Cardiac Rehab Research

Cardiac Rehab Research

Cardiac Rehab Research Abstracts 2010 - Present

Cardiac Rehab Research Abstracts 2010 - Present

Hitt, E., Huberty, J., Scales, R., Whited, H. (2020). Accessing medically-based exercise therapy via cardiac rehabilitation and preventive cardiology. Medicine & Science in Sports & Exercise, Abstract 1779, 52, 5: S384.

Hitt, E., Huberty, J., Scales, R., Whited, H. (2020). Accessing medically-based exercise therapy via cardiac rehabilitation and preventive cardiology. Medicine & Science in Sports & Exercise, Abstract 1779, 52, 5: S384.

Cardiac rehabilitation (CR) is a potential avenue to exercise therapy for cancer survivors (CS). This investigation evaluated the status of medically based exercise rehabilitation for CS in Arizona. A statewide structured telephone interview (STI) was conducted with CR programs (n=34) and cancer treatment centers (CTCs; n=32). Compliance with the STI was 97% and 44% for CR and the CTCs respectively. Thirteen CR programs (39%) offered self-pay onsite supervised exercise training for CS. Two (6%) offered a preventive cardiology exercise consultation with a home-based prescription. Six (43%) CTCs offered exercise services to CS. Eleven (79%) CTCs referred survivors to physical therapy and five (36%) recommended community-based exercise programs. CR may be viable option for onsite medically-based exercise therapy in the growing number of CS in Arizona. Preventive cardiology has an opportunity to expand these services and increase patient accessibility by offering medically-directed exercise physiology consultations. These delivery models provide a potential solution to the lack of rehabilitation resources available to CS. It is recommended that a directory of resources remains current with routine updates in an effort to increase patient accessibility to care. Additional cancer rehabilitation efficacy studies are needed to further clarify evidence-based practice guidelines and provide direction for optimal methods of healthcare delivery.


Scales, R., Lew, K, Parker, C., Raad, A., Lester, S. (2020). Connected health remote monitoring in atrial fibrillation care management. Circulation Online, 141, Suppl. 1, Abstract P198.

Scales, R., Lew, K, Parker, C., Raad, A., Lester, S. (2020). Connected health remote monitoring in atrial fibrillation care management. Circulation Online, 141, Suppl. 1, Abstract P198.

Avoiding early hospital readmission after a diagnosis of atrial fibrillation (AF) lowers healthcare costs. This investigation pilot tested the process of using a Connected Health (CH) communication platform in AF care management. A self-selected group of patients (n=18, 56% male, mean age=69 years, SD=12.6) diagnosed with hemodynamically stable AF and an uncontrolled ventricular response with heart rates >110 bpm were recruited. Eligibility criteria included a recent AF related emergency department or outpatient clinic visit and the new prescription of a rate control medication. This included AV node modifying medications (either a beta blocker or non-dihydropyradine calcium channel blocker) at a starting dose determined by the supervising physician. A care management team (CMT) coordinated by a nurse practitioner provided individualized telephone medical management with no planned clinical visits during a period of early recovery. Patients were equipped with the AliveCorTM Kardia electrocardiogram (ECG) home monitoring device and a supporting mobile device application. Patients returned home with medical guidance from the CMT and ECG recording instructions. Heart rate and rhythm were monitored remotely by the NP and the medication dose was adjusted to reach a target resting heart rate <110 bpm. Patients were managed for 3-weeks before being discharged back to primary care or outpatient cardiology for consideration of a rate versus rhythm control strategy if spontaneous restoration of sinus rhythm had not occurred. Patients recorded an average of 50 (SD=40.0) ECG tracings with a mean of 13 (SD=3.79) related CMT telephone contacts. The mean resting heart rate was significantly lower (p<0.05) at the completion of the intervention (72.9 bpm, SD=17.31) compared to baseline (102.3 bpm, SD=27.17). All of the AF patients achieved adequate heart rate control or spontaneously returned to sinus rhythm. However, 4 patients (22%) required a related emergency room visit and unplanned hospitalization. In this small feasibility study, an electronic healthcare device (biosensor) paired with a mobile-heath application provided a practical remote monitoring communication platform to support tele-management, but the intervention did not prevent hospital readmission. Further research is needed to identify factors that will improve the process of applying CH to AF care management.


Brewer, L., Kaihol, B., Leth, S., Squires, R., Thomas, R., Scales, R., Trejo-Gutierrez, Kopecky, S. (2019). Virtual world-based cardiac rehabilitation to promote healthy lifestyle among cardiac patients. Journal of Clinical and Translational Science, 3, S1, Abstract 3086, 61-62.

Brewer, L., Kaihol, B., Leth, S., Squires, R., Thomas, R., Scales, R., Trejo-Gutierrez, Kopecky, S. (2019). Virtual world-based cardiac rehabilitation to promote healthy lifestyle among cardiac patients. Journal of Clinical and Translational Science, 3, S1, Abstract 3086, 61-62.

Our aim was to access the feasibility and acceptability of a Virtual World (VW)-based cardiac rehabilitation (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 as an extension of conventional CR and would have high acceptability among cardiac patients. We recruited 30 adult cardiac patients (10/site) hospitalized at Mayo Clinic Hospitals in Rochester, MN, Jacksonville, FL or Scottsdale, AZ with a diagnosis for CR (e.g. acute coronary syndrome (ACS), heart failure, elective percutaneous coronary intervention (PCI). Other inclusion criteria included at least 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 participated in 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 (e.g. blood pressure (BP), lipids) at baseline and immediate post-intervention. 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, +10.7 (SD=11.7) minutes/day (p=0.05) and flexibility exercises +0.9 (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). 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 burden.


Bright, H., Hitt, E., Scales, R. (2019). The status of cardiac and pulmonary rehabilitation programs in Arizona: 2019 Update. Proceedings of a conference. Arizona Society of Cardiovascular and Pulmonary Rehabilitation annual meeting, Scottsdale, Arizona.

Bright, H., Hitt, E., Scales, R. (2019). The status of cardiac and pulmonary rehabilitation programs in Arizona: 2019 Update. Proceedings of a conference. Arizona Society of Cardiovascular and Pulmonary Rehabilitation annual meeting, Scottsdale, Arizona.

The American Association of Cardiovascular and Pulmonary Rehabilitation (AACVPR) recommend that every cardiac and pulmonary rehabilitation program becomes nationally certified to ensure strict standards of patient care and quality programming. This investigation was conducted to update Arizona Society of Cardiovascular and Pulmonary Rehabilitation (ASCVPR) records of the number of cardiac rehabilitation (CR) and pulmonary rehabilitation (PR) programs that were AACVPR certified in Arizona (AZ). It also quantified the number of CR programs that offered billable Supervised Exercise Training (SET) for Peripheral Artery Disease (PAD) through the end of 2018. A delegated ASCVPR representative provided a record of programs that offered early outpatient CR and PR within the state. An updated record was then compiled. All programs were invited to complete a structured telephone interview and there was a 97% compliance rate. According to ASCVPR records, there were 33 early outpatient CR programs and 20 outpatient PR programs in Arizona. There were 21 (64%) CR and 5 (25%) PR certified programs. Five (15%) CR programs also provided billable SET for PAD. In 2014, there were 19 (59%) certified CR programs out of 32 facilities offering CR at that time. Three out of 11 (27%) PR programs were certified. It is recommended that the ASCVPR continues to routinely update their record of CR and PR programs and that initiatives be developed to assist programs in the AACVPR certification process.


Scales, R., Lew, K., Parker, C., Buman, M., Akalan, C., Vucicevic, D., Steidley, E., Raad, A., Lester, S. (2016). Connected health exercise consultations in a heart failure telemanagement program. Proceedings of a conference. Clinical Poster 7: http://www.aacvpr.org/Events-Education/Annual-Meeting/2016-Annual-Meeting-Poster-Presentations American Association of Cardiovascular and Pulmonary Rehabilitation's 31st Annual Meeting, New Orleans, Louisiana.

Scales, R., Lew, K., Parker, C., Buman, M., Akalan, C., Vucicevic, D., Steidley, E., Raad, A., Lester, S. (2016). Connected health exercise consultations in a heart failure telemanagement program. Proceedings of a conference. Clinical Poster 7: http://www.aacvpr.org/Events-Education/Annual-Meeting/2016-Annual-Meeting-Poster-Presentations American Association of Cardiovascular and Pulmonary Rehabilitation's 31st Annual Meeting, New Orleans, Louisiana.

Medically-directed exercise is a recognized therapy for optimal heart failure (HF) management. This pilot study evaluated the process of delivering brief connected health (CH) exercise consultations to a group of HF patients who elected to participate in a cardiology-based telemanagement program. Thirty patients were enrolled to receive medically-directed CH consultations from an interdisciplinary healthcare team over a 4-month period. Portable Bluetooth technology with Wi-Fi connectivity was used to remotely monitor health parameters in the home (weight, blood pressure, oxygen saturation, heart rate, steps/day). Pre and post exercise participation was evaluated with the Physical Activity Vital Sign (PAVS) and a 7-day recall. An exercise physiologist (EP) provided telephone HF exercise therapy education plus guidance with exercise prescription and short-term progressive goal setting. Patients received the option to enroll in supervised cardiac rehabilitation (SCR) close to home when feasible. Twenty-five patients (mean age=64.2 years, SD=13.4; 76% male) completed pre and post testing and participated in the exercise intervention. The mean ejection fraction was 31% (SD=15.7), 64% (n=16) had an ICD/pacemaker and 36% (n=9) were classified with a NYHA Functional Class III-IV. The total telephone exercise consultation time/patient was 83.0 (SD=26.4) minutes with a mean of 5.8 (SD=1.3) calls/patient over the 4-month period. The mean telephone call time was 14.3 minutes. The PAVS current (past week) number of days/week with 30+ minutes of accumulated continuous exercise significantly changed from a mean score of 1.1 (SD=1.8) day/week to 3.4 (SD=2.5) days/week (p<0.005). The PAVS typical (past 3-months) number of days/week significantly changed from 1.1 (SD=1.7) day/week to 2.7 (SD=2.2) days/week (p<0.005). Exercise participation quantified with the 7-day recall changed from 4.3 (SD=5.1) to 9.0 (SD=12.1) MET-hours/week (p>0.005). The mean time invested to structured continuous exercise changed from 1.3 (SD=1.6) hours/week to 2.5 (SD=3.4) hours/week (p>0.005). Pre and post SCR enrollment changed from 8% (n=2) to 36% (n=9). In this self-selected population, it was feasible for an EP to conduct CH exercise consultations within a comprehensive HF telemanagement program. CH may provide a process to deliver cardiac rehabilitation support away from the clinic.


Scales, R., Hall, L., Bright, H. (2014). The status of cardiac and pulmonary rehabilitation programs in Arizona: 2014 Update. Proceedings of a conference. Arizona Society of Cardiovascular and Pulmonary Rehabilitation Annual Meeting, Scottsdale, Arizona

Scales, R., Hall, L., Bright, H. (2014). The status of cardiac and pulmonary rehabilitation programs in Arizona: 2014 Update. Proceedings of a conference. Arizona Society of Cardiovascular and Pulmonary Rehabilitation Annual Meeting, Scottsdale, Arizona

The American Association of Cardiovascular and Pulmonary Rehabilitation (AACVPR) recommend that every cardiac and pulmonary rehabilitation program becomes nationally certified to ensure strict standards of patient care and quality programming. This investigation was conducted to update Arizona Society of Cardiovascular and Pulmonary Rehabilitation (ASCVPR) records of the number of cardiac rehabilitation (CR) and pulmonary rehabilitation (PR) programs that were AACVPR certified in Arizona (AZ). A delegated ASCVPR representative provided a record of programs that offered early outpatient CR and PR within the state. An updated record through March, 2014 was then compiled. There were 19 CR and 3 PR certified programs in AZ. According to ASCVPR records, 32 programs offered early outpatient CR. Eleven programs offered outpatient PR. This means that 59% of all early outpatient CR programs and 27% of PR programs in AZ were certified. In 2010, there were 11 certified CR programs, which was 32% of the 34 institutions offering CR at that time. It is recommended that the ASCVPR continues to routinely update their record of CR and PR programs and that initiatives be developed to assist programs in the certification process.


Scales, R., Hall, L., Gallagher, A., Obioha, J., Bright, H., Cornella, K. A., Kane, C., Liffiton, J., Royter, A., Bazzell, J., Lynch, J. (2014). Expanding partnerships within the healthcare system to bring outpatient cardiac rehabilitation closer to home. Proceedings of a conference (pp. 17). Mayo Clinic 2014 Quality Symposium, Phoenix, Arizona.

Scales, R., Hall, L., Gallagher, A., Obioha, J., Bright, H., Cornella, K. A., Kane, C., Liffiton, J., Royter, A., Bazzell, J., Lynch, J. (2014). Expanding partnerships within the healthcare system to bring outpatient cardiac rehabilitation closer to home. Proceedings of a conference (pp. 17). Mayo Clinic 2014 Quality Symposium, Phoenix, Arizona.

Outpatient cardiac rehabilitation (CR) is underutilized within the United States. The commute distance to a program and the lack of physician referral are barriers to participation. This project developed a quality improvement process (QIP) that enabled Mayo Clinic (MC) patients to participate in supervised outpatient CR closer to home. The project was coordinated by a medical practice assistant (MPA). A directory was compiled with all of the referral forms for CR programs within Arizona. The MPA received a weekly list of patients that were discharged from inpatient CR after a cardiac procedure. Required paperwork for a referral to an outside CR facility was prepared for the cardiologist prior to the routine outpatient follow-up visit. A signed physician referral was then faxed to the outside CR program. The MPA requested intermittent progress reports to confirm the patient had completed enrollment in the program (>1 CR exercise session) and was an active participant at 4-weeks. 255 patients received inpatient CR at MC-Arizona between February-November, 2013. 127 (50%) agreed to a referral to outpatient CR, including 78 (31%) to an outside program. 53 (68%) outside referrals had a confirmation of enrollment. 46 (87%) of these patients were actively participating at 4-weeks. More patients participated in outside CR (54%) than MC CR (46%). This QIP assisted physicians in expediting a CR referral close to the patient’s home and elevated participation in outpatient CR for MC patients to more than double the national average. Further investigation is needed to determine the influence on hospital readmission.


Pierce, C., Staley, L., Scales, R., Bright, H., Arabia, F. (2010). Early trends in a new ventricular assist device program: Establishing a need for cardiac rehabilitation. Journal of Cardiopulmonary Rehabilitation and Prevention, Abstract S132, 30, 4: 278.

Pierce, C., Staley, L., Scales, R., Bright, H., Arabia, F. (2010). Early trends in a new ventricular assist device program: Establishing a need for cardiac rehabilitation. Journal of Cardiopulmonary Rehabilitation and Prevention, Abstract S132, 30, 4: 278.

The implantation of a ventricular assist device (VAD) may provide a bridge to transplant (BTT) or bridge to recovery (BTR) for some patients with end-stage heart failure or serve as a destination therapy (DT) for those ineligible for transplantation surgery. Outpatient cardiac rehabilitation (CR) may benefit patients that receive long-term VAD support. This investigation was conducted to determine the number of VAD supported patients that were discharged from a new mechanical circulatory support device (MCSD) program based in the southwestern region of the United States. The study involved a retrospective analysis of the hospital's MCSD database, which was standardized to comply with national requirements for an accredited mechanical heart program. Records were identified for all VAD implants since the program's inception in October, 2005 through December, 2009. This included patients who received left (LVAD), right (RVAD) or bilateral (BiVAD) support for BTT, BTR or DT. A total of 162 patients received a VAD implant during the designated timeframe, resulting in the accumulation of 14436 days of VAD support. Fifty-six patients (35%; LVAD=42; RVAD=1; BiVAD=13) were implanted with discharge capable devices (2005=2; 2006=5; 2007=10; 2008=16; 2009=23) and accounted for 87% of the total VAD support days (total=12551; 2005=53; 2006=310; 2007=1348; 2008=3297; 2009=7543). Thirty-seven of the fifty-six patients (66%) were discharged home (2005=0; 2006=1; 2007=8; 2008=9; 2009=19) at mean post-operative day 42 (SD=27) for all indications. In this preliminary study of the data associated with this relatively new MCSD program, there was an upward trend in the number of discharge capable VAD implants and there was a steady increase in the number of patients that were discharged home on VAD support. Further research is needed to help CR professionals understand the specific needs of VAD patients as they transition from the hospital to an outpatient setting.


Bright, H., Scales, R. (2010). National program certification: The status of cardiac rehabilitation programs in Arizona. Proceedings of a conference. Arizona Society of Cardiovascular and Pulmonary Rehabilitation Annual Meeting, Phoenix, Arizona.

Bright, H., Scales, R. (2010). National program certification: The status of cardiac rehabilitation programs in Arizona. Proceedings of a conference. Arizona Society of Cardiovascular and Pulmonary Rehabilitation Annual Meeting, Phoenix, Arizona.

The American Association of Cardiovascular and Pulmonary Rehabilitation (AACVPR) recommend that every cardiac rehabilitation (CR) program becomes nationally certified to ensure strict standards of patient care and quality programming. Future Medicare reimbursement for CR services may be tied to program standards that are considered imperative, such as those required in the AACVPR program certification process. This investigation was conducted to determine the number of CR programs that are AACVPR certified in Arizona (AZ). The Arizona Society of Cardiovascular and Pulmonary Rehabilitation (ASCVPR) is an affiliate organization of the AACVPR and represents cardiac and pulmonary rehabilitation professionals within the state. Delegated ASCVPR representatives provided a record of programs that offered early outpatient CR within the state. An updated record through December 2009 was then compiled. There was a total of 11 AACVPR certified CR programs in AZ. According to ASCVPR records, 34 programs offer early outpatient CR. This means that 32% of all early outpatient CR programs in AZ are certified. It is recommended that the ASCVPR continues to routinely update their record of CR programs and that initiatives be developed to assist CR programs in the certification process.