Design og vurdering af et kvindeligt hjerterehabiliteringsprogram (CARE). (CARE)

Inclusion Criteria:

• Provision of signed and dated informed consent form
• Stated willingness to comply with all study procedures and availability to participate in study procedures for the duration of the study
• Identify as a female
• Be between the ages of 40-80 years, inclusive
• Documented diagnosis of CR indications of stable and/or refractory angina pectoris (with or without coronary obstructive disease), acute myocardial infarction (MI) within the preceding 12 months (including MINOCA), percutaneous coronary interventions (PCI), surgical and transvalvular aortic valve replacement, spontaneous coronary artery dissection (SCAD), post-aortic surgery with or without aortic valve, coronary artery bypass grafting (CABG) and mitral valve replacement or repair with or without CABG
• Referred to outpatient CR at the University of Michigan, Domino's Farms or Brighton Center for Specialty Care Cardiac Rehabilitation site based on Michigan Medicine's Division of Cardiovascular Medicine Policy and Procedure.

Exclusion Criteria:

• Not being "cleared" for CR based on Michigan Medicine's Division of Cardiovascular Medicine Policy and Procedures
• Prior participation in CR
• Inability to understand spoken and written English, either due to language barrier or cognitive limitation for any reason, including deaf or blind
• Frailty, fall risk, or muscle, joint or back pain as defined as the inability to perform activities of daily living without limitations and engage in mild physical activity (i.e. unable to walk up 1 flight of stairs unaided)
• Any of the following as the indication for CR: aortic repair or replacement for aortic dissection, untreated or greater than New York Heart Association (NYHA) class II congestive heart failure, cardiac transplant candidate or recipient, tricuspid or pulmonic valve repair or replacement
• Life threatening ventricular arrythmias without an implanted defibrillator; very frequent premature ventricular contraction or premature atrial contractions symptomatic or not; poorly controlled atrial fibrillation
• Associated more than mild valvular heart disease, untreated congestive heart failure; unstable angina or heart pain with minimal activity; angina or congestive heart failure limiting ability to climb one flight of stairs without help (NHYA Functional Classification >2)
• Severe pulmonary hypertension (right heart systolic pressure greater than 60 millimeters of mercury); clot in the heart; treated venous thrombosis with or without pulmonary embolism in past 6 months; more than mild dyspnea related to chronic lung disease or asthma
• Chronic kidney disease (creatinine >2 milligrams per deciliter (mg/dl)); symptomatic active liver disease (infectious or inflammatory), symptomatic chronic liver disease (except for nonalcoholic fatty liver disease), kidney dialysis or kidney transplant recipient, active or chronic renal disease (rise by 0.5mg/dL in past 3 months or chronic elevated serum creatinine 2.0 milligrams per milliliter (mg/mL) or greater.
• Poorly controlled diabetes defined as uninterrupted HbA1c >8.0% for ≥1 year despite standard care, baseline HbA1c prior to CR > 8.5%.
• Immunosuppressive drug requirement, acute anemia, chronic anemia with Hemoglobin < 10mg/mL
• Limiting chronic muscle, joint, or back pain; identified as fall risk from poor balance or neurologic syndromes; frailty defined as the inability to perform activities of daily living in older adults that carries an increased risk for poor health outcomes including falls, incident disability, hospitalization, and mortality
• Untreated or active substance abuse/addiction including alcohol and drugs; depression (defined as a score ≥ 15 or depression positive answer to #8 or #9 on Patient Health Questionnaire-9) unless deemed acceptable by mental health care provider; severe anxiety
• Severe obesity (Body mass index ≥ 40 kilograms/meters squared), history of bariatric surgery within previous 3 years and >5% body weight loss over preceding 12 months; chronic venous insufficiency with cellulitis or > 1+ edema unless controlled with support hose.