An Early Cardiac Access Clinic Significantly Improves Cardiac Rehabilitation Participation and Completion Rates in Low-Risk ST-Elevation Myocardial Infarction Patients

Parker, Karen; Stone, James A.; Arena, Ross; Lundberg, Debra; Aggarwal, Sandeep; Goodhart, David; Traboulsi, Mouhieddin

doi:10.1016/j.cjca.2010.12.076

Cited by 42 publications

(34 citation statements)

References 32 publications

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“…11,12 However, effect of later CR entry on cardiovascular fitness and other key CR outcomes has not been examined in the post-CABG population specifically, where different findings may be observed owing to a different early recovery trajectory. Moreover, there may be unique barriers that delay entry to CR in CABG compared with nonsurgical patients.…”

Section: Editorial See P 539mentioning

confidence: 99%

Delays in Referral and Enrolment Are Associated With Mitigated Benefits of Cardiac Rehabilitation After Coronary Artery Bypass Surgery

Marzolini

Blanchard

Alter

et al. 2015

Circ: Cardiovascular Quality and Outcomes

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Background-Cardiac rehabilitation (CR) is recommended after coronary artery bypass graft surgery; however, the consequences of longer wait times to start CR have not been elucidated. Method and Results-Cardiopulmonary, demographic, and anthropometric assessments were conducted before and after 6 months of CR in consecutively enrolled patients from January 1995 to October 2012. Wait times were ascertained from referral forms and charts. Neighborhood characteristics were ascertained using census data and cross-referencing with patients' home geographic location. Among 6497 post-coronary artery bypass graft participants, mean and median total wait time (time from surgery to first exercise session) was 101.1±47.9 and 80 days, respectively. In multiple linear regression, correlates of longer total wait time and the 2 wait-time phases, time from surgery to CR referral and time from CR referral to first exercise session, were determined. Factors influencing longer wait times included female sex, greater age, being employed, less social support, longer drive time to CR, lower neighborhood socioeconomic status, higher systolic blood pressure, abdominal obesity, and a complex medical history. After adjusting for correlates of delayed entry, longer wait time for each of the total and 2 wait-time phases was significantly associated with less improvement in cardiopulmonary fitness (VO 2peak ; β=−0.165, P<0.001), body fat percentage (β=0.032, P<0.02), resting heart rate (β=0.066, P<0.001), and poorer attendance to CR classes (β=−0.081, P<0.001) and completion rate (β=2.741, P<0.001). Conclusions-Strategies for timely access to CR at each phase of the process are important given the negative impact that wait time has on key clinical outcomes. This is relevant because optimizing VO 2peak and attendance to CR has been shown to confer a mortality advantage. (Circ Cardiovasc Qual Outcomes. 2015;8:608-620.

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Section: Editorial See P 539mentioning

confidence: 99%

Delays in Referral and Enrolment Are Associated With Mitigated Benefits of Cardiac Rehabilitation After Coronary Artery Bypass Surgery

Marzolini

Blanchard

Alter

et al. 2015

Circ: Cardiovascular Quality and Outcomes

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“…It should be noted that recent evidence indicates initiation of structured cardiac rehabilitation shortly after hospital discharge for a recent MI significantly improves program participation. 517 Clinicians should therefore strongly consider facilitation of cardiac rehabilitation as soon as possible after hospital discharge. If cardiac rehabilitation facilities are not available, activity guidelines can still be provided to cardiac subjects, and they should be encouraged to exercise.…”

Section: Medically Supervised Exercisementioning

confidence: 99%

Exercise Standards for Testing and Training

Fletcher¹,

Ades²,

Kligfield³

et al. 2013

Circulation

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760

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“…Similarly, Soga et al 15 noted an absolute 21% increase in the rate of exercise continuation among patients who underwent a submaximal treadmill exercise test the day after PCI as part of CR versus those who did not undergo early exercise testing. Parker et al, 22 using an early clinic appointment for ST-segment elevation MI patients, also demonstrated significantly improved enrollment in CR. Thus, in several different settings, early contact has been shown to improve CR participation.…”

Section: Discussionmentioning

confidence: 99%

An Early Appointment to Outpatient Cardiac Rehabilitation at Hospital Discharge Improves Attendance at Orientation

et al. 2013

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Background-Outpatient cardiac rehabilitation (CR) decreases mortality rates but is underutilized. Current median time from hospital discharge to enrollment is 35 days. We hypothesized that an appointment within 10 days would improve attendance at CR orientation. Methods and Results-At hospital discharge, 148 patients with a nonsurgical qualifying diagnosis for CR were randomized to receive a CR orientation appointment either within 10 days (early) or at 35 days (standard). The primary end point was attendance at CR orientation. Secondary outcome measures were attendance at ≥1 exercise session, the total number of exercise sessions attended, completion of CR, and change in exercise training workload while in CR. Average age was 60±12 years; 56% of participants were male and 49% were black, with balanced baseline characteristics between groups. Median time (95% confidence interval) to orientation was 8.5 (7-13) versus 42 (35 to NA [not applicable]) days for the early and standard appointment groups, respectively (P<0.001). Attendance rates at the orientation session were 77% (57/74) versus 59% (44/74) in the early and standard appointment groups, respectively, which demonstrates a significant 18% absolute and 56% relative improvement (relative risk, 1.56; 95% confidence interval, 1.03-2.37; P=0.022). The number needed to treat was 5.7. There was no difference (P>0.05) in any of the secondary outcome measures, but statistical power for these end points was low. Safety analysis demonstrated no difference between groups in CR-related adverse events. Conclusions-Early

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An Early Cardiac Access Clinic Significantly Improves Cardiac Rehabilitation Participation and Completion Rates in Low-Risk ST-Elevation Myocardial Infarction Patients

Cited by 42 publications

References 32 publications

Delays in Referral and Enrolment Are Associated With Mitigated Benefits of Cardiac Rehabilitation After Coronary Artery Bypass Surgery

Delays in Referral and Enrolment Are Associated With Mitigated Benefits of Cardiac Rehabilitation After Coronary Artery Bypass Surgery

Exercise Standards for Testing and Training

An Early Appointment to Outpatient Cardiac Rehabilitation at Hospital Discharge Improves Attendance at Orientation

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