scholarly journals Exercise-based cardiac rehabilitation adaptation protocol during COVID-19 pandemic achieved similar results as compared to non-pandemic usual practice: a single-center retrospective study

2021 ◽  
Vol 28 (Supplement_1) ◽  
Author(s):  
AB Hartopo ◽  
ZH Islami ◽  
IA Arso ◽  
AM Ambari ◽  
B Dwiputra ◽  
...  

Abstract Funding Acknowledgements Type of funding sources: Public hospital(s). Main funding source(s): Dr. Sardjito Hospital Funding Background During the COVID-19 pandemic, exercise-based cardiac rehabilitation (EBCR) faced challenges. Patients could not freely attend EBCR in hospital. In our hospital, cardiac rehabilitation (CR) service adapted to the pandemic condition by reducing to sessions per week.  Purpose This study aimed to investigate whether the adaptation protocol of EBCR during COVID-19 period influenced the CR result. Methods This was a retrospective cohort study. The subjects were patients underwent EBCR program in CR Service of our hospital. We retrieved the CR program registry and divided it into two periods, namely the non-pandemic period (January 2019 – February 2020) and the COVID-19 period (March 2020 – December 2020). During the non-pandemic period, subjects performed EBCR 3 times (@45 min) per week for 10-12 total sessions. During the COVID-19 period, the EBCR session was reduced 2 times (@45 min) per week for 10-12 total sessions. However, patients might modify the sessions provided space availability and acceptable reason. After total sessions were completed, the treadmill test evaluation was performed. We compared the duration and metabolic equivalent (METs) achieved in the treadmill test evaluation. Results There was nearly 50% reduction in patients who underwent EBCR during the COVID-19 pandemic (n = 48), compared to during the non-pandemic period (n = 96). Post septal defect closure (42.7% vs. 60.4%) and mitral valve surgery (35.4% vs. 29.2%) predominated subjects registered for EBCR during the non-pandemic and the COVID-19 period, whereas post CABG was the minority (4.2% vs. 4.2%). Among 144 registered subjects, majority completed EBCR sessions and underwent treadmill test evaluation (79 (82.3%) vs. 37 (77.1%) during the non-pandemic and the COVID-19 period). During the COVID-19 period, the most common sessions were 2 times per week (48.6%), followed by 5 times per week (32.4%), whereas during the non-pandemic period, 3 times per week was the most common (77.2%), followed by 5 times per week (19.0%) (p < 0.001). Total sessions did not significantly differ between the non pandemic and the COVID-19 period. Total sessions also did not significantly differ among subjects undergoing 2 times per week, 3 times per week, and 5 times per week sessions. There was no difference in duration (7.1 ± 1.9 min vs. 6.6 ± 1.9 min, p = 0,136) and METs (7.5 ± 1.8 vs. 6.9 ± 1.9, p = 0.192) achieved on treadmill evaluation between subjects on two time periods. There was no significant difference in duration (6.9 ± 1.9 min, 7.0 ± 1.9 min and 6.8 ± 1.8 min)and METs (7.1 ± 1.9, 7.3 ± 1.7 and 7.4 ± 2.1) achieved on treadmill evaluation among subjects who underwent EBCR 2 times per week, 3 times per week and 5 times per week respectively. Conclusion The adaptation protocol of EBCR during the COVID-19 period by reducing sessions per week did not influence the duration and METs achieved on treadmill evaluation at the end of CR as compared to usual EBCR practice.

2021 ◽  
Vol 20 (Supplement_1) ◽  
Author(s):  
G Caughers ◽  
J Bradley ◽  
P Donnelly ◽  
D Fitzsimons

Abstract Funding Acknowledgements Type of funding sources: Other. Main funding source(s): Research and Development PhD Fellowship Background Poor uptake and adherence to Cardiac Rehabilitation (CR) is a longstanding problem exacerbated by the Covid-19 pandemic. Since lockdown, several alternative formats have been utilised to adapt to social distancing requirements, but evaluation of these is needed1. Purpose This study uses Experience Based Co-Design to identify novel approaches to delivering CR in a post COVID-19 era. Methods Using a co-design approach 58 participants were recruited, these included staff, patients who attended, dropped out or did not attend CR. Interviews and focus groups were recorded, transcribed, and analysed using template analysis. The results will be depicted through video at a co-design workshop where innovative approaches will be discussed and prioritised by the study participants. Results The main themes developed from interview and focus group include 1. Staff & hospital treatment, 2. Patient characteristics, 3. Emotional state, 4. What Cardiac Rehabilitation is, 5. Time, location and delivery, 6. Self-Care and finally, 7. Technology. These themes are conveyed through a 15-minute trigger video along with quotations to stimulate discussion. Anticipated outcome will be 4-5 approaches which can be adapted for implementation. Conclusion The forthcoming co-design workshop will present findings to patients and staff in a virtual setting allowing valuable co-ownership of the outcomes. This presentation will describe an innovative process that has redesigned CR using the perspective of all stakeholders and sought to maximise choice and flexibility for a post-COVID climate.


Author(s):  
Giulia Foccardi ◽  
Marco Vecchiato ◽  
Daniel Neunhaeuserer ◽  
Michele Mezzaro ◽  
Giulia Quinto ◽  
...  

Although the efficacy of cardiac rehabilitation (CR) is proven, the need to improve patients’ adherence has emerged. There are only a few studies that have investigated the effect of sending text messages after a CR period to stimulate subjects’ ongoing engagement in regular physical activity (PA). A randomized controlled pilot trial was conducted after CR, sending a daily PA text message reminder to an intervention group (IG), which was compared with a usual care control group (CG) during three months of follow-up. Thirty-two subjects were assessed pre- and post-study intervention with GPAQ, submaximal iso-watt exercise testing, a 30 s sit-to-stand test, a bilateral arm curl test, and a final survey on a seven-point Likert scale. A statistically significant difference in the increase of moderate PA time (Δ 244.7 (95% CI 189.1, 300.4) minutes, p < 0.001) and in the reduction of sedentary behavior time (Δ −77.5 (95% CI 104.9, −50.1) minutes, p = 0.004) was shown when the IG was compared with the CG. This was associated with an improvement in heart rate, blood pressure, and patients’ Borg rating on the category ratio scale 10 (CR10) in iso-watt exercise testing (all p < 0.05). Furthermore, only the IG did not show a worsening of the strength parameters in the follow-up leading to a change of the 30 s sit-to-stand test with a difference of +2.2 (95% CI 1.23, 3.17) repetitions compared to CG (p = 0.03). The telemedical intervention has been appreciated by the IG, whose willingness to continue with regular PA emerged to be superior compared to the CG. Text messages are an effective and inexpensive adjuvant after phase 2 CR that improves adherence to regular PA. Further studies are needed to confirm these results in a larger patient population and in the long term.


2021 ◽  
Vol 28 (Supplement_1) ◽  
Author(s):  
M Cabral ◽  
R Santos ◽  
F Januario ◽  
A Antunes ◽  
R Fonseca-Pinto

Abstract Funding Acknowledgements Type of funding sources: None. Cardiac rehabilitation (CR) has well known beneficial effects on physical capacity, health-related quality of life, morbidity and mortality following an acute cardiac event. It is also known that smoking status is a powerful predictor of recurrent cardiovascular disease events. However, it has been noted that smoker patients may be less likely to access or complete CR. The aim of this study was to determine the levels of anxiety and depression and its improvement, depending on the smoking status of patients with coronary artery disease (CAD) on phase 2 of the Cardiac Rehabilitation Program (CRP). Additionally, we intend to investigate the mental health impact on smoker patients" group in conventional CR versus telemonitored CR. A retrospective study was conducted and patients in CRP between 2017 and 2020 were included. Patient selection and information collection were obtained through medical records. The outcomes of anxiety and depression were evaluated through the Hospital Anxiety and Depression Scale (HADS). Patients were divided into two groups: group 1 for non-smokers or ex-smokers and group 2 for smokers. For group 2 patients, a sub-analysis was performed for patients following the conventional CR versus the telemonitored CR, with the use of MOVIDA mobile application. Variables were analysed in the beginning (T0) and in the end (T1) of phase 2, around 3 months after. Group comparisons tests and statistical analysis were performed using SPSS software v25.0. A p-value less than 0.05 is statistically significant.  We analysed 107 patients, which 93 of these were assiduous and 69 concluded the phase 2 of CRP: 39 patients in group 1 and 30 patients in group 2. Two groups have similar baseline characteristics, except for the higher presence of diabetes (p = 0.02) in group 1. It was noted an improvement in both anxiety and depression items for group 1 (p &lt; 0.01 for both), but only for anxiety item for group 2 (p = 0.03). In subgroup analysis, we observed no improvement for smoking patients following the conventional CR for both anxiety and depression items (p = 0.60 and p = 0.71, respectably) versus a significant difference in telemonitored CR patients (p = 0.02 and p = 0.04). We hypothesise that, when compared to conventional CR, cardiac telemonitored exercise using modern communication methods may result in an improved mental health state among smoking patients, which can lead to a better adherence for CRP. Further studies including more patients and phase 3 of CRP are needed to confirm these results.


2021 ◽  
Vol 13 (2) ◽  
pp. 446
Author(s):  
Anna Rutkowska ◽  
Katarzyna Kacperak ◽  
Sebastian Rutkowski ◽  
Luisa Cacciante ◽  
Pawel Kiper ◽  
...  

The lockdown with a prohibition of free mobility introduced in many countries has affected restrictions in physical activity (PA). The purpose of the study was to compare PA during restrictions and the “unfreezing” stage. The study group consisted of 89 healthy adult students. To assess the level of PA, a long version of the International Physical Activity Questionnaire (IPAQ) was used. The first evaluation was carried out in the period from 16 to 20 April 2020 at the time of the lockdown and the second in the period from 11 to 14 May 2020 during the so-called “unfreezing”. The average total PA rate during the first measurement was 8640 metabolic equivalent (MET)-min/week and in the second, 10,560 MET-min/week. The analysis of total energy expenditure showed a statistically significant difference (p < 0.029). The establishment of “unfreezing” laws for sport and recreation and the reduction of restrictions have significantly contributed to an increase in the overall level of PA. Based on our outcomes, we recommend students follow the scientific guidelines for undertaking PA (i.e., WHO) during the pandemic in order to maintain an appropriate pro-healthy dose of exercise.


2021 ◽  
Vol 28 (Supplement_1) ◽  
Author(s):  
OV Kopylova ◽  
NA Sirota ◽  
VM Yaltonsky

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Low adherence to healthy lifestyle and CVD preventive medical treatment is a seriouse problem in lowering of CVD morbidity and mortality. Using modern medical, psychological and remote technologies may help to increase patients" adherence. Purpose To study the efficacy of medical and psychological counselling using remote technologies in rising patients" adherence to CVD preventive treatment. Methods The study included 140 patients with risk factors for cardiovascular disease (RF CVD), who were divided into two comparable groups: group of medical and psychological counselling with the use of remote technologies (n = 70) and group of control (n = 70).  The study lastet 12 months. Level of adherence was measured via standard Morisky-Green"s 4-item questionnaire as well as via additional questionnaire developed by authors for this study. Results Comparative analysis of the level of adherence in the two groups did not reveal statistically significant differences at baseline. After 12 months, the experimental group showed a statistically significant increase in adherence to preventive treatment compared with the control group (р=0,001) Conclusion(s) Medical and psychological counselling using remote technologies is an effective method for rising patients" adherence to CVD preventive medical treatment


2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
V Houben ◽  
J.A Snoek ◽  
E Prescott ◽  
N Mikkelsen ◽  
A.E Van Der Velde ◽  
...  

Abstract Background and purpose Although participation in cardiac rehabilitation (CR) improves quality of life (QoL), participation in CR, especially among elderly, is limited. We conducted this study to assess whether mobile home-based CR (mCR) increases QoL in elderly (≥65 years old) patients with coronary artery disease (CAD) or a valvular intervention who decline participation in conventional CR. Methods It is designed as a randomised multi-centre study with two parallel arms. Randomisation assigned patients either to mCR or a control group. mCR Consisted of six months of home-based CR with telemonitoring and coaching. Control-group patients did not receive any form of CR throughout the study period. Quality of life was measured with the SF-36v2 questionnaire at 0, 6 and 12 months. Results A total of 179 patients were included in this study (90 control, 89 mCR). A flowchart of the trial is presented in Figure 1. Patients were predominantly male (81.1%). Baseline characteristics can be found in Table 1. Patients using mCR improved on physical QoL after 6 (p=0.026) and 12 (p=0.008) months. There was no difference on mental QoL for both groups (mCR 6 months p=0.563, 12 months p=0.945; control 6 months p=0.589, 12 months p=0.542). No difference existed in QoL between the mCR and control group (physical: 6 months p=0.070, 12 months p=0.150; mental: 6 months p=0.355, 12 months p=0.625). Conclusion Although there is no significant difference in QoL between the control and mCR group, mCR increases physical QoL after 6 and 12 months in elderly patients who decline participation in conventional CR. Therefore E-Health tools should be considered as an alternative for conventional CR when (elderly) patients decline to participate in conventional CR. Figure 1. Flow chart of all eligible patients Funding Acknowledgement Type of funding source: Public grant(s) – EU funding. Main funding source(s): European Union's Horizon 2020 research and innovation programme


2021 ◽  
Vol 28 (Supplement_1) ◽  
Author(s):  
A Abdul Razzack ◽  
D Rocha Castellanos ◽  
A Lopez Mendez ◽  
M Fernando Perez Paz ◽  
S Pothuru ◽  
...  

Abstract Funding Acknowledgements Type of funding sources: None. Background- Patients with small Abdominal Aortic Aneurysms are managed with surveillance as there is currently insufficient evidence to recommend surgical aneurysm repair. Hence, there is a dire need and interest in pharmacotherapy like tetracycline antibiotics to reduce the need for aneurysm repair. Purpose- To determine the efficacy and safety of doxycycline in the management of small abdominal aortic aneurysms. Methods- Electronic databases (PubMed, Scopus, Embase, Cochrane) were searched until 25th November 2020.The primary outcomes were the mean difference (MD) in aneurysm diameter and the odds ratio (OR) calculated to compare the number of individuals referred to Abdominal aortic aneurysm repair in each group. Results- A total of three studies with 572 participants (Doxycycline = 290; Placebo = 282 ) were included in our analysis. Average follow up was a period of 18 months. For AAA expansion, the combined results demonstrated a statistically significant mean difference in expansion rates favoring the placebo groups over the intervention (WMD-0.75, 95%CI 0.12-1.38; p = 0.02;I2 = 0%) There was no statistically significant difference in the efficacy and safety of doxycycline as opposed to placebo groups for referral to AAA surgery (OR 1.01, 95%CI 0.61-1.69; p = 0.96, I2 = 0%) and all-cause mortality(OR 0.51; 95%CI 0.18-1.43; p = 0.20, I2 =0%) Conclusion- Amongst patients with small abdominal aortic aneurysms, doxycycline did not significantly reduce aneurysm growth. Abstract Figure. A) AAA expansion B)Surgery C)Mortality


2021 ◽  
Vol 28 (Supplement_1) ◽  
Author(s):  
S Pallikadavath ◽  
R Patel ◽  
CL Kemp ◽  
M Hafejee ◽  
N Peckham ◽  
...  

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Cardiovascular adaptations as a result of exercise conducted at high-intensity and high-volume are often termed the ‘Athlete’s heart’. Studies have shown that these cardiovascular adaptations vary between sexes. It is important that both sexes are well represented in this literature. However, many studies assessing the impact of high-dose exercise on cardiovascular outcomes under-recruit female participants. Purpose This scoping review aimed to evaluate the representation of females in studies assessing the impact of high-dose exercise on cardiovascular outcomes and demonstrate how this has changed over time. Methods The scoping review protocol as outlined by Arksey and O’Malley was used. OVID and EMBASE databases were searched and studies independently reviewed by two reviewers. Studies must have investigated the effects of high-dose exercise on cardiovascular outcomes. To assess how the recruitment of females has changed over time, two methods were used. One, the median study date was used to categorise studies into two groups. Two, studies were divided into deciles to form ten equal groups over the study period. Mean percentage of female recruitment and percentage of studies that failed to include females were calculated. Results Overall, 250 studies were included. Over half the studies (50.8%, n = 127) did not include female participants. Only 3.2% (n = 8) did not include male participants. Overall, mean percentage recruitment was 18.2%. The mean percentage of recruitment was 14.5% before 2011 and 21.8% after 2011. The most recent decile of studies demonstrated the highest mean percentage of female recruitment (29.3%) and lowest number of studies that did not include female participants (26.9%). Conclusion Female participants are significantly underrepresented in studies assessing cardiovascular outcomes caused by high-dose exercise. The most recent studies show that female recruitment may be improving, however, this still falls significantly short for equal representation. Risk factors, progression and management of cardiovascular diseases vary between sexes, hence, translating findings from male dominated data is not appropriate. Future investigators should aim to establish barriers and strategies to optimise fair recruitment. Mean percentage females recruited per study (%) Percentage studies that do not include women (%) Overall (n = 250) 18.2 50.8 (n = 127) Studies before 2011 (n = 121) 14.5 59.5 (n = 72) Studies after 2011 (n = 129) 21.8 42.6 (n = 55) Table 1: Female recruitment characteristics. The year 2011 (median study year) was chosen as this divides all included studies into two equal groups.


2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
J Redfern ◽  
K Hyun ◽  
D Brieger ◽  
D Chew ◽  
J French ◽  
...  

Abstract Background Cardiovascular disease is the leading cause of disease burden globally. With advancements in medical and surgical care more people are surviving initial acute coronary syndrome (ACS) and are in need of secondary prevention and cardiac rehabilitation (CR). Increasing availability of high quality individual-level data linkage provides robust estimates of outcomes long-term. Purpose To compare 3 year outcomes amongst ACS survivors who did and did not participate in Australian CR programs. Methods SNAPSHOT ACS follow-up study included 1806 patients admitted to 232 hospitals who were followed-up by data linkage (cross-jurisdictional morbidity, national death index, Pharmaceutical Benefit Schedule) at 6 and 36 months to compare those who did/not attend CR. Results In total, the cohort had a mean age of 65.8 (13.4) years, 60% were male, only 25% (461/1806) attended CR. During index admission, attendees were more likely to have had PCI (39% v 14%, p&lt;0.001), CABG (11% v 2%, p&lt;0.001) and a diagnosis of STEMI (21% v 5%, p&lt;0.001) than those who did not attend. However, there was no significant difference between CR attendees/non-attendees for risk factors (LDL-cholesterol, smoking, obesity). Only 19% of eligible women attended CR compared to 30% of men (p&lt;0.001). At 36 months, there were fewer deaths amongst CR attendees (19/461, 4.1%) than non-attendees (116/1345, 8.6%) (p=0.001). CR attendees were more likely to have repeat ACS, PCI, CABG at both 6 and 36 months (Table). At 36 months, CR attendees were more likely to have been prescribed antiplatelets (78% v 53%, p&lt;0.001), statins (91% 73%, p&lt;0.001), beta-blockers (11% v 13%, p=0.002) and ACEI/ARBs (72% v 61%, p&lt;0.001) than non-attendees. Conclusions Amongst Australian ACS survivors, participation in CR was associated with less likelihood of death and increased prescription of pharmacotherapy. However, attendance at CR was associated with higher rates of repeat ACS and revascularisation. Funding Acknowledgement Type of funding source: Foundation. Main funding source(s): New South Wales Cardiovascular Research Network, National Heart Foundation


2021 ◽  
Vol 28 (Supplement_1) ◽  
Author(s):  
Z Bargaoui ◽  
K Mzoughi ◽  
I Zairi ◽  
O Aouina

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Smoking is a public health problem. Doctors have an important role in the fight against smoking, in particular through the minimum advice they can give. Purpose The aim of this work was to study the prevalence of the application of minimal advice by medical residents and to identify factors that may influence its practice. Methods We conducted a descriptive and analytical study with a prospective data collection that included 302 residents practicing in Tunisia and who agreed to respond to an online questionnaire submitted between February and March 2020. Results Residents mean age was of 28 ± 2 years and the gender ratio was 0.65. Sixty-four percent of residents were non-smokers. During their practice, 94% of residents systematically identified the patient"s smoking status and 61.9% were unfamiliar with the concept of minimal advice. The rate of application of the minimum advice by residents was 57.6%. In multivariate analysis, the factors influencing the application of minimum counseling were: gender (OR =0.321, p = 0.0001), knowledge of minimum counseling (OR = 2.808, p = 0.002) and having attended the minimum advice given by a senior (OR = 2.328, p = 0.0001). Conclusion The rate of application of the minimum advice remains low. Improving one"s theoretical and practical teaching during medical studies is essential.


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