Cardiac rehabilitation outcomes following a 6-week program of PCI and CABG Patients

Impact of Prior COVID-19 Infections on Cardiac Rehabilitation Completion Rates and Outcomes

PURPOSE

This is a retrospective cohort study designed to evaluate the impact of having a prior COVID-19 infection on cardiac rehabilitation (CR) completion rates and outcomes.

METHODS

Participants enrolled into the CR program from June 1, 2020, to March 30, 2022. They completed both physical and mental health assessments prior to enrollment and upon completion of the program. The cohort was divided into (-) COVID and (+) COVID based on whether they self-reported a prior COVID-19 infection. Outcome measures included General Anxiety Disorder-7, Patient Health Questionnaire-9, Mental Composite Score (Short Form Health Survey-36), Physical Composite Score (Short Form Health Survey-36), and exercise capacity (reported in METs). Program completion rates and outcome measures were compared between (-) COVID and (+) COVID cohorts.

RESULTS

A total of 806 participants were enrolled in the study. Program completion rates were 58.7% in the (-) COVID group and 67.2% in the (+) COVID group ( P = .072). African Americans ( P = .017), diabetics ( P = .017), and current smokers ( P = .003) were less likely to complete the program. Both (-) COVID and (+) COVID groups showed significant improvement in all outcome measures after completing the CR program. However, there was no difference in outcomes between groups.

CONCLUSIONS

Having a prior COVID-19 infection did not negatively impact the mental and physical health benefits obtained by completing the CR program, regardless of the American Association of Cardiovascular and Pulmonary Rehabilitation risk category.

Heart Rate Variability Measurement through a Smart Wearable Device: Another Breakthrough for Personal Health Monitoring?

Heart rate variability (HRV) is a measurement of the fluctuation of time between each heartbeat and reflects the function of the autonomic nervous system. HRV is an important indicator for both physical and mental status and for broad-scope diseases. In this review, we discuss how wearable devices can be used to monitor HRV, and we compare the HRV monitoring function among different devices. In addition, we have reviewed the recent progress in HRV tracking with wearable devices and its value in health monitoring and disease diagnosis. Although many challenges remain, we believe HRV tracking with wearable devices is a promising tool that can be used to improve personal health.

The Effects of Cardiac Rehabilitation including Nordic Walking in Patients with Chronic Coronary Syndromes after Percutaneous Coronary Interventions in Elective Mode

Background: Percutaneous coronary intervention (PCI) in patients with chronic coronary syndrome (CCS) is a worldwide method of coronary revascularisation. The aim of this study was to assess the immediate and long-term effects of Nordic Walking (NW) training added to a standard cardiac rehabilitation programme on physical activity (PA) and capacity and life quality, as well as selected proatherogenic risk factors. Methods: The studied group comprised 50 patients (considering exclusion criteria, 40 patients), aged 56-70, with CCS after elective PCI qualified them for a 6-weeks-long cardiac rehabilitation. The follow-up period lasted 4 months, and control visits occurred at 2 and 4 months. The studied patients were randomly divided into two groups: control group-standard cardiac rehabilitation programme and experimental group-standard cardiac rehabilitation programme additionally combined with NW training. Results: The cardiac rehabilitation programme in the experimental, compared to the control group, increased intense PA (from 731.43 ± 909.9 to 2740 ± 2875.96 vs. from 211.43 ± 259.43 to 582.86 ± 1289.74 MET min/week) and aerobic efficiency-VO2peak (from 8.67 ± 0.88 to 9.96 ± 1.35 vs. from 7.39 ± 2 to 7.41 ± 2.46 METs), as well as quality of life according to the WHOQOL-BREF questionnaire (from 3.57 ± 0.51 to 4.14 ± 0.36 vs. from 3.29 ± 0.47 to 3.57 ± 0.51 points). The walking distance assessed with the 6-min walk test did not differ between the groups before the beginning of the rehabilitation programme. Both at the I follow-up and II follow-up time points, a significant increase in the walking distance was noted in the control and experimental groups compared to baseline, and the difference between both groups was significant at the end of follow-up (378.57 ± 71.35 vs. 469.29 ± 58.07, p = 0.003). Moreover, NW had a positive effect on the modulation within selected biochemical risk factors of atherosclerosis, as well as subjective quality of life and well-being. Conclusions: Introducing NW training into the cardiac rehabilitation process proved to be a more effective form of therapy in patients with CCS treated via PCI, as compared to the standard cardiac rehabilitation programme alone.

Exercise training and cardiac autonomic function following coronary artery bypass grafting: a systematic review and meta-analysis

BACKGROUND

Exercise training improves cardiac autonomic function is still debatable in patients with coronary artery bypass grafting (CABG). The aim of the present review is to assess the effect of exercise on CABG patient's heart rate variability (HRV) and heart rate recovery (HRR) parameters.

MAIN BODY

Databases (PubMed, Web of Science and PEDro) were accessed for systematic search from inception till May 2022. Eleven potential studies were qualitatively analyzed by using PEDro and eight studies were included in the quantitative synthesis. Meta-analysis was conducted by using a random-effect model, inverse-variance approach through which standardized mean differences (SMDs) were estimated. The analysis of pooled data showed that exercise training improved HRV indices of standard deviation of the R-R intervals (SDNN) [SMD 0.44, 95% CI 0.17, 0.71, p = 0.002], square root of the mean squared differences between adjacent R-R intervals (RMSSD) [SMD 0.68, 95% CI 0.28, 1.08, p = 0.0008], high frequency (HF) [SMD 0.58, 95% CI 0.18, 0.98, p = 0.005] and low frequency-to-high frequency (LF/HF) ratio [SMD - 0.34, 95% CI - 0.65, - 0.02, p = 0.03].

CONCLUSIONS

Exercise training enhances cardiac autonomic function in CABG patients. Owing to the methodological inconsistencies in assessing HRV, the precise effect on autonomic function still remains conflicted. Future high-quality trials are needed focusing on precise methodological approach and incorporation of various types of exercise training interventions will give clarity regarding autonomic adaptations post-exercise training in CABG. Trial registration CRD42021230270 , February 19, 2021.

Outcomes of Genetic Testing-Based Cardiac Rehabilitation Program in Patients with Acute Myocardial Infarction after Percutaneous Coronary Intervention

Objective

There can be extreme variability between individual responses to exercise training, and the identification of genetic variants associated with individual variabilities in exercise-related traits could guide individualized exercise programs. We aimed to screen the exercise-related gene sensitivity of patients with acute myocardial infarction after PCI by establishing the gene spectrum of aerobic exercise and cardiopulmonary function sensitivity, test the effect of individualized precision exercise therapy, and provide evidence for the establishment of a precision medicine program for clinical research.

Methods

Aerobic exercise- and cardiopulmonary function-related genes and single-nucleotide polymorphisms (SNPs) were obtained by data mining utilizing a major publicly available biomedical repository, the NCBI PubMed database. Biological samples from all participants underwent DNA testing. We performed SNP detection using Samtools. A total of 122 patients who underwent PCI were enrolled in the study. We screened the first 24 cases with a high mutation frequency for aerobic exercise- and cardiopulmonary function-related genes and the last 24 cases with a low mutation frequency and separated them into two groups for the exercise intervention experiment.

Results

In both the low mutation frequency group and the high mutation frequency group, after 8 weeks of exercise intervention, 6 MWT distance, 6 MWT%, VO₂/kg at peak, and VO₂/kg at AT were significantly improved, and the effect in the high mutation frequency group was significantly higher than that in the low mutation frequency group (6 MWT distance: 468 vs. 439, P=0.003; 6 MWT%: 85 vs. 77, P=0.002, VO₂/kg at peak: 14.7 vs. 13.3, P=0.002; VO₂/kg at AT: 11.9 vs. 13.3, P=0.003).

Conclusions

There is extreme variability between individual responses to exercise training. The identification of genetic variants associated with individual variabilities in exercise-related traits could guide individualized exercise programs. We found that the subjects with a high mutation frequency in aerobic exercise and cardiopulmonary function-related genes achieved more cardiorespiratory fitness benefits in the aerobic exercise rehabilitation program and provided evidence for the establishment of a precision medicine program for clinical research.

Changes Observed in the 6-minute Walk Test in Response to Exercise-based Cardiac Rehabilitation

Objectives: The six-minute walk test (6MWT) is widely used in exercise based cardiac rehabilitation (EBCR) for assessment of functional capacity. The purpose of this study was to assess the effect of structured exercise in an EBCR program on 6MWT change and to determine the significance of age, gender, body mass index (BMI), pathology and exercise attendance on influencing this outcome.Methods: Data from a single centre 6-week (twice weekly exercise and education of one-hour duration) exercise-based cardiac rehabilitation program were analysed. Between 2006 and 2019, 2524 patients (males 1923, females 601, mean age 63.5 ± 11.2 years) with cardiovascular disease completed a pre and post 6MWT. Analysis included the effect of age, gender, pathology, BMI and exercise attendance on 6MWT outcome.Results: The group mean improvement in the 6MWT was 21.8% (pre 6MWT 432 ± 83, post 6MWT 527 ± 102 metres). The age-related improvement showed that both males and females achieved a post 6MWT results equivalent to the pre 6MWT result of patients two decades younger with improvement in the 6MWT unrelated to exercise attendance.Conclusions: The 6MWT provides simple safe method for assessment of functional capacity in an out-of-hospital environment being suitable for all ages. The post EBCR 6MWT results showed a group mean improvement in excess of 20% for both sexes. The decline per decade in 6MWT distance is less than 20 metres up to the sixth decade with a more marked decline from the sixth to the eighth decade, the decline being approximately 40-metres for both sexes in the eighth decade.

Effectiveness of technology-assisted cardiac rehabilitation: A systematic review and meta-analysis

OBJECTIVES

The objectives of this review were to identify different technology-assisted interventions in cardiac rehabilitation, to explore and examine the effectiveness of technology-assisted cardiac rehabilitation.

DESIGN

A systematic review and meta-analysis.

METHODS

A systematic search was performed on six electronic databases: CINALH Complete, Cochrane Library, PubMed, MEDLINE via OvidSP, British Nursing Index and PsycINFO to identify randomised controlled trials from 2010 to 2020. Selection of studies was performed by screening the titles, abstracts and full texts, and two reviewers independently and critically appraised the included studies using the revised Cochrane risk of bias tool for randomized trials (RoB 2).

RESULTS

Nine randomised controlled trials met the inclusion criteria; five studies with some bias concerns related to allocation concealment (n = 2) and measurement of outcome (n = 4), and four studies were of low risk of bias. The pooled effect size showed comparable effectiveness between technology-assisted cardiac rehabilitation and conventional/centre-based cardiac rehabilitation on modifiable coronary risk factors (systolic and diastolic blood pressure, total cholesterol, p>0.05), psychological outcomes (anxiety: SMD 0.25, 95% CI -0.11 to 0.62, p = 0.17 and depression: SMD 0.09, 95% CI -0.16 to 0.35, p = 0.47). Narrative synthesis was performed for adherence to prescribed exercise sessions in cardiac rehabilitation. No significant adverse events occurred. The adverse events that did occur were self-reported, mostly unrelated to the interventions with technology and the number of events was comparable between both groups. Inconsistent results were found across the studies. This review revealed lack of self-efficacy and behaviour change theories/strategies, and educational emphasis among studies.

CONCLUSIONS

The results in the meta-analysis have indicated that technology-assisted cardiac rehabilitation demonstrated comparable results to conventional/centre-based cardiac rehabilitation. Technology-assisted cardiac rehabilitation is a potential alternative not only to remove cardiac rehabilitation barriers but also in the midst of current prolonged pandemic. Future studies on technology-assisted cardiac rehabilitation with the emphasis behavior change theories/strategies and education are required.

The influence of cardiac rehabilitation on heart rate variability indices in men with type 2 diabetes and coronary artery disease

METHOD

The study population included 141 male CAD patients prospectively and consecutively admitted to an outpatient comprehensive CR program. Twenty-seven patients with type-2 diabetes were compared with 114 males without diabetes. The participants performed a 45-min cycle ergometer interval training alternating 4-min workload and a 2-min active restitution three times a week for 8 weeks. The training intensity was adjusted so that the patient's heart rate achieved the training heart rate calculated according to the Karvonen formula. At the baseline and after 8 weeks, all the patients underwent the HRV assessment.

RESULTS

HRV indices in the patients with diabetes were significantly lower as compared to the patients without diabetes in SDNN, TP, LF parameters, both at the baseline and after 8 weeks of CR. After 8 weeks of CR, a significant improvement of TP, SDNN, pNN50% and HF occurred in the patients without diabetes, whereas in the patients with diabetes only HF component improved significantly.

CONCLUSIONS

As regards HRV indices, CR seems to be less effective in patients with CAD and type-2 diabetes.

Effect of Early Rehabilitation on Physical Function in Patients Undergoing Coronary Artery Bypass Grafting: A Nationwide Inpatient Database Study

It is unclear when to begin rehabilitation after coronary artery bypass grafting (CABG) in the intensive care unit (ICU). Using the Japanese Diagnosis Procedure Combination inpatient database from 2010 to 2018, we identified adult patients who underwent a CABG and who were admitted to the ICU for ≥3 consecutive days from the date of their CABG. Patients who started any rehabilitation program prescribed by physicians or therapists within 3 days of CABG were defined as the early rehabilitation group, and the remaining patients were defined as the usual care group. We identified 30,568 eligible patients, with 13,150 (43%) patients in the early rehabilitation group. An inverse probability of treatment weighting analyses showed that the Barthel Index score at discharge in the early rehabilitation group was significantly higher than that in the usual care group (difference: 3.2; 95% confidence interval: 1.5–4.8). The early rehabilitation group had significantly lower in-hospital mortality, total hospitalization costs, length of ICU stay, and hospital stay vs. the usual care group. Our results suggested that early rehabilitation by physicians or therapists beginning within 3 days of CABG was safe, as suggested by the low mortality and improved physical function in patients who underwent CABG.

Effects of a home based exercise intervention on cardiac biomarkers, liver enzymes, and cardiometabolic outcomes in CABG and PCI patients

Background

We investigated the impact of a home-based exercise intervention (HBEI) on cardiac biomarkers, liver enzymes, cardiometabolic outcomes, and health-related quality of life (HRQL) in clinically stable patients after coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI).

Materials and Methods

The study was a nonrandomized clinical trial conducted in Tehran, Iran, from July 2019 to January 2020. Forty cardiac patients (after the cardiac intervention, CABG, n = 32; PCI, n = 8) were recruited based on the study inclusion criteria and were allocated consecutively to one of two groups: (1) HBEI (n = 18) and (2) conventional center-based exercise program (CBEP, n = 22). The CBEP group performed the routine exercise program of Sadr Heart Clinic, and the HBEI group performed a home-based remotely monitored exercise protocol, both three times per week, for 8 weeks. The following variables were assessed before and after the intervention: anthropometric measures; blood pressure; lipid profile; cardiac biomarkers including cardiac troponin I, creatine kinase, and total and Mb isozyme; liver enzymes including aspartate aminotransferase and alanine aminotransferase; creatinine; urea; exercise capacity; and HRQL.

Results

In comparison with pretest in both CBEP and HBEI groups, a significant improvement in all of the measured variables (P < 0.05), but not in ejection fraction was observed (P > 0.05). Moreover, in the CBEP group, a more significant decline in troponin I levels (P = 0.03), and in the HBEI group, a greater reduction in weight (P = 0.01) and body mass index (P = 0.04) occurred.

Conclusion

The findings suggest that a properly designed and monitored HBEI may be as effective as conventional center-based cardiac rehabilitation (CR) exercise programs and should be encouraged in those cardiac patients who are unable or uninterested in conventional center-based CR exercise programs.

Shorter Wait Times to Cardiac Rehabilitation Associated With Greater Exercise Capacity Improvements: A MULTISITE STUDY

PURPOSE

Comprehensive exercise-based cardiac rehabilitation (CR) results in improved, though highly variable, exercise capacity outcomes. Whether modifiable factors such as CR program wait time and session duration are associated with exercise capacity outcomes has not been adequately investigated.

METHODS

Patients with coronary heart disease (±primary and elective percutaneous coronary interventions, cardiac surgery) who participated in CR programs involved in a three-state audit (n = 32 sites) were eligible. Exercise capacity was measured using the 6-min walk test before and after a 6- to 12-wk supervised exercise program. CR program characteristics were also recorded (wait time, number of sessions). Correlations and linear mixed-effects models were used to identify associations between sociodemographic and CR program characteristics and change in exercise capacity.

RESULTS

Patients (n = 894) had a mean age of 65.9 ± 11.8 yr, 71% were males, 33% were referred for cardiac surgery, and median wait time was 16 d (interquartile range 9, 26). Exercise capacity improved significantly and clinically (mean increase 70.4 ± 61.8 m). After adjusting for statistically significant factors including younger age (<50 vs ≥80 yr [β = 52.07]), female sex (β = -15.86), exercise capacity at CR entry (β = 0.22) and those nonsignificant (ethnicity, risk factors, and number of sessions), shorter wait time was associated with greater exercise capacity improvement (β = 0.23).

CONCLUSIONS

This study confirms that greater exercise capacity improvements occur with shorter wait times. Coordinators should prioritize implementing strategies to shorten wait time to optimize the benefits of CR.

Effectiveness of Resistance Training with the Use of a Suspension System in Patients after Myocardial Infarction

The aim of the study was to assess the effects of resistance training with the use of a suspension system on exercise tolerance, evaluated through an exercise test, and the changes in selected echocardiographic parameters of patients after myocardial infarction. The study involved 44 males. The subjects were divided into two groups: Standard (20) and Suspension system (24). All the subjects had undergone an angioplasty with stent implantation. The standard and suspension system groups carried out a 24-day improvement program comprising 22 training units. Each session consisted of endurance, general stamina and resistance training. Instead of resistance training, the experimental group made multijoint exercises with a suspension system. Statistically significant changes in both groups were observed in the parameters of the echocardiographic exercise test, such as test duration (p = 0.000), distance covered (p = 0.000), MET (p = 0.000), VO2max (p = 0.000) and SBPrest (p = 0.013). Additionally, SBPmax in the suspension system group improved (p = 0.035). The echocardiographic test revealed significant improvement of Left Ventricular Ejection Fraction in both groups (SP group p = 0.001, standard group p = 0.005). The lipid profile test in the SP group revealed statistically significant improvement of TC (p = 0.003), HDL (p = 0.000) and LDL (p = 0.005). Training with the suspension system had a positive effect on the change of exercise tolerance level, left ventricular function and blood lipid profile.

Impact of Cardiac Rehabilitation on Functional Capacity and Physical Activity after Coronary Revascularization: A Scientific Review

Background

Coronary revascularization procedures often cause lowered exercise capacity and declining physical activity levels. These outcomes are paramount in predicting morbidity and mortality after these procedures. Cardiac rehabilitation (CR) focuses on incrementing cardiovascular endurance, exercise capacity, muscle strength, levels of physical activity, and quality of life through health education and lifestyle modification in post-coronary revascularization patients.

Objective

To review the impact of cardiac rehabilitation on functional capacity, levels of physical activity, and health related quality of life in patients following coronary revascularization.

Methods

A structured literature search in PubMed, Scopus, CINAHL, and ProQuest for studies focused on CR and its effects on functional capacity, physical activity, and quality of life after coronary revascularization.

Results

A total of 2,010 studies were retrieved. Deduplication and eligibility screening included 190 studies after the application of filters. A sum of 21 studies were considered for this review. Most studies reported that exercise and physical activity programs were centre-based and home-based and via telerehabilitation. Treadmill and cycle ergometry training with callisthenics and flexibility exercises in phase 2 CR exhibited significant improvement in functional capacity and physical activity levels in patients after coronary revascularization procedures.

Conclusion

Although centre-based supervised CR programs do improve functional capacity after coronary revascularization, home-based or telerehabilitation-based CR programs are feasible, improve patient compliance in improving physical activity, and thereby increase functional capacity. Patient education improves levels of physical activity, health related quality of life, and adherence to home- and centre-based CR programs.

Investigation of Linear and Nonlinear Properties of a Heartbeat Time Series Using Multiscale Rényi Entropy

The time series of interbeat intervals of the heart reveals much information about disease and disease progression. An area of intense research has been associated with cardiac autonomic neuropathy (CAN). In this work we have investigated the value of additional information derived from the magnitude, sign and acceleration of the RR intervals. When quantified using an entropy measure, these time series show statistically significant differences between disease classes of Normal, Early CAN and Definite CAN. In addition, pathophysiological characteristics of heartbeat dynamics provide information not only on the change in the system using the first difference but also the magnitude and direction of the change measured by the second difference (acceleration) with respect to sequence length. These additional measures provide disease categories to be discriminated and could prove useful for non-invasive diagnosis and understanding changes in heart rhythm associated with CAN.

Effects of Exercise after Percutaneous Coronary Intervention on Cardiac Function and Cardiovascular Adverse Events in Patients with Coronary Heart Disease: Systematic Review and Meta-Analysis

Exercise program has been associated with improved cardiovascular outcomes in patients sustaining coronary artery disease. However, little is known about the role of exercise after percutaneous coronary intervention (PCI). Published literature was searched from Embase, PubMed, Wanfang Data, Cochrane Database of Systematic Reviews, China National Knowledge Infrastructure (CNKI) and Central Database. Exercise versus no exercise following PCI in the patients with coronary heart disease (CHD) was investigated in randomized trials. Left ventricular end diastolic diameter (LVEDD), left ventricular ejection fraction (LVEF), 6-minute walking distance (6MWD), cardiac death, myocardial infarction, coronary angioplasty, coronary artery bypass surgery (CABG), and angina pectoris or restenosis per randomized patients were analyzed by meta-analytic procedure to compare the curative effect of exercise program with exclusive exercise program after PCI. Ten randomized controlled trials including 1274 subjects (636 in exercise group and 638 in control group) were analyzed. The meta-analysis demonstrated that LVEF was significantly improved in exercise group (MD = 2.82, 95% CI [1.50, 4.14], p < 0.05). In contrast, the incidence rate of cardiac death (RR = 0.24, 95% CI [007, 0.76], p = 0.02), myocardial infarction (RR = 0.23, 95% CI [0.09, 0.57], p = 0.002), coronary angioplasty (RR = 0.47, 95% CI [0.26, 0.84], p = 0.01), angina pectoris (RR = 0.39, 95% CI [0.24, 0.64], p = 0.0002) and restenosis (RR = 0.36, 95% CI [0.16, 0.83], p = 0.02) were significantly lower in exercise group. LVEDD (MD = -2.01, 95% CI [-4.72, 0.70]), 6MWD (MD = 50.85, 95% CI [-13.24, 114.94]), and CABG (RD = -0.01, 95% CI [-0.05, 0.03]) were not significantly different in the patients with or without exercise (p = 0.71). Trial sequential analysis reflected traditional meta-analysis might generate a false positive conclusion for MI and cardiac death. There was no firm evidence to support the beneficial effects of exercise after PCI for the CHD patients to improve heart function or to reduce the incidence of adverse cardiovascular events.

Does CABG with Saphenous Vein Grafting and Standard Cardiac Rehabilitation Affect Lower Limb Function? A Clinical Study

BACKGROUND

The aim of the study was to assess lower limb function in response to two cardiac rehabilitation (CR) protocols after coronary artery bypass surgery with saphenous vein grafting.

METHODS

Clinically-stable male patients aged 50-70 years were recruited 4 weeks post-surgery in which to group. Group I (n = 47) receive standard CR in a hospital setting for 3 weeks and Group II (n = 14) receive CR with a resistance training component in an outpatient setting for 8 weeks. Measures included body mass and composition, lower limb temperature distribution, lower limb hemodynamics, and dorsal and plantar flexor muscle strength.

RESULTS

Average temperature of the operated limb decreased only in Group II after cardiac rehabilitation. Venous blood flow improved in both groups as evidenced by increased blood refilling time. Isokinetic strength was greater in Group I.

CONCLUSIONS

The results suggest a 3-week intensive CR protocol to be most effective in restoring lower limb function in CABG patients after saphenectomy.

Evolution of depression during rehabilitation program in patients with cardiovascular diseases

Background: Cardiovascular diseases represent the main cause of death in the world. Rehabilitation through exercise is more and more used in cardiac patients. Given that these patients suffer from depressive symptoms, the risk of having recurrent cardiovascular problems increases. Thus, the aim of this study is to identify the effects of a rehabilitation program on the physiological and psychological parameters; with a particular attention on the depression scores between the scales.Methods: Twenty-eight cardiac patients participated in this study during a cardiovascular rehabilitation program. They are tested at their entry and at their exit with an evaluation of their physical fitness on an electromagnetic cycle ergometer and by four depression scales (Beck Depression Inventory, Hospital Anxiety and Depression Scale (HADS), Center for Epidemiologic Studies - Depression and Geriatric Depression Screening).Results: We observe that 21.4-50% of these patients have depressive symptoms, according to depression scales. The women have depression scores significantly higher than the men. The rehabilitation program improves their maximal oxygen consumption and their maximal aerobic power. At the end of the rehabilitation program, our analysis identifies a significant decrease in the depression score for the HADS. Regardless of the physical deconditioning level and of the improvement of the maximal oxygen consumption, our results show an effect of the rehabilitation program on the depression scores. No correlation between the physical deconditioning and the different depression scores is observed.Conclusions: This study shows the importance of measuring depression and its severity to improve the care of patients. Our findings show that between 21.4% and 50% of patients have depressive symptoms which challenges the categorical approach of the self-report depression scales.Implications for rehabilitationDepression and cardiovascular diseases have an impact on the patients' physical fitness.The rehabilitation program, primarily based around exercise, reduces depressive symptoms.As soon as cardiovascular diseases patients enter in a rehabilitation program, the depression should be measured by a psychologist.Taking into account the depressive symptoms of the patients as soon as their cardiac event occurs makes it possible to improve the care of patients.

The Importance of the Double Product in the Six-Minute Walk Test to Predict Myocardial Function

Introduction

The Six-Minute Walk Test (6MWT) is a widely used test to measure the physical performance of patients to assess the effectiveness of treatment, to qualify for rehabilitation, and to evaluate its effects..

Aim

This paper focuses on the assessment of the growth of a double product (DP) during the 6MWT and its diagnostic value in the assessment of patients with heart failure.

Material and Methods

The paper has retrospective character. We analyzed medical records of 412 patients hospitalized for cardiac reasons, in whom a 6MWT was performed. The patients were divided into two groups: one with diagnosed heart failure and a control group.

Results

The patients with diagnosed heart failure, compared to the control group, were characterized by a shorter walking distance and greater DP increase at equal walking intervals. After distinguishing the group with the preserved and decreased left ventricle ejection fraction, the value of the DP increase was still higher compared to the control group. The mean DP increase corresponding to one meter of walk was the only one that correlated negatively with the left ventricular ejection fraction.

Conclusion

The assessment of the increase of the DP during the march test seems to be a better parameter reflecting the efficiency of the myocardium from the distance of the march.

Heart rate recovery of individuals undergoing cardiac rehabilitation after acute coronary syndrome

BACKGROUND

An efficient cardiac rehabilitation programme (CRP) can improve the functional ability of patients after acute coronary syndrome (ACS).

OBJECTIVE

To examine the effect of a CRP on parasympathetic reactivation and heart rate recovery (HRR) measured after a 6-min walk test (6MWT), and correlation with 6MWT distance and well-being after ACS.

METHODS

Eleven normoweight patients after ACS (BMI<25kg/m²; 10 males; mean [SD] age 61 [9] years) underwent an 8-week CRP. Before (pre-) and at weeks 4 (W4) and 8 (W8) during the CRP, they performed a 6MWT on a treadmill, followed by 10-min of seated passive recovery, with HRR and HR variability (HRV) recordings. HRR was measured at 1, 3, 5 and 10min after the 6MWT (HRR1, HRR3, HRR5, HRR10), then modelized by a mono-exponential function. Time-domain (square root of the mean of the sum of the squares of differences between adjacent normal R-R intervals [RMSSD]) and frequency-domain (with high- and low-frequency band powers) were used to analyse HRV. Participants completed a mental and physical well-being questionnaire at pre- and W8. Exhaustion after tests was assessed by the Borg scale. Pearson correlation was used to assess correlations.

RESULTS

HRR3, HRR5 and HRR10 increased by 37%, 36% and 28%, respectively, between pre- and W8 (P<0.05), and were positively correlated with change in 6MWT distance (r=0.58, 0.66 and 0.76; P<0.05). Percentage change in HRR3 was positively correlated with change in well-being (r=0.70; P=0.01). Parasympathic reactivation (RMSSD) was improved only during the first 30sec of recovery (P=0.04).

CONCLUSION

Among patients undergoing a CRP after ACS, increased HRR after a 6MWT, especially at 3min, was positively correlated with 6MWT distance and improved well-being. HRR raw data seem more sensitive than post-exercise HRV analysis for monitoring functional and autonomic improvement after ACS.

The Influence of Comprehensive Cardiac Rehabilitation on Heart Rate Variability Indices after CABG is More Effective than after PCI

The aim of this study was to evaluate the influence of cardiac rehabilitation (CR) on heart rate variability (HRV) indices in men with coronary artery disease (CAD) treated with percutaneous coronary intervention (PCI) or coronary artery bypass graft surgery (CABG). The study population consisted of 131 male patients with CAD prospectively and consecutively admitted to CR after PCI n = 72, or CABG n = 59. Participants performed cycle ergometer interval training for 45 min three times a week for 8 weeks. At baseline and after 8 weeks, all patients underwent the HRV assessment. HRV indices in CAGB survivals were significantly lower in comparison to PCI patients at baseline. Significant increases were seen for SDNN, rMSSD, and HF in the CABG group and only in HF component in PCI group after 8 weeks of CR. Eight weeks of CR seems to be more effective in CABG patients than patients after PCI.

Assessing mood symptoms through heartbeat dynamics: An HRV study on cardiosurgical patients

BACKGROUND

Heart Rate Variability (HRV) is reduced both in depression and in coronary heart disease (CHD) suggesting common pathophysiological mechanisms for the two disorders. Within CHD, cardiac surgery patients (CSP) with postoperative depression are at greater risk of adverse cardiac events. Therefore, CSP would especially benefit from depression early diagnosis. Here we tested whether HRV-multi-feature analysis discriminates CSP with or without depression and provides an effective estimation of symptoms severity.

METHODS

Thirty-one patients admitted to cardiac rehabilitation after first-time cardiac surgery were recruited. Depressive symptoms were assessed with the Center for Epidemiologic Studies Depression Scale (CES-D). HRV features in time, frequency, and nonlinear domains were extracted from 5-min-ECG recordings at rest and used as predictors of "least absolute shrinkage and selection" (LASSO) operator regression model to estimate patients' CES-D score and to predict depressive state.

RESULTS

The model significantly predicted the CES-D score in all subjects (the total explained variance of CES-D score was 89.93%). Also it discriminated depressed and non-depressed CSP with 86.75% accuracy. Seven of the ten most informative metrics belonged to non-linear-domain.

LIMITATIONS

A higher number of patients evaluated also with a structured clinical interview would help to generalize the present findings.

DISCUSSION

To our knowledge this is the first study using a multi-feature approach to evaluate depression in CSP. The high informative power of HRV-nonlinear metrics suggests their possible pathophysiological role both in depression and in CHD. The high-accuracy of the algorithm at single-subject level opens to its translational use as screening tool in clinical practice.

Community health service center-based cardiac rehabilitation in patients with coronary heart disease: a prospective study

BACKGROUND

Despite considerable efforts to encourage participation, even in some developed countries, proportion of patients participating in institution-based cardiac rehabilitation (CR) programs remained sub-optimal. The present study was designed to investigate the acceptability of community health service center (CHSC)-based Cardiac Rehabilitation (CR), and examine its effectiveness in terms of changes in quality of life (QOL), psychological state and exercise capacity.

METHODS

A consecutive series of eligible patients was recruited from the health registration system of two CHSCs in Shijiazhuang, Hebei, China. Patients in intervention site were provided with CR (CR-group) while patients in non-intervention site were offered the usual care (UC-group). Data regarding health-related QOL (HRQoL), psychological state and exercise capacity (6-min walk test = 6MWT) were collected and compared at baseline and at 6 months post-intervention.

RESULTS

Among invited patients eligible for CR program, 65.3% participated, while 5.3% of the participants dropped out during follow-up. Patients in CR-group showed significant decrease in the scores for anxiety and depression as per the Hospital Anxiety and Depression Scale (HADS), along with marked increases in the Short-Form Health Survey (SF-12)-based Physical (PCS) and Mental Component Summary (MCS) scores. Moreover, the measurement of 6MWT showed a significant increase of 57.42 m walking distance among CR patients in contrast with a slight increase among UC patients.

CONCLUSIONS

Given the high participation and low withdrawal along with considerable improvements in HRQoL, psychological state and exercise capacity, CHSC was likely to be the optimal setting for implementing CR for patients with CHD in China.

TRIAL REGISTRATION

ChiCTR-TRC- 12002500 . Registered 16 September 2012.

Impact of South Asian Ethnicity on Long-Term Outcomes After Coronary Artery Bypass Grafting Surgery: A Large Population-Based Propensity Matched Study

Background

Ethnicity is an important predictor of coronary artery bypass graft surgery (CABG) outcomes. South Asians (SA), one of the largest ethnic groups with a high burden of cardiovascular disease, are hypothesized to have inferior outcomes after CABG compared to other ethnic groups. Given the paucity and controversy of literature in this area, the objective of this study was to examine the impact of SA versus the general population (GP) on long‐term outcomes following CABG.

Method and Results

Using administrative databases and a surname algorithm, 83 850 patients (SA: 2653, GP: 81 197) who underwent isolated CABG in Ontario, Canada from 1996 to 2007 were identified; mean follow‐up was 9.1±3.9 years. SA were younger (SA: 61.7±9.4, GP: 64.1±10.0 years, standardized difference=0.25) with more cardiac risk factors, including diabetes (SA: 54.1%, GP: 34.9%, standardized difference =0.40). Propensity‐score matching resulted in 2473 matched pairs between SA and GP with all baseline covariates being balanced (standardized difference <0.1). Being a SA compared to the GP was protective against freedom from major adverse cardiac and cerebrovascular events, defined by all‐cause death, myocardial infarction, stroke, or coronary reintervention: Adjusted Cox‐proportional hazard ratio 0.91, 95% CI (0.83–0.99), adjusted‐P=0.04; this was also true for freedom from all‐cause mortality: hazard ratio 0.81, 95% CI (0.72–0.91), adjusted P=0.0004. The adjusted proportion of major adverse cardiac and cerebrovascular events was lower in the SA (SA: 34.7%, GP: 37.8%, McNemar P=0.03), driven largely by all‐cause mortality (SA: 20.4%, GA: 24.3%, McNemar P=0.001).

Conclusions

Contrary to existing notions, our study finds that being a SA is protective with respect to freedom from long‐term major adverse cardiac and cerebrovascular events and mortality after CABG. More studies are required to corroborate and explore causal factors of these findings.