Onset of exercise training 14 days after uncomplicated myocardial infarction: a randomized controlled trial

Aamot, Inger-Lise; Moholdt, Trine; Amundsen, Brage H.; Solberg, Hilde Strøm; Mørkved, Siv; Støylen, Asbjørn

doi:10.1097/hjr.0b013e328333edf9

Cited by 21 publications

(23 citation statements)

References 21 publications

(18 reference statements)

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“…Our study provides insight regarding the views and perceptions of different stakeholders on a topic that is, both in daily practice and in national policies, often determined by non-empirical assessment among a small number of individuals. There is no objective standard for acceptable wait times, other than participation rates [3,4,18,19] and some emerging evidence of a relationship between wait time and peak oxygen consumption achieved [20,21] at this time, but our analysis of the subjective views of these stakeholders has provided important information regarding the appropriateness of the consensus recommendations.…”

Section: Discussionmentioning

confidence: 99%

Perceptions of cardiac rehabilitation patients, specialists and rehabilitation programs regarding cardiac rehabilitation wait times

Grace

Tan

Marcus

et al. 2012

BMC Health Serv Res

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BackgroundIn 2006, the Canadian Cardiovascular Society (CCS) Access to Care Working Group recommended a 30-day wait time benchmark for cardiac rehabilitation (CR). The objectives of the current study were to: (1) describe cardiac patient perceptions of actual and ideal CR wait times, (2) describe and compare cardiac specialist and CR program perceptions of wait times, as well as whether the recommendations are appropriate and feasible, and (3) investigate actual wait times and factors that CR programs perceive to affect these wait times.MethodsPostal and online surveys to assess perceptions of CR wait times were administered to CR enrollees at intake into 1 of 8 programs, all CCS member cardiac specialists treating patients indicated for CR, and all CR programs listed in Canadian directories. Actual wait times were ascertained from the Canadian Cardiac Rehabilitation Registry. The design was cross-sectional. Responses were described and compared.ResultsResponses were received from 163 CR enrollees, 71 cardiac specialists (9.3% response rate), and 92 CR programs (61.7% response rate). Patients reported that their wait time from hospital discharge to CR initiation was 65.6 ± 88.4 days (median, 42 days), while their ideal median wait time was 28 days. Most patients (91.5%) considered their wait to be acceptable, but ideal wait times varied significantly by the type of cardiac indication for CR. There were significant differences between specialist and program perceptions of the appropriate number of days to wait by most indications, with CR programs perceiving shorter waits as appropriate (p < 0.05). CR programs reported that feasible wait times were significantly longer than what was appropriate for all indications (p < 0.05). They perceived that patient travel and staff capacity were the main factors negatively affecting waits. The median wait time from referral to program initiation was 64 days (mean, 80.0 ± 62.8 days), with no difference in wait by indication.ConclusionsWait times following access to cardiac rehabilitation are prolonged compared with consensus recommendations, and yet are generally acceptable to most patients. Wait times following percutaneous coronary intervention in particular may need to be shortened. Future research is required to provide an evidence base for wait time benchmarks.

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Section: Discussionmentioning

confidence: 99%

Perceptions of cardiac rehabilitation patients, specialists and rehabilitation programs regarding cardiac rehabilitation wait times

Grace

Tan

Marcus

et al. 2012

BMC Health Serv Res

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“…Therefore, it is most important to improve cardiopulmonary function and prevent recurrence of myocardial infarction after AMI, and cardiac rehabilitation improves both effectively 3,4. Furthermore, as the period of hospitalization for myocardial infarction becomes shorter and many patients return to their daily life immediately after early discharge, several studies are investigating methods to maximize effects of cardiac rehabilitation programs by applying the programs as early as possible 12,13…”

Section: Discussionmentioning

confidence: 99%

The Impact of Early Regular Cardiac Rehabilitation Program on Myocardial Function after Acute Myocardial Infarction

Kim

Lee

2011

Ann Rehabil Med

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ObjectiveTo determine if an early regular cardiac rehabilitation program would have an adverse effect on myocardial function after acute myocardial infarction (AMI).MethodPatients who received percutaneous coronary intervention (PCI) after AMI were divided into the exercise group and control group in accordance with their willingness to participate. Patients in the exercise group (n=18) received ECG monitored exercise for six weeks and were instructed to maintain self exercise in their communities for four months. The control group (n=16) patients were just instructed of risk factor control. All the subjects underwent echocardiography at the time of the AMI as well as six months later. The echocardiography parameters, including the left ventricular ejection fraction (LVEF), stroke volume (SV), left ventricular end-diastolic diameter (LVEDD) and end-systolic diameter (LVESD), were measured.ResultsIn the exercise group, the LVEF increased to 59.58±9.24% and 61.58±9.63% after six weeks and six months, respectively (p<0.05), but SV, LVEDD and LVESD did not change (p>0.05).ConclusionActive participation in the cardiac rehabilitation program approximately two weeks after AMI did not have an adverse effect on the size of the left ventricle and myocardial function.

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“…Finally, 2 studies randomized patients to an early or later entry CR group. 42,43 Both studies excluded patients who had complications, such as heart failure, or were living far from the CR center. Macchi et al randomized 350 postvalve or CABG surgery patients to a 3-week CR program either early after surgery (mean of 7.8±2.7 days) or later (24.6±2.1 days).…”

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confidence: 99%

Delays in Referral and Enrolment Are Associated With Mitigated Benefits of Cardiac Rehabilitation After Coronary Artery Bypass Surgery

Marzolini

Blanchard

Alter

et al. 2015

Circ: Cardiovascular Quality and Outcomes

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Background-Cardiac rehabilitation (CR) is recommended after coronary artery bypass graft surgery; however, the consequences of longer wait times to start CR have not been elucidated. Method and Results-Cardiopulmonary, demographic, and anthropometric assessments were conducted before and after 6 months of CR in consecutively enrolled patients from January 1995 to October 2012. Wait times were ascertained from referral forms and charts. Neighborhood characteristics were ascertained using census data and cross-referencing with patients' home geographic location. Among 6497 post-coronary artery bypass graft participants, mean and median total wait time (time from surgery to first exercise session) was 101.1±47.9 and 80 days, respectively. In multiple linear regression, correlates of longer total wait time and the 2 wait-time phases, time from surgery to CR referral and time from CR referral to first exercise session, were determined. Factors influencing longer wait times included female sex, greater age, being employed, less social support, longer drive time to CR, lower neighborhood socioeconomic status, higher systolic blood pressure, abdominal obesity, and a complex medical history. After adjusting for correlates of delayed entry, longer wait time for each of the total and 2 wait-time phases was significantly associated with less improvement in cardiopulmonary fitness (VO 2peak ; β=−0.165, P<0.001), body fat percentage (β=0.032, P<0.02), resting heart rate (β=0.066, P<0.001), and poorer attendance to CR classes (β=−0.081, P<0.001) and completion rate (β=2.741, P<0.001). Conclusions-Strategies for timely access to CR at each phase of the process are important given the negative impact that wait time has on key clinical outcomes. This is relevant because optimizing VO 2peak and attendance to CR has been shown to confer a mortality advantage. (Circ Cardiovasc Qual Outcomes. 2015;8:608-620.

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Onset of exercise training 14 days after uncomplicated myocardial infarction: a randomized controlled trial

Abstract: An early start of exercise training did not increase VO2peak compared to 4 weeks of delay. For low-risk patients with high motivation for exercise training, home-based walking is an option as a moderate start of cardiac rehabilitation the first weeks after MI.

Cited by 21 publications

References 21 publications

Perceptions of cardiac rehabilitation patients, specialists and rehabilitation programs regarding cardiac rehabilitation wait times

Perceptions of cardiac rehabilitation patients, specialists and rehabilitation programs regarding cardiac rehabilitation wait times

The Impact of Early Regular Cardiac Rehabilitation Program on Myocardial Function after Acute Myocardial Infarction

Delays in Referral and Enrolment Are Associated With Mitigated Benefits of Cardiac Rehabilitation After Coronary Artery Bypass Surgery

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