Tag Archives: cardiac rehabilitation

Introduction Exercise-based cardiac rehabilitation (ExCR) is integral to the management of people with chronic heart failure (CHF).1 It not only improves quality of life (QoL), but is likely to reduce hospital admissions and mortality in this population.1 In response to this evidence, offering a personalised ExCR to all patients with stable CHF is included in the current National Institute for Health and Care Excellence (NICE) guidelines.2 Most CHF diagnoses (up to 80%) occur during an inpatient stay for acute decompensated heart failure (ADHF).3 An admission presents the opportunity for most people with CHF to be offered ExCR. CHF is associa

Introduction The COVID-19 pandemic resulted in significant disruption to the delivery of cardiovascular rehabilitation (CR) services in the UK, following staff redeployment to acute services and limited access to workspaces.1 With restrictions being placed on face-to-face services due to concerns about safety and disease transmission, many CR services rapidly moved to remote delivery.2 These adjustments led to a significant drop in group-based exercise (–36%) and group-based education (–29%) with a corresponding increase (+16%) in CR staff supported self-managed options.3 In the future, those with cardiovascular disease are likely to be

Introduction Cardiac rehabilitation (CR) is a multi-factorial intervention incorporating education, physical activity and psychosocial support to address the risk factors for cardiovascular disease (CVD) and improve health behaviour.1,2 A recent Cochrane review evaluating 85 randomised-controlled trials concluded that the benefits of exercise-based CR include reduced mortality, lowering hospital admissions, and may improve health-related quality of life.3 Research by Hinde et al. suggests the achievement of 85% engagement in CR could see a reduction of 49,000 hospital admissions and 19,500 fewer deaths over 10 years, saving millions in costs

Introduction Claire Jones Research suggests that globally, attainment of lipid targets is poor, with significant scope for improved optimisation of lipid lowering therapy (LLT) and cardiovascular (CV) risk factor management. Evidence suggests that the key initiating event in atherogenesis is retention of low-density lipoprotein cholesterol (LDL-C). To align with this, the European Society of Cardiology and European Atherosclerosis Society (ESC/EAS) proposed new LDL-C goals in 2019,1 and revised CV risk stratification guidance (particularly relevant to high-risk and very high-risk patients). National Institute for Health and Care Excellence (N

Introduction Dr Cong Ying Hey Disparities in cardiovascular (CV) morbidity and mortality are among the major health and social care concerns in our modern society. In the UK, people living in the most deprived areas are four times more likely to die prematurely from CV disease (CVD) than those living in the least deprived areas.1 To address the disparities in CV outcomes, it is imperative to recognise the presence of inequalities at different interfaces of cardiology services. This article, therefore, aims to provide a focused discussion concerning potential measures to reduce health inequalities in cardiology through the lens of the challeng

Introduction Completion of a functional capacity test before cardiac rehabilitation (CR) is one of the British Association for Cardiovascular Prevention and Rehabilitation (BACPR) Standards.1 The incremental shuttle walk test (ISWT) is an externally paced submaximal walking test with strong reliability, test–retest reliability, validity and responsiveness in cardiac populations.2,3 It is a test that is widely used to inform both risk stratification for cardiovascular events during CR, and for exercise prescription. The use of an electrocardiogram (ECG) to monitor the safety of the ISWT (indicated by the absence of major ECG changes) has not

“The COVID-19 pandemic is arguably one of the greatest public health challenges of our time, however, cardiovascular disease (CVD) remains the most common global cause of morbidity and mortality with over 18 million deaths per year. Understandably, hospitals have postponed non-critical services so that healthcare professionals can be deployed to areas dealing with patients who have the COVID-19 virus. However, there remains an ongoing need to assess, support and rehabilitate those who have CVD or are newly diagnosed with it to prevent the significant risk of unintended, yet significant consequences in the long-term. The consequence of withd

Introduction Atrial fibrillation (AF) is the most common cardiac rhythm disturbance in adults, estimated to affect 3.29% of the population in the UK in 2016.1 The condition is strongly associated with increased cardiovascular morbidity and mortality, in addition to reduced quality of life.2 The healthcare costs of managing patients with AF are high: estimates of the direct cost in Western Europe range from €450 to €3,000 per patient-year.3 Exercise-based cardiac rehabilitation is an established intervention in the management of several cardiovascular conditions, including coronary artery disease4 and heart failure.5 There is increasing re

Introduction ACRAN healthcare team Cardiac rehabilitation (CR) services are comprehensive, long-term programmes involving medical evaluation, prescribed exercise, cardiac risk factor modification, education and counselling. CR has been extensively reviewed in the literature,1 and, in patients after myocardial infarction, has been shown to reduce all-cause and cardiovascular mortality rates in a Cochrane review.2 However, it has also been shown by others to have little effect on outcomes.3 Doubts over the efficacy of CR have led commissioners to question the value of such services. While the debate continues, the Anglia region CR services (reb

Introduction Exercise is well recognised as a tool for assessment, prevention and management of cardiovascular disease.1 Cardiac patients are encouraged to attend cardiac rehabilitation programmes including elements of supervised exercise. Such programmes can reduce mortality and morbidity rates by up to 27%.2,3 Despite the benefits derived from participation in exercise-based cardiac rehabilitation, exercise itself may act as a trigger for myocardial ischaemia or cardiac arrest in patients with established coronary heart disease.4 During rehabilitation, cardiovascular event rates range from 12.3 to 37.4 per million patient hours of exercise.