Half the difference in one-year survival rates, however, remained unexplained. Nearly one-third of the racial difference in one-year survival was dependent on measured patient factors. Only a small proportion was explained by racial differences in hospital care and approximately one-half was due to differences in care after discharge, according to a news release from the heart association.

Researchers studied patients 65 and older who suffered in-hospital cardiac arrest and survived until discharge between 2000-2011. Survivors from the Get With The Guidelines – Resuscitation registry whose data could be linked to Medicare claims were either black or white. Their survival was studied at 1-year, 3-year and 5-year intervals.

“Compared with white patients, blacks had substantially lower 1-year, 3-year and 5-year survival rates with 28 percent lower relative likelihood of surviving one year and a 33 percent lower relative likelihood of surviving to five years,” said the study’s lead author Lena Chen, M.D., M.S., assistant professor of internal medicine at the University of Michigan in Ann Arbor.

The black patients in this study were younger, more often female, and were sicker, with higher rates of kidney and respiratory insufficiency, pneumonia, and more often required dialysis prior to cardiac arrest, compared to white patients studied.

“Notably, black patients were less likely to have had a heart attack during hospital admission or a prior history of heart attack. As a result, they were more likely to have a non-shockable initial heart rhythm of pulseless electrical activity and to have experienced their heart stoppage in an unmonitored hospital unit,” Chen said.

The study did not look into how caregivers may have been different for black patients versus white ones, nor did it look at socioeconomic factors like household income or social support.

“Our study’s findings suggest a need to examine to what degree differences in post-discharge care explain racial differences in long-term survival after heart stoppages,” Chen said.

Statements and conclusions of study authors published in American Heart Association scientific journals are solely those of the study authors and do not necessarily reflect the association’s policy or position. The association makes no representation or guarantee as to their accuracy or reliability. The association receives funding primarily from individuals; foundations and corporations (including pharmaceutical, device manufacturers and other companies) also make donations and fund specific association programs and events. The association has strict policies to prevent these relationships from influencing the science content. Revenues from pharmaceutical and device corporations and health insurance providers are available at www.heart.org/corporatefunding.

About the American Heart Association

The American Heart Association is devoted to saving people from heart disease and stroke – the two leading causes of death in the world. We team with millions of volunteers to fund innovative research, fight for stronger public health policies and provide lifesaving tools and information to prevent and treat these diseases. The Dallas-based association is the nation’s oldest and largest voluntary organization dedicated to fighting heart disease and stroke. To learn more or to get involved, call 1-800-AHA-USA1, visit www.heart.org  or call any of our offices around the country.

The analysis represents progress for patients who participate in cardiac rehab programs and typically do well during enrollment but tend to revert to unhealthy lifestyles once the formal gym-based regimens end.

The researchers’ 12-week mobile health, or mHealth, program not only kept cardiac rehab patients from losing ground, it appeared to help them maintain and even gain fitness. The investigators have published their findings in the American Heart Journal and are now looking to conduct another study with a larger group of patients.

“The benefits of a cardiac rehab program are well-established, but the gains tend to be temporary,” said senior author William Kraus, M.D., who led the project as part of the Duke Molecular Physiology Institute. “Good habits are hard to maintain for a lot of people once they are on their own and no longer have someone overseeing their progress.”

Kraus and exercise physiologist Brian Duscha used modern devices to build a post-rehab regimen that could provide a measure of oversight and motivation outside of a gym-based regimen.

The researchers enrolled 25 heart disease patients after they completed a typical cardiac rehabilitation program, which included 36 medically guided exercise sessions in a gym setting, diet counseling and other programs that encourage healthy lifestyle choices.

Following rehab, 16 of the patients were randomly selected to participate in the mHealth intervention, consisting of a wearable activity tracker, a personalized prescription to walk a certain number of steps a day, and up to 12 weeks of personalized virtual sessions with a health coach over the phone or computer.

A comparison group of nine patients were discharged from cardiac rehab with usual care, which did not include any specific lifestyle recommendations other than advice to continue with good diet and exercise choices.

After 12 weeks, the researchers measured fitness levels and physical activity levels of participants in both groups. As expected, the usual care group’s peak fitness fell by a statistically significant 8.5 percent. But the mHealth group not only sustained their fitness levels, but actually continued to increase peak fitness, although not at a statistically significant rate, given the small size of the study.

While the minutes per week of physical activity of people in the usual care group tailed off across all levels of activity, those in the mHealth group shifted their activity level to a higher intensity from moderate-low to moderate-high intensity.

“While both groups were exercising above the government guidelines of 150 minutes per week of moderate intensity at the end of cardiac rehab, only the mHealth group members were meeting this guideline 12 weeks after cardiac rehab,” Duscha said.

“The mHealth group only decreased their moderate level exercise by 16 minutes per week, while the usual care group fell off by 113 minutes per week,” he said. “This has important public health implications, because maintenance of physical activity and physical fitness are inversely associated with cardiovascular events, such as heart attack and stroke.”

The slow and gentle movements of Tai Chi hold promise as an alternative exercise option for patients who decline traditional cardiac rehabilitation, according to preliminary research in Journal of the American Heart Association, the Open Access Journal of the American Heart Association/American Stroke Association.

After a heart attack, more than 60 percent of patients decline participation in cardiac rehabilitation. Although the reasons include financial concerns and distance to a rehab center, many patients stay away because they perceive physical exercise as unpleasant, painful or impossible given their current physical condition.

This is the first study suggesting that Tai Chi may improve exercise behaviors in this high-risk population.

“We thought that Tai Chi might be a good option for these people because you can start very slowly and simply and, as their confidence increases, the pace and movements can be modified to increase intensity,” said Elena Salmoirago-Blotcher, M.D., Ph.D., lead author of the study and assistant professor of medicine at the Warren Alpert School of Medicine at Brown University. “Tai Chi exercise can reach low-to-moderate intensity levels. The emphasis on breathing and relaxation can also help with stress reduction and psychological distress.”

Researchers adapted a Tai Chi routine for use in heart disease patients from a protocol previously used in patients with lung disease and heart failure. They compared the safety and compliance of two regimes: LITE, a shorter program with 24 classes over 12 weeks and PLUS, a longer program with 52 classes over 24 weeks. All participants received a DVD to use for home practice during and after receiving the classes.

The study was conducted at The Miriam Hospital in Providence, Rhode Island and included 29 physically inactive heart disease patients (8 women and 21 men, average age 67.9 years) who expressed an interest in a Tai Chi program. Although the majority had experienced a previous heart attack (58.6 percent) or procedure to open a blocked artery (PCI – 82.8 percent; CABG – 31 percent), all had declined cardiac rehabilitation and continued to have many high-risk characteristics, including current smoker (27.6 percent), diabetes (48.3 percent), high cholesterol (75.9 percent), and overweight (35 percent) or obese (45 percent). All had received physician clearance to undergo Tai Chi training and none had orthopedic problems (such as recent joint replacement surgery) that would preclude doing Tai Chi.

Researchers found Tai Chi:

• was safe, with no adverse events related to the exercise program except for minor muscular pain at the beginning of training;
• was well liked by participants (100 percent would recommend it to a friend);
• was feasible, with patients attending about 66 percent of scheduled classes;
• did not raise aerobic fitness on standard tests after 3 months of either the programs; and
• did raise the weekly amount of moderate to vigorous physical activity (as measured by a wearable device) after three and six months in the group participating in the longer program, but not in those who took part in the shorter program.

“On its own, Tai Chi wouldn’t obviously replace other components of traditional cardiac rehabilitation, such as education on risk factors, diet and adherence to needed medications,” said Salmoirago-Blotcher. “If proven effective in larger studies, it might be possible to offer it as an exercise option within a rehab center as a bridge to more strenuous exercise, or in a community setting with the educational components of rehab delivered outside of a medical setting.”

Statements and conclusions of study authors published in American Heart Association scientific journals are solely those of the study authors and do not necessarily reflect the association’s policy or position. The association makes no representation or guarantee as to their accuracy or reliability. The association receives funding primarily from individuals; foundations and corporations (including pharmaceutical, device manufacturers and other companies) also make donations and fund specific association programs and events. The association has strict policies to prevent these relationships from influencing the science content. Revenues from pharmaceutical and device corporations and health insurance providers are available at www.heart.org/corporatefunding.

About the American Heart Association

The American Heart Association is devoted to saving people from heart disease and stroke – the two leading causes of death in the world. We team with millions of volunteers to fund innovative research, fight for stronger public health policies and provide lifesaving tools and information to prevent and treat these diseases. The Dallas-based association is the nation’s oldest and largest voluntary organization dedicated to fighting heart disease and stroke. To learn more or to get involved, call 1-800-AHA-USA1, visit http://www.heart.org/ or call any of our offices around the country. Follow us on Facebook and Twitter.