Effect of Early Enrollment on Outcomes in Cardiac Rehabilitation

Johnson, Dominic; Sacrinty, Matthew; Gomadam, Pallavi; Mehta, Hardik; Brady, Molly; Douglas, Christopher J.; Paladenech, Connie; Robinson, Killian

doi:10.1016/j.amjcard.2014.09.036

Cited by 28 publications

(21 citation statements)

References 9 publications

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“…This seems to fit with a recent study of 1241 CR patients which concluded delayed enrolment is directly related to patient outcome (metabolic equivalent of tasks (METs) and weight improvement). 10 Additional evidence has also suggested that lifestyle changes peak in the first 6 months for patients with ACS patients undergoing exercise and lifestyle interventions, thus timing of CR is critical to optimise response. 18 …”

Section: Discussionmentioning

confidence: 99%

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Does the timing of cardiac rehabilitation impact fitness outcomes? An observational analysis

2016

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ObjectivesTo ascertain the characteristics associated with delayed cardiac rehabilitation (CR) and determine if an association between CR timing and fitness outcomes exists in patients receiving routine care.MethodsThe study used data from the UK National Audit of Cardiac Rehabilitation, a data set which captures information on routine CR practice and patient outcomes. Data from 1 January 2012 to 8 September 2015 were included. Logistic regression models were used to explore the relationship between timing of CR and fitness-related outcomes as measured by patient-reported exercise level (150 min/week: yes/no), Dartmouth quality of life physical fitness scale and the incremental shuttle-walk test.ResultsBased on UK data current CR practice shows that programmes do not always adhere to recommendations on the start of prompt CR, that is, start CR within 28 days of referral (42 days for coronary artery bypass graft (CABG)). Wait time exceeded recommendations in postmyocardial infarction (post-MI), elective percutaneous coronary intervention (PCI), MI-PCI and post-CABG surgery patients. This was particularly pronounced in the medically managed post-MI group, median wait time 40 days. Furthermore, statistical analysis revealed that delayed CR significantly impacts fitness outcomes. For every 1-day increase in CR wait time, patients were 1% less likely to improve across all fitness-related measures (p<0.05).ConclusionsWith the potential for suboptimal patient outcome if starting CR is delayed, efforts should be made to identify and overcome barriers to timely CR provision.

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Section: Discussionmentioning

confidence: 99%

“…9 There is, however, a perception that such delays may not only reduce the chances of enrolment but also the impact of CR, and emerging evidence appears to demonstrate this may be the case. 10–12 …”

Section: Introductionmentioning

confidence: 99%

Does the timing of cardiac rehabilitation impact fitness outcomes? An observational analysis

2016

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“…However, sub-acute and community-based services also suffer from the constant pressure of lengthy waiting lists [ 6 – 9 ]. Delays in access to care for these services have been associated with poorer patient outcomes [ 10 , 11 ], anxiety [ 12 ], and reduced engagement with services [ 13 , 14 ].…”

Section: Introductionmentioning

confidence: 99%

A model of access combining triage with initial management reduced waiting time for community outpatient services: a stepped wedge cluster randomised controlled trial

Harding

Leggat

Watts

et al. 2018

BMC Med

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BackgroundLong waiting times are associated with public community outpatient health services. This trial aimed to determine if a new model of care based on evidence-based strategies that improved patient flow in two small pilot trials could be used to reduce waiting time across a variety of services. The key principle of the Specific Timely Appointments for Triage (STAT) model is that patients are booked directly into protected assessment appointments and triage is combined with initial management as an alternative to a waiting list and triage system.MethodsA stepped wedge cluster randomised controlled trial was conducted between October 2015 and March 2017, involving 3116 patients at eight sites across a major Australian metropolitan health network.ResultsThe intervention reduced waiting time to first appointment by 33.8% (IRR = 0.663, 95% CI 0.516 to 0.852, P = 0.001). Median waiting time decreased from a median of 42 days (IQR 19 to 86) in the control period to a median of 24 days (IQR 13 to 48) in the intervention period. A substantial reduction in variability was also noted. The model did not impact on most secondary outcomes, including time to second appointment, likelihood of discharge by 12 weeks and number of appointments provided, but was associated with a small increase in the rate of missed appointments.ConclusionsBroad-scale implementation of a model of access and triage that combined triage with initial management and actively managed the relationship between supply and demand achieved substantial reductions in waiting time without adversely impacting on other aspects of care. The reductions in waiting time are likely to have been driven, primarily, by substantial reductions for those patients previously considered low priority.Trial registrationAustralian New Zealand Clinical Trials Registry ACTRN12615001016527 registration date: 29/09/2015.

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“…Therefore, an increase in peak aerobic capacity via exercise training is important even for early post-MI patients. Moreover, early initiation of moderate intensity aerobic training may be more beneficial to improve peak aerobic capacity than late initiation (Johnson et al 2014 ). Assessing the effects of aerobic training on muscle deoxygenation can be useful and helpful in understanding the increase in peripheral variables and its relation to increased peak aerobic capacity in MI patients.…”

Section: Introductionmentioning

confidence: 99%

Aerobic training enhances muscle deoxygenation in early post-myocardial infarction

et al. 2016

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PurposeExercise-induced skeletal muscle deoxygenation is startling by its absence in early post-myocardial infarction (MI) patients. Exercise training early post-MI is associated with reduced cardiovascular risk and increased aerobic capacity. We therefore investigated whether aerobic training could enhance the muscle deoxygenation in early post-MI patients.Methods21 ± 8 days after the first MI patients (n = 16) were divided into 12-week aerobic training (TR, n = 10) or non-training (CON, n = 6) groups. Before and after intervention, patients performed ramp bicycle exercise until exhaustion. Muscle deoxygenation was measured at vastus lateralis by near-infrared spectroscopy during exercise.ResultsAerobic training significantly increased peak oxygen uptake (VO2) (18.1 ± 3.0 vs. 22.9 ± 2.8 mL/kg/min), decreased the change in muscle oxygen saturation from rest to submaximal and peak exercise (∆SmO2; 2.4 ± 5.7 vs. −7.0 ± 3.4 %), and increased the relative change in deoxygenated hemoglobin/myoglobin concentration from rest to submaximal (−1.5 ± 2.3 vs. 3.0 ± 3.6 μmol/L) and peak exercise (1.1 ± 4.5 vs. 8.2 ± 3.5 μmol/L). Change in total hemoglobin/myoglobin concentration in muscle was not significantly affected by training. In CON, no significant alterations were found after 12 weeks in either muscle deoxygenation or peak VO2 (18.6 ± 3.8 vs. 18.9 ± 4.6 mL/kg/min). An increase in peak VO2 was significantly negatively correlated with change in ∆SmO2 (r = −0.65) and positively associated with change in ∆deoxy-Hb/Mb at peak exercise (r = 0.64) in TR.ConclusionsIn early post-MI patients, aerobic training enhanced skeletal muscle deoxygenation, and the enhancement was related to increased aerobic capacity.

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Effect of Early Enrollment on Outcomes in Cardiac Rehabilitation

Cited by 28 publications

References 9 publications

Does the timing of cardiac rehabilitation impact fitness outcomes? An observational analysis

Does the timing of cardiac rehabilitation impact fitness outcomes? An observational analysis

A model of access combining triage with initial management reduced waiting time for community outpatient services: a stepped wedge cluster randomised controlled trial

Aerobic training enhances muscle deoxygenation in early post-myocardial infarction

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