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Background: Ischemic heart disease (IHD) is linked to brain white matter (WM) breakdown but how age or disease effects WM integrity, and whether it is reversible using cardiac rehabilitation (CR), remains unclear. Purpose: To assess the effects of brain aging, cardiovascular disease, and CR on WM microstructure in brains of IHD patients following a cardiac event. Study Type: Retrospective. Population: Thirty‐five IHD patients (9 females; mean age = 59 ± 8 years), 21 age‐matched healthy controls (10 females; mean age = 59 ± 8 years), and 25 younger controls (14 females; mean age = 26 ± 4 years). Field Strength/Sequence: 3 T diffusion‐weighted imaging with single‐shot echo planar imaging acquired at 3 months and 9 months post‐cardiac event. Assessment: Tract‐based spatial statistics (TBSS) and tractometry were used to compare fractional anisotropy (FA), mean diffusivity (MD), axial diffusivity (AD), and radial diffusivity (RD) in cerebral WM between: 1) older and younger controls to distinguish age‐related from disease‐related WM changes; 2) IHD patients at baseline (pre‐CR) and age‐matched controls to investigate if cardiovascular disease exacerbates age‐related WM changes; and 3) IHD patients pre‐CR and post‐CR to investigate the neuroplastic effect of CR on WM microstructure. Statistical Tests: Two‐sample unpaired t‐test (age: older vs. younger controls; IHD: IHD pre‐CR vs. age‐matched controls). One‐sample paired t‐test (CR: IHD pre‐ vs. post‐CR). Statistical threshold: P < 0.05 (FWE‐corrected). Results: TBSS and tractometry revealed widespread WM changes in older controls compared to younger controls while WM clusters of decreased FA in the fornix and increased MD in body of corpus callosum were observed in IHD patients pre‐CR compared to age‐matched controls. Robust WM improvements (increased FA, increased AD) were observed in IHD patients post‐CR. Data Conclusion: In IHD, both brain aging and cardiovascular disease may contribute to WM disruptions. IHD‐related WM disruptions may be favorably modified by CR. Level of Evidence: 3 Technical Efficacy: Stage 2 [ABSTRACT FROM AUTHOR]

Coronary artery disease (CAD) poses a risk to the cerebrovascular function of older adults and has been linked to impaired cognitive abilities. Using magnetic resonance perfusion imaging, we investigated changes in resting cerebral blood flow (CBF) and cerebrovascular reactivity (CVR) to hypercapnia in 34 CAD patients and 21 age-matched controls. Gray matter volume (GMV) images were acquired and used as a confounding variable to separate changes in structure from function. Compared to healthy controls, CAD patients demonstrated reduced CBF in the superior frontal, anterior cingulate (AC), insular, pre- and post-central gyri, middle temporal, and superior temporal regions. Subsequent analysis of these regions demonstrated decreased CVR in the AC, insula, post-central and superior frontal regions. Except in the superior frontal and precentral regions, regional reductions in CBF and CVR were identified in brain areas where no detectable reductions in GMV were observed, demonstrating that these vascular changes were independent of brain atrophy. Because aerobic fitness training can improve brain function, potential changes in regional CBF were investigated in the CAD patients after completion of a 6-months exercise-based cardiac rehabilitation program. Increased CBF was observed in the bilateral AC, as well as recovery of CBF in the dorsal aspect of the right AC, where the magnitude of increased CBF was roughly equal to the reduction in CBF at baseline compared to controls. These exercise-related improvements in CBF in the AC is intriguing given the role of this area in cognitive processing and regulation of cardiovascular autonomic control.

Coronary artery disease (CAD) poses a risk to the cerebrovascular function of older adults and has been linked to impaired cognitive abilities. Using magnetic resonance perfusion imaging, we investigated changes in resting cerebral blood flow (CBF) and cerebrovascular reactivity (CVR) to hypercapnia in 34 CAD patients and 21 age-matched controls. Gray matter volume (GMV) images were acquired and used as a confounding variable to separate changes in structure from function. Compared to healthy controls, CAD patients demonstrated reduced CBF in the superior frontal, anterior cingulate (AC), insular, pre- and post-central gyri, middle temporal, and superior temporal regions. Subsequent analysis of these regions demonstrated decreased CVR in the AC, insula, post-central and superior frontal regions. Except in the superior frontal and precentral regions, regional reductions in CBF and CVR were identified in brain areas where no detectable reductions in GMV were observed, demonstrating that these vascular changes were independent of brain atrophy. Because aerobic fitness training can improve brain function, potential changes in regional CBF were investigated in the CAD patients after completion of a 6-months exercise-based cardiac rehabilitation program. Increased CBF was observed in the bilateral AC, as well as recovery of CBF in the dorsal aspect of the right AC, where the magnitude of increased CBF was roughly equal to the reduction in CBF at baseline compared to controls. These exercise-related improvements in CBF in the AC is intriguing given the role of this area in cognitive processing and regulation of cardiovascular autonomic control.

Transitional care to cardiac rehabilitation during the pandemic was a complex process for older adults, with additional challenges for decision-making and participation. This study aimed to explore the perspectives of older adults and health providers on transitional care from the hospital to cardiac rehabilitation, focusing on patient participation in decision-making. A qualitative exploratory design was used. Semi-structured interviews were conducted with 15 older adults and 6 healthcare providers. Document analysis and reflexive journaling were used to support triangulation of findings. Six themes emerged from the data, related to insufficient follow-up from providers, the importance of patients' emotional and psychological health and the support provided by family members, the need for information tailored to patients' needs and spaces for participation in decision-making, as well as challenges during COVID-19, including delayed medical procedures, rushed discharge and isolating hospital stays. The findings of this study indicated a number of potential gaps in the provision of transitional care services as reported by older adults who had a cardiovascular event, often during the first few weeks post hospital discharge. [ABSTRACT FROM AUTHOR]

Cardiac rehabilitation (CR) is most often provided in a hospital setting. Home-based models of care have been developed to overcome geographic, among other, barriers in patients at a lower risk. This study assessed whether clinical and geographic factors were related to the use of either a hospital-based or a home-based program. Secondary analysis was undertaken within a study of 1268 cardiac outpatients recruited from 97 cardiologist practices where clinical data were extracted. Participants completed a survey including the Duke Activity Status Index. They reported CR utilization in a second survey mailed 9 months later, including CR site and program model. Geographic information systems were used to determine the distances and the drive times to the CR site attended from patients' homes. Overall, 469 (37.0%) participants attended CR at one of 41 programs. Of the 373 (79.5%) participants with complete geographic data, 43 (11.5%) reported attending home-based CR. The sole clinical difference was in activity status, where patients attending a hospital-based program had lower activity status (P less than 0.01). There were no differences in model attended on the basis of geographic parameters including urban versus rural dwelling or drive times (P greater than 0.05). In conclusion, only one-tenth of outpatients participated in a home-based program, and this allocation was unrelated to geographic considerations. Although patients should continue to be appropriately triaged on the basis of clinical risk to ensure safety, more targeted allocation of patients to home-based services may be warranted. This may optimize the degree of participation and potentially patient outcomes. (Contains 1 figure and 2 tables.)