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Yang Y, Wang Y, Yang L. Association between physical activity and sedentary behavior and depression in US adults with cardiovascular disease: NHANES 2007-2016. J Affect Disord 2024; 367:342-349. [PMID: 39236885 DOI: 10.1016/j.jad.2024.09.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2024] [Revised: 07/10/2024] [Accepted: 09/02/2024] [Indexed: 09/07/2024]
Abstract
BACKGROUND Previous studies reported the effect of physical activity (PA) or sedentary behavior (SB) on increasing occurrence of depression in patients with cardiovascular disease, leading to a higher risk of adverse clinical outcomes. However, the association between the combination of PA and SB and depression in patients with cardiovascular disease remained unstudied. METHODS Patients with cardiovascular disease (aged ≥18 years) who participated in the National Health and Nutrition Examination Survey (NHANES) from 2007 to 2016. Multivariable logistic regression was used to investigate the association between PA, SB, and depression. RESULTS Among the 2585 patients (mean age 64.43 years; 54.65 % male) in this study, the prevalence of depression was 16.40 %. After adjustment for age, gender, race, education level, marital status, poverty income ratio, employment status, smoking, alcohol use, BMI, hypertension, and number of cardiovascular diseases, depression was negatively associated with higher PA (adjusted OR = 0.567, 95 % CI 0.403, 0.799) and positively associated with higher SB (adjusted OR = 1.472, 95 % CI 1.089, 1.990), respectively. The risk of depression associated with higher PA and lower SB was significantly lower (adjusted OR = 0.464, 95 % CI 0.307, 0.702) compared to those with lower PA but higher SB. LIMITATIONS This was a cross-sectional study with limited ability to make causal inferences. CONCLUSIONS Our findings indicate that patients with higher PA and lower SB have a lower risk of depression than those with low PA levels and high SB levels. Moving more and sitting less is a potential preventive measure against depression in patients with cardiovascular disease.
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Affiliation(s)
- Yuting Yang
- Department of Nursing, the Fourth Affiliated Hospital of School of Medicine, and International School of Medicine, International Institutes of Medicine, Zhejiang University, Yiwu, 322000, China
| | - Yunjing Wang
- Department of Statistics, College of Science, Wuhan University of Technology, Wuhan, 430070, China
| | - Lili Yang
- Department of Nursing, the Fourth Affiliated Hospital of School of Medicine, and International School of Medicine, International Institutes of Medicine, Zhejiang University, Yiwu, 322000, China.
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2
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Kundi H, Amin ZM, Friedman M, Hagan K, Al-Kindi S, Javed Z, Nasir K. Association of Obesity With Psychological Distress in Young Adults: Patterns by Sex and Race or Ethnicity. JACC. ADVANCES 2024; 3:101115. [PMID: 39156117 PMCID: PMC11327462 DOI: 10.1016/j.jacadv.2024.101115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/01/2024] [Revised: 05/26/2024] [Accepted: 06/07/2024] [Indexed: 08/20/2024]
Abstract
Background Recent studies have emphasized the intricate relationship between obesity and psychological distress, unraveling the complex interplay of biological, psychological, and sociocultural factors. However, a conspicuous knowledge gap persists in understanding the association between obesity severity and psychological distress, particularly in young adults, marked by limited empirical data. Objectives This study comprehensively investigates the link between obesity and psychological distress among young adults, emphasizing potential variations based on gender and race or ethnicity. Addressing this gap is crucial for informing targeted interventions and understanding the nuanced impact of obesity on mental health in this demographic. Methods Utilizing data from the 2013 to 2018 National Health Interview Survey, individuals aged 18 to 26 years were analyzed. Body mass index served as the primary exposure variable, with the Kessler Psychological Distress Scale assessing the primary outcome. Fully-adjusted ordinal regression models were employed for analyses. Results Among the 20,954 participants included in this study, representing 35,564,990 adults, 27% were overweight and 24% had obesity. In class III obesity, individuals experienced 1.4 times more psychological distress than those with normal weight (OR: 1.393; 95% CI: 1.181-1.644; P < 0.001). Subgroup analyses revealed consistent trends in non-Hispanic White (OR: 1.615; 95% CI: 1.283-2.032; P < 0.001) and female participants (OR: 1.408; 95% CI: 1.408-2.096; P < 0.001). Conclusions This study underscores the association between obesity and psychological distress in young adults, notably impacting non-Hispanic White and female populations. The findings bear significant implications for shaping future health policies, addressing the mental health crisis, and mitigating the increasing prevalence of obesity among young U.S. adults.
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Affiliation(s)
- Harun Kundi
- Houston Methodist Department of Cardiology, Houston, Texas, USA
- Cardiovascular Research Foundation, New York, New York, USA
| | - Zahir M. Amin
- Houston Methodist Department of Cardiology, Houston, Texas, USA
- Cardiovascular Research Foundation, New York, New York, USA
| | - Michael Friedman
- Houston Methodist Department of Cardiology, Houston, Texas, USA
- Cardiovascular Research Foundation, New York, New York, USA
| | - Kobina Hagan
- Houston Methodist Department of Cardiology, Houston, Texas, USA
- Cardiovascular Research Foundation, New York, New York, USA
| | - Sadeer Al-Kindi
- Houston Methodist Department of Cardiology, Houston, Texas, USA
- Cardiovascular Research Foundation, New York, New York, USA
| | - Zulqarnain Javed
- Houston Methodist Department of Cardiology, Houston, Texas, USA
- Cardiovascular Research Foundation, New York, New York, USA
| | - Khurram Nasir
- Houston Methodist Department of Cardiology, Houston, Texas, USA
- Cardiovascular Research Foundation, New York, New York, USA
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3
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Ren Y, Tang H, Zhang L, Ying C, Luo H. Exploration of therapeutic models for psycho-cardiology: From cardiac to psychological rehabilitation. Heliyon 2024; 10:e27484. [PMID: 38524561 PMCID: PMC10958220 DOI: 10.1016/j.heliyon.2024.e27484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Revised: 02/13/2024] [Accepted: 02/29/2024] [Indexed: 03/26/2024] Open
Abstract
The prevalence and mortality of cardiovascular disease are relatively high. Currently, depression has been proven to be an independent risk factor for the occurrence and poor prognosis of cardiovascular disease. Psycho-cardiovascular comorbidity, as a reciprocal cause and effect, affects each other, leading to the deterioration of clinical prognosis and forming a vicious circle. Coronary artery disease comorbidity with depression is a common disease in psycho-cardiology medicine. This paper expounds on the exploration of the treatment model of psycho-cardiology from the aspects of epidemiological characteristics, comorbidity mechanism, screening, diagnosis, and treatment.
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Affiliation(s)
- Yu Ren
- Department of Pharmacy, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Taizhou, 317000, Zhejiang, China
| | - Huilin Tang
- Department of General Surgery, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Taizhou, 317000, Zhejiang, China
| | - Liwei Zhang
- Department of Orthopedic, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Taizhou, 317000, Zhejiang, China
| | - Chenfei Ying
- Department of Orthopedic, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Taizhou, 317000, Zhejiang, China
| | - Hua Luo
- Department of Orthopedic, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Taizhou, 317000, Zhejiang, China
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Economidou EC, Lianopoulou B, Soteriades S, Soteriades ES. Cardiac Rehabilitation Programs: Content, Effectiveness, Limitations, and Gaps in Knowledge. Cardiol Rev 2024; 32:157-161. [PMID: 36730494 DOI: 10.1097/crd.0000000000000492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Cardiac rehabilitation (CR) constitutes a valuable therapeutic approach for patients with a broad spectrum of cardiovascular diseases facilitating the development and maintenance of a desirable level of physical, social, and psychological functioning following the onset of cardiovascular disease. Nowadays, cardiac rehabilitation programs emphasize the use of a multidisciplinary approach. The current review aims at presenting the state-of-the-art knowledge on the indications of patients entering cardiac rehabilitation programs, including their core components, duration, and effectiveness. Following a careful review of the international literature, we conclude that there are significant differences between the most commonly cited international CR guidelines as well as additional limitations and gaps in knowledge. Despite the benefits associated with CR and despite their widespread acceptance, CR referrals and program attendance remains low, while many questions have not been so far addressed through scientific research. Overall, the findings of our study suggest a critical need for the development of robust and evidence-based standardized CR interventions to increase their use and effectiveness throughout the world.
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Affiliation(s)
- Eleftheria C Economidou
- From the Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Barbara Lianopoulou
- Management Organization Unit of Development Programs, Human Resource Management, Ministry of Development and Investments, Republic of Greece, Athens, Greece
| | - Soteris Soteriades
- Hull Royal Infirmary, Hull University Teaching Hospitals NHS Trust, Hull, United Kingdom
| | - Elpidoforos S Soteriades
- Healthcare Management Program, School of Economics and Management, Open University of Cyprus, Nicosia, Cyprus
- Environmental and Occupational Medicine and Epidemiology (EOME), Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA
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5
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Valtueña-Gimeno N, Ferrer-Sargues FJ, Fabregat-Andrés O, Martínez-Hurtado I, Martínez-Olmos FJ, Lluesma-Vidal M, Arguisuelas MD. The impact of a neuromuscular rehabilitation programme on the quality of life of patients with acute coronary syndrome and its relationship with sexual dysfunction: a randomised controlled trial. Qual Life Res 2024; 33:433-442. [PMID: 37985639 DOI: 10.1007/s11136-023-03534-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/29/2023] [Indexed: 11/22/2023]
Abstract
PURPOSE Many patients with acute coronary syndrome experience problematic or altered sexual function. This aspect of the disease is frequently ignored or overlooked by the healthcare community even though it can strongly influence health-related patient quality of life (HRQoL). Thus, the aim of this study was to compare the effects of a specific cardiac rehabilitation programme focused on aerobic and neuromuscular strength-resistance training to those of a classic rehabilitation programme, both in terms of HRQoL and erectile dysfunction in patients with acute coronary syndrome. METHODS This study reports both secondary and unregistered outcomes from a double-blinded, randomised, and controlled clinical trial. The proposed intervention was based on the completion of a 20-session (10-week) cardiac rehabilitation programme for patients with cardiovascular disease. The patient cohort had been diagnosed with acute coronary syndrome and was recruited at the Cardiology Service of a private tertiary hospital. The outcomes assessed in this study were HRQoL and erectile disfunction assessed at baseline, after the intervention, and at a 6-month follow-up. RESULTS A total of 30 participants were randomly allocated to each study arm. The results of the two-way mixed ANOVAs showed significant group × time interactions for all the outcome measures (EQ-5D_index, p = 0.004; EQ-5D_VAS, p = 0.017; QLMI-Q, p ≤ 0.001; and IIEF-5, p = 0.001). CONCLUSION The neuromuscular strength training programme was more effective than the classic strength training programme in terms of increasing the HRQoL and improving erectile dysfunction in patients following acute coronary syndrome, with differences still remaining between these groups at the 6-month follow-up.
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Affiliation(s)
- Noemí Valtueña-Gimeno
- Department of Nursing and Physiotherapy, Universidad Cardenal Herrera CEU, CEU Universities, Calle Santiago Ramón y Cajal, 20, 46115, Alfara del Patriarca, Valencia, Spain
| | - Francisco José Ferrer-Sargues
- Department of Nursing and Physiotherapy, Universidad Cardenal Herrera CEU, CEU Universities, Calle Santiago Ramón y Cajal, 20, 46115, Alfara del Patriarca, Valencia, Spain
| | - Oscar Fabregat-Andrés
- Department of Medicine, Universidad Cardenal Herrera CEU, CEU Universities, Calle Santiago Ramón y Cajal, 20, 46115, Alfara del Patriarca, Valencia, Spain
- Department of Cardiology, Hospital IMED, Av. de la ilustración, 1, 46100, Burjassot, Valencia, Spain
| | - Isabel Martínez-Hurtado
- Department of Nursing and Physiotherapy, Universidad Cardenal Herrera CEU, CEU Universities, Calle Santiago Ramón y Cajal, 20, 46115, Alfara del Patriarca, Valencia, Spain
| | - F J Martínez-Olmos
- Department of Nursing and Physiotherapy, Universidad Cardenal Herrera CEU, CEU Universities, Calle Santiago Ramón y Cajal, 20, 46115, Alfara del Patriarca, Valencia, Spain
| | - Marta Lluesma-Vidal
- Department of Nursing and Physiotherapy, Universidad Cardenal Herrera CEU, CEU Universities, Calle Santiago Ramón y Cajal, 20, 46115, Alfara del Patriarca, Valencia, Spain.
| | - María Dolores Arguisuelas
- Department of Nursing and Physiotherapy, Universidad Cardenal Herrera CEU, CEU Universities, Calle Santiago Ramón y Cajal, 20, 46115, Alfara del Patriarca, Valencia, Spain
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Kupper N, van den Houdt S, Kuijpers PMJC, Widdershoven J. The importance, consequences and treatment of psychosocial risk factors in heart disease: less conversation, more action! Neth Heart J 2024; 32:6-13. [PMID: 38015346 PMCID: PMC10781929 DOI: 10.1007/s12471-023-01831-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/10/2023] [Indexed: 11/29/2023] Open
Abstract
Psychosocial factors play a significant role in the incidence and prognosis of cardiovascular disease with a rapidly increasing body of knowledge, as acknowledged by their inclusion in the European Society of Cardiology cardiovascular prevention guideline since 2012. Nevertheless, psychosocial risk is not consistently assessed, acknowledged and treated in daily clinical practice. Therefore, adopting a multidimensional approach that encompasses biological, psychological, and social factors is crucial for understanding the dynamic nature of cardiovascular health and disease, delivering patient-centred care, and developing effective interventions to ultimately enhance health and satisfaction with contemporary medicine and care. The current review summarises the state-of-the-art evidence for screening and treating psychological risk factors in coronary heart disease, heart failure, and atrial fibrillation in the context of cardiac rehabilitation, along with accompanying recommendations. The limited adoption of routine screening, despite longstanding recommendations, highlights the importance of prioritising the implementation and expansion of routine screening in primary and secondary prevention. To advance psychosocial treatment, a standardised and personalised approach including comprehensive education, physical exercise, and psychosocial support with a focus on patient-reported outcomes is crucial. Treating heart and mind together has the potential to decrease psychosocial risk while enhancing the prognosis and quality of life, therefore delivering true patient-centred care.
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Affiliation(s)
- Nina Kupper
- Center of Research on Psychological Disorders and Somatic Diseases, Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands.
- Department of Cardiology, Elisabeth-TweeSteden Hospital, Tilburg, The Netherlands.
| | - Sophie van den Houdt
- Center of Research on Psychological Disorders and Somatic Diseases, Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands
| | | | - Jos Widdershoven
- Center of Research on Psychological Disorders and Somatic Diseases, Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands
- Department of Cardiology, Elisabeth-TweeSteden Hospital, Tilburg, The Netherlands
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7
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Nemani RRS, Gade BS, Panchumarthi D, Bathula BVSR, Pendli G, Panjiyar BK. Role of Cardiac Rehabilitation in Improving Outcomes After Myocardial Infarction. Cureus 2023; 15:e50886. [PMID: 38249185 PMCID: PMC10799544 DOI: 10.7759/cureus.50886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/20/2023] [Indexed: 01/23/2024] Open
Abstract
Myocardial infarction, an integral part of acute coronary syndrome (ACS), occurs due to atherosclerotic narrowing of the coronary (heart) blood vessels. Acute coronary syndrome, being one of the major cardiovascular diseases (CVDs), has led to a significant amount of mortality and morbidity, the majority of it due to MI. Over a long period following an MI, the physical, psychological, social, emotional, and occupational well-being are greatly impacted. Cardiac rehabilitation (CR) can address the above and help improve long-term well-being and overall quality of life. The benefits of CR include enhanced exercise capacity, risk factor reduction, improved quality of life (QOL), reduced mortality, and hospital readmissions. We used a systematic literature review (SLR) approach in this article to provide a global overview of cutting-edge CR in the post-MI phase. We reviewed 45 articles from journals of good repute published between 2013 and December 1st, 2023, focusing on seven selected papers for in-depth analysis. The analysis was focused on factors such as the positive outcomes of CR and the effects of CR post-MI. There are only a few statistically significant studies in a few domains of CR benefits, namely decreased mortality, cardiac events, depression, depression-associated mortality, hospital readmissions, increased left ventricular ejection fraction (LVEF), left ventricular end-diastolic dimension (LVEDD), left ventricular end-systolic volume (LVESV), metabolic equivalent of task (MET), maximal oxygen consumption (VO2max), and the six-minute walk test (6MWT), and as a result, increased physical performance. Further research is needed to enhance the understanding of its mechanisms and statistically prove its effectiveness in all other domains. As CR continues to evolve, referral and participation in CR should be increased as it improves overall health and well-being.
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Affiliation(s)
| | | | | | | | - Ganesh Pendli
- Medicine, PES Institue of Medical Sciences and Research, Kuppam, IND
| | - Binay K Panjiyar
- Research, Texas Tech University Health Sciences Center, Odessa, USA
- Internal Medicine, Harvard Medical School, Boston, USA
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
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8
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Adam T, Al Sharif AI, Alamri TSM, Al-Nashri RAO, Alluwimi AIM, Samkri AY, Alharthi MA, Moafa AY, Alsaadi NA, Alraimi AMS, Alquzi RHM. The State of Cardiac Rehabilitation in Saudi Arabia: Barriers, Facilitators, and Policy Implications. Cureus 2023; 15:e48279. [PMID: 38058323 PMCID: PMC10695855 DOI: 10.7759/cureus.48279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/04/2023] [Indexed: 12/08/2023] Open
Abstract
Cardiovascular disease (CVD) is a critical public health issue in Saudi Arabia, where it is the leading cause of death. The economic burden of CVD in the country is expected to triple by 2035, reaching $9.8 billion. This paper provides an overview of CVD in Saudi Arabia and its risk factors, impact on healthcare, and effects on patients' quality of life. The review emphasizes the potential of cardiac rehabilitation (CR) programs in addressing the CVD epidemic. CR programs have been shown to reduce morbidity, mortality, and hospital readmissions while improving patients' cardiovascular health and overall well-being. However, these programs are underutilized and inaccessible in Saudi Arabia. The paper highlights the urgent need for CR programs in the country and suggests key strategies for implementation. These include increasing patient referrals, tailoring programs to individual needs, enhancing patient education, and making CR accessible through home-based options. Fostering multidisciplinary collaboration and developing tailored guidelines for Arab countries can further enhance the impact of CR programs. In conclusion, this review underscores the vital importance of comprehensive CR programs in Saudi Arabia to combat the rising CVD burden, improve patient quality of life, and align with the goals of the Saudi 2030 Vision for a healthier society.
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Affiliation(s)
- Tasneem Adam
- Medical Affairs, College of Applied Medical Sciences, King Saud Medical City, Riyadh, SAU
| | - Abdullah I Al Sharif
- Healthcare Planning and Development, Ministry of Health, Kingdom of Saudi Arabia, Riyadh, SAU
- College of Medicine, Alfaisal University, Riyadh, SAU
| | | | - Rawan Ahmad O Al-Nashri
- General Practice, Primary Healthcare Center, General Directorate of Health Affairs, Aseer, SAU
| | | | - Amani Yosef Samkri
- General Practice, Al Aziziah Primary Health Care Center, Ministry of Health, Makkah, SAU
| | | | | | - Nawaf A Alsaadi
- Medical Affairs, College of Medicine, King Saud Medical City, Riyadh, SAU
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9
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Blumenthal JA, Rozanski A. Exercise as a therapeutic modality for the prevention and treatment of depression. Prog Cardiovasc Dis 2023; 77:50-58. [PMID: 36848966 DOI: 10.1016/j.pcad.2023.02.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 02/21/2023] [Indexed: 02/27/2023]
Abstract
While maintaining an active lifestyle and engaging in regular exercise are known to promote cardiovascular (CV) health, increasing evidence has emerged to indicate that these lifestyle behaviors also can promote psychological health and well-being. This has led to research to determine if exercise can serve as a potential therapeutic modality for major depressive disorder (MDD), which is a leading cause of mental-health impairment and overall disability worldwide. The strongest evidence to support this use comes from an increasing number of randomized clinical trials (RCTs) that have compared exercise to usual care, placebo controls, or established therapies in healthy adults and in various clinical populations. The relatively large number of RCTs has led to numerous reviews and meta-analyses, which generally have been concordant in indicating that exercise ameliorates depressive symptoms, improves self-esteem, and enhances various aspects of quality of life. Together, these data indicate that exercise should be considered as a therapeutic modality for improving CV health and psychological well-being. The emerging evidence also has led to a new proposed subspecialty of "lifestyle psychiatry", which promotes the use of exercise as an adjunctive treatment for patients with MDD. Indeed, some medical organizations have now endorsed lifestyle-based approaches as foundational aspects of depression management, with adoption of exercise as a treatment option for MDD. This review summarizes research in the area and provides practical suggestions for the use of exercise in clinical practice.
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Affiliation(s)
- James A Blumenthal
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA.
| | - Alan Rozanski
- Division of Cardiology, Mount Sinai Morningside Hospital, Mount Sinai Heart, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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10
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Akbari N, Heinze G, Rauch G, Sander B, Becher H, Dunkler D. Causal Model Building in the Context of Cardiac Rehabilitation: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3182. [PMID: 36833877 PMCID: PMC9968189 DOI: 10.3390/ijerph20043182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 02/07/2023] [Accepted: 02/07/2023] [Indexed: 06/18/2023]
Abstract
Randomization is an effective design option to prevent bias from confounding in the evaluation of the causal effect of interventions on outcomes. However, in some cases, randomization is not possible, making subsequent adjustment for confounders essential to obtain valid results. Several methods exist to adjust for confounding, with multivariable modeling being among the most widely used. The main challenge is to determine which variables should be included in the causal model and to specify appropriate functional relations for continuous variables in the model. While the statistical literature gives a variety of recommendations on how to build multivariable regression models in practice, this guidance is often unknown to applied researchers. We set out to investigate the current practice of explanatory regression modeling to control confounding in the field of cardiac rehabilitation, for which mainly non-randomized observational studies are available. In particular, we conducted a systematic methods review to identify and compare statistical methodology with respect to statistical model building in the context of the existing recent systematic review CROS-II, which evaluated the prognostic effect of cardiac rehabilitation. CROS-II identified 28 observational studies, which were published between 2004 and 2018. Our methods review revealed that 24 (86%) of the included studies used methods to adjust for confounding. Of these, 11 (46%) mentioned how the variables were selected and two studies (8%) considered functional forms for continuous variables. The use of background knowledge for variable selection was barely reported and data-driven variable selection methods were applied frequently. We conclude that in the majority of studies, the methods used to develop models to investigate the effect of cardiac rehabilitation on outcomes do not meet common criteria for appropriate statistical model building and that reporting often lacks precision.
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Affiliation(s)
- Nilufar Akbari
- Institute of Biometry and Clinical Epidemiology, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Georg Heinze
- Center for Medical Data Science, Institute of Clinical Biometrics, Medical University of Vienna, Spitalgasse 23, 1090 Vienna, Austria
| | - Geraldine Rauch
- Institute of Biometry and Clinical Epidemiology, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117 Berlin, Germany
- Technische Universität Berlin, Straße des 17, Juni 135, 10623 Berlin, Germany
| | - Ben Sander
- Institute of Biometry and Clinical Epidemiology, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Heiko Becher
- Institute of Global Health, University Hospital Heidelberg, Im Neuenheimer Feld 130.3, 69120 Heidelberg, Germany
| | - Daniela Dunkler
- Center for Medical Data Science, Institute of Clinical Biometrics, Medical University of Vienna, Spitalgasse 23, 1090 Vienna, Austria
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11
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Yang H, Sun D, Yang Y, Lin R, Xu J, Wu J, Cui X, Li J, Qin G, Han X, Yu Y. Association of depression with all-cause and cardiovascular mortality among US adults with high and low baseline risk of cardiovascular disease. Psychiatry Res 2023; 320:115051. [PMID: 36652845 DOI: 10.1016/j.psychres.2023.115051] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 01/04/2023] [Accepted: 01/05/2023] [Indexed: 01/13/2023]
Abstract
The intervention of depression was considered a prevention and treatment option for cardiovascular disease (CVD). However, evidence regarding whether association of depression with mortality differed among people at high or low risk of CVD yielded conflicting results. We aimed to investigate associations between depression and all-cause and CVD mortality among 3854 and 3044 US adults at high and low baseline risk of CVD, respectively. Among participants at high risk of CVD, depression and per 5-point increase in PHQ-9 score were associated with 81% (HR=1.81, 95%CI: 1.15-2.86) and 33% (HR=1.33, 95%CI: 1.14-1.55) increased all-cause mortality, respectively. We did not find statistically significant associations between depression (HR=1.40, 95%CI: 0.67-2.95) and PHQ-9 score (HR=1.28, 95%CI: 1.00-1.63) with CVD mortality due to a small number of mortality events. Among people with low risk of CVD, each 5-point increment in PHQ-9 score was associated with all-cause mortality (HR=1.26, 95%CI: 1.02-1.56), while there was no statistically significant association of depression with all-cause mortality (HR=1.69, 95%CI: 0.75-3.81) and CVD mortality (HR=1.99, 95%CI: 0.83-4.81). This study found that depression was associated with all-cause mortality among individuals at a high baseline risk of CVD, but no significant association was observed in people at a low baseline risk of CVD.
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Affiliation(s)
- Hui Yang
- Department of Biostatistics, School of Public Health, and The Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, Shanghai, China
| | - Di Sun
- Department of Cardiology, Shengli Oilfield Central Hospital, Dongying, Shandong, China
| | - Yating Yang
- Department of Biostatistics, School of Public Health, and The Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, Shanghai, China
| | - Ruilang Lin
- Department of Biostatistics, School of Public Health, and The Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, Shanghai, China
| | - Jiaqin Xu
- Department of Biostatistics, School of Public Health, and The Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, Shanghai, China
| | - Jingyi Wu
- Department of Biostatistics, School of Public Health, and The Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, Shanghai, China
| | - Xiaorui Cui
- Department of Biostatistics, School of Public Health, and The Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, Shanghai, China
| | - Jiong Li
- Department of Clinical Medicine-Department of Clinical Epidemiology, Aarhus University, Aarhus, Denmark
| | - Guoyou Qin
- Department of Biostatistics, School of Public Health, and The Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, Shanghai, China; Shanghai Institute of Infectious Disease and Biosecurity, Shanghai, China.
| | - Xiaojie Han
- The Fifth People's Hospital of Shanghai, Fudan University, Shanghai, China.
| | - Yongfu Yu
- Department of Biostatistics, School of Public Health, and The Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, Shanghai, China; Shanghai Institute of Infectious Disease and Biosecurity, Shanghai, China.
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12
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Schumacher BT, Di C, Bellettiere J, LaMonte MJ, Simonsick EM, Parada H, Hooker SP, LaCroix AZ. Validation, Recalibration, and Predictive Accuracy of Published V̇O 2max Prediction Equations for Adults Ages 50-96 Yr. Med Sci Sports Exerc 2023; 55:322-332. [PMID: 36069964 PMCID: PMC9840647 DOI: 10.1249/mss.0000000000003033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
PURPOSE Maximal oxygen uptake ( ) is the criterion measure of cardiorespiratory fitness. Lower cardiorespiratory fitness is a strong predictor of poor health outcomes, including all-cause mortality. Because testing is resource intensive, several non-exercise-based V˙O 2max prediction equations have been published. We assess these equations' ability to predict measured V˙O 2max , recalibrate these equations, and quantify the association of measured and predicted V˙O 2max with all-cause mortality. METHODS Baltimore Longitudinal Study of Aging participants with valid V˙O 2max tests were included ( n = 1080). Using published V˙O 2max prediction equations, we calculated predicted V˙O 2max and present performance metrics before and after recalibration (deriving new regression estimates by regressing measured V˙O 2max on Baltimore Longitudinal Study of Aging covariates). Cox proportional hazards models were fit to quantify associations of measured, predicted, and recalibration-predicted values of V˙O 2max with mortality. RESULTS Mean age and V˙O 2max were 69.0 ± 10.4 yr and 21.6 ± 5.9 mL·kg -1 ·min -1 , respectively. The prediction equations yielded root mean square error values ranging from 4.2 to 20.4 mL·kg -1 ·min -1 . After recalibration, these values decreased to 3.9-4.2 mL·kg -1 ·min -1 . Adjusting for all covariates, all-cause mortality risk was 66% lower for the highest quartile of measured V˙O 2max relative to the lowest. Predicted V˙O 2max variables yielded similar estimates in unadjusted models but were not robust to adjustment. CONCLUSIONS Measured V˙O 2max is an extremely strong predictor of all-cause mortality. Several published V˙O 2max prediction equations yielded the following: 1) reasonable performance metrics relative to measured V˙O 2max especially when recalibrated, and 2) all-cause mortality hazard ratios similar to those of measured V˙O 2max , especially when recalibrated, yet 3) were not robust to adjustment for basic demographic covariates likely because these were used in the equation for predicted V˙O 2max .
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Affiliation(s)
- Benjamin T. Schumacher
- Herbert Wertheim School of Public Health and Human Longevity Science, UC San Diego, La Jolla, CA
| | - Chongzhi Di
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - John Bellettiere
- Herbert Wertheim School of Public Health and Human Longevity Science, UC San Diego, La Jolla, CA
| | - Michael J. LaMonte
- Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, University at Buffalo–SUNY, Buffalo, NY
| | - Eleanor M. Simonsick
- Translational Gerontology Branch, Intramural Research Program, National Institute on Aging, National Institutes of Health, Baltimore, MD
| | - Humberto Parada
- Division of Epidemiology and Biostatistics, School of Public Health, San Diego State University, San Diego, CA
- University of California, San Diego Moores Cancer Center, La Jolla, CA
| | - Steven P. Hooker
- College of Health and Human Services, San Diego State University, San Diego, CA
| | - Andrea Z. LaCroix
- Herbert Wertheim School of Public Health and Human Longevity Science, UC San Diego, La Jolla, CA
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13
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Lavie C, Abelhad N, Kachur S, Sanchez A, Milani R. Impact of cardiac rehabilitation on psychological factors, cardiorespiratory fitness, and survival: A narrative review. HEART AND MIND 2023. [DOI: 10.4103/hm.hm_58_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023] Open
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14
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The Relationship between the Frequency and Duration of Physical Activity and Depression in Older Adults with Multiple Chronic Diseases. J Clin Med 2022; 11:jcm11216355. [PMID: 36362583 PMCID: PMC9657565 DOI: 10.3390/jcm11216355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 10/24/2022] [Accepted: 10/26/2022] [Indexed: 11/17/2022] Open
Abstract
Research has demonstrated that older adults with multiple chronic diseases (CD) are particularly vulnerable to depression. Meeting current recommendations for physical activity (PA) may help ameliorate the impact of depression on this population. Nonetheless, the impact of frequency versus duration of PA on depression in older adults remains to be explored. Therefore, the purpose of the present study was to determine the combined effect of PA and multiple CD on depression and the combined effect of the frequency, duration, and multiple CD on depression in older adults. Methods: The present study utilized data from the 2017 and 2020 Living Profiles of Older People Surveys. Data from a total of 19,907 older adults (10,042 older adults from 2017 and 9865 older adults from 2020) were included in the present study. Depression was assessed using the Korean version of the Short Form of Geriatric Depression Scale (K-SGDS) and CD included cardiovascular disease, respiratory diseases, thyroid syndromes, orthopedic complications, and diabetes. Participants who participated in PA ≥ 150 min/week were categorized as the high PA group, and those who participated in PA < 150 min/week were categorized as the low PA group. Furthermore, the frequency of PA (FRE) was divided into high FRE (≥5 times/week) and low FRE (<5 times/week), and duration (DUR) was divided into DUR30 (≥30 min/bout) and DUR0 (<30 min/bout). Results: The high PA group exhibited a lower risk of depression relative to the low PA group (p < 0.001). Furthermore, the risk of depression was consistently lower at DUR30 than DUR0 regardless of FRE in all CD categories and this result was maintained after adjusting for age, gender, BMI, height, weight, income, education levels, smoking status, and cognitive function. Conclusion: These results interestingly demonstrated that it is important for older adults to participate in a longer duration of PA to impact and prevent depression symptoms regardless of FRE.
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15
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Kowalczys A, Bohdan M, Wilkowska A, Pawłowska I, Pawłowski L, Janowiak P, Jassem E, Lelonek M, Gruchała M, Sobański P. Comprehensive care for people living with heart failure and chronic obstructive pulmonary disease—Integration of palliative care with disease-specific care: From guidelines to practice. Front Cardiovasc Med 2022; 9:895495. [PMID: 36237915 PMCID: PMC9551106 DOI: 10.3389/fcvm.2022.895495] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Accepted: 08/22/2022] [Indexed: 12/02/2022] Open
Abstract
Heart failure (HF) and chronic obstructive pulmonary disease (COPD) are the leading global epidemiological, clinical, social, and economic burden. Due to similar risk factors and overlapping pathophysiological pathways, the coexistence of these two diseases is common. People with severe COPD and advanced chronic HF (CHF) develop similar symptoms that aggravate if evoking mechanisms overlap. The coexistence of COPD and CHF limits the quality of life (QoL) and worsens symptom burden and mortality, more than if only one of them is present. Both conditions progress despite optimal, guidelines directed treatment, frequently exacerbate, and have a similar or worse prognosis in comparison with many malignant diseases. Palliative care (PC) is effective in QoL improvement of people with CHF and COPD and may be a valuable addition to standard treatment. The current guidelines for the management of HF and COPD emphasize the importance of early integration of PC parallel to disease-modifying therapies in people with advanced forms of both conditions. The number of patients with HF and COPD requiring PC is high and will grow in future decades necessitating further attention to research and knowledge translation in this field of practice. Care pathways for people living with concomitant HF and COPD have not been published so far. It can be hypothesized that overlapping of symptoms and similarity in disease trajectories allow to draw a model of care which will address symptoms and problems caused by either condition.
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Affiliation(s)
- Anna Kowalczys
- 1st Department of Cardiology, Medical University of Gdańsk, Gdańsk, Poland
- *Correspondence: Anna Kowalczys,
| | - Michał Bohdan
- 1st Department of Cardiology, Medical University of Gdańsk, Gdańsk, Poland
| | - Alina Wilkowska
- Department of Psychiatry, Medical University of Gdańsk, Gdańsk, Pomeranian, Poland
| | - Iga Pawłowska
- Department of Pharmacology, Medical University of Gdańsk, Gdańsk, Pomeranian, Poland
| | - Leszek Pawłowski
- Department of Palliative Medicine, Medical University of Gdańsk, Gdańsk, Pomeranian, Poland
| | - Piotr Janowiak
- Department of Pneumonology, Medical University of Gdańsk, Gdańsk, Pomeranian, Poland
| | - Ewa Jassem
- Department of Pneumonology, Medical University of Gdańsk, Gdańsk, Pomeranian, Poland
| | - Małgorzata Lelonek
- Department of Noninvasive Cardiology, Medical University of Lodz, Łódź, Poland
| | - Marcin Gruchała
- 1st Department of Cardiology, Medical University of Gdańsk, Gdańsk, Poland
| | - Piotr Sobański
- Palliative Care Unit and Competence Centre, Department of Internal Medicine, Schwyz Hospital, Schwyz, Switzerland
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16
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Nanayakkara GL, Krincic L, Lightfoot R, Reinhardt W, De Silva K, Senaratne JM, Senaratne MPJ. Demographics and risk factors that influence the prevalence of depression in patients attending cardiac rehabilitation. Medicine (Baltimore) 2022; 101:e30470. [PMID: 36086695 PMCID: PMC10980405 DOI: 10.1097/md.0000000000030470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 08/02/2022] [Indexed: 11/25/2022] Open
Abstract
Depression has been associated with adverse outcomes in patients with cardiac disease. Data on its prevalence and the factors influencing it are limited in the cardiac rehabilitation program (CRP) setting. To elucidate the prevalence of and the factors that influence depression in patients attending CRP. Patients attending the CRP from 2003 to 2016 were included in the study. All patients had a Beck Depression Inventory-II (BDI-II) performed prior to commencement in CRP and were followed longitudinally. The BDI-II for the 4989 patients were as follows: 0 to 13 (normal) = 3623 (72%); 14 to 19 (mild depression) = 982 (20%); 20 to 28 (moderate depression) = 299 (6%); 29 to 63 (severe depression) = 85 (2%). The BDI-II (mean ± SEM) for males (mean age: 60.8 ± 0.1 years) and females (mean age: 63.4 ± 0.3 years, P < .001) were 7.0 ± 0.1 and 8.5 ± 0.2 (P < .001), respectively. Elevated BDI-II scores (14-63) were more common in type 1 (41.1%) and type 2 (30.5%) diabetics than nondiabetics (25.7%). Similarly, elevated scores were more common in smokers (36.1%) than never-smokers (24.7%). The BDI-II scores for Caucasians, South Asians, and East Asians were 7.3 ± 0.1, 8.0 ± 0.3, and 7.0 ± 0.3 respectively (P = .01 for CA vs SA by 1-way ANOVA and least significant difference test). The prevalence of depression is high in patients attending CRP affecting 28% of the population. BDI-II is a simple validated screening tool that can be applied to patients attending CRP. Diabetics, current smokers, and South Asians all had a higher prevalence of depression.
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Affiliation(s)
| | - Lena Krincic
- Grey Nuns Community Hospital, Edmonton, AB, Canada
| | | | | | | | - Janek M. Senaratne
- Grey Nuns Community Hospital, Edmonton, AB, Canada
- Division of Cardiology, University of Alberta, Edmonton, AB, Canada
| | - Manohara P. J. Senaratne
- Grey Nuns Community Hospital, Edmonton, AB, Canada
- Division of Cardiology, University of Alberta, Edmonton, AB, Canada
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17
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Lee JH, Hwang KK. End-of-Life Care for End-stage Heart Failure Patients. Korean Circ J 2022; 52:659-679. [PMID: 36097835 PMCID: PMC9470494 DOI: 10.4070/kcj.2022.0211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 08/11/2022] [Indexed: 11/11/2022] Open
Abstract
Efforts to improve end-of-life (EOL) care have generally been focused on cancer patients, but high-quality EOL care is also important for patients with other serious medical illnesses including heart failure (HF). Recent HF guidelines offer more clinical considerations for palliative care including EOL care than ever before. Because HF patients can experience rapid, unexpected clinical deterioration or sudden death throughout the disease trajectory, choosing an appropriate time to discuss issues such as advance directives or hospice can be challenging in real clinical situations. Therefore, EOL issues should be discussed early. Conversations are important for understanding patient and family expectations and developing mutually agreed goals of care. In particular, high-quality communication with patient and family through a multidisciplinary team is necessary to define patient-centered goals of care and establish treatment based on goals. Control of symptoms such as dyspnea, pain, anxiety/depression, fatigue, nausea, anorexia, and altered mental status throughout the dying process is an important issue that is often overlooked. When quality-of-life outweighs expanding quantity-of-life, the transition to EOL care should be considered. Advanced care planning including resuscitation (i.e., do-not resuscitate order), device deactivation, site for last days and bereavement support for the family should focus on ensuring a good death and be reviewed regularly. It is essential to ensure that treatment for all HF patients incorporates discussions about the overall goals of care and individual patient preferences at both the EOL and sudden changes in health status. In this review, we focus on EOL care for end-stage HF patients.
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Affiliation(s)
- Ju-Hee Lee
- Department of Internal Medicine, Chungbuk National University College of Medicine, Cheongju, Korea
- Division of Cardiology, Department of Internal Medicine, Chungbuk National University Hospital, Cheongju, Korea
| | - Kyung-Kuk Hwang
- Department of Internal Medicine, Chungbuk National University College of Medicine, Cheongju, Korea
- Division of Cardiology, Department of Internal Medicine, Chungbuk National University Hospital, Cheongju, Korea.
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18
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Jeemon P, Reethu S, Ganapathi S, Lakshmi Kanth LR, Punnoose E, Abdullakutty J, Mattumal S, Joseph J, Joseph S, Venkateswaran C, Sunder P, Babu AS, Padickaparambil S, Neenumol KR, Chacko S, Shajahan S, Krishnankutty K, Devis S, Joseph R, Shemija B, John SA, Harikrishnan S. A multicentric, 2 × 2 factorial, randomised, open-label trial to evaluate the clinical effectiveness of structured physical activity training and cognitive behavioural therapy versus usual care in heart failure patients: a protocol for the PACT-HF trial. Wellcome Open Res 2022; 7:210. [PMID: 36105556 PMCID: PMC9445562 DOI: 10.12688/wellcomeopenres.18047.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/05/2022] [Indexed: 11/20/2022] Open
Abstract
Background: Heart failure (HF) is a multi-morbid chronic condition, which adversely affects the quality of life of the affected individual. Engaging the patient and their caregivers in self-care is known to reduce mortality, rehospitalisation and improve quality of life among HF patients. The PACT-HF trial will answer whether clinical benefits in terms of mortality and hospitalisation outcomes can be demonstrated by using a pragmatic design to explore the specific effects of physical activity, and cognitive behavioural therapy in HF patients in India. Methods: We will conduct a 2 × 2 factorial, randomized, open-label trial, which aims to see if rehabilitation strategies of structured physical activity training and cognitive behavioural therapy for depression and self-management reduce the risk of repeat hospitalisation and deaths in HF patients in India. Patients will be randomised to (1) physical activity + usual care (2) cognitive behaviour therapy + usual care, (3) physical activity + cognitive behaviour therapy + usual care, and (4) usual care at 1:1:1:1 ratio. Time to mortality will be the primary outcome. A composite of mortality and hospitalisation for HF will be the main secondary outcome. Additional secondary outcomes will include 'days alive and out of hospital', cumulative hospitalisation, quality of life, Minnesota Living with Heart Failure questionnaire score, depression score, six minutes walking distance, handgrip strength, and adherence to medicines and lifestyle. The effects of intervention on the primary outcome will be estimated from Cox proportional hazard models. For the continuous secondary outcome variables, differences between randomised groups will be estimated from linear mixed models or generalised estimating equations (GEE) as appropriate. Discussion: PACT-HF is designed to provide reliable evidence about the balance of benefits and risks conferred by physical activity and cognitive behavioural therapy-based cardiac rehabilitation for those with HF, irrespective of their initial disease severity.
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Affiliation(s)
- Panniyammakal Jeemon
- ICMR-Centre for Advanced Research and Excellence in Heart Failure (CARE-HF) and Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India
| | - Salim Reethu
- ICMR-Centre for Advanced Research and Excellence in Heart Failure (CARE-HF), Sree Chitra Thirunal Institute of Medical Sciences and Technology, Trivandrum, Kerala, 695011, India
| | - Sanjay Ganapathi
- ICMR-Centre for Advanced Research and Excellence in Heart Failure (CARE-HF), Sree Chitra Thirunal Institute of Medical Sciences and Technology, Trivandrum, Kerala, 695011, India
| | - Lakshmipuram Rajappan Lakshmi Kanth
- ICMR-Centre for Advanced Research and Excellence in Heart Failure (CARE-HF), Sree Chitra Thirunal Institute of Medical Sciences and Technology, Trivandrum, Kerala, 695011, India
| | | | | | | | | | - Stigi Joseph
- Little flower hospital and research centre, Angamali, India
| | | | | | - Abraham Samuel Babu
- Department of Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, India
| | - Sebastian Padickaparambil
- Department of Clinical Psychology, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, India
| | - Kandagathuparambil Rajan Neenumol
- ICMR-Centre for Advanced Research and Excellence in Heart Failure (CARE-HF), Sree Chitra Thirunal Institute of Medical Sciences and Technology, Trivandrum, Kerala, 695011, India
| | - Susanna Chacko
- ICMR-Centre for Advanced Research and Excellence in Heart Failure (CARE-HF), Sree Chitra Thirunal Institute of Medical Sciences and Technology, Trivandrum, Kerala, 695011, India
| | - Shamla Shajahan
- ICMR-Centre for Advanced Research and Excellence in Heart Failure (CARE-HF), Sree Chitra Thirunal Institute of Medical Sciences and Technology, Trivandrum, Kerala, 695011, India
| | | | - Selma Devis
- Little flower hospital and research centre, Angamali, India
| | | | | | | | - Sivadasanpillai Harikrishnan
- ICMR-Centre for Advanced Research and Excellence in Heart Failure (CARE-HF), Sree Chitra Thirunal Institute of Medical Sciences and Technology, Trivandrum, Kerala, 695011, India
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19
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Naami R, Naami E, Omari T, Lowi SG, Natanzon SS, Patel V, Lerner A, Rozner E, Turgeman Y, Koren O. Cardiac rehabilitation performance predicts 1-year major adverse cardiovascular events. Clin Cardiol 2022; 45:1036-1043. [PMID: 35904222 PMCID: PMC9574735 DOI: 10.1002/clc.23890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 06/30/2022] [Accepted: 07/04/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Cardiac Rehabilitation is an essential following major adverse cardiovascular events however there is no current data correlating rehab performance to long term outcomes. HYPOTHESIS Patient exercise performance during cardiac rehabilitation reliably predicts future cardiovascular events. METHODS We conducted a single-center study of 486 consecutive patients who participated in a CR program between January 2018 and August 2021. We assessed patient performance using a novel index, the CR-score, which integrated duration, speed of work, and workload conducted on each training device (TD). We used a binary recursive partition model to determine the optimal thresholds for cumulative CR score. We used Cox regression analysis to assess the mortality rate among patients who developed MACE ("study group") and those who did not ("control group"). RESULTS Among 486 eligible patients, 1-year MACE occurred in 27 (5.5%) patients and was more common in patients with prior cerebrovascular accident or transient ischemic attack (14.8% vs. 3.5%, p < .001). Age, gender, comorbidities, heart failure, and medical treatment did not significantly affect the outcome. The median cumulative CR score of the study group was significantly lower than the control group (595 ± 185.6 vs. 3500 ± 1104.7, p < .0001). A cumulative CR-score of ≥1132 correlated with the outcome (98.5% sensitivity, 99.6% specificity, 95% CI: 0.985-0.997, area 0.994, p < .0001). Patients older than 55 with a cumulative CR score of <1132 were at particularly high risk (OR: 7.4, 95% CI: 2.84-18.42) for 1-year MACE (log-rank p = .03). CONCLUSION Our proposed CR-score accurately identifies patients at high risk for 1-year MACE following the rehabilitation program. Multicenter validation is required.
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Affiliation(s)
- Robert Naami
- Internal Medicine, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Edmund Naami
- School of Medicine, University of Illinois, Springfield, Illinois, USA
| | | | | | | | - Vivek Patel
- Cedars-Sinai Medical Center, Smidt Heart Institute, Los Angeles, California, USA
| | - Addee Lerner
- David Geffen School of Medicine, University of California (UCLA), Los Angeles, California, USA
| | | | - Yoav Turgeman
- Emek Medical Center, Afula, Israel.,Technion Israel Institute of Technology, Bruce Rappaport Faculty of Medicine, Haifa, Israel
| | - Ofir Koren
- Emek Medical Center, Afula, Israel.,Cedars-Sinai Medical Center, Smidt Heart Institute, Los Angeles, California, USA.,Technion Israel Institute of Technology, Bruce Rappaport Faculty of Medicine, Haifa, Israel
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20
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Garfein J, Guhl EN, Swabe G, Sekikawa A, Barinas-Mitchell E, Forman DE, Magnani JW. Racial and Ethnic Differences in Cardiac Rehabilitation Participation: Effect Modification by Household Income. J Am Heart Assoc 2022; 11:e025591. [PMID: 35730601 PMCID: PMC9333381 DOI: 10.1161/jaha.122.025591] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Background Cardiac rehabilitation (CR) is associated with improved cardiovascular outcomes. Racial and ethnic differences in CR have been identified, but whether income may attenuate these disparities remains unknown. We evaluated (1) racial/ethnic differences in CR participation in a contemporary sample of insured US adults, and (2) assessed how household income modifies associations between race or ethnicity and CR participation. Methods and Results We identified 107 199 individuals with a CR‐qualifying diagnosis between January 1, 2016 and December 31, 2018 in Optum’s de‐identified Clinformatics database. We evaluated associations between race or ethnicity and participation in CR, and assessed interaction between race or ethnicity and annual household income. The mean±SD age of all participants was 70.4±11.6 years; 37.4% were female and 76.0% were White race. Overall, 28 443 (26.5%) attended ≥1 CR sessions. After adjustment, compared with White individuals, the probability of attending CR was 31% lower for Asian individuals (95% CI, 27%–36%), 19% lower for Black individuals (95% CI, 16%–22%), and 43% lower for Hispanic individuals (95% CI, 40%–45%), all P<0.0001. The time to CR attendance was also significantly longer for Asian, Black, and Hispanic individuals. Associations between race or ethnicity and attendance at CR differed significantly across household income categories (P interaction=0.0005); however, Asian, Black, and Hispanic individuals were less likely to attend CR at all incomes. Conclusions In a geographically and racially diverse cohort, participation in CR was low overall, and was lowest among Asian, Black, and Hispanic candidates. Household income may impact the link between race or ethnicity and attendance at CR, but substantial racial and ethnic disparities exist across incomes.
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Affiliation(s)
- Joshua Garfein
- Department of Medicine University of Pittsburgh School of Medicine Pittsburgh PA
| | - Emily N Guhl
- Heart and Vascular Institute University of Pittsburgh Medical Center Pittsburgh PA.,Department of Epidemiology, Graduate School of Public Health University of Pittsburgh PA
| | - Gretchen Swabe
- Department of Medicine University of Pittsburgh School of Medicine Pittsburgh PA
| | - Akira Sekikawa
- Department of Epidemiology, Graduate School of Public Health University of Pittsburgh PA
| | - Emma Barinas-Mitchell
- Department of Epidemiology, Graduate School of Public Health University of Pittsburgh PA
| | - Daniel E Forman
- Department of Medicine University of Pittsburgh School of Medicine Pittsburgh PA.,Heart and Vascular Institute University of Pittsburgh Medical Center Pittsburgh PA
| | - Jared W Magnani
- Department of Medicine University of Pittsburgh School of Medicine Pittsburgh PA.,Heart and Vascular Institute University of Pittsburgh Medical Center Pittsburgh PA.,Department of Epidemiology, Graduate School of Public Health University of Pittsburgh PA
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21
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Qu X, Houser SH, Zhang J, Wen J, Zhang W. Association between using social media WeChat and depressive symptoms among middle-aged and older people: findings from a national survey. BMC Geriatr 2022; 22:351. [PMID: 35448984 PMCID: PMC9023108 DOI: 10.1186/s12877-022-03054-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 04/11/2022] [Indexed: 02/05/2023] Open
Abstract
Objectives We aimed to assess the characteristics and health status of a study sample using social media WeChat and to identify the association between social media usage and depressive symptoms among people aged 45 and older in China. Methods Data were drawn from the China Health and Retirement Longitudinal Study (CHARLS). Depressive symptoms were measured by the 10-item form of the Center for Epidemiologic Studies Depression Scale (CES-D-10). The propensity score matching method (PSM) was performed to balance the characteristics of WeChat users and non-WeChat users. Multilevel logistic regression was used to test the association between the incidence of depressive symptoms and WeChat usage by introducing covariates step by step. Sensitivity analysis was conducted to estimate the robustness of the primary findings. Results A total of 5415 matching cases out of 11,338 total sample were used in this study to generate the final analysis. A multilevel logistic regression model showed that a significantly lower incidence of depression was related to WeChat usage after adjusting for all possible covariates (OR: 0.76, 95% CI: 0.62–0.94). The most popular WeChat functions used by the study population were watching news (80.4%), posting Moment messages (75.5%), chatting with friends (66.0%), and watching videos (65.2%). The sensitivity analysis yielded similar findings to the primary analyses. Conclusions Using social media WeChat showed an association with lower depressive symptoms among people aged ≥45 and older in our study sample. Further studies need to be explored on the promotion and education of social media WeChat usage, targeting the improvement of mental health-related issues through social network connections. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-022-03054-y.
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Affiliation(s)
- Xing Qu
- Institute of Hospital Management, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Shannon H Houser
- Department of Health Services Administration, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Jian Zhang
- West China Biomedical Big Data Center, West China Hospital, Sichuan University, Chengdu, 610041, China.,Medical Big Data Center, Sichuan University, Chengdu, 610041, China
| | - Jin Wen
- Institute of Hospital Management, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Wei Zhang
- West China Biomedical Big Data Center, West China Hospital, Sichuan University, Chengdu, 610041, China. .,Medical Big Data Center, Sichuan University, Chengdu, 610041, China. .,Mental Health Center, West China Hospital, Sichuan University, No. 37, Guoxue Lane, Chengdu, 610041, China.
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Sangani D, Krupadev V, Crawford M, Deere B, Hendel R. A Quality Improvement Initiative for Increasing Cardiac Rehabilitation Referrals Using Plan-Do-Study-Act (PDSA) Methodology. Am J Med 2022; 135:512-516. [PMID: 34813738 DOI: 10.1016/j.amjmed.2021.10.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 10/18/2021] [Accepted: 10/19/2021] [Indexed: 01/25/2023]
Abstract
BACKGROUND Cardiovascular rehabilitation has been shown to improve morbidity and mortality in patients with cardiac illnesses; however, the referral rate for eligible patients at Tulane Medical Center has remained below best practice standards. METHODS This is a single-center, quality-improvement study conducted from January 2020 through December 2020, with historical controls from 2019. Using Plan-Do-Study-Act cycle methodology, interventions were designed to improve referral rates for cardiac rehabilitation-eligible patients. Interventions included a presentation about the importance of cardiac rehabilitation and the current state of referrals, weekly reminders to residents and fellows on inpatient services with eligible patients, and an admission order set that included a default order for cardiac rehabilitation. RESULTS The primary outcome was referral rate, which was measured by the total number of referrals compared with the total number of patients eligible for cardiac rehabilitation. In this quality-improvement study of 770 patients, there was a significant increase in the referral rate for cardiac rehabilitation-eligible patients. When comparing the referral rate in 2020-following institution of quality-improvement interventions-with that from 2019, there was an increase from 27% to 70%. CONCLUSIONS This quality-improvement study found that various interventions significantly increased the cardiac rehabilitation referral rate through a straightforward and simple strategy. Further efforts are underway to promote additional referral in order to meet or exceed the >90% best practice standard.
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Affiliation(s)
- Deep Sangani
- Deming Department of Medicine, Section of Cardiology, Tulane University School of Medicine, New Orleans, La
| | - Vinay Krupadev
- Deming Department of Medicine, Section of Cardiology, Tulane University School of Medicine, New Orleans, La
| | - Michael Crawford
- Deming Department of Medicine, Section of Cardiology, Tulane University School of Medicine, New Orleans, La
| | - Brad Deere
- Deming Department of Medicine, Section of Cardiology, Tulane University School of Medicine, New Orleans, La
| | - Robert Hendel
- Deming Department of Medicine, Section of Cardiology, Tulane University School of Medicine, New Orleans, La.
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Sawan MA, Calhoun AE, Fatade YA, Wenger NK. Cardiac rehabilitation in women, challenges and opportunities. Prog Cardiovasc Dis 2022; 70:111-118. [PMID: 35150655 DOI: 10.1016/j.pcad.2022.01.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Accepted: 01/29/2022] [Indexed: 10/19/2022]
Abstract
Cardiac rehabilitation(CR) has known proven benefits in reducing mortality related to cardiovascular disease (CVD), improving quality of life (QoL), and preventing CVD-related readmissions. Despite these known benefits, CR remains underutilized among women relative to men. Disparities exist at the level of referral, enrollment, and program completion. Much is left to be understood regarding the utility of CR in female-predominant CVD such as postpartum cardiomyopathy and Spontaneous Coronary Artery Dissection. This review identifies the benefits of CR for specific populations of women and elucidates on the barriers to CR. We also describe current recommendations to overcome barriers to CR in women.
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Affiliation(s)
- Mariem A Sawan
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA, USA.
| | - Avery E Calhoun
- Department of Internal Medicine, Emory University Atlanta, GA, USA
| | - Yetunde A Fatade
- Department of Internal Medicine, Emory University Atlanta, GA, USA
| | - Nanette K Wenger
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA, USA
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Simning A, Orth J, Temkin-Greener H, Li Y, Simons KV, Conwell Y. Skilled Nursing Facility-to-Home Trajectories for Older Adults With Mental Illness or Dementia. Am J Geriatr Psychiatry 2022; 30:223-234. [PMID: 34284892 PMCID: PMC8710182 DOI: 10.1016/j.jagp.2021.06.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 03/24/2021] [Accepted: 06/21/2021] [Indexed: 02/03/2023]
Abstract
OBJECTIVES To examine how mental illness (MI) and Alzheimer's disease and related dementias (ADRD) were associated with whether skilled nursing facility (SNF) residents returned to and remained in the community and if receipt of home health services was associated with post-SNF home time. DESIGN Retrospective cohort study based on secondary data analyses. SETTING New York State Medicare beneficiaries who were admitted to an SNF in 2014. PARTICIPANTS Total of 46,137 older adults admitted to SNFs and 25,357 discharged from SNFs to home. MEASUREMENTS We used Medicare claims and assessment databases to derive our outcomes (discharge to the community and home time [i.e., days alive in the community]), determine MI/ADRD status, and obtain socio-demographic and clinical characteristics. RESULTS Among SNF admissions, 22.9% had MI, 22.6% had ADRD, and 59.0% were discharged to the community. In analyses adjusting for socio-demographic and clinical characteristics, MI and ADRD were associated with decreased odds of community discharge and less home time during 90-days of follow-up. However, when we included depressive symptoms, aggressive behaviors, and daily functioning in the analyses, these associations were attenuated. Receipt of post-SNF home health services was associated with increased home time among those with MI or ADRD. CONCLUSION Newly admitted SNF residents with MI or ADRD were less likely to be discharged and, if discharged, spent less time in the community. Interventions targeting depressive symptoms, aggressive behaviors, and functioning and improving linkage with home health services may help decrease differences in post-acute care trajectories between those with and without MI and ADRD.
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Affiliation(s)
- Adam Simning
- University of Rochester, Department of Psychiatry, Rochester, NY; University of Rochester, Department of Public Health Sciences, Rochester, NY.
| | | | | | - Yue Li
- UR, Department of Public Health Sciences
| | | | - Yeates Conwell
- University of Rochester (UR), Department of Psychiatry,UR, Office for Aging Research and Health Services
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25
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Defining the importance of stress reduction in managing cardiovascular disease - the role of exercise. Prog Cardiovasc Dis 2022; 70:84-93. [DOI: 10.1016/j.pcad.2022.01.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Accepted: 01/29/2022] [Indexed: 12/14/2022]
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A prospective cohort study of the impact of outpatient Intensive Cardiac Rehabilitation on depression and cardiac self-efficacy. AMERICAN HEART JOURNAL PLUS: CARDIOLOGY RESEARCH AND PRACTICE 2022; 13. [PMID: 36407054 PMCID: PMC9671388 DOI: 10.1016/j.ahjo.2022.100100] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Study objective: To evaluate whether an Intensive Cardiac Rehabilitation (ICR) program improves depression and cardiac self-efficacy among patients with a qualifying cardiac diagnosis. Design: Prospective, longitudinal cohort design. Setting: Single-center, tertiary referral, outpatient cardiac rehabilitation center. Participants: Patients with a qualifying diagnosis for ICR. Interventions: Outpatient ICR. Main outcome measure(s): Mental health, as assessed using the Patient Health Questionnaire-9 (PHQ-9) and cardiac self-efficacy using the Cardiac Self-Efficacy (CSE) scale. Results: Of the 268 patients included (median age 69 y, 73% men), 70% had no depressive symptoms at baseline (PHQ-9 score <5). PHQ-9 scores improved in the overall sample (p < 0.0001), with greater improvements among patients with mild depressive symptoms at baseline (−4 points, p < 0.001) and those with moderate to severe depressive symptoms at baseline (−5.5 points, p < 0.001). Cardiac self-efficacy improved overall, and the two subsections of the cardiac self-efficacy questionnaire titled, “maintain function” and “control symptoms” improved (all p < 0.001). Conclusions: Participation in an outpatient ICR program is associated with fewer depressive symptoms and greater cardiac self-efficacy among patients with CVD who qualify for ICR. The improvement in depression was greatest for those with moderate to severe depressive symptoms.
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Impact of cardiorespiratory fitness on outcomes in cardiac rehabilitation. Prog Cardiovasc Dis 2021; 70:2-7. [PMID: 34780726 DOI: 10.1016/j.pcad.2021.11.001] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 11/08/2021] [Indexed: 12/12/2022]
Abstract
Cardiovascular rehabilitation (CR) significantly improves outcomes in patients with cardiovascular diseases (CVD), especially coronary heart disease and heart failure (HF). Although CR is often considered as an exercise training (ET) program for patients following CVD events, CR is more than just ET as it involves education, dietary and psychological counseling, as well as a multi-factorial risk factor modification. However, a major component of ET involves efforts to measure and improve levels of cardiorespiratory fitness (CRF). In this state-of-the-art review, we analyze the data, including from our John Ochsner Heart and Vascular Institute, evaluating CRF and its impact on psychological improvements and major outcomes with CR, especially long-term survival.
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Kim YJ, Crane PA, Houmard JA, Swift DL, Wu Q. Minor Improvement in Activity and Participation and Decline in Physical Activity Motivation After Cardiac Rehabilitation Discharge. J Cardiopulm Rehabil Prev 2021; 41:419-425. [PMID: 34727561 DOI: 10.1097/hcr.0000000000000586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE To investigate the changes in activities and participation, and mental and physical functions for 9 mo after cardiac rehabilitation (CR) among adults with chronic cardiac conditions. METHODS Twenty-five adults with chronic cardiac conditions scheduled for discharge from CR were assessed at four different times: within 2-wk window of CR discharge date, 1 mo, 3 mo, and 9 mo after CR discharge. Nine assessments according to the International Classification of Functioning, Disability and Health were used to track the changes post-CR. RESULTS Participants showed significant changes in the Cognitive Instrumental Activities of Daily Living adequacy of Performance Assessment of Self-Care Skills-Clinic (F = 8.10, P = .017) and improvements in the applied cognitive domain of the Activity Measure for Post-Acute Care Outpatient Short Form (F = 4.493, P = .016). Participants also showed significant decline in the CogState Detection test (F = 3.307, P = .045), the Physical Activity and Leisure Motivation Scale (PALMS) (F = 4.749, P = .005), and the affiliation subscale of the PALMS (F = 5.316, P = .002), and improvements in the 6-min walk test (F = 9.000, P = .011). Lastly, participants showed depressive symptoms for 3 mo post-CR. No other significant changes were detected among other outcome measures. CONCLUSIONS Adults with chronic cardiac conditions discharged from site-based CR maintained their activity and participation level following discharge with little improvement. They also showed depressive symptoms and decreased motivation for physical activity post-CR.
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Affiliation(s)
- Young Joo Kim
- Departments of Occupational Therapy (Dr Kim), Kinesiology (Drs Houmard and Swift), and Biostatistics (Dr Wu), East Carolina University, Greenville, North Carolina; and College of Nursing, East Carolina University, Greenville, and School of Nursing, University of North Carolina Charlotte, Charlotte, North Carolina (Dr Crane)
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Qi-Regulating and Blood Circulation-Promoting Therapy Improves Health Status of Stable Angina Pectoris Patients with Depressive Symptoms. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2021; 2021:7319417. [PMID: 34567219 PMCID: PMC8460386 DOI: 10.1155/2021/7319417] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 08/04/2021] [Accepted: 08/12/2021] [Indexed: 11/17/2022]
Abstract
Depressive symptoms have been found to be highly prevalent among patients with coronary heart disease (CHD) and seriously affect the patients' quality of life. However, most psychotropic drugs have warnings about potential side effects. Accordingly, safer effective alternatives are urgently demanded. Angina pectoris of CHD is considered as “chest stuffiness and heartache syndrome” in traditional Chinese medicine, with the major syndrome type named Qi stagnation and blood stasis. Qi-regulating and blood circulation-promoting therapy has increasingly shown unique advantages in CHD patients. This study investigated the efficacy of Xuefu Zhuyu decoction, a representative prescription of Qi-regulating and blood circulation-promoting therapy, on angina pectoris patients with depressive symptoms. Depressive symptoms were stratified at baseline in 30 patients with stable angina pectoris who participated in both baseline and 12-week follow-up studies. After performing a stratified analysis, the angina pectoris-specific health status and traditional Chinese medicine “chest stuffiness and heartache syndrome” were evaluated by self-reports using the associated questionnaire scales, respectively. We measured serum concentrations of serotonin, brain-derived neurotrophic factor, and ATP, which are associated with the development of depression. We found that the Xuefu Zhuyu granule significantly improved the angina pectoris-specific health status in patients after 12 weeks of treatment; specifically, it had a better curative effect on patients with depressive symptoms. Xuefu Zhuyu granule also significantly improved the chest stuffiness and heartache syndrome in patients with depressive symptoms (efficacy index is 61.24%, P < 0.05 versus baseline). Interestingly, Xuefu Zhuyu granule has been found to be more susceptible to improving ATP levels in patients with depressive symptoms, indicating that the improvement in serum ATP levels might account for the better efficacy of Xuefu Zhuyu granule in patients with depressive symptoms. Our data provide prospective evidence that Xuefu Zhuyu granule improves angina pectoris-specific health status through regulating Qi and promoting blood circulation. This trial is registered with ChiCTR-IOR-15006989.
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Review of Recent Cardiac Rehabilitation Research Related to Enrollment/Adherence, Mental Health, and Other Populations. J Cardiopulm Rehabil Prev 2021; 41:302-307. [PMID: 34461620 DOI: 10.1097/hcr.0000000000000649] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
This review overviews three topic areas observed to be highly active in the cardiac rehabilitation (CR) research literature published in 2019 and 2020. Topics summarized were enrollment or adherence in CR programs; mental health, particularly depression, stress, and anxiety of patients participating in CR programs; and patients participating in CR programs with diagnoses other than coronary artery bypass graft, myocardial infarction, or percutaneous coronary interventions.
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31
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Bermudez T, Bierbauer W, Scholz U, Hermann M. Depression and anxiety in cardiac rehabilitation: differential associations with changes in exercise capacity and quality of life. ANXIETY STRESS AND COPING 2021; 35:204-218. [PMID: 34269151 DOI: 10.1080/10615806.2021.1952191] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Cardiac rehabilitation (CR) has been successful in improving exercise capacity (EC) and quality of life (QoL). However, depression and anxiety are highly prevalent among cardiac patients and might represent risk factors for rehabilitation outcomes. The aim of this study was to investigate the role of depression and anxiety as possible independent risk factors for CR outcomes. METHODS The study applied a pre-post-design. The sample comprised N = 3'434 cardiac disease patients taking part in a Swiss inpatient CR center. Variables measured at the beginning (T1) and end of rehabilitation (T2) included depression and anxiety (HADS), EC, and QoL (MacNew). A path analysis was conducted. RESULTS Depression at T1 had a significant negative relationship with improvements in EC and in all aspects of QoL during rehabilitation. Anxiety at T1 was positively related to improvements in EC and in emotional and physical QoL. Improvements in depression during CR were positively related with improvements in all outcomes. Improvements in anxiety showed no significant association with the outcomes. CONCLUSION Depression and anxiety should be screened for during CR. Depression should be treated due to the negative association found with rehabilitation outcomes. Underlying mechanisms of the positive association of anxiety with rehabilitation outcomes need further investigation.
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Affiliation(s)
- Tania Bermudez
- Applied Social and Health Psychology Unit, Department of Psychology, University of Zurich, Zurich, Switzerland.,University Research Priority Program "Dynamics of Healthy Aging", University of Zurich, Zurich, Switzerland
| | - Walter Bierbauer
- Applied Social and Health Psychology Unit, Department of Psychology, University of Zurich, Zurich, Switzerland.,University Research Priority Program "Dynamics of Healthy Aging", University of Zurich, Zurich, Switzerland
| | - Urte Scholz
- Applied Social and Health Psychology Unit, Department of Psychology, University of Zurich, Zurich, Switzerland.,University Research Priority Program "Dynamics of Healthy Aging", University of Zurich, Zurich, Switzerland
| | - Matthias Hermann
- University Heart Center Zurich, Department of Cardiology, University Hospital Zurich, Zurich, Switzerland
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Malian HM, Smith PJ, Hoffman B, Jiang W, Ammerman K, Kraus WE, Hinderliter A, Sherwood A, Blumenthal JA. Effects of Acute Exercise on Anxiety Ratings in Patients With Coronary Heart Disease and Elevated Anxiety. J Cardiopulm Rehabil Prev 2021; 41:277-281. [PMID: 34158457 PMCID: PMC9558052 DOI: 10.1097/hcr.0000000000000579] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To explore individual differences in state anxiety following a single, acute bout of aerobic exercise among anxious patients with diagnosed coronary heart disease (CHD). METHODS One hundred eighteen CHD patients with elevated symptoms of anxiety enrolled in the UNderstanding the Benefits of Exercise and Escitalopram in Anxious Patients WIth coroNary Heart Disease (UNWIND) clinical trial rated their level of anxiety using a 100-mm visual analog scale before and after a symptom-limited exercise treadmill test. A number of exercise (eg, peak oxygen uptake, exercise duration, maximum heart rate, anaerobic threshold) and psychological variables were examined as potential predictors of exercise response. Changes in anxiety and their association with psychological variables were examined using general linear models. RESULTS Fifty patients (42%) rated a reduction in anxiety relative to their pre-exercise ratings following the exercise treadmill test. While a number of factors were examined, the only factor that distinguished those individuals who reported a reduction in anxiety symptoms compared with those who either remained the same or actually reported an increase in anxiety was a higher pre-exercise visual analog scale anxiety rating. No differences were observed as a function of sex, severity of trait anxiety, the presence of an anxiety disorder, exercise test duration, or age. CONCLUSIONS Although many variables were examined, only higher baseline anxiety distinguished those who showed a reduction in their visual analog scale ratings from those whose anxiety remained the same or got worse. The extent to which the response to acute exercise predicts the anxiolytic effects of chronic exercise needs further study.
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Affiliation(s)
- Hannah M Malian
- Departments of Psychiatry and Behavioral Sciences (Mss Malian and Ammerman and Drs Smith, Hoffman, Jiang, Sherwood, and Blumenthal) and Medicine (Dr Kraus), Duke University Medical Center, Durham, North Carolina; and Department of Medicine (Dr Hinderliter), University of North Carolina Hospitals, Chapel Hill, North Carolina
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Symptoms of Depression and Anxiety in Patients With Type 2 Diabetes in a Canadian Outpatient Cardiac Rehabilitation Program. J Cardiopulm Rehabil Prev 2021; 41:328-335. [PMID: 33883472 DOI: 10.1097/hcr.0000000000000603] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE The objective of this study was to determine whether type 2 diabetes status is associated with an increased likelihood of depressed mood and anxiety in patients attending cardiac rehabilitation (CR) and to explore predictors of depression and anxiety after CR completion in patients with diabetes. METHODS A retrospective analysis was conducted in patients who completed a 12-wk CR program between 2002 and 2016. Patients were classified as reporting normal-to-mild or moderate-to-severe symptoms of depression and anxiety using the Hospital Anxiety and Depression Scale (HADS). Logistic regression models were used to compare predictors of depression and anxiety prior to CR enrollment and investigate predictors of post-CR HADS scores among a subset of patients with diabetes. RESULTS Data from 6746 patients (mean age 61 ± 11 yr, 18% female, 18% with diabetes) were analyzed. After controlling for known predictors of depression, patients with diabetes were not more likely to report moderate-to-severe levels of depression prior to or after completing CR. In patients with diabetes, younger age predicted moderate-to-severe depression post-CR (OR = 0.95: 95% CI, 0.93-0.98). Patients with diabetes were also more likely to report moderate-to-severe levels of anxiety after completing CR (OR = 1.45: 95% CI, 1.02-2.07). Younger age (OR = 0.93: 95% CI, 0.88-0.97) and smoking status (OR = 3.3: 95% CI, 1.15-7.06) predicted moderate-to-severe post-CR anxiety in patients with diabetes. CONCLUSIONS Patients with diabetes, particularly younger patients who currently smoke or recently quit, are more likely to report having anxiety following CR. These patients may therefore require additional management of anxiety symptoms during CR. Larger studies of CR patients with diabetes and more variable depression and anxiety levels are needed.
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Benasi G, Fava GA, Rafanelli C. Kellner's Symptom Questionnaire, a Highly Sensitive Patient-Reported Outcome Measure: Systematic Review of Clinimetric Properties. PSYCHOTHERAPY AND PSYCHOSOMATICS 2021; 89:74-89. [PMID: 32050199 DOI: 10.1159/000506110] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/26/2019] [Accepted: 01/23/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Patient-reported outcomes (PROs) are of increasing importance in clinical medicine. However, their evaluation by classic psychometric methods carries considerable limitations. The clinimetric approach provides a viable framework for their assessment. OBJECTIVE The aim of this paper was to provide a systematic review of clinimetric properties of the Symptom Questionnaire (SQ), a simple, self-rated instrument for the assessment of psychological symptoms (depression, anxiety, hostility, and somatization) and well-being (contentment, relaxation, friendliness, and physical well-being). METHODS The PRISMA guidelines were used. Electronic databases were searched from inception up to March 2019. Only original research articles, published in English, reporting data about the clinimetric properties of the SQ, were included. RESULTS A total of 284 studies was selected. The SQ has been used in populations of adults, adolescents, and older individuals. The scale significantly discriminated between subgroups of subjects in both clinical and nonclinical settings, and differentiated medical and psychiatric patients from healthy controls. In longitudinal studies and in controlled pharmacological and psychotherapy trials, it was highly sensitive to symptoms and well-being changes and discriminated between the effects of psychotropic drugs and placebo. CONCLUSIONS The SQ is a highly sensitive clinimetric index. It may yield clinical information that similar scales would fail to provide and has a unique position among the PROs that are available. Its use in clinical trials is strongly recommended.
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Affiliation(s)
- Giada Benasi
- Department of Psychology, University of Bologna, Bologna, Italy
| | - Giovanni A Fava
- Department of Psychiatry, University at Buffalo, State University of New York, Buffalo, New York, USA
| | - Chiara Rafanelli
- Department of Psychology, University of Bologna, Bologna, Italy,
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Scott-Sheldon LAJ, Gathright EC, Salmoirago-Blother E, Wu WC. Women's participation in stress management interventions for chronic heart failure: a meta-analysis of randomized controlled trials. PSYCHOL HEALTH MED 2021; 27:761-779. [PMID: 33486993 DOI: 10.1080/13548506.2021.1874436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Stress management interventions (SMIs) can alleviate the psychosocial stress often experienced by women with heart failure. The purpose of this meta-analysis was to summarize women's participation rates, and predictors of participation, in SMIs for the management of psychosocial distress in women with chronic HF. Studies were retrieved from bibliographic databases, reference sections of relevant papers, and research registries. Included studies (a) evaluated a SMI approach for the management of chronic HF, (b) sampled chronic HF patients, and (c) used a randomized controlled trial (RCT) design. Independent coders extracted the relevant data. Thirty-five RCTs met inclusion criteria (N = 3,649; mean age = 63.5 ± 7.0 years). All studies sampled both men and women; the mean proportion of women who participated in the trials was 38.8% (95% confidence interval [CI] = 34.5-43.4; I2 = 82.4, 95% CI = 81.0-83.6). Women's participation rates were higher in studies sampling more HF patients with hypertension (B = 1.01, SE = 0.45, P = .046) but fewer HF patients prescribed beta blockers (B = -1.10, SE = 0.33, P = .006), F (2,12) = 6.27, P = 0.014, adjusted R2 = 61%. SMIs may offer women a complementary or integrative approach to standard treatment to help manage the psychological distress associated with HF. Future research should explore the potential benefits of offering stress management approaches to women as part of comprehensive HF care.
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Affiliation(s)
- Lori A J Scott-Sheldon
- Center for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, RI, United States.,Department of Psychiatry and Human Behavior, Alpert School of Medicine, Brown University, Providence, RI.,Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI
| | - Emily C Gathright
- Center for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, RI, United States.,Department of Psychiatry and Human Behavior, Alpert School of Medicine, Brown University, Providence, RI
| | - Elena Salmoirago-Blother
- Center for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, RI, United States.,Department of Medicine, Alpert School of Medicine, Brown University, Providence, RI.,Department of Epidemiology, Brown University School of Public Health, Providence, RI
| | - Wen-Chih Wu
- Department of Medicine, Alpert School of Medicine, Brown University, Providence, RI.,Department of Epidemiology, Brown University School of Public Health, Providence, RI.,Chief of Cardiology, Providence VA Medical Center, Providence, RI.,Medical Director, Center for Cardiac Fitness, The Miriam Hospital, Providence, RI, USA
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Gobeil K, White K, Bhat A, Szalai H, Lagu TC, Pack QR. Cardiac rehabilitation in Takotsubo cardiomyopathy: Predictors of utilization and effects of exercise training. Heart Lung 2020; 50:230-234. [PMID: 33340825 DOI: 10.1016/j.hrtlng.2020.12.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 12/06/2020] [Accepted: 12/07/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Takotsubo cardiomyopathy (TCM) patients may benefit from cardiac rehabilitation (CR). OBJECTIVES The purpose to this study is to examine utilization of CR in TCM. METHODS We conducted a review of hospitalized TCM patients at Baystate Medical Center between 2010 and 2017. We evaluated rates of referral, enrollment, adherence, and changes in exercise capacity. Predictors of CR utilization were analyzed using t-test, chi-square/odds ratio and multivariable hierarchical modeling when appropriate. RESULTS Over 8 years, 35% of 590 patients with TCM were evaluated by phase I (inpatient) and 13.6% enrolled in phase II (outpatient) CR. Inpatient CR evaluation (OR 21, 95% CI 7-64) and cardiac catheterization (OR 5.7, 95% CI 1.9-17) were strong predictors of outpatient CR participation. Patients enrolling in CR attended 15±14 sessions and increased their exercise capacity by 1.2 METs (95% CI 0.9-1.5). CONCLUSION CR is inconsistently used in TCM, despite the potential physiologic benefits of exercise in TCM.
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Affiliation(s)
- Kyle Gobeil
- Department of Medicine, Baystate Medical Center, Springfield, MA, United States.
| | - Kevin White
- University of Massachusetts School of Medicine, Worcester, MA, United States
| | - Anusha Bhat
- Department of Medicine, Baystate Medical Center, Springfield, MA, United States
| | - Heidi Szalai
- Department of Cardiovascular Disease, Baystate Medical Center, Springfield, MA, United States
| | - Tara C Lagu
- Department of Medicine, Baystate Medical Center, Springfield, MA, United States; Institute of Healthcare Delivery and Population Science, University of Massachusetts School of Medicine-Baystate, Springfield, MA, United States
| | - Quinn R Pack
- Department of Medicine, Baystate Medical Center, Springfield, MA, United States; Department of Cardiovascular Disease, Baystate Medical Center, Springfield, MA, United States; Institute of Healthcare Delivery and Population Science, University of Massachusetts School of Medicine-Baystate, Springfield, MA, United States.
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Lavie CJ, Pack QR, Levine GN. Expanding Traditional Cardiac Rehabilitation in the 21st Century. J Am Coll Cardiol 2020; 75:1562-1564. [PMID: 32241372 DOI: 10.1016/j.jacc.2020.02.038] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Revised: 02/06/2020] [Accepted: 02/10/2020] [Indexed: 12/17/2022]
Affiliation(s)
- Carl J Lavie
- Department of Cardiovascular Diseases, The John Ochsner Heart and Vascular Institute, Ochsner Clinical School-The University of Queensland School of Medicine, New Orleans, Louisiana.
| | - Quinn R Pack
- Department of Internal Medicine and Institute of Health Care Delivery and Population Science, University of Massachusetts Medical School and Division of Cardiovascular Medicine, Bay State Medical Center, Springfield, Massachusetts
| | - Glenn N Levine
- Section of Cardiology, Baylor College of Medicine and Michael E. DeBakey VA Medical Center, Houston, Texas
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Depression Is Associated With Reduced Outpatient Cardiac Rehabilitation Completion Rates: A SYSTEMATIC LITERATURE REVIEW AND META-ANALYSIS. J Cardiopulm Rehabil Prev 2020; 39:365-372. [PMID: 30913045 DOI: 10.1097/hcr.0000000000000419] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
PURPOSE Depression is associated with recurrent cardiac events and death in patients with coronary heart disease and congestive heart failure. Furthermore, depression may be associated with reduced completion of outpatient cardiac rehabilitation (CR), an empirically supported treatment for patients with coronary heart disease and congestive heart failure that reduces recurrent coronary events and cardiac mortality. The goal of the current systematic review and meta-analysis was to explore the association between depression and outpatient CR completion. METHOD A systematic literature review cross-referenced 3 electronic databases (PsycINFO, MEDLINE, and Dissertation Abstracts International) from inception through February 15, 2015. Studies quantifying an association between depression and outpatient CR completion were identified for review. A random-effects model was used to pool quantitative data, moderators were tested, and publication bias was analyzed. RESULTS Seventeen studies with 19 independent samples consisting of 30 586 cardiac patients were included in the meta-analysis. A moderate inverse relationship between depression and outpatient CR completion was observed (g = -0.44; 95% CI, -0.59 to -0.29), indicating that depressed CR patients were significantly less likely to complete their prescribed CR programs. No significant moderator variables were identified. A minor amount of publication bias was detected. CONCLUSION Depression is associated with reduced outpatient CR completion rates. Future research should focus on attendance interventions for depressed CR patients, as completion of outpatient CR reduces cardiac and all-cause mortality.
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Alpert JS. Cardiac Rehabilitation: An Underutilized Class I Treatment for Cardiovascular Disease. Am J Med 2020; 133:1005-1006. [PMID: 32027835 DOI: 10.1016/j.amjmed.2020.01.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Accepted: 01/30/2020] [Indexed: 12/30/2022]
Affiliation(s)
- Joseph S Alpert
- Department of Medicine, University of Arizona College of Medicine, Sarver Heart Center, Tucson; Editor in Chief, The American Journal of Medicine.
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Krishnamurthi N, Schopfer DW, Shen H, Whooley MA. Association of Mental Health Conditions With Participation in Cardiac Rehabilitation. J Am Heart Assoc 2020; 8:e011639. [PMID: 31115253 PMCID: PMC6585364 DOI: 10.1161/jaha.118.011639] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Background Mental health conditions are associated with adverse cardiovascular outcomes in patients with ischemic heart disease, and much of this risk can be attributed to poor health behaviors. Although all patients with ischemic heart disease should be referred for cardiac rehabilitation (CR), whether patients with mental health conditions are willing to participate in CR programs is unknown. We sought to compare CR participation rates among patients with ischemic heart disease with versus without comorbid depression and/or posttraumatic stress disorder (PTSD). Methods and Results We used national electronic health records to identify all patients hospitalized for acute myocardial infarction or coronary revascularization at Veterans Health Administration hospitals between 2010 and 2014. Multivariable logistic regression models were used to determine whether comorbid depression/PTSD was associated with CR participation during the 12 months after hospital discharge. Of the 86 537 patients hospitalized for ischemic heart disease between 2010 and 2014, 24% experienced PTSD and/or depression. Patients with PTSD and/or depression had higher CR participation rates than those without PTSD or depression (11% versus 8%; P<0.001). In comparison to patients without PTSD or depression, the odds of participation was 24% greater in patients with depression alone (odds ratio, 1.24; 95% CI, 1.15–1.34), 38% greater in patients with PTSD alone (odds ratio, 1.38; 95% CI, 1.24–1.54), and 57% greater in patients with both PTSD and depression (odds ratio, 1.57; 95% CI, 1.43–1.74). Conclusions Among patients with ischemic heart disease, the presence of comorbid depression and/or PTSD is associated with greater participation in CR, providing an important opportunity to promote healthy lifestyle behaviors and reduce adverse cardiovascular outcomes among these patients.
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Affiliation(s)
- Nirupama Krishnamurthi
- 1 Department of Medicine University of California, San Francisco San Francisco CA.,3 San Francisco Veterans Affairs Medical Center San Francisco CA
| | - David W Schopfer
- 1 Department of Medicine University of California, San Francisco San Francisco CA.,3 San Francisco Veterans Affairs Medical Center San Francisco CA
| | - Hui Shen
- 3 San Francisco Veterans Affairs Medical Center San Francisco CA
| | - Mary A Whooley
- 1 Department of Medicine University of California, San Francisco San Francisco CA.,2 Department of Epidemiology and Biostatistics University of California, San Francisco San Francisco CA.,3 San Francisco Veterans Affairs Medical Center San Francisco CA
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Sever S, Doherty P, Golder S, Harrison AS. Is improvement in depression in patients attending cardiac rehabilitation with new-onset depressive symptoms determined by patient characteristics? Open Heart 2020; 7:e001264. [PMID: 32847994 PMCID: PMC7451288 DOI: 10.1136/openhrt-2020-001264] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 06/24/2020] [Accepted: 07/13/2020] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Patients with cardiovascular disease (CVD) commonly experience depressive symptoms which is associated with adverse outcome and increased mortality. Examining the baseline characteristics of cardiac rehabilitation (CR) patients that determine Hospital Anxiety and Depression Scale (HADS) depression outcome may facilitate adjustments in CR programme delivery. This study aims to investigate whether comorbidities, demographic and clinical characteristics of patients, with new-onset post-cardiac event depressive symptoms, determine change in their depression following CR. METHODS Analysing the routine practice data of British Heart Foundation National Audit of Cardiac Rehabilitation between April 2012 and March 2018, an observational study was conducted. Patients with new-onset post-cardiac event depressive symptoms and no previous documented history of depression constituted the study population. RESULTS The analyses included 64 658 CR patients (66.24±10.69 years, 75% male) with new-onset HADS measures, excluding patients with a history of depression. The comorbidities determining reduced likelihood of improvement in depression outcomes after CR were angina, diabetes, stroke, emphysema and chronic back problems. In addition, higher total number of comorbidities, increased weight, a higher HADS anxiety score, smoking at baseline, physical inactivity, presence of heart failure and being single were other significant determinants. However, receiving coronary artery bypass graft treatment was associated with better improvement. CONCLUSION The study identified specific baseline comorbid conditions of patients with new-onset depressive symptoms including angina, diabetes, stroke, emphysema and chronic back problems that were determinants of poorer mental health outcomes (HADS) following CR. Higher total number of comorbidities, increased weight, physical inactivity, smoking, presence of heart failure and being single were other determinants of a negative change in depression. These findings could help CR programmes focus on tailoring the CR intervention around comorbidity, physical activity status, weight management and smoking cessation in patients with new-onset depressive symptoms.
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Affiliation(s)
- Serdar Sever
- Department of Health Sciences, University of York, York, North Yorkshire, UK
| | - Patrick Doherty
- Department of Health Sciences, University of York, York, North Yorkshire, UK
| | - Su Golder
- Department of Health Sciences, University of York, York, North Yorkshire, UK
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Zhang S, Liang C, Yang Y, Zhao Z, Li J, Meng X. Effects of Yangxinshi tablet on exercise tolerance in patients with coronary heart disease: A protocol of randomized, double-blind, placebo-controlled, and multi-center trial. Medicine (Baltimore) 2020; 99:e21485. [PMID: 32756176 PMCID: PMC7402915 DOI: 10.1097/md.0000000000021485] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Accepted: 06/29/2020] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Exercise intolerance is very common in patients with coronary heart disease (CHD). Although some researches confirming the validation of traditional Chinese medicine (TCM) on CHD treatment, the effect of TCM on improving the exercise tolerance of patients with CHD remains unclear so far. Our trial is to investigate whether the Yangxinshi (YXS) tablet can improve exercise tolerance as well as the quality of life among CHD patients. METHODS It is a randomized, double-blind, placebo-controlled, multi-center trial. A total of 90 patients with CHD from 3 hospitals in China will be enrolled and randomly assigned to one of 2 groups: YXS group, N = 45; placebo group, N = 45. The 2 groups will simultaneously receive standardized western medicine and exercise-based cardiac rehabilitation program for 12 weeks. The primary outcome measure is the exercise capacity, which will be evaluated by the cardiopulmonary exercise test and 6-minute walking test. The 2nd outcomes include symptom improvement, psychologic issues, laboratory tests, side effects, and adverse events. DISCUSSION To our knowledge, it is the 1st randomized controlled trial to evaluate the effect of TCM YXS tablet on exercise tolerance in patients with CHD. The results will provide more evidence for future studies in this area. TRIAL REGISTRATION This study protocol was registered in Research Registry (researchregistry5752).
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Affiliation(s)
- Sisi Zhang
- Cardiovascular and Cardiac Rehabilitation Department, First Affiliated Hospital of Changchun Chinese Medicine University, Changchun City, Jilin Province
| | - Congying Liang
- Cardiovascular and Cardiac Rehabilitation Department, First Affiliated Hospital of Changchun Chinese Medicine University, Changchun City, Jilin Province
| | - Yang Yang
- Cardiovascular and Cardiac Rehabilitation Department, First Affiliated Hospital of Changchun Chinese Medicine University, Changchun City, Jilin Province
| | - Zhijia Zhao
- Cardiovascular and Cardiac Rehabilitation Department, First Affiliated Hospital of Changchun Chinese Medicine University, Changchun City, Jilin Province
| | - Jiaojiao Li
- Operating Room Department, Feicheng Mining Bureau Central Hospital, Tai’an City, Shandong Province, China
| | - Xiaoping Meng
- Cardiovascular and Cardiac Rehabilitation Department, First Affiliated Hospital of Changchun Chinese Medicine University, Changchun City, Jilin Province
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Varghese TP, Kumar AV, Varghese NM, Chand S. Depression Related Pathophysiologies Relevant in Heart Disease: Insights into the Mechanism Based on Pharmacological Treatments. Curr Cardiol Rev 2020; 16:125-131. [PMID: 31775601 PMCID: PMC7460711 DOI: 10.2174/1573403x15666191127104520] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Revised: 11/05/2019] [Accepted: 11/21/2019] [Indexed: 01/08/2023] Open
Abstract
Depressive symptoms are highly prevalent in patients with cardiac diseases. Co-morbid Depression in cardiac patients causes a significant reduction in health-related quality of life for the patients and inflicts an economic burden on the society. Two types of mechanisms that may explain the link between depression and cardiac diseases are the psychosocial and physiopathological mechanisms. Physiopathological mechanisms are direct biological mechanisms, which include hyperactivity of non-adrenergic and Hypothalamic Pituitary Adrenal Axis (HPA), abnormal platelet activation, endothelial dysfunction, and inflammatory process. Psychosocial factors include behavioral or lifestyle factors like smoking alcoholism and physical inactivity. Pharmacologic and therapeutic interventions are effective at reducing symptoms of depression in patients with cardiac disorders. Among pharmacological treatment, SSRIs seems to be effective for the reduction of depressive symptoms among patients with cardiac disorders because of their good efficacy and minimal cardiovascular side effects. Mechanisms of action of SSRI’s in depressive patients with cardiac disorders are associated with their ability to reduce inflammation, platelet, and endothelial dysfunction. This review focuses on the potential pathophysiological and psychosocial links between cardiac diseases and depression, the treatment options, and the importance of routine screening of depressive symptoms in cardiac settings.
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Affiliation(s)
- Treesa P Varghese
- Department of Pharmacy Practice, NGSMIPS, Nitte (Deemed to be University), Mangaluru, Karnataka 575018, India
| | - Anand V Kumar
- Department of Pharmacology, JSS College of Pharmacy, Ooty, Tamilnadu, India
| | - Nila M Varghese
- Department of Pharmaceutics, St. Johnes College of Pharmaceutical Sciences and Research, Idukki, Kerala, India
| | - Sharad Chand
- Department of Pharmacy Practice, NGSMIPS, Nitte (Deemed to be University), Mangaluru, Karnataka 575018, India
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Nicholson B, Morse S, Lundgren T, Vadiei N, Bhattacharjee S. Effect of depression on health behavior among myocardial infarction survivors in the United States. Ment Health Clin 2020; 10:222-231. [PMID: 32685333 PMCID: PMC7337999 DOI: 10.9740/mhc.2020.07.222] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
Introduction The purpose of this study was to evaluate the effect of depression on health behavior among myocardial infarction (MI) survivors. Methods This retrospective, cross-sectional study used publicly available 2015 Behavioral Risk Factor Surveillance System (BRFSS) data. Our study sample includes adults aged 50 years or older who completed the 2015 BRFSS survey and reported having MI. The BRFSS participants with a yes response to the question, Has a doctor, nurse, or other health care professional ever told you that you had a heart attack, also called a myocardial infarction? were identified as MI survivors. The presence or absence of depression among MI survivors was identified using a similar question. Health behaviors, the dependent variable of this study, included physical activity, smoking status, alcohol use, body mass index, last flu immunization, last physical checkup, last blood cholesterol check, heavy drinking, and vegetable and fruit consumption. Univariate (χ2 tests) and multivariable (binomial logistic regression) analyses were used to assess the differences in health behaviors between MI survivors with or without depression. Results Our final study sample consists of 20 483 older adults with MI among whom 5343 (26.19%) reported having depression. Multivariable analyses reveal MI survivors with depression are more overweight, have less physical activity, and have higher likelihood of smoking but less odds of consuming alcohol compared to MI survivors without depression. Discussion In this nationally representative sample of adults aged over 50 years in the United States, MI survivors with depression exhibited poorer health behaviors compared to those without depression.
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Affiliation(s)
- Brooke Nicholson
- Pharmacist, Banner University Medical Center South, Tucson, Arizona
| | | | | | - Nina Vadiei
- Assistant Professor, Department of Pharmacy Practice and Science, College of Pharmacy, The University of Arizona, Tucson, Arizona
| | - Sandipan Bhattacharjee
- Pharmacist, Banner University Medical Center South, Tucson, Arizona.,Pharmacist, Walmart, Sierra Vista, Arizona.,Pharmacist, Genoa Healthcare, Tucson, Arizona.,Assistant Professor, Department of Pharmacy Practice and Science, College of Pharmacy, The University of Arizona, Tucson, Arizona
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The Journal of Cardiopulmonary Rehabilitation and Prevention at 40 yr and Its Role in Promoting Preventive Cardiology: Part 2. J Cardiopulm Rehabil Prev 2020; 40:209-214. [DOI: 10.1097/hcr.0000000000000523] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Salzwedel A, Jensen K, Rauch B, Doherty P, Metzendorf MI, Hackbusch M, Völler H, Schmid JP, Davos CH. Effectiveness of comprehensive cardiac rehabilitation in coronary artery disease patients treated according to contemporary evidence based medicine: Update of the Cardiac Rehabilitation Outcome Study (CROS-II). Eur J Prev Cardiol 2020; 27:1756-1774. [PMID: 32089005 PMCID: PMC7564293 DOI: 10.1177/2047487320905719] [Citation(s) in RCA: 129] [Impact Index Per Article: 32.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Background Despite numerous studies and meta-analyses the prognostic effect of cardiac rehabilitation is still under debate. This update of the Cardiac Rehabilitation Outcome Study (CROS II) provides a contemporary and practice focused approach including only cardiac rehabilitation interventions based on published standards and core components to evaluate cardiac rehabilitation delivery and effectiveness in improving patient prognosis. Design A systematic review and meta-analysis. Methods Randomised controlled trials and retrospective and prospective controlled cohort studies evaluating patients after acute coronary syndrome, coronary artery bypass grafting or mixed populations with coronary artery disease published until September 2018 were included. Results Based on CROS inclusion criteria out of 7096 abstracts six additional studies including 8671 patients were identified (two randomised controlled trials, two retrospective controlled cohort studies, two prospective controlled cohort studies). In total, 31 studies including 228,337 patients were available for this meta-analysis (three randomised controlled trials, nine prospective controlled cohort studies, 19 retrospective controlled cohort studies; 50,653 patients after acute coronary syndrome 14,583, after coronary artery bypass grafting 163,101, mixed coronary artery disease populations; follow-up periods ranging from 9 months to 14 years). Heterogeneity in design, cardiac rehabilitation delivery, biometrical assessment and potential confounders was considerable. Controlled cohort studies showed a significantly reduced total mortality (primary endpoint) after cardiac rehabilitation participation in patients after acute coronary syndrome (prospective controlled cohort studies: hazard ratio (HR) 0.37, 95% confidence interval (CI) 0.20–0.69; retrospective controlled cohort studies HR 0.64, 95% CI 0.53–0.76; prospective controlled cohort studies odds ratio 0.20, 95% CI 0.08–0.48), but the single randomised controlled trial fulfilling the CROS inclusion criteria showed neutral results. Cardiac rehabilitation participation was also associated with reduced total mortality in patients after coronary artery bypass grafting (retrospective controlled cohort studies HR 0.62, 95% CI 0.54–0.70, one single randomised controlled trial without fatal events), and in mixed coronary artery disease populations (retrospective controlled cohort studies HR 0.52, 95% CI 0.36–0.77; two out of 10 controlled cohort studies with neutral results). Conclusion CROS II confirms the effectiveness of cardiac rehabilitation participation after acute coronary syndrome and after coronary artery bypass grafting in actual clinical practice by reducing total mortality under the conditions of current evidence-based coronary artery disease treatment. The data of CROS II, however, underscore the urgent need to define internationally accepted minimal standards for cardiac rehabilitation delivery as well as for scientific evaluation.
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Affiliation(s)
- Annett Salzwedel
- Department of Rehabilitation Research, University of Potsdam, Germany
| | - Katrin Jensen
- Institute of Medical Biometry and Informatics (IMBI), University of Heidelberg, Germany
| | | | | | - Maria-Inti Metzendorf
- Cochrane Metabolic and Endocrine Disorders Group, Heinrich Heine University Düsseldorf, Germany
| | - Matthes Hackbusch
- Institute of Medical Biometry and Informatics (IMBI), University of Heidelberg, Germany
| | - Heinz Völler
- Department of Rehabilitation Research, University of Potsdam, Germany
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Abstract
The heart failure (HF) guidelines recommend palliative care; however, it can often be difficult to determine the timing of palliative care referral. Because HF with fluid retention and low-cardiac output may trigger several unpleasant symptoms, continuous HF treatment is required to alleviate these symptoms in advanced HF. The patients with HF often suffer from total pain; therefore, the support from a multidisciplinary team plays a crucial role to improve quality of life of the patients and their families not only in the terminal phase but also from the early stage.
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Affiliation(s)
- Keisuke Kida
- Department of Pharmacology, St. Marianna University School of Medicine, 2-16-1 Sugao Miyamae, Kawasaki, Kanagawa 216-8511, Japan.
| | - Shunichi Doi
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, 2-16-1 Sugao Miyamae, Kawasaki, Kanagawa 216-8511, Japan
| | - Norio Suzuki
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine Yokohama City Seibu Hospital, 1197-1 Yasachi-chou, Asahi-ku, Yokohama, Kanagawa 241-0811, Japan
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O'Neill D, Forman DE. The importance of physical function as a clinical outcome: Assessment and enhancement. Clin Cardiol 2020; 43:108-117. [PMID: 31825137 PMCID: PMC7021659 DOI: 10.1002/clc.23311] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Accepted: 11/20/2019] [Indexed: 02/06/2023] Open
Abstract
The burgeoning population of older adults is intrinsically prone to cardiovascular disease (CVD) in a context of multimorbidity and geriatric syndromes. Risks include high susceptibility to functional decline, with many older adults tipping towards patterns of sedentary behavior and to downstream effects of frailty, falls, disability, poor quality of life, as well as increased morbidity and mortality even if the incident CVD was treated perfectly. While physical activity has been shown to moderate these patterns both as primary or secondary preventive medical care, the majority of older adults fail to meet physical activity recommendations. Clinicians of all specialities, including CVD medicine, can benefit from greater proficiency in functional assessments for their older adults, as well as from insights how to initiate effective functional enhancing approaches even in older adults who may be frail, deconditioned, and medically complex. Pertinent functional assessments include traditional cardiovascular metrics of cardiorespiratory fitness, as well as strength and balance. This review summarizes the components of a wide-ranging functional assessment that can be used to enhance care for older adults with CVD, as well as interventions to improve physical function.
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Affiliation(s)
| | - Daniel E. Forman
- Professor of MedicineUniversity of Pittsburgh University of Pittsburgh Medical Center and VA Pittsburgh Healthcare SystemPittsburghPennsylvania
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Li G, Li J, Gao F. Exercise and Cardiovascular Protection. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2020; 1228:205-216. [PMID: 32342460 DOI: 10.1007/978-981-15-1792-1_14] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Accumulating evidence has demonstrated that exercise training not only reduces cardiovascular disease risk but also provides direct endogenous cardiovascular protection. The mechanisms that have been proposed to be responsible for exercise-induced cardioprotection include intrinsic myocardial changes such as increased cytosolic antioxidant capacity and altered mitochondrial phenotype, myokine-mediated metabolic and anti-inflammatory effects in the cardiovascular system, and systemic effects on the cardiovascular system via interorgan cross talk. There remains much to be elucidated in the mechanisms for exercise-afforded cardioprotection. This chapter reviews exercise-induced acute and chronic responses in cardiovascular system, the epidemiological evidence of exercise training and cardiorespiratory fitness in the primary and secondary prevention of cardiovascular diseases, and the current understanding of the mechanisms of exercise-induced cardiovascular protective effects.
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Affiliation(s)
- Guohua Li
- School of Aerospace Medicine, The Fourth Military Medical University, Xi'an, China
| | - Jia Li
- School of Aerospace Medicine, The Fourth Military Medical University, Xi'an, China
| | - Feng Gao
- School of Aerospace Medicine, The Fourth Military Medical University, Xi'an, China.
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Sever S, Doherty P, Harrison AS, Golder S. To what extent is multi-morbidity associated with new onset depression in patients attending cardiac rehabilitation? BMC Cardiovasc Disord 2019; 19:256. [PMID: 31726981 PMCID: PMC6857318 DOI: 10.1186/s12872-019-1245-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Accepted: 11/06/2019] [Indexed: 11/21/2022] Open
Abstract
Background Depression is associated with increased mortality and poor prognosis in patients with cardiovascular disease (CVD). However, little is known about the patient characteristics associated with new onset post heart event depressive symptoms, specifically medical comorbidities, among cardiac rehabilitation (CR) participants. Therefore, this paper examines the comorbidity profile and characteristics associated with new onset depressive symptoms in patients attending CR. Methods An observational study using the routine practice data of British Heart Foundation National Audit of Cardiac Rehabilitation (NACR) from the last six years between April 2012 and March 2018. Patients with new onset post heart event depression and no previous documented history of depression were selected as the study population. An independent samples t-test and chi square tests were used to compare the association between new onset depressive symptoms and patient variables including demographics, clinical measures and comorbidities. A binary logistic regression was conducted to investigate the predictors of new onset depressive symptoms employing log-likelihood ratio statistic. Results The analyses included 109,055 CR patients with new onset depression measured by Hospital Anxiety and Depression Scale (HADS). At baseline assessment, comorbidity measures associated with new onset depressive symptoms were increased total number of comorbidities and a range of comorbidities - including diabetes, angina, arthritis, chronic back problems, asthma, stroke, anxiety, rheumatism, claudication, osteoporosis, chronic bronchitis and emphysema. After multivariate adjustments were done, at the start of CR, the significant predictors of new onset depressive symptoms were physical inactivity, high HADS anxiety score measurement, increased weight, total number of comorbidities, diabetes, stroke, chronic back problems, being from areas with higher levels of social deprivation, being single, and male. Conclusion The research findings establish new insights into the association between patient demographic and clinical variables across a range of comorbidities in patients with new onset post heart event depressive symptoms. At the start of CR, patients with new onset depressive symptoms need to be assessed skilfully as they tend to have a complex multi-morbid presentation linked to psychosocial risk factors known to hinder CR engagement.
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Affiliation(s)
- Serdar Sever
- Department of Health Sciences, Faculty of Science, University of York, York, UK.
| | - Patrick Doherty
- Department of Health Sciences, Faculty of Science, University of York, ATB/255 Seebohm Rowntree Building, York, UK
| | - Alexander Stephen Harrison
- Department of Health Sciences, Faculty of Science, University of York, ATB/255 Seebohm Rowntree Building, York, UK
| | - Su Golder
- Department of Health Sciences, Faculty of Science, University of York, ATB/255 Seebohm Rowntree Building, York, UK
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