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Itoh H, Amiya E, Jimba T, Shimbo M, Narita K, Taya M, Kadokami T, Yasu T, Oka H, Sogawa M, Yokoi H, Mizutani K, Miura SI, Tokeshi T, Date A, Noma T, Kutsuzawa D, Usui S, Sugawara S, Kanazawa M, Sekino H, Nishitani Yokoyama M, Okumura T, Ugata Y, Fujishima S, Hirabayashi K, Ishizaki Y, Kuwahara K, Kaji Y, Shimizu H, Koyama T, Adachi H, Kurumatani Y, Taniguchi R, Ohori K, Shiraishi H, Hasegawa T, Makita S, Komuro I, Kimura Y. Efficacy and safety of remote cardiac rehabilitation in the recovery phase of cardiovascular diseases (RecRCR study): A multicenter, nonrandomized, and interventional trial in Japan. IJC HEART & VASCULATURE 2024; 52:101421. [PMID: 38799401 PMCID: PMC11127237 DOI: 10.1016/j.ijcha.2024.101421] [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: 01/31/2024] [Revised: 04/18/2024] [Accepted: 05/02/2024] [Indexed: 05/29/2024]
Abstract
Backgrounds Remote cardiac rehabilitation has proven useful in patients with cardiovascular disease; however, the methodology had not been fully validated. This study aimed to investigate the efficacy and safety of remote cardiac rehabilitation (RCR) with real-time monitoring and an ergometer using a bidirectional communication tool during the recovery phase of cardiovascular diseases. Methods This multicenter, nonrandomized, interventional study was conducted at 29 institutions across Japan and enrolled patients with cardiovascular diseases who met indications for cardiac rehabilitation (CR) after receiving in-hospital treatment. The RCR group exercised at home using an ergometer and was monitored in real-time using interactive video and monitoring tools for 2-3 months. Educational instructions were provided concurrently through e-learning approaches. The safety of the RCR protocol and the improvement in peak oxygen consumption (VO2) were compared with those of the historical control group that participated in center-based CR. Results Fifty-three patients from the RCR group were compared with 103 historical controls having similar background characteristics. No patients in RCR experienced significant cardiovascular complications while engaging in exercise sessions. After 2-3 months of RCR, the peak VO2 improved significantly, and the increases in the RCR group did not exhibit any significant differences compared to those in the historical controls. During follow-up, the proportion of patients whose exercise capacity increased by 10% or more was also evaluated; this finding did not indicate a statistically significant distinction between the groups. Conclusions RCR during the recovery phase of cardiovascular diseases proved equally efficient and safe as center-based CR.
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Affiliation(s)
- Hidetaka Itoh
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Eisuke Amiya
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
- Department of Therapeutic Strategy for Heart Failure, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Takahiro Jimba
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Mai Shimbo
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Koichi Narita
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Masanobu Taya
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | | | - Takanori Yasu
- Department of Cardiovascular Medicine and Nephrology, Dokkyo Medical University Nikko Medical Center, Tochigi, Japan
| | | | | | | | | | - Shin-ichiro Miura
- Department of Cardiology, Fukuoka University School of Medicine, Fukuoka, Japan
| | | | - Ayumi Date
- Asahikawa Medical University Hospital, Hokkaido, Japan
| | - Takahisa Noma
- Department of Cardiorenal and Cerebrovascular Medicine, Faculty of Medicine, Kagawa University, Kagawa, Japan
| | - Daisuke Kutsuzawa
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine, Yamagata, Japan
| | - Soichiro Usui
- Department of Cardiovascular Medicine, Kanazawa University School of Medical Science, Ishikawa, Japan
| | | | - Masanori Kanazawa
- Department of Cardiology, Iwate Prefectural Central Hospital, Iwate, Japan
| | - Hisakuni Sekino
- Department of Cardiac Surgery, Association of Healthcare Corporation Kyufukukai Sekino Hospital, Tokyo, Japan
| | - Miho Nishitani Yokoyama
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Takahiro Okumura
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yusuke Ugata
- Jichi Medical University Saitama Medical Center, Saitama, Japan
| | | | | | - Yuta Ishizaki
- Kurume University School of Medicine, Fukuoka, Japan
| | - Koichiro Kuwahara
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, Nagano, Japan
| | - Yuko Kaji
- Department of Nursing, Hiraka General Hospital, Akita, Japan
| | - Hiroki Shimizu
- Department of Cardiology, Konan Medical Center, Hyogo, Japan
| | | | | | | | - Ryoji Taniguchi
- Hyogo Prefectural Amagasaki General Medical Center, Hyogo, Japan
| | - Katsuhiko Ohori
- Department of Cardiology, Hokkaido Cardiovascular Hospital, Hokkaido, Japan
| | - Hirokazu Shiraishi
- Department of Cardiovascular Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | | | - Shigeru Makita
- Kawaguchi Cupola Rehabilitation Hospital/Saitama Medical University International Medical Center, Saitama, Japan
| | - Issei Komuro
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
- Department of Frontier Cardiovascular Science, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
- International University of Health and Welfare, Tokyo, Japan
| | | | - RecRCR registry investigators
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
- Department of Therapeutic Strategy for Heart Failure, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
- Saiseikai Futsukaichi Hospital, Fukuoka, Japan
- Department of Cardiovascular Medicine and Nephrology, Dokkyo Medical University Nikko Medical Center, Tochigi, Japan
- Nijigaoka Hospital, Nagasaki, Japan
- Moriyama Memorial Hospital, Tokyo, Japan
- Fukuoka Sanno Hospital, Fukuoka, Japan
- Rokko Island Konan Hospital, Hyogo, Japan
- Department of Cardiology, Fukuoka University School of Medicine, Fukuoka, Japan
- Shonan Hospital, Okinawa, Japan
- Asahikawa Medical University Hospital, Hokkaido, Japan
- Department of Cardiorenal and Cerebrovascular Medicine, Faculty of Medicine, Kagawa University, Kagawa, Japan
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine, Yamagata, Japan
- Department of Cardiovascular Medicine, Kanazawa University School of Medical Science, Ishikawa, Japan
- Nihonkai General Hospital, Yamagata, Japan
- Department of Cardiology, Iwate Prefectural Central Hospital, Iwate, Japan
- Department of Cardiac Surgery, Association of Healthcare Corporation Kyufukukai Sekino Hospital, Tokyo, Japan
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
- Jichi Medical University Saitama Medical Center, Saitama, Japan
- Cardiovascular Center, Steel Memorial Yawata Hospital, Fukuoka, Japan
- Department of Cardiology, Tomakomai City Hospital, Hokkaido, Japan
- Kurume University School of Medicine, Fukuoka, Japan
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, Nagano, Japan
- Department of Nursing, Hiraka General Hospital, Akita, Japan
- Department of Cardiology, Konan Medical Center, Hyogo, Japan
- Kameda Medical Center, Chiba, Japan
- Gunma Prefectural Cardiovascular Center, Gunma, Japan
- Kofu Kyoritsu Hospital, Yamanashi, Japan
- Hyogo Prefectural Amagasaki General Medical Center, Hyogo, Japan
- Department of Cardiology, Hokkaido Cardiovascular Hospital, Hokkaido, Japan
- Department of Cardiovascular Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
- Japan Telemedicine Society, Japan
- Kawaguchi Cupola Rehabilitation Hospital/Saitama Medical University International Medical Center, Saitama, Japan
- Department of Frontier Cardiovascular Science, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
- International University of Health and Welfare, Tokyo, Japan
- Kansai Medical University, Osaka, Japan
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da Silveira AD, Scolari FL, Saadi MP, Brahmbhatt DH, Milani M, Milani JGPO, Junior GC, Sartor ITS, Zavaglia GO, Tonini ML, da Costa MSC, Scotta MC, Stein RT, Rosa RG. Long-term reduced functional capacity and quality of life in hospitalized COVID-19 patients. Front Med (Lausanne) 2024; 10:1289454. [PMID: 38516229 PMCID: PMC10957227 DOI: 10.3389/fmed.2023.1289454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 12/27/2023] [Indexed: 03/23/2024] Open
Abstract
Background Persistent symptoms and exercise intolerance have been reported after COVID-19, even months after the acute disease. Although, the long-term impact on exercise capacity and health-related quality of life (HRQoL) is still unclear. Research question To assess the long-term functional capacity and HRQoL in patients hospitalized due to COVID-19. Study design and methods This is a prospective cohort study, conducted at two centers in Brazil, that included post-discharge COVID-19 patients and paired controls. The cohort was paired by age, sex, body mass index and comorbidities, using propensity score matching in a 1:3 ratio. Patients were eligible if signs or symptoms suggestive of COVID-19 and pulmonary involvement on chest computed tomography. All patients underwent cardiopulmonary exercise testing (CPET) and a HRQoL questionnaire (SF-36) 6 months after the COVID-19. The main outcome was the percentage of predicted peak oxygen consumption (ppVO2). Secondary outcomes included other CPET measures and HRQoL. Results The study sample comprised 47 post-discharge COVID-19 patients and 141 healthy controls. The mean age of COVID-19 patients was 54 ± 14 years, with 19 (40%) females, and a mean body mass index of 31 kg/m2 (SD, 6). The median follow-up was 7 months (IQR, 6.5-8.0) after hospital discharge. PpVO2 in COVID-19 patients was lower than in controls (83% vs. 95%, p = 0.002) with an effect size of 0.38 ([95%CI], 0.04-0.70). Mean peak VO2 (22 vs. 25 mL/kg/min, p = 0.04) and OUES (2,122 vs. 2,380, p = 0.027) were also reduced in the COVID-19 patients in comparison to controls. Dysfunctional breathing (DB) was present in 51%. HRQoL was significantly reduced in post COVID patients and positively correlated to peak exercise capacity. Interpretation Hospitalized COVID-19 patients presented, 7 months after discharge, with a reduction in functional capacity and HRQoL when compared to historical controls. HRQoL were reduced and correlated with the reduced peak VO2 in our population.
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Affiliation(s)
- Anderson Donelli da Silveira
- Division of Cardiology, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
- Postgraduate Program in Cardiology, Universidade Federal do Rio Grande do Sul, Rio de Janeiro, Brazil
| | - Fernando Luis Scolari
- Division of Cardiology, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
- Postgraduate Program in Cardiology, Universidade Federal do Rio Grande do Sul, Rio de Janeiro, Brazil
- Ted Rogers Centre for Heart Research, Peter Munk Cardiac Centre, University of Toronto, Toronto, ON, Canada
- Social Responsibility, Hospital Moinhos de Vento, Porto Alegre, Brazil
| | - Marina Petersen Saadi
- Division of Cardiology, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
- Postgraduate Program in Cardiology, Universidade Federal do Rio Grande do Sul, Rio de Janeiro, Brazil
| | - Darshan H. Brahmbhatt
- Ted Rogers Centre for Heart Research, Peter Munk Cardiac Centre, University of Toronto, Toronto, ON, Canada
| | - Mauricio Milani
- Hasselt University, REVAL/BIOMED, Hasselt, Belgium
- Health Sciences and Technologies Graduate Program, University of Brasilia (UnB), Brasilia, Brazil
| | | | - Gerson Cipriano Junior
- Health Sciences and Technologies Graduate Program, University of Brasilia (UnB), Brasilia, Brazil
| | | | | | - Maiko Luis Tonini
- General Coordination, Chronic and Airborne Disease Surveillance Coordination, Health Surveillance Secretariat, Brazilian Ministry of Health, Brasilia, Brazil
| | - Marcela Santos Correa da Costa
- General Coordination, National Immunization Program, Health Surveillance Secretariat, Brazilian Ministry of Health, Brasilia, Brazil
| | | | - Renato T. Stein
- Social Responsibility, Hospital Moinhos de Vento, Porto Alegre, Brazil
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Brouwers RWM, Scherrenberg M, Kemps HMC, Dendale P, Snoek JA. Cardiac telerehabilitation: current status and future perspectives. Neth Heart J 2024; 32:31-37. [PMID: 38085505 PMCID: PMC10781917 DOI: 10.1007/s12471-023-01833-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/20/2023] [Indexed: 01/04/2024] Open
Abstract
Multidisciplinary cardiac rehabilitation (CR) improves the prognosis and quality of life of patients with cardiovascular disease and has therefore received strong recommendations in international guidelines for the treatment of patients with chronic coronary syndromes and chronic heart failure. Aiming to both resolve several barriers that impede participation in CR and to improve the effectiveness of CR, cardiac telerehabilitation (CTR) has emerged as a cost-effective alternative to traditional, centre-based CR. Although the body of evidence for the feasibility and effectiveness of CTR is large and still growing, real-life implementations are scarce, which may be due to insufficient knowledge about CTR interventions and due to the challenges its implementation comes with. Up to now, mainly exercise-related core components of CR and e‑coaching have been investigated in the setting of CTR. Translation of research findings to clinical practice may be hampered by methodological limitations present in most CTR studies, being selection bias of participants, lack of long-term follow-up, heterogeneity of studied interventions and the lack of robust outcome measures. Besides conducting highly needed implementation studies for CTR interventions, their implementation could be facilitated by the development of guideline-based, multidisciplinary and personalised CTR programmes and widespread reimbursement for CTR.
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Affiliation(s)
- Rutger W M Brouwers
- Department of Cardiology, Máxima Medical Center, Veldhoven, The Netherlands.
- Heart Centre, Catharina Hospital, Eindhoven, The Netherlands.
- Department of Industrial Design, Eindhoven University of Technology, Eindhoven, The Netherlands.
| | - Martijn Scherrenberg
- Heart Centre Hasselt, Jessa Hospital, Hasselt, Belgium
- Faculty of Medicine and Health Sciences, Antwerp University, Antwerp, Belgium
- Faculty of Medicine and Life Sciences, Hasselt University, Diepenbeek, Belgium
| | - Hareld M C Kemps
- Department of Cardiology, Máxima Medical Center, Veldhoven, The Netherlands
- Department of Industrial Design, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Paul Dendale
- Heart Centre Hasselt, Jessa Hospital, Hasselt, Belgium
- Faculty of Medicine and Health Sciences, Antwerp University, Antwerp, Belgium
- Faculty of Medicine and Life Sciences, Hasselt University, Diepenbeek, Belgium
| | - Johan A Snoek
- Isala Heart Centre, Zwolle, The Netherlands
- Sports Medicine Department, Isala, Zwolle, The Netherlands
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Heutinck JM, de Koning IA, Vromen T, Thijssen DHJ, Kemps HMC. Exercise-based cardiac rehabilitation in stable angina pectoris: a narrative review on current evidence and underlying physiological mechanisms. Neth Heart J 2024; 32:23-30. [PMID: 37982981 PMCID: PMC10781904 DOI: 10.1007/s12471-023-01830-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/10/2023] [Indexed: 11/21/2023] Open
Abstract
Stable angina pectoris (SAP) is a prevalent condition characterised by a high disease burden. Based on recent evidence, the need for revascularisation in addition to optimal medical treatment to reduce mortality and re-events is heavily debated. These observations may be explained by the fact that revascularisation is targeted at the local flow-limiting coronary artery lesion, while the aetiology of SAP relates to the systemic, inflammatory process of atherosclerosis, causing generalised vascular dysfunction throughout the entire vascular system. Moreover, cardiovascular events are not solely caused by obstructive plaques but are also associated with plaque burden and high-risk plaque features. Therefore, to reduce the risk of cardiovascular events and angina, and thereby improve quality of life, alternative therapeutic approaches to revascularisation should be considered, preferably targeting the cardiovascular system as a whole with a physiological approach. Exercise-based cardiac rehabilitation fits this description and is a promising strategy as a first-line treatment in addition to optimal medical treatment. In this review, we discuss the role of exercise-based cardiac rehabilitation in SAP in relation to the underlying physiological mechanisms, we summarise the existing evidence and highlight future directions.
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Affiliation(s)
- Joyce M Heutinck
- Department of Medical BioSciences, Radboud University Medical Center, Nijmegen, The Netherlands.
- Department of Industrial Design, Eindhoven University of Technology, Eindhoven, The Netherlands.
| | - Iris A de Koning
- Department of Medical BioSciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Tom Vromen
- Department of Cardiology, Maxima Medical Centre, Veldhoven, The Netherlands
| | - Dick H J Thijssen
- Department of Medical BioSciences, Radboud University Medical Center, Nijmegen, The Netherlands
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK
| | - Hareld M C Kemps
- Department of Industrial Design, Eindhoven University of Technology, Eindhoven, The Netherlands
- Department of Cardiology, Maxima Medical Centre, Veldhoven, The Netherlands
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den Uijl I, Sunamura M, Brouwers RMW, Stam HJ, Boersma E, van den Berg-Emons RJG, Ter Hoeve N. Cardiac rehabilitation for patients with obesity: lessons learned from the OPTICARE XL trial. Neth Heart J 2024; 32:14-22. [PMID: 37982980 PMCID: PMC10781911 DOI: 10.1007/s12471-023-01832-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/19/2023] [Indexed: 11/21/2023] Open
Abstract
Obesity is a known and commonly encountered risk factor for the development of cardiac diseases. Patients with cardiac diseases who also have obesity do not benefit optimally from standard cardiac rehabilitation (CR) programs. Exercises performed during CR are not the best fit for patients with obesity and counselling sessions often do not address their specific needs. OPTICARE XL is the first large multicentre randomised controlled trial to investigate the added value of a dedicated one-year CR program specifically designed for patients with obesity and integrated in daily practice. The short-term effects on body weight and physical activity were promising and patients with obesity experienced the program as highly desirable. However, the OPTICARE XL CR program did not show long-term added value compared with standard CR on health-related quality of life, psychosocial well-being, body weight, physical activity and physical fitness, nor on costs. The current article offers an overview of the background of this trial and discusses the most important results of the OPTICARE XL trial and the reasons behind the unanticipated long-term outcomes. Furthermore, it offers recommendations for future research and how to redesign the OPTICARE XL CR program to expand the short-term results.
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Affiliation(s)
- Iris den Uijl
- Department of Rehabilitation Medicine, Erasmus University Medical Centre, Rotterdam, The Netherlands
- Capri Cardiac Rehabilitation, Rotterdam, The Netherlands
| | | | - Rutger M W Brouwers
- Department of Cardiology, Máxima Medical Centre, Eindhoven/Veldhoven, The Netherlands
| | - Henk J Stam
- Department of Rehabilitation Medicine, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Eric Boersma
- Department of Cardiology, Thoraxcenter, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | | | - Nienke Ter Hoeve
- Department of Rehabilitation Medicine, Erasmus University Medical Centre, Rotterdam, The Netherlands.
- Capri Cardiac Rehabilitation, Rotterdam, The Netherlands.
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Dijkstra S, Hartog J, Fleer J, van der Harst P, van der Woude LHV, Mariani MA. Feasibility of preoperative and postoperative physical rehabilitation for cardiac surgery patients - a longitudinal cohort study. BMC Sports Sci Med Rehabil 2023; 15:173. [PMID: 38115103 PMCID: PMC10731823 DOI: 10.1186/s13102-023-00786-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 12/07/2023] [Indexed: 12/21/2023]
Abstract
BACKGROUND This study aimed to determine the feasibility of a preoperative and postoperative (in- and outpatient) physical rehabilitation program, the Heart-ROCQ-pilot program. METHODS This cohort study included patients undergoing cardiac surgery (including coronary artery bypass graft surgery, valve surgery, aortic surgery, or combinations of these surgeries) and participated in the Heart-ROCQ-pilot program. Feasibility involved compliance and characteristics of bicycle and strength training sessions in the three rehabilitation phases. RESULTS Of the eligible patients, 56% (n = 74) participated in the program (41% of exclusions were due to various health reasons). On average across the rehabilitation phases, the compliance rates of bicycle and strength training were 88% and 83%, respectively. Workload to heart rate (W/HR) ratio and total absolute volume load for bicycle and strength training, respectively, improved in each rehabilitation phase (P < 0.05). The W/HR-ratio was higher during the last postoperative session compared to the first preoperative session (0.48 to 0.63 W/beat, P < 0.001) and similar to the last preoperative session (0.65 to 0.64 W/beat, P < 0.497). During less than 1% of the bicycle sessions, patients reported discomfort scores of 5 to 6 (scale 0-10, with higher scores indicating a higher level). CONCLUSIONS The Heart-ROCQ-pilot program was feasible for patients awaiting cardiac surgery. Patients were very compliant and were able to safely increase the training load before surgery and regained this improvement within eight weeks after surgery.
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Affiliation(s)
- Sandra Dijkstra
- Department of Cardio-Thoracic Surgery, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands.
| | - Johanneke Hartog
- Department of Cardio-Thoracic Surgery, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
| | - Joke Fleer
- Department of Health Sciences, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
| | - Pim van der Harst
- Department of Cardiology, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
- Department of Cardiology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Lucas H V van der Woude
- Center for Human Movement Sciences, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
- Department of Rehabilitation Medicine, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
| | - Massimo A Mariani
- Department of Cardio-Thoracic Surgery, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
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Perone F, Ancona R, di Stasio F, La Gambina V, Comenale Pinto S. Myocardial Work Assessment in Patients after Coronary Artery Bypass Grafting during Cardiac Rehabilitation. J Clin Med 2023; 12:7540. [PMID: 38137609 PMCID: PMC10744037 DOI: 10.3390/jcm12247540] [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: 11/15/2023] [Revised: 11/30/2023] [Accepted: 12/03/2023] [Indexed: 12/24/2023] Open
Abstract
BACKGROUND Myocardial work is an innovative echocardiographic tool to assess left ventricular performance. Emerging data have shown the added value of this method for evaluating cardiac function compared to traditional echocardiographic parameters and global longitudinal strain. However, few studies are present in the literature about the role of myocardial work during cardiac rehabilitation. Our aim was to assess the impact of a rehabilitation program on myocardial work indices in patients with preserved left ventricular ejection fraction and after coronary artery bypass grafting. In addition, we assessed the correlation between baseline myocardial work indices and their change after cardiac rehabilitation, establishing an optimal cut-off value to predict the improvement. METHODS An observational, single-center, and prospective study was conducted. We enrolled patients referred to cardiac rehabilitation after coronary artery bypass grafting and with preserved left ventricular ejection fraction. Before and after the cardiac rehabilitation program, a comprehensive patient assessment was performed, including traditional transthoracic echocardiography, myocardial work analysis, and a six-minute walk test. RESULTS Eighty-four patients were enrolled; the mean age was 67.96 (±7.42) years and 78.6% were male. The left ventricular ejection fraction was preserved in all patients, and the global longitudinal strain was -16.18 ± 2.55%, the global work index was 1588.56 ± 345 mmHg%, the global constructive work was 1771.27 ± 366.36 mmHg%, the global wasted work was 105.8 ± 72.02 mmHg%, and the global work efficiency was 92.63 ± 3.9% at baseline. After the cardiac rehabilitation program, the global work index, the global constructive work, and the six-minute walk test improved significantly (1588.56 ± 345 vs. 1960.2 ± 377.03 mmHg%, p-value < 0.001; 1771.27 ± 366.36 vs. 2172.01 ± 418.73 mmHg%, p-value < 0.001; 70.71 ± 40.2 vs. 437.5 ± 108.70 m, p-value < 0.001, respectively). CONCLUSIONS Myocardial work indices, specifically global work index and global constructive work, improve after cardiac rehabilitation program in patients undergoing coronary artery bypass grafting with preserved left ventricular ejection fraction.
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Affiliation(s)
- Francesco Perone
- Cardiac Rehabilitation Unit, Rehabilitation Clinic “Villa delle Magnolie”, 81020 Castel Morrone, Italy; (F.d.S.); (V.L.G.); (S.C.P.)
| | - Roberta Ancona
- Pediatric Cardiology Unit and ICCU, A.O.R.N. dei Colli, Monaldi Hospital, “L.Vanvitelli” University, 80131 Naples, Italy;
| | - Fausto di Stasio
- Cardiac Rehabilitation Unit, Rehabilitation Clinic “Villa delle Magnolie”, 81020 Castel Morrone, Italy; (F.d.S.); (V.L.G.); (S.C.P.)
| | - Vito La Gambina
- Cardiac Rehabilitation Unit, Rehabilitation Clinic “Villa delle Magnolie”, 81020 Castel Morrone, Italy; (F.d.S.); (V.L.G.); (S.C.P.)
| | - Salvatore Comenale Pinto
- Cardiac Rehabilitation Unit, Rehabilitation Clinic “Villa delle Magnolie”, 81020 Castel Morrone, Italy; (F.d.S.); (V.L.G.); (S.C.P.)
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Braver J, Marwick TH, Oldenburg B, Issaka A, Carrington MJ. Digital Health Programs to Reduce Readmissions in Coronary Artery Disease: A Systematic Review and Meta-Analysis. JACC. ADVANCES 2023; 2:100591. [PMID: 38938339 PMCID: PMC11198697 DOI: 10.1016/j.jacadv.2023.100591] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 05/25/2023] [Accepted: 06/09/2023] [Indexed: 06/29/2024]
Abstract
Background The use of mobile health (mHealth, wireless communication devices, and/or software technologies) in health care delivery has increased rapidly in recent years. Their integration into disease management programs (DMPs) has tremendous potential to improve outcomes for patients with coronary artery disease (CAD), yet a more robust evaluation of the evidence is required. Objectives The purpose of this study was to undertake a systematic review and meta-analysis of mHealth-enabled DMPs to determine their effectiveness in reducing readmissions and mortality in patients with CAD. Methods We systematically searched English language studies from January 1, 2007, to August 3, 2021, in multiple databases. Studies comparing mHealth-enabled DMPs with standard DMPs without mHealth were included if they had a minimum 30-day follow-up for at least one of all-cause or cardiovascular-related mortality, readmissions, or major adverse cardiovascular events. Results Of the 3,411 references from our search, 155 full-text studies were assessed for eligibility, and data were extracted from 18 publications. Pooled findings for all-cause readmissions (10 studies, n = 1,514) and cardiac-related readmissions (9 studies, n = 1,009) indicated that mHealth-enabled DMPs reduced all-cause (RR: 0.68; 95% CI: 0.50-0.91) and cardiac-related hospitalizations (RR: 0.55; 95% CI: 0.44-0.68) and emergency department visits (RR: 0.37; 95% CI: 0.26-0.54) compared to DMPs without mHealth. There was no significant reduction for mortality outcomes (RR: 1.72; 95% CI: 0.64-4.64) or major adverse cardiovascular events (RR: 0.68; 95% CI: 0.40-1.15). Conclusions DMPs integrated with mHealth should be considered an effective intervention for better outcomes in patients with CAD.
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Affiliation(s)
- Justin Braver
- Baker Department of Cardiometabolic Health, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Victoria, Australia
- Pre-Clinical Disease and Prevention Unit, Baker Heart and Diabetes Institute, Victoria, Australia
| | - Thomas H. Marwick
- Baker Department of Cardiometabolic Health, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Victoria, Australia
- Pre-Clinical Disease and Prevention Unit, Baker Heart and Diabetes Institute, Victoria, Australia
| | - Brian Oldenburg
- Non-Communicable Diseases and Implementation Science Unit, Baker Heart and Diabetes Institute, Victoria, Australia
- School of Psychology and Public Health, La Trobe University, Melbourne, Australia
| | - Ayuba Issaka
- Non-Communicable Diseases and Implementation Science Unit, Baker Heart and Diabetes Institute, Victoria, Australia
- School of Psychology and Public Health, La Trobe University, Melbourne, Australia
| | - Melinda J. Carrington
- Baker Department of Cardiometabolic Health, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Victoria, Australia
- Pre-Clinical Disease and Prevention Unit, Baker Heart and Diabetes Institute, Victoria, Australia
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9
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Shibata K, Kameshima M, Adachi T, Araya K, Shimada A, Tamaki M, Kitamura H. Association between outpatient cardiac rehabilitation and all-cause mortality after cardiovascular surgery: A propensity score-matched analysis. JTCVS OPEN 2023; 15:313-323. [PMID: 37808037 PMCID: PMC10556827 DOI: 10.1016/j.xjon.2023.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 05/19/2023] [Accepted: 06/07/2023] [Indexed: 10/10/2023]
Abstract
Objectives Cardiac rehabilitation (CR) is a class I recommendation in the treatment guidelines for cardiovascular disease; however, its postoperative prognostic effects after surgery are not fully understood. Therefore, this study aimed to examine the effect of multidisciplinary outpatient CR on postdischarge all-cause mortality in patients who underwent cardiovascular surgery. Methods This retrospective cohort study included consecutive patients who underwent elective cardiovascular surgery between April 2015 and March 2021. Patients were categorized into CR and non-CR groups. The primary outcome measure was all-cause mortality. Propensity score-matching analysis was performed to minimize selection bias and differences in clinical characteristics. The propensity score for each patient was produced using logistic regression analysis, with the CR group and the subsequent 27 variables as the dependent and independent variables, respectively. Results In our cohort (n = 1095), 51 patients (4.7%) died during the follow-up period (mean, 1042 days). The CR group had a significantly lower mortality rate than the non-CR group (hazard ratio, 0.45; 95% CI, 0.21-0.95; P = .036). After propensity score matching adjusted for confounders, the association between CR and reduced risk of all-cause mortality remained (hazard ratio, 0.35; 95% CI, 0.14-0.85; P = .02). Conclusions Postdischarge multidisciplinary outpatient CR in patients who underwent cardiovascular surgery was associated with a substantial survival benefit, which persisted after adjusting for variables, including age, operative factors, physical and cognitive functions, and nutritional status.
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Affiliation(s)
- Kenichi Shibata
- Department of Cardiac Rehabilitation, Nagoya Heart Center, Nagoya, Japan
| | - Masataka Kameshima
- Department of Cardiac Rehabilitation, Nagoya Heart Center, Nagoya, Japan
| | - Takuji Adachi
- Department of Integrated Health Sciences, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Kanako Araya
- Department of Nursing, Nagoya Heart Center, Nagoya, Japan
| | - Akiko Shimada
- Department of Nutrition, Nagoya Heart Center, Nagoya, Japan
| | - Mototsugu Tamaki
- Department of Cardiovascular Surgery, Nagoya Heart Center, Nagoya, Japan
| | - Hideki Kitamura
- Department of Cardiovascular Surgery, Nagoya Heart Center, Nagoya, Japan
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10
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Rehm M, Jaensch A, Schöttker B, Mons U, Hahmann H, Koenig W, Brenner H, Rothenbacher D. Medical care and biomarker-based assessment of mortality in two cohorts of patients with chronic coronary syndrome 10 years apart. BMC Cardiovasc Disord 2023; 23:428. [PMID: 37644408 PMCID: PMC10466796 DOI: 10.1186/s12872-023-03469-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 08/23/2023] [Indexed: 08/31/2023] Open
Abstract
BACKGROUND This study aimed to describe the characteristics and mortality of two cohorts of patients with chronic coronary syndrome (CCS) recruited with identical study designs in the same rehabilitation clinics but approximately 10 years apart. METHODS The KAROLA cohorts included patients with CCS participating in an inpatient cardiac rehabilitation programme in Germany (KAROLA-I: years 1999/2000, KAROLA-II: 2009-2011). Blood samples and information on sociodemographic factors, lifestyle, and medical treatment were collected at baseline, at the end of rehabilitation, and after one year of follow-up. A biomarker-based risk model (ABC-CHD model) and Cox regression analysis were used to evaluate cardiovascular (CV) and non-CV mortality risk. RESULTS We included 1130 patients from KAROLA-I (mean age 58.7 years, 84.4% men) and 860 from KAROLA-II (mean age 60.4 years, 83.4% men). Patients in the KAROLA-I cohort had significantly higher concentrations of CV biomarkers and fewer patients were taking CV medications, except for statins. The biomarker-based ABC-CHD model provided a higher estimate of CV death risk for patients in the KAROLA-I cohort (median 3-year risk, 3.8%) than for patients in the KAROLA-II cohort (median 3-year risk, 2.7%, p-value for difference < 0.001). After 10 years of follow-up, 91 (8.1%) patients in KAROLA-I and 45 (5.2%) in KAROLA-II had died from a CV event. CONCLUSIONS Advances in disease management over the past 20 years may have led to modest improvements in pharmacological treatment during cardiac rehabilitation and long-term outpatient care for patients with CCS. However, modifiable risk factors such as obesity have increased in the more recent cohort and should be targeted to further improve the prognosis of these patients.
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Affiliation(s)
- Martin Rehm
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | - Andrea Jaensch
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | - Ben Schöttker
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Ute Mons
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany
- Department of Cardiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Harry Hahmann
- Klinik Schwabenland, Isny-Neutrauchburg, Isny, Germany
| | - Wolfgang Koenig
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
- Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
- German Centre for Cardiovascular Research (DZHK), partner site Munich Heart Alliance, Munich, Germany
| | - Hermann Brenner
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany
- Division of Preventive Oncology, German Cancer Research Center (DKFZ) and National Center for Tumour Diseases (NCT), Heidelberg, Germany
- German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Dietrich Rothenbacher
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany.
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany.
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11
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Sokolski M, Kalużna-Oleksy M, Tycińska A, Jankowska EA. Telemedicine in Heart Failure in the COVID-19 and Post-Pandemic Era: What Have We Learned? Biomedicines 2023; 11:2222. [PMID: 37626719 PMCID: PMC10452788 DOI: 10.3390/biomedicines11082222] [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: 07/02/2023] [Revised: 07/27/2023] [Accepted: 08/02/2023] [Indexed: 08/27/2023] Open
Abstract
Numerous studies showed that patients with heart failure (HF) and COVID-19 are at high risk of in-hospital complications and long-term mortality. Changes in the organisation of the medical system during the pandemic also worsened access to standard procedures, increasing the general mortality in HF and forcing the systems to be reorganised with the implementation and development of telemedical technologies. The main challenges for HF patients during the pandemic could be solved with new technologies aimed to limit the risk of SARS-CoV-2 transmission, optimise and titrate the therapy, prevent the progression and worsening of HF, and monitor patients with acute HF events in the course of and after COVID-19. Dedicated platforms, phone calls or video conferencing and consultation, and remote non-invasive and invasive cardiac monitoring became potential tools used to meet the aforementioned challenges. These solutions showed to be effective in the model of care for patients with HF and undoubtedly will be developed after the experience of the pandemic. However, the multitude of possibilities requires central coordination and collaboration between institutes with data protection and cost reimbursement to create effective mechanisms in HF management. It is crucial that lessons be learned from the pandemic experience to improve the quality of care for HF patients.
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Affiliation(s)
- Mateusz Sokolski
- Institute of Heart Disease, Wrocław University Hospital, Wroclaw Medical University, 50-556 Wrocław, Poland
- Institute of Heart Diseases, University Hospital, 50-556 Wroclaw, Poland
| | - Marta Kalużna-Oleksy
- Department of Cardiology, Poznan University of Medical Sciences, 61-701 Poznań, Poland
| | - Agnieszka Tycińska
- Department of Cardiology, Medical University of Bialystok, 15-089 Białystok, Poland
| | - Ewa A. Jankowska
- Institute of Heart Disease, Wrocław University Hospital, Wroclaw Medical University, 50-556 Wrocław, Poland
- Institute of Heart Diseases, University Hospital, 50-556 Wroclaw, Poland
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12
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Abdul-Rahman T, Lizano-Jubert I, Garg N, Talukder S, Lopez PP, Awuah WA, Shah R, Chambergo D, Cantu-Herrera E, Farooqi M, Pyrpyris N, de Andrade H, Mares AC, Gupta R, Aldosoky W, Mir T, Lavie CJ, Abohashem S. The common pathobiology between coronary artery disease and calcific aortic stenosis: Evidence and clinical implications. Prog Cardiovasc Dis 2023; 79:89-99. [PMID: 37302652 DOI: 10.1016/j.pcad.2023.06.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 06/08/2023] [Indexed: 06/13/2023]
Abstract
Calcific aortic valve stenosis (CAS), the most prevalent valvular disease worldwide, has been demonstrated to frequently occur in conjunction with coronary artery disease (CAD), the third leading cause of death worldwide. Atherosclerosis has been proven to be the main mechanism involved in CAS and CAD. Evidence also exists that obesity, diabetes, and metabolic syndrome (among others), along with specific genes involved in lipid metabolism, are important risk factors for CAS and CAD, leading to common pathological processes of atherosclerosis in both diseases. Therefore, it has been suggested that CAS could also be used as a marker of CAD. An understanding of the commonalities between the two conditions may improve therapeutic strategies for treating both CAD and CAS. This review explores the common pathogenesis and disparities between CAS and CAD, alongside their etiology. It also discusses clinical implications and provides evidence-based recommendations for the clinical management of both diseases.
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Affiliation(s)
- Toufik Abdul-Rahman
- Medical Institute, Sumy State University; Toufik's World Medical Association, Sumy, Ukraine
| | | | - Neil Garg
- Rowan-Virtua School of Osteopathic Medicine, One Medical Center Drive, Stratford, NJ, United States
| | | | - Pablo Perez Lopez
- Faculty of Medicine, Autonomous University of Madrid (UAM), Madrid, Spain; Puerta de Hierro Majadahonda University Hospital, Majadahonda, Spain
| | - Wireko Andrew Awuah
- Medical Institute, Sumy State University; Toufik's World Medical Association, Sumy, Ukraine
| | | | - Diego Chambergo
- Faculty of Medicine, Anahuac University, Huixquilucan, Mexico
| | - Emiliano Cantu-Herrera
- Department of Clinical Sciences, Division of Health Sciences, University of Monterrey, San Pedro Garza García, Nuevo León, Mexico
| | | | - Nikolaos Pyrpyris
- School of Medicine, National and Kapodistrian University of Athens, Greece
| | | | - Adriana C Mares
- Cardiovascular Medicine, Yale School of Medicine, New Haven, CT, United States
| | - Rahul Gupta
- Lehigh Valley Heart Institute, Lehigh Valley Health Network, Allentown, PA, United States of America.
| | - Wesam Aldosoky
- Cardiovascular Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, United States
| | - Tanveer Mir
- Detroit Medical Center - Cardiology department, Wayne State University, Detroit, United States
| | - Carl J Lavie
- Department of Cardiology, Ochsner Clinic Foundation, New Orleans, LA, United States of America; The University of Queensland Medical School, Ochsner Clinical School, New Orleans, LA, United States of America
| | - Shady Abohashem
- Cardiovascular Research Center, Massachusetts General Hospital and Harvard Medical School Boston, MA, United States; Epidemiology Department, Harvard T. Chan of Public Health, Boston, MA, United States
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13
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Adachi T, Iritani N, Kamiya K, Iwatsu K, Kamisaka K, Iida Y, Yamada S. Prognostic effects of cardiac rehabilitation in heart failure patients classified according to physical frailty: A propensity score-matched analysis of a nationwide prospective cohort study. INTERNATIONAL JOURNAL OF CARDIOLOGY. CARDIOVASCULAR RISK AND PREVENTION 2023; 17:200177. [PMID: 36941975 PMCID: PMC10024177 DOI: 10.1016/j.ijcrp.2023.200177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 01/23/2023] [Accepted: 02/09/2023] [Indexed: 03/08/2023]
Abstract
Background Research regarding cardiac rehabilitation (CR) in the prognosis of heart failure (HF) patients and frailty remains lacking. Here, the effects of CR on the 2-year prognosis of HF patients were examined according to their frailty status. Methods This multicenter prospective cohort study enrolled patients hospitalized for HF. Patients who underwent ≥1 session per 2 weeks of CR within 3 months after discharge were categorized in the CR group. Patients were divided in a non-frailty (≤8 points) and physical frailty group (≥9 points) based on their FLAGSHIP frailty score. The score is based on HF prognosis, with a higher score indicating worsened physical frailty. A propensity score-matched analysis was performed to compare survival rates between the two groups according to their physical frailty status. Endpoints included HF re-hospitalization and all-cause mortality during a 2-year follow-up period. Results Of 2697 patients included in the analysis, 285 and 95 matched pairs were distributed in the non-frailty and physical frailty groups, respectively, after propensity-score matching. CR was associated with lower incidence of HF rehospitalization in both non-frailty (hazard ratio 0.65; 95% confidence interval 0.44-0.96; p = 0.032) and physical frailty (0.54; 0.32-0.90; p = 0.019) groups. CR was not associated with all-cause mortality in either group (log-rank test, p > 0.05). Conclusion These findings suggest the effects of CR on reduced HF rehospitalization, regardless of physical frailty status.
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Affiliation(s)
- Takuji Adachi
- Department of Integrated Health Sciences, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Naoki Iritani
- Department of Cardiac Rehabilitation, Toyohashi Heart Center, Toyohashi, Japan
| | - Kuniyasu Kamiya
- Department of Hygiene & Public Health, Osaka Medical and Pharmaceutical University, Takatsuki, Japan
| | - Kotaro Iwatsu
- Department of Rehabilitation, Hirakata Kohsai Hospital, Hirakata, Japan
| | - Kenta Kamisaka
- Department of Rehabilitation, Tazuke Kofukai Medical Institute Kitano Hospital, Osaka, Japan
| | - Yuki Iida
- Department of Physical Therapy, Toyohashi SOZO University, Toyohashi, Japan
| | - Sumio Yamada
- Department of Integrated Health Sciences, Nagoya University Graduate School of Medicine, Nagoya, Japan
- Corresponding author. PT Department of Cardiology, Aichi Medical University 1Yazakokarimata, Nagakute, 480TEL, Japan.
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14
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Heutinck JM, De Koning IA, Vromen T, Van Geuns RJM, Thijssen DHJ, Kemps HMC. Impact of a comprehensive cardiac rehabilitation programme versus coronary revascularisation in patients with stable angina pectoris: study protocol for the PRO-FIT randomised controlled trial. BMC Cardiovasc Disord 2023; 23:238. [PMID: 37147562 PMCID: PMC10163688 DOI: 10.1186/s12872-023-03266-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 04/26/2023] [Indexed: 05/07/2023] Open
Abstract
BACKGROUND Currently, in the majority of patients with stable angina pectoris (SAP) treatment consists of optimal medical treatment, potentially followed by coronary angiography and subsequent coronary revascularisation if necessary". Recent work questioned the effectiveness of these invasive procedures in reducing re-events and improving prognosis. The potential of exercise-based cardiac rehabilitation on clinical outcomes in patients with coronary artery disease is well-known. However, in the modern era, no studies compared the effects of cardiac rehabilitation versus coronary revascularisation in patients with SAP. METHODS In this multicentre randomised controlled trial, 216 patients with stable angina pectoris and residual anginal complaints under optimal medical treatment will be randomised to: 1) usual care (i.e., coronary revascularisation), or 2) a 12-month cardiac rehabilitation (CR) programme. CR consists of a multidisciplinary intervention, including education, exercise training, lifestyle coaching and a dietary intervention with a stepped decline in supervision. The primary outcome will be anginal complaints (Seattle Angina Questionnaire-7) following the 12-month intervention. Secondary outcomes include cost-effectiveness, ischemic threshold during exercise, cardiovascular events, exercise capacity, quality of life and psychosocial wellbeing. DISCUSSION In this study, we will examine the hypothesis that multidisciplinary CR is at least equally effective in reducing anginal complaints as the contemporary invasive approach at 12-months follow-up for patients with SAP. If proven successful, this study will have significant impact on the treatment of patients with SAP as multidisciplinary CR is a less invasive and potentially less costly and better sustainable treatment than coronary revascularisations. TRIAL REGISTRATION Netherlands Trial Register, NL9537. Registered 14 June 2021.
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Affiliation(s)
- Joyce M Heutinck
- Department of Industrial Design, Eindhoven University of Technology, Eindhoven, the Netherlands.
- Department of Medical BioSciences, Radboud University Medical Centre, Nijmegen, the Netherlands.
| | - Iris A De Koning
- Department of Medical BioSciences, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Tom Vromen
- Department of Cardiology, Maxima Medical Centre, Eindhoven, the Netherlands
| | | | - Dick H J Thijssen
- Department of Medical BioSciences, Radboud University Medical Centre, Nijmegen, the Netherlands
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK
| | - Hareld M C Kemps
- Department of Industrial Design, Eindhoven University of Technology, Eindhoven, the Netherlands
- Department of Cardiology, Maxima Medical Centre, Eindhoven, the Netherlands
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15
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Echocardiographic follow-up after cardiac rehabilitation designed for patients with obesity. THE INTERNATIONAL JOURNAL OF CARDIOVASCULAR IMAGING 2023; 39:945-954. [PMID: 36928518 PMCID: PMC10160212 DOI: 10.1007/s10554-023-02805-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 01/27/2023] [Indexed: 03/18/2023]
Abstract
We hypothesize that a novel tailor-made cardiac rehabilitation (CR) program for obesity patients (OPTICARE XL) has better outcomes as compared to usual CR regarding parameters of cardiac function as measured by conventional and advanced transthoracic echocardiography. This is an open-label, randomized controlled trial. Inclusion criteria were: patients referred to CR with a body mass index (BMI) ≥30 kg/m2, and age ≥18 years with either coronary artery disease or nonvalvular atrial fibrillation. The experimental group participated in OPTICARE XL and the controls received the usual CR. Subjects randomized to OPTICARE XL received on top of usual CR behavioural therapy for a healthy diet and an active lifestyle for the first 12 weeks. Also, the exercise program was more tailored. Furthermore, a behavioural after-care program was organized with 6 meetings between weeks 13-52. Transthoracic (speckle tracking) echocardiography was performed at baseline and one-year follow-up. A total of 42 patients completed the follow-up, 21 in both groups. There was a mild but statistically significant reduction in weight over time, however, this was comparable between groups. There was no improvement observed in any of the echocardiographic parameters. In conclusion, cardiac function in obesity patients was not improved one-year after a novel tailor-made CR program (OPTICARE XL) as compared to usual CR.
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16
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Akbari N, Heinze G, Rauch G, Sander B, Becher H, Dunkler D. Causal Model Building in the Context of Cardiac Rehabilitation: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3182. [PMID: 36833877 PMCID: PMC9968189 DOI: 10.3390/ijerph20043182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 02/07/2023] [Accepted: 02/07/2023] [Indexed: 06/18/2023]
Abstract
Randomization is an effective design option to prevent bias from confounding in the evaluation of the causal effect of interventions on outcomes. However, in some cases, randomization is not possible, making subsequent adjustment for confounders essential to obtain valid results. Several methods exist to adjust for confounding, with multivariable modeling being among the most widely used. The main challenge is to determine which variables should be included in the causal model and to specify appropriate functional relations for continuous variables in the model. While the statistical literature gives a variety of recommendations on how to build multivariable regression models in practice, this guidance is often unknown to applied researchers. We set out to investigate the current practice of explanatory regression modeling to control confounding in the field of cardiac rehabilitation, for which mainly non-randomized observational studies are available. In particular, we conducted a systematic methods review to identify and compare statistical methodology with respect to statistical model building in the context of the existing recent systematic review CROS-II, which evaluated the prognostic effect of cardiac rehabilitation. CROS-II identified 28 observational studies, which were published between 2004 and 2018. Our methods review revealed that 24 (86%) of the included studies used methods to adjust for confounding. Of these, 11 (46%) mentioned how the variables were selected and two studies (8%) considered functional forms for continuous variables. The use of background knowledge for variable selection was barely reported and data-driven variable selection methods were applied frequently. We conclude that in the majority of studies, the methods used to develop models to investigate the effect of cardiac rehabilitation on outcomes do not meet common criteria for appropriate statistical model building and that reporting often lacks precision.
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Affiliation(s)
- Nilufar Akbari
- Institute of Biometry and Clinical Epidemiology, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Georg Heinze
- Center for Medical Data Science, Institute of Clinical Biometrics, Medical University of Vienna, Spitalgasse 23, 1090 Vienna, Austria
| | - Geraldine Rauch
- Institute of Biometry and Clinical Epidemiology, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117 Berlin, Germany
- Technische Universität Berlin, Straße des 17, Juni 135, 10623 Berlin, Germany
| | - Ben Sander
- Institute of Biometry and Clinical Epidemiology, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Heiko Becher
- Institute of Global Health, University Hospital Heidelberg, Im Neuenheimer Feld 130.3, 69120 Heidelberg, Germany
| | - Daniela Dunkler
- Center for Medical Data Science, Institute of Clinical Biometrics, Medical University of Vienna, Spitalgasse 23, 1090 Vienna, Austria
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17
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Vladimirsky VE, Vladimirsky EV, Lebedeva OD, Fesyun AD, Yakovlev MY, Lunina AN. [Cardiac rehabilitation: investigation of efficacy, results, perspectives]. VOPROSY KURORTOLOGII, FIZIOTERAPII, I LECHEBNOI FIZICHESKOI KULTURY 2023; 100:45-55. [PMID: 38016056 DOI: 10.17116/kurort202310005145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2023]
Abstract
Previous research experience on cardiac rehabilitation programs as a part of general health care system has shown that they are an important part of the management of cardiovascular patients. Improving quality of life, reducing the severity of risk factors, increasing physical performance, slowing disease progression, decrease in morbidity and mortality indicate the clinical efficacy of cardiac rehabilitation and make it an integral part of therapeutic interventions. Heart rehabilitation is a 1st class recommendation in the majority of modern cardiovascular guidelines around the world.
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Affiliation(s)
| | | | - O D Lebedeva
- National Medical Research Center for Rehabilitation and Balneology, Moscow, Russia
| | - A D Fesyun
- National Medical Research Center for Rehabilitation and Balneology, Moscow, Russia
| | - M Yu Yakovlev
- National Medical Research Center for Rehabilitation and Balneology, Moscow, Russia
| | - A N Lunina
- E.A. Wagner Perm State Medical University, Perm, Russia
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18
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Yuen T, Buijs DM, Hong Y, Van Damme A, Meyer TC, Nagendran J, Gyenes GT. Comparing the Effectiveness of Two Cardiac Rehabilitation Exercise Therapy Programs. CJC Open 2022; 5:215-219. [PMID: 37013075 PMCID: PMC10066431 DOI: 10.1016/j.cjco.2022.11.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 11/24/2022] [Indexed: 12/12/2022] Open
Abstract
Cardiovascular diseases are among the leading causes of morbidity and mortality in Canada, highlighting the critical role of disease prevention and risk reduction programs. Cardiac rehabilitation (CR) is a key component of comprehensive cardiovascular care. Currently, more than 200 CR programs are established across the country, varying in duration, number of in-person supervised exercise sessions, and recommendations for exercise frequency at-home. In an increasingly cost-conscious healthcare environment, the effectiveness of healthcare services must be consistently reevaluated. This study evaluates the impact of 2 CR programs implemented by the Northern Alberta Cardiac Rehabilitation Program, by comparing peak metabolic equivalents achieved by study participants in each program. We hypothesize that our "hybrid" CR program, which is structured as an 8-week program with weekly in-person exercise sessions and a prescribed home exercise program, has patient outcomes similar to those of our "traditional" CR program, which required biweekly in-person exercise sessions over the course of 5 weeks. The results of this study may have implications for evaluating how to minimize barriers to both rehabilitation participation and long-term effectiveness of CR programs. The results may help inform the structuring and funding of future rehabilitation programs.
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Affiliation(s)
- Tiffany Yuen
- Division of Cardiology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - David M. Buijs
- Jim Pattison Centre for Heart Health, Mazankowski Alberta Heart Institute, Edmonton, Alberta, Canada
| | - Yongzhe Hong
- Division of Cardiac Surgery, Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Andrea Van Damme
- Jim Pattison Centre for Heart Health, Mazankowski Alberta Heart Institute, Edmonton, Alberta, Canada
| | - Tara C. Meyer
- Jim Pattison Centre for Heart Health, Mazankowski Alberta Heart Institute, Edmonton, Alberta, Canada
| | - Jeevan Nagendran
- Division of Cardiac Surgery, Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Gabor T. Gyenes
- Division of Cardiology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
- Jim Pattison Centre for Heart Health, Mazankowski Alberta Heart Institute, Edmonton, Alberta, Canada
- Corresponding author: Dr Gabor T. Gyenes, 2C2 Cardiology, University of Alberta Hospital, 8440-112 Street, Edmonton, AB T6G 2B7, Canada. Tel.: +1-780-407-2704.
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19
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Thygesen LC, Zinckernagel L, Dalal H, Egstrup K, Glümer C, Grønbæk M, Holmberg T, Køber L, la Cour K, Nakano A, Nielsen CV, Sibilitz KL, Tolstrup JS, Zwisler AD, Taylor RS. Cardiac rehabilitation for patients with heart failure: association with readmission and mortality risk. EUROPEAN HEART JOURNAL. QUALITY OF CARE & CLINICAL OUTCOMES 2022; 8:830-839. [PMID: 34850879 DOI: 10.1093/ehjqcco/qcab086] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 11/08/2021] [Accepted: 11/17/2021] [Indexed: 02/07/2023]
Abstract
AIMS To examine the temporal trends and factors associated with national cardiac rehabilitation (CR) referral and compare the risk of hospital readmission and mortality in those referred for CR versus no referral. METHODS AND RESULTS This cohort study includes all adult patients alive 120 days from incident heart failure (HF) identified by the Danish Heart Failure Registry (n = 33 257) between 2010 and 2018. Multivariable logistic regression models were used to assess the association between CR referral and patient factors and acute all-cause hospital readmission and mortality at 1 year following HF admission. Overall, 46.7% of HF patients were referred to CR, increasing from 31.7% in 2010 to 52.2% in 2018. Several factors were associated with lower odds of CR referral: male sex [odds ratio (OR): 0.85; 95% confidence interval: 0.80-0.89], older age, unemployment, retirement, living alone, non-Danish ethnic origin, low educational level, New York Heart Association (NYHA) class IV vs. I (OR: 0.75; 0.60-0.95), left ventricular ejection fraction >40%, and comorbidity (stroke, chronic kidney disease, atrial fibrillation/flutter, and diabetes). Myocardial infarction, arthritis, coronary artery bypass grafting, percutaneous coronary intervention, valvular surgery, NYHA class II, and use of angiotensin-converting enzyme inhibitors were associated with higher odds of CR referral. CR referral was associated with lower risk of acute all-cause readmission (OR: 0.92; 0.87-0.97) and all-cause mortality (OR: 0.65; 0.58-0.72). CONCLUSION Although increased over time, only one in two HF patients in Denmark were referred to CR in 2018. Strategies are needed to reduce referral disparities, focusing on subgroups of patients at highest risk of non-referral.
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Affiliation(s)
- Lau Caspar Thygesen
- National Institute of Public Health, University of Southern Denmark, Studiestræde 6, DK-1455 Copenhagen, Denmark
| | - Line Zinckernagel
- National Institute of Public Health, University of Southern Denmark, Studiestræde 6, DK-1455 Copenhagen, Denmark
| | - Hasnain Dalal
- University of Exeter Medical School, Knowledge Spa, Royal Cornwall Hospital, Truro, UK.,Primary Care Research Group, University of Exeter Medical School, St Luke's Campus, Exeter, UK
| | - Kenneth Egstrup
- Department of Cardiovascular Research, Odense University Hospital, Svendborg, Denmark
| | - Charlotte Glümer
- Center for Diabetes in the City of Copenhagen, Copenhagen, Denmark
| | - Morten Grønbæk
- National Institute of Public Health, University of Southern Denmark, Studiestræde 6, DK-1455 Copenhagen, Denmark
| | - Teresa Holmberg
- National Institute of Public Health, University of Southern Denmark, Studiestræde 6, DK-1455 Copenhagen, Denmark
| | - Lars Køber
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Karen la Cour
- Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Anne Nakano
- The Danish Clinical Registries (RKKP), Aarhus. Denmark
| | - Claus Vinther Nielsen
- Institute of Public Health, Aarhus University, Aarhus, Denmark.,DEFACTUM, Central Denmark Region, Aarhus, Denmark.,Regional Hospital West Jutland, Herning, Denmark
| | - Kirstine Lærum Sibilitz
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Janne Schurmann Tolstrup
- National Institute of Public Health, University of Southern Denmark, Studiestræde 6, DK-1455 Copenhagen, Denmark
| | - Ann Dorthe Zwisler
- REHPA, The Danish Knowledge Centre for Rehabilitation and Palliative Care, Odense University Hospital and University of Southern Denmark, Nyborg, Denmark
| | - Rod S Taylor
- National Institute of Public Health, University of Southern Denmark, Studiestræde 6, DK-1455 Copenhagen, Denmark.,Institute of Health and Well Being, University of Glasgow, Glasgow, UK
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20
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Antoniou V, Xanthopoulos A, Giamouzis G, Davos C, Batalik L, Stavrou V, Gourgoulianis KI, Kapreli E, Skoularigis J, Pepera G. Efficacy, efficiency and safety of a cardiac telerehabilitation programme using wearable sensors in patients with coronary heart disease: the TELEWEAR-CR study protocol. BMJ Open 2022; 12:e059945. [PMID: 35738643 PMCID: PMC9226468 DOI: 10.1136/bmjopen-2021-059945] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION Exercise-based cardiac rehabilitation (CR) is a beneficial tool for the secondary prevention of cardiovascular diseases with, however, low participation rates. Telerehabilitation, intergrading mobile technologies and wireless sensors may advance the cardiac patients' adherence. This study will investigate the efficacy, efficiency, safety and cost-effectiveness of a telerehabilitation programme based on objective exercise telemonitoring and evaluation of cardiorespiratory fitness. METHODS AND ANALYSIS A supervised, parallel-group, single-blind randomised controlled trial will be conducted. A total of 124 patients with coronary disease will be randomised in a 1:1 ratio into two groups: intervention telerehabilitation group (TELE-CR) (n=62) and control centre-based cardiac rehabilitation group (CB-CR) (n=62). Participants will receive a 12-week exercise-based rehabilitation programme, remotely monitored for the TELE-CR group and standard supervised for the CB-CR group. All participants will perform aerobic training at 70% of their maximal heart rate, as obtained from cardiopulmonary exercise testing (CPET) for 20 min plus 20 min for strengthening and balance training, three times per week. The primary outcomes will be the assessment of cardiorespiratory fitness, expressed as peak oxygen uptake assessed by the CPET test and the 6 min walk test. Secondary outcomes will be the physical activity, the safety of the exercise intervention (number of adverse events that may occur during the exercise), the quality of life, the training adherence, the anxiety and depression levels, the nicotine dependence and cost-effectiveness. Assessments will be held at baseline, end of intervention (12 weeks) and follow-up (36 weeks). ETHICS AND DISSEMINATION The study protocol has been reviewed and approved by the Ethics Committee of the University of Thessaly (1108/1-12-2021) and by the Ethics Committee of the General University Hospital of Larissa (3780/31-01-2022). The results of this study will be disseminated through manuscript publications and conference presentations. TRIAL REGISTRATION NUMBER NCT05019157.
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Affiliation(s)
- Varsamo Antoniou
- Clinical Exercise Physiology and Rehabilitation Research Laboratory, Physiotherapy Department, University of Thessaly School of Health Sciences, Lamia, Greece
| | | | - Gregory Giamouzis
- Cardiology, University of Thessaly Faculty of Medicine, Larissa, Greece
| | - Constantinos Davos
- Cardiovascular Research, Biomedical Research Foundation of the Academy of Athens, Athens, Greece
| | - Ladislav Batalik
- Department of Rehabilitation, University Hospital Brno, Brno, Czech Republic
- Department of Public Health, Masaryk University Brno, Brno, Czech Republic
| | - Vasileios Stavrou
- Laboratory of Cardio-Pulmonary Testing, Department of Respiratory Medicine, University of Thessaly Faculty of Medicine, Larissa, Greece
| | - Konstantinos I Gourgoulianis
- Laboratory of Cardio-Pulmonary Testing, Department of Respiratory Medicine, University of Thessaly Faculty of Medicine, Larissa, Greece
| | - Eleni Kapreli
- Clinical Exercise Physiology and Rehabilitation Research Laboratory, Physiotherapy Department, University of Thessaly School of Health Sciences, Lamia, Greece
| | - John Skoularigis
- Cardiology, University of Thessaly Faculty of Medicine, Larissa, Greece
| | - Garyfallia Pepera
- Clinical Exercise Physiology and Rehabilitation Research Laboratory, Physiotherapy Department, University of Thessaly School of Health Sciences, Lamia, Greece
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21
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Abstract
In recent decades, life expectancy has been increasing significantly. In this scenario, health interventions are necessary to improve prognosis and quality of life of elderly with cardiovascular risk factors and cardiovascular disease. However, the number of elderly patients included in clinical trials is low, thus current clinical practice guidelines do not include specific recommendations. This document aims to review prevention recommendations focused in patients ≥ 75 years with high or very high cardiovascular risk, regarding objectives, medical treatment options and also including physical exercise and their inclusion in cardiac rehabilitation programs. Also, we will show why geriatric syndromes such as frailty, dependence, cognitive impairment, and nutritional status, as well as comorbidities, ought to be considered in this population regarding their important prognostic impact.
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22
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Safdar B, Mori M, Nowroozpoor A, Geirsson A, D'Onofrio G, Mangi AA. Clinical Profile and Sex-Specific Recovery With Cardiac Rehabilitation After Coronary Artery Bypass Grafting Surgery. Clin Ther 2022; 44:846-858. [DOI: 10.1016/j.clinthera.2022.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Revised: 02/15/2022] [Accepted: 04/07/2022] [Indexed: 02/03/2023]
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23
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Tenbult N, Kraal J, Brouwers R, Spee R, Eijsbouts S, Kemps H. Adherence to a Multidisciplinary Lifestyle Program for Patients With Atrial Fibrillation and Obesity: Feasibility Study. JMIR Form Res 2022; 6:e32625. [PMID: 35486435 PMCID: PMC9107041 DOI: 10.2196/32625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 12/23/2021] [Accepted: 01/13/2022] [Indexed: 11/23/2022] Open
Abstract
Background Atrial fibrillation is commonly associated with obesity. Observational studies have shown that weight loss is associated with improved prognosis and a decrease in atrial fibrillation frequency and severity. However, despite these benefits, nonadherence to lifestyle programs is common. Objective In this study, we evaluated adherence to and feasibility of a multidisciplinary lifestyle program focusing on behavior change in patients with atrial fibrillation and obesity. Methods Patients with atrial fibrillation and obesity participated in a 1-year goal-oriented cardiac rehabilitation program. After baseline assessment, the first 3 months included a cardiac rehabilitation intervention with 4 fixed modules: lifestyle counseling (with an advanced nurse practitioner), exercise training, dietary consultation, and psychosocial therapy; relaxation sessions were an additional optional treatment module. An advanced nurse practitioner monitored the personal lifestyle of each individual patient, with assessments and consultations at 3 months (ie, immediately after the intervention) and at the end of the year (ie, 9 months after the intervention). At each timepoint, level of physical activity, personal goals and progress, atrial fibrillation symptoms and frequency (Atrial Fibrillation Severity Scale), psychosocial stress (Generalized Anxiety Disorder–7), and depression (Patient Health Questionnaire–9) were assessed. The primary endpoints were adherence (defined as the number of visits attended as percentage of the number of planned visits) and completion rates of the cardiac rehabilitation intervention (defined as performing at least of 80% of the prescribed sessions). In addition, we performed an exploratory analysis of effects of the cardiac rehabilitation program on weight and atrial fibrillation symptom frequency and severity. Results Patients with atrial fibrillation and obesity (male: n=8; female: n=2; age: mean 57.2 years, SD 9.0; baseline weight: mean 107.2 kg, SD 11.8; baseline BMI: mean 32.4 kg/m2, SD 3.5) were recruited. Of the 10 participants, 8 participants completed the 3-month cardiac rehabilitation intervention, and 2 participants did not complete the cardiac rehabilitation intervention (both because of personal issues). Adherence to the fixed treatment modules was 95% (mean 3.8 sessions attended out of mean 4 planned) for lifestyle counseling, 86% (mean 15.2 sessions attended out of mean 17.6 planned) for physiotherapy sessions, 88% (mean 3.7 sessions attended out of mean 4.1 planned) for dietician consultations, and 60% (mean 0.6 sessions attended out of mean 1.0 planned) for psychosocial therapy; 70% of participants (7/10) were referred to the optional relaxation sessions, for which adherence was 86% (mean 2 sessions attended out of mean 2.4 planned). The frequency of atrial fibrillation symptoms was reduced immediately after the intervention (before: mean 35.6, SD 3.8; after: mean 31.2, SD 3.3), and this was sustained at 12 months (mean 24.8, SD 3.2). The severity of atrial fibrillation complaints immediately after the intervention (mean 20.0, SD 3.7) and at 12 months (mean 9.3, SD 3.6) were comparable to that at baseline (mean 16.6, SD 3.3). Conclusions A 1-year multidisciplinary lifestyle program for obese patients with atrial fibrillation was found to be feasible, with high adherence and completion rates. Exploratory analysis revealed a sustained reduction in atrial fibrillation symptoms; however, these results remain to be confirmed in large-scale studies.
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Affiliation(s)
- Nicole Tenbult
- Telemedicine and Rehabilitation in Chronic Disease, Flow, Center for Prevention, Máxima MC, Veldhoven/Eindhoven, Netherlands
| | - Jos Kraal
- Telemedicine and Rehabilitation in Chronic Disease, Flow, Center for Prevention, Máxima MC, Veldhoven/Eindhoven, Netherlands.,Faculty Industrial Design Engineering, Delft, Netherlands
| | - Rutger Brouwers
- Telemedicine and Rehabilitation in Chronic Disease, Flow, Center for Prevention, Máxima MC, Veldhoven/Eindhoven, Netherlands
| | - Ruud Spee
- Telemedicine and Rehabilitation in Chronic Disease, Flow, Center for Prevention, Máxima MC, Veldhoven/Eindhoven, Netherlands.,Department of Cardiology, Máxima MC, Veldhoven/Eindhoven, Netherlands
| | - Sabine Eijsbouts
- Department of Cardiology, Máxima MC, Veldhoven/Eindhoven, Netherlands
| | - Hareld Kemps
- Telemedicine and Rehabilitation in Chronic Disease, Flow, Center for Prevention, Máxima MC, Veldhoven/Eindhoven, Netherlands.,Department of Cardiology, Máxima MC, Veldhoven/Eindhoven, Netherlands.,Department of Industrial Design, University of Technology Eindhoven, Eindhoven, Netherlands
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24
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Choi JY, Kim JB, Lee S, Lee SJ, Shin SE, Park SH, Park EJ, Kim W, Na JO, Choi CU, Rha SW, Park CG, Seo HS, Ahn J, Jeong HG, Kim EJ. A Smartphone App (AnSim) With Various Types and Forms of Messages Using the Transtheoretical Model for Cardiac Rehabilitation in Patients With Coronary Artery Disease: Development and Usability Study. JMIR Med Inform 2021; 9:e23285. [PMID: 34878987 PMCID: PMC8693185 DOI: 10.2196/23285] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Revised: 03/27/2021] [Accepted: 10/10/2021] [Indexed: 12/05/2022] Open
Abstract
Background Despite strong evidence of clinical benefit, cardiac rehabilitation (CR) programs are currently underutilized and smartphone-based CR strategies are thought to address this unmet need. However, data regarding the detailed process of development are scarce. Objective This study focused on the development of a smartphone-based, patient-specific, messaging app for patients who have undergone percutaneous coronary intervention (PCI). Methods The AnSim app was developed in collaboration with a multidisciplinary team that included cardiologists, psychiatrists, nurses, pharmacists, nutritionists, and rehabilitation doctors and therapists. First, a focus group interview was conducted, and the narratives of the patients were analyzed to identify their needs and preferences. Based on the results, health care experts and clinicians drafted messages into 5 categories: (1) general information regarding cardiovascular health and medications, (2) nutrition, (3) physical activity, (4) destressing, and (5) smoking cessation. In each category, 90 messages were developed according to 3 simplified steps of the transtheoretical model of behavioral change: (1) precontemplation, (2) contemplation and preparation, and (3) action and maintenance. After an internal review and feedback from potential users, a bank of 450 messages was developed. Results The focus interview was conducted with 8 patients with PCI within 1 year, and 450 messages, including various forms of multimedia, were developed based on the transtheoretical model of behavioral change in each category. Positive feedback was obtained from the potential users (n=458). The mean Likert scale score was 3.95 (SD 0.39) and 3.91 (SD 0.39) for readability and usefulness, respectively, and several messages were refined based on the feedback. Finally, the patient-specific message delivery system was developed according to the baseline characteristics and stages of behavioral change in each participant. Conclusions We developed an app (AnSim), which includes a bank of 450 patient-specific messages, that provides various medical information and CR programs regarding coronary heart disease. The detailed process of multidisciplinary collaboration over the course of the study provides a scientific basis for various medical professionals planning smartphone-based clinical research.
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Affiliation(s)
- Jah Yeon Choi
- Cardiovascular Center, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Ji Bak Kim
- Cardiovascular Center, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Sunki Lee
- Division of Cardiology, Department of Internal Medicine, Hallym University Dongtan Sacred Heart Hospital, Dongtan, Republic of Korea
| | - Seo-Joon Lee
- Department of Medical Informatics, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Seung Eon Shin
- Cardiovascular Center, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | | | - Eun Jin Park
- Cardiovascular Center, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Woohyeun Kim
- Cardiovascular Center, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Jin Oh Na
- Cardiovascular Center, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Cheol Ung Choi
- Cardiovascular Center, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Seung-Woon Rha
- Cardiovascular Center, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Chang Gyu Park
- Cardiovascular Center, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Hong Seog Seo
- Cardiovascular Center, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Jeonghoon Ahn
- Department of Health Convergence, Ewha Womans University, Seoul, Republic of Korea
| | - Hyun-Ghang Jeong
- Department of Psychiatry, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Eung Ju Kim
- Sports Medical Center, Seoul, Republic of Korea
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25
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Brouwers RWM, van der Poort EKJ, Kemps HMC, van den Akker-van Marle ME, Kraal JJ. Cost-effectiveness of Cardiac Telerehabilitation With Relapse Prevention for the Treatment of Patients With Coronary Artery Disease in the Netherlands. JAMA Netw Open 2021; 4:e2136652. [PMID: 34854907 PMCID: PMC8640894 DOI: 10.1001/jamanetworkopen.2021.36652] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 10/05/2021] [Indexed: 12/25/2022] Open
Abstract
Importance Cardiac telerehabilitation (CTR) has been found to be a safe and beneficial alternative to traditional center-based cardiac rehabilitation (CR) and might be associated with higher participation rates by reducing barriers to CR use. However, implementation of CTR interventions remains low, which may be owing to a lack of cost-effectiveness analyses of data from large-scale randomized clinical trials. Objective To assess the cost-effectiveness of CTR with relapse prevention compared with center-based CR among patients with coronary artery disease. Design, Setting, and Participants This economic evaluation performed a cost-utility analysis of data from the SmartCare-CAD (Effects of Cardiac Telerehabilitation in Patients With Coronary Artery Disease Using a Personalized Patient-Centred ICT Platform) randomized clinical trial. The cost-effectiveness and utility of 3 months of cardiac telerehabilitation followed by 9 months of relapse prevention were compared with the cost-effectiveness of traditional center-based cardiac rehabilitation. The analysis included 300 patients with stable coronary artery disease who received care at a CR center serving 2 general hospitals in the Netherlands between May 23, 2016, and July 26, 2018. All patients were entering phase 2 of outpatient CR and were followed up for 1 year (until August 14, 2019). Data were analyzed from September 21, 2020, to September 24, 2021. Intervention After baseline measurements were obtained, participants were randomly assigned on a 1:1 ratio to receive CTR (intervention group) or center-based CR (control group) using computerized block randomization. After 6 supervised center-based training sessions, patients in the intervention group continued training at home using a heart rate monitor and accelerometer. Patients uploaded heart rate and physical activity data and discussed their progress during a weekly video consultation with their physical therapist. After 3 months, weekly coaching was concluded, and on-demand coaching was initiated for relapse prevention; patients were instructed to continue using their wearable sensors and were contacted in cases of nonadherence to the intervention or reduced exercise or physical activity volumes. Main Outcomes and Measures Quality-adjusted life-years were assessed using the EuroQol 5-Dimension 5-Level survey (EQ-5D-5L) and the EuroQol Visual Analogue Scale (EQ-VAS), and cardiac-associated health care costs and non-health care costs were measured by health care consumption, productivity, and informal care questionnaires (the Medical Consumption Questionnaire, the Productivity Cost Questionnaire, and the Valuation of Informal Care Questionnaire) designed by the Institute for Medical Technology Assessment. Costs were converted to 2020 price levels (in euros) using the Dutch consumer price index (to convert to US dollars, euro values were multiplied by 1.142, which was the mean exchange rate in 2020). Results Among 300 patients (266 men [88.7%]), the mean (SD) age was 60.7 (9.5) years. The quality of life among patients receiving CTR vs center-based CR was comparable during the study according to the results of both utility measures (mean difference on EQ-5D-5L: -0.004; P = .82; mean difference on EQ-VAS: -0.001; P = .92). Intervention costs were significantly higher for CTR (mean [SE], €224 [€4] [$256 ($4)]) compared with center-based CR (mean [SE], €156 [€5] [$178 ($6)]; P < .001); however, no difference in overall cardiac health care costs was observed between CTR (mean [SE], €4787 [€503] [$5467 ($574)] and center-based CR (mean [SE], €5507 [€659] [$6289 ($753)]; P = .36). From a societal perspective, CTR was associated with lower costs compared with center-based CR (mean [SE], €20 495 [€ 2751] [$23 405 ($3142)] vs €24 381 [€3613] [$27 843 ($4126)], respectively), although this difference was not statistically significant (-€3887 [-$4439]; P = .34). Conclusions and Relevance In this economic evaluation, a CTR intervention with relapse prevention was likely to be cost-effective compared with center-based CR, suggesting that CTR maybe used as an alternative intervention for the treatment of patients with coronary artery disease. These results add to the evidence base in favor of CTR and may increase the implementation of CTR interventions in clinical practice.
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Affiliation(s)
- Rutger W. M. Brouwers
- Vitality Center, Máxima Medical Center, Eindhoven/Veldhoven, Veldhoven, the Netherlands
- Department of Cardiology, Máxima Medical Center, Eindhoven/Veldhoven, Veldhoven, the Netherlands
| | - Esmée K. J. van der Poort
- Department of Biomedical Data Sciences, Medical Decision-Making Unit, Leiden University Medical Center, Leiden, the Netherlands
| | - Hareld M. C. Kemps
- Vitality Center, Máxima Medical Center, Eindhoven/Veldhoven, Veldhoven, the Netherlands
- Department of Cardiology, Máxima Medical Center, Eindhoven/Veldhoven, Veldhoven, the Netherlands
- Department of Industrial Design, Eindhoven University of Technology, Eindhoven, the Netherlands
| | | | - Jos J. Kraal
- Department of Human-Centered Design, Faculty of Industrial Design Engineering, Delft University of Technology, Delft, the Netherlands
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26
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Buckley BJR, de Koning IA, Harrison SL, Fazio-Eynullayeva E, Underhill P, Kemps HMC, Lip GYH, Thijssen DHJ. Exercise-based cardiac rehabilitation vs. percutaneous coronary intervention for chronic coronary syndrome: impact on morbidity and mortality. Eur J Prev Cardiol 2021; 29:1074-1080. [PMID: 34788451 DOI: 10.1093/eurjpc/zwab191] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 09/28/2021] [Accepted: 10/29/2021] [Indexed: 01/09/2023]
Abstract
AIMS Accumulating evidence questions the clinical value of percutaneous coronary intervention (PCI) for patients with chronic coronary syndrome (CCS). We therefore compare the impact of exercise-based cardiac rehabilitation (CR) vs. PCI in patients with CCS on 18-month mortality and morbidity, and evaluate the effects of combining PCI with exercise-based CR. METHODS AND RESULTS A retrospective cohort study was conducted in March 2021. An online, real-world dataset of CCS patients was acquired, utilizing TriNetX, a global federated health research network. Patients with CCS who received PCI were first compared with patients who were prescribed exercise-based CR. Second, we compared patients who received both CR + PCI vs. CR alone. For both comparisons, patients were propensity-score matched by age, sex, race, comorbidities, medications, and procedures. We ascertained 18-month incidence of all-cause mortality, rehospitalization, and cardiovascular comorbidity [stroke, acute myocardial infarction (AMI), and new-onset heart failure]. The initial cohort consisted of 18 383 CCS patients. Following propensity score matching, exercise-based CR was associated with significantly lower odds of all-cause mortality [0.37 (95% confidence interval (CI): 0.29-0.47)], rehospitalization [0.29 (95% CI: 0.27-0.32)], and cardiovascular morbidities, compared to PCI. Subsequently, patients that received both CR + PCI did not have significantly different odds for all-cause mortality [1.00 (95% CI: 0.63-1.60)], rehospitalization [1.00 (95% CI: 0.82-1.23)], AMI [1.11 (95% CI: 0.68-1.81)], and stroke [0.71 (95% CI: 0.39-1.31)], compared to CR only. CONCLUSIONS Compared to PCI, exercise-based CR associated with significantly lower odds of 18-month all-cause mortality, rehospitalization, and cardiovascular morbidity in patients with CCS, whilst combining PCI and exercise-based CR associated with lower incident heart failure only.
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Affiliation(s)
- Benjamin J R Buckley
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, William Henry Duncan Building, Liverpool L7 8TX, UK.,Cardiovascular and Metabolic Medicine, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool L7 8TX, UK
| | - Iris A de Koning
- Department of Physiology, Research Institute for Health Science, Radboud University Medical Centrum, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands
| | - Stephanie L Harrison
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, William Henry Duncan Building, Liverpool L7 8TX, UK.,Cardiovascular and Metabolic Medicine, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool L7 8TX, UK
| | | | | | - Hareld M C Kemps
- Department of Cardiology, Máxima Medical Centre, Veldhoven, Dominee Theodor Fliednerstraat 1, 5631 BM Eindhoven, The Netherlands.,Department of Industrial Design, Eindhoven University of Technology, Dominee Theodor Fliednerstraat 1, 5631, Eindhoven, The Netherlands
| | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, William Henry Duncan Building, Liverpool L7 8TX, UK.,Cardiovascular and Metabolic Medicine, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool L7 8TX, UK.,Liverpool Centre for Cardiovascular Science, Liverpool John Moores University, Liverpool L3 3AF, UK.,Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Søndre Skovvej 15, Forskningens Hus 9000, Aalborg, Denmark
| | - Dick H J Thijssen
- Department of Physiology, Research Institute for Health Science, Radboud University Medical Centrum, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands.,Liverpool Centre for Cardiovascular Science, Liverpool John Moores University, Liverpool L3 3AF, UK
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27
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MEdical TReatment Optimization in cardiac rehabilitation (METRO study) : a French multicenter study. Ann Cardiol Angeiol (Paris) 2021; 70:275-280. [PMID: 34635328 DOI: 10.1016/j.ancard.2021.08.009] [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: 08/24/2021] [Accepted: 08/28/2021] [Indexed: 11/21/2022]
Abstract
BACKGROUND Cardiac rehabilitation (CR) is the right place to optimize the medical treatment in coronary artery disease (CAD) patients. AIMS To report the medical management in CAD patients during CR and evaluate the consequences. METHODS CAD patients who attended a CR program within less than three months of an acute coronary syndrome (ACS), a percutaneous coronary intervention (PCI), or a coronary artery bypass graft (CABG) were included in a prospective multicenter study. Medical treatments were analyzed at the beginning and at discharge of the CR stay. Results of exercise tests were compared between 4 groups. G1: unchanged medication, n=443, G2: beta-blockers or bradycardic agents adaptation n=199, G3: renin-angiotensin system (RAS) inhibitors adaptation, n=194, G4: both medications adaptation, n=164. RESULTS One thousand consecutive patients were included in 23 French CR centers (85.3% males; mean age 59.9 ± 11 years). The index event was ACS (68.5%), PCI (62.6%) and CABG (36.3%). During CR, we noted an adaptation for beta-blockers in 32.1%, in other bradycardic agents (ivabradine, verapamil, diltiazem, amiodarone) in 9.5%, and in RAS inhibitors in 36.3%. Patients of group 1 had an initial resting heart rate lower than in group 2 and 4, but at the final exercise testing, the range of the decrease was more important in group 2 and 4. The combination of physical training and therapeutic modifications resulted in similar exercise capacities in the four groups, from 5.2, 5.3, 5.4 and 5.2 MET (p=0.68), to 6.3, 6.5, 6.5 and 6.1 MET (p=0.44), respectively. CONCLUSION The METRO study showed that significant alteration in medical treatment during cardiac rehabilitation programs could take part in improving physical capacity.
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Mechanisms of Exercise Capacity Improvement after Cardiac Rehabilitation Following Myocardial Infarction Assessed with Combined Stress Echocardiography and Cardiopulmonary Exercise Testing. J Clin Med 2021; 10:jcm10184083. [PMID: 34575194 PMCID: PMC8471103 DOI: 10.3390/jcm10184083] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Revised: 08/26/2021] [Accepted: 09/06/2021] [Indexed: 12/16/2022] Open
Abstract
Cardiac rehabilitation (CR) is indicated in all patients after acute myocardial infarction (AMI) to improve prognosis and exercise capacity (EC). Previous studies reported that up to a third of patients did not improve their EC after CR (non-responders). Our aim was to assess the cardiac and peripheral mechanisms of EC improvement after CR using combined exercise echocardiography and cardiopulmonary exercise testing (CPET-SE). The responders included patients with an improved EC assessed as a rise in peak oxygen uptake (VO2) ≥ 1 mL/kg/min. Peripheral oxygen extraction was calculated as arteriovenous oxygen difference (A-VO2Diff). Out of 41 patients (67% male, mean age 57.5 ± 10 years) after AMI with left ventricular ejection fraction (LVEF) ≥ 40%, 73% improved their EC. In responders, peak VO2 improved by 27% from 17.9 ± 5.2 mL/kg/min to 22.7 ± 5.1 mL/kg/min, p < 0.001, while non-responders had a non-significant 5% decrease in peak VO2. In the responder group, the peak exercise heart rate, early diastolic myocardial velocity at peak exercise, LVEF at rest and at peak exercise, and A-VO2Diff at peak exercise increased, the minute ventilation to carbon dioxide production slope decreased, but the stroke volume and cardiac index were unchanged after CR. Non-responders had no changes in assessed parameters. EC improvement after CR of patients with preserved LVEF after AMI is associated with an increased heart rate response and better peripheral oxygen extraction during exercise.
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Predictors for one-year outcomes of cardiorespiratory fitness and cardiovascular risk factor control after cardiac rehabilitation in elderly patients: The EU-CaRE study. PLoS One 2021; 16:e0255472. [PMID: 34351942 PMCID: PMC8341663 DOI: 10.1371/journal.pone.0255472] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 07/16/2021] [Indexed: 11/22/2022] Open
Abstract
Introduction Studies on effectiveness of cardiac rehabilitation (CR) in elderly cardiovascular disease patients are rare, and it is unknown, which patients benefit most. We aimed to identify predictors for 1-year outcomes of cardiorespiratory fitness and CV risk factor (CVRF) control in patients after completing CR programs offered across seven European countries. Methods Cardiovascular disease patients with minimal age 65 years who participated in comprehensive CR were included in this observational study. Peak oxygen uptake (VO2), body mass index (BMI), resting systolic blood pressure (BPsys), and low-density lipoprotein-cholesterol (LDL-C) were assessed before CR (T0), at termination of CR (T1), and 12 months after start of CR (T2). Predictors for changes were identified by multivariate regression models. Results Data was available from 1241 out of 1633 EU-CaRE patients. The strongest predictor for improvement in peak VO2 was open chest surgery, with a nearly four-fold increase in surgery compared to non-surgery patients. In patients after surgery, age, female sex, physical inactivity and time from index event to T0 were negative predictors for improvement in peak VO2. In patients without surgery, previous acute coronary syndrome and higher exercise capacity at T0 were the only negative predictors. Neither number of attended training sessions nor duration of CR were significantly associated with change in peak VO2. Non-surgery patients were more likely to achieve risk factor targets (BPsys, LDL-C, BMI) than surgery patients. Conclusions In a previously understudied population of elderly CR patients, time between index event and start of CR in surgery and disease severity in non-surgery patients were the most important predictors for long-term improvement of peak VO2. Non-surgery patients had better CVRF control.
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Hartog J, Mousavi I, Dijkstra S, Fleer J, van der Woude LHV, van der Harst P, Mariani MA. Prehabilitation to prevent complications after cardiac surgery - A retrospective study with propensity score analysis. PLoS One 2021; 16:e0253459. [PMID: 34270545 PMCID: PMC8284810 DOI: 10.1371/journal.pone.0253459] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 06/04/2021] [Indexed: 11/28/2022] Open
Abstract
Background The rising prevalence of modifiable lifestyle-related risk factors (e.g. overweight and physical inactivity) suggests the need for effective and safe preoperative interventions to improve outcomes after cardiac surgery. This retrospective study explored potential short-term postoperative benefits and unintended consequences of a multidisciplinary prehabilitation program regarding in-hospital complications. Methods Data on patients who underwent elective cardiac surgery between January 2014 and April 2017 were analyzed retrospectively. Pearson’s chi-squared tests were used to compare patients who followed prehabilitation (three times per week, at a minimum of three weeks) during the waiting period with patients who received no prehabilitation. Sensitivity analyses were performed using propensity-score matching, in which the propensity score was based on the baseline variables that affected the outcomes. Results Of 1201 patients referred for elective cardiac surgery, 880 patients met the inclusion criteria, of whom 91 followed prehabilitation (53.8% ≥ 65 years, 78.0% male, median Euroscore II 1.3, IQR, 0.9–2.7) and 789 received no prehabilitation (60.7% ≥ 65 years, 69.6% male, median Euroscore II 1.6, IQR, 1.0–2.8). The incidence of atrial fibrillation (AF) was significantly lower in the prehabilitation group compared to the unmatched and matched standard care group (resp. 14.3% vs. 23.8%, P = 0.040 and 14.3% vs. 25.3%, P = 0.030). For the other complications, no between-group differences were found. Conclusions Prehabilitation might be beneficial to prevent postoperative AF. Patients participated safely in prehabilitation and were not at higher risk for postoperative complications. However, well-powered randomized controlled trials are needed to confirm and deepen these results.
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Affiliation(s)
- Johanneke Hartog
- Department of Cardiothoracic Surgery, University of Groningen, University Medical Center Groningen, Groningen, Groningen, The Netherlands
- * E-mail:
| | - Iman Mousavi
- Department of Cardiothoracic Surgery, University of Groningen, University Medical Center Groningen, Groningen, Groningen, The Netherlands
| | - Sandra Dijkstra
- Department of Cardiothoracic Surgery, University of Groningen, University Medical Center Groningen, Groningen, Groningen, The Netherlands
| | - Joke Fleer
- Department of Health Psychology, University of Groningen, University Medical Center Groningen, Groningen, Groningen, The Netherlands
| | - Lucas H. V. van der Woude
- Center for Human Movement Sciences, University of Groningen, University Medical Center Groningen, Groningen, Groningen, The Netherlands
- Department of Rehabilitation Medicine, University of Groningen, University Medical Center Groningen, Groningen, Groningen, The Netherlands
| | - Pim van der Harst
- Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, Groningen, The Netherlands
| | - Massimo A. Mariani
- Department of Cardiothoracic Surgery, University of Groningen, University Medical Center Groningen, Groningen, Groningen, The Netherlands
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Abstract
PURPOSE OF REVIEW To summarize recent innovations in cardiac rehabilitation and provide a view towards the future of cardiac rehabilitation as it adjusts to the pressures of a global pandemic. RECENT FINDINGS Although cardiac rehabilitation has been shown to result in a mortality benefit, research continues to enumerate the benefits of cardiac rehabilitation to patient function and quality of life in a growing range of cardiovascular diseases. In addition, new methodologies and new models of cardiac rehabilitation have emerged with the goal of increasing patient referral and participation. SUMMARY Cardiac rehabilitation continues to evolve and adapt to serve a growing and diversifying number of patients with cardiovascular disease with the goal of both decreasing mortality and improving patient function.
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Vromen T, Brouwers RWM, Jorstad HT, Kraaijenhagen RA, Spee RF, Wittekoek ME, Cramer MJ, van Hal JMC, Hofstra L, Kuijpers PMJC, de Melker EC, Rodrigo SF, Sunamura M, Uszko-Lencer NHMK, Kemps HM. Novel advances in cardiac rehabilitation : Position paper from the Working Group on Preventive Cardiology and Cardiac Rehabilitation of the Netherlands Society of Cardiology. Neth Heart J 2021; 29:479-485. [PMID: 34114176 PMCID: PMC8455729 DOI: 10.1007/s12471-021-01585-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/03/2021] [Indexed: 01/16/2023] Open
Abstract
Cardiac rehabilitation (CR) has evolved as an important part of the treatment of patients with cardiovascular disease. However, to date, its full potential is fairly underutilised. This review discusses new developments in CR aimed at improving participation rates and long-term effectiveness in the general cardiac population. It consecutively highlights new or challenging target groups, new delivery modes and new care pathways for CR programmes. These new or challenging target groups include patients with atrial fibrillation, obesity and cardiovascular disease, chronic coronary syndromes, (advanced) chronic heart failure with or without intracardiac devices, women and frail elderly patients. Also, the current evidence regarding cardiac telerehabilitation and loyalty programmes is discussed as new delivery modes for CR. Finally, this paper discusses novel care pathways with the integration of CR in residual risk management and transmural care pathways. These new developments can help to make optimal use of the benefits of CR. Therefore we should seize the opportunities to reshape current CR programmes, broaden their applicability and incorporate them into or combine them with other cardiovascular care programmes/pathways.
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Affiliation(s)
- T Vromen
- Department of Cardiology, Maastricht University Medical Centre, Maastricht, The Netherlands.
| | - R W M Brouwers
- Department of Cardiology, Máxima Medical Centre, Veldhoven, The Netherlands
| | - H T Jorstad
- Department of Cardiology, Amsterdam University Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | | | - R F Spee
- Department of Cardiology, Máxima Medical Centre, Veldhoven, The Netherlands
| | | | - M J Cramer
- Department of Cardiology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - J M C van Hal
- Department of Cardiology, Slingeland Hospital, Doetinchem, The Netherlands
| | - L Hofstra
- Cardiology Centres Netherlands, Utrecht, The Netherlands
| | - P M J C Kuijpers
- Department of Cardiology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - E C de Melker
- Department of Cardiology, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands
| | - S F Rodrigo
- Basalt Rehabilitation, Leiden, The Netherlands
| | - M Sunamura
- Capri Cardiac Rehabilitation, Rotterdam, The Netherlands
| | - N H M K Uszko-Lencer
- Department of Cardiology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - H M Kemps
- Department of Cardiology, Máxima Medical Centre, Veldhoven, The Netherlands.,Department of Industrial Design, Eindhoven University of Technology, Eindhoven, The Netherlands
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Buckley BJR, Harrison SL, Fazio-Eynullayeva E, Underhill P, Lane DA, Thijssen DHJ, Lip GYH. Exercise-Based Cardiac Rehabilitation and All-Cause Mortality Among Patients With Atrial Fibrillation. J Am Heart Assoc 2021; 10:e020804. [PMID: 34096332 PMCID: PMC8477861 DOI: 10.1161/jaha.121.020804] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Background There is limited evidence of long‐term impact of exercise‐based cardiac rehabilitation (CR) on clinical end points for patients with atrial fibrillation (AF). We therefore compared 18‐month all‐cause mortality, hospitalization, stroke, and heart failure in patients with AF and an electronic medical record of exercise‐based CR to matched controls. Methods and Results This retrospective cohort study included patient data obtained on February 3, 2021 from a global federated health research network. Patients with AF undergoing exercise‐based CR were propensity‐score matched to patients with AF without exercise‐based CR by age, sex, race, comorbidities, cardiovascular procedures, and cardiovascular medication. We ascertained 18‐month incidence of all‐cause mortality, hospitalization, stroke, and heart failure. Of 1 366 422 patients with AF, 11 947 patients had an electronic medical record of exercise‐based CR within 6‐months of incident AF who were propensity‐score matched with 11 947 patients with AF without CR. Exercise‐based CR was associated with 68% lower odds of all‐cause mortality (odds ratio, 0.32; 95% CI, 0.29–0.35), 44% lower odds of rehospitalization (0.56; 95% CI, 0.53–0.59), and 16% lower odds of incident stroke (0.84; 95% CI, 0.72–0.99) compared with propensity‐score matched controls. No significant associations were shown for incident heart failure (0.93; 95% CI, 0.84–1.04). The beneficial association of exercise‐based CR on all‐cause mortality was independent of sex, older age, comorbidities, and AF subtype. Conclusions Exercise‐based CR among patients with incident AF was associated with lower odds of all‐cause mortality, rehospitalization, and incident stroke at 18‐month follow‐up, supporting the provision of exercise‐based CR for patients with AF.
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Affiliation(s)
- Benjamin J R Buckley
- Liverpool Centre for Cardiovascular Science University of Liverpool and Liverpool Heart & Chest Hospital Liverpool United Kingdom.,Cardiovascular and Metabolic Medicine Institute of Life Course and Medical Sciences University of Liverpool United Kingdom
| | - Stephanie L Harrison
- Liverpool Centre for Cardiovascular Science University of Liverpool and Liverpool Heart & Chest Hospital Liverpool United Kingdom.,Cardiovascular and Metabolic Medicine Institute of Life Course and Medical Sciences University of Liverpool United Kingdom
| | | | | | - Deirdre A Lane
- Liverpool Centre for Cardiovascular Science University of Liverpool and Liverpool Heart & Chest Hospital Liverpool United Kingdom.,Cardiovascular and Metabolic Medicine Institute of Life Course and Medical Sciences University of Liverpool United Kingdom.,Aalborg Thrombosis Research Unit Department of Clinical Medicine Aalborg University Aalborg Denmark
| | - Dick H J Thijssen
- Research Institute for Sport and Exercise Sciences Liverpool John Moores University Liverpool United Kingdom.,Department of Physiology Research Institute for Health Science, Radboud University Medical Centerum Nijmegen The Netherlands
| | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science University of Liverpool and Liverpool Heart & Chest Hospital Liverpool United Kingdom.,Cardiovascular and Metabolic Medicine Institute of Life Course and Medical Sciences University of Liverpool United Kingdom.,Aalborg Thrombosis Research Unit Department of Clinical Medicine Aalborg University Aalborg Denmark
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Collet JP, Thiele H, Barbato E, Barthélémy O, Bauersachs J, Bhatt DL, Dendale P, Dorobantu M, Edvardsen T, Folliguet T, Gale CP, Gilard M, Jobs A, Jüni P, Lambrinou E, Lewis BS, Mehilli J, Meliga E, Merkely B, Mueller C, Roffi M, Rutten FH, Sibbing D, Siontis GC. Guía ESC 2020 sobre el diagnóstico y tratamiento del síndrome coronario agudo sin elevación del segmento ST. Rev Esp Cardiol (Engl Ed) 2021. [DOI: 10.1016/j.recesp.2020.12.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Scherrenberg M, Wilhelm M, Hansen D, Völler H, Cornelissen V, Frederix I, Kemps H, Dendale P. The future is now: a call for action for cardiac telerehabilitation in the COVID-19 pandemic from the secondary prevention and rehabilitation section of the European Association of Preventive Cardiology. Eur J Prev Cardiol 2021; 28:524-540. [PMID: 32615796 PMCID: PMC7928994 DOI: 10.1177/2047487320939671] [Citation(s) in RCA: 117] [Impact Index Per Article: 39.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 06/15/2020] [Indexed: 12/13/2022]
Abstract
The role of comprehensive cardiac rehabilitation is well established in the secondary prevention of cardiovascular diseases such as coronary artery disease and heart failure. Numerous trials have demonstrated both the effectiveness as well as the cost-effectiveness of comprehensive cardiac rehabilitation in improving exercise capacity and quality of life, and in reducing cardiovascular mortality and morbidity. However, the current COVID-19 pandemic has led to closure of many cardiac rehabilitation centres in Europe resulting in many eligible patients unable to participate in the optimisation of secondary prevention and physical performance. This elicits an even louder call for alternatives such as cardiac telerehabilitation to maintain the delivery of the core components of cardiac rehabilitation to cardiovascular disease patients. The present call for action paper gives an update of recent cardiac telerehabilitation studies and provides a practical guide for the setup of a comprehensive cardiac telerehabilitation intervention during the COVID-19 pandemic. This set up could also be relevant to any cardiovascular disease patient not able to visit cardiac rehabilitation centres regularly after the COVID-19 pandemic ceases.
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Affiliation(s)
- Martijn Scherrenberg
- />Faculty of Medicine and Life Sciences, UHasselt – Hasselt University, Belgium
- />Department of Cardiology, Jessa Hospital, Belgium
| | - Matthias Wilhelm
- />Department of Cardiology, University Hospital of Bern, Switzerland
| | - Dominique Hansen
- />Faculty of Rehabilitation Sciences, UHasselt – Hasselt University, Belgium
- />BIOMED/REVAL (Rehabilitation Research Centre), Belgium
- />Heart Centre Hasselt, Jessa Hospital, Belgium
| | - Heinz Völler
- />Department of Rehabilitation Medicine, University of Potsdam, Germany
- />Rehabilitation Centre for Internal Medicine, Klinik am See, Germany
| | | | - Ines Frederix
- />Faculty of Medicine and Health Sciences, Antwerp University, Belgium
- />Intenisve Care Unit, Antwerp University Hospital, Belgium
| | - Hareld Kemps
- />Department of Cardiology, Máxima Medical Center, The Netherlands
- />Department of Industrial Design, Technical University Eindhoven, The Netherlands
| | - Paul Dendale
- />Faculty of Medicine and Life Sciences, UHasselt – Hasselt University, Belgium
- />Department of Cardiology, Jessa Hospital, Belgium
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Novaković M, Novak T, Vižintin Cuderman T, Krevel B, Tasič J, Rajkovič U, Fras Z, Jug B. Exercise capacity improvement after cardiac rehabilitation following myocardial infarction and its association with long-term cardiovascular events. Eur J Cardiovasc Nurs 2021; 21:76-84. [PMID: 33864065 DOI: 10.1093/eurjcn/zvab015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Revised: 12/12/2020] [Accepted: 02/10/2021] [Indexed: 11/12/2022]
Abstract
AIMS Cardiovascular rehabilitation (CR) improves aerobic capacity and quality of life in patients after myocardial infarction (MI). The aim was to examine the associations between exercise capacity improvement and different clinically relevant cardiovascular events. METHODS AND RESULTS This was a registry-based study of post-MI patients, referred to CR. All patients were submitted to exercise testing before and after CR (36 sessions, 2-3 times/week, and combined exercise). Patients were divided into two groups, based on the difference in exercise capacity before and after the CR programme with the cut-off of two metabolic equivalents (METs) improvement. We assessed the correlation between the extent of exercise capacity improvement and the following cardiovascular events: major adverse cardiac events (MACE), cardiovascular-related hospitalizations, and unplanned coronary angiography. A total of 499 patients were included (mean age 56 ± 10 years, 20% women). Both groups significantly improved in terms of exercise capacity, natriuretic peptide levels, resting heart rate, and resting diastolic pressure; however, lipid status significantly improved only in patients with ≥2 METs difference in exercise capacity. A total of 13.4% patients suffered MACE (median follow-up 858 days); 21.8% were hospitalized for cardiovascular reasons (median follow-up 791 days); and 19.8% had at least one unplanned coronary angiography (median follow-up 791 days). Exercise capacity improvement of ≥2 METs was associated with lower rates of MACE, cardiovascular hospitalizations, and unplanned coronary angiography in all examined univariate and multivariate models. CONCLUSION This study has shown that exercise improvement of ≥2 METs is associated with a significant decrease in MACE, cardiac hospitalizations, and unplanned coronary angiography.
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Affiliation(s)
- Marko Novaković
- Department of Vascular Diseases, Centre for Preventive Cardiology, University Medical Centre Ljubljana, Zaloška cesta 7/VI, Ljubljana SI-1000, Slovenia
| | - Tjaša Novak
- Faculty of Medicine, University of Ljubljana, Vrazov trg 2, Ljubljana SI-1000, Slovenia
| | - Tjaša Vižintin Cuderman
- Department of Vascular Diseases, Centre for Preventive Cardiology, University Medical Centre Ljubljana, Zaloška cesta 7/VI, Ljubljana SI-1000, Slovenia
| | - Barbara Krevel
- Department of Vascular Diseases, Centre for Preventive Cardiology, University Medical Centre Ljubljana, Zaloška cesta 7/VI, Ljubljana SI-1000, Slovenia
| | - Jerneja Tasič
- Department of Vascular Diseases, Centre for Preventive Cardiology, University Medical Centre Ljubljana, Zaloška cesta 7/VI, Ljubljana SI-1000, Slovenia
| | - Uroš Rajkovič
- Faculty of Organizational Sciences, University of Maribor, Kidričeva cesta 55a, Kranj SI-4000, Slovenia
| | - Zlatko Fras
- Department of Vascular Diseases, Centre for Preventive Cardiology, University Medical Centre Ljubljana, Zaloška cesta 7/VI, Ljubljana SI-1000, Slovenia.,Faculty of Medicine, University of Ljubljana, Vrazov trg 2, Ljubljana SI-1000, Slovenia
| | - Borut Jug
- Department of Vascular Diseases, Centre for Preventive Cardiology, University Medical Centre Ljubljana, Zaloška cesta 7/VI, Ljubljana SI-1000, Slovenia.,Faculty of Medicine, University of Ljubljana, Vrazov trg 2, Ljubljana SI-1000, Slovenia
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Collet JP, Thiele H, Barbato E, Barthélémy O, Bauersachs J, Bhatt DL, Dendale P, Dorobantu M, Edvardsen T, Folliguet T, Gale CP, Gilard M, Jobs A, Jüni P, Lambrinou E, Lewis BS, Mehilli J, Meliga E, Merkely B, Mueller C, Roffi M, Rutten FH, Sibbing D, Siontis GCM. 2020 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation. Eur Heart J 2021; 42:1289-1367. [PMID: 32860058 DOI: 10.1093/eurheartj/ehaa575] [Citation(s) in RCA: 2612] [Impact Index Per Article: 870.7] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
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Epstein E, Patel N, Maysent K, Taub PR. Cardiac Rehab in the COVID Era and Beyond: mHealth and Other Novel Opportunities. Curr Cardiol Rep 2021; 23:42. [PMID: 33704611 PMCID: PMC7947942 DOI: 10.1007/s11886-021-01482-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/17/2021] [Indexed: 12/17/2022]
Abstract
Purpose of Review The COVID-19 pandemic has forced many center-based cardiac rehabilitation (CBCR) programs to close or limit their usual offerings. In order for patients to continue to benefit from CR, programs need to rapidly adapt to the current environment. This review highlights ways CR has evolved, and reviews the history of CR and recent advancements in telemedicine including remote patient monitoring, and mobile health that can be applied to CR. Recent Findings Despite that initial studies indicate that home-based CR (HBCR) is safe and effective, HBCR has faced several challenges that have prevented it from becoming more widely implemented. Many previous concerns can now be addressed through the use of new innovations in home-based healthcare delivery. Summary Since its inception, CR has become increasingly recognized as an important tool to improve patient mortality and quality of life in a broad range of cardiac diseases. While there has been little need to modify the delivery of CR since the 1950s, COVID-19 now serves as the necessary impetus to make HBCR an equal alternative to CBCR.
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Affiliation(s)
- Elizabeth Epstein
- University of California, 9300 Campus Point Drive, La Jolla, San Diego, CA 92037 USA
| | - Neeja Patel
- University of California, 9300 Campus Point Drive, La Jolla, San Diego, CA 92037 USA
| | - Kathryn Maysent
- University of California, 9300 Campus Point Drive, La Jolla, San Diego, CA 92037 USA
| | - Pam R. Taub
- University of California, 9300 Campus Point Drive, La Jolla, San Diego, CA 92037 USA
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Kanaoka K, Soeda T, Terasaki S, Nishioka Y, Myojin T, Kubo S, Okada K, Noda T, Watanabe M, Kawakami R, Sakata Y, Imamura T, Saito Y. Current Status and Effect of Outpatient Cardiac Rehabilitation After Percutaneous Coronary Intervention in Japan. Circ Rep 2021; 3:122-130. [PMID: 33738344 PMCID: PMC7956885 DOI: 10.1253/circrep.cr-20-0143] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Background:
Although cardiac rehabilitation (CR) has been reported to be associated with better clinical outcomes in patients with cardiovascular diseases, there are few nationwide studies about CR participation by patients with coronary artery disease in Japan. Methods and Results:
We performed a nationwide retrospective cohort study using the National Database of Health Insurance Claims and Specific Health Checkups of Japan between April 2014 and March 2018. Patients were divided into 2 groups (acute coronary syndrome [ACS] and stable coronary artery disease [sCAD]), and the rates of participation in in- and outpatient CR after percutaneous coronary intervention (PCI) were investigated. Propensity score-matched analysis was performed and the association between outpatient CR participation and all-cause mortality 3 months after PCI was examined. Overall, 616,664 patients (ACS, n=202,853; sCAD, n=413,811) were analyzed. The participation rates of CR increased annually. The participation rate was higher for inpatient than outpatient CR in both the ACS (52% vs. 9%, respectively) and sCAD (15% vs. 3%, respectively) groups. Prognosis was better for patients with than without outpatient CR in both the ACS (hazard ratio [HR] 0.52; 95% confidence interval [CI] 0.47–0.59) and sCAD (HR 0.72; 95% CI 0.65–0.80) groups. Conclusions:
Outpatient CR was associated with a better prognosis in patients with ACS or sCAD. The participation rates of outpatient CR following PCI were extremely low in Japan.
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Affiliation(s)
- Koshiro Kanaoka
- Department of Cardiovascular Medicine, Nara Medical University Kashihara Japan
| | - Tsunenari Soeda
- Department of Cardiovascular Medicine, Nara Medical University Kashihara Japan
| | - Satoshi Terasaki
- Department of Cardiovascular Medicine, Nara Medical University Kashihara Japan
| | - Yuichi Nishioka
- Department of Public Health, Health Management and Policy, Nara Medical University Kashihara Japan
| | - Tomoya Myojin
- Department of Public Health, Health Management and Policy, Nara Medical University Kashihara Japan
| | - Shinichiro Kubo
- Department of Public Health, Health Management and Policy, Nara Medical University Kashihara Japan
| | - Katsuki Okada
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine Osaka Japan
| | - Tatsuya Noda
- Department of Public Health, Health Management and Policy, Nara Medical University Kashihara Japan
| | - Makoto Watanabe
- Department of Cardiovascular Medicine, Nara Medical University Kashihara Japan
| | - Rika Kawakami
- Department of Cardiovascular Medicine, Nara Medical University Kashihara Japan
| | - Yasushi Sakata
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine Osaka Japan
| | - Tomoaki Imamura
- Department of Public Health, Health Management and Policy, Nara Medical University Kashihara Japan
| | - Yoshihiko Saito
- Department of Cardiovascular Medicine, Nara Medical University Kashihara Japan
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De Smet S, Van Craenenbroeck AH. Exercise training in patients after kidney transplantation. Clin Kidney J 2021; 14:ii15-ii24. [PMID: 33981416 PMCID: PMC8101622 DOI: 10.1093/ckj/sfab022] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Accepted: 01/11/2021] [Indexed: 02/07/2023] Open
Abstract
Kidney transplantation is the treatment of choice for patients with end-stage renal disease. Next to the risk of allograft failure, major obstacles for disease-free survival after kidney transplantation include a higher incidence of cancer, infection and cardiovascular events. Risk factors for adverse clinical outcomes include pre-existent comorbidities, the introduction of an immunodeficient status and (lack of) lifestyle changes after transplantation. Indeed, physical inactivity and poor physical fitness are important targets to address in order to improve clinical outcomes after kidney transplantation. This review summarizes the current evidence on exercise training after kidney transplantation, derived from randomized controlled trials. As much as possible, results are discussed in the perspective of the Standardized Outcomes in Nephrology-Transplantation core outcomes, which were recently described as critically important outcome domains for trials in kidney transplant recipients.
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Affiliation(s)
- Stefan De Smet
- Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium
| | - Amaryllis H Van Craenenbroeck
- Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium.,Department of Nephrology and Renal Transplantation, University Hospitals Leuven, Leuven, Belgium
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Predictors of cardiac rehabilitation referral, enrolment and completion after acute myocardial infarction: an exploratory study. Neth Heart J 2020; 29:151-157. [PMID: 33030659 PMCID: PMC7904980 DOI: 10.1007/s12471-020-01492-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/08/2020] [Indexed: 11/29/2022] Open
Abstract
Background Despite proven clinical benefits, only a minority of patients complete outpatient cardiac rehabilitation (CR) after acute myocardial infarction (AMI). The main purpose of this study was to evaluate to what extent and at which time patients drop out of CR, and to assess which patient-related characteristics can predict dropout. Methods In a retrospective cohort study, we selected patients who had been hospitalised with an AMI in our centre in 2015 or 2016. Patients were selected pseudonymously based on reimbursement codes in the electronic health record. We extracted baseline characteristics and data on CR referral, enrolment and completion for each patient. Multivariable logistic regression was used to assess which characteristics predicted referral and dropout. Results The 666 patients included were predominantly male (66%), with a mean age of 69.0 years. Of the 640 eligible patients, 201 (31%) were not referred for CR. Enrolment after referral was 94%. Nonreferral was independently associated with older age, female sex, traveling distance, non-ST-elevation myocardial infarction (NSTEMI; as compared with STEMI), no coronary revascularisation and prior manifestations of coronary artery disease. Of the 414 enrolled patients, 24% did not complete their CR programmes (i.e. dropped out). Older age and worse exercise capacity at baseline were independently associated with dropout. The ability of the multiple regression models to predict nonreferral and noncompletion was good to fair, with an area under the receiver operating characteristic curves of 0.86 and 0.71, respectively. Conclusion The main reason for not participating in or not completing CR after AMI was nonreferral. To optimise CR utilisation, improvement of referral rates should be prioritised.
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Kamiya K, Sato Y, Takahashi T, Tsuchihashi-Makaya M, Kotooka N, Ikegame T, Takura T, Yamamoto T, Nagayama M, Goto Y, Makita S, Isobe M. Multidisciplinary Cardiac Rehabilitation and Long-Term Prognosis in Patients With Heart Failure. Circ Heart Fail 2020; 13:e006798. [DOI: 10.1161/circheartfailure.119.006798] [Citation(s) in RCA: 56] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Background:
Exercise-based cardiac rehabilitation (CR) improves health-related quality of life and exercise capacity in patients with heart failure (HF). However, CR efficacy in patients with HF who are elderly, frail, or have HF with preserved ejection fraction remains unclear. We examined whether participation in multidisciplinary outpatient CR is associated with long-term survival and rehospitalization in patients with HF, with subgroup analysis by age, sex, comorbidities, frailty, and HF with preserved ejection fraction.
Methods:
This multicenter retrospective cohort study was performed in patients hospitalized for acute HF at 15 hospitals in Japan, 2007 to 2016. The primary outcome (composite of all-cause mortality and HF rehospitalization after discharge) and secondary outcomes (all-cause mortality and HF rehospitalization) were analyzed in outpatient CR program participants versus nonparticipants.
Results:
Of the 3277 patients, 26% (862) participated in outpatient CR. After propensity matching for potential confounders, 1592 patients were included (n=796 pairs), of which 511 had composite outcomes (223 [14%] all-cause deaths and 392 [25%] HF rehospitalizations, median 2.4-year follow-up). Hazard ratios associated with CR participation were 0.77 (95% CI, 0.65–0.92) for composite outcome, 0.67 (95% CI, 0.51–0.87) for all-cause mortality, and 0.82 (95% CI, 0.67–0.99) for HF-related rehospitalization. CR participation was also associated with numerically lower rates of composite outcome in patients with HF with preserved ejection fraction or frail patients.
Conclusions:
Outpatient CR participation was associated with substantial prognostic benefit in a large HF cohort regardless of age, sex, comorbidities, frailty, and HF with preserved ejection fraction.
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Affiliation(s)
- Kentaro Kamiya
- Department of Rehabilitation, School of Allied Health Sciences (K.K.), Kitasato University, Kanagawa, Japan
| | - Yukihito Sato
- Department of Cardiology, Hyogo Prefectural Amagasaki General Medical Center, Japan (Y.S.)
| | - Tetsuya Takahashi
- Department of Physical Therapy, Juntendo University, Tokyo, Japan (T. Takahashi)
| | | | - Norihiko Kotooka
- Department of Cardiovascular Medicine, Saga University, Japan (N.K.)
| | - Toshimi Ikegame
- Department of Nursing (T.I.), Sakakibara Heart Institute, Tokyo, Japan
| | - Tomoyuki Takura
- Department of Healthcare Economics and Health Policy, Graduate School of Medicine, The University of Tokyo, Japan (T. Takura)
| | - Takanobu Yamamoto
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Japan (T.Y.)
| | - Masatoshi Nagayama
- Department of Cardiovascular Medicine (M.N.), Sakakibara Heart Institute, Tokyo, Japan
| | - Yoichi Goto
- Yoka Municipal Hospital, Hyogo, Japan (Y.G.)
| | - Shigeru Makita
- Department of Cardiac Rehabilitation, Saitama Medical University International Medical Center, Japan (S.M.)
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Doimo S, Fabris E, Piepoli M, Barbati G, Antonini-Canterin F, Bernardi G, Maras P, Sinagra G. Impact of ambulatory cardiac rehabilitation on cardiovascular outcomes: a long-term follow-up study. Eur Heart J 2020; 40:678-685. [PMID: 30060037 DOI: 10.1093/eurheartj/ehy417] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Revised: 01/03/2018] [Accepted: 07/20/2018] [Indexed: 12/14/2022] Open
Abstract
AIMS To evaluate the long-term clinical impact of the application of cardiac rehabilitation (CR) early after discharge in a real-world population. METHODS AND RESULTS We analysed the 5-year incidence of cardiovascular mortality and hospitalization for cardiovascular causes in two populations, attenders vs. non-attenders to an ambulatory CR program which were consecutively discharged from two tertiary hospitals, after ST-elevation myocardial infarction, non-ST-elevation myocardial infarction, coronary artery bypass graft, or planned percutaneous coronary intervention. A primary analysis using multivariable regression model and a secondary analysis using the propensity score approach were performed. Between 1 January 2009 and 31 December 2010, 839 patients attended a CR program planned at discharged, while 441 patients were discharged from Cardiovascular Department without any program of CR. During follow-up, the incidence of cardiovascular mortality was 6% in both groups (P = 0.62). The composite outcome of hospitalizations for cardiovascular causes and cardiovascular mortality were lower in CR group compared to no-CR group (18% vs. 30%, P < 0.001) and was driven by lower hospitalizations for cardiovascular causes (15 vs. 27%, P < 0.001). At multivariable Cox proportional hazard analysis, CR program was independent predictor of lower occurrence of the composite outcome (hazard ratio 0.58, 95% confidence interval 0.43-0.77; P < 0.001), while in the propensity-matched analysis CR group experienced also a lower total mortality (10% vs. 19%, P = 0.002) and cardiovascular mortality (2% vs. 7%, P = 0.008) compared to no-CR group. CONCLUSION This study showed, in a real-world population, the positive effects of ambulatory CR program in improving clinical outcomes and highlights the importance of a spread use of CR in order to reduce cardiovascular hospitalizations and cardiovascular mortality during a long-term follow-up.
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Affiliation(s)
- Sara Doimo
- Cardiovascular Department, Azienda Sanitaria Universitaria Integrata, University of Trieste, Via Pietro Valdoni n. 7, Trieste, Italy
| | - Enrico Fabris
- Cardiovascular Department, Azienda Sanitaria Universitaria Integrata, University of Trieste, Via Pietro Valdoni n. 7, Trieste, Italy
| | - Massimo Piepoli
- Heart Failure Unit, Cardiac Department, Guglielmo da Saliceto Hospital, Piacenza, Italy
| | - Giulia Barbati
- Biostatistics Unit, Department of Medical Sciences, University of Trieste, Italy
| | | | - Guglielmo Bernardi
- Division of Cardiology, "Santa Maria degli Angeli" Hospital, Pordenone, ASS5, Italy
| | - Patrizia Maras
- Cardiovascular Department, Azienda Sanitaria Universitaria Integrata, University of Trieste, Via Pietro Valdoni n. 7, Trieste, Italy
| | - Gianfranco Sinagra
- Cardiovascular Department, Azienda Sanitaria Universitaria Integrata, University of Trieste, Via Pietro Valdoni n. 7, Trieste, Italy
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Zhang C, Soliman-Hamad M, Robijns R, Verberkmoes N, Verstappen F, IJsselsteijn WA. Promoting Physical Activity With Self-Tracking and Mobile-Based Coaching for Cardiac Surgery Patients During the Discharge-Rehabilitation Gap: Protocol for a Randomized Controlled Trial. JMIR Res Protoc 2020; 9:e16737. [PMID: 32812886 PMCID: PMC7468644 DOI: 10.2196/16737] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Revised: 02/29/2020] [Accepted: 03/21/2020] [Indexed: 12/11/2022] Open
Abstract
Background Home-based cardiac rehabilitations (CRs) with digital technologies have been researched and implemented to replace, augment, and complement traditional center-based CR in recent years with considerable success. One problem that technology-enhanced home-based CR can potentially address is the gap between cardiac interventions and formal CR programs. In the Netherlands and some other countries (eg, Australia), patients after cardiac interventions stay at home for 3-4 weeks without much support from their physicians, and often engage in very little physical activity (PA). A home-based exercise program enabled by digital technologies may help patients to better prepare for the later center-based CR programs, potentially increasing the uptake rate of those programs. Objective In a randomized controlled trial (RCT), we will evaluate the effectiveness of a home-based walking exercise program enhanced by self-tracking and mobile-based coaching (treatment condition), comparing it with a version of the same program without these technologies (control condition). The added value of the digital technologies is justified if patients in the treatment group walk more steps on average (primary outcome) and show better physical fitness in a bicycle ergometer test and higher self-efficacy toward PA (secondary outcomes). Methods Based on a power analysis, we will recruit 100 cardiac patients and assign them evenly to the 2 parallel groups. Eligible patients are those who are scheduled in the postanesthesia care unit, know the Dutch language, have basic literacy of using smartphones, and are without medical conditions that may increase risks associated with PA. In a face-to-face meeting with a nurse practitioner, all patients are prescribed a 3-week exercise program at home (2 walking exercises per day with increasing duration), based on national and international guidelines and tailored to their physical conditions after cardiac intervention. Their physical activities (daily steps) will be measured by the Axivity AX3 accelerometer worn at hip position. Patients in the treatment group will also be supported by a Neo Health One self-tracking device and a mobile platform called Heart Angel, through which they are monitored and coached by their nurses. After the study, all patients will perform a bicycle ergometer test and return the devices within 1 week. In addition, 5 questionnaires will be sent to the patients by emails to assess their self-efficacy toward PA and other psychological states for exploratory analyses (at discharge, at the end of each monitoring week, and 1 week after the study). To minimize bias, the randomization procedure will be performed after introducing the exercise program, so the nurse practitioners are blind to the experimental conditions until that point. Results The study protocol has been approved by the Medical Research Ethics Committees United on February 26, 2018 (NL 62142.100.17/R17.51). By the end of 2018, we completed a small pilot study with 8 patients and the results based on interviews and app usage data suggest that a larger clinical trial with the targeted population is feasible. We expect to complete the RCT by the end of 2021, and statistical analyses will follow. Conclusions Results of the RCT will help us to test the hypothesized benefits of self-tracking and mobile-based coaching for cardiac patients in home-based exercise programs during the discharge–rehabilitation gap. If the results are positive, cost-effectiveness analysis will be performed based on the insights of the study to inform the translation of the technology-enhanced program to clinical practice. We also note limitations of the trial in the discussion. Trial Registration Registered at Netherlands Trial Register NL8040; https://www.trialregister.nl/trial/8040 International Registered Report Identifier (IRRID) PRR1-10.2196/16737
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Affiliation(s)
- Chao Zhang
- Eindhoven University of Technology, Eindhoven, Netherlands
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Eijsvogels TMH, Maessen MFH, Bakker EA, Meindersma EP, van Gorp N, Pijnenburg N, Thompson PD, Hopman MTE. Association of Cardiac Rehabilitation With All-Cause Mortality Among Patients With Cardiovascular Disease in the Netherlands. JAMA Netw Open 2020; 3:e2011686. [PMID: 32716516 DOI: 10.1001/jamanetworkopen.2020.11686] [Citation(s) in RCA: 53] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
IMPORTANCE Cardiac rehabilitation (CR) is an effective strategy to improve clinical outcomes, but it remains underused in some subgroups of patients with cardiovascular disease (CVD). OBJECTIVE To investigate the implications of sex, age, socioeconomic status, CVD diagnosis, cardiothoracic surgery, and comorbidity for the association between CR participation and all-cause mortality. DESIGN, SETTING, AND PARTICIPANTS Observational cohort study with patient enrollment between July 1, 2012, and December 31, 2017, and a follow-up to March 19, 2020. The dates of analysis were March to May 2020. This study was performed among Dutch patients with CVD with a multidisciplinary outpatient CR program indication and who were insured at Coöperatie Volksgezondheidszorg, one of the largest health insurance companies in the Netherlands. Among 4.1 million beneficiaries, patients with CVD with an acute coronary event (myocardial infarction or unstable angina pectoris), stable angina pectoris, chronic heart failure, or cardiothoracic surgery (coronary artery bypass grafting, valve replacement, or percutaneous coronary intervention) were identified by inpatient diagnosis codes and included in the study. MAIN OUTCOMES AND MEASURES Cox proportional hazards models were used to evaluate the association between CR participation and all-cause mortality. Stabilized inverse propensity score weighting was used to account for patient and disease characteristics associated with CR participation. RESULTS Among 83 687 eligible patients with CVD (mean [SD] age, 67 [12] years; 60.4% [n = 50 512] men), only 31.3% (n = 26 171) participated in CR, with large variation across different subgroups (range, 5.1%-73.0%). During a mean (SD) of 4.7 (1.8) years of follow-up, 1966 CR participants (7.5%) and 13 443 CR nonparticipants (23.4%) died. After multivariable adjustment, CR participation was associated with a 32% lower risk of all-cause mortality (adjusted hazard ratio, 0.68; 95% CI, 0.65-0.71) compared with nonparticipation. Sex, age, socioeconomic status, and comorbidity did not alter risk reduction after CR participation, but a statistically significant interaction association was found across categories of CVD diagnosis and cardiothoracic surgery. Larger reductions in risk estimates for all-cause mortality were found after CR participation for STEMI (adjusted HR, 0.59; 95% CI, 0.52-0.68 vs 0.72; 95% CI, 0.65-0.79; P < .001), NSTEMI (adjusted HR, 0.64; 95% CI, 0.58-0.70 vs 0.72; 95% CI, 0.65-0.79; P < .001), and stable AP (adjusted HR, 0.69; 95% CI, 0.63-0.76 vs 0.72; 95% CI, 0.65-0.79; P < .001) compared with patients with chronic heart failure, whereas unstable AP had a smaller risk reduction (adjusted HR, 0.75; 95% CI, 0.67-0.85 vs 0.72; 95% CI, 0.65-0.79; P < .001). CONCLUSIONS AND RELEVANCE In this cohort study, CR participation was associated with a 32% risk reduction in all-cause mortality, and this benefit was independent of sex, age, socioeconomic status, and comorbidity. These findings reinforce the importance of CR participation in secondary prevention and highlight the possibility that CR should be prescribed more widely to vulnerable patients with CVD, such as older adults with chronic diseases or multimorbidity.
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Affiliation(s)
- Thijs M H Eijsvogels
- Department of Physiology, Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Martijn F H Maessen
- Department of Physiology, Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, the Netherlands
- Coöperatie Volksgezondheidszorg, Business Intelligence Services, Arnhem, the Netherlands
| | - Esmée A Bakker
- Department of Physiology, Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, the Netherlands
- Research Institute for Sports and Exercise Sciences, Liverpool John Moores University, Liverpool, United Kingdom
| | - Esther P Meindersma
- Department of Cardiology, Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Niels van Gorp
- Coöperatie Volksgezondheidszorg, Business Intelligence Services, Arnhem, the Netherlands
| | - Nicole Pijnenburg
- Coöperatie Volksgezondheidszorg, Business Intelligence Services, Arnhem, the Netherlands
| | - Paul D Thompson
- Division of Cardiology, Hartford Hospital, Hartford, Connecticut
| | - Maria T E Hopman
- Department of Physiology, Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, the Netherlands
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Affiliation(s)
- Randal J Thomas
- Preventive Cardiology Division, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - LaPrincess C Brewer
- Preventive Cardiology Division, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
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48
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Brouwers RWM, van Exel HJ, van Hal JMC, Jorstad HT, de Kluiver EP, Kraaijenhagen RA, Kuijpers PMJC, van der Linde MR, Spee RF, Sunamura M, Uszko-Lencer NHMK, Vromen T, Wittekoek ME, Kemps HMC. Cardiac telerehabilitation as an alternative to centre-based cardiac rehabilitation. Neth Heart J 2020; 28:443-451. [PMID: 32495296 PMCID: PMC7431507 DOI: 10.1007/s12471-020-01432-y] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Multidisciplinary cardiac rehabilitation (CR) reduces morbidity and mortality and increases quality of life in cardiac patients. However, CR utilisation rates are low, and targets for secondary prevention of cardiovascular disease are not met in the majority of patients, indicating that secondary prevention programmes such as CR leave room for improvement. Cardiac telerehabilitation (CTR) may resolve several barriers that impede CR utilisation and sustainability of its effects. In CTR, one or more modules of CR are delivered outside the environment of the hospital or CR centre, using monitoring devices and remote communication with patients. Multidisciplinary CTR is a safe and at least equally (cost-)effective alternative to centre-based CR, and is therefore recommended in a recent addendum to the Dutch multidisciplinary CR guidelines. In this article, we describe the background and core components of this addendum on CTR, and discuss its implications for clinical practice and future perspectives.
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Affiliation(s)
- R W M Brouwers
- Flow, Centre for Prevention, Telemedicine and Rehabilitation in Chronic Disease, Máxima Medical Centre, Eindhoven, The Netherlands.
| | | | - J M C van Hal
- Department of Cardiology, Slingeland Hospital, Doetinchem, The Netherlands
| | - H T Jorstad
- Department of Cardiology, Amsterdam University Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | | | - R A Kraaijenhagen
- NDDO Institute for Prevention and E-health Development (NIPED), Amsterdam, The Netherlands
| | - P M J C Kuijpers
- Department of Cardiology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - M R van der Linde
- Department of Cardiology, Nij Smellinghe Hospital, Drachten, The Netherlands
| | - R F Spee
- Flow, Centre for Prevention, Telemedicine and Rehabilitation in Chronic Disease, Máxima Medical Centre, Eindhoven, The Netherlands.,Department of Cardiology, Máxima Medical Centre, Veldhoven, The Netherlands
| | - M Sunamura
- Capri Cardiac Rehabilitation, Rotterdam, The Netherlands
| | - N H M K Uszko-Lencer
- Department of Cardiology, Maastricht University Medical Centre, Maastricht, The Netherlands.,Department of Research and Education, Centre of Expertise for Chronic Organ Failure (CIRO+), Horn, The Netherlands
| | - T Vromen
- Department of Cardiology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | | | - H M C Kemps
- Flow, Centre for Prevention, Telemedicine and Rehabilitation in Chronic Disease, Máxima Medical Centre, Eindhoven, The Netherlands.,Department of Cardiology, Máxima Medical Centre, Veldhoven, The Netherlands
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Ambrosetti M, Abreu A, Corrà U, Davos CH, Hansen D, Frederix I, Iliou MC, Pedretti RF, Schmid JP, Vigorito C, Voller H, Wilhelm M, Piepoli MF, Bjarnason-Wehrens B, Berger T, Cohen-Solal A, Cornelissen V, Dendale P, Doehner W, Gaita D, Gevaert AB, Kemps H, Kraenkel N, Laukkanen J, Mendes M, Niebauer J, Simonenko M, Zwisler ADO. Secondary prevention through comprehensive cardiovascular rehabilitation: From knowledge to implementation. 2020 update. A position paper from the Secondary Prevention and Rehabilitation Section of the European Association of Preventive Cardiology. Eur J Prev Cardiol 2020; 28:460-495. [PMID: 33611446 DOI: 10.1177/2047487320913379] [Citation(s) in RCA: 318] [Impact Index Per Article: 79.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Accepted: 02/26/2020] [Indexed: 12/24/2022]
Abstract
Secondary prevention through comprehensive cardiac rehabilitation has been recognized as the most cost-effective intervention to ensure favourable outcomes across a wide spectrum of cardiovascular disease, reducing cardiovascular mortality, morbidity and disability, and to increase quality of life. The delivery of a comprehensive and 'modern' cardiac rehabilitation programme is mandatory both in the residential and the out-patient setting to ensure expected outcomes. The present position paper aims to update the practical recommendations on the core components and goals of cardiac rehabilitation intervention in different cardiovascular conditions, in order to assist the whole cardiac rehabilitation staff in the design and development of the programmes, and to support healthcare providers, insurers, policy makers and patients in the recognition of the positive nature of cardiac rehabilitation. Starting from the previous position paper published in 2010, this updated document maintains a disease-oriented approach, presenting both well-established and more controversial aspects. Particularly for implementation of the exercise programme, advances in different training modalities were added and new challenging populations were considered. A general table applicable to all cardiovascular conditions and specific tables for each clinical condition have been created for routine practice.
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Affiliation(s)
- Marco Ambrosetti
- Department of Cardiac Rehabilitation, ICS Maugeri Care and Research Institute, Italy
| | - Ana Abreu
- Serviço de Cardiologia, Hospital Universitário de Santa Maria/Centro Hospitalar Universitário Lisboa Norte (CHULN), Centro Académico de Medicina de Lisboa (CAML), Centro Cardiovascular da Universidade de Lisboa (CCUL), Faculdade de Medicina, Universidade de Lisboa, Portugal
| | - Ugo Corrà
- Department of Cardiac Rehabilitation, ICS Maugeri Care and Research Institute, Italy
| | - Constantinos H Davos
- Cardiovascular Research Laboratory, Biomedical Research Foundation, Academy of Athens, Greece
| | - Dominique Hansen
- REVAL and BIOMED-Rehabilitation Research Centre, Hasselt University, Belgium
| | | | - Marie C Iliou
- Department of Cardiac Rehabilitation and Secondary Prevention, Hôpital Corentin Celton, Assistance Publique Hopitaux de Paris Centre-Universite de Paris, France
| | | | | | | | - Heinz Voller
- Klinik am See, Rehabilitation Centre for Internal Medicine, Rüdersdorf and Centre of Rehabilitation Medicine, University Potsdam, Germany
| | - Matthias Wilhelm
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Massimo F Piepoli
- Heart Failure Unit, G. da Saliceto Hospital, AUSL Piacenza and University of Parma, Italy
| | - Birna Bjarnason-Wehrens
- Department of Preventive and Rehabilitative Sport Medicine and Exercise Physiology, Institute for Cardiology and Sports Medicine, German Sport University Cologne, Germany
| | | | - Alain Cohen-Solal
- Cardiology Department, Hopital Lariboisiere, Paris University, France
| | | | - Paul Dendale
- Heart Centre, Jessa Hospital Campus Virga Jesse, Belgium
| | - Wolfram Doehner
- Department of Cardiology (Virchow Klinikum), German Centre for Cardiovascular Research (DZHK), Germany.,BCRT - Berlin Institute of Health Centre for Regenerative Therapies, and Centre for Stroke Research Berlin, Charité Universitätsmedizin Berlin, Germany
| | - Dan Gaita
- University of Medicine & Pharmacy 'Victor Babes' Cardiovascular Prevention & Rehabilitation Clinic, Romania
| | - Andreas B Gevaert
- Heart Centre, Jessa Hospital Campus Virga Jesse, Belgium.,Research group Cardiovascular Diseases, GENCOR Department, University of Antwerp, Belgium
| | - Hareld Kemps
- Department of Cardiology, Maxima Medical Centre, The Netherlands
| | - Nicolle Kraenkel
- Charité - University Medicine Berlin, Germany.,German Centre for Cardiovascular Research (DZHK), Germany
| | - Jari Laukkanen
- Central Finland Health Care District Hospital District, Finland
| | - Miguel Mendes
- Cardiology Department, CHLO-Hospital de Santa Cruz, Portugal
| | - Josef Niebauer
- University Institute of Sports Medicine, Prevention and Rehabilitation, Paracelsus Medical University, Austria
| | - Maria Simonenko
- Physiology Research and Blood Circulation Department, Cardiopulmonary Exercise Test SRL, Heart Transplantation Outpatient Department, Federal State Budgetary Institution, 'V.A. Almazov National Medical Research Centre' of the Ministry of Health of the Russian Federation, Russian Federation
| | - Ann-Dorthe Olsen Zwisler
- REHPA-Danish Knowledge Centre for Rehabilitation and Palliative Care, University of Southern Denmark, Odense University Hospital, Denmark
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50
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Sunamura M, Ter Hoeve N, van den Berg-Emons RJG, Boersma E, Geleijnse ML, van Domburg RT. Patients who do not complete cardiac rehabilitation have an increased risk of cardiovascular events during long-term follow-up. Neth Heart J 2020; 28:460-466. [PMID: 32198644 PMCID: PMC7431499 DOI: 10.1007/s12471-020-01413-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Background Cardiac rehabilitation (CR) has favourable effects on cardiovascular mortality and morbidity. Therefore, it might reasonable to expect that incomplete CR participation will result in suboptimal patient outcomes. Methods We studied the 914 post-acute coronary syndrome patients who participated in the OPTImal CArdiac REhabilitation (OPTICARE) trial. They all started a ‘standard’ CR programme, with physical exercises (group sessions) twice a week for 12 weeks. Incomplete CR was defined as participation in <75% of the scheduled exercise sessions. Patients were followed-up for 2.7 years, and the incidence of cardiac events was recorded. Major adverse cardiac events (MACE) included all-cause mortality, non-fatal myocardial infarction and coronary revascularisation. Results A total of 142 (16%) patients had incomplete CR. They had a higher incidence of MACE than their counterparts who completed CR (11.3% versus 3.8%, adjusted hazard ratio [aHR] 2.86 and 95% confidence interval [CI] 1.47–5.26). Furthermore, the incidence of any cardiac event, including MACE and coronary revascularisation, was higher (20.4% versus 11.0%, aHR 1.54; 95% CI 0.98–2.44). Patients with incomplete CR were more often persistent smokers than those who completed CR (31.7% versus 11.5%), but clinical characteristics were similar otherwise. Conclusion Post-ACS patients who did not complete a ‘standard’ 12-week CR programme had a higher incidence of adverse cardiac events during long-term follow-up than those who completed the programme. Since CR is proven beneficial, further research is needed to understand the reasons why patients terminate prematurely.
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Affiliation(s)
- M Sunamura
- Capri Cardiac Rehabilitation, Rotterdam, The Netherlands
| | - N Ter Hoeve
- Capri Cardiac Rehabilitation, Rotterdam, The Netherlands.,Department of Rehabilitation Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - R J G van den Berg-Emons
- Department of Rehabilitation Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - E Boersma
- Department of Cardiology, Thorax center, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - M L Geleijnse
- Department of Cardiology, Thorax center, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - R T van Domburg
- Department of Cardiology, Thorax center, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands.
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