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Cardiovascular risk factor control: is it possible with a home-based cardiac rehabilitation program?
Session:
CO 09 - Cardiologia Preventiva
Speaker:
Nelson P. Cunha
Congress:
CPC 2021
Topic:
J. Preventive Cardiology
Theme:
28. Risk Factors and Prevention
Subtheme:
28.14 Risk Factors and Prevention - Other
Session Type:
Comunicações Orais
FP Number:
---
Authors:
Nelson P. Cunha; Inês Aguiar-Ricardo; Tiago Rodrigues; Sara Couto Pereira; Pedro Silvério António; Pedro Alves da Silva; Beatriz Valente Silva; Beatriz Garcia; Rita Pinto; Madalena Lemos Pires; Mariana Borges; Alda Jordão; Carla Rodrigues; Fausto j. Pinto; Ana Abreu
Abstract
<p style="text-align:justify"><span style="font-size:12px"><strong>Introduction:</strong> Cardiovascular risk factors (CVRF) control, needing different strategies, through patient education, lifestyle changes and therapeutic optimization is a central core of cardiac rehabilitation. However, further studies are needed to demonstrate effectiveness of home-based Cardiac Rehabilitation (CR-HB) programs in controlling CVRF. </span></p> <p style="text-align:justify"><span style="font-size:12px"><strong>Purpose:</strong> To evaluate the effectiveness of a CR-HB program in controlling cardiovascular risk factors.</span></p> <p style="text-align:justify"><span style="font-size:12px"><strong>Methods:</strong> Prospective cohort study including patients who were previously participating in a centre-based CR program and accepted to participate in a CR-HB program due to forced closure of the centre-based CR program for COVID-19 pandemic. The CR-HB consisted of a multidisciplinary digital CR program, including patient regular assessment, exercise, educational, and psychological and relaxation sessions. A structured online educational program for patients and family members/caregivers was provided including educational videos, and powerpoints and webinars. A real time Webinar regarding ”nutritional myths and facts” was organized with the duration of 90 minutes as a substitution of the regular face-to-face regular workshop provided at our centre-based CR program. Also, self-control of blood pressure and heart rate and of glycemia in diabetics were promoted, as well as smoking cessation.</span></p> <p style="text-align:justify"><span style="font-size:12px">To assess the impact of the CR-HB on risk factors control, all the patients were submitted to a clinical and analytical evaluation before and after the end of this at distance program. </span></p> <p style="text-align:justify"><span style="font-size:12px"><strong>Results:</strong> 116 cardiovascular disease patients (62.6±8.9 years, 95 males) who were attending a face-to-face CR program were included in a CR-HB program. Almost 90% (n=103) of the participants had coronary artery disease. Regarding risk factors, obesity was the most prevalent risk factor (74.7 %) followed by hypertension (59.6%), family history (41.8%), dyslipidaemia (37.9%), diabetes (18.1%), and smoking (12.9%). </span></p> <p style="text-align:justify"><span style="font-size:12px">Regarding the blood pressure control, 80% of the patients stated that almost daily they measured blood pressure at home; baseline systolic pressure decreased from 117 ± 13 to 113 ±12mmHg, p=0.007, while there was no significant change in diastolic pressure. </span></p> <p style="text-align:justify"><span style="font-size:12px">The majority (76%) of diabetic patients said they controlled blood glucose; HbA1c decreased from 6.1 ± 1.1 to 5.9 ± 0.9mg/dL (p=0.047).</span></p> <p style="text-align:justify"><span style="font-size:12px">Considering the lipid profile, LDL decreased (from 75 ± 30 to 65 ± 26mg/dL, p = 0.012). The Nt-proBNP also decreased (818 ± 1332 vs 414pg/ml ± 591, p = 0.042). There were no other statistically significant differences concerning risk factors modification. </span></p> <p style="text-align:justify"><span style="font-size:12px"><strong>Conclusions:</strong> Our study showed that a Home-based Cardiac Rehabilitation program can improve or maintain cardiovascular risk factors control, which has important prognostic implications and is frequently a difficult task to achieve.</span></p>
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