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Cardiac Rehabilitation Among Veterans: A Narrative Review
Merilyn S Varghese1, Wen-Chih Wu, Kariann R Drwal
1Author Affiliations: VA Connecticut Healthcare System, West Haven, Connecticut (Drs Varghese, Burg, Gaffey, Brandt, Bastian, and Gandhi); Yale School of Medicine, New Haven, Connecticut (Drs Varghese, Burg, Gaffey, Brandt, Bastian, Gandhi); Providence VA Medical Center and the Miriam Hospital Cardiovascular Rehabilitation Center, Providence, Rhode Island (Dr Wu); Departments of Medicine, Epidemiology and Center for Global Cardiometabolic Health, Brown University, Providence, Rhode Island (Dr Wu); VA Office of Rural Health (ORH), Veterans Rural Health Resource Center-Iowa City, Iowa City VA Healthcare System, Iowa City, Iowa (Dr Drwal); The Center for Access and Delivery Research and Evaluation (CADRE) Iowa City VA Healthcare System, Iowa City, Iowa (Dr Drwal); Richard A. and Susan F. Smith Center for Outcomes Research, Beth Israel Deaconess Medical Center, Boston, Massachusetts (Dr Kazi); Harvard Medical School, Boston, Massachusetts (Dr Kazi); VA Central Western Massachusetts Healthcare System, Leeds, Massachusetts (Dr Mattocks); and University of Massachusetts Medical School, Worcester, Massachusetts (Dr Mattocks).
Cardiac rehabilitation (CR) participation is low for Veterans despite its benefits. Home-based CR shows promise for overcoming barriers like transportation, improving outcomes for cardiovascular disease secondary prevention.
Area of Science:
- Cardiology
- Public Health
- Health Services Research
Background:
- Veterans have a higher risk of cardiovascular disease.
- The Veterans Affairs (VA) healthcare system serves a unique population with distinct healthcare needs.
- Cardiac rehabilitation (CR) is crucial for secondary prevention in this demographic.
Purpose of the Study:
- To review existing data on CR utilization and outcomes specifically among U.S. Veterans.
- To identify challenges and facilitators for CR participation in the Veteran population.
- To assess the effectiveness of different CR delivery models for Veterans.
Main Methods:
- A comprehensive literature search was performed using major scientific databases (PubMed, Scopus).
- Keywords included "cardiac rehabilitation" and "U.S. Veterans".
- The review focused on studies examining CR utilization, barriers, and outcomes within the Veteran population.
Main Results:
- Veterans can access CR through VA medical centers (in-person or home-based) or community centers.
- Low participation rates persist, with transportation to in-person CR being a significant barrier.
- Home-based CR emerges as a promising alternative, mitigating transportation issues and proving resilient during the pandemic.
Conclusions:
- CR participation among Veterans is suboptimal despite proven benefits like improved exercise capacity, reduced depressive symptoms, and decreased mortality.
- Home-based CR offers a viable solution to increase access and overcome participation barriers.
- Further research is needed on CR uptake, mental health impacts, disparities (sex/race), and long-term outcomes in Veterans.
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