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Purpose Cardiac rehabilitation (CR) is an effective treatment to reduce the burden of cardiovascular disease (CVD) but is underutilized. This study characterized CR enrollment barriers and perceived physician endorsement of CR in patient subgroups at increased risk of poor outcomes. Materials and Methods The association between sociodemographic and clinical characteristics and Cardiac Rehabilitation Barriers Scale (CRBS) item and subscale scores were examined using secondary data analysis of patients with acute coronary syndrome referred to, but not yet enrolled in, a 12-week CR program. Participants rated perceived strength of recommendation to attend CR on 1–5 scale. Results The three most endorsed CRBS items were inclement weather, travel, and work responsibilities. Additional barriers (e.g. time constraints, already exercising, family responsibilities) emerged in certain patient subgroups. Perceived strength of physician endorsement was high in the overall sample. After statistical adjustment for confounds, depressed mood was positively associated with logistical (b = 0.05, p = 0.002), and comorbidity-related barriers (b = 0.02, p < 0.001). Female sex (b = 0.62, p = 0.004), higher body mass index (b = 0.05, p = 0.009), and diabetes (b = 1.08, p < 0.001), were associated with logistical barriers. Conclusions Patients require individualized support to address CR enrollment barriers. Given their crucial role in supporting patients to access CR, nurses are well-positioned to identify and address CR barriers.

Cardiac rehabilitation (CR) is a multicomponent intervention to reduce adverse outcomes from coronary artery disease, but its mechanisms are not fully understood. The aims of this study were to examine the impact of CR on survival and cardiovascular risk factors, and to determine potential mediators between CR attendance and reduced mortality. A retrospective mediation analysis was conducted among 11 196 patients referred to a 12-week CR program following an acute coronary syndrome event between 2009 and 2019. A panel of cardiovascular risk factors was assessed at a CR intake visit and repeated on CR completion. All-cause and cardiovascular mortality were ascertained via health care administrative data sets at mean 4.2-year follow-up (SD, 2.81 years). CR completion was associated with reduced all-cause (adjusted hazard ratio [HR], 0.67 [95% CI, 0.54-0.83]) and cardiovascular (adjusted HR, 0.57 [95% CI, 0.40-0.81]) mortality, as well as improved cardiorespiratory fitness, lipid profile, body composition, psychological distress, and smoking rates (P<0.001). CR attendance had an indirect effect on all-cause mortality via improved cardiorespiratory fitness (ab=-0.006 [95% CI, -0.008 to -0.003]) and via low-density lipoprotein cholesterol (ab=-0.002 [95% CI, -0.003 to -0.0003]) and had an indirect effect on cardiovascular mortality via cardiorespiratory fitness (ab=-0.007 [95% CI, -0.012 to -0.003]). Cardiorespiratory fitness and lipid control partly explain the mortality benefits of CR and represent important secondary prevention targets.

We estimate the costs of financial distress prior to default (predefault costs) separately from the loss incurred at default (the loss given default) using a dynamic tradeoff model of capital structure. We show that predefault costs account for a large fraction of total distress costs, approximately 64.1%. At the same time, they vary across industries ranging from 32.1% to 75%. We demonstrate that the expected predefault costs of financial distress vary significantly across industries with a range between 3.2% and 8.3% and are higher for small firms relative to larger ones. This paper was accepted by Lukas Schmid, finance. Supplemental Material: The data files are available at https://doi.org/10.1287/mnsc.2023.4974 .

We read with interest the letter to the editor entitled “Is it possible to reach reliable conclusions doing meta-analyses with resistance training studies?” (Arruda et al., 2016). We thank the jour...

ABSTRACTWe consider an asset allocation problem for a multi-asset fund where multiple decentralized managers implement investment strategies in separate asset classes that include alternative investments. In this setting it is common practice to use traditional asset allocation methodology (e.g. mean-variance optimization) to obtain optimal target weights and to compel investment managers to stay close to their targets. However, the sophistication and high level of specialization involved in alternative investments often result in deviations from target weights. Misallocations may require ad hoc investment adjustments to maintain feasibility of the fund with respect to overall risk and return profiles. We develop an asset allocation model that provides a range of portfolio allocations (i.e. bounds) for individual managers. These bounds represent the maximum flexibility managers have in their investments without affecting the overall portfolio characteristics. Based on out-of-sample testing, our model is more robust than traditional asset allocation methodology with respect to misallocations.