The effectiveness of intensive and traditional cardiac rehabilitation programs for improving cardiometabolic outcomes in patients with cardiovascular disease
Authors: Swiatkiewicz I , De Fazio L , Mazzilli V , Di Somma S , Taub P.R 
Published: November 2020

Abstract

Background
Cardiac rehabilitation (CR) is integral to the optimal medical management of patients with cardiovascular disease (CVD).

Purpose
This study aims at evaluating the effectiveness of traditional (TCR) and intensive (ICR) CR programs for improving cardiometabolic outcomes of patients with CVD.

Methods
The study is based on retro-prospective review of hospital medical data of patients enrolled in TCR or ICR programs. TCR involved 36 supervised exercise and educational sessions (1 hr) 3 days/week over 12 weeks. ICR included a structured class model (4 hrs) twice a week over 9 weeks (a total of 18 sessions, 72 hrs). The ICR sessions were provided by a multidisciplinary team and consisted of supervised exercise, plant-based diet, nutrition education, stress management, and social support. The comparative analyses of numerous biomarkers and hemodynamic parameters before and after CR program for both groups were performed. The occurrence of major cardiac adverse events (MACE) in the long-term follow-up was assessed.

Results
In total, 314 patients (213 in TCR and 101 in ICR) were enrolled. Mean treatment adherence was 78% (97% in ICR vs 68% in TCR, p=0.000). Mean follow-up for MACE was 12.6 months (13.2 in ICR vs 12 in TCR, p=0.038). No differences were observed between TCR and ICR in patient age (66 years on average) and gender (68–73% of males). Coronary heart disease, hypertension, and heart failure (HF) were the most frequent CVDs in both TCR and ICR groups (88% vs 95%, p=0.044, 75% vs 66%, p=0.104, 48% vs 25%, p=0.000, respectively). There was no significant difference in incidence of diabetes and chronic kidney disease, and pharmacotherapy between groups. TCR program resulted in significant improvements in body and visceral fat, waist circumference, and exercise capacity whereas no significant changes were observed in weight, body mass index (BMI), blood pressure (BP), heart rate (HR), and lipids levels. ICR resulted in significant improvements in most metabolic biomarkers (weight, BMI, body and visceral fat, waist circumference), hemodynamic parameters (exercise capacity, BP) and lipid biomarkers levels (total cholesterol, low-density and non-high-density-lipoprotein cholesterol). Compared with TCR, ICR resulted in more significant improvements of metabolic biomarkers such as weight (p&lt;0.001), BMI (p&lt;0.001), body fat (p&lt;0.05) and waist circumference (p=0.002), and hemodynamic parameters such as diastolic BP (p&lt;001) and HR (p=0.05). A trend towards lower incidence of MACE (all-cause death, non-fatal myocardial infarction, unstable angina, and revascularisation) with significantly lower rates of hospitalisation for HF (2 vs 24, p=0.005) in the long-term follow-up was observed in ICR compared with TCR group.

Conclusion
Intense and more comprehensive lifestyle modification provided by the ICR program had greater impact on improving cardiometabolic outcomes including long-term MACE compared to the TCR program.

Funding Acknowledgement
Type of funding source: None