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Terbraak M, Verweij L, Jepma P, Buurman B, Jørstad H, Scholte Op Reimer W, van der Schaaf M. Feasibility of home-based cardiac rehabilitation in frail older patients: a clinical perspective. Physiother Theory Pract 2023; 39:560-575. [PMID: 35068322 DOI: 10.1080/09593985.2022.2025549] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
(A) BACKGROUND Home-based cardiac rehabilitation (CR) is an attractive alternative for frail older patients who are unable to participate in hospital-based CR. Yet, the feasibility of home-based CR provided by primary care physiotherapists (PTs) to these patients remains uncertain. (B) OBJECTIVE To investigate physiotherapists' (PTs) clinical experience with a guideline-centered, home-based CR protocol for frail older patients. (C) METHODS A qualitative study examined the home-based CR protocol of a randomized controlled trial. Observations and interviews of the CR-trained primary care PTs providing home-based CR were conducted until data saturation. Two researchers separately coded the findings according to the theoretical framework of Gurses. (D) RESULTS The enrolled PTs (n = 8) had a median age of 45 years (IQR 27-57), and a median work experience of 20 years (IQR 5-33). Three principal themes were identified that influence protocol-adherence by PTs and the feasibility of protocol-implementation: 1) feasibility of exercise testing and the exercise program; 2) patients' motivation and PTs' motivational techniques; and 3) interdisciplinary collaboration with other healthcare providers in monitoring patients' risks. (E) CONCLUSION Home-based CR for frail patients seems feasible for PTs. Recommendations on the optimal intensity, use of home-based exercise tests and measurement tools, and interventions to optimize self-regulation are needed to facilitate home-based CR.
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Affiliation(s)
- Michel Terbraak
- Department of Physical Therapy, Center of Expertise Urban Vitality, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, Netherlands.,Amsterdam UMC, University of Amsterdam, Department of Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam, Netherlands
| | - Lotte Verweij
- Department of Physical Therapy, Center of Expertise Urban Vitality, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, Netherlands.,Amsterdam UMC, University of Amsterdam, Department of Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam, Netherlands
| | - Patricia Jepma
- Department of Physical Therapy, Center of Expertise Urban Vitality, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, Netherlands.,Amsterdam UMC, University of Amsterdam, Department of Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam, Netherlands
| | - Bianca Buurman
- Department of Physical Therapy, Center of Expertise Urban Vitality, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, Netherlands.,Amsterdam UMC, University of Amsterdam, Department of Internal Medicine, Section of Geriatric Medicine, Amsterdam Public Health Research Institute, Amsterdam, Netherlands
| | - Harald Jørstad
- Amsterdam UMC, University of Amsterdam, Department of Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam, Netherlands
| | - Wilma Scholte Op Reimer
- Amsterdam UMC, University of Amsterdam, Department of Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam, Netherlands.,HU University of Applied Sciences Utrecht, Research Group Chronic Diseases, Utrecht, Netherlands
| | - Marike van der Schaaf
- Department of Physical Therapy, Center of Expertise Urban Vitality, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, Netherlands.,Amsterdam UMC, University of Amsterdam, Department of Rehabilitation, Amsterdam Movement Sciences, Amsterdam, Netherlands
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Yoshihisa A, Sato Y, Sato T, Suzuki S, Oikawa M, Takeishi Y. Better clinical outcome with direct oral anticoagulants in hospitalized heart failure patients with atrial fibrillation. BMC Cardiovasc Disord 2018; 18:11. [PMID: 29368593 PMCID: PMC5784680 DOI: 10.1186/s12872-018-0746-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Accepted: 01/16/2018] [Indexed: 01/29/2023] Open
Abstract
Background Atrial fibrillation (AF) is common in patients with heart failure and is associated with higher mortality. Although previous studies have reported that direct oral anticoagulants (DOACs) reduce the risk of cardiovascular events in out-patients with AF, it remains unclear whether DOACs reduce mortality in hospitalized heart failure (HHF) patients with AF. Therefore, we examined the impact of DOACs on mortality in this group of patients. Methods Consecutive 497 HHF patients with AF were retrospectively registered and divided into three groups on the basis of the presence of anticoagulant therapy: non-anticoagulant group (Non, n = 90), Vit K antagonists (VKAs) group (n = 257) and DOACs group (n = 150). We followed up all the patients for mortality. Results In the Kaplan-Meier analysis (mean follow-up of 1093 days), all-cause mortality was significantly lower in the VKAs and DOACs groups than in the Non group (31.1% and 15.3% vs. 43.3%, log-rank P < 0.001). In the multivariable Cox proportional hazard analysis after adjusting for other potential confounding factors, usage of DOACs and VKAs were independently associated with lower mortality in HHF patients AF (DOACs, HR 0.356, P = 0.001; VKAs, HR 0.472, P = 0.002). Furthermore, the propensity-matched 1:1 cohort was assessed based on the propensity score (DOACs, n = 114 and VKAs, n = 114). All-cause mortality was significantly lower in the DOACs group than in the VKAs group in the post-matched cohort (12.3% vs. 35.1%, log-rank P = 0.038). In the Cox proportional hazard analysis, the use of DOACs was associated with lower mortality in the post-matched cohort (HR 0.526, P = 0.041). Conclusion Appropriate use of anticoagulants in HHF patients with AF is important, and DOACs potentially improve all-cause mortality in such patients. Electronic supplementary material The online version of this article (10.1186/s12872-018-0746-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Akiomi Yoshihisa
- Department of Cardiovascular Medicine, Fukushima Medical University, 1 Hikarigaoka, Fukushima, 960-1295, Japan.
| | - Yu Sato
- Department of Cardiovascular Medicine, Fukushima Medical University, 1 Hikarigaoka, Fukushima, 960-1295, Japan
| | - Takamasa Sato
- Department of Cardiovascular Medicine, Fukushima Medical University, 1 Hikarigaoka, Fukushima, 960-1295, Japan
| | - Satoshi Suzuki
- Department of Cardiovascular Medicine, Fukushima Medical University, 1 Hikarigaoka, Fukushima, 960-1295, Japan
| | - Masayoshi Oikawa
- Department of Cardiovascular Medicine, Fukushima Medical University, 1 Hikarigaoka, Fukushima, 960-1295, Japan
| | - Yasuchika Takeishi
- Department of Cardiovascular Medicine, Fukushima Medical University, 1 Hikarigaoka, Fukushima, 960-1295, Japan
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Chioncel O, Mebazaa A, Harjola VP, Coats AJ, Piepoli MF, Crespo-Leiro MG, Laroche C, Seferovic PM, Anker SD, Ferrari R, Ruschitzka F, Lopez-Fernandez S, Miani D, Filippatos G, Maggioni AP. Clinical phenotypes and outcome of patients hospitalized for acute heart failure: the ESC Heart Failure Long-Term Registry. Eur J Heart Fail 2017; 19:1242-1254. [DOI: 10.1002/ejhf.890] [Citation(s) in RCA: 222] [Impact Index Per Article: 31.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Revised: 04/12/2017] [Accepted: 04/15/2017] [Indexed: 12/28/2022] Open
Affiliation(s)
- Ovidiu Chioncel
- University of Medicine Carol Davila, Bucuresti; Institutul de Urgente Boli Cardiovasculare C.C. Iliescu; Bucuresti Romania
| | - Alexandre Mebazaa
- University Paris Diderot, Sorbonne Paris Cité, Paris, France; 4APHP, Department of Anaesthesia and Critical Care; Hôpitaux Universitaires Saint Louis-Lariboisière; Paris France
| | - Veli-Pekka Harjola
- Emergency Medicine, Helsinki University, Department of Emergency Medicine and Services; Helsinki University Hospital; Helsinki Finland
| | - Andrew J. Coats
- Monash University, Australia and University of Warwick; Coventry UK
| | | | - Maria G. Crespo-Leiro
- Unidad de Insuficiencia Cardiaca Avanzada y Trasplante Cardiaco; Complejo Hospitalario Universitario A Coruna (CHUAC), CIBERCV; La Coruna Spain
| | - Cecile Laroche
- EURObservational Research Programme, European Society of Cardiology; Sophia Antipolis France
| | - Petar M. Seferovic
- Department of Internal Medicine; Belgrade University School of Medicine and Heart Failure Centre, Belgrade University Medical Centre; Belgrade Serbia
| | - Stefan D. Anker
- Innovative Clinical Trials, Department of Cardiology and Pneumology; University Medical Center Göttingen (UMG); Göttingen Germany
| | - Roberto Ferrari
- Department of Cardiology and LTTA Centre; University Hospital of Ferrara and Maria Cecilia Hospital, GVM Care and Research, ES Health Science Foundation; Cotignola Italy
| | - Frank Ruschitzka
- Department of Cardiology, Heart Failure Clinic and Transplantation; University Heart Centre Zurich; Zurich Switzerland
| | | | - Daniela Miani
- Cardiology; University Hospital S. Maria della Misericordia; Udine Italy
| | - Gerasimos Filippatos
- National and Kapodistrian University of Athens, School of Medicine; University Hospital Attikon; Athens Greece
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