Core Components of Cardiac Rehabilitation Programs: 2024 Update: A Scientific Statement From the American Heart Association and the American Association of Cardiovascular and Pulmonary Rehabilitation: Endorsed by the American College of Cardiology.

The science of cardiac rehabilitation and the secondary prevention of cardiovascular disease has progressed substantially since the most recent American Heart Association and American Association of Cardiovascular and Pulmonary Rehabilitation update on the core components of cardiac rehabilitation and secondary prevention programs was published in 2007. In addition, the advent of new care models, including virtual and remote delivery of cardiac rehabilitation services, has expanded the ways that cardiac rehabilitation programs can reach patients. In this scientific statement, we update the scientific basis of the core components of patient assessment, nutritional counseling, weight management and body composition, cardiovascular disease and risk factor management, psychosocial management, aerobic exercise training, strength training, and physical activity counseling.

Is 70% Achievable? Hospital-Level Variation in Rates of Cardiac Rehabilitation Use Among Medicare Beneficiaries.

Background: Despite national goals to enroll 70% of cardiac rehabilitation (CR)-eligible patients, enrollment remains low.

Objectives: The purpose of this study was to evaluate how the treating hospital influences CR enrollment nationally.

Methods: We included Fee-for-Service Medicare beneficiaries aged ≥66 years who were hospitalized for acute myocardial infarction, coronary artery bypass grafting, percutaneous coronary intervention, or heart valve repair/replacement.

Tobacco Use, Electronic Nicotine Delivery Systems, and Vulnerable Populations: Current Landscape and Opportunities for Improvement.

The tobacco epidemic has claimed countless lives, caused significant morbidity, and cost billions of dollars in direct costs and lost productivity. Despite its acute vascular effects, nicotine alone has not been definitively linked to cardiovascular events. Rather, additives found in cigarettes and other tobacco products likely play a bigger role in tobacco's link to cardiovascular events.

Core Components of Cardiac Rehabilitation Programs: 2024 Update: A Scientific Statement From the American Heart Association and the American Association of Cardiovascular and Pulmonary Rehabilitation.

The science of cardiac rehabilitation and the secondary prevention of cardiovascular disease has progressed substantially since the most recent American Heart Association and American Association of Cardiovascular and Pulmonary Rehabilitation update on the core components of cardiac rehabilitation and secondary prevention programs was published in 2007. In addition, the advent of new care models, including virtual and remote delivery of cardiac rehabilitation services, has expanded the ways that cardiac rehabilitation programs can reach patients. In this scientific statement, we update the scientific basis of the core components of patient assessment, nutritional counseling, weight management and body composition, cardiovascular disease and risk factor management, psychosocial management, aerobic exercise training, strength training, and physical activity counseling.

Differential Impact of Systolic and Diastolic Heart Failure on In-Hospital Treatment, Outcomes, and Cost of Patients Admitted for Pneumonia.

Background: Patients admitted with pneumonia and heart failure (HF) have increased mortality and cost compared to those without HF, but it is not known whether outcomes differ between systolic and diastolic HF. Management of concomitant pneumonia and HF is complicated because HF treatments can worsen complications of pneumonia.

Methods: This is a retrospective cohort study from the Premier Database among patients admitted with pneumonia between 2010-2015.

County-Level Cardiac Rehabilitation and Broadband Availability: Opportunities for Hybrid Care in the United States.

Purpose: Cardiac rehabilitation (CR) improves patient outcomes and quality of life and can be provided virtually through hybrid CR. However, little is known about CR availability in conjunction with broadband access, a requirement for hybrid CR. This study examined the intersection of CR and broadband availability at the county level, nationwide.

Clinical challenges facing patient participation in cardiac rehabilitation: cigarette smoking.

Introduction: Cardiac rehabilitation (CR) is highly effective at reducing morbidity and mortality. However, CR is underutilized, and adherence remains challenging. In no group is CR attendance more challenging than among patients who smoke.

Electrocardiogram changes as predictors for new imaging findings in repeat transthoracic echocardiography.

To determine if electrocardiogram (EKG) findings may be a useful tool to predict changes in repeat transthoracic echocardiogram (TTE). We evaluated patients who underwent TTE during hospitalization and their EKGs, and whether findings differed between studies. Of 229 hospitalized patients who underwent repeat TTE, 183 (80%) were abnormal.

Effects of Exercise Testing and Cardiac Rehabilitation in Patients with Coronary Heart Disease on Fear and Self-Efficacy of Exercise: A Pilot Study.

Background: Exercise fear and low exercise self-efficacy are common in patients attending cardiac rehabilitation (CR). This study tested whether exercise prescription methods influence exercise fear and exercise self-efficacy. We hypothesized that the use of graded exercise testing (GXT) with a target heart rate range exercise prescription, relative to standard exercise prescription using rating of perceived exertion (RPE), would produce greater reductions in exercise fear and increase self-efficacy during CR.

Assisted ambulation to improve health outcomes for older medical inpatients (AMBULATE): study protocol for a randomized controlled trial.

Background: Hospitalized older adults spend as much as 95% of their time in bed, which can result in adverse events and delay recovery while increasing costs. Observational studies have shown that general mobility interventions (e.g.

"I Just Wanted Nothing More Than to Get in a Real Shower": Patient Experience of the Inpatient Wait for a Heart Transplant.

Background: Patients waiting for heart transplant may be hospitalized for weeks to months before undergoing transplantation. This high-stress period is further complicated by restrictions of daily privileges including diet, rooming, access to the outdoors, and hygiene (eg, limited in ability to shower). However, there is a paucity of research on the experience of this waiting period.

Stepped care versus center-based cardiopulmonary rehabilitation for older frail adults living in rural MA: Design of a feasibility randomized controlled trial.

Background: Cardiac and pulmonary rehabilitation programs are grossly underutilized, and participation is particularly low in rural regions.

Methods: We are conducting a 2-arm, randomized controlled feasibility trial. Eligible participants include older frail adults with cardiac or pulmonary disease living in a predominantly rural county in western Massachusetts.

A New Era in Cardiac Rehabilitation Delivery: Research Gaps, Questions, Strategies, and Priorities.

Cardiac rehabilitation (CR) is a guideline-recommended, multidisciplinary program of exercise training, risk factor management, and psychosocial counseling for people with cardiovascular disease (CVD) that is beneficial but underused and with substantial disparities in referral, access, and participation. The emergence of new virtual and remote delivery models has the potential to improve access to and participation in CR and ultimately improve outcomes for people with CVD. Although data suggest that new delivery models for CR have safety and efficacy similar to traditional in-person CR, questions remain regarding which participants are most likely to benefit from these models, how and where such programs should be delivered, and their effect on outcomes in diverse populations.

Promoting Participation in Pulmonary Rehabilitation after Hospitalization for Chronic Obstructive Pulmonary Disease, Strategies of Top-performing Systems: A Qualitative Study.

Pulmonary rehabilitation (PR) after hospitalization for chronic obstructive pulmonary disease (COPD) is recommended by guidelines; however, few patients participate, and rates vary between hospitals. To identify contextual factors and strategies that may promote participation in PR after hospitalization for COPD. Using a positive-deviance approach, we calculated hospital-specific rates of PR after hospitalization for COPD among a cohort of Medicare beneficiaries.

Strategies to Improve Enrollment and Participation in Pulmonary Rehabilitation Following a Hospitalization for COPD: RESULTS OF A NATIONAL SURVEY.

Purpose: Pulmonary rehabilitation (PR) improves outcomes for patients with chronic obstructive pulmonary disease (COPD); however, very few patients attend. We sought to describe strategies used to promote participation in PR after a hospitalization for COPD.

Methods: A random sample of 323 United States based PR programs was surveyed.

Relation of Patient's Opinion of Alcohol's Health Effects and Drinking Habits Among Hospitalized Patients With Cardiovascular Disease.

Media reports frequently cite observational studies and meta-analyses to promote the reputed cardiovascular benefits of moderate alcohol consumption; however, it is unclear whether public opinion or drinking behavior align with these reports. We administered an anonymous, single-center, 35-question, cross-sectional survey among patients hospitalized for acute cardiac illnesses from June to September 2019, who were eligible for cardiac rehabilitation. We assessed patient opinions toward alcohol use, perceptions of alcohol's health impact, and role of media in forming these beliefs.

Acute but not chronic heart failure is associated with higher mortality among patients hospitalized with pneumonia: An analysis of a nationwide database.

Background: Among patients admitted for pneumonia, heart failure (HF) is associated with worse outcomes. It is unclear whether this association is due to acute HF exacerbations, complex medical management, or chronic co-morbid conditions.

Methods: This is a retrospective cohort study of patients admitted between July 2010 and June 2015 at 651 US hospitals with a principal diagnosis of either pneumonia or secondary diagnosis of pneumonia with a primary diagnosis of respiratory failure or sepsis.

Relation of a Maximal Exercise Test to Change in Exercise Tolerance During Cardiac Rehabilitation.

The purpose of this study was to test the hypothesis that an individualized exercise training target heart rate (HR) based on a maximal graded exercise test (GXT) is associated with greater improvements in exercise tolerance during cardiac rehabilitation (CR) compared with no GXT. In this retrospective study, we identified patients who completed 9 to 36 visits of CR between 2001 and 2016, with a length of stay ≤18 weeks and a visit frequency of 1 to 3 days per week. Patients were grouped based on whether their exercise was guided by a target HR determined from a GXT.

Comparison of Ratings of Perceived Exertion and Target Heart Rate-Based Exercise Prescription in Cardiac Rehabilitation: A RANDOMIZED CONTROLLED PILOT STUDY.

Purpose: Although ratings of perceived exertion (RPE) are widely used to guide exercise intensity in cardiac rehabilitation (CR), it is unclear whether target heart rate ranges (THRRs) can be implemented in CR programs that predominantly use RPE and what impact this has on changes in exercise capacity.

Methods: We conducted a three-group pilot randomized control trial (#NCT03925493) comparing RPE of 3-4 on the 10-point modified Borg scale, 60-80% of heart rate reserve (HRR) with heart rate (HR) monitored by telemetry, or 60-80% of HRR with a personal HR monitor (HRM) for high-fidelity adherence to THRR. Primary outcomes were protocol fidelity and feasibility.

Exercise Prescription Methods and Attitudes in Cardiac Rehabilitation: A NATIONAL SURVEY.

Purpose: High-quality exercise training improves outcomes in cardiac rehabilitation (CR), but little is known about how most programs prescribe exercise. Thus, the aim was to describe how current CR programs prescribe exercise.

Methods: We conducted a 33-item anonymous survey of CR program directors registered with the American Association of Cardiovascular and Pulmonary Rehabilitation.