The Effects on Functional Capacity and Quality of Life for Participants of a Community Based Cardiac Wellness Program

Abstract

Background: Cardiac rehabilitation (CR) is a proven means of reducing risk and improving quality of life for patients, yet it is grossly under-utilized. This is due to both health system and patient-level issues. Both levels were addressed concurrently in this study, which examined factors affecting verified CR referral and enrollment.Methods: 97 Ontario cardiologists, the most frequent CR referrers, and a subsample of approximately 15 their coronary artery disease (CAD) outpatients each (N ϭ 1490, mean age 65.60 Ϯ 11.44; n ϭ 430, 28.7% female), were surveyed prospectively to explore factors affecting CR referral and enrollment according to Andersen's model of healthcare utilization. 1268 outpatients (90% retention) responded to the follow-up survey assessing CR utilization. Participants' homes and CR sites were mapped by postal code, to generate distances in kilometers to the closest CR site using GIS. CR utilization was verified with 40 CR sites.Results: 550 (43.4%) outpatients were referred, and 469 (37.0%) enrolled in CR. Factors affecting verified referral in hierarchical logistic regression analyses were positive physician perceptions of CR (P ϭ .03), shorter patient distance to the closest CR site (P ϭ .003), fewer perceived CR barriers (P < .001) and personal control (P ϭ .001). Factors affecting verified CR enrollment were being married (P ϭ .01), greater strength of physician endorsement (P ϭ .005), shorter distance to CR (P ϭ .001), and fewer perceived CR barriers (P ϭ .03).Background and Purpose: Regular physical activity is an important means to improve quality of life and reduce mortality in patients with CAD. We designed the CardioFit internet-based expert system to prescribe and track physical activity in patients with CAD who were not intending to participate in cardiac rehabilitation. The purpose of this randomized controlled trial was to compare CardioFit to Usual Care for effects on objectively measured physical activity levels 6 months following hospitalization for acute coronary syndrome. Methods:In a parallel, two-group, post-test only clinical trial, 137 participants were recruited and randomly assigned to either CardioFit (n ϭ 66) or Usual Care (n ϭ 71). The CardioFit group received a personalized physical activity plan while in hospital and access to a secure website for activity planning and tracking. They were asked to complete a series of 5 on-line tutorials over a six month period and were in communication with an on-line coach (trained exercise specialist). The Usual Care group received physical activity guidance from their attending cardiologist. The primary outcome of interest was physical activity measured by pedometer over a 7-day period, 6 months after randomization. Secondary outcomes of interest included 7-day recall of moderate, hard, and very hard intensity leisure time activities. Outcome data were analyzed with analysis of covariance procedures in which site, age, gender, and physical activity prior to hospitalization were used as covariates.Results: At follow-up, the tot...