High-intensity interval training for intermittent claudication in a vascular rehabilitation program.

This article reports an observational study investigating the safety and effectiveness of a high-intensity interval exercise program for patients with peripheral arterial disease. Patients were asked to walk on a treadmill to maximal claudication pain six times in each exercise session, with 3-minute rests in between. Once a patient could walk continuously for 6 minutes without reaching maximal pain, speed and/or grade was increased. To account for the changes in speed and grade, patients' walking ability was measured as a rehabilitation score, calculated as the product of the two. A total of 47 patients were included in the study. Results showed overall improvement in the rehabilitation score with participation in the program, and specifically showed that participation in more exercise sessions led to greater improvement. Moreover, no adverse events occurred in the study patients, suggesting patients with peripheral arterial disease can safely tolerate high-intensity exercise programs.

Effectiveness and cost of a transitional care program for heart failure: a prospective study with concurrent controls.

BACKGROUND: Randomized controlled trials have demonstrated the efficacy of nurse-led transitional care programs to reduce readmission rates for patients with heart failure; the effectiveness of these programs in real-world health care systems is less well understood. METHODS: We performed a prospective study with concurrent controls to test an advanced practice nurse-led transitional care program for patients with heart failure who were 65 years or older and were discharged from Baylor Medical Center Garland (BMCG) from August 24, 2009, through April 30, 2010. We compared the effect of the program on 30-day (from discharge) all-cause readmission rate, length of stay, and 60-day (from admission) direct cost for BMCG with that of other hospitals within the Baylor Health Care System. We also performed a budget impact analysis using costs and reimbursement experience from the intervention. RESULTS: The intervention significantly reduced adjusted 30-day readmission rates to BMCG by 48% during the postintervention period, which was better than the secular reductions seen at all other facilities in the system. The intervention had little effect on length of stay or total 60-day direct costs for BMCG. Under the current payment system, the intervention reduced the hospital financial contribution margin on average $227 for each Medicare patient with heart failure. CONCLUSIONS: Preliminary results suggest that transitional care programs reduce 30-day readmission rates for patients with heart failure. This underscores the potential of the intervention to be effective in a real-world setting, but payment reform may be required for the intervention to be financially sustainable by hospitals.

Challenging traditional activity limits after coronary artery bypass graft surgery: a simulated lawn-mowing activity.

PURPOSE: Physician advice and restrictions to patients following a cardiac event can, in some instances, lead patients to be fearful regarding their activities even to the point of inactivity. The purpose of this study was to test whether lawn mowing, one of the activities most strongly discouraged after coronary artery bypass surgery, could be safely performed in a supervised setting. METHOD: Subjects participated in a 6-session simulated lawn-mowing protocol, calibrated to match the push and pull forces of using an outdoor nonpropelled lawn mower. Plain chest radiographs were taken before and after the protocol period. During each session, subjects' sternums were carefully palpated and electrocardiograms, heart rates, and blood pressures were monitored. RESULTS: None of the 13 subjects experienced adverse arrhythmia events or detrimental heart rate, blood pressure, or sternal palpation findings that led to study discontinuation. The radiographs taken after protocol completion showed stable sternal wires with no evidence of sternal dehiscence. CONCLUSION: Simulated lawn mowing did not negatively affect the sternal incision, electrocardiogram findings, blood pressure, or heart rate in this small sample.