Expanding Traditional Cardiac Rehabilitation in the 21st Century

Lavie, Carl J.; Pack, Quinn R.; Levine, Glenn N.

doi:10.1016/j.jacc.2020.02.038

Cited by 6 publications

(4 citation statements)

References 20 publications

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“…Instead, other forms of physical activity, such as calisthenics, chair-based exercises, and resistance and balance exercises should be explored. Furthermore, the use of yoga in CR could hold potential for use among individuals with CVD to further expand the scope of CR, 15 provided adequate training is provided before initiation. 16 Accordingly, for those already in a CR program, HBCR would be a viable option during the COVID-19 pandemic.…”

mentioning

confidence: 99%

COVID-19: A Time for Alternate Models in Cardiac Rehabilitation to Take Centre Stage

Babu

Arena

Ozemek

et al. 2020

Canadian Journal of Cardiology

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The coronavirus disease 2019 (COVID-19) pandemic has resulted in large-scale social distancing, working from home, prohibiting large group gatherings, 1 and staying at home. 2 These public health measures have been shown to be effective in the influenza pandemic of 1918 3 and continue to hold a place in today's scenario. Social distancing requires one to maintain a distance of at least 2 m or 6 feet between individuals in public spaces 4 whereas stay at home orders require an individual to remain confined to one's home with the provision to leave for essential errands (ie, groceries, medicine, and health care). 2 Although these measures are necessary to curb the widespread transmission of respiratory infection disease, their implementation makes the delivery of traditional, centre-based cardiac rehabilitation (CBCR; ie, face-toface, 12 weeks, 36 sessions) virtually impossible, because CBCR services have been suspended because of their nonessential designation during the COVID-19 pandemic. Essentially, because of the COVID-19 pandemic, the participation rate has decreased to virtually 0%. Before the COVID-19 outbreak, CBCR participation in many jurisdictions, including Canada and the United States was already a longstanding concern, with less than a quarter of eligible American patients participating in traditional cardiac rehabilitation (CR). 5 Although many factors are associated with these sobering participation rates, limited access to CBCR is a prominent contributor within the United States and other countries. 6 To increase participation, key CR stakeholders (eg, physicians, allied health professionals, scientists, professional organizations, etc) have been calling for alternate delivery models to increase access and participation. These trends and

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confidence: 99%

COVID-19: A Time for Alternate Models in Cardiac Rehabilitation to Take Centre Stage

Babu

Arena

Ozemek

et al. 2020

Canadian Journal of Cardiology

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“…Moreover, MHD are often ignored when it comes to cardiovascular prevention strategies because of a lack of awareness about the implications of MHD among patients with CVD like lesser odds of coronary revascularization and consequent poorer long-term outcomes due to factors like inadequate self-care, non-adherence to medications and follow-ups, as well as unfamiliarity with the potential psychological interventions that could potentially improve overall outcomes. Our findings are particularly important in the light of recent evidence suggestive of interventions like exercise training and cardiac rehabilitation to help improve psychological risk factors and reduces stress-related mortality among patients with CVD [ 39 , 40 ]. While clinicians may feel inadequately trained to address MHD themselves, it is worthwhile to utilize a team-based approach to care and involve psychologists, psychotherapists, and other behavioral therapists as indicated.…”

Section: Discussionmentioning

confidence: 87%

Mental health disorders among patients with acute myocardial infarction in the United States

Sreenivasan

Khan

et al. 2021

American Journal of Preventive Cardiology

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Objective To assess the prevalence, temporal trends and sex- and racial/ethnic differences in the burden of mental health disorders (MHD) and outcomes among patients with myocardial infarction (MI) in the United States. Methods Using the National Inpatient Sample Database, we evaluated a contemporary cohort of patients hospitalized for acute MI in the United States over 10 years period from 2008 to 2017. We used multivariable logistic regression analysis for in-hospital outcomes, yearly trends and estimated annual percent change (APC) in odds of MHD among MI patients. Results We included a total sample of 6,117,804 hospitalizations for MI (ST elevation MI in 30.4%), with a mean age of 67.2 ± 0.04 years and 39% females. Major depression (6.2%) and anxiety disorders (6.0%) were the most common MHD, followed by bipolar disorder (0.9%), schizophrenia/psychotic disorders (0.8%) and post-traumatic stress disorder (PTSD) (0.3%). Between 2008 and 2017, the prevalences significantly increased for major depression (4.7%–7.4%, APC +6.2%, p < .001), anxiety disorders (3.2%–8.9%, APC +13.5%, p < .001), PTSD (0.2%–0.6%, +12.5%, p < .001) and bipolar disorder (0.7%–1.0%, APC +4.0%, p < .001). Significant sex- and racial/ethnic-differences were also noted. Major depression, bipolar disorder or schizophrenia/psychotic disorders were associated with a lower likelihood of coronary revascularization. Conclusion MHD are common among patients with acute MI and there was a concerning increase in the prevalence of major depression, bipolar disorder, anxiety disorders and PTSD over this 10-year period. Focused mental health interventions are warranted to address the increasing burden of comorbid MHD among acute MI.

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“…Strategies such as physician and patient education on the benefits of CR, automatic patient referral, flexible hours as well as optimization of expense coverage and early appointments after hospital discharge have been among some of the modalities postulated as to tackle some of these barriers[ 14 , 83 , 85 ]. Additionally, the potential utilization of alternative modalities should also be reflected upon, to mitigate some of these barriers[ 82 , 86 - 88 ]. Interestingly, and as discussed below, home-based CR (HBCR) as well as the incorporation of different technologies (such as sensors) could also be of interest, as to address some of these gaps[ 82 , 83 , 89 , 90 ].…”

Section: Challenges To Crmentioning

confidence: 99%

Current role and future perspectives of cardiac rehabilitation in coronary heart disease

Vilela¹,

Ladeiras-Lopes²,

João³

et al. 2021

WJC

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Ischaemic heart disease (IHD) is a major cause of morbidity and mortality worldwide. While there have been major advances in this field, these patients are still a higher risk subgroup. As such, strategies to mitigate risk and tailor secondary prevention measures are of the utmost relevance. Cardiac rehabilitation (CR), encompassing several domains including exercise training, cardiovascular risk factor optimization, nutritional and psychological assessments, as well as other ancillary interventions has shown to be one of the pillars in the contemporary management of patients with IHD. Indeed, CR is associated with several benefits in this population, ranging from functional capacity to improvements in outcomes. Whilst this, there are still several issues concerning the optimal application of CR which are still not fully ascertained, such as lack of referral and completion, as well as questions related to programme design (particularly among patients with multiple comorbidities). In this review, we aim at presenting a pragmatic overview on the current role of CR in the management of individuals with IHD, while also discussing some of the caveats in the current data, as well as future concepts which could help improve the uptake and personalization of this pivotal time-tested intervention.

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Expanding Traditional Cardiac Rehabilitation in the 21st Century

Cited by 6 publications

References 20 publications

COVID-19: A Time for Alternate Models in Cardiac Rehabilitation to Take Centre Stage

COVID-19: A Time for Alternate Models in Cardiac Rehabilitation to Take Centre Stage

Mental health disorders among patients with acute myocardial infarction in the United States

Current role and future perspectives of cardiac rehabilitation in coronary heart disease

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