Journal of Cardiopulmonary Rehabilitation and Prevention最新文献

{"title":"Implementation of a Clinical Decision Support Tool to Improve Cardiac Rehabilitation Referral.","authors":"Joseph F Nowatzke, Jared M O'Leary, Shi Huang, Adam Wright, T Lorraine Patterson, Justin M Bachmann","doi":"10.1097/HCR.0000000000000902","DOIUrl":"10.1097/HCR.0000000000000902","url":null,"abstract":"<p><strong>Purpose: </strong>Inadequate referral to cardiac rehabilitation (CR) is a major barrier to CR participation. We investigated the implementation of a clinical decision support (CDS) tool on improving CR referral for patients hospitalized with acute myocardial infarction (AMI) at an academic medical center.</p><p><strong>Methods: </strong>We developed a CDS tool that identified patients admitted with AMI and reminded physicians to refer patients to CR. We used multivariable-adjusted logistic regression to evaluate predictors of CR referral prior to the CDS tool. We then conducted an interrupted time series (ITS) analysis on CR referral rates before and after intervention.</p><p><strong>Results: </strong>A total of 1985 patients admitted with acute MI from December 2014 through March 2023 were included. Prior to CDS implementation, 1218 of 1657 patients (74%) were referred to CR. Multivariable-adjusted logistic regression demonstrated that ST-segment elevation myocardial infarction on arrival (OR = 1.70: 95% CI, 1.29-2.23, P < .001) and percutaneous coronary intervention during the hospitalization (OR = 2.25: 95% CI, 1.60-3.15, P < .001) were associated with a higher odds of CR referral. After implementation of the CDS tool, 308 of 328 patients (94%) received CR referrals. An ITS analysis demonstrated that the increase in CR referral from 74-94% after the CDS tool was highly significant (P < .01).</p><p><strong>Conclusions: </strong>The implementation of a CDS tool reminding physicians to refer patients with AMI to CR markedly improved CR referral rates at our institution. These findings are important for institutions seeking to improve outcomes in patients with AMI.</p>","PeriodicalId":15192,"journal":{"name":"Journal of Cardiopulmonary Rehabilitation and Prevention","volume":"45 1","pages":"29-36"},"PeriodicalIF":3.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142921811","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"In Memoriam: Philip A Ades, MD, MAACVPR.","authors":"Sherrie Khadanga, Patrick D Savage","doi":"10.1097/HCR.0000000000000934","DOIUrl":"https://doi.org/10.1097/HCR.0000000000000934","url":null,"abstract":"","PeriodicalId":15192,"journal":{"name":"Journal of Cardiopulmonary Rehabilitation and Prevention","volume":"45 1","pages":"1"},"PeriodicalIF":3.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143189566","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Patterns of Adherence to Home Blood Pressure Monitoring Among Older Adults With Ischemic Heart Disease: An Analysis From the RESILIENT Trial of Mobile Health Cardiac Rehabilitation.","authors":"Lara C Kovell, Victoria Bothwick, Paul McCabe, Stephen P Juraschek, Yuchen Meng, Ritika Revoori, Stephanie Pena, Antoinette Schoenthaler, Samrachana Adhikari, John A Dodson","doi":"10.1097/HCR.0000000000000911","DOIUrl":"10.1097/HCR.0000000000000911","url":null,"abstract":"<p><strong>Purpose: </strong>Hypertension (HTN) is common and represents a major modifiable risk factor for ischemic heart disease in older adults. While home blood pressure monitoring (HBPM) is important in HTN management, patterns of HBPM engagement in older adults undergoing mobile health cardiac rehabilitation (mHealth-CR) are unknown. We aimed to identify patterns of adherence to HBPM in a cohort of older adults undergoing mHealth-CR to optimize HBPM use in the future.</p><p><strong>Methods: </strong>We used interim data from the ongoing Rehabilitation using Mobile Health for Older Adults with Ischemic Heart Disease in the Home Setting (RESILIENT) randomized trial, in which intervention arm participants (adults ≥ 65 years with ischemic heart disease) were instructed to monitor blood pressure (BP) at least weekly. Engagement groups were determined by latent class analysis and compared using ANOVA or Chi-Square tests. Longitudinal mixed effect modeling determined the associations between weekly HBPM and baseline covariates including uncontrolled HTN, obesity, diabetes, depression, alcohol, and tobacco use.</p><p><strong>Results: </strong>Of the 111 participants, the mean age was 71.9 ± 5.6 years, and 83% had HTN. Over the 12-week study, mean HBPM engagement was 2.3 ± 2.3 d/wk. We observed 3 distinct patterns of engagement: high engagement (22%), gradual decline (10%), and sustained baseline engagement (68%). HBPM adherence decreased in two of the engagement groups over time. Of the covariates tested, only depression was associated with weekly HBPM after adjusting for relevant covariates (OR 9.09, P  = .03).</p><p><strong>Conclusions: </strong>In this older adult cohort undergoing mHealth-CR, we found three main engagement groups with declining engagement over time in two of the three groups. These patterns can inform future mHealth-CR interventions.</p>","PeriodicalId":15192,"journal":{"name":"Journal of Cardiopulmonary Rehabilitation and Prevention","volume":" ","pages":"57-64"},"PeriodicalIF":3.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142739784","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of Exercise-Based Cardiac Rehabilitation on Patients With Chronic Heart Failure After Transcatheter Aortic Valve Replacement: A Randomized Controlled Trial.","authors":"Jingjin Song, Xiang Chen, Bin Wang, Ye Cheng, Yan Wang","doi":"10.1097/HCR.0000000000000912","DOIUrl":"10.1097/HCR.0000000000000912","url":null,"abstract":"<p><strong>Purpose: </strong>The objective of this study was to assess the effect of exercise-based cardiac rehabilitation (CR) with individualized exercise prescription in patients with chronic heart failure (HF) undergoing transcatheter aortic valve replacement (TAVR) in a randomized controlled trial.</p><p><strong>Methods: </strong>A total of 60 patients with chronic HF who received TAVR treatment were randomly divided into the control group (n = 30) and exercise training (ET) group (n = 30). The control group was treated with conventional rehabilitation, and the ET group was given personalized exercise-based CR based on a cardiopulmonary exercise test (CPX). The CPX parameters, echocardiography, 6-minute walk test distance, and quality of life were evaluated in the two groups.</p><p><strong>Results: </strong>All patients who completed symptom-restricted CPX showed no complications. After the 12-week rehabilitation period, the levels of anaerobic threshold, peak oxygen uptake, peak oxygen pulse, peak power, left ventricular ejection fraction, and 6-minute walk test distance in the ET group were significantly higher than those in the control group ( P  < .05). Scores on the Minnesota Life with Heart Failure Questionnaire in the ET group were lower than those in the control group ( P < .05).</p><p><strong>Conclusion: </strong>Exercise-based CR significantly improves cardiopulmonary function, exercise tolerance, and quality of life in patients with chronic HF who undergo TAVR.</p>","PeriodicalId":15192,"journal":{"name":"Journal of Cardiopulmonary Rehabilitation and Prevention","volume":" ","pages":"51-56"},"PeriodicalIF":3.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142739782","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pulmonary Rehabilitation for Diseases Other Than COPD.","authors":"Katherine E Menson, Leona Dowman","doi":"10.1097/HCR.0000000000000915","DOIUrl":"10.1097/HCR.0000000000000915","url":null,"abstract":"<p><p>Review the current literature regarding pulmonary rehabilitation (PR) for non-chronic obstructive pulmonary disease (COPD) diagnoses and what the evidence is regarding expected outcomes based on disease manifestations. Literature search was performed using PubMed database from March 2024 to June 2024. Terms included \"pulmonary rehabilitation\" and \"exercise training\" in conjunction with key words \"interstitial lung disease (ILD),\" \"idiopathic pulmonary fibrosis,\" \"asthma,\" \"bronchiectasis,\" \"post-acute sequalae of SARS-CoV-2 (PASC),\" \"long COVID,\" \"pulmonary hypertension (PH),\" and \"lung cancer.\" Results were filtered for English language, randomized controlled trial, clinical trial, observational trial, meta-analysis, and guidelines. Emphasis was placed on more recent publications since prior reviews, where applicable. The abundance of literature involved ILD, where studies have demonstrated significant improvements in exercise capacity, health-related quality of life (HRQoL), and dyspnea, despite heterogeneity of diseases; benefits are similar to those seen with COPD. Those with milder disease have more sustained benefits longer term. Patients with asthma benefit in severe disease, lower exercise activity, elevated body mass index, or when comorbid conditions are present, and breathing exercises can improve symptoms of breathlessness. Patients with PASC have a multitude of symptoms and lack benefits in HRQoL measurements; PR improves performance on post-COVID-19 functional status scale, a more comprehensive measurement of symptoms. Those with bronchiectasis benefit from PR when airflow limitation or exacerbations are impacting symptoms and HRQoL. Those with stable PH can improve their exertional capacity without change in disease severity. PR reduces perioperative complications in those with lung cancer and preserve fitness during treatment.</p>","PeriodicalId":15192,"journal":{"name":"Journal of Cardiopulmonary Rehabilitation and Prevention","volume":" ","pages":"425-431"},"PeriodicalIF":3.3,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142466289","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Long-Term Physical Activity Behavior Change in Pulmonary Rehabilitation: Promoting Motivation.","authors":"Rachel S Tappan, Margaret K Danilovich, David E Conroy","doi":"10.1097/HCR.0000000000000888","DOIUrl":"10.1097/HCR.0000000000000888","url":null,"abstract":"","PeriodicalId":15192,"journal":{"name":"Journal of Cardiopulmonary Rehabilitation and Prevention","volume":"44 6","pages":"395-398"},"PeriodicalIF":3.3,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142562445","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An Introduction to the Journal of Cardiopulmonary Rehabilitation and Prevention's Special Issue on Pulmonary Rehabilitation.","authors":"Daniel Stevens, Abraham Samuel Babu, Gerene Bauldoff","doi":"10.1097/HCR.0000000000000920","DOIUrl":"10.1097/HCR.0000000000000920","url":null,"abstract":"","PeriodicalId":15192,"journal":{"name":"Journal of Cardiopulmonary Rehabilitation and Prevention","volume":"44 6","pages":"385-386"},"PeriodicalIF":3.3,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142562421","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Contemporary Performance Measurement in Pulmonary Rehabilitation.","authors":"Dianne V Jewell, Anne Gavic-Ott","doi":"10.1097/HCR.0000000000000908","DOIUrl":"10.1097/HCR.0000000000000908","url":null,"abstract":"","PeriodicalId":15192,"journal":{"name":"Journal of Cardiopulmonary Rehabilitation and Prevention","volume":"44 6","pages":"391-394"},"PeriodicalIF":3.3,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142562440","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Obesity Paradox in Pulmonary Rehabilitation: Relevance and Implications to Clinical Practice.","authors":"Abebaw M Yohannes, Mark T Dransfield, Peter E Morris","doi":"10.1097/HCR.0000000000000913","DOIUrl":"10.1097/HCR.0000000000000913","url":null,"abstract":"<p><p>Pulmonary rehabilitation (PR) increases exercise capacity, reduces dyspnea, and improves quality of life (QoL) in patients with chronic obstructive pulmonary disease (COPD). Patients requiring PR can present with multiple comorbidities. One of the most common comorbidities is obesity. The prevalence of obesity in patients with COPD is increasing at an alarming rate. To date the efficacy of PR to ameliorate obesity in patients with COPD is unclear. Obesity in patients with COPD is associated with increased morbidity and mortality compared to patients without obesity. However, the benefits of obesity paradox in lower mortality rate health-related QoL and health care utilization remain unclear. This review discusses the challenges of prescribing PR to patients with obesity and COPD. In addition, the definition of and the potential challenges and benefits of the obesity paradox in patients with COPD will be discussed. Treatment strategies that include combining PR with lifestyle management, individually tailored nutritional advice, pharmacotherapy, and surgery need to be tested in prospective, randomized controlled trials. The challenges of providing complex care, prioritizing patient needs, and future directions will also be discussed for patients with obesity and COPD.</p>","PeriodicalId":15192,"journal":{"name":"Journal of Cardiopulmonary Rehabilitation and Prevention","volume":"44 6","pages":"417-424"},"PeriodicalIF":3.3,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142562450","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Alternative Modes of Delivery in Pulmonary Rehabilitation: A Critical Appraisal of the Literature.","authors":"Ana Machado, Chris Burtin, Martijn A Spruit","doi":"10.1097/HCR.0000000000000910","DOIUrl":"10.1097/HCR.0000000000000910","url":null,"abstract":"<p><strong>Purpose: </strong>This review presents an overview of the safety and efficacy of alternative modes of pulmonary rehabilitation (PR) in people with chronic obstructive pulmonary disease (COPD).</p><p><strong>Review methods: </strong>We identified recently published systematic reviews, meta-analyses, and guidelines, as well as relevant studies, exploring the safety and effectiveness of community-based PR, home-based PR, telerehabilitation, and web-based rehabilitation in people with COPD. A narrative summary of the main findings is presented.</p><p><strong>Summary: </strong>Although evidence suggests that community-based PR, home-based PR, telerehabilitation, and web-based rehabilitation are effective alternatives to center-based PR, it requires a careful interpretation as several of these programs do not comply with PR definition and have been compared with center-based PR programs that do not reach the minimal clinically important differences. Moreover, there is a huge heterogeneity among programs, and the confidence and quality of the evidence is mostly low. Hence, these novel modes of PR and center-based PR are not interchangeable. Instead, these are alternative modes aiming to increase access to PR. Questions remain regarding the most efficient way of implementing each PR mode, level of access, reimbursement policies, and data privacy in the use of technology. Standard protocols on how to set up each alternative PR mode need to be developed. Future research needs to explore how to use the treatable traits approach in combination with individual preferences and needs, program availability, safety, social support network, digital literacy, and health system context to identify the optimal PR program for each patient.</p>","PeriodicalId":15192,"journal":{"name":"Journal of Cardiopulmonary Rehabilitation and Prevention","volume":"44 6","pages":"399-408"},"PeriodicalIF":3.3,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142562419","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}