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Rao P, Belanger MJ, Robbins JM. Exercise, Physical Activity, and Cardiometabolic Health: Insights into the Prevention and Treatment of Cardiometabolic Diseases. Cardiol Rev 2022; 30:167-178. [PMID: 34560712 PMCID: PMC8920940 DOI: 10.1097/crd.0000000000000416] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Physical activity (PA) and exercise are widely recognized as essential components of primary and secondary cardiovascular disease (CVD) prevention efforts and are emphasized in the health promotion guidelines of numerous professional societies and committees. The protean benefits of PA and exercise extend across the spectrum of CVD, and include the improvement and reduction of risk factors and events for atherosclerotic CVD (ASCVD), cardiometabolic disease, heart failure, and atrial fibrillation (AF), respectively. Here, we highlight recent insights into the salutary effects of PA and exercise on the primary and secondary prevention of ASCVD, including their beneficial effects on both traditional and nontraditional risk mediators; exercise "prescriptions" for ASCVD; the role of PA regular exercise in the prevention and treatment of heart failure; and the relationships between, PA, exercise, and AF. While our understanding of the relationship between exercise and CVD has evolved considerably, several key questions remain including the association between extreme volumes of exercise and subclinical ASCVD and its risk; high-intensity exercise and resistance (strength) training as complementary modalities to continuous aerobic exercise; and dose- and intensity-dependent associations between exercise and AF. Recent advances in molecular profiling technologies (ie, genomics, transcriptomics, proteomics, and metabolomics) have begun to shed light on interindividual variation in cardiometabolic responses to PA and exercise and may provide new opportunities for clinical prediction in addition to mechanistic insights.
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Affiliation(s)
- Prashant Rao
- Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Boston, MA
- Cardiovascular Research Center, Beth Israel Deaconess Medical Center, Boston, MA
| | | | - Jeremy M. Robbins
- Cardiovascular Research Center, Beth Israel Deaconess Medical Center, Boston, MA
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA
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102
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Curran T, Mitchell A, Goncerz O, Gauthier N. Improving referral rates and utilization of a pediatric cardiac rehabilitation program for patients with congenital and pediatric acquired heart disease. PROGRESS IN PEDIATRIC CARDIOLOGY 2022. [DOI: 10.1016/j.ppedcard.2022.101555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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103
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Kottke TE, Gupta AK, Thomas RJ. Failing Cardiovascular Health. J Am Coll Cardiol 2022; 80:152-154. [DOI: 10.1016/j.jacc.2022.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 05/05/2022] [Accepted: 05/12/2022] [Indexed: 10/17/2022]
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104
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Guduguntla V, Yaser JM, Keteyian SJ, Pagani FD, Likosky DS, Sukul D, Thompson MP. Variation in Cardiac Rehabilitation Participation During Aortic Valve Replacement Episodes of Care. Circ Cardiovasc Qual Outcomes 2022; 15:e009175. [PMID: 35559710 PMCID: PMC10068673 DOI: 10.1161/circoutcomes.122.009175] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Despite reported benefit in the setting of aortic valve replacement (AVR), cardiac rehabilitation (CR) utilization remains low, with few studies evaluating hospital and patient-level variation in CR participation. We explored determinants of CR variability during AVR episodes of care: transcatheter aortic valve replacement (TAVR) and surgical aortic valve replacement (SAVR). METHODS A cohort of 10 124 AVR episodes of care (TAVR n=5121 from 24 hospitals; SAVR n=5003 from 32 hospitals) were identified from the Michigan Value Collaborative statewide multipayer registry (2015-2019). CR enrollment was defined as the presence of a single professional or facility claim within 90 days of discharge: 93 797, 93 798, G0422, G0423. Annual trends and hospital variation in CR were described for TAVR, SAVR, and all AVR. Multilevel logistic regression was used to estimate effects of predictors and hospital risk-adjusted rates of CR enrollment. RESULTS Overall, 4027 (39.8%) patients enrolled in CR, with significant differences by treatment strategy: SAVR=50.9%, TAVR=28.9% (P<0.001). CR use after SAVR was significantly higher than after TAVR and increased over time for both modalities (P<0.001). There were significant differences in CR enrollment across age, gender, payer, and some comorbidities (P<0.05). At the hospital level, CR participation rates for all AVR varied 10-fold (4.8% to 68.7%) and were moderately correlated between SAVR and TAVR (Pearson r=0.56, P<0.01). CONCLUSIONS Substantial variation exists in CR participation during AVR episodes of care across hospitals. However, within-hospital CR participation rates were significantly correlated across treatment strategies. These findings suggest that CR participation is the product of hospital-specific practice patterns. Identifying hospital practices associated with higher CR participation can help assist future quality improvement efforts to increase CR use after AVR.
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Affiliation(s)
- Vinay Guduguntla
- Department of Internal Medicine, University of California, San Francisco (V.G.)
- Michigan Value Collaborative, University of Michigan, Ann Arbor (V.G., J.M.Y., M.P.T.)
| | - Jessica M Yaser
- Michigan Value Collaborative, University of Michigan, Ann Arbor (V.G., J.M.Y., M.P.T.)
| | - Steven J Keteyian
- Division of Cardiovascular Medicine, Henry Ford Health, Detroit, MI (S.J.K.)
| | - Francis D Pagani
- Department of Cardiac Surgery, Michigan Medicine, Ann Arbor (F.D.P., D.S.L., M.P.T.)
- Michigan Society of Thoracic and Cardiovascular Surgeons Quality Collaborative, Ann Arbor, MI (F.D.P., D.S.L., M.P.T.)
| | - Donald S Likosky
- Department of Cardiac Surgery, Michigan Medicine, Ann Arbor (F.D.P., D.S.L., M.P.T.)
| | - Devraj Sukul
- Department of Internal Medicine, University of California, San Francisco (V.G.)
- Division of Cardiovascular Medicine, Department of Internal Medicine, Michigan Medicine, Ann Arbor (D.S.)
| | - Michael P Thompson
- Michigan Value Collaborative, University of Michigan, Ann Arbor (V.G., J.M.Y., M.P.T.)
- Department of Cardiac Surgery, Michigan Medicine, Ann Arbor (F.D.P., D.S.L., M.P.T.)
- Michigan Society of Thoracic and Cardiovascular Surgeons Quality Collaborative, Ann Arbor, MI (F.D.P., D.S.L., M.P.T.)
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105
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Garfein J, Guhl EN, Swabe G, Sekikawa A, Barinas-Mitchell E, Forman DE, Magnani JW. Racial and Ethnic Differences in Cardiac Rehabilitation Participation: Effect Modification by Household Income. J Am Heart Assoc 2022; 11:e025591. [PMID: 35730601 PMCID: PMC9333381 DOI: 10.1161/jaha.122.025591] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Background Cardiac rehabilitation (CR) is associated with improved cardiovascular outcomes. Racial and ethnic differences in CR have been identified, but whether income may attenuate these disparities remains unknown. We evaluated (1) racial/ethnic differences in CR participation in a contemporary sample of insured US adults, and (2) assessed how household income modifies associations between race or ethnicity and CR participation. Methods and Results We identified 107 199 individuals with a CR‐qualifying diagnosis between January 1, 2016 and December 31, 2018 in Optum’s de‐identified Clinformatics database. We evaluated associations between race or ethnicity and participation in CR, and assessed interaction between race or ethnicity and annual household income. The mean±SD age of all participants was 70.4±11.6 years; 37.4% were female and 76.0% were White race. Overall, 28 443 (26.5%) attended ≥1 CR sessions. After adjustment, compared with White individuals, the probability of attending CR was 31% lower for Asian individuals (95% CI, 27%–36%), 19% lower for Black individuals (95% CI, 16%–22%), and 43% lower for Hispanic individuals (95% CI, 40%–45%), all P<0.0001. The time to CR attendance was also significantly longer for Asian, Black, and Hispanic individuals. Associations between race or ethnicity and attendance at CR differed significantly across household income categories (P interaction=0.0005); however, Asian, Black, and Hispanic individuals were less likely to attend CR at all incomes. Conclusions In a geographically and racially diverse cohort, participation in CR was low overall, and was lowest among Asian, Black, and Hispanic candidates. Household income may impact the link between race or ethnicity and attendance at CR, but substantial racial and ethnic disparities exist across incomes.
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Affiliation(s)
- Joshua Garfein
- Department of Medicine University of Pittsburgh School of Medicine Pittsburgh PA
| | - Emily N Guhl
- Heart and Vascular Institute University of Pittsburgh Medical Center Pittsburgh PA.,Department of Epidemiology, Graduate School of Public Health University of Pittsburgh PA
| | - Gretchen Swabe
- Department of Medicine University of Pittsburgh School of Medicine Pittsburgh PA
| | - Akira Sekikawa
- Department of Epidemiology, Graduate School of Public Health University of Pittsburgh PA
| | - Emma Barinas-Mitchell
- Department of Epidemiology, Graduate School of Public Health University of Pittsburgh PA
| | - Daniel E Forman
- Department of Medicine University of Pittsburgh School of Medicine Pittsburgh PA.,Heart and Vascular Institute University of Pittsburgh Medical Center Pittsburgh PA
| | - Jared W Magnani
- Department of Medicine University of Pittsburgh School of Medicine Pittsburgh PA.,Heart and Vascular Institute University of Pittsburgh Medical Center Pittsburgh PA.,Department of Epidemiology, Graduate School of Public Health University of Pittsburgh PA
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Drugescu A, Roca M, Zota IM, Costache AD, Gavril OI, Gavril RS, Vasilcu TF, Mitu O, Esanu IM, Roca IC, Ghiciuc CM, Mitu F. Value of the Neutrophil to Lymphocyte Ratio and Platelet to Lymphocyte Ratio in Predicting CPET Performance in Patients with Stable CAD and Recent Elective PCI. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58060814. [PMID: 35744077 PMCID: PMC9229341 DOI: 10.3390/medicina58060814] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Revised: 06/05/2022] [Accepted: 06/14/2022] [Indexed: 02/07/2023]
Abstract
Background and Objectives: Functional capacity (FC) assessed via cardiopulmonary exercise testing (CPET) is a novel, independent prognostic marker for patients with coronary artery disease (CAD). Neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) are two readily available predictors of systemic inflammation and cardiovascular event risk, which could be used as cost-effective predictors of poor FC. The purpose of this study was to evaluate the utility of NLR and PLR in predicting poor FC in patients with CAD and recent elective percutaneous coronary intervention (PCI). Materials and Methods: Our cross-sectional retrospective analysis included 80 patients with stable CAD and recent elective PCI (mean age 55.51 ± 11.83 years, 71.3% male) who were referred to a cardiovascular rehabilitation center from January 2020 to June 2021. All patients underwent clinical examination, cardiopulmonary exercise testing on a cycle ergometer, transthoracic echocardiography and standard blood analysis. Results: Patients were classified according to percent predicted oxygen uptake (% VO2 max) in two groups—poor FC (≤70%, n = 35) and preserved FC (>70%, n = 45). There was no significant difference between groups regarding age, gender ratio, presence of associated comorbidities, left ventricular ejection fraction and NLR. PLR was higher in patients with poor FC (169.8 ± 59.3 vs. 137.4 ± 35.9, p = 0.003). A PLR cut-off point of 139 had 74% sensitivity and 60% specificity in predicting poor FC. After multivariate analysis, PLR remained a significant predictor of poor functional status. Conclusions: Although CPET is the gold standard test for assessing FC prior to cardiovascular rehabilitation, its availability remains limited. PLR, a cheap and simple test, could predict poor FC in patients with stable CAD and recent elective PCI and help prioritize referral for cardiovascular rehabilitation in high-risk patients.
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Affiliation(s)
- Andrei Drugescu
- Medical I Department, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (A.D.); (A.-D.C.); (O.I.G.); (R.S.G.); (T.F.V.); (O.M.); (I.M.E.); (F.M.)
| | - Mihai Roca
- Medical I Department, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (A.D.); (A.-D.C.); (O.I.G.); (R.S.G.); (T.F.V.); (O.M.); (I.M.E.); (F.M.)
- Correspondence: (M.R.); (I.M.Z.)
| | - Ioana Mădălina Zota
- Medical I Department, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (A.D.); (A.-D.C.); (O.I.G.); (R.S.G.); (T.F.V.); (O.M.); (I.M.E.); (F.M.)
- Correspondence: (M.R.); (I.M.Z.)
| | - Alexandru-Dan Costache
- Medical I Department, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (A.D.); (A.-D.C.); (O.I.G.); (R.S.G.); (T.F.V.); (O.M.); (I.M.E.); (F.M.)
| | - Oana Irina Gavril
- Medical I Department, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (A.D.); (A.-D.C.); (O.I.G.); (R.S.G.); (T.F.V.); (O.M.); (I.M.E.); (F.M.)
| | - Radu Sebastian Gavril
- Medical I Department, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (A.D.); (A.-D.C.); (O.I.G.); (R.S.G.); (T.F.V.); (O.M.); (I.M.E.); (F.M.)
| | - Teodor Flaviu Vasilcu
- Medical I Department, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (A.D.); (A.-D.C.); (O.I.G.); (R.S.G.); (T.F.V.); (O.M.); (I.M.E.); (F.M.)
| | - Ovidiu Mitu
- Medical I Department, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (A.D.); (A.-D.C.); (O.I.G.); (R.S.G.); (T.F.V.); (O.M.); (I.M.E.); (F.M.)
| | - Irina Mihaela Esanu
- Medical I Department, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (A.D.); (A.-D.C.); (O.I.G.); (R.S.G.); (T.F.V.); (O.M.); (I.M.E.); (F.M.)
| | - Iulia-Cristina Roca
- Surgery II Department, Faculty of Medicine, ”Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania;
| | - Cristina Mihaela Ghiciuc
- Morpho-Functional Sciences II Department, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania;
| | - Florin Mitu
- Medical I Department, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (A.D.); (A.-D.C.); (O.I.G.); (R.S.G.); (T.F.V.); (O.M.); (I.M.E.); (F.M.)
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Daw P, Harrison A, Doherty PJ, van Zanten JJCSV, Dalal HM, Taylor RS, van Beurden SB, McDonagh STJ, Greaves CJ. A pragmatic effectiveness-implementation study comparing trial evidence with routinely collected outcome data for patients receiving the REACH-HF home-based cardiac rehabilitation programme. BMC Cardiovasc Disord 2022; 22:270. [PMID: 35710336 PMCID: PMC9202968 DOI: 10.1186/s12872-022-02707-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 06/02/2022] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Cardiac rehabilitation for heart failure continues to be greatly underused worldwide despite being a Class I recommendation in international clinical guidelines and uptake is low in women and patients with mental health comorbidities. METHODS Rehabilitation EnAblement in CHronic Heart Failure (REACH-HF) programme was implemented in four UK National Health Service early adopter sites ('Beacon Sites') between June 2019 and June 2020. Implementation and patient-reported outcome data were collected across sites as part of the National Audit of Cardiac Rehabilitation. The change in key outcomes before and after the supervised period of REACH-HF intervention across the Beacon Sites was assessed and compared to those of the intervention arm of the REACH-HF multicentre trial. RESULTS Compared to the REACH-HF multicentre trial, patients treated at the Beacon Site were more likely to be female (33.8% vs 22.9%), older (75.6 vs 70.1), had a more severe classification of heart failure (26.5% vs 17.7%), had poorer baseline health-related quality of life (MLHFQ score 36.1 vs 31.4), were more depressed (HADS score 6.4 vs 4.1) and anxious (HADS score 7.2 vs 4.7), and had lower exercise capacity (ISWT distance 190 m vs 274.7 m). There appeared to be a substantial heterogeneity in the implementation process across the four Beacon Sites as evidenced by the variation in levels of patient recruitment, operationalisation of the REACH-HF intervention and patient outcomes. Overall lower improvements in patient-reported outcomes at the Beacon Sites compared to the trial may reflect differences in the population studied (having higher morbidity at baseline) as well as the marked challenges in intervention delivery during the COVID-19 pandemic. CONCLUSION The results of this study illustrate the challenges in consistently implementing an intervention (shown to be clinically effective and cost-effective in a multicentre trial) into real-world practice, especially in the midst of a global pandemic. Further research is needed to establish the real-world effectiveness of the REACH-HF intervention in different populations.
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Affiliation(s)
- Paulina Daw
- grid.6572.60000 0004 1936 7486School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Edgbaston, B15 2TT UK
| | - Alexander Harrison
- grid.5685.e0000 0004 1936 9668Health Sciences, University of York, York, UK
| | - Patrick J. Doherty
- grid.5685.e0000 0004 1936 9668Health Sciences, University of York, York, UK
| | | | - Hasnain M. Dalal
- grid.416116.50000 0004 0391 2873University of Exeter Medical School, Royal Cornwall Hospital, Truro, UK
- grid.8391.30000 0004 1936 8024Primary Care Research Group, University of Exeter Medical School, St Luke’s Campus, Exeter, UK
| | - Rod S. Taylor
- grid.8756.c0000 0001 2193 314XMRC/CSO Social and Public Health Sciences Unit & Robertson Centre for Biostatistics, Institute of Health and Well Being, University of Glasgow, Glasgow, UK
| | - Samantha B. van Beurden
- grid.8391.30000 0004 1936 8024College of Medicine and Health, University of Exeter, Exeter, UK
| | - Sinéad T. J. McDonagh
- grid.8391.30000 0004 1936 8024Primary Care Research Group, College of Medicine and Health, University of Exeter, St Luke’s Campus, Exeter, UK
| | - Colin J. Greaves
- grid.6572.60000 0004 1936 7486School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Edgbaston, B15 2TT UK
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108
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Amir NH, Dorobantu DM, Wadey CA, Caputo M, Stuart AG, Pieles GE, Williams CA. Exercise training in paediatric congenital heart disease: fit for purpose? Arch Dis Child 2022; 107:525-534. [PMID: 34535443 DOI: 10.1136/archdischild-2020-321390] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 08/30/2021] [Indexed: 11/03/2022]
Abstract
Exercise and physical activity (PA) have been shown to be effective, safe and feasible in both healthy children and children with congenital heart disease (CHD). However, implementing exercise training as an intervention is still not routine in children with CHD despite considerable evidence of health benefits and well-being. Understanding how children with CHD can safely participate in exercise can boost participation in PA and subsequently reduce inactivity-related diseases. Home-based exercise intervention, with the use of personal wearable activity trackers, and high-intensity interval training have been beneficial in adults' cardiac rehabilitation programmes. However, these remain underutilised in paediatric care. Therefore, the aims of this narrative review were to synthesise prescribed exercise interventions in children with CHD, identify possible limitation to exercise training prescription and provide an overview on how to best integrate exercise intervention effectively for this population into daily practice.
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Affiliation(s)
- Nurul Hidayah Amir
- Department of Translational Health Sciences and Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.,Faculty of Sports Science and Recreation, Universiti Teknologi MARA Cawangan Perlis, Kampus Arau, Arau, Perlis, Malaysia
| | - Dan M Dorobantu
- Department of Translational Health Sciences and Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.,Children's Health and Exercise Research Centre (CHERC), University of Exeter, Exeter, UK
| | - Curtis A Wadey
- Children's Health and Exercise Research Centre (CHERC), University of Exeter, Exeter, UK
| | - Massimo Caputo
- Department of Translational Health Sciences and Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.,National Institute for Health Research (NIHR), Cardiovascular Biomedical Research Centre, Congenital Heart Unit, Bristol Heart Institute, Bristol, UK
| | - A Graham Stuart
- Department of Translational Health Sciences and Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.,National Institute for Health Research (NIHR), Cardiovascular Biomedical Research Centre, Congenital Heart Unit, Bristol Heart Institute, Bristol, UK
| | - Guido E Pieles
- Department of Translational Health Sciences and Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK .,National Institute for Health Research (NIHR), Cardiovascular Biomedical Research Centre, Congenital Heart Unit, Bristol Heart Institute, Bristol, UK.,Institute of Sport, Exercise and Health, University College London, London, UK
| | - Craig A Williams
- Children's Health and Exercise Research Centre (CHERC), University of Exeter, Exeter, UK
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Kanaoka K, Iwanaga Y, Fukuma N, Nakai M, Sumita Y, Nishioka Y, Okada K, Noda T, Sakata Y, Imamura T, Miyamoto Y. Trends and Factors Associated With Cardiac Rehabilitation Participation ― Data From Japanese Nationwide Databases ―. Circ J 2022; 86:1998-2007. [DOI: 10.1253/circj.cj-22-0095] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Koshiro Kanaoka
- Department of Medical and Health Information Management, National Cerebral and Cardiovascular Center
| | - Yoshitaka Iwanaga
- Department of Medical and Health Information Management, National Cerebral and Cardiovascular Center
| | - Nagaharu Fukuma
- School of Nursing, Japanese Red Cross Toyota College of Nursing Toyota Japan
| | - Michikazu Nakai
- Department of Medical and Health Information Management, National Cerebral and Cardiovascular Center
| | - Yoko Sumita
- Department of Medical and Health Information Management, National Cerebral and Cardiovascular Center
| | - Yuichi Nishioka
- Department of Public Health, Health Management and Policy, Nara Medical University
| | - Katsuki Okada
- Department of Transformative System for Medical Information, Osaka University Graduate School of Medicine
| | - Tatsuya Noda
- Department of Public Health, Health Management and Policy, Nara Medical University
| | - Yasushi Sakata
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine
| | - Tomoaki Imamura
- Department of Public Health, Health Management and Policy, Nara Medical University
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Ding M, Zhang F, Hu J. Effectiveness of "Internet+" Based Cardiac Rehabilitation on Prognosis of Patients with Coronary Heart Disease: A Meta-Analysis. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2022; 2022:1574774. [PMID: 35633921 PMCID: PMC9142280 DOI: 10.1155/2022/1574774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 03/28/2022] [Accepted: 04/07/2022] [Indexed: 11/17/2022]
Abstract
Objective Meta-analysis was used to systematically evaluate the impact of Internet-based cardiac rehabilitation on the health of patients with coronary heart disease. Methods Randomized controlled trial study (RCTs) of the effects of Internet-based cardiac rehabilitation on cardiovascular risk factors, motor function and psychological status in patients with coronary heart disease has been systematically studied. Results A total of 13 articles were included. Meta-analysis showed that internet-based cardiac rehabilitation training could effectively reduce the total cholesterol level [MD = -0.15, 95% CI (-0.28, -0.02), P = 0.02] and triglyceride level [MD = -0.19, 95% CI (-0.32, -0.06), P = 0.01], increase the maximal oxygen uptake (VO2 max) [MD = 0.9995, CI (0.161.83) P = 0.02] and physical activity level [SMD = 0.51, 95% CI (0.07, 0.9), P = 0.02], and improve the self-efficacy [SMD = 0.50, 95% CI (0.17, 0.83), P = 0.01] and improved quality of life [SMD = 1.34, 95% CI (0.12, 2.56), P = 0.03] of patients. However, there was no significant improvement in blood pressure and body mass index, depression and anxiety. Conclusion Internet-based cardiac rehabilitation can significantly reduce cholesterol and triglyceride levels and improve theVO2 max, physical activity, self-efficacy and quality of life, but is not effective on the level of blood pressure, BMI, anxiety and depression. Due to the limitations of methodological quality and sample size of included studies, more studies with high-quality and large sample are needed to further evaluate its effectiveness.
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Affiliation(s)
- Meng Ding
- Department of Operation Room, Wuhan Hankou Hospital, Wuhan, Hubei 430012, China
| | - Fan Zhang
- Department of Information Centre, Wuhan Hankou Hospital, Wuhan, Hubei 430012, China
| | - Jiashun Hu
- Department of Internal Medicine-Cardiovascular, Wuhan Hankou Hospital, Wuhan, Hubei 430012, China
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111
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Ownbey N, Soukup J, Fugate-Whitlock E, Newsham TMK. Evaluation of Telephone-Based Cardiac Rehabilitation Services Delivered to Adults 65 and Older During the Early Months of the COVID-19 Pandemic. J Appl Gerontol 2022; 41:2226-2234. [PMID: 35593005 PMCID: PMC9125130 DOI: 10.1177/07334648221104380] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
This study was performed to evaluate the effectiveness of a hybrid,
telephone-based cardiac rehabilitation (TBCR) program implemented early in the
COVID-19 pandemic compared with in-person, center-based programming offered
prior to the pandemic. The focus was on older adults’ engagement and outcomes.
Matched groups of hybrid and in-person cardiac rehabilitation (CR) participants
were created from existing data and compared using t-tests and repeated measures
ANOVAs. Qualitative interviews were conducted with participating CR staff then
transcribed, coded, and analyzed for key themes. There were significant
differences in body mass index and weight from pre-to post-CR within both hybrid
and in-person groups. Despite this, CR staff believed exercise adherence was
reduced in the hybrid group when compared to those in the in-person program. In
the future, TBCR should be considered as an adjunct to in-person CR. Reluctance
to prescribe exercise needs to be addressed through CR staff training.
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Affiliation(s)
- Nicholas Ownbey
- Master of Science in Applied Gerontology Program, University of North Carolina Wilmington, Wilmington, NC, USA
| | - Jeff Soukup
- Cardiopulmonary Rehabilitation & Wellness, 24520New Hanover Regional Medical Center (now Novant Health), Wilmington, NC, USA
| | - Elizabeth Fugate-Whitlock
- School of Health and Applied Human Sciences, 14621University of North Carolina Wilmington, Wilmington, NC, USA
| | - Tina M K Newsham
- School of Health and Applied Human Sciences, 14621University of North Carolina Wilmington, Wilmington, NC, USA
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Nagatomi Y, Ide T, Higuchi T, Nezu T, Fujino T, Tohyama T, Nagata T, Higo T, Hashimoto T, Matsushima S, Shinohara K, Yokoyama T, Eguchi A, Ogusu A, Ikeda M, Ishikawa Y, Yamashita F, Kinugawa S, Tsutsui H. Home-based cardiac rehabilitation using information and communication technology for heart failure patients with frailty. ESC Heart Fail 2022; 9:2407-2418. [PMID: 35534907 PMCID: PMC9288767 DOI: 10.1002/ehf2.13934] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Revised: 01/30/2022] [Accepted: 04/04/2022] [Indexed: 12/30/2022] Open
Abstract
AIMS Cardiac rehabilitation (CR) is an evidence-based, secondary preventive strategy that improves mortality and morbidity rates in patients with heart failure (HF). However, the implementation and continuation of CR remains unsatisfactory, particularly for outpatients with physical frailty. This study investigated the efficacy and safety of a comprehensive home-based cardiac rehabilitation (HBCR) programme that combines patient education, exercise guidance, and nutritional guidance using information and communication technology (ICT). METHODS AND RESULTS This study was a single-centre, open-label, randomized, controlled trial. Between April 2020 and November 2020, 30 outpatients with chronic HF (New York Heart Association II-III) and physical frailty were enrolled. The control group (n = 15) continued with standard care, while the HBCR group (n = 15) also received comprehensive, individualized CR, including ICT-based exercise and nutrition guidance using ICT via a Fitbit® device for 3 months. The CR team communicated with each patient in HBCR group once a week via the application messaging tool and planned the training frequency and intensity of training individually for the next week according to each patient's symptoms and recorded pulse data during exercise. Dietitians conducted a nutritional assessment and then provided individual nutritional advice using the picture-posting function of the application. The primary outcome was the change in the 6 min walking distance (6MWD). The participants' mean age was 63.7 ± 10.1 years, 53% were male, and 87% had non-ischaemic heart disease. The observed change in the 6MWD was significantly greater in the HBCR group (52.1 ± 43.9 m vs. -4.3 ± 38.8 m; P < 0.001) at a 73% of adherence rate. There was no significant change in adverse events in either group. CONCLUSIONS Our comprehensive HBCR programme using ICT for HF patients with physical frailty improved exercise tolerance and improved lower extremity muscle strength in our sample, suggesting management with individualized ICT-based programmes as a safe and effective approach. Considering the increasing number of HF patients with frailty worldwide, our approach provides an efficient method to keep patients engaged in physical activity in their daily life.
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Affiliation(s)
- Yuta Nagatomi
- Department of Rehabilitation Medicine, Kyushu University Hospital, Fukuoka, Japan.,Department of Cardiovascular Medicine, Faculty of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka-shi, Fukuoka, 812-8582, Japan
| | - Tomomi Ide
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka-shi, Fukuoka, 812-8582, Japan.,Division of Cardiovascular Medicine, Research Institute of Angiocardiology, Faculty of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Tae Higuchi
- Department of Rehabilitation Medicine, Kyushu University Hospital, Fukuoka, Japan.,Department of Cardiovascular Medicine, Faculty of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka-shi, Fukuoka, 812-8582, Japan
| | - Tomoyuki Nezu
- Department of Rehabilitation Medicine, Kyushu University Hospital, Fukuoka, Japan.,Department of Cardiovascular Medicine, Faculty of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka-shi, Fukuoka, 812-8582, Japan
| | - Takeo Fujino
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka-shi, Fukuoka, 812-8582, Japan
| | - Takeshi Tohyama
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka-shi, Fukuoka, 812-8582, Japan.,Center for Clinical and Translational Research of Kyushu University Hospital, Fukuoka, Japan
| | - Takuya Nagata
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka-shi, Fukuoka, 812-8582, Japan.,Center for Clinical and Translational Research of Kyushu University Hospital, Fukuoka, Japan
| | - Taiki Higo
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka-shi, Fukuoka, 812-8582, Japan
| | - Toru Hashimoto
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka-shi, Fukuoka, 812-8582, Japan.,Department of Advanced Cardiopulmonary Failure, Faculty of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Shouji Matsushima
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka-shi, Fukuoka, 812-8582, Japan.,Division of Cardiovascular Medicine, Research Institute of Angiocardiology, Faculty of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Keisuke Shinohara
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka-shi, Fukuoka, 812-8582, Japan
| | - Tomiko Yokoyama
- Department of Nutrition, Kyushu University Hospital, Fukuoka, Japan
| | - Aika Eguchi
- Department of Nutrition, Kyushu University Hospital, Fukuoka, Japan
| | - Ayumi Ogusu
- Department of Nutrition, Kyushu University Hospital, Fukuoka, Japan
| | - Masataka Ikeda
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka-shi, Fukuoka, 812-8582, Japan.,Division of Cardiovascular Medicine, Research Institute of Angiocardiology, Faculty of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yusuke Ishikawa
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka-shi, Fukuoka, 812-8582, Japan
| | - Fumika Yamashita
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka-shi, Fukuoka, 812-8582, Japan
| | - Shintaro Kinugawa
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka-shi, Fukuoka, 812-8582, Japan.,Division of Cardiovascular Medicine, Research Institute of Angiocardiology, Faculty of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Hiroyuki Tsutsui
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka-shi, Fukuoka, 812-8582, Japan.,Division of Cardiovascular Medicine, Research Institute of Angiocardiology, Faculty of Medical Sciences, Kyushu University, Fukuoka, Japan
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113
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Li Y, Zhou Y, Chen M, Fu MR, Luo B, Yu P, Zheng H, Liu F. A WeChat-Based Rehabilitation Platform for Children and Adolescents with Congenital Heart Disease to Promote Cardiac FITness (HeartFIT): Protocol for a Mixed-Methods Strategy from Evidence-Based Design to Pilot Study. J Multidiscip Healthc 2022; 15:907-920. [PMID: 35519154 PMCID: PMC9064066 DOI: 10.2147/jmdh.s349519] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 04/19/2022] [Indexed: 02/05/2023] Open
Abstract
Progress in medical and surgical care has tremendously improved the survival rates of children with congenital heart disease (CHD). However, reduced aerobic capacity and health-related issues remain a threaten to quality survival and prevention of related complications among children and adolescents with CHD. This research program aims to develop and evaluate a WeChat-based health platform (HeartFIT) to facilitate cardiac rehabilitation and promote physical fitness for this rapidly expanding young population. The study protocol describes the use of an iterative process of using a mixed-methods strategy to develop, refine, and pilot test the proposed HeartFIT platform. A sequential problem-solving process comprising four iterative phases with ongoing end-user input will be implemented. In phase 1, relevant literature was systematically reviewed (completed) and then child-parent dyads will be interviewed to understand the broad context and the requirements and considerations of the target population toward the WeChat-based rehabilitation platform. In phase 2, key features and priority functionalities for the platform will be ideated and refined, and a digital interactive prototype will be created. In phase 3, heuristic evaluation and three rounds of end-user testing will be conducted to ensure further refinement and usability of the prototype. In phase 4, a prospective pilot study will be performed to investigate the feasibility, acceptability, and preliminary efficacy of the developed platform over a 12-week intervention period. If HeartFIT intervention is feasible, acceptable, and demonstrates promising efficacy, an adequately powered randomized controlled trial (future work) will be deployed to test the real-world effectiveness of the intervention.
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Affiliation(s)
- Yuan Li
- Nursing Department, West China Second University Hospital, Sichuan University, Chengdu, People's Republic of China.,Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, People's Republic of China.,West China School of Nursing, Sichuan University, Chengdu, People's Republic of China
| | - Yaxin Zhou
- Rehabilitation Medicine Center, Sichuan University, Chengdu, People's Republic of China.,West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Miao Chen
- Department of Cardiovascular Surgery, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Mei R Fu
- Rutgers University, School of Nursing, Camden, NJ, USA
| | - Biru Luo
- Nursing Department, West China Second University Hospital, Sichuan University, Chengdu, People's Republic of China.,Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, People's Republic of China.,West China School of Nursing, Sichuan University, Chengdu, People's Republic of China
| | - Pengming Yu
- Rehabilitation Medicine Center, Sichuan University, Chengdu, People's Republic of China.,West China Hospital, Sichuan University, Chengdu, People's Republic of China.,Key Laboratory of Rehabilitation Medicine in Sichuan Province, Chengdu, People's Republic of China
| | - Hong Zheng
- Nursing Department, West China Second University Hospital, Sichuan University, Chengdu, People's Republic of China.,Department of Pediatric Cardiology, West China Second University Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Fangfei Liu
- Nursing Department, West China Second University Hospital, Sichuan University, Chengdu, People's Republic of China.,Department of Pediatric Cardiology, West China Second University Hospital, Sichuan University, Chengdu, People's Republic of China
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114
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Wright CX, Fournier S, Deng Y, Meng C, Hiller S, Oen‐Hsiao JM, Dreyer RP. Implementation of an Appointment-Based Cardiac Rehabilitation Approach: A Single-Center Experience. J Am Heart Assoc 2022; 11:e024066. [PMID: 35499969 PMCID: PMC9238587 DOI: 10.1161/jaha.121.024066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Background There has been a focus on alternative cardiac rehabilitation (CR) delivery models aimed at improving CR adherence and completion. We examined pre- and post-CR health outcomes, reasons for discharge, and predictors of completion using a patient-driven appointment-based CR approach that uses center-scheduled class start times. Methods and Results Data were used from an urban single-center CR program at Yale New Haven Health (2012-2017) that enrolled 2135 patients. We evaluated pre- and post-CR outcomes (12 weeks) using paired t tests and used a multivariable logistic regression model to examine predictors of CR completion (≥36 sessions) for the overall cardiovascular disease population. The mean age of participants was 65±12 years, 27.9% were women, and 5.1% were Black patients, and patients completed a median of 30 of 36 sessions. Patients achieved significant improvements in health outcomes, including across age and sex subgroups. The primary reason for discharge was completion of all 36 sessions of CR (46.4%). The final logistic regression model contained 12 predictors: age, sex, Black race, marital status, employment, number of physician-reported risk factors, dietary fat intake >30%, obesity, lack of exercise, benign prostatic hyperplasia, and self-reported stress and physical activity. Conclusions We demonstrated that patients participating in an appointment-based CR program achieved significant improvements in health outcomes and across sex/age subgroups. In addition, older individuals were more likely to complete CR. An appointment-based approach could be a viable alternative CR method to aid in optimizing the dose-response benefit of CR for patients with cardiovascular disease.
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Affiliation(s)
| | - Sean Fournier
- Yale New Haven Hospital Heart and Vascular CenterNew HavenCT
| | - Yanhong Deng
- Yale Center for Analytical SciencesSchool of Public HealthYale UniversityNew HavenCT
| | - Can Meng
- Yale Center for Analytical SciencesSchool of Public HealthYale UniversityNew HavenCT
| | - Susan Hiller
- Yale New Haven Hospital Heart and Vascular CenterNew HavenCT
| | | | - Rachel P. Dreyer
- Department of Emergency MedicineYale School of MedicineNew HavenCT,Center for Outcomes Research and Evaluation (CORE)Yale New Haven HealthNew HavenCT,Department of Biostatistics (Health Informatics)Yale School of Public HealthNew HavenCT
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115
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Tang LH, Harrison A, Skou ST, Taylor RS, Dalal H, Doherty P. Are patient characteristics and modes of delivery associated with completion of cardiac rehabilitation? A national registry analysis. Int J Cardiol 2022; 361:7-13. [DOI: 10.1016/j.ijcard.2022.05.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 02/23/2022] [Accepted: 05/02/2022] [Indexed: 12/17/2022]
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116
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Pogosova NV. [The importance of cardiorehabilitation in the era of modern treatment of cardio-vascular diseases]. KARDIOLOGIIA 2022; 62:3-11. [PMID: 35569158 DOI: 10.18087/cardio.2022.4.n2015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 02/04/2022] [Indexed: 06/15/2023]
Abstract
Cardiac rehabilitation (CR) has a class IA indication in international and national guidelines as an intervention with proven efficacy for decreasing cardiovascular and all-cause mortality in various categories of cardiological patients. However, CR is one of the least used current technologies for the treatment of patients with cardiovascular diseases worldwide. This article presents the state of the CR problem during the epoch of high-tech treatments of cardiovascular diseases; the prevalence of using CR in various countries; traditional and new methodological approaches, including telemedicine; and clinical and prognostic effects of CR in various categories of patients with cardiovascular diseases.
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Affiliation(s)
- N V Pogosova
- National Medical Research Center of Cardiology, Moscow
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117
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Piao JJ, Wan B, Zhao H, Shang Z, Yan L, Hao Z, Wang Y, Zhang Y, Gu Y. Effects of different brisk walking intensities on adherence and cardiorespiratory endurance of cardiac rehabilitation among patients with CHD after PCI: protocol for a randomised controlled trial. BMJ Open 2022; 12:e055437. [PMID: 35418429 PMCID: PMC9013999 DOI: 10.1136/bmjopen-2021-055437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION Cardiac rehabilitation (CR) is a critical treatment for patients with coronary heart disease after percutaneous coronary intervention. Unfortunately, participation and adherence of CR are unexpectedly poor. This study aims to test whether low-intensity or medium-intensity brisk walking is more helpful in improving early attendance, adherence and physical results. METHODS AND ANALYSIS This randomised controlled study will compare the effects of low-intensity and medium-intensity brisk walking to improve adherence and cardiopulmonary endurance. Participants will be randomly allocated to low-intensity or medium-intensity groups and will be followed-up for 8 weeks. Primary and secondary outcome data will be collected at baseline and at 2, 4 and 8 weeks. Primary outcomes measure changes in oxygen consumption (VO2) peak value (mL/kg/min), as well as adherence. Secondary outcomes include changes in body mass index, oxygen pulse, maximal metabolic equivalent, breathing reserve, vital capacity, ratio of forced expiratory volume in 1 s to forced vital capacity, Δoxygen consumption/Δwork rate (ΔVO2/ΔWR), minute ventilation/carbon dioxide production and self-efficacy. ETHICS AND DISSEMINATION Ethical approval and informed consent form have been obtained from the Ethics Committee of Hebei General Hospital (approval number: NA-2021-03). The study background and main objective, as well as potential benefits and risks, will be fully explained to the participants and their families. Findings from this study will be published on academic journals in Chinese or in English for widespread dissemination of the results TRIAL REGISTRATION NUMBER: ChiCTR2100047568.
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Affiliation(s)
- Jing Jing Piao
- School of Nursing, Hebei University of Chinese Medicine, Shijiazhuang, China
| | - Boya Wan
- School of Nursing, Hebei University of Chinese Medicine, Shijiazhuang, China
- Hebei General Hospital, Shijiazhuang, China
| | - Haomei Zhao
- School of Nursing, Hebei University of Chinese Medicine, Shijiazhuang, China
| | - Zhiyang Shang
- Affiliated Hospital of Hebei University, Baoding, Hebei, China
| | - Lingjun Yan
- School of Nursing, Hebei University of Chinese Medicine, Shijiazhuang, China
- The Third Hospital Of Shijiazhuang, Shijiazhuang, China
| | - Zhina Hao
- Hospital of Stomatology Hebei Medical University, Shijiazhuang, China
| | - Yonghong Wang
- School of Nursing, Hebei University of Chinese Medicine, Shijiazhuang, China
| | - Yanqing Zhang
- School of Nursing, Hebei University of Chinese Medicine, Shijiazhuang, China
| | - Yanmei Gu
- School of Nursing, Hebei University of Chinese Medicine, Shijiazhuang, China
- Key Laboratory for HealthCare with Chinese Medicine of Hebei Province, Shijiazhuang, China
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118
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Franzoni LT, Garcia EL, Motta SB, Ahner MM, Bertoletti OA, Saffi MAL, da Silveira AD, Pereira AA, Pereira AH, Danzmann LC, Stein R. Aerobic exercise and telomere length in patients with systolic heart failure: protocol study for a randomized controlled trial. Trials 2022; 23:283. [PMID: 35410445 PMCID: PMC8996601 DOI: 10.1186/s13063-022-06257-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 03/29/2022] [Indexed: 11/23/2022] Open
Abstract
Background Heart failure (HF) with reduced ejection fraction (HFrEF) is a syndrome that leads to fatigue and reduced functional capacity due to disease-related pathophysiological mechanisms. Aerobic exercise (AERO) plays a key role in improving HF outcomes, such as an increase in peak oxygen uptake (VO2peak). In addition, HF promotes cell senescence, which involves reducing telomere length. Several studies have shown that patients with a worse prognosis (i.e., reduced VO2 peak) also have shorter telomeres. However, the effects of AERO on telomere length in patients with HFrEF are still unknown. In an attempt to fill this gap, we designed a study to determine the effects of 16 weeks of aerobic training (32 sessions) on telomere length in HFrEF patients. Methods In this single-center randomized controlled trial, men and women between 50 and 80 years old will be allocated into two different groups: a moderate-intensity aerobic training and a control grouTelomere length, functional capacity, echocardiographic variables, endothelial function, and walking ability will be assessed before and after the 16-week intervention period. Discussion Understanding the role of physical exercise in biological aging in HFrEF patients is relevant. Due to cell senescence, these individuals have shown a shorter telomere length. AERO can delay biological aging according to a balance in oxidative stress through antioxidant action. Positive telomere length results are expected for the aerobic training group. Trial registration ClinicalTrials.gov NCT03856736. Registered on February 27, 2019
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119
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Nso N, Nassar M, Mbome Y, Emmanuel KE, Lyonga Ngonge A, Badejoko S, Akbar S, Landry I, Alfishawy M, Munira M, Rizzo V. Comparative Assessment of the Long-Term Efficacy of Home-Based Versus Center-Based Cardiac Rehabilitation. Cureus 2022; 14:e23485. [PMID: 35475109 PMCID: PMC9035293 DOI: 10.7759/cureus.23485] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/25/2022] [Indexed: 11/09/2022] Open
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120
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Lahtio H, Rintala A, Immonen J, Sjögren T. The Effectiveness of Physical Activity-Promoting Web- and Mobile-Based Distance Weight Loss Interventions on Body Composition in Rehabilitation Settings: Systematic Review, Meta-analysis, and Meta-Regression Analysis. J Med Internet Res 2022; 24:e25906. [PMID: 35323126 PMCID: PMC8990343 DOI: 10.2196/25906] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Revised: 03/06/2021] [Accepted: 12/28/2021] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Overweight and obesity are major problems worldwide, and they lead to an increased risk for several diseases. The use of technology in the treatment of obesity is promising, but in the existing literature, there is considerable uncertainty regarding its efficacy. In this review, we included web- and mobile-based weight loss interventions that were implemented remotely in rehabilitation settings. OBJECTIVE The aim of this systematic review is to study the effectiveness of physical activity-promoting web- and mobile-based distance weight loss interventions in rehabilitation settings on body composition in comparison with control groups that did not use technology. METHODS Studies were searched from 9 databases. The inclusion criteria were as follows: population: age 18-65 years; intervention: physical activity-promoting web- and mobile-based distance weight loss interventions; comparison: control groups without the use of technology; outcome: changes in BMI, waist circumference, or body fat percentage; study design: randomized controlled trial. The quality of the studies was assessed by 2 researchers. Meta-analysis was performed, and we also conducted a meta-regression analysis to evaluate the factors associated with the changes in body composition outcomes if statistical heterogeneity was observed. RESULTS The meta-analysis included 30 studies. The mean quality of the studies was 7 of 13 (SD 1.9; range 3-10). A statistically significant difference was observed in BMI (mean difference [MD] 0.83, 95% CI 0.51-1.15 kg/m2; P<.001), waist circumference (MD 2.45, 95% CI 1.83-3.07 cm; P<.001), and body fat percentage (MD 1.07%, 95% CI 0.74%-1.41%; P<.001) in favor of the weight loss groups using web- or mobile-based interventions. Meta-regression analyses found an association between personal feedback and BMI (P=.04), but other factors did not play a role in explaining statistical heterogeneity. CONCLUSIONS Web- and mobile-based distance weight loss interventions significantly reduced BMI, waist circumference, and body fat percentage. Future studies should focus on the comparability of the intervention content. Future studies are needed to better understand weight loss and identify which components are essential in achieving it. TRIAL REGISTRATION PROSPERO CRD42016035831; https://tinyurl.com/7c93tvd4.
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Affiliation(s)
- Heli Lahtio
- Faculty of Sport and Health Sciences, The University of Jyväskylä, Jyväskylä, Finland.,Faculty of Social Services and Health Care, LAB University of Applied Sciences, Lahti, Finland
| | - Aki Rintala
- Faculty of Social Services and Health Care, LAB University of Applied Sciences, Lahti, Finland.,Department of Neurosciences, Center for Contextual Psychiatry, KU Leuven, Leuven, Belgium
| | - Jaakko Immonen
- Faculty of Mathematics and Science, The University of Jyväskylä, Jyväskylä, Finland
| | - Tuulikki Sjögren
- Faculty of Sport and Health Sciences, The University of Jyväskylä, Jyväskylä, Finland
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121
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Sieczkowska SM, Astley C, Marques IG, Iraha AY, Franco TC, Ihara BP, Martins Lavorato SS, Lindoso L, Demitrol Setoue DN, Tanigava NY, Campos LMA, Pereira RMR, Aikawa NE, Roschel H, Queiroz LB, Polanczyk GV, Silva CA, Gualano B. A home-based exercise program during COVID-19 pandemic: Perceptions and acceptability of juvenile systemic lupus erythematosus and juvenile idiopathic arthritis adolescents. Lupus 2022; 31:443-456. [PMID: 35264025 PMCID: PMC8914298 DOI: 10.1177/09612033221083273] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To investigate the perceptions and acceptability of a home-based exercise intervention in systemic lupus erythematosus (JSLE) and juvenile idiopathic arthritis (JIA) adolescent patients during the COVID-19 pandemic, and to explore the effects of the intervention on health-related quality of life (HRQoL), sleep quality, and mental health conditions parameters. METHODS This was a randomized controlled trial of a 12-week, home-based exercise training program conducted between October and December 2020. During this period, social distancing measures were in place in Brazil to contain the spread of COVID-19. Adolescent patients diagnosed with JSLE and JIA participated in the study. Health-related qualitative and quantitative data were collected before and after the follow-up. RESULTS 21 JSLE patients and 30 JIA patients were analyzed. Six themes emerged from patients' feedback: 1) Suitability of the home-based format; 2) Appropriate trainer supervision, 3) Motivators and facilitators for the program; 4) Barriers to the program; 5) Health benefits; 6) Patients' suggestions to improve the program. Overall, data indicated that the intervention showed good acceptability and elicited improvements in the perceived HRQoL and fatigue in JIA and JSLE patients during the pandemic. However, further quantitative analyses with validated HRQoL, sleep quality, and mental health conditions instruments did not capture these benefits (p>0.05). CONCLUSION Our main findings based on in-depth qualitative assessments suggest that a home-based exercise training program was suitable and well-accepted by adolescents with JSLE and JIA during the COVID-19 pandemic. Nonetheless, adherence was not high, particularly among JIA patients, suggesting that facilitators and barriers identified in the current study should be explored to improve the quality of new home-based exercise programs implementation, particularly in a future emerging crisis.
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Affiliation(s)
- Sofia Mendes Sieczkowska
- Applied Physiology and Nutrition Research Group, School of Physical Education and Sport, 2028133Universidade de Sao Paulo, Sao Paulo, Brazil.,Rheumatology Division, Clinical Hospital, Hospital das Clinicas HCFMUSP, 2037884Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Camilla Astley
- Applied Physiology and Nutrition Research Group, School of Physical Education and Sport, 2028133Universidade de Sao Paulo, Sao Paulo, Brazil.,Rheumatology Division, Clinical Hospital, Hospital das Clinicas HCFMUSP, 2037884Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Isabela Gouveia Marques
- Applied Physiology and Nutrition Research Group, School of Physical Education and Sport, 2028133Universidade de Sao Paulo, Sao Paulo, Brazil.,Rheumatology Division, Clinical Hospital, Hospital das Clinicas HCFMUSP, 2037884Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Amanda Yuri Iraha
- Applied Physiology and Nutrition Research Group, School of Physical Education and Sport, 2028133Universidade de Sao Paulo, Sao Paulo, Brazil.,Rheumatology Division, Clinical Hospital, Hospital das Clinicas HCFMUSP, 2037884Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Tathiane Christine Franco
- Applied Physiology and Nutrition Research Group, School of Physical Education and Sport, 2028133Universidade de Sao Paulo, Sao Paulo, Brazil.,Rheumatology Division, Clinical Hospital, Hospital das Clinicas HCFMUSP, 2037884Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Bianca Pires Ihara
- Instituto da Criança e do Adolescente (ICr), Hospital das Clinicas HCFMUSP, 2037884Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Sofia Simão Martins Lavorato
- Instituto da Criança e do Adolescente (ICr), Hospital das Clinicas HCFMUSP, 2037884Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Livia Lindoso
- Instituto da Criança e do Adolescente (ICr), Hospital das Clinicas HCFMUSP, 2037884Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Debora Narumi Demitrol Setoue
- Instituto da Criança e do Adolescente (ICr), Hospital das Clinicas HCFMUSP, 2037884Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Nicolas Yamada Tanigava
- Rheumatology Division, Clinical Hospital, Hospital das Clinicas HCFMUSP, 2037884Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Lucia Maria Arruda Campos
- Instituto da Criança e do Adolescente (ICr), Hospital das Clinicas HCFMUSP, 2037884Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Rosa Maria Rodrigues Pereira
- Rheumatology Division, Clinical Hospital, Hospital das Clinicas HCFMUSP, 2037884Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Nadia Emi Aikawa
- Rheumatology Division, Clinical Hospital, Hospital das Clinicas HCFMUSP, 2037884Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil.,Instituto da Criança e do Adolescente (ICr), Hospital das Clinicas HCFMUSP, 2037884Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Hamilton Roschel
- Applied Physiology and Nutrition Research Group, School of Physical Education and Sport, 2028133Universidade de Sao Paulo, Sao Paulo, Brazil.,Rheumatology Division, Clinical Hospital, Hospital das Clinicas HCFMUSP, 2037884Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Ligia Bruni Queiroz
- Instituto da Criança e do Adolescente (ICr), Hospital das Clinicas HCFMUSP, 2037884Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Guilherme V Polanczyk
- Instituto da Criança e do Adolescente (ICr), Hospital das Clinicas HCFMUSP, 2037884Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Clovis Artur Silva
- Rheumatology Division, Clinical Hospital, Hospital das Clinicas HCFMUSP, 2037884Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil.,Instituto da Criança e do Adolescente (ICr), Hospital das Clinicas HCFMUSP, 2037884Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Bruno Gualano
- Applied Physiology and Nutrition Research Group, School of Physical Education and Sport, 2028133Universidade de Sao Paulo, Sao Paulo, Brazil.,Rheumatology Division, Clinical Hospital, Hospital das Clinicas HCFMUSP, 2037884Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil.,Food Research Center, 2028133University of Sao Paulo, Sao Paulo, Brazil
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Alves Bernardes R, Parreira P, Sousa L, Cruz A. Complexity and intention to use an innovative device for post-infarction patients: rehabilitation nurses' perspectives. CENTRAL EUROPEAN JOURNAL OF NURSING AND MIDWIFERY 2022. [DOI: 10.15452/cejnm.2021.12.0034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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123
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Van Iterson EH, Laffin LJ, Cho L. Expanding the availability of cardiac rehabilitation by offering a virtual option: forecasting the financial implications. Am J Prev Cardiol 2022; 10:100334. [PMID: 35342891 PMCID: PMC8943252 DOI: 10.1016/j.ajpc.2022.100334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 01/03/2022] [Accepted: 03/10/2022] [Indexed: 11/30/2022] Open
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124
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Heald FA, Marzolini S, Colella TJF, Oh P, Nijhawan R, Grace SL. Profile of women choosing mixed-sex, women-only, and home-based cardiac rehabilitation models and impact on utilization. Women Health 2022; 62:98-107. [DOI: 10.1080/03630242.2021.2023247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Fiorella A. Heald
- Faculty of Health, York University, Toronto, Ontario, Canada
- KITE-Toronto Rehabilitation Institute, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Susan Marzolini
- Faculty of Health, York University, Toronto, Ontario, Canada
- KITE-Toronto Rehabilitation Institute, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Tracey J. F. Colella
- KITE-Toronto Rehabilitation Institute, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Paul Oh
- Faculty of Health, York University, Toronto, Ontario, Canada
- KITE-Toronto Rehabilitation Institute, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Rajni Nijhawan
- KITE-Toronto Rehabilitation Institute, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Sherry L. Grace
- Faculty of Health, York University, Toronto, Ontario, Canada
- KITE-Toronto Rehabilitation Institute, University Health Network, University of Toronto, Toronto, Ontario, Canada
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125
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Scherrenberg M, Marinus N, Giallauria F, Falter M, Kemps H, Wilhelm M, Prescott E, Vigorito C, De Kluiver E, Cipriano G, Dendale P, Hansen D. The need for long-term personalized management of frail CVD patients by rehabilitation and telemonitoring: a framework. Trends Cardiovasc Med 2022:S1050-1738(22)00023-8. [PMID: 35121082 DOI: 10.1016/j.tcm.2022.01.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 01/24/2022] [Accepted: 01/29/2022] [Indexed: 10/19/2022]
Abstract
Due to advances in cardiovascular medicine and preventive cardiology, patients benefit from a better prognosis, even in case of significant disease burden such as acute and chronic coronary syndromes, advanced valvular heart disease and chronic heart failure. These advances have allowed CVD patients to increase their life expectancy, but on the other hand also experience aging-related syndromes such as frailty. Despite being underrecognized, frailty is a critical, common, and co-existent condition among older CVD patients, leading to exercise intolerance and compromised adherence to cardiovascular rehabilitation. Moreover, frail patients need a different approach for CR and are at very high risk for adverse events, but yet are underrepresented in conventional CR. Fortunately, recent advances have been made in technology, allowing remote monitoring, coaching and supervision of CVD patients in secondary prevention programs with promising benefits. Similarly, we hypothesized that such programs should also be implemented to treat frailty in CVD patients. However, considering frail patients' particular needs and challenges, telerehabilitation interventions should thus be appropriately adapted. Our purpose is to provide, for the first time and based on expert opinions, a framework of how such a cardiac telerehabilitation program could be developed and implemented to manage a prevention and rehabilitation program for CVD patients with frailty.
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Affiliation(s)
- Martijn Scherrenberg
- Heart Centre Hasselt, Jessa Hospital, Hasselt, Belgium; UHasselt, Faculty of Medicine and Life Sciences, Diepenbeek, Belgium; Faculty of Medicine and Health Sciences, Antwerp University, Belgium
| | - Nastasia Marinus
- UHasselt, Faculty of Rehabilitation Sciences, BIOMED-REVAL, Hasselt, Belgium
| | | | - Maarten Falter
- Heart Centre Hasselt, Jessa Hospital, Hasselt, Belgium; UHasselt, Faculty of Medicine and Life Sciences, Diepenbeek, Belgium; Faculty of Medicine, Department of Cardiology, KULeuven, Herestraat 49, 3000, Leuven, Belgium
| | - Hareld Kemps
- Department of Cardiology, Máxima Medical Center, The Netherlands; Department of Industrial Design, Technical University Eindhoven, The Netherlands
| | - Matthias Wilhelm
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Eva Prescott
- Department of Cardiology, Bispebjerg University Hospital, University of Copenhagen, Copenhagen, NW, Denmark
| | - Carlo Vigorito
- Department of Translational Medical Sciences, Federico II University of Naples
| | | | | | - Paul Dendale
- Heart Centre Hasselt, Jessa Hospital, Hasselt, Belgium; UHasselt, Faculty of Medicine and Life Sciences, Diepenbeek, Belgium
| | - Dominique Hansen
- Heart Centre Hasselt, Jessa Hospital, Hasselt, Belgium; UHasselt, Faculty of Rehabilitation Sciences, BIOMED-REVAL, Hasselt, Belgium.
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126
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Belenkov YN, Kozhevnikova MV. [Mobile health technologies in cardiology]. KARDIOLOGIIA 2022; 62:4-12. [PMID: 35168528 DOI: 10.18087/cardio.2022.1.n1963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 01/13/2022] [Indexed: 06/14/2023]
Abstract
Digital medicine is becoming an essential part of the healthcare system. The intense development of mobile technologies, the global coverage of mobile networks, and the growing attachment in the society to mobile devices have prompted the creation of mobile healthcare (mHealth). At present, mobile healthcare technologies have been tested in various cardiovascular diseases. Among the main tasks set for telemedicine, it is necessary to note improvements of general medical care, monitoring of patients' condition, accuracy of clinical diagnoses, timely correction of therapy, and improvement of emergency care. Clinical studies are performed in parallel with active work in the field of informational technologies to provide safety of data storage and intellectual processing. Finally, despite the broad public support for the development of this area of medicine, the search continues for methods to improve patients' compliance with the prescribed therapy. This article presents current information about the use of mHealth in cardiology, study results, prospects of mobile healthcare, and major difficulties in implementing projects in this area.
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Affiliation(s)
- Yu N Belenkov
- I.M. Sechenov First Moscow Medical University (Sechenov University), Moscow
| | - M V Kozhevnikova
- I.M. Sechenov First Moscow Medical University (Sechenov University), Moscow
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127
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Kirsch M, Vitiello D. The COVID-19 Pandemic Lowers Active Behavior of Patients with Cardiovascular Diseases, Healthy Peoples and Athletes. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19031108. [PMID: 35162128 PMCID: PMC8834491 DOI: 10.3390/ijerph19031108] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 01/14/2022] [Accepted: 01/19/2022] [Indexed: 02/04/2023]
Abstract
Aim: The paper aims to describe the impact of the increasing sedentary lifestyle due to the coronavirus disease-2019 (COVID-19) pandemic restrictions in patients with cardiovascular diseases (CVDs), healthy individuals, and athletes. Methods: A review of studies investigating the impact of the COVID-19 restrictions on patients with CVDs, healthy subjects, and athletes has been conducted in the PubMed, Medline, and Google Scholar medical databases. Results: The review highlighted the significant decrease of active behavior in patients with CVDs and mainly heart-failure patients, illustrated by a reduction of their daily steps and hours of being active during the COVID-19 pandemic. This review also enlightened a significant increase of the time spent in sedentary behavior and the sleep in healthy individuals. Finally, this review reported that the COVID-19 pandemic restrictions induced detraining periods in athletes, altering their health. These periods might also lead to a decrease of their future performances. Conclusions: Staying active and maintaining sufficient levels of physical activity during the COVID-19 pandemic are essential to preserve good health, despite the circumstances of quarantine. Alternatives such as completing a cardiac telerehabilitation for CVD patients or training at home for healthy subjects and athletes may be taken into consideration to maintain a regular active behavior in this sanitary context and potential future pandemics.
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128
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Komiyama J, Iwagami M, Mori T, Kuroda N, Jin X, Ito T, Tamiya N. Factors Associated with Outpatient Cardiac Rehabilitation Participation in Older Patients: A Population-Based Study Using Claims Data from Two Cities in Japan. ANNALS OF CLINICAL EPIDEMIOLOGY 2022; 4:11-19. [PMID: 38505282 PMCID: PMC10760477 DOI: 10.37737/ace.22003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 06/09/2021] [Indexed: 03/21/2024]
Abstract
BACKGROUND Although outpatient cardiac rehabilitation has been shown to be effective, the participation status of older cardiac patients is unclear in real-world settings. We investigated the proportion and associated factors of outpatient cardiac rehabilitation participation among older patients with heart diseases after cardiac intervention. METHODS We analyzed data from medical and long-term care insurance claims data from two municipalities in Japan. The data coverage period was between April 2014 and March 2019 in City A and between April 2012 and November 2016 in City B. We identified patients aged ≥65 years with post-operative acute myocardial infarction, angina pectoris, or heart valve disease. We estimated the proportion of cardiac rehabilitation participation and conducted logistic regression to identify factors (age, sex, type of cardiac disease, open-heart surgery, Charlson comorbidity index, long-term care need level, catecholamine use, inpatient cardiac rehabilitation, and hospital volume for cardiac rehabilitation) associated with outpatient cardiac rehabilitation participation. RESULTS A total of 690 patients were included in this study. The proportion of patients receiving outpatient cardiac rehabilitation was 9.0% overall. Multivariable logistic regression analysis suggested that men (adjusted OR 3.98; 95% CI 1.69-9.37), acute myocardial infarction (adjusted OR 2.76; 95% CI 1.20-6.36; reference angina pectoris), inpatient cardiac rehabilitation (adjusted OR 17.01; 95% CI 5.33-54.24), and "hospital volume" for cardiac rehabilitation (adjusted OR 4.35; 95% CI 1.14-16.57 for high-volume hospitals; reference low-volume hospital) were independently associated with outpatient cardiac rehabilitation. CONCLUSIONS The participation rate of outpatient cardiac rehabilitation among older post-operative cardiac patients was suboptimal. Further studies are warranted to examine its generalizability and whether a targeted approach to a group of patients who are less likely to receive outpatient cardiac rehabilitation could improve the participation rate.
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Affiliation(s)
- Jun Komiyama
- Graduate school of Comprehensive Human Sciences, University of Tsukuba
| | - Masao Iwagami
- Department of Health Services Research, Faculty of Medicine, University of Tsukuba
- Health Services Research and Development Center, University of Tsukuba
| | - Takahiro Mori
- Health Services Research and Development Center, University of Tsukuba
- Department of General Internal Medicine, Eastern Chiba Medical Center
| | - Naoaki Kuroda
- Health Services Research and Development Center, University of Tsukuba
- Department of Public Health and Welfare, Tsukuba City
- Community Clinic Tsukuba
| | - Xueying Jin
- Department of Health Services Research, Faculty of Medicine, University of Tsukuba
- Health Services Research and Development Center, University of Tsukuba
| | - Tomoko Ito
- Department of Health Services Research, Faculty of Medicine, University of Tsukuba
- Health Services Research and Development Center, University of Tsukuba
| | - Nanako Tamiya
- Department of Health Services Research, Faculty of Medicine, University of Tsukuba
- Health Services Research and Development Center, University of Tsukuba
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129
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Ramachandran HJ, Jiang Y, Teo JYC, Yeo TJ, Wang W. Technology Acceptance of Home-Based Cardiac Telerehabilitation Programs in Patients With Coronary Heart Disease: Systematic Scoping Review. J Med Internet Res 2022; 24:e34657. [PMID: 34994711 PMCID: PMC8783276 DOI: 10.2196/34657] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 11/24/2021] [Accepted: 11/27/2021] [Indexed: 01/20/2023] Open
Abstract
Background An understanding of the technology acceptance of home-based cardiac telerehabilitation programs is paramount if they are to be designed and delivered to target the needs and preferences of patients with coronary heart disease; however, the current state of technology acceptance of home-based cardiac telerehabilitation has not been systematically evaluated in the literature. Objective We aimed to provide a comprehensive summary of home-based cardiac telerehabilitation technology acceptance in terms of (1) the timing and approaches used and (2) patients’ perspectives on its usability, utility, acceptability, acceptance, and external variables. Methods We searched PubMed, CENTRAL, Embase, CINAHL, PsycINFO, and Scopus (inception to July 2021) for English-language papers that reported empirical evidence on the technology acceptance of early-phase home-based cardiac telerehabilitation in patients with coronary heart disease. Content analysis was undertaken. Results The search identified 1798 studies, of which 18 studies, with 14 unique home-based cardiac telerehabilitation programs, met eligibility criteria. Technology acceptance (of the home-based cardiac telerehabilitation programs) was mostly evaluated at intra- and posttrial stages using questionnaires (n=10) and usage data (n=11). The least used approach was evaluation through qualitative interviews (n=3). Usability, utility, acceptability, and acceptance were generally favored. External variables that influenced home-based cardiac telerehabilitation usage included component quality, system quality, facilitating conditions, and intrinsic factors. Conclusions Home-based cardiac telerehabilitation usability, utility, acceptability, and acceptance were high; yet, a number of external variables influenced acceptance. Findings and recommendations from this review can provide guidance for developing and evaluating patient-centered home-based cardiac telerehabilitation programs to stakeholders and clinicians.
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Affiliation(s)
- Hadassah Joann Ramachandran
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Ying Jiang
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Jun Yi Claire Teo
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Tee Joo Yeo
- Cardiac Rehabilitation, Department of Cardiology, National University Heart Centre, Singapore, Singapore
| | - Wenru Wang
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
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130
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Alexander S, Li S, Tracy M. Cardiac rehabilitation - The answer for the second chance. AMERICAN HEART JOURNAL PLUS : CARDIOLOGY RESEARCH AND PRACTICE 2022; 13:100108. [PMID: 38560078 PMCID: PMC10978207 DOI: 10.1016/j.ahjo.2022.100108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Revised: 01/10/2022] [Accepted: 02/09/2022] [Indexed: 04/04/2024]
Abstract
In the United States and worldwide, the leading cause of death in females is cardiovascular disease (CVD). However, compared to males, females have overall higher mortality rates, especially within the first few years of having an acute myocardial infarction (AMI). Despite the increased awareness of CVD in females and established benefits of cardiac rehabilitation (CR) programs, there is still delayed initiation of care, under-recognition of atypical presentations of angina in females, under referral of females to CR, and under-representation of females in CVD trials. In this paper, we will investigate the barriers to female participation in CR, explore the fundamental differences in physiology between males and females, and current limitations in CVD trials where females are under-represented. Finally, we aim to provide potential methods to increase enrollment of females in CR and CR related trials.
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Affiliation(s)
- Sarah Alexander
- Community Care Network, Inc., Munster, IN, United States of America
| | - Shannon Li
- RUSH University Medical Center, Chicago, IL, United States of America
| | - Melissa Tracy
- RUSH University Medical Center, Chicago, IL, United States of America
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131
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Lutz AH, Forman DE. Cardiac rehabilitation in older adults: Apropos yet significantly underutilized. Prog Cardiovasc Dis 2022; 70:94-101. [PMID: 35016915 PMCID: PMC8930627 DOI: 10.1016/j.pcad.2022.01.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Accepted: 01/03/2022] [Indexed: 01/12/2023]
Abstract
Cardiac Rehabilitation (CR) is a comprehensive disease management program that utilizes exercise training, behavioral modification, education, and psychosocial counseling to optimize outcomes and functionality in patients with cardiovascular disease (CVD)1). While CR was initially designed as an exercise training and fitness program for younger patients, usually men, after debilitating hospitalizations for myocardial infarction or cardiac surgery, evidence has expanded to also include other types of CVD in women as well as men, including heart failure, valvular disease, and peripheral arterial disease2-4). As the population of older adults continues to expand, age-related CVD is endemic and is commonly associated with exercise decline, diminished quality of life, and dependence. CR has the potential to counterbalance these patterns, and therefore stands out as a particularly important consideration for older adults with CVD. Nevertheless, CR remains highly underutilized5,6). Novel approaches to CR including home-based and hybrid CR programs show promise for enhanced outreach to patients who may not otherwise participate. This review summarizes the current data available regarding CR in older adults with CVD with a focus on geriatric-specific complexities, current barriers to utilization, and approaches to enhance participation and effectiveness.
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Affiliation(s)
| | - Daniel E. Forman
- University of Pittsburgh, Department of Medicine, Divisions of Geriatrics and Cardiology Pittsburgh Geriatrics Research, Education and Clinical Center, VA Pittsburgh Healthcare System
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132
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Alfaraidhy MA, Regan C, Forman DE. Cardiac rehabilitation for older adults: current evidence and future potential. Expert Rev Cardiovasc Ther 2022; 20:13-34. [PMID: 35098848 PMCID: PMC8858649 DOI: 10.1080/14779072.2022.2035722] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Growth of the older adult demographic has resulted in an increased number of older patients with cardiovascular disease (CVD) in combination with comorbid diseases and geriatric syndromes. Cardiac rehabilitation (CR) is utilized to promote recovery and improve outcomes, but remains underutilized, particularly by older adults. CR provides an opportunity to address the distinctive needs of older adults, with focus on CVD as well as geriatric domains that often dominate management and outcomes. AREAS COVERED Utility of CR for CVD in older adults as well as pertinent geriatric syndromes (e.g. multimorbidity, frailty, polypharmacy, cognitive decline, psychosocial stress, and diminished function) that affect CVD management. EXPERT OPINION Mounting data substantiate the importance of CR as part of recovery for older adults with CVD. The application of CR as a standard therapy is especially important as the combination of CVD and geriatric syndromes catalyzes functional decline and can trigger progressive clinical deterioration and dependency. While benefits of CR for older adults with CVD are already evident, further reengineering of CR is necessary to better address the needs of older candidates who may be frail, especially as remote and hybrid formats of CR are becoming more widespread.
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Affiliation(s)
- Maha A. Alfaraidhy
- Department of Medicine, University of Maryland School of Medicine, Baltimore, MD,Department of Medicine, King Abdulaziz University School of Medicine, Jeddah, KSA
| | - Claire Regan
- University of Maryland School of Nursing, Baltimore, MD
| | - Daniel E. Forman
- Department of Medicine (Geriatrics and Cardiology), Section of Geriatric Cardiology, University of Pittsburgh, Pittsburgh, Pennsylvania, PA,Geriatric Research, Education, and Clinical Center, VA Pittsburgh Healthcare System, University of Pittsburgh, Pittsburgh, PA
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133
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OUP accepted manuscript. Eur J Prev Cardiol 2022; 29:1072-1073. [DOI: 10.1093/eurjpc/zwac034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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134
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Dalli Peydró E, Sanz Sevilla N, Tuzón Segarra MT, Miró Palau V, Sánchez Torrijos J, Cosín Sales J. A randomized controlled clinical trial of cardiac telerehabilitation with a prolonged mobile care monitoring strategy after an acute coronary syndrome. Clin Cardiol 2021; 45:31-41. [PMID: 34952989 PMCID: PMC8799046 DOI: 10.1002/clc.23757] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 11/29/2021] [Indexed: 02/03/2023] Open
Abstract
Background Center‐based cardiac rehabilitation (CBCR) improves health outcomes but has some limitations. We designed and validated a telerehabilitation system to overcome these barriers. Methods We included 67 low‐risk acute coronary syndrome patients in a randomized controlled trial allocated 1:1 to a 10‐month cardiac telerehabilitation (CTR) program or an 8‐week CBCR program. Patients underwent ergospirometry, blood tests, anthropometric measurements, IPAQ, PREDIMED, HADS, and EQ‐5D questionnaires at baseline and 10 months. Data collectors were blinded to the treatment groups. Results The intention‐to‐treat analysis included 31 patients in the CTR group and 28 patients in the CBCR group. The primary outcome showed increased physical activity according to the IPAQ survey in the CTR group compared to the CBCR group (median increase 1726 METS‐min/week vs. 636, p = .045). Mean VO2max increased 1.62 ml/(kg min) (95% confidence interval [CI]: 0.56–2.69, p < .004) from baseline in the CTR group, and 0.60 mL/(kg min) (p = .40) in the CBCR group. Mean apoB/apoA‐I ratio decreased 0.13 (95% CI: −0.03 to 0.24, p = .017) in the CTR group, with no significant change in the CBCR group (p = .092). The median non‐HDL cholesterol increased by 7.3 mg/dl (IQR: −2.4 to 18.6, p = .021) in the CBCR group, but the increase was not significant in the CTR group (p = .080). Adherence to a Mediterranean diet, psychological distress, and quality of life showed greater improvement in the CTR group than in the CBCR group. Return‐to‐work time was reduced with the telerehabilitation strategy. Conclusion This system allows minimal in‐hospital training and prolonged follow‐up. This strategy showed better results than CBCR.
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Affiliation(s)
| | - Nuria Sanz Sevilla
- Department of Physical Medicine and Rehabilitation, University Hospital Doctor Peset, Valencia, Spain
| | | | | | | | - Juan Cosín Sales
- Department of Cardiology, Hospital Arnau de Vilanova, Valencia, Spain
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135
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Besnier F, Dupuy EG, Gagnon C, Vincent T, Grégoire CA, Blanchette CA, Saillant K, Bouabdallaoui N, Grau JI, Bérubé B, Olmand M, Marin MF, Belleville S, Juneau M, Vitali P, Gayda M, Nigam A, Bherer L. Investigation of the Effects of Home-Based Exercise and Cognitive Training on Cognitive and Physical Functions in Cardiac Patients: The COVEPICARDIO Study Protocol of a Randomized Clinical Trial. Front Cardiovasc Med 2021; 8:740834. [PMID: 34938780 PMCID: PMC8685268 DOI: 10.3389/fcvm.2021.740834] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 11/19/2021] [Indexed: 11/19/2022] Open
Abstract
Introduction: During the COVID-19 pandemic, confinement measures are likely to produce collateral damage to health (stress, confusion, anxiety), especially in frail individuals and those living with cardiovascular disease (CVD). In cardiac patients in particular, these measures dramatically increase the level of physical inactivity and sedentary lifestyle, which can decrease cardiorespiratory capacity and increase the risk of acute events, rehospitalization, and depressive syndromes. Maintaining a minimum level of physical activity and cognitive stimulation during the COVID-19 crisis is essential for cardiac patients. This study is designed to document the effects of 6 months of home-based physical exercise alone or combined with cognitive training on cognitive and physical functions in patients with CVD over 50 years old. Methods and Analysis: 122 patients (>50 years old) with stable CVD and no contraindication to perform physical exercise training will be recruited and randomly assigned to one of the 2 following arms: (1) Home-based physical exercise alone, (2) Home-based physical exercise combined with cognitive training. The intervention lasts 6 months, with remote assessments performed prior to, mid and post-training. A follow-up 6 months after the end of the intervention (12 month) is also proposed. The primary outcome is cognition, including general functioning (Montreal Cognitive Assessment (MoCA) score), as well as performances on measures of executive functions, processing speed, and episodic memory. The secondary outcome is physical performance, including balance, gait and mobility, leg muscle strength and estimated cardiorespiratory fitness. Tertiary outcomes include mood, anxiety, and health-related quality of life as assessed by self-reported online questionnaires. Discussion: With the COVID-19 crisis, there is a critical need for remote exercise and cognitive training, and to further investigate this topic, in particular for cardiac patients. The present context can be viewed as an opportunity to perform a major shift from center-based programs to home-based physical exercise. This is especially important to reach out to older adults living in remote areas, where access to such interventions is limited. ClinicalTrials.gov: [https://clinicaltrials.gov/ct2/show/NCT04661189], NCT04661189.
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Affiliation(s)
- Florent Besnier
- Research Center and Centre ÉPIC, Montreal Heart Institute, Montréal, QC, Canada.,Department of Medicine, Faculty of Medicine, Université de Montréal, Montréal, QC, Canada
| | - Emma Gabrielle Dupuy
- Research Center and Centre ÉPIC, Montreal Heart Institute, Montréal, QC, Canada.,Department of Medicine, Faculty of Medicine, Université de Montréal, Montréal, QC, Canada
| | - Christine Gagnon
- Research Center and Centre ÉPIC, Montreal Heart Institute, Montréal, QC, Canada
| | - Thomas Vincent
- Research Center and Centre ÉPIC, Montreal Heart Institute, Montréal, QC, Canada
| | | | - Caroll-Ann Blanchette
- Research Center and Centre ÉPIC, Montreal Heart Institute, Montréal, QC, Canada.,Department of Medicine, Faculty of Medicine, Université de Montréal, Montréal, QC, Canada
| | - Kathia Saillant
- Research Center and Centre ÉPIC, Montreal Heart Institute, Montréal, QC, Canada.,Department of Psychologie, Université du Québec à Montréal, Montréal, QC, Canada
| | - Nadia Bouabdallaoui
- Research Center and Centre ÉPIC, Montreal Heart Institute, Montréal, QC, Canada.,Department of Medicine, Faculty of Medicine, Université de Montréal, Montréal, QC, Canada
| | - Josep Iglésies Grau
- Research Center and Centre ÉPIC, Montreal Heart Institute, Montréal, QC, Canada.,Department of Medicine, Faculty of Medicine, Université de Montréal, Montréal, QC, Canada
| | - Béatrice Bérubé
- Research Center and Centre ÉPIC, Montreal Heart Institute, Montréal, QC, Canada.,Department of Psychologie, Université du Québec à Montréal, Montréal, QC, Canada.,Research Center, Institut Universitaire de Gériatrie de Montréal, Montréal, QC, Canada
| | - Miloudza Olmand
- Research Center and Centre ÉPIC, Montreal Heart Institute, Montréal, QC, Canada.,Department of Psychology, Université de Montréal, Montréal, QC, Canada
| | - Marie-France Marin
- Department of Psychologie, Université du Québec à Montréal, Montréal, QC, Canada.,Research Center of the Montreal Mental Health University Institute, Montréal, QC, Canada
| | - Sylvie Belleville
- Research Center, Institut Universitaire de Gériatrie de Montréal, Montréal, QC, Canada.,Department of Psychology, Université de Montréal, Montréal, QC, Canada
| | - Martin Juneau
- Research Center and Centre ÉPIC, Montreal Heart Institute, Montréal, QC, Canada.,Department of Medicine, Faculty of Medicine, Université de Montréal, Montréal, QC, Canada
| | - Paolo Vitali
- McGill University Research Centre for Studies on Aging, Montréal, QC, Canada.,McGill University Department of Neurology and Neurosurgery, Faculty of Medicine, Montréal, QC, Canada
| | - Mathieu Gayda
- Research Center and Centre ÉPIC, Montreal Heart Institute, Montréal, QC, Canada.,Department of Medicine, Faculty of Medicine, Université de Montréal, Montréal, QC, Canada
| | - Anil Nigam
- Research Center and Centre ÉPIC, Montreal Heart Institute, Montréal, QC, Canada.,Department of Medicine, Faculty of Medicine, Université de Montréal, Montréal, QC, Canada
| | - Louis Bherer
- Research Center and Centre ÉPIC, Montreal Heart Institute, Montréal, QC, Canada.,Department of Medicine, Faculty of Medicine, Université de Montréal, Montréal, QC, Canada.,Research Center, Institut Universitaire de Gériatrie de Montréal, Montréal, QC, Canada
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136
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Squires RW, Bonikowske AR. Cardiac rehabilitation for heart transplant patients: Considerations for exercise training. Prog Cardiovasc Dis 2021; 70:40-48. [PMID: 34942234 DOI: 10.1016/j.pcad.2021.12.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Accepted: 12/12/2021] [Indexed: 11/09/2022]
Abstract
Heart transplantation (HT) is the treatment of choice for eligible patients with end-stage chronic heart failure (HF). One-year survival world-wide is >85%. Many patients experience a reasonable functional ability post-HT, but episodes of acute rejection, as well as multiple co-morbidities such as hypertension, diabetes, chronic kidney disease and cardiac allograft vasculopathy are common. Immunosuppression with prednisone frequently results in increased body fat and skeletal muscle atrophy. Exercise capacity is below normal for most patients with a mean peak oxygen uptake (VO2) of approximately 60% of expected. HT recipients have abnormal exercise physiology findings related to surgical cardiac denervation, diastolic dysfunction, and the legacy of reduced skeletal muscle oxidative capacity and impaired vasodilatory ability resulting from pre-HT chronic HF. The heart rate response to exercise is blunted. Cardiac reinnervation resulting in partial normalization of the heart rate response to exercise occurs in approximately 40% of HT recipients months to years after HT. Supervised exercise training in cardiac rehabilitation (CR) programs is safe and is recommended by professional societies both before (pre-habilitation) and after HT. Exercise training does not require alteration in immunosuppressants. Exercise training in adults after HT improves peak VO2 and skeletal muscle strength. It has also been demonstrated to reduce the severity of cardiac allograft vasculopathy. In addition, CR exercise training is associated with reduced stroke risk, percutaneous coronary intervention, hospitalization for either acute rejection or HF, and death. There are only limited data for exercise training in the pediatric population.
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Affiliation(s)
- Ray W Squires
- Department of Cardiovascular Medicine, Division of Preventive Cardiology, Mayo Clinic, Rochester, MN, United States of America.
| | - Amanda R Bonikowske
- Department of Cardiovascular Medicine, Division of Preventive Cardiology, Mayo Clinic, Rochester, MN, United States of America
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137
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Heald FA, Marzolini S, Colella TJF, Oh P, Nijhawan R, Grace SL. Women's outcomes following mixed-sex, women-only, and home-based cardiac rehabilitation participation and comparison by sex. BMC Womens Health 2021; 21:413. [PMID: 34911506 PMCID: PMC8672337 DOI: 10.1186/s12905-021-01553-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 11/26/2021] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Despite women's greater need for cardiac rehabilitation (CR), they are less likely to utilize it. Innovative CR models have been developed to better meet women's needs, yet there is little controlled, comparative data assessing the effects of these models for women. This study compared outcomes in women electing to participate in mixed-sex, women-only, or home-based CR, and a matched sample of men. METHODS In this retrospective study, electronic records of CR participants in Toronto who were offered the choice of program model between January 2017 and July 2019 were analyzed; clinical outcomes comprised cardiorespiratory fitness, risk factors and psychosocial well-being. These were assessed at intake and post-6-month program and analyzed using general linear mixed models. RESULTS There were 1181 patients (727 women [74.7% mixed, 22.0% women-only, 3.3% home-based]; 454 age and diagnosis-matched men) who initiated CR; Cardiorespiratory fitness among women was higher at initiation of mixed-sex than women-only (METs 5.1 ± 1.5 vs 4.6 ± 1.3; P = .007), but no other outcome differences were observed. 428 (58.9%) women completed the programs, with few women retained in the home-based model limiting comparisons. There were significant improvements in high-density lipoprotein cholesterol (P = .001) and quality of life (P = .001), and lower depressive symptoms (P = .030) as well as waist circumference (P = .001) with mixed-sex only. VO2peak was significantly higher at discharge in mixed-sex than women-only (estimate = 1.67, standard error = 0.63, 95% confidence interval = 0.43-2.91). CONCLUSION Participation in non-gender-tailored women-only CR was not advantageous as expected. More research is needed, particularly including women participating in home-based programs.
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Affiliation(s)
- Fiorella A Heald
- Faculty of Health, York University, Bethune 368, 4700 Keele Street, Toronto, ON, M3J 1P3, Canada
- KITE-Toronto Rehabilitation Institute, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Susan Marzolini
- Faculty of Health, York University, Bethune 368, 4700 Keele Street, Toronto, ON, M3J 1P3, Canada
- KITE-Toronto Rehabilitation Institute, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Tracey J F Colella
- KITE-Toronto Rehabilitation Institute, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Paul Oh
- Faculty of Health, York University, Bethune 368, 4700 Keele Street, Toronto, ON, M3J 1P3, Canada
- KITE-Toronto Rehabilitation Institute, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Rajni Nijhawan
- KITE-Toronto Rehabilitation Institute, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Sherry L Grace
- Faculty of Health, York University, Bethune 368, 4700 Keele Street, Toronto, ON, M3J 1P3, Canada.
- KITE-Toronto Rehabilitation Institute, University Health Network, University of Toronto, Toronto, ON, Canada.
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138
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Harzand A, Weidman AC, Rayl KR, Adesanya A, Holmstrand E, Fitzpatrick N, Vathsangam H, Murali S. Retrospective Analysis and Forecasted Economic Impact of a Virtual Cardiac Rehabilitation Program in a Third-Party Payer Environment. Front Digit Health 2021; 3:678009. [PMID: 34901923 PMCID: PMC8653769 DOI: 10.3389/fdgth.2021.678009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 10/15/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Participation in cardiac rehabilitation (CR) is recommended for all patients with coronary artery disease (CAD) following hospitalization for acute coronary syndrome or stenting. Yet, few patients participate due to the inconvenience and high cost of attending a facility-based program, factors which have been magnified during the ongoing COVID pandemic. Based on a retrospective analysis of CR utilization and cost in a third-party payer environment, we forecasted the potential clinical and economic benefits of delivering a home-based, virtual CR program, with the goal of guiding future implementation efforts to expand CR access. Methods: We performed a retrospective cohort study using insurance claims data from a large, third-party payer in the state of Pennsylvania. Primary diagnostic and procedural codes were used to identify patients admitted for CAD between October 1, 2016, and September 30, 2018. Rates of enrollment in facility-based CR, as well as all-cause and cardiovascular hospital readmission and associated costs, were calculated during the 12-months following discharge. Results: Only 37% of the 7,264 identified eligible insured patients enrolled in a facility-based CR program within 12 months, incurring a mean delivery cost of $2,922 per participating patient. The 12-month all-cause readmission rate among these patients was 24%, compared to 31% among patients who did not participate in CR. Furthermore, among those readmitted, CR patients were readmitted less frequently than non-CR patients within this time period. The average per-patient cost from hospital readmissions was $30,814 per annum. Based on these trends, we forecasted that adoption of virtual CR among patients who previously declined CR would result in an annual cost savings between $1 and $9 million in the third-party healthcare system from a combination of increased overall CR enrollment and fewer hospital readmissions among new HBCR participants. Conclusions: Among insured patients eligible for CR in a third-party payer environment, implementation of a home-based virtual CR program is forecasted to yield significant cost savings through a combination of increased CR participation and a consequent reduction in downstream healthcare utilization.
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Affiliation(s)
- Arash Harzand
- Emory University School of Medicine, Atlanta, GA, United States
| | - Aaron C Weidman
- VITAL Innovation, Highmark Health, Pittsburgh, PA, United States
| | - Kenneth R Rayl
- VITAL Innovation, Highmark Health, Pittsburgh, PA, United States
| | | | | | | | | | - Srinivas Murali
- Cardiovascular Institute, Allegheny Health Network, Pittsburgh, PA, United States
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139
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Winnige P, Filakova K, Hnatiak J, Dosbaba F, Bocek O, Pepera G, Papathanasiou J, Batalik L, Grace SL. Validity and Reliability of the Cardiac Rehabilitation Barriers Scale in the Czech Republic (CRBS-CZE): Determination of Key Barriers in East-Central Europe. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182413113. [PMID: 34948722 PMCID: PMC8701715 DOI: 10.3390/ijerph182413113] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 12/09/2021] [Accepted: 12/10/2021] [Indexed: 02/07/2023]
Abstract
Cardiovascular rehabilitation (CR) is an effective secondary preventive model of care. However, the use of CR is insufficient, and the reasons for this are not well-characterized in East-Central Europe. This prospective observational study psychometrically validated the recently translated Cardiac Rehabilitation Barriers Scale for the Czech language (CRBS-CZE) and identified the main CR barriers. Consecutive cardiac in/out-patients were approached from January 2020 for 18 months, of whom 186 (89.9%) consented. In addition to sociodemographic characteristics, participants completed the 21-item CRBS-CZE (response options 1-5, with higher scores representing greater barriers), and their CR utilization was tracked. Forty-five (24.2%) participants enrolled in CR, of whom 42 completed the CRBS a second time thereafter. Factor analysis revealed four factors, consistent with other CRBS translations. Internal reliability was acceptable for all but one factor (Cronbach's alpha range = 0.44-0.77). Mean total barrier scores were significantly higher in non-enrollers (p < 0.001), decreased from first and second administration in these enrollers (p < 0.001), and were lower in CR completers (p < 0.001), supporting criterion validity. There were also significant differences in barrier scores by education, geography, tobacco use, among other variables, further supporting validity. The biggest barriers to enrolment were distance, work responsibilities, lack of time, transportation problems, and comorbidities; and the greatest barriers to adherence were distance and travel. Several items were considered irrelevant at first and second administration. Other barriers included wearing a mask during the COVID-19 pandemic. The study demonstrated sufficient validity and reliability of CRBS-CZE, which supports its use in future research.
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Affiliation(s)
- Petr Winnige
- Department of Public Health, Faculty of Medicine, Masaryk University, 62500 Brno, Czech Republic;
- Department of Rehabilitation, University Hospital Brno, 62500 Brno, Czech Republic; (K.F.); (J.H.); (F.D.)
| | - Katerina Filakova
- Department of Rehabilitation, University Hospital Brno, 62500 Brno, Czech Republic; (K.F.); (J.H.); (F.D.)
| | - Jakub Hnatiak
- Department of Rehabilitation, University Hospital Brno, 62500 Brno, Czech Republic; (K.F.); (J.H.); (F.D.)
- Faculty of Medicine, Masaryk University, 62500 Brno, Czech Republic
| | - Filip Dosbaba
- Department of Rehabilitation, University Hospital Brno, 62500 Brno, Czech Republic; (K.F.); (J.H.); (F.D.)
| | - Otakar Bocek
- Department of Internal Cardiology Medicine, University Hospital Brno, 62500 Brno, Czech Republic;
| | - Garyfallia Pepera
- Physiotherapy Department, Faculty of Health Sciences, University of Thessaly, 35100 Lamia, Greece;
| | - Jannis Papathanasiou
- Department of Medical Imaging, Allergology & Physiotherapy, Faculty of Dental Medicine, Medical University of Plovdiv, 4002 Plovdiv, Bulgaria;
- Department of Kinesitherapy, Faculty of Public Health, Medical University of Sofia, 1431 Sofia, Bulgaria
| | - Ladislav Batalik
- Department of Public Health, Faculty of Medicine, Masaryk University, 62500 Brno, Czech Republic;
- Department of Rehabilitation, University Hospital Brno, 62500 Brno, Czech Republic; (K.F.); (J.H.); (F.D.)
- Correspondence:
| | - Sherry L. Grace
- Faculty of Health, York University & KITE-Toronto Rehabilitation Institute, University Health Network, University of Toronto, Toronto, ON M3J 1P3, Canada;
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140
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Kaihara T, Scherrenberg M, Falter M, Frederix I, Itoh H, Makita S, Akashi YJ, Dendale P. Cardiac Telerehabilitation - A Solution for Cardiovascular Care in Japan. Circ Rep 2021; 3:733-736. [PMID: 34950799 PMCID: PMC8651469 DOI: 10.1253/circrep.cr-21-0126] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 09/16/2021] [Indexed: 01/02/2023] Open
Abstract
Cardiac rehabilitation (CR) is a well-known intervention for the secondary prevention of cardiovascular diseases. However, in Japan, the outpatient CR participation rate is estimated to be very low. Cardiac telerehabilitation (CTR) can be defined as a remote CR program using digital health technology to support it. Evidence regarding the use of CTR has been accumulated, and the COVID-19 pandemic has accelerated the need for CTR. Japan has sufficient potential to benefit from CTR because, nationally, digital literacy is high and the infrastructure for telemedicine is developed. To overcome several barriers, evidence of CTR in Japan, well-educated multidisciplinary CTR teams, a good combination of center-based CR and CTR, and sophisticated systems including social insurance and adequate legislation need to be developed immediately. CTR has the potential to increase the low CR participation rate in Japan. CTR also has many different effects that not only cardiologists, but also paramedics who engage in CTR, have to be aware of.
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Affiliation(s)
- Toshiki Kaihara
- Heart Centre Hasselt, Jessa Hospital Hasselt Belgium.,Hasselt University, Faculty of Medicine and Life Sciences Diepenbeek Belgium.,Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine Kawasaki Japan
| | - Martijn Scherrenberg
- Heart Centre Hasselt, Jessa Hospital Hasselt Belgium.,Hasselt University, Faculty of Medicine and Life Sciences Diepenbeek Belgium.,University of Antwerp, Faculty of Medicine and Health Sciences Antwerp Belgium
| | - Maarten Falter
- Heart Centre Hasselt, Jessa Hospital Hasselt Belgium.,Hasselt University, Faculty of Medicine and Life Sciences Diepenbeek Belgium.,University of Leuven, Faculty of Medicine Leuven Belgium
| | - Ines Frederix
- Heart Centre Hasselt, Jessa Hospital Hasselt Belgium.,Hasselt University, Faculty of Medicine and Life Sciences Diepenbeek Belgium.,University of Antwerp, Faculty of Medicine and Health Sciences Antwerp Belgium.,Antwerp University Hospital Edegem Belgium
| | - Haruki Itoh
- Department of Cardiology, Sakakibara Heart Institute Tokyo Japan
| | - Shigeru Makita
- Department of Cardiac Rehabilitation, Saitama Medical University International Medical Center Saitama Japan
| | - Yoshihiro J Akashi
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine Kawasaki Japan
| | - Paul Dendale
- Heart Centre Hasselt, Jessa Hospital Hasselt Belgium.,Hasselt University, Faculty of Medicine and Life Sciences Diepenbeek Belgium
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141
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Lawton JS, Tamis-Holland JE, Bangalore S, Bates ER, Beckie TM, Bischoff JM, Bittl JA, Cohen MG, DiMaio JM, Don CW, Fremes SE, Gaudino MF, Goldberger ZD, Grant MC, Jaswal JB, Kurlansky PA, Mehran R, Metkus TS, Nnacheta LC, Rao SV, Sellke FW, Sharma G, Yong CM, Zwischenberger BA. 2021 ACC/AHA/SCAI Guideline for Coronary Artery Revascularization: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation 2021; 145:e18-e114. [PMID: 34882435 DOI: 10.1161/cir.0000000000001038] [Citation(s) in RCA: 139] [Impact Index Per Article: 46.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
AIM The guideline for coronary artery revascularization replaces the 2011 coronary artery bypass graft surgery and the 2011 and 2015 percutaneous coronary intervention guidelines, providing a patient-centric approach to guide clinicians in the treatment of patients with significant coronary artery disease undergoing coronary revascularization as well as the supporting documentation to encourage their use. METHODS A comprehensive literature search was conducted from May 2019 to September 2019, encompassing studies, reviews, and other evidence conducted on human subjects that were published in English from PubMed, EMBASE, the Cochrane Collaboration, CINHL Complete, and other relevant databases. Additional relevant studies, published through May 2021, were also considered. Structure: Coronary artery disease remains a leading cause of morbidity and mortality globally. Coronary revascularization is an important therapeutic option when managing patients with coronary artery disease. The 2021 coronary artery revascularization guideline provides recommendations based on contemporary evidence for the treatment of these patients. The recommendations present an evidence-based approach to managing patients with coronary artery disease who are being considered for coronary revascularization, with the intent to improve quality of care and align with patients' interests.
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142
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Lawton JS, Tamis-Holland JE, Bangalore S, Bates ER, Beckie TM, Bischoff JM, Bittl JA, Cohen MG, DiMaio JM, Don CW, Fremes SE, Gaudino MF, Goldberger ZD, Grant MC, Jaswal JB, Kurlansky PA, Mehran R, Metkus TS, Nnacheta LC, Rao SV, Sellke FW, Sharma G, Yong CM, Zwischenberger BA. 2021 ACC/AHA/SCAI Guideline for Coronary Artery Revascularization: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. J Am Coll Cardiol 2021; 79:e21-e129. [PMID: 34895950 DOI: 10.1016/j.jacc.2021.09.006] [Citation(s) in RCA: 490] [Impact Index Per Article: 163.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
AIM The guideline for coronary artery revascularization replaces the 2011 coronary artery bypass graft surgery and the 2011 and 2015 percutaneous coronary intervention guidelines, providing a patient-centric approach to guide clinicians in the treatment of patients with significant coronary artery disease undergoing coronary revascularization as well as the supporting documentation to encourage their use. METHODS A comprehensive literature search was conducted from May 2019 to September 2019, encompassing studies, reviews, and other evidence conducted on human subjects that were published in English from PubMed, EMBASE, the Cochrane Collaboration, CINHL Complete, and other relevant databases. Additional relevant studies, published through May 2021, were also considered. STRUCTURE Coronary artery disease remains a leading cause of morbidity and mortality globally. Coronary revascularization is an important therapeutic option when managing patients with coronary artery disease. The 2021 coronary artery revascularization guideline provides recommendations based on contemporary evidence for the treatment of these patients. The recommendations present an evidence-based approach to managing patients with coronary artery disease who are being considered for coronary revascularization, with the intent to improve quality of care and align with patients' interests.
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143
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Jafri SH, Imran TF, Medbury E, Ursillo J, Ahmad K, Imran H, Drwal K, Wu WC. Cardiovascular Outcomes of Patients Referred to Home Based Cardiac Rehabilitation. Heart Lung 2021; 52:1-7. [PMID: 34801771 PMCID: PMC8600943 DOI: 10.1016/j.hrtlng.2021.11.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 11/02/2021] [Accepted: 11/04/2021] [Indexed: 12/19/2022]
Abstract
Background Home Based Cardiac Rehabilitation (HBCR) has been considered a reasonable alternative to Center-based Cardiac Rehabilitation (CBCR) in patients with established cardiovascular disease, especially in the midst of COVID-19 pandemic. However, the long-term cardiovascular outcomes of patients referred to HBCR remains unknown. Objectives To compare outcomes of patients who were referred and attended HBCR vs patients referred but did not attend HBCR (Non-HBCR). Methods We performed a retrospective study of 269 patients referred to HBCR at Providence Veterans Affairs Medical Center (PVAMC). From November 2017 to March 2020, 427 patients were eligible and referred for Cardiac Rehabilitation (CR) at PVAMC. Of total patients, 158 patients were referred to CBCR and 269 patients to HBCR based on patient and/or clinician preference. The analysis of outcomes was focused on HBCR patients. We compared outcomes of patients who were referred and attended HBCR vs patients referred but did not attend HBCR (Non-HBCR) from 3 to 12 months of the referral date. HBCR consisted of face-to-face entry exam with exercise prescription, weekly phone calls for education and exercise monitoring, with adjustments where applicable, for 12-weeks and an exit exam. Primary outcome was composite of all-cause mortality and hospitalizations. Secondary outcomes were all-cause hospitalization, all-cause mortality and cardiovascular hospitalizations, separately. We used cox proportional methods to calculate hazard ratios (HR) and 95% CI. We adjusted for imbalanced characteristics at baseline: smoking, left ventricular ejection fraction and CABG status. Results A total of 269 patients (mean age: 72, 98% Male) were referred to HBCR, however, only 157 (58%) patients attended HBCR. The primary outcome occurred in 30 patients (19.1%) in the HBCR group and 30 patients (30%) in the Non-HBCR group (adjusted HR=0.56, CI 0.33-0.95, P=.03). All-cause mortality occurred in 6.4% of patients in the HBCR group and 13% patients in the Non-HBCR group 3 to 12 months after HBCR referral (adjusted HR=0.43, CI 0.18-1.0, P= .05). There was no difference in cardiovascular hospitalizations (HBCR: 5.7% vs Non-HBCR: 10%, adjusted HR 0.57, CI 0.22-1.4, P= .23) or all cause hospitalizations at 3 to 12 months between the groups (HBCR: 12.7% vs Non-HBCR: 21%, adjusted HR 0.53, CI 0.28-1.01, P= .05). Conclusion Completion of HBCR among referred patients was associated with a lower risk of the combined all-cause mortality and all-cause hospitalizations up to 12 months. Based on the outcomes, HBCR is a reasonable option that can improve access to CR for patients who are not candidates of or cannot attend CBCR. Randomized-controlled studies are needed to confirm these findings.
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Affiliation(s)
- S Hammad Jafri
- Providence Veterans Affairs Medical Center, Providence, RI; Miriam Hospital Cardiac Rehabilitation Center, Providence, RI; Alpert Medical School, Brown University, Providence, RI
| | - Tasnim F Imran
- Providence Veterans Affairs Medical Center, Providence, RI; Miriam Hospital Cardiac Rehabilitation Center, Providence, RI; Alpert Medical School, Brown University, Providence, RI
| | | | | | - Khansa Ahmad
- Providence Veterans Affairs Medical Center, Providence, RI; Miriam Hospital Cardiac Rehabilitation Center, Providence, RI; Alpert Medical School, Brown University, Providence, RI
| | - Hafiz Imran
- Providence Veterans Affairs Medical Center, Providence, RI; Miriam Hospital Cardiac Rehabilitation Center, Providence, RI; Alpert Medical School, Brown University, Providence, RI
| | - Kariann Drwal
- Iowa City VA Healthcare System, Veterans Rural Health Resource Center-Central Region, VA Office of Rural Health, Iowa City, Iowa
| | - Wen-Chih Wu
- Providence Veterans Affairs Medical Center, Providence, RI; Miriam Hospital Cardiac Rehabilitation Center, Providence, RI; Alpert Medical School, Brown University, Providence, RI.
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144
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Scrutinio D, Guida P, Passantino A, Scalvini S, Bussotti M, Forni G, Vaninetti R, La Rovere MT. Characteristics, outcomes and long-term survival of heart failure patients undergoing inpatient cardiac rehabilitation. Arch Phys Med Rehabil 2021; 103:891-898.e4. [PMID: 34740595 DOI: 10.1016/j.apmr.2021.10.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 10/06/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To investigate the association of CR participation with all-cause mortality after a hospitalization for HF and to describe the characteristics and functional and clinical outcomes of heart failure (HF) patients undergoing inpatient cardiac rehabilitation (CR). DESIGN Multicenter cohort study. The association between CR participation and all-cause mortality from discharge from the acute care setting was assessed using Cox regression analysis adjusting for established prognostic factors. SETTING Six inpatients rehabilitation facilities (IRF). PARTICIPANTS 3,219 HF patients admitted to inpatient CR between January 2013 and December 2016. Of these patients, 1,455 had been transferred directly from acute care hospitals after a hospitalization for HF (CR-Group 1) and 1,764 had been admitted from the community due to worsening functional disability or worsening clinical conditions (CR-Group 2). Six hundred thirty-three patients not referred to CR after a hospitalization for HF served as control group (non-CR Group). INTERVENTION Cardiac rehabilitation. MAIN OUTCOME MEASURE long-term mortality. Secondary outcomes were: 1. Change in functional capacity, as assessed by change in 6-minute walking distance (6MWD) from admission to discharge; 2. Clinical outcomes of the index inpatient rehabilitation admission, including in-hospital mortality and unplanned (re)admission to the acute care. RESULTS Compared with the non-CR Group, the adjusted hazard ratios of mortality at 1, 3, and 5 years for CR-Group 1 patients were 0.82 (0.68-0.97), 0.81 (0.71-0.93), and 0.80 (0.70-0.91). 6MWD increased from 230 to 292 m (p<.001) and 43.4% of the patients gained >50 m improvement. Overall, 2.5% of the patients died in hospital and 4.7% of the patients experienced unplanned (re)admissions to acute care, with significant differences between Group 1 and Group 2. CONCLUSIONS Our data show that inpatient CR is effective in improving functional capacity and suggest that inpatient CR provided in the earliest period following a hospitalization for HF is associated with long-term improved survival.
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Affiliation(s)
- Domenico Scrutinio
- Istituti Clinici Scientifici Maugeri SpA SB, IRCCS, Institute of Bari, Bari, Italy.
| | - Pietro Guida
- Istituti Clinici Scientifici Maugeri SpA SB, IRCCS, Institute of Bari, Bari, Italy
| | - Andrea Passantino
- Istituti Clinici Scientifici Maugeri SpA SB, IRCCS, Institute of Bari, Bari, Italy
| | - Simonetta Scalvini
- Istituti Clinici Scientifici Maugeri SpA SB, IRCCS. Institute of Lumezzane, Brescia, Italy
| | - Maurizio Bussotti
- Istituti Clinici Scientifici Maugeri SpA SB, IRCCS. Institute of Milano-Camaldoli, Milano, Italy
| | - Giovanni Forni
- Istituti Clinici Scientifici Maugeri SpA SB, IRCCS. Institute of Pavia, Pavia, Italy
| | - Raffaella Vaninetti
- Istituti Clinici Scientifici Maugeri SpA SB, IRCCS, Institute of Tradate, Varese, Italy
| | - Maria Teresa La Rovere
- Istituti Clinici Scientifici Maugeri SpA SB, IRCCS, Institute of Montescano, Pavia, Italy
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145
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Mazzucco GA, Pilon L, Escalante JP, Chichizola N, Torres-Castro R. Cardiac Rehabilitation in a Patient With Severe Heart Failure and Ventricular Septal Defect Secondary to Acute Myocardial Infarction. Cureus 2021; 13:e19901. [PMID: 34966609 PMCID: PMC8710137 DOI: 10.7759/cureus.19901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/25/2021] [Indexed: 11/16/2022] Open
Abstract
The treatment of choice for patients with advanced heart failure (HF) and with limiting symptoms with evidence of a poor prognosis despite optimal conventional treatment is a heart transplant. However, there is little literature dealing with the effects of cardiovascular prehabilitation with an important change in physical capacity, which can influence the admission on the waiting list for a heart transplant. We presented one young male, smoker, with no prior history of cardiovascular disease, severe ventricular dysfunction, interventricular defect, and HF. It was decided to implant a cardioverter-defibrillator as primary prevention of sudden death and start the pre-cardiac transplant evaluation and subsequent inclusion in the waiting list on an elective basis. While waiting for the transplant, cardiopulmonary rehabilitation (CPR) was indicated. After 15 months of CPR, the patient improved his left ventricular ejection fraction (LVEF; 20% to 40%), systolic pulmonary artery pressure (55 to 40 mmHg), and peak oxygen uptake (23.9 to 29.1 ml/kg/min). In this patient, a program of CPR improved cardiac function and physical capacity, allowing him to be removed from the national waiting list for a heart transplant.
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Affiliation(s)
- Guillermo A Mazzucco
- Cardiopulmonary Rehabilitation Unit, Instituto Cardiovascular de Rosario, Rosario, ARG
- Unidad de Investigación en Kinesiología Cardiorespiratoria, Universidad del Gran Rosario, Rosario, ARG
| | - Leonardo Pilon
- Cardiology, Instituto Cardiovascular de Rosario, Rosario, ARG
| | | | | | - Rodrigo Torres-Castro
- PhysioEvidence, International Physiotherapy Research Network, Barcelona, ESP
- Departamento de Kinesiología, Facultad de Medicina, Universidad de Chile, Santiago, CHL
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146
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Atti V, Devarakonda PK, Raina S. Differential Effects of Cardiac Rehabilitation in Obese and Non-Obese Population. Cureus 2021; 13:e18227. [PMID: 34703710 PMCID: PMC8541824 DOI: 10.7759/cureus.18227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/23/2021] [Indexed: 11/05/2022] Open
Abstract
Background Cardiac rehabilitation (CR) improves outcomes in patients with heart disease. We investigated the differences in outcomes of comprehensive phase II CR in obese and non-obese patients. Methods We performed a retrospective analysis of functional outcomes including metabolic equivalents (METS), heart rate (chronotropic competence - CC), and blood pressure response (BPR) in 178 patients undergoing CR based on underlying body mass index (BMI). Demographic and clinical variables were assessed for age, gender, race, smoking, hypertension, hyperlipidemia, diabetes mellitus, coronary artery disease, stroke, heart failure, medication use, and several sessions attended. Results Initial CC and METS were impaired in majority of patients attending CR, whereas BPR to exercise was mostly preserved. Significant improvement occurred in CC (non-obese: 0.71 ± 0.11 vs 0.76 ± 0.11, p < 0.001; obese: 0.72 ± 0.10 vs 0.75 ± 0.12, p = 0.0010) and METS (non-obese: 4.96 ± 1.98 vs 7.33 ± 2.94, p < 0.001; obese: 4.39 ± 1.81 vs 6.79 ± 3.34, p < 0.001). Post-CR obese patients were able to reach similar level of physical activity as non-obese patients (6.79 ± 3.34 vs 7.33 ± 2.94; p = 0.2). Improvement in BPR was only seen in non-obese patients (24.02 ± 20.07 vs 30.18 ± 21.93; p = 0.019). Improvement in functional variables occurred despite increase in BMI in non-obese (25.91 ± 2.85 vs 26.21 ± 2.96; p = 0.031), and there was no significant change in BMI in obese (35.30 ± 5.60 vs 34.93 ± 5.42; p > 0.05). Conclusion CR concurrently improves functional outcomes in both obese and non-obese patients despite no associated weight loss. The difference in BPR, however, is seen in only non-obese individuals. Future studies are needed to validate the role of weight-optimized CR protocols as a potential target for improving cardiac outcomes.
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Affiliation(s)
- Varunsiri Atti
- Cardiology, West Virginia University Heart and Vascular Institute, Morgantown, USA
| | | | - Sameer Raina
- Cardiology, West Virginia University Heart and Vascular Institute, Morgantown, USA
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147
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Beatty AL, Brown TM, Corbett M, Diersing D, Keteyian SJ, Mola A, Stolp H, Wall HK, Sperling LS. Million Hearts Cardiac Rehabilitation Think Tank: Accelerating New Care Models. Circ Cardiovasc Qual Outcomes 2021; 14:e008215. [PMID: 34587751 PMCID: PMC10088365 DOI: 10.1161/circoutcomes.121.008215] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
This article describes the October 2020 proceedings of the Million Hearts Cardiac Rehabilitation Think Tank: Accelerating New Care Models, convened with representatives from professional organizations, cardiac rehabilitation (CR) programs, academic institutions, federal agencies, payers, and patient representative groups. As CR delivery evolves, terminology is evolving to reflect not where activities occur (eg, center, home) but how CR is delivered: in-person synchronous, synchronous with real-time audiovisual communication (virtual), or asynchronous (remote). Patients and CR staff may interact through ≥1 delivery modes. Though new models may change how CR is delivered and who can access CR, new models should not change what is delivered-a multidisciplinary program addressing CR core components. During the coronavirus disease 2019 (COVID-19) public health emergency, Medicare issued waivers to allow virtual CR; it is unclear whether these waivers will become permanent policy post-public health emergency. Given CR underuse and disparities in delivery, new models must equitably address patient and health system contributors to disparities. Strategies for implementing new CR care models address safety, exercise prescription, monitoring, and education. The available evidence supports the efficacy and safety of new CR care models. Still, additional research should study diverse populations, impact on patient-centered outcomes, effect on long-term outcomes and health care utilization, and implementation in diverse settings. CR is evolving to include in-person synchronous, virtual, and remote modes of delivery; there is significant enthusiasm for implementing new care models and learning how new care models can broaden access to CR, improve patient outcomes, and address health inequities.
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Affiliation(s)
- Alexis L Beatty
- Department of Epidemiology and Biostatistics, Medicine, UCSF, San Francisco, CA (A.L.B.)
| | - Todd M Brown
- Department of Medicine, University of Alabama, Birmingham (T.M.B.)
| | - Mollie Corbett
- American Association of Cardiovascular and Pulmonary Rehabilitation, Chicago, IL (M.C.)
| | - Dean Diersing
- Physical Medicine and Rehabilitation, UMC Health System, Lubbock, TX (D.D.)
| | - Steven J Keteyian
- Division of Cardiovascular Medicine, Henry Ford Medical Group, Detroit, MI (S.J.K.)
| | - Ana Mola
- Department of Rehabilitation Medicine, NYU Langone Health, New York, NY (A.M.)
| | - Haley Stolp
- IHRC, Inc, Atlanta, GA (H.S.).,CDC, Atlanta, GA (H.S., H.K.W., L.S.S.)
| | | | - Laurence S Sperling
- CDC, Atlanta, GA (H.S., H.K.W., L.S.S.).,Emory Center for Heart Disease Prevention, Atlanta, GA (L.S.S.)
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148
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Fliegner MA, Sukul D, Thompson MP, Shah NJ, Soroushmehr R, McCullough JS, Likosky DS. Evaluating treatment-specific post-discharge quality-of-life and cost-effectiveness of TAVR and SAVR: Current practice & future directions. IJC HEART & VASCULATURE 2021; 36:100864. [PMID: 34522766 PMCID: PMC8427226 DOI: 10.1016/j.ijcha.2021.100864] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Accepted: 08/23/2021] [Indexed: 11/06/2022]
Abstract
Post-TAVR HRQOL shows more rapid short-term improvement than SAVR within trials. Higher TAVR use requires better real-world TAVR/SAVR cost-effectiveness comparisons. Wearable devices should be used in real-world settings to compare TAVR/SAVR HRQOL.
Background Aortic stenosis is a prevalent valvular heart disease that is treated primarily by surgical aortic valve replacement (SAVR) or transcatheter aortic valve replacement (TAVR), which are common treatments for addressing symptoms secondary to valvular heart disease. This narrative review article focuses on the existing literature comparing recovery and cost-effectiveness for SAVR and TAVR. Methods Major databases were searched for relevant literature discussing HRQOL and cost-effectiveness of TAVR and SAVR. We also searched for studies analyzing the use of wearable devices to monitor post-discharge recovery patterns. Results The literature focusing on quality-of-life following TAVR and SAVR has been limited primarily to single-center observational studies and randomized controlled trials. Studies focused on TAVR report consistent and rapid improvement relative to baseline status. Common HRQOL instruments (SF-36, EQ-5D, KCCQ, MLHFQ) have been used to document that TF-TAVR is advantageous over SAVR at 1-month follow-up, with the benefits leveling off following 1 year. TF-TAVR is economically favorable relative to SAVR, with estimated incremental cost-effectiveness ratio values ranging from $50,000 to $63,000/QALY gained. TA-TAVR has not been reported to be advantageous from an HRQOL or cost-effectiveness perspective. Conclusions While real-world experiences are less described, large-scale trials have advanced our understanding of recovery and cost-effectiveness of aortic valve replacement treatment strategies. Future work should focus on scalable wearable device technology, such as smartwatches and heart-rate monitors, to facilitate real-world evaluation of TAVR and SAVR to support clinical decision-making and outcomes ascertainment.
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Affiliation(s)
- Maximilian A Fliegner
- Department of Cardiac Surgery, Michigan Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Devraj Sukul
- Division of Cardiovascular Medicine, Department of General Internal Medicine, Michigan Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Michael P Thompson
- Department of Cardiac Surgery, Michigan Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Nirav J Shah
- Department of Anesthesiology, Michigan Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Reza Soroushmehr
- Department of Computational Medicine and Bioinformatics, University of Michigan, Ann Arbor, MI, United States
| | - Jeffrey S McCullough
- Department of Health Management and Policy, School of Public Health, University of Michigan., Ann Arbor, MI, United States
| | - Donald S Likosky
- Department of Cardiac Surgery, Michigan Medicine, University of Michigan, Ann Arbor, MI, United States
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149
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Shiraishi Y, Niimi N, Goda A, Takei M, Kimura T, Kohno T, Kawana M, Fukuda K, Kohsaka S. Assessment of Physical Activity Using Waist-Worn Accelerometers in Hospitalized Heart Failure Patients and Its Relationship with Kansas City Cardiomyopathy Questionnaire. J Clin Med 2021; 10:jcm10184103. [PMID: 34575215 PMCID: PMC8470222 DOI: 10.3390/jcm10184103] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 09/03/2021] [Accepted: 09/09/2021] [Indexed: 12/11/2022] Open
Abstract
The health benefits of physical activity have been widely recognized, yet there is limited information on associations between accelerometer-related parameters and established patient-reported health status. This study investigated the association between the waist-worn accelerometer measurements, cardiopulmonary exercise testing (CPX), and results of the Kansas City Cardiomyopathy Questionnaire (KCCQ) in heart failure (HF) patients hospitalized for acute decompensation. A total of 31 patients were enrolled and wore a validated three-axis accelerometer for 2 weeks and completed the short version of the KCCQ after removing the device. Daily step counts, exercise time (metabolic equivalents × hours), and %sedentary time (sedentary time/device-equipped time) were measured. Among the measured parameters, the best correlation was observed between %sedentary time and the KCCQ overall and clinical summary scores (r = -0.65 and -0.65, each p < 0.001). All of the individual domains of the KCCQ (physical limitation, symptom frequency, and quality of life), with the exception of the social limitation domain, showed moderate correlations with %sedentary time. Finally, oxygen consumption assessed by CPX demonstrated only weak associations with the accelerometer-measured parameters. An accelerometer could complement the KCCQ results in accurately assessing the physical activity in HF patients immediately after hospitalization, albeit its correlation with CPX was at most moderate.
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Affiliation(s)
- Yasuyuki Shiraishi
- Department of Cardiology, Keio University School of Medicine, Tokyo 160-8582, Japan; (N.N.); (T.K.); (K.F.); (S.K.)
- Correspondence: ; Tel.: +81-3-3353-1211; Fax: +81-3-5843-6167
| | - Nozomi Niimi
- Department of Cardiology, Keio University School of Medicine, Tokyo 160-8582, Japan; (N.N.); (T.K.); (K.F.); (S.K.)
| | - Ayumi Goda
- Department of Cardiovascular Medicine, Kyorin University Faculty of Medicine, Tokyo 181-8611, Japan; (A.G.); (T.K.)
| | - Makoto Takei
- Department of Cardiology, Tokyo Saiseikai Central Hospital, Tokyo 108-0073, Japan;
| | - Takehiro Kimura
- Department of Cardiology, Keio University School of Medicine, Tokyo 160-8582, Japan; (N.N.); (T.K.); (K.F.); (S.K.)
| | - Takashi Kohno
- Department of Cardiovascular Medicine, Kyorin University Faculty of Medicine, Tokyo 181-8611, Japan; (A.G.); (T.K.)
| | - Masataka Kawana
- Department of Medicine, Division of Cardiovascular Medicine, Stanford University, Stanford, CA 94305, USA;
| | - Keiichi Fukuda
- Department of Cardiology, Keio University School of Medicine, Tokyo 160-8582, Japan; (N.N.); (T.K.); (K.F.); (S.K.)
| | - Shun Kohsaka
- Department of Cardiology, Keio University School of Medicine, Tokyo 160-8582, Japan; (N.N.); (T.K.); (K.F.); (S.K.)
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150
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Graham H, Prue-Owens K, Kirby J, Ramesh M. Systematic Review of Interventions Designed to Maintain or Increase Physical Activity Post-Cardiac Rehabilitation Phase II. Rehabil Process Outcome 2021; 9:1179572720941833. [PMID: 34497468 PMCID: PMC8282140 DOI: 10.1177/1179572720941833] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 06/18/2020] [Indexed: 12/21/2022] Open
Abstract
Background: Cardiovascular disease (CVD) continues to be the No. 1 cause of death in the United States and globally, and individuals with a history of a cardiac event are at increased risk for a repeat event. Physical inactivity creates health problems for individuals with chronic heart disease. Evidence shows that physical activity (PA), as a central component of cardiac rehabilitation phase II (CRII), decreases hospital readmission and mortality. Yet, individual adherence to PA tends to decline several months following CRII completion. Objective: The purpose of this review was to evaluate current literature for interventions designed to assist individuals diagnosed with myocardial infarction (MI), coronary artery bypass graft (CABG), coronary artery disease (CAD), and percutaneous coronary intervention (PCI) to maintain or increase PA post-CRII. Methods: A systematic search of 5 electronic databases including hand-searched articles between 2000 and 2019. Key Medical Subject Headings (MeSH) search terms included cardiac rehabilitation, intervention, exercise or PA, outcomes, compliance, adherence, or maintenance. Only interventions implemented following CRII program completion were included for review. Results: Based on the inclusion criteria, the search yielded 19 randomized control trials retained for descriptive analysis. Interventions were categorized into 3 domains. The intervention designs varied widely in terms of duration of the intervention and the length of time to outcome measurement. Most interventions were short-term with only 2 studies offering a long-term intervention of greater than 1 year. Interventions using a theoretical approach most often included a cognitive-behavioral model. Conclusions: Interventions offered shortly after completion of CRII may help cardiac patients maintain PA and reduce the risk of experiencing additional cardiac events; however, more quality research is needed. Additional research to examine PA maintenance in older adults (70 years and older) would be valuable based on the increase in average lifespan. Studies with larger and more diverse samples, and less variation in methods and outcomes would greatly increase the ability to conduct a high-quality meta-analysis.
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Affiliation(s)
- Helen Graham
- Helen and Arthur E. Johnson Beth-El College of Nursing and Health Sciences, University of Colorado Colorado Springs, Colorado Springs, CO, USA
| | - Kathy Prue-Owens
- Helen and Arthur E. Johnson Beth-El College of Nursing and Health Sciences, University of Colorado Colorado Springs, Colorado Springs, CO, USA
| | - Jess Kirby
- Helen and Arthur E. Johnson Beth-El College of Nursing and Health Sciences, University of Colorado Colorado Springs, Colorado Springs, CO, USA
| | - Mythreyi Ramesh
- Helen and Arthur E. Johnson Beth-El College of Nursing and Health Sciences, University of Colorado Colorado Springs, Colorado Springs, CO, USA
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