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Hosseinpour A, Azami P, Hosseinpour H, Attar A, Koushkie Jahromi M. Efficacy of exercise training-based cardiac rehabilitation programmes after transcatheter aortic valve implantation: A systematic review and meta-analysis. INTERNATIONAL JOURNAL OF CARDIOLOGY. CARDIOVASCULAR RISK AND PREVENTION 2024; 20:200238. [PMID: 38322761 PMCID: PMC10844670 DOI: 10.1016/j.ijcrp.2024.200238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 01/18/2024] [Indexed: 02/08/2024]
Abstract
Background The beneficial effects of exercise training-based cardiac rehabilitation (CR) in different cardiac conditions have been previously studied. In this meta-analysis, we focused on the potential impact of CR on patients undergoing transcatheter aortic valve implantation (TAVI). Methods Multiple databases were searched in a systematic approach to find the eligible studies. All the studies investigating the potential impact of exercise training-based CR programmes on exercise capacity and health-related quality of life in patients undergoing TAVI were retrieved. The primary endpoint of interest was 6-min walk test (6MWT). The pooled standardized mean difference (SMD) and 95 % confidence interval (CI) were measured to compare the improvement or worsening the endpoints using a random- or fixed-effects model, as appropriate. Results A total of eleven studies (685 patients) were considered eligible for quantitative synthesis. The results showed that performing exercise training-based CR after TAVI is associated with significant improvement in 6MWT (SMD 0.59, 95 % CI (0.48; 0.71), p < 0.01), Barthel index (SMD 0.73, 95 % CI (0.57; 0.89), p < 0.01), 12-item Short Form (SF-12) physical (SMD 0.30, 95 % CI (0.08; 0.52), p < 0.01) and mental (SMD 0.27, 95 % CI (0.05; 0.49), p = 0.02) survey scores, and hospital anxiety and depression scale - depression (HADS-D) score (SMD -0.26, 95 % CI (-0.42; -0.10), p < 0.01). Conclusion Performing exercise training-based CR following TAVI has significant benefits regarding physical capacity and health-related quality of life irrespective of the programme duration.
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Affiliation(s)
- Alireza Hosseinpour
- Department of Cardiovascular Medicine, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
- School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Pouria Azami
- Department of Cardiovascular Medicine, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
- School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Armin Attar
- Department of Cardiovascular Medicine, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
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Masule LS, Amakali K, Wilkinson WE. Nurses' knowledge, attitudes, and practices about rehabilitation of patients after heart valve surgery in Namibia. Health SA 2024; 29:2396. [PMID: 38322374 PMCID: PMC10839222 DOI: 10.4102/hsag.v29i0.2396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 11/08/2023] [Indexed: 02/08/2024] Open
Abstract
Background A cardiac rehabilitation programme is a medically supervised intervention to assist patients in recovery after heart surgeries and to prevent potential complications. Nurses should have the knowledge, a positive attitudes, and good practices to improve patient quality of life during the recovery process. Aim This study aimed to describe the knowledge, attitudes, and practices of the nurses regarding cardiac rehabilitation for patients after heart valve surgery. Setting The study setting was Windhoek Central Hospital, Cardiac Unit, in Windhoek, Namibia. Methods A quantitative and descriptive research design was used for convenient non-probability sampling of (N = 23) nurses who consented to participate in the study. Data were collected through self-administered questionnaires and analyzed using SPSS Version 26. Descriptive statistics were used and Fischer's Exact test for associations of variables was performed. Results The study results showed a high level of knowledge, good attitudes, and poor to fair practices toward cardiac rehabilitation. However, the respondents demonstrate a lack of knowledge about the indications, and benefits of cardiac rehabilitation, negative attitudes regarding counselling of patients on sexual activities, and poor practice regarding exercises and counseling of patients and caregivers on cardiac rehabilitation. Furthermore, there is a positive relationship between the respondents' older age, senior rank, and having been trained I cardiac conditions and their knowledge, attitudes and practices regarding some core components of cardiac rehabilitation with P-value < 0.050. Conclusion There is a need for a cardiac rehabilitation programme to improve nurses' attitudes and practices toward cardiac rehabilitation. Contribution Understanding the gap in knowledge, attitudes, and practices among the nurses regarding cardiac rehabilitation would guide the Ministry of Health and Social Services (MoHSS) in the implementation of the cardiac rehabilitation for patients after heart valve surgery.
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Affiliation(s)
- Lilian S Masule
- Department of General Nursing Science, Faculty of Health Sciences and Veterinary Medicine, University of Namibia, Windhoek, Namibia
| | - Kristofina Amakali
- Department of General Nursing Science, Faculty of Health Sciences and Veterinary Medicine, University of Namibia, Windhoek, Namibia
| | - Wilma E Wilkinson
- Department of General Nursing Science, Faculty of Health Sciences and Veterinary Medicine, School of Nursing and Public Health, University of Namibia, Windhoek, Namibia
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Suen WL, Bhasin S, Betti V, Bruckel JT, Oldham MA. Mental health and transcatheter aortic valve replacement: A scoping systematic review. Gen Hosp Psychiatry 2024; 86:10-23. [PMID: 38043178 PMCID: PMC10842766 DOI: 10.1016/j.genhosppsych.2023.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 11/22/2023] [Accepted: 11/23/2023] [Indexed: 12/05/2023]
Abstract
OBJECTIVE To systematically review the literature on mental health symptoms before and after transcatheter aortic valve replacement (TAVR) and describe reported clinical associations with these symptoms. METHODS Using the Preferred Reporting Items for Systematic reviews and Meta-Analysis extension for Scoping Reviews (PRISMA-ScR) guidelines, we reviewed studies involving pre- or post-TAVR mental health assessments or psychiatric diagnoses. RESULTS Eighteen studies were included. Before TAVR, clinically significant depression and anxiety prevalence is 15-30% and 25-30%, respectively, with only a third of these meeting diagnostic thresholds. These symptoms generally improve over the year post-TAVR. Depression is associated with functional impairment, multimorbidity, and lower physical activity; few associations have been described in relation to anxiety. Inconsistent evidence finds depression associated with post-TAVR mortality. One notable study found persistent depression independently predictive of 12-month mortality, and another found depression and cognition to have additive value in predicting mortality risk. CONCLUSIONS Mental health symptoms occur in a significant proportion of the TAVR population. Although symptoms tend to improve, the associations with depression, particularly persistent depression, call for further investigation to examine their associated outcomes. Research is also needed to understand the relationships between mental health conditions and cognition in TAVR-related outcomes.
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Affiliation(s)
- Wei-Li Suen
- Department of Psychiatry, University of Rochester Medical Center, USA
| | - Shreya Bhasin
- School of Medicine & Dentistry, University of Rochester Medical Center, USA
| | - Vincent Betti
- School of Medicine & Dentistry, University of Rochester Medical Center, USA
| | | | - Mark A Oldham
- Department of Psychiatry, University of Rochester Medical Center, USA.
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Oz A, Tsoumas I, Lampropoulos K, Xanthos T, Karpettas N, Papadopoulos D. Cardiac Rehabilitation After TAVI -A Systematic Review and Meta-Analysis. Curr Probl Cardiol 2023; 48:101531. [PMID: 36493915 DOI: 10.1016/j.cpcardiol.2022.101531] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Accepted: 12/01/2022] [Indexed: 12/12/2022]
Abstract
Despite the increasing popularity of Transcatheter aortic valve implantation (TAVI) in patients with high surgical risk, there is no current guideline for the management of patients following the intervention. This systematic review and meta-analysis aims to summarize and analyse all clinical data and evidence regarding the effectiveness and outcomes of CR following TAVI. The first meta-analysis measured the walked distance in the Six-Minute Walk Test (6MWT) and the second meta-analysis included studies that showed the Barthel Index (BI) before and after CR. The mean distance walked prior to CR was 235.88 ± 69.36 m increased to 292.12 ± 54.92 m after rehabilitation, signifying a moderate clinically relevant effect size (0.593 (0.42, 0.76); P=0.00). The mean BI score before CR was 76.6 ± 11.5 which increased to 89.8 ± 5.5 after the programme and similarly demonstrated a significant standardized mean improvement (0.75 (0.57, 0.93); I= 0.00). Exercise-based CR in patients with aortic stenosis treated with TAVI demonstrated a significant improvement in exercise tolerance and functional independence shown by the 6MWT and BI.
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Affiliation(s)
- Asena Oz
- European University Cyprus, School of medicine, Nicosia, Cyprus.
| | - Ioannis Tsoumas
- European University Cyprus, School of medicine, Nicosia, Cyprus
| | | | | | - Nikos Karpettas
- European University Cyprus, School of medicine, Nicosia, Cyprus
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Valente CJ, Chiuzan C, Alreshq R, Blot T, Fine D, Helmke S, Rodriguez C, Sabogal N, Teruya S, Winburn M, Kurian D, Raiszadeh F, Maurer MS, Ruberg FL. Physical Performance in Black and Hispanic Outpatients with Heart Failure: The SCAN-MP Study. CJC Open 2022; 5:292-302. [PMID: 37124967 PMCID: PMC10140745 DOI: 10.1016/j.cjco.2022.12.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 12/21/2022] [Indexed: 12/28/2022] Open
Abstract
Background Deficits of physical function are associated with poor quality of life and adverse health outcomes, but data informing the association of these assessments among Black and Hispanic outpatients with heart failure (HF) are limited. Methods The multicentre, prospective Screening for Cardiac Amyloidosis With Nuclear Imaging for Minority Populations (SCAN-MP) study identified Black and Hispanic subjects with stable HF, collected baseline characteristics, and took measures using the short physical performance battery. Subjects completed a Kansas City Cardiomyopathy Questionnaire (KCCQ), and the clinical outcomes of HF hospitalization and death were ascertained by telephone and review of the electronic health record. Results Of 320 participants, 227 (70.9%) had physical deficits, defined by a battery score of ≤ 9. Patients with severe physical deficits reported overall lower KCCQ scores compared to those with no deficits (KCCQ score of 57.0 vs 72.4, P < 0.001). Physical limitation was significantly associated with risk of HF hospitalization, after adjustments for age, sex, and New York Heart Association class (severe physical deficit hazard ratio, 3.61; 95% confidence interval [CI], 1.19-10.93; P = 0.024; mild physical deficit hazard ratio, 2.59; 95% CI, 0.86-7.75; P = 0.090). Conclusions Reduced physical performance is highly prevalent among Black and Hispanic outpatients with HF, and it is associated with overall KCCQ score, as well as an increased risk for HF hospitalization.
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Thorup CB, Villadsen A, Andreasen JJ, Aarøe J, Andreasen J, Brocki BC. Patient and health professional perspectives on participations in a feasibility study on exercise-based cardiac telerehabilitation after transcatheter aortic valve implantation: A qualitative study. (Preprint). JMIR Form Res 2022; 6:e35365. [PMID: 35723925 PMCID: PMC9253976 DOI: 10.2196/35365] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 04/29/2022] [Accepted: 05/16/2022] [Indexed: 11/23/2022] Open
Abstract
Background Aortic valve stenosis affects approximately half of people aged ≥85 years, and the recommended surgical treatment for older patients is transcatheter aortic valve implantation (TAVI). Despite strong evidence for its advantages, low attendance rate in cardiac rehabilitation is observed among patients after TAVI. Cardiac telerehabilitation (CTR) has proven comparable with center-based rehabilitation; however, no study has investigated CTR targeting patients after TAVI. On the basis of participatory design, an exercise-based CTR program (TeleTAVI) was developed, which included a web-based session with a cardiac nurse, a tablet containing an informative website, an activity tracker, and supervised home-based exercise sessions that follow the national recommendations for cardiac rehabilitation. Objective This study aims to explore patients’ and health professionals’ experiences with using health technologies and participating in the exercise-based CTR program, TeleTAVI. Methods This study is a part of a feasibility study and will only report patients’ and health professionals’ experiences of being a part of TeleTAVI. A total of 11 qualitative interviews were conducted using a semistructured interview guide (n=7, 64% patients and n=4, 36% health professionals). Patient interviews were conducted after 8 weeks of participation in TeleTAVI, and interviews with health professionals were conducted after the end of the program. The analysis was conducted as inductive content analysis to create a condensed meaning presented as themes. Results Reticence toward using the website was evident with reduced curiosity to explore it, and reduced benefit from using the activity tracker was observed, as the patients’ technical competencies were challenged. This was also found when using the tablet for web-based training sessions, leading to patients feeling worried before the training, as they anticipated technical problems. Disadvantages of the TeleTAVI program were technical problems and inability to use hands-on guidance with the patients. However, both physiotherapists and patients reported a feeling of improvement in patients’ physical fitness. The home training created a feeling of safety, supported adherence, and made individualization possible, which the patients valued. A good relationship and continuity in the contact with health professionals seemed very important for the patients and affected their positive attitude toward the program. Conclusions The home-based nature of the TeleTAVI program seems to provide the opportunity to support individualization, autonomy, independence, and adherence to physical training in addition to improvement in physical capability in older patients. Despite technological challenges, basing the relationship between the health professionals and patients on continuity may be beneficial for patients. Prehabilitation may also be considered, as it may create familiarity toward technology and adherence to the training.
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Affiliation(s)
- Charlotte Brun Thorup
- Department of Cardiothoracic Surgery, Aalborg University Hospital, Aalborg, Denmark
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | - Anne Villadsen
- Department of Sociology and Social Work, Aalborg University, Aalborg, Denmark
| | - Jan Jesper Andreasen
- Department of Cardiothoracic Surgery, Aalborg University Hospital, Aalborg, Denmark
- Clinical Institute, Aalborg University, Aalborg, Denmark
| | - Jens Aarøe
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | - Jane Andreasen
- Department of Physiotherapy and Occupational Therapy, Aalborg University Hospital, Aalborg, Denmark
- Public Health and Epidemiology Group, Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - Barbara Cristina Brocki
- Department of Physiotherapy and Occupational Therapy, Aalborg University Hospital, Aalborg, Denmark
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Interventions for Frailty Among Older Adults With Cardiovascular Disease: JACC State-of-the-Art Review. J Am Coll Cardiol 2022; 79:482-503. [PMID: 35115105 PMCID: PMC8852369 DOI: 10.1016/j.jacc.2021.11.029] [Citation(s) in RCA: 136] [Impact Index Per Article: 68.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 11/03/2021] [Indexed: 12/15/2022]
Abstract
With the aging of the world's population, a large proportion of patients seen in cardiovascular practice are older adults, but many patients also exhibit signs of physical frailty. Cardiovascular disease and frailty are interdependent and have the same physiological underpinning that predisposes to the progression of both disease processes. Frailty can be defined as a phenomenon of increased vulnerability to stressors due to decreased physiological reserves in older patients and thus leads to poor clinical outcomes after cardiovascular insults. There are various pathophysiologic mechanisms for the development of frailty: cognitive decline, physical inactivity, poor nutrition, and lack of social supports; these risk factors provide opportunity for various types of interventions that aim to prevent, improve, or reverse the development of frailty syndrome in the context of cardiovascular disease. There is no compelling study demonstrating a successful intervention to improve a global measure of frailty. Emerging data from patients admitted with heart failure indicate that interventions associated with positive outcomes on frailty and physical function are multidimensional and include tailored cardiac rehabilitation. Contemporary cardiovascular practice should actively identify patients with physical frailty who could benefit from frailty interventions and aim to deliver these therapies in a patient-centered model to optimize quality of life, particularly after cardiovascular interventions.
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The Impact of Cardiac Rehabilitation on the Level of Anxiety and Symptoms of Depression in Patients after Coronary Revascularization. POSTEP HIG MED DOSW 2021. [DOI: 10.2478/ahem-2021-0048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
Introduction
The coexistence of depression and anxiety disorder significantly worsens the results of treatment and increases the risk of recurrent cardiovascular incidents.
The aim of the study was to assess the impact of cardiac rehabilitation on anxiety and depression symptoms in patients after interventional cardiology or coronary artery bypass graft (CABG).
Material and Methods
The study enrolled 40 participants aged 70.75±7.38 years, treated interventionally for ACS or undergoing urgent coronary artery bypass graft (CABG). Patients participated in 3-week stationary early cardiac rehabilitation. At the beginning and end of the study, the Beck Depression Inventory (BDI) and Spielberger’s State-Trait Anxiety Inventory (STAI) were performed.
Results
92.5% of subjects had at least one comorbidity, mostly hypertension (67.5%) and heart failure (60.0%). At the beginning the BDI level was 14.55±6.47; depression symptoms were present in 65% of subjects. At the end, BDI decreased significantly to 8.28±5.26; p<0.001. BDI was statistically significantly higher at the beginning and end in women than in men (17.94±7.07 vs. 11.78±4.40; p<0.05 and 10.56±5.90 vs. 6.41±3.88; p<0.01). Persons before rehabilitation were characterized by medium and low levels of STAI-X1 anxiety (31.80±7.24 and STAI-X2: 35.98±8.29). Finally, anxiety decreased statistically significantly to 26.40±6.30 and 29.80±6.57; p<0.001. At the beginning and end, it strongly correlated positively with the severity of depressive symptoms (STAI-X1 R=0.76; p<0.001, STAI-X2 R=0.70; p<0.001 and R=0.76; p<0.001, R=0.70; p<0.001).
Conclusions
Cardiac rehabilitation contributes significantly to reducing anxiety levels and reducing symptoms of depression. Implementation of these interventions as soon as possible brings the best results, contributing to reducing the risk of coronary events.
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Yu Z, Zhao Q, Ye Y, Wang M, Zhou Z, Zhang H, Zhao Z, Liu Q, Zhang Z, Wu Y, Xu H. Comprehensive Geriatric Assessment and Exercise Capacity in Cardiac Rehabilitation for Patients Referred to Transcatheter Aortic Valve Implantation. Am J Cardiol 2021; 158:98-103. [PMID: 34465453 DOI: 10.1016/j.amjcard.2021.07.045] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 07/22/2021] [Accepted: 07/26/2021] [Indexed: 10/20/2022]
Abstract
Comprehensive geriatric assessment (CGA)-based cardiac rehabilitation (CR) program is essential for patients before and after transcatheter aortic valve implantation (TAVI). This study aimed to explore the values of CGA and exercise capacity in CR for patients referred to TAVI. A retrospective analysis was conducted in 90 patients referred to TAVI from January to October 2019. CR strategies started before TAVI. The association between clinical characteristics, CGA, and change in six-minute walk distance (Δ6MWD) was analyzed with multivariate regression models. Most of patients had cognitive impairment (50%), malnutrition (61%), and frailty (83%). After the CR, the proportion of cognitive impairment, malnutrition, and frail patients was significantly decreased by 21%, 40%, and 57%, respectively (p = 0.002, p <0.001, p <0.001). The 6MWD at a month after discharge (291.9 ± 98.8 m) was significantly improved than that at discharge after TAVI (218.8 ± 114.3m, p <0.001). The multivariate regression analysis indicated body mass index (BMI; Δ6MWD:12.0, 95% confidence interval [CI] 0.3 to 23.8, p = 0.045), frailty (Δ6MWD: -57.9, 95% CI -81.8 to -34.1, p <0.001) and malnutrition (Δ6MWD: -25.1, 95% CI -47.0 to -3.2, p = 0.026) as the associated predictors of Δ6MWD. In conclusion, functional status in patients referred to TAVI could be improved by CGA-based CR. BMI, frailty, and malnutrition were associated with the efficacy of CR on exercise capacity. CGA can play the important role in the evaluation and making strategies for CR in patients.
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Rauch B, Salzwedel A, Bjarnason-Wehrens B, Albus C, Meng K, Schmid JP, Benzer W, Hackbusch M, Jensen K, Schwaab B, Altenberger J, Benjamin N, Bestehorn K, Bongarth C, Dörr G, Eichler S, Einwang HP, Falk J, Glatz J, Gielen S, Grilli M, Grünig E, Guha M, Hermann M, Hoberg E, Höfer S, Kaemmerer H, Ladwig KH, Mayer-Berger W, Metzendorf MI, Nebel R, Neidenbach RC, Niebauer J, Nixdorff U, Oberhoffer R, Reibis R, Reiss N, Saure D, Schlitt A, Völler H, von Känel R, Weinbrenner S, Westphal R. Cardiac Rehabilitation in German Speaking Countries of Europe-Evidence-Based Guidelines from Germany, Austria and Switzerland LLKardReha-DACH-Part 1. J Clin Med 2021; 10:2192. [PMID: 34069561 PMCID: PMC8161282 DOI: 10.3390/jcm10102192] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Revised: 03/20/2021] [Accepted: 03/23/2021] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Although cardiovascular rehabilitation (CR) is well accepted in general, CR-attendance and delivery still considerably vary between the European countries. Moreover, clinical and prognostic effects of CR are not well established for a variety of cardiovascular diseases. METHODS The guidelines address all aspects of CR including indications, contents and delivery. By processing the guidelines, every step was externally supervised and moderated by independent members of the "Association of the Scientific Medical Societies in Germany" (AWMF). Four meta-analyses were performed to evaluate the prognostic effect of CR after acute coronary syndrome (ACS), after coronary bypass grafting (CABG), in patients with severe chronic systolic heart failure (HFrEF), and to define the effect of psychological interventions during CR. All other indications for CR-delivery were based on a predefined semi-structured literature search and recommendations were established by a formal consenting process including all medical societies involved in guideline generation. RESULTS Multidisciplinary CR is associated with a significant reduction in all-cause mortality in patients after ACS and after CABG, whereas HFrEF-patients (left ventricular ejection fraction <40%) especially benefit in terms of exercise capacity and health-related quality of life. Patients with other cardiovascular diseases also benefit from CR-participation, but the scientific evidence is less clear. There is increasing evidence that the beneficial effect of CR strongly depends on "treatment intensity" including medical supervision, treatment of cardiovascular risk factors, information and education, and a minimum of individually adapted exercise volume. Additional psychologic interventions should be performed on the basis of individual needs. CONCLUSIONS These guidelines reinforce the substantial benefit of CR in specific clinical indications, but also describe remaining deficits in CR-delivery in clinical practice as well as in CR-science with respect to methodology and presentation.
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Affiliation(s)
- Bernhard Rauch
- Institut für Herzinfarktforschung Ludwigshafen, D-67063 Ludwigshafen, Germany
- Zentrum für Ambulante Rehabilitation, ZAR Trier GmbH, D-54292 Trier, Germany
| | - Annett Salzwedel
- Department of Rehabilitation Medicine, Faculty of Health Sciences Brandenburg, University of Potsdam, D-14469 Potsdam, Germany; (A.S.); (S.E.); (H.V.)
| | - Birna Bjarnason-Wehrens
- Institut für Kreislaufforschung und Sportmedizin, Abt. Präventive und rehabilitative Sport- und Leistungsmedizin, Deutsche Sporthochschule Köln, D-50937 Köln, Germany;
| | - Christian Albus
- Department of Psychosomatics and Psychotherapy, Faculty of Medicine, University Hospital, D-50937 Köln, Germany;
| | - Karin Meng
- Institut für Klinische Epidemiologie und Biometrie (IKE-B), Universität Würzburg, D-97078 Würzburg, Germany;
| | | | | | - Matthes Hackbusch
- Institute of Medical Biometry and Informatics (IMBI), University of Heidelberg, D-69120 Heidelberg, Germany; (M.H.); (K.J.); (D.S.)
| | - Katrin Jensen
- Institute of Medical Biometry and Informatics (IMBI), University of Heidelberg, D-69120 Heidelberg, Germany; (M.H.); (K.J.); (D.S.)
| | - Bernhard Schwaab
- Curschmann Klinik Dr. Guth GmbH & Co KG, D-23669 Timmendorfer Strand, Germany;
| | | | - Nicola Benjamin
- Zentrum für Pulmonale Hypertonie, Thorax-Klinik am Universitätsklinikum Heidelberg, D-69126 Heidelberg, Germany; (N.B.); (E.G.)
| | - Kurt Bestehorn
- Institut für Klinische Pharmakologie, Technische Universität Dresden, Fiedlerstraße 42, D-01307 Dresden, Germany;
| | - Christa Bongarth
- Klinik Höhenried gGmbH, Rehabilitationszentrum am Starnberger See, D-82347 Bernried, Germany; (C.B.); (H.-P.E.)
| | - Gesine Dörr
- Alexianer St. Josefs-Krankenhaus Potsdam-Sanssouci, D-14471 Potsdam, Germany;
| | - Sarah Eichler
- Department of Rehabilitation Medicine, Faculty of Health Sciences Brandenburg, University of Potsdam, D-14469 Potsdam, Germany; (A.S.); (S.E.); (H.V.)
| | - Hans-Peter Einwang
- Klinik Höhenried gGmbH, Rehabilitationszentrum am Starnberger See, D-82347 Bernried, Germany; (C.B.); (H.-P.E.)
| | - Johannes Falk
- Deutsche Rentenversicherung Bund (DRV-Bund), D-10709 Berlin, Germany; (J.F.); (S.W.)
| | - Johannes Glatz
- Reha-Zentrum Seehof der Deutschen Rentenversicherung Bund, D-14513 Teltow, Germany;
| | - Stephan Gielen
- Klinikum Lippe, Standort Detmold, D-32756 Detmold, Germany;
| | - Maurizio Grilli
- Universitätsbibliothek, Universitätsmedizin Mannheim, D-68167 Mannheim, Germany;
| | - Ekkehard Grünig
- Zentrum für Pulmonale Hypertonie, Thorax-Klinik am Universitätsklinikum Heidelberg, D-69126 Heidelberg, Germany; (N.B.); (E.G.)
| | - Manju Guha
- Reha-Zentrum am Sendesaal, D-28329 Bremen, Germany;
| | - Matthias Hermann
- Klinik für Kardiologie, Universitätsspital Zürich, Rämistrasse 100, CH-8091 Zürich, Switzerland;
| | - Eike Hoberg
- Wismarstraße 13, D-24226 Heikendorf, Germany;
| | - Stefan Höfer
- Universitätsklinik für Medizinische Psychologie und Psychotherapie, Medizinische Universität Innsbruck, A-6020 Innsbruck, Austria;
| | - Harald Kaemmerer
- Klinik für Angeborene Herzfehler und Kinderkardiologie, Deutsches Herzzentrum München, Klinik der Technischen Universität München, D-80636 München, Germany;
| | - Karl-Heinz Ladwig
- Department of Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar, Technische Universität München (TUM) Langerstraße 3, D-81675 Munich, Germany;
| | - Wolfgang Mayer-Berger
- Klinik Roderbirken der Deutschen Rentenversicherung Rheinland, D-42799 Leichlingen, Germany;
| | - Maria-Inti Metzendorf
- Cochrane Metabolic and Endocrine Disorders Group, Institute of General Practice (ifam), Medical Faculty of the Heinrich-Heine University, Werdener Straße. 4, D-40227 Düsseldorf, Germany;
| | - Roland Nebel
- Hermann-Albrecht-Klinik METTNAU, Medizinische Reha-Einrichtungen der Stadt Radolfzell, D-73851 Radolfzell, Germany;
| | - Rhoia Clara Neidenbach
- Institut für Sportwissenschaft, Universität Wien, Auf der Schmelz 6 (USZ I), AU-1150 Wien, Austria;
| | - Josef Niebauer
- Universitätsinstitut für Präventive und Rehabilitative Sportmedizin, Uniklinikum Salzburg Paracelsus Medizinische Privatuniversität, A-5020 Salzburg, Austria;
| | - Uwe Nixdorff
- EPC GmbH, European Prevention Center, Medical Center Düsseldorf, D-40235 Düsseldorf, Germany;
| | - Renate Oberhoffer
- Lehrstuhl für Präventive Pädiatrie, Fakultät für Sport- und Gesundheitswissenschaften, Technische Universität München, D-80992 München, Germany;
| | - Rona Reibis
- Kardiologische Gemeinschaftspraxis Am Park Sanssouci, D-14471 Potsdam, Germany;
| | - Nils Reiss
- Schüchtermann-Schiller’sche Kliniken, Ulmenallee 5-12, D-49214 Bad Rothenfelde, Germany;
| | - Daniel Saure
- Institute of Medical Biometry and Informatics (IMBI), University of Heidelberg, D-69120 Heidelberg, Germany; (M.H.); (K.J.); (D.S.)
| | - Axel Schlitt
- Paracelsus Harz-Klinik Bad Suderode GmbH, D-06485 Quedlinburg, Germany;
| | - Heinz Völler
- Department of Rehabilitation Medicine, Faculty of Health Sciences Brandenburg, University of Potsdam, D-14469 Potsdam, Germany; (A.S.); (S.E.); (H.V.)
- Klinik am See, D-15562 Rüdersdorf, Germany
| | - Roland von Känel
- Klinik für Konsiliarpsychiatrie und Psychosomatik, Universitätsspital Zürich, CH-8091 Zürich, Switzerland;
| | - Susanne Weinbrenner
- Deutsche Rentenversicherung Bund (DRV-Bund), D-10709 Berlin, Germany; (J.F.); (S.W.)
| | - Ronja Westphal
- Herzzentrum Segeberger Kliniken, D-23795 Bad Segeberg, Germany;
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11
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Sperlongano S, Renon F, Bigazzi MC, Sperlongano R, Cimmino G, D’Andrea A, Golino P. Transcatheter Aortic Valve Implantation: The New Challenges of Cardiac Rehabilitation. J Clin Med 2021; 10:jcm10040810. [PMID: 33671340 PMCID: PMC7922533 DOI: 10.3390/jcm10040810] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 02/04/2021] [Accepted: 02/09/2021] [Indexed: 12/13/2022] Open
Abstract
Transcatheter aortic valve implantation (TAVI) is an increasingly widespread percutaneous intervention of aortic valve replacement (AVR). The target population for TAVI is mainly composed of elderly, frail patients with severe aortic stenosis (AS), multiple comorbidities, and high perioperative mortality risk for surgical AVR (sAVR). These vulnerable patients could benefit from cardiac rehabilitation (CR) programs after percutaneous intervention. To date, no major guidelines currently recommend CR after TAVI. However, emerging scientific evidence shows that CR in patients undergoing TAVI is safe, and improves exercise tolerance and quality of life. Moreover, preliminary data prove that a CR program after TAVI has the potential to reduce mortality during follow-up, even if randomized clinical trials are needed for confirmation. The present review article provides an overview of all scientific evidence concerning the potential beneficial effects of CR after TAVI, and suggests possible fields of research to improve cardiac care after TAVI.
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Affiliation(s)
- Simona Sperlongano
- Department of Translational Medical Sciences, Division of Cardiology, University of Campania Luigi Vanvitelli, Monaldi Hospital, 80131 Naples, Italy; (F.R.); (M.C.B.); (G.C.); (P.G.)
- Correspondence: ; Tel.: +39-0817065185 or +39-0817064149
| | - Francesca Renon
- Department of Translational Medical Sciences, Division of Cardiology, University of Campania Luigi Vanvitelli, Monaldi Hospital, 80131 Naples, Italy; (F.R.); (M.C.B.); (G.C.); (P.G.)
| | - Maurizio Cappelli Bigazzi
- Department of Translational Medical Sciences, Division of Cardiology, University of Campania Luigi Vanvitelli, Monaldi Hospital, 80131 Naples, Italy; (F.R.); (M.C.B.); (G.C.); (P.G.)
| | - Rossella Sperlongano
- Department of Experimental Sciences, University of Campania Luigi Vanvitelli, 80138 Naples, Italy;
| | - Giovanni Cimmino
- Department of Translational Medical Sciences, Division of Cardiology, University of Campania Luigi Vanvitelli, Monaldi Hospital, 80131 Naples, Italy; (F.R.); (M.C.B.); (G.C.); (P.G.)
| | - Antonello D’Andrea
- Department of Cardiology and Intensive Coronary Care, Umberto I Hospital, 84014 Nocera Inferiore, Italy;
| | - Paolo Golino
- Department of Translational Medical Sciences, Division of Cardiology, University of Campania Luigi Vanvitelli, Monaldi Hospital, 80131 Naples, Italy; (F.R.); (M.C.B.); (G.C.); (P.G.)
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12
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Tamulevičiūtė-Prascienė E, Beigienė A, Thompson MJ, Balnė K, Kubilius R, Bjarnason-Wehrens B. The impact of additional resistance and balance training in exercise-based cardiac rehabilitation in older patients after valve surgery or intervention: randomized control trial. BMC Geriatr 2021; 21:23. [PMID: 33413144 PMCID: PMC7792183 DOI: 10.1186/s12877-020-01964-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 12/15/2020] [Indexed: 01/14/2023] Open
Abstract
Background To evaluate the short- and mid-term effect of a specially tailored resistance and balance training provided in addition to usual cardiac rehabilitation (CR) care program in older patients after valve surgery/intervention. Methods Single-center (inpatient CR clinic in Lithuania) randomized controlled trial. Two hundred fifty-two patients were assessed for eligibility on the first day of admittance to CR early after (14.5 ± 5.9 days) valve surgery/intervention between January 2018 and November 2019. Participants were coded centrally in accordance with randomization 1:1 using a computerized list. Control group (CG) patients were provided with usual care phase-II-CR inpatient multidisciplinary CR program, while intervention group (IG) patients received additional resistance and balance training (3 d/wk). Patients participated in a 3-month follow-up. Main outcome measures were functional capacity (6 min walk test (6MWT, meters), cardiopulmonary exercise testing), physical performance (Short Physical Performance Battery (SPPB, score) and 5-m walk test (5MWT, meters/second)), strength (one repetition maximum test for leg press), physical frailty (SPPB, 5MWT). Results One hundred sixteen patients (76.1 ± 6.7 years, 50% male) who fulfilled the study inclusion criteria were randomized to IG (n = 60) or CG (n = 56) and participated in CR (18.6 ± 2.7 days). As a result, 6MWT (IG 247 ± 94.1 vs. 348 ± 100.1, CG 232 ± 102.8 vs. 333 ± 120.7), SPPB (IG 8.31 ± 2.21 vs. 9.51 ± 2.24, CG 7.95 ± 2.01 vs. 9.08 ± 2.35), 5MWT (IG 0.847 ± 0.31 vs. 0.965 ± 0.3, CG 0.765 ± 0.24 vs 0.879 ± 0.29) all other outcome variables and physical frailty level improved significantly (p < 0.05) in both groups with no significant difference between groups. Improvements were sustained over the 3-month follow-up for 6MWT (IG 348 ± 113 vs. CG 332 ± 147.4), SPPB (IG 10.37 ± 1.59 vs CG 9.44 ± 2.34), 5MWT (IG 1.086 ± 0. 307 vs CG 1.123 ± 0.539) and other variables. Improvement in physical frailty level was significantly more pronounced in IG (p < 0.05) after the 3-month follow-up. Conclusion Exercise-based CR improves functional and exercise capacity, physical performance, and muscular strength, and reduces physical frailty levels in patients after valve surgery/intervention in the short and medium terms. SPPB score and 5MWT were useful for physical frailty assessment, screening and evaluation of outcomes in a CR setting. Additional benefit from the resistance and balance training could not be confirmed. Trial registration NCT04234087, retrospectively registered 21 January 2020.
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Affiliation(s)
| | - Aurelija Beigienė
- Rehabilitation Department, Lithuanian University of Health Sciences, Eiveniu g. 2, LT-50161, Kaunas, Lithuania
| | | | - Kristina Balnė
- Faculty of Medicine, Lithuanian University of Health Sciences, A. Mickevičiaus g. 9, LT-44307, Kaunas, Lithuania
| | - Raimondas Kubilius
- Rehabilitation Department, Lithuanian University of Health Sciences, Eiveniu g. 2, LT-50161, Kaunas, Lithuania
| | - Birna Bjarnason-Wehrens
- Institute of Cardiology and Sports Medicine, Department of Preventive and Rehabilitative Sport and Exercise Medicine, German Sport University Cologne, Am Sportpark Muengersdorf 6, 50933, Cologne, Germany
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13
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Bhattal GK, Park KE, Winchester DE. Home-Based Cardiac Rehabilitation (HBCR) In Post-TAVR Patients: A Prospective, Single-Center, Cohort, Pilot Study. Cardiol Ther 2020; 9:541-548. [PMID: 32535753 PMCID: PMC7584688 DOI: 10.1007/s40119-020-00186-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Cardiac rehabilitation after transcatheter aortic valve replacement (TAVR) safely improves exercise tolerance, functional independence, and quality of life. However, barriers such as transportation, cost, and limited access to rehabilitation programs prohibits participation. In 2010, the Veterans Affairs Medical Center (VAMC) started a 12-week home-based cardiac rehabilitation (HBCR) program at 13 sites around the country to increase participation by reducing such barriers. We present the findings of HBCR in post-TAVR patients from the VAMC in Gainesville, FL, USA. METHODS Fifty-nine patients who underwent TAVR between 2015 and 2018 at the Gainesville VA were offered HBCR. Forty-one patients enrolled, 28 completed the program, and 14 completed the surveys. We used various performance measures including Life's Simple 7 survey, 6-min Walk (6-MW), Duke Activity Survey Index (DASI), and Short Form-36 (SF-36) health survey to assess the pre and post-HBCR changes in emotional, functional, and physical well-being of the patients. RESULTS Paired comparison of pre and post-HBCR using Wilcoxon signed-rank test revealed a statistically significant difference in the pre and post-HBCR scores for DASI, DASI-Mets, and SF-36 physical functioning (p values 0.05, 0.034, and 0.016, respectively), suggesting an improvement in the patients' physical functioning after participating in the HBCR program. CONCLUSIONS In conclusion, our pilot study offers novel insight into the role of HBCR in improving physical health and well-being in post-TAVR patients while eliminating the barriers of transportation and access to cardiac rehabilitation programs.
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Affiliation(s)
| | - Ki E Park
- University of Florida Health, Gainesville, FL, USA
- Malcom Randall Department of Veterans Affairs Medical Center, North Florida South Georgia VAMC, Gainesville, FL, USA
| | - David E Winchester
- University of Florida Health, Gainesville, FL, USA
- Malcom Randall Department of Veterans Affairs Medical Center, North Florida South Georgia VAMC, Gainesville, FL, USA
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14
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Lawless M, Harrison AS, Doherty P. Multiple interventions following an acute coronary syndrome event increase uptake into cardiac rehabilitation. Int J Cardiol 2020; 326:1-5. [PMID: 33181160 DOI: 10.1016/j.ijcard.2020.11.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 10/29/2020] [Accepted: 11/04/2020] [Indexed: 12/01/2022]
Abstract
AIMS Cardiac rehabilitation (CR) improves morbidity and mortality. Uptake varies for patients following acute coronary syndrome (ACS). Entry into CR is often dependent on the management strategy received, lower following percutaneous coronary intervention (PCI), higher following coronary artery bypass grafting (CABG). This study sought to investigate differences in CR uptake following an ACS event for those patients receiving multiple treatments. METHODS Data was from the National Audit of CR between 2016 and 2019. Patients with ACS were categorised as: no intervention; one treatment (such as any PCI, CABG, any valve surgery and any device therapy); two treatments; or three or more treatments. Baseline demographics and logistic regression were used to analyse the effect of multiple treatment intervention on uptake into CR. RESULTS A total of 6833 ACS patients were included in the analysis (0 treatments 2014, 1 treatment 3104, ≥2 treatments 2799). Patients who received ≥2 therapeutic interventions were more likely to be male, partnered and >2 comorbidities. Logistic regression showed a positive relationship between uptake total intervention. Similar associations were seen: being younger, male, partnered and having any comorbidity. The hospital stay, history of angina, diabetes and stroke was negatively correlated with an uptake. CONCLUSION This study showed for the first time that multiple interventions following ACS is a significant predictor of uptake into CR. The findings align with recent trends with medically managed myocardial infarction uptake. Our findings identify factors associated with poor uptake to CR which should be considered as part of strategy to increase participation.
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Affiliation(s)
- M Lawless
- Department of Health Sciences, University of York, York, UK
| | - A S Harrison
- Department of Health Sciences, University of York, York, UK.
| | - P Doherty
- Department of Health Sciences, University of York, York, UK
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15
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Suppan M, Barcelos G, Luise S, Diaper J, Frei A, Ellenberger C, Adamopoulos D, Noble S, Licker M. Improved Exercise Tolerance, Oxygen Delivery, and Oxygen Utilization After Transcatheter Aortic Valve Implantation for Severe Aortic Stenosis. CJC Open 2020; 2:490-496. [PMID: 33305208 PMCID: PMC7710946 DOI: 10.1016/j.cjco.2020.06.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Accepted: 06/11/2020] [Indexed: 12/19/2022] Open
Abstract
Background Transcatheter aortic valve implantation (TAVI) represents an effective therapeutic procedure, particularly in patients with severe aortic stenosis. We hypothesized that the decreased afterload induced by TAVI would improve exercise capacity by enhancing oxygen uptake in working muscles. Methods A standardized exercise test was performed in patients with severe aortic stenosis the day before TAVI and within 5 days thereafter. The main study endpoint was the workload achieved during a 5-minute standardized exercise test. Using electrical cardiometry and near-infrared spectroscopy, we explored and compared the changes in cardiac index (CI), as well as muscular and cerebral tissue oximetry, during the 2 exercise tests. Results Thirty patients completed the study protocol. Compared with the pre-TAVI period, patients achieved a higher median workload after TAVI (316 Joules [interquartile range {IQR}: 169–494] vs 190 Joules [IQR: 131–301], P = 0.002). Baseline CI increased from 2.5 l/min per m2 (IQR: 2.1–2.9) to 2.9 l/min per m2 (IQR: 2.5–3.2; P = 0.009), whereas CI at the end of the exercise test increased from 4.5 l/min per m2 (IQR: 3.4–5.3) to 4.7 l/min per m2 (3.4–6.4; P = 0.019). At the end of the exercise test, cerebral tissue oximetry increased from 70% (IQR: 65–72) to 74% (IQR: 66–78), and muscle tissue oximetry increased from 62% (IQR: 58–65) to 71% (65–74; P = 0.046 and P < 0.001, respectively). Conclusions Early improvement of exercise capacity after TAVI is associated with increased CI and better oxygen utilization in the brain and skeletal muscles.
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Affiliation(s)
- Mélanie Suppan
- Department of Anesthesiology, Pharmacology and Intensive Care, Geneva University Hospitals, Geneva, Switzerland
| | - Gleicy Barcelos
- Department of Anesthesiology, Pharmacology and Intensive Care, Geneva University Hospitals, Geneva, Switzerland
| | - Stéphane Luise
- Department of Anesthesiology, Pharmacology and Intensive Care, Geneva University Hospitals, Geneva, Switzerland
| | - John Diaper
- Department of Anesthesiology, Pharmacology and Intensive Care, Geneva University Hospitals, Geneva, Switzerland
| | - Angela Frei
- Division of Cardiology, Geneva University Hospitals, Geneva, Switzerland
| | - Christoph Ellenberger
- Department of Anesthesiology, Pharmacology and Intensive Care, Geneva University Hospitals, Geneva, Switzerland
| | | | - Stéphane Noble
- Division of Cardiology, Geneva University Hospitals, Geneva, Switzerland.,Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Marc Licker
- Department of Anesthesiology, Pharmacology and Intensive Care, Geneva University Hospitals, Geneva, Switzerland.,Faculty of Medicine, University of Geneva, Geneva, Switzerland
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Acute Care Physical and Occupational Therapy Early Intervention Pathway After Transcatheter Aortic Valve Replacement: A Retrospective Study. JOURNAL OF ACUTE CARE PHYSICAL THERAPY 2020. [DOI: 10.1097/jat.0000000000000147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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17
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Carvalho TD, Milani M, Ferraz AS, Silveira ADD, Herdy AH, Hossri CAC, Silva CGSE, Araújo CGSD, Rocco EA, Teixeira JAC, Dourado LOC, Matos LDNJD, Emed LGM, Ritt LEF, Silva MGD, Santos MAD, Silva MMFD, Freitas OGAD, Nascimento PMC, Stein R, Meneghelo RS, Serra SM. Brazilian Cardiovascular Rehabilitation Guideline - 2020. Arq Bras Cardiol 2020; 114:943-987. [PMID: 32491079 PMCID: PMC8387006 DOI: 10.36660/abc.20200407] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Affiliation(s)
- Tales de Carvalho
- Clínica de Prevenção e Reabilitação Cardiosport , Florianópolis , SC - Brasil
- Universidade do Estado de Santa Catarina (Udesc), Florianópolis , SC - Brasil
| | | | | | - Anderson Donelli da Silveira
- Programa de Pós-Graduação em Cardiologia e Ciências Cardiovasculares da Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre , RS - Brasil
- Hospital de Clínicas de Porto Alegre , Universidade Federal do Rio Grande do Sul (HCPA/UFRGS), Porto Alegre , RS - Brasil
- Vitta Centro de Bem Estar Físico , Porto Alegre , RS - Brasil
| | - Artur Haddad Herdy
- Clínica de Prevenção e Reabilitação Cardiosport , Florianópolis , SC - Brasil
- Instituto de Cardiologia de Santa Catarina , Florianópolis , SC - Brasil
- Unisul: Universidade do Sul de Santa Catarina (UNISUL), Florianópolis , SC - Brasil
| | | | | | | | | | | | - Luciana Oliveira Cascaes Dourado
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HC-FMUSP), Rio de Janeiro , RJ - Brasil
| | | | | | - Luiz Eduardo Fonteles Ritt
- Hospital Cárdio Pulmonar , Salvador , BA - Brasil
- Escola Bahiana de Medicina e Saúde Pública , Salvador , BA - Brasil
| | | | - Mauro Augusto Dos Santos
- ACE Cardiologia do Exercício , Rio de Janeiro , RJ - Brasil
- Instituto Nacional de Cardiologia , Rio de Janeiro , RJ - Brasil
| | | | | | - Pablo Marino Corrêa Nascimento
- Universidade Federal Fluminense (UFF), Rio de Janeiro , RJ - Brasil
- Instituto Nacional de Cardiologia , Rio de Janeiro , RJ - Brasil
| | - Ricardo Stein
- Programa de Pós-Graduação em Cardiologia e Ciências Cardiovasculares da Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre , RS - Brasil
- Hospital de Clínicas de Porto Alegre , Universidade Federal do Rio Grande do Sul (HCPA/UFRGS), Porto Alegre , RS - Brasil
- Vitta Centro de Bem Estar Físico , Porto Alegre , RS - Brasil
| | - Romeu Sergio Meneghelo
- Instituto Dante Pazzanese de Cardiologia , São Paulo , SP - Brasil
- Hospital Israelita Albert Einstein , São Paulo , SP - Brasil
| | - Salvador Manoel Serra
- Instituto Estadual de Cardiologia Aloysio de Castro (IECAC), Rio de Janeiro , RJ - Brasil
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18
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Nechwatal RM, Bestehorn K, Leuschner F, Hagendorff A, Guha M, Schlitt A. [Postacute care after transcatheter aortic valve implantation (TAVI)]. Herz 2020; 46:41-47. [PMID: 32313970 DOI: 10.1007/s00059-020-04915-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 07/30/2019] [Accepted: 03/19/2020] [Indexed: 11/26/2022]
Abstract
With increasing age valvular heart disease is among the most frequent diseases of the heart. Relevant valvular disease impairs not only the long-term prognosis but also physical resilience, activities of daily living and the quality of life. In cases of middle to high-grade symptomatic cardiac defects, valve replacement or valve reconstruction is still the surgical procedure of choice; however, in recent years the transcatheter percutaneous aortic valve replacement (TAVI) procedure has become more prominent for the most frequent defect, aortic valve stenosis. This article provides an overview of the aftercare and rehabilitation of patients following a TAVI intervention.
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Affiliation(s)
- Robert Michael Nechwatal
- Rehaklinik Heidelberg-Königstuhl, Fachklinik für Herz‑, Kreislauf‑, Gefäß‑, Lungen- und Bronchialerkrankungen, Kohlhof 6, 69117, Heidelberg, Deutschland.
| | - Kurt Bestehorn
- Institut für Klinische Pharmakologie, TU Dresden, Dresden, Deutschland
| | - Florian Leuschner
- Klinik für Kardiologie, Angiologie und Pneumologie, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - Andreas Hagendorff
- Klinik und Poliklinik für Kardiologie, Universitätsklinikum Leipzig, Leipzig, Deutschland
| | - Manju Guha
- Reha-Klinik am Sendesaal, Bremen, Deutschland
| | - Axel Schlitt
- Abteilung für Kardiologie und Diabetologie, Paracelsus-Harz-Klinik Bad Suderode, Quedlinburg, Deutschland
- Medizinische Fakultät, Martin-Luther-Universität Halle-Wittenberg, Halle, Deutschland
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19
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Eichler S, Völler H, Reibis R, Wegscheider K, Butter C, Harnath A, Salzwedel A. Geriatric or cardiac rehabilitation? Predictors of treatment pathways in advanced age patients after transcatheter aortic valve implantation. BMC Cardiovasc Disord 2020; 20:158. [PMID: 32252646 PMCID: PMC7137198 DOI: 10.1186/s12872-020-01452-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Accepted: 03/29/2020] [Indexed: 01/06/2023] Open
Abstract
Background Aim of the study was to find predictors of allocating patients after transcatheter aortic valve implantation (TAVI) to geriatric (GR) or cardiac rehabilitation (CR) and describe this new patient group based on a differentiated characterization. Methods From 10/2013 to 07/2015, 344 patients with an elective TAVI were consecutively enrolled in this prospective multicentric cohort study. Before intervention, sociodemographic parameters, echocardiographic data, comorbidities, 6-min walk distance (6MWD), quality of life and frailty (score indexing activities of daily living [ADL], cognition, nutrition and mobility) were documented. Out of these, predictors for assignment to CR or GR after TAVI were identified using a multivariable regression model. Results After TAVI, 249 patients (80.7 ± 5.1 years, 59.0% female) underwent CR (n = 198) or GR (n = 51). GR patients were older, less physically active and more often had a level of care, peripheral artery disease as well as a lower left ventricular ejection fraction. The groups also varied in 6MWD. Furthermore, individual components of frailty revealed prognostic impact: higher values in instrumental ADL reduced the probability for referral to GR (OR:0.49, p < 0.001), while an impaired mobility was positively associated with referral to GR (OR:3.97, p = 0.046). Clinical parameters like stroke (OR:0.19 of GR, p = 0.038) and the EuroSCORE (OR:1.04 of GR, p = 0.026) were also predictive. Conclusion Advanced age patients after TAVI referred to CR or GR differ in several parameters and seem to be different patient groups with specific needs, e.g. regarding activities of daily living and mobility. Thus, our data prove the eligibility of both CR and GR settings.
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Affiliation(s)
- Sarah Eichler
- Department of Rehabilitation Medicine, University of Potsdam, Faculty of Health Sciences Brandenburg, Am Neuen Palais 10, D-14469, Potsdam, Germany
| | - Heinz Völler
- Department of Rehabilitation Medicine, University of Potsdam, Faculty of Health Sciences Brandenburg, Am Neuen Palais 10, D-14469, Potsdam, Germany. .,Klinik am See, Rehabilitation Center for Internal Medicine, Rüdersdorf, Germany.
| | - Rona Reibis
- Cardiological Outpatient Clinic Am Park Sanssouci, Potsdam, Germany
| | - Karl Wegscheider
- Department of Medical Biometry and Epidemiology, University Medical Center, Hamburg-Eppendorf, Germany
| | - Christian Butter
- Heart Center Brandenburg, Medical School Brandenburg, Bernau, Germany
| | | | - Annett Salzwedel
- Department of Rehabilitation Medicine, University of Potsdam, Faculty of Health Sciences Brandenburg, Am Neuen Palais 10, D-14469, Potsdam, Germany
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20
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Ghannem M, Ghannem L. [Rehabilitation of valvular patient]. Ann Cardiol Angeiol (Paris) 2019; 68:490-498. [PMID: 31668337 DOI: 10.1016/j.ancard.2019.09.013] [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: 11/26/2022]
Abstract
Valvular disease is the second indication of cardiac rehabilitation (CR) after coronary artery disease. Patients suffering valvular disease are addressed to CR after valvular repair, and are usually old. Valvular replacement are the most frequent, and more and more patients being treated by TAVI are addressed to CR. CR takes place on two phases: From the seventh (day 7) to the fifteenth (day 15) day: management of complications, respiratory physio, and help to autonomy if necessary. From the fifteenth day (day 15): rehabilitation to exercise after an exercise stress test with or without MVO2 measurement. Because the patients are taking anticoagulants and are at risk of endocarditis, therapeutic education takes an important place during the stage. CR of patients suffering valvular disease has demonstrated its usefulness with: An increase of exercise capacity in all kind of valvular disease; A reduction of left ventricular hypertrophy in patients with aortic valve stenosis. No serious complication was observed in all studies regarding CR in patients with valvular disease.
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Affiliation(s)
- M Ghannem
- EA-3300 APERE, université de Picardie, Jules Verne, 3, rue des Louvels, 80036 Amiens, France; Faculté de médecine de Sousse, Avenue M. Karoui, Tunisie; Service de cardiologie, hôpital de Gonesse, avenue du 19 mars 1962, 95500 Gonesse, France.
| | - L Ghannem
- Faculté de médecine de Bobigny, 74, rue Marcel Cachin, 93000 Bobigny, France
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21
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Tarro Genta F. Cardiac Rehabilitation for Transcatheter Aortic Valve Replacement. Clin Geriatr Med 2019; 35:539-548. [DOI: 10.1016/j.cger.2019.07.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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22
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Drudi LM, Ades M, Turkdogan S, Huynh C, Lauck S, Webb JG, Piazza N, Martucci G, Langlois Y, Perrault LP, Asgar AW, Labinaz M, Lamy A, Noiseux N, Peterson MD, Arora RC, Lindman BR, Bendayan M, Mancini R, Trnkus A, Kim DH, Popma JJ, Afilalo J. Association of Depression With Mortality in Older Adults Undergoing Transcatheter or Surgical Aortic Valve Replacement. JAMA Cardiol 2019; 3:191-197. [PMID: 29344620 DOI: 10.1001/jamacardio.2017.5064] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Importance Depression is increasingly recognized as a risk factor for adverse outcomes in cardiovascular disease. However, little is known about depression in older adults undergoing transcatheter (TAVR) or surgical (SAVR) aortic valve replacement. Objective To determine the prevalence of depression and its association with all-cause mortality in older adults undergoing TAVR or SAVR. Design, Setting, and Participants This preplanned analysis of the Frailty Aortic Valve Replacement (FRAILTY-AVR) prospective cohort study included 14 centers in 3 countries from November 15, 2011, through April 7, 2016. Individuals 70 years or older who underwent TAVR or SAVR were enrolled. Depressive symptoms were evaluated using the Geriatric Depression Scale Short Form at baseline and follow-up. Main Outcomes and Measures All-cause mortality at 1 and 12 months after TAVR or SAVR. Logistic regression was used to determine the association of depression with mortality after adjusting for confounders such as frailty and cognitive impairment. Results Among 1035 older adults (427 men [41.3%] and 608 women [58.7%]) with a mean (SD) age of 81.4 (6.1) years, 326 (31.5%) had a positive result of screening for depression, whereas only 89 (8.6%) had depression documented in their clinical record. After adjusting for clinical and geriatric confounders, baseline depression was found to be associated with mortality at 1 month (odds ratio [OR], 2.20; 95% CI, 1.18-4.10) and at 12 months (OR, 1.532; 95% CI, 1.03-2.24). Persistent depression, defined as baseline depression that was still present 6 months after the procedure, was associated with a 3-fold increase in mortality at 12 months (OR, 2.98; 95% CI, 1.08-8.20). Conclusions and Relevance One in 3 older adults undergoing TAVR or SAVR had depressive symptoms at baseline and a higher risk of short-term and midterm mortality. Patients with persistent depressive symptoms at follow-up had the highest risk of mortality.
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Affiliation(s)
- Laura M Drudi
- Centre for Clinical Epidemiology, Jewish General Hospital, Montreal, Quebec, Canada.,Division of Vascular Surgery, McGill University, Montreal, Quebec, Canada.,Faculty of Medicine, McGill University, Montreal, Quebec, Canada
| | - Matthew Ades
- Faculty of Medicine, McGill University, Montreal, Quebec, Canada
| | - Sena Turkdogan
- Faculty of Medicine, McGill University, Montreal, Quebec, Canada
| | - Caroline Huynh
- Faculty of Medicine, McGill University, Montreal, Quebec, Canada
| | - Sandra Lauck
- Centre for Heart Valve Innovation, St Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - John G Webb
- Centre for Heart Valve Innovation, St Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Nicolo Piazza
- Division of Cardiology, McGill University Health Centre, Montreal, Quebec, Canada
| | - Giuseppe Martucci
- Division of Cardiology, McGill University Health Centre, Montreal, Quebec, Canada
| | - Yves Langlois
- Division of Cardiac Surgery, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | - Louis P Perrault
- Division of Cardiac Surgery, Institut de Cardiologie de Montréal, Université de Montréal, Montreal, Quebec, Canada
| | - Anita W Asgar
- Division of Cardiology, Institut de Cardiologie de Montréal, Université de Montréal, Montreal, Quebec, Canada
| | - Marino Labinaz
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Andre Lamy
- Division of Cardiac Surgery, Hamilton Health Sciences, Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Nicolas Noiseux
- Division of Cardiac Surgery, Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada
| | - Mark D Peterson
- Division of Cardiac Surgery, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Rakesh C Arora
- Division of Cardiac Surgery, St Boniface Hospital, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Brian R Lindman
- Division of Cardiology, Washington University School of Medicine, St Louis, Missouri
| | - Melissa Bendayan
- Centre for Clinical Epidemiology, Jewish General Hospital, Montreal, Quebec, Canada.,Division of Experimental Medicine, McGill University, Montreal, Quebec, Canada
| | - Rita Mancini
- Centre for Clinical Epidemiology, Jewish General Hospital, Montreal, Quebec, Canada
| | - Amanda Trnkus
- Centre for Clinical Epidemiology, Jewish General Hospital, Montreal, Quebec, Canada
| | - Dae H Kim
- Division of Gerontology, Beth Israel Deaconess Medical Center, Harvard University, Boston, Massachusetts
| | - Jeffrey J Popma
- Division of Cardiology, Beth Israel Deaconess Medical Center, Harvard University, Boston, Massachusetts
| | - Jonathan Afilalo
- Centre for Clinical Epidemiology, Jewish General Hospital, Montreal, Quebec, Canada.,Faculty of Medicine, McGill University, Montreal, Quebec, Canada.,Division of Experimental Medicine, McGill University, Montreal, Quebec, Canada.,Division of Cardiology, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
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Ghorayeb N, Stein R, Daher DJ, Silveira ADD, Ritt LEF, Santos DFPD, Sierra APR, Herdy AH, Araújo CGSD, Colombo CSSDS, Kopiler DA, Lacerda FFRD, Lazzoli JK, Matos LDNJD, Leitão MB, Francisco RC, Alô ROB, Timerman S, Carvalho TD, Garcia TG. The Brazilian Society of Cardiology and Brazilian Society of Exercise and Sports Medicine Updated Guidelines for Sports and Exercise Cardiology - 2019. Arq Bras Cardiol 2019; 112:326-368. [PMID: 30916199 PMCID: PMC6424031 DOI: 10.5935/abc.20190048] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Affiliation(s)
- Nabil Ghorayeb
- Instituto Dante Pazzanese de Cardiologia, São Paulo, SP - Brazil
- Hospital do Coração (HCor), Associação do Sanatório Sírio, São Paulo, SP - Brazil
- Programa de Pós-Graduação em Medicina do Esporte da Universidade Federal de São Paulo (UNIFESP), São Paulo, SP - Brazil
- Instituto de Assistência Médica ao Servidor Público Estadual (IAMSPE), São Paulo, SP - Brazil
| | - Ricardo Stein
- Programa de Pós-Graduação em Cardiologia e Ciências Cardiovasculares da Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS - Brazil
- Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul (HCPA/UFRGS), Porto Alegre, RS - Brazil
- Vitta Centro de Bem Estar Físico, Porto Alegre, RS - Brazil
| | - Daniel Jogaib Daher
- Hospital do Coração (HCor), Associação do Sanatório Sírio, São Paulo, SP - Brazil
| | - Anderson Donelli da Silveira
- Programa de Pós-Graduação em Cardiologia e Ciências Cardiovasculares da Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS - Brazil
- Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul (HCPA/UFRGS), Porto Alegre, RS - Brazil
- Vitta Centro de Bem Estar Físico, Porto Alegre, RS - Brazil
| | - Luiz Eduardo Fonteles Ritt
- Hospital Cárdio Pulmonar, Salvador, BA - Brazil
- Escola Bahiana de Medicina e Saúde Pública, Salvador, BA - Brazil
| | | | | | - Artur Haddad Herdy
- Instituto de Cardiologia de Santa Catarina, Florianópolis, SC - Brazil
- Clínica Cardiosport de Prevenção e Reabilitação, Florianópolis, SC - Brazil
| | | | - Cléa Simone Sabino de Souza Colombo
- Hospital do Coração (HCor), Associação do Sanatório Sírio, São Paulo, SP - Brazil
- Sports Cardiology, Cardiology Clinical Academic Group - St George's University of London,14 London - UK
| | - Daniel Arkader Kopiler
- Sociedade Brasileira de Medicina do Esporte e do Exercício (SBMEE), São Paulo, SP - Brazil
- Instituto Nacional de Cardiologia (INC), Rio de Janeiro, RJ - Brazil
| | - Filipe Ferrari Ribeiro de Lacerda
- Programa de Pós-Graduação em Cardiologia e Ciências Cardiovasculares da Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS - Brazil
| | - José Kawazoe Lazzoli
- Sociedade Brasileira de Medicina do Esporte e do Exercício (SBMEE), São Paulo, SP - Brazil
- Federação Internacional de Medicina do Esporte (FIMS), Lausanne - Switzerland
| | | | - Marcelo Bichels Leitão
- Sociedade Brasileira de Medicina do Esporte e do Exercício (SBMEE), São Paulo, SP - Brazil
| | - Ricardo Contesini Francisco
- Instituto Dante Pazzanese de Cardiologia, São Paulo, SP - Brazil
- Hospital do Coração (HCor), Associação do Sanatório Sírio, São Paulo, SP - Brazil
| | - Rodrigo Otávio Bougleux Alô
- Instituto Dante Pazzanese de Cardiologia, São Paulo, SP - Brazil
- Hospital Geral de São Mateus, São Paulo, SP - Brazil
| | - Sérgio Timerman
- Instituto do Coração da Faculdade de Medicina da Universidade de São Paulo (InCor-FMUSP), São Paulo, SP - Brazil
- Universidade Anhembi Morumbi, Laureate International Universities, São Paulo, SP - Brazil
| | - Tales de Carvalho
- Clínica Cardiosport de Prevenção e Reabilitação, Florianópolis, SC - Brazil
- Departamento de Ergometria e Reabilitação Cardiovascular da Sociedade Brasileira de Cardiologia (DERC/SBC), Rio de Janeiro, RJ - Brazil
- Universidade do Estado de Santa Catarina (UDESC), Florianópolis, SC - Brazil
| | - Thiago Ghorayeb Garcia
- Instituto Dante Pazzanese de Cardiologia, São Paulo, SP - Brazil
- Hospital do Coração (HCor), Associação do Sanatório Sírio, São Paulo, SP - Brazil
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van Dam van Isselt EF, van Wijngaarden J, Lok DJA, Achterberg WP. Geriatric rehabilitation in older patients with cardiovascular disease: a feasibility study. Eur Geriatr Med 2018; 9:853-861. [PMID: 30546796 PMCID: PMC6267640 DOI: 10.1007/s41999-018-0119-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Accepted: 10/04/2018] [Indexed: 11/17/2022]
Abstract
PURPOSE Cardiac rehabilitation in older patients after hospitalization because of cardiovascular disease is recommended. However, many older patients do not receive cardiac rehabilitation in daily practice, due to lack of referral and poor adherence. This can be related to impaired clinical and functional status of these patients, who are more likely to present with frailty, frequent comorbidities, and disability. Geriatric rehabilitation might be a possible solution to reduce barriers to cardiac rehabilitation attendance. We developed and implemented an inpatient geriatric rehabilitation programme that was provided immediately after discharge from the hospital, for older patients with a significant functional decline during hospital admission because of cardiovascular disease: 'the GR-cardio programme'. The primary aim of the present study is to investigate feasibility of the GR-cardio programme. METHODS This is a retrospective real-life feasibility study describing a consecutive series of older patients receiving the GR-cardio programme, with no control group. All patients had been hospitalized because of cardiovascular disease. Data on patient characteristics, functional status, health-related quality of life (HRQoL), readmissions, and mortality were collected from the patients file on admission, at discharge and 6 months after discharge from the GR-cardio programme. Feasibility of the programme was evaluated using the following outcomes: recruitment, resulting sample characteristics, safety, and preliminary evaluation of patients' responses to the GR-cardio programme. RESULTS In total, 58 patients [mean age 78.8 (± 9.8) years; 43% male] were included in the study. On admission, functional status and HRQoL were severely impaired but showed clinically relevant improvements. During the programme, three patients died. Eighty-three percent of all patients were discharged back home after completing the rehabilitation programme with a mean length of 38 days. Mortality rate during follow-up was the highest in patients with heart failure (32%). CONCLUSIONS This study indicates that geriatric rehabilitation for patients with cardiovascular disease is feasible. Furthermore, our results show that the GR-cardio programme can probably offer substantial benefits for patients in terms of improving functional status and HRQoL.
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Affiliation(s)
- Eléonore F van Dam van Isselt
- Department of Public Health and Primary Care, Leiden University Medical Centre, PO Box 9600, 2300 RC, Leiden, The Netherlands.
- Zorggroep Solis, Deventer, The Netherlands.
| | | | - Dirk J A Lok
- Department of Cardiology, Deventer Hospital, Deventer, The Netherlands
| | - Wilco P Achterberg
- Department of Public Health and Primary Care, Leiden University Medical Centre, PO Box 9600, 2300 RC, Leiden, The Netherlands
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25
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Butter C, Groß J, Haase-Fielitz A, Sims H, Deutsch C, Bramlage P, Neuss M. Impact of Rehabilitation on Outcomes after TAVI: A Preliminary Study. J Clin Med 2018; 7:jcm7100326. [PMID: 30301135 PMCID: PMC6210128 DOI: 10.3390/jcm7100326] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Revised: 09/21/2018] [Accepted: 10/02/2018] [Indexed: 12/23/2022] Open
Abstract
The benefit of rehabilitation in elderly patients undergoing transcatheter aortic valve implantation (TAVI) for treatment of severe aortic stenosis is unknown. The impact of declining rehabilitation programs on mortality has also not been described. In a longitudinal cohort study of 1056 patients undergoing elective TAVI between 2008 and 2016, logistic regression analysis was used to assess the relationship between treatment modality and outcome according to whether or not patients participated in a three-week rehabilitation program after TAVI. Subgroup analyses included patient outcome separated according to cardiac, geriatric, or no rehabilitation. A total of 1017 patients survived until hospital discharge (96.3%) and were offered rehabilitation, 366 patients (36.0%) declined to undergo rehabilitation, with the remaining patients undergoing either cardiac (n = 435; 42.8%) or geriatric rehabilitation (n = 216; 21.2%). Mortality at six months was lower for patients receiving rehabilitation compared with those who had not (adjusted odds ratio (OR): 0.49; 95% confidence interval (confidence interval [CI]: 0.25–0.94; p = 0.032). Sub-analysis showed the benefit of cardiac (adjusted OR: 0.31; 95% CI 0.14–0.71, p = 0.006), but not geriatric rehabilitation (adjusted OR 0.83; 95% CI 0.37–1.85, p = 0.65). A program of rehabilitation after TAVI has the potential to reduce mortality. Future studies should focus on health-orientated behavior and identifying risk factors for declining rehabilitation programs.
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Affiliation(s)
- Christian Butter
- Department of Cardiology, Heart Center Brandenburg, Bernau 16321, Germany.
- Brandenburg Medical School (MHB) "Theodor Fontane", Neuruppin 16816, Germany.
| | - Jessica Groß
- Department of Cardiology, Heart Center Brandenburg, Bernau 16321, Germany.
- Brandenburg Medical School (MHB) "Theodor Fontane", Neuruppin 16816, Germany.
| | - Anja Haase-Fielitz
- Department of Cardiology, Heart Center Brandenburg, Bernau 16321, Germany.
- Brandenburg Medical School (MHB) "Theodor Fontane", Neuruppin 16816, Germany.
| | - Helen Sims
- Institute for Pharmacology and Preventive Medicine, Cloppenburg 49661, Germany.
| | - Cornelia Deutsch
- Institute for Pharmacology and Preventive Medicine, Cloppenburg 49661, Germany.
| | - Peter Bramlage
- Institute for Pharmacology and Preventive Medicine, Cloppenburg 49661, Germany.
| | - Michael Neuss
- Department of Cardiology, Heart Center Brandenburg, Bernau 16321, Germany.
- Brandenburg Medical School (MHB) "Theodor Fontane", Neuruppin 16816, Germany.
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26
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Frailty and Exercise Training: How to Provide Best Care after Cardiac Surgery or Intervention for Elder Patients with Valvular Heart Disease. BIOMED RESEARCH INTERNATIONAL 2018; 2018:9849475. [PMID: 30302342 PMCID: PMC6158962 DOI: 10.1155/2018/9849475] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Revised: 08/01/2018] [Accepted: 08/29/2018] [Indexed: 12/13/2022]
Abstract
The aim of this literature review was to evaluate existing evidence on exercise-based cardiac rehabilitation (CR) as a treatment option for elderly frail patients with valvular heart disease (VHD). Pubmed database was searched for articles between 1980 and January 2018. From 2623 articles screened, 61 on frailty and VHD and 12 on exercise-based training for patients with VHD were included in the analysis. We studied and described frailty assessment in this patient population. Studies reporting results of exercise training in patients after surgical/interventional VHD treatment were analyzed regarding contents and outcomes. The tools for frailty assessment included fried phenotype frailty index and its modifications, multidimensional geriatric assessment, clinical frailty scale, 5-meter walking test, serum albumin levels, and Katz index of activities of daily living. Frailty assessment in CR settings should be based on functional, objective tests and should have similar components as tools for risk assessment (mobility, muscle mass and strength, independence in daily living, cognitive functions, nutrition, and anxiety and depression evaluation). Participating in comprehensive exercise-based CR could improve short- and long-term outcomes (better quality of life, physical and functional capacity) in frail VHD patients. Such CR program should be led by cardiologist, and its content should include (1) exercise training (endurance and strength training to improve muscle mass, strength, balance, and coordination), (2) nutrition counseling, (3) occupational therapy (to improve independency and cognitive function), (4) psychological counseling to ensure psychosocial health, and (5) social worker counseling (to improve independency). Comprehensive CR could help to prevent, restore, and reduce the severity of frailty as well as to improve outcomes for frail VHD patients after surgery or intervention.
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27
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Imran HM, Baig M, Mujib M, Beale C, Gaw A, Stabile L, Shah NR, Gordon PC, Wu WC. Comparison of phase 2 cardiac rehabilitation outcomes between patients after transcatheter versus surgical aortic valve replacement. Eur J Prev Cardiol 2018; 25:1577-1584. [DOI: 10.1177/2047487318792099] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Background Referral rates and outcomes of cardiac rehabilitation have not been evaluated in patients with transcatheter aortic valve replacement or compared with surgical aortic valve replacement. Method A retrospective cohort study was conducted in 488 patients who underwent transcatheter aortic valve replacement ( n = 199) and surgical aortic valve replacement ( n = 289) from a university-based statewide transcatheter aortic valve replacement/surgical aortic valve replacement program during 2015–2017. Cardiac rehabilitation consisted of supervised exercise, diet education, and stress and depression management. We compared changes from baseline in exercise duration and intensity during cardiac rehabilitation sessions, quality-of-life (36-Item Short-Form Health Survey), and psychosocial measures (anxiety, depression, mood, social support, and diet) between transcatheter aortic valve replacement and surgical aortic valve replacement patients using t-test and chi-square analyses. Results Of 488 patients, cardiac rehabilitation referral rates were similar at 41% (transcatheter aortic valve replacement 81/199 versus surgical aortic valve replacement 117/289), but enrollment rates were lower in transcatheter aortic valve replacement (27/199, 14%) versus surgical aortic valve replacement (102/289, 35%, p < 0.01). Among eligible patients, cardiac rehabilitation completion rates were lower in transcatheter aortic valve replacement (12%) than surgical aortic valve replacement (32%). Exercise intensity during cardiac rehabilitation improved in both groups in a similar fashion (transcatheter aortic valve replacement 1.03 ± 1.09 versus surgical aortic valve replacement 1.34 ± 1.15 metabolic equivalents), but increase in exercise duration was higher in transcatheter aortic valve replacement patients versus surgical aortic valve replacement patients (14.52 ± 6.42 versus 10.67 ± 8.38 min, p = 0.02). Improvement in physical composite score was higher in surgical aortic valve replacement versus transcatheter aortic valve replacement (8.72 ± 7.87 versus 2.36 ± 7.6, p = 0.02) while improvement in mental composite score was higher in transcatheter aortic valve replacement (8.19 ± 8.50) versus surgical aortic valve replacement (1.18 ± 7.23, p = 0.02). There was no significant difference between the two groups in improvement in psychosocial measures. Conclusion Cardiac rehabilitation enrollment was low in transcatheter aortic valve replacement patients versus surgical aortic valve replacement patients despite similar referral rates. Improvement in functional and quality-of-life performance was achieved in both transcatheter aortic valve replacement and surgical aortic valve replacement. Future studies should address obstacles for enrollment of transcatheter aortic valve replacement patients.
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Affiliation(s)
- Hafiz M Imran
- Department of Medicine, VA Medical Center, USA
- Center for Cardiac and Pulmonary Rehabilitation, The Miriam Hospital, USA
| | - Muhammad Baig
- Department of Medicine, Brown University Alpert Medical School, USA
| | - Marjan Mujib
- Department of Medicine, VA Medical Center, USA
- Center for Cardiac and Pulmonary Rehabilitation, The Miriam Hospital, USA
| | - Charles Beale
- Department of Medicine, VA Medical Center, USA
- Department of Medicine, Brown University Alpert Medical School, USA
| | - Arlene Gaw
- Center for Cardiac and Pulmonary Rehabilitation, The Miriam Hospital, USA
| | - Loren Stabile
- Center for Cardiac and Pulmonary Rehabilitation, The Miriam Hospital, USA
| | - Nishant R Shah
- Department of Medicine, VA Medical Center, USA
- Center for Cardiac and Pulmonary Rehabilitation, The Miriam Hospital, USA
| | - Paul C Gordon
- Department of Medicine, Brown University Alpert Medical School, USA
| | - Wen-Chih Wu
- Department of Medicine, VA Medical Center, USA
- Center for Cardiac and Pulmonary Rehabilitation, The Miriam Hospital, USA
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29
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Hansen D. Exercise intervention after transcatheter aortic valve implantation: Current evidence and issues to be resolved. Eur J Prev Cardiol 2018; 25:791-793. [PMID: 29547005 DOI: 10.1177/2047487318765258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Dominique Hansen
- Heart Centre Hasselt, Jessa Hospital, Belgium.,Faculty of Medicine and Life Sciences, Hasselt University, Belgium
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30
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Cardiac Rehabilitation in Older Persons with Cardiovascular Disease. CURRENT CARDIOVASCULAR RISK REPORTS 2018. [DOI: 10.1007/s12170-018-0569-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Hansen TB, Berg SK, Sibilitz KL, Zwisler AD, Norekvål TM, Lee A, Buus N. Patient perceptions of experience with cardiac rehabilitation after isolated heart valve surgery. Eur J Cardiovasc Nurs 2017; 17:45-53. [DOI: 10.1177/1474515117716245] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background: Little evidence exists on whether cardiac rehabilitation is effective for patients after heart valve surgery. Yet, accepted recommendations for patients with ischaemic heart disease continue to support it. To date, no studies have determined what heart valve surgery patients prefer in a cardiac rehabilitation programme, and none have analysed their experiences with it. Aims: The purpose of this qualitative analysis was to gain insight into patients’ experiences in cardiac rehabilitation, the CopenHeartVR trial. This trial specifically assesses patients undergoing isolated heart valve surgery. Methods: Semi-structured interviews were conducted with nine patients recruited from the intervention arm of the trial. The intervention consisted of a physical training programme and a psycho-educational intervention. Participants were interviewed three times: 2–3 weeks, 3–4 months and 8–9 months after surgery between April 2013 and October 2014. Data were analysed using qualitative thematic analysis. Results: Participants had diverse needs and preferences. Two overall themes emerged: cardiac rehabilitation played an important role in (i) reducing insecurity and (ii) helping participants to take active personal responsibility for their health. Despite these benefits, participants experienced existential and psychological challenges and musculoskeletal problems. Participants also sought additional advice from healthcare professionals both inside and outside the healthcare system. Conclusions: Even though the cardiac rehabilitation programme reduced insecurity and helped participants take active personal responsibility for their health, they experienced existential, psychological and physical challenges during recovery. The cardiac rehabilitation programme had several limitations, having implications for designing future programmes.
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Affiliation(s)
- Tina B Hansen
- Department of Cardiology, Zealand University Hospital, Roskilde, Denmark
| | - Selina K Berg
- The Heart Centre, Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Denmark
| | - Kirstine L Sibilitz
- The Heart Centre, Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Denmark
| | - Ann D Zwisler
- National Centre of Rehabilitation and Palliation, University of Southern Denmark and University Hospital of Odense, Odense, Denmark
| | - Tone M Norekvål
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | - Anne Lee
- Institute of Public Health, University of Southern Denmark, Odense, Denmark
| | - Niels Buus
- Faculty of Nursing and Midwifery, University of Sydney, Australia
- St Vincent’s Private Hospital Sydney, Australia
- St Vincent’s Hospital Sydney, Australia
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Abdul-Jawad Altisent O, Puri R, Regueiro A, Chamandi C, Rodriguez-Gabella T, Del Trigo M, Campelo-Parada F, Couture T, Marsal JR, Côté M, Paradis JM, DeLarochellière R, Doyle D, Mohammadi S, Dumont E, Rodés-Cabau J. Predictors and Association With Clinical Outcomes of the Changes in Exercise Capacity After Transcatheter Aortic Valve Replacement. Circulation 2017; 136:632-643. [PMID: 28588077 DOI: 10.1161/circulationaha.116.026349] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Accepted: 05/12/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND At present, there are no objective data specifically examining the clinical impact of variations in exercise capacity post-transcatheter aortic valve replacement (TAVR). We describe the changes in exercise capacity between baseline and 6 months post-TAVR, and ascertain factors associated with and clinical implications of a lack of improvement in exercise capacity post-TAVR. METHODS A total of 305 patients (mean age, 79±9 years; 44% men; Society of Thoracic Surgeons predicted risk mortality score, 6.7±4.2%) undergoing TAVR completed both baseline and follow-up exercise capacity assessments at 6 months post-TAVR. Exercise capacity was evaluated by the 6-minute walk test (6MWT). Clinical outcomes were compared between patients displaying greater than (n=152; improving group) versus less than (n=153; nonimproving group) the median percentage change in distance walked between baseline and 6-month follow-up examinations. The primary outcome measure was clinical event rates, measured from the 6-month post-TAVR period onward. Further dichotomization according to baseline 6MWT distance (less than versus more than median walking distance, or slow walker versus fast walker) was also assessed. RESULTS The mean overall distances walked pre- and post-TAVR (6 months post-TAVR) were 204±119 and 263±116 m, respectively (Δ6MWT=60±106 m), with 219 (72%) patients demonstrating an increase in their walking distance (median percentage increase of the entire population was 20% [interquartile range, 0%-80%]). Factors independently correlated with reduced exercise capacity improvement included a range of baseline clinical characteristics (older age, female sex, chronic obstructive pulmonary disease; P<0.05 for all), periprocedural major or life-threatening bleeding (P=0.009) and new-onset anemia at 6 months post-TAVR (P=0.009). Failure to improve the 6MWT distance by at least 20% was independently associated with all-cause mortality (P=0.002) and cardiovascular death or rehospitalization for cardiovascular causes (P=0.001). Baseline slow walkers who were able to improve the 6MWT distance presented with significantly better outcomes than nonimprovers (P=0.01 for all-cause mortality; P=0.001 for cardiovascular end point). CONCLUSIONS Approximately one-third of patients undergoing TAVR did not improve their exercise capacity postprocedure. The lack of functional improvement post-TAVR was predicted by a mix of baseline and periprocedural factors translating into poorer clinical outcomes. These results suggest that systematically implementing exercise capacity assessment pre- and post-TAVR may help to improve patient risk stratification.
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Affiliation(s)
- Omar Abdul-Jawad Altisent
- From Quebec Heart and Lung Institute, Laval University, Quebec City, Canada (O.A.-J.A., R.P., A.R., C.C., T.R.-G., M.d.T., F.C.-P., T.C., M.C., J.-M.P., R.D., D.D., S.M., E.D., J.R.-C.); Department of Medicine, University of Adelaide, Australia; Cleveland Clinic Coordinating Center for Clinical Research, OH (R.P.); and Epidemiology Unit of the Cardiology Department, Vall d'Hebron Hospital, Barcelona, Spain (J.R.M.)
| | - Rishi Puri
- From Quebec Heart and Lung Institute, Laval University, Quebec City, Canada (O.A.-J.A., R.P., A.R., C.C., T.R.-G., M.d.T., F.C.-P., T.C., M.C., J.-M.P., R.D., D.D., S.M., E.D., J.R.-C.); Department of Medicine, University of Adelaide, Australia; Cleveland Clinic Coordinating Center for Clinical Research, OH (R.P.); and Epidemiology Unit of the Cardiology Department, Vall d'Hebron Hospital, Barcelona, Spain (J.R.M.)
| | - Ander Regueiro
- From Quebec Heart and Lung Institute, Laval University, Quebec City, Canada (O.A.-J.A., R.P., A.R., C.C., T.R.-G., M.d.T., F.C.-P., T.C., M.C., J.-M.P., R.D., D.D., S.M., E.D., J.R.-C.); Department of Medicine, University of Adelaide, Australia; Cleveland Clinic Coordinating Center for Clinical Research, OH (R.P.); and Epidemiology Unit of the Cardiology Department, Vall d'Hebron Hospital, Barcelona, Spain (J.R.M.)
| | - Chekrallah Chamandi
- From Quebec Heart and Lung Institute, Laval University, Quebec City, Canada (O.A.-J.A., R.P., A.R., C.C., T.R.-G., M.d.T., F.C.-P., T.C., M.C., J.-M.P., R.D., D.D., S.M., E.D., J.R.-C.); Department of Medicine, University of Adelaide, Australia; Cleveland Clinic Coordinating Center for Clinical Research, OH (R.P.); and Epidemiology Unit of the Cardiology Department, Vall d'Hebron Hospital, Barcelona, Spain (J.R.M.)
| | - Tania Rodriguez-Gabella
- From Quebec Heart and Lung Institute, Laval University, Quebec City, Canada (O.A.-J.A., R.P., A.R., C.C., T.R.-G., M.d.T., F.C.-P., T.C., M.C., J.-M.P., R.D., D.D., S.M., E.D., J.R.-C.); Department of Medicine, University of Adelaide, Australia; Cleveland Clinic Coordinating Center for Clinical Research, OH (R.P.); and Epidemiology Unit of the Cardiology Department, Vall d'Hebron Hospital, Barcelona, Spain (J.R.M.)
| | - Maria Del Trigo
- From Quebec Heart and Lung Institute, Laval University, Quebec City, Canada (O.A.-J.A., R.P., A.R., C.C., T.R.-G., M.d.T., F.C.-P., T.C., M.C., J.-M.P., R.D., D.D., S.M., E.D., J.R.-C.); Department of Medicine, University of Adelaide, Australia; Cleveland Clinic Coordinating Center for Clinical Research, OH (R.P.); and Epidemiology Unit of the Cardiology Department, Vall d'Hebron Hospital, Barcelona, Spain (J.R.M.)
| | - Francisco Campelo-Parada
- From Quebec Heart and Lung Institute, Laval University, Quebec City, Canada (O.A.-J.A., R.P., A.R., C.C., T.R.-G., M.d.T., F.C.-P., T.C., M.C., J.-M.P., R.D., D.D., S.M., E.D., J.R.-C.); Department of Medicine, University of Adelaide, Australia; Cleveland Clinic Coordinating Center for Clinical Research, OH (R.P.); and Epidemiology Unit of the Cardiology Department, Vall d'Hebron Hospital, Barcelona, Spain (J.R.M.)
| | - Thomas Couture
- From Quebec Heart and Lung Institute, Laval University, Quebec City, Canada (O.A.-J.A., R.P., A.R., C.C., T.R.-G., M.d.T., F.C.-P., T.C., M.C., J.-M.P., R.D., D.D., S.M., E.D., J.R.-C.); Department of Medicine, University of Adelaide, Australia; Cleveland Clinic Coordinating Center for Clinical Research, OH (R.P.); and Epidemiology Unit of the Cardiology Department, Vall d'Hebron Hospital, Barcelona, Spain (J.R.M.)
| | - Josep Ramon Marsal
- From Quebec Heart and Lung Institute, Laval University, Quebec City, Canada (O.A.-J.A., R.P., A.R., C.C., T.R.-G., M.d.T., F.C.-P., T.C., M.C., J.-M.P., R.D., D.D., S.M., E.D., J.R.-C.); Department of Medicine, University of Adelaide, Australia; Cleveland Clinic Coordinating Center for Clinical Research, OH (R.P.); and Epidemiology Unit of the Cardiology Department, Vall d'Hebron Hospital, Barcelona, Spain (J.R.M.)
| | - Mélanie Côté
- From Quebec Heart and Lung Institute, Laval University, Quebec City, Canada (O.A.-J.A., R.P., A.R., C.C., T.R.-G., M.d.T., F.C.-P., T.C., M.C., J.-M.P., R.D., D.D., S.M., E.D., J.R.-C.); Department of Medicine, University of Adelaide, Australia; Cleveland Clinic Coordinating Center for Clinical Research, OH (R.P.); and Epidemiology Unit of the Cardiology Department, Vall d'Hebron Hospital, Barcelona, Spain (J.R.M.)
| | - Jean-Michel Paradis
- From Quebec Heart and Lung Institute, Laval University, Quebec City, Canada (O.A.-J.A., R.P., A.R., C.C., T.R.-G., M.d.T., F.C.-P., T.C., M.C., J.-M.P., R.D., D.D., S.M., E.D., J.R.-C.); Department of Medicine, University of Adelaide, Australia; Cleveland Clinic Coordinating Center for Clinical Research, OH (R.P.); and Epidemiology Unit of the Cardiology Department, Vall d'Hebron Hospital, Barcelona, Spain (J.R.M.)
| | - Robert DeLarochellière
- From Quebec Heart and Lung Institute, Laval University, Quebec City, Canada (O.A.-J.A., R.P., A.R., C.C., T.R.-G., M.d.T., F.C.-P., T.C., M.C., J.-M.P., R.D., D.D., S.M., E.D., J.R.-C.); Department of Medicine, University of Adelaide, Australia; Cleveland Clinic Coordinating Center for Clinical Research, OH (R.P.); and Epidemiology Unit of the Cardiology Department, Vall d'Hebron Hospital, Barcelona, Spain (J.R.M.)
| | - Daniel Doyle
- From Quebec Heart and Lung Institute, Laval University, Quebec City, Canada (O.A.-J.A., R.P., A.R., C.C., T.R.-G., M.d.T., F.C.-P., T.C., M.C., J.-M.P., R.D., D.D., S.M., E.D., J.R.-C.); Department of Medicine, University of Adelaide, Australia; Cleveland Clinic Coordinating Center for Clinical Research, OH (R.P.); and Epidemiology Unit of the Cardiology Department, Vall d'Hebron Hospital, Barcelona, Spain (J.R.M.)
| | - Siamak Mohammadi
- From Quebec Heart and Lung Institute, Laval University, Quebec City, Canada (O.A.-J.A., R.P., A.R., C.C., T.R.-G., M.d.T., F.C.-P., T.C., M.C., J.-M.P., R.D., D.D., S.M., E.D., J.R.-C.); Department of Medicine, University of Adelaide, Australia; Cleveland Clinic Coordinating Center for Clinical Research, OH (R.P.); and Epidemiology Unit of the Cardiology Department, Vall d'Hebron Hospital, Barcelona, Spain (J.R.M.)
| | - Eric Dumont
- From Quebec Heart and Lung Institute, Laval University, Quebec City, Canada (O.A.-J.A., R.P., A.R., C.C., T.R.-G., M.d.T., F.C.-P., T.C., M.C., J.-M.P., R.D., D.D., S.M., E.D., J.R.-C.); Department of Medicine, University of Adelaide, Australia; Cleveland Clinic Coordinating Center for Clinical Research, OH (R.P.); and Epidemiology Unit of the Cardiology Department, Vall d'Hebron Hospital, Barcelona, Spain (J.R.M.)
| | - Josep Rodés-Cabau
- From Quebec Heart and Lung Institute, Laval University, Quebec City, Canada (O.A.-J.A., R.P., A.R., C.C., T.R.-G., M.d.T., F.C.-P., T.C., M.C., J.-M.P., R.D., D.D., S.M., E.D., J.R.-C.); Department of Medicine, University of Adelaide, Australia; Cleveland Clinic Coordinating Center for Clinical Research, OH (R.P.); and Epidemiology Unit of the Cardiology Department, Vall d'Hebron Hospital, Barcelona, Spain (J.R.M.).
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McMahon SR, Ades PA, Thompson PD. The role of cardiac rehabilitation in patients with heart disease. Trends Cardiovasc Med 2017; 27:420-425. [PMID: 28318815 DOI: 10.1016/j.tcm.2017.02.005] [Citation(s) in RCA: 144] [Impact Index Per Article: 20.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Accepted: 02/09/2017] [Indexed: 11/16/2022]
Abstract
Cardiac rehabilitation is a valuable treatment for patients with a broad spectrum of cardiac disease. Current guidelines support its use in patients after acute coronary syndrome, coronary artery bypass grafting, coronary stent placement, valve surgery, and stable chronic systolic heart failure. Its use in these conditions is supported by a robust body of research demonstrating improved clinical outcomes. Despite this evidence, cardiac rehabilitation referral and attendance remains low and interventions to increase its use need to be developed.
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Affiliation(s)
- Sean R McMahon
- Cardiology Unit and Cardiovascular Research Institute, Department of Medicine, Larner College of Medicine at the University of Vermont, Burlington, VT, USA.
| | - Philip A Ades
- Cardiology Unit and Cardiovascular Research Institute, Department of Medicine, Larner College of Medicine at the University of Vermont, Burlington, VT, USA
| | - Paul D Thompson
- Heart and Vascular Institute, Department of Medicine, Hartford HealthCare, Hartford, CT, USA
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Pressler A. Cardiac rehabilitation after transcatheter aortic valve implantation: Growing needs in a growing population. Eur J Prev Cardiol 2017; 24:685-687. [DOI: 10.1177/2047487317693953] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- Axel Pressler
- Department of Prevention, Rehabilitation and Sports Medicine, Technische Universität München, Germany
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Tarro Genta F, Tidu M, Bouslenko Z, Bertolin F, Salvetti I, Comazzi F, Giannuzzi P. Cardiac rehabilitation after transcatheter aortic valve implantation compared to patients after valve replacement. J Cardiovasc Med (Hagerstown) 2017; 18:114-120. [DOI: 10.2459/jcm.0000000000000494] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Ribeiro GS, Melo RD, Deresz LF, Dal Lago P, Pontes MR, Karsten M. Cardiac rehabilitation programme after transcatheter aortic valve implantation versus surgical aortic valve replacement: Systematic review and meta-analysis. Eur J Prev Cardiol 2017; 24:688-697. [PMID: 28071146 DOI: 10.1177/2047487316686442] [Citation(s) in RCA: 80] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Background Aortic stenosis is a valvular heart disease characterised by fixed obstruction of the left ventricular outflow. It can be managed by surgical aortic valve replacement (sAVR) or transcatheter aortic valve implantation (TAVI). This review aimed to describe the evidence supporting a cardiac rehabilitation programme on functional capacity and quality of life in aortic stenosis patients after sAVR or TAVI. Methods The search was conducted on multiple databases from January to March 2016. All studies were eligible that evaluated the effects of a post-interventional cardiac rehabilitation programme in aortic stenosis patients. The methodological quality was assessed using the PEDro scale. Meta-analysis was performed separately by procedure and between procedures. The walked distance during the six-minute walk test (6MWD) and Barthel index were evaluated. The analysis was conducted in Review Manager. Results Five studies were included (292 TAVI and 570 sAVR patients). The meta-analysis showed that a cardiac rehabilitation programme was associated with a significant improvement in 6MWD (0.69 (0.47, 0.91); P < 0.001) and Barthel index (0.80 (0.29, 1.30); P = 0.002) after TAVI and 6MWD (0.79 (0.43, 1.15); P < 0.001) and Barthel index (0.93 (0.67, 1.18); P < 0.001) after sAVR. In addition, the meta-analysis showed that the cardiac rehabilitation programme promoted a similar gain in 6MWD (4.28% (-12.73, 21.29); P = 0.62) and Barthel index (-1.52 points (-4.81, 1.76); P = 0.36) after sAVR or TAVI. Conclusions The cardiac rehabilitation programme improved the functional capacity and quality of life in aortic stenosis patients. Patients who underwent TAVI benefitted with a cardiac rehabilitation programme similar to sAVR patients.
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Affiliation(s)
- Gustavo S Ribeiro
- 1 Programa de Pós-graduação em Ciências da Reabilitação, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Brazil
| | - Rosangela D Melo
- 1 Programa de Pós-graduação em Ciências da Reabilitação, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Brazil
| | - Luís F Deresz
- 1 Programa de Pós-graduação em Ciências da Reabilitação, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Brazil.,2 Departamento de Educação Física, Universidade Federal de Juiz de Fora (UFJF), Brazil
| | - Pedro Dal Lago
- 1 Programa de Pós-graduação em Ciências da Reabilitação, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Brazil.,3 Departamento de Fisioterapia, UFCSPA, Brazil
| | - Mauro Rn Pontes
- 4 Departamento de Farmacociências, UFCSPA, Brazil.,5 Unidade de Pesquisa, Hospital São Francisco, Brazil
| | - Marlus Karsten
- 1 Programa de Pós-graduação em Ciências da Reabilitação, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Brazil.,6 Departamento de Fisioterapia, Universidade do Estado de Santa Catarina (UDESC), Brazil
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Vigorito C, Abreu A, Ambrosetti M, Belardinelli R, Corrà U, Cupples M, Davos CH, Hoefer S, Iliou MC, Schmid JP, Voeller H, Doherty P. Frailty and cardiac rehabilitation: A call to action from the EAPC Cardiac Rehabilitation Section. Eur J Prev Cardiol 2016; 24:577-590. [PMID: 27940954 DOI: 10.1177/2047487316682579] [Citation(s) in RCA: 141] [Impact Index Per Article: 17.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Frailty is a geriatric syndrome characterised by a vulnerability status associated with declining function of multiple physiological systems and loss of physiological reserves. Two main models of frailty have been advanced: the phenotypic model (primary frailty) or deficits accumulation model (secondary frailty), and different instruments have been proposed and validated to measure frailty. However measured, frailty correlates to medical outcomes in the elderly, and has been shown to have prognostic value for patients in different clinical settings, such as in patients with coronary artery disease, after cardiac surgery or transvalvular aortic valve replacement, in patients with chronic heart failure or after left ventricular assist device implantation. The prevalence, clinical and prognostic relevance of frailty in a cardiac rehabilitation setting has not yet been well characterised, despite the increasing frequency of elderly patients in cardiac rehabilitation, where frailty is likely to influence the onset, type and intensity of the exercise training programme and the design of tailored rehabilitative interventions for these patients. Therefore, we need to start looking for frailty in elderly patients entering cardiac rehabilitation programmes and become more familiar with some of the tools to recognise and evaluate the severity of this condition. Furthermore, we need to better understand whether exercise-based cardiac rehabilitation may change the course and the prognosis of frailty in cardiovascular patients.
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Affiliation(s)
- Carlo Vigorito
- 1 Department of Translational Medical Sciences, University of Naples Federico II, Italy
| | - Ana Abreu
- 2 Cardiology Department Hospital Santa Marta, Centro Hospitalar Lisboa Central, Portugal
| | - Marco Ambrosetti
- 3 Cardiovascular Rehabilitation Unit, Le Terrazze Clinic, Cunardo, Italy
| | | | - Ugo Corrà
- 5 Department of Cardiac Rehabilitation, Salvatore Maugeri Foundation, Veruno, Italy
| | - Margaret Cupples
- 6 Department of General Practice, UKCRC Centre of Excellence for Public Health Research (NI), Northern Ireland, Queens University, Belfast
| | - Constantinos H Davos
- 7 Cardiovascular Research Laboratory, Biomedical Research Foundation Academy of Athens, Greece
| | | | - Marie-Christine Iliou
- 9 Cardiac Rehabilitation Department, Hopital Corentin Celton-Assistance Publique Hôpitaux de Paris, France
| | - Jean-Paul Schmid
- 10 Cardiology Clinic, Tiefenau Hospital and University of Bern, Switzerland
| | - Heinz Voeller
- 11 Center of Rehabilitation Research, University of Potsdam, Germany; Department of Cardiology, Klinic am See, Rudersdorf
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Pressler A, Christle JW, Lechner B, Grabs V, Haller B, Hettich I, Jochheim D, Mehilli J, Lange R, Bleiziffer S, Halle M. Exercise training improves exercise capacity and quality of life after transcatheter aortic valve implantation: A randomized pilot trial. Am Heart J 2016; 182:44-53. [PMID: 27914499 DOI: 10.1016/j.ahj.2016.08.007] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2016] [Accepted: 08/21/2016] [Indexed: 01/18/2023]
Abstract
BACKGROUND Transcatheter aortic valve implantation (TAVI) is increasingly applied for aortic stenosis in elderly patients with impaired mobility and reduced quality of life. These patients may particularly benefit from postinterventional exercise programs, but no randomized study has evaluated the safety and efficacy of exercise in this population. METHODS In a prospective pilot study, 30 patients after TAVI (mean age, 81±6 years, 44% female, 83±34 days postintervention) were randomly allocated 1:1 to a training group (TG) performing 8 weeks of supervised combined endurance and resistance exercise or to usual care. The formal primary efficacy end point was between-group difference in change in peak oxygen uptake assessed by cardiopulmonary exercise testing; secondary end points included muscular strength, 6-minute walk distance, and quality of life (Kansas City Cardiomyopathy Questionnaire and Medical Outcomes Study 12-Item Short-Form Health Survey questionnaires). Safety was assessed by documenting training-related adverse events, prosthesis, and renal function. RESULTS Significant changes in favor of TG were observed for peak oxygen uptake (group difference, 3.7 mL/min per kg [95% CI, 1.1-6.3; P=.007]), muscular strength (bench press, 6 kg [95% CI, 3-10; P=.002]; rowing, 7 kg [95% CI, 3-11; P<.001]; pulldown, 9 kg [95% CI, 4-14; P=.001]; shoulder press, 5 kg [95% CI, 1-8; P=.008]; leg press, 17 kg [95% CI 6-28; P=.005]), components of quality of life (Kansas City Cardiomyopathy Questionnaire physical limitation, 19.2 [95% CI, 4.1-34.2; P=.015]; symptom burden, 12.3 [95% CI, 0.5-24.0; P=.041]; clinical summary, 12.4 [3.4-21.4; P=.009]), but not for other questionnaire subscales and 6-minute walk distance (15 m [95% CI, -23 to 53; P=.428]). Three dropouts unrelated to exercise occurred (TG=2; usual care,=1); prosthesis and renal function were not affected by the exercise intervention. CONCLUSIONS In patients after TAVI, exercise training appears safe and highly effective with respect to improvements in exercise capacity, muscular strength, and quality of life. CLINICAL TRIAL REGISTRATION Clinicaltrials.govNCT01935297.
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Affiliation(s)
- Axel Pressler
- Department of Prevention, Rehabilitation and Sports Medicine, Klinikum rechts der Isar, Technische Universität München, Munich, Germany.
| | - Jeffrey W Christle
- Department of Prevention, Rehabilitation and Sports Medicine, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Benjamin Lechner
- Department of Prevention, Rehabilitation and Sports Medicine, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Viola Grabs
- Department of Prevention, Rehabilitation and Sports Medicine, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Bernhard Haller
- Institute for Medical Statistics and Epidemiology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Ina Hettich
- Department of Pneumology, University Hospital Freiburg, Freiburg, Germany
| | - David Jochheim
- Cardiology Department, Munich University Clinic, Munich, Germany
| | - Julinda Mehilli
- Cardiology Department, Munich University Clinic, Munich, Germany; DZHK (German Center for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany
| | - Rüdiger Lange
- Clinic for Cardiovascular Surgery, German Heart Center Munich, Munich, Germany
| | - Sabine Bleiziffer
- Clinic for Cardiovascular Surgery, German Heart Center Munich, Munich, Germany
| | - Martin Halle
- Department of Prevention, Rehabilitation and Sports Medicine, Klinikum rechts der Isar, Technische Universität München, Munich, Germany; DZHK (German Center for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany; Else Kröner-Fresenius-Zentrum am Klinikum rechts der Isar, Technische Universität München, Munich, Germany
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Eichler S, Salzwedel A, Reibis R, Nothroff J, Harnath A, Schikora M, Butter C, Wegscheider K, Völler H. Multicomponent cardiac rehabilitation in patients after transcatheter aortic valve implantation: Predictors of functional and psychocognitive recovery. Eur J Prev Cardiol 2016; 24:257-264. [DOI: 10.1177/2047487316679527] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Sarah Eichler
- Centre of Rehabilitation Research, University of Potsdam, Germany
| | - Annett Salzwedel
- Centre of Rehabilitation Research, University of Potsdam, Germany
| | - Rona Reibis
- Cardiological Outpatient Clinic Am Park Sanssouci, Potsdam, Germany
| | - Jörg Nothroff
- MediClin Rehabilitation Centre Spreewald, Burg, Germany
| | | | | | | | - Karl Wegscheider
- Department of Medical Biometry and Epidemiology, University Medical Centre, Hamburg-Eppendorf, Germany
| | - Heinz Völler
- Centre of Rehabilitation Research, University of Potsdam, Germany
- Klinik am See, Rehabilitation Centre for Internal Medicine, Rüdersdorf, Germany
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Pack QR, Lahr BD, Squires RW, Lopez-Jimenez F, Greason KL, Michelena HI, Goel K, Thomas RJ. Survey Reported Participation in Cardiac Rehabilitation and Survival After Mitral or Aortic Valve Surgery. Am J Cardiol 2016; 117:1985-91. [PMID: 27138188 DOI: 10.1016/j.amjcard.2016.03.052] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Revised: 03/25/2016] [Accepted: 03/25/2016] [Indexed: 02/04/2023]
Abstract
We sought to measure the impact of cardiac rehabilitation (CR) on mortality in patients with mitral or aortic heart valve surgery (HVS) and nonobstructive coronary artery disease. We surveyed all patients (or a close family member if the patient was deceased) who had HVS without coronary artery bypass in 2006 through 2010 at the Mayo Clinic to assess if they attended CR after their HVS. We performed a propensity-adjusted landmark analysis to test the association between CR attendance and long-term all-cause mortality conditional on surviving the first year after HVS. Survey response rate was 40% (573/1,420), with responders more likely to be older, have longer hospitalizations, and have more aortic valve disease. A total of 547 patients (59% aortic surgery, ejection fraction 64%) with valid survey responses and 1-year follow-up were included in the propensity analysis, of whom 296 (54%) attended CR. There were 100 deaths during a median follow-up of 5.8 years. For all patients, the propensity-adjusted model suggested no impact of CR on mortality (hazard ratio [HR] 1.03, 95% CI 0.66 to 1.62). When stratified by procedure, results suggested a potentially favorable, but nonsignificant, effect in patients with mitral valve surgery (HR 0.49, 95% CI 0.15 to 1.56), but not in patients with aortic valve surgery (HR 1.00, 95% CI 0.61 to 1.64.) In conclusion, we found no survival advantage for patients with normal preoperative ejection fraction who attended CR after surgical "correction" of their severe aortic or mitral valve disease.
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Schwarz S, Boscheri A, Christle J, Duvinage A, Esefeld K, Fricke H, Pitsch N, Pressler A, Weichenberger M, Halle M. [Exercise training in the therapy of heart diseases: Current evidence and future options]. Herz 2016; 41:159-69; quiz 170-1. [PMID: 26914583 DOI: 10.1007/s00059-016-4403-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Exercise training has been firmly established as an additional therapeutic strategy in addition to pharmacological and interventional treatment in patients with cardiovascular disease. Benefits for quality of life as well as prognosis have been confirmed for cardiovascular risk factors, ischemic heart disease, after myocardial infarction, in heart failure with preserved as well as reduced ejection fraction, in atrial fibrillation and in patients after catheter-assisted aortic valve implantation (TAVI), with an implantable cardioverter defibrillator (ICD) or with left ventricular assist devices (VAD). Training programs have to be tailored according to the disease, stage of disease, comorbidities, age of the patient, medication as well as exercise capacity. For prescribing exercise mode and intensity, a maximum exercise test has to be performed. Ideally, this is accompanied by spirometry to assess maximum values such as maximum oxygen consumption. Training intensity will then be prescribed according to the optimal training range and maximum training intensity.
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Affiliation(s)
- S Schwarz
- Präventive und Rehabilitative Sportmedizin, Klinikum rechts der Isar, TU München, Georg-Brauchle-Ring 56, 80992, München, Deutschland
| | - A Boscheri
- Präventive und Rehabilitative Sportmedizin, Klinikum rechts der Isar, TU München, Georg-Brauchle-Ring 56, 80992, München, Deutschland
| | - J Christle
- Präventive und Rehabilitative Sportmedizin, Klinikum rechts der Isar, TU München, Georg-Brauchle-Ring 56, 80992, München, Deutschland
| | - A Duvinage
- Präventive und Rehabilitative Sportmedizin, Klinikum rechts der Isar, TU München, Georg-Brauchle-Ring 56, 80992, München, Deutschland
- Deutsches Zentrum für Herzkreislaufforschung (DZHK), Munich Heart Alliance, München, Deutschland
| | - K Esefeld
- Präventive und Rehabilitative Sportmedizin, Klinikum rechts der Isar, TU München, Georg-Brauchle-Ring 56, 80992, München, Deutschland
| | - H Fricke
- Präventive und Rehabilitative Sportmedizin, Klinikum rechts der Isar, TU München, Georg-Brauchle-Ring 56, 80992, München, Deutschland
| | - N Pitsch
- Präventive und Rehabilitative Sportmedizin, Klinikum rechts der Isar, TU München, Georg-Brauchle-Ring 56, 80992, München, Deutschland
| | - A Pressler
- Präventive und Rehabilitative Sportmedizin, Klinikum rechts der Isar, TU München, Georg-Brauchle-Ring 56, 80992, München, Deutschland
| | - M Weichenberger
- Präventive und Rehabilitative Sportmedizin, Klinikum rechts der Isar, TU München, Georg-Brauchle-Ring 56, 80992, München, Deutschland
| | - M Halle
- Präventive und Rehabilitative Sportmedizin, Klinikum rechts der Isar, TU München, Georg-Brauchle-Ring 56, 80992, München, Deutschland.
- Deutsches Zentrum für Herzkreislaufforschung (DZHK), Munich Heart Alliance, München, Deutschland.
- Else Kröner-Fresenius-Zentrum, Klinikum rechts der Isar, München, Deutschland.
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Abstract
In recent years, experience with transcatheter aortic valve implantation has led to improved outcomes in elderly patients with severe aortic stenosis (AS) who may not have previously been considered for intervention. These patients are often frail with significant comorbid conditions. As the prevalence of AS increases, there is a need for improved assessment parameters to determine the patients most likely to benefit from this novel procedure. This review discusses the diagnostic criteria for severe AS and the trials available to aid in the decision to refer for aortic valve procedures in the elderly.
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Affiliation(s)
- Matthew Finn
- Department of Cardiology, Columbia University Medical Center, New York, NY.
| | - Philip Green
- Department of Cardiology, Columbia University Medical Center, New York, NY
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Górski A, Weber-Dabrowska B. The potential role of endogenous bacteriophages in controlling invading pathogens. Cell Mol Life Sci 2005; 62:511-9. [PMID: 15747058 DOI: 10.1007/s00018-004-4403-6] [Citation(s) in RCA: 109] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Bacteriophages (phages) are omnipresent in our environment, and recent studies highlight their potential impact on the microbial world. Phages can also be present in mammalian organisms, including man (intestines, oral cavity, urine, sputum and serum). Data are available which suggest that those endogenous phages could play an important role in eliminating bacteria and regulating the body ecosystem. Furthermore, our most recent findings suggest that phages can exert immunosuppressive action in the gut, helping control local inflammatory and autoimmune reactions, and demonstrate anticancer activity. We hypothesize that phages could act in concert with the immune system in immunosurveillance against bacteria, viruses and cancer.
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Affiliation(s)
- Andrzej Górski
- L. Hirszfeld Institute of Immunology and Experimental Therapy, Polish Academy of Sciences, 53114, Wroclaw, Poland.
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