Effectiveness of Cardiac Rehabilitation for Patients after Coronary Artery Bypass Graft: Randomized Controlled Trial
,
Abstract
Background: Cardiac rehabilitation is a program designed to help patients adopt healthy lifestyles. This study aims to investigate the effectiveness of the comprehensive cardiac rehabilitation program (CCRP) on anxiety, depression, perceived health status (PHS), and 90-day readmission rate for Coronary artery bypass grafting (CABG) patients.
Methods: 122 patients were randomized into two groups; the intervention group received a CCRP. The program was 12 weeks. Anxiety and depression were assessed using the hospital anxiety and depression scale, and PHS was assessed using the short form-36 health survey. The effectiveness of the CCRP was measured using ANOVA.
Results: The sample comprised 122 participants, most of them were male (n = 85; 69.7%), with a mean age of 53.01 (±7.26) years. At baseline, the groups had no significant differences. At 12 weeks and one month later, significant differences have been observed with between-group effect of (F (1) = 937.69, P <.001, partial η2 = .90), (F (1) = 1036.00, p<0.001, partial η2 = .91), (F (1) = 14.73, p <.001, partial η2 = .13), (F (1) = 13.87, p <.001, partial η2 = .121) for anxiety, depression, physical component summary and mental component summary of perceived health status respectively.
Conclusion: CCRP appeared to be an effective intervention that could significantly improve anxiety, depression, and PHS. Although the difference in the readmission rate was not significant, it may result in substantial rewards.
The protocol of the present study was registered and approved in ClinicalTrials.gov PRS
ID: NCT06118918
November /2023
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2. Mohr FW, Morice M-C, Kappetein AP, Feldman TE, Ståhle E, Colombo A, et al. Coronary artery bypass graft surgery versus percutaneous coronary intervention in patients with three-vessel disease and left main coronary disease: 5-year follow-up of the randomised, clinical SYNTAX trial. The lancet. 2013;381(9867):629-38.
3. Hojskov IE, Moons P, Egerod I, Olsen PS, Thygesen LC, Hansen NV, et al. Early physical and psycho-educational rehabilitation in patients with coronary artery bypass grafting: A randomized controlled trial. J Rehabil Med. 2019;51(2):136-43.
4. Members WC, Drozda Jr J, Messer JV, Spertus J, Abramowitz B, Alexander K, et al. ACCF/AHA/AMA–PCPI 2011 performance measures for adults with coronary artery disease and hypertension: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Performance Measures and the American Medical Association–Physician Consortium for Performance Improvement. Circulation. 2011;124(2):248-70.
5. Thomas RJ, Beatty AL, Beckie TM, Brewer LC, Brown TM, Forman DE, et al. Home-based cardiac rehabilitation: a scientific statement from the American Association of Cardiovascular and Pulmonary Rehabilitation, the American Heart Association, and the American College of Cardiology. Circulation. 2019;140(1):e69-e89.
6. Yeh RW, Tamez H, Secemsky EA, Grantham JA, Sapontis J, Spertus JA, et al. Depression and angina among patients undergoing chronic total occlusion percutaneous coronary intervention: the OPEN-CTO registry. JACC Cardiovasc Interv. 2019;12(7):651-8.
7. Ratnoo B, Mulla A, Oza F, Vyas M. Prevalence of Anxiety, Depression, Kinesiophobia, and Impaired Shoulder Function in Patients following Coronary Artery Bypass Grafting: An Observational Study. Journal of Indian College of Cardiology. 2023;13(4):147-53.
8. Kashif M, Hamid M, Raza A. Influence of Preoperative Anxiety Level on Postoperative Pain After Cardiac Surgery. Cureus. 2022;14(2):e22170.
9. Iryanidar I, Irwan AM. Stress and coping mechanisms in patients undergoing CABG: An integrative review. Clinical Epidemiology and Global Health. 2023;23:101388.
10. Blumenthal JA, Lett HS, Babyak MA, White W, Smith PK, Mark DB, et al. Depression as a risk factor for mortality after coronary artery bypass surgery. Lancet. 2003;362(9384):604-9.
11. Sangtarash F, Choobsaz H, Zarrin M, Salari S, Manshadi EM, Esmaeili AA, et al. The Relationship between DASS-42 Questionnaire, Salivary Cortisol and Heart Rate Variability. Journal of Modern Rehabilitation. 2024.
12. Souto TS, Ramires A, Leite Â, Santos V, Santo RE. Health perception: validation of a scale for the portuguese population. Trends in Psychology. 2018;26:2167-83.
13. Kahkonen O, Saaranen T, Lamidi M-L, Miettinen H, Kankkunen P. Perceived Health among Patients with Coronary Heart Disease Four Months after a Percutaneous Coronary Intervention. International Journal of Caring Sciences. 2017;10(1).
14. Calvert M, King M, Mercieca-Bebber R, Aiyegbusi O, Kyte D, Slade A, et al. SPIRIT-PRO Extension explanation and elaboration: guidelines for inclusion of patient-reported outcomes in protocols of clinical trials. BMJ open. 2021;11(6):e045105.
15. Far BM, Naimi SS, Abedi M, Raeissadat SA, Monfared MB, Baghban AA. Immediate Respiratory Warm-Up Effect on Dynamic Inspiratory Muscle Strength in Cardiac Surgery Candidates. Journal of Modern Rehabilitation. 2024.
16. AbuRuz ME, Al-Dweik G. Depressive symptoms, perceived control and quality of life among patients undergoing coronary artery bypass graft: a prospective cohort study. BMC Nurs. 2022;21(1):87.
17. Hansen D, Abreu A, Ambrosetti M, Cornelissen V, Gevaert A, Kemps H, et al. Exercise intensity assessment and prescription in cardiovascular rehabilitation and beyond: why and how: a position statement from the Secondary Prevention and Rehabilitation Section of the European Association of Preventive Cardiology. European journal of preventive cardiology. 2022;29(1):230-45.
18. Shi Y, Lan J. Effect of stress management training in cardiac rehabilitation among coronary artery disease: a systematic review and meta-analysis. Rev Cardiovasc Med. 2021;22(4):1491-501.
19. Ma C, Wang B, Zhao X, Fu F, Zheng L, Li G, et al. WeChat-based education and rehabilitation program in unprotected left main coronary artery disease patients after coronary artery bypass grafting: an effective approach in reducing anxiety, depression, loss to follow-up, and improving quality of life. Braz J Med Biol Res. 2021;54.
20. Terkawi AS, Tsang S, AlKahtani GJ, Al-Mousa SH, Al Musaed S, AlZoraigi US, et al. Development and validation of Arabic version of the Hospital Anxiety and Depression Scale. Saudi J Anaesth. 2017;11(Suppl 1):S11-s8.
21. Ware JE, Jr., Sherbourne CD. The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. Med Care. 1992;30(6):473-83.
22. Von Der Heyde R. Chapter 6 - Assessment of Functional Outcomes. In: Cooper C, editor. Fundamentals of Hand Therapy. Saint Louis: Mosby; 2007. p. 98-113.
23. Khader S, Hourani M, Al-Akour N. Normative data and psychometric properties of short form 36 health survey (SF-36, version 1.0) in the population of north Jordan. East Mediterr Health J. 2011;17(5):368-74.
24. Brown TM, Pack QR, Aberegg E, Brewer LC, Ford YR, Forman DE, et al. Core components of cardiac rehabilitation programs: 2024 update: a scientific statement from the American Heart Association and the American Association of Cardiovascular and Pulmonary Rehabilitation. Circulation. 2024;150(18):e328-e47.
25. Verdicchio C, Freene N, Hollings M, Maiorana A, Briffa T, Gallagher R, et al. A clinical guide for assessment and prescription of exercise and physical activity in cardiac rehabilitation. A CSANZ position statement. Heart, Lung and Circulation. 2023;32(9):1035-48.
26. Bok D, Rakovac M, Foster C. An examination and critique of subjective methods to determine exercise intensity: the talk test, feeling scale, and rating of perceived exertion. Sports Med. 2022;52(9):2085-109.
27. Chen B, Wen J, You D, Zhang Y. Implication of cognitive-behavioral stress management on anxiety, depression, and quality of life in acute myocardial infarction patients after percutaneous coronary intervention: a multicenter, randomized, controlled study. Ir J Med Sci. 2024;193(1):101-9.
28. Nasirnejad S, Molavynejad S, Jahani S, Maraghi E. Effect of rhythmic breathing on the severity of pain and anxiety in patients after coronary artery bypass graft: A clinical trial study. Pak J Med Health Sci. 2020;14(2):1260-5.
29. Powell-Wiley TM, Baumer Y, Baah FO, Baez AS, Farmer N, Mahlobo CT, et al. Social Determinants of Cardiovascular Disease. Circ Res. 2022;130(5):782-99.
30. Blumenthal JA, Smith PJ, Jiang W, Hinderliter A, Watkins LL, Hoffman BM, et al. Effect of Exercise, Escitalopram, or Placebo on Anxiety in Patients With Coronary Heart Disease: The Understanding the Benefits of Exercise and Escitalopram in Anxious Patients With Coronary Heart Disease (UNWIND) Randomized Clinical Trial. JAMA Psychiatry. 2021;78(11):1270-8.
31. Wang L, Sun Y, Zhan J, Wu Z, Zhang P, Wen X, et al. Effects of Exercise Therapy on Anxiety and Depression in Patients With Coronary Heart Disease: A Meta-Analysis of a Randomized Controlled Study. Front Cardiovasc Med. 2021;8:730155.
32. Korzeniowska-Kubacka I, Bilińska M, Piotrowska D, Stepnowska M, Piotrowicz R. The impact of exercise-only-based rehabilitation on depression and anxiety in patients after myocardial infarction. Eur J Cardiovasc Nurs. 2017;16(5):390-6.
33. Shan R, Zhang L, Zhu Y, Ben L, Xin Y, Wang F, et al. Effect of Early Exercise Rehabilitation on Cardiopulmonary Function and Quality of Life in Patients after Coronary Artery Bypass Grafting. Contrast Media Mol Imaging. 2022;2022.
34. Subih M, Elshatarat RA, Sawalha MA, Almarwani AM, Alhadidi M, Alrahahleh M, et al. Exploring the Impact of Cardiac Rehabilitation Programs on Health-Related Quality of Life and Physiological Outcomes in Patients Post Coronary Artery Bypass Grafts: A Systematic Review. Rev Cardiovasc Med. 2024;25(4):145.
35. Osailan A, Abdelbasset WK. Exercise-based cardiac rehabilitation for postcoronary artery bypass grafting and its effect on hemodynamic responses and functional capacity evaluated using the Incremental Shuttle Walking Test: A retrospective pilot analysis. J Saudi Heart Assoc. 2020;32(1):25-33.
36. Shan R, Zhang L, Zhu Y, Ben L, Xin Y, Wang F, et al. Effect of Early Exercise Rehabilitation on Cardiopulmonary Function and Quality of Life in Patients after Coronary Artery Bypass Grafting. Contrast Media Mol Imaging. 2022;2022:4590037.
37. Schulté B, Nieborak L, Leclercq F, Villafañe JH, Sánchez Romero EA, Corbellini C. The comparison of high-intensity interval training Versus Moderate-Intensity continuous training after coronary artery bypass graft: a systematic review of recent studies. Journal of Cardiovascular Development and Disease. 2022;9(10):328.
38. Members WC, Virani SS, Newby LK, Arnold SV, Bittner V, Brewer LC, et al. 2023 AHA/ACC/ACCP/ASPC/NLA/PCNA guideline for the management of patients with chronic coronary disease: a report of the American Heart Association/American College of Cardiology Joint Committee on Clinical Practice Guidelines. J Am Coll Cardiol. 2023;82(9):833-955.
39. Virani SS, Newby LK, Arnold SV, Bittner V, Brewer LC, Demeter SH, et al. 2023 AHA/ACC/ACCP/ASPC/NLA/PCNA Guideline for the Management of Patients With Chronic Coronary Disease: A Report of the American Heart Association/American College of Cardiology Joint Committee on Clinical Practice Guidelines. Circulation. 2023;148(9):e9-e119.
40. Visseren FL, Mach F, Smulders YM, Carballo D, Koskinas KC, Bäck M, et al. 2021 ESC Guidelines on cardiovascular disease prevention in clinical practice: Developed by the Task Force for cardiovascular disease prevention in clinical practice with representatives of the European Society of Cardiology and 12 medical societies With the special contribution of the European Association of Preventive Cardiology (EAPC). European journal of preventive cardiology. 2022;29(1):5-115.
41. Chew DP, Scott IA, Cullen L, French JK, Briffa TG, Tideman PA, et al. National Heart Foundation of Australia & Cardiac Society of Australia and New Zealand: Australian Clinical Guidelines for the Management of Acute Coronary Syndromes 2016. Heart Lung Circ. 2016;25(9):895-951.
42. Kulaylat AS, Jung J, Hollenbeak CS, Messaris E, editors. Readmissions, penalties, and the hospital readmissions reduction program. Seminars in Colon and Rectal Surgery; 2018: Elsevier.
43. Wellman CD, Franks AM, Stickler M, Rollyson W, Korkmaz A, Christiansen MQ, et al. Targeted care coordination towards patients with a history of multiple readmissions effectively reduces readmissions. Fam Pract. 2024;41(3):326-32.
44. Hahn B, Ball T, Diab W, Choi C, Bleau H, Flynn A. Utilization of a multidisciplinary hospital-based approach to reduce readmission rates. SAGE Open Medicine. 2024;12:20503121241226591.
2. Mohr FW, Morice M-C, Kappetein AP, Feldman TE, Ståhle E, Colombo A, et al. Coronary artery bypass graft surgery versus percutaneous coronary intervention in patients with three-vessel disease and left main coronary disease: 5-year follow-up of the randomised, clinical SYNTAX trial. The lancet. 2013;381(9867):629-38.
3. Hojskov IE, Moons P, Egerod I, Olsen PS, Thygesen LC, Hansen NV, et al. Early physical and psycho-educational rehabilitation in patients with coronary artery bypass grafting: A randomized controlled trial. J Rehabil Med. 2019;51(2):136-43.
4. Members WC, Drozda Jr J, Messer JV, Spertus J, Abramowitz B, Alexander K, et al. ACCF/AHA/AMA–PCPI 2011 performance measures for adults with coronary artery disease and hypertension: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Performance Measures and the American Medical Association–Physician Consortium for Performance Improvement. Circulation. 2011;124(2):248-70.
5. Thomas RJ, Beatty AL, Beckie TM, Brewer LC, Brown TM, Forman DE, et al. Home-based cardiac rehabilitation: a scientific statement from the American Association of Cardiovascular and Pulmonary Rehabilitation, the American Heart Association, and the American College of Cardiology. Circulation. 2019;140(1):e69-e89.
6. Yeh RW, Tamez H, Secemsky EA, Grantham JA, Sapontis J, Spertus JA, et al. Depression and angina among patients undergoing chronic total occlusion percutaneous coronary intervention: the OPEN-CTO registry. JACC Cardiovasc Interv. 2019;12(7):651-8.
7. Ratnoo B, Mulla A, Oza F, Vyas M. Prevalence of Anxiety, Depression, Kinesiophobia, and Impaired Shoulder Function in Patients following Coronary Artery Bypass Grafting: An Observational Study. Journal of Indian College of Cardiology. 2023;13(4):147-53.
8. Kashif M, Hamid M, Raza A. Influence of Preoperative Anxiety Level on Postoperative Pain After Cardiac Surgery. Cureus. 2022;14(2):e22170.
9. Iryanidar I, Irwan AM. Stress and coping mechanisms in patients undergoing CABG: An integrative review. Clinical Epidemiology and Global Health. 2023;23:101388.
10. Blumenthal JA, Lett HS, Babyak MA, White W, Smith PK, Mark DB, et al. Depression as a risk factor for mortality after coronary artery bypass surgery. Lancet. 2003;362(9384):604-9.
11. Sangtarash F, Choobsaz H, Zarrin M, Salari S, Manshadi EM, Esmaeili AA, et al. The Relationship between DASS-42 Questionnaire, Salivary Cortisol and Heart Rate Variability. Journal of Modern Rehabilitation. 2024.
12. Souto TS, Ramires A, Leite Â, Santos V, Santo RE. Health perception: validation of a scale for the portuguese population. Trends in Psychology. 2018;26:2167-83.
13. Kahkonen O, Saaranen T, Lamidi M-L, Miettinen H, Kankkunen P. Perceived Health among Patients with Coronary Heart Disease Four Months after a Percutaneous Coronary Intervention. International Journal of Caring Sciences. 2017;10(1).
14. Calvert M, King M, Mercieca-Bebber R, Aiyegbusi O, Kyte D, Slade A, et al. SPIRIT-PRO Extension explanation and elaboration: guidelines for inclusion of patient-reported outcomes in protocols of clinical trials. BMJ open. 2021;11(6):e045105.
15. Far BM, Naimi SS, Abedi M, Raeissadat SA, Monfared MB, Baghban AA. Immediate Respiratory Warm-Up Effect on Dynamic Inspiratory Muscle Strength in Cardiac Surgery Candidates. Journal of Modern Rehabilitation. 2024.
16. AbuRuz ME, Al-Dweik G. Depressive symptoms, perceived control and quality of life among patients undergoing coronary artery bypass graft: a prospective cohort study. BMC Nurs. 2022;21(1):87.
17. Hansen D, Abreu A, Ambrosetti M, Cornelissen V, Gevaert A, Kemps H, et al. Exercise intensity assessment and prescription in cardiovascular rehabilitation and beyond: why and how: a position statement from the Secondary Prevention and Rehabilitation Section of the European Association of Preventive Cardiology. European journal of preventive cardiology. 2022;29(1):230-45.
18. Shi Y, Lan J. Effect of stress management training in cardiac rehabilitation among coronary artery disease: a systematic review and meta-analysis. Rev Cardiovasc Med. 2021;22(4):1491-501.
19. Ma C, Wang B, Zhao X, Fu F, Zheng L, Li G, et al. WeChat-based education and rehabilitation program in unprotected left main coronary artery disease patients after coronary artery bypass grafting: an effective approach in reducing anxiety, depression, loss to follow-up, and improving quality of life. Braz J Med Biol Res. 2021;54.
20. Terkawi AS, Tsang S, AlKahtani GJ, Al-Mousa SH, Al Musaed S, AlZoraigi US, et al. Development and validation of Arabic version of the Hospital Anxiety and Depression Scale. Saudi J Anaesth. 2017;11(Suppl 1):S11-s8.
21. Ware JE, Jr., Sherbourne CD. The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. Med Care. 1992;30(6):473-83.
22. Von Der Heyde R. Chapter 6 - Assessment of Functional Outcomes. In: Cooper C, editor. Fundamentals of Hand Therapy. Saint Louis: Mosby; 2007. p. 98-113.
23. Khader S, Hourani M, Al-Akour N. Normative data and psychometric properties of short form 36 health survey (SF-36, version 1.0) in the population of north Jordan. East Mediterr Health J. 2011;17(5):368-74.
24. Brown TM, Pack QR, Aberegg E, Brewer LC, Ford YR, Forman DE, et al. Core components of cardiac rehabilitation programs: 2024 update: a scientific statement from the American Heart Association and the American Association of Cardiovascular and Pulmonary Rehabilitation. Circulation. 2024;150(18):e328-e47.
25. Verdicchio C, Freene N, Hollings M, Maiorana A, Briffa T, Gallagher R, et al. A clinical guide for assessment and prescription of exercise and physical activity in cardiac rehabilitation. A CSANZ position statement. Heart, Lung and Circulation. 2023;32(9):1035-48.
26. Bok D, Rakovac M, Foster C. An examination and critique of subjective methods to determine exercise intensity: the talk test, feeling scale, and rating of perceived exertion. Sports Med. 2022;52(9):2085-109.
27. Chen B, Wen J, You D, Zhang Y. Implication of cognitive-behavioral stress management on anxiety, depression, and quality of life in acute myocardial infarction patients after percutaneous coronary intervention: a multicenter, randomized, controlled study. Ir J Med Sci. 2024;193(1):101-9.
28. Nasirnejad S, Molavynejad S, Jahani S, Maraghi E. Effect of rhythmic breathing on the severity of pain and anxiety in patients after coronary artery bypass graft: A clinical trial study. Pak J Med Health Sci. 2020;14(2):1260-5.
29. Powell-Wiley TM, Baumer Y, Baah FO, Baez AS, Farmer N, Mahlobo CT, et al. Social Determinants of Cardiovascular Disease. Circ Res. 2022;130(5):782-99.
30. Blumenthal JA, Smith PJ, Jiang W, Hinderliter A, Watkins LL, Hoffman BM, et al. Effect of Exercise, Escitalopram, or Placebo on Anxiety in Patients With Coronary Heart Disease: The Understanding the Benefits of Exercise and Escitalopram in Anxious Patients With Coronary Heart Disease (UNWIND) Randomized Clinical Trial. JAMA Psychiatry. 2021;78(11):1270-8.
31. Wang L, Sun Y, Zhan J, Wu Z, Zhang P, Wen X, et al. Effects of Exercise Therapy on Anxiety and Depression in Patients With Coronary Heart Disease: A Meta-Analysis of a Randomized Controlled Study. Front Cardiovasc Med. 2021;8:730155.
32. Korzeniowska-Kubacka I, Bilińska M, Piotrowska D, Stepnowska M, Piotrowicz R. The impact of exercise-only-based rehabilitation on depression and anxiety in patients after myocardial infarction. Eur J Cardiovasc Nurs. 2017;16(5):390-6.
33. Shan R, Zhang L, Zhu Y, Ben L, Xin Y, Wang F, et al. Effect of Early Exercise Rehabilitation on Cardiopulmonary Function and Quality of Life in Patients after Coronary Artery Bypass Grafting. Contrast Media Mol Imaging. 2022;2022.
34. Subih M, Elshatarat RA, Sawalha MA, Almarwani AM, Alhadidi M, Alrahahleh M, et al. Exploring the Impact of Cardiac Rehabilitation Programs on Health-Related Quality of Life and Physiological Outcomes in Patients Post Coronary Artery Bypass Grafts: A Systematic Review. Rev Cardiovasc Med. 2024;25(4):145.
35. Osailan A, Abdelbasset WK. Exercise-based cardiac rehabilitation for postcoronary artery bypass grafting and its effect on hemodynamic responses and functional capacity evaluated using the Incremental Shuttle Walking Test: A retrospective pilot analysis. J Saudi Heart Assoc. 2020;32(1):25-33.
36. Shan R, Zhang L, Zhu Y, Ben L, Xin Y, Wang F, et al. Effect of Early Exercise Rehabilitation on Cardiopulmonary Function and Quality of Life in Patients after Coronary Artery Bypass Grafting. Contrast Media Mol Imaging. 2022;2022:4590037.
37. Schulté B, Nieborak L, Leclercq F, Villafañe JH, Sánchez Romero EA, Corbellini C. The comparison of high-intensity interval training Versus Moderate-Intensity continuous training after coronary artery bypass graft: a systematic review of recent studies. Journal of Cardiovascular Development and Disease. 2022;9(10):328.
38. Members WC, Virani SS, Newby LK, Arnold SV, Bittner V, Brewer LC, et al. 2023 AHA/ACC/ACCP/ASPC/NLA/PCNA guideline for the management of patients with chronic coronary disease: a report of the American Heart Association/American College of Cardiology Joint Committee on Clinical Practice Guidelines. J Am Coll Cardiol. 2023;82(9):833-955.
39. Virani SS, Newby LK, Arnold SV, Bittner V, Brewer LC, Demeter SH, et al. 2023 AHA/ACC/ACCP/ASPC/NLA/PCNA Guideline for the Management of Patients With Chronic Coronary Disease: A Report of the American Heart Association/American College of Cardiology Joint Committee on Clinical Practice Guidelines. Circulation. 2023;148(9):e9-e119.
40. Visseren FL, Mach F, Smulders YM, Carballo D, Koskinas KC, Bäck M, et al. 2021 ESC Guidelines on cardiovascular disease prevention in clinical practice: Developed by the Task Force for cardiovascular disease prevention in clinical practice with representatives of the European Society of Cardiology and 12 medical societies With the special contribution of the European Association of Preventive Cardiology (EAPC). European journal of preventive cardiology. 2022;29(1):5-115.
41. Chew DP, Scott IA, Cullen L, French JK, Briffa TG, Tideman PA, et al. National Heart Foundation of Australia & Cardiac Society of Australia and New Zealand: Australian Clinical Guidelines for the Management of Acute Coronary Syndromes 2016. Heart Lung Circ. 2016;25(9):895-951.
42. Kulaylat AS, Jung J, Hollenbeak CS, Messaris E, editors. Readmissions, penalties, and the hospital readmissions reduction program. Seminars in Colon and Rectal Surgery; 2018: Elsevier.
43. Wellman CD, Franks AM, Stickler M, Rollyson W, Korkmaz A, Christiansen MQ, et al. Targeted care coordination towards patients with a history of multiple readmissions effectively reduces readmissions. Fam Pract. 2024;41(3):326-32.
44. Hahn B, Ball T, Diab W, Choi C, Bleau H, Flynn A. Utilization of a multidisciplinary hospital-based approach to reduce readmission rates. SAGE Open Medicine. 2024;12:20503121241226591.
| Issue | Articles in Press | |
| Section | Research Article(s) | |
| Keywords | ||
| Cardiac rehabilitation, Anxiety, Depression, Health status | ||
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How to Cite
1.
Lam S, Harbi A, Yubbu P, Geok S. Effectiveness of Cardiac Rehabilitation for Patients after Coronary Artery Bypass Graft: Randomized Controlled Trial. jmr. 2025;(-).
