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Okoye C, Qiu C, Xia X, Lip GYH, Bellelli G, Welmer AK, Calderón-Larrañaga A, Vetrano DL. Atrial fibrillation accelerates functional decline in older adults: a 15-year follow-up population-based study. Europace 2024; 26:euae173. [PMID: 38912858 PMCID: PMC11273222 DOI: 10.1093/europace/euae173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Accepted: 05/30/2024] [Indexed: 06/25/2024] Open
Abstract
AIMS Atrial fibrillation (AF) has been associated with functional impairment. However, the role exerted by AF on the long-term trajectories of functional mobility remains to be elucidated. This study aimed to evaluate the impact of AF on functional mobility by tracing walking speed (WS) trajectories over 15 years of follow-up in a population-based cohort of individuals aged 60+ years. METHODS AND RESULTS This population-based cohort study included 3141 community-dwelling participants (mean age 73.7 years; 63.6% women) from the Swedish National Study on Aging and Care in Kungsholmen, who were regularly examined from 2001-2004 to 2016-2019. Functional mobility was assessed by measuring WS in a standardized way. The association between AF and WS trajectories was assessed by multivariable joint models accounting for the longitudinal dropouts due to death. Stratified analyses by demographic and clinical factors were performed. The effect-modifying role of oral anticoagulant therapy (OAC), incident heart failure (HF), and incident stroke was finally investigated. At baseline, 285 (9.1%) participants were ascertained to have AF. A faster annual WS decline was observed in persons with AF than in non-AF peers (adjusted β coefficient per year = -0.011, 95% confidence interval: -0.016 to -0.005). Incident HF and stroke were associated with greater WS decline in participants with AF. OAC use was not associated with a slower functional decline. CONCLUSION Atrial fibrillation is associated with a faster physical function decline in older individuals. Incident HF and stroke possibly accelerate WS decline over time in AF participants.
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Affiliation(s)
- Chukwuma Okoye
- Aging Research Center, Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institutet, Stockholm University, Tomtebodavägen 18a, 171 65 Solna, Sweden
- Department of Medicine and Surgery, University of Milan-Bicocca, Via Cadore 48, 20900 Monza Italy
- Acute Geriatric Unit, IRCCS Foundation San Gerardo dei Tintori, Monza, Via Pergolesi 33, 20900 Monza, Italy
| | - Chengxuan Qiu
- Aging Research Center, Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institutet, Stockholm University, Tomtebodavägen 18a, 171 65 Solna, Sweden
| | - Xin Xia
- Division of Neurogeriatrics, Department of NVS, Karolinska Institutet, Stockholm, Sweden
| | - Gregory Yoke Hong Lip
- Liverpool Centre for Cardiovascular Science, University of Liverpool, Liverpool, UK
- Liverpool John Moores University, Liverpool, UK
- Liverpool Heart and Chest Hospital, Liverpool, UK
- Danish Center for Health Services Research, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Giuseppe Bellelli
- Department of Medicine and Surgery, University of Milan-Bicocca, Via Cadore 48, 20900 Monza Italy
- Acute Geriatric Unit, IRCCS Foundation San Gerardo dei Tintori, Monza, Via Pergolesi 33, 20900 Monza, Italy
| | - Anna-Karin Welmer
- Aging Research Center, Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institutet, Stockholm University, Tomtebodavägen 18a, 171 65 Solna, Sweden
- Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
- Stockholm Gerontology Research Centre, Stockholm, Sweden
- Women’s Health and Allied Health Professionals Theme, Medical Unit Medical Psychology, Karolinska University Hospital, Stockholm, Sweden
| | - Amaia Calderón-Larrañaga
- Aging Research Center, Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institutet, Stockholm University, Tomtebodavägen 18a, 171 65 Solna, Sweden
| | - Davide Liborio Vetrano
- Aging Research Center, Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institutet, Stockholm University, Tomtebodavägen 18a, 171 65 Solna, Sweden
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Nozaki K, Hamazaki N, Kamiya K, Uchida S, Noda T, Ueno K, Hotta K, Maekawa E, Matsunaga A, Yamaoka-Tojo M, Ako J. Association between walking speed early after admission and all-cause death and/or re-admission in patients with acute decompensated heart failure. Eur J Cardiovasc Nurs 2024; 23:374-381. [PMID: 37672640 DOI: 10.1093/eurjcn/zvad092] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 08/30/2023] [Accepted: 09/01/2023] [Indexed: 09/08/2023]
Abstract
AIMS Patients with heart failure (HF) frequently experience decreased physical function, including walking speed. Slower walking speed is associated with poorer prognosis. However, most of these reports focused on patients with stable HF, and the relationship between walking speed in acute phase and clinical outcomes is unclear. Therefore, we aimed to investigate the associations between walking speed early after admission and clinical events in patients with acute decompensated HF (ADHF). METHODS AND RESULTS We reviewed consecutive 1391 patients admitted due to ADHF. We measured walking speed the first time to walk on the ward more than 10 m after admission, and the speed within 4 days after admission was included in this study. The primary outcome was combined events (all-cause death and/or re-admission due to HF). The follow-up period was up to 1 year from the discharge. The study population had a median age of 74 years [interquartile range (IQR): 65-80 years], and 35.9% of patients were females. The median walking speed was 0.70 m/s (IQR: 0.54-0.88 m/s). Combined events occurred in 429 (30.8%) patients. Faster walking speed was independently associated with lower rate of combined events (adjusted hazard ratio per 0.1 m/s increasing: 0.951, 95% confidence interval: 0.912-0.992). CONCLUSION Faster walking speed within 4 days after admission was associated with favourable clinical outcomes in patients with ADHF. The results suggest that measuring walking speed in acute phase is useful for earlier risk stratification.
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Affiliation(s)
- Kohei Nozaki
- Department of Rehabilitation, Kitasato University Hospital, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa 252-0375, Japan
| | - Nobuaki Hamazaki
- Department of Rehabilitation, Kitasato University Hospital, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa 252-0375, Japan
| | - Kentaro Kamiya
- Department of Rehabilitation, School of Allied Health Sciences, Kitasato University, Sagamihara, Japan
- Department of Cardiovascular Medicine, Kitasato University Graduate School of Medical Sciences, Sagamihara, Japan
| | - Shota Uchida
- Department of Cardiovascular Medicine, Kitasato University Graduate School of Medical Sciences, Sagamihara, Japan
- Research Fellow of Japan Society for the Promotion of Science, Tokyo, Japan
| | - Takumi Noda
- Department of Cardiovascular Medicine, Kitasato University Graduate School of Medical Sciences, Sagamihara, Japan
- Exercise Physiology and Cardiovascular Health Lab, Division of Cardiac Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, Canada
| | - Kensuke Ueno
- Department of Cardiovascular Medicine, Kitasato University Graduate School of Medical Sciences, Sagamihara, Japan
| | - Kazuki Hotta
- Department of Rehabilitation, School of Allied Health Sciences, Kitasato University, Sagamihara, Japan
- Department of Cardiovascular Medicine, Kitasato University Graduate School of Medical Sciences, Sagamihara, Japan
| | - Emi Maekawa
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, Sagamihara, Japan
| | - Atsuhiko Matsunaga
- Department of Rehabilitation, School of Allied Health Sciences, Kitasato University, Sagamihara, Japan
- Department of Cardiovascular Medicine, Kitasato University Graduate School of Medical Sciences, Sagamihara, Japan
| | - Minako Yamaoka-Tojo
- Department of Rehabilitation, School of Allied Health Sciences, Kitasato University, Sagamihara, Japan
- Department of Cardiovascular Medicine, Kitasato University Graduate School of Medical Sciences, Sagamihara, Japan
| | - Junya Ako
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, Sagamihara, Japan
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Matsuo K, Yoneki K, Kobayashi K, Onoda D, Mibu K, Furuzono K, Mashimo N, Yasuda S, Suzuki T, Nakao K, Tatsuki H, Tamiya S. Impact of Changes in Rectus Femoris Cross-Sectional Area Measured by Ultrasound on the Prognosis of Patients With Acute Heart Failure. Circ J 2024; 88:713-721. [PMID: 38508754 DOI: 10.1253/circj.cj-23-0925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/22/2024]
Abstract
BACKGROUND Low muscle mass in patients with acute heart failure (AHF) is associated with poor prognosis; however, this is based on a single baseline measurement, with little information on changes in muscle mass during hospitalization and their clinical implications. This study investigated the relationship between changes in rectus femoris cross-sectional area (RFCSA) on ultrasound and the prognosis of patients with AHF.Methods and Results: This is a retrospective evaluation of 284 AHF patients (mean [±SD] age 79.1±11.9 years; 116 female). RFCSA assessments at admission (pre-RFCSA), ∆RFCSA (i.e., the percentage change in RFCSA from admission to 2 weeks), and composite prognosis (all-cause death and heart failure-related readmission) within 1 year were determined. Patients were divided into 4 groups according to their median pre-RFCSA and ∆RFCSA after sex stratification: Group A, higher pre-RFCSA/better ∆RFCSA; Group B, higher pre-RFCSA/worse ∆RFCSA; Group C, lower pre-RFCSA/better ∆RFCSA; Group D, lower pre-RFCSA/worse ∆RFCSA. In the Cox regression analysis, with Group A as the reference, the cumulative event rate of Group C (hazard ratio [HR] 3.39; 95% confidence interval [CI] 0.71-16.09; P=0.124) did not differ significantly; however, the cumulative event rates of Group B (HR 7.93; 95% CI 1.99-31.60; P=0.003) and Group D (HR 9.24; 95% CI 2.57-33.26; P<0.001) were significantly higher. CONCLUSIONS ∆RFCSA during hospitalization is useful for risk assessment of prognosis in patients with AHF.
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Affiliation(s)
- Koji Matsuo
- Department of Rehabilitation, Sagamihara Kyodo Hospital
| | - Kei Yoneki
- Department of Rehabilitation, Sagamihara Kyodo Hospital
- Department of Rehabilitation Sciences, Graduate School of Medical Sciences, Kitasato University
| | | | - Daiki Onoda
- Department of Rehabilitation, Sagamihara Kyodo Hospital
| | - Kazuhiro Mibu
- Department of Rehabilitation, Sagamihara Kyodo Hospital
| | | | - Noa Mashimo
- Department of Rehabilitation, Sagamihara Kyodo Hospital
| | - Shiori Yasuda
- Department of Rehabilitation, Sagamihara Kyodo Hospital
| | - Toru Suzuki
- Department of Rehabilitation, Sagamihara Kyodo Hospital
| | - Ken Nakao
- Department of Rehabilitation, Sagamihara Kyodo Hospital
| | | | - Seiji Tamiya
- Department of Cardiovascular Medicine, Sagamihara Kyodo Hospital
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Chen YH, Yin MQ, Fan LH, Jiang XC, Xu HF, Zhu XY, Zhang T. Causal relationship between nutritional assessment phenotypes and heart failure: A Mendelian randomization study. Heliyon 2024; 10:e28619. [PMID: 38590862 PMCID: PMC11000018 DOI: 10.1016/j.heliyon.2024.e28619] [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: 10/18/2023] [Revised: 03/20/2024] [Accepted: 03/21/2024] [Indexed: 04/10/2024] Open
Abstract
Introduction Malnutrition is strongly associated with heart failure (HF); however, the causal link remains unclear. We used Mendelian randomization (MR) to infer causal associations between different nutritional assessment phenotypes and HF and to analyze whether these associations were mediated by common HF risk factors. Methods Two-sample bidirectional MR was used to infer causal associations between nutritional assessment phenotypes and HF. Mutual influences between different nutritional assessment phenotypes and potential correlations were estimated using multivariate MR methods. Two-step MR was used to quantify the mediating effects of common HF risk factors on the causal associations. Results Three phenotypes were positively associated with the development of HF: waist circumference (WC) (odds ratio [OR] = 1.74; 95% confidence interval [CI], 1.60-1.90; P = 3.95 × 10-39), body mass index (BMI) (OR = 1.70; 95%CI, 1.60-1.80; P = 1.35 × 10-73), and whole body fat mass (WBFM) (OR = 1.54; 95%CI, 1.44-1.65; P = 4.82 × 10-37). Multivariate MR indicated that WBFM remained positively associated with HF after conditioning on BMI and WC (OR = 2.05; 95%CI, 1.27-3.31; P = 0.003). Three phenotypes were negatively correlated with the development of HF: usual walking pace (UWP) (OR = 0.40; 95%CI, 0.27-0.60; P = 8.41 × 10-6), educational attainment (EA) (OR = 0.73; 95%CI, 0.67-0.79; P = 2.27 × 10-13), and total cholesterol (TC) (OR = 0.90; 95%CI, 0.84-0.96; P = 4.22 × 10-3). There was a bidirectional causality between HF and UWP (Effect estimate = -0.03; 95%CI, -0.05 to -0.01; P = 1.95 × 10-3). Mediation analysis showed that common risk factors for HF (hypertension, coronary artery disease, cardiomyopathy, and valvular heart disease) mediated these causal associations (all P < 0.05). Conclusions BMI, WC, and WBFM are potential risk factors for HF, and the correlation between WBFM and HF was significantly stronger than that between BMI and WC, and HF. EA, UWP, and TC are potential protective factors against HF. Common risk factors for HF mediate these causal pathways. Early identification of potential risk or protective factors for HF patients from the dimension of nutritional status is expected to further improve patient outcomes.
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Affiliation(s)
- Yun-Hu Chen
- Cardiovascular Department, Taicang TCM Hospital Affiliated to Nanjing University of Chinese Medicine, Suzhou, 215400, China
| | - Mo-Qing Yin
- Cardiovascular Department, Taicang TCM Hospital Affiliated to Nanjing University of Chinese Medicine, Suzhou, 215400, China
| | - Li-Hua Fan
- Cardiovascular Department, Taicang TCM Hospital Affiliated to Nanjing University of Chinese Medicine, Suzhou, 215400, China
| | - Xue-Chun Jiang
- Cardiovascular Department, Taicang TCM Hospital Affiliated to Nanjing University of Chinese Medicine, Suzhou, 215400, China
| | - Hong-Feng Xu
- Cardiovascular Department, Taicang TCM Hospital Affiliated to Nanjing University of Chinese Medicine, Suzhou, 215400, China
| | - Xing-Yu Zhu
- Clinical Pharmacy Department, Taicang TCM Hospital Affiliated to Nanjing University of Chinese Medicine, Suzhou, 215400, China
| | - Tao Zhang
- Cardiovascular Department, Changzhou Hospital Affiliated to Nanjing University of Chinese Medicine, Changzhou, 213003, China
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Hanada S, Adachi T, Iwatsu K, Kamisaka K, Kamiya K, Yamada S. Changes in walking speed 6 months after discharge may be more sensitive to subsequent prognosis than handgrip strength in patients hospitalized for heart failure. Int J Cardiol 2024; 400:131778. [PMID: 38218246 DOI: 10.1016/j.ijcard.2024.131778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 11/25/2023] [Accepted: 01/09/2024] [Indexed: 01/15/2024]
Abstract
BACKGROUND Despite the prognostic importance of walking speed (WS) and handgrip strength (HGS) in patients with heart failure (HF), no study has reported the prognostic impact of changes in these parameters. This study aimed to examine the association between changes after discharge and the subsequent prognosis. METHODS This study included 881 elderly patients hospitalized for HF. WS and HGS were measured at discharge and 6 months after discharge. Based on the presence of slowness (WS <0.98 m/s) or weakness (HGS <30.0 kg for men and < 17.5 kg for women) at both points, patients were divided into four groups (WS: A = -/-, B = -/+, C = +/-, D = +/+; HGS: E = -/-, F = -/+, G = +/-, H = +/+). The study endpoint was a composite of all-cause mortality and HF rehospitalization during the 18 months after 6 months of discharge. The Cox proportional hazards model was used to assess the association between the groups and study outcomes. RESULTS Stratified by the WS change patterns, groups B and D showed higher risk of the study outcomes than group A [B: hazard ratio 2.34, 95% confidence interval (CI) 1.29-4.28; D: 2.38, 1.67-3.39], whereas group C was not. When stratified by the HGS change in patterns, only group H was associated with a worse prognosis (HR; 1.85, 95%CI; 1.31-2.60). CONCLUSION Changes in WS were related to HF prognosis, suggesting that changes in WS may be more sensitive to further risk stratification than changes in HGS.
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Affiliation(s)
- Satoru Hanada
- Department of Rehabilitation, Miyakonojo Medical Association Hospital, Miyakonojo, Japan
| | - Takuji Adachi
- Department of Integrated Health Sciences, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Kotaro Iwatsu
- Department of Rehabilitation, Hirakata Kosai Hospital, Hirakata, Japan
| | - Kenta Kamisaka
- Department of Rehabilitation, Kitano Hospital, Osaka, Japan
| | - Kuniyasu Kamiya
- Department of Basic Medical Sciences Region, Kobe City College of Nursing, Kobe, Japan
| | - Sumio Yamada
- Department of Cardiology, Aichi Medical University, Nagakute, Japan.
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Shakuta S, Noda T, Kamiya K, Hamazaki N, Nozaki K, Yamashita M, Uchida S, Ueno K, Maekawa E, Yamaoka-Tojo M, Matsunaga A, Ako J. Clinical Impact of Improvement in Sarcopenia through Cardiac Rehabilitation in Patients with Heart Failure. J Am Med Dir Assoc 2024; 25:514-520.e2. [PMID: 38182121 DOI: 10.1016/j.jamda.2023.10.035] [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: 06/29/2023] [Revised: 10/14/2023] [Accepted: 10/16/2023] [Indexed: 01/07/2024]
Abstract
OBJECTIVES Sarcopenia in patients with heart failure (HF) is associated with poor prognosis. Cardiac rehabilitation (CR) decreases the incidence of adverse events in patients with HF. However, the clinical implications of improving sarcopenia status through CR remain unclear. This study investigated the relationship between the changes in sarcopenia status in patients with HF undergoing outpatient CR and the risk of mortality and adverse events. DESIGN This was a retrospective cohort study of patients hospitalized at the Kitasato University Hospital Cardiovascular Center for the treatment of HF between January 2007 and December 2020. SETTING AND PARTICIPANTS Patients with HF whose sarcopenia status was assessed at hospital discharge and following at least 3 months of outpatient CR were included. Based on the sarcopenia status, all patients were divided into 3 groups: patients without sarcopenia at discharge (ie, robust), patients with sarcopenia at discharge but no sarcopenia following CR (ie, improved), and patients with sarcopenia at discharge and following CR (ie, unimproved). METHODS Cox regression analysis was used to examine the risk of all-cause death associated with the 3 sarcopenia status groups. RESULTS Of 546 patients with HF (median age: 70 years; male: 63.6%), 377 (69.0%), 54 (9.9%), and 115 (21.1%) were classified as robust, improved, and unimproved, respectively. Multivariate Cox regression analysis showed that the unimproved group had a significantly greater risk of all-cause death when compared to the robust group [hazard ratio (HR) 2.603, 95% CI 1.375-4.930, P = .004], but it did not differ from the improved group (HR 1.403, 95% CI 0.598-3.293, P = .43). CONCLUSIONS AND IMPLICATIONS No improvement in sarcopenia status in patients with HF undergoing outpatient CR was associated with a higher risk of all-cause death. Sarcopenia may be an important target to improve the prognosis of patients with HF.
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Affiliation(s)
- Saki Shakuta
- Department of Rehabilitation, Kitasato University Hospital, Sagamihara, Japan
| | - Takumi Noda
- Department of Rehabilitation Sciences, Kitasato University Graduate School of Medical Sciences, Sagamihara, Japan; Exercise Physiology and Cardiovascular Health Lab, Division of Cardiac Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, Canada
| | - Kentaro Kamiya
- Department of Rehabilitation Sciences, Kitasato University Graduate School of Medical Sciences, Sagamihara, Japan; Department of Rehabilitation, School of Allied Health Sciences, Kitasato University, Sagamihara, Japan.
| | - Nobuaki Hamazaki
- Department of Rehabilitation, Kitasato University Hospital, Sagamihara, Japan
| | - Kohei Nozaki
- Department of Rehabilitation, Kitasato University Hospital, Sagamihara, Japan
| | - Masashi Yamashita
- Department of Rehabilitation Sciences, Kitasato University Graduate School of Medical Sciences, Sagamihara, Japan; Division of Research, ARCE Inc, Sagamihara, Japan
| | - Shota Uchida
- Department of Rehabilitation Sciences, Kitasato University Graduate School of Medical Sciences, Sagamihara, Japan; Research fellow, Japan Society for the Promotion of Science, Tokyo, Japan
| | - Kensuke Ueno
- 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
| | - Minako Yamaoka-Tojo
- Department of Rehabilitation Sciences, Kitasato University Graduate School of Medical Sciences, Sagamihara, Japan; Department of Rehabilitation, School of Allied Health Sciences, Kitasato University, Sagamihara, Japan
| | - Atsuhiko Matsunaga
- Department of Rehabilitation Sciences, Kitasato University Graduate School of Medical Sciences, Sagamihara, Japan; Department of Rehabilitation, School of Allied Health Sciences, Kitasato University, Sagamihara, Japan
| | - Junya Ako
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, Sagamihara, Japan
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Nabavi H, Mehdizadeh S, Shum LC, Flint AJ, Mansfield A, Taati B, Iaboni A. A pilot observational study of gait changes over time before and after an unplanned hospital visit in long-term care residents with dementia. BMC Geriatr 2023; 23:723. [PMID: 37940854 PMCID: PMC10634101 DOI: 10.1186/s12877-023-04385-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 10/05/2023] [Indexed: 11/10/2023] Open
Abstract
BACKGROUND Older adults with dementia living in long-term care (LTC) have high rates of hospitalization. Two common causes of unplanned hospital visits for LTC residents are deterioration in health status and falls. Early detection of health deterioration or increasing falls risk may present an opportunity to intervene and prevent hospitalization. There is some evidence that impairments in older adults' gait, such as reduced gait speed, increased variability, and poor balance may be associated with hospitalization. However, it is not clear whether changes in gait are observable and measurable before an unplanned hospital visit and whether these changes persist after the acute medical issue has been resolved. The objective of this study was to examine gait changes before and after an unplanned acute care hospital visit in people with dementia. METHODS We performed a secondary analysis of quantitative gait measures extracted from videos of natural gait captured over time on a dementia care unit and collected information about unplanned hospitalization from health records. RESULTS Gait changes in study participants before hospital visits were characterized by decreasing stability and step length, and increasing step variability, although these changes were also observed in participants without hospital visits. In an age and sex-adjusted mixed effects model, gait speed and step length declined more quickly in those with a hospital visit compared to those without. CONCLUSIONS These results provide preliminary evidence that clinically meaningful longitudinal gait changes may be captured by repeated non-invasive gait monitoring, although a larger study is needed to identify changes specific to future medical events.
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Affiliation(s)
- Hoda Nabavi
- KITE Research Institute - Toronto Rehabilitation Institute, University Health Network, 550 University Avenue, Toronto, ON, M5G 2A2, Canada
| | - Sina Mehdizadeh
- KITE Research Institute - Toronto Rehabilitation Institute, University Health Network, 550 University Avenue, Toronto, ON, M5G 2A2, Canada
| | - Leia C Shum
- KITE Research Institute - Toronto Rehabilitation Institute, University Health Network, 550 University Avenue, Toronto, ON, M5G 2A2, Canada
| | - Alastair J Flint
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- Centre for Mental Health, University Health Network, Toronto, ON, Canada
| | - Avril Mansfield
- KITE Research Institute - Toronto Rehabilitation Institute, University Health Network, 550 University Avenue, Toronto, ON, M5G 2A2, Canada
- Evaluative Clinical Sciences, Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, ON, Canada
- Department of Physical Therapy, University of Toronto, Toronto, ON, Canada
| | - Babak Taati
- KITE Research Institute - Toronto Rehabilitation Institute, University Health Network, 550 University Avenue, Toronto, ON, M5G 2A2, Canada
- Department of Computer Science, University of Toronto, Toronto, ON, Canada
- Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, ON, Canada
- Vector Institute for Artificial Intelligence, Toronto, ON, Canada
| | - Andrea Iaboni
- KITE Research Institute - Toronto Rehabilitation Institute, University Health Network, 550 University Avenue, Toronto, ON, M5G 2A2, Canada.
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada.
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8
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Hamazaki N, Kamiya K, Nozaki K, Koike T, Miida K, Yamashita M, Uchida S, Noda T, Maekawa E, Yamaoka-Tojo M, Matsunaga A, Arai M, Kitamura T, Ako J, Miyaji K. Trends and Outcomes of Early Rehabilitation in the Intensive Care Unit for Patients With Cardiovascular Disease: A Cohort Study With Propensity Score-Matched Analysis. Heart Lung Circ 2023; 32:1240-1249. [PMID: 37634967 DOI: 10.1016/j.hlc.2023.05.023] [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: 12/26/2022] [Revised: 05/21/2023] [Accepted: 05/24/2023] [Indexed: 08/29/2023]
Abstract
BACKGROUND The effectiveness of acute-phase cardiovascular rehabilitation (CR) in intensive care settings remains unclear in patients with cardiovascular disease (CVD). This study aimed to investigate the trends and outcomes of acute-phase CR in the intensive care unit (ICU) for patients with CVD, including in-hospital and long-term clinical outcomes. METHOD This retrospective cohort study reviewed a total of 1,948 consecutive patients who were admitted to a tertiary academic ICU for CVD treatment and underwent CR during hospitalisation. The endpoints of this study were the following: in-hospital outcomes: probabilities of walking independence and returning home; and long-term outcomes: clinical events 5 years following hospital discharge, including all-cause readmission or cardiovascular events. It evaluated the associations of CR implementation during ICU treatment (ICU-CR) with in-hospital and long-term outcomes using propensity score-matched analysis. RESULTS Among the participants, 1,092 received ICU-CR, the rate of which tended to increase with year trend (p for trend <0.001). After propensity score matching, 758 patients were included for analysis (pairs of n=379 ICU-CR and non-ICU-CR). ICU-CR was significantly associated with higher probabilities of walking independence (rate ratio, 2.04; 95% CI 1.77-2.36) and returning home (rate ratio, 1.22; 95% CI 1.05-1.41). These associations were consistently observed in subgroups aged >65 years, after surgery, emergency, and prolonged ICU stay. ICU-CR showed significantly lower incidences of all-cause (HR 0.71; 95% CI 0.56-0.89) and cardiovascular events (HR 0.69; 95% CI 0.50-0.95) than non-ICU-CR. CONCLUSIONS The implementation of acute-phase CR in ICU increased with year trend, and is considered beneficial to improving in-hospital and long-term outcomes in patients with CVD and various subgroups.
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Affiliation(s)
- Nobuaki Hamazaki
- Department of Rehabilitation, Kitasato University Hospital, Sagamihara, Kanagawa, Japan.
| | - Kentaro Kamiya
- Department of Rehabilitation, Kitasato University School of Allied Health Sciences, Sagamihara, Kanagawa, Japan
| | - Kohei Nozaki
- Department of Rehabilitation, Kitasato University Hospital, Sagamihara, Kanagawa, Japan
| | - Tomotaka Koike
- Department of Intensive Care, Kitasato University Hospital, Sagamihara, Kanagawa, Japan
| | - Kazumasa Miida
- Department of Rehabilitation, Kitasato University Hospital, Sagamihara, Kanagawa, Japan
| | - Masashi Yamashita
- Department of Rehabilitation Sciences, Kitasato University Graduate School of Medical Sciences, Sagamihara, Kanagawa, Japan
| | - Shota Uchida
- Department of Rehabilitation Sciences, Kitasato University Graduate School of Medical Sciences, Sagamihara, Kanagawa, Japan
| | - Takumi Noda
- Department of Rehabilitation Sciences, Kitasato University Graduate School of Medical Sciences, Sagamihara, Kanagawa, Japan
| | - Emi Maekawa
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan
| | - Minako Yamaoka-Tojo
- Department of Rehabilitation, Kitasato University School of Allied Health Sciences, Sagamihara, Kanagawa, Japan
| | - Atsuhiko Matsunaga
- Department of Rehabilitation, Kitasato University School of Allied Health Sciences, Sagamihara, Kanagawa, Japan
| | - Masayasu Arai
- Department of Anesthesiology, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan
| | - Tadashi Kitamura
- Department of Cardiovascular Surgery, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan
| | - Junya Ako
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan
| | - Kagami Miyaji
- Department of Cardiovascular Surgery, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan
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9
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Tamura S, Miyata K, Igarashi T, Iizuka T, Otani T, Usuda S. Minimal clinically important difference of the short physical performance battery and comfortable walking speed in old-old adults with acute cardiovascular disease: a multicenter, prospective, observational study. Disabil Rehabil 2023; 45:1079-1086. [PMID: 35341435 DOI: 10.1080/09638288.2022.2052978] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
PURPOSE The physical function of older adults age ≥ 75 years hospitalized for cardiovascular disease (CVD) often decrease. The Minimal Clinically Important Difference (MCID) is the smallest clinically meaningful difference due to therapy. The Short Physical Performance Battery (SPPB) and Comfortable Walking Speed (CWS) are physical function evaluations commonly used in people with CVD. This study aims to clarify the MCIDs of the SPPB and CWS in old-old adult with CVD. MATERIALS AND METHODS This was a multicenter, prospective study of 58 old-old adults with acute CVD and rehabilitation. The MCID was estimated using the participants' and physical therapists' (PT) Global Rating of Change (GRC) scales as anchors for changes in the SPPB and CWS. The area under the curve (AUC) was used to measure the discrimination accuracy. RESULTS The MCID of SPPB was 3 points when the GRC from PT was used as an anchor (AUC = 0.70). The MCID of CWS was 0.10 m/s when the GRC from participants and PT were used as anchors (AUC = 0.70 and 0.73, respectively). CONCLUSIONS The MCID of 3 SPPB points and 0.10 m/s CWS in old-old adults with acute CVD may help determine the effectiveness of therapy and improve prognosis.Implications for rehabilitationFor people with cardiovascular disease (CVD), the Short Physical Performance Battery (SPPB) and comfortable walking speed (CWS) are often used to measure physical function.The MCID of SPPB and CWS was estimated to be 3 points and 0.10 m/s, respectively, in older adults with CVD aged ≥75 years.This finding is useful for clinicians to evaluate the efficacy of cardiac rehabilitation.
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Affiliation(s)
- Shuntaro Tamura
- Department of Rehabilitation, Fujioka General Hospital, Fujioka, Japan
| | - Kazuhiro Miyata
- Department of Physical Therapy, Ibaraki Prefectural University of Health Sciences, Ibaraki, Japan
| | - Tatsuya Igarashi
- Department of basic rehabilitation, Gunma University Graduate School of Health Sciences, Maebashi, Japan
- Numata Neurosurgery & Heart Disease Hospital, Numata, Japan
| | | | - Tomohiro Otani
- Department of Physical Therapy, Ota college of medical technology, Ota, Japan
| | - Shigeru Usuda
- Gunma University Graduate School of Health Sciences, Maebashi, Japan
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10
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Overlapping states of AWGS muscle dysfunction and inverse feasibility of ADL recovery by rehabilitation in older inpatients. Sci Rep 2022; 12:22283. [PMID: 36566322 PMCID: PMC9789953 DOI: 10.1038/s41598-022-26622-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Accepted: 12/16/2022] [Indexed: 12/25/2022] Open
Abstract
Rehabilitation based on guided walking is effective to recover activity of daily living (ADL) in frail older adults, even octogenarians. However, muscle dysfunction obviously reflects disability, and few studies have focused on ADL recovery by rehabilitation. We employed the state of muscle dysfunctions proposed by the Asian Working Group for Sarcopenia (AWGS) in 2019 and attempted to clarify the relation between the overlapping dysfunctions and the feasibility of ADL recovery after rehabilitation. In total, 297 frail older patients (the mean age: 82.8 years, 46.1% of patients were male) participated in a walking-guided rehabilitation program to achieve the goal of ambulatory discharge. Muscle dysfunction was categorized by four standardized methods at the start of rehabilitation (grip strength, gait speed, time of five sit-to-stand, and short physical performance battery: SPPB), according to the AWGS proposal. ADLs were monitored by Barthel index before admission, at the start of rehabilitation, and at discharge. At least one dysfunction was present in 95.3% of patients. If a single patient had three or more muscle dysfunction, the ADLs recovery was significantly limited (interaction: p < 0.05). The overlapped counts of AWGS muscle dysfunction helps to predict inverse feasibility of ADL recovery in frail older patients through rehabilitation.
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11
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Braun T, Wiegard A, Geritz J, Hansen C, Tan KE, Hildesheim H, Kudelka J, Maetzler C, Welzel J, Romijnders R, Maetzler W, Bergmann P. Association between heart failure severity and mobility in geriatric patients: an in-clinic study with wearable sensors. J Geriatr Cardiol 2022; 19:660-674. [PMID: 36284678 PMCID: PMC9548060 DOI: 10.11909/j.issn.1671-5411.2022.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023] Open
Abstract
BACKGROUND Individuals with heart failure (HF) frequently experience limitations in mobility, but specific aspects of these limitations are not well understood. This study investigated the association of HF severity, based on the New York Heart Association (NYHA) classes, with digital mobility outcomes (DMOs) and handgrip strength in older inpatients with HF. METHODS For this explorative analysis, hospital admission and discharge data from an ongoing, prospective cohort study were used. The sample included older participants with HF and a sub-sample of heart-healthy individuals. Participants were equipped with a wearable inertial measurement unit (IMU) system during mobility performance (balancing, sit-to-stand transfer, walking). We analyzed the association between 17 DMOs and HF severity with multiple linear regression models. RESULTS The total sample included 61 older participants (65-97 years of age, 55.7% female). Of all DMOs, only sway path in a semi-tandem stance position (m/s²) showed a relevant association with NYHA classes (admission: β = -0.28, P = 0.09; discharge: β = -0.39, P = 0.02). Handgrip strength showed a trend towards a significant association (admission: β = -0.15, P = 0.10; discharge: β = -0.15, P = 0.19). CONCLUSIONS This is to our best knowledge the first analysis on the association of HF severity and IMU-based DMOs. Sway path and handgrip strength may be the most promising parameters for monitoring mobility aspects in treatment of HF.
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Affiliation(s)
- Tobias Braun
- Department of Neurology, Kiel University, Arnold-Heller-Straße 3, 24105 Kiel, Germany
- Department of Applied Health Sciences, Division of Physiotherapy, Hochschule für Gesundheit (University of Applied Sciences), Gesundheitscampus 6-8, 44801 Bochum, Germany
- HSD Hochschule Döpfer (University of Applied Sciences), Waidmarkt 3 und 9, 50676 Cologne, Germany
| | - Anna Wiegard
- Department of Neurology, Kiel University, Arnold-Heller-Straße 3, 24105 Kiel, Germany
| | - Johanna Geritz
- Department of Neurology, Kiel University, Arnold-Heller-Straße 3, 24105 Kiel, Germany
| | - Clint Hansen
- Department of Neurology, Kiel University, Arnold-Heller-Straße 3, 24105 Kiel, Germany
| | - Kim Eng Tan
- Department of Neurology, Kiel University, Arnold-Heller-Straße 3, 24105 Kiel, Germany
| | - Hanna Hildesheim
- Department of Neurology, Kiel University, Arnold-Heller-Straße 3, 24105 Kiel, Germany
| | - Jennifer Kudelka
- Department of Neurology, Kiel University, Arnold-Heller-Straße 3, 24105 Kiel, Germany
| | - Corina Maetzler
- Department of Neurology, Kiel University, Arnold-Heller-Straße 3, 24105 Kiel, Germany
| | - Julius Welzel
- Department of Neurology, Kiel University, Arnold-Heller-Straße 3, 24105 Kiel, Germany
| | - Robbin Romijnders
- Department of Neurology, Kiel University, Arnold-Heller-Straße 3, 24105 Kiel, Germany
| | - Walter Maetzler
- Department of Neurology, Kiel University, Arnold-Heller-Straße 3, 24105 Kiel, Germany
| | - Philipp Bergmann
- Department of Internal Medicine I, Christian-Albrechts-University of Kiel, Arnold-Heller-Straße 3, 24105 Kiel, Germany
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12
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Matsunaga Y, Takahashi H, Suzuki Y, Yamamoto S, Imamura K, Yoshikoshi S, Uchida J, Nakajima T, Fukuzaki N, Harada M, Matsuzawa R, Yoshida A, Ichikura K, Fukase Y, Murayama N, Murase H, Tagaya H, Matsunaga A. Relationship between psychiatric symptoms and activities of daily living in patients undergoing hemodialysis. RENAL REPLACEMENT THERAPY 2022. [DOI: 10.1186/s41100-022-00425-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Accurately identifying the factors contributing to decline in activities of daily living (ADL) is important for preventing such decline in patients undergoing hemodialysis (HD). We studied the prevalence and number of overlapping psychiatric symptoms (depressive symptoms, apathy, and sleep disturbance) in patients undergoing HD and examined the relationship between psychiatric symptoms and ADL.
Methods
The study utilized a cross-sectional research design. The sample included 203 outpatients (median age: 69 years) undergoing stable HD treatment three times a week. Patient characteristics, including age, sex, body composition, dialysis vintage, primary kidney disease, comorbidity, and nutritional status, were collected from patients’ medical records. Functional status was assessed based on the self-reported questionnaire that combined five basic and eight instrumental ADL items. Usual walking speed was used as an index of physical function. Additionally, the short version of the Center for Epidemiologic Studies Depression Scale was used to assess depressive symptoms. Further, apathy and sleep disturbance were assessed using the Motivation Score and the Athens Insomnia Scale, respectively.
Results
Overall, 59 (29.1%) patients demonstrated depressive symptoms, 100 (49.3%) reported apathy, 83 (40.9%) had sleep disturbance, 31 (15.3%) had three overlapping psychiatric symptoms, 43 (21.2%) had two overlapping psychiatric symptoms, 63 (31.0%) had only one symptom, and 66 (32.5%) had no psychiatric symptoms. Multiple logistic regression analysis showed that having two or three overlapping psychiatric symptoms was independently and significantly associated with ADL (functional status of 13 points for the ADL maintenance group, and of < 13 points for the ADL decline group, respectively), even after adjusting for patient characteristics and walking speed (odds ratio: 2.74, 95% confidence interval: 1.12–6.69, reference; no psychiatric symptoms).
Conclusion
The present study clarified that the overlapping symptoms, including depressive symptoms, apathy, and sleep disturbance, were independently associated with ADL decline in patients undergoing HD. It is useful to examine not only depressive symptoms but also other symptoms such as apathy and sleep disturbance to elucidate factors associated with deteriorated ADL in chronic patients. Our findings provide a strong basis for targeted interventions to prevent functional dependence in the HD population.
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Aoyagi Y, Mori E, Ishii H, Kono Y, Sato A, Okochi Y, Funahashi R, Kagaya H. Poor walking ability outcome and activities of daily living improvement in patients undergoing cardiac rehabilitation during COVID-19 pandemic. Eur J Phys Rehabil Med 2022; 58:606-611. [PMID: 34870386 PMCID: PMC9980481 DOI: 10.23736/s1973-9087.21.07054-4] [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] [Indexed: 11/08/2022]
Abstract
BACKGROUND The COVID-19 pandemic has had wide-ranging impacts across international healthcare systems and direct impacts on rehabilitation professionals. Few outcome data for cardiac patients undergoing rehabilitation programs during the COVID-19 pandemic are available. AIM We conducted a study to compare the effect of modified rehabilitation therapies mainly performed in wards versus conventional therapies mainly performed in rehabilitation units in which exercise on a treadmill and cardiopulmonary exercise testing were available. DESIGN Observational study. SETTING University hospital. POPULATION Fifty-five consecutive inpatients admitted to a university hospital and underwent a cardiac rehabilitation program from August 2019 to June 2020. METHODS The patients were divided into two groups: those admitted during the COVID-19 outbreak (Group A, N.=28) and those admitted before the COVID-19 outbreak (Group B, N.=27). The evaluation included age, sex, duration of the rehabilitation intervention program, days before initiation of the rehabilitation program, functional status, and Functional Independence Measure (FIM) Score. RESULTS A higher proportion of patients in Group A than B underwent a cardiac rehabilitation program provided in wards (88.5% vs. 48.8%, respectively). Group A showed a significantly lower 6-minute walking distance and walking speed than Group B at discharge (P=0.031 and 0.014, respectively). Group A showed a significantly shorter exercise time using an ergometer than Group B (P=0.028). CONCLUSIONS The difference in the cardiac rehabilitation location during the COVID-19 pandemic may affect the rehabilitation contents and lead to less improvement in physical function. CLINICAL REHABILITATION IMPACT A cardiac rehabilitation program was performed mainly in wards instead of in rehabilitation units during the COVID-19 pandemic. Walking abilities were adversely affected by the modified cardiac rehabilitation program.
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Affiliation(s)
- Yoichiro Aoyagi
- Department of Rehabilitation Medicine, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan - .,Department of Rehabilitation Medicine I, School of Medicine, Fujita Health University, Toyoake, Japan -
| | - Etsuko Mori
- Faculty of Rehabilitation, Fujita Health Bantane University Hospital, Nagoya, Japan
| | - Hideki Ishii
- Department of Cardiology, Fujita Health Bantane University Hospital, Nagoya, Japan
| | - Yuji Kono
- Faculty of Rehabilitation, Fujita Health Bantane University Hospital, Nagoya, Japan
| | - Ayako Sato
- Faculty of Rehabilitation, Fujita Health Bantane University Hospital, Nagoya, Japan
| | - Yuki Okochi
- Faculty of Rehabilitation, Fujita Health Bantane University Hospital, Nagoya, Japan
| | - Reisuke Funahashi
- Department of Rehabilitation Medicine I, School of Medicine, Fujita Health University, Toyoake, Japan
| | - Hitoshi Kagaya
- Department of Rehabilitation Medicine I, School of Medicine, Fujita Health University, Toyoake, Japan
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14
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Ueno K, Kamiya K, Kaneko H, Okada A, Itoh H, Fujiu K, Takeda N, Morita H, Michihata N, Jo T, Yasunaga H, Komuro I. Acute-Phase Initiation of Cardiac Rehabilitation for Short-Term Improvement in Activities of Daily Living in Patients Hospitalized for Acute Heart Failure. J Cardiovasc Dev Dis 2022; 9:97. [PMID: 35448073 PMCID: PMC9025467 DOI: 10.3390/jcdd9040097] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 03/14/2022] [Accepted: 03/23/2022] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Whether acute-phase cardiac rehabilitation (CR) is beneficial for short-term improvement in activities of daily living (ADL) in patients hospitalized for acute heart failure (AHF) remains unclear. AIM To investigate the association of acute-phase initiation of CR with short-term improvement in ADL in patients hospitalized for AHF. METHODS We retrospectively analyze data from the Diagnosis Procedure Combination Database, a nationwide inpatient database. Patients hospitalized for HF between January 2010 and March 2018 are included. Propensity score matching and generalized linear models are built to examine the association between improvement in ADL and acute-phase CR initiation, defined as the initiation of CR within two days of admission. RESULTS Among 306,826 eligible patients, CR is initiated in 45,428 patients (14.8%) within two days of hospital admission. Propensity score matching creates 45,427 pairs. CR initiation within two days of hospital admission is associated with ADL improvement (risk ratio: 1.018; 95% confidence interval: 1.004-1.032), particularly in elderly patients, females, and individuals with low ADL at admission, body mass index of 18.5-24.9 kg/m2, and New York Heart Association class IV. CONCLUSIONS Our analyses highlight the possibility that acute-phase CR initiation may result in short-term improvement in ADL in patients hospitalized for AHF.
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Affiliation(s)
- Kensuke Ueno
- Department of Cardiovascular Medicine, The University of Tokyo, Tokyo 113-8655, Japan; (K.U.); (H.K.); (H.I.); (K.F.); (N.T.); (H.M.); (I.K.)
- Department of Rehabilitation Sciences, Graduate School of Medical Sciences, Kitasato University, Sagamihara 252-0373, Japan
| | - Kentaro Kamiya
- Department of Rehabilitation, School of Allied Health Sciences, Kitasato University, Sagamihara 252-0373, Japan
| | - Hidehiro Kaneko
- Department of Cardiovascular Medicine, The University of Tokyo, Tokyo 113-8655, Japan; (K.U.); (H.K.); (H.I.); (K.F.); (N.T.); (H.M.); (I.K.)
- Department of Advanced Cardiology, The University of Tokyo, Tokyo 113-8655, Japan
| | - Akira Okada
- Department of Prevention of Diabetes and Lifestyle-Related Diseases, Graduate School of Medicine, The University of Tokyo, Tokyo 113-8655, Japan;
| | - Hidetaka Itoh
- Department of Cardiovascular Medicine, The University of Tokyo, Tokyo 113-8655, Japan; (K.U.); (H.K.); (H.I.); (K.F.); (N.T.); (H.M.); (I.K.)
| | - Katsuhito Fujiu
- Department of Cardiovascular Medicine, The University of Tokyo, Tokyo 113-8655, Japan; (K.U.); (H.K.); (H.I.); (K.F.); (N.T.); (H.M.); (I.K.)
- Department of Advanced Cardiology, The University of Tokyo, Tokyo 113-8655, Japan
| | - Norifumi Takeda
- Department of Cardiovascular Medicine, The University of Tokyo, Tokyo 113-8655, Japan; (K.U.); (H.K.); (H.I.); (K.F.); (N.T.); (H.M.); (I.K.)
| | - Hiroyuki Morita
- Department of Cardiovascular Medicine, The University of Tokyo, Tokyo 113-8655, Japan; (K.U.); (H.K.); (H.I.); (K.F.); (N.T.); (H.M.); (I.K.)
| | - Nobuaki Michihata
- Department of Health Services Research, The University of Tokyo, Tokyo 113-0033, Japan; (N.M.); (T.J.)
| | - Taisuke Jo
- Department of Health Services Research, The University of Tokyo, Tokyo 113-0033, Japan; (N.M.); (T.J.)
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo 113-0033, Japan;
| | - Issei Komuro
- Department of Cardiovascular Medicine, The University of Tokyo, Tokyo 113-8655, Japan; (K.U.); (H.K.); (H.I.); (K.F.); (N.T.); (H.M.); (I.K.)
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15
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Trends in Frailty and Use of Evidence-Based Pharmacotherapy for Heart Failure in Australian Hospitalised Patients: An Observational Study. J Clin Med 2021; 10:jcm10245780. [PMID: 34945076 PMCID: PMC8704527 DOI: 10.3390/jcm10245780] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Revised: 12/06/2021] [Accepted: 12/09/2021] [Indexed: 11/16/2022] Open
Abstract
Frailty increases morbidity and mortality in heart failure (HF) patients. Current risk-adjustment models do not include frailty-status and the relationship between frailty and pharmacotherapy is unclear. This study explored trends in frailty over time and its relationship with prescription of heart failure specific pharmacotherapy in hospitalised HF patients. We used the Hospital Frailty Risk Score (HFRS) to determine frailty status of patients ≥18 years admitted between 2015-2019 at two tertiary hospitals in Australia. Patients with an HFRS ≥ 5 were classified as frail. In the 3706 patients with a mean (SD) age of 76.1 (14.4) years, 876 (23.6%) were classified as frail. HFRS was weakly correlated with age (r = 0.16) and Charlson-index (r = 0.35) (both p values < 0.001). Whilst frailty was more common in older HF patients (28.9% of patients ≥80 years), 15.1% of patients ≤65 years of age were also found to be frail. The proportion of frail patients increased from 19.4% in 2015 to 29.2% in 2019 despite no significant change in age during this period. The proportion of patients who received heart failure specific pharmacotherapy decreased from 86.7% in 2015 to 82.9% in 2019 (p value = 0.03) and frail patients were significantly less likely to be prescribed HF specific pharmacotherapy than non-frail patients (77.4% vs. 85.9%, p < 0.001).
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16
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Gait speed and 6-minute walking distance are useful for identifying difficulties in activities of daily living in patients with cardiovascular disease. Heart Lung 2021; 51:46-51. [PMID: 34731697 DOI: 10.1016/j.hrtlng.2021.09.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 08/31/2021] [Accepted: 09/01/2021] [Indexed: 01/14/2023]
Abstract
BACKGROUND Difficulty in activities of daily living (ADL) is common in patients with cardiovascular disease (CVD) and is associated with mortality. OBJECTIVES The relationship between gait speed/6-minute walking distance (6MWD) and difficulties in ADL in patients with CVD was explored. METHODS The study population consisted of 447 patients with CVD for whom data on gait speed, 6MWD, and difficulty in ADL during outpatient rehabilitation were available. Relationships of gait speed/6MWD and difficulty in ADL were examined using propensity-adjusted logistic regression analysis. RESULTS Both gait speed and 6MWD were significantly related to difficulty in ADL, and the areas under the curves were large. The cutoff values ranged from 0.93 to 1.30 m/s for gait speed and 370 to 500 m for 6MWD, from basic ADL to vigorous activities. CONCLUSIONS Both gait speed and 6MWD were used for the estimation of difficulty in ADL in patients with CVD. Gait speed can be measured easily and therefore could be incorporated in busy clinical practice to identify patients at risk for functional decline.
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Hamazaki N, Kamiya K, Fukaya H, Nozaki K, Ichikawa T, Matsuzawa R, Yamashita M, Uchida S, Maekawa E, Meguro K, Yamaoka-Tojo M, Matsunaga A, Ako J. Effect of atrial fibrillation on response to exercise-based cardiac rehabilitation in older individuals with heart failure. Ann Phys Rehabil Med 2021; 64:101466. [PMID: 33316434 DOI: 10.1016/j.rehab.2020.101466] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 10/18/2020] [Accepted: 11/18/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Although the coexistence of heart failure (HF) with atrial fibrillation (AF) exhibits poor outcomes, the correlation between AF status and outcomes after exercise-based cardiac rehabilitation (CR) remains unclear in older individuals with HF. OBJECTIVE This retrospective study aimed to investigate the impact of AF on changes in physical function and prognosis after CR in older individuals with HF. METHODS We enrolled consecutive individuals with HF who were ≥ 60 years old who received 5-month CR. Exercise-based CR involved moderate-intensity aerobic exercises tailored to each participant. Isometric quadriceps strength (QS) and 6-min walk distance (6MWD) were measured as physical function, at baseline and 5 months thereafter. We compared QS and 6MWD changes from baseline to the 5-month observation period (QS and 6MWD) between sinus rhythm and AF. We examined composite incidence of all-cause death or unplanned readmission after 5-month CR and analysed the association of QS and 6MWD with clinical events, estimating adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs). RESULTS Of the 764 participants, 476 (62%) had sinus rhythm, and 288 (38%) had AF. AF was associated with lower QS and 6MWD at baseline. The 2 groups did not differ in QS and 6MWD after adjusting for clinical confounders. With sinus rhythm, greater change in QS and 6MWD was significantly associated with reduced incidence of clinical events (QS tertile: aHR 0.75 [95% CI 0.60-0.92]; 6MWD tertile: aHR 0.59 [95% CI 0.46-0.76]); however, with AF, this association was observed for only 6MWD and not QS (QS: aHR 0.92 [95% CI 0.72-1.17]; 6MWD: aHR 0.73 [95% CI 0.54-0.98]). CONCLUSION AF in older individuals with HF is associated with reduced physical function at baseline but not response to exercise-based CR. Furthermore, positive response of physical function after CR is associated with better prognosis regardless of AF, which suggests that exercise-based CR is potentially effective in older individuals with HF and AF.
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Affiliation(s)
- Nobuaki Hamazaki
- Department of Rehabilitation, Kitasato University Hospital, 1-15-1 Kitasato, Minami-ku, 252-0375 Sagamihara, Kanagawa, Japan.
| | - Kentaro Kamiya
- Department of Rehabilitation, Kitasato University School of Allied Health Sciences, Sagamihara, Japan
| | - Hidehira Fukaya
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, Sagamihara, Japan
| | - Kohei Nozaki
- Department of Rehabilitation, Kitasato University Hospital, 1-15-1 Kitasato, Minami-ku, 252-0375 Sagamihara, Kanagawa, Japan
| | - Takafumi Ichikawa
- Department of Rehabilitation, Kitasato University Hospital, 1-15-1 Kitasato, Minami-ku, 252-0375 Sagamihara, Kanagawa, Japan
| | - Ryota Matsuzawa
- Department of Physical Therapy, School of Rehabilitation, Hyogo University of Health Sciences, Kobe, 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
| | - Kentaro Meguro
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, Sagamihara, Japan
| | - Minako Yamaoka-Tojo
- Department of Rehabilitation, Kitasato University School of Allied Health Sciences, Sagamihara, Japan
| | - Atsuhiko Matsunaga
- Department of Rehabilitation, Kitasato University School of Allied Health Sciences, Sagamihara, Japan
| | - Junya Ako
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, Sagamihara, Japan
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18
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Tanrıverdi A, Özcan Kahraman B, Acar S, Özsoy İ, Özpelit E, Şentürk B, Akdeniz B, Savcı S. Determinants of gait speed in patients with heart failure with reduced ejection fraction. Anatol J Cardiol 2021; 25:617-622. [PMID: 34498592 DOI: 10.5152/anatoljcardiol.2021.17735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE Given the prognostic significance of gait speed, there is insufficient evidence about possible functional determinants of gait speed in patients with heart failure with reduced ejection fraction (HFrEF). Therefore, the objective of this study was to investigate the functional determinants of gait speed in patients with HFrEF. METHODS Fifty-nine patients with HFrEF participated in this cross-sectional study. Demographic and clinical characteristics were recorded. The gait speed was determined with a 4-meter walking test. Dyspnea perception was assessed with the modified medical research council (mMRC) scale. Functional capacity was evaluated with a 6-minute walk test (6MWT). The five times sit-to-stand (5-STS) test and the Berg Balance Scale (BBS) were used to measure functional mobility and balance. Physical activity was evaluated with the International Physical Activity Questionnaire (IPAQ) Short-Form. RESULTS Gait speed was correlated with age (r=-0.368, p=0.004), NYHA functional class (r=-0.438, p=0.001), mMRC score (r=-0.422, p=0.001), 6MWT (r=0.650, p<0.001), 5STS (r=-0.506, p<0.001), BBS (r=0.586, p<0.001), IPAQ (r=0.305, p=0.019) and IPAQ-Sitting time (r=-0.327, p=0.011). On multiple linear regression analysis, the 6MWT distance and BBS were independent determinants of the usual gait speed in patients with HFrEF, accounting for 44.4% of the variance. CONCLUSION This study indicates that functional capacity and balance are independent functional determinants of gait speed in patients with HFrEF.
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Affiliation(s)
- Aylin Tanrıverdi
- Department of Institute of Health Sciences, Faculty of Medicine, Dokuz Eylül University; İzmir-Turkey
| | - Buse Özcan Kahraman
- Department of School of Physical Therapy and Rehabilitation, Faculty of Medicine, Dokuz Eylül University; İzmir-Turkey
| | - Serap Acar
- Department of School of Physical Therapy and Rehabilitation, Faculty of Medicine, Dokuz Eylül University; İzmir-Turkey
| | - İsmail Özsoy
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Selçuk University; Konya-Turkey
| | - Ebru Özpelit
- Department of Cardiology, Faculty of Medicine, Dokuz Eylül University; İzmir-Turkey
| | - Bihter Şentürk
- Department of Cardiology, Faculty of Medicine, Dokuz Eylül University; İzmir-Turkey
| | - Bahri Akdeniz
- Department of Cardiology, Faculty of Medicine, Dokuz Eylül University; İzmir-Turkey
| | - Sema Savcı
- Department of School of Physical Therapy and Rehabilitation, Faculty of Medicine, Dokuz Eylül University; İzmir-Turkey
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19
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Nozaki K, Kamiya K, Hamazaki N, Saito H, Saito K, Ogasahara Y, Maekawa E, Konishi M, Kitai T, Iwata K, Jujo K, Wada H, Kasai T, Nagamatsu H, Ozawa T, Izawa K, Yamamoto S, Aizawa N, Makino A, Oka K, Momomura SI, Kagiyama N, Matsue Y. Validity and Utility of the Questionnaire-based FRAIL Scale in Older Patients with Heart Failure: Findings from the FRAGILE-HF. J Am Med Dir Assoc 2021; 22:1621-1626.e2. [PMID: 33785309 DOI: 10.1016/j.jamda.2021.02.025] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 02/02/2021] [Accepted: 02/09/2021] [Indexed: 01/22/2023]
Abstract
OBJECTIVES We investigated whether the FRAIL scale questionnaire is consistent with the Fried criteria, predicts all-cause mortality, and reflects physical dysfunction in patients with heart failure (HF). DESIGN Secondary analysis of FRAGILE-HF, a cohort study that enrolled participants from 2016 to 2018 and followed-up for 1-year of discharge. SETTING AND PARTICIPANTS A prospective multicenter cohort study in which 15 hospitals in Japan (8 university hospitals and 7 nonuniversity teaching hospitals) participated. We prospectively enrolled 1332 consecutive hospitalized patients ≥65 years old with HF and analyzed 1028 patients after excluding 304 patients with missing data on the FRAIL scale. METHODS The FRAIL scale, the Fried model, and physical function were measured before discharge. The endpoint was all-cause mortality. RESULTS According to the FRAIL scale, 459 (44.6%) and 491 (47.8%) were classified as frail and prefrail, respectively. The Kappa coefficient between the FRAIL scale and the Fried criteria were 0.39 [95% confidence interval (CI) 0.34-0.44; P < .001]. The area under the receiver-operating characteristic curves for frailty diagnosed by the Fried criteria of the FRAIL scale was 0.74 (95% CI 0.71-0.76; P < .001). A total of 118 deaths occurred during 1 year of follow-up. After adjusting for the MAGGIC risk score and log-BNP, The FRAIL scale predicted all-cause mortality (hazard ratio 1.17; 95% CI 1.01-1.36; P = .035). The FRAIL scale was also associated with various physical dysfunctions that correlated with poor prognosis. CONCLUSIONS AND IMPLICATIONS The FRAIL scale had moderate consistency with the Fried criteria, predicted all-cause mortality, and reflected clinically important physical dysfunctions.
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Affiliation(s)
- Kohei Nozaki
- Department of Rehabilitation, Kitasato University Hospital, Sagamihara, Japan
| | - Kentaro Kamiya
- Department of Rehabilitation, School of Allied Health Science, Kitasato University, Sagamihara, Japan.
| | - Nobuaki Hamazaki
- Department of Rehabilitation, Kitasato University Hospital, Sagamihara, Japan
| | - Hiroshi Saito
- Department of Rehabilitation, Kameda Medical Center, Kamogawa, Japan; Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Kazuya Saito
- Department of Rehabilitation, The Sakakibara Heart Institute of Okayama, Okayama, Japan
| | - Yuki Ogasahara
- Department of Nursing, The Sakakibara Heart Institute of Okayama, Okayama, Japan
| | - Emi Maekawa
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, Sagamihara, Japan
| | - Masaaki Konishi
- Division of Cardiology, Yokohama City University Medical Center, Yokohama, Japan
| | - Takeshi Kitai
- Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Kentaro Iwata
- Department of Rehabilitation, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Kentaro Jujo
- Department of Cardiology, Nishiarai Heart Center Hospital, Tokyo, Japan
| | - Hiroshi Wada
- Department of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Takatoshi Kasai
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan; Cardiovascular Respiratory Sleep Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Hirofumi Nagamatsu
- Department of Cardiology, Tokai University School of Medicine, Isehara, Japan
| | - Tetsuya Ozawa
- Department of Rehabilitation, Odawara Municipal Hospital, Odawara, Japan
| | - Katsuya Izawa
- Department of Rehabilitation, Kasukabe Chuo General Hospital, Kasukabe, Japan
| | - Shuhei Yamamoto
- Department of Rehabilitation, Shinshu University Hospital, Matsumoto, Japan
| | - Naoki Aizawa
- Department of Cardiovascular Medicine, Nephrology and Neurology, University of Ryukyus, Okinawa, Japan
| | - Akihiro Makino
- Department of Rehabilitation, Kitasato University Medical Center, Kitamoto, Japan
| | - Kazuhiro Oka
- Department of Rehabilitation, Saitama Citizens Medical Center, Saitama, Japan
| | | | - Nobuyuki Kagiyama
- Department of Cardiology, The Sakakibara Heart Institute of Okayama, Okayama, Japan; West Virginia University Heart and Vascular Institute, Morgantown, WV, USA
| | - Yuya Matsue
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan; Cardiovascular Respiratory Sleep Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
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20
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Yanagi N, Kamiya K, Hamazaki N, Matsuzawa R, Nozaki K, Ichikawa T, Valley TS, Nakamura T, Yamashita M, Maekawa E, Koike T, Yamaoka-Tojo M, Arai M, Matsunaga A, Ako J. Post-intensive care syndrome as a predictor of mortality in patients with critical illness: A cohort study. PLoS One 2021; 16:e0244564. [PMID: 33690614 PMCID: PMC7946187 DOI: 10.1371/journal.pone.0244564] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 12/13/2020] [Indexed: 01/20/2023] Open
Abstract
Introduction The post-intensive care syndrome (PICS) encompasses multiple, diverse conditions, such as physical disability, cognitive impairment, and depression. We sought to evaluate whether conditions within PICS have similar associations with mortality among survivors of critical illness. Materials and methods In this retrospective cohort study, we identified 248 critically ill patients with intensive care unit stay ≥72 hours, who underwent PICS evaluation. Patients with disability in activities of daily living, cognitive impairment, or depression before hospitalization were excluded. We defined PICS using established measures of physical disability (usual gait speed), cognitive impairment (Mini-Cog test), and depression (Patient Health Questionnaire-2) at hospital discharge. The endpoint was all-cause mortality. Results Patients had a median age of 69 years and Acute Physiology and Chronic Health Evaluation (APACHE) II score of 16. One hundred thirty-two patients were classified as having PICS, and 19 patients died. 81/248 (34%) patients had physical disability, 42/248 (19%) had cognitive impairment, and 44/248 (23%) had depression. After adjusting for covariates on multivariable Cox regression analyses, PICS was significantly associated with all-cause mortality (hazard ratio [HR] 3.78, 95% confidence interval [CI] 1.02 – 13.95; P = 0.046). However, the association between PICS and all-cause mortality was related to physical disability and cognitive impairment (P = 0.001 and P = 0.027, respectively), while depression was not (P = 0.623). Conclusion While PICS as a syndrome has been useful in gaining attention to the sequelae of critical illness, its relationship with long-term mortality is driven largely by physical disability and cognitive impairment and not depression.
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Affiliation(s)
- Naoya Yanagi
- Department of Rehabilitation Sciences, Graduate School of Medical Sciences, Kitasato University, Sagamihara, Japan
| | - Kentaro Kamiya
- Department of Rehabilitation Sciences, Graduate School of Medical Sciences, Kitasato University, Sagamihara, Japan.,Department of Rehabilitation, School of Allied Health Sciences, Kitasato University, Sagamihara, Japan
| | - Nobuaki Hamazaki
- Department of Rehabilitation, Kitasato University Hospital, Sagamihara, Japan
| | - Ryota Matsuzawa
- Department of Physical Therapy, School of Rehabilitation, Hyogo University of Health Sciences, Kobe, Japan
| | - Kohei Nozaki
- Department of Rehabilitation, Kitasato University Hospital, Sagamihara, Japan
| | - Takafumi Ichikawa
- Department of Rehabilitation, Kitasato University Hospital, Sagamihara, Japan
| | - Thomas S Valley
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, United States of America.,Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, United States of America.,Center for Bioethics and Social Sciences in Medicine, University of Michigan, Ann Arbor, MI, United States of America
| | - Takeshi Nakamura
- Department of Rehabilitation Sciences, Graduate School of Medical Sciences, Kitasato University, Sagamihara, Japan.,Department of Rehabilitation, Juntendo University Hospital, Tokyo, Japan
| | - Masashi Yamashita
- Department of Rehabilitation Sciences, Graduate School of Medical Sciences, Kitasato University, Sagamihara, Japan
| | - Emi Maekawa
- Department of Cardiovascular Medicine, School of Medicine, Kitasato University, Sagamihara, Japan
| | - Tomotaka Koike
- Department of Intensive Care Center, Kitasato University Hospital, Sagamihara, Japan
| | - Minako Yamaoka-Tojo
- Department of Rehabilitation, School of Allied Health Sciences, Kitasato University, Sagamihara, Japan.,Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kitasato University, Sagamihara, Japan
| | - Masayasu Arai
- Division of Intensive Care Medicine, Department of Research and Development Center for New Medical Frontiers, School of Medicine, Kitasato University, Sagamihara, Japan
| | - Atsuhiko Matsunaga
- Department of Rehabilitation Sciences, Graduate School of Medical Sciences, Kitasato University, Sagamihara, Japan.,Department of Rehabilitation, School of Allied Health Sciences, Kitasato University, Sagamihara, Japan
| | - Junya Ako
- Department of Cardiovascular Medicine, School of Medicine, Kitasato University, Sagamihara, Japan.,Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kitasato University, Sagamihara, Japan
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21
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Yoon S, Jung HW, Jung H, Kim K, Hong SK, Roh H, Oh BM. Development and Validation of 2D-LiDAR-Based Gait Analysis Instrument and Algorithm. SENSORS 2021; 21:s21020414. [PMID: 33430161 PMCID: PMC7826665 DOI: 10.3390/s21020414] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Revised: 01/05/2021] [Accepted: 01/06/2021] [Indexed: 12/16/2022]
Abstract
Acquiring gait parameters from usual walking is important to predict clinical outcomes including life expectancy, risk of fall, and neurocognitive performance in older people. We developed a novel gait analysis tool that is small, less-intrusive and is based on two-dimensional light detection and ranging (2D-LiDAR) technology. Using an object-tracking algorithm, we conducted a validation study of the spatiotemporal tracking of ankle locations of young, healthy participants (n = 4) by comparing our tool and a stereo camera with the motion capture system as a gold standard modality. We also assessed parameters including step length, step width, cadence, and gait speed. The 2D-LiDAR system showed a much better accuracy than that of a stereo camera system, where mean absolute errors were 46.2 ± 17.8 mm and 116.3 ± 69.6 mm, respectively. Gait parameters from the 2D-LiDAR system were in good agreement with those from the motion capture system (r = 0.955 for step length, r = 0.911 for cadence). Simultaneous tracking of multiple targets by the 2D-LiDAR system was also demonstrated. The novel system might be useful in space and resource constrained clinical practice for older adults.
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Affiliation(s)
- Seongjun Yoon
- Dyphi Research Institute, Dyphi Inc., Daejeon 34068, Korea;
| | - Hee-Won Jung
- Department of Internal Medicine, Seoul National University Hospital, Seoul 03080, Korea;
- Division of Geriatrics, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul 03080, Korea
| | - Heeyoune Jung
- Department of Rehabilitation Medicine, National Traffic Injury Rehabilitation Hospital, Gyeonggi-do 12564, Korea; (H.J.); (S.-K.H.)
| | - Keewon Kim
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul 03080, Korea;
| | - Suk-Koo Hong
- Department of Rehabilitation Medicine, National Traffic Injury Rehabilitation Hospital, Gyeonggi-do 12564, Korea; (H.J.); (S.-K.H.)
| | - Hyunchul Roh
- Dyphi Research Institute, Dyphi Inc., Daejeon 34068, Korea;
- Correspondence: (H.R.); (B.-M.O.)
| | - Byung-Mo Oh
- Department of Rehabilitation Medicine, National Traffic Injury Rehabilitation Hospital, Gyeonggi-do 12564, Korea; (H.J.); (S.-K.H.)
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul 03080, Korea;
- Correspondence: (H.R.); (B.-M.O.)
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22
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Fuentes-Abolafio IJ, Stubbs B, Pérez-Belmonte LM, Bernal-López MR, Gómez-Huelgas R, Cuesta-Vargas AI. Physical functional performance and prognosis in patients with heart failure: a systematic review and meta-analysis. BMC Cardiovasc Disord 2020; 20:512. [PMID: 33297975 PMCID: PMC7724724 DOI: 10.1186/s12872-020-01725-5] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 10/04/2020] [Indexed: 12/13/2022] Open
Abstract
Background Patients with Heart Failure (HF) show impaired functional capacities which have been related to their prognosis. Moreover, physical functional performance in functional tests has also been related to the prognosis in patients with HF. Thus, it would be useful to investigate how physical functional performance in functional tests could determine the prognosis in patients with HF, because HF is the leading cause of hospital admissions for people older than 65 years old. This systematic review and meta-analysis aims to summarise and synthesise the evidence published about the relationship between physical functional performance and prognosis in patients with HF, as well as assess the risk of bias of included studies and the level of evidence per outcome. Methods Major electronic databases, such as PubMed, AMED, CINAHL, EMBASE, PEDro, Web of Science, were searched from inception to March 2020 for observational longitudinal cohort studies (prospective or retrospective) examining the relationship between physical functional performance and prognosis in patients with HF. Results 44 observational longitudinal cohort studies with a total of 22,598 patients with HF were included. 26 included studies reported a low risk of bias, and 17 included studies showed a moderate risk of bias. Patients with poor physical functional performance in the Six Minute Walking Test (6MWT), in the Short Physical Performance Battery (SPPB) and in the Gait Speed Test showed worse prognosis in terms of larger risk of hospitalisation or mortality than patients with good physical functional performance. However, there was a lack of homogeneity regarding which cut-off points should be used to stratify patients with poor physical functional performance from patients with good physical functional performance. Conclusion The review includes a large number of studies which show a strong relationship between physical functional performance and prognosis in patients with HF. Most of the included studies reported a low risk of bias, and GRADE criteria showed a low and a moderate level of evidence per outcome.
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Affiliation(s)
- Iván José Fuentes-Abolafio
- Department of Physiotherapy, Faculty of Health Science, University of Malaga, The Institute of Biomedical Research in Malaga (IBIMA), Clinimetric Group FE-14, Malaga, Spain
| | - Brendon Stubbs
- Physiotherapy Department, South London and Maudsley NHS Foundation Trust, Denmark Hill, London, UK.,Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.,Positive Ageing Research Intitute (PARI), Faculty of Health Social Care and Education, Anglia Ruskin University, Chelmsford, UK
| | - Luis Miguel Pérez-Belmonte
- Internal Medicine Department, Instituto de Investigación Biomédica de Malaga (IBIMA), Regional University Hospital of Málaga, Málaga, Spain.,Unidad de Neurofisiología Cognitiva, Centro de Investigaciones Médico Sanitarias (CIMES), Instituto de Investigación Biomédica de Málaga (IBIMA), Universidad de Málaga (UMA), Campus de Excelencia Internacional (CEI) Andalucía Tech, Málaga, Spain.,Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain
| | - María Rosa Bernal-López
- Internal Medicine Department, Instituto de Investigación Biomédica de Malaga (IBIMA), Regional University Hospital of Málaga, Málaga, Spain.,CIBER Fisio-patología de la Obesidad y la Nutrición, Instituto de Salud Carlos III, Madrid, Spain
| | - Ricardo Gómez-Huelgas
- Internal Medicine Department, Instituto de Investigación Biomédica de Malaga (IBIMA), Regional University Hospital of Málaga, Málaga, Spain.,CIBER Fisio-patología de la Obesidad y la Nutrición, Instituto de Salud Carlos III, Madrid, Spain
| | - Antonio Ignacio Cuesta-Vargas
- Department of Physiotherapy, Faculty of Health Science, University of Malaga, The Institute of Biomedical Research in Malaga (IBIMA), Clinimetric Group FE-14, Malaga, Spain. .,School of Clinical Sciences, Faculty of Health at the Queensland University of Technology, Brisbane, Queensland, Australia.
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23
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Nakamura T, Kamiya K, Hamazaki N, Matsuzawa R, Nozaki K, Ichikawa T, Yamashita M, Maekawa E, Reed JL, Noda C, Meguro K, Yamaoka-Tojo M, Matsunaga A, Ako J. Quadriceps Strength and Mortality in Older Patients With Heart Failure. Can J Cardiol 2020; 37:476-483. [PMID: 32622879 DOI: 10.1016/j.cjca.2020.06.019] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Revised: 06/21/2020] [Accepted: 06/28/2020] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND This study was performed to test the hypothesis that low quadriceps isometric strength (QIS) is associated with greater risk of mortality and has the additive prognostic significance to the severity of heart failure (HF) and gait speed in older patients with HF. METHODS A retrospective cohort study was performed in 1273 patients ≥ 60 years of age with HF (mean age 75 ± 8 years, 59.1% men); all of whom were evaluated during hospitalization for usual gait speed and maximal QIS. The QIS was expressed relative to body mass (% BM). The endpoint was all-cause mortality. RESULTS Over a median follow-up period of 1.59 years (interquartile range, 0.58 to 3.42 years), 224 patients died. The cutoff value based on the Youden index for the QIS discriminating those at high risk of mortality was 36.2% BM for overall, and we defined less than this cutoff point of QIS as low QIS. After adjustment for the HF risk score, the hazard ratio in low QIS was 1.55 for overall (95% confidence interval [CI], 1.17-2.06). The addition of low QIS to the HF risk score and gait speed was associated with significant increases in both net reclassification improvement (NRI, 0.239 for overall; 95% CI, 0.096-0.381) and integrated discrimination improvement (IDI, 0.004 for overall; 95% CI, 0.001-0.009) for all-cause mortality. CONCLUSION Low QIS was strongly associated with poor prognosis and showed complementary prognostic predictive capability to the HF risk score and gait speed in older patients with HF.
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Affiliation(s)
- Takeshi Nakamura
- Department of Rehabilitation Sciences, Kitasato University Graduate School of Medical Sciences, Sagamihara, Japan; Department of Rehabilitation, Juntendo University Hospital, Tokyo, Japan
| | - Kentaro Kamiya
- Department of Rehabilitation Sciences, Kitasato University Graduate School of Medical Sciences, Sagamihara, Japan; Department of Rehabilitation, School of Allied Health Sciences, Kitasato University, Sagamihara, Japan.
| | - Nobuaki Hamazaki
- Department of Rehabilitation, Kitasato University Hospital, Sagamihara, Japan
| | - Ryota Matsuzawa
- Department of Physical Therapy, School of Rehabilitation, Hyogo University of Health Sciences, Kobe, Japan
| | - Kohei Nozaki
- Department of Rehabilitation, Kitasato University Hospital, Sagamihara, Japan
| | - Takafumi Ichikawa
- Department of Rehabilitation, Kitasato University Hospital, Sagamihara, Japan
| | - Masashi Yamashita
- 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, Ontario, Canada; School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada; School of Human Kinetics, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - Chiharu Noda
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, Sagamihara, Japan
| | - Kentaro Meguro
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, Sagamihara, Japan
| | - Minako Yamaoka-Tojo
- Department of Rehabilitation Sciences, Kitasato University Graduate School of Medical Sciences, Sagamihara, Japan; Department of Rehabilitation, School of Allied Health Sciences, Kitasato University, Sagamihara, Japan
| | - Atsuhiko Matsunaga
- Department of Rehabilitation Sciences, Kitasato University Graduate School of Medical Sciences, Sagamihara, Japan; Department of Rehabilitation, School of Allied Health Sciences, Kitasato University, Sagamihara, Japan
| | - Junya Ako
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, Sagamihara, Japan
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24
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Aida K, Kamiya K, Hamazaki N, Matsuzawa R, Nozaki K, Ichikawa T, Nakamura T, Yamashita M, Maekawa E, Yamaoka-Tojo M, Matsunaga A, Ako J. Usefulness of the Simplified Frailty Scale in Predicting Risk of Readmission or Mortality in Elderly Patients Hospitalized with Cardiovascular Disease. Int Heart J 2020; 61:571-578. [PMID: 32418965 DOI: 10.1536/ihj.19-557] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The simplified frailty scale is a simple frailty assessment tool modified from Fried's phenotypic frailty criteria, which is easy to administer in hospitalized patients. The applicability of the simplified frailty scale to indicate prognosis in elderly hospitalized patients with cardiovascular disease (CVD) was examined.This cohort study was performed in 895 admitted patients ≥ 65 years (interquartile range, 71.0-81.0, 541 men) with CVD. Patients were classified as robust, prefrail, or frail based on the five components of the simplified frailty scale: weakness, slowness, exhaustion, low activity, and weight loss. The primary endpoint was the composite outcome of all-cause mortality and unplanned readmission for CVD.Patients positive for greater numbers of frailty components showed higher risk of all-cause mortality or unplanned CVD-related readmission (P for trend < 0.001). Classification as both frail (adjusted HR: 3.27, 95% confidence interval [CI]: 1.49-7.21, P = 0.003) and prefrail (adjusted HR: 2.19, 95% CI: 1.00-4.79, P = 0.049) independently predicted the composite endpoint compared with robust after adjusting for potential confounding factors. The inclusion of prefrail, frail, and number of components of frailty increased both continuous net reclassification improvement (0.113, P = 0.049; 0.426, P < 0.001; and 0.321, P < 0.001) and integrated discrimination improvement (0.007, P = 0.037; 0.009, P = 0.038; and 0.018, P = 0.002) for the composite endpoint.Higher scores on the simplified frailty scale were associated with increased risk of mortality or readmission in elderly patients hospitalized for CVD.
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Affiliation(s)
- Keita Aida
- Department of Rehabilitation Sciences, Kitasato University Graduate School of Medical Sciences
| | - Kentaro Kamiya
- Department of Rehabilitation, Kitasato University School of Allied Health Sciences
| | | | - Ryota Matsuzawa
- Department of Physical Therapy, School of Rehabilitation, Hyogo University of Health Sciences
| | - Kohei Nozaki
- Department of Rehabilitation, Kitasato University Hospital
| | | | - Takeshi Nakamura
- Department of Rehabilitation Sciences, Kitasato University Graduate School of Medical Sciences
| | - Masashi Yamashita
- Department of Rehabilitation Sciences, Kitasato University Graduate School of Medical Sciences
| | - Emi Maekawa
- Department of Cardiovascular Medicine, Kitasato University School of Medicine
| | - Minako Yamaoka-Tojo
- Department of Rehabilitation, Kitasato University School of Allied Health Sciences
| | - Atsuhiko Matsunaga
- Department of Rehabilitation Sciences, Kitasato University Graduate School of Medical Sciences.,Department of Rehabilitation, Kitasato University School of Allied Health Sciences
| | - Junya Ako
- Department of Cardiovascular Medicine, Kitasato University School of Medicine
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25
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Keppler AM, Holzschuh J, Pfeufer D, Neuerburg C, Kammerlander C, Böcker W, Fürmetz J. Postoperative physical activity in orthogeriatric patients - new insights with continuous monitoring. Injury 2020; 51:628-632. [PMID: 32033808 DOI: 10.1016/j.injury.2020.01.041] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Accepted: 01/28/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND An early postoperative mobilization shows beneficial effects in terms of complications and long-term mobilization scores in elderly adult fracture patients. The primary objective of this study was to evaluate the overall mobilization of orthogeriatric patients during the postoperative hospital stay based on a continuous accelerometry measurement. Secondly, the collected data was analyzed to detect fracture related differences. We hypothesized that upper extremity fractures come along with higher levels of physical activity compared to fractures of the lower extremity. METHODS Thirty-one orthogeriatric patients with proximal femur fractures (PFF) and proximal humerus fractures (PHF) were enrolled consecutively in a maximum care hospital in a prospective study design (level of evidence 2). In the PFF study group 9 patients received hip arthroplasty and 11 patients intramedullary nailing (PFNA) and in the PHF group 10 patients received osteosynthesis of the proximal humerus. All patients worn a waist placed accelerometer during the length of hospitalization to quantify mobilization and physical activity. RESULTS The PFF group (n = 21) had a mean age of 80.86 years (SD ± 6.75), the PHF (n = 10) group had a mean age of 75.20 (SD ± 6.86). A significantly higher gait speed was observed in the PHF group of 0.52 m/s (SD ± 0.27) compared to the slower PFF group with 0.29 (SD ± 0.45); p = 0.0403. Quantitative mobility was measured by using the average number of daily steps. This showed a significantly lower number of steps in the PFF group (102.7; SD ± 188.1) compared to the PHF group (413.5; SD ± 287.7; p = 0.0002). CONCLUSIONS Our data demonstrates that it is feasible and accepted by the patient to continuously measure the mobility including gait speed and characteristics of orthogeriatric patients using waist worn accelerometry based wearables. Postoperative mobility and gait speed was generally low in both groups. Actions to improve postoperative mobility of orthogeriatric patients are urgently needed. Level Of Evidence Prospective cohort study, Level of Evidence 2.
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Affiliation(s)
- Alexander M Keppler
- Department for General, Trauma and Reconstructive Surgery, University Hospital LMU Munich, Germany.
| | - Jenny Holzschuh
- Department for General, Trauma and Reconstructive Surgery, University Hospital LMU Munich, Germany
| | - Daniel Pfeufer
- Department for General, Trauma and Reconstructive Surgery, University Hospital LMU Munich, Germany
| | - Carl Neuerburg
- Department for General, Trauma and Reconstructive Surgery, University Hospital LMU Munich, Germany
| | - Christian Kammerlander
- Department for General, Trauma and Reconstructive Surgery, University Hospital LMU Munich, Germany
| | - Wolfgang Böcker
- Department for General, Trauma and Reconstructive Surgery, University Hospital LMU Munich, Germany
| | - Julian Fürmetz
- Department for General, Trauma and Reconstructive Surgery, University Hospital LMU Munich, Germany
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