Early mobilization post-myocardial infarction: A scoping review

Early mobilization for acute heart failure: A scoping and a systematic review

Early mobilization of hospitalized patients is beneficial under certain circumstances. This has been applied in clinical practice for patients with acute heart failure (HF). However, its current definition, effectiveness, and safety are not well established. This review aimed to clarify the current definition of "early mobilization," and summarize its effectiveness and safety in acute HF. We conducted a scoping review to define early mobilization (Part 1) and a systematic review and meta-analysis (Part 2) to evaluate its effectiveness and safety. For Part 1, we searched MEDLINE (Ovid), and for Part 2, we searched the Cochrane Central Register of Controlled Trials, MEDLINE (Ovid), Embase (ProQuest Dialog), CINAHL, and PEDro. We included 12 studies in Part 1 and defined early mobilization as protocol-based interventions or walking within 3 days of admission. Based on this definition, two observational studies were included in Part 2, with no randomized controlled trials. Early mobilization may result in a large reduction in the readmission rate compared with that of the control (two studies, 283 participants: odds ratio 0.25, 95 % confidence interval 0.14 to 0.42; I2 = 0 %; low certainty evidence). We could not define frequency, intensity, or quantity because many of the included studies did not describe them. In conclusions, our review suggests that early mobilization, defined as protocol-based interventions or walking within 3 days of admission, may be associated with a low readmission rate in patients with acute HF. Future studies are essential, to investigate the causal relationship between early mobilization and possible outcomes.

Sedentary Time in Older Adults With Acute Cardiovascular Disease

Background

Older adults may be subject to prolonged bedrest during hospitalization for acute cardiovascular disease, which can contribute to poor functional outcomes posthospitalization. Our objective was to describe mobility status in hospitalized older adults with acute cardiovascular disease.

Methods

Patients aged ≥ 60 years old in the cardiac intensive care unit and cardiovascular ward at a tertiary care academic centre in Montréal, Québec were prospectively enrolled from April 2019 to March 2020. Activity levels were measured with the ActiGraph GT9X Link 3-axis accelerometer (ActiGraph, Pensacola, FL). Sedentary was defined as lying in bed or in a sitting position. Health-related quality of life (HRQOL) was measured with the Short-Form 36 (SF-36) questionnaire by telephone at 1 month posthospitalization. The primary outcome was percentage of sedentary time during hospitalization.

Results

There were 35 patients included in the analysis (75.7 ± 6.9 years old; 45.7% female; 22.9% ischemic heart disease; 20.0% heart failure). Patients spent 91.2% ± 5.5 in a sedentary position during their hospital stay. Mean steps per minute were 1.0 ± 1.2, and mean kcals consumed per day were 116.6 ± 124.5. In the multivariable analysis, a higher percentage of sedentary time and lower steps per minute were each associated with lower total SF-36 scores at 1-month posthospitalization (both P < 0.05).

Conclusions

Older adults with acute cardiovascular disease may be sedentary for a large part of their hospital stay. Increased sedentary time is associated with worse self-reported posthospital HRQOL. Future studies are needed to determine whether interventions to increase activity during hospitalization improve posthospital HRQOL and functional outcomes.

Sarcopenia-derived exosomal micro-RNA 16-5p disturbs cardio-repair via a pro-apoptotic mechanism in myocardial infarction in mice

Sarcopenia is a pathophysiological malfunction induced by skeletal muscle atrophy. Several studies reported an association between sarcopenia-induced cardiac cachexia and poor prognosis in heart disease. However, due to lack of an established animal models, the underlying mechanism of disturbed cardiac repair accompanied with sarcopenia remains poorly understood. Here, we developed a novel sarcopenia-induced cardiac repair disturbance mouse model induced by tail suspension (TS) after cardiac ischemia and reperfusion (I/R). Importantly, we identified a specific exosomal-microRNA marker, miR-16-5p, in the circulating exosomes of I/R-TS mice. Of note, sarcopenia after I/R disturbed cardiac repair and raised the level of circulating-exosomal-miR-16-5p secreting from both the atrophic limbs and heart of TS mice. Likewise, miR-16-5p mimic plasmid disturbed cardiac repair in I/R mice directly. Additionally, in neonatal rat ventricular myocytes (NRVMs) cultured in vitro under hypoxic conditions in the presence of a miR-16-5p mimic, we observed increased apoptosis through p53 and Caspase3 upregulation, and also clarified that autophagosomes were decreased in NRVMs via SESN1 transcript interference-mediated mTOR activation. In conclusion, we show the pro-apoptotic effect of sarcopenia-derived miR-16-5p, which may be behind the exacerbation of myocardial infarction. Therefore, miR-16-5p can be a novel therapeutic target in the context of cardiac repair disturbances in sarcopenia-cachexia.