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A Novel Digital Platform for a Monitored Home-based Cardiac Rehabilitation Program
Published on: April 19, 2019
Cardiovascular Health in Cardiac Rehabilitation: Applying the American Heart Association Life's Simple 7 Framework in
Audry Chacin-Suarez1,2,3, Tomoaki Hama1,4, Matthew P Johnson5
1Department of Cardiovascular Medicine Mayo Clinic Rochester MN.
Insights
Cardiac rehabilitation (CR) improves cardiovascular health (CVH) metrics. However, blood glucose management requires enhancement, with tailored interventions potentially optimizing CR participant outcomes.
Area of Science:
- Cardiology
- Preventive Medicine
- Public Health
Background:
- Cardiac rehabilitation (CR) programs aim to reduce cardiovascular disease morbidity and mortality through lifestyle interventions.
- The American Heart Association cardiovascular health (CVH) framework assesses health behaviors and clinical factors.
- The effectiveness of the CVH framework within CR settings requires further evaluation.
Purpose of the Study:
- To evaluate the American Heart Association's cardiovascular health (CVH) framework in patients undergoing cardiac rehabilitation (CR).
- To assess changes in CVH scores from baseline to post-CR.
- To identify demographic factors influencing CVH improvements during CR.
Main Methods:
- Retrospective cohort study of 937 patients attending CR between January 2018 and September 2020.
- Evaluation of 3 clinical factors (blood pressure, cholesterol, hemoglobin A1c) and 4 health behaviors (smoking, BMI, physical activity, diet) at baseline and post-CR.
- Calculation of CVH scores (0-14 points) categorized as poor, intermediate, or ideal, with multiple imputation for missing data.
Main Results:
- Pre-CR, 97.2% of patients had poor CVH scores; none achieved ideal scores.
- Post-CR, significant improvements were observed in most CVH components, except for hemoglobin A1c, which worsened.
- Younger patients showed improved hemoglobin A1c, while older patients demonstrated better body mass index and blood pressure control.
Conclusions:
- Cardiac rehabilitation effectively enhances overall cardiovascular health (CVH).
- There is a critical need to improve blood glucose management within CR programs.
- Personalized interventions considering age and sex may further enhance CR effectiveness.
Background:
Cardiac rehabilitation (CR) is a comprehensive secondary cardiovascular disease program with structured lifestyle interventions to reduce morbidity and mortality. The American Heart Association cardiovascular health (CVH) framework measures health-promoting behaviors and clinical factors, but it has not been rigorously evaluated in the CR setting.
Methods:
This retrospective cohort study analyzed patients attending CR from January 2018 to September 2020. Patients were evaluated at baseline (pre-CR) and completion (post-CR) using 3 clinical factors (blood pressure, cholesterol, and hemoglobin A1c) and 4 health behaviors (smoking, body mass index, physical activity, and diet). CVH score was computed as a composite of each Life's Simple 7 component by assigning 0 points for poor, 1 point for intermediate, or 2 points for ideal (range 0-14 points). CVH scores were further categorized as poor (0-6 points), intermediate (7-8 points), and ideal (9-14 points). Missing data in the analysis were accounted for using a multiple imputation procedure.
Results:
Patients (N=937) were aged 64.0±13.4 years old, 34% women, and attended 11±12 CR sessions. Pre-CR, 97.2% had poor CVH scores, 2.8% had intermediate scores, and none met ideal CVH criteria. Post-CR, there was a reduction in poor scores across all metrics except for hemoglobin A1c, which increased (40.6%-43.5%). Younger patients showed improvement in hemoglobin A1c, while older patients improved in body mass index and blood pressure.
Conclusions:
Our study demonstrates the efficacy of CR in improving CVH but underscores the need for better blood glucose management. Tailored interventions based on age and sex may further optimize outcomes for CR participants.
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