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de Santiago González C, Ciudad Martín J, García Alonso MM. [Risk factor control, lifestyle intervention, and prescribed medication in a cohort of patients with ischemic heart disease]. Semergen 2024; 50:102175. [PMID: 38301397 DOI: 10.1016/j.semerg.2023.102175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Revised: 12/09/2023] [Accepted: 12/17/2023] [Indexed: 02/03/2024]
Abstract
OBJECTIVE The aim of this study was to analyze the recommended prevention measures in our health area for patients discharged after a myocardial infarction. METHODS This was a retrospective descriptive study that selected patients with acute coronary syndrome in our health area in the previous calendar year. Control of the risk factors observed at the time of the coronary event and at 1 year and medication prescribed 1 year after the episode were studied. Variables including age, sex, control of dyslipidemia, hypertension or diabetes mellitus, adherence to treatment and lifestyle habits were analyzed. RESULTS Risk factor control was insufficient and sometimes even unassessed at the time of infarction. Although a slight improvement was perceived, control remained insufficient 1 year later. Moreover, patients, particularly women, were undertreated: one fifth (20%) more men were receiving appropriate treatment than women year after the myocardial event. CONCLUSIONS An additional effort must be made compared to what is currently being done, both by specialists in Hospital Care and Primary Care, to carry out good control of risk factors, meaning the control of certain diseases such as diabetes, high blood pressure or dyslipidemia, as well as habits or lifestyles that increase the probability of suffering a cardiovascular event. Furthermore, it is important to avoid these cardiovascular diseases and their relapse to reinforce adherence to the prescribed treatments.
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Affiliation(s)
- C de Santiago González
- Medicina familiar y Comunitaria, Centro de Salud de Alaejos, Área de Atención Primaria de Valladolid Este, Valladolid, España.
| | - J Ciudad Martín
- Medicina Familiar y Comunitaria, Hospital Clínico de Valladolid y Área de Atención Primaria de Valladolid Este, Valladolid, España
| | - M M García Alonso
- Medicina Familiar y Comunitaria, Centro de Salud de Circunvalación, Gerencia de Atención Primaria de Valladolid Este, Valladolid, España
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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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Gambó Ruberte E, Chabbar Boudet MC, Albarrán Martín C, Untoria Agustín C, Murlanch Dosset E, Peiró Aventín B, Garza Benito F. [Prognostic effects of cardiac rehabilitation in patients with acute coronary syndrome]. J Healthc Qual Res 2023; 38:206-213. [PMID: 36804861 DOI: 10.1016/j.jhqr.2023.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 12/03/2022] [Accepted: 01/10/2023] [Indexed: 02/17/2023]
Abstract
AIM Reduction of major adverse cardiovascular events (MACE) at 5 years in patients with acute coronary syndrome (ACS) and percutaneous coronary intervention who completed a cardiac rehabilitation program. METHODS We included 230 consecutive men with a diagnosis of ACS and percutaneous coronary intervention in the first half of 2015 according to the inclusion criteria. Two cohorts of 115 patients each were compared, one of them (rehabilitated group) with patients who completed the cardiac rehabilitation program and the other (control group) who received conventional outpatient care. Base-line characteristics and MACE at 5-years follow-up were compared and analyzed. MACE included re-infarction, heart failure, cerebrovascular accident and all-cause mortality. RESULTS At 5 years of follow-up, a statistically significant reduction in MACE (27.19% vs 7.83%; OR 0.23 [IC 0.10-0.50]; P=.0001), all-cause mortality (OR 0.12 [IC 0.01-0.94]; P=0.01), re-infarction rate (OR 0.29 [IC 0.11-0.77]; P=.007) and cerebrovascular accident (P=.014) was found in the rehabilitated group (RG). MACE-free survival was significantly longer in the RG, regardless of risk (HR 0.25 [IC 0.12-0.53]; P=.000). CONCLUSION In our sample, cardiac rehabilitation programs showed a prognostic benefit in patients with ACS and percutaneous coronary intervention, with a statistically significant reduction in MACE, re-infarction rate and CVA at five-year follow-up.
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Affiliation(s)
- E Gambó Ruberte
- Departamento de Cardiología, Hospital Arnau de Vilanova, Lleida, España.
| | - M C Chabbar Boudet
- Unidad de Prevención Cardiovascular y Rehabilitación Cardiaca, Hospital Nuestra Señora de Gracia, Zaragoza, España
| | - C Albarrán Martín
- Unidad de Prevención Cardiovascular y Rehabilitación Cardiaca, Hospital Nuestra Señora de Gracia, Zaragoza, España
| | - C Untoria Agustín
- Unidad de Prevención Cardiovascular y Rehabilitación Cardiaca, Hospital Nuestra Señora de Gracia, Zaragoza, España
| | - E Murlanch Dosset
- Departamento de Cardiología, Hospital Clínico Universitario Lozano Blesa, Zaragoza, España
| | - B Peiró Aventín
- Departmento de Cardiología, Hospital Universitario Miguel Servet, Zaragoza, España
| | - F Garza Benito
- Unidad de Prevención Cardiovascular y Rehabilitación Cardiaca, Hospital Nuestra Señora de Gracia, Zaragoza, España
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Santaularia N, Arnau A, Jaarsma T, Torà N, Vázquez-Oliva G. Efficacy of a supervised exercise training program on five-year readmission rates in patients with acute coronary syndrome. A randomised controlled trial. Rehabilitacion (Madr) 2023; 57:100720. [PMID: 35317941 DOI: 10.1016/j.rh.2021.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 12/10/2021] [Indexed: 06/14/2023]
Abstract
INTRODUCTION AND OBJECTIVES Exercise-based cardiac rehabilitation programmes can reduce mortality but their effects on readmission rates are unclear. The primary aim was to evaluate the efficacy of a supervised exercise-based cardiac rehabilitation programme on cardiac readmissions in patients with acute coronary syndrome at five years. METHODS We conducted an open, controlled, randomized, hospital-based clinical trial. Patients were assigned either to the control group (CG) who received standard care or to the intervention group (IG) who participated in a supervised exercise programme (3h per week of supervised exercise training for 10 weeks). Patients were evaluated at 5 years. RESULTS Seventy-six patients [41 CG, 35 IG, mean age 59.2 (SD 10.4), 82.9% men] were included. Cardiac readmission rates at 5 years were 24% in the CG compared to 9% in the IG (p=0.068), and readmission rates for all causes were 42% in the CG and 23% in the IG (p=0.085). Emergency care for cardiac disease was required more frequently in the CG (17% vs 11%, p=0.486). IG patients performed more regular and intensive exercise (62% vs. 33%, p=0.088). In both groups there were significant deterioration in systolic and diastolic blood pressure, body mass index, waist circumference, HbAc1, triglycerides, LDL and diet, and a significant increase in HDL. CONCLUSIONS Patients who participated in the supervised exercise training programme were readmitted less often than controls for cardiac disease and for all causes at 5 years, the reduction was clinically meaningful although not statistically significant. Control of cardiovascular risk factors deteriorated in both groups.
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Affiliation(s)
- N Santaularia
- Cardiac Rehabilitation Integrated Practice Unit, Althaia Xarxa Assistencial Universitària de Manresa, Manresa, Spain; Faculty of Health Sciences at Manresa, Universitat de Vic - Universitat Central de Catalunya (UVic-UCC), Manresa, Spain.
| | - A Arnau
- Central Catalonia Chronicity Research Group (C3RG), Research and Innovation Unit, Althaia Xarxa Assistencial Universitària de Manresa, Manresa, Spain; Centre d'Estudis Sanitaris i Socials, (CESS), Universitat de Vic-Universitat Central de Catalunya (UVIC-UCC), Vic, Spain
| | - T Jaarsma
- Department of Health, Medicine and Care, Division of Nursing Science, Linköping University, Faculty of Medicine and Health Sciences, Linköping, Sweden
| | - N Torà
- Research and Innovation Unit, Althaia Xarxa Assistencial Universitària de Manresa, Manresa, Spain
| | - G Vázquez-Oliva
- Department of Cardiology, Althaia Xarxa Assistencial Universitària de Manresa, Manresa, Spain; Faculty of Medicine, Universitat de Vic, Universitat Central de Catalunya (UVic-UCC), Vic, Spain
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Ferrer-Sargues FJ, Fabregat-Andrés Ó, Martínez-Hurtado I, Salvador-Coloma P, Martínez-Olmos FJ, Lluesma-Vidal M, Biviá-Roig G, Segrera-Rovira MJ, Arguisuelas MD, Valtueña-Gimeno N. Effects of neuromuscular training compared to classic strength-resistance training in patients with acute coronary syndrome: A study protocol for a randomized controlled trial. PLoS One 2020; 15:e0243917. [PMID: 33362223 PMCID: PMC7757882 DOI: 10.1371/journal.pone.0243917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Accepted: 11/25/2020] [Indexed: 12/03/2022] Open
Abstract
The aim of the present clinical trial is to evaluate the effectiveness of neuromuscular versus classical strength-resistance training as part of a cardiac rehabilitation programme in patients following acute coronary syndrome. The study is designed as a double-blinded, randomised, and controlled clinical trial. Thirty participants suffering from acute coronary syndrome who meet our inclusion criteria will be recruited by a private tertiary hospital. The intervention group will follow 20 sessions of a cardiac rehabilitation programme divided into two parts: aerobic training and neuromuscular strength-resistance training. The control group will complete the same aerobic training as well as a classical strength-resistance training workout programme. The primary outcome of the study will be the mean difference in change from baseline in the Incremental Shuttle Walking Test. The secondary outcomes will be the cardiorespiratory fitness of the patients (assessed by means of the Chester Step Test), lower-limb performance (assessed with the 30-Second Chair Stand Test and Single-Leg Squat Test), lower-limb strength (hip flexor handheld dynamometry), sexual dysfunction assessment (Sex Health Inventory for Men) and quality of life (EQ-5D-5L). This work will provide evidence for the effectiveness of a neuromuscular versus a classic strength-training programme in terms of cardiorespiratory fitness, lower-limb performance capacities and quality of life, in cardiac patients. The data obtained could lead to more effective and functional workouts which, in turn, may enhance the speed at which these patients can return to their everyday activities of life and improve the efficiency of their movement patterns and heart responses. Furthermore, patients may find neuromuscular workout routines more motivating and engaging, thus encouraging them to adopt healthier lifestyle patterns.
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Affiliation(s)
| | - Óscar Fabregat-Andrés
- Department of Medicine, Universidad Cardenal Herrera CEU, CEU Universities, Valencia, Spain
- Department of Cardiology, Hospital IMED, Valencia, Spain
| | - Isabel Martínez-Hurtado
- Department of Physiotherapy, Universidad Cardenal Herrera CEU, CEU Universities, Valencia, Spain
| | - Pablo Salvador-Coloma
- Department of Physiotherapy, Universidad Cardenal Herrera CEU, CEU Universities, Valencia, Spain
| | | | - Marta Lluesma-Vidal
- Department of Nursing, Universidad Cardenal Herrera CEU, CEU Universities, Valencia, Spain
| | - Gemma Biviá-Roig
- Department of Physiotherapy, Universidad Cardenal Herrera CEU, CEU Universities, Valencia, Spain
| | | | | | - Noemí Valtueña-Gimeno
- Department of Physiotherapy, Universidad Cardenal Herrera CEU, CEU Universities, Valencia, Spain
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Madueño-Caro AJ, Mellado-Fernández ML, Pardos-Lafarga M, Muñoz-Ayllón M, Saez-Garcia L, Gómez-Salgado J. Cardiac Rehabilitation in Primary Care. Impact of an Intervention on Perceived Self-Efficacy. J Funct Morphol Kinesiol 2019; 4:E32. [PMID: 33467347 PMCID: PMC7739278 DOI: 10.3390/jfmk4020032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Revised: 05/29/2019] [Accepted: 05/31/2019] [Indexed: 12/04/2022] Open
Abstract
Cardiac rehabilitation is cost-effective and should be considered a part of the care system provided to patients who have suffered a myocardial infarction or another heart disease. The main variable to study was the scoring, prior to and after the intervention in the General Scale of Self-Efficacy by Baessler & Schwarzer. A clinical community trial that was open controlled and randomised was used. All adult subjects of both sexes who had completed a cardiac rehabilitation program for 12 months at the reference hospital were selected and offered to participate. The psychometric variables registered were the Salamanca screening questionnaire, the Hamilton Anxiety Rating Scale, and the Beck Depression Inventory. Eighty-nine subjects accepted to participate in the study (93.89% response rate), with an average age of 63.01 years (SD 8.75). Once the study was concluded, the main outcome was a difference in means of 6.09 points in the General Scale of Self-Efficacy (p < 0.0053, 96% confidence interval-4.1950-10.29), showing that the group exposed to the intervention reached a higher score in the above-mentioned scale. However, there were no significant differences (t-student 0.1211; p = 0.943) after the estimation and contrast of population means for score differences between the groups regarding the Hamilton scale. Similarly, there were no significant differences between the groups regarding the means obtained in the variable score difference in the Beck Depression Inventory (t-student -0.1281; p = 0.8987). The results showed an increase in those scores related to general self-efficacy among the population that completed the intervention program, as compared to the control group.
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Affiliation(s)
| | | | | | | | - Laura Saez-Garcia
- La Laguna Health Centre, Andalusian Health Service, 11010 Cádiz, Spain
| | - Juan Gómez-Salgado
- Department of Sociology, Social Work and Public Health, University of Huelva, 21007 Huelva, Spain
- Safety and Health Posgrade Program, Universidad Espíritu Santo, Guayaquil 091650, Ecuador
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Cost-Effectiveness of Exercise-Based Cardiac Rehabilitation in Chilean Patients Surviving Acute Coronary Syndrome. J Cardiopulm Rehabil Prev 2019; 39:168-174. [PMID: 31021998 DOI: 10.1097/hcr.0000000000000356] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To assess the cost-effectiveness of 3 models of exercise-based cardiac rehabilitation (CR) compared with standard care in survivors of acute coronary syndrome (ACS) within the public health system in Chile. METHODS A Markov model was designed using 5 health states: ACS survivor, second ACS, complications, general mortality, and cardiovascular mortality. The transition probabilities between health states for standard care and corresponding relative risk for CR were calculated from a systematic review. Health benefits were measured with the EuroQol 5-dimensional 3-level (EQ-5D-3L) survey. Costs for each health state were quantified using the national cost verification study. The CR cost was estimated with a microcosting methodology. The time horizon was a lifetime and the discount rate was 3% per year for costs and benefits. Deterministic and probabilistic analyses were performed. Structural uncertainty was managed by designing 3 scenarios: CR as currently delivered in a specific Chilean public health center, CR as recommended by South American guidelines, and CR as proposed for low-resource settings. RESULTS Cardiac rehabilitation versus standard care showed an incremental cost-effectiveness ratio for the standard model of $722, for the South American model of $1247, and for the low-resource model of $666. The tornado diagram showed higher uncertainty in relative risk for the complications state and for the second ACS state. CONCLUSION Considering a cost-effectiveness threshold of 1 unit of gross domestic product per capita (∼$19 000), CR is highly cost-effective for the public health system in Chile.
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Xia TL, Huang FY, Peng Y, Huang BT, Pu XB, Yang Y, Chai H, Chen M. Efficacy of Different Types of Exercise-Based Cardiac Rehabilitation on Coronary Heart Disease: a Network Meta-analysis. J Gen Intern Med 2018; 33:2201-2209. [PMID: 30215179 PMCID: PMC6258639 DOI: 10.1007/s11606-018-4636-y] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2017] [Revised: 10/16/2017] [Accepted: 08/06/2018] [Indexed: 02/05/2023]
Abstract
BACKGROUND Exercise-based cardiac rehabilitation (CR) has been recognized as an essential component of the treatment for coronary heart disease (CHD). Determining the efficacy of modern alternative treatment methods is the key to developing exercise-based CR programs. METHODS Studies published through June 6, 2016, were identified using MEDLINE, EMBASE, and the Cochrane Library. English-language articles regarding the efficacy of different modes of CR in patients with CHD were included in this analysis. Two investigators independently reviewed abstracts and full-text articles and extracted data from the studies. According to the categories described by prior Cochrane reviews, exercise-based CR was classified into center-based CR, home-based CR, tele-based CR, and combined CR for this analysis. Outcomes included all-cause mortality, cardiovascular death, recurrent fatal and/or nonfatal myocardial infarction, recurrent cardiac artery bypass grafting, recurrent percutaneous coronary intervention (PCI), and hospital readmissions. RESULTS Sixty randomized clinical trials (n = 19,411) were included in the analysis. Network meta-analysis (NMA) demonstrated that only center-based CR significantly reduced all-cause mortality (center-based: RR = 0.76 [95% CI 0.64-0.90], p = 0.002) compared to usual care. Other modes of CR were not significantly different from usual care with regard to their ability to reduce mortality. Treatment ranking indicated that combined CR exhibited the highest probability (86.9%) of being the most effective mode, but this finding was not statistically significant due to the small sample size (combined: RR = 0.50 [95% CI 0.20-1.27], p = 0.146). CONCLUSIONS Current evidence suggests that center-based CR is acceptable for patients with CHD. As home- and tele-based CR can save time, money, effort, and resources and may be preferred by patients, their efficacy should be investigated further in subsequent studies.
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Affiliation(s)
- Tian-Li Xia
- Department of Cardiology, West China Hospital, Sichuan University, 37 Guoxue Street, Chengdu, 610041, People's Republic of China
| | - Fang-Yang Huang
- Department of Cardiology, West China Hospital, Sichuan University, 37 Guoxue Street, Chengdu, 610041, People's Republic of China
| | - Yong Peng
- Department of Cardiology, West China Hospital, Sichuan University, 37 Guoxue Street, Chengdu, 610041, People's Republic of China
| | - Bao-Tao Huang
- Department of Cardiology, West China Hospital, Sichuan University, 37 Guoxue Street, Chengdu, 610041, People's Republic of China
| | - Xiao-Bo Pu
- Department of Cardiology, West China Hospital, Sichuan University, 37 Guoxue Street, Chengdu, 610041, People's Republic of China
| | - Yong Yang
- Department of Cardiology, West China Hospital, Sichuan University, 37 Guoxue Street, Chengdu, 610041, People's Republic of China
| | - Hua Chai
- Department of Cardiology, West China Hospital, Sichuan University, 37 Guoxue Street, Chengdu, 610041, People's Republic of China
| | - Mao Chen
- Department of Cardiology, West China Hospital, Sichuan University, 37 Guoxue Street, Chengdu, 610041, People's Republic of China.
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Powell R, McGregor G, Ennis S, Kimani PK, Underwood M. Is exercise-based cardiac rehabilitation effective? A systematic review and meta-analysis to re-examine the evidence. BMJ Open 2018; 8:e019656. [PMID: 29540415 PMCID: PMC5857699 DOI: 10.1136/bmjopen-2017-019656] [Citation(s) in RCA: 62] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES To determine the contemporary effectiveness of exercise-based cardiac rehabilitation (CR) in terms of all-cause mortality, cardiovascular mortality and hospital admissions. DATA SOURCES Studies included in or meeting the entry criteria for the 2016 Cochrane review of exercise-based CR in patients with coronary artery disease. STUDY ELIGIBILITY CRITERIA Randomised controlled trials (RCTs) of exercise-based CR versus a no-exercise control whose participants were recruited after the year 2000. STUDY APPRAISAL AND SYNTHESIS METHODS Two separate reviewers independently screened the characteristics of studies. One reviewer quality appraised any new studies and assessed their risk of bias using the Cochrane Collaboration's recommended risk of bias tool. Data were reported as the risk difference (95% CI). RESULTS We included 22 studies with 4834 participants (mean age 59.5 years, 78.4% male). We found no differences in outcomes between exercise-based CR and a no-exercise control at their longest follow-up period for: all-cause mortality (19 studies; n=4194; risk difference 0.00, 95% CI -0.02 to 0.01, P=0.38) or cardiovascular mortality (9 studies; n=1182; risk difference -0.01, 95% CI -0.02 to 0.01, P=0.25). We found a small reduction in hospital admissions of borderline statistical significance (11 studies; n=1768; risk difference -0.05, 95% CI -0.10 to -0.00, P=0.05). CONCLUSIONS AND IMPLICATIONS OF KEY FINDINGS Our analysis indicates conclusively that the current approach to exercise-based CR has no effect on all-cause mortality or cardiovascular mortality, when compared with a no-exercise control. There may be a small reduction in hospital admissions following exercise-based CR that is unlikely to be clinically important. PROSPERO REGISTRATION NUMBER CRD42017073616.
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Affiliation(s)
- Richard Powell
- Department of Cardiac Rehabilitation, Centre for Exercise & Health, University Hospitals, Coventry, UK
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
| | - Gordon McGregor
- Department of Cardiac Rehabilitation, Centre for Exercise & Health, University Hospitals, Coventry, UK
- Faculty of Health and Life Sciences, Coventry University, Coventry, UK
| | - Stuart Ennis
- Department of Cardiac Rehabilitation, Centre for Exercise & Health, University Hospitals, Coventry, UK
- Cardiff Centre for Exercise & Health, Cardiff Metropolitan University, Cardiff, UK
| | - Peter K Kimani
- Statistics and Epidemiology Unit, Warwick Medical School, University of Warwick, Coventry, UK
| | - Martin Underwood
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
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Abell B, Glasziou P, Hoffmann T. The Contribution of Individual Exercise Training Components to Clinical Outcomes in Randomised Controlled Trials of Cardiac Rehabilitation: A Systematic Review and Meta-regression. SPORTS MEDICINE - OPEN 2017; 3:19. [PMID: 28477308 PMCID: PMC5419959 DOI: 10.1186/s40798-017-0086-z] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/04/2016] [Accepted: 04/27/2017] [Indexed: 12/26/2022]
Abstract
BACKGROUND While the clinical benefits of exercise-based cardiac rehabilitation are well established, there is extensive variation in the interventions used within these trials. It is unknown whether variations in individual components of these exercise interventions provide different relative contributions to overall clinical outcomes. This study aims to systematically examine the relationship between individual components of the exercise intervention in cardiac rehabilitation (such as intensity and frequency) and clinical outcomes for people with coronary heart disease. METHODS In this systematic review, eligible trials were identified via searches of databases (PubMed, Allied and Complementary Medicine, EMBASE, PEDro, Science Citation Index Expanded, CINAHL, The Cochrane Library, SPORTDiscus) from citation tracking and hand-searching. Studies were included if they were randomised trials of a structured exercise intervention (versus usual care) for participants with coronary heart disease and reported at least one of cardiovascular mortality, total mortality, myocardial infarction or revascularisation outcomes. Each included trial was assessed using the Cochrane Risk of Bias Tool. Authors were also contacted for missing intervention details or data. Random effects meta-analysis was performed to calculate a summary risk ratio (RR) with 95% confidence interval (CI) for the effect of exercise on outcomes. Random effects meta-regression and subgroup analyses were conducted to examine the association between pre-specified co-variates (exercise components or trial characteristics) and each clinical outcome. RESULTS Sixty-nine trials were included, evaluating 72 interventions which differed markedly in terms of exercise components. Exercise-based cardiac rehabilitation was effective in reducing cardiovascular mortality (RR 0.74, 95% CI 0.65 to 0.86), total mortality (RR 0.90, 95% CI 0.83 to 0.99) and myocardial infarction (RR 0.80, 95% CI 0.70 to 0.92). This effect generally demonstrated no significant differences across subgroups of patients who received various types of usual care, more or less than 150 min of exercise per week and of differing cardiac aetiologies. There was however some heterogeneity observed in the efficacy of cardiac rehabilitation in reducing total mortality based on the presence of lipid lowering therapy (I 2 = 48%, p = 0.15 for subgroup treatment interaction effect). No single exercise component was identified through meta-regression as a significant predictor of mortality outcomes, although reductions in both total (RR 0.81, p = 0.042) and cardiovascular mortality (RR 0.72, p = 0.045) were observed in trials which reported high levels of participant exercise adherence, versus those which reported lower levels. A dose-response relationship was found between an increasing exercise session time and increasing risk of myocardial infarction (RR 1.01, p = 0.011) and the highest intensity of exercise prescribed and an increasing risk of percutaneous coronary intervention (RR 1.05, p = 0.047). CONCLUSIONS Exercise-based cardiac rehabilitation is effective at reducing important clinical outcomes in patients with coronary heart disease. While our analysis was constrained by the quality of included trials and missing information about intervention components, there appears to be little differential effect of variations in exercise intervention, particularly on mortality outcomes. Given the observed effect between higher adherence and improved outcomes, it may be more important to provide exercise-based cardiac rehabilitation programs which focus on achieving increased adherence to the exercise intervention.
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Affiliation(s)
- Bridget Abell
- Centre for Research in Evidence-Based Practice, Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, 4229, Australia.
| | - Paul Glasziou
- Centre for Research in Evidence-Based Practice, Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, 4229, Australia
| | - Tammy Hoffmann
- Centre for Research in Evidence-Based Practice, Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, 4229, Australia
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Autoeficacia percibida, rasgos de personalidad y biotipos previos a programa de rehabilitación cardíaca en atención primaria de salud. ENFERMERIA CLINICA 2017; 27:346-351. [DOI: 10.1016/j.enfcli.2017.04.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Revised: 04/16/2017] [Accepted: 04/18/2017] [Indexed: 11/17/2022]
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Santiago de Araújo Pio C, Marzolini S, Pakosh M, Grace SL. Effect of Cardiac Rehabilitation Dose on Mortality and Morbidity: A Systematic Review and Meta-regression Analysis. Mayo Clin Proc 2017; 92:1644-1659. [PMID: 29101934 DOI: 10.1016/j.mayocp.2017.07.019] [Citation(s) in RCA: 81] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Revised: 07/17/2017] [Accepted: 07/31/2017] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To ascertain the effect of cardiac rehabilitation (CR) dose (ie, duration × frequency/wk; categorized as low [<12 sessions], medium [12-35 sessions], or high [≥36 sessions]) on mortality and morbidity. METHODS The Cochrane, CINAHL, EMBASE, PsycINFO, and MEDLINE databases were systematically searched from inception through November 30, 2015. Inclusion criteria included randomized or nonrandomized studies with a minimum CR dose of 4 or higher and presence of a control/comparison group. Citations were considered for inclusion, and data were extracted in included studies independently by 2 investigators. Studies were pooled using random-effects meta-analysis and meta-regression where warranted (covariates included study quality, country, publication year, and diagnosis). RESULTS Of 4630 unique citations, 33 trials were included comparing CR to usual care (ie, no dose). In meta-regression, greater dose was significantly related to lower all-cause mortality (high: -0.77; SE, 0.22; P<.001; medium: -0.80; SE, 0.21; P<.001) when compared with low dose. With regard to morbidity, meta-analysis revealed that dose was significantly associated with fewer percutaneous coronary interventions (high: relative risk, 0.65; 95% CI, 0.50-0.84; medium/low: relative risk, 1.04; 95% CI, 0.74-1.48; between subgroup difference P=.03). This reduction was also significant in meta-regression (high vs medium/low: -0.73; SE, 0.20; P<.001). Publication bias was not evident. No dose-response association was found for cardiovascular mortality, all-cause hospitalization, coronary artery bypass graft surgery, or myocardial infarction. CONCLUSION A minimum of 36 CR sessions may be needed to reduce percutaneous coronary interventions. Future studies should examine the effect of actual dose of CR, and trials are needed comparing different doses. PROSPERO REGISTRATION CRD42016036029.
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Affiliation(s)
| | - Susan Marzolini
- University Health Network-University of Toronto, Toronto, Ontario, Canada
| | - Maureen Pakosh
- University Health Network-University of Toronto, Toronto, Ontario, Canada
| | - Sherry L Grace
- York University, School of Kinesiology and Health Science, Toronto, Ontario, Canada; University Health Network-University of Toronto, Toronto, Ontario, Canada.
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Maroto-Montero JM, Maroto-de Pablo M, Starling-Duarte J, Prados-Cabiedas C, Villahoz-Garcia C, Cabrero-Soblechero L, Sánchez-Corbal M, Valverde-Dos Anjos B, Muñoz-Sanjuan Y. [Sexual activity in implantable cardioverter defibrillator patients included in cardiac rehabilitation]. ARCHIVOS DE CARDIOLOGIA DE MEXICO 2017; 88:116-123. [PMID: 28847542 DOI: 10.1016/j.acmx.2017.07.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Revised: 07/20/2017] [Accepted: 07/26/2017] [Indexed: 10/19/2022] Open
Abstract
OBJECTIVES To analyse the effects of a Cardiac Rehabilitation Program (CRP) on quality of life and sexual activity levels in patients with implantable cardioverter defibrillators (ICD). METHOD A total of 25 patients (22 men and 3 women) were included in a study that consisted of the analysis of any defibrillator discharges, their repercussion on the couple, and the effects of CRP on physical and psychological aspects, and on sexual activity (SA). RESULTS The mean age of the patients was 55years (22 to 79). Initially, fear for device discharges was present in all patients. On arrival, 14 patients (56%) did not have any SA: 2 with ages of 69 and 79years; one woman due to severe anxiety; an alcoholic man, and 10 because the ICD had been implanted less than 1 month before. Nine men and two women had restarted SA: 5 of them 5-52months after the implantation, and the other 6, 30days after implantation of the ICD while attending the CRP. At the end of the study, 21 patients had regained SA. Two men had clinical signs of depression and anxiety, with one requiring specialised treatment. Functional capacity improved significantly, 6.5±3.0METs at the beginning of the program and 9.2±3.3METs at the end, with a P<.005. There was only one inappropriate discharge. CONCLUSIONS Discharges caused by newest devices have dropped significantly. This fact, together with the action of CRP at physical, psychological, and informative levels, makes it possible to control the dysfunctions in the quality of life and sexuality in patients.
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Affiliation(s)
- José María Maroto-Montero
- Unidad de Rehabilitación Cardiaca, Hospital Vithas Nuestra Señora de Fátima, Vigo, Pontevedra, España; Unidad de Rehabilitación Cardiaca Ecoplar, Residencia Socio Sanitaria, Madrid, España.
| | - Marta Maroto-de Pablo
- Unidad de Rehabilitación Cardiaca Ecoplar, Residencia Socio Sanitaria, Madrid, España; Facultad de Medicina, Universidad Autónoma, Madrid, España
| | - Juan Starling-Duarte
- Unidad de Rehabilitación Cardiaca, Hospital Vithas Nuestra Señora de Fátima, Vigo, Pontevedra, España
| | - Carolina Prados-Cabiedas
- Unidad de Rehabilitación Cardiaca, Servicio de Cardiología, Hospital Universitario Ramón y Cajal, Madrid, España
| | | | | | - Marta Sánchez-Corbal
- Unidad de Rehabilitación Cardiaca, Hospital Vithas Nuestra Señora de Fátima, Vigo, Pontevedra, España
| | - Belén Valverde-Dos Anjos
- Unidad de Rehabilitación Cardiaca, Hospital Vithas Nuestra Señora de Fátima, Vigo, Pontevedra, España
| | - Yésica Muñoz-Sanjuan
- Unidad de Rehabilitación Cardiaca, Hospital Vithas Nuestra Señora de Fátima, Vigo, Pontevedra, España
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Richards SH, Anderson L, Jenkinson CE, Whalley B, Rees K, Davies P, Bennett P, Liu Z, West R, Thompson DR, Taylor RS. Psychological interventions for coronary heart disease. Cochrane Database Syst Rev 2017; 4:CD002902. [PMID: 28452408 PMCID: PMC6478177 DOI: 10.1002/14651858.cd002902.pub4] [Citation(s) in RCA: 93] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Coronary heart disease (CHD) is the most common cause of death globally, although mortality rates are falling. Psychological symptoms are prevalent for people with CHD, and many psychological treatments are offered following cardiac events or procedures with the aim of improving health and outcomes. This is an update of a Cochrane systematic review previously published in 2011. OBJECTIVES To assess the effectiveness of psychological interventions (alone or with cardiac rehabilitation) compared with usual care (including cardiac rehabilitation where available) for people with CHD on total mortality and cardiac mortality; cardiac morbidity; and participant-reported psychological outcomes of levels of depression, anxiety, and stress; and to explore potential study-level predictors of the effectiveness of psychological interventions in this population. SEARCH METHODS We updated the previous Cochrane Review searches by searching the following databases on 27 April 2016: CENTRAL in the Cochrane Library, MEDLINE (Ovid), Embase (Ovid), PsycINFO (Ovid), and CINAHL (EBSCO). SELECTION CRITERIA We included randomised controlled trials (RCTs) of psychological interventions compared to usual care, administered by trained staff, and delivered to adults with a specific diagnosis of CHD. We selected only studies estimating the independent effect of the psychological component, and with a minimum follow-up of six months. The study population comprised of adults after: a myocardial infarction (MI), a revascularisation procedure (coronary artery bypass graft (CABG) or percutaneous coronary intervention (PCI)), and adults with angina or angiographically defined coronary artery disease (CAD). RCTs had to report at least one of the following outcomes: mortality (total- or cardiac-related); cardiac morbidity (MI, revascularisation procedures); or participant-reported levels of depression, anxiety, or stress. DATA COLLECTION AND ANALYSIS Two review authors independently screened titles and abstracts of all references for eligibility. A lead review author extracted study data, which a second review author checked. We contacted study authors to obtain missing information. MAIN RESULTS This review included 35 studies which randomised 10,703 people with CHD (14 trials and 2577 participants added to this update). The population included mainly men (median 77.0%) and people post-MI (mean 65.7%) or after undergoing a revascularisation procedure (mean 27.4%). The mean age of participants within trials ranged from 53 to 67 years. Overall trial reporting was poor, with around a half omitting descriptions of randomisation sequence generation, allocation concealment procedures, or the blinding of outcome assessments. The length of follow-up ranged from six months to 10.7 years (median 12 months). Most studies (23/35) evaluated multifactorial interventions, which included therapies with multiple therapeutic components. Ten studies examined psychological interventions targeted at people with a confirmed psychopathology at baseline and two trials recruited people with a psychopathology or another selecting criterion (or both). Of the remaining 23 trials, nine studies recruited unselected participants from cardiac populations reporting some level of psychopathology (3.8% to 53% with depressive symptoms, 32% to 53% with anxiety), 10 studies did not report these characteristics, and only three studies excluded people with psychopathology.Moderate quality evidence showed no risk reduction for total mortality (risk ratio (RR) 0.90, 95% confidence interval (CI) 0.77 to 1.05; participants = 7776; studies = 23) or revascularisation procedures (RR 0.94, 95% CI 0.81 to 1.11) with psychological therapies compared to usual care. Low quality evidence found no risk reduction for non-fatal MI (RR 0.82, 95% CI 0.64 to 1.05), although there was a 21% reduction in cardiac mortality (RR 0.79, 95% CI 0.63 to 0.98). There was also low or very low quality evidence that psychological interventions improved participant-reported levels of depressive symptoms (standardised mean difference (SMD) -0.27, 95% CI -0.39 to -0.15; GRADE = low), anxiety (SMD -0.24, 95% CI -0.38 to -0.09; GRADE = low), and stress (SMD -0.56, 95% CI -0.88 to -0.24; GRADE = very low).There was substantial statistical heterogeneity for all psychological outcomes but not clinical outcomes, and there was evidence of small-study bias for one clinical outcome (cardiac mortality: Egger test P = 0.04) and one psychological outcome (anxiety: Egger test P = 0.012). Meta-regression exploring a limited number of intervention characteristics found no significant predictors of intervention effects for total mortality and cardiac mortality. For depression, psychological interventions combined with adjunct pharmacology (where deemed appropriate) for an underlying psychological disorder appeared to be more effective than interventions that did not (β = -0.51, P = 0.003). For anxiety, interventions recruiting participants with an underlying psychological disorder appeared more effective than those delivered to unselected populations (β = -0.28, P = 0.03). AUTHORS' CONCLUSIONS This updated Cochrane Review found that for people with CHD, there was no evidence that psychological treatments had an effect on total mortality, the risk of revascularisation procedures, or on the rate of non-fatal MI, although the rate of cardiac mortality was reduced and psychological symptoms (depression, anxiety, or stress) were alleviated; however, the GRADE assessments suggest considerable uncertainty surrounding these effects. Considerable uncertainty also remains regarding the people who would benefit most from treatment (i.e. people with or without psychological disorders at baseline) and the specific components of successful interventions. Future large-scale trials testing the effectiveness of psychological therapies are required due to the uncertainty within the evidence. Future trials would benefit from testing the impact of specific (rather than multifactorial) psychological interventions for participants with CHD, and testing the targeting of interventions on different populations (i.e. people with CHD, with or without psychopathologies).
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Affiliation(s)
- Suzanne H Richards
- Leeds Institute of Health Sciences, University of Leeds, Charles Thackrah Building, 101 Clarendon Road, Leeds, UK, LS2 9LJ
- Primary Care, University of Exeter Medical School, St Luke's Campus, Magdalen Road, Exeter, Devon, UK, EX1 2LU
| | - Lindsey Anderson
- Institute of Health Research, University of Exeter Medical School, Veysey Building, Salmon Pool Lane, Exeter, UK, EX2 4SG
| | - Caroline E Jenkinson
- Primary Care, University of Exeter Medical School, St Luke's Campus, Magdalen Road, Exeter, Devon, UK, EX1 2LU
| | - Ben Whalley
- School of Psychology, University of Plymouth, Plymouth, UK
| | - Karen Rees
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK, CV4 7AL
| | - Philippa Davies
- School of Social and Community Medicine, University of Bristol, Canynge Hall, Bristol, UK, BS8 2PS
| | - Paul Bennett
- Department of Psychology, University of Swansea, Singleton Park, Swansea, UK, SA2 8PP
| | - Zulian Liu
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Robert West
- Wales Heart Research Institute, Cardiff University, Heath Park, Cardiff, UK, CF14 4XN
| | - David R Thompson
- Department of Psychiatry, University of Melbourne, St Vincent's Hospital, Melbourne, Victoria, Australia, VIC 3000
| | - Rod S Taylor
- Institute of Health Research, University of Exeter Medical School, Veysey Building, Salmon Pool Lane, Exeter, UK, EX2 4SG
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[Cardiac rehabilitation after myocardial infarction]. Ann Cardiol Angeiol (Paris) 2015; 64:517-26. [PMID: 26548984 DOI: 10.1016/j.ancard.2015.09.058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Although the proofs of the benefits of cardiac rehabilitation accumulate, many patients are not sent to rehabilitation units, especially younger and very elderly patients. As the length of stay in acute care units decreases, rehabilitation offers more time to fully assess the patients' conditions and needs. Meta-analyses of randomised trials suggest that mortality can be improved by as much as 20-30%. In addition, rehabilitation helps managing risk factors, including hyperlipidemia, diabetes, smoking and sedentary behaviours. Physical training also helps improving exercise capacity. Because of all of these effects, cardiac rehabilitation for post-myocardial infarction patients has been given a class IA recommendation in current guidelines.
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Abell B, Glasziou P, Hoffmann T. Reporting and Replicating Trials of Exercise-Based Cardiac Rehabilitation. Circ Cardiovasc Qual Outcomes 2015; 8:187-94. [DOI: 10.1161/circoutcomes.114.001381] [Citation(s) in RCA: 64] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Bridget Abell
- From the Centre for Research in Evidence-Based Practice, Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Australia (B.A., P.G., T.H.); and School of Health and Rehabilitation Sciences, Faculty of Health and Behavioural Sciences, University of Queensland, Brisbane, Australia (T.H.)
| | - Paul Glasziou
- From the Centre for Research in Evidence-Based Practice, Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Australia (B.A., P.G., T.H.); and School of Health and Rehabilitation Sciences, Faculty of Health and Behavioural Sciences, University of Queensland, Brisbane, Australia (T.H.)
| | - Tammy Hoffmann
- From the Centre for Research in Evidence-Based Practice, Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Australia (B.A., P.G., T.H.); and School of Health and Rehabilitation Sciences, Faculty of Health and Behavioural Sciences, University of Queensland, Brisbane, Australia (T.H.)
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18
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Cordero A, Masiá MD, Galve E. Physical exercise and health. ACTA ACUST UNITED AC 2014; 67:748-53. [PMID: 25172071 DOI: 10.1016/j.rec.2014.04.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2014] [Accepted: 04/04/2014] [Indexed: 11/24/2022]
Abstract
Regular physical exercise is an established recommendation for preventing and treating the main modifiable cardiovascular risk factors, such as diabetes mellitus, hypertension, and dyslipidemia. Performing physical activity of moderate intensity for a minimum of 30 min 5 days a week or of high intensity for a minimum of 20 min 3 days a week improves functional capacity and is associated with reductions in the incidence of cardiovascular disease and mortality. Physical exercise induces physiological cardiovascular adaptations that improve physical performance, and only in extreme cases can these adaptations lead to an increased risk of physical exercise-associated complications. The incidence of sudden death or serious complications during physical exercise is very low and is concentrated in people with heart diseases or with pathological cardiac adaptation to exercise. Most of these cases can be detected by cardiology units or well-trained professionals.
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Affiliation(s)
- Alberto Cordero
- Departamento de Cardiología, Hospital Universitario de San Juan, San Juan de Alicante,, Alicante, Spain.
| | - M Dolores Masiá
- Departamento de Cardiología, Hospital Universitario de San Juan, San Juan de Alicante,, Alicante, Spain
| | - Enrique Galve
- Departamento de Cardiología, Hospital Universitari de la Vall d'Hebron, Barcelona, Spain
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Dedieu N, Fernández L, Garrido-Lestache E, Sánchez I, Jesus Lamas M. Effects of a Cardiac Rehabilitation Program in Patients with Congenital Heart Disease. ACTA ACUST UNITED AC 2014. [DOI: 10.4236/ojim.2014.41004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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20
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Lewin R, Doherty P. Cardiac rehabilitation and mortality reduction after myocardial infarction: the emperor's new clothes? Evidence in favour of cardiac rehabilitation. Heart 2013; 99:909-11. [PMID: 23644410 DOI: 10.1136/heartjnl-2013-303704] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
This piece highlights the strength of evidence in favour of cardiac rehabilitation (CR) and postulates that the emperor is indeed well dressed. The reason why a single negative trial, in the UK, has caused such hullabaloo in the literature and clinical practice is examined against overwhelming evidence from over 40 positive randomised controlled trials. The lack of motivation to promote lifestyle change and the role of patients in determining outcome is also explored. To conclude, we set the scene for the final chapter of this story by outlining what needs to be done to answer the question about the real-world effectiveness of CR.
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Affiliation(s)
- Robert Lewin
- Department of Health Sciences, University of York, Area 4, Seebohm Rowntree Building, York, YO10 5DD, UK.
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Lewinter C, Bland JM, Crouch S, Doherty P, Lewin RJ, Køber L, Hall AS, Gale CP. The effect of referral for cardiac rehabilitation on survival following acute myocardial infarction: a comparison survival in two cohorts collected in 1995 and 2003. Eur J Prev Cardiol 2012. [DOI: 10.1177/2047487312469124] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
| | - John M Bland
- Department of Health Science, University of York, UK
| | - Simon Crouch
- Department of Health Science, University of York, UK
| | - Patrick Doherty
- Faculty of Health and Life sciences, York St John University, UK
| | | | - Lars Køber
- Department of Cardiology, Rigshospitalet, University of Copenhagen, Denmark
| | - Alistair S Hall
- Centre for Epidemiology and Biostatistics, University of Leeds, UK
- Department of Cardiology, Leeds Teaching Hospitals NHS Trust, UK
| | - Christopher P Gale
- Centre for Epidemiology and Biostatistics, University of Leeds, UK
- Department of Cardiology, York Teaching Hospital NHS Foundation Trust, UK
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Whalley B, Rees K, Davies P, Bennett P, Ebrahim S, Liu Z, West R, Moxham T, Thompson DR, Taylor RS. Psychological interventions for coronary heart disease. Cochrane Database Syst Rev 2011:CD002902. [PMID: 21833943 DOI: 10.1002/14651858.cd002902.pub3] [Citation(s) in RCA: 98] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Psychological symptoms are strongly associated with coronary heart disease (CHD), and many psychological treatments are offered following cardiac events or procedures. OBJECTIVES Update the existing Cochrane review to (1) determine the independent effects of psychological interventions in patients with CHD (principal outcome measures included total or cardiac-related mortality, cardiac morbidity, depression, and anxiety) and (2) explore study-level predictors of the impact of these interventions. SEARCH STRATEGY The original review searched Cochrane Controleed Trials Register (CCTR, Issue 4, 2001), MEDLINE, EMBASE, PsycINFO, and CINAHL to December 2001. This was updated by searching the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE and EMBASE, PsycINFO and CINAHL from 2001 to January 2009. In addition, we searched reference lists of papers, and expert advice was sought for the original and update review. SELECTION CRITERIA Randomised controlled trials of psychological interventions compared to usual care, administered by trained staff. Only studies estimating the independent effect of the psychological component with a minimum follow-up of six months. Adults with specific diagnosis of CHD. DATA COLLECTION AND ANALYSIS Titles and abstracts of all references screened for eligibility by two reviewers independently; data extracted by the lead author and checked by a second reviewer. Authors contacted where possible to obtain missing information. MAIN RESULTS There was no strong evidence that psychological intervention reduced total deaths, risk of revascularisation, or non-fatal infarction. Amongst a smaller group of studies reporting cardiac mortality there was a modest positive effect of psychological intervention (relative risk: 0.80 (95% CI 0.64 to 1.00)). Furthermore, psychological intervention did result in small/moderate improvements in depression, standardised mean difference (SMD): -0.21 (95% CI -0.35, -0.08) and anxiety, SMD: -0.25 (95% CI -0.48 to -0.03). Results for mortality indicated some evidence of small-study bias, though results for other outcomes did not. Meta regression analyses revealed four significant predictors of intervention effects on depression were found: (1) an aim to treat type-A behaviours (ß = -0.32, p = 0.03) were more effective than other interventions. In contrast, interventions which (2) aimed to educate patients about cardiac risk factors (ß = 0.23, p = 0.03), (3) included client-led discussion and emotional support as core therapeutic components (ß = 0.31, p < 0.01), or (4) included family members in the treatment process (ß = 0.26, p < 0.01) were significantly less effective. AUTHORS' CONCLUSIONS Psychological treatments appear effective in treating psychological symptoms of CHD patients. Uncertainly remains regarding the subgroups of patients who would benefit most from treatment and the characteristics of successful interventions.
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Affiliation(s)
- Ben Whalley
- Centre for Multilevel Modelling, Graduate School of Education, University of Bristol, 2 Priory Road, Bristol, UK, BS8 1TX
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Abstract
At the time of evidence-based medicine, while the proofs of the benefits of cardiac rehabilitation to the coronary multiply, a large number of patients are still managed without any form of rehabilitation. In particular, younger patients with myocardial infarction treated by early reperfusion and older subjects. The objective of in-hospital or ambulatory cardiac rehabilitation is a global coverage of the patient and his/her risk factors, that the short duration of hospitalization in the acute phase does not allow. Several randomized studies, metaanalyses, and registers show a decrease from 20 to 30% of the mortality after cardiac rehabilitation. The benefits of physical training on risk factors modification are demonstrated by numerous works: improvement of lipid parameters and arterial pressure, prevention of diabetes, increased smoking cessation, loss of weight, better overall well-being; besides the management of risk factors, physical training improves exercise capacity, a recognised prognostic factor. The efficiency of cardiac rehabilitation may be comparable with that of the key treatments of coronary artery disease, such as beta-blockers or coronary angioplasty. All these proofs give to the cardiac rehabilitation in post-myocardial infarction a high-level recommendation, grade IA.
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Affiliation(s)
- M Ghannem
- Centre de réadaptation cardiaque Léopold-Bellan-d'Ollencourt, centre hospitalier de Gonesse, Tracy Le Mont, France.
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Current status of cardiac rehabilitation in Latin America and the Caribbean. Am Heart J 2009; 158:480-7. [PMID: 19699874 DOI: 10.1016/j.ahj.2009.06.020] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2009] [Accepted: 06/10/2009] [Indexed: 01/09/2023]
Abstract
BACKGROUND The prevalence of coronary artery disease (CAD) in Latin America is increasing and contributes importantly to the global burden of cardiovascular diseases. Advanced resources for the diagnosis and treatment of CAD are available in most of the region. However, preventive approaches such as cardiovascular rehabilitation programs (CVRP) may not be widely implemented. METHODS We carried out a telephone-based survey to hospitals sampled in a random and population-weighted fashion from a list of 202 centers with cardiac catheterization laboratories in Mexico, Central and South America, and the Caribbean. We collected information of availability of cardiac procedures and imaging techniques and also extensive data about the presence, characteristics, and quality measures of CVRP. RESULTS A total of 98 centers were contacted, and a complete survey was provided by 59 centers (60%) from 13 countries. Cardiovascular rehabilitation programs were available in only 56% of centers. There were no differences between centers with and without CVRP regarding type of hospital, availability of cardiac surgery, and annual volume of patients with myocardial infarction. Among centers with CVRP, 70% offered all phases of CVRP. The lack of CVRP was attributed to lack of qualified personnel in 41% of centers, financial constraints in 33%, and lack of physical space in 13%. All centers without CVRP performed cardiac surgery and percutaneous interventions. CONCLUSIONS Despite the presence of state-of-the-art technology for the diagnosis and treatment of CAD, availability of CVRP, a less expensive yet effective tool for the treatment of CAD, appears to be limited in Latin America and the Caribbean.
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Muñoz MA, Subirana I, Ramos R, Franzi A, Vila J, Marrugat J. [Efficacy of an intensive prevention programme of coronary heart disease: 5 year follow-up outcomes]. Med Clin (Barc) 2008; 130:521-5. [PMID: 18457617 DOI: 10.1157/13119713] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
BACKGROUND AND OBJECTIVE Most evidence on the efficacy of intensive preventive programs of secondary prevention of coronary diseases comes from Anglo-Saxon countries and effectiveness remains controversial. We have scarce information about the efficacy of these types of programs in Spain. In the present analysis we show the results of the ICAR (Intervención en la Comunidad de Alto Riesgo coronario) study, aimed to analyze the efficacy of an intensive preventive program primary care based in reducing the cardiovascular recurrences and mortality in patients with coronary heart disease. PATIENTS AND METHOD We designed a randomized clinical trial, multicenter and community based, which included 23 health care areas in Catalonia, Spain. We followed for 5 years 2 cohorts of patients with coronary heart disease, aged 30-80 years. The intervention group was quarterly examined by their general practitioner, who adjusted treatments to control their cardiovascular risk factors thoroughly and reinforced life style behaviours. In order to do that, patient's weight and blood pressure were determined in each visit and laboratory test carried out twice a year. Patients in the control group received the usual care. In order to analyze the effect of the intervention cardiovascular recurrences and mortality were registered. RESULTS We included 983 patients. Mean (standard deviation) age was 64 (10) and 74.5% were men. During the follow-up 235 patients suffered some non-fatal cardiovascular recurrence (109 vs 126 in the control and intervention group, respectively; p = 0.84), and 45 died from cardiovascular recurrences (23 vs 22, respectively; p = 0.57). Adjusted hazard ratio of cardiovascular event and total mortality, for the intervention group were 1.01 (95% confidence interval, 0.74-1.39), and 0.92 (95% confidence interval, 0.54-1.56), respectively. CONCLUSIONS The implementation of an intensive secondary prevention program based on periodical reminds to patients with stable coronary heart disease to attend their general practitioners did not reduce either the cardiovascular recurrences or mortality at 5 years as compared with usual care.
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Affiliation(s)
- Miguel A Muñoz
- EAP Montornés-Montmeló, Institut Català de la Salut, Montmeló, Barcelona, España
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Alfonso F, Segovia J, Heras M, Bermejo J. Prevención cardiovascular: ¿siempre demasiado tarde? Rev Esp Cardiol 2008. [DOI: 10.1157/13116657] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Plaza I, García S, Madero R, Zapata MA, Perea J, Sobrino JA, López-Sendón JL. Programa de prevención secundaria: influencia sobre el riesgo cardiovascular. Rev Esp Cardiol 2007. [DOI: 10.1157/13099469] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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de Pablo y Zarzosa C, Grima-Serrano A, Luengo-Pérez E, Mazón-Ramos P. Prevención cardiovascular y rehabilitación cardiaca. Rev Esp Cardiol 2007; 60 Suppl 1:68-78. [PMID: 17352857 DOI: 10.1157/13099714] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
This article reviews the main developments in cardiovascular disease prevention reported in recent publications. The prevention of coronary heart disease often begins with the identification of risk factors. Better understanding of emerging risk factors could help to improve risk assessment and increase the efficacy of preventative measures. Lifestyle modification and the introduction of better-tolerated and effective new drugs have been shown to prevent atherosclerosis and prolong survival.
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