Cardiac Rehabilitation and Risk Reduction

Abstract

Atherosclerotic cardiovascular disease (ASCVD) continues to increase annually in the United States along with its associated enormous costs. A multidisciplinary cardiac rehabilitation (CR) and risk reduction program is an essential component of ASCVD prevention and management. Despite the strong evidence for CR in the secondary prevention of ASCVD, it remains vastly underutilized due to significant barriers. The current model of CR delivery is unsustainable and needs significant improvement to provide cost-effective, patient-centered, comprehensive secondary ASCVD prevention.

Loss‐Framed Financial Incentives and Personalized Goal‐Setting to Increase Physical Activity Among Ischemic Heart Disease Patients Using Wearable Devices: The ACTIVE REWARD Randomized Trial

“…IHD patients in this study all met eligibility criteria for cardiac rehabilitation, but only 7.6% reported enrolling in a formal program by the end of the intervention. Nationally, cardiac rehabilitation enrollment rates are suboptimal 8, 10, 11. Although our intervention does not substitute for cardiac rehabilitation, it may be an effective method to increase physical activity in patients who are eligible but do not participate in these programs.…”

“…Regular physical activity reduces the risk of cardiovascular events among patients with IHD 1, 3. For example, participation in exercise‐based cardiac rehabilitation has been demonstrated to reduce mortality by up to 30% 4, 5, 6, 7, 8, 9. However, the majority of eligible patients do not participate in a cardiac rehabilitation program 8, 10, 11.…”

“…For example, participation in exercise‐based cardiac rehabilitation has been demonstrated to reduce mortality by up to 30% 4, 5, 6, 7, 8, 9. However, the majority of eligible patients do not participate in a cardiac rehabilitation program 8, 10, 11. Recent evidence also suggests that IHD patients do not often achieve physical activity goals on their own 12…”

Loss‐Framed Financial Incentives With a Wearable Device for Secondary Prevention of Ischemic Heart Disease: Stepping Up to the Challenge?

“…Wearable devices combined with loss‐framed financial incentives may be a possible home‐based alternative to cardiac rehabilitation, providing patients with the opportunity to receive personalized activity goals. It is notable, however, that only 8 of 105 eligible patients (7.6%) enrolled in cardiac rehabilitation over the study period, an unexpected finding in this relatively affluent urban population with predicted higher levels of enrollment 9. Future studies are, thus, necessary to demonstrate that a home‐based program with wearable devices does not detract from enrollment in a formal rehabilitation program or provides results that are comparable.…”

“…Finally, could the use of wearable devices after an acute myocardial infarction transform long‐term care or potentially lead to unintended harm? As the authors note, most eligible patients do not enroll in cardiac rehabilitation, in part secondary to limited access to health care 9. Wearable devices combined with loss‐framed financial incentives may be a possible home‐based alternative to cardiac rehabilitation, providing patients with the opportunity to receive personalized activity goals.…”