ASEAN Heart Journal

Intended for healthcare professional

Original Article

ASEAN Heart Journal

October 2016, 24:5

First online: 13 October 2016

Original Article

Impact of Community-Based Cardiac Rehabilitation on Clinical Parameters of Patients with Cardiovascular Diseases

Kheng Yong Ong,1 Elise Yap,2 Yvonne May Fen Chia,3 Hung Yong Tay,4 Peter Ting,5 Sui Yung Chan,2 Yu Heng Kwan2, 3, 4
Open Access
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Abstract

Background:
Cardiac rehabilitation (CR) programmes have been shown to improve patient outcomes, but vary widely in their components. The impact of Singapore’s CR programme on clinical outcomes is currently not known.

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Objective:
To evaluate the effects of a community-based CR programme on important clinical parameters in patients with cardiovascular disease in Singapore.

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Method:
A retrospective cohort study was conducted. Cardiovascular patients who had completed a hospital-based CR programme were included. Patients who continued with community-based CR (n = 94) during the period of 2009-2013 were compared with patients who received regular care (n = 157). Changes in clinical and physical examination parameters between baseline and one-year post follow-up were analyzed. Within-group differences were compared using the paired t-test, while multivariate linear regression was used to compare the changes in the various parameters between the intervention and control groups. The primary outcome measure was low density lipoprotein (LDL) levels.

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Results:
Patients in the intervention group had significant lowering of LDL (2.5 to 2.2 mmol/L, p<0.01), while the control group’s LDL increased (2.2 to 2.4 mmol/L, p<0.01). The intervention group had greater improvements in LDL (-0.3 vs. +0.2 mmol/L, p<0.01), triglycerides (-0.1 vs. +0.1 mmol/L, p=0.01), total cholesterol (-0.3 vs. +0.3 mmol/L, p<0.01), fasting blood glucose (-0.5 vs. +0.3 mmol/L, p<0.01), systolic blood pressure (-3.2 vs. +5 mmHg, p<0.01) and diastolic blood pressure (-2.6 vs. +2.8 mmHg, p<0.01).

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Conclusion:
The community-based CR programme in Singapore is associated with improvements in several cardiovascular clinical parameters and may be of benefit to cardiovascular patients.

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Keywords:
Community - Cardiovascular Disease - Cardiac Rehabilitation - Clinical Outcomes - Low density lipoprotein


a Department of Pharmacy, Singapore General Hospital, Republic of Singapore,
b Department of Pharmacy, Faculty of Science, National University of Singapore, Republic of Singapore,
c Duke-NUS Medical School, Republic of Singapore,
d Heart Wellness Centre, Singapore Heart Foundation, Republic of Singapore,
e Department of Cardiology, National Heart Centre Singapore, Republic of Singapore.

‚Äč Correspondence to and requests for reprints to be made to Yu Heng Kwan, MD-PhD Candidate, Program in Health Services and Systems Research, Duke-NUS Medical School. 8 College Road, Singapore 169857. Tel: +65 - 9023 1226; Fax: +65 - 6779 1554 Email: [email protected] Conflict of interest declaration: The authors declare no conflict of interest nor any sources of funding for this study.

‚Äč ¬© The Author(s) 2016. This article is published with open access by ASEAN Federation of Cardiology.

Supplementary Material

Nil

 

References

1.¬†Rosenfeld RM,¬†Piccirillo JF, Chandrasekhar SS,¬†et al. Clinical practice guideline (update): adult sinusitis.¬†Otolaryngology‚Äď head and neck surgery:¬†Official journal of American Academy of Otolaryngology-Head and Neck Surgery¬†2015; 152: S1-s39.

2. Sasayama S. Heart disease in Asia. Circulation 2008; 118: 2669-2671. PubMed

3. Leon AS, Franklin BA, Costa F, et al. Cardiac rehabilitation and secondary prevention of coronary heart disease: an American Heart Association scientific statement from the Council on Clinical Cardiology (Subcommittee on Exercise, Cardiac Rehabilitation, and Prevention) and the Council on Nutrition, Physical Activity, and Metabolism (Subcommittee on Physical Activity), in collaboration with the American association of Cardiovascular and Pulmonary Rehabilitation. Circulation 2005; 111: 369-376. PubMed

4. Goel K, Lennon RJ, Tilbury RT, Squires RW, Thomas RJ. Impact of cardiac rehabilitation on mortality and cardiovascular events after percutaneous coronary intervention in the community. Circulation 2011; 123: 2344-2352. PubMed

5. Dalal HM, Doherty P, Taylor RS. Cardiac rehabilitation. BMJ (Clinical research ed) 2015; 351: h5000.

6. Richardson G,¬†van Woerden HC, Morgan L, et al. Healthy hearts‚Äďa community-based primary prevention programme to reduce coronary heart disease.¬†BMC cardiovascular disorders¬†2008; 8: 1-8.

7. Kubilius R, Jasiukeviciene L, Grizas V, Kubiliene L, Jakubseviciene E, Vasiliauskas D. The impact of complex cardiac rehabilitation on manifestation of risk factors in patients with coronary heart disease. Medicina (Kaunas, Lithuania) 2012; 48: 166-173.

8. Mosleh SM, Bond CM, Lee AJ, Kiger A, Campbell NC. Effects of community based cardiac rehabilitation: Comparison with a hospital-based programme. European journal of cardiovascular nursing : journal of the Working Group on Cardiovascular Nursing of the European Society of Cardiology 2015; 14: 108-116.

9. Arena R. Exercise and Rehabilitation in Heart Failure, An Issue of Heart Failure Clinics: Elsevier; 2014 11 Dec 2014.

10. Meng Khoo C, Tai ES. Trends in the incidence and mortality of coronary heart disease in asian pacific region: the Singapore experience. Journal of atherosclerosis and thrombosis 2014; 21 Suppl 1: S2-8. PubMed

11. Jackson JL, Emery CF. Emotional distress, alexithymia, and coping as predictors of cardiac rehabilitation outcomes and attendance. Journal of cardiopulmonary rehabilitation and prevention 2013; 33: 26-32. PubMed

12. Morrin L, Black S, Reid R. Impact of duration in a cardiac rehabilitation program on coronary risk profile and healthrelated quality of life outcomes. Journal of cardiopulmonary rehabilitation 2000; 20: 115-121. PubMed

13. Stone NJ, Robinson JG, Lichtenstein AH, et al. 2013 ACC/ AHA guideline on the treatment of blood cholesterol to reduce atherosclerotic cardiovascular risk in adults: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Journal of the American College of Cardiology 2014; 63: 2889-2934. PubMed

14. Hoogwerf BJ, Huang JC. Cardiovascular Disease Prevention 2012 [cited 2015 15 August]. Available from: http://www.clevelandclinicmeded.com/medicalpubs/diseasemanagement/cardiology/heart-disease-risk-reduction/ .

15. Saraf S,¬†Ray KK. New worldwide lipid guidelines.¬†Current opinion in cardiology¬†2015; 30: 447-453. PubMed ‚Äč

16. American Diabetes Association. (8) Cardiovascular disease and risk management. Diabetes care 2015; 38 Suppl: S49-57.

17. Qiu M, Shen W, Song X, et al. Effects of prediabetes mellitus alone or plus hypertension on subsequent occurrence of cardiovascular disease and diabetes mellitus: longitudinal study. Hypertension 2015; 65: 525-530. PubMed

18. James PA, Oparil S, Carter BL, et al. 2014 evidence-based guideline for the management of high blood pressure in adults: report from the panel members appointed to the Eighth Joint National Committee (JNC 8). Jama 2014; 311: 507-520. PubMed

19. Solway S, Brooks D, Lacasse Y, Thomas S. A qualitative systematic overview of the measurement properties of functional walk tests used in the cardiorespiratory domain. Chest 2001; 119: 256-270. PubMed

About this Article

Title

Impact of Community-Based Cardiac Rehabilitation on Clinical Parameters of Patients with Cardiovascular Diseases


Open Access

Available under Open Access


Journal

>> ASEAN Heart Journal 
>> 24:1


Online Date

21 November 2019


DOI

10.7603/s40602-016-0005-4


Online ISSN

2315-4551


Publisher

ASEAN Federation of Cardiology


Additional Links

>> About The AHJ


Topics

Cardiology


Keywords

Community
Cardiovascular Disease
Cardiac Rehabilitation
Clinical Outcomes
Low density lipoprotein


Author Affiliations

1. Department of Pharmacy, Singapore General Hospital, Republic of Singapore, Singapore
2. Department of Pharmacy, Faculty of Science, National University of Singapore, Republic of Singapore, Singapore
3. Duke-NUS Medical School, 8 College Road, Republic of Singapore, 169857, Singapore
4. Heart Wellness Centre, Singapore Heart Foundation, Republic of Singapore, Singapore
5. Department of Cardiology, National Heart Centre Singapore, Republic of Singapore, Singapore