Home-Based Cardiac Rehabilitation: A Scientific Statement From the American Association of Cardiovascular and Pulmonary Rehabilitation, the American Heart Association, and the American College of Cardiology.

Cardiac rehabilitation (CR) is an evidence-based intervention that uses patient education, health behavior modification, and exercise training to improve secondary prevention outcomes in patients with cardiovascular disease. CR programs reduce morbidity and mortality rates in adults with ischemic heart disease, heart failure, or cardiac surgery but are significantly underused, with only a minority of eligible patients participating in CR in the United States. New delivery strategies are urgently needed to improve participation. One potential strategy is home-based CR (HBCR). In contrast to center-based CR services, which are provided in a medically supervised facility, HBCR relies on remote coaching with indirect exercise supervision and is provided mostly or entirely outside of the traditional center-based setting. Although HBCR has been successfully deployed in the United Kingdom, Canada, and other countries, most US healthcare organizations have little to no experience with such programs. The purpose of this scientific statement is to identify the core components, efficacy, strengths, limitations, evidence gaps, and research necessary to guide the future delivery of HBCR in the United States. Previous randomized trials have generated low- to moderate-strength evidence that HBCR and center-based CR can achieve similar improvements in 3- to 12-month clinical outcomes. Although HBCR appears to hold promise in expanding the use of CR to eligible patients, additional research and demonstration projects are needed to clarify, strengthen, and extend the HBCR evidence base for key subgroups, including older adults, women, underrepresented minority groups, and other higher-risk and understudied groups. In the interim, we conclude that HBCR may be a reasonable option for selected clinically stable low- to moderate-risk patients who are eligible for CR but cannot attend a traditional center-based CR program.

Home-Based Cardiac Rehabilitation: A Scientific Statement From the American Association of Cardiovascular and Pulmonary Rehabilitation, the American Heart Association, and the American College of Cardiology.

Cardiac rehabilitation (CR) is an evidence-based intervention that uses patient education, health behavior modification, and exercise training to improve secondary prevention outcomes in patients with cardiovascular disease. CR programs reduce morbidity and mortality rates in adults with ischemic heart disease, heart failure, or cardiac surgery but are significantly underused, with only a minority of eligible patients participating in CR in the United States. New delivery strategies are urgently needed to improve participation. One potential strategy is home-based CR (HBCR). In contrast to center-based CR services, which are provided in a medically supervised facility, HBCR relies on remote coaching with indirect exercise supervision and is provided mostly or entirely outside of the traditional center-based setting. Although HBCR has been successfully deployed in the United Kingdom, Canada, and other countries, most US healthcare organizations have little to no experience with such programs. The purpose of this scientific statement is to identify the core components, efficacy, strengths, limitations, evidence gaps, and research necessary to guide the future delivery of HBCR in the United States. Previous randomized trials have generated low- to moderate-strength evidence that HBCR and center-based CR can achieve similar improvements in 3- to 12-month clinical outcomes. Although HBCR appears to hold promise in expanding the use of CR to eligible patients, additional research and demonstration projects are needed to clarify, strengthen, and extend the HBCR evidence base for key subgroups, including older adults, women, underrepresented minority groups, and other higher-risk and understudied groups. In the interim, we conclude that HBCR may be a reasonable option for selected clinically stable low- to moderate-risk patients who are eligible for CR but cannot attend a traditional center-based CR program.

Home-Based Cardiac Rehabilitation: A SCIENTIFIC STATEMENT FROM THE AMERICAN ASSOCIATION OF CARDIOVASCULAR AND PULMONARY REHABILITATION, THE AMERICAN HEART ASSOCIATION, AND THE AMERICAN COLLEGE OF CARDIOLOGY.

Cardiac rehabilitation (CR) is an evidence-based intervention that uses patient education, health behavior modification, and exercise training to improve secondary prevention outcomes in patients with cardiovascular disease. CR programs reduce morbidity and mortality rates in adults with ischemic heart disease, heart failure, or cardiac surgery but are significantly underused, with only a minority of eligible patients participating in CR in the United States. New delivery strategies are urgently needed to improve participation. One potential strategy is home-based CR (HBCR). In contrast to center-based CR services, which are provided in a medically supervised facility, HBCR relies on remote coaching with indirect exercise supervision and is provided mostly or entirely outside of the traditional center-based setting. Although HBCR has been successfully deployed in the United Kingdom, Canada, and other countries, most US healthcare organizations have little to no experience with such programs. The purpose of this scientific statement is to identify the core components, efficacy, strengths, limitations, evidence gaps, and research necessary to guide the future delivery of HBCR in the United States. Previous randomized trials have generated low- to moderate-strength evidence that HBCR and center-based CR can achieve similar improvements in 3- to 12-month clinical outcomes. Although HBCR appears to hold promise in expanding the use of CR to eligible patients, additional research and demonstration projects are needed to clarify, strengthen, and extend the HBCR evidence base for key subgroups, including older adults, women, underrepresented minority groups, and other higher-risk and understudied groups. In the interim, we conclude that HBCR may be a reasonable option for selected clinically stable low- to moderate-risk patients who are eligible for CR but cannot attend a traditional center-based CR program.

Factors Associated With First-Time NCLEX-RN Success: A Descriptive Research Study.

BACKGROUND: The purpose of this study was to identify variables associated with scores achieved on the Health Education Systems, Inc. (HESI) exit examination and successful first-time NCLEX-RN® pass rates. METHOD: A retrospective descriptive study examined the administrative data of 211 baccalaureate nursing students. RESULTS: Students who completed the program in sequence and scored higher in certain HESI course examinations were more likely to have a better performance on the HESI exit examination. The higher the scores students achieved on the HESI exit examination, the more likely they were to pass the NCLEX-RN on their first attempt. CONCLUSION: These findings add to the growing body of literature seeking to identify variables associated with success in first-time NCLEX-RN success. Further research is needed to identify strategies that can be implemented to ensure timely progression, program completion, and licensure examination success. [J Nurs Educ. 2017;56(9):542-545.].

Assessing Physical Activity as a Core Component in Cardiac Rehabilitation: A POSITION STATEMENT OF THE AMERICAN ASSOCIATION OF CARDIOVASCULAR AND PULMONARY REHABILITATION.

Physical inactivity is a well-established major risk factor for cardiovascular disease. As such, physical activity counseling is 1 of the 10 core components of cardiac rehabilitation/secondary prevention programs recommended by the American Heart Association and the American Association of Cardiovascular and Pulmonary Rehabilitation (AACVPR). In addition, the ability to perform a physical activity assessment and report outcomes is 1 of the 10 core competencies of cardiac rehabilitation/secondary prevention professionals published by the AACVPR. Unfortunately, standardized procedures for physical activity assessment of cardiac rehabilitation patients have not been developed and published. Thus, the objective of this AACVPR statement is to provide an overview of physical activity assessment concepts and procedures and to provide a recommended approach for performing a standardized assessment of physical activity in all comprehensive cardiac rehabilitation programs following the core components recommendations.

Heart Failure as a Newly Approved Diagnosis for Cardiac Rehabilitation: Challenges and Opportunities.

Many see the broadened eligibility of cardiac rehabilitation (CR) to include heart failure with reduced ejection fraction (HFrEF) as a likely catalyst to high CR enrollment and improved care. However, such expectation contrasts with the reality that CR enrollment of eligible coronary heart disease patients has remained low for decades. In this review, entrenched obstacles impeding utilization of CR are considered, particularly in relation to potential HFrEF management. The strengths and limitations of the HF-ACTION (Heart Failure-A Controlled Trial Investigating Outcomes of Exercise Training) trial to advance precepts of CR are considered, as well as gaps that this trial failed to address, such as the utility of CR for patients with heart failure with preserved ejection fraction and the conundrum of poor patient adherence.

Support for diabetes using technology: a pilot study to improve self-management.

Technology may assist people living with type 2 diabetes with self-management. A pilot study that used Apple iPad technology to support diabetes self-management is described.

A program to provide resources and support for clinical associates.

Clinical associates are necessary and valued contributors to nursing education. All those involved in student instruction need to have clearly defined expectations that are aligned with the conceptual framework and program outcomes. Additionally, they must have the necessary resources to facilitate their ability to effectively instruct and evaluate nursing students in the clinical setting. Preparing competent clinical associates to provide effective clinical instruction requires detailed planning and development that includes guided mentoring from faculty. This article describes the development of an orientation course and ongoing resources and support designed to facilitate the transition into a clinical instructor role for registered nurses teaching in a baccalaureate nursing program. The Clinical Associate Resources and Support program was designed to enhance learning experiences for both clinical associates and the recipients of clinical education, nursing students.

International Charter on Cardiovascular Prevention and Rehabilitation: a call for action.

Cardiovascular disease remains the leading cause of death in both women and men globally and is a growing epidemic in low- to middle-income countries. Without systematic access to cardiac rehabilitation (CR), these individuals may experience multiple recurrent acute care events and suffer unnecessarily premature death. The 2 aims of this Charter are (1) to bring together national associations from around the world to harmonize efforts in promoting cardiovascular prevention and rehabilitation and (2) to document consensus among national associations globally, regarding the internationally common core elements and benefits of cardiovascular disease prevention and rehabilitation. The Global Charter on CR calls to action those responsible for administering patient care to (a) establish CR as an obligatory, not optional service, and (b) to support countries to establish and augment programs of CR to ensure broad access to these proven services. In addition, the Charter calls for CR organizations and associations in high-income countries to collaborate with those in low- to middle-income countries, to support capacity building and provide tangible toolkits for program development and maintenance. The aim of this Charter is to maintain and grow this global consortium through partnerships with international organizations and to consider and communicate ongoing consensus of evidence-based standards for CR worldwide.

Writing for publication: faculty development initiative using social learning theory.

Demonstrating scholarly competency is an expectation for nurse faculty. However, there is hesitancy among some faculty to fully engage in scholarly activities. To strengthen a school of nursing's culture of scholarship, a faculty development writing initiative based on Social Learning Theory was implemented. The authors discuss this initiative to facilitate writing for publication productivity among faculty and the successful outcomes.

Recipe for health: impacting diabetes in African Americans through faith-based edcuation.

The Recipe For Health educational initiative was designed to increase knowledge of diabetes prevention and management for African Americans (AAs) in rural Alabama. By providing culturally competent information, training, and skill-building activities to lay leaders in faith-based settings who teach church members, Recipe For Health can create a ripple effect of diabetes knowledge that could lower disease complications in the AA population.

Clinical research in cardiac rehabilitation and secondary prevention: looking back and moving forward.

Cardiac rehabilitation/secondary prevention (CR/SP) programs are considered standard of care and provide critically important resources for optimizing the care of cardiac patients. The objective of this article is to briefly review the evolution of CR/SP programs from a singular exercise intervention to its current, more comprehensive multifaceted approach. In addition, we offer perspective on critical concerns and suggest future research considerations to optimize the effectiveness and utilization of CR/SP program interventions.

Cardiac rehabilitation outcomes: impact of comorbidities and age.

PURPOSE: Medical comorbidities (CM) contribute to cardiac rehabilitation (CR) underutilization. Whether individuals with coronary heart disease and an increased CM burden achieve similar benefits from CR as those with a low CM burden is unknown. METHODS: We analyzed 794 patients with coronary heart disease completing CR from 1/96 to 4/08. Medical CM burden was assessed using a comorbidity index (CMI) previously validated in a CR population. Distance achieved on a 6-minute walk test, body mass index, and the physical and mental component scores on the Medical Outcomes Short Form 36 were measured at baseline and at CR completion. We performed multivariable linear regression to compare changes in these parameters between individuals with a low CM burden (CMI = 0) and those with a moderate (CMI = 1-2) or high (CMI > 2) CM burden by age group (<56, 56-65, and >65 years of age). RESULTS: Mean age was 61.6 ± 10.6 years, 29% were women, 31% nonwhite; 305 individuals had a CMI = 0, 305 had a CMI = 1 to 2, and 184 had a CMI > 2. All subgroups, regardless of age or CMI, demonstrated improvements with CR on virtually all parameters measured. Among individuals younger than 56 years, those with a CMI = 0 had greater improvements in these parameters after multivariable adjustment than those with a CMI of 1 to 2 or more than 2. In contrast, in older age groups, the degree of improvement was similar regardless of CMI. CONCLUSION: All patient groups, regardless of CM burden, benefited from CR. Medical CM burden, especially among older patients, should not discourage referral to CR.

Core competencies for cardiac rehabilitation/secondary prevention professionals: 2010 update: position statement of the American Association of Cardiovascular and Pulmonary Rehabilitation.

Cardiac rehabilitation/secondary prevention (CR/SP) services are typically delivered by a multidisciplinary team of health care professionals. The American Association of Cardiovascular and Pulmonary Rehabilitation (AACVPR) recognizes that to provide high-quality services, it is important for these health care professionals to possess certain core competencies. This update to the previous statement identifies 10 areas of core competencies for CR/SP health care professionals and identifies specific knowledge and skills for each core competency. These core competency areas are consistent with the current list of core components for CR/SP programs published by the AACVPR and the American Heart Association and include comprehensive cardiovascular patient assessment; management of blood pressure, lipids, diabetes, tobacco cessation, weight, and psychological issues; exercise training; and counseling for psychosocial, nutritional, and physical activity issues.

Exercise as a treatment for the risk of cardiovascular disease.

OPINION STATEMENT: Regular physical activity decreases the risk of cardiovascular disease and modifies multiple cardiovascular risk factors. The optimum amount of exercise continues to generate debate; however, the general recommendation is that all adults should engage in 30 min of moderate-intensity physical activity on five, and preferably all, days of the week. Despite extensive data and recommendations, a significant proportion of the US adult population remains sedentary. Promoting physical activity at a public level remains a major challenge because of the presence of multiple behavioral, physical, and environmental barriers. Health care providers have an opportunity and a responsibility to include exercise counseling in routine office visits.

Cardiac rehabilitation and women: what keeps them away?

BACKGROUND: Cardiac rehabilitation (CR) is underutilized, especially among women. The goal of this study was to examine CR referral and enrollment patterns among eligible women and identify factors associated with utilization. METHODS: The sample included women (n = 131) hospitalized with an eligible CR diagnosis between April 2001 and August 2002. Inpatient interviews were conducted to explore the perceptions of women about CR. Demographic and clinical characteristics were compared between women who were referred and those who were not referred to CR. Enrollment to CR was ascertained more than 60 days postdischarge. Among referred women, clinical and demographic characteristics and perceptions about CR were compared between women who enrolled and those who did not enroll. Separate multivariate regression analyses identified factors associated with (1) referral to CR and (2) enrollment in CR among women who had been referred. RESULTS: There were 77 (59%) women referred to CR. In the final regression model, no demographic or clinical factors were found to be associated with CR referral. Among the women referred to CR, 34% enrolled in CR. In the final regression model, it was found that nonenrollees had lower education levels (<12 years) than did enrollees, and women who enrolled were more likely to give the highest score for "likely to attend CR" during the interview compared with nonenrollees (P < .05). CONCLUSION: CR referral and enrollment rates among women remain disappointingly low. Societal barriers, such as low education, often impede CR participation. However, intent to enroll as expressed by the patient may be amenable to an intervention during the hospital stay.

Assessing patient recall of discharge instructions for acute myocardial infarction.

Guidelines for acute myocardial infarction (AMI) include secondary prevention (SP) strategies, but little is known about patients' recall of instructions following hospital discharge. We conducted telephone interviews to assess recall of risk-reduction information among patients discharged with AMI. Results indicated similar proportions of documented and patient recall of discharge instructions. However, lifestyle recommendations were documented and recalled less frequently than pharmacologic therapy. Many patients were unable to name their diagnosis or link known risk factors as contributing causes, which may contribute to low adherence to SP therapies. Quality improvement strategies are needed to guide more effective provider-patient communication.

Comparison of baseline characteristics and outcomes in younger and older patients completing cardiac rehabilitation.

PURPOSE: Cardiac rehabilitation (CR) in patients with coronary heart disease (CHD) remains underutilized especially among older patients. The present study compares baseline characteristics and CR outcomes between younger and older patients participating in CR. METHODS: Comparisons were made between "younger" (<65 years) and "older" patients (> or = 65 years) for baseline characteristics, changes in selected measures during CR, and the proportion of patients at secondary prevention treatment goals before and after CR. Subanalyses were conducted between "young-old" (65-74 years) and "old-old" (> or = 75 years) patients. RESULTS: At baseline, older patients had lower body mass indexes, better lipid profiles, lower hemoglobin A1c levels (when diabetes was present), and lower Beck Depression Inventory scores (all P < .05) but had higher blood pressures, more comorbidities, and poorer functional capacity as demonstrated by shorter 6-minute walk distance (all P < .05). At CR completion, improvement (P < .05) was achieved among younger patients for all measures except for high-density lipoprotein cholesterol and among older patients for all measures except for diastolic blood pressure and high-density lipoprotein cholesterol. Similar improvements from baseline to CR completion were evident among the "old-old." While the degree of improvement in individual outcomes varied by age, age group was not a significant predictor of achieving secondary prevention goals at CR completion. CONCLUSIONS: Older patients with CHD entered CR with less adverse risk factors but had a higher comorbidity burden than did younger patients. Both groups exhibited significant improvements by CR completion, and these improvements extended to the oldest patients.