Poor Implementation of Cardiac Rehabilitation Despite Broad Dissemination of Coronary Interventions for Acute Myocardial Infarction in Japan  A Nationwide Survey

Goto, Yoichi; Saito, Muneyasu; Iwasaka, Toshiji; Daida, Hiroyuki; Kohzuki, Masahiro; Ueshima, Kenji; Makita, Shigeru; Adachi, Hitoshi; Yokoi, Hiroyoshi; Omiya, Kazuto; Mikouchi, Hiroshi; Yokoyama, Hiroyuki; Investigators, The Japanese Cardiac Rehabilitation Survey

doi:10.1253/circj.71.173

Cited by 71 publications

(52 citation statements)

References 26 publications

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“…It could offer an efficacious, low-cost alternative to traditional models for PAOD or for other patient populations whose rehabilitation programs are often poorly implemented. 29 Further studies are needed to evaluate its effectiveness when compared to a supervised program by a randomized trial, and its relation to vascular remodelling in PAD.…”

Section: Discussionmentioning

confidence: 99%

Training Rather Than Walking The Test In - Train Out Program for Home-Based Rehabilitation in Peripheral Arteriopathy

Manfredini

Malagoni

Mascoli

et al. 2008

Circ J

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xercise training is an effective, low-cost therapy that improves the functional ability of patients with intermittent claudication. [1][2][3][4] Its diffusion could be favoured by models of intervention that would help ensure functional and cardiovascular improvements, patient compliance and lower costs for the healthcare system.In order to optimise these positive outcomes, the model of intervention and the prescribed exercise intensity are of primary importance. Unfortunately, specific recommendations regarding exercise prescription and programming are limited. 2 However, it is known that exercise is preferably carried out at moderate to near-maximal pain, and that better results are obtained at the hospital under the supervision of the rehabilitative team. These center-based programs for peripheral arterial disease (PAD) have been found to be more effective at improving walking ability in training up to 6 months compared with home-based programs, with unclear effect of supervision. 5,6 On the other hand, home-based programs, which are based on simple instructions about the exercise to be performed (eg, walk up to pain tolerance), in general, show higher long-term adherence to exercise, with lower cost to the healthcare system. 6 An alternative model without supervision, based on the assessment of functional capacity at hospital during monthly check-ups and a personalized prescription of exercise to be performed at home at maximal asymptomatic speed (MAS) has been developed recently. 7,8 This novel approach to rehabilitation for patients with PAD, the 'test in -train out' program (Ti-To), aims to combine the advantages of a traditional home-based program (eg, long-term adherence and lower cost) with those of a supervised program (especially, exercise at selected intensities).The Ti-To program makes use of the MAS; that is, the walking intensity below the individual pain threshold speed (PTS) 9 that combines pain-free training with functional, hemodynamic and cardiovascular adaptations. 7 The present study aimed to test the effectiveness of the Ti-To program on walking ability and hemodynamic parameters in a group of patients exercising at home at their MAS compared with patients following a traditional home-based free walking exercise (Tr-E) at self-selected speeds up to pain tolerance over a 6-month period. Background Exercise training reduces walking disability in peripheral arterial disease (PAD). This non-randomized study evaluates the effects on walking ability and hemodynamic parameters of a novel approach to home-based rehabilitation, the test in -train out program (Ti-To), compared with the traditional home-based free walking exercise (Tr-E). Methods and Results A total of 143 patients with claudication (117 men, average age 68±10 years), were included in a Ti-To (n=83) or Tr-E program (n=60). Evaluations, which were carried out upon entry and at 1, 2, 3, 4 and 6 months, included: self-reported claudication, walking ability (ie, absolute claudication distance, pain threshold speed), resting/exercise hea...

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Section: Discussionmentioning

confidence: 99%

Training Rather Than Walking The Test In - Train Out Program for Home-Based Rehabilitation in Peripheral Arteriopathy

Manfredini

Malagoni

Mascoli

et al. 2008

Circ J

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“…As a final point, the response rate was low in some studies (n=3, 16% <40%) 24,48,78 , and not reported in many others (n=6, 21%) 55,53,60,69,72,73 , and hence caution is warranted in generalizing results from those studies in particular.…”

Section: Accepted Manuscriptmentioning

confidence: 92%

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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“…The rationale and complete design of the questionnaires have been published elsewhere. 12 Questionnaires were sent to a total of 1,875 hospitals including all of 859 "cardiology training hospitals" authorized by the Japanese Circulation Society (JCS), 311 "JCS associated training hospitals" and 705 randomly sampled non-training hospitals. Effective replies were obtained from 1,059 hospitals (56%) including 526 training hospitals (61% of 859 training hospitals), 194 associated hospitals (62% of 311 associated hospitals), and 339 non-training hospitals (48% of 705 non-training hospitals).…”

Section: Methodsmentioning

confidence: 99%

“…12 Indeed, there has not been a multicenter study or nationwide survey on the efficacy and/or safety of CR in Japan.…”

Section: Definition Of Cr Programmentioning

confidence: 99%

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Safety of Exercise-Based Cardiac Rehabilitation and Exercise Testing for Cardiac Patients in Japan

Saito

Ueshima

Saito

et al. 2014

Circ J

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Poor Implementation of Cardiac Rehabilitation Despite Broad Dissemination of Coronary Interventions for Acute Myocardial Infarction in Japan A Nationwide Survey

Cited by 71 publications

References 26 publications

Training Rather Than Walking The Test In - Train Out Program for Home-Based Rehabilitation in Peripheral Arteriopathy

Training Rather Than Walking The Test In - Train Out Program for Home-Based Rehabilitation in Peripheral Arteriopathy

A Review of Cardiac Rehabilitation Delivery Around the World

Safety of Exercise-Based Cardiac Rehabilitation and Exercise Testing for Cardiac Patients in Japan

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