Early Termination of Cardiac Rehabilitation Is More Common With Heart Failure With Reduced Ejection Fraction Than With Ischemic Heart Disease.
PURPOSE: Despite known benefits of cardiac rehabilitation (CR), early termination (failure to complete >1 mo of CR) attenuates these benefits. We analyzed whether early termination varied by referral indication in the context of recent growth in patients referred for heart failure with reduced ejection fraction (HFrEF). METHODS: We reviewed records from 1111 consecutive patients enrolled in the NYU Langone Health Rusk CR program (2013-2017). Sessions attended, demographics, and comorbidities were abstracted, as well as primary referral indication: HFrEF or ischemic heart disease (IHD; including post-coronary revascularization, post-acute myocardial infarction, or chronic stable angina). We compared rates of early termination between HFrEF and IHD, and used multivariable logistic regression to determine whether differences persisted after adjusting for relevant characteristics (age, race, ethnicity, body mass index, smoking, hypertension, chronic obstructive pulmonary disease, and depression). RESULTS: Mean patient age was 64 yr, 31% were female, and 28% were nonwhite. Most referrals (85%) were for IHD; 15% were for HFrEF. Early termination occurred in 206 patients (18%) and was more common in HFrEF (26%) than in IHD (17%) (P < .01). After multivariable adjustment, patients with HFrEF remained at higher risk of early termination than patients with IHD (unadjusted OR = 1.73, 95% CI, 1.17-2.54; adjusted OR = 1.53, 95% CI, 1.01-2.31). CONCLUSIONS: Nearly 1 in 5 patients in our program terminated CR within 1 mo, with HFrEF patients at higher risk than IHD patients. While broad efforts at preventing early termination are warranted, particular attention may be required in patients with HFrEF.
Bostrom John; Searcy Ryan; Walia Ahana; Rzucidlo Justyna; Banco Darcy; Quien Mary; Sweeney Greg; Pierre Alicia; Tang Ying; Mola Ana; Xia Yuhe; Whiteson Jonathan; Dodson John A
Journal of cardiopulmonary rehabilitation and prevention
2020
2020-02
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
Journal Article
<a href="http://doi.org/10.1097/HCR.0000000000000495" target="_blank" rel="noreferrer noopener">10.1097/HCR.0000000000000495</a>
Body mass index moderates the effects of portable oxygen transport modality on
*Oxygen Inhalation Therapy/instrumentation/methods; *Pulmonary Disease; *Quality of Life; Activities of Daily Living; Aged; Body Mass Index; Chronic Obstructive – Diagnosis; Chronic Obstructive – Metabolism; Chronic Obstructive – Physiopathology; Chronic Obstructive – Psychosocial Factors; Chronic Obstructive – Therapy; Chronic Obstructive/diagnosis/metabolism/physiopathology/psychology/therapy; Drug Delivery Systems – Methods; Drug Delivery Systems – Standards; Drug Delivery Systems/methods/standards; Exercise Test – Methods; Exercise Test/methods; Exertion; Female; Heart Rate; Hemoglobins – Analysis; Human; Humans; Male; Middle Age; Middle Aged; Outcome Assessment; Outcome Assessment (Health Care); Oxygen Consumption; Oxygen Therapy – Equipment and Supplies; Oxygen Therapy – Methods; Oxyhemoglobins/analysis; Physical Exertion; Pulmonary Disease; Quality of Life; Walking – Physiology; Walking/*physiology
PURPOSE: While portable, supplemental oxygen is often necessary for patients with chronic obstructive pulmonary disease (COPD) to retain independence, it may provide functional limitations because of the increased workload imposed. This issue may result in nonuse, creating a need to identify carrying modalities that optimize transport. This study assessed the effects of 3 methods of portable oxygen transport on 6-minute walk distance (6 MWD), rate of perceived exertion (RPE), heart rate (HR), and oxyhemoglobin saturation (SpO2). As weight status is known to impact functional ability in COPD, effects of body mass index (BMI) were also assessed. METHODS: Data were analyzed using the mixed-model procedure to test for effects of transport modality (reference, rolling cart, backpack, shoulderstrap), time (minutes 1-6), BMI, non-overweight, overweight, and interactions of these variables on outcome parameters. RESULTS: A main effect of condition was found for 6 MWD, and an interaction of condition x BMI was found for HR and RPE, and of time x BMI for 6 MWD and SpO2. Participants walked the least distance in rolling cart condition, which was also characterized by the greatest RPE. For the overweight group, HR was least in the reference compared with other conditions; but for the non-overweight group, the opposite pattern was observed. At latter time points, 6 MWD was greater in the non-overweight group, while SpO2 was reduced. CONCLUSION: Results demonstrate that transport modality of portable oxygen exerts differential effects on functional performance in COPD patients and that BMI may moderate underlying physiologic factors that contribute to performance outcomes.
Pohle-Krauza Rachael J; McCarroll Michele L; Pannikottu Kurian; Latta Tiffany N; DiNuoscio David R; Volsko Teresa A; Gothard M David; Krauza Matthew L
Journal of cardiopulmonary rehabilitation and prevention
2014
2014-02
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1097/HCR.0000000000000035" target="_blank" rel="noreferrer noopener">10.1097/HCR.0000000000000035</a>