Cardiac rehabilitation in the elderly Sara K. Pasquali, BS, Karen P. Alexander, MD, and Eric D. Peterson, MD, MPH Durham, NC

Save this PDF as:
 WORD  PNG  TXT  JPG

Size: px
Start display at page:

Download "Cardiac rehabilitation in the elderly Sara K. Pasquali, BS, Karen P. Alexander, MD, and Eric D. Peterson, MD, MPH Durham, NC"

Transcription

1 Curriculum in Cardiology Cardiac rehabilitation in the elderly Sara K. Pasquali, BS, Karen P. Alexander, MD, and Eric D. Peterson, MD, MPH Durham, NC Background Although patients 65 years old account for the majority of cardiac admissions and procedures in the United States, studies of cardiac rehabilitation have traditionally focused on younger patients. Only recently has the effectiveness of cardiac rehabilitation in the elderly population begun to receive more attention. Methods We present a comprehensive literature review of studies that have looked specifically at the effectiveness of cardiac rehabilitation in the elderly. We discuss the methodologic limitations of studies to date, compare outcomes among elderly rehabilitation patients with those of younger patients, and examine barriers to participation among the elderly. Results The majority of studies published to date have been small observational case series. Despite these limitations, these studies generally show consistent improvements in exercise capacity, cardiac risk factors, and quality-of-life parameters in elderly cardiac rehabilitation patients. These benefits appear to be similar to those seen in younger patients. In spite of this, participation rates among the elderly are low, primarily because of less aggressive referral. Conclusions Although further studies are necessary, the current literature shows that cardiac rehabilitation is associated with improved outcomes after a cardiac event, regardless of age. However, innovative recommendation and referral strategies are needed because few elderly patients actually enroll. (Am Heart J 2001;142: ) Although patients 65 years old account for more than half of all acute myocardial infarctions and coronary bypass operations in the United States, they have generally been underrepresented in cardiovascular clinical research. 1-3 This is particularly true in the field of cardiac rehabilitation, where studies have traditionally focused on patients younger than 65 years. 4 The lack of a clear evidence base has likely played a role in the underreferral of elderly patients to rehabilitation programs. 5 In response to this, several more recent studies have specifically looked at the effectiveness of cardiac rehabilitation in the elderly In this article we review the cardiac rehabilitation literature as it pertains to the elderly population. We will discuss the methodologic limitations of current studies and compare outcomes among elderly patients in rehabilitation with those of younger patients. Finally, we will examine barriers to participation among this age group. From the Outcomes Research and Assessment Group, Duke Clinical Research Institute, Durham, NC. E. D. P. is a Paul Beeson Faculty Scholar, and K. P. A. is a Doris Duke Clinical Research Scientist Awardee. Guest Editor for this manuscript was Frank Aguirre, Prairie Cardiovascular Consultants, Ltd, PO Box 19420, Springfield, IL Submitted February 16, 2001; accepted July 17, Reprint requests: Eric D. Peterson, MD, MPH, Division of Cardiology, Duke University Medical Center, Box 3236, Durham, NC Copyright 2001 by Mosby, Inc /2001/$ /1/ doi: /mhj Benefits of cardiac rehabilitation in younger patients Comprehensive cardiac rehabilitation programs consist of medical screening, cardiac risk factor education, psychosocial support, and exercise training. 4 Over the past 3 decades numerous studies have demonstrated the benefits of cardiac rehabilitation in younger patients. Two metaanalyses done in the late 1980s that looked at >4000 patients from 22 randomized controlled trials showed a 20% to 25% mortality reduction at 3-year follow-up among patients who participated in cardiac rehabilitation after myocardial infarction. 23,24 A more recent meta-analysis of >7000 patients confirmed this mortality benefit. 25 In addition, several randomized controlled trials have shown that cardiac rehabilitation also improves functional capacity, psychologic well-being, overall quality of life, and cardiac risk factors such as lipid profiles and obesity indices. 4,26,27 These improvements are greatest when exercise, risk factor modification, and psychosocial support are provided together in comprehensive programs. 4,26,28 On the basis of this literature, the Clinical Practice Guidelines of the Agency for Health Care Policy and Research, American Heart Association, and American College of Cardiology recommend comprehensive cardiac rehabilitation programs as standard of care after myocardial infarction and revascularization procedures. 4,27 29 Studies of cardiac rehabilitation in the elderly The generalizability of these cardiac rehabilitation recommendations to elderly cardiac patients is unclear.

2 American Heart Journal Volume 142, Number 5 Pasquali, Alexander, and Peterson 749 Table I. Studies of cardiac rehabilitation comparing outcomes in older and younger patients Relative improvement in elderly vs younger Population Population Compresize age (y) study hensive Functional Risk Study (No. [% elderly])* vs control program capacity factors QOL Observational Williams et al (1985) (21%) 65 vs <65 Equal Ades and Grunvald (1990) 7 59 (37%) 62 vs <62 Equal Ades et al (1993) 8 45 (36%) 70 vs Equal Lavie et al (1993) (34%) 65 vs <65 Equal Equal Lavie and Milani (1995) (43%) 65 vs <65 + Greater Equal Greater Lavie and Milani (1996) (19%) >75 vs <60 + Equal Equal Greater McConnell and Laubach (1996) (50%) Mean 69.2 vs mean 48.3 Equal McConnell et al (1997) (19%) 70 vs <70 Equal Equal Fragnoli-Munn et al (1998) (42%) 62 vs <60 + Equal Lavie and Milani (2000) (31%) >70 vs <55 + Less Greater McConnell et al (2000) (35%) >70 vs Equal Equal QOL, Quality of life; Equal, elderly and younger patients show similar improvements in all outcome measures;, no data available; Greater, compared with younger patients, elderly patients show significantly greater improvement in one or more outcome measures; Less, compared to younger patients, elderly patients show significantly less improvement in one or more outcome measures. *Elderly as defined within each study. Obesity indices and lipid profiles. Table II. Studies of cardiac rehabilitation comparing subgroups of elderly patients Population Population age (y) Comprehensive Study size (No.) (study vs control) program Observational Ades et al (1992) (women vs men) + Lavie and Milani (1997) >65 (women vs men) + Milani and Lavie (1998) (depressed vs nondepressed) + Ades et al (1992) (nonparticipants vs participants) + Controlled trial Bondestam et al (1995) (cardiac rehab vs usual care) + Ades et al (1995) (cardiac rehab vs usual care) Randomized controlled trial Stahle et al (1999) (cardiac rehab vs usual care) rehab, Rehabilitation. Because of their lower functional capacity and high rate of depression and social isolation, elderly patients may gain the most from comprehensive rehabilitation programs. 10,14,30-34 On the other hand, comorbidities such as arthritis, peripheral vascular disease, and chronic pulmonary disease or the cardiovascular changes that come with age may limit the benefits of cardiac rehabilitation in this age group Unfortunately, only 2 of the 22 studies included in the meta-analyses included any patients >65 years old and none of the studies included patients >70 years old. 23,24 Therefore subgroup analysis from the randomized trial data is not possible. In response to this paucity of information, several recent studies have specifically looked at the effectiveness of cardiac rehabilitation in elderly populations (Table I and II). Below, we comment on methodologic issues in these elderly-specific trials. We also review the conclusions regarding the effectiveness of cardiac rehabilitation in the elderly. Methodologic issues The 18 elderly-specific studies of cardiac rehabilitation are summarized in Tables I and II. In terms of design, the majority of these studies are observational case series, comparing older and younger cohorts of patients in cardiac rehabilitation, without including a nonexercising control group While 2 other studies had a control group but were not randomized, only one study was both randomized and controlled The lack of nonexercising controls prevents a true evalua-

3 750 Pasquali, Alexander, and Peterson American Heart Journal November 2001 tion of the incremental benefit of cardiac rehabilitation within the elderly population, and the lack of randomization introduces significant participation biases. Those elderly who elect to participate are likely to be healthier and more fit at baseline. In terms of size, the majority are single-center studies. 5,7,8,11-22 Only 2 studies enrolled >500 patients, with the median sample size being 226 total patients. 13,18 On average, elderly patients represented only approximately one third of the total patient population in these studies. When comparing outcomes among older and younger patients in their analysis, none of the studies adjusted for baseline differences in clinical characteristics, functional status, or other factors. This would be particularly important given the nonrandomized design. In addition, the variable definitions of elderly (ranging from 62 to 75 years), the study population (often including combinations of patients with myocardial infarction, bypass grafting, or percutaneous intervention), treatment (exercise only vs comprehensive rehabilitation), and outcomes (eg, exercise capacity as VO 2max, estimated peak aerobic capacity, or treadmill duration) across these studies makes comparison of results challenging. However, despite these limitations, consistent findings can be gleaned regarding the relative impact of cardiac rehabilitation in younger and older patients, which we outline below. Outcomes Morbidity and mortality. Published studies that have included elderly patients are not powered to assess whether participation in cardiac rehabilitation confers a mortality benefit However, one study found that cardiac rehabilitation does reduce morbidity in the elderly, with a lower incidence of rehospitalization at 3 months (13% vs 29%, P <.04) and 1 year compared with control subjects. 20 Cardiac rehabilitation has been shown to be extremely safe, with a multicenter report of >140 US programs documenting a mortality rate of 1 per 784,000 patienthours. 38 However, the applicability of this data to the elderly is uncertain because ages of participants were not reported. It is known that no fatalities among patients participating in cardiac rehabilitation have been reported in the 18 elderly-specific studies Functional status. Functional capacity is usually assessed through a treadmill exercise tolerance test, and reported as peak aerobic capacity (VO 2max, on the basis of measurements of expired gas) or estimated exercise capacity (METs, a multiple of resting energy expenditure calculated from standard formulas based on work load and exercise time). 39 At baseline, elderly patients are significantly less fit, having lower measured (VO 2max, 19% to 30%) and estimated (METs, 27% to 42%) exercise capacity than younger patients. 7-10,15 In spite of this, observational studies have shown significant improvements in VO 2max (+13% to +27%), estimated exercise capacity (METs, +32% to +43%), and treadmill duration (+62%) in elderly patients after cardiac rehabilitation Importantly, the improvement in functional status indicators was of similar magnitude in both young and old patients and was evident even in the very elderly ( 75 years old) (Table I, Figure 1) In 2 studies with nonexercising controls, elderly patients in cardiac rehabilitation had significantly greater increases in measured maximal exercise capacity (+17% vs +3%, P <.001) and treadmill duration (+47% vs 8%, P <.001) but not in VO 2max (+16% vs +7%, P not significant) after 3 months of training. 21,22 In one study, this benefit was still present at 1 year follow-up in a subset of patients who continued to exercise for an additional 9 months. 21 In contrast, the benefit was no longer significant in the other study where a group of patients exercised for an additional 3 months, so the duration of training necessary for durable longterm effects is unknown. 22 Even less is known about improving strength through resistance training in elderly cardiac patients. In one observational study, elderly men and women significantly improved leg (+35%) and arm (+14%) strength to a degree similar to that of younger patients after a resistance training program (Table I). 14 This is important because even activities classically considered aerobic, such as walking, are limited by leg strength in elderly patients. 40 Risk factor modification. As in younger patients, cardiac rehabilitation modestly improves risk factor profiles in the elderly population. After 3 months of comprehensive rehabilitation, limited improvements are seen in obesity indices such as body mass index (~ 1%) and percent body fat (~ 6%) in the elderly (Table I, Figure 2) In addition, lipid profiles, including high-density lipoprotein (~+5%) and the low-density lipoprotein/high-density lipoprotein ratio, (~ 7%) also modestly improve (Table I, Figure 3) Resting systolic blood pressure and plasma glucose levels in elderly patients do not seem to change. 6,8,11 Interestingly, neither the rehabilitation patients nor control subjects in the 2 controlled trials showed any improvements in weight or blood pressure. 21,22 In addition, lipid parameters did not improve in either group. 22 It should be noted that these trials tested an exerciseonly intervention as opposed to a comprehensive program. It is likely that improving risk factor profiles in elderly patients, whether in the setting of cardiac rehabilitation or usual medical care, requires combining exercise, diet modification, and risk factor education, as previously documented in younger patients. 4,26,28 Psychosocial aspects. Type-A behavior, depres-

4 American Heart Journal Volume 142, Number 5 Pasquali, Alexander, and Peterson 751 Figure 1 Estimated aerobic capacity before and after 3 months of cardiac rehabilitation in older and younger patients. In all 4 studies, elderly patients had significantly lower estimated aerobic capacity at baseline. All cohorts showed significant improvements after rehabilitation. In the 1995 study of Lavie and Milani, 10 the improvement was statistically greater in older versus younger (+43% vs +32%, P <.01). There were similar improvements in older versus younger (P not significant) in the other 3 studies. Figure 2 Percent body fat before and after 3 months of cardiac rehabilitation in older and younger patients. Older and younger patients were similar at baseline. All cohorts showed a significant decrease after rehabilitation, except for the elderly cohort in the 1996 study of Lavie and Milani 11 ( 7%, P =.13). The decrease in percent body fat was statistically similar between older and younger cohorts in all studies.

5 752 Pasquali, Alexander, and Peterson American Heart Journal November 2001 Figure 3 The low-density lipoprotein (LDL)/high-density lipoprotein (HDL) ratio before and after 3 months of cardiac rehabilitation in older and younger patients. Older and younger patients were similar at baseline, except in the 1995 study of Lavie and Milani, 10 where elderly patients had significantly lower ratios than did younger patients (3.1 vs 3.6, P.01). The ratio decreased significantly in all cohorts after rehabilitation, and this decrease was similar between older and younger patients. sion, and social isolation have all been shown to increase the risk for development of coronary disease, as well as the risk of morbidity and mortality after a cardiac event. 32,33,41 Of elderly patients referred for cardiac rehabilitation in one study, 18% met criteria for clinical depression, as assessed by a validated symptom questionnaire. 19 In this study, other behavioral parameters such as anxiety, somatization, and hostility were also assessed by validated symptom questionnaire, whereas quality of life and its components were assessed with the Medical Outcomes Study Short Form-36. At baseline, depressed patients had significantly lower exercise capacity ( 15%, P =.02) and quality of life ( 21%, P =.0001) and much higher levels of anxiety (+363%), hostility (+392%), and somatization (+76%) compared with nondepressed patients (all P =.0001). After 3 months of cardiac rehabilitation, the depressed subgroup showed significant improvements in exercise capacity (+27%, P =.0001), hostility ( 36%, P =.004), and somatization ( 39%, P =.0001), similar in magnitude to nondepressed patients. Their improvements in anxiety ( 53% vs 25%, P =.01), depression ( 57% vs 7%, P =.001), and total quality of life (+32% vs +16%, P <.0001) were statistically greater. Overall, the incidence of depression decreased by 54%. These findings indicate that, as in the younger population, cardiac rehabilitation is particularly beneficial to elderly patients who are depressed, in terms of both physical and emotional health. Quality of life. Beyond increasing exercise capacity, cardiac rehabilitation also improves overall quality of life in elderly patients. In observational studies, elderly cardiac rehabilitation patients demonstrate significant improvements in aspects of quality of life, as assessed by the Medical Outcomes Study Short Form-36, including mental health (+5%), energy (+18%), general health (+8%), pain (+20%), function (+16%), well-being (+11%), and total quality of life (+13%) (Table I, Figure 4). 10 These improvements were similar to those in younger patients, except for mental health, which was significantly greater in the elderly (+5% vs +2%, P =.05). The one randomized controlled trial that looked at quality of life after cardiac rehabilitation in elderly patients with use of a validated symptom-based questionnaire (Karolinska questionnaire) showed significant improvements in symptoms of shortness of breath ( 28% vs 11%), palpitations ( 12% vs +6%), fitness

6 American Heart Journal Volume 142, Number 5 Pasquali, Alexander, and Peterson 753 Figure 4 Physical function score, before and after 3 months of rehabilitation in older and younger patients. In both studies elderly patients had a significantly lower score at baseline (34.6 vs 37.5, P =.02 and 30.2 vs 35.4, P <.01). All cohorts improved significantly after rehabilitation, and this improvement was similar between young and old patients. (+20 vs +5%), and physical activity (+45% vs +22%) after 3 months of training (all P <.05). 22 However, no improvement was seen in symptoms of chest pain, daily activity, or self-perceived health. Referral patterns. Although the available evidence indicates that cardiac rehabilitation benefits young and old alike, elderly patients are 1.5 to 2 times less likely to participate in rehabilitation programs. 9,10 For example, a study of patients >62 years old who were hospitalized for acute myocardial infarction or coronary artery bypass surgery at the University of Vermont Medical Center documented a 21% participation rate compared with 42% in younger patients. 5 In this study, patients who participated in rehabilitation were more likely to be younger, male, white collar workers, with more formal education and less chronic disease. Commute time, patient denial of severity of illness, and history of depression were also significant predictors of participation. By multivariate analysis, the strength of the primary physician s referral was the single most powerful predictor of participation, with 2% of elderly patients participating when the recommendation was weak compared with 66% when it was strong. Elderly women tend to have even lower participation rates than elderly men (15% vs 25%, P =.06), primarily related to less physician recommendation. 17 Women also had more transportation problems, were more likely to be widowed or to have a dependent spouse at home, and had more comorbid conditions. These studies suggest that lower participation rates in the elderly are primarily due to lack of physician referral and support the findings of others who have shown that physicians are generally less aggressive in the treatment of cardiovascular disease in women and the elderly Conclusions and future directions At present, we lack a solid base of clinical studies to define the role of cardiac rehabilitation in improving outcomes for elderly cardiac patients. The majority of studies published to date have been small in size and observational, without appropriate controls. Despite these limitations, these studies show consistent improvements in exercise capacity, cardiac risk factors, and psychologic and quality-of-life parameters in elderly cardiac rehabilitation patients. These benefits are similar to those seen in younger patients. In spite of this, participation rates among the elderly are low, primarily because of less aggressive referral. Larger trials are needed to confirm the benefits of car-

7 754 Pasquali, Alexander, and Peterson American Heart Journal November 2001 diac rehabilitation over usual care in the elderly, as well as to assess long-term outcomes. Because randomization of patients to rehabilitation would be difficult, as it has become the standard of care in the United States, observational studies that control for the natural course of recovery after a cardiac event, as well as differences in baseline functioning, may be more appropriate. In addition, we need better studies to assess the effectiveness of cardiac rehabilitation not only on physical capacity and cardiac risk factors but also on quality of life in the elderly population. Finally, investigating new strategies to encourage participation and improve the referral process is warranted. While awaiting these studies, we believe that the current cardiac rehabilitation guidelines should be applied to elderly cardiac patients, given the consistent positive findings to date. Specifically, we recommend that after an acute myocardial infarction or revascularization procedure all elderly patients who are physically able to participate should receive recommendation and referral to a rehabilitation program from their physicians as this recommendation is a key determinant of subsequent program enrollment. We would like to acknowledge the excellent editorial assistance of Tracey A. Dryden. References 1. American Heart Association Heart and stroke statistical update. Dallas (TX): American Heart Association; Alexander KP, Peterson ED. Coronary artery bypass grafting in the elderly. Am Heart J 1997;134: Gurwitz JH, Col NF, Avorn J. The exclusion of the elderly and women from clinical trials in acute myocardial infarction. JAMA 1992;268: Wenger NK, Froehlicher ES, Smith LK, et al. Cardiac rehabilitation: clinical practice guideline No. 17. Rockville (MD): US Department of Health and Human Services, Public Health Service, Agency for Health Care Policy and Research and the National Heart, Lung, and Blood Institute; AHCPR Publication No.: Ades PA, Waldmann ML, McCann WJ, et al. Predictors of cardiac rehabilitation participation in older coronary patients. Arch Intern Med 1992;152: Williams MA, Maresh CM, Esterbrooks DJ, et al. Early exercise training in patients older than age 65 years compared with that in younger patients after acute myocardial infarction or coronary artery bypass grafting. Am J Cardiol 1985;55: Ades PA, Grunvald MH. Cardiopulmonary exercise testing before and after conditioning in older coronary patients. Am Heart J 1990; 120: Ades PA, Waldmann ML, Poehlman ET, et al. Exercise conditioning in older coronary patients: submaximal lactate response and endurance capacity. Circulation 1993;88: Lavie CJ, Milani RV, Littman AB. Benefits of cardiac rehabilitation and exercise training in secondary coronary prevention in the elderly. J Am Coll Cardiol 1993;22: Lavie CJ, Milani RV. Effects of cardiac rehabiliation programs on exercise capacity, coronary risk factors, behavioral characteristics, and quality of life in a large elderly cohort. Am J Cardiol 1995;76: Lavie CJ, Milani RV. Effects of cardiac rehabiliation and exercise training programs in patients greater or equal to 75 years of age. Am J Cardiol 1996;78: McConnell TR, Laubach CA. Elderly cardiac patients show greater improvements in ventilation at submaximal levels of exercise. Am J Geriatr Cardiol 1996;5: McConnell TR, Laubach CA, Szmedra L. Age and gender related trends in body composition, lipids, and exercise capacity during cardiac rehabilitation. Am J Geriatr Cardiol 1997;6: Fragnoli-Munn K, Savage PD, Ades PA. Combined resistive-aerobic training in older patients with coronary artery disease early after myocardial infarction. J Cardiopulm Rehabil 1998;18: Lavie CJ, Milani RV. Disparate effects of improving aerobic capacity and quality of life after cardiac rehabilitation in young and elderly coronary patients. J Cardiopulm Rehabil 2000;20: McConnell TR, Laubach CA, Memom M, et al. Quality of life and self-efficacy in cardiac rehabilitation patients over 70 years of age following acute myocardial infarction and bypass revascularization surgery. Am J Geriatr Cardiol 2000;9: Ades PA, Waldmann ML, Polk DM, et al. Referral patterns and exercise response in the rehabilitation of female coronary patients aged 62 years. Am J Cardiol 1992;69: Lavie CJ, Milani RV. Benefits of cardiac rehabilitation and exercise training in elderly women. Am J Cardiol 1997;79: Milani RV, Lavie CJ. Prevalence and effects of cardiac rehabilitation on depression in the elderly with coronary heart disease. Am J Cardiol 1998;81: Bondestam E, Breikss A, Hartford M. Effects of early rehabilitation on consumption of medical care during the first year after acute myocardial infarction in patients greater or equal to 65 years of age. Am J Cardiol 1995;75: Ades PA, Waldmann ML, Gillespie C. A controlled trial of exercise training in older coronary patients. J Gerontol 1995;50A: M Ståhle A, Mattsson E, Rydén L, et al. Improved physical fitness and quality of life following training of elderly patients after acute coronary events: a 1 year follow-up randomized controlled study. Eur Heart J 1999;20: Oldridge NB, Guyatt GH, Fischer ME, et al. Cardiac rehabilitation after myocardial infarction: combined experience of randomized clinical trials. JAMA 1998;260: O Connor GT, Buring JE, Yusuf S, et al. An overview of randomized trials of rehabilitation with exercise after myocardial infarction. Circulation 1989;80: Jolliffe JA, Rees K, Taylor RS, et al. Exercise-based rehabilitation for coronary heart disease. In: The Cochrane Library, issue 4. Oxford: Update Software; Ades PA, Coello CE. Effects of exercise and cardiac rehabilitation on cardiovascular outcomes. Med Clin North Am 2000;84: Balady GJ, Fletcher BJ, Froelicher ES, et al. American Heart Association: cardiac rehabiliation programs. Scienfific statements. Dallas (TX): American Heart Association; Brochu M, Poehlman ET, Savage P, et al. Modest effects of exercise training alone on coronary risk factors and body composition in coronary patients. J Cardiopulm Rehabil 2000;20: Ryan TJ, Antman EM, Brooks NH, et al. ACC/AHA guidelines for the management of patients with acute myocardial infarction: 1999 update: A report of the American College of Cardiology/ American Heart Association Task Force on Practice Guidelines

8 American Heart Journal Volume 142, Number 5 Pasquali, Alexander, and Peterson 755 (Committee on Management of Acute Myocardial Infarction). Available at: Accessed on November 28, Milani RV, Lavie CJ, Cassidy MM. Effects of cardiac rehabilitation and exercise training programs on depression in patients after major coronary events. Am Heart J 1996;132: Blazer D. Depression in the elderly: myths and misconceptions. Psychiatr Clin North Am 1997;20: Blazer DG, Kessler RC, McGonagle KA, et al. The prevalence and distribution of major depression in a national community survey: the National Comorbidity Survey. Am J Psychiatry 1994; 151: Frasure-Smith N, Lesperance F, Talajic M. Depression following myocardial infarction: impact on 6-month survival. JAMA 1993; 270: Ruberman W, Weinblatt E, Goldberg JD, et al. Psychosocial influences on mortality after myocardial infarction. N Engl J Med 1984; 311: Ades PA, Waldmann ML, Meyer WL, et al. Skeletal muscle and cardiovascular adaptations to exercise conditioning in older coronary patients. Circulation 1996;94: Lakatta EG, Mitchell JH, Pomerance A, et al. Human aging: changes in structure and function. J Am Coll Cardiol 1987;10:42-7A. 37. Vaitkevicius PV, Fleg JL, Engel JH, et al. Effects of age and aerobic capacity on arterial stiffness in healthy adults. Circulation 1993;88: Van Camp ST, Peterson RA. Cardiovascular complications of outpatient cardiac rehabilitation. JAMA 1986;256: Bardsley WT, Mavkin HT. Exercise testing. In: Brandenburg RD, Fuster V, Giuliani ER, et al, editors. Cardiology fundamentals and practice. Chicago: Year Book; p Ades PA, Ballor DL, Ashikaga T, et al. Weight training improves walking endurance in the healthy elderly. Ann Intern Med 1996; 124: Ariyo AA, Haan M, Tangen CM, et al. Depressive symptoms and risks of coronary heart disease and mortality in elderly Americans. Circulation 2000;102: Ayanian JZ, Epstein AM. Differences in the use of procedures between women and men hospitalized for coronary heart disease. N Engl J Med 1991;325: Tobin JN, Wassertheil-Smoller S, Wexler JP, et al. Sex bias in considering coronary bypass surgery. Ann Intern Med 1987; 107: Yusef S, Furberg CD. Are we biased in our approach to treating elderly patients with heart disease? Am J Cardiol 1991;68:54-6. Receive tables of contents by To receive the tables of contents by , sign up through our web site at mosby.com/ahj Choose notification Simply type your address in the box and click on the subscribe button Alternatively, you may send an message to Leave the subject line blank, and type the following as the body of your message: subscribe ahj_toc You will receive an to confirm that you have been added to the mailing list. Note that TOC s will be sent out when a new issue is posted to the Web site.

Cardiac Rehabilitation An Underutilized Class I Treatment for Cardiovascular Disease

Cardiac Rehabilitation An Underutilized Class I Treatment for Cardiovascular Disease Cardiac Rehabilitation An Underutilized Class I Treatment for Cardiovascular Disease What is Cardiac Rehabilitation? Cardiac rehabilitation is a comprehensive exercise, education, and behavior modification

More information

Utilization Review Cardiac Rehabilitation Services: Underutilized

Utilization Review Cardiac Rehabilitation Services: Underutilized Utilization Review Cardiac Rehabilitation Services: Underutilized William J. Gill, MD Krannert Institute of Cardiology Indiana University School of Medicine Indianapolis, Indiana What is Cardiac Rehab?

More information

Cardiac Rehabilitation: An Under-utilized Resource Making Patients Live Longer, Feel Better

Cardiac Rehabilitation: An Under-utilized Resource Making Patients Live Longer, Feel Better Cardiac Rehabilitation: An Under-utilized Resource Making Patients Live Longer, Feel Better Marian Taylor, M.D. Medical University of South Carolina Director, Cardiac Rehabilitation I have no disclosures.

More information

The Department of Vermont Health Access Medical Policy

The Department of Vermont Health Access Medical Policy State of Vermont Department of Vermont Health Access 312 Hurricane Lane, Suite 201 [Phone] 802-879-5903 Williston, VT 05495-2807 [Fax] 802-879-5963 www.dvha.vermont.gov Agency of Human Services The Department

More information

Protocol. Cardiac Rehabilitation in the Outpatient Setting

Protocol. Cardiac Rehabilitation in the Outpatient Setting Protocol Cardiac Rehabilitation in the Outpatient Setting (80308) Medical Benefit Effective Date: 07/01/14 Next Review Date: 09/15 Preauthorization No Review Dates: 07/07, 07/08, 05/09, 05/10, 05/11, 05/12,

More information

Use of a Prognostic Treadmill Score in Identifying Diagnostic Coronary Disease Subgroups

Use of a Prognostic Treadmill Score in Identifying Diagnostic Coronary Disease Subgroups Use of a Prognostic Treadmill Score in Identifying Diagnostic Coronary Disease Subgroups Leslee J. Shaw, PhD; Eric D. Peterson, MD, MPH; Linda K. Shaw, MS; Karen L. Kesler, MS; Elizabeth R. DeLong, PhD;

More information

Listen to your heart: Good Cardiovascular Health for Life

Listen to your heart: Good Cardiovascular Health for Life Listen to your heart: Good Cardiovascular Health for Life Luis R. Castellanos MD, MPH Assistant Clinical Professor of Medicine University of California San Diego School of Medicine Sulpizio Family Cardiovascular

More information

Summary Evaluation of the Medicare Lifestyle Modification Program Demonstration and the Medicare Cardiac Rehabilitation Benefit

Summary Evaluation of the Medicare Lifestyle Modification Program Demonstration and the Medicare Cardiac Rehabilitation Benefit The Centers for Medicare & Medicaid Services' Office of Research, Development, and Information (ORDI) strives to make information available to all. Nevertheless, portions of our files including charts,

More information

The ACC 50 th Annual Scientific Session

The ACC 50 th Annual Scientific Session Special Report The ACC 50 th Annual Scientific Session Part Two From March 18 to 21, 2001, physicians from around the world gathered to learn, to teach and to discuss at the American College of Cardiology

More information

Temporal Trends and Associated Factors of Inpatient Cardiac Rehabilitation in Patients With Acute Myocardial Infarction: A Community-wide Perspective

Temporal Trends and Associated Factors of Inpatient Cardiac Rehabilitation in Patients With Acute Myocardial Infarction: A Community-wide Perspective Temporal Trends and Associated Factors of Inpatient Cardiac Rehabilitation in Patients With Acute Myocardial Infarction: A Community-wide Perspective Frederick A. Spencer, MD; Bobak Salami, MD; Jorge Yarzebski,

More information

Cardiac Rehabilitation (Outpatient Phase II) Corporate Medical Policy. Medical Policy

Cardiac Rehabilitation (Outpatient Phase II) Corporate Medical Policy. Medical Policy Cardiac Rehabilitation (Outpatient Phase II) Corporate Medical Policy File name: Cardiac Rehabilitation (Outpatient Phase II) File code: UM.REHAB.04 Origination: 08/1994 Last Review: 08/2011 Next Review:

More information

The Canadian Association of Cardiac

The Canadian Association of Cardiac Reinventing Cardiac Rehabilitation Outside of acute care institutions, cardiovascular disease is a chronic, inflammatory process; the reduction or elimination of recurrent acute coronary syndromes is a

More information

Barriers to Healthcare Services for People with Mental Disorders. Cardiovascular disorders and diabetes in people with severe mental illness

Barriers to Healthcare Services for People with Mental Disorders. Cardiovascular disorders and diabetes in people with severe mental illness Barriers to Healthcare Services for People with Mental Disorders Cardiovascular disorders and diabetes in people with severe mental illness Dr. med. J. Cordes LVR- Klinikum Düsseldorf Kliniken der Heinrich-Heine-Universität

More information

The Effects of Short-term Cardiac Rehabilitation on Post-CABG Patients Fitness

The Effects of Short-term Cardiac Rehabilitation on Post-CABG Patients Fitness 2012 International Conference on Life Science and Engineering IPCBEE vol.45 (2012) (2012) IACSIT Press, Singapore DOI: 10.7763/IPCBEE. 2012. V45. 15 The Effects of Short-term Cardiac Rehabilitation on

More information

Cardiac Rehabilitation The Best Medicine for Your CAD Patients. James A. Stone

Cardiac Rehabilitation The Best Medicine for Your CAD Patients. James A. Stone James A. Stone BPHE, BA, MSc, MD, PhD, FRCPC, FAACVPR, FACC Clinical Professor of Medicine, University of Calgary Total Cardiology, Calgary Acknowledgements and Disclosures Acknowledgements Jacques Genest

More information

Presenter: Praveen N Pakeerappa, MBBS, PGY-3 Department of Physical Medicine and Rehabilitation, University of Kentucky, Lexington, KY

Presenter: Praveen N Pakeerappa, MBBS, PGY-3 Department of Physical Medicine and Rehabilitation, University of Kentucky, Lexington, KY Outcomes in Phase II Cardiac Rehabilitation: A Retrospective Analysis Comparing Participants with CABG to Participants with Non-Surgical Interventions Praveen N Pakeerappa, Beth Cundiff, Robert Nickerson,

More information

BEHAVIORAL CARDIOLOGY: Overview, Traditional Roles, and Future. Directions. Jerold M. Grodin, Ph.D.

BEHAVIORAL CARDIOLOGY: Overview, Traditional Roles, and Future. Directions. Jerold M. Grodin, Ph.D. BEHAVIORAL CARDIOLOGY: Overview, Traditional Roles, and Future Directions Jerold M. Grodin, Ph.D. www.psychservicespc.com PSYServ@aol.com Over the past decade, there has been a large body of research that

More information

Main Effect of Screening for Coronary Artery Disease Using CT

Main Effect of Screening for Coronary Artery Disease Using CT Main Effect of Screening for Coronary Artery Disease Using CT Angiography on Mortality and Cardiac Events in High risk Patients with Diabetes: The FACTOR-64 Randomized Clinical Trial Joseph B. Muhlestein,

More information

Cardiac Assessment for Renal Transplantation: Pre-Operative Clearance is Only the Tip of the Iceberg

Cardiac Assessment for Renal Transplantation: Pre-Operative Clearance is Only the Tip of the Iceberg Cardiac Assessment for Renal Transplantation: Pre-Operative Clearance is Only the Tip of the Iceberg 2 nd Annual Duke Renal Transplant Symposium March 1, 2014 Durham, NC Joseph G. Rogers, M.D. Associate

More information

PCHC FACTS ABOUT HEALTH CONDITIONS AND MOOD DIFFICULTIES

PCHC FACTS ABOUT HEALTH CONDITIONS AND MOOD DIFFICULTIES PCHC FACTS ABOUT HEALTH CONDITIONS AND MOOD DIFFICULTIES Why should mood difficulties in individuals with a health condition be addressed? Many people with health conditions also experience mood difficulties

More information

Remote Delivery of Cardiac Rehabilitation

Remote Delivery of Cardiac Rehabilitation Remote Delivery of Cardiac Rehabilitation Bonnie Wakefield, RN, PhD Kariann Drwal, MS Melody Scherubel, RN Thomas Klobucar, PhD Skyler Johnson, MS Peter Kaboli, MD, MS VA Rural Health Resource Center Central

More information

Atrial Fibrillation Prevention

Atrial Fibrillation Prevention Atrial Fibrillation Prevention Thierry C. Gillebert, MD, PhD, FESC Ghent University, Belgium ESC Global Scientific Activities SHA, Riyadh, Feb. 14, 2015 Mechanisms of AF Sinusal rhythm Mechanisms of AF

More information

KIH Cardiac Rehabilitation Program

KIH Cardiac Rehabilitation Program KIH Cardiac Rehabilitation Program For any further information Contact: +92-51-2870361-3, 2271154 Feedback@kih.com.pk What is Cardiac Rehabilitation Cardiac rehabilitation describes all measures used to

More information

CARDIAC REHABILITATION Winnipeg Region Annual Report 2013-14

CARDIAC REHABILITATION Winnipeg Region Annual Report 2013-14 CARDIAC REHABILITATION Winnipeg Region Annual Report 2013-14 PROGRAM OVERVIEW The Cardiac Rehabilitation Program (CRP) operates out of two medical fitness facilities in Winnipeg, the Reh- Fit Centre and

More information

Statins: Can there be too much of a good thing?

Statins: Can there be too much of a good thing? Statins: Can there be too much of a good thing? Spoiler alert No Oh Contraire Haaaaiiiiiiile No! Frequently under prescribing statin therapy! Typical Case 68 YO Smoker ACS Multiple prior PCI s Multiple

More information

Always Start with PECO

Always Start with PECO Goals of This Course Be able to understand a study design (very basic concept) Be able to understand statistical concepts in a medical paper Be able to perform a data analysis Understanding: PECO study

More information

ECG may be indicated for patients with cardiovascular risk factors

ECG may be indicated for patients with cardiovascular risk factors eappendix A. Summary for Preoperative ECG American College of Cardiology/ American Heart Association, 2007 A1 2002 A2 European Society of Cardiology and European Society of Anaesthesiology, 2009 A3 Improvement,

More information

THE EFFECTIVENESS OF CARDIAC REHABILITATION PROGRAMS IN FEMALES FOLLOWING AN ACUTE MYOCARDIAL INFARCTION. Submitted by.

THE EFFECTIVENESS OF CARDIAC REHABILITATION PROGRAMS IN FEMALES FOLLOWING AN ACUTE MYOCARDIAL INFARCTION. Submitted by. THE EFFECTIVENESS OF CARDIAC REHABILITATION PROGRAMS IN FEMALES FOLLOWING AN ACUTE MYOCARDIAL INFARCTION Submitted by Katie Carnelia A project presented to the Department of Physician Assistant and the

More information

Osama Jarkas. in Chest Pain Patients. STUDENT NAME: Osama Jarkas DATE: August 10 th, 2015

Osama Jarkas. in Chest Pain Patients. STUDENT NAME: Osama Jarkas DATE: August 10 th, 2015 STUDENT NAME: Osama Jarkas DATE: August 10 th, 2015 PROJECT TITLE: Analysis of ECG Exercise Stress Testing and Framingham Risk Score in Chest Pain Patients PRIMARY SUPERVISOR NAME: Dr. Edward Tan DEPARTMENT:

More information

Psoriasis Co-morbidities: Changing Clinical Practice. Theresa Schroeder Devere, MD Assistant Professor, OHSU Dermatology. Psoriatic Arthritis

Psoriasis Co-morbidities: Changing Clinical Practice. Theresa Schroeder Devere, MD Assistant Professor, OHSU Dermatology. Psoriatic Arthritis Psoriasis Co-morbidities: Changing Clinical Practice Theresa Schroeder Devere, MD Assistant Professor, OHSU Dermatology Psoriatic Arthritis Psoriatic Arthritis! 11-31% of patients with psoriasis have psoriatic

More information

The Link Between Obesity and Diabetes The Rapid Evolution and Positive Results of Bariatric Surgery

The Link Between Obesity and Diabetes The Rapid Evolution and Positive Results of Bariatric Surgery The Link Between Obesity and Diabetes The Rapid Evolution and Positive Results of Bariatric Surgery Michael E. Farkouh, MD, MSc Peter Munk Chair in Multinational Clinical Trials Director, Heart and Stroke

More information

R.P. Zecchin*, J. Baihn, Y.Y. Chai, J. Hungerford, G. Lindsay, M. Owen, J. Thelander, D.L. Ross, C. Chow, A.R. Denniss. Westmead Hospital, Sydney,

R.P. Zecchin*, J. Baihn, Y.Y. Chai, J. Hungerford, G. Lindsay, M. Owen, J. Thelander, D.L. Ross, C. Chow, A.R. Denniss. Westmead Hospital, Sydney, R.P. Zecchin*, J. Baihn, Y.Y. Chai, J. Hungerford, G. Lindsay, M. Owen, J. Thelander, D.L. Ross, C. Chow, A.R. Denniss. Westmead Hospital, Sydney, Australia Cardiac rehabilitation is an effective and safe

More information

Exercise Stress Electrocardiography. Historical Perspective. Historical Perspective. Subject Population. Learning Objectives. ECG Exercise Testing

Exercise Stress Electrocardiography. Historical Perspective. Historical Perspective. Subject Population. Learning Objectives. ECG Exercise Testing Learning Objectives Exercise Stress Electrocardiography Gerald F. Fletcher MD Mayo Clinic Florida No Disclosures Provide an understanding of the value of the multiple ECG and Physiological measures that

More information

Cardiovascular Prevention and Rehabilitation Program

Cardiovascular Prevention and Rehabilitation Program Cardiovascular Prevention and Rehabilitation Program Leading the way to a healthier heart For people who have had a heart attack, heart surgery or other cardiac event, or for those who have two or more

More information

Atrial Fibrillation 2014 How to Treat How to Anticoagulate. Allan Anderson, MD, FACC, FAHA Division of Cardiology

Atrial Fibrillation 2014 How to Treat How to Anticoagulate. Allan Anderson, MD, FACC, FAHA Division of Cardiology Atrial Fibrillation 2014 How to Treat How to Anticoagulate Allan Anderson, MD, FACC, FAHA Division of Cardiology Projection for Prevalence of Atrial Fibrillation: 5.6 Million by 2050 Projected number of

More information

INTERMITTENT CLAUDICATION CLASS. Liz Bouch (Senior Specialist Physiotherapist) Manchester Royal Infirmary BACPAR - Nov 14

INTERMITTENT CLAUDICATION CLASS. Liz Bouch (Senior Specialist Physiotherapist) Manchester Royal Infirmary BACPAR - Nov 14 INTERMITTENT CLAUDICATION CLASS Liz Bouch (Senior Specialist Physiotherapist) Manchester Royal Infirmary BACPAR - Nov 14 AIMS What is Intermittent Claudication? NICE guideline Treatment options Exercise

More information

8 31, ,542 20, ,029 ( 2005:30(1):12-20)

8 31, ,542 20, ,029 ( 2005:30(1):12-20) 3 4 88 90 0 6 45 4 86 (p< 0.05) 6 8 3,06 6 0,54 0,564 0.069 98,09 ( 005:30():-0) (cardiac rehabilitation) 3-5 Relman 988 3 99 Levin 5 3 4 (0)33456-7556 E-mail ytw@ccms.ntu.edu.tw 004 7 004 9 7 6 6 87 86

More information

AVAILABILITY AND ACCESSIBILITY OF CARDIAC REHABILITATION SERVICES IN LOW- AND MIDDLE-INCOME COUNTRIES QUESTIONNAIRE

AVAILABILITY AND ACCESSIBILITY OF CARDIAC REHABILITATION SERVICES IN LOW- AND MIDDLE-INCOME COUNTRIES QUESTIONNAIRE AVAILABILITY AND ACCESSIBILITY OF CARDIAC REHABILITATION SERVICES IN LOW- AND MIDDLE-INCOME COUNTRIES QUESTIONNAIRE To be completed by Staff Cardiologists at an adult cardiac institute/department. INSTRUCTIONS:

More information

CARE MANAGEMENT FOR LATE LIFE DEPRESSION IN URBAN CHINESE PRIMARY CARE CLINICS

CARE MANAGEMENT FOR LATE LIFE DEPRESSION IN URBAN CHINESE PRIMARY CARE CLINICS CARE MANAGEMENT FOR LATE LIFE DEPRESSION IN URBAN CHINESE PRIMARY CARE CLINICS Dept of Public Health Sciences February 6, 2015 Yeates Conwell, MD Dept of Psychiatry, University of Rochester Shulin Chen,

More information

Stress is linked to exaggerated cardiovascular reactivity. 1) Stress 2) Hostility 3) Social Support. Evidence of association between these

Stress is linked to exaggerated cardiovascular reactivity. 1) Stress 2) Hostility 3) Social Support. Evidence of association between these Psychosocial Factors & CHD Health Psychology Psychosocial Factors 1) Stress 2) Hostility 3) Social Support Evidence of association between these psychosocial factors and CHD Physiological Mechanisms Stress

More information

Mental Health Referral Practices and Diabetic Management at Community Medical Alliance Clinic (Bell Site) Northeast Community Clinic (NECC)

Mental Health Referral Practices and Diabetic Management at Community Medical Alliance Clinic (Bell Site) Northeast Community Clinic (NECC) Mental Health Referral Practices and Diabetic Management at Community Medical Alliance Clinic (Bell Site) Northeast Community Clinic (NECC) MaryAnn Garcia, SUNY Downstate Medical College NMF PCLP Scholar

More information

Primary Prevention of Cardiovascular Disease with a Mediterranean diet

Primary Prevention of Cardiovascular Disease with a Mediterranean diet Primary Prevention of Cardiovascular Disease with a Mediterranean diet Alejandro Vicente Carrillo, Brynja Ingadottir, Anne Fältström, Evelyn Lundin, Micaela Tjäderborn GROUP 2 Background The traditional

More information

Peripheral Arterial Disease: Why You Should Care & How You Can Help. Jon Zlabek, MD, FACP Vascular Medicine

Peripheral Arterial Disease: Why You Should Care & How You Can Help. Jon Zlabek, MD, FACP Vascular Medicine Peripheral Arterial Disease: Why You Should Care & How You Can Help Jon Zlabek, MD, FACP Vascular Medicine jazlabek@gundluth.org Today s Objectives Review the assessment, diagnosis and treatment of peripheral

More information

Key Components of the Research Question PICOT

Key Components of the Research Question PICOT Key Components of the Research Question PICOT CONTEXT: Low birth weight is implicated as a risk factor for type 2 diabetes. However, the strength, consistency, independence, and shape of the association

More information

Introduction to Exercise: Physiology & Sports Medicine

Introduction to Exercise: Physiology & Sports Medicine Introduction to Exercise: Physiology & Sports Medicine Course Coordinator: Dr. Yiftah Beer M.D. Course Description: Sports and physical training are now considered the basis of healthy lifestyles. As such,

More information

What is meant by "randomization"? (Select the one best answer.)

What is meant by randomization? (Select the one best answer.) Preview: Post-class quiz 5 - Clinical Trials Question 1 What is meant by "randomization"? (Select the one best answer.) Question 2 A. Selection of subjects at random. B. Randomization is a method of allocating

More information

Integrative Medicine

Integrative Medicine The Efficacy and Cost Effectiveness of Integrative Medicine A Review of the Medical and Corporate Literature A Bravewell Collaborative Report Health & Wellbeing By Erminia (Mimi) Guarneri, MD Founder and

More information

Take a moment Confer with your neighbour And try to solve the following word picture puzzle slides.

Take a moment Confer with your neighbour And try to solve the following word picture puzzle slides. Take a moment Confer with your neighbour And try to solve the following word picture puzzle slides. Example: = Head Over Heels Take a moment Confer with your neighbour And try to solve the following word

More information

Role of elevated heart rate in the development of cardiovascular disease in hypertension

Role of elevated heart rate in the development of cardiovascular disease in hypertension ONLINE SUPPLEMENT Role of elevated heart rate in the development of cardiovascular disease in By Palatini P Department of Clinical and Experimental Medicine University of Padova, Padua, Italy Running title:

More information

UNIVERSITY OF MEDICINE AND PHARMACY CRAIOVA DOCTORAL SCHOOL DOCTORATE THESIS. - Summary

UNIVERSITY OF MEDICINE AND PHARMACY CRAIOVA DOCTORAL SCHOOL DOCTORATE THESIS. - Summary UNIVERSITY OF MEDICINE AND PHARMACY CRAIOVA DOCTORAL SCHOOL DOCTORATE THESIS - Summary CHRONIC COMPLICATIONS IN PATIENTS WITH TYPE 1 DIABETES MELLITUS - Epidemiological study - PhD Manager: Professor PhD.

More information

Effects of Long-Term and Ongoing Cardiac Rehabilitation in Elderly Patients With Coronary Heart Disease

Effects of Long-Term and Ongoing Cardiac Rehabilitation in Elderly Patients With Coronary Heart Disease Original Paper Effects of Long-Term and Ongoing Cardiac Rehabilitation in Elderly Patients With Coronary Heart Disease Mathieu Gayda, PhD; 1,2 Martin Juneau, MD; 1 Sylvie Levesque, MSc; 1 Marie Claude

More information

MEDICAL POLICY SUBJECT: CARDIAC REHABILITATION. POLICY NUMBER: 8.01.14 CATEGORY: Therapy/ Rehabilitation

MEDICAL POLICY SUBJECT: CARDIAC REHABILITATION. POLICY NUMBER: 8.01.14 CATEGORY: Therapy/ Rehabilitation MEDICAL POLICY SUBJECT: CARDIAC REHABILITATION PAGE: 1 OF: 6 If the member's subscriber contract excludes coverage for a specific service it is not covered under that contract. In such cases, medical policy

More information

Establishing Equivalence of Exercise Intensities

Establishing Equivalence of Exercise Intensities The Open Sports Medicine Journal, 2009, 3, 21-25 21 Establishing Equivalence of Exercise Intensities Aaron Lewicke 1,2 and Kenneth C. Beck *,2 Open Access 1 Clarkson University, Potsdam, NY 13699, USA

More information

Guidance for Industry Diabetes Mellitus Evaluating Cardiovascular Risk in New Antidiabetic Therapies to Treat Type 2 Diabetes

Guidance for Industry Diabetes Mellitus Evaluating Cardiovascular Risk in New Antidiabetic Therapies to Treat Type 2 Diabetes Guidance for Industry Diabetes Mellitus Evaluating Cardiovascular Risk in New Antidiabetic Therapies to Treat Type 2 Diabetes U.S. Department of Health and Human Services Food and Drug Administration Center

More information

Clinical Research on Lifestyle Interventions to Treat Obesity and Asthma in Primary Care Jun Ma, M.D., Ph.D.

Clinical Research on Lifestyle Interventions to Treat Obesity and Asthma in Primary Care Jun Ma, M.D., Ph.D. Clinical Research on Lifestyle Interventions to Treat Obesity and Asthma in Primary Care Jun Ma, M.D., Ph.D. Associate Investigator Palo Alto Medical Foundation Research Institute Consulting Assistant

More information

Coronary Heart Disease (CHD) Brief

Coronary Heart Disease (CHD) Brief Coronary Heart Disease (CHD) Brief What is Coronary Heart Disease? Coronary Heart Disease (CHD), also called coronary artery disease 1, is the most common heart condition in the United States. It occurs

More information

Therapeutic Approach in Patients with Diabetes and Coronary Artery Disease

Therapeutic Approach in Patients with Diabetes and Coronary Artery Disease Home SVCC Area: English - Español - Português Therapeutic Approach in Patients with Diabetes and Coronary Artery Disease Martial G. Bourassa, MD Research Center, Montreal Heart Institute, Montreal, Quebec,

More information

Success factors in Behavioral Medicine

Success factors in Behavioral Medicine Success factors in Behavioral Medicine interventions post myocardial infarction Depression Gunilla post myocardial Burell, PhD infarction Department of Public Health, Uppsala University, Sweden XIII Svenska

More information

Rehabilitation and Lung Cancer Resection. Roberto Benzo MD MS Mindful Breathing Laboratory Division of Pulmonary & CCM Mayo Clinic

Rehabilitation and Lung Cancer Resection. Roberto Benzo MD MS Mindful Breathing Laboratory Division of Pulmonary & CCM Mayo Clinic Rehabilitation and Lung Cancer Resection Roberto Benzo MD MS Mindful Breathing Laboratory Division of Pulmonary & CCM Mayo Clinic Disclosure Funded by the National Cancer Institute NIH for Preoperative

More information

Outpatient/Ambulatory Rehab. Dedicated Trans-disciplinary Team (defined within Annotated References)

Outpatient/Ambulatory Rehab. Dedicated Trans-disciplinary Team (defined within Annotated References) CARDIAC The delivery of Cardiac Rehab is unlike most other rehab populations. The vast majority of patients receive their rehab in outpatient or community settings and only a small subset requires an inpatient

More information

3/2/2010 Post CABG R h e bili a i tat on Ahmed Elkerdany Professor o f oof C ardiac Cardiac Surgery Ain Shams University 1

3/2/2010 Post CABG R h e bili a i tat on Ahmed Elkerdany Professor o f oof C ardiac Cardiac Surgery Ain Shams University 1 Post CABG Rehabilitation i Ahmed Elkerdany Professor of Cardiac Surgery Ain Shams University 1 Definition Cardiac rehabilitation services are comprehensive, long-term programs involving : medical evaluation.

More information

Post-MI Cardiac Rehabilitation. Mark Mason Consultant Cardiologist Harefield Hospital Royal Brompton and Harefield NHS Foundation Trust

Post-MI Cardiac Rehabilitation. Mark Mason Consultant Cardiologist Harefield Hospital Royal Brompton and Harefield NHS Foundation Trust Post-MI Cardiac Rehabilitation Mark Mason Consultant Cardiologist Harefield Hospital Royal Brompton and Harefield NHS Foundation Trust 'the sum of activities required to influence favourably the underlying

More information

Statins and Risk for Diabetes Mellitus. Background

Statins and Risk for Diabetes Mellitus. Background Statins and Risk for Diabetes Mellitus Kevin C. Maki, PhD, FNLA Midwest Center for Metabolic & Cardiovascular Research and DePaul University, Chicago, IL 1 Background In 2012 the US Food and Drug Administration

More information

A list of FDA-approved testosterone products can be found by searching for testosterone at http://www.accessdata.fda.gov/scripts/cder/drugsatfda/.

A list of FDA-approved testosterone products can be found by searching for testosterone at http://www.accessdata.fda.gov/scripts/cder/drugsatfda/. FDA Drug Safety Communication: FDA cautions about using testosterone products for low testosterone due to aging; requires labeling change to inform of possible increased risk of heart attack and stroke

More information

Depression in patients with coronary heart disease (CHD): screening, referral and treatment. 2014 Na)onal Heart Founda)on of Australia

Depression in patients with coronary heart disease (CHD): screening, referral and treatment. 2014 Na)onal Heart Founda)on of Australia Depression in patients with coronary heart disease (CHD): screening, referral and treatment Screening, referral and treatment for depression in patients with CHD A consensus statement from the National

More information

Evidence-based Synthesis Program. October 2012

Evidence-based Synthesis Program. October 2012 Department of Veterans Affairs Health Services Research & Development Service Effects of Health Plan-Sponsored Fitness Center Benefits on Physical Activity, Health Outcomes, and Health Care Costs and Utilization:

More information

RATE VERSUS RHYTHM CONTROL OF ATRIAL FIBRILLATION: SPECIAL CONSIDERATION IN ELDERLY. Charles Jazra

RATE VERSUS RHYTHM CONTROL OF ATRIAL FIBRILLATION: SPECIAL CONSIDERATION IN ELDERLY. Charles Jazra RATE VERSUS RHYTHM CONTROL OF ATRIAL FIBRILLATION: SPECIAL CONSIDERATION IN ELDERLY Charles Jazra NO CONFLICT OF INTEREST TO DECLARE Relationship Between Atrial Fibrillation and Age Prevalence, percent

More information

Measure #257 (NQF 1519): Statin Therapy at Discharge after Lower Extremity Bypass (LEB) National Quality Strategy Domain: Effective Clinical Care

Measure #257 (NQF 1519): Statin Therapy at Discharge after Lower Extremity Bypass (LEB) National Quality Strategy Domain: Effective Clinical Care Measure #257 (NQF 1519): Statin Therapy at Discharge after Lower Extremity Bypass (LEB) National Quality Strategy Domain: Effective Clinical Care 2016 PQRS OPTIONS FOR INDIVIDUAL MEASURES: REGISTRY ONLY

More information

The Women s Health Initiative: The Role of Hormonal Therapy in Disease Prevention

The Women s Health Initiative: The Role of Hormonal Therapy in Disease Prevention The Women s Health Initiative: The Role of Hormonal Therapy in Disease Prevention Robert B. Wallace, MD, MSc Departments of Epidemiology and Internal Medicine University of Iowa College of Public Health

More information

Journal Club: Niacin in Patients with Low HDL Cholesterol Levels Receiving Intensive Statin Therapy by the AIM-HIGH Investigators

Journal Club: Niacin in Patients with Low HDL Cholesterol Levels Receiving Intensive Statin Therapy by the AIM-HIGH Investigators Journal Club: Niacin in Patients with Low HDL Cholesterol Levels Receiving Intensive Statin Therapy by the AIM-HIGH Investigators Shaikha Al Naimi Doctor of Pharmacy Student College of Pharmacy Qatar University

More information

Steven J. Yakubov, MD FACC For the CoreValve US Clinical Investigators

Steven J. Yakubov, MD FACC For the CoreValve US Clinical Investigators Long-Term Outcomes Using a Self- Expanding Bioprosthesis in Patients With Severe Aortic Stenosis Deemed Extreme Risk for Surgery: Two-Year Results From the CoreValve US Pivotal Trial Steven J. Yakubov,

More information

How to train the cardiovascular patient? Physical activity in patients with heart disease: how much is good enough?

How to train the cardiovascular patient? Physical activity in patients with heart disease: how much is good enough? How to train the cardiovascular patient? Physical activity in patients with heart disease: how much is good enough? Per Anton Sirnes MD.Phd.FESC Moss, Norway Chair, ESC Council on Cardiology Practice Conflicts

More information

REFERRAL HOSPITAL. The Importance of Door In Door Out Time DIDO

REFERRAL HOSPITAL. The Importance of Door In Door Out Time DIDO REFERRAL HOSPITAL The Importance of Door In Door Out Time DIDO Time to Treatment is critical for STEMI patients For patients with ST-segment elevation myocardial infarction (STEMI), percutaneous coronary

More information

CARDIAC REHABILITATION

CARDIAC REHABILITATION Paul Peacock Cardiac Rehabilitation Nurse Friday, 4 August 2006 1 The rehab Team Chris Murphy Kate O Reilly Paul Peacock Increased to 2 FTEs March 06 Wellington & Kapiti Coast MDT involvement Friday, 4

More information

on a daily basis. On the whole, however, those with heart disease are more limited in their activities, including work.

on a daily basis. On the whole, however, those with heart disease are more limited in their activities, including work. Heart Disease A disabling yet preventable condition Number 3 January 2 NATIONAL ACADEMY ON AN AGING SOCIETY Almost 18 million people 7 percent of all Americans have heart disease. More than half of the

More information

South African Cholesterol Guidelines Compared

South African Cholesterol Guidelines Compared South African Cholesterol Guidelines Compared Jacqueline van Schoor, Amayeza Info Centre While infectious diseases are currently the leading cause of death in South Africa, cardiovascular disease (CVD)

More information

The WHI 12 Years Later: What Have We Learned about Postmenopausal HRT?

The WHI 12 Years Later: What Have We Learned about Postmenopausal HRT? AACE 23 rd Annual Scientific and Clinical Congress (2014) Syllabus Materials: The WHI 12 Years Later: What Have We Learned about Postmenopausal HRT? JoAnn E. Manson, MD, DrPH, FACP, FACE Chief, Division

More information

Texto proveniente de: ACSM s Certified News

Texto proveniente de: ACSM s Certified News Texto proveniente de: ACSM s Certified News Peripheral Arterial Disease By Nina Markil, B.S. Exercise Science and Health Promotion at Florida Atlantic University. CNews19.2Final.JR:Layout 1 5/6/09 Peripheral

More information

What is a Heart Attack? 1,2,3

What is a Heart Attack? 1,2,3 S What is a Heart Attack? 1,2,3 Heart attacks, otherwise known as myocardial infarctions, are caused when the blood supply to a section of the heart is suddenly disrupted. Without the oxygen supplied by

More information

New Cholesterol Guidelines: Carte Blanche for Statin Overuse Rita F. Redberg, MD, MSc Professor of Medicine

New Cholesterol Guidelines: Carte Blanche for Statin Overuse Rita F. Redberg, MD, MSc Professor of Medicine New Cholesterol Guidelines: Carte Blanche for Statin Overuse Rita F. Redberg, MD, MSc Professor of Medicine Disclosures & Relevant Relationships I have nothing to disclose No financial conflicts Editor,

More information

Stanford University s Chronic Disease Self-Management Program Curriculum and Evidence

Stanford University s Chronic Disease Self-Management Program Curriculum and Evidence Stanford University s Chronic Disease Self-Management Program Curriculum and Evidence What is the Chronic Disease Self-Management Program? The Chronic Disease Self-Management Program (CDSMP), developed

More information

Women and cardiac rehabilitation: a review of the literature

Women and cardiac rehabilitation: a review of the literature School of Nursing School of Nursing Journal Articles coda Year 2008 Women and cardiac rehabilitation: a review of the literature Wendy K. Day Universal College of Learning (UCOL), w.day@ucol.ac.nz This

More information

AMBREEN RAZA MBBS VARUN MALAYALA MBBS, MPH. University at Buffalo/Sisters of Charity Hospital

AMBREEN RAZA MBBS VARUN MALAYALA MBBS, MPH. University at Buffalo/Sisters of Charity Hospital AMBREEN RAZA MBBS VARUN MALAYALA MBBS, MPH University at Buffalo/Sisters of Charity Hospital Conflict of interest: None Financial disclosures: None United States Preventive Services Taskforce (USPSTF)

More information

Systolic Blood Pressure Intervention Trial (SPRINT) Principal Results

Systolic Blood Pressure Intervention Trial (SPRINT) Principal Results Systolic Blood Pressure Intervention Trial (SPRINT) Principal Results Paul K. Whelton, MB, MD, MSc Chair, SPRINT Steering Committee Tulane University School of Public Health and Tropical Medicine, and

More information

WEIGHT LOSS SURGERY. Pre-Clinic Conference Jennifer Kinley, MD 12/15/2010

WEIGHT LOSS SURGERY. Pre-Clinic Conference Jennifer Kinley, MD 12/15/2010 WEIGHT LOSS SURGERY Pre-Clinic Conference Jennifer Kinley, MD 12/15/2010 EDUCATIONAL OBJECTIVES: Discuss the available pharmaceutical options for weight loss and risks of these medications Explain the

More information

Section 8: Clinical Exercise Testing. a maximal GXT?

Section 8: Clinical Exercise Testing. a maximal GXT? Section 8: Clinical Exercise Testing Maximal GXT ACSM Guidelines: Chapter 5 ACSM Manual: Chapter 8 HPHE 4450 Dr. Cheatham Outline What is the purpose of a maximal GXT? Who should have a maximal GXT (and

More information

PPA Educational Foundation Grant Report 2013 Kristin M. Franks

PPA Educational Foundation Grant Report 2013 Kristin M. Franks PPA Educational Foundation Grant Report 2013 Kristin M. Franks The impact of an Incentivized Employer-Driven, Pharmacist Run Know Your Numbers Clinic Kristin M. Franks, Pharm.D., Suzanne Higginbotham,

More information

The Role of Insurance in Providing Access to Cardiac Care in Maryland. Samuel L. Brown, Ph.D. University of Baltimore College of Public Affairs

The Role of Insurance in Providing Access to Cardiac Care in Maryland. Samuel L. Brown, Ph.D. University of Baltimore College of Public Affairs The Role of Insurance in Providing Access to Cardiac Care in Maryland Samuel L. Brown, Ph.D. University of Baltimore College of Public Affairs Heart Disease Heart Disease is the leading cause of death

More information

Post discharge tariffs in the English NHS

Post discharge tariffs in the English NHS Post discharge tariffs in the English NHS Martin Campbell Department of Health 4th June 2013 Contents Rationale and objectives Non payment for avoidable readmissions Development of post discharge tariffs

More information

Prevention of Cardiovascular Disease in Children with Diabetes

Prevention of Cardiovascular Disease in Children with Diabetes Prevention of Cardiovascular Disease in Children with Diabetes Stephen R. Daniels, MD, PhD Department of Pediatrics University of Colorado School of Medicine The Children s Hospital Anschutz Medical Campus

More information

Low-gradient severe aortic stenosis with normal LVEF: A disturbing clinical entity

Low-gradient severe aortic stenosis with normal LVEF: A disturbing clinical entity Low-gradient severe aortic stenosis with normal LVEF: A disturbing clinical entity Jean-Luc MONIN, MD, PhD Henri Mondor University Hospital Créteil, FRANCE Disclosures : None 77-year-old woman, mild dyspnea

More information

Robert Okwemba, BSPHS, Pharm.D. 2015 Philadelphia College of Pharmacy

Robert Okwemba, BSPHS, Pharm.D. 2015 Philadelphia College of Pharmacy Robert Okwemba, BSPHS, Pharm.D. 2015 Philadelphia College of Pharmacy Judith Long, MD,RWJCS Perelman School of Medicine Philadelphia Veteran Affairs Medical Center Background Objective Overview Methods

More information

This supplementary material has been provided by the authors to give readers additional information about their work.

This supplementary material has been provided by the authors to give readers additional information about their work. SUPPLEMENTAL MATERIAL Table S1. The logistic regression model used to calculate the propensity score. Table S2. Distribution of propensity score among the treat and control groups of the full and matched

More information

ACSM Risk Factor Identification and Risk Stratification

ACSM Risk Factor Identification and Risk Stratification Thresholds for Use With ACSM Risk Stratification (p 24G) ACSM Risk Factor Identification and Risk Stratification By Dr. Sue Beckham, Ph.D., RCEP, PD Positive Family History Cigarette Smoking Myocardial

More information

AEROBIC EXERCISE EARLY AFTER STROKE Information for Patients and Families

AEROBIC EXERCISE EARLY AFTER STROKE Information for Patients and Families AEROBIC EXERCISE EARLY AFTER STROKE Information for Patients and Families What is aerobic exercise? Aerobic exercise refers to physical activity that requires the body to use oxygen to generate energy.

More information

MANAGEMENT OF LIPID DISORDERS: IMPLICATIONS OF THE NEW GUIDELINES

MANAGEMENT OF LIPID DISORDERS: IMPLICATIONS OF THE NEW GUIDELINES MANAGEMENT OF LIPID DISORDERS: IMPLICATIONS OF THE NEW GUIDELINES Robert B. Baron MD MS Professor and Associate Dean UCSF School of Medicine Declaration of full disclosure: No conflict of interest EXPLAINING

More information

Impact of Massachusetts Health Care Reform on Racial, Ethnic and Socioeconomic Disparities in Cardiovascular Care

Impact of Massachusetts Health Care Reform on Racial, Ethnic and Socioeconomic Disparities in Cardiovascular Care Impact of Massachusetts Health Care Reform on Racial, Ethnic and Socioeconomic Disparities in Cardiovascular Care Michelle A. Albert MD MPH Treacy S. Silbaugh B.S, John Z. Ayanian MD MPP, Ann Lovett RN

More information

The largest clinical study of Bayer's Xarelto (rivaroxaban) Wednesday, 14 November 2012 07:38

The largest clinical study of Bayer's Xarelto (rivaroxaban) Wednesday, 14 November 2012 07:38 Bayer HealthCare has announced the initiation of the COMPASS study, the largest clinical study of its oral anticoagulant Xarelto (rivaroxaban) to date, investigating the prevention of major adverse cardiac

More information

Achieving Quality and Value in Chronic Care Management

Achieving Quality and Value in Chronic Care Management The Burden of Chronic Disease One of the greatest burdens on the US healthcare system is the rapidly growing rate of chronic disease. These statistics illustrate the scope of the problem: Nearly half of

More information

PREVENTIVE CARDIOLOGY CURRICULUM. Overview

PREVENTIVE CARDIOLOGY CURRICULUM. Overview PREVENTIVE CARDIOLOGY CURRICULUM Overview The primary goal of the Preventive Cardiology curriculum for the University of Wisconsin Cardiovascular Medicine Fellowship is to provide the knowledge and skills

More information