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Kawamura T, Sakaniwa R, Nishimura M, Matsuo Y, Imai Y, Hori Y, Tsukizawa T, Fukuda K, Matsuura M, Takemoto T, Furuya O, Kuroyanagi S, Higashiue S, Iso H, Sobue T. Early achievement of walkability after cardiac surgery and the risk of cardiovascular disease after hospital discharge. ESC Heart Fail 2024; 11:3033-3040. [PMID: 38845360 PMCID: PMC11424298 DOI: 10.1002/ehf2.14875] [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: 10/13/2023] [Revised: 04/17/2024] [Accepted: 05/12/2024] [Indexed: 09/27/2024] Open
Abstract
AIMS This study aimed to investigate the association between the time to achieve walkability after cardiac surgery and the risk of cardiovascular disease after hospital discharge. METHODS We conducted a prospective cohort study involving 553 ambulatory patients aged 71.5 (range, 64.0-77.0) years who underwent cardiac surgery. All patients were divided into five groups based on the time to achieve walkability ≥100 m within 1, 2, 3, 4 or 5 days after cardiac surgery. We examined the risk of post-cardiovascular disease outcomes, including readmission due to heart failure, ischaemic heart disease and other cardiovascular disease, according to the time to achieve walkability with reference to 5 days using the Fine and Gray regression model, considering competing risks. RESULTS In the survival curve analysis, we examined the time to experience post-cardiovascular disease incidence after hospital discharge. During a median of 3.3 years of follow-up, 118 patients developed cardiovascular disease. We observed a positive association between the time to achieve walkability and cardiovascular disease risk, particularly heart failure. The multivariate hazard ratios (95% confidence intervals) for heart failure readmission were N/A (not assessed due to the sample size being too small) for 1 day, 0.31 (0.10-0.99) for 2 days, 0.60 (0.21-1.79) for 3 days and 0.76 (0.22-2.72) for 4 days (P for trend = 0.032). CONCLUSIONS The shorter walkability achievement time was associated with a lower risk of cardiovascular diseases, more specifically heart failure readmission, among patients who underwent cardiac surgery. The time required to achieve walkability is a useful predictor for cardiovascular diseases after hospital discharge.
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Affiliation(s)
- Tomonori Kawamura
- Department of Social Medicine, Osaka University Graduate School of Medicine, Suita, Japan
- Department of Rehabilitation, Kishiwada Tokushukai Hospital, Kishiwada, Japan
| | - Ryoto Sakaniwa
- Department of Social Medicine, Osaka University Graduate School of Medicine, Suita, Japan
| | - Masato Nishimura
- Department of Rehabilitation, Chugoku Rosai Hospital, Hiroshima, Japan
| | - Yoshimi Matsuo
- Graduate School of Health and Sports Science, Mukogawa Women's University, Nishinomiya, Japan
| | - Yoshihide Imai
- Department of Rehabilitation, Kishiwada Tokushukai Hospital, Kishiwada, Japan
| | - Yusuke Hori
- Department of Rehabilitation, Kishiwada Tokushukai Hospital, Kishiwada, Japan
| | - Tomohumi Tsukizawa
- Department of Cardiology, Kishiwada Tokushukai Hospital, Kishiwada, Japan
| | - Keisuke Fukuda
- Department of Cardiology, Tanesogo Hospital, Osaka, Japan
| | - Makoto Matsuura
- Department of Cardiovascular Surgery, Kishiwada Tokushukai Hospital, Kishiwada, Japan
| | - Tetsushi Takemoto
- Department of Cardiovascular Surgery, Kishiwada Tokushukai Hospital, Kishiwada, Japan
| | - Oniti Furuya
- Department of Cardiovascular Surgery, Kishiwada Tokushukai Hospital, Kishiwada, Japan
| | - Satoshi Kuroyanagi
- Department of Cardiovascular Surgery, Kishiwada Tokushukai Hospital, Kishiwada, Japan
| | - Shiniti Higashiue
- Department of Cardiovascular Surgery, Kishiwada Tokushukai Hospital, Kishiwada, Japan
| | - Hiroyasu Iso
- Department of Social Medicine, Osaka University Graduate School of Medicine, Suita, Japan
- Institute for Global Health Policy Research, Bureau of International Health Cooperation, National Center for Global Health and Medicine, Tokyo, Japan
| | - Tomotaka Sobue
- Department of Social Medicine, Osaka University Graduate School of Medicine, Suita, Japan
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Takahashi T, Watanabe H, Mochizuki M, Kikuchi Y, Kitahara E, Yokoyama-Nishitani M, Morisawa T, Saitoh M, Iwatsu K, Minamino T, Tabata M, Fujiwara T, Daida H. Relationship between prehabilitation responsiveness and postoperative physical functional recovery in cardiovascular surgery. J Cardiol 2024:S0914-5087(24)00097-2. [PMID: 38839042 DOI: 10.1016/j.jjcc.2024.05.008] [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] [Received: 12/26/2023] [Revised: 05/16/2024] [Accepted: 05/28/2024] [Indexed: 06/07/2024]
Abstract
BACKGROUND The purpose of this study was to examine the relationship between responsiveness to prehabilitation and postoperative recovery of physical function in cardiac surgery patients. METHODS Ninety-three cardiac surgery patients (mean age: 76.4 years) were included in this retrospective cohort study. Preoperative physical function was measured using the Short Physical Performance Battery (SPPB), and a prehabilitation exercise program was implemented for the SPPB domains with low scores. Among the patients, those whose SPPB score was over 11 from the start of prehabilitation and remained over 11 on the day before surgery were defined as the high-functioning group, and those whose SPPB score improved by 2 points or more from the start of prehabilitation and exceeded 11 points were defined as the responder group. Those whose SPPB score did not exceed 11 immediately before surgery were classified as non-responders. The characteristics of each group and postoperative recovery of physical function were investigated. RESULTS There were no serious adverse events during prehabilitation. Mean days of prehabilitation was 5.4 days. The responder group showed faster improvement in postoperative physical function and shorter time to ambulatory independence than the non-responder group. The non-responder group had lower preoperative skeletal muscle index, more severe preoperative New York Heart Association classification, and a history of musculoskeletal disease or stroke. CONCLUSION There were responders and non-responders to prehabilitation among cardiac surgery patients. Cardiac surgery patients who respond to prehabilitation had faster recovery of physical function. Further research is needed to determine what type of prehabilitation is more effective in postoperative recovery of physical function in cardiac surgery patients.
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Affiliation(s)
- Tetsuya Takahashi
- Department of Physical Therapy, Faculty of Health Science, Juntendo University, Tokyo, Japan; Department of Rehabilitation, Juntendo University Hospital, Tokyo, Japan; Juntendo University Graduate School of Health Science, Tokyo, Japan.
| | - Hidetaka Watanabe
- Department of Rehabilitation, Juntendo University Hospital, Tokyo, Japan
| | | | - Yuta Kikuchi
- Department of Rehabilitation, Juntendo University Hospital, Tokyo, Japan
| | - Eriko Kitahara
- Department of Rehabilitation, Juntendo University Hospital, Tokyo, Japan
| | - Miho Yokoyama-Nishitani
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Tomoyuki Morisawa
- Department of Physical Therapy, Faculty of Health Science, Juntendo University, Tokyo, Japan; Department of Rehabilitation, Juntendo University Hospital, Tokyo, Japan; Juntendo University Graduate School of Health Science, Tokyo, Japan
| | - Masakazu Saitoh
- Department of Physical Therapy, Faculty of Health Science, Juntendo University, Tokyo, Japan; Department of Rehabilitation, Juntendo University Hospital, Tokyo, Japan; Juntendo University Graduate School of Health Science, Tokyo, Japan
| | - Kotaro Iwatsu
- Department of Physical Therapy, Faculty of Health Science, Juntendo University, Tokyo, Japan; Department of Rehabilitation, Juntendo University Hospital, Tokyo, Japan
| | - Tohru Minamino
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Minoru Tabata
- Department of Cardiovascular Surgery, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Toshiyuki Fujiwara
- Department of Physical Therapy, Faculty of Health Science, Juntendo University, Tokyo, Japan; Department of Rehabilitation, Juntendo University Hospital, Tokyo, Japan; Department of Rehabilitation Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan; Juntendo University Graduate School of Health Science, Tokyo, Japan
| | - Hiroyuki Daida
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan; Juntendo University Graduate School of Health Science, Tokyo, Japan
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Maze Y, Tokui T, Narukawa T, Murakami M, Yamaguchi D, Inoue R, Hirano K, Takamura T, Nakamura K, Seko T, Kasai A. Impact of the Barthel Index Score and Prognosis on Patients Undergoing Transcatheter Aortic Valve Replacement and Surgical Aortic Valve Replacement. Circ J 2024; 88:483-491. [PMID: 37899252 DOI: 10.1253/circj.cj-23-0458] [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] [Indexed: 10/31/2023]
Abstract
BACKGROUND Few studies have compared the Barthel Index (BI) score and postoperative outcomes of transcatheter aortic valve replacement (TAVR) and surgical aortic valve replacement (SAVR). We aimed to examine the relationship between the BI score and postoperative outcomes in patients who underwent TAVR and SAVR. METHODS AND RESULTS The study included patients who underwent SAVR between January 2014 and December 2022 (n=293) and patients who underwent TAVR between January 2016 and December 2022 (n=312). We examined the risk factors for long-term mortality in the 2 groups. The mean (±SD) preoperative BI score was 88.7±18.0 in the TAVR group and 95.8±12.3 in the SAVR group. The home discharge rate was significantly lower in the SAVR than TAVR group. The BI score at discharge was significantly higher in the SAVR than in TAVR group (86.2 vs. 80.2; P<0.001). Significant risk factors for long-term mortality in the TAVR group were sex (P<0.001) and preoperative hemoglobin level (P=0.008), whereas those in the SAVR group were preoperative albumin level (P=0.04) and postoperative BI score (P=0.02). The cut-off point of the postoperative BI score determined by receiver operating characteristic curve analysis was 60.0. CONCLUSIONS The BI score at discharge was a significant risk factor for long-term mortality in the SAVR group, with a cut-off value of 60.0.
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Affiliation(s)
- Yasumi Maze
- Department of Thoracic and Cardiovascular Surgery, Ise Red Cross Hospital
| | - Toshiya Tokui
- Department of Thoracic and Cardiovascular Surgery, Ise Red Cross Hospital
| | - Takahiro Narukawa
- Department of Thoracic and Cardiovascular Surgery, Ise Red Cross Hospital
| | - Masahiko Murakami
- Department of Thoracic and Cardiovascular Surgery, Ise Red Cross Hospital
| | - Daisuke Yamaguchi
- Department of Thoracic and Cardiovascular Surgery, Ise Red Cross Hospital
| | - Ryosai Inoue
- Department of Thoracic and Cardiovascular Surgery, Ise Red Cross Hospital
| | - Koji Hirano
- Department of Thoracic and Cardiovascular Surgery, Ise Red Cross Hospital
| | | | | | - Tetsuya Seko
- Department of Cardiology, Ise Red Cross Hospital
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Honda Y, Honma K, Nishimura S, Nakao S, Sasanuma N, Manabe E, Uchiyama Y, Takahashi K, Sakaguchi T, Domen K. Predictors of postoperative physical functional decline at hospital discharge in elderly patients with prolonged intensive care unit stay after cardiac surgery. Heart Lung 2024; 64:86-92. [PMID: 38070278 DOI: 10.1016/j.hrtlng.2023.11.014] [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: 07/22/2023] [Revised: 11/22/2023] [Accepted: 11/27/2023] [Indexed: 03/18/2024]
Abstract
BACKGROUND A prolonged stay in the intensive care (ICU) is associated with physical function decline following cardiac surgery. To predict physical function decline after cardiac surgery, it may be important to evaluate physical function in the ICU. OBJECTIVES This study aimed to determine that physical function examination at ICU discharge was independently associated with physical functional decline at hospital discharge in elderly patients who had undergone cardiac surgery and prolonged the ICU stay. METHODS We assessed physical function before and after cardiac surgery in elderly patients who had spent ≥72 h in the ICU in this retrospective cohort study using the short physical performance battery (SPPB). At hospital discharge, a decrease of at least 1 point on the SPPB was considered a postoperative physical functional decline. Postoperative physical functional decline at hospital discharge was predicted using multiple logistic regression. RESULTS We revealed postoperative physical functional deterioration in 28.0% of patients who spent ≥72 h in the ICU following cardiac surgery. The Medical Research Council sum score (MRC-SS) (OR: 0.96, 95% CI: 0.82-0.99) and mechanical ventilation days (OR: 1.27, 95% CI: 1.01-1.64) were independently associated with physical functional decline at hospital discharge. CONCLUSIONS Physical function at ICU discharge and mechanical ventilation days were predictors of postoperative physical functional decline at hospital discharge in patients. MRC-SS was more accurate in predicting postoperative physical functional decline at hospital discharge when performed at the time of ICU discharge.
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Affiliation(s)
- Yosuke Honda
- Department of Rehabilitation, Hyogo Medical University Hospital.
| | - Keisuke Honma
- Department of Rehabilitation, Hyogo Medical University Hospital
| | | | - Shiomi Nakao
- Department of Rehabilitation, Hyogo Medical University Hospital
| | - Naoki Sasanuma
- Department of Rehabilitation, Hyogo Medical University Hospital
| | - Eri Manabe
- Department of Cardiovascular and Renal Medicine, Hyogo Medical University
| | - Yuuki Uchiyama
- Department of Rehabilitation Medicine, School of Medicine, Hyogo Medical University
| | - Keiko Takahashi
- Department of Cardiovascular and Renal Medicine, Hyogo Medical University
| | | | - Kazuhisa Domen
- Department of Rehabilitation Medicine, School of Medicine, Hyogo Medical University
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Shimizu M, Adachi T, Kobayashi K, Mutsuga M, Oshima H, Usui A, Yamada S. Factors associated with postsurgical muscle weakness in patients who undergo thoracic aortic surgery: a retrospective cohort study. Physiother Theory Pract 2023; 39:2180-2188. [PMID: 35606903 DOI: 10.1080/09593985.2022.2068168] [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: 10/25/2021] [Revised: 02/03/2022] [Accepted: 04/15/2022] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Aortic surgery is often performed in elderly patients, and these patients have a high risk of postsurgical muscle weakness. To reinforce purposeful postsurgical rehabilitation, we aimed to investigate the factors associated with postsurgical muscle weakness in patients who underwent thoracic aortic surgery. METHODS This retrospective cohort study analyzed data of consecutive patients who underwent elective thoracic aortic surgery with cardiopulmonary bypass, and whose knee extensor isometric muscle strength (KEIS) were measured pre- and postoperatively at University Hospital between January 2012 and December 2018. The primary outcome was percent change in KEIS (% change in KEIS). Multivariate linear regression analysis was used to identify independent risk factors for % change in KEIS. RESULTS Overall, 218 patients were included. Multivariate linear regression analysis showed that mechanical ventilation time, days from initial sitting to 100 m walking, and the number of exercises in the rehabilitation room were associated with % change in KEIS. CONCLUSIONS This study may serve as a reference to stratify patients at risk of postsurgical muscle weakness. The preventive or alternative interventions in patients undergoing thoracic aortic surgery will be assessed in future studies.
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Affiliation(s)
- Miho Shimizu
- Program in Physical and Occupational Therapy, Nagoya University Graduate School of Medicine, Nagoya, Japan
- Department of Rehabilitation, Nagoya University Hospital, Nagoya, Japan
| | - Takuji Adachi
- Department of Integrated Health Sciences, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | | | - Masato Mutsuga
- Department of Cardiac Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | | | - Akihiko Usui
- Department of Cardiac Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Sumio Yamada
- Department of Integrated Health Sciences, Nagoya University Graduate School of Medicine, Nagoya, Japan
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6
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Bauer PDS, Teixeira C, Leão BM, Rosa RG. Predictive factors of functional limitation after cardiac surgery: a retrospective cohort study. Braz J Phys Ther 2023; 27:100550. [PMID: 37801775 PMCID: PMC10562669 DOI: 10.1016/j.bjpt.2023.100550] [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: 07/07/2022] [Revised: 08/24/2023] [Accepted: 09/11/2023] [Indexed: 10/08/2023] Open
Abstract
BACKGROUND Functional limitation is relatively common and can negatively influence the postoperative outcome of patients after cardiac surgery. OBJECTIVE To identify the predictive factors of functional limitation in patients undergoing elective cardiac surgery. METHODS Retrospective cohort study was performed to evaluate patients undergoing elective cardiac surgery. All patients underwent a cardiovascular rehabilitation protocol. Functional limitation was defined based on performance in the rehabilitation protocol following cardiac surgery. Poor performance in the cardiac surgery rehabilitation protocol defined functional limitation, whereas good performance indicated no limitation. RESULTS Data were collected from 548 patients; of these, 190 (34.7%) had functional limitation. In multivariate analysis, the factors associated with postoperative functional limitation were as follows: hospitalization by the public healthcare system [OR: 2.14; 95% confidence interval (CI): 1.73, 2.65]; age (OR 1.23; 95% CI: 1.15, 1.31); length of hospitalization in the intensive care unit (OR 1.03; 95% CI: 1.01, 1.05); history of previous acute myocardial infarction (OR 1.40; 95% CI: 1.13, 1.73); presence of previous comorbidities [chronic kidney disease (OR 1.56; 95% CI: 1.15, 2.10); cerebrovascular disease (OR 1.57; 95% CI: 1.19, 2.07)]; presence of expiratory muscle weakness (OR 1.54; 95% CI: 1.08, 2.20); and intercurrence of cardiorespiratory arrest during hospitalization (OR 1.76; 95% CI: 1.40, 2.22). CONCLUSION Functional limitation after cardiac surgery could be predicted by multiple pre and postoperative factors, except for preoperative functionality, which does not suggest to be an independent factor for functional limitation after surgery.
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Affiliation(s)
- Patrícia da Silva Bauer
- Post-graduate Program in Rehabilitation Sciences of the Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, RS, Brazil.
| | - Cassiano Teixeira
- Post-graduate Program in Rehabilitation Sciences of the Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, RS, Brazil
| | - Bruna Muller Leão
- Post-graduate Program in Rehabilitation Sciences of the Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, RS, Brazil
| | - Regis Goulart Rosa
- Intensive Care Department of Hospital Moinhos de Vento, Porto Alegre (RS), Brazil
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Hori K, Nakayama A, Kobayashi D, Adachi Y, Hirakawa K, Shimokawa T, Isobe M. Exploring the Frailty Components Related to Hospitalization-Associated Disability in Older Patients After Cardiac Surgery Using a Comprehensive Frailty Assessment. Circ J 2023; 87:1112-1119. [PMID: 37150607 DOI: 10.1253/circj.cj-23-0102] [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] [Indexed: 05/09/2023]
Abstract
BACKGROUND We investigated the components of frailty associated with hospitalization-associated disability (HAD) after cardiac surgery. METHODS AND RESULTS This retrospective, observational study evaluated 1,446 older patients after elective cardiac surgery at the Sakakibara Heart Institute. We examined the association between HAD and 7 domains of frailty assessed by the Kihon Checklist. HAD was defined as a decline in the ability to perform activities of daily living (ADL) between admission and discharge, as assessed by the Barthel Index. Logistic regression and decision tree analysis were used to identify associations between the number and type of frailty components and HAD. Of the 1,446 patients, 190 were excluded, and 90 (7%) developed HAD. An increase in the number of frailty components was a risk factor for HAD (odds ratio: 1.88, 95% confidence interval: 1.62-2.17). Decision tree analysis identified physical functional decline, depression, and cognitive dysfunction as factors associated with HAD. The incidence of HAD was highest in cases of physical functional decline (21%) and lowest for cases in which the 3 aforementioned factors were absent (2.8%). CONCLUSIONS An increased number of frailty factors increased the risk of HAD and the findings also reaffirmed the importance of a comprehensive assessment to evaluate the risk of HAD, including evaluation of physical function, cognitive function, and depression.
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Affiliation(s)
- Kentaro Hori
- Department of Rehabilitation, Sakakibara Heart Institute
| | | | | | - Yuichi Adachi
- Department of Rehabilitation, Sakakibara Heart Institute
| | | | - Tomoki Shimokawa
- Department of Cardiovascular Surgery, Sakakibara Heart Institute
- Department of Cardiovascular Surgery, Teikyo University Hospital
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Ishimaru Y, Adachi T, Ashikawa H, Hori M, Shimozato T, Ohtake H, Shimizu S, Ueyama J, Yamada S. Association Between the Redox State of Human Serum Albumin and Exercise Capacity in Patients With Cardiac Disease. Am J Cardiol 2023; 189:56-60. [PMID: 36508763 DOI: 10.1016/j.amjcard.2022.11.034] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 10/10/2022] [Accepted: 11/19/2022] [Indexed: 12/14/2022]
Abstract
The redox state of human serum albumin (HSA) is reported to be an oxidative stress biomarker; however, its clinical use in cardiac disease has not yet been examined. This study aimed to investigate the relation between the redox state of HSA and exercise capacity, which is a robust prognostic factor, in patients with cardiovascular disease. This cross-sectional study included outpatients with cardiac disease. Exercise capacity was assessed by peak oxygen consumption (peakVO2) measured using symptom-limited cardiopulmonary exercise testing. The high-performance liquid chromatography postcolumn bromocresol green method was used to part HSA into human nonmercaptalbumin (oxidized form) and human mercaptalbumin (HMA, reduced form). The fraction of human mercaptalbumin found in HSA (f[HMA]) was calculated as an indicator of the redox state of HSA. The association between peakVO2 and f(HMA) was examined using the Spearman correlation coefficient and multivariate linear regression analysis. A total of 70 patients were included (median age 76 years; 44 men; median peakVO2 15.5 ml/kg/min). The f(HMA) was positively correlated with peakVO2 (r = 0.38, p <0.01). Even after controlling for potential confounders, this association remained in the multivariate linear regression analysis (standardized beta = 0.24, p <0.05). We found a positive association between f(HMA) and peakVO2, independent of potential confounders in patients with cardiac disease, suggesting that f(HMA) may be a novel biomarker related to exercise capacity in cardiac disease. Longitudinal studies are required to further examine the prognostic capability of f(HMA), the responsiveness to clinical intervention, and the association between f(HMA) and cardiac disease.
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Affiliation(s)
- Yo Ishimaru
- Department of Rehabilitation, Japanese Red Cross Aichi Medical Center Nagoya Daiichi Hospital, Nagoya, Japan
| | - Takuji Adachi
- Department of Integrated Health Sciences, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Hironobu Ashikawa
- Program in Physical and Occupational Therapy, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Masaya Hori
- Department of Cardiac Rehabilitation, Gifu Heart Center, Gifu, Japan
| | | | - Hiroshi Ohtake
- Department of Rehabilitation, Nagoya Tokushukai General Hospital, Kasugai, Japan
| | - Shinya Shimizu
- Department of Cardiology, Fujita Health University Bantane Hospital, Nagoya, Japan
| | - Jun Ueyama
- Department of Biomolecular Sciences, Field of Omics Health Sciences, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Sumio Yamada
- Department of Cardiology, Aichi Medical University, Nagakute, Japan.
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Sezai A, Shimokawa T, Kanaoka K, Fukuma N, Sekino H, Shiraishi H, Sumita Y, Nakai M, Iwanaga Y, Furukawa Y, Miura SI, Oya Y, Yasu T, Makita S. Efficacy of Early Cardiac Rehabilitation After Cardiac Surgery - Verification Using Japanese Diagnosis Procedure Combination Data. Circ Rep 2022; 4:505-516. [PMID: 36408360 PMCID: PMC9638512 DOI: 10.1253/circrep.cr-22-0088] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Accepted: 08/28/2022] [Indexed: 10/31/2023] Open
Abstract
Background: The current status of cardiac rehabilitation (CR) after cardiac surgery and the introduction of early CR (E-CR) in Japan are not fully understood. In this study, the current status of E-CR and its efficacy were investigated by the Academic Committee of the Japanese Association of Cardiac Rehabilitation. Methods and Results: We examined the rate of introduction of E-CR and its effects among 220,122 patients who underwent major cardiac and thoracic vascular surgery, as registered in the Diagnosis Procedure Combination (DPC) classification system, between April 2012 and March 2018. In this study, E-CR was defined as CR starting within 1 day after surgery. Patients with and without E-CR were propensity score matched and analyzed for clinical outcomes. Of all patients participating in CR after surgery, E-CR was initiated in 52.1%, 56.9%, 47.4%, and 54.1% of patients undergoing coronary artery bypass grafting, valve surgery, aortic surgery, and other cardiovascular surgery, respectively. After propensity score matching, outcomes for E-CR were significantly superior to non-E-CR in terms of in-hospital deaths, Barthel Index score at discharge, length of hospital stay, and hospitalization costs. Conclusions: E-CR after cardiac surgery was effective in terms of prognosis, hospital stay, and medical costs. This study is the first report using big data in Japan. The results indicate that further introduction of E-CR needs to be recommended in the future.
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Affiliation(s)
- Akira Sezai
- Department of Cardiovascular Surgery, Nihon University School of Medicine Tokyo Japan
| | - Tomoki Shimokawa
- Department of Cardiovascular Surgery, Sakakibara Heart Institute Tokyo Japan
- Department of Cardiovascular Surgery, Teikyo University School of Medicine Tokyo Japan
| | - Koshiro Kanaoka
- Department of Medical and Health Information Management, National Cerebral and Cardiovascular Center Osaka Japan
| | - Nagaharu Fukuma
- The Faculty of Rehabilitation and Care, Seijoh University Aichi Japan
| | | | - Hirokazu Shiraishi
- Department of Cardiovascular Medicine, Kyoto Prefectural University of Medicine Kyoto Japan
| | - Yoko Sumita
- Department of Medical and Health Information Management, National Cerebral and Cardiovascular Center Osaka Japan
| | - Michikazu Nakai
- Department of Medical and Health Information Management, National Cerebral and Cardiovascular Center Osaka Japan
| | - Yoshitaka Iwanaga
- Department of Medical and Health Information Management, National Cerebral and Cardiovascular Center Osaka Japan
| | - Yutaka Furukawa
- Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital Hyogo Japan
| | - Shin-Ichiro Miura
- Department of Cardiology, Fukuoka University School of Medicine Fukuoka Japan
| | - Yusuke Oya
- Department of Cardiovascular Medicine, Nephrology and Neurology, University of The Ryukyus Okinawa Japan
| | - Takanori Yasu
- Department of Cardiovascular Medicine, Dokkyo Medical University Nikko Medical Center Tochigi Japan
| | - Shigeru Makita
- Department of Cardiac Rehabilitation, Saitama Medical University Saitama Japan
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10
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Hirakawa K, Nakayama A, Saitoh M, Hori K, Shimokawa T, Iwakura T, Haraguchi G, Isobe M. Factors Related to Hospitalisation-Associated Disability in Patients after Surgery for Acute Type A Aortic Dissection: A Retrospective Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:12918. [PMID: 36232218 PMCID: PMC9566428 DOI: 10.3390/ijerph191912918] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 10/06/2022] [Accepted: 10/07/2022] [Indexed: 06/16/2023]
Abstract
The in-hospital mortality rate among patients after surgery for acute type A aortic dissection (ATAAD) has improved chronologically. However, the relationship between the incidence of hospitalisation-associated disability (HAD) and acute cardiac rehabilitation in patients after surgery for ATAAD has not been reported. Therefore, this study evaluated factors related to HAD in patients after surgery for ATAAD. This single-centre retrospective observational study included 483 patients who required emergency surgery for ATAAD. HAD occurred in 104 (21.5%) patients following cardiovascular surgery. Factors associated with HAD were age (odds ratio [OR], 1.05; 95% confidence interval [CI], 1.02-1.09; p = 0.001), noninvasive positive pressure ventilation (NPPV; OR, 2.15; 95% CI, 1.10-4.19; p = 0.025), postoperative delirium (OR, 2.93; 95% CI, 1.60-5.37; p = 0.001), and timing of walking onset (OR, 1.29; 95% CI, 1.07-1.56; p = 0.008). Furthermore, a late walking onset was associated with a higher risk of developing HAD and more severe functional decline. Early rehabilitation based on appropriate criteria has possibility of preventing HAD.
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Affiliation(s)
- Kotaro Hirakawa
- Department of Rehabilitation, Sakakibara Heart Institute, Tokyo 183-0003, Japan
| | - Atsuko Nakayama
- Department of Cardiology, Sakakibara Heart Institute, Tokyo 183-0003, Japan
| | - Masakazu Saitoh
- Department of Physical Therapy, Faculty of Health Science, Juntendo University, Tokyo 113-0033, Japan
| | - Kentaro Hori
- Department of Rehabilitation, Sakakibara Heart Institute, Tokyo 183-0003, Japan
| | - Tomoki Shimokawa
- Department of Cardiovascular Surgery, Sakakibara Heart Institute, Tokyo 183-0003, Japan
| | - Tomohiro Iwakura
- Department of Cardiovascular Surgery, Sakakibara Heart Institute, Tokyo 183-0003, Japan
| | - Go Haraguchi
- Division of Intensive Care Unit, Sakakibara Heart Institute, Tokyo 183-0003, Japan
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11
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Impact of minimally invasive mitral valve surgery on sexual dysfunction in male patients. J Cardiothorac Surg 2022; 17:77. [PMID: 35421997 PMCID: PMC9008948 DOI: 10.1186/s13019-022-01814-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Accepted: 03/21/2022] [Indexed: 11/21/2022] Open
Abstract
Background Sexual dysfunction after cardiac surgery can seriously affect patients’ quality of life, but the impact of cardiac surgery on sexual function has long been neglected. Compared with conventional cardiac surgery, minimally invasive cardiac surgery has the advantages of aesthetic appearance and no disruption of the sternal structure, which can greatly improve the patient's quality of life. However, studies focusing on the effects of minimally invasive mitral valve surgery (MIMVS) on sexual function have not been reported. The objective of this research was to investigate the effects of totally endoscopic mitral valve surgery on health-related quality of life and sexual function in male patients and to provide possible recommendations. Methods Patients who underwent median sternotomy or totally endoscopic mitral valve surgery at our institution from January 2019 to December 2020 were selected using an electronic medical record system. Data were collected by questionnaires, including the MOS 36-item short-form health survey and the International Erectile Function Questionnaire. Results There were 156 male patients who participated in our study. Of these, 112 patients completed all questionnaires. Forty-five patients (40.18%) developed postoperative sexual dysfunction, including 15 patients (29.41%) in the MIMVS group and 30 patients (49.18%) in the conventional MVS group, indicating that the incidence of sexual dysfunction could be reduced by MIMVS and that the MIMVS group scored better on the International Erectile Function Questionnaire (P < 0.05). On the evaluation of health-related quality of life, the MIMVS group scored better than the MVS group on the mental health and bodily pain subscales of the MOS 36-item short-form health survey. In addition, our study showed that postoperative sexual dysfunction was associated with physical functioning and mental health. Conclusions In our study, totally endoscopic mitral valve surgery had less adverse effects on sexual function in male patients than conventional mitral valve surgery. In terms of health-related quality of life, totally endoscopic mitral valve surgery was superior to conventional surgery. Patients who opt for totally endoscopic mitral valve surgery may have a more satisfying and healthier sexual life than those who undergo conventional mitral valve surgery.
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12
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Hospital-Acquired Functional Decline and Clinical Outcomes in Older Cardiac Surgical Patients: A Multicenter Prospective Cohort Study. J Clin Med 2022; 11:jcm11030640. [PMID: 35160093 PMCID: PMC8836607 DOI: 10.3390/jcm11030640] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2021] [Revised: 01/22/2022] [Accepted: 01/25/2022] [Indexed: 02/04/2023] Open
Abstract
This study aimed to determine the effect of hospital-acquired functional decline (HAFD) on prognosis, 1-year post-hospital discharge, of older patients who had undergone cardiac surgery in seven Japanese hospitals between June 2017 and June 2018. This multicenter prospective cohort study involved 247 patients with cardiac disease aged ≥65 years. HAFD was defined as a decrease in the short physical performance battery at hospital discharge compared with before surgery. Primary outcomes included a composite outcome of frailty severity, total mortality, and cardiovascular readmission 1-year post-hospital discharge. Secondary outcomes were changes in the total score and sub-item scores in the Ki-hon Checklist (KCL), assessed pre- and 1-year postoperatively. Poor prognostic outcomes were observed in 33% of patients, and multivariate analysis identified HAFD (odds ratio [OR] 3.43, 95% confidence interval [CI] 1.75–6.72, p < 0.001) and low preoperative gait speed (OR 2.47, 95% CI 1.18–5.17, p = 0.016) as independent predictors of poor prognosis. Patients with HAFD had significantly worse total KCL scores and subscale scores for instrumental activities of daily living, mobility, oral function, and depression at 1-year post-hospital discharge. HAFD is a powerful predictor of prognosis in older patients who have undergone cardiac surgery.
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13
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Zhang X, Peng Y, Zhong F, Li S, Huang X, Huang Q, Chen L, Lin Y. Effects of neuromuscular electrical stimulation on functional capacity and quality of life among patients after cardiac surgery: A systematic review and meta-analysis. J Cardiol 2021; 79:291-298. [PMID: 34657773 DOI: 10.1016/j.jjcc.2021.09.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 08/03/2021] [Accepted: 09/09/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Neuromuscular electrical stimulation (NMES) is a possible adjunctive therapy applied to cardiac surgery patients to improve physical function, but the results are still controversial. A systematic review and meta-analysis was conducted to investigate the effects of NMES on functional capacity and quality of life (QoL) in cardiac surgery patients. METHODS The following databases PubMed, Embase, Medicine, CINAHL, and the Cochrane Central Register of Controlled Trials were searched for the English language from inception up to March 2021. A systematic targeted literature search evaluating the effects of NMES on physical function and QoL in cardiac surgery patients. The effect size of NMES was presented as the mean difference (MD)/standardized mean difference (SMD) and its 95% confidence interval using fixed/random effect models according to heterogeneity. Two reviewers independently screened and appraised each study by using the Cochrane Risk of Bias Tool. RESULTS Six studies were included involving 400 cardiac surgery patients. The meta-analysis showed that NMES had effect on knee extensor strength (SMD=1.68; p=0.05), but had no effects on 6-minute walking distance (MD=44.08; p=0.22), walking speed (MD=0.05; p=0.24), grip strength (MD=3.01; p=0.39), or QoL (SMD=0.53; p=0.19). CONCLUSIONS NMES use in cardiac surgery patients is limited by low to moderate quality. Existing evidence shows that NMES is safe and effective for improving knee extensor strength.
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Affiliation(s)
- Xu Zhang
- School of Nursing, Fujian Medical University, Fuzhou, China
| | - Yanchun Peng
- Department of Cardiac Surgery, Fujian Medical University Union Hospital, Fuzhou, China
| | - Fuxiu Zhong
- Department of Nursing, Fujian Medical University Union Hospital, Fuzhou, China
| | - Sailan Li
- Department of Cardiac Surgery, Fujian Medical University Union Hospital, Fuzhou, China
| | - Xizhen Huang
- Department of Cardiac Surgery, Fujian Medical University Union Hospital, Fuzhou, China
| | - Qubo Huang
- Department of Cardiac Surgery, Fujian Medical University Union Hospital, Fuzhou, China
| | - Liangwan Chen
- Department of Cardiac Surgery, Fujian Medical University Union Hospital, Fuzhou, China; Fujian Heart Medicine Research Center, Fuzhou, China.
| | - Yanjuan Lin
- Department of Nursing, Fujian Medical University Union Hospital, Fuzhou, China; Fujian Heart Medicine Research Center, Fuzhou, China.
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14
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Hori K, Usuba K, Sakuyama A, Adachi Y, Hirakawa K, Nakayama A, Nagayama M, Shimokawa T, Takanashi S, Isobe M. Hospitalization-Associated Disability After Cardiac Surgery in Elderly Patients - Exploring the Risk Factors Using Machine Learning Algorithms. Circ Rep 2021; 3:423-430. [PMID: 34414331 PMCID: PMC8338437 DOI: 10.1253/circrep.cr-21-0057] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 06/17/2021] [Accepted: 06/22/2021] [Indexed: 01/06/2023] Open
Abstract
Background:
Hospitalization-associated disability (HAD) is associated with prolonged functional decline and increased mortality after discharge. Therefore, we examined the incidence and risk factors associated with HAD in elderly patients undergoing cardiac surgery in Japan. Methods and Results:
We retrospectively examined 2,262 elderly patients who underwent elective cardiac surgery at Sakakibara Heart Institute. HAD was defined as a functional decline between time of admission and discharge measured by the Barthel Index. We analyzed clinical characteristics using machine learning algorithms to identify the risk factors associated with HAD. After excluding 203 patients, 2,059 patients remained, of whom 108 (5.2%) developed HAD after cardiac surgery. The risk factors identified were age, serum albumin concentration, estimated glomerular filtration rate, Revised Hasegawa’s Dementia Scale, N-terminal pro B-type natriuretic peptide, vital capacity, preoperative Short Physical Performance Battery (SPPB) score, operation times, cardiopulmonary bypass times, ventilator times, length of postoperative intensive care unit stay, and postoperative ambulation start day. The highest incidence of HAD was found in patients with an SPPB score ≤9 and in those who started ambulation >6 days after surgery (76.9%). Conclusions:
Several risk factors for HAD are components of frailty, suggesting that preoperative rehabilitation to reduce the risk of HAD is feasible. Furthermore, the association between HAD and a delayed start of ambulation reaffirms the importance of early mobilization and rehabilitation.
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Affiliation(s)
- Kentaro Hori
- Department of Rehabilitation, Sakakibara Heart Institute Tokyo Japan
| | - Koyo Usuba
- Research Centre for Evaluating Children's Health Outcomes (ECHO), Laurentian University Sudbury, ON Canada.,Child Health Evaluative Sciences Program, Research Institute, The Hospital for Sick Children (SickKids) Toronto, ON Canada
| | - Akihiro Sakuyama
- Department of Physical Therapy, Faculty of Health Science, Juntendo University Tokyo Japan
| | - Yuichi Adachi
- Department of Rehabilitation, Sakakibara Heart Institute Tokyo Japan
| | - Kotaro Hirakawa
- Department of Rehabilitation, Sakakibara Heart Institute Tokyo Japan
| | - Atsuko Nakayama
- Department of Cardiology, Sakakibara Heart Institute Tokyo Japan
| | | | - Tomoki Shimokawa
- Department of Cardiovascular Surgery, Sakakibara Heart Institute Tokyo Japan.,Department of Cardiovascular Surgery, Teikyo University Hospital Tokyo Japan
| | - Shuichiro Takanashi
- Department of Cardiovascular Surgery, Sakakibara Heart Institute Tokyo Japan.,Department of Cardiovascular Surgery, Kawasaki Saiwai Hospital Kanagawa Japan
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15
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Morisawa T, Saitoh M, Otsuka S, Takamura G, Tahara M, Ochi Y, Takahashi Y, Iwata K, Oura K, Sakurada K, Takahashi T. Perioperative changes in physical performance affect short-term outcome in elderly cardiac surgery patients. Geriatr Gerontol Int 2021; 21:676-682. [PMID: 34212472 DOI: 10.1111/ggi.14227] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 02/03/2021] [Accepted: 06/14/2021] [Indexed: 01/06/2023]
Abstract
AIM The effect of changes in physical performance during the perioperative period on the prognosis of older patients undergoing cardiac surgery has not been studied in detail. This study aimed to investigate the effect of perioperative changes in physical performance on the prognosis of older patients undergoing cardiac surgery. METHODS A total of 223 patients were graded as either frail or non-frail according to a cutoff score of 9 based on preoperative Short Physical Performance Battery scores. The non-frail patients were further grouped into high, recovery, or decreased score groups, depending on their score at the time of discharge compared with preoperative scores. Basic characteristics, preoperative and postoperative clinical data, 6-month post-discharge mortality, readmission rates, and vital function (Kihon Checklist scores) were compared. RESULTS In total, 16.1% of patients were in the frail group, while 18.4%, 35.4%, and 30.1% were in the decreased, recovery, and high score groups, respectively. The Short Physical Performance Battery scores in the decreased group were significantly lower at discharge, and the rate of readmission was significantly higher (17.7%, P < 0.05). In addition, the Kihon Checklist scores were significantly lower than the preoperative scores (5.7 ± 4.0 vs 8.6 ± 5.5, P < 0.05). CONCLUSIONS Both preoperative and postoperative physical performance must be considered when predicting the prognosis of older patients undergoing cardiac surgery. Geriatr Gerontol Int 2021; 21: 676-682.
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Affiliation(s)
| | - Masakazu Saitoh
- Department of Physical Therapy, Juntendo University, Tokyo, Japan
| | - Shota Otsuka
- Department of Rehabilitation, The Sakakibara Heart Institute of Okayama, Okayama, Japan
| | - Go Takamura
- Department of Rehabilitation, Tsuchiya General Hospital, Hiroshima, Japan
| | - Masayuki Tahara
- Department of Physical Therapy, Higashi Takarazuka Satoh Hospital, Takarazuka-shi, Japan
| | - Yusuke Ochi
- Department of Rehabilitation, Fukuyama Cardiovascular Hospital, Fukuyama-shi, Japan
| | - Yo Takahashi
- Department of Rehabilitation, Tomishiro Central Hospital, Okinawa, Japan
| | - Kentaro Iwata
- Department of Rehabilitation, Kobe City Medical Center General Hospital, Kobe-shi, Japan
| | - Keisuke Oura
- Department of Rehabilitation, Kansai Electronic Power Hospital, Osaka-shi, Japan
| | - Koji Sakurada
- Department of Rehabilitation, The Cardiovascular Institute, Tokyo, Japan
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16
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Morisawa T, Saitoh M, Takahashi T, Watanabe H, Mochizuki M, Kitahara E, Fujiwara T, Fujiwara K, Nishitani-Yokoyama M, Minamino T, Shimada K, Honzawa A, Shimada A, Yamamoto T, Asai T, Amano A, Daida H. Association of phase angle with hospital-acquired functional decline in older patients undergoing cardiovascular surgery. Nutrition 2021; 91-92:111402. [PMID: 34364266 DOI: 10.1016/j.nut.2021.111402] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Revised: 06/14/2021] [Accepted: 06/20/2021] [Indexed: 12/15/2022]
Abstract
OBJECTIVE The aim of this study was to examine whether preoperative phase angle (PhA) measured by bioelectrical impedance analysis was associated with a hospital-acquired functional decline in older patients undergoing cardiovascular surgery. METHODS This was an observational study of prospectively collected data of 114 patients (>65 y of age) with cardiovascular disease who underwent elective cardiovascular surgery between September 2019 and August 2020. Patients were classified into tertiles based on PhA levels. Factors associated with the occurrence of hospital-acquired functional decline (postoperative recovery to preoperative physical function was not possible) were analyzed using univariate and multivariate analyses. RESULTS Patients in the low PhA group were significantly older than those in the middle and high PhA groups; were predominantly women; had higher New York Heart Association cardiovascular and EuroSCORE severity scores; and had significantly lower levels of body mass index, Geriatric Nutritional Risk Index, hemoglobin, and albumin. There was a significant correlation between PhA and nutrition and physical function. The incidence of hospital-acquired functional decline occurred in 26.3% of all patients, with a significantly higher incidence in patients in the low PhA group. Multivariate analysis showed that PhA was extracted as a factor for the hospital-acquired functional decline in all the models. CONCLUSIONS PhA was associated with hospital-acquired functional decline in older patients undergoing cardiovascular surgery. PhA is likely to be a comprehensive indicator of physical health that indicates nutritional status, physical function, and geriatric syndrome (frailty/sarcopenia), and is an important predictor of hospital-acquired functional decline in this group of older patients.
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Affiliation(s)
- Tomoyuki Morisawa
- Faculty of Health Science, Juntendo University, Tokyo, Japan; Department of Rehabilitation, Juntendo University Hospital, Tokyo, Japan.
| | - Masakazu Saitoh
- Faculty of Health Science, Juntendo University, Tokyo, Japan; Department of Rehabilitation, Juntendo University Hospital, Tokyo, Japan
| | - Tetsuya Takahashi
- Faculty of Health Science, Juntendo University, Tokyo, Japan; Department of Rehabilitation, Juntendo University Hospital, Tokyo, Japan
| | - Hidetaka Watanabe
- Department of Rehabilitation, Juntendo University Hospital, Tokyo, Japan
| | | | - Eriko Kitahara
- Department of Rehabilitation, Juntendo University Hospital, Tokyo, Japan
| | - Toshiyuki Fujiwara
- Faculty of Health Science, Juntendo University, Tokyo, Japan; Department of Rehabilitation, Juntendo University Hospital, Tokyo, Japan; Department of Rehabilitation Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Kei Fujiwara
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Miho Nishitani-Yokoyama
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Tohru Minamino
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | | | - Akio Honzawa
- Cardiovascular Rehabilitation and Fitness, Juntendo University Hospital, Tokyo, Japan
| | - Akie Shimada
- Department of Cardiovascular Surgery, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Taira Yamamoto
- Department of Cardiovascular Surgery, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Tohru Asai
- Department of Cardiovascular Surgery, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Atsushi Amano
- Department of Cardiovascular Surgery, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Hiroyuki Daida
- Faculty of Health Science, Juntendo University, Tokyo, Japan; Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
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17
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Morimoto Y, Matsuo T, Yano Y, Fukushima T, Eishi K, Kozu R. Impact of sarcopenia on the progress of cardiac rehabilitation and discharge destination after cardiovascular surgery. J Phys Ther Sci 2021; 33:213-221. [PMID: 33814707 PMCID: PMC8012189 DOI: 10.1589/jpts.33.213] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Accepted: 12/01/2020] [Indexed: 11/24/2022] Open
Abstract
[Purpose] To investigate the factors that affect the progress of cardiac rehabilitation, length of stay in the hospital, and discharge destination after cardiovascular surgery. [Participants and Methods] This was a prospective observational study. Sixty-seven patients scheduled to undergo open-heart surgery were included in the study. We evaluated physical and psychiatric functions pre- and post-surgery. Sarcopenia was defined as a short physical performance battery score of <9.5. [Results] Sarcopenia was a significant factor of delay of the day of the first rehabilitation, independence in 100-m walking, and exercise training at the rehabilitation gym. Comparisons between pre- and post-surgery were performed in the sarcopenia group. No significant decreases in physical and psychiatric functions were found. The discharge transfer rate was significantly different between the sarcopenia and non-sarcopenia groups. Sarcopenia and the decline in balance score significantly correlated with discharge transfer. [Conclusion] Cardiac rehabilitation can achieve recovery of physical and psychiatric functions even in patients with sarcopenia; however, the discharge transfer rate among the patients with sarcopenia was high. Improving balance ability may result in early home discharge.
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Affiliation(s)
- Yosuke Morimoto
- Department of Physical Therapy, Faculty of Rehabilitation,
Kobe Gakuin University: 518 Ikawadanicho, Arise, Nishi-ku, Kobe, Hyogo 651-2180,
Japan
| | - Tomohiro Matsuo
- Department of Rehabilitation, Nishi Memorial Port-island
Rehabilitation Hospital, Japan
| | - Yudai Yano
- Department of Rehabilitation Medicine, Nagasaki University
Hospital, Japan
| | - Takuya Fukushima
- Department of Musculoskeletal Oncology and Rehabilitation,
National Cancer Center Hospital, Japan
| | - Kiyoyuki Eishi
- Department of Cardiovascular Surgery, Nagasaki University
Hospital, Japan
| | - Ryo Kozu
- Department of Rehabilitation Medicine, Nagasaki University
Hospital, Japan
- Department of Cardiopulmonary Rehabilitation Science,
Nagasaki University Graduate School of Biomedical Sciences, Japan
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18
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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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19
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Ventilatory efficiency during ramp exercise in relation to age and sex in a healthy Japanese population. J Cardiol 2020; 77:57-64. [PMID: 32768174 DOI: 10.1016/j.jjcc.2020.07.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 06/03/2020] [Accepted: 06/25/2020] [Indexed: 12/29/2022]
Abstract
BACKGROUND The current understanding of ventilator efficiency variables during ramp exercise testing in the normal Japanese population is insufficient, and the responses of tidal volume (VT) and minute ventilation (V̇E) to the ramp exercise test in the normal Japanese population are not known. METHODS A total of 529 healthy Japanese subjects aged 20-78 years underwent cardiopulmonary exercise testing using a cycle ergometer with ramp protocols. VT and V̇E at rest, at anaerobic threshold, and at peak exercise were determined. The slope of V̇E versus carbon dioxide (V̇CO2) (V̇E vs. V̇CO2 slope), minimum V̇E/V̇CO2, and oxygen uptake efficiency slope (OUES) were determined. RESULTS For males and females in their 20 s, peak VT (VTpeak) was 2192 ± 376 and 1509 ± 260 mL (p < 0.001), peak V̇E (V̇Epeak) was 80.6 ± 18.7 and 57.7 ± 13.9 L/min (sex differences p < 0.001), the V̇E vs. V̇CO2 slope was 24.4 ± 3.2 and 25.7 ± 3.2 (p = 0.035), the minimum V̇E/V̇CO2 was 24.2 ± 2.3 and 27.0 ± 2.8 (p < 0.001), and the OUES was 2452 ± 519 and 1991 ± 315 (p < 0.001), respectively. VTpeak and V̇Epeak decreased with age and increased with weight and height. The V̇E vs. V̇CO2 slope and minimum V̇E/V̇CO2 increased with age, while conversely, the OUES decreased with age. CONCLUSIONS We have established the normal range of VT and V̇E responses, the V̇E vs. V̇CO2 slope, the minimum V̇E/V̇CO2, and the OUES for a healthy Japanese population. Some of these parameters were influenced by weight, height, sex, and age. These results provide useful reference values for interpreting the results of cardiopulmonary exercise testing in cardiac patients.
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20
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Mori M, Djulbegovic M, Hajduk AM, Holland ML, Krumholz HM, Chaudhry SI. Changes in Functional Status and Health-Related Quality of Life in Older Adults After Surgical, Interventional, or Medical Management of Acute Myocardial Infarction. Semin Thorac Cardiovasc Surg 2020; 33:72-81. [PMID: 32439546 DOI: 10.1053/j.semtcvs.2020.05.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 05/01/2020] [Indexed: 02/07/2023]
Abstract
Functional status and health-related quality of life (HRQoL) are important outcomes, particularly among older patients. However, data on such patient-centered outcomes after cardiac surgery are limited. We evaluated the incidence and predictors of decline in functional status and HRQoL among older patients hospitalized for acute myocardial infarction (AMI). Participants were age 75 years or older hospitalized for AMI at 94 US sites. We examined decline in functional status (defined as decline in 1 or more activities of daily living, ADLs), as well as mental (MCS) and physical component scales (PCS) of the SF-12 to assess HRQoL (5-point decline or greater in each scale) between 1 month prior to the hospitalization and 6 months after. Multivariable model compared the risk of decline after coronary artery bypass graft (CABG), percutaneous coronary intervention (PCI) and medical management. Among 3041 patients (1708 PCI, 362 CABG, and 971 medical management), 1525 (50.2%) experienced decline in 1 or more domain: 633 (20.8%) declined in ADLs, 786 (25.9%) declined in the MCS, and 1078 (35.5%) declined in the PCS. The unadjusted incidence of ADL decline was the lowest among patients who underwent CABG (n = 50, 13.8%) compared with PCI (n = 271, 15.9%) or medical management (n = 312, 32.1%). Patients who underwent CABG and PCI had lower adjusted risk of decline in functional and HRQoL compared with those who received medical therapy. The risks after CABG and PCI were not significantly different. Over half of older patients significantly declined in function or HRQoL after AMI. Compared with medical management, risk of decline was lower in those who underwent revascularization.
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Affiliation(s)
- Makoto Mori
- Section of Cardiac Surgery, Yale School of Medicine, New Haven, Connecticut; Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut.
| | - Mia Djulbegovic
- National Clinician Scholars Program, Yale University School of Medicine, New Haven, Connecticut; Veterans Affairs Connecticut Healthcare System, West Haven, Connecticut
| | - Alexandra M Hajduk
- Section of General Internal Medicine, Department of Medicine, Yale School of Medicine, New Haven, Connecticut
| | | | - Harlan M Krumholz
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut; Department of Health Policy and Management, Yale School of Public Health, New Haven, Connecticut
| | - Sarwat I Chaudhry
- Section of General Internal Medicine, Department of Medicine, Yale School of Medicine, New Haven, Connecticut
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