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A Novel Digital Platform for a Monitored Home-based Cardiac Rehabilitation Program
Published on: April 19, 2019
Shorter Wait Times to Cardiac Rehabilitation Associated With Greater Exercise Capacity Improvements: A MULTISITE
Dion Candelaria1, Robert Zecchin, Cate Ferry
1Susan Wakil School of Nursing and Midwifery, and Charles Perkins Centre, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia (Mr Candelaria and Drs Ladak, Randall, and Gallagher); Western Sydney Local Health District, Sydney, Australia (Mr Zecchin); National Heart Foundation of Australia, Sydney, Australia (Ms Ferry); and The Aga Khan University, Karachi, Pakistan (Dr Ladak).
Insights
Shorter wait times in cardiac rehabilitation (CR) are linked to greater improvements in exercise capacity. Optimizing CR benefits requires implementing strategies to reduce program wait times for patients with heart disease.
Area of Science:
- Cardiology
- Rehabilitation Medicine
- Exercise Physiology
Background:
- Comprehensive exercise-based cardiac rehabilitation (CR) improves exercise capacity, but outcomes vary significantly.
- The influence of modifiable factors like CR program wait times and session duration on these outcomes remains under-investigated.
Purpose of the Study:
- To investigate the association between cardiac rehabilitation (CR) program wait time and exercise capacity outcomes.
- To determine if modifiable factors influence exercise capacity improvements in patients undergoing CR.
Main Methods:
- A three-state audit included 894 patients with coronary heart disease undergoing CR.
- Exercise capacity was measured using the 6-min walk test pre- and post- a 6- to 12-week supervised program.
- Correlations and linear mixed-effects models analyzed associations between patient/program characteristics and exercise capacity changes.
Main Results:
- Patients (n=894) showed significant exercise capacity improvement (mean increase 70.4 ± 61.8 m).
- A shorter wait time for CR was significantly associated with greater exercise capacity improvement (β = 0.23), after adjusting for other factors.
- Younger age and female sex were also associated with exercise capacity changes.
Conclusions:
- This study confirms that shorter wait times correlate with enhanced exercise capacity improvements in cardiac rehabilitation.
- Healthcare providers should focus on strategies to minimize CR wait times to maximize patient benefits.
Purpose:
Comprehensive exercise-based cardiac rehabilitation (CR) results in improved, though highly variable, exercise capacity outcomes. Whether modifiable factors such as CR program wait time and session duration are associated with exercise capacity outcomes has not been adequately investigated.
Methods:
Patients with coronary heart disease (±primary and elective percutaneous coronary interventions, cardiac surgery) who participated in CR programs involved in a three-state audit (n = 32 sites) were eligible. Exercise capacity was measured using the 6-min walk test before and after a 6- to 12-wk supervised exercise program. CR program characteristics were also recorded (wait time, number of sessions). Correlations and linear mixed-effects models were used to identify associations between sociodemographic and CR program characteristics and change in exercise capacity.
Results:
Patients (n = 894) had a mean age of 65.9 ± 11.8 yr, 71% were males, 33% were referred for cardiac surgery, and median wait time was 16 d (interquartile range 9, 26). Exercise capacity improved significantly and clinically (mean increase 70.4 ± 61.8 m). After adjusting for statistically significant factors including younger age (<50 vs ≥80 yr [β = 52.07]), female sex (β = -15.86), exercise capacity at CR entry (β = 0.22) and those nonsignificant (ethnicity, risk factors, and number of sessions), shorter wait time was associated with greater exercise capacity improvement (β = 0.23).
Conclusions:
This study confirms that greater exercise capacity improvements occur with shorter wait times. Coordinators should prioritize implementing strategies to shorten wait time to optimize the benefits of CR.
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