Standard Cardiac Rehabilitation Is Less Effective for Diabetics

Suresh, V; Harrison, Roger; Houghton, Pamela E.; Naqvi, Nayyar

doi:10.1111/j.1742-1241.2001.tb11088.x

Cited by 27 publications

(1 citation statement)

References 21 publications

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“…Furthermore, prior studies cite an improvement in cardiorespiratory fitness to be associated with improved mortality and cardiovascular prognosis. 18,22,23 Although the improvement of exercise capacity between patients with and with no diabetes is highly debated in current literature, [24][25][26][27][28][29] compliance and participation rates are low among DM patients. 30 However, patients with DM who followed up and completed CR improved in functional status and mortality.…”

Section: Patient Safety and Medical Disruptions In Crmentioning

confidence: 99%

Medical Disruptions During Center-Based Cardiac Rehabilitation

Khong

Liu

Giancaterino

et al. 2023

Journal of Cardiopulmonary Rehabilitation and Prevention

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The purpose of this study is to show that with remote and virtual cardiac rehabilitation (CR) care models rapidly emerging, CR core components must be maintained to prioritize safety and effectiveness. Currently, there is a paucity of data on medical disruptions in phase 2 center-based CR (cCR). This study aimed to characterize the frequency and types of unplanned medical disruptions. Methods: We reviewed 5038 consecutive sessions from 251 patients enrolled in cCR program from October 2018 to September 2021. Quantification of events was normalized to sessions to control for multiple disruptions that occurred to a single patient. A multivariate logistical regression model was used to predict comorbid risk factors for disruptions. Results: Fifty percent of patients experienced one or more disruptions during cCR. Glycemic events (71%) and blood pressure (12%) abnormalities accounted for most of these while symptomatic arrhythmias (8%) and chest pain (7%) were less frequent. Sixty-six percent of events occurred within the first 12 wk. The regression model showed that a diagnosis of diabetes mellitus was the strongest predictor for disruptions (OR = 2.66: 95% CI, 1.57-4.52; P < .0001). Conclusions: Medical disruptions were frequent during cCR, with glycemic events being most common and occurring early. A diagnosis of diabetes mellitus was a strong independent risk factor for events. This appraisal suggests that patients living with diabetes mellitus, particularly those on insulin, need to be the highest priority for monitoring and planning and suggests that a hybrid care model may be beneficial in this population.

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Section: Patient Safety and Medical Disruptions In Crmentioning

confidence: 99%

Medical Disruptions During Center-Based Cardiac Rehabilitation

Khong

Liu

Giancaterino

et al. 2023

Journal of Cardiopulmonary Rehabilitation and Prevention

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show abstract

Effects of Cardiac Rehabilitation in Diabetic Patients: Both Cardiac and Noncardiac Factors Determine Improvement in Exercise Capacity

Clair

Mehta

Sacrinty

et al. 2014

Clinical Cardiology

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Background Diabetic patients have a worse prognosis than nondiabetic patients after myocardial infarction. Although exercise improves risk factors, exercise capacity, and mortality, it is still unclear if these benefits are the same as in nondiabetics. Furthermore, although exercise tolerance is predicted by systolic and diastolic dysfunction in nondiabetics, its role as a predictor of exercise capacity in diabetics remains unclear. Hypothesis Diabetics and nondiabetics see a similar improvement in their cardiac risk factors and exercise parameters from exercise‐based cardiac rehabilitation (CR). Methods A series of 370 diabetics and 942 nondiabetics entered a 36‐session outpatient CR program after interventions for coronary heart disease or after bypass or cardiac valve surgery. The program consisted of physical exercise, lifestyle modification, and pharmacotherapy. Results Quality of life, weight, blood pressure, and lipid profiles improved significantly in both groups during the 12‐week program. Baseline metabolic equivalents (METs) were lower in diabetics vs nondiabetics at the start of CR (2.4 vs 2.7, P < 0.001). Although both groups increased their exercise capacity, diabetics had less improvement (change in METs 1.7 vs 2.6, P < 0.001). Significant predictors for improvement after CR included age, sex, and weight, as well as both systolic and diastolic function. After adjustment for these, diabetes remained a significant predictor of reduced improvement in exercise capacity. Conclusions Diabetics saw a significant benefit in quality of life, weight, exercise tolerance, and cardiac risk factors, but to a lesser extent when compared with nondiabetics. The mechanisms for poorer improvement in diabetics following CR also include noncardiac factors and require further study.

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More audit of hospital activity is needed to improve outcomes for patients with diabetes

Lawrenson

2004

Pract Diab Int

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Standard Cardiac Rehabilitation Is Less Effective for Diabetics

Cited by 27 publications

References 21 publications

Medical Disruptions During Center-Based Cardiac Rehabilitation

Medical Disruptions During Center-Based Cardiac Rehabilitation

Effects of Cardiac Rehabilitation in Diabetic Patients: Both Cardiac and Noncardiac Factors Determine Improvement in Exercise Capacity

More audit of hospital activity is needed to improve outcomes for patients with diabetes

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