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Vahedian-Azimi A, Sanjari MJ, Rahimi-Bashar F, Gohari-Mogadam K, Ouahrani A, Mustafa EMM, Ait Hssain A, Sahebkar A. Cardiac Rehabilitation Using the Family-Centered Empowerment Model is Effective in Improving Long-term Mortality in Patients with Myocardial Infarction: A 10-year Follow-Up Randomized Clinical Trial. High Blood Press Cardiovasc Prev 2024; 31:189-204. [PMID: 38564167 DOI: 10.1007/s40292-024-00636-2] [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: 01/09/2024] [Accepted: 03/21/2024] [Indexed: 04/04/2024] Open
Abstract
INTRODUCTION Cardiac rehabilitation (CR) play a critical role in reducing the risk of future cardiovascular events and enhancing the quality of life for individuals who have survived a heart attack. AIM To assess the mortality rates and stability of the effects in myocardial infarction (MI) survivors after implementing a Family-Centered Empowerment Model (FCEM)-focused hybrid cardiac rehabilitation program. METHODS This double-blind randomized controlled clinical trial, conducted at Shariati Hospital, an academic teaching hospital in Tehran, Iran (2012-2023), involved 70 MI patients and their families. Participants were randomly assigned to an FCEM intervention group or standard CR control group. The intervention commenced after the MI patient's safe discharge from the CCU and continued for the entire 10-year follow-up period. Various questionnaires were utilized to collect data on mortality rates and health-related quality of life (HRQoL). RESULTS The 10-year follow-up period revealed lower mortality rates in the intervention group (5.7%, 11.4%, and 17.1% at 5, 7, and 10 years, respectively) compared to the control group (20%, 37.1%, and 48.9%). After adjusting for age, gender, and BMI, the control group had a four times higher mortality risk (HR: 4.346, 95% CI 1.671-7.307, P = 0.003). The FCEM-focused program demonstrated a significant and sustained positive impact on participants' quality of life for 48 months, with greater improvement compared to the control group. CONCLUSION This study highlights the effectiveness of FCEM-based hybrid CR programs in enhancing long-term patient outcomes and reducing mortality rates among MI survivors. Further research is needed to explore the potential benefits in larger samples and diverse populations. TRIAL REGISTRATION This study (Identifier: NCT02402582) was registered in the ClinicalTrials.gov on 03/30/2015.
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Affiliation(s)
- Amir Vahedian-Azimi
- Trauma research center, Nursing Faculty, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Mohammad Javad Sanjari
- Trauma research center, Nursing Faculty, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | | | - Keivan Gohari-Mogadam
- Medical ICU and Pulmonary Unit, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Ayoub Ouahrani
- Department of Anesthesiology and Intensive Care, Dijon University Hospital, Dijon, France
| | | | - Ali Ait Hssain
- Medical Intensive Care Unit, Hamad General Hospital, Doha, Qatar.
- Department of Medicine, Weill Cornell Medical College, Doha, Qatar.
| | - Amirhossein Sahebkar
- Center for Global Health Research, Saveetha Medical College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, India.
- Applied Biomedical Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.
- Biotechnology Research Center, Pharmaceutical Technology Institute, Mashhad University of Medical Sciences, Mashhad, Iran.
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Gore S, Khanna H, Kumar A. Effects of Comprehensive Outpatient Cardiac Rehabilitation on Exercise Capacity, Functional Status, and Quality of Life in People With Heart Failure: A Systematic Review and Meta-Analysis. Phys Ther 2023; 103:pzad119. [PMID: 37658777 PMCID: PMC10630615 DOI: 10.1093/ptj/pzad119] [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: 09/19/2022] [Revised: 04/20/2023] [Accepted: 07/02/2023] [Indexed: 09/05/2023]
Abstract
PURPOSE The purpose of this study was to systematically review and conduct a meta-analysis to examine the impact of comprehensive outpatient cardiac rehabilitation on exercise capacity, functional status, and quality of life in patients with heart failure. METHODS PubMed, Embase, and CINAHL were searched using keywords and MeSH terms on heart failure and cardiac rehabilitation. Randomized clinical trials published in English using outpatient exercise-based cardiac rehabilitation in patients with heart failure were included. The Grading of Recommendations Assessment, Development, and Evaluation was utilized for quality appraisal. Pooled estimates were computed using standardized mean differences (SMDs) and 95% CIs. Primary outcomes were functional status (6-minute walk distance, quality of life, exercise capacity using peak oxygen consumption, muscle strength, and endurance). RESULTS Eleven randomized controlled trials including 1523 participants ranging from 45 to 80 years old and an intervention duration ranging from 2 to 26 weeks were analyzed. Pooled results indicated significant improvements with comprehensive cardiac rehabilitation on 6-minute walk distance (SMD = 0.30; 95% CI = 0.06 to 0.54) and oxygen consumption (SMD = 0.23; 95% CI = 0.06 to 0.40). However, there was no additional benefit for the quality of life beyond that seen in the comparison groups. CONCLUSION Results of this study suggest that comprehensive outpatient cardiac rehabilitation is associated with significantly better clinical outcomes than single-component exercise programs in cardiac rehabilitation settings, multicomponent exercise in noncardiac rehabilitation settings, or no exercise. IMPACT Heart failure is significantly associated with an increased risk of poor exercise tolerance. Despite the proven benefit of cardiac rehabilitation on exercise tolerance and physical activities from individual randomized clinical trials, questions regarding its impact on clinical outcomes such as exercise capacity, functional status, and quality of life remain inadequate. This systematic review and meta-analysis provides strong evidence supporting comprehensive outpatient cardiac rehabilitation for improving clinical outcomes in heart failure.
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Affiliation(s)
- Shweta Gore
- Department of Physical Therapy, School of Health and Rehabilitation Sciences, MGH Institute of Health Professions, Boston, Massachusetts, USA
| | - Hargun Khanna
- Department of Physical Therapy, School of Health and Rehabilitation Sciences, MGH Institute of Health Professions, Boston, Massachusetts, USA
| | - Amit Kumar
- Department of Physical Therapy and Athletic Training, College of Health, University of Utah, Salt Lake City, Utah, USA
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Hoerold M, Heytens H, Debbeler CM, Ehrentreich S, Rauwolf T, Schmeißer A, Gottschalk M, Bitzer EM, Braun-Dullaeus RC, Apfelbacher CJ. An evidence map of systematic reviews on models of outpatient care for patients with chronic heart diseases. Syst Rev 2023; 12:80. [PMID: 37149625 PMCID: PMC10163805 DOI: 10.1186/s13643-023-02227-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 03/30/2023] [Indexed: 05/08/2023] Open
Abstract
BACKGROUND Chronic heart disease affects millions of people worldwide and the prevalence is increasing. By now, there is an extensive literature on outpatient care of people with chronic heart disease. We aimed to systematically identify and map models of outpatient care for people with chronic heart disease in terms of the interventions included and the outcomes measured and reported to determine areas in need of further research. METHODS We created an evidence map of published systematic reviews. PubMed, Cochrane Library (Wiley), Web of Science, and Scopus were searched to identify all relevant articles from January 2000 to June 2021 published in English or German language. From each included systematic review, we abstracted search dates, number and type of included studies, objectives, populations, interventions, and outcomes. Models of care were categorised into six approaches: cardiac rehabilitation, chronic disease management, home-based care, outpatient clinic, telemedicine, and transitional care. Intervention categories were developed inductively. Outcomes were mapped onto the taxonomy developed by the COMET initiative. RESULTS The systematic literature search identified 8043 potentially relevant publications on models of outpatient care for patients with chronic heart diseases. Finally, 47 systematic reviews met the inclusion criteria, covering 1206 primary studies (including double counting). We identified six different models of care and described which interventions were used and what outcomes were included to measure their effectiveness. Education-related and telemedicine interventions were described in more than 50% of the models of outpatient care. The most frequently used outcome domains were death and life impact. CONCLUSION Evidence on outpatient care for people with chronic heart diseases is broad. However, comparability is limited due to differences in interventions and outcome measures. Outpatient care for people with coronary heart disease and atrial fibrillation is a less well-studied area compared to heart failure. Our evidence mapping demonstrates the need for a core outcome set and further studies to examine the effects of models of outpatient care or different interventions with adjusted outcome parameters. SYSTEMATIC REVIEW REGISTRATION PROSPERO (CRD42020166330).
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Affiliation(s)
- Madlen Hoerold
- Institute of Social Medicine and Health Systems Research, Medical Faculty, Otto von Guericke University Magdeburg, Leipziger Str. 44, Magdeburg, Sachsen-Anhalt, 39120, Germany.
| | - Heike Heytens
- Institute of Social Medicine and Health Systems Research, Medical Faculty, Otto von Guericke University Magdeburg, Leipziger Str. 44, Magdeburg, Sachsen-Anhalt, 39120, Germany
| | - Carla Maria Debbeler
- Institute of Social Medicine and Health Systems Research, Medical Faculty, Otto von Guericke University Magdeburg, Leipziger Str. 44, Magdeburg, Sachsen-Anhalt, 39120, Germany
| | - Saskia Ehrentreich
- Institute of Social Medicine and Health Systems Research, Medical Faculty, Otto von Guericke University Magdeburg, Leipziger Str. 44, Magdeburg, Sachsen-Anhalt, 39120, Germany
| | - Thomas Rauwolf
- Department of Angiology and Cardiology, Otto-von-Guericke University of Magdeburg, Leipziger Str. 44, Magdeburg, Sachsen-Anhalt, 39120, Germany
| | - Alexander Schmeißer
- Department of Angiology and Cardiology, Otto-von-Guericke University of Magdeburg, Leipziger Str. 44, Magdeburg, Sachsen-Anhalt, 39120, Germany
| | - Marc Gottschalk
- Department of Angiology and Cardiology, Otto-von-Guericke University of Magdeburg, Leipziger Str. 44, Magdeburg, Sachsen-Anhalt, 39120, Germany
| | - Eva Maria Bitzer
- Department of Public Health and Health Education, University of Education Freiburg, Kunzenweg 21, Freiburg, Baden-Würtemberg, 79117, Germany
| | - Ruediger C Braun-Dullaeus
- Department of Angiology and Cardiology, Otto-von-Guericke University of Magdeburg, Leipziger Str. 44, Magdeburg, Sachsen-Anhalt, 39120, Germany
| | - Christian J Apfelbacher
- Institute of Social Medicine and Health Systems Research, Medical Faculty, Otto von Guericke University Magdeburg, Leipziger Str. 44, Magdeburg, Sachsen-Anhalt, 39120, Germany
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Leźnicka K, Pawlak M, Maciejewska-Skrendo A, Buczny J, Wojtkowska A, Pawlus G, Machoy-Mokrzyńska A, Jażdżewska A. Is Physical Activity an Effective Factor for Modulating Pressure Pain Threshold and Pain Tolerance after Cardiovascular Incidents? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:11276. [PMID: 36141549 PMCID: PMC9517088 DOI: 10.3390/ijerph191811276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 08/27/2022] [Accepted: 09/06/2022] [Indexed: 06/16/2023]
Abstract
The purpose of this study was to investigate whether regular physical activity can alter the pressure pain threshold, pain tolerance, and subjective pain perception in individuals who have experienced a cardiovascular event. The study involved 85 individuals aged 37 to 84 years (M = 65.36) who qualified for outpatient cardiac rehabilitation, which consisted of 24 physical training sessions. The patients were all tested twice: on the first and last day of the outpatient cardiac rehabilitation program. Assessments of the pressure pain threshold and pain tolerance were performed with an algometer. To assess the pain coping strategies, the Pain Coping Strategies Questionnaire (CSQ) and parenting styles were measured retrospectively with subjective survey questions. The main results of the study showed that patients achieved significantly higher pressure pain thresholds after a physical training cycle (ps < 0.05, η2 = 0.05-0.14), but found no differences in the pain tolerance (ps > 0.05). A lower preference for the better pain coping strategy explanation (ß = -0.42, p = 0.013) and growing up in a family with a less neglectful atmosphere (ß = -0.35, p = 0.008) were associated with increased pressure pain threshold after physical training. The results suggest that physical activity is an important factor in modulating the pressure pain threshold.
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Affiliation(s)
- Katarzyna Leźnicka
- Department of Physical Education, Academy of Physical Education and Sport, ul. Kazimierza Górskiego 1, 80-336 Gdansk, Poland
| | - Maciej Pawlak
- Department of Physiology and Biochemistry, Poznan University of Physical Education, 61-871 Poznan, Poland
| | - Agnieszka Maciejewska-Skrendo
- Department of Physical Education, Academy of Physical Education and Sport, ul. Kazimierza Górskiego 1, 80-336 Gdansk, Poland
- Institute of Physical Culture and Health Promotion, University of Szczecin, 70-237 Szczecin, Poland
| | - Jacek Buczny
- Institute of Psychology, SWPS University of Social Sciences and Humanities, 81-745 Sopot, Poland
- Department of Experimental and Applied Psychology, Faculty of Behavioural and Movement Sciences, Vrije Universiteit, 1081 HV Amsterdam, The Netherlands
| | - Anna Wojtkowska
- Institute of Psychology, SWPS University of Social Sciences and Humanities, 53-238 Wroclaw, Poland
| | - Grzegorz Pawlus
- Department of Physical Education, Academy of Physical Education and Sport, ul. Kazimierza Górskiego 1, 80-336 Gdansk, Poland
| | - Anna Machoy-Mokrzyńska
- Department of Experimental and Clinical Pharmacology, Pomeranian Medical University, 70-111 Szczecin, Poland
| | - Aleksandra Jażdżewska
- Department of Physical Education, Academy of Physical Education and Sport, ul. Kazimierza Górskiego 1, 80-336 Gdansk, Poland
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Vonk T, Bakker EA, Zegers ES, Hopman MTE, Eijsvogels TMH. Effect of a personalised mHealth home-based training application on physical activity levels during and after centre-based cardiac rehabilitation: rationale and design of the Cardiac RehApp randomised control trial. BMJ Open Sport Exerc Med 2021; 7:e001159. [PMID: 34567787 PMCID: PMC8438852 DOI: 10.1136/bmjsem-2021-001159] [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] [Accepted: 08/17/2021] [Indexed: 01/18/2023] Open
Abstract
Many patients lapse into a physically inactive lifestyle within months after cardiac rehabilitation (CR) programme completion. A mobile-health (mHealth) home-based training application can be used to intensify and/or prolong the CR programme to induce long-lasting improvements of habitual physical activity levels. This study will assess the effect of an additional home-based training module during CR and post-CR on habitual physical activity levels among coronary artery disease patients. A total of 132 patients (>18 years old) will be recruited in an 18-week randomised controlled trial with four arms: (1) 6 weeks centre-based CR (ie, standard care), (2) 6 weeks combined centre-based+mHealth home-based CR, (3) 6 weeks centre-based CR followed by 12 weeks mHealth home-based CR, (4) 6 weeks combined centre-based+mHealth home-based CR followed by 12 weeks mHealth home-based CR. The intervention groups will receive a daily and personalised exercise training using a smartphone application (Virtual Training) in addition to and/or as extension of the centre-based CR programme. The participants will be assessed prior to the centre-based CR programme, after completion of the 6-week CR programme and after the 12 weeks extension. Primary outcome will be objectively measured habitual physical activity levels expressed as moderate to vigorous intensity activities (min/week). Secondary outcome parameters include sedentary behaviour, physical fitness (estimated VO2max), handgrip strength, cardiovascular risk profile, quality of life and cardiac anxiety scores. The findings of the Cardiac RehApp study will provide insight into the added value of a personalised mHealth home-based training application on physical activity levels during and after centre-based CR. Trial registration number: NL72182.091.019.
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Affiliation(s)
- Thijs Vonk
- Department of Physiology, Radboudumc, Nijmegen, The Netherlands
| | - Esmee A Bakker
- Department of Physiology, Radboudumc, Nijmegen, The Netherlands
| | - Erwin S Zegers
- Department of Cardiology, Canisius Wilhelmina Ziekenhuis, Nijmegen, The Netherlands
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