Implementation and prospective evaluation of the Country Heart Attack Prevention model of care to improve attendance and completion of cardiac rehabilitation for patients with cardiovascular diseases living in rural Australia: a study protocol.

INTRODUCTION: Despite extensive evidence of its benefits and recommendation by guidelines, cardiac rehabilitation (CR) remains highly underused with only 20%-50% of eligible patients participating. We aim to implement and evaluate the Country Heart Attack Prevention (CHAP) model of care to improve CR attendance and completion for rural and remote participants. METHODS AND ANALYSIS: CHAP will apply the model for large-scale knowledge translation to develop and implement a model of care to CR in rural Australia. Partnering with patients, clinicians and health service managers, we will codevelop new approaches and refine/expand existing ones to address known barriers to CR attendance. CHAP will codesign a web-based CR programme with patients expanding their choices to CR attendance. To increase referral rates, CHAP will promote endorsement of CR among clinicians and develop an electronic system that automatises referrals of in-hospital eligible patients to CR. A business model that includes reimbursement of CR delivered in primary care by Medicare will enable sustainable access to CR. To promote CR quality improvement, professional development interventions and an accreditation programme of CR services and programmes will be developed. To evaluate 12-month CR attendance/completion (primary outcome), clinical and cost-effectiveness (secondary outcomes) between patients exposed (n=1223) and not exposed (n=3669) to CHAP, we will apply a multidesign approach that encompasses a prospective cohort study, a pre-post study and a comprehensive economic evaluation. ETHICS AND DISSEMINATION: This study was approved by the Southern Adelaide Clinical Human Research Ethics Committee (HREC/20/SAC/78) and by the Department for Health and Wellbeing Human Research Ethics Committee (2021/HRE00270), which approved a waiver of informed consent. Findings and dissemination to patients and clinicians will be through a public website, online educational sessions and scientific publications. Deidentified data will be available from the corresponding author on reasonable request. TRIAL REGISTRATION NUMBER: ACTRN12621000222842.

Sources of PM2.5 and its responses to emission reduction strategies in the Central Plains Economic Region in China: Implications for the impacts of COVID-19.

The Central Plains Economic Region (CPER) located along the transport path to the Beijing-Tianjin-Hebei area has experienced severe PM2.5 pollution in recent years. However, few modeling studies have been performed on the sources of PM2.5, especially the impacts of emission reduction strategies. In this study, the Nested Air Quality Prediction Model System (NAQPMS) with an online tracer-tagging module was adopted to investigate source sectors of PM2.5 and a series of sensitivity tests were conducted to investigate the impacts of different sector-based mitigation strategies on PM2.5 pollution. The response surfaces of pollutants to sector-based emission changes were built. The results showed that resident-related sector (resident and agriculture), fugitive dust, traffic and industry emissions were the main sources of PM2.5 in Zhengzhou, contributing 49%, 19%, 15% and 13%, respectively. Response surfaces of pollutants to sector-based emission changes in Henan revealed that the combined reduction of resident-related sector and industry emissions efficiently decreased PM2.5 in Zhengzhou. However, reduced emissions in only the Henan region barely satisfied the national air quality standard of 75 µg/m3, whereas a 50%-60% reduction in resident-related sector and industry emissions over the whole region could reach this goal. On severely polluted days, even a 60% reduction in these two sectors over the whole region was insufficient to satisfy the standard of 75 µg/m3. Moreover, a reduction in traffic emissions resulted in an increase in the O3 concentration. The results of the response surface method showed that PM2.5 in Zhengzhou decreased by 19% in response to the COVID-19 lockdown, which approached the observed reduction of 21%, indicating that the response surface method could be employed to study the impacts of the COVID-19 lockdown on air pollution. This study provides a scientific reference for the formulation of pollution mitigation strategies in the CPER.

Assessment of a self-administered adapted 6-minute walk test.

PURPOSE: This study assessed the reliability and viability of the Home-Heart-Walk (HHW) test, adapting a standardized 6-minute walk test protocol for self-administration. METHODS: Twenty-nine volunteers with documented coronary heart disease (CHD) undertook a structured 7-day program using the HHW. RESULTS: The intervention was well received by participants. The intraclass correlation coefficient of the test distance over 7 days was 0.98, and the correlations between investigator and participant measures were high (r = 0.99 for day 1 [first test], r = 0.99 for day 1 [second test], and r = 0.99 on day 7). CONCLUSION: These data demonstrate the potential of the HHW as a tool to promote and monitor physical activity in community-based settings. These observations require further investigation and testing in other populations.

A review of the six-minute walk test: its implication as a self-administered assessment tool.

BACKGROUND: Promoting self-management and monitoring physical activity are important strategies in chronic heart disease (CHD) management. The six-minute walk test (6MWT) is a commonly used sub-maximal exercise test for measuring physical functional capacity. AIM: The aim of this paper is to review the current literature on 6MWT relating to methodological issues as well as exploring the potential of the protocol to be adopted as a self-administered exercise test. METHOD: The Medline, CINAHL, Science Direct and the World Wide Web using the search engine Google, were searched for articles describing the administration, reliability and validity of the 6MWT. Findings of the integrative literature review The 6MWT is a simple, safe and inexpensive sub-maximal exercise test. The 6MWT distance is strongly associated with functional capacity, and it is a useful prognostic tool. To date, the capacity for self-administration of the 6MWT has not been investigated. CONCLUSIONS: Adapting the 6MWT as a patient-reported outcome measure may enhance the capacity, not only for clinicians to monitor functional status, but also promote self-management by enabling individuals to monitor changes in their functional capacity.