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Grave C, Gabet A, Iliou MC, Cinaud A, Tuppin P, Blacher J, Olié V. Temporal trends in admission for cardiac rehabilitation after an acute coronary syndrome in France from 2009 to 2021: Persistent sex, age and social disparities. Arch Cardiovasc Dis 2024; 117:234-243. [PMID: 38458957 DOI: 10.1016/j.acvd.2023.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 12/17/2023] [Accepted: 12/19/2023] [Indexed: 03/10/2024]
Abstract
BACKGROUND Cardiac rehabilitation after an acute coronary syndrome is recommended to decrease patient morbidity and mortality and to improve quality of life. AIMS To describe time trends in the rates of patients undergoing cardiac rehabilitation after an acute coronary syndrome in France from 2009 to 2021, and to identify possible disparities. METHODS All patients hospitalized for acute coronary syndrome in France between January 2009 and June 2021 were identified from the national health insurance database. Cardiac rehabilitation attendance was identified within 6 months of acute coronary syndrome hospital discharge. Age-standardized cardiac rehabilitation rates were computed and stratified for sex and acute coronary syndrome subtypes (ST-segment elevation and non-ST-segment elevation). Patient characteristics and outcomes were described and compared. Factors independently associated with cardiac rehabilitation attendance were identified. RESULTS In 2019, among 134,846 patients with an acute coronary syndrome, 22.3% underwent cardiac rehabilitation within 6 months of acute coronary syndrome hospital discharge. The mean age of patients receiving cardiac rehabilitation was 62 years. The median delay between acute coronary syndrome hospitalization and cardiac rehabilitation was 32 days, with about 60% receiving outpatient cardiac rehabilitation. Factors significantly associated with higher cardiac rehabilitation rates were male sex, younger age (35-64 years), least socially disadvantaged group, ST-segment elevation, percutaneous coronary intervention and coronary artery bypass graft. Between 2009 and 2019, cardiac rehabilitation rates increased by 40% from 15.9% to 22.3%. Despite greater upward trends in women, their cardiac rehabilitation rate was significantly lower than that for men (14.8% vs. 25.8%). In 2020, cardiac rehabilitation attendance dropped because of the coronavirus disease 2019 pandemic. CONCLUSIONS Despite the health benefits of cardiac rehabilitation, current cardiac rehabilitation attendance after acute coronary syndrome remains insufficient in France, particularly among the elderly, women and socially disadvantaged people.
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Affiliation(s)
- Clémence Grave
- Surveillance des maladies cardio-neuro-vasculaires, direction des maladies non transmissibles, Santé Publique France, 94415 Saint-Maurice, France.
| | - Amélie Gabet
- Surveillance des maladies cardio-neuro-vasculaires, direction des maladies non transmissibles, Santé Publique France, 94415 Saint-Maurice, France
| | | | - Alexandre Cinaud
- Centre de diagnostic et de thérapeutique, université Paris-Cité, Hôpital Hôtel-Dieu, AP-HP, 75004 Paris, France
| | - Philippe Tuppin
- Direction de la stratégie, des études et des statistiques, Caisse Nationale de l'Assurance Maladie, 75020 Paris, France
| | - Jacques Blacher
- Centre de diagnostic et de thérapeutique, université Paris-Cité, Hôpital Hôtel-Dieu, AP-HP, 75004 Paris, France
| | - Valérie Olié
- Surveillance des maladies cardio-neuro-vasculaires, direction des maladies non transmissibles, Santé Publique France, 94415 Saint-Maurice, France
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Kirsch M, Iliou MC, Vitiello D. Hemodynamic Response to Exercise Training in Heart Failure With Reduced Ejection Fraction Patients. Cardiol Res 2024; 15:18-28. [PMID: 38464706 PMCID: PMC10923260 DOI: 10.14740/cr1591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 12/27/2023] [Indexed: 03/12/2024] Open
Abstract
Background Supervised exercise training decreases total and cardiac mortality and increases quality of life of heart failure with reduced ejection fraction (HFrEF) patients. However, response to training is variable from one patient to another and factors responsible for a positive response to training remain unclear. The aims of the study were to compare cardiac hemodynamic changes after an exercise training program in responders (R) versus non-responders (NR) HFrEF patients, and to compare different discriminators used to assess response to training. Methods Seventy-six HFrEF patients (86% males, 57 ± 12 years) completed an exercise training program for 4 weeks. Patients underwent cardiopulmonary exercise testing (CPET) on a cycle ergometer before and after training. Cardiac hemodynamics were measured by impedance cardiography during CPET. The R and NR groups were classified using the median change in peak oxygen uptake (V̇O2peak). Results There were statistically significant differences in V̇O2peak (+35% vs. -1%, P < 0.0001) and in peaks of ventilation (+30% vs. +2%, P < 0.0001), cardiac output (COpeak) (+25% vs. +4%, P < 0.01), systolic blood pressure (+12% vs. +2%, P < 0.05), diastolic blood pressure (+9% vs. +4%, P < 0.05) and heart rate (+8% vs. +1%, P < 0.01) between R and NR after the training program. V̇O2peak was the best discriminator between R and NR (receiver operating characteristic (ROC) area under the curve (AUC) = 0.83, P < 0.0001), followed by COpeak (ROC AUC = 0.77, P < 0.0001). Conclusion V̇O2peak is the best discriminator between HFrEF R and NR patients after the training program. Responders showed improvements in peak hemodynamic parameters. These results pave the way for other studies to determine how the individualization of exercise training programs and peak hemodynamic parameters potentially linked to a better positive response status.
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Affiliation(s)
- Marine Kirsch
- Institut des Sciences du Sport Sante de Paris (I3SP), URP 3625, Universite Paris Cite, Paris 75015, France
| | - Marie-Christine Iliou
- Department of Cardiac Rehabilitation and Secondary Prevention, Hopital Corentin Celton, APHP Centre, France
| | - Damien Vitiello
- Institut des Sciences du Sport Sante de Paris (I3SP), URP 3625, Universite Paris Cite, Paris 75015, France
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Mroué A, Roueff S, Vanorio-Vega I, Lazareth H, Kovalska O, Flahault A, Tuppin P, Thervet E, Iliou MC. Benefits of Cardiac Rehabilitation in Cardio-Renal Patients With Heart Failure With Reduced Ejection Fraction. J Cardiopulm Rehabil Prev 2023; 43:444-452. [PMID: 36892848 DOI: 10.1097/hcr.0000000000000781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/10/2023]
Abstract
PURPOSE Chronic kidney disease (CKD) is common in heart failure (HF). Chronic kidney disease often worsens the prognosis and impairs the management of patients with HF. Chronic kidney disease is frequently accompanied by sarcopenia, which limits the benefits of cardiac rehabilitation (CR). The aim of this study was to evaluate the impact of CR on cardiorespiratory fitness in HF patients with reduced ejection fraction (HFrEF) according to the CKD stage. METHODS We conducted a retrospective study including 567 consecutive patients with HFrEF, who underwent a 4-wk CR program, and who were evaluated by cardiorespiratory exercise test before and after the program. Patients were stratified according to their estimated glomerular filtration rate (eGFR). We performed multivariate analysis looking for factors associated with an improvement of 10% in peak oxygen uptake (V˙ o2peak ). RESULTS Thirty-eight percent of patients had eGFR <60 mL/min/1.73m². With decreasing eGFR, we observed deterioration in V˙ o2peak , first ventilatory threshold (VT1) and workload and an increase in brain natriuretic peptide levels at baseline. After CR, there was an improvement in V˙ O2peak (15.3 vs 17.8 mL/kg/min, P < .001), VT1 (10.5 vs 12.4 mL/kg/min, P < .001), workload (77 vs 94 W, P < .001), and brain natriuretic peptide (688 vs 488 pg/mL, P < .001). These improvements were statistically significant for all stages of CKD. In a multivariate analysis predicting factors associated with V˙ o2peak improvement, renal function did not interfere with results. CONCLUSIONS Cardiac rehabilitation is beneficial in patients with HFrEF with CKD regardless of CKD stage. The presence of CKD should not prevent the prescription of CR in patients with HFrEF.
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Affiliation(s)
- Ahmad Mroué
- Department of Nephrology, Georges Pompidou European Hospital, APHP, Paris, France (Drs Mroué, Roueff, Lazareth, Flahault, and Thervet); Direction de la stratégie des études et des statistiques, Caisse nationale de l'assurance maladie (CNAM), Paris, France (Drs Vanorio-Vega and Tuppin); Agence de la biomédecine, Saint-Denis, France (Dr Vanorio-Vega); Université Paris Cité, Paris, France (Drs Lazareth, Flahault, and Thervet); and Department of Cardiac Rehabilitation and Secondary Prevention, Corentin Celton Hospital, APHP, Paris, France (Drs Kovalska and Iliou)
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Charbonnel C, Jagu A, Vannier C, De Cordoue M, Aroulanda MJ, Lozinguez O, Komajda M, Garcon P, Antakly-Hanon Y, Moeuf Y, Lesage JB, Mantes L, Midey C, Izabel M, Boukefoussa W, Manne J, Standish B, Duc P, Iliou MC, Cador R. [Introduction of treatments for heart failure and reduced ejection fraction under 50 % : In-hospital optimization using an algorithmic approach]. Ann Cardiol Angeiol (Paris) 2023; 72:101640. [PMID: 37677914 DOI: 10.1016/j.ancard.2023.101640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 08/07/2023] [Accepted: 08/08/2023] [Indexed: 09/09/2023]
Abstract
Recent international guidelines recommend rapid initiation and titration of basic treatments of heart failure but do not explain how to achieve this goal. Despite these recommendations, implementation of treatment in daily practice is poor. This may be partly explained by the profile of the patients (frailty, comorbidities), safety considerations and tolerability issues related to kydney function, low blood pressure or heart rate and hyperkalaemia. In this special article, we intended to help the physician, through an algorithmic approach, to quickly and safely introduce guideline-directed medical therapy in the field of heart failure with ejection fraction under 50%.
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Affiliation(s)
- Clément Charbonnel
- Service de Cardiologie, Groupe Hospitalier Paris Saint Joseph, Paris, France.
| | - Annabelle Jagu
- Service de Cardiologie, Groupe Hospitalier Paris Saint Joseph, Paris, France
| | - Claire Vannier
- Service de Cardiologie, Groupe Hospitalier Paris Saint Joseph, Paris, France
| | - Maylis De Cordoue
- Service de Cardiologie, Groupe Hospitalier Paris Saint Joseph, Paris, France
| | | | - Olivier Lozinguez
- Service de Cardiologie, Groupe Hospitalier Paris Saint Joseph, Paris, France
| | - Michel Komajda
- Service de Cardiologie, Groupe Hospitalier Paris Saint Joseph, Paris, France
| | - Philippe Garcon
- Service de Cardiologie, Groupe Hospitalier Paris Saint Joseph, Paris, France
| | - Yara Antakly-Hanon
- Service de Cardiologie, Groupe Hospitalier Paris Saint Joseph, Paris, France
| | - Yoann Moeuf
- Service de Cardiologie, Groupe Hospitalier Paris Saint Joseph, Paris, France
| | | | - Lucie Mantes
- Service de Cardiologie, Groupe Hospitalier Paris Saint Joseph, Paris, France
| | - Charlotte Midey
- Service de Cardiologie, Groupe Hospitalier Paris Saint Joseph, Paris, France
| | - Mathilde Izabel
- Service de Cardiologie, Groupe Hospitalier Paris Saint Joseph, Paris, France
| | - Wahiba Boukefoussa
- Service de Cardiologie, Groupe Hospitalier Paris Saint Joseph, Paris, France
| | - Julien Manne
- Service de Cardiologie, Groupe Hospitalier Paris Saint Joseph, Paris, France
| | - Brigitte Standish
- Service de Cardiologie, Groupe Hospitalier Paris Saint Joseph, Paris, France
| | - Philippe Duc
- Service de Cardiologie, Groupe Hospitalier Paris Saint Joseph, Paris, France
| | | | - Romain Cador
- Service de Cardiologie, Groupe Hospitalier Paris Saint Joseph, Paris, France
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5
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Eser P, Marcin T, Prescott E, Prins LF, Kolkman E, Bruins W, van der Velde AE, Gil CP, Iliou MC, Ardissino D, Zeymer U, Meindersma EP, Van’t Hof AWJ, de Kluiver EP, Wilhelm M. Breathing pattern and pulmonary gas exchange in elderly patients with and without left ventricular dysfunction-modification with exercise-based cardiac rehabilitation and prognostic value. Front Cardiovasc Med 2023; 10:1219589. [PMID: 37727302 PMCID: PMC10505741 DOI: 10.3389/fcvm.2023.1219589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 08/01/2023] [Indexed: 09/21/2023] Open
Abstract
Background Inefficient ventilation is an established prognostic marker in patients with heart failure. It is not known whether inefficient ventilation is also linked to poor prognosis in patients with left ventricular dysfunction (LVD) but without overt heart failure. Objectives To investigate whether inefficient ventilation in elderly patients with LVD is more common than in patients without LVD, whether it improves with exercise-based cardiac rehabilitation (exCR), and whether it is associated with major adverse cardiovascular events (MACE). Methods In this large multicentre observational longitudinal study, patients aged ≥65 years with acute or chronic coronary syndromes (ACS, CCS) without cardiac surgery who participated in a study on the effectiveness of exCR in seven European countries were included. Cardiopulmonary exercise testing (CPET) was performed before, at the termination of exCR, and at 12 months follow-up. Ventilation (VE), breathing frequency (BF), tidal volume (VT), and end-expiratory carbon dioxide pressure (PETCO2) were measured at rest, at the first ventilatory threshold, and at peak exercise. Ventilatory parameters were compared between patients with and without LVD (based on cardio-echography) and related to MACE at 12 month follow-up. Results In 818 patients, age was 72.5 ± 5.4 years, 21.9% were women, 79.8% had ACS, and 151 (18%) had LVD. Compared to noLVD, in LVD resting VE was increased by 8%, resting BF by 6%, peak VE, peak VT, and peak PETCO2 reduced by 6%, 8%, and 5%, respectively, and VE/VCO2 slope increased by 11%. From before to after exCR, resting VE decreased and peak PETCO2 increased significantly more in patients with compared to without LVD. In LVD, higher resting BF, higher nadir VE/VCO2, and lower peak PETCO2 at baseline were associated with MACE. Conclusions Similarly to patients with HF, in elderly patients with ischemic LVD, inefficient resting and exercise ventilation was associated with worse outcomes, and ExCR alleviated abnormal breathing patterns and gas exchange parameters.
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Affiliation(s)
- Prisca Eser
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Thimo Marcin
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Eva Prescott
- Department of Cardiology, Bispebjerg Frederiksberg University Hospital, Copenhagen, Denmark
| | | | | | | | | | - Carlos Peña Gil
- Department of Cardiology, Hospital Clínico Universitario de Santiago, University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Marie-Christine Iliou
- Department of Cardiac Rehabilitation, Assistance Publique Hopitaux de Paris, Paris, France
| | - Diego Ardissino
- Department of Cardiology, Parma University Hospital, Parma, Italy
| | - Uwe Zeymer
- Klinikum Ludwigshafen and Institut für Herzinfarktforschung Ludwigshafen, Ludwigshafen, Germany
| | | | - Arnoud W. J. Van’t Hof
- Isala Heart Centre, Zwolle, Netherlands
- Department of Cardiology, Maastricht University Medical Center, Maastricht, Netherlands
- Department of Cardiology, Zuyderland Medical Center, Heerlen, Netherlands
| | | | - Matthias Wilhelm
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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Mroue A, Roueff S, Kovalska O, Iliou MC. Benefits of cardiac rehabilitation in cardio-renal patients: a retrospective study of heart failure 578 patients with reduced ejection fraction. Eur J Prev Cardiol 2022. [DOI: 10.1093/eurjpc/zwac056.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Introduction
Chronic kidney disease (CKD) is common during the course of heart failure (HF). It is often associated with worse prognosis and complicates the management of these patients. Moreover CKD is accompanied by sarcopenia, which may limit the benefits of cardiac rehabilitation (CR) in the cardio-renal syndrome (CRS).
The aim of this study was to evaluate the effect of CR on the physical capacities according to the stage of CKD assessed by a cardiorespiratory exercise test (CPET) at the beginning and end of the program in patients with reduced ejection fraction (HFrEF).
Methods
This is a retrospective study, conducted from January 2004 to December 2019 on 573 consecutive HFrEF patients, who benefited from a 4-week CR.
Patients were divided into 4 groups according to their GFR (group (G) 1 >= 60; G2: 45-59; G3: 30-44; G4 < 30 ml/min/1.73m². We compared these groups (ANOVA test) and looked with multivariate analysis for factors associated with an improvement in peak VO2 (VO2p).
Results
Of the general population, 38% of patients had a GFR<60ml/min. After CR, there was an improvement in VO2p (15.4 vs 17.8, p=0.00009), SV1 (10.5 vs12.4, p=0.0001), watts (77 vs 93.6, p<0.000), and BNP (688 vs 488, p=0.00002). With decreasing stages of CKD, there was a deterioration in VO2p (16.2, 14.3, 13.6, 13.3), SV1 (10.9, 10.1, 9.3, 9.1), watts (83.4, 69.2, 66.3, 55.2), and an increase BNP levels (570, 885, 771, 1235 pg/ml). The improvement in VO2p, SV1, watts, BNP was statistically significant for all stages of CKD except in group 4 for VO2p (13.3 vs 14.4, p=0.1).
In multivariate analysis factors predicting improvement in VO2p were baseline VO2p and maximal systolic blood pressure.
Conclusion
CR is beneficial in HFrEF patients with CKD. CRS should not be a barrier to prescribing CR.
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Affiliation(s)
- A Mroue
- Hopital Europeen Georges Pompidou- University Paris Descartes, Nephrology, Paris, France
| | - S Roueff
- Hopital Europeen Georges Pompidou- University Paris Descartes, Nephrology, Paris, France
| | - O Kovalska
- Corentin Celton Hospital APHP, Cardiac rehabilitation, Issy Les Moulineaux, France
| | - MC Iliou
- Corentin Celton Hospital APHP, Cardiac rehabilitation, Issy Les Moulineaux, France
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Zhou N, Fortin G, Balice M, Kovalska O, Cristofini P, Ledru F, Mampuya WM, Iliou MC. Evolution of Early Postoperative Cardiac Rehabilitation in Patients with Acute Type A Aortic Dissection. J Clin Med 2022; 11:jcm11082107. [PMID: 35456200 PMCID: PMC9025085 DOI: 10.3390/jcm11082107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Revised: 03/29/2022] [Accepted: 04/01/2022] [Indexed: 12/10/2022] Open
Abstract
Introduction: Surgically treated acute type A aortic dissection (ATAAD) patients are often restricted from physical exercise due to a lack of knowledge about safe blood pressure (BP) ranges. The aim of this study was to describe the evolution of early postoperative cardiac rehabilitation (CR) for patients with ATAAD. Methods: This is a retrospective study of 73 patients with ATAAD who were referred to the CR department after surgery. An incremental symptom-limited exercise stress test (ExT) on a cyclo-ergometer was performed before and after CR, which included continuous training and segmental muscle strengthening (five sessions/week). Systolic and diastolic blood pressure (SBP and DBP) were monitored before and after all exercise sessions. Results: The patients (78.1% male; 62.2 ± 12.7 years old; 54.8% hypertensive) started CR 26.2 ± 17.3 days after surgery. During 30.4 ±11.6 days, they underwent 14.5 ± 4.7 sessions of endurance cycling training, and 11.8 ± 4.3 sessions of segmental muscle strengthening. At the end of CR, the gain of workload during endurance training and functional capacity during ExT were 19.6 ± 10.2 watts and 1.2 ± 0.6 METs, respectively. The maximal BP reached during endurance training was 143 ± 14/88 ± 14 mmHg. The heart rate (HR) reserve improved from 20.2 ± 13.9 bpm to 33.2 ± 16.8 bpm while the resting HR decreased from 86.1 ± 17.4 bpm to 76.4 ± 13.3 bpm. Conclusion: Early post-operative exercise-based CR is feasible and safe in patients with surgically treated ATAAD. The CR effect is remarkable, but it requires a close BP monitoring and supervision by a cardiologist and physical therapist during training.
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Affiliation(s)
- Na Zhou
- Department of Cardiac Rehabilitation and Secondary Prevention, Corentin Celton Hospital, 92130 Paris, France; (N.Z.); (M.B.); (O.K.); (P.C.); (F.L.)
| | - Gabriel Fortin
- Service de Cardiologie, Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, QC J1H 5H3, Canada; (G.F.); (W.M.M.)
| | - Maria Balice
- Department of Cardiac Rehabilitation and Secondary Prevention, Corentin Celton Hospital, 92130 Paris, France; (N.Z.); (M.B.); (O.K.); (P.C.); (F.L.)
| | - Oksana Kovalska
- Department of Cardiac Rehabilitation and Secondary Prevention, Corentin Celton Hospital, 92130 Paris, France; (N.Z.); (M.B.); (O.K.); (P.C.); (F.L.)
| | - Pascal Cristofini
- Department of Cardiac Rehabilitation and Secondary Prevention, Corentin Celton Hospital, 92130 Paris, France; (N.Z.); (M.B.); (O.K.); (P.C.); (F.L.)
| | - Francois Ledru
- Department of Cardiac Rehabilitation and Secondary Prevention, Corentin Celton Hospital, 92130 Paris, France; (N.Z.); (M.B.); (O.K.); (P.C.); (F.L.)
| | - Warner M. Mampuya
- Service de Cardiologie, Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, QC J1H 5H3, Canada; (G.F.); (W.M.M.)
| | - Marie-Christine Iliou
- Department of Cardiac Rehabilitation and Secondary Prevention, Corentin Celton Hospital, 92130 Paris, France; (N.Z.); (M.B.); (O.K.); (P.C.); (F.L.)
- Correspondence:
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8
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Wilhelm M, Abreu A, Adami PE, Ambrosetti M, Antonopoulou M, Biffi A, Cavarretta E, D'Ascenzi F, Gibson I, Grobbee DE, Iliou MC, Koskinas K, Marques-Vidal P, Nixdorff U, Papadakis M, Piepoli MF, Vassiliou V, Wood D, Dendale P, Halle M. EAPC Core Curriculum for Preventive Cardiology. Eur J Prev Cardiol 2022; 29:251-274. [PMID: 33791783 DOI: 10.1093/eurjpc/zwab017] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 01/15/2021] [Accepted: 01/19/2021] [Indexed: 02/06/2023]
Abstract
Preventive cardiology encompasses the whole spectrum of cardiovascular disease (CVD) prevention, at individual and population level, through all stages of life. This includes promotion of cardiovascular (CV) health, management of individuals at risk of developing CVD, and management of patients with established CVD, through interdisciplinary care in different settings. Preventive cardiology addresses all aspects of CV health in the context of the social determinants of health, including physical activity, exercise, sports, nutrition, weight management, smoking cessation, psychosocial factors and behavioural change, environmental, genetic and biological risk factors, and CV protective medications. This is the first European Core Curriculum for Preventive Cardiology, which will help to standardize, structure, deliver, and evaluate training in preventive cardiology across Europe. It will be the basis for dedicated fellowship programmes and a European Society of Preventive Cardiology (EAPC) subspecialty certification for cardiologists, with the intention to improve quality and outcome in CVD prevention.
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Affiliation(s)
- Matthias Wilhelm
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 46, 3010 Bern, Switzerland
| | - Ana Abreu
- Servico de Cardioologia, Hospital Universitario de Santa Maria/Centro Hospitalar Universitario Lisboa Norte (CHULN), Centro Academico de Medicina de Lisboa (CAML), Centro Cardiovascular da Universidade de Lisboa (CCUL), Avenida Professor Egas Moniz, 1649-035 Lisbon, Portugal
| | - Paolo Emilio Adami
- Health and Science Department, World Athletics, Monaco Principality, 6-8 Quai Antoine 1er, 98007 Monaco, Monaco
| | - Marco Ambrosetti
- Cardiac Rehabilitation Unit, ASST, Via Medaglie D'Oro, 9, 26013 Crema, Italy
| | - Maria Antonopoulou
- Spili Primary Care Centre, Regional Health System of Crete, 740 53 Spili, Greece
| | - Alessandro Biffi
- Med-Ex Medicine & Exercise, Medical Partner Scuderia Ferrari, Via Vittorio Veneto 108, 00187 Rome, Italy
| | - Elena Cavarretta
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Corso della Repubblica 97, 04100 Latina, Italy
- Mediterranea Cardiocentro, Via Orazio, 2, 80122 Naples, Italy
| | - Flavio D'Ascenzi
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Viale Mario Bracci 16, 53100 Siena, Italy
| | - Irene Gibson
- National Institute for Prevention and Cardiovascular Health, Moyola Lane, Newcastle, Galway H91 FF68, Ireland
| | - Diederick E Grobbee
- Julius Center for Health Sciences and Primary Care, and University Medical Center Utrecht, 3584 CX Utrech, The Netherlands
| | - Marie-Christine Iliou
- Cardiac Rehabilitation and Secondary Prevention Department, Corentin Celton Hospital, Assistance Publique Hopitaux de Paris Centre Université de Paris, Parvis Corentin Celton 4, 92130 Issy-les-Moulineaux, Paris, France
| | - Konstantinos Koskinas
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 46, 3010 Bern, Switzerland
| | - Pedro Marques-Vidal
- Department of Medicine, Internal Medicine, Lausanne University Hospital (CHUV), Rue du Bugnon 46, 1011 Lausanne, Switzerland
| | - Uwe Nixdorff
- European Prevention Center c/o Medical Center Düsseldorf, Luise-Rainer-Straße 6-10, 40235 Düsseldorf, Germany
| | - Michael Papadakis
- Cardiovascular Clinical Academic Group, St George's, University of London, London SW17 0RE, UK
| | - Massimo F Piepoli
- Cardiac Unit, Guglielmo da Saliceto Hospital, University of Parma, 29121 Piacenza, Italy
| | - Vass Vassiliou
- Department of Cardiovascular Medicine, University of East Anglia, Norwich Research Park, Norwich NR4 7TJ, UK
| | - David Wood
- National Institute for Prevention and Cardiovascular Health, National University of Ireland Galway, University Road, Galway H91 TK33, Ireland
- National Heart and Lung Institute, Imperial College London, London SW3 6LY, UK
| | - Paul Dendale
- Heart Centre Hasselt and Hasselt University, 3500 Hasselt, Belgium
| | - Martin Halle
- Department of Prevention and Sports Medicine, University Hospital rechts der Isar, Technical University Munich, German Centre for Cardiovascular Research, Georg-Brauchle-Ring 56, 80992 Munich, Germany
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9
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Hansen D, Abreu A, Ambrosetti M, Cornelissen V, Gevaert A, Kemps H, Laukkanen JA, Pedretti R, Simonenko M, Wilhelm M, Davos CH, Doehner W, Iliou MC, Kränkel N, Völler H, Piepoli M. Exercise intensity assessment and prescription in cardiovascular rehabilitation and beyond: why and how: a position statement from the Secondary Prevention and Rehabilitation Section of the European Association of Preventive Cardiology. Eur J Prev Cardiol 2022; 29:230-245. [PMID: 34077542 DOI: 10.1093/eurjpc/zwab007] [Citation(s) in RCA: 97] [Impact Index Per Article: 48.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 01/02/2021] [Accepted: 01/08/2021] [Indexed: 12/12/2022]
Abstract
A proper determination of the exercise intensity is important for the rehabilitation of patients with cardiovascular disease (CVD) since it affects the effectiveness and medical safety of exercise training. In 2013, the European Association of Preventive Cardiology (EAPC), together with the American Association of Cardiovascular and Pulmonary Rehabilitation and the Canadian Association of Cardiac Rehabilitation, published a position statement on aerobic exercise intensity assessment and prescription in cardiovascular rehabilitation (CR). Since this publication, many subsequent papers were published concerning the determination of the exercise intensity in CR, in which some controversies were revealed and some of the commonly applied concepts were further refined. Moreover, how to determine the exercise intensity during resistance training was not covered in this position paper. In light of these new findings, an update on how to determine the exercise intensity for patients with CVD is mandatory, both for aerobic and resistance exercises. In this EAPC position paper, it will be explained in detail which objective and subjective methods for CR exercise intensity determination exist for aerobic and resistance training, together with their (dis)advantages and practical applications.
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Affiliation(s)
- Dominique Hansen
- Department of Cardiology, Heart Centre Hasselt, Jessa Hospital, Hasselt, Belgium
- UHasselt, Faculty of Rehabilitation Sciences, BIOMED-REVAL-Rehabilitation Research Centre, Hasselt University, Agoralaan, Building A, 3590 Hasselt, Belgium
| | - Ana Abreu
- Cardiology Department, Hospital Universitário de Santa Maria/Centro Académico de Medicina de Lisboa (CAML), Exercise and Cardiovascular Rehabilitation Laboratory, Centro Cardiovascular da Universidade de Lisboa (CCUL), Lisbon, Portugal
| | - Marco Ambrosetti
- Cardiac Rehabilitation Unit, ASST Ospedale Maggiore Crema, Crema, Italy
| | - Veronique Cornelissen
- Research Unit of Cardiovascular Exercise Physiology, Department of Rehabilitation Sciences, Faculty of Kinesiology and Rehabilitation Sciences, KU Leuven, Belgium
| | - Andreas Gevaert
- Research Group Cardiovascular Diseases, GENCOR Department, University of Antwerp, Antwerp, Belgium
- Department of Cardiology, Antwerp University Hospital (UZA), Belgium
| | - Hareld Kemps
- Department of Cardiology, Maxima Medical Centre, Veldhoven, The Netherlands
- Department of Industrial Design, Eindhoven University of Technology, Eindhoven, The Netherlands
- Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Jari A Laukkanen
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
- Cardiovascular Department, IRCCS MultiMedica, Care and Research Institute, Sesto San Giovanni, Milano, Italy
| | - Roberto Pedretti
- Heart Transplantation Outpatient Department, Cardiopulmonary Exercise Test Research Department, Almazov National Medical Research Centre, St. Petersburg, Russia
| | - Maria Simonenko
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Matthias Wilhelm
- Cardiovascular Research Laboratory, Biomedical Research Foundation, Academy of Athens, Athens, Greece
| | - Constantinos H Davos
- BCRT-Berlin Institute of Health Center for Regenerative Therapies, Department of Cardiology (Virchow Klinikum), Charité - Universitätsmedizin Berlin, Partner Site Berlin, Germany
| | - Wolfram Doehner
- Cardiac Rehabilitation and Secondary Prevention Department, Corentin Celton Hospital, Assistance Publique Hopitaux de Paris Centre Université de Paris, Paris, France
- German Centre for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin D-1220, Germany
| | - Marie-Christine Iliou
- Charité - University Medicine Berlin, Campus Benjamin Franklin, Department of Cardiology, Hindenburgdamm 30, 12203 Berlin, Germany
| | - Nicolle Kränkel
- German Centre for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin D-1220, Germany
- Klinik am See, Rehabilitation Centers for Internal Medicine, Berlin, Germany
| | - Heinz Völler
- Department of Rehabilitation Medicine, University of Potsdam, Potsdam, Germany
- Heart Failure Unit, G. da Saliceto Hospital, AUSL Piacenza and University of Parma, Parma, Italy
| | - Massimo Piepoli
- Heart Failure Unit, G. da Saliceto Hospital, AUSL Piacenza and University of Parma, Parma, Italy
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10
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Scherrenberg M, Zeymer U, Schneider S, Van der Velde AE, Wilhelm M, Van't Hof AWJ, Kolkman E, Prins LF, Prescott E, Iliou MC, Peña-Gil C, Ardissino D, De Kluiver EP, Dendale P. EU-CaRE study: Could exercise-based cardiac telerehabilitation also be cost-effective in elderly? Int J Cardiol 2021; 340:1-6. [PMID: 34419529 DOI: 10.1016/j.ijcard.2021.08.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 08/11/2021] [Accepted: 08/16/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND The role of cardiac rehabilitation (CR) is well established in the secondary prevention of ischemic heart disease. Unfortunately, the participation rates across Europe remain low, especially in elderly. The EU-CaRE RCT investigated the effectiveness of a home-based mobile CR programme in elderly patients that were not willing to participate in centre-based CR. The initial study concluded that a 6-month home-based mobile CR programme was safe and beneficial in improving VO2peak when compared with no CR. OBJECTIVE To assess whether a 6-month guided mobile CR programme is a cost-effective therapy for elderly patients who decline participation in CR. METHODS Patients were enrolled in a multicentre randomised clinical trial from November 11, 2015, to January 3, 2018, and follow-up was completed on January 17, 2019, in a secondary care system with 6 cardiac institutions across 5 European countries. A total of 179 patients who declined participation in centre-based CR and met the inclusion criteria consented to participate in the European Study on Effectiveness and Sustainability of Current Cardiac Rehabilitation Programs in the Elderly trial. The data of patients (n = 17) that were lost in follow-up were excluded from this analysis. The intervention (n = 79) consisted of 6 months of mobile CR programme with telemonitoring, and coaching based on motivational interviewing to stimulate patients to reach exercise goals. Control patients did not receive any form of CR throughout the study period. The costs considered for the cost-effectiveness analysis of the RCT are direct costs 1) of the mobile CR programme, and 2) of the care utilisation recorded during the observation time from randomisation to the end of the study. Costs and outcomes (utilities) were compared by calculation of the incremental cost-effectiveness ratio. RESULTS The healthcare utilisation costs (P = 0.802) were not significantly different between the two groups. However, the total costs were significantly higher in the intervention group (P = 0.040). The incremental cost-effectiveness ratio for the primary endpoint VO2peak at 6 months was €1085 per 1-unit [ml/kg/min] improvement in change VO2peak and at 12 months it was €1103 per 1 unit [ml/kg/min] improvement in change VO2peak. Big differences in the incremental cost-effectiveness ratios for the primary endpoint VO2peak at 6 months and 12 months were present between the adherent participants and the non-adherent participants. CONCLUSION From a health-economic point of view the home-based mobile CR programme is an effective and cost-effective alternative for elderly cardiac patients who are not willing to participate in a regular rehabilitation programme to improve cardiorespiratory fitness. The change of QoL between the mobile CR was similar for both groups. Adherence to the mobile CR programme plays a significant role in the cost-effectiveness of the intervention. Future research should focus on the determinants of adherence, on increasing the adherence of patients and the implementation of comprehensive home-based mobile CR programmes in standard care.
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Affiliation(s)
- M Scherrenberg
- Heart Centre Hasselt, Jessa Hospital, Hasselt, Belgium; UHasselt, Faculty of Medicine and Life Sciences, Diepenbeek, Belgium.
| | - U Zeymer
- Institut für Herzinfarktforschung Ludwigshafen, Ludwigshafen, Germany
| | - S Schneider
- Institut für Herzinfarktforschung Ludwigshafen, Ludwigshafen, Germany
| | | | - M Wilhelm
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - A W J Van't Hof
- Isala Heart Centre, Zwolle, the Netherlands; MUMC+, Dpt of Cardiology, Maastricht, the Netherlands; CArdiovascular Research Institute, Maastricht (CARIM), University of Maastricht, the Netherlands; Zuyderland Medical Center, Heerlen, the Netherlands
| | | | | | - E Prescott
- Bispebjerg University Hospital, Copenhagen, Denmark
| | - M C Iliou
- Cardiac Rehabilitation Department, Corentin Celton Hospital, Assistance Publique Hôpitaux de Paris Centre, Issy les Mx, France
| | - C Peña-Gil
- Department of Cardiology, Complexo Hospitalario Universitario de Santiago de Compostela, SERGAS IDIS CIBERCV, Spain
| | - D Ardissino
- Department of Cardiology, Parma University Hospital, Italy
| | | | - P Dendale
- Heart Centre Hasselt, Jessa Hospital, Hasselt, Belgium; UHasselt, Faculty of Medicine and Life Sciences, Diepenbeek, Belgium
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11
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Marcin T, Eser P, Prescott E, Prins LF, Kolkman E, Bruins W, van der Velde AE, Peña Gil C, Iliou MC, Ardissino D, Zeymer U, Meindersma EP, Van’t Hof AWJ, de Kluiver EP, Wilhelm M. Changes and prognostic value of cardiopulmonary exercise testing parameters in elderly patients undergoing cardiac rehabilitation: The EU-CaRE observational study. PLoS One 2021; 16:e0255477. [PMID: 34343174 PMCID: PMC8330933 DOI: 10.1371/journal.pone.0255477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 07/16/2021] [Indexed: 11/21/2022] Open
Abstract
Objective We aimed 1) to test the applicability of the previously suggested prognostic value of CPET to elderly cardiac rehabilitation patients and 2) to explore the underlying mechanism of the greater improvement in exercise capacity (peak oxygen consumption, VO2) after CR in surgical compared to non-surgical cardiac patients. Methods Elderly patients (≥65 years) commencing CR after coronary artery bypass grafting, surgical valve replacement (surgery-group), percutaneous coronary intervention, percutaneous valve replacement or without revascularisation (non-surgery group) were included in the prospective multi-center EU-CaRE study. CPETs were performed at start of CR, end of CR and 1-year-follow-up. Logistic models and receiver operating characteristics were used to determine prognostic values of CPET parameters for major adverse cardiac events (MACE). Linear models were performed for change in peak VO2 (start to follow-up) and parameters accounting for the difference between surgery and non-surgery patients were sought. Results 1421 out of 1633 EU-CaRE patients performed a valid CPET at start of CR (age 73±5.4, 81% male). No CPET parameter further improved the receiver operation characteristics significantly beyond the model with only clinical parameters. The higher improvement in peak VO2 (25% vs. 7%) in the surgical group disappeared when adjusted for changes in peak tidal volume and haemoglobin. Conclusion CPET did not improve the prediction of MACE in elderly CR patients. The higher improvement of exercise capacity in surgery patients was mainly driven by restoration of haemoglobin levels and improvement in respiratory function after sternotomy. Trial registration Netherlands Trial Register, Trial NL5166.
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Affiliation(s)
- Thimo Marcin
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- * E-mail:
| | - Prisca Eser
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Eva Prescott
- Department of Cardiology, Bispebjerg Frederiksberg University Hospital, Copenhagen, Denmark
| | | | | | | | | | - Carlos Peña Gil
- Department of Cardiology, Complexo Hospitalario Universitario de Santiago de Compostela, SERGAS IDIS CIBERCV, Santiago, Spain
| | - Marie-Christine Iliou
- Department of Cardiac Rehabilitation, Assistance Publique Hopitaux de Paris, Paris, France
| | - Diego Ardissino
- Department of Cardiology, Parma University Hospital, Parma, Italy
| | - Uwe Zeymer
- Klinikum Ludwigshafen and Institut für Herzinfarktforschung Ludwigshafen, Ludwigshafen, Germany
| | - Esther P. Meindersma
- Isala Heart Centre, Zwolle, The Netherlands
- Department of Cardiology, Radboud University, Nijmegen, The Netherlands
| | - Arnoud W. J. Van’t Hof
- Isala Heart Centre, Zwolle, The Netherlands
- Department of Cardiology, Maastricht University Medical Center and Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands
- Department of Cardiology, Zuyderland Medical Center, Heerlen, The Netherlands
| | | | - Matthias Wilhelm
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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12
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Snoek JA, Prescott EI, van der Velde AE, Eijsvogels TMH, Mikkelsen N, Prins LF, Bruins W, Meindersma E, González-Juanatey JR, Peña-Gil C, González-Salvado V, Moatemri F, Iliou MC, Marcin T, Eser P, Wilhelm M, Van't Hof AWJ, de Kluiver EP. Effectiveness of Home-Based Mobile Guided Cardiac Rehabilitation as Alternative Strategy for Nonparticipation in Clinic-Based Cardiac Rehabilitation Among Elderly Patients in Europe: A Randomized Clinical Trial. JAMA Cardiol 2021; 6:463-468. [PMID: 33112363 PMCID: PMC7593879 DOI: 10.1001/jamacardio.2020.5218] [Citation(s) in RCA: 50] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Importance Although nonparticipation in cardiac rehabilitation is known to increase cardiovascular mortality and hospital readmissions, more than half of patients with coronary artery disease in Europe are not participating in cardiac rehabilitation. Objective To assess whether a 6-month guided mobile cardiac rehabilitation (MCR) program is an effective therapy for elderly patients who decline participation in cardiac rehabilitation. Design, Setting, and Participants Patients were enrolled in this parallel multicenter randomized clinical trial from November 11, 2015, to January 3, 2018, and follow-up was completed on January 17, 2019, in a secondary care system with 6 cardiac institutions across 5 European countries. Researchers assessing primary outcome were masked for group assignment. A total of 4236 patients were identified with a recent diagnosis of acute coronary syndrome, coronary revascularization, or surgical or percutaneous treatment for valvular disease, or documented coronary artery disease, of whom 996 declined to start cardiac rehabilitation. Subsequently, 179 patients who met the inclusion and exclusion criteria consented to participate in the European Study on Effectiveness and Sustainability of Current Cardiac Rehabilitation Programmes in the Elderly trial. Data were analyzed from January 21 to October 11, 2019. Interventions Six months of home-based cardiac rehabilitation with telemonitoring and coaching based on motivational interviewing was used to stimulate patients to reach exercise goals. Control patients did not receive any form of cardiac rehabilitation throughout the study period. Main Outcomes and Measures The primary outcome parameter was peak oxygen uptake (Vo2peak) after 6 months. Results Among 179 patients randomized (145 male [81%]; median age, 72 [range, 65-87] years), 159 (89%) were eligible for primary end point analysis. Follow-up at 1 year was completed for 151 patients (84%). Peak oxygen uptake improved in the MCR group (n = 89) at 6 and 12 months (1.6 [95% CI, 0.9-2.4] mL/kg-1/min-1 and 1.2 [95% CI, 0.4-2.0] mL/kg-1/min-1, respectively), whereas there was no improvement in the control group (n = 90) (+0.2 [95% CI, -0.4 to 0.8] mL/kg-1/min-1 and +0.1 [95% CI, -0.5 to 0.7] mL/kg-1/min-1, respectively). Changes in Vo2peak were greater in the MCR vs control groups at 6 months (+1.2 [95% CI, 0.2 to 2.1] mL/kg-1/min-1) and 12 months (+0.9 [95% CI, 0.05 to 1.8] mL/kg-1/min-1). The incidence of adverse events was low and did not differ between the MCR and control groups. Conclusions and Relevance These results suggest that a 6-month home-based MCR program for patients 65 years or older with coronary artery disease or a valvular intervention was safe and beneficial in improving Vo2peak when compared with no cardiac rehabilitation. Trial Registration trialregister.nl Identifier: NL5168.
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Affiliation(s)
- Johan A Snoek
- Isala Heart Center, Zwolle, the Netherlands.,Sports Medicine Department Isala, Zwolle, the Netherlands
| | - Eva I Prescott
- Department of Cardiology, Bispebjerg Frederiksberg University Hospital, Copenhagen, Denmark
| | | | - Thijs M H Eijsvogels
- Radboud Institute for Health Sciences, Department of Physiology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Nicolai Mikkelsen
- Department of Cardiology, Bispebjerg Frederiksberg University Hospital, Copenhagen, Denmark
| | | | | | - Esther Meindersma
- Department of Cardiology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - José R González-Juanatey
- Department of Cardiology, Hospital Clínico Universitario de Santiago, Instituto de Investigación Sanitaria, CIBER CV, Madrid, Spain
| | - Carlos Peña-Gil
- Department of Cardiology, Hospital Clínico Universitario de Santiago, Instituto de Investigación Sanitaria, CIBER CV, Madrid, Spain
| | - Violeta González-Salvado
- Department of Cardiology, Hospital Clínico Universitario de Santiago, Instituto de Investigación Sanitaria, CIBER CV, Madrid, Spain
| | - Feriel Moatemri
- Department of Cardiac Rehabilitation, Assistance Publique Hopitaux de Paris, Paris, France
| | - Marie-Christine Iliou
- Department of Cardiac Rehabilitation, Assistance Publique Hopitaux de Paris, Paris, France
| | - Thimo Marcin
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Prisca Eser
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Matthias Wilhelm
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Arnoud W J Van't Hof
- Department of Cardiology, Maastricht University Medical Center and Cardiovascular Research Institute Maastricht (CARIM), Maastricht, the Netherlands.,Department of Cardiology, Zuyderland Medical Center, Heerlen, the Netherlands
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13
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Pedretti RFE, Iliou MC, Israel CW, Abreu A, Miljoen H, Corrà U, Stellbrink C, Gevaert AB, Theuns DA, Piepoli MF, Reibis R, Schmid JP, Wilhelm M, Heidbuchel H, Völler H. Comprehensive multicomponent cardiac rehabilitation in cardiac implantable electronic devices recipients: a consensus document from the European Association of Preventive Cardiology (EAPC; Secondary prevention and rehabilitation section) and European Heart Rhythm Association (EHRA). Europace 2021; 23:1336-1337o. [PMID: 33636723 DOI: 10.1093/europace/euaa427] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 10/25/2020] [Accepted: 11/02/2020] [Indexed: 11/13/2022] Open
Abstract
Cardiac rehabilitation (CR) is a multidisciplinary intervention including patient assessment and medical actions to promote stabilization, management of cardiovascular risk factors, vocational support, psychosocial management, physical activity counselling, and prescription of exercise training. Millions of people with cardiac implantable electronic devices live in Europe and their numbers are progressively increasing, therefore, large subsets of patients admitted in CR facilities have a cardiac implantable electronic device. Patients who are cardiac implantable electronic devices recipients are considered eligible for a CR programme. This is not only related to the underlying heart disease but also to specific issues, such as psychological adaptation to living with an implanted device and, in implantable cardioverter-defibrillator patients, the risk of arrhythmia, syncope, and sudden cardiac death. Therefore, these patients should receive special attention, as their needs may differ from other patients participating in CR. As evidence from studies of CR in patients with cardiac implantable electronic devices is sparse, detailed clinical practice guidelines are lacking. Here, we aim to provide practical recommendations for CR in cardiac implantable electronic devices recipients in order to increase CR implementation, efficacy, and safety in this subset of patients.
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Affiliation(s)
- Roberto F E Pedretti
- Cardiovascular Department, IRCCS MultiMedica, Care and Research Institute, Via Milanese 300, Sesto San Giovanni, Milano 20099, Italy
| | - Marie-Christine Iliou
- Department of Cardiac Rehabilitation and Secondary Prevention, Hôpital Corentin Celton, Assistance Pulique Hopitaux de Paris centre-Universite de Paris, France
| | - Carsten W Israel
- Department of Cardiology, Bethel Clinic, J.W. Goethe University, Frankfurt, Germany
| | - Ana Abreu
- Servico de Cardiologia, Hospital Universitário de Santa Maria/Centro Hospitalar Universitário Lisboa Norte (CHULN), Centro Academico de Medicina de Lisboa (CAML), Centro Cardiovascular da Universidade de Lisboa (CCUL), Faculdade de Medicina, Universidade de Lisboa, Portugal
| | - Hielko Miljoen
- Department of Cardiology, University of Antwerp and University Hospital Antwerp, Antwerp, Belgium
| | - Ugo Corrà
- Department of Cardiac Rehabilitation, ICS Maugeri Care and Research Institute, Veruno, Novara, Italy
| | - Christoph Stellbrink
- Department of Cardiology and Intensive Care Medicine, Klinikum Bielefeld GmbH, Bielefeld, Germany
| | - Andreas B Gevaert
- Department of Cardiology, University of Antwerp and University Hospital Antwerp, Antwerp, Belgium
| | - Dominic A Theuns
- Department of Cardiology, Erasmus MC, Rotterdam, The Netherlands
| | - Massimo F Piepoli
- Heart Failure Unit, G. da Saliceto Hospital, AUSL Piacenza and University of Parma, Parma, Italy
| | - Rona Reibis
- Department of Rehabilitation Medicine, Faculty of Health Sciences Brandenburg, University of Potsdam, Potsdam, Germany.,Cardiac Outpatient Clinic Am Park Sanssouci, Potsdam, Germany
| | - Jean Paul Schmid
- Department of Cardiology, Clinic Barmelweid, Erlinsbach, Switzerland
| | - Matthias Wilhelm
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Hein Heidbuchel
- Department of Cardiology, University of Antwerp and University Hospital Antwerp, Antwerp, Belgium
| | - Heinz Völler
- Department of Rehabilitation Medicine, Faculty of Health Sciences Brandenburg, University of Potsdam, Potsdam, Germany.,Klinik am See, Rehabilitation Centre for Internal Medicine, Rüdersdorf, Germany
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14
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Legendre A, Moatemri F, Kovalska O, Balice-Pasquinelli M, Blanchard JC, Lamar-Tanguy A, Ledru F, Cristofini P, Iliou MC. Responses to exercise training in patients with heart failure. Analysis by oxygen transport steps. Int J Cardiol 2021; 330:120-127. [PMID: 33571565 DOI: 10.1016/j.ijcard.2021.02.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 01/09/2021] [Accepted: 02/03/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Exercise training (ET) increases exercise tolerance, improves quality of life and likely the prognosis in heart failure patients with reduced ejection fraction (HFrEF). However, some patients do not improve, whereas exercise training response is still poorly understood. Measurement of cardiac output during cardiopulmonary exercise test might allow ET response assessment according to the different steps of oxygen transport. METHODS Fifty-three patients with HFrEF (24 with ischemic cardiomyopathy (ICM) and 29 with dilated cardiomyopathy (DCM) had an aerobic ET. Before and after ET program, peak oxygen consumption (VO2peak) and cardiac output using thoracic impedancemetry were measured. Oxygen convection (QO2peak) and diffusion (DO2) were calculated using Fick's principle and Fick's simplified law. Patients were considered as responders if the gain was superior to 10%. RESULTS We found 55% VO2peak responders, 62% QO2peak responders and 56% DO2 responders. Four patients did not have any response. None baseline predictive factor for VO2peak response was found. QO2peak response was related to exercise stroke volume (r = 0.84), cardiac power (r = 0.83) and systemic vascular resistance (SVRpeak) (r = -0.42) responses. Cardiac power response was higher in patients with ICM than in those with DCM (p < 0.05). Predictors of QO2peak response were low baseline exercise stroke volume and ICM etiology. Predictors of DO2 response were higher baseline blood creatinine and prolonged training. CONCLUSION The analysis of the response to training in patients with HFrEF according to the different steps of oxygen transport revealed different phenotypes on VO2peak responses, namely responses in either oxygen convection and/or diffusion.
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Affiliation(s)
- Antoine Legendre
- M3C-Necker, Congenital and Pediatric Cardiology, Hôpital Universitaire Necker-Enfants Malades, Paris, France; Adult Congenital Heart Disease Unit, Cardiology Department, Hôpital Européen Georges Pompidou, Centre de référence des Malformations Cardiaques Congénitales Complexes, M3C, Assistance Publique-Hôpitaux de Paris, Paris, France..
| | - Feriel Moatemri
- Cardiac Rehabilitation and Secondary Prevention Department, Corentin Celton Hospital, APHP Centre University of Paris, Issy les Moulineaux, France
| | - Oksana Kovalska
- Cardiac Rehabilitation and Secondary Prevention Department, Corentin Celton Hospital, APHP Centre University of Paris, Issy les Moulineaux, France
| | - Maria Balice-Pasquinelli
- Cardiac Rehabilitation and Secondary Prevention Department, Corentin Celton Hospital, APHP Centre University of Paris, Issy les Moulineaux, France
| | - Jean-Christophe Blanchard
- Cardiac Rehabilitation and Secondary Prevention Department, Corentin Celton Hospital, APHP Centre University of Paris, Issy les Moulineaux, France
| | - Aurelia Lamar-Tanguy
- Cardiac Rehabilitation and Secondary Prevention Department, Corentin Celton Hospital, APHP Centre University of Paris, Issy les Moulineaux, France
| | - François Ledru
- Cardiac Rehabilitation and Secondary Prevention Department, Corentin Celton Hospital, APHP Centre University of Paris, Issy les Moulineaux, France
| | - Pascal Cristofini
- Cardiac Rehabilitation and Secondary Prevention Department, Corentin Celton Hospital, APHP Centre University of Paris, Issy les Moulineaux, France
| | - Marie-Christine Iliou
- Cardiac Rehabilitation and Secondary Prevention Department, Corentin Celton Hospital, APHP Centre University of Paris, Issy les Moulineaux, France
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15
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González-Salvado V, Peña-Gil C, Lado-Baleato Ó, Cadarso-Suárez C, Prada-Ramallal G, Prescott E, Wilhelm M, Eser P, Iliou MC, Zeymer U, Ardissino D, Bruins W, van der Velde AE, Van't Hof AWJ, de Kluiver EP, Kolkman EK, Prins L, González Juanatey JR. Offering, participation and adherence to cardiac rehabilitation programmes in the elderly: a European comparison based on the EU-CaRE multicentre observational study. Eur J Prev Cardiol 2021; 28:558-568. [PMID: 33558875 DOI: 10.1093/eurjpc/zwaa104] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 06/28/2020] [Accepted: 10/10/2020] [Indexed: 12/16/2022]
Abstract
AIMS Cardiac rehabilitation (CR) is strongly recommended but participation of elderly patients has not been well characterized. This study aims to analyse current rates and determinants of CR referral, participation, adherence, and compliance in a contemporary European cohort of elderly patients. METHODS AND RESULTS The EU-CaRE observational study included data from consecutive patients aged ≥ 65 with acute coronary syndrome, revascularization, stable coronary artery disease, or heart valve replacement, recruited in eight European centres. Rates and factors determining offering, participation, and adherence to CR programmes and compliance with training sessions were studied across centres, under consideration of extensive-outpatient vs. intensive-inpatient programmes. Three thousand, four hundred, and seventy-one patients were included in the offering and participation analysis. Cardiac rehabilitation was offered to 80.8% of eligible patients, formal contraindications being the main reason for not offering CR. Mean participation was 68.0%, with perceived lack of usefulness and transport issues being principal barriers. Mean adherence to CR programmes of participants in the EU-CaRE study (n = 1663) was 90.3%, with hospitalization/physical impairment as principal causes of dropout. Mean compliance with training sessions was 86.1%. Older age was related to lower offering and participation, and comorbidity was associated with lower offering, participation, adherence, and compliance. Intensive-inpatient programmes displayed higher adherence (97.1% vs. 85.9%, P < 0.001) and compliance (full compliance: 66.0% vs. 38.8%, P < 0.001) than extensive-outpatient programmes. CONCLUSION In this European cohort of elderly patients, older age and comorbidity tackled patients' referral and uptake of CR programmes. Intensive-inpatient CR programmes showed higher completion than extensive-outpatient CR programmes, suggesting this formula could suit some elderly patients.
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Affiliation(s)
- Violeta González-Salvado
- Department of Cardiology, University Hospital of Santiago de Compostela, SERGAS, IDIS (CIBER-CV), A Choupana s/n, 15706 Santiago de Compostela (A Coruña), Spain
| | - Carlos Peña-Gil
- Department of Cardiology, University Hospital of Santiago de Compostela, SERGAS, IDIS (CIBER-CV), A Choupana s/n, 15706 Santiago de Compostela (A Coruña), Spain
| | - Óscar Lado-Baleato
- Department of Statistics, Mathematical Analysis and Optimization, Universidade de Santiago de Compostela, Santiago de Compostela, Spain
| | - Carmen Cadarso-Suárez
- Department of Statistics, Mathematical Analysis and Optimization, Universidade de Santiago de Compostela, Santiago de Compostela, Spain
| | - Guillermo Prada-Ramallal
- Epidemiology, Statistics and Research Methodology Unit, Santiago de Compostela Institute for Research Foundation (FIDIS), Santiago de Compostela, Spain
| | - Eva Prescott
- Department of Cardiology, Bispebjerg Frederiksberg University Hospital, Copenhagen, Denmark
| | - Matthias Wilhelm
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Prisca Eser
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Marie-Christine Iliou
- Department of Cardiac Rehabilitation, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Uwe Zeymer
- Institut für Herzinfarktforschung Ludwigshafen, Ludwigshafen, Germany
| | - Diego Ardissino
- Department of Cardiology, Parma University Hospital, Parma, Italy
| | | | - Astrid E van der Velde
- Department of Cardiology, Cardiovascular Research Institute Maastricht, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Arnoud W J Van't Hof
- Isala Heart Centre, Zwolle, The Netherlands.,Department of Cardiology, Cardiovascular Research Institute Maastricht, Maastricht University Medical Center, Maastricht, The Netherlands.,Department of Cardiology, Zuyderland Medical Center, Heerlen, The Netherlands
| | | | | | | | - José Ramón González Juanatey
- Department of Cardiology, University Hospital of Santiago de Compostela, SERGAS, IDIS (CIBER-CV), A Choupana s/n, 15706 Santiago de Compostela (A Coruña), Spain
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16
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Pedretti RFE, Iliou MC, Israel CW, Abreu A, Miljoen H, Corrà U, Stellbrink C, Gevaert AB, Theuns DA, Piepoli MF, Reibis R, Schmid JP, Wilhelm M, Heidbuchel H, Völler H, Ambrosetti M, Deneke T, Cornelissen V, R Heinzel F, Davos CH, Kudaiberdieva G, Frederix I, Svendsen JH, Hansen D. Comprehensive multicomponent cardiac rehabilitation in cardiac implantable electronic devices recipients: a consensus document from the European Association of Preventive Cardiology (EAPC; Secondary prevention and rehabilitation section) and European Heart Rhythm Association (EHRA). Eur J Prev Cardiol 2021; 28:1736-1752. [PMID: 34038513 DOI: 10.1093/eurjpc/zwaa121] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 10/25/2020] [Accepted: 11/02/2020] [Indexed: 12/13/2022]
Abstract
Cardiac rehabilitation (CR) is a multidisciplinary intervention including patient assessment and medical actions to promote stabilization, management of cardiovascular risk factors, vocational support, psychosocial management, physical activity counselling, and prescription of exercise training. Millions of people with cardiac implantable electronic devices live in Europe and their numbers are progressively increasing, therefore, large subsets of patients admitted in CR facilities have a cardiac implantable electronic device. Patients who are cardiac implantable electronic devices recipients are considered eligible for a CR programme. This is not only related to the underlying heart disease but also to specific issues, such as psychological adaptation to living with an implanted device and, in implantable cardioverter-defibrillator patients, the risk of arrhythmia, syncope, and sudden cardiac death. Therefore, these patients should receive special attention, as their needs may differ from other patients participating in CR. As evidence from studies of CR in patients with cardiac implantable electronic devices is sparse, detailed clinical practice guidelines are lacking. Here, we aim to provide practical recommendations for CR in cardiac implantable electronic devices recipients in order to increase CR implementation, efficacy, and safety in this subset of patients.
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Affiliation(s)
- Roberto F E Pedretti
- Cardiovascular Department, IRCCS MultiMedica, Care and Research Institute, Via Milanese 300, Sesto San Giovanni, Milano 20099, Italy
| | - Marie-Christine Iliou
- Department of Cardiac Rehabilitation and Secondary Prevention, Hôpital Corentin Celton, Assistance Pulique Hopitaux de Paris centre-Universite de Paris, France
| | - Carsten W Israel
- Department of Cardiology, Bethel Clinic, J.W. Goethe University, Frankfurt, Germany
| | - Ana Abreu
- Servico de Cardiologia, Hospital Universitário de Santa Maria/Centro Hospitalar Universitário Lisboa Norte (CHULN), Centro Academico de Medicina de Lisboa (CAML), Centro Cardiovascular da Universidade de Lisboa (CCUL), Faculdade de Medicina, Universidade de Lisboa, Portugal
| | - Hielko Miljoen
- Department of Cardiology, University of Antwerp and University Hospital Antwerp, and Antwerp University, Antwerp, Belgium
| | - Ugo Corrà
- Department of Cardiac Rehabilitation, ICS Maugeri Care and Research Institute, Veruno, Novara, Italy
| | - Christoph Stellbrink
- Department of Cardiology and Intensive Care Medicine, Klinikum Bielefeld GmbH, Bielefeld, Germany
| | - Andreas B Gevaert
- Department of Cardiology, University of Antwerp and University Hospital Antwerp, and Antwerp University, Antwerp, Belgium
| | - Dominic A Theuns
- Department of Cardiology, Erasmus MC, Rotterdam, The Netherlands
| | - Massimo F Piepoli
- Heart Failure Unit, G. da Saliceto Hospital, AUSL Piacenza and University of Parma, Parma, Italy
| | - Rona Reibis
- Department of Rehabilitation Medicine, Faculty of Health Sciences Brandenburg, University of Potsdam, Potsdam, Germany.,Cardiac Outpatient Clinic Am Park Sanssouci, Potsdam, Germany
| | - Jean Paul Schmid
- Department of Cardiology, Clinic Barmelweid, Erlinsbach, Switzerland
| | - Matthias Wilhelm
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Hein Heidbuchel
- Department of Cardiology, University of Antwerp and University Hospital Antwerp, and Antwerp University, Antwerp, Belgium
| | - Heinz Völler
- Department of Rehabilitation Medicine, Faculty of Health Sciences Brandenburg, University of Potsdam, Potsdam, Germany.,Klinik am See, Rehabilitation Centre for Internal Medicine, Rüdersdorf, Germany
| | | | - Marco Ambrosetti
- Cardiovascular Rehabilitation Unit, ASST Crema, Santa Marta Hospital, Rivolta d'Adda, Italy
| | - Thomas Deneke
- Heart Center Rhön-Klinikum Campus Bad Neustadt, Bad Neustadt, Germany
| | - Veronique Cornelissen
- Cardiovascular Exercise Physiology Unit, Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
| | - Frank R Heinzel
- Department of Cardiology, Charité-Universitaetsmedizin Berlin, Campus Virchow-Klinikum, Berlin, Germany.,Berlin Institute of Health, Berlin, Germany
| | - Constantinos H Davos
- Cardiovascular Research Laboratory, Biomedical Research Foundation, Academy of Athens, Athens, Greece
| | - Gulmira Kudaiberdieva
- SRI of Heart Surgery and Organ Transplantation, Center Scientific Research and Development of Education, Bishkek Kyrgyzstan, Adana, Turkey
| | - Ines Frederix
- Hasselt University, Faculty of Medicine & Life Sciences, Hasselt, Belgium.,Antwerp University, Faculty of Medicine & Health Sciences, Antwerp, Belgium.,Department of Cardiology, Jessa Hospital, Hasselt, Belgium.,Intensive Care Unit, Antwerp University Hospital, Edegem, Belgium
| | - Jesper Hastrup Svendsen
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.,Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Dominique Hansen
- Heart Centre Hasselt, Jessa Hospital, Hasselt, Belgium.,Faculty of Medicine and Life Sciences, UHasselt, BIOMED-REVAL-Rehabilitation Research Centre, Hasselt University, Hasselt, Belgium
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17
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Iliou MC. Algorithme pour décider de la reprise du travail après syndrome coronaire aigu. ARCH MAL PROF ENVIRO 2020. [DOI: 10.1016/j.admp.2020.03.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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18
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Eser P, Marcin T, Prescott E, Prins LF, Kolkman E, Bruins W, van der Velde AE, Peña-Gil C, Iliou MC, Ardissino D, Zeymer U, Meindersma EP, Van'tHof AWJ, de Kluiver EP, Laimer M, Wilhelm M. Clinical outcomes after cardiac rehabilitation in elderly patients with and without diabetes mellitus: The EU-CaRE multicenter cohort study. Cardiovasc Diabetol 2020; 19:37. [PMID: 32192524 PMCID: PMC7081600 DOI: 10.1186/s12933-020-01013-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2020] [Accepted: 03/09/2020] [Indexed: 12/22/2022] Open
Abstract
Background The prevalence of patients with concomitant cardiovascular disease and diabetes mellitus (DM) is increasing rapidly. We aimed to compare the effectiveness of current cardiac rehabilitation (CR) programs across seven European countries between elderly cardiac patients with and without DM. Methods 1633 acute and chronic coronary artery disease (CAD) patients and patients after valve intervention with an age 65 or above who participated in comprehensive CR (3 weeks to 3 months, depending on centre) were included. Peak oxygen uptake (VO2 peak), body mass index, resting systolic blood pressure, low-density lipoprotein-cholesterol (LDL-C), and glycated haemoglobin (HbA1c) were assessed before start of CR, at termination of CR (variable time point), and 12 months after start of CR, with no intervention after CR. Baseline values and changes from baseline to 12-month follow-up were compared between patients with and without DM using mixed models, and mortality and hospitalisation rates using logistic regression. Results 430 (26.3%) patients had DM. Patients with DM had more body fat, lower educational level, more comorbidities, cardiovascular risk factors, and more advanced CAD. Both groups increased their VO2 peak over the study period but with a significantly lower improvement from baseline to follow-up in patients with DM. In the DM group, change in HbA1c was associated with weight change but not with change in absolute VO2 peak. 12-month cardiac mortality was higher in patients with DM. Conclusions While immediate improvements in VO2 peak after CR in elderly patients with and without DM were similar, 12-month maintenance of this improvement was inferior in patients with DM, possibly related to disease progression. Glycemic control was less favourable in diabetic patients needing insulin in the short- and long-term. Since glycemic control was only related to weight loss but not to increase in exercise capacity, this highlights the importance of weight loss in obese DM patients during CR. Trial registration NTR5306 at trialregister.nl; trial registered 07/16/2015; https://www.trialregister.nl/trial/5166
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Affiliation(s)
- Prisca Eser
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Thimo Marcin
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Eva Prescott
- Department of Cardiology, Bispebjerg Frederiksberg University Hospital, Copenhagen, Denmark
| | | | | | | | | | - Carlos Peña-Gil
- Department of Cardiology, Hospital Clínico Universitario de Santiago, SERGAS, FIDIS, CIBER CV, University of Santiago de Compostela, Santiago, Spain
| | - Marie-Christine Iliou
- Department of Cardiac Rehabilitation, Assistance Publique Hopitaux de Paris, Paris, France
| | - Diego Ardissino
- Department of Cardiology, Parma University Hospital, Parma, Italy
| | - Uwe Zeymer
- Klinikum Ludwigshafen and Institut für Herzinfarktforschung Ludwigshafen, Ludwigshafen, Germany
| | - Esther P Meindersma
- Isala Heart Centre, Zwolle, The Netherlands.,Department of Cardiology, Radboud University, Nijmegen, The Netherlands
| | - Arnoud W J Van'tHof
- Isala Heart Centre, Zwolle, The Netherlands.,Department of Cardiology, Maastricht University Medical Centre, Maastricht, The Netherlands.,Department of Cardiology, Zuyderland Medical Centre, Heerlen, The Netherlands
| | | | - Markus Laimer
- Department of Diabetes, Endocrinology, Clinical Nutrition & Metabolism (UDEM), Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Matthias Wilhelm
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
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19
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Kjesbu I, Mikkelsen N, Sibilitz K, Wilhelm M, Gil CP, Iliou MC, Zeymer U, Meindersma EP, Ardissino D, Van Der Velde AE, Van't Hof AWJ, De Kluiver EP, Prescott E. P6218Greater burden of risk factors and need of cardiac rehabilitation in elderly patients with lower educational attainment. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.0822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
A socioeconomic gap in cardiac rehabilitation (CR) has been described in younger populations but whether this is also true in the ageing population is unknown.
Purpose
To describe if poorer education is a predictor for exercise capacity, comorbidity, lifestyle- and risk factors and medical treatment at baseline in CR in an elderly population.
Methods
The observational EU-CaRE study is a European prospective study with eight participating CR centers in seven countries (Denmark, France, Germany, the Netherlands, Italy, Spain and Switzerland). Patients aged 65 or older with CHD or valve surgery participating in CR were consecutively included. Educational attainment was divided into basic, intermediate and high
Results
A total of 1626 patients were included. Educational attainment differed across centers (p<0.001). The groups differed little regarding index event, comorbidity and medical treatment. However, patients with only basic education had more diabetes, higher BMI, less physical activity, lower exercise capacity and higher scores for depression (PHQ 9) and anxiety (GAD). Differences were not affected by adjustment for age, gender and country.
Demographics and risk factor control N=1626 High (N=388) Intermediate (N=788) Basic (N=460) p-value* DEMOGRAPHICS Age (yrs), median (IQR) 72 (68, 76) 71 (68, 75) 74 (70, 78) <0.001 Men 330 (86.8%) 603 (79.3%) 291 (67.4%) <0.001 RISK FACTORS p-value** LDL >1.8 mmol/l*** 255 (66.1%) 518 (66.8%) 293 (63.7%) 0.060 Systolic BP >140 mmHg 85 (22.0%) 179 (23.1%) 100 (21.7%) 0.601 Smoker 26 (6.8%) 80 (10.3%) 46 (10.0%) 0.214 Moderate exercise <4days/week 179 (46.4%) 340 (43.9%) 271 (58.9%) 0.024 BMI >27 kg/m2 133 (35.5%) 389 (50.2%) 255 (55.4%) <0.001 VO2 peak <80% of predicted 220 (57.0%) 443 (57.2%) 252 (54.8%) 0.037 HbA1c >48mmol/mol*** 115 (29.8%) 264 (34.1%) 230 (50.0%) <0.001 Diet score, mean (SD) 6.50 (2.28) 5.93 (2.47) 7.32 (2.35) <0.001 GAD score, median (IQR) 2.0 (0.0,4.0) 2.0 (0.0,5.0) 3.5 (0.0,7.0) 0.051 PHQ-9 score, median (IQR) 4.0 (1.0,7.0) 4.0 (1.0,7.0) 6.0 (2.0,10.0) 0.020 Abbreviations: IQR, interquartile range; SD, standard deviation; ACS, acute coronary syndrome; CAD, coronary artery disease. *Adjusted for center. **Adjusted for center, age, gender. ***Only for ischemic heart disease patients.
Conclusions
The results emphasize the need of CR in this patient-group and that a targeted CR approach should be considered to achieve equal health opportunities also in the elderly.
Acknowledgement/Funding
Horizon2020
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Affiliation(s)
- I Kjesbu
- Bispebjerg University Hospital, Copenhagen, Denmark
| | - N Mikkelsen
- Bispebjerg University Hospital, Copenhagen, Denmark
| | - K Sibilitz
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology, Copenhagen, Denmark
| | - M Wilhelm
- University of Bern, University Clinic of Cardiology, Inelspital, Bern, Switzerland
| | - C P Gil
- University Hospital of Santiago de Compostela, Department of Cardiology, Santiago de Compostela, Spain
| | - M C Iliou
- University Paris-Descartes, Assistance Publique Hopitaux, Department of Cardiac Rehabilitation, Paris, France
| | - U Zeymer
- Stiftung Institut für Herzinfarktforschung, Ludwigshafen, Germany
| | - E P Meindersma
- Radboud University Medical Centre, Department of Cardiology, Nijmegen, Netherlands (The)
| | - D Ardissino
- University Hospital of Parma, Department of Cardiology, Parma, Italy
| | | | | | | | - E Prescott
- Bispebjerg University Hospital, Copenhagen, Denmark
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20
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De Kluiver EP, Van Der Velde AE, Meindersma EP, Prins LF, Wilhelm M, Iliou MC, Pena Gil C, Gonzalez-Juanatey JR, Snoek JA, Kolkman E, Van't Hof AWJ, Prescott E. P1927A European randomised controlled trial for m-health guided cardiac rehabilitation in the elderly; results of the EU-CaRE RCT study. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0674] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Introduction
Knowledge about effectiveness of cardiac rehabilitation (CR) in the elderly is limited. Participation rates in supervised CR are consistently lower in the elderly and innovative interventions are needed. The EU has granted a CR study project; a randomised controlled trial conducted in 5 European countries, investigating the effectiveness of mobile telemonitoring guided CR (mCR) in elderly cardiac patients who declined regular CR.
Methods
Patients ≥65 years with indication for CR who declined regular CR were eligible for inclusion. Patients were randomised between regular care (without CR) and a 6-month mCR programme: dedicated programmed smartphone, heartrate monitoring (target HR zones) and coaching. The primary endpoint is the difference in VO2peak between 6-months follow-up and baseline.
Results
Between 2015 and 2018 179 patients were included. Baseline characteristics between groups (table 1) did not differ significantly, except for hypertension. The difference in VO2peak was significantly better in the mCR group (table 1). After correction (mixed linear model) for baseline VO2 peak (fixed factor) and centre (random factor) this difference remained significant. Mean number of registered activity sessions was 4.79 (95% CI; 4.07–5.50) per patient per week.
Table 1. Baseline and primary outcome parameters Baseline Control Programme (n=90) mCR Programme (n=89) P-value Gender (m/f) 76/14 69/20 0.238 Age (mean±SD) 73.57±5.46 72.38±5.37 0.121 Diabetes 15 (16.7%) 23 (25.8%) 0.133 Hypertension 60 (66.7%) 73 (82.0%) 0.019* Hypercholesteremia 71 (78.3%) 74 (83.1%) 0.468 Normal LV-function 48/89 (53.9%) 53/89 (59.6%) 0.497 Index event (CABG/Valve/PCI/none) 0.735 Cardiac history prior to index event 48/89 (53.9%) 53/89 (59.6%) 0.702 Non cardiac comorbidity 40 (44.4%) 44 (49.4%) 0.503 Results Baseline VO2peak (ml/kg/min) (95% CI) 19.83 (18.65–21.01) 18.78 (18.67–19.89) 0.191 Delta VO2peak at 6 months (ml/kg/min) (95% CI) 0.20 4 (−0.34–0.83) 1.62 (0.86–2.39) 0.005* Corrected delta VO2peak at 6 months (ml/kg/min) 0.50 (−1.04–2.04) 1.65 (0.11–3.2) 0.015* *Significant.
Conclusions
The application of mCR in elderly patients who declined regular CR results in a better physical condition after 6 months. Compliance to mCR was excellent.
Acknowledgement/Funding
European Union's Horizon 2020 research and innovation programme under grant agreement number 634439, and funding from the Swiss Government.
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Affiliation(s)
| | | | - E P Meindersma
- Radboud University Medical Centre, Nijmegen, Netherlands (The)
| | - L F Prins
- Diagram BV, Zwolle, Netherlands (The)
| | - M Wilhelm
- Preventive Cardiology & Sports Medicine, Inselspital Bern, Bern, Switzerland
| | - M C Iliou
- Assistance Hopiteaux Publique de Paris, Paris, France
| | - C Pena Gil
- University Hospital of Santiago de Compostela, Santiago de Compostela, Spain
| | | | - J A Snoek
- Isala Hospital, Zwolle, Netherlands (The)
| | - E Kolkman
- Diagram BV, Zwolle, Netherlands (The)
| | - A W J Van't Hof
- Maastricht University Medical Centre (MUMC), Maastricht, Netherlands (The)
| | - E Prescott
- Bispebjerg University Hospital, Copenhagen, Denmark
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21
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Kjesbu I, Mikkelsen N, Sibilitz K, Wilhelm M, Gil CP, Iliou MC, Zeymer U, Meindersma EP, Ardissino D, Van Der Velde AE, Van't Hof AWJ, De Kluiver EP, Prescott E. P2509Less effect of cardiac rehabilitation for elderly cardiac patients with lower educational attainment. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Previous analyses from EU-CaRE study have shown that elderly cardiac patients with basic education have a greater burden of cardiovascular risk factors and a lower exercise capacity at baseline of cardiac rehabilitation (CR). We hypothesize that participation in CR will diminish this socioeconomic gap.
Purpose
To describe if educational level predicts the benefits of CR in an elderly population in Europe.
Methods
The observational EU-CaRE study is a prospective study with eight participating CR centers in seven countries (Denmark, France, Germany, the Netherlands, Italy, Spain and Switzerland). Consecutive patients age 65 or older with coronary heart disease or valve surgery participating in CR were included. Data were obtained at baseline (T0) and at the end of CR (T1) and include risk factors for cardiovascular disease, clinical and psychological assessment, medical treatment and exercise capacity. Patients were divided into basic, intermediate and higher educational levels. We compared changes from T0-T1 by multiple regression models.
Results
A total of 1621 (99% of included) patients were eligible for follow-up analyses. At baseline patients with basic education had more diabetes, higher BMI, lower exercise capacity (VO2 peak) and higher scores for depression (GAD) and anxiety (PHQ-9). At T1 they had improved significantly less on these parameters. The results were not affected by adjustment for gender, age, country and baseline value of the variable. Use of evidence-based medication did not differ by level of education.
Difference between T0 and T1 Factor High Intermediate Basic p-value* N total 1621 N=386 N=775 N=460 BMI, mean (SD) −0.16 (0.71) −0.08 (0.82) −0.26 (0.95) 0.794 LDL (mmol/L), mean (SD) −0.07 (0.63) −0.11 (0.62) −0.04 (0.58) 0.978 HbA1c (mmol/mol), mean (SD) 0.23 (3.70) 0.52 (4.39) 0.04 (5.79) 0.021 GAD score, mean (SD) −0.92 (2.72) −0.76 (3.07) −0.13 (3.47) 0.003 PHQ-9 score, mean (SD) −1.45 (3.21) −1.16 (3.36) −0.93 (4.49) <0.001 Diet score, mean (SD) 0.57 (1.72) 0.63 (1.90) 0.23 (1.81) 0.003 VO2 peak (ml/kg/min), mean (SD) 2.47 (2.90) 1.95 (2.78) 1.75 (2.56) 0.016 *Adjusted for gender, age, country and baseline value.
Difference in VO2peak, GAD and PHQ score
Conclusions
In this large European study with high-quality data from 7 CR centers we found an increased gap disfavoring the lower educated elderly patients participating in CR. These results indicate that “one-size cardiac rehabilitation” does not fit all and indicate that a more personalized CR with attention to the different needs of some patient groups is appropriate.
Acknowledgement/Funding
Horizon2020
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Affiliation(s)
- I Kjesbu
- Bispebjerg University Hospital, Copenhagen, Denmark
| | - N Mikkelsen
- Bispebjerg University Hospital, Copenhagen, Denmark
| | - K Sibilitz
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology, Copenhagen, Denmark
| | - M Wilhelm
- University of Bern, University Clinic of Cardiology, Inelspital, Bern, Switzerland
| | - C P Gil
- University Hospital of Santiago de Compostela, Department of Cardiology, Santiago de Compostela, Spain
| | - M C Iliou
- University Paris-Descartes, Assistance Publique Hopitaux, Department of Cardiac Rehabilitation, Paris, France
| | - U Zeymer
- Stiftung Institut für Herzinfarktforschung, Ludwigshafen, Germany
| | - E P Meindersma
- Radboud University Medical Centre, Department of Cardiology, Nijmegen, Netherlands (The)
| | - D Ardissino
- University Hospital of Parma, Department of Cardiology, Parma, Italy
| | | | | | | | - E Prescott
- Bispebjerg University Hospital, Copenhagen, Denmark
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22
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Pena-Gil C, Prada-Ramallal G, Gonzalez-Salvado V, Sestayo-Fernandez M, Lado-Baleato O, Cadarso-Suarez C, Prescott E, Wilhelm M, Iliou MC, Zeymer U, Ardissino D, Van Der Velde AE, Van 'T Hof AWJ, De Kluiver EP, Gonzalez-Juanatey JR. P2513Offer and participation in different European cardiac rehabilitation programs in the elderly after ACS or coronary revascularization. The EU-CaRE study. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Cardiac rehabilitation programs (CRP) are strongly recommended after acute coronary syndrome (ACS) or coronary revascularization (PCI or CABG), but actual offer and participation among elderly patients (age ≥65) have not been well characterised.
Purpose
To analyse current offer and participation rates in different European CRP in elderly patients.
Methods
Data from elderly patients recruited for CRP, after ACS, PCI or CABG, in centres from seven European countries participating in the EU-CaRE study (NTR5306), were analysed.
Results
3471 patients were screened, of whom 80.9% (n=2806) were offered participation and 68.0% of these (n=1908) agreed to participate in a CRP.
Outpatient CRP were offered to 73–92% of screened patients. Among reasons for not offering the program were contraindications and geographical conditions. Patients who were not offered were mainly older, with worse cardiovascular risk profile and comorbidities. In the multivariable analysis main variables related with offering in Copenhagen were age (OR=0.92, CI95% 0.87–0.98), gender (male, OR=2.42, CI95% 1.10–5.31) and previous CABG (OR=0.12, CI95% 0.04–0.36). In Bern, age (OR=0.89, CI95% 0.85–0.93), ACS (OR=1.85, CI95% 1.01–3.54) and smoking status (OR=0.47, CI95% 0.24–0.93). In Zwolle, age (OR=0.89, CI95% 0.91–0.97), CABG (OR=4.34, CI95% 1.37->10), smoking status (OR=0.23, CI95% 0.06–1.11), diabetes mellitus (OR=0.33, CI95% 0.13–0.91) and comorbidities (i.e. obstructive pulmonary disease). In Santiago, age (OR=0.83, CI95% 0.73–0.91), index event PCI (OR=14.21, CI95% 3.68->10) and rheumatoid arthritis.
The ratio of participation among those who were offered the program varied from 46% to 94% (46% to 67% in outpatients' programs). Main reasons for not participating were patients considered that it was not useful (366, 10.5%), travel distance (205, 5.8%), transport difficulties (134, 3.8%) and exercises on own initiative (70, 2.0%). In a center-specific analysis we performed predictive models of participation. In Copenhagen (AUC=0.69) the main variables predicting participation were age (OR=0.99, CI95% 0.96–1.03), not living alone (OR=1.53, CI95% 0.96–2.42), CABG (OR=2.69, CI95% 1.51–4.80) and comorbidities. In Bern (AUC=0.81), age (OR=0.92, CI95% 0.89–0.95), ACS (OR=3.99, CI95% 2.56–6.20) and peripheral artery disease. In Zwolle (AUC=0.71), age (OR=0.94, CI95% 0.91–0.98), employment status (OR=0.28, CI95% 0.13–0.60), CABG (OR=3.62, CI95% 2.28–5.77) and previous ACS (OR=0.58, CI95% 0.35–0.95). In Santiago (AUC=0.85), age (OR=0.95, CI95% 0.90–0.99), rural habitat (OR=0.58, CI95% 0.32–1.04), valvulopathy (OR=0.33, CI95% 0.14–0.79) and the index intervention PCI.
Conclusions
Knowing reasons (travel distance, usefulness of the program understood by patient) and variables (age, living alone or in rural area) that determine if CRP is offered and whether or not patients participate will help redesign CRP to better adapt to actual needs of an elderly European population.
Acknowledgement/Funding
This project has received funding from the European Union's Horizon 2020 research and innovation programme under grant agreement number 634439
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Affiliation(s)
- C Pena-Gil
- University Hospital of Santiago de Compostela, Department of Cardiology, Santiago de Compostela, Spain
| | - G Prada-Ramallal
- University Hospital of Santiago de Compostela, Department of Cardiology, Santiago de Compostela, Spain
| | - V Gonzalez-Salvado
- University Hospital of Santiago de Compostela, Department of Cardiology, Santiago de Compostela, Spain
| | - M Sestayo-Fernandez
- University Hospital of Santiago de Compostela, Department of Cardiology, Santiago de Compostela, Spain
| | - O Lado-Baleato
- University of Santiago de Compostela, School of Medicine, Biostatistics Unit, Santiago de Compostela, Spain
| | - C Cadarso-Suarez
- University of Santiago de Compostela, School of Medicine, Biostatistics Unit, Santiago de Compostela, Spain
| | - E Prescott
- Frederiksberg University Hospital, Department of Cardiology, Frederiksberg, Denmark
| | - M Wilhelm
- Bern University Hospital, Preventive Cardiology & Sports Medicine, University Clinic for Cardiology, Inselspital, Bern, Switzerland
| | - M C Iliou
- Paris Region Hospitals, Assistance Publique Hopitaux de Paris, Department of Cardiac Rehabilitation, Paris, France
| | - U Zeymer
- Stiftung Institut für Herzinfarktforschung, Ludwigshafen, Germany
| | - D Ardissino
- University Hospital of Parma, Department of Cardiology, Parma, Italy
| | | | | | - E P De Kluiver
- Isala Clinics, Isala Heart Centre, Zwolle, Netherlands (The)
| | - J R Gonzalez-Juanatey
- University Hospital of Santiago de Compostela, Department of Cardiology, Santiago de Compostela, Spain
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Prescott E, Prisca E, Mikkelsen N, Iliou MC, Wilhelm M, Van't Hof A, Zeymer U, Ardissino D, Meindersma E, Van Der Velde A, Pena Gil C, De Kluiver E. P1557Sustainable effectiveness of cardiac rehabilitation in elderly patients in 7 European countries: main results from the EU-CARE study. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
The EU-CaRE project aims to obtain the evidence base to improve, tailor and optimise cardiac rehabilitation (CR) programmes regarding sustainable effectiveness, cost-effectiveness and participation level in the elderly.
Purpose
To compare the effect of CR programmes in 7 European countries on the main outcome.
Methods
The observational EU-CaRE study is a prospective study with eight participating CR sites in seven countries (Denmark, France, Germany, Italy, the Netherlands, Spain and Switzerland). Consecutive patients age 65 or older with coronary heart disease or valve surgery undergoing CR were included. Data were obtained at baseline (T0), at the end of CR (T1) and at 1 year (T2). VO2peak was assessed by cardiopulmonary exercise test. We compared changes in VO2peak across sites in multilevel regression models for repeated measures, adjusting for age, gender, baseline VO2peak, comorbidities, CVD risk factors and educational attainment. Results are reported separately for patients undergoing surgery (CABG/valve replacement) and other indications (MI/stable CAD/PCI).
Results
1633 patients were included, and VO2peak was available at all three timepoints for 1243 patients (76%), 492 undergoing surgery and 751 for other indications. Lag time from index event to first CPET and baseline VO2peak varied significantly across centres. Mean age was 72.9 (range 65–90), mean VO2peak at T0 was 16.49 (SD 4.94), at T1, 18.55 (5.33) and at T2 19.03 (5.43) ml/kg/min.
For patients not undergoing surgery mean improvement T0-T1 was 1.57 (2.98) and T0-T2 was 1.40 (3.17) ml/kg/min (both p<0.001). In the surgery patients as expected baseline VO2peak was lower but in contrast to non-surgery continued to improve after CR: T0-T1 improvement was 2.77 (2.76) and T0-T2 improvement was 4.29 (3.83) (both p<0.001). At one-year follow-up surgery and non-surgery patients had similar VO2peak (p=0.59). The greatest mean improvement in a site from baseline to one year was 2.04 (3.74) and the smallest 0.59 (2.54) ml/kg/min for non-surgery and, correspondingly 6.13 (4.83) and 1.29 (2.06) ml/kg/min for surgery patients (both multivariable adjusted p for differences between sites p<0.001).
In addition to age and gender, baseline and one-year VO2peak was lower in patients with diabetes, hypertension, smokers, patients with other co-morbidity, lower educational attainment and lower mental component score of the SF36. These factors had no systematic impact on the effect of CR.
VO2peak at baseline, after CR and 1 year
Conclusions
The study provides high-quality data on the effectiveness of current CR programmes in Western Europe. Overall, CR was effective in achieving significant improvements in exercise and maintaining these effects. There were significant differences in effect between sites indicating a potential for improvement by adapting CR programs.
Acknowledgement/Funding
Horizon 2020
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Affiliation(s)
- E Prescott
- Bispebjerg Hospital of the Copenhagen University Hospital, Department of Cardiology, Copenhagen, Denmark
| | - E Prisca
- Bern University Hospital, Preventive Cardiology & Sports Medicine, Bern, Switzerland
| | - N Mikkelsen
- Bispebjerg Hospital of the Copenhagen University Hospital, Department of Cardiology, Copenhagen, Denmark
| | - M C Iliou
- Assistance Publique Hopitaux de Paris, Department of Cardiac Rehabilitation, Paris, France
| | - M Wilhelm
- Bern University Hospital, Preventive Cardiology & Sports Medicine, Bern, Switzerland
| | - A Van't Hof
- Maastricht University Medical Centre (MUMC), Department of Cardiology, Maastricht, Netherlands (The)
| | - U Zeymer
- Maastricht University Medical Centre (MUMC), Department of Cardiology, Maastricht, Netherlands (The)
| | - D Ardissino
- University Hospital of Parma, Department of Cardiology, Parma, Italy
| | - E Meindersma
- Radboud University Center, Department of Cardiology, Radboud, Netherlands (The)
| | | | - C Pena Gil
- University Hospital of Santiago de Compostela, Department of Cardiology, Santiago de Compostela, Spain
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Zores F, Iliou MC, Gellen B, Kubas S, Berthelot E, Guillo P, Bauer F, Lamblin N, Bosser G, Damy T, Cohen-Solal A, Beauvais F. Physical activity for patients with heart failure: Position paper from the heart failure (GICC) and cardiac rehabilitation (GERS-P) Working Groups of the French Society of Cardiology. Arch Cardiovasc Dis 2019; 112:723-731. [PMID: 31542331 DOI: 10.1016/j.acvd.2019.07.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Revised: 07/02/2019] [Accepted: 07/22/2019] [Indexed: 12/12/2022]
Abstract
Physical activity is important in heart failure to improve functional capacity, quality of life and prognosis, and is a class IA recommendation in the European Society of Cardiology guidelines (Ponikowski et al., 2016). The benefits of exercise training are widely recognized. Cardiac rehabilitation centres offer tailored exercise training to patients with heart failure, as part of specialized multidisciplinary care, alongside pharmacological treatment optimization and patient education. After cardiac rehabilitation, maintenance of regular physical activity long term is essential, as the benefits of exercise training vanish within a few weeks. Unfortunately, only 10% of patients benefit from a cardiac rehabilitation programme after hospitalization for acute heart failure, and the majority of patients do not pursue long-term physical activity. In this paper, two Working Groups of the French Society of Cardiology (the heart failure group [Groupe Insuffisance Cardiaque et Cardiomyopathies; GICC] and the cardiac rehabilitation group [Groupe Exercice Réadaptation Sport et Prévention; GERS-P]) discuss the obstacles to broader access to cardiac rehabilitation centres, and propose ways to improve the diffusion of cardiac rehabilitation programmes and encourage long-term adherence to physical activity.
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Affiliation(s)
- Florian Zores
- Groupe médical spécialisé, 67000 Strasbourg, France.
| | - Marie-Christine Iliou
- Service de réadaptation cardiaque et prévention secondaire, hôpital Corentin-Celton, AP-HP, 92130 Issy-les-Moulineaux, France
| | | | | | - Emmanuelle Berthelot
- Pôle Thorax, service de cardiologie, hôpital Bicêtre, AP-HP, 94270 Le-Kremlin-Bicêtre, France
| | | | - Fabrice Bauer
- Service de cardiologie, CHU de Rouen, 76000 Rouen, France
| | - Nicolas Lamblin
- Inserm, institut Pasteur, U1167, université de Lille, CHU de Lille, 59000 Lille, France
| | - Gilles Bosser
- Cardiology Department, University Hospital, 54511 Vandoeuvre-lès-Nancy, France; EA 3450, Development, Adaptation and Disadvantage, Faculty of Medicine, University of Lorraine, 54600 Villers-lès-Nancy, France
| | - Thibaud Damy
- CHU d'Henri-Mondor, AP-HP, 94010 Créteil, France
| | - Alain Cohen-Solal
- UMR-S 942, service de cardiologie, hôpital Lariboisière, université de Paris, AP-HP, 75010 Paris, France
| | - Florence Beauvais
- UMR-S 942, service de cardiologie, hôpital Lariboisière, université de Paris, AP-HP, 75010 Paris, France
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25
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Gabet A, De Peretti C, Iliou MC, Nicolau J, Olié V. National trends in admission for cardiac rehabilitation after a myocardial infarction in France from 2010 to 2014. Arch Cardiovasc Dis 2018; 111:625-633. [DOI: 10.1016/j.acvd.2017.07.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Revised: 05/16/2017] [Accepted: 07/29/2017] [Indexed: 10/18/2022]
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26
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Tea V, Bonaca M, Chamandi C, Iliou MC, Lhermusier T, Aissaoui N, Cayla G, Angoulvant D, Ferrières J, Schiele F, Simon T, Danchin N, Puymirat E. Appropriate secondary prevention and clinical outcomes after acute myocardial infarction according to atherothrombotic risk stratification: The FAST-MI 2010 registry. Eur J Prev Cardiol 2018; 26:411-419. [PMID: 30354737 DOI: 10.1177/2047487318808638] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Full secondary prevention medication regimen is often under-prescribed after acute myocardial infarction. DESIGN The purpose of this study was to analyse the relationship between prescription of appropriate secondary prevention treatment at discharge and long-term clinical outcomes according to risk level defined by the Thrombolysis In Myocardial Infarction (TIMI) Risk Score for Secondary Prevention (TRS-2P) after acute myocardial infarction. METHODS We used data from the 2010 French Registry of Acute ST-Elevation or non-ST-elevation Myocardial Infarction (FAST-MI) registry, including 4169 consecutive acute myocardial infarction patients admitted to cardiac intensive care units in France. Level of risk was stratified in three groups using the TRS-2P score: group 1 (low-risk; TRS-2P=0/1); group 2 (intermediate-risk; TRS-2P=2); and group 3 (high-risk; TRS-2P≥3). Appropriate secondary prevention treatment was defined according to the latest guidelines (dual antiplatelet therapy and moderate/high dose statins for all; new-P2Y12 inhibitors, angiotensin-converting-enzyme inhibitor/angiotensin-receptor-blockers and beta-blockers as indicated). RESULTS Prevalence of groups 1, 2 and 3 was 46%, 25% and 29% respectively. Appropriate secondary prevention treatment at discharge was used in 39.5%, 37% and 28% of each group, respectively. After multivariate adjustment, evidence-based treatments at discharge were associated with lower rates of major adverse cardiovascular events (death, re-myocardial infarction or stroke) at five years especially in high-risk patients: hazard ratio = 0.82 (95% confidence interval: 0.59-1.12, p = 0.21) in group 1, 0.74 (0.54-1.01; p = 0.06) in group 2, and 0.64 (0.52-0.79, p < 0.001) in group 3. CONCLUSIONS Use of appropriate secondary prevention treatment at discharge was inversely correlated with patient risk. The increased hazard related to lack of prescription of recommended medications was much larger in high-risk patients. Specific efforts should be directed at better prescription of recommended treatment, particularly in high-risk patients.
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Affiliation(s)
- Victoria Tea
- 1 Department of Cardiology, Hôpital Européen Georges Pompidou (HEGP), France
| | - Marc Bonaca
- 2 Division of Cardiovascular Medicine, Brigham and Women's Hospital, USA
| | - Chekrallah Chamandi
- 1 Department of Cardiology, Hôpital Européen Georges Pompidou (HEGP), France
| | | | | | | | - Guillaume Cayla
- 6 Department of Cardiology, University Hospital of Nimes, France
| | - Denis Angoulvant
- 7 Department of Cardiology, CHU Tours & Tours University, France
| | | | - François Schiele
- 8 Department of Cardiology, University Hospital Jean Minjoz, France
| | - Tabassome Simon
- 9 Department of Clinical Pharmacology, Hôpital Saint Antoine, France.,10 Université Pierre et Marie Curie, France
| | - Nicolas Danchin
- 1 Department of Cardiology, Hôpital Européen Georges Pompidou (HEGP), France
| | - Etienne Puymirat
- 1 Department of Cardiology, Hôpital Européen Georges Pompidou (HEGP), France
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27
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Iliou MC, Corone S, Gellen B, Denolle T, Roche F, Nelson AC, Darné C. Is ventilatory therapy combined with exercise training effective in patients with heart failure and sleep-disordered breathing? Results of a randomized trial during a cardiac rehabilitation programme (SATELIT-HF). Arch Cardiovasc Dis 2018; 111:573-581. [DOI: 10.1016/j.acvd.2018.03.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Revised: 02/23/2018] [Accepted: 03/03/2018] [Indexed: 12/13/2022]
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28
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Marcadet DM, Pavy B, Bosser G, Claudot F, Corone S, Douard H, Iliou MC, Vergès-Patois B, Amedro P, Le Tourneau T, Cueff C, Avedian T, Solal AC, Carré F. French Society of Cardiology guidelines on exercise tests (part 1): Methods and interpretation. Arch Cardiovasc Dis 2018; 111:782-790. [PMID: 30093254 DOI: 10.1016/j.acvd.2018.05.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Accepted: 05/16/2018] [Indexed: 11/27/2022]
Abstract
The exercise test is still a key examination in cardiology, used for the diagnosis of myocardial ischemia, as well as for the clinical evaluation of other heart diseases. The cardiopulmonary exercise test can further define functional capacity and prognosis for any given cardiac pathology. These new guidelines focus on methods, interpretation and indications for an exercise test or cardiopulmonary exercise test, as summarized below. The safety rules associated with the exercise test must be strictly observed. Interpretation of exercise tests and cardiopulmonary exercise tests must be multivariable. Functional capacity is a strong predictor of all-cause mortality and cardiovascular events. Chest pain, ST-segment changes and an abnormal ST/heart rate index constitute the first findings in favor of myocardial ischemia, mostly related to significant coronary artery disease. Chronotropic incompetence, abnormal heart rate recovery, QRS changes (such as enlargement or axial deviations) and the use of scores (based on the presence of various risk factors) must also be considered in exercise test interpretation for a coronary artery disease diagnosis. Arrhythmias or conduction disorders arising during the exercise test must be considered in the assessment of prognosis, in addition to a decrease or low increase in blood pressure during the exercise phase. When performing a cardiopulmonary exercise test, peak oxygen uptake and the volume of expired gas/carbon dioxide output slope are the two main variables used to evaluate prognosis.
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Affiliation(s)
| | - Bruno Pavy
- Cardiac Rehabilitation Department, Loire-Vendée-Océan Hospital, boulevard des Régents, BP2, 44270 Machecoul, France.
| | - Gilles Bosser
- Paediatric and Congenital Cardiology Department, M3C Regional Competences Centre, University Hospital, 54511 Vandoeuvre-les-Nancy, France; EA 3450, Development, Adaptation and Disadvantage, Faculty of Medicine, University of Lorraine, 54600 Villers-lès-Nancy, France
| | - Frédérique Claudot
- Platform for Clinical Research Assistance, University Hospital, 54511 Vandoeuvre-les-Nancy, France; EA 4360 APEMAC, Faculty of Medicine, University of Lorraine, 54600 Villers-lès-Nancy, France
| | - Sonia Corone
- Cardiac Rehabilitation Department, Bligny Medical Centre, 91640 Briis-sous-Forges, France
| | - Hervé Douard
- Cardiac Rehabilitation Department, Bordeaux University Hospital, 33604 Pessac, France
| | - Marie-Christine Iliou
- Cardiac Rehabilitation Department, Corentin-Celton Hospital, 92130 Issy-Les-Moulineaux, France
| | | | - Pascal Amedro
- Paediatric and Congenital Cardiology Department, M3C Regional Reference Centre, University Hospital, 34295 Montpellier, France; Physiology and Experimental Biology of Heart and Muscles Laboratory, PHYMEDEXP, UMR CNRS 9214-Inserm U1046, University of Montpellier, 34295 Montpellier, France
| | - Thierry Le Tourneau
- Cardiology Functional Evaluation Department, University Hospital Laennec, 44800 Nantes, France
| | - Caroline Cueff
- Cardiology Functional Evaluation Department, University Hospital Laennec, 44800 Nantes, France
| | - Taniela Avedian
- Cardiac Rehabilitation Department, Turin Clinic, 75008 Paris, France
| | | | - François Carré
- Department of Sport Medicine, Pontchaillou Hospital, Inserm 1099, University of Rennes 1, 35043 Rennes, France
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29
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Marcadet DM, Pavy B, Bosser G, Claudot F, Corone S, Douard H, Iliou MC, Vergès-Patois B, Amedro P, Le Tourneau T, Cueff C, Avedian T, Solal AC, Carré F. French Society of Cardiology guidelines on exercise tests (part 2): Indications for exercise tests in cardiac diseases. Arch Cardiovasc Dis 2018; 112:56-66. [PMID: 30093255 DOI: 10.1016/j.acvd.2018.07.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Accepted: 05/16/2018] [Indexed: 12/28/2022]
Abstract
The exercise test is performed routinely in cardiology; its main indication is the diagnosis of myocardial ischemia, evaluated along with the subject's pretest probability and cardiovascular risk level. Other criteria, such as analysis of repolarization, must be taken into consideration during the interpretation of an exercise test, to improve its predictive value. An exercise test is also indicated for many other cardiac diseases (e.g. rhythm and conduction disorders, severe asymptomatic aortic stenosis, hypertrophic cardiomyopathy, peripheral artery disease, hypertension). Moreover, an exercise test may be indicated for specific populations (women, the elderly, patients with diabetes mellitus, patients in a preoperative context, asymptomatic patients and patients with congenital heart defects). Some cardiac diseases (such as chronic heart failure or arterial pulmonary hypertension) require a cardiopulmonary exercise test. Finally, an exercise test or a cardiopulmonary exercise test is indicated to prescribe a cardiac rehabilitation programme, adapted to the patient.
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Affiliation(s)
| | - Bruno Pavy
- Cardiac Rehabilitation Department, Loire-Vendée-Océan Hospital, boulevard des Régents, BP2, 44270 Machecoul, France.
| | - Gilles Bosser
- Paediatric and Congenital Cardiology Department, M3C Regional Competences Centre, University Hospital, 54511 Vandoeuvre-les-Nancy, France; EA 3450, Development, Adaptation and Disadvantage, Faculty of Medicine, University of Lorraine, 54600 Villers-lès-Nancy, France
| | - Frédérique Claudot
- Platform for Clinical Research Assistance, University Hospital, 54511 Vandoeuvre-les-Nancy, France; EA 4360 APEMAC, Faculty of Medicine, University of Lorraine, 54600 Villers-lès-Nancy, France
| | - Sonia Corone
- Cardiac Rehabilitation Department, Bligny Medical Centre, 91640 Briis-sous-Forges, France
| | - Hervé Douard
- Cardiac Rehabilitation Department, Bordeaux University Hospital, 33604 Pessac, France
| | - Marie-Christine Iliou
- Cardiac Rehabilitation Department, Corentin-Celton Hospital, 92130 Issy-Les-Moulineaux, France
| | | | - Pascal Amedro
- Paediatric and Congenital Cardiology Department, M3C Regional Reference Centre, University Hospital, 34295 Montpellier, France; Physiology and Experimental Biology of Heart and Muscles Laboratory, PHYMEDEXP, UMR CNRS 9214-Inserm U1046, University of Montpellier, 34295 Montpellier, France
| | - Thierry Le Tourneau
- Cardiology Functional Evaluation Department, University Hospital Laennec, 44800 Nantes, France
| | - Caroline Cueff
- Cardiology Functional Evaluation Department, University Hospital Laennec, 44800 Nantes, France
| | - Taniela Avedian
- Cardiac Rehabilitation Department, Turin Clinic, 75008 Paris, France
| | | | - François Carré
- Department of Sport Medicine, Pontchaillou Hospital, University of Rennes 1, Inserm 1099, 35043 Rennes, France
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Puymirat E, Iliou MC, Ducrocq G, Douard H, Labrunee M, Plastaras P, Chevalereau P, Taldir G, Bataille V, Ferrieres J, Schiele F, Simon T, Danchin N. P1231Clinical impact of cardiac rehabilitation according to the atherothrombotic risk stratification after acute myocardial infarction. The FAST-MI registries. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.p1231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- E Puymirat
- European Hospital Georges Pompidou, Cardiology, Paris, France
| | - M C Iliou
- Corentin Celton Hospital APHP, Issy Les Moulineaux, France
| | - G Ducrocq
- Hospital Bichat-Claude Bernard, Paris, France
| | - H Douard
- Hospital Haut Leveque, Bordeaux-Pessac, France
| | - M Labrunee
- Toulouse Rangueil University Hospital (CHU), Toulouse, France
| | | | | | - G Taldir
- Centre Hospitalier, Saint-Brieuc, France
| | - V Bataille
- Toulouse Rangueil University Hospital (CHU), Toulouse, France
| | - J Ferrieres
- Toulouse Rangueil University Hospital (CHU), Toulouse, France
| | - F Schiele
- University of Besançon, Besançon, France
| | - T Simon
- Hospital Saint-Antoine, Paris, France
| | - N Danchin
- Hôpital Européen Georges Pompidou, Université Paris Descartes, Cardiology, Paris, France
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31
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Kubas S, Poirette L, Six MM, Tisseau A, Mouvier MA, Boiteux MC, Bosse Pilon C, Darchis J, Durand S, Pierre B, Iliou MC. P4223Cardiac rehabilitation for heart assist device patients: a register from 11 French centers. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.p4223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- S Kubas
- Bois Gibert, Ballan Mire, France
| | | | - M M Six
- CRF - Les hautois Doignies, Oignies, France
| | | | | | | | | | | | | | | | - M C Iliou
- Corentin Celton Hospital APHP, Issy Les Moulineaux, France
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32
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Hansen D, Rovelo Ruiz G, Doherty P, Iliou MC, Vromen T, Hinton S, Frederix I, Wilhelm M, Schmid JP, Abreu A, Ambrosetti M, Garcia-Porrero E, Coninx K, Dendale P. Do clinicians prescribe exercise similarly in patients with different cardiovascular diseases? Findings from the EAPC EXPERT working group survey. Eur J Prev Cardiol 2018; 25:682-691. [DOI: 10.1177/2047487318760888] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Background Although disease-specific exercise guidelines for cardiovascular disease (CVD) are widely available, it remains uncertain whether these different exercise guidelines are integrated properly for patients with different CVDs. The aim of this study was to assess the inter-clinician variance in exercise prescription for patients with various CVDs and to compare these prescriptions with recommendations from the EXercise Prescription in Everyday practice and Rehabilitative Training (EXPERT) tool, a digital decision support system for integrated state-of-the-art exercise prescription in CVD. Design The study was a prospective observational survey. Methods Fifty-three CV rehabilitation clinicians from nine European countries were asked to prescribe exercise intensity (based on percentage of peak heart rate (HRpeak)), frequency, session duration, programme duration and exercise type (endurance or strength training) for the same five patients. Exercise prescriptions were compared between clinicians, and relationships with clinician characteristics were studied. In addition, these exercise prescriptions were compared with recommendations from the EXPERT tool. Results A large inter-clinician variance was found for prescribed exercise intensity (median (interquartile range (IQR)): 83 (13) % of HRpeak), frequency (median (IQR): 4 (2) days/week), session duration (median (IQR): 45 (18) min/session), programme duration (median (IQR): 12 (18) weeks), total exercise volume (median (IQR): 1215 (1961) peak-effort training hours) and prescription of strength training exercises (prescribed in 78% of all cases). Moreover, clinicians’ exercise prescriptions were significantly different from those of the EXPERT tool ( p < 0.001). Conclusions This study reveals significant inter-clinician variance in exercise prescription for patients with different CVDs and disagreement with an integrated state-of-the-art system for exercise prescription, justifying the need for standardization efforts regarding integrated exercise prescription in CV rehabilitation.
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Affiliation(s)
- Dominique Hansen
- Heart Centre Hasselt, Jessa Hospital, Hasselt, Belgium
- UHasselt, Faculty of Medicine and Life Sciences, BIOMED-REVAL-Rehabilitation Research Centre, Hasselt University, Belgium
| | - Gustavo Rovelo Ruiz
- UHasselt, Faculty of Sciences, Expertise Centre for Digital Media, Hasselt University, Belgium
| | | | - Marie-Christine Iliou
- Cardiac Rehabilitation Department, Hôpital Corentin Celton, Hôpitaux Universitaires Paris Ouest, Issy les Moulineaux, France
| | - Tom Vromen
- Academic Medical Centre, Department of Medical Informatics, Amsterdam, Maxima Medisch Centrum, Department of Cardiology, Veldhoven, The Netherlands
| | - Sally Hinton
- British Association for Cardiovascular Prevention and Rehabilitation, UK
| | - Ines Frederix
- Heart Centre Hasselt, Jessa Hospital, Hasselt, Belgium
- UHasselt, Faculty of Medicine and Life Sciences, BIOMED-REVAL-Rehabilitation Research Centre, Hasselt University, Belgium
- Faculty of Medicine and Health Sciences, Antwerp University, Antwerpen, Belgium
| | - Matthias Wilhelm
- Department of Cardiology, Interdisciplinary Center for Sports Medicine, Inselspital, University Hospital Bern, Bern, Switzerland
| | - Jean-Paul Schmid
- Clinic Barmelweid, Department of Cardiology, Barmelweid, Switzerland
| | - Ana Abreu
- Cardiology Department, Hospital Santa Marta, Lisbon, Portugal
| | - Marco Ambrosetti
- Cardiovascular Rehabilitation Unit, Le Terrazze Clinic, Cunardo, Italy
| | | | - Karin Coninx
- UHasselt, Faculty of Sciences, Expertise Centre for Digital Media, Hasselt University, Belgium
| | - Paul Dendale
- Heart Centre Hasselt, Jessa Hospital, Hasselt, Belgium
- UHasselt, Faculty of Medicine and Life Sciences, BIOMED-REVAL-Rehabilitation Research Centre, Hasselt University, Belgium
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Latil F, Iliou MC, Boileau C, Pietri JX, Lechien C, Ha-Vinh P, Guimond C. [Returning to work after an acute coronary syndrome: When waiting is wasting]. Ann Cardiol Angeiol (Paris) 2017; 66:81-86. [PMID: 28318518 DOI: 10.1016/j.ancard.2016.12.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Accepted: 12/21/2016] [Indexed: 06/06/2023]
Abstract
BACKGROUND Return to work (RTW) after acute coronary syndrome (ACS) is an important issue for the patient's future. AIMS The study aim was to determine whether RTW practice complies with guidelines or is delayed by failure in patient management. We analysed the factors influencing RTW beyond the 90-day period recommended by guidelines. METHODS We conducted a survey of 216 self-employed workers admitted to the hospital for ACS using self-report questionnaires and medical examination. Factors influencing RTW, occupational and cardiac features, and recall and source of medical information were investigated. RESULTS Ninety-three of 216 patients did not return to work by 90 days, despite good cardiac performance in 30 cases (32 %). The mean sick leave duration was 93.3±103.7 days. Advice concerning return to work was completely missing for 44 % of patients. Cardiac performance was independent of sick leave duration, but was correlated with the likelihood of RTW (P<0.001). Patients assimilated about 70 % of the medical information they were provided, but only 53 % of work-related information. Recall of work-related information was better among patients admitted to a rehabilitation facility (65 %) compared to those who did not receive rehabilitation (P<0.05). CONCLUSION Cardiologists should assess the patient's cardiac performance within 2 months after ACS. Patient management should also include cardiac rehabilitation or therapeutic education toward improving information recall.
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Affiliation(s)
- F Latil
- Service médical du RSI, 139, rue de Saussure, 75017 Paris, France.
| | - M C Iliou
- Service de réadaptation cardiaque, hôpital Corentin-Celton, 92130 Issy-les-Moulineaux, France
| | - C Boileau
- Service médical du RSI, 139, rue de Saussure, 75017 Paris, France
| | - J X Pietri
- Service médical du RSI, 139, rue de Saussure, 75017 Paris, France
| | - C Lechien
- Service médical du RSI, 139, rue de Saussure, 75017 Paris, France
| | - P Ha-Vinh
- Service médical du RSI, 139, rue de Saussure, 75017 Paris, France
| | - C Guimond
- Service médical du RSI, 139, rue de Saussure, 75017 Paris, France
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Vigorito C, Abreu A, Ambrosetti M, Belardinelli R, Corrà U, Cupples M, Davos CH, Hoefer S, Iliou MC, Schmid JP, Voeller H, Doherty P. Frailty and cardiac rehabilitation: A call to action from the EAPC Cardiac Rehabilitation Section. Eur J Prev Cardiol 2016; 24:577-590. [PMID: 27940954 DOI: 10.1177/2047487316682579] [Citation(s) in RCA: 138] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Frailty is a geriatric syndrome characterised by a vulnerability status associated with declining function of multiple physiological systems and loss of physiological reserves. Two main models of frailty have been advanced: the phenotypic model (primary frailty) or deficits accumulation model (secondary frailty), and different instruments have been proposed and validated to measure frailty. However measured, frailty correlates to medical outcomes in the elderly, and has been shown to have prognostic value for patients in different clinical settings, such as in patients with coronary artery disease, after cardiac surgery or transvalvular aortic valve replacement, in patients with chronic heart failure or after left ventricular assist device implantation. The prevalence, clinical and prognostic relevance of frailty in a cardiac rehabilitation setting has not yet been well characterised, despite the increasing frequency of elderly patients in cardiac rehabilitation, where frailty is likely to influence the onset, type and intensity of the exercise training programme and the design of tailored rehabilitative interventions for these patients. Therefore, we need to start looking for frailty in elderly patients entering cardiac rehabilitation programmes and become more familiar with some of the tools to recognise and evaluate the severity of this condition. Furthermore, we need to better understand whether exercise-based cardiac rehabilitation may change the course and the prognosis of frailty in cardiovascular patients.
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Affiliation(s)
- Carlo Vigorito
- 1 Department of Translational Medical Sciences, University of Naples Federico II, Italy
| | - Ana Abreu
- 2 Cardiology Department Hospital Santa Marta, Centro Hospitalar Lisboa Central, Portugal
| | - Marco Ambrosetti
- 3 Cardiovascular Rehabilitation Unit, Le Terrazze Clinic, Cunardo, Italy
| | | | - Ugo Corrà
- 5 Department of Cardiac Rehabilitation, Salvatore Maugeri Foundation, Veruno, Italy
| | - Margaret Cupples
- 6 Department of General Practice, UKCRC Centre of Excellence for Public Health Research (NI), Northern Ireland, Queens University, Belfast
| | - Constantinos H Davos
- 7 Cardiovascular Research Laboratory, Biomedical Research Foundation Academy of Athens, Greece
| | | | - Marie-Christine Iliou
- 9 Cardiac Rehabilitation Department, Hopital Corentin Celton-Assistance Publique Hôpitaux de Paris, France
| | - Jean-Paul Schmid
- 10 Cardiology Clinic, Tiefenau Hospital and University of Bern, Switzerland
| | - Heinz Voeller
- 11 Center of Rehabilitation Research, University of Potsdam, Germany; Department of Cardiology, Klinic am See, Rudersdorf
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Kakou-Guikahue M, N’Guetta R, Anzouan-Kacou JB, Kramoh E, N’Dori R, Ba SA, Diao M, Sarr M, Kane A, Kane A, Damorou F, Balde D, Diarra MB, Djiddou M, Kimbally-Kaki G, Zabsonre P, Toure IA, Houénassi M, Gamra H, Chajai B, Gerardin B, Pillière R, Aubry P, Iliou MC, Isnard R, Leprince P, Cottin Y, Bertrand E, Juillière Y, Monsuez JJ. Optimizing the management of acute coronary syndromes in sub-Saharan Africa: A statement from the AFRICARDIO 2015 Consensus Team. Arch Cardiovasc Dis 2016; 109:376-83. [DOI: 10.1016/j.acvd.2015.12.005] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2015] [Accepted: 12/18/2015] [Indexed: 11/26/2022]
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Moatemri F, Lamar-Tanguy A, Blanchard JC, Cristofini P, Ledru F, Iliou MC. 0525: Gender related differences on cardiac rehabilitation benefits for heart failure. Archives of Cardiovascular Diseases Supplements 2016. [DOI: 10.1016/s1878-6480(16)30262-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Pouche M, Ruidavets JB, Ferrières J, Iliou MC, Douard H, Lorgis L, Carrié D, Brunel P, Simon T, Bataille V, Danchin N. Cardiac rehabilitation and 5-year mortality after acute coronary syndromes: The 2005 French FAST-MI study. Arch Cardiovasc Dis 2015; 109:178-87. [PMID: 26711546 DOI: 10.1016/j.acvd.2015.09.009] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Revised: 09/28/2015] [Accepted: 09/30/2015] [Indexed: 11/27/2022]
Abstract
BACKGROUND Clinical studies have shown a beneficial effect of cardiac rehabilitation (CR) on mortality. OBJECTIVE To study the effect of CR prescription at discharge on 5-year mortality in patients with acute myocardial infarction (AMI). METHODS Participants, from the 2005 French FAST-MI hospital registry, were 2894 survivors at discharge, divided according to AMI type: ST-segment elevation myocardial infarction (STEMI; n=1523) and non-STEMI (NSTEMI; n=1371). The effect of CR prescription on mortality was analysed using a Cox proportional hazards model. RESULTS At discharge, 22.1% of patients had a CR prescription. Patients referred to CR were younger (62.4 vs. 67.5years), were more frequently men and more had presented with STEMI (67.8% vs. 48.3%) than non-referred patients. Ninety-four (14.7%) deaths occurred among patients referred to CR and 585 (25.9%) among non-referred patients (P<0.001). After multivariable adjustment, the association between CR and mortality remained significant (hazard ratio [HR] 0.76, 95% confidence interval [CI] 0.60-0.96). Analyses stratified by sex, age (<60 vs.≥60years) and AMI type showed that the inverse association was stronger in men (HR 0.64, 95% CI 0.48-0.87) than in women (HR 0.95, 95% CI 0.64-1.39), in younger (HR 0.34, 95% CI 0.15-0.77) than in older patients (HR 0.84, 95% CI 0.65-1.07) and in NSTEMI (HR 0.63, 95% CI 0.46-0.88) than in STEMI (HR 0.99, 95% CI 0.69-1.40). CONCLUSION After hospitalization for AMI, referral to CR remains a significant predictor of improved patient survival; some subgroups seem to gain greater benefit.
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Affiliation(s)
- Marion Pouche
- Department of Epidemiology, Health Economics and Public Health, UMR1027 Inserm-University of Toulouse III, Toulouse University Hospital (CHU), 31073 Toulouse cedex 7, France
| | - Jean-Bernard Ruidavets
- Department of Epidemiology, Health Economics and Public Health, UMR1027 Inserm-University of Toulouse III, Toulouse University Hospital (CHU), 31073 Toulouse cedex 7, France.
| | - Jean Ferrières
- Department of Epidemiology, Health Economics and Public Health, UMR1027 Inserm-University of Toulouse III, Toulouse University Hospital (CHU), 31073 Toulouse cedex 7, France; Department of Cardiology B, Toulouse Rangueil University Hospital (CHU), 31059 Toulouse cedex 9, France
| | - Marie-Christine Iliou
- Department of Cardiac Rehabilitation, AP-HP, Corentin-Celton Hospital, 92130 Issy-les Moulineaux, France
| | - Hervé Douard
- Department of Cardiology, Bordeaux University Hospital, 33604 Pessac, France
| | - Luc Lorgis
- Department of Cardiology, University Hospital, Laboratory of Cardiometabolic Physiopathology and Pharmacology, Inserm U866, University of Burgundy, 21034 Dijon, France
| | - Didier Carrié
- Department of Cardiology B, Toulouse Rangueil University Hospital (CHU), 31059 Toulouse cedex 9, France
| | - Philippe Brunel
- Department of Cardiology, Nouvelles Cliniques Nantaises, 44277 Nantes cedex 2, France
| | - Tabassome Simon
- Department of Pharmacology and Clinical Research Unit (URCEST), AP-HP, Saint-Antoine Hospital, Pierre-and-Marie-Curie University (UPMC-Paris 06), Inserm U970, 75012 Paris, France
| | - Vincent Bataille
- Department of Epidemiology, Health Economics and Public Health, UMR1027 Inserm-University of Toulouse III, Toulouse University Hospital (CHU), 31073 Toulouse cedex 7, France
| | - Nicolas Danchin
- Department of Cardiology, AP-HP, Georges-Pompidou European Hospital, René-Descartes University, Inserm U970, 75908 Paris, France
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Vergès B, Patois-Vergès B, Iliou MC, Simoneau-Robin I, Bertrand JH, Feige JM, Douard H, Catargi B, Fischbach M. Influence of glycemic control on gain in VO2 peak, in patients with type 2 diabetes enrolled in cardiac rehabilitation after an acute coronary syndrome. The prospective DARE study. BMC Cardiovasc Disord 2015; 15:64. [PMID: 26152221 PMCID: PMC4495681 DOI: 10.1186/s12872-015-0055-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2015] [Accepted: 06/10/2015] [Indexed: 01/04/2023] Open
Abstract
Background Gain in VO2 peak after cardiac rehabilitation (CR) following an acute coronary syndrome (ACS), is associated with reduced mortality and morbidity. We have previously shown in CR, that gain in VO2 peak is reduced in Type 2 diabetic patients and that response to CR is impaired by hyperglycemia. Methods We set up a prospective multicenter study (DARE) whose primary objective was to determine whether good glycemic control during CR may improve the gain in VO2 peak. Sixty four type 2 diabetic patients, referred to CR after a recent ACS, were randomized to insulin intensive therapy or a control group with continuation of the pre-CR antidiabetic treatment. The primary objective was to study the effect of glycemic control during CR on the improvement of peak VO2 by comparing first the 2 treatment groups (insulin intensive vs. control) and second, 2 pre-specified glycemic control groups according to the final fructosamine level (below and above the median). Results At the end of the CR program, the gain in VO2 peak and the final fructosamine level (assessing glycemic level during CR) were not different between the 2 treatment groups. However, patients who had final fructosamine level below the median value, assessing good glycemic control during CR, showed significantly higher gain in VO2 peak (3.5 ± 2.4 vs. 1.7 ± 2.4 ml/kg/min,p = 0.014) and ventilatory threshold (2.7 ± 2.5 vs. 1.2 ± 1.9 ml/kg/min,p = 0.04) and a higher proportion of good CR-responders (relative gain in VO2 peak ≥ 16 %): 66 % vs. 36 %, p = 0.011. In multivariate analysis, gain in VO2 peak was associated with final fructosamine level (p = 0.010) but not with age, gender, duration of diabetes, type of ACS, insulin treatment or basal fructosamine. Conclusions The DARE study shows that, in type 2 diabetes, good glycemic control during CR is an independent factor associated with gain in VO2 peak. This emphasizes the need for good glycemic control in CR for type 2 diabetic patients. Trial registration Trial registered as NCT00354237 (19 July 2006).
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Affiliation(s)
- Bruno Vergès
- Service endocrinologie, diabétologie, CHU Le Bocage, 21000, Dijon, France.
| | | | - Marie-Christine Iliou
- Service réadaptation cardiaque, Hôpital Corentin Celton, Issy les Moulineaux, France.
| | | | | | - Jean-Michel Feige
- Unité de réadaptation cardiaque, Clinique du Lavarin, Avignon, France.
| | - Hervé Douard
- Service réadaptation cardiaque, Hôpital du Haut Lévêque, Pessac, France.
| | - Bogdan Catargi
- Service endocrinologie, diabétologie, Hôpital du Haut Lévêque, Pessac, France.
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Meurin P, Lelay-Kubas S, Pierre B, Pereira H, Pavy B, Iliou MC, Bussière JL, Weber H, Beugin JP, Farrokhi T, Bellemain-Appaix A, Briota L, Tabet JY. Colchicine for postoperative pericardial effusion: a multicentre, double-blind, randomised controlled trial. Heart 2015; 101:1711-6. [PMID: 26076938 DOI: 10.1136/heartjnl-2015-307827] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Accepted: 05/24/2015] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES Pericardial effusion is common after cardiac surgery. Growing evidence suggests that colchicine may be useful for acute pericarditis, but its efficacy in reducing pericardial effusion volume postoperatively has not been assessed. METHODS This randomised, double-blind, placebo-controlled study conducted in 10 centres in France included 197 patients at high risk of tamponade (ie, with moderate to large-sized persistent effusion (echocardiography grades 2, 3 or 4 on a scale of 0-4)) at 7-30 days after cardiac surgery. Patients were randomly assigned to receive colchicine, 1 mg daily (n=98), or a matching placebo (n=99). The main end point was change in pericardial effusion grade after 14-day treatment. Secondary end points included frequency of late cardiac tamponade. RESULTS The placebo and the colchicine groups showed a similar mean baseline pericardial effusion grade (2.9±0.8 vs 3.0±0.8) and similar mean decrease from baseline after treatment (-1.1±1.3 vs -1.3±1.3 grades). The mean difference in grade decrease between groups was -0.19 (95% CI -0.55 to 0.16, p=0.23). In total, 13 cases of cardiac tamponade occurred during the 14-day treatment (7 and 6 in the placebo and colchicine groups, respectively; p=0.80). At 6-month follow-up, all patients were alive and had undergone a total of 22 (11%) drainages: 14 in the placebo group and 8 in the colchicine group (p=0.20). CONCLUSIONS In patients with pericardial effusion after cardiac surgery, colchicine administration does not reduce the effusion volume or prevent late cardiac tamponade. CLINICAL TRIAL REG NO NCT01266694.
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Affiliation(s)
- P Meurin
- Department of Cardiology, Les Grands Prés (CRCB), Villeneuve St Denis, France
| | - S Lelay-Kubas
- Centre de Réadaptation Bois Gibert, Ballan Mire, France
| | | | - H Pereira
- Assistance Publique, Hôpitaux de Paris, Hôpital Européen Georges-Pompidou, Unité d'Épidémiologie et de Recherche Clinique, Paris, France INSERM, Centre d'Investigation Clinique 1418, module Épidémiologie Clinique, Paris, France
| | - B Pavy
- Centre Hospitalier Loire Vendée Océan, Machecoul, France
| | - M C Iliou
- Corentin-Celton Hospital, Issy Les Moulineaux, France
| | | | - H Weber
- Department of Cardiology, Les Grands Prés (CRCB), Villeneuve St Denis, France
| | - J P Beugin
- Clinique de la Mitterie 195 rue Adolphe Defrenne, Lomme, France
| | - T Farrokhi
- Bligny Hospital, Briis-sous-Forges, France
| | | | - L Briota
- Centre Dieuleufit santé, Dieulefit, France
| | - J Y Tabet
- Department of Cardiology, Les Grands Prés (CRCB), Villeneuve St Denis, France Private Hospital Jacques Cartier, Institut cardiovasculaire Paris Sud, Massy, France
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Iliou MC, Vergès B, Mabire JP, Pavy B, Bossee-Pilon C, Morvan Y, Kessler E, Ghannem M. 0195 : Muscular effects of electrical myostimulation in heart failure patients. CREMS-HF substudy (SFC). Archives of Cardiovascular Diseases Supplements 2015. [DOI: 10.1016/s1878-6480(15)30208-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Bégué C, Lamar Tanguy A, De Almeida A, Cristofini P, Ledru F, Dervaux N, Iliou MC. 0233 : Response to exercise training is not predicted by exercise oxygen pulse profile. Archives of Cardiovascular Diseases Supplements 2015. [DOI: 10.1016/s1878-6480(15)30203-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Pavy B, Iliou MC, Höfer S, Vergès-Patois B, Corone S, Aeberhard P, Curnier D, Henry J, Ponchon-Weess A, Oldridge N. Validation of the French version of the MacNew heart disease health-related quality of life questionnaire. Arch Cardiovasc Dis 2014; 108:107-17. [PMID: 25453715 DOI: 10.1016/j.acvd.2014.09.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2014] [Revised: 09/16/2014] [Accepted: 09/18/2014] [Indexed: 12/20/2022]
Abstract
BACKGROUND Assessment of health-related quality of life is widely recommended by European health agencies in relevant research studies as well as in clinical care. AIMS To validate the French version of the MacNew heart disease health-related quality of life questionnaire. METHODS As part of the International HeartQoL Project, 323 French-speaking patients with ischaemic heart disease (angina, n=76; myocardial infarction [MI], n=155; heart failure, n=91; mean age 58.6±11.3 years) were recruited at seven cardiac rehabilitation centres. All patients completed the French versions of the MacNew questionnaire, the Short Form-36 Health Survey (SF-36) and the Hospital Anxiety and Depression Scale, to evaluate the psychometric properties of the French version of the MacNew instrument. RESULTS The mean MacNew global scale scores were 4.6±0.8, 5.0±1.0 and 4.8±0.9 in patients with angina, MI and heart failure, respectively (P<0.05, MI versus angina). We observed minimal missing items and ceiling effects and no floor effects. Factor analysis confirmed a three factorial structure explaining 55.9% of the observed variance. Internal consistency reliability (Cronbach's α) ranged from 0.86 to 0.94 and test-retest reliability ranged from 0.68 to 0.73 Convergent validity was confirmed in the total group and each diagnosis, although the correlations between the MacNew physical subscale and the SF-36 mental component summary were higher than expected. Discriminative validity was partially confirmed with the SF-36 health transition item and fully confirmed with anxiety and depression as predictor variables. CONCLUSION The French version of MacNew questionnaire is recommended for assessing health-related quality of life in French-speaking patients with ischaemic heart disease.
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Affiliation(s)
- Bruno Pavy
- Cardiovascular rehabilitation department, Loire-Vendée-Océan hospital, boulevard des Régents, 44270 Machecoul, France.
| | - Marie-Christine Iliou
- Cardiac rehabilitation department, Corentin-Celton hospital, AP-HP, Issy-Les-Moulineaux, France
| | - Stefan Höfer
- Department of medical psychology, Innsbruck medical university, Innsbruck, Austria
| | | | - Sonia Corone
- Cardiac rehabilitation department, Bligny, France
| | | | - Daniel Curnier
- Research center, Sainte-Justine hospital, Montreal, QC, Canada; Cardiovascular and pulmonary rehabilitation centre, Saint-Orens, France
| | | | | | - Neil Oldridge
- College of Health Sciences, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin, USA
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Iliou MC, Pavy B, Martinez J, Corone S, Meurin P, Tuppin P. Exercise training is safe after coronary stenting: A prospective multicentre study. Eur J Prev Cardiol 2013; 22:27-34. [DOI: 10.1177/2047487313505819] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Affiliation(s)
| | - Bruno Pavy
- Centre Hospitalier Loire Vendée Océan, Machecoul, France
| | | | - Sonia Corone
- Centre Hospitalier Bligny, Briis Sous Forges, France
| | - Philippe Meurin
- Cardiac Rehabilitation Center, Villeneuve Saint Denis, France
| | - Philippe Tuppin
- Caisse Nationale Asuurance Maladie des Travailleurs Salariés, Paris, France
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Vergès B, Vergès B, Iliou MC, Feige JM, Bertrand JH, Douard H, Catargi B, Fischbach M, Cabanot-Sarrau C, Delenne B, Pierre B. 240: Significant improvement of VO2 peak, after myocardial infarction, in type 2 diabetes when glycemic level is well controlled during cardiac rehabilitation. The DARE Study. Archives of Cardiovascular Diseases Supplements 2013. [DOI: 10.1016/s1878-6480(13)71171-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Pavy B, Iliou MC, Vergès-Patois B, Brion R, Monpère C, Carré F, Aeberhard P, Argouach C, Borgne A, Consoli S, Corone S, Fischbach M, Fourcade L, Lecerf JM, Mounier-Vehier C, Paillard F, Pierre B, Swynghedauw B, Theodose Y, Thomas D, Claudot F, Cohen-Solal A, Douard H, Marcadet D. French Society of Cardiology guidelines for cardiac rehabilitation in adults. Arch Cardiovasc Dis 2012; 105:309-28. [DOI: 10.1016/j.acvd.2012.01.010] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2012] [Accepted: 01/23/2012] [Indexed: 12/18/2022]
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Trochu JN, Leprince P, Bielefeld-Gomez M, Bastien O, Beauvais F, Gueffet JP, Logeart D, Isnard R, Iliou MC, Leclercq C, Girard C. Left ventricle assist device: when and which patients should we refer? Arch Cardiovasc Dis 2012; 105:114-21. [PMID: 22424329 DOI: 10.1016/j.acvd.2011.11.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2011] [Revised: 11/06/2011] [Accepted: 11/08/2011] [Indexed: 11/17/2022]
Abstract
Progress in the medical treatment of patients with heart failure with systolic dysfunction, cardiac resynchronization therapy, internal cardiac defibrillators and multidisciplinary management programmes has resulted in dramatic improvements in survival and quality of life; however, this progress has led to an increase in the prevalence of advanced heart failure. In the context of organ shortage for cardiac transplantation, the technological developments in left ventricular assist devices, shown in recent positive clinical studies, provide real hope for patients with advanced heart failure. This article summarizes the most recent clinical studies concerning left ventricular assist devices and discusses for whom and when a left ventricular assist device should be proposed.
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Affiliation(s)
- Jean-Noël Trochu
- Inserm, UMR, université de Nantes, l'institut du thorax, CHU de Nantes, France.
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Iliou MC, Landès MN, Khoranian P, Arroussi I, Guerin A, Peault F. [Screening for sleep-disordered breathing during cardiac rehabilitation]. Soins 2011:S13-S15. [PMID: 21919296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Sleep-disordered breathing may take the form of apnoea or hypopnoea. These conditions have physiological consequences on the cardiovascular function. Night staff in cardiac rehabilitation departments must therefore be able to organise themselves to screen for risks of sleep-disordered breathing, with collaboration between medical and paramedical staff.
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Vergès B, Iliou MC, Corone S, Pierre B, Meurin P, Fischbach M, Pavy B, Carré F, Feige JM, Brion R, Douard H. [The best of cardiac rehabilitation in 2006]. Arch Mal Coeur Vaiss 2007; 100 Spec No 1:89-94. [PMID: 17405571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
The meta-analysis showing the benefits of physical training revisited: Taylor examined only the cardiac rehabilitation trials of exercise intervention alone (versus usual care) and demonstrated that cardiac mortality is 28 % reduced and exercise appears to have an independent mortality benefit. An economic evaluation of cardiac rehabilitation: a systematic review of 15 economic evaluations. Evidence to support the cost-effectiveness of supervised cardiac rehabilitation compared with usual care in myocardial infarction and heart failure was identified. But further well-designed trials are required. Pronostic value of some variables determined by exercise testing entering cardiac rehabilitation and after physical training. A beneficial effect of physical training versus usual care on BNP and neurohormones in patients with chronic heart disease. Patients on beta blockers after myocardial infarction: determination of a more accurate training heart frequency derived from the classical Karvonen's formula. The combination of trimetazidine with exercise training provides greater improvements in functional capacity, left ventricular function and the endothelium-dependent relaxation of the brachial artery than exercise training alone in patients with ischaemic cardiomyopathy referred for cardiac rehabilitation. Guidelines for resistance exercise after cardiac event: a new paradigm less restrictive, safe and efficient to accelerate patients' return to daily activities. Recommendations for participation in leisure-time physical activity and competitive sports for patients with ischaemic heart disease: the result of consensus among experts from the ESC study group of sports cardiology.
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Affiliation(s)
- B Vergès
- Unité de readaptation cardiaque, centre convalescence et rééducation, 23. rue Gaffarel. 21000 Dijon.
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Corone S, Vergès B, Iliou MC, Meurin P, Fischbach M, Pierre B, Pavy B, Henry J. [Best of functional evaluation and cardiac rehabilitation in 2005]. Arch Mal Coeur Vaiss 2006; 99 Spec No 1:85-9. [PMID: 16479969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
The latest in cardiac rehabilitation has been impacted by: The East German PET publication which showed fewer ischaemic events and progression of the atheromatous disease in symptomatic and stable coronary patients who carry out regular physical exercise in comparison with patients who underwent angioplasty with stenting. Two meta-analyses updated the data showing the benefits of physical training: a 20% reduction in global mortality in coronary disease and 35% in cardiac failure. Two French studies reporting reassuring data for our daily practice: the serious complications of cardiac rehabilitation are exceptionally rare: the register for 2003 with data from 65 French centres, over 25,000 patients and 743,000 patient/exercise hours. Physical training two weeks after mitral valvuloplasty is not harmful for the valve repair and is beneficial in terms of exercise capacity for the patient. Epidemiological studies showing that women and elderly patients are, unfortunately, often excluded from programmes of cardiac rehabilitation.
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Affiliation(s)
- S Corone
- Service de réadaptation cardiaque, Centre médical de Bligny, 91640 Briissous-Forges.
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Meurin P, Iliou MC, Driss AB, Pierre B, Corone S, Cristofini P, Tabet JY. Early Exercise Training After Mitral Valve Repair: A Multicentric Prospective French Study. Cardiopulm Phys Ther J 2005. [DOI: 10.1097/01823246-200516040-00006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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