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Engagement with mHealth-CR Varies Widely Among Older Adults [Meeting Abstract]

Graves, C; Schoenthaler, A; Sweeney, G; Fonceva, A; Whiteson, J; George, B; Marzo, K; Rerisi, E; Kovell, L; Adhikari, S; Dodson, J
Background: Mobile health cardiac rehabilitation (mHealth-CR) may improve outcomes among older adults with ischemic heart disease, but variable engagement is not yet understood. We therefore analyzed preliminary data from the RESILIENT trial, an ongoing randomized trial of mHealth-CR vs. usual care in patients age >= 65.
Method(s): Data from the first 50 intervention participants were analyzed. Weekly engagement was scored from 0-11 based on exercise completion, therapist communication, video viewing, and BP self-measurement. Participants were classified as high or low engagement based on median engagement scores. Groups were compared by age, sex, social support (living alone), depression (PHQ-8), and Charlson Comorbidity Index (CCI).
Result(s): There was widely varying engagement with mHealth-CR that ranged from nearly zero to nearly perfect engagement (Figure). There were no significant differences between high and low engagement groups based on mean age (72.6 vs. 72.8, P=0.8), sex (76% male vs. 80%, P=0.7), living alone (28% vs. 44%, P=0.2), depression (mean 3.9 vs. 4.6, P=0.5), or comorbidity burden (mean 4.4 vs. 4.8, P=0.3), although the sample size was small.
Conclusion(s): Our early findings show wide variation in mHealth-CR engagement among older adults
EMBASE:637954339
ISSN: 1531-5487
CID: 5252422

Response to letter to the editor regarding "Multi-Disciplinary collaborative consensus guidance statement on the assessment and treatment of fatigue in patients with Post-Acute sequelae of SARS-CoV-2 infection (PASC)" [Letter]

Herrera, Joseph E; Niehaus, William N; Whiteson, Jonathan; Azola, Alba; Baratta, John M; Fleming, Talya K; Kim, Soo Yeon; Naqvi, Huma; Sampsel, Sarah; Silver, Julie K; Gutierrez, Monica Verduzco; Maley, Jason H; Herman, Eric; Abramoff, Benjamin
PMID: 34617402
ISSN: 1934-1563
CID: 5067742

Acceptability of capnography-assisted respiratory therapy: a new mind-body intervention for COPD

Norweg, Anna Migliore; Skamai, Anne; Kwon, Simona C; Whiteson, Jonathan; MacDonald, Kyle; Haas, Francois; Collins, Eileen G; Goldring, Roberta M; Reibman, Joan; Wu, Yinxiang; Sweeney, Greg; Pierre, Alicia; Troxel, Andrea B; Ehrlich-Jones, Linda; Simon, Naomi M
Dyspnoea self-management is often suboptimal for patients with COPD. Many patients with COPD experience chronic dyspnoea as distressing and disabling, especially during physical activities. Breathing therapy is a behavioural intervention that targets reducing the distress and impact of dyspnoea on exertion in daily living. Using a qualitative design, we conducted interviews with 14 patients after they participated in a novel mind-body breathing therapy intervention adjunct, capnography-assisted respiratory therapy (CART), combined with outpatient pulmonary rehabilitation. Comprehensive CART consisted of patient-centred biofeedback, tailored breathing exercises, a home exercise programme and motivational interviewing counselling. We assessed participants' perceptions and reported experiences to gauge the acceptability of CART and refine CART based on feedback. Constant comparative analysis was used to identify commonalities and themes. We identified three main themes relating to the acceptability and reported benefits of CART: (1) self-regulating breathing; (2) impact on health; and (3) patient satisfaction. Our findings were used to refine and optimise CART (i.e. its intensity, timing and format) for COPD. By addressing dysfunctional breathing behaviours and dysregulated interoception, CART offers a promising new paradigm for relieving dyspnoea and related anxiety in patients with COPD.
PMCID:8685511
PMID: 34938800
ISSN: 2312-0541
CID: 5109002

Multidisciplinary collaborative consensus guidance statement on the assessment and treatment of fatigue in postacute sequelae of SARS-CoV-2 infection (PASC) patients

Herrera, Joseph E; Niehaus, William N; Whiteson, Jonathan; Azola, Alba; Baratta, John M; Fleming, Talya K; Kim, Soo Yeon; Naqvi, Huma; Sampsel, Sarah; Silver, Julie K; Gutierrez, Monica Verduzco; Maley, Jason; Herman, Eric; Abramoff, Benjamin
PMCID:8441628
PMID: 34346558
ISSN: 1934-1563
CID: 5004222

Demonstrating the vital role of physiatry throughout the health care continuum: Lessons learned from the impacts of the COVID-19 pandemic on inpatient rehabilitation

Whiteson, Jonathan H; Escalón, Miguel Xavier; Maltser, Susan; Verduzco-Gutierrez, Monica
PMID: 34097361
ISSN: 1934-1563
CID: 4899632

CARDIAC REHABILITATION IMPROVES FUNCTIONAL CAPACITY IN PATIENTS WITH ADULT CONGENITAL HEART DISEASE [Meeting Abstract]

Sheng, S; Feinberg, J; Bostrom, J; Tang, Y; Sweeney, G; Pierre, A; Katz, E; Whiteson, J; Haas, F; Dodson, J; Halpern, D
Background Cardiac rehabilitation (CR) is increasingly being prescribed for adult congenital heart disease (ACHD) patients after cardiac procedures or for reduced exercise tolerance. We aim to describe the functional capacity improvements of ACHD patients in CR. Methods This retrospective study included ACHD patients at NYU Rusk Cardiac Rehabilitation from 2013-2019. We collected data on patient characteristics, number of sessions attended, and exercise testing results. Paired sample t-tests were used to assess for changes between pre- and post-CR exercise time and metabolic equivalents (METs). Results In total, 76 ACHD patients (mean age 38.2 years, 56.6% female, 89.5% moderate or complex conditions by anatomic classification) participated in CR. Referral indication was reduced exercise tolerance for 43.4% and was post-cardiac procedure (transcatheter or surgical) for the remainder. Among 37 patients (48.7%) who finished all 36 CR sessions, complete exercise testing data was available for 29 of them. Exercise time increased by 83.8 seconds (95% CI, 43.9 - 123.8; baseline mean 520.7), METs increased by 1.2 (95% CI, 0.6 - 1.8; baseline mean 8.1), and both parameters increased for 72.4% of these patients. These statistically significant improvements were observed across referral indications. Conclusion On average, CR benefits ACHD patients who complete the program, regardless of referral indication. Efforts to increase CR referral and retention would allow more patients to benefit. [Formula presented]
Copyright
EMBASE:2011750530
ISSN: 0735-1097
CID: 4884642

Early Termination of Cardiac Rehabilitation Is More Common With Heart Failure With Reduced Ejection Fraction Than With Ischemic Heart Disease

Bostrom, John; Searcy, Ryan; Walia, Ahana; Rzucidlo, Justyna; Banco, Darcy; Quien, Mary; Sweeney, Greg; Pierre, Alicia; Tang, Ying; Mola, Ana; Xia, Yuhe; Whiteson, Jonathan; Dodson, John A
PURPOSE/OBJECTIVE:Despite known benefits of cardiac rehabilitation (CR), early termination (failure to complete >1 mo of CR) attenuates these benefits. We analyzed whether early termination varied by referral indication in the context of recent growth in patients referred for heart failure with reduced ejection fraction (HFrEF). METHODS:We reviewed records from 1111 consecutive patients enrolled in the NYU Langone Health Rusk CR program (2013-2017). Sessions attended, demographics, and comorbidities were abstracted, as well as primary referral indication: HFrEF or ischemic heart disease (IHD; including post-coronary revascularization, post-acute myocardial infarction, or chronic stable angina). We compared rates of early termination between HFrEF and IHD, and used multivariable logistic regression to determine whether differences persisted after adjusting for relevant characteristics (age, race, ethnicity, body mass index, smoking, hypertension, chronic obstructive pulmonary disease, and depression). RESULTS:Mean patient age was 64 yr, 31% were female, and 28% were nonwhite. Most referrals (85%) were for IHD; 15% were for HFrEF. Early termination occurred in 206 patients (18%) and was more common in HFrEF (26%) than in IHD (17%) (P < .01). After multivariable adjustment, patients with HFrEF remained at higher risk of early termination than patients with IHD (unadjusted OR = 1.73, 95% CI, 1.17-2.54; adjusted OR = 1.53, 95% CI, 1.01-2.31). CONCLUSIONS:Nearly 1 in 5 patients in our program terminated CR within 1 mo, with HFrEF patients at higher risk than IHD patients. While broad efforts at preventing early termination are warranted, particular attention may be required in patients with HFrEF.
PMID: 32084031
ISSN: 1932-751x
CID: 4313382

Mobile health and cardiac rehabilitation in older adults

Bostrom, John; Sweeney, Greg; Whiteson, Jonathan; Dodson, John A
With the ubiquity of mobile devices, the availability of mobile health (mHealth) applications for cardiovascular disease (CVD) has markedly increased in recent years. Older adults represent a population with a high CVD burden and therefore have the potential to benefit considerably from interventions that utilize mHealth. Traditional facility-based cardiac rehabilitation represents one intervention that is currently underutilized for CVD patients and, because of the unique barriers that older adults face, represents an attractive target for mHealth interventions. Despite potential barriers to mHealth adoption in older populations, there is also evidence that older patients may be willing to adopt these technologies. In this review, we highlight the potential for mHealth uptake for older adults with CVD, with a particular focus on mHealth cardiac rehabilitation (mHealth-CR) and evidence being generated in this field.
PMID: 31825132
ISSN: 1932-8737
CID: 4238842

Early termination of cardiac rehabilitation in older adults [Meeting Abstract]

Searcy, R; Bostrom, J; Walia, A; Rzucidlo, J; Banco, D; Quien, M; Sweeney, G; Pierre, A; Whiteson, J; Dodson, J
Background: Among older adults with cardiovascular disease (CVD), cardiac rehabilitation (CR) has multiple benefits including improved quality of life and reduced mortality. Despite the known benefits of CR, early termination (ET) by patients (attending <12/36 recommended sessions) may attenuate these benefits. Our aim was to determine the incidence of ET in our older adult patient population, as well as risk factors associated with this outcome.
Method(s): We reviewed records from 792 consecutive older adult patients (>= 65 years old) enrolled in the NYU Langone Rusk CR program (2013-2017). Sessions attended, demographics, comor-bidities, and primary referral diagnosis were abstracted. We analyzed the overall rate of ET (defined as attending <12 sessions). Categorical variables were described with percentages and continuous variables with mean values. Multivariable logistic regression was subsequently used to analyze predictors of ET, considering age, race, ethnicity, sex, body mass index, diabetes, chronic lung disease, coronary artery disease, heart failure, and stroke.
Result(s): In our total study population, mean age was 74 +/- 7 years, mean BMI was 26 +/- 5, 38% were female, and 18% were nonwhite. Most patients (65%) were referred to CR due to ischemic heart disease (chronic stable angina, post-myocardial infarction, CABG, or elective PCI), with an additional 23% referred for valvular heart disease, 9% for systolic heart failure, and 3% for congenital heart disease. Early termination occurred in 129 patients (16.3%). Patients who terminated early were significantly older (75.6 vs. 73.9, p=0.005) and less likely to have coronary artery disease (13.6% vs. 19.5%, p=0.03). After multivariable logistic regression, the independent risk factors for ET were age (adjusted OR 1.04, 95% CI 1.01-1.07) and Hispanic ethnicity (adjusted OR 2.32, 95% CI 1.01-5.33).
Conclusion(s): Nearly 1 in 6 older adults terminated CR within 1 month (<12/36 sessions), potentially limiting the benefits of CR within this subgroup. Among factors we analyzed, age and Hispanic ethnicity were risk factors for ET, but the overall strength of associ-ation was weak. Further research is necessary to identify novel risk factors for ET in order to better target prevention efforts
EMBASE:627352655
ISSN: 1532-5415
CID: 3831812

Engagement and outcomes among older adults with mobile health (mHealth) cardiac rehabilitation: pilot study [Meeting Abstract]

Grant, E.; Hochman, J.; Summapund, J.; Zhong, H.; Guo, Y.; Estrin, D.; Troxel, A.; Whiteson, J.; Sweeney, G.; Blaum, C.; Dodson, J. A.
ISI:000430468400836
ISSN: 0002-8614
CID: 3084872