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Inpatient and outpatient cardiac rehabilitation programmes improve cardiometabolic risk in revascularized coronary patients with type 2 diabetes  [PDF]
Claudiu Avram,Adina Avram,L.aura Cr?ciun,Stela Iurciuc
Timisoara Physical Education and Rehabilitation Journal , 2010,
Abstract: The purpose of this paper is to evaluate cardiometabolic risk reduction of diabetic patients following coronary revascularizationprocedures after participation in outpatients or inpatients cardiac rehabilitation programmes. Materials and methods: weperformed a retrospective analytical study which included a group of 103 revascularized coronary patients with diabetesmellitus. Depending on participation in a cardiac rehabilitation program we have defined the following subgroups of patients:Group O (N=37) - attended the outpatient cardiac rehabilitation program; Group H (N=37) - attended the inpatient cardiacrehabilitation program; Group C (N=34) - did not participate in any cardiac rehabilitation program. Between those two momentsof assessment: T0 - revascularization / early post-revascularization and T1 - time of the interview (16±2.3 months afterrevascularization), patients in groups A and S participated in outpatient cardiac rehabilitation program (12 weeks, 3sessions/week of exercise training, with clinical and paraclinical evaluation scheduled at 1, 6, 12 months afterrevascularization), or inpatient cardiac rehabilitation program (3 weeks, intensive sessions, scheduled at 1, 3, 6 and 12months after revascularization). Results: at the end of the study, we found significant differences among the three groups forthe following parameters: body mass index (p=0.01), systolic blood pressure (p=0.002), total cholesterol (p<0.001), LDLcholesterol(p<0.001) and non-HDL cholesterol (p=0.004) in favor of groups A and S, that have participated in comprehensivecardiac rehabilitation programs. Conclusions: comprehensive cardiac rehabilitation programmes, performed outpatient orinpatient, are effective methods of reducing the high cardiometabolic risk, specific in revascularized coronary patients withdiabetes.
Effectiveness of inpatient and outpatient strategies in increasing referral and utilization of cardiac rehabilitation: a prospective, multi-site study  [cached]
Grace Sherry L,Angevaare Kelly L,Reid Robert D,Oh Paul
Implementation Science , 2012, DOI: 10.1186/1748-5908-7-120
Abstract: Background Despite the evidence of benefit, cardiac rehabilitation (CR) remains highly underutilized. The present study examined the effect of two inpatient and one outpatient strategy on CR utilization: allied healthcare provider completion of referral (a policy that had been endorsed and approved by the cardiac program leadership in advance; PRE-APPROVED); CR intake appointment booked before hospital discharge (PRE-BOOKED); and early outpatient education provided at the CR program shortly after inpatient discharge (EARLY ED). In this prospective observational study, 2,635 stable cardiac inpatients from 11 Ontario hospitals completed a sociodemographic survey, and clinical data were extracted from charts. One year later, participants were a mailed survey that assessed CR use. Participating inpatient units and CR programs to which patients were referred were coded to reflect whether each of the strategies was used (yes/no). The effect of each strategy on participants’ CR referral and enrollment was examined using generalized estimating equations. Results A total of 1,809 participants completed the post-test survey. Adjusted analyses revealed that the implementation of one of the inpatient strategies was significantly related to greater referral and enrollment (PRE-APPROVED: OR = 1.96, 95%CI = 1.26 to 3.05, and OR = 2.91, 95%CI = 2.20 to 3.85, respectively). EARLY ED also resulted in significantly greater enrollment (OR = 4.85, 95%CI = 2.96 to 7.95). Conclusions These readily-implementable strategies could significantly increase access to and enrollment in CR for the cardiac population. The impact of these strategies on wait times warrants exploration.
A mobile phone-based care model for outpatient cardiac rehabilitation: the care assessment platform (CAP)
Darren L Walters, Antti Sarela, Anita Fairfull, Kylie Neighbour, Cherie Cowen, Belinda Stephens, Tom Sellwood, Bernadette Sellwood, Marie Steer, Michelle Aust, Rebecca Francis, Chi-Keung Lee, Sheridan Hoffman, Gavin Brealey, Mohan Karunanithi
BMC Cardiovascular Disorders , 2010, DOI: 10.1186/1471-2261-10-5
Abstract: We have integrated mobile phones and web services into a comprehensive home- based care model for outpatient cardiac rehabilitation. Mobile phones with a built-in accelerometer sensor are used to measure physical exercise and WellnessDiary software is used to collect information on patients' physiological risk factors and other health information. Video and teleconferencing are used for mentoring sessions aiming at behavioural modifications through goal setting. The mentors use web-portal to facilitate personal goal setting and to assess the progress of each patient in the program. Educational multimedia content are stored or transferred via messaging systems to the patients phone to be viewed on demand. We have designed a randomised controlled trial to compare the health outcomes and cost efficiency of the proposed model with a traditional community based rehabilitation program. The main outcome measure is adherence to physical exercise guidelines.The study will provide evidence on using mobile phones and web services for mentoring and self management in a home-based care model targeting sustainable behavioural modifications in cardiac rehabilitation patients.The trial has been registered in the Australian New Zealand Clinical Trials Registry (ANZCTR) with number ACTRN12609000251224.Cardiovascular disease (CVD) is the most common cause of death in Australia, accounting for 34% and 39% of male and female deaths, respectively in Australia in 2007 [1]. Ischemic heart disease is the leading cause of mortality and accounts for 17.4% of all deaths in both males and females attributable to life-style related risk-factors [1]. The total burden of this disease is likely to increase given the increase in morbid obesity and diabetes and the growing number of elderly patients in whom these diseases are more common.A number of modifiable environmental and patient specific factors increase the chance of developing coronary heart disease [2]. These include smoking, high blood cho
Infection Prevention Strategies in Cardiac Rehabilitation [1]—A Behavioral Intervention for Patients [2]  [PDF]
Wendy Bjerke
Health (Health) , 2017, DOI: 10.4236/health.2017.99092
Abstract: Background: Healthcare Acquired Infections (HAI) result in over 100 thousand deaths each year with one third of these deaths preventable via behaviors such as hand washing among health care providers in inpatient settings. Less research has been conducted in outpatient exercise settings such as cardiac rehabilitation (CR) among patients. Purpose: The purpose of this study was to examine the effectiveness of HAI prevention strategies in a CR setting among patients. Methods: Observations of the frequency of hand washing among CR patients pre and post four HAI strategies including provision of HAI education and signs, hand washing demonstrations, a HAI prevention video, and hand sanitizer samples. Washing hands prior to CR (WI) was observed as well as washing hands prior to leaving the CR center (WO). Methods included recording the frequency of WI and WO among all patients at baseline and after each of the four interventions. Mean frequencies of WI and WO were compared among a mean of 22 - 43 CR patient visits over 12 weeks using descriptive statistics and t-tests to determine if changes were significant pre and post intervention strategies. Results: At baseline, no patients WI or WO during an outpatient CR visit. Post interventions 1 - 4, the percentage of patients WI and WO was 33 and 34, 32 and 26, 32 and 29, 33 and 22 respectively. At a one-year follow up, the percentage of patients WI and WO was 40%. Conclusion: Increases in frequency and the percentage of WI and WO were observed among patients meriting continued examination of HAI prevention strategies among patients in outpatient exercise settings such as CR.
Primary care provider perceptions of intake transition records and shared care with outpatient cardiac rehabilitation programs
Jonathan Yee, Karen Unsworth, Neville Suskin, Robert D Reid, Veronica Jamnik, Sherry L Grace
BMC Health Services Research , 2011, DOI: 10.1186/1472-6963-11-231
Abstract: 144 PCPs of consenting enrollees from 8 regional and urban Ontario CR programs participated in this cross-sectional study. Intake transition records were tracked from the CR program to the PCP's office. Sixty-six PCPs participated in structured telephone interviews.Sixty-eight (47.6%) PCPs received a CR intake transition record. Fifty-eight (87.9%) PCPs desired intake transition records, with most wanting it transmitted via fax (n = 52, 78.8%). On a 5-point Likert scale, PCPs strongly agreed that the CR transition record met their needs for providing patient care (4.32 ± 0.61), with 48 (76.2%) reporting that it improved their management of patients' cardiac risk. PCPs rated the following elements as most important to include in an intake transition record: clinical status (4.67 ± 0.64), exercise test results (4.61 ± 0.52), and the proposed patient care plan (4.59 ± 0.71).Less than half of intake transition records are reaching PCPs, revealing a large gap in continuity of patient care. PCP responses should be used to develop an evidence-based intake transition record, and procedures should be implemented to ensure high-quality transitional care.Cardiovascular disease (CVD) is a leading cause of mortality and morbidity in the developed world [1]. Indeed, while many patients are surviving and living with CVD, substantial health risks continue following cardiac events and procedures. The standard of in-patient cardiac care in clinical practice guidelines in many countries [2-5] consists of referral to cardiac rehabilitation (CR) and facilitation of post-discharge primary care provider (PCP) follow-up. Certainly, shared care [6] is particularly important to support risk reduction in the period following cardiac hospitalization, to minimize this risk of recurrent or adverse events. For instance, Ahmed et al. [7] showed that following cardiac hospitalization, shared care between generalists and cardiac specialists resulted in significantly improved left ventricular functio
Effect of Cardiac Rehabilitation Program on Heart Rate Recovery after Percutaneous Coronary Intervention and Coronary Artery Bypass Grafting
Abbas Soleimani,Mohammad Alidoosti,Mojtaba Salarifar,Seyed Ebrahim Kassaian
Journal of Tehran University Heart Center , 2008,
Abstract: Background: The objective of this study was to evaluate the effect of a hospital-based cardiac rehabilitation program on heart rate recovery (HRR) in patients who received percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG). Methods: Two hundred forty patients, who completed 24 sessions of a cardiac rehabilitation program (phase 2) after PCI (n=62) or CABG (n=178) at the rehabilitation department of Tehran Heart Center were included in the present study. Demographic and clinical characteristics and exercise capacity at baseline and at follow-up were compared between the two groups. The main outcome measurements were: Resting heart rate, peak heart rate, and HRR.Results: All the patients showed significant improvements in heart rate parameters from the baseline to the last sessions. The profile of atherosclerotic risk factors (except for diabetes mellitus) was similar between the PCI and CABG subjects. After eight weeks of cardiac rehabilitation, HRR increased averagely about 17 and 21 bpm among the CABG and PCI patients, respectively (p=0.019). Conclusion: The results of the present study were indicative of an increase in HRR over 1 minute in patients irrespective of their initial revascularization modality (i.e. PCI or CABG) after the completion of cardiac rehabilitation. Be that as it may, the PCI patients achieved greater improvement in HRR by comparison with the CABG patients.
Association between Participation in Outpatient Cardiac Rehabilitation and Self-Reported Receipt of Lifestyle Advice from a Healthcare Provider: Results of a Population-Based Cross-Sectional Survey  [PDF]
Natalie A. Johnson,Kerry J. Inder,Ben D. Ewald,Erica L. James,Steven J. Bowe
Rehabilitation Research and Practice , 2010, DOI: 10.1155/2010/541741
Abstract: We test the hypothesis that the odds of self-reported receipt of lifestyle advice from a health care provider will be lower among outpatient cardiac rehabilitation (OCR) nonattendees and nonreferred patients compared to OCR attendees. Logistic regression was used to analyse cross-sectional data provided by 65% (4971/7678) of patients aged 20 to 84 years discharged from public hospitals with a diagnosis indicating eligibility for OCR between 2002 and 2007. Among respondents, 71% (3518) and 55% (2724) recalled advice regarding physical activity and diet, respectively, while 88% (592/674) of smokers recalled quit advice. OCR attendance was low: 36% (1764) of respondents reported attending OCR, 11% (552) did not attend following referral, and 45% (2217) did not recall being invited. The odds of recalling advice regarding physical activity and diet were significantly lower among OCR nonattendees compared to attendees (OR 0.34, 95% CI 0.21, 0.56 and OR 0.33, 95% CI 0.25, 0.44, resp.) and among nonreferred respondents compared to OCR attendees (OR 0.10, 95% CI 0.07, 0.15 and OR 0.17, 95% CI 0.14, 0.22, resp.). Patients hospitalised for coronary heart disease should be referred to OCR or a suitable alternative to improve recall of lifestyle advice that will reduce the risk of further coronary events. 1. Introduction Coronary heart disease (CHD) is a major cause of death and disability [1–3]. The benefit of lifestyle changes on mortality in patients with CHD has been established [4], and guidelines for the management of acute coronary syndromes recommend that patients be given lifestyle advice that will reduce the risk of further CHD events [5, 6]. Health education, counseling, and behaviour modification strategies are core components of inpatient and outpatient cardiac rehabilitation (OCR) programs, which are recommended for all patients with CHD [5–9]. Unfortunately, decreases in the length of stay for cardiac conditions [7, 8] and suboptimal rates of attendance at OCR programs [10–12] have reduced opportunities for the provision of lifestyle advice via these programs. Patients with CHD may also receive lifestyle advice during routine consultations with clinicians after discharge from hospital. However, results of the EUROASPIRE surveys indicate that lifestyle risk factors receive insufficient attention [13]. Barriers to counseling include time limitations and inadequate reimbursement [14, 15]. Duration of advice has been shown to be predictive of patient recall of advice in relation to physical activity, diet, and smoking, with an additional minute of
A randomized controlled trial of an extensive lifestyle management intervention (ELMI) following cardiac rehabilitation: study design and baseline data
Scott A Lear, Andrew Ignaszewski, Wolfgang Linden, Anka Brozic, Marla Kiess, John J Spinelli, P Haydn Pritchard, Jiri J Frohlich
Trials , 2002, DOI: 10.1186/1468-6708-3-9
Abstract: Patients with ischemic heart disease (IHD) were randomized following a standard CRP to the ELMI or to usual care. The ELMI program is a case-managed intervention aimed at individualizing risk factor and lifestyle management based on current treatment guidelines. The program consists of cardiac rehabilitation sessions, telephone follow-up and risk factor and lifestyle counselling sessions. Health professionals work with participants using behavioural counselling and communications with participants' family physicians. Usual care participants return to their family physicians' care, and come to the study clinic only to undergo annual outcomes assessment. The primary outcome is change in IHD global risk after four years. Secondary outcomes include combined cardiovascular events, health care utilization, lifestyle adherence, quality of life and risk factors.Over 28 months, 302 men and women were randomized. This represented 29% of the total population screened. The average age of study participants is 64 years, 18% are women, 53% have had a previous myocardial infarction, 73% have undergone previous revascularization and 20% have diabetes mellitus. Ischemic heart disease risk factors for the entire cohort improved significantly after subjects had gone through previous CRPs. Baseline risk factors, lifestyle behaviours and medications were similar between the groups.This study population is representative of patients completing a standard CRP. Results of the ELMI trial will provide valuable information for the future design of CRPs.Current cardiac rehabilitation programs (CRPs) employ pharmacological management, smoking cessation, nutrition, and exercise and behavioural counselling to effectively manage ischemic heart disease (IHD) risk factors and to promote favourable lifestyle changes. Previous research has demonstrated that CRPs can reduce morbidity and mortality as well as cost of care. [1-5] Studies such as the Stanford Coronary Risk Intervention Project (SCRIP) and
The influences of positive end expiratory pressure (PEEP) associated with physiotherapy intervention in phase I cardiac rehabilitation
Borghi-Silva, Audrey;Mendes, Renata Gon?alves;Costa, Fernando de Souza Melo;Di Lorenzo, Valéria Amorim Pires;Oliveira, Claudio Ricardo de;Luzzi, Sérgio;
Clinics , 2005, DOI: 10.1590/S1807-59322005000600007
Abstract: purpose: to evaluate the effects of positive end expiratory pressure and physiotherapy intervention during phase i of cardiac rehabilitation on the behavior of pulmonary function and inspiratory muscle strength in postoperative cardiac surgery. methods: a prospective randomized study, in which 24 patients were divided in 2 groups: a group that performed respiratory exercises with positive airway expiratory pressure associated with physiotherapy intervention (gep, n = 8) and a group that received only the physiotherapy intervention (gpi, n = 16). pulmonary function was evaluated by spirometry on the preoperative and on the fifth postoperative days; inspiratory muscle strength was measured by maximal inspiratory pressure on the same days. results: spirometric variables were significantly reduced from the preoperative to the fifth postoperative day for the gpi, while the gep had a significant reduction only for vital capacity (p < .05). when the treatments were compared, smaller values were observed in the gpi for peak flow on the fifth postoperative day. significant reductions of maximal inspiratory pressure from preoperative to the first postoperative day were found in both groups. however, the reduction in maximal inspiratory pressure from the preoperative to the fifth postoperative day was significant only in the gpi (p < .05). conclusions: these data suggest that cardiac surgery produces a reduction in inspiratory muscle strength, pulmonary volume, and flow. the association of positive expiratory pressure with physiotherapy intervention was more efficient in minimizing these changes, in comparison to the physiotherapy intervention alone. however, in both groups, the pulmonary volumes were not completely reestablished by the fifth postoperative day, and it was necessary to continue the treatment after hospital convalescence.
The influences of positive end expiratory pressure (PEEP) associated with physiotherapy intervention in phase I cardiac rehabilitation  [cached]
Borghi-Silva Audrey,Mendes Renata Gon?alves,Costa Fernando de Souza Melo,Di Lorenzo Valéria Amorim Pires
Clinics , 2005,
Abstract: PURPOSE: To evaluate the effects of positive end expiratory pressure and physiotherapy intervention during Phase I of cardiac rehabilitation on the behavior of pulmonary function and inspiratory muscle strength in postoperative cardiac surgery. METHODS: A prospective randomized study, in which 24 patients were divided in 2 groups: a group that performed respiratory exercises with positive airway expiratory pressure associated with physiotherapy intervention (GEP, n = 8) and a group that received only the physiotherapy intervention (GPI, n = 16). Pulmonary function was evaluated by spirometry on the preoperative and on the fifth postoperative days; inspiratory muscle strength was measured by maximal inspiratory pressure on the same days. RESULTS: Spirometric variables were significantly reduced from the preoperative to the fifth postoperative day for the GPI, while the GEP had a significant reduction only for vital capacity (P < .05). When the treatments were compared, smaller values were observed in the GPI for peak flow on the fifth postoperative day. Significant reductions of maximal inspiratory pressure from preoperative to the first postoperative day were found in both groups. However, the reduction in maximal inspiratory pressure from the preoperative to the fifth postoperative day was significant only in the GPI (P < .05). CONCLUSIONS: These data suggest that cardiac surgery produces a reduction in inspiratory muscle strength, pulmonary volume, and flow. The association of positive expiratory pressure with physiotherapy intervention was more efficient in minimizing these changes, in comparison to the physiotherapy intervention alone. However, in both groups, the pulmonary volumes were not completely reestablished by the fifth postoperative day, and it was necessary to continue the treatment after hospital convalescence.
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