Lessons from contemporary trials of cardiovascular prevention and rehabilitation: A systematic review and meta-analysis

Halewijn, Gijs van; Deckers, Jaap W.; Tay, Hung Yong; Domburg, Ron van; Kotseva, Kornelia; Wood, David

doi:10.1016/j.ijcard.2016.12.125

Cited by 148 publications

(139 citation statements)

References 43 publications

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“…25 Based on these findings, the improvement in CHD risk factors observed with CR were likely associated with concomitant comprehensive medical management during the ET-based programs, suggesting a critical role of risk factor modification in the secondary prevention of CHD. The overall benefits of CR programs for CHD are summarized in Fig 1. …”

Section: Impact Of Cr On the Cvd Risk Factor Profilementioning

confidence: 81%

“…25 This study was the first to show a significant reduction in stroke rates in this population after CR; however, this may be attributed to more comprehensive CV care, medication optimization, and improvements in CVD risk factors, such as BP control, smoking cessation, and reduced cholesterol levels, rather than the effects of ET alone.…”

mentioning

confidence: 74%

“…97 Another meta-analysis that only involved RCTs from 2010-2015 (18 trials, 7,691 patients) supported the impact of supervised ET programs on CVD mortality (Hazard risk 0.58, 95% CI 0.21-0.88), but also did not find a significant effect on all-cause mortality. 25 Interestingly, the investigators also…”

Section: Impact Of Cr On Mortalitymentioning

confidence: 99%

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Impact of cardiac rehabilitation and exercise training programs in coronary heart disease

Kachur

Chongthammakun

Lavie

et al. 2017

Progress in Cardiovascular Diseases

129

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Section: Impact Of Cr On the Cvd Risk Factor Profilementioning

confidence: 81%

mentioning

confidence: 74%

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Impact of cardiac rehabilitation and exercise training programs in coronary heart disease

Kachur

Chongthammakun

Lavie

et al. 2017

Progress in Cardiovascular Diseases

129

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“…164 While exercise training remains the cornerstone of cardiac rehabilitation, an additional goal is to identify patients with psychosocial risk factors and to offer stress-management interventions for those in need. 165 Meta-analyses suggest that exercise-based cardiac rehabilitation is effective at reducing cardiovascular risk, 164,166 although there are notable exceptions with null findings (e.g., the large UK RAMIT trial). 167 Exercise training in patients with chronic disease may additionally have stress mitigating effects.…”

Section: Targeted Strategiesmentioning

confidence: 99%

Effects of stress on the development and progression of cardiovascular disease

2017

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Cardiovascular disease remains the leading cause of disease burden globally, which underlies the continuing need to identify new complementary targets for prevention. Over the past 5-10 years, the pooling of multiple data sets into 'mega-studies' has accelerated progress in research on stress as a risk and prognostic factor for cardiovascular disease. Severe stressful experiences in childhood, such as physical abuse and household substance abuse, can damage health and increase the risk of multiple chronic conditions in adulthood. Compared with childhood stress and adulthood classic risk factors, such as smoking, high blood pressure, and high serum cholesterol levels, the harmful effects of stress in adulthood are generally less marked. However, adulthood stress has an important role as a disease trigger in individuals who already have a high atherosclerotic plaque burden, and as a determinant of prognosis and outcome in those with pre-existing cardiovascular or cerebrovascular disease. In real-life settings, mechanistic studies have corroborated earlier laboratory-based observations on stress-related pathophysiological changes that underlie triggering, such as lowered arrhythmic threshold and increased sympathetic activation with related increases in blood pressure, as well as pro-inflammatory and procoagulant responses. In some clinical guidelines, stress is already acknowledged as a target for prevention for people at high overall risk of cardiovascular disease or with established cardiovascular disease. However, few scalable, evidence-based interventions are currently available.

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“…Many meta-analyses demonstrate that participation in CR is associated with improved quality of life, as well as decreased morbidity and mortality [4][5][6][7] . CR is also cost-effective 8 .…”

Section: Accepted M Manuscriptmentioning

confidence: 99%

A Review of Cardiac Rehabilitation Delivery Around the World

Pesah

Supervía

Turk-Adawi

et al. 2017

Progress in Cardiovascular Diseases

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Herein, 28 publications describing cardiac rehabilitation (CR) delivery in 50 of the 113 countries globally suspected to deliver it are reviewed, to characterize the nature of services. Government funding was the main source of CR reimbursement in most countries (73%), with private and patient funding in about ¼ of cases.Myocardial infarction patients and those having revascularization were commonly served. The main professions delivering CR were physicians, nurses, and physiotherapists. Programs offered a median of 20 sessions, although this varied. Most programs offered the core components of exercise training, patient education and nutrition counselling. Alternative models were not commonly offered. Lack of human and/or financial resources as well as space constraints were reported as the major barriers to delivery. Overall, CR delivery has been characterized in less than half of the countries where it is offered. The nature of services delivered is fairly consistent with major CR guidelines and statements.Keywords: cardiac rehabilitation, global health, secondary prevention Alphabetical List of Abbreviations: AS= administrative support CABG = coronary artery bypass graft CB = community-based A C C E P T E D M A N U S C R I P T ACCEPTED MANUSCRIPT2 CR = cardiac rehabilitation CPR= cardiopulmonary resuscitation CVD = cardiovascular disease ECG = electrocardiogram EQ= equipment ET = exercise training FR= financial resources HB = home-based HF = heart failure HR= human resources IA = initial assessment IB = internet-based IHD = ischemic heart disease LMIC = low-and middle-income country MI = myocardial infarction NC = nutrition counseling NZ = New Zealand PAW= patient awareness PCI = percutaneous coronary intervention PE = patient education PR= patient referral RF = risk factor management SC = smoking cessation SM = stress management and/or psychosocial support/counselling TI = transportation issues UAE = United Arab Emirates VAD = ventricular assist device A C C E P T E D M A N U S C R I P T ACCEPTED MANUSCRIPT3 By 2030, it is expected 84 million individuals will be diagnosed with cardiovascular disease (CVD) 1 .Moreover, it is among the leading causes of disability around the world, and contributes to 10% of disabilityadjusted life years lost world-wide 2 . With improved survival (in high-income countries 3 ), clearly there is a great need for secondary prevention, such as is offered in cardiac rehabilitation (CR) programs.Many meta-analyses demonstrate that participation in CR is associated with improved quality of life, as well as decreased morbidity and mortality [4][5][6][7] . CR is also cost-effective 8 . Accordingly, it is a class 1 level A recommendation in clinical practice guidelines for CVD patients 9,10 . 19 , have established guidelines to ensure consistent provision and quality of CR delivery in order to achieve the greatest population health benefits. They all outline the nature of patients indicated for services, and make recommendations regarding the composition of a multi-disciplinary...

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Lessons from contemporary trials of cardiovascular prevention and rehabilitation: A systematic review and meta-analysis

Cited by 148 publications

References 43 publications

Impact of cardiac rehabilitation and exercise training programs in coronary heart disease

Impact of cardiac rehabilitation and exercise training programs in coronary heart disease

Effects of stress on the development and progression of cardiovascular disease

A Review of Cardiac Rehabilitation Delivery Around the World

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