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Liang Q, Wang Z, Liu J, Yan Z, Liu J, Lei M, Zhang H, Luan X. Effect of Exercise Rehabilitation in Patients With Acute Heart Failure: A Systematic Review and Meta-analysis. J Cardiovasc Nurs 2024; 39:390-400. [PMID: 37487171 DOI: 10.1097/jcn.0000000000001010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/26/2023]
Abstract
BACKGROUND Exercise rehabilitation is conducive to increasing functional ability and improving health outcomes, but its effectiveness in patients with acute heart failure (AHF) is still controversial. PURPOSE In this study, our aim was to systematically examine the efficacy of exercise rehabilitation in people with AHF. METHODS A search was conducted for randomized controlled trial studies on exercise rehabilitation in patients with AHF up to November 2021. Two investigators conducted literature selection, quality assessments, and data extractions independently. The primary outcome was 6-minute walk distance, and the secondary outcomes were left ventricular ejection fraction, quality of life, Short Physical Performance Battery, readmission, and mortality. RevMan (version 5.3) software was used for the meta-analysis. RESULTS Twelve studies with 1215 participants were included. Exercise rehabilitation significantly improved the 6-minute walk distance (mean difference [MD], 33.04; 95% confidence interval [CI], 31.37-34.70; P < .001; I2 = 0%), quality of life (MD, -11.57; 95% CI, -19.25 to -3.89; P = .003; I2 = 98%), Short Physical Performance Battery (MD, 1.40; 95% CI, 1.36-1.44; P < .001; I2 = 0%), and rate of readmission for any cause (risk ratio, 0.48; 95% CI, 0.26-0.88; P = .02; I2 = 7%), compared with routine care. However, no statistically significant effects on left ventricular ejection fraction (MD, 0.94; 95% CI, -1.62 to 3.51; P = .47; I2 = 0%) and mortality (risk ratio, 1.07; 95% CI, 0.64-1.80; P = .79; I2 = 0%) were observed. CONCLUSIONS Compared with routine care, exercise rehabilitation improved functional ability and quality of life, reducing readmission in patients with AHF.
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Bader J, Bachmann JM. Observational Studies of Cardiac Rehabilitation: ANALYTIC CHALLENGES, SIGNIFICANT OPPORTUNITIES. J Cardiopulm Rehabil Prev 2024; 44:77-78. [PMID: 38407805 DOI: 10.1097/hcr.0000000000000866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/27/2024]
Affiliation(s)
- Jad Bader
- Washington University, St Louis, Missouri (Mr Bader); and Veterans Affairs Tennessee Valley Healthcare System, Nashville, and Vanderbilt University Medical Center, Nashville, Tennessee (Dr Bachmann)
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Wasilewski M, Vijayakumar A, Szigeti Z, Sathakaran S, Wang KW, Saporta A, Hitzig SL. Barriers and Facilitators to Delivering Inpatient Cardiac Rehabilitation: A Scoping Review. J Multidiscip Healthc 2023; 16:2361-2376. [PMID: 37605772 PMCID: PMC10440091 DOI: 10.2147/jmdh.s418803] [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: 05/24/2023] [Accepted: 07/20/2023] [Indexed: 08/23/2023] Open
Abstract
Objective The purpose of this scoping review was to summarize the literature on barriers and facilitators that influence the provision and uptake of inpatient cardiac rehabilitation (ICR). Methods A literature search was conducted using PsycINFO, MEDLINE, EMBASE, CINAHL and AgeLine. Studies were included if they were published in English after the year 2000 and focused on adults who were receiving some form of ICR (eg, exercise counselling and training, education for heart-healthy living). For studies meeting inclusion criteria, descriptive data on authors, year, study design, and intervention type were extracted. Results The literature search resulted in a total of 44,331 publications, of which 229 studies met inclusion criteria. ICR programs vary drastically and often focus on promoting physical exercises and patient education. Barriers and facilitators were categorized through patient, provider and system level factors. Individual characteristics and provider knowledge and efficacy were categorized as both barriers and facilitators to ICR delivery and uptake. Team functioning, lack of resources, program coordination, and inconsistencies in evaluation acted as key barriers to ICR delivery and uptake. Key facilitators that influence ICR implementation and engagement include accreditation and professional associations and patient and family-centred practices. Conclusion ICR programs can be highly effective at improving health outcomes for those living with CVDs. Our review identified several patient, provider, and system-level considerations that act as barriers and facilitators to ICR delivery and uptake. Future research should explore how to encourage health promotion knowledge amongst ICR staff and patients.
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Affiliation(s)
- Marina Wasilewski
- St. John’s Rehab, Sunnybrook Research Institute, North York, Ontario, Canada
- Department of Occupational Science & Occupational Therapy, University of Toronto, Toronto, Ontario, Canada
- Rehabilitation Sciences Institute (RSI), University of Toronto, Toronto, Ontario, Canada
| | - Abirami Vijayakumar
- St. John’s Rehab, Sunnybrook Research Institute, North York, Ontario, Canada
| | - Zara Szigeti
- St. John’s Rehab, Sunnybrook Research Institute, North York, Ontario, Canada
| | - Sahana Sathakaran
- Department of Occupational Science & Occupational Therapy, University of Toronto, Toronto, Ontario, Canada
| | - Kuan-Wen Wang
- Department of Occupational Science & Occupational Therapy, University of Toronto, Toronto, Ontario, Canada
| | - Adam Saporta
- St. John’s Rehab, Sunnybrook Research Institute, North York, Ontario, Canada
| | - Sander L Hitzig
- St. John’s Rehab, Sunnybrook Research Institute, North York, Ontario, Canada
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Murata M, Yanai S, Nitta S, Yamashita Y, Shitara T, Kazama H, Ueda M, Kobayashi Y, Namasu Y, Adachi H. Improved Peak Oxygen Uptake Reduces Cardiac Events After 3 Weeks of Inpatient Cardiac Rehabilitation for Chronic Heart Failure Patients. Circ Rep 2023; 5:238-244. [PMID: 37305791 PMCID: PMC10247349 DOI: 10.1253/circrep.cr-23-0040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 04/12/2023] [Indexed: 06/13/2023] Open
Abstract
Background: The incidence of heart failure (HF) is increasing, and the mortality from HF remains high in an aging society. Cardiac rehabilitation (CR) programs (CRP) increase oxygen uptake (V̇O2) and reduce HF rehospitalization and mortality. Therefore, CR is recommended for every HF patient. However, the number of outpatients undergoing CR remains low, with insufficient attendance at CRP sessions. In this study we evaluated the outcomes of 3 weeks of inpatient CRP (3w In-CRP) for HF patients. Methods and Results: This study enrolled 93 HF patients after acute-phase hospitalization between 2019 and 2022. Patients participated in 30 sessions of 3w In-CRP (30 min aerobic exercise twice daily, 5 days/week). Before and after 3w In-CRP, patients underwent a cardiopulmonary exercise test, and cardiovascular (CV) events (mortality, HF rehospitalization, myocardial infarction, and cerebrovascular disease) after discharge were evaluated. After 3w In-CPR, mean (±SD) peak V̇O2 increased from 11.8±3.2 to 13.7±4.1 mL/min/kg (116.5±22.1%). During the follow-up period (357±292 days after discharge), 20 patients were rehospitalized for HF, 1 had a stroke, and 8 died for any reasons. Proportional hazard and Kaplan-Meier analyses demonstrated that CV events were reduced among patients with a 6.1% improvement in peak V̇O2 than in patients without any improvement in peak V̇O2. Conclusions: 3w In-CRP for HF patients improved peak V̇O2 and reduced CV events in HF patients with a 6.1% improvement in peak V̇O2.
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Affiliation(s)
- Makoto Murata
- Department of Cardiology, Gunma Prefectural Cardiovascular Center Maebashi Japan
| | - Saya Yanai
- Department of Rehabilitation, Gunma Prefectural Cardiovascular Center Maebashi Japan
| | - Shogo Nitta
- Department of Rehabilitation, Gunma Prefectural Cardiovascular Center Maebashi Japan
| | - Yuhei Yamashita
- Department of Rehabilitation, Gunma Prefectural Cardiovascular Center Maebashi Japan
| | - Tatsunori Shitara
- Department of Rehabilitation, Gunma Prefectural Cardiovascular Center Maebashi Japan
| | - Hiroko Kazama
- Department of Rehabilitation, Gunma Prefectural Cardiovascular Center Maebashi Japan
| | - Masanori Ueda
- Department of Physiological Examination, Gunma Prefectural Cardiovascular Center Maebashi Japan
| | - Yasuyuki Kobayashi
- Department of Physiological Examination, Gunma Prefectural Cardiovascular Center Maebashi Japan
| | - Yoshihisa Namasu
- Department of Rehabilitation, Gunma Prefectural Cardiovascular Center Maebashi Japan
| | - Hitoshi Adachi
- Department of Cardiology, Gunma Prefectural Cardiovascular Center Maebashi Japan
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Sakurai S, Murata M, Yanai S, Nitta S, Yamashita Y, Shitara T, Kazama H, Ueda M, Kobayashi Y, Namasu Y, Adachi H. Three Weeks of Inpatient Cardiac Rehabilitation Improves Metabolic Exercise Data Combined With Cardiac and Kidney Indexes Scores for Heart Failure With Reduced Ejection Fraction. Circ Rep 2023; 5:231-237. [PMID: 37305794 PMCID: PMC10247351 DOI: 10.1253/circrep.cr-23-0016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 04/12/2023] [Indexed: 06/13/2023] Open
Abstract
Background: Heart failure with reduced ejection fraction (HFrEF) has a high mortality rate, and cardiac rehabilitation programs (CRP) reduce HFrEF rehospitalization and mortality rates. Some countries attempt 3 weeks of inpatient CRP (3w In-CRP) for cardiac diseases. However, whether 3w In-CRP reduces the prognostic parameter of the Metabolic Exercise data combined with Cardiac and Kidney Indexes (MECKI) score is unknown. Therefore, we investigated whether 3w In-CRP improves MECKI scores in patients with HFrEF. Methods and Results: This study enrolled 53 patients with HFrEF who participated in 30 inpatient CRP sessions, consisting of 30 min of aerobic exercise twice daily, 5 days a week for 3 weeks, between 2019 and 2022. Cardiopulmonary exercise tests and transthoracic echocardiography were performed, and blood samples were collected, before and after 3w In-CRP. MECKI scores and cardiovascular (CV) events (heart failure rehospitalization or death) were evaluated. The MECKI score improved from a median 23.34% (interquartile range [IQR] 10.21-53.14%) before 3w In-CRP to 18.66% (IQR 6.54-39.94%; P<0.01) after 3w In-CRP because of improved left ventricular ejection fraction and percentage peak oxygen uptake. Patients' improved MECKI scores corresponded with reduced CV events. However, patients who experienced CV events did not have improved MECKI scores. Conclusions: In this study, 3w In-CRP improved MECKI scores and reduced CV events for patients with HFrEF. However, patients whose MECKI scores did not improve despite 3w In-CRP require careful heart failure management.
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Affiliation(s)
- Shinichiro Sakurai
- Department of Cardiology, Gunma Prefectural Cardiovascular Center Maebashi Japan
| | - Makoto Murata
- Department of Cardiology, Gunma Prefectural Cardiovascular Center Maebashi Japan
| | - Saya Yanai
- Department of Rehabilitation, Gunma Prefectural Cardiovascular Center Maebashi Japan
| | - Shogo Nitta
- Department of Rehabilitation, Gunma Prefectural Cardiovascular Center Maebashi Japan
| | - Yuhei Yamashita
- Department of Rehabilitation, Gunma Prefectural Cardiovascular Center Maebashi Japan
| | - Tatsunori Shitara
- Department of Rehabilitation, Gunma Prefectural Cardiovascular Center Maebashi Japan
| | - Hiroko Kazama
- Department of Rehabilitation, Gunma Prefectural Cardiovascular Center Maebashi Japan
| | - Masanori Ueda
- Department of Physiological Examination, Gunma Prefectural Cardiovascular Center Maebashi Japan
| | - Yasuyuki Kobayashi
- Department of Physiological Examination, Gunma Prefectural Cardiovascular Center Maebashi Japan
| | - Yoshihisa Namasu
- Department of Rehabilitation, Gunma Prefectural Cardiovascular Center Maebashi Japan
| | - Hitoshi Adachi
- Department of Cardiology, Gunma Prefectural Cardiovascular Center Maebashi Japan
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Ahmad AM, Elshenawy AI, Abdelghany M, Elghaffar HAA. Effects of early mobilisation program on functional capacity, daily living activities, and N-terminal prohormone brain natriuretic peptide in patients hospitalised for acute heart failure. A randomised controlled trial. Hong Kong Physiother J 2023; 43:19-31. [PMID: 37584047 PMCID: PMC10423683 DOI: 10.1142/s1013702523500014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 07/20/2022] [Indexed: 08/17/2023] Open
Abstract
Background Patients hospitalised for acute decompensated heart failure (ADHF) show reduced functional capacity, limited activities of daily living (ADL), and elevated N-terminal prohormone of brain natriuretic peptide (NT-proBNP). The management of these patients focuses mainly on medical therapy with little consideration for in-patient cardiac rehabilitation. There has been a growing interest in evaluating the efficacy of early mobilisation, as the core for in-hospital rehabilitation, in ADHF patients in the last decade; however, the randomised trials on this topic are few. Objective This randomised-controlled study, therefore, aimed to further test the hypothesis that early supervised mobilisation would have beneficial effects on functional capacity, ADL, and NT-proBNP in stabilised patients following ADHF. Methods This is a single-centered, randomised-controlled, parallel-group trial in which 30 patients hospitalised for ADHF were randomly assigned to two groups; the study group (age = 55 . 4 ± 5 . 46 years, n 1 = 15 ) and the control group (age = 55 . 73 ± 5 . 61 years, n 2 =15). Inclusion criteria were ADHF on top of chronic heart failure independent of etiology or ejection fraction, clinical/hemodynamic stability, age from 40 to 60 years old, and both genders. Exclusion criteria were cardiogenic shock, acute coronary ischemia, or significant arrhythmia. Both groups received the usual medical care, but only the study group received an early structured mobilisation protocol within 3 days of hospital admission till discharge. The outcome measures were the 6-min walk distance (6-MWD) and the rating of perceived exertion (RPE) determined from the 6-min walk test at discharge, the Barthel index (BI), NT-proBNP, and the length of hospital stays (LOS). Results The study group showed significantly greater improvements compared to the controls in the 6-MWD (252 . 28 ± 92 . 32 versus 106 . 35 ± 56 . 36 m, P < 0 . 001 ), the RPE (12 . 53 ± 0 . 91 versus 15 . 4 ± 1 . 63 , P < 0 . 001 ), and the LOS (10 . 42 ± 4 . 23 versus 16 . 85 ± 6 . 87 days, p = 0 . 009 ) at discharge. Also, the study group showed significant improvements in the BI compared to baseline [100 (100-100) versus 41.87 (35-55), p = 0 . 009 ] and the controls [100 (100-100) versus 92.5(85-95), p = 0 . 006 ]. The mean value of NT-proBNP showed a significant reduction only compared to baseline (786 . 28 ± 269 . 5 versus 1069 . 03 ± 528 . 87 pg/mL, p = 0 . 04 ) following the intervention. The absolute mean change (Δ ) of NT-proBNP showed an observed difference between groups in favor of the study group (i.e., Δ = ↓ 282 . 75 ± 494 . 13 pg/mL in the study group versus ↓ 26 . 42 ± 222 . 21 pg/mL in the control group, p = 0 . 077 ). Conclusion Early structured mobilisation under the supervision of a physiotherapist could be strongly suggested in combination with the usual medical care to help improve the functional capacity and daily living activities, reduce NT-proBNP levels, and shorten the hospital stay in stabilised patients following ADHF. Trial registration number: PACTR202202476383975.
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Affiliation(s)
- Ahmad Mahdi Ahmad
- Department of Physical Therapy for Cardiovascular and Respiratory Disorders, Faculty of Physical Therapy, Cairo University, Giza, Egypt
| | | | - Mohammed Abdelghany
- Department of Cardiology, Faculty of Medicine, Cairo University, Giza, Egypt
| | - Heba Ali Abd Elghaffar
- Department of Physical Therapy for Cardiovascular and Respiratory Disorders, Faculty of Physical Therapy, Cairo University, Giza, Egypt
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Wang Y, Xiao Y, Tang J, Liu Y, Li H, Peng Z, Xu D, Shen L. Effects of early phase 1 cardiac rehabilitation on cardiac function evaluated by impedance cardiography in patients with coronary heart disease and acute heart failure. Front Cardiovasc Med 2022; 9:958895. [PMID: 36093175 PMCID: PMC9449118 DOI: 10.3389/fcvm.2022.958895] [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: 06/01/2022] [Accepted: 08/01/2022] [Indexed: 11/13/2022] Open
Abstract
Purpose The purpose of the study was to access the impact of phase 1 cardiac rehabilitation (CR) on cardiac function and hemodynamic changes in patients with coronary heart disease (CHD) and acute heart failure (AHF). Materials and methods A total of 98 patients with CHD and AHF were recruited and randomized into two groups. Control group received standard pharmacotherapy and CR group received standard pharmacotherapy combined phase 1 CR. NT-proBNP and hemodynamic parameters measured by impedance cardiography (ICG) were estimated at baseline and at the end of treatment period. Results Phase 1 CR combined routine medical treatment could lower NT-proBNP levels. The percentage of high-risk patients was significantly decreased in CR group, although the post-treatment NT-proBNP level between control group and CR group showed no significant differences. Similarly, most hemodynamic parameters improved in the CR group, but not in the control group, suggesting that phase 1 CR in combination with the standard pharmacotherapy improved hemodynamic characteristics by elevating cardiac output, ameliorating preload, improving systolic and diastolic function, and relieving afterload, although the post-treatment hemodynamic parameters showed no statistically significant differences between the control group and the CR group. Conclusion Phase 1 CR combined routine medication can improve cardiac function and hemodynamic characteristics in patients with CHD and AHF. Thus, recommendation of phase 1 CR to stable patients is necessary.
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Affiliation(s)
- Yishu Wang
- Department of Internal Cardiovascular Medicine, Second Xiangya Hospital, Central South University, Changsha, China
| | - Yanchao Xiao
- Department of Internal Cardiovascular Medicine, Second Xiangya Hospital, Central South University, Changsha, China
| | - Jianjun Tang
- Department of Internal Cardiovascular Medicine, Second Xiangya Hospital, Central South University, Changsha, China
| | - Yutao Liu
- The First People’s Hospital of Xiangtan City, Xiangtan, China
| | - Hui Li
- Department of Internal Cardiovascular Medicine, Second Xiangya Hospital, Central South University, Changsha, China
| | - Zengjin Peng
- Department of Internal Cardiovascular Medicine, Second Xiangya Hospital, Central South University, Changsha, China
| | - Danyan Xu
- Department of Internal Cardiovascular Medicine, Second Xiangya Hospital, Central South University, Changsha, China
| | - Li Shen
- Department of Internal Cardiovascular Medicine, Second Xiangya Hospital, Central South University, Changsha, China
- *Correspondence: Li Shen,
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Martin AK, Feinman JW, Bhatt HV, Subramani S, Malhotra AK, Townsley MM, Fritz AV, Sharma A, Patel SJ, Zhou EY, Owen RM, Ghofaily LA, Read SN, Teixeira MT, Arora L, Jayaraman AL, Weiner MM, Ramakrishna H. The Year in Cardiothoracic and Vascular Anesthesia: Selected Highlights from 2021. J Cardiothorac Vasc Anesth 2021; 36:940-951. [PMID: 34801393 DOI: 10.1053/j.jvca.2021.10.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 10/11/2021] [Indexed: 11/11/2022]
Abstract
This special article is the fourteenth in an annual series for the Journal of Cardiothoracic and Vascular Anesthesia. The authors thank the Editor-in-Chief, Dr. Kaplan, and the editorial board for the opportunity to continue this series; namely, the research highlights of the past year in the specialty of cardiothoracic and vascular anesthesiology. The major themes selected for 2021 are outlined in this introduction, and each highlight is reviewed in detail in the main body of the article. The literature highlights in the specialty for 2021 begin with an update on structural heart disease, with a focus on updates in arrhythmia and aortic valve disorders. The second major theme is an update on coronary artery disease, with discussion of both medical and procedural management. The third major theme is focused on the perioperative management of patients with COVID-19, with the authors highlighting literature discussing the impact of the disease on the right ventricle and thromboembolic events. The fourth and final theme is an update in heart failure, with discussion of diverse aspects of this area. The themes selected for this fourteenth special article are only a few of the diverse advances in the specialty during 2021. These highlights will inform the reader of key updates on a variety of topics, leading to improvement of perioperative outcomes for patients with cardiothoracic and vascular disease.
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Affiliation(s)
- Archer Kilbourne Martin
- Division of Cardiovascular and Thoracic Anesthesiology, Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Jacksonville, FL
| | - Jared W Feinman
- Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Himani V Bhatt
- Department of Anesthesiology, Perioperative, and Pain Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Sudhakar Subramani
- Department of Anesthesiology, University of Iowa Hospitals and Clinics, Iowa City, IA
| | - Anita K Malhotra
- Division of Cardiothoracic Anesthesiology and Critical Care, Penn State Hershey Medical Center, Hershey, PA
| | - Matthew M Townsley
- Department of Anesthesiology and Perioperative Medicine, The University of Alabama at Birmingham School of Medicine, Birmingham, AL; Bruno Pediatric Heart Center, Children's of Alabama, Birmingham, AL
| | - Ashley Virginia Fritz
- Division of Cardiovascular and Thoracic Anesthesiology, Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Jacksonville, FL
| | - Archit Sharma
- Department of Anesthesiology, University of Iowa Hospitals and Clinics, Iowa City, IA
| | - Saumil J Patel
- Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Elizabeth Y Zhou
- Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Robert M Owen
- Department of Anesthesiology, Perioperative, and Pain Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Lourdes Al Ghofaily
- Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Selina N Read
- Division of Cardiothoracic Anesthesiology and Critical Care, Penn State Hershey Medical Center, Hershey, PA
| | - Miguel T Teixeira
- Division of Cardiovascular and Thoracic Anesthesiology, Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN
| | - Lovkesh Arora
- Department of Anesthesiology, University of Iowa Hospitals and Clinics, Iowa City, IA
| | - Arun L Jayaraman
- Division of Cardiovascular and Thoracic Anesthesiology, Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Scottsdale, AZ
| | - Menachem M Weiner
- Department of Anesthesiology, Perioperative, and Pain Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Harish Ramakrishna
- Division of Cardiovascular and Thoracic Anesthesiology, Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN
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Amjad A, Brubaker PH, Upadhya B. Exercise training for prevention and treatment of older adults with heart failure with preserved ejection fraction. Exp Gerontol 2021; 155:111559. [PMID: 34547406 DOI: 10.1016/j.exger.2021.111559] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 09/09/2021] [Accepted: 09/15/2021] [Indexed: 10/20/2022]
Abstract
Heart failure (HF) with preserved ejection fraction (HFpEF) is the most rapidly increasing form of HF, occurs primarily in older women, and is associated with high rates of morbidity, mortality, and health care expenditures. In the highest age decile (≥90 years old), nearly all patients with HFpEF. As our understanding of the disease has grown in the last few years, we now know that HFpEF is a systemic disorder influenced by aging processes. The involvement of this broad collection of abnormalities in HFpEF, the recognition of the high frequency and impact of noncardiac comorbidities, and systemic, multiorgan involvement, and its nearly exclusive existence in older persons, has led to the recognition of HFpEF as a true geriatric syndrome. Most of the conventional therapeutics used in other cardiac diseases have failed to improve HFpEF patient outcomes significantly. Several recent studies have evaluated exercise training (ET) as a therapeutic management strategy in patients with HFpEF. Although these studies were not designed to address clinical endpoints, such as HF hospitalizations and mortality, they have shown that ET is a safe and effective intervention to improve peak oxygen consumption, physical function, and quality of life in clinically stable HF patients. Recently, a progressive, multidomain physical rehabilitation study among older adults showed that it is feasible in older patients with acute decompensated HF who have high frailty and comorbidities and showed improvement in physical function. However, the lack of Centers for Medicare and Medicaid Services coverage can be a major barrier to formal cardiac rehabilitation in older HFpEF patients. Unfortunately, insistence upon demonstration of mortality improvement before approving reimbursement overlooks the valuable and demonstrated benefits of physical function and life quality.
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Affiliation(s)
- Aysha Amjad
- Cardiovascular Medicine Section, Department of Internal Medicine, Wake Forest School of Medicine, Winston Salem, USA
| | - Peter H Brubaker
- Department of Health and Exercise Science, Wake Forest School of Medicine, Winston Salem, USA
| | - Bharathi Upadhya
- Cardiovascular Medicine Section, Department of Internal Medicine, Wake Forest School of Medicine, Winston Salem, USA.
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Kitzman DW, Whellan DJ, Duncan P, Pastva AM, Mentz RJ, Reeves GR, Nelson MB, Chen H, Upadhya B, Reed SD, Espeland MA, Hewston L, O’Connor CM. Physical Rehabilitation for Older Patients Hospitalized for Heart Failure. N Engl J Med 2021; 385:203-216. [PMID: 33999544 PMCID: PMC8353658 DOI: 10.1056/nejmoa2026141] [Citation(s) in RCA: 259] [Impact Index Per Article: 86.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Older patients who are hospitalized for acute decompensated heart failure have high rates of physical frailty, poor quality of life, delayed recovery, and frequent rehospitalizations. Interventions to address physical frailty in this population are not well established. METHODS We conducted a multicenter, randomized, controlled trial to evaluate a transitional, tailored, progressive rehabilitation intervention that included four physical-function domains (strength, balance, mobility, and endurance). The intervention was initiated during, or early after, hospitalization for heart failure and was continued after discharge for 36 outpatient sessions. The primary outcome was the score on the Short Physical Performance Battery (total scores range from 0 to 12, with lower scores indicating more severe physical dysfunction) at 3 months. The secondary outcome was the 6-month rate of rehospitalization for any cause. RESULTS A total of 349 patients underwent randomization; 175 were assigned to the rehabilitation intervention and 174 to usual care (control). At baseline, patients in each group had markedly impaired physical function, and 97% were frail or prefrail; the mean number of coexisting conditions was five in each group. Patient retention in the intervention group was 82%, and adherence to the intervention sessions was 67%. After adjustment for baseline Short Physical Performance Battery score and other baseline characteristics, the least-squares mean (±SE) score on the Short Physical Performance Battery at 3 months was 8.3±0.2 in the intervention group and 6.9±0.2 in the control group (mean between-group difference, 1.5; 95% confidence interval [CI], 0.9 to 2.0; P<0.001). At 6 months, the rates of rehospitalization for any cause were 1.18 in the intervention group and 1.28 in the control group (rate ratio, 0.93; 95% CI, 0.66 to 1.19). There were 21 deaths (15 from cardiovascular causes) in the intervention group and 16 deaths (8 from cardiovascular causes) in the control group. The rates of death from any cause were 0.13 and 0.10, respectively (rate ratio, 1.17; 95% CI, 0.61 to 2.27). CONCLUSIONS In a diverse population of older patients who were hospitalized for acute decompensated heart failure, an early, transitional, tailored, progressive rehabilitation intervention that included multiple physical-function domains resulted in greater improvement in physical function than usual care. (Funded by the National Institutes of Health and others; REHAB-HF ClinicalTrials.gov number, NCT02196038.).
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Affiliation(s)
- Dalane W. Kitzman
- Department of Internal Medicine, Sections on Cardiovascular Medicine and Geriatrics, Wake Forest School of Medicine, Winston-Salem, NC
| | - David J. Whellan
- Department of Medicine, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA
| | - Pamela Duncan
- Department of Neurology, Wake Forest School of Medicine, Winston-Salem, NC
| | - Amy M. Pastva
- Department of Orthopaedic Surgery, Doctor of Physical Therapy Division, Duke University School of Medicine, Durham, NC
| | - Robert J. Mentz
- Department of Medicine, Division of Cardiology, Duke University School of Medicine, Durham, NC
| | | | - M. Benjamin Nelson
- Department of Internal Medicine, Section on Cardiovascular Medicine, Wake Forest School of Medicine, Winston-Salem, NC
| | - Haiying Chen
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, NC
| | - Bharathi Upadhya
- Department of Internal Medicine, Section on Cardiovascular Medicine, Wake Forest School of Medicine, Winston-Salem, NC
| | - Shelby D. Reed
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC
| | - Mark A. Espeland
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, NC
- Department of Internal Medicine, Section on Geriatrics, Wake Forest School of Medicine, Winston-Salem, NC
| | - LeighAnn Hewston
- Department of Physical Therapy, Jefferson College of Rehabilitation Sciences, Philadelphia, PA
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11
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Mentz RJ, Whellan DJ, Reeves GR, Pastva AM, Duncan P, Upadhya B, Nelson MB, Chen H, Reed SD, Rosenberg PB, Bertoni AG, O'Connor CM, Kitzman DW. Rehabilitation Intervention in Older Patients With Acute Heart Failure With Preserved Versus Reduced Ejection Fraction. JACC-HEART FAILURE 2021; 9:747-757. [PMID: 34246602 DOI: 10.1016/j.jchf.2021.05.007] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 05/15/2021] [Indexed: 01/06/2023]
Abstract
OBJECTIVES This study assessed for treatment interactions by ejection fraction (EF) subgroup (≥45% [preserved EF (HFpEF); vs <45% [reduced EF; (HFrEF)]). BACKGROUND The REHAB-HF trial showed that an early multidomain rehabilitation intervention improved physical function, frailty, quality-of-life, and depression in older patients hospitalized with acute decompensated heart failure (ADHF). METHODS Three-month outcomes were: Short Physical Performance Battery (SPPB), 6-min walk distance (6MWD), and Kansas City Cardiomyopathy Questionnaire (KCCQ). Six-month end points included all-cause rehospitalization and death and a global rank of death, all-cause rehospitalization, and SPPB. Prespecified significance level for interaction was P ≤ 0.1. RESULTS Among 349 total participants, 185 (53%) had HFpEF and 164 (47%) had HFrEF. Compared with HFrEF, HFpEF participants were more often women (61% vs 43%) and had significantly worse baseline physical function, frailty, quality of life, and depression. Although interaction P values for 3-month outcomes were not significant, effect sizes were larger for HFpEF vs HFrEF: SPPB +1.9 (95% CI: 1.1-2.6) vs +1.1 (95% CI: 0.3-1.9); 6MWD +40 meters (95% CI: 9 meters-72 meters) vs +27 (95% CI: -6 meters to 59 meters); KCCQ +9 (2-16) vs +6 (-2 to 14). All-cause rehospitalization rate was nominally lower with intervention in HFpEF but not HFrEF [effect size 0.83 (95% CI: 0.64-1.09) vs 0.99 (95% CI: 0.74-1.33); interaction P = 0.40]. There were significantly greater treatment benefits in HFpEF vs HFrEF for all-cause death [interaction P = 0.08; intervention rate ratio 0.63 (95% CI: 0.25-1.61) vs 2.21 (95% CI: 0.78-6.25)], and the global rank end point (interaction P = 0.098) with benefit seen in HFpEF [probability index 0.59 (95% CI: 0.50-0.68)] but not HFrEF. CONCLUSIONS Among older patients hospitalized with ADHF, compared with HFrEF those with HFpEF had significantly worse impairments at baseline and may derive greater benefit from the intervention. (A Trial of Rehabilitation Therapy in Older Acute Heart Failure Patients [REHAB-HF]; NCT02196038).
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Affiliation(s)
- Robert J Mentz
- Division of Cardiology, Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| | - David J Whellan
- Department of Medicine, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Gordon R Reeves
- Doctor of Physical Therapy Division, Departments of Orthopaedic Surgery, Medicine, & Population Health Sciences, Duke University School of Medicine, Durham, North Carolina, USA
| | - Amy M Pastva
- Doctor of Physical Therapy Division, Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, North Carolina, USA
| | - Pamela Duncan
- Department of Neurology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Bharathi Upadhya
- Section on Cardiovascular Medicine, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - M Benjamin Nelson
- Section on Cardiovascular Medicine, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Haiying Chen
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Shelby D Reed
- Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina
| | - Paul B Rosenberg
- Division of Cardiology, Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| | - Alain G Bertoni
- Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | | | - Dalane W Kitzman
- Section on Cardiovascular Medicine, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA; Sections on Geriatrics, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA.
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12
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Review of Trials on Exercise-Based Rehabilitation Interventions Following Acute Decompensated Heart Failure: OBSERVATIONS FROM THE WHO INTERNATIONAL CLINICAL TRIALS REGISTRY PLATFORM. J Cardiopulm Rehabil Prev 2021; 41:214-223. [PMID: 34158455 DOI: 10.1097/hcr.0000000000000583] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE Cardiac rehabilitation is an important intervention for patients with heart failure. However, its clinical application in acute decompensated heart failure (ADHF) remains underutilized with limited research available. An assessment of current research in this area will help guide future investigations. The aim of this review is to summarize the current research focusing on rehabilitation interventions following recovery from ADHF. REVIEW METHODS A systematic search was carried out on all trials registered in the clinical trial registry database of the World Health Organization-International Clinical Trial Registry Platform (WHO-ICTRP). Studies focusing on ADHF and utilizing any exercise and rehabilitation-based intervention were included. RESULTS A majority of 11 trial protocols, including 3827 participants with low ejection fraction (<40%), were identified from the WHO-ICTRP database. Majority of the protocols (64%) focused on exercise-based interventions with approximately one-quarter (29%) focusing on neuromuscular electrical stimulation and one on noninvasive ventilation during exercise. Irrespective of the mode of exercise, all protocols employed low-moderate intensity training with outcomes focusing on physical function and quality of life. CONCLUSION Studies on rehabilitative interventions for ADHF are still in their early stages. More research is needed using innovative methodologies and testing for feasibility and fidelity.
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Gupta AK, Tomasoni D, Sidhu K, Metra M, Ezekowitz JA. Evidence-Based Management of Acute Heart Failure. Can J Cardiol 2021; 37:621-631. [PMID: 33440229 DOI: 10.1016/j.cjca.2021.01.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 12/21/2020] [Accepted: 01/04/2021] [Indexed: 10/22/2022] Open
Abstract
Acute heart failure (AHF) is a complex, heterogeneous, clinical syndrome with high morbidity and mortality, incurring significant health care costs. Patients transition from home to the emergency department, the hospital, and home again and require decisions surrounding diagnosis, treatment, and prognosis at each step of the way. The purpose of this review is to examine the epidemiology, etiology, and classifications of AHF and specifically focus on practical information relevant to the clinician. We examine the mechanisms of decompensation relevant to clinical presentations-including precipitating factors, neuroendocrine interactions, and inflammation-along with how consideration of these factors may help select therapies for an individual patient. The prevalence and significance of end-organ manifestations such as renal, gastrointestinal, respiratory, and neurologic manifestations are discussed. We also highlight how the development of renal dysfunction relates to the choice of a variety of diuretics that may be useful in specific circumstances and review guideline-directed medical therapy. We discuss the practical use (and pitfalls) of a variety of evidence-based clinical scoring criteria available to risk stratify patients with AHF. Finally, evidence-based management of AHF is discussed, including both pharmacologic and nonpharmacologic therapies, including the lack of evidence for using old and new vasodilators and the recent evidence regarding initiation of newer therapies in hospital. Overall, we suggest that clinicians consider implementing the newer data in AHF and subject existing practice patterns and treatments to the same rigour as new therapies.
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Affiliation(s)
- Arjun K Gupta
- Division of Cardiology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Daniela Tomasoni
- Institute of Cardiology, ASST Spedali Civili di Brescia and Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Kiran Sidhu
- Section of Cardiology, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Marco Metra
- Institute of Cardiology, ASST Spedali Civili di Brescia and Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Justin A Ezekowitz
- Division of Cardiology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada; Canadian VIGOUR Centre, University of Alberta, Edmonton, Alberta, Canada.
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14
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Impact of inpatient cardiac rehabilitation on Barthel Index score and prognosis in patients with acute decompensated heart failure. Int J Cardiol 2019; 293:125-130. [DOI: 10.1016/j.ijcard.2019.06.071] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Revised: 06/23/2019] [Accepted: 06/26/2019] [Indexed: 01/09/2023]
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15
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Cops J, Haesen S, De Moor B, Mullens W, Hansen D. Exercise intervention in hospitalized heart failure patients, with emphasis on congestion-related complications: a review. Heart Fail Rev 2019; 25:257-268. [DOI: 10.1007/s10741-019-09833-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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16
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Scrutinio D, Guida P, Passantino A, Lagioia R, Raimondo R, Venezia M, Ammirati E, Oliva F, Stucchi M, Frigerio M. Female gender and mortality risk in decompensated heart failure. Eur J Intern Med 2018; 51:34-40. [PMID: 29317139 DOI: 10.1016/j.ejim.2018.01.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Revised: 01/02/2018] [Accepted: 01/04/2018] [Indexed: 12/25/2022]
Abstract
BACKGROUND Still there is conflicting evidence about gender-related differences in prognosis among patients with heart failure. This prognostic uncertainty may have implications for risk stratification and planning management strategy. The aim of the present study was to explore the association between gender and one-year mortality in patients admitted with acute decompensated heart failure (ADHF). METHODS We studied 1513 patients. The Cumulative Incidence Function (CIF) method was used to estimate the absolute rate of mortality, heart transplantation (HT)/ventricular assist device (VAD) implantation, and survival free of HT/VAD implantation at 1year. An interaction analysis was performed to assess the association between covariates, gender, and mortality risk. Propensity score matching and Cox regression were used to compare mortality rates in the gender subgroups. RESULTS The CIF estimates of 1-year mortality, HT/VAD implantation, and survival free of HT/VAD implantation at 1year were 33.1%, 7.0%, and 59.9% for women and 30.2%, 10.2%, and 59.6% for men, respectively. Except for diabetes, there was no significant interaction between gender, covariates, and mortality risk. In the matched cohort, the hazard ratio of death for women was 1.19 (95% confidence intervals [CIs]: 0.90-1.59; p=.202). After adjusting for age and baseline risk, the hazard ratio of death for women was 1.18 (95% CIs: 0.95-1.43; p=.127). The use of gender-specific predictive models did not allow improving the accuracy of risk prediction. CONCLUSIONS Our data strongly suggest that women and men have comparable outcome in the year following a hospitalization for ADHF.
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Affiliation(s)
- Domenico Scrutinio
- Istituti Clinici Scientifici Maugeri SPA SB, I.R.C.C.S. Division of Cardiology and Cardiac Rehabilitation, Institute of Cassano Murge, Bari, Italy.
| | - Pietro Guida
- Istituti Clinici Scientifici Maugeri SPA SB, I.R.C.C.S. Division of Cardiology and Cardiac Rehabilitation, Institute of Cassano Murge, Bari, Italy
| | - Andrea Passantino
- Istituti Clinici Scientifici Maugeri SPA SB, I.R.C.C.S. Division of Cardiology and Cardiac Rehabilitation, Institute of Cassano Murge, Bari, Italy
| | - Rocco Lagioia
- Istituti Clinici Scientifici Maugeri SPA SB, I.R.C.C.S. Division of Cardiology and Cardiac Rehabilitation, Institute of Cassano Murge, Bari, Italy
| | - Rosa Raimondo
- Istituti Clinici Scientifici Maugeri SPA SB, I.R.C.C.S. Division of Cardiology and Cardiac Rehabilitation, Institute of Tradate, Varese, Italy
| | - Mario Venezia
- Istituti Clinici Scientifici Maugeri SPA SB, Institute of Ginosa Marina, Taranto, Italy
| | - Enrico Ammirati
- "De Gasperis" Cardio Center, Niguarda Hospital, Milan, Italy
| | - Fabrizio Oliva
- "De Gasperis" Cardio Center, Niguarda Hospital, Milan, Italy
| | - Miriam Stucchi
- "De Gasperis" Cardio Center, Niguarda Hospital, Milan, Italy
| | - Maria Frigerio
- "De Gasperis" Cardio Center, Niguarda Hospital, Milan, Italy
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17
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Evaluation of Skeletal Muscle Function and Effects of Early Rehabilitation during Acute Heart Failure: Rationale and Study Design. BIOMED RESEARCH INTERNATIONAL 2018; 2018:6982897. [PMID: 29721510 PMCID: PMC5867689 DOI: 10.1155/2018/6982897] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/17/2017] [Revised: 02/07/2018] [Accepted: 02/11/2018] [Indexed: 12/17/2022]
Abstract
Background Acute heart failure (AHF) is associated with disturbances of the peripheral perfusion leading to the dysfunction of many organs. Consequently, an episode of AHF constitutes a “multiple organ failure” which may also affect the skeletal muscles. However, the abnormalities within skeletal muscles during AHF have not been investigated so far. The aim of this project is to comprehensively evaluate skeletal muscles (at a functional and tissue level) during AHF. Methods The study will include ≥63 consecutive AHF patients who will be randomized into 2 groups: ≥42 with cardiac rehabilitation group versus ≥21 with standard pharmacotherapy alone. The following tests will be conducted on the first and last day of hospitalization, at rest and after exercise, and 30 days following the discharge: clinical evaluation, medical interview, routine physical examination, echocardiography, and laboratory tests (including the assessment of NT-proBNP, inflammatory markers, and parameters reflecting the status of the kidneys and the liver); hemodynamic evaluation, noninvasive determination of cardiac output and systemic vascular resistance using the impedance cardiography; evaluation of biomarkers reflecting myocyte damage, immunochemical measurements of tissue-specific enzymatic isoforms; evaluation of skeletal muscle function, using surface electromyography (sEMG) (maximum tonus of the muscles will be determined along with the level of muscular fatigability); evaluation of muscle tissue perfusion, assessed on the basis of the oxygenation level, with noninvasive direct continuous recording of perfusion in peripheral tissues by local tissue oximetry, measured by near-infrared spectroscopy (NIRS). Results and Conclusions Our findings will demonstrate that the muscle tissue is another area of the body which should be taken into consideration in the course of treatment of AHF, requiring a development of targeted therapeutic strategies, such as a properly conducted rehabilitation.
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18
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Amiya E, Taya M. Is Exercise Training Appropriate for Patients With Advanced Heart Failure Receiving Continuous Inotropic Infusion? A Review. CLINICAL MEDICINE INSIGHTS-CARDIOLOGY 2018; 12:1179546817751438. [PMID: 29326534 PMCID: PMC5757424 DOI: 10.1177/1179546817751438] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Accepted: 12/07/2017] [Indexed: 12/18/2022]
Abstract
Exercise-based rehabilitation programs have been reported to have beneficial effects for patients with heart failure. However, there is little evidence about whether this is the case in patients with more severe heart failure. In particular, there is a question in the clinical setting whether patients with advanced heart failure and continuous inotropic infusion should be prescribed exercise training. In contrast, many studies conclude that prolonged immobility associated with heart failure profoundly impairs physical function and promotes muscle wasting that could further hasten the course of heart failure. By contrast, exercise training has various effects not only in improving exercise capacity but also on vascular function, skeletal muscle, and autonomic balance. In this review, we summarize the effectiveness and discuss methods of exercise training in patients with advanced heart failure receiving continuous inotropic agents such as dobutamine.
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Affiliation(s)
- Eisuke Amiya
- 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.,Department of Rehabilitation Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
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Rosenbaum AN, Kremers WK, Schirger JA, Thomas RJ, Squires RW, Allison TG, Daly RC, Kushwaha SS, Edwards BS. Association Between Early Cardiac Rehabilitation and Long-term Survival in Cardiac Transplant Recipients. Mayo Clin Proc 2016; 91:149-56. [PMID: 26848001 DOI: 10.1016/j.mayocp.2015.12.002] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2015] [Accepted: 12/07/2015] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To determine whether participation in early cardiac rehabilitation (CR) after heart transplant (HTx) affects long-term survival. PATIENTS AND METHODS A retrospective review was conducted in 201 patients who underwent HTx at Mayo Clinic between June 1, 2000, and July 31, 2013. Patients were excluded with multiorgan transplant, no CR data, and follow-up less than 90 days after HTx. Demographic and exercise data at baseline before HTx were collected. Post-HTx exercise capacity, biopsy, CR data, and medications were collected at 1 through 5 and 10 years. RESULTS Overall survival at 1, 5, and 10 years was 98%, 88%, and 82%, respectively; 29 patients died. Number of CR sessions attended in the first 90 days after HTx predicted survival in multivariate regression, controlling for baseline post-HTx 6-minute walk test (6MWT) results and rejection episodes (hazard ratio, 0.90; 95% CI, 0.82-0.97; P=.007). Additional univariate predictors of survival included pre-HTx 6MWT results, weight at HTx, and body mass index and systolic blood pressure at CR enrollment. Pre-HTx 6MWT results, body mass index, and post-HTx were associated with improvement in peak oxygen consumption. CONCLUSION This report demonstrates, for the first time, an association between CR and long-term survival in patients after HTx. Further work should clarify the most beneficial aspects of CR.
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Affiliation(s)
| | - Walter K Kremers
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN; William J. von Liebig Center for Transplantation and Clinical Regeneration, Mayo Clinic, Rochester, MN
| | - John A Schirger
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN; William J. von Liebig Center for Transplantation and Clinical Regeneration, Mayo Clinic, Rochester, MN
| | - Randal J Thomas
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN
| | - Ray W Squires
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN
| | | | - Richard C Daly
- Division of Cardiovascular Surgery, Mayo Clinic, Rochester, MN; William J. von Liebig Center for Transplantation and Clinical Regeneration, Mayo Clinic, Rochester, MN
| | - Sudhir S Kushwaha
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN; William J. von Liebig Center for Transplantation and Clinical Regeneration, Mayo Clinic, Rochester, MN
| | - Brooks S Edwards
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN; William J. von Liebig Center for Transplantation and Clinical Regeneration, Mayo Clinic, Rochester, MN
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Amao R, Imamura T, Sawada Y, Endo S, Ozaki S, Okamura K, Masuzawa A, Takaoka T, Hirata Y, Shindo T, Ono M, Haga N. Experiences With Aggressive Cardiac Rehabilitation in Pediatric Patients Receiving Mechanical Circulatory Supports. Int Heart J 2016; 57:769-772. [DOI: 10.1536/ihj.16-067] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Rie Amao
- Department of Rehabilitation, Graduate School of Medicine, The University of Tokyo
| | - Teruhiko Imamura
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo
| | - Yusuke Sawada
- Department of Rehabilitation, Graduate School of Medicine, The University of Tokyo
| | - Sachiko Endo
- Department of Rehabilitation, Graduate School of Medicine, The University of Tokyo
| | - Shinichi Ozaki
- Department of Cardiac Surgery, Graduate School of Medicine, The University of Tokyo
| | - Kenichi Okamura
- Department of Cardiac Surgery, Graduate School of Medicine, The University of Tokyo
| | - Akihiro Masuzawa
- Department of Cardiac Surgery, Graduate School of Medicine, The University of Tokyo
| | - Tetsuhiro Takaoka
- Department of Cardiac Surgery, Graduate School of Medicine, The University of Tokyo
| | - Yasutaka Hirata
- Department of Cardiac Surgery, Graduate School of Medicine, The University of Tokyo
| | - Takahiro Shindo
- Department of Pediatrics, Graduate School of Medicine, The University of Tokyo
| | - Minoru Ono
- Department of Cardiac Surgery, Graduate School of Medicine, The University of Tokyo
| | - Nobuhiko Haga
- Department of Rehabilitation, Graduate School of Medicine, The University of Tokyo
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21
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Fleg JL, Cooper LS, Borlaug BA, Haykowsky MJ, Kraus WE, Levine BD, Pfeffer MA, Piña IL, Poole DC, Reeves GR, Whellan DJ, Kitzman DW. Exercise training as therapy for heart failure: current status and future directions. Circ Heart Fail 2015; 8:209-20. [PMID: 25605639 DOI: 10.1161/circheartfailure.113.001420] [Citation(s) in RCA: 120] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- Jerome L Fleg
- From the Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD (J.L.F., L.S.C.); Division of Cardiovascular Disease, Mayo Clinic, Rochester, MN (B.A.B.); Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta, Canada (M.J.H.); Division of Cardiology, Duke University School of Medicine, Durham, NC (W.E.K.); Institute for Exercise and Environmental Medicine, University of Texas Southwestern Medical Center, Dallas (B.D.L.); Cardiovascular Division, Brigham and Women's Hospital, Boston, MA (M.A.P.); Division of Cardiology, Albert Einstein College of Medicine, Bronx, NY (I.L.P.); Department of Kinesiology (D.C.P.) and Department of Anatomy and Physiology (D.C.P.), Kansas State University, Manhattan; Division of Cardiology, Jefferson Medical College, Philadelphia, PA (G.R.R., D.J.W.); and Sections on Cardiology and Geriatrics, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC (D.W.K.).
| | - Lawton S Cooper
- From the Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD (J.L.F., L.S.C.); Division of Cardiovascular Disease, Mayo Clinic, Rochester, MN (B.A.B.); Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta, Canada (M.J.H.); Division of Cardiology, Duke University School of Medicine, Durham, NC (W.E.K.); Institute for Exercise and Environmental Medicine, University of Texas Southwestern Medical Center, Dallas (B.D.L.); Cardiovascular Division, Brigham and Women's Hospital, Boston, MA (M.A.P.); Division of Cardiology, Albert Einstein College of Medicine, Bronx, NY (I.L.P.); Department of Kinesiology (D.C.P.) and Department of Anatomy and Physiology (D.C.P.), Kansas State University, Manhattan; Division of Cardiology, Jefferson Medical College, Philadelphia, PA (G.R.R., D.J.W.); and Sections on Cardiology and Geriatrics, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC (D.W.K.)
| | - Barry A Borlaug
- From the Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD (J.L.F., L.S.C.); Division of Cardiovascular Disease, Mayo Clinic, Rochester, MN (B.A.B.); Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta, Canada (M.J.H.); Division of Cardiology, Duke University School of Medicine, Durham, NC (W.E.K.); Institute for Exercise and Environmental Medicine, University of Texas Southwestern Medical Center, Dallas (B.D.L.); Cardiovascular Division, Brigham and Women's Hospital, Boston, MA (M.A.P.); Division of Cardiology, Albert Einstein College of Medicine, Bronx, NY (I.L.P.); Department of Kinesiology (D.C.P.) and Department of Anatomy and Physiology (D.C.P.), Kansas State University, Manhattan; Division of Cardiology, Jefferson Medical College, Philadelphia, PA (G.R.R., D.J.W.); and Sections on Cardiology and Geriatrics, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC (D.W.K.)
| | - Mark J Haykowsky
- From the Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD (J.L.F., L.S.C.); Division of Cardiovascular Disease, Mayo Clinic, Rochester, MN (B.A.B.); Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta, Canada (M.J.H.); Division of Cardiology, Duke University School of Medicine, Durham, NC (W.E.K.); Institute for Exercise and Environmental Medicine, University of Texas Southwestern Medical Center, Dallas (B.D.L.); Cardiovascular Division, Brigham and Women's Hospital, Boston, MA (M.A.P.); Division of Cardiology, Albert Einstein College of Medicine, Bronx, NY (I.L.P.); Department of Kinesiology (D.C.P.) and Department of Anatomy and Physiology (D.C.P.), Kansas State University, Manhattan; Division of Cardiology, Jefferson Medical College, Philadelphia, PA (G.R.R., D.J.W.); and Sections on Cardiology and Geriatrics, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC (D.W.K.)
| | - William E Kraus
- From the Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD (J.L.F., L.S.C.); Division of Cardiovascular Disease, Mayo Clinic, Rochester, MN (B.A.B.); Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta, Canada (M.J.H.); Division of Cardiology, Duke University School of Medicine, Durham, NC (W.E.K.); Institute for Exercise and Environmental Medicine, University of Texas Southwestern Medical Center, Dallas (B.D.L.); Cardiovascular Division, Brigham and Women's Hospital, Boston, MA (M.A.P.); Division of Cardiology, Albert Einstein College of Medicine, Bronx, NY (I.L.P.); Department of Kinesiology (D.C.P.) and Department of Anatomy and Physiology (D.C.P.), Kansas State University, Manhattan; Division of Cardiology, Jefferson Medical College, Philadelphia, PA (G.R.R., D.J.W.); and Sections on Cardiology and Geriatrics, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC (D.W.K.)
| | - Benjamin D Levine
- From the Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD (J.L.F., L.S.C.); Division of Cardiovascular Disease, Mayo Clinic, Rochester, MN (B.A.B.); Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta, Canada (M.J.H.); Division of Cardiology, Duke University School of Medicine, Durham, NC (W.E.K.); Institute for Exercise and Environmental Medicine, University of Texas Southwestern Medical Center, Dallas (B.D.L.); Cardiovascular Division, Brigham and Women's Hospital, Boston, MA (M.A.P.); Division of Cardiology, Albert Einstein College of Medicine, Bronx, NY (I.L.P.); Department of Kinesiology (D.C.P.) and Department of Anatomy and Physiology (D.C.P.), Kansas State University, Manhattan; Division of Cardiology, Jefferson Medical College, Philadelphia, PA (G.R.R., D.J.W.); and Sections on Cardiology and Geriatrics, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC (D.W.K.)
| | - Marc A Pfeffer
- From the Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD (J.L.F., L.S.C.); Division of Cardiovascular Disease, Mayo Clinic, Rochester, MN (B.A.B.); Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta, Canada (M.J.H.); Division of Cardiology, Duke University School of Medicine, Durham, NC (W.E.K.); Institute for Exercise and Environmental Medicine, University of Texas Southwestern Medical Center, Dallas (B.D.L.); Cardiovascular Division, Brigham and Women's Hospital, Boston, MA (M.A.P.); Division of Cardiology, Albert Einstein College of Medicine, Bronx, NY (I.L.P.); Department of Kinesiology (D.C.P.) and Department of Anatomy and Physiology (D.C.P.), Kansas State University, Manhattan; Division of Cardiology, Jefferson Medical College, Philadelphia, PA (G.R.R., D.J.W.); and Sections on Cardiology and Geriatrics, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC (D.W.K.)
| | - Ileana L Piña
- From the Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD (J.L.F., L.S.C.); Division of Cardiovascular Disease, Mayo Clinic, Rochester, MN (B.A.B.); Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta, Canada (M.J.H.); Division of Cardiology, Duke University School of Medicine, Durham, NC (W.E.K.); Institute for Exercise and Environmental Medicine, University of Texas Southwestern Medical Center, Dallas (B.D.L.); Cardiovascular Division, Brigham and Women's Hospital, Boston, MA (M.A.P.); Division of Cardiology, Albert Einstein College of Medicine, Bronx, NY (I.L.P.); Department of Kinesiology (D.C.P.) and Department of Anatomy and Physiology (D.C.P.), Kansas State University, Manhattan; Division of Cardiology, Jefferson Medical College, Philadelphia, PA (G.R.R., D.J.W.); and Sections on Cardiology and Geriatrics, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC (D.W.K.)
| | - David C Poole
- From the Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD (J.L.F., L.S.C.); Division of Cardiovascular Disease, Mayo Clinic, Rochester, MN (B.A.B.); Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta, Canada (M.J.H.); Division of Cardiology, Duke University School of Medicine, Durham, NC (W.E.K.); Institute for Exercise and Environmental Medicine, University of Texas Southwestern Medical Center, Dallas (B.D.L.); Cardiovascular Division, Brigham and Women's Hospital, Boston, MA (M.A.P.); Division of Cardiology, Albert Einstein College of Medicine, Bronx, NY (I.L.P.); Department of Kinesiology (D.C.P.) and Department of Anatomy and Physiology (D.C.P.), Kansas State University, Manhattan; Division of Cardiology, Jefferson Medical College, Philadelphia, PA (G.R.R., D.J.W.); and Sections on Cardiology and Geriatrics, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC (D.W.K.)
| | - Gordon R Reeves
- From the Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD (J.L.F., L.S.C.); Division of Cardiovascular Disease, Mayo Clinic, Rochester, MN (B.A.B.); Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta, Canada (M.J.H.); Division of Cardiology, Duke University School of Medicine, Durham, NC (W.E.K.); Institute for Exercise and Environmental Medicine, University of Texas Southwestern Medical Center, Dallas (B.D.L.); Cardiovascular Division, Brigham and Women's Hospital, Boston, MA (M.A.P.); Division of Cardiology, Albert Einstein College of Medicine, Bronx, NY (I.L.P.); Department of Kinesiology (D.C.P.) and Department of Anatomy and Physiology (D.C.P.), Kansas State University, Manhattan; Division of Cardiology, Jefferson Medical College, Philadelphia, PA (G.R.R., D.J.W.); and Sections on Cardiology and Geriatrics, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC (D.W.K.)
| | - David J Whellan
- From the Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD (J.L.F., L.S.C.); Division of Cardiovascular Disease, Mayo Clinic, Rochester, MN (B.A.B.); Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta, Canada (M.J.H.); Division of Cardiology, Duke University School of Medicine, Durham, NC (W.E.K.); Institute for Exercise and Environmental Medicine, University of Texas Southwestern Medical Center, Dallas (B.D.L.); Cardiovascular Division, Brigham and Women's Hospital, Boston, MA (M.A.P.); Division of Cardiology, Albert Einstein College of Medicine, Bronx, NY (I.L.P.); Department of Kinesiology (D.C.P.) and Department of Anatomy and Physiology (D.C.P.), Kansas State University, Manhattan; Division of Cardiology, Jefferson Medical College, Philadelphia, PA (G.R.R., D.J.W.); and Sections on Cardiology and Geriatrics, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC (D.W.K.)
| | - Dalane W Kitzman
- From the Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD (J.L.F., L.S.C.); Division of Cardiovascular Disease, Mayo Clinic, Rochester, MN (B.A.B.); Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta, Canada (M.J.H.); Division of Cardiology, Duke University School of Medicine, Durham, NC (W.E.K.); Institute for Exercise and Environmental Medicine, University of Texas Southwestern Medical Center, Dallas (B.D.L.); Cardiovascular Division, Brigham and Women's Hospital, Boston, MA (M.A.P.); Division of Cardiology, Albert Einstein College of Medicine, Bronx, NY (I.L.P.); Department of Kinesiology (D.C.P.) and Department of Anatomy and Physiology (D.C.P.), Kansas State University, Manhattan; Division of Cardiology, Jefferson Medical College, Philadelphia, PA (G.R.R., D.J.W.); and Sections on Cardiology and Geriatrics, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC (D.W.K.)
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