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Manolis AS, Manolis AA. Exercise and Arrhythmias: A Double-Edged Sword. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2016; 39:748-62. [PMID: 27120033 DOI: 10.1111/pace.12879] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Revised: 04/07/2016] [Accepted: 04/09/2016] [Indexed: 12/18/2022]
Abstract
Ample evidence indicates that moderate regular exercise is beneficial for both normal individuals and patients with cardiovascular (CV) disease. However, intense and strenuous exercise in individuals with evident or occult underlying CV abnormalities may have adverse effects with provocation and exacerbation of arrhythmias that may lead to life-threatening situations. Both of these aspects of exercise-induced effects are herein reviewed.
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Affiliation(s)
- Antonis S Manolis
- Third Department of Cardiology, Athens University School of Medicine, Athens, Greece
| | - Antonis A Manolis
- Third Department of Cardiology, Athens University School of Medicine, Athens, Greece
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102
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Butrous H, Hummel SL. Heart Failure in Older Adults. Can J Cardiol 2016; 32:1140-7. [PMID: 27476982 DOI: 10.1016/j.cjca.2016.05.005] [Citation(s) in RCA: 85] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Revised: 04/21/2016] [Accepted: 05/04/2016] [Indexed: 12/11/2022] Open
Abstract
Heart failure (HF) is a leading cause of morbidity, hospitalization, and mortality in older adults and a growing public health problem placing a huge financial burden on the health care system. Many challenges exist in the assessment and management of HF in geriatric patients, who often have coexisting multimorbidity, polypharmacy, cognitive impairment, and frailty. These complex "geriatric domains" greatly affect physical and functional status as well as long-term clinical outcomes. Geriatric patients have been under-represented in major HF clinical trials. Nonetheless, available data suggest that guideline-based medical and device therapies improve morbidity and mortality. Nonpharmacologic strategies, such as exercise training and dietary interventions, are an active area of research. Targeted geriatric evaluation, including functional and cognitive assessment, can improve risk stratification and guide management in older patients with HF. Clinical trials that enroll older patients with multiple morbidities and HF and evaluate functional status and quality of life in addition to mortality and cardiovascular morbidity should be encouraged to guide management of this age group.
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Affiliation(s)
- Hoda Butrous
- Oakland University William Beaumont School of Medicine, Beaumont Dearborn-Oakwood Hospital, Dearborn, Michigan, USA
| | - Scott L Hummel
- Frankel Cardiovascular Center, University of Michigan, Ann Arbor, Michigan, USA; Ann Arbor Veterans Affairs Health System, Ann Arbor, Michigan, USA.
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103
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Effects of Neuromuscular Electrical Stimulation on Physiologic and Functional Measurements in Patients With Heart Failure. J Cardiopulm Rehabil Prev 2016; 36:157-66. [DOI: 10.1097/hcr.0000000000000151] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
OBJECTIVE Psychological distress has been associated with poor outcomes in patients with chronic heart failure (HF), which is assumed to be partly due to poor HF self-care behavior. This systematic review and meta-analysis describes the current evidence concerning psychological determinants of self-care in patients with chronic HF. METHODS Eligible studies were systematically identified by searching electronic databases PubMed, PsycINFO, and the Conference Proceedings Citation Index (Web of Science) for relevant literature (1980-October 17, 2014). Study quality was assessed according to the level of risk of bias. Quantitative data were pooled using random-effects models. RESULTS Sixty-five studies were identified for inclusion that varied considerably with respect to sample and study characteristics. Risk of bias was high in the reviewed studies and most problematic with regard to selection bias (67%). Depression (r = -0.19, p < .001), self-efficacy (r = 0.37, p < .001), and mental well-being (r = 0.14, p = .030) were significantly associated with self-reported self-care. Anxiety was not significantly associated with either self-reported (r = -0.18, p = .24) or objective self-care (r = -0.04, p = .79), neither was depression associated with objectively measured medication adherence (r = -0.05, p = .44). CONCLUSIONS Psychological factors (depression, self-efficacy, and mental well-being) were associated with specific self-care facets in patients with chronic HF. These associations were predominantly observed with self-reported indices of self-care and not objective indices. Methodological heterogeneity and limitations preclude definite conclusions about the association between psychological factors and self-care and should be addressed in future research.
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Abstract
The estimated cost of treating patients with HF in the United States is expected to more than double by 2030.65 This forecast of the impact of HF in the United States should serve as a call to action. Despite well-documented benefits, participation in exercise training and CR programs by patients with HF remains low. In this article, standards and guidelines for exercise and CR in HF were reviewed. Although traditional CR had core components, it lacked care management specific for HF. Chronic stable HF patients can safely exercise; however, there are many unique needs that are not currently addressed at the patient, system, and provider levels. As we face economic and political forces that are expected to require major change to the health care delivery system, it becomes even more important to capitalize on the advantages that come with team-based care. CR has always served as a model of team-based care; however, the model must now include professionals with HF expertise to guide patients in safe exercise and self-management strategies appropriate for this chronically ill population.
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Affiliation(s)
- Bunny Pozehl
- University of Nebraska Medical Center, College of Nursing, 1230 O Street, Suite 131, Lincoln, NE 68588-0220, USA.
| | - Rita McGuire
- University of Nebraska Medical Center, College of Nursing, 1230 O Street, Suite 131, Lincoln, NE 68588-0220, USA
| | - Joseph Norman
- Division of Physical Therapy Education, 984420 Nebraska Medical Center, Omaha, NE 68198-4420, USA
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Tei C, Imamura T, Kinugawa K, Inoue T, Masuyama T, Inoue H, Noike H, Muramatsu T, Takeishi Y, Saku K, Harada K, Daida H, Kobayashi Y, Hagiwara N, Nagayama M, Momomura S, Yonezawa K, Ito H, Gojo S, Akaishi M, Miyata M, Ohishi M. Waon Therapy for Managing Chronic Heart Failure - Results From a Multicenter Prospective Randomized WAON-CHF Study. Circ J 2016; 80:827-34. [PMID: 27001189 DOI: 10.1253/circj.cj-16-0051] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Waon therapy improves heart failure (HF) symptoms, but further evidence in patients with advanced HF remains uncertain. METHODS AND RESULTS In 19 institutes, we prospectively enrolled hospitalized patients with advanced HF, who had plasma levels of B-type natriuretic peptide (BNP) >500 pg/ml on admission and BNP >300 pg/ml regardless of more than 1 week of medical therapy. Enrolled patients were randomized into Waon therapy or control groups. Waon therapy was performed once daily for 10 days with a far infrared-ray dry sauna maintained at 60℃ for 15 min, followed by bed rest for 30 min covered with a blanket. The primary endpoint was the ratio of BNP before and after treatment. In total, 76 Waon therapy and 73 control patients (mean age 66 years, men 61%, mean plasma BNP 777 pg/ml) were studied. The groups differed only in body mass index and the frequency of diabetes. The plasma BNP, NYHA classification, 6-min walk distance (6MWD), and cardiothoracic ratio significantly improved only in the Waon therapy group. Improvements in NYHA classification, 6MWD, and cardiothoracic ratio were significant in the Waon therapy group, although the change in plasma BNP did not reach statistical significance. No serious adverse events were observed in either group. CONCLUSIONS Waon therapy, a holistic soothing warmth therapy, showed clinical advantages in safety and efficacy among patients with advanced HF.
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Keteyian SJ, Kerrigan DJ. Tugging on a Simpler Test to Evaluate Physical Mobility and Function in Patients With Heart Failure. J Card Fail 2016; 22:651-2. [PMID: 26777756 DOI: 10.1016/j.cardfail.2016.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Revised: 01/05/2016] [Accepted: 01/05/2016] [Indexed: 10/22/2022]
Affiliation(s)
- Steven J Keteyian
- Division of Cardiovascular Medicine, Henry Ford Medical Group, Henry Ford Health System, Detroit, Michigan.
| | - Dennis J Kerrigan
- Division of Cardiovascular Medicine, Henry Ford Medical Group, Henry Ford Health System, Detroit, Michigan
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Gilstrap LG, Joynt KE. Both processes and readmissions matter for heart failure: How can we align them? Am Heart J 2015; 170:968-70. [PMID: 26542506 DOI: 10.1016/j.ahj.2015.07.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Accepted: 07/15/2015] [Indexed: 11/29/2022]
Affiliation(s)
- Lauren Gray Gilstrap
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA
| | - Karen E Joynt
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA.
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Affiliation(s)
- Sunny Intwala
- From Section of Cardiology, Boston Medical Center, MA; and Boston University School of Medicine, MA
| | - Gary J Balady
- From Section of Cardiology, Boston Medical Center, MA; and Boston University School of Medicine, MA.
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Affiliation(s)
- Hasnain M Dalal
- University of Exeter Medical School (primary care), Truro Campus, Knowledge Spa, Royal Cornwall Hospital, Truro TR1 3HD, UK
| | - Patrick Doherty
- Department of Health Sciences, University of York, York YO10 5DD, UK
| | - Rod S Taylor
- Institute of Health Research, University of Exeter Medical School, Exeter EX1 2LU, UK
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Compostella L, Russo N, Setzu T, Bottio T, Compostella C, Tarzia V, Livi U, Gerosa G, Iliceto S, Bellotto F. A Practical Review for Cardiac Rehabilitation Professionals of Continuous-Flow Left Ventricular Assist Devices. J Cardiopulm Rehabil Prev 2015; 35:301-11. [DOI: 10.1097/hcr.0000000000000113] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Exercise physiology, testing, and training in patients supported by a left ventricular assist device. J Heart Lung Transplant 2015; 34:1005-16. [DOI: 10.1016/j.healun.2014.12.006] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2014] [Revised: 12/03/2014] [Accepted: 12/17/2014] [Indexed: 01/14/2023] Open
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Southern WM, Ryan TE, Kepple K, Murrow JR, Nilsson KR, McCully KK. Reduced skeletal muscle oxidative capacity and impaired training adaptations in heart failure. Physiol Rep 2015; 3:3/4/e12353. [PMID: 25855248 PMCID: PMC4425959 DOI: 10.14814/phy2.12353] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Systolic heart failure (HF) is associated with exercise intolerance that has been attributed, in part, to skeletal muscle dysfunction. The purpose of this study was to compare skeletal muscle oxidative capacity and training-induced changes in oxidative capacity in participants with and without HF. Participants with HF (n = 16, 65 ± 6.6 years) were compared with control participants without HF (n = 23, 61 ± 5.0 years). A subset of participants (HF: n = 7, controls: n = 5) performed 4 weeks of wrist-flexor exercise training. Skeletal muscle oxidative capacity was determined from the recovery kinetics of muscle oxygen consumption measured by near-infrared spectroscopy (NIRS) following a brief bout of wrist-flexor exercise. Oxidative capacity, prior to exercise training, was significantly lower in the HF participants in both the dominant (1.31 ± 0.30 min−1 vs. 1.59 ± 0.25 min−1, P = 0.002; HF and control groups, respectively) and nondominant arms (1.29 ± 0.24 min−1 vs. 1.46 ± 0.23 min−1, P = 0.04; HF and control groups, respectively). Following 4 weeks of endurance training, there was a significant difference in the training response between HF and controls, as the difference in oxidative training adaptations was 0.69 ± 0.12 min−1 (P < 0.001, 95% CI 0.43, 0.96). The wrist-flexor training induced a ∼50% improvement in oxidative capacity in participants without HF (mean difference from baseline = 0.66 ± 0.09 min−1, P < 0.001, 95% CI 0.33, 0.98), whereas participants with HF showed no improvement in oxidative capacity (mean difference from baseline = −0.04 ± 0.08 min−1, P = 0.66, 95% CI −0.24, 0.31), suggesting impairments in mitochondrial biogenesis. In conclusion, participants with HF had reduced oxidative capacity and impaired oxidative adaptations to endurance exercise compared to controls.
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Affiliation(s)
| | | | | | - Jonathan R Murrow
- University of Georgia, Athens, Georgia Georgia Regents University, Athens, Georgia
| | - Kent R Nilsson
- University of Georgia, Athens, Georgia Georgia Regents University, Athens, Georgia
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Fleg JL, Cooper LS, Borlaug BA, Haykowsky MJ, Kraus WE, Levine BD, Pfeffer MA, Piña IL, Poole DC, Reeves GR, Whellan DJ, Kitzman DW. Exercise training as therapy for heart failure: current status and future directions. Circ Heart Fail 2015; 8:209-20. [PMID: 25605639 DOI: 10.1161/circheartfailure.113.001420] [Citation(s) in RCA: 120] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- Jerome L Fleg
- From the Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD (J.L.F., L.S.C.); Division of Cardiovascular Disease, Mayo Clinic, Rochester, MN (B.A.B.); Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta, Canada (M.J.H.); Division of Cardiology, Duke University School of Medicine, Durham, NC (W.E.K.); Institute for Exercise and Environmental Medicine, University of Texas Southwestern Medical Center, Dallas (B.D.L.); Cardiovascular Division, Brigham and Women's Hospital, Boston, MA (M.A.P.); Division of Cardiology, Albert Einstein College of Medicine, Bronx, NY (I.L.P.); Department of Kinesiology (D.C.P.) and Department of Anatomy and Physiology (D.C.P.), Kansas State University, Manhattan; Division of Cardiology, Jefferson Medical College, Philadelphia, PA (G.R.R., D.J.W.); and Sections on Cardiology and Geriatrics, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC (D.W.K.).
| | - Lawton S Cooper
- From the Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD (J.L.F., L.S.C.); Division of Cardiovascular Disease, Mayo Clinic, Rochester, MN (B.A.B.); Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta, Canada (M.J.H.); Division of Cardiology, Duke University School of Medicine, Durham, NC (W.E.K.); Institute for Exercise and Environmental Medicine, University of Texas Southwestern Medical Center, Dallas (B.D.L.); Cardiovascular Division, Brigham and Women's Hospital, Boston, MA (M.A.P.); Division of Cardiology, Albert Einstein College of Medicine, Bronx, NY (I.L.P.); Department of Kinesiology (D.C.P.) and Department of Anatomy and Physiology (D.C.P.), Kansas State University, Manhattan; Division of Cardiology, Jefferson Medical College, Philadelphia, PA (G.R.R., D.J.W.); and Sections on Cardiology and Geriatrics, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC (D.W.K.)
| | - Barry A Borlaug
- From the Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD (J.L.F., L.S.C.); Division of Cardiovascular Disease, Mayo Clinic, Rochester, MN (B.A.B.); Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta, Canada (M.J.H.); Division of Cardiology, Duke University School of Medicine, Durham, NC (W.E.K.); Institute for Exercise and Environmental Medicine, University of Texas Southwestern Medical Center, Dallas (B.D.L.); Cardiovascular Division, Brigham and Women's Hospital, Boston, MA (M.A.P.); Division of Cardiology, Albert Einstein College of Medicine, Bronx, NY (I.L.P.); Department of Kinesiology (D.C.P.) and Department of Anatomy and Physiology (D.C.P.), Kansas State University, Manhattan; Division of Cardiology, Jefferson Medical College, Philadelphia, PA (G.R.R., D.J.W.); and Sections on Cardiology and Geriatrics, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC (D.W.K.)
| | - Mark J Haykowsky
- From the Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD (J.L.F., L.S.C.); Division of Cardiovascular Disease, Mayo Clinic, Rochester, MN (B.A.B.); Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta, Canada (M.J.H.); Division of Cardiology, Duke University School of Medicine, Durham, NC (W.E.K.); Institute for Exercise and Environmental Medicine, University of Texas Southwestern Medical Center, Dallas (B.D.L.); Cardiovascular Division, Brigham and Women's Hospital, Boston, MA (M.A.P.); Division of Cardiology, Albert Einstein College of Medicine, Bronx, NY (I.L.P.); Department of Kinesiology (D.C.P.) and Department of Anatomy and Physiology (D.C.P.), Kansas State University, Manhattan; Division of Cardiology, Jefferson Medical College, Philadelphia, PA (G.R.R., D.J.W.); and Sections on Cardiology and Geriatrics, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC (D.W.K.)
| | - William E Kraus
- From the Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD (J.L.F., L.S.C.); Division of Cardiovascular Disease, Mayo Clinic, Rochester, MN (B.A.B.); Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta, Canada (M.J.H.); Division of Cardiology, Duke University School of Medicine, Durham, NC (W.E.K.); Institute for Exercise and Environmental Medicine, University of Texas Southwestern Medical Center, Dallas (B.D.L.); Cardiovascular Division, Brigham and Women's Hospital, Boston, MA (M.A.P.); Division of Cardiology, Albert Einstein College of Medicine, Bronx, NY (I.L.P.); Department of Kinesiology (D.C.P.) and Department of Anatomy and Physiology (D.C.P.), Kansas State University, Manhattan; Division of Cardiology, Jefferson Medical College, Philadelphia, PA (G.R.R., D.J.W.); and Sections on Cardiology and Geriatrics, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC (D.W.K.)
| | - Benjamin D Levine
- From the Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD (J.L.F., L.S.C.); Division of Cardiovascular Disease, Mayo Clinic, Rochester, MN (B.A.B.); Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta, Canada (M.J.H.); Division of Cardiology, Duke University School of Medicine, Durham, NC (W.E.K.); Institute for Exercise and Environmental Medicine, University of Texas Southwestern Medical Center, Dallas (B.D.L.); Cardiovascular Division, Brigham and Women's Hospital, Boston, MA (M.A.P.); Division of Cardiology, Albert Einstein College of Medicine, Bronx, NY (I.L.P.); Department of Kinesiology (D.C.P.) and Department of Anatomy and Physiology (D.C.P.), Kansas State University, Manhattan; Division of Cardiology, Jefferson Medical College, Philadelphia, PA (G.R.R., D.J.W.); and Sections on Cardiology and Geriatrics, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC (D.W.K.)
| | - Marc A Pfeffer
- From the Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD (J.L.F., L.S.C.); Division of Cardiovascular Disease, Mayo Clinic, Rochester, MN (B.A.B.); Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta, Canada (M.J.H.); Division of Cardiology, Duke University School of Medicine, Durham, NC (W.E.K.); Institute for Exercise and Environmental Medicine, University of Texas Southwestern Medical Center, Dallas (B.D.L.); Cardiovascular Division, Brigham and Women's Hospital, Boston, MA (M.A.P.); Division of Cardiology, Albert Einstein College of Medicine, Bronx, NY (I.L.P.); Department of Kinesiology (D.C.P.) and Department of Anatomy and Physiology (D.C.P.), Kansas State University, Manhattan; Division of Cardiology, Jefferson Medical College, Philadelphia, PA (G.R.R., D.J.W.); and Sections on Cardiology and Geriatrics, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC (D.W.K.)
| | - Ileana L Piña
- From the Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD (J.L.F., L.S.C.); Division of Cardiovascular Disease, Mayo Clinic, Rochester, MN (B.A.B.); Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta, Canada (M.J.H.); Division of Cardiology, Duke University School of Medicine, Durham, NC (W.E.K.); Institute for Exercise and Environmental Medicine, University of Texas Southwestern Medical Center, Dallas (B.D.L.); Cardiovascular Division, Brigham and Women's Hospital, Boston, MA (M.A.P.); Division of Cardiology, Albert Einstein College of Medicine, Bronx, NY (I.L.P.); Department of Kinesiology (D.C.P.) and Department of Anatomy and Physiology (D.C.P.), Kansas State University, Manhattan; Division of Cardiology, Jefferson Medical College, Philadelphia, PA (G.R.R., D.J.W.); and Sections on Cardiology and Geriatrics, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC (D.W.K.)
| | - David C Poole
- From the Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD (J.L.F., L.S.C.); Division of Cardiovascular Disease, Mayo Clinic, Rochester, MN (B.A.B.); Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta, Canada (M.J.H.); Division of Cardiology, Duke University School of Medicine, Durham, NC (W.E.K.); Institute for Exercise and Environmental Medicine, University of Texas Southwestern Medical Center, Dallas (B.D.L.); Cardiovascular Division, Brigham and Women's Hospital, Boston, MA (M.A.P.); Division of Cardiology, Albert Einstein College of Medicine, Bronx, NY (I.L.P.); Department of Kinesiology (D.C.P.) and Department of Anatomy and Physiology (D.C.P.), Kansas State University, Manhattan; Division of Cardiology, Jefferson Medical College, Philadelphia, PA (G.R.R., D.J.W.); and Sections on Cardiology and Geriatrics, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC (D.W.K.)
| | - Gordon R Reeves
- From the Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD (J.L.F., L.S.C.); Division of Cardiovascular Disease, Mayo Clinic, Rochester, MN (B.A.B.); Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta, Canada (M.J.H.); Division of Cardiology, Duke University School of Medicine, Durham, NC (W.E.K.); Institute for Exercise and Environmental Medicine, University of Texas Southwestern Medical Center, Dallas (B.D.L.); Cardiovascular Division, Brigham and Women's Hospital, Boston, MA (M.A.P.); Division of Cardiology, Albert Einstein College of Medicine, Bronx, NY (I.L.P.); Department of Kinesiology (D.C.P.) and Department of Anatomy and Physiology (D.C.P.), Kansas State University, Manhattan; Division of Cardiology, Jefferson Medical College, Philadelphia, PA (G.R.R., D.J.W.); and Sections on Cardiology and Geriatrics, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC (D.W.K.)
| | - David J Whellan
- From the Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD (J.L.F., L.S.C.); Division of Cardiovascular Disease, Mayo Clinic, Rochester, MN (B.A.B.); Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta, Canada (M.J.H.); Division of Cardiology, Duke University School of Medicine, Durham, NC (W.E.K.); Institute for Exercise and Environmental Medicine, University of Texas Southwestern Medical Center, Dallas (B.D.L.); Cardiovascular Division, Brigham and Women's Hospital, Boston, MA (M.A.P.); Division of Cardiology, Albert Einstein College of Medicine, Bronx, NY (I.L.P.); Department of Kinesiology (D.C.P.) and Department of Anatomy and Physiology (D.C.P.), Kansas State University, Manhattan; Division of Cardiology, Jefferson Medical College, Philadelphia, PA (G.R.R., D.J.W.); and Sections on Cardiology and Geriatrics, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC (D.W.K.)
| | - Dalane W Kitzman
- From the Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD (J.L.F., L.S.C.); Division of Cardiovascular Disease, Mayo Clinic, Rochester, MN (B.A.B.); Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta, Canada (M.J.H.); Division of Cardiology, Duke University School of Medicine, Durham, NC (W.E.K.); Institute for Exercise and Environmental Medicine, University of Texas Southwestern Medical Center, Dallas (B.D.L.); Cardiovascular Division, Brigham and Women's Hospital, Boston, MA (M.A.P.); Division of Cardiology, Albert Einstein College of Medicine, Bronx, NY (I.L.P.); Department of Kinesiology (D.C.P.) and Department of Anatomy and Physiology (D.C.P.), Kansas State University, Manhattan; Division of Cardiology, Jefferson Medical College, Philadelphia, PA (G.R.R., D.J.W.); and Sections on Cardiology and Geriatrics, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC (D.W.K.)
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The association of ADORA2A and ADORA2B polymorphisms with the risk and severity of chronic heart failure: a case-control study of a northern Chinese population. Int J Mol Sci 2015; 16:2732-46. [PMID: 25629231 PMCID: PMC4346862 DOI: 10.3390/ijms16022732] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2014] [Accepted: 01/22/2015] [Indexed: 01/28/2023] Open
Abstract
The causes of chronic heart failure (CHF) and its progression are likely to be due to complex genetic factors. Adenosine receptors A2A and A2B (ADORA2A and ADORA2B, respectively) play an important role in cardio-protection. Therefore, polymorphisms in the genes encoding those receptors may affect the risk and severity of CHF. This study was a case-control comparative investigation of 300 northern Chinese Han CHF patients and 400 ethnicity-matched healthy controls. Four common single-nucleotide polymorphisms (SNPs) of ADORA2A (rs2236625, rs2236624, rs4822489, and rs5751876) and one SNP of ADORA2B (rs7208480) were genotyped and an association between SNPs and clinical outcomes was evaluated. Odds ratios (ORs) with 95% confidence intervals (CIs) were used to assess the association. The rs4822489 was significantly associated with the severity of CHF after adjustment for traditional cardiovascular risk factors (p = 0.040, OR = 1.912, 95% CI = 1.029–3.550). However, the five SNPs as well as the haplotypes were not found to be associated with CHF susceptibility. The findings of this study suggest that rs4822489 may contribute to the severity of CHF in the northern Chinese. However, further studies performed in larger populations and aimed at better defining the role of this gene are required.
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Galve E, Cordero A, Bertomeu-Martínez V, Fácila L, Mazón P, Alegría E, Fernández de Bobadilla J, García-Porrero E, Martínez-Sellés M, González-Juanatey JR. Update in cardiology: vascular risk and cardiac rehabilitation. ACTA ACUST UNITED AC 2015; 68:136-43. [PMID: 25583549 DOI: 10.1016/j.rec.2014.10.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2014] [Accepted: 10/02/2014] [Indexed: 01/03/2023]
Abstract
As in other fields, understanding of vascular risk and rehabilitation is constantly improving. The present review of recent epidemiological update shows how far we are from achieving good risk factor control: in diet and nutrition, where unhealthy and excessive societal consumption is clearly increasing the prevalence of obesity; in exercise, where it is difficult to find a balance between benefit and risk, despite systemization efforts; in smoking, where developments center on programs and policies, with the electronic cigarette seeming more like a problem than a solution; in lipids, where the transatlantic debate between guidelines is becoming a paradigm of the divergence of views in this extensively studied area; in hypertension, where a nonpharmacological alternative (renal denervation) has been undermined by the SYMPLICITY HTN-3 setback, forcing a deep reassessment; in diabetes mellitus, where the new dipeptidyl peptidase-4 and sodium-glucose cotransporter type 2 inhibitors and glucagon like peptide 1 analogues have contributed much new information and a glimpse of the future of diabetes treatment, and in cardiac rehabilitation, which continues to benefit from new information and communication technologies and where clinical benefit is not hindered by advanced diseases, such as heart failure. Our summary concludes with the update in elderly patients, whose treatment criteria are extrapolated from those of younger patients, with the present review clearly indicating that should not be the case.
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Affiliation(s)
- Enrique Galve
- Servicio de Cardiología, Hospital Universitari Vall d'Hebron, Barcelona, Spain.
| | - Alberto Cordero
- Departamento de Cardiología, Hospital Universitario de San Juan, San Juan de Alicante, Alicante, Spain
| | - Vicente Bertomeu-Martínez
- Departamento de Cardiología, Hospital Universitario de San Juan, San Juan de Alicante, Alicante, Spain
| | - Lorenzo Fácila
- Servicio de Cardiología, Consorcio Hospital General de Valencia, Valencia, Spain
| | - Pilar Mazón
- Servicio de Cardiología, Hospital Universitario Santiago de Compostela, Santiago de Compostela, A Coruña, Spain
| | - Eduardo Alegría
- Servicio de Cardiología, Policlínica Gipuzkoa, San Sebastián, Guipúzcoa, Spain
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118
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Understanding physical activity and exercise behaviors in patients with heart failure. Heart Lung 2015; 44:2-8. [DOI: 10.1016/j.hrtlng.2014.08.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2014] [Revised: 08/25/2014] [Accepted: 08/25/2014] [Indexed: 11/30/2022]
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119
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Borghi-Silva A, Trimer R, Mendes RG, Arena RA, Schwartzmann PV. Rehabilitation practice patterns for patients with heart failure: the South American perspective. Heart Fail Clin 2014; 11:73-82. [PMID: 25432475 DOI: 10.1016/j.hfc.2014.08.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Heart failure (HF) is an important public health issue in South America. Economic impacts are substantial. Chagas heart disease is a prevalent HF etiology; it is caused by the protozoan Trypanosoma cruzi. Cardiac rehabilitation (CR) is an integral component of HF care. The benefits of CR in HF patients need to be assessed. The effectiveness and safety of CR delivery, such as home-based interventions, should be explored. Strategies to improve adherence in CR are imperative. We describe past and current CR trends for HF patients and discuss the future of this important intervention.
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Affiliation(s)
- Audrey Borghi-Silva
- Cardiopulmonary Physiotherapy Laboratory, Federal University of Sao Carlos, Rod Washington Luis Km 235 - SP - 310, Sao Carlos, Sao Paulo 13565-90, Brazil.
| | - Renata Trimer
- Cardiopulmonary Physiotherapy Laboratory, Federal University of Sao Carlos, Rod Washington Luis Km 235 - SP - 310, Sao Carlos, Sao Paulo 13565-90, Brazil
| | - Renata G Mendes
- Cardiopulmonary Physiotherapy Laboratory, Federal University of Sao Carlos, Rod Washington Luis Km 235 - SP - 310, Sao Carlos, Sao Paulo 13565-90, Brazil
| | - Ross A Arena
- Integrative Physiology Laboratory, Department of Physical Therapy, College of Applied Health Sciences, University of Illinois Chicago, 1918 West Taylor Street, Chicago, IL 60612, USA
| | - Pedro V Schwartzmann
- Clinical Hospital, Rehabilitation Institute Lucy Montoro, Ribeirao Preto School of Medicine, University of Sao Paulo, Monte Alegre, Ribeirão Preto, Sao Paulo 14048-900, Brazil
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120
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Kohli P, Whelton SP, Hsu S, Yancy CW, Stone NJ, Chrispin J, Gilotra NA, Houston B, Ashen MD, Martin SS, Joshi PH, McEvoy JW, Gluckman TJ, Michos ED, Blaha MJ, Blumenthal RS. Clinician's guide to the updated ABCs of cardiovascular disease prevention. J Am Heart Assoc 2014; 3:e001098. [PMID: 25246448 PMCID: PMC4323829 DOI: 10.1161/jaha.114.001098] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
To facilitate the guideline-based implementation of treatment recommendations in the ambulatory setting and to encourage participation in the multiple preventive health efforts that exist, we have organized several recent guideline updates into a simple ABCDEF approach. We would remind clinicians that evidence-based medicine is meant to inform recommendations but that synthesis of patient-specific data and use of appropriate clinical judgment in each individual situation is ultimately preferred.
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Affiliation(s)
- Payal Kohli
- Division of Cardiology, University of California San Francisco (UCSF), San Francisco, CA (P.K.)
| | - Seamus P. Whelton
- The Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD (S.P.W., S.H., J.C., N.A.G., B.H., D.A., S.S.M., P.H.J., J.W.M.E., T.J.G., E.D.M., M.J.B., R.S.B.)
| | - Steven Hsu
- The Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD (S.P.W., S.H., J.C., N.A.G., B.H., D.A., S.S.M., P.H.J., J.W.M.E., T.J.G., E.D.M., M.J.B., R.S.B.)
| | - Clyde W. Yancy
- Division of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, IL (C.W.Y., N.J.S.)
| | - Neil J. Stone
- Division of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, IL (C.W.Y., N.J.S.)
| | - Jonathan Chrispin
- The Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD (S.P.W., S.H., J.C., N.A.G., B.H., D.A., S.S.M., P.H.J., J.W.M.E., T.J.G., E.D.M., M.J.B., R.S.B.)
| | - Nisha A. Gilotra
- The Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD (S.P.W., S.H., J.C., N.A.G., B.H., D.A., S.S.M., P.H.J., J.W.M.E., T.J.G., E.D.M., M.J.B., R.S.B.)
| | - Brian Houston
- The Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD (S.P.W., S.H., J.C., N.A.G., B.H., D.A., S.S.M., P.H.J., J.W.M.E., T.J.G., E.D.M., M.J.B., R.S.B.)
| | - M. Dominique Ashen
- The Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD (S.P.W., S.H., J.C., N.A.G., B.H., D.A., S.S.M., P.H.J., J.W.M.E., T.J.G., E.D.M., M.J.B., R.S.B.)
| | - Seth S. Martin
- The Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD (S.P.W., S.H., J.C., N.A.G., B.H., D.A., S.S.M., P.H.J., J.W.M.E., T.J.G., E.D.M., M.J.B., R.S.B.)
| | - Parag H. Joshi
- The Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD (S.P.W., S.H., J.C., N.A.G., B.H., D.A., S.S.M., P.H.J., J.W.M.E., T.J.G., E.D.M., M.J.B., R.S.B.)
| | - John W. McEvoy
- The Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD (S.P.W., S.H., J.C., N.A.G., B.H., D.A., S.S.M., P.H.J., J.W.M.E., T.J.G., E.D.M., M.J.B., R.S.B.)
| | - Ty J. Gluckman
- The Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD (S.P.W., S.H., J.C., N.A.G., B.H., D.A., S.S.M., P.H.J., J.W.M.E., T.J.G., E.D.M., M.J.B., R.S.B.)
| | - Erin D. Michos
- The Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD (S.P.W., S.H., J.C., N.A.G., B.H., D.A., S.S.M., P.H.J., J.W.M.E., T.J.G., E.D.M., M.J.B., R.S.B.)
| | - Michael J. Blaha
- The Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD (S.P.W., S.H., J.C., N.A.G., B.H., D.A., S.S.M., P.H.J., J.W.M.E., T.J.G., E.D.M., M.J.B., R.S.B.)
| | - Roger S. Blumenthal
- The Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD (S.P.W., S.H., J.C., N.A.G., B.H., D.A., S.S.M., P.H.J., J.W.M.E., T.J.G., E.D.M., M.J.B., R.S.B.)
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121
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Behrens K, Hottenrott K, Weippert M, Montanus H, Kreuzfeld S, Rieger A, Lübke J, Werdan K, Stoll R. [Individualization of exercise load control for inpatient cardiac rehabilitation. Development and evaluation of a HRV-based intervention program for patients with ischemic heart failure]. Herz 2014; 40 Suppl 1:61-9. [PMID: 24441395 DOI: 10.1007/s00059-013-4037-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2013] [Revised: 10/30/2013] [Accepted: 12/08/2013] [Indexed: 12/01/2022]
Abstract
BACKGROUND The effective use of rehabilitation programs is of primary importance in order to improve the physical performance of cardiac disease patients. A modular program has been developed which is intended to structure and individualize conventional, exercise-based rehabilitation programs according to the individual needs and physical condition of each patient. The individualization of the program is based on detailed diagnostics before patients enter the program and daily measurements of heart rate variability (HRV) during cardiac rehabilitation. METHODS A total of 30 patients with ischemic heart disease were randomly assigned either to the intervention group (IG), completing the modular individualized rehabilitation program [n=15, mean age 54.4±4.2 years and mean left ventricular ejection fraction (LVEF) 28.53±6.25%) or to the control group (CG) taking part in the conventional rehabilitation program (n=15, mean age 56.4±4.4 years and mean LVEF 27.63±5.62). Before and after the intervention, cardiorespiratory fitness was assessed by measurement of maximal oxygen consumption (relative VO2max) during bicycle ergometry and the 6-minute walk test (6-MWT). Pre-post comparisons of cardiorespiratory fitness indicators were used to evaluate the effectiveness of the rehabilitation program. In addition to the results of the basic clinical investigations and the cardiorespiratory testing, results of standardized HRV measurements of 10 min at morning rest served as criteria for program individualization. RESULTS The relative VO2max increased significantly (p<0.05) in the IG whereas no change was found in the CG. Similar results were found for maximum power output during bicycle ergometry (p<0.01) and for 6-MWT distance (p<0.001). Although patients in the IG completed less aerobic exercise sessions than those in the CG (p<0.001) the physical performance of the IG improved significantly. DISCUSSION The results prove the effectiveness and efficacy of the modular individualized rehabilitation program. They further suggest the need for an individual program matrix instead of a maximum performance matrix in cardiac rehabilitation. Individualization should be based on clinical and performance diagnostics before and accompanying assessments of training condition, e.g. by HRV measurements, during rehabilitation programs. Each patient should only perform those intervention programs which match the results of the basic clinical investigation and additional analyses during rehabilitation.
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Affiliation(s)
- K Behrens
- Institut für Präventivmedizin, Universitätsmedizin Rostock, St.-Georg-Str. 108, 18055, Rostock, Deutschland,
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