1
|
Liu S, Yuan X, Liang H, Jiang Z, Yang X, Gao H. Development and validation of frailty risk prediction model for elderly patients with coronary heart disease. BMC Geriatr 2024; 24:742. [PMID: 39244543 PMCID: PMC11380413 DOI: 10.1186/s12877-024-05320-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Accepted: 08/20/2024] [Indexed: 09/09/2024] Open
Abstract
OBJECTIVE To analyze the influential factors of frailty in elderly patients with coronary heart disease (CHD), develop a nomogram-based risk prediction model for this population, and validate its predictive performance. METHODS A total of 592 elderly patients with CHD were conveniently selected and enrolled from 3 tertiary hospitals, 5 secondary hospitals, and 3 community health service centers in China between October 2022 and January 2023. Data collection involved the use of the general information questionnaire, the Frail scale, and the instrumental ability of daily living assessment scale. And the patients were categorized into two groups based on frailty, and χ2 test as well as logistic regression analysis were used to identify and determine the influencing factors of frailty. The nomograph prediction model for elderly patients with CHD was developed using R software (version 4.2.2). The Hosmer-Lemeshow test and the area under the receiver operating characteristic (ROC) curve were employed to assess the predictive performance of the model. Additionally, the Bootstrap resampling method was utilized to validate the model and generate the calibration curve of the prediction model. RESULTS The prevalence of frailty in elderly patients with CHD was 30.07%. The multiple factor analysis revealed that poor health status (OR = 28.169)/general health status (OR = 18.120), age (OR = 1.046), social activities (OR = 0.673), impaired instrumental ability of daily living (OR = 2.384) were independent risk factors for frailty (all P < 0.05). The area under the ROC curve of the nomograph prediction model was 0.847 (95% CI: 0.809 ~ 0.878, P < 0.001), with a sensitivity of 0.801, and specificity of 0.793; the Hosmer- Lemeshow χ2 value was 12.646 (P = 0.125). The model validation results indicated that the C value of 0.839(95% CI: 0.802 ~ 0.879) and Brier score of 0.139, demonstrating good consistency between predicted and actual values. CONCLUSION The prevalence of frailty is high among elderly patients with CHD, and it is influenced by various factors such as health status, age, lack of social participation, and impaired ability of daily life. These factors have certain predictive value for identifying frailty early and intervention in elderly patients with CHD.
Collapse
Affiliation(s)
- Siqin Liu
- Department of Neurology, Affiliated Hospital of Zunyi Medical University, Zunyi, China
- Nursing Department, Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Xiaoli Yuan
- Nursing Department, Affiliated Hospital of Zunyi Medical University, Zunyi, China.
| | - Heting Liang
- Nursing Department, Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Zhixia Jiang
- College Office, Guizhou Nursing Vocational and Technical College, Guiyang, China
| | - Xiaoling Yang
- College Office, Guizhou Nursing Vocational and Technical College, Guiyang, China
| | - Huiming Gao
- Nursing Department, Affiliated Hospital of Zunyi Medical University, Zunyi, China
| |
Collapse
|
2
|
Díez-Villanueva P, Jiménez-Méndez C, Cepas-Guillén P, Arenas-Loriente A, Fernández-Herrero I, García-Pardo H, Díez-Delhoyo F. Current Management of Non-ST-Segment Elevation Acute Coronary Syndrome. Biomedicines 2024; 12:1736. [PMID: 39200201 PMCID: PMC11352006 DOI: 10.3390/biomedicines12081736] [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: 06/30/2024] [Revised: 07/27/2024] [Accepted: 07/30/2024] [Indexed: 09/02/2024] Open
Abstract
Cardiovascular disease constitutes the leading cause of morbimortality worldwide. Non-ST-segment elevation acute coronary syndrome (NSTE-ACS) is a common cardiovascular condition, closely related to the ageing population and significantly affecting survival and quality of life. The management of NSTE-ACS requires specific diagnosis and therapeutic strategies, thus highlighting the importance of a personalized approach, including tailored antithrombotic therapies and regimens, combined with timely invasive management. Moreover, specific and frequent populations in clinical practice, such as the elderly and those with chronic kidney disease, pose unique challenges in the management of NSTE-ACS due to their increased risk of ischemic and hemorrhagic complications. In this scenario, comprehensive management strategies and multidisciplinary care are of great importance. Cardiac rehabilitation and optimal management of cardiovascular risk factors are essential elements of secondary prevention since they significantly improve prognosis. This review highlights the need for a personalized approach in the management of NSTE-ACS, especially in vulnerable populations, and emphasizes the importance of precise antithrombotic management together with tailored revascularization strategies, as well as the role of cardiac rehabilitation in NSTE-ACS patients.
Collapse
Affiliation(s)
| | - César Jiménez-Méndez
- Cardiology Department, Hospital Universitario Puerta del Mar, 11009 Cádiz, Spain;
| | - Pedro Cepas-Guillén
- Cardiology Department, Hospital Clinic, 08036 Barcelona, Spain; (P.C.-G.); (A.A.-L.)
| | | | - Ignacio Fernández-Herrero
- Cardiology Department, Hospital Universitario Doce de Octubre, 28041 Madrid, Spain; (I.F.-H.); (F.D.-D.)
| | - Héctor García-Pardo
- Cardiology Department, Hospital Universitario Río Hortega, 47012 Valladolid, Spain;
| | - Felipe Díez-Delhoyo
- Cardiology Department, Hospital Universitario Doce de Octubre, 28041 Madrid, Spain; (I.F.-H.); (F.D.-D.)
| |
Collapse
|
3
|
Vazquez-Guajardo M, Rivas D, Duque G. Exercise as a Therapeutic Tool in Age-Related Frailty and Cardiovascular Disease: Challenges and Strategies. Can J Cardiol 2024; 40:1458-1467. [PMID: 38215969 DOI: 10.1016/j.cjca.2024.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 12/12/2023] [Accepted: 01/07/2024] [Indexed: 01/14/2024] Open
Abstract
Understanding the link between heart disease and frailty in older adults is crucial. Although medical progress has extended life, it has not fully addressed the decline in function and quality of life in frail older people. Frailty is a state of vulnerability to health stressors that needs comprehensive solutions. Its assessment within health care, especially in cardiology, is important owing to its association with worse clinical outcomes. Recent evidence and guidelines suggest that the prescription of a comprehensive exercise regimen, tailored to progressively include strength, balance, mobility, and endurance training improves adherence, functionality, and health-related quality of life, in both acute and chronic cardiovascular diseases. In addition, exercise is a vital tool that improves function, targets frailty, and holistically affects the body's systems. Still, many frail people do not exercise enough, and when they do, they usually do not follow an appropriate plan tailored for better functional outcomes. Overcoming barriers and limitations in exercise enrollment and adherence through strategies such as automated cardiac rehabilitation referral, patient education, and eHealth tools can notably improve clinical outcomes.
Collapse
Affiliation(s)
| | - Daniel Rivas
- Bone, Muscle and Geroscience Research Group, Research Institute of the McGill University Health Centre, Montréal, Québec, Canada
| | - Gustavo Duque
- Bone, Muscle and Geroscience Research Group, Research Institute of the McGill University Health Centre, Montréal, Québec, Canada; Geriatric Medicine, Faculty of Medicine, McGill University, Montréal, Québec, Canada.
| |
Collapse
|
4
|
Bigot M, Guy JM, Monpere C, Cohen-Solal A, Pavy B, Iliou MC, Bosser G, Corone S, Douard H, Farrokhi T, Guerder A, Guillo P, Houppe JP, Pezel T, Pierre B, Roueff S, Thomas D, Verges B, Blanchard JC, Ghannem M, Marcadet D. Cardiac rehabilitation recommendations of the Group Exercise Rehabilitation Sports - Prevention (GERS-P) of the French Society of Cardiology: 2023 update. Arch Cardiovasc Dis 2024; 117:521-541. [PMID: 39174436 DOI: 10.1016/j.acvd.2024.05.119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2024] [Revised: 05/15/2024] [Accepted: 05/16/2024] [Indexed: 08/24/2024]
Affiliation(s)
- Muriel Bigot
- Centre de réadaptation cardiaque, Cardiocéan, 17138 Puilboreau, France.
| | - Jean Michel Guy
- Le Clos Champirol rééducation, 42270 Saint-Priest-en-Jarez, France
| | | | - Alain Cohen-Solal
- Service de cardiologie, centre de réadaptation cardiaque, hôpital Lariboisière, Assistance publique-Hôpitaux de Paris, Inserm UMRS-942, université Paris Cité, 75010 Paris, France
| | - Bruno Pavy
- Service de réadaptation cardiovasculaire, CH Loire Vendée Océan, 44270 Machecoul, France
| | - Marie Christine Iliou
- Centre de réadaptation cardiaque, groupe hospitalier Paris Saint-Joseph, 75014 Paris, France
| | - Gilles Bosser
- Service de cardiologie pédiatrique et congénitale, CHU Nancy, 54600 Vandœuvre-Lès-Nancy, France
| | - Sonia Corone
- Service réadaptation cardiaque, centre hospitalier de Bligny, 91640 Briis-sous-Forges, France
| | | | - Titi Farrokhi
- Service réadaptation cardiaque, centre hospitalier de Bligny, 91640 Briis-sous-Forges, France
| | - Antoine Guerder
- Service de pneumologie, hôpital Pitié-Salpêtrière, Assistance publique-Hôpitaux de Paris, 75013 Paris, France
| | - Pascal Guillo
- Centre de réadaptation Saint-Yves, 35000 Rennes, France
| | | | - Theo Pezel
- Service de cardiologie, hôpital Lariboisière, AP-HP, université Paris Est Créteil, 75010 Paris, France
| | | | - Stephane Roueff
- Service de néphrologie, hôpital européen Georges-Pompidou, Assistance publique-Hôpitaux de Paris, 75015 Paris, France
| | - Daniel Thomas
- Institut de cardiologie Pitié-Salpêtrière, AP-HP, 75013 Paris, France
| | | | | | - Mohamed Ghannem
- Service de cardiologie, hôpital de Gonesse, faculté de médecine, Sousse, Tunisia; Université Picardie Jules-Verne, 80000 Amiens, France
| | | |
Collapse
|
5
|
Pal T, Baba DF, Preg Z, Nemes-Nagy E, Nyulas KI, German-Sallo M. The Risk of Atrial Fibrillation and Previous Ischemic Stroke in Cognitive Decline. J Clin Med 2024; 13:4117. [PMID: 39064156 PMCID: PMC11277964 DOI: 10.3390/jcm13144117] [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: 06/03/2024] [Revised: 06/29/2024] [Accepted: 07/11/2024] [Indexed: 07/28/2024] Open
Abstract
Objectives: Our study investigated the inverse relationship between cognitive decline (CD) and the presence of documented atrial fibrillation (AFib), ischemic stroke, heart failure, lower extremity peripheral artery disease, and diabetes mellitus. Methods: We conducted a retrospective cross-sectional study between December 2016 and November 2019. A total of 469 patients were enrolled who underwent cognitive evaluation with three cognitive tests (Montreal Cognitive Assessment-MOCA, Mini-Mental State Examination-MMSE, and General Practitioner Assessment of Cognition-GPCOG). We used the standard cut-off values, and the optimal thresholds were obtained from the receiver operating characteristic curves. Results: The standard cut-off level of the MOCA (<26 points) was associated with the presence of AFib (OR: 1.83, 95% CI: 1.11-3.01) and the optimal cut-off level with <23 points with ischemic stroke (OR: 2.64, 95% CI: 1.47-4.74; p = 0.0011). The optimal cut-off value of the MMSE (<28 points) was associated with the presence of ischemic stroke (OR: 3.07, 95% CI: 1.56-6.07; p = 0.0012), AFib (OR: 1.65, 95% CI: 1.05-2.60; p = 0.0287), and peripheral artery disease (OR: 2.72, 95% CI: 1.38-5.36; p = 0.0039). GPCOG < 8 points were associated with ischemic stroke (OR: 2.18, 95% CI: 1.14-4.14; p = 0.0176) and heart failure (OR: 1.49, 95% CI: 1.01-2.21; p = 0.0430). Conclusions: Our research highlighted the broader utility of cognitive assessment. The MOCA and MMSE scores proved to be associated with documented AFib. Higher cognitive test results than the standard threshold for CD of the MMSE, GPCOG, and lower MOCA scores represented risk factors for the presence of previous ischemic stroke.
Collapse
Affiliation(s)
- Tunde Pal
- Department of Internal Medicine V, George Emil Palade University of Medicine Pharmacy, Science, and Technology of Targu Mures, 540142 Targu Mures, Romania
| | - Dragos-Florin Baba
- Department of Cell and Molecular Biology, George Emil Palade University of Medicine Pharmacy, Science, and Technology of Targu Mures, 540142 Targu Mures, Romania
| | - Zoltan Preg
- Department of Family Medicine, George Emil Palade University of Medicine Pharmacy, Science, and Technology of Targu Mures, 540142 Targu Mures, Romania;
- Department of Cardiovascular Rehabilitation, County Emergency Clinical Hospital, 540042 Targu Mures, Romania;
| | - Eniko Nemes-Nagy
- Department of Chemistry and Medical Biochemistry, George Emil Palade University of Medicine Pharmacy, Science, and Technology of Targu Mures, 540142 Targu Mures, Romania;
- Department of Clinical Laboratory, County Emergency Clinical Hospital, 540042 Targu Mures, Romania
| | - Kinga-Ilona Nyulas
- PhD Student-Doctoral School, George Emil Palade University of Medicine Pharmacy, Science, and Technology of Targu Mures, 540142 Targu Mures, Romania;
| | - Marta German-Sallo
- Department of Cardiovascular Rehabilitation, County Emergency Clinical Hospital, 540042 Targu Mures, Romania;
- Department of Internal Medicine III, George Emil Palade University of Medicine Pharmacy, Science, and Technology of Targu Mures, 540142 Targu Mures, Romania
| |
Collapse
|
6
|
Steinmetz C, Krause L, Sulejmanovic S, Kaumkötter S, Hartog J, Scheenstra B, Stefan F, Mengden T, Grefe C, Knoglinger E, Reiss N, Bjarnason-Wehrens B, Schmidt T, Sadlonova M, von Arnim CAF, Heinemann S. Evaluation of frailty in geriatric patients undergoing cardiac rehabilitation after cardiac procedure: results of a prospective, cross-sectional study. BMC Sports Sci Med Rehabil 2024; 16:146. [PMID: 38956610 PMCID: PMC11221201 DOI: 10.1186/s13102-024-00937-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2024] [Accepted: 06/24/2024] [Indexed: 07/04/2024]
Abstract
BACKGROUND Frailty is an indicator of a decline in quality of life and functional capacity in cardiac rehabilitation (CR) patients. Currently, there is no standardized assessment tool for frailty used in CR. The aim of this study was to determine if the Clinical Frailty Scale (CFS) is feasible for assessing frailty in CR. METHODS Prospective, cross-sectional study within the framework of the ongoing multicenter prehabilitation study "PRECOVERY". Patients ≥75 years undergoing CR after cardiac procedure (n=122) were recruited in four German inpatient CR facilities. Assessments included: CFS, Katz-Index, hand grip strength (HGS), Short Physical Performance Battery (SPPB) and six-minute-walk test (6MWT). Outcomes were frailty (CFS≥4) and the correlation of frailty with assessments of functional capacity, activities of daily living and clinical parameters. Statistical analysis included descriptive statistics and correlations, using the spearman correlation coefficient and chi-square test to test for significance. RESULTS Data from 101 patients (79.9±4.0 years; 63% male) were analyzed. The mean CFS score was 3.2±1.4; 41.6% were defined as frail (CFS≥4). The mean time required to assess the CFS was 0.20 minutes. The findings show that CFS correlates significantly (p<0.001) with the following factors: Katz-Index, HGS, SPPB-Score and 6MWT (r≤-0.575). In addition, CFS correlated with small to moderate effects with co-morbidities (r=0.250), as-needed medications and need for nursing assistance (r≤0.248). CONCLUSIONS The CFS assessment can be performed in under one minute and it correlates significantly with assessments of functional capacity, activities of daily living and clinical parameters in the CR setting. TRIAL REGISTRATION German Clinical Trials Register (DRKS; http:// www. drks. de; DRKS00032256). Retrospectively registered on 13 July 2023.
Collapse
Affiliation(s)
- Carolin Steinmetz
- Department of Geriatrics, University Medical Center Goettingen, Robert-Koch-Straße 40, 37075, Goettingen, Germany.
| | - Laura Krause
- Department of Geriatrics, University Medical Center Goettingen, Robert-Koch-Straße 40, 37075, Goettingen, Germany
| | - Samra Sulejmanovic
- Department of Sports Science, University of Hildesheim, Universitätsplatz 1, 31141, Hildesheim, Germany
| | - Sabrina Kaumkötter
- Schüchtermann-Schiller'sche Clinic, Ulmenallee 11, 49214, Bad Rothenfelde, Germany
| | - Johanneke Hartog
- Department of Cardio-Thoracic Surgery, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ, Groningen, Netherlands
| | - Bart Scheenstra
- Department of Cardiothoracic Surgery, Heart and Vascular Center, Maastricht University Medical Center, Professor Debyelaan 25, 6229 HX, Netherlands, Maastricht
| | - Flohr Stefan
- Department of Sports Science, University of Hildesheim, Universitätsplatz 1, 31141, Hildesheim, Germany
| | - Thomas Mengden
- Department of Rehabilitation, Kerckhoff Heart Center, Ludwigstraße 41, 61231, Bad Nauheim, Germany
| | - Clemens Grefe
- Clinic and Rehabilitation Center Lippoldsberg, Birkenallee 1, 34399, Wesertal, Germany
| | - Ernst Knoglinger
- Kirchberg-Clinic Bad Lauterberg, Kirchberg 7-11, 37431, Bad Lauterberg, Germany
| | - Nils Reiss
- Schüchtermann-Schiller'sche Clinic, Ulmenallee 11, 49214, Bad Rothenfelde, Germany
| | - Birna Bjarnason-Wehrens
- Institute of Cardiology and Sports Medicine, Department Preventive and Rehabilitative Sport and Exercise Medicine, German Sport University, Am Sportpark Müngersdorf 6, 50933, Cologne, Germany
| | - Thomas Schmidt
- Schüchtermann-Schiller'sche Clinic, Ulmenallee 11, 49214, Bad Rothenfelde, Germany
- Institute of Cardiology and Sports Medicine, Department Preventive and Rehabilitative Sport and Exercise Medicine, German Sport University, Am Sportpark Müngersdorf 6, 50933, Cologne, Germany
| | - Monika Sadlonova
- Department of Geriatrics, University Medical Center Goettingen, Robert-Koch-Straße 40, 37075, Goettingen, Germany
- Department of Psychosomatic Medicine and Psychotherapy, University of Goettingen Medical Center, Robert-Koch-Straße 40, 37075, Goettingen, Germany
- Department of Cardiovascular and Thoracic Surgery, University of Goettingen Medical Center, Robert-Koch-Straße 40, 37075, Goettingen, Germany
- German Center for Cardiovascular Research (DZHK), partner site Goettingen, Robert-Koch-Straße 42a, 37075, Goettingen, Germany
| | - Christine A F von Arnim
- Department of Geriatrics, University Medical Center Goettingen, Robert-Koch-Straße 40, 37075, Goettingen, Germany
- German Center for Cardiovascular Research (DZHK), partner site Goettingen, Robert-Koch-Straße 42a, 37075, Goettingen, Germany
| | - Stephanie Heinemann
- Department of Geriatrics, University Medical Center Goettingen, Robert-Koch-Straße 40, 37075, Goettingen, Germany
| |
Collapse
|
7
|
Alonso Salinas GL, Cepas-Guillén P, León AM, Jiménez-Méndez C, Lozano-Vicario L, Martínez-Avial M, Díez-Villanueva P. The Impact of Geriatric Conditions in Elderly Patients with Coronary Heart Disease: A State-of-the-Art Review. J Clin Med 2024; 13:1891. [PMID: 38610656 PMCID: PMC11012545 DOI: 10.3390/jcm13071891] [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: 03/03/2024] [Revised: 03/18/2024] [Accepted: 03/22/2024] [Indexed: 04/14/2024] Open
Abstract
The growing geriatric population presenting with coronary artery disease poses a primary challenge for healthcare services. This is a highly heterogeneous population, often underrepresented in studies and clinical trials, with distinctive characteristics that render them particularly vulnerable to standard management/approaches. In this review, we aim to summarize the available evidence on the treatment of acute coronary syndrome in the elderly. Additionally, we contextualize frailty, comorbidity, sarcopenia, and cognitive impairment, common in these patients, within the realm of coronary artery disease, proposing strategies for each case that may assist in therapeutic approaches.
Collapse
Affiliation(s)
- Gonzalo Luis Alonso Salinas
- Cardiology Department, Hospital Universitario de Navarra (HUN-NOU), Calle de Irunlarrea, 3, 31008 Pamplona, Spain;
- Navarrabiomed (Miguel Servet Foundation), IdiSNA, 31008 Pamplona, Spain;
- Heath Sciences Department, Universidad Pública de Navarra (UPNA-NUP), 31006 Pamplona, Spain
| | - Pedro Cepas-Guillén
- Quebec Heart and Lung Institute, Laval University, 2725 Ch Ste-Foy, Quebec, QC G1V 4G5, Canada;
| | - Amaia Martínez León
- Cardiology Department, Hospital Universitario de Navarra (HUN-NOU), Calle de Irunlarrea, 3, 31008 Pamplona, Spain;
- Navarrabiomed (Miguel Servet Foundation), IdiSNA, 31008 Pamplona, Spain;
| | - César Jiménez-Méndez
- Cardiology Department, Hospital Universitario Puerta del Mar, Avda Ana de Viya 21, 11009 Cádiz, Spain;
| | - Lucia Lozano-Vicario
- Navarrabiomed (Miguel Servet Foundation), IdiSNA, 31008 Pamplona, Spain;
- Geriatric Medicine Department, Hospital Universitario de Navarra (HUN-NOU), Calle de Irunlarrea, 3, 31008 Pamplona, Spain
| | - María Martínez-Avial
- Cardiology Department, Hospital Universitario La Princesa, Calle Diego de León 62, 28006 Madrid, Spain; (M.M.-A.); (P.D.-V.)
| | - Pablo Díez-Villanueva
- Cardiology Department, Hospital Universitario La Princesa, Calle Diego de León 62, 28006 Madrid, Spain; (M.M.-A.); (P.D.-V.)
| |
Collapse
|
8
|
Kambič T, Hansen D, Harber MP. Resistance Training in Cardiac Rehabilitation: PAST, PRESENT, AND FUTURE. J Cardiopulm Rehabil Prev 2024; 44:79-82. [PMID: 38407806 DOI: 10.1097/hcr.0000000000000851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/27/2024]
Affiliation(s)
- Tim Kambič
- Department of Medical Sciences in Sport, Faculty of Sport, University of Ljubljana, Ljubljana, Slovenia (Dr Kambič); Heart Centre Hasselt, Jessa Hospital, Hasselt, Belgium (Dr Hansen); BIOMED (Biomedical Research Institute) and REVAL (Rehabilitation Research Centre) (REVAL/BIOMED), Hasselt University, Diepenbeek, Belgium (Dr Hansen); and Clinical Exercise Physiology Program, Human Performance Laboratory, Ball State University, Muncie, Indiana (Dr Harber)
| | | | | |
Collapse
|
9
|
Petrovic M, Spirito A, Sartori S, Vogel B, Tchetche D, Petronio AS, Mehilli J, Lefevre T, Presbitero P, Capranzano P, Pileggi B, Iadanza A, Sardella G, van Mieghem NM, Meliga E, Feng Y, Dumonteil N, Cohen R, Fraccaro C, Trabattoni D, Mikhail G, Ferrer-Gracia MC, Naber C, Sharma SK, Watanabe Y, Morice MC, Dangas GD, Chieffo A, Mehran R. Prognostic Impact of Prefrailty and Frailty in Women Undergoing TAVR: Insights From the WIN-TAVI Registry. Can J Cardiol 2024; 40:457-467. [PMID: 37923124 DOI: 10.1016/j.cjca.2023.10.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Revised: 10/20/2023] [Accepted: 10/24/2023] [Indexed: 11/07/2023] Open
Abstract
BACKGROUND The risks of prefrail and frail women undergoing transcatheter aortic valve replacement (TAVR) have not been fully examined. The aim of the analysis was to assess the prognostic impact of prefrailty and frailty in women undergoing TAVR. METHODS Women at intermediate or high surgical risk with severe aortic stenosis undergoing TAVR from the prospective multicentre WIN-TAVI (Women's International Transcatheter Aortic Valve Implantation) registry were stratified based on the number of Fried frailty criteria (weight loss, exhaustion, low physical activity, slow gait, weakness) met: nonfrail (no criteria), prefrail (1 or 2 criteria), or frail (3 or more criteria). The primary outcome at 1 year was the Valve Academic Research Consortium 2 (VARC-2) efficacy end point, a composite of mortality, stroke, myocardial infarction, hospitalisation for valve-related symptoms or heart failure, and valve-related dysfunction; secondary outcomes included the composite of VARC-2 life-threatening or major bleeding. RESULTS Out of 1019 women, 297 (29.1%) met at least 1 frailty criterion: 264 (25.9%) had prefrailty and 33 (3.2%) frailty. The 1-year risk of the primary outcome was significantly higher in prefrail and frail (20.2%) than in nonfrail (14.9%) women (adjusted hazard ratio [aHR] 1.51, 95% confidence interval [CI] 1.07-2.12). The risk of VARC-2 life-threatening or major bleeding was higher in prefrail or frail (19.9%) than in nonfrail (10.0%) women (aHR 2.06, 95% CI 1.42-2.97). These risks were consistently increased in the prefrail and frail groups assessed separately. CONCLUSIONS In women undergoing TAVR, the presence of prefrailty or frailty conferred an increased risk of the VARC-2 efficacy end point and of VARC-2 life-threatening or major bleeding.
Collapse
Affiliation(s)
- Marija Petrovic
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | | | - Samantha Sartori
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Birgit Vogel
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | | | | | - Julinda Mehilli
- Munich University Clinic, Ludwig-Maximilians University and German Centre for Cardiovascular Research, Munich Heart Alliance, Munich, Germany
| | - Thierry Lefevre
- Institut Hospitalier Jacques Cartier, Ramsay Générale de Santé, Massy, France
| | | | - Piera Capranzano
- Cardiology, Policlinico Hospital, University of Catania, Catania, Italy
| | - Brunna Pileggi
- Icahn School of Medicine at Mount Sinai, New York, New York, USA; Department of Cardiopneumonology, Heart Institute of the University of São Paulo, São Paulo, Brazil
| | - Alessandro Iadanza
- Azienda Ospedaliera Universitaria Senese, Policlinico Le Scotte, Siena, Italy
| | - Gennaro Sardella
- Policlinico Umberto I "Sapienza," University of Rome, Rome, Italy
| | | | | | - Yihan Feng
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | | | - Rebecca Cohen
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | | | | | - Ghada Mikhail
- Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, United Kingdom
| | | | - Christoph Naber
- Contilia Heart and Vascular Centre, Elisabeth Krankenhaus, Essen, Germany
| | - Samin K Sharma
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Yusuke Watanabe
- Department of Cardiology, Teikyo University School of Medicine, Tokyo, Japan
| | - Marie-Claude Morice
- Institut Hospitalier Jacques Cartier, Ramsay Générale de Santé, Massy, France
| | - George D Dangas
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | | | - Roxana Mehran
- Icahn School of Medicine at Mount Sinai, New York, New York, USA.
| |
Collapse
|
10
|
Rashid C, Pollock C, Aldworth M, Chow J, Kent M, Sapardanis K, Yentin S, Jaglal S, Colella TJ. Development of an Algorithm to Screen for Frailty Using the Clinical Frailty Scale with Postoperative Patients Entering Cardiac Rehabilitation. Physiother Can 2024; 76:78-85. [PMID: 38465304 PMCID: PMC10919360 DOI: 10.3138/ptc-2021-0098] [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: 09/25/2021] [Revised: 03/14/2022] [Accepted: 03/28/2022] [Indexed: 03/12/2024]
Abstract
Purpose Frailty is not commonly assessed on intake to cardiac rehabilitation (CR), but screening could enable targeted interventions and potentially reduce secondary complications. This study aimed to develop and retrospectively examine the feasibility of utilizing a CR-specific algorithm based on the Clinical Frailty Scale (CFS). Our CFS-CR algorithm endeavoured to screen for frailty in older adults (> 65 y) entering CR following cardiac surgery/procedure. Method The charts of 30 former patients (mean age: 74.0 ± 6.9 y) were examined by a clinician working in CR. Results The clinician was unable to score any of the patients based on their medical charts using the CFS-CR due to insufficient data. Documentation was typically limited in the areas of instrumental and basic activities of daily living whereas exercise data were readily available. Conclusions Current intake documentation in CR limited the ability to retrospectively screen for frailty. This finding suggests a need for a frailty-specific tool to support routine clinical screening. Prospective evaluation of the CFS-CR is warranted to further examine the clinical utility of the algorithm during CR intake assessments.
Collapse
Affiliation(s)
- Coomal Rashid
- From the: Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
| | - Courtney Pollock
- Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada
| | - Madeleine Aldworth
- From the: Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
| | - Jennifer Chow
- From the: Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
| | - Michael Kent
- From the: Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
| | - Kristina Sapardanis
- From the: Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
| | - Sam Yentin
- From the: Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
| | - Susan Jaglal
- From the: Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
- KITE, University Health Network Toronto Rehabilitation Institute, Toronto, Ontario, Canada
| | - Tracey Jf Colella
- From the: Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
- KITE, University Health Network Toronto Rehabilitation Institute, Toronto, Ontario, Canada
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
11
|
Niebauer J, Bäck C, Bischoff-Ferrari HA, Dehbi HM, Szekely A, Völler H, Sündermann SH. Preinterventional frailty assessment in patients scheduled for cardiac surgery or transcatheter aortic valve implantation: a consensus statement of the European Association for Cardio-Thoracic Surgery (EACTS) and the European Association of Preventive Cardiology (EAPC) of the European Society of Cardiology (ESC). Eur J Prev Cardiol 2024; 31:146-181. [PMID: 37804173 DOI: 10.1093/eurjpc/zwad304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 03/22/2023] [Indexed: 10/09/2023]
Affiliation(s)
- Josef Niebauer
- Paracelsus Medical University Salzburg, Institute of Sports Medicine, Prevention and Rehabilitation, Salzburg, Austria
- Ludwig Boltzmann Institute for Digital Health and Prevention, Salzburg, Austria
- REHA-Zentrum Salzburg, University Hospital Salzburg, Austria
| | - Caroline Bäck
- Department of Cardiothoracic Surgery, RT, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Heike A Bischoff-Ferrari
- Center on Ageing and Mobility, University Hospital and University of Zurich, Zurich, Switzerland
| | - Hakim-Moulay Dehbi
- University College London, Comprehensive Clinical Trials Unit, London, Great Britain
| | - Andrea Szekely
- Semmelweis University, Department of Anesthesiology and Intensive Therapy, Budapest, Hungary
| | - Heinz Völler
- Faculty of Health Sciences Brandenburg, University of Potsdam, Department of Rehabilitation Medicine, Potsdam, Germany
- Klinik am See, Rehabilitation Centre for Internal Medicine, Rüdersdorf, Germany
| | - Simon H Sündermann
- Deutsches Herzzentrum der Charité, Department of Cardiothoracic and Vascular Surgery, Berlin, Germany
- Charité- Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany
- DZHK (German Center of Cardiovascular Research), Partner Site Berlin, Berlin, Germany
| |
Collapse
|
12
|
Lakušić N, Sopek Merkaš I. Quo vadis cardiac rehabilitation; the role of comprehensive cardiac rehabilitation in modern cardiology. World J Cardiol 2023; 15:627-632. [PMID: 38173904 PMCID: PMC10758603 DOI: 10.4330/wjc.v15.i12.627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 11/07/2023] [Accepted: 11/29/2023] [Indexed: 12/25/2023] Open
Abstract
In accordance with the guidelines established by prominent European and global cardiology associations, comprehensive cardiac rehabilitation (CR) stands as an officially endorsed and highly recommended therapeutic approach (class I recommendations; level of evidence A) for a diverse spectrum of cardiac patients. Nevertheless, it is a cause for concern to observe that fewer than 50% of eligible patients are being effectively referred for CR, whether in an outpatient or inpatient setting. Concurrently, studies reveal that a substantial proportion of individuals with atherosclerotic cardiovascular disease maintain unhealthy lifestyles and exhibit suboptimal management of modifiable cardiovascular risk factors, including hypertension, lipid levels, and diabetes. Beyond the conventional patient profile encompassing those recovering from acute coronary syndrome with or without percutaneous coronary intervention, as well as patients who have undergone coronary or valvular surgery, contemporary CR now emphasizes specialized subgroups of patients. These include frail elderly patients, the female population with its unique considerations, individuals burdened by multiple cardiovascular comorbidities, those who have developed psychological consequences due to a cardiac illness and particularly those grappling with chronic heart failure. This editorial seeks to offer a state-of-the-art assessment of the significance and role of comprehensive CR within modern cardiology.
Collapse
Affiliation(s)
- Nenad Lakušić
- Department of Cardiology, Special Hospital for Medical Rehabilitation Krapinske Toplice, Krapinske Toplice 49217, Croatia
- Department of Clinical Medicine, Faculty of Dental Medicine and Health Osijek, J. J. Strossmayer University of Osijek, Osijek 31000, Croatia
- Department of Internal Medicine, Family Medicine and History of Medicine, Faculty of Medicine Osijek, J. J. Strossmayer University of Osijek, Osijek 31000, Croatia
| | - Ivana Sopek Merkaš
- Department of Cardiology, Special Hospital for Medical Rehabilitation Krapinske Toplice, Krapinske Toplice 49217, Croatia.
| |
Collapse
|
13
|
Zou J, Yuan J, Liu J, Geng Q. Impact of cardiac rehabilitation on pre- and post-operative transcatheter aortic valve replacement prognoses. Front Cardiovasc Med 2023; 10:1164104. [PMID: 38152609 PMCID: PMC10751363 DOI: 10.3389/fcvm.2023.1164104] [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: 02/12/2023] [Accepted: 11/28/2023] [Indexed: 12/29/2023] Open
Abstract
Transcatheter aortic valve replacement (TAVR) is a relatively new treatment method for aortic stenosis (AS) and has been demonstrated to be suitable for patients with varying risk levels. Indeed, among high-risk patients, TAVR outcomes are comparable to, or even better, than that of the traditional surgical aortic valve replacement (SAVR) method. TAVR outcomes, with respect to post-surgical functional capacity and quality of life, have also been found to be improved, especially when combined with cardiac rehabilitation (CR). CR is a multidisciplinary system, which integrates cardiology with other medical disciplines, such as sports, nutritional, mind-body, and behavioral medicine. It entails the development of appropriate medication, exercise, and diet prescriptions, along with providing psychological support, ensuring the cessation of smoking, and developing risk factor management strategies for cardiovascular disease patients. However, even with CR being able to improve TAVR outcomes and reduce post-surgical mortality rates, it still has largely been underutilized in clinical settings. This article reviews the usage of CR during both pre-and postoperative periods for valvular diseases, and the factors involved in influencing subsequent patient prognoses, thereby providing a direction for subsequent research and clinical applications.
Collapse
Affiliation(s)
- Jieru Zou
- The Second Clinical Medical College, Jinan University, Shenzhen, Guangdong, China
| | - Jie Yuan
- The Second Clinical Medical College, Jinan University, Shenzhen, Guangdong, China
- Department of Cardiology, Shenzhen People's Hospital (The Second Clinical Medical College, Jinan University; The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen, Guangdong, China
- Department of Cardiology, Shenzhen Cardiovascular Minimally Invasive Medical Engineering Technology Research and Development Center, Shenzhen People's Hospital (The Second Clinical Medical College, Jinan University; The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen, China
- Department of Geriatrics, Shenzhen People's Hospital (The Second Clinical Medical College, Jinan University, The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen, Guangdong, China
| | - Jingjin Liu
- The Second Clinical Medical College, Jinan University, Shenzhen, Guangdong, China
- Department of Cardiology, Shenzhen People's Hospital (The Second Clinical Medical College, Jinan University; The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen, Guangdong, China
- Department of Cardiology, Shenzhen Cardiovascular Minimally Invasive Medical Engineering Technology Research and Development Center, Shenzhen People's Hospital (The Second Clinical Medical College, Jinan University; The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen, China
- Department of Geriatrics, Shenzhen People's Hospital (The Second Clinical Medical College, Jinan University, The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen, Guangdong, China
| | - Qingshan Geng
- The Second Clinical Medical College, Jinan University, Shenzhen, Guangdong, China
- Department of Cardiology, Shenzhen People's Hospital (The Second Clinical Medical College, Jinan University; The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen, Guangdong, China
- Department of Cardiology, Shenzhen Cardiovascular Minimally Invasive Medical Engineering Technology Research and Development Center, Shenzhen People's Hospital (The Second Clinical Medical College, Jinan University; The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen, China
- Department of Geriatrics, Shenzhen People's Hospital (The Second Clinical Medical College, Jinan University, The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen, Guangdong, China
| |
Collapse
|
14
|
Bonaros N, Van Craenenbroeck E. A good operation is not enough, when it comes to frail patients. Eur J Cardiothorac Surg 2023; 64:ezad205. [PMID: 37233205 DOI: 10.1093/ejcts/ezad205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 05/24/2023] [Indexed: 05/27/2023] Open
Affiliation(s)
- Nikolaos Bonaros
- Department of Cardiac Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | | |
Collapse
|
15
|
Sündermann SH, Bäck C, Bischoff-Ferrari HA, Dehbi HM, Szekely A, Völler H, Niebauer J. Preinterventional frailty assessment in patients scheduled for cardiac surgery or transcatheter aortic valve implantation: a consensus statement of the European Association for Cardio-Thoracic Surgery (EACTS) and the European Association of Preventive Cardiology (EAPC) of the European Society of Cardiology (ESC). Eur J Cardiothorac Surg 2023; 64:ezad181. [PMID: 37804175 DOI: 10.1093/ejcts/ezad181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 03/22/2023] [Indexed: 10/09/2023] Open
Affiliation(s)
- Simon H Sündermann
- Deutsches Herzzentrum der Charité, Department of Cardiothoracic and Vascular Surgery, Berlin, Germany
- Charité- Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany
- DZHK (German Center of Cardiovascular Research), Partner Site Berlin, Berlin, Germany
| | - Caroline Bäck
- Department of Cardiothoracic Surgery, RT, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Heike A Bischoff-Ferrari
- Center on Ageing and Mobility, University Hospital and University of Zurich, Zurich, Switzerland
| | - Hakim-Moulay Dehbi
- University College London, Comprehensive Clinical Trials Unit, London, Great Britain
| | - Andrea Szekely
- Semmelweis University, Department of Anesthesiology and Intensive Therapy, Budapest, Hungary
| | - Heinz Völler
- Faculty of Health Sciences Brandenburg, University of Potsdam, Department of Rehabilitation Medicine, Potsdam, Germany
- Klinik am See, Rehabilitation Centre for Internal Medicine, Rüdersdorf, Germany
| | - Josef Niebauer
- Paracelsus Medical University Salzburg, Institute of Sports Medicine, Prevention and Rehabilitation, Salzburg, Austria
- Ludwig Boltzmann Institute for Digital Health and Prevention, Salzburg, Austria
- REHA-Zentrum Salzburg, University Hospital Salzburg, Austria
| |
Collapse
|
16
|
van Leunen MMCJ, de Lathauwer ILJ, Verstappen CCAG, Visser-Stevelink DMG, Brouwers RWM, Herkert C, Tio RA, Spee RF, Lu Y, Kemps HMC. Telerehabilitation in patients with recent hospitalisation due to acute decompensated heart failure: protocol for the Tele-ADHF randomised controlled trial. BMC Cardiovasc Disord 2023; 23:379. [PMID: 37516829 PMCID: PMC10386674 DOI: 10.1186/s12872-023-03407-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 07/19/2023] [Indexed: 07/31/2023] Open
Abstract
BACKGROUND Cardiac rehabilitation in patients with chronic heart failure (CHF) has favourable effects on exercise capacity, the risk at hospital (re-)admission and quality of life. Although cardiac rehabilitation is generally recommended it is still under-utilised in daily clinical practice, particularly in frail elderly patients after hospital admission, mainly due to low referral and patient-related barriers. Cardiac telerehabilitation (CTR) has the potential to partially solve these barriers. The purpose of this study is to evaluate the effects of CTR as compared to standard remote care after hospital admission on physical functional capacity in CHF patients. METHODS In this randomised controlled trial, 64 CHF patients will be recruited during hospitalisation for acute decompensated heart failure, and randomised to CTR combined with remote patient management (RPM) or RPM alone (1:1). All participants will start with RPM after hospital discharge for early detection of deterioration, and will be up titrated to optimal medical therapy before being randomised. CTR will start after randomisation and consists of an 18-week multidisciplinary programme with exercise training by physical and occupational therapists, supported by a (remote) technology-assisted dietary intervention and mental health guiding by a physiologist. The training programme consists of three centre-based and two home-based video exercise training sessions followed by weekly video coaching. The mental health and dietary programme are executed using individual and group video sessions. A wrist-worn device enables remote coaching by the physical therapist. The web application is used for promoting self-management by the following modules: 1) goal setting, 2) progress tracking, 3) education, and 4) video and chat communication. The primary outcome measure is physical functional capacity evaluated by the Short Physical Performance Battery (SPPB) score. Secondary outcome measures include frailty scoring, recovery after submaximal exercise, subjective health status, compliance and acceptance to the rehabilitation programme, and readmission rate. DISCUSSION The Tele-ADHF trial is the first prospective randomised controlled trial designed for evaluating the effects of a comprehensive combined RPM and CTR programme in recently hospitalised CHF patients. We hypothesize that this intervention has superior effects on physical functional capacity than RPM alone. TRIAL REGISTRATION Netherlands Trial Registry (NTR) NL9619, registered 21 July 2021.
Collapse
Affiliation(s)
- Mayke M C J van Leunen
- Department of Cardiology, Máxima Medical Centre, De Run 4600, 5504 DB, Veldhoven, The Netherlands.
- Department of Industrial Design, Eindhoven University of Technology, Eindhoven, the Netherlands.
| | - Ignace L J de Lathauwer
- Department of Cardiology, Máxima Medical Centre, De Run 4600, 5504 DB, Veldhoven, The Netherlands
- Department of Industrial Design, Eindhoven University of Technology, Eindhoven, the Netherlands
| | - Cindy C A G Verstappen
- Department of Cardiology, Catharina Hospital Eindhoven, Eindhoven, the Netherlands
- Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands
| | | | - Rutger W M Brouwers
- Department of Cardiology, Máxima Medical Centre, De Run 4600, 5504 DB, Veldhoven, The Netherlands
- Department of Industrial Design, Eindhoven University of Technology, Eindhoven, the Netherlands
- Department of Cardiology, Catharina Hospital Eindhoven, Eindhoven, the Netherlands
| | - Cyrille Herkert
- Department of Cardiology, Máxima Medical Centre, De Run 4600, 5504 DB, Veldhoven, The Netherlands
- Department of Cardiology, Catharina Hospital Eindhoven, Eindhoven, the Netherlands
| | - René A Tio
- Department of Cardiology, Catharina Hospital Eindhoven, Eindhoven, the Netherlands
| | - Ruud F Spee
- Department of Cardiology, Máxima Medical Centre, De Run 4600, 5504 DB, Veldhoven, The Netherlands
| | - Yuan Lu
- Department of Industrial Design, Eindhoven University of Technology, Eindhoven, the Netherlands
| | - Hareld M C Kemps
- Department of Cardiology, Máxima Medical Centre, De Run 4600, 5504 DB, Veldhoven, The Netherlands
- Department of Industrial Design, Eindhoven University of Technology, Eindhoven, the Netherlands
| |
Collapse
|
17
|
Quach J, Kehler DS, Giacomantonio N, McArthur C, Blanchard C, Firth W, Rockwood K, Theou O. Association of admission frailty and frailty changes during cardiac rehabilitation with 5-year outcomes. Eur J Prev Cardiol 2023; 30:807-819. [PMID: 36799963 PMCID: PMC10335868 DOI: 10.1093/eurjpc/zwad048] [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: 11/24/2022] [Revised: 02/11/2023] [Accepted: 02/15/2023] [Indexed: 02/18/2023]
Abstract
AIMS Examine the association between (1) admission frailty and (2) frailty changes during cardiac rehabilitation (CR) with 5-year outcomes (i.e. time to mortality, first hospitalization, first emergency department (ED) visit, and number of hospitalizations, hospital days, and ED visits). METHODS AND RESULTS Data from patients admitted to a 12-week CR programme in Halifax, Nova Scotia, from May 2005 to April 2015 (n = 3371) were analysed. A 25-item frailty index (FI) estimated frailty levels at CR admission and completion. FI improvements were determined by calculating the difference between admission and discharge FI. CR data were linked to administrative health data to examine 5-year outcomes [due to all causes and cardiovascular diseases (CVDs)]. Cox regression, Fine-Gray models, and negative binomial hurdle models were used to determine the association between FI and outcomes. On average, patients were 61.9 (SD: 10.7) years old and 74% were male. Mean admission FI scores were 0.34 (SD: 0.13), which improved by 0.07 (SD: 0.09) by CR completion. Admission FI was associated with time to mortality [HRs/IRRs per 0.01 FI increase: all causes = 1.02(95% CI 1.01,1.04); CVD = 1.03(1.02,1.05)], hospitalization [all causes = 1.02(1.01,1.02); CVD = 1.02(1.01,1.02)], ED visit [all causes = 1.01(1.00,1.01)], and the number of hospitalizations [all causes = 1.02(95% CI 1.01,1.03); CVD = 1.02(1.00,1.04)], hospital days [all causes = 1.01(1.01,1.03)], and ED visits [all causes = 1.02(1.02,1.03)]. FI improvements during CR had a protective effect regarding time to all-cause hospitalization [0.99(0.98,0.99)] but were not associated with other outcomes. CONCLUSION Frailty status at CR admission was related to long-term adverse outcomes. Frailty improvements during CR were associated with delayed all-cause hospitalization, in which a larger effect was associated with a greater chance of improved outcome.
Collapse
Affiliation(s)
- Jack Quach
- School of Physiotherapy, Dalhousie University, 5869 University Ave, Halifax, NS B3H 4R2, Canada
- Division of Geriatric Medicine, Dalhousie University, 5955 Veterans Memorial Lane, Halifax, NS B3H 2E1, Canada
| | - Dustin Scott Kehler
- School of Physiotherapy, Dalhousie University, 5869 University Ave, Halifax, NS B3H 4R2, Canada
- Division of Geriatric Medicine, Dalhousie University, 5955 Veterans Memorial Lane, Halifax, NS B3H 2E1, Canada
| | - Nicholas Giacomantonio
- Division of Cardiology, Dalhousie University, 1796 Summer Street, Halifax, NS B3H 3A7, Canada
- Department of Medicine, Dalhousie University, 1276 South Park Street, Halifax, NS B3H 2Y9, Canada
| | - Caitlin McArthur
- School of Physiotherapy, Dalhousie University, 5869 University Ave, Halifax, NS B3H 4R2, Canada
| | - Chris Blanchard
- Department of Medicine, Dalhousie University, 1276 South Park Street, Halifax, NS B3H 2Y9, Canada
| | - Wanda Firth
- Queen Elizabeth II Health Sciences Centre, Heart Health, 1276 South Park St, Halifax, NS B3H 2Y9, Canada
| | - Kenneth Rockwood
- Division of Geriatric Medicine, Dalhousie University, 5955 Veterans Memorial Lane, Halifax, NS B3H 2E1, Canada
| | - Olga Theou
- School of Physiotherapy, Dalhousie University, 5869 University Ave, Halifax, NS B3H 4R2, Canada
- Division of Geriatric Medicine, Dalhousie University, 5955 Veterans Memorial Lane, Halifax, NS B3H 2E1, Canada
| |
Collapse
|
18
|
Terbraak M, Verweij L, Jepma P, Buurman B, Jørstad H, Scholte Op Reimer W, van der Schaaf M. Feasibility of home-based cardiac rehabilitation in frail older patients: a clinical perspective. Physiother Theory Pract 2023; 39:560-575. [PMID: 35068322 DOI: 10.1080/09593985.2022.2025549] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
(A) BACKGROUND Home-based cardiac rehabilitation (CR) is an attractive alternative for frail older patients who are unable to participate in hospital-based CR. Yet, the feasibility of home-based CR provided by primary care physiotherapists (PTs) to these patients remains uncertain. (B) OBJECTIVE To investigate physiotherapists' (PTs) clinical experience with a guideline-centered, home-based CR protocol for frail older patients. (C) METHODS A qualitative study examined the home-based CR protocol of a randomized controlled trial. Observations and interviews of the CR-trained primary care PTs providing home-based CR were conducted until data saturation. Two researchers separately coded the findings according to the theoretical framework of Gurses. (D) RESULTS The enrolled PTs (n = 8) had a median age of 45 years (IQR 27-57), and a median work experience of 20 years (IQR 5-33). Three principal themes were identified that influence protocol-adherence by PTs and the feasibility of protocol-implementation: 1) feasibility of exercise testing and the exercise program; 2) patients' motivation and PTs' motivational techniques; and 3) interdisciplinary collaboration with other healthcare providers in monitoring patients' risks. (E) CONCLUSION Home-based CR for frail patients seems feasible for PTs. Recommendations on the optimal intensity, use of home-based exercise tests and measurement tools, and interventions to optimize self-regulation are needed to facilitate home-based CR.
Collapse
Affiliation(s)
- Michel Terbraak
- Department of Physical Therapy, Center of Expertise Urban Vitality, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, Netherlands.,Amsterdam UMC, University of Amsterdam, Department of Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam, Netherlands
| | - Lotte Verweij
- Department of Physical Therapy, Center of Expertise Urban Vitality, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, Netherlands.,Amsterdam UMC, University of Amsterdam, Department of Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam, Netherlands
| | - Patricia Jepma
- Department of Physical Therapy, Center of Expertise Urban Vitality, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, Netherlands.,Amsterdam UMC, University of Amsterdam, Department of Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam, Netherlands
| | - Bianca Buurman
- Department of Physical Therapy, Center of Expertise Urban Vitality, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, Netherlands.,Amsterdam UMC, University of Amsterdam, Department of Internal Medicine, Section of Geriatric Medicine, Amsterdam Public Health Research Institute, Amsterdam, Netherlands
| | - Harald Jørstad
- Amsterdam UMC, University of Amsterdam, Department of Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam, Netherlands
| | - Wilma Scholte Op Reimer
- Amsterdam UMC, University of Amsterdam, Department of Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam, Netherlands.,HU University of Applied Sciences Utrecht, Research Group Chronic Diseases, Utrecht, Netherlands
| | - Marike van der Schaaf
- Department of Physical Therapy, Center of Expertise Urban Vitality, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, Netherlands.,Amsterdam UMC, University of Amsterdam, Department of Rehabilitation, Amsterdam Movement Sciences, Amsterdam, Netherlands
| |
Collapse
|
19
|
Kambic T, Jug B, Piepoli MF, Lainscak M. Is blood flow restriction resistance training the missing piece in cardiac rehabilitation of frail patients? Eur J Prev Cardiol 2023; 30:117-122. [PMID: 35253869 DOI: 10.1093/eurjpc/zwac048] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 03/01/2022] [Accepted: 03/03/2022] [Indexed: 01/27/2023]
Affiliation(s)
- Tim Kambic
- Cardiac Rehabilitation Unit and Department of Research and Education, General Hospital Murska Sobota, Rakican, Ulica dr. Vrbnjaka 6, Murska Sobota 9000, Slovenia
| | - Borut Jug
- Department of Vascular Diseases, University Medical Centre Ljubljana, Zaloška 7, Ljubljana 1000, Slovenia
- Faculty of Medicine, University of Ljubljana, Zaloška 7, Ljubljana 1000, Slovenia
| | - Massimo Francesco Piepoli
- Heart Failure Unit, G. da Saliceto Hospital, AUSL Piacenza, Via Taverna Giuseppe 49, Piacenza 29121, Italy
- Institute of Life Sciences, Sant'Anna School of Advanced Studies, Via Santa Cecilia 3, Pisa 56127, Italy
| | - Mitja Lainscak
- Faculty of Medicine, University of Ljubljana, Zaloška 7, Ljubljana 1000, Slovenia
- Division of Cardiology, Department of Internal Medicine, General Hospital Murska Sobota, Rakican, Ulica dr. Vrbnjaka 6, Murska Sobota 9000, Slovenia
| |
Collapse
|
20
|
Contribution of individual and cumulative frailty-related health deficits on cardiac rehabilitation completion. BMC Geriatr 2023; 23:34. [PMID: 36658538 PMCID: PMC9854083 DOI: 10.1186/s12877-022-03624-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Accepted: 11/14/2022] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Despite the high burden of frailty among cardiac rehabilitation (CR) participants, it is unclear which frailty-related deficits are related to program completion. METHODS Data from a single-centre exercise- and education-based CR program were included. A frailty index (FI) based on 25 health deficits was constructed. Logistic regression was used to estimate the odds of CR completion based on the presence of individual FI items. The odds of completion for cumulative deficits related to biomarkers, body composition, quality of life, as well as a composite of traditional and non-traditional cardiovascular risk factor domains were examined. RESULTS A total of 3,756 individuals were included in analyses. Eight of 25 FI variables were positively associated with program completion while 8 others were negatively associated with completion. The variable with the strongest positive association was the food frequency questionnaire score (OR 1.27 (95% CI 1.14, 1.41), whereas the deficit with strongest negative association was a decline in health over the last year (OR 0.74 (95% CI 0.58, 0.93). An increased number of cardiovascular deficits were associated with an increased odds of CR completion (OR per 1 deficit increase 1.16 (95% CI 1.11, 1.22)). A higher number of traditional CR deficits were predictive of CR completion (OR 1.22 (95% CI 1.16, 1.29)), but non-traditional measures predicted non-completion (OR 0.95 (95% CI 0.92, 0.97)). CONCLUSION A greater number of non-traditional cardiovascular deficits was associated with non-completion. These data should be used to implement intervention to patients who are most vulnerable to drop out to maximize retention.
Collapse
|
21
|
MacEachern E, Giacomantonio N, Theou O, Quach J, Firth W, Abel-Adegbite I, Kehler DS. Comparing Virtual and Center-Based Cardiac Rehabilitation on Changes in Frailty. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:1554. [PMID: 36674308 PMCID: PMC9865753 DOI: 10.3390/ijerph20021554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 01/09/2023] [Accepted: 01/11/2023] [Indexed: 06/17/2023]
Abstract
Many patients with cardiovascular disease (CVD) are frail. Center-based cardiac rehabilitation (CR) can improve frailty; however, whether virtual CR provides similar frailty improvements has not been examined. To answer this question, we (1) compared the effect of virtual and accelerated center-based CR on frailty and (2) determined if admission frailty affected frailty change and CVD biomarkers. The virtual and accelerated center-based CR programs provided exercise and education on nutrition, medication, exercise safety, and CVD. Frailty was measured with a 65-item frailty index. The primary outcome, frailty change, was analyzed with a two-way mixed ANOVA. Simple slopes analysis determined whether admission frailty affected frailty and CVD biomarker change by CR model type. Our results showed that admission frailty was higher in center-based versus virtual participants. However, we observed no main effect of CR model on frailty change. Results also revealed that participants who were frailer at CR admission observed greater frailty improvements and reductions in triglyceride and cholesterol levels when completing virtual versus accelerated center-based CR. Even though both program models did not change frailty, higher admission frailty was associated with greater frailty reductions and change to some CVD biomarkers in virtual CR.
Collapse
Affiliation(s)
- Evan MacEachern
- School of Physiotherapy, Dalhousie University, Halifax, NS B3H 4R2, Canada
| | | | - Olga Theou
- School of Physiotherapy, Dalhousie University, Halifax, NS B3H 4R2, Canada
- Division of Geriatric Medicine, Dalhousie University, Halifax, NS B3H 4R2, Canada
| | - Jack Quach
- Faculty of Health, Dalhousie University, Halifax, NS B3H 4R2, Canada
| | - Wanda Firth
- Hearts and Health in Motion, Nova Scotia Health, Halifax, NS B3L 0B7, Canada
| | | | - Dustin Scott Kehler
- School of Physiotherapy, Dalhousie University, Halifax, NS B3H 4R2, Canada
- Division of Geriatric Medicine, Dalhousie University, Halifax, NS B3H 4R2, Canada
| |
Collapse
|
22
|
Kokorelias KM, Cronin SM, Munce SEP, Eftekhar P, McGilton KS, Vellani S, Colella TJF, Kontos P, Grigorovich A, Furlan A, Salbach NM, Jaglal S, Chan B, Cameron JI. Conceptualization of frailty in rehabilitation interventions with adults: a scoping review. Disabil Rehabil 2023; 45:117-153. [PMID: 34889703 DOI: 10.1080/09638288.2021.2012844] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Purpose: We aimed to synthesize the literature that considered frailty in the evaluation of rehabilitation interventions for adults (aged ≥18) by answering: (1) how is frailty defined in rehabilitation intervention research?; (2) how is frailty operationalized in rehabilitation intervention research?; (3) what are the characteristics of rehabilitation interventions for frail adults and what frailty related outcomes are assessed?Materials and methods: A scoping review was conducted. Data were analyzed using descriptive statistics and qualitative content analysis.Results: 53 articles met the inclusion criteria. Most studies were conducted in Europe and involved randomized control trials. The included studies reported on rehabilitation interventions that only included individuals aged 50 or older. Thirteen studies used Fried's definition of frailty, but most (n = 27) did not use any definition. Many studies did not differentiate between the conceptualization (e.g., definition) and operationalization (e.g., use of inclusion/exclusion criteria, outcome measures) of frailty. Most interventions focused on exercise. Instrumental activities of daily living reported most frequently as outcomes (n = 11).Conclusions: There is an absence of consistent definitions of frailty in rehabilitation interventions and current definitions tend to focus on physical functioning. The authors suggest rehabilitation researchers consider an expanded definition of frailty informed by the International Classification of Functioning, Disability and Health framework.IMPLICATIONS FOR REHABILITATIONRehabilitation professionals should use an expanded definition of frailty, informed by the International Classification of Functioning, Disability and Health framework, should include physical, mental, personal, environmental, and social factors to decrease, delay, or prevent frailty in adults.Rehabilitation professionals should consider a broader operationalization of frailty that is not dependent on age and physical functioning.Rehabilitation professionals that consider a broader conceptualization of frailty should tailor interventions to the specific needs of frail adults.
Collapse
Affiliation(s)
- Kristina M Kokorelias
- Rehabilitation Sciences Institute, Faculty of Medicine, University of Toronto, Toronto, Canada.,KITE - Toronto Rehabilitation Institute - UHN, Toronto, Canada
| | - Shawna M Cronin
- Rehabilitation Sciences Institute, Faculty of Medicine, University of Toronto, Toronto, Canada.,Department of Physical Therapy, University of Toronto, UHN, Toronto, Canada
| | - Sarah E P Munce
- Rehabilitation Sciences Institute, Faculty of Medicine, University of Toronto, Toronto, Canada.,KITE - Toronto Rehabilitation Institute - UHN, Toronto, Canada.,Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | - Parvin Eftekhar
- KITE - Toronto Rehabilitation Institute - UHN, Toronto, Canada
| | - Katherine S McGilton
- KITE - Toronto Rehabilitation Institute - UHN, Toronto, Canada.,Lawrence S Bloomberg, Faculty of Nursing, University of Toronto, Toronto, Canada
| | - Shirin Vellani
- KITE - Toronto Rehabilitation Institute - UHN, Toronto, Canada.,Lawrence S Bloomberg, Faculty of Nursing, University of Toronto, Toronto, Canada
| | - Tracey J F Colella
- KITE - Toronto Rehabilitation Institute - UHN, Toronto, Canada.,Lawrence S Bloomberg, Faculty of Nursing, University of Toronto, Toronto, Canada
| | - Pia Kontos
- KITE - Toronto Rehabilitation Institute - UHN, Toronto, Canada
| | | | - Andrea Furlan
- KITE - Toronto Rehabilitation Institute - UHN, Toronto, Canada.,Department of Medicine, University of Toronto, Toronto, Canada.,Institute for Work & Health, Toronto, Toronto, Canada
| | - Nancy M Salbach
- KITE - Toronto Rehabilitation Institute - UHN, Toronto, Canada.,Department of Physical Therapy, University of Toronto, UHN, Toronto, Canada
| | - Susan Jaglal
- KITE - Toronto Rehabilitation Institute - UHN, Toronto, Canada.,Department of Physical Therapy, University of Toronto, UHN, Toronto, Canada
| | - Brian Chan
- KITE - Toronto Rehabilitation Institute - UHN, Toronto, Canada
| | - Jill I Cameron
- Rehabilitation Sciences Institute, Faculty of Medicine, University of Toronto, Toronto, Canada.,KITE - Toronto Rehabilitation Institute - UHN, Toronto, Canada.,Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, Canada
| |
Collapse
|
23
|
Physical Frailty is Modifiable in Young Cardiac Rehabilitation Patients. Pediatr Cardiol 2022; 43:1799-1810. [PMID: 35511282 DOI: 10.1007/s00246-022-02917-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 04/15/2022] [Indexed: 10/18/2022]
Abstract
Frailty is a standardized, quantitative metric used to assess multisystem physiologic reserve and vulnerability to poor health outcomes. Cardiac rehabilitation (CR) positively impacts patient outcomes, including frailty, in adult cardiovascular disease (CVD); however, both the frailty paradigm and CR are understudied in pediatric CVD. This retrospective, single-center cohort study aimed to determine baseline composite frailty for pediatric-onset CVD patients and examine its change throughout CR using a proposed frailty assessment tool. Youth with pediatric-onset CVD participating in CR were stratified into five CVD diagnostic groups: post-heart transplant (HTx) (n = 34), post-ventricular assist device (VAD) (n = 12), single ventricle (n = 20) and biventricular (n = 29) congenital heart disease, and cardiomyopathy (n = 25), and frailty was assessed at baseline and every 30 days during CR. Post-HTx and post-VAD groups had significantly higher median frailty scores at baseline (6/10 and 5.75/10, respectively) driven by reduced strength, gait speed, and functional status. All groups except post-VAD displayed a significant absolute reduction in frailty from baseline to 120 days (HTx: - 3.5; VAD: - 3; SV CHD: - 1; BV CHD: - 1; CM: - 1.5), with similar median post-CR scores (1-3/10 in all groups). These improvements did not significantly correlate with number of CR sessions attended. This study established that frailty exhibits discriminatory utility across pediatric-onset CVD groups at baseline and is significantly modifiable over time. Improvements in frailty and other fitness metrics are likely due to a combination of post-operative recovery, post-diagnosis pharmacological and lifestyle changes, and CR. Further study of this frailty tool is needed to explore its prognostic utility.
Collapse
|
24
|
Vigorè M, Granata N, Callegari G, Vaninetti R, Conti S, Maestri R, Piaggi G, Cremonese G, Pierobon A. Frailty and rehabilitation outcome in older patients with cardiorespiratory disease: preliminary multidimensional data. Monaldi Arch Chest Dis 2022; 93. [PMID: 36458416 DOI: 10.4081/monaldi.2022.2447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 11/28/2022] [Indexed: 12/04/2022] Open
Abstract
Chronic heart failure (CHF) and chronic obstructive pulmonary disease (COPD) are two clinical conditions often associated with cognitive dysfunctions, psychological distress, poor quality of life (QoL), and functional worsening. In addition, since patients suffering from these conditions are often older adults, frailty syndrome represents a further and important issue to be investigated. The present preliminary study aimed to perform a multidimensional assessment of CHF and/or COPD older patients (age ≥65) undergoing cardiac or pulmonary rehabilitation. The characteristics of the included patients (30 CHF and 30 COPD) resulted almost similar, except for the COPD patients' longer duration of illness and better performances in Addenbrooke's cognitive examination III subtests and short physical performance battery (SPPB). No significant differences were found in the frailty evaluation, but a consistent number of patients resulted to be frail (CHF=36.7% vs COPD=26.6%). After the rehabilitation program, a significant improvement was found in the whole sample concerning the executive functions (14.34±2.49 vs 15.62±2.22, p=0.001), quality of life (58.77±18.87 vs 65.82±18.45, p=0.003), depressive and anxious symptoms (6.27±4.21 vs 3.77±3.39, p=0.001 and 5.17±3.40 vs 3.38±3.21, p=0.001), frailty status [4.00 (3.00,5.00) vs 3.00 (3.00,5.00) p=0.035] and functional exercise abilities [SPPB, 7.40±3.10 vs 9.51±3.67, p=0.0002; timed up and go test, 14.62±4.90 vs 11.97±4.51, p<0.0001; 6-minute walking test, 353.85±127.62 vs 392.59±123.14, p=0.0002]. Preliminary results showed a substantial homogeneity of CHF and COPD older patients' cognitive, psychosocial, frailty, and functional characteristics. Nevertheless, the specific rehabilitation intervention appears promising in both clinical populations. This trial has been registered with the ClinicalTrials.gov, NCT05230927 registration number (clinicaltrials.gov/ct2/show/NCT05230927).
Collapse
Affiliation(s)
- Martina Vigorè
- Psychology Unit, ICS Maugeri IRCCS Institute of Montescano.
| | - Nicolo Granata
- Department of Cardiac Respiratory Rehabilitation, ICS Maugeri IRCCS Institute of Tradate (VA).
| | | | - Raffaella Vaninetti
- Department of Cardiac Respiratory Rehabilitation, ICS Maugeri IRCCS Institute of Tradate (VA).
| | - Simona Conti
- Department of Cardiac Respiratory Rehabilitation, ICS Maugeri IRCCS Institute of Tradate (VA).
| | - Roberto Maestri
- Department of Biomedical Engineering, ICS Maugeri IRCCS Institute of Montescano.
| | - Giancarlo Piaggi
- Pulmonary Rehabilitation, ICS Maugeri IRCCS Institute of Montescano.
| | - Gioele Cremonese
- Department of Cardiac Respiratory Rehabilitation, ICS Maugeri IRCCS Institute of Tradate (VA).
| | | |
Collapse
|
25
|
Bencivenga L, Femminella GD, Ambrosino P, Bosco Q, De Lucia C, Perrotta G, Formisano R, Komici K, Vitale DF, Ferrara N, Maniscalco M, Cacciatore F, Papa A, Rengo G. Role of frailty on cardiac rehabilitation in hospitalized older patients. Aging Clin Exp Res 2022; 34:2675-2682. [PMID: 36065074 PMCID: PMC9675689 DOI: 10.1007/s40520-022-02220-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 08/03/2022] [Indexed: 01/04/2023]
Abstract
BACKGROUND Cardiovascular diseases are the leading cause of mortality, morbidity, and disability in the world, especially in the older adults. A relevant proportion of patients admitted to Cardiac Rehabilitation (CR) may suffer from frailty, a complex geriatric syndrome with multifactorial aetiology. AIMS The hypothesis underlying the study is that frailty complicates the management of older patients undergoing CR. The main objective is, therefore, to determine the relationship between frailty and CR outcomes in hospitalized older adults. METHODS The participants have been recruited among patients aged ≥ 65 years admitted at the hospital for CR. A Comprehensive Geriatric Assessment (CGA)-based Frailty Index (FI) was created following a standard procedure. The outcome was measured as the ratio between 6-min walk test (6MWT) distance at the end of CR and normal predicted values for a healthy adult of same age and gender, according to reference equations. RESULTS The study population consisted of 559 elderly patients, 387 males (69.2%), with age of 72 (69-76) years. The most frequent diagnosis at admission was ischaemic heart disease (231, 41.5%) and overall 6MWT ratio was 0.62 ± 0.21. At the multivariable regression analysis, gender, diagnosis and FI were significantly and independently associated with 6MWT ratio (p ≤ 0.0001, p ≤ 0.001 and p ≤ 0.0001, respectively), while no significant association emerged for age. CONCLUSION FI resulted independently correlated to 6MWT ratio in a population of older patients undergoing in-hospital CR programs. Frailty is a multifactorial geriatric syndrome whose assessment is essential for prognostic evaluation of older patients, also in CR clinical setting.
Collapse
Affiliation(s)
- Leonardo Bencivenga
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Naples, Italy
- Gérontopôle de Toulouse, Institut du Vieillissement, CHU de Toulouse, Toulouse, France
| | | | - Pasquale Ambrosino
- Cardiac Rehabilitation Unit, Istituti Clinici Scientifici Maugeri IRCCS, Scientific Institute of Telese Terme, Bagni Vecchi, 1, 82037, Telese Terme, Italy
| | - Quirino Bosco
- Cardiac Rehabilitation Unit, Istituti Clinici Scientifici Maugeri IRCCS, Scientific Institute of Telese Terme, Bagni Vecchi, 1, 82037, Telese Terme, Italy
| | - Claudio De Lucia
- Cardiac Rehabilitation Unit, Istituti Clinici Scientifici Maugeri IRCCS, Scientific Institute of Telese Terme, Bagni Vecchi, 1, 82037, Telese Terme, Italy
| | - Giovanni Perrotta
- Department of Translational Medical Sciences, University of Naples "Federico II", Naples, Italy
- Cardiac Rehabilitation Unit, Istituti Clinici Scientifici Maugeri IRCCS, Scientific Institute of Telese Terme, Bagni Vecchi, 1, 82037, Telese Terme, Italy
| | - Roberto Formisano
- Cardiac Rehabilitation Unit, Istituti Clinici Scientifici Maugeri IRCCS, Scientific Institute of Telese Terme, Bagni Vecchi, 1, 82037, Telese Terme, Italy
| | - Klara Komici
- Department of Medicine and Health Sciences, University of Molise, 86100, Campobasso, Italy
| | | | - Nicola Ferrara
- Department of Translational Medical Sciences, University of Naples "Federico II", Naples, Italy
- Department of Medicine and Health Sciences, University of Molise, 86100, Campobasso, Italy
| | - Mauro Maniscalco
- Cardiac Rehabilitation Unit, Istituti Clinici Scientifici Maugeri IRCCS, Scientific Institute of Telese Terme, Bagni Vecchi, 1, 82037, Telese Terme, Italy
| | - Francesco Cacciatore
- Department of Translational Medical Sciences, University of Naples "Federico II", Naples, Italy
| | - Antimo Papa
- Cardiac Rehabilitation Unit, Istituti Clinici Scientifici Maugeri IRCCS, Scientific Institute of Telese Terme, Bagni Vecchi, 1, 82037, Telese Terme, Italy.
| | - Giuseppe Rengo
- Department of Translational Medical Sciences, University of Naples "Federico II", Naples, Italy.
- Cardiac Rehabilitation Unit, Istituti Clinici Scientifici Maugeri IRCCS, Scientific Institute of Telese Terme, Bagni Vecchi, 1, 82037, Telese Terme, Italy.
| |
Collapse
|
26
|
Igarashi T, Miyata K, Tamura S, Otani T, Iizuka T, Usuda S. Relationship between the characteristics of lower extremity function and activities of daily living in hospitalized middle-aged and older adults with subacute cardiovascular disease. J Phys Ther Sci 2022; 34:752-758. [PMID: 36337222 PMCID: PMC9622349 DOI: 10.1589/jpts.34.752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 08/30/2022] [Indexed: 11/08/2022] Open
Abstract
[Purpose] To clarify the relationship between lower extremity function and activities of
daily living and characterize lower extremity function in hospitalized middle-aged and
older adults with subacute cardiovascular disease. [Participants and Methods] The Short
Physical Performance Battery, 6-minute walk distance, and functional independence measure
tests were conducted in 79 inpatients with subacute cardiovascular disease (mean age, 76.7
± 11.9 years; 34 females). Multiple regression analysis used the functional independence
measure score as the dependent variable and the Short Physical Performance Battery and
6-minute walk distance scores as independent variables. Cross-tabulations were performed
for each age group, and patients who performed the Short Physical Performance Battery and
6-minute walk distance tests were divided into two groups by their respective cutoff
values. [Results] Only the Short Physical Performance Battery (β=0.568) and 6-minute walk
distance (β=0.479) scores were adopted as significant independent variables in each
multiple regression model. The age <75 years group had the most patients with both good
lower extremity function and aerobic capacity, whereas the age ≥75 years group had the
most patients with both functions impaired. [Conclusion] Although cardiovascular disease
is generally associated with decreased aerobic capacity, many older patients with
cardiovascular disease in this study had decreased lower extremity function, too.
Collapse
Affiliation(s)
- Tatsuya Igarashi
- Physical Therapy Division, Department of Rehabilitation,
Numata Neurosurgery and Cardiovascular Hospital: 8 Sakaemachi, Numata-shi, Gunma 378-0014,
Japan, Gunma University Graduate School of Health Sciences,
Japan,Corresponding author. Tatsuya Igarashi (E-mail: )
| | - Kazuhiro Miyata
- Department of Physical Therapy, Ibaraki Prefectural
University of Health Science, Japan
| | - Shuntaro Tamura
- Department of Rehabilitation, Fujioka General Hospital,
Japan
| | | | | | - Shigeru Usuda
- Gunma University Graduate School of Health Sciences,
Japan
| |
Collapse
|
27
|
Vigorè M, Granata N, Braga SS, Piaggi G, Audifreddi S, Ferrari M, La Rovere MT, Pierobon A. Cognitive impairment, frailty and rehabilitation outcome in older cardiorespiratory patients. DEC_FRAinRIAB: Study protocol. PLoS One 2022; 17:e0272132. [PMID: 35925981 PMCID: PMC9351997 DOI: 10.1371/journal.pone.0272132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 07/08/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Chronic heart failure (CHF) and chronic obstructive pulmonary disease (COPD) are two clinical conditions often associated with functional worsening, cognitive dysfunctions, treatment non-adherence, psychological distress and poor quality of life (QoL). In addition, since patients suffering from these conditions are often older adults, the presence of frailty syndrome could worsen the clinical situation. METHODS AND DESIGN This study protocol of a prospective multi-center clinical trial, will be conducted at two hospitals of the Istituti Clinici Scientifici Maugeri IRCCS group, from July 2020 until December 2022. CHF and COPD older patients (age ≥65) will undergo a multidisciplinary assessment at admission, discharge and at 6 months follow-up, from an inpatient rehabilitation program: disease-related clinical characteristics, functional variables, cognitive screening, treatment adherence, anxiety, depression, QoL and frailty. The estimated sample size will consist of 300 patients. DISCUSSION The expected results are related to the possibility of an improvement in the areas of intervention after the rehabilitative program and the maintenance of these improvements over time. The assessment of clinical and functional status, cognitive impairment, treatment adherence, psychosocial characteristics, and frailty could provide more specific and useful information about the main features to be considered in the evaluation and treatment of older patients suffering from CHF and COPD undergoing a rehabilitative pathway. TRIAL REGISTRATION The study has been registered on January 28, 2022 with the ClinicalTrials.gov NCT05230927 registration number (clinicaltrials.gov/ct2/show/NCT05230927).
Collapse
Affiliation(s)
- Martina Vigorè
- Istituti Clinici Scientifici Maugeri, IRCCS, Psychology Unit of Montescano Institute, Pavia, Italy
| | - Nicolò Granata
- Istituti Clinici Scientifici Maugeri, IRCCS, Cardiac Rehabilitation Division of Tradate Institute, Varese, Italy
| | - Simona Sarzi Braga
- Istituti Clinici Scientifici Maugeri, IRCCS, Cardiac Rehabilitation Division of Tradate Institute, Varese, Italy
| | - Giancarlo Piaggi
- Istituti Clinici Scientifici Maugeri, IRCCS, Respiratory Rehabilitation Division of Montescano Institute, Pavia, Italy
| | - Silvia Audifreddi
- Istituti Clinici Scientifici Maugeri, IRCCS, Health Direction of Tradate Institute, Varese, Italy
| | - Marina Ferrari
- Istituti Clinici Scientifici Maugeri, IRCCS, Cardiac Rehabilitation Division of Montescano Institute, Pavia, Italy
| | - Maria Teresa La Rovere
- Istituti Clinici Scientifici Maugeri, IRCCS, Cardiac Rehabilitation Division of Montescano Institute, Pavia, Italy
| | - Antonia Pierobon
- Istituti Clinici Scientifici Maugeri, IRCCS, Psychology Unit of Montescano Institute, Pavia, Italy
| |
Collapse
|
28
|
Butkuviene M, Tamuleviciute-Prasciene E, Beigiene A, Barasaite V, Sokas D, Kubilius R, Petrenas A. Wearable-Based Assessment of Frailty Trajectories During Cardiac Rehabilitation After Open-Heart Surgery. IEEE J Biomed Health Inform 2022; 26:4426-4435. [PMID: 35700246 DOI: 10.1109/jbhi.2022.3181738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Frailty in patients after open-heart surgery influences the type and intensity of a cardiac rehabilitation program. The response to tailored exercise training can be different, requiring convenient tools to assess the effectiveness of a training program routinely. The study aims to investigate whether kinematic measures extracted from the acceleration signals can provide information about frailty trajectories during rehabilitation. One hundred patients after open-heart surgery, assigned to the equal-sized intervention and control groups, participated in exercise training during inpatient rehabilitation. After rehabilitation, the intervention group continued exercise training at home, whereas the control group was asked to maintain the usual physical activity regimen. Stride time, cadence, movement vigor, gait asymmetry, Lissajous index, and postural sway were estimated during the clinical walk and stair-climbing tests before and after inpatient rehabilitation as well as after home-based exercise training. Frailty was assessed using the Edmonton frail scale. Most kinematic measures estimated during walking improved after rehabilitation along with the improvement in frailty status, i.e., stride time, cadence, postural sway, and movement vigor improved in 71%, 77%, 81%, and 83% of patients, respectively. Meanwhile, kinematic measures during stair-climbing improved to a lesser extent compared to walking. Home-based exercise training did not result in a notable change in kinematic measures which agrees well with only a negligible deterioration in frailty status. The study demonstrates the feasibility to follow frailty trajectories during inpatient rehabilitation after open-heart surgery based on kinematic measures extracted using a single wearable sensor.
Collapse
|
29
|
Wang J, Lee SY, Chao CT, Huang JW, Chien KL. The frailty risk trajectory associated with kidney and cardiovascular morbidities among patients with incident diabetes: A population-based study. Atherosclerosis 2022; 358:60-67. [DOI: 10.1016/j.atherosclerosis.2022.06.1010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 05/25/2022] [Accepted: 06/09/2022] [Indexed: 11/02/2022]
|
30
|
Bonanad C, Fernández-Olmo R, García-Blas S, Alarcon JA, Díez-Villanueva P, Mansilla CR, García-Pardo H, Toledo P, Ayesta A, Pereira E, Carol A, Castro-Conde A, de Pablo-Zarzoso C, Martínez-Sellés M, Arrarte V, Campuzano R, Ariza-Solé A. Cardiovascular prevention in elderly patients. J Geriatr Cardiol 2022; 19:377-392. [PMID: 35722032 PMCID: PMC9170910 DOI: 10.11909/j.issn.1671-5411.2022.05.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
In recent decades, life expectancy has been increasing significantly. In this scenario, health interventions are necessary to improve prognosis and quality of life of elderly with cardiovascular risk factors and cardiovascular disease. However, the number of elderly patients included in clinical trials is low, thus current clinical practice guidelines do not include specific recommendations. This document aims to review prevention recommendations focused in patients ≥ 75 years with high or very high cardiovascular risk, regarding objectives, medical treatment options and also including physical exercise and their inclusion in cardiac rehabilitation programs. Also, we will show why geriatric syndromes such as frailty, dependence, cognitive impairment, and nutritional status, as well as comorbidities, ought to be considered in this population regarding their important prognostic impact.
Collapse
Affiliation(s)
- Clara Bonanad
- Servicio de Cardiología, Hospital Clínico Universitario de Valencia, Valencia, Spain
- Instituto de Investigación Sanitaria INCLIVA, Valencia, Spain
| | | | - Sergio García-Blas
- Servicio de Cardiología, Hospital Clínico Universitario de Valencia, Valencia, Spain
- Instituto de Investigación Sanitaria INCLIVA, Valencia, Spain
| | | | | | | | | | - Pablo Toledo
- Servicio Cardiología Hospital Clínico San Cecilio de Granada, Spain
| | - Ana Ayesta
- Servicio de Cardiología, Hospital Universitario Central de Asturias, Spain
| | - Eva Pereira
- Servicio de Cardiologia, Hospital de Lugo, Spain
| | - Antoni Carol
- Servicio de Cardiología, Hospital Moisés Broggi de Barcelona, Spain
| | | | | | - Manuel Martínez-Sellés
- Department of Cardiology. Hospital Universitario Gregorio Marañón, CIBERCV. Universidad Europea, Universidad Compluten
| | - Vicente Arrarte
- Servicio de Cardiología del Hospital General de Alicante, Spain
| | - Raquel Campuzano
- Servicio de Cardiología Hospital, Universitario Fundación de Alcorcón de Madrid, Spain
| | - Albert Ariza-Solé
- Servicio de Cardiología, Hospital Bellvitge de Barcelona, Bioheart, Grup de Malalties Cardiovasculars, Institut d’Investigació Biomèdica de Bellvitge, IDIBELL, L’Hospitalet de Llobregat, Barcelona, Spain
| |
Collapse
|
31
|
Tashiro H, Tanaka A, Takagi K, Uemura Y, Inoue Y, Umemoto N, Negishi Y, Shibata N, Yoshioka N, Shimizu K, Morishima I, Watarai M, Asano H, Ishii H, Murohara T. Incidence and Predictors of Frailty Progression among Octogenarians with ST-elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention. Arch Gerontol Geriatr 2022; 102:104737. [PMID: 35671551 DOI: 10.1016/j.archger.2022.104737] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 05/15/2022] [Accepted: 05/26/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND Frailty is one of the most serious health problems in older individuals with cardiovascular disease. Moreover, frailty progression is associated with subsequent adverse outcomes; therefore, the prevention of frailty progression is an important clinical issue. However, the incidence and predictors of frailty progression following acute myocardial infarction have not yet been fully elucidated. METHODS The present study is a sub-analysis of an observational multicenter registry retrospectively evaluating clinical outcomes of 288 octogenarians who underwent primary percutaneous coronary intervention (PCI) for ST-elevation myocardial infarction (STEMI) between January 2014 and December 2016 at five hospitals. We identified 244 patients who survived until discharge and evaluated frailty at baseline and discharge using the Clinical Frailty Scale (CFS). We defined frailty progression as an increase of at least one level in the CFS score at discharge from baseline and assessed the predictors of frailty progression. RESULTS Frailty progression was observed in 29.5% of patients. Patients with frailty progression were older, had more severe conditions with a higher prevalence of Killip 4 status and mechanical circulatory support use, more frequently experienced in-hospital events such as stroke (4/72, 6% vs. 0/172, 0%, p = 0.007), and had longer hospital stays than those without frailty progression [19 (11-35) vs. 13 (9-19) days, p<0.01]. Multivariate analysis showed that age (odds ratio 1.08, 95% confidence interval 1.00-1.17, p = 0.046) and Killip 4 status at baseline (odds ratio 3.34, 95% confidence interval 1.26-8.85, p = 0.01) were significant predictors of frailty progression. CONCLUSIONS In-hospital frailty progression was commonly observed in octogenarians with STEMI who underwent primary PCI and survived until discharge, and was associated with more severe clinical conditions.
Collapse
Affiliation(s)
- Hiroshi Tashiro
- Department of Cardiology, Ichinomiya Municipal Hospital, Ichinomiya, Japan; Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Akihito Tanaka
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan.
| | - Kensuke Takagi
- Department of Cardiology, Ogaki Municipal Hospital, Ogaki, Japan
| | - Yusuke Uemura
- Cardiovascular Center, Anjo Kosei Hospital, Anjo, Japan
| | - Yosuke Inoue
- Department of Cardiology, Tosei General Hospital, Seto, Japan
| | - Norio Umemoto
- Department of Cardiology, Ichinomiya Municipal Hospital, Ichinomiya, Japan
| | - Yosuke Negishi
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Naoki Shibata
- Department of Cardiology, Ichinomiya Municipal Hospital, Ichinomiya, Japan; Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Naoki Yoshioka
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan; Department of Cardiology, Ogaki Municipal Hospital, Ogaki, Japan
| | - Kiyokazu Shimizu
- Department of Cardiology, Ichinomiya Municipal Hospital, Ichinomiya, Japan
| | - Itsuro Morishima
- Department of Cardiology, Ogaki Municipal Hospital, Ogaki, Japan
| | | | - Hiroshi Asano
- Department of Cardiology, Tosei General Hospital, Seto, Japan
| | - Hideki Ishii
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan; Department of Cardiology, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Toyoaki Murohara
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| |
Collapse
|
32
|
Aida K, Kamiya K, Hamazaki N, Nozaki K, Ichikawa T, Nakamura T, Yamashita M, Uchida S, Maekawa E, Reed JL, Yamaoka-Tojo M, Matsunaga A, Ako J. Optimal cutoff values for physical function tests in elderly patients with heart failure. Sci Rep 2022; 12:6920. [PMID: 35484373 PMCID: PMC9051131 DOI: 10.1038/s41598-022-10622-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Accepted: 04/11/2022] [Indexed: 11/09/2022] Open
Abstract
Six-minute walk distance (6MWD) of 300 and 400 m are important targets of functional capacity. The present study was performed to determine cutoff values of physical function associated with 6MWD < 300 m and < 400 m in elderly patients with heart failure (HF). 6MWD, handgrip strength, quadriceps isometric strength (QIS), one-leg standing time (OLST), and 5-times sit-to-stand (5STS) before hospital discharge were evaluated in 1001 patients > 65 years (median age, 75: interquartile range, 71-80, 607 men) with HF. 6MWD < 300 and < 400 m were seen in 323 patients (32.3%) and 658 patients (65.7%), respectively. Handgrip strength, QIS, OLST, and 5STS were associated with 6MWD < 300 and < 400 m, respectively (P < 0.001). The cutoff values of handgrip strength, QIS, OLST, and 5STS were 18.9 kg, 35.0% body mass (BM), 9.1 s, and 9.5 s for 6MWD < 300 m, and 21.9 kg, 40.0% BM, 12.0 s, and 8.8 s for < 400 m, respectively. The cutoff values of physical function could be used to set cardiac rehabilitation goals and limiting determinants of reduced functional capacity in a clinical setting in elderly patients with HF.
Collapse
Affiliation(s)
- Keita Aida
- Department of Rehabilitation Sciences, Kitasato University Graduate School of Medical Sciences, Sagamihara, Japan.,Department of Physical Medicine and Rehabilitation, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Kentaro Kamiya
- Department of Rehabilitation, Kitasato University School of Allied Health Sciences, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa, 252-0375, Japan.
| | - Nobuaki Hamazaki
- Department of Rehabilitation, Kitasato University Hospital, Sagamihara, Japan
| | - Kohei Nozaki
- Department of Rehabilitation, Kitasato University Hospital, Sagamihara, Japan
| | - Takafumi Ichikawa
- Department of Rehabilitation, Kitasato University Hospital, Sagamihara, Japan
| | - Takeshi Nakamura
- Department of Rehabilitation Sciences, Kitasato University Graduate School of Medical Sciences, Sagamihara, Japan
| | - Masashi Yamashita
- Department of Rehabilitation Sciences, Kitasato University Graduate School of Medical Sciences, Sagamihara, Japan
| | - Shota Uchida
- Department of Rehabilitation Sciences, Kitasato University Graduate School of Medical Sciences, Sagamihara, Japan
| | - Emi Maekawa
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, Sagamihara, Japan
| | - Jennifer L Reed
- Exercise Physiology and Cardiovascular Health Lab, Division of Cardiac Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, Canada.,Faculty of Medicine, University of Ottawa, Ottawa, Canada.,Faculty of Health Sciences, School of Human Kinetics, University of Ottawa, Ottawa, Canada
| | - Minako Yamaoka-Tojo
- Department of Rehabilitation, Kitasato University School of Allied Health Sciences, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa, 252-0375, Japan
| | - Atsuhiko Matsunaga
- Department of Rehabilitation Sciences, Kitasato University Graduate School of Medical Sciences, Sagamihara, Japan.,Department of Rehabilitation, Kitasato University School of Allied Health Sciences, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa, 252-0375, Japan
| | - Junya Ako
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, Sagamihara, Japan
| |
Collapse
|
33
|
Usefulness of measuring maximal gait speed in conjunction with usual gait speed for risk stratification in patients with cardiovascular disease. Exp Gerontol 2022; 164:111810. [PMID: 35452782 DOI: 10.1016/j.exger.2022.111810] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 03/27/2022] [Accepted: 04/13/2022] [Indexed: 11/21/2022]
Abstract
BACKGROUND Usual gait speed is a prognostic factor in cardiovascular disease (CVD) patients; however, given the aging population, there has been an increase in patients with CVD with slow usual gait speed. Even among patients with slow usual gait speed, some can walk with sufficient speed during maximal gait, while others cannot. This study aimed to investigate the relationship between maximal gait speed and prognosis, and the utility of evaluating maximal gait speed in conjunction with usual gait speed in risk stratification of prognosis in patients with CVD. METHODS We included 2953 CVD patients who underwent evaluation of both usual and maximal gait speeds. They were classified into the usual (+) group [usual gait speed ≥1.0 m/s], usual (-) and maximal (+) group [usual gait speed <1.0 m/s and maximal gait speed ≥1.0 m/s], and usual (-) and maximal (-) group [usual gait speed <1.0 m/s and maximal gait speed <1.0 m/s]. RESULTS Slower maximal gait speed was significantly associated with higher mortality in CVD patients. This association was consistent across various subgroups, including older patients, patients with slow usual gait speed, and patients with heart failure. Maximal gait speed provided additional prognostic information to that of pre-existing prognostic factors and usual gait speed (p = 0.049). The usual (-) and maximal (-) group showed higher mortality (hazard ratio: 1.63; 95% confidence interval: 1.17-2.26; p = 0.003) than the usual (-) and maximal (+) group. There was no significant difference in mortality between the usual (+) group and the usual (-) and maximal (+) group. CONCLUSIONS Maximal gait speed was an independent prognostic predictor for CVD patients. Evaluating maximal gait speed in conjunction with usual gait speed was useful for further risk stratification of prognosis in CVD patients.
Collapse
|
34
|
Corrà U, Giordano A, Gnemmi M, Gambarin FI, Marcassa C, Pistono M. Cardiovascular disease patients and predictors of length of stay of residential of cardiac rehabilitation. A specific rehabilitation is mandatory in very old patients? Monaldi Arch Chest Dis 2022; 92. [PMID: 35393851 DOI: 10.4081/monaldi.2022.2125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 03/29/2022] [Indexed: 11/23/2022] Open
Abstract
As more adults are living into old age, they are predisposed to cardiovascular disease (CVD) and the demand for cardiac rehabilitation is increasing. We aimed to verify predictors of length of stay (LOS) in young (Y) vs older (O) vs very old (VO) CVD patients, admitted to residential cardiac rehabilitation. Patients' demographic and clinical characteristics at admission, as well as Barthel index (BI), Cumulative Illness Rating Scale (CIRS), comorbidity severity/complexity, NYHA classification, left ventricular ejection fraction (LVEF), physical activity level were compared in Y (≤65 years) vs O (between >65 and <76 years) vs VO patients (with an age of ≥76 years) against LOS. In 5,070 consecutively CVD patients were included; they were 1392 Y (38%) 1944 O (35%) 1334 VO patients (27%) and LOS duration was 16±7, 19±9 and 22±10 days, respectively (p<0.0001). In Y, LOS was linked to BI (p=0.000) and to LVEF (p=0.000) at multivariable analysis with area under ROC curve of 0.82, whereas in O, LOS was associated to gender (p=0.013) CIRS severity (p=0.000), BI (p=0.000), LVEF (p=0.000), and in those VO to gender (p=0.004), BI (p=0.000) and medical infusion (p=0.000) at multivariable with ROC curve of 0.83 and 0.74, respectively. In very old patients, a prolonged LOS is related to extra-cardiac conditions. Therefore, we promote a specific cardiac rehabilitation for these patients.
Collapse
Affiliation(s)
- Ugo Corrà
- Division of Cardiology, ICS Maugeri IRCCS, Rehabilitation Center of Veruno, Gattico-Veruno (NO).
| | - Andrea Giordano
- Bio-engineering Service, ICS Maugeri IRCCS, Rehabilitation Center of Veruno, Gattico-Veruno (NO).
| | - Marco Gnemmi
- Division of Cardiology, ICS Maugeri IRCCS, Rehabilitation Center of Veruno, Gattico-Veruno (NO).
| | | | - Claudio Marcassa
- Division of Cardiology, ICS Maugeri IRCCS, Rehabilitation Center of Veruno, Gattico-Veruno (NO).
| | - Massimo Pistono
- Division of Cardiology, ICS Maugeri IRCCS, Rehabilitation Center of Veruno, Gattico-Veruno (NO).
| |
Collapse
|
35
|
|
36
|
Krivoshapova KE, Vegner EA, Barbarash OL. [Frailty syndrome as an independent predictor of adverse prognosis in patients with chronic heart failure]. KARDIOLOGIIA 2022; 62:89-96. [PMID: 35414366 DOI: 10.18087/cardio.2022.3.n1206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Accepted: 07/29/2020] [Indexed: 06/14/2023]
Abstract
This review presents results of clinical studies of senile asthenia ("fragility") syndrome and chronic heart failure (CHF). Recent reports of the "fragility" prevalence in patients with CHF are described. The review presents specific features of pathophysiological pathways underlying the development of both senile asthenia syndrome and CHF; the role of "fragility" in the progression and complications of CHF is addressed. Senile asthenia syndrome associated with CHF is regarded as an independent predictor of unfavorable prognosis and high mortality in this patient category. The authors concluded that methods for "fragility" evaluation in CHF patients followed by risk stratification and selection of individual management tactics should be implemented in clinical practice.
Collapse
Affiliation(s)
- K E Krivoshapova
- Research Institute for Complex Issues of Cardiovascular Diseases
| | | | - Olga L Barbarash
- Research Institute for Complex Issues of Cardiovascular Diseases; Kemerovo State Medical
| |
Collapse
|
37
|
Marinus N, Vigorito C, Giallauria F, Dendale P, Meesen R, Bokken K, Haenen L, Jansegers T, Vandenheuvel Y, Scherrenberg M, Spildooren J, Hansen D. Frailty Test Battery Development including Physical, Socio-Psychological and Cognitive Domains for Cardiovascular Disease Patients: A Preliminary Study. J Clin Med 2022; 11:jcm11071926. [PMID: 35407534 PMCID: PMC9014815 DOI: 10.3390/jcm11071926] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 03/25/2022] [Accepted: 03/28/2022] [Indexed: 01/23/2023] Open
Abstract
Frailty is an age-related decline in physical, socio-psychological and cognitive function that results in extreme vulnerability to stressors. Therefore, this study aimed to elucidate which tests have to be selected to detect frailty in a comprehensive and feasible manner in cardiovascular disease (CVD) patients based on multivariate regression and sensitivity/specificity analyses. Patients (n = 133, mean age 78 ± 7 years) hospitalised for coronary revascularisation or heart failure (HF) were examined using the Fried and Vigorito criteria, together with some additional measurements. Moreover, to examine the association of frailty with 6-month clinical outcomes, hospitalisations and mortality up to 6 months after the initial hospital admission were examined. Some level of frailty was detected in 44% of the patients according to the Vigorito criteria and in 65% of the patients according to the Fried criteria. Frailty could best be detected by a score based on: sex, Mini Nutritional Assessment (MNA), Katz scale, timed up-and-go test (TUG), handgrip strength, Mini-Mental State Examination (MMSE), Geriatric Depression Scale (GDS-15) and total number of medications. Frailty and specific markers of frailty were significantly associated with mortality and six-month hospitalisations. We thus can conclude that, in patients with CVD, sex, MNA, Katz scale, TUG, handgrip strength, MMSE, GDS-15 and total number of medications play a key role in detecting frailty, assessed by a new time- and cost-efficient test battery.
Collapse
Affiliation(s)
- Nastasia Marinus
- REVAL-Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, 3590 Diepenbeek, Belgium; (R.M.); (K.B.); (L.H.); (T.J.); (Y.V.); (J.S.); (D.H.)
- BIOMED-Biomedical Research Center, Hasselt University, 3590 Diepenbeek, Belgium; (P.D.); (M.S.)
- Correspondence: ; Tel.: +32-(0)11-269203
| | - Carlo Vigorito
- Department of Translational Medical Sciences, Federico II University of Naples, 80131 Naples, Italy; (C.V.); (F.G.)
| | - Francesco Giallauria
- Department of Translational Medical Sciences, Federico II University of Naples, 80131 Naples, Italy; (C.V.); (F.G.)
- Faculty of Science and Technology, University of New England, Armidale, NSW 2350, Australia
| | - Paul Dendale
- BIOMED-Biomedical Research Center, Hasselt University, 3590 Diepenbeek, Belgium; (P.D.); (M.S.)
- Heart Centre Hasselt, Jessa Hospital, 3500 Hasselt, Belgium
| | - Raf Meesen
- REVAL-Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, 3590 Diepenbeek, Belgium; (R.M.); (K.B.); (L.H.); (T.J.); (Y.V.); (J.S.); (D.H.)
| | - Kevin Bokken
- REVAL-Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, 3590 Diepenbeek, Belgium; (R.M.); (K.B.); (L.H.); (T.J.); (Y.V.); (J.S.); (D.H.)
| | - Laura Haenen
- REVAL-Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, 3590 Diepenbeek, Belgium; (R.M.); (K.B.); (L.H.); (T.J.); (Y.V.); (J.S.); (D.H.)
| | - Thomas Jansegers
- REVAL-Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, 3590 Diepenbeek, Belgium; (R.M.); (K.B.); (L.H.); (T.J.); (Y.V.); (J.S.); (D.H.)
| | - Yenthe Vandenheuvel
- REVAL-Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, 3590 Diepenbeek, Belgium; (R.M.); (K.B.); (L.H.); (T.J.); (Y.V.); (J.S.); (D.H.)
| | - Martijn Scherrenberg
- BIOMED-Biomedical Research Center, Hasselt University, 3590 Diepenbeek, Belgium; (P.D.); (M.S.)
- Heart Centre Hasselt, Jessa Hospital, 3500 Hasselt, Belgium
| | - Joke Spildooren
- REVAL-Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, 3590 Diepenbeek, Belgium; (R.M.); (K.B.); (L.H.); (T.J.); (Y.V.); (J.S.); (D.H.)
| | - Dominique Hansen
- REVAL-Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, 3590 Diepenbeek, Belgium; (R.M.); (K.B.); (L.H.); (T.J.); (Y.V.); (J.S.); (D.H.)
- BIOMED-Biomedical Research Center, Hasselt University, 3590 Diepenbeek, Belgium; (P.D.); (M.S.)
- Heart Centre Hasselt, Jessa Hospital, 3500 Hasselt, Belgium
| |
Collapse
|
38
|
Wu L, Li J, Chen L, Xue M, Zheng Y, Meng F, Jiang H, Shi Z, Zhang P, Dai C. The Efficacy and Safety of Phase I Cardiac Rehabilitation in Patients Hospitalized in Cardiac Intensive Care Unit With Acute Decompensated Heart Failure: A Study Protocol for a Randomized, Controlled, Clinical Trial. Front Cardiovasc Med 2022; 9:788503. [PMID: 35350537 PMCID: PMC8958022 DOI: 10.3389/fcvm.2022.788503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2021] [Accepted: 01/31/2022] [Indexed: 11/24/2022] Open
Abstract
Background Cardiac rehabilitation (CR) improves outcomes in patients with heart failure. However, data on CR efficacy in patients with acute decompensated heart failure is limited. This study is designed to assess the efficacy and safety of CR in patients hospitalized in cardiac intensive care unit (CICU) with acute decompensated heart failure (ADHF). Methods This is a single-center, randomized controlled, single-blind clinical trial. A total of 120 participants hospitalized in CICU with ADHF will be randomly allocated in the ratio of 1:1 to two groups: CR group and control group. Participants will receive tailored and progressive CR intervention or attention control. The CR intervention include personalized breathing training, small muscle group resistance training, and aerobic endurance training based on the physical fitness assessment results. The subjects will receive the CR training for 5 days and will be followed up for 6 months. The primary endpoints are the score of the short physical performance battery (SPPB) and 6-month all-cause rehospitalization. The secondary endpoints include cardio-pulmonary function, activities of daily living (ADL), in-hospital mortality rate and 6-month all-cause mortality rate. Discussion This randomized, controlled, clinical trial will assess whether CR improves physical function and reduces rehospitalization in patients hospitalized in CICU with ADHF. The results will provide further research-based evidence for the clinical application of CR in patients with ADHF. Trial Registration Chinese Clinical Trial Registry ChiCTR2100050151. Registered on 19 August 2021.
Collapse
Affiliation(s)
- Linjing Wu
- Department of Cardiology, Xiamen Cardiovascular Hospital of Xiamen University, School of Medcine, Xiamen University, Xiamen, China
| | - Jiahua Li
- Department of Cardiology, Xiamen Cardiovascular Hospital of Xiamen University, School of Medcine, Xiamen University, Xiamen, China
| | - Linjian Chen
- Department of Cardiology, Xiamen Cardiovascular Hospital of Xiamen University, School of Medcine, Xiamen University, Xiamen, China
| | - Mengmeng Xue
- Department of Cardiology, Xiamen Cardiovascular Hospital of Xiamen University, School of Medcine, Xiamen University, Xiamen, China
| | - Yamin Zheng
- Department of Cardiology, Xiamen Cardiovascular Hospital of Xiamen University, School of Medcine, Xiamen University, Xiamen, China
| | - Fanqi Meng
- Department of Cardiology, Xiamen Cardiovascular Hospital of Xiamen University, School of Medcine, Xiamen University, Xiamen, China
| | - Hongfei Jiang
- Department of Cardiology, Xiamen Cardiovascular Hospital of Xiamen University, School of Medcine, Xiamen University, Xiamen, China
| | - Zaixing Shi
- Key Laboratory of Health Technology Assessment of Fujian Province, School of Public Health, Xiamen University, Xiamen, China
| | - Peng Zhang
- Department of Cardiology, Xiamen Cardiovascular Hospital of Xiamen University, School of Medcine, Xiamen University, Xiamen, China
- *Correspondence: Peng Zhang
| | - Cuilian Dai
- Department of Cardiology, Xiamen Cardiovascular Hospital of Xiamen University, School of Medcine, Xiamen University, Xiamen, China
- Cuilian Dai
| |
Collapse
|
39
|
Wilhelm M, Abreu A, Adami PE, Ambrosetti M, Antonopoulou M, Biffi A, Cavarretta E, D'Ascenzi F, Gibson I, Grobbee DE, Iliou MC, Koskinas K, Marques-Vidal P, Nixdorff U, Papadakis M, Piepoli MF, Vassiliou V, Wood D, Dendale P, Halle M. EAPC Core Curriculum for Preventive Cardiology. Eur J Prev Cardiol 2022; 29:251-274. [PMID: 33791783 DOI: 10.1093/eurjpc/zwab017] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 01/15/2021] [Accepted: 01/19/2021] [Indexed: 02/06/2023]
Abstract
Preventive cardiology encompasses the whole spectrum of cardiovascular disease (CVD) prevention, at individual and population level, through all stages of life. This includes promotion of cardiovascular (CV) health, management of individuals at risk of developing CVD, and management of patients with established CVD, through interdisciplinary care in different settings. Preventive cardiology addresses all aspects of CV health in the context of the social determinants of health, including physical activity, exercise, sports, nutrition, weight management, smoking cessation, psychosocial factors and behavioural change, environmental, genetic and biological risk factors, and CV protective medications. This is the first European Core Curriculum for Preventive Cardiology, which will help to standardize, structure, deliver, and evaluate training in preventive cardiology across Europe. It will be the basis for dedicated fellowship programmes and a European Society of Preventive Cardiology (EAPC) subspecialty certification for cardiologists, with the intention to improve quality and outcome in CVD prevention.
Collapse
Affiliation(s)
- Matthias Wilhelm
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 46, 3010 Bern, Switzerland
| | - Ana Abreu
- Servico de Cardioologia, Hospital Universitario de Santa Maria/Centro Hospitalar Universitario Lisboa Norte (CHULN), Centro Academico de Medicina de Lisboa (CAML), Centro Cardiovascular da Universidade de Lisboa (CCUL), Avenida Professor Egas Moniz, 1649-035 Lisbon, Portugal
| | - Paolo Emilio Adami
- Health and Science Department, World Athletics, Monaco Principality, 6-8 Quai Antoine 1er, 98007 Monaco, Monaco
| | - Marco Ambrosetti
- Cardiac Rehabilitation Unit, ASST, Via Medaglie D'Oro, 9, 26013 Crema, Italy
| | - Maria Antonopoulou
- Spili Primary Care Centre, Regional Health System of Crete, 740 53 Spili, Greece
| | - Alessandro Biffi
- Med-Ex Medicine & Exercise, Medical Partner Scuderia Ferrari, Via Vittorio Veneto 108, 00187 Rome, Italy
| | - Elena Cavarretta
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Corso della Repubblica 97, 04100 Latina, Italy
- Mediterranea Cardiocentro, Via Orazio, 2, 80122 Naples, Italy
| | - Flavio D'Ascenzi
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Viale Mario Bracci 16, 53100 Siena, Italy
| | - Irene Gibson
- National Institute for Prevention and Cardiovascular Health, Moyola Lane, Newcastle, Galway H91 FF68, Ireland
| | - Diederick E Grobbee
- Julius Center for Health Sciences and Primary Care, and University Medical Center Utrecht, 3584 CX Utrech, The Netherlands
| | - Marie-Christine Iliou
- Cardiac Rehabilitation and Secondary Prevention Department, Corentin Celton Hospital, Assistance Publique Hopitaux de Paris Centre Université de Paris, Parvis Corentin Celton 4, 92130 Issy-les-Moulineaux, Paris, France
| | - Konstantinos Koskinas
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 46, 3010 Bern, Switzerland
| | - Pedro Marques-Vidal
- Department of Medicine, Internal Medicine, Lausanne University Hospital (CHUV), Rue du Bugnon 46, 1011 Lausanne, Switzerland
| | - Uwe Nixdorff
- European Prevention Center c/o Medical Center Düsseldorf, Luise-Rainer-Straße 6-10, 40235 Düsseldorf, Germany
| | - Michael Papadakis
- Cardiovascular Clinical Academic Group, St George's, University of London, London SW17 0RE, UK
| | - Massimo F Piepoli
- Cardiac Unit, Guglielmo da Saliceto Hospital, University of Parma, 29121 Piacenza, Italy
| | - Vass Vassiliou
- Department of Cardiovascular Medicine, University of East Anglia, Norwich Research Park, Norwich NR4 7TJ, UK
| | - David Wood
- National Institute for Prevention and Cardiovascular Health, National University of Ireland Galway, University Road, Galway H91 TK33, Ireland
- National Heart and Lung Institute, Imperial College London, London SW3 6LY, UK
| | - Paul Dendale
- Heart Centre Hasselt and Hasselt University, 3500 Hasselt, Belgium
| | - Martin Halle
- Department of Prevention and Sports Medicine, University Hospital rechts der Isar, Technical University Munich, German Centre for Cardiovascular Research, Georg-Brauchle-Ring 56, 80992 Munich, Germany
| |
Collapse
|
40
|
Scherrenberg M, Marinus N, Giallauria F, Falter M, Kemps H, Wilhelm M, Prescott E, Vigorito C, De Kluiver E, Cipriano G, Dendale P, Hansen D. The need for long-term personalized management of frail CVD patients by rehabilitation and telemonitoring: a framework. Trends Cardiovasc Med 2022:S1050-1738(22)00023-8. [PMID: 35121082 DOI: 10.1016/j.tcm.2022.01.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 01/24/2022] [Accepted: 01/29/2022] [Indexed: 10/19/2022]
Abstract
Due to advances in cardiovascular medicine and preventive cardiology, patients benefit from a better prognosis, even in case of significant disease burden such as acute and chronic coronary syndromes, advanced valvular heart disease and chronic heart failure. These advances have allowed CVD patients to increase their life expectancy, but on the other hand also experience aging-related syndromes such as frailty. Despite being underrecognized, frailty is a critical, common, and co-existent condition among older CVD patients, leading to exercise intolerance and compromised adherence to cardiovascular rehabilitation. Moreover, frail patients need a different approach for CR and are at very high risk for adverse events, but yet are underrepresented in conventional CR. Fortunately, recent advances have been made in technology, allowing remote monitoring, coaching and supervision of CVD patients in secondary prevention programs with promising benefits. Similarly, we hypothesized that such programs should also be implemented to treat frailty in CVD patients. However, considering frail patients' particular needs and challenges, telerehabilitation interventions should thus be appropriately adapted. Our purpose is to provide, for the first time and based on expert opinions, a framework of how such a cardiac telerehabilitation program could be developed and implemented to manage a prevention and rehabilitation program for CVD patients with frailty.
Collapse
Affiliation(s)
- Martijn Scherrenberg
- Heart Centre Hasselt, Jessa Hospital, Hasselt, Belgium; UHasselt, Faculty of Medicine and Life Sciences, Diepenbeek, Belgium; Faculty of Medicine and Health Sciences, Antwerp University, Belgium
| | - Nastasia Marinus
- UHasselt, Faculty of Rehabilitation Sciences, BIOMED-REVAL, Hasselt, Belgium
| | | | - Maarten Falter
- Heart Centre Hasselt, Jessa Hospital, Hasselt, Belgium; UHasselt, Faculty of Medicine and Life Sciences, Diepenbeek, Belgium; Faculty of Medicine, Department of Cardiology, KULeuven, Herestraat 49, 3000, Leuven, Belgium
| | - Hareld Kemps
- Department of Cardiology, Máxima Medical Center, The Netherlands; Department of Industrial Design, Technical University Eindhoven, The Netherlands
| | - Matthias Wilhelm
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Eva Prescott
- Department of Cardiology, Bispebjerg University Hospital, University of Copenhagen, Copenhagen, NW, Denmark
| | - Carlo Vigorito
- Department of Translational Medical Sciences, Federico II University of Naples
| | | | | | - Paul Dendale
- Heart Centre Hasselt, Jessa Hospital, Hasselt, Belgium; UHasselt, Faculty of Medicine and Life Sciences, Diepenbeek, Belgium
| | - Dominique Hansen
- Heart Centre Hasselt, Jessa Hospital, Hasselt, Belgium; UHasselt, Faculty of Rehabilitation Sciences, BIOMED-REVAL, Hasselt, Belgium.
| |
Collapse
|
41
|
Li Y, Gao Y, Hu S, Chen H, Zhang M, Yang Y, Liu Y. Effects of multicomponent exercise on the muscle strength, muscle endurance and balance of frail older adults: A meta-analysis of randomised controlled trials. J Clin Nurs 2022; 32:1795-1805. [PMID: 34989056 DOI: 10.1111/jocn.16196] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Revised: 12/11/2021] [Accepted: 12/21/2021] [Indexed: 12/01/2022]
Abstract
OBJECTIVES This study aims to evaluate the effects of multicomponent exercise on the muscle strength, muscle endurance and balance of frail older adults living in the community and provide the latest evidence from published randomised controlled trials (RCTs). BACKGROUND The number of frail older adults is rapidly increasing. Previous studies have reported that multicomponent exercise is one of the best types of intervention for increasing muscle strength, muscle endurance and balance for frail older adults. However, due to the small sample size and lack of evidential support, a meta-analysis of RCTs remains necessary. METHODS RCTs reporting the effects of multicomponent exercise on the muscle strength, muscle endurance and balance of frail older adults, published in English, were retrieved from five electronic databases: PubMed, CINAHL, Web of Science, Embase and Cochrane Library available from their inception up to January 2021. RevMan5.3 software was adopted for statistical analysis. This study followed the PRSIMA checklist. RESULTS A total of 10 articles and 667 patients were included in this study. Meta-analysis showed that multicomponent exercise could improve the muscle strength [MD = 2.46, p = .007], muscle endurance [MD = 2.16, p = .03] and balance [MD = .39, p = .03] of frail older adults, and subgroup analysis showed the muscle endurance of frail older adults was significantly improved as the intervention lasted for >12 weeks. CONCLUSIONS RCTs provided in this study show the latest evidence that multicomponent exercise can improve the muscle strength, endurance and balance of frail older adults and that long-duration (>12weeks) multicomponent exercise is more effective for improving muscle endurance. RELEVANCE TO CLINICAL PRACTICE Multicomponent exercise contributes to improving the muscle strength, muscle endurance and balance of frail older adults, so it can be considered as a complement to the physical function management programme for frail older adults.
Collapse
Affiliation(s)
- Yao Li
- Nursing Department, the First Affiliated Hospital of China Medical University, Shenyang, Liaoning, China
| | - Yan Gao
- School of Continuing Education, Peking University, Haidian, Beijing, China
| | - Shuang Hu
- Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China
| | - Hongyu Chen
- Nursing Department, the First Affiliated Hospital of China Medical University, Shenyang, Liaoning, China
| | - Minyi Zhang
- Nursing Department, the First Affiliated Hospital of China Medical University, Shenyang, Liaoning, China
| | - Yi Yang
- Neurosurgery Department, the First Affiliated Hospital of China Medical University, Shenyang, Liaoning, China
| | - Yan Liu
- Neurosurgery Department, the First Affiliated Hospital of China Medical University, Shenyang, Liaoning, China
| |
Collapse
|
42
|
Furukawa H. Current Clinical Implications of Frailty and Sarcopenia in Vascular Surgery: A Comprehensive Review of the Literature and Consideration of Perioperative Management. Ann Vasc Dis 2022; 15:165-174. [PMID: 36310738 PMCID: PMC9558142 DOI: 10.3400/avd.ra.22-00035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 06/15/2022] [Indexed: 11/27/2022] Open
Abstract
Frailty is a well-known geriatric syndrome of impaired physiological reserve and increased vulnerability to stressors. Sarcopenia is also used as a parameter of physical impairment characterized by muscle weakness. As population aging has become more prominent in recent years, both modalities are now regarded as clinically important prognostic tools defined by multidimensional factors that may affect clinical outcomes in various clinical settings. A preoperative surgical risk analysis is mandatory to predict clinical and surgical outcomes in all surgical practices, particularly in high-risk surgical patients. In vascular surgical settings, frailty and sarcopenia have been accepted as useful prognostic tools to evaluate patient characteristics before surgery, as these may predict perioperative clinical and surgical outcomes. Although minimally invasive surgical approaches, such as endovascular therapy, and hybrid approaches have been universally developed, achieving good vascular surgical outcomes for high-risk cohorts remains to be challenge due to the increasing prevalence of elderly patients and multiple preoperative co-morbidities in addition to frailty and sarcopenia. Therefore, to further improve clinical and surgical outcomes, these preoperative geriatric prognostic factors will be of great importance and interest in vascular surgical settings for both physicians and surgeons.
Collapse
Affiliation(s)
- Hiroshi Furukawa
- Department of Cardiovascular Surgery, Tokyo Women’s Medical University Adachi Medical Center
| |
Collapse
|
43
|
Giallauria F, Strisciuglio T, Cuomo G, Di Lorenzo A, D'Angelo A, Volpicelli M, Izzo R, Manzi MV, Barbato E, Morisco C. Exercise Training: The Holistic Approach in Cardiovascular Prevention. High Blood Press Cardiovasc Prev 2021; 28:561-577. [PMID: 34724167 PMCID: PMC8590648 DOI: 10.1007/s40292-021-00482-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 10/23/2021] [Indexed: 12/26/2022] Open
Abstract
Nowadays, there are robust clinical and pathophysiological evidence supporting the beneficial effects of physical activity on cardiovascular (CV) system. Thus, the physical activity is considered a key strategy for CV prevention. In fact, exercise training exerts favourable effects on all risk factors for CV diseases (i.e. essential hypertension, type 2 diabetes mellitus, hypercholesterolemia, obesity, metabolic syndrome, etc…). In addition, all training modalities such as the aerobic (continuous walking, jogging, cycling, etc.) or resistance exercise (weights), as well as the leisure-time physical activity (recreational walking, gardening, etc) prevent the development of the major CV risk factors, or delay the progression of target organ damage improving cardio-metabolic risk. Exercise training is also the core component of all cardiac rehabilitation programs that have demonstrated to improve the quality of life and to reduce morbidity in patients with CV diseases, mostly in patients with coronary artery diseases. Finally, it is still debated whether or not exercise training can influence the occurrence of atrial and ventricular arrhythmias. In this regard, there is some evidence that exercise training is protective predominantly for atrial arrhythmias, reducing the incidence of atrial fibrillation. In conclusion, the salutary effects evoked by physical acitvity are useful in primary and secondary CV prevention.
Collapse
Affiliation(s)
- Francesco Giallauria
- Department of Translational Medical Sciences, "Federico II" University of Naples, 80131, Naples, Italy
| | - Teresa Strisciuglio
- Department of Advanced Biomedical Sciences, "Federico II" University of Naples, 80131, Naples, Italy
| | - Gianluigi Cuomo
- Department of Translational Medical Sciences, "Federico II" University of Naples, 80131, Naples, Italy
| | - Anna Di Lorenzo
- Department of Translational Medical Sciences, "Federico II" University of Naples, 80131, Naples, Italy
| | - Andrea D'Angelo
- Department of Translational Medical Sciences, "Federico II" University of Naples, 80131, Naples, Italy
| | - Mario Volpicelli
- Department of Cardiology, "Santa Maria della Pietà" Hospital (ASL Napoli 3 Sud), 80035, Nola, NA, Italy
| | - Raffaele Izzo
- Department of Advanced Biomedical Sciences, "Federico II" University of Naples, 80131, Naples, Italy
| | - Maria Virginia Manzi
- Department of Advanced Biomedical Sciences, "Federico II" University of Naples, 80131, Naples, Italy
| | - Emanuele Barbato
- Department of Advanced Biomedical Sciences, "Federico II" University of Naples, 80131, Naples, Italy
| | - Carmine Morisco
- Department of Advanced Biomedical Sciences, "Federico II" University of Naples, 80131, Naples, Italy.
| |
Collapse
|
44
|
Bianchi S, Maloberti A, Peretti A, Garatti L, Palazzini M, Occhi L, Bassi I, Sioli S, Biolcati M, Giani V, Monticelli M, Leidi F, Ruzzenenti G, Beretta G, Giannattasio C, Riccobono S. Determinants of Functional Improvement After Cardiac Rehabilitation in Acute Coronary Syndrome. High Blood Press Cardiovasc Prev 2021; 28:579-587. [PMID: 34515960 PMCID: PMC8590661 DOI: 10.1007/s40292-021-00473-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Accepted: 08/28/2021] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Cardiac rehabilitation (CR) is an effective tool for secondary prevention after acute coronary syndrome (ACS). AIM Aim of our study was to find the significant determinants of exercise capacity (evaluated with the six-minute walking test-6-MWT) and functional improvement in patients undergoing CR after an ACS. METHODS The study group included 298 patients (mean age 61.6 ± 10.2 years; males 80.2%) who, after ACS, were enrolled in CR program at Niguarda Hospital in Milan from 2015 to 2018. For all patients, we collected anamnestic, clinical and instrumental cardiological data. All patients performed a 6-MWT at the beginning (6-MWT-1) and at the end (6-MWT-2) of CR program. Δ meters were used to represent functional improvement. RESULTS Multiple linear regression models were carried out for 6-MWT-1, 6-MWT-2, Δ meters and % Δ meters. Standardized regression coefficients showed that age (β = - 0.237; p < 0.001), BMI (β = - 0.116; p = 0.006) and heart rate (β = - 0.082; p = 0.040) were determinants of exercise capacity (6MWT-1 and 2), whereas age (β = -.231; p = 0.004), sex (β = - 0.187; p = 0.008) and BMI (β = - 0.164; p = 0.022) were determinants of functional improvement (Δ meters). CONCLUSIONS Our data showed that functional improvement after CR in ACS patients is mainly related to non-cardiological variables. Instead it is related to intrinsic factors, both modifiable (BMI) and non-modifiable (age, sex).
Collapse
Affiliation(s)
- Sofia Bianchi
- School of Medicine and Surgery, Milano-Bicocca University, Milan, Italy
| | - Alessandro Maloberti
- School of Medicine and Surgery, Milano-Bicocca University, Milan, Italy.
- Dipartimento A. De Gasperis, Cardiac Rehabilitation, Cardiology 4, Niguarda Hospital, Piazza Ospedale Maggiore 3, 20159, Milan, Italy.
| | - Alessio Peretti
- School of Medicine and Surgery, Milano-Bicocca University, Milan, Italy
- Dipartimento A. De Gasperis, Cardiac Rehabilitation, Cardiology 4, Niguarda Hospital, Piazza Ospedale Maggiore 3, 20159, Milan, Italy
| | - Laura Garatti
- School of Medicine and Surgery, Milano-Bicocca University, Milan, Italy
- Dipartimento A. De Gasperis, Cardiac Rehabilitation, Cardiology 4, Niguarda Hospital, Piazza Ospedale Maggiore 3, 20159, Milan, Italy
| | - Matteo Palazzini
- School of Medicine and Surgery, Milano-Bicocca University, Milan, Italy
- Dipartimento A. De Gasperis, Cardiac Rehabilitation, Cardiology 4, Niguarda Hospital, Piazza Ospedale Maggiore 3, 20159, Milan, Italy
| | - Lucia Occhi
- Dipartimento A. De Gasperis, Cardiac Rehabilitation, Cardiology 4, Niguarda Hospital, Piazza Ospedale Maggiore 3, 20159, Milan, Italy
| | - Ilaria Bassi
- Dipartimento A. De Gasperis, Cardiac Rehabilitation, Cardiology 4, Niguarda Hospital, Piazza Ospedale Maggiore 3, 20159, Milan, Italy
| | - Sabrina Sioli
- Dipartimento A. De Gasperis, Cardiac Rehabilitation, Cardiology 4, Niguarda Hospital, Piazza Ospedale Maggiore 3, 20159, Milan, Italy
| | - Marco Biolcati
- School of Medicine and Surgery, Milano-Bicocca University, Milan, Italy
- Dipartimento A. De Gasperis, Cardiac Rehabilitation, Cardiology 4, Niguarda Hospital, Piazza Ospedale Maggiore 3, 20159, Milan, Italy
| | - Valentina Giani
- School of Medicine and Surgery, Milano-Bicocca University, Milan, Italy
- Dipartimento A. De Gasperis, Cardiac Rehabilitation, Cardiology 4, Niguarda Hospital, Piazza Ospedale Maggiore 3, 20159, Milan, Italy
| | - Massimiliano Monticelli
- School of Medicine and Surgery, Milano-Bicocca University, Milan, Italy
- Dipartimento A. De Gasperis, Cardiac Rehabilitation, Cardiology 4, Niguarda Hospital, Piazza Ospedale Maggiore 3, 20159, Milan, Italy
| | - Filippo Leidi
- School of Medicine and Surgery, Milano-Bicocca University, Milan, Italy
- Dipartimento A. De Gasperis, Cardiac Rehabilitation, Cardiology 4, Niguarda Hospital, Piazza Ospedale Maggiore 3, 20159, Milan, Italy
| | - Giacomo Ruzzenenti
- School of Medicine and Surgery, Milano-Bicocca University, Milan, Italy
- Dipartimento A. De Gasperis, Cardiac Rehabilitation, Cardiology 4, Niguarda Hospital, Piazza Ospedale Maggiore 3, 20159, Milan, Italy
| | - Giovanna Beretta
- Rehabilitative Medicine and Neuro-Rehabilitation, Niguarda Hospital, Milan, Italy
| | - Cristina Giannattasio
- School of Medicine and Surgery, Milano-Bicocca University, Milan, Italy
- Dipartimento A. De Gasperis, Cardiac Rehabilitation, Cardiology 4, Niguarda Hospital, Piazza Ospedale Maggiore 3, 20159, Milan, Italy
| | - Salvatore Riccobono
- Dipartimento A. De Gasperis, Cardiac Rehabilitation, Cardiology 4, Niguarda Hospital, Piazza Ospedale Maggiore 3, 20159, Milan, Italy
| |
Collapse
|
45
|
Baritello O, Salzwedel A, Sündermann SH, Niebauer J, Völler H. The Pandora's Box of Frailty Assessments: Which Is the Best for Clinical Purposes in TAVI Patients? A Critical Review. J Clin Med 2021; 10:jcm10194506. [PMID: 34640525 PMCID: PMC8509314 DOI: 10.3390/jcm10194506] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Revised: 09/15/2021] [Accepted: 09/24/2021] [Indexed: 02/07/2023] Open
Abstract
Frailty assessment is recommended before elective transcatheter aortic valve implantation (TAVI) to determine post-interventional prognosis. Several studies have investigated frailty in TAVI-patients using numerous assessments; however, it remains unclear which is the most appropriate tool for clinical practice. Therefore, we evaluate which frailty assessment is mainly used and meaningful for ≤30-day and ≥1-year prognosis in TAVI patients. Randomized controlled or observational studies (prospective/retrospective) investigating all-cause mortality in older (≥70 years) TAVI patients were identified (PubMed; May 2020). In total, 79 studies investigating frailty with 49 different assessments were included. As single markers of frailty, mostly gait speed (23 studies) and serum albumin (16 studies) were used. Higher risk of 1-year mortality was predicted by slower gait speed (highest Hazard Ratios (HR): 14.71; 95% confidence interval (CI) 6.50–33.30) and lower serum albumin level (highest HR: 3.12; 95% CI 1.80–5.42). Composite indices (five items; seven studies) were associated with 30-day (highest Odds Ratio (OR): 15.30; 95% CI 2.71–86.10) and 1-year mortality (highest OR: 2.75; 95% CI 1.55–4.87). In conclusion, single markers of frailty, in particular gait speed, were widely used to predict 1-year mortality. Composite indices were appropriate, as well as a comprehensive assessment of frailty.
Collapse
Affiliation(s)
- Omar Baritello
- Department of Rehabilitation Medicine, Faculty of Health Sciences Brandenburg, University of Potsdam, 14469 Brandenburg, Germany;
- Research Group Molecular and Clinical Life Science of Metabolic Diseases, Faculty of Health Sciences Brandenburg, University of Potsdam, 14476 Potsdam, Germany;
| | - Annett Salzwedel
- Research Group Molecular and Clinical Life Science of Metabolic Diseases, Faculty of Health Sciences Brandenburg, University of Potsdam, 14476 Potsdam, Germany;
| | - Simon H. Sündermann
- Department of Cardiovascular Surgery, Charité—Universitätsmedizin Berlin, 10117 Berlin, Germany;
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, 13353 Berlin, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site Berlin, 13353 Berlin, Germany
| | - Josef Niebauer
- University Institute of Sports Medicine, Prevention and Rehabilitation and Research Institute of Molecular Sports Medicine and Rehabilitation, Paracelsus Medical University, A-5020 Salzburg, Austria;
| | - Heinz Völler
- Research Group Molecular and Clinical Life Science of Metabolic Diseases, Faculty of Health Sciences Brandenburg, University of Potsdam, 14476 Potsdam, Germany;
- Correspondence: ; Tel.: +49-(03)-319774061
| |
Collapse
|
46
|
Visseren FLJ, Mach F, Smulders YM, Carballo D, Koskinas KC, Bäck M, Benetos A, Biffi A, Boavida JM, Capodanno D, Cosyns B, Crawford C, Davos CH, Desormais I, Di Angelantonio E, Franco OH, Halvorsen S, Hobbs FDR, Hollander M, Jankowska EA, Michal M, Sacco S, Sattar N, Tokgozoglu L, Tonstad S, Tsioufis KP, van Dis I, van Gelder IC, Wanner C, Williams B. 2021 ESC Guidelines on cardiovascular disease prevention in clinical practice. Eur J Prev Cardiol 2021; 29:5-115. [PMID: 34558602 DOI: 10.1093/eurjpc/zwab154] [Citation(s) in RCA: 211] [Impact Index Per Article: 70.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
| | | | | | | | | | | | | | - Alessandro Biffi
- European Federation of Sports Medicine Association (EFSMA).,International Federation of Sport Medicine (FIMS)
| | | | | | | | | | | | | | | | | | | | - F D Richard Hobbs
- World Organization of National Colleges, Academies and Academic Associations of General Practitioners/Family Physicians (WONCA) - Europe
| | | | | | | | | | | | | | | | | | | | | | - Christoph Wanner
- European Renal Association - European Dialysis and Transplant Association (ERA-EDTA)
| | | | | |
Collapse
|
47
|
Visseren FLJ, Mach F, Smulders YM, Carballo D, Koskinas KC, Bäck M, Benetos A, Biffi A, Boavida JM, Capodanno D, Cosyns B, Crawford C, Davos CH, Desormais I, Di Angelantonio E, Franco OH, Halvorsen S, Hobbs FDR, Hollander M, Jankowska EA, Michal M, Sacco S, Sattar N, Tokgozoglu L, Tonstad S, Tsioufis KP, van Dis I, van Gelder IC, Wanner C, Williams B. 2021 ESC Guidelines on cardiovascular disease prevention in clinical practice. Eur Heart J 2021; 42:3227-3337. [PMID: 34458905 DOI: 10.1093/eurheartj/ehab484] [Citation(s) in RCA: 2438] [Impact Index Per Article: 812.7] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Affiliation(s)
| | | | | | | | | | | | | | - Alessandro Biffi
- European Federation of Sports Medicine Association (EFSMA)
- International Federation of Sport Medicine (FIMS)
| | | | | | | | | | | | | | | | | | | | - F D Richard Hobbs
- World Organization of National Colleges, Academies and Academic Associations of General Practitioners/Family Physicians (WONCA) - Europe
| | | | | | | | | | | | | | | | | | | | | | - Christoph Wanner
- European Renal Association - European Dialysis and Transplant Association (ERA-EDTA)
| | | |
Collapse
|
48
|
Nakaya Y, Akamatsu M, Ogimoto A, Kitaoka H. Early cardiac rehabilitation for acute decompensated heart failure safely improves physical function (PEARL study): a randomized controlled trial. Eur J Phys Rehabil Med 2021; 57:985-993. [PMID: 34291626 DOI: 10.23736/s1973-9087.21.06727-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Improvements in the Short Physical Performance Battery (SPPB) rather than exercise tolerance reportedly lead to favorable prognosis in elderly patients with acute decompensated heart failure (ADHF). However, about 50% of heart failure shows heart failure with preserved ejection fraction, safe and effective interventions to improve SPPB for these types remain unclear. In addition, although a standard cardiac rehabilitation (CR) program for heart failure is widely used in Japan, whether this is sufficient to improve SPPB in elderly patients with ADHF remains unclear. AIM This study was to evaluate whether the addition of multidisciplinary physical interventions to the standard CR program would prove effective for improving SPPB among elderly patients with ADHF regardless types of heart failure. DESING Randomized, prospective study. SETTING Patients admitted to our hospital due to ADHF in Japan. POPULATION Elderly patients with ADHF between March 2019 and March 2020 were randomized to two groups, an Intervention group and a Control group. METHODS The Control group performed standard CR. The Intervention group received balance training and resistance training and used a cycling ergometer in addition to the standard CR program. The primary outcome was the improvement in SPPB after CR. RESULTS Seventy-five patients with ADHF were divided into the two groups (Intervention group, n=36; Control group, n=39). At baseline, both groups showed low physical performance and a high prevalence of frailty. Intervention size effect was an improvement in SPPB score of +2.2 (+3.7±1.1 vs. +1.5±1.7; p<0.001). Of the 3 components of SPPB, both gait speed and timed repeated chair rise were significantly improved in the Intervention group compared to the Control group, with intervention size effect of +0.76 and +0.94, respectively (p<0.001). Subgroup analysis of heart failure with preserved ejection fraction showed significant improvement in SPPB score in the Intervention group compared to the Control group (p<0.001).No adverse events were observed during the study period. CONCLUSIONS A multi-faceted intervention in addition to standard CR improved physical performance among elderly patients with ADHF regardless types of heart failure. CLINICAL REHABILITATION IMPACT We believe that use of a cycling ergometer and loadspecific resistance training provide specific CR for patients with ADHF during acute hospitalization and highlight the need for active intervention.
Collapse
Affiliation(s)
- Yuta Nakaya
- Department of Rehabilitation, Uwajima City Hospital, Uwajima, Japan - .,Medical Science Graduate School of Kochi University, Kochi, Japan -
| | | | | | - Hiroaki Kitaoka
- Department of Cardiology and Geriatrics, Kochi Medical School, Kochi University, Kochi, Japan
| |
Collapse
|
49
|
Kambic T, Šarabon N, Hadžić V, Lainscak M. Effects of high-load and low-load resistance training in patients with coronary artery disease: rationale and design of a randomised controlled clinical trial. BMJ Open 2021; 11:e051325. [PMID: 34301669 PMCID: PMC8728351 DOI: 10.1136/bmjopen-2021-051325] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Resistance training (RT) combined with aerobic training (AT) enhances the effects of cardiac rehabilitation (CR) in patients with coronary artery disease (CAD). However, it remains to be investigated which type of RT (high loads (HLs) vs low loads (LLs)) is more efficacious in improving exercise performance, cardio-metabolic health and quality of life. METHODS AND ANALYSIS A randomised, controlled, clinical trial will enrol 20 patients with CAD into each of three study arms (total 60 patients): HL-RT (70%-80% of one repetition maximum (1-RM)) combined with AT; LL-RT (30%-40% of 1-RM) combined with AT and AT alone as standard care. Primary outcomes (maximal aerobic capacity, maximal leg isometric strength) will be assessed at baseline and after 36 training sessions. Other outcomes will include acute haemodynamic responses to LL-RT and HL-RT, body composition, physical performance, blood biomarkers (lipids, glucose metabolism, inflammation, growth factors), physical activity and quality of life. The intention-to-treat principle will be used to analyse the data. ETHICS AND DISSEMINATION The study design and protocol have been approved by the National Medical Ethics Committee of Slovenia (registration number: 0120-573/2019/15). The study will be conducted in accordance with the Declaration of Helsinki. The results of the study will be published as peer-reviewed manuscripts and congress presentations, communicated with patients and the clinical community, and shared through posts on social media. The findings of the study will be disseminated among the national CR clinical community (CR centres, Slovenian association of coronary clubs) with active participation of the patients enrolled in the study. This study will expand our knowledge of RT in combination with AT in CR. We expect to find different effects of HL-RT versus LL-RT, with implications for RT strategies in rehabilitation of patients with CAD. TRIAL REGISTRATION NUMBER NCT04638764.
Collapse
Affiliation(s)
- Tim Kambic
- Department of Research and Education, General Hospital Murska Sobota, Murska Sobota, Slovenia
| | - Nejc Šarabon
- University of Primorska, Faculty of Health Sciences, Izola, Slovenia
- Laboratory for Motor Control and Motor Behavior, S2P, Science to Practice, Ljubljana, Slovenia
- Human Health Department, InnoRenew CoE, Izola, Slovenia
| | - Vedran Hadžić
- Department of Sports Medicine, University of Ljubljana, Faculty of Sport, Ljubljana, Slovenia
| | - Mitja Lainscak
- Division of Cardiology, General Hospital Murska Sobota, Murska Sobota, Slovenia
- University of Ljubljana, Faculty of Medicine, Ljubljana, Slovenia
- University of Maribor, Faculty of Natural Sciences and Mathematics, Maribor, Slovenia
| |
Collapse
|
50
|
Cardiac Rehabilitation in Frail Older Adults With Cardiovascular Disease: A NEW DIAGNOSTIC AND TREATMENT PARADIGM. J Cardiopulm Rehabil Prev 2021; 40:72-78. [PMID: 31939755 DOI: 10.1097/hcr.0000000000000492] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Older adults with cardiovascular disease (CVD) pose challenges to cardiac rehabilitation (CR) clinicians because their disease is often coupled to physical frailty. Older patients with CVD and frailty may be less likely to tolerate conventional CR exercise training due to multidimensional (ie, strength, mobility, and balance) physical impairments. Furthermore, conventional CR typically emphasizes endurance training without addressing the intrinsic skeletal muscle impairments of frail patients that often manifest as deficits in strength, mobility, and balance, undercutting feasibility and any likely benefits. However, if appropriately modified to meet the needs of frail older adults, CR may be a powerful tool for this challenging population. To best serve frail, older adults with CVD, CR programs can incorporate well-validated strategies to assess frailty and physical function that also fit within the workflows and patient populations of individual programs. Such frailty assessments provide opportunities to identify specific targets (eg, weakness) that need to be addressed before a subsequent aerobic training program can be successfully implemented and sustained. The current review focuses on the use of physical frailty measures in older adults with CVD, with practical considerations for their clinical use in contemporary CR, as well as directions for future research.
Collapse
|