Cardiac Rehabilitation and Survival in Older Coronary Patients

Suaya, José A.; Stason, William B.; Ades, Philip A.; Normand, Sharon‐Lise T.; Shepard, Donald S.

doi:10.1016/j.jacc.2009.01.078

Cited by 443 publications

(388 citation statements)

References 28 publications

(19 reference statements)

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“…Observational studies with long‐term mortality were sparse and mainly focused on CR participation. Prior studies lack detailed clinical and treatment information, data on severity of medical conditions, and information about other quality of care/risk interventions that patients received, which serve as important factors for CR referral and participation 4, 22, 41, 44. Most prior studies were based on claims databases that do not contain information on CR referral.…”

Section: Discussionmentioning

confidence: 99%

“…Suaya et al used a landmark propensity score analysis as well as 2 instrumental variables derived from the Medicare beneficiary database to estimate the association between CR attendance and mortality. They provided key evidence for a strong inverse association between CR attendance and mortality 22. However, it was unclear how many non‐CR attendance patients did not actually receive CR referral.…”

Section: Discussionmentioning

confidence: 99%

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Sex and Racial Disparities in Cardiac Rehabilitation Referral at Hospital Discharge and Gaps in Long‐Term Mortality

Fonarow

Mukamal

et al. 2018

JAHA

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BackgroundCardiac rehabilitation (CR) referral is recommended for eligible patients, regardless of sex or race. It is unclear whether inequality in CR referral practices was associated with patients’ long‐term survival.Methods and ResultsWe linked the American Heart Association Get With The Guidelines Coronary Artery Disease registry with Medicare claims data for 48 993 coronary artery disease patients from 365 hospitals across the United States between 2003 and 2009. We used generalized estimation equations to estimate the association between CR referral and mortality accounting for clustering within hospitals. Between 2003 and 2009, only 40% of eligible patients received CR referrals. Females were 12% less likely to receive CR referral compared with males. Black, Hispanic, and Asian patients were 20%, 36%, and 50% less likely, respectively, to receive CR referral than white patients. CR referral was associated with 40% lower 3‐year all‐cause mortality. Women and minorities who received CR referral at hospital discharge had significantly lower mortality compared with those who did not (odds ratios=0.61 [95% confidence interval, 0.56–0.66] for women, 0.75 [95% confidence interval, 0.63–0.88] for black, 0.62 [95% confidence interval, 0.50–0.79] for Hispanic, and 0.63 [95% confidence interval, 0.46–0.85] for Asian patients). Seven percent of the black versus white mortality gap could potentially be reduced by equitable CR referral.Conclusions CR referral rates at hospital discharge remained low. Gaps in receiving CR referral at hospital discharge were large for women and minorities, and the mortality gap could potentially be reduced through elimination of inequality in CR referral.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Sex and Racial Disparities in Cardiac Rehabilitation Referral at Hospital Discharge and Gaps in Long‐Term Mortality

Fonarow

Mukamal

et al. 2018

JAHA

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“…De estos últimos pacientes, solamente 30% ingresa a RCV en Europa 8 , 15-25% en Estados Unidos de Norteamérica 10 y menos de 10% en América Latina 11 . Las posibles razones para esto incluyen el escepticismo médico sobre los beneficios de la RCV, la accesibilidad variable, la preferencia por indicar ejercicio en casa y el enfoque prioritario en los procedimientos de revascularización y medicación, por sobre las estrategias de cambios en los estilos de vida 12 . Algunos factores, dependientes del paciente son la falta de voluntad para comprometerse con el elevado número de sesiones de RCV y temas económicos, entre otros [13][14][15][16] .…”

Section: Rehabilitación Cardiovascular Y Ejercicio En Prevención Secuunclassified

Rehabilitación cardiovascular y ejercicio en prevención secundaria

et al. 2013

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L a enfermedad cardiovascular (ECV) es la primera causa de muerte en el mundo. En las últimas décadas, si bien el tratamiento y control de algunos factores de riesgo (FR), como la hipertensión y la dislipidemia, han mejorado, el manejo de otros FR, como el sobrepeso, obesidad y sedentarismo, ha sido menos exitoso.Estudios epidemiológicos han demostrado que la capacidad aeróbica se asocia en forma inversa y significativa a mortalidad cardiovascular y general, tanto en sujetos sanos 1,2 , como en prevención secundaria 3 . Esta relación es consistente y graduada 2,4 e independiente de confusión. Basándose en la evidencia disponible, acerca de los beneficios del ejercicio en la reducción del riesgo de desarrollo y progresión de ECV, se ha recomendado la práctica de actividad física regular como una estrategia para reducir su incidencia.A pesar de los esfuerzos para promover la actividad física, el sedentarismo sigue siendo altamente prevalente en Chile 5 , como en América Latina, Norteamérica y Europa 6 .El objetivo de esta revisión es presentar una actualización sobre rehabilitación cardiovascular (fase II) y ejercicio en prevención cardiovascular secundaria. Rehabilitación cardiovascular y ejercicio en prevención secundariaDebido al avance diagnóstico y terapéutico en ECV, actualmente un mayor número de personas sobrevive a un evento cardiovascular, conllevando a una alta carga de enfermedades crónicas posteriores. Por ello, se requiere un abordaje que apoye al paciente, interviniendo los FR de manera integral, además de controles médicos y terapia farmacológica adecuada. Los programas de rehabilitación cardiovascular (RCV) incluyen estas características, influyendo además en la restauración de la calidad de vida y la mejoría de la capacidad funcional.El rol del ejercicio en sujetos con ECV ha sido estudiado rigurosamente, con sólidos resultados en materia de seguridad, aumento de la capacidad funcional y reducción de la mortalidad cardiovascular y total 7 . La RCV ha sido definida por la Asociación Europea de Prevención y Rehabili-

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“…[9] The application of CR to elderly patients has gained an increasing acceptance, and its benefits and safety have been documented. [10] In spite of this fact, CR is vastly underutilized in the elderly, and particularly in women. [3,11,12] A fear that physical training may not be safe, other than for patients at low risk, has led to many patients being excluded from CR programmes, even though the risk of a cardiovascular event is considered low after both high-intensity-and moderate-intensity exercise in a CR setting.…”

Section: Introductionmentioning

confidence: 99%

Physical activity in women after an acute myocardial infarction

Løvlien

Mundal

Hall‐Lord

2015

JNEP

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Citation for the original published paper (version of record):Løvlien, M., Mundal, L., Hall-Lord, M-L. (2015) Physical activity in women after an acute myocardial infarction.. ABSTRACT Background: Physical activity is recognized as being important in reducing mortality after an acute myocardial infarction. The study aimed to describe younger and older women's leisure time physical activity after an acute myocardial infarction, their motivations and barriers for engaging in physical activity and to assess aspects associated with referral and attendance in cardiac rehabilitation programmes. Methods: Women diagnosed with an acute myocardial infarction were consecutively recruited and answered a questionnaire 2-3 months after hospital discharge. Journal of Nursing Education andResults: The majority of the respondents (86%) were physically active after their acute myocardial infarction and 34% were physically active ≥ 4 days a week for ≥ 30 minutes. Respondents ≥ 66 years were less likely than respondents < 66 years to report moderate physical activity (39% vs. 58%, p = .03) and more likely to report low physical activity (27% vs. 8%, p < .01). No differences were found between these age groups reporting high physical activity (34% vs. 34%). Respondents ≥ 66 years were also less likely than younger respondents to maintain or increase their physical activity after the acute event (59% vs. 76%, p < .01), to be informed about the significance of physical activity while in hospital (61% vs. 80%, p = .01), to be referred to a cardiac rehabilitation programme (49% vs. 75%, p ≤ .01) and to attend such a programme (30% vs. 65%, p < .01). Conclusions: Women's age was associated with physical activity as well as their possibilities regarding cardiac rehabilitation after an acute myocardial infarction.

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Cardiac Rehabilitation and Survival in Older Coronary Patients

Cited by 443 publications

References 28 publications

Sex and Racial Disparities in Cardiac Rehabilitation Referral at Hospital Discharge and Gaps in Long‐Term Mortality

Sex and Racial Disparities in Cardiac Rehabilitation Referral at Hospital Discharge and Gaps in Long‐Term Mortality

Rehabilitación cardiovascular y ejercicio en prevención secundaria

Physical activity in women after an acute myocardial infarction

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