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A Novel Digital Platform for a Monitored Home-based Cardiac Rehabilitation Program
Published on: April 19, 2019
Effect of early enrollment on outcomes in cardiac rehabilitation
Dominic A Johnson1, Matthew T Sacrinty1, Pallavi S Gomadam1
1Department of Internal Medicine, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, North Carolina; Department of Cardiology, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, North Carolina.
Insights
Starting cardiac rehabilitation (CR) within 15 days of a cardiac event maximizes benefits for weight and exercise capacity. Delayed CR enrollment impacts patient outcomes, with significant improvements still observed but of lesser magnitude.
Area of Science:
- Cardiology
- Rehabilitation Medicine
- Preventive Cardiology
Background:
- Outpatient cardiac rehabilitation (CR) is recommended within 1-3 weeks post-cardiac event.
- The impact of delayed CR enrollment on patient outcomes remains unclear.
- Understanding factors influencing CR delays is crucial for optimizing patient recovery.
Purpose of the Study:
- To investigate the effects of delayed enrollment in outpatient cardiac rehabilitation on patient outcomes.
- To identify demographic and clinical factors associated with delayed CR initiation.
- To determine the optimal timing for CR initiation to maximize patient benefits.
Main Methods:
- A cohort of 1,241 patients undergoing CR after cardiac events or surgery was analyzed.
- Risk factors and metabolic equivalent levels (METs) were assessed pre- and post-CR.
- CR delay times were categorized (0-15, 16-30, >30 days) and correlated with outcomes.
Main Results:
- Mean CR delay was 34 days; delays >30 days were linked to older age, female gender, nonwhite race, unemployment, and longer hospital stays.
- Patients with delayed CR (>30 days) showed significant improvements but lesser gains in peak METs and weight compared to those starting CR earlier (0-15 days).
- Multivariate analysis confirmed that delayed CR (>30 days) independently predicted reduced MET improvement (β = -0.59, p <0.001).
Conclusions:
- CR enrollment timing varies significantly, influenced by patient demographics and initial hospital stay duration.
- Delayed CR enrollment negatively impacts patient outcomes, particularly exercise capacity and weight management.
- Initiating CR within 15 days of a cardiac event yields the greatest benefits for patient recovery and functional improvement.
Abstract:
Outpatient cardiac rehabilitation (CR) is most beneficial when delivered 1 to 3 weeks after the index cardiac event. The effects of delayed enrollment on subsequent outcomes are unclear. A total of 1,241 patients were enrolled in CR after recent (<1 year) treatment of cardiac events or postcardiac surgery. Risk factors and metabolic equivalent levels (METs) during aerobic exercise were calculated before and after CR. The mean CR delay time was 34 days (maximum of 327). Delay time >30 days was associated with older age, female gender, nonwhite race, being unemployed, and increased length of hospital stay before CR after index cardiac event (p <0.05 vs 0 to 15 and 16 to 30 days for all comparisons). Patients with delay time >30 days had significant improvements in all CR metrics, but peak METs and weight improvements were lesser in magnitude compared with patients with CR delay times 0 to 15 and 16 to 30 days. After multivariate adjustment, delay time >30 days remained an independent predictor of decreased MET improvement compared with delay time 0 to 15 days (β = -0.59, p <0.001). In conclusion, time to enrollment in CR varies substantially and is independently linked to demographics and length of index hospital stay. Delayed enrollment in CR is directly related to patient outcomes. Although all patients showed improvements in key metrics regardless of delay time, CR was of greatest benefit, particularly for weight and exercise capacity, when initiated within 15 days of the index event.
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