Cardiac Rehabilitation and Secondary Prevention in Patients with Coronary Artery Disease and Atrial Fibrillation

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dc.contributor.advisorWilton, Stephen
dc.contributor.advisorTian, Ye
dc.contributor.authorLiu, Hongwei
dc.contributor.committeememberJames, Matthew
dc.contributor.committeememberSajobi, Tolulope
dc.contributor.committeememberArena, Ross
dc.contributor.committeememberShaheen, Abdel-Aziz
dc.contributor.committeememberOh, Paul
dc.date2021-11
dc.date.accessioned2021-09-02T13:41:13Z
dc.date.available2021-09-02T13:41:13Z
dc.date.issued2021-08-26
dc.description.abstractBackground: Referral to and participation in cardiac rehabilitation (CR) in Canada and elsewhere remains suboptimal. The evidence for the benefits of CR in reducing incidence of atrial fibrillation (AF) in patients with coronary artery disease (CAD) is modest. Furthermore, whether multifactorial risk factor intervention is effective in improving prognosis in patients with AF remains unclear. Methods: We studied these questions by conducting two projects. Project 1 is a systematic review, which evaluated evidence on the effects of multifactorial risk factor intervention in patients with AF. Project 2 is a retrospective cohort study, which evaluated the relationships of CR completion status and cardiorespiratory fitness (CRF) across a CR program with the risk of incident AF. These analyses in Project 2 were performed by linking databases from an Alberta provincial cardiac catheterization registry, a city-wide CR program in Calgary, and Alberta provincial health administrative datasets. Results: In Project 1, the systematic review suggested that multifactorial risk factor intervention was positively associated with improved AF-related symptoms and health-related quality of life. In Project 2, we first used electrocardiography data to improve the diagnostic yield of administrative data-based AF identification algorithms. We further demonstrated that CR program completion was not associated with lower risk of incident AF after adjusting for baseline characteristics. However, both baseline CRF, 12-week CRF, and CRF changes following CR completion had inverse dose-dependent relationships with the risk of incident AF. Furthermore, we developed a risk prediction model for incident AF in patients completing a CR program, which showed good discrimination and was well calibrated in predicting the risk of AF at 5-years follow-up. Conclusions: These findings have enhanced the importance of multifactorial risk factor intervention in managing patients with AF, and added to the current state of knowledge of CR in improving the prognosis of patients with CAD, thereby providing further support for the promotion of CR. Furthermore, the risk prediction model will help prioritize resources for patients who are at high risk of developing AF and can benefit the most from screening for AF and participating in personalized CR services.en_US
dc.identifier.citationLiu, H. (2021). Cardiac Rehabilitation and Secondary Prevention in Patients with Coronary Artery Disease and Atrial Fibrillation (Doctoral thesis, University of Calgary, Calgary, Canada). Retrieved from https://prism.ucalgary.ca.en_US
dc.identifier.doihttp://dx.doi.org/10.11575/PRISM/39153
dc.identifier.urihttp://hdl.handle.net/1880/113808
dc.language.isoengen_US
dc.publisher.facultyCumming School of Medicineen_US
dc.publisher.institutionUniversity of Calgaryen
dc.rightsUniversity of Calgary graduate students retain copyright ownership and moral rights for their thesis. You may use this material in any way that is permitted by the Copyright Act or through licensing that has been assigned to the document. For uses that are not allowable under copyright legislation or licensing, you are required to seek permission.en_US
dc.subjectcardiac rehabilitationen_US
dc.subjectsecondary preventionen_US
dc.subjectcoronary artery diseaseen_US
dc.subjectatrial fibrillationen_US
dc.subjectcardiorespiratory fitnessen_US
dc.subject.classificationEpidemiologyen_US
dc.subject.classificationHealth Care Managementen_US
dc.subject.classificationPublic Healthen_US
dc.subject.classificationRehabilitation and Therapyen_US
dc.titleCardiac Rehabilitation and Secondary Prevention in Patients with Coronary Artery Disease and Atrial Fibrillationen_US
dc.typedoctoral thesisen_US
thesis.degree.disciplineMedicine – Community Health Sciencesen_US
thesis.degree.grantorUniversity of Calgaryen_US
thesis.degree.nameDoctor of Philosophy (PhD)en_US
ucalgary.item.requestcopytrueen_US
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