title: Time-to-referral, use, and efficacy of cardiac rehabilitation after heart transplantation.
abstract: BACKGROUND
  Timely access, adherence, and efficacy of cardiac rehabilitation programs (CRP) are important given the potential to mitigate or reverse the side effects of immunosuppressive medications, weight gain, and cardiovascular deconditioning that place heart transplant (HT) recipients at increased cardiovascular risk. However, there is a dearth of information on use and efficacy of CRPs. Therefore, we examined process indicators (time to referral and correlates, program adherence) and clinical outcome indicators (functional capacity (VO(2peak)), anthropometrics) of CR post-HT compared to post-coronary artery bypass graft (CABG).
  
  
  METHODS
  Baseline, 6-month exercise stress test results, and anthropometrics were examined retrospectively among consecutively enrolled post-HT and age-matched and sex-matched CABG patients. Time to referral and program entry, attendance, and completion rates were also measured.
  
  
  RESULTS
  Heart transplant (n=43) and CABG patients were referred 24.9 ± 48.9 and 2.1 ± 3.6 months, respectively, after surgery (P=0.003). Once referred, there was no difference in elapsed-time to program entry (P=0.2). There was a positive relationship between time to referral and baseline waist circumference (r=0.5, P=0.001), body mass index (r=0.5, P=0.002), hip circumference (r=0.4, P=0.008), and body fat percentage (r=0.4, P=0.03) in HT. Heart transplant and CABG patients had similar rates of CRP dropout (27.9% vs. 37.2% respectively, P=0.4). There was improvement in VO(2peak) for HT (2.4 ± 4.2 mL/kg/min; P=0.02) and CABG (5.5 ± 5.4 mL/kg/min, P<0.001), but was greater for CABG (P=0.04). Anthropometric measures remained stable for both cohorts (P>0.05).
  
  
  CONCLUSIONS
  There is a lengthy delay in time from HT to CRP referral, though once referred, gain significant benefit in functional capacity. The appropriateness of this wait needs to be elucidated; however, it appears that longer wait times are associated with adverse effects on body composition.
authors.affiliation: 1 Cardiovascular Prevention and Rehabilitation Program, Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada. 2 Heart and Stroke Foundation, Canadian Partnership for Stroke Recovery, Ottawa, ON, Canada. 3 Faculty of Health, York University, Toronto, ON, Canada. 4 Department of Physical Therapy, University of Toronto, Toronto, ON, Canada. 5 University of Ottawa, Department of Cellular and Molecular Medicine, Ottawa, ON, Canada.
authors.forename: Susan
authors.initials: S
authors.lastname: Marzolini
authors.forename: Sherry L
authors.initials: SL
authors.lastname: Grace
authors.forename: Dina
authors.initials: D
authors.lastname: Brooks
authors.forename: Dale
authors.initials: D
authors.lastname: Corbett
authors.forename: Sunita
authors.initials: S
authors.lastname: Mathur
authors.forename: Robert
authors.initials: R
authors.lastname: Bertelink
authors.forename: Valerie
authors.initials: V
authors.lastname: Skeffington
authors.forename: David
authors.initials: D
authors.lastname: Alter
authors.forename: Paul
authors.initials: P
authors.lastname: Oh
mesh_terms: D000328:Adult; D000368:Aged; D000886:Anthropometry; D001823:Body Composition; D015992:Body Mass Index; D001026:Coronary Artery Bypass / Q000379:methods; D005080:Exercise Test; D005260:Female; D006333:Heart Failure / Q000601:surgery*; D016027:Heart Transplantation; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D010100:Oxygen / Q000737:chemistry; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D061665:Time-to-Treatment
chemical_list: D007166:Immunosuppressive Agents; D010100:Oxygen