Assessing feasibility and sex-related inequity in the cardiac rehabilitation quality indicators in Manitoba.

The cardiac rehabilitation quality indicators (CRQIs) developed by the Canadian Cardiovascular Society provide a means to standardize program assessment and identify sex-related inequities. No formal evaluation of the CRQIs has been conducted in Manitoba. An environmental scan for the CRQIs was performed using data in the electronic medical record at two cardiac rehabilitation (CR) sites in Winnipeg for 2016-2019 referrals. Of the 8116 referrals, 7758 (5491 males and 2267 females) had geographical access and were eligible for CR. The Manitoba Centre for Health Policy Data Quality Framework informed the data quality assessment. Thirteen CRQIs were available; four were considered high quality; nine demonstrated moderate to significant missing data. In addition to missing values, potential misclassification of risk (CR-4) and physiologically implausible and invalid dates were assessed and identified (CR-13 and CR-17). Each site had a physician medical director (CR-31) and a documented emergency response strategy (CR-32). Only high-quality data were evaluated for sex-related differences using chi-square and median tests. Women had lower enrollment (CR-3), and more women enrolled after the median of 41 days (CR-2b). Engagement with CR partners, including frontline staff, and utilizing strategies to assess and limit physiologically implausible values and dates will enhance data capture and quality.

Impact of the medical fitness model on long term health outcomes in older adults.

BACKGROUND: Physical inactivity is common among older adults and is associated with poor health outcomes. Medical fitness facilities provide a medically focused approach to physical fitness and can improve physical activity in their communities. This study aimed to assess the relationship between membership in the medical fitness model and all-cause mortality, health care utilization, and major adverse cardiac events in older adults. METHODS: A propensity weighted retrospective cohort study linked individuals that attended medical fitness facilities to provincial health administrative databases. Older adults who had at least 1 year of health coverage from their index date between January 1st, 2005 to December 31st 2015 were included. Controls were assigned a pseudo-index date at random based on the frequency distribution of index dates in members. Members were stratified into low frequency attenders (< 1 Weekly Visits) and regular frequency attenders (> 1 Weekly Visits). Time to event models estimated the hazard ratios (HRs) for risk of all-cause mortality and major adverse cardiac event. Negative binomial models estimated the risk ratios (RRs) for risk of hospitalizations, outpatient primary care visits and emergency department visits. RESULTS: Among 3,029 older adult members and 91,734 controls, members had a 45% lower risk of all-cause mortality (HR: 0.55, 95% CI: 0.50 - 0.61), 20% lower risk of hospitalizations (RR: 0.80, 95% CI: 0.75 - 0.84), and a 27% (HR: 0.72, 95% CI: 0.66 - 0.77), lower risk of a major adverse cardiovascular event. A dose-response effect with larger risk reductions was associated with more frequent attendance as regular frequency attenders were 4% more likely to visit a general practitioner for a routine healthcare visit (RR: 1.04, 95% CI: 1.01 - 1.07), but 23% less likely to visit the emergency department (RR: 0.87, 95% CI: 0.82 - 0.92). CONCLUSIONS: Membership at a medical fitness facility was associated with a decreased risk of mortality, health care utilization and cardiovascular events. The medical fitness model may be an alternative approach for public health strategies to promote positive health behaviors in older adult populations.

Prehabilitation program for elective coronary artery bypass graft surgery patients: a pilot randomized controlled study.

OBJECTIVE: To determine the feasibility of a cardiac prehabilitation (Prehab) program for patients waiting for elective coronary artery bypass graft (CABG). DESIGN: A two-group parallel randomized controlled trial. SETTING: Medical fitness facility. SUBJECTS: Seventeen preoperative elective CABG surgery patients were randomized to standard care (n = 9) or Prehab (n = 8). INTERVENTION: Standard care: three-hour preassessment appointment. Prehab: exercise and education classes for 60 minutes/day, twice weekly for at least four weeks. MAIN MEASURES: Data were collected at baseline, one week preoperatively, and three months postoperatively. The primary outcome measure was walking distance using a 6-minute walk test. Secondary outcome variables included 5-meter gait speed, and cardiac rehabilitation attendance three months postoperatively. RESULTS: Fifteen patients (standard care, n = 7; Prehab, n = 8) completed the study. No Prehab patients developed cardiac symptoms during study participation. Walking distance remained unchanged in the standard care group; whereas, the Prehab group increased their walking distance to mean ± SD 474 ±101 and 487 ±106 m at the preoperative and three month postoperative assessments (p < 0.05). Gait speed was unchanged in the standard care group, but improved in the Prehab group by 27% and 33% preoperatively and three months postoperatively, respectively (p < 0.05). Enrollment in cardiac rehabilitation three months postoperatively was higher for Prehab participants (100%) than standard care participants (43%; p < 0.05). CONCLUSION: These data provide evidence for the feasibility of a Prehab intervention to improve the health status of patients waiting for elective CABG surgery. A larger trial of 92 patients will be utilized to demonstrate the safety and efficacy of Prehab.

Association of Membership at a Medical Fitness Facility With Adverse Health Outcomes.

INTRODUCTION: Interventions that increase physical activity behavior can reduce morbidity and prolong life, but long-term effects in large populations are unproven. This study investigates the association of medical fitness facility membership and frequency of attendance with all-cause mortality and rate of hospitalization. METHODS: A propensity weighted retrospective cohort study was conducted by linking individuals who attended medical fitness facilities in Winnipeg, Canada to provincial health administrative databases. Members aged ≥18 years who had ≥1 year of provincial health coverage from their index date between January 1, 2005 and December 31, 2015 were included. Controls were assigned a pseudo-index date at random on the basis of the frequency distribution of index dates in the intervention group. Members were stratified into low-frequency attenders (<1 weekly visit), moderate-frequency attenders (1-3 weekly visits), and high-frequency attenders (>3 weekly visits). The primary outcomes were time to all-cause mortality and rate of hospitalizations. Statistical analyses were performed between 2018 and 2020. RESULTS: Among 19,300 adult members and 515,810 controls, members had a 60% lower risk of all-cause mortality during the first 651 days and 48% after 651 days. Membership was associated with a 13% lower risk of hospitalizations. A dose-response effect was apparent because higher weekly attendance was associated with a lower risk of hospitalizations (low frequency: 9%, moderate frequency: 20%, high frequency: 39%). CONCLUSIONS: Membership at a medical fitness facility was associated with a reduced risk of all-cause mortality and hospitalizations. Healthcare systems should consider the medical fitness model as a preventative public health strategy to encourage physical activity participation.

Examining Patient Outcome Quality Indicators Based on Wait Time From Referral to Entry Into Cardiac Rehabilitation: A PILOT OBSERVATIONAL STUDY.

PURPOSE: The purpose of this study was to examine whether meeting the Canadian Cardiovascular Society (CCS) ≤60-day wait time from cardiac rehabilitation (CR) referral to enrollment is associated with CCS patient-level quality indicator outcomes. METHODS: This pilot observational study consisted of 69 participants entering CR separated into 2 groups based on wait time (≤60-day, n = 45; >60-day, n = 24). Data were collected at baseline, and 1, 4 (CR completion), 6, and 12 months after baseline. Quality indicators for achieving a 0.5 peak metabolic equivalent (MET) improvement at CR completion, physical activity of 150 min/wk of moderate-vigorous physical activity, and CR adherence were assessed. Depressive symptoms were assessed with the Patient Health Questionnaire. RESULTS: Sixty participants completed the study (≤60-day, n = 40; >60-day, n = 20). In the ≤60-day group, 92% of participants achieved the 0.5 MET improvement upon CR completion; whereas 60% of the >60-day group met this criteria (P ≤ .05). For the 150 min/wk of moderate-vigorous physical activity and CR adherence, both groups were not significantly different at any time. Elevated depressive symptoms were initially observed in 45% of participants in the ≤60-day group and 35% in the >60-day group (NS) and decreased to 8% in the ≤60-day group compared with 30% in the >60-day group at 12 months (P ≤ .05). CONCLUSIONS: Meeting the CCS 60-day acceptable wait time is associated with improvements in METs and depressive symptoms, but not with physical activity or CR adherence. A larger observational study is warranted to explore patient-level CCS quality indicators during and after CR.

Integrated testing of standing balance and cognition: test-retest reliability and construct validity.

Balance and cognitive impairments which are common with aging often coexist, are prognostic of future adverse health events, including fall injuries. Consequently, dual-task assessment programs that simultaneously address both stability and cognition are important to consider in rehabilitation and benefit healthy aging. The objective of this study was to establish test-retest reliability and construct validity of a dual-task computer game-based platform (TGP) that integrates head tracking and cognitive tasks with balance activities. Thirty healthy, community-dwelling individuals median age 64 (range 60-67) were recruited from a certified Medical Fitness Facility. Participants performed a series of computerized head tracking and cognitive game tasks while standing on fixed and sponge surfaces. Testing was conducted on two occasions, one week apart. Moderate to high test retest reliability (ICC values of 0.55-0.75) was observed for all outcome measures representing balance, gaze performance, cognition, and dual-task performance. A significant increase in center of foot pressure (COP) excursion was observed during both head tracking and cognitive dual-task conditions. The results demonstrate the system's ability to reliably detect changes related to specific and integrated aspects of balance, gaze, and cognitive performance.