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Myneni P, Bodduluri M, Gadde ST, Nimmagadda R, Manvitha M, Valiveti SC, Sahu S, Younas S. Effectiveness of Cardiac Rehabilitation in Enhancing Clinical Outcomes for Coronary Artery Disease: A Systematic Analysis. Cureus 2024; 16:e69224. [PMID: 39398827 PMCID: PMC11470123 DOI: 10.7759/cureus.69224] [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: 09/11/2024] [Indexed: 10/15/2024] Open
Abstract
Cardiac rehabilitation (CR) is a structured intervention aimed at improving the clinical outcomes for patients with coronary artery disease (CAD). This systematic review assesses how well different types of CR, such as high-intensity interval training (HIIT), moderate-intensity continuous training (MICT), Nordic walking (NW), and home-based cardiac rehabilitation (HBCR), improve exercise capacity, quality of life, and lower death and illness rates. The objective is to assess the effectiveness of cardiovascular rehabilitation programs in enhancing clinical outcomes for patients diagnosed with CAD. A comprehensive literature search was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) model across Google Scholar, EMBASE, PubMed, Medline, and web browsers. Keywords such as "cardiac rehabilitation," "coronary artery disease," "exercise testing," "VO2 peak," and "physical activity" were used in different combinations. Studies were included if they were randomized controlled trials, observational studies, or longitudinal studies published after 2013 in English, with a focus on the impact of CR on CAD. Articles were excluded if they were reviews, meta-analyses, or did not meet the keyword requirements. A total of 375 articles were initially identified with relevant citations. After further screening, 10 studies met the inclusion criteria for analysis. The studies reviewed demonstrated that all forms of CR, including HIIT, MICT, NW, and HBCR, significantly improved exercise capacity and quality of life, and reduced depression severity among CAD patients. Nordic walking showed marked improvements in functional capacity, while HIIT resulted in higher VO2 peak levels compared to moderate-intensity exercise. Home-based CR showed greater adherence rates, especially among older patients and those with strong family support. The results also highlighted the importance of individualized exercise programs to enhance adherence and outcomes. Cardiac rehabilitation is a vital component of secondary prevention in CAD patients, significantly improving clinical outcomes, including exercise capacity, quality of life, and mortality rates. The findings underscore the importance of maintaining and expanding access to CR programs and tailoring interventions to patient needs to optimize long-term health outcomes. Future research should explore the comparative effectiveness of different CR modalities and strategies to increase patient adherence.
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Affiliation(s)
| | | | - Sai T Gadde
- General Medicine, All India Institute of Medical Sciences (AIIMS) Mangalagiri, Mangalagiri, IND
| | - Rithish Nimmagadda
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Male Manvitha
- Internal Medicine, Sri Venkateswara Institute of Medical Sciences (SVIMS) Sri Padmavathi Medical College for Women (SPMCW), Tirupati, IND
| | - Sindhu Chowdary Valiveti
- General Medicine, Sri Venkateswara Institute of Medical Sciences (SVIMS) Sri Padmavathi Medical College for Women (SPMCW), Tirupati, IND
| | - Sweta Sahu
- Internal Medicine, JJM Medical College, Davanagere, IND
| | - Salma Younas
- Pharmacy, Punjab University College of Pharmacy, Lahore, PAK
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Murphy BE, Card PD, Ramirez-Kelly L, Xaysuda AM, Heidel RE. Effects of the Strong Hearts program after a major cardiovascular event in patients with cardiovascular disease. J Osteopath Med 2023; 123:279-285. [PMID: 36958944 DOI: 10.1515/jom-2022-0141] [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: 09/26/2022] [Accepted: 02/21/2023] [Indexed: 03/25/2023]
Abstract
CONTEXT Cardiac rehabilitation (CR) and intensive cardiac rehabilitation (ICR) are secondary prevention interventions for cardiovascular disease (CVD) with a class 1a indication yet suboptimal utilization. To date, there are only three approved ICR programs. Alternative programing should be explored to increase enrollment and adherence in these interventions. OBJECTIVES This study aims to evaluate the effectiveness of the Strong Hearts program in cardiovascular patients following a major cardiovascular event. METHODS One hundred ninety-seven (n = 197) participants were enrolled in this prospective, nonrandomized study. Patients were eligible for participation if they were referred by a physician after a major cardiovascular event, defined as any of the following: (1) acute myocardial infarction (MI) within the preceding 12 months; (2) current stable or unstable angina pectoris; (3) heart valve procedure; (4) percutaneous intervention of any kind; (5) heart transplant; (6) coronary artery bypass grafting (CABG); or (7) congestive heart failure (CHF) with reduced or preserved ejection fraction. Participants were asked to attend program visits four times per week for 9 weeks. Visits consisted of individualized exercise and intensive healthy lifestyle education. Paired t tests were utilized to compare pre- and postprogram outcome measures. RESULTS One hundred twenty-eight (n = 128) participants completed the program within the 9-week time frame and their outcome measures were included in the data analysis. Among this, 35.2% participants were female and 64.8% were male. The mean age was 65 (range, 19-88). Qualifying diagnoses were percutaneous coronary intervention (PCI; 60, 46.9%), CABG (33, 25.8%), angina (24, 18.8%), valve procedures (8, 6.2%), and CHF (3, 2.3%). After implementation of the intervention, statistically significant decreases in weight (P < .001), body mass index (BMI, P < .001), waist circumference (P < .001), triglycerides (P = .01), systolic blood pressure (SBP, P <.001), diastolic blood pressure (DBP, P = .002), total fat mass (P < .001), Dartmouth Quality of Life Index P < .001), and cardiac depression scores (P = .044) were detected. In other instances, there were statistically significant increases across time for the clinical parameters of high-density lipoprotein (HDL, P = .02), Vitamin D (P = .001), metabolic equivalents (METS, P < .001), Duke activity scores (P < .001), and Rate Your Plate nutrition scores (P < .001). There were no significant changes across time for total cholesterol (P = .17), low-density lipoprotein (LDL, P = .21), A1c (P = .27), or dual-energy X-ray absorptiometry (DXA) total lean mass (P = .86). CONCLUSIONS The 9-week structured program resulted in significant cardiovascular benefit to patients with CVD by reducing cardiac risk factors, increasing exercise capacity, and improving quality of life.
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Affiliation(s)
| | | | | | | | - R Eric Heidel
- University of Tennessee Graduate School of Medicine, Knoxville, TN, USA
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Awosika A, Hillman AR, Millis RM, Adeniyi MJ. Cardiac Rehabilitation and Cardiopulmonary Fitness in Children and Young Adults With Congenital Heart Diseases: A Critically Appraised Topic. Cureus 2022; 14:e31483. [PMID: 36408315 PMCID: PMC9665330 DOI: 10.7759/cureus.31483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/14/2022] [Indexed: 11/16/2022] Open
Abstract
Public health guidelines and a myriad of studies have proven that exercise is beneficial in the alleviation of various cardio-metabolic diseases. Congenital heart disease (ConHD) is one of the most frequently occurring congenital structural malfunctions in the pediatric population, affecting nine of every 1,000 live births. Only a few studies have established the impact of a structured exercise program on cardiopulmonary fitness in diverse groups of patients with ConHD. It is also alarming to know that a substantial number of these patients and their caregivers often remain very wary of exercise. Anxiety about exercise may increase the risk of developing morbid obesity and other long-term health complications of ConHD. The present review of a critically appraised topic is undertaken to answer the question, “Does structured exercise intervention (cardiac rehabilitation) improve cardiorespiratory fitness in children and young adults with ConHD?” Exercise science and the medical literature were searched for studies that engaged the use of aerobic exercise in patients with different ConHD diagnoses. The search yielded four studies after screening with the inclusion and exclusion criteria, which were further narrowed to three studies after a full-text review. These studies yielded results showing significant increments in peak exercise workload, duration, power output, peak oxygen uptake, or improved tissue oxygenation and muscle strength after an exercise training intervention. It is noteworthy that a group identified as “cyanotic palliated” exhibited the most significant impairment both at baseline and after the exercise intervention. This review provides level 1b medical evidence that a structured exercise program may improve cardiopulmonary fitness in patients with ConHD, which is likely to be beneficial to their overall physical, motor, and psychosocial development. The results of this review may be useful for alleviating the anxiety of patients and their caregivers about participation in structured exercise programs. This review should also motivate future research investigations to develop clinical guidelines for the management of patients with ConHD by adding exercise prescriptions to their daily therapeutic regimens.
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Giannaki A, Sagris M, Toskas P, Antonopoulos AS, Oikonomou E, Theofilis P, Lazaros G, Tousoulis D. The Effect of Stress Management in Patients Post-acute Myocardial Infarction. Hellenic J Cardiol 2022; 70:85-88. [PMID: 36328160 DOI: 10.1016/j.hjc.2022.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Revised: 09/19/2022] [Accepted: 10/28/2022] [Indexed: 11/04/2022] Open
Affiliation(s)
- Anastasia Giannaki
- 1(st) Cardiology Clinic, 'Hippokration' General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Marios Sagris
- 1(st) Cardiology Clinic, 'Hippokration' General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Padelis Toskas
- 1(st) Cardiology Clinic, 'Hippokration' General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Alexios S Antonopoulos
- 1(st) Cardiology Clinic, 'Hippokration' General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Evangelos Oikonomou
- 1(st) Cardiology Clinic, 'Hippokration' General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Panagiotis Theofilis
- 1(st) Cardiology Clinic, 'Hippokration' General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - George Lazaros
- 1(st) Cardiology Clinic, 'Hippokration' General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Dimitrios Tousoulis
- 1(st) Cardiology Clinic, 'Hippokration' General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece.
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Effects of Hatha Yoga on Cardiac Hemodynamic Parameters and Physical Capacity in Cardiac Rehabilitation Patients. J Cardiopulm Rehabil Prev 2021; 40:263-267. [PMID: 32604254 DOI: 10.1097/hcr.0000000000000503] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE The purpose of the present study was to assess the effect of hatha yoga training that was added to the standard cardiac rehabilitation (CR) program on the cardiac hemodynamic parameters and physical capacity of patients with ST-elevation myocardial infarction (STEMI). METHODS The study included 70 male patients aged 45-65 yr with STEMI who were treated by angioplasty. Patients were randomized to standard CR (control group) versus standard CR plus hatha yoga (experimental group). The training program lasted for a total of 24 d for each patient, with day 1 and day 24 used for medical examinations (electrocardiogram, spiroergometric submaximal treadmill test, and echocardiography). The remaining 22 d consisted of the actual training. RESULTS After the CR program the spiroergometric stress test parameters and left ventricular ejection fraction (LVEF) improved in both the experimental and control groups. The most notable changes in echocardiography parameters and physical capacity were in the experimental group. The results showed significant main effect over time, a time-versus-group interaction in LVEF, the duration of the test, and peak oxygen uptake, and a time-versus-group interaction in metabolic equivalents (METs). We also noted the improvement of left ventricular end-diastolic diameter, left ventricular end-systolic diameter, and heart rate over time. CONCLUSION The results revealed better effectiveness in the CR program with a modified hatha yoga training program. Hatha yoga training could be recommended as an adjunct to standard CR.
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Chacin-Suarez AS, Bonikowske AR, Medina-Inojosa JR, Gulati R, Best PJ, Hayes SN, Tweet MS. Physical Activity and Exercise Patterns After Spontaneous Coronary Artery Dissection: Insights From a Large Multinational Registry. Front Cardiovasc Med 2021; 8:642739. [PMID: 34212011 PMCID: PMC8240509 DOI: 10.3389/fcvm.2021.642739] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 04/20/2021] [Indexed: 01/16/2023] Open
Abstract
Objective: The objective of the study was to assess the physical activity (PA) and exercise patterns among participants in a large multinational spontaneous coronary artery dissection (SCAD) registry. Patients and Methods: Participants with SCAD enrolled from March 2011 to November 2019 completed surveys including details regarding PA and exercise habits prior to SCAD, and PA counseling received from their provider after SCAD. Demographics and clinical characteristics were collected by electronic record review. Exercise prescribed to patients after SCAD was categorized according to exercise components: type, intensity, frequency, time/session, and extreme environmental conditions. Results: We included 950 participants; mean ± age was 46.8 ± 9.5 years old at the time of first SCAD; most (96.3%) were women and (77.0%) attended ≥1 cardiac rehabilitation session. Hyperlipidemia (34.3%), hypertension (32.8%), and elevated body weight (overweight = 27.0%; obesity = 20.0%) were the most common comorbidities. Prior to SCAD, 48.5% performed aerobic exercise ≥3 times/week, and only 32.0% performed strength-building exercise regularly. PA counseling details after SCAD in 299/950 participants showed that most (93.3%) patients received some form of counseling including exercise prescription (EXP), non-specific recommendations, and discouraged from any exercise. Limits regarding exercise type and intensity were the most common advice among participants who received EXP. Conclusion: Insights from our study suggest that only 48% of the patients performed some aerobic exercise three or more times per week, and 32.0% performed strength-building exercises, which suggest that most of them may not be as active as assumed. Furthermore, 70% of the SCAD patients have ≥1 cardiovascular risk factors. We suggest guiding patients based on individual assessment, taking into consideration baseline PA habits, treatment, and risk factors. SCAD-tailored PA guidelines are needed for optimal EXP without compromising patient safety.
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Affiliation(s)
| | - Amanda R Bonikowske
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, United States
| | | | - Rajiv Gulati
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, United States
| | - Patricia J Best
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, United States
| | - Sharonne N Hayes
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, United States
| | - Marysia S Tweet
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, United States
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Pecci C, Ajmal M. Cardiac Rehab in the COVID-19 Pandemic. Am J Med 2021; 134:559-560. [PMID: 33577752 PMCID: PMC9745923 DOI: 10.1016/j.amjmed.2021.01.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 01/06/2021] [Accepted: 01/07/2021] [Indexed: 12/16/2022]
Affiliation(s)
- Cristina Pecci
- Cardiology Fellow, College of Medicine, University of Arizona, Phoenix
| | - Muhammad Ajmal
- Cardiology Fellow, College of Medicine, University of Arizona, Tucson.
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Exercise Training and Cardiac Rehabilitation in COVID-19 Patients with Cardiovascular Complications: State of Art. Life (Basel) 2021; 11:life11030259. [PMID: 33801080 PMCID: PMC8004041 DOI: 10.3390/life11030259] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 03/15/2021] [Accepted: 03/16/2021] [Indexed: 02/06/2023] Open
Abstract
Recent scientific literature has investigated the cardiovascular implications of COVID-19. The mechanisms of cardiovascular damage seem to involve the protein angiotensin-converting enzyme 2 (ACE2), to which severe acute respiratory syndrome (SARS) coronavirus-2 (CoV-2) binds to penetrate cells and other mechanisms, most of which are still under study. Cardiovascular sequelae of COVID-19 include heart failure, cardiomyopathy, acute coronary syndrome, arrhythmias, and venous thromboembolism. This article aims to collect scientific evidence by exploiting PubMed, Scopus, and Pedro databases to highlight the cardiovascular complications of COVID-19 and to define the physiotherapy treatment recommended for these patients. Exercise training (ET), an important part of cardiac rehabilitation, is a powerful tool in physiotherapy, capable of inducing significant changes in the cardiovascular system and functional in the recovery of endothelial dysfunction and for the containment of thromboembolic complications. In conclusion, due to the wide variety of possible exercise programs that can be obtained by combining intensity, duration, and speed in various ways, and by adjusting the program based on continuous patient monitoring, exercise training is well suited to the treatment of post-COVID patients with an impaired cardiovascular system of various degrees.
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Jahandideh S, Jahandideh M, Barzegari E. Individuals' Intention to Engage in Outpatient Cardiac Rehabilitation Programs: Prediction Based on an Enhanced Model. J Clin Psychol Med Settings 2021; 28:798-807. [PMID: 33723685 DOI: 10.1007/s10880-021-09771-7] [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: 03/01/2021] [Indexed: 11/29/2022]
Abstract
Motivation is an important factor in encouraging individuals to attend rehabilitation and underpins many approaches to engagement. The aims of this study were to develop an accurate model able to predict individual intention to engage in outpatient cardiac rehabilitation (CR) programs based on the first stage of the Model of Therapeutic Engagement integrated into a socio-environmental context. The cross-sectional study in the cardiology ward of an Australian hospital included a total of 217 individuals referred to outpatient CR. Through an ordinal logistic regression, the effect of random forest (RF)-selected profile features on individual intention to engage in outpatient CR was explored. The RF based on the conditional inference trees predicted the intention to engage in outpatient CR with high accuracy. The findings highlighted the significant roles of individuals' 'willingness to consider the treatment', 'perceived self-efficacy' and 'perceived need for rehabilitation' in their intention, while the involvement of 'barriers to engagement' and 'demographic and medical factors' was not evident.
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Affiliation(s)
- Sepideh Jahandideh
- School of Human Services and Social Work, Menzies Health Institute Queensland, Griffith University, Gold Coast Campus, Queensland, Australia
| | - Mina Jahandideh
- Department of Mathematics, Faculty of Science, Zanjan University, Zanjan, Iran
| | - Ebrahim Barzegari
- Medical Biology Research Center, Health Technology Institute, Kermanshah University of Medical Sciences, P.O. Box: 67155-1616, Zakariya Razi Blvd., Kermanshah, Iran.
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Araya-Ramírez F, Moncada-Jiménez J, Grandjean PW, Franklin BA. Improved Walk Test Performance and Blood Pressure Responses in Men and Women Completing Cardiac Rehabilitation: Implications Regarding Exercise Trainability. Am J Lifestyle Med 2021; 16:772-778. [DOI: 10.1177/1559827621995129] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Revised: 12/26/2020] [Accepted: 01/27/2021] [Indexed: 12/29/2022] Open
Abstract
Purpose. To evaluate changes in walk test performance and blood pressure (BP) responses following a 12-week exercise-based outpatient cardiac rehabilitation (CR) program. Methods. Six-Minute Walk Test (6MWT) and resting systolic BP (SBP), diastolic BP (DBP), post-6MWT heart rate (HR), and post-6MWT BPs were measured before and after CR in 311 (237 men,74 women) patients. Using age as a covariate, 2 by 2 (Gender × Measurement) ANCOVAs were used to determine differences in 6MWT performance and hemodynamic variables. Results. After adjusting for age, men covered a greater 6MWT distance than women; pre-CR versus post-CR program values are as follows: men, 429.3 ± 94.6 versus 557.6 ± 90.7 m, P ≤ .001; women, 374.9 ± 100.7 versus 483.2 ± 82.9 m, P ≤ .001. Both genders reduced resting DBP following the CR program (men: 67.2 ± 9.8 vs 65.6 ± 8.5 mm Hg, P = .034; women: 69.2 ± 10.7 vs 65.0 ± 8.0 mm Hg, P = .001) and increased HR following the 6MWT after the CR program (men: 97.7 ± 16.8 vs 112.7 ± 21.3 bpm, P ≤ .001; women: 100.7 ± 20.8 vs 110.2 ± 22.0 bpm, P ≤ .001). Similarly, SBP increased immediately following the 6MWT (122.8 ± 18.5 vs 133.6 ± 20.7 mm Hg; P ≤ .001) in men but not in women. Conclusion. The present findings indicate similar relative improvements in 6MWT performance and BP responses in adherent men and women following an exercise-based CR program.
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Affiliation(s)
- Felipe Araya-Ramírez
- School of Human Movement Science and Quality of Life, National University, Heredia, Costa Rica
| | - José Moncada-Jiménez
- Human Movement Sciences Research Center (CIMOHU), University of Costa Rica, San Jose, Costa Rica
| | - Peter W. Grandjean
- Department of Health, Exercise Science and Recreation Management, University of Mississippi, Oxford, Mississippi
| | - Barry A. Franklin
- Preventive Cardiology and Cardiac Rehabilitation, William Beaumont Hospital, Royal Oak, Michigan, and Oakland University William Beaumont School of Medicine, Rochester, Michigan
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Abstract
PURPOSE Clinical interventions in programs such as cardiac rehabilitation (CR) are guided by clinical characteristics of participating patients. This study describes changes in CR participant characteristics over 20 yr. METHODS To examine changes in patient characteristics over time, we analyzed data from 1996 to 2015 (n = 5396) garnered from a systematically and prospectively gathered database. Linear, logistic, multinomial logistic or negative binomial regression was used, as appropriate. Effects of sex and index diagnosis were considered both as interactions and as additive effects. RESULTS Analyses revealed that mean age increased (from 60.7 to 64.2 yr), enrollment of women increased (from 26.8% to 29.6%), and index diagnosis has shifted; coronary artery bypass surgery decreased (from 37.2% to 21.6%), whereas heart valve repair/replacement increased (from 0% to 10.6%). Risk factors also shifted with increases in body mass index (28.7 vs 29.6 kg/m), obesity (from 33.2% to 39.6%), hypertension (from 51% to 62.5%), type 2 diabetes mellitus (from 17.3% to 21.7%), and those reporting current smoking (from 6.6% to 8.4%). Directly measured peak aerobic capacity remained relatively stable throughout. The proportion of patients on statin therapy increased from 63.6% to 98.9%, coinciding with significant improvements in lipid levels. CONCLUSIONS Compared with 1996, participants entering CR in 2015 were older, more overweight, and had a higher prevalence of coronary risk factors. Lipid values improved substantially concurrent with increased statin use. While the percentage of female participants increased, they continue to be underrepresented. Patients with heart valve repair/replacement now constitute 10.6% of the patients enrolled. Clinical programs need to recognize changing characteristics of attendees to best tailor interventions.
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Jiménez López E. Cambios de composición corporal posterior a un programa de rehabilitación cardíaca fase II. REVISTA COLOMBIANA DE CARDIOLOGÍA 2020. [DOI: 10.1016/j.rccar.2019.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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Affiliation(s)
- Randal J Thomas
- Preventive Cardiology Division, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - LaPrincess C Brewer
- Preventive Cardiology Division, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
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Wu LP, Zhang YQ, Chen LJ, Liu YQ. Diagnosis of anomalous origin of the right coronary artery from the pulmonary artery by echocardiography. J Med Ultrason (2001) 2019; 46:335-341. [PMID: 30790093 DOI: 10.1007/s10396-019-00933-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Accepted: 01/07/2019] [Indexed: 11/25/2022]
Abstract
PURPOSE To review the imaging characteristics and evaluate the diagnostic value of echocardiography for diagnosing anomalous origin of the right coronary artery from the pulmonary artery (ARCAPA). METHODS We retrospectively reviewed the echocardiographic records and compared these images with operative findings in six children with ARCAPA. RESULTS ARCAPA was characterized by dilation of the left coronary artery, inappropriate origin of the right coronary artery from the pulmonary artery, and collaterals within the interventricular septum. The associated malformations included atrial septal defect in four cases. Four of six cases were diagnosed correctly, while the remaining two cases were misdiagnosed: one of fistula between the pulmonary artery and the left coronary artery and another of ARCAPA diagnosed intraoperatively in one case of atrial septal defect. CONCLUSION ARCAPA can be diagnosed by echocardiography but is prone to misdiagnosis. This malformation should be distinguished from coronary artery fistula.
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Affiliation(s)
- Lan-Ping Wu
- Department of Pediatric Cardiology, Shanghai Children'S Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai, 200127, People's Republic of China
| | - Yu-Qi Zhang
- Department of Pediatric Cardiology, Shanghai Children'S Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai, 200127, People's Republic of China.
| | - Li-Jun Chen
- Department of Pediatric Cardiology, Shanghai Children'S Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai, 200127, People's Republic of China
| | - Yi-Qing Liu
- Department of Pediatric Cardiology, Shanghai Children'S Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai, 200127, People's Republic of China
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Saeidi M, Soroush A, Komasi S, Brugnera A, Patucelli M, Carrozzino D, Fulcheri M, Compare A. Efficacy of Alternative Cardiac Rehabilitation Delivery Formats in Improving Psychological Symptoms after Coronary Artery Bypass Grafting. J Tehran Heart Cent 2019; 13:103-107. [PMID: 30745922 PMCID: PMC6368916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background: Health-care systems always strive for alternative cardiac rehabilitation (CR) models to ensure that options available to patients better fit their needs, risk factor profiles, and preferences. We assessed the effects of hospital-based cardiac rehabilitation (HBCR) and hybrid cardiac rehabilitation (HCR) on psychological symptoms (i.e., anxiety, depression, and stress) among patients following coronary artery bypass graft surgery (CABG). Methods: This cross-sectional study recruited 115 CABG patients who were referred to the Department of Cardiac Rehabilitation at Imam Ali Hospital in the Iranian city of Kermanshah between January and May 2016. The patients were assigned to 1 of the 2 programs of HBCR (26 sessions) and HCR (10 sessions). The study population’s psychological symptoms were assessed using the Depression, Anxiety, and Stress Scale (DASS) before and after the intervention, and the data were analyzed using paired t-tests and ANCOVA. Results: A total of 105 (91%) patients concluded the CR program. Respectively, 50.8% and 26.2% of the participants in the HBCR and HCR programs were female. The mean age was 59.6±9.2 years in the HBCR group and 58.7±6.1 years in the HCR group. The ANCOVA results indicated that both HBCR and HCR programs were equally effective in reducing anxiety (P=0.001 vs. P=0.015) and stress (P=0.002 vs. P=0.003) among the CABG patients, while only HBCR was effective in alleviating depressive symptoms (P=0.001). Conclusion: Our results demonstrated the efficacy of HBCR and HCR in diminishing stress and anxiety levels among the CABG patients. However, depression was affected only by HBCR.
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Affiliation(s)
- Mozhgan Saeidi
- Cardiac Rehabilitation Center, Imam Ali Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Ali Soroush
- Heart Research Center, Imam Ali Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Saeid Komasi
- Clinical Research Development Center, Imam Reza Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Agostino Brugnera
- Department of Human and Social Sciences, University of Bergamo, Bergamo, Italy
| | - Marco Patucelli
- Department of Human and Social Sciences, University of Bergamo, Bergamo, Italy
| | | | - Mario Fulcheri
- University "G. d'Annunzio" of Chieti and Pescara, Chieti, Italy
| | - Angelo Compare
- Department of Human and Social Sciences, University of Bergamo, Bergamo, Italy
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Alsabah Alavizadeh N, Rashidlamir A, Hejazi SM. Effects of Eight Weeks of Cardiac Rehabilitation Training on Serum Levels of Sirtuin1 and Functional Capacity of Post- Coronary Artery Bypass Grafting Patients. MEDICAL LABORATORY JOURNAL 2019. [DOI: 10.29252/mlj.13.2.41] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
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17
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Duan YP, Liang W, Guo L, Wienert J, Si GY, Lippke S. Evaluation of a Web-Based Intervention for Multiple Health Behavior Changes in Patients With Coronary Heart Disease in Home-Based Rehabilitation: Pilot Randomized Controlled Trial. J Med Internet Res 2018; 20:e12052. [PMID: 30455167 PMCID: PMC6277829 DOI: 10.2196/12052] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Revised: 10/20/2018] [Accepted: 10/20/2018] [Indexed: 01/23/2023] Open
Abstract
Background Web-based and theory-based interventions for multiple health behaviors appears to be a promising approach with respect to the adoption and maintenance of a healthy lifestyle in cardiac patients who have been discharged from the hospital. Until now, no randomized controlled trials have tested this assumption among Chinese rehabilitation patients with coronary heart disease using a Web-based intervention. Objective The study aim was to evaluate the effect of an 8-week Web-based intervention in terms of physical activity (PA), fruit and vegetable consumption (FVC), lifestyle changes, social-cognitive outcomes, and health outcomes compared with a waiting control group in Chinese cardiac patients. The intervention content was theory-based on the health action process approach. Self-reported data were evaluated, including PA, FVC, healthy lifestyle (the synthesis of PA and FVC), internal resources (combination of intention, self-efficacy, and planning), and an external resource (social support) of PA and FVC behaviors, as well as perceived health outcomes (body mass index, quality of life, and depression). Methods In a randomized controlled trial, 136 outpatients with coronary heart disease from the cardiac rehabilitation center of a hospital in China were recruited. After randomization and exclusion of unsuitable participants, 114 patients were assigned to 1 of the 2 groups: (1) the intervention group: first 4 weeks on PA and subsequent 4 weeks on FVC and (2) the waiting control group. A total of 2 Web-based assessments were conducted, including 1 at the beginning of the intervention (T1, N=114), and 1 at the end of the 8-week intervention (T2, N=83). The enrollment and follow-up took place from December 2015 to May 2016. Results The Web-based intervention outperformed the control condition for PA, FVC, internal resources of PA and FVC, and an external resource of FVC, with an eta-squared effect size ranging from 0.06 to 0.43. Furthermore, the intervention effect was seen in the improvement of quality of life (F1,79=16.36, P<.001, η2=.17). When predicting a healthy lifestyle at follow-up, baseline lifestyle (odds ratio, OR 145.60, 95% CI 11.24-1886; P<.001) and the intervention (OR 21.32, 95% CI 2.40-189.20; P=.006) were found to be significant predictors. Internal resources for FVC mediated the effect of the intervention on the adoption of a healthy lifestyle (R2adj=.29; P=.001), indicating that if the intervention increased the internal resource of behavior, the adoption of a healthy lifestyle was more likely. Conclusions Patients’ psychological resources such as motivation, self-efficacy, planning, and social support as well as lifestyle can be improved by a Web-based intervention that focuses on both PA and FVC. Such an intervention enriches extended rehabilitation approaches for cardiac patients to be active and remain healthy in daily life after hospital discharge. Trial Registration ClinicalTrials.gov NCT01909349; https://clinicaltrials.gov/ct2/show/NCT01909349 (Archived by WebCite at http://www.webcitation.org/6pHV1A0G1)
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Affiliation(s)
- Yan Ping Duan
- Department of Sport and Physical Education, Faculty of Social Sciences, Hong Kong Baptist University, Hong Kong, China (Hong Kong)
| | - Wei Liang
- Department of Sport and Physical Education, Faculty of Social Sciences, Hong Kong Baptist University, Hong Kong, China (Hong Kong)
| | - Lan Guo
- Cardiac Rehabilitation Centre, Guangdong General Hospital, Guangzhou, China
| | - Julian Wienert
- Department of Psychology & Methods, Jacobs University Bremen, Bremen, Germany
| | - Gang Yan Si
- Sport Psychology Centre, Hong Kong Sports Institute, Hong Kong, China (Hong Kong)
| | - Sonia Lippke
- Department of Psychology & Methods, Jacobs University Bremen, Bremen, Germany
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Szylińska A, Listewnik M, Rotter I, Rył A, Kotfis K, Mokrzycki K, Kuligowska E, Walerowicz P, Brykczyński M. The Efficacy of Inpatient vs. Home-Based Physiotherapy Following Coronary Artery Bypass Grafting. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:E2572. [PMID: 30453599 PMCID: PMC6266912 DOI: 10.3390/ijerph15112572] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Revised: 11/08/2018] [Accepted: 11/11/2018] [Indexed: 11/16/2022]
Abstract
Background: Intensive post-operative physiotherapy after cardiac surgery helps to reduce the number of complications, accelerating convalescence and decreasing peri-operative mortality. Cardiac rehabilitation is aimed at regaining lost function and sustaining the effect of cardiac surgery. The aim of this study was to compare the efficacy of inpatient and home-based phase II physiotherapy following coronary artery bypass grafting, and inpatient phase II post-operative physiotherapy based on the analysis of the spirometry results. Methods: A prospective observational study included 104 adult patients of both sexes undergoing planned coronary artery bypass grafting and were randomized to one of the two groups-inpatients (InPhysio) and home-based (HomePhysio) at a 1:1 ratio. All patients had undergone spirometry testing prior to surgery (S1) and on the fifth day after the operation (S2), i.e., on the day of completion of the first phase (PI) of physiotherapy. Both the study group (InPhysio) and the control group (HomePhysio) performed the same set of exercises in the second phase (PII) of cardiac physiotherapy, either in the hospital or at home, respectively, according to the program obtained in the hospital. Both groups have undergone spirometry testing (S3) at 30 days after the operation. Results: The demographic and peri-operative data for both groups were comparable and showed no statistically significant differences. An analysis of gradients between the results of spirometry tests before surgery and at 30 days after the surgery showed a smaller decrease in forced vital capacity (FVC) in the study group than in the control group (p < 0.001). The results at five and 30 days after the surgery showed a greater increase in FVC in the study group than in the control group (680 mL vs. 450 mL, p = 0.009). There were no statistically significant differences in other parameters studied. Conclusions: The advantage of inpatient over home-based physiotherapy was evidenced by much smaller decreases in FVC between the initial and final tests, and greater increases between the fifth day after surgery and the final test. Our analysis showed greater efficacy of inpatient physiotherapy as compared with home-based exercises and raises concerns about patient adherence.
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Affiliation(s)
- Aleksandra Szylińska
- Department of Medical Rehabilitation and Clinical Physiotherapy, Pomeranian Medical University in Szczecin, ul. Żołnierska 54, 70-204 Szczecin, Poland.
| | - Mariusz Listewnik
- Department of Cardiac Surgery, Pomeranian Medical University in Szczecin, al. Powstańców Wlkp. 72, 70-111 Szczecin, Poland.
| | - Iwona Rotter
- Department of Medical Rehabilitation and Clinical Physiotherapy, Pomeranian Medical University in Szczecin, ul. Żołnierska 54, 70-204 Szczecin, Poland.
| | - Aleksandra Rył
- Department of Medical Rehabilitation and Clinical Physiotherapy, Pomeranian Medical University in Szczecin, ul. Żołnierska 54, 70-204 Szczecin, Poland.
| | - Katarzyna Kotfis
- Department of Anesthesiology, Intensive Therapy and Acute Intoxications, Pomeranian Medical University in Szczecin, al. Powstańców Wlkp. 72, 70-111 Szczecin, Poland.
| | - Krzysztof Mokrzycki
- Department of Cardiac Surgery, Pomeranian Medical University in Szczecin, al. Powstańców Wlkp. 72, 70-111 Szczecin, Poland.
| | - Ewelina Kuligowska
- Department of Cardiac Surgery, Pomeranian Medical University in Szczecin, al. Powstańców Wlkp. 72, 70-111 Szczecin, Poland.
| | - Paweł Walerowicz
- Department of Cardiac Surgery, Pomeranian Medical University in Szczecin, al. Powstańców Wlkp. 72, 70-111 Szczecin, Poland.
| | - Mirosław Brykczyński
- Department of Cardiac Surgery, Pomeranian Medical University in Szczecin, al. Powstańców Wlkp. 72, 70-111 Szczecin, Poland.
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Stuebe J, Rydingsward J, Lander H, Ng J, Xu X, Kaneko T, Shekar P, Muehlschlegel JD, Body SC. A Pragmatic Preoperative Prediction Score for Nonhome Discharge After Cardiac Operations. Ann Thorac Surg 2018; 105:1384-1391. [DOI: 10.1016/j.athoracsur.2017.11.060] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Revised: 11/22/2017] [Accepted: 11/27/2017] [Indexed: 10/18/2022]
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del Pozo-Cruz B, Carrick-Ranson G, Reading S, Nolan P, Dalleck LC. The relationship between exercise dose and health-related quality of life with a phase III cardiac rehabilitation program. Qual Life Res 2018; 27:993-998. [DOI: 10.1007/s11136-018-1784-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/09/2018] [Indexed: 01/22/2023]
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21
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Marcucci R, Gori A, Burgisser C, Francini S, Roberts A, Sofi F, Gensini G, Abbate R, Fattirolli F, Cesari F. Adherence to lifestyle modifications after a cardiac rehabilitation program and endothelial progenitor cells. Thromb Haemost 2017; 112:196-204. [DOI: 10.1160/th13-10-0869] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2013] [Accepted: 02/13/2014] [Indexed: 11/05/2022]
Abstract
SummaryAn increase of endothelial progenitor cells (EPCs) among acute myo-cardial infarction (AMI) patients participating in a cardiac rehabilitation (CR) program has been reported, but no data on the impact of adherence to lifestyle recommendations provided during a CR program on EPCs are available. It was our aim to investigate the effect of adherence to lifestyle recommendations on EPCs, inflammatory and functional parameters after six months of a CR program in AMI patients. In 110 AMI patients (90 male/20 female; mean age 57.9 ± 9.4 years) EPCs, high sensitivity C-reactive protein (hsCRP), N-terminal pro-brain natriuretic peptide (NT-ProBNP) levels, and cardiopulmonary testings were determined at the end of the CR (T1) and at a six-month follow-up (T2). At T2 we administered a questionnaire assessing dietary habits and physical activity. At T2, we observed a decrease of EPCs (p<0.05), of hsCRP (p=0.009) and of NT-ProBNP (p<0.0001). Patient population was divided into three categories by Healthy Lifestyle (HL) score (none/low, moderate and high adherence to lifestyle recommendations). We observed a significant association between adherence to lifestyle recommendations, increase in EPCs and exercise capacity between T1 and T2 (Δ EPCs p for trend <0.05; ΔWatt max p for trend=0.004). In a multivariate logistic regression analyses, being in the highest tertile of HL score affected the likelihood of an increase of EPC levels at T2 [OR (95% confidence interval): 3.36 (1.0–10.72) p=0.04]. In conclusion, adherence to lifestyle recommendations provided during a CR program positively influences EPC levels and exercise capacity.
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Maddocks S, Cobbing S. Patients' Experiences of and Perspectives on Phase 1 Cardiac Rehabilitation after Coronary Artery Bypass Graft Surgery. Physiother Can 2017; 69:333-340. [PMID: 30369701 DOI: 10.3138/ptc.2016-39gh] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Purpose: This study explored and described patients' experiences and perceptions of phase 1 cardiac rehabilitation (CR) after a coronary artery bypass graft (CABG) at a public hospital in the province of KwaZulu-Natal, South Africa. CR is recognized around the world as an effective means of preventing disability and prolonging life in post-CABG patients. Despite this, participation in CR is low. Furthermore, little is known about patients' perceptions of CR programmes in South Africa. Method: We used a descriptive qualitative study design to study nine purposively selected participants (mean age 56 y) who had received only individualized CR post-CABG or individualized CR in combination with group CR exercise. The participants were organized into focus groups of attenders and non-attenders of the group CR exercise classes. The four attenders were all men, and the non-attenders were three men and two women. Interviews were transcribed verbatim and subjected to thematic analysis. Results: The three main themes that emerged were communication challenges between health care professionals and patients, the patients' experience of physiotherapy, and their recommendations for service delivery. Conclusion: Patients' perceptions of the current delivery of phase 1 CR in this study setting emphasized that improvements need to be made in the areas of patient-centred care, equality of access to programmes, and appropriateness of programme content. The results appear to indicate that patients have a limited awareness of and participation in in-patient and outpatient CR programmes. Research into improving the design of CR programmes in South Africa is required, in consultation with patients and the multidisciplinary health care team.
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Affiliation(s)
- Stacy Maddocks
- Department of Physiotherapy, School of Health Sciences, University of KwaZulu-Natal (Westville Campus), Durban, South Africa
| | - Saul Cobbing
- Department of Physiotherapy, School of Health Sciences, University of KwaZulu-Natal (Westville Campus), Durban, South Africa
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Anomalous Coronary Arteries on Computer Tomography Angiography: a Pictorial Review. CURRENT CARDIOVASCULAR IMAGING REPORTS 2017. [DOI: 10.1007/s12410-017-9430-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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24
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Huang SC, Wong MK, Lin PJ, Tsai FC, Chu JJ, Wu MY, Fu TC, Wang JS. Short-term intensive training attenuates the exercise-induced interaction of mono-1/2 cells and platelets after coronary bypass in cardiac patients. Thromb Haemost 2017; 117:1761-1771. [PMID: 28492701 DOI: 10.1160/th17-03-0184] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Accepted: 04/14/2017] [Indexed: 12/12/2022]
Abstract
The interaction between platelets and monocytes plays a critical role in the pathogenesis and progression of cardiovascular diseases. This study investigated how short-term intensive training (SIT) influences monocyte subset characteristics and exercise-induced monocyte and platelet aggregates (MPAs) following elective coronary bypass (CABG) in cardiac patients. Forty-nine patients hospitalised for CABG were randomised into SIT (N=26) and conventional training (CT, N=23) groups. The SIT subjects underwent supervised aerobic training at 80~120 % of the ventilatory anaerobic threshold based on sub-maximal exercise tests performed 7 days post-CABG for 20 sessions with two sessions/day and 30 min/session, which were completed within four weeks after surgery. The CT subjects performed light-intensity conditioning exercise for ≤4 sessions. Resting and maximal exercise-mediated monocyte characteristics and MPA were determined before and following intervention. The SIT group had a larger improvement in ventilation efficiency and anaerobic threshold than the CT group; the SIT group exhibited larger reductions in blood monocyte subtypes 1 and 2 (Mono1 and 2) counts at rest than the CT group; the SIT group but not the CT group exhibited attenuated formation of Mono1/platelet hetero-aggregation (MPA1) and CD42b expression on Mono1/2 caused by strenuous exercise; and plasma levels of macrophage inflammatory protein-1β and soluble P-selectin showed similar trends as Mono1/2 and MPA1, respectively. In conclusion, SIT modestly improved aerobic capacity in patients following CABG. Moreover, SIT simultaneously ameliorated the CD42b expression of Mono1/2 cells and maximal exercise-induced MPA1, which may reduce the risk of inflammatory thrombosis.
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Affiliation(s)
| | | | | | | | | | | | | | - Jong-Shyan Wang
- Prof. Jong-Shyan Wang, Healthy Aging Research Center, Graduate Institute of Rehabilitation Science, Medical College, Chang Gung University, 259 Wen-Hwa 1st Road, Kwei-Shan, Tao-Yuan, 333, Taiwan, Tel.: +886 3 2118800, ext 5748, E-mail:
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25
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Siegmund LA, Ahmed HM, Crawford MT, Bena JF. Feasibility of a Facebook Intervention for Exercise Motivation and Cardiac Rehabilitation Adherence: Study Protocol. JMIR Res Protoc 2017; 6:e162. [PMID: 28821473 PMCID: PMC5581387 DOI: 10.2196/resprot.7554] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Revised: 06/16/2017] [Accepted: 07/12/2017] [Indexed: 12/28/2022] Open
Abstract
Background While cardiac rehabilitation has been shown to be effective at improving coronary heart disease (CHD), participation is generally poor. Attempts to increase uptake and adherence often fail. Use of a Facebook intervention for this population may be a unique opportunity to support self-determined motivation and affect adherence. Objective To evaluate the impact of a Facebook intervention on motivation for exercise and adherence to cardiac rehabilitation in patients with CHD during a 12-week, Phase II cardiac rehabilitation program. Methods A prospective, randomized controlled pilot study, grounded in Self-Determination Theory, will be conducted. Participants will be recruited from inpatient, or the intake visit to outpatient, cardiac rehabilitation, and then randomly assigned to the intervention or comparison group. Participants in the intervention group will take part in a private Facebook group. Weekly posts will be designed to support self-determined motivation, measured at baseline and postcardiac rehabilitation by the Behavioral Regulation in Exercise Questionnaire-3 (BREQ-3). The Psychological Need Satisfaction for Exercise (PNSE) scale will measure fulfillment of needs that affect motivation. Participants in the comparison group will be given the same materials, but these will be supplied via handouts and email. The number of sessions attended will be tallied and analyzed using t tests. Overall motivation will be evaluated using analysis of covariance (ANCOVA) models. Multivariate analysis of variance models will be used to evaluate differences in the change across motivation subtypes. If significant, ANCOVA models for each subtype will be fit. ANCOVA models will be used to compare changes in needs satisfaction, overall and separately among the three subscales, between groups. Engagement in the Facebook group will be measured by number of “likes” and self-report of weekly visits to the group. Results This project was funded in July 2017 and recruitment is currently underway. The recruitment goal is 60 cardiac rehabilitation patients. Data collection is anticipated to be complete by July 2018. Conclusions This pilot study will be the first to examine the effect of a Facebook intervention on patient adherence and motivation for exercise in a cardiac rehabilitation setting. Engagement in the Facebook group and participation in the study will help to determine the feasibility of using Facebook to affect adherence and motivation in cardiac rehabilitation patients, potentially improving outcomes through the use of a unique intervention. Trial Registration ClinicalTrials.gov NCT02971813; https://clinicaltrials.gov/ct2/show/NCT02971813 (Archived by WebCite at http://www.webcitation.org/6sRsz8Zpa)
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Affiliation(s)
- Lee Anne Siegmund
- Nursing Institute, Office of Nursing Research and Innovation, The Cleveland Clinic, Cleveland, OH, United States
| | - Haitham M Ahmed
- Heart and Vascular Institute, Department of Cardiovascular Medicine, The Cleveland Clinic, Cleveland, OH, United States
| | - Michael Todd Crawford
- Heart and Vascular Institute, Department of Cardiovascular Medicine, The Cleveland Clinic, Cleveland, OH, United States
| | - James Frank Bena
- Lerner Research Institute, Quantitative Health Sciences, The Cleveland Clinic, Cleveland, OH, United States
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Abstract
OBJECTIVE The aim of this study was to examine physical and heart rhythm management device malfunction complications after participating in a cardiac rehabilitation program intervention compared with usual care. METHOD This study was a clinical trial of 100 patients. After randomization, intervention group patients received 8 cardiac rehabilitation program sessions for 8 weeks and follow-up phone calls. Each session consisted of exercise training, education, and psychological interventions. Data were collected at 3 points in both groups-baseline and 8 and 12 weeks after the first day of the intervention-using a researcher-designed case report form. Data were analyzed using descriptive and nonparametric tests. RESULTS Of the participants, 59% were men, and the sample was aged 40 to 60 years. At the 8- to 12-week follow-up, there were less physical complications among the cardiac rehabilitation group (P < .001) and no between-group differences in complications related to device malfunction. By heart rhythm device type, cardiac rehabilitation had the greatest efficacy in reducing physical complications in patients with cardioverter/defibrillators. CONCLUSIONS Cardiac rehabilitation reduced physical complications in patients with cardiac rhythm management devices, especially in patients with cardioverter/defibrillators. Cardiac clinical nurse specialists should recommend rehabilitation programs as part of postimplantation rhythm device treatment to decrease the risk of physical complications.
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Pietrabissa G, Manzoni GM, Rossi A, Castelnuovo G. The MOTIV-HEART Study: A Prospective, Randomized, Single-Blind Pilot Study of Brief Strategic Therapy and Motivational Interviewing among Cardiac Rehabilitation Patients. Front Psychol 2017; 8:83. [PMID: 28223950 PMCID: PMC5293749 DOI: 10.3389/fpsyg.2017.00083] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2016] [Accepted: 01/13/2017] [Indexed: 01/09/2023] Open
Abstract
Background: Psychological distress, biomedical parameters, and unhealthy lifestyles contribute to a poorer prognosis for cardiac disease. Public health's challenge is to motivate patients to utilize self-care. Objective: This prospective, randomized, single-blind pilot study aimed at testing the incremental efficacy of Brief Strategic Therapy (BST) combined with Motivational Interviewing (MI) in improving selected biomedical and psychological outcomes over and beyond those of the stand-alone BST in a residential Cardiac Rehabilitation (CR) program. Method: Fourty-two inpatients (17 females), enrolled in a 1-month CR program, were randomly allocated into two conditions: (a) Three sessions of BST and (b) Three sessions of BST plus MI. Data were collected at baseline, discharge, and after 3 months through phone interviews. Results: At discharge, no significant between-group difference was found in any outcome variable. Changes from pre- to post-treatment within each condition showed significant improvements only in the BST group, where the level of external regulation diminished, and both the participants' self-regulation (Relative Autonomous Motivation Index, RAI) and willingness to change improved. At the 3-month follow-up, within-group analyses on responders (BST = 9; BST + MI = 11) showed a statistically significant improvement in the level of systolic blood pressure in both groups. Discussion: Findings showed no evidence of the incremental efficacy of combining BST and MI over and beyond BST alone on either selected biomedical or psychological outcomes among CR patients. Conclusions: Ends and limitations from the present pilot study should be considered and addressed in future investigations.
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Affiliation(s)
- Giada Pietrabissa
- Psychology Research Laboratory, Ospedale San Giuseppe, IRCSS Istituto Auxologico Italiano IRCCSVerbania, Italy; Department of Psychology, Catholic University of MilanMilan, Italy
| | - Gian Mauro Manzoni
- Psychology Research Laboratory, Ospedale San Giuseppe, IRCSS Istituto Auxologico Italiano IRCCSVerbania, Italy; Faculty of Psychology, eCampus UniversityNovedrate, Italy
| | - Alessandro Rossi
- Psychology Research Laboratory, Ospedale San Giuseppe, IRCSS Istituto Auxologico Italiano IRCCS Verbania, Italy
| | - Gianluca Castelnuovo
- Psychology Research Laboratory, Ospedale San Giuseppe, IRCSS Istituto Auxologico Italiano IRCCSVerbania, Italy; Department of Psychology, Catholic University of MilanMilan, Italy
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Pinkstaff SO, McNeil A, Arena R, Cahalin L. Healthy Living Medicine in the Workplace: More Work to Do. Prog Cardiovasc Dis 2016; 59:440-447. [PMID: 28038911 DOI: 10.1016/j.pcad.2016.12.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Accepted: 12/21/2016] [Indexed: 11/20/2022]
Abstract
Non-communicable diseases (NCDs) are five of the top ten causes of death for Americans: cardiovascular disease (CVD), cancer, lower respiratory disease, stroke and diabetes mellitus. Risk factors for these NCDs and for CVD are tobacco use, poor diet quality, physical inactivity, increase body mass index, increased blood pressure, increased blood cholesterol, and glucose intolerance. Depression, depressive symptoms and anxiety also contribute to CVD risk. There is also evidence work stress itself contributes to CVD risk. By 2024 there is expected to be approximately 164 million workers in the US labor force and the share of older workers will likewise increase. Currently, about 25 million of those are over the age of 55, the age at which many diseases of lifestyle become clinically apparent. Furthermore, Americans spend as much as half of their waking hours at work. This makes the worksite an important target for the delivery of healthy living medicine.
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Affiliation(s)
- Sherry O Pinkstaff
- Department of Clinical & Applied Movement Sciences, Brooks College of Health, University of North Florida, Jacksonville, FL.
| | - Amy McNeil
- Department of Physical Therapy, Department of Kinesiology and Nutrition, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL, USA
| | - Ross Arena
- Department of Physical Therapy, Department of Kinesiology and Nutrition, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL, USA
| | - Lawrence Cahalin
- Department of Physical Therapy, Leonard M. Miller School of Medicine, University of Miami, FL
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Pack QR, Lahr BD, Squires RW, Lopez-Jimenez F, Greason KL, Michelena HI, Goel K, Thomas RJ. Survey Reported Participation in Cardiac Rehabilitation and Survival After Mitral or Aortic Valve Surgery. Am J Cardiol 2016; 117:1985-91. [PMID: 27138188 DOI: 10.1016/j.amjcard.2016.03.052] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Revised: 03/25/2016] [Accepted: 03/25/2016] [Indexed: 02/04/2023]
Abstract
We sought to measure the impact of cardiac rehabilitation (CR) on mortality in patients with mitral or aortic heart valve surgery (HVS) and nonobstructive coronary artery disease. We surveyed all patients (or a close family member if the patient was deceased) who had HVS without coronary artery bypass in 2006 through 2010 at the Mayo Clinic to assess if they attended CR after their HVS. We performed a propensity-adjusted landmark analysis to test the association between CR attendance and long-term all-cause mortality conditional on surviving the first year after HVS. Survey response rate was 40% (573/1,420), with responders more likely to be older, have longer hospitalizations, and have more aortic valve disease. A total of 547 patients (59% aortic surgery, ejection fraction 64%) with valid survey responses and 1-year follow-up were included in the propensity analysis, of whom 296 (54%) attended CR. There were 100 deaths during a median follow-up of 5.8 years. For all patients, the propensity-adjusted model suggested no impact of CR on mortality (hazard ratio [HR] 1.03, 95% CI 0.66 to 1.62). When stratified by procedure, results suggested a potentially favorable, but nonsignificant, effect in patients with mitral valve surgery (HR 0.49, 95% CI 0.15 to 1.56), but not in patients with aortic valve surgery (HR 1.00, 95% CI 0.61 to 1.64.) In conclusion, we found no survival advantage for patients with normal preoperative ejection fraction who attended CR after surgical "correction" of their severe aortic or mitral valve disease.
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Alharbi M, Bauman A, Neubeck L, Gallagher R. Validation of Fitbit-Flex as a measure of free-living physical activity in a community-based phase III cardiac rehabilitation population. Eur J Prev Cardiol 2016; 23:1476-85. [PMID: 26907794 DOI: 10.1177/2047487316634883] [Citation(s) in RCA: 97] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2015] [Accepted: 02/04/2016] [Indexed: 12/17/2022]
Abstract
BACKGROUND Accurate physical activity monitoring is important for cardiac patients. Novel activity monitoring devices may enable precise measurement of physical activity. This study aimed to validate Fitbit-Flex against Actigraph accelerometer for monitoring physical activity. DESIGN A validation study with a comparative design. METHODS Cardiac patients and family members participating in community-based exercise programs wore Fitbit-Flex and Actigraph simultaneously over four days to monitor daily step counts and minutes of moderate to vigorous physical activity (MVPA). RESULTS Participants (N = 48) comprised 52.1% males, with a mean age of 65.6 ± 6.9 years and 58.9% had a cardiac diagnosis. Fitbit-Flex and Actigraph were significantly correlated in males, females, total participants and cardiac patients for step counts (r = .96; r = .95; r = .95; r = .95), though less so for MVPA (r = .81; r = .65, r = .74; r = .71). As step counts increased the differences between Fitbit-Flex and Actigraph also increased. Fitbit-Flex over-estimated step counts in females (556 steps/day), males (1462 steps/day) and total participants (1038 steps/day) as well as for minutes of MVPA in females (4 min/day), males (15 min/day) and total participants (10 min/day). Fitbit-Flex had high sensitivity and specificity in classifying participants who achieved the recommended physical activity guidelines. CONCLUSION Fitbit-Flex is accurate in assessing attainment of physical activity guideline recommendations and is useful for monitoring physical activity in cardiac patients. The device does, however, slightly over-estimate step counts and MVPA.
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Affiliation(s)
| | - Adrian Bauman
- Charles Perkins Centre, University of Sydney, Australia
| | - Lis Neubeck
- Charles Perkins Centre, University of Sydney, Australia
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Rosenbaum AN, Kremers WK, Schirger JA, Thomas RJ, Squires RW, Allison TG, Daly RC, Kushwaha SS, Edwards BS. Association Between Early Cardiac Rehabilitation and Long-term Survival in Cardiac Transplant Recipients. Mayo Clin Proc 2016; 91:149-56. [PMID: 26848001 DOI: 10.1016/j.mayocp.2015.12.002] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2015] [Accepted: 12/07/2015] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To determine whether participation in early cardiac rehabilitation (CR) after heart transplant (HTx) affects long-term survival. PATIENTS AND METHODS A retrospective review was conducted in 201 patients who underwent HTx at Mayo Clinic between June 1, 2000, and July 31, 2013. Patients were excluded with multiorgan transplant, no CR data, and follow-up less than 90 days after HTx. Demographic and exercise data at baseline before HTx were collected. Post-HTx exercise capacity, biopsy, CR data, and medications were collected at 1 through 5 and 10 years. RESULTS Overall survival at 1, 5, and 10 years was 98%, 88%, and 82%, respectively; 29 patients died. Number of CR sessions attended in the first 90 days after HTx predicted survival in multivariate regression, controlling for baseline post-HTx 6-minute walk test (6MWT) results and rejection episodes (hazard ratio, 0.90; 95% CI, 0.82-0.97; P=.007). Additional univariate predictors of survival included pre-HTx 6MWT results, weight at HTx, and body mass index and systolic blood pressure at CR enrollment. Pre-HTx 6MWT results, body mass index, and post-HTx were associated with improvement in peak oxygen consumption. CONCLUSION This report demonstrates, for the first time, an association between CR and long-term survival in patients after HTx. Further work should clarify the most beneficial aspects of CR.
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Affiliation(s)
| | - Walter K Kremers
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN; William J. von Liebig Center for Transplantation and Clinical Regeneration, Mayo Clinic, Rochester, MN
| | - John A Schirger
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN; William J. von Liebig Center for Transplantation and Clinical Regeneration, Mayo Clinic, Rochester, MN
| | - Randal J Thomas
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN
| | - Ray W Squires
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN
| | | | - Richard C Daly
- Division of Cardiovascular Surgery, Mayo Clinic, Rochester, MN; William J. von Liebig Center for Transplantation and Clinical Regeneration, Mayo Clinic, Rochester, MN
| | - Sudhir S Kushwaha
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN; William J. von Liebig Center for Transplantation and Clinical Regeneration, Mayo Clinic, Rochester, MN
| | - Brooks S Edwards
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN; William J. von Liebig Center for Transplantation and Clinical Regeneration, Mayo Clinic, Rochester, MN
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Veal FC, Bereznicki LRE, Thompson AJ, Peterson GM, Orlikowski CE. Pain and Functionality Following Sternotomy: A Prospective 12-Month Observational Study. PAIN MEDICINE 2016; 17:1155-1162. [PMID: 26814306 DOI: 10.1093/pm/pnv066] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To document pain levels, functionality, and analgesic use in the 12 months following a sternotomy to identify factors associated with the development of persistent post-sternotomy pain. DESIGN Prospective observational study. SETTINGS Royal Hobart Hospital, Australia. SUBJECTS Patients undergoing a sternotomy between January and November 2013. METHODS One hundred and ten patients were recruited and followed for 12 months, with telephone calls at 10 days, 6 weeks, 3 months, and 12 months. An initial survey was completed at the point of recruitment including patient history, depression and anxiety scales, self-rated health, and pain catastrophizing scale. RESULTS The mean age of participants was 69.6 years, with the majority of participants being male (84.5%). The proportion of patients reporting pain in the early post-discharge period was high, with 30% of patients experiencing on average moderate-severe pain in the 10 days following discharge and 11% experiencing on average moderate-severe pain at 6 weeks. At 12 months, 15.5% of participants reported on average mild pain and 0.9% an average of moderate-severe pain in the preceding week at their sternotomy site. Pain of neuropathic origin was reported by 41.2% of those with on average daily pain at 12 months. CONCLUSION This study highlights the need for further research to investigate whether more intensive pain management in the post-discharge period following sternotomy as well as the early identification of patients with neuropathic pain symptoms can reduce the incidence of persistent post-operative pain at 12 months.
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Affiliation(s)
- Felicity C Veal
- *Unit for Medication Outcomes Research and Education, Pharmacy, School of Medicine, University of Tasmania, Tasmania, Australia;
| | - Luke R E Bereznicki
- *Unit for Medication Outcomes Research and Education, Pharmacy, School of Medicine, University of Tasmania, Tasmania, Australia
| | - Angus J Thompson
- *Unit for Medication Outcomes Research and Education, Pharmacy, School of Medicine, University of Tasmania, Tasmania, Australia
| | - Gregory M Peterson
- *Unit for Medication Outcomes Research and Education, Pharmacy, School of Medicine, University of Tasmania, Tasmania, Australia
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Komasi S, Saeidi M, Montazeri N, Masoumi M, Soroush A, Ezzati P. Which Factors Unexpectedly Increase Depressive Symptom Severity in Patients at the End of a Cardiac Rehabilitation Program? Ann Rehabil Med 2015; 39:872-9. [PMID: 26798600 PMCID: PMC4720762 DOI: 10.5535/arm.2015.39.6.872] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2015] [Accepted: 07/10/2015] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To investigate predictors of depressive symptom aggravation at the end of a cardiac rehabilitation (CR) program. METHODS The design of the study was retrospective. The administrative data were obtained from the database of the CR department of a heart hospital in Iran. The demographic and clinical information of 615 CR patients between January 2000 and January 2010 was analyzed using binary logistic regression analysis. RESULTS The results showed that 10.7% of the patients completed the CR program with aggravated depressive symptoms. After adjustment for gender, age, and pre-intervention depression score, lower education level (p<0.05) and smoking (p<0.01) were significant predictors of increased depressive symptoms at the end of the program. Our model variables could explain 6% to 13% of the dependent variable variance. CONCLUSION The results suggest that targeting patients who are less literate or who smoke could allow for taking the required measures to prevent or control depression at the end of a CR program. It is suggested that future studies consider other variables.
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Affiliation(s)
- Saeid Komasi
- Cardiac Rehabilitation Center, Imam ALI Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Mozhgan Saeidi
- Cardiac Rehabilitation Center, Imam ALI Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Nafiseh Montazeri
- Imam ALI hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | | | - Ali Soroush
- Department of Sports Medicine and Rehabilitation, Imam Reza Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Parvin Ezzati
- Cardiac Rehabilitation Center, Imam ALI Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran
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Heydarpour B, Saeidi M, Ezzati P, Soroush A, Komasi S. Sociodemographic Predictors in Failure to Complete Outpatient Cardiac Rehabilitation. Ann Rehabil Med 2015; 39:863-71. [PMID: 26798599 PMCID: PMC4720761 DOI: 10.5535/arm.2015.39.6.863] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2015] [Accepted: 06/19/2015] [Indexed: 11/10/2022] Open
Abstract
Objective To investigate the role of sociodemographic factors in failure to complete outpatient cardiac rehabilitation (CR). Methods This was a retrospective study that used information obtained from the database of the cardiac rehabilitation department of a cardiac hospital in Iran. Data from 1,050 CR patients treated at the hospital between January 2001 and January 2013 was analyzed using binary logistic regression analysis. Results Only 49% of the patients completed the CR program. After adjustment for baseline variables, it was found that the following were significantly associated with failure to complete the CR program: illiteracy (p<0.001), old age (p<0.001), being an employee or retired (p<0.05), having a low capacity for exercise (p<0.001), depression (p<0.001), low anxiety (p<0.001), and not currently being a smoker (p<0.001). Conclusion Paying more attention to older patients with low literacy levels and limited exercise capacity, who are employed or retired, and who are not current smokers, and taking therapeutic measures to control psychological complications such as depression, may be effective in ensuring that patients complete outpatient cardiac rehabilitation.
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Affiliation(s)
- Behzad Heydarpour
- Cardiac Rehabilitation Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Mozhgan Saeidi
- Cardiac Rehabilitation Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Parvin Ezzati
- Cardiac Rehabilitation Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Ali Soroush
- Lifestyle Modification Research Center, Imam Reza Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Saeid Komasi
- Cardiac Rehabilitation Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
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Saeidi M, Komasi S, Heydarpour B, Karim H, Nalini M, Ezzati P. Predictors of Clinical Anxiety Aggravation at the End of a Cardiac Rehabilitation Program. Res Cardiovasc Med 2015; 5:e30091. [PMID: 26937419 PMCID: PMC4750222 DOI: 10.5812/cardiovascmed.30091] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2015] [Revised: 06/13/2015] [Accepted: 06/29/2015] [Indexed: 11/20/2022] Open
Abstract
Background: Anxiety is one of the most primary and common reactions to a cardiac event can lead to hypertension, tachycardia, and high cardiac output. Objectives: To investigate the predictors of clinical anxiety aggravation at the end of a cardiac rehabilitation (CR) program. Patients and Methods: This retrospective study used a database of a CR ward of a hospital in Iran. The demographic and clinical information of 574 patients participating in the CR program from April 2005 through April 2010 were analyzed. In order to determine the predictors of anxiety, binary logistic regression was performed. Results: After adjustment for gender, age and education, the results showed that 16.7% of the patients completed their CR program with increased levels of clinical anxiety. The following study variables were independently predictive of increased anxiety at the end of the CR program: male gender (OR = 2.04, 95% CI = 1.11 to 3.33, P = 0.048), no history of diabetes (OR = 4.24, 95% CI = 172 to 10.44, P = 0.002), family history of cardiac disease (OR = 2.63, 95% CI = 1.03 to 6.74, P = 0.043), and not quitting smoking (OR = 3.29, 95% CI = 1.38 to 7.85, P = 0.007). These variables could explain 9% - 15% of the variance in the dependent variable. Conclusions: It is possible to predict higher anxiety levels at the end of the CR program and implement preventive measures to control anxiety by considering certain demographic and clinical variables. Future studies should assess the predictive power of other variables.
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Affiliation(s)
- Mozhgan Saeidi
- Department of Clinical Psychology, Cardiac Rehabilitation Center, Imam Ali Hospital, Kermanshah University of Medical Sciences, Kermanshah, IR Iran
| | - Saeid Komasi
- Department of Clinical Psychology, Cardiac Rehabilitation Center, Imam Ali Hospital, Kermanshah University of Medical Sciences, Kermanshah, IR Iran
- Corresponding author: Saeid Komasi, Department of Clinical Psychology, Cardiac Rehabilitation Center, Imam Ali Hospital, Kermanshah University of Medical Sciences, Kermanshah, IR Iran., Tel.: +98-8338380698, Fax: +98-8338360043, E-mail:
| | - Behzad Heydarpour
- Department of Clinical Psychology, Cardiac Rehabilitation Center, Imam Ali Hospital, Kermanshah University of Medical Sciences, Kermanshah, IR Iran
| | - Hossein Karim
- Department of Cardiovascular Surgery, Imam Ali Heart Hospital, Kermanshah University of Medical Sciences, Kermanshah, IR Iran
| | - Mehdi Nalini
- Heart Researches Center, Imam Ali Heart Hospital, Kermanshah University of Medical Sciences, Kermanshah, IR Iran
| | - Parvin Ezzati
- Department of Clinical Psychology, Cardiac Rehabilitation Center, Imam Ali Hospital, Kermanshah University of Medical Sciences, Kermanshah, IR Iran
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Lin X, Zhang X, Guo J, Roberts CK, McKenzie S, Wu WC, Liu S, Song Y. Effects of Exercise Training on Cardiorespiratory Fitness and Biomarkers of Cardiometabolic Health: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. J Am Heart Assoc 2015; 4:JAHA.115.002014. [PMID: 26116691 PMCID: PMC4608087 DOI: 10.1161/jaha.115.002014] [Citation(s) in RCA: 423] [Impact Index Per Article: 47.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Guidelines recommend exercise for cardiovascular health, although evidence from trials linking exercise to cardiovascular health through intermediate biomarkers remains inconsistent. We performed a meta-analysis of randomized controlled trials to quantify the impact of exercise on cardiorespiratory fitness and a variety of conventional and novel cardiometabolic biomarkers in adults without cardiovascular disease. METHODS AND RESULTS Two researchers selected 160 randomized controlled trials (7487 participants) based on literature searches of Medline, Embase, and Cochrane Central (January 1965 to March 2014). Data were extracted using a standardized protocol. A random-effects meta-analysis and systematic review was conducted to evaluate the effects of exercise interventions on cardiorespiratory fitness and circulating biomarkers. Exercise significantly raised absolute and relative cardiorespiratory fitness. Lipid profiles were improved in exercise groups, with lower levels of triglycerides and higher levels of high-density lipoprotein cholesterol and apolipoprotein A1. Lower levels of fasting insulin, homeostatic model assessment-insulin resistance, and glycosylated hemoglobin A1c were found in exercise groups. Compared with controls, exercise groups had higher levels of interleukin-18 and lower levels of leptin, fibrinogen, and angiotensin II. In addition, we found that the exercise effects were modified by age, sex, and health status such that people aged <50 years, men, and people with type 2 diabetes, hypertension, dyslipidemia, or metabolic syndrome appeared to benefit more. CONCLUSIONS This meta-analysis showed that exercise significantly improved cardiorespiratory fitness and some cardiometabolic biomarkers. The effects of exercise were modified by age, sex, and health status. Findings from this study have significant implications for future design of targeted lifestyle interventions.
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Affiliation(s)
- Xiaochen Lin
- Department of Epidemiology, School of Public Health, Brown University, Providence, RI (X.L., W.C.W., S.L.)
| | - Xi Zhang
- Department of Epidemiology, Richard M. Fairbanks School of Public Health, Indiana University, Indianapolis, IN (X.Z., Y.S.)
| | - Jianjun Guo
- Center for the Youth Sport Research and Development, China Institute of Sport Science, Beijing, China (J.G.)
| | - Christian K Roberts
- Geriatrics, Research, Education and Clinical Centers, VA Greater Los Angeles Healthcare System, Los Angeles, CA (C.K.R.)
| | - Steve McKenzie
- Department of Kinesiology, Center for Physical Activity in Wellness and Prevention, Indiana University-Purdue University at Indianapolis, IN (S.M.K.)
| | - Wen-Chih Wu
- Department of Epidemiology, School of Public Health, Brown University, Providence, RI (X.L., W.C.W., S.L.) Division of Cardiology and Veterans Affairs Medical Center, Department of Medicine, Alpert Medical School, Brown University, Providence, RI (W.C.W., S.L.)
| | - Simin Liu
- Department of Epidemiology, School of Public Health, Brown University, Providence, RI (X.L., W.C.W., S.L.) Division of Cardiology and Veterans Affairs Medical Center, Department of Medicine, Alpert Medical School, Brown University, Providence, RI (W.C.W., S.L.) Division of Endocrinology, Department of Medicine, Rhode Island Hospital, Providence, RI (S.L.)
| | - Yiqing Song
- Department of Epidemiology, Richard M. Fairbanks School of Public Health, Indiana University, Indianapolis, IN (X.Z., Y.S.)
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Chen HM, Liu CK, Chen HW, Shia BC, Chen M, Chung CH. Efficiency of rehabilitation after acute myocardial infarction. Kaohsiung J Med Sci 2015; 31:351-7. [PMID: 26162815 DOI: 10.1016/j.kjms.2015.04.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2015] [Revised: 04/20/2015] [Accepted: 04/22/2015] [Indexed: 10/23/2022] Open
Abstract
The purpose of this study was to evaluate the recurrence rate and medical expenses of acute myocardial infarction (AMI) following inpatient cardiac rehabilitation. A total of 834 patients with AMI were divided into Group 1 (with inpatient cardiac rehabilitation) and Group 2 (without inpatient cardiac rehabilitation). The results showed that Group 1 had a lower AMI recurrence rate (a 0.640-fold lower hazards ratio) than Group 2 [95% confidence interval (CI) = 0.197-1.863; p = 0.004]. Compared with the medical costs of Group 2, Group 1 also had lower medical costs (a 0.947-fold lower hazards ratio) than Group 2 (95% CI = 0.934-0.981; p = 0.042). These findings have implications for the decision making of clinicians and health policymakers attempting to provide adequate services for patients with AMI.
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Affiliation(s)
- Hui-Ming Chen
- Department of Nursing, Cardinal Tien College of Healthcare & Management, Taipei, Taiwan
| | - Chih-Kuang Liu
- Department of Graduate Institute of Business Administration, Fu Jen Catholic University, Taipei, Taiwan; Department of Medicine, Fu Jen Catholic University, Taipei, Taiwan; Department of Urology, Taipei City Hospital (Zhong-Xing Branch), Taipei, Taiwan
| | - Hui-Wen Chen
- Department of Graduate Institute of Business Administration, Fu Jen Catholic University, Taipei, Taiwan; Department of Medicine, Fu Jen Catholic University, Taipei, Taiwan; Department of Physical Medicine and Rehabilitation, Fu Jen Catholic Hospital, Taipei, Taiwan.
| | - Ben-Chang Shia
- Department of School of Health Care Administration, Taipei Medical University, Taipei, Taiwan
| | - Mingchih Chen
- Department of Graduate Institute of Business Administration, Fu Jen Catholic University, Taipei, Taiwan
| | - Chi-Hsiang Chung
- Taiwanese Injury Prevention and Safety Promotion Association, Taipei, Taiwan
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Gérin C, Guillemot P, Bayat M, André A, Daniel V, Rochcongar P. Enquête auprès des médecins généralistes sur leur expérience et leur avis en matière de prescription d’activité physique. Sci Sports 2015. [DOI: 10.1016/j.scispo.2013.12.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Kadda O, Manginas A, Stavridis G, Balanos D, Kotiou M, Panagiotakos DB. Gender Analysis in the Outcomes of a Lifestyle Intervention Among Patients Who Had an Open Heart Surgery. Angiology 2015; 67:66-74. [PMID: 25818103 DOI: 10.1177/0003319715577293] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
UNLABELLED The aim of this study was to evaluate the gender-oriented differences in the outcomes of a lifestyle intervention trial (diet, smoking cessation, and exercise) among patients who had open heart surgery. A randomized, nonblind intervention study was performed on 500 patients who had open heart surgery. Immediately after hospital discharge, 250 patients were randomly allocated lifestyle intervention by receiving oral and written information in the form of a booklet with specific educational information for postoperative rehabilitation. The remaining 250 patients received the regular oral instructions. The applied lifestyle intervention proved to be beneficial only in men as far as quitting smoking (relative risk [RR]: 0.36, confidence interval [CI]: 0.16-0.80; P = .01) and returning to work (RR: 0.35, CI: 0.13-0.92; P = .03) are concerned. For both genders, no significant associations between dietary and physical activity recommendations were observed. CONCLUSION Lifestyle nursing intervention immediately after open heart surgery had a beneficial effect on men 1 year after the surgery but not on women. Thus, there is a need for gender-specific studies among women.
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Affiliation(s)
- Olga Kadda
- Department of Critical Care, School of Medicine, University of Athens, Athens, Greece
| | | | - George Stavridis
- Department of Cardiac Surgery, Onassis Cardiac Surgery Center, Athens, Greece
| | - Dimitris Balanos
- Department of Cardiac Surgery, Onassis Cardiac Surgery Center, Athens, Greece
| | - Maria Kotiou
- Department of Cardiac Surgery, Onassis Cardiac Surgery Center, Athens, Greece
| | - Demosthenes B Panagiotakos
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens, Greece
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Rare case of truncus arteriosus with anomalous origin of the right coronary artery from the pulmonary artery (ARCAPA) and unilateral left pulmonary artery agenesis. Jpn J Radiol 2015; 33:220-4. [DOI: 10.1007/s11604-015-0404-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2014] [Accepted: 02/16/2015] [Indexed: 01/19/2023]
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Kadda O, Kotanidou A, Manginas A, Stavridis G, Nanas S, Panagiotakos DB. Lifestyle intervention and one-year prognosis of patients following open heart surgery: a randomised clinical trial. J Clin Nurs 2015; 24:1611-21. [PMID: 25727522 DOI: 10.1111/jocn.12762] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/03/2014] [Indexed: 01/20/2023]
Abstract
AIMS AND OBJECTIVES To evaluate the one-year prognosis of a lifestyle counselling intervention (diet, smoking cessation and exercise) among patients who had open heart surgery. BACKGROUND Cardiovascular disease is the leading cause of morbidity worldwide in both developing and developed countries. Lifestyle modification plays an important role for patients who are at a high risk of developing cardiovascular disease and for those with an established cardiovascular disease. DESIGN Randomised, nonblind and lifestyle counselling intervention study with a one-year follow-up. METHODS A randomised, nonblind intervention study was performed on 500 patients who had open heart surgery. After hospital discharge, 250 patients (intervention group) were randomly allocated lifestyle counselling according to the recent guidelines provided by the European Society of Cardiology (European Journal Preventive Cardiology, 19, 2012, 585). The remaining 250 patients (control group) received the regular instructions. Primary end-point was the development of a cardiovascular disease (nonfatal event) during the first year; secondary end-points included fatal events, smoking abstinence, dietary habits and a physical activity evaluation. RESULTS According to the primary end-point, the odds of having a nonfatal cardiovascular disease event are 0·56-times (95%CI 0·28, 0·96, p = 0·03) lower for the intervention group compared to the control group. One-year after surgery, it was found that participants in the intervention group were 1·96-times (95%CI 1·31, 2·93, p < 0·001) more likely to achieve dietary recommendations, 3·32-times (95%CI 2·24, 4·91, p < 0·001) more likely to achieve physical activity recommendations and 1·34-times (95%CI 1·15, 1·56, p < 0·001) more likely to return to work. CONCLUSION Lifestyle counselling intervention following open heart surgery can improve health outcomes and reduce the risk of a new cardiac event. Health care services must recommend and organise well-structured cardiac rehabilitation programmes adjusted to the patient's needs. RELEVANCE TO CLINICAL PRACTICE A well-structured cardiac rehabilitation programme adjusted to the patient's profile is a safe and cost-effective way to improve patients' outcome.
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Affiliation(s)
- Olga Kadda
- Department of Critical Care, School of Medicine, University of Athens, Athens, Greece
| | - Anastasia Kotanidou
- Department of Critical Care, School of Medicine, University of Athens, Athens, Greece
| | | | - George Stavridis
- Department of Cardiac Surgery, Onassis Cardiac Surgery Center, Athens, Greece
| | - Serafim Nanas
- Department of Critical Care, School of Medicine, University of Athens, Athens, Greece
| | - Demosthenes B Panagiotakos
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens, Greece
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Mehta PK, Wei J, Wenger NK. Ischemic heart disease in women: a focus on risk factors. Trends Cardiovasc Med 2015; 25:140-51. [PMID: 25453985 PMCID: PMC4336825 DOI: 10.1016/j.tcm.2014.10.005] [Citation(s) in RCA: 104] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2014] [Revised: 10/08/2014] [Accepted: 10/09/2014] [Indexed: 02/08/2023]
Abstract
Heart disease remains a major contributor to morbidity and mortality in women in the United States and worldwide. This review highlights known and emerging risk factors for ischemic heart disease (IHD) in women. Traditional Framingham risk factors such as hypertension, hyperlipidemia, diabetes, smoking, as well as lifestyle habits such as unhealthy diet and sedentary lifestyle are all modifiable. Health care providers should be aware of emerging cardiac risk factors in women such as adverse pregnancy outcomes, systemic autoimmune disorders, obstructive sleep apnea, and radiation-induced heart disease; psychosocial factors such as mental stress, depression, anxiety, low socioeconomic status, and work and marital stress play an important role in IHD in women. Appropriate recognition and management of an array of risk factors is imperative given the growing burden of IHD and need to deliver cost-effective, quality care for women.
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Affiliation(s)
- Puja K Mehta
- Barbra Streisand Women׳s Heart Center, Cedars-Sinai Heart Institute, 127S San Vicente Boulevard, A 3212, Los Angeles, CA 90048.
| | - Janet Wei
- Barbra Streisand Women׳s Heart Center, Cedars-Sinai Heart Institute, 127S San Vicente Boulevard, A 3212, Los Angeles, CA 90048
| | - Nanette K Wenger
- Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, GA
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Abstract
Congenital coronary artery anomalies are rare. Pathologists are exposed to those in mainly two settings; in association with sudden death and usually extreme exercise in young adults, and in association with complex congenital heart disease in the pediatric and perinatal population. Pediatric pathologists, other pathologists and pathologists' assistants performing pediatric or forensic autopsies therefore need to be familiar with coronary artery anomalies.
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Gender, race and cardiac rehabilitation in the United States: is there a difference in care? Am J Med Sci 2014; 348:146-52. [PMID: 25010188 DOI: 10.1097/maj.0000000000000306] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Coronary heart disease is the leading cause of death within the United States, involving both genders and among all races and ethnic populations. Cardiac rehabilitation (CR) has been shown to significantly improve morbidity and mortality, and these benefits extend to individuals of both genders and all ages with coronary heart disease. Despite this, referral and participation rates remain surprisingly low. Furthermore, women and minorities have even lower referral rates than do their male and white counterparts. Over the course of this article, we will review CR referral and participation among women, as well as racial and ethnic minorities in the United States. We will also examine barriers to CR participation among these subgroups.
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Dunlay SM, Pack QR, Thomas RJ, Killian JM, Roger VL. Participation in cardiac rehabilitation, readmissions, and death after acute myocardial infarction. Am J Med 2014; 127:538-46. [PMID: 24556195 PMCID: PMC4035431 DOI: 10.1016/j.amjmed.2014.02.008] [Citation(s) in RCA: 180] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2014] [Revised: 02/05/2014] [Accepted: 02/05/2014] [Indexed: 11/15/2022]
Abstract
BACKGROUND Participation in cardiac rehabilitation has been shown to decrease mortality after acute myocardial infarction, but its impact on readmissions requires examination. METHODS We conducted a population-based surveillance study of residents discharged from the hospital after their first-ever myocardial infarction in Olmsted County, Minnesota, from January 1, 1987, to September 30, 2010. Patients were followed up through December 31, 2010. Participation in cardiac rehabilitation after myocardial infarction was determined using billing data. We used a landmark analysis approach (cardiac rehabilitation participant vs not determined by attendance in at least 1 session of cardiac rehabilitation at 90 days post-myocardial infarction discharge) to compare readmission and mortality risk between cardiac rehabilitation participants and nonparticipants accounting for propensity to participate using inverse probability treatment weighting. RESULTS Of 2991 patients with incident myocardial infarction, 1569 (52.5%) participated in cardiac rehabilitation after hospital discharge. The cardiac rehabilitation participation rate did not change during the study period, but increased in the elderly and decreased in men and younger patients. After adjustment, cardiac rehabilitation participants had lower all-cause readmission (hazard ratio [HR], 0.75; 95% confidence interval [CI], 0.65-0.87; P < .001), cardiovascular readmission (HR, 0.80; 95% CI, 0.65-0.99; P = .037), noncardiovascular readmission (HR, 0.72; 95% CI, 0.61-0.85; P < .001), and mortality (HR, 0.58; 95% CI, 0.49-0.68; P < .001) risk. CONCLUSIONS Cardiac rehabilitation participation is associated with a markedly reduced risk of readmission and death after incident myocardial infarction. Improving cardiac rehabilitation participation rates may have a large impact on post-myocardial infarction healthcare resource use and outcomes.
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Affiliation(s)
- Shannon M Dunlay
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minn; Department of Health Sciences Research, Mayo Clinic, Rochester, Minn.
| | - Quinn R Pack
- Division of Cardiology, Baystate Medical Center, Springfield, Mass
| | - Randal J Thomas
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minn
| | - Jill M Killian
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minn
| | - Véronique L Roger
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minn; Department of Health Sciences Research, Mayo Clinic, Rochester, Minn
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Shuaib W, Arepalli C, Vijayasarathi A, Gunn ML, Nicolau S, Mehta AS, Johnson JO, Khosa F. Coronary anomalies encountered in the acute setting: an imaging review. Emerg Radiol 2014; 21:631-41. [PMID: 24861184 DOI: 10.1007/s10140-014-1238-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2014] [Accepted: 05/06/2014] [Indexed: 01/14/2023]
Abstract
A broad spectrum of congenital coronary anomalies may be discovered on imaging and sometimes in the emergency setting on computed tomography (CT). Most coronary artery anomalies are of academic interest; however, a minority can cause morbidity and mortality and symptoms such as angina, myocardial infarction, or arrhythmias. These anomalies are usually discovered as an incidental finding on CT examinations as part of the diagnostic workup for other pathology or on dedicated coronary computed tomography angiography (CCTA) as part of the evaluation for a coronary cause of chest pain. The purpose of this pictorial review is to demonstrate the types of coronary anomalies and to enhance the clinicians' understanding of the imaging classifications and clinical implications.
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Affiliation(s)
- Waqas Shuaib
- Department of Radiology and Imaging Sciences, Emory University Hospital, Atlanta, GA, USA,
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Fauchère I, Weber D, Maier W, Altwegg L, Lüscher TF, Grünenfelder J, Nowak A, Tüller D, Genoni M, Falk V, Hermann M. Rehabilitation after TAVI compared to surgical aortic valve replacement. Int J Cardiol 2014; 173:564-6. [DOI: 10.1016/j.ijcard.2014.03.121] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2014] [Accepted: 03/14/2014] [Indexed: 10/25/2022]
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Barawid E, Covarrubias N, Tribuzio B, Liao S. The Benefits of Rehabilitation for Palliative Care Patients. Am J Hosp Palliat Care 2013; 32:34-43. [DOI: 10.1177/1049909113514474] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Palliative care requires an interdisciplinary team approach to provide the best care for patients with life-threatening illnesses. Like palliative medicine, rehabilitation also uses an interdisciplinary approach to treating patients with chronic illnesses. This review article focuses on rehabilitation interventions that can be beneficial in patients with late stage illnesses. Rehabilitation may be useful in improving the quality of life by palliating function, mobility, activities of daily living, pain relief, endurance, and the psyche of a patient while helping to maintain as much independence as possible, leading to a decrease in burden on caregivers and family. Rehabilitative services are underutilized in the palliative care setting, and more research is needed to address how patients may benefit as they approach the end of their lives.
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Affiliation(s)
- Edward Barawid
- Department of Physical Medicine and Rehabilitation, University of California Irvine Medical Center, Orange, CA, USA
| | - Natalia Covarrubias
- Department of Physical Medicine and Rehabilitation, University of California Irvine Medical Center, Orange, CA, USA
| | - Bianca Tribuzio
- Department of Physical Medicine and Rehabilitation, University of California Irvine Medical Center, Orange, CA, USA
| | - Solomon Liao
- Department of Palliative Care, University of California Irvine Medical Center, Orange, CA, USA
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