Blood Pressure Monitoring, Ambulatory ; COVID-19/therapy* ; Cardiac Rehabilitation ; Cardiovascular Diseases/therapy* ; Communicable Disease Control ; Contact Tracing ; Health Literacy ; Health Services Accessibility ; Healthcare Disparities ; Humans ; Internet Access ; Poverty ; SARS-CoV-2 ; Singapore ; Social Class ; Social Conditions ; Socioeconomic Factors ; Telemedicine ; Telerehabilitation ; Transients and Migrants

With the increasing number of cardiovascular patients, more and more people are living with diseases. Cardiac rehabilitation (CR) is an effective treatment and prevention measure for cardiovascular disease (CVD), which aims to relieve both psychological and physiological stress of CVD, reduce risk of death from CVD, improve cardiovascular function and patients' quality of life. Tai Chi is popular in China and mainly used as a daily leisure activity for the elderly to strengthen their bodies. This review discusses whether Tai Chi could be taken as a positive intervention in CR and what is the exact role and its mechanisms as exercise therapy for CVD. The authors detail the role of Tai Chi on CR from the aspects of exercise capacity, risk factors of CVD and psychological factors, etc., as well as highlight the limitation of Tai Chi research at present.
Cardiac Rehabilitation ; methods ; Cardiovascular Diseases ; therapy ; Exercise Therapy ; methods ; Humans ; Tai Ji

BACKGROUND: Though clinical practice guidelines (CPGs) for cardiac rehabilitation (CR) are an effective and widely used treatment method worldwide, they are as yet not widely accepted in Korea. Given that cardiovascular disease is the second leading cause of death in Korea, it is urgent that CR programs be developed. In 2008, the Government of Korea implemented CR programs at 11 university hospitals as part of its Regional Cardio-Cerebrovascular Center Project, and 3 additional medical facilities will be added in 2019. In addition, owing to the promotion of CR nationwide and the introduction of CR insurance benefits, 40 medical institutions nationwide have begun CR programs even as a growing number of medical institutions are preparing to offer CR. The purpose of this research was to develop evidence-based CPGs to support CR implementation in Korea. METHODS: This study is based on an analysis of CPGs elsewhere in the world, an extensive literature search, a systematic analysis of multiple randomized control trials, and a CPG management, development, and assessment committee comprised of 33 authors—primarily rehabilitation specialists, cardiologists, and thoracic surgeons in 21 university hospitals and 2 general hospitals. Twelve consultants, primarily rehabilitation, sports medicine, and preventive medicine specialists, CPG experts, nurses, physical therapists, clinical nutritionists, and library and information experts participated in the research and development of these CPGs. After the draft guidelines were developed, 3 rounds of public hearings were held with staff members from relevant academic societies and stakeholders, after which the guidelines were further reviewed and modified. RESULTS: CR involves a more cost-effective use of healthcare resources relative to that of general treatments, and the exercise component of CR lowers cardiovascular mortality and readmission rates, regardless of the type of coronary heart disease and type and setting of CR. CONCLUSION: Individualized CR programs should be considered together with various factors, including differences in heart function and lifestyle, and doing so will boost participation and adherence with the CR program, ultimately meeting the final goals of the program, namely reducing the recurrence of myocardial infarction and mortality rates.
Acute Coronary Syndrome ; Cardiovascular Diseases ; Cause of Death ; Consultants ; Coronary Disease ; Delivery of Health Care ; Heart ; Hospitals, General ; Hospitals, University ; Humans ; Insurance Benefits ; Korea ; Life Style ; Methods ; Mortality ; Myocardial Infarction ; Nutritionists ; Physical Therapists ; Preventive Medicine ; Recurrence ; Rehabilitation ; Secondary Prevention ; Specialization ; Sports Medicine ; Surgeons

OBJECTIVE: Though clinical practice guidelines (CPGs) for cardiac rehabilitation (CR) are an effective and widely used treatment method worldwide, they are as yet not widely accepted in Korea. Given that cardiovascular disease is the second leading cause of death in Korea, it is urgent that CR programs be developed. In 2008, the Government of Korea implemented CR programs at 11 university hospitals as part of its Regional Cardio-Cerebrovascular Center Project, and three additional medical facilities will be added in 2019. In addition, owing to the promotion of CR nationwide and the introduction of CR insurance benefits, 40 medical institutions nationwide have begun CR programs even as a growing number of medical institutions are preparing to offer CR. The purpose of this research was to develop evidence-based CPGs to support CR implementation in Korea. METHODS: This study is based on an analysis of CPGs elsewhere in the world, an extensive literature search, a systematic analysis of multiple randomized control trials, and a CPG management, development, and assessment committee comprised of 33 authors—primarily rehabilitation specialists, cardiologists, and thoracic surgeons in 21 university hospitals and two general hospitals. Twelve consultants, primarily rehabilitation, sports medicine, and preventive medicine specialists, CPG experts, nurses, physical therapists, clinical nutritionists, and library and information experts participated in the research and development of these CPGs. After the draft guidelines were developed, three rounds of public hearings were held with staff members from relevant academic societies and stakeholders, after which the guidelines were further reviewed and modified. PRINCIPAL CONCLUSIONS: CR involves a more cost-effective use of healthcare resources relative to that of general treatments, and the exercise component of CR lowers cardiovascular mortality and readmission rates, regardless of the type of coronary heart disease and type and setting of CR. Individualized CR programs should be considered together with various factors, including differences in heart function and lifestyle, and doing so will boost participation and adherence with the CR program, ultimately meeting the final goals of the program, namely reducing the recurrence of myocardial infarction and mortality rates.
Acute Coronary Syndrome ; Cardiovascular Diseases ; Cause of Death ; Consultants ; Coronary Disease ; Delivery of Health Care ; Heart ; Hospitals, General ; Hospitals, University ; Humans ; Insurance Benefits ; Korea ; Life Style ; Methods ; Mortality ; Myocardial Infarction ; Nutritionists ; Physical Therapists ; Preventive Medicine ; Recurrence ; Rehabilitation ; Secondary Prevention ; Specialization ; Sports Medicine ; Surgeons

BACKGROUND: Health care services effort to provide alternative cardiac rehabilitation (CR) models to serve patients according to their preferences and needs. So, the present study aimed to assess and compare the effects of hospital-based and hybrid CR programs on chest pain intensity and discomfort in cardiac surgery patients. METHODS: In this prospective study, 110 cardiac surgery patients were invited to the CR department of a hospital in the western part of Iran between March and July 2016. Patients were divided into two groups: hospital-based and hybrid CR. The hospital-based program included 26 sessions, and the hybrid program included 10 training sessions and exercise. The Brief Pain Inventory and Pain Discomfort Scale were used as research instrument, and data were analyzed using the paired t-test and ANCOVA. RESULTS: The results indicated that both hospital-based and hybrid CR are effective in reducing the chest pain intensity and discomfort of cardiac surgery patients (P < 0.05). In addition, the comparison of scores before and after treatment using ANCOVA shows that no significant differences were observed between the two programs (P > 0.05). CONCLUSIONS: Traditional hospital-based CR delivery is still the first choice for treatment in developing countries. However, hybrid CR is as effective as a hospital-based program in reducing pain components and it includes only 38% of the total cost in comparison to hospital-based delivery. So, we recommend using hybrid CR according with the recommendations of American Heart Association about using CR for the management of angina symptoms.
American Heart Association ; Cardiovascular Diseases ; Chest Pain* ; Cost-Benefit Analysis ; Delivery of Health Care ; Developing Countries ; Home Care Services ; Humans ; Iran ; Prospective Studies ; Rehabilitation* ; Thoracic Surgery ; Thorax*

OBJECTIVE: To evaluate the level of health-related quality of life (HRQoL), life satisfaction, and their present awareness of cardiac rehabilitation (CR) program in people with cardiovascular diseases. METHODS: A questionnaire survey was completed by 53 patients (mean age, 65.7±11.6 years; 33 men and 20 women) with unstable angina, myocardial infarction, or heart failure. The questionnaire included the Medical Outcome Study 36-item Short-Form Health Survey (MOS SF-36), life domain satisfaction measure (LDSM), and the awareness and degree of using CR program. RESULTS: The average scores of physical component summary (PCS) and mental component summary (MCS) were 47.7±18.5 and 56.5±19.5, respectively. There were significant differences in physical role (F=4.2, p=0.02), vitality (F=10.7, p<0.001), mental health (F=15.9, p<0.001), PCS (F=3.6, p=0.034), and MCS (F=11.9, p<0.001) between disease types. The average LDSM score was 4.7±1.5. Age and disease duration were negatively correlated with multiple HRQoL areas (p<0.05). Monthly income, ejection fraction, and LDSM were positively correlated with several MOS SF-36 factors (p<0.05). However, the number of modifiable risk factors had no significant correlation with medication. Thirty-seven subjects (69.8%) answered that they had not previously heard about CR program. Seventeen patients (32.1%) reported that they were actively participating in CR program. Most people said that a reasonable cost of CR was less than 100,000 Korean won per month. CONCLUSION: CR should focus on improving the physical components of quality of life. In addition, physicians should actively promote CR to cardiovascular disease patients to expand the reach of CR program.
Angina, Unstable ; Cardiovascular Diseases* ; Coronary Disease ; Health Surveys ; Heart Failure ; Humans ; Male ; Mental Health ; Myocardial Infarction ; Outcome Assessment (Health Care) ; Quality of Life* ; Rehabilitation* ; Risk Factors

Cardiac rehabilitation (CR) is an integral component of the continuum of care for patients with cardiovascular disease. Today, the efficacy and safety of CR are well established, but the rate of participation in CR is only at 20% to 40% in patients who actually need CR. CR restores a patient's exercise capacity, brings emotional stability, and helps a patient to effectively control risk factors of cardiovascular diseases. In addition, CR decreases recurrence, re-hospitalization, and reintervention, as well as mortality. CR is indicated for myocardial infarction, percutaneous coronary intervention, bypass graft surgery, and cardiac valve surgery, but also for advanced heart failure, pacemaker implantation, left ventricular assistive device implantation, and transplantation surgery. The core components of CR (designed to lead the patient to reach target levels) are patient evaluation, dietary treatment, weight management, blood pressure management, blood lipid management, diabetes management, smoking cessation, psycho-social management, physical activity counseling, and exercise training. In order for exercise training to be safely conducted, the risk stratification for exercise-related cardiovascular complications must be evaluated and high risk patients should exercise under supervision, including electrocardiogram monitoring. Given the low participation rate of eligible patients in hospital-based CR, alternative approaches using smart phones or mobile electrocardiogram devices instead of the traditional supervised intervention can be applied in low-risk patients. The ultimate goal is to implement appropriate CR programs in all patients who need CR to help them effectively manage cardiovascular risk factors and lead healthy lives.
Blood Pressure ; Cardiovascular Diseases ; Continuity of Patient Care ; Counseling ; Electrocardiography ; Heart Failure ; Heart Valves ; Humans ; Mortality ; Motor Activity ; Myocardial Infarction ; Organization and Administration ; Percutaneous Coronary Intervention ; Recurrence ; Rehabilitation* ; Risk Factors ; Secondary Prevention ; Self-Help Devices ; Smartphone ; Smoking Cessation ; Transplants

Sleep related breathing disorders comprises disorders related abnormal pattern and status of the gas exchange during sleep. It has been reported that abnormal sleep pattern could results in an autonomic dysfunction during sleep and ends up to increase possibility to induce stroke and cardiovascular disease associated with atherosclerosis. Stroke is a disorder, which could cause death and critical disability in the adulthood. Sleep related breathing disorders and stroke has causal relationship in each other, which could influence on recovery to each other. Systematic evaluation and management for sleep disorder after stroke might have clinical importance. This review will comprise of topics about sleep related disorders in stroke patients including epidemiology, relationship between stroke and sleep disorder, diagnosis, and management of frequent sleep disorder.
Atherosclerosis ; Cardiovascular Diseases ; Diagnosis ; Epidemiology ; Humans ; Rehabilitation ; Respiration ; Sleep Apnea Syndromes ; Stroke*

Cardiac Rehabilitation ; Cardiovascular Diseases ; prevention & control ; China ; Humans

PURPOSE: This study was to analyze research reports published in Korea on cardiac rehabilitation for patients with cardiovascular disease. METHODS: Based on inclusion criteria, 19 research reports were included in this review. Published year of selected articles was between 1996 and 2008. Nineteen studies were analyzed by guidelines of the cardiac rehabilitation programs done by the American Heart Association (AHA) and Scottish Intercollegiate Guidelines Network (SIGN). RESULTS: The characteristics of patients were mostly of ischemic heart disease, 50-59 yr old, and male. Educational sessions were administered twice, and each lesson lasted less than 30 min. Exercise was done 3 times per week for 6 weeks. Most educational content were about risk factors, but there was no information, such as coping with feelings. Most exercise was performed as ROM, treadmill, and cycle ergometer. A large percentage of outcome indicators were health behavior, hemodynamic changes, and exercise capacity. There was more 'no effect' than 'positive effect' in trait anxiety and depression, whereas similar in physiologic domain. CONCLUSION: Various types of cardiac rehabilitation in Korea were performed by researchers. Therefore, we need to develop the standard protocol, to add psychosocial intervention, and to study cost effectiveness of cardiac rehabilitation.
Cardiovascular Diseases/*rehabilitation ; Exercise Therapy ; Humans ; Korea ; Male ; Myocardial Ischemia/rehabilitation ; Patient Education as Topic ; Program Development