The Role of Cardiac Rehabilitation in Achieving Optimal Treatment

2011 ◽  
Vol 7 (1) ◽  
pp. 62
Author(s):  
Miguel Mendes ◽  
Keyword(s):  
Secondary Prevention ◽  
Cardiac Rehabilitation ◽  
Medical Treatment ◽  
Lifestyle Changes ◽  
Coronary Syndrome ◽  
Secondary Prevention Programme ◽  
Lifestyle Measures ◽  
The Cost

The clinical practice of European cardiologists is directed by the European Society of Cardiology’s guidelines for several clinical entities, in which ‘optimal medical treatment’ (a specific drug regime and lifestyle measures) for each syndrome is defined. The described pharmacotherapy is composed of several drugs, since the clinical research behind the recommendations is conducted using an ‘on top of’ strategy. For example, an asymptomatic patient after an acute coronary syndrome with normal ventricular function and without residual ischaemia has an indication to take at least four types of tablets per day, which is difficult to understand and to follow long term. The cost of the drugs is sometimes beyond the patient’s means, which also contributes to lower compliance. A clinician’s practice is usually very busy, which means it is almost impossible to perform patient education and promote adherence to drug therapy and lifestyle changes. Cardiac rehabilitation, as proved by the Global Secondary Prevention Strategies to Limit Event Recurrence after Myocardial Infarction (GOSPEL) study, may be considered the best available secondary prevention programme, as it educates patients and promotes adherence to the optimal medical treatment to a greater degree than usual care.

Cardiac rehabilitation during COVID-19 pandemic – new challenges, new opportunities

2021 ◽  
Vol 14 (3) ◽  
pp. 215-221
Author(s):  
Maciej Janiszewski ◽  
Artur Mamcarz
Keyword(s):  
Secondary Prevention ◽  
Cardiac Rehabilitation ◽  
Second Phase ◽  
Mortality And Morbidity ◽  
Rehabilitation Programs ◽  
Rehabilitation Centers ◽  
New Challenges ◽  
Artery Disease

The role of comprehensive cardiac rehabilitation (CCR) is well established in the secondary prevention of cardiovascular diseases such as coronary artery disease and heart failure. Many clinical trials demonstrated effectiveness of CCR in improving exercise capacity, quality of life, and in reducing cardiovascular mortality and morbidity. However, even before the era of the COVID-19 pandemic comprehensive cardiac rehabilitation program’s implementation, especially the second phase, had many barriers. One of the main reasons for not attending in second phase of CCR was lack of transportation from patient’s home to rehabilitation centers. Additionally, in recent months COVID-19 pandemic has led to closure of many cardiac rehabilitation centres resulting in many eligible patients unable to participate in the optimisation of secondary prevention. During the coronavirus disease-2019 pandemic, hybrid telerehabilitation has become the leading solution in the cardiac rehabilitation programs. The present paper contains key information about structures, effectives and safety of hybrid telerehabilitation during the COVID-19 era.

Cardiac rehabilitation

2020 ◽  
pp. 371-384
Keyword(s):  
Coronary Heart Disease ◽  
Cardiac Rehabilitation ◽  
Cardiac Disease ◽  
Cardiac Event ◽  
Cardiovascular Prevention ◽  
Improvement Plan ◽  
National Service Framework ◽  
Long Time

This chapter looks at the role of cardiac rehabilitation for those at risk of cardiac disease or who have sustained a cardiac event. Cardiac rehabilitation has been a priority area for a long time in the National Service Framework for Coronary Heart Disease, NHS Improvement Plan, and now features in the NHS Long Term Plan. The introduction of certification for cardiovascular prevention and rehabilitation programmes (CPRP) has meant that their quality can be measured. The introduction of more technology-based interventions has opened up the opportunity for more people to participate, particularly for individuals who could not, or did not want to attend a traditional CPRP.

P6218Greater burden of risk factors and need of cardiac rehabilitation in elderly patients with lower educational attainment

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
I Kjesbu ◽  
N Mikkelsen ◽  
K Sibilitz ◽  
M Wilhelm ◽  
C P Gil ◽  
...  
Keyword(s):  
Risk Factors ◽  
Educational Attainment ◽  
Cardiac Rehabilitation ◽  
Medical Treatment ◽  
Exercise Capacity ◽  
Basic Education ◽  
The Elderly ◽  
P Value ◽  
Ageing Population ◽  
Coronary Syndrome

Abstract Background A socioeconomic gap in cardiac rehabilitation (CR) has been described in younger populations but whether this is also true in the ageing population is unknown. Purpose To describe if poorer education is a predictor for exercise capacity, comorbidity, lifestyle- and risk factors and medical treatment at baseline in CR in an elderly population. Methods The observational EU-CaRE study is a European prospective study with eight participating CR centers in seven countries (Denmark, France, Germany, the Netherlands, Italy, Spain and Switzerland). Patients aged 65 or older with CHD or valve surgery participating in CR were consecutively included. Educational attainment was divided into basic, intermediate and high Results A total of 1626 patients were included. Educational attainment differed across centers (p<0.001). The groups differed little regarding index event, comorbidity and medical treatment. However, patients with only basic education had more diabetes, higher BMI, less physical activity, lower exercise capacity and higher scores for depression (PHQ 9) and anxiety (GAD). Differences were not affected by adjustment for age, gender and country. Demographics and risk factor control N=1626 High (N=388) Intermediate (N=788) Basic (N=460) p-value* DEMOGRAPHICS Age (yrs), median (IQR) 72 (68, 76) 71 (68, 75) 74 (70, 78) <0.001 Men 330 (86.8%) 603 (79.3%) 291 (67.4%) <0.001 RISK FACTORS p-value** LDL >1.8 mmol/l*** 255 (66.1%) 518 (66.8%) 293 (63.7%) 0.060 Systolic BP >140 mmHg 85 (22.0%) 179 (23.1%) 100 (21.7%) 0.601 Smoker 26 (6.8%) 80 (10.3%) 46 (10.0%) 0.214 Moderate exercise <4days/week 179 (46.4%) 340 (43.9%) 271 (58.9%) 0.024 BMI >27 kg/m2 133 (35.5%) 389 (50.2%) 255 (55.4%) <0.001 VO2 peak <80% of predicted 220 (57.0%) 443 (57.2%) 252 (54.8%) 0.037 HbA1c >48mmol/mol*** 115 (29.8%) 264 (34.1%) 230 (50.0%) <0.001 Diet score, mean (SD) 6.50 (2.28) 5.93 (2.47) 7.32 (2.35) <0.001 GAD score, median (IQR) 2.0 (0.0,4.0) 2.0 (0.0,5.0) 3.5 (0.0,7.0) 0.051 PHQ-9 score, median (IQR) 4.0 (1.0,7.0) 4.0 (1.0,7.0) 6.0 (2.0,10.0) 0.020 Abbreviations: IQR, interquartile range; SD, standard deviation; ACS, acute coronary syndrome; CAD, coronary artery disease. *Adjusted for center. **Adjusted for center, age, gender. ***Only for ischemic heart disease patients. Conclusions The results emphasize the need of CR in this patient-group and that a targeted CR approach should be considered to achieve equal health opportunities also in the elderly. Acknowledgement/Funding Horizon2020

Long-Term Risk of Major Adverse Cardiovascular Events in Patients With Acute Coronary Syndrome: Prognostic Role of Complete Blood Cell Count

Angiology ◽  
2020 ◽  
Vol 71 (9) ◽  
pp. 831-839
Author(s):  
Nuccia Morici ◽  
Valentina Molinari ◽  
Silvia Cantoni ◽  
Andrea Rubboli ◽  
Laura Antolini ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
High Risk ◽  
Blood Cell ◽  
Cardiovascular Events ◽  
Major Adverse Cardiovascular Events ◽  
Blood Cell Count ◽  
Prognostic Role ◽  
Coronary Syndrome

Individual parameters of complete blood count (CBC) have been associated with worse outcome in patients with acute coronary syndrome (ACS). However, the prognostic role of CBC taken as a whole has never been evaluated for long-term incidence of major adverse cardiovascular events (MACEs). Patients were grouped according to their hematopoietic cells’ inflammatory response at different time points during hospital stay. Patients with admission white blood cell count >10 × 109/L, discharge hemoglobin <120 g/L, and discharge platelet count >250 × 109/L were defined as “high-risk CBC.” Among 1076 patients with ACS discharged alive, 129 (12%) had a “high-risk CBC” and 947 (88%) had a “low-risk CBC.” Patients with “high-risk CBC” were older and had more comorbidities. Over a median follow-up of 665 days, they experienced a higher incidence of MACE compared to “low-risk CBC” patients (18.6% vs 8.1%). After adjustment for age, age-adjusted Charlson comorbidity index, female sex, cardiac arrest, suboptimal discharge therapy, coronary artery bypass, and ejection fraction, a high-risk CBC was significantly associated with increased MACE occurrence (adjusted hazard ratio 1.80; 95% CI: 1.09-3.00). The CBC was a prognostic marker in patients with ACS, and its evaluation at admission and discharge could better classify patient’s risk and improve therapeutic management.

scholarly journals Effect of cardiac rehabilitation on 24-month all-cause hospital readmissions: A prospective cohort study

2018 ◽  
Vol 18 (3) ◽  
pp. 234-244 ◽  
Author(s):  
Emma Thomas ◽  
Mojtaba Lotfaliany ◽  
Sherry L Grace ◽  
Brian Oldenburg ◽  
C Barr Taylor ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Cohort Study ◽  
Length Of Stay ◽  
Cardiac Rehabilitation ◽  
Hospital Readmission ◽  
Hospital Admissions ◽  
P Value ◽  
Post Discharge ◽  
Coronary Syndrome

Background: Ageing populations and increasing survival following acute coronary syndrome has resulted in large numbers of people living with cardiovascular disease and at high risk of hospitalizations. Rising hospital admissions have a significant financial cost to the healthcare system. Aim: The purpose of this study was to determine whether cardiac rehabilitation is protective against long-term hospital readmission (frequency and length) following acute coronary syndrome. Methods: Data from 416 Australian patients with acute coronary syndrome enrolled in the Anxiety Depression and heart rate Variability in cardiac patients: Evaluating the impact of Negative emotions on functioning after Twenty four months (ADVENT) prospective cohort study between January 2013–June 2014 was analyzed secondarily. Participants self-reported cardiac rehabilitation attendance over the 12 months post-discharge. All-cause readmission data were extracted from hospital records 24 months post-index event. The association between cardiac rehabilitation and all-cause readmission, frequency of readmissions, and length of stay was assessed using three methods (a) regression analysis, (b) propensity score matching, and (c) inverse probability treatment weighting. Results: Overall, 416 patients consented (53% of eligible patients), of which 414 (99.5%) survived the first 30 days post-discharge and were included in the analysis. Medical records were located for 409 participants after 24 months (98% follow-up rate). In total, 267 (65%) reported attending cardiac rehabilitation; there were 392 readmissions by 239 patients. Cardiac rehabilitation attendance was not associated with all-cause hospital readmission; however, it was associated with lower frequency of hospital admissions (odds ratio 0.53, 95% confidence interval: 0.31–0.91 p-value:0.022) and length of stay (coefficient –1.21 days, 95% confidence interval: –2.46–0.26; marginally significant p-value: 0.055) in adjusted models. Conclusion: This study substantiates the long-term benefits of cardiac rehabilitation on readmissions, including length of stay, which would result in lower costs to the healthcare system.

Sign in / Sign up

Export Citation Format

Share Document