Early interventions to promote healthy lifestyle and risk factor control in subjects with elevated cardiovascular risk. A 3-year randomized clinical trial

Background

Cardiovascular risk factor control is suboptimal in Europe, including Norway. The present study examined the efficacy of a multimodal primary prevention intervention program based on the existing Norwegian health care system.

Methods

In this open-label randomized controlled trial, adult patients with elevated cardiovascular risk were randomly assigned to an intervention program including a hospital-based lifestyle course and primary care follow-up or to a control group. The participants were recruited between 2011 and 2015. Primary outcome was change in validated cardiovascular risk scores (NORRISK, NORRISK2, Framingham, PROCAM) between baseline and follow-up. Secondary outcomes included major cardiovascular risk factors.

Results

After 36 months the NORRISK score was significantly improved in patients assigned to the intervention group (IG) compared to patients assigned to the control group (CG); absolute difference in mean delta score in the IG (n=305) compared to mean delta score in the CG (n=296): −0.92, 95% CI: −1.48 to −0.36, p=0.001. The results for NORRISK2, Framingham and PROCAM showed similar significant effects. The secondary endpoints including total cholesterol and blood pressure were only minimally, and non-significantly, reduced in the IG, but the proportion of smokers (p=0.0028) and with metabolic syndrome (p<0.0001) were significantly reduced. A limited number of cardiovascular events were observed, IG (n=9), CG (n=16).

Conclusions

In subjects with elevated cardiovascular risk, a newly developed prevention program, combining a hospital-based lifestyle course and primary care follow-up, significantly reduced cardiovascular risk scores after 36 months. This benefit appeared achievable primarily through improvements in metabolic syndrome characteristics and smoking habits as prominent contributors to the positive results.

Funding Acknowledgement

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): The trial is funded in a grant from the Norwegian healthdepartment.

Cardiac arrhythmias 3 months after hospitalization for COVID-19

Background

The long-term frequencies of cardiac arrhythmias in hospitalized coronavirus disease 2019 (COVID-19) patients have not been thoroughly investigated.

Purpose

To describe the prevalence of cardiac arrhythmias, 3–4 months after hospitalization for COVID-19.

Methods and results

Participants with COVID-19 discharged from five large Norwegian hospitals were invited to participate in a prospective cohort study. We examined 201 participants (44% females, mean age 58.5 years) with 24-hour electrocardiogram 3–4 months after discharge. Body mass index (BMI) was 28.3±4.5 kg/m2 (mean ± SD), and obesity (BMI >30) was found in 70 participants (34%). Clinically significant arrhythmias were defined as; ventricular tachycardia (non-sustained or sustained), premature ventricular contractions (PVC) exceeding 200/24 h, or coupled PVC, atrial fibrillation/flutter, second-degree atrioventricular block (AV-block) type 2, complete AV-block, sinoatrial (SA) block exceeding 3 s, premature AV-nodal beats in bigeminy, supraventricular tachycardia (SVT) exceeding 30 s, and sinus bradycardia with less than 30 beats/min. High-sensitive cardiac troponin T (hs-cTnT) was measured at the 3-month follow-up.

Results

Cardiac arrhythmias were found in 27% (n=54) of the participants. Ventricular premature contractions and non-sustained ventricular tachycardia were the most common arrhythmias, found in 22% (n=44) of the participants. Premature ventricular contractions were the most frequent cardiac arrhythmia. More than 200 PVCs per day were observed in 37 participants (18%) with a mean of 1300 PVC/day, and in 35 (95%) of these participants, the PVCs were polymorphic.

Among 10 patients experiencing NSVT, 5 participants had previous CVD, including coronary heart disease (n=1), 1 atrial fibrillation, 2 venous thromboembolism, 4 heart failure. Atrial fibrillation was found in seven patients (3%), none of them of new-onset.

SA block >3 seconds was only observed in one patient, and no incidence of high degree AV block was discovered. Pre-existing cardiovascular disease or hypertension (CVDH) were reported in 40% (n=81) of the participants. The CVDH group had an increased amount of arrhythmia compared to the group free of CVDH (p=0.04). High PVCs showed a fair correlation with hs-cTnT levels at 3 months (ρ=0.21 p=0.048).

Conclusions

Three months following hospital discharge with COVID-19, cardiac arrhythmia was found in every fourth participant and was associated with a higher concentration of hs-cTnT at 3 months. The clinical implications of persistent ventricular arrhythmia following COVID-19 is not clear, but ventricular ectopy has been linked to increased risk of cardiac disease, including cardiomyopathy and sudden cardiac death.

Funding Acknowledgement

Type of funding sources: Public Institution(s). Main funding source(s): The National Association for Heart, Lung diseases and the Norwegian Health Association and Akershus University Hospital.

[Multiple sclerosis and prerequisites for driver's licence. A retrospective study of 33 patients with multiple sclerosis assessed at Sunnaas hospital]

There is increasing interest in assessing the prerequisites for a driver's licence among patients with traumatic brain injury, cerebrovascular accidents and other diseases of the central nervous system which cause cognitive impairments. In the present study, 33 patients with multiple sclerosis, 20 females and 13 males of mean age 43 years, were medically and neuropsychologically examined, and some were assessed in a practical driving test. In total, 19 patients were allowed to drive and 14 were refused. Regression analysis showed that, when deciding for or against driving, cognitive and emotional deficits were given more weight than duration of illness and degree of neurologic deficit. The authors discuss guidelines for assessing the prerequisites for a driver's licence among patients with multiple sclerosis, and indicators for when assessment is warranted.

[Amantadine in cognitive failure in patients with traumatic head injuries]

In patients with severe cerebral injuries, attentional dysfunction may cause greater difficulties for rehabilitation than neurological deficits. These functions seem to be controlled by catecholaminergic neural systems in the central nervous system. Dopamine agonists have therefore been recently introduced in the treatment of these patients. We describe two patients treated with amantadine in daily doses of 200-400 mg. We observed improvement of cognitive functions such as visual attention, speed of information processing, attentional span, learning capacity and alertness. We stress the value of amantadine as a treatment adjuvant in patients with severe attentional deficits following injury of the brain.

[Urinary problems among patients with stroke. Are these problems underestimated?]

The article, based on a survey and a study of the literature, focuses on the problems of urinary disorders in patients who have suffered a stroke. The incidence of incontinence and other urination disorders was studied upon admission and six weeks later in ten stroke patients admitted consecutively to a hospital for rehabilitation. The results of the present study agreed with those of other studies, indicating that urination disorders, especially motoric urge incontinence, are common among stroke patients. The literature indicates that urinary incontinence has a negative influence on the rehabilitation process. Therefore the rehabilitation team should be particularly aware of such problems, and carry out both diagnostic and therapeutic procedures.