Exercise-based cardiac rehabilitation for patients with coronary heart disease: a systematic review and evidence mapping study.

INTRODUCTION: Exercise-based cardiac rehabilitation (CR) plays a critical role in coronary heart disease (CHD) management. There is a heritage in the effect of exercise-based CR with different exercise programs or intervention settings. This study developed an evidence matrix that systematically assesses, organizes, and presents the available evidence regarding exercise-based CR in CHD management. EVIDENCE ACQUISITION: A comprehensive literature search was conducted across six databases. Two reviewers screened the identified literature, extracted relevant data, and assessed the quality of the studies. An evidence-mapping framework was established to present the findings in a structured manner. Bubble charts were used to represent the included systematic reviews (SRs). The charts incorporated information, exercise prescriptions, outcome indicators, associated P values, research quality, and the number of original studies. A descriptive analysis summarized the types of CR, intervention settings, influential factors, and adverse events. EVIDENCE SYNTHESIS: Sixty-two SRs were included in this analysis, focusing on six exercise types in addition to assessing major adverse cardiovascular events (MACE), cost and rehabilitation outcomes. The most commonly studied exercise types were unspecified (28 studies, 45.2%) and aerobic (11 studies, 17.7%) exercises. All-cause mortality was the most frequently reported MACE outcome (22 studies). Rehabilitation outcomes primarily centered around changes in cardiac function (135 outcomes from 39 SRs). Only 8 (12.9%) studies were rated as "high quality." No significant adverse events were observed in the intervention group. Despite some variations among the included studies, most SRs demonstrated the benefits of exercise in improving one or more MACE or rehabilitation outcomes among CHD patients. CONCLUSIONS: The proportion of high-quality evidence remains relatively low. Limited evidence is available regarding the effectiveness of specific exercise types and specific populations, necessitating further evaluation.

Acceptability, Preferred Medium, and Components of Nurse-Led Cardiac Telerehabilitation: A Cross-Sectional Study.

Cardiac rehabilitation (CR) is a comprehensive and multidisciplinary secondary prevention care in coronary heart disease (CHD). There are barriers at the patient and health system levels that prevent CR from being utilized. Cardiac telerehabilitation led by nurses (Ne-CTR) can alleviate the obstacles to participation in CR. A patient perspective can improve CR access. This study was the first pre-program investigation to clarify the status of knowledge and participation in CTR. We sought to clarify the acceptability, the reasons for rejection, the desired form, components, and associated factors with the components needed for (Ne-CTR) in patients with CHD. The study aimed to help develop a protocol for Ne-CTR for Chinese patients with CHD. A cross-sectional study was conducted between 2020 and 2021. Hospitals in four provinces in China were included. The participants were 671 patients with CHD in hospitals located in three regions of China. A self-administered questionnaire collected information about demographics, knowledge, and participation in CTR, acceptability, preferred medium, and components of Ne-CTR. Student's t-test, analysis of variance, and multiple linear regression analyzed the factors associated with component needs. All the analyses were conducted using IBM SPSS version 25.0. Most participants (n = 434, 66.77%) had a poor understanding and participation in CTR. In addition, 65.38% (n = 439) of participants were willing to accept the Ne-CTR program, and 43.56% (n = 98) identified safety as reasons for not accepting such a program. In the group accepting Ne-CTR, 35% chose hospital-designed professional applications as a medium for Ne-CTR when offered. Education (4.44 ± 1.056) and drug information (4.44 ± 1.040) had the highest average need score. Education, monthly income, marital status, previous CTR participation, and health insurance were associated with the demand level scores of Ne-CTR. This study demonstrated high levels of need for Ne-CTR among patients with CHD and identified the desired medium, components, and associated factors of Ne-CTR. These findings provide reference information for the construction of a Ne-CTR program.

Effectiveness of Telehealth Cardiac Rehabilitation Programs on Health Outcomes of Patients With Coronary Heart Diseases: An Umbrella Review.

PURPOSE: The aim of this study was to conduct an umbrella review summarizing the evidence from existing systematic reviews of telehealth cardiac rehabilitation (CR) on health outcomes of patients with coronary heart disease (CHD). REVIEW METHODS: An umbrella review of systematic reviews was undertaken in accordance with the PRISMA and JBI guidelines. A systematic search was conducted in Medline, APA PsycINFO, Embase, CINAHL, Web of Science, Cochrane database of systematic reviews, JBI evidence synthesis, Epistemonikos, and PROSPERO, searching for systematic reviews published from 1990 to current and was limited to the language source of English and Chinese. Outcomes of interest were health behaviors and modifiable CHD risk factors, psychosocial outcomes, and other secondary outcomes. Study quality was appraised using the JBI checklist for systematic reviews. A narrative analysis was conducted, and meta-analysis results were synthesized. SUMMARY: From 1301 identified reviews, 13 systematic reviews (10 meta-analyses) comprised 132 primary studies conducted in 28 countries. All the included reviews have high quality, with scores ranging 73-100%. Findings to the health outcomes remained inconclusive, except solid evidence was found in the significant improvement in physical activity (PA) levels and behaviors from telehealth interventions, exercise capacity from mobile health (m-health) only and web-based only interventions, and medication adherence from m-health interventions. Telehealth CR programs, work adjunct or in addition to traditional CR and standard care, are effective in improving health behaviors and modifiable CHD risk factors, particularly in PA. In addition, it does not increase the incidence in terms of mortality, adverse events, hospital readmission, and revascularization.

Technology-assisted cardiac rehabilitation for coronary heart disease patients with central obesity: a randomized controlled trial.

BACKGROUND: Limited empirical evidence is available regarding the effect of technology-assisted cardiac rehabilitation (TACR) among coronary heart disease (CHD) patients with central obesity. AIM: To determine the effects of 12-week TACR on health outcomes of patients with CHD. DESIGN: Two-arm randomized controlled trial. SETTING: Cardiovascular department of a regional hospital. POPULATION: Coronary heart disease patients with central obesity. METHODS: The study randomized 78 hospitalized CHD patients to receive either the 12-week TACR intervention or usual care. Guided by social cognitive theory, the intervention began with an in-person assessment and orientation session to assess and identify individual risks and familiarize with the e-platform/device before discharge. After discharge, patients were encouraged to visit the interactive CR website for knowledge and skills acquisition, data uploading, use the pedometer for daily step tracking, and interact with peers and professionals via social media for problem-solving and mutual support. Data were collected at baseline (T0), six-week (T1), and 12-week (T2). RESULTS: Participants in the intervention group showed significant improvement in daily steps at six weeks but not 12 weeks (T1: ß=2713.48, P=0.03; T2:ß=2450.70, P=0.08), weekly sitting minutes (T1: ß=-665.17, P=0.002; T2: ß=-722.29, P=0.02), and total (vigorous, moderate, and walking) exercise at 12-week (ß=-2445.99, P=0.008). Improvement in health-promoting lifestyle profile (T1: ß=24.9, P<0.001; T2: ß=15.50, P<0.001), smoking cessation (T2: ß=-2.28, P<0.04), self-efficacy (T2: ß=0.63, P=0.02), body mass index (T1:ß =-0.97, P=0.03; T2: ß=-0.73, P=0.04) and waist circumferences (T1: ß =-1.97, P=0.003; T2: ß =-3.14, P=0.002) were identified. CONCLUSIONS: Results indicated the effectiveness of the TACR intervention in improving healthy behaviors and anthropometric parameters for CHD patients with central obesity. Individual assessment, collaborative action planning, and ongoing obesity management support should be highlighted in TACR programs for CHD patients. CLINICAL REHABILITATION IMPACT: Central obesity should be assessed and highlighted in TACR intervention as an independent risk factor that requires corresponding behavior change and body fat management.

Evaluating a technologically enhanced rehabilitation programme for wound healing in patients with coronary heart disease.

Wound healing symptoms in patients with coronary heart disease (CHD) are frequently problematic, potentially resulting in complications. In order to tackle this concern, a state-of-the-art rehabilitation programme was created, which incorporated telehealth, virtual reality and robotics in an effort to optimize wound healing in patients with coronary heart disease. The purpose of this research was to assess the efficacy of a rehabilitation programme that utilized cutting-edge technology in enhancing the outcomes of wound recovery for individuals diagnosed with (CHD). Data from 120 CHD patients who participated in this longitudinal randomized controlled trial of a specialized rehabilitation programme intended to promote wound repair were utilized in a cross-sectional analysis. Anthropometric measurements, sociodemographical factors, exercise capacity and the progression of wound recovery were gathered as data. The research participants were primarily comprised of older males from various socioeconomic backgrounds. Age, gender, BMI, socio-educational orientation, physical activity, identified regulation and identified regulation were all significant determinants of wound healing. The significance of customized strategies in cardiac rehabilitation programmes that aim to achieve favourable wound healing outcomes is underscored by these results. In conclusion, this study emphasized the importance of incorporating unique patient attributes when designing technologically advanced rehabilitation protocols aimed at facilitating wound recovery in patients with coronary heart disease. Personalized interventions that consider these variables could potentially result in improved outcomes for wound healing among this particular group of patients.

Optimal outcomes from cardiac rehabilitation are associated with longer-term follow-up and risk factor status at 12 months: An observational registry-based study.

AIM: The purpose of Cardiac Rehabilitation (CR) is to promote and reduce risk factors in the short and long term, however, the latter has, to date, been poorly evaluated. We explored characteristics associated with provision and outcomes of a long-term assessment in CR. METHOD: Data from the UK National Audit of CR between April 2015 and March 2020 was used. Programmes were selected if they had an established mechanism and routine methodology to collect the 12-month assessments. Risk factors pre and post phase II CR and at the 12-month assessment were explored; BMI ≤30, ≥150 min of physical activity per week, hospital anxiety and depression scale (HADS) scores <8. The data came from 32 programmes, 24,644 patients with coronary heart disease. Patients being in at least one optimal risk factor stage throughout phase II CR (OR = 1.43 95% CI 1.28 to 1.59) or successfully reaching an optimal stage during phase II CR (OR = 1.61 95% CI 1.44 to 1.80) had an increased likelihood of being assessed at 12 months compared to those who did not. Patients being in the optimal stage upon completion of phase II CR had an increased likelihood of still being in the optimal stage at 12 months. Most prominent was BMI; (OR = 14.6 (95% CI 11.1 to 19.2) for patients reaching an optimal stage throughout phase II CR. CONCLUSION: Being in an optimal stage upon routine CR completion could be an overlooked predictor in the provision of a long-term CR service and prediction of longer-term risk factor status.

Does problem-based learning improve patient empowerment and cardiac risk factors in patients with coronary heart disease in a Swedish primary care setting? A long-term prospective, randomised, parallel single randomised trial (COR-PRIM).

OBJECTIVES: To investigate long-term effects of a 1-year problem-based learning (PBL) on self-management and cardiac risk factors in patients with coronary heart disease (CHD). DESIGN: A prospective, randomised, parallel single centre trial. SETTINGS: Primary care settings in Sweden. PARTICIPANTS: 157 patients with stable CHD completed the study. Subjects with reading and writing impairments, mental illness or expected survival less than 1 year were excluded. INTERVENTION: Participants were randomised and assigned to receive either PBL (intervention) or home-sent patient information (control group). In this study, participants were followed up at baseline, 1, 3 and 5 years. PRIMARY AND SECONDARY OUTCOMES: Primary outcome was patient empowerment (Swedish Coronary Empowerment Scale, SWE-CES) and secondary outcomes General Self-Efficacy Scale (GSES), self-rated health status (EQ-VAS), high-density lipoprotein cholesterol (HDL-C), body mass index (BMI), weight and smoking. Outcomes were adjusted for sociodemographic factors. RESULTS: The PBL intervention group resulted in a significant improved change in SWE-CES over the 5-year period (mean (M), 39.39; 95% CI 37.88 to 40.89) compared with the baseline (M 36.54; 95% CI 35.40 to 37.66). PBL intervention group increased HDL-C level (M 1.39; 95% CI 1.28 to 1.50) compared with baseline (M 1.24; 95% CI 1.15 to 1.33) and for EQ-VAS (M 77.33; 95% CI 73.21 to 81.45) compared with baseline (M 68.13; 95% CI 63.66 to 72.59) while these outcomes remained unchanged in the control group. There were no significant differences in BMI, weight or scores on GSES, neither between nor within groups over time. The overall proportion of smokers was significantly higher in the control group than in the experimental group. CONCLUSION: One-year PBL intervention had positive effect on patient empowerment, health status and HDL-C at a 5-year follow-up compared with the control group. PBL education aiming to improve patient empowerment in cardiac rehabilitation should account for sociodemographic factors. TRIAL REGISTRATION NUMBER: NCT01462799.

Effect of a mutual goal-based continuous care program on self-management behaviour and health outcomes in patients after percutaneous coronary intervention: A randomized controlled trial.

AIMS: To evaluate the effects of mutual goal-based continuous care program on the outcomes of patients with coronary heart disease (CHD) after percutaneous coronary intervention (PCI). DESIGN: A single-blinded randomized controlled trial. METHODS: 87 patients with CHD after PCI in Hangzhou, Zhejiang, China, were randomly divided into study (n = 42) and control (n = 45) groups. The control group received 12-week cardiac rehabilitation and routine care. The study group received routine care and cardiac rehabilitation and the 12-week intervention program developed according to the goal attainment theory, including the mutual goal-based face-to-face guidance, and every-2-week telephone follow-ups. The self-management behaviour, quality of life, unscheduled readmission rate, and satisfaction of patients were examined. RESULTS: For the patients subjected to the developed continuous nursing program based on mutual goals, achievement rates of all dimension mutual goals were at high levels (from 80.21% to 98.41%), except for the weight control (60.94%). Moreover, according to the comparable base data, compared with the control group, the self-management behaviour (study group 93.43 vs. control group 76.00), quality of life (QoL), and patients' satisfaction (study group 4.64 vs. control group 4.11) were higher, while the unscheduled readmission rate (study group 4.76% vs. control group 22.22%) was lower, in the study group, with statistically significant differences.

Experience of coronary heart disease patients with a nurse-led eHealth cardiac rehabilitation: Qualitative process evaluation of a randomized controlled trial.

BACKGROUND: A previous randomized controlled trial (NeCR) has indicated the effectiveness of nurse-led eHealth cardiac rehabilitation (CR) on modifying the behaviors of patients with coronary heart disease. However, limited qualitative studies explore the experiences of using eHealth CR that led to such benefits. OBJECTIVE: The study aimed to explore the experiences of patients who participated in the NeCR program. METHODS: A descriptive qualitative study was employed among 20 intervention group patients who used the eHealth CR website and ranked differently (0-35th percentile, >35th percentile, and > 70% percentile) in the improvement of health-promoting behaviors. RESULTS: Five themes emerged: the NeCR program has promoted behavior change and mitigated emotional distress post-CHD. Patients described how the NeCR influenced cognitive determinants (knowledge and skill acquisition, having a roadmap, self-monitoring, and self-evaluation and resolution) and offered social support (professional counseling and peer interaction via multimedia chat) toward such change. Patients also appreciated the high affordability, accessibility, reliability of the NeCR, and expressed psychological, contextual, and technical barriers. CONCLUSIONS: Providing eHealth CR during patient discharge is warranted as an affordable, accessible, and reliable alternative to obtain health benefits. Extensive behavior change techniques, actionable CR guidance, and increased awareness are widely perceived enablers. Offering professional support and moderation is critical for early post-discharge consultation and for introducing direct peer interaction to reassure patients.

Targeting Obesity to Optimize Weight Loss in Cardiac Rehabilitation: A PILOT STUDY.

PURPOSE: Cardiac rehabilitation (CR) programs are integral in the treatment of coronary heart disease (CHD). However, most programs do not incorporate structured, evidence-based obesity treatment, potentially limiting efficacy for the large number of CHD patients with overweight/obesity. This pilot study determined the feasibility of adding a behavioral weight loss intervention during standard CR. METHODS: Adults aged ≥40 yr with CHD and overweight/obesity were randomized to 6 mo of CR alone or CR plus a behavioral weight loss program incorporating meal replacements and individual dietary counseling (CR + WL). Body weight, adiposity, cardiometabolic risk factors, self-efficacy for eating, and stages and processes of change for weight management (S-Weight, P-Weight) were assessed at baseline and during follow-up. RESULTS: Thirty-eight participants (64.5 ± 7.9 yr, 24% female, 16% Black/Hispanic) were enrolled over 18 mo. Retention was high, with 95% of participants completing the 6-mo follow-up visit. Participants attended ∼58% of the prescribed exercise sessions, and those in the CR + WL group attended 98% of the prescribed weight loss sessions. The CR + WL group lost significantly more weight than the CR group (6.4 ± 4.7% vs 1.2 ± 3.0%, P = .001), and there were significant treatment effects for total/regional adiposity, eating self-efficacy, and P-weight scores (all P values < .05). Overall, greater weight loss was associated with improvements in self-efficacy ( P = .014) and P-weight scores for weight consequences evaluation ( P = .007) and weight management actions ( P = .04). CONCLUSIONS: A behavioral weight loss intervention during CR is feasible and safe, leading to greater weight and fat loss and related improvements in weight maintenance behaviors in overweight/obese adults with CHD.

Exercise capacity and its determinants among postcardiac rehabilitation patients with coronary heart disease.

AIM: To investigate the determinants of exercise capacity in postcardiac rehabilitation patients with coronary heart disease (CHD). DESIGN: A cross-sectional design was used. METHODS: This study analysed the cross-sectional data from the baseline assessment of 130 CHD patients who participated in a longitudinal randomized controlled trial of music-paced physical activity intervention for CHD patients (ChiCTR-IOR-17011015) (September 2017 to February 2019). Exercise capacity was measured by using the 10-metre incremental shuttle-walk test. The amount of physical activity, exercise self-determination and exercise self-efficacy were measured by validated instruments. Participants' anthropometric parameters (body mass index, body fat mass percentage and waist circumference) were measured. Hierarchical regression analyses were used to identify the factors influencing exercise capacity. RESULTS: The mean incremental shuttle-walk test distance was 493.00 ± 180.04 m. The factors significantly associated with exercise capacity were age (ß = -.42), female (ß = -.35), body mass index (ß = -.25) and exercise self-efficacy (ß = -.20). These factors accounted for 56.5% of the total variance of exercise capacity.

Effects of telecardiac rehabilitation on coronary heart disease: A PRISMA-compliant systematic review and meta-analysis.

BACKGROUND: We performed a meta-analysis to investigate the effectiveness of telecardiac rehabilitation compared to center-based rehabilitation on cardiorespiratory fitness, blood pressure, blood lipids, body composition, and quality of life in patients with coronary heart disease. METHODS: We searched the Medical Literature Analysis and Retrieval System Online, Cumulative Index to Nursing and Allied Health Literature, Cochrane, Embase, and Scopus databases and retrieved studies published until October 8, 2021. Randomized controlled trials were included to evaluate cardiorespiratory fitness, blood pressure, blood lipids, body composition, and quality of life after telecardiac rehabilitation and center-based rehabilitation in patients with coronary heart disease. The criteria of the Cochrane Handbook for Systematic Reviews of Interventions were used to evaluate the methodological quality of the studies. Funnel plot analysis and Egger test were performed to confirm the publication bias. RESULTS: A total of 8 studies, including 750 participants, reported the effectiveness of the telecardiac rehabilitation and center-based rehabilitation included in the analysis. Except for total cholesterol and mental quality of life (P < .05), all parameters were not significantly different between telecardiac rehabilitation and center-based rehabilitation (P > .05). CONCLUSION: Telecardiac rehabilitation was similar to the effects of center-based rehabilitation. The overall prognosis of patients with coronary heart disease can be improved by increasing patients' participation in cardiac rehabilitation through telerehabilitation.

Sleep behaviour and cardiorespiratory fitness in patients after percutaneous coronary intervention during cardiac rehabilitation: protocol for a longitudinal study.

INTRODUCTION: Most patients with coronary heart disease experience sleep disturbances and low cardiorespiratory fitness (CRF), but their relationship during cardiac rehabilitation (CR) is still unclear. This article details a protocol for the study of sleep trajectory in patients with coronary heart disease during CR and the relationship between sleep and CRF. A better understanding of the relationship between sleep and CRF on patient outcomes can improve sleep management strategies. METHODS AND ANALYSIS: This is a longitudinal study with a recruitment target of 101 patients after percutaneous cardiac intervention from the Seventh People's Hospital of Shanghai, China. Data collection will include demographic characteristics, medical history, physical examination, blood sampling, echocardiography and the results of cardiopulmonary exercise tests. The information provided by a 6-min walk test will be used to supplement the CPET. The Pittsburgh Sleep Quality Index will be used to understand the sleep conditions of the participants in the past month. The Patient Health Questionnaire and General Anxiety Disorder Scale will be used to assess depression and anxiety, respectively. All participants will be required to wear an actigraphy on their wrists for 72 hours to monitor objective sleep conditions. This information will be collected four times within 6 months of CR, and patients will be followed up for 1 year. The growth mixture model will be used to analyse the longitudinal sleep data. The generalised estimating equation will be used to examine the associations between sleep and CRF during CR. ETHICS AND DISSEMINATION: Ethical approval for this observational longitudinal study was granted by the Shanghai Seventh People's Hospital Ethics Committee on 23 April 2021 (2021-7th-HIRB-012). Study results will be disseminated in peer-reviewed journal articles.

Efficacy, efficiency and safety of a cardiac telerehabilitation programme using wearable sensors in patients with coronary heart disease: the TELEWEAR-CR study protocol.

INTRODUCTION: Exercise-based cardiac rehabilitation (CR) is a beneficial tool for the secondary prevention of cardiovascular diseases with, however, low participation rates. Telerehabilitation, intergrading mobile technologies and wireless sensors may advance the cardiac patients' adherence. This study will investigate the efficacy, efficiency, safety and cost-effectiveness of a telerehabilitation programme based on objective exercise telemonitoring and evaluation of cardiorespiratory fitness. METHODS AND ANALYSIS: A supervised, parallel-group, single-blind randomised controlled trial will be conducted. A total of 124 patients with coronary disease will be randomised in a 1:1 ratio into two groups: intervention telerehabilitation group (TELE-CR) (n=62) and control centre-based cardiac rehabilitation group (CB-CR) (n=62). Participants will receive a 12-week exercise-based rehabilitation programme, remotely monitored for the TELE-CR group and standard supervised for the CB-CR group. All participants will perform aerobic training at 70% of their maximal heart rate, as obtained from cardiopulmonary exercise testing (CPET) for 20 min plus 20 min for strengthening and balance training, three times per week. The primary outcomes will be the assessment of cardiorespiratory fitness, expressed as peak oxygen uptake assessed by the CPET test and the 6 min walk test. Secondary outcomes will be the physical activity, the safety of the exercise intervention (number of adverse events that may occur during the exercise), the quality of life, the training adherence, the anxiety and depression levels, the nicotine dependence and cost-effectiveness. Assessments will be held at baseline, end of intervention (12 weeks) and follow-up (36 weeks). ETHICS AND DISSEMINATION: The study protocol has been reviewed and approved by the Ethics Committee of the University of Thessaly (1108/1-12-2021) and by the Ethics Committee of the General University Hospital of Larissa (3780/31-01-2022). The results of this study will be disseminated through manuscript publications and conference presentations. TRIAL REGISTRATION NUMBER: NCT05019157.

Rehabilitation effects of circuit resistance training in coronary heart disease patients: A systematic review and meta-analysis.

BACKGROUND AND HYPOTHESIS: The rehabilitation effect of circuit resistance training in coronary heart disease (CHD) patients remains unclear. We perform this review to examine the rehabilitation effect of circuit resistance training in CHD patients and to provide a basis for the formulation of reasonable individual exercise prescriptions for CHD patients. METHODS: Randomized controlled trials (RCTs) were searched on PubMed, Web of Science, The Cochrane Library, Embase, Clinical Trials, and CNKI. About 1232 studies were identified. Nine RCTs were finally used for the present meta-analysis to determine the rehabilitation effect of circuit resistance training in CHD patients, compared to aerobic training. Individuals enrolled for the studies were at a mean age of 60.5 years old and were all CHD patients. Following the PRISMA guidelines, we extracted basic information about the study and patient characteristics, as well as measurements (e.g., the peak oxygen uptake, the body mass index [BMI], the body fat percentage, the systolic blood pressure, the total cholesterol, and triglycerides). Subsequently, this meta-analysis determined the overall effect by using standardized mean difference (SMD) and 95% confidence interval (CI). RESULTS: Compared with aerobic training, circuit resistance training significantly decrease the BMI and the body fat percentage. CONCLUSIONS: As suggested from the present meta-analysis of RCTs, circuit resistance training is effective in improving the BMI and the body fat percentage in CHD patients and may help delay the progression of CHD. CRT has the advantage of lower load in most cases with a similar effect.

Are patient characteristics and modes of delivery associated with completion of cardiac rehabilitation? A national registry analysis.

AIM: To achieve effectiveness and reduce inequality in everyday cardiac rehabilitation, this study aims to compare individual patient characteristics along with completion rates to traditional and evolving modes of delivery in cardiac rehabilitation. METHOD: Patients were included from the UK National Audit of Cardiac Rehabilitation (NACR) database. All patients with coronary heart disease (≥18 years) between the 1st of January 2014 to 31st of December 2019 that started core rehabilitation with a recorded mode of cardiac rehabilitation delivery were eligible. Modes of delivery were divided into: centre-based, home-based, and hybrid. Logistic regression models were used to investigate association between modes of delivery and completion adjusting for patient demographics. RESULT: In total 182,722 patients had mode of delivery recorded: 72.8% centre-based, 8.3% home-based and 18.9% hybrid. The home-based mode in comparison to hybrid and centre-based had significantly higher rates of females, single, white, and unemployed patients (p < 0.001). There was a higher proportion of cardiovascular risk factors in home-based than the other modes (p < 0.001). There was a reduced likelihood of completing home-based cardiac rehabilitation compared to centre-based with an odds ratio of 0.66, (95% CI: 0.48 to 0.91) but no significant difference between hybrid and centre-based modes (odds ratio, 1.18; 95% CI 0.92 to 1.51). CONCLUSIONS: From large real-world data, home-based modes of delivery appear to have significantly lower levels of completion than centre-based modes. Cardiac rehabilitation programs offering home-based and hybrid delivery modes need to be structured to ensure adequacy of completion.

Effectiveness of "Internet+" Based Cardiac Rehabilitation on Prognosis of Patients with Coronary Heart Disease: A Meta-Analysis.

Objective: Meta-analysis was used to systematically evaluate the impact of Internet-based cardiac rehabilitation on the health of patients with coronary heart disease. Methods: Randomized controlled trial study (RCTs) of the effects of Internet-based cardiac rehabilitation on cardiovascular risk factors, motor function and psychological status in patients with coronary heart disease has been systematically studied. Results: A total of 13 articles were included. Meta-analysis showed that internet-based cardiac rehabilitation training could effectively reduce the total cholesterol level [MD = -0.15, 95% CI (-0.28, -0.02), P = 0.02] and triglyceride level [MD = -0.19, 95% CI (-0.32, -0.06), P = 0.01], increase the maximal oxygen uptake (VO2 max) [MD = 0.9995, CI (0.161.83) P = 0.02] and physical activity level [SMD = 0.51, 95% CI (0.07, 0.9), P = 0.02], and improve the self-efficacy [SMD = 0.50, 95% CI (0.17, 0.83), P = 0.01] and improved quality of life [SMD = 1.34, 95% CI (0.12, 2.56), P = 0.03] of patients. However, there was no significant improvement in blood pressure and body mass index, depression and anxiety. Conclusion: Internet-based cardiac rehabilitation can significantly reduce cholesterol and triglyceride levels and improve theVO2 max, physical activity, self-efficacy and quality of life, but is not effective on the level of blood pressure, BMI, anxiety and depression. Due to the limitations of methodological quality and sample size of included studies, more studies with high-quality and large sample are needed to further evaluate its effectiveness.

Effects of different brisk walking intensities on adherence and cardiorespiratory endurance of cardiac rehabilitation among patients with CHD after PCI: protocol for a randomised controlled trial.

INTRODUCTION: Cardiac rehabilitation (CR) is a critical treatment for patients with coronary heart disease after percutaneous coronary intervention. Unfortunately, participation and adherence of CR are unexpectedly poor. This study aims to test whether low-intensity or medium-intensity brisk walking is more helpful in improving early attendance, adherence and physical results. METHODS AND ANALYSIS: This randomised controlled study will compare the effects of low-intensity and medium-intensity brisk walking to improve adherence and cardiopulmonary endurance. Participants will be randomly allocated to low-intensity or medium-intensity groups and will be followed-up for 8 weeks. Primary and secondary outcome data will be collected at baseline and at 2, 4 and 8 weeks. Primary outcomes measure changes in oxygen consumption (VO2) peak value (mL/kg/min), as well as adherence. Secondary outcomes include changes in body mass index, oxygen pulse, maximal metabolic equivalent, breathing reserve, vital capacity, ratio of forced expiratory volume in 1 s to forced vital capacity, Δoxygen consumption/Δwork rate (ΔVO2/ΔWR), minute ventilation/carbon dioxide production and self-efficacy. ETHICS AND DISSEMINATION: Ethical approval and informed consent form have been obtained from the Ethics Committee of Hebei General Hospital (approval number: NA-2021-03). The study background and main objective, as well as potential benefits and risks, will be fully explained to the participants and their families. Findings from this study will be published on academic journals in Chinese or in English for widespread dissemination of the results TRIAL REGISTRATION NUMBER: ChiCTR2100047568.

Validation of the PROMIS-29v2 Health-Related Quality-of-Life Questionnaire in Patients With Coronary Heart Disease Participating in Remote Cardiac Rehabilitation.

PURPOSE: The aim of this study was to validate the 29-item Patient-Reported Outcomes Measurement Information System version 2.0 (PROMIS-29v2) health-related quality-of-life (HRQL) questionnaire for use in patients with coronary heart disease (CHD) participating in remotely delivered cardiac rehabilitation (CR). METHODS: Patients commencing remote CR across four sites in New South Wales, Australia, answered the PROMIS-29v2 and 12-item Short Form Health Survey version 2.0 (SF-12v2) questionnaires at CR entry and completion (6 wk). The data were analyzed for validity, reliability, and responsiveness to change. RESULTS: Patients (N = 89) had a mean age of 66.9 ± 9.3 yr; 83% were male and were referred to CR for elective percutaneous coronary intervention (PCI) (42%), myocardial infarction (36%), and coronary artery bypass grafting (22%). Internal consistency reliability was adequate, with the Cronbach α ranging from 0.78-0.98. Convergent validity between the PROMIS-29v2 and SF-12v2 summary scores showed significantly strong correlations for physical ( r = 0.62) and moderate for mental ( r = 0.36) health. Discriminant validity was confirmed for sex (women reported lower physical and mental health) and referral diagnosis (patients who had elective PCI reported better physical health). Effect size (ES) comparisons confirmed responsiveness to change from CR entry to completion in physical health (ES = 0.51) and demonstrated evidence of more responsiveness than SF-12v2 for mental health (ES = 0.70). CONCLUSION: The PROMIS-29v2 is reliable, valid, and responsive to changes in patients with CHD attending remotely delivered CR and allows for baseline HRQL assessment, between-diagnosis comparisons, and evaluation of changes over time.

Effectiveness of home-based cardiac telerehabilitation as an alternative to Phase 2 cardiac rehabilitation of coronary heart disease: a systematic review and meta-analysis.

AIMS: The onset of the COVID-19 pandemic saw the suspension of centre-based cardiac rehabilitation (CBCR) and has underscored the need for home-based cardiac telerehabilitation (HBCTR) as a feasible alternative rehabilitation delivery model. Yet, the effectiveness of HBCTR as an alternative to Phase 2 CBCR is unknown. We aimed to conduct a meta-analysis to quantitatively appraise the effectiveness of HBCTR. METHODS AND RESULTS: PubMed, EMBASE, CENTRAL, CINAHL, Scopus, and PsycINFO were searched from inception to January 2021. We included randomized controlled trials (RCTs) comparing HBCTR to Phase 2 CBCR or usual care in patients with coronary heart disease (CHD). Out of 1588 studies, 14 RCTs involving 2869 CHD patients were included in this review. When compared with usual care, participation in HBCTR showed significant improvement in functional capacity {6-min walking test distance [mean difference (MD) 25.58 m, 95% confidence interval (CI) 14.74-36.42]}; daily step count (MD 1.05 K, 95% CI 0.36-1.75) and exercise habits [odds ratio (OR) 2.28, 95% CI 1.30-4.00)]; depression scores (standardized MD -0.16, 95% CI -0.32 to 0.01) and quality of life [Short-Form mental component summary (MD 2.63, 95% CI 0.06-5.20) and physical component summary (MD 1.99, 95% CI 0.83-3.16)]. Effects on medication adherence were synthesized narratively. HBCTR and CBCR were comparably effective. CONCLUSION: In patients with CHD, HBCTR was associated with an increase in functional capacity, physical activity (PA) behaviour, and depression when compared with UC. When HBCTR was compared to CBCR, an equivalent effect on functional capacity, PA behaviour, QoL, medication adherence, smoking behaviour, physiological risk factors, depression, and cardiac-related hospitalization was observed.