This study aimed to investigate the effectiveness of the HBCR program among patients unwilling to participate in CBCR.

METHODS

A randomized prospective study enrolled 45 participants to a 6-mo HBCR program and the remaining 24 were allocated to regular care. Both groups were digitally monitored for physical activity (PA) and self-reported outcomes. Change in peak oxygen uptake (VO 2peak ), the primary study outcome, was measured by the cardiopulmonary exercise test, immediately before program start and 4 mo thereafter.

RESULTS

The study included 69 patients, 81% men, aged 55.9 ±12 yr, enrolled in a 6-mo HBCR program to follow a myocardial infarction (25.4%) or coronary interventions (41.3%), heart failure hospitalization (29%), or heart transplantation (10%). Weekly aerobic exercise totaled a median of 193.2 (110.2-251.5) min (129% of set exercise goal), of which 112 (70-150) min was in the heart rate zone recommended by the exercise physiologist.After 4 mo, VO 2peak improved by 10.2% in the intervention group versus -2.7% in the control group (+2.46 ± 2.67 vs -0.72 ± 3.02 mL/kg/min; P < .001).

CONCLUSION

The monthly PA of patients in the HBCR versus conventional CBCR group were well within guideline recommendations, showing a significant improvement in cardiorespiratory fitness. Risk level, age, and lack of motivation at the beginning of the program did not prevent achieving goals and maintaining adherence.

"Challenges to Normalcy"- Perceived Barriers to Adherence to Home-Based Cardiac Rehabilitation Exercise in Patients with Chronic Heart Failure

Purpose

The aim of this study was to explore perceived barriers to adherence to home-based cardiac rehabilitation exercise in patients with chronic heart failure.

Patients and Methods

A qualitative descriptive study was conducted in this study from May to July 2023. A purposive sampling approach was adopted to select patients with chronic heart failure. Semi-structured interviews were completed to collect qualitative data for exploring the perceived barriers. In addition, information saturation and validation strategies were adopted to prove the adequacy of qualitative data. Transcripts were analysed using thematic analysis.

Results

A total of 16 patients with chronic heart failure were included in this study. Analysis of the data revealed five main barriers to adherence to home-based cardiac rehabilitation in patients with chronic heart failure. These include (1) lack of knowledge, (2) activity intolerance, (3) exercise fear, (4) role conflict, and (5) lower exercise self-efficacy.

Conclusion

This study delved deeper into understanding the challenges faced by chronic heart failure patients in adhering to home-based cardiac rehabilitation exercise. The development of precise and effective management and intervention strategies based on these barriers is necessary to improve patient compliance with home-based cardiac rehabilitation exercise.

Assessment of on-site and remote cardiac rehabilitation in Romania

: Introduction: It is well known that cardiovascular diseases are the leading cause of death worldwide. In Romania in 2015, cardiovascular diseases led to 153.953 deaths, representing 59.3% of deaths from all causes. Most people in Romania today have an unhealthy lifestyle, characterised mainly by a poor nutritious diet, low physical activity and a lack of medical screening. Purpose: Considering these deficits of secondary prevention in the treatment line of the Romanian cardiovascular patient, we aimed through this study to assess the current access of the Romanian population to on-site and remote cardiac rehabilitation programs as well as their opinion regarding the telemedicine for future cardiovascular care modelling. Methods: It was a prospective observational study, which was carried out by means of an online questionnaire composed of 26 items. It was dispersed in the online environment, including Social Media platforms, where it was active for ten weeks. Results: Our online evaluation questionnaire had 1115 participants, with a minimum age of 18 years old, a preponderance of female sex and a predominantly urban background. The study participants were from all educational levels, from low to superior. We observed that most participants have an internet connection at home and use at least one form of technology daily, but most have never used a telemedicine service. Conclusions: In conclusion, the access of cardiovascular patients to on-site cardiac rehabilitation services is extremely low and for remote ones, it is almost non-existent. For a middle-income country like Romania with such a high incidence of cardiovascular disease, it is almost mandatory to provide publicly funded cardiac telerehabilitation services also for the future.

Examining the effectiveness of home-based cardiac rehabilitation programs for heart failure patients with reduced ejection fraction: a critical review

BACKGROUND

Heart failure (HF) is the most common cardiovascular reason for hospital admission, particularly among patients older than 60 years old. Heart failure with reduced ejection fraction (HFrEF) comprises approximately 50% of all heart failure cases. Home-based cardiac rehabilitation (HBCR) is an alternative option to enhance the participation rate in cardiac rehabilitation (CR) interventions for patients who are not able to attend center-based cardiac rehabilitation (CBCR). The purpose of this review is to clarify the extent to which present studies of HBCR align with the core components defined by both the European Society of Cardiology (ESC) and the British Association for Cardiac Prevention and Rehabilitation (BACPR).

METHODS

A critical review was conducted through four databases, MEDLINE, Embase, Cochrane Central Register of Controlled Trials, and Cochrane Database of Systematic Reviews, to identify randomized controlled trials up until June 2022. We scrutinized the commonalities between BACPR and ESC and developed a list of standards. The risk of bias was assessed using the RoB 2 tool.

RESULTS

Among the 87 papers selected for full-text screening, 11 studies met the inclusion criteria. Six papers possessed a high proportion of fidelity to essential standards, four studies had a medium alliance, and one intervention had a low level of alliance.

CONCLUSION

Overall, the majority of included studies had medium to high alignment with standards and core components. However, a need for more attention to long-term strategy as an important standard is revealed. Rapid identification and initial assessment are the most met standards; however, lifestyle risk factor management and long-term outcomes were recognized as the least met standards.

Home Based Cardiac Rehabilitation Participation Among Patients With Heart Failure

INTRODUCTION

Patients with Heart Failure (HF) have significant morbidity and mortality. Home Based Cardiac Rehabilitation (HBCR) is a form of Cardiac Rehabilitation (CR) which has been proven beneficial for the patients with cardiovascular disease; However, cardiovascular outcomes in patients with HF who was referred to HBCR is not known.

METHODS

A retrospective study of 188 patients with HF (HFrEF or heart failure with reduced ejection fraction and HFpEF or heart failure with preserved ejection fraction) referred to HBCR at Veterans Affairs Medical Center (VAMC) from November 2017 to March 2020. We used the outcomes of patients with HF who attended HBCR and compared with the outcomes of patients who did not attend HBCR (Non-HBCR) from 3 months after starting HBCR till 12 months. Primary outcome was composite of all-cause mortality and cardiovascular hospitalizations. Secondary outcomes were all-cause mortality, cardiovascular hospitalizations and all-cause hospitalization, separately. We used cox proportional methods to calculate hazard ratios (HR) and 95% CI. We adjusted for imbalanced characteristics at baseline: age, smoking, PCI and CABG status. In subgroup analysis, we compared HFrEF and HFpEF patients who have completed HBCR and compared differences of their outcomes (weight, blood pressure, cholesterol, LDL, HDL, triglycerides, HbA1C, 6 Minutes walking test, duke score and PHQ-9) pre- and post-HBCR.

RESULTS

Mean age of the patients was 72 year and 98% were male. Out of 188 patients total, 11 patients were excluded for the main analysis as their outcomes occurred within first 90 days of HBCR enrollment, 105/177 (59%) patients attended HBCR while 72/177 (41%) patients did not attend HBCR and 93/105 (89%) patients have completed HBCR. The primary outcome occurred in 14 patients (13.3%) in the HBCR group and 19 patients (26.4%) in the Non-HBCR group (adjusted HR=0.32, CI 0.15-0.68). There was no difference in cardiovascular hospitalization among two groups, however patients in HBCR group have lower all-cause hospitalizations and all-cause death, separately. After HBCR completion, all outcomes (weight, blood pressure, cholesterol, LDL, HDL, triglycerides, HbA1C, 6 Minutes walking test, duke score and PHQ-9) have improved in both HFrEF and HFpEF group.

CONCLUSION

Patients with HF who have completed HBCR have a lower risk of all-cause mortality, all cause hospitalization separately and lower risk of combined all-cause mortality and cardiovascular hospitalization. Patients with HFrEF and HFpEF have equal degree of improvement after completing HBCR when compared with each other. HBCR is an ideal opportunity for patients with HF who cannot attend center-based CR and also for patients with HFpEF since CR is not approved for those patients.

Cost-effectiveness analysis of digital therapeutics for home-based cardiac rehabilitation for patients with chronic heart failure: model development and data analysis

BACKGROUND

In recent years, numerous guidelines and expert consensus have recommended the inclusion of digital technologies and products in cardiac rehabilitation. Digital therapeutics (DTx) is an evidence-based medicine that uses digital means for data collection and monitoring of indicators to control and optimize the treatment, management, and prevention of disease.

OBJECTIVE

This study collected and reviewed real-world data and built a model using health economics assessment methods to analyze the potential cost-effectiveness of DTx applied to home-based cardiac rehabilitation for patients with chronic heart failure. From the perspective of medical and health decision-makers, the economic value of DTx is evaluated prospectively to provide the basis and reference for the application decision and promotion of DTx.

METHODS

Markov models were constructed to simulate the outcomes of DTx for home-based cardiac rehabilitation (DT group) compared to conventional home-based cardiac rehabilitation (CH group) in patients with chronic heart failure. The model input parameters were clinical indicators and cost data. Outcome indicators were quality-adjusted life years (QALYs) and incremental cost-effectiveness ratios (ICERs). The robustness of the evaluation methods and results was tested using sensitivity analyses. Clinical indicators, cost data, and health utility values were obtained from real-world data, including clinical study data, published literature, and public website information.

RESULTS

The Markov model simulated a time span of 10 years, with a cycle set at one month, for 120 cycles. The results showed that the per capita cost of the CH group was 38,442.11 CNY/year, with a QALY of 0.7196 per person per year. The per capita cost of the DT group was 42,300.26 CNY/year, with a QALY of 0.81687 per person per year. The ICER per person was 39,663.5 CNY/QALY each year, which was below the willingness-to-pay threshold of 85,698 CNY (China's GDP per capita in 2022).

CONCLUSIONS

DTx for home-based cardiac rehabilitation is an extremely cost-effective rehabilitation option compared with conventional home-based cardiac rehabilitation. DTx for home-based cardiac rehabilitation is potentially valuable from the perspective of healthcare decision-makers.

Effectiveness of home-based cardiac telerehabilitation in patients with heart failure: A systematic review and meta-analysis of randomised controlled trials

AIMS AND OBJECTIVES

To evaluate the effectiveness of home-based cardiac telerehabilitation in patients with heart failure.

DESIGN

This systematic review and meta-analysis of randomised controlled trials were designed and reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.

METHODS

Two researchers independently screened eligible studies. The Cochrane Handbook for Systematic Reviews of Interventions was used to assess the risk of bias within the included studies. A fixed- or random-effects meta-analysis model was used to determine the mean difference, based on the results of the heterogeneity test.

DATA SOURCES

A librarian-designed search of the Cochrane Library, PubMed, Web of Science, EMBASE, CINAHL, CBM, CNKI and Wanfang databases was conducted to identify studies in English or Chinese on randomised controlled trials up to 15 August 2022.

RESULTS

A total of 2291 studies were screened. The meta-analysis included data from 16 studies representing 4557 participants. The results indicated that home-based cardiac telerehabilitation could improve heart rate, VO2 peak, 6-minute walk distance, quality of life and reduce readmission rates. No significant differences were observed in the left ventricular ejection fraction percentages between the home-based cardiac telerehabilitation and usual care groups. Compared with centre-based cardiac rehabilitation, home-based cardiac telerehabilitation showed no significant improvement in outcome indicators.

CONCLUSION

Patients with heart failure benefit from home-based cardiac telerehabilitation intervention. With the rapid development of information and communication technology, home-based cardiac telerehabilitation has great potential and may be used as an adjunct or substitute for centre-based cardiac rehabilitation.

IMPACT

This systematic review and meta-analysis found that patients with heart failure would benefit from home-based cardiac telerehabilitation intervention in terms of cardiac function, functional capacity, quality-of-life management and readmission rate. Future clinical interventions should consider home-based cardiac telerehabilitation as an alternative to conventional cardiac rehabilitation in patients with heart failure to improve their quality of life.

NO PATIENT OR PUBLIC CONTRIBUTION

Our paper is a systematic review and meta-analysis, and such details do not apply to our work.

Impact of Marital Stress on 1-Year Health Outcomes Among Young Adults With Acute Myocardial Infarction

Background Stress experienced in a marriage or committed relationship may be associated with worse patient-reported outcomes after acute myocardial infarction (AMI), but little is known about this association in young adults (≤55 years) with AMI. Methods and Results We used data from VIRGO (Variation in Recovery: Role of Gender on Outcomes of Young AMI Patients), an observational cohort study that enrolled individuals aged 18 to 55 years with AMI (2008-2012). Marital stress was self-reported 1 month after AMI using the Stockholm Marital Stress Scale (categorized as absent/mild, moderate, and severe). Outcomes were physical/mental health (Short Form-12), generic health status (EuroQol-5 Dimensions), cardiac-specific quality of life and angina (Seattle Angina Questionnaire), depressive symptoms (Patient Health Questionnaire-9), and all-cause readmission 1 year after AMI. Regression models were sequentially adjusted for baseline health, demographics (sex, age, race or ethnicity), and socioeconomic factors (education, income, employment, and insurance). Sex and marital stress interaction was also tested. Among 1593 married/partnered participants, 576 (36.2%) reported severe marital stress, which was more common in female than male participants (39.4% versus 30.4%, P=0.001). Severe marital stress was significantly associated with worse mental health (beta=-2.13, SE=0.75, P=0.004), generic health status (beta=-3.87, SE=1.46, P=0.008), cardiac-specific quality of life (beta=-6.41, SE=1.65, P<0.001), and greater odds of angina (odds ratio [OR], 1.49 [95% CI, 1.06-2.10], P=0.023) and all-cause readmissions (OR, 1.45 [95% CI, 1.04-2.00], P=0.006), after adjusting for baseline health, demographics, and socioeconomic factors. These associations were similar across sexes (P-interaction all >0.05). Conclusions The association between marital stress and worse 1-year health outcomes was statistically significant in young patients with AMI, suggesting a need for routine screening and the creation of interventions to support patients with stress recovering from an AMI.

Personalized smart voice-based electronic prescription for remote at-home feedback management in cardiovascular disease rehabilitation: a multi-center randomized controlled trial

Objective

To investigate the quality and efficacy of remote at-home rehabilitation for patients with cardiovascular disease (CVD) using personalized smart voice-based electronic prescription, and further explore the standardized health management mode of remote family cardiac rehabilitation. Trial design: A multicenter, randomized (1:1), non-blind, parallel controlled study.

Methods

A total of 171 patients with CVD who were admitted to 18 medical institutions in China from April 2021 to October 2022 were randomly divided into a treatment group (86 cases) and a control group (85 cases) in a non-blinded experiment, based on the sequence of enrollment. The control group received routine at-home rehabilitation training, and the treatment group received remote feedback-based at-home cardiac rehabilitation management based on routine at-home rehabilitation training. The primary outcome was the difference in VO2peak (mL/min/kg) after 12 weeks. A linear mixed model was developed with follow-up as the dependent variable. Age and baseline data were utilized as covariates, whereas hospital and patient characteristics were adjusted as random-effect variables. As the linear mixed model can accommodate missing data under the assumption of random missing data, there was no substitute missing value for quantitative data.

Results

A total of 171 participants, with 86 in the experimental group and 85 in the control group, were included in the main analysis. The analysis, which used linear mixing model, revealed significant differences in cardiopulmonary function indexes (VO2/kg peak, VO2peak, AT, METs, and maximum resistance) at different follow-up time (0, 4, and 12 weeks) in the experimental group (p < 0.05). In the control group, there was no significant difference in cardiopulmonary values at different follow-up time (0, 4, and 12 weeks; p > 0.05). VO2/kg peak (LS mean 1.49, 95%CI 0.09-2.89, p = 0.037) and other indicators of cardiopulmonary function (p < 0.05) were significantly different between the experimental group and the control group at week 12. The results were comparable in the complete case analysis.

Conclusion

The remote home cardiac rehabilitation management mode using personalized smart voice-based electronic prescription provides several benefits to patients, including improvements in muscle strength, endurance, cardiopulmonary function, and aerobic metabolism. It also helps reduce risk factors for cardiovascular disease and enhances patients' self-management abilities and treatment compliance.Clinical trial registration: http://www.chictr.org.cn, identifier ChiCTR2100044063.

Multimodal Prehabilitation in Heart Transplant Recipients Improves Short-Term Post-Transplant Outcomes without Increasing Costs

(1) Background and aim: This study aimed to investigate the impact of prehabilitation on the postoperative outcomes of heart transplantation and its cost-effectiveness. (2) Methods: This single-center, ambispective cohort study included forty-six candidates for elective heart transplantation from 2017 to 2021 attending a multimodal prehabilitation program consisting of supervised exercise training, physical activity promotion, nutritional optimization, and psychological support. The postoperative course was compared to a control cohort consisting of patients transplanted from 2014 to 2017 and those contemporaneously not involved in prehabilitation. (3) Results: A significant improvement was observed in preoperative functional capacity (endurance time 281 vs. 728 s, p < 0.001) and quality-of-life (Minnesota score 58 vs. 47, p = 0.046) after the program. No exercise-related events were registered. The prehabilitation cohort showed a lower rate and severity of postoperative complications (comprehensive complication index 37 vs. 31, p = 0.033), lower mechanical ventilation time (37 vs. 20 h, p = 0.032), ICU stay (7 vs. 5 days, p = 0.01), total hospitalization stay (23 vs. 18 days, p = 0.008) and less need for transfer to nursing/rehabilitation facilities after hospital discharge (31% vs. 3%, p = 0.009). A cost-consequence analysis showed that prehabilitation did not increase the total surgical process costs. (4) Conclusions: Multimodal prehabilitation before heart transplantation has benefits on short-term postoperative outcomes potentially attributable to enhancement of physical status, without cost-increasing.

Young Women With Acute Myocardial Infarction: Risk Prediction Model for 1-Year Hospital Readmission

Background

Although young women ( aged ≤ 55 years) are at higher risk than similarly aged men for hospital readmission within 1 year after an acute myocardial infarction (AMI), no risk prediction models have been developed for them. The present study developed and internally validated a risk prediction model of 1-year post-AMI hospital readmission among young women that considered demographic, clinical, and gender-related variables.

Methods

We used data from the US Variation in Recovery: Role of Gender on Outcomes of Young AMI Patients (VIRGO) study (n = 2007 women), a prospective observational study of young patients hospitalized with AMI. Bayesian model averaging was used for model selection and bootstrapping for internal validation. Model calibration and discrimination were respectively assessed with calibration plots and area under the curve.

Results

Within 1-year post-AMI, 684 women (34.1%) were readmitted to the hospital at least once. The final model predictors included: any in-hospital complication, baseline perceived physical health, obstructive coronary artery disease, diabetes, history of congestive heart failure, low income ( < $30,000 US), depressive symptoms, length of hospital stay, and race (White vs Black). Of the 9 retained predictors, 3 were gender-related. The model was well calibrated and exhibited modest discrimination (area under the curve = 0.66).

Conclusions

Our female-specific risk model was developed and internally validated in a cohort of young female patients hospitalized with AMI and can be used to predict risk of readmission. Whereas clinical factors were the strongest predictors, the model included several gender-related variables (ie, perceived physical health, depression, income level). However, discrimination was modest, indicating that other unmeasured factors contribute to variability in hospital readmission risk among younger women.

Effects of different exercise modalities on inhibiting left ventricular pathological remodeling in patients with heart failure with reduced ejection fraction: A systematic review and network meta-analysis

AIMS

To evaluate the effects of different exercise training modalities on inhibiting the left ventricular pathological remodeling in patients with heart failure with reduced ejection fraction (HFrEF) and screen out the optimal exercise modality.

METHODS

We performed a network meta-analysis based on the Frequentist model. Random-effect meta-analyses were used to estimate mean differences (MD) and 95 % confidence intervals.

KEY FINDINGS

25 randomized controlled trials (1284 patients) were enrolled in this study. Results revealed that: high-intensity interval training had the best effect in improving left ventricular ejection fraction (p-score = 0.93, MD: 6.44 (3.61 to 9.28)), reducing left ventricular end-diastolic diameter (p-score = 0.97, MD: -6.73 (-10.27 to -3.19)) and left ventricular end-systolic diameter (p-score = 0.97, MD: -9.33 (-14.90 to -3.76)). Combined aerobic training with resistance training and inspiratory muscle training had the best effect in improving maximal oxygen consumption (p-score = 0.90, MD: 5.19 (3.12 to 7.25)).

SIGNIFICANCE

Current evidence revealed that exercise training could effectively inhibit left ventricular pathological remodeling in patients with HFrEF. For efficacy, high-intensity interval training may have greater potential.

A Conceptual Model of Home-Based Cardiac Rehabilitation Exercise Adherence in Patients with Chronic Heart Failure: A Constructivist Grounded Theory Study

Purpose

This study aimed to explore a conceptual model of home-based cardiac rehabilitation exercise adherence and reveal its internal behavioral logic.

Patients and Methods

A constructivist grounded theory design was adopted to explore the conceptual model of home-based cardiac rehabilitation exercise adherence. Semi-structured interviews were completed to collect qualitative data for constructing the conceptual model. The theoretical saturation and validation strategies were adopted to demonstrate the adequacy of qualitative data. A three-level coding procedure with constant comparisons was completed to analyze this qualitative data.

Results

A total of 21 patients with chronic heart failure were recruited in this study. As a result of this study, 32 initial codes, 12 category codes, and four core categories were extracted, namely, seeking supports, rehabilitation exercise, exercise monitoring and information feedback. According to the internal behavioral logic, the conceptual model of home cardiac rehabilitation exercise adherence was finally formed. In this closed-chain model, seeking supports is the initial adherence behavior, and rehabilitation exercise is the core adherence behavior, and exercise monitoring is the key adherence behavior, and information feedback is the driving adherence behavior.

Conclusion

The conceptual model of home-based cardiac rehabilitation exercise adherence in patients with chronic heart failure was developed, revealing its internal behavioral logic and providing theoretical references for developing relevant clinical research tools with comprehensive coverage and identifying weak links.

Assessing the Efficacy of a Virtual Assistant in the Remote Cardiac Rehabilitation of Heart Failure and Ischemic Heart Disease Patients: Case-Control Study of Romanian Adult Patients

Cardiovascular diseases (CVDs) are the leading cause of mortality in Europe, with potentially more than 60 million deaths per year, with an age-standardized rate of morbidity-mortality higher in men than women, exceeding deaths from cancer. Heart attacks and strokes account for more than four out of every five CVD fatalities globally. After a patient overcomes an acute cardiovascular event, they are referred for rehabilitation to help them to restore most of their normal cardiac functions. One effective way to provide this activity regimen is via virtual models or telerehabilitation, where the patient can avail themselves of the rehabilitation services from the comfort of their homes at designated timings. Under the funding of the European Union's Horizon 2020 Research and Innovation program, grant no 769807, a virtual rehabilitation assistant has been designed for elderly patients (vCare), with the overall objective of supporting recovery and an active life at home, enhancing patients' quality of life, lowering disease-specific risk factors, and ensuring better adherence to a home rehabilitation program. In the vCare project, the Carol Davila University of Bucharest (UMFCD) was in charge of the heart failure (HF) and ischemic heart disease (IHD) groups of patients. By creating a digital environment at patients' homes, the vCare system's effectiveness, use, and feasibility was evaluated. A total of 30 heart failure patients and 20 ischemic heart disease patients were included in the study. Despite the COVID-19 restrictions and a few technical difficulties, HF and IHD patients who performed cardiac rehabilitation using the vCare system had similar results compared to the ambulatory group, and better results compared to the control group.

Hierarchical multiple regression investigating factors associated with depressive symptoms in the middle-aged and elderly undergoing haemodialysis

BACKGROUND

Depressive moods are commonly seen in patients who receive haemodialysis. This can cause a lack of compliance in their treatment procedures and increase the rate of hospitalization. This study aimed to investigate the relationship between social support and degree of depression in middle-aged and elderly patients undergoing haemodialysis and the predictors of depressive symptoms.

METHODS

A cross-sectional correlational study was designed with a structured questionnaire survey. Patients over 40 years of age were included from five haemodialysis centres. Measures embraced a demographic and clinical characteristics questionnaire, the Centre for Epidemiologic Studies Depression Scale, and the Personal Resource Questionnaire 2000. Statistical analysis was performed using hierarchical multiple regression analysis.

RESULTS

A total of 179 patients over 40 years of age were included from five haemodialysis centres in the analysis. The mean CES-D score was 19.0(12.3); the majority of participants (60.3%) had a CES-D score ≥ 15, indicating likely depressive status. The mean PRQ2000 score was 75.7(15.9). The proportional mean of the PRQ2000 was 72.11%, indicating moderate social support for participants in this study. Data disclosed that marital status, number of comorbidities, exercise behaviour, and social support could significantly predict depressive symptoms; total explanatory variance was 31.3%.

CONCLUSION

Health care professionals should identify those at high risk of depressive symptoms when they provide care to the middle-aged and elderly patients undergoing haemodialysis. These findings may lead to greater insights into the nursing and rehabilitative care of patients treated by chronic maintenance haemodialysis.

Protective effect of urotensin II receptor antagonist urantide and exercise training on doxorubicin-induced cardiotoxicity

Doxorubicin (DOX) has a wide antitumor spectrum, but its adverse cardiotoxicity may lead to heart failure. Urotensin II (UII) is the most potent vasoconstrictor in mammals. It plays a role by activating the UII receptor (UT), the orphan G protein-coupled receptor (GPR14), collectively referred to as the UII/UT system. In the new version of "Chinese expert consensus on cardiac rehabilitation of chronic heart failure," it is pointed out that exercise rehabilitation is the cornerstone of cardiac rehabilitation. In this study, in vitro and in vivo assessments were performed using DOX-treated H9C2 cells and rats. It was found that the UT antagonist Urantide and exercise training improved DOX-induced cardiac insufficiency, reduced DOX-induced cardiomyocyte apoptosis, improved the structural disorder of myocardial fibers, and inhibited DOX-induced myocardial fibrosis. Further studies showed that Urantide alleviated DOX-induced cardiotoxicity by downregulating the expression levels of the p38 mitogen-activated protein kinase signaling pathway.

Home-based cardiac rehabilitation: A review of bibliometric studies and visual analysis of CiteSpace (2012-2021)

Home-based cardiac rehabilitation has been a major area in cardiac rehabilitation research for a long time. However, there are few systematic studies in this field using bibliometric analysis. We collected articles and reviews for home-based cardiac rehabilitation from the Web of Science Core Collection. Our objectives were to perform a bibliometric analysis and visualization study to determine hotspots and trends of home-based cardiac rehabilitation, identify collaboration and influence among authors, countries, institutions, and journals, and assess the knowledge base to develop clinical research in the future. This study will provide a valuable reference for researchers concerned with HBCR.

Preoperative Evaluation and Care of Heart Transplant Candidates

Heart transplantation is recommended for patients with advanced heart failure refractory to medical and device therapy, and who do not have absolute contraindications. When patients become eligible for heart transplantation, they undergo comprehensive evaluation and preparation to optimize their posttransplantation outcomes. This review provides an overview of the processes that are employed to enable the candidates to be transplant-ready when donor hearts are available.

Home-Based Robotic Upper Limbs Cardiac Telerehabilitation System

This article proposes a new, improved home-based cardiac telerehabilitation system enhanced by a robotic and Virtual Reality module for cardiac patients to be used in their rehabilitation program. In this study, a novel strategy was used to integrate existing equipment and applications with newly developed ones, with the aim of reducing the need for technical skills of patients using remote control. Patients with acute or chronic heart diseases require long-term, individualized rehabilitation in order to promote their motor recovery and maintain an active and independent lifestyle. This will be accomplished by creating a system for at-home cardiac telerehabilitation augmented by a VR and cobot systems, which can be used long-term at home by each individual patient. In the pre-feasibility study carried out on healthy volunteers familiar with software applications and robotic systems, we demonstrate that RoboTeleRehab could be technically feasible both hardware and software.

Adaptive Posture-Balance Cardiac Rehabilitation Exercise Significantly Improved Physical Tolerance in Patients with Cardiovascular Diseases

Cardiac rehabilitation (CR) requires more professional exercise modalities to improve the efficiency of treatment. Adaptive posture-balance cardiac rehabilitation exercise (APBCRE) is an emerging, balance-based therapy from clinical experience, but lacks evidence of validity. Our study aimed to observe and assess the rehabilitation effect of APBCRE on patients with cardiovascular diseases (CVDs). All participants received one-month APBCRE therapy evenly three times per week and two assessments before and after APBCRE. Each assessment included cardiopulmonary exercise testing (CPET), resting metabolic rate (RMR) detection, and three questionnaires about general health. The differences between two assessments were analyzed to evaluate the therapeutic effects of APBCRE. A total of 93 participants (80.65% male, 53.03 ± 12.02 years) were included in the analysis. After one-month APBCRE, oxygen uptake (VO2, 11.16 ± 2.91 to 12.85 ± 3.17 mL/min/kg, p < 0.01) at anaerobic threshold (AT), ventilation (VE, 28.87 ± 7.26 to 32.42 ± 8.50 mL/min/kg, p < 0.01) at AT, respiratory exchange ratio (RER, 0.93 ± 0.06 to 0.95 ± 0.05, p < 0.01) at AT and oxygen uptake efficiency slope (OUES, 1426.75 ± 346.30 to 1547.19 ± 403.49, p < 0.01) significantly improved in CVD patients. The ≤55-year group had more positive improvements (VO2 at AT, 23% vs. 16%; OUES, 13% vs. 6%) compared with the >55-year group. Quality of life was also increased after APBCRE (47.78 ± 16.74 to 59.27 ± 17.77, p < 0.001). This study proved that APBCRE was a potentially available exercise rehabilitation modality for patients with CVDs, which performed significant increases in physical tolerance and quality of life, especially for ≤55-year patients.

Cardiac rehabilitation: Effective yet underutilized in patients with cardiovascular disease

Cardiac rehabilitation is a comprehensive program that treats patients with multiple cardiac conditions including post-myocardial infarction, stable angina, post-coronary artery bypass surgery, chronic heart failure, and peripheral vascular disease with structured exercise, and nutrition and risk factor counseling. It is an effective tool that has been shown to improve not only quality of life but also reduce adverse cardiac events, including death. While the value of cardiac rehabilitation is supported by a large body of evidence and its recommendation by the American Heart Association/American College of Cardiology it is significantly underutilized due to both patient and systemic factors. Continued efforts should be made to remove the obstacles to make cardiac rehabilitation available to all those who qualify.

Optimal effectiveness of heart failure management - an umbrella review of meta-analyses examining the effectiveness of interventions to reduce (re)hospitalizations in heart failure

Heart failure (HF) is a major health concern, which accounts for 1-2% of all hospital admissions. Nevertheless, there remains a knowledge gap concerning which interventions contribute to effective prevention of HF (re)hospitalization. Therefore, this umbrella review aims to systematically review meta-analyses that examined the effectiveness of interventions in reducing HF-related (re)hospitalization in HFrEF patients. An electronic literature search was performed in PubMed, Web of Science, PsycInfo, Cochrane Reviews, CINAHL, and Medline to identify eligible studies published in the English language in the past 10 years. Primarily, to synthesize the meta-analyzed data, a best-evidence synthesis was used in which meta-analyses were classified based on level of validity. Secondarily, all unique RCTS were extracted from the meta-analyses and examined. A total of 44 meta-analyses were included which encompassed 186 unique RCTs. Strong or moderate evidence suggested that catheter ablation, cardiac resynchronization therapy, cardiac rehabilitation, telemonitoring, and RAAS inhibitors could reduce (re)hospitalization. Additionally, limited evidence suggested that multidisciplinary clinic or self-management promotion programs, beta-blockers, statins, and mitral valve therapy could reduce HF hospitalization. No, or conflicting evidence was found for the effects of cell therapy or anticoagulation. This umbrella review highlights different levels of evidence regarding the effectiveness of several interventions in reducing HF-related (re)hospitalization in HFrEF patients. It could guide future guideline development in optimizing care pathways for heart failure patients.

The Role of Perceived Social Support on Quality of Life in People with Cardiovascular Diseases

Background

Cardiovascular Diseases (CVDs) are one of the major causes of hospitalization and mortality worldwide. Strengthening perceived social support and quality of life can reduce these problems. This study aimed to describe the role of perceived social support on cardiovascular patients' quality of life.

Methods

This cross-sectional study was conducted from September 2020 to February 2021. We selected 150 cardiovascular patients through convenience sampling. The questionnaires included: the Persian version of the WHOQOL-BREF, Perceived Social Support, and demographic variables. Hierarchical linear regression was used to explore the association between perceived social support and quality of life. Data were analyzed by SPSS version 21.0 software. A P-value less than 0.05 is considered statistically significant.

Results

The demographic variables could predict 12.2% of the variance of quality of life in the first step. In the second step, after adjusting control variables and dimensions of social support, the predictability increased to 29% of the variance with the addition of variables. All dimensions of social support, excluding tangible assets support, were significant predictors of quality of life and monthly income status. Self-esteem support (β= 0.387) was the strongest predictor of quality of life in cardiovascular patients.

Conclusions

Patients with higher perceived social support have a better quality of life than the other patients. Perceived social support is one of the strategies that can be utilized to improve quality of life and overcome disease in cardiovascular patients.

Effectiveness of home-based telerehabilitation programs on functional capacity and cardiac function in elderly heart failure patients: A prospective longitudinal study

Decreased functional capacity and reduced cardiac function were the main symptoms in patients with heart failure (HF) and the incidence increases with advanced age. The guidelines recommend that exercise training should be considered for medically stable HF outpatients. Studies have confirmed that exercise can improve functional capacity, prognosis, and reduced hospitalization rates; however, very few studies have investigated the elderly. It is not clear whether exercise could be feasible in elderly HF. The aim of this study was to evaluate the effect of the 6-month heart failure post-acute care program focused on home-based cardiac telerehabilitation (HCTR) on functional capacity, cardiac function, and readmission rates in HF patients. A prospective longitudinal study was conducted. Study duration was from January 2018 to December 2019. HF patients with a left ventricular ejection fraction <40% and age ≧65 years were included and divided into intervention (n = 40) and control group (n = 41). We arranged a 6-month heart failure post-acute care program that included outpatient cardiac rehabilitation and home exercise for the intervention group. The response to home exercise was followed by telemonitor. The exercise parameters were recorded on the HF health management mobile application system platform by each patient and daily transmission to hospital's cloud database as HCTR, usual care program for the control group. Information such as general data, laboratory data, six-minute walk test, cardiac function, and admission record was collected from all patients. Eighty one patients between the ages of 65 and 92 completed the study. The mean age was 73.3 ± 5.0 and 75.6 ± 6.0 years in control and intervention group, respectively. The intervention group showed a statistically significant improvement in functional capacity, percentage change in the of six-minute walk distance (51.2% vs 17.7%, P < .05, 95% confidence interval -45.9 to -6.3). Left ventricular ejection fraction increased by 7.7%, which corresponds to 25.6% in relative terms (P < .05, 95% confidence interval -7.8 to -0.5). The readmission rate was 4.6% in the intervention group. Six months of post-acute HF focused on HCTR programs was safe, improved functional capacity, cardiac function, and decreased readmission rate in elderly patients with HF patients.

Prognostic value of patient-reported outcomes in predicting 30 day all-cause readmission among older patients with heart failure

AIMS

Previous prediction studies for 30 day readmission in patients with heart failure were built mainly based on electronic medical records and rarely involved patient-reported outcomes. This study aims to develop and validate a nomogram including patient-reported outcomes to predict the possibility of 30 day all-cause readmission in older patients with heart failure and to explore the value of patient-reported outcomes in prediction model.

METHODS AND RESULTS

This was a prospective cohort study. The nomogram was developed and internally validated by Logistic regression analysis based on 381 patients in training group from March to December 2019. The nomogram was externally validated based on 170 patients from July to October 2020. Receiver operating characteristic curves, calibration plots and decision-curve analysis were used to evaluate the performance of the nomogram. A total of 381 patients' complete data were analysed in the training group and 170 patients were enrolled in the external validation group. In the training group, 14.4% (n = 55) patients were readmitted to hospitals within 30 days of discharge and 15.9% (n = 27) patients were readmitted in the external validation group. The nomogram included six factors: history of surgery, changing the type of medicine by oneself, information acquisition ability, subjective support, depression level, quality of life, all of which were significantly associated with 30 day readmission in older patients with heart failure. The areas under the receiver operating characteristic curves of nomogram were 0.949 (95% CI: 0.925, 0.973, sensitivity: 0.873, specificity: 0.883) and 0.804 (95% CI: 0.691, 0.917, sensitivity: 0.778, specificity: 0.832) respectively in the training and external validation groups, which indicated that the nomogram had better discrimination ability. The calibration plots demonstrated favourable coordination between predictive probability of 30 day readmission and observed probability. Decision-curve analysis showed that the net benefit of the nomogram was better between threshold probabilities of 0-85%.

CONCLUSIONS

A novel and easy-to-use nomogram is constructed and demonstrated which emphasizes the important role of patient-reported outcomes in predicting studies. The performance of the nomogram drops in the external validation cohort and the nomogram must be validated in a wide prospective cohort of HF patients before its clinical relevance can be demonstrated. All these findings in this study can assist professionals in identifying the needs of HF patients so as to reduce 30 day readmission.

Point-of-care heart failure platform: where are we now and where are we going to?

INTRODUCTION

Heart failure (HF) remains a leading cause of cardiovascular (CV) mortality in patients with CV disease. The point-of-care (POC) HF platform seems to be an ideal noninvasive workflow-adapted system for personally adjusted management of patients with HF.

AREAS COVERED

In the present manuscript, we reviewed the literature covering some relevant studies regarding the role of point-of care heart failure platform in the risk stratification, earlier diagnosis and prognostically beneficial treatment of patients with different phenotypes of HF.

EXPERT OPINION

POC HF platform including personal consultation, optimization of the comorbidity treatment, step-by-step HF diagnostic algorithm, single biomarker measurements, has also partially been provided in the current guidelines. Although there are several obstacles to implement POC in routine practice, such as education level, aging, affordability of health care, even partial implementation of POC can also improve clinical outcomes. POC seems to be an evolving model, more research studies are required to clearly see whether it helps to make better decisions with diagnosis and care of HF, as well helps to achieve better clinical outcomes.In summary, the POC HF platform is considered to be a more effective tool than conventional algorithm of HF management.

Consideration of future consequences and self-control mediate the impact of time perspectives on self-rated health and engagement in healthy lifestyles among young adults

The study investigated how different time perspectives predict people's self-rated health and engagement in healthy lifestyles, and explored the mediating effects of consideration of future consequences (CFC) and self-control as the underlying mechanisms. Young adults (n = 299, M age = 23.65, ranges from 18 to 30 years old) completed measures of time perspectives, CFC, self-control and engagement in daily health behaviors. Generalized linear regression models showed that Past-Negative time perspective negatively predicted sleep quality; Future time perspective negatively predicted unhealthy eating patterns; Future time perspective was the only protective factor of risky drinking, while both Past-Positive and Future time perspective were protective factors of smoking. Mediation analyses showed that CFC-Immediate and self-control mediated the relationship between Future time perspective and eating patterns. Results suggested that consideration of future consequences and self-control partially explained how time perspectives affect engagement in healthy lifestyles among young Chinese adults. Implications of the current research for promoting healthy living and directions for future research are discussed.

Supplementary Information

The online version contains supplementary material available at 10.1007/s12144-022-03135-6.

Efficacy of a 6-Week Home-Based Online Supervised Exercise Program Conducted During COVID-19 in Patients With Post Percutaneous Coronary Intervention: A Single-Blind Randomized Controlled Trial

Objective

The aim of this study was to assess the efficacy of a 6-week cardiac rehabilitation (CR) program designed for patients with coronary artery disease (CAD) after percutaneous coronary intervention (PCI) that involved an online supervised exercise program that they could access during COVID-19.

Methods

One hundred patients were randomly allocated into control group (CG) and supervision group (SG). CG accepted conventional health education with a home exercise program booklet delivered before discharge, SG had an additional home-based online supervised exercise program (HOSEP). Questionnaires, motor function and lipid profile were administered at baseline. Questionnaires included the Godin-Shephard Leisure-Time Physical Activity questionnaire (GSLTPAQ) and Bandura's Exercise Self-efficacy (ESE). Motor function included: 6-min walk test (6 MWT), timed up and go test (TUG), 30-s sit to stand (30-s STS), and Hand Grip Strength (HG). Lipid profile included: low-density lipoprotein (LDL), high-density lipoprotein (HDL), total cholesterol (TC) and triglycerides (TG). The questionnaires were re-administered after 2-weeks, all tests were re-evaluated after 6-weeks.

Results

the questionnaire results showed that scores on GSLTPAQ and ESE were significantly improved in the SG. The changes in GSLTPAQ scores from baseline to 2- and 6-weeks in the SG were significantly higher than in the CG (2-week: 6.9 ± 13.0 for SG and 0.2 ± 10.2 for CG, p = 0.005; 6-week: 9.4 ± 18.1 for SG and 0.2 ± 11.8 for CG, p = 0.003). in terms of motor function, both the CG and SG improved TUG and 6 MWT performance, with the 6 MWT improvement being significantly greater in the SG than CG (43.7 ± 39.2 m for SG and 16.6 ± 39.1 m for CG, p = 0.001). Improvement in the 30-s STS was significantly greater in the SG than CG (2.4 ± 3.6 repetitions for SG and 0.4 ± 3.5 repetitions for CG, p = 0.007). the lipid profile level significantly improved over baseline in both SG and CG after 6-week intervention, and these changes were not statistically different between groups.

Conclusion

This pilot randomized control study demonstrated that a 6-week HOSEP, when added to education delivered pre-hospital discharge for CAD patients following PCI, was beneficial with respect to exercise self-efficacy, exercise behavior, motor function and lipid profile. Supervised exercise programs delivered online in addition to education providing effective and accessible CR during COVID-19.

Patient Perception When Transitioning from Classic to Remote Assisted Cardiac Rehabilitation

Cardiac rehabilitation is an individualized outpatient program of physical exercises and medical education designed to accelerate recovery and improve health status in heart disease patients. In this study, we aimed for assessment of patients’ perception of the involvement of technology and remote monitoring devices in cardiac recovery. During the Living Lab Phase of the Virtual Coaching Activities for Rehabilitation in Elderly (vCare) project, we evaluated eleven patients (five heart failure patients and six ischemic heart disease patients). Patient admission in the UMFCD cardiology clinical department served as a shared inclusion criterion for both study groups. In addition, the presence of II or III heart failure NYHA stage status was considered an inclusion criterion for the heart failure study group and patients diagnosed with ischemic heart disease for the second one. We conducted a system usability survey to assess the patients’ perception of the system’s technical and medical functions. The survey had excellent preliminary results in the heart failure study group and good results in the ischemic heart disease group. The limited access of patients to cardiac rehabilitation in Romania has led to increased interest and motivation in this study. The final version of the product is designed to adapt to patient needs and necessities; therefore, patient perception is necessary.

Mobilizing artificial intelligence to cardiac telerehabilitation

Cardiac telerehabilitation is a method that uses digital technologies to deliver cardiac rehabilitation from a distance. It has been shown to have benefits to improve patients' disease outcomes and quality of life, and further reduce readmission and adverse cardiac events. The outbreak of the coronavirus pandemic has brought considerable new challenges to cardiac rehabilitation, which foster cardiac telerehabilitation to be broadly applied. This transformation is associated with some difficulties that urgently need some innovations to search for the right path. Artificial intelligence, which has a high level of data mining and interpretation, may provide a potential solution. This review evaluates the current application and limitations of artificial intelligence in cardiac telerehabilitation and offers prospects.

Effects of Supervised Cardiac Rehabilitation Programmes on Quality of Life among Myocardial Infarction Patients: A Systematic Review and Meta-Analysis

Coronary heart disease is the leading cause of death and disability worldwide. Traditionally, cardiac rehabilitation programmes are offered after cardiac events to aid recovery, improve quality of life, and reduce adverse events. The objective of this review was to assess the health-related quality of life, after a supervised cardiac rehabilitation programme, of patients who suffered a myocardial infarction. A systematic review was carried out in the CINAHL, Cochrane, LILACS, Medline, Scopus, and SciELO databases, according to the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines. Randomised controlled trials were selected. Meta-analyses were performed for the Short Form Health Survey SF-36, Myocardial Infarction Dimensional Assessment Scale (MIDAS), MacNew Heart Disease-Health-Related Quality of Life (HRQL) questionnaire, and European Quality of Life-Visual Analogue Scale (EuroQol-VAS) with the software Cochrane RevMan Web. Ten articles were found covering a total of 3577 patients. In the meta-analysis, the effect size of the cardiac rehabilitation programme was statistically significant in the intervention group for physical activity, emotional reaction, and dependency dimensions of the MIDAS questionnaire. For the control group, the score improved for SF-36 physical functioning, and body pain dimensions. The mean difference between the control and intervention group was not significant for the remaining dimensions, and neither for the MacNew Heart Disease-HRQL and EuroQol-VAS questionnaires. Supervised cardiac rehabilitation programmes were effective in improving health-related quality of life, however, there was a potential variability in the interventions; therefore, the results should be interpreted with caution. This study supports the importance of providing care and evaluating interventions via the supervision of trained health professionals, and further randomised clinical trials are needed to analyse the positive changes in mental and physical health outcomes.

Cardiovascular Outcomes of Patients Referred to Home Based Cardiac Rehabilitation

Background

Home Based Cardiac Rehabilitation (HBCR) has been considered a reasonable alternative to Center-based Cardiac Rehabilitation (CBCR) in patients with established cardiovascular disease, especially in the midst of COVID-19 pandemic. However, the long-term cardiovascular outcomes of patients referred to HBCR remains unknown.

Objectives

To compare outcomes of patients who were referred and attended HBCR vs patients referred but did not attend HBCR (Non-HBCR).

Methods

We performed a retrospective study of 269 patients referred to HBCR at Providence Veterans Affairs Medical Center (PVAMC). From November 2017 to March 2020, 427 patients were eligible and referred for Cardiac Rehabilitation (CR) at PVAMC. Of total patients, 158 patients were referred to CBCR and 269 patients to HBCR based on patient and/or clinician preference. The analysis of outcomes was focused on HBCR patients. We compared outcomes of patients who were referred and attended HBCR vs patients referred but did not attend HBCR (Non-HBCR) from 3 to 12 months of the referral date. HBCR consisted of face-to-face entry exam with exercise prescription, weekly phone calls for education and exercise monitoring, with adjustments where applicable, for 12-weeks and an exit exam. Primary outcome was composite of all-cause mortality and hospitalizations. Secondary outcomes were all-cause hospitalization, all-cause mortality and cardiovascular hospitalizations, separately. We used cox proportional methods to calculate hazard ratios (HR) and 95% CI. We adjusted for imbalanced characteristics at baseline: smoking, left ventricular ejection fraction and CABG status.

Results

A total of 269 patients (mean age: 72, 98% Male) were referred to HBCR, however, only 157 (58%) patients attended HBCR. The primary outcome occurred in 30 patients (19.1%) in the HBCR group and 30 patients (30%) in the Non-HBCR group (adjusted HR=0.56, CI 0.33-0.95, P=.03). All-cause mortality occurred in 6.4% of patients in the HBCR group and 13% patients in the Non-HBCR group 3 to 12 months after HBCR referral (adjusted HR=0.43, CI 0.18-1.0, P= .05). There was no difference in cardiovascular hospitalizations (HBCR: 5.7% vs Non-HBCR: 10%, adjusted HR 0.57, CI 0.22-1.4, P= .23) or all cause hospitalizations at 3 to 12 months between the groups (HBCR: 12.7% vs Non-HBCR: 21%, adjusted HR 0.53, CI 0.28-1.01, P= .05).

Conclusion

Completion of HBCR among referred patients was associated with a lower risk of the combined all-cause mortality and all-cause hospitalizations up to 12 months. Based on the outcomes, HBCR is a reasonable option that can improve access to CR for patients who are not candidates of or cannot attend CBCR. Randomized-controlled studies are needed to confirm these findings.