The Journal of the Arkansas Medical Society Med Journal March 2019 Final 2 | Page 14

SCIENTIFIC ARTICLE
Early Impact of Cardiovascular Rehabilitation on Medication
Requirements in Patients with Coronary Artery Disease
Edouard M. Oudin, MD 1 ; Yuemeng Dai, MD 2 ; Gerardo Rodriguez-Araujo, MD 3,4*
UAMS, Little Rock, AR; 2 Mesquite Rehabilitation Institute, Mesquite, TX
3
Arkansas Heart Hospital, Little Rock, AR; 4 ProSciento, Inc, Chula Vista, CA
1
Abstract
P
olypharmacy is common in
patients with coronary ar-
tery disease (CAD). This study
evaluates the impact of cardiovascular
rehabilitation on alleviating polypharma-
cy practices. We collected retrospective
data on CAD patients in a cardiovascular
rehabilitation program at the Arkansas
Heart Hospital, and average number of
medications were compared before and
after rehabilitation. Results demonstrated a
significant decrease in antihypertensive re-
quirement (2.42±1.56 before to 2.13±1.48
after, p=0.0316), insignificant decrease
in antihyperlipidemics, no change in an-
tidiabetics, and decreased total medica-
tion requirement approaching significance
(9.08±4.35 to 8.75±4.10, p=0.0574). We
concluded that cardiovascular rehabilita-
tion programs can play a role in alleviating
polypharmacy in patients with CAD.
Introduction
Cardiovascular rehabilitation programs
provide great benefit to patients with coronary
artery disease (CAD). 1 Current AHA guidelines
recommend that patients with a diagnosis of CAD
participate in at least 30 minutes of exercise per
day for a minimum of five days per week. 2 Ad-
ditional guidelines are in place outlining dietary
modifications for these patients. 2 Cardiovascular
rehabilitation programs are playing a large role in
increased adherence to these suggested lifestyle
modifications. 3 Many of these programs not only
utilize exercise sessions for patients, but also ed-
ucate patients on the implementation of healthy
dietary habits.
In addition to challenging lifestyle modifica-
tions, patients with CAD are often prescribed nu-
merous daily medications, making the practice
of polypharmacy common. 4 The reasons for this
vary and can include the need for strict control of
cardiovascular risk factors to avoid progression
of the disease. The presence of multiple comor-
bidities in patients with coronary artery disease
further increases the need for concomitant med-
ications. 4 Polypharmacy presents an increased
risk for drug interactions, adverse drug effects,
and issues with medication adherence, among
other things. 5
The various positive effects of cardiovas-
cular rehabilitation programs could alleviate
the need for polypharmacy and its associated
issues. Because of increased use of these pro-
grams, there is further incentive to investigate
the role that they may play in overall medication
requirements for patients with CAD.
Methods
Study Design and Data Collection
This is a retrospective analysis of patients
with CAD who have participated in a cardiovas-
cular rehabilitation program at the Arkansas
Heart Hospital. Inclusion criteria for the study:
1) The patient must have a diagnosis of coro-
nary artery disease; 2) The patient must have
fully participated in the cardiovascular rehabili-
tation program at the Arkansas Heart Hospital.
Each session of rehabilitation included one hour
of guided exercise, with some sessions being
followed by cooking or diet education classes.
Full participation was considered completion
of 72 sessions of outpatient rehabilitation, or
206 • THE JOURNAL OF THE ARKANSAS MEDICAL SOCIETY
18 weeks of enrollment in the program; 3) The
patient must be taking at least one antihy-
pertensive, antihyperlipidemic, or antidiabetic
medication.
Data was collected using electronic medical
records from the rehabilitation clinic. Daily prog-
ress reports written by the therapists included
any medication changes made between that
session and the previous session. These reports
were used to identify medication changes made
during the course of rehabilitation. A patient’s
medications before rehabilitation were com-
pared to their medications after completion of
the program.
Primary and Secondary Endpoints
The primary endpoints used for data collec-
tion include: 1) discontinuation of any medica-
tion; 2) addition of any medication; 3) discontin-
uation of either an antihypertensive, antihyper-
lipidemic, or antidiabetic medication; 4) addition
of any antihypertensive, antihyperlipidemic, or
antidiabetic medication; 5) decreased dose of
either an antihypertensive, antihyperlipidemic,
or antidiabetic medication; and 6) increased
dose of any antihypertensive, antihyperlipid-
emic, or antidiabetic medication. Average num-
ber of medications per patient were calculated
and analyzed for significance. A secondary end-
point investigated which medication type was
most likely to be discontinued first.
Statistical Analysis
Data analysis utilized t-testing to demon-
strate statistical significance in the differences
observed for medication requirements before
and after rehabilitation. The software used was
Stata version 11.1 (Stata Corp LLC, College Sta-
tion, Texas, USA).
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