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PURPOSE: Cardiovascular disease is the leading cause of mortality and morbidity in lower-middle income countries (LMICs), including Bangladesh. Cardiac rehabilitation (CR) as part of secondary prevention of cardiovascular disease has been shown to reduce mortality and morbidity and improve quality of life and exercise capacity. However, to date, very few controlled trials of CR have been conducted in LMICs.METHODS: A quasi-randomized controlled trial comparing home-based CR plus usual care with usual care alone was undertaken with patients following coronary artery bypass graft surgery. Participants in the CR group received an in-hospital CR class and were introduced to a locally developed educational booklet with details of a home-based exercise program and then received monthly telephone calls for 12 mo. Primary outcomes were coronary heart disease (CHD) risk factors, health-related quality of life (HRQOL), and mental well-being. Maximal oxygen uptake as a measure of exercise capacity was a secondary outcome.RESULTS: In total, 142 of 148 eligible participants took part in the trial (96%); 71 in each group. At 12-mo follow-up, 61 patients (86%) in the CR group and 40 (56%) in the usual care group provided complete outcome data. Greater reductions in CHD risk factors and improvements in HRQOL, mental well-being, and exercise capacity were seen for the CR group compared with the usual care group.CONCLUSIONS: In the context of a single-center LMIC setting, this study demonstrated the feasibility of home-based CR programs and offers a model of service delivery that could be replicated on a larger scale.

Aim To quantify the provision of standard cardiac rehabilitation to Danish survivors of cardiac arrest at a programme level, and to analyse whether organizational factors influenced the provision. Method We mapped the provision of cardiac rehabilitation core components to survivors of cardiac arrest and compared this with a reference group of patients after acute myocardial infarction using data from a cross-sectional programme-level survey among all hospitals (n = 34) and municipalities (n = 98) in Denmark. Organizational factors of potential importance to service provision were considered: health care region, size of catchment area/population, type of department/municipality and socioeconomic index. Results Response rates for the provision of each core component of cardiac rehabilitation ranged from 64% to 98%. All hospitals and municipalities provided some aspect of cardiac rehabilitation to survivors of cardiac arrest. Across hospitals, provision of four core components of cardiac rehabilitation to survivors of cardiac arrest was lower compared with post acute myocardial infarction patients: patient education (relative risk (RR) = 0.45 (95% confidence interval (CI) 0.27 to 0.75)), exercise training (RR = 0.69 (95% CI 0.49 to 0.98)), screening for anxiety and depression (RR = 0.64 (95% CI 0.46 to 0.90) and nutritional counselling RR = 0.76 (95% CI 0.62 to 0.93)). No difference was found in the provision of core components across municipalities. Overall, the provision of cardiac rehabilitation to survivors of cardiac arrest was not affected by organizational factors Conclusion This study indicates a need for future research to inform the development, adoption and implementation of equal access to all components of cardiac rehabilitation for survivors of cardiac arrest in Denmark

Aim: To generate knowledge about how relatives of out-of-hospital cardiac arrest survivors experience the transition between hospital and daily life. The research question was “how do relatives of out-of-hospital cardiac arrest survivors experience collaboration and communication with healthcare professionals, and what is emphasized as important in the transition from hospital to daily life”. Design: Qualitative design. Methods: Six semi-structured focus group interviews were conducted with 23 relatives of out-of-hospital cardiac arrest survivors who participated in a residential rehabilitation course. Data was collected between November 2018 and March 2019. Transcripts were analysed using a phenomenological hermeneutic approach. Results: The analysis generated three themes “a necessary presence,” “communication with healthcare professionals on the cardiac ward” and “the abrupt disappearance of the system.” Relatives of out-of-hospital cardiac arrest survivors feel a great responsibility when coping and adjusting to their new life. In the transition to daily life, a focus on systematic involvement and collaboration with relatives should be an essential part of the post-cardiac arrest pathway.

Aim: This study aimed to examine the associations between participation in physical activities and objective and subjective factors modifiable by rehabilitation in cardiac arrest survivors with fatigue.Methods: Participants in a clinical feasibility study (N = 19) completed several subjective (patient-reported) and objective outcome measures on one occasion only. The associations between an individual's level of participation in physical activities (Participation Objective Participation Subjective) and their levels of cognition (Computer Assessment of Mild Cognitive Impairment), body movement (Keitel Functional Test), depressive symptoms (Center for Epidemiologic Studies Depression Scale), ambulation and pain (Health Utilities Index Mark 3), and fatigue impact (Modified Fatigue Impact Scale) were explored. Pearson's correlation coefficient r was calculated for all associations, except for body movement (Spearman's correlation coefficient r s ). Results: As hypothesized, we found weak-to-moderate, positive associations between participation in physical activities and objective factors of cognition ( r = 0.370) and body movement ( r s = 0.414) and a subjective factor of ambulation ability ( r = 0.501). We found moderate, negative associations between participation in physical activities and subjective factors of depressive symptoms ( r=-0.590), pain ( r=-0.495), physical fatigue impact ( r=-0.629), cognitive fatigue impact ( r=-0.591), and psychosocial fatigue impact ( r=-0.557). Conclusion: The moderate, negative and positive associations between participation in physical activities and subjective factors suggest that subjective complaints of depressive symptoms, ambulation ability, pain, and fatigue impact may be important factors when seeking to improve participation in physical activities. In particular, addressing physical and cognitive endurance as well as perceptions of fatigue may hold the key to increasing physical activity in cardiac arrest survivors with fatigue.

Background Today, many more people are surviving sudden cardiovascular events and living longer with cardiovascular disease, thanks to advances in preventive strategies and advanced treatment. Hence, rehabilitation and palliative care interventions have become an important focus for improving the lives of patients living with cardiovascular diseases. Drawing on ‘review of reviews’ and rapid review methodology, as well as evidence gap maps, we worked with non-academic stakeholders at the Danish Heart Foundation (DHF) to co-produce a contemporary overview to uniquely bring together the evidence for the efficacy of rehabilitation and palliative care across a wide spectrum of cardiovascular diseases. The overview summarises the current evidence but also identifies where gaps in the evidence exist. Methods End user feedback was sought on the protocol and at key points in the overview process. Six bibliographic databases were searched for systematic reviews. Only articles published after 2009 were included. Quality of SRs was assessed using the R-AMSTAR tool. A narrative synthesis was performed and a summary of the most recent systematic review(s)/meta-analyses for efficacy of rehabilitation for each of the included CVD conditions presented using accessible graphic visualisations of data (infographics). Results The overview finds that the evidence for rehabilitation in coronary heart disease and heart failure is well established as well as supervised exercise training in intermittent claudication. Improved access to rehabilitation is needed for these indications. There is a dearth of studies on the efficacy of dietary and smoking interventions in CVD indications. Also, further research is needed on palliative care interventions for heart failure and other life-threatening cardiovascular diseases. Conclusion A pragmatic, flexible approach to conducting this overview, together with meaningful involvement of end users, facilitated completion of a comprehensive overview to deadline (six months), identified gaps in the evidence, improved accessibility of findings and ensured relevance to real world settings. Limitations included no attempt to search for individual randomised controlled trials (RCTs), to perform updates or undertake de novo SRs. We only focused on the effectiveness of rehabilitation and palliative interventions for CVD relative to control and did not consider the relative effectiveness of different components of interventions (for example, type, duration, frequency of exercise training) or settings. The overview highlights the need to prioritise high quality studies that establish the effectiveness of rehabilitation in cardiovascular indications where there is currently little or no evidence.