Cardiac rehabilitation effectiveness for coronary artery disease by clinical era: trial sequential analysis

Oliveros, María-José; Serón, Pamela; Buitrago-Garcia, D.; Grace, Sherry L.

doi:10.1093/eurjpc/zwaa110

Cited by 3 publications

(4 citation statements)

References 9 publications

(12 reference statements)

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“…Similarly, Argentina and Colombia showed declines of 51% and 6.5%, respectively. However, despite this declining trend, interventions such as cardiac rehabilitation have been shown to be effective reducing cardiovascular mortality, even in the angioplasty era (RR = 0.48; 95% CI 0.28-0.83) (Oliveros et al, 2022a). On the contrary, in some countries such as Mexico the mortality rate increases in 61% (Arroyo-Quiroz et al, 2020).…”

Section: Introductionmentioning

confidence: 99%

A hybrid exercise-based cardiac rehabilitation program is an effective strategy to improve muscle strength and functional exercise capacity in adults and older people with coronary artery disease

Marzuca‐Nassr

Serón²,

Román³

et al. 2022

Front. Physiol.

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Coronary heart disease is the most common cause of death worldwide. Standard cardiac rehabilitation (face-to-face sessions) has shown benefits in increasing muscle strength and functional exercise capacity in adults and older people. However, it is unknown whether hybrid cardiac rehabilitation (a first face-to-face phase + a second remote monitoring phase) will have similar benefits in adults versus older subjects. The aim of this study was to compare the effects of a hybrid exercise-based cardiac rehabilitation program on muscle strength and functional exercise capacity in “adult” versus “older” people with coronary artery disease. We hypothesized that a hybrid exercise-based cardiac rehabilitation program would improve muscle strength and functional exercise capacity, but the impact would be smaller in the older group than the adult individuals. This study is part of a larger project (The Hybrid Cardiac Rehabilitation Trial-HYCARET). We subjected 22 adult (<60 y) females and males (ADULT; n = 5/17 (f/m); 52 ± 5 y; 28.9 ± 3.4 kg·m-2) and 20 older (≥60 y) females and males (OLDER; n = 6/14 (f/m); 66 ± 4 y; 27.4 ± 3.9 kg·m-2) with coronary artery disease to 12 weeks of hybrid exercise-based cardiac rehabilitation program. Prior to and after 12 weeks of a hybrid exercise-based cardiac rehabilitation program, grip strength (handgrip), leg strength (chair stand test), and functional exercise capacity (6-minute walk test, 6MWT) were assessed. The hybrid exercise-based cardiac rehabilitation program resulted in a 9.4 ± 14.6% and a 6.2 ± 12.1% grip strength increase, a 14.4 ± 39.4% and a 28.9 ± 48.1% legs strength increase, and a 14.6 ± 26.4% and a 6.8 ± 14.0% functional exercise capacity improvement in ADULT and OLDER, respectively (p < 0.05) with no differences between groups. In conclusion, a hybrid exercise-based cardiac rehabilitation program could increase muscle strength and improve functional exercise capacity in adults and older people with coronary artery disease. More future studies comparing effectiveness among these age groups are needed to strengthen this conclusion.

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Section: Introductionmentioning

confidence: 99%

A hybrid exercise-based cardiac rehabilitation program is an effective strategy to improve muscle strength and functional exercise capacity in adults and older people with coronary artery disease

Marzuca‐Nassr

Serón²,

Román³

et al. 2022

Front. Physiol.

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“…Благодаря достижениям современной медицины больным открыт широкий доступ к методам реваскуляризации миокарда (тромболизису, ЧКВ), что позволяет достигать лучших результатов. На основании этого некоторые исследователи выдвигают тезис о том, что КР может оказывать меньшее влияние на клинические исходы в эпоху современного лечения, хотя Кокрейновский обзор Anderson [31]. Была поставлена цель -оценить эффективность КР в разные периоды: в эру посттромболизиса (РКИ с 1990-х гг), в эру пост-ангиопластики (РКИ с 2000-х гг) и суммарный эффект РКИ разных периодов.…”

Section: эффекты кр на сердечно-сосудистые события в разных странах с...unclassified

Clinical effects of training programs in cardiac rehabilitation. Experience from different countries

Aronov,

Bubnova

2024

Cardiovasc Ther Prev

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“…4 Despite advancements in medical care, CR's benefits, including cost-effectiveness, persist. 5,6 Despite this evidence, CR remains underused globally, with only 55% of countries offering a CR program. 7 Also, access to CR varies widely, with lower-resource regions, such as Latin America, experiencing lower rates.…”

Section: Introductionmentioning

confidence: 99%

“…A Cochrane review indicated that CR was associated with reduced likelihood of a second heart attack by 7% and hospitalization risk by 23% compared with standard care and with significant improvements in health-related quality of life (HRQOL) . Despite advancements in medical care, CR’s benefits, including cost-effectiveness, persist …”

Section: Introductionmentioning

confidence: 99%

Hybrid Cardiac Rehabilitation Program in a Low-Resource Setting

Seron,

Oliveros,

Marzuca-Nassr

et al. 2024

JAMA Netw Open

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ImportanceWhile effective, cardiovascular rehabilitation (CR) as traditionally delivered is not well implemented in lower-resource settings.ObjectiveTo test the noninferiority of hybrid CR compared with traditional CR in terms of cardiovascular events.Design, Setting, and ParticipantsThis pragmatic, multicenter, parallel arm, open-label randomized clinical trial (the Hybrid Cardiac Rehabilitation Trial [HYCARET]) with blinded outcome assessment was conducted at 6 referral centers in Chile. Adults aged 18 years or older who had a cardiovascular event or procedure, no contraindications to exercise, and access to a mobile telephone were eligible and recruited between April 1, 2019, and March 15, 2020, with follow-up until July 29, 2021.InterventionsParticipants were randomized 1:1 in permuted blocks to the experimental arm, which received 10 center-based supervised exercise sessions plus counseling in 4 to 6 weeks and then were supported at home via telephone calls and text messages through weeks 8 to 12, or the control arm, which received the standard CR of 18 to 22 sessions with exercises and education in 8 to 12 weeks.Main Outcomes and MeasuresThe primary outcome was cardiovascular events or mortality. Secondary outcomes were quality of life, return to work, and lifestyle behaviors measured with validated questionnaires; muscle strength and functional capacity, measured through physical tests; and program adherence and exercise-related adverse events, assessed using checklists.ResultsA total of 191 participants were included (mean [SD] age, 58.74 [9.80] years; 145 [75.92%] male); 93 were assigned to hybrid CR and 98 to standard CR. At 1 year, events had occurred in 5 unique participants in the hybrid CR group (5.38%) and 9 in the standard CR group (9.18%). In the intention-to-treat analysis, the hybrid CR group had 3.80% (95% CI, –11.13% to 3.52%) fewer cardiovascular events than the standard CR group, and relative risk was 0.59 (95% CI, 0.20-1.68) for the primary outcome. In the per-protocol analysis at different levels of adherence to the intervention, all 95% CIs crossed the noninferiority boundary (eg, 20% adherence: absolute risk difference, −0.35% [95% CI, −7.56% to 6.85%]; 80% adherence: absolute risk difference, 3.30% [95% CI, −3.70% to 10.31%]). No between-group differences were found for secondary outcomes except adherence to supervised CR sessions (79.14% [736 of 930 supervised sessions] in the hybrid CR group vs 61.46% [1201 of 1954 sessions] in the standard CR group).Conclusions and RelevanceThe results suggest that a hybrid CR program is noninferior to standard center-based CR in a low-resource setting, primarily in terms of recurrent cardiovascular events and potentially in terms of intermediate outcomes. Hybrid CR may induce superior adherence to supervised exercise. Clinical factors and patient preferences should inform CR model allocation.Trial RegistrationClinicalTrials.gov Identifier: NCT03881150

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Cardiac rehabilitation effectiveness for coronary artery disease by clinical era: trial sequential analysis

Cited by 3 publications

References 9 publications

A hybrid exercise-based cardiac rehabilitation program is an effective strategy to improve muscle strength and functional exercise capacity in adults and older people with coronary artery disease

A hybrid exercise-based cardiac rehabilitation program is an effective strategy to improve muscle strength and functional exercise capacity in adults and older people with coronary artery disease

Clinical effects of training programs in cardiac rehabilitation. Experience from different countries

Hybrid Cardiac Rehabilitation Program in a Low-Resource Setting

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