Cardiovascular Health in Cardiac Rehabilitation: Applying the American Heart Association Life's Simple 7 Framework in a Center-Based Cohort.

Abstract

Background: Cardiac rehabilitation (CR) is a comprehensive secondary cardiovascular disease program with structured lifestyle interventions to reduce morbidity and mortality. The American Heart Association cardiovascular health (CVH) framework measures health-promoting behaviors and clinical factors, but it has not been rigorously evaluated in the CR setting.

Methods: This retrospective cohort study analyzed patients attending CR from January 2018 to September 2020. Patients were evaluated at baseline (pre-CR) and completion (post-CR) using 3 clinical factors (blood pressure, cholesterol, and hemoglobin A1c) and 4 health behaviors (smoking, body mass index, physical activity, and diet). CVH score was computed as a composite of each Life's Simple 7 component by assigning 0 points for poor, 1 point for intermediate, or 2 points for ideal (range 0-14 points). CVH scores were further categorized as poor (0-6 points), intermediate (7-8 points), and ideal (9-14 points). Missing data in the analysis were accounted for using a multiple imputation procedure.

Results: Patients (N=937) were aged 64.0±13.4 years old, 34% women, and attended 11±12 CR sessions. Pre-CR, 97.2% had poor CVH scores, 2.8% had intermediate scores, and none met ideal CVH criteria. Post-CR, there was a reduction in poor scores across all metrics except for hemoglobin A1c, which increased (40.6%-43.5%). Younger patients showed improvement in hemoglobin A1c, while older patients improved in body mass index and blood pressure.

Conclusions: Our study demonstrates the efficacy of CR in improving CVH but underscores the need for better blood glucose management. Tailored interventions based on age and sex may further optimize outcomes for CR participants.