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Yanagi H, Konishi H, Omae K, Yamamoto K, Murata M, Ueda N, Ishibashi K, Noguchi T, Kusano K. Association Between Adherence to a 3-Month Cardiac Rehabilitation Program and Long-Term Clinical Outcomes in Japanese Patients With Cardiac Implantable Electronic Devices. J Cardiopulm Rehabil Prev 2024; 44:248-256. [PMID: 38836846 DOI: 10.1097/hcr.0000000000000868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/06/2024]
Abstract
PURPOSE The objective of this study was to evaluate the association between comprehensive cardiac rehabilitation (CCR) completion and long-term clinical outcomes in patients with cardiac implantable electronic devices (CIED). METHODS This retrospective cohort study included 834 patients with CIED who participated in CCR, which included a cardiopulmonary exercise test or 6-min walk test. Patients with a left ventricular ejection fraction ≤40%, predicted peak oxygen uptake ≤80%, or B-type natriuretic peptide level ≥80 pg/mL were eligible. The primary outcome was all-cause mortality. RESULTS After excluding 241 patients with duplicate records and 69 who underwent CCR in the outpatient department, the data of 524 patients were analyzed. Mean age was 64 ± 15 yr, 389 (74%) patients were men, left ventricular ejection fraction was 31 ± 15%, and 282 (54%) patients had a history of hospitalization for worsening heart failure. Of the patients referred for CCR, 294 (56%) completed the program, and an additional 230 patients started but did not complete CCR. Over a 3.7-yr median follow-up period, all-cause mortality occurred in 156 (30%) patients. Completers had lower all-cause mortality rates than non-completers (log-rank 15.77, P < .001). After adjusting for prognostic baseline characteristics, completers had 58% lower all-cause mortality risks than non-completers (HR = 0.42; 95% CI, 0.27-0.64, P < .001). CONCLUSIONS Three-mo CCR program completion was associated with lower mortality risks in patients with CIED. New programs or management methods are needed to decrease mortality risks, especially for those who cannot complete CCR programs.
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Affiliation(s)
- Hidetoshi Yanagi
- Authors Affiliations: Department of Cardiovascular Rehabilitation (Drs Yanagi, Yamamoto, and Murata), Department of Nursing (Ms Konishi), Data Science (Dr Omae), Department of Cardiovascular Medicine (Drs Murata, Ueda, Ishibashi, Noguchi, Kusano), National Cerebral and Cardiovascular Center, Suita, Japan
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Lee MK, Lee CJ, Goo SY, Lee TH, Moon JY, Jung J, Kim MJ, Shin SH, Kim JN, Han SN, Lee JE, Lee JY, Chung IM, Jeon JY. Development and application of a home-based exercise program for patients with cardiovascular disease: a feasibility study. BMC Sports Sci Med Rehabil 2024; 16:51. [PMID: 38378630 PMCID: PMC10880299 DOI: 10.1186/s13102-024-00835-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 01/30/2024] [Indexed: 02/22/2024]
Abstract
BACKGROUND Cardiac rehabilitation (CR) is recommended for patients with cardiovascular disease. However, the participation and completion rates for hospital-based CR are low, and home-based CR has been suggested as an alternative. This study aimed to develop a home-based CR program and assess the feasibility of the program over a 6-week period in patients with left ventricular dysfunction or a history of myocardial infarction. METHODS This feasibility study consisted of two phases. The initial phase (Study 1) focused on developing the home-based exercise protocol. Systematic approaches to developing evidence-based home-based exercise intervention were implemented including systematic review, patient surveys, and expert consensus. Study 2 aimed to evaluate the feasibility of a 6-week home-based CR program that was based on the results of Study 1. Study 2 included two exercise education sessions and four telephone counseling sessions. During this stage of the exercise program, the participants exercised on two separate days and their experiences while performing the aerobic and resistance exercises were surveyed. Eight participants participated in Study 1 and 16 participated in Study 2. RESULTS Participants expressed overall satisfaction with the exercise program in Study 1. Heart rate increased in response to exercise, but this did not correspond with perceived exertion. The aim of the home-based CR exercise program was for participants to achieve exercise goals (≥150 min/week of aerobic type exercises as well as at least twice weekly resistance exercise using own body weights). We aimed to increase compliance and adherence to the home-based CR program. In Study 2, 13 out of 16 participants (81.3%) completed the 6-week home-based CR program, with a participation rate of 100% in both exercise education and phone counseling sessions. Adherence to the home-based exercise protocol was 83.1% and no serious adverse events were observed. At the beginning of the study, only three out of 13 participants (23.1%) met the requirements for both aerobic and resistance exercises, but at the end of the 6-week program, 10 out of 13 participants (76.9%) fulfilled the requirements. CONCLUSION The exercise program developed in this study was safe and feasible, and the 6-week home-based CR program was feasible for patients with cardiovascular disease without any reported adverse effects.
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Affiliation(s)
- Mi Kyung Lee
- Frontier Research Institute of Convergence Sports Science, FRICSS, Yonsei University, Seoul, South Korea
| | - Chan Joo Lee
- Division of Cardiology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Seon Young Goo
- Department of Sport Industry Studies, Yonsei University, Seoul, South Korea
| | - Tae Ho Lee
- Department of Sport Industry Studies, Yonsei University, Seoul, South Korea
| | - Jin Young Moon
- Department of Sport Industry Studies, Yonsei University, Seoul, South Korea
| | - Jiyoung Jung
- Cardiology Division, Ewha Womans University Mokdong Hospital, Seoul, South Korea
| | - Min Jung Kim
- Department of Educational Psychology, Seoul Women's University, Seoul, South Korea
| | - Sang Hee Shin
- Cardiology Division, Ewha Womans University Mokdong Hospital, Seoul, South Korea
| | - Jong Nam Kim
- Department of Educational Psychology, Seoul Women's University, Seoul, South Korea
| | - Sung Nim Han
- Department of Food and Nutrition, College of Human Ecology, Seoul National University, Seoul, South Korea
| | - Jung Eun Lee
- Department of Food and Nutrition, College of Human Ecology, Seoul National University, Seoul, South Korea
| | - Jong Young Lee
- Division of Cardiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Ick-Mo Chung
- Division of Cardiology, Department of Internal Medicine, Mokdong Hospital, School of Medicine, Ewha Womans University, Seoul, South Korea.
- Division of Cardiology, Ewha Womans University Mokdong Hospital, 1071 Anyangcheon-ro, Yangcheon-gu, Seoul, Republic of Korea.
| | - Justin Y Jeon
- Frontier Research Institute of Convergence Sports Science, FRICSS, Yonsei University, Seoul, South Korea.
- Department of Sport Industry Studies, Yonsei University, Seoul, South Korea.
- Exercise Medicine Center for Diabetes and Cancer Patients, ICONS, Yonsei University, Seoul, South Korea.
- Cancer Prevention Center, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Republic of Korea.
- Department of Sport Industry Studies and Exercise Medicine Center for Diabetes and Cancer Patients, Yonsei University, 50 Yonsei-ro, Seodaemun-gu, Seoul, Republic of Korea.
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Pavía-López AA, Magaña-Serrano JA, Cigarroa-López JA, Chávez-Mendoza A, Mayorga-Butrón JL, Araiza-Garaygordobil D, Ivey-Miranda JB, Méndez-Machado GF, González-Godínez H, Aguilera-Mora LF, Jordán-Ríos A, Olmos-Domínguez L, Olalde-Román MJ, Miranda-Malpica EM, Vázquez-Ortiz Z, Rayo-Chávez J, Mendoza AA, Márquez-Murillo MF, Chávez-Leal SA, Gabriel AÁS, Silva-García MA, Pacheco-Bouthiller AD, Aldrete-Velazco JA, Guizar-Sánchez CA, Gaxiola-López E, Guerra-López A, Figueiras-Graillet L, Sánchez-Miranda G, Mendoza-Zavala GH, Aceves-García M, Chávez-Negrete A, Arroyo-Hernández M, Montaño-Velázquez BB, Romero-Moreno LF, Baquero-Hoyos MM, Velasco-Hidalgo L, Rodríguez-Lozano AL, Aguilar-Gómez NE, Rodríguez-Vega M, Cossío-Aranda JE. Clinical practice guidelines for diagnostic and treatment of the chronic heart failure. ARCHIVOS DE CARDIOLOGIA DE MEXICO 2024; 94:1-74. [PMID: 38648647 PMCID: PMC11160508 DOI: 10.24875/acm.m24000095] [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: 02/01/2024] [Accepted: 02/08/2024] [Indexed: 04/25/2024] Open
Abstract
Chronic heart failure continues to be one of the main causes of impairment in the functioning and quality of life of people who suffer from it, as well as one of the main causes of mortality in our country and around the world. Mexico has a high prevalence of risk factors for developing heart failure, such as high blood pressure, diabetes, and obesity, which makes it essential to have an evidence-based document that provides recommendations to health professionals involved in the diagnosis and treatment of these patients. This document establishes the clinical practice guide (CPG) prepared at the initiative of the Mexican Society of Cardiology (SMC) in collaboration with the Iberic American Agency for the Development and Evaluation of Health Technologies, with the purpose of establishing recommendations based on the best available evidence and agreed upon by an interdisciplinary group of experts. This document complies with international quality standards, such as those described by the US Institute of Medicine (IOM), the National Institute of Clinical Excellence (NICE), the Intercollegiate Network for Scottish Guideline Development (SIGN) and the Guidelines International Network (G-I-N). The Guideline Development Group was integrated in a multi-collaborative and interdisciplinary manner with the support of methodologists with experience in systematic literature reviews and the development of CPG. A modified Delphi panel methodology was developed and conducted to achieve an adequate level of consensus in each of the recommendations contained in this CPG. We hope that this document contributes to better clinical decision making and becomes a reference point for clinicians who manage patients with chronic heart failure in all their clinical stages and in this way, we improve the quality of clinical care, improve their quality of life and reducing its complications.
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Affiliation(s)
- Abel A. Pavía-López
- Coordinador de las Guías Mexicanas de Práctica Clínica de la Sociedad Mexicana de Cardiología, Centro Médico ABC, Ciudad de México, México
| | - José A. Magaña-Serrano
- Jefe de la División de Insuficiencia Cardiaca y Trasplante, Hospital Asociación Mexicana de Insuficiencia Cardiaca, Hospital de Cardiología, Centro Médico Nacional Siglo XXI, Ciudad de México, México
- Presidente de la Asociación Mexicana de Insuficiencia Cardiaca, Ciudad de México, México
| | - José A. Cigarroa-López
- Jefe de la Clínica de Insuficiencia Cardiaca y Trasplante, Hospital de Cardiología, Centro Médico Nacional Siglo XXI, Ciudad de México, México
| | - Adolfo Chávez-Mendoza
- Jefe de la Clínica de Insuficiencia Cardiaca Hospital de Día, Hospital de Cardiología, Centro Médico Nacional Siglo XXI, Ciudad de México, México
| | - José L. Mayorga-Butrón
- Instituto Nacional de Pediatría, Secretaría de Salud, Ciudad de México, México
- Unidad de Posgrado, Facultad de Medicina, Universidad Nacional Autónoma de México, Ciudad de México, México
- Ibero American Agency for Development & Assessment of Health Technologies
| | - Diego Araiza-Garaygordobil
- Adscrito a la Unidad Coronaria, Instituto Nacional de Cardiología Ignacio Chávez, Ciudad de México, México
| | - Juan B. Ivey-Miranda
- Adscrito a la Clínica de Insuficiencia Cardiaca Avanzada y Trasplante, Hospital de Cardiología, Centro Médico Nacional Siglo XXI, Ciudad de México, México
| | - Gustavo F. Méndez-Machado
- Cardiólogo Especialista en Insuficiencia Cardiaca, Imperial College, Londres, Reino Unido
- Unidad de Investigación Clínica Hospital Ángeles Xalapa, Veracruz, México
| | | | - Luisa F. Aguilera-Mora
- Directora de la Clínica de Insuficiencia Cardiaca, Instituto Cardiovascular de Mínima Invasión, Hospital Puerta de Hierro, Zapopan, Jalisco, México
| | - Antonio Jordán-Ríos
- Coordinador Digital, Sociedad Mexicana de Cardiología A.C., México
- Cardiólogo Clínico, Ecocardiografía Adultos, Instituto Nacional de Cardiología Ignacio Chávez, Ciudad de México, México
| | - Luis Olmos-Domínguez
- Cardiólogo Adscrito a la Clínica de Insuficiencia Cardiaca, Hospital de Cardiología, Centro Médico Nacional Siglo XXI, Ciudad de México, México
| | - Marcos J. Olalde-Román
- Cardiólogo Adscrito a la Clínica de Insuficiencia Cardiaca, Hospital de Cardiología, Centro Médico Nacional Siglo XXI, Ciudad de México, México
| | | | | | - Jorge Rayo-Chávez
- Adscrito a la Clínica de Insuficiencia Cardiaca, Hospital de Cardiología, Centro Médico Nacional Siglo XXI, Ciudad de México, México
| | - Alexandra A. Mendoza
- Cardióloga Especialista en Medicina Crítica, Centro Médico ABC Observatorio, Ciudad de México, México
- Jefa de Urgencias y Unidad Coronaria, Instituto Nacional de Cardiología Ignacio Chávez, Ciudad de México, México
| | - Manlio F. Márquez-Murillo
- Cardiólogo Especialista en Electrofisiología, Instituto Nacional de Cardiología Ignacio Chávez, Ciudad de México, México
| | - Sergio A. Chávez-Leal
- Clínica de Insuficiencia Cardiaca, SIMNSA Health Care, Tijuana, Baja California, México
| | - Amada Álvarez-San Gabriel
- Coordinadora del Programa de Insuficiencia Cardiaca, Instituto Nacional de Cardiología Ignacio Chávez, Ciudad de México, México
| | | | - Alex D. Pacheco-Bouthiller
- Director de la Clínica de Arritmias y Estimulación Cardiaca, Instituto Cardiovascular de Mínima Invasión, Hospital Puerta de Hierro, Zapopan, Jalisco, México
| | | | - Carlos A. Guizar-Sánchez
- Coordinador del Programa de Insuficiencia Cardiaca, Instituto Nacional de Cardiología Ignacio Chávez, Ciudad de México, México
- Hospital Central Sur, PEMEX, Ciudad de México, México
| | | | | | | | | | - Genaro H. Mendoza-Zavala
- Adscrito a la Clínica de Insuficiencia Cardiaca, Hospital de Cardiología, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Ciudad de México, México
| | - Moisés Aceves-García
- Adscrito a la Clínica de Insuficiencia Cardiaca, Hospital de Cardiología, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Ciudad de México, México
| | | | - Marisol Arroyo-Hernández
- Adscrito a la Unidad Coronaria, Instituto Nacional de Cardiología Ignacio Chávez, Ciudad de México, México
- Servicio de Neumología, Instituto Nacional de Cancerología, Tlapan, México
| | - Bertha B. Montaño-Velázquez
- Adscrito a la Unidad Coronaria, Instituto Nacional de Cardiología Ignacio Chávez, Ciudad de México, México
- Hospital de Especialidades, Centro Médico Nacional La Raza, Ciudad de México, México
| | - Luis F. Romero-Moreno
- Adscrito a la Unidad Coronaria, Instituto Nacional de Cardiología Ignacio Chávez, Ciudad de México, México
- Médico Adscrito a la Fundación Hospital de la Misericordia, Bogotá, Colombia
| | - María M. Baquero-Hoyos
- Unidad de Posgrado, Facultad de Medicina, Universidad Nacional Autónoma de México, Ciudad de México, México
- Adscrito a la Unidad Coronaria, Instituto Nacional de Cardiología Ignacio Chávez, Ciudad de México, México
| | - Liliana Velasco-Hidalgo
- Unidad de Posgrado, Facultad de Medicina, Universidad Nacional Autónoma de México, Ciudad de México, México
- Adscrito a la Unidad Coronaria, Instituto Nacional de Cardiología Ignacio Chávez, Ciudad de México, México
| | - Ana L. Rodríguez-Lozano
- Unidad de Posgrado, Facultad de Medicina, Universidad Nacional Autónoma de México, Ciudad de México, México
- Adscrito a la Unidad Coronaria, Instituto Nacional de Cardiología Ignacio Chávez, Ciudad de México, México
| | - Nancy E. Aguilar-Gómez
- Unidad de Posgrado, Facultad de Medicina, Universidad Nacional Autónoma de México, Ciudad de México, México
- Adscrito a la Unidad Coronaria, Instituto Nacional de Cardiología Ignacio Chávez, Ciudad de México, México
| | - Mario Rodríguez-Vega
- Adscrito a la Unidad Coronaria, Instituto Nacional de Cardiología Ignacio Chávez, Ciudad de México, México
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Kuhara S, Matsugaki R, Imamura H, Itoh H, Oginosawa Y, Araki M, Fushimi K, Matsuda S, Saeki S. A survey of the implementation rate of cardiac rehabilitation for patients with heart disease undergoing device implantation in Japan. J Arrhythm 2022; 38:1049-1055. [DOI: 10.1002/joa3.12792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 09/26/2022] [Accepted: 10/15/2022] [Indexed: 11/07/2022] Open
Affiliation(s)
- Satoshi Kuhara
- Rehabilitation Center of University Hospital University of Occupational and Environmental Health Kitakyushu Japan
| | - Ryutaro Matsugaki
- Department of Preventive Medicine and Community Health University of Occupational and Environmental Health Kitakyushu Japan
| | - Hanaka Imamura
- Department of Preventive Medicine and Community Health University of Occupational and Environmental Health Kitakyushu Japan
| | - Hideaki Itoh
- Department of Rehabilitation Medicine University of Occupational and Environmental Health Kitakyushu Japan
| | - Yasushi Oginosawa
- Department of Health Policy and Informatics Tokyo Medical and Dental University Graduate School Tokyo Japan
| | - Masaru Araki
- Department of Health Policy and Informatics Tokyo Medical and Dental University Graduate School Tokyo Japan
| | - Kiyohide Fushimi
- Second Department of Internal Medicine University of Occupational and Environmental Health Kitakyushu Japan
| | - Shinya Matsuda
- Department of Preventive Medicine and Community Health University of Occupational and Environmental Health Kitakyushu Japan
| | - Satoru Saeki
- Department of Rehabilitation Medicine University of Occupational and Environmental Health Kitakyushu Japan
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Prokopidis K, Isanejad M, Akpan A, Stefil M, Tajik B, Giannos P, Venturelli M, Sankaranarayanan R. Exercise and nutritional interventions on sarcopenia and frailty in heart failure: a narrative review of systematic reviews and meta-analyses. ESC Heart Fail 2022; 9:2787-2799. [PMID: 35840310 PMCID: PMC9715780 DOI: 10.1002/ehf2.14052] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 05/16/2022] [Accepted: 06/27/2022] [Indexed: 11/10/2022] Open
Abstract
The purpose of this review is to describe the present evidence for exercise and nutritional interventions as potential contributors in the treatment of sarcopenia and frailty (i.e. muscle mass and physical function decline) and the risk of cardiorenal metabolic comorbidity in people with heart failure (HF). Evidence primarily from cross-sectional studies suggests that the prevalence of sarcopenia in people with HF is 37% for men and 33% for women, which contributes to cardiac cachexia, frailty, lower quality of life, and increased mortality rate. We explored the impact of resistance and aerobic exercise, and nutrition on measures of sarcopenia and frailty, and quality of life following the assessment of 35 systematic reviews and meta-analyses. The majority of clinical trials have focused on resistance, aerobic, and concurrent exercise to counteract the progressive loss of muscle mass and strength in people with HF, while promising effects have also been shown via utilization of vitamin D and iron supplementation by reducing tumour necrosis factor-alpha (TNF-a), c-reactive protein (CRP), and interleukin-6 (IL-6) levels. Experimental studies combining the concomitant effect of exercise and nutrition on measures of sarcopenia and frailty in people with HF are scarce. There is a pressing need for further research and well-designed clinical trials incorporating the anabolic and anti-catabolic effects of concurrent exercise and nutrition strategies in people with HF.
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Affiliation(s)
- Konstantinos Prokopidis
- Department of Musculoskeletal Biology, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
| | - Masoud Isanejad
- Department of Musculoskeletal Biology, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
| | - Asangaedem Akpan
- Department of Musculoskeletal Biology, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK.,Aintree University Hospital, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Maria Stefil
- Liverpool Centre for Cardiovascular Science, University of Liverpool, Liverpool, UK.,Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Behnam Tajik
- Kuopio Musculoskeletal Research Unit, University of Eastern Finland, Kuopio, Finland.,National Institute for Health Research Northwest Coast CRN, Liverpool, UK
| | - Panagiotis Giannos
- Department of Life Sciences, Faculty of Natural Sciences, Imperial College London, London, UK
| | - Massimo Venturelli
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Rajiv Sankaranarayanan
- Liverpool Centre for Cardiovascular Science, University of Liverpool, Liverpool, UK.,Liverpool Heart and Chest Hospital NHS Foundation Trust, Liverpool, UK
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Association of time-varying changes in physical activity with cardiac death and all-cause mortality after ICD or CRT-D implantation. J Geriatr Cardiol 2022; 19:177-188. [PMID: 35464647 PMCID: PMC9002081 DOI: 10.11909/j.issn.1671-5411.2022.03.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVE To evaluate the association of longitudinal changes in physical activity (PA) with long-term outcomes after implantable cardioverter-defibrillator (ICD) or cardiac resynchronization therapy defibrillator (CRT-D) implantation. METHODS Patients with ICD/CRT-D implantation from SUMMIT registry were retrospectively analyzed. Accelerometer-derived PA changes over 12 months post implantation were obtained from the archived home monitoring data. The primary endpoints were cardiac death and all-cause mortality. The secondary endpoints were the first ventricular arrthymia (VA) and first appropriate ICD shock. RESULTS In 705 patients, 446 (63.3%) patients showed improved PA over 12 months after implantation. During a mean 61.5-month follow-up duration, 99 cardiac deaths (14.0%) and 153 all-cause deaths (21.7%) occurred. Compared to reduced/unchanged PA, improved PA over 12 months could result in significantly reduced risks of cardiac death (improved PA ≤ 30 min: hazard ratio (HR) = 0.494, 95% CI: 0.288-0.848; > 30 min: HR = 0.390, 95% CI: 0.235-0.648) and all-cause mortality (improved PA ≤ 30 min: HR = 0.467, 95%CI: 0.299-0.728; > 30 min: HR = 0.451, 95% CI: 0.304-0.669). No differences in the VAs or ICD shocks were observed across different groups of PA changes. PA changes can predict the risks of cardiac death only in the low baseline PA group, but improved PA was associated with 56.7%, 57.4%, and 62.3% reduced risks of all-cause mortality in the low, moderate, and high baseline PA groups, respectively, than reduced/unchanged PA. CONCLUSIONS Improved PA could protect aganist cardiac death and all-cause mortality, probably reflecting better clinical efficacy after ICD/CRT-D implantation. Low-intensity exercise training might be encouraged among patients with different baseline PA levels.
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Holber JP, Abebe KZ, Huang Y, Jakicic JM, Anderson AM, Belnap BH, Rollman BL. The Relationship Between Objectively Measured Step Count, Clinical Characteristics, and Quality of Life Among Depressed Patients Recently Hospitalized With Systolic Heart Failure. Psychosom Med 2022; 84:231-236. [PMID: 34724453 PMCID: PMC10030253 DOI: 10.1097/psy.0000000000001034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Physical activity (PA) can improve symptoms of both depression and heart failure (HF), but objective activity data among recently hospitalized HF patients with comorbid depression are lacking. We examined PA and the relationship between daily step counts and mood, health-related quality of life (HRQoL), and heart health among patients enrolled in a clinical trial treating HF and comorbid depression. METHODS We screened hospitalized patients with systolic HF (left ventricular ejection fraction [LVEF] ≤45%) and New York Heart Association class II-IV symptoms for depression using the two-item Patient Health Questionnaire (PHQ-2) and telephoned screen-positive patients to administer the PHQ-9 2 weeks after discharge. If the patient scored PHQ-9 ≥10 and agreed to continue in our study, we administered our baseline assessment and mailed them an armband accelerometer. We instructed patients to wear the armbands for 7 days before returning them and classified their data as "usable" if they wore it ≥10 hours per day on ≥4 separate days. RESULTS We mailed accelerometers to 531 depressed HF patients, and 222 (42%) returned them with usable data. Their median age was 64 years, 54% were women, 23% were non-White, and they walked a median of 1170 steps daily. Higher median daily step counts were associated with lower New York Heart Association class and better physical- and HF-specific HRQoL, but not mood symptoms, mental HRQoL, or LVEF. CONCLUSIONS Patients with HF and comorbid depression are generally sedentary after hospital discharge. Although mood symptoms and LVEF were unrelated to objective PA, patients with higher step counts self-reported better HRQoL.Trial Registration:ClinicalTrials.gov identifier NCT02044211.
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Affiliation(s)
- Julia P. Holber
- Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA
- Albert Einstein College of Medicine, Bronx, NY
- Center for Behavioral Health, Media, and Technology, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Kaleab Z. Abebe
- Center for Clinical Trials & Data Coordination, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Yan Huang
- Center for Clinical Trials & Data Coordination, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - John M. Jakicic
- School of Education, University of Pittsburgh, Pittsburgh, PA
| | - Amy M. Anderson
- Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA
- Center for Behavioral Health, Media, and Technology, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Bea Herbeck Belnap
- Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA
- Center for Behavioral Health, Media, and Technology, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Bruce L. Rollman
- Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA
- Center for Behavioral Health, Media, and Technology, University of Pittsburgh School of Medicine, Pittsburgh, PA
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Koike A, Sobue Y, Kawai M, Yamamoto M, Banno Y, Harada M, Kiyono K, Watanabe E. Safety and feasibility of a telemonitoring-guided exercise program in patients receiving cardiac resynchronization therapy. Ann Noninvasive Electrocardiol 2021; 27:e12926. [PMID: 34863002 PMCID: PMC8916563 DOI: 10.1111/anec.12926] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Revised: 11/17/2021] [Accepted: 11/22/2021] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Telerehabilitation is an alternative clinic-based rehabilitation. A remote monitoring (RM) system attached to a cardiac rhythm device can collect physiological data and the device function. This study aimed to evaluate the safety and feasibility of telerehabilitation supervised by an RM in patients receiving cardiac resynchronization therapy (CRT). METHODS A single group pre-post exercise program was implemented for 3 months in 18 CRT recipients. The exercise regimen consisted of walking a prescribed number of steps based on a 6-min walk distance (6MWD) achieved at baseline. The patients were asked to exercise 3 to 5 times per week for up to 30 min per session, wearing an accelerometer to document the number of steps taken. The safety was assessed by the heart failure hospitalizations and all-cause death. The feasibility was measured by the improvement in the quality of life (QOL) using the EuroQol 5 dimensions, and daily active time measured by the CRT, 6MWD, B-type natriuretic peptide (BNP) level, and left ventricular ejection fraction (LVEF). RESULTS No patients had heart failure hospitalizations or died. No patients had any ventricular tachyarrhythmias. One patient needed to suspend the exercise due to signs of exacerbated heart failure by the RM. Compared to baseline, there were significant improvements in the QOL (-0.037, p < .05), active time (1.12%/day, p < .05), and 6MWD (11 m, p < .001), but not the BNP (-32.4 pg/ml, p = .07) or LVEF (0.28%, p = .55). CONCLUSIONS Three months of RM-guided walking exercise in patients with CRT significantly increased the QOL, active time, and exercise capacity without any adverse effects.
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Affiliation(s)
- Asami Koike
- Department of Laboratory MedicineFujita Health University HospitalToyoakeJapan
| | - Yoshihiro Sobue
- Division of CardiologyDepartment of Internal MedicineFujita Health University Bantane HospitalNagoyaJapan
| | - Mayumi Kawai
- Department of CardiologyFujita Health University School of MedicineToyoakeJapan
| | - Masaru Yamamoto
- Department of Laboratory MedicineFujita Health University HospitalToyoakeJapan
| | - Yukina Banno
- Department of Laboratory MedicineFujita Health University HospitalToyoakeJapan
| | - Mashide Harada
- Department of CardiologyFujita Health University School of MedicineToyoakeJapan
| | - Ken Kiyono
- Division of BioengineeringGraduate School of Engineering ScienceOsaka UniversityToyonakaJapan
| | - Eiichi Watanabe
- Division of CardiologyDepartment of Internal MedicineFujita Health University Bantane HospitalNagoyaJapan
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