2018 ACC/AHA Clinical Performance and Quality Measures for Cardiac Rehabilitation

Thomas, Randal J.; Balady, Gary J.; Banka, Gaurav; Beckie, Theresa M.; Chiu, Jensen; Gokak, Sana; Ho, P. Michael; Keteyian, Steven J.; King, Marjorie L.; Lui, Karen; Pack, Quinn R.; Sanderson, Bonnie; Wang, Tracy Y.

doi:10.1016/j.jacc.2018.01.004

Cited by 155 publications

(46 citation statements)

References 64 publications

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“…e 6MWT implemented at the commencement and completion of phase 2 CR [41] is routinely denoted and calculated as peak VO2 uptake (peak oxygen uptake); functional capacity has been observed to have been improved with CR. e programs focused on improving the distance walked, i.e., aerobic capacity of patients as an outcome of CR, thereby improving the functional capacity [11].…”

Section: Cr and Functional Capacitymentioning

confidence: 99%

“…Alternately, a retrospective cohort observed a decline in HRQoL presenting a strong association between preoperative and postoperative scores under the physical and mental domains [10]. Following these revascularization procedures, issues of lowered aerobic capacity, levels of physical activity, and quality of life necessitated referrals to cardiac rehabilitation programs as an essential constituent for holistic treatment in patients with CVD [5,7,[10][11][12][13].…”

Section: Introductionmentioning

confidence: 99%

“…Before and after cardiac surgery, the goal of CR is to optimise a patient's functional status and aerobic capacity. Phase 2 CR primarily focuses on testing and improving exercise capacity of the cardiac patient over a period of six weeks after the in-hospital phase (phase 1) [11]. Treatment strategies over time have been modified and various methods of treatment have been incorporated in CR [14].…”

Section: Introductionmentioning

confidence: 99%

“…Performance measures were designed as referrals to CR in the inpatient/outpatient settings, exercise training for heart failure (HF) in both inpatient/outpatient settings, and enrollment in CR through an electronic health record or registry. Time taken to CR patient enrollment, adherence to CR (>36 sessions), communications about adherence, enrollment, and outcomes were categorized as quality measures with a need for testing [11].…”

Section: Introductionmentioning

confidence: 99%

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Impact of Cardiac Rehabilitation on Functional Capacity and Physical Activity after Coronary Revascularization: A Scientific Review

Prabhu

Maiya

2020

Cardiology Research and Practice

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Background. Coronary revascularization procedures often cause lowered exercise capacity and declining physical activity levels. These outcomes are paramount in predicting morbidity and mortality after these procedures. Cardiac rehabilitation (CR) focuses on incrementing cardiovascular endurance, exercise capacity, muscle strength, levels of physical activity, and quality of life through health education and lifestyle modification in post-coronary revascularization patients. Objective. To review the impact of cardiac rehabilitation on functional capacity, levels of physical activity, and health related quality of life in patients following coronary revascularization. Methods. A structured literature search in PubMed, Scopus, CINAHL, and ProQuest for studies focused on CR and its effects on functional capacity, physical activity, and quality of life after coronary revascularization. Results. A total of 2,010 studies were retrieved. Deduplication and eligibility screening included 190 studies after the application of filters. A sum of 21 studies were considered for this review. Most studies reported that exercise and physical activity programs were centre-based and home-based and via telerehabilitation. Treadmill and cycle ergometry training with callisthenics and flexibility exercises in phase 2 CR exhibited significant improvement in functional capacity and physical activity levels in patients after coronary revascularization procedures. Conclusion. Although centre-based supervised CR programs do improve functional capacity after coronary revascularization, home-based or telerehabilitation-based CR programs are feasible, improve patient compliance in improving physical activity, and thereby increase functional capacity. Patient education improves levels of physical activity, health related quality of life, and adherence to home- and centre-based CR programs.

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Section: Cr and Functional Capacitymentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Impact of Cardiac Rehabilitation on Functional Capacity and Physical Activity after Coronary Revascularization: A Scientific Review

Prabhu

Maiya

2020

Cardiology Research and Practice

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“…Both the control and WMI groups participated in a CR programme in a rural community following PCI or CABS at a tertiary medical centre. All CR programmes, including CR programmes in this study, provide care based on national standards set forth by the American Association of Cardiovascular and Pulmonary Rehabilitation (AACVPR; Thomas et al, 2010;Thomas et al, 2018). The 12-week WMI was initiated within 2 weeks after cardiac revascularisation.…”

Section: Designmentioning

confidence: 99%

Weight management telehealth intervention for overweight and obese rural cardiac rehabilitation participants: A randomised trial

Barnason

Zimmerman

Schulz

et al. 2019

Journal of Clinical Nursing

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Aims and Objectives To determine whether a weight management intervention (WMI) plus cardiac rehabilitation (CR) compared to CR alone improves outcomes for overweight and obese cardiac revascularisation patients. Background Despite participating in cardiac rehabilitation (CR), few cardiac patients lose enough weight to achieve clinically significant cardiovascular disease risk reduction. Design A randomised controlled design was used with measurements at baseline, 4 and 6 months, guided by the CONSORT checklist, see Supporting Information File S1. Adults who had undergone either coronary artery bypass surgery (CABS) or percutaneous coronary intervention (PCI) and participated in a rural CR programmes were recruited. Subjects were randomised to a 12‐week telehealth WMI or control group. The primary outcome was weight loss. Secondary outcomes included physical activity, patient activation, perceived self‐efficacy and use of weight management behaviours. Results A total of 43 subjects participated, with a mean age of 63 (±9.3) years. The WMI group had significantly more weight loss averaged across the 4 and 6 months of 13.8 (±2.8) pounds compared to the control group [mean = 7.8 (±2.2) pounds]. There were no significant differences in physical activity (activity counts or daily minutes in moderate or more intense activity). The WMI group had significantly higher levels of patient activation. They also had significantly higher total scores on the Diet and Exercise Self‐Management survey, and subscales that included self‐efficacy for specific eating habits and managing diet behaviour. Conclusions Findings demonstrated the usefulness and feasibility of using telehealth delivery of the WMI for cardiac rehabilitation participants in rural communities to improve weight management outcomes. Relevance to Practice Study findings underscore the opportunity to further improve weight loss of overweight and obese cardiac participants using a weight management intervention to augment CR participation.

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Association of Cardiac Rehabilitation With Decreased Hospitalization and Mortality Risk After Cardiac Valve Surgery

et al. 2019

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IMPORTANCE National guidelines recommend cardiac rehabilitation (CR) after cardiac valve surgery, and CR is covered by Medicare for this indication. However, few data exist regarding current CR enrollment after valve surgery.OBJECTIVE To characterize CR enrollment after cardiac valve surgery and its association with outcomes, including hospitalizations and mortality. DESIGN, SETTING, AND PARTICIPANTS This cohort study of patients undergoing valve surgery was conducted in calendar year 2014, with follow-up through 2015. The study included all fee-for-service Medicare beneficiaries undergoing open cardiac valve surgery in 2014. Patients identified by inpatient diagnosis codes for open aortic, mitral, tricuspid, and pulmonary valve surgery were included. Data analysis occurred from January 2018 to March 2019. EXPOSURES Logistic regression was used to evaluate sociodemographic and clinical factors associated with CR enrollment. MAIN OUTCOMES AND MEASURES We used Andersen-Gill models to evaluate the association of CR enrollment with 1-year hospitalization risk and Cox regression models to evaluate the association of CR enrollment with 1-year mortality risk. RESULTS A total of 41 369 Medicare beneficiaries (median [interquartile range] age, 73 [68-79] years; 16 935 [40.9%] female) underwent open valve surgery in the United States in 2014. Fewer than half of patients (17 855 [43.2%]) who had valve surgery enrolled in CR programs. Several racial/ethnic groups had lower odds of enrolling in CR programs after valve surgery compared with white patients, including Asian patients (odds ratio [OR], 0.36 [95% CI, 0.28-0.47]), black patients (OR, 0.60 [95% CI, 0.54-0.67]), and Hispanic patients (OR, 0.36 [95% CI, 0.28-0.46]). Patients undergoing concomitant coronary artery bypass grafting had higher odds of CR enrollment (OR, 1.26 [95% CI,) than those without the concomitant coronary artery bypass graft procedure, as did patients in the Midwest census region (OR, 2.40 [95% CI, 2.28-2.54]) compared with those in the South (reference). Cardiac rehabilitation enrollment was associated with fewer hospitalizations within 1 year of discharge (hazard ratio, 0.66 [95% CI, 0.63-0.69] after multivariable adjustment). Enrollment was also associated with a 4.2% absolute decrease in 1-year mortality risk (hazard ratio, 0.39 [95% CI, 0.35-0.44] after multivariable adjustment).CONCLUSIONS AND RELEVANCE Fewer than half of Medicare beneficiaries undergoing cardiac valve surgery enroll in CR programs, and there are marked racial/ethnic disparities among those that do. Cardiac rehabilitation is associated with decreased 1-year cumulative hospitalization and mortality risk after valve surgery. These results invite further study on barriers to CR enrollment in this population.

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2018 ACC/AHA Clinical Performance and Quality Measures for Cardiac Rehabilitation

Cited by 155 publications

References 64 publications

Impact of Cardiac Rehabilitation on Functional Capacity and Physical Activity after Coronary Revascularization: A Scientific Review

Impact of Cardiac Rehabilitation on Functional Capacity and Physical Activity after Coronary Revascularization: A Scientific Review

Weight management telehealth intervention for overweight and obese rural cardiac rehabilitation participants: A randomised trial

Association of Cardiac Rehabilitation With Decreased Hospitalization and Mortality Risk After Cardiac Valve Surgery

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