Hama, Tomoaki

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.

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.

Introduction: Many center-based cardiac rehabilitation programs were forced to close during the pandemic resulting in a programmatic shift to delivering cardiac rehabilitation remotely in the home-based setting. This study examined sex differences in the change of exercise frequency and exercise capacity in patients participating in home-based cardiac rehabilitation (HBCR) during the COVID-19 pandemic. Methods: Retrospective cohort study of 567 HBCR patients between March 2020 and May 2021. Patients who completed the Duke Activity Status Index questionnaire before and after HBCR were included. We calculated the number of reported exercise days/ week, exercise min/day, and VO 2 peak estimated. Patients were divided into two groups according to sex (Male/Female). Continuous data are described as mean±SD and baseline data compared with a two-sample t-test. The delta change from pre-post between groups also are compared with a two-sample t-test. Results: Of 567 HBCR patients, 118 patients completed both pre and post HBCR questionnaires (Male, n=82, 66±12 yo vs Female, n=36, 65±12 yo, p=0.80). There were no differences between groups for baseline exercise days/week or exercise min/day pre HBCR (4.0±2.8 vs 4.1±3.0 days, p=0.87; 22±20 vs 18±20 min, p=0.33); however, VO 2 peak at baseline HBCR was higher in males than females (22.3±8.1 vs 18.9±5.9 ml/kg/min, p<0.05). Both groups improved exercise days/week (4.0±2.8 to 5.7±1.5 vs 4.1±3.0 to 5.7±1.4 days, p<0.05 for both), exercise min/day (22±20 to 40±15 vs 18±20 to 37±21 min, p<0.05 for both), and VO 2 peak (22.3±8.1 to 27.8±8.0 vs 18.9±5.9 to 22.7±6.5, ml/kg/min, p<0.05 for both). In addition, there was no significant difference for the delta change of the three outcomes between groups (1.7±2.7 vs 1.6±2.5 days; 18±19 vs 19±18 min; 5.5±6.5 vs 3.8±4.5 ml/min/kg, p>0.05 for all). Conclusions: Female patients entering HBCR during the COVID-19 pandemic demonstrated lower exercise capacity compared to males; however, both female and male patients increased exercise frequency (days/week and min/day) and exercise capacity (estimated VO 2 peak) similarly after attending HBCR during the COVID-19 pandemic.

Introduction: The COVID-19 pandemic resulted in the closure of many center-based cardiac rehabilitation programs leading many institutions to rely on home-based cardiac rehabilitation (HBCR) to provide critical secondary cardiovascular disease prevention and rehabilitation. The impact of age on the change of exercise frequency and exercise capacity as a result of HBCR during the COVID-19 pandemic remains unknown. Methods: Retrospective cohort study of 567 HBCR patients between March 2020 and May 2021. Patients who completed the Duke Activity Status Index questionnaire at enrollment and completion of HBCR were included. We calculated the number of reported exercise days/week , exercise min/day, and VO 2 peak estimated. Patients were divided into two groups according to age (Younger<65 y.o; Older≥65 y.o). Continuous data are described as mean ±SD and baseline data compared with a two-sample t-test. The delta change from pre-post between groups also are compared with a two-sample t-test. Results: Of 567 HBCR patients, 118 patients completed both pre and post HBCR questionnaires (Younger, n=54, 56±8 years old vs Older, n=64, 74±7 y.o, p<0.05). Both groups improved exercise days/week (4.4±2.8 to 5.8±1.3 vs 3.8±2.9 to 5.6±1.6 days, p<0.05 for both), exercise min/day (21±20 to 41±17 vs 20±20 to 37±17 min, p<0.05 for both), and VO 2 peak (20.5±7.1 to 27.6±8.0 vs 21.9±8.1 to 25.1±7.7 ml/min/kg, p<0.05 for both). The delta change for exercise days/week and exercise min/day were not significantly different between groups (1.4±2.7 vs 1.9±2.7 days and 19±19 vs 17±18 min, p>0.05); however, the Younger patients significantly increased their VO 2 peak more than the older patients (7.1±6.1 vs 3.2±5.3 ml/min/kg, p<0.05). Conclusions: During the COVID-19 pandemic, exercise frequency (days/week and min/day) and exercise capacity (estimated VO2peak) increased in all patients participating in HBCR. With this, the increase in estimated exercise capacity was greater in younger patients compared with older patients. These findings suggest that additional work is needed to explore factors potentially limiting improvement and strategies to maximize improvement in exercise capacity in older patients participating in HBCR.