Cardiac Rehabilitation (CR) is a recommendation in international clinical practice guidelines given its' benefits, however use is suboptimal. The purpose of this position statement was to translate ...evidence on interventions that increase CR enrolment and adherence into implementable recommendations.
The writing panel was constituted by representatives of societies internationally concerned with preventive cardiology, and included disciplines that would be implementing the recommendations. Patient partners served, as well as policy-makers. The statement was developed in accordance with AGREE II, among other guideline checklists. Recommendations were based on our update of the Cochrane review on interventions to promote patient utilization of CR. These were circulated to panel members, who were asked to rate each on a 7-point Likert scale in terms of scientific acceptability, actionability, and feasibility of assessment. A web call was convened to achieve consensus and confirm strength of the recommendations (based on GRADE). The draft underwent external review and public comment.
The 3 drafted recommendations were that to increase enrolment, healthcare providers, particularly nurses (strong), should promote CR to patients face-to-face (strong), and that to increase adherence part of CR could be delivered remotely (weak). Ratings for the 3 recommendations were 5.95 ± 0.69 (mean ± standard deviation), 5.33 ± 1.12 and 5.64 ± 1.08, respectively.
Interventions can significantly increase utilization of CR, and hence should be widely applied. We call upon cardiac care institutions to implement these strategies to augment CR utilization, and to ensure CR programs are adequately resourced to serve enrolling patients and support them to complete programs.
•Cardiac rehabilitation (CR) is grossly under-utilized, despite its' proven benefits.•A recently-updated Cochrane review established interventions to increase use.•These were translated into implementable recommendations, using best practices.•Implementation tools include an online course to educate inpatient care providers.•Patient preferences and barriers should be considered to optimize use.
The aim of this study was to evaluate the effects of a mobile health (mHealth) intervention, HerBeat, compared with educational usual care (E-UC) for improving exercise capacity (EC) and other ...patient-reported outcomes at 3 mo among women with coronary heart disease.
Women were randomized to the HerBeat group (n = 23), a behavior change mHealth intervention with a smartphone, smartwatch, and health coach or to the E-UC group (n = 24) who received a standardized cardiac rehabilitation workbook. The primary endpoint was EC measured with the 6-min walk test (6MWT). Secondary outcomes included cardiovascular disease risk factors and psychosocial well-being.
A total of 47 women (age 61.2 ± 9.1 yr) underwent randomization. The HerBeat group significantly improved on the 6MWT from baseline to 3 mo ( P = .016, d = .558) while the E-UC group did not ( P = .894, d =-0.030). The between-group difference of 38 m at 3 mo was not statistically significant. From baseline to 3 mo, the HerBeat group improved in anxiety ( P = .021), eating habits confidence ( P = .028), self-efficacy for managing chronic disease ( P = .001), diastolic blood pressure ( P = .03), general health perceptions ( P = .047), perceived bodily pain ( P = .02), and waist circumference ( P = .008) while the E-UC group showed no improvement on any outcomes.
The mHealth intervention led to improvements in EC and several secondary outcomes from baseline to 3 mo while the E-UC intervention did not. A larger study is required to detect small differences between groups. The implementation and outcomes evaluation of the HerBeat intervention was feasible and acceptable with minimal attrition.
Adverse pregnancy outcomes are common among pregnant individuals and are associated with long-term risk of cardiovascular disease. Individuals with adverse pregnancy outcomes also have an increased ...incidence of cardiovascular disease risk factors after delivery. Despite this, evidence-based approaches to managing these patients after pregnancy to reduce cardiovascular disease risk are lacking. In this scientific statement, we review the current evidence on interpregnancy and postpartum preventive strategies, blood pressure management, and lifestyle interventions for optimizing cardiovascular disease using the American Heart Association Life's Essential 8 framework. Clinical, health system, and community-level interventions can be used to engage postpartum individuals and to reach populations who experience the highest burden of adverse pregnancy outcomes and cardiovascular disease. Future trials are needed to improve screening of subclinical cardiovascular disease in individuals with a history of adverse pregnancy outcomes, before the onset of symptomatic disease. Interventions in the fourth trimester, defined as the 12 weeks after delivery, have great potential to improve cardiovascular health across the life course.
Women-focused cardiovascular rehabilitation (CR; phase II) aims to better engage women, and might result in better quality of life than traditional programs. This first clinical practice guideline by ...the International Council of Cardiovascular Prevention and Rehabilitation (ICCPR) provides guidance on how to deliver women-focused programming. The writing panel comprised experts with diverse geographic representation, including multidisciplinary health care providers, a policy-maker, and patient partners. The guideline was developed in accordance with Appraisal of Guidelines for Research and Evaluation (AGREE) II and the Reporting Items for practice Guidelines in HealTh care (RIGHT). Initial recommendations were on the basis of a meta-analysis. These were circulated to a Delphi panel (comprised of corresponding authors from review articles and of programs delivering women-focused CR identified through ICCPR’s audit; N = 76), who were asked to rate each on a 7-point Likert scale in terms of impact and implementability (higher scores positive). A Web call was convened to achieve consensus; 15 panelists confirmed strength of revised recommendations (Grading of Recommendations Assessment, Development, and Evaluation GRADE). The draft underwent external review from CR societies internationally and was posted for public comment. The 14 drafted recommendations related to referral (systematic, encouragement), setting (model choice, privacy, staffing), and delivery (exercise mode, psychosocial, education, self-management empowerment). Nineteen (25.0%) survey responses were received. For all but 1 recommendation, ≥ 75% voted to include; implementability ratings were < 5/7 for 4 recommendations, but only 1 for effect. Ultimately 1 recommendation was excluded, 1 separated into 2 and all revised (2 substantively); 1 recommendation was added. Overall, certainty of evidence for the final recommendations was low to moderate, and strength mostly strong. These recommendations and associated tools can support all programs to feasibly offer some women-focused programming.
La réadaptation cardiaque centrée (RC) sur les femmes (phase II) vise une meilleure participation des femmes, et pourrait permettre une plus grande amélioration de leur qualité de vie que les programmes traditionnels. Ces premières lignes directrices de pratique clinique, élaborées par l’International Council of Cardiovascular Prevention and Rehabilitation (ICCPR), comportent des directives sur la façon de mettre en place des programmes de réadaptation centrée sur les femmes. Le comité de rédaction était composé d’experts provenant de diverses régions géographiques, dont des professionnels de la santé de plusieurs disciplines, un décideur politique et des patients partenaires. Les lignes directrices ont été élaborées selon les principes AGREE II (Appraisal ofGuidelines forResearch andEvaluation II) et RIGHT (ReportingItems for practiceGuidelines inHealThcare). Les premières recommandations, basées sur une méta-analyse, ont été soumises à un panel Delphi composé d’auteurs d’articles de synthèse et de programmes de RC centrée sur les femmes, ciblés lors de l’enquête menée par l’ICCPR (N = 76). Les membres du panel ont évalué chacune des recommandations sur une échelle de Likert à sept points (dans laquelle un score plus élevé correspondait à une perception plus positive), en fonction de leurs répercussions et de leur applicabilité. Une rencontre virtuelle a été tenue pour atteindre un consensus et 15 panélistes ont confirmé la force des recommandations passées en revue (selon l’approche GRADE Grading ofRecommendationsAssessment,Development, andEvaluation). La version préliminaire des recommandations a été soumise à une révision externe par des sociétés de RC de partout dans le monde et a été diffusée publiquement en vue d’obtenir des commentaires. Les 14 recommandations préliminaires portaient sur l’orientation (l’orientation systématique et les encouragements à participer), le contexte (le choix du modèle, le respect de la vie privée et le personnel) et la prestation du programme (la modalité des exercices, l’aspect psychosocial, la formation et le renforcement des capacités d’autoprise en charge). Dix-neuf (25,0 %) réponses ont été reçues lors d’un sondage. Sauf pour une recommandation, les votes étaient à ≥ 75 % en faveur de l’inclusion des recommandations; quatre recommandations ont obtenu un score inférieur à 5/7 pour ce qui est de l’applicabilité, et une seule recommandation a obtenu un tel score pour ce qui est des répercussions. En définitive, une recommandation a été retirée, une a été séparée en deux recommandations distinctes, et toutes ont fait l’objet d’une révision (deux recommandations ont été révisées considérablement); une recommandation a ensuite été ajoutée. Dans l’ensemble, le degré de certitude des données probantes pour les recommandations finales a été évalué comme étant faible à modéré, tandis que la force des recommandations a été évaluée comme étant généralement élevée. Ces recommandations et les outils qui y sont associés peuvent soutenir la mise en place de tous les programmes, afin d’offrir de façon réalisable des programmes de RC centrée sur les femmes.
Display omitted
Reviewer Employment Research Grant Other Research Support Speakers' Bureau/Honoraria Expert Witness Ownership Interest Consultant/Advisory Board Other Vera Bittner University of Alabama at Birmingham ...Gilead: WISQ Studydagger; Roche-DAL-Outcomes Studydagger; GSK-Stability Trialdagger; NIH/Yale-VIRGO Registrydagger; NIH/Abbott-AIM HIGH trialdagger National Coordinator for the ALECARDIO trial (Roche)* None None None Pfizer* Immediate past president, National Lipid Association* Eliot A. Brinton University of Utah Abbottdagger; GSKdagger; Merckdagger None Abbottdagger; Daiichi-Sankyo*; GSKdagger; Kaneka*; Merckdagger; Takedadagger None None Abbott*; Amarin*; Atherotechdagger; Daiichi-Sankyo*; Essentialis*; GSK*; Merck*; Takeda* None Monique V. Chireau Duke University Duke Translational Research Institutedagger; Duke Clinical Research Unit* None None None None Chireau Consultant/Advisory Board, Templeton Foundation* None Jennifer Cummings Akron General Medical Center None None Sanofi Aventis*; Boston Scientific*; Medtronic*; St Jude* None None Corazon Consulting*; St Jude*; Medtronic* None Claire Duvernoy VA Healthcare System VA Cooperative Studies Program* Sanofi-Aventis* None None None None None Federico Gentile Centro Medico Diagnostico (Naples, Italy) None None None None None None None Suzanne Hughes Summa Health System (Akron, OH) None None None None None None None Courtney O. Jordan University of Minnesota None None None None None None None Sanjay Kaul Cedars-Sinai Medical Center Hoffman La Roche* None None None Johnson & Johnson* Hoffman La Roche*; FDA* None Mary McGrae McDermott Northwestern University NHLBIdagger None None None None None Contributing editor, JAMAdagger Laxmi S. Mehta Ohio State University None None None None None None None C. Venkata S. Ram Dallas Nephrology Associates None None None None None None None Rita F. Redberg UCSF Flight Attendant Medical Research Institute* None None None None GTAF*; FDA CVD Expert Panel* None Vincent L. Sorrell University of Arizona None None None None None None None Deborah Wesley Wake Forest University None None None None None None None * Reviewer Disclosures This table represents the relationships of reviewers that may be perceived as actual or reasonably perceived conflicts of interest as reported on the Disclosure Questionnaire, which all reviewers are required to complete and submit.
The current review examined the influence of psychosocial factors on adolescents' perinatal anxiety (PA) and perinatal depression (PND) across geographical regions. Three databases were searched for ...articles published between 2017 and 2022 and 15 articles were reviewed. We categorized factors into social, cultural, and environmental domains. Social factors included adolescent caregiver trust/attachment, social support, perceived social support, trauma/poly-traumatization, and peer solidarity. Cultural factors included feelings of shame, marital satisfaction, partner's rejection of pregnancy, lack of parental involvement in care, parenting stress, childhood household dysfunction, and adverse childhood events. Environmental factors included neighborhood support, food insecurity, domestic violence, going to church, going out with friends, and sources for obtaining information. Routine assessment of psychosocial factors among perinatal teens is crucial to identify those at higher risk for PA and PND. Further research is necessary to examine the influence of cultural and environmental factors on PA, PND, and perinatal outcomes among adolescents.
(2), 13-22..
Improving cancer survival represents the most significant effect of precision medicine and personalized molecular and immunologic therapeutics. Cardiovascular health becomes henceforth a key ...determinant for the direction of overall outcomes after cancer. Comprehensive tissue diagnostic studies undoubtedly have been and continue to be at the core of the fight against cancer. Will a systemic approach integrating circulating blood-derived biomarkers, multimodality imaging technologies, strategic panomics, and real-time streams of digitized physiological data overcome the elusive cardiovascular tissue diagnosis in cardio-oncology? How can such a systemic approach be personalized for application in day-to-day clinical work, with diverse patient populations, cancer diagnoses, and therapies? To address such questions, this scientific statement approaches a broad definition of the biomarker concept. It summarizes the current literature on the utilization of a multitude of established cardiovascular biomarkers at the intersection with cancer. It identifies limitations and gaps of knowledge in the application of biomarkers to stratify the cardiovascular risk before cancer treatment, monitor cardiovascular health during cancer therapy, and detect latent cardiovascular damage in cancer survivors. Last, it highlights areas in biomarker discovery, validation, and clinical application for concerted efforts from funding agencies, scientists, and clinicians at the cardio-oncology nexus.
This study compared attendance of women participating in a motivationally enhanced, gender-tailored cardiac rehabilitation (CR) program with that of women attending a traditional outpatient CR ...program. We also sought to determine the significant baseline predictors of attendance of the exercise and education components of the interventions.
Data from 252 women with CHD in the randomized clinical trial, the Women's-Only Cardiac Rehabilitation Program, were used in this study. The experimental design used 2 treatment groups: both receiving a comprehensive, 12-week, CR program, with 1 group receiving a gender-tailored, stage-of-change matched, behavioral enhancement using individualized motivational interviewing.
Compared with women in the traditional CR program, women in the gender-tailored program attended significantly more of the prescribed exercise (90% vs 77%) and education sessions (87% vs 56%). Group assignment accounted for about 5% of the variance in exercise attendance (F1,250 = 12.755, P < .001) and about 24% of the variance in education attendance (F1,250 = 77.942, P < .001). After controlling for group assignment, the baseline characteristics of smoking status, marital status, and anxiety accounted for about 17% of the variance in exercise attendance (F5,245 = 10.494, P < .001). Smoking status and marital status were significant baseline predictors of education attendance (F5,245 = 6.115, P < .001) after controlling for group assignment.
The long-standing, poor attendance of women in CR continues to be an unresolved international challenge. Gender-tailored, stage-matched, CR programs hold promise for enhancing attendance to prescribed protocols. Additional research examining the efficacy of gender-sensitive, motivationally enhanced CR for women compared with generic CR programs is warranted.
PDF
