Performance Measures for Short-Term Cardiac Rehabilitation in Patients of Working Age: Results of the Prospective Observational Multicenter Registry OutCaRe

Abstract

Objective To determine immediate performance measures for short-term, multicomponent cardiac rehabilitation (CR) in clinical routine in patients of working age, taking into account cardiovascular risk factors, physical performance, social medicine, and subjective health parameters and to explore the underlying dimensionality. Design Prospective observational multicenter register study in 12 rehabilitation centers throughout Germany. Setting Comprehensive 3-week CR. Participants Patients (N=1586) ≤65 years of age (mean 53.8±7.3y, 77.1% men) in CR (May 2017-May 2018). Interventions Not applicable. Main Outcome Measures Feasibility, defined by data availability for ≥85% of patients (CR admission and discharge), and modifiability based on pre-post comparison (statistical significance, with P value<.01; standardized effect size≥.35; change by ≥5% points in categorical variables). In addition, latent factors were identified using an exploratory factor analysis (EFA). Results Based on feasibility and modifiability criteria, smoking behavior, lifestyle change behavior, blood pressure, endurance training load, depression in Patient Health Questionnaire-9 (PHQ-9), the 5-item World Health Organization Well-Being Index (WHO-5), physical and mental health and pain scale of the indicators of rehabilitation status-24 (IRES-24), and self-assessed health prognosis proved to be suitable performance measures. As a result of the EFA, 2 solid factors were identified: (1) subjective mental health including PHQ-9, WHO-5, mental health (IRES-24), mental quality of life, and anxiety and (2) physical health including physical quality of life, physical health and pain scale of IRES-24, and self-assessed occupational prognosis. A third factor represents the blood pressure. Conclusions We provide a small set of performance measures, that are essentially based on 3 latent factors (subjective mental health, physical health, blood pressure). These performance measures can represent immediate success of comprehensive CR and be applied easily in clinical practice.

Patient-reported outcomes predict return to work and health-related quality of life six months after cardiac rehabilitation: Results from a German multi-centre registry (OutCaRe)

“…[20] Subsequently, a national multi-centre register study was performed to evaluate the predefined indicators regarding feasibility and modifiability of the CR routine. [21] This paper analyses these parameters in terms of their mid-term predictive value for return to work and HRQL after CR.…”

“…All patients performed a standardised comprehensive CR programme with a regular duration of three to four weeks according to the specifications of the German pension insurance. [21] The programme could be performed in either an inpatient or outpatient setting and consisted of all-day activities including counseling by a cardiologist, risk-factor modification strategies (e.g. patient education on nutritional habits, smoking cessation, physical activity and medication adherence), physician-supervised exercise training and sports therapy (e.g.…”

“…In addition, the feasibility of a parameter as a performance measure was assessed in terms of data availability. [21] Patients were allowed to refrain from answering parts of the questionnaires or individual questions. Missing values were imputed in the statistical models to balance the data.…”

Development of the International Cardiac Rehabilitation Registry Including Variable Selection and Definition Process

“…As per COS-STAD, we also considered the patient voice, by considering variables recommended in the International Consortium for Health Outcome Measurement’s standard set for coronary artery disease ( https://www.ichom.org/portfolio/coronary-artery-disease/ ) and the peer-reviewed literature [ 29 30 ], as well as seeking input from patients in low-resource settings. Finally, we checked that we assess CR quality indicators assessed by CR associations globally identified in a previous review [ 31 32 ], and also assessed whether CR practice guideline recommendations were assessable in the initial potential ICRR variable list by cross-referencing the variable list with recommendations from the highest-quality CR guidelines relevant to low-resource settings [ 33 ], to be used by the World Health Organization (WHO) in their Package of Rehabilitation Interventions for ischemic heart disease [ 34 ].…”

Cardiac Rehabilitation: Patient-Reported Outcomes Are Decisive for Success

“…This resulted in 20 agreed-upon "success parameters" for cardiac rehabilitation (3). These indicators were evaluated in a prospective registry study with 1 586 patients in twelve rehabilitation centers (05/2017 -05/2018) with regard to modifiability during rehabilitation and the predictive power of return to work and healthrelated quality of life at six months after rehabilitation (4,5).…”