Prioritization, Development, and Validation of American Association of Cardiovascular and Pulmonary Rehabilitation Performance Measures

Pack, Quinn R.; Bauldoff, Gerene; Lichtman, Steven W.; Buckley, Maria L.; Eichenauer, Kent; Gavic, Anne M.; Garvey, Chris; King, Marjorie L.

doi:10.1097/hcr.0000000000000358

Cited by 15 publications

(11 citation statements)

References 21 publications

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“…Our results show that most CR programs are not following guidelines for either ET or exercise intensity. They also demonstrate a significant opportunity to improve the quality and consistency of the exercise we deliver in CR so that more patients meet AACVPR performance measures for improvement in CRF 10…”

Section: Discussionmentioning

confidence: 99%

Exercise Prescription Methods and Attitudes in Cardiac Rehabilitation

Pack

Shea

Brawner

et al. 2022

Journal of Cardiopulmonary Rehabilitation and Prevention

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Section: Discussionmentioning

confidence: 99%

Exercise Prescription Methods and Attitudes in Cardiac Rehabilitation

Pack

Shea

Brawner

et al. 2022

Journal of Cardiopulmonary Rehabilitation and Prevention

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“…37 The HADS is a validated and reliable instrument in research and clinical practice within medical populations, 38 including patients with coronary heart disease, 37 and has been approved for use in the American Association of Cardiovascular and Pulmonary Rehabilitation performance measures. 39 The minimal clinically important difference for the HADS is ≥1.7 points. 40 A 20-question patient feedback questionnaire was developed by scientists and clinicians involved in CR at the UOHI.…”

Section: Outcome Measuresmentioning

confidence: 99%

Sex and Age Differences in Anxiety and Depression Levels Before and After Aerobic Interval Training in Cardiac Rehabilitation

O’Neill

Vidal-Almela

Terada

et al. 2021

Journal of Cardiopulmonary Rehabilitation and Prevention

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The objective of this study was to investigate sex and age differences in anxiety and depression among patients with cardiovascular disease at baseline and following aerobic interval training (AIT)-based cardiac rehabilitation (CR) and secondarily to compare dropout rates between sexes and age groups. Methods: Participants were younger (≤44 yr), middle-aged (45-64 yr), and older adults (≥65 yr). The AIT protocol consisted of: 4 × 4-min of high-intensity work periods at 85-95% peak heart rate (HR) interspersed with 3 min of lower-intensity intervals at 60-70% peak HR, twice weekly for 10 wk. Anxiety and depression were assessed using the Hospital Anxiety and Depression Scale at baseline and following CR. Results: At baseline, of 164 participants (32% female), 14 (35% female) were younger, 110 (33% female) were middle-aged, and 40 (30% female) were older. Older adults reported lower anxiety levels versus younger (4.4 ± 2.6 vs 7.8 ± 3.4 points, P = .008) and middle-aged adults (4.4 ± 2.6 vs 6.1 ± 3.6 points, P = .05). Baseline depression levels did not differ between age groups (P = .749). All age groups experienced a reduction in anxiety (younger = −2.67; middle-aged = −1.40; older = −0.85) and depression (younger = −1.50; middle-aged = −0.83; older = −0.70) levels following CR. Differences in dropout rates were observed between age groups (χ 2 [1] = 13.4, P = .001). Within each age group, 43% (female n = 2, male n = 4) of younger, 10% (female n = 8, male n = 3) of middle-aged, and 2.5% (female n = 0, male n = 1) of older participants dropped out. Conclusions: Younger and middle-aged adults experience higher levels of anxiety upon entry into CR compared with older adults. Cardiac rehabilitation was associated with significant reductions in anxiety and depression severity, yet dropout rates were highest among younger adults.

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“…Nutrition and psychosocial stress levels are difficult to grade and were therefore not routinely monitored and not included in the 2PBM but they are core components of CR 34. Adding the Perceived Stress Scale37 as an outcome measure and depression performance38 would further increase the comprehensibility of the benchmark and might be included in a future version of the 2PBM. Further improvement could be accomplished by checking the reliability of the smoking status by testing carbon monoxide or urinary/serum cotinine 39,40.…”

Section: Discussionmentioning

confidence: 99%

A Comprehensive Secondary Prevention Benchmark (2PBM) Score Identifying Differences in Secondary Prevention Care in Patients After Acute Coronary Syndrome

Haegele

Liu

Frey

et al. 2023

Journal of Cardiopulmonary Rehabilitation and Prevention

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The objective of this study was to quantify secondary prevention care by creating a secondary prevention benchmark (2PBM) score for patients undergoing ambulatory cardiac rehabilitation (CR) after acute coronary syndrome (ACS). Methods: In this observational cohort study, 472 consecutive ACS patients who completed the ambulatory CR program between 2017 and 2019 were included. Benchmarks for secondary prevention medication and clinical and lifestyle targets were predefined and combined in the comprehensive 2PBM score with maximum 10 points. The association of patient characteristics and achievement rates of components and the 2PBM were assessed using multivariable logistic regression analysis. Results: Patients were on average 62 ± 11 yr of age and predominantly male (n = 406; 86%). The types of ACS were STelevation myocardial infarction (STEMI) in 241 patients (51%) and non-ST-elevation myocardial infarction in 216 patients (46%). Achievement rates for components of the 2PBM were 71% for medication, 35% for clinical benchmark, and 61% for lifestyle benchmark. Achievement of medication benchmark was associated with younger age (OR = 0.979: 95% CI, 0.959-0.996, P = .021), STEMI (OR = 2.05: 95% CI, 1.35-3.12, P = .001), and clinical benchmark (OR = 1.80: 95% CI, 1.15-2.88, P = .011). Overall ≥8 of 10 points were reached by 77% and complete 2PBM by 16%, which was independently associated with STEMI (OR = 1.79: 95% CI, 1.06-3.08, P = .032). Conclusions: Benchmarking with 2PBM identifies gaps and achievements in secondary prevention care. ST-elevation myocardial infarction was associated with the highest 2PBM scores, suggesting best secondary prevention care in patients after ST-elevation myocardial infarction.

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Prioritization, Development, and Validation of American Association of Cardiovascular and Pulmonary Rehabilitation Performance Measures

Abstract: We developed and validated 5 new PMs for use in cardiac and pulmonary rehabilitation program quality assessment, improvement, and certification.

Cited by 15 publications

References 21 publications

Exercise Prescription Methods and Attitudes in Cardiac Rehabilitation

Exercise Prescription Methods and Attitudes in Cardiac Rehabilitation

Sex and Age Differences in Anxiety and Depression Levels Before and After Aerobic Interval Training in Cardiac Rehabilitation

A Comprehensive Secondary Prevention Benchmark (2PBM) Score Identifying Differences in Secondary Prevention Care in Patients After Acute Coronary Syndrome

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