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Elzeneini M, George J, Ashraf H, Xu K, Petersen J, Anderson RD, Handberg EM, Pepine CJ, Aggarwal M. Impact of a preventive cardiology clinic focusing on lifestyle and nutrition counseling: A pilot analysis. AMERICAN HEART JOURNAL PLUS : CARDIOLOGY RESEARCH AND PRACTICE 2021; 6:100032. [PMID: 38560555 PMCID: PMC10976304 DOI: 10.1016/j.ahjo.2021.100032] [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: 05/27/2021] [Accepted: 06/15/2021] [Indexed: 04/04/2024]
Abstract
Standard cardiology practice often defers preventive strategies to primary care providers. We aimed to evaluate the effectiveness of a preventive cardiology clinic focused on lifestyle and nutrition counseling combined with guideline-directed medical therapy on reducing cardiovascular disease (CVD) risk. We queried the University of Florida-Health database for patients enrolled in the preventive cardiology clinic, and a general and interventional cardiology clinic from January 2016 to October 2019. Mean change in weight and blood cholesterol including LDL cholesterol (LDL-C), total cholesterol (TC) and triglycerides (TG) were compared in the three clinics in the initial cohort and stratified into primary and secondary prevention. A propensity score-matched analysis was done to adjust for CVD risk factors and statin use. Among a cohort of 239 patients, enrollment in the preventive clinic (n = 99) was associated with greater weight loss at 6 months compared to other clinics (n = 140) (mean -1.7 vs +0.1 kg, p 0.007). Preventive clinic was also associated with greater mean reduction in LDL-C (-24.8 vs -7.1 mg/dl, p 0.021), TC (-29.3 vs -2.0, p 0.003) and TG (-19.7 vs +13.3, p 0.002) at both initial and last follow-up (median time 6 and 16 months). The association with reduction in TG was observed in both primary and secondary prevention, but reduction in LDL-C and TC was only significant in secondary prevention. In a propensity-matched linear regression analysis, preventive clinic was independently associated with LDL-C reduction (b -14.7, r -0.3, p 0.038). A preventive cardiology clinic focused on patient education can be effective in reducing CVD risk.
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Affiliation(s)
- Mohammed Elzeneini
- Department of Internal Medicine, University of Florida, Gainesville, FL, USA
| | - Jerin George
- Department of Internal Medicine, University of Florida, Gainesville, FL, USA
| | - Hassan Ashraf
- Department of Internal Medicine, University of Florida, Gainesville, FL, USA
| | - Ke Xu
- Department of Health Outcomes and Biomedical Informatics, University of Florida, Gainesville, FL, USA
| | - John Petersen
- Division of Cardiovascular Medicine, University of Florida, Gainesville, FL, USA
| | - R. David Anderson
- Division of Cardiovascular Medicine, University of Florida, Gainesville, FL, USA
| | - Eileen M. Handberg
- Division of Cardiovascular Medicine, University of Florida, Gainesville, FL, USA
| | - Carl J. Pepine
- Division of Cardiovascular Medicine, University of Florida, Gainesville, FL, USA
| | - Monica Aggarwal
- Division of Cardiovascular Medicine, University of Florida, Gainesville, FL, USA
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Winnige P, Vysoky R, Dosbaba F, Batalik L. Cardiac rehabilitation and its essential role in the secondary prevention of cardiovascular diseases. World J Clin Cases 2021; 9:1761-1784. [PMID: 33748226 PMCID: PMC7953385 DOI: 10.12998/wjcc.v9.i8.1761] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Revised: 01/18/2021] [Accepted: 02/01/2021] [Indexed: 02/06/2023] Open
Abstract
Cardiovascular diseases are the most common causes of mortality worldwide. They are frequently the reasons for patient hospitalization, their incapability for work, and disability. These diseases represent a significant socio-economic burden affecting the medical system as well as patients and their families. It has been demonstrated that the etiopathogenesis of cardiovascular diseases is significantly affected by lifestyle, and so modification of the latter is an essential component of both primary and secondary prevention. Cardiac rehabilitation (CR) represents an efficient secondary prevention model that is especially based on the positive effect of regular physical activity. This review presents an overview of basic information on CR with a focus on current trends, such as the issue of the various training modalities, utilization, and barriers to it or the use of telemedicine technologies. Appropriate attention should be devoted to these domains, as CR continues evolving as an effective and readily available intervention in the future.
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Affiliation(s)
- Petr Winnige
- Department of Public Health, Faculty of Medicine, Masaryk University, Czech Republic, Brno 62500, Jihomoravsky, Czech Republic
- Department of Rehabilitation, University Hospital Brno, Brno 62500, Czech Republic
| | - Robert Vysoky
- Department of Public Health, Faculty of Medicine, Masaryk University, Czech Republic, Brno 62500, Jihomoravsky, Czech Republic
- Department of Health Promotion, Faculty of Sports Studies, Masaryk University, Brno 62500, Jihomoravsky, Czech Republic
| | - Filip Dosbaba
- Department of Rehabilitation, University Hospital Brno, Brno 62500, Czech Republic
| | - Ladislav Batalik
- Department of Rehabilitation, University Hospital Brno, Brno 62500, Czech Republic
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Lindman BR, Gillam LD, Coylewright M, Welt FGP, Elmariah S, Smith SA, McKeel DA, Jackson N, Mukerjee K, Cloud H, Hanna N, Purpura J, Ellis H, Martinez V, Selberg AM, Huang S, Harrell FE. Effect of a pragmatic home-based mobile health exercise intervention after transcatheter aortic valve replacement: a randomized pilot trial. EUROPEAN HEART JOURNAL. DIGITAL HEALTH 2021; 2:90-103. [PMID: 34048509 PMCID: PMC8139414 DOI: 10.1093/ehjdh/ztab007] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 01/12/2021] [Accepted: 01/28/2021] [Indexed: 01/31/2023]
Abstract
AIMS Impaired physical function is common in patients undergoing transcatheter aortic valve replacement (TAVR) and associated with worse outcomes. Participation in centre-based cardiac rehabilitation (CR) after cardiovascular procedures is sub-optimal. We aimed to test a home-based mobile health exercise intervention as an alternative or complementary approach. METHODS AND RESULTS At five centres, after a run-in period, eligible individuals treated with TAVR were randomized 1:1 at their 1-month post-TAVR visit to an intervention group [activity monitor (AM) with personalized daily step goal and resistance exercises] or a control group for 6 weeks. Among 50 participants, average age was 76 years, 34% were female, average STS score was 2.91.8, and 40% had Short Physical Performance Battery (SPPB) 9. Daily compliance with wearing the AM and performing exercises averaged 8590%. In the intention to treat population, there was no evidence that the intervention improved the co-primary endpoints: daily steps +769 (95% CI 244 to +1783); SPPB +0.68 (0.27 to 1.53); and Kansas City Cardiomyopathy Questionnaire 1.7 (9.1 to 7.1). The intervention did improve secondary physical activity parameters, including moderate-to-intense daily active minutes (P<0.05). In a pre-specified analysis including participants who did not participate in CR (n=30), the intervention improved several measures of physical activity: +1730 (1003360) daily steps; +66 (28105) daily active minutes; +53 (2780) moderate-to-intense active minutes; and 157 (265 to 50) sedentary minutes. CONCLUSION Among selected participants treated with TAVR, this study did not provide evidence that a pragmatic home-based mobile health exercise intervention improved daily steps, physical performance or QoL for the overall cohort. However, the intervention did improve several measures of daily activity, particularly among individuals not participating in CR. TRIAL REGISTRY Clinicaltrials.gov NCT03270124.
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Affiliation(s)
- Brian R Lindman
- Structural Heart and Valve Center, Vanderbilt University Medical Center, 2525 West End Ave., Suite 300-A, Nashville, TN 37203, USA,Cardiovascular Medicine Division, Vanderbilt University Medical Center, Nashville, TN, USA,Corresponding author. Tel: +1 615 936 5949, Fax: +1 615 322 3837,
| | - Linda D Gillam
- Department of Cardiovascular Medicine, Morristown Medical Center/Atlantic Health System, Morristown, NJ, USA
| | - Megan Coylewright
- Section of Cardiovascular Medicine, Heart and Vascular Center, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | - Frederick G P Welt
- Division of Cardiovascular Medicine, University of Utah Health, Salt Lake City, UT, USA
| | - Sammy Elmariah
- Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Stephanie A Smith
- Vanderbilt Coordinating Center, Vanderbilt University Medical Center, Nashville, TN, USA
| | - David A McKeel
- Vanderbilt Coordinating Center, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Natalie Jackson
- Structural Heart and Valve Center, Vanderbilt University Medical Center, 2525 West End Ave., Suite 300-A, Nashville, TN 37203, USA,Cardiovascular Medicine Division, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Kush Mukerjee
- Department of Cardiovascular Medicine, Morristown Medical Center/Atlantic Health System, Morristown, NJ, USA
| | - Harrison Cloud
- Structural Heart and Valve Center, Vanderbilt University Medical Center, 2525 West End Ave., Suite 300-A, Nashville, TN 37203, USA,Cardiovascular Medicine Division, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Narden Hanna
- Structural Heart and Valve Center, Vanderbilt University Medical Center, 2525 West End Ave., Suite 300-A, Nashville, TN 37203, USA,Cardiovascular Medicine Division, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Jenelle Purpura
- Department of Cardiovascular Medicine, Morristown Medical Center/Atlantic Health System, Morristown, NJ, USA
| | - Hannah Ellis
- Section of Cardiovascular Medicine, Heart and Vascular Center, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | - Vong Martinez
- Division of Cardiovascular Medicine, University of Utah Health, Salt Lake City, UT, USA
| | - Alexandra M Selberg
- Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Shi Huang
- Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Frank E Harrell
- Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, TN, USA
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