Shultz, Adam M.

Apply It! • This electrocardiogram (ECG) primer will provide basic knowledge and standardized strategies needed to prepare and complete a resting ECG, as well as adjust electrode placement for exercise testing. • A simple, evidence-based, systematic approach to resting and exercise ECG interpretation is included. • Exercise professionals may directly apply these concepts to diverse settings, including clinics, hospitals, cardiac rehabilitation, stress testing, research, and academia.

Background: Cardiac rehabilitation (CR) is essential to secondary cardiovascular disease prevention and management of cardiac patients. Despite its proven benefits, CR remains underutilized with enrollment and completion rates ranging from 10-30% in the US. Yet, there is a scarcity of nationally representative data among diverse populations on socioeconomic differences in barriers and beliefs of CR participation and delivery mode preferences. Hypothesis: The perceptions (barriers, beliefs), CR delivery mode preferences, and CR utilization (prior enrollment) varies by socioeconomic status (SES) among CR-eligible individuals. Methods: We conducted an anonymous national electronic survey from March 2023 to January 2024 of individuals self-reporting a prior CR-eligible diagnosis. The 22-item CR Barriers Scale assessed perceived barriers to CR enrollment and participation using a 5-point Likert scale (strongly disagree to strongly agree). A 13-item, validated questionnaire assessed 4 subscales pertaining to patients’ beliefs about CR, each rated on a 5-point Likert scale (strongly disagree to strongly agree): perceived necessity, concerns about exercise, practical barriers and perceived suitability. CR delivery mode preferences were ascertained (eg, virtual, at-home, etc.). Mean barriers and belief scores as well as delivery mode preferences were stratified by SES. Low SES was defined as ≤ high school education, Medicaid insurance, or uninsured. High SES was defined as > high school education and non-Medicaid health insurance. Responses were analyzed using descriptive statistics with R software. Results: A total of 466 participants completed the survey (38.1% women, 30.6% minoritized racial/ethnic group, 29.6% low SES, 95% response rate) ( Table 1 ). The majority indicated prior enrollment in CR (81.5%) with no difference by SES. CR barrier scores did not differ significantly by SES (p=0.331) ( Table 2 ). Beliefs about CR perceived necessity and perceived suitability differed by SES (p<0.001 and p=0.025), but beliefs regarding concerns about exercise and practical barriers did not. The low SES group reported a higher preference for completely at-home CR compared to the high SES group (33.6% vs 7.4%, p<0.001). Conclusion: Our findings suggest that CR beliefs varied by SES while utilization did not. For CR-eligible patients experiencing socioeconomic disadvantage, at-home CR may be a preferred alternative to center-based CR to increase CR participation and adherence.

Background Innovative restructuring of cardiac rehabilitation (CR) delivery remains critical to reduce barriers and improve access to diverse populations. Destination Cardiac Rehab is a novel virtual world technology‐based CR program delivered through the virtual world platform, Second Life, which previously demonstrated high acceptability as an extension of traditional center‐based CR. This study aims to evaluate efficacy and adherence of the virtual world–based CR program compared with center‐based CR within a community‐informed, implementation science framework. Methods Using a noninferiority, hybrid type 1 effectiveness‐implementation, randomized controlled trial, 150 patients with an eligible cardiovascular event will be recruited from 6 geographically diverse CR centers across the United States. Participants will be randomized 1:1 to either the 12‐week Destination Cardiac Rehab or the center‐based CR control groups. The primary efficacy outcome is a composite cardiovascular health score based on the American Heart Association Life's Essential 8 at 3 and 6 months. Adherence outcomes include CR session attendance and participation in exercise sessions. A diverse patient/caregiver/stakeholder advisory board was assembled to guide recruitment, implementation, and dissemination plans and to contextualize study findings. The institutional review board–approved randomized controlled trial will enroll and randomize patients to the intervention (or control group) in 3 consecutive waves/year over 3 years. The results will be published at data collection and analyses completion. Conclusions The Destination Cardiac Rehab randomized controlled trial tests an innovative and potentially scalable model to enhance CR participation and advance health equity. Our findings will inform the use of effective virtual CR programs to expand equitable access to diverse patient populations. Registration URL: https://www.clinicaltrials.gov ; Unique identifier: NCT05897710.

Introduction: The COVID-19 pandemic imposed significant constraints to delivery of cardiac rehabilitation (CR) with many programs relying on delivery of home-based cardiac rehabilitation (HBCR). We sought to compare the effects of HBCR vs conventional center-based CR (CBCR) on clinical metrics, health-related quality of life, and modifiable risk factors in CR patients. Methods: Retrospective cohort study comparing 511 HBCR patients (March 2020-April 2021; COVID-19 pandemic) and 765 age and sex matched CBCR patients (Jan 2018-Jan2020; immediately pre-pandemic) from the Mayo Clinic Health System. We assessed changes in clinical outcomes before and after CR. HBCR included 12 sessions (one in-person assessment + weekly education and exercise monitoring phone/video calls). Conventional CBCR included 36 sessions (3 sessions per week for 12 weeks). Continuous data were described as mean±SD, and comparisons of change between groups were assessed with linear regression adjusting for baseline value, in complete cases. Results: HBCR and CBCR patients were 65±14 yrs old (68% male) and 65±14 yrs old (67% male) respectively. HBCR patients demonstrated greater improvement in exercise days/week whereas CBCR patients had greater improvement in exercise min/day. HBCR patients had greater improvement in blood glucose with a trend towards greater improvement in non-HDL cholesterol. Both groups demonstrated similar improvement on nutrition, depression, health-related quality of life surveys and total, LDL and HDL cholesterol, as well as HbA1c between the groups. Conclusions: Collecting clinical metrics during the COVID-19 pandemic proved challenging due to the initial closure of out-patient services. For patients in whom data was captured, HBCR appears to be similarly effective at improving several intermediate outcomes compared to CBCR. HBCR may be an effective alternative for improving clinical outcomes in patients who are unable to participate in CBCR.

e24030 Background: Physical activity (PA) in cancer survivors improves quality of life (QOL), functioning, fatigue, and reduces the risk of treatment complications, cancer recurrence and death. However, the optimal intervention for increasing PA is not established. Most prospective studies have shown a 6-12-week program to be an effective intervention but this is often not feasible. Therefore, we piloted a one-time individualized exercise prescription in our cardiac rehabilitation center to improve PA in cancer survivors. Methods: We prospectively enrolled cancer survivors who had completed curative intent treatment, with no evidence of active disease in this pilot study. Survivors who consented underwent a consultation with an exercise physiologist for needs assessment followed by a supervised exercise session with a tailored exercise prescription. Survivors also filled out surveys assessing their PA and QOL at baseline (bl), 3, 6 and 12 months after intervention. Clinical information was collected via chart review. We estimated longitudinal PA score and change in PA using mixed models incorporating scores from all available time points using SAS (v 9.4). Results: Between May 2018 and January 2020, 50 participants (26 lymphoma and 24 solid tumor survivors) completed the intervention. 20% participants were on maintenance therapy during the study. Clinical characteristics of 42 evaluable participants are summarized in Table. The survey response rate was 82%, 58%, 58%, 46% at bl, 3, 6 and 12 months respectively. The level of PA improved with time [mean (SE) PA score: 58.5 (4.3) bl, 63.9 (4.8) at 3, 57.6 (4.8) at 6, 62.6 (5.3) at 12 months]. The change in PA from baseline to follow-up time-points [bl vs 3m p=0.41; bl vs 6m p=0.88; bl vs 12m p=0.55] or between the lymphoma and solid tumor survivors was not statistically significant and limited by sample size. No significant trend in QOL was seen. Conclusions: Individualized exercise prescription using the cardiac rehabilitation program may be a feasible, widely applicable tool to implement a PA intervention among cancer survivors. The trend towards improvement in PA in this novel one-time intervention provides intriguing evidence and deserves future study in larger sample sizes to understand if it can improve and create sustainable PA change comparable to longer term exercise interventions.[Table: see text]