1. Programs designed to reduce patient risk factors associated with chronic kidney disease and cardiovascular disease
Fergus W Gardiner BMSc MBA PhD(c)
Charles Sturt University
Australian National University
Department of Health
Elizabeth Regan
Calvary Public Hospital Bruce
28th June 2017
Calvary Public Hospital Grand Rounds

2. Session aims
Pathophysiologic mechanisms in the development of HT in DM patients, and its subsequent link to CKD and CVD
Cardiac rehabilitation
Overview of the cardiac rehabilitation program
Outpatient cardiac rehabilitation: Patient perceived benefits, barriers, and reasons for non-attendance
Outpatient cardiac rehabilitation: Patient pathological benefits
Future abstract presentations and pending research
Cardiac Rehabilitation and HbA1c pathology

3. Pathophysiologic mechanisms in the development of HT in DM patients, and its subsequent link to CKD   
HT and DM are primary risk factors for atherosclerosis, and its related complications such as heart attack, stroke (B. M. Y. Cheung & Li, 2012), and CKD (Schiffrin et al., 2007). DM, HT, and CKD have substantial overlap in there etiology and disease mechanism. In clinical practice DM and HT, which can contribute to CKD, are found in the same patients more often than can be explained by chance alone, with the overlap between dyglycemia and elevated BP is even more common. One study conducted in Hong Kong found that only 42% people with DM had normal BP (<120/80) and only 56% of patients with HT had normal glucose tolerance (B. M. Cheung, 2010). Similar findings and conclusions have been found in other populations (Gress, Nieto, Shahar, Wofford, & Brancati, 2000; Landsberg & Molitch, 2004). These studies suggest that there are shared genetic and/or environmental factors in the HT, DM, and CKD etiology.

4. Cardiac rehabilitation program: overview

5. Cardiac rehabilitation
Cardiovascular disease (CVD) remains one of the leading causes of death globally.
It is essential that interventions shown to be effective in slowing progression of the disease are used effectively.
Cardiac rehabilitation (CR) is an intervention that has been strongly associated with a reduction in all-cause mortality.
However it is believed, limited studies have investigated the effects of a CR program on key pathological risk factors, such as pre and post CR program measurements of blood pressure (BP), heart rate (HR), and weight and girth. Furthermore, limited Canberra based studies have considered changes in the physical fitness and mental health of CR program participation.
There have been no studies that consider the perceived patient benefits of a CR program.

6. Cardiac Rehabilitation Program Participants
Outpatient cardiac rehabilitation: Patient perceived benefits, barriers, and reasons for non-attendance.
Fergus William Gardiner1,2,3, Ezekiel Uba Nwose1, Elizabeth Regan2, Peter French2, Phillip Taderera Bwititi4, Judith Crockett1, Lexin Wang4
1School of Community Health, Charles Sturt University, Australia
2Calvary Hospital, ACT Australia
3 School of Community Health, Charles Sturt University, Australia
4 School of Biomedical Science, Charles Sturt University, Australia
Introduction
Studies have considered the medical benefits associated with cardiac rehabilitation (CR) programs, and barriers to patient attendance. However, no studies have considered the benefits or barriers associated with CR programs as perceived by the patient.
This study therefore sought to determine the patients’ perceived benefits or barriers in participating in the CR program and the various reasons for declining the program.
Patient perceived changes in emotional and physical well-being before and after the CR program
Materials and methods
Data collected included patients’ responses to the self-administrated ‘Outpatient Cardiac Rehabilitation Program Evaluation’ form, after attending the CR program. The evaluation involved analysis of 9- binary and open ended questions. A retrospective study was completed on data collected from January 2010 to December 2015 (6 years) and included 643 adult cases comprising 500 men and 143 women.
Cardiac Rehabilitation Program Participants
Picture here
Results
N = 279 patients participated
83.8% males & 16.2% females
96.1% indicated benefits from attending the CR program,
43% of eligible patients population
96.8% significant changes to their
sense of well-being improvement (p < 0.001)
lifestyle (p < 0.01)
79.2% indicated that they understood their heart problem prior to attending the CR program, 19.7% did not have an understanding.
Perceived changes indicated in Figure
56.6% eligible participants declined participation
The major reasons for declining participation was ‘not wanting to attend’ (19.3%), ‘referred to another hospital service’ (10.6%), and ‘work related commitments’ (7.3%).
Copyright Colin Purrington (
Conclusions
This study reports a large percentage of patients declining CR. This trend is worrying, and needs further investigation, considering the benefits of such a program as cited by the patients that took part in CR. The proportion of men referred to the CR program was 3.5 times more than women and the reasons for this disparity warrants further investigation. It is important to ascertain if barriers to attendance are related to age or gender as potential explanatory factors, and if so this could perhaps call for tailored CR programs. It is believed that if the barriers to attendance are reduced, participants who would have otherwise declined participation, may subsequently perceive the CR program as beneficial.
Acknowledgments
We would like to thank the employees and patients of the Calvary Public Hospital Bruce for their support. We would also like to give a special thankyou to the following clinicians: Narelle Comer; Kate Silk; Tanya Buettikofer; Cate Walker; Linda Adiaanse; Kim Hale; Bo Kyung Park; Helen Browning; Andrea Wilson; Marie Smith; Hamish Patterson; Sarah Reid; and Matthew Stewart.

7. Outpatient cardiac rehabilitation: Patient pathological benefits.
Fergus William Gardiner1,2,3, Ezekiel Uba Nwose1, Elizabeth Regan2, Peter French2, Phillip Taderera Bwititi4, Judith Crockett1, Lexin Wang4
1School of Community Health, Charles Sturt University, Australia
2Calvary Hospital, ACT Australia
3 School of Community Health, Charles Sturt University, Australia
4 School of Biomedical Science, Charles Sturt University, Australia
Introduction
Cardiac Rehabilitation (CR) has been associated with a reduction in all-cause mortality. Limited Australian studies have investigated the effects of a CR program on key pathological risk factors. The aims of this study included determining whether the CR program benefited the patient medically, including reductions to pathological risk factors, improvements to functional capacity, and improvements in mental health; and to what extent were the targets for blood pressure (BP) control in patients with hypertension (HT) and diabetes mellitus (DM) achieved.
Results
Seventy nine (79) participants (58.1%) were included in the study, due to 57 participants (41.9%) attending less than 10 CR sessions. Significant improvements were associated with reductions in BP (p =<0.05), LDL cholesterol (p =<0.05), and improvements in participants PHQ-9 scores (p =<0.001), and their 6MWT (p =<0.001). Participants were able to better manage medication use (p =<0.05).
Pre- vs. post-CR median values of measurement
Materials and methods
Data was collected from the 1st June 2014 until the 31st December 2015 (19 months). The collected participant data included: demographic information (age, gender, ethnicity), past medical history including cardiovascular diseases, diagnosis, physiological risk factors, height, weight, girth, blood pressure (BP), heart rate (HR), medications, and pathology consisting of lipid profile. Furthermore, data was collected on The Patient Health Questionnaire (PHQ-9) factors, and on the participants 6 minute walk test (6MWT). Study participants were included if they attended 10 or more CR program sessions out of 12.
Patient medical history: patient reasons for hospital admission and program inclusion, prior diagnosis, and risk factors.
Copyright Colin Purrington (
Cardiac Rehabilitation Program Participants
Conclusions
This study has demonstrated that a CR program can reduce patient pathology risk factors, associated with CVD, while improving the mental health and physical fitness of the participants.
Acknowledgments
We would like to thank the employees and patients of the Calvary Public Hospital Bruce for their support. We would also like to give a special thankyou to the following clinicians: Narelle Comer; Kate Silk; Tanya Buettikofer; Cate Walker; Linda Adiaanse; Kim Hale; Bo Kyung Park; Helen Browning; Andrea Wilson; Marie Smith; Hamish Patterson; Sarah Reid; and Matthew Stewart

8. Cardiac rehabilitation: diabetes mellitus participant results

9. Thank you