TotalCardiology ResearchIntegrating Science and Practice

Ross Arena, PhD, PT, FAHA, FESC

University of Illinois at Chicago

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Relationships with Financial Sponsors:

- Grants or Research Support: None

- Speakers Honoraria: None

- Consulting Fees: None

- Patents: None

- Other: None

Faculty Presenter Disclosure

Cardiology for the Non-Cardiologist

Faculty: Ross Arena

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Potential for conflicts of interest: None

Disclosure of Financial Support

Cardiology for the Non-Cardiologist has received financial support from Pharmaceutical companies Bayer, Bristol-Meyers Squibb/Pfizer, Servier, Novartis, Amgen, AstraZeneca and Merck in the form of unrestricted educational grants.

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• While we have received unrestricted educational grants from several pharmaceutical companies, most presentations have no mention of specific products and are unrelated to the supporting companies or their products. No specific presentations will be supported or sponsored by a specific company.

• Information on specific products will be presented in the context of an unbiased overview of all products related to treating patients.

• All scientific research related to, reported or used in this CME activity in support or justification of patient care recommendations conforms to the generally accepted standards.

• Clinical medicine is based in evidence that is accepted within the profession.

Mitigating Potential Bias

My journey part I

▪ VCU Major academic medical center

▪ Started as a clinician in CR at VCU in 1999

▪ PhD in Physiology from VCU in 2001 Focus on human subjects research

▪ Became a faculty member at VCU in 2002 Began to conceptualize integrating a research laboratory into CR

Working side-by-side with clinicians would facilitate answering those questions

Important that clinical practice could not be impacted

▪ Had a different vision on how to have a research career More about developing a network of collaborators vs. an

individual laboratory

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My journey part II

▪ Met Leslie Austford, Trina Hauer, James Stone

▪ Started to discuss CR in Calgary

Excellence in clinical care

Desire to develop an research agenda but could not impact clinical care

From there

TC Registry DB and Merge with Approach

Developed a research committee

No extramural funding

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What has happened since then?

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8Int J Cardiol. 2011 Aug 4;150(3):355-6

One thousand one hundred and forty subjects (950 males and 190 females, 61.4 ±10.4 years)

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“Improvement in CRF at 12 weeks was associated with decreased overall mortality, with a 13%point reduction with each MET increase (P

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10,732 (1955 [18.2%] female; mean age 60.4, standard deviation [SD] 10.5 years) subjects who completed the 12-week comprehensive CR program between 1996 and 2016.

ResultsAcross all fitness groups, mean baseline METs was the strongest predictor of CRF at completion of CR. Other factors—including sex, age, current smoking status, obesity, and diabetes—were highly predictive of post-CR CRF (all P < 0.05). Compared with H-fit patients, coronary artery bypass graft and chronic obstructive pulmonary disease in L-Fit patients, and cerebrovascular disease in M-Fit patients had an additional negative effect on the overall model variance in post-CR CRF.

36Curr Probl Cardiol. 2018

37Curr Probl Cardiol 2018;43:138–153.

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Results: Compared to those in usual care, patients who received the motivational intervention reported higher intention to attend CR (p = .001), viewed CR as more necessary (p = .036), had fewer concerns about exercise (p = .011), and attended more exercise sessions (p = .008).

Overall, patients reported high intention to attend CR (M = 6.20/7.00, SD = 1.67), most (85%) enrolled, and they attended an average of 65% of scheduled CR sessions.

Single 30-60-minute intervention. The intervention was based on [19] and included: 1) developing rapport; 2) clarifying and building importance (providing education as-needed, tying CR participation to personal goals/values); 3) building confidence and collaboratively problem-solving CR barriers, and; 4) summarizing the session.

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Intention to attend CR was measured using the average of two items adapted from Blanchard et al. Participants were asked to rate on a seven-point scale the strength of intention to attend CR exercise sessions and the proportion of exercise classes they planned to attend

CR Barriers were assessed using a modified version of the CRBS,29 a 21-item self-report questionnaire where higher scores reflect greater perceived barriers. Patients rate the extent to which various factors will interfere with CR participation using a 5-point scale (1=strongly disagree, 5=strongly agree).

Conference Abstracts

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Conference Abstracts

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Conference Abstracts

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Conference Abstracts

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Current and Future Plans

▪ Active areas of research

Multimorbidity focus

Patients with COPD

Patients with Afib

Continued PAD research

Artificial intelligence initiative

Cognitive behavioral therapy projects

▪ Continue to explore beneficial collaborative relationships

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▪ First annual research retreat to be held on March 20, 2019

▪ Invited trainees will: Prepare one “conference-ready abstract” and present it in a 10-

minute talk during the retreat. Prepare and present a 10-minute research proposal focused on

new analyses using the TotalCardiology Rehabilitation registry and/or other data sources

Discuss your career plans and receive support and feedback from TCRN members

▪ After the retreat, the TCRN will work with you to prepare manuscripts for submission to a peer-reviewed journal and to support your ongoing career development.

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Current and Future Plans

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Questions and Discussion

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