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Pavasini R, Biscaglia S, Kunadian V, Hakeem A, Campo G. Coronary artery disease management in older adults: revascularization and exercise training. Eur Heart J 2024; 45:2811-2823. [PMID: 38985545 DOI: 10.1093/eurheartj/ehae435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Revised: 04/10/2024] [Accepted: 06/23/2024] [Indexed: 07/12/2024] Open
Abstract
The mean age of patients with coronary artery disease (CAD) is steadily increasing. In older patients, there is a tendency to underutilize invasive approach, coronary revascularization, up-to-date pharmacological therapies, and secondary prevention strategies, including cardiac rehabilitation. Older adults with CAD commonly exhibit atypical symptoms, multi-vessel disease involvement, complex coronary anatomy, and a higher presence of risk factors and comorbidities. Although both invasive procedures and medical treatments are characterized by a higher risk of complications, avoidance may result in a suboptimal outcome. Often, overlooked factors, such as coronary microvascular disease, malnutrition, and poor physical performance, play a key role in determining prognosis, yet they are not routinely assessed or addressed in older patients. Historically, clinicians have relied on sub-analyses or observational findings to make clinical decisions, as older adults were frequently excluded or under-represented in clinical studies. Recently, dedicated evidence through randomized clinical trials has become available for older CAD patients. Nevertheless, the management of older CAD patients still raises several important questions. This review aims to comprehensively summarize and critically evaluate this emerging evidence, focusing on invasive management and coronary revascularization. Furthermore, it seeks to contextualize these interventions within the framework of improved risk stratification tools for older CAD patients, through user-friendly scales along with emphasizing the importance of promoting physical activity and exercise training to enhance the outcomes of invasive and medical treatments. This comprehensive approach may represent the key to improving prognosis in the complex and growing patient population of older CAD patients.
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Affiliation(s)
- Rita Pavasini
- Cardiology Unit, Azienda Ospedaliero Universitaria di Ferrara, Via Aldo Moro 8, 44124 Ferrara, Italy
| | - Simone Biscaglia
- Cardiology Unit, Azienda Ospedaliero Universitaria di Ferrara, Via Aldo Moro 8, 44124 Ferrara, Italy
| | - Vijay Kunadian
- Translational and Clinical Research Institute, Newcastle University and Cardiothoracic Centre, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Abdul Hakeem
- National Institute of Cardiovascular Diseases (NICVD), Karachi, Pakistan
| | - Gianluca Campo
- Cardiology Unit, Azienda Ospedaliero Universitaria di Ferrara, Via Aldo Moro 8, 44124 Ferrara, Italy
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2
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Whitler C, Varkoly KS, Patel H, Assaf AD, Hoose J, Brannan GD, Miller R, Zughaib M. Improved Cardiac Rehabilitation Referral Rate Utilizing a Multidisciplinary Quality Improvement Team. Cureus 2024; 16:e61157. [PMID: 38933616 PMCID: PMC11200930 DOI: 10.7759/cureus.61157] [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: 05/27/2024] [Indexed: 06/28/2024] Open
Abstract
Introduction Cardiac rehabilitation (CR) is an underutilized resource in patients with ischemic heart disease, despite being a Class IA recommendation. In this study, a multidisciplinary quality improvement (QI) team aimed to improve CR referrals by standardizing the ordering process at our hospital system. Method By using a collaborative approach involving the electronic medical record (EMR), medical provider education, and hospital protocols, our two-hospital healthcare system was able to successfully identify barriers to CR referral rates and implement interventions for these barriers. All physicians and medical providers, including ancillary staff, were educated on the EMR order sets to improve compliance by using automated order sets in the EMR. The CR referral order in the EMR included a statement regarding the application of evidence-based medicine, and a computerized provider order entry was included as a reminder to the ordering provider. The use of EMR was monitored monthly by the QI committee. Chi-square test and odds ratios were obtained for statistical analysis. Results Through provider-EMR education and patient education on discharge, CR referral rates significantly improved from 51.2 to 87.1% (p = 0.0001) in a 12-month period. The study included 1,499 patients in total. The improvement was statistically significant regardless of patient gender, race, or insurance coverage. Additionally, subgroup analysis in this study found that prior to standardization of the ordering process, African American patients were significantly less likely to be referred to CR compared to Caucasian patients. (51.2% vs. 41.0%, p=0.01). There was no statistically significant difference in the likelihood of CR referral between Caucasian and African American patients following the intervention (84.0% vs. 78.0%, p = 0.166). Conclusion This study shows that CR is an underutilized resource and that effective QI initiatives may not only increase CR referral rates but also close the gap between racial inequities in referral rates. Future research with multi-center randomized control trials is needed to further enhance its external generalizability to other institutions.
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Affiliation(s)
- Cameron Whitler
- Department of Cardiovascular Medicine, Ascension Providence Hospital, Southfield, USA
| | - Kyle S Varkoly
- Department of Internal Medicine, McLaren Macomb Hospital, Mount Clemens, USA
| | - Harshil Patel
- Department of Cardiovascular Medicine, Ascension Providence Hospital, Southfield, USA
| | - Andrew D Assaf
- Department of Cardiovascular Medicine, Ascension Providence Hospital, Southfield, USA
| | - Jennifer Hoose
- Department of Cardiovascular Medicine, Ascension Providence Hospital, Southfield, USA
| | - Grace D Brannan
- Department of Research, GDB Research and Statistical Consulting, Athens, USA
| | - Ronald Miller
- Department of Cardiovascular Medicine, Ascension Providence Hospital, Southfield, USA
| | - Marcel Zughaib
- Department of Cardiovascular Medicine, Ascension Providence Hospital, Southfield, USA
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3
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Dehmer GJ, Grines CL, Bakaeen FG, Beasley DL, Beckie TM, Boyd J, Cigarroa JE, Das SR, Diekemper RL, Frampton J, Hess CN, Ijioma N, Lawton JS, Shah B, Sutton NR. 2023 AHA/ACC Clinical Performance and Quality Measures for Coronary Artery Revascularization: A Report of the American College of Cardiology/American Heart Association Joint Committee on Performance Measures. J Am Coll Cardiol 2023; 82:1131-1174. [PMID: 37516946 DOI: 10.1016/j.jacc.2023.03.409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/31/2023]
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4
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Dehmer GJ, Grines CL, Bakaeen FG, Beasley DL, Beckie TM, Boyd J, Cigarroa JE, Das SR, Diekemper RL, Frampton J, Hess CN, Ijioma N, Lawton JS, Shah B, Sutton NR. 2023 AHA/ACC Clinical Performance and Quality Measures for Coronary Artery Revascularization: A Report of the American College of Cardiology/American Heart Association Joint Committee on Performance Measures. Circ Cardiovasc Qual Outcomes 2023; 16:e00121. [PMID: 37499042 DOI: 10.1161/hcq.0000000000000121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/29/2023]
Affiliation(s)
| | | | | | | | | | | | | | - Sandeep R Das
- ACC/AHA Joint Committee on Performance Measures liaison
| | | | | | | | | | | | - Binita Shah
- Society for Cardiovascular Angiography and Interventions representative
| | - Nadia R Sutton
- AHA/ACC Joint Committee on Clinical Data Standards liaison
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5
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Kanaoka K, Iwanaga Y, Nakai M, Nishioka Y, Myojin T, Kubo S, Okada K, Soeda T, Noda T, Sakata Y, Miyamoto Y, Saito Y, Imamura T. Hospital- and Patient-Level Analysis of Quality Indicators in Acute Coronary Syndrome Care: A Nationwide Database Study. Can J Cardiol 2022; 39:515-523. [PMID: 36503027 DOI: 10.1016/j.cjca.2022.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 11/13/2022] [Accepted: 12/01/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND This study aimed to clarify the variations in the quality of care provided to patients with acute coronary syndrome (ACS) and to investigate the association between quality of care and mortality at both hospital and patient levels with the use of a nationwide database. METHODS Patients with ACS who underwent percutaneous coronary intervention (PCI) from April 2014 to March 2018 were included from the National Database of Health Insurance Claims and Specific Health Checkups of Japan. Twelve quality indicators (QIs) available from administrative data and the association of the QIs with all-cause mortality were investigated. RESULTS From the analysis of 216,436 patients from 1215 hospitals, adherence to PCI on admission day, aspirin use on arrival, P2Y12 inhibitor use, and left ventricular function assessment were high (median proportion > 90%), and adherence to outpatient cardiac rehabilitation was low (median proportion < 10%). At the hospital level, acute-phase composite QI score was associated with reduced risk-adjusted 30-day mortality (β = -0.92 [95% confidence interval -1.19 to -0.65]; P < 0.001). At the patient level, all acute-phase and subacute-phase QIs were inversely associated with 30-day and 2-year mortalities, respectively (all P < 0.001). CONCLUSIONS Substantial variations in ACS care were observed in the current nationwide database. High adherence to the QI sets was associated with significant survival gains at both hospital and patient levels. Multilevel approach in QI assessment may be effective for improvement of survival in this population.
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Affiliation(s)
- Koshiro Kanaoka
- Department of Medical and Health Information Management, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan; Department of Cardiovascular Medicine, Nara Medical University, Kashihara, Nara, Japan
| | - Yoshitaka Iwanaga
- Department of Medical and Health Information Management, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Michikazu Nakai
- Department of Medical and Health Information Management, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Yuichi Nishioka
- Department of Public Health, Health Management, and Policy, Nara Medical University, Kashihara, Nara, Japan
| | - Tomoya Myojin
- Department of Public Health, Health Management, and Policy, Nara Medical University, Kashihara, Nara, Japan
| | - Shinichiro Kubo
- Department of Public Health, Health Management, and Policy, Nara Medical University, Kashihara, Nara, Japan
| | - Katsuki Okada
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Suita, Osaka, Japan; Department of Transformative System for Medical Information, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Tsunenari Soeda
- Department of Cardiovascular Medicine, Nara Medical University, Kashihara, Nara, Japan
| | - Tatsuya Noda
- Department of Public Health, Health Management, and Policy, Nara Medical University, Kashihara, Nara, Japan
| | - Yasushi Sakata
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Yoshihiro Miyamoto
- Open Innovation Center, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Yoshihiko Saito
- Department of Cardiovascular Medicine, Nara Medical University, Kashihara, Nara, Japan
| | - Tomoaki Imamura
- Department of Public Health, Health Management, and Policy, Nara Medical University, Kashihara, Nara, Japan.
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6
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Schultz K, Koczulla AR. [Pulmonary Rehabilitation in Patients with Chronic Obstructive Airway Diseases]. Dtsch Med Wochenschr 2022; 147:961-973. [PMID: 35915882 DOI: 10.1055/a-1854-7286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
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7
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Delbaere Q, Akodad M, Roubille F, Lattuca B, Cayla G, Leclercq F. One-Year Follow-Up of Patients Admitted for Emergency Coronary Angiography after Resuscitated Cardiac Arrest. J Clin Med 2022; 11:3738. [PMID: 35807020 PMCID: PMC9267145 DOI: 10.3390/jcm11133738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 06/15/2022] [Accepted: 06/17/2022] [Indexed: 12/05/2022] Open
Abstract
(1) Background: Despite the improvement of the in-hospital survival rate after aborted sudden cardiac death (SCD), cerebral anoxia may have severe neurologic consequences and may impair long-term outcome and quality of life of surviving patients. The aim of this study was to assess neurological outcomes at one year after resuscitated cardiac arrest; (2) Methods: This prospective, observational, and multicentre study included patients >18 yo admitted in the catheterisation laboratory for coronary angiography after aborted SCD between 1 May 2018 and 31 May 2020. Only patients who were discharged alive from hospital were evaluated. The primary endpoint was survival without neurological sequelae at one-year follow-up defined by a cerebral performance category (CPC) of one or two. Secondary end points included all-cause mortality, New York Heart Association (NYHA) functional class, neurologic evaluation at discharge, three-month and one-year follow-up using the CPC scale, and quality of life at 1 year using the Quality of Life after Brain Injury (QOLIBRI) questionnaire; (3) Results: Among 143 patients admitted for SCD within the study period, 61 (42.7%) were discharged alive from hospital, among whom 55 (90.1%) completed the one-year follow-up. No flow and low flow times were 1.9 ± 2.4 min and 16.5 ± 10.4 min, respectively. For 93.4% of the surviving patients, an initial shockable rhythm (n = 57) was observed and acute coronary syndrome was diagnosed in 75.4% of them (n = 46). At 1 year, survival rate without neurologic sequelae was 87.2% (n = 48). Patients with poor outcome were older (69.3 vs. 57.4 yo; p = 0.04) and had lower body mass index (22.4 vs. 26.7; p = 0.013) and a lower initial Left Ventricle Ejection Fraction (LVEF) (32.1% vs. 40.3%; p = 0.046). During follow-up, neurological status improved in 36.8% of patients presenting sequelae at discharge, and overall quality of life was satisfying for 66.7% of patients according to the QOLIBRI questionnaire; (4) Conclusions: Among patients admitted to the catheterisation laboratory for aborted SCD, mainly related to Acute Coronary Syndrom (ACS), less than a half of them were alive at discharge. However, the one-year survival rate without neurological sequelae was high and overall quality of life was good.
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Affiliation(s)
- Quentin Delbaere
- Department of Cardiology, Arnaud de Villeneuve University Hospital, 34295 Montpellier, France; (M.A.); (F.R.); (F.L.)
| | - Myriam Akodad
- Department of Cardiology, Arnaud de Villeneuve University Hospital, 34295 Montpellier, France; (M.A.); (F.R.); (F.L.)
| | - François Roubille
- Department of Cardiology, Arnaud de Villeneuve University Hospital, 34295 Montpellier, France; (M.A.); (F.R.); (F.L.)
| | - Benoît Lattuca
- Department of Cardiology, Caremeau University Hospital, 30900 Nîmes, France; (B.L.); (G.C.)
| | - Guillaume Cayla
- Department of Cardiology, Caremeau University Hospital, 30900 Nîmes, France; (B.L.); (G.C.)
| | - Florence Leclercq
- Department of Cardiology, Arnaud de Villeneuve University Hospital, 34295 Montpellier, France; (M.A.); (F.R.); (F.L.)
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8
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Dodson JA, Schoenthaler A, Sweeney G, Fonceva A, Pierre A, Whiteson J, George B, Marzo K, Drewes W, Rerisi E, Mathew R, Aljayyousi H, Chaudhry SI, Hajduk AM, Gill TM, Estrin D, Kovell L, Jennings LA, Adhikari S. Rehabilitation Using Mobile Health for Older Adults With Ischemic Heart Disease in the Home Setting (RESILIENT): Protocol for a Randomized Controlled Trial. JMIR Res Protoc 2022; 11:e32163. [PMID: 35238793 PMCID: PMC8931649 DOI: 10.2196/32163] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 10/29/2021] [Accepted: 12/08/2021] [Indexed: 11/23/2022] Open
Abstract
Background Participation in ambulatory cardiac rehabilitation remains low, especially among older adults. Although mobile health cardiac rehabilitation (mHealth-CR) provides a novel opportunity to deliver care, age-specific impairments may limit older adults’ uptake, and efficacy data are currently lacking. Objective This study aims to describe the design of the rehabilitation using mobile health for older adults with ischemic heart disease in the home setting (RESILIENT) trial. Methods RESILIENT is a multicenter randomized clinical trial that is enrolling patients aged ≥65 years with ischemic heart disease in a 3:1 ratio to either an intervention (mHealth-CR) or control (usual care) arm, with a target sample size of 400 participants. mHealth-CR consists of a commercially available mobile health software platform coupled with weekly exercise therapist sessions to review progress and set new activity goals. The primary outcome is a change in functional mobility (6-minute walk distance), which is measured at baseline and 3 months. Secondary outcomes are health status, goal attainment, hospital readmission, and mortality. Among intervention participants, engagement with the mHealth-CR platform will be analyzed to understand the characteristics that determine different patterns of use (eg, persistent high engagement and declining engagement). Results As of December 2021, the RESILIENT trial had enrolled 116 participants. Enrollment is projected to continue until October 2023. The trial results are expected to be reported in 2024. Conclusions The RESILIENT trial will generate important evidence about the efficacy of mHealth-CR among older adults in multiple domains and characteristics that determine the sustained use of mHealth-CR. These findings will help design future precision medicine approaches to mobile health implementation in older adults. This knowledge is especially important in light of the COVID-19 pandemic that has shifted much of health care to a remote, internet-based setting. Trial Registration ClinicalTrials.gov NCT03978130; https://clinicaltrials.gov/ct2/show/NCT03978130 International Registered Report Identifier (IRRID) DERR1-10.2196/32163
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Affiliation(s)
- John A Dodson
- Geriatric Cardiology Program, Medicine and Population Health, Leon H Charney Division of Cardiology, NYU Grossman School of Medicine, New York, NY, United States
| | - Antoinette Schoenthaler
- Department of Population Health, Department of Medicine, NYU Grossman School of Medicine, New York, NY, United States
| | - Greg Sweeney
- Department of Rehabilitation Medicine, NYU Grossman School of Medicine, New York, NY, United States
| | - Ana Fonceva
- Leon H Charney Division of Cardiology, NYU Grossman School of Medicine, New York, NY, United States
| | - Alicia Pierre
- Department of Rehabilitation Medicine, NYU Grossman School of Medicine, New York, NY, United States
| | - Jonathan Whiteson
- Department of Rehabilitation Medicine, Department of Medicine, NYU Grossman School of Medicine, New York, NY, United States
| | - Barbara George
- Division of Cardiology, Department of Medicine, NYU Long Island School of Medicine, Mineola, NY, United States
| | - Kevin Marzo
- Department of Medicine, Division of Cardiology, NYU Long Island School of Medicine, Mineola, NY, United States
| | - Wendy Drewes
- Division of Cardiology, NYU Langone Hospital Long Island, Mineola, NY, United States
| | - Elizabeth Rerisi
- Division of Cardiology, NYU Langone Hospital Long Island, Mineola, NY, United States
| | - Reena Mathew
- Division of Cardiology, NYU Langone Hospital Long Island, Mineola, NY, United States
| | - Haneen Aljayyousi
- Leon H Charney Division of Cardiology, NYU Grossman School of Medicine, New York, NY, United States
| | - Sarwat I Chaudhry
- Section of General Medicine, Yale University School of Medicine, New Haven, NY, United States
| | | | - Thomas M Gill
- Yale University School of Medicine, New Haven, CT, United States
| | - Deborah Estrin
- Cornell Tech and Weill Cornell Medicine, New York, NY, United States
| | - Lara Kovell
- Department of Medicine, University of Massachusetts Medical School, UMass Memorial Medical Center, Worcester, MA, United States
| | - Lee A Jennings
- Reynolds Section of Geriatric Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
| | - Samrachana Adhikari
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, United States
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Abstract
Cardiovascular disease is a leading cause of morbidity and mortality in males and females in the United States and globally. Cardiac rehabilitation (CR) is recommended by the American Heart Association/American College of Cardiology for secondary prevention for patients with cardiovascular disease. CR participation is associated with improved cardiovascular disease risk factor management, quality of life, and exercise capacity as well as reductions in hospital admissions and mortality. Despite these advantageous clinical outcomes, significant sex disparities exist in outpatient phase II CR programming. This article reviews sex differences that are present in the spectrum of care provided by outpatient phase II CR programming (ie, from referral to clinical management). We first review CR participation by detailing the sex disparities in the rates of CR referral, enrollment, and completion. In doing so, we discuss patient, health care provider, and social/environmental level barriers to CR participation with a particular emphasis on those barriers that majorly impact females. We also evaluate sex differences in the core components incorporated into CR programming (eg, patient assessment, exercise training, hypertension management). Next, we review strategies to mitigate these sex differences in CR participation with a focus on automatic CR referral, female-only CR programming, and hybrid CR. Finally, we outline knowledge gaps and areas of future research to minimize and prevent sex differences in CR programming.
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Affiliation(s)
- Joshua R Smith
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | - Randal J Thomas
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | | | - Shane M Hammer
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | - Thomas P Olson
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
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Nemoto S, Kasahara Y, Izawa KP, Watanabe S, Yoshizawa K, Takeichi N, Kamiya K, Suzuki N, Omiya K, Kida K, Matsunaga A, Akashi YJ. New Formula to Predict Heart Rate at Anaerobic Threshold That Considers the Effects of β-Blockers in Patients With Myocardial Infarction: MULTI-INSTITUTIONAL RETROSPECTIVE CROSS-SECTIONAL STUDY. J Cardiopulm Rehabil Prev 2022; 42:E1-E6. [PMID: 33883473 DOI: 10.1097/hcr.0000000000000602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE It is recommended that patients with myocardial infarction (MI) be prescribed exercise by target heart rate (HR) at the anaerobic threshold (AT) via cardiopulmonary exercise testing (CPX). Although percent HR reserve using predicted HRmax (%HRRpred) is used to prescribe exercise if CPX or an exercise test cannot be performed, %HRRpred is especially difficult to use when patients take β-blockers. We devised a new formula to predict HR at AT (HRAT) that considers β-blocker effects in MI patients and validated its accuracy. METHODS The new formula was created using the data of 196 MI patients in our hospital (derivation sample), and its accuracy was assessed using the data of 71 MI patients in other hospitals (validation sample). All patients underwent CPX 1 mo after MI onset, and resting HR, resting systolic blood pressure (SBP), and HRAT were measured during CPX. RESULTS The results of multiple regression analysis in the derivation sample gave the following formula (R2 = 0.605, P < .001): predicted HRAT = 2.035 × (≥65 yr:-1, <65 yr:1) + 3.648 × (body mass index <18.5 kg/m2:-1, body mass index ≥18.5 kg/m2:1) + 4.284 × (β1-blocker(+):-1, β1-blocker(-):1) + 0.734 × (HRrest) + 0.078 × (SBPrest) + 36.812. This formula consists entirely of predictors that can be obtained at rest. HRAT and predicted HRAT with the new formula were not significantly different in the validation sample (mean absolute error: 5.5 ± 4.1 bpm). CONCLUSIONS The accuracy of the new formula appeared to be favorable. This new formula may be a practical method for exercise prescription in MI patients, regardless of their β-blocker treatment status, if CPX is unavailable.
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Affiliation(s)
- Shinji Nemoto
- Department of Rehabilitation Medicine, St Marianna University School of Medicine Yokohama City Seibu Hospital, Yokohama, Japan (Drs Nemoto and Kasahara); Department of Rehabilitation Sciences, Kitasato University Graduate School of Medical Sciences, Sagamihara, Japan (Drs Nemoto, Kamiya, and Matsunaga); Department of Public Health, Kobe University Graduate School of Health Sciences, Kobe, Japan (Dr Izawa); Department of Rehabilitation Medicine, St Marianna University School of Medicine Hospital, Kawasaki, Japan (Messrs Watanabe and Takeichi); Department of Rehabilitation Medicine, Kawasaki Municipal Tama Hospital, Kawasaki, Japan (Mr Yoshizawa); Division of Cardiology, Department of Internal Medicine, St Marianna University School of Medicine Hospital, Kawasaki, Japan (Drs Suzuki and Akashi); Department of Internal Medicine, Shimazu Medical Clinic, Yokohama, Japan (Dr Omiya); and Department of Pharmacology, St Marianna University School of Medicine, Kawasaki, Japan (Dr Kida)
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Minatoguchi S, Minagawa T, Nishigaki K, Ojio S, Yasuda S, Osawa K, Sasaki M, Ogawa M, Marumo T, Takano S. Kurort Health Walking Preferentially Decreases Higher Blood Pressure and Improves Mood. Circ Rep 2021; 3:639-646. [PMID: 34805603 PMCID: PMC8578131 DOI: 10.1253/circrep.cr-21-0108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 08/20/2021] [Accepted: 09/02/2021] [Indexed: 11/30/2022] Open
Abstract
Background:Kurort
is a German term from the words
kur
(cure) and
ort
(area), and refers to improvements in patients’ health in areas full of nature. We investigated the effect of
kurort
health walking in the 2 urban-style
kurort
health walking courses opened in Gifu City on systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate, and mood. Methods and Results:
The subjects were 454 people (136 males, 318 females; mean [±SD] age 61.7±9.9 years) taking part in
kurort
health walking for the first time. SBP, DBP, and heart rate were measured before and after
kurort
health walking. Mood was assessed using a 10-item checklist after
kurort
health walking.
Kurort
health walking significantly decreased SBP and DBP and increased heart rate. The decrease in SBP was significantly greater in the SBP ≥140 than <140 mmHg group, indicating that SBP before
Kurort
health walking was inversely correlated with the change in SBP. Similarly, the decrease in DBP was significantly greater in the DBP ≥90 than <90 mmHg group, indicating that DBP before
kurort
health walking was also inversely correlated with the change in DBP. All 10 items on the mood assessment were significantly improved after
kurort
health walking. Conclusions:Kurort
health walking preferentially decreases higher blood pressure and improves mood.
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Affiliation(s)
| | | | | | | | | | - Kaori Osawa
- Cardiology, Gifu Municipal Hospital Gifu Japan
| | | | - Masashi Ogawa
- Health Promotion Section, Gifu Municipal Office Gifu Japan
| | | | - Shin Takano
- Health Promotion Section, Gifu Municipal Office Gifu Japan
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Rodrigo SF, Van Exel HJ, Van Keulen N, Van Winden L, Beeres SLMA, Schalij MJ. Referral and participation in cardiac rehabilitation of patients following acute coronary syndrome; lessons learned. IJC HEART & VASCULATURE 2021; 36:100858. [PMID: 34466654 PMCID: PMC8382985 DOI: 10.1016/j.ijcha.2021.100858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Revised: 07/27/2021] [Accepted: 08/10/2021] [Indexed: 10/31/2022]
Abstract
PURPOSE Cardiac rehabilitation (CR) after hospitalization for acute coronary syndrome (ACS) has shown to reduce mortality, readmissions, and improve quality of life. CR is recommended by international guidelines but previous studies have shown low participation rates. Systematic CR referral might improve CR participation. METHODS The present study evaluates CR referral and CR participation of patients hospitalized for ACS in 2017 and treated according to local protocol, which includes systematic CR referral. Participation rate was divided into a group that finished the CR program and drop outs. In addition, factors associated with CR referral and participation rate were evaluated. RESULTS A total of 469 patients eligible for CR were included in the study, of which 377 (80%) were referred for CR and 353 (75%) participated in CR. Ninety percent of participants completed the CR program. Factors independently associated with CR referral included age (50-60 year vs. > 70 year: odds ratio [OR] 4.7, 95% confidence interval [CI] 1.98-11.2), diagnosis (ST-elevation myocardial infarction vs. unstable angina: OR 17.7, CI 7.59-41.7), previous cardiovascular disease (OR 0.4, CI 0.19-0.73) and left ventricular dysfunction vs. normal function (OR 2.2, CI 1.11-4.52). A larger distance to the CR center was associated with lower CR participation (<5km vs. > 20 km: OR 3.1, CI 1.20-7.72). CONCLUSIONS Systematic CR referral in ACS patients results in high CR referral (80%) and participation (75%) rates. CR adherence might be further improved by increasing CR referral, especially in older patients and patients with NSTEMI or unstable angina.
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Key Words
- ACS, Acute coronary syndrome
- CI, Confidence interval
- CR, Cardiac rehabilitation
- CVA, Cerebrovascular accident
- Cardiac rehabilitation
- DBC, Diagnosis treatment combination (Diagnose behandel combinatie)
- EPD, Electronic patient dossier
- LV, Left ventricular
- NSTEMI, Non ST-elevation myocardial infarction
- OR, Odds ratio
- Patient participation
- Referral
- SES, Socio-economic status
- STEMI, ST-elevation myocardial infarction
- Secondary prevention
- TIA, Transient ischemic attack
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Affiliation(s)
- Sander F Rodrigo
- Basalt Rehabilitation, Leiden, the Netherlands
- Deparment of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
| | | | - Nicole Van Keulen
- Deparment of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Loes Van Winden
- Deparment of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Saskia L M A Beeres
- Deparment of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Martin J Schalij
- Deparment of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
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13
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Schultz K, Koczulla AR. [Pulmonary Rehabilitation in Patients with Chronic Obstructive Airway Diseases]. Pneumologie 2021; 75:457-473. [PMID: 34116577 DOI: 10.1055/a-1239-0026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Pulmonary rehabilitation of asthma and COPD patients can improve their physical performance and quality of life, maintain participation in social and professional life and actively promote self-help. In addition, the resources for acute medical treatment can be spared. In case of COPD, rehabilitation directly after exacerbation can also improve the poor survival prognosis and reduce the risk of emergency hospital readmission. Therefore, pulmonary rehabilitation is an essential component of evidence-based long-term management of both bronchial asthma and, in particular, COPD. In the German healthcare system, however, pneumological rehabilitation is offered only for a small fraction of patients. Despite a very good evidence of pulmonary rehabilitation, especially in COPD patients, their share in all rehabilitation services is remarkably low. It does not even amount to 3 % of all medical rehabilitation measures approved by the German Pension Insurance.
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14
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High-intensity interval training in cardiac rehabilitation. SPORT SCIENCES FOR HEALTH 2021. [DOI: 10.1007/s11332-021-00731-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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15
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Exposito Ordóñez E, Roldán Conesa D, Vicente Vera T. Prognostic effects of cardiovascular rehabilitation: facts and myths. Panminerva Med 2021; 63:160-169. [PMID: 33755389 DOI: 10.23736/s0031-0808.21.04267-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Since CR was introduced, studies have been carried out to discover the effect of CRHPs on cardiovascular morbidity and mortality and on heart-disease patients' quality of life. The first meta-analyses showed improvement in cardiovascular morbidity and mortality, although the studies were conducted in the coronary pre-reperfusion era, before the generalized use in secondary prevention of drugs such as statins, beta-blockers, or renin-angiotensin-system inhibitors, which have produced a decrease in cardiovascular mortality. In Europe, analyzing 25 studies with more than 200,000 patients. It concluded that, in spite of the great heterogeneity of the programs, CR clearly decreases mortality after ACS. Nevertheless, a strategy of CRHP standardization and evaluation is needed. In 2017, a study was carried out in our hospital to evaluate the effectiveness of multidisciplinary CRHP intervention on cardiovascular morbidity and mortality, recurrence of cardiovascular events, the control of RFCV and lifestyle changes in patients after ACS. A total of 442 patients were included who had presented an acute cardiovascular event in the previous six months; 306 patients from the CR group and 136 others with standard cardiology follow-up were used as controls. 405 patients completed follow-up for a median of 60 months. Compared to the usual treatments in cardiology, the patients who underwent CRHPs presented fewer readmissions for cardiovascular reasons (17% vs. 43.38%, P<0.001), fewer major cardiovascular events (11.9% vs. 27.2%, P<0.001) and new revascularizations (9.3% vs. 21.32%, P=0.001), with lower cardiovascular mortality (0 vs. 2.2%, P=0.014). It also led to better control of the RFCV (66% vs. 19.85%, P<0.001) and favored lifestyle changes in these patients (91% vs. 61%, P<0.001). Therefore, in our setting, the performance of CRHPs was shown to be effective in reducing cardiovascular morbidity and mortality and in the secondary prevention of coronary patients.
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Affiliation(s)
| | - Diego Roldán Conesa
- Cardiac Rehabilitation Unit, Reina Sofia de Murcia University Hospital, Murcia, Spain
| | - Tomás Vicente Vera
- Cardiac Rehabilitation Unit, Reina Sofia de Murcia University Hospital, Murcia, Spain - .,Catholic University of San Antonio de Murcia, Department of Cardiology, Reina Sofia de Murcia University Hospital, Murcia, Spain
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16
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Kanaoka K, Soeda T, Terasaki S, Nishioka Y, Myojin T, Kubo S, Okada K, Noda T, Watanabe M, Kawakami R, Sakata Y, Imamura T, Saito Y. Current Status and Effect of Outpatient Cardiac Rehabilitation After Percutaneous Coronary Intervention in Japan. Circ Rep 2021; 3:122-130. [PMID: 33738344 PMCID: PMC7956885 DOI: 10.1253/circrep.cr-20-0143] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Background:
Although cardiac rehabilitation (CR) has been reported to be associated with better clinical outcomes in patients with cardiovascular diseases, there are few nationwide studies about CR participation by patients with coronary artery disease in Japan. Methods and Results:
We performed a nationwide retrospective cohort study using the National Database of Health Insurance Claims and Specific Health Checkups of Japan between April 2014 and March 2018. Patients were divided into 2 groups (acute coronary syndrome [ACS] and stable coronary artery disease [sCAD]), and the rates of participation in in- and outpatient CR after percutaneous coronary intervention (PCI) were investigated. Propensity score-matched analysis was performed and the association between outpatient CR participation and all-cause mortality 3 months after PCI was examined. Overall, 616,664 patients (ACS, n=202,853; sCAD, n=413,811) were analyzed. The participation rates of CR increased annually. The participation rate was higher for inpatient than outpatient CR in both the ACS (52% vs. 9%, respectively) and sCAD (15% vs. 3%, respectively) groups. Prognosis was better for patients with than without outpatient CR in both the ACS (hazard ratio [HR] 0.52; 95% confidence interval [CI] 0.47–0.59) and sCAD (HR 0.72; 95% CI 0.65–0.80) groups. Conclusions:
Outpatient CR was associated with a better prognosis in patients with ACS or sCAD. The participation rates of outpatient CR following PCI were extremely low in Japan.
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Affiliation(s)
- Koshiro Kanaoka
- Department of Cardiovascular Medicine, Nara Medical University Kashihara Japan
| | - Tsunenari Soeda
- Department of Cardiovascular Medicine, Nara Medical University Kashihara Japan
| | - Satoshi Terasaki
- Department of Cardiovascular Medicine, Nara Medical University Kashihara Japan
| | - Yuichi Nishioka
- Department of Public Health, Health Management and Policy, Nara Medical University Kashihara Japan
| | - Tomoya Myojin
- Department of Public Health, Health Management and Policy, Nara Medical University Kashihara Japan
| | - Shinichiro Kubo
- Department of Public Health, Health Management and Policy, Nara Medical University Kashihara Japan
| | - Katsuki Okada
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine Osaka Japan
| | - Tatsuya Noda
- Department of Public Health, Health Management and Policy, Nara Medical University Kashihara Japan
| | - Makoto Watanabe
- Department of Cardiovascular Medicine, Nara Medical University Kashihara Japan
| | - Rika Kawakami
- Department of Cardiovascular Medicine, Nara Medical University Kashihara Japan
| | - Yasushi Sakata
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine Osaka Japan
| | - Tomoaki Imamura
- Department of Public Health, Health Management and Policy, Nara Medical University Kashihara Japan
| | - Yoshihiko Saito
- Department of Cardiovascular Medicine, Nara Medical University Kashihara Japan
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17
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Andersen JH, Burns K, Guassora ADK, Cerqueira C, Jørgensen T, Lundstrøm SL. Taking no for an answer. Nurses' consultations with people with cardiac disease about rehabilitation: A qualitative study. Appl Nurs Res 2021; 58:151397. [PMID: 33745551 DOI: 10.1016/j.apnr.2021.151397] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 09/15/2020] [Accepted: 12/31/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND Research shows that many people with cardiac disease decline cardiac rehabilitation. There is little or no knowledge on how health professionals respond to these people. OBJECTIVES To investigate how nurses respond to people who do not wish to participate in cardiac rehabilitation and what influences the nurses´ approach towards these people. DESIGN A qualitative study involving interviews and video-recordings using an analysis inspired by ethnographic principles and categorisation theory. SETTING A rehabilitation clinic at a large hospital in the Capital Region of Denmark. PARTICIPANTS Five cardiac nurses and 28 people with cardiac disease. METHODS We video-recorded the first consultation people with cardiac disease attended regarding cardiac rehabilitation, where the nurses followed up on these people's recovery, medication, lifestyle and need for rehabilitation. We conducted semi-structured interviews with the cardiac nurses. We asked the nurses about the purpose of the first rehabilitation consultation and how they handle people with cardiac disease who say no to rehabilitation. The nurses were shown video-clips with the people they had talked to in their consultation in order to facilitate a dialogue. RESULTS When people with cardiac disease were reluctant to participate in rehabilitation, the nurses made an individual assessment of how much effort to put into motivating them, taking a complex range of factors into account. The effort among the nurses towards people with cardiac disease who decline rehabilitation was smaller in cases when the nurses believed an individual would benefit less from rehabilitation or have difficulty participating. It was important for the nurses to balance their motivational efforts with showing respect for people's autonomy. CONCLUSION Even when nurses endorse rehabilitation, some people with cardiac disease decline rehabilitation. The nurses' recommendation of the rehabilitation programme is influenced by the knowledge they obtain about the people with cardiac disease during consultations.
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Affiliation(s)
- Julie Høgsgaard Andersen
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, P.O. Boks 2099, 1014 København K., Denmark.
| | - Karin Burns
- Center for Clinical Research and Prevention, Bispebjerg og Frederiksberg Hospital, Nordre Fasanvej 57, Hovedvejen 5, 2000 Frederiksberg, Denmark.
| | - Ann Dorrit Kristiane Guassora
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, P.O. Boks 2099, 1014 København K., Denmark.
| | - Charlotte Cerqueira
- Danish Clinical Quality Program, National Clinical Registries, Frederiksberg Hospital, Nordre Fasanvej 57, Vej 3, indgang 4, 2000 Frederiksberg. Denmark.
| | - Torben Jørgensen
- Center for Clinical Research and Prevention, Bispebjerg og Frederiksberg Hospital, Nordre Fasanvej 57, Hovedvejen 5, 2000 Frederiksberg, Denmark.
| | - Sanne Lykke Lundstrøm
- Center for Clinical Research and Prevention, Bispebjerg og Frederiksberg Hospital, Nordre Fasanvej 57, Hovedvejen 5, 2000 Frederiksberg, Denmark.
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Kamiya K, Sato Y, Takahashi T, Tsuchihashi-Makaya M, Kotooka N, Ikegame T, Takura T, Yamamoto T, Nagayama M, Goto Y, Makita S, Isobe M. Multidisciplinary Cardiac Rehabilitation and Long-Term Prognosis in Patients With Heart Failure. Circ Heart Fail 2020; 13:e006798. [DOI: 10.1161/circheartfailure.119.006798] [Citation(s) in RCA: 56] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Background:
Exercise-based cardiac rehabilitation (CR) improves health-related quality of life and exercise capacity in patients with heart failure (HF). However, CR efficacy in patients with HF who are elderly, frail, or have HF with preserved ejection fraction remains unclear. We examined whether participation in multidisciplinary outpatient CR is associated with long-term survival and rehospitalization in patients with HF, with subgroup analysis by age, sex, comorbidities, frailty, and HF with preserved ejection fraction.
Methods:
This multicenter retrospective cohort study was performed in patients hospitalized for acute HF at 15 hospitals in Japan, 2007 to 2016. The primary outcome (composite of all-cause mortality and HF rehospitalization after discharge) and secondary outcomes (all-cause mortality and HF rehospitalization) were analyzed in outpatient CR program participants versus nonparticipants.
Results:
Of the 3277 patients, 26% (862) participated in outpatient CR. After propensity matching for potential confounders, 1592 patients were included (n=796 pairs), of which 511 had composite outcomes (223 [14%] all-cause deaths and 392 [25%] HF rehospitalizations, median 2.4-year follow-up). Hazard ratios associated with CR participation were 0.77 (95% CI, 0.65–0.92) for composite outcome, 0.67 (95% CI, 0.51–0.87) for all-cause mortality, and 0.82 (95% CI, 0.67–0.99) for HF-related rehospitalization. CR participation was also associated with numerically lower rates of composite outcome in patients with HF with preserved ejection fraction or frail patients.
Conclusions:
Outpatient CR participation was associated with substantial prognostic benefit in a large HF cohort regardless of age, sex, comorbidities, frailty, and HF with preserved ejection fraction.
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Affiliation(s)
- Kentaro Kamiya
- Department of Rehabilitation, School of Allied Health Sciences (K.K.), Kitasato University, Kanagawa, Japan
| | - Yukihito Sato
- Department of Cardiology, Hyogo Prefectural Amagasaki General Medical Center, Japan (Y.S.)
| | - Tetsuya Takahashi
- Department of Physical Therapy, Juntendo University, Tokyo, Japan (T. Takahashi)
| | | | - Norihiko Kotooka
- Department of Cardiovascular Medicine, Saga University, Japan (N.K.)
| | - Toshimi Ikegame
- Department of Nursing (T.I.), Sakakibara Heart Institute, Tokyo, Japan
| | - Tomoyuki Takura
- Department of Healthcare Economics and Health Policy, Graduate School of Medicine, The University of Tokyo, Japan (T. Takura)
| | - Takanobu Yamamoto
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Japan (T.Y.)
| | - Masatoshi Nagayama
- Department of Cardiovascular Medicine (M.N.), Sakakibara Heart Institute, Tokyo, Japan
| | - Yoichi Goto
- Yoka Municipal Hospital, Hyogo, Japan (Y.G.)
| | - Shigeru Makita
- Department of Cardiac Rehabilitation, Saitama Medical University International Medical Center, Japan (S.M.)
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19
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Kim SH, Ro JS, Kim Y, Leigh JH, Kim WS. Underutilization of Hospital-based Cardiac Rehabilitation after Acute Myocardial Infarction in Korea. J Korean Med Sci 2020; 35:e262. [PMID: 32743992 PMCID: PMC7402922 DOI: 10.3346/jkms.2020.35.e262] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 05/27/2020] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Cardiac rehabilitation (CR) after acute myocardial infarction (AMI) is recommended as a mandatory intervention in several national clinical practice guidelines published in America, Europe, and Korea to reduce recurrence and mortality. However, underutilization of CR is an established worldwide issue. In Korea, the promotion of CR is expected due to coverage by National Health Insurance. Nevertheless, the national status of CR use has not been reported. This retrospective cohort study aimed to investigate the current status of CR use in patients with AMI using nationwide data from the National Health Insurance Service of Korea. METHODS Patients with AMI admitted with the diagnosis of 'I21' code (from International Classification of Diseases, 10th revision, Clinical Modification) from July 1st, 2017 to June 30th, 2018 were included. CR use was defined as CR treatment or evaluation being performed during an outpatient follow-up period within 6 months after discharge. Participation rate and density were calculated nationally and by administrative division. Logistic regression analysis was performed to identify the influencing factors of CR participation. RESULTS Nationally, 1.5% of AMI patients (960/64,982) underwent CR during outpatient treatment after discharge. CR density was approximately 10. Logistic regression analysis revealed that influencing factors included old age, female sex, rural residence, and low Charlson comorbidity index. CONCLUSION Hospital-based CR after AMI is underutilized despite its coverage by the National Health Insurance. More CR facilities have to be installed according to the needs of CR in various regions.
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Affiliation(s)
- Sun-Hyung Kim
- Department of Rehabilitation Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Jun-soo Ro
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Yoon Kim
- Department of Health Policy and Management, Seoul National University College of Medicine, Seoul, Korea
- Institute of Health Policy and Management, Medical Research Center, Seoul National University, Seoul, Korea
| | - Ja-Ho Leigh
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Won-Seok Kim
- Department of Rehabilitation Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
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20
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Ohashi J, Sakakura K, Sasaki W, Taniguchi Y, Kani K, Yamamoto K, Tsukui T, Seguchi M, Wada H, Momomura SI, Fujita H. Usefulness of 500-m walk electrocardiogram test on clinical outcomes in patients with ST-segment elevation myocardial infarction. Heart Vessels 2020; 36:48-57. [PMID: 32671463 DOI: 10.1007/s00380-020-01667-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2020] [Accepted: 07/10/2020] [Indexed: 10/23/2022]
Abstract
The current Japanese guideline for ST-segment elevation myocardial infarction (STEMI) recommends 500-m walk electrocardiogram (ECG) test for patients with STEMI during hospitalization. However, little is known regarding the association between acute phase 500-m walk ECG test and clinical outcomes. The purpose of this study was to investigate the association between 500-m walk ECG test and mid-term clinical outcomes in patients with STEMI. A total of 313 STEMI patients who underwent primary percutaneous coronary interventions were included, and were divided into the successful 500-m group (n = 263) and the unsuccessful 500-m group (n = 50). The primary endpoint was the major adverse cardiovascular events (MACE), which were defined as the composite of all cause death, acute myocardial infarction, readmission for heart failure, and ischemia-driven target vessel revascularization (TVR). During the follow-up period (median 223 days), a total of 55 MACE were observed. The log-rank test revealed that MACE, all cause death, readmission for heart failure, and ischemia-driven TVR were more frequently observed in the unsuccessful 500-m group than the successful 500-m group. In the multivariate Cox proportional hazard model, the unsuccessful 500-m walk ECG test was significantly associated with MACE (OR 5.62, 95% CI 3.08-10.08, P < 0.01) after controlling confounding factors such as age, and serum creatinine levels. In conclusion, the unsuccessful 500-m walk ECG test was significantly associated with poor mid-term outcomes in patients with STEMI. Our results suggest the usefulness of 500-m walk ECG test to stratify the high-risk group from patients with STEMI.
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Affiliation(s)
- Jumpei Ohashi
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, 1-847 Omiya-ku, Amanuma, Saitama, 330-8503, Japan
| | - Kenichi Sakakura
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, 1-847 Omiya-ku, Amanuma, Saitama, 330-8503, Japan.
| | - Wataru Sasaki
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, 1-847 Omiya-ku, Amanuma, Saitama, 330-8503, Japan
| | - Yousuke Taniguchi
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, 1-847 Omiya-ku, Amanuma, Saitama, 330-8503, Japan
| | - Kunihiro Kani
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, 1-847 Omiya-ku, Amanuma, Saitama, 330-8503, Japan
| | - Kei Yamamoto
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, 1-847 Omiya-ku, Amanuma, Saitama, 330-8503, Japan
| | - Takunori Tsukui
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, 1-847 Omiya-ku, Amanuma, Saitama, 330-8503, Japan
| | - Masaru Seguchi
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, 1-847 Omiya-ku, Amanuma, Saitama, 330-8503, Japan
| | - Hiroshi Wada
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, 1-847 Omiya-ku, Amanuma, Saitama, 330-8503, Japan
| | - Shin-Ichi Momomura
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, 1-847 Omiya-ku, Amanuma, Saitama, 330-8503, Japan
| | - Hideo Fujita
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, 1-847 Omiya-ku, Amanuma, Saitama, 330-8503, Japan
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21
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Takada S, Sabe H, Kinugawa S. Abnormalities of Skeletal Muscle, Adipocyte Tissue, and Lipid Metabolism in Heart Failure: Practical Therapeutic Targets. Front Cardiovasc Med 2020; 7:79. [PMID: 32478098 PMCID: PMC7235191 DOI: 10.3389/fcvm.2020.00079] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Accepted: 04/15/2020] [Indexed: 12/21/2022] Open
Abstract
Chronic diseases, including heart failure (HF), are often accompanied with skeletal muscle abnormalities in both quality and quantity, which are the major cause of impairment of the activities of daily living and quality of life. We have shown that skeletal muscle abnormalities are a hallmark of HF, in which metabolic pathways involving phosphocreatine and fatty acids are largely affected. Not only in HF, but the dysfunction of fatty acid metabolism may also occur in many chronic diseases, such as arteriosclerosis, as well as through insufficient physical exercise. Decreased fatty acid catabolism affects adenosine triphosphate (ATP) production in mitochondria, via decreased activity of the tricarboxylic acid cycle; and may cause abnormal accumulation of adipose tissue accompanied with hyperoxidation and ectopic lipid deposition. Such impairments of lipid metabolism are in turn detrimental to skeletal muscle, which is hence a chicken-and-egg problem between skeletal muscle and HF. In this review, we first discuss skeletal muscle abnormalities in HF, including sarcopenia; particularly their association with lipid metabolism and adipose tissue. On the other hand, the precise mechanisms involved in metabolic reprogramming and dysfunction are beginning to be understood, and an imbalance of daily nutritional intake of individuals has been found to be a causative factor for the development and worsening of HF. Physical exercise has long been known to be beneficial for the prevention and even treatment of HF. Again, the molecular mechanisms by which exercise promotes skeletal muscle as well as cardiac muscle functions are being clarified by recent studies. We propose that it is now the time to develop more “natural” methods to prevent and treat HF, rather than merely relying on drugs and medical interventions. Further analysis of the basic design of and molecular mechanisms involved in the human body, particularly the inextricable association between physical exercise and the integrity and functional plasticity of skeletal and cardiac muscles is required.
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Affiliation(s)
- Shingo Takada
- Faculty of Lifelong Sport, Department of Sports Education, Hokusho University, Ebetsu, Japan.,Department of Molecular Biology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Hisataka Sabe
- Department of Molecular Biology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Shintaro Kinugawa
- Department of Cardiovascular Medicine, Hokkaido University Graduate School of Medicine, Sapporo, Japan
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El Missiri AM, Awadalla HM, Almoudi MM. Gender differences among ischemic heart disease patients enrolled in a cardiac rehabilitation program. Egypt Heart J 2020; 72:15. [PMID: 32232591 PMCID: PMC7105560 DOI: 10.1186/s43044-020-00052-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Accepted: 03/20/2020] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Cardiac rehabilitation programs reduce cardiovascular events and mortality in ischemic heart disease patients. The aim of this study was to assess gender differences among ischemic heart disease patients enrolled in a cardiac rehabilitation program regarding adherence to the program, as well as, changes in clinical, laboratory, and echocardiographic parameters. RESULTS A prospective study that included 30 men and 30 women with stable ischemic heart disease who had been totally revascularized by percutaneous coronary intervention. Patients were enrolled in a 12-week cardiac rehabilitation program. Assessment of demographics, anthropometric measurements, risk factors, and functional capacity was performed. Lipid profile, glycated hemoglobin, and left ventricular ejection fraction were assessed. Assessments were performed at baseline and after completion of the program. Time to enrollment in the program was prolonged for women 39.17 ± 40.49 vs. 19.77 ± 10.26 days (p = 0.014). At baseline, more women were diabetic (p = 0.004), hypertensive (p = 0.02), had a larger waist circumference (p = 0.022), a higher BMI (p = 0.011), and higher HbA1c (p = 0.033). More men were active smokers (p < 0.001). After completion of the program, it was found that men attended 19.1 ± 4.77 (79.6%) sessions compared to 15.7 ± 5.72 (65.4%) sessions for women (p = 0.015). Women had more reduction in diastolic BP - 10.93 ± 8.94 vs. - 5.47 ± 12.57 mmHg (p = 0.058). The magnitude of reduction in resting heart rate was significant in men (p = 0.018) but not in women (p = 0.376). The magnitude of reduction in serum total cholesterol and triglycerides was more in men (p = 0.018 and p = 0.014). Women showed more reduction in HbA1c (p = 0.052). CONCLUSION Men are more adherent to cardiac rehabilitation programs. Recruitment of women is significantly delayed. Women have a higher cardiovascular risk burden in the form of prevalence of diabetes, hypertension, and obesity. Completion of a cardiac rehabilitation program causes a reduction in BMI, waist circumference, blood pressure measurements, total cholesterol, triglycerides, LDL-C, HDL-C, HbA1c, and LVEDD with an increase in LVEF in both genders. Men show more reduction in resting HR, total cholesterol, and triglyceride levels while women show more reduction in diastolic BP and HBA1c.
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Affiliation(s)
- Ahmed Mohamed El Missiri
- Cardiology Department, Faculty of Medicine, Ain Shams University, Abbassia square, Abbasia, Cairo, 11566 Egypt
| | - Hany Mohamed Awadalla
- Cardiology Department, Faculty of Medicine, Ain Shams University, Abbassia square, Abbasia, Cairo, 11566 Egypt
| | - Mosadaq Mustafa Almoudi
- Cardiology Department, Faculty of Medicine, Ain Shams University, Abbassia square, Abbasia, Cairo, 11566 Egypt
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Krishnamurthi N, Schopfer DW, Shen H, Whooley MA. Association of Cardiac Rehabilitation With Survival Among US Veterans. JAMA Netw Open 2020; 3:e201396. [PMID: 32196104 PMCID: PMC7084171 DOI: 10.1001/jamanetworkopen.2020.1396] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE Participation in cardiac rehabilitation (CR) programs at Veterans Affairs (VA) facilities is low. Most veterans receive CR through purchased care at non-VA programs. However, limited literature exists on the comparison of outcomes between VA and non-VA CR programs. OBJECTIVE To compare 1-year mortality and 1-year readmission rates for myocardial infarction or coronary revascularization between VA vs non-VA CR participants. DESIGN, SETTING, AND PARTICIPANTS This cohort study included 7320 patients hospitalized for myocardial infarction or coronary revascularization at the VA between 2010 and 2014 who did not die within 30 days of discharge and who participated in 2 or more CR sessions after discharge. The study excluded individuals hospitalized for ischemic heart disease after December 2014 when the VA Choice Act changed referral criteria for non-VA care. Data analysis was performed from November 2019 to January 2020. EXPOSURES Participation in 2 or more CR sessions within 12 months of discharge at a VA or non-VA facility. MAIN OUTCOMES AND MEASURES The 1-year all-cause mortality and 1-year readmission rates for myocardial infarction or coronary revascularization from date of discharge were compared between VA vs non-VA CR participants using Cox proportional hazards models with inverse probability treatment weighting. RESULTS The 7320 veterans with ischemic heart disease who participated in CR programs had a mean (SD) age of 65.13 (8.17) years and were predominantly white (6005 patients [82.0%]), non-Hispanic (6642 patients [91.0%]), and male (7191 patients [98.2%]). Among these 7320 veterans, 2921 (39.9%) attended a VA facility, and 4399 (60.1%) attended a non-VA CR facility. Black and Hispanic veterans were more likely to attend CR programs at VA facilities (509 patients [17.4%] and 378 patients [12.9%], respectively), whereas white veterans were more likely to attend CR programs at non-VA facilities (3759 patients [85.5%]). After inverse probability treatment weighting, rates of 1-year mortality were 1.7% among VA CR participants vs 1.3% among non-VA CR participants (hazard ratio, 1.32; 95% CI, 0.90-1.94; P = .15). Rates of readmission for myocardial infarction or revascularization during the 12 months after discharge were 4.9% among VA CR participants vs 4.4% among non-VA CR participants (hazard ratio, 1.06; 95% CI, 0.83-1.35; P = .62). CONCLUSIONS AND RELEVANCE These findings suggest that rates of 1-year mortality and 1-year readmission for myocardial infarction or revascularization did not differ for participants in VA vs non-VA cardiac rehabilitation programs. Eligible patients with ischemic heart disease should participate in CR programs regardless of where they are provided.
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Affiliation(s)
- Nirupama Krishnamurthi
- San Francisco Veterans Affairs Medical Center, San Francisco, California
- Icahn School of Medicine at Mount Sinai St Luke’s and Mount Sinai West, New York, New York
| | - David W. Schopfer
- San Francisco Veterans Affairs Medical Center, San Francisco, California
- Department of Medicine, University of California, San Francisco
| | - Hui Shen
- San Francisco Veterans Affairs Medical Center, San Francisco, California
- Department of Medicine, University of California, San Francisco
| | - Mary A. Whooley
- San Francisco Veterans Affairs Medical Center, San Francisco, California
- Department of Medicine, University of California, San Francisco
- Department of Epidemiology and Biostatistics, University of California, San Francisco
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24
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Uithoven KE, Smith JR, Medina-Inojosa JR, Squires RW, Olson TP. The Role of Cardiac Rehabilitation in Reducing Major Adverse Cardiac Events in Heart Transplant Patients. J Card Fail 2020; 26:645-651. [PMID: 31981697 DOI: 10.1016/j.cardfail.2020.01.011] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Revised: 09/21/2019] [Accepted: 01/17/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND Methods for reducing major adverse cardiac events (MACE) in patients after heart transplantation (HTx) are critical for long-term quality outcomes. METHODS AND RESULTS Patients with cardiopulmonary exercise testing prior to HTx and at least 1 session of cardiac rehabilitation (CR) after HTx were included. Exercise sessions were evaluated as ≥ 23 or < 23 sessions based on recursive partitioning. We included 140 patients who had undergone HTx (women: n = 41 (29%), age: 52 ± 12 years, body mass index: 27 ± 5 kg/m2). Mean follow-up was 4.1 ± 2.7 years, and 44 patients (31%) had a MACE: stroke (n = 1), percutaneous intervention (n = 5), heart failure (n = 6), myocardial infarction (n = 1), rejection (n = 16), or death (n = 15). CR was a significant predictor of MACE, with ≥ 23 sessions associated with a ∼ 60% reduction in MACE risk (hazard ratio [HR]: 0.42, 95% CI: 0.19-0.94, P = 0.035). This remained after adjusting for age, sex and history of diabetes (HR: 0.41, 95% CI: 0.18-0.94, P = 0.035) as well as body mass index and pre-HTx peak oxygen consumption (HR: 0.40, 95% CI: 0.18-0.92, P = 0.031). CONCLUSIONS After adjustment for covariates of age, sex, diabetes, body mass index, and pre-HTx peak oxygen consumption, CR attendance of ≥ 23 exercise sessions was predictive of lower MACE risk following HTx. In post-HTx patients, CR was associated with MACE prevention and should be viewed as a critical tool in post-HTx treatment strategies.
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Affiliation(s)
- Katelyn E Uithoven
- School of Kinesiology, University of Minnesota, Minneapolis, MN 55455, USA.
| | - Joshua R Smith
- Division of Preventive Cardiology, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | - Jose R Medina-Inojosa
- Division of Preventive Cardiology, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | - Ray W Squires
- Division of Preventive Cardiology, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | - Thomas P Olson
- Division of Preventive Cardiology, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN 55905, USA
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25
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Izawa H, Yoshida T, Ikegame T, Izawa KP, Ito Y, Okamura H, Osada N, Kinugawa S, Kubozono T, Kono Y, Kobayashi K, Nishigaki K, Higo T, Hirashiki A, Miyazawa Y, Morio Y, Yanase M, Yamada S, Ikeda H, Momomura SI, Kihara Y, Yamamoto K, Goto Y, Makita S. Standard Cardiac Rehabilitation Program for Heart Failure. Circ J 2019; 83:2394-2398. [DOI: 10.1253/circj.cj-19-0670] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Hideo Izawa
- Department of Cardiology, Fujita Health University Bantane Hospital
| | - Toshiko Yoshida
- Graduate School of Nursing Science, St. Luke’s International University
| | - Toshimi Ikegame
- Department of Nursing Administration, Sakakibara Heart Institute, Japan Research Promotion Society for Cardiovascular Disease
| | | | | | - Hideo Okamura
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Naohiko Osada
- Department of Cardiology, St. Marianna University School of Medicine Toyoko Hospital
| | - Shintaro Kinugawa
- Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University
| | - Takuro Kubozono
- Department of Cardiovascular Medicine and Hypertension, Graduate School of Medical and Dental Sciences, Kagoshima University
| | - Yuji Kono
- Department of Rehabilitation, Fujita Health University Bantane Hospital
| | | | | | - Taiki Higo
- Department of Cardiovascular Medicine, Kyushu University
| | - Akihiro Hirashiki
- Department of Cardiology, National Center for Geriatrics and Gerontology
| | | | - Yuji Morio
- Department of Rehabilitation Medicine, Shonan University of Medical Sciences
| | - Masanobu Yanase
- Department of Transplantation, National Cerebral and Cardiovascular Center
| | - Sumio Yamada
- School of Health Sciences, Nagoya University Graduate School of Medicine
| | - Hisao Ikeda
- Faculty of Fukuoka Medical Technology, Teikyo University
| | | | - Yasuki Kihara
- Department of Cardiovascular Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University
| | - Kazuhiro Yamamoto
- Department of Molecular Medicine and Therapeutics, Faculty of Medicine, Tottori University
| | - Yoichi Goto
- Department of Cardiovascular Medicine, Yoka Municipal Hospital
| | - Shigeru Makita
- Department of Cardiac Rehabilitation, Saitama Medical University International Medical Center
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Terada T, Chirico D, Tulloch HE, Scott K, Pipe AL, Reed JL. Sex differences in psychosocial and cardiometabolic health among patients completing cardiac rehabilitation. Appl Physiol Nutr Metab 2019; 44:1237-1245. [DOI: 10.1139/apnm-2018-0876] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Current programs of cardiac rehabilitation (CR) typically provide a standardized approach to all patients. We examined whether CR would produce similar improvements in psychosocial and cardiometabolic health indicators in women compared with men. The records of patients who completed a 3-month outpatient CR program were examined. We compared health-related quality of life (i.e., Physical Component Summary (PCS) and Mental Component Summary (MCS) scores), anxiety, depression, and cardiometabolic health indicators between women and men completing CR. Of the 591 participants who completed CR, 155 (26.2%) were women and 436 (73.8%) were men. At baseline, women were older (64 ± 9 vs. 62 ± 9 years, p = 0.045), had lower PCS (39.5 ± 8.1 vs. 43.9 ± 7.8 points, p < 0.001), and MCS (46.6 ± 10.8 vs. 49.4 ± 9.8 points, p = 0.003) scores, experienced elevated levels of anxiety (6.4 ± 4.0 vs. 5.2 ± 4.0 points, p = 0.001) and depression (4.7 ± 3.5 vs. 3.6 ± 3.3 points, p = 0.001), and had higher low-density lipoprotein cholesterol (2.1 ± 0.9 vs. 1.7 ± 0.7 mmol/L, p < 0.001) and high-density lipoprotein cholesterol (1.4 ± 0.4 vs. 1.1 ± 0.3 mmol/L, p < 0.001) concentrations when compared with men. Following CR, women showed smaller improvements in percent body mass (+1.1% ± 10.1% vs. −2.1% ± 9.7%, p = 0.002) and PCS scores (3.0 ± 8.1 vs. 6.3 ± 7.5 points, p < 0.001) when compared with men. Considering poorer psychosocial health at baseline and smaller improvements in health-related quality of life in women when compared with men, more specific CR strategies addressing the particular needs of women are required to improve their health status and reduce the risk of secondary cardiac events.
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Affiliation(s)
- Tasuku Terada
- Exercise Physiology and Cardiovascular Health Lab, Division of Cardiac Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, ON K1Y 4W7, Canada
| | - Daniele Chirico
- Exercise Physiology and Cardiovascular Health Lab, Division of Cardiac Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, ON K1Y 4W7, Canada
| | - Heather E. Tulloch
- Division of Cardiac Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, ON K1Y 4W7, Canada
- Faculty of Medicine, University of Ottawa, Ottawa, ON K1H 8M5, Canada
| | - Kyle Scott
- Exercise Physiology and Cardiovascular Health Lab, Division of Cardiac Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, ON K1Y 4W7, Canada
| | - Andrew L. Pipe
- Division of Cardiac Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, ON K1Y 4W7, Canada
- Faculty of Medicine, University of Ottawa, Ottawa, ON K1H 8M5, Canada
| | - Jennifer L. Reed
- Exercise Physiology and Cardiovascular Health Lab, Division of Cardiac Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, ON K1Y 4W7, Canada
- Faculty of Medicine, University of Ottawa, Ottawa, ON K1H 8M5, Canada
- School of Human Kinetics, Faculty of Health Sciences, University of Ottawa, Ottawa, ON K1N 6N5, Canada
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27
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Thomas RJ, Huang HH. Cardiac Rehabilitation for Secondary Prevention of Cardiovascular Disease: 2019 Update. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2019; 21:56. [PMID: 31486974 DOI: 10.1007/s11936-019-0759-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
PURPOSE OF REVIEW To provide updated information on the science and practice of cardiac rehabilitation (CR). RECENT FINDINGS Evidence continues to mount that supports the many benefits of CR as well as the important gap in delivering CR to all eligible patients. Recent studies have identified center-based and home-based strategies to improve the reach and impact of CR. Cardiac rehabilitation is a systematic, evidence-based approach to deliver effective secondary CVD preventive therapies to individuals with cardiovascular conditions. Because of a number of benefits that have been associated with CR, clinical practice guidelines strongly endorse CR services for eligible patients. Research supports CR as a high value service, with evidence of favorable clinical outcomes and costs. Unfortunately, a significant gap exists in CR participation due to a number of patient-, provider-, and system-level barriers. Solutions to most of these barriers have been identified and involve systematic approaches to CR delivery. The future is bright for CR as new strategies, new policies, and new methods of delivery continue to develop to help provide CR services to all eligible patients.
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Affiliation(s)
- Randal J Thomas
- Mayo Clinic Cardiac Rehabilitation Program, Division of Preventive Cardiology, Department of Cardiovascular Medicine, Mayo Clinic, 200 First Street, SW, Rochester, MN, 55905, USA.
| | - Hsu-Hang Huang
- Mayo Clinic Cardiac Rehabilitation Program, Division of Preventive Cardiology, Department of Cardiovascular Medicine, Mayo Clinic, 200 First Street, SW, Rochester, MN, 55905, USA
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28
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Tousignant M, Mampuya WM, Bissonnette J, Guillemette E, Lauriault F, Lavoie J, St-Laurent ME, Pagé C. Telerehabilitation with live-feed biomedical sensor signals for patients with heart failure: a pilot study. Cardiovasc Diagn Ther 2019; 9:319-327. [PMID: 31555536 DOI: 10.21037/cdt.2019.03.05] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Background Integrating biomedical sensors to a telerehabilitation platform allowed clinicians to receive real-time transmissions of the electrocardiogram (ECG) signal, oxygen saturation, and heart rate during an exercise program. These clinical data could be helpful to adjust and personalize the intensity of exercises to each patient's condition. The purpose of this study was to evaluate the feasibility and usefulness of biomedical sensors in telerehabilitation in patients with heart failure (HF). Methods Four participants with HF (mean age 66 years) followed the 12-week cardiac program using telerehabilitation, including sensors to monitor real-time vital signs during sessions. The exercise program included cardiovascular, strengthening and flexibility exercises. Participants were evaluated before the intervention and one month after the end of the program. Functional capacity was measured with Cardiopulmonary Exercise Testing (CPX), the 6-minute walk test (6MWT), and the sit to stand test (STST). Quality of life was objectified using the Kansas City Cardiomyopathy Questionnaire (KCCQ). Results Our main objective demonstrated that real-time biomedical sensors can be safely used by clinicians during a telerehabilitation session. Most participants showed a tendency to improve their physical capacities such as walking distance and lower limb muscular strength. As a main outcome of cardiac rehabilitation (CR), quality of life seems to improve after the 12-week intervention. Conclusions This study proved the feasibility of using telerehabilitation with real-time biomedical sensors as an alternative or a complement to the conventional CR program. Use of sensors allowed a safe environment for the patient and an adequate and personalized exercise prescription. Limitation in one-to-one supervision must be challenged in future clinical trials to demonstrate that telerehabilitation could be efficient for cardiac patients requiring more individual supervision than group sessions in a gymnasium.
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Affiliation(s)
- Michel Tousignant
- School of Rehabilitation, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Quebec, Canada.,Research Centre on Aging, Centre intégré universitaire de santé et de services sociaux de l'Estrie - Centre hospitalier universitaire de Sherbrooke (CIUSSS de l'Estrie-CHUS), Sherbrooke, Quebec, Canada
| | - Warner M Mampuya
- Department of Medicine (Cardiology), Centre intégré universitaire de santé et de services sociaux de l'Estrie - Centre hospitalier universitaire de Sherbrooke (CIUSSS de l'Estrie-CHUS), Sherbrooke, Quebec, Canada
| | - Josiane Bissonnette
- School of Rehabilitation, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Emilie Guillemette
- School of Rehabilitation, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Fannie Lauriault
- School of Rehabilitation, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Julie Lavoie
- School of Rehabilitation, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Marie-Elisabeth St-Laurent
- School of Rehabilitation, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Catherine Pagé
- Research Centre on Aging, Centre intégré universitaire de santé et de services sociaux de l'Estrie - Centre hospitalier universitaire de Sherbrooke (CIUSSS de l'Estrie-CHUS), Sherbrooke, Quebec, Canada
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29
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Ji H, Fang L, Yuan L, Zhang Q. Effects of Exercise-Based Cardiac Rehabilitation in Patients with Acute Coronary Syndrome: A Meta-Analysis. Med Sci Monit 2019; 25:5015-5027. [PMID: 31280281 PMCID: PMC6636406 DOI: 10.12659/msm.917362] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Acute coronary syndrome (ACS) has become an important cause of death from cardiovascular disease. Cardiac rehabilitation (CR) plays an essential role in ACS patients after treatment. Therefore, in order to detect the impact of CR on mortality and major adverse cardiac events in patients with ACS, we conducted this meta-analysis. MATERIAL AND METHODS We searched PubMed, Web of science, and EMBASE databases to obtain published research results from 2010 to August 2018 to determine the relevant research. Random-effects model or fixed-effects model were used to calculate relative risk (RR) and 95% confidence interval (CI). RESULTS Overall, a total of 25 studies with 55 035 participants were summarized in our meta-analysis. The results indicated that the hazard ratio (HR) of mortality significantly lower in the CR group than in the non-CR group (HR=-0.47; 95% CI=(-0.56 to -0.39; P<0.05). Fourteen studies on mortality rate showed exercise was associated with reduced cardiac death rates (RR=0.40; 95% CI=0.30 to 0.53; P<0.05). We found the risk of major adverse cardiac events (MACE) was lower in the rehabilitation group (RR=0.49; 95% CI=0.44 to 0.55; P<0.05). In 11 articles on CR including 8098 participants, the benefit in the CR group was greater than in the control group concerning revascularization (RR=0.69, 95% CI: 0.53 to 0.88; P=0.003). The recurrence rate of MI was reported in 13 studies, and the risk was lower in the CR group (RR=0.63, 95% CI: 0.57-0.70; P<0.05). CONCLUSIONS Our meta-analysis results suggest that CR is clearly associated with reductions in cardiac mortality, recurrence of MI, repeated PCI, CABG, and restenosis.
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Affiliation(s)
- Haigang Ji
- Department of Cardiology, Changzhou Hospital Affiliated to Nanjing University of Chinese Medicine, Changzhou, Jiangsu, China (mainland)
| | - Liang Fang
- Department of Cardiology, Changzhou Traditional Chinese Medicine Hospital, Changzhou, Jiangsu, China (mainland)
| | - Ling Yuan
- Department of Cardiology, Changzhou Traditional Chinese Medicine Hospital, Changzhou, Jiangsu, China (mainland)
| | - Qi Zhang
- Department of Cardiology, Changzhou Traditional Chinese Medicine Hospital, Changzhou, Jiangsu, China (mainland)
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30
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Kurose S, Miyauchi T, Yamashita R, Tamaki S, Imai M, Nakashima Y, Umeda Y, Sato S, Kimura Y, Masuda I. Association of locomotive activity with sleep latency and cognitive function of elderly patients with cardiovascular disease in the maintenance phase of cardiac rehabilitation. J Cardiol 2019; 73:530-535. [DOI: 10.1016/j.jjcc.2018.12.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Revised: 11/06/2018] [Accepted: 12/11/2018] [Indexed: 11/26/2022]
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Salman A, Doherty P. To what extent is the variation in cardiac rehabilitation quality associated with patient characteristics? BMC Health Serv Res 2019; 19:3. [PMID: 30606181 PMCID: PMC6318968 DOI: 10.1186/s12913-018-3831-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2018] [Accepted: 12/17/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Huge variability in quality of service delivery of cardiac rehabilitation (CR) in the UK. This study aimed to ascertain whether the variation in quality of CR delivery is associated with participants' characteristics. METHODS Individual patient data from 1 April 2013 to 31 March 2014 were collected electronically from the UK's National Audit of Cardiac Rehabilitation database. Quality of CR delivery is categorised as low, middle, and high based on six service-level criteria. The study included a range of patient variables: patient demographics, cardiovascular risk factors, comorbidities, physical and psychosocial health measures, and index of multiple deprivation. RESULTS The chance that a CR patient with more comorbidities attended a high-quality programme was 2.13 and 1.85 times higher than the chance that the same patient attended a low- or middle-quality programme, respectively. Patients who participated in high-quality CR programmes tended to be at high risk (e.g. increased waist size and high blood pressure); high BMI, low physical activity levels and high Hospital Anxiety and Depression Scale scores; and were more likely to be smokers, and be in more socially deprived groups than patients in low-quality programmes. CONCLUSIONS These findings show that the quality of CR delivery can be improved and meet national standards by serving a more multi-morbid population which is important for patients, health providers and commissioners of healthcare. In order for low-quality programmes to meet clinical standards, CR services need to be more inclusive in respect of patients' characteristics identified in the study. Evaluation and dissemination of information about the populations served by CR programmes may help low-quality programmes to be more inclusive.
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Affiliation(s)
- Ahmad Salman
- Department of Health Sciences, University of York, York, UK
- Ministry of Health, Kuwait City, Kuwait
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32
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Minatoguchi S, Ando T, Tanaka T, Yamada Y, Kanamori H, Kawasaki M, Nishigaki K, Minatoguchi S. Cardiac Rehabilitation With Dynamic Exercise Increases the Number of Muse Cells in the Peripheral Blood of Patients With Heart Disease. Circ Rep 2018; 1:17-19. [PMID: 33693070 PMCID: PMC7925125 DOI: 10.1253/circrep.cr-18-0003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background:
It is still unclear whether dynamic exercise increases the number of Muse cells, pluripotent stem cells, in the peripheral blood. Methods and Results:
The number of Muse cells, SSEA3+ and CD105+ double-positive cells, in the peripheral blood was measured using FACS before and after 40 min of cardiac rehabilitation with dynamic exercise in 6 patients with heart disease. The number of Muse cells significantly increased after cardiac rehabilitation in all patients. Muse cell mobilization may be related to the beneficial clinical outcome of cardiac rehabilitation. Conclusions:
Cardiac rehabilitation increases the number of Muse cells in the peripheral blood.
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Affiliation(s)
- Shingo Minatoguchi
- Department of Cardiology, Gifu University Graduate School of Medicine Gifu Japan
| | - Takahiro Ando
- Department of Cardiology, Gifu University Graduate School of Medicine Gifu Japan
| | - Toshiki Tanaka
- Department of Cardiology, Gifu University Graduate School of Medicine Gifu Japan
| | - Yoshihisa Yamada
- Department of Cardiology, Gifu University Graduate School of Medicine Gifu Japan
| | - Hiromitsu Kanamori
- Department of Cardiology, Gifu University Graduate School of Medicine Gifu Japan
| | - Masanori Kawasaki
- Department of Cardiology, Gifu University Graduate School of Medicine Gifu Japan
| | | | - Shinya Minatoguchi
- Department of Circulatory and Respiratory Advanced Medicine, Gifu University Graduate School of Medicine Gifu Japan.,Cardiology, Gifu Municipal Hospital Gifu Japan
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33
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Kim HB, Hong YJ, Park HJ, Ahn Y, Jeong MH. Effects of Ivabradine on Left Ventricular Systolic Function and Cardiac Fibrosis in Rat Myocardial Ischemia-Reperfusion Model. Chonnam Med J 2018; 54:167-172. [PMID: 30288372 PMCID: PMC6165924 DOI: 10.4068/cmj.2018.54.3.167] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Revised: 08/14/2018] [Accepted: 08/16/2018] [Indexed: 12/12/2022] Open
Abstract
We evaluated the effects of Ivabradine on left ventricle (LV) ejection fraction (EF) and LV infarcted tissue in the rat myocardial ischemia-reperfusion model. Twenty rats were randomly assigned to group 1 (ischemia-reperfusion, no treatment, n=10) and group 2 (ischemia-reperfusion + Ivabradine 10 mg/kg, n=10). Ivabradine was administered for 28 days. Echocardiography was performed at 7 days and at 28 days after the induction of ischemia-reperfusion injury. Cardiac fibrosis induced by ischemia-reperfusion injury was evaluated by Masson's trichrome staining. The infarct size was quantified using the Image J program. At the 28-day follow-up, LVEF was significantly higher (36.02±6.16% vs. 45.72±2.62%, p<0.001) and fractional shortening was significantly higher (15.23±2.84% vs. 20.13±1.38%, p<0.001) in group 2 than group 1. Delta (28 day minus 7 day) EF was significantly higher in group 2 than group 1 (-4.36±3.49% vs. 4.31±5.63%, p<0.001). Also, heart rate (beats/min) was significantly lower in group 2 than group 1 (251.67±25.19 vs. 199.29±31.33, p=0.025). Group 2 had a smaller infarct size (40.70±8.94% vs. 30.19±5.89%, p<0.01) than group 1 at 28-day follow-up. Oral administration of Ivabradine could improve LV systolic function and reduce infarcted tissue area in rat myocardial ischemia-reperfusion model.
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Affiliation(s)
- Han Byul Kim
- Division of Cardiology, Chonnam National University Hospital, Cardiovascular Convergence Research Center Nominated by Korea Ministry of Health and Welfare, Gwangju, Korea
| | - Young Joon Hong
- Division of Cardiology, Chonnam National University Hospital, Cardiovascular Convergence Research Center Nominated by Korea Ministry of Health and Welfare, Gwangju, Korea
| | - Hyuk Jin Park
- Division of Cardiology, Chonnam National University Hospital, Cardiovascular Convergence Research Center Nominated by Korea Ministry of Health and Welfare, Gwangju, Korea
| | - Youngkeun Ahn
- Division of Cardiology, Chonnam National University Hospital, Cardiovascular Convergence Research Center Nominated by Korea Ministry of Health and Welfare, Gwangju, Korea
| | - Myung Ho Jeong
- Division of Cardiology, Chonnam National University Hospital, Cardiovascular Convergence Research Center Nominated by Korea Ministry of Health and Welfare, Gwangju, Korea
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34
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Ögmundsdottir Michelsen H, Nilsson M, Scherstén F, Sjölin I, Schiopu A, Leosdottir M. Tailored nurse-led cardiac rehabilitation after myocardial infarction results in better risk factor control at one year compared to traditional care: a retrospective observational study. BMC Cardiovasc Disord 2018; 18:167. [PMID: 30111283 PMCID: PMC6094912 DOI: 10.1186/s12872-018-0907-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Accepted: 08/09/2018] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Cardiac rehabilitation improves prognosis after an acute myocardial infarction (AMI), however, the optimal method of implementation is unknown. The aim of the study was to evaluate the effect of individually-tailored, nurse-led cardiac rehabilitation on patient outcomes. METHOD This single-centre retrospective observational study included 217 patients (62 ± 9 years, 73% men). All patients attended cardiac rehabilitation including at least two follow-up consultations with a nurse. Patients receiving traditional care (n = 105) had a routine cardiologist consultation, while for those receiving tailored care (n = 112) their need for a cardiologist consultation was individually evaluated by the nurses. Regression analysis was used to analyse risk factor control and hospital readmissions at one year. RESULTS Patients in the tailored group achieved better control of total cholesterol (- 0.1 vs + 0.4 mmol/L change between baseline (time of index event) and 12-14-month follow-up, (p = 0.01), LDL cholesterol (- 0.1 vs + 0.2 mmol/L, p = 0.02) and systolic blood pressure (- 2.1 vs + 4.3 mmHg, p = 0.01). Active smokers, at baseline, were more often smoke-free at one-year in the tailored group [OR 0.32 (0.1-1.0), p = 0.05]. There was a no significant difference in re-admissions during the first year of follow-up. In the tailored group 60% of the patients had a cardiologist consultation compared to 98% in the traditional group (p < 0.001). The number of nurse visits was the same in both groups, while the number of telephone contacts was 38% higher in the tailored group (p = 0.02). CONCLUSION A tailored, nurse-led cardiac rehabilitation programme can improve risk factor management in post-AMI patients.
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Affiliation(s)
- Halldora Ögmundsdottir Michelsen
- Department of Coronary Disease, Skåne University Hospital, Inga Marie Nilsson gata 47, Malmö, Sweden
- Department of Clinical Sciences Malmö, Faculty of Medicine, Lund University, Box 117, SE-221 00 Lund, Sweden
| | - Marie Nilsson
- Department of Coronary Disease, Skåne University Hospital, Inga Marie Nilsson gata 47, Malmö, Sweden
| | - Fredrik Scherstén
- Department of Coronary Disease, Skåne University Hospital, Inga Marie Nilsson gata 47, Malmö, Sweden
| | - Ingela Sjölin
- Department of Coronary Disease, Skåne University Hospital, Inga Marie Nilsson gata 47, Malmö, Sweden
- Department of Clinical Sciences Malmö, Faculty of Medicine, Lund University, Box 117, SE-221 00 Lund, Sweden
| | - Alexandru Schiopu
- Department of Coronary Disease, Skåne University Hospital, Inga Marie Nilsson gata 47, Malmö, Sweden
- Department of Clinical Sciences Malmö, Faculty of Medicine, Lund University, Box 117, SE-221 00 Lund, Sweden
| | - Margret Leosdottir
- Department of Coronary Disease, Skåne University Hospital, Inga Marie Nilsson gata 47, Malmö, Sweden
- Department of Clinical Sciences Malmö, Faculty of Medicine, Lund University, Box 117, SE-221 00 Lund, Sweden
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Resurrección DM, Moreno-Peral P, Gómez-Herranz M, Rubio-Valera M, Pastor L, Caldas de Almeida JM, Motrico E. Factors associated with non-participation in and dropout from cardiac rehabilitation programmes: a systematic review of prospective cohort studies. Eur J Cardiovasc Nurs 2018; 18:38-47. [PMID: 29909641 DOI: 10.1177/1474515118783157] [Citation(s) in RCA: 117] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND Although evidence exists for the efficacy of cardiac rehabilitation programmes to reduce morbidity and mortality among patients with cardiovascular disease, cardiac rehabilitation programmes are underused. We aimed systematically to review the evidence from prospective cohort studies on factors associated with non-participation in and/or dropping out from cardiac rehabilitation programmes. METHODS MedLine, Embase, Scopus, Open Grey and Cochrane Database were searched for relevant publications from inception to February 2018. Search terms included (a) coronary heart disease and other cardiac conditions; (b) cardiac rehabilitation and secondary prevention; and (c) non-participation in and/or dropout. Databases were searched following the PRISMA statement. Study selection, data extraction and the assessment of study quality were performed in duplicate. RESULTS We selected 43 studies with a total of 63,425 patients from 10 different countries that met the inclusion criteria. Factors associated with non-participation in and dropout from cardiac rehabilitation were grouped into six broad categories: intrapersonal factors, clinical factors, interpersonal factors, logistical factors, cardiac rehabilitation programme factors and health system factors. We found that clinical factors, logistical factors and health system factors were the main factors assessed for non-participation in cardiac rehabilitation. We also found differences between the factors associated with non-participation and dropout. CONCLUSIONS Several factors were determinant for non-participation in and dropout from cardiac rehabilitation. These findings could be useful to clinicians and policymakers for developing interventions aimed at improving participation and completion of cardiac rehabilitation, such as E-health or home-based delivery programmes. Trial Registration: International Prospective Register of Systematic Reviews (PROSPERO) identifier: CRD42016032973.
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Affiliation(s)
| | - Patricia Moreno-Peral
- 2 SAMSERAP Group, Primary Care Prevention and Health Promotion Research Network (RedIAPP), Spain.,3 SAMSERAP Group, Instituto de Investigación Biomédica de Malaga (IBIMA), Spain
| | | | - Maria Rubio-Valera
- 5 Research and Development Unit, Institut de Recerca Sant Joan de Déu, Spain.,6 Grupo PRISMA, Centro de Investigación Biomédica en Red Epidemiología y Salud Pública, Spain
| | - Luis Pastor
- 7 Unidad Clínica de Cardiología, Hospital Nuestra Señora de Valme, Spain
| | | | - Emma Motrico
- 1 Departamento de Psicología, Universidad Loyola Andalucía, Spain.,2 SAMSERAP Group, Primary Care Prevention and Health Promotion Research Network (RedIAPP), Spain
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Duscha BD, Piner LW, Patel MP, Craig KP, Brady M, McGarrah RW, Chen C, Kraus WE. Effects of a 12-week mHealth program on peak VO 2 and physical activity patterns after completing cardiac rehabilitation: A randomized controlled trial. Am Heart J 2018; 199:105-114. [PMID: 29754647 DOI: 10.1016/j.ahj.2018.02.001] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Accepted: 02/02/2018] [Indexed: 11/27/2022]
Abstract
BACKGROUND Site-based cardiac rehabilitation (CR) provides supervised exercise, education and motivation for patients. Graduates of CR have improved exercise tolerance. However, when participation in CR ceases, adherence to regular physical activity often declines, consequently leading to worsening risk factors and clinical events. Therefore, the purpose of this pilot study was to evaluate if a mHealth program could sustain the fitness and physical activity levels gained during CR. METHODS AND RESULTS A 12-week mHealth program was implemented using physical activity trackers and health coaching. Twenty-five patients were randomized into mHealth or usual care after completing CR. The combination of a 4.7±13.8% increase in the mHealth and a 8.5±11.5% decrease in the usual care group resulted in a difference between groups (P≤.05) for absolute peak VO2. Usual care decreased the amount of moderate-low physical activity minutes per week (117±78 vs 50±53; P<.05) as well as moderate-high (111±87 vs 65±64; P<.05). mHealth increased moderate-high physical activity (138±113 vs 159±156; NS). The divergent changes between mHealth and usual care in moderate-high physical activity minutes/week resulted in a difference between groups (21±103 vs - 46±36; P<.05). CONCLUSIONS A 12-week mHealth program of physical activity trackers and health coaching following CR graduation can sustain the gains in peak VO2 and physical activity achieved by site-based CR.
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Affiliation(s)
- Brian D Duscha
- Duke University School of Medicine, Division of Cardiology, Durham, NC and Duke Molecular Physiology Institute.
| | - Lucy W Piner
- Duke University School of Medicine, Division of Cardiology, Durham, NC and Duke Molecular Physiology Institute
| | - Mahesh P Patel
- Duke University School of Medicine, Division of Cardiology, Durham, NC and Duke Molecular Physiology Institute
| | - Karen P Craig
- Duke University School of Medicine, Division of Cardiology, Durham, NC and Duke Molecular Physiology Institute
| | | | - Robert W McGarrah
- Duke University School of Medicine, Division of Cardiology, Durham, NC and Duke Molecular Physiology Institute
| | | | - William E Kraus
- Duke University School of Medicine, Division of Cardiology, Durham, NC and Duke Molecular Physiology Institute
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Madhavan MV, Gersh BJ, Alexander KP, Granger CB, Stone GW. Coronary Artery Disease in Patients ≥80 Years of Age. J Am Coll Cardiol 2018; 71:2015-2040. [DOI: 10.1016/j.jacc.2017.12.068] [Citation(s) in RCA: 78] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2017] [Revised: 12/14/2017] [Accepted: 12/19/2017] [Indexed: 02/07/2023]
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Li S, Fonarow GC, Mukamal K, Xu H, Matsouaka RA, Devore AD, Bhatt DL. Sex and Racial Disparities in Cardiac Rehabilitation Referral at Hospital Discharge and Gaps in Long-Term Mortality. J Am Heart Assoc 2018; 7:JAHA.117.008088. [PMID: 29626153 PMCID: PMC6015394 DOI: 10.1161/jaha.117.008088] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Background Cardiac rehabilitation (CR) referral is recommended for eligible patients, regardless of sex or race. It is unclear whether inequality in CR referral practices was associated with patients’ long‐term survival. Methods and Results We linked the American Heart Association Get With The Guidelines Coronary Artery Disease registry with Medicare claims data for 48 993 coronary artery disease patients from 365 hospitals across the United States between 2003 and 2009. We used generalized estimation equations to estimate the association between CR referral and mortality accounting for clustering within hospitals. Between 2003 and 2009, only 40% of eligible patients received CR referrals. Females were 12% less likely to receive CR referral compared with males. Black, Hispanic, and Asian patients were 20%, 36%, and 50% less likely, respectively, to receive CR referral than white patients. CR referral was associated with 40% lower 3‐year all‐cause mortality. Women and minorities who received CR referral at hospital discharge had significantly lower mortality compared with those who did not (odds ratios=0.61 [95% confidence interval, 0.56–0.66] for women, 0.75 [95% confidence interval, 0.63–0.88] for black, 0.62 [95% confidence interval, 0.50–0.79] for Hispanic, and 0.63 [95% confidence interval, 0.46–0.85] for Asian patients). Seven percent of the black versus white mortality gap could potentially be reduced by equitable CR referral. Conclusions CR referral rates at hospital discharge remained low. Gaps in receiving CR referral at hospital discharge were large for women and minorities, and the mortality gap could potentially be reduced through elimination of inequality in CR referral.
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Affiliation(s)
- Shanshan Li
- Boston University School of Medicine, Boston, MA
| | | | | | - Haolin Xu
- Duke Clinical Research Institute, Durham, NC
| | - Roland A Matsouaka
- Duke Clinical Research Institute, Durham, NC.,Department of Biostatistics and Bioinformatics, Duke University, Durham, NC
| | | | - Deepak L Bhatt
- Brigham and Women's Hospital Heart & Vascular Center, Harvard Medical School, Boston, MA
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Thomas RJ, Balady G, Banka G, Beckie TM, Chiu J, Gokak S, Ho PM, Keteyian SJ, King M, Lui K, Pack Q, Sanderson BK, Wang TY. 2018 ACC/AHA Clinical Performance and Quality Measures for Cardiac Rehabilitation: A Report of the American College of Cardiology/American Heart Association Task Force on Performance Measures. Circ Cardiovasc Qual Outcomes 2018; 11:e000037. [DOI: 10.1161/hcq.0000000000000037] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
| | | | | | | | | | | | - P. Michael Ho
- ACC/AHA Task Force on Performance Measures Liaison. American Association of Cardiovascular and Pulmonary Rehabilitation Representative
| | - Steven J. Keteyian
- ACC/AHA Task Force on Performance Measures Liaison. American Association of Cardiovascular and Pulmonary Rehabilitation Representative
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Thomas RJ, Balady G, Banka G, Beckie TM, Chiu J, Gokak S, Ho PM, Keteyian SJ, King M, Lui K, Pack Q, Sanderson BK, Wang TY. 2018 ACC/AHA Clinical Performance and Quality Measures for Cardiac Rehabilitation: A Report of the American College of Cardiology/American Heart Association Task Force on Performance Measures. J Am Coll Cardiol 2018; 71:1814-1837. [PMID: 29606402 DOI: 10.1016/j.jacc.2018.01.004] [Citation(s) in RCA: 131] [Impact Index Per Article: 21.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Clinical outcomes after acute myocardial infarction according to a novel stratification system linked to a rehabilitation program. J Cardiol 2018; 72:227-233. [PMID: 29548664 DOI: 10.1016/j.jjcc.2018.02.008] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Revised: 12/31/2017] [Accepted: 02/06/2018] [Indexed: 11/20/2022]
Abstract
BACKGROUND A risk classification of acute myocardial infarction (AMI) linked to a rehabilitation program has not been established. METHODS We allocated 292 patients with AMI into the low- (L) (n=108), intermediate- (I) (n=72), and high- (H) (n=112) risk groups according to our original risk classification. The primary endpoint was major adverse cardiac events (MACE), defined as the composite of cardiac death, non-fatal AMI, stent thrombosis, and ischemia-driven target vessel revascularization. The mean follow-up period was 252 days. RESULTS The length of coronary care unit (CCU) stay and hospital stay was shortest in the L-risk group (CCU stay, 1.0±1.0 days; hospital stay, 5.6±3.2 days), followed by the I-risk group (CCU stay, 2.3±1.8 days; hospital stay, 8.1±2.7 days), and longest in the H-risk group (CCU stay, 5.1±5.0 days; hospital stay, 14.6±12.6 days) (p<0.001). MACE were most frequently observed in the H-risk group (26.8%), followed by the I-risk group (5.6%), and least in the L-risk group (1.9%) (p<0.001). CONCLUSIONS The lengths of hospital stay and CCU stay were significantly shortest in the L-risk group, followed by the I-risk group, and longest in the H-risk group. MACE were most frequently observed in the H-risk group, followed by the I-risk group, and least in the L-risk group. These results support the validity of our new classification system.
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Bittner V. Cardiac Rehabilitation for Women. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2018; 1065:565-577. [DOI: 10.1007/978-3-319-77932-4_34] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Nogic J, Thein PM, Cameron J, Mirzaee S, Ihdayhid A, Nasis A. The utility of personal activity trackers (Fitbit Charge 2) on exercise capacity in patients post acute coronary syndrome [UP-STEP ACS Trial]: a randomised controlled trial protocol. BMC Cardiovasc Disord 2017; 17:303. [PMID: 29284402 PMCID: PMC5747185 DOI: 10.1186/s12872-017-0726-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2017] [Accepted: 12/04/2017] [Indexed: 01/22/2023] Open
Abstract
Background The benefits of physical activity and cardiovascular rehabilitation on the reduction of cardiovascular risk are well documented. Despite this, significant barriers and challenges remain in optimizing patient risk factors post acute coronary syndromes (ACS) and ensuring patient compliance. Consumer wearable personal activity trackers represent a cost effective and readily available technology that may aid in this endeavour. Methods UP-STEP ACS is a prospective single-blinded, two-arm, parallel, randomized control trial with an aim to enrol 200 patients all undertaking cardiac rehabilitation. It will assess the affect that personal activity monitors have on change in exercise capacity in patients post acute coronary syndromes primarily measured by a six-minute walk test (6MWT). Secondary end points will be the improvement in other cardiovascular risk factors, namely; blood lipid and glucose levels, weight, waist circumference, along with mood, quality of life and cardiac rehabilitation adherence. Patients will be randomized to either receive a personal activity tracker or standard post hospital care during their index event. After the 8- week intervention period, patients will return for a clinical review and repeat of baseline assessments including the 6MWT. Discussion The utility and impact on exercise capacity of personal activity trackers in patient’s post-acute coronary syndrome has not been assessed. This study aims to add to the scientific evidence emerging regarding the clinical utility and validity of these devices in different patient population groups. If proven to be of benefit, these devices represent a cost effective, easily accessible technology that could aid in the reduction of cardiovascular events. Trial registration The trial has been registered with the Australian New Zealand Clinical Trials Registry (ANZCTR). The registration number is ACTRN12617000312347 (28/02/2017).
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Affiliation(s)
- Jason Nogic
- MonashHeart, Monash Health and Monash Cardiovascular Research Centre, 246 Clayton Road, Clayton, Melbourne, VIC, 3168, Australia.
| | - Paul Min Thein
- MonashHeart, Monash Health and Monash Cardiovascular Research Centre, 246 Clayton Road, Clayton, Melbourne, VIC, 3168, Australia
| | - James Cameron
- MonashHeart, Monash Health and Monash Cardiovascular Research Centre, 246 Clayton Road, Clayton, Melbourne, VIC, 3168, Australia
| | - Sam Mirzaee
- MonashHeart, Monash Health and Monash Cardiovascular Research Centre, 246 Clayton Road, Clayton, Melbourne, VIC, 3168, Australia
| | - Abdul Ihdayhid
- MonashHeart, Monash Health and Monash Cardiovascular Research Centre, 246 Clayton Road, Clayton, Melbourne, VIC, 3168, Australia
| | - Arthur Nasis
- MonashHeart, Monash Health and Monash Cardiovascular Research Centre, 246 Clayton Road, Clayton, Melbourne, VIC, 3168, Australia
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Disparities in Cardiac Rehabilitation Participation in the United States: A SYSTEMATIC REVIEW AND META-ANALYSIS. J Cardiopulm Rehabil Prev 2017; 37:2-10. [PMID: 27676464 DOI: 10.1097/hcr.0000000000000203] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE Phase 2 cardiac rehabilitation (CR) is a class I recommendation for all patients following an acute cardiac event or cardiac surgery according to the The American Heart Association and the American College of Cardiology Foundation. Studies have shown that there are differences in cardiac rehabilitation participation rates between sociodemographic groups. The purpose of this systematic review and meta-analyses was to synthesize quantitative data on the relationship between outpatient cardiac rehabilitation (OCR) attendance and various sociodemographic factors. METHODS We conducted a search of PubMed, PsycINFO, CINAHL, Google Scholar, Dissertations & Theses A&I, and conference abstracts for observational studies conducted in the United States that fit our inclusion criteria. A total of 21 studies were included in our final review and meta-analyses. RESULTS Our meta-analyses showed that overall, attenders were younger than nonattenders (mean difference=-3.74 years, 95% CI =-5.87 to -1.61) and the odds of participation were lower among females (OR = 0.59; 95% CI = 0.51-0.69), individuals with a high school degree or less (OR = 0.67; 95% CI = 0.50-0.91), and the uninsured or self-payers (OR = 0.32; 95% CI = 0.14-0.71). Full- or part-time employees were more likely to participate than those not employed (OR = 1.45; 95% CI = 1.08-1.95). CONCLUSIONS Our systematic review and meta-analyses showed that there are significant sociodemographic disparities in CR participation. On the basis of this knowledge, clinicians and policy makers should focus on identifying and eliminating barriers to participation.
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Heron N, Kee F, Mant J, Reilly PM, Cupples M, Tully M, Donnelly M. Stroke Prevention Rehabilitation Intervention Trial of Exercise (SPRITE) - a randomised feasibility study. BMC Cardiovasc Disord 2017; 17:290. [PMID: 29233087 PMCID: PMC5727948 DOI: 10.1186/s12872-017-0717-9] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Accepted: 11/21/2017] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND The value of cardiac rehabilitation (CR) after a transient ischaemic attack (TIA) or minor stroke is untested despite these conditions sharing similar pathology and risk factors to coronary heart disease. We aimed to evaluate the feasibility of conducting a trial of an adapted home-based CR programme, 'The Healthy Brain Rehabilitation Manual', for patients following a TIA/minor stroke, participants' views on the intervention and, to identify the behaviour change techniques (BCTs) used. METHODS Clinicians were asked to identify patients attending the Ulster Hospital, Belfast within 4 weeks of a first TIA or minor stroke. Those who agreed to participate underwent assessments of physical fitness, cardiovascular risk, quality of life and mental health, before random allocation to: Group (1) standard/usual care; (2) rehabilitation manual or (3) manual plus pedometer. All participants received telephone support at 1 and 4 weeks, reassessment at 6 weeks and an invitation to a focus group exploring views regarding the study. Two trained review authors independently assessed the manual to identify the BCTs used. RESULTS Twenty-eight patients were invited to participate, with 15 (10 men, 5 women; 9 TIA, 6 minor stroke; mean age 69 years) consenting and completing the study. Mean time to enrolment from the TIA/stroke was 20.5 days. Participants completed all assessment measures except VO2max testing, which all declined. The manual and telephone contact were viewed positively, as credible sources of advice. Pedometers were valued highly, particularly for goal-setting. Overall, 36 individual BCTs were used, the commonest being centred around setting goals and planning as well as social support. CONCLUSION Recruitment and retention rates suggest that a trial to evaluate the effectiveness of a novel home-based CR programme, implemented within 4 weeks of a first TIA/minor stroke is feasible. The commonest BCTs used within the manual revolve around goals, planning and social support, in keeping with UK national guidelines. The findings from this feasibility work have been used to further refine the next stage of the intervention's development, a pilot study. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02712385 . This study was registered prospectively on 18/03/2016.
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Affiliation(s)
- Neil Heron
- Department of General Practice and Primary Care, Queen’s University, Belfast, UK
- Centre for Public Health Research, Queen’s University, Belfast, UK
- UKCRC Centre of Excellence for Public Health Research (NI), Belfast, Northern Ireland
- Department of General Practice, Queen’s University, Dunluce Health Centre, Level 4, 1 Dunluce Avenue, Belfast, BT9 7HR UK
| | - Frank Kee
- Department of General Practice and Primary Care, Queen’s University, Belfast, UK
- Centre for Public Health Research, Queen’s University, Belfast, UK
- UKCRC Centre of Excellence for Public Health Research (NI), Belfast, Northern Ireland
| | - Jonathan Mant
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Strangeways Research Laboratory, Cambridge, UK
| | - Philip M. Reilly
- Patient and Public Involvement (PPI) Representative for SPRITE Studies, Belfast, Northern Ireland
| | - Margaret Cupples
- Department of General Practice and Primary Care, Queen’s University, Belfast, UK
- Centre for Public Health Research, Queen’s University, Belfast, UK
- UKCRC Centre of Excellence for Public Health Research (NI), Belfast, Northern Ireland
| | - Mark Tully
- Department of General Practice and Primary Care, Queen’s University, Belfast, UK
- Centre for Public Health Research, Queen’s University, Belfast, UK
- UKCRC Centre of Excellence for Public Health Research (NI), Belfast, Northern Ireland
| | - Michael Donnelly
- Department of General Practice and Primary Care, Queen’s University, Belfast, UK
- Centre for Public Health Research, Queen’s University, Belfast, UK
- UKCRC Centre of Excellence for Public Health Research (NI), Belfast, Northern Ireland
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Predictors of improvements in exercise capacity during cardiac rehabilitation in the recovery phase after coronary artery bypass graft surgery versus acute myocardial infarction. Heart Vessels 2017; 33:358-366. [DOI: 10.1007/s00380-017-1076-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Accepted: 11/01/2017] [Indexed: 10/18/2022]
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47
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Jiménez-Navarro MF, Lopez-Jimenez F, Pérez-Belmonte LM, Lennon RJ, Diaz-Melean C, Rodriguez-Escudero JP, Goel K, Crusan D, Prasad A, Squires RW, Thomas RJ. Benefits of Cardiac Rehabilitation on Cardiovascular Outcomes in Patients With Diabetes Mellitus After Percutaneous Coronary Intervention. J Am Heart Assoc 2017; 6:e006404. [PMID: 29021270 PMCID: PMC5721849 DOI: 10.1161/jaha.117.006404] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2017] [Accepted: 08/14/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND Participation in cardiac rehabilitation (CR) is an essential component of care for patients with coronary artery disease. However, little is known about its benefit on cardiovascular outcomes in patients with diabetes mellitus (DM) who have undergone percutaneous coronary intervention. The aim of our study was to evaluate the impact of CR in this high-risk group of patients. METHODS AND RESULTS We performed a retrospective analysis of all patients with DM who underwent percutaneous coronary intervention in Olmsted County (Minnesota) between 1994 and 2010, assessing the impact of CR participation on clinical outcomes. CR participation was significantly lower in patients with DM (38%, 263/700) compared with those who did not have DM (45%, 1071/2379; P=0.004). Using propensity score adjustment, we found that in patients with DM, CR participation was associated with significantly reduced all-cause mortality (hazard ratio, 0.56; 95% confidence interval, 0.39-0.80; P=0.002) and composite end point of mortality, myocardial infarction, or revascularization (hazard ratio, 0.77; 95% confidence interval, 0.60-0.98; P=0.037), during a median follow-up of 8.1 years. In patients without DM, CR participation was associated with a significant reduction in all-cause mortality (hazard ratio, 0.67; 95% confidence interval, 0.55-0.82; P<0.001) and cardiac mortality (hazard ratio, 0.67; 95% confidence interval, 0.47-0.95; P=0.024). CONCLUSIONS CR participation after percutaneous coronary intervention is associated with lower all-cause mortality rates in patients with DM, to a similar degree as for those without DM. However, CR participation was lower in patients with DM, suggesting the need to identify and correct the barriers to CR participation for this higher-risk group of patients.
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Affiliation(s)
- Manuel F Jiménez-Navarro
- UGC Corazón, Hospital Universitario Virgen de la Victoria, Instituto de Biomedicina de Málaga, CIBERCV Enfermedades Cardiovasculares, Universidad de Málaga, Spain
| | - Francisco Lopez-Jimenez
- The Department of Cardiovascular Diseases and Department of Health Sciences Research, Mayo Clinic, Rochester, MN
| | - Luis M Pérez-Belmonte
- UGC Corazón, Hospital Universitario Virgen de la Victoria, Instituto de Biomedicina de Málaga, CIBERCV Enfermedades Cardiovasculares, Universidad de Málaga, Spain
| | - Ryan J Lennon
- The Department of Cardiovascular Diseases and Department of Health Sciences Research, Mayo Clinic, Rochester, MN
| | - Carlos Diaz-Melean
- The Department of Cardiovascular Diseases and Department of Health Sciences Research, Mayo Clinic, Rochester, MN
| | - J P Rodriguez-Escudero
- The Department of Cardiovascular Diseases and Department of Health Sciences Research, Mayo Clinic, Rochester, MN
| | - Kashish Goel
- The Department of Cardiovascular Diseases and Department of Health Sciences Research, Mayo Clinic, Rochester, MN
| | - Daniel Crusan
- The Department of Cardiovascular Diseases and Department of Health Sciences Research, Mayo Clinic, Rochester, MN
| | - Abhiram Prasad
- The Department of Cardiovascular Diseases and Department of Health Sciences Research, Mayo Clinic, Rochester, MN
| | - Ray W Squires
- The Department of Cardiovascular Diseases and Department of Health Sciences Research, Mayo Clinic, Rochester, MN
| | - Randal J Thomas
- The Department of Cardiovascular Diseases and Department of Health Sciences Research, Mayo Clinic, Rochester, MN
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Graversen CB, Eichhorst R, Ravn L, Christiansen SSR, Johansen MB, Larsen ML. Social inequality and barriers to cardiac rehabilitation in the rehab-North register. SCAND CARDIOVASC J 2017; 51:316-322. [DOI: 10.1080/14017431.2017.1385838] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Christina Boesgaard Graversen
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
- Danish Centre against Inequality in Health (DACUS), Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | - Regina Eichhorst
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | - Lisbeth Ravn
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | | | - Martin Berg Johansen
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
- Unit of Clinical Biostatistics and Bioinformatics, Aalborg University Hospital, Aalborg, Denmark
| | - Mogens Lytken Larsen
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
- Danish Centre against Inequality in Health (DACUS), Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
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CHA2DS2-VASc score and exercise capacity of patients with coronary artery disease participating in cardiac rehabilitation programs. Coron Artery Dis 2017; 28:697-701. [PMID: 28857776 DOI: 10.1097/mca.0000000000000550] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
BACKGROUND Exercise based cardiac rehabilitation improves prognosis and quality of life in patients with coronary artery disease. We aimed to investigate whether the CHA2DS2-VASc score may be a predictor of improvement in exercise capacity in acute coronary syndrome (ACS) patients participating in a cardiac rehabilitation program. METHODS Included were patients following a hospital admission due to ACS and were subsequently referred for an exercise based cardiac rehabilitation during 2010-2015. Participants were divided into three groups of low (1-2), intermediate (3) and high (4≤) CHA2DS2-VASc score. Exercise capacity was evaluated by a treadmill stress test at baseline and following 9 months. The primary endpoint was the percent of patients who achieved at least 25% improvement in exercise capacity. RESULTS The 597 patients included in the study had a mean age of 65.5±9.3 years and consisted of 22.5% women. The primary endpoint of at least 25% improvement in exercise capacity following 9 months of cardiac rehabilitation occurred more frequently in patients in the high CHA2DS2-VASc group compared to the intermediate and low CHA2DS2-VASc score groups (47.3, 29.9 and 36.1% in the high, intermediate and low CHA2DS2-VASc score groups respectively, P=0.002). CONCLUSION The CHA2DS2-VASc score may serve as a predictor of exercise capacity improvement. Its use for tailoring specific cardiac rehabilitation programs for ACS patients may yield further improvement in functional capacity and better utilization of resources.
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Widmer RJ, Allison TG, Lennon R, Lopez-Jimenez F, Lerman LO, Lerman A. Digital health intervention during cardiac rehabilitation: A randomized controlled trial. Am Heart J 2017; 188:65-72. [PMID: 28577682 DOI: 10.1016/j.ahj.2017.02.016] [Citation(s) in RCA: 100] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2016] [Accepted: 02/06/2017] [Indexed: 12/11/2022]
Abstract
BACKGROUND Digital health interventions (DHI) have been shown to improve intermediates of cardiovascular health, but their impact on cardiovascular (CV) outcomes has not been fully explored. The aim of this study was to determine whether DHI administered during cardiac rehabilitation (CR) would reduce CV-related emergency department (ED) visits and rehospitalizations in patients after percutaneous coronary intervention (PCI) for acute coronary syndrome (ACS). METHODS We randomized patients undergoing CR following ACS and PCI to standard CR (n=40) or CR+DHI (n=40) for 3 months with 3 patients withdrawing from CR prior to initiation in the treatment arm and 6 in the control group. The DHI incorporated an online and smartphone-based CR platform asking the patients to report of dietary and exercise habits throughout CR as well as educational information toward patients' healthy lifestyles. We obtained data regarding ED visits and rehospitalizations at 180 days, as well as other metrics of secondary CV prevention at baseline and 90 days. RESULTS Baseline demographics were similar between the groups. The DHI+CR group had improved weight loss compared to the control group (-5.1±6.5 kg vs. -0.8±3.8 kg, respectively, P=.02). Those in the DHI+CR group also showed a non-significant reduction in CV-related rehospitalizations plus ED visits compared to the control group at 180 days (8.1% vs 26.6%; RR 0.30, 95% CI 0.08-1.10, P=.054). CONCLUSIONS The current study demonstrated that complementary DHI significantly improves weight loss, and might offer a method to reduce CV-related ED visits plus rehospitalizations in patients after ACS undergoing CR. The study suggests a role for DHI as an adjunct to CR to improve secondary prevention of CV disease. TRIAL REGISTRATION This trial is registered at clinicaltrials.gov (NCT01883050).
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Affiliation(s)
- R Jay Widmer
- Division of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic and College of Medicine, Rochester, MN 55905, USA
| | - Thomas G Allison
- Division of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic and College of Medicine, Rochester, MN 55905, USA
| | - Ryan Lennon
- Division of Biostatistics, Mayo Clinic and College of Medicine, Rochester, MN 55905, USA
| | - Francisco Lopez-Jimenez
- Division of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic and College of Medicine, Rochester, MN 55905, USA
| | - Lilach O Lerman
- Division of Nephrology and Hypertension, Department of Internal Medicine, Mayo Clinic and College of Medicine, Rochester, MN 55905, USA
| | - Amir Lerman
- Division of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic and College of Medicine, Rochester, MN 55905, USA.
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