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Swenski TN, Fox KR, Udaipuria S, Korth CX, Daniels CJ, Jackson JL. Age moderates change in disease-related stress among congenital heart disease survivors: a 6-year follow-up. Eur J Cardiovasc Nurs 2024; 23:62-68. [PMID: 37163661 PMCID: PMC10783978 DOI: 10.1093/eurjcn/zvad045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 05/05/2023] [Accepted: 05/09/2023] [Indexed: 05/12/2023]
Abstract
AIMS As congenital heart disease (CHD) survivors age, they are confronted with elevated risk of cardiovascular morbidity and increasingly complex disease self-management demands. Given that stress is associated with poor physical and psychosocial outcomes, it is crucial to examine how disease-related stress changes over time in this population. However, this outcome has received little research attention to date. This study aimed to identify demographic and clinical predictors of change in disease-related stress over 6 years among CHD survivors. METHODS AND RESULTS Congenital heart disease survivors (N = 252, Mage = 25.6 ± 7.1, 52.9% female) completed the first 13 items of the Responses to Stress Questionnaire, adapted for use among CHD survivors, to assess disease-related stressors at study entry (T1) and 6-year follow-up (T2). Age, gender, estimated family income, and New York Heart Association (NYHA) functional class at T1 were entered into mixed linear models to determine their impact on change in disease-related stress. Older age (P < 0.001), lower income (P < 0.001), and presence of functional limitations (NYHA ≥ II) (P < 0.001) predicted greater increases in disease-related stress. When controlling for NYHA, functional class, and income, a significant time by age interaction was identified such that disease-related stress increased over time among those who were adolescents at T1 [b = 4.20, P = 0.010, 95% confidence interval (1.01, 7.40)], but remained stable among young adults. CONCLUSION The transition from adolescence to adulthood may be a period of increasing disease-related stress. Healthcare providers should consider screening adolescents for elevated disease-related stress during transition education and provide resources to bolster resilience.
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Affiliation(s)
- Taylor N Swenski
- Department of Psychology, DePaul University, 2219 N. Kenmore Ave., Chicago, IL 60614, USA
| | - Kristen R Fox
- Center for Biobehavioral Health, Nationwide Children’s Hospital, 700 Children’s Dr., Near East Office Building, 3rd Floor, Columbus, OH 43205, USA
| | - Shivika Udaipuria
- Center for Biobehavioral Health, Nationwide Children’s Hospital, 700 Children’s Dr., Near East Office Building, 3rd Floor, Columbus, OH 43205, USA
| | - Christina X Korth
- Department of Psychological Sciences, Kent State University, 600 Hilltop Drive, Kent, OH 44242, USA
| | - Curt J Daniels
- Department of Pediatrics, The Ohio State University, 370 W. 9th Ave., Columbus, OH 43210, USA
- The Heart Center, Nationwide Children’s Hospital, 700 Children’s Dr., Columbus, OH 43205, USA
| | - Jamie L Jackson
- Center for Biobehavioral Health, Nationwide Children’s Hospital, 700 Children’s Dr., Near East Office Building, 3rd Floor, Columbus, OH 43205, USA
- Department of Pediatrics, The Ohio State University, 370 W. 9th Ave., Columbus, OH 43210, USA
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Zahid S, Din MTU, Khan MZ, Rai D, Ullah W, Sanchez-Nadales A, Elkhapery A, Khan MU, Goldsweig AM, Singla A, Fonarrow G, Balla S. Trends, Predictors, and Outcomes of 30-Day Readmission With Heart Failure After Transcatheter Aortic Valve Replacement: Insights From the US Nationwide Readmission Database. J Am Heart Assoc 2022; 11:e024890. [PMID: 35929464 PMCID: PMC9496292 DOI: 10.1161/jaha.121.024890] [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] [Indexed: 11/25/2022]
Abstract
BACKGROUND Data on trends, predictors, and outcomes of heart failure (HF) readmissions after transcatheter aortic valve replacement (TAVR) remain limited. Moreover, the relationship between hospital TAVR discharge volume and HF readmission outcomes has not been established. METHODS AND RESULTS The Nationwide Readmission Database was used to identify 30‐day readmissions for HF after TAVR from October 1, 2015, to November 30, 2018, using International Classification of Diseases, Tenth Revision, Clinical Modification (ICD‐10‐CM) codes. A total of 167 345 weighted discharges following TAVR were identified. The all‐cause readmission rate within 30 days of discharge was 11.4% (19 016). Of all the causes of 30‐day rehospitalizations, HF comprised 31.4% (5962) of all causes. The 30‐day readmission rate for HF did not show a significant decline during the study period (Ptrend=0.06); however, all‐cause readmission rates decreased significantly (Ptrend=0.03). HF readmissions were comparable between high‐ and low‐volume TAVR centers. Charlson Comorbidity Index >8, length of stay >4 days during the index hospitalization, chronic obstructive pulmonary disease, atrial fibrillation, chronic HF, preexisting pacemaker, complete heart block during index hospitalization, paravalvular regurgitation, chronic kidney disease, and end‐stage renal disease were independent predictors of 30‐day HF readmission after TAVR. HF readmissions were associated with higher mortality rates when compared with non‐HF readmissions (4.9% versus 3.3%; P<0.01). Each HF readmission within 30 days was associated with an average increased cost of $13 000 more than for each non‐HF readmission. CONCLUSIONS During the study period from 2015 to 2018, 30‐day HF readmissions after TAVR remained steady despite all‐cause readmissions decreasing significantly. All‐cause readmission mortality and HF readmission mortality also showed a nonsignificant downtrend. HF readmissions were comparable across low‐, medium‐, and high‐volume TAVR centers. HF readmission was associated with increased mortality and resource use attributed to the increased costs of care compared with non‐HF readmission. Further studies are needed to identify strategies to decrease the burden of HF readmissions and related mortality after TAVR.
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Affiliation(s)
- Salman Zahid
- Department of Medicine Rochester General Hospital Rochester NY
| | | | - Muhammad Zia Khan
- Division of Cardiology West Virginia University Heart & Vascular Institute Morgantown WV
| | - Devesh Rai
- Department of Medicine Rochester General Hospital Rochester NY
| | - Waqas Ullah
- Department of Cardiovascular Medicine Jefferson University Hospitals Philadelphia PA
| | | | - Ahmed Elkhapery
- Department of Medicine Rochester General Hospital Rochester NY
| | - Muhammad Usman Khan
- Division of Cardiology West Virginia University Heart & Vascular Institute Morgantown WV
| | - Andrew M Goldsweig
- Division of Cardiovascular Medicine University of Nebraska Medical Center Omaha NE
| | | | - Greg Fonarrow
- Division of Cardiovascular Medicine University of California Los Angeles Los Angeles CA
| | - Sudarshan Balla
- Division of Cardiology West Virginia University Heart & Vascular Institute Morgantown WV
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Schmidt T, Kowalski M, Bjarnason-Wehrens B, Ritter F, Mönnig G, Reiss N. Feasibility of inpatient cardiac rehabilitation after percutaneous mitral valve reconstruction using clipping procedures: a retrospective analysis. BMC Sports Sci Med Rehabil 2022; 14:120. [PMID: 35787297 PMCID: PMC9254646 DOI: 10.1186/s13102-022-00517-y] [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: 01/27/2022] [Accepted: 06/13/2022] [Indexed: 11/24/2022]
Abstract
Background To date, no studies on the feasibility or outcomes of cardiac rehabilitation (CR) after percutaneous mitral valve reconstruction using clipping procedures have been published. The aim of this study was to report on our first experiences with this special target group. Methods Monocentric retrospective analysis of 27 patients (72 ± 12 years old, 52% female) who underwent multimodal inpatient CR in the first 2 month after MitraClip™ implantation. A six-minute-walking-test, a handgrip-strength-test and the Berg-Balance-Scale was conducted at the beginning and end of CR. Echocardiography was performed to rule out device-related complications. Results Adapted inpatient CR started 16 ± 13 days after clipping intervention and lasted 22 ± 4 days. In 4 patients (15%) CR had to be interrupted or aborted prematurely due to cardiac decompensations. All other patients (85%) completed CR period without complications. Six-minute-walking-distance improved from 272 ± 97 to 304 ± 111 m (p < .05) and dependence on rollator walker or walking aids was significantly reduced (p < .05). Results of handgrip-strength-test and Berg-Balance-Scale increased (p < .05). Overall, social-medical and psychological consultations were well received by the patients and no device-related complications occurred during rehabilitation treatments. Conclusions The results indicate that an adapted inpatient CR in selected patients after MitraClip™ implantation is feasible. Patients benefited from treatments both at functional and social-medical level and no device-related complications occurred. Larger controlled studies are needed.
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Affiliation(s)
- Thomas Schmidt
- Institute for Cardiovascular Research, Schüchtermann-Klinik Bad Rothenfelde, Ulmenallee 5-11, 49214, Bad Rothenfelde, Germany. .,Department of Preventive and Rehabilitative Sport and Exercise Medicine, Institute for Cardiology and Sports Medicine, German Sports University Cologne, Am Sportpark Müngerdorf 6, 50933, Cologne, Germany.
| | - Marek Kowalski
- Institute for Cardiovascular Research, Schüchtermann-Klinik Bad Rothenfelde, Ulmenallee 5-11, 49214, Bad Rothenfelde, Germany
| | - Birna Bjarnason-Wehrens
- Department of Preventive and Rehabilitative Sport and Exercise Medicine, Institute for Cardiology and Sports Medicine, German Sports University Cologne, Am Sportpark Müngerdorf 6, 50933, Cologne, Germany
| | - Frank Ritter
- Institute for Cardiovascular Research, Schüchtermann-Klinik Bad Rothenfelde, Ulmenallee 5-11, 49214, Bad Rothenfelde, Germany
| | - Gerold Mönnig
- Institute for Cardiovascular Research, Schüchtermann-Klinik Bad Rothenfelde, Ulmenallee 5-11, 49214, Bad Rothenfelde, Germany
| | - Nils Reiss
- Institute for Cardiovascular Research, Schüchtermann-Klinik Bad Rothenfelde, Ulmenallee 5-11, 49214, Bad Rothenfelde, Germany
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Sabbahi A, Canada JM, Babu AS, Severin R, Arena R, Ozemek C. Exercise training in cardiac rehabilitation: Setting the right intensity for optimal benefit. Prog Cardiovasc Dis 2022; 70:58-65. [PMID: 35149002 DOI: 10.1016/j.pcad.2022.02.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 02/03/2022] [Indexed: 12/18/2022]
Abstract
Cardiac rehabilitation (CR) programs are recommended standard-of-care by all major cardiovascular medicine professional organizations. Exercise training is the cornerstone for CR, with aerobic training being the primary form of training. The benefits of exercise training are multiple; however, improved cardiorespiratory fitness is of utmost importance. Moderate-intensity continuous training, supplemented with resistance training, has traditionally been the most common form of exercise training in CR. This review discusses the role of aerobic exercise training in CR and the importance of effective and personalized exercise prescription for optimized results. We also focus on the benefits and utility of high-intensity interval training across different clinical populations commonly seen in the CR setting.
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Affiliation(s)
- Ahmad Sabbahi
- Department of Physical Therapy, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL, USA; School of Physical Therapy, South College, Knoxville, TN, USA.
| | - Justin M Canada
- VCU Pauley Heart Center, Division of Cardiology, Department of Internal Medicine, Virginia Commonwealth University, Richmond, VA, USA
| | - Abraham Samuel Babu
- Department of Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, India
| | - Richard Severin
- Department of Physical Therapy, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL, USA; Department of Physical Therapy, Robbins College of Health and Human Sciences, Baylor University, Waco, TX, USA
| | - Ross Arena
- Department of Physical Therapy, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL, USA
| | - Cemal Ozemek
- Department of Physical Therapy, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL, USA
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Abstract
PURPOSE OF REVIEW To summarize recent innovations in cardiac rehabilitation and provide a view towards the future of cardiac rehabilitation as it adjusts to the pressures of a global pandemic. RECENT FINDINGS Although cardiac rehabilitation has been shown to result in a mortality benefit, research continues to enumerate the benefits of cardiac rehabilitation to patient function and quality of life in a growing range of cardiovascular diseases. In addition, new methodologies and new models of cardiac rehabilitation have emerged with the goal of increasing patient referral and participation. SUMMARY Cardiac rehabilitation continues to evolve and adapt to serve a growing and diversifying number of patients with cardiovascular disease with the goal of both decreasing mortality and improving patient function.
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Penati C, Incorvaia C, Mollo V, Lietti F, Gatto G, Stefanelli M, Centeleghe P, Talarico G, Mori I, Franzelli C, Ratti F, Ponticelli MP, Ridolo E, Febo OC. Cardiac rehabilitation outcome after transcatheter aortic valve implantation. Monaldi Arch Chest Dis 2021; 91. [PMID: 33849260 DOI: 10.4081/monaldi.2021.1621] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 12/02/2020] [Indexed: 11/23/2022] Open
Abstract
Patients with severe aortic stenosis are increasingly treated with transcatheter aortic valve implantation (TAVI) as a safer option to surgical aortic valve replacement (sAVR). Similar to many other heart diseases, after the specific therapeutic intervention patients are eligible for cardiac rehabilitation (CR) for the purpose of functional recovery. Thus far, CR after both sAVR and TAVI has been used to a limited extent, as shown by the availability of only two meta-analyses including 5 studies and 6 studies, respectively. Recent observational studies reported a significant improvement in functional indexes such as the Barthel scale and the 6-minute walk test (6MWT). We evaluated the outcome of CR in patients after TAVI treatment by measuring changes in the commonly used Barthel scale and 6MWT and adding the short physical performance battery (SPPB) scale as an index to assess lower extremity function. All indexes demonstrated a significant improvement, namely p<0.001 with the Barthel scale, p=0.043 for the 6MWT, and p=0.002 for SPPB. These results confirm the significant improvement of the Barthel scale and 6MWT reported in the previous meta-analysis and suggest the utility of SPPB as a further index of efficacy of CR in patients with severe aortic stenosis treated with TAVI.
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Affiliation(s)
- Chiara Penati
- Cardiac/Pulmonary Rehabilitation, ASST Pini-CTO, Milan.
| | | | | | | | - Gemma Gatto
- Cardiac/Pulmonary Rehabilitation, ASST Pini-CTO, Milan.
| | | | | | | | - Ileana Mori
- Cardiac/Pulmonary Rehabilitation, ASST Pini-CTO, Milan.
| | | | - Fosco Ratti
- Cardiac/Pulmonary Rehabilitation, ASST Pini-CTO, Milan.
| | | | - Ermina Ridolo
- Allergy and Clinical Immunology, Medicine and Surgery Department, University of Parma.
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Fedson S. Rethinking the Meaning of Palliation in Heart Failure. Curr Heart Fail Rep 2020; 17:309-313. [PMID: 32876934 DOI: 10.1007/s11897-020-00483-x] [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: 11/28/2022]
Abstract
PURPOSE OF REVIEW Palliative care follows a philosophy of care that focuses upon the quality of life in patients with chronic or life-threatening illness. It also focuses upon the needs of their families which is a wider scope of care. Cardiovascular disease, and specifically heart failure, affects millions of patients and family members who have a symptom burden that exceeds that of many cancers and other chronic diseases. RECENTLY FINDINGS Historically palliative care has been viewed as an alternative to curative therapies, but over time, it is now recognized that it should be implemented earlier in the course of chronic diseases. Although non-oncologic patients now comprise over half of the patient seen by palliative care, patients with cardiovascular disease are still not being referred to palliative care. Palliative care goes beyond advance directives and end of life planning. There is a need to continue to expand the view of palliative care to encompass interventions that help improve the overall health of these patients, including their psychosocial well-being and quality of life. The collection of papers in this journal provides insight into the breadth of palliative care for patients with heart failure and other cardiovascular diseases.
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Affiliation(s)
- Savitri Fedson
- Section of Cardiology, Michael E DeBakey VA Medical Center, Center for Medical Ethics and Health Policy, Baylor College of Medicine, One Baylor Plaza, Suite 310D, Houston, TX, 77030, USA.
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