Document Type

Final Project

Graduation Date

Spring 5-6-2023

Degree Name

Doctor of Nursing Practice

First Advisor

Susan Barnason

Second Advisor

Sue Scheulke

Abstract

Background: Traditional cardiac rehabilitation (CR) is a multidisciplinary, multifaceted program for cardiac patients. Throughout the Covid-19 pandemic, health care, including center-based CR (CBCR) programs, were closed to in-person sessions. Even with the return to CBCR participation, patient outcomes may have been affected by this disruption in care. The goal of this study was to determine if CR participation outcomes differed before and after CBCR program closure due to Covid-19.

Methods: A retrospective comparative cohort design was used to examine CR participant outcome data before and after the Covid-19 pandemic. Convenience sampling of CR participants at a large, urban midwestern community hospital was used. Comparison of CR patients who completed CBCR prior to restriction (within 60 days prior to Covid-19 closure) were compared to CR participants attending CBCR within the 60 days following CBCR restriction. Data was collected from CR participants’ medical record and included: a) participant demographic and clinical characteristics, and b) CR outcomes: BMI, BP, MET’s and diet modification.

Results: A total of 37 CR participants were included in this study; 12 participants in the pre-Covid group and 25 participants in the post-Covid group. The mean age of CR participants in both groups was 71 years (pre-Covid M=71.17, post-Covid M=71.32). The average number of CBCR classes attended by the pre-Covid group was M=23.36, compared to M=27.12 in the post-Covid group. Data analysis to compare differences between demographic, clinical and outcome variables in each group were analyzed using chi square and t-test statistical analysis. There were no statistically significant differences between the pre- or post-Covid groups. Baseline and discharge BMI for the pre-Covid group was M=31.36 and M=29.19 respectively; compared to the post-Covid group BMI M=29.66 at baseline and M=29.7l at discharge. Blood pressure (BP) was categorized as normal, Stage 1 hypertension, or Stage 2 hypertension. The majority of the pre-Covid group had participants in the normal BP category at CR baseline and discharge. The majority of the post-Covid group had participants in the elevated BP category at CR baseline and normal at CR discharge. Dietary modification was measured by Rate Your Plate (RYP). The pre-Covid group had a RYP score of M=65.78, with decrease to M=61.66 at CR discharge; compared to the post-Covid RYP score of M=61.00 at baseline and increase to M=67.25 at discharge. A six-minute walk test completed at CR admission and discharge demonstrated both groups increased distance walked. The pre-Covid group baseline was M=1211.36 ft. and increased to M=1800.00 ft at discharge; compared to post-Covid group with CR baseline M=1085 ft and increased to M=1533 ft at discharge.

Conclusions: During the pre-post Covid phases of the pandemic, CR participant outcomes were comparable. During the pandemic, CR participants were able to demonstrate progress in cardiovascular health and improvements in secondary cardiovascular risk reduction. Furthermore, the evaluation of CR participant outcomes provides a basis for providers to coach and support CR participants’ secondary CV risk reduction after completion of the CBCR program. Limitations to the study includes the number of available patients observed through chart review.

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