Validity and Reliability of the Cardiac Rehabilitation Barriers Scale in the Czech Republic (CRBS-CZE): Determination of Key Barriers in East-Central Europe

Adoption of the cardiopulmonary exercise test in the exercise ability and cardiopulmonary function rehabilitation of coronary artery disease (CAD) patients

BACKGROUND

This study aimed to explore the application of cardiopulmonary exercise testing in coronary artery disease (CAD) patients, evaluate its impact on exercise ability and cardiopulmonary function in patients with coronary heart disease (CHD), and promote the application of cardiopulmonary exercise testing in CAD management.

METHODS

Fifty CHD patients after percutaneous coronary intervention (PCI) were recruited and randomly enrolled into the control (Ctrl) group and intervention (Int) group. Routine health education and health education combined with RT training were carried out for the two groups. Blood lipid levels and lung function were compared between the two groups after intervention. Cardiac function was evaluated by Doppler ultrasonography, and cardiopulmonary fitness and exercise ability were evaluated by a cardiopulmonary exercise test (CPET). The self-rating anxiety scale (SAS) and self-rating depression scale (SDS) were employed to evaluate negative emotions. The 36-item short-form (SF-36) was adopted to evaluate quality of life.

RESULT

Compared with those in the Ctrl group, the levels of serum total cholesterol (TC), triglycerides (TGs), high-density lipoprotein (HDL), and low-density lipoprotein (LDL) decreased in the Int group, while the levels of high-density lipoprotein increased (P < 0.05). The quantitative load results showed that compared with the Ctrl group, the heart rate (HR) and self-perceived fatigue degree of the Int group decreased, and the ST segment increased (P < 0.05). Compared with the Ctrl group, the left ventricular ejection fraction (LVEF), forced expiratory volume at 1 s (FEV1), ratio of forced expiratory volume to forced vital volume (FEV1/FVC%), and maximum chase volume (MVV) increased in the Int group, while the left ventricular end diastolic diameter and left ventricular end contractile diameter decreased (P < 0.05). The results of the CPET showed that compared with the Ctrl group, minute ventilation/carbon dioxide production slope, VE/VCO2 - Peak, anaerobic threshold (AT), peak oxygen pulse (VO2/HR peak), oxygen uptake efficiency platform (OUEP), increasing power exercise time (IPEt), HR recovery 1 min after exercise, peak load power (Watt peak), and value metabolic equivalent (Watt peak) increased in the Int group (P < 0.05). Compared with the Ctrl group, the SAS and SDS scores in the Int group decreased (P < 0.05). The results of the quality of life evaluation showed that compared with the Ctrl group, the score of the SF-36 dimensions increased in the Int group (P < 0.05).

CONCLUSION

RT training can reduce postoperative blood lipid and quantitative load levels in CAD patients and improve adverse mood. Furthermore, it can improve patients' cardiopulmonary function, cardiopulmonary fitness, exercise ability, and quality of life.

Safety and long-term outcomes of remote cardiac rehabilitation in coronary heart disease patients: A systematic review

Objective

To systematically review the safety and the long-term mortality and morbidity risk-rates of the remotely-delivered cardiac rehabilitation (RDCR) interventions in coronary heart disease (CHD) patients.

Methods

The protocol was registered in the International Prospective Register of Systematic Reviews (CRD42023455471). Five databases (Pubmed, Scopus, Cochrane Central Register of Controlled Trials in the Cochrane Library, Cinahl and Web of Science) were reviewed from January 2012 up to August 2023. Inclusion criteria were: (a) randomized controlled trials, (b) RDCR implementation of at least 12 weeks duration, (c) assessment of safety, rates of serious adverse events (SAEs) and re-hospitalization incidences at endpoints more than 6 months. Three reviewers independently performed data extraction and assessed the risk of bias using the Cochrane Risk of Bias tool.

Results

14 studies were identified involving 2012 participants and a range of RDCR duration between 3 months to 1 year. The incidence rate of exercise-related SAEs was estimated at 1 per 53,770 patient-hours of RDCR exercise. A non-statistically significant reduction in the re-hospitalization rates and the days lost due to hospitalization was noticed in the RDCR groups. There were no exercise-related deaths. The overall study quality was of low risk.

Conclusions

RDCR can act as a safe alternative delivery mode of cardiac rehabilitation (CR). The low long-term rates of reported SAEs and re-hospitalization incidences of the RDCR could enhance the uptake rates of CR interventions. However, further investigation is needed in larger populations and longer assessment points.

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.

Women's Cardiac Rehabilitation Barriers: Results of the International Council of Cardiovascular Prevention and Rehabilitation's First Global Assessment

BACKGROUND

Cardiac rehabilitation (CR) programs are underutilized globally, especially by women. In this study we investigated sex differences in CR barriers across all world regions, to our knowledge for the first time, the characteristics associated with greater barriers in women, and women's greatest barriers according to enrollment status.

METHODS

In this cross-sectional study, the English, Simplified Chinese, Arabic, Portuguese, or Korean versions of the Cardiac Rehabilitation Barriers Scale was administered to CR-indicated patients globally via Qualtrics from October 2021 to March 2023. Members of the International Council of Cardiovascular Prevention and Rehabilitation community facilitated participant recruitment. Mitigation strategies were provided and rated.

RESULTS

Participants were 2163 patients from 16 countries across all 6 World Health Organization regions; 916 (42.3%) were women. Women did not report significantly greater total barriers overall, but did in 2 regions (Americas, Western Pacific) and men in 1 (Eastern Mediterranean; all P < 0.001). Women's barriers were greatest in the Western Pacific (2.6 ± 0.4/5) and South East Asian (2.5 ± 0.9) regions (P < 0.001), with lack of CR awareness as the greatest barrier in both. Women who were unemployed reported significantly greater barriers than those not (P < 0.001). Among nonenrolled referred women, the greatest barriers were not knowing about CR, not being contacted by the program, cost, and finding exercise tiring or painful. Among enrolled women, the greatest barriers to session adherence were distance, transportation, and family responsibilities. Mitigation strategies were rated as very helpful (4.2 ± 0.7/5).

CONCLUSIONS

CR barriers-men's and women's-vary significantly according to region, necessitating tailored approaches to mitigation. Efforts should be made to mitigate unemployed women's barriers in particular.

Efficacy of supervised home-based, real time, videoconferencing telerehabilitation in patients with type 2 diabetes: a single-blind randomized controlled trial

BACKGROUND

Exercise-based interventions prevent or delay symptoms and complications of type 2 diabetes (T2D) and are highly recommended for T2D patients; though with very low participation rates. Τelerehabilitation (TR) could act as an alternative to overcome the barriers preventing the promotion of T2D patients' well-being.

AIM

Determine the effects of a six-week TR program on glycemic control, functional capacity, muscle strength, PA, quality of life and body composition in patients with T2D.

DESIGN

A multicenter randomized, single-blind, parallel-group clinical study.

SETTING

Clinical trial.

POPULATION

Patients with T2D.

METHODS

Thirty T2D patients (75% male, 60.1±10.9 years) were randomly allocated to an intervention group (IG) and a control group (CG) with no exercise intervention. IG enrolled in a supervised, individualized exercise program (combination of aerobic and resistance exercises), 3 times/week for 6 weeks at home via a TR platform. Glycated hemoglobin (HbA1c), six-minute walk test (6MWT), muscle strength (Hand Grip Strength Test [HGS], 30-Second Chair Stand test [30CST] physical activity [IPAQ-SF]), quality of life (SF-36) and anthropometric variables were assessed.

RESULTS

Two-way repeated-ANOVA showed a statistically significant interaction between group, time and test differences (6MWT, muscle strength) (V=0.33, F [2.17]=4.14, P=0.03, partial η2=0.22). Paired samples t-test showed a statistically significant improvement in HbA1c (Z=-2.7), 6MWT (Μean ∆=-36.9±27.2 m, t=-4.5), muscle strength (Μean ∆=-1.5±1.4 kg, t=-2.22). Similarly, SF-36 (mental health [Μean ∆=-13.3±21.3%], general health [Μean ∆=-11.4±16.90%]) were statistically improved only in IG.

CONCLUSIONS

The findings of this study indicate that a 6-week supervised home-based TR exercise program induced significant benefits in patients with T2D, thus enabling telehealth implementation in rehabilitation practice as an alternative approach.

CLINICAL REHABILITATION IMPACT

Home-based exercise via the TR platform is a feasible and effective alternative approach that can help patients with T2D eliminate barriers and increase overall rehabilitation utilization.

Barriers to Participation in Cardiac Rehabilitation Among Patients with Coronary Heart Disease After Reperfusion Therapy: A Scoping Review

Patients with coronary heart disease (CHD) experience many barriers to participate in cardiac rehabilitation (CR) programs. Several studies identify barriers that can affect participation in CR among patients with CHD after reperfusion therapy. However, there has yet to be a review specifically in this population. This review aims to identify the literature systematically that analyzes the barriers that affect the participation of CHD patients after reperfusion therapy in implementing the CR program. This study used the Preferred Reporting Item for PRISMA Extension for Scoping Reviews (PRISMA-ScR) with databases PubMed, ScienceDirect, EBSCO-hosted Academic Search Complete, Scopus, Taylor & Francis, and Sage Journals. The keywords used in English were "coronary artery disease OR myocardial infarction OR cardiovascular disease OR heart disease" AND "Barrier OR obstacle", AND "percutaneous coronary intervention OR PCI OR angioplasty OR coronary artery bypass graft surgery OR CABG" AND "cardiac rehabilitation OR rehabilitation OR recovery". The inclusion criteria in this review were full-text articles in English, articles with a descriptive, cross-sectional, and cohort design with a minimum of 100 participants that discussed barriers to participation in patients with CHD after undergoing reperfusion therapy, and the CR phases such as I, II, III, and IV have also been identified. Based on the initial search, there are 23 relevant studies out of 7400. The results of this study reported that most of the participants from the studies analyzed had a low level of participation in CR (≤50%). We classify the factors that affect the level of CR participation into five categories: individual factors, health history, environmental, logistical, and health system. The most reported barriers in each category were age, comorbidities, lack of support from friends, family and health workers, distance or travel time, and cost and economic status. Professional health workers, especially nurses, can identify various barriers that patients feel so that they can increase their participation in attending CR.

Barriers and Facilitators to Delivering Inpatient Cardiac Rehabilitation: A Scoping Review

Objective

The purpose of this scoping review was to summarize the literature on barriers and facilitators that influence the provision and uptake of inpatient cardiac rehabilitation (ICR).

Methods

A literature search was conducted using PsycINFO, MEDLINE, EMBASE, CINAHL and AgeLine. Studies were included if they were published in English after the year 2000 and focused on adults who were receiving some form of ICR (eg, exercise counselling and training, education for heart-healthy living). For studies meeting inclusion criteria, descriptive data on authors, year, study design, and intervention type were extracted.

Results

The literature search resulted in a total of 44,331 publications, of which 229 studies met inclusion criteria. ICR programs vary drastically and often focus on promoting physical exercises and patient education. Barriers and facilitators were categorized through patient, provider and system level factors. Individual characteristics and provider knowledge and efficacy were categorized as both barriers and facilitators to ICR delivery and uptake. Team functioning, lack of resources, program coordination, and inconsistencies in evaluation acted as key barriers to ICR delivery and uptake. Key facilitators that influence ICR implementation and engagement include accreditation and professional associations and patient and family-centred practices.

Conclusion

ICR programs can be highly effective at improving health outcomes for those living with CVDs. Our review identified several patient, provider, and system-level considerations that act as barriers and facilitators to ICR delivery and uptake. Future research should explore how to encourage health promotion knowledge amongst ICR staff and patients.

Global perspectives on heart disease rehabilitation and secondary prevention: a scientific statement from the Association of Cardiovascular Nursing and Allied Professions, European Association of Preventive Cardiology, and International Council of Cardiovascular Prevention and Rehabilitation

Cardiovascular disease is a leading cause of death, morbidity, disability, and reduced health-related quality of life, as well as economic burden worldwide, with some 80% of disease burden occurring in the low- and middle-income country (LMIC) settings. With increasing numbers of people living longer with symptomatic disease, the effectiveness and accessibility of secondary preventative and rehabilitative health services have never been more important. Whilst LMICs experience the highest prevalence and mortality rates, the global approach to secondary prevention and cardiac rehabilitation, which mitigates this burden, has traditionally been driven from clinical guidelines emanating from high-income settings. This state-of-the art review provides a contemporary global perspective on cardiac rehabilitation and secondary prevention, contrasting the challenges of and opportunities for high vs. lower income settings. Actionable solutions to overcome system, clinician, programme, and patient level barriers to cardiac rehabilitation access in LMICs are provided.

The cost-effectiveness of exercise-based cardiac telerehabilitation intervention: a systematic review

INTRODUCTION

Alternatives such as remotely delivered therapy in the home environment or telehealth represent an opportunity to increase overall cardiac rehabilitation (CR) utilization. Implementing alternatives into regular practice is the next step in development; however, the cost aspect is essential for policymakers. Limited economic budgets lead to cost-effectiveness analyses before implementation. They are appropriate in cases where there is evidence that the compared intervention provides a similar health benefit to usual care. This systematic review aimed to compare the cost-effectiveness of exercise-based telehealth CR interventions compared to standard exercise-based CR.

EVIDENCE ACQUISITION

PubMed and Web of Science databases were systematically searched up to August 2022 to identify randomized controlled trials assessing patients undergoing telehealth CR. The intervention was compared to standard CR protocols. The primary intent was to identify the cost-effectiveness. Interventions that met the criteria were home-based telehealth CR interventions delivered by information and communications technology (telephone, computer, internet, or videoconferencing) and included the results of an economic evaluation, comparing interventions in terms of cost-effectiveness, utility, costs and benefits, or cost-minimization analysis. The systematic review protocol was registered in the PROSPERO Registry (CRD42022322531).

EVIDENCE SYNTHESIS

Out of 1525 identified studies, 67 articles were assessed for eligibility, and, at the end of the screening process, 12 studies were included in the present systematic review. Most studies (92%) included in this systematic review found strong evidence that exercise-based telehealth CR is cost-effective. Compared to CBCR, there were no major differences, except for three studies evaluating a significant difference in average cost per patient and intervention costs in favor of telehealth CR.

CONCLUSIONS

Telehealth CR based on exercise is as cost-effective as CBCR interventions. Funding telehealth CR by third-party payers may promote patient participation to increase overall CR utilization. High-quality research is needed to identify the most cost-effective design.

Translation, Cross-Cultural Adaptation and Psychometric Validation of the Greek Version of the Cardiac Rehabilitation Barriers Scale (CRBS-GR): What Are the Barriers in South-East Europe?

Cardiac Rehabilitation (CR) is a secondary prevention intervention proven to improve quality of life, yet with low participation. The Cardiac Rehabilitation Barriers Scale (CRBS) was developed to assess multi-level barriers to participation. This study aimed at the translation, and cross-cultural adaptation of the CRBS into the Greek language (CRBS-GR), followed by psychometric validation. Some 110 post-angioplasty patients with coronary artery disease (88.2% men, age 65.3 ± 10.2 years) answered the CRBS-GR. Factor analysis was performed to obtain the CRBS-GR subscales/factors. The internal consistency and 3-week test-retest reliability was evaluated using Cronbach's alpha (α) and intraclass correlation coefficient (ICC), respectively. Construct validity was tested via convergent and divergent validity. Concurrent validity was assessed with the Hospital Anxiety and Depression Scale (HADS). Translation and adaptation resulted in 21 items similar to the original version. Face validity and acceptability were supported. Construct validity assessment revealed four subscales/factors, with acceptable overall reliability (α = 0.70) and subscale internal consistency for all but one factor (α range = 0.56-0.74). The 3-week test-retest reliability was 0.96. Concurrent validity assessment demonstrated a small to moderate correlation of the CRBS-GR with the HADS. The greatest barriers were the distance from the rehabilitation center, the costs, the lack of information about CR, and already exercising at home. The CRBS-GR is a reliable and valid tool for identifying CR barriers among Greek-speaking patients.

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.

Barriers to Establishing Outpatient Cardiac Rehabilitation in the Western Region of Saudi Arabia: A Cross-Sectional Study

Background

The core of cardiac rehabilitation (CR) is structured exercise training. CR reduces 28-56% hospital readmission rate, and around 25% increases cardiorespiratory fitness but the number of outpatients CR centers in Saudi Arabia (SA) is very limited and there is a need to establish outpatient CR (Phase III) in SA. Furthermore, the awareness of outpatient CR in SA is unknown.

Aim

To determine the main barriers to establishing an outpatient CR program (Phase III) in the western region of SA, as well as assess the awareness of outpatient CR (Phase III) in the western region of SA.

Methods

A cross-sectional study survey was conducted between March - July 2021 among physiotherapists, cardiologists and the cardiac surgeon using a questionnaire distributed electronically to determine the awareness level of outpatient CR and barriers to establishing outpatient CR (Phase III) in the western region of SA. Frequencies and percentages were used to report the variables.

Results

Of the 141 participants who completed the online survey, our findings showed that 131 (93%) were aware of CR but only 29 (21%) were aware of the four phases of CR. There were three main barriers to establishing CR: lack of appropriate CR 135 (96%); lack of awareness among healthcare professions of CR and its benefits 134 (95%) and the lack of healthcare providers trained in CR 133 (94%). There was a significant relationship between physiotherapists and cardiologists' responses on agreeing to all barriers to establishing CR in SA (r=0.69, P =0.03).

Conclusion

To overcome the barriers to establishing CR outpatient centers in the western region of SA, it is recommended to provide more CR outpatient training programs to healthcare providers and raise the awareness of the CR phases, its benefits, and the risk factors for developing cardiac diseases among healthcare providers.

Patient Preferences for Cardiac Rehabilitation - A Systematic Review

BACKGROUND

Although a large number of studies have demonstrated the effectiveness of cardiac rehabilitation(CR), patient preferences for CR remain unclear. Knowing patient preferences may contribute to increasing patient participation and adherence, thus improving patient prognosis.

METHODS

A systematic search was carried out using electronic databases and manual reference checks from inception until 15th June 2022. Quantitative studies, qualitative studies and mixed methods studies assessing patient preferences for CR were included. Two researchers independently conducted study selectionand data extraction. CR preferences were divided into three categories: CR settings, CR components, and CR contents. A narrative synthesis was applied to integrate the results of the included studies. The Mixed Methods Appraisal Tool (MMAT) was used to assess the quality of included studies.

RESULTS

Ultimately, 17 publications were included in this study. Regarding CR settings, most patients preferred the hospital to home, some considered both, and a few were willing to accept the local CR club as an alternative setting to the hospital. For CR components, regardless of age and gender, patients considered exercise training and nutrition counseling to be the most important and smoking cessation to be the least important. In exercise intervention of CR contents, progress discussion and encouragement were rated as most critical, and non-conflicting with other activities was rated as least critical. In psychological intervention of CR contents, most patients were willing to accept psychological intervention, and a few patients wanted to heal the trauma with the passage of time.

CONCLUSION

This systematic review provides important insights into patient preferences for CR, clarifying patient preferences for CR settings, components, and contents, along with possible influencing factors. Patient preferences may change due to the COVID-19 epidemic, and there is still a need to focus on patient preferences for CR and conduct more relevant primary research to validate the findings of this paper in the future.

Feasibility of the 30 s Sit-to-Stand Test in the Telehealth Setting and Its Relationship to Persistent Symptoms in Non-Hospitalized Patients with Long COVID

Fatigue, dyspnea and pain are the main limitations of patients with long COVID. The aim of this study was to determine the feasibility of the 30 s sit-to-stand (30s-STS) test in the telehealth setting and its relationship to persistent symptoms in a sample of non-hospitalized patients with long COVID. A cross-sectional study was conducted in community patients with long COVID. Data collection and assessments were performed by videoconference and consisted of the fatigue assessment scale (FAS), London activity of daily living scale (LCADL), post-COVID-19 functional status (PCFS) and European quality of life questionnaire (EQ-5D-5L), including the pain/discomfort dimension. The 30s-STS test was performed using a standardized protocol adapted for remote use, and the modified Borg scale (0−10) was used to assess dyspnea and lower limb fatigue immediately after the test. The feasibility of the 30s-STS test was assessed by the proportion of eligible participants who were able to complete the test. Safety was assessed by the number of adverse events that occurred during the test. Seventy-nine participants were included (median age: 44 years, 86.1% women). Performance in the 30s-STS test was 11.5 ± 3.2 repetitions with 60.8% of the sample below reference values. All eligible participants were able to complete the test. No adverse events were reported during the evaluation. Participants with lower 30s-STS performance had more fatigue and dyspnea, worse quality of life, more severe pain/discomfort, and worse functional status (p < 0.05). A significant correlation was obtained between LCADL and dyspnea, reported on the Borg scale (0−10) post 30s-STS (r = 0.71; p < 0.001). In conclusion, the 30s-STS test proved to be a feasible test to implement in the telehealth setting and is related to fatigue, dyspnea, quality of life and pain in non-hospitalized patients with long COVID. Clinicians may use this test when assessment of the physical sequelae of COVID-19 in the face-to-face setting is not possible.

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.

Barriers to hospital-based phase 2 cardiac rehabilitation among patients with coronary heart disease in China: a mixed-methods study

BACKGROUND

Coronary heart disease (CHD) has become a leading cause of morbidity and premature death worldwide. Cardiac rehabilitation (CR) was proved to have substantial benefits for patients with CHD. The CR was divided into three phases. Phase 2 is the important part of CR which involves hospital-based structured and closely monitored exercises and activities. However, CR utilization is low worldwide. The barriers to hospital-based phase 2 CR in China have not been well identified.

AIMS

To investigate barriers to hospital-based phase 2 cardiac rehabilitation among coronary heart disease patients in China and to explore the reasons.

METHODS

This study employed an explanatory sequential mixed-methods design. The study was conducted in a university hospital in China from July 2021 to December 2021. Quantitative data was collected through the Cardiac Rehabilitation Barrier Scale. Qualitative data was collected through unstructured face-to-face interviews. Data analysis included descriptive statistics and inductive qualitative content analysis.

RESULTS

One hundred and sixty patients completed the Cardiac Rehabilitation Barrier Scale and 17 patients participated in unstructured face-to-face interviews. The main barriers identified were distance (3.29 ± 1.565), transportation (2.99 ± 1.503), cost (2.76 ± 1.425), doing exercise at home (2.69 ± 1.509) and time constraints (2.48 ± 1.496). Six themes were identified; logistical factors, social support, misunderstanding of cardiac rehabilitation, program and health system-level factors, impression of CR team and psychological distress. The first four themes confirmed the quantitative results and provide a deeper explanation for the quantitative results. The last two themes were new information that emerged in the qualitative phase.

CONCLUSION

This study provides a better understanding of the barriers to hospital-based phase 2 cardiac rehabilitation among coronary heart disease patients in the Chinese context during the Covid-19 pandemic. Innovative programs such as home-based CR, mobile health, and hybrid programs might be considered to overcome some of these barriers. In addition, psychosocial intervention should be included in these programs to mitigate some of the barriers associated with the impression of CR team and psychological distress.

Safety of home-based cardiac rehabilitation: A systematic review

BACKGROUND

Cardiac rehabilitation is an evidence-based intervention that aims to improve health outcomes in cardiovascular disease patients, but it is largely underutilized. One strategy for improving utilization is home-based cardiac rehabilitation (HBCR). Previous research has shown that HBCR programs are feasible and effective. However, there is a lack of evidence on safety issues in different cardiac populations. This systematic review aimed to provide an evidence-based overview of the safety of HBCR.

OBJECTIVES

To examine the incidence and severity of adverse events of HBCR.

METHODS

The following databases were searched: CINAHL, The Cochrane Library, Embase, MEDLINE, PubMed, Web of Science, Global Health, and Chinese BioMedical Literature Database for randomized controlled trials. The included trials were written in English and analyzed the incidence of adverse events (AEs) as a primary or secondary intervention outcome.

RESULTS

Five studies showed AEs incidence, of which only one study reported severe AE associated with HBCR exercise. The incidence rate of severe AEs from the sample (n = 808) was estimated as 1 per 23,823 patient-hour of HBCR exercise. More than half patients included were stratified into a high-risk group. In the studies were found no deaths or hospitalizations related to HBCR exercise.

CONCLUSION

The risk of AEs during HBCR seems very low. Our results concerning the safety of HBCR should induce cardiac patients to be more active in their environment and practice physical exercise regularly.

A survey of the perceptions of barriers to and facilitators of cardiac rehabilitation in healthcare providers and policy stakeholders

Background

Cardiac rehabilitation (CR) is a prognostic management strategy to help patients with CVD achieve a good quality of life and lower the rates of recurrence, readmission, and premature death from disease. Globally, cardiac rehabilitation is poorly established in hospitals and communities. Hence, this study aimed to investigate the discrepancies in the perceptions of the need for CR programs and relevant health policies between directors of hospitals and health policy personnel in South Korea to shed light on the status and to establish practically superior and effective strategies to promote CR in South Korea.

Methods

We sent a questionnaire to 592 public health policy managers and directors of selected hospitals, 132 of whom returned a completed questionnaire (response rate: 22.3%). The participants were categorized into five types of organizations depending on their practice of PCI (Percutaneous Coronary Intervention), establishment of cardiac rehabilitation, director of hospital, and government's policy makers. Differences in the opinions between directors of hospitals that perform/do not perform PCI, directors of hospitals with/without cardiac rehabilitation, and between hospital directors and health policy makers were analyzed.

Results

Responses about targeting diseases for cardiac rehabilitation, patients’ roles in cardiac rehabilitation, hospitals’ roles in cardiac rehabilitation, and governmental health policies’ roles in cardiac rehabilitation were more positive among hospitals that perform PCI than those that do not. Responses to questions about the effectiveness of cardiac rehabilitation and hospitals’ roles in cardiac rehabilitation tended to be more positive in hospitals with cardiac rehabilitation than in those without. Hospital directors responded more positively to questions about targeting diseases for cardiac rehabilitation and governmental health policies’ roles in cardiac rehabilitation than policy makers, and both hospitals and public organizations provided negative responses to the question about patients’ roles in cardiac rehabilitation. Responses to questions about targeting diseases for cardiac rehabilitation, patients’ roles in cardiac rehabilitation, and governmental health policies’ roles in cardiac rehabilitation were more positive in hospitals that perform PCI than those that do not and public organizations.

Conclusions

Hospitals must ensure timely referral, provide education, and promote the need for cardiac rehabilitation. In addition, governmental socioeconomic support is needed in a varity of aspects.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12913-022-08298-3.

Effectiveness of Home-Based Cardiac Rehabilitation, Using Wearable Sensors, as a Multicomponent, Cutting-Edge Intervention: A Systematic Review and Meta-Analysis

Exercise-based cardiac rehabilitation is a highly recommended intervention towards the advancement of the cardiovascular disease (CVD) patients’ health profile; though with low participation rates. Although home-based cardiac rehabilitation (HBCR) with the use of wearable sensors is proposed as a feasible alternative rehabilitation model, further investigation is needed. This systematic review and meta-analysis aimed to evaluate the effectiveness of wearable sensors-assisted HBCR in improving the CVD patients’ cardiorespiratory fitness (CRF) and health profile. PubMed, Scopus, Cinahl, Cochrane Library, and PsycINFO were searched from 2010 to January 2022, using relevant keywords. A total of 14 randomized controlled trials, written in English, comparing wearable sensors-assisted HBCR to center-based cardiac rehabilitation (CBCR) or usual care (UC), were included. Wearable sensors-assisted HBCR significantly improved CRF when compared to CBCR (Hedges’ g = 0.22, 95% CI 0.06, 0.39; I2 = 0%; p = 0.01), whilst comparison of HBCR to UC revealed a nonsignificant effect (Hedges’ g = 0.87, 95% CI −0.87, 1.85; I2 = 96.41%; p = 0.08). Effects on physical activity, quality of life, depression levels, modification of cardiovascular risk factors/laboratory parameters, and adherence were synthesized narratively. No significant differences were noted. Technology tools are growing fast in the cardiac rehabilitation era and promote exercise-based interventions into a more home-based setting. Wearable-assisted HBCR presents the potential to act as an adjunct or an alternative to CBCR.

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.

Prognostic Utility of a New Risk Stratification Protocol for Secondary Prevention in Patients Attending Cardiac Rehabilitation

Several risk scores have been used to predict risk after an acute coronary syndrome (ACS), but none of these risk scores include functional class. The aim was to assess the predictive value of risk stratification (RS), including functional class, and how cardiac rehabilitation (CR) changed RS. Two hundred and thirty-eight patients with ACS from an ambispective observational registry were stratified as low (L) and no-low (NL) risk and classified according to exercise compliance; low risk and exercise (L-E), low risk and control (no exercise) (L-C), no-low risk and exercise (NL-E), and no-low risk and control (NL-C). The primary endpoint was cardiac rehospitalization. Multivariable analysis was performed to identify variables independently associated with the primary endpoint. The L group included 56.7% of patients. The primary endpoint was higher in the NL group (18.4% vs. 4.4%, p < 0.001). After adjustment for age, sex, diabetes, and exercise in multivariable analysis, HR (95% CI) was 3.83 (1.51−9.68) for cardiac rehospitalization. For RS and exercise, the prognosis varied: the L-E group had a cardiac rehospitalization rate of 2.5% compared to 26.1% in the NL-C group (p < 0.001). Completing exercise training was associated with reclassification to low-risk, associated with a better outcome. This easy-to-calculate risk score offers robust prognostic information. No-exercise groups were independently associated with the worst outcomes. Exercise-based CR program changed RS, improving classification and prognosis.

Heart Failure Patients’ Adherence to Hybrid Comprehensive Telerehabilitation and Its Impact on Prognosis Based on Data from TELEREH-HF Randomized Clinical Trial

(1) Background Adherence to treatment guidelines in heart failure (HF) patients is of major prognostic importance, but thorough implementation of guidelines in routine care remains insufficient. Introducing hybrid comprehensive telerehabilitation (HCTR) consisting of telecare, telerehabilitation, and remote monitoring of implantable devices might be an option to improve adherence to recommendation and can affect the prognosis. The purpose is to investigate the association of adherence to HCTR with mortality and hospitalization. (2) Methods This analysis formed part of TELEREH-HF multi-center, randomized trial that enrolled 850HF patients (NYHA I-III;LVEF ≤ 40%). Patients were randomized 1:1 to 9-week HCTR (1 week in hospital and 8 weeks at home) plus usual care or usual care only and followed-up for 14 to 26 months. This analysis focuses on the HCTR group. Adherent patients were those who adhered both to the number of training sessions prescribed and to the duration of the prescribed cycle by at least 80%; non-adherent patients were those who adhered<20% to the prescribed number of training sessions and their duration. The remaining patients were classified as partially adherent. (3) Results There were 350 (88.4%) adherent patients, 39 (9.8%) partially adherent patients, and 7 (1.8%) non-adherent patients. There were 46 deaths during follow-up. Non-adherence or partial adherence was associated with higher risk of cardiovascular (CV) mortality (hazard ratio (HR) = 2.62, p = 0.021); all-cause mortality or HF hospitalization (HR = 1.71, p = 0.038); CV mortality or HF hospitalization (HR = 1.89, p = 0.014). (4) Conclusions The adherence to HCTR was high. Adherence to HCTR was associated with improved prognosis for CV mortality and the reduction in the combined outcome of CV mortality or HF hospitalization.

Cardio-Oncology Rehabilitation and Telehealth: Rationale for Future Integration in Supportive Care of Cancer Survivors

The direct toxicity of cancer treatment threatens patients and survivors with an increased risk of cardiovascular disease or adverse functional changes with subsequent progression of cardiovascular complications. An accumulation of cardiovascular risk factors combined with an unhealthy lifestyle has recently become more common in cancer patients and survivors. It has been recommended to integrate a comprehensive cardiac rehabilitation model called cardio-oncology rehabilitation to mitigate cardiovascular risk. Nevertheless, cardiac rehabilitation interventions limit barriers in low utilization, further exacerbated by the restrictions associated with the COVID-19 pandemic. Therefore, it is essential to integrate alternative interventions such as telehealth, which can overcome several barriers. This literature review was designed as a framework for developing and evaluating telehealth interventions and mobile applications for comprehensive cardio-oncology rehabilitation. We identify knowledge gaps and propose strategies to facilitate the development and integration of cardio-oncology rehabilitation telehealth as an alternative approach to the standard of care for cancer patients and survivors. Despite the limited evidence, the pilot results from included studies support the feasibility and acceptability of telehealth and mobile technologies in cardio-oncology rehabilitation. This new area suggests that telehealth interventions are feasible and induce physiological and psychological benefits for cancer patients and survivors. There is an assumption that telehealth interventions and exercise may be an effective future alternative approach in supportive cancer care.