Linda G. Park

Was not provided for this article.

Was not provided for this article.

Background: Heart failure (HF) affects 6.7 million American adults and is associated with significant morbidity and mortality. Cardiac rehabilitation (CR) is a behavior modification program recommended to improve health outcomes in patients with HF. In 2014, Medicare began covering facility‐based CR for patients with stable HF, and some Veterans Affairs (VA) facilities began offering home‐based CR. Methods: We conducted an observational study to assess CR participation among patients with stable HF and patient characteristics associated with participation. National electronic health record data from the VA and claims data from a 5% Medicare sample were used to identify patients using International Classification of Diseases, Ninth Revision ( ICD‐9 ) or Tenth Revision ( ICD‐10 ) codes. CR participation was determined using Current Procedural Terminology codes and VA stop codes during the 12 months following HF diagnosis. A multivariable logistic regression was constructed to identify patient characteristics associated with participation. Results: From 2012 to 2022, VA participation increased from 7.4% to 10.4% and Medicare decreased from 7.4% to 5.1%. From 2016 to 2022, 13.2% of veterans and 6.7% of Medicare beneficiaries with stable HF participated in CR. Older age, female sex, and non‐White race were associated with lower participation, and comorbid ischemic heart disease was associated with greater participation (odds ratio [OR], 1.48 [95% CI, 1.45–1.52] in VA; OR, 2.69 [95% CI, (2.62–2.78] in Medicare). Conclusions: Following the VA's implementation of home‐based CR and Medicare's facility‐based CR coverage for stable HF, participation increased among veterans but not among Medicare beneficiaries. Lower participation was observed among women and non‐White patients. These findings suggest that covering home‐based CR could improve participation among Medicare beneficiaries.

Background: There is mounting evidence to suggest that immersive virtual reality (IVR) can improve pain in older adults in community settings, yet the use of IVR postoperatively in the acute postoperative period following major elective abdominal surgery remains largely underexplored. Objective: This single-arm pilot study aimed to assess the feasibility, acceptability, and preliminary impact of IVR on self-reported postoperative pain and relaxation levels in older adults following elective major abdominal surgery. Methods: We recruited individuals aged 55 years and older undergoing elective abdominal surgery at an academic medical center from October 2023 to February 2024. We evaluated feasibility through accrual rate, intervention completion, and questionnaire compliance; acceptability via the System Usability Scale (SUS) and a user experience survey; and tolerability by monitoring self-reported side effects. The preliminary impact of IVR on self-reported pain intensity and relaxation levels was assessed through pre- and postintervention comparisons. Results: A total of 29 participants, with a median age of 73 (IQR 55‐81) years, were enrolled and completed at least 1 IVR session, with 19 also completing a second session. Perceived usability and overall acceptance of IVR were high, with minimal side effects reported. In terms of the preliminary impact of IVR, statistically significant improvements were observed in both pain and relaxation levels from pre- to post-IVR on day 1 and day 2. Conclusions: This study suggests the feasibility and acceptability of IVR as a potential future intervention for postoperative pain management and enhancing relaxation among older adults following elective inpatient abdominal surgery. The preliminary findings suggest the need for large-scale studies across additional complex inpatient abdominal surgeries to confirm the acceptance and efficacy of IVR as a postoperative pain management intervention across a wide range of diverse older demographics. Future research is critical to evaluating the therapeutic potential of IVR in a variety of surgical and patient-specific contexts.

Digital health technologies include an array of mobile or digital devices and apps that may be used by patients to support lifestyle modification or medical apps that monitor vital parameters and provide data that may influence treatment decisions. The use of digital health technologies is a growing opportunity for disease prevention and management of cardiovascular disease (CVD) for both patients to engage in self-management as well as nurses to monitor patients remotely and facilitate clinical decision support. The aims of this review article are to provide an overview of pertinent digital health technologies in CVD care, address social determinants of health and other enablers/barriers to digital health implementation, and provide perspectives on novel models of care incorporating digital technologies. Based on the latest evidence, recommendations for special considerations and implementation of digital health technologies in low- and middle- vs high-income countries are presented. In addition, tables reviewing functionality of the digital tools and global examples of their use are provided. Extensive empirical evidence from diverse populations suggests adoption of these innovative tools has been low in clinical settings. We provide a table summarizing these barriers and include the facilitators that can improve the adoption of digital health tools to improve behavioral lifestyle modification. For learning purpose, implementation of an innovative model of care is illustrated graphically and in text. We include a call to action to achieve the maximum impact of digital technology to support nurses who work in almost all settings improving CVD prevention and management globally. The multiple roles of nurses using digital health for global CVD prevention and management are discussed in the settings of clinical practice, research, education, public health, health policy/leadership, and informatics.