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Cui Y, Yao J, Zhang J, Liu Z, Chen T, Zhou Y. Catheter Ablation for Atrial Fibrillation in Patients with Left Ventricular Ejection Fraction ≤ 45%: A Meta-Analysis of Randomized Controlled Trials. Arq Bras Cardiol 2024; 121:e20230214. [PMID: 38422349 PMCID: PMC11098583 DOI: 10.36660/abc.20230214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 08/21/2023] [Accepted: 10/25/2023] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND Atrial fibrillation (AF) and heart failure (HF) frequently coexist, resulting in adverse outcomes. However, controversies remain regarding the efficacy of catheter ablation (CA) in AF patients with severe left ventricular dysfunction. OBJECTIVES The purpose of this study was to perform a meta-analysis of prospective randomized controlled trials to evaluate the efficacy of CA versus medical therapy (MT) in AF patients with left ventricular ejection fraction (LVEF) ≤45%. METHODS We searched the literature for studies that compared CA to MT in AF patients with LVEF ≤45%. A meta-analysis of 7 clinical trials was performed, including 1163 patients with AF and HF. Subgroup analysis was performed based on baseline LVEF. All tests were 2-sided; only the p-value <0.05 was considered statistically significant. RESULTS We found that CA was associated with lower all-cause mortality (risk ratio: 0.52, 95% CI: 0.37 to 0.72; p<0.01) and greater improvements in LVEF (mean difference: 4.80%, 95% CI: 2.29% to 7.31%; p<0.01) compared to MT. Patients in the CA group had a lower risk of HF hospitalization and AF recurrence and a significantly better quality of life than those in the MT group. The results of subgroup analysis indicated that patients with milder left ventricular dysfunction improved LVEF after AF ablation (mean difference: 6.53%, 95% CI: 6.18% to 6.88%; p<0.01) compared to patients with more severe disease (mean difference: 2.02%, 95% CI: 0.87% to 3.16%; p<0.01). CONCLUSIONS Our meta-analysis demonstrated that CA was associated with significant improvements in outcomes of AF patients with LVEF ≤45%. Additionally, AF patients with milder left ventricular dysfunction could benefit more from CA.
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Affiliation(s)
- Yujie Cui
- Medical CenterSoochow UniversitySuzhou Dushu Lake HospitalSuzhouChina Department of Cardiology, Dushu Lake Hospital Affiliated to Soochow University, Medical Center of Soochow University , Suzhou Dushu Lake Hospital , Suzhou – China
| | - Jialu Yao
- Department of CardiologyThe First Affiliated HospitalSoochow UniversitySuzhouChina Department of Cardiology , The First Affiliated Hospital of Soochow University , Suzhou – China
| | - Junyi Zhang
- Medical CenterSoochow UniversitySuzhou Dushu Lake HospitalSuzhouChina Department of Cardiology, Dushu Lake Hospital Affiliated to Soochow University, Medical Center of Soochow University , Suzhou Dushu Lake Hospital , Suzhou – China
| | - Zhenghao Liu
- Medical CenterSoochow UniversitySuzhou Dushu Lake HospitalSuzhouChina Department of Cardiology, Dushu Lake Hospital Affiliated to Soochow University, Medical Center of Soochow University , Suzhou Dushu Lake Hospital , Suzhou – China
| | - Tan Chen
- Medical CenterSoochow UniversitySuzhou Dushu Lake HospitalSuzhouChina Department of Cardiology, Dushu Lake Hospital Affiliated to Soochow University, Medical Center of Soochow University , Suzhou Dushu Lake Hospital , Suzhou – China
| | - Yafeng Zhou
- Medical CenterSoochow UniversitySuzhou Dushu Lake HospitalSuzhouChina Department of Cardiology, Dushu Lake Hospital Affiliated to Soochow University, Medical Center of Soochow University , Suzhou Dushu Lake Hospital , Suzhou – China
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Scrutinio D, Guida P, Passantino A. Prognostic Value of 6-Minute Walk Test in Advanced Heart Failure With Reduced Ejection Fraction. Am J Cardiol 2023; 199:37-43. [PMID: 37245248 DOI: 10.1016/j.amjcard.2023.04.041] [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] [Received: 03/14/2023] [Revised: 04/13/2023] [Accepted: 04/30/2023] [Indexed: 05/30/2023]
Abstract
There is limited evidence regarding the prognostic value of the 6-minute walk test for patients with advanced heart failure (HF). Accordingly, we studied 260 patients presenting to inpatient cardiac rehabilitation (CR) with advanced HF. The primary outcome was 3-year all-cause mortality after discharge from CR. The association between 6-minute walk distance (6MWD) and the primary outcome was determined using the multivariable Cox regression analysis. To avoid collinearity, 6MWD at admission (6MWDadm) to CR and 6MWD at discharge (6MWDdisch) from CR were analyzed separately. At multivariable analysis, 4 baseline characteristics (age, ejection fraction, systolic blood pressure, and blood urea nitrogen) were identified as prognostic of the primary outcome (baseline risk model). After adjusting for the baseline risk model, the hazard ratios of 6MWDadm and 6MWDdisch modeled as per 50-m increase for the primary outcome were 0.92 (95% confidence interval [CI] 0.85 to 0.99, p = 0.035) and 0.93 (95% CI 0.88 to 0.99, p = -017), respectively. After adjusting for the Meta-analysis Global Group in Chronic Heart Failure (MAGGIC) score, the corresponding hazard ratios were 0.91 (95% CI 0.84 to 0.98, p = 0.017) and 0.93 (95% CI 0.88 to 0.99, p = 0.016). The addition of either 6MWDadm or 6MWDdisch to the baseline risk model or the MAGGIC score yielded a statistically significant increase in global chi-square and in the net proportion of survivors reclassified downward. In conclusion, our data suggest that the distance covered during a 6-minute walk test predicts survival and provides incremental prognostic information on the top of well-established prognostic factors and the MAGGIC risk score in advanced HF.
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Affiliation(s)
- Domenico Scrutinio
- Scientific Clinical Institutes Maugeri, Institutes of Care and Research, Institute of Bari, Bari, Italy.
| | - Pietro Guida
- Regional General Hospital "F. Miulli," Acquaviva delle Fonti, Bari, Italy
| | - Andrea Passantino
- Scientific Clinical Institutes Maugeri, Institutes of Care and Research, Institute of Bari, Bari, Italy
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Murata M, Yanai S, Nitta S, Yamashita Y, Shitara T, Kazama H, Ueda M, Kobayashi Y, Namasu Y, Adachi H. Improved Peak Oxygen Uptake Reduces Cardiac Events After 3 Weeks of Inpatient Cardiac Rehabilitation for Chronic Heart Failure Patients. Circ Rep 2023; 5:238-244. [PMID: 37305791 PMCID: PMC10247349 DOI: 10.1253/circrep.cr-23-0040] [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: 04/11/2023] [Accepted: 04/12/2023] [Indexed: 06/13/2023] Open
Abstract
Background: The incidence of heart failure (HF) is increasing, and the mortality from HF remains high in an aging society. Cardiac rehabilitation (CR) programs (CRP) increase oxygen uptake (V̇O2) and reduce HF rehospitalization and mortality. Therefore, CR is recommended for every HF patient. However, the number of outpatients undergoing CR remains low, with insufficient attendance at CRP sessions. In this study we evaluated the outcomes of 3 weeks of inpatient CRP (3w In-CRP) for HF patients. Methods and Results: This study enrolled 93 HF patients after acute-phase hospitalization between 2019 and 2022. Patients participated in 30 sessions of 3w In-CRP (30 min aerobic exercise twice daily, 5 days/week). Before and after 3w In-CRP, patients underwent a cardiopulmonary exercise test, and cardiovascular (CV) events (mortality, HF rehospitalization, myocardial infarction, and cerebrovascular disease) after discharge were evaluated. After 3w In-CPR, mean (±SD) peak V̇O2 increased from 11.8±3.2 to 13.7±4.1 mL/min/kg (116.5±22.1%). During the follow-up period (357±292 days after discharge), 20 patients were rehospitalized for HF, 1 had a stroke, and 8 died for any reasons. Proportional hazard and Kaplan-Meier analyses demonstrated that CV events were reduced among patients with a 6.1% improvement in peak V̇O2 than in patients without any improvement in peak V̇O2. Conclusions: 3w In-CRP for HF patients improved peak V̇O2 and reduced CV events in HF patients with a 6.1% improvement in peak V̇O2.
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Affiliation(s)
- Makoto Murata
- Department of Cardiology, Gunma Prefectural Cardiovascular Center Maebashi Japan
| | - Saya Yanai
- Department of Rehabilitation, Gunma Prefectural Cardiovascular Center Maebashi Japan
| | - Shogo Nitta
- Department of Rehabilitation, Gunma Prefectural Cardiovascular Center Maebashi Japan
| | - Yuhei Yamashita
- Department of Rehabilitation, Gunma Prefectural Cardiovascular Center Maebashi Japan
| | - Tatsunori Shitara
- Department of Rehabilitation, Gunma Prefectural Cardiovascular Center Maebashi Japan
| | - Hiroko Kazama
- Department of Rehabilitation, Gunma Prefectural Cardiovascular Center Maebashi Japan
| | - Masanori Ueda
- Department of Physiological Examination, Gunma Prefectural Cardiovascular Center Maebashi Japan
| | - Yasuyuki Kobayashi
- Department of Physiological Examination, Gunma Prefectural Cardiovascular Center Maebashi Japan
| | - Yoshihisa Namasu
- Department of Rehabilitation, Gunma Prefectural Cardiovascular Center Maebashi Japan
| | - Hitoshi Adachi
- Department of Cardiology, Gunma Prefectural Cardiovascular Center Maebashi Japan
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Sakurai S, Murata M, Yanai S, Nitta S, Yamashita Y, Shitara T, Kazama H, Ueda M, Kobayashi Y, Namasu Y, Adachi H. Three Weeks of Inpatient Cardiac Rehabilitation Improves Metabolic Exercise Data Combined With Cardiac and Kidney Indexes Scores for Heart Failure With Reduced Ejection Fraction. Circ Rep 2023; 5:231-237. [PMID: 37305794 PMCID: PMC10247351 DOI: 10.1253/circrep.cr-23-0016] [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: 04/11/2023] [Accepted: 04/12/2023] [Indexed: 06/13/2023] Open
Abstract
Background: Heart failure with reduced ejection fraction (HFrEF) has a high mortality rate, and cardiac rehabilitation programs (CRP) reduce HFrEF rehospitalization and mortality rates. Some countries attempt 3 weeks of inpatient CRP (3w In-CRP) for cardiac diseases. However, whether 3w In-CRP reduces the prognostic parameter of the Metabolic Exercise data combined with Cardiac and Kidney Indexes (MECKI) score is unknown. Therefore, we investigated whether 3w In-CRP improves MECKI scores in patients with HFrEF. Methods and Results: This study enrolled 53 patients with HFrEF who participated in 30 inpatient CRP sessions, consisting of 30 min of aerobic exercise twice daily, 5 days a week for 3 weeks, between 2019 and 2022. Cardiopulmonary exercise tests and transthoracic echocardiography were performed, and blood samples were collected, before and after 3w In-CRP. MECKI scores and cardiovascular (CV) events (heart failure rehospitalization or death) were evaluated. The MECKI score improved from a median 23.34% (interquartile range [IQR] 10.21-53.14%) before 3w In-CRP to 18.66% (IQR 6.54-39.94%; P<0.01) after 3w In-CRP because of improved left ventricular ejection fraction and percentage peak oxygen uptake. Patients' improved MECKI scores corresponded with reduced CV events. However, patients who experienced CV events did not have improved MECKI scores. Conclusions: In this study, 3w In-CRP improved MECKI scores and reduced CV events for patients with HFrEF. However, patients whose MECKI scores did not improve despite 3w In-CRP require careful heart failure management.
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Affiliation(s)
- Shinichiro Sakurai
- Department of Cardiology, Gunma Prefectural Cardiovascular Center Maebashi Japan
| | - Makoto Murata
- Department of Cardiology, Gunma Prefectural Cardiovascular Center Maebashi Japan
| | - Saya Yanai
- Department of Rehabilitation, Gunma Prefectural Cardiovascular Center Maebashi Japan
| | - Shogo Nitta
- Department of Rehabilitation, Gunma Prefectural Cardiovascular Center Maebashi Japan
| | - Yuhei Yamashita
- Department of Rehabilitation, Gunma Prefectural Cardiovascular Center Maebashi Japan
| | - Tatsunori Shitara
- Department of Rehabilitation, Gunma Prefectural Cardiovascular Center Maebashi Japan
| | - Hiroko Kazama
- Department of Rehabilitation, Gunma Prefectural Cardiovascular Center Maebashi Japan
| | - Masanori Ueda
- Department of Physiological Examination, Gunma Prefectural Cardiovascular Center Maebashi Japan
| | - Yasuyuki Kobayashi
- Department of Physiological Examination, Gunma Prefectural Cardiovascular Center Maebashi Japan
| | - Yoshihisa Namasu
- Department of Rehabilitation, Gunma Prefectural Cardiovascular Center Maebashi Japan
| | - Hitoshi Adachi
- Department of Cardiology, Gunma Prefectural Cardiovascular Center Maebashi Japan
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Scrutinio D, Guida P, La Rovere MT, Bussotti M, Corrà U, Forni G, Raimondo R, Scalvini S, Passantino A. Functional outcome after cardiac rehabilitation and its association with survival in heart failure across the spectrum of ejection fraction. Eur J Intern Med 2023; 110:86-92. [PMID: 36759307 DOI: 10.1016/j.ejim.2023.02.002] [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: 11/23/2022] [Revised: 01/31/2023] [Accepted: 02/02/2023] [Indexed: 02/10/2023]
Abstract
BACKGROUND There is limited evidence regarding the effects of cardiac rehabilitation (CR) in patients with heart failure and preserved ejection fraction (HFpEF). METHODS We studied 1784 patients admitted to inpatient CR. The patients were grouped into HFpEF (EF≥0.50), HF with mildly reduced EF (HFmrEF; EF 41-49), and HF with reduced EF (HFrEF; EF≤0.40). A standardized 6-min walking test was performed at admission and discharge. Measures of functional outcome were: (1) absolute increase in 6-min walking distance (6MWD) from admission to discharge >50 m and (2) increase in 6MWD to ≥300 among the patients who walked <300 m at admission. RESULTS After adjustment, the patients with HFpEF or HFmrEF were as likely as those with HFrEF to achieve an increase in 6MWD >50 m (odds ratio 0.95 [95%CI 0.71-1.24; p=0.648] and 1.04 [95%CI 0.77-1.41; p=0.769], respectively) or an increase in 6MWD to ≥300 m (odds ratio 0.79 [95%CI 0.51-1.23; p=0.299] and 0.65 [95%CI 0.38-1.12; p=0.118], respectively). The adjusted hazard ratio of 5-year mortality for patients who achieved an increase in 6MWD >50 m was 0.60 (95%CI 0.51-0.71; p<0.001) and that for patients who achieved an increase in 6MWD at discharge to ≥300 m 0.61 (95%CI 0.48-0.79; p<0.001). In each EF group, both outcomes remained independently associated with improved survival. CONCLUSIONS Our data suggest that patients with HFpEF or HFmrEF are as likely as those with HFrEF to benefit from CR in terms of functional improvement. Functional improvement was independently associated with improved long-term survival, regardless of EF.
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Affiliation(s)
- Domenico Scrutinio
- Istituti Clinici Scientifici Maugeri SpA SB, IRCCS, Institute of Bari, Via Generale Nicola Bellomo 73/75, Bari, Italy.
| | - Pietro Guida
- Istituti Clinici Scientifici Maugeri SpA SB, IRCCS, Institute of Bari, Via Generale Nicola Bellomo 73/75, Bari, Italy
| | - Maria Teresa La Rovere
- Istituti Clinici Scientifici Maugeri SpA SB, IRCCS, Institute of Montescano, Pavia, Italy
| | - Maurizio Bussotti
- Istituti Clinici Scientifici Maugeri SpA SB, IRCCS, Institute of Milano, Milano, Italy
| | - Ugo Corrà
- Istituti Clinici Scientifici Maugeri SpA SB, IRCCS, Institute of Veruno, Novara, Italy
| | - Giovanni Forni
- Istituti Clinici Scientifici Maugeri SpA SB, IRCCS, Institute of Pavia, Pavia, Italy
| | - Rosa Raimondo
- Istituti Clinici Scientifici Maugeri SpA SB, IRCCS, Institute of Tradate, Varese, Italy
| | - Simonetta Scalvini
- Istituti Clinici Scientifici Maugeri SpA SB, IRCCS, Institute of Lumezzane, Brescia, Italy
| | - Andrea Passantino
- Istituti Clinici Scientifici Maugeri SpA SB, IRCCS, Institute of Bari, Via Generale Nicola Bellomo 73/75, Bari, Italy
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Younes H, Noujaim C, Mekhael M, Chouman N, Assaf A, Kreidieh O, Lim C, Marrouche N, Donnellan E. Atrial fibrillation ablation as first-line therapy for patients with heart failure with reduced ejection fraction (HFrEF): evaluating the impact on patient survival. Expert Rev Cardiovasc Ther 2023; 21:111-121. [PMID: 36680789 DOI: 10.1080/14779072.2023.2172402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
INTRODUCTION Atrial fibrillation and congestive heart failure share several pathophysiological mechanisms. As a result of their association, patients have worse outcomes than if either condition were present alone. AREAS COVERED While multiple trials report no significant difference between the use of pharmacological rhythm control and the use of rate control in terms of mortality and morbidity in patients with HFrEF, there is evidence to suggest that catheter ablation is beneficial in this patient population. The present review aims to provide a comprehensive overview of catheter ablation as a treatment modality for atrial fibrillation in patients with HFrEF as well as evaluate its outcome on survival. EXPERT OPINION An appropriate patient selection strategy for patients with HFrEF could be the next step in determining which patients might benefit most from catheter ablation. Future atrial fibrillation management may incorporate digital health and pulsed-field ablation.
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Affiliation(s)
- Hadi Younes
- Tulane Research and Innovation for Arrhythmia Discoveries- TRIAD Center, Tulane University School of Medicine, New Orleans, LA, USA
| | - Charbel Noujaim
- Tulane Research and Innovation for Arrhythmia Discoveries- TRIAD Center, Tulane University School of Medicine, New Orleans, LA, USA
| | - Mario Mekhael
- Tulane Research and Innovation for Arrhythmia Discoveries- TRIAD Center, Tulane University School of Medicine, New Orleans, LA, USA
| | - Nour Chouman
- Tulane Research and Innovation for Arrhythmia Discoveries- TRIAD Center, Tulane University School of Medicine, New Orleans, LA, USA
| | - Ala Assaf
- Tulane Research and Innovation for Arrhythmia Discoveries- TRIAD Center, Tulane University School of Medicine, New Orleans, LA, USA
| | - Omar Kreidieh
- Tulane Research and Innovation for Arrhythmia Discoveries- TRIAD Center, Tulane University School of Medicine, New Orleans, LA, USA
| | - Chanho Lim
- Tulane Research and Innovation for Arrhythmia Discoveries- TRIAD Center, Tulane University School of Medicine, New Orleans, LA, USA
| | - Nassir Marrouche
- Tulane Research and Innovation for Arrhythmia Discoveries- TRIAD Center, Tulane University School of Medicine, New Orleans, LA, USA
| | - Eoin Donnellan
- Tulane Research and Innovation for Arrhythmia Discoveries- TRIAD Center, Tulane University School of Medicine, New Orleans, LA, USA
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Yu S, Qian H, Tian D, Yang M, Li D, Xu H, Chen J, Yang J, Hao X, Liu Z, Zhong J, Yang H, Chen X, Min X, Chen J. Linggui Zhugan Decoction activates the SIRT1-AMPK-PGC1α signaling pathway to improve mitochondrial and oxidative damage in rats with chronic heart failure caused by myocardial infarction. Front Pharmacol 2023; 14:1074837. [PMID: 37089931 PMCID: PMC10113531 DOI: 10.3389/fphar.2023.1074837] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 03/27/2023] [Indexed: 04/25/2023] Open
Abstract
Objective: To investigate the effects of Linggui Zhugan Decoction on mitochondrial and oxidative damage in rats with chronic heart failure after myocardial infarction and the related mechanisms. Methods: Chronic heart failure after myocardial infarction was established by coronary artery ligation. Heart failure rats were randomly divided into three groups: Model group (n = 11), Linggui Zhugan Decoction group (n = 12), and captopril group (n = 11). Rats whose coronary arteries were only threaded and not ligated were sham group (n = 11). Cardiac function, superoxide dismutase (SOD), malondialdehyde (MDA) contents, soluble growth-stimulating expression factor (ST2), and N-terminal B-type brain natriuretic peptide precursor (NTproBNP) levels were analyzed after treatment. Moreover, the level of mitochondrial membrane potential was detected by JC-1 staining, the ultrastructural of myocardial mitochondria were observed by transmission electron microscopy. The related signal pathway of silent information regulator factor 2-related enzyme 1 (SIRT1), adenylate activated protein kinase (AMPK), phosphorylated adenylate activated protein kinase (p-AMPK), and peroxisome proliferator-activated receptor γ coactivator 1α (PGC-1α) is an important pathway to regulate mitochondrial energy metabolism, and to initiate mitochondrial biogenesis. The expression level was detected by Western blot and reverse transcription to explore the mechanism of the decoction. Results: Compared with the model rats, Linggui Zhugan Decoction significantly improved cardiac function (p < 0.05), reduced MDA production (p < 0.01), increased SOD activity (p < 0.05), reduced ST-2(p < 0.01), and NT-proBNP(p < 0.05) levels, increased mitochondrial membrane potential, and improved mitochondria function. In addition, Linggui Zhugan Decoction upregulated the expression of SIRT1, p-AMPK, PGC-1α protein, and mRNA in cardiac myocytes. Conclusion: Linggui Zhugan Decoction can improve the cardiac function of heart failure rats by enhancing myocardial antioxidant capacity and protecting the mitochondrial function, the mechanism is related to activating SIRT1/AMPK/PGC-1α signaling pathway.
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Affiliation(s)
- Siyi Yu
- Sinopharm Dongfeng General Hospital (Hubei Clinical Research Center of Hypertension), Hubei University of Medicine, Shiyan, Hubei, China
- Jiujiang No. 1 People’s Hospital, Affiliated Jiujiang Hospital of Nanchang University, Jiujiang, Jiangxi, China
| | - Hang Qian
- Sinopharm Dongfeng General Hospital (Hubei Clinical Research Center of Hypertension), Hubei University of Medicine, Shiyan, Hubei, China
| | - Dawei Tian
- Sinopharm Dongfeng General Hospital (Hubei Clinical Research Center of Hypertension), Hubei University of Medicine, Shiyan, Hubei, China
| | - Mingming Yang
- Sinopharm Dongfeng General Hospital (Hubei Clinical Research Center of Hypertension), Hubei University of Medicine, Shiyan, Hubei, China
| | - Dongfeng Li
- Sinopharm Dongfeng General Hospital (Hubei Clinical Research Center of Hypertension), Hubei University of Medicine, Shiyan, Hubei, China
| | - Hao Xu
- Sinopharm Dongfeng General Hospital (Hubei Clinical Research Center of Hypertension), Hubei University of Medicine, Shiyan, Hubei, China
| | - Jishun Chen
- Sinopharm Dongfeng General Hospital (Hubei Clinical Research Center of Hypertension), Hubei University of Medicine, Shiyan, Hubei, China
| | - Jingning Yang
- Department of Immunology, School of Basic Medicine, Hubei University of Medicine, Shiyan, Hubei, China
| | - Xincai Hao
- Hubei Key Laboratory of Wudang Local Chinese Medicine Research (Hubei University of Medicine), Shiyan, Hubei, China
| | - Zhixin Liu
- Institute of Virology, Hubei University of Medicine, Shiyan, Hubei, China
| | - Jixin Zhong
- Department of Rheumatology and Immunology, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Handong Yang
- Sinopharm Dongfeng General Hospital (Hubei Clinical Research Center of Hypertension), Hubei University of Medicine, Shiyan, Hubei, China
| | - Xinlong Chen
- Yunxi Hospital of Chinese Medicine, Shiyan, Hubei, China
- *Correspondence: Xinlong Chen, ; Xinwen Min, ; Jun Chen,
| | - Xinwen Min
- Sinopharm Dongfeng General Hospital (Hubei Clinical Research Center of Hypertension), Hubei University of Medicine, Shiyan, Hubei, China
- *Correspondence: Xinlong Chen, ; Xinwen Min, ; Jun Chen,
| | - Jun Chen
- Sinopharm Dongfeng General Hospital (Hubei Clinical Research Center of Hypertension), Hubei University of Medicine, Shiyan, Hubei, China
- Department of Immunology, School of Basic Medicine, Hubei University of Medicine, Shiyan, Hubei, China
- Hubei Key Laboratory of Wudang Local Chinese Medicine Research (Hubei University of Medicine), Shiyan, Hubei, China
- Institute of Virology, Hubei University of Medicine, Shiyan, Hubei, China
- *Correspondence: Xinlong Chen, ; Xinwen Min, ; Jun Chen,
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Clark HI, Pearson MJ, Smart NA. Rate adaptive pacing in people with chronic heart failure increases peak heart rate but not peak exercise capacity: a systematic review. Heart Fail Rev 2023; 28:21-34. [PMID: 35138522 PMCID: PMC9902309 DOI: 10.1007/s10741-022-10217-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/24/2022] [Indexed: 02/07/2023]
Abstract
Rate adaptive cardiac pacing (RAP) allows increased heart rate (HR) in response to metabolic demand in people with implantable electronic cardiac devices (IECD). The aim of this work was to conduct a systematic review to determine if RAP increases peak exercise capacity (peak VO2) in line with peak HR in people with chronic heart failure. We conducted a systematic literature search from 1980, when IECD and RAP were first introduced, until 31 July 2021. Databases searched include PubMed, Medline, EMBASE, EBSCO, and the Clinical Trials Register. A comprehensive search of the literature produced a total of 246 possible studies; of these, 14 studies were included. Studies and subsequent analyses were segregated according to comparison, specifically standard RAP (RAPON) vs fixed rate pacing (RAPOFF), and tailored RAP (TLD RAPON) vs standard RAP (RAPON). Pooled analyses were conducted for peak VO2 and peak HR for RAPON vs RAPOFF. Peak HR significantly increased by 15 bpm with RAPON compared to RAPOFF (95%CI, 7.98-21.97, P < 0.0001). There was no significant difference between pacing mode for peak VO2 0.45 ml kg-1 min-1 (95%CI, - 0.55-1.47, P = 0.38). This systematic review revealed RAP increased peak HR in people with CHF; however, there was no concomitant improvement in peak VO2. Rather RAP may provide benefits at submaximal intensities by controlling the rise in HR to optimise cardiac output at lower workloads. HR may be an important outcome of CHF management, reflecting myocardial efficiency.
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Affiliation(s)
- H. I. Clark
- grid.1020.30000 0004 1936 7371School of Science & Technology, Exercise & Sports Science, University of New England, Armidale, NSW Australia
| | - M. J. Pearson
- grid.1020.30000 0004 1936 7371School of Science & Technology, Exercise & Sports Science, University of New England, Armidale, NSW Australia
| | - N. A. Smart
- grid.1020.30000 0004 1936 7371School of Science & Technology, Exercise & Sports Science, University of New England, Armidale, NSW Australia
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9
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Chang TY, Chao TF, Lin CY, Lin YJ, Chang SL, Lo LW, Hu YF, Chung FP, Chen SA. Catheter ablation of atrial fibrillation in heart failure with impaired systolic function: An updated meta-analysis of randomized controlled trials. J Chin Med Assoc 2023; 86:11-18. [PMID: 36227015 DOI: 10.1097/jcma.0000000000000823] [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: 01/28/2023] Open
Abstract
BACKGROUND The recent Atrial Fibrillation Management in Congestive Heart Failure With Ablation trial did not reveal any benefit of catheter ablation in patients with atrial fibrillation (AF), advanced heart failure (HF), and severely reduced left ventricular ejection fraction (LVEF). We hypothesized that radiofrequency catheter ablation (RFCA) could improve outcomes in HF patients with AF and impaired left ventricular systolic function (LVEF <50%) as compared with only medical therapy. METHODS We searched the literature for randomized clinical trials (RCTs) that compared RFCA to medical therapy in this population. RESULTS Compared with the medical therapy group, the RFCA group had significantly less all-cause mortality, HF hospitalization, and AF recurrence rates. The RFCA group had significantly higher peak oxygen consumption (VO 2max ), a better quality of life (Minnesota Living with Heart Failure Questionnaire score), and improved LVEF. However, RFCA for AF failed to reduce all-cause mortality in a specific meta-analysis of four RCTs that enrolled patients with LVEF ≤35%. CONCLUSION Compared with medical therapy, RFCA for AF in the setting of HF with impaired systolic function is associated with better clinical (HF hospitalization and all-cause mortality), structural (LVEF improvement), functional (VO 2max ), and quality of life outcomes. However, RFCA for AF failed to reduce all-cause mortality in RCTs that enrolled patients with LVEF ≤35% and thereby indicated the necessary stratification to identify patients who may benefit more from RFCA.
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Affiliation(s)
- Ting-Yung Chang
- Division of Cardiology, Department of Medicine, Heart Rhythm Center, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Division of Cardiology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Institute of Clinical Medicine, and Institute of Cardiovascular Research, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- National Taipei University of Nursing and Health Sciences, Taipei, Taiwan, ROC
| | - Tze-Fan Chao
- Division of Cardiology, Department of Medicine, Heart Rhythm Center, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Division of Cardiology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Institute of Clinical Medicine, and Institute of Cardiovascular Research, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Chin-Yu Lin
- Division of Cardiology, Department of Medicine, Heart Rhythm Center, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Division of Cardiology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Institute of Clinical Medicine, and Institute of Cardiovascular Research, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Yenn-Jiang Lin
- Division of Cardiology, Department of Medicine, Heart Rhythm Center, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Division of Cardiology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Institute of Clinical Medicine, and Institute of Cardiovascular Research, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Shih-Lin Chang
- Division of Cardiology, Department of Medicine, Heart Rhythm Center, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Division of Cardiology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Institute of Clinical Medicine, and Institute of Cardiovascular Research, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Li-Wei Lo
- Division of Cardiology, Department of Medicine, Heart Rhythm Center, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Division of Cardiology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Institute of Clinical Medicine, and Institute of Cardiovascular Research, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Yu-Feng Hu
- Division of Cardiology, Department of Medicine, Heart Rhythm Center, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Division of Cardiology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Institute of Clinical Medicine, and Institute of Cardiovascular Research, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Fa-Po Chung
- Division of Cardiology, Department of Medicine, Heart Rhythm Center, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Division of Cardiology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Institute of Clinical Medicine, and Institute of Cardiovascular Research, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Shih-Ann Chen
- Division of Cardiology, Department of Medicine, Heart Rhythm Center, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Division of Cardiology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Institute of Clinical Medicine, and Institute of Cardiovascular Research, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Cardiovascular Center, Taichung Veterans General Hospital, Taichung, Taiwan, ROC
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10
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Hanna M, Fine NM, Gundapaneni B, Sultan MB, Witteles RM. Improvements in Efficacy Measures With Tafamidis in the Tafamidis in Transthyretin Cardiomyopathy Clinical Trial. JACC. ADVANCES 2022; 1:100148. [PMID: 38939456 PMCID: PMC11198604 DOI: 10.1016/j.jacadv.2022.100148] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 09/16/2022] [Accepted: 10/04/2022] [Indexed: 06/29/2024]
Abstract
Background Transthyretin amyloid cardiomyopathy (ATTR-CM) is a fatal disease. Tafamidis was approved to treat patients with ATTR-CM based on findings from the ATTR-ACT (Tafamidis in Transthyretin Cardiomyopathy Clinical Trial). Objectives This post hoc analysis examined the proportion of patients who experienced improved efficacy measures through 30 months of treatment with tafamidis or placebo in ATTR-ACT. Methods Patients with ATTR-CM were randomized to tafamidis (80 mg or 20 mg) or placebo. Change from baseline in 6-minute walk test distance, Kansas City Cardiomyopathy Questionnaire Overall Summary score, N-terminal pro-B-type natriuretic peptide concentration, patient global assessment of overall health, and New York Heart Association functional class were assessed at regular time points. The proportion of patients with improvement was summarized for each time point with odds ratio. Missing data were imputed as deterioration. Results Higher proportions of tafamidis-treated patients (n = 264) than placebo-treated patients (n = 177) showed improvement in all assessments. The odds ratio for improvement favored tafamidis for all measures and at all time points. It was significant (P < 0.001) at month 30 for 6-minute walk test distance (4.9; 95% CI: 2.28-10.69), Kansas City Cardiomyopathy Questionnaire Overall Summary score (3.3; 95% CI: 1.85-5.78), N-terminal pro-B-type natriuretic peptide concentration (5.3; 95% CI: 2.66-10.73), and patient global assessment of overall health (2.9; 95% CI: 1.69-4.95). Conclusions This analysis found that higher proportions of patients treated with tafamidis experienced improvement from baseline in measures of heart failure, functional capacity, and health-related quality of life than those treated with placebo during ATTR-ACT. These data provide further evidence of the clinical benefits of tafamidis in patients with ATTR-CM. (Safety and Efficacy of Tafamidis in Patients With Transthyretin Cardiomyopathy [ATTR-ACT]; NCT01994889).
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11
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Judge DP, Lakdawala NK, Taylor MRG, Mestroni L, Li H, Oliver C, Angeli FS, Lee PA, MacRae CA. Long-Term Efficacy and Safety of ARRY-371797 (PF-07265803) in Patients With Lamin A/C-Related Dilated Cardiomyopathy. Am J Cardiol 2022; 183:93-98. [PMID: 36114020 DOI: 10.1016/j.amjcard.2022.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 07/28/2022] [Accepted: 08/06/2022] [Indexed: 11/01/2022]
Abstract
Dilated cardiomyopathy associated with lamin A/C (LMNA) gene variants (LMNA-related dilated cardiomyopathy [DCM]) is a life-threatening condition with a high unmet need, accounting for approximately 6% of idiopathic DCM cases. Currently, no disease-specific treatments target the underlying disease mechanism. ARRY-371797 (PF-07265803), a potent, selective, oral, small-molecule inhibitor of the p38α mitogen-activated protein kinase pathway, improved 6-minute walk test (6MWT) distance in 12 patients with symptomatic LMNA-related DCM in a 48-week, open-label, phase 2 study. This long-term extension study examined the safety and efficacy of ARRY-371797 in patients from the phase 2 study. 6MWT, N-terminal pro-B-type natriuretic peptide concentration, and 12-item Kansas City Cardiomyopathy Questionnaire score were assessed at weeks 48, 72, 96, 120, and 144 from phase 2 study baseline. Eight patients enrolled (mean [SD] age, 51 [10] years, 4 male). Mean 6MWT increased by >30 m (>10%) from phase 2 study baseline up to week 120. The decrease in N-terminal pro-B-type natriuretic peptide observed in the phase 2 study was maintained throughout the present study. Twelve-item Kansas City Cardiomyopathy Questionnaire Physical Limitation increased from baseline at all visits except week 96 (range: -0.8 [week 96] to 13.8 [week 120]); results for other domains were variable. Treatment was generally well tolerated; 2 patients discontinued because of causes not considered treatment-related. There were no deaths. ARRY-371797 was generally well tolerated over median (range) 155.7 (61 to 327)-week exposure; evidence suggested preserved exercise capacity over the study period. The ongoing, pivotal, phase 3, randomized, placebo-controlled study REALM-DCM investigates the efficacy and safety of ARRY-371797 (PF-07265803) in LMNA-related DCM. (ClinicalTrials.gov Identifier: NCT02351856).
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Affiliation(s)
- Daniel Philip Judge
- Cardiovascular Genetics, Medical University of South Carolina, Charleston, South Carolina.
| | - Neal Kush Lakdawala
- Cardiovascular Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | | | - Luisa Mestroni
- Department of Medicine, Adult Medical Genetics Program, University of Colorado, Aurora, Colorado
| | - Huihua Li
- Pfizer Inc., Collegeville, Pennsylvania
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12
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Frundi DS, Kettig E, Popp LL, Hoffman M, Dumartin M, Hughes M, Lamy E, Fru YJW, Bano A, Muka T, Wilhelm M. Physical performance and glycemic control under SGLT-2-inhibitors in patients with type 2 diabetes and established atherosclerotic cardiovascular diseases or high cardiovascular risk (PUSH): Design of a 4-week prospective observational study. Front Cardiovasc Med 2022; 9:907385. [PMID: 35935634 PMCID: PMC9354468 DOI: 10.3389/fcvm.2022.907385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 06/24/2022] [Indexed: 11/30/2022] Open
Abstract
Background Type 2 diabetes (T2D) is associated with limitation in physical performance. Results from animal studies report enhancement of physical performance in T2D rodents treated with sodium glucose cotransporter 2 inhibitors (SGLT2is). However, in human patients with T2D and established atherosclerotic cardiovascular disease (ASCVD) or high cardiovascular risk, the impact of guideline directed SGLT2i medication on physical performance has not been sufficiently examined. Objectives The main objectives of this study are thus firstly, to assess the changes in physical performance after 4 weeks of exercise therapy in patients with established ASCVD or high cardiovascular risk categorized into three groups according to their glycemic control at baseline. Secondly, to investigate the association of glycemic control at baseline and new guideline directed antidiabetic treatment (inadequate glycemic control and diabetes + new SGLT2i vs. adequate glycemic control and diabetes vs. no diabetes) with change in physical performance. Methods and design This is a 4-week prospective observational study of 450 participants with established ASCVD or high cardiovascular risk with or without T2D and without previous SGLT2i medication undergoing exercise therapy during inpatient rehabilitation in a single center in Switzerland. Upon admission, participants are categorized into 3 groups of 150 participants each according to their glycemic control. Group I consisting of participants with inadequately controlled T2D defined as mean fasting plasma glucose (FPG) of ≥7 mmol/L, who are consequently administered new treatment with an SGLT2i. Group II comprises of participants with adequately controlled T2D with mean FPG of <7 mmol/L requiring no antidiabetic medication change. Group III consists of participants with no diabetes and mean FPG of ≤ 5.5 mmol/L. Primary outcomes are 6-min walk distance and rate of perceived exertion. Secondary outcomes are echocardiographic parameters (left ventricular mass index; global longitudinal strain average; end-diastolic volume), fatigue, muscle, metabolic, and anthropometric measures. Ethics and dissemination This study is conducted in accordance with the Declaration of Helsinki with ethical approval from the Cantonal Ethical Commission of Bern, Switzerland. The results will be published in a peer-reviewed journal. The implementation and reporting will be according to the SPIRIT guidelines. Study protocol registration https://www.clinicaltrials.gov/, identifier: NCT03422263.
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Affiliation(s)
- Devine S. Frundi
- Berner Klinik Montana, Zentrum für Medizinische und Neurologische Rehabilitation, Crans-Montana, Switzerland
- Permanence Médicale, Hôpital de Sierre, Sierre, Switzerland
- *Correspondence: Devine S. Frundi
| | - Eva Kettig
- Berner Klinik Montana, Zentrum für Medizinische und Neurologische Rehabilitation, Crans-Montana, Switzerland
| | - Lena Luise Popp
- Berner Klinik Montana, Zentrum für Medizinische und Neurologische Rehabilitation, Crans-Montana, Switzerland
| | - Melanie Hoffman
- Berner Klinik Montana, Zentrum für Medizinische und Neurologische Rehabilitation, Crans-Montana, Switzerland
| | - Marine Dumartin
- Berner Klinik Montana, Zentrum für Medizinische und Neurologische Rehabilitation, Crans-Montana, Switzerland
| | - Magali Hughes
- Berner Klinik Montana, Zentrum für Medizinische und Neurologische Rehabilitation, Crans-Montana, Switzerland
| | - Edgar Lamy
- Berner Klinik Montana, Zentrum für Medizinische und Neurologische Rehabilitation, Crans-Montana, Switzerland
| | | | - Arjola Bano
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland
- Center for Preventive Cardiology, University Hospital Bern and University of Bern, Bern, Switzerland
| | - Taulant Muka
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland
| | - Matthias Wilhelm
- Center for Preventive Cardiology, University Hospital Bern and University of Bern, Bern, Switzerland
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13
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Tsai WJ, Wen YK, Cheng YY, Huang JL, Chen YW. Effectiveness of home-based telerehabilitation programs on functional capacity and cardiac function in elderly heart failure patients: A prospective longitudinal study. Medicine (Baltimore) 2022; 101:e29799. [PMID: 35838996 PMCID: PMC11132345 DOI: 10.1097/md.0000000000029799] [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: 07/26/2021] [Accepted: 05/26/2022] [Indexed: 11/26/2022] Open
Abstract
Decreased functional capacity and reduced cardiac function were the main symptoms in patients with heart failure (HF) and the incidence increases with advanced age. The guidelines recommend that exercise training should be considered for medically stable HF outpatients. Studies have confirmed that exercise can improve functional capacity, prognosis, and reduced hospitalization rates; however, very few studies have investigated the elderly. It is not clear whether exercise could be feasible in elderly HF. The aim of this study was to evaluate the effect of the 6-month heart failure post-acute care program focused on home-based cardiac telerehabilitation (HCTR) on functional capacity, cardiac function, and readmission rates in HF patients. A prospective longitudinal study was conducted. Study duration was from January 2018 to December 2019. HF patients with a left ventricular ejection fraction <40% and age ≧65 years were included and divided into intervention (n = 40) and control group (n = 41). We arranged a 6-month heart failure post-acute care program that included outpatient cardiac rehabilitation and home exercise for the intervention group. The response to home exercise was followed by telemonitor. The exercise parameters were recorded on the HF health management mobile application system platform by each patient and daily transmission to hospital's cloud database as HCTR, usual care program for the control group. Information such as general data, laboratory data, six-minute walk test, cardiac function, and admission record was collected from all patients. Eighty one patients between the ages of 65 and 92 completed the study. The mean age was 73.3 ± 5.0 and 75.6 ± 6.0 years in control and intervention group, respectively. The intervention group showed a statistically significant improvement in functional capacity, percentage change in the of six-minute walk distance (51.2% vs 17.7%, P < .05, 95% confidence interval -45.9 to -6.3). Left ventricular ejection fraction increased by 7.7%, which corresponds to 25.6% in relative terms (P < .05, 95% confidence interval -7.8 to -0.5). The readmission rate was 4.6% in the intervention group. Six months of post-acute HF focused on HCTR programs was safe, improved functional capacity, cardiac function, and decreased readmission rate in elderly patients with HF patients.
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Affiliation(s)
- Wei-Jung Tsai
- Department of Physical Medicine and Rehabilitation, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Yan-Kai Wen
- Department of Physical Medicine and Rehabilitation, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Yuan-Yang Cheng
- Department of Physical Medicine and Rehabilitation, Taichung Veterans General Hospital, Taichung, Taiwan
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Jin-Long Huang
- Cardiovascular Center, Taichung Veterans General Hospital, Taichung, Taiwan
- Institute of Clinical Medicine, and Cardiovascular Research Institute, Department of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Yan-Wen Chen
- Department of Physical Medicine and Rehabilitation, Taichung Veterans General Hospital, Taichung, Taiwan
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14
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Aida K, Kamiya K, Hamazaki N, Nozaki K, Ichikawa T, Nakamura T, Yamashita M, Uchida S, Maekawa E, Reed JL, Yamaoka-Tojo M, Matsunaga A, Ako J. Optimal cutoff values for physical function tests in elderly patients with heart failure. Sci Rep 2022; 12:6920. [PMID: 35484373 PMCID: PMC9051131 DOI: 10.1038/s41598-022-10622-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Accepted: 04/11/2022] [Indexed: 11/09/2022] Open
Abstract
Six-minute walk distance (6MWD) of 300 and 400 m are important targets of functional capacity. The present study was performed to determine cutoff values of physical function associated with 6MWD < 300 m and < 400 m in elderly patients with heart failure (HF). 6MWD, handgrip strength, quadriceps isometric strength (QIS), one-leg standing time (OLST), and 5-times sit-to-stand (5STS) before hospital discharge were evaluated in 1001 patients > 65 years (median age, 75: interquartile range, 71-80, 607 men) with HF. 6MWD < 300 and < 400 m were seen in 323 patients (32.3%) and 658 patients (65.7%), respectively. Handgrip strength, QIS, OLST, and 5STS were associated with 6MWD < 300 and < 400 m, respectively (P < 0.001). The cutoff values of handgrip strength, QIS, OLST, and 5STS were 18.9 kg, 35.0% body mass (BM), 9.1 s, and 9.5 s for 6MWD < 300 m, and 21.9 kg, 40.0% BM, 12.0 s, and 8.8 s for < 400 m, respectively. The cutoff values of physical function could be used to set cardiac rehabilitation goals and limiting determinants of reduced functional capacity in a clinical setting in elderly patients with HF.
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Affiliation(s)
- Keita Aida
- Department of Rehabilitation Sciences, Kitasato University Graduate School of Medical Sciences, Sagamihara, Japan.,Department of Physical Medicine and Rehabilitation, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Kentaro Kamiya
- Department of Rehabilitation, Kitasato University School of Allied Health Sciences, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa, 252-0375, Japan.
| | - Nobuaki Hamazaki
- Department of Rehabilitation, Kitasato University Hospital, Sagamihara, Japan
| | - Kohei Nozaki
- Department of Rehabilitation, Kitasato University Hospital, Sagamihara, Japan
| | - Takafumi Ichikawa
- Department of Rehabilitation, Kitasato University Hospital, Sagamihara, Japan
| | - Takeshi Nakamura
- Department of Rehabilitation Sciences, Kitasato University Graduate School of Medical Sciences, Sagamihara, Japan
| | - Masashi Yamashita
- Department of Rehabilitation Sciences, Kitasato University Graduate School of Medical Sciences, Sagamihara, Japan
| | - Shota Uchida
- Department of Rehabilitation Sciences, Kitasato University Graduate School of Medical Sciences, Sagamihara, Japan
| | - Emi Maekawa
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, Sagamihara, Japan
| | - Jennifer L Reed
- Exercise Physiology and Cardiovascular Health Lab, Division of Cardiac Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, Canada.,Faculty of Medicine, University of Ottawa, Ottawa, Canada.,Faculty of Health Sciences, School of Human Kinetics, University of Ottawa, Ottawa, Canada
| | - Minako Yamaoka-Tojo
- Department of Rehabilitation, Kitasato University School of Allied Health Sciences, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa, 252-0375, Japan
| | - Atsuhiko Matsunaga
- Department of Rehabilitation Sciences, Kitasato University Graduate School of Medical Sciences, Sagamihara, Japan.,Department of Rehabilitation, Kitasato University School of Allied Health Sciences, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa, 252-0375, Japan
| | - Junya Ako
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, Sagamihara, Japan
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15
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Delgado B, Novo A, Lopes I, Rebelo C, Almeida C, Pestana S, Gomes B, Froelicher E, Klompstra L. The effects of early rehabilitation on functional exercise tolerance in decompensated heart failure patients: Results of a multicenter randomized controlled trial (ERIC-HF study). Clin Rehabil 2022; 36:813-821. [PMID: 35313751 PMCID: PMC9082976 DOI: 10.1177/02692155221088684] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective To analyze (1) the effect of an aerobic training program on functional exercise tolerance in decompensated heart failure (DHF) patients; (2) to assess the effects of an aerobic training program on functional independence; and (3) dyspnea during activities of daily living. Design A randomized controlled clinical trial with follow-up at discharge. Settings Eight hospitals. Recruitment took place between 9/ 2017 and 3/2019. Group Assignments Patients with DHF who were admitted to the hospital, were randomly assigned to usual rehabilitation care guideline recommended (control group) or aerobic training program (exercise group). Main outcome Functional exercise tolerance was measured with a 6-min walking test at discharge. Results In total 257 patients with DHF were included, with a mean age of 67 ± 11 years, 84% (n = 205) had a reduced ejection fraction and the hospital stay was 16 ± 10 days. At discharge, patients in the intervention group walked further compared to the control group (278 ± 117m vs 219 ± 115m, p < 0.01) and this difference stayed significant after correcting for confounders (p < 0.01). A significant difference was found favoring the exercise group in functional independence (96 ± 7 vs 93 ± 12, p = 0.02) and dyspnea associated to ADL (13 ± 5 vs 17 ± 7, p < 0.01) and these differences persisted after correcting for baseline values and confounders (functional independence p < 0.01; dyspnea associated with ADL p = 0.02). Conclusion The ERIC-HF program is safe, feasible, and effective in increasing functional exercise tolerance and functional independence in hospitalized patients admitted due to DHF.
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Affiliation(s)
- Bruno Delgado
- Centro Hospitalar Universitário do Porto, Instituto de Ciências Biomédicas Abel Salazar
| | - André Novo
- 386399Instituto Politécnico de Bragança, CINTESIS:NursID, Portugal
| | - Ivo Lopes
- Centro Hospitalar Universitário do Porto
| | | | | | | | - Bárbara Gomes
- 112123Escola Superior de Enfermagem do Porto, CINTESIS:NursID, Portugal
| | - Erika Froelicher
- Department of Physiological Nursing, School of Nursing and Department of Epidemiology & Biostatistics, School of Medicine, University of California San Francisco, USA
| | - Leonie Klompstra
- Departement of Social and Welfare Studies, Linköping University, Linköping, Sweden
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Scrutinio D, Guida P, Passantino A, Scalvini S, Bussotti M, Forni G, Tibollo V, Vaninetti R, La Rovere MT. Association of improvement in functional capacity after rehabilitation with long-term survival in heart failure. Int J Cardiol 2022; 352:92-97. [DOI: 10.1016/j.ijcard.2022.01.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 01/05/2022] [Accepted: 01/19/2022] [Indexed: 11/05/2022]
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17
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Scrutinio D, Guida P, Passantino A, Scalvini S, Bussotti M, Forni G, Vaninetti R, La Rovere MT. Characteristics, outcomes and long-term survival of heart failure patients undergoing inpatient cardiac rehabilitation. Arch Phys Med Rehabil 2021; 103:891-898.e4. [PMID: 34740595 DOI: 10.1016/j.apmr.2021.10.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 10/06/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To investigate the association of CR participation with all-cause mortality after a hospitalization for HF and to describe the characteristics and functional and clinical outcomes of heart failure (HF) patients undergoing inpatient cardiac rehabilitation (CR). DESIGN Multicenter cohort study. The association between CR participation and all-cause mortality from discharge from the acute care setting was assessed using Cox regression analysis adjusting for established prognostic factors. SETTING Six inpatients rehabilitation facilities (IRF). PARTICIPANTS 3,219 HF patients admitted to inpatient CR between January 2013 and December 2016. Of these patients, 1,455 had been transferred directly from acute care hospitals after a hospitalization for HF (CR-Group 1) and 1,764 had been admitted from the community due to worsening functional disability or worsening clinical conditions (CR-Group 2). Six hundred thirty-three patients not referred to CR after a hospitalization for HF served as control group (non-CR Group). INTERVENTION Cardiac rehabilitation. MAIN OUTCOME MEASURE long-term mortality. Secondary outcomes were: 1. Change in functional capacity, as assessed by change in 6-minute walking distance (6MWD) from admission to discharge; 2. Clinical outcomes of the index inpatient rehabilitation admission, including in-hospital mortality and unplanned (re)admission to the acute care. RESULTS Compared with the non-CR Group, the adjusted hazard ratios of mortality at 1, 3, and 5 years for CR-Group 1 patients were 0.82 (0.68-0.97), 0.81 (0.71-0.93), and 0.80 (0.70-0.91). 6MWD increased from 230 to 292 m (p<.001) and 43.4% of the patients gained >50 m improvement. Overall, 2.5% of the patients died in hospital and 4.7% of the patients experienced unplanned (re)admissions to acute care, with significant differences between Group 1 and Group 2. CONCLUSIONS Our data show that inpatient CR is effective in improving functional capacity and suggest that inpatient CR provided in the earliest period following a hospitalization for HF is associated with long-term improved survival.
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Affiliation(s)
- Domenico Scrutinio
- Istituti Clinici Scientifici Maugeri SpA SB, IRCCS, Institute of Bari, Bari, Italy.
| | - Pietro Guida
- Istituti Clinici Scientifici Maugeri SpA SB, IRCCS, Institute of Bari, Bari, Italy
| | - Andrea Passantino
- Istituti Clinici Scientifici Maugeri SpA SB, IRCCS, Institute of Bari, Bari, Italy
| | - Simonetta Scalvini
- Istituti Clinici Scientifici Maugeri SpA SB, IRCCS. Institute of Lumezzane, Brescia, Italy
| | - Maurizio Bussotti
- Istituti Clinici Scientifici Maugeri SpA SB, IRCCS. Institute of Milano-Camaldoli, Milano, Italy
| | - Giovanni Forni
- Istituti Clinici Scientifici Maugeri SpA SB, IRCCS. Institute of Pavia, Pavia, Italy
| | - Raffaella Vaninetti
- Istituti Clinici Scientifici Maugeri SpA SB, IRCCS, Institute of Tradate, Varese, Italy
| | - Maria Teresa La Rovere
- Istituti Clinici Scientifici Maugeri SpA SB, IRCCS, Institute of Montescano, Pavia, Italy
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Cosiano MF, Tobin R, Mentz RJ, Greene SJ. Physical Functioning in Heart Failure With Preserved Ejection Fraction. J Card Fail 2021; 27:1002-1016. [PMID: 33991684 DOI: 10.1016/j.cardfail.2021.04.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 04/16/2021] [Accepted: 04/19/2021] [Indexed: 11/27/2022]
Abstract
Heart failure with preserved ejection fraction (HFpEF) is increasingly prevalent, yet interventions and therapies to improve outcomes remain limited. There has been increasing attention towards the impact of comorbidities and physical functioning (PF) on poor clinical outcomes within this population. In this review, we summarize and discuss the literature on PF in HFpEF, its association with clinical and patient-centered outcomes, and future advances in the care of HFpEF with respect to PF. Multiple PF metrics have been demonstrated to provide prognostic value within HFpEF, yet the data are less robust compared with other patient populations, highlighting the need for further investigation. The evaluation and detection of poor PF provides a potential strategy to improve care in HFpEF, and future studies are needed to understand if modulating PF improves clinical and/or patient-reported outcomes. LAY SUMMARY: • Patients with heart failure with preserved ejection fraction (HFpEF) commonly have impaired physical functioning (PF) demonstrated by limitations across a wide range of common PF metrics.• Impaired PF metrics demonstrate prognostic value for both clinical and patient-reported outcomes in HFpEF, making them plausible therapeutic targets to improve outcomes.• Clinical trials are ongoing to investigate novel methods of detecting, monitoring, and improving impaired PF to enhance HFpEF care.Heart failure with preserved ejection fraction (HFpEF) is increasingly prevalent, yet interventions and therapies to improve outcomes remain limited. As such, there has been increasing focus on the impact of physical performance (PF) on clinical and patient-centered outcomes. In this review, we discuss the state of PF in patients with HFpEF by examining the multitude of PF metrics available, their respective strengths and limitations, and their associations with outcomes in HFpEF. We highlight future advances in the care of HFpEF with respect to PF, particularly regarding the evaluation and detection of poor PF.
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Affiliation(s)
| | | | - Robert J Mentz
- Division of Cardiology, Duke University School of Medicine; Duke Clinical Research Institute, Durham, North Carolina
| | - Stephen J Greene
- Division of Cardiology, Duke University School of Medicine; Duke Clinical Research Institute, Durham, North Carolina.
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19
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van der Meulen M, den Boer S, du Marchie Sarvaas GJ, Blom N, Ten Harkel ADJ, Breur HMPJ, Rammeloo LAJ, Tanke R, Bogers AJJC, Helbing WA, Boersma E, Dalinghaus M. Predicting outcome in children with dilated cardiomyopathy: the use of repeated measurements of risk factors for outcome. ESC Heart Fail 2021; 8:1472-1481. [PMID: 33547769 PMCID: PMC8006605 DOI: 10.1002/ehf2.13233] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 01/18/2021] [Accepted: 01/23/2021] [Indexed: 12/02/2022] Open
Abstract
Aims We aimed to determine whether in children with dilated cardiomyopathy repeated measurement of known risk factors for death or heart transplantation (HTx) during disease progression can identify children at the highest risk for adverse outcome. Methods and results Of 137 children we included in a prospective cohort, 36 (26%) reached the study endpoint (SE: all‐cause death or HTx), 15 (11%) died at a median of 0.09 years [inter‐quartile range (IQR) 0.03–0.7] after diagnosis, and 21 (15%) underwent HTx at a median of 2.9 years [IQR 0.8–6.1] after diagnosis. Median follow‐up was 2.1 years [IQR 0.8–4.3]. Twenty‐three children recovered at a median of 0.6 years [IQR 0.5–1.4] after diagnosis, and 78 children had ongoing disease at the end of the study. Children who reached the SE could be distinguished from those who did not, based on the temporal evolution of four risk factors: stunting of length growth (−0.42 vs. −0.02 length Z‐score per year, P < 0.001), less decrease in N‐terminal pro‐B‐type natriuretic peptide (NT‐proBNP) (−0.26 vs. −1.06 2log pg/mL/year, P < 0.01), no decrease in left ventricular internal diastolic dimension (LVIDd; 0.24 vs. −0.60 Boston Z‐score per year, P < 0.01), and increase in New York University Pediatric Heart Failure Index (NYU PHFI; 0.49 vs. −1.16 per year, P < 0.001). When we compared children who reached the SE with those with ongoing disease (leaving out the children who recovered), we found similar results, although the effects were smaller. In univariate analysis, NT‐proBNP, length Z‐score, LVIDd Z‐score, global longitudinal strain (%), NYU PHFI, and age >6 years at presentation (all P < 0.001) were predictive of adverse outcome. In multivariate analysis, NT‐proBNP appeared the only independent predictor for adverse outcome, a two‐fold higher NT‐proBNP was associated with a 2.8 times higher risk of the SE (hazard ratio 2.78, 95% confidence interval 1.81–3.94, P < 0.001). Conclusions The evolution over time of NT‐proBNP, LVIDd, length growth, and NYU PHFI identified a subgroup of children with dilated cardiomyopathy at high risk for adverse outcome. In this sample, with a limited number of endpoints, NT‐proBNP was the strongest independent predictor for adverse outcome.
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Affiliation(s)
- Marijke van der Meulen
- Department of Pediatric Cardiology, Erasmus MC, University Medical Center Rotterdam, Dr Molewaterplein 60, PO Box 2060, Rotterdam, 3000 CB, The Netherlands
| | - Susanna den Boer
- Department of Pediatric Cardiology, Erasmus MC, University Medical Center Rotterdam, Dr Molewaterplein 60, PO Box 2060, Rotterdam, 3000 CB, The Netherlands
| | - Gideon J du Marchie Sarvaas
- Department of Pediatric Cardiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Nico Blom
- Leiden University Medical Center, Department of Pediatric Cardiology, University of Leiden, Leiden, The Netherlands.,Academic Medical Center, Department of Pediatric Cardiology, University of Amsterdam, Amsterdam, The Netherlands
| | - Arend D J Ten Harkel
- Leiden University Medical Center, Department of Pediatric Cardiology, University of Leiden, Leiden, The Netherlands
| | - Hans M P J Breur
- Department of Pediatric Cardiology, University of Utrecht, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Lukas A J Rammeloo
- Department of Pediatric Cardiology, Free University of Amsterdam, Free University Medical Center, Amsterdam, The Netherlands
| | - Ronald Tanke
- Department of Pediatric Cardiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Ad J J C Bogers
- Department of Cardiothoracic Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Willem A Helbing
- Department of Pediatric Cardiology, Erasmus MC, University Medical Center Rotterdam, Dr Molewaterplein 60, PO Box 2060, Rotterdam, 3000 CB, The Netherlands.,Department of Pediatric Cardiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Eric Boersma
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Michiel Dalinghaus
- Department of Pediatric Cardiology, Erasmus MC, University Medical Center Rotterdam, Dr Molewaterplein 60, PO Box 2060, Rotterdam, 3000 CB, The Netherlands
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20
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Fuentes-Abolafio IJ, Stubbs B, Pérez-Belmonte LM, Bernal-López MR, Gómez-Huelgas R, Cuesta-Vargas AI. Physical functional performance and prognosis in patients with heart failure: a systematic review and meta-analysis. BMC Cardiovasc Disord 2020; 20:512. [PMID: 33297975 PMCID: PMC7724724 DOI: 10.1186/s12872-020-01725-5] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 10/04/2020] [Indexed: 12/13/2022] Open
Abstract
Background Patients with Heart Failure (HF) show impaired functional capacities which have been related to their prognosis. Moreover, physical functional performance in functional tests has also been related to the prognosis in patients with HF. Thus, it would be useful to investigate how physical functional performance in functional tests could determine the prognosis in patients with HF, because HF is the leading cause of hospital admissions for people older than 65 years old. This systematic review and meta-analysis aims to summarise and synthesise the evidence published about the relationship between physical functional performance and prognosis in patients with HF, as well as assess the risk of bias of included studies and the level of evidence per outcome. Methods Major electronic databases, such as PubMed, AMED, CINAHL, EMBASE, PEDro, Web of Science, were searched from inception to March 2020 for observational longitudinal cohort studies (prospective or retrospective) examining the relationship between physical functional performance and prognosis in patients with HF. Results 44 observational longitudinal cohort studies with a total of 22,598 patients with HF were included. 26 included studies reported a low risk of bias, and 17 included studies showed a moderate risk of bias. Patients with poor physical functional performance in the Six Minute Walking Test (6MWT), in the Short Physical Performance Battery (SPPB) and in the Gait Speed Test showed worse prognosis in terms of larger risk of hospitalisation or mortality than patients with good physical functional performance. However, there was a lack of homogeneity regarding which cut-off points should be used to stratify patients with poor physical functional performance from patients with good physical functional performance. Conclusion The review includes a large number of studies which show a strong relationship between physical functional performance and prognosis in patients with HF. Most of the included studies reported a low risk of bias, and GRADE criteria showed a low and a moderate level of evidence per outcome.
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Affiliation(s)
- Iván José Fuentes-Abolafio
- Department of Physiotherapy, Faculty of Health Science, University of Malaga, The Institute of Biomedical Research in Malaga (IBIMA), Clinimetric Group FE-14, Malaga, Spain
| | - Brendon Stubbs
- Physiotherapy Department, South London and Maudsley NHS Foundation Trust, Denmark Hill, London, UK.,Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.,Positive Ageing Research Intitute (PARI), Faculty of Health Social Care and Education, Anglia Ruskin University, Chelmsford, UK
| | - Luis Miguel Pérez-Belmonte
- Internal Medicine Department, Instituto de Investigación Biomédica de Malaga (IBIMA), Regional University Hospital of Málaga, Málaga, Spain.,Unidad de Neurofisiología Cognitiva, Centro de Investigaciones Médico Sanitarias (CIMES), Instituto de Investigación Biomédica de Málaga (IBIMA), Universidad de Málaga (UMA), Campus de Excelencia Internacional (CEI) Andalucía Tech, Málaga, Spain.,Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain
| | - María Rosa Bernal-López
- Internal Medicine Department, Instituto de Investigación Biomédica de Malaga (IBIMA), Regional University Hospital of Málaga, Málaga, Spain.,CIBER Fisio-patología de la Obesidad y la Nutrición, Instituto de Salud Carlos III, Madrid, Spain
| | - Ricardo Gómez-Huelgas
- Internal Medicine Department, Instituto de Investigación Biomédica de Malaga (IBIMA), Regional University Hospital of Málaga, Málaga, Spain.,CIBER Fisio-patología de la Obesidad y la Nutrición, Instituto de Salud Carlos III, Madrid, Spain
| | - Antonio Ignacio Cuesta-Vargas
- Department of Physiotherapy, Faculty of Health Science, University of Malaga, The Institute of Biomedical Research in Malaga (IBIMA), Clinimetric Group FE-14, Malaga, Spain. .,School of Clinical Sciences, Faculty of Health at the Queensland University of Technology, Brisbane, Queensland, Australia.
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21
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Shibata MC, Curl-Roper J, Van Veldhuisen DJ, Roughton M, Coats AJS, Flather M. Six-minute walk test: prognostic value and effects of nebivolol versus placebo in elderly patients with heart failure from the SENIORS trial. Clin Res Cardiol 2020; 110:1193-1201. [PMID: 33136223 DOI: 10.1007/s00392-020-01768-w] [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: 01/15/2020] [Accepted: 10/20/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND There is limited information about the 6-min walk test (6MWT) in elderly patients with heart failure. We evaluated 6MWT and the effect of nebivolol on 6MWT from the SENIORS trial. METHODS AND RESULTS The SENIORS trial evaluated nebivolol versus placebo on death and hospitalisation in patients aged ≥ 70 years with heart failure. A total of 1982 patients undertook a 6MWT at baseline and 1716 patients at 6 months. Patients were divided into tertiles (≤ 200 m, 201 to ≤ 300 m and > 300 m) and to change in distance walked between baseline and 6 months (< 0 m, 0 to < 30 m and ≥ 30 m). The primary outcome was all-cause mortality and cardiovascular hospital admission. Secondary endpoint was all-cause mortality. Baseline walk distance of ≤ 200 m incurred a greater risk of the primary and secondary outcomes (HR 1.41, CI 95% 1.17-1.69, p < 0.001) and (HR 1.37, CI 95% 1.05-1.78, p = 0.019). A decline in walk distance over 6 months was associated with increased risk of clinical events. Nebivolol had no influence on change in walk distance over 6 months. CONCLUSIONS The 6MWT has prognostic utility in elderly patients. Those who walked less than 200 m were at highest risk. Nebivolol had no effect on 6MWT.
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Affiliation(s)
- Marcelo C Shibata
- University of Alberta, and Covenant Health, Misericordia Hospital, Suite 362, Heritage Medical Research Centre, Edmonton, AB, T6G 2C8, Canada.
| | - Jordan Curl-Roper
- University of East Anglia and Norfolk and Norwich University Hospital, Norwich, UK
| | - Dirk J Van Veldhuisen
- Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | | | | | - Marcus Flather
- University of East Anglia and Norfolk and Norwich University Hospital, Norwich, UK
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22
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Greene SJ, Adusumalli S, Albert NM, Hauptman PJ, Rich MW, Heidenreich PA, Butler J. Building a Heart Failure Clinic: A Practical Guide from the Heart Failure Society of America. J Card Fail 2020; 27:2-19. [PMID: 33289664 DOI: 10.1016/j.cardfail.2020.10.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 10/13/2020] [Indexed: 01/09/2023]
Abstract
Heart failure (HF) remains a leading cause of mortality and morbidity and a primary driver of health care resource use in the United States. As such, there continues to be much interest in the development and refinement of HF clinics that manage patients with HF in a guideline-directed, technology-enabled, and coordinated approach. Optimization of resource use and maintenance of collaboration with other providers are also important themes when considering implementation of HF clinics. Through this document, the Heart Failure Society of America aims to provide a contemporary, practical guide to creating and sustaining a HF clinic. The guide discusses (1) patient care considerations for delivering guideline-directed and patient-centered care, and (2) operational considerations including development of a HF clinic business plan, setting goals, leadership support, triggers for patient referral and patient follow-up, patient population served, optimal clinic staffing models, relationships with subspecialists, and continuous quality improvement. This document was developed to empower providers and clinicians who wish to build and sustain community-based, successful HF clinics.
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Affiliation(s)
- Stephen J Greene
- Duke Clinical Research Institute, Durham, North Carolina, USA; Division of Cardiology, Duke University School of Medicine, Durham, North Carolina, USA
| | - Srinath Adusumalli
- Division of Cardiovascular Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA; Cardiovascular Outcomes, Quality, and Evaluative Research Center, University of Pennsylvania, Philadelphia, Pennsylvania, USA; Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Nancy M Albert
- Nursing Institute and Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio USA
| | - Paul J Hauptman
- University of Tennessee Graduate School of Medicine, Knoxville, Tennessee, USA
| | - Michael W Rich
- Washington University School of Medicine, St. Louis, Missouri, USA
| | | | - Javed Butler
- University of Mississippi Medical Center, Jackson, Mississippi, USA.
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23
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Kanejima Y, Shimogai T, Kitamura M, Ishihara K, Izawa KP. Effect of Early Mobilization on Physical Function in Patients after Cardiac Surgery: A Systematic Review and Meta-Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17197091. [PMID: 32998202 PMCID: PMC7578990 DOI: 10.3390/ijerph17197091] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Revised: 09/15/2020] [Accepted: 09/25/2020] [Indexed: 11/30/2022]
Abstract
The objective effects of early mobilization on physical function in patients after cardiac surgery remain unknown. The purpose of the present study was to clarify the effects of early mobilization on physical function in patients after cardiac surgery through meta-analysis. Four electronic databases were searched on 2 August 2019. We used search keywords related to “early mobilization”, “cardiac surgery”, and “randomized controlled trials”. All randomized controlled trials conducting early mobilization after cardiac surgery were included. We defined early mobilization as the application of physical activity within the first five postoperative days. Citations and data extraction were independently screened in duplicate by two authors. The meta-analysis was conducted using random-effects modeling with EZR software. The primary outcome was the distance walked during the six-minute walking test at hospital discharge. Six randomized controlled trials comprising 391 patients were included following screening of 591 studies. All studies included coronary artery bypass grafting as the cardiac surgery conducted. Early mobilization started on postoperative days 1–2 and was conducting twice daily. Early mobilization showed a trend of being combined with respiratory exercise or psychoeducation. The meta-analysis showed that the distance walked during the 6-min walking test improved by 54 m (95% confidence interval, 31.1–76.9; I2 = 52%) at hospital discharge. The present study suggested that early mobilization after cardiac surgery may improve physical function at discharge.
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Affiliation(s)
- Yuji Kanejima
- Department of Public Health, Graduate School of Health Sciences, Kobe University, Kobe 654-0142, Japan; (Y.K.); (T.S.); (M.K.); (K.I.)
- Cardiovascular Stroke Renal Project (CRP), Kobe 654-0142, Japan
- Department of Rehabilitation, Kobe City Medical Center General Hospital, Kobe 650-0047, Japan
| | - Takayuki Shimogai
- Department of Public Health, Graduate School of Health Sciences, Kobe University, Kobe 654-0142, Japan; (Y.K.); (T.S.); (M.K.); (K.I.)
- Cardiovascular Stroke Renal Project (CRP), Kobe 654-0142, Japan
- Department of Rehabilitation, Kobe City Medical Center General Hospital, Kobe 650-0047, Japan
| | - Masahiro Kitamura
- Department of Public Health, Graduate School of Health Sciences, Kobe University, Kobe 654-0142, Japan; (Y.K.); (T.S.); (M.K.); (K.I.)
- Cardiovascular Stroke Renal Project (CRP), Kobe 654-0142, Japan
- Department of Physical Therapy, Kokura Rehabilitation College, 2-10 Kuzuharahigashi 2-chome, Kokuraminami-ku, Kitakyushu 800-0206, Japan
| | - Kodai Ishihara
- Department of Public Health, Graduate School of Health Sciences, Kobe University, Kobe 654-0142, Japan; (Y.K.); (T.S.); (M.K.); (K.I.)
- Cardiovascular Stroke Renal Project (CRP), Kobe 654-0142, Japan
- Department of Rehabilitation, Sakakibara Heart Institute of Okayama, 5-1 Nakaicho 2-chome, Kita-ku, Okayama 700-0804, Japan
| | - Kazuhiro P. Izawa
- Department of Public Health, Graduate School of Health Sciences, Kobe University, Kobe 654-0142, Japan; (Y.K.); (T.S.); (M.K.); (K.I.)
- Cardiovascular Stroke Renal Project (CRP), Kobe 654-0142, Japan
- Correspondence: ; Tel.: +81-78-796-4566
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24
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Du T, Fernandez C, Barshop R, Guralnik J, Bazzano LA. Cardiovascular risk factors from childhood and midlife physical function: The Bogalusa Heart Study. Exp Gerontol 2020; 136:110947. [PMID: 32294512 DOI: 10.1016/j.exger.2020.110947] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Revised: 03/17/2020] [Accepted: 04/07/2020] [Indexed: 12/25/2022]
Abstract
OBJECTIVES Life-course models have been infrequently applied to physical function. We sought to examine the effects of the cumulative burden of cardiovascular risk factors (CVRFs) from childhood on physical function in midlife. METHODS This longitudinal study consisted of 718 participants (aged 37 to 56 years at follow-up) who were examined for CVRFs at least four times during childhood and at least twice in adulthood, with 39 years of follow-up. We assessed physical function in 2013-2016 with the Short Physical Performance Battery (SPPB), 6-minute walking test (6MWT), and handgrip strength. The area under the growth curve (AUC) was used as a measure of cumulative exposure to CVRFs during childhood. RESULTS AUC of HDL-cholesterol levels in childhood were positively associated with SPPB score. AUC levels of body mass index (BMI) and triglycerides (TG) were inversely associated with 6MWT. Higher AUC levels of systolic/diastolic blood pressure (BP) predicted poorer hand grip strength. The number of childhood CVRFs in the top quartile, including AUC levels of BMI and TG, were inversely associated with 6MWT and remained significant after adjustment for the adulthood CVRFs. CONCLUSION Cumulative burden of CVRFs from childhood were associated with worse physical function in midlife independent of adulthood CVRFs.
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Affiliation(s)
- Tingting Du
- Department of Endocrinology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China; Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, USA
| | - Camilo Fernandez
- Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, USA
| | - Rupert Barshop
- Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, USA
| | - Jack Guralnik
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, MD, USA
| | - Lydia A Bazzano
- Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, USA.
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25
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Delgado BM, Lopes I, Gomes B, Novo A. Early rehabilitation in cardiology - heart failure: The ERIC-HF protocol, a novel intervention to decompensated heart failure patients rehabilitation. Eur J Cardiovasc Nurs 2020; 19:592-599. [PMID: 32316758 DOI: 10.1177/1474515120913806] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Decompensated heart failure patients are characterised by functional dependence and low exercise tolerance. Aerobic exercise can improve symptoms, functional capacity and an increase in exercise tolerance. However, the benefits of early rehabilitation have not yet been validated. OBJECTIVE To evaluate the safety and feasibility of an aerobic exercise training programme in functional capacity of decompensated heart failure patients. METHODOLOGY A single centre, parallel, randomised controlled, open label trial, with 100 patients. The training group (TG, n=50) performed the training protocol and the control group (CG, n=50) performed the usual rehabilitation procedures. The London chest activity of daily living (LCADL) scale, the Barthel index (BI) and the 6 minute walking test (6MWT) at discharge were used to evaluate the efficacy of the protocol. Safety was measured by the existence of adverse events. RESULTS The mean age of the patients was 70 years, 20% were New York Heart Association (NYHA) class IV and 80% NYHA class III at admission. The major heart failure aetiology was ischaemic (35 patients) and valvular disease (25 patients). There were no significant differences between groups at baseline in terms of sociodemographic or pathophysiological characteristics. There was a statistically significant difference of 54.2 meters for the training group (P=0.026) in the 6MWT and at LCADL 12 versus 16 (P=0.003), but the BI did not: 96 versus 92 (P=0.072). No major adverse events occurred. CONCLUSIONS The training protocol demonstrated safety and efficacy, promoting functional capacity. This study elucidated about the benefits of a systematised implementation of physical exercise during the patient's clinical stabilisation phase, which had not yet been demonstrated.Trial registration: Clinicaltrials.gov NCT03838003, URL: https://clinicaltrials.gov/ct2/show/NCT03838003.
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Affiliation(s)
- Bruno Miguel Delgado
- Porto University, Instituto de Ciencias Biomedicas Abel Salazar, Portugal.,Cardiology Department, CHUP, Portugal.,NursID, Cintesis, Portugal
| | - Ivo Lopes
- Cardiology Department of Centro Hospitalar do Porto, Hospital de St António Largo, Prof Abel Salazar, Portugal
| | - Bárbara Gomes
- Rehabilitation Department, Escola Superior de Enfermagem do Porto, Portugal
| | - André Novo
- NursID, Cintesis, Portugal.,Nursing Department, Instituto Politecnico de Bragança, Portugal
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26
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Del Buono MG, Arena R, Borlaug BA, Carbone S, Canada JM, Kirkman DL, Garten R, Rodriguez-Miguelez P, Guazzi M, Lavie CJ, Abbate A. Exercise Intolerance in Patients With Heart Failure: JACC State-of-the-Art Review. J Am Coll Cardiol 2020; 73:2209-2225. [PMID: 31047010 DOI: 10.1016/j.jacc.2019.01.072] [Citation(s) in RCA: 222] [Impact Index Per Article: 55.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Accepted: 01/21/2019] [Indexed: 02/07/2023]
Abstract
Exercise intolerance is the cardinal symptom of heart failure (HF) and is of crucial relevance, because it is associated with a poor quality of life and increased mortality. While impaired cardiac reserve is considered to be central in HF, reduced exercise and functional capacity are the result of key patient characteristics and multisystem dysfunction, including aging, impaired pulmonary reserve, as well as peripheral and respiratory skeletal muscle dysfunction. We herein review the different modalities to quantify exercise intolerance, the pathophysiology of HF, and comorbid conditions as they lead to reductions in exercise and functional capacity, highlighting the fact that distinct causes may coexist and variably contribute to exercise intolerance in patients with HF.
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Affiliation(s)
- Marco Giuseppe Del Buono
- VCU Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia; Department of Cardiovascular and Thoracic Sciences, Catholic University of the Sacred Heart, Rome, Italy
| | - Ross Arena
- Department of Physical Therapy, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, Illinois; Total Cardiology Research Network, Calgary, Alberta, Canada
| | - Barry A Borlaug
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
| | - Salvatore Carbone
- VCU Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia
| | - Justin M Canada
- VCU Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia
| | - Danielle L Kirkman
- Department of Kinesiology and Health Sciences, Virginia Commonwealth University, Richmond, Virginia
| | - Ryan Garten
- Department of Kinesiology and Health Sciences, Virginia Commonwealth University, Richmond, Virginia
| | - Paula Rodriguez-Miguelez
- Department of Kinesiology and Health Sciences, Virginia Commonwealth University, Richmond, Virginia
| | - Marco Guazzi
- Cardiology University Department, Heart Failure Unit, University of Milan, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Carl J Lavie
- Department of Cardiovascular Diseases, Ochsner Clinical School, New Orleans, Louisiana
| | - Antonio Abbate
- VCU Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia.
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27
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van der Meulen MH, Boer SD, du Marchie Sarvaas GJ, Blom NA, ten Harkel ADJ, Breur HMPJ, Rammeloo LAJ, Tanke R, Helbing WA, Boersma E, Dalinghaus M. Does Repeated Measurement of a 6-Min Walk Test Contribute to Risk Prediction in Children with Dilated Cardiomyopathy? Pediatr Cardiol 2020; 41:223-229. [PMID: 31713652 PMCID: PMC7072046 DOI: 10.1007/s00246-019-02244-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 10/31/2019] [Indexed: 11/26/2022]
Abstract
A single 6-min walk test (6MWT) can be used to identify children with dilated cardiomyopathy (DCM) with a high risk of death or heart transplantation. To determine if repeated 6MWT has added value in addition to a single 6MWT in predicting death or heart transplantation in children with DCM. Prospective multicenter cohort study including ambulatory DCM patients ≥ 6 years. A 6MWT was performed 1 to 4 times per year. The distance walked was expressed as percentage of predicted (6MWD%). We compared the temporal evolution of 6MWD% in patients with and without the study endpoint (SE: all-cause death or heart transplantation), using a linear mixed effects model. In 57 patients, we obtained a median of 4 (IQR 2-6) 6MWTs per patient during a median of 3.0 years of observation (IQR 1.5-5.1). Fourteen patients reached a SE (3 deaths, 11 heart transplantations). At any time during follow-up, the average estimate of 6MWD% was significantly lower in patients with a SE compared to patients without a SE. In both patients groups, 6MWD% remained constant over time. An absolute 1% lower 6MWD% was associated with an 11% higher risk (hazard) of the SE (HR 0.90, 95% CI 0.86-0.95 p < 0.001). Children with DCM who died or underwent heart transplantation had systematically reduced 6MWD%. The performance of all patients was stable over time, so repeated measurement of 6MWT within this time frame had little added value over a single test.
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Affiliation(s)
- Marijke H. van der Meulen
- Department of Pediatric Cardiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Susanna den Boer
- Department of Pediatric Cardiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Gideon J. du Marchie Sarvaas
- Department of Pediatric Cardiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Nico A. Blom
- Department of Pediatric Cardiology, Leiden University Medical Center, Leiden, The Netherlands
- Department of Pediatric Cardiology, Academic Medical Center, Amsterdam, The Netherlands
| | - Arend D. J. ten Harkel
- Department of Pediatric Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Hans M. P. J. Breur
- Department of Pediatric Cardiology, Wilhelmina Children’s Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Lukas A. J. Rammeloo
- Department of Pediatric Cardiology, Free University Medical Center, Amsterdam, The Netherlands
| | - Ronald Tanke
- Department of Pediatric Cardiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Willem A. Helbing
- Department of Pediatric Cardiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
- Department of Pediatric Cardiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Eric Boersma
- Department of Biostatistics, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Michiel Dalinghaus
- Department of Pediatric Cardiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
- Department of Pediatric Cardiology, Erasmus University Medical Center, Dr. Molewaterplein 60, P.O. Box 2060, 3000 CB Rotterdam, The Netherlands
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Wu L, Zhang Q, Shu Q, Zhang R, Meng Y. Sex-dependent changes in physical, mental, and quality of life outcomes in metoprolol-treated Chinese chronic heart failure patients. Medicine (Baltimore) 2019; 98:e18331. [PMID: 31852127 PMCID: PMC6922588 DOI: 10.1097/md.0000000000018331] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
This study assessed sex differences in cardiac and motor functions, quality of life (QoL), and mental status in Chinese chronic heart failure (CHF) patients after metoprolol treatment.This single-center prospective study, conducted from February 2013 to April 2016, included CHF patients (men and women) with resting heart rate (HR) >80 beats/min using metoprolol continuous release tablets. Metoprolol-induced changes in cardiac and motor functions, QoL, and mental status at 1, 3, 6, 9, and 12 months from baseline, within and between the sexes, were analyzed. Descriptive data were represented as counts, percentages, and mean ± standard deviation. Differences at various follow-up periods were compared using repeated measures one-way analysis of variance, followed by post hoc Dunnett's multiple comparison test. Statistical significance was considered at P < .05.Compared with men, women reported significantly higher systolic blood pressure (SBP) (122.28 ± 6.76 vs 125.47 ± 6.67 mm Hg, P < .05) and Veterans Specific Activity Questionnaire score (8.16 ± 0.98 vs 8.47 ± 0.89, P = .05) at 12 months. Men reported higher Hospital Anxiety and Depression Scale scores for depression than women at 1 month (10.27 vs 8.83, P < .05) and for anxiety at 12 months (8.4 vs 7.72, P < .05). Metoprolol significantly decreased HR and Minnesota Living with Heart Failure Questionnaire score in men (64.5 ± 3.13 and 53.7 ± 8.00) and women (65.38 ± 3.32 and 53.85 ± 8.42, respectively). Ejection fraction (%, men: 50.00 ± 4.45, women: 50.72 ± 4.09), cardiac index (L/min/m, men: 2.70 ± 0.25, women: 2.78 ± 0.23), 6-minute walk test distance (m, men: 414.41 ± 20.84, women: 420.34 ± 20.35), and short form-8 questionnaire scores (men: 52.05 ± 1.94, women: 52.19 ± 2.58) increased significantly in both the sexes (P < .001 for all) at 12 months. Copenhagen Burnout Inventory score significantly increased in men (mean score 62.43, P < .05).Metoprolol treatment improves cardiac and motor functions, QoL, and anxiety scores but causes greater depression and burnout in men and women. Sex was seen to affect mental status of CHF patients the most.
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Kono Y, Izawa H, Aoyagi Y, Ishikawa A, Sugiura T, Mori E, Yanohara R, Ishiguro T, Yamada R, Okumura S, Fujiwara W, Hayashi M, Saitoh E. Predictive impact of early mobilization on rehospitalization for elderly Japanese heart failure patients. Heart Vessels 2019; 35:531-536. [PMID: 31559458 PMCID: PMC7222093 DOI: 10.1007/s00380-019-01517-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Accepted: 09/20/2019] [Indexed: 01/27/2023]
Abstract
The aim of this study was to determine whether early mobilization was associated with rehospitalization among elderly heart failure patients. We measured the time from admission to mobilization and other clinical characteristics for 190 heart failure patients (mean age, 80.7 years). The primary outcome was heart failure rehospitalization. Kaplan-Meier survival curves were plotted and the hazard ratios for rehospitalization were determined using Cox proportional hazards regression models. During a median follow-up period of 750 days, 58 patients underwent rehospitalization. The time from admission to mobilization was significantly longer for these patients than for those who were not rehospitalized. Univariate and multivariate Cox proportional hazards analyses showed that the time from admission to mobilization was an independent predictor of rehospitalization, and receiver-operating characteristic analysis determined an optimal cutoff value of 3 days for differentiating the patients more likely to experience a subsequent cardiac event (sensitivity, 76%; specificity, 69%; area under the curve, 0.667). Kaplan-Meier survival curve analysis showed a significantly lower event rate in the ≤ 3-day group (p = 0.001, log-rank test). In conclusion, the time from admission to mobilization may be one of the strongest predictors of rehospitalization in elderly heart failure patients. Early mobilization within 3 days may be an initial target for the acute phase treatment of heart failure.
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Affiliation(s)
- Yuji Kono
- Department of Rehabilitation, Fujita Health University Bantane Hospital, Nagoya, Japan.,Department of Rehabilitation Medicine I, School of Medicine, Fujita Health University, Toyoake, Japan
| | - Hideo Izawa
- Department of Cardiology, Fujita Health University Bantane Hospital, 3-6-10, Otobashi, Nakagawa-ku, Nagoya, Japan.
| | - Yoichiro Aoyagi
- Department of Rehabilitation Medicine I, School of Medicine, Fujita Health University, Toyoake, Japan
| | - Ayako Ishikawa
- Department of Rehabilitation, Fujita Health University Bantane Hospital, Nagoya, Japan
| | - Tsubasa Sugiura
- Department of Rehabilitation, Fujita Health University Bantane Hospital, Nagoya, Japan
| | - Etsuko Mori
- Department of Rehabilitation, Fujita Health University Bantane Hospital, Nagoya, Japan
| | - Ryuzo Yanohara
- Department of Rehabilitation, Fujita Health University Bantane Hospital, Nagoya, Japan
| | - Tomoya Ishiguro
- Department of Cardiology, Fujita Health University Bantane Hospital, 3-6-10, Otobashi, Nakagawa-ku, Nagoya, Japan
| | - Ryo Yamada
- Department of Cardiology, Fujita Health University Bantane Hospital, 3-6-10, Otobashi, Nakagawa-ku, Nagoya, Japan
| | - Satoshi Okumura
- Department of Cardiology, Fujita Health University Bantane Hospital, 3-6-10, Otobashi, Nakagawa-ku, Nagoya, Japan
| | - Wakaya Fujiwara
- Department of Cardiology, Fujita Health University Bantane Hospital, 3-6-10, Otobashi, Nakagawa-ku, Nagoya, Japan
| | - Mutsuharu Hayashi
- Department of Cardiology, Fujita Health University Bantane Hospital, 3-6-10, Otobashi, Nakagawa-ku, Nagoya, Japan
| | - Eiichi Saitoh
- Department of Rehabilitation Medicine I, School of Medicine, Fujita Health University, Toyoake, Japan
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Tanaka S, Kamiya K, Hamazaki N, Matsuzawa R, Nozaki K, Nakamura T, Yamashita M, Maekawa E, Noda C, Yamaoka-Tojo M, Matsunaga A, Masuda T, Ako J. Short-Term Change in Gait Speed and Clinical Outcomes in Older Patients With Acute Heart Failure. Circ J 2019; 83:1860-1867. [PMID: 31281168 DOI: 10.1253/circj.cj-19-0136] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Evidence for the prognostic value of gait speed is largely based on a single measure at baseline, so we investigated the prognostic significance of change in gait speed in hospitalized older acute heart failure (AHF) patients.Methods and Results:This retrospective study was performed in a cohort of 388 AHF patients ≥60 years old (mean age: 74.8±7.8 years, 228 men). Routine geriatric assessment included gait speed measurement at baseline and at discharge. The primary outcome of this study was all-cause death. Gait speed increased from 0.74±0.25 m/s to 0.98±0.27 m/s after 13.5±11.0 days. Older age, shorter height and lower hemoglobin level at admission, prior HF admission, and higher baseline gait speed were independently associated with lesser improvement in gait speed. A total of 80 patients died and 137 patients were readmitted for HF over a mean follow-up period of 2.1±1.9 years. In multivariate analyses, change in gait speed showed inverse associations with all-cause death (hazard ratio [HR] per 0.1 m/s increase: 0.83; 95% confidence interval [CI]: 0.73 to 0.95; P=0.006) and with risk of readmission for HF (HR: 0.91; 95% CI: 0.83 to 0.99; P=0.036). CONCLUSIONS Short-term improvement in gait speed during hospitalization was associated with reduced risks of death and readmission for HF in older patients with AHF.
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Affiliation(s)
- Shinya Tanaka
- Department of Rehabilitation, School of Allied Health Sciences, Kitasato University.,Department of Rehabilitation, Nagoya University Hospital
| | - Kentaro Kamiya
- Department of Rehabilitation, School of Allied Health Sciences, Kitasato University.,Department of Rehabilitation Sciences, Graduate School of Medical Sciences, Kitasato University
| | - Nobuaki Hamazaki
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kitasato University.,Department of Rehabilitation, Kitasato University Hospital
| | | | - Kohei Nozaki
- Department of Rehabilitation, Kitasato University Hospital
| | - Takeshi Nakamura
- Department of Rehabilitation Sciences, Graduate School of Medical Sciences, Kitasato University
| | - Masashi Yamashita
- Department of Rehabilitation Sciences, Graduate School of Medical Sciences, Kitasato University
| | - Emi Maekawa
- Department of Cardiovascular Medicine, Kitasato University School of Medicine
| | - Chiharu Noda
- Department of Cardiovascular Medicine, Kitasato University School of Medicine
| | - Minako Yamaoka-Tojo
- Department of Rehabilitation, School of Allied Health Sciences, Kitasato University.,Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kitasato University
| | - Atsuhiko Matsunaga
- Department of Rehabilitation, School of Allied Health Sciences, Kitasato University.,Department of Rehabilitation Sciences, Graduate School of Medical Sciences, Kitasato University
| | - Takashi Masuda
- Department of Rehabilitation, School of Allied Health Sciences, Kitasato University.,Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kitasato University
| | - Junya Ako
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kitasato University.,Department of Cardiovascular Medicine, Kitasato University School of Medicine
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McCrary JM, Goldstein D, Wyld D, Henderson R, Lewis CR, Park SB. Mobility in survivors with chemotherapy-induced peripheral neuropathy and utility of the 6-min walk test. J Cancer Surviv 2019; 13:495-502. [PMID: 31172429 DOI: 10.1007/s11764-019-00769-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Accepted: 05/17/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Chemotherapy-induced peripheral neuropathy (CIPN) is a significant and often lasting side effect of cancer treatment, with increasing CIPN severity associated with increasing deficits in balance, gait, and mobility. The 6-min walk test (6MWT) is a widely validated and utilized measure of general physical functioning and mobility, although its utility in a CIPN context is unclear. This study aimed to determine the utility of the 6MWT as an assessment of mobility deficits in a CIPN cohort and utilize the 6MWT to compare mobility data from CIPN patients to those of healthy and clinical populations. METHODS Cancer survivors exposed to neurotoxic chemotherapies (N = 100; mean 17 ± 13 months post-treatment; mean age 59 ± 13 years) completed a single cross-sectional assessment of patient-reported and objective CIPN, mobility (6MWT), and disability. RESULTS CIPN symptoms were reported in the majority of the cohort (87%). Increasing age, patient-reported and objective CIPN symptoms, and disability were associated with decreasing 6MWT distance (.48 ≤ R ≤ .63; p < .001) in bivariate models. Multiple regression models of 6MWT distance included age, sex, and patient-reported or objective CIPN severity as significant independent correlates (.62 ≤ R ≤ .64; p < .03). 6MWT distances in patients with CIPN symptom severity above the cohort mean were consistent with mean values reported in diabetic neuropathy and clinical populations. CONCLUSIONS Increased CIPN symptoms are associated with increased mobility deficits. The 6MWT demonstrates promising utility as a mobility assessment in a CIPN cohort. IMPLICATIONS FOR CANCER SURVIVORS The impact of the progression of CIPN on mobility deficits in survivors emphasizes the need for effective interventions to treat and prevent CIPN.
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Affiliation(s)
- J Matt McCrary
- Prince of Wales Clinical School, University of New South Wales, Kensington, Australia
| | - David Goldstein
- Prince of Wales Clinical School, University of New South Wales, Kensington, Australia.,Prince of Wales Hospital, Randwick, Australia
| | - David Wyld
- Royal Brisbane and Women's Hospital, Brisbane, Australia.,Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - Robert Henderson
- Royal Brisbane and Women's Hospital, Brisbane, Australia.,Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - Craig R Lewis
- Prince of Wales Clinical School, University of New South Wales, Kensington, Australia.,Prince of Wales Hospital, Randwick, Australia
| | - Susanna B Park
- Prince of Wales Clinical School, University of New South Wales, Kensington, Australia. .,Brain and Mind Centre, The University of Sydney, Camperdown, NSW, 2050, Australia.
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Agasthi P, Lee JZ, Amin M, Al‐Saffar F, Goel V, Tseng A, Almader‐Douglas D, Killu AM, Deshmukh AJ, Del‐Carpio Munoz F, Mulpuru SK. Catheter ablation for treatment of atrial fibrillation in patients with heart failure with reduced ejection fraction: A systematic review and meta-analysis. J Arrhythm 2019; 35:171-181. [PMID: 31007780 PMCID: PMC6457370 DOI: 10.1002/joa3.12146] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Revised: 10/09/2018] [Accepted: 11/08/2018] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Atrial fibrillation (AF) among patients with heart failure with reduced ejection fraction (HFrEF) is associated with adverse clinical outcomes. Our primary aim was to evaluate patient-centered outcomes and surrogate outcomes following catheter ablation (CA) of AF among patients with HFrEF compared to standard medical therapy with or without device therapy (atrioventricular node ablation and cardiac resynchronization therapy). METHODS A systematic literature review was performed limiting our searches to randomized control trials reporting outcomes of CA compared to standard medical therapy with or without device therapy were included. Patient-centered outcomes were relative reduction in all-cause mortality, heart failure readmissions, and recurrence of AF. Surrogate outcomes of interest were change in ejection fraction, change in peak oxygen consumption, reduction in brain natriuretic peptide levels, change in 6-minute walk distance, and change in Minnesota living with heart failure score. RESULTS Seven randomized control trials (Patient n = 721) met our inclusion criteria. All trials used radiofrequency energy for CA of AF. CA for AF was associated with significantly lower all-cause mortality (Risk ratio [RR] = 0.52, 95% confidence interval [CI] = 0.35-0.76, P = 0.001, I 2 = 0%), lower rate of heart failure readmission (RR = 0.58, 95% CI = 0.46-0.74, P < 0.001, I 2 = 0%) and lower rate of AF recurrence (RR = 0.33, 95% CI = 0.22-0.50, P < 0.001, I 2 = 68%) as compared to standard medical therapy. Surrogate outcomes showed a similar benefit favoring CA. CONCLUSION AND RELEVANCE Catheter ablation for AF in HFrEF is associated with improvement in patient-centered outcomes and surrogate outcomes when compared to standard medical therapy with or without device therapy.
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Affiliation(s)
- Pradyumna Agasthi
- Department of Cardiovascular DiseasesMayo Clinic ArizonaPhoenixArizona
| | - Justin Z. Lee
- Department of Cardiovascular DiseasesMayo Clinic ArizonaPhoenixArizona
| | - Mustapha Amin
- Department of Cardiovascular DiseasesMayo Clinic RochesterRochesterMinnesota
| | - Farah Al‐Saffar
- Department of Cardiovascular DiseasesMayo Clinic ArizonaPhoenixArizona
| | - Vasudha Goel
- Department of Anesthesiology and Pain MedicineUniversity of ArizonaTucsonArizona
| | - Andrew Tseng
- Department of Cardiovascular DiseasesMayo Clinic ArizonaPhoenixArizona
| | | | - Ammar M. Killu
- Department of Cardiovascular DiseasesMayo Clinic RochesterRochesterMinnesota
| | | | | | - Siva K. Mulpuru
- Department of Cardiovascular DiseasesMayo Clinic ArizonaPhoenixArizona
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Shu Q, Wu L, Zhang R, Zhang Q, Huang J, Meng Y. Age-dependent changes in cardiac performance, motor function, QoL, and mental status in metoprolol-treated chronic heart failure patients. Sci Rep 2019; 9:453. [PMID: 30679746 PMCID: PMC6345765 DOI: 10.1038/s41598-018-37520-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Accepted: 12/06/2018] [Indexed: 01/11/2023] Open
Abstract
No previous study reports the effect of age on cardiac performance, motor function and quality of life (QoL) in Chinese chronic heart failure (CHF) patients. This single-center, prospective study enrolled CHF patients with resting heart rate (RHR) > 80 bpm, who were treated with metoprolol and were followed up at 1, 3, 6, and 12 months. Changes in cardiac, motor, and QoL parameters between patients aged ≥60 years and those aged <60 years were compared at all time points. P < 0.05 was considered significant. A total of 154 patients were enrolled (median age: 66.39 years; 116 aged ≥60 years, 38 aged <60 years; 95% New York Heart Association class III-IV). RHR decreased significantly in both patient groups (P < 0.0001 for both groups). Patients aged ≥60 years had a significant improvement in both ejection fraction (EF) at 6 and 12 months and in cardiac index (CI) at 3, 6, and 12 months. However, no major difference was observed in motor function in both groups. Significantly higher SF-8 scores showed greater improvement in QoL in the <60 age group at 12 months (P = 0.0008). Metoprolol demonstrated improvement in cardiac performance, motor function, QoL, and anxiety with increase in depression and burnout in both genders; however, the findings were independent of age.
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Affiliation(s)
- Qiuhong Shu
- Department of Cardiology, The Second Affiliated Hospital of Kunming Medical University, No. 374, Dianmian Road, Kunming, Yunnan, 650101, China
| | - Liyong Wu
- Department of Cardiology, The Second Affiliated Hospital of Kunming Medical University, No. 374, Dianmian Road, Kunming, Yunnan, 650101, China
| | - Ran Zhang
- Department of Cardiology, The Second Affiliated Hospital of Kunming Medical University, No. 374, Dianmian Road, Kunming, Yunnan, 650101, China
| | - Qian Zhang
- Department of Cardiology, The Second Affiliated Hospital of Kunming Medical University, No. 374, Dianmian Road, Kunming, Yunnan, 650101, China
| | - Jingjing Huang
- Department of Cardiology, The Second Affiliated Hospital of Kunming Medical University, No. 374, Dianmian Road, Kunming, Yunnan, 650101, China
| | - Yong Meng
- Department of Cardiology, The Second Affiliated Hospital of Kunming Medical University, No. 374, Dianmian Road, Kunming, Yunnan, 650101, China.
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Turagam MK, Garg J, Whang W, Sartori S, Koruth JS, Miller MA, Langan N, Sofi A, Gomes A, Choudry S, Dukkipati SR, Reddy VY. Catheter Ablation of Atrial Fibrillation in Patients With Heart Failure: A Meta-analysis of Randomized Controlled Trials. Ann Intern Med 2019; 170:41-50. [PMID: 30583296 DOI: 10.7326/m18-0992] [Citation(s) in RCA: 77] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
UNLABELLED This article has been corrected. The original version (PDF) is appended to this article as a Supplement. BACKGROUND Atrial fibrillation (AF) and heart failure (HF) frequently coexist and are associated with increased morbidity and mortality risk. PURPOSE To compare benefits and harms between catheter ablation and drug therapy in adult patients with AF and HF. DATA SOURCES ClinicalTrials.gov, PubMed, Web of Science (Clarivate Analytics), EBSCO Information Services, Cochrane Central Register of Controlled Trials, Google Scholar, and various scientific conference sessions from 1 January 2005 to 1 October 2018. STUDY SELECTION Randomized controlled trials (RCTs) published in English that had at least 6 months of follow-up and compared clinical outcomes of catheter ablation versus drug therapy in adults with AF and HF. DATA EXTRACTION 2 investigators independently extracted data and assessed study quality. DATA SYNTHESIS 6 RCTs involving 775 patients met inclusion criteria. Compared with drug therapy, AF ablation reduced all-cause mortality (9.0% vs. 17.6%; risk ratio [RR], 0.52 [95% CI, 0.33 to 0.81]) and HF hospitalizations (16.4% vs. 27.6%; RR, 0.60 [CI, 0.39 to 0.93]). Ablation improved left ventricular ejection fraction (LVEF) (mean difference, 6.95% [CI, 3.0% to 10.9%]), 6-minute walk test distance (mean difference, 20.93 m [CI, 5.91 to 35.95 m]), peak oxygen consumption (Vo2max) (mean difference, 3.17 mL/kg per minute [CI, 1.26 to 5.07 mL/kg per minute]), and quality of life (mean difference in Minnesota Living with Heart Failure Questionnaire score, -9.02 points [CI, -19.75 to 1.71 points]). Serious adverse events were more common in the ablation groups, although differences between the ablation and drug therapy groups were not statistically significant (7.2% vs. 3.8%; RR, 1.68 [CI, 0.58 to 4.85]). LIMITATION Results driven primarily by 1 clinical trial, possible patient selection bias in the ablation group, lack of patient-level data, open-label trial designs, and heterogeneous follow-up length among trials. CONCLUSION Catheter ablation was superior to conventional drug therapy in improving all-cause mortality, HF hospitalizations, LVEF, 6-minute walk test distance, Vo2max, and quality of life, with no statistically significant increase in serious adverse events. PRIMARY FUNDING SOURCE None.
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Affiliation(s)
- Mohit K Turagam
- Mount Sinai Hospital, New York, New York (M.K.T., J.G., W.W., S.S., J.S.K., M.A.M., N.L., A.S., A.G., S.C., S.R.D., V.Y.R.)
| | - Jalaj Garg
- Mount Sinai Hospital, New York, New York (M.K.T., J.G., W.W., S.S., J.S.K., M.A.M., N.L., A.S., A.G., S.C., S.R.D., V.Y.R.)
| | - William Whang
- Mount Sinai Hospital, New York, New York (M.K.T., J.G., W.W., S.S., J.S.K., M.A.M., N.L., A.S., A.G., S.C., S.R.D., V.Y.R.)
| | - Samantha Sartori
- Mount Sinai Hospital, New York, New York (M.K.T., J.G., W.W., S.S., J.S.K., M.A.M., N.L., A.S., A.G., S.C., S.R.D., V.Y.R.)
| | - Jacob S Koruth
- Mount Sinai Hospital, New York, New York (M.K.T., J.G., W.W., S.S., J.S.K., M.A.M., N.L., A.S., A.G., S.C., S.R.D., V.Y.R.)
| | - Marc A Miller
- Mount Sinai Hospital, New York, New York (M.K.T., J.G., W.W., S.S., J.S.K., M.A.M., N.L., A.S., A.G., S.C., S.R.D., V.Y.R.)
| | - Noelle Langan
- Mount Sinai Hospital, New York, New York (M.K.T., J.G., W.W., S.S., J.S.K., M.A.M., N.L., A.S., A.G., S.C., S.R.D., V.Y.R.)
| | - Aamir Sofi
- Mount Sinai Hospital, New York, New York (M.K.T., J.G., W.W., S.S., J.S.K., M.A.M., N.L., A.S., A.G., S.C., S.R.D., V.Y.R.)
| | - Anthony Gomes
- Mount Sinai Hospital, New York, New York (M.K.T., J.G., W.W., S.S., J.S.K., M.A.M., N.L., A.S., A.G., S.C., S.R.D., V.Y.R.)
| | - Subbarao Choudry
- Mount Sinai Hospital, New York, New York (M.K.T., J.G., W.W., S.S., J.S.K., M.A.M., N.L., A.S., A.G., S.C., S.R.D., V.Y.R.)
| | - Srinivas R Dukkipati
- Mount Sinai Hospital, New York, New York (M.K.T., J.G., W.W., S.S., J.S.K., M.A.M., N.L., A.S., A.G., S.C., S.R.D., V.Y.R.)
| | - Vivek Y Reddy
- Mount Sinai Hospital, New York, New York (M.K.T., J.G., W.W., S.S., J.S.K., M.A.M., N.L., A.S., A.G., S.C., S.R.D., V.Y.R.)
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Kheiri B, Osman M, Abdalla A, Haykal T, Ahmed S, Bachuwa G, Hassan M, Bhatt DL. Catheter ablation of atrial fibrillation with heart failure: An updated meta-analysis of randomized trials. Int J Cardiol 2018; 269:170-173. [DOI: 10.1016/j.ijcard.2018.07.024] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Revised: 06/05/2018] [Accepted: 07/03/2018] [Indexed: 10/28/2022]
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36
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Tanaka S, Kamiya K, Hamazaki N, Matsuzawa R, Nozaki K, Ichinosawa Y, Harada M, Nakamura T, Maekawa E, Noda C, Yamaoka-Tojo M, Matsunaga A, Masuda T, Ako J. SARC-F questionnaire identifies physical limitations and predicts post discharge outcomes in elderly patients with cardiovascular disease. JCSM CLINICAL REPORTS 2018. [DOI: 10.17987/jcsm-cr.v3i1.56] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background A simple and inexpensive sarcopenia screening tool would be beneficial in clinical practice. This study was performed to determine whether SARC-F questionnaire can be used to identify physical limitations and poor prognosis in elderly cardiovascular disease (CVD) patients.Methods The study population consisted of 257 Japanese patients ≥65 years old admitted to our hospital for CVD. Prior to discharge from hospital, SARC-F, handgrip strength, usual gait speed, short physical performance battery score, and 6-minute walking distance were measured in all patients. The patients were divided into two groups according to SARC-F score: SARC-F <4 and SARC-F ≥4. The study endpoint was the first occurrence of all-cause emergency readmission or all-cause mortality.Results The prevalence rate of SARC-F ≥4 was 26.8%, and increased with age and number of comorbidities. Even after adjusting for covariates, physical function was significantly poorer and the risks of physical function measurements below the critical cut-off values were higher in the SARC-F ≥4 group compared to the SARC-F <4 group. Sixty (23.3%) patients were readmitted and 17 (6.6%) died over a median follow-up period of 11 months (interquartile range: 6–13 months). SARC-F score was a significant predictor of adverse events after discharge. Patients with SARC-F ≥4 showed higher event risk than those with SARC-F <4 (adjusted hazard ratio: 1.78; 95% confidence interval: 1.03–3.07; P = 0.040).Conclusions SARC-F questionnaire is useful to identify patients at high risk of physical limitations and to predict post-discharge outcomes in elderly CVD patients.
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Bertomeu-González V, Cordero A. Early benefits of sacubitril/valsartan: Hype or hope. Int J Cardiol 2018; 252:140-141. [DOI: 10.1016/j.ijcard.2017.11.058] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Accepted: 11/16/2017] [Indexed: 12/11/2022]
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38
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Schmidt T, Bjarnason-Wehrens B, Bartsch P, Deniz E, Schmitto J, Schulte-Eistrup S, Willemsen D, Reiss N. Exercise Capacity and Functional Performance in Heart Failure Patients Supported by a Left Ventricular Assist Device at Discharge From Inpatient Rehabilitation. Artif Organs 2017. [DOI: 10.1111/aor.12936] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Thomas Schmidt
- Department for Cardiac Rehabilitation, Schüchtermann-Klinik Bad Rothenfelde, Bad Rothenfelde, Germany
- Department of Preventive and Rehabilitative Sport and Exercise Medicine, Institute for Cardiology and Sports Medicine, German Sports University Cologne, Cologne, Germany
| | - Birna Bjarnason-Wehrens
- Department of Preventive and Rehabilitative Sport and Exercise Medicine, Institute for Cardiology and Sports Medicine, German Sports University Cologne, Cologne, Germany
| | - Petra Bartsch
- Department for Cardiac Rehabilitation, Schüchtermann-Klinik Bad Rothenfelde, Bad Rothenfelde, Germany
| | - Ezin Deniz
- Department for Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Jan Schmitto
- Department for Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | | | - Detlev Willemsen
- Department for Cardiac Rehabilitation, Schüchtermann-Klinik Bad Rothenfelde, Bad Rothenfelde, Germany
| | - Nils Reiss
- Department for Cardiac Rehabilitation, Schüchtermann-Klinik Bad Rothenfelde, Bad Rothenfelde, Germany
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Abdul-Jawad Altisent O, Puri R, Regueiro A, Chamandi C, Rodriguez-Gabella T, Del Trigo M, Campelo-Parada F, Couture T, Marsal JR, Côté M, Paradis JM, DeLarochellière R, Doyle D, Mohammadi S, Dumont E, Rodés-Cabau J. Predictors and Association With Clinical Outcomes of the Changes in Exercise Capacity After Transcatheter Aortic Valve Replacement. Circulation 2017; 136:632-643. [PMID: 28588077 DOI: 10.1161/circulationaha.116.026349] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Accepted: 05/12/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND At present, there are no objective data specifically examining the clinical impact of variations in exercise capacity post-transcatheter aortic valve replacement (TAVR). We describe the changes in exercise capacity between baseline and 6 months post-TAVR, and ascertain factors associated with and clinical implications of a lack of improvement in exercise capacity post-TAVR. METHODS A total of 305 patients (mean age, 79±9 years; 44% men; Society of Thoracic Surgeons predicted risk mortality score, 6.7±4.2%) undergoing TAVR completed both baseline and follow-up exercise capacity assessments at 6 months post-TAVR. Exercise capacity was evaluated by the 6-minute walk test (6MWT). Clinical outcomes were compared between patients displaying greater than (n=152; improving group) versus less than (n=153; nonimproving group) the median percentage change in distance walked between baseline and 6-month follow-up examinations. The primary outcome measure was clinical event rates, measured from the 6-month post-TAVR period onward. Further dichotomization according to baseline 6MWT distance (less than versus more than median walking distance, or slow walker versus fast walker) was also assessed. RESULTS The mean overall distances walked pre- and post-TAVR (6 months post-TAVR) were 204±119 and 263±116 m, respectively (Δ6MWT=60±106 m), with 219 (72%) patients demonstrating an increase in their walking distance (median percentage increase of the entire population was 20% [interquartile range, 0%-80%]). Factors independently correlated with reduced exercise capacity improvement included a range of baseline clinical characteristics (older age, female sex, chronic obstructive pulmonary disease; P<0.05 for all), periprocedural major or life-threatening bleeding (P=0.009) and new-onset anemia at 6 months post-TAVR (P=0.009). Failure to improve the 6MWT distance by at least 20% was independently associated with all-cause mortality (P=0.002) and cardiovascular death or rehospitalization for cardiovascular causes (P=0.001). Baseline slow walkers who were able to improve the 6MWT distance presented with significantly better outcomes than nonimprovers (P=0.01 for all-cause mortality; P=0.001 for cardiovascular end point). CONCLUSIONS Approximately one-third of patients undergoing TAVR did not improve their exercise capacity postprocedure. The lack of functional improvement post-TAVR was predicted by a mix of baseline and periprocedural factors translating into poorer clinical outcomes. These results suggest that systematically implementing exercise capacity assessment pre- and post-TAVR may help to improve patient risk stratification.
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Affiliation(s)
- Omar Abdul-Jawad Altisent
- From Quebec Heart and Lung Institute, Laval University, Quebec City, Canada (O.A.-J.A., R.P., A.R., C.C., T.R.-G., M.d.T., F.C.-P., T.C., M.C., J.-M.P., R.D., D.D., S.M., E.D., J.R.-C.); Department of Medicine, University of Adelaide, Australia; Cleveland Clinic Coordinating Center for Clinical Research, OH (R.P.); and Epidemiology Unit of the Cardiology Department, Vall d'Hebron Hospital, Barcelona, Spain (J.R.M.)
| | - Rishi Puri
- From Quebec Heart and Lung Institute, Laval University, Quebec City, Canada (O.A.-J.A., R.P., A.R., C.C., T.R.-G., M.d.T., F.C.-P., T.C., M.C., J.-M.P., R.D., D.D., S.M., E.D., J.R.-C.); Department of Medicine, University of Adelaide, Australia; Cleveland Clinic Coordinating Center for Clinical Research, OH (R.P.); and Epidemiology Unit of the Cardiology Department, Vall d'Hebron Hospital, Barcelona, Spain (J.R.M.)
| | - Ander Regueiro
- From Quebec Heart and Lung Institute, Laval University, Quebec City, Canada (O.A.-J.A., R.P., A.R., C.C., T.R.-G., M.d.T., F.C.-P., T.C., M.C., J.-M.P., R.D., D.D., S.M., E.D., J.R.-C.); Department of Medicine, University of Adelaide, Australia; Cleveland Clinic Coordinating Center for Clinical Research, OH (R.P.); and Epidemiology Unit of the Cardiology Department, Vall d'Hebron Hospital, Barcelona, Spain (J.R.M.)
| | - Chekrallah Chamandi
- From Quebec Heart and Lung Institute, Laval University, Quebec City, Canada (O.A.-J.A., R.P., A.R., C.C., T.R.-G., M.d.T., F.C.-P., T.C., M.C., J.-M.P., R.D., D.D., S.M., E.D., J.R.-C.); Department of Medicine, University of Adelaide, Australia; Cleveland Clinic Coordinating Center for Clinical Research, OH (R.P.); and Epidemiology Unit of the Cardiology Department, Vall d'Hebron Hospital, Barcelona, Spain (J.R.M.)
| | - Tania Rodriguez-Gabella
- From Quebec Heart and Lung Institute, Laval University, Quebec City, Canada (O.A.-J.A., R.P., A.R., C.C., T.R.-G., M.d.T., F.C.-P., T.C., M.C., J.-M.P., R.D., D.D., S.M., E.D., J.R.-C.); Department of Medicine, University of Adelaide, Australia; Cleveland Clinic Coordinating Center for Clinical Research, OH (R.P.); and Epidemiology Unit of the Cardiology Department, Vall d'Hebron Hospital, Barcelona, Spain (J.R.M.)
| | - Maria Del Trigo
- From Quebec Heart and Lung Institute, Laval University, Quebec City, Canada (O.A.-J.A., R.P., A.R., C.C., T.R.-G., M.d.T., F.C.-P., T.C., M.C., J.-M.P., R.D., D.D., S.M., E.D., J.R.-C.); Department of Medicine, University of Adelaide, Australia; Cleveland Clinic Coordinating Center for Clinical Research, OH (R.P.); and Epidemiology Unit of the Cardiology Department, Vall d'Hebron Hospital, Barcelona, Spain (J.R.M.)
| | - Francisco Campelo-Parada
- From Quebec Heart and Lung Institute, Laval University, Quebec City, Canada (O.A.-J.A., R.P., A.R., C.C., T.R.-G., M.d.T., F.C.-P., T.C., M.C., J.-M.P., R.D., D.D., S.M., E.D., J.R.-C.); Department of Medicine, University of Adelaide, Australia; Cleveland Clinic Coordinating Center for Clinical Research, OH (R.P.); and Epidemiology Unit of the Cardiology Department, Vall d'Hebron Hospital, Barcelona, Spain (J.R.M.)
| | - Thomas Couture
- From Quebec Heart and Lung Institute, Laval University, Quebec City, Canada (O.A.-J.A., R.P., A.R., C.C., T.R.-G., M.d.T., F.C.-P., T.C., M.C., J.-M.P., R.D., D.D., S.M., E.D., J.R.-C.); Department of Medicine, University of Adelaide, Australia; Cleveland Clinic Coordinating Center for Clinical Research, OH (R.P.); and Epidemiology Unit of the Cardiology Department, Vall d'Hebron Hospital, Barcelona, Spain (J.R.M.)
| | - Josep Ramon Marsal
- From Quebec Heart and Lung Institute, Laval University, Quebec City, Canada (O.A.-J.A., R.P., A.R., C.C., T.R.-G., M.d.T., F.C.-P., T.C., M.C., J.-M.P., R.D., D.D., S.M., E.D., J.R.-C.); Department of Medicine, University of Adelaide, Australia; Cleveland Clinic Coordinating Center for Clinical Research, OH (R.P.); and Epidemiology Unit of the Cardiology Department, Vall d'Hebron Hospital, Barcelona, Spain (J.R.M.)
| | - Mélanie Côté
- From Quebec Heart and Lung Institute, Laval University, Quebec City, Canada (O.A.-J.A., R.P., A.R., C.C., T.R.-G., M.d.T., F.C.-P., T.C., M.C., J.-M.P., R.D., D.D., S.M., E.D., J.R.-C.); Department of Medicine, University of Adelaide, Australia; Cleveland Clinic Coordinating Center for Clinical Research, OH (R.P.); and Epidemiology Unit of the Cardiology Department, Vall d'Hebron Hospital, Barcelona, Spain (J.R.M.)
| | - Jean-Michel Paradis
- From Quebec Heart and Lung Institute, Laval University, Quebec City, Canada (O.A.-J.A., R.P., A.R., C.C., T.R.-G., M.d.T., F.C.-P., T.C., M.C., J.-M.P., R.D., D.D., S.M., E.D., J.R.-C.); Department of Medicine, University of Adelaide, Australia; Cleveland Clinic Coordinating Center for Clinical Research, OH (R.P.); and Epidemiology Unit of the Cardiology Department, Vall d'Hebron Hospital, Barcelona, Spain (J.R.M.)
| | - Robert DeLarochellière
- From Quebec Heart and Lung Institute, Laval University, Quebec City, Canada (O.A.-J.A., R.P., A.R., C.C., T.R.-G., M.d.T., F.C.-P., T.C., M.C., J.-M.P., R.D., D.D., S.M., E.D., J.R.-C.); Department of Medicine, University of Adelaide, Australia; Cleveland Clinic Coordinating Center for Clinical Research, OH (R.P.); and Epidemiology Unit of the Cardiology Department, Vall d'Hebron Hospital, Barcelona, Spain (J.R.M.)
| | - Daniel Doyle
- From Quebec Heart and Lung Institute, Laval University, Quebec City, Canada (O.A.-J.A., R.P., A.R., C.C., T.R.-G., M.d.T., F.C.-P., T.C., M.C., J.-M.P., R.D., D.D., S.M., E.D., J.R.-C.); Department of Medicine, University of Adelaide, Australia; Cleveland Clinic Coordinating Center for Clinical Research, OH (R.P.); and Epidemiology Unit of the Cardiology Department, Vall d'Hebron Hospital, Barcelona, Spain (J.R.M.)
| | - Siamak Mohammadi
- From Quebec Heart and Lung Institute, Laval University, Quebec City, Canada (O.A.-J.A., R.P., A.R., C.C., T.R.-G., M.d.T., F.C.-P., T.C., M.C., J.-M.P., R.D., D.D., S.M., E.D., J.R.-C.); Department of Medicine, University of Adelaide, Australia; Cleveland Clinic Coordinating Center for Clinical Research, OH (R.P.); and Epidemiology Unit of the Cardiology Department, Vall d'Hebron Hospital, Barcelona, Spain (J.R.M.)
| | - Eric Dumont
- From Quebec Heart and Lung Institute, Laval University, Quebec City, Canada (O.A.-J.A., R.P., A.R., C.C., T.R.-G., M.d.T., F.C.-P., T.C., M.C., J.-M.P., R.D., D.D., S.M., E.D., J.R.-C.); Department of Medicine, University of Adelaide, Australia; Cleveland Clinic Coordinating Center for Clinical Research, OH (R.P.); and Epidemiology Unit of the Cardiology Department, Vall d'Hebron Hospital, Barcelona, Spain (J.R.M.)
| | - Josep Rodés-Cabau
- From Quebec Heart and Lung Institute, Laval University, Quebec City, Canada (O.A.-J.A., R.P., A.R., C.C., T.R.-G., M.d.T., F.C.-P., T.C., M.C., J.-M.P., R.D., D.D., S.M., E.D., J.R.-C.); Department of Medicine, University of Adelaide, Australia; Cleveland Clinic Coordinating Center for Clinical Research, OH (R.P.); and Epidemiology Unit of the Cardiology Department, Vall d'Hebron Hospital, Barcelona, Spain (J.R.M.).
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den Boer SL, Flipse DHK, van der Meulen MH, Backx APCM, du Marchie Sarvaas GJ, Ten Harkel ADJ, van Iperen GG, Rammeloo LAJ, Tanke RB, Helbing WA, Takken T, Dalinghaus M. Six-Minute Walk Test as a Predictor for Outcome in Children with Dilated Cardiomyopathy and Chronic Stable Heart Failure. Pediatr Cardiol 2017; 38:465-471. [PMID: 27909753 PMCID: PMC5355503 DOI: 10.1007/s00246-016-1536-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Accepted: 11/12/2016] [Indexed: 11/24/2022]
Abstract
Cardiopulmonary exercise testing is an important tool to predict prognosis in children and adults with heart failure. A much less sophisticated exercise test is the 6 min walk test, which has been shown an independent predictor for morbidity and mortality in adults with heart failure. Therefore, we hypothesized that the 6 min walk test could be predictive for outcome in children with dilated cardiomyopathy. We prospectively included 49 children with dilated cardiomyopathy ≥6 years who performed a 6 min walk test. Median age was 11.9 years (interquartile range [IQR] 7.4-15.1), median time after diagnosis was 3.6 years (IQR 0.6-7.4). The 6 min walk distance was transformed to a percentage of predicted, using age- and gender-specific norm values (6MWD%). For all patients, mean 6MWD% was 70 ± 21%. Median follow-up was 33 months (IQR 14-50). Ten patients reached the combined endpoint of death or heart transplantation. Using univariable Cox regression, a higher 6MWD% resulted in a lower risk of death or transplantation (hazard ratio 0.95 per percentage increase, p = 0.006). A receiver operating characteristic curve was generated to define the optimal threshold to identify patients at highest risk for an endpoint. Patients with a 6MWD% < 63% had a 2 year transplant-free survival of 73%, in contrast to a transplant-free survival of 92% in patients with a 6MWD% ≥ 63% (p = 0.003). In children with dilated cardiomyopathy, the 6 min walk test is a simple and feasible tool to identify children with a higher risk of death or heart transplantation.
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Affiliation(s)
- Susanna L. den Boer
- Division of Pediatric Cardiology, Sophia Children’s Hospital, Erasmus University Medical Center, Dr. Molewaterplein 60, P.O. Box 2060, 3000 CB Rotterdam, The Netherlands
| | - Daniël H. K. Flipse
- Division of Pediatric Cardiology, Sophia Children’s Hospital, Erasmus University Medical Center, Dr. Molewaterplein 60, P.O. Box 2060, 3000 CB Rotterdam, The Netherlands
| | - Marijke H. van der Meulen
- Division of Pediatric Cardiology, Sophia Children’s Hospital, Erasmus University Medical Center, Dr. Molewaterplein 60, P.O. Box 2060, 3000 CB Rotterdam, The Netherlands
| | - Ad P. C. M. Backx
- Division of Pediatric Cardiology, Emma Children’s Hospital, Academic Medical Center, Amsterdam, The Netherlands
| | - Gideon J. du Marchie Sarvaas
- Division of Pediatric Cardiology, Beatrix Children’s Hospital, University of Groningen, Groningen, The Netherlands
| | - Arend D. J. Ten Harkel
- Division of Pediatric Cardiology, Department of Pediatrics, Leiden University Medical Center, Leiden, The Netherlands
| | - Gabriëlle G. van Iperen
- Division of Pediatric Cardiology, Wilhelmina Children’s Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Lukas A. J. Rammeloo
- Division of Pediatric Cardiology, Department of Pediatrics, Free University Medical Center, Amsterdam, The Netherlands
| | - Ronald B. Tanke
- Division of Pediatric Cardiology, Department of Pediatrics, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Willem A. Helbing
- Division of Pediatric Cardiology, Sophia Children’s Hospital, Erasmus University Medical Center, Dr. Molewaterplein 60, P.O. Box 2060, 3000 CB Rotterdam, The Netherlands
| | - Tim Takken
- Child Development and Exercise Center, Wilhelmina Children’s Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Michiel Dalinghaus
- Division of Pediatric Cardiology, Sophia Children’s Hospital, Erasmus University Medical Center, Dr. Molewaterplein 60, P.O. Box 2060, 3000 CB Rotterdam, The Netherlands
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Peripartum Cardiomyopathy Characteristics and Outcomes in Canadian Aboriginal and Non-Aboriginal Women. Can J Cardiol 2016; 33:471-477. [PMID: 28169090 DOI: 10.1016/j.cjca.2016.11.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2015] [Revised: 11/02/2016] [Accepted: 11/06/2016] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Peripartum cardiomyopathy (PPCM) is a heterogeneous condition characterized by heart failure and left ventricular dysfunction (left ventricular ejection fraction [LVEF] < 45%) in the absence of an alternative cause and a previous diagnosis of cardiomyopathy. The Aboriginal population (Inuit, First Nations, Metis) of Canada often has barriers to health care, which can lead to delays in diagnosis and treatment. Our objectives are to describe PPCM in a Canadian population, and to determine if Canadian Aboriginal women have worse clinical outcomes than non-Aboriginal women. METHODS A retrospective study was performed at a single tertiary care centre, between 2008 and 2014. Demographic characteristics, symptoms at presentation, medical history, discharge medications, blood work, echocardiographic parameters, and follow-up information were collected. RESULTS A total of 177 women were screened, and 23 were included in the study (52% were Aboriginal). Aboriginal women were found to have higher rates of gravidity and parity, and higher incidence of tobacco smoking than non-Aboriginal women, and were more likely to be discharged with diuretic medications. At diagnosis, Aboriginal women were more likely to have a lower LVEF (20% [interquartile range (IQR), 15%-23%] vs 40% [IQR, 30%-42%]; P = 0.02) and a more dilated left ventricle (left ventricular end-diastolic diameter, 64 mm [IQR, 57-74 mm] vs 54 mm [IQR, 50-57mm]; P < 0.01). Recovery rate, defined as LVEF > 50%, was similar (46% in Aboriginal patients and 60% in non-Aboriginal patients). CONCLUSIONS Our findings support that Aboriginal women with PPCM are more likely to present with lower LVEF and a more dilated left ventricle, as well, require more symptomatic management. To our knowledge, this is the first description and contrast of PPCM between Aboriginal and non-Aboriginal Canadians.
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Loo G, Chua AP, Tay HY, Poh R, Tai BC, Lee CH. Sleep-disordered Breathing in Cardiac Rehabilitation: Prevalence, Predictors, and Influence on the Six-Minute Walk Test. Heart Lung Circ 2016; 25:584-91. [DOI: 10.1016/j.hlc.2015.12.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2015] [Revised: 11/25/2015] [Accepted: 12/08/2015] [Indexed: 10/22/2022]
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Faria Júnior NSD, Nakata CH, Oliveira LVFD, Chiappa GR, Cipriano Júnior G. Evaluation of the best environment for the six-minute walk test. FISIOTERAPIA EM MOVIMENTO 2015. [DOI: 10.1590/0103-5150.028.003.ao01] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
AbstractIntroduction The purpose of the six-minute walk test (6MWT) is to evaluate cardiopulmonary capacity using a low-cost test that is easy to administer, generally well tolerated by different populations and reflects one’s performance on activities of daily living. However, few studies have been conducted to determine the difference between performing the 6MWT indoors and outdoors.Objective The aim of the present study was to compare the distance covered on the 6MWT performed indoors and outdoors and evaluate the following physiological variables: heart rate, blood pressure and the subjective sensation of shortness of breath, using the Borg perceived exertion scale.Materials and methods A prospective, randomized, clinical trial was conducted involving eight healthy females not engaged in regular physical activity, with mean age 23.75 ± 1.67 years. Each subject performed the 6MWT indoors and outdoors with a 30-minute interval between tests. The order of the tests was determined randomly.Results The mean distance traveled was 578 ± 50.07 m on the outdoor trial and 579.95 ± 45.35 m on the indoor trial (p = 0.932). The mean physiological variables were 82.25 ± 11.02 bpm (indoors) versus 84.38 ± 9.42 bpm (outdoors) for heart rate, 121.88 ± 10.28 mmHg (indoors)versus 118.75 ± 19.40 mmHg (outdoors) for systolic blood pressure, 81.88 ± 9.74 mmHg (indoors) versus 80.50 ± 7.89 mmHg (outdoors) for diastolic blood pressure and a mean score of 12 on the perceived exertion score in both environments.Conclusions The present data demonstrate no differences in the distance walked on the 6MWT or the physiologic variables of participants between the indoor and outdoor trials.
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Al Halabi S, Qintar M, Hussein A, Alraies MC, Jones DG, Wong T, MacDonald MR, Petrie MC, Cantillon D, Tarakji KG, Kanj M, Bhargava M, Varma N, Baranowski B, Wilkoff BL, Wazni O, Callahan T, Saliba W, Chung MK. Catheter Ablation for Atrial Fibrillation in Heart Failure Patients: A Meta-Analysis of Randomized Controlled Trials. JACC Clin Electrophysiol 2015; 1:200-209. [PMID: 26258174 DOI: 10.1016/j.jacep.2015.02.018] [Citation(s) in RCA: 75] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Rhythm control with antiarrhythmic drugs (AADs) is not superior to rate control in patients with heart failure (HF) and atrial fibrillation (AF), but AF ablation may be more successful at achieving rhythm control than AADs. However, risks for both ablation and AADs are likely higher and success rates lower in patients with HF. OBJECTIVE To compare rate control versus AF catheter ablation strategies in patients with AF and HF. METHODS We conducted a meta-analysis of trials which randomized HF patients (LVEF<50%) with AF to a rate control or AF catheter ablation strategy and reported change in LVEF, quality of life, 6-minute walk test, or peak oxygen consumption. Study quality and heterogenity were assessed using Jadad scores and Cochran's Q statistics, respectively. Mantel Haenszel relative risks and mean differences were calculated using random effect models. RESULTS Four trials (N=224) met inclusion criteria; 82.5% (n=185) had persistent AF. AF ablation was associated with an increase in LVEF (mean difference 8.5%; 95%CI 6.4,10.7%; P<0.001) compared to rate control. AF ablation was superior in improving quality of life by Minnesota Living with Heart Failure (MLWHF) questionnaire scores (mean difference -11.9; 95%CI -17.1, -6.6; P<0.001). Peak oxygen consumption and 6-minute walk distance increased in AF ablation compared to rate control patients (mean difference 3.2; 95%CI 1.1,5.2; P=0.003; mean difference 34.8; 95%CI 2.9, 66.7; P = 0.03, respectively). In the persistent AF subgroup LVEF and MLWHF were significantly improved with AF ablation. Major adverse event rates (RR 1.3; 95% CI, 0.4, 3.9; p=0.64) were not significantly different. No significant heterogeneity was evident. CONCLUSIONS In patients with HF and AF, AF catheter ablation is superior to rate control in improving LVEF, quality of life and functional capacity. Prior to accepting a rate control strategy in HF patients with persistent or drug refractory AF, consideration should be given to AF ablation.
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Affiliation(s)
- Shadi Al Halabi
- The Department of Cardiovascular Medicine, Heart & Vascular Institute, Cleveland Clinic, Cleveland, OH
| | - Mohammed Qintar
- The Department of Cardiovascular Medicine, Heart & Vascular Institute, Cleveland Clinic, Cleveland, OH
| | - Ayman Hussein
- The Department of Cardiovascular Medicine, Heart & Vascular Institute, Cleveland Clinic, Cleveland, OH
| | - M Chadi Alraies
- The Department of Cardiology, University of Minnesota, Minneapolis, MN
| | - David G Jones
- Royal Brompton and Harefield National Health Service Foundation Trust, London, United Kingdom ; National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Tom Wong
- Royal Brompton and Harefield National Health Service Foundation Trust, London, United Kingdom ; National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | | | - Mark C Petrie
- Golden Jubilee National Hospital, Glasgow, Scotland, United Kingdom
| | - Daniel Cantillon
- The Department of Cardiovascular Medicine, Heart & Vascular Institute, Cleveland Clinic, Cleveland, OH
| | - Khaldoun G Tarakji
- The Department of Cardiovascular Medicine, Heart & Vascular Institute, Cleveland Clinic, Cleveland, OH
| | - Mohamed Kanj
- The Department of Cardiovascular Medicine, Heart & Vascular Institute, Cleveland Clinic, Cleveland, OH
| | - Mandeep Bhargava
- The Department of Cardiovascular Medicine, Heart & Vascular Institute, Cleveland Clinic, Cleveland, OH
| | - Niraj Varma
- The Department of Cardiovascular Medicine, Heart & Vascular Institute, Cleveland Clinic, Cleveland, OH
| | - Bryan Baranowski
- The Department of Cardiovascular Medicine, Heart & Vascular Institute, Cleveland Clinic, Cleveland, OH
| | - Bruce L Wilkoff
- The Department of Cardiovascular Medicine, Heart & Vascular Institute, Cleveland Clinic, Cleveland, OH
| | - Oussama Wazni
- The Department of Cardiovascular Medicine, Heart & Vascular Institute, Cleveland Clinic, Cleveland, OH
| | - Thomas Callahan
- The Department of Cardiovascular Medicine, Heart & Vascular Institute, Cleveland Clinic, Cleveland, OH
| | - Walid Saliba
- The Department of Cardiovascular Medicine, Heart & Vascular Institute, Cleveland Clinic, Cleveland, OH
| | - Mina K Chung
- The Department of Cardiovascular Medicine, Heart & Vascular Institute, Cleveland Clinic, Cleveland, OH
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Compostella L, Nicola R, Tiziana S, Caterina C, Fabio B. Autonomic dysfunction predicts poor physical improvement after cardiac rehabilitation in patients with heart failure. Res Cardiovasc Med 2014; 3:e25237. [PMID: 25780782 PMCID: PMC4347727 DOI: 10.5812/cardiovascmed.25237] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2014] [Accepted: 11/20/2014] [Indexed: 12/29/2022] Open
Abstract
Background: Cardiac autonomic dysfunction, clinically expressed by reduced heart rate variability (HRV), is present in patients with congestive heart failure (CHF) and is related to the degree of left ventricular dysfunction. In athletes, HRV is an indicator of ability to improve performance. No similar data are available for CHF. Objectives: The aim of this study was to assess whether HRV could predict the capability of CHF patients to improve physical fitness after a short period of exercise-based cardiac rehabilitation (CR). Patients and Methods: This was an observational, non-randomized study, conducted on 57 patients with advanced CHF, admitted to a residential cardiac rehabilitation unit 32 ± 22 days after an episode of acute heart failure. Inclusion criteria were sinus rhythm, stable clinical conditions, no diabetes and ejection fraction ≤ 35%. HRV (time-domain) and mean and minimum heart rate (HR) were evaluated using 24-h Holter at admission. Patients’ physical fitness was evaluated at admission by 6-minute walking test (6MWT) and reassessed after two weeks of intensive exercise-based CR. Exercise capacity was evaluated by a symptom-limited cardiopulmonary exercise test (CPET). Results: Patients with very depressed HRV (SDNN 55.8 ± 10.0 ms) had no improvement in their walking capacity after short CR, walked shorter absolute distances at final 6MWT (348 ± 118 vs. 470 ± 109 m; P = 0.027) and developed a peak-VO2 at CPET significantly lower than patients with greater HRV parameters (11.4 ± 3.7 vs. an average > 16 ± 4 mL/kg/min). Minimum HR, but not mean HR, showed a negative correlation (ρ = -0.319) with CPET performance. Conclusions: In patients with advanced CHF, depressed HRV and higher minimum HR were predictors of poor working capacity after a short period of exercise-based CR. An individualized and intensive rehabilitative intervention should be considered for these patients.
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Affiliation(s)
- Leonida Compostella
- Preventive Cardiology and Rehabilitation, Institute Codivilla-Putti, Cortina d'Ampezzo, Italy
- Corresponding author: Leonida Compostella, Preventive Cardiology and Rehabilitation, Institute Codivilla-Putti, Cortina d'Ampezzo, Italy. Tel: +39-3201722751, Fax +39-0436883379, E-mail:
| | - Russo Nicola
- Preventive Cardiology and Rehabilitation, Institute Codivilla-Putti, Cortina d'Ampezzo, Italy
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy
| | - Setzu Tiziana
- Preventive Cardiology and Rehabilitation, Institute Codivilla-Putti, Cortina d'Ampezzo, Italy
| | - Compostella Caterina
- Department of Medical and Surgical Sciences, School of Emergency Medicine, University of Padua, Padua, Italy
| | - Bellotto Fabio
- Preventive Cardiology and Rehabilitation, Institute Codivilla-Putti, Cortina d'Ampezzo, Italy
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46
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Use of the 6-Min Walk Distance to Identify Variations in Treatment Benefits From Implantable Cardioverter-Defibrillator and Amiodarone. J Am Coll Cardiol 2014; 63:2560-2568. [DOI: 10.1016/j.jacc.2014.02.602] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2013] [Revised: 01/24/2014] [Accepted: 02/25/2014] [Indexed: 11/17/2022]
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47
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Weir NA, Brown AW, Shlobin OA, Smith MA, Reffett T, Battle E, Ahmad S, Nathan SD. The Influence of Alternative Instruction on 6-Min Walk Test Distance. Chest 2013; 144:1900-1905. [DOI: 10.1378/chest.13-0287] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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48
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Yuwono M, Su SW, Moulton BD, Nguyen HT. Gait cycle spectrogram analysis using a torso-attached inertial sensor. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2013; 2012:6539-42. [PMID: 23367427 DOI: 10.1109/embc.2012.6347492] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Measurement of gait parameters can provide important information about a person's health and safety. Automatic analysis of gait using kinematic sensors is a newly emerging area of research. We describe a new way to detect walking, and measure gait cadence, by using time-frequency signal processing together with spectrogram analysis of signals from a chest-worn inertial measurement unit (IMU). A pilot study of 11 participants suggests that this method is able to distinguish between walk and non-walk activities with up to 88.70% sensitivity and 97.70% specificity. Limitations of the method include instability associated with manual fine-tuning of local and global threshold levels.
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Affiliation(s)
- Mitchell Yuwono
- Faculty of Engineering and Information Technology, University of Technology, Sydney, Ultimo, 2007 NSW, Australia.
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49
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Russo N, Compostella L, Tarantini G, Setzu T, Napodano M, Bottio T, D’Onofrio A, Isabella G, Gerosa G, Iliceto S, Bellotto F. Cardiac rehabilitation after transcatheter versus surgical prosthetic valve implantation for aortic stenosis in the elderly. Eur J Prev Cardiol 2013; 21:1341-8. [DOI: 10.1177/2047487313494029] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Affiliation(s)
- Nicola Russo
- Preventive Cardiology and Rehabilitation, Istituto Codivilla-Putti, Cortina d’Ampezzo (BL), Italy
- Dept of Cardiac, Thoracic and Vascular Sciences, Padua University Medical School, Italy
| | - Leonida Compostella
- Preventive Cardiology and Rehabilitation, Istituto Codivilla-Putti, Cortina d’Ampezzo (BL), Italy
| | - Giuseppe Tarantini
- Dept of Cardiac, Thoracic and Vascular Sciences, Padua University Medical School, Italy
| | - Tiziana Setzu
- Preventive Cardiology and Rehabilitation, Istituto Codivilla-Putti, Cortina d’Ampezzo (BL), Italy
| | - Massimo Napodano
- Dept of Cardiac, Thoracic and Vascular Sciences, Padua University Medical School, Italy
| | - Tomaso Bottio
- Dept of Cardiac, Thoracic and Vascular Sciences, Padua University Medical School, Italy
| | - Augusto D’Onofrio
- Dept of Cardiac, Thoracic and Vascular Sciences, Padua University Medical School, Italy
| | - Gianbattista Isabella
- Dept of Cardiac, Thoracic and Vascular Sciences, Padua University Medical School, Italy
| | - Gino Gerosa
- Dept of Cardiac, Thoracic and Vascular Sciences, Padua University Medical School, Italy
| | - Sabino Iliceto
- Dept of Cardiac, Thoracic and Vascular Sciences, Padua University Medical School, Italy
| | - Fabio Bellotto
- Preventive Cardiology and Rehabilitation, Istituto Codivilla-Putti, Cortina d’Ampezzo (BL), Italy
- Dept of Cardiac, Thoracic and Vascular Sciences, Padua University Medical School, Italy
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50
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Inpatient cardiac rehabilitation soon after hospitalization for acute decompensated heart failure: a propensity score study. J Cardiopulm Rehabil Prev 2012; 32:71-7. [PMID: 22193932 DOI: 10.1097/hcr.0b013e31823be124] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE Postdischarge management of acute decompensated heart failure (ADHF) remains an ongoing challenge. We sought to assess whether inpatient cardiac rehabilitation (CR) soon after hospitalization for ADHF improves outcome. METHODS Patients (N = 275) hospitalized for ADHF were enrolled. The primary outcome was a composite of all-cause mortality and urgent heart transplantation (UHT) at 1 year. The followup started at the time of discharge from the acute care setting. Because of the observational nature of the study, a propensity score analysis was used to predict the likelihood of undergoing CR. A multivariable Cox regression analysis adjusted for propensity score was used to assess the effect of CR on the primary outcome. RESULTS Of the 275 patients, 130 underwent CR. Among the baseline variables of the index hospitalization for ADHF, propensity score derivation identified male gender, New York Heart Association Class IV, refractory HF, moderate to severe mitral or tricuspid regurgitation, nonuse of renin-angiotensin-aldosterone system inhibitors, and daily dosage of furosemide, as being independently associated with the likelihood of undergoing CR. No patient was lost to followup. During the 12-month followup, 74 patients died and 3 underwent UHT. The overall incidence of the primary outcome was 28%. On propensity score-adjusted Cox multivariable analysis, the relative risk of the primary outcome for participants in CR compared with nonparticipants in CR was 0.58 (confidence interval [CI]: 0.34-0.99; P = .04). CONCLUSIONS Results suggest that the strategy of inpatient CR soon after discharge from the acute care setting improves 1-year UHT-free survival of patients with ADHF.
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