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Marçal IR, Vidal-Almela S, Blanchard C, Prince SA, Way KL, Reed JL. Sex Differences in Physical Activity Levels and Sitting Time in Patients With Atrial Fibrillation. J Cardiopulm Rehabil Prev 2024; 44:280-288. [PMID: 38836648 DOI: 10.1097/hcr.0000000000000867] [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: 06/06/2024]
Abstract
PURPOSE While research demonstrates low levels of physical activity (PA) among adults living with atrial fibrillation (AF), there is limited evidence investigating sex differences in moderate to vigorous intensity physical activity (MVPA) and sedentary time in this population. The primary aim was to examine sex differences in MVPA levels and sitting time between women and men with AF. Secondary aims explored sex differences in sociodemographic factors, outcome expectations, and task self-efficacy toward PA levels. METHODS This was a subanalysis of the CHAMPLAIN-AF cohort study. Women and men with AF completed a survey, including the Short-Form International Physical Activity Questionnaire. RESULTS A total of 210 women (median = 66.0 yr: 95% CI, 63.5-68.0) and 409 men (median = 66.0 yr: 95% CI, 64.0-67.0) were included. No sex differences were observed in median weekly MVPA (60 min/wk: 95% CI, 0-120 in women vs 120 min/wk: 95% CI, 85-150 in men) and daily sitting time (5.5 hr/d: 95% CI, 5.0-6.0 in women vs 6.0 hr/d: 95% CI, 5.0-6.0 in men). Women engaged in significantly less vigorous-intensity PA than men ( P = .03) and demonstrated significantly lower task self-efficacy ( P < .01). Significant positive correlations in PA levels with outcome expectations (mostly weak) and task self-efficacy (mostly strong) were observed in both sexes. CONCLUSION Most women and men with AF did not meet the global MVPA guidelines but met the sitting time recommendation. Women presented with lower vigorous-intensity physical activity levels and confidence than men. Strategies to increase physical activity behavior, considering sociodemographic factors and task self-efficacy, are needed and may differ between sexes.
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Affiliation(s)
- Isabela R Marçal
- Author Affiliations: Exercise Physiology and Cardiovascular Health Laboratory, Division of Cardiac Prevention and Rehabilitation, University of Ottawa Heart Institute, (Mss Marçal and Vidal-Almela, and Drs Way and Reed); Faculty of Health Sciences, School of Human Kinetics, University of Ottawa, (Ms Marçal and Dr Reed); Faculty of Medicine, Dalhousie University, Halifax, Canada (Dr Blanchard); Centre for Surveillance and Applied Research, Public Health Agency of Canada, Ottawa, Canada (Dr Prince); Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia (Dr Way); and Faculty of Medicine, School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada (Dr Reed)
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2
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Pearsons A, Hanson CL, Hendriks JM, Neubeck L. Understanding for whom, under what conditions, and how an integrated approach to atrial fibrillation service delivery works: a realist review. Eur J Cardiovasc Nurs 2024; 23:323-336. [PMID: 38165026 DOI: 10.1093/eurjcn/zvad093] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 08/30/2023] [Accepted: 09/05/2023] [Indexed: 01/03/2024]
Abstract
AIMS To understand for whom, under what conditions, and how an integrated approach to atrial fibrillation (AF) service delivery works (or does not work). METHODS AND RESULTS A realist review of integrated approaches to AF service delivery for adult populations aged ≥18 years. An expert panel developed an initial programme theory, searched and screened literature from four databases until October 2022, extracted and synthesized data using realist techniques to create context-mechanism-outcome configurations for integrated approaches to AF service, and developed an integrated approach refined programme theory. A total of 5433 documents were screened and 39 included. The refined programme theory included five context-mechanism-outcome configurations for how clinical and system-wide outcomes are affected by the way integrated approaches to AF service delivery are designed and delivered. This review identifies core mechanisms underpinning the already known fundamental components of integrated care. This includes having a central coordinator responsible for service organization to provide continuity of care across primary and secondary care ensuring services are patient centred. Additionally, a fifth pillar, lifestyle and risk factor reduction, should be recognized within an AF care pathway. CONCLUSION It is evident from our provisional theory that numerous factors need to interlink and interact over time to generate a successfully integrated model of care in AF. Stakeholders should embrace this complexity and acknowledge that the learnings from this review are integral to shaping future service delivery in the face of an aging population and increased prevalence of AF.
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Affiliation(s)
- Alice Pearsons
- School of Health and Social Care, Edinburgh Napier University, Sighthill Campus, Sighthill Court, Edinburgh EH11 4BN, UK
| | - Coral L Hanson
- School of Health and Social Care, Edinburgh Napier University, Sighthill Campus, Sighthill Court, Edinburgh EH11 4BN, UK
| | - Jeroen M Hendriks
- College of Nursing and Health Sciences, Caring Futures Institute, Flinders University, Sturt Road, Bedford Park, SA 5001, Australia
- Centre for Heart Rhythm Disorders, University of Adelaide and Royal Adelaide Hospital, Port Road, Adelaide, SA 5001, Australia
| | - Lis Neubeck
- School of Health and Social Care, Edinburgh Napier University, Sighthill Campus, Sighthill Court, Edinburgh EH11 4BN, UK
- Sydney Nursing School, Charles Perkins Centre, University of Sydney, Johns Hopkins Road, Sydney, NSW 2006, Australia
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3
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Jaramillo AP, Jaramillo L, Briones Andriuoli RR, Revilla JC, Castells J, Ibrahimli S, Villacres JL, Garzon Mora N. The Effectiveness of Ablation Therapy for Atrial Fibrillation: A Systematic Review. Cureus 2023; 15:e43992. [PMID: 37641724 PMCID: PMC10460603 DOI: 10.7759/cureus.43992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/23/2023] [Indexed: 08/31/2023] Open
Abstract
It is expected that the prevalence of atrial fibrillation (AF), the most prevalent cardiac arrhythmia among people aged 65 to 85, would be mostly classified using the CHAS2DS2-VASc approach for anticoagulation therapy. A high number of people in the entire world will be living with AF by 2030. Long-term follow-up data are sparse, although radiofrequency catheter ablation (CA) for symptomatic AF patients has the potential to be a curative therapy. Although women are referred later and less often than men, the outcomes following ablation are comparable across both genders. Health-related quality of life suffers from AF, and patients often find themselves less active as a result of their condition. AF may have a wide variety of symptoms and signs from the clinic's point of view. Women are more likely to exhibit symptoms than men; one reason for this is that women have an average QT interval that is 10-20 milliseconds longer than men, which is more likely to exacerbate tachycardia symptoms. In search of medical databases for relevant medical literature, we looked at PubMed/Medline, the Cochrane Library, and Google Scholar. Ten publications were gathered after the papers were located, assessed, and qualifying criteria applied were used to select them. The finished articles were done to give an overview of the effectiveness of ablation therapy for AF. Some studies showed that there was no statistical significance between invasive and pharmacological treatments. Other research found no difference in the recurrence of atrial arrhythmia between pulmonary vein isolation (PVI) CA alone and PVI + enhancement magnetic resonance imaging (MRI)-guided fibrosis ablation in individuals with persistent AF. The oldest individuals in studies comparing CA to medical treatment for AF demonstrated no improvement in prognosis after CA. Also, complications from therapy and CA's efficacy in preventing future atrial arrhythmias were similarly low across all age groups. Based on the above, we concluded that more studies are required to establish the most effective approach to treating AF to apply it in daily practice and gain more knowledge about it.
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Affiliation(s)
| | - Luisa Jaramillo
- Internal Medicine, Universidad Católica Santiago de Guayaquil, Guayaquil, ECU
| | | | | | - Javier Castells
- Medicine, Universidad Católica Santiago de Guayaquil, Guayaquil, ECU
| | | | - Jossua L Villacres
- Internal Medicine, Universidad Católica Santiago de Guayaquil, Guayaquil, ECU
| | - Neyla Garzon Mora
- Medicine, Universidad Católica Santiago de Guayaquil, Guayaquil, ECU
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4
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Liu H, Brobbey A, Ejaredar M, Lorenzetti D, Sajobi T, Arena R, James MT, Wilton SB. Effect of Multifactorial Risk Factor Interventions on Atrial Fibrillation: A Systematic Review and Meta-Analysis. Curr Probl Cardiol 2023; 48:101572. [PMID: 36584724 DOI: 10.1016/j.cpcardiol.2022.101572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 12/23/2022] [Indexed: 12/29/2022]
Abstract
Evidence supports the benefit of managing atrial fibrillation (AF) specific risk factors in secondary prevention of AF. However, a comprehensive summary of the effect of multifactorial risk factor interventions on outcomes of patients with AF over long-term is lacking. We searched MEDLINE, EMBASE, CINAHL, and Cochrane CENTRAL databases from inception to October 2021 for both randomized controlled trials (RCT) and observational studies comparing multifactorial risk factor interventions to usual care in patients with AF. Fifteen studies (10 RCT, 5 observational) with 3786 patients were included (mean age 63.8 years, 64.0% males). Follow-up ranged from 3 to 42 months. We found no significant effects of multifactorial risk factor interventions on AF recurrence [pooled relative risk (RR): 0.93, 95% CI: 0.74-1.16, P = 0.51, I2 = 54%], AF-related rehospitalization at 12 months (RR: 0.69, 95% CI: 0.43-1.11, P= 0.13, I2 = 0%), cardiovascular rehospitalization at 12 months (RR: 0.76, 95% CI: 0.53-1.09, P= 0.13, I2 = 53%), or AF-related adverse events at 12 and 15 months. However, multifactorial interventions were associated with reduced AF-related symptoms and improved health-related quality of life (HRQoL) at all studied time points. Current evidence does not support consistent associations between multifactorial risk factor interventions and AF recurrence after rhythm control therapy or AF-related or cardiovascular hospitalization in patients with AF. However, these interventions are associated with clinically relevant improvement in AF-related symptoms and HRQoL. Additional randomized studies are required to evaluate the impact of multifactorial risk factor interventions on patient-centered health outcomes.
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Affiliation(s)
- Hongwei Liu
- Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada; Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
| | - Anita Brobbey
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Maede Ejaredar
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Diane Lorenzetti
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada; Health Sciences Library, University of Calgary, Calgary, AB, Canada
| | - Tolulope Sajobi
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Ross Arena
- TotalCardiology(TM) Research Network, Calgary, AB, Canada; Department of Physical Therapy, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL
| | - Matthew T James
- Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada; Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Stephen B Wilton
- Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada; Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada; TotalCardiology(TM) Research Network, Calgary, AB, Canada
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5
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Carnlöf C, Iwarzon M, Jensen-Urstad M, Gadler F, Insulander P. Women with atrial fibrillation undergoing pulmonary vein isolation are more symptomatic but improve more in health-related quality of life and symptom burden than men. SCAND CARDIOVASC J 2022; 56:316-324. [PMID: 35941825 DOI: 10.1080/14017431.2022.2107235] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
Abstract
Gender differences in symptoms and perceived health-related quality of life (HRQOL) in patients with atrial fibrillation (AF) referred to pulmonary vein isolation (PVI) have been reported previously. Women experience a lower HRQOL, faster heart rate, and more symptoms such as palpitation and dyspnea than men. Furthermore, they experience worse physical functioning independently of other heart diseases or age. This study evaluates referral patterns and symptoms, morbidity, functional impairment, and HRQOL from a gender perspective in patients with AF before and 6 months after PVI. The study includes 242 patients (121 men), mean age 62 ± 9 years, referred for PVI. Symptoms were assessed with the Symptom Checklist: Frequency and Severity (SCL), HRQOL with Short Form 36 (SF-36), and the functional impairment with Sickness Impact Profile (SIP). The patients' own experiences of the referral process and history of their disease were evaluated with a supplementary questionnaire. The results showed that women improved more than men in HRQOL, SIP, and SCL 6 months post PVI. There were no sex differences in proportion of paroxysmal and persistent AF or ablation outcome. At baseline, women scored higher than men in both scales of the SCL (p < 0.001), scored lower in all components in SF-36, and scored higher in five categories of the SIP. Women were not more reluctant to accept referral for ablation when offered. The conclusion is that women with AF undergoing PVI are more symptomatic but also improve more in HRQOL and in symptom burden than men.
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Affiliation(s)
- Carina Carnlöf
- Karolinska Institutet and Heart, Vascular & Neurology Theme, Karolinska University Hospital, Stockholm, Sweden
| | - Marie Iwarzon
- Department of Neurobiology, Care Sciences and Society, Huddinge, Sweden
| | - Mats Jensen-Urstad
- Karolinska Institutet and Heart, Vascular & Neurology Theme, Karolinska University Hospital, Stockholm, Sweden
| | - Fredrik Gadler
- Karolinska Institutet and Heart, Vascular & Neurology Theme, Karolinska University Hospital, Stockholm, Sweden
| | - Per Insulander
- Karolinska Institutet and Heart, Vascular & Neurology Theme, Karolinska University Hospital, Stockholm, Sweden
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6
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Bubnova MG, Aronov DM. Atrial Fibrillation: the Association with Physical Activity and the Effects of Cardiac Rehabilitation. RATIONAL PHARMACOTHERAPY IN CARDIOLOGY 2020. [DOI: 10.20996/1819-6446-2020-10-21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The purpose of this review was to present modern studies that examine the relationship of physical activity and risk of atrial fibrillation (AF) development and the impact of cardiac rehabilitation programs in patients with all forms of AF. Data of 52 Russian and foreign scientific sources published in 1998- 2020 were presented. In our study, 48 patients with paroxysmal AF after radiofrequency ablation (RFA) were randomly assigned to a physical rehabilitation/standard therapy or control (standard therapy) group. Aerobic physical training was conducted for 6 months 3 times a week. AF is one of the most common cardiac arrhythmias. Despite modern advances, results of treatment of this disease are far from optimal. Many problems of patients with AF can be addressed through enrolment in multidisciplinary cardiac rehabilitation programs. But this question remains open. This is mainly due to the complexity of selection of physical rehabilitation program for patients with AF. It is known that physical activity can trigger an episode of AF. In the following review article, the approaches to functional capacity assessment of patient with AF are described, recommendations for prescribing safe exercise training to achieve a therapeutic effect are presented. Various aspects of the effects of physical rehabilitation are discussed, including its impact on cardiovascular risk factors, influence on atrial remodeling processes and associated biomarkers, prevention of AF progression and occurrence of cardiovascular complications. Results of our own research indicate effectiveness of physical training in patients with AF after RFA: increase in exercise duration by 18.6% (p<0.001) and load by 24.8% (p<0.01) during exercise test, increase in level of everyday physical activity by 23.8% (p=0.001); left atrium dimensions remain stable comparing with control group. That was combined with a decrease of post ablation atrial arrhythmias: after 6 months, they were registered in 4.5% of trained patients vs 17.4% of control group patients (p<0.01). Steady growth in the number of patients with AF and catheter ablation procedures around the world dictates the need for organization of multi-purpose medical rehabilitation.
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Affiliation(s)
- M. G. Bubnova
- National Medical Research Center for Therapy and Preventive Medicine
| | - D. M. Aronov
- National Medical Research Center for Therapy and Preventive Medicine
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7
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Strømnes LA, Ree H, Gjesdal K, Ariansen I. Sex Differences in Quality of Life in Patients With Atrial Fibrillation: A Systematic Review. J Am Heart Assoc 2020; 8:e010992. [PMID: 30957624 PMCID: PMC6507196 DOI: 10.1161/jaha.118.010992] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background The goal of this literature review was to assess sex differences in the quality of life (QoL) in patients with atrial fibrillation ( AF ) and, if possible, to determine if these are due to AF . Methods and Results The electronic database PubMed was searched on January 23, 2018, using the search terms "QoL", gender differences, " AF " female, and gender to find potential articles that assessed sex differences in QoL in AF patients. In all, 851 articles were identified, from which 25 original studies were eligible for this systematic review. Female AF patients were found to have poorer QoL and more symptoms than male AF patients. They scored lower, predominantly on the physical component score of the Medical Outcomes Study Short-Form 36 Health Survey. Conclusions The available literature consistently describes poorer QoL in female AF patients but does not clearly address whether this is a reflection of sex differences seen in the general population or is related to AF per se. It is also questionable whether the relatively poorer QoL in women is large enough to be of clinical importance.
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Affiliation(s)
| | - Helene Ree
- 1 Faculty of Medicine Oslo University Oslo Norway
| | - Knut Gjesdal
- 2 Institute of Clinical Medicine Oslo University Oslo Norway.,3 Department of Cardiology Oslo University Hospital Ullevål Oslo Norway
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8
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Moons P. Quality-of-life research in the European Journal of Cardiovascular Nursing: A call for more conceptual scrutiny. Eur J Cardiovasc Nurs 2020; 19:373-375. [PMID: 32114797 DOI: 10.1177/1474515120910868] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Philip Moons
- KU Leuven Department of Public Health and Primary Care, KU Leuven, Belgium.,Institute of Health and Care Sciences, University of Gothenburg, Sweden.,Department of Paediatrics and Child Health, University of Cape Town, South Africa
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9
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Thrysoee L, Thorup CB, Rasmussen TB, Borregaard B, Christensen AV, Juel K, Ekholm O, Vamosi M, Banke A, Berg SK. Patient-reported outcomes at hospital discharge among patients with arrhythmia: Results from the national DenHeart survey. Eur J Cardiovasc Nurs 2019; 19:248-259. [PMID: 31744327 DOI: 10.1177/1474515119888813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Patient-reported outcomes are important predictors of mortality, cardiovascular events and hospitalisation in patients with cardiac diseases, but differences in patient-reported outcomes between groups of patients with arrhythmia have not yet been investigated. AIMS To describe and compare patient-reported outcomes at discharge among patients with different types of cardiac arrhythmia and to examine the associations between demographic characteristics, inhospital factors and patient-reported outcomes. METHODS Data were derived from the national DenHeart study including patient-reported outcomes from the following questionnaires: the hospital anxiety and depression scale (HADS), HeartQoL, short form 12 (SF-12), current health status (EQ-5D), brief illness perception questionnaire (B-IPQ) and the Edmonton symptom assessment scale (ESAS). Clinical and demographic data were obtained from national registers. Multiple linear and logistic regression models were used to investigate the associations between the potential risk factors and the patient-reported outcomes. RESULTS A total of 4251 patients diagnosed with arrhythmia completed the questionnaire. Across the arrhythmia subgroups, some differences were observed. In general, patient-reported outcome scores were worst among patients with 'ventricular arrhythmia' (e.g. highest depression scores and highest prevalence of feeling unsafe at discharge). Regression analysis revealed that longer hospital stay, female gender, being unmarried and having a short education were significantly associated with poor health for almost all arrhythmia subgroups. CONCLUSION Differences exist in self-reported health, quality of life and symptom burden across arrhythmia groups with patients with ventricular arrhythmia reporting poorer patient-reported outcomes. Longer hospital stay, female gender, being unmarried and having a low level of education were significantly associated with worse outcomes among the total population.
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Affiliation(s)
- Lars Thrysoee
- Department of Cardiology, Odense University Hospital, Denmark.,Department of Health Sciences, Department of Clinical Research, University of Southern Denmark, Denmark
| | - Charlotte Brun Thorup
- Department of Cardiology and Department of Cardiothoracic Surgery and Clinical Nursing Research Unit, Aalborg University Hospital, Denmark
| | | | - Britt Borregaard
- Department of Health Sciences, Department of Clinical Research, University of Southern Denmark, Denmark.,Department of Cardiothoracic and Vascular Surgery, Odense University Hospital, Denmark
| | | | - Knud Juel
- National Institute of Public Health, University of Southern Denmark, Denmark
| | - Ola Ekholm
- National Institute of Public Health, University of Southern Denmark, Denmark
| | - Marianne Vamosi
- Section for Nursing Department of Public Health, Aarhus University, Department of Cardiology, Aarhus University Hospital, Denmark
| | - Ann Banke
- Department of Cardiology, Odense University Hospital, Denmark.,Department of Health Sciences, Department of Clinical Research, University of Southern Denmark, Denmark
| | - Selina Kikkenborg Berg
- The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Denmark.,National Institute of Public Health, University of Southern Denmark, Denmark
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10
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Tian XT, Xu YJ, Yang YQ. Gender Differences in Arrhythmias: Focused on Atrial Fibrillation. J Cardiovasc Transl Res 2019; 13:85-96. [PMID: 31637585 DOI: 10.1007/s12265-019-09918-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Accepted: 09/20/2019] [Indexed: 01/08/2023]
Abstract
There are significant differences in clinical presentation and treatment of atrial fibrillation (AF) between women and men. The primary goal of AF management is to restore sinus rhythm and to prevent various complications, including stroke and heart failure. In many areas of AF, such as prevalence, clinical manifestations, morbidity, risk factors, pathophysiology, treatment strategies, and complications, gender-specific variability is observed and needs to be further addressed by large-scale population researches or randomized clinical trials, which help to promote the customization of AF treatment programs, hence to maximize the success rate of AF therapy in both sexes. This review highlights our current understanding of these gender differences in AF and how these differences affect treatment decisions on AF.
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Affiliation(s)
- Xiao-Ting Tian
- Department of Cardiology, Cardiovascular Research Laboratory, and Center Laboratory, The Fifth People's Hospital of Shanghai, Fudan University, No. 801 Heqing Road, Shanghai, 200240, China
| | - Ying-Jia Xu
- Department of Cardiology, Cardiovascular Research Laboratory, and Center Laboratory, The Fifth People's Hospital of Shanghai, Fudan University, No. 801 Heqing Road, Shanghai, 200240, China
| | - Yi-Qing Yang
- Department of Cardiology, Cardiovascular Research Laboratory, and Center Laboratory, The Fifth People's Hospital of Shanghai, Fudan University, No. 801 Heqing Road, Shanghai, 200240, China.
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11
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Reed JL, Terada T, Chirico D, Prince SA, Pipe AL. The Effects of Cardiac Rehabilitation in Patients With Atrial Fibrillation: A Systematic Review. Can J Cardiol 2018; 34:S284-S295. [PMID: 30274639 DOI: 10.1016/j.cjca.2018.07.014] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Revised: 07/15/2018] [Accepted: 07/16/2018] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Atrial fibrillation (AF), the most common sustained cardiac arrhythmia, is associated with substantial morbidity and mortality. Clinical guidelines for managing patients with AF do not include a referral to cardiac rehabilitation (CR) at present, although it is routine for most other cardiovascular conditions. The number of studies evaluating the impact of CR on the health of patients with AF is growing, but there has been no consolidation of the findings. The objective of this systematic review was to evaluate the impact of CR programs on physical and mental health outcomes in patients with all forms of AF. METHODS Six electronic databases were searched to identify all studies that reported on the impact of CR in patients with AF. Searching identified 5771 potential articles, of which 12 were included. The physical health outcomes evaluated included cardiometabolic health indicators, aerobic and functional capacity, severity of symptoms, recurrence of AF, hospitalizations, and mortality. The mental health outcomes assessed included quality of life, anxiety, depression, and quality of sleep. RESULTS The limited evidence supports the use of CR to improve cardiometabolic health indicators and aerobic and functional capacity in patients with AF. The current evidence suggests that prominent improvements in aerobic fitness are associated with lower risk of hospitalization and mortality. The conflicting mental health findings may be due to the varying severity of AF and or modes of exercise interventions. CONCLUSIONS Gaps in the research identified the need for greater rigor in the reporting of intervention details, outcomes, and statistical methodology; sex- and gender-based analyses; and effectiveness trials. This review serves as a call to action for more work globally on this important area.
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Affiliation(s)
- Jennifer L Reed
- Exercise Physiology and Cardiovascular Health Lab, University of Ottawa Heart Institute, Ottawa, Ontario, Canada; Division of Cardiac Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, Ontario, Canada; University of Ottawa, Faculty of Medicine, Ottawa, Ontario, Canada; School of Human Kinetics, Faculty of Health Sciences, University of Ottawa, Ontario, Canada.
| | - Tasuku Terada
- Exercise Physiology and Cardiovascular Health Lab, University of Ottawa Heart Institute, Ottawa, Ontario, Canada; Division of Cardiac Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Daniele Chirico
- Exercise Physiology and Cardiovascular Health Lab, University of Ottawa Heart Institute, Ottawa, Ontario, Canada; Division of Cardiac Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Stephanie A Prince
- Division of Cardiac Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Andrew L Pipe
- Division of Cardiac Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, Ontario, Canada; University of Ottawa, Faculty of Medicine, Ottawa, Ontario, Canada
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12
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Mohanty S, Trivedi C, Gianni C, Natale A. Gender specific considerations in atrial fibrillation treatment: a review. Expert Opin Pharmacother 2018; 19:365-374. [DOI: 10.1080/14656566.2018.1434144] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Affiliation(s)
- Sanghamitra Mohanty
- Texas Cardiac Arrhythmia Institute, St. David’s Medical Center, Austin, TX, USA
- Department of Internal Medicine, Dell Medical School, Austin, TX, USA
| | - Chintan Trivedi
- Texas Cardiac Arrhythmia Institute, St. David’s Medical Center, Austin, TX, USA
| | - Carola Gianni
- Texas Cardiac Arrhythmia Institute, St. David’s Medical Center, Austin, TX, USA
| | - Andrea Natale
- Texas Cardiac Arrhythmia Institute, St. David’s Medical Center, Austin, TX, USA
- Department of Internal Medicine, Dell Medical School, Austin, TX, USA
- Electrophysiology and Arrhythmia Services, California Pacific Medical Center, San Francisco, CA, USA
- Metro Health Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA
- Division of Cardiology, Stanford University, Stanford, CA, USA
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