Effectiveness of Intensive Cardiac Rehabilitation in High-Risk Patients with Cardiovascular Disease in Real-World Practice

• Published in: Nutrients 2021-10, Vol.13 (11), p.3883
• Main Authors: Świątkiewicz, Iwona, Di Somma, Salvatore, De Fazio, Ludovica, Mazzilli, Valerio, Taub, Pam R.
• Format: Article
• Language: English
• Subjects: Adipose tissue; Blood pressure; Body weight; cardiometabolic risks; Cardiovascular disease; Cardiovascular diseases; cardiovascular risk factors; Cholesterol; Congestive heart failure; Coronary artery; Coronary artery disease; Health risks; Hemoglobin; High density lipoprotein; Laboratories; lifestyle intervention; Lipids; Low density lipoprotein; obesity; Patients; Quality of life; Rehabilitation; Risk analysis; Risk factors; Risk groups; secondary prevention; Signs and symptoms; Social interactions; Womens health
• ISSN: 2072-6643; 2072-6643
• DOI: 10.3390/nu13113883

Structured lifestyle interventions through cardiac rehabilitation (CR) are critical to improving the outcome of patients with cardiovascular disease (CVD) and cardiometabolic risk factors. CR programs’ variability in real-world practice may impact CR effects. This study evaluates intensive CR (ICR) and standard CR (SCR) programs for improving cardiometabolic, psychosocial, and clinical outcomes in high-risk CVD patients undergoing guideline-based therapies. Both programs provided lifestyle counseling and the same supervised exercise component. ICR additionally included a specialized plant-based diet, stress management, and social support. Changes in body weight (BW), low-density lipoprotein cholesterol (LDL-C), and exercise capacity (EC) were primary outcomes. A total of 314 patients (101 ICR and 213 SCR, aged 66 ± 13 years, 75% overweight/obese, 90% coronary artery disease, 29% heart failure, 54% non-optimal LDL-C, 43% depressive symptoms) were included. Adherence to ICR was 96% vs. 68% for SCR. Only ICR resulted in a decrease in BW (3.4%), LDL-C (11.3%), other atherogenic lipids, glycated hemoglobin, and systolic blood pressure. Both ICR and SCR increased EC (52.2% and 48.7%, respectively) and improved adiposity indices, diastolic blood pressure, cholesterol intake, depression, and quality of life, but more for ICR. Within 12.6 ± 4.8 months post-CR, major adverse cardiac events were less likely in the ICR than SCR group (11% vs. 17%), especially heart failure hospitalizations (2% vs. 8%). A comprehensive ICR enhanced by a plant-based diet and psychosocial management is feasible and effective for improving the outcomes in high-risk CVD patients in real-world practice.