title: The impact of professional status on the effects of and adherence to the outpatient followed by home-based telemonitored cardiac rehabilitation in patients referred by a social insurance institution.
abstract: OBJECTIVE
  Legislators and policymakers have expressed strong interest in intervention programs to reduce dependence on social disability benefits. Hybrid: ambulatory followed by home-based cardiac telerehabilitation--hybrid cardiac rehabilitation (HCR) seems to be a novel alternative for standard cardiac rehabilitation for patients with cardiovascular diseases (CVD) as a form of pension prevention paid by the Social Insurance Institution (SII). The kind of professional status may bias the motivation to return to work after HCR. The aim of our study was to evaluate whether the professional status can affect the effects of HCR.
  
  
  METHODS
  One hundred fifty-two patients with CVD referred by the SII for a 5-week HCR were qualified for the study. Patients (87.7% males), aged 57.31 ± 5.61 years, were divided into 2 subgroups: W) white-collar employees (N = 22) and B) blue-collar employees (N = 130). To evaluate functional capacity, an exercise test on a treadmill was used.
  
  
  RESULTS
  The number of days of absence in the cardiac rehabilitation program did not differ between the groups (mean ± standard deviation--B: 1.09 ± 3.10 days, W: 1.95 ± 3.64 days). There were significant improvements (p < 0.05) in measured variables after HCR in both (W and B) groups (max workload: 8.21 ± 2.88 METs (measured in metabolic equivalents) vs. 9.6 ± 2.49 METs, 7.76 ± 2.51 METs vs. 8.73 ± 2.7 METs, resting heart rate (RHR): 77 ± 16.22 bpm vs. 69.94 ± 12.93 bpm, 79.59 ± 14 bpm vs. 75.24 ± 11.87 bpm; double product, i.e., product of heart rate and systolic BP (DP rest) 10 815.22 ± 2968.24 vs. 9242.94 ± 1923.08, 10 927.62 ± 2508.47 vs. 9929.7 ± 2304.94). In group B, a decrease in systolic blood pressure (BP syst. - 137.03 ± 17.14 mm Hg vs. 131.82 ± 21.13 mm Hg), heart rate recovery in the 1st minute after the end of peak exercise (HRR1) (99.38 ± 19.25 vs. 93.9 ± 19.48) and New York Heart Association (NYHA) class (1.22 ± 0.53 vs. 1.11 ± 0.36) was observed. In group W, a decrease in diastolic blood pressure (BP diast.) at rest was observed (88.28 ± 9.79 mm Hg vs. 83.39 ± 8.95 mm Hg). The decrease in resting HR was significantly greater in group W (69.94 ± 12.93 vs. 75.24 ± 11.87, p = 0.034).
  
  
  CONCLUSIONS
  Hybrid cardiac rehabilitation is feasible and safe with high adherence to the program regardless of the patient's professional status. Professional status did not influence the beneficial effect of HCR on exercise tolerance.
authors.affiliation: Medical University of Gdańsk, Gdańsk, Poland (Department of Rehabilitation). dziel@gumed.edu.pl.
authors.forename: Dominika
authors.initials: D
authors.lastname: Szalewska
authors.affiliation: Medical University of Gdańsk, Gdańsk, Poland (Department of Rehabilitation).
authors.forename: Piotr
authors.initials: P
authors.lastname: Niedoszytko
authors.affiliation: Medical University of Gdańsk, Gdańsk, Poland (Department of Rehabilitation).
authors.forename: Katarzyna
authors.initials: K
authors.lastname: Gierat-Haponiuk
mesh_terms: D001794:Blood Pressure / Q000502:physiology; D000072038:Cardiac Rehabilitation / Q000379:methods*; D015444:Exercise / Q000502:physiology*; D005080:Exercise Test; D005260:Female; D005500:Follow-Up Studies; D006339:Heart Rate / Q000502:physiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009784:Occupational Diseases / Q000503:physiopathology / Q000534:rehabilitation*; D016272:Occupational Health; D010045:Outpatients; D010349:Patient Compliance; D011044:Poland; D019114:Remote Consultation; D012189:Retrospective Studies; D012943:Social Security; D013997:Time Factors
keywords: cardiac rehabilitation; coronary artery disease; occupational status; rehabilitation; social benefit; telemedicine