How to Reduce Inequity of Access to Cardiac Rehabilitation After Surgical Aortic Valve Replacement. Recommendations for the Post–COVID-19 Era From a Real-World, Population-Based Study

Borsoi, Ludovica; Callea, Giuditta; Tarricone, Rosanna

doi:10.1016/j.clinthera.2022.02.002

Cited by 3 publications

(4 citation statements)

References 50 publications

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“…Research-grade motion sensors, such as wearables, can overcome some of these issues by directly tracking the activity of individuals in their everyday surroundings as they go about their usual activities. The importance of monitoring physical function in AS patients before and soon after AVR is essential for providing appropriate care and support for more frail or deconditioned individuals, optimizing health outcomes, and identifying cardiac rehabilitation opportunities [ 13 ].…”

Section: Introductionmentioning

confidence: 99%

Wearable Activity Trackers Objectively Measure Incidental Physical Activity in Older Adults Undergoing Aortic Valve Replacement

Straiton

Hollings

Gullick

et al. 2023

Sensors

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Background: For older adults with severe aortic stenosis (AS) undergoing aortic valve replacement (AVR), recovery of physical function is important, yet few studies objectively measure it in real-world environments. This exploratory study explored the acceptability and feasibility of using wearable trackers to measure incidental physical activity (PA) in AS patients before and after AVR. Methods: Fifteen adults with severe AS wore an activity tracker at baseline, and ten at one month follow-up. Functional capacity (six-minute walk test, 6MWT) and HRQoL (SF 12) were also assessed. Results: At baseline, AS participants (n = 15, 53.3% female, mean age 82.3 ± 7.0 years) wore the tracker for four consecutive days more than 85% of the total prescribed time, this improved at follow-up. Before AVR, participants demonstrated a wide range of incidental PA (step count median 3437 per day), and functional capacity (6MWT median 272 m). Post-AVR, participants with the lowest incidental PA, functional capacity, and HRQoL at baseline had the greatest improvements within each measure; however, improvements in one measure did not translate to improvements in another. Conclusion: The majority of older AS participants wore the activity trackers for the required time period before and after AVR, and the data attained were useful for understanding AS patients’ physical function.

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Section: Introductionmentioning

confidence: 99%

Wearable Activity Trackers Objectively Measure Incidental Physical Activity in Older Adults Undergoing Aortic Valve Replacement

Straiton

Hollings

Gullick

et al. 2023

Sensors

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“…6,17,18 Among Black patients with HFrEF, referring providers' perception of socioeconomic challenges to CR participation and other race-based conscious and subconscious biases may contribute to lower referral rates. 19,20 Similarly, high travel time and limited availability of CR in rural areas may also limit CR participation among patients living in rural regions leading to lower referral rates. 21,22 This is particularly relevant as prior studies have identified geographic proximity to a CR facility as an important predictor of CR utilization.…”

Section: Discussionmentioning

confidence: 99%

Patterns of Referral and Postdischarge Utilization of Cardiac Rehabilitation Among Patients Hospitalized With Heart Failure: An Analysis From the GWTG-HF Registry

Keshvani

Subramanian

Wrobel

et al. 2023

Circ: Heart Failure

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BACKGROUND: Coverage for cardiac rehabilitation (CR) for patients with heart failure with reduced ejection fraction was expanded in 2014, but contemporary referral and participation rates remain unknown. METHODS: Patients hospitalized for heart failure with reduced ejection fraction (≤35%) in the American Heart Association Get With The Guidelines–Heart Failure registry from 2010 to 2020 were included, and CR referral status was described as yes, no, or not captured. Temporal trends in CR referral were assessed in the overall cohort. Patient and hospital-level predictors of CR referral were assessed using multivariable-adjusted logistic regression models. Additionally, CR referral and proportional utilization of CR within 1-year of referral were evaluated among patients aged >65 years with available Medicare administrative claims data who were clinically stable for 6-weeks postdischarge. Finally, the association of CR referral with the risk of 1-year death and readmission was evaluated using multivariable-adjusted Cox models. RESULTS: Of 69,441 patients with heart failure with reduced ejection fraction who were eligible for CR (median age 67 years; 33% women; 30% Black), 17,076 (24.6%) were referred to CR, and referral rates increased from 8.1% in 2010 to 24.1% in 2020 ( P trend <0.001). Of 8310 patients with Medicare who remained clinically stable 6-weeks after discharge, the CR referral rate was 25.8%, and utilization of CR among referred patients was 4.1% (mean sessions attended: 6.7). Patients not referred were more likely to be older, of Black race, and with a higher burden of comorbidities. In adjusted analysis, eligible patients with heart failure with reduced ejection fraction who were referred to CR (versus not referred) had a lower risk of 1-year death (hazard ratio, 0.84 [95% CI, 0.70–1.00]; P =0.049) without significant differences in 1-year readmission. CONCLUSIONS: CR referral rates have increased from 2010 to 2020. However, only 1 in 4 patients are referred to CR. Among eligible patients who received CR referral, participation was low, with <1 of 20 participating in CR.

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“…Of note, it is important to consider aspects related to COVID-19 pandemic regarding rehabilitation after cardiac valve surgery from two perspectives. One is the problems encountered as to the delivery of rehabilitation during the pandemic, not sufficiently being offered, and the need of evolution of different models of delivery, such as home-based models 11 . On the other hand, from the mechanism-related aspect, there are grounds to speculate that SARS-CoV-2 may attack cardiac valves with the potential to damage cardiac valves warranting examination of heart valves of individuals having recovered from COVID-19, 12 with implications of extended need for rehabilitation.…”

Section: What Are the Implications Of The Cochrane Evidence For Pract...mentioning

confidence: 99%

“…One is the problems encountered as to the delivery of rehabilitation during the pandemic, not sufficiently being offered, and the need of evolution of different models of delivery, such as home-based models. 11 On the other hand, from the mechanism-related aspect, there are grounds to speculate that SARS-CoV-2 may attack cardiac valves with the potential to damage cardiac valves warranting examination of heart valves of individuals having recovered from COVID-19, 12 with implications of extended need for rehabilitation. Although home-based cardiac rehabilitation has been shown to be as effective as center-based rehabilitation in improving clinical and health-related quality of life outcomes after myocardial infarction or revascularization or in heart failure patients, 13 no such evidence is yet available for cardiac rehabilitation after heart valve surgery.…”

Section: What Are the Implications Of The Cochrane Evidence For Pract...mentioning

confidence: 99%

Does Exercise-Based Cardiac Rehabilitation Reduce Mortality and Hospitalization Rates After Heart Valve Surgery?

Akpinar

Oral²

2022

Am J Phys Med Rehabil

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How to Reduce Inequity of Access to Cardiac Rehabilitation After Surgical Aortic Valve Replacement. Recommendations for the Post–COVID-19 Era From a Real-World, Population-Based Study

Cited by 3 publications

References 50 publications

Wearable Activity Trackers Objectively Measure Incidental Physical Activity in Older Adults Undergoing Aortic Valve Replacement

Wearable Activity Trackers Objectively Measure Incidental Physical Activity in Older Adults Undergoing Aortic Valve Replacement

Patterns of Referral and Postdischarge Utilization of Cardiac Rehabilitation Among Patients Hospitalized With Heart Failure: An Analysis From the GWTG-HF Registry

Does Exercise-Based Cardiac Rehabilitation Reduce Mortality and Hospitalization Rates After Heart Valve Surgery?

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