CARDIAC REHABILITATION UTILIZATION AND CARDIOVASCULAR HEALTH PROMOTION

Abstract

THE IMPORTANCE OF CARDIAC REHABILITATION AND GAPS IN KNOWLEDGE Cardiac Rehabilitation (CR) is a multidisciplinary and comprehensive outpatient secondary prevention program. Its substantial secondary prevention benefits grant it a strong recommendation for multiple indications (Balady et al., 2011; Smith et al., 2011; Piepoli et al., 2016). Well-conducted clinical trials and meta-analyses have demonstrated that CR participation is associated with a 13% reduction in all-cause mortality, 26% reduction in cardiovascular mortality, and a 31% reduction in re-hospitalizations (Anderson et al., 2016). Currently, CR is covered by Medicare for the following seven indications: Within 12 months of acute myocardial infarction (AMI), post coronary artery bypass surgery, current stable angina that is resistant to conventional therapy, post heart valve surgery, post percutaneous coronary intervention (PCI), symptomatic heart failure with reduced ejection fraction (EF <35%) and post-heart transplantation. Although the concept of cardiac rehabilitation dates from the 1950s, there remain many gaps in our knowledge (Levine et al. 1952). Most current papers address the CR benefits, for example, its role in improving the total mortality, CV death, hospitalization, or specific medical conditions like diabetes or obesity. There is a scanty amount of paper that addresses the CR in improving overall health. Moreover, underutilization is a significant challenge that has limited the CR benefits for decades (Ades et al., 2017). Most current research in this domain focuses on referral rate, participation rate, and adherence with limited reporting on completion rate. In this dissertation, we report our scientific investigations: first, predictors for cardiac rehabilitation completion; second, changes in the Life Simple 7 score among CR completers.