Clinical and Demographic Trends in Cardiac Rehabilitation: 1996-2015

Abstract

Purpose: Clinical interventions in programs such as cardiac rehabilitation (CR) are guided by clinical characteristics of participating patients. This study describes changes in CR participant characteristics over 20 yr. Methods:To examine changes in patient characteristics over time, we analyzed data from 1996 to 2015 (n = 5396) garnered from a systematically and prospectively gathered database. Linear, logistic, multinomial logistic or negative binomial regression were used, as appropriate. Effects of sex and index diagnosis were considered both as interactions and as additive effects.Results: Analyses revealed that mean age increased (60.7 to 64.2 yr), enrollment of women increased (26.8% to 29.6%), and index diagnosis has shifted; coronary artery bypass surgery decreased (37.2% to 21.6%) while heart valve (HV) repair/replace increased (0 to 11.4%). Risk factors also shifted with increases in body mass index (28.7 vs 29.6 kg/m 2 ), obesity (33.2% to 39.6%), hypertension (51% to 62.5%), type 2 diabetes mellitus (17.3% to 21.7%), and those reporting current smoking (6.6% to 8.4%). Directly measured peak aerobic capacity remained relatively stable throughout. The proportion of patients on statin therapy increased from 63.6% to 98.9% coinciding with significant improvements in lipid levels.Conclusions: Compared to 1996, participants entering CR in 2015 were older, more overweight, and had a higher prevalence of coronary risk factors. Lipid values improved substantially concurrent with increased statin use. While the percentage of female participants increased, they continue to be underrepresented. HV patients now constitute 11.4% of the patients enrolled. Clinical programs need to recognize changing characteristics of attendees to best tailor interventions.

Sex Differences in Cardiac Rehabilitation Outcomes

“…A follow-up study investigated how clinical characteristics of patients enrolled in CR have changed from 1996 to 2015 and found an increase in the prevalence of obesity during this time period. 65 However, no sex differences were present in BMI or frequency of obesity (as indicated by BMI) in patients at CR entry which is consistent with previous studies. 58,65,94–96 The AHA/ACC Secondary Prevention goal for weight management is a BMI of 18.5 to 24.9 kg/m 2 ; however, this goal is one of the least likely to be achieved at CR completion.…”

“…64 Consistent with this, females enrolled in CR generally exhibit a lower VO 2 peak before CR initiation compared with males. 57,58,65 Importantly, numerous studies have reported sex differences in VO 2 peak following CR with females having less of an improvement. [57][58][59]66 For example, Rengo et al 57 recently investigated if sex differences are present in the VO 2 peak improvement following CR programming in 1789 patients.…”

Validity and Reliability of a Brief Dietary Assessment Questionnaire in a Cardiac Rehabilitation Program

“…The Cohen weighted kappa (κw) = 0.71 similarly indicates a good agreement of these tertile rankings. 17 The demographics of our study population are similar in sex, race, weight, and BMI to recently reported larger CR cohorts (a 12 984-member CR cohort in the United States during 2000-2009 19 and a 5396-member cohort 20 in Vermont collected over 20 yr). Participants in this study reported dietary fat composition and fiber intake that are very similar to NHANES dietary intake data reported for 2015-2016 21 but, on average, reported about 300 kcal less energy intake/d and almost half the sodium intake.…”

Implementation of an Appointment‐Based Cardiac Rehabilitation Approach: A Single‐Center Experience

“…Overall, the sex and age demographic distribution of the patients who participated in CR in our study is largely similar to those in previously published studies, with mean age around 65 years and women making up slightly <30% of the patient population. 30 , 31 Patients participating in CR had a high prevalence of cardiac risk factors, with an average of 5.4 physician‐identified risk factors on intake to CR, with the most common being hyperlipidemia and hypertension. In particular, we found that women had a clustering of adverse risk factors and comorbidities: women were older, had poorer control of cardiac risk factors, and were more likely to have a lifestyle with little to no regular exercise, were more likely to be obese, and had higher rates of stress than men.…”

“…A significant number of patients, about 1 in 5, came to CR after receiving cardiac valvular interventions, which reflects the increase in patients in CR with valvular interventions since the Centers for Medicare and Medicaid Services expanded CR coverage to this population in 2006. 31 , 34…”