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AACVPR 34th Annual Meeting Scientific Abstract Presentations

Journal of Cardiopulmonary Rehabilitation and Prevention: September 2019 - Volume 39 - Issue 5 - p E28–E51
doi: 10.1097/HCR.0000000000000478
Association Annual Meeting

AACVPR Research Committee



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Beginning Investigator Presentations, 2:00 PM–3:30 PM Thursday, September 19, 2019

Abstract ID: S112

Title: Changes in Cardiovascular Disease Risk, Quality of Life and Functional Capacity Following an Intensive Cardiac Rehabilitation Program

Track: Cardiovascular Rehabilitation & Clinical Cardiology

Author(s): Sydney Stripling, MS, ACSM-CEP, Colleen Daubert, MS, ACSM-CEP, Jennifer Joseph, RN, BSN, Holly Konrady, MEd, MS, RYT, Rachael DeCaria, RD, LDN, Seth Boynton, LCSW, Callan Hoerdemann, RD, LDN, Ashley Swavely, MS, ACSM-CEP, Jeffrey Soukup, PhD, ACSM-CEP.

Institution(s): New Hanover Regional Medical Center, Wilmington, NC, USA.

Introduction: Intensive Cardiac Rehabilitation (ICR) is a lesser used but potentially more beneficial outpatient intervention for patients who have an incurred a cardiovascular event.

Purpose: To report the favorable changes in cardiovascular risk, depression, quality of life and functional capacity following ICR.

Design: Pre and post-program measures for cardiovascular risk, health-related quality of life, depression, and functional capacity were analyzed in 71 patients from seven cohorts who completed ICR.

Methods: Each patient underwent pre and post program testing which included 1) blood work for the determination of hsCRP, HbA1C, TCHOL, LDL-C, HDL-C, and TRIG; 2) depression screening using the CESD scale; 3) health-related quality of life assessment using the SF-36; and 4) functional capacity using the 6MWT. ICR followed the Ornish Lifestyle Medicine model consisting of 18 4-hour sessions performed twice weekly for 9 weeks and included 1 hour of exercise, 1 hour of education during a plant-based, whole foods meal, 1 hour of stress management, and 1 hour of group support. Participant adherence to the program was tracked throughout. Statistical significance was determined using dependent samples t-tests and significance was set at p<0.05.

Results: Participants completed an average of 16.7 four-hour sessions in 9 weeks for a 92.8% attendance rate. The average program adherence score was 80% with a range of 45.3% - 125.5%. Significant reductions in cardiovascular risk were evidenced by decreases in bodyweight (Pre=195.1 ± 34.8 lbs vs. Post=185.8 ± 32.0 lbs; p=0.000), BMI (Pre=29.9 ± 5.4 kg/m2 vs. Post=28.4 ± 4.9 kg/m2; p=0.000), SBP (Pre=125.7 ± 19.9 mm Hg vs. Post=119.2 ± 15.2 mm Hg; p=0.009), DBP (Pre=71.2 ± 9.7 mm Hg vs. Post=68.1 ± 8.2 mm Hg; p=0.009), TCHOL (Pre=149.7 ± 37.5 mg/dL vs. Post=127.4 ± 36.4 mg/dL; p=0.000), and LDL-C (Pre=96.9 ± 41.4 mg/dL vs. Post=79.8 ± 42.2 mg/dL; p=0.000). Improvements in health-related quality of life were seen, as both physical (Pre=43.4 ± 10.1 vs. Post=49.7 ± 14.5; p=0.000) and mental (Pre=49.7 ± 9.8 vs. Post 54.7 ± 6.9; p=0.000) composite scores increased. There was a significant reduction in depression (Pre=11.5 ± 10.9 vs. Post=5.9 ± 6.3; p=0.000). There was a significant improvement in functional capacity (Pre=448.0 ± 116.2 m vs. Post=504.0 ± 112.0 m; p=0.000). All data reported in mean ± standard deviation.

Conclusions: ICR produced an attendance rate of 92.8% and resulted in significant reductions in cardiovascular disease risk and depression, along with improvements health-related quality of life and functional capacity.

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Abstract ID: S113

Title: Electronic Cigarette Use Among Heart Failure Patients in the United States

Track: Behavior Change

Author(s): Emily C. Gathright, PhD, Wen-Chih Wu, MD, Lori Scott-Sheldon, PhD

Institution(s): The Miriam Hospital/Alpert Medical School of Brown University, Providence, RI, USA.

Introduction: Smoking cessation is an important modifiable cardiac risk factor recommended during cardiac rehabilitation. Noncombustible nicotine products such as electronic cigarettes (e-cigs) have been promoted as a harm reduction approach for cigarette smokers who are unable or unwilling to quit. However, there is limited knowledge regarding the prevalence of e-cig use among adults with HF.

Purpose: To determine prevalence of, and reasons for, e-cig use among adults with HF.

Design: Data from the Population Assessment of Tobacco and Health (PATH) Study (Wave 1: 2013-2014), a household-based, nationally representative longitudinal cohort study of 32,320 U.S. adults ≥18 years of age, were analyzed.

Methods: Participants were asked a series of questions regarding their tobacco use and reasons for use. Current e-cig users were defined as those who reported (a) fairly regular use and current some or every day e-cig use, OR (b) current some or every day e-cig use without history of fairly regular use. Current cigarette users were defined as those who reported (a) smoking >100 cigarettes in their lifetime and current some or every day cigarette use OR (b) smoking ≤100 cigarettes in their lifetime, and currently some or every day cigarette use. Frequencies, percentages, and weighted percentages were calculated to determine patterns of and reasons for e-cig use among adults with HF.

Results: Of the adult respondents, 486 (1.84% [weighted], 95% CI: 1.65-2.07) reported a HF diagnosis (48% female [weighted]; 40% ≥65 years [weighted]). Of those with HF, 70 (14%; 6.29% [weighted], 95% CI: 4.80-8.21) endorsed current e-cig use. Regarding conventional cigarettes, 245 (50%; 23.09% [weighted], 95% CI: 19.68-26.91) reported current use and 184 (38%; 18.18% [weighted], 95% CI: 15.31-21.45) used cigarettes alone. Sixty individuals (12%; 5.31% [weighted], 95% CI: 3.88-7.24) reported dual e-cig/cigarette use. The most common reasons for using e-cigs reported by regular users are as follows: e-cigs (a) may be less harmful than cigarettes (87%), (b) may be less harmful to nearby people than cigarettes (87%), (c) help people quit smoking (84%), and (d) can be used in places where smoking is not allowed (79%).

Conclusions: Rates of cigarette, e-cig, and dual cigarette/e-cig use among adults with HF were 50%, 14%, and 12%, respectively. Given the growing use of e-cigs in the U.S., patterns and preferences related to use of e-cigs should be monitored alongside ongoing efforts to understand the safety and potential efficacy of e-cigs as a harm reduction approach for patients with HF.

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Abstract ID: S114

Title: Mobile4Heart: A Pilot Randomized Controlled Trial Applying Mobile Health Strategies to Promote Physical Activity After Completion of Cardiac Rehabilitation

Track: Cardiovascular Rehabilitation & Clinical Cardiology

Author(s): Linda G. Park, PhD, MS, FNP-BC1,2, Abdelaziz Elnaggar, MBBS, MPH1,2, Stephanie Merek, MPH2, Craig Meyer, PhD, MPH, MS1,2, Julia von Oppenfeld, BA2, Mary A. Whooley, MD1,2

Institution(s):1University of California, San Francisco, San Francisco, CA, USA, 2Department of Veterans Affairs, San Francisco, CA, USA.

Introduction: Little is known about long-term adherence to physical activity for patients who complete cardiac rehabilitation (CR). After discharge from a CR program, many patients return to a sedentary lifestyle leading to deteriorating exercise capacity. Providing education and support through mobile heath strategies is a promising approach to increase adherence to physical activity.

Purpose: We sought to determine whether mobile health strategies (MOVN mobile app for self-monitoring, supportive push-through messages, and wearable activity tracker) would improve physical activity and exercise capacity over 2 months. The objectives of this study were to: 1) Establish an effect size based on functional exercise capacity (6 minute walk test [6MWT]) for a full scale clinical trial; and 2) Evaluate feasibility and acceptability of the intervention in the intervention group (MOVN app and Fitbit) and the control group (pedometer only).

Design: A pilot randomized controlled trial.

Methods: During the final week of outpatient CR, patients were randomized 1:1 to the intervention or control group. The intervention group downloaded the MOVN mobile app, received supportive push-through messages on motivation and secondary prevention of cardiovascular disease (CVD) 3 times per week, and wore a Fitbit Charge 2 to track steps. Participants in the usual care group wore a pedometer and recorded their daily steps in a diary. Data from the 6MWT and self-reported questionnaires were collected at baseline and 2 months.

Results: We recruited 60 patients from 2 CR sites at a community hospital in Northern California from February 2018 through January 2019 with a retention rate of 85%. Our results of 51 patients (mean age 66.8 ± 8.6, 22% female) showed that 6MWT distance improved in both intervention and control groups, but the amount of improvement was similar in both groups (Cohen's d=0.40; 95% CI: -0.45 to +1.25) after adjusting for age, white race, and college-education. Overall, participants were satisfied with using the MOVN app, Fitbit, and push-through messages. Participants reported high usability without significant technical difficulties.

Conclusions: Our technology-based intervention using a mobile app, push-through messages, and Fitbit proposes a low-cost, pragmatic, and contemporary approach to promote physical activity and sustain exercise capacity after completing CR. This study provides support for a full-scale randomized controlled trial with adequate power to determine efficacy of this innovative approach of using mobile health strategies to help high risk patients with CVD sustain physical activity after CR.

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Abstract ID: S115

Title: Efficacy of an ADL Simulation and Energy Conservation Intervention in Combination With Pulmonary Rehabilitation on Dyspnea and HRQoL

Track: Pulmonary Rehabilitation & Medicine

Author(s): Kayla B. Mahoney, MS, CCRP, CSCS1, Jacqueline Pierce, PT, CCS, CCRP1, Stacey Papo, BS, CCRP2, Hafiz Imran, MD1,3, Samuel Evans, MD2, Wen Chih Wu, MD1,3

Institution(s):1Miriam Hospital Cardiac and Pulmonary Rehab, Providence, RI, USA, 2Newport Hospital Cardiac and Pulmonary Rehab, Newport, RI, USA, 3Providence VA Medical Center, Providence, RI, USA.

Introduction: Pulmonary rehabilitation (PR) is well documented to improve exercise capacity, dyspnea, and Health-related quality-of-life (HRQoL); however, exercise modalities offered as part of traditional pulmonary rehab (TPR) do not always translate to Activity of Daily Living (ADL) performance. Evidence based clinical guidelines for exercise prescription recommend inclusion of upper and lower body resistance training however, guidelines on functional training specific to improving ADL performance are lacking.

Purpose: The aim of this study was to determine the impact of ADL simulation and energy conservation (EC) practice added to TPR as part of a quality-initiative on dyspnea, fatigue, and HRQoL among patients in PR.

Design: Retrospective chart review and comparison of patients enrolled in PR before (October 2016 through August 2017) and after (September 2017 to September 2018) the implementation of the new EC training in combination with TPR intervention.

Methods: Patients in the TPR arm (n = 91) received 12 weeks of twice weekly 90-minute TPR sessions of supervised exercise (60-minute aerobic and resistance training) in addition to a 30-minute education class. Patients in the EC arm (n = 85) received TPR sessions and three monthly 90-minute sessions consisting of 60-minutes of ADL simulation training and a 30-minute education class in place of regular TPR. Patients rotated through 12 supervised stations tailored to include exercises specific to ADLs (stair-climbing, bending and reaching tasks, etc.). The 30-minute education focused on energy conservation strategies, assistive devices, pacing, and pursed lips breathing with performing common household activities. The change from baseline on MMRC dyspnea score, COPD assessment test (CAT), the CRQ dyspnea score, and CRQ fatigue score questionnaires, and six-minute-walk-test were compared within and between patients in the EC versus the TPR arms via T-tests.

Results: The characteristics of patients in TPR (59% COPD) versus EC (69% COPD) were similar (mean age = 68.1 ± 10.4, 45 % female). When compared to baseline, patients in TPR demonstrated significant improvement in all study outcomes (all p's = 0.01), except for CAT score (p = 0.39). Conversely, patients in the EC arm achieved significant improvement in all study outcomes including the CAT score (all p's = 0.01). The improvement was significantly higher in the EC versus TPR arm in the CAT (p = 0.01) and CRQ Dyspnea (p = 0.05) scores.

Conclusions: Addition of ADL simulation with focused exercise training and education in EC strategies to TPR can improve HRQoL and dyspnea outcomes among PR patients.

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Abstract ID: S116

Title: Physical Activity Levels One Year After Completing Phase 2 Cardiac Rehabilitation

Track: Cardiovascular Rehabilitation & Clinical Cardiology

Author(s): Anton F. Pecha IV, MS, Luke A. Soelch, BS, Patrick D. Savage, MS, Philip A. Ades, MD

Institution(s): University of Vermont Medical Center, South Burlington, VT, USA.

Introduction: Cardiac rehabilitation (CR) has been shown to reduce mortality in patients with coronary heart disease. Maintaining an exercise training regimen after completing CR is important for secondary prevention of cardiovascular events.

Purpose: Assess adherence with recommended physical activity (PA) guidelines for recent graduates of Phase II CR.

Design: Prospective, observational.

Methods: Graduates of our Phase 2 CR program from May 2017 to March 2018 participated in a telephone survey based on the International Physical Activity Questionnaire regarding self-reported PA levels. Individuals were called a mean of 13.7 months 2.9 (range 9-21 months) after CR completion. For analysis, the cohort was split into 2 groups: Group 1 included graduates meeting the PA Guidelines for Americans ≥150 minutes of some combination of moderate and vigorous activity or ≥75 minutes per week of vigorous activity or; Group 2 included graduates not meeting PA guidelines. Variables considered for analysis included baseline peak aerobic capacity in Metabolic Equivalents of Task (METs), body mass index (BMI), waist circumference (WC), sex, age, diagnosis of diabetes mellitus, total comorbidity score, and change in METs during CR. Statistical methods included unpaired t-tests and univariate and stepwise multivariate regression. Results are presented as mean ± SD and statistical significance was set at p<0.05.

Results: The cohort consisted of 155 participants (121 male, 34 female) with a mean age of 66.8±10.9 years (range 35-90 years). Overall, individuals reported engaging in a mean of 104.2±10.2 total minutes of moderate and/or vigorous activity and 37% of the cohort reported meeting the recommended levels of PA (p<0.0001). Univariate factors associated with meeting the PA guidelines included baseline METs (r =.284), BMI (r =-.201), and WC (r =-.219) (all, p<0.01). Independent correlates of meeting PA guidelines included higher baseline METs and lower BMI (adjusted R2= .107, p=0.002).

Conclusions: Only 37% of CR graduates are achieving nationally recommended PA guidelines one year after CR completion. Given that these results were determined by self-report, and not a more objective measure such as accelerometers, our results may overestimate the actual level of PA being performed. Interventions need to be developed, such as counseling from an exercise specialist prior to graduation, to ensure that CR graduates achieve long-term PA levels that are adherent with recommended PA guidelines.

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Abstract ID: S117

Title: Superior Effects of High Intensity Interval vs Moderate Continuous Exercise in Women: A Randomized Control Trial

Track: Cardiovascular Rehabilitation & Clinical Cardiology

Author(s): Sherrie Khadanga, MD, Patrick Savage, MS, Anton Pecha, MS, Jason Rengo, MS, Philip Ades, MD

Institution(s): University of Vermont Medical Center, Burlington, VT, USA.

Introduction: Cardiopulmonary fitness (VO2peak) is a powerful predictor of prognosis in individuals with cardiovascular disease. Despite lower baseline fitness, women do not improve VO2peak as much as men in cardiac rehabilitation (CR).

Purpose: To examine the value of high intensity interval training (HIT) and strength training to maximize aerobic training response in CR for women.

Design: Randomized Control Trial.

Methods: Twenty-three female patients were randomized to isocaloric standard exercise training (control) or HIT three times per week plus additional lower extremity strength training. Exclusion criteria included: VO2peak <12mL·kg−1·min−1, orthopedic limitations (i.e. inability to walk on a treadmill), exertional angina, or respiratory exchange ratio <1.00 on exercise tolerance test. The HIT group exercised for 33 minutes (5 minute warm-up followed by five intervals of 4 minutes at an intensity of 90-95% of peak heart rate [HRpeak] followed by 4 minute recovery period at 50-60% HRpeak). The control group exercised aerobically for 45 minutes at a moderate continuous intensity (70-85% of HRpeak). The control group performed 1 set of 10 repetitions at 60-65% of a single repetition maximal lift (1-RM) for leg press while the HIT group did 2 sets of 10 repetitions at 80% of 1-RM. Statistical methods: Non-paired t-tests and simple and multivariate regression. Variables in the analyses included exercise HR, 1-RM, % of HRpeak, and rate of perceived exertion (RPE).

Results: The HIT and control groups were similar at baseline by age (65.2±8.7 vs 65.3±17.4 years), VO2peak, (19.2±4.4 vs 18±5.8 mL·kg−1·min−1) and 1-RM (49.9±15 vs 52.4±17.3 kg). The HIT group exercised at a higher percentage of HRpeak (88.3±9.5%) compared to the control group (78±7.4%) (p <0.01). VO2peak increased significantly more on the HIT vs the control group (3.8±1.9 vs 2.2±1.1 mL·kg−1·min−1, p <0.04). This represents a 68% greater increase in VO2peak. There was a trend towards a significant improvement in leg press in the HIT group compared to the control (12±10 vs 4±9.1, p <0.08). Correlates with change in VO2peak were RPE at session 36 (r=0.75), exercise HR at session 36 (r=0.52) and % of HRpeak at sessions 18 (r=0.53) and 36 (r=0.62) (all p <0.01). The only independent predictor for change in VO2peak was RPE at session 36 (adjusted R2=0.184, p <0.02).

Conclusions: Women randomized to HIT and more strength training experienced significantly greater improvements in VO2peak during CR. To address differences in outcomes compared to men, women should perform HIT and strength training to maximize improvements in cardiorespiratory fitness during CR.

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Scientific Oral Abstract Presentations, 3:45 PM–5:15 PM, Thursday, September 19, 2019

Abstract ID: S101

Title: Cardiac Rehabilitation for Individuals With Severe Mobility Disability

Track: Cardiovascular Rehabilitation & Clinical Cardiology

Author(s): Patrick Savage, MS, Jason Rengo, MS, Philip A. Ades, MD

Institution(s): University of Vermont Medical Center, South Burlington, VT, USA.

Introduction: Many patients entering Cardiac Rehabilitation (CR) have severe mobility disability (SMD) related, in part, to significant comorbid conditions. Little is known about the characteristics of individuals with SMD and their ability to participate in and complete CR.

Purpose: We characterize and contrast individuals with SMD compared to participants that are able to perform an entry phase 2 CR exercise tolerance test (ETT).

Design: Prospective, observational.

Methods: All physically able enrollees in CR underwent a baseline ETT. If, however, in the clinical assessment of the physician, an individual was deemed physical unable, an ETT was not performed. An inability to ambulate safely in a clinic at a pace of approximately 1.5 miles (2.42 kilometers) per hour defined SMD and was the threshold below which an ETT was not performed. The cohort was split in to 2 groups: (1) individuals with SMD and (2) participants able to complete an ETT. Study measures included age, sex, handgrip dynamometer, self-reported physical function (Medical Outcomes Study Short-Form-36), depression symptoms (Patient Health Questionnaire-9), and number of CR sessions attended. Unpaired t-test was used to compare continuous variables. Chi-square test was used to compare categorical variables. Results are presented as mean±>SD.

Results: The cohort included 1817 (Men=1291; 71%) consecutive patients evaluated at entry to CR between 2014-18. Of the entire cohort, 141 (8%) had SMD and were physically unable to complete an ETT; thus, 1676 patients (92%) performed a baseline ETT. The distribution by sex in the SMD group (Male=71, Female=70) was significantly different then the group able to perform an ETT (Male=1220, Female=456) (p<0.0001) with relatively more women having SMD. Participants with SMD compared to individuals able to perform an ETT were significantly older (73.8±10.3 vs 65.3±11.1years); had lower handgrip strength (23.4±9.5 vs 35.6±11.6kg); self-reported lower levels of physical function (33.2±22.6 vs 65.8±25.3); and had higher levels of depressive symptoms (6.5±6.1 vs 4.3±4.4) (all, p<0.0001). Both groups, however, completed a similar number of CR sessions (SMD group=21.6±14.2 vs ETT group=23.2±13.4; p=0.19).

Conclusions: Patients entering CR with SMD defines a group of patients that are more likely to be female, older and remarkably more disabled by self-report compared to participants that are able to perform an ETT. Despite higher levels of depressive symptoms and low levels of function and strength, individuals with SMD attend a similar number of CR sessions as compared to individuals able to perform an entry ETT.

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Abstract ID: S103

Title: Home-Based Cardiac Rehabilitation and Mortality in Patients With Cardiovascular Disease: Results From the San Francisco Healthy Heart Program

Track: Cardiovascular Rehabilitation & Clinical Cardiology

Author(s): Nirupama Krishnamurthi, MBBS, MPH, David W. Schopfer, MD, MAS, Hui Shen, MS, Mary A. Whooley, MD

Institution(s): San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA.

Introduction: In an effort to increase participation in cardiac rehabilitation (CR), the Veterans Health Administration (VA) Office of Rural Health has implemented new home-based cardiac rehabilitation (HBCR) programs at selected VA facilities. HBCR programs have been shown to be equally effective to traditional facility-based programs in clinical trials and Cochrane meta-analysis. However, the real-world effect of HBCR on mortality is unknown.

Purpose: To compare mortality rates in HBCR participants versus non-participants.

Design: Observational study.

Methods: We evaluated all patients who were referred to and eligible for outpatient (Phase II) CR between 2013-2018 at the San Francisco VA. Patients who chose to attend facility-based CR and those who died within 30 days of hospitalization were excluded. Patients were followed through December 31 2018. We used Cox-proportional hazards regression models with inverse probability treatment weighting to compare mortality in HBCR participants vs. non-participants.

Results: Of the 1,135 patients (mean age 68, 98% male, 75% White) who were referred to and eligible, 494 (44%) participated in HBCR. During a median follow-up of 2.8 years, 126 patients (11%) died. As compared with the 641 non-participants, mortality was lower among the 494 HBCR participants (8% vs. 13%; p=0.005). In an inverse probability weighted cox regression analysis adjusted for patient demographics and comorbid conditions, mortality remained 36% lower among HBCR participants versus non-participants [HR 0.64, 95% CI 0.43, 0.96, p=0.03].

Conclusions: Among patients eligible for CR, participation in HBCR was associated with 36% lower mortality. Although we cannot rule out the possibility of unmeasured confounding, participation in HBCR remained associated with lower mortality after inverse-probability weighted analyses. These findings suggest that HBCR may benefit patients who cannot attend traditional CR programs.

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Abstract ID: S104

Title: Effect of Coronary Artery Bypass Surgery on Physical Function Prior to Cardiac Rehabilitation

Track: Cardiovascular Rehabilitation & Clinical Cardiology

Author(s): Jason L. Rengo, MSc1, Patrick D. Savage, MS1, Philip A. Ades, MD1,2, Michael J. Toth, PhD2

Institution(s):1University of Vermont Medical Center, Burlington, VT, USA, 2University of Vermont College of Medicine, Burlington, VT, USA.

Introduction: Coronary Artery Bypass Surgery (CABG) can prolong survival and improves symptoms in patients with coronary artery disease. Despite benefits, post-surgical convalescence promotes cardiorespiratory and skeletal muscle deconditioning. While cardiac rehabilitation (CR) can counter reductions in physiological function, patients typically begin CR 1-month following hospital discharge. Knowledge of the reduction in functional capacity can lead to development of new transitional care services.

Purpose: Characterize early, post-surgical functional and physiological adaptations in CABG patients

Design: Prospective.

Methods: Patients between 50-80 years were approached prior to urgent or elective CABG surgery. Functional assessments, including the Short Physical Performance Battery (SPPB: balance, 4 m gait speed and 5-times sit-to-stand (FTSTS)) and 6-minute walk (6MW), were obtained pre-surgery (baseline), prior to hospital discharge (D/C) and 1-month post-discharge (1-month), except that the 6MW was not performed pre-surgery. The SPPB is scored on a scale of 0-12 with higher scores indicating low risk of disability for activities of daily living. Statistical analysis included repeated measures ANOVA and paired t-tests. Data is presented as mean ± SD.

Results: The cohort consisted of 11 male patients aged 66±7 yr. Mean hospital stay post-surgery was 5.3±0.8 d with in-hospital testing occurring at 4.6±0.7 d and 1-month testing at 30.3±2.3 d following discharge. There was a significant effect by time for SPPB scores (p<0.001) with differences observed between baseline and D/C (10.2±1.5 vs 8.5±2.2, p=0.045) and D/C to 1-month (8.5±2.2 vs 10.8±0.9, p<0.01). Baseline, D/C and 1-month gait speed was 0.92±0.18, 0.73±0.21 and 1.06±0.14 m/s respectively. Significant differences were observed across all time points (baseline vs D/C, p<0.01; D/C vs 1-month, p<0.001; baseline vs 1-month, p=0.029). Significant effects by time were observed for FTSTS (p=0.004) with differences between baseline and D/C (13.21±4.06 vs 18.13±6.85 s, p=0.017) and D/C to 1-month (18.13±6.85 vs 12.43±1.98 s, p=0.02). FTSTS performance at D/C indicated increased risk of recurrent falls (>15s). 6MW improvement of 162±58 m (249 vs 411 m, p<0.001) from D/C to 1-month was clinically significant, but remained below average compared to healthy populations.

Conclusions: CABG surgery has short-term detrimental effects on physical functional capacity, as evidenced by reductions in gait speed, leg strength (FTSTS) and aerobic function (6MW). While patients recover to pre-surgery levels around the time they commence CR participation, they remain significantly deconditioned. Providing early intervention in this population may speed functional recovery and reduce the potential for physical disability.

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Abstract ID: S105

Title: Cardiopulmonary Responses to Treadmill and Upper Body Ergometry Exercise in Symptomatic Peripheral Artery Disease

Track: Cardiovascular Rehabilitation & Clinical Cardiology

Author(s): Dereck L. Salisbury, PhD, Rebecca JL Brown, MEd, MN, RN, Laura Kirk, PhD, RN, Erica Schoor, PhD, BSBA, RN, Diane Treat-Jacobson, PhD, RN, FAHA, FSVM, FAAN

Institution(s): University of Minnesota, Minneapolis, MN, USA.

Introduction: Treadmill exercise and the evaluation of treadmill-based walking outcomes (i.e. peak and claudication onset walking distance) represent the gold standard treatments and measurements related to the rehabilitation of symptomatic peripheral artery disease (PAD). However, treadmill walking performance may be limited by claudication. In an environment where exercise-induced cardiovascular stress is desirable, such as in cardiac stress testing or clinical trials, an alternative modality of exercise testing may be required. Upper body ergometry, can circumvent several of the problems associated with treadmill walking and may provide an alternative method to elicit a greater cardiorespiratory response or patient effort.

Purpose: The purpose of this study was to compare peak cardiorespiratory responses on cardiopulmonary exercise tests performed on upper body ergometer (UBE-CPET) and treadmill (TM-CPET) in patients with symptomatic PAD.

Design: Cross-Sectional.

Methods: 75 men (age 67.7 years) and 29 women (age 67.7 years) with mild-moderate PAD completed two symptom-limited graded CPET at baseline as part of the Exercise to Reduce Claudication (EXERT) study. TM-CPET was performed to peak claudication, while UBE-CPET was performed to volitional fatigue. Indicators of cardiorespiratory fitness measured and assessed at peak exercise (i.e. the highest value in the last minute of exercise) included: minute ventilation (VE), respiratory rate (RR), tidal volume (VT), respiratory exchange ratio (RER), heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), metabolic equivalents of task (METS), oxygen consumption (VO2), cardiac output (CO), rating of perceived exertion (RPE), and rate pressure product (RPP). Differences among peak CPET variables between TM-CPET and UBE-CPET were assessed by paired samples T-test (alpha was set at 0.05).

Results: UBE-CPET produced significantly higher peak RER (1.07 [.15] vs. 1.01 [.15]), SBP (171.7 [21.8] vs. 163.3 [24.4] mmHg), DBP (76.0 [14.5] vs. 73.2 [13.6] mmHg) and RPE (17.6 [1.5] vs. 15.6 [2.4]) comparted to treadmill CPET. However, TM-CPET produced greater peak VO2 (14.8 [3.8] vs. 10.4 [4.5] ml/kg/min), HR (106.9 [19.8] vs. 103.2 [20.5] bpm), and VE (45.5 [12.5] vs. 37.9 [12.2] L/min).

Conclusions: UBE-CPET elicits a greater pressure response, RER and RPE compared to TM-CPET suggesting greater effort given on the UBE-CPET. However, despite being limited by claudication, persons with PAD still achieve higher peak VO2 on TM-CPET than UBE-CPET. UBE recruits a smaller muscle mass and may represent a form of unaccustomed exercise causing a local skeletal muscle fatigue resulting in a lower VO2 peak, despite the higher indicators of patient effort.

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Abstract ID: S106

Title: Virtual World-based Cardiac Rehabilitation to Promote Healthy Lifestyle Among Cardiac Patients: A Multicenter Pilot Study

Track: Cardiovascular Rehabilitation & Clinical Cardiology

Author(s):LaPrincess Brewer, MD, MPH1, Brian Kaihoi, BS2, Shawn Leth, MEd, CEP1, Ray Squires, PhD1, Randal Thomas, MD1, Robert Scales, PhD3, Jorge Trejo-Gutierrez, MD4, Stephen Kopecky, MD1.

Institution(s):1Mayo Clinic College of Medicine, Rochester, MN, USA, 2Mayo Clinic Global Products and Services, Rochester, MN, USA, 3Mayo Clinic College of Medicine, Scottsdale, AZ, USA, 4Mayo Clinic College of Medicine, Jacksonville, FL, USA.

Introduction: Cardiac rehabilitation (CR) has the lowest participation rates among under-resourced populations most affected by cardiovascular disease (CVD) including rural residents, economically disadvantaged patients, racial/ethnic minorities and women. Telehealth interventions harnessing virtual world (VW) technology have emerged as modalities to increase CR accessibility by offering unique social interactivity and active learning.

Purpose: To assess the feasibility and acceptability of a VW-based CR program (Destination Rehab) as an extension of a face-to-face conventional CR program. We hypothesized that a VW-based CR program could be successfully implemented and would have high acceptability among cardiac patients.

Design: Quasi-experimental pre-post study among three hospitals.

Methods: We recruited 30 patients (10/site) hospitalized at Mayo Clinic Hospitals in Rochester, MN, Jacksonville, FL and Scottsdale, AZ with a diagnosis for CR (eg, acute coronary syndrome (ACS), heart failure, elective percutaneous coronary intervention (PCI)). Other inclusion criteria were ≥1 modifiable, lifestyle risk factor target: sedentary lifestyle (<3 hours physical activity (PA)/week), unhealthy diet (<5 servings fruits and vegetables/day) or current smoking (>1 year). Patients followed an 8-week, health education program using a VW platform from a prior proof-of-concept study and provided intervention usability, usefulness and satisfaction feedback. We assessed cardiovascular (CV) health behaviors (diet, PA) and risk factors (eg, blood pressure (BP), lipids) at baseline and immediate post-intervention.

Results: Among 30 patients enrolled (mean age, 59 years; 50% women; 65% <college graduate; 32% annual household income <$50,000), 28 (98%) completed the study. The majority (64%) were enrolled in conventional CR with a high session completion rate (median 36 sessions, interquartile range 8-36). The most common CR indication was PCI (68%). There were statistically significant improvements in PA from baseline to post-intervention: vigorous PA, +11 (SD 11.7) minutes/day (p =0.05) and flexibility exercises +1 (SD 0.9) days/week for men (p=0.05). There were favorable trends in risk factors: systolic BP (−6.8 mmHg, SD 29.8), total cholesterol (−31.6 mg/dL, SD 46.2) and LDL (−26 mg/dL, SD 44.8) from baseline to post-intervention, although not statistically significant. The majority reported that they would continue to use VW as a resource (76%) and agreed/strongly agreed that the program improved their heart health knowledge (86%) and assisted with adapting healthier lifestyle (100%). Overall, the VW CR program received a rating of 8 (scale 0-10).

Conclusions: VW-based CR program is a feasible, highly acceptable and innovative platform to influence health behaviors and CV risk and can increase accessibility to disadvantaged populations with higher CVD burdens.

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Scientific Oral Abstract Presentations, 2:15 PM–3:30 PM Friday, September 20, 2019

Abstract ID: S107

Title: The Impact of Cardiac Rehabilitation on LVAD and Transplant Patients

Track: Cardiovascular Rehabilitation & Clinical Cardiology

Author(s): Mike McNamara, MS, FAACVPR, Carrie Oser, MPH, Crystelle Fogle, MS, MBA, RD

Institution(s): Montana Cardiovascular Health Program, Helena, MT, USA.

Introduction: Heart transplant (HTx) and left ventricular assist device (LVAD) patients experience unique challenges in cardiac rehab (CR). External hardware, medication regimens and added surveillance increase the level of complexity of this special population compared to the traditional non-transplant/LVAD patient.

Purpose: To investigate the impact that CR has on this unique patient population related to well established outcome indicators.

Design: A cross-sectional study design was used for CR facilities participating in the Montana Outcomes Project (MOP).

Methods: The sample was drawn from programs participating in the MOP and included 89 HTx patients and 64 LVAD patients. The time frame for data collection was from October 2015 through September 2018. Statistical analysis included Chi-square and ANOVA tests with p-value of ≤ 0.05 indicating statistical significance.

Results: The majority of the sample was male (66% HTx - 80% LVAD), predominantly white (86% HTx - 81% LVAD), and mean age was 58 years for the HTx sample and 60 years for the LVAD group. The number of completed CR visits was similar in both groups (29 HTx - 28 LVAD). Both populations had similar rates of diabetes at approximately 34%. Functional capacity, measured by the Duke Activity Status Index, significantly improved over the course of CR in both populations - 5.3 METs pre CR to 6.8 METS post CR for the HTx group and 4.8 METS pre CR to 5.9 METS post CR for the LVAD population. Quality of life (QOL) scores, measured by the Dartmouth COOP, significantly improved as well with the HTx population starting CR with a score of 21.5 and improving to 18.38 post CR while the LVAD group started at 22.7 and improved to 19.2 post CR. Depression screening using the PHQ-9 significantly improved with the mean CR entry score of 5.1, which decreased to 3.0 post CR in the HTx group, and the LVAD group started CR with a mean score of 5.4 and ended CR with a mean score of 4.1. Sixty-one percent of the HTx population experienced at least 1 level of severity improvement in PHQ-9 scores while 71% of the LVAD population demonstrated similar improvements over the course of CR.

Conclusions: Despite the added complexity that HTx and LVAD patients bring to CR, both populations benefit positively from this therapy. Significant improvements in functional capacity, QOL, and depression scores were observed over the course of CR.

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Abstract ID: S108

Title: The Use of Cardiac Rehabilitation for Patients at Risk of Cancer-Related Cardiotoxicity During Active Treatment

Track: Cardiovascular Rehabilitation & Clinical Cardiology

Author(s): Dennis Kerrigan, PhD, Madhulata Reddy, MD, Eleanor Walker, MD, Randa Loutfi, MD, Jodi Baxter, BS, Matthew Saval, MS, Steven Keteyian, PhD

Institution(s): Henry Ford Hospital, Detroit, MI, USA.

Introduction: While cancer survivor rates continue to grow, the risk of other debilitating conditions, such as cancer-related heart failure (HF), may increase up to three-fold among cancer survivors. Exercise has been shown to improve several cancer-associated side-effects, as well as mitigate (in animal models) the pathophysiological changes which lead to HF. Cardiac rehabilitation (CR) is an established service with clinicians trained to provide exercise in higher risk populations.

Purpose: Describe CR related adherence and patient-reported program outcomes in a cohort of individuals receiving known cardiotoxic cancer treatment who are found to have subclinical changes in either cardiac troponin (TnI) or left ventricular global longitudinal strain (GLS).

Design: Patients during active cancer treatment (ACT) who were found to have either a TnI ≥ 15 ng/L or a relative drop in GLS by >10% were asked to participate in 10 weeks of CR. Changes in patient reported outcomes, estimated exercise METS, and attendance were compared to a cohort of age and BMI matched females with CAD who participated in CR during the same time.

Methods: ACT patients participated in three times/week CR program, performing interval training at 60%-90% of heart rate reserve using a treadmill or bike. A dependent-t test was used to compare within group differences, while an independent-t test was used to compare against the matched cohort. Alpha level was set at 0.05.

Results: The ACT group (n=20, 100% female) showed significant pre-post improvements in exercise training METS (3.6 ± 1.1 vs. 5.2 ± 1.8, p <0.001), the Patient Health Questionnaire (PHQ-9) (4.7 ± 6.8 vs. 2.6 ± 4.0, p = 0.04), and the Rate Your Plate (RYP) nutrition survey (51 ± 10 vs. 55 ± 8, p=0.007). The magnitude of these improvements were similar to the cohort of matched females (n=56) with CAD. Between group improvements in METS and self-reported measures in ACT vs. the matched CAD group were as follows: (MET change = ACT 1.6 ± 1.1 vs. CAD 1.1 ± 1.1 p=0.119; PHQ-9 change = ACT -2.1 ± 2.9 vs. CAD -1.6 ± 3.9, p=0.694; RYP change = ACT 3.4 ± 3.6 vs. CAD 7.2 ± 10.3, p=0.101). Attendance in the ACT vs. CAD group was 72% vs. 57% respectively (p=0.082).

Conclusions: This pilot study supports the utilization of CR to deliver exercise in patients during active cancer treatment who are at risk for cardiotoxicity.

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Abstract ID: S109

Title: Patient Characteristics Predictive of Cardiac Rehabilitation Participation

Track: Cardiovascular Rehabilitation & Clinical Cardiology

Author(s): Sherrie Khadanga, MD, Patrick Savage, MS, Diann Gaalema, PhD., Philip Ades, MD

Institution(s): University of Vermont Medical Center, Burlington, VT, USA.

Introduction: Although the benefits of cardiac rehabilitation (CR) have been clearly established, participation rates remain quite low, ranging from 19-34%.

Purpose: To assess the demographic, medical, and psychosocial factors that influence CR participation.

Design: Prospective observational study.

Methods: Patients hospitalized for an acute cardiac event and eligible for CR completed a series of assessments focusing on psychosocial factors including screening for anxiety (General Anxiety Disorder [GAD-7]), screening for depression (Patient Health Questionnaire [PHQ-9]), and assessment of social support via the Duke Social Support Index. Smoking status (current smoker vs former/non-smoker), education level (≤high school vs college degree or higher), and diagnosis (surgical vs non-surgical) were also ascertained. One week post discharge, patients were called to assess the strength of physician recommendation to CR (5 point Likert scale with options ranging from 1 ‘recommend against CR' to 5 ‘strongly recommend CR'). We then followed patients to determine their participation and adherence. Statistical methods included logistic regression analysis, chi square, and non-paired t-tests. The following variables were included in the analyses: age, sex, diagnosis, smoking status, education level, referral via electronic medical record, depression score, anxiety score and strength of physician recommendation. A p value of <0.05 was used to determine significance.

Results: 132 patients were approached and of those, 117 enrolled in the study. 55 individuals (47%) participated in CR of whom 16 were female (29%), 38 were male (71%), mean age was 69±11 years old, and 33 had a college degree or higher (60%). Current smokers were less likely to attend (p <0.01) compared to non-smokers. Similarly, those with an education level ≤high school were less likely to participate compared to those with a college degree or higher (p <0.006). Use of electronic referral (r=0.36, p <0.0001), surgical diagnosis (r= 0.24, p <0.009) and strength of physician recommendation to CR (r=0.27p <0.008) were associated with CR participation. Surgical diagnosis, level of education, electronic referral, smoking status, and strength of physician recommendation were independently associated with CR participation (adjusted R2=0.396, p<0.001).

Conclusions: Only half of eligible patients enroll in CR. Our results suggest that efforts should be directed toward ensuring that patients are referred and encouraged by physicians to participate in CR. Conversely, specific interventions need to be developed to increase participation among current smokers and patients of lower levels of education.

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Abstract ID: S110

Title: Implementation of Objective Measurement of Carbon Monoxide Status in Cardiac Rehabilitation

Track: Cardiovascular Rehabilitation & Clinical Cardiology

Author(s): Diann Gaalema, PhD1, Patrick Savage, MS2, Jason Rengo, MS2, Deborah Denkmann, RN1, Philip Ades, MD2

Institution(s):1University of Vermont, Burlington, VT, USA, 2University of Vermont Medical Center, Burlington, VT, USA.

Introduction: Exposure to carbon monoxide (CO) is a serious health concern. The primary source of CO exposure is smoking. Most cardiac rehabilitation (CR) programs rely on self-report to assess smoking status.

Purpose: We measured CO concentration in expired air and self-reported smoking status at CR entry to examine if those with significant CO exposure were being missed by traditional screening methods.

Design: Prospective, observational.

Methods: Consecutive patients were screened for CO exposure at the intake assessment using objective monitoring of breath CO levels (Micro Smokerlyzer, coVita). Patient characteristics (age, fitness, education, depressive symptoms) of those with elevated vs. nominal levels of CO exposure were compared. Discrepancy between exposure status based on self-report and objective measurement was examined. Unpaired t-tests were used to analyze between group differences, results are presented as mean+SD and a p value of .05 was used to assess significance.

Results: Of the 329 patients screened at CR entry, 36 patients met the criteria for significant CO exposure (breath CO ≥6 ppm) of whom 26 self-reported as current smokers. Within those with elevated CO levels, 28% (10/36) would have been missed by self-report measure (3% of the overall sample, 10/329). CO averaged 14.5±9.6 ppm in group with significant exposure. When comparing individuals with elevated CO levels to those without, those with elevated CO levels were younger (60.8±12.9 vs. 68.0±11.0, p<0.001) but had a similar fitness level (METS: 6.16±2.0 vs. 5.84±1.9, p=0.378). Those with elevated CO levels also had higher depression scores (PHQ-9: 7.1±5.4 vs. 3.9±4.1, p<0.001) and lower levels of educational attainment (years: 12.6±2.3 vs. 14.9±3.4, P<.001).

Conclusions: Our results suggest that patients with significant CO exposure risk are being missed by relying on self-reported clinical history. Given the serious health effects of CO exposure patients must be appropriately identified so they can receive intervention. This high exposure group is also a group likely in need of extra support in CR given their limited educational attainment and high depression scores.

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Abstract ID: S111

Title: Sleep Quality Predicts Change in Functional Status Among Patients in a Cardiac Rehabilitation Program

Track: Cardiovascular Rehabilitation & Clinical Cardiology

Author(s): Jacob D. Landers, MA1, Derek R. Anderson, PhD2, Kristie M. Harris, PhD3, Steven E. Schiele, MA1, Jocelyn D. Shoemaker, MA, MPH1, Ihsan N. Rodriguez, BA1, Charles F. Emery, PhD1

Institution(s):1The Ohio State University, Department of Psychology, Columbus, OH, USA, 2VA Puget Sound: American Lake Division, Seattle, WA, USA, 3Yale School of Medicine, Department of Internal Medicine - Cardiology, New Haven, CT, USA.

Introduction: Although cardiac rehabilitation (CR) is associated with numerous health benefits (e.g., improved functional status), not all CR participants experience improvements during CR. Poor sleep quality is a risk factor for poor cardiovascular health and cardiac events. Prior cross-sectional research suggests that sleep disordered breathing is associated with poorer functional status among CR patients. However, sleep quality has not been evaluated in relation to change in indicators of health status such as functional status or dietary behavior during participation in a CR program.

Purpose: Evaluate pre-CR sleep quality as a predictor of change in functional status and dietary behavior during CR.

Design: Single cohort, longitudinal study.

Methods: 33 participants (8 women; mean age 58.1±11.7 years) were recruited upon entry into a three-month CR program. At baseline, participants completed the Pittsburgh Sleep Quality Index (PSQI). At baseline and post-CR, participants completed the Northwest Lipid Research Clinic Fat Intake Scale (FIS) and a six-minute walk test (6MWT). The primary mode of data analysis was hierarchical regression, predicting post-CR 6MWT performance and lipid intake from pre-CR sleep quality, controlling for baseline functional status or lipid intake. Sex was controlled in the 6MWT analysis.

Results: Pre-CR PSQI scores exceeded the threshold for poor sleep quality (threshold = 5; mean = 7.9±4.4). 6MWT performance increased (mean = 31.6±37.4 meters, p <.0001), and lipid intake decreased (mean = -1.3±2.9, p = .013) after CR participation. Post-CR 6MWT performance was greater in men than women (F(1,32) = 5.57, p = .025). Hierarchical regression revealed that higher pre-CR PSQI predicted poorer post-CR 6MWT performance (β= -3.30, p = .032). Pre-CR PSQI did not predict post-CR lipid intake (β= -.08, p = .497).

Conclusions: Overall, sleep quality was poor among participants entering CR. Although lipid intake and functional status improved during CR, poorer sleep quality at baseline predicted less improvement in functional status. Baseline sleep quality was not associated with change in lipid intake. Thus, poor sleep quality may have a negative influence on improvements in functional status among patients in CR. CR programs should consider evaluating sleep quality upon entry, and patients reporting poor sleep quality may benefit from sleep intervention.

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Moderated Poster Presentations, 10:45 AM–12:00 PM Thursday, September 19, 2019

Abstract ID: S118

Title: Right Ventricle Dysfunction & Exercise Tolerance in Pulmonary Rehabilitation - A Retrospective Study

Track: Pulmonary Rehabilitation & Medicine

Author(s): Scott K. Young, MD1, Charlotte C. Teneback1, MD, Bradley Tompkins2.

Institution(s): 1University of Vermont Medical Center, Burlington, VT, USA, 2University of Vermont Department of Medicine Quality Program, Burlington, VT, USA.

Introduction: Pulmonary rehabilitation (PR) is known to improve exercise capacity in individuals with chronic lung disease. Supervised exercise therapy has similar results in individuals with pulmonary hypertension. However, it has never been shown whether a traditional, COPD-oriented PR program can provide the same benefits to patients with right ventricle (RV) dysfunction as it does to other participants. Historically, there was a fear of enrolling patients with RV dysfunction in PR due to concern of adverse events. Here, the outcomes of individuals with RV dysfunction in a traditional PR program was studied using a large existing dataset.

Purpose: To test the hypothesis that patients with echocardiographic evidence of RV dysfunction have a significant improvement in exercise tolerance as measured by 6-minute walk distance (6MWD) after completion of PR. RV dysfunction was selected as a less subjective measure than pulmonary pressures on echo.

Design: Retrospective chart review.

Methods: PR enrollment records were used to identify subjects. Hospital records were reviewed for presence of an echocardiogram within 1 year of enrollment in PR.


Inclusion criteria:

Enrollment in UVM MC PR program between January 1, 2013 and July 1, 2018

Completion of at least 50% of PR sessions

Completion of pre and post 6MWD

Exclusion criteria:

No echocardiographic data from within 1 year of enrollment in PR.

Statistical analysis: We hypothesized that patients with RV dysfunction will have a significant improvement in their 6MWD after completion of PR. A two-tailed t-test with an alpha of 5% was applied, using Microsoft Excel and STATA.

Results: 21 patients met inclusion criteria and had RV dysfunction. These patients had a significant increase in their 6MWD (p = 0.0014, Mean 63.55 meters, 95% CI= 25.3 to 103.4 m). There was no difference in the change in 6MWD between those with RV dysfunction (64.16 meters; n=21) vs. those without RV dysfunction (63.55 meters; n=92); (two-sample t-test; t = -0.039; p = 0.97). No adverse events were recorded.

Conclusions: Individuals with RV systolic dysfunction were able to safely exercise in a traditional PR program, and had statistically significant (p<0.01) and clinically meaningful improvement in their 6MWD, similar to that of a typical participant. While this study has a small sample size, these findings support the use of PR for patients with RV dysfunction.

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Abstract ID: S119

Title: Cardiac Rehabilitation in Patients With Type 2 Myocardial Infarction: A Report of a Case Series

Track: Cardiovascular Rehabilitation & Clinical Cardiology

Author(s): Melissa J. Bowman, BS, CEP, Kasara A. Mahlmeister, MS, RCEP, Jose R. Medina Inojosa, MD, Maria Irene Barillas Lara, MD, Amanda R. Bonikowske, PhD, Randal J. Thomas, MD, Ray W. Squires, PhD

Institution(s): Mayo Clinic, Rochester, MN, USA.

Introduction: A type 2 myocardial infarction (MI) is caused by a myocardial oxygen supply and demand mismatch in the absence of coronary thrombosis (coronary artery disease). Although underappreciated, type 2 MI may be even more common than type 1 MI and is associated with a poor prognosis. Although cardiac rehabilitation (CR) is recommended for all post MI patients, the utility and benefits of CR for patients with type 2 MI have not been established.

Purpose: To determine if patients with type 2 MI participate in CR and to evaluate responses of participants to the program.

Design: Case series study of type 2 MI patients who participated in CR.

Methods: Data were extracted from medical records and available databases for the period of February 2016 to April 2018 to identify patients with type 2 MI who participated in CR. We assessed age and sex, causes of type 2 MI, number of exercise sessions, aerobic exercise modalities, duration of aerobic exercise, complications resulting from training, and baseline and post CR six minute walk distance. We also assessed vital status as of April 5, 2019.

Results: We identified a total of 289 participants with MI (66±13 years of age); 12 with type 2 MI (4.2%); seven women and five men, mean age 74±10 years of age. Causes of type 2 MI included: tachycardia, hypotension, stress cardiomyopathy, demand ischemia due to sepsis, anemia, and hypertension. Total number of exercise sessions was 257 with a mean of 21±13 per patient. Exercise modalities included non-weight bearing combination arm/leg stepper in 6 patients, treadmill in five patients and walking track in one patient. Average duration of aerobic training was 30±6 minutes. All patients performed resistance training and aerobic high-intensity interval training. The only complication was symptomatic bradycardia during a single training session in one patient. Pre- post CR six minute walk distance improved by 64±24 m (n=7; p=0.03). One patient died during the 38 month period of observation.

Conclusions: Very few patients with type 2 MI participate in CR. Type 2 MI patients are older than the typical MI patient in CR. The exercise prescription for these patients is typical for all post MI patients and is well-tolerated. Six minute walk distance improves and adverse events during training are rare. Increased participation in CR and further research is needed to assess mortality and outcomes of type 2 MI patients.

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Abstract ID: S120

Title: What Cardiology Fellows Know and Think About Cardiac Rehabilitation

Track: Cardiovascular Rehabilitation & Clinical Cardiology

Author(s): Garrett Kellar, EdD(C), CCRP, RCEP, EP-C, EIM31, Kelly Allsup, BS3, Gavin Hickey, MD1,2,3

Institution(s):1University of Pittsburgh, Pittsburgh, PA, USA, 2University of Pittsburgh Medical Center, Pittsburgh, PA, USA, 3VA Pittsburgh Healthcare System, Pittsburgh, PA, USA.

Introduction: Cardiac rehabilitation (CR) is a Class 1A recommendation for those with cardiovascular disease (CVD) and is a vital step in their recovery. However, it is vastly under referred. CR referrals at teaching hospitals are the lowest, thus indicating a gap that needs to be addressed as part of the physician education process.

Purpose: While independently practicing physician knowledge (what is known about CR) and attitudes (what is thought about CR) has been evaluated there has been limited work isolating cardiology fellows. The purpose of this study was to assess cardiology fellows' knowledge and attitudes towards CR.

Design: An anonymous 9-question survey was electronically distributed to 30 Department of Medicine Cardiology Fellows.

Methods: The survey questions were chosen from surveys used in previous work to assess physicians' knowledge and attitudes towards CR. Each question had correct and incorrect answers. Initially, fellows were asked a multiple choice question regarding the indication for CR. Next, fellows were asked about: eligibility requirements, benefits, and what CR entails. The highest possible scores were 7, 6, and 5 respectively. The overall aggregate score for knowledge categories is the sum of correct responses minus incorrect responses. Correct answers were based on current American Heart Association (AHA) and American College of Cardiology (ACC) guidelines. A higher score indicates increased knowledge. Attitudes in various domains were measured with a 7-point Likert Scale.

Results: Twenty-one (70%) fellows completed the survey. Twenty (95%) of the fellows were aware of CR being a Class 1A indication. The fellows had low knowledge scores in eligibility 3.33 (48%), benefits 2.0 (33%) and what CR entails 1.62 (32%). In terms of attitudes, fellows deny being skeptical of the the benefits of CR 1.48 (95%), local CR programs 1.62 (95%), and CR's costeffectiveness 1.76 (95%). Additionally, fellows do not refer patients to CR because they forget 4.38 (67%) or are unaware how to refer 4.48 (62%).

Conclusions: Despite knowing that CR is a Class 1A indication, fellows demonstrate a lack of knowledge regarding CR. Although fellows believe in the benefits of CR they are unaware of the specifics. Furthermore, fellows are uncomfortable answering questions about CR, are forgetful of CR, and are unaware of referral processes. To date, no known interventions have been developed, tested or implemented at the fellowship level. Identification of these knowledge gaps can help inform the design of education programs for cardiology fellows, as well as enhance what is currently in place.

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Abstract ID: S121

Title: Comparison of Two Pulmonary Rehabilitation Regimens for Recovery After Lung Transplantation

Track: Pulmonary Rehabilitation & Medicine

Author(s): Jeremy McNatt, M.Ed., ACSM-CCES, Erin Mwizerwa, RN, BSN, Katelyn McCloskey, RRT, Ivan Robbins, MD, Ciara Shaver, MD, PhD, Stephanie Norfolk, MD, April Williams, MS, ACSM-RCEP, Karen Klein, MS, Rachel Moore, MS, ACSM-CEP, Sara Tebos, RN, BSN

Institution(s): Vanderbilt Medical Center, Nashville, TN, USA.

Introduction: Pulmonary rehabilitation (PR) is a key part of patient care prior to lung transplantation. However, the optimal strategy for post-transplant PR is uncertain.

Purpose: We hypothesized that more intensive supervised pulmonary rehabilitation after lung transplantation would correlate with improved 6 minute walk distance (6MWD) and reduced time needed to reach a goal of 30 minutes of continuous cardiovascular exercise.

Design: We performed a cohort study of lung transplant recipients to compare the efficacy of two PR regimens.

Methods: Seventy-eight consecutive lung transplant recipients at Vanderbilt University Medical Center between 7/2015 and 9/2018 who survived > 90 days were included. One group (n=48, 7/2015-6/2017) was prescribed supervised PR 5 days/week for 10 weeks (5×10 group). Another group (n=30, 7/2017-9/2018) was prescribed supervised PR 3 days/week for 8 weeks (3×8 group), supplemented by additional self-exercise on non-PR days for a total of 10 weeks. All patients completed 6MWD tests, PHQ-9, and RPD assessments on their initial and final visits. The goal of PR was to be able to complete 30 minutes of continuous exercise. The primary outcome was improvement in 6MWD. The secondary outcomes were time needed to achieve the PR goal and changes in PHQ-9 and RPD scores. Improvement in 6MWD, PHQ-9, and RPD were assessed by paired Wilcoxon signed rank testing. Other continuous variables were compared using Mann Whitney U testing and categorical variables were compared using Chi squared testing. p <0.05 indicated statistical significance.

Results: The 3×8 group received more double lung transplants (93% vs. 63%, p=0.009) and were younger (52 vs. 58 years, p=0.02). Both groups completed 10 weeks of PR. The 5×10 group completed 42 supervised visits while the 3×8 group completed 24 supervised and 12 unmonitored visits (p<0.001 for # supervised PR). The 6MWD increased significantly in both groups (p<0.001) with the 5×10 group increasing by 680 ft (65%) and the 3×8 group increasing 515 ft (53%) (p<0.037). The median time to reach PR goal was 8 visits for the 5×10 group and 13 visits for the 3×8 group (p<0.001); 97% of patients met PR goals by 12 weeks. PHQ-9 and RPD also improved in both groups.

Conclusions: Both PR regimens tested were effective and resulted in improved 6MWD. More intensive supervised PR was associated with greater improvement in 6MWD and reduced time to achieve PR goals. Further work is needed to determine the optimal strategy for PR after lung transplantation.

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Abstract ID: S122

Title: The Impact of Resource Utilization in Cardiac Rehabilitation of Behavioral and Nutritional Therapy on Weight Loss in Men Versus Women

Track: Cardiovascular Rehabilitation & Clinical Cardiology

Author(s): Arlene Gaw, RN, BSN, MS, CCRP, BC-CVN1, Reema Qureshi, MD1, Wen Chih Wu, MD2, Donna Attardo, RN, BSN, CCRP, BS-CVN1, Loren Stabile, MS3

Institution(s):1Miriam Hospital Cardiac and Pulmonary Rehab, Providence, RI, USA, 2Miriam Hospital Cardiac and Pulmonary Rehab, Providence VA Medical Center, Providence, RI, USA, 3The Miriam Hospital, Providence, RI, USA.

Introduction: In traditional cardiac rehabilitation (CR), weight loss is minimal unless specifically defined as an objective. With CR facilities now offering behavioral therapy (BT) and nutritional therapy (NT), it would be prudent to evaluate their utilization and efficacy.

Purpose: To examine the differences in patterns of resource utilization (BT, NT or both) between men and women, and their respective weight loss outcomes.

Design: A retrospective study was conducted evaluating all CR patients from October 2017 to September 2018 with body mass index (BMI)>25 who attended at least 50% of their scheduled visits.

Methods: Data was obtained from the American Association of Cardiovascular and Pulmonary Rehabilitation registry and local chart review, and imported into STATA for statistical analysis. Chi-square tests was performed to evaluate the utilization of NT, BT or both in Men and Women. T-tests were performed to evaluate the difference in weight loss comparing men and women attending NT, BT or Both.

Results: Of the 273 patients included, 76% were men, the average age was 63.98±11.63, the total weight loss after CR was 1.39±3.30kg. In men the average weight loss was 1.42±3.50kg versus 1.28±2.56kg in women, p=0.72. There were 75 (27%) patients who used BT, representing 24% of all men and 38% of all women attending CR; p=0.023. There were 167 (61%) patients who used NT, representing 58% of all men and 72% of all women attending CR; p=0.035. There were 65 (24%) patients who used both BT and NT representing 21% of all men and 32% of all women attending CR; p=0.51. The weight loss did not significantly vary amongst those who used BT (1.39±3.28kg vs 1.38±3.32kg, p=0.99), NT (1.45±2.99kg vs 1.28±3.75kg, p=0.69), or both (1.22±3.41kg vs 1.44±3.27kg, p=0.65). Of the 75 patients who used BT; men lost a mean of 1.24±3.48kg, whereas women lost a mean of 1.69±2.88kg; p=0.55. Of the 167 who used NT, men lost a mean of 1.42±3.16kg, whereas women lost a mean of 1.55±2.55kg; p=0.78. Of the 65 patients who used both; men lost a mean of 1.04±3.61kg whereas women lost a mean of 1.60±3.00kg; p=0.51.

Conclusions: Women were more likely to attend BT or NT. However, attendance was not significantly associated with weight loss. Future studies are needed using a formal behavioral weight loss program in-order to show an impact on weight loss. Percentage of body weight lost for a comparison of men vs women would also be an alternative metric.

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Moderated Poster Presentations, 9:45 AM–10:45 AM, Friday, September 20, 2019

Abstract ID: S123

Title: A Qualitative Assessment of Endorsement and Referral of Cardiology Fellows

Track: Cardiovascular Rehabilitation & Clinical Cardiology

Author(s): Garrett Kellar, EdD(C), CCRP, RCEP, EP-C, EIM31, Kelly Allsup, BS2, Gavin Hickey, MD1,3Institution(s):1University of Pittsburgh, Pittsburgh, PA, USA, 2VA Pittsburgh Healthcare System, Pittsburgh, PA, USA, 3University of Pittsburgh Medical Center, Pittsburgh, PA, USA.

Introduction: In the United States, cardiac rehabilitation (CR) is vastly underutilized with only 19-34% of eligible patients participate. Lack of physician endorsement and referral to CR is a significant modifiable barrier that often stems from lack of CR knowledge. Studies show that physicians, of varying specialties, lack the necessary knowledge of CR and referral processes significantly limiting their endorsement but none have isolated cardiology fellows. Cardiology fellows spend a significant amount of time treating eligible patients, making them critically important to increasing participation at teaching hospitals where referral is lowest.

Purpose: Previous studies have assessed physicians' barriers to CR endorsement and referral, but limited work has been done to assess barriers of cardiology fellows. This study utilized qualitative approached to assess cardiology fellows' perceived barriers and facilitators to CR endorsement and referral.

Design: Qualitative semi structured interviews were conducted.

Methods: Seventeen of 30 (57%) Department of Medicine Cardiology Fellows were interviewed. Interviews were recorded and transcribed, a single coder conducted thematic analysis by manual coding utilizing the test-retest method to identify key themes across all interviews.

Results: Four themes for barriers and two for facilitators were identified related to endorsement to CR and referral to CR. The most common barriers for endorsement were 1) knowledge of how CR operates, 2) limited of communication between CR and providers, 3) patient level factors that the providers assumed would be barriers, and 4) limited time with patient. The most common facilitators were 1) research and 2) patient-centered outcomes. The most common barriers to referral to CR were 1) understanding referral process, 2) multiple hospital rotations, 3) intrinsic physician barriers, and 4) presumed patient barriers. The most common facilitators were 1) ease of access order-sets and 2) reminders in the order-set and from other healthcare professionals.

Conclusions: The findings of this study present in-depth thought processes regarding barriers to CR endorsement and referral that were previously unknown in cardiology fellows. Addressing these specific barriers through fellowship education programming may increase endorsement and referrals. Additionally, targeting the specific thought processes that lead to these perceived fellow barriers could ultimately lead to improved CR participation.

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Abstract ID: S124

Title: A Pilot Study: Impact of Prehabilitation Prior to Cardiothoracic Surgery to Increase Physical Function

Track: Physical Activity/Exercise

Author(s): Kayla A. Kennedy, BA1, Kelly Allsup, BS1, Thomas Byard, BS, MS1,2, Daniel E. Hall, MD, MDiv, MHSc, FACS1,3

Institution(s):1VA Pittsburgh Healthcare System, Pittsburgh, PA, USA, 2University of Pittsburgh, Pittsburgh, PA, USA, 3University of Pittsburgh Medical Center, Pittsburgh, PA, USA.

Introduction: The decision to undergo surgery is complicated and becomes even more complicated as people age. Older adults are at a greater risk of increased functional limitations that often lead to poor post-surgical outcomes. Prehabilitation presents an opportunity to improve post-surgical outcomes by improving physical function in older patients prior to surgery.

Purpose: To assess whether prehabilitation, consisting of an exercise intervention of three to six weeks, prior to cardiothoracic surgery can improve a patient's physical function.

Design: A pilot study to evaluate feasibility of prehablitation prior to surgery.

Methods: Veterans scheduled to undergo either thoracic or cardiac surgery had their functional capacity assessed at baseline and day of surgery. Functional capacity was measured by modified tug (TUG), hand grip (HG), gait speed (GS), maximum expiratory pressure (MEP), maximum inspiratory pressure (MIP), and a six-minute walk distance (6MWD). Each patient completed a prehabilitation regimen in a combination of on-site and at home exercise, that focused on aerobic, breathing, strength, balance, and transitional movement exercises. Exercise intensity was based on rate of perceived exertion (RPE) and exercises were adjusted based on ability to meet set RPE levels, with a goal of 5 days a week of exercise as directed by the study exercise physiologist.

Results: FourteenVeterans age 68.25±7.95 completed an average of 4 weeks of prehabilitation and underwent thoracic or cardiac surgery. We found significant improvements in function in TUG (19.90±4.50 vs 18.10±4.40, p=0.013), GS (1.11±0.24 vs 1.21±0.24, p=0.011), MEP (96.71±32.70 vs 117.78±32.24, p=0.011), and 6MWD (329.44±157.38 vs 365.4±179.42, p=0.012) between baseline and day of surgery. No significant differences were seen in HG (34.73±8.30 vs 34.61±8.01, p=0.890) and MIP (69.64±23.02 vs 70±22.39, p=0.920).

Conclusions: Prehabilitation prior to thoracic or cardiac surgery significantly improved function. This demonstrates patients benefit from prehabilitation prior to surgery by increasing functional capacity. These improvements in functional capacity may additionally improve post-surgical outcomes. Often there is a drive to perform surgery as soon as possible once the need for surgery is determined, however significant improvements in functional capacity in the weeks prior to surgery implies there may be a benefit in delaying surgery for some patients.

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Abstract ID: S125

Title: Factors Associated With Perceived Stress in Cardiac Rehabilitation Patients

Track: Cardiovascular Rehabilitation & Clinical Cardiology

Author(s): Joseph R. Merighi, PhD, MSW, LISW1, Timothy C. O'Keefe, MSW, LGSW2, Mingyang Zheng, MSW1, Marsha Burt, MS/RCEP, CCRP3, Aaron Pergolski, MA/RCEP, CCRP4, Teresa Fietek, BA, CES, RCEP, CCRP5, Maureen Devereaux, OTR/L, CES, CCRP2

Institution(s):1University of Minnesota - Twin Cities, Saint Paul, MN, USA, 2Fairview Health Services, Minneapolis, MN, USA, 3Fairview Health Services, Wyoming, MN, USA, 4Fairview Health Services, Edina, MN, USA, 5Fairview Health Services, Burnsville, MN, USA.

Introduction: Cardiovascular disease is the leading cause of mortality in the United States. Research has shown that stress is not only a risk factor for developing cardiovascular disease, it also affects cardiovascular recovery. As a result, many cardiac rehabilitation (CR) programs provide stress management approaches for their patients to promote better health outcomes. However, because the factors associated with a stress response among CR patients remain unclear, it is difficult to develop an effective stress management intervention that aims to alleviate the sources of stress in this patient population.

Purpose: The aim of this study was to explore factors associated with perceived stress among CR patients. Guided by an ecological framework, the study hypothesized that individual characteristics and environmental factors were associated with self-reported stress.

Design: A cross-sectional survey design was used to measure CR patients' perceived stress (Perceived Stress Scale-10, PSS-10), demographic characteristics, barriers to health care access, and self-reported health status.

Methods: The survey was self-administered and took patients an average of 30 minutes to complete. The total sample size was 149 across four rehabilitation centers. Data were analyzed using multiple regression to explore significant predictors of perceived stress.

Results: The multiple regression model explained 23% of the variance in the CR patients' PSS-10 scores [F(9, 139) = 4.52, p < .001]. Four significant factors were identified. Higher health care barrier index scores predicted higher PSS-10 scores (ß = 0.16, t = 2.71, p < .01). Patients who reported better health status were associated with lower PSS-10 scores (ß = -2.34, t = -2.03, p < .05). Female patients, on average, had a higher PSS-10 score than male patients (ß = 2.87, t = 2.45, p < .05). Older age was a predictor of lower PSS-10 scores (ß = -0.1, t = -2.02, p < .05).

Conclusions: This study contributes to the literature and clinical practice by identifying the significant factors associated with stress levels among CR patients. Findings from this study can be used by CR program staff and leadership to develop tailored interventions and curricula to reduce the CR patients' perceptions of stress, as well as the physical and psychological sequalae of chronic stress.

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Abstract ID: S126

Title: Outpatient Pediatric Prehabilitation Before Heart Transplantation

Track: Cardiovascular Rehabilitation & Clinical Cardiology

Author(s): Angela J. Heydmann, BS, CEP, Melissa J. Bowman, BS, CEP, Kasara A. Mahlmeister, MS, RCEP, Ray W. Squires, PhD, Randal J. Thomas, MD, Amanda R. Bonikowske, PhD

Institution(s): Mayo Clinic, Rochester, MN, USA.

Introduction: The waiting period for organ transplantation poses unique challenges and stressors for transplant candidates and their families. We postulated that participation in outpatient cardiac rehabilitation (CR) before transplantation (prehabilitation) would provide emotional support and result in improved fitness. Prehabilitation is structured exercise over a period of weeks prior to major surgery with the goal of improving cardiovascular, respiratory and skeletal muscle conditioning. It is associated with lower postoperative complication rates and earlier restoration of physical function.

Purpose: To describe the course of prehabilitation for two young patients who were awaiting heart transplantation.

Design: Case-based descriptive study of a novel CR service.

Methods: In 2019, two male pediatric patients were referred to CR while awaiting heart transplantation. Patient A was 12 years old with a diagnosis of complex cyanotic congenital heart disease. Patient B was 15 years old with a diagnosis of idiopathic dilated cardiomyopathy with implantable cardioverter- defibrillator implantation. Patients performed aerobic and muscle strengthening exercises using a circuit training approach of 10-15 minute segments designed to facilitate patient engagement. Exercise intensity was prescribed using ratings of perceived exertion of 12-14 on the 6-20 scale. Frequency was prescribed at three sessions per week. Goal total duration was 45 minutes.

Results: The patients have performed a total of 26 exercise sessions to date. Aerobic exercise modes for Patient A include pediatric upright cycle and Wii boxing (his preferences). He also performs 7 strength training exercises. Aerobic exercise modes for Patient B include treadmill and arm/leg combination cycle (his preferences). He also performs the strength training exercises. Patient A has participated much longer than Patient B and intermediary outcome measures are available for Patient A: progression of cycle exercise time to 30 minutes (2 × 15 minute segments) and intensity (15 watts to 25 watts, approximately 2 METs to 2.7METs); increases in strength training dose: +3 lbs. for bicep curl, +13 lbs. for back row, +6 lbs. for triceps extension, +12 lbs. for chest press, +3 lbs. for shoulder shrugs, +10 repetitions for lunges, and +10 repetitions for calf raises. Six minute walk distance increased by 170.7m (560 feet). Both patients are tolerating the training without complications. Patient A is more enthusiastic regarding participation than is Patient B. Both patients' parents are supportive.

Conclusions: Pediatric prehabilitation before heart transplantation appears feasible, is well-tolerated and results in improved fitness. Additional work is required to more completely evaluate this novel CR service.

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Scientific Posters

Abstract ID: S127

Title: The Promotion of Exercise Oncology as a Standard Part of Clinical Practice

Track: Physical Activity/Exercise

Author(s): Karen Wonders, PhD1,2, Rob Wise, CES1, Danielle Ondreka, CES1, Trent Seitz, CES1

Institution(s):1Maple Tree Cancer Alliance, Dayton, OH, USA, 2Wright State University, Dayton, OH, USA.

Introduction: Exercise is safe and effective during cancer treatment and a valid option for health care providers to address the short and long-term effects of current cancer therapy and minimize toxicities. However, nationally, less than 5% of cancer patients exercise during treatment.

Purpose: The purpose of this investigation was to promote the standardization of exercise oncology as part of clinical practice by examining its effect on symptom severity, program outcome, and cost savings.

Design: This controlled clinical trial evaluated the effects of individualized exercise therapy in 1,191 patients undergoing chemotherapy treatment.

Methods: Each participant participated in a 12-week individualized exercise program through Maple Tree Cancer Alliance, and completed a comprehensive fitness assessment and a subjective symptom checklist at the start and conclusion of their treatment regimen. ER visits, length of hospital stay, and 30-day readmits were restrospectively analyzed following cessation of treatment.

Results: Individualized exercise had a positive impact on fitness parameters and symptom severity, and produced cost savings of approximately $3,000 in the first 6 months of exercise. Specifically, cardiovascular endurance, muscular strength, quality of life, depression, fear fatigue, and pain all improved following the exercise intervention.

Conclusions: Exercise is an effective means to manage treatment-related symptoms in cancer and should be a part of the standard of care.

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Abstract ID: S128

Title: Smart Phone Enabled Cardiac Rehabilitation

Track: Physical Activity/Exercise

Author(s): Lindsay James Riegler, PhD, CCS-SLP, CBIS, Kendra Unterbrink, PA, Deonna Suggs, BS

Institution(s): Cincinatti VA Medical Center, Cincinnati, OH, USA.

Introduction: Cardiac rehabilitation (CR) is a life-saving program that reduces hospital readmission and cardiovascular death in those with CHD. Less than 10% of Veterans enroll in center-based cardiac rehab due to cost, limited availability of on-site CR programs and distance to sites. Home-based programs and mobile technologies may help to address these barriers.

Purpose: The purpose of our study is to test feasibility and acceptance of a home-based, smartphone enabled CR application in the Veteran population at the Cincinnati VA Medical Center (CVAMC) facilitated by non-clinical personnel that received specialized training.

Design: The intervention is a 12-week, home-based CR program delivered through a commercially available platform (Movn) that includes patient-facing smartphone application and hospital-facing online dashboard. The dashboard allows a trained coach to monitor patient performance remotely by reviewing the patient entered data, develop tailored exercise plans for each participant and review patient messages/alerts. The application features daily reminders, a virtual diary to document progress, videos on heart conditions and risk factor modification and two-way messaging with the coach.

Methods: Participants were enrolled as part of a convenience sample from those eligible for outpatient CR at CVAMC July through November 2018. Eligible participants were 18 years of age and older with a qualifying indication for CR.

Results: CVAMC consented 16 participants with a mean age of 66.25 (SD +/− 6.71 years) Of which 13 were Caucasian, 2 African=American, 1 Asian. Three participants withdrew due to medical complications. Among program completers (n=8), average number of minutes exercised from 30 days to 90 days increased by more than 200% (400 minutes < 30 days to 1,361 minutes = 90 days) with recorded weight loss in 63% (five lost weight, one maintained and two gained). Participants averaged 6 days of app participation per week across the 90-day protocol with a median of 7 messages sent from the patient to the provider (SD+/−8) and an average of 18 messages sent from the provider to the patients (SD+/− 6).

Conclusions: Our study supports smartphone-enabled, home-based CR as an acceptable and feasible alternative to center-based CR. Participants were satisfied or very satisfied with the intervention and most utilized the secure messaging component of the app to communicate with the coach. Participants reported improved exercise adherence, weight loss and a likeness for the application. The results should be interpreted with consideration taken for the small sample size, absence of a control group and a short follow-up period.

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Abstract ID: S129

Title: Enhanced Depression Screening in the Cardiac Rehabilitation Setting

Track: Cardiovascular Rehabilitation & Clinical Cardiology

Author(s): Heidi Winslow, DNP, MSN-NE

Institution(s): UNCW-SON, Wilmington, NC, USA.

Introduction: Depression is common among patients with cardiovascular disease. The American Heart Advisory Council recommends depression screening, treatment, and support to provide adequate diagnosis to patients. The problem is, a systematic approach to depression management is lacking in the cardiac rehabilitation unit.

Purpose: This evidence-based project was designed to evaluate the impact of a practice improvement intervention for screening and referrals in cardiac patients with depression. The overall goal of this project was to provide the best evidence for practice improvement in depression care for patients with cardiac disease.

Design: The design for this project was a doctoral quality improvement project. The problem is current depression screening and referrals are not being documented electronically in the cardiac rehabilitation setting limiting real-time communication amongst the healthcare team. This project successfully implemented a new electronic Patient Health Questionnaire 2-9 (PHQ2-9) depression and referral screening document flowsheet. Descriptive data (number of patients screened, positive screens documented, and number of appropriate referrals completed electronically) were collected and evaluated.

Methods: Descriptive data (number of patients screened, positive screens documented, and number of appropriate referrals completed electronically) were collected and evaluated.

Results: A 30-day post intervention chart audit revealed a 97% documentation improvement rate for PHQ2-9 surveys. 11% of the patients screened positive for moderate depression. 27% of those patients received a documented referral.

Conclusions: Electronic documentation of depression management is recommended by the American Heart Association and the Agency for Healthcare Research and Quality. A cardiac rehabilitation unit practice change to eletronic documentation improves real-time communication amongst cardiac healthcare professionals. Further research needs to be conducted to evaluate existing barriers for multi-disciplinary documentation of cardiac depression management.

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Abstract ID: S130

Title: The Use of Mobile Health Devices in Cardiac Rehabilitation

Track: Cardiovascular Rehabilitation & Clinical Cardiology

Author(s): Robert Wesley Bloom, BS1, Prashant Rao, MD1, David Shipon, MD1, Drew Nielsen, BS2

Institution(s):1Thomas Jefferson University, Berwyn, PA, USA, 2Thomas Jefferson University, Philadelphia, PA, USA.

Introduction: As of 2017, there are 86.7 million wearable device users in the United States. The increased adoption of these technologies represents an opportunity to improve patient health outcomes. Within the setting of cardiac rehabilitation, where program attrition rates reach 65%, there is potential to use these devices to improve program completion. There are no clear data regarding whether patients undergoing cardiac rehabilitation would be amenable to using these technologies.

Purpose: We sought to evaluate patients' perspectives regarding the use of wearable technologies within cardiac rehabilitation. We hope this would inform decisions on how to implement a wearable device program that meets the needs of this population.

Design: Between August 2018 and November 2018, 41 questionnaires were distributed to consecutive outpatients referred to Jefferson Cardiac Rehabilitation Unit.

Methods: As part of the questionnaire, individuals were assessed demographically as well as asked about their current frequency of vitals self-monitoring, what electronic devices they currently own, their current interest in or usage of wearable devices, what barriers exist to them not currently using a wearable device, what characteristics of a wearable device they would find most valuable, if they felt that utilizing a device would help them to feel more control in control of their health, and if they felt a device would help them to better adhere to their cardiac rehab program. Survey data was analyzed through cross-tabulation to assess differences in responses among patient subgroups.

Results: In the 3 month period, 41 individuals completed questionnaires. 59% were male and the and 79% of those surveyed were over the age of 55. 28 (68%) did not own a wearable device, and of this group, 19 (67%) were interested in obtaining a device. 27 (65%) of respondents reported they would be more likely to adhere to cardiac rehabilitation if they owned a device. 78% of respondents reported they would be interested in a device that would send data to their physician. All individuals who were skeptical regarding the benefit of a wearable device in cardiac rehabilitation were >55 years old.

Conclusions: The majority of patients referred to cardiac rehabilitation do not currently own a wearable device but recognize the potential for devices to help adherence to the program. Older individuals may be more resistant to embracing these technologies. This study highlights the need to expand our use of wearable technology in cardiac rehabilitation to help increase adherence and improve health outcomes.

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Abstract ID: S131

Title: Use of Aromatherapy in the Outpatient Cardiac Rehabilitation Setting

Track: Behavior Change

Author(s): Carol A. Smith, RN, BSN, Janice L. Baker, MSN, RN, CEPS, NEA-BC, FHRS

Institution(s): Chester County Hospital, West Chester, PA, USA.

Introduction: Stress is a major risk factor for heart disease and its progression. Stress management is essential to secondary prevention of heart disease for the cardiac rehabilitation patient. It is well established in the research that aromatherapy is beneficial in the reduction of stress in many inpatient populations, such as labor/delivery and CABG patients. After an extensive medical literature review, it was determined that there are no published studies regarding the use of aromatherapy in the outpatient cardiac rehabilitation setting.

Purpose: Finding new and innovative methods to reduce stress is challenging. It was hypothesized that the outpatient cardiac rehabilitation patient could experience similar benefits of stress/anxiety reduction as demonstrated by inpatient populations.

Design: To measure the efficacy of aromatherapy, both subjective and objective measures of stress reduction were utilized. Objectively, a review of the literature pointed to the State-Trait Anxiety Inventory (STAI). Subjectively, patients were questioned “Do you feel the patch helped relieve your stress?” The Bergamot patch was the instrument of delivery. Inclusion criteria were participants of cardiac rehabilitation who identified moderate/high levels of stress at time of initial interview, PHQ9 score &gt 10, and those who demonstrated increased stress levels during rehabilitation. Excluded were patients with respiratory disease, known allergy or aversion to the ingredients, and patients not interested.

Methods: 25 patients were provided a single use aromatherapy patch to be used at home when experiencing moderate/high stress. Prior to application, patients were instructed to complete STAI questionnaire #1. Patients were then instructed to complete #2 STAI questionnaire in 2-3 hours post patch application or upon wakening if they had fallen asleep. Questionnaires were then returned next cardiac rehabilitation session. Averages of STAI score pre/post were compiled and evaluated. In addition, efficacy was analyzed by age and sex. Percentage of respondents who found patch helpful was calculated.

Results: Data analyzed demonstrated stress reduction with the use of aromatherapy. Objectively, STAI scores reduced by 27% post patch application. Subjectively 57% indicated the patch helped with stress reduction. Most improvement was noted among younger females.

Conclusions: Aromatherapy continues to be utilized in this setting. Expansion of aromatherapy to the satellite location and other aromatherapy modalities including air diffusers, lotions, etc. are upon consideration. Limitation of this project was the small number of participants enrolled from a single suburban location. Next steps would be to replicate this project in additional programs in urban, suburban, and rural locations.

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Abstract ID: S132

Title: VERCI (Veterans Enrolled in Restorative Care Plus Intervention)

Track: Physical Activity/Exercise

Author(s): Mary L. Lewis, BS1, Jamie Giffuni, MS2, Nana-Yaw N. Adu-Sarkodie, MD, MPH2

Institution(s):1Morgan State University, Baltimore, MD, USA, 2MD VA Health System, Baltimore, MD, USA.

Introduction: Background: Older U.S. Veterans in the VA Community Living and Rehabilitation Center (CLC) have disproportionately higher rates of sarcopenia, dynapenia, and higher incidences of frailty which result in loss of functional mobility and increased risks of falls and fall-related injuries than older non-veterans.

Purpose: Examined whether a four week, once weekly, low impact strength training intervention can improve physical function in measures of grip strength, upper/lower extremity function, gait speed, and Short Physical Performance Battery (SPPB) score.

Design: 11 patients were selected. Eligibility criteria: Participation in Restorative Care Program. Exclusion criteria: unstable chest pain, hospice, advanced dementia, and open infectious wounds. Consent from the patients' families was obtained. For final inclusion of the project, 7 patients were chosen to participate by exercise physiology team. 3 patients were excluded due to known volatile behavior, blindness, bed-bound, and 1 patient declined.

Methods: Physical performance was assessed at baseline and post-intervention; baseline results were used to develop an individualized exercise prescription. The SPPB battery included the following tests: Standing balance battery,8 Foot Walk-test, 5 Chair Stands and 30 Second Arm Curl Test The primary outcome measures will be balance and strength/power at baseline (pre-test) and after the intervention (post-test). All exercises were performed seated or lying in bed with head raised to minimize the risk of falling. Body weight, resistance bands, or hand/ankle weights were used depending on SPPB and RPE. The duration of each session per patient ranged from 30-60 minutes.

Results: Seven male Veterans (5 AA/2 White), (mean age 73 years (55-98), completed 4 weeks of training. 100% (N=7) were functionally impaired with a SPPB 9. After four weeks of the V.E.R.C.I. Project, 79% (N=6) improved their SPPB score. Mean improvement was 6% (from 3.0±3 to 3.2±3, (+0.8) mean + SD). Of those who improved, 42.8% (3/7) individuals increased their SPPB score. When stratified by total hand grip strength and arm curls (N=6), hand grip strength improved by 15% (from 35 ± 21 to 41.5 ± 23 (+1.2), mean + SD), arm curls improved by 19% (from 12+4 to 17+4, When examining measures in gait speed, 57% (N=4) improved their overall gait speed by 40% (from 0.33+ 0.11 to 0.5+0.03, (+1.7).

Conclusions: The limitations were the small sample size, short duration of the intervention; lack of psycho-social evaluation for pre-and post-intervention. A future study for larger sample size and longer duration with pre-and post psycho-social evaluation are needed.

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Abstract ID: S133

Title: The Cardiac Rehab Experience: A Narrative Inquiry

Track: Behavior Change

Author(s): Jordan Ellis, MA, Emily Midgette, BA, Taylor Freeman, MA, Alexander Capiaghi, BS, Matthew Whited, PhD

Institution(s): East Carolina University, Greenville, NC, USA.

Introduction: Patient education allow patients to be well-informed regarding their healthcare; however, education often lacks patient “stories” or narratives. Patient narratives can provide information about subjective illness experiences, and can provide patients with a better understanding of what they may experience related to their illness, treatment, or rehabilitation. Research has indicated that narrative formats of communication are at least as effective as patient education that takes a didactic or statistical evidence approach for improving engagement in health behaviors.

Purpose: The purpose of the present study was to use narrative inquiry techniques to analyze qualitative interviews with cardiac rehabilitation (CR) patients to produce a composite narrative that could be used to enhance future educational materials.

Design: Participants (N =17) were recruited from a CR program located in a Southeastern city. The study utilized qualitative data collected and thematically analyzed from a previous study, and employed narrative inquiry to create a first-person composite narrative.

Methods: For the current post-hoc composite narrative analysis, a team of four researchers re-examined interview content related to the previously identified themes and concepts. Excerpts describing CR experiences were then restructured, combined, and incorporated to create a unique narrative. This composite narrative methodology has been used in prior research across a variety of phenomena. The narrative was then reviewed and approved by two senior staff members at the CR program from which the data were collected.

Results: A hypothetical patient character representing an amalgam of 17 CR patients was produced, and the narrative was written to include an initial cardiac event, description of rehabilitation, difficult experiences, and reflection on accomplishments and personal values. The story is set around the time of a patient's graduation from a CR program.

Conclusions: The narrative resulting from our rigorous qualitative analysis of CR interview data is fit for use as a tool among providers and patients to provide a deeper understanding of the experiences they, or their patients, may have during CR. This narrative is especially suited for patient recruitment materials and early-provider education. Continued research will be directed towards determining whether the inclusion of the narrative in patient education/recruitment materials results in greater CR participation and completion rates.

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Abstract ID: S134

Title: Identifying Specific Elements Necessary for a Pediatric Cardiac Rehabilitation Program: An e-Delphi Study

Track: Cardiovascular Rehabilitation & Clinical Cardiology

Author(s): Tracy Curran, PhD1, Rachele Pojednic, PhD2, Naomi Gauthier, MD1, Susan Duty, ScD, RN, ANP-BC2

Institution(s):1Boston Children's Hospital, Boston, MA, USA, 2Simmons University, Boston, MA, USA.

Introduction: Encouraging children and adolescents with congenital heart disease (CHD) to participate in regular exercise is an essential component in helping them rise toward their full potential physically, socially, and emotionally. Identifying appropriate tools and resources that promote healthy and active lifestyles specifically for this population are currently lacking and must be developed. Cardiac rehabilitation programs are an effective modality with beneficial clinical outcomes for adult patients living with coronary heart disease, however these programs are scarce for the CHD pediatric population and not well defined.

Purpose: The purpose of this study was to identify relevant content for the development and structure of a pediatric cardiac rehabilitation curriculum for young patients with CHD using a consensus approach.

Design: A three-round e-Delphi method was used to identify specific content for a pediatric cardiac rehabilitation curriculum among CHD and pediatric exercise physiology experts from across the nation. The study was conducted over a 4 month period via Research Electronic Data Capture, an online survey platform.

Methods: Experts provided opinions in a closed- and open-ended electronic questionnaire in round one. In the second round, experts were asked to re-rate the same items after feedback and summary data was provided from round one. In the third round, the same experts were asked to re-rate items that did not reach consensus from round two. Statistical analysis of demographic data and response data for each questionnaire item included mean, median, mode, count, count percentage, range and standard deviation scores, one item used the co-efficient of variation. Consensus was determined a priori and was considered complete when the majority of the expert panel responses achieved that set threshold.

Results: 37 experts consented, 35 completed round one, 29 completed round two and 28 completed the final round. After the third round, consensus was reached in 55 of 60 (92%) questionnaire items. Experts identified specific elements across four domains: exercise training, education, outcome measures and self-confidence to be included in a Pediatric Cardiac Rehab Curriculum.

Conclusions: This study established consensus toward the ideal program structure, exercise training principles, educational content, patient outcome measures and self-confidence promotion. By identifying the key components within each domain, there is potential to benchmark recommended standards and practice guidelines for the development of a Pediatric Cardiac Rehab curriculum to be used by exercise physiologists, pediatric and adult congenital cardiologists, and other healthcare team members for optimizing the health and wellness of pediatric CHD patients.

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Abstract ID: S135

Title: Correlation of Readmission Rates and Quality of Life of Patients Who Attend Cardiac Rehabilitation Versus Those Patient Who Do Not Attend

Track: Cardiovascular Rehabilitation & Clinical Cardiology

Author(s): Margarita Erb, RN, CCRP

Institution(s): NorthBay Healthcare, Vacaville, CA, USA.

Introduction: This study will show that patients who attend cardiac rehabilitation have a decrease readmission rate and can better manage their activities of daily living as evidenced by improved quality of life (QoL) survey scores.

Purpose: The purpose is to explore if there is a correlation between participating in cardiac rehabilitation, readmission rates and QoL. It is well documented that cardiac rehabilitation is an underutilized program. According to AACVPR and the American Heart Association, cardiac rehabilitation has positive outcomes for those who participate.

Design: The design is a mixed method research using a retrospective case control coupled with grounded theory. It was conducted once patients had completed the cardiac rehabilitation program, comparing QoL, and thirty day readmission rates between the patients that attended cardiac rehabilitation versus those who did not complete the program.

Methods: Patients admitted to the hospital or direct referrals from a doctor's office with a primary diagnosis of CHF, PCI, CABG, valve repair or replacement, stable angina, STEMI or NSTEMI were included in the study. The sampling size was 289. Two quality of life surveys were utilized: PHQ-9 and Dartmouth COOP. Statistical analysis tests used were a one-proportion z-test to determine whether or not there was a statistically significant decrease in the readmission rate. The hypotheses are H0: the readmission rate is 15.4% versusHa: participation the program decreases the readmission rate to 10.01%.

Results: For the readmission part of this study, 218 patients completed the program, 1 patient being readmitted within 30 days. 60 patients did not complete the program and 1 was readmitted within 30 day. The sample readmission rate for patients who attended cardiac rehabilitation is 1/218=0.004587. The sample readmission rate for patient who did not attend is 1/60=0.016667. The sample difference of -0.012080 has a P-value of 0.386, which is greater than our chosen level of significance . There is no statistically significant difference in the readmission rate for patients who attended vs. those that did not. For the QoL part of this study 268 patients met inclusion criteria. For the COOP data 228/268 = 85.1% of patients reported an improvement and for the PHQ9 216/267=80.9% of the patients reported an improvement.

Conclusions: Even though this study did not have a statistical significance, it does show that there is a compelling improvement in both areas, readmission and QoL, proving the benefits of participation.

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Abstract ID: S136

Title: Exercise Training for VAD Eligibility in a Severely Deconditioned IV Inotrope HF Patient: A Case Study

Track: Cardiovascular Rehabilitation & Clinical Cardiology

Author(s): Colleen Daubert, MS, Jennifer Joseph, RN, BSN, Rachel Hayworth, RN, BSN, CHFN, Catherine Garner, RN, Jeffrey Soukup, PhD

Institution(s): New Hanover Regional Medical Center, Wilmington, NC, USA.

Introduction: Heart failure (HF) may be defined as an inability of the heart to meet the metabolic demands of the tissue resulting in symptoms of fatigue or dyspnea on exertion. Although diminished cardiac output plays a central role, additional factors including skeletal muscle atrophy and altered muscle metabolism contribute to reduced exercise tolerance. Exercise has become part of the treatment plan in patients with NYHA class I-III HF, however, there is little evidence supporting exercise in patients with NYHA class IV, advanced HF. To become eligible for advanced therapies such as VAD implant or heart transplant, patients must demonstrate adequate levels of muscular strength, muscular endurance, balance and agility. Failure to do so will disqualify them from consideration. Our patient had been disqualified for VAD implant consideration due to diminished muscular strength and poor balance and was receiving IV milrinone as destination therapy.

Purpose: To report on the exercise training methods used to successfully qualify a severely deconditioned, IV inotrope HF patient for VAD implantation.

Design: A case study report of methods employed during training are provided.

Methods: The Short Physical Performance Battery (SPPB) was used as part of VAD implant eligibility determination and served as the focus of pre and post program measures. The SPPB included repeated chair stands, balance testing and an eight-foot walk test. The patient participated in phase II cardiac rehabilitation 3 days per week for a total of eight weeks. Aerobic exercise was performed on a NuStep consisting of 15-25 minutes of at an intensity of 20-30 beats above rest and a RPE of 11-14 on the Borg scale. Resistance training consisted of 3 sets of 5-10 repetitions of chair stands using body weight or a seated leg press.

Results: Our patient increased aerobic exercise intensity by 88% (pre = 1.8 METs vs. post = 3.3 METs) and resistance training volume, measured as sets x repetitions x load, by 460% (pre = 150 pounds vs. post = 840 pounds). In the SPPB post test, he was able to complete 5 chair stands without the use of his arms, increased his balance time (pre = 9 seconds, post = 10 seconds) and decreased time to walk eight feet (pre = 4.59 seconds, post = 2.0 seconds).

Conclusions: The combination of progressive aerobic and resistive training was employed to allow an advanced HF patient to qualify for VAD implantation.

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Abstract ID: S137

Title: Exercise Testing, Prescription and Training Using Cycle Ergometry in the Intensive Care Unit After Total Artificial Heart

Track: Cardiovascular Rehabilitation & Clinical Cardiology

Author(s): Katelyn D. Brown, BS EP, CCRP1, Jenny Adams, PhD1, Kristen Tecson, PhD2, Dan Meyer, MD3

Institution(s):1Baylor Heart and Vascular Hospital, Dallas, TX, USA, 2Baylor Heart and Vascular Institute, Dallas, TX, USA, 3Baylor University Medical Center, Dallas, TX, USA.

Introduction: In the cardiovascular intensive care unit (CVICU), physical activity is essential to the recovery and rehabilitation of the patient. Inadequate activity is associated with poor outcomes and increased morbidity and mortality. However, it is difficult to achieve the proper amount of activity due to barriers with the patient and environment including acuity, multiple lines, tubes and drains, and staff availability. Patients who receive a total artificial heart (TAH) may be even more restricted due to the equipment and labor required to power, control and monitor the device during activity.

Purpose: The purpose of this study was to investigate the safety and effectiveness of bedside cycle ergometer training on exercise performance and cardiorespiratory fitness in a total artificial heart recipient during an extended stay in the CVICU.

Design: Case study with intervention.

Methods: Following implantation of a TAH, a 53 year old male performed a symptom-limited exercise tolerance test and 5 subsequent exercise sessions on a cycle ergometer placed at bedside in the CVICU between April 19, 2018 and May 3, 2018. The exercise test utilized a ramp protocol guided by the fill volume and blood pressure guidelines for TAH, as well as patient-reported symptoms. The subsequent exercise sessions were performed replications of this method, increasing or decreasing intensity as allowed by the TAH guidelines. Traditional heart rate guidelines and telemetry were not used in this patient, as no cardiac rhythm was present; the beat rate was fixed at 126 for each session. Differences over time in distance pedaled, METs, and duration of exercise are presented as raw numbers and as percentages.

Results: Distance pedaled increased by 1.98 miles (320%), functional capacity increased by 0.9 MET (31%), and duration of exercise tolerated increased by 14 minutes (233%).

Conclusions: After 6 training sessions on the cycle ergometer over 2 weeks in the CVICU, this TAH recipient demonstrated an improvement in functional exercise capacity, distance pedaled, and exercise tolerance. Using a cycle ergometer placed at bedside allowed for the patient to perform physical activity without leaving the room, overcoming environmental barriers to activity while in the CVICU. This patient achieved a 1 MET increase, corresponding to a 20% decrease in risk of mortality and was subsequently bridged to transplant without complication or readmission.

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Abstract ID: S138

Title: Comparison of Outcomes Related to Shortness of Breath in Phase II Pulmonary Rehabilitation

Track: Pulmonary Rehabilitation & Medicine

Author(s): Teresa M. Corbisiero, MBA, BSN, RN-BC, FAACVPR1, Julia M. Day, BA, AD, RN, CCRP2, Nathan J. Boehlke, MS, ACSM, FAACVPR1, Allison B. Haverkate, BS, EP, CCRP1, Jillian N. Omtvedt, MBA ACSM-CEP, CCRP1, Caitlin M. Stackpool, MS, ACSM-CEP1, Hollie K. Caldwell, PhD, RN1, Joseph C. Kitto, BS, EP, CCRP3, Kiersten L. Jordan, BS, EP, CCRP3, Erin Lucy Hinesley, BS, EP, CCRP3

Institution(s):1Porter Adventist Hospital/Centura Health, Denver, CO, USA, 2St. Anthony Hospital/Centura Health, Lakewood, CO, USA, 3St. Anthony North/Centura Health, Westminster, CO, USA.

Introduction: Pulmonary Rehabilitation (PR) is an integral treatment for patients with Chronic Obstructive Pulmonary Disease (COPD). It is not established whether any baseline parameter can predict response or compliance.

Purpose: The aim was to compare pre and post San Diego Shortness of Breath Questionnaire (SOBQ) scores and 6-Minute Walk Distance (6MWD) results among Phase II PR participants.

Design: A retrospective comparative design contrasted participants of a Phase II PR program who completed ≥ 12 sessions between January 2015 and December 2018 at two hospital-based PR programs located in the west.

Methods: The SOBQ survey (24-items) assesses self-reported shortness of breath while performing a variety of activities of daily living (ADL) using a 6-point scale (0 = “not at all” to 5 = “maximal or unable to do because of breathlessness”). Score range is 0 to 120. A medical record review was conducted to collect completed SOBQ scores, 6MWD distance, number of PR sessions, gender, and age among PR recipients. The t-test was used to determine statistical significance along with Pearson correlation.

Results: Forty-two males (mean age = 73.5) and 50 females (mean age = 69.8 years) participated (n =92). When differences were examined between pre SOBQ and post SOBQ scores, the results were statistically significant with a mean difference of -10.2 (p =<0.001). The results for pre-6MWT and post- 6MWT were also statistically significant with a mean difference of 71.6 (p =<0.001). However, when comparing SOBQ scores and number of sessions attended for patients with COPD, the linear correlation was not significant (F (1,118), p = .674, p = .413).

Conclusions: Participants attending PR significantly improved their SOBQ scores and 6MWT distance. Preliminary data suggest there was no significant Pearson correlation between change in SOBQ score and number of sessions attended. It is hypothesized SOB self-awareness is related to severity of disease progression. Research Implication: Severity of disease progression can be tracked by looking at pre and post PFT data to rule out patients whose pulmonary function has declined. Clinical Implication: Oftentimes, patients starting PR have limited their daily activities due to their perception of their SOB. As patients' progress through PR, confidence improves, increasing their desire to perform higher levels of ADL, resulting in a higher self-awareness of the severity of their SOB. It may be beneficial to assess the potential correlation between quality of life scores and number of completed PR sessions.

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Abstract ID: S139

Title: Implementing Left Ventricular Assist Device Policies for the Care of the Biventricular Assist Device Patient: A Quality Improvement Initiative

Track: Cardiovascular Rehabilitation & Clinical Cardiology

Author(s): Donna Attardo, RN, BSN, CCRP, BC-CVN1, Wen-Chih Wu, MD1,2, Khansa Ahmad, MD1,2, Loren Stabile, MS1, Arlene Gaw, RN, BSN, MS, CCRP, BC-CVN1

Institution(s):1The Miriam Hospital, Providence, RI, USA, 2Providence Veterans Medical Center, Providence, RI, USA.

Introduction: The use of BiVentricular Assist Device (BiVAD) is gradually increasing given improvements in the technology of heart failure care and 5.2% of overall Ventricular Assist Device (VAD) implants in the last 10 years required both left and right supportive devices. The described cardiac rehabilitation (CR) program has worked with Left Ventricular Assist Device (LVAD) recipients for the past 5 years, with continuous improvements in the LVAD outpatient CR protocol. However, the care of BiVAD patients in the traditional CR setting remains challenging.

Purpose: To derive a safe CR protocol for patients with BiVAD.

Design: We used the Deming's cycle (Plan-Do-Study-Act) approach to formulate a care plan for the BiVAD patient.

Methods: Our multi-disciplinary team of CR specialists had undergone 8 hours of (didactic and simulative) LVAD educational training. The LVAD policy and guidelines for rehabilitation were reviewed in conjunction with the patient's cardiologist and adapted for the BiVAD patient. Four important modifications were made to the LVAD protocol: 1) addition of a second VAD-battery for back-up during exercise, 2) addition of a second set of VAD parameter recordings: pre-, during, and post-exercise, 3) upper body exercise adaptations to protect two drive lines, and 4) increased emphasis on adequate hydration. Exercise RPE (Rated Perceived Exertion) and BiVAD and hemodynamic parameters were documented during the exercise sessions. Team members convened weekly to evaluate the data and adjust the exercise prescription to maximize patient satisfaction and METs achieved while maintaining a moderate RPE and Mean-Arterial-Pressure of 70-105 mmHg.

Results: 57 year-old white male, enrolled in CR 11 months after BiVAD implantation. He initially exercised for 22 minutes at a functional capacity of 2.7 METS, 3 sessions a week using the treadmill, bike, and nustep modalities. His workload progressed on an average of 0.2 METs weekly. His CR was uneventful except for a hospitalization for bacteremia after 18 sessions. He graduated after completing 33 sessions of CR. At the final CR week his exercise duration increased to 55 minutes (150% improvement from baseline) at 4.9 METS (81% improvement) and included resistance training with 5-pound free weights. Depression and anxiety scores remained normal throughout CR. Patient underwent successful heart transplantation 3 months after CR.

Conclusions: CR is safe and effective for patients with BiVAD after adequate program planning, education, and iterative team learning.

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Abstract ID: S140

Title: Level of Education Affects Cardiorespiratory Fitness

Track: Physical Activity/Exercise

Author(s): Mineok Chang, MD, Ju-Eun Chae, PT, Jin-Hee Jeung, RN

Institution(s): Seoul St. Mary's Hospital, Seoul, Korea, Republic of.

Introduction: Socioeconomic status is associated with metabolic syndrome and cardiovascular risk factors. Level of education has been extensively used as an indicator of overall socioeconomic status, and it has been suggested as the most constant determinant among the components, because it can be measured with much accuracy, and it affects various socioeconomic factors robust over the lifespan.

Purpose: The object of this study was to evaluate the relationship between educational level as a surrogate marker of cardiorespiratory fitness (CRF) and the risk of metabolic syndrome.

Design: Observational study.

Methods: Study subjects were 988 healthy adults (601 men and 387 women) who underwent regular health checkup in Seoul St. Mary's Hospital. Education level was categorized into three groups according to their final graduation: (1) middle or high school (≤12 years of education), (2) college or university (12-16 years of education), and (3) postgraduate (≥16 years of education). CRF was assessed by cardiopulmonary exercise testing, biceps strength, hand grip strength, and bioelectrical impedance analysis.

Results: The highest educational group had significantly higher peak VO<sub>2</sub> (27.4±6.5 mL/Kg/min), peak expiratory flow (101.0±17.4 m/s), biceps strength (31.7±11.3 kg), hand grip strength (70.1±17.9 kg) and skeletal muscle mass (29.4±5.3 kg) than other groups (all p<0.001). And this group had better diastolic function (deceleration time 226.0±38.5 msec, p=0.024 and maximal tricuspid valve regurgitation velocity 2.1±0.2 m/sec, p=0.003) on echocardiography than other groups. However, the prevalence of metabolic syndrome was not significantly different among the groups.

Conclusions: Level of education was significantly related to all aspect of CRF in healthy adults. Further educational programs are needed to promote public health and prevent metabolic syndrome and cardiovascular disease.

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Abstract ID: S141

Title: Differences in Referral to Cardiac Rehabilitation in Patients With Different Revascularization Procedures: Same Risk but Different Referral Patterns

Track: Cardiovascular Rehabilitation & Clinical Cardiology

Author(s): Garrett Kellar, EdD (C), CCRP, RCEP, EP-C, EIM31,2, Kelly Allsup1, BS, Daniel E. Forman, MD1,2

Institution(s):1VA Pittsburgh Healthcare System, Pittsburgh, PA, USA, 2University of Pittsburgh, Pittsburgh, PA, USA.

Introduction: Cardiac rehabilitation (CR) is an effective secondary prevention mechanism in the management of coronary heart disease (CHD). For patients with CHD, percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) procedures are Class 1A indications for referral to CR.

Purpose: Referral of eligible patients to outpatient CR is the first step to participation. We evaluated referral rates between these two principal cardiac revascularization interventions. We hypothesize that there are key differences in referral patterns despite similarities in the clinical needs for patients with CHD undergoing either procedure.

Design: In a retrospective quality improvement project we evaluated patients undergoing PCI and CABG at the VA Pittsburgh Healthcare System (VAPHS) from June 2015-September 2018.

Methods: A comparison was conducted of the number of procedures versus the number referred to and participated in CR to compare differences between those who had received PCI versus those had received CABG.

Results: 346 CABG procedures and 822 PCI procedures were completed. While 346 of 346 CABG patients were referred to CR (100%), only 228 of 822 PCI patients were referred (28%). Of the 346 CABG patients who were referred to CR, 285 (82%) participated in ≥1 session. Of the 228 PCI patients who were referred to CR, 167 (73%) patients participated in ≥1 session. Overall, 82% of all CABG patients participated in ≥1 CR session versus only 20% of PCI patients (p= 0.004).

Conclusions: Patients undergoing CABG procedures are referred to, and participate in CR in significantly higher proportions than patients undergoing PCI. Patients undergoing either procedure share similar underlying CHD pathophysiology, and are likely to derive similar mortality, morbidity, risk factor modification, and quality of life benefits from CR. Furthermore, given that PCI patients are relatively more likely to require repeat revascularization, the proven utility of CR to reduce rehospitalization may be even more advantageous in this patient group. Such discrepancies of CR referral and utilization suggests there are opportunities to improve care. Further study is needed to better determine the reasons and subsequent implementation of change concepts for increased referral, consistent with the Million Hearts initiative and other efforts to broaden this vital program of secondary prevention.

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Abstract ID: S143

Title: Changes in the Behavior of the Risk Factors for Atherosclerotic Coronary Disease at the End of a Cardiovascular Rehabilitation Program Phase II

Track: Cardiovascular Rehabilitation & Clinical Cardiology

Author(s): Juan D. Perez, MD1, Juan M. Sarmiento, MD2,3, Alberto Lineros, MD1, Carolina Sanchez, Ms4

Institution(s):1Universidad El Bosque, Bogota DC, Colombia, 2Fundacion Clinica Shaio, Bogota DC, Colombia, 3Universidad El Bosque, Bogota, Colombia, 4Fundacion Clnica Shaio, Bogota DC, Colombia.

Introduction: Cardiovascular diseases are the leading cause of disability and premature death. Risk factors that lead these deaths are hypertension, smoking, diabetes mellitus, dyslipidemia, sedentary lifestyle and obesity.

Purpose: To determine the prevalence of risk factors in patients with a history of coronary atherosclerotic disease in a phase II cardiovascular rehabilitation program and to be able to identify significant changes after completing at least 30 sessions from January 2015 to March 2018 taking into account the groups of gender and age.

Design: Quasi-experimental analytical study with the participation of 707 subjects selected from the database of a Colombian Cardiovascular Prevention Center.

Methods: After characterizing the clinical variables, changes were observed in the behavior of risk factors for atherosclerotic coronary disease: dyslipidemia, diabetes mellitus, hypertension, obesity, sedentary lifestyle and smoking, taking into account gender and age group. Statistical software Stata® (Version 15) was used to analyze the information. Statistical software Stata® was used to analyze the information. The statistical tests used were analyzed under a level of significance of 5%. The quantitative variables were described by median and interquartile ranges, after checking for normality in their distribution with the Shapiro - Wilk test. The qualitative variables were measured by absolute frequencies and percentages. To determine if there were changes in the measurement of pre- and post-intervention variables, the Wilcoxon rank test was used in quantitative variables. In qualitative variables, the X2 test was used when the expected values in each cell were ≥5 otherwise an exact Fisher test was used.

Results: A prevalence of dyslipidemia was found in 59.83%, smoking history was 55.46%, diabetes mellitus 47.81%, sedentary lifestyle 47.31%, hypertension 33.66% and obesity 15.84%. It was evidenced that women had a higher prevalence in most of the risk factors. There were significant changes in variables except for glycemia, HbA1c, systolic and diastolic blood pressure. The age group with the highest prevalence and where the greatest significant changes were found was from 61 to 74 years.

Conclusions: The most prevalent cardiovascular risk factors were dyslipidemia for both men and women, smoking history for men while sedentary lifestyle, hypertension and obesity for women. Regarding the prevalence of age, the group of 61 to 74 years in all the risk factors was the most representative except for active smoking that was 41 to 60 years old.

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Abstract ID: S144

Title: Functional Capacity and Body Composition Changes in Patients With Cardiovascular Disease After an Interval Training in During Phase III Cardiovascular Rehabilitation Program

Track: Cardiovascular Rehabilitation & Clinical Cardiology

Author(s): Carlos A. Rodriguez, MD1, Juan M. Sarmiento, MD1,2, Javier O. Pereira, MD2, Alberto Lineros, MD1, Carolina Sanchez, Ms2

Institution(s):1Universidad El Bosque, Bogota DC, Colombia, 2Fundacion Clinica Shaio, Bogota DC, Colombia.

Introduction: Cardiovascular diseases (CVD) continue to be the leading cause of death worldwide. Phase III cardiovascular rehabilitation (CR) program aims to improve adherence, commitment and additional behavioral changes among participants, in addition to those tools learned in phase II.

Purpose: To evaluate the performance of functional capacity (FC) and body composition before and after an High-interval intensity training in phase III CR among patients with CVD between April 2014 and October 2018.

Design: Retrospective, observational and descriptive study.

Methods: Patients with CVD who completed a phase II CR program and willing to continue into phase III CR program were included. The variable assessed were FC in METs, body composition, risk stratification for progression of coronary disease according with AACVPR before and after CR program. The quantitative variables were described using medians and interquartile ranges and for comparison before and after the intervention, a Wilcoxon rank sum test was used. The qualitative variables were described by proportions and for comparison a Pearson's x ^ 2 test or Fisher's exact test was conducted. The correlation between variables was measured using Pearson correlation coefficient. The analysis of the information was conducted using statistical software Stata® the statistical tests were significant at a level α≤0.05.

Results: 88 patients fulfilled the criteria to be included in this study. 80 of participants were male and the mean age was 60 years for both groups. The CF and the abdominal perimeter reported a significant improvement (p <0.05), lowering their values. Progression of the coronary disease classification also reported significant differences (p <0.005), with a reduction on the risk level. Variables evidenced statistically significant correlation values between the number of sessions completed and METs achieved (rho: 0.3079, p <0.005) and muscle mass at the end of phase III and the METs reached by the patient (rho: 0.2778, p = 0.0088). Inverse relationship was found between the percentage of visceral fat and METs achieved (rho: - 0.282, p = 0.0083) and, between body fat percentage and total METS achieved at the end of the phase III program (rho: -0.2987, p = 0.0047).

Conclusions: Patients with CVD participating into CR phase III seems to reduce their cardiovascular risk associated to the improve on their CF and to a reduction of the abdominal perimeter. Also, changes in body composition seem to improve in the number of METs reached at the end of phase III of CR programs.

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Abstract ID: S145

Title: Changes in Cognitive Function & Depression After Telehealth Pulmonary Rehabilitation: Pilot Study

Track: Pulmonary Rehabilitation & Medicine

Author(s): Mon Bryant, PT, PhD1,2, Christina K. Nguyen, RRT, BS3, Hung Nguyen, PhD3,4, Mohsen Zahiri, PhD3,4, Venkata Bandi, MD3, Bijan Najafi, PhD4, Amir Sharafkhaneh, MD, PhD3

Institution(s):1Medical Care Line, Michael E DeBakey VA Medical Center, Houston, TX, USA, 2Physical Medicine & Rehabilitation, Baylor College of Medicine, Houston, TX, USA, 3Michael E DeBakey VA Medical Center, Houston, TX, USA, 4Baylor College of Medicine, Houston, TX, USA.

Introduction: Cognitive impairment and depression are highly prevalent in patients with chronic obstructive pulmonary disease (COPD). They are associated with increased disability and often untreated. Pulmonary rehabilitation consisting of exercise training and education through telehealth service may positively impact these psychosocial impairments, however, its effect has not been reported. This pilot study was to examine the effect of telehealth pulmonary rehabilitation on cognition and depression in patients with COPD.

Purpose: To study the changes in cognitive ability and depression after completing a telehealth home based pulmonary rehabilitation program.

Design: Single group pre- and post-test.

Methods: Eight males with COPD were studied. They were assessed cognitive function and depression at the base line and after completing the 18 sessions of the telehealth pulmonary rehabilitation program. Cognitive function was assessed by the Montreal Cognitive Assessment (MoCA). Depression was assessed by the Patient Health Questionnaire (PHQ-9).

Results: MoCA score increased significantly after the telehealth program (24.63 ± 2.50 vs. 26.75 ± 3.11, p = 0.041). PHQ-9 score was not different from the baseline (7.88 ± 3.44 vs. 3.75 ± 4.46; p = 0.141), however, the result showed a tendency to improve with a large effect size of 1.03.

Conclusions: Cognition improved after the program. Depression showed a tendency to improve. The home-based telehealth pulmonary rehabilitation improved cognitive function and potentially alleviated depression in patients with COPD. A larger sample size is needed to validate these preliminary findings.

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Abstract ID: S146

Title: Are Traditional Forms of Exercise Feasible and Acceptable for Chronic Heart Failure Patients in China? A Mixed-Method Pilot Study

Track: Cardiovascular Rehabilitation & Clinical Cardiology

Author(s): Xiankun Chen, MM1,2, Weihui Lu, PhD2, Zehuai Wen, PhD2, Huiying Zhu, MM2, Gaetano Marrone, PhD1, Wei Jiang, PhD2

Institution(s):1Karolinska Institutet, Stockholm, Sweden, 2Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China.

Introduction: Baduanjin (eight silken movements), a traditional Chinese exercise, combines systematic muscular movements with breathing patterns and inner mental focus. It has been shown to have cardiovascular benefits. Moreover, it is simple, inexpensive, and practical, making it a promising solution to the poor uptake of cardiac rehabilitation due to low availability and unaffordability in China. The BaduanjinEight-Silken-Movements wIth Self- Efficacy building for Heart Failure (BESMILE-HF) program is the first to apply Baduanjin as the core component in a multi-component exercise-based cardiac rehab program (exercise-education-evaluation- consultancy-adherence strategies).

Purpose: Assess the feasibility and acceptability of the BESMILE-HF rehabilitation program for chronic heart failure in China.

Design: Mixed-methods pilot study including a two-group, parallel, pilot randomized controlled trial and end-of-study semi-structured interviews.

Methods: Eighteen patients with NYHA II∼III without restrictions on ejection fraction participated in this pilot study in 2017. After informed consent, they were randomized into either an intervention group receiving the BESMILE-HF program plus the usual medications, or a control group receiving only usual medications for 6 weeks. Feasibility was based on: Baduanjin intensity (breath-by-breath gas exchange and ventilation continuously measured throughout a single Baduanjin session at baseline); home-based exercise related issues (adherence, facilitators and barriers); potential physical (exercise capacity, biomarkers, cardiac function) and psychological (quality of life, self-efficacy, anxiety, and depression) benefits. Clinical measurements were conducted before and after intervention. Acceptability was based on end-of-study semi-structured interviews among the intervention group. We used nonparametric test to analysis between-group difference and spearman correlation to explore factors related to exercise times, with p≤.05.

Results: Cardiorespiratory data for Baduanjin showed that it was a moderate-intensity exercise for participants (43%-60% of peak VO2). The intervention group had done the required home exercises (27.5 minutes/day, 5.6 days/week), and total home-practice time had a significant positive correlation with baseline self-efficacy scores (r=0.831, P =0.011). Self-efficacy increased significantly in the BESMILE-HF group (3.2; 95% CI 0.6 to 5.9). The decline in peak VO2 was significant in the control group (-2.6±1.8, P =0.018), but not the BESMILE-HF group (-1.2±1.2, P =0.063), without between group difference (1.5 mL/kg/min, 95%CI, -0.3 to 3.2). Similar tendency was also observed in VE/VCO2 slope. Interviews showed that perceived improvement was the motivation to continue exercise, and that participants enjoyed Baduanjin and its flexibility.

Conclusions: Our findings suggest it is feasible to integrate Baduanjin into cardiac rehabilitation. They also supported using the BESMILE-HF program for chronic heart failure patients in full-scale trials to access clinical effects.

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Abstract ID: S147

Title: Addressing Treatment for Fall Risk Patients in Cardiopulmonary Rehabilitation

Track: Cardiovascular Rehabilitation & Clinical Cardiology

Author(s): Tara Encarnacion, MS, ACSM-CEP, Bari DiUbaldo, MEd, CCRP, Crystal Zimmerman, MS, ACSM, CEP

Institution(s): Lehigh Valley Health Network, Allentown, PA, USA.

Introduction: The Agency for Healthcare Research and Quality estimates that 700,000 to one million hospitalized patients fall each year. This problem is devastating in terms of additional costs and patient quality of life. Therefore, inpatient hospital fall risk screenings and protocols exist to decrease in-hospital fall rates and to promote patient safety. In the ambulatory setting, fall screenings are used, however, are often not accompanied by follow up protocols to treat at risk patients. To address this concern, the cardiopulmonary team developed a defined intervention for fall risk patients inside the department.

Purpose: To set a treatment protocol for fall risk patients in cardiopulmonary rehabilitation. It was hypothesized that completion of defined core strength and balance exercises during exercise sessions would result in improved Timed Up and Go scores. Improved patient confidence to exercise and improved Dartmouth Quality of Life (QOL) scores were also expected.

Design: Experimental study of all patients identified as positive fall risks. No control group was used.

Methods: Patients completed the standard hospital fall risk questionnaire. If a positive result occurred, the patient completed the Timed Up and Go (TUG) Test. Scores greater than or equal to 14 seconds were deemed high risk. Scores less than 14 seconds were deemed low risk. Low risk patients were given higher level balance and core strength exercises to perform at exercise sessions. High risk patients were offered a referral to physical therapy to address balance deficits. They were also given lower level balance and core strength exercises to perform during exercise sessions. The TUG test was repeated at regular intervals of every 30 days.

Results: Participants showed an average decrease in TUG scores of 1.40 seconds over the course of the program. Patients' self-reported “confidence in safe exercise” increased from a baseline of 92.3% to 94.3% as measured through the Press Ganey Patient Satisfaction survey during the study period. Pre and post program Dartmouth QOL scores averaged an improvement from 21.8 to 20.6.

Conclusions: Including risk stratified core and balance programming to the exercise prescription reduced the risk of falling for at risk participants in a Cardiopulmonary Rehabilitation Program. Incorporating balance exercises into the patient's plan of care also contributed to improved Press Ganey Patient Satisfaction and Dartmouth QOL scores.

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Abstract ID: S148

Title: Can CHF Patients Avoid ICD's?

Track: Cardiovascular Rehabilitation & Clinical Cardiology

Author(s): Betsy Ann Hart, MS, CCEP, CCRP, Linda Kehoe, RN

Institution(s): MacNeal Hospital, Berwyn, IL, USA.

Introduction: In the past several years patients with Congestive Heart Failure (CHF) have been commonly prescribed the use of a Wearable Cardioverter Defibrillator (WCD) and a course of cardiac rehabilitation to improve their ejection fraction prior to the implantation of an Implantable Cardioverter Defibrillator (ICD). Given the risks associated with the implantation of an ICD to treat CHF, including bleeding, surgical site infections, pneumothorax, mechanism failure or malfunction and damage to the heart or blood vessels determining whether cardiac rehabilitation in combination with a WCD will result in sufficient improvement of the ejection fraction to reduce the need for implantation of an ICD is an important treatment issue to explore.

Purpose: It is our hypothesis that examination of the available literature and the results of our work with patients with CHF who are using a WCD in the MacNeal Hospital Cardiac Rehabilitation program will support that WCDs and cardiac rehabilitation together will further reduce the need for the use of ICDs.

Design: A thorough literature review was completed of medical, nursing and online journals examining available data on the impact WCDs on the need for implantation of an ICD.

Methods: All patients enrolled in our cardiac rehabilitation program with CHF and a WCD were followed to determine if their ejection fraction improved sufficiently to avoid the need for an ICD.

Results: Results reported in the literature ranged from 16.4% to 32.4% of patients no longer needing an ICD after use of a WCD. Our own program we found that of the patients in the study group 61% no longer needed an ICD after completing cardiac rehabilitation while using a WCD.

Conclusions: Further studies with a larger sample size are warranted as well as longer follow up periods to determine how long the patients' improvement is maintained. In our own department we will be following up with our patients one year post treatment to determine if their improvement has been maintained. The results of the literature review and the improvement of our own patients supports the hypothesis that cardiac rehabilitation in combination with a WCD may be more effective than the use of a WCD alone while also reducing the exposure of patients to the risks associated with the implantation of an ICD.

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Abstract ID: S149

Title: Prehabilitation and Post-Surgical Function in Thoracic Surgery Patients: A Systematic Review

Track: Physical Activity/Exercise

Author(s): Joseph Madden, DPT, Melanie Lauderdale, DPT

Institution(s): University of Mississippi Medical Center, Jackson, MS, USA.

Introduction: Patients with reduced functional capacity, prior to thoracic surgery, may have an increased risk of functional decline after surgery. Many of the poor lifestyle habits that initially contribute to individuals requiring thoracic surgery, such as lack of physical activity, often impact recovery as well. Prehabilitation has been shown to improve postoperative outcomes in other surgical patient populations.

Purpose: The purpose of this review is to determine if a prehabilitation program involving physical activity is effective in improving functional outcomes after thoracic surgery.

Design: The design of this study was a systematic review.

Methods: PubMed was searched in February 2019. Search terms for the topic included keywords related to thoracic surgery and preoperative exercise. Electronic limitations included humans and English language. Inclusion criteria consisted of individuals who were awaiting thoracic surgery and participating in a prehabilitation program that included some form of physical activity. Quality of the studies was evaluated using PEDro and the NIH Quality Assessment Tool for Before-After (Pre-Post) Studies with No Control Group (NIHQATBASNCG). PEDro measures the internal validity of randomized control trials that involve physical therapy interventions, while the NIHQATBASNCG evaluates the internal validity for studies that involve an intervention with no control group. PEDro is evaluated on a ten-point scale and NIHQATBASNCG is based on an eleven-point scale where higher scores reflect stronger studies in both measures.

Results: After the initial search and title and abstract screen, seven articles met all criteria and were included in the review. There were four studies evaluated by PEDro with an average score of 6.75/10 and 2 studies evaluated by the NIHQATBASNCG with an average score of 7.5/11. Subjects in all seven of the studies who underwent some type of preoperative exercise demonstrated significant improvements in functional capacity and/or pulmonary function tests from the pre-to-post operative period. In the four studies that had a control group, the treatment group demonstrated significant improvements in function after surgery compared to the control group.

Conclusions: The results of this study suggest that physical prehabilitation for patients awaiting thoracic surgery improves some functional outcomes after surgery. Limitations of this review include the heterogeneity of the studies in the review and the fact that only one database was searched which limited the scope of the review. Further research is recommended with stronger study designs to determine the most effective type of prehabilitation program for patients awaiting thoracic surgery.

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Abstract ID: S150

Title: Technology Enabled Home Based Cardiac Rehab Augments Site Based Program

Track: Cardiovascular Rehabilitation & Clinical Cardiology

Author(s): Columbus D. Batiste, MD, FACC, FSCAI1, Christine M. Ruygrok, RN, MBA2, Timothy M. Cotter, MD, FACC, CPC3, Tadashi T. Funahashi, MD, FAAOS4

Institution(s):1Kaiser Permanente, Riverside, CA, USA, 2Kaiser Permanente, Pasadena, CA, USA, 3Kaiser Permanente, Baldwin Park, CA, USA, 4Kaiser Permanente, Irvine, CA, USA.

Introduction: The benefits of Cardiac Rehabilitation (CR) are well studied and proven to have positive outcomes such as reduced secondary events and re-hospitalization. Our team came together to build a solution that would provide increased enrollment for our existing program while maintaining a high quality, multi-disciplinary approach. Within the 13 Kaiser Permanente Southern California medical centers, there is an AACVPR accredited on-site program at Riverside Medical Center. Despite the success of this program, there was a continued underutilization of CR. Additional data showed the average Riverside patient lives 32.7 miles away from the center and 45.7% are of working age.

Purpose: To demonstrate that a virtual run program can reduce obstacles to access while maintaining quality.

Design: The team translated a multi-disciplinary CR program into an app that would run on a smart phone and watch. Exercise, medicine adherence, education, and behavioral modification are core components of the program. A pilot program (n=37) was run using the solution. The home-based pilot produced a completion rate of 87% as opposed to 50% for our site-based program. Based on the results of the pilot, a scaled version was ordered for all Southern California sites. Patients with a clinical indication are referred via EMR, scheduled for in person nursing evaluation and provided with a wearable. This device allows selection of exercise, self-assessment of RPE and symptoms. All data generated through the wearable is available to providers. Patients complete a video education program and are scheduled weekly virtual visits with the case manager. Visits focus on disease modification, depression screening, behavioral coaching and support.

Methods: All patients enrolled in the program have been included in our analysis. We utilized data from our EMR system and CR Dashboard to aggregate results.

Results: The program launched with first patient enrollments in April 2018. As of March 2019, the program has enrolled 1,789 patients across the Southern California sites. The program has graduated 87.7% of enrolled patients and 67.0% of those exercised on a daily basis. There have only been 3 post-graduation hospitalization events in this group. Total referrals to all CR have increased 44.5% since launch of the home-based program with choice of site being at the discretion of the provider.

Conclusions: A technology enabled virtual CR program delivered on a large scale can produce improved completion and adherence rates. Access to all CR services has greatly improved and enhanced provider awareness.

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Abstract ID: S151

Title: The Impact of Abdominal Obesity on Cardiopulmonary Fitness in Chinese Heart Failure Patients

Track: Cardiovascular Rehabilitation & Clinical Cardiology

Author(s): Huiying Zhu, MM1, Xiankun Chen, MM1,2, Weihui Lu, PhD1, Xiaojing Dang, PhD1, Tao Chen, MM1, Yunxiang Fan, MMS1, Gaetano Marrone, PhD2, Wei Jiang, PhD1

Institution(s):1Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China, 2Karolinska Institutet, Stockholm, Sweden.

Introduction: There is an inverse relationship between abdominal obesity measured by waist circumference (WC) and cardiopulmonary fitness (peak oxygen consumption, VO2peak) among healthy white people. However, knowledge of Chinese heart failure patients remains scant because heart failure patients generally experience significant impaired cardiopulmonary fitness, and Asian populations tend to have more abdominal fat compared to white populations.

Purpose: Evaluate whether abdominal obesity results in significant changes in VO2peak, and the impact of WC on VO2peak in heart failure patients from Southern China.

Design: Cross-sessional study.

Methods: Data was collected from 72 heart failure patients with NYHA classI∼IV (80% II) and a mean ejection fraction of 46.5%. VO2peak was measured during a symptom-limited bicycle exercise test; and WC was measured between the lower rib and the iliac crest. Abdominal obesity was defined by the recommended Asian cut-off points (90 cm for men, 80 cm for women). Other clinical variables were collected from electronic medical records. Non-parametric tests, Spearman's correlation coefficients, and a linear regression model were used with p-value<0.05 as statistically significant.

Results: Mean age was 65.4 (range: 36∼91); 80.6% were male; their mean BMI (kg/m2) was 24.4 with 63% classified as abdominally obese. Overall, significant lower VO2peak value was found in the abdominal obesity group including men and women (-2.6 mL/kg/min, 95%CI: -4.5, -0.8) than in the normal WC group. When patients were stratified into two gender groups and three age groups (young:<60, middle age: 60-69, elderly: ≥70), this significant result remained only in the male (-2.8 mL/kg/min, 95%CI: -4.9, -0.8), and the yung (<60 years, -3.9 mL/kg/min, 95%CI: -6.6, -1.2), respectively. In addition, correlation coefficients between WC and VO2peak were statistically significant in men (r =−0.356, p =0.006); and in the young age group (r =−0.651, p =0.03). No relationship was found for women or other age groups. For each cm increase in WC, VO2peak decreased 0.168 mL/kg/min in men (p=0.01); and 0.23 mL/kg/min in the young group (p =0.002).

Conclusions: Recommended Asian WC thresholds for abdominal obesity are a useful instrument for detecting clinically, statistically relevant decreases in VO2peak among heart failure patients. For male patients or those under 60, WC was inversely associated with their VO2peak. For each 5∼6cm increase in WC, reducing VO2peak showed a clinically significant decrease of 1 mL/kg/min among heart failure patients. Further research with larger sample sizes is needed to support WC as a cardiopulmonary fitness self-management tool.

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Abstract ID: S152

Title: Current Status of Cardiovascular Rehabilitation in Argentina

Track: Cardiovascular Rehabilitation & Clinical Cardiology

Author(s): Diego Esteban Iglesias, MD1, Cecilia Zeballos, MD2, Ignacio Davolos, MD3, Oscar Mendoza, MD2, Carolina Oviedo, MD4, Julieta Bustamante, MD5, Enrique Gonzalez Naya, MD6, Sofia Nievas, MD7

Institution(s):1Hospital Italiano, Buenos Aires, Argentina, 2Instituto Cardiovascular de Buenos Aires, Buenos Aires, Argentina, 3Hopital de Clinicas, Buenos Aires, Argentina, 4Fundación Favaloro, Buenos Aires, Argentina, 5Hospital Austral, PilarArgentina, 6Intituto Argentino de Diagnostico y Tratamiento, Buenos Aires, Argentina, 7Fundacion CENCOR, SAN JUAN, Argentina.

Introduction: Cardiac rehabilitation (CR) programs are the cornerstone of comprehensive secondary prevention programs. They are class I recommendation in the American and European guidelines for various cardiovascular diseases. Despite this, in Argentina, we don't have any study that describes the reality of the local CR centers.

Purpose: To conduct a survey that describes the current status of CR in Argentina.

Design: The Council of Exercise Cardiology of the Argentinean Society of Cardiology (SAC) conducted a survey from April 2018 to December 2018 to know the current status of the Cardiovascular Rehabilitation Centers (CRCs) in the whole country.

Methods: We did a Google base online survey which consisted off 12 trunk questions with several sub questions. The survey was posted on the website of the SAC. We sent an invitation mail to respond to the 6500 members of SAC around the country.

Results: 78 CRCs answered the survey. Most of them were located in large urban areas (69,23% are located in Buenos Aires city and province of Buenos Aires). CRCs inside hospital are 45 (57,69%) the others, 33 (42,31%) are located in other health facilities. The annual average of patient's participation among CRCs is: 221,9 patients (range 3 to 1200). Patients do 10,4 sessions per month. The main diagnosis of the patients enrolled in CRCs are Coronary Artery Disease, Heart Failure, after heart valve surgery, peripheral arterial disease, after Heart Transplantation and CDI. In terms of who finances the CRCs, 52 are private (66,67 %), 21 (29,92%) are public and 5 (3,41%) are from another funding source (armed forces and trade unions). In addition to the workout sessions in the CRC, we saw a low usage rate of the other components of the comprehensive integral model of cardiac rehabilitation care. 45 out of 72 CRC responded if they had: Initial cardiological evaluation (61,5%), exercise counseling (57,6%), psychological support (30,7%), depression evaluation (8,9%), sleep apneas questionnaires (6,4%), training for patient's heart rate taking (51,2%), educational talks (41%), nutritional education (41%), management of risk factors (48,7%), follow-up programs (39,7%), family counseling (25,6%) and recreational sports and other activities (26,9%).

Conclusions: We observed that most of the CRCs in Argentina are exercise-based, and only about half perform comprehensive cardiac rehabilitation care. Most of the centers are located in big urban areas and are private which make us think that CR is for a segment (middle class and wealthy) of the Argentine population.

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Abstract ID: S153

Title: Comparison of Non-HDL-C in Traditional Versus Intensive Cardiac Rehabilitation

Track: Cardiovascular Rehabilitation & Clinical Cardiology

Author(s): Ashley Cotta, RDN, Wen-Chih Wu, MD, Julianne DeAngelis, MS, CCRP, Karen Aspry, MD, Hafiz Imran, MD

Institution(s): The Miriam Hospital, East Greenwich, RI, USA.

Introduction: Non-HDL-cholesterol (non-HDL-C) is a more robust predictor of cardiovascular disease (CVD) risk as it is a measure of LDL-cholesterol plus all other atherogenic remnants. Non-HDL-C can be modified through lifestyle changes but is underutilized in cardiac rehabilitation (CR).

Purpose: To compare change in non-HDL-C in patients with CVD at baseline and upon discharge of CR between an Intensive Cardiac Rehabilitation (ICR) program and a Traditional Cardiac Rehabilitation (TCR) program. Our hypothesis is that ICR participants will have greater reductions in non-HDL-C than TCR participants due to greater emphasis in therapeutic lifestyle interventions.

Design: Retrospective chart review of patients at baseline and upon discharge of CR.

Methods: Requirements for data inclusion: patients with non-HDL-C data at baseline and discharge of CR, within 6 months of entry and 4 weeks of discharge. There were 715 available records from TCR from 2/1/17-6/30/18 and 156 available records from ICR from 1/1/18-2/28/19. Incomplete records from both programs were excluded. Patients in ICR (n=114) attended a 9-week program consisting of 4 hour sessions, twice a week. The four hours consisted of exercise, education on a whole-food-plant-based diet, group support and stress management. Patients in TCR (n=148) attended a 12-week program consisting of 1.5 hours sessions, 3 times per week. Participants exercised for 1 hour, with a half-hour education session on various topics. Non-HDL-C levels were compared at baseline and discharge within each CR program and between programs using T-tests. Subgroup analysis was conducted by gender.

Results: The average age (68 +/− 11 years in ICR vs. 64 +/− 11 years in TCR) and gender composition (62% men in ICR vs. 74% men in TCR) between populations were similar. There were reductions in non-HDL-C in ICR (-24.65 +/− 41.11) and TCR (-23.65 +/− 43.29). Differences between programs were insignificant (p = 0.85). Change in non-HDL-C among men in ICR (-30.47 +/− 40.46) was significantly greater (p =0.04) than that in women in ICR (-14.95 +/− 40.34). In TCR, similar changes in non-HDL-C (p =0.77) were observed for both men (-24.37 +/− 39) and women (-21.55 +/− 53.30).

Conclusions: Similar changes in non-HDL-C were observed between programs likely due to ICR patients making multiple lifestyle changes and partaking in more hours of CR each week. Limitations to this study include: unknown dietary adherence, data exclusion and incompatible data timelines. Further research is warranted to identify if greater reductions in non-HDL-C may be observed if CR duration was identical.

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Abstract ID: S154

Title: Patient Education in Cardiac Rehabilitation: Helpfulness Ratings and Reasons for Non-Participation

Track: Cardiovascular Rehabilitation & Clinical Cardiology

Author(s): Joseph R. Merighi, PhD, MSW, LISW1, Timothy C. O'Keefe, MSW, LGSW2, Mingyang Zheng, MSW1, Marsha Burt, MS/RCEP, CCRP3, Aaron Pergolski, MA/RCEP, CCRP4, Teresa Fietek, BA, CES, RCEP, CCRP5, Maureen Devereaux, OTR/L, CES, CCRP2

Insitution(s):1University of Minnesota - Twin Cities, Saint Paul, MN, USA, 2Fairview Health Services, Minneapolis, MN, USA, 3Fairview Health Services, Wyoming, MN, USA, 4Fairview Health Services, Edina, MN, USA, 5Fairview Health Services, Burnsville, MN, USA.

Introduction: Patient education is an essential component of cardiac rehabilitation (CR) because it has been linked to improved health behaviors. Despite the benefits of education classes, participation in educational programming is voluntary and may be influenced by patients' perceptions of its relevance to their recovery process.

Purpose: To assess CR patients' helpfulness ratings for education classes by gender and health status, and to pinpoint key reasons for non-participation in specific classes.

Design: Descriptive, multi-center, cross-sectional survey, non-probabilistic sample.

Methods: A self-administered survey was completed by 150 CR patients at four rehabilitation centers. Participants were asked to rate seven class topics provided as part of the patient education program. The majority of patients were men (n=106, 70.7%), white (n=134, 89%), married (n=99, 66%), and in good health (n=63, 42%) based on a self-rating. The number of CR sessions completed at the time of survey completion was: 1-6 (n=52, 34.7%); 7-12 (n=43, 28.7%); 13-18 (n=25, 16.7%); 19-24 (n=20, 13.3%); 25-30 (n=6, 4.0%); and 31-36 (n=4, 2.6%). Descriptive statistics and chi-square tests were used to address the study aims.

Results: Patients' helpfulness ratings were reported for seven educational topics using a 5-point scale, from 1 (not at all helpful) to 5 (extremely helpful). They included: All About Your Heart (n=44 completed the class, 89% rated as it as either “very helpful” or “extremely helpful”); Blood Pressure (n=52, 79%); Medication/Pharmacy (n=49, 76%); Nutrition (n=72; 75%); Emotional Aspects/The Healing Process (n=36; 64%); Exercise Principles (n=37; 60%); and Relaxation Response (n=46, 56%). Individual sample sizes vary by class topic given the variability in CR sessions completed. For each of the seven class topics, level of helpfulness was not significantly associated with gender or health status at an alpha level of .05. When patients who completed 7-24 CR sessions were asked why they did not participate in an education class, 16.1% (range=10%-27%) indicated “not interested” (highest percentage for Medication/Prescription class) and 5.6% (range=3%-12%) stated “not applicable” (highest percentage for Blood Pressure and Nutrition classes).

Conclusions: Given the benefits of education on CR patients' recovery and health behaviors, it is important to understand how to improve class participation and provide content that is aligned with patients' learning goals. The limited interest in some education classes and helpfulness ratings below 75% underscores the need for patients and CR staff to collaborate on evaluations of class content as a first step in curricular redesign to enhance educational programming.

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Abstract ID: S155

Title: The Impact of Body-Mass Index on Cardiopulmonary Fitness in Chinese Heart Failure Patients

Track: Cardiovascular Rehabilitation & Clinical Cardiology

Author(s): Wei Jiang, PhD1, Xiankun Chen, MM1,2, Huiying Zhu, MM1, Xiaojing Dang, PhD1, Tao Chen, MM1, Yunxiang Fan, MMS1, Gaetano Marrone, PhD2, Weihui Lu, PhD1

Institution(s):1Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China, 2Karolinska Institutet, Stockholm, Sweden.

Introduction: Body-mass index (BMI) and cardiopulmonary fitness measured by peak oxygen consumption (VO2peak) are inversely related among healthy Caucasians. However, knowledge of Chinese heart failure patients remains scant because they experience significant impaired cardiopulmonary fitness, and Asians have lower BMI cut-offs than whites.

Purpose: Evaluate whether Asian-specific BMI cut-offs for overweight (23 kg/m2) and obese (27.5 kg/m2) reflect significant VO2peak changes, and BMI's impact on VO2peak in Chinese heart failure patients.

Design: Cross-sessional study.

Methods: Data was collected from 70 heart failure patients with NYHA class I∼IV (83% II) and mean ejection fraction of 46.3% in Guangdong Provincial Hospital of Chinese Medicine. VO2peak was measured via symptom-limited bicycle exercise test. Height and weight were measured to calculate BMI. Participants were categorized as healthy (BMI 18.5-22.9 kg/m2), overweight (BMI 23-27.4 kg/m2), or obese (BMI ≥27.5 kg/m2). Those with BMI below 18.5 kg/m2 were excluded. Between-group differences were identified by one-way ANOVA and post-hoc Tukey's test. Spearman's correlation coefficients and binary linear regression evaluated the relationship between BMI and VO2peak. p<0.05 indicates statistical significance.

Results: Among 70 patients, 24 (34%) were classified healthy (BMI >18 kg/m2), 34 (49%) overweight (BMI 23-27.4 kg/m2), and 12 (17%) obese (BMI ≥27.5 kg/m2). VO2peak differed between the three BMI groups (p=0.017); and the obese group had significantly lower VO2peak than the heathy group (-3.9 mL/kg/min, 95%CI: -6.6, -1.2). When patients were sex-age stratified (young:<60, middle age: 60-69, elderly: ≥70), only male (p=0.006) and young (<60 years, p<0.001) subsets were significant. Male-obese had a significant VO2peak value 2.8 mL/kg/min (95%CI: -4.9, -0.8) lower than male-healthy, and 2.9 mL/kg/min (95%CI: -5.7, -0.13) lower than male-overweight. Young-obese had lower VO2peak than young-healthy (-6.9 mL/kg/min, 95%CI: -9.9, -4). There was a high negative correlation between BMI and VO2peak for young (r =−0.7, p =0.001), a moderate correlation for men (r =−0.316, p =0.017); and a low correlation cumulatively (r =−0.266, p =0.026). For each unit increase in BMI, VO2peak decreased 0.69 mL/kg/min in young (p < 0.001).

Conclusions: Asian-specific BMI cut-offs are useful clinical instruments for detecting statistically relevant decreases in VO2peak among heart failure patients. A negative association exists between BMI and VO2peak, especially in those under 60. For each 1.5 unit increase in BMI, reducing VO2peak showed a clinically significant 1 mL/kg/min decrease among heart failure patients. Larger sample-size research could reveal robust quantitative relationships between BMI and cardiopulmonary fitness.

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Abstract ID: S156

Title: Air Quality as a Topic for Cardiac Rehabilitation Patient Care and Communication: Insights From a Patients and Providers

Track: Behavior Change

Author(s): Mary Clare Hano, PhD1, Steve Prince, PhD1, Christina Baghdikian, MPH1, Elizabeth Sams, MSPH1, Susan Stone, MS1, Alison Davis, MS1, Bryan Hubbell, PhD1, Gail Robarge, MS2, Stacy Katz, MS2, Wayne Cascio, MD, FACC1

Institution(s):1U.S. Environmental Protection Agency, Durham, NC, USA, 2U.S. Environmental Protection Agency, Washington, DC, USA.

Introduction: Ample epidemiological evidence demonstrates adverse cardiovascular health outcomes associated with exposure to unhealthy air. Further, cardiac rehabilitation patients are at increased risk for future adverse health events related to air quality. This study investigates knowledge, attitudes, beliefs, and behaviors related to risks of poor air quality for cardiovascular health and the use of portable air purifiers as a strategy to reduce those risks. Disclaimer: The views expressed herein are those of the authors and do not reflect the views or policies of the U.S. Environmental Protection Agency.

Purpose: The EPA works with the American Heart Association and the Million Hearts initiative on communicating air quality health risks. These partners along with the European Society of Cardiology recently included exposure to fine particulate matter less than 2.5μm (PM2.5) as a risk factor for cardiovascular disease. There is little guidance about how to integrate this topic into cardiac care and rehabilitation.

Design: We use an inductive qualitative focus group design, with a series of three discussions among cardiac rehabilitation stakeholders including: 1) cardiac patients, 2) non-physician cardiac rehabilitation providers, and 3) physicians. These focus groups are part of and inform a broader research agenda centered on air quality health risk communication related to cardiac care.

Methods: A within-case thematic inductive analysis of each discussion is used to understand the nature of communication, logistics, guidance, and overall substance of the cardiac rehabilitation educational experience.

Results: Patient behavior change is an important objective of cardiac care, and education efforts are key to strategies related to that objective. Balancing the volume and breadth of this learning process with actual change is a challenge for patients, physicians, and non-physician providers. Air quality, as a patient health concern and area for behavioral modification, was neither prioritized, nor well understood. Although barriers were noted, several options arose for incorporating this topic into patient care and communication efforts. A package of educational outreach including continuing education geared toward healthcare providers is necessary to complement patient-centric health risk messaging.

Conclusions: A gap exists between epidemiological evidence about associations between exposure to unhealthy air and cardiovascular health, and standard health risk messaging about this in cardiac care. Opportunities exist for integrating air quality health risk messaging into cardiac rehabilitation and are worth further exploring for effectiveness and feasibility. This information could be packaged as a suite of educational materials that includes components geared toward the different rehabilitation stakeholders.

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Abstract ID: S157

Title: The Impact of Inpatient Rehabilitation on Endurance and Shortness of Breath Pre and Post Bilateral Lung Transplantation: A Case Study

Track: Pulmonary Rehabilitation & Medicine

Author(s): Mary Keenan, PT, DPT

Institution(s): NYU Langone Health, New York, New York, NY, USA.

Introduction: In 2017, 2,449 lung transplants (LT) were performed in the U.S. making up 7% of organ transplants with 76.6 % accounting for bilateral LT and 23.4% for single LT.2, 3, 4 As the prevalence of LT increase, physical therapy (PT) prior to and following LT becomes an important part of a patient's recovery, survival rate, and continuum of care.

Purpose: The purpose of this case study is to highlight the effects of pre and post-transplant inpatient rehabilitation (IR) on quality of life (QOL), endurance, functional mobility and independence in this growing patient population.

Design: Case study following a 46 year old male with a history of Hepatitis C, anxiety, steroid induced hyperglycemia, and COPD requiring home oxygen for two years prior to admission. He received two hours of PT and one hour of OT, five to six days a week, consisting of: bed mobility, transfer training, progressive ambulation, endurance training, lower extremity strengthening, postural re-education, gait and balance training, and oxygen titration for a total of 15 days pre-transplant and 14 days post-transplant.

Methods: The following outcome measures were evaluated throughout the patient's IR stays: the Functional Independence Measure (FIM), the Quality Indicators (QI), the BORG Rate of Perceived Exertion Scale (RPE), the 6 Minute Walk Test (6MWT), the San Diego Shortness of Breath Questionnaire (SOBQ), the Dyspnea 12 Questionnaire (D-12), and the Patient Health Questionnaire (PHQ-9).

Results: The patient's 6 MWT and SOBQ were two outcome measures that improved significantly during rehab. From initial evaluation (IE) to discharge (DC) pre-transplant his 6MWT improved by 166ft and he was weaned off 3 Liters of supplemental oxygen. Post-transplant he improved his 6MWT by 200 ft from IE to re-evaluation and improved by another 370 ft by DC while ambulating on room air. His SOBQ also improved by 19 points post LT.

Conclusions: Physical therapists in the IR setting play a vital role in pre and post LT rehabilitation by safely monitoring vital sign responses, providing appropriate exercise prescriptions and home exercise programs, and progressing a patient's functional mobility in order for a patient to reach their optimal physical capacity on their road to recovery post transplantation. This case study describes the positive impact that can be made in two weeks of IR in terms of functional mobility, exercise tolerance, and QOL through the guidance provided by trained physical therapists pre-and post-LT.

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Abstract ID: S158

Title: Special Considerations for Transgender Patients in Cardiac Rehabilitation

Track: Cardiovascular Rehabilitation & Clinical Cardiology

Author(s): Anne D. Wolter, BS CEP, Ray W. Squires, PhD, Birgit Kantor, MD, Randal J. Thomas, MD, Amanda R. Bonikowske, PhD

Institutions(s): Mayo Clinic, Rochester, MN, USA.

Introduction: The need for transgender medicine has increased yet we have little data to help direct the care of this patient population. The preferences, facility requirements, and additional education and medical service needs are unknown.

Purpose: To subjectively evaluate the experience of the first patients to enter our cardiac rehabilitation (CR) program. To describe our experience and special considerations from the patients and staff.

Design: A report of the observations of transgender patient experiences and program delivery considerations in CR.

Methods: We gathered patient feedback on their experience. We collected information on the process of involving upper management, legal counsel, and the CR staff. Specific areas of focus included the patient experience, staff identified areas of insufficient evidence-based recommendations on the delivery of care, and facility and built environment requirements.

Results: We found the transgender population requires special considerations for program delivery, assessment, facility requirements and staff interaction. Patient feedback included considerations for the facility and the interaction with staff. Specifically, one patient stated “I just want to blend in and I don't want any special treatment” and “I want to use the locker room facility I am most comfortable in”. From a legal perspective, there are no specific guidelines outside of maintaining confidentiality and not discriminating which is standard care. Based on patient feedback we found the need for staff to be aware of unconscious bias and confident in using the patient's preferred gender pronoun and name. In addition to standard CR education and services, we discovered they appear to have increased mental health needs over the traditional CR patient. In regards to patient assessment, we lack normative data for assessing and reporting gender and sex specific CR outcomes. We found this patient population needs more assistance in facilitating non-cardiac appointments, specifically, the high volume of endocrinology appointments. Based on feedback from patients, upper management, and legal we identified a need for facility renovation.

Conclusions: The transgender population does require additional services and special considerations in CR. Because this patient's transformation is in flux, care is not black and white. There is still much that we don't know, don't understand, and has not been considered which is why involvement of the patients in conversations aimed at improving care delivery is essential. Prospective, longitudinal studies are needed to examine outcomes and develop normative data to aid in providing high quality, value-based CR for this patient population.

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Abstract ID: S159

Title: What Should We Expect: A Look at Rehabilitation in Heart Failure and Setting Evidence Based Goals, Treatment Time and Length of Stay in a Subacute Facility

Track: Cardiovascular Rehabilitation & Clinical Cardiology

Author(s): Stacey Lefkowitz, COTA/L, Suzanne Bodian, PT, DPT, GCS, CCI, CCCE, Lauren Raschen, OTR/L, MHA, RAC-T

Institution(s): The New Jewish Home, New York, NY, USA.

Introduction: Limited research into how much rehab treatment a heart failure (HF) patient should be participating in, we examine realistic functional goals, length of stay, and amount of weekly treatment time. Our NY based subacute rehab facility with three years of joint commission accreditation in HF which led us to the question - what are realistic goals for our HF patients? Additional evidence is needed.

Purpose: The purpose of the study is to determine what realistic goals are in a subacute rehab setting, specifically: ambulation distance, assistance, treatment time, and length of stay in accordance with evidence.

Design: Qualitative research design including manual review of HF patients who were discharged from our facility. Functional data was pulled from the electronic medical record (EMR) with the goal of capturing those who were able to ambulate 100ft with supervision through rehab's grading scale called CAREtool. CAREtool defines supervision as verbal cues and/or touching assistance only. Additionally, length of stay and amount of therapy provided weekly was captured and calculated through the EMR.

Methods: For patients admitted with the diagnosis of HF, the medical team places an order set for the HF program and evaluating therapists utilize secondary program of “cardiac telemetry” within their EMR aiding in data collection. Rehab documents ambulation distance and assistance. At discharge ambulation distance/assistance is captured by the therapists' discharge documentation while capturing length of stay and manual review of weekly treatment time.

Results: Data collection for 2018 gathered and reviewed ambulation distance and assistance, length of stay, and amount of rehabilitation provided. Of the 130 patients discharged from the HF program, 78% were able to ambulate over 100 feet with supervision. The average length of stay was 16 days and the amount of therapy varied between 5-12.5 hours a week of rehabilitation combined.

Conclusions: Research is lacking in what are appropriate goals for those with HF who have been admitted to subacute rehab. The question is what are realistic goals, in, ambulation length of stay, and amount of rehab services weekly? In review of our patient population, there are a higher percent of patients who are able to ambulate 50 feet with supervision than our goal of 100 feet with supervision. With subacute rehab services on the brink of change, determining realistic goals and time frame is essential to not only HF patients but all patients in subacute rehab.

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Abstract ID: S160

Title: Collaborative Assessments of Back Pain in Cardiac Rehabilitation

Track: Cardiovascular Rehabilitation & Clinical Cardiology

Author(s): Wendy Bjerke, PhD1, Eunice Lisk, MS2, Hannah Chamblin, BS1, Marc Brodsky, MD3, Evan Qatani, BS1, Chloe Barcial, BS1

Institution(s):1Sacred Heart University, Fairfield, CT, USA, 2Griffin Hospital, Derby, CT, USA, 3Center for Integrative Medicine and Wellness, Stamford, CT, USA.

Introduction: Approximately 80% of individuals report low back pain (LBP) within their lifetime. Approximately 20% of the population reports acute LBP. Given these statistics, LBP should be assessed and considered in cardiac rehabilitation (CR) settings.

Purpose: Our purpose is to report the prevalence, intensity, and frequency of LBP in a CR setting and compare findings to general patients with LBP pursuant to a gained understanding of LBP in CR.

Design: Collaborative researchers from two hospitals and one university in Connecticut compared LBP data collected in 2018. Correlates with LBP in addition to the prevalence, frequency, and intensity of LBP in CR were examined retrospectively and compared. The design combines features of a case-control study with demographic data from a clinical trial.

Methods: 120 CR patients (average age 65 and 75% male) attended an average of 26 CR sessions in 2018. LBP prevalence, frequency, and intensity were examined during treatment. Concurrently, 60 individuals with LBP (average age 48 and 80% male) were assessed for pain intensity and correlation with the ability to walk and climb stairs using the Roland-Morris Disability Questionnaire (RDQ). LBP prevalence, frequency, and intensity were assessed with descriptive statistics. LBP intensity and correlations with stairs and walking were assessed with descriptive and inferential statistics. Statistical analysis was completed with SPSS software.

Results: LBP prevalence among CR patients was 18.3%. Among CR patients with LBP, the average intensity of pain (1-10 RDQ scale) was 4.89 (2.18 SD). The average frequency of pain was 3 days out of all CR sessions (range 1-36). Among 60 patients with LBP, the average intensity of pain was 4.36 (2.3 SD). The intensity of pain was positively but weakly and not significantly correlated with both walking (R = .17) and climbing stairs (R = .26). The impact of LBP on walking ability was moderately, positively, and significantly correlated with the ability to climb stairs (R = .55, p = .00001).

Conclusions: Prevalence of LBP among CR patients was similar to general prevalence and average pain was similar among CR patients and LBP patients despite significant differences in age. Also noted were weak correlations between pain intensity and walking and climbing stairs, but a strong relationship between the two activities. Given that CR patients perform different types of exercises (i.e., aerobic, resistance training, stretching) during CR sessions, CR professionals should consider tailoring some exercise types to treat the co-morbidity of LBP.

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Abstract ID: S161

Title: The Influence of Exercise Intensity Progression Across Thirty-six Sessions of Cardiac Rehabilitation on Functional Capacity

Track: Cardiovascular Rehabilitation & Clinical Cardiology

Author(s): Truman Haeny, MS1, Rachael Nelson, PhD2, Jeremy Ducharme, MS1, Micah Zuhl, PhD1,2

Institution(s):1University of New Mexico, Albuquerque, NM, USA, 2Central Michigan University, Mt. Pleasant, MI, USA.

Introduction: The primary functional goal of cardiac rehabilitation (CR) programs is to improve peak exercise capacity, or functional capacity. More robust improvements in functional capacity following CR are associated with better health outcomes for cardiac patients. Higher exercise intensity achieved among patients during CR has been linked to greater functional capacity outcomes. However, uncertainty exists regarding how to most effectively progress exercise intensity among heart disease patients throughout a CR program. Defining key time frames to increase exercise workloads may lead to improve functional capacity outcomes.

Purpose: Therefore, the purpose of this study was to investigate the association between progression of exercise intensity on functional capacity among cardiac patients who completed a 36-session CR program.

Design: This was a retrospective database analysis study.

Methods: Extracted data included: demographic, functional capacity (in METs), and exercise intensity during exercise sessions 2, 12, 24, and 36 from 150 CR patients who completed a 36 session out-patient CR program in Albuquerque, NM. The progression of exercise was determined by calculating the percent change in treadmill exercise intensity within predefined time frames of CR. The time frames were percent change from exercise session 2 to 12 (“%ΔS2-S12); percent change from 12 to 24 (%ΔS12-S24), and percent change from 24 to 36 (%ΔS24-S36). Data was used to develop a multiple linear regression model to predict change in functional capacity (ΔMETs) based on exercise progression using %ΔS2-S12, %ΔS12-S24, and %ΔS24-S36, while controlling for confounding variables (i.e., age, sex, and body mass index).

Results: Our regression model identified that significant proportion (21%) of the total variation in change in METs was predicted by %ΔS2-12, %ΔS12-24, %ΔS24-36, age, sex, and BMI. Further, percent change between sessions 12 to 24 (%ΔS12-24; β=0.17, p=0.03) and sessions 24 to 36 (%ΔS24-36; β=0.23, p<0.01) were significant predictors. Age (β=-0.24, p<0.01) and the sex (female; β=-0.16, p=0.02) were significant negative predictors.

Conclusions: Based on the regression analysis, progressing patients between exercise sessions 12 to 24, and 24 to 36 predicted significant change in functional capacity. This reinforces the importance of emphasizing increased progression of exercise intensity across all thirty-six sessions of CR to improve functional capacity.

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Abstract ID: S162

Title: Social Assistive Robot in Cardiac Rehabilitation

Track: Cardiovascular Rehabilitation & Clinical Cardiology

Author(s): Monica Rincon-Roncancio, MD1, Karen Moreno-Medina, PT1, Carlos Cifuentes2, Lorena Pinzón, PT1, Marcela Munera2, Luisa Fernanda Gutiérrez, MD1, Nathalia Céspedes2

Institution(s):1Fundacion Cardioinfantil, Bogota Colombia, 2Escuela Colombiana de Ingeniería Julio Garavito, Bogota, Colombia.

Introduction: Social Robots (SR) have potential for several healthcare applications, especially in rehabilitation areas. Our research has focused on working with a socially assistive robot system for cardiac rehabilitation (CRH), based on a model-controller structure through a finite-state machine and a behavior module. The platform has been designed to provide social support and assistance during the session, aiming to improve the quality of the service, as well as the engagement and performance of the patients.

Purpose: The aim of this study is to describe cardiovascular variables measured through a Social Robot in patients included in a Cardiac Rehabilitation Program (CRP) in a cardiovascular referral center.

Design: The development of a sensor interface for CRH on a treadmill was realized. This interface measures different variables during session: cardiopulmonary parameters: peak heart rate, heart rate variability and evolution of heart rate; gait spatiotemporal parameters: cadence, step length and speed; and physical activity difficulty parameters: Borg Scale and treadmill's inclination. The interface consists of 4 main modules: Graphical User Interface which allows the user to interact with the system, Sensor Manager dedicated to handle the sensory data acquisition and processing, Storage System that allows communication and data transmission between modules and Social Robot to provide social interaction during the therapy.

Methods: Randomized clinical trial. Patients prescribed to CRP, diagnosed with coronary disease or taken to a percutaneous coronary angioplasty who were able to exercise on a treadmill, were randomly allocated in a conventional CRP (control group) or a program including a SR (robot group) for physiological measurements and patient's feedback. Heart rate and blood pressure were measured at the beginning and end of each session.

Results: 15 patients have been included in the trial. Four patients for each group have completed the CRP. All the patients were males, and, in both groups, the most common diagnosis was myocardial infarction. In both groups, mean HR during sessions increase through the CRP. When exercise HR is compared with the mean heart rate 1 minute after finishing the exercise the largest difference was found in patients in SR group.

Conclusions: Cardiovascular variables measurement in patients included in a CRP can be enhanced with a Social Robot, that registers data from physiological variables in real time as well as interacts with the patients providing feedback during the session. These are preliminary results. Funding for the present study was provided by COLCIENCIAS Colombia, contract 813-2017.

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Abstract ID: S163

Title: Comparison of Seated Battle Rope Training Exercise Intensities in Healthy, Young Adults

Track: Physical Activity/Exercise

Author(s): Nathan J. Hellyer, PT, PhD, Kent Deardorf, SPT, Sonya Hagberg, SPT, Alex Nagel, SPT, Michael Wilshusen, SPT

Insitution(s): Mayo Clinic, Rochester, MN, USA.

Introduction: Rhythmic, aerobic exercise modes for the upper extremities are limited, with arm crank ergometry most commonly utilized to improve cardiovascular fitness. Battle rope exercise training (BRET) is an alternative to ergometry, but is typically associated with high-intensity interval training. BRET is an exercise mode that is independent of lower extremity function and can be performed seated. However, there is limited knowledge of workload intensity in healthy individuals, especially while seated and whether BRET can be employed at lower intensity intervals.

Purpose: The purpose of this study was to investigate BRET heart rate response in a seated position between two separate exercise intensities.

Design: The study is a crossover design with two randomly assigned groups differing in exercise treatment order. Twenty-two healthy subjects (eighteen-40 years old), eleven male and eleven female, were recruited and completed the study.

Methods: Subjects participated in two, eight minute sessions of BRET with one session targeting high intensity training (HIT) and a second session targeting a low intensity training (LIT). Subjects were randomly assigned session order, with one week in between sessions. HIT employed a 15 m long, 14 kg rope and 1:3 work ratio and LIT employed a 9 m long, 4.5 kg rope and a 1:1 work ratio. Mean exercise heart rate (HR), percent heart rate reserve (%HRV) and rating of perceived exertion (RPE) were analyzed by paired t-tests. Mean ± S.E are presented.

Results: Mean resting HR was not significantly different between groups (p>0.5). Mean HR during exercise was 119 ± 5 bpm for LIT and 140 ± 18 bpm for HIT with a mean difference of 21 ± 4 bpm (p<0.05). Mean post exercise HR was for HIT and for LIT. Mean %HRR was 41 ± 5% for LIT and 57 ± 4% for HIT with a mean difference of 16 ± 4% (p<0.05). Mean RPE (1-10) during LIT and HIT were 4.0 ± 0.4 and 7.0 ± 0.3, respectively with a mean difference of 3.0 ± 0.4 (p<0.05).

Conclusions: Seated BRET can be performed at both high and low intensities. We observed lower RPE, exercise HR and %HRR for LIT versus HIT exercises, indicative of a lower cardiac workload for LIT. Seated BRET appears to be an adaptable upper extremity aerobic exercise training mode that allows for lower and higher intensity cardio-respiratory fitness prescriptions.

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Abstract ID: S164

Title: Food as Medicine- Incorporating Plant Based Nutrition Education Into Cardiac Rehabilitation

Track: Nutrition

Author(s): Julee Arbuckle, BSN, RN, CCRP, Craig Clemens, MA, ACSM-CEP, Sheri Berger, RDN

Institution(s): El Camino Hospital, Mountain View, CA, USA.

Introduction: Poor nutrition is a factor in more than 50% of chronic diseases, including heart disease. Cardiac rehabilitation programs have been exercise focused. In 2010 Medicare increased coverage to include nutrition and stress management, based on research showing reversal of coronary artery disease with comprehensive lifestyle education and practice. Our program emphasis was on exercise. Patients received 36-monitored exercise sessions and a single nutrition lecture and introduction to stress management. The majority of patients with a weight loss goal were not getting the support needed to be successful. A plant based nutrition curriculum was implemented to improve our cardiac rehabilitation program and patient outcomes.

Purpose: To develop and implement a comprehensive nutritional program shown by research and best practice to reduce the progression of heart disease and co-morbid conditions when followed consistently by patients.

Design: A multidisciplinary task force met to define a quality improvement project in nutrition education. Funding was established through a Foundation Grant enabling a full-time Registered Dietician. A new class structure incorporated an evidence based “Food as Medicine” curriculum focused on the importance of food as it relates to heart disease, including plant-based nutrition. All patients were offered personalized one on one dietary consultation. Cooking demonstrations and recipes were available, as well as a nutrition library for patients.

Methods: A quality improvement database captured metrics during initial assessment of all patients, and at the final discharge session. The measurement period included all patients with paired data from Quarter 1, 2017 through Quarter 4, 2018. A paired t test was used for all analysis.

Results: The program restructure resulted in a 5 fold year-over-year increase in group nutrition education hours. There was a statistically significant improvement on SF36 scores in 5 of 8 heath domains. Patients maintained MET measurements of fitness improvement in the new class structure. Dietary Risk Assessment (DRA) scores improved by 10.9%. There is a significant increase in weight loss for those with a weight loss goal with a pvalue of 0.0012 and a sample size of 113.

Conclusions: A new class structure that incorporated six plant strong nutritional modules was successfully implemented and has shown favorable results in outcome data. This quality improvement project has enabled our staff to provide more comprehensive cardiac rehabilitation and enhance the tools for our patients for their cardiovascular risk factor reduction goals and improved health.

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Abstract ID: S165

Title: Specificity of Training in Cardiac Rehabilitation to Facilitate a Patient's Return to Strenuous Work Following Aortic Valve Replacement

Track: Cardiovascular Rehabilitation & Clinical Cardiology

Author(s): Stephanie McCray, RN-BC, Nicole Jenkins, BS CEP, Katelyn Brown, BS EP, CCRP, Jenny Adams, PhD, Tim Bilbrey, MS, Jeffrey Schussler, MD

Institution(s): Baylor Scott and White Heart and Vascular Hospital, Dallas, TX, USA.

Introduction: A 30-year-old male roughneck worker on an oil rig underwent aortic valve replacement via full median sternotomy and subsequently enrolled in the Baylor Heart and Vascular Hospital cardiac rehabilitation (CR) program. Traditional CR exercise training guidelines for post sternotomy patients are too conservative for return to high-intensity work.

Purpose: The purpose of this study was to rehabilitate a patient for return to work using a telemetry-supervised, high-intensity exercise program that simulated his job requirements.

Design: An interventional and observational case report.

Methods: CR staff designed and implemented comprehensive tests and a 5-week exercise program that included 6 exercises simulating his job functions. To determine the initial weight prescription for 3 of the 6 exercises, CR staff measured his maximum force using a multidimensional strength assessment system. Max forces were measured and averaged. The initial weight prescription for these 3 exercises was set at 30% of max force. For the remaining 3 exercises, no tests were performed. Instead, exercise prescription was based off of the patient's capability. For each individual oil rig activity, poundage goals were set. Additionally, a job specific 7-point likert scale confidence questionnaire (All of the time to None of the time) was given before and after initiation of the training program.

Results: The patient successfully reached each of his poundage goals. Over the course of CR, the amount of weight the patient lifted increased by the following percentages: (1) 66.67%, 45lbs to 75lbs; (2) 81.82%, 44lbs to 80lbs; (3) 400%, 16lbs to 80lbs; (4) 317%, 12lbs to 50lbs; (5) 233%, 15lbs to 50lbs; and (6) 367%, 21lbs to 100lbs. Additionally, the patient's confidence score increased from 46% to 86% after completion of this program.

Conclusions: This case report demonstrates how a customized, medically supervised training program can safely and effectively return a patient to a level of strength and fitness that enabled him to return to a physically demanding job within 3 months of aortic valve replacement via sternotomy. The high-intensity exercise program was successfully completed without adverse signs or symptoms and enabled the patient to return to work within 2 months of completion of CR.

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Abstract ID: S166

Title: Thriving Downtown: PR In the Inner City

Track: Pulmonary Rehabilitation & Medicine

Author(s): Kimberley Ray, RRT, Danele Adams, RRT, Rachel Nicholas, RRT, Sarah Roark, MD Institution(s): Denver Health and Hospital Authority, Denver, CO, USA.

Introduction: Little information exists on pulmonary rehab (PR) programs in an inner-city setting as compared to other programs nationally. Inner-city patient populations tend to have higher severity of illness and significant social barriers to health care. These factors make PR a great value but also create a challenge to maintain similar results. Additionally, staffing resources for PR are limited and without support of nutrition or physical therapy. Through a retrospective review of national data it has shown that a small inner-city PR program can align with other programs nationally.

Purpose: A review was done to investigate the outcomes of a small inner-city PR program as compared to other programs nationally. Is it possible to achieve similar outcomes with fewer resources for the program as well as patients? Due to limited resources the DH PR program is shorter in length and smaller in capacity with a wait list. Patient barriers are significant as demonstrated by 75% of referrals never enrolling.

Design: Using the AACVPR national database, a retrospective review of data was performed to compare the Denver Health PR program to all others nationally dating from 1/1/2018 through 12/31/2018.

Methods: Elements reviewed included QOL scores, comorbidities, oxygen needs, medications, pulmonary function, functional capacity, diagnosis, demographics and PHQ-9. Graduation is defined as completing 16 sessions within the DH program. By comparison, the average session number completed nationally is 24. Appropriate statistical analyses were performed including a T-test to compare oxygen needs between the DH PR program and others nationally both at rest and exercise.

Results: Of the 132 patients referred in 2018 to DH PR program, 25 completed and graduated the program. Oxygen needs at rest and with exercise were found to be higher in the DH PR program (p<.0001). This represents a marker of more severe illness. In comparison, outcomes such as quality of life scores were not significantly different, highlighting the DH PR program consistency with other national programs despite a shorter duration and sicker patients.

Conclusions: The DH PR program is a small inner-city program caring for patients with significant challenges to healthcare and a high level of severe illness. The PR program, while shorter in duration and with significant challenges for staff and patients, is able to meet the national standard of outcomes.

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Abstract ID: S167

Title: Sleep Disorders in Patients Attending Cardiac Rehabilitation

Track: Cardiovascular Rehabilitation & Clinical Cardiology

Author(s): Jonathan Gallagher, MPsychSc

Institution(s): Beaumont Hospital, Dublin, Ireland.

Introduction: There is convincing evidence that sleep disturbances independently contribute to poorer cardiovascular health1,2, and may represent important and novel targets for CVD reduction. Insomnia and obstructive sleep apnea (OSA) frequently co-occur and have been shown to operate synergistically to result in poorer outcomes in both hypertensive and depressed patients3. Poor sleep quality has also been associated with decreased health-related quality of life in patients attending CR4. Although such findings suggest that sleep disturbance in cardiac patients may hamper rehabilitative efforts, sleep disorders typically go undiagnosed and little is known about the extent of sleep dysfunction in patients attending CR.

Purpose: The present study sought to investigate: (a) the prevalence of insomnia and OSA risk respectively in a sample of cardiac patients attending CR; and (b) the extent to which these sleep disorders co-occur in at-risk patients.

Design: 220 patients (77% male; mean age 65 years) attending a hospital-based comprehensive CR programme were routinely screened at baseline for symptoms of insomnia and their risk of obstructive sleep apnea (OSA).

Methods: The Sleep Condition Indicator (SCI)5 was used to measure sleep quality and allowed evaluation of symptoms against DSM-V criteria for insomnia disorder (ID). In addition, the STOP-BANG6 was employed to determine the prevalence of sleep apnea risk in this sample of patients. CR audit data was examined to provide data on key comorbidities and clinical variables relevant to sleep.

Results: Applying DSM-V criteria, 29.5% (65/220) of CR patients screened as having probable insomnia disorder; with a further 3.6% (8/220) reporting symptoms consistent with acute insomnia. 66.9% (147/220) did not report any clinically significant symptoms of insomnia. With regard to obstructive sleep apnoea (OSA), 23.2% (51/220) were identified to be at low risk of OSA; 52.3% (116/220) were at moderate risk of OSA; and 13.6% (30/220) screened as high risk of OSA. The prevalence of CR patients with co-morbid OSA risk and insomnia was also calculated. 21.8% (48/220) of patients were identified to be at risk of both chronic insomnia and moderate-high risk of OSA.

Conclusions: There was a high prevalence of patients at risk of ≥1 sleep disorder in this CR cohort (∼70%), with almost a quarter of patients reporting symptoms of both OSA and chronic insomnia. The importance of screening for sleep disorders systematically in CR is therefore highlighted. Early identification and treatment of sleep disorders in this population has the potential to improve both cardiovascular and psychosocial outcomes.

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Abstract ID: S168

Title: The Role of Exercise Mode on Functional Capacity Changes in Cardiac Rehabilitation: A Meta-Analysis

Track: Cardiovascular Rehabilitation & Clinical Cardiology

Author(s): Stephanie Gerlach, PhD1, Christine Mermier, PhD1, Lance Dalleck, PhD2, Len Kravtiz, PhD1, Micah Zuhl, PhD1

Institution(s):1University of New Mexico, Albuquerque, NM, USA, 2Western Colorado University, Gunnison, CO, USA.

Introduction: For heart disease patients, cardiac rehabilitation (CR) is the gold standard recommendation to reduce mortality risk. The primary exercise outcome in CR is an improvement in functional capacity. National (U.S.) and international exercise prescription guidelines for cardiac patients have been established by various groups (e.g., clinical organizations, government agencies) to guide clinical exercise physiologists. Regarding mode of exercise, the broad recommendation is for patients to perform whole body aerobic exercise (i.e., treadmill); however, localized lower body exercise (i.e., cycling) is also a common alternative. Limited research exists comparing the role of exercise mode in CR on functional capacity.

Purpose: To compare treadmill versus cycling-based cardiac rehabilitation on functional capacity outcomes.

Design: Systematic review and meta-analysis.

Methods: PubMed, ScienceDirect, Cochrane Library, and Google Scholar were searched for randomized studies using single modality continuous exercise. Appropriate studies were identified and selected meeting the inclusion criteria. All studies implemented a continuous cycling or treadmill specific protocol and compared it to a control condition. The effect of single modality exercise on FC (VO2 peak) was analyzed. Differences in the effect of CR on FC was assessed between the mode subgroup (cycling vs. treadmill) and disease state subgroup (CAD vs. CHF) within both the cycling and treadmill groups.

Results: Data were extracted from 23 studies including 600 patients (mean age 60yrs, 86% male). Overall, single modality cardiac rehabilitation induced a significant increase in FC (VO2peak) from pre- to post-rehabilitation (g = 0.72; 95% CI, 0.47 - 0.96; P < 0.0001). There was a significant difference in effect size between studies that used cycling, Hedges' g=0.85 (95% CI, 0.52 - 1.17, k=13) and studies that used treadmill exercise, Hedges' g=0.46 (95% CI, 0.22 - 0.70, k=8). Significant heterogeneity (I2= 86%) was identified, and reflects differences identified in samples. Within cycling studies (n=14), FC was higher among coronary artery disease (CAD) patients compared to chronic heart failure (CHF) (Z=23.95, p<0.001). Conversely, among treadmill studies (n=9), FC was higher among CHF patients compared to CAD (Z=-2.39, p<0.01).

Conclusions: The comparison between cycling and treadmill studies demonstrated that when cycling is the primary mode of exercise in CR there is a larger change in FC than treadmill only. In addition, CAD patients appeared to experience better gains if cycling was the primary mode of exercise in CR while CHF patients may benefit more from treadmill-based exercise.

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Abstract ID: S169

Title: Evaluation of the Impact of an Aerobic Exercise Program on Cardiovascular Health, Quality of Life and Disability of Patients With Lower Limb Amputation Secondary to Diabetic Foot Complications

Track: Physical Activity/Exercise

Author(s): Roberto C. Sahagun Olmos, MD, MSc1, Juana Zavala Ramirez, MD, MSHPM1, Brenda F. Valdez Gutierrez, MD1, Beatriz G. Gutierrez Castellanos, MD2, Alicia G. Vazquez Lara Santoyo, MD3, Maria del Rosario Perez Molina, PT1, Mayra P. Estrella Piñon, MD, MSc4, Carlos Pineda, MD, PhD1, Marwin Gutierrez, MD1, Ingrid C. Contreras Guerrero, MD1

Institution(s):1Instituto Nacional de Rehabilitacion “Luis Guillermo Ibarra Ibarra”, Mexico City, Mexico, 2Hospital Regional de Alta Especialidad “Ciudad Salud”, Tapachula, Mexico, 3Instituto Mexicano del Seguro Social, Ciudad Juarez, Mexico, 4Instituto Nacional de Perinatologia “Isidro Espinosa de los Reyes”, Mexico City, Mexico.

Introduction: Diabetes mellitus (DM) is one of the most common chronic diseases, with about 425 million cases worldwide; this population are 2 to 3 times more likely to develop cardiovascular disease; and their risk of lower-limb amputation is increased about 10-20 times. Several studies have reported that patients with diabetes-related foot amputation have an increased risk of major cardiovascular events. Aerobic exercise is one of the most effective therapeutic interventions for primary and secondary cardiovascular prevention; although many studies has shown exercise benefits for people living with DM and some for lower limb amputation, to the authors' knowledge no study has investigated the impact of aerobic exercise programs in people with secondary amputation to diabetes-related foot; hence, we ask the following research question: What is the impact of a 6-week aerobic exercise program on the cardiovascular health, quality of life and disability of patients with lower limb amputation secondary to diabetic foot complications?

Purpose: Evaluate the impact of an aerobic exercise program on cardiovascular health, quality of life and disability of patients with lower limb amputation secondary to diabetic foot complications.

Design: Quasi-experimental, prospective and analytical study.

Methods: A sample of patients over 18 years, of either sex, with lower-limb amputation secondary to diabetic necrobiosis, were recruited to participate in a calisthenics exercises program involving all 4 extremities (including the residual limb) 45 minutes, 3 sessions a week, reported by Beim J et al.; the parameters evaluated before and after are the following: arm ergometry exercise stress testing, biochemical parameters, disability (WHODAS 2.0) and quality of life (WHOQOL-BREF). Wilcoxon signed rank test for paired samples was used in this study.

Results: Nine male subjects were included, median age of 57 years (interquartile range 12.5), median time of diagnosis of DM was 16.6 years (interquartile range 22.79), median time of amputation of 15 months (IQR=14). Wilcoxon signed-rank test was applied and we found statistically significant differences between the pre and post exercise program evaluations: functional capacity VO2max (p=0.004) medians 21.15 ml/kg/min (IQR=9.08) versus 23.2 ml/kg/min (IQR=6.5); glycated haemoglobin (p=0.031) medians 8.2% (IQR=1.25) versus 6.9% (IQR=0.9); WHODAS 2.0 (p=0004) medians 71 points (IQR=28) versus 22 points (IQR=51); and WHOQOL- BREF (p=0.004) medians 70 points (IQR=13.5) versus 95 points (IQR=12).

Conclusions: This program shows the potential to improve functional capacity, glycated hemoglobin, disability and quality of life in these patients. However, more studies are needed to evaluate the consistency of the results.

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Abstract ID: S170

Title: Identifying Exercise Prescription Components That Predict Improvements in Functional Capacity Among Participants Enrolled in Cardiac Rehabilitation

Track: Cardiovascular Rehabilitation & Clinical Cardiology

Author(s): Stephanie Gerlach, PhD1,2, Len Kravitz, PhD1, Christine Mermier, PhD1, Lance Dalleck, PhD3, Micah Zuhl, PhD1,4

Institution(s): University of New Mexico, Albuquerque, NM, USA, Western Colorado University, Gunnison, CO, USA, Central Michigan University, Mt. Pleasant, MI, USA.

Introduction: Worldwide, inconsistent exercise prescription guidelines exist for patients enrolled in cardiac rehabilitation (CR). This may be in response to lack of understanding of how exercise components predict changes in functional capacity (FC) within a CR program. Evaluating the impact of intensity, duration and frequency of exercise in CR programs will direct clinicians towards designing and implementing effective exercise programs.

Purpose: The purpose of this study was to evaluate the role of exercise prescription variables on FC changes among coronary artery disease (CAD) patients who completed 36 sessions of CR.

Design: This was a retrospective database study between the years 2014 to 2018.

Methods: Data were extracted for 151 CAD patients from a clinic located in Albuquerque, NM. Exercise prescription data (e.g., intensity, duration, and frequency) for each patient was obtained from the in-house clinical database. Outcome data (FC - measured as change in peak metabolic equivalents, METs, from pre- to post-CR) was extracted from the AACVPR registry. Average intensity was based on treadmill exercise workload throughout CR calculated as a percentage of pre-CR peak METs (from baseline treadmill test). Average session duration (in minutes) was calculated from completed minutes of treadmill exercise. Frequency was calculated as the number of exercise days per week. Data was used to develop a multiple linear regression model to predict change in FC. The predictors in the model were average intensity, duration, and frequency throughout 36 sessions of CR. Age and sex were inputted as confounding variables in the model.

Results: The regression model identified that a significant proportion (29%) of the total variation of change in FC was predicted by intensity, duration, frequency, age, and sex. Average treadmill intensity (β=0.029, p<0.0001) and duration (β=0.109, p=0.001) were significant predictors in the model.

Conclusions: Among a cohort of CAD patients, treadmill intensity and duration were significant predictors of FC while controlling for frequency, age and sex. Based on the unstandardized beta (β=0.029), an increase in average treadmill intensity by nearly 35% predicted a 1 MET increase in FC across 36 CR sessions. Similarly, an increase in average treadmill duration by 10 minutes throughout a 36 session CR program predicted a 1MET increase. As treadmill duration and intensity predict change in FC, clinical exercise physiologists should strive to progress patients in these variables throughout CR.

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Abstract ID: S171

Title: Physician Led Cardiac Wellness Group Clinic for Rehabilitation and Lifestyle Transformation Through Deeper Self-Awareness

Track: Behavior Change

Author(s): Anand Chockalingam, MD, FACC, FAHA, FASE

Institution(s): University of Missouri, Columbia, MO, USA.

Introduction: Simple lifestyle changes life diet, exercise and smoking cessation can significantly reduce cardiovascular disease (CVD). Cardiac rehabilitation has the potential to impact high risk patients but only about 20% eligible patients complete these programs. Over a longer time-course of years, compliance with lifestyle recommendations declines, making CVD a chronic incurable disease with high mortality and morbidity.

Purpose: Gaining a deeper self-awareness through targeted learning and mindfulness techniques has the potential to change perceptions and outlook at the sub-conscious level. This can transform lifestyle and sustainably improve compliance to prevent CVD events.

Design: MD led 8 week group clinics as supplement to guideline mediated CVD management and traditional rehabilitation.

Methods: Our VA hospital serves mid Missouri offering whole Health program is a patient-centric holistic health initiative that targets chronic diseases prevention through health buddies and mind-body methods. Over the last 3 years, we screen veterans with CVD in our cardiology clinics, catheterization lab and post- surgical revascularization. When veteran is able to travel weekly and open to taking more responsibility towards health, they are offered enrollment along with their significant others. Veterans living far away or dealing with cognitive disabilities do not participate. As our MD led wellness program is structured as a group clinic, veterans receive travel pay to attend the sessions.

Results: The self-awareness based cardiac wellness clinics occur 3 times a year for the last few years. We have enrolled over 50 veterans and their spouses and majority completed the program. The first 30 minutes of each session is didactic presentation about cardiac risk factors, diet, exercise, smoking cessation, stress and relaxation, sleep and mindfulness. Next 15 minutes is interactive to individually tailor the program recommendations and overcome patient barriers to daily implementation of these concepts. The last 15 minutes is used for novel mindfulness practices to improve self-awareness, confidence and perceptions about health. We see significant improvements in various scales like perceived stress, mindfulness and optimism in veterans completing the program. Compliance with diet, exercise, stress control and smoking cessation improved.

Conclusions: Patients with CVD can be encouraged to take more responsibility for their health through physician led group clinics. Targeting self-awareness through novel, widely available tools can transform lifestyle long-term through gaining confidence and learning at the sub-conscious level. Randomized studies may demonstrate effectiveness of these holistic programs to lower healthcare costs and prevent CVD.

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Abstract ID: S172

Title: Physical and Psychological Effects of Cardiac Rehab on Patients Following Mitral Valve and Aortic Valve Procedures

Track: Cardiovascular Rehabilitation & Clinical Cardiology

Author(s): S. Hammad Jafri, MD1, Pavel Hushcha, MBBS2, Pranav Dorbala, BS3, Gisele Bousquet, MS, RN2, Christine Lutfy, RN2, Jodi Klein, PT2, Lindsay Sonis, RN2, Donna Polk, MD, MPH2, Hicham Skali, MD, MSc2

Institution(s):1Harvard Medical School, Boston, MA, USA, 2Brigham and Women's Hospital, Boston, MA, USA, 3Georgia Institute of Technology, Atlanta, GA, USA.

Introduction: Patients participating in Cardiac Rehabilitation (CR) following an aortic valve (AV) procedure demonstrate improvements in physical capacity and psychological well-being. There is however little data about the effect of CR on patients following mitral valve (MV) procedures. The primary aims of this study are to evaluate baseline exercise capacity and psychological well-being for MV patients participating in CR and to compare outcomes between MV and AV patients.

Purpose: To compare change in 6-minute walk test, anxiety and depression scores between subjects who had MV Procedure (MVP) and those who had AV Procedure (AVP). We hypothesized that CR will equally improve physical capacity and well being in participants following MVP when compared to AVP.

Design: Retrospective cohort analyzing characteristics of patients after AVP and MVP underwent CR.

Methods: Between January 2015 and December 2018, 78 patients with aortic valve procedure and 30 with mitral valve were enrolled prospectively in cardiac rehab. Patients who had double valve procedure were excluded from this analysis. Primary endpoint was improvement in 6-minute walk distance (6MWD). Secondary endpoints included change in exercise minutes per week (EMW), depression scores (PHQ9) and anxiety scores (GAD7).

Results: There were no significant difference in age or gender between the two groups. Patients in the MVP group had lower prevalence of diabetes or prediabetes, were less likely to be on statins, and had a higher exercise capacity at baseline (MVP: 7.2 METs (5.4-10.0) vs. AVP: 5.3 (3.8-8.6), p=0.026). Overall rates of CR completion were similar in both groups (76% in MV group vs. 70% in AV group, p=0.57). At the completion of their CR program, patients with MVP and those with AVP had similar improvements in their 6MWD (MVP: 179 feet (116-238 feet) vs. AVP 194 ft (122, 303), p=0.69); EMW (MVP: 82 minutes (40-168) vs AVP: 90 minutes (60-155), p=0.63). Changes in anxiety (GAD7 and depression (PHQ9) scores were minimal but similar between the two groups.

Conclusions: CR participation results in similar improvements in physical activity between patients with MVP and those with AVP. Psychological well-being and quality of life scores improved minimally and similarly between the two groups. Larger studies are needed to confirm these findings, in the meantime patients with MVP should continue to be encouraged to participate in CR.

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Abstract ID: S173

Title: Weight Loss and Its Predictors During Cardiac Rehabilitation

Track: Cardiovascular Rehabilitation & Clinical Cardiology

Author(s): Pavel V. Hushcha, MD1, S. Hammad Jafri, MD1, Pranav Dorbala, BS2, Gisele Bousquet, RN, MS1, Lexie Cabral, RN1, Jodi Klein, PT1, Frances Parpos, RD, CDE1, Lauren Mellett, PT1, Donna Polk, MD, MPH1, Hicham Skali, MD, MSc1

Institution(s):1Brigham and Women's Hospital, Boston, MA, USA, 2Georgia Institute of Technology, Atlanta, GA, USA.

Introduction: Obesity remains a modifiable risk factor for cardiovascular diseases. Exercise-based cardiac rehabilitation (CR) programs encourage lifestyle changes that should positively alter weight and body mass index (BMI). Predictors of weight loss at the completion of CR are not well known.

Purpose: The purpose of this retrospective cohort study was to examine how CR attendance affected participants' body weight and BMI and to identify predictors of weight loss by the completion of CR program.

Design: We utilized data from participants with paired weight data and baseline BMI≥25, who were enrolled in a 12-week CR outpatient program between January 2015 and December 2018. Their baseline characteristics, anthropometric measures, blood pressure, laboratory values, exercise capacity, depression and anxiety questionnaires (PHQ-9 and GAD-7), and Rate Your Plate - Heart (RYP-H) survey were assessed. Weight loss was defined as at least 3% decrease in body weight by the end of the CR program.

Methods: Subjects with the defined weight loss were compared to the remaining individuals with BMI≥25. Multivariable logistic regression was used to determine predictors of the weight loss.

Results: Overall, 91/352 (26%) participants (80% male; mean±SD for age: 62±12 years, baseline weight: 217±42 lbs, and baseline BMI: 33.0±5.7) decreased their body weight as defined above (average percent weight change: -4.9%±1.5 vs. -0.02%±2.2 and average weight change: -10.7±4.5 lbs vs. -0.1±4.5 lbs; p<0.001). This group tended to be younger (p=0.04), more likely referred for coronary artery disease diagnoses (p=0.049), and with less prevalent hypertension (p=0.033), compared to the remaining 261 individuals. Participants without diabetes or prediabetes were similar between the two groups. Their baseline PHQ-9 and GAD-7 scores were similar as well. Individuals who lost at least 3% of their weight achieved a higher RYP-H score (median [IQR]: 7.0 [3.0, 13.0] vs. 4.0 [1.0, 8.0]; p<0.001). In a multivariable model, baseline predictors of the defined weight loss included higher BMI and higher metabolic equivalents of task (METs) achieved during exercise stress test.

Conclusions: Throughout a relatively short period (12 weeks), CR attendance resulted in at least 3% body weight loss in 26% of the participants, which was associated with higher baseline BMI and functional exercise capacity (METs). It remains to be seen whether this achieved weight loss is sustainable and predicts better clinical outcomes.

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Abstract ID: S174

Title: Impact of an Automatic Referral Prompt on Patient Population Enrolled in a Cardiac Rehab Program

Track: Cardiovascular Rehabilitation & Clinical Cardiology

Author(s): Hicham Skali, MD, MSc, Pranav Dorbala, BS, Gisele Bousquet, RN, MS, S. Hammad Jafri, MD, Pavel Hushcha, MBBS, Christine Lutfy, RN, Jodi Klein, PT, Lindsay Sonis, RN, Lauren Mellett, PT, Donna Polk, MD, MPH

Insitution(s): Brigham and Women's Hospital, Boston, MA, USA.

Introduction: Referral rates to Cardiac Rehab (CR) are notoriously low in various settings. One of the methods to increase referral rates is to implement an Automatic Prompt in electronic health records (EHR) system for eligible diagnoses. With implementation of automatic referral orders or prompts, referrals to cardiac rehab are expected to increase. However, it is unclear if the patients who are automatically referred are different from patients referred by a non-automatic order. Differences might inform programs on resource allocations in the future.

Purpose: To study the impact of an automatic referral prompt on the volume and type of patients enrolled in CR.

Design: This was a retrospective chart review of patients enrolled in CR categorized by enrollment date and source of referral.

Methods: An automatic referral prompt for inpatients with diagnoses eligible for CR referral was implemented in our EHR system was implemented June 2017. Between January 2015 and December 2018, 641 patients were enrolled in our cardiac program. Patients were grouped in categories based on when and how they were referred: group 1: before June 2017 (n = 319), group 2: after June 2017 via internal automatic prompt (n=196), and group 3: after June 2017 without a matched automatic prompt referral order (n=126). Baseline demographic and clinical characteristics were compared using standard statistical methods.

Results: There were 319/641 (49.8%) patients who enrolled in CR prior to the implementation of automatic referral prompt at a rate of 129 per year. This increased to 211 per year after system change in June 2017. Of the patients enrolled following the automatic prompt implementation, 60% (n=196/322) were enrolled via the prompt and 40% (n=126/322) without the prompt. CR participants enrolled before June 2017 tended to be younger, less likely to be referred for heart failure reduced LVEF diagnosis than those referred after. For subjects enrolled after June 2017, there was no significant difference in demographic or clinical characteristics between those enrolled following the use automatic prompt and those enrolled without the automatic prompt.

Conclusions: While the implementation of an automatic EHR referral prompt resulted in a significant increase in the number of patients enrolled in CR, baseline patient clinical and demographic characteristics were not significantly different. It remains to be seen whether completion rates and long-term outcomes are maintained in all these patients.

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Abstract ID: S175

Title: Effect of Inspiratory Muscle Training on Cardiopulmonary Function in Patients With Heart Failure

Track: Cardiovascular Rehabilitation & Clinical Cardiology

Author(s): Yu-shan Lin, PT, MS1,2, Hsin-Yi Huang, PT, MS1, Bo-Yan Chen, PT1, Wei-Ning Syu, PT1, Li-Ying Kuo, PT, MS1, Hui-Yu Tsai, PT1, Shiang-Lin Shen, PT1, Li-Ying Wang, PhD3

Institution(s):1Cheng-Hsin general hospital, Peitou, Taipei, Taiwan, 2School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan, 3School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University Hospital, Taipei, Taiwan.

Introduction: Respiratory function is compromised in chronic heart failure (HF) and accounts for exercise intolerance.

Purpose: We aimed to assess the effect of inspiratory muscle training (IMT) on respiratory function and exercise tolerance in patients with HF.

Design: We carried out a meta-analysis of controlled clinical trials of IMT in patients with HF.

Methods: Data Sources A computerized literature search of PubMed, EMBASE, the Cochrane Controlled Trials Register and the Trip Medical Database was conducted. Study Selection Medical subject headings and search terms including heart failure, breathing exercise, respiratory muscle training, inspiratory muscle training and diaphragm breathing were used. Data Extraction and Data Synthesis Outcome measurements included maximal inspiratory pressure (PIMAX), peak oxygen uptake (peak VO2), and six minute walk test (6MWT) distance. The standard mean difference was pooled by a random-effects model.

Results: The analysis included six randomized controlled trials and four controlled trials. For PIMAX, the overall standard mean difference was 3.23 (95% CI 1.70-4.77, p value < 0.001). For peak and functional exercise capacity, the pooled effect size achieved significance (peak VO2 2.45, 95% CI 0.89-4.0, p value 0.001; 6MWT 2.46, 95% CI 0.58-4.33, p value 0.005). Sensitivity analyses suggested a greater effect of PIMAX on patients with inspiratory muscle weakness, but these patients showed less improvement in peak VO2 and 6MWT.

Conclusions: In conclusion, this meta-analysis provides insight into IMT intervention, which improves the respiratory function and exercise tolerance of patients with HF. On the basis of the available evidence, a negative relationship between PIMAX and functional improvement may be present in patients with HF.

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Abstract ID: S176

Title: Benefits of Pulmonary Rehabilitation in Hermansky-Pudlak Syndrome Associated Idiopathic Pulmonary Fibrosis

Track: Pulmonary Rehabilitation & Medicine

Author(s): Hope D. Sellon, RRT, BA, AE-C, Gerilynn A. Connors, BS, RRT, MAACVPR, FAARC, Kimberly A. Palczynski, RRT, Rebecca A. Kopelen, RRT, Rabih S. Halabi, MD, James P. Lamberti, MD, FCCP

Institution(s): Inova Fairfax Medical Campus, Falls Church, VA, USA.

Introduction: Hermansky-Pudlak syndrome (HPS) is a rare autosomal recessive disorder associated with Pulmonary Fibrosis (PF). Studies demonstrate that pulmonary rehabilitation (PR) benefits patients with COPD and our goal was to demonstrate PR benefits in patients with HPS.

Purpose: To demonstrate through outcomes the impact PR has on the HPS patient with associated PF pre and post lung transplant.

Design: Patient referred to comprehensive PR program pre and post lung transplant. To include assessment, education, therapeutic exercise, psychosocial intervention and long term adherence.

Methods: The patient participated in a nine week, three times a week comprehensive PR treatment program in 2015 which consisted of 21 of 24 exercise sessions and 9 of 9 educational sessions followed by maintenance exercise and post lung transplant PR.

Results: The HPS-PF patient was a 44 year old female. Pre and post Six Minute walk data was: distance (6MWD) 1,627 feet (ft) (496 meters), Post 6MWD 1,783 ft (544 meters), Pre highest Borg 3, Post highest Borg 3, Pre lowest O2 sat 90% on 2 l/m nasal cannula (NC), Post lowest O2 sat 89% on 6 l/m NC, Pre and post Hospital Anxiety and Depression Scale; anxiety 10 out of 21, depression 3 out of 21, Post anxiety 6 out of 21, depression 2 out of 21, Pre and post St. George Respiratory Questionnaire Pre Score 50 out of 100, Post Score 56 out of 100. Patient participated in maintenance exercise program at PR facility and was successfully transplanted in early 2018 followed by post PR. Participated in an eight week, twice a week PR program completing 16 out of 16 visits Post-transplant 6MWD 985 ft (544 meters), Post 6MWD 1,363 ft (416 meters), Pre highest Borg 3, Post highest Borg 1, Pre lowest O2 sat 92% on room air, Post lowest O2 sat 92% on room air, Pre HADS anxiety 5 and depression 3, Post HADS anxiety 4, depression 2, Pre St. George Respiratory Questionnaire Score 52, Post Score 33.

Conclusions: The improvement in outcomes demonstrates the benefits of PR in improving exercise capacity and quality of life in patients diagnosed with HPS-PF.

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Abstract ID: S177

Title: Cardiac Rehabilitation: Therapy or Diagnostic Intervention

Track: Cardiovascular Rehabilitation & Clinical Cardiology

Author(s): Justine D. Shertzer, MS, Wayne A. Mays, MS, Andrea L. Grzeszczak, MS, Malloree Rice, MS, Sandra K. Knecht, MS, Adam W. Powell, MD, Clifford Chin, MD, Samuel G. Wittekind, MD

Institution(s): Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.

Introduction: Cardiac rehabilitation may be an intervention that provides both a therapeutic result and serves as a source for diagnostic information in pediatric and young adult congenital heart disease patients and those with acquired heart disease.

Purpose: To evaluate the diagnostic potential of standard cardiovascular rehabilitation sessions above and beyond standard exercise testing modalities.

Design: We retrospectively reviewed individual cardiac rehabilitation (CR) sessions for our pediatric and young adult patients that completed their cardiac rehabilitation program during the period of December, 2017 to February, 2019.

Methods: The patient's referral history and testing was reviewed. All participants completed a maximal Cardiopulmonary Exercise Test (CPET) using a ramp protocol on an upright cycle ergometer (Lode Corival) and all exercised to exhaustion. Metabolic measures were obtained using a Medgraphics metabolic cart (Ultima CPX). A 12 lead electrocardiograph (ECG) (GE Case 8000) was continuously monitored through-out the test. Manual blood pressure with an appropriate cuff size was recorded at rest, during each minute of exercise and 1, 3, 5, and 10 minutes post exercise along with pulse oximetry (Masimo Radical). All CR sessions were continuously monitored electrocardiographically using the ScottCare system. Results were characterized with means and standard deviations

Results: During this period, 31 patients completed their program and their individual CR sessions were reviewed. We identified new diagnostic findings in 6 patients (4 males, 2 females) that were present only during their CR sessions. The average patient age was 22.5 ± 12.2 years old. Patient 1: Congenital heart block with artificial pacemaker diagnosis developed inappropriate upper rate phenomenon. Patient 2: Myocarditis diagnosis developed ventricular tachycardia (VT) terminated by ICD. Patient 3: Transposition of the great arteries developed VT. Patient 4: Ventricular septal defect with subaortic stenosis developed factitious syncope. Patient 5: Post-anthracycline cardiomyopathy developed panic attacks leading to psych admit. Case 6: Coarctation of the aorta developed frequent non sustained VT.

Conclusions: Our results indicate that the individual CR session can provide important diagnostic information that may not be uncovered during other testing and evaluations. This supports routine use of continuous ECG monitoring and blood pressure measurement during CR sessions.

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Abstract ID: S178

Title: Safety and Efficacy of High Intensity Exercise in Interstitial Lung Disease (ILD) Patients

Track: Cardiovascular Rehabilitation & Clinical Cardiology

Author(s): Noah Greenspan, PT, DPT, CCS, EMT-B1, Aastha Joshi, MS, PT1, Marion Mackles, PT1, Wai Chin, MS, EP1, Akua Adu-Labi, MS, EP1, Patricia Rocco, MS, PT, Mark Mangus, RRT, RPFT1, Marcella Debidda, PhD2

Institution(s):1Pulmonary Wellness & Rehabilitation Center, New York, NY, USA, 2monARC Bio, San Francisco, CA, USA.

Introduction: Safety and Efficacy of High Intensity Aerobic Exercise and Strength Training in Patients with Interstitial Lung Disease (ILD).

Purpose: To evaluate high-intensity aerobic exercise and strength training in patients with ILD.

Design: Thirty-two patients (19 female/13 male; mean age 65.91+11.69 years) with ILD underwent pre- and post-program evaluation using treadmill walking protocols.

Methods: All patients underwent cardiopulmonary PT for 90 minutes, 2 times per week, for 12 weeks for a total of 24 sessions consisting of breathing retraining, monitored aerobic exercise, upper and lower body strength training, and patient education.

Results: The mean peak MET level achieved during the pre- and post-rehabilitation exercise tests was 3.37 ± 0.93 and 5.43 ± 1.5 METs, respectively. The difference in peak MET level pre- and post-rehabilitation was statistically significant at p=0.004. Mean peak MET level improvement from pre- to post-rehabilitation exercise test was 2.06 +1.66 METs. The mean percent improvement in peak MET level following rehabilitation was 66.59% ±47.08%.

Conclusions: In a closely-supervised, monitored exercise setting, aerobic exercise and strength training is safe and effective in patients with ILD across all age groups and gender.

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Abstract ID: S179

Title: Arrhythmia Frequency During Cardiopulmonary Exercise Testing in Pediatric and Young Adult Congenital Heart Patients Pre and Post Cardiac Rehabilitation

Track: Cardiovascular Rehabilitation & Clinical Cardiology

Author(s): Andrea L. Grzeszczak, MS, Wayne A. Mays, MS, Justine D. Shertzer, MS, Malloree C. Rice, MS, Sandra K. Knecht, MS, Adam W. Powell, MD, Clifford Chin, MS, Samuel G. Wittekind, MD

Institution(s): Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.

Introduction: Cardiac rehabilitation (CR) may be an intervention that provokes covert cardiac arrhythmias in pediatric and young adult congenital heart disease patients participating in cardiac rehabilitation. Cardiopulmonary exercise testing is an effective tool in eliciting these responses and thus allowing therapeutic intervention.

Purpose: To evaluate the frequency and type of arrhythmia uncovered by cardiopulmonary exercise testing (CPET) obtained pre and post cardiac rehabilitation in pediatric and young adult congenital heart disease patients.

Design: We retrospectively reviewed CPET results for our pediatric and young adult congenital heart patients that completed their cardiac rehabilitation program during the period of December, 2017 to February, 2019.

Methods: All participants completed a maximal Cardiopulmonary Exercise Test (CPET) using a ramp protocol on an upright cycle ergometer (Lode Corival). All patients exercised to exhaustion. Metabolic measures were obtained using a Medgraphics metabolic cart (Ultima CPX). A 12 lead electrocardiograph (ECG) (GE Case 8000) was continuously monitored through-out the test. Manual blood pressure with an appropriate cuff size was recorded at rest, during each minute of exercise and 1, 3, 5, and 10 minutes post exercise along with pulse oximetry (Masimo Radical). Results were characterized with means and standard deviations and compared pre and post cardiac rehabilitation CPET. Significance was set at p < 0.05.

Results: During this period, 31 patients completed their CR program and 14 of these patients had a CPET pre and post CR. Average duration of the CR program was 17.9 ± 7.4 weeks. In these 14 patients (4 males, 10 females), there was a significant increase in weight (65.9 ± 21.4 vs 68.3 ± 20.9 Kg, p<0.005). There was no significant change in pre vs post maximal VO2 or RER (22 ± 7 vs 22 ± 8 ml/min/kg, 1.17 ± 0.08 vs 1.20 ± 0.10, respectively). ECG analysis showed that 5 of the 14 patients had premature ventricular contractions (PVCs) with 2 having multi-formed PVCs and 2 having ventricular couplets. One patient had ventricular bigeminy. Three patients had premature atrial contractions (PACs) with 1 having atrial couplets. Two patients had an ectopic atrial rhythm and 2 patients developed significant ST segment depression.

Conclusions: Our results indicate that pediatric and young adult congenital heart disease patients undergoing a cardiac rehabilitation program can have a significant frequency of cardiac arrhythmia that can be uncovered with CPET. This supports use of continuous electrocardiographic monitoring during cardiac rehabilitation in this group.

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Abstract ID: S180

Title: Safety and Efficacy of High Intensity Training in Patients With Pulmonary Hypertension - A Pilot Study

Track: Cardiovascular Rehabilitation & Clinical Cardiology

Author(s): Noah Greenspan, PT, DPT, CCS, EMT-B1, Aastha Joshi, MS, PT, CEP1, Marion Mackles, PT1, Akua Adu-Labi, MS, EP1, Wai Chin, MS, EP1, Patricia Rocco, MS, PT1, Mark Mangus, RRT, RPFT1, Marcella Debidda, PhD2

Institution(s):1Pulmonary Wellness & Rehabilitation Center, New York, NY, USA, 2monARC Bionetworks, San Francisco, CA, USA.

Introduction: Safety and Efficacy of Moderate to High Intensity Aerobic Exercise and Strength Training in Pulmonary Hypertension (PH): A Pilot Study.

Purpose: To assess the safety and efficacy of aerobic exercise and strength training in patients with Pulmonary Hypertension.

Design: Patients underwent monitored aerobic exercise program with pre- and post-program evaluation using treadmill protocols and measuring clinical parameters.

Methods: Patients (5 female/3 male; mean age of 52.5) with PH underwent monitored cardiopulmonary PT for 90 minutes, 2 times per week, for 12 weeks for a total of 24 sessions consisting of breathing retraining, monitored aerobic exercise, upper and lower body strength training, and patient education.

Results: The mean peak MET level achieved during the post-rehabilitation exercise tests (6.74 ± 2.48 METs) was significantly HIGHER (p=0.018) than pre-rehabilitation exercise test (4.27 ± 2.02 METs) . The mean peak Rate of Perceived Exertion (RPE) level achieved during the post-rehabilitation exercise tests (13.38 ± 1.19) was significantly LOWER (P=0.041) than pre-rehabilitation exercise test (14.50 ± 0.93). The mean peak Dyspnea level achieved during the post-rehabilitation exercise tests (13.63 ± 1.30) was significantly LOWER (P=0.041) than pre-rehabilitation exercise test (14.75 ± 0.89). In this study, Improvements in METs, RPE and Dyspnea have a large clinical significance (effect sizes 0.72-0.84).

Conclusions: Monitored Moderate to High Intensity Aerobic Training with use of supplemental oxygen is safe and effective in improving exercise capacity and exercise tolerance in PH patients.

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Abstract ID: S181

Title: Exploring Behavior Change in Group vs Individual Orientation

Track: Cardiovascular Rehabilitation & Clinical Cardiology

Author(s): Carolyn Palka, MS, ACSM-CEP, Diane Perry, MS, ACSM-CEP, Joseph Bryant, BS, ACSM-CEP, Melvyn Rubenfire, MD, Dan Montgomery, BS.

Institution(s): University of Michigan, Ann Arbor, MI, USA

Introduction: Cardiac rehabilitation (CR) eligible patients are being discharged earlier than in years past. It is well-known that heightened anxiety, hostility, and increased social isolation appear to put patients at an emotional disadvantage for effectively optimizing behavior. It also presents greater challenges for CR staff.

Purpose: To identify and address the emotional differences between group and individual orientation connections and pathways that lead to behavior change.

Design: In 2012 Group orientation was instituted for the Michigan Medicine outpatient CR program. This was instituted as a result of adopting a department Patient Family Centered Care model. Group orientation is co-led by patient advisors and CR staff qualified in empowerment training. Patients and families share their stories inadvertently planting seeds of emotional connections that ultimately grow into improved patient engagement. A guided tour by a patient advisor, along with a power-point presentation describing the emotional recovery process and resources for coping strategies.

Methods: Over a two-year period, 692 CR patients participated in CR. 196 patients chose Individual orientation, and 496 patients chose Group orientation with the majority accompanied by a family member. All patients were screened and cleared for CR participation by a registered nurse. Clinical exercise physiologists examined the outcomes including the measured variables of depression, anxiety, hostility, and a global severity index (GSI) in the Brief Symptom Inventory-53 (BSI), Short Form (SF)-12 measured variables of general health, physical function, social function, mental health, and graduation rates. The graduation rates for the two groups were compared using Chi-Square analysis. Differences between the groups in SF-12 and BSI scores pre and post program were compared using the Student's T-test.

Results: Overall, 68.1% graduated from the Group orientation compared to 51.5% graduated from the Individual orientation (p value <.001). Of the BSI survey, anxiety levels were significantly lower in the Group orientation as compared to the Individual Orientation (p value <.001). Hostility levels were significantly lower in the Group orientation as compared to the Individual orientation (p value =.006). GSI in the Group Orientation was significantly lower (p value =.001) as compared to Individual orientation. Depression was borderline significantly lower in the Group Orientation (p value =0.06). Of the SF-12 survey, social function was found to be significantly greater in the Group orientation as compared to the Individual orientation (p value =.006). No differences were noted in the other SF 12 variables.

Conclusions: Patients attending group vs. individual CR orientation have higher CR graduation rates, which may be related to reduced psychological distress and increased social functioning. The degree to which this impacts intermediate and longer term outcomes needs to be assessed in a randomized trial.

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Abstract ID: S182

Title: Preliminary Results in a Holistic Cardiac Rehabilitation Program in Children With Congenital Heart Disease

Track: Cardiovascular Rehabilitation & Clinical Cardiology

Author(s): Marta Supervía, MD MSc1,2, Mariola Cortina Barranco, MD1, Mirley Echevarria Ulloa, MD1, Olga Arroyo Riano, MD1

Institution(s):1Gregorio Marañón General University Hospital, Gregorio Marañón Health Research Institute, Madrid, Spain, 2Mayo Clinic, Rochester, MN, USA.

Introduction: Despite medical and surgical advances have contributed to an increase in survival rates of children with congenital heart disease (CHD), this condition still have an important impact in terms of morbidity affect the survivors. While there is an overwhelming evidence in Cardiac Rehabilitation (CR) for adults, there are very few studies CR in infants with CHD, so more studies in pediatric population are needed.

Purpose: The aim of this study is to assess the effectiveness of a holistic and tailored CR program of Rehabilitation (including cardiac, pulmonary and musculoskeletal rehabilitation management) among children with CHD.

Design: This prospective observational study included children with CHD that attended to our CR outpatient program for 3 months (twice per week) since 2017. Our tailored CR program included stretching, resistance, aerobic and ventilatory muscle training.

Methods: Cardiopulmonary stress test and 6 minutes walk test (6MWT) were conducted before and after the CR program in order to assess functional capacity. We also assessed Inspiratory muscle strength (by measuring maximal respiratory pressures), physical activity level (using the International Physical Activity Questionnnaire), quality of live (QoL) of the children and their families (PedsQl questionnaire), and other clinical variables (body mass index, waist circumference, hip ratio, etc) at baseline and after completion of the CR program.

Results: Nine children (age 8±2.5) completed the CR program. Maximum oxygen uptake (VO2), 6MWT distance and inspiratory muscle pressure improved significantly following completion of the CR program. There was no significant change in body mass index. Greater adherence to physical activity was reported at the end of the program. The QoL of children perceived by the parents improved after completion of the CR program when comparing with the initial assessment. There were no adverse events related to the CR program.

Conclusions: Tailored CR program seems beneficial for children with CHD when regarding clinical, functional and psychosocial aspects. Despite these promising preliminary results, further studies are needed with larger samples and with a longer follow-up in order to prove the benefits of a holistic program of CR program in children with CHD.

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Abstract ID: S183

Title: Use of Animal-Assisted Therapy to Decrease Anxiety in the Outpatient Cardiac Rehabilitation Setting

Track: Cardiovascular Rehabilitation & Clinical Cardiology

Author(s): Heath W. Shirkey, BSN, RN MSHI, CCRP, Katelyn D. Brown, BS EP CCRP, Tiffany Shock, BS ACSM-CEP, CCRP, Jenny Adams, PhD, Jeffrey Schussler, MD

Institution(s): Baylor Scott and White, Dallas, TX, USA.

Introduction: Anxiety after a cardiac event can disrupt treatment adherence to required or prescribed lifestyle alterations and risk behavior modifications, thus leading to readmissions or future cardiac events. The introduction of Animal-Assisted Therapy (AAT) to help alleviate state anxiety, particularly therapy dogs, has shown great success in the Inpatient realm. Unfortunately, the effectiveness in a Traditional Outpatient Cardiac Rehabilitation (TCR) setting has not been investigated.

Purpose: To analyze the effectiveness of a single bout of AAT on state anxiety in cardiac rehab subjects after myocardial infarction with or without stent, or valve surgery.

Design: A randomized, pre and post experimental design will be used for this study

Methods: Subjects were randomized into a control arm (60 minutes TCR) or treatment arm (50 minutes TCR and 10 minutes AAT). The State Trait Anxiety Inventory Short Form Y1 (STAIAD) tool was used to measure anxiety levels pre and post session for both groups. Animal Assisted Therapy dogs were provided by Baylor Scott and White Health Animal Assisted Therapy Program. A One-way ANCOVA was used to analyze the difference in the change in STAIAD scores between groups.

Results: N=26, the control group Pre and Post scores Mean (SD) were 48.5 (13.4) and 46.72 (13.46) respectively. Treatment group Pre and Post scores Mean (SD) were 55 (14.19) and 49.53 (15.49) respectively. A one-way ANCOVA yielded a p value= 0.24.

Conclusions: The results of this study demonstrate a reduction in anxiety within the AAT and TCR groups, however, no statistical difference was determined. The AAT group demonstrated a greater decrease in state anxiety between pre and post-tests than the control group and a lack of significance may be due to the small number of subjects. Further investigation into the effect of AAT on state anxiety is warranted due to the impact anxiety has on a patient's rehabilitative efforts and quality of life.

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Abstract ID: S184

Title: User Experience in Applying Digital Technology After Completion of Cardiac Rehabilitation Program to Sustain Physical Activity: The Mobile4Heart Study

Track: Cardiovascular Rehabilitation & Clinical Cardiology

Author(s): Abdelaziz Elnaggar, MBBS, MPH1, Julia Von Oppenfeld2, BA, Stephanie Merek, MPH2, Mary A. Whooley, MD1, Linda G. Park, PhD, MS, FNP-BC1

Institution(s):1University of California, San Francisco, San Francisco, CA, USA, 2Department of Veterans Affairs, San Francisco, San Francisco, CA, USA.

Introduction: While behavioral change to increase physical activity is one of the primary goals of cardiac rehabilitation (CR), many patients do not sustain the same level of activity after CR discharge. Wearable activity trackers and mobile phone apps show promising potential of enhancing physical activity following CR completion. These technologies provide a platform for self-management among older adults with cardiovascular disease (CVD).

Purpose: The objective was to evaluate the usability of the MOVN mobile application (app) with Fitbit device/app to facilitate physical activity following CR discharge over a 2-month period.

Design: Mixed-methods research with individuals interviews and a quantitative satisfaction scale to assess user experience after participation in a pilot randomized controlled trial.

Methods: Participants downloaded the Fitbit mobile app and wore the Fitbit Charge 2, downloaded the MOVN mobile app, and received push-messages from study staff through the MOVN app 3 times a week on CVD prevention and physical activity. All of the participants in the intervention group were asked about their experience with the technology. In addition, semi-structured individual interviews were conducted with 7 representative participants to obtain more in-depth feedback as well as administration of a 30-item Likert scale questionnaire. We conducted a content analysis with emphasis on usability of technology.

Results: We enrolled 60 participants from 2 CR centers at a community hospital. There were 26 participants in the intervention group who completed follow-up (mean age 66.7 ± 8.6, 23% female). User feedback included the following: (1) the Fitbit device should be waterproof with a bigger screen and the Fitbit app is user-friendly with the advantage of showing sleep tracking and instant overall progress; (2) the MOVN app enables patients to be in contact with study staff and provides push-through notifications to record workouts are a reminder to remain motivated; and (3) push-messages were generic and should be more customized. The individual interviews provided more in-depth feedback with varying levels of satisfaction with the different technology components. A 5-point Likert scale showed high overall satisfaction: Fitbit device 4.86, Fitbit app 4.29, MOVN app 4.5, and push-messages 3.14.

Conclusions: New technologies propose innovative solutions for daily challenges in healthcare. By applying wearable fitness trackers and mobile phone apps, our study shows strong potential for new technologies to be adopted by older adults with CVD to sustain physical activity after CR discharge.

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Abstract ID: S185

Title: Development of a Multivariate Prediction Model for Cardiovascular Mortality in Lower Limb Diabetes-Related Amputation. Preliminary Results of a Three-Year Cohort

Track: Cardiovascular Rehabilitation & Clinical Cardiology

Author(s): Juana Zavala Ramirez, MD, MHA1, Roberto C. Sahagun Olmos, MD, MSc1, Edgar F. Sanchez Limon, MD2, María de Lourdes Dergal Carreto, MD3, Ingrid S. Morales Sanchez, MD4

Institution(s):1Instituto Nacional de Rehabilitacion “Luis Guillermo Ibarra Ibarra”, Mexico City, Mexico, 2Instituto Mexicano del Seguro Social, Guadalajara, Mexico, 3Clinica de Rehabilitación Sports And Medical Therapy, State of Mexico, Mexico, 4Hospital General de Mexico “Dr. Eduardo Liceaga”, Mexico City, Mexico.

Introduction: Diabetes mellitus is one of the most prevalent chronic diseases worldwide, and one of its main economic burden; foot infection is the cause of up to 80% of amputations in the world. The mortality rate increases up to 70% at 5 years after amputation. The impact of comorbidities on the risk of mortality in Mexican population has not been reported, the current cardiovascular risk calculators, may underestimate this cardiovascular event probability.

Purpose: To develop a cardiovascular mortality risk estimation model for cardiovascular mortality in lower limb diabetes-related amputation. Preliminary results of a three-year cohort.

Design: Prospective cohort study.

Methods: We recruited 126 patients with lower limb diabetes-related amputation; we assessed family history, biochemical parameters, exercise stress testing (EST), ophthalmological and psychological evaluations; quality of life survey Diabetes-39 (D39), perception of disability WHODAS 2.0 scale (PDW2S), risk stratification according to Framingham Scale (FS), Globorisk equation (GE) and the Charlson comorbidity index (CCI). A telephonic follow-up will be done once a year for 5 years in search of a mortality rate and its cause. The correlation between different variables and the estimation of the survival rate were evaluated using the Kaplan-Meier (KM) method and a multivariate logistic regression analysis (MLRA).

Results: Of 126 participants; 90 (71.4%) male, average age 61±10 years, transfemoral 74.6%, transtibial 23% amputation; 71% with family history of diabetes, 57.1% former smokers, 12% active smokers, smoking index (SI) as intense in 36%, 29±33 months in time of amputation, 187±138 months after diagnosis of diabetes, 165±130 months between the diagnosis of diabetes and amputation, FS 18±11, GE 17±11, CCI 27±30. In the MLRA was observed statistical significance between the CCI (p=0.0466), WHODAS 2.0 (p=0.0119), lenght in months of cardiac rehabilitation inclusion (p=0.0142) and time in months with systemic arterial hypertension (p=0.0001). The KM method showed that patients with chronic kidney disease and diabetic retinopathy have greater morbidity and mortality (Log Rank= 0.0249 and 0.0182 respectivelly). A new amputation, labor reintegration, SI and high GE showed greater morbidity and mortality during the study period without reaching statistical significance.

Conclusions: The CCI was more sensitive for the detection of mortality in populations with multiple comorbidities. There was a 6.29% of deaths (4.75% of cardiovascular causes); patients with chronic kidney disease and diabetic retinopathy have greater risk of morbidity and mortality. It is necessary to complete the 5-year follow-up to get conclusive results and integrate the prediction model.

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Abstract ID: S186

Title: Beliefs About Cardiovascular Medicines & Adherence in Patients Attending Cardiac Rehabilitation

Track: Cardiovascular Rehabilitation & Clinical Cardiology

Author(s): Jonathan Gallagher, MPsychSc

Institution(s): Beaumont Hospital, Dublin, Ireland.

Introduction: Following a cardiac event medication adherence is crucial for risk reduction, and medication non-adherence has been consistently associated with worse clinical outcomes1. However, despite their therapeutic benefits, many patients do not persistently adhere to their prescribed cardiovascular medications2, with a recent meta-analysis estimating that approximately one third of patients after a cardiac event are non-adherent, irrespective of the cardiac medication prescribed3. Patients' beliefs about medications have been shown to directly influence treatment engagement4, and cardiac patients' perceived necessity for and concerns about heart medications have been independently associated with adherence to β-blockers, ACEi/ARBs and statins respectively5.

Purpose: The present study investigated the impact of beliefs about medication on adherence in a cohort of patients attending CR.

Design: 82 patients [77% male; mean age 65 years] attending Beaumont Hospital's CR programme were assessed at programme entry with respect to beliefs about medicines and self-reported adherence behaviour.

Methods: The Beliefs about Medicines Questionnaire (BMQ-Specific)6 was used to measure beliefs about cardiac medications, and a single item question identified the medication currently of most concern to each patient. In addition, the Medication Adherence Report Scale (MARS)7 was employed to determine the degree of patients' self-reported medication adherence. Medical records provided information on key clinical variables and currently prescribed cardiac medicines. All data were analysed using SPSS 23.

Results: Using the BMQ 14.6% of patients (N=12) were considered ‘at risk' of non-adherence as they had an NCD score (i.e. BMQ ‘concerns' minus ‘necessity') ≥0. Alternatively, when categorizing patients according to actual self-reported adherence, 40.8% (N = 31) were deemed to be non-adherent as they reported less than perfect adherence (i.e. MARS score ≥ 6). Only 18 patients specified the medication they were most concerned about, with anti-coagulants (N=6) and statins (N=4) cited as giving most cause for concern. A multiple regression analysis was performed using BMQ-Concerns and Necessity total scores as independent variables, and MARS total score as the dependent variable. The model achieved an R2 score of 0.302 indicating that the predictor variables accounted for 30.2% of the variance of MARS scores, F(3,62)=10.364, p<0.001. Concerns and Necessity beliefs both significantly contributed to the model (p<.001).

Conclusions: Routine assessment of patients' medication beliefs during CR may be important to identify those at greatest risk of intentional non-adherence. Implementing tailored interventions to modify beliefs such as self-reported low necessity and/or high concerns about medications may assist with improving adherence and, ultimately, clinical outcomes.

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Abstract ID: S187

Title: Maximising CR Referrals and Enrolment - A Single Centre Experience

Track: Cardiovascular Rehabilitation & Clinical Cardiology

Author(s): Jonathan Gallagher, MPsychSc

Institution(s): Beaumont Hospital, Dublin, Ireland.

Introduction: The effectiveness of cardiac rehabilitation (CR) for both reducing mortality and secondary prevention is well established. Although rates of CR participation remain sub-optimal, high performance CR centres achieving CR rates of ≥ 65% have been shown to produce a 30% reduction in hospital readmissions1. The current target set by the AACVPR is to achieve a CR uptake rate of 70% by 20222. CR guidelines further recommend that all CR-eligible inpatients should be referred to CR prior to hospital discharge, with a rate of ≥ 85% recommended as a benchmark3.

Purpose: We sought to determine the respective achievement of two CR quality indicators (QIs): inpatient CR referral rate (%) and CR participation rate (%) in a single CR centre.

Design: A clinical audit was conducted to ascertain the performance of a hospital-based CR programme in achieving both of these CR quality indicators (QIs): (a) the effect of a systematic inpatient referral strategy (during Phase I CR) on meeting this CR quality indicator; and (b) the rate of CR uptake (%) achieved during the corresponding period.

Methods: Using established criteria4, a clinical audit of consecutive referrals was conducted to evaluate the performance of the Cardiac Rehabilitation (CR) Programme in Beaumont Hospital against both CR QIs. Administrative data and/or medical records were used to identify all potentially CR-eligible inpatients, and these were assessed with regard to meeting standardized CR referral inclusion/exclusion criteria. Rates for both inpatient referrals and CR participation were calculated for this 12-month period (2016-2017). CR participation rates were calculated to include CR referrals received from other hospitals.

Results:CR inpatient referral: 366 inpatients [72% male; mean age 64.64 years (SD = 10.89)] were identified as eligible for referral to a hospital-based CR programme. Of these, 338 (92.34%) were directly referred to CR via a systematic inpatient referral strategy employed by CR co-ordinators during phase I CR. CR Enrolment: A participation rate of 61.2% was demonstrated for CR-eligible referred patients enrolled in the hospital's CR programme during this period.

Conclusions: Early, effective referral of appropriate inpatients prior to discharge ensures the attainment of this CR quality indicator and facilitates high levels of subsequent participation in CR.

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Abstract ID: S188

Title: Satisfaction With Cardiac Rehabilitation: What Do Patients Think?

Track: Cardiovascular Rehabilitation & Clinical Cardiology

Author(s): Jonathan Gallagher, MPsychSc

Institution(s): Beaumont Hospital, Dublin, Ireland.

Introduction: Cardiac Rehabilitation (CR) is a medically supervised programme providing individually tailored exercise prescription, risk factor modification, education, stress management and psychological therapy for patients adjusting to cardiac illness1. Systematic reviews show that CR reduces future cardiac events, mortality, cardiac readmissions and improves health-related quality of life1-4. Patient satisfaction is considered a key indicator of healthcare quality, and the EACPR5 recommend that data on patient satisfaction is routinely collected as part of clinical audit. Unfortunately, this is rarely conducted in CR practice, and even then, administration of non-validated measures can result in exaggerated satisfaction ratings

Purpose: We investigated the degree of patient satisfaction with CR using psychometrically validated measures, and ascertained which components of CR are prioritized by patients.

Design: A clinical audit was conducted of a consecutive sample of patients attending a hospital-based comprehensive CR programme.

Methods: 145 patients [79% male; mean age 64 years] completed a series of measures assessing satisfaction with CR and preferred CR components. Patients completed the Cardiac Rehabilitation Preference Form (CRPF-R)6, the Patient Assessment of Chronic Illness Care (PACIC)7, and suggestions for improving CR were assessed via a single item. Quantitative data was analysed using SPSS 23.

Results:Patient Satisfaction: Satisfaction was greatest (4.22 ±.97) for the delivery system/practice design domain (i.e. actions that organize care and provide information to patients to enhance their understanding of care); and lowest (3.06 ±1.26) for the follow-up/coordination subscale (i.e. making proactive contact with patients to assess progress and coordinate care). CR Programme Preferences: Of 15 individual components of CR assessed, ‘receiving encouragement from professionals' (2.85 ± .36) and ‘individualized attention' (2.76 ± .49) were assigned the greatest importance, whereas ‘doesn't interference with other activities' (2.10 ± .79) and ‘available transport' (2.09 ± .84) were rated by patients as the least important features of CR. No age differences were observed, however, women placed a greater importance on convenience features of CR than did men (t = -209; p=0.49). Suggested improvements to CR: Longer CR programme & follow-up (18); newer equipment/facilities (8), and more flexible/alternative CR models (5) were cited as suggested improvements to CR.

Conclusions: The current audit identified important considerations for both the structuring and delivery of our CR programme. Patient satisfaction should be routinely assessed, and interventions to improve patient satisfaction with CR should be evaluated to determine if they have a demonstrable impact on important clinical outcomes.

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Abstract ID: S189

Title: Patient Perceptions of ECG Monitoring (Telemetry) During CR: A Nationwide Study

Track: Cardiovascular Rehabilitation & Clinical Cardiology

Author(s): Jonathan Gallagher, MPsychSc

Institution(s): Beaumont Hospital, Dublin, Ireland.

Introduction: Debate about the role of telemetry during CR frequently address risk-stratification and patient safety. However, little is known regarding patients' perception of telemetry during CR, or what (if any) psychological benefit is derived from this aspect of care. A recent study1 by the Irish Heart Foundation indicated that patients viewed telemetry as a crucial component of CR care, and informed the development of a larger multicentre survey to determine if these patient views were replicated on a wider scale.

Purpose: We sought to determine patients' views on how telemetry monitoring impacted their engagement with CR (i.e. participation, experience) and whether psychological factors (anxiety, depression, perceived risk) differed according to risk stratification.

Design: 690 patients from 11 CR centres were surveyed. CR attendees were recruited from across all provinces, encompassing rural and urban populations, in hospital and community settings.

Methods: Telemetry-specific items were developed and administered together with established measures of patient satisfaction (PACIC)2; and CR component preferences (CRPF)3. CR attendees were asked to respond to the following questions: (a) How Important was the availability of ECG monitoring (telemetry) in your decision to attend CR? (0 = ‘not all important', 10 = ‘extremely important'); (b) How Important was ECG monitoring (telemetry) in your experience of CR? (0 = ‘not all important', 10 = ‘extremely important'); (c) How much did having ECG monitoring (telemetry) affect your confidence to exercise during CR? (0 = ‘no affect at all on my confidence', 10 = ‘greatly improved my confidence'). Data on anxiety (GAD-7) and depression (PHQ-9) were also collected in addition to a single question on perceived likelihood of another cardiac event. Patients were stratified according to AACVPR risk categories respectively: 29% (low), 49% (moderate) and 22% (high).

Results: Average scores reported were: impact of telemetry on decision to attend CR: mean =8.99 [range 7.9-9.71]; impact of telemetry on experience of CR: mean =9.39 [range 8.58-9.9]; and impact of telemetry on confidence to exercise during CR: mean =8.71[range 8.3-10.0]. No association was found between patients' AACVPR risk stratification and baseline psychological functioning [depression (p>.05); anxiety (p>.05)]; perceived risk of a recurrent cardiac event (p>.05); or satisfaction with CR (p>.05).

Conclusions: The role of telemetry during CR appears to be important for a significant number of cardiac patients, who may derive benefit irrespective of risk-stratification. Further research is warranted to establish whether telemetry has any impact on psychological outcomes during CR.

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Abstract ID: S190

Title: Maximizing Availability of Pulmonary Rehabilitation for Patients With Fibrotic Lung Diseases Through Partnership with a Cardiovascular Rehabilitation Center: A Pilot Study

Track: Cardiovascular Rehabilitation & Clinical Cardiology

Author(s): Andrew B. Sorey, BSN, RN, CCRP1, Pauline A. Bianchi, RN, BSN2, Dan R. Ofak, MHA, RRT-NPS1, Luis A. Arellano, BS2, Katherine M. Gates, MSc2, Anne Dimmock, MS1, Whitney J. Hohn, RRT1, Rebecca Bascom, MD, MPH1

Institution(s):1Penn State Milton S. Hershey Medical Center, Hershey, PA, USA, 2Pulmonary Fibrosis Foundation, Chicago, IL, USA.

Introduction: The Pulmonary Fibrosis Foundation's (PFF) is to act as the trusted resource for all who are affected by Pulmonary Fibrosis (PF) and, through its Care Center Network (CCN), to develop essential programs available to those living and working with PF. PF is characterized by dyspnea, restrictive physiology and progressive hypoxemia. Consensus guidelines recommend pulmonary rehabilitation (PR) for PF patients, despite the smaller evidence base than for COPD. Insurance restrictions and rural areas play a role in limited access to PR for PF patients.

Purpose: 1) To assess access to PF care in rural areas 2) To design a pilot program expanding PR availability at a PFF CCN site that serves a largely rural community.

Design: The PFF Rural Health Outreach (RHO) Working Group mapped the dimensions of rural PF care and partnered with a well-established CVR facility to pilot adding PF PR at a CCN site serving a largely rural population. CVR personnel are ideally suited to increase PR availability for patients given the cardiopulmonary stress associated with PF.

Methods: Using Geographic Information System (GIS) software Carto®, the PFF mapped its CCN sites against rural zip codes using Rural-Urban Continuum Codes (RUC) and all individuals who have reached out to the PFF for information. Our local team assessed the feasibility (facilities, staff) of a partnership with CVR to increase PR access.

Results: Nationwide, there are 1685 CVR but only 895 PR programs ( GIS mapping showed geographic diversity and care gaps, particularly in rural areas, of individuals who have been in contact with the PFF. We identified two afternoons with excess capacity in the local CVR unit during which to hold PR sessions. Provision of oxygen was not a capacity of the CVR unit, so an oxygen supply company was contracted to assure access for PF patients. Locally, CVR staff from various educational backgrounds expressed hesitancy due to inexperience in caring for pulmonary patients. Staff training (lunch-and-learns, formal education programs) filled this gap. The PFF developed a pocket guide for RT/PTs providing a comparison of PF, COPD, and CF, entitled: About Pulmonary Rehabilitation: A Guide for Allied Health Professionals, which is another education source for staff.

Conclusions: We propose this partnership model to address the PR gap experienced by rural PF patients. Based this successful pilot project, the PFF proposes to conduct a needs assessment, creating educational tools to better prepare CVR staff for these roles.

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