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Li R, Wang M, Chen S, Zhang L. Comparative efficacy and adherence of telehealth cardiac rehabilitation interventions for patients with cardiovascular disease: A systematic review and network meta-analysis. Int J Nurs Stud 2024; 158:104845. [PMID: 39032245 DOI: 10.1016/j.ijnurstu.2024.104845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Revised: 06/19/2024] [Accepted: 06/20/2024] [Indexed: 07/23/2024]
Abstract
BACKGROUND Traditional center-based cardiac rehabilitation had low adherence rates. With the increasing utilization of digital technology in healthcare services, telehealth can overcome common barriers to improve adherence, and some telehealth interventions have been proven safe and effective. However, it remains unclear which telehealth intervention types can maximize the efficacy and adherence for cardiac rehabilitation. OBJECTIVE To compare the effect of different types of telehealth interventions on the efficacy and adherence of patients with cardiovascular disease in cardiac rehabilitation. DESIGN Systematic review and network meta-analysis. METHODS We systematically searched PubMed, Cochrane Central Register of Controlled Trials, Web of Science, CINAHL, ProQuest, Scopus, and Embase databases for randomized controlled trials of telehealth cardiac rehabilitation for cardiovascular disease patients from January 2013 to March 2024. The primary outcomes were peak oxygen uptake (VO2 peak) and adherence. Secondary outcomes included 6-minute walking distance, moderate-to-vigorous intensity physical activity, depression, self-reported quality of life, and patient satisfaction. The study protocol has been registered on PROSPERO (ID: CRD42023459643). RESULTS This network meta-analysis included 46 randomized controlled trials. The results indicated that telehealth cardiac rehabilitation improved VO2 peak, 6-minute walking distance, moderate-to-vigorous intensity physical activity, and adherence. The surface under the cumulative ranking curve (SUCRA) results showed that the Wearable Devices + Smartphone Applications (SUCRA = 86.8 %, mean rank = 1.7) was the most effective telehealth intervention for improving VO2 peak. The Smartphone Applications + Instant Communication Tools (SUCRA = 74.2 %, mean rank = 2.6) was the most effective telehealth intervention for promoting adherence. CONCLUSIONS Combining two or more types of telehealth interventions was found to be effective. Future efforts should prioritize conducting high-quality randomized controlled trials to identify more effective combinations with traditional cardiac rehabilitation.
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Affiliation(s)
- Ruru Li
- The First School of Medicine, Wenzhou Medical University, Wenzhou 325200, Zhejiang Province, China
| | - Miao Wang
- The School of Nursing, Wenzhou Medical University, Wenzhou 325200, Zhejiang Province, China
| | - Shuoshuo Chen
- The First School of Medicine, Wenzhou Medical University, Wenzhou 325200, Zhejiang Province, China
| | - Liqing Zhang
- The Department of Nursing, First Affiliated Hospital, Wenzhou Medical University, Wenzhou 325200, Zhejiang Province, China.
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Gao H, Li Z, Gan L, Chen X. The Role and Potential Mechanisms of Rehabilitation Exercise Improving Cardiac Remodeling. J Cardiovasc Transl Res 2024; 17:923-934. [PMID: 38558377 DOI: 10.1007/s12265-024-10498-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 02/08/2024] [Indexed: 04/04/2024]
Abstract
Rehabilitation exercise is a crucial non-pharmacological intervention for the secondary prevention and treatment of cardiovascular diseases, effectively ameliorating cardiac remodeling in patients. Exercise training can mitigate cardiomyocyte apoptosis, reduce extracellular matrix deposition and fibrosis, promote angiogenesis, and regulate inflammatory response to improve cardiac remodeling. This article presents a comprehensive review of recent research progress, summarizing the pivotal role and underlying mechanism of rehabilitation exercise in improving cardiac remodeling and providing valuable insights for devising effective rehabilitation treatment programs. Graphical Abstract.
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Affiliation(s)
- Haizhu Gao
- Colleague of Clinical Medicine, Jining Medical University, Jining, Shandong, China
| | - Zhongxin Li
- Colleague of Clinical Medicine, Jining Medical University, Jining, Shandong, China
| | - Lijun Gan
- Department of Cardiology, Jining Key Laboratory for Diagnosis and Treatment of Cardiovascular Diseases, Affiliated Hospital of Jining Medical University, No.89 Guhuai Road, Jining, 272029, Shandong, China
| | - Xueying Chen
- Department of Cardiology, Jining Key Laboratory for Diagnosis and Treatment of Cardiovascular Diseases, Affiliated Hospital of Jining Medical University, No.89 Guhuai Road, Jining, 272029, Shandong, China.
- Postdoctoral Mobile Station of Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China.
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Torun A, Topcu B, Buyukkilic BZ, Kilic S, Yilmaz I, Uzun M. The Impact of Education on Patients Eligible for Cardiac Rehabilitation and Factors Contributing to Declining Participation in Turkish Society: Are Patients Aware of Cardiac Rehabilitation? Cureus 2024; 16:e62508. [PMID: 39022492 PMCID: PMC11252897 DOI: 10.7759/cureus.62508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/13/2024] [Indexed: 07/20/2024] Open
Abstract
OBJECTIVE Despite their effectiveness, cardiac rehabilitation (CR) programs have low participation and adherence rates. CR participation and adherence are directly related to the social, economic, cultural, and geographical characteristics of the society. Therefore, our study aimed to investigate the reasons behind low participation in CR within Turkish society, as well as the barriers that restrict participation despite educational efforts. METHOD The research was conducted with participants who were over 18 years of age, had any history of heart disease, and had been hospitalized in the last year. The patients' medical history, chronic diseases, demographics, habits, employment and income status, educational status, and approaches to CR were surveyed. Additionally, patients who still did not consider participating in CR after receiving information were asked about the reasons for their decisions. RESULTS Although 95.6% of patients were eligible for CR, 91.9% of them were previously unaware of this treatment option. After being informed, 29.4% of patients agreed to participate in CR. The most common reasons for not participating after receiving information were as follows: three days a week is too much (21.9%); this place is far away, but if it were closer, I would come (18.1%); I can't come on weekdays (15.6%); and I would come if someone brought me (14.4%). CONCLUSION We observed that the participation rate in CR increased from 0% to 29.4% after receiving information. Furthermore, it was determined that the CR schedule and transportation were significant factors influencing participation.
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Affiliation(s)
- Akin Torun
- Department of Cardiology, Sultan II. Abdulhamid Han Training and Research Hospital, Istanbul, TUR
| | - Berrin Topcu
- Department of Sports Medicine, Sultan II. Abdulhamid Han Training and Research Hospital, Istanbul, TUR
| | | | - Sahhan Kilic
- Department of Cardiology, Sultan II. Abdulhamid Han Training and Research Hospital, Istanbul, TUR
| | - Irem Yilmaz
- Department of Cardiology, Sultan II. Abdulhamid Han Training and Research Hospital, Istanbul, TUR
| | - Mehmet Uzun
- Department of Cardiology, Sultan II. Abdulhamid Han Training and Research Hospital, Istanbul, TUR
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Boggess K, Hayes E, Duffy ML, Indranoi C, Sorey AB, Blaine T, McKeon L. Nurse-Led Cardiac Rehabilitation Care Coordination Program: Improving Functional Outcomes for Patients Through Automatic Referral and Effective Care Coordination. J Cardiopulm Rehabil Prev 2024; 44:168-173. [PMID: 38502090 DOI: 10.1097/hcr.0000000000000854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/20/2024]
Abstract
PURPOSE The aim of this investigation was to evaluate the impact of automated cardiac rehabilitation (CR) referral and nurse care coordination on patient and program outcomes. Specifically, the aim was to identify whether differences exist in physical and psychological function at CR Phase 2 enrollment and completion and CR Phase 2 participation and completion for hospitalized patients who receive in-person CR nurse visits versus phone consultation. Using a retrospective pre-/post-intervention descriptive design, a purposive sampling technique was used to select groups with matching clinical attributes. Dates were selected to mitigate the impact of COVID-19 on CR program enrollment and completion. METHODS Data were abstracted from the patient electronic medical record, telemetry documentation, and CR referral tracking tool. Patient descriptors included age, sex, cardiac diagnosis/procedure (post-coronary artery bypass graft surgery, myocardial infarction, percutaneous coronary intervention, heart failure, and aortic valve repair and replacement) and cardiac risk stratification category. Patient functional outcomes included the 6-min walk test and metabolic equivalents of task levels for functional capacity; psychological function was measured by the Patient Health Questionnaire assessment. Program outcomes included discharge to CR Phase 2 enrollment, CR sessions, and completion. RESULTS Each group had 52 patients. Age was 64 ± 12 yr, 68% were male. Perhaps indications for CR included coronary artery bypass graft surgery (44%), myocardial infarction (19%), percutaneous coronary intervention (20%), heart failure (10%), aortic valve repair and replacement (8%). Cardiac risk was low in 30%, intermediate in 65%, and high in 5%. The post-intervention group compared with the pre-intervention group had a shorter discharge to CR Phase 2 enrollment (35 ± 18 d vs 41 ± 28 d, P = .078) and significantly fewer sessions required for CR completion. CONCLUSION Automated CR referral and nurse care coordination visits for hospitalized patients decreased the transition period between CR Phase 1 and 2. Patients were physically and psychologically prepared for earlier CR Phase 2 enrollment and successfully completed the program in fewer days than the pre-intervention group.
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Affiliation(s)
- Kristi Boggess
- Author Affiliations: The University of Tennessee Medical Center, Knoxville (Ms Boggess and Dr McKeon); Heart Lung Vascular Institute, The University of Tennessee Medical Center, Knoxville (Mss Hayes and Duffy); Patient Care Pathways, The University of Tennessee Medical Center, Knoxville (Mr Indranoi); and Cardiovascular and Pulmonary Rehabilitation, The University of Tennessee Medical Center, Knoxville (Mr Sorey). The University of Tennessee Medical Center, Knoxville (Ms Blaine)
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McKeever AN, Drouet PC, Vera JA, Thomas WE, Coburn JW, Costa PB. A Retrospective Analysis of the Effects of Cardiac Rehabilitation on Health Markers and Performance Outcomes among Diabetic and Non-Diabetic Patients with Coronary Artery Bypass Grafting and Percutaneous Coronary Intervention. Sports (Basel) 2024; 12:122. [PMID: 38786991 PMCID: PMC11126023 DOI: 10.3390/sports12050122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2024] [Revised: 04/23/2024] [Accepted: 04/23/2024] [Indexed: 05/25/2024] Open
Abstract
BACKGROUND The aim of this study was to investigate the effects of cardiac rehabilitation on health markers and performance outcomes among diabetic and nondiabetic patients with coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI). METHODS One hundred and ninety-seven patients with PCI and CABG, who attended phase 2 cardiac rehabilitation, were included in the study. Patient data were separated by cardiac diagnosis, (PCI and CABG), diabetes category (diabetic and nondiabetic), number of sessions attended (12-24 or 25-36), and time (pre- to post-test). The Duke Activity Score Index and Patient Health Questionnaire-9 questionnaires and measurements for total cholesterol, high-density lipoprotein, low-density lipoprotein, triglycerides, and, if diabetic, A1c and fasting blood glucose, were taken at baseline and upon completion of the program. RESULTS High-density lipoprotein (p < 0.001), diastolic blood pressure (p = 0.004), Duke Activity Score Index questionnaire (p < 0.001), Patient Health Questionnaire-9 (p < 0.001), and A1c (p = 0.003) significantly improved from pre- to post-testing. Total cholesterol (p < 0.001) and low-density lipoprotein (p < 0.001) for the 25-36 nondiabetic PCI group significantly decreased. Triglycerides decreased for all 12-24 session groups (p = 0.015). Fasting blood glucose significantly decreased (p = 0.037) for the 12-24 PCI group with diabetes. No significant interactions were found for systolic blood pressure and body weight. CONCLUSION Cardiac rehabilitation resulted in significant improvements in the lipid panel, diastolic blood pressure, and questionnaire results, regardless of the number of sessions attended. However, no significant benefits for systolic blood pressure were observed.
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Affiliation(s)
- Amy N. McKeever
- Cardiac Rehabilitation Program, Providence St. Jude Medical Center, Fullerton, CA 92835, USA
- Department of Kinesiology, California State University, Fullerton, CA 92831, USA
| | - Phillip C. Drouet
- Cardiac Rehabilitation Program, Providence St. Jude Medical Center, Fullerton, CA 92835, USA
- Department of Kinesiology, California State University, Fullerton, CA 92831, USA
| | - Jesus A. Vera
- Cardiac Rehabilitation Program, Providence St. Jude Medical Center, Fullerton, CA 92835, USA
| | - William E. Thomas
- Department of Kinesiology, California State University, Fullerton, CA 92831, USA
| | - Jared W. Coburn
- Department of Kinesiology, California State University, Fullerton, CA 92831, USA
| | - Pablo B. Costa
- Department of Kinesiology, California State University, Fullerton, CA 92831, USA
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Chen W, Feng Y, Yu M, Zhang Z, Wu J, Liu W, Gu W. Effects of different rehabilitation modality on cardiopulmonary function in patients with acute coronary syndrome after revascularization. Front Cardiovasc Med 2024; 10:1120665. [PMID: 38500679 PMCID: PMC10945546 DOI: 10.3389/fcvm.2023.1120665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Accepted: 12/04/2023] [Indexed: 03/20/2024] Open
Abstract
Objective To investigate the effects of different rehabilitation modalities on cardiopulmonary function in patients with acute coronary syndrome after revascularization. Methods Two randomized controlled trials were conducted. All patients were stable for more than 48 h and less than 1 week after revascularization for acute coronary syndrome and were randomly assigned to Group A (home-based rehabilitation group) or Group B (center guided home-based rehabilitation group). The cardiopulmonary exercise test was mainly performed before and 3 months after cardiac rehabilitation (at the end of intervention). The primary endpoints of the study were peak oxygen uptake (VO2peak), and the secondary endpoints were maximum metabolic equivalents (METs), anaerobic threshold exercise load (Load AT), maximal workload (Load max), and anaerobic threshold oxygen uptake (VO2 AT). Results A total of 106 patients were included in the study, with 47 patients in Group A (with 6 losses) and 50 patients in Group B (with 3 losses). There were no significant difference between the two groups in terms of age, gender, body mass index (BMI), left ventricular ejection fraction(LVEF), low-density lipoprotein cholesterol(LDL-C),cardiovascular risk factors. In Group A, no significant differences in CPET indices were observed before and after the intervention. In Group B, values of maximum metabolic equivalents (METs), peak heart rate (PHR), anaerobic threshold exercise load (Load AT), maximal workload (Load max), maximum ventilation per minute (VE max), peak oxygen uptake (VO2peak), anaerobic threshold oxygen uptake (VO2 AT) and maximum oxygen pulse (VO2/HRmax) were higher than those before the intervention (P < 0.05). In addition, METs (max), Load AT, Load max, VO2 AT, and VO2peak in Group B were higher than those in group A (P < 0.05). The change rates of VO2peak, METs(max), PHR, Load max, VO2 AT, VE max, VO2/HR(max) in the two groups were significantly different before and after intervention (P < 0.05). Conclusion Cardiac exercise rehabilitation is helpful for improving patients' cardiopulmonary endurance and quality of life. Moreover, rehabilitation modalities with regular hospital guidance can improve cardiopulmonary function in a shorter period,which seems to be more effective than a complete home-based rehabilitation model. Clinical Trial Registration http://www.chictr.org.cn, identifier (ChiCTR2400081034).
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Affiliation(s)
- Wanping Chen
- Cardiac Rehabilitation Center, Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, School of General Practice and Continuing Education, Capital Medical University, Beijing, China
| | - Yan Feng
- Cardiac Rehabilitation Center, Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, School of General Practice and Continuing Education, Capital Medical University, Beijing, China
| | - Meili Yu
- Cardiac Rehabilitation Center, Beijing Hospital of Integrated Traditional Chinese and Western Medicine, Beijing, China
| | - Zhaoguo Zhang
- Cardiac Rehabilitation Center, Beijing Hospital of Integrated Traditional Chinese and Western Medicine, Beijing, China
| | - Jiahui Wu
- Cardiac Rehabilitation Center, Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, School of General Practice and Continuing Education, Capital Medical University, Beijing, China
| | - Wenxian Liu
- Cardiac Rehabilitation Center, Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, School of General Practice and Continuing Education, Capital Medical University, Beijing, China
| | - Wei Gu
- Coronary Heart Disease Center, Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
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Bhatla A, Kim CH, Nimbalkar M, Ng‐Thow‐Hing AS, Isakadze N, Spaulding E, Zaleski A, Craig KJ, Verbrugge DJ, Dunn P, Nag D, Bankar D, Martin SS, Marvel FA. Cardiac Rehabilitation Enabled With Health Technology: Innovative Models of Care Delivery and Policy to Enhance Health Equity. J Am Heart Assoc 2024; 13:e031621. [PMID: 38226509 PMCID: PMC10926793 DOI: 10.1161/jaha.123.031621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 10/11/2023] [Indexed: 01/17/2024]
Affiliation(s)
- Anjali Bhatla
- Division of Cardiology, Department of MedicineJohns Hopkins University School of MedicineBaltimoreMD
- Digital Health Innovation Laboratory, Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of MedicineJohns Hopkins University School of MedicineBaltimoreMD
| | - Chang H. Kim
- Division of Cardiology, Department of MedicineJohns Hopkins University School of MedicineBaltimoreMD
- Digital Health Innovation Laboratory, Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of MedicineJohns Hopkins University School of MedicineBaltimoreMD
- Center for Mobile Technologies to Achieve Equity in Cardiovascular Health (mTECH Center), an AHA Health Technology & Innovation SFRN CenterBaltimoreMD
| | - Mansi Nimbalkar
- Digital Health Innovation Laboratory, Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of MedicineJohns Hopkins University School of MedicineBaltimoreMD
- Center for Mobile Technologies to Achieve Equity in Cardiovascular Health (mTECH Center), an AHA Health Technology & Innovation SFRN CenterBaltimoreMD
| | - Anthony Sky Ng‐Thow‐Hing
- Digital Health Innovation Laboratory, Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of MedicineJohns Hopkins University School of MedicineBaltimoreMD
| | - Nino Isakadze
- Division of Cardiology, Department of MedicineJohns Hopkins University School of MedicineBaltimoreMD
- Digital Health Innovation Laboratory, Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of MedicineJohns Hopkins University School of MedicineBaltimoreMD
- Center for Mobile Technologies to Achieve Equity in Cardiovascular Health (mTECH Center), an AHA Health Technology & Innovation SFRN CenterBaltimoreMD
| | - Erin Spaulding
- Digital Health Innovation Laboratory, Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of MedicineJohns Hopkins University School of MedicineBaltimoreMD
- Center for Mobile Technologies to Achieve Equity in Cardiovascular Health (mTECH Center), an AHA Health Technology & Innovation SFRN CenterBaltimoreMD
- School of NursingJohns Hopkins UniversityBaltimoreMD
- Welch Center for Prevention, Epidemiology, and Clinical ResearchJohns Hopkins Bloomberg School of Public HealthBaltimoreMD
| | | | | | | | | | | | | | - Seth S. Martin
- Division of Cardiology, Department of MedicineJohns Hopkins University School of MedicineBaltimoreMD
- Digital Health Innovation Laboratory, Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of MedicineJohns Hopkins University School of MedicineBaltimoreMD
- Center for Mobile Technologies to Achieve Equity in Cardiovascular Health (mTECH Center), an AHA Health Technology & Innovation SFRN CenterBaltimoreMD
| | - Francoise A. Marvel
- Division of Cardiology, Department of MedicineJohns Hopkins University School of MedicineBaltimoreMD
- Digital Health Innovation Laboratory, Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of MedicineJohns Hopkins University School of MedicineBaltimoreMD
- Center for Mobile Technologies to Achieve Equity in Cardiovascular Health (mTECH Center), an AHA Health Technology & Innovation SFRN CenterBaltimoreMD
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Thakker R, Khan M, Al-Hemyari B. Cardiac Rehabilitation After Hospitalization for Acute Coronary Syndrome. Curr Cardiol Rep 2023; 25:1699-1703. [PMID: 38063996 DOI: 10.1007/s11886-023-02010-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/27/2023] [Indexed: 01/26/2024]
Abstract
PURPOSE OF REVIEW Acute coronary syndrome (ACS) carries a high burden of morbidity and mortality. Cardiac rehabilitation over the past century has developed as an important tool in treating and preventing future myocardial infarction events in this critical group. We summarize the rationale and literature evidence supporting the use of cardiac rehabilitation and its role in ACS patients, with an emphasis on its impact on outcomes following hospitalization. RECENT FINDINGS Current literature and large-scale reviews and registry analyses provide conflicting data on the benefits of cardiac rehabilitation after ACS, including its impact on mortality, readmission, and quality of life. Cardiac rehabilitation is an important tool in the management ACS patients. It encompasses not only a graduated exercise regimen but also a holistic approach and is therefore best implemented as a comprehensive cardiac rehabilitation strategy including, in addition to exercise regimen, psychosocial counseling, smoking cessation education, medication adherence, nutrition guidance, and other tools for risk modification. Further trials on the role of cardiac rehabilitation after ACS are needed, especially trials examining different cardiac rehabilitation protocols, time period for its implementation after ACS, and optimal program duration.
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Affiliation(s)
- Ravi Thakker
- Division of Cardiovascular Medicine, University of Texas Medical Branch, Galveston, TX, 77555, USA
| | - Mahin Khan
- Division of Cardiovascular Medicine, University of Texas Medical Branch, Galveston, TX, 77555, USA
| | - Bashar Al-Hemyari
- Division of Cardiovascular Medicine, University of Texas Medical Branch, Galveston, TX, 77555, USA.
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Yang Z, Jia H, Wang A. Predictors of home-based cardiac rehabilitation exercise adherence among patients with chronic heart failure: a theory-driven cross-sectional study. BMC Nurs 2023; 22:415. [PMID: 37926820 PMCID: PMC10626687 DOI: 10.1186/s12912-023-01566-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 10/19/2023] [Indexed: 11/07/2023] Open
Abstract
BACKGROUND The factors influencing home-based cardiac rehabilitation exercise adherence among patients with chronic heart failure remain unclear. This study aimed to explore predictors of home-based cardiac rehabilitation exercise adherence in these patients, based on the theory of planned behavior. METHODS This theory-driven, cross-sectional study used convenience sampling to recruit patients with chronic heart failure undergoing home-based cardiac rehabilitation. Instruments used included the Home-Based Cardiac Rehabilitation Exercise Adherence Scale, the Multidimensional Self-Efficacy for Exercise Scale, the Perceived Social Support Scale, and the Tampa Scale for Kinesiophobia Heart. Multivariate linear hierarchical regression analysis was employed to examine the factors influencing exercise adherence. RESULTS A total of 215 patients with chronic heart failure undergoing home-based cardiac rehabilitation participated in the study. The overall score for home cardiac rehabilitation exercise adherence was (48.73 ± 3.92). Multivariate linear hierarchical regression analysis revealed that age (β=-0.087, p = 0.012), education level (β = 0.080, p = 0.020), fear of movement (β=-0.254, p < 0.001), perceived social support (β = 0.451, p < 0.001), and exercise self-efficacy (β = 0.289, p < 0.001) influenced home-based cardiac rehabilitation exercise adherence. In the second model, fear of exercise explained 23.60% of the total variance, while perceived social support and exercise self-efficacy explained 26.60% of the total variance in the third model. CONCLUSION This study found that home-based cardiac rehabilitation exercise adherence in patients with chronic heart failure was suboptimal, and identified its influencing factors. Targeted interventions addressing these factors, such as tailored education, support, and addressing fear of exercise, may help improve exercise adherence.
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Affiliation(s)
- Zhen Yang
- The First Affiliated Hospital of China Medical University, Shenyang, Liaoning, China
| | - Honghong Jia
- Department of Nursing, Harbin Medical University, Harbin, Heilongjiang, China
| | - Aiping Wang
- The First Affiliated Hospital of China Medical University, Shenyang, Liaoning, China.
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Qi R, Liu S, Wang H, He X, Liu W, Huang F, Zhao Y, Yang B, Xu S, Zeng H. Effects of perioperative exercise on cardiorespiratory endurance in children with congenital heart disease in plateau areas after surgical repair. Sci Rep 2023; 13:18088. [PMID: 37872227 PMCID: PMC10593799 DOI: 10.1038/s41598-023-45310-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Accepted: 10/18/2023] [Indexed: 10/25/2023] Open
Abstract
We aimed to explore the effects of perioperative exercise on cardiorespiratory endurance in children with congenital heart disease (CHD) in plateau areas after surgical repair. Fifty children with CHD in the plateau admitted to our hospital were randomly divided into the exercise and control groups. The exercise group received a perioperative exercise intervention beginning within 24 h postoperatively, while the control group received routine nursing and treatment alone. To assess the 6 min walk distance (6MWD) at baseline and at end of intervention, children participated in a 6-min walk test before cardiac repair and at 1 week after general ward transfer. A subset of children in the study underwent the cardiopulmonary exercise test pre-operatively. The 6MWD of children with CHD at baseline was positively correlated with the peak oxygen uptake pre-operatively. No significant difference was reported in the preoperative baseline data of both groups. The 6MWD of the exercise group was significantly higher than that of the control group. Early exercise therapy after cardiac repair could significantly improve the cardiorespiratory endurance and exercise capacity of children with CHD in plateau areas.
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Affiliation(s)
- Ruixue Qi
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 1095, Jiefang Avenue, Wuhan, Hubei, China
- Hubei Provincial Engineering Research Centre of Vascular Interventional Therapy, Wuhan, China
- Department of Cardiology, Zhengzhou Cardiovascular Hospital, Henan Medical Key Laboratory of Arrhythmia, Zhengzhou, China
| | - Shijie Liu
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 1095, Jiefang Avenue, Wuhan, Hubei, China
- Hubei Provincial Engineering Research Centre of Vascular Interventional Therapy, Wuhan, China
| | - Hongjie Wang
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 1095, Jiefang Avenue, Wuhan, Hubei, China
- Hubei Provincial Engineering Research Centre of Vascular Interventional Therapy, Wuhan, China
| | - Xingwei He
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 1095, Jiefang Avenue, Wuhan, Hubei, China
- Hubei Provincial Engineering Research Centre of Vascular Interventional Therapy, Wuhan, China
| | - Wanjun Liu
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 1095, Jiefang Avenue, Wuhan, Hubei, China
- Hubei Provincial Engineering Research Centre of Vascular Interventional Therapy, Wuhan, China
| | - Fen Huang
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 1095, Jiefang Avenue, Wuhan, Hubei, China
- Hubei Provincial Engineering Research Centre of Vascular Interventional Therapy, Wuhan, China
| | - Yujie Zhao
- Department of Cardiology, Zhengzhou Cardiovascular Hospital, Henan Medical Key Laboratory of Arrhythmia, Zhengzhou, China
| | - Bin Yang
- Department of Cardiology, Zhengzhou Cardiovascular Hospital, Henan Medical Key Laboratory of Arrhythmia, Zhengzhou, China
| | - Shunlin Xu
- Department of Cardiology, Peking University Third Hospital, NHC Key Laboratory of Cardiovascular Molecular Biology and Regulatory Peptides, Key Laboratory of Molecular Cardiovascular Science, Ministry of Education, 49 North Garden Road, Beijing, 100191, China.
| | - Hesong Zeng
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 1095, Jiefang Avenue, Wuhan, Hubei, China.
- Hubei Provincial Engineering Research Centre of Vascular Interventional Therapy, Wuhan, China.
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Yu Q, Guo D, Peng J, Wu Q, Yao Y, Ding M, Wang J. Prevalence and adverse outcomes of frailty in older patients with acute myocardial infarction after percutaneous coronary interventions: A systematic review and meta-analysis. Clin Cardiol 2022; 46:5-12. [PMID: 36168782 PMCID: PMC9849439 DOI: 10.1002/clc.23929] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2022] [Revised: 09/09/2022] [Accepted: 09/15/2022] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND The association between frailty and older patients with acute myocardial infarction (AMI) after percutaneous coronary intervention (PCI) is unclear. Therefore, we conducted a systematic review and meta-analysis to investigate the prevalence of frailty in older patients with AMI following PCI, and determine the relationship between frailty and adverse outcomes in these patients. HYPOTHESIS Older patients with AMI have a higher prevalence of frailty after PCI, and the frailty in these patients increases the risk of adverse outcomes. METHODS A comprehensive search of the PubMed, Cochrane, Ovid (Medline), Ovid (Embase), and Web of Science databases was performed for articles published until October 2021. A meta-analysis was performed using stata12.0 software. A random-effects model was used when I2 was greater than 50%; otherwise, a fixed-effects model was used. RESULTS There were a total of 274,976 older patients in the included studies. Nine studies investigated the prevalence of frailty in older patients with AMI after PCI, with an overall prevalence of 39% (95% confidence interval [CI]: 18%-60%, p < .001). Six studies included adverse outcomes of frailty in older patients with AMI after PCI, including all-cause mortality (hazard ratio [HR] = 2.29, 95% CI: 1.65-3.16, p = .285), rehospitalization (HR = 2.53, 95% CI: 1.38-4.63), and in-hospital major bleeding (HR = 1.93, 95% CI: 1.29-2.90, p = .825). CONCLUSION The frailty prevalence is increased in older patients with AMI after PCI, especially in ST-segment elevation myocardial infarction (STEMI). AMI with frailty after PCI is more likely to be associated with worse clinical outcomes, such as death, bleeding, and rehospitalization.
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Affiliation(s)
- Qian Yu
- College of NursingGannan Medical UniversityGanzhouJiangxiChina
| | - Dawei Guo
- Department of MedicineJingGangshan UniversityJi'anJiangxiChina
| | - Jianan Peng
- Department of MedicineJingGangshan UniversityJi'anJiangxiChina
| | - Qifei Wu
- College of NursingGannan Medical UniversityGanzhouJiangxiChina
| | - Yonghuan Yao
- College of NursingGannan Medical UniversityGanzhouJiangxiChina
| | - Mei Ding
- College of NursingGannan Medical UniversityGanzhouJiangxiChina
| | - Jiang Wang
- Department of MedicineJingGangshan UniversityJi'anJiangxiChina
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Shen ZL, Liu Z, Zhang P, Chen WZ, Dong WX, Chen WH, Lin F, Zang WF, Yan XL, Yu Z. Prognostic significance of postoperative loss of skeletal muscle mass in patients underwent coronary artery bypass grafting. Front Nutr 2022; 9:970729. [PMID: 36118747 PMCID: PMC9478409 DOI: 10.3389/fnut.2022.970729] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Accepted: 08/10/2022] [Indexed: 11/13/2022] Open
Abstract
Background Increasing life expectancy of coronary artery bypass grafting (CABG) remains to be the major concern of cardiac surgeons. However, few studies have investigated the effect of postoperative skeletal muscle index (SMI) loss on prognosis. This study aims to evaluate the prognostic role of postoperative SMI loss ≥ 5% after CABG, in order to develop a novel nomogram to predict overall survival (OS). Methods Patients underwent CABG via midline sternotomy from December 2015 to March 2021 were recruited in this study. Preoperative and postoperative 3 months chest computed tomography (CT) images were compared to assess changes in SMI at T12 level. Based on this, patients were classified into the presence or absence of SMI loss ≥ 5%. The association between postoperative SMI loss ≥ 5% and OS was then analyzed by the Kaplan-Meier curves and Cox model. A novel nomogram incorporating independent clinical prognostic variables was also developed. Results The study enrolled 506 patients receiving CABG, of whom 98 patients experienced T12 SMI loss ≥ 5% and had a significantly worse OS (P < 0.0001). Multivariate regression analysis showed that T12 SMI per cent change (%T12 SMI-change) was an independent prognostic factor for OS (HR = 0.809, 95% CI = 0.749–0.874). The nomogram incorporating %T12 SMI-change with other variables was accurate for predicting OS. Besides, we also found that postoperative oral nutritional supplement (ONS) can rescue T12 SMI loss. Conclusion Postoperative SMI loss can predict survival outcome after CABG. The nomogram incorporating changes in SMI provides a superior performance than existing systems.
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Affiliation(s)
- Zi-Le Shen
- Department of Gastrointestinal Surgery, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, China
| | - Zhang Liu
- Department of Cardio-Thoracic Surgery, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, China
| | - Peng Zhang
- Department of Cardio-Thoracic Surgery, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, China
| | - Wei-Zhe Chen
- Department of Gastrointestinal Surgery, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, China
| | - Wen-Xi Dong
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Wen-Hao Chen
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Feng Lin
- Department of Gastrointestinal Surgery, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, China
| | - Wang-Fu Zang
- Department of Cardio-Thoracic Surgery, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, China
- *Correspondence: Wang-Fu Zang,
| | - Xia-Lin Yan
- Department of Colorectal Anal Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
- Xia-Lin Yan,
| | - Zhen Yu
- Department of Gastrointestinal Surgery, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, China
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
- Zhen Yu,
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13
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Knight JB, Subramanian H, Sultan I, Kaczorowski DJ, Subramaniam K. Prehabilitation of Cardiac Surgical Patients, Part 1: Anemia, Diabetes Mellitus, Obesity, Sleep Apnea, and Cardiac Rehabilitation. Semin Cardiothorac Vasc Anesth 2022; 26:282-294. [PMID: 36006868 DOI: 10.1177/10892532221121118] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The concept of "prehabilitation" consists of screening for and identification of pre-existing disorders followed by medical optimization. This is performed for many types of surgery, but may have profound impacts on outcomes particularly in cardiac surgery given the multiple comorbidities typically carried by these patients. Components of prehabilitation include direct medical intervention by preoperative specialists as well as significant care coordination and shared decision making. In this two-part review, the authors describe existing evidence to support the optimization of various preoperative problems and present a few institutional protocols utilized by our center for cardiac presurgical care. This first installment will focus on the management of anemia, obesity, sleep apnea, diabetes, and cardiac rehabilitation prior to surgery. The second will focus on frailty, malnutrition, respiratory disease, alcohol and smoking cessation, and depression.
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Affiliation(s)
- Joshua B Knight
- 6595University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | | | - Ibrahim Sultan
- 6595University of Pittsburgh Medical Center, Pittsburgh, PA, USA
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