Abstract 134: Implementation of Home-Based Cardiac Rehabilitation in the VA

2017 ◽  
Vol 10 (suppl_3) ◽  
Author(s):  
David W Schopfer ◽  
Nirupama Krishnamurthi ◽  
Hui Shen ◽  
Mary A Whooley
Keyword(s):  
Cardiac Rehabilitation ◽  
Artery Bypass ◽  
Coronary Intervention ◽  
The United States ◽  
Medical Centers ◽  
The United Kingdom ◽  
Home Based ◽  
Percutaneous Coronary ◽  
The Us ◽  
Va Hospitals

Objective: Referral to cardiac rehabilitation (CR) is one of nine performance measures for patients with ischemic heart disease (IHD), but fewer than 20% of eligible patients participate in the United States. Home-based CR programs (available in the United Kingdom, Australia, and Canada) have similar effects on morbidity and mortality as traditional (facility-based) CR, but they are not currently available or reimbursed in the US. We sought to determine whether implementing home-based programs could increase CR participation among patients with IHD. Methods: Using electronic health records from 134 VA medical centers, we identified 106,277 veterans hospitalized for acute myocardial infarction, percutaneous coronary intervention or coronary artery bypass grafting between 2010 and 2015. We compared the proportion of eligible patients who participated in CR at 13 VA hospitals that offered referral to either home-based CR or facility-based CR vs. 121 VA hospitals that offered referral to only facility-based CR (usual care). Results: The number of VA medical centers offering home-based CR increased from 2 in 2010 to 13 in 2015. Among the 20,949 eligible patients hospitalized at VA medical centers that implemented home-based CR between 2010 and 2015, CR participation increased from 11% to 26% (Figure). Among the 85,328 eligible patients hospitalized at VA medical centers that did not offer home-based CR, CR participation increased from only 8% to 11%. Conclusion: Among eligible patients with IHD, participation in CR more than doubled at VA medical centers that implemented home-based CR programs between 2010 and 2015, whereas participation increased by only 3% at VA medical centers that did not implement home-based CR programs. Home-based CR is an effective way of engaging patients who may otherwise decline to participate in CR.

Abstract 310: Neighborhood Socioeconomic Context Predicts Cardiac Rehabilitation Participation Above and Beyond Individual Socioeconomic Status

2015 ◽  
Vol 8 (suppl_2) ◽  
Author(s):  
Justin M Bachmann ◽  
Loren Lipworth ◽  
Thomas J Wang ◽  
Michael T Mumma ◽  
Mary A Whooley ◽  
...  
Keyword(s):  
United States ◽  
Socioeconomic Status ◽  
Cohort Study ◽  
Cardiac Rehabilitation ◽  
Cox Regression ◽  
Artery Bypass ◽  
Coronary Intervention ◽  
The United States ◽  
Socioeconomic Context ◽  
Percutaneous Coronary

Background: Cardiac rehabilitation (CR) is underutilized in the United States, with less than 20% of eligible patients participating in CR programs. Individual socioeconomic status is associated with CR utilization, but the effect of neighborhood socioeconomic context on CR use has not been described. We investigated the association of CR participation with neighborhood socioeconomic context in the Southern Community Cohort Study (SCCS). Methods: The SCCS is a prospective cohort study of 84,569 largely poor adults in the southeastern United States, of which 52,117 participants have Medicare or Medicaid claims. Using these claims data, we identified SCCS participants with hospitalizations for myocardial infarction, percutaneous coronary intervention, coronary artery bypass surgery or cardiac valve surgery and ascertained their CR utilization. Neighborhood socioeconomic context was assessed using a previously validated neighborhood deprivation index. This index was derived using 11 census-tract level variables including median household value and percentage of households with public assistance income. We used multivariable-adjusted logistic and Cox regression to evaluate the association of CR participation with neighborhood socioeconomic context and mortality. Results: A total of 4456 SCCS participants (56% female, 59% Black) were eligible for CR at a mean age of 60.5 + 9.1 years and an average of 4.0 + 2.5 years after study enrollment. CR utilization was low as expected, with 308 subjects (6.9%) participating in CR programs. CR participation is inversely associated with all-cause mortality (hazard ratio [HR] 0.52, 95% confidence interval [CI] 0.39-0.70, p=<0.0001) and cardiovascular disease (CVD) mortality (HR 0.38, 95% CI 0.22-0.65, p=<0.001) after multivariable adjustment. Neighborhood socioeconomic context is strongly associated with CR participation after adjustment for individual socioeconomic status (educational level and household income) as well as rural status (Table). Conclusions: Neighborhood socioeconomic context predicts CR participation in addition to individual socioeconomic status. These data invite research on interventions to increase CR access in deprived communities.

Abstract 17159: Comparing Functional Status in Home-Based to Facility-Based Cardiac Rehabilitation Participants

Circulation ◽  
2018 ◽  
Vol 138 (Suppl_1) ◽  
Author(s):  
David W Schopfer ◽  
Mary A Whooley ◽  
Kelly Allsup ◽  
Claire S Duvernoy ◽  
Daniel E Forman
Keyword(s):  
Cardiac Rehabilitation ◽  
Functional Status ◽  
San Francisco ◽  
Artery Bypass ◽  
Coronary Intervention ◽  
Clinical Indication ◽  
Home Based ◽  
Percutaneous Coronary ◽  
Ann Arbor ◽  
The Difference

Introduction: Cardiac rehabilitation (CR) remains underutilized in patients with ischemic heart disease (IHD). Home-based CR (CR) has been promulgated as a model of delivery that may improve participation, but its impact on functional status is unclear. Hypothesis: We sought to compare change in 6-minute-walk-distance (6MWD) among patients enrolled in home-based vs. facility-based CR after myocardial infarction, percutaneous coronary intervention, or coronary artery bypass surgery. Methods: We evaluated change in 6MWD among 231 Veterans with IHD via home-based vs. facility-based CR after an IHD event. Between 9/2015 and 9/2017, all eligible patients enrolling in home-based (San Francisco VA) or facility-based CR (VA Ann Arbor and VA Pittsburgh) were invited to participate. 6MWD was assessed at baseline, 3-, and 6-months. Results: Median baseline 6MWD were similar in 116 patients who completed home-based vs. facility-based CR (1155 vs. 1160 ft, p=0.52). Median time from referral to enrollment was shorter for home-based vs. facility-based CR (14 vs. 42 days, p<0.001). At 3 months, patients participating in home-based CR demonstrated greater increase in 6MWD (324 vs. 128 feet; p<0.001). After adjusting for demographics, comorbidities, and clinical indication, the mean 3-month change in 6MWD remained significantly greater (330 feet vs. 127 feet; p<0.001). However, the difference was no longer statistically significant at 6 months of follow-up (295 vs. 191 feet; p=0.10). Conclusions: Participants in home-based CR experienced faster time to enrollment and greater 3-month increases in 6MWD than those in facility-based CR, but differences were no longer significant at 6 months. The early superiority of HBCR may relate to shorter delay from referral to participation. Both groups demonstrated similar safety and efficacy. These findings suggest that among selected patients who cannot attend facility-based CR, home-based CR may provide a reasonable alternative.

Bivalirudin, a bivalent, thrombin specific anticoagulant as an alternative to heparin in interventional procedures

2002 ◽  
Vol 22 (03) ◽  
pp. 142-148 ◽  
Author(s):  
D. P. Chew
Keyword(s):  
Artery Bypass ◽  
Bypass Graft ◽  
Coronary Intervention ◽  
The United States ◽  
Bleeding Complications ◽  
Amino Acid Residues ◽  
Artery Bypass Graft ◽  
Small Peptide ◽  
Percutaneous Coronary ◽  
Coronary Syndromes

SummaryAmong the antithrombotic therapies evaluated to date, the synthetic peptide bivalirudin is unique in its ability to reduce both ischemic and bleeding complications associated with percutaneous coronary intervention (PCI). Bivalirudin is a small peptide consisting of 20 amino acid residues that binds thrombin in a direct, reversible, and bivalent fashion. The agent is approved for use in the United States and New Zealand as an anticoagulant in patients with unstable angina undergoing PCI and may also prove beneficial in patients with acute coronary syndromes (ACS), acute myocardial infarction (AMI) and in patients undergoing coronary artery bypass graft (CABG) procedures. This article examines bivalirudin in more detail.

scholarly journals Dynamics of the number of myocardial revascularization operations in some countries in comparison with the Russian Federation in 2000–2018

2021 ◽  
Vol 10 (4) ◽  
pp. 68-78
Author(s):  
V. Yu. Semenov ◽  
I. V. Samorodskaya
Keyword(s):  
United States ◽  
Artery Bypass ◽  
Myocardial Revascularization ◽  
Coronary Vessels ◽  
The United States ◽  
Optimal Method ◽  
Percutaneous Coronary ◽  
Surgical Methods ◽  
The Us ◽  
Financial Characteristics

Aim. To study the dynamics of the number of coronary artery bypass grafting (CABG) and percutaneous coronary interventions (PCI) in some countries and Russia in the 2000–2018..Methods. The data of the official statistics of the Organization for Economic Cooperation and Development on the number of CABG and PCI were used. The countries that have provided data for most of the analyzed years and have more than 30 CABG per 100,000 population (22 countries) were selected. Data on the number of interventions in Russia were obtained from the CNIIOiIZ and Bakulev NMICSSH. The US data are obtained from the literature.Results. In most countries, the number of CABG decreased by 2018.The United States, Denmark, Finland, Israel, and Luxembourg were the most variable in the average indicator. The most expressed decrease occurred in Finland (2.9 times). The number of PCI has increased significantly (in 9 countries by more than 2 times). The exception was the United States, where the number of PCI decreased by 2 times from 2003 to 2016. In Russia, there was an increase in CABG and PCI (by 10.2 and 50.5 times, respectively). The number of CABG and PCI per 100,000 population was 23 and 34 times less, respectively, in Russia than the international average in 2000, and 1.4 and 1.55 times less in 2018. The decrease in CABG is due to the improvement of PCI technologies, as well as the improvement of pharmaceutical treatment of coronary vessels. The number of proceedings, including court ones, on the validity of stent implantation is growing. The crosscountry variability of the use of cardiac surgical methods is influenced by the organizational and financial characteristics of the healthcare system, demographic and clinical characteristics of patients, the knowledge of doctors, etc. The experience of Russia fully confirms this.Conclusion. There is no optimal method for accurately assessing the population's need for certain treatment methods. Each country chooses its own tactics, taking into account its resource capabilities, approaches to decision-making, its values and preferences, but the general trend is a decrease in the number of CABG operations while increasing the PCI. In Russia, there is a multiple increase in the number of CABG and PCI, but it is less than the indicators of most countries. 

Cardiac bypass and valve surgery

2010 ◽  
pp. 2942-2946
Author(s):  
Graham Cooper
Keyword(s):  
Artery Bypass ◽  
Coronary Intervention ◽  
Risk Profile ◽  
Valve Surgery ◽  
Drug Eluting Stents ◽  
Bypass Grafting ◽  
Matched Cohort ◽  
The United Kingdom ◽  
Percutaneous Coronary ◽  
Drug Eluting

Coronary artery bypass grafting (CABG)—the two main indications for are for relief of symptoms, usually angina and/or breathlessness, that persist even with optimal medical therapy (OMT), and/or prognosis. There is a prognostic benefit of CABG in patients with large volumes of ischaemia (i.e. affecting >12% of the ventricular mass), and the benefit of revascularization increases with increasing volumes of ischaemia. The overall mortality for elective CABG in the United Kingdom is around 1% and has continued to fall over the last decade despite an increasingly adverse risk profile of patients undergoing surgery. In randomized trials and large propensity-matched cohort registries CABG, in comparison to percutaneous coronary intervention (PCI) even with drug-eluting stents, has been shown to improve survival and to reduce the subsequent risk of myocardial infarction and recurrent angina. Approximately 80% of patients are alive a decade after surgery of whom around 70% are still free from angina....

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