Long-term Cardiac Maintenance Programming: A SINGLE-SITE ANALYSIS OF MORE THAN 200 PARTICIPANTS.

PURPOSE: Greater than 65% of all cardiac mortality is related to coronary artery disease (CAD). Cardiac rehabilitation (CR) aims to reduce cardiovascular risk and number of hospital readmissions. Cardiac maintenance programs (CMPs) are designed to sustain or improve health after completing early CR. Although CMPs are supported by most national health guidelines, few long-term studies on these diverse programs have been performed. METHODS: This was a retrospective repeated-measures analysis with case-controlled subanalysis. Within-subject differences for CMP participants were examined between enrollment and last clinical visit. Assessments included medical history, anthropometry, blood analysis, and cardiopulmonary exercise testing. A subset of 20 CMP participants were compared with 20 patients with CAD who chose not to participate in CMP, matched for age, sex, and follow-up duration. RESULTS: A total of 207 patients (60 ± 9 yr, 16% female) were included for the primary analyses. Average follow-up was 6.3 ± 4.8 yr (range 4-20 yr). CMP participants reduced peak workload (1.76 ± 0.56 to 1.60 ± 0.58 W/kg; P < .001) and aerobic capacity (26.1 ± 6.2 to 24.6 ± 7.1 mL/kg/min; P = .003). High-density lipoprotein-cholesterol increased significantly (48 ± 12 to 51 ± 14 mg/dL; P < .001), whereas all other metabolic risk factors remained unaffected. Matched controls had higher functional capacity (2.35 ± 0.81 vs 1.56 ± 0.52 W/kg; P < .001) and lower body mass index (25.3 ± 3.6 vs 28.6 ± 3.9 kg/m2) at baseline, but no significant differences with respect to long-term efficacy were observed. CONCLUSIONS: Long-term participation in CMP did not result in maintaining functional capacity or cardiovascular risk profile in patients with CAD. However, compared with matched nonparticipants, CMP participants (are more deconditioned at baseline) but do not seem to deteriorate as quickly.

Effect of Individualized Combined Exercise Versus Group-Based Maintenance Exercise in Patients With Heart Disease and Reduced Exercise Capacity: THE DOPPELHERZ TRIAL.

PURPOSE: To compare individualized endurance + resistance exercises (ICE) with a traditional cardiac maintenance program (CMP) on exercise performance in patients with cardiac disease and low exercise capacity. METHODS: Patients eligible for cardiac rehabilitation with peak exercise capacity <6 metabolic equivalents (METs) were randomly allocated to once-weekly ICE or CMP for 6 mo. ICE used 60 min of individualized moderate endurance and strength exercises. CMP used 60 min of group calisthenics plus relaxation and flexibility exercises. Maximal and submaximal endurance and strength exercise performance were assessed at baseline and 6 mo. RESULTS: Seventy patients (70 ± 9 y; 38% female) were included in the intention-to-treat analyses. Large and significant improvements in both submaximal endurance and maximal strength were observed in the ICE group compared with the CMP group. Submaximal exercise duration (+111 ± 112 sec vs +14 ± 120 sec, P < .01), workload (+16 ± 16 W vs +2 ± 17 W, P < .01), and muscular strength (+7 ± 8 kg vs 0 ± 7 kg and +16 ± 14 kg vs 0.2 ± 12 kg for upper- and lower-body strength, P < .01) all favored ICE over CMP. No significant between-group differences were observed in peak exercise performance (+0.05 ± 0.17 W/kg vs +0.04 ± 0.17 W/kg, P = .83) or peak oxygen uptake (-0.1 ± 3.1 mL/kg/min vs +0.6 ± 3.2 mL/kg/min, P = .38). CONCLUSIONS: Patients with cardiac disease and low exercise capacity improved submaximal exercise performance and muscular strength with once-weekly ICE but not with CMP. Neither ICE nor CMP led to an improvement in peak exercise endurance performance. The implementation of ICE in this population would be feasible and may result in greater benefit for performing activities of daily living.

How lapse and slip errors influence head-of-bed angle compliance rates as measured by a portable, wireless data collection system.

The recommended protocols to prevent ventilator-associated pneumonia include keeping ventilated patients' head and upper body elevated to an angle between 30 and 45 degrees. These recommendations are largely based on a study that has been difficult to replicate, because studies that have attempted to replicate the original conditions have failed to achieve the necessary bed angles consistently. This work suggests the possibility that two specific types of human error, slips and lapses, contribute to non-compliant bed angles. A novel device provided 83,655 samples of bed angles over a period of 1579 hours. The bed angle was out of compliance 64.2% of the time analyzed. Slips, the accident of raising the bed to an angle slightly less than the desired angle, accounted for most of the out-of-compliance measurements, or 55.9% of the time analyzed. It appears that stochastic variation in the bed adjustments results in the bed being out of compliance. Interventions should be investigated such as increasing the target angle and providing feedback at the moment the bed is raised to close to, but less than, the target angle.