Sex Differences in Cardiac Rehabilitation Enrollment: A Meta-analysis

Background

The present systematic review and meta-analysis examines studies published in the past 10 years that described cardiac rehabilitation (CR) enrollment among women and men, to determine whether a significant sex difference persists despite the evidence supporting the benefits of CR to women as well as men.

Methods

Scopus, MEDLINE, CINAHL, PsycINFO, PubMed, and The Cochrane Library databases were systematically searched for peer-reviewed articles published from July 2000 to July 2011. Titles and abstracts were screened, and the 623 selected full-text articles were independently screened based on predefined inclusion/exclusion criteria (guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses; PRISMA) and assessed for quality using the Strengthening the Reporting of Observational studies in Epidemiology (STROBE) statement form. The meta-analysis was undertaken using Review Manager software.

Results

Twenty-six eligible observational studies reporting data for 297,719 participants (128,499 [43.2%] women) were included. On average, 45.0% of men and 38.5% of women enrolled in CR. In the pooled analysis, men were more likely to be enrolled in CR compared with women (female enrollment vs male enrollment odds ratio, 0.64; 95% confidence interval, 0.57-0.72; P < 0.00001). Heterogeneity was considered high (I² = 78%). In the subgroup analyses, systematic CR referral during inpatient tertiary care resulted in significantly greater enrollment among women than nonsystematic referral.

Conclusions

Overall, rates of CR enrollment among women are significantly lower compared with men, with women being 36% less likely to enroll in a rehabilitation program.     

Referral,Enrollment, and Delivery of Cardiac Rehabilitation for Women

Coronary heart disease is the leading killer of women worldwide. Empirical literature documents substantial morbidity and mortality benefits for cardiac rehabilitation participants. Scientific advances have informed the development of evidence-based guidelines for improving the delivery of cardiac rehabilitation yet persistent themes surrounding the substandard referral and utilization rates by women continue unabated in the literature. This review provides an update of the current status of cardiac rehabilitation for women, including a brief overview of the latest findings regarding the unique presentations of heart disease in women. An innovative secondary prevention program, designed exclusively for women is described, and illustrates an attempt to modify a contemporary traditional cardiac rehabilitation program to improve attendance rates and health outcomes in women. Future research with large, diverse samples of women are essential for guiding gender-appropriate referral strategies, effective modifications to traditional center-based programs, and the efficacy of alternative cardiac rehabilitation care models for women.     

The Effect of Cardiac Rehabilitation and a Specialized Clinic on Outcomes of Patients With Atrial Fibrillation

Background

Cardiac rehabilitation (CR) intervention programs are currently not part of management in patients with atrial fibrillation (AF). We sought to determine the effect of CR compared with a specialized AF clinic (AFC) and usual care on outcomes in patients with AF.

The Effect of Cardiac Rehabilitation Attendance on Sexual Activity Outcomes in Cardiovascular Disease Patients: A Systematic Review

Background

Decreased sexual activity (SA) is a common problem in patients with cardiovascular disease (CVD). Although there is evidence that cardiac rehabilitation (CR) is effective in improving physical outcomes and overall quality of life, its effects on SA remain unclear. In this systematic review we assessed the association between CR attendance and SA outcomes in adults with CVD.

Significance of Comorbid Psychological Stress and Depression on Outcomes After Cardiac Rehabilitation

Background

Depression is associated with increased mortality in stable coronary heart disease. Cardiac rehabilitation and exercise training has been shown to decrease depression, psychological stress, and mortality after a coronary heart disease event. The presence of depression at completion of cardiac rehabilitation and exercise training is associated with increased mortality. However, it is unknown if depression with comorbid psychological risk factors such as anxiety or hostility confers an additional mortality disadvantage. We evaluated the mortality effect of anxiety and hostility on depression after cardiac rehabilitation and exercise training.

Patients and Methods

We studied 1150 patients with coronary heart disease following major coronary heart disease events who had completed formal cardiac rehabilitation and exercise training. Using Kellner questionnaires, stress levels were measured in 1 of 3 domains: anxiety, hostility, and depression (with an aggregated overall psychological stress score) and divided into 3 groups: nondepressed (n = 1072), depression alone (n = 18), and depression with anxiety or hostility (n = 60). Subjects were analyzed for all-cause mortality over 161 months of follow-up (mean 6.4 years) by National Death Index.

Results

Depression after cardiac rehabilitation was not common (6.8%; mortality 20.8%) but when present, frequently associated with either anxiety or hostility (77% of depressed patients; mortality 22.0%). After adjustment for age, sex, ejection fraction, and baseline peak oxygen consumption, depression alone (hazard ratio [HR] 1.73, P = .04), as well as depression with comorbid psychological stress, was associated with higher mortality (HR 1.98, P = .03). Furthermore, our data showed an increased mortality when both anxiety and hostility were present in addition to depression after cardiac rehabilitation (HR 2.41, P = .04).

Conclusions

After cardiac rehabilitation, depression, when present, is usually associated with other forms of psychological stress, which confers additional mortality. More measures are needed to address psychological stress after cardiac rehabilitation.     

Physician Factors Affecting Cardiac Rehabilitation Referral and Patient Enrollment: A Systematic Review

Physicians play an important role in CR referral and enrollment. Despite established benefits and recommendations, cardiac rehabilitation (CR) enrollment rates are pervasively low. The reasons cardiac patients are missing from CR programs are multifactorial and include provider factors. A number of studies have now investigated physician factors associated with referral to CR programs and patient enrollment. The objective of this study was to qualitatively and systematically review this literature. A literature search of MEDLINE, PsycINFO, CINAHL, Embase, and EBM was conducted for published articles from database inception to October 2011. Overall, 17 articles were included following a process of independent review of each article by 2 authors. Seven (41.2%) were graded as good quality according to Downs and Black criteria. There were no randomized controlled trials. Results showed that medical specialty (ie, cardiac specialists more likely to refer; n = 8 studies) and other physician‐reported reasons (eg, physician report of their reasons for CR referral and physician sex) were related to referral. Physician factors related to patient enrollment in CR were physician endorsement, medical specialty, being referred, and physician attitudes toward CR. Physician factors are consistently related to CR referral and enrollment. The role of physician endorsements in promoting patient enrollment should be optimized and exploited.     

早期康复对心脏重症患者的作用及安全性分析研究

【摘要】 目的 探讨早期康复对心脏重症患者的短期临床作用和安全性。方法 选择2019年6月至2020年5月间在阜外华中心血管病医院心脏重症监护室(Cardiac Intensive Care Unit, CICU)接受机械通气治疗的患者63例,按患者出生月份单双数随机分为两组：对照组（32例）：进行常规的心脏重症监护与诊治;观察组（31例）：除常规监护与诊治外,进行基于无创心排量评估的早期康复治疗。分别统计两组的机械通气时间、每搏输出量（stroke volume, SV）、心输出量（cardiac output, CO）、心指数（cardiac index, CI）、肺炎发生率和不良事件发生率。结果 通过对比,观察组的机械通气时间明显缩短[(21.48±2.13) vs. (29.09±3.65),p<0.05];肺炎发生率明显下降[3.2% vs. 15.6%,p<0.05];出CICU时每搏输出量（SV）[(56.38±3.36) vs. (53.85±3.89),p<0.05]、心输出量（CO）[(4.82±1.14) vs. (3.90±1.23),p<0.05]和心指数（CI）[(3.62±1.36) vs. (3.01±1.24),p<0.05]均明显提高,差异具有统计学意义;两组间不良事件发生率[1.0% vs. 0,p>0.05]差异无统计学意义。结论 早期康复对心脏重症患者安全有效,促进心脏功能恢复,值得在临床推广。     

Long-term Enrollment in Cardiac Rehabilitation Benefits Cardiorespiratory Fitness and Skeletal Muscle Strength in Men With Cardiovascular Disease

BackgroundDespite known associations between fitness and recurrent cardiovascular events, changes in cardiorespiratory fitness (CRF) and muscle strength with long-term cardiac rehabilitation (CR) have not been extensively examined. The objectives of this study were to (1) examine changes in CRF and muscle strength associated with long-term CR program enrollment in men, and (2) compare these changes to previously published rates of decline (2.0% per year for CRF and 2.36% per year for muscle strength in healthy age-matched individuals).MethodsData were extracted from the program charts of 160 men (64 ± 9 years) who were enrolled ≥ 1 year in a maintenance-phase CR program and who completed ≥ 2 exercise tests. CRF was represented by peak oxygen consumption (VO_2peak, mL/min/kg). The skeletal muscle strength was assessed using 1-repetition maximum tests for chest press, seated row, and knee extension. Mixed model analyses with polynomial functions were used to determine changes in CRF (up to 5.5 years) and muscle strength (up to 10 years).ResultsCRF increased nonlinearly up to 3 years (range, 0.33%-3.23% per year) and then declined nonlinearly to the 5.5-year endpoint (range, 1.03%-2.59% per year). Chest press and seated row strength declined at < 1% per year over 10 years, whereas knee extension increased nonlinearly by 0.18%-1.40% per year from baseline until 4 years and then declined nonlinearly at 1.00%-3.58% per year until the 10-year endpoint. All declines were similar to literature rates.ConclusionsThe results indicate that significant health benefits are associated with maintenance-phase CR programs for men. Enrollment was associated with preserved CRF and lower body muscle strength for 3-4 years.     

早期康复护理干预对脑卒中吞咽功能障碍患者的影响

目的探讨早期康复护理干预对脑卒中吞咽功能障碍患者的影响,旨在为患者的快速康复寻求有效护理方法。方法将本科2010年8月—2011年4月收治的120例脑卒中患者,随机分为观察组和治疗组,各60例。对照组采用神经内科常规治疗和护理;观察组在对照组常规护理基础上,病情稳定时给予早期康复护理干预,比较两组患者康复情况。结果观察组总有效率为91.67%;对照组总有效率为68.33%。两组比较差异有统计学意义(P<0.05)。结论早期康复护理干预能提高脑卒中吞咽功能障碍患者的康复率,提高患者的生活质量。     

Cardiac Rehabilitation in India

Cardiovascular diseases (CVDs) are the leading cause of death and disability in India. Moreover, mortality following an acute myocardial infarction is high, which may be due to gaps in secondary prevention in general and a lack of cardiac rehabilitation (CR) services in particular. This review discusses the availability of CR in India, its putative role in reducing adverse outcomes over the long-term and suggests a road map for future research to enhance CR in this country. Currently, there is limited evidence, conducted in India, demonstrating CR efficacy. Moreover, there is currently limited availability of outpatient CR programs in India. Even so, there is consensus that CR is effective and essential in the CVD population. Therefore, efforts are needed to continue CR research in India and facilitate clinical implementation.     

Cardiac Rehabilitation in Europe

Cardiovascular disease (CVD) remains the main cause of death for men in most European countries, and in all for women. While mortality rates have been declining in most countries, hospital discharge for CVD has been stable since 2004, increasing the pool of patients eligible for cardiac rehabilitation (CR). The physical rehabilitation of patients with CVD has been practiced in Europe to varying degrees since the early 1970s with most countries now engaged in Phase I through Phase III programs. Funding for CR comes from a variety of sources including patient pay, private insurance, retirement and/or obligatory and governmental subsidy. CR is practiced based on best available evidence but participation rates range between 30–50% of eligible patients. Participation rates present one of several challenges and opportunities for future research in Europe, along with assessment of long-term CR outcomes and better extension to primary prevention.     

Outcomes in a Community-Based Intensive Cardiac Rehabilitation Program: Comparison with Hospital-Based and Academic Programs

Background

The purpose of this study was to test the hypothesis that a community-based intensive cardiac rehabilitation program could produce positive changes in risk factor profile and outcomes in an at-risk population.

Cardiac Rehabilitation in the Elderly

Coronary heart disease (CHD) is the leading cause of death worldwide. Advanced age is associated with a higher prevalence of CHD as well as increased morbidity and mortality. One key vulnerability relates to the fact that older individuals are generally among the least fit, least active cohort and at increased risk of complications after an acute cardiac event and/or major surgery. There is ample evidence to demonstrate the beneficial effects of exercised-based cardiac rehabilitation (CR) programs on improving functional capacity and other indices of cardiovascular (CV) health. Although the predominant number of studies is in middle-aged patients, there is an escalating amount of new information that establishes the cardioprotective role of CR and, in particular, structured exercise therapy (ET) among the elderly. The present review summarizes the current data available regarding CR and ET and its salutary impact on today's growing population of older adults with CHD.     

Cardiac Rehabilitation in Real Life

Participation in cardiac rehabilitation programs (CRPs) improves prognosis in patients with coronary artery disease (CAD). However, not much is known about the effectiveness of CRP in real life. The aim of this analysis was to identify factors related to the referral to CRP following hospitalization for CAD and estimate the effectiveness of the programs in real life.Medical records of 1061 consecutive patients aged ≤80 years, hospitalized due to an acute coronary syndrome or for a myocardial revascularization procedure in 5 hospitals serving the city and surrounding counties, were reviewed and 611 patients were interviewed 6–18 months posthospitalization.Of 611 patients participating in the interview, 212 (34.7%) were referred following the hospitalization to a center providing CRP. Age, hospitalization in a teaching hospital, and index diagnosis were independently related to being granted a referral. Among the referred patients, 86.3% participated in the CRP. Participation in CRP was related to the lower probability of having high total cholesterol (23% vs 32%, P < 0.05), fasting glucose (11% vs 18%, P = 0.05), Hb_A1c (8% vs 16%, P = 0.05), and body mass index (27% vs 37%, P < 0.05). Generally, the effect of the CRP was significant in participants with a higher education, but not in those with a low education level. Other factors were not significantly related to the effectiveness of CRP.This study shows that CRPs are effective, but underused in Poland. The participant''s education level may influence the effectiveness of CRP. Therefore, in order to increase the impact of CRP, the content of such programs should vary depending on the education level of the participants.