Subject(s)
Coronary Disease/prevention & control , Coronary Disease/rehabilitation , Physician Executives/organization & administration , Physician Executives/standards , Ambulatory Care/organization & administration , Ambulatory Care/standards , American Heart Association , Humans , Models, Organizational , Patient Care Team/organization & administration , Patient Care Team/standards , Rehabilitation Centers/organization & administration , Rehabilitation Centers/standards , United StatesABSTRACT
OBJECTIVE: The purposes of this study were (1). to determine if six-minute walk (6MW) performance improved after short-term cardiac rehabilitation (CR) across multiple outpatient programs; (2). to examine differences in 6MW performance by patient age, sex, and race; and (3). to determine what relationships existed, if any, between 6MW performance and subscales of the Ferrans and Powers' Quality of Life Index-Cardiac Version III (QOLI). DESIGN: Study design was nonexperimental, prospective, and comparative. SETTING: Study setting included 14 outpatient CR programs from urban and rural settings across North Carolina. PATIENTS: Adults aged 40 to 89 years (N = 630; men = 424 [67%], women = 206 [33%]; mean age, 61 +/- 10.32 years) with medically or surgically treated coronary heart disease enrolled in outpatient CR. OUTCOME MEASURES: Study measures included scores on the QOLI and distance walked (feet) on the 6MW test. RESULTS: Six-minute walk tests and QOLI surveys were administered before and immediately after short-term CR participation. Six-minute walk distance increased for all patients in all age categories across programs after CR (P <.0001). As a group, women improved 6MW distance by 15% (1243.9 +/- 301.2 to 1435.3 +/- 298.1; P <.001). Men also improved 6MW distance by 15% (1463.3 +/- 339.5 to 1683.7 +/- 346.9; P <.001) and walked farther than women on both the initial and follow-up 6MW tests (P <.0001). By age, there were no differences in 6MW scores between men and women aged 40 to 49 years (n = 58) and 50 to 59 years (n = 140; P = 0.54). Both of these age groups had greater initial and discharge 6MW scores than those aged 70 to 79 years (n = 183) and 80 to 89 years (n = 22; P <.001). Those aged 60 to 69 years (n = 227) had lower 6MW scores than those aged 40 to 49 years (P = 0.001) and 50 to 59 years (P <.05), and greater scores than those aged 70 to 79 years (P <.05) and 80 to 89 years (P <.05). Those aged 70 to 79 years had greater initial and follow-up 6MW scores than those aged 80 to 89 years(P <.001). Overall improvements in 6MW performance were found in both white subjects (n = 575; P <.001) and African-Americans (n = 54; P <.001). There were no apparent relationships between 6MW performance and overall or Health and Function QOLI scores (r <.21). CONCLUSIONS: Participation in short-term outpatient CR improved 6MW performance in patients aged 40 to 89 years across 14 programs in North Carolina. No relationships were found between 6MW performance and any domain of the QOLI, including the Health and Function domain.
