Assessing the quality of cardiac rehabilitation programs by measuring adherence to the Australian quality indicators.

BACKGROUND: Every year, over 65,000 Australians experience an acute coronary syndrome (ACS) and around one-third occur in people with prior coronary heart disease. Cardiac rehabilitation (CR) aims to prevent a repeat ACS by supporting patients' return to an active and fulfilling lifestyle. CR programs are efficacious, but audits of clinical practice show variability of program delivery, which may compromise patient outcomes. Core components, quality indicators and accreditation of programs have been introduced internationally to increase program standardisation. With Australian quality indicators (QIs) for cardiac rehabilitation recently introduced, we aimed to conduct a survey in one state of Australia to assess the extent to which programs adhere to the measurement of QIs comparing country, metropolitan, telephone and face to face programs. METHODS: A cross- sectional survey design with face validity testing was used to formulate questions to evaluate cardiac rehabilitation program and personnel characteristics and QI adherence. Between October 2020- December 2021, 23 cardiac rehabilitation programs across country and metropolitan areas were invited to participate. Quality improvement was defined as adherence to the Australian Quality Indicators, and we developed an objective score to calculate program performance categorised by quartiles. Significance of CR completion and time to enrolment between program type (telephone versus face to face) and location (country versus metropolitan were compared using Pearson's Chi-square and Mann-Whitney U tests. RESULTS: Among the 23 CR programs, 15 were country and 8 metropolitan-based and 22 were face to face and 1 telephone-based. Median wait time from discharge was 27.0 days, (interquartile range 19.3-46.0) across all programs and country completions of enrolled were 76.9% versus metropolitan 56.5%, p < 0.001 and telephone versus face to face 92.9% versus 59.6% p < 0.001. Pre-program QI adherence was higher than post program for depression, medication adherence, health-related quality of life and comprehensive re-assessment. Seventy four percent of programs were ranked at a medium level of performance (mean score: 11.4/16, SD ± 0.79). CONCLUSIONS: A survey of 23 cardiac rehabilitation programs, showed variability in adherence to measurement of the Australian Cardiovascular and Rehabilitation Association and Australian Heart Foundation Cardiac Rehabilitation Quality Indicators. TRIAL REGISTRATION: Australia New Zealand Clinical Trials Registry (ANZCTR), ACTRN12621000222842 , registered 03/03/2021.

Genotoxicity in Brazilian coal miners and its associated factors.

The present study aims to evaluate the potential genotoxic and associated factors among coal miners, divided by degree of exposure. Blood and buccal smears were collected from 158 workers, who actively participate in different activities in coal mining, and 48 individuals living in the same city but do not have participation in coal mining activities (control group). The workers were divided into three different groups, according to the level of contact with coal extraction. A questionnaire intended to identify factors associated with DNA damage was performed in participants. The results regarding oral mucosa micronucleus test showed a significant difference ( p < 0.001) of the worker groups 1 and 2 in relation to the control group, where the group 1 has a higher degree of exposure to coal than group 2. For the lymphocyte micronucleus test and comet assay, there was no significant difference between the exposed groups and control group. There is an association between the outcome and the fact of living in the municipality of the mining company and the exposure to radiation in the last 12 months. Besides, the multivariate analysis showed an association of the tail moment with radiation exposure in the last 12 months. Thus, the findings of this study reveal genotoxicity in oral mucosa cells of workers exposed to coal and that workers with higher degree of contact with coal have a more pronounced response.