Predictors of Early and Late Enrollment in Cardiac Rehabilitation, Among Those Referred, After Acute Myocardial Infarction

Parashar, Susmita; Spertus, John A.; Tang, Fengming; Bishop, Kathy; Vaccarino, Viola; Jackson, Charles F.; Boyden, Thomas F.; Sperling, Laurence

doi:10.1161/circulationaha.111.088799

Cited by 71 publications

(83 citation statements)

References 29 publications

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“…IHD patients in this study all met eligibility criteria for cardiac rehabilitation, but only 7.6% reported enrolling in a formal program by the end of the intervention. Nationally, cardiac rehabilitation enrollment rates are suboptimal 8, 10, 11. Although our intervention does not substitute for cardiac rehabilitation, it may be an effective method to increase physical activity in patients who are eligible but do not participate in these programs.…”

Section: Discussionmentioning

confidence: 96%

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Loss‐Framed Financial Incentives and Personalized Goal‐Setting to Increase Physical Activity Among Ischemic Heart Disease Patients Using Wearable Devices: The ACTIVE REWARD Randomized Trial

Chokshi

Adusumalli

Small

et al. 2018

JAHA

124

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BackgroundRegular physical activity reduces the risk of cardiovascular events, but most ischemic heart disease (IHD) patients do not obtain enough.Methods and ResultsACTIVE REWARD (A Clinical Trial Investigating Effects of a Randomized Evaluation of Wearable Activity Trackers with Financial Rewards) was a 24‐week home‐based, remotely monitored, randomized trial with a 16‐week intervention (8‐week ramp‐up incentive phase and 8‐week maintenance incentive phase) and an 8‐week follow‐up. Patients used wearable devices to track step counts and establish a baseline. Patients in control received no other interventions. Patients in the incentive arm received personalized step goals and daily feedback for all 24 weeks. In the ramp‐up incentive phase, daily step goals increased weekly by 15% from baseline with a maximum of 10 000 steps and then remained fixed. Each week, $14 was allocated to a virtual account; $2 could be lost per day for not achieving step goals. The primary outcome was change in mean daily steps from baseline to the maintenance incentive phase. Ischemic heart disease patients had a mean (SD) age of 60 (11) years and 70% were male. Compared with control, patients in the incentive arm had a significantly greater increase in mean daily steps from baseline during ramp‐up (1388 versus 385; adjusted difference, 1061 [95% confidence interval, 386–1736]; P<0.01), maintenance (1501 versus 264; adjusted difference, 1368 [95% confidence interval, 571–2164]; P<0.001), and follow‐up (1066 versus 92; adjusted difference, 1154 [95% confidence interval, 282–2027]; P<0.01).ConclusionsLoss‐framed financial incentives with personalized goal setting significantly increased physical activity among ischemic heart disease patients using wearable devices during the 16‐week intervention, and effects were sustained during the 8‐week follow‐up.Clinical Trial Registration URL: https://www.clinicaltrials.gov. Unique identifier: NCT02531022.

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Section: Discussionmentioning

confidence: 96%

“…For example, participation in exercise‐based cardiac rehabilitation has been demonstrated to reduce mortality by up to 30% 4, 5, 6, 7, 8, 9. However, the majority of eligible patients do not participate in a cardiac rehabilitation program 8, 10, 11. Recent evidence also suggests that IHD patients do not often achieve physical activity goals on their own 12…”

mentioning

confidence: 99%

Loss‐Framed Financial Incentives and Personalized Goal‐Setting to Increase Physical Activity Among Ischemic Heart Disease Patients Using Wearable Devices: The ACTIVE REWARD Randomized Trial

Chokshi

Adusumalli

Small

et al. 2018

JAHA

124

View full text Add to dashboard Cite

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“…57,296,299,300,307,309 Women particularly absent from CR include the uninsured, unmarried, socioeconomically disadvantaged, smokers, depressed, obese, sedentary, elderly, and nonwhite and those with less education, less social support, and competing family obligations. [310][311][312][313][314][315][316][317] Depressive symptoms are linked to suboptimal CR attendance, and depressed women have a 2-fold increased risk of noncompletion. [318][319][320] Evidence suggests that CR exercise training improves depression in women.…”

Section: Nonpharmacological Treatment Cardiac Rehabilitation Referralmentioning

confidence: 99%

Acute Myocardial Infarction in Women

Mehta¹,

Beckie²,

DeVon³

et al. 2016

Circulation

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910

393

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Cardiovascular disease is the leading cause of mortality in American women. Since 1984, the annual cardiovascular disease mortality rate has remained greater for women than men; however, over the last decade, there have been marked reductions in cardiovascular disease mortality in women. The dramatic decline in mortality rates for women is attributed partly to an increase in awareness, a greater focus on women and cardiovascular disease risk, and the increased application of evidence-based treatments for established coronary heart disease. This is the first scientific statement from the American Heart Association on acute myocardial infarction in women. Sex-specific differences exist in the presentation, pathophysiological mechanisms, and outcomes in patients with acute myocardial infarction. This statement provides a comprehensive review of the current evidence of the clinical presentation, pathophysiology, treatment, and outcomes of women with acute myocardial infarction.

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“…In one prospective study, 29% and 46% of patients participated in CR at 1 month and 6 months, respectively, from time of referral. 90 The proportion of patients referred to CR was observed to vary by 40% in a Canadian medical centre, according to the inpatient unit from which the patient was referred. 91 Importantly, the current model of CR delivery needs significant modification to overcome these barriers.…”

Section: Barriers To Cr and Underutilization Of Comprehensive CV Riskmentioning

confidence: 99%

Comprehensive Cardiovascular Risk Reduction and Cardiac Rehabilitation in Diabetes and the Metabolic Syndrome

Heinl

Dhindsa

Mahlof

et al. 2016

Canadian Journal of Cardiology

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The epidemic of obesity has contributed to a growing burden of metabolic syndrome (MetS) and diabetes mellitus (DM) worldwide. MetS is defined as central obesity along with associated factors such as hypertriglyceridemia, low high-density lipoprotein cholesterol, hyperglycemia, and hypertension. MetS and DM are associated with significant cardiovascular morbidity and mortality. Healthy behavioural modification is the cornerstone for reducing the atherosclerotic cardiovascular disease burden in this population. Comprehensive, multi-disciplinary cardiac rehabilitation (CR) programs reduce mortality and hospitalizations in patients with MetS and DM. Despite this benefit, patients with MetS and DM are less likely to attend and complete CR because of numerous barriers. Implementation of innovative CR delivery models might improve utilization of CR and cardiovascular outcomes in this high-risk population.

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Predictors of Early and Late Enrollment in Cardiac Rehabilitation, Among Those Referred, After Acute Myocardial Infarction

Cited by 71 publications

References 29 publications

Loss‐Framed Financial Incentives and Personalized Goal‐Setting to Increase Physical Activity Among Ischemic Heart Disease Patients Using Wearable Devices: The ACTIVE REWARD Randomized Trial

Loss‐Framed Financial Incentives and Personalized Goal‐Setting to Increase Physical Activity Among Ischemic Heart Disease Patients Using Wearable Devices: The ACTIVE REWARD Randomized Trial

Acute Myocardial Infarction in Women

Comprehensive Cardiovascular Risk Reduction and Cardiac Rehabilitation in Diabetes and the Metabolic Syndrome

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